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This electroencephalographic (EEG) study tested whether cortical EEG rhythms (especially delta and alpha) show a progressive increasing or decreasing trend across physiological aging. To this aim, we analyzed the type of correlation (linear and nonlinear) between cortical EEG rhythms and age. Resting eyes‐closed EEG data were recorded in 108 young (Nyoung; age range: 18–50 years, mean age 27.3 ± 7.3 SD) and 107 elderly (Nold; age range: 51–85 years, mean age 67.3 ± 9.2 SD) subjects. The EEG rhythms of interest were delta (2–4 Hz), theta (4–8 Hz), alpha 1 (8–10.5 Hz), alpha 2 (10.5–13 Hz), beta 1 (13–20 Hz), and beta 2 (20–30 Hz). EEG cortical sources were estimated by low‐resolution brain electromagnetic tomography (LORETA). Statistical results showed that delta sources in the occipital area had significantly less magnitude in Nold compared to Nyoung subjects. Similarly, alpha 1 and alpha 2 sources in the parietal, occipital, temporal, and limbic areas had significantly less magnitude in Nold compared to Nyoung subjects. These nine EEG sources were given as input for evaluating the type (linear, exponential, logarithmic, and power) of correlation with age. When subjects were considered as a single group there was a significant linear correlation of age with the magnitude of delta sources in the occipital area and of alpha 1 sources in occipital and limbic areas. The same was true for alpha 2 sources in the parietal, occipital, temporal, and limbic areas. In general, the EEG sources showing significant linear correlation with age also supported a nonlinear correlation with age. These results suggest that the occipital delta and posterior cortical alpha rhythms decrease in magnitude during physiological aging with both linear and nonlinear trends. In conclusion, this new methodological approach holds promise for the prediction of dementia in mild cognitive impairment by regional source rather than surface EEG data and by both linear and nonlinear predictors. Hum Brain Mapp, 2005. © 2005 Wiley‐Liss, Inc.

(2005). Selected E-ISNR 2004 Conference Presentation Abstracts. Journal of Neurotherapy: Vol. 9, No. 1, pp. 103-108.

In a multicenter study involving 217 subjects of European ancestry [106 patients with schizophrenia and 111 healthy subjects], we tested the hypothesis that the catechol- O -methyl transferase (COMT) Val 158 Met and/or the brain-derived neurotrophic factor (BDNF) C 270 T gene polymorphisms are associated with schizophrenia. The COMT and BDNF genotype and their allele distribution did not differ between patients with schizophrenia and healthy comparison subjects. These results do not support the hypothesis that the COMT Val 158 Met or BDNF C 270 T gene polymorphisms are associated with liability to schizophrenia.

The present study focused on functional coupling between human bilateral auditory cortices and on possible influence of right over left auditory cortex during dichotic listening of complex non-verbal tones having near (competing) compared with distant non-competing fundamental frequencies. It was hypothesized that dichotic stimulation with competing tones would induce a decline of functional coupling between the two auditory cortices, as revealed by a decrease of electroencephalography coherence and an increase of directed transfer function from right (specialized for the present stimulus material) to left auditory cortex. Electroencephalograph was recorded from T3 and T4 scalp sites, overlying respectively left and right auditory cortices, and from Cz scalp site (vertex) for control purposes. Event-related coherence between T3 and T4 scalp sites was significantly lower for all electroencephalography bands of interest during dichotic listening of competing than non-competing tone pairs. This was a specific effect, since event-related coherence did not differ in a monotic control condition. Furthermore, event-related coherence between T3 and Cz and between T4 and Cz scalp sites showed no significant effects. Conversely, the directed transfer function results showed negligible influence at group level of right over left auditory cortex during dichotic listening. These results suggest a decrease of functional coupling between bilateral auditory cortices during competing dichotic stimuli as a possible neural substrate for the lateralization of auditory stimuli during dichotic listening.

Cognitive and motor deficits have been proposed as markers of abnormal neurodevelopment in schizophrenia and have been associated with genetic liability. In a multicenter study involving 106 subjects, 56 with deficit schizophrenia and 50 with nondeficit schizophrenia, we tested the hypothesis that the catechol-O-methyltransferase (COMT) Val158Met polymorphism is associated with cognitive and motor deficits either in schizophrenia as a whole or in its deficit subtype. The COMT Val158Met polymorphism shared 6.6% of the executive/attention dysfunction variance in patients with schizophrenia and 15.6% of the motor impairment variance in patients with deficit schizophrenia. These results support the hypothesis that the COMT Val158Met polymorphism influences executive functions in schizophrenia and the neuromotor performance in the deficit subtype only.

Objective Neuropsychological, brain imaging and electrophysiological research have consistently shown a dysfunction of fronto-striato-thalamic pathways in subjects with obsessive–compulsive disorder (OCD). The functional meaning of the observed dysfunction in the pathogenesis of OCD is still debated. In the present study the hypothesis that it might be related to a hyperactive executive control is explored by means of neuropsychological and electrophysiological measures. Methods Multilead quantitative EEG (QEEG) characteristics and neuropsychological performance on tests exploring executive functions, attention, short-term memory and the ability to learn supraspan recurring sequences were investigated in 32 drug-free patients with DSM-IV OCD. Multilead QEEG characteristics were also investigated in 32 healthy controls, matched with patients for age, gender and handedness. Results A decrease of the slow α-band power in OCD as compared to healthy subjects was observed. A significant negative correlation between the slow α-band power and the time to complete a neuropsychological test exploring executive functions was found: the more reduced the slow α-band power, the slower the performance on this test. Conclusions The topographic distribution of the observed QEEG abnormalities, as well as their correlations with neuropsychological indices, suggest an increased activation of frontal networks in OC patients. Significance Study findings support the presence of a hyperactivity of attention/executive control mechanisms in obsessive–compulsive patients.

The present magnetoencephalography (MEG) study on auditory evoked magnetic fields (AEFs) was aimed at verifying whether during dichotic listening the contralateral auditory pathway inhibits the ipsilateral one, as suggested by behavioural and patient studies. Ten healthy subjects were given a randomized series of three complex tones (261, 293 and 391 Hz, 500 ms duration), which were delivered monotically and dichotically with different intensities [60, 70 or 80 dBA (audio decibels)]. MEG data were recorded from the right auditory cortex. Results showed that the M100 amplitude over the right auditory cortex increased progressively when tones of increasing intensity were provided at the ipsilateral (right) ear. This effect on M100 was abolished when a concurrent tone of constant intensity was delivered dichotically at the contralateral (left) ear, suggesting that the contralateral pathway inhibited the ipsilateral one. The ipsilateral inhibition was present only when the contralateral tone fundamental frequency was similar to the ipsilateral tone. It was proposed that the occlusion mechanism would be exerted in cortical auditory areas as the dichotic effects were observed at M100 but not M50 component. This is the first evidence showing a neurophysiological inhibition driven by the contralateral auditory pathway over the ipsilateral one during dichotic listening.

ObjectiveTo examine the effect of cariprazine, a dopamine D3/D2 receptor partial agonist with preferential binding to D3 receptors, on predominant negative symptoms of schizophrenia.MethodsSubjects with schizophrenia and PANSS factor score for negative symptoms (PANSS-FSNS) ≥ 24 and no pseudospecific factors (e.g. extrapyramidal symptoms, depression) were randomized to cariprazine 4.5 mg/d (dose range: 3-6 mg/d) or risperidone 4 mg/d (dose range: 3-6 mg/d) for 6 months.ResultsFour hundred and sixty-one patients were randomized 1:1 to double-blind risperidone (n = 231) or cariprazine (n = 230) treatment. Change from Baseline (CfB) at week 26 in the primary parameter, PANSS-FSNS, was larger in the cariprazine group than in the risperidone group (LSMD = −1.47; 95% CI: [−2.39, −0.53]; P = 0.002) significant from week 14 onwards. CfB at week 26 in the functional parameter, Personal and Social Performance (PSP) total score, showed similarly greater improvement with cariprazine than risperidone (LSMD = 4.63; 95% CI: [2.71, 6.56]; P < 0.001) significant from week 10 onward. Statistically significant differences in favor of cariprazine at week 26 were shown in the PSP areas of self-care, socially useful activities and personal and social relationships. Most patients tolerated the study treatment well, as reflected by low discontinuation rates due to adverse events (AEs). Adverse event profiles of cariprazine and risperidone were similar. The most common AEs during study treatment were insomnia (10.0%), and headache (10.4%), both in the risperidone group.Conclusion26-week cariprazine treatment, given as antipsychotic monotherapy, was significantly more effective on negative symptoms and on functioning than risperidone in patients with predominant negative symptoms of schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction: The main objective of this study was to compare clinical and functional outcomes of patients with schizophrenia in Italy and Sweden with a special focus on daily functioning performance and real life milestones. Also, to study if outcome is to be regarded as a consequence of premorbid function, the level of symptom control and functional capacity or if other influences, such as cultural differences, must parallel be considered. Method: Ninety-five patients from three centres, Milan and Naples in Italy and Trollhattan in Sweden were investigated. The Positive and Negative Syndrome Scale and the UCSD Performance-Based Skills Assessment - Brief version were used together with patients' school history and their status of accommodation and occupation. Results: Patients in Trollhattan were more likely to live independently and patients in Naples to have a work or take part in education. Differences in symptoms and the performance test were present but subtle. Discussion: Differences in real life milestones were not explained by corresponding differences in symptoms, premorbid function or the performance-based test. It is therefore not appropriate only to present functional outcome as an expression of how successful treatment has been. (C) 2011 Elsevier Masson SAS. All rights reserved.

IntroductionAn impairment of premorbid adjustment (PA) has been regarded among poor prognostic indicators of schizophrenia. Some discrepancies in the literature suggest the usefulness of further characterizations of its impact on different aspects of the disease.AimsThe present study aimed to investigate the association of poor PA with psychopathology, neurocognition and real-life functioning in patients with schizophrenia recruited within the multicenter study of the Italian network for research on psychoses. functioning during childhood and adolescence (early adjustment) was assessed also in a group of healthy controls (HC) and one of unaffected relatives of patients (UR).MethodsGroup comparisons were performed between patients with poor and those with good PA. Differences in frequency of poor early adjustment were investigated among patients, HC and UR.ResultsPatients with poor PA, as compared to those with good PA, showed earlier age of onset, more severe negative symptoms and disorganization, greater impairment on all cognitive domains with the exception of attention/vigilance and worse real-life functioning in the considered areas (interpersonal relationships, community activities and work abilities). The pattern of poor early adjustment was more frequent in patients with respect to UR and HC and, to a less degree, in UR with respect to HC.ConclusionsOur findings confirm that poor PA in schizophrenia is associated with poorer illness outcome, and offer a further characterization of PA impact on different psychopathological and cognitive domains. They also suggest that poor early adjustment is a candidate endophenotype of schizophrenia, occurring in patients and their unaffected relatives.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionMobile health (m-health) technology has been growing rapidly in the last decades. The use of this technology represents an advantage, especially for reaching patients who otherwise would have no access to healthcare. However, many ethical issues arise from the use of m-health. Health equity, privacy policies, adequate informed consent and a competent, safe and high quality healthcare need to be guaranteed; professional standards and quality of doctor-patient relationship in the digital setting should not be lower than those set for in-person practice.AimsTo assess advantages and threats that may arise from the wide use of m-health technologies, in order to guarantee the application of the best medical practices, resulting in the highest quality healthcare.MethodsA literature search has been conducted to highlight the most pressing ethical issues emerging from the spreading of m-health technologies.ResultsFew ethical guidelines on the appropriate use of m-health have been developed to help clinicians adopt a professional conduct within digital settings. They focus on the need for professional associations to define ethical guidelines and for physicians to take care of their education and online behavior when using m-health technologies.ConclusionsThe rapid spreading of m-health technologies urges us to evaluate all ethical issues related to its use. It would be advisable to produce an ethical code for the use of these new technologies, to guarantee health equity, privacy protection, high quality doctor-patient relationships and to ensure that m-health is not chosen over traditional care for merely economic purposes.Disclosure of interestSG received honoraria or Advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter. All other authors have declared.

IntroductionImpaired motivation is considered a fundamental aspect of the Avolition domain of negative symptoms. The ventral tegmental area (VTA) contains the highest number of DA neurons projecting to the brain areas involved in motivation-related processes.AimThe aim of our study was to investigate by functional MRI the resting-state functional connectivity (RS-FC) of the VTA in patients with schizophrenia and its relationships with real-life motivation and avolition.MethodThe RS-FC was investigated in 22 healthy controls (HC) and in 26 schizophrenia patients (SCZ) treated with second generation antipsychotics only and divided in high (HA = 13) and low avolition (LA = 13) subgroups. We used the Quality of Life Scale and the Schedule for the Deficit Syndrome to assess real-life motivation and avolition, respectively.ResultsHA, as compared to LA and HC, showed a reduced RS-FC of VTA with the right ventrolateral prefrontal cortex (R VLPFC), right posterior insula (R pINS) and right lateral occipital cortex (R LOC). The RS-FC for these regions was positively correlated with motivation in the whole sample and negatively correlated with avolition in schizophrenia patients.ConclusionOur findings demonstrate that motivational deficits in schizophrenia patients are linked to reduced functional connectivity in the DA circuit involved in retrieval of the outcome values of different actions to guide behavior. Further characterization of the factors modulating the functional connectivity in this circuit might foster the development of innovative treatments for avolition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionIn subjects with schizophrenia (SCZ), the disorganization factor was found to be a strong predictor of real-life functioning. “Conceptual disorganization” (P2), “difficulties in abstract thinking” (N5) and “poor attention” (G11) are considered core aspects of the disorganization factor, as assessed by PANSS. The overlap of these items with neurocognitive functions is debated and should be further investigated.AimsWithin the Italian network for research on psychoses study, electrophysiological and neurocognitive correlates of the disorganization factor and its component items were investigated.MethodsResting state EEGs were recorded in 145 stabilized SCZ and 69 matched healthy controls (HC). Spectral amplitude (SAmp) was averaged in nine frequency bands. MATRICS consensus cognitive battery (MCCB) was used for neurocognitive assessment. Band SAmp differences and correlations with psychopathology and MCCB scores were explored by global randomization statistics.ResultsSCZ showed increased delta, theta, and beta1 and decreased alpha2 SAmp. A negative correlation between alpha1 and disorganization was observed in SCZ. At the item level, only N5 showed this correlation. MCCB neurocognitive composite was associated with P2 and N5 but not with alpha1 SAmp.ConclusionsOur findings suggest an heterogeneity of the disorganization dimension and a partial overlap with neurocognitive domains. The N5, “difficulties in abstract thinking”, had a unique association with alpha1 SAmp, which is thought to be involved in the formation of conceptual maps.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionImproving mental health of people is an important goal of the present millennium. Community-based services programs for prevention of mental disorders and promotion of mental health have been implemented in several countries. However, the proportion of people suffering from mental disorders is significantly and persistently high, and psychosocial distress due to migration, natural disasters, and terrorism; in general, feeling of insecurity is unlikely to improve current figures.AimsTo highlight the interrelatedness of mental health, development and human rights, in particular in women and girls.MethodsThe presentation will consider conceptual aspects of mental health in its intersection with human rights and development, with particular reference to women and girls.ResultsCurrent definitions of mental health might be misleading and convey the false expectation that mental health coincides with happiness and productivity. An alternative conceptual framework will be presented, in which mental health is a dynamic state of internal equilibrium that enables individuals to use their abilities in harmony with universal values of society. Different factors concur to the dynamic equilibrium, and will be discussed in their intersection with human rights and development, with particular reference to the most frequent violations of human rights (e.g. trafficking, domestic abuse, sexual violence) that contribute to increase the risk of mental disorders in women and girls.ConclusionMental health is rooted in personal development and social context in which the person lives. Strategies aimed to address mental health in women and girls will need to consider gender, country and socio-cultural specificities.Disclosure of interestHonoraria or Advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter.

IntroductionAvolition represents an important domain of negative symptoms in schizophrenia with a strong impact on functional outcome. Primary and persistent avolition is refractory to available pharmacological and psychological treatments. A better understanding of its pathophysiological mechanisms is fundamental to promote development of new treatments. Recent models of avolition converge on dopaminergic circuits involved in motivation and its translation in goal-directed behavior. Deficits in task-related activation or connectivity within mesolimbic and mesocortical dopamine circuits were reported in schizophrenia but the relationship with avolition was not fully established.AimsThe present study aimed to investigate resting-state functional connectivity (RS-FC) within the motivation circuits in schizophrenia patients and its relationships with primary and persistent avolition.MethodsRS-FC, using VTA as a seed region, was investigated in 22 healthy controls (HC) and in 26 schizophrenia patients (SCZ) divided in high (HA) and low avolition (LA) subgroups. Avolition was assessed using the Schedule for the Deficit Syndrome.ResultsHA, in comparison to LA and HC, showed significantly reduced RS-FC with the right ventrolateral prefrontal cortex (R-VLPFC), right insula (R-INS) and right lateral occipital cortex (R-LOC). The RS-FC of these regions was negatively correlated to avolition.ConclusionsOur findings demonstrate that avolition in schizophrenia is linked to dysconnection of VTA from key cortical regions involved in retrieval of outcome values of instrumental actions to motivate behavior.Disclosure of interestAM received honoraria or advisory board/consulting fees from the following companies: Janssen Pharmaceuticals, Otsuka, Pfizer and Pierre Fabre. SG received honoraria or advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter. All other Authors declare no potential conflict of interest.

Patients with schizophrenia have been hypothesized to have a functional impairment in filtering irrelevant sensory information, which may result in positive symptoms such as hallucinations or delusions. Many evidences suggest that abnormalities in the event-related brain potentials (ERPs), resting state electroencephalography (EEG) and synchronized oscillatory activity of neurons may reflect core pathophysiological mechanisms of schizophrenia. Abnormalities in amplitude and latency of the ERPs reflecting aberrations in gating and difficulties in the detection of changes in auditory stimuli, as well as defects in stimuli evaluation and integration of information are common in patients with schizophrenia. This chapter highlights the findings of electrophysiological studies in schizophrenia dealing with early sensory perception and attention, automatic sensory detection of stimuli changes and cognitive evaluation and integration of information, relevant to the pathophysiological mechanisms underpinning hallucinations and delusions. Results of electrophysiological studies investigating the neural correlates of positive symptoms suggest aberrant intrinsic organization of functional brain networks.

Care and outcomes for people with schizophrenia have improved in recent years, but further progress is needed to help more individuals achieve an independent and fulfilled life. This report sets out the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future. The authors recommend the following policy actions, based on research evidence, stakeholder consultation, and examples of best practice worldwide. (1) Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. (2) Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the complex benefit and employment systems. (3) Provide concrete support, information, and educational programs to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their lives. (4) All stakeholders, including organizations that support people living with schizophrenia, should be consulted to regularly revise, update, and improve policy on the management of schizophrenia. (5) Provide support, which is proportionate to the impact of the disease, for research and development of new treatments. (6) Establish adequately funded, ongoing, and regular awareness-raising campaigns that form an integral part of routine plans of action. Implementation of the above recommendations will require engagement by every stakeholder, but with commitment from all, change can be achieved.

Clinical heterogeneity is a confound common to all of schizophrenia research. Deficit schizophrenia has been proposed as a homogeneous disease entity within the schizophrenia syndrome. The use of the Schedule for the Deficit Syndrome (SDS) has allowed the definition of a subgroup dominated by persistent and primary negative symptoms. While a number of studies have appeared over the years examining the electrophysiological correlates of the cluster of negative symptoms in schizophrenia, only a few studies have actually focused on the Deficit Syndrome (DS). In this chapter, electrophysiological investigations utilizing EEG, Evoked Potentials (EPs), polysomnography (PSG), or magnetoencephalography (MEG) to probe "negative symptoms," or "Deficit Syndrome" are reviewed. While this line of research is evidently in its infancy, two significant trends emerge. First, spectral EEG studies link increased slow wave activity during wakefulness to the prevalence of negative symptoms. Second, sleep studies point to an association between decrease in slow wave sleep and prevalence of negative symptoms. Several studies also indicate a relationship of negative symptoms with reduced alpha activity. A host of other abnormalities including sensory gating and P300 attenuation are less consistently reported. Three studies specifically addressed electrophysiology of the DS. Two of the three studies provided evidence suggesting that the DS may be a separate disease entity and not simply a severe form of schizophrenia.

Patients with schizophrenia have been hypothesized to have a functional impairment in filtering irrelevant sensory information, which may result in positive symptoms such as hallucinations or delusions. Many evidences suggest that abnormalities in the event-related brain potentials (ERPs), resting state electroencephalography (EEG) and synchronized oscillatory activity of neurons may reflect core pathophysiological mechanisms of schizophrenia. Abnormalities in amplitude and latency of the ERPs reflecting aberrations in gating and difficulties in the detection of changes in auditory stimuli, as well as defects in stimuli evaluation and integration of information are common in patients with schizophrenia. This chapter highlights the findings of electrophysiological studies in schizophrenia dealing with early sensory perception and attention, automatic sensory detection of stimuli changes and cognitive evaluation and integration of information, relevant to the pathophysiological mechanisms underpinning hallucinations and delusions. Results of electrophysiological studies investigating the neural correlates of positive symptoms suggest aberrant intrinsic organization of functional brain networks.

Clinical heterogeneity is a confound common to all of schizophrenia research. Deficit schizophrenia has been proposed as a homogeneous disease entity within the schizophrenia syndrome. The use of the Schedule for the Deficit Syndrome (SDS) has allowed the definition of a subgroup dominated by persistent and primary negative symptoms. While a number of studies have appeared over the years examining the electrophysiological correlates of the cluster of negative symptoms in schizophrenia, only a few studies have actually focused on the Deficit Syndrome (DS). In this chapter, electrophysiological investigations utilizing EEG, Evoked Potentials (EPs), polysomnography (PSG), or magnetoencephalography (MEG) to probe “negative symptoms,” or “Deficit Syndrome” are reviewed. While this line of research is evidently in its infancy, two significant trends emerge. First, spectral EEG studies link increased slow wave activity during wakefulness to the prevalence of negative symptoms. Second, sleep studies point to an association between decrease in slow wave sleep and prevalence of negative symptoms. Several studies also indicate a relationship of negative symptoms with reduced alpha activity. A host of other abnormalities including sensory gating and P300 attenuation are less consistently reported. Three studies specifically addressed electrophysiology of the DS. Two of the three studies provided evidence suggesting that the DS may be a separate disease entity and not simply a severe form of schizophrenia.

Brain electrical microstates represent spatial configurations of scalp recorded brain electrical activity and are considered to be the basic elements of stepwise processing of information in the brain. In the present study, the hypothesis of a temporo-limbic dysfunction in panic disorder (PD) was tested by investigating the topographic descriptors of brain microstates, in particular the one corresponding to the Late Positive Complex (LPC), an event-related potential (ERP) component with generators in these regions. ERPs were recorded in PD patients and matched healthy subjects during a target detection task, in a central (CC) and a lateral condition (LC). In the CC, a leftward shift of the LPC microstate positive centroid was observed in the patients with PD versus the healthy control subjects. In the LC, the topographic descriptor of the first microstate showed a rightward shift, while those of both the second and the fourth microstate, corresponding to the LPC, revealed a leftward shift in the PD patients versus the healthy control subjects. These findings indicate an overactivation of the right hemisphere networks involved in early visual processing and a hypoactivation of the right hemisphere circuits involved in LPC generators in PD. In line with this interpretation, the abnormal topography of the LPC microstate, observed in the CC, was associated with a worse performance on a test exploring right temporo-hippocampal functioning. Topographical abnormalities found for the LPC microstate in the LC were associated with a higher number of panic attacks, suggesting a pathogenetic role of the right temporo-hippocampal dysfunction in PD.

We tested for associations between five single nucleotide polymorphisms (SNPs) located in the area containing the Neuregulin 1 gene (NRG1) and three SNPs within the brain-derived neutrophic factor gene (BDNF) in an Italian sample consisting of 171 schizophrenia subjects and 349 controls. No association was found for any of the polymorphisms tested, either in single locus or in haplotype analysis.

The present study explored the frequency of neuromorphological, neurological and neuropsychological abnormalities in 13 patients with an ICD-8/9 diagnosis of simple schizophrenia, also fulfilling DSM-IV criteria for 'simple deteriorative disorder', and in 13 matched patients with an ICD-8/9 diagnosis of a subtype of schizophrenia other than simple schizophrenia, fulfilling DSM-IV criteria for schizophrenia. The frequency of neuromorphological abnormalities in the two patient groups was also compared with that observed in 13 neurological control subjects. Both patients with simple schizophrenia and those with other schizophrenia subtypes showed a higher frequency of brain developmental abnormalities and greater ventricular and subarachnoid space volumes than controls. There was no significant difference between the two groups of patients with respect to neuromorphological variables. Two patients with simple schizophrenia (vs. none of those with other schizophrenia subtypes) had gross brain abnormalities; they were the most deteriorated subjects in the whole sample. Patients with simple schizophrenia, as compared to those with other schizophrenia subtypes, presented a higher frequency of soft neurological signs and a greater impairment of social relationships.

The present paper is aimed at providing an outline of the process of reconceptualization of cognitive functions and emotions in neuropsychology, recently promoted by the acknowledgment of complex, nonlinear dynamics in brain structure and function.

Studies and meta-analyses investigating the influence of substance use disorder (SUD) (substance abuse or dependence) on psychopathology and neurocognitive function in schizophrenia patients have revealed controversial results. Most studies did only have small samples and did not focus exclusively on first-episode schizophrenia patients.Method: In a post-hoc analysis of the European First Episode Schizophrenia Trial (EUFEST) psychopathology and cognitive performances of patientswith (FE-SUD, N = 119, consisting of N = 88 patientswith persisting SUD at baseline and N = 31 patients with previous SUD) and without SUD (FE-non-SUD, N = 204) were compared at baseline and 6 months follow-up. Neurocognitive assessment included the Rey Auditory Verbal Learning Test (RAVLT); Trail Making Tests A and B (TMT), Purdue Pegboard and Digit-Symbol Coding.Results: In total 31.1% of patients reported SUD, and 22.2% of patients used cannabis. There were no significant differences between patients with and without SUD concerning PANSS scores, extrapyramidal motor symptoms or neurocognitive measures except better performance in psychomotor speed (TMT-A, p = 0.033, Cohen's d = 0.26) in patients with SUD at 6 months follow-up. Interestingly, SUD patients with ongoing substance use at follow-up showed elevated positive symptoms (PANSS positive score, p = 0.008, Cohen's d = 0.84) compared to those who abstained. PANSS scores at baseline were increased in patients with an onset of SUD before the age of 16 years. In addition we found a correlation between longer duration of cannabis use and higher cognitive performance as well as reduced symptom improvement and more extrapyramidal motor symptoms in patients with higher frequency of cannabis consumption.Conclusions: FE-SUD and FE-non-SUD show similar psychopathology and neuropsychological performances at baseline and during the first 6 months of antipsychotic treatment. (C) 2013 Elsevier B. V. All rights reserved.

Rehabilitation programs integrating cognitive remediation (CR) and psychosocial rehabilitation are often implemented as they seem to yield greater improvements in functional outcome than stand alone treatment approaches. Mechanisms underlying synergistic effects of combining CR with psychosocial interventions are not fully understood. Disentangling the relative contribution of each component of integrated programs might improve understanding of underlying mechanisms. In the present study we compared the efficacy of two components of our rehabilitation program [the Neurocognitive Individualized Training (NIT) and the Social Skills Individualized Training (SSIT)]. Seventy-two patients with schizophrenia or schizoaffective disorder were randomly assigned to one of two treatment groups. Changes in cognitive, psychopathological and real-world functioning indices after 6 and 12 months were compared between the two groups. After both 6 and 12 months, NIT produced an improvement of attention, verbal memory and perseverative aspects of executive functioning, while SSIT produced a worsening of visuo-spatial memory and attention and no significant effect on the other cognitive domains. As to the real-world functioning, NIT produced a significant improvement of interpersonal relationships, while SSIT yielded a significant improvement of QLS instrumental role subscale. According to our findings, cognitive training is more effective than social skills training on several cognitive domains and indices of real-world functioning relevant to subject's relationships with other people. Integrated approaches might target different areas of functional impairment but should be planned carefully and individually to fully exploit the synergistic potential.

Negative symptoms of schizophrenia represent a heterogeneous psychopathological domain. Both categorical and dimensional approaches have been proposed to reduce negative symptoms heterogeneity. In the present 5-year follow-up study, long-term stability and impact on outcome of different aspects of negative symptoms were investigated. Following a categorical approach, long-term stability and outcome of deficit schizophrenia (DS), in comparison with nondeficit schizophrenia (NDS), were assessed. Following a dimensional approach, the factor structure and stability of broadly defined negative symptoms and the ability of the identified factors to predict functional outcome were investigated. DS and NDS subjects included in a previous study were invited to participate. Fifty-one out of 58 patients previously diagnosed as DS and 44 out of 54 NDS patients were included in the present study. The DS/NDS categorization was confirmed in 82.4% of DS and 79.6% of NDS subjects. At follow-up, DS patients showed more severe negative symptoms and greater social dysfunction than NDS ones. Schedule for the Deficit Syndrome (SDS) severity scores loaded on two factors: “Poor Emotional Expression” and “Avolition” and the factor structure was stable after 5 years. Avolition was associated to social outcome measures and Poor Emotional Expression to functioning in household activities. Psychosocial outcome was predicted by SDS factors reflecting the severity of broadly defined negative symptoms, but not by the DS/NDS categorization. This might lend support to the recent shift of research focus from the categorical approach focusing on the presence of primary and enduring negative symptoms to the investigation of key domains of broadly defined negative symptoms.

La schizofrenia rappresenta ancora oggi una delle principali cause di disabilita in tutto il mondo. Secondo le stime dell’Organizzazione Mondiale della Sanita, essa si colloca nella graduatoria delle malattie causa di disabilita, al quinto posto per i maschi e al sesto posto per le femmine (World Health Organization, 2008).

IntroductionNegative symptoms have long been recognized as a central feature of schizophrenia, which limit recovery, having a strong negative impact on real-life functioning. External validators of the negative symptoms domains might help refining hypotheses on their pathophysiological basis.AimsThe objective of this study was to evaluate, in the context of the multicenter study of the Italian Network for Research on Psychoses, the relationships between auditory event-related potentials (ERPs) components and negative symptom domains in patients with schizophrenia (SCZ).MethodsWe examined ERPs recorded during an auditory odd-ball task in 115 chronic stabilized SCZ (78% on second-generation antipsychotics) and 62 matched healthy controls (HC). Negative symptoms were assessed using the Brief Negative Symptom Scale.ResultsOur main findings included significant N100 and P3b amplitude reductions in SCZ compared to HC. P3b amplitude did not correlate with any negative symptom domain, while N100 amplitude correlated with both anhedonia and avolition domains.ConclusionsAvolition and anhedonia, often clustering in the same factor, are related to abnormalities of early components of the ERPs correlated with perceptual and automatic attention processes. None of the negative symptom domains is associated with abnormalities of the later stages indexed by P3 amplitude.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionCurrent research suggested that avolition in patients with schizophrenia (SCZ) is not due to a deficit of hedonic experience, but to a poor ability to translate pleasurable experiences into motivational states. In line with this hypothesis, several evidences showed a preserved hedonic experience, even in the presence of severe trait anhedonia and avolition in SCZ.ObjectivesTo test the hypothesis that memory dysfunction, generally found in SCZ, could lead to inaccurate representations of emotional experiences and interfere with translation of pleasurable experience in motivation.AimsThe present study was aimed to investigate the relationships between state and trait anhedonia, avolition and cognitive functioning in 35 SCZ.MethodsIn SCZ and matched healthy controls (HC) the Temporal experience of Pleasure (TEPS) and Chapman's scales were used to assess trait anhedonia. The MID task was used to assess in-the-moment hedonic experience. Avolition was measured by the Schedule for the Deficit Syndrome. MATRICS Consensus Cognitive Battery was used to assess cognition.ResultsSCZ did not differ from HC on TEPS or on MID task performance but reported higher scores for trait social anhedonia. Trait social anhedonia was associated with memory dysfunction and showed a correlation with avolition.ConclusionsOur results confirm the disjunction between state and trait anhedonia and demonstrate a relationship of the latter with memory impairment and avolition, suggesting that inaccurate representations of emotional experiences might impede their translation in motivation to act.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionDifficult access and low quality of health care are recognized as factors that may account for the excess deaths widely reported in patients with schizophrenia. As a matter of fact, psychiatrists not always possess adequate competences in the assessment of physical health, while non-psychiatric physicians receive little training in psychiatry and are not prepared to take care of subjects with severe mental illnesses.ObjectivesWe present a comprehensive and systematic algorithm for screening medical comorbidities, conceived to be easy to use for psychiatrists, after a brief training.AimsThe study is aimed to implement an instrument for proper detection and management of physical illnesses in people with schizophrenia.MethodsThe screening protocol, developed by internal medicine specialists, was applied to 15 subjects in two independent assessments, one performed by trainees in psychiatry, after a brief training, and one carried out by one specialist and two trainees in internal medicine. The analysis of the inter-rater reliability was carried out by calculating the Cohen's kappa coefficient and the intraclass correlation coefficient as appropriate.ResultsThe agreement among raters resulted excellent for 61% of items, good for 17%, moderate for 18% and scarce for 4%. The few items showing scarce inter-rater reliability were excluded. The final algorithm is being tested for feasibility in psychiatric settings.ConclusionsThe proposed screening protocol resulted in a suitable tool, showing moderate to excellent inter-rater reliability, that can be used in clinical practice by psychiatrists after a brief training.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The construct of negative symptoms has undergone significant changes since the introduction of first generation assessment scales, such as the Scale for the Assessment of Negative Symptoms or the Positive and Negative Syndrome Scale. Blunted affect, Alogia, Asociality, Anhedonia and Avolition are largely recognized as valid domains of the negative symptoms construct.Among the new assessment instruments, both the Brief Negative Symptom Scale (BNSS) and the Clinical Assessment Interview for Negative Symptoms (CAINS) are considered adequate in their coverage of the negative symptoms domains. They include the assessment of both behavior and internal experience for Anhedonia, Asociality and Avolition to avoid overlap with functional outcome measures, as well as consummatory and anticipatory components of anhedonia with an emphasis on the internal experience of pleasure.Strengths and limitations of these new assessment instruments will be reviewed in the light of some existing challenges, such as the distinction between primary and secondary negative symptoms and development of innovative treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

BackgroundIt is hypothesized that the event-related potentials are generated by different electrophysiological mechanisms, i.e., event-related power increase and enhanced degree of phase-locking over trial. The study aimed to characterize the relative contribution of these mechanisms to the ERP in patients with schizophrenia (SCZ).Materials and methodsOne hundred and fifteen chronic stabilized SCZ and 62 healthy controls (HC) recruited to the study of the Italian Network for Research on Psychoses were included. Scalp potentials were recorded during a standard auditory oddball task. Stimulus-locked segments were extracted for all standard trials and correctly hit target trials. Trials contaminated by other artifacts were rejected. For each subject and stimulus type the event-related spectral perturbation (ERSP) and the inter-trial-coherence (ITC) were computed to assess event-related power increase and inter-trial phase-locking. The two groups were compared using Student's t-test followed by Bonferroni correction for multiple comparisons.ResultsSCZ presented a reduced amplitude of both N100 and P3b. For both standard and target stimuli, at Cz and Pz, ERSP was reduced in SCZ in the delta-theta band (from 0 up to 400 ms). The ITC index, at the same channels, was reduced in SCZ in the delta band for standard stimuli (from 0 to 300 ms), and in both delta and theta bands for target stimuli (from 300 to 400 ms).ConclusionsOur results indicate that alterations of both mechanisms are involved in N100 and P3b amplitude reduction observed in SCZ. Inter-trial phase-locking abnormalities for N100 were limited to the delta band, while for P3b involved delta and theta frequencies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionNeural dysconnectivity is hypothesized to be a key element in pathophysiology of schizophrenia. However, the relation of disordered connectivity with the different clinical characteristics of the syndrome is not fully elucidated.ObjectivesThe current research investigated the relations between resting-state EEG Source Functional Connectivity (EEG-SFC) and the two main clusters of negative symptoms derived from the Brief Negative Symptom Scale, the Expressive Deficit (ED) and the Avolition (AV), in subjects with schizophrenia (SCZ) enrolled to the multicentre study of the Italian Network for Research on Psychoses.MethodsOut of 97 chronic, stabilized SCZ included, we selected subjects according the lower and the upper quartile of the ED and AV value distribution: 25 were in upper and 24 in the lower quartile of ED (respectively, HIGH-ED and LOW-ED); 27 were in upper and 24 in the lower quartile of AV (respectively, HIGH-AV and LOW-AV). Fifty-five healthy controls (HC) were included, comparable to SCZ for gender, age and educational level. EEG-SFC analysis was based on the lagged phase synchronization (LPS) computed by eLORETA from 5 minutes resting-state EEG recordings in eyes closed condition. LPS indices were determined for each spectrum band and between all 28 regions of interest (ROI) pairs. Group differences were significant for corrected P-value < 0.05.ResultsSCZ had higher theta band LPS than HC. Respect to LOW-ED, HIGH-ED showed significant increased alpha LPS in fronto-cingulate, para-hippocampal and insular inter-hemispheric ROI pairs. No significant difference emerged between HIGH-AV and LOW-AV.ConclusionsSubgrouping SCZ according to negative symptom severity reveals heterogeneous patterns of resting-state LPS connectivity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe inter-relationships of neurocognition, social cognition, residual psychopathology and real-life functioning are poorly understood. A large multicenter study was carried out by the Italian Network for Research on Psychoses to model relationships between neurocognitive deficits, psychopathology and real-life functioning, taking into account the role of functional capacity and social cognition.MethodsA structural equation model was used to investigate direct and indirect effects of neurocognition and psychopathology on real-life functioning. Social cognition and functional capacity were modeled as mediators.ResultsIn 921 patients with schizophrenia, neurocognition had both direct and indirect effects, through functional capacity and social cognition, on real-life functioning. Neurocognition predicted to a large extent social cognition on which depression and disorganization had a modest effect. Social cognition showed a significant direct impact on real-life functioning.ConclusionOur results support a strong link between neurocognition and functional outcome, independent of psychopathology. Social cognition accounted for unique incremental variance in real-life functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPeople with schizophrenia exhibit deficits in neurocognitive and social cognitive (SC) processes which limit their social reintegration. SC was found to mediate in part the impact of neurocognitive dysfunctions on real-life functioning.ObjectiveThe purpose of this study was to implement a new intervention for patients with schizophrenia, the Social Cognition Individualized Activities Lab (So.C.I.A.L.) which trains both social cognition and neurocognitive functions.AimsTo determine the efficacy of the So.C.I.A.L in improving SC by a comparison with a validated cognitive remediation (CR) intervention: the Social Skills And Neurocognitive Individualized Training (SSANIT).MethodsNine stabilized patients accepted to participate in this pilot study. Five were randomized to So.C.I.A.L. and 4 to SSANIT. The two programs were matched for the overall treatment duration (20 weeks), as well as frequency and duration of the sessions. Both interventions included individual sessions of neurocognitive individualized training; So.C.I.A.L included group sessions on Emotion Recognition and Theory of Mind, while SSANIT group sessions of Social Skills Individualized Training.ResultsNo group difference was found for changes in neurocognition, while a significant group effect was observed for changes in SC, due to improvement only in the So.C.I.A.L. group.ConclusionsThe study results showed a specific effect of the So.C.I.A.L. on SC, beyond the effect on neurocognition. Further studies are needed to assess the impact of So.C.I.A.L. on real-life functioning in a larger group of subjects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Deficit schizophrenia (DS) represents a promising putative clinical subtype of schizophrenia and is characterized by the presence of primary and enduring negative symptoms. Previous studies have often reported a reduced amount of gray matter within prefrontal and temporal cortices in schizophrenia subjects with prevailing negative symptoms; however, the evidence concerning brain structural abnormalities in patients with DS remains controversial. The aim of the present study was to investigate whether patients with DS differed from those with nondeficit schizophrenia (NDS) with respect to the volume of the dorsolateral prefrontal cortex (DLPFC) and hippocampus, two brain areas considered as key regions in the pathogenesis of schizophrenia. In the present study a 3D-T1w MR imaging procedure and an extensive clinical assessment was carried out in 18 patients with schizophrenia, (10 DS and 8 NDS). 3D MPRAGE images were preprocessed with SPM software and two regions of interest (hippocampus and DLPFC) were manually traced to obtain their gray matter volumes. We found a significant reduction of DLPFC in the entire schizophrenia group, with respect to healthy subjects. Although the subgroup of patients with DS had a more severe clinical picture and more impaired social functioning, the DLPFC volume reduction was greater in NDS than in DS patients. In conclusion, according to our structural neuroimaging findings, DS patients, although characterized by a more severe clinical picture and a worse outcome, show less neurobiological abnormalities. (C) 2012 Elsevier Inc. All rights reserved.

European Archives of Psychiatry and Clinical Neuroscience, 262 (3), ISSN:0940-1334, ISSN:1433-8491

List of Contributors. Preface. 1 Historical Review of Electroencephalography in Psychiatry (Nash Boutros). Introduction. The early pre-clinical era. Early history of human electroencephalography. Electroencephalography in psychiatry today. References. 2 Physiologic Basis of the EEG Signal (Paola Bucci and Silvana Galderisi). Membrane potentials. Excitatory and inhibitory postsynaptic potentials. Nonsynaptic intercellular events contributing to the EEG signal. Factors determining polarity and other characteristics of the surface EEG waveforms. Brain structures involved in the genesis of EEG rhythms. References. 3 EEG Recording and Analysis (Oliver Pogarell). Techniques and technical background. References. 4 Normal EEG Patterns and Waveforms (Paola Bucci, Armida Mucci and Silvana Galderisi). Introduction. Normal EEG patterns in the waking adult. References. 5 Abnormal Patterns (Oliver Pogarell). Introduction. Detection of artefacts. Abnormal patterns. Focal alterations. References. 6 The Role of EEG in the Diagnostic Work Up in Psychiatry: Nonconvulsive Status Epilepticus, Frontal Lobe Seizures, Non-Epileptic Seizures (Silvana Riggio). Nonconvulsive status. Psychogenic non-epileptic seizures. Frontal lobe seizures. References. 7 EEG in Childhood Psychiatric Disorders (Mary W. Roberts and Nash Boutros). Introduction. Attention deficit disorder. Autistic spectrum disorders. References. 8 EEG in Psychoses, Mood Disorders and Catatonia (Nash Boutros, Silvana Galderisi, Oliver Pogarell and Felix Segmiller). Introduction. EEG in psychoses. EEG in mood disorders. EEG findings in catatonia. References. 9 Standard EEG in Personality and Anxiety Disorders (Nash Boutros). Introduction. EEG in aggression and impulse dyscontrol. Panic attacks. Borderline personality disorder. References. 10 EEG in Delirium and Dementia (Sophia Wang and Silvana Riggio). Introduction: Epidemiology of delirium and dementia. Clinical diagnosis in delirium. EEG work up in delirium. Metabolic causes of delirium. Infectious causes of delirium. Clinical diagnosis and EEG work up in dementia. Conclusion. References. 11 Effects of Psychotropic Drugs on EEG (Silvana Galderisi and Armida Mucci). Introduction. The role of EEG assessment of drug-induced CNS toxicity in psychiatric patients. Antipsychotic drugs. Lithium. Other mood stabilisers. Anxiolytics. Antidepressants. Recreational drugs. Case vignette. References. 12 Certification and Training in EEG and Clinical Neurophysiology (Nash Boutros and Silvana Galderisi). Clinical neurophysiology board certification. Index.

The field of applied electrophysiology in psychiatry for diagnostic and therapeutic purposes remains in its formative stages. While the scope of the field is rather large, the bona fide clinical applications are limited. A definition of the field, its scope and practice guidelines is needed for the clinical discipline to develop properly. The chapter discusses currently available certification venues for Clinical Neurophysiology along with limitations of each venue and discusses the need for developing training guidelines and certification processes specific to Neuropsychiatric Electrophysiology.

Negative symptoms of schizophrenia have often been associated with poor functional outcome and poor response to antipsychotic treatment. Studies reporting drug induced significant reduction of negative symptoms after treatment actually refer to negative symptoms secondary to positive, depressive and/or extrapyramidal symptoms. Negative symptoms that do not improve following antipsychotic treatment represent a real challenge for future development of effective treatments. Two approaches have been so far proposed to improve research on these negative symptoms. The first one is based on the identification of primary and enduring negative symptoms, that characterize a schizophrenia subtype known as deficit schizophrenia (DS). The prevalence of DS is 15%–20% in population based samples, but tends to be much lower in first-episode patients. Individuals with DS have worse long-term outcome and poorer response to antipsychotics than those with other forms of schizophrenia. The second approach is based on the identification of persistent negative symptoms, which are likely to be primary, but may be secondary. Few data are available on the prevalence of persistent negative symptoms in patients with schizophrenia. In first episode subjects from the EUFEST study 11% of the study sample showed persistent negative symptoms (PNS). They had poorer functional outcome and lower remission rates than those without PNS after 1 year of treatment. Research on clinical and biological correlated of primary and/or persistent negative symptoms might help in reducing schizophrenia heterogeneity and developing new treatments.

In this chapter, the characteristics of EEG activities in the waking adult (alpha rhythm, beta and gamma activity, low voltage records, mu, theta, and lambda waves) as well as their modifications induced by activation procedures are described and illustrated with several examples. EEG patterns in infancy and childhood, in normal aging, and during sleep are also reported. Unusual EEG patterns and their distinction in non-controversial and controversial are described.

Outcome measurement tools were almost exclusively used, so far, in research studies, while in routine clinical practice gross descriptive evaluation was generally provided. Discrepancies among studies and among stakeholders as to the effectiveness of one or the other treatment, study designs based on strict inclusion and exclusion criteria unlikely to generalize to clinical practice, the choice of outcome measures not always clinically meaningful, difficulties in the interpretation of clinical trials results and the relatively short trial duration have contributed to clinicians’ skeptical attitude toward clinical trials findings. Researchers designing future clinical trials are confronted with the need of providing clinically meaningful outcome measures, without undermining the statistical power of the study. However, integrative measures, such as "time to discontinuation for any reason", thought to convey information about efficacy, tolerability and safety, can be influenced by several nonspecific variables likely to vary from site to site and from doctor to doctor. Simple and global measurements, such as CGI-SCH, while preferred by many clinicians, might not capture the non unitary nature of the schizophrenia outcome constructs. Remission criteria are still limited to symptoms and clinicians would certainly like to see criteria for functional remission implemented as well. Clinical trials based on simple designs and on more comprehensive outcome measures will probably contribute to reduce the gap between research findings and clinical practice.

IntroductionClinical studies on cognitive effects of second generation antipsychotics produced disappointing findings probably due to the heterogeneity of the clinical populations under investigation, as well as to poor sensitivity of neurocognitive indices. Event-Related Potentials (ERPs) provide a functional measure of electrical brain activity time-locked to discrete stages of information processing. They have been widely used as putative biological markers of cognitive abnormalities in schizophrenia and represent useful indices in the investigation of the cognitive effects of psychotropic drugs.ObjectivesThe present study investigated the effect of risperidone, haloperidol and placebo on N1 and P3 in male healthy subjects.MethodsERPs were recorded during a three-tone oddball task in which target, standard and rare-nontarget tones were randomly presented. Subjects had to press a button when hearing a target tone. Amplitude and topography of the ERP component maps at peak latencies were compared across conditions. If a significant drug effect was obtained, changes in the cortical sources of the corresponding ERP component were analyzed using Low-Resolution Electromagnetic Tomography (LORETA).ResultsThe amplitude of N1 for attended stimuli and of P3 for rare-nontargets (P3a) was significantly increased only by risperidone. No significant change was observed in overall topographic features and in LORETA cortical sources of the same components. No significant drug effect was demonstrated for the latency of all the investigated components and for P3b amplitude.ConclusionsOur findings suggest that risperidone has a favorable effect on early attention processes and automatic attention allocation.

Background: Relatively few studies have examined how patients with schizophrenia and depression view psychiatric research and what influences their readiness to participate.Methods: A total of 763 patients (48% schizophrenia, 52% depression) from 7 European countries were examined using a specifically designed self-report questionnare ["Hamburg Attitudes to Psychiatric Research Questionnaire" (HAPRQ)].Results: Most patients (98%) approved of psychiatric research, in general, at least "a little". There was a tendency to approve psychosocial rather than biological research topics (e.g. research on the role of the family by 91% of patients compare to 79% in genetics). Reasons to participate were mainly altruistic. Only a minority (28%) considered monetary incentives important. Patients wanted extensive background information and a feedbak of the results; both were significantly more expressed by schizophrenia as compared to depressive patients, although these findings need to be interpreted with care because of age and gender differences between the diagnostic groups.Conclusion: While patients expressed discerning views of psychiatric reserch, only few differences were apparent between the two diagnostic groups. Patients' research priorities are not the same as those of many professionals and funding bodies. Their demonstrated critical appraisal should inform future research ensuring an increased patient role in the research process.

The EEG is the recording of the spontaneous electrical activity generated by cerebral neurons. Like all other cells in the body, neurons have high concentrations of potassium (K+) and chloride (Cl−) ions inside, while high concentrations of sodium (Na+) and calcium (Ca2+) ions are kept outside. This leads to a voltage difference of about −60 to −70 mV with respect to the outside of the cell membrane. Such a voltage difference is modified by the flux of ions depending on the opening and closing of ion channels induced by electrical or chemical stimuli. A reduction of charge separation across the membrane, due to an influx of positive charged ions into the cell, results in a less negative membrane potential and is termed depolarisation, whereas an increase in charge separation leading to a more negative membrane potential is called hyperpolarisation. When a critical amount of Na+ enters the cell and the membrane potential reaches a threshold level, the opening of additional Na+ channels is facilitated leading to a sudden marked increase of depolarisation. This fast depolarising event corresponds to the rising phase of the action potential, while the falling phase is related to an outflux of K+ ions which, combined with a decrease of Na+ influx, induces a repolarisation of the cell. After an action potential, there is a transitory inactivation of Na+ channels that causes a refractory period during which another action potential cannot be generated.

Differences between female and male patients with schizophrenia in psychopathology and course of illness have frequently been reported. However, the influence of sex on symptomatic and social remission is still an open issue. In the present study, differences between males and females in both clinical and social remission rates and in scores on several scales assessing social functioning were evaluated in 295 stabilized patients with schizophrenia, schizoaffective or delusional disorder. Female patients, as compared with males, showed a later onset of the illness, less negative symptoms and less frequent alcohol abuse. No significant difference was found between females and males in the rate of symptomatic and functional remission. No significant effect of sex was observed on any index of social functioning.

Research aimed to foster the understanding of causes and consequences of mental disorders and to improve their outcome should be a priority in the agenda of clinicians, researchers and health policy makers. Published guidelines for research in Psychiatry have highlighted main requirements, which will be summarized and discussed in the presentation. Research in Psychiatry has to conform to ethical principles and rigorous scientific standards. Openness and transparency should characterize the management of eventual conflicts of interests; professional integrity and independence from external pressure and influence must represent an obligation. In addition to human research ethical principles, research in Psychiatry involves unique aspects relevant to the nature of mental disorders. Awareness of general and disorder specific ethical aspects has to be promoted among trainees and researchers and adequate procedures to deal with these aspects must be implemented. Studies should address clinically relevant questions, select the least vulnerable individuals to adequately answer the study questions; the design and methods should minimize risks and threats for patients and be adequate to address the study questions. Care must be taken to ensure privacy and patients' freedom to leave the experimental protocol at any time without negative consequences for their clinical care. Translating these principles into everyday research activities is the present challenge for researchers in Psychiatry and for all those caring for the progress of the discipline. National and international educational programmes for trainees in Psychiatry, for investigators conducting research involving people with mental disorders, and for members of institutional review boards should be developed.