Background: comorbidity with cardiovascular disorders and metabolic syndrome influences QTc elongation in psychiatric sufferers, rather than antipsychotic treatment. Female gender and advanced age predict QTc elongation in psychiatric patients, while some studies questioned the impact of antipsychotic treatment. Objective: we hypothesized that female gender, advanced age, metabolic syndrome, smoking, somatic and cardiovascular comorbidities would predict QTc elongation in a sample of 84 persons with severe mental disorders consecutively admitted in the psychiatric ward of Portogruaro Hospital from January to June 2012. Method: all participants to this naturalistic, cross-sectional study were treated with antipsychotics only, antipsychotics plus antidepressants/mood stabilizers or antidepressants/mood stabilizers. The cut-off for prolonged QTc interval was set at 420 ms. Results: statistically significant differences in weight, HDL cholesterol and BMI were found between patients taking antipsychotics only, antipsychotics plus mood stabilizers/antidepressants and mood stabilizers/antidepressants only. Pearson’s positive correlations were found among QTc, history of cardiovascular diseases and mean drug dosage, while inverted correlations appeared among drug dose, total cholesterol, and HDL cholesterol. HDL cholesterol was negatively associated with weight. Correlations among total cholesterol, weight and BMI were negative as well. Linear regression evidenced three predictors of QTc elongation: age, mean antipsychotics dosage and non-cardiovascular somatic comorbidities. In participants older than 50, only drug dosage and weight predicted QTc increment. Conclusion: differently than previous researches, female gender, smoking and cardiovascular comorbidities did not predict QTc elongation, despite a higher proportion of female participants. Further studies will clarify the influence of metabolic syndrome in causing severe electrocardiographic alterations in psychiatric sufferers. Keywords: Antipsychotics, adverse effects, electrocardiography, long QT syndrome, mental disorders, metabolic syndrome.

Despite their widespread use, long acting antipsychotics, are often regarded with prejudice, due to fears of punishment, control and insufficient evolution towards psychosocial development of psychotic patients raised by their improper utilization. Another major shortcoming of long-acting antipsychotics is the impossibility of altering their dosage if side-effects appear. However, long-acting antipsychotics proved effective in schizophrenia and other severe psychotic disorders as a consequence of stable dose administration, leading to reduction of relapses and increased treatment adherence. Therapeutic opportunities have also risen after introduction of newer long acting second generation antipsychotics in recent years. Newer long-acting antipsychotics were developed to tackle the need for pharmacotherapy enhancing adherence in integrated rehabilitation programmes. This review is an outline of the development and introduction of older and newer long-acting antipsychotics in the treatment of schizophrenia and other psychoses, with considerations on past and present pharmacological and therapeutic issues.

Although clozapine proved effective in treating 30–50% of the cases of resistant schizophrenia, its clinical use is hampered by significant side effects. To overcome this problem, augmentation with other atypical antipsychotics has been attempted, with conflicting results. A clozapine–aripiprazole combination showed interesting properties, due to the favourable complementary pharmacodynamic receptor profile and to the negligible metabolic interactions. In this retrospective case series, we investigated the change in BPRS scores and metabolic features like BMI, fasting glucose, total and LDL cholesterol, triglycerides, functional outcome HoNOS Rome and PSP scores after aripiprazole augmentation in 16 persons with treatment-resistant schizophrenia who were already treated with clozapine. The results demonstrated a statistically significant improvement in metabolic indices, psychopathology and functional outcome measures from baseline to endpoint (6 weeks) after augmentation with aripiprazole. Statistically significant correlations were observed between psychopathological and behavioural measures at baseline and at endpoint. Linear regression analysis defined a tripartite model, in which item HoNOS Rome 11, measuring autonomy in everyday life, explained nearly half of functional outcome PSP score predictive variance, together with BPRS total psychopathology score and HoNOS Rome total social functioning score. Adequately conducted randomised double-blind studies should provide further specific data highlighting the role of a clozapine–aripiprazole combination in improving functional outcome of persons with treatment-resistant schizophrenia.

SUMMARY Aims – To evaluate the psychometric properties of the Italian version of the Insight Scale (IS), self-report questionnaire assessing the awareness of psychiatric illness. The instrument contains two forms, the first A that enquires about the present status, and the second B that concerns past episodes of illness. Method – Factorial structure, internal consistency and concurrent validity (towards three selected items of the 24-item BPRS, Unusual thought content”, Conceptual disorganisation and Uncooperativeness) were studied on 80 chronic subjects affected by schizophrenia. Differences between acute and stabilised patients were investigated. Test-retest reliability was assessed in a sub-sample of 22 stable cases. Results – The Italian IS showed satisfactory concurrent validity and reliability. Acute patients had lower scores than stabilised ones. Factorial analysis brought to the distinction between insight for need for care in the present and in the past, which seems both plausible and clinically-useful. Conclusion æ The use of the IS Italian version may be encouraged as a valid insight self–report instrument. Sensitivity to change and predictive power concerning clinical and social outcome and adherence to treatment should be investigated. Declaration of Interest: the study was supported by the National Project Mental Health, Mental Health Institute, Rome, Italy.

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This chapter discusses the main operational issues of a peculiar aspect of social cognition, “theory of mind,” and its implications in schizophrenia. A brief review of current literature on theory of mind is provided, together with an outline of our department’s contribution to this issue in the evaluation of a small sample of people affected by chronic schizophrenia and divided into subgroups according to psychopathological dimensions compared with normal controls. People with chronic schizophrenia and normal IQs have significantly worse performances than normal controls in both first- and second-order theory of mind stories. In first-order stories (a false belief about the state of the world), significant differences were found among psychopathological dimensions. As for second-order stories (a false belief about the belief of another character), one out of four patients subgroups performed worse than the others in one of the four theory of mind stories in our experimental model. Social cognition abilities may be a relevant aspect in social interactions involving people affected by schizophrenia and need to be further investigated in clinical research.