Dispositional Mindfulness Mediates the Relationship between Psychotic Symptoms and Psychological Quality of Life / [El mindfulness disposicional media la relación entre los síntomas psicóticos y la calidad de vida psicológica]

Background: To assess the mediator effect of dispositional mindfulness on the relationship between psychotic symptoms and psychological quality of life of people experiencing psychosis. Method: One hundred thirty-eight participants with psychosis were recruited. Psychotic symptoms were assessed through the PANSS scale, dispositional mindfulness was assessed using the MAAS questionnaire, and psychological quality of life was tapped with the WHOQOL-BREF questionnaire. Mediational analysis was performed setting PANSS factors as independent variables, MAAS scores as mediator, and WHOQOL-BREF Psychological as dependent variable. Results: MAAS scores mediated the relationship between WHOQOL-BREF Psychological scores and PANSS Positive (b = -.246, BCa CI [-.345, -.153]), PANSS Negative (b = -.173, BCa CI [-.251, -.096]), and PANSS Depressed scores (b = -.227, BCa CI [-.31, -.148]). Conclusions: Dispositional mindfulness can ameliorate the negative impact of hallucinations, delusions, negative symptoms, and depression feelings on psychological quality of life of people experiencing psychosis.(AU)

Antecedentes: Evaluar el efecto mediador de la atención plena disposicional en la relación entre los síntomas psicóticos y la calidad de vida psicológica de las personas que experimentan psicosis. Método: Se reclutaron 138 participantes con psicosis. Los síntomas psicóticos se evaluaron mediante la escala PANSS, la atención plena disposicional se evaluó utilizando la escala MAAS y la calidad de vida psicológica se exploró con el cuestionario WHOQOL-BREF. Se realizó un análisis de mediación estableciendo los factores PANSS como variables independientes, los puntajes MAAS como mediador y WHOQOL-BREF Psicológico como variable dependiente. Resultados: Las puntuaciones en la MAAS mediaron la relación entre WHOQOL-BREF-Psicológico y PANSS Positivo (b = -.246, IC BCa [-.345, -.153]), PANSS Negativo (b = -.173, IC BCa [-.251, -.096]) y PANSS Depresión (b = -.227, IC BCa [-.31, -.148]). Conclusiones: El mindfulness disposicional puede reducir el impacto negativo de las alucinaciones, delirios, síntomas negativos y sentimientos de depresión en la calidad de vida psicológica de las personas que experimentan psicosis.(AU)

Deterioro funcional y neurocognitivo en pacientes con esquizofrenia deficitaria en Perú y confiabilidad de la estructura bidimensional de la sintomatología negativa / Functional and neurocognitive impairment in deficit schizophrenia patients in Peru and reliability of the bidimensional structure of negative symptomatology

Resumen La mayoría de los estudios sugieren que los pacientes con esquizofrenia deficitaria presentan un deterioro funcional y neurocognitivo más grave en comparación con los pacientes con esquizofrenia no deficitaria. Sin embargo, existen pocos estudios al respecto en América Latina. Examinar las diferencias entre el funcionamiento y el deterioro neurocognitivo en pacientes con y sin esquizofrenia deficitaria; y analizar la validez de la estructura bifactorial de los síntomas negativos en una muestra de pacientes peruanos. Se reclutó a un total de 53 pacientes peruanos con esquizofrenia. Se utilizó la versión en español del Schedule for the Deficit Syndrome (SDS) para diagnosticar el síndrome deficitario, el Functioning Assessment Short Test (FAST) para evaluar el funcionamiento global, y el Screen for Cognitive Impairment in Psychiatry (SCIP) para evaluar el funcionamiento neurocognitivo. La prevalencia de esquizofrenia deficitaria fue del 62,3 %. Los pacientes con esquizofrenia deficitaria presentan un mayor deterioro en la memoria de trabajo (p = 0,003), fluidez verbal (p = 0,002), aprendizaje verbal retardado (p = 0,039) y velocidad de procesamiento (p = 0,004). En cuanto al funcionamiento global, los pacientes con esquizofrenia deficitaria muestran un rendimiento inferior en las dimensiones de autonomía (p = 0,002), laboral (p = 0,001), cognitiva (p = 0,010), finanzas (p = 0,015), relaciones interpersonales (p < 0,001) y tiempo de ocio (p < 0,001). Los pacientes con esquizofrenia deficitaria muestran un mayor deterioro en el funcionamiento global y cognitivo. La replicación de la estructura bidimensional de los síntomas negativos en una muestra peruana contribuye a la hipótesis de la universalidad del modelo de «déficit expresivo¼ y «apatía-abulia¼.

ABSTRACT Many studies suggest that patients with deficit schizophrenia exhibit a more severe functional and neurocognitive impairment than those with non-deficit schizophrenia. However, there are few studies on this topic in Latin America. To examine the differences in functioning and neurocognitive impairment between patients with and without deficit schizophrenia, and to analyze the validity of the bifactorial structure of negative symptoms in a sample of Peruvian patients. A total of 53 Peruvian patients with schizophrenia were recruited. The Spanish version of the Schedule for the Deficit Syndrome (SDS) was used to diagnose the syndrome under study. The Functioning Assessment Short Test (FAST) was employed to assess global functioning, and the Screen for Cognitive Impairment in Psychiatry (SCIP), to evaluate neurocognitive functioning. The prevalence of deficit schizophrenia was 62.3%. Patients with deficit schizophrenia exhibited greater impairment in working memory (p = 0.003), verbal fluency (p = 0.002), delayed verbal learning (p = 0.039), and processing speed (p = 0.004). Regarding global functioning, patients with deficit schizophrenia demonstrated poorer performance in the domains of autonomy (p = 0.002), occupational functioning (p = 0.001), cognitive functioning (p = 0.010), financial functioning (p = 0.015), interpersonal relationships (p < 0.001), and leisure time (p < 0.001). Patients with deficit schizophrenia display greater impairment in global and cognitive functioning. The replication of the bidimensional structure of negative symptoms in a Peruvian sample contributes to the hypothesis of the universality of the "expressive deficit" and "apathy-abulia" model.

Risk factors of deficit and non-deficit schizophrenia: Results from a cross-sectional study.

AIM: It has been observed that deficit and non-deficit schizophrenia (SCZ-D and SCZ-ND) might be characterized by different risk factors. Therefore, the present study aimed to assess as to whether previously reported risk factors of schizophrenia are specifically associated with SCZ-D and SCZ-ND. METHOD: This study was based on a cohort of 118 stable outpatients with schizophrenia. A diagnosis of SCZ-D was established using the Schedule for the Deficit Syndrome (SDS). Risk factors were recorded using structured interview, the Operational Criteria for Psychotic Illness (OPCRIT) checklist and the Traumatic Experience Checklist (TEC). The following risk factors were explored: male sex, a history of schizophrenia in first-degree relatives, seasonality of birth, birth weight <3000g, delivery by cesarean section, a history of childhood trauma (emotional abuse, emotional neglect, physical abuse and sexual abuse) as well as substance abuse (other than nicotine) and cigarette smoking at psychosis onset. RESULTS: Individuals with SCZ-D were more likely to be males as well as reported higher rates of birth weight <3000g and any categories of childhood trauma. In turn, substance abuse (other than nicotine) at psychosis onset was significantly more frequent in patients with SCZ-ND. Binary logistic regression, controlling for multiple comparisons, revealed similar findings, except for the association with any categories of childhood trauma that appeared to be not significant. CONCLUSION: Our findings partially replicate differential patterns of risk factors for SCZ-D (male sex and birth weight <3000g) and SCZ-ND (substance abuse at psychosis onset), likely attributable to the effects of timing of exposure.

Risk factors of deficit and non-deficit schizophrenia: Results from a cross-sectional study / Factores de riesgo para la esquizofrenia deficitaria y no deficitaria: resultados de un estudio transversal

Aim: It has been observed that deficit and non-deficit schizophrenia (SCZ-D and SCZ-ND) might be characterized by different risk factors. Therefore, the present study aimed to assess as to whether previously reported risk factors of schizophrenia are specifically associated with SCZ-D and SCZ-ND. Method: This study was based on a cohort of 118 stable outpatients with schizophrenia. A diagnosis of SCZ-D was established using the Schedule for the Deficit Syndrome (SDS). Risk factors were recorded using structured interview, the Operational Criteria for Psychotic Illness (OPCRIT) checklist and the Traumatic Experience Checklist (TEC). The following risk factors were explored: male sex, a history of schizophrenia in first-degree relatives, seasonality of birth, birth weight <3000g, delivery by cesarean section, a history of childhood trauma (emotional abuse, emotional neglect, physical abuse and sexual abuse) as well as substance abuse (other than nicotine) and cigarette smoking at psychosis onset. Results: Individuals with SCZ-D were more likely to be males as well as reported higher rates of birth weight <3000g and any categories of childhood trauma. In turn, substance abuse (other than nicotine) at psychosis onset was significantly more frequent in patients with SCZ-ND. Binary logistic regression, controlling for multiple comparisons, revealed similar findings, except for the association with any categories of childhood trauma that appeared to be not significant. Conclusion: Our findings partially replicate differential patterns of risk factors for SCZ-D (male sex and birth weight <3000g) and SCZ-ND (substance abuse at psychosis onset), likely attributable to the effects of timing of exposure. (AU)

Objetivo: Se ha observado que la esquizofrenia deficitaria y no deficitaria (ES-D y ES-ND) pueden caracterizarse por diferentes factores de riesgo. El presente estudio tuvo como objetivo evaluar si los factores de riesgo de esquizofrenia previamente informados están específicamente asociados con ES-D y ES-ND. Método: Este estudio se basó en una cohorte de 118 pacientes ambulatorios. Se estableció el diagnóstico de ES-D mediante el Inventario para la Esquizofrenia Deficitaria. Los factores de riesgo se registraron mediante entrevista estructurada, la lista de verificación de Criterios Operativos para Enfermedades Psicóticas y la Lista de Verificación de Experiencia Traumática. Se exploraron los siguientes factores de riesgo: sexo masculino, antecedentes de esquizofrenia en familiares de primer grado, estacionalidad del nacimiento, peso al nacer <3.000g, parto por cesárea, antecedentes de trauma infantil, así como el abuso de sustancias (aparte de la nicotina) y el tabaquismo al inicio de la psicosis. Resultados: Las personas con ES-D tenían más probabilidades de ser varones y también informaron de tasas más altas de peso al nacer <3.000g y cualquier categoría de trauma infantil. A su vez, el abuso de sustancias (diferentes a la nicotina) al inicio de la psicosis fue significativamente más frecuente en pacientes con ES-ND. La regresión logística binaria, controlando comparaciones múltiples, reveló hallazgos similares, excepto por la asociación con cualquier categoría de trauma infantil que pareció no ser significativa. Conclusión: Nuestros resultados replican parcialmente los patrones diferenciales de los factores de riesgo para ES-D (sexo masculino y peso al nacer <3.000g) y ES-ND (abuso de sustancias al inicio de la psicosis), probablemente atribuibles a los efectos del momento de la exposición. (AU)

Defining negative symptoms remission in schizophrenia using the Brief Negative Symptom Scale.

INTRODUCTION: This study aimed to propose criteria for negative symptoms remission (NSR) in schizophrenia using the Brief Negative Symptom Scale (BNSS). MATERIAL AND METHODS: 274 participants were assessed on the Positive and Negative Syndrome Scale (PANSS), BNSS and Social and Occupational Functioning Assessment Scale (SOFAS). Two criteria for NSR on the BNSS were proposed - NSR based on the BNSS domains scores (NSRBNSS_DOMAINS) and NSR based on 5 key items of the BNSS (NSRBNSS_5ITEMS). A SOFAS score of 61 and above was considered as functional remission (FR). Logistic regressions were run to examine the association between FR and NSR. Receiver operating characteristic (ROC) curve analysis was performed for the NSR criteria on FR. Kappa agreement statistic was used to evaluate the agreement between the two NSR criteria. RESULTS: Eighty-nine (32.5%) participants fulfilled NSRBNSS_DOMAINS criterion whereas 70 (25.6%) participants fulfilled NSRBNSS_5ITEMS criterion. The two NSR criteria had substantial agreement (Kappa statistic=0.797) with each other. Sixty-one (25.3%) participants were in FR. FR was significantly associated with NSR, irrespective of the criterion used. To predict FR, the Area Under the Curve for NSRBNSS_DOMAINS and NSRBNSS_5ITEMS were 0.761 (CI: 0.696-0.826, p<0.001) and 0.723 (CI: 0.656-0.790, p<0.001), respectively. Hence, both NSR criteria demonstrated a fair ability to discriminate between functional remitters and non-remitters. CONCLUSIONS: Depending on the setting and needs, clinicians and researchers might employ either the full BNSS or an abbreviated 5-item BNSS scale to identify NSR in schizophrenia. More research is needed to further examine the validity of these criteria in schizophrenia.

Validation of a European Spanish-version of the Self-Evaluation of Negative Symptoms (SNS) in patients with schizophrenia.

INTRODUCTION: Negative symptoms can be grouped into five domains: apathy/avolition, anhedonia, asociality, alogia, and affective flattening. There are few validate self-rated measures that assess these five dimensions. Therefore, this study aimed to validate the Self-Evaluation of Negative Symptoms (SNS) in Spanish patients with schizophrenia. MATERIAL AND METHODS: Cross-sectional, validation study in 104 outpatients with schizophrenia evaluated using the Spanish version of the following scales: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale - Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) and the Self-Evaluation of Negative Symptoms (SNS). RESULTS RELIABILITY: Internal consistency (Cronbach's alpha) was 0.915. Convergent validity: The Pearson correlation coefficient between MAP-SR and SNS Total scores was 0.660 (p<0.001). For PANSS-N, the correlation was 0.437 (p<0.005) and with the CAINS-Total was 0.478 (p<0.005). Divergent validity: The Pearson correlation coefficient between SNS and PSP was r=-0.372 (p≤0.001), and with SF-36 Physical and Mental Summary Component scores were r=-0.213 (p=0.066) and r=-0.144 (p=0.219), respectively. Discriminant validity: SNS Total scores were significantly statistically different according to the severity of the negative symptomatology rated by the CGI-SCH negative scale (p<0.001). CONCLUSION: The SNS is a reliable and valid instrument to self-rate the five domains of negative symptoms in patients with schizophrenia and seems to be appropriate for use in everyday clinical practice as a complementary measure to the evaluation performed by the clinician.

Defining negative symptoms remission in schizophrenia using the Brief Negative Symptom Scale / Criterios de remisión de síntomas negativos utilizando la Escala Breve de Síntomas Negativos (BNSS)

Introduction: This study aimed to propose criteria for negative symptoms remission (NSR) in schizophrenia using the Brief Negative Symptom Scale (BNSS).Material and methods: 274 participants were assessed on the Positive and Negative Syndrome Scale (PANSS), BNSS and Social and Occupational Functioning Assessment Scale (SOFAS). Two criteria for NSR on the BNSS were proposed – NSR based on the BNSS domains scores (NSRBNSS_DOMAINS) and NSR based on 5 key items of the BNSS (NSRBNSS_5ITEMS). A SOFAS score of 61 and above was considered as functional remission (FR). Logistic regressions were run to examine the association between FR and NSR. Receiver operating characteristic (ROC) curve analysis was performed for the NSR criteria on FR. Kappa agreement statistic was used to evaluate the agreement between the two NSR criteria.Results: Eighty-nine (32.5%) participants fulfilled NSRBNSS_DOMAINS criterion whereas 70 (25.6%) participants fulfilled NSRBNSS_5ITEMS criterion. The two NSR criteria had substantial agreement (Kappa statistic=0.797) with each other. Sixty-one (25.3%) participants were in FR. FR was significantly associated with NSR, irrespective of the criterion used. To predict FR, the Area Under the Curve for NSRBNSS_DOMAINS and NSRBNSS_5ITEMS were 0.761 (CI: 0.696–0.826, p<0.001) and 0.723 (CI: 0.656–0.790, p<0.001), respectively. Hence, both NSR criteria demonstrated a fair ability to discriminate between functional remitters and non-remitters. Conclusions: Depending on the setting and needs, clinicians and researchers might employ either the full BNSS or an abbreviated 5-item BNSS scale to identify NSR in schizophrenia. More research is needed to further examine the validity of these criteria in schizophrenia. (AU)

Introducción: El objetivo de este estudio fue proponer criterios para la remisión de síntomas negativos (NSR) en la esquizofrenia utilizando la Escala Breve de Síntomas Negativos (BNSS). Material y métodos: 274 participantes fueron evaluados con la Escala de Síndrome Positivo y Negativo (PANSS), BNSS y la Escala de Evaluación del Funcionamiento Social y Ocupacional (SOFAS). Se propusieron dos criterios para NSR en el BNSS: NSR basado en las puntuaciones de los dominios BNSS (NSRBNSS_DOMAINS) y NSR basado en 5 elementos clave del BNSS (NSRBNSS_5ITEMS). Una puntuación SOFAS de 61 y superior se consideró como remisión funcional (FR). Se realizaron regresiones logísticas para examinar la asociación entre FR y NSR. El análisis de la curva de características operativas del receptor (ROC) se realizó para los criterios NSR en FR. Se utilizó la estadística de concordancia Kappa para evaluar la concordancia entre los dos criterios de NSR.Resultados: Ochenta y nueve (32,5%) participantes cumplieron el criterio NSRBNSS_DOMAINS mientras que 70 (25,6%) participantes cumplieron el criterio NSRBNSS_5ITEMS. Los dos criterios de NSR tuvieron un acuerdo sustancial (estadística Kappa = 0,797) entre sí. Sesenta y un (25,3%) participantes estaban en FR. La FR se asoció significativamente con la NSR, independientemente del criterio utilizado. Para predecir la FR, el área bajo la curva para NSRBNSS_DOMAINS y NSRBNSS_5ITEMS fueron 0,761 (IC: 0,696-0,826, p <0,001) y 0,723 (IC: 0,656-0,790, p <0,001), respectivamente. Por lo tanto, ambos criterios NSR demostraron una capacidad adecuada para discriminar entre remitentes funcionales y no remitentes. Conclusiones: Dependiendo del entorno y las necesidades, los médicos e investigadores pueden emplear la BNSS completa o una escala BNSS abreviada de 5 ítems para identificar la NSR en la esquizofrenia. Se necesita más investigación para examinar a fondo la validez de estos criterios en la esquizofrenia. (AU)

Validation of a European Spanish-version of the Self-Evaluation of Negative Symptoms (SNS) in patients with schizophrenia / Validación de la versión española de SNS (Self-Evaluation of Negative Symptoms-Autoevaluación de síntomas negativos) en pacientes esquizofrénicos

Introduction:Negative symptoms can be grouped into five domains: apathy/avolition, anhedonia, asociality, alogia, and affective flattening. There are few validate self-rated measures that assess these five dimensions. Therefore, this study aimed to validate the Self-Evaluation of Negative Symptoms (SNS) in Spanish patients with schizophrenia.Material and methods:Cross-sectional, validation study in 104 outpatients with schizophrenia evaluated using the Spanish version of the following scales: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale – Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) and the Self-Evaluation of Negative Symptoms (SNS).Results Reliability:Internal consistency (Cronbach's alpha) was 0.915. Convergent validity: The Pearson correlation coefficient between MAP-SR and SNS Total scores was 0.660 (p<0.001). For PANSS-N, the correlation was 0.437 (p<0.005) and with the CAINS-Total was 0.478 (p<0.005). Divergent validity: The Pearson correlation coefficient between SNS and PSP was r=−0.372 (p≤0.001), and with SF-36 Physical and Mental Summary Component scores were r=−0.213 (p=0.066) and r=−0.144 (p=0.219), respectively. Discriminant validity: SNS Total scores were significantly statistically different according to the severity of the negative symptomatology rated by the CGI-SCH negative scale (p<0.001). (AU)

Introducción:Los síntomas negativos pueden agruparse en 5 dominios: apatía/abulia, anhedonia, conductas asociales, afasia y aplanamiento afectivo. Existen pocas medidas validadas autocalificadas que evalúen estas 5 dimensiones. Por tanto, el objetivo de este estudio fue validar la herramienta Self-Evaluation of Negative Symptoms (SNS, Autoevaluación de síntomas negativos) en pacientes españoles esquizofrénicos.Material y métodos:Estudio transversal de validación en 104 pacientes esquizofrénicos externos, evaluados utilizando la versión española de las escalas siguientes: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale-Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) y la SNS.Resultados: Respecto a la fiabilidad,la consistencia interna (α de Cronbach) fue de 0,915. En cuanto a validez convergente, el coeficiente de correlación de Pearson entre las puntuaciones totales de MAP-SR y SNS fue de 0,660 (p < 0,001). Para PANSS-N, la correlación fue de 0,437 (p < 0,005) y de 0,478 (p < 0,005) con CAINS-Total. Respecto a la validez divergente, el coeficiente de correlación de Pearson entre las puntuaciones SNS y PSP fue de r = –0,372 (p ≤ 0,001) y con las puntuaciones de SF-36 Physical and Mental Summary Component fueron de r = −0,213 (p = 0,066) y r = −0,144 (p = 0,219), respectivamente. En la validez discriminante, las puntuaciones totales de SNS fueron diferentes desde un punto de vista estadístico significativo, conforme a la gravedad de la sintomatología negativa calificada por la escala negativa CGI-SCH (p < 0,001). (AU)

Defining negative symptoms remission in schizophrenia using the Brief Negative Symptom Scale.

INTRODUCTION: This study aimed to propose criteria for negative symptoms remission (NSR) in schizophrenia using the Brief Negative Symptom Scale (BNSS). MATERIAL AND METHODS: 274 participants were assessed on the Positive and Negative Syndrome Scale (PANSS), BNSS and Social and Occupational Functioning Assessment Scale (SOFAS). Two criteria for NSR on the BNSS were proposed - NSR based on the BNSS domains scores (NSRBNSS_DOMAINS) and NSR based on 5 key items of the BNSS (NSRBNSS_5ITEMS). A SOFAS score of 61 and above was considered as functional remission (FR). Logistic regressions were run to examine the association between FR and NSR. Receiver operating characteristic (ROC) curve analysis was performed for the NSR criteria on FR. Kappa agreement statistic was used to evaluate the agreement between the two NSR criteria. RESULTS: Eighty-nine (32.5%) participants fulfilled NSRBNSS_DOMAINS criterion whereas 70 (25.6%) participants fulfilled NSRBNSS_5ITEMS criterion. The two NSR criteria had substantial agreement (Kappa statistic=0.797) with each other. Sixty-one (25.3%) participants were in FR. FR was significantly associated with NSR, irrespective of the criterion used. To predict FR, the Area Under the Curve for NSRBNSS_DOMAINS and NSRBNSS_5ITEMS were 0.761 (CI: 0.696-0.826, p<0.001) and 0.723 (CI: 0.656-0.790, p<0.001), respectively. Hence, both NSR criteria demonstrated a fair ability to discriminate between functional remitters and non-remitters. CONCLUSIONS: Depending on the setting and needs, clinicians and researchers might employ either the full BNSS or an abbreviated 5-item BNSS scale to identify NSR in schizophrenia. More research is needed to further examine the validity of these criteria in schizophrenia.

Psychosis in Huntington´s Disease. a rare and Under-Investigated Psychiatric Manifestation / Psychosis in Huntington's Disease: uma manifestação psiquiátrica rara e pouco investigada

Introduction: Psychotic symptoms are among the least prevalent and under-investigated psychiatric manifestations (PM) of Huntington's disease (HD). Case report: We herein report a case of a 31-year-old male patient who presented PM with a predominance of negative symptoms, without any significant abnormal movement. HD was diagnosed based on positive DNA analysis and family history. HD imposes longitudinal follow-up through a multidisciplinary approach in order to improve the quality of life and prognosis. Conclusion: This case report highlights the importance of comprehending the PM in the initial presentation of HD so that the diagnosis is not delayed until the onset of motor symptoms.

Introdução: Os sintomas psicóticos estão entre as manifestações psiquiátricas (MP) menos prevalentes e pouco investigadas da doença de Huntington (DH). Relado de caso: Relatamos o caso de um paciente do sexo masculino, 31 anos, que apresentou MP com predomínio de sintomas negativos, sem qualquer movimento anormal significativo. A DH foi diagnosticada com base em uma análise de DNA positiva e na história familiar. A DH impõe um acompanhamento longitudinal por meio de uma abordagem multidisciplinar, a fim de melhorar a qualidade de vida e o prognóstico. Conclusão: Este relato de caso destaca a importância da compreensão das MPs na apresentação inicial da DH, para que o diagnóstico não seja atrasado até ao aparecimento dos sintomas motores

Validation of a European Spanish-version of the Self-Evaluation of Negative Symptoms (SNS) in patients with schizophrenia.

INTRODUCTION: Negative symptoms can be grouped into five domains: apathy/avolition, anhedonia, asociality, alogia, and affective flattening. There are few validate self-rated measures that assess these five dimensions. Therefore, this study aimed to validate the Self-Evaluation of Negative Symptoms (SNS) in Spanish patients with schizophrenia. MATERIAL AND METHODS: Cross-sectional, validation study in 104 outpatients with schizophrenia evaluated using the Spanish version of the following scales: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale - Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) and the Self-Evaluation of Negative Symptoms (SNS). RESULTS RELIABILITY: Internal consistency (Cronbach's alpha) was 0.915. Convergent validity: The Pearson correlation coefficient between MAP-SR and SNS Total scores was 0.660 (p<0.001). For PANSS-N, the correlation was 0.437 (p<0.005) and with the CAINS-Total was 0.478 (p<0.005). Divergent validity: The Pearson correlation coefficient between SNS and PSP was r=-0.372 (p≤0.001), and with SF-36 Physical and Mental Summary Component scores were r=-0.213 (p=0.066) and r=-0.144 (p=0.219), respectively. Discriminant validity: SNS Total scores were significantly statistically different according to the severity of the negative symptomatology rated by the CGI-SCH negative scale (p<0.001). CONCLUSION: The SNS is a reliable and valid instrument to self-rate the five domains of negative symptoms in patients with schizophrenia and seems to be appropriate for use in everyday clinical practice as a complementary measure to the evaluation performed by the clinician.

Can interleukin-2 and interleukin-1ß be specific biomarkers of negative symptoms in schizophrenia? / ¿Pueden ser la interleucina-2 y la interleucina-1ß biomarcadores específicos de la sintomatología negativa en la esquizofrenia?

INTRODUCTION: Evidence suggests the existence of cytokine disturbances in patients with schizophrenia but their association with psychopathology is still unclear. The aim of the current study was to determine if pro-inflammatory cytokine levels (tumor necrosis factor-α, interleukin (IL)-6, IL-2, IL-1ß, IL-1RA) are increased in stable outpatients compared with healthy subjects, and to analyze if they could be specific biomarkers of clinical dimensions in schizophrenia. METHODS: We studied 73 stable outpatients with schizophrenia in their first 10 years of illness and 73 age- and sex-matched healthy controls. An accurate assessment of clinical dimensions (positive, negative, depressive, cognitive) was performed in patients. RESULTS: Only IL-6 levels were significantly increased in patients after controlling for body mass index, waist circumference, smoking, and psychopharmacological treatment, compared with healthy subjects. After adjusting for several confounders, multiple linear regression models identified that Positive and Negative Syndrome Scale negative symptoms, general psychopathology, and global severity are predicted by IL-1ß concentrations, while motivation and pleasure domain of Clinical Assessment Interview for Negative Symptoms and Personal and Social Performance global functioning scores are predicted by IL-2 levels. Cognitive performance, positive, and depressive symptom severity did not correlate with any cytokine. CONCLUSIONS: Our findings suggested that IL-6 concentrations are elevated in stable patients with schizophrenia. Whereas IL-2 specifically marks severity of the motivation and pleasure domain of negative symptoms, IL-1ß is not specific to this dimension as it also predicts severity of general and global symptomatology.

Oxidative stress biomarkers and clinical dimensions in first 10 years of schizophrenia. / Biomarcadores de estrés oxidativo y dimensiones clínicas en los 10 primeros años de esquizofrenia.

INTRODUCTION: Several studies have described increased oxidative stress parameters in patients with schizophrenia. The objectives of the current study were to identify potential oxidative stress biomarkers in stable patients during first 10 years of schizophrenia and determine if they are associated with specific clinical dimensions. MATERIAL AND METHODS: Seventy-three clinically stable outpatients with schizophrenia and 73 sex and age-matched healthy controls were recruited. Sociodemographic, clinical and biological data were collected at enrollment. Blood biomarkers included homocysteine, the percentage of hemolysis, lipid peroxidation subproducts, and as an antioxidant biomarker, catalase activity in erythrocytes. RESULTS: Comparative analyses after controlling for smoking and metabolic syndrome evidenced a significant increase in catalase activity in patients. Also, lower lipid peroxidation levels showed an association with negative symptoms. CONCLUSIONS: In conclusion, compensatory antioxidant mechanisms might be increased in stable patients with schizophrenia at early stages. Furthermore, there may be an inverse relationship between oxidative stress and negative dimension.

Spanish validation of the Negative Symptom Assessment-16 (NSA-16) in patients with schizophrenia. / Validación española de la escala de evaluación de los síntomas negativos-16 (NSA-16) en pacientes con esquizofrenia.

INTRODUCTION: Negative symptoms are prevalent in schizophrenia and associated with a poorer outcome. Validated newer psychometric instruments could contribute to better assessment and improved treatment of negative symptoms. The Negative Symptom Assessment-16 (NSA-16) has been shown to have strong psychometric properties, but there is a need for validation in non-English languages. This study aimed to examine the psychometric properties of a Spanish version of the NSA-16 (Sp-NSA-16). MATERIAL AND METHOD: Observational, cross-sectional validation study in a sample of 123 outpatients with schizophrenia. ASSESSMENTS: NSA-16, PANSS, HDRS, CGI-SCH and PSP. RESULTS: The results indicate appropriate psychometric properties, high internal consistency (Cronbach's alpha=0.86), convergent validity (PANSS negative scale, PANSS Marder Negative Factor and CGI-negative symptoms r values between 0.81 and 0.94) and divergent validity (PANSS positive scale and the HDRS r values between 0.10 and 0.34). In addition, the NSA-16 also exhibited discriminant validity (ROC curve=0.97, 95% CI=0.94 to 1.00; 94.3% sensitivity and 83.3% specificity). CONCLUSIONS: The Sp-NSA-16 is reliable and valid for measuring negative symptoms in patients with schizophrenia. This provides Spanish clinicians with a new tool for clinical practice and research. However, it is necessary to provide further information about its inter-rater reliability.

Effectiveness, efficiency and efficacy in the multidimensional treatment of schizophrenia: Rethinking project. / Eficacia, eficiencia y efectividad en el tratamiento multidimensional de la esquizofrenia: proyecto Rethinking.

Schizophrenia is a clinically heterogeneous syndrome affecting multiple dimensions of patients' life. Therefore, its treatment might require a multidimensional approach that should take into account the efficacy (the ability of an intervention to get the desired result under ideal conditions), the effectiveness (the degree to which the intended effect is obtained under routine clinical practice conditions or settings) and the efficiency (value of the intervention as relative to its cost to the individual or society) of any therapeutic intervention. In a first step of the process, a group of 90 national experts from different areas of health-care and with a multidimensional and multidisciplinary perspective of the disease, defined the concepts of efficacy, effectiveness and efficiency of established therapeutic interventions within 7 key dimensions of the illness: symptomatology; comorbidity; relapse and adherence; insight and subjective experience; cognition; quality of life, autonomy and functional capacity; and social inclusion and associated factors. The main conclusions and recommendations of this stage of the work are presented herein.

Differential blood-based biomarkers of psychopathological dimensions of schizophrenia. / Biomarcadores sanguíneos diferenciales de las dimensiones psicopatológicas de la esquizofrenia.

Symptomatology of schizophrenia is heterogeneous, there is not any pathognomonic symptom. Moreover, the diagnosis is difficult, since it is based on subjective information, instead of markers. The purpose of this study is to provide a review of the current status of blood-based biomarkers of psychopathological dimensions of schizophrenia. Inflammatory, hormonal or metabolic dysfunctions have been identified in patients with schizophrenia and it has attempted to establish biomarkers responsible for these dysfunctions. The identification of these biomarkers could contribute to the diagnosis and treatment of schizophrenia.

La terapia cognitivo conductual y los síntomas negativos en la esquizofrenia / Cognitive behavioral therapy and negative symptoms in schizophrenia

INTRODUCCIÓN: La esquizofrenia constituye un problema sanitario y social de grandes dimensiones que afecta no sólo al paciente sino a su entorno familiar y social. Dentro de las aproximaciones psicoterapéuticas dirigidas a pacientes con esquizofrenia, las terapias cognitivo conductuales (TCC) son las que cuentan con mayor evidencia de efectividad para diferentes propósitos y etapas del trastorno. OBJETIVO: Analizar las técnicas y efectos específicos sobre síntomas negativos de las principales TCC para pacientes con esquizofrenia: Psicoeducación, Entrenamiento en Habilidades Sociales, Rehabilitación Cognitiva, TCC para Síntomas Positivos y TCC orientada a la Recuperación (TCC-R). MÉTODO: Se llevó a cabo una búsqueda y análisis de literatura científica en PSYCLIT, MEDLINE, EBSCO-HOST y PROQUEST publicada entre 1990 y 2014 en revistas indexadas en inglés y español, utilizando como palabras clave los nombres de las diferentes TCC para la esquizofrenia que se cruzaron en todos los casos con el diagnóstico. Se recopiló también la literatura relevante citada en estos artículos, sobre todo en las revisiones de literatura antecedentes. RESULTADOS: A pesar de los avances que han presentado las TCC en la recuperación de pacientes con diagnóstico de esquizofrenia, los problemas generados por la sintomatología negativa no han sido resueltos por completo. DISCUSIÓN Y CONCLUSIÓN: La TCC-R se considera un estilo terapéutico prometedor para alcanzar los objetivos de recuperación de los pacientes con bajo funcionamiento psicosocial y predominio de sintomatología negativa.

INTRODUCTION: Schizophrenia is a health and social problem of great dimensions, affecting not only the patient but their family and social environment. Within the psychotherapeutic approaches for patients with schizophrenia, Cognitive Behavioral Therapy (CBT) has most evidence of effectiveness for different porpoises and stages of the disorder. OBJECTIVE: Analyze the specific techniques and outcome on negative symptoms of the major CBT for patients with schizophrenia: Psychoeducation, Social Skills Training, Cognitive Remediation, CBT for positive symptoms and Cognitive Behavioral Recovery Oriented Therapy (CBT-R). METHOD: A searching and analysis of scientific literature published in English and Spanish between 1990 and 2014 were performed in PSYCLIT, MEDLINE, EBSCO-HOST and PROQUEST, employing as key words the names of the different CBT for schizophrenia and the diagnosis. Relevant literature included in review articles was also included. RESULTS: Despite the advances of CBT, the problems generated by negative symptoms of patients with schizophrenia are not completely solved. DISCUSSION AND CONCLUSION: CBT-R is considered a promising therapeutic style to achieve the objectives of recovery in patients with low psychosocial functioning and predominance of negative symptomatology.

Experiencias perceptuales inusuales, experiencias anómalo/paranormales y propensión a la esquizotipia / Unusual perceptual experiences, anomalous/paranormal experiences and proneness to schizotypy

Parece haber similitudes entre el trastorno esquizotípico de personalidad (TEP) y las experiencias paranormales. De hecho, algunos de los síntomas en el TEP en el Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) coinciden con un número de experiencias anómalo/paranormales. La esquizotipia positiva, que incluye pensamiento mágico, alucinaciones y otras experiencias perceptuales inusuales, también ha estado relacionada con experiencias y creencias paranormales. Sin embargo, las experiencias paranormales difieren de las experiencias psicóticas en la población no clínica. Para examinar diferencias en síntomas positivos y negativos de esquizotipia se comparó un grupo de individuos interesados en temas paranormales (N = 121) con uno de estudiantes universitarios (N = 588). Como estaba previsto en las hipótesis, las personas interesadas en temas paranormales puntuaron más alto en el subtotal de síntomas positivos de esquizotipia en comparación con los estudiantes, sin diferencias en síntomas negativos. Los síntomas positivos se presentan también en estudiantes que indican tener experiencias paranormales en comparación con aquellos sin experiencias, con una diferencia marginalmente significativa en los síntomas negativos entre ambos grupos.

There seems to be similarities between schizotypal personality and paranormal experiences, in fact, some of the symptoms of PTSD in The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) match a number of anomalous/paranormal experiences. Positive schizotypy, including magical thinking, hallucinations and other unusual perceptual experiences, has also been associated with paranormal experiences and beliefs. However, paranormal experiences differ from psychotic experiences in nonclinical populations. In order to establish differences between positive and negative symptoms of schizotypy, we compared a group of believers in the paranormal (N = 121) and a sample of undergraduate students (N = 588). The hypothesis that believers would have higher scores in schizotypy positive symptoms was confirmed. There was a significant difference in positive symptoms of schizotypy among the group of students with and no experiences, although not significant for negative symptoms.

Estimulación magnética transcraneal para síntomas negativos en la esquizofrenia: una revisión / The transcraneal magnetic stimulation for the negative symptoms in schizofrenia: a review

Schizophrenia is one of the most studied diseases in psychiatry and different dysfunctions of thinking, emotions, perception, movement, and behavior converge in it. These dysfunctions affect the quality of life of the patients in different ways. It is a disease that has been observed in the whole world, with a 0.5 to 1.5% prevalence among adults. Although the biological basis of schizophrenia is not clear enough, the dopaminergic hypothesis is preponderant in our understanding of the symptoms of the disease. A mesolimbic pathway hyperactivity is related to a positive symptomathology, while a prefrontal dopaminergic hypofunction relates to negative symptoms. It has been observed that using serotoninergic antagonists, which promote dopaminergic activity in the prefrontal cortex, translates in to a reduction of the intensity of negative symptoms. This negative syndrome includes a difficulty to initiate new activities (apathy), speech and creativity impoverishment (alogia), alterations in emotional expression, and a lack of capacity to experiment joy. Patients with negative symptoms present gray and white matter loss in left-sided cerebral structures, including temporal lobe, anterior cingulated, and medial frontal cortex. Such a loss seems to be more evident in prefrontal regions, such as the dorsolateral prefrontal region, which connects with anterior temporal structures. Persistent negative symptomathology is a concept proposed by Buchanan, which must fulfill the following criteria: symptoms are primary to the disease or secondary but have not responded to current treatment; interfere with the patient's capacity to accomplish normal functioning; persist during periods of clinical stability, and represent an unresolved therapeutic need. They must be measurable by clinical scales and persist, at least, six months. The Food and Drug Administration has recently considered negative symptoms as an investigation target or new treatments due to their prevalence and high negative impact in the life of the schizophrenic population. Nowadays, the current treatments available for such an entity are second generation antipshycotics and glutamatergic agents -such as d-cycloserine and glicine-, amisulpiride and seleginine, even though their efficacy is limited. Dysfunction of the human prefrontal cortex is considered to be implicated in the pathophisiology of negative symptoms. This cerebral region is essential in the regulation of emotions and cognition. Multiple neural networks begin in the prefrontal cortex and go towards other cortical association areas, to insular region, thalamic structures, basal ganglia and limbic system. It regulates dopaminergic mesencephalic activity through activating and inhibitory pathways, allowing a precise regulation of dopaminergic activity. This double modulation model of dopaminergic pathways has been recently sustained by studies which prove that extracellular dopaminergic concentration in nucleus accumbens increases or reduces after a high or low frequency stimulation of the prefrontal cortex, respectively. A prefrontal cortex lesion causes a syndrome similar to the negative symptomathology in schizophrenia. Transcraneal magnetic stimulation (TMS) could be effective in the treatment of negative symptoms by activating the prefrontal cortex, maybe by stimulating the liberation of dopamine in the mesolimbic and mesoestriatal pathways which have a crucial role in the pathogenesis of negative symptoms such as apathy and anhedonia. TMS was introduced in 1985 and since the early 90's its potential as a treatment has been tested in numerous neurological and psychiatric conditions. It is a noninvasive means of stimulating nervous cells in superficial areas of the brain. During a TMS procedure, an electrical current passes through a wire coil placed over the scalp. This induces a magnetic field that can produce a substantive electrical field in the brain. This electrical field produces in turn a depolarization of nervous cells resulting in the stimulation or disruption of brain activity. TMS may be applied as a single stimulus or repeated many times per second (repetitive TMS), with variations in the intensity, site, and orientation of the magnetic field. Most research and interest has focused on the potential application of repetitive TMS (rTMS) in the treatment of depression. In addition, in recent years an increasing number of open and double-blinded studies of rTMS were conducted in patients with schizophrenia. Most investigators have chosen to focus on the treatment of specific refractory symptoms or syndromes within the disorder such as refractory auditory hallucinations or persistent negative symptoms. TMS has become widely used in research, especially as a method to probe normal and abnormal brain function, motor cortical physiology, and cognition. Regarding negative symptoms in schizophrenia, eleven studies using TMS were carried out until 2006, with a total of 172 patients studied. These studies are difficult to compare because they used different stimulation parameters and the symptoms described were heterogenic. Six studies were blind and five were open, using high frequency TMS in all of them (frequencies above 1 Hz), which is the type of stimulation most commonly used in treatment studies. Six of these studies found a reduction in the severity of the symptoms, but the reduction was not significant in two of them. Ten were the maximum number of sessions included in every study, except for one, in which 20 sessions of TMS were given. In this study, the score of negative subscale of the PANSS was reduced in 33%, which is considered a significant response, and this result was sustained within the next month. In one of these studies, researchers compared 3- and 20-Hz stimulation with sham stimulation and stimulation provided at the patient's individual alpha frequency. Alpha-frequency stimulation was calculated as the patient's peak alpha frequency from five frontal EEG leads. Stimulation of alpha frequency resulted in a significantly greater reduction in negative symptoms than the other conditions. This finding could suggest that negative symptoms may specifically relate to alpha EEG oscillations, which is interesting and requires further exploration and confirmation. Another two studies were conducted in 2007; in the first one, no improvement in negative, positive of affective symptoms was found. The second one, which was a double-blinded clinical trial, found a significant reduction in the intensity of negative, positive, and general symptoms with the active TMS. We should remark that TMS produces changes in the cortical activity in ventral and dorsoestratial regions, but other cerebral regions could be stimulated too, since some activation abnormalities in the left globus palidus, bilateral caudate nucleus, prefrontal, and temporal right cortex have been found and are associated with the etiology of the negative syndrome. In addition, it will be interesting to see whether changes in subcortical dopamine release, which were shown with rTMS in normal volunteers, can be demonstrated in clinical populations, such as patients with schizophrenia, and how this may relate to response to treatment. There is still a need for a larger number of controlled studies, with larger samples, longer periods of evaluation, and constant stimulation parameters, so they can be compared between them and the exact efficacy of TMS as a treatment for negative symptoms can be established.

La estimulación magnética transcraneal (EMT) es un método no invasivo que utiliza campos magnéticos alternantes para inducir corrientes eléctricas en el tejido cortical en diferentes áreas cerebrales. Se considera una forma de tratamiento para diferentes trastornos psiquiátricos, especialmente en la depresión, adicciones y esquizofrenia. Está técnica terapéutica ofrece una vía innovadora para estudiar la excitabilidad de la corteza, la conectividad regional cortical, la plasticidad de las respuestas cerebrales y las funciones cognitivas en el estado del enfermo. Aunque se han documentado resultados positivos en la estimulación de la CPF izquierda y en la CPF derecha, se sugiere que puede ejercer su acción beneficiosa a través de diversos mecanismos de acción aún no comprendidos en su totalidad. La corteza prefrontal humana es esencial en el control e integración de las emociones, la cognición y la regulación del Sistema Nervioso Autónomo. Numerosas conexiones neuronales bidireccionales se originan en la CPF y se extienden al resto de las áreas de asociación cortical, región insular, sistema límbico y los ganglios basales. La CPF modula la actividad dopaminérgica mesencefálica mediante una vía activadora y otra inhibidora, lo que permite una regulación sumamente fina de la actividad dopaminérgica. La vía activadora funciona por medio de proyecciones glutamatérgicas directas e indirectas a las células dopaminérgicas. La vía inhibitoria hace lo propio mediante eferencias glutamatérgicas prefrontales a las interneuronas GABAérgicas mesencefálicas y a las neuronas GABAérgicas estriatomesencefálicas. El modelo de la doble modulación del sistema dopaminérgico mesolímbico demuestra que la concentración dopaminérgica extracelular en el núcleo accumbens disminuye o aumenta después de la estimulación de la corteza prefrontal a baja o alta frecuencia, respectivamente. Dentro de los estudios que utilizan la EMT en la esquizofrenia, se ha encontrado que, tras una EMT de alta frecuencia (>1Hz) o repetititiva (EMTr), hay un aumento de la excitabilidad en varias áreas cerebrales, mientras que la excitabilidad cortical disminuye tras una EMT de baja frecuencia (<1Hz). La excitabilidad cortical también depende de la intensidad y duración de la estimulación, lo que quiere decir que a intensidades más altas habrá mayor actividad cortical y a trenes prolongados habrá cambios duraderos en la excitabilidad cortical. Una gama de síntomas de difícil tratamiento en la esquizofrenia son los síntomas negativos persistentes, donde se ha demostrado una disminución de la actividad en la CPF, por lo que la EMT se ha utilizado para revertir dicha hipoactividad y disminuir los síntomas. De forma contraria, los síntomas positivos, como las alucinaciones, se asocian con una hiperactividad de las áreas témporo-parietales y por tanto debería resultar beneficiosa la aplicación de EMT de baja frecuencia en dichas áreas. La EMT de alta frecuencia también se ha utilizado para tratar a sujetos con síntomas catatónicos prominentes y se ha logrado una mejoría con el tratamiento. El objetivo de esta revisión es que se comprendan mejor la EMT y el uso que se le puede dar para tratar diversos síntomas en la esquizofrenia.

Evolución de los síntomas negativos de la esquizofrenia / The evolution of the negative symptoms of schizophrenia

El tratamiento de los síntomas negativos de la esquizofrenia constituye aún un desafío para la Neuropsicofarmacología, dada su persistencia en la evolución de los pacientes en la clínica. El objetivo fue analizar la evolución de los síntomas negativos en pacientes ambulatorios, con diagnóstico de esquizofrenia, de ambos sexos, tratados con neurolépticos. La población estudiada consistió en pacientes ambulatorios de 18 a 65 años de edad, 35 mujeres y 25 varones, con diagnóstico de esquizofrenia paranoide (295.30) con la presencia de síntomas negativos, medicados con risperidona 1 mg/día, haloperidol 5 mg/día, aripiprazol y olanzapina. Se efectuó una entrevista clínica realizada por profesionales que incluyó la administración de la escala PANSS. Los resultados mostraron una mejoría siginifictiva estadísticamente de los síntomas negativos en su conjunto entre el comienzo del tratamiento y el primer mes, el comienzo y el tercer mes y entre el comienzo y el sexto mes. Los pacientes que recibían risperidona mostraron una mejoría de los síntomas negativos durante el tratamiento y aquellos tratados con haloperidol mejoraron al primer y al tercer mes, pero no al sexto. No se analizaron los otros fármacos debido al tamaño de la muestra. Surge la necesidad de continuar y profundizar las investigaciones a fin de lograr una mejoría sustancial en los síntomas negativos de la esquizofrenia, que pueden originar estados invalidantes.

The treatment of the negative symptoms of schizophrenia remains a challenge to Neuropsychopharmacology, given their persistence in the evolution of outpatients. The aim was to analyse the evolution of negative symptoms in ambulatory patients, male and female, diagnosed with schizophrenia and treated with neuroleptics. The studied population consisted in ambulatory patients aged 18 to 65 years-old, of which 35 were women and 25 were men, who had been diagnosed with paranoid schizophrenia (295.30) and who displayed negative sympotoms, that were treated with 1 mg/day risperidone, 5 ml/day haloperidol, aripiprazol and olanzanie. A clinical interview designed by professionals, which included the administration of the PANSS Scale, was performed. The outcomes demonstrated a statistically significant imporvement of negative sympotoms as a whole, between the beginning of treatment and the first month, the beginning of treatment and the third month, and between the beginning of treatment and the sixth month. Patients receiving risperidone showed improved in the first and the third month, but not in the sixth month. No further pharmacological drugs were assessed, due to the sample size. In order to achieve significant improvement in the negative sympotoms of schizophrenia which may lead to a disabling condition, it is necessary to continue with and to emphasize investigations.