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We investigated the relations between deficit as part of schizophrenic symptomatology and the popular but unclear concept of quality of life (QOL). In a 47-patient sample, subjective QOL was compared in schizophrenics with and without the deficit syndrome. Self- and hetero-rated QOL is more impaired in deficit patients. Differences between deficit and non-deficit groups are more significant as the index used for measuring QOL gets less “behavioral” and more “psycho-pathological”. These results are consistent with existing literature. The “behavioral” dimensions of Heinrichs’ quality of life scale (QLS) are less discriminative between deficit and non-deficit schizophrenics, but they are more independent of the symptoms. They might have a special clinical meaning, which needs to be defined. The concepts of QOL (as used in QLS) and deficit symptomatology are partially redundant. QLS might be an inappropriate, or at least un-specific measure of QOL. [Copyright &y& Elsevier]

Objective: The objective of this systematic review was to investigate which specific and especially neurocognitive factors related to schizophrenia, were associated with homicide risk. Methods: A systematic English-French Medline literature search of cohort studies, case-control studies and transversal studies published from January 1999 to December 2009 was performed combining the MeSH terms “schizophrenia”, “homicide”, “violence”, “mental process”, “cognition”, “risk”, “risk factors”,. Abstract selection was based on the STROBE checklist for observational studies and on the consort statement for clinical trials. Results: Of the 366 selected studies, 65 observational or prospective studies, 10 systematic reviews and meta-analysis and 2 interventional studies met the selection criteria and were included in the final analysis. Firstly, we highlighted that historical (past violence, juvenile detention, physical abuse, parental arrest record), dispositional (male gender, young age, low socioeconomic status) and contextual (recent divorce, unemployment, victimisation) factors could be considered as general homicide-related factors. Clinical factors (clinical paranoid, delusions of persecution or thought insertion, substance abuse, disorganized thinking, long duration of untreated psychosis, stopped monitoring or treatment) were more schizophrenia-specific factors for homicide. Most of the excess risk appears to be mediated by substance abuse. Secondly, our results suggested that schizophrenics with a history of aggressive behaviour compared to those without such history, had better performances on global neuropsychological tests exploring executive functions but performed more poorly as considering orbitofrontal functions. Conclusions: We suggest that every comprehensive psychiatric assessment should explore the risk of homicide, including historical, dispositional, contextual, clinical and neurocognitive (low insight capacity, impaired frontal functions) factors of violence. [Copyright &y& Elsevier]

Introduction Une patiente âgée de 60 ans est adressée au CPOA pour troubles de la personnalité et du comportement chez l’adulte (F60–F69) dans un contexte de voyage pathologique. Case report L’histoire retrouve chez cette patiente un départ impromptu pour la Belgique. Elle présente dans ses antécédents un VIH non traité et un paludisme. Elle n’a pas d’antécédent psychiatrique. Un passage dans deux services d’urgences générales montre un examen clinique général normal et des examens biologiques et tomodensitométrique cérébral sans particularité. Elle se présente en état d’incurie et désorientée dans l’espace, avec une bizarrerie. Elle tient un discours désorganisé. Elle est persécutée et agitée de manière fluctuante, et en alternance rapide avec un état de perplexité sans autre symptôme thymique ou catatonique. Un diagnostic de confusion mentale est porté, une imagerie par résonance magnétique encéphalique est réalisée. Il montre un hypersignal FLAIR de la substance blanche péri-ventriculaire, profonde (supra- et infratentorielle) et du tronc cérébral, en faveur d’une leucoencéphalopathie multifocale progressive (LEMP) à VIH. Un transfert en médecine interne et des examens complémentaires confirment le diagnostic. Discussion La LEMP est une affection démyélinisante due au virus JC qui survient généralement avec un taux de CD4+ < 100/mm 3 [1] . La littérature montre qu’une infection VIH peut s’exprimer par des troubles psychiatriques au stade SIDA avec une prévalence de 0,23 %–15,2 % [3] . Les troubles psychotiques sont plus rares que les troubles thymiques [2] . L’IRM est l’examen de choix pour confirmer le diagnostic de LEMP. Le traitement étiologique est la restauration immunitaire. Le traitement symptomatique de référence est la risperidone et la clozapine [2] en raison d’une plus grande sensibilité aux effets secondaires extra-pyramidaux [2] de ces patients. Conclusion Des troubles psychiatriques accompagnés de confusion mentale dans un contexte d’infection VIH doivent faire suspecter une atteinte neurologique, le diagnostic psychiatrique étant un diagnostic d’élimination. [ABSTRACT FROM AUTHOR]

We assessed the subjective quality of life (QOL) of 30 deficit schizophrenic patients compared to 112 nondeficit schizophrenic patients. The deficit patients did not differ in term of QOL, total score of positive symptoms, general psychopathology from the nondeficit patients. This result suggested an absence of impact of primary negative symptoms on the subjective QOL in schizophrenic patients.

In order to test the hypothesis that an excess of summer births is a risk factor for deficit syndrome, the month of birth was studied in 53 deficit schizophrenic patients compared to 158 non-deficit patients. No significant difference in terms of month of birth or season of birth was observed between deficit and non-deficit patients, suggesting that summer births might not be a risk factor for deficit schizophrenia.