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Evidence-based rehabilitative treatment is constrained due to limited knowledge about disability and its related factors among individuals with schizophrenia across West Africa. This study aims to investigate the pattern of disability, and the associated factors among individuals with schizophrenia. One hundred consecutively recruited consenting participants were subjected to designed questionnaire to inquire about their demographic and illness-related variables. This was followed by the administration of Structured Clinical Interview for DSM-IV-TR Axis I Disorders and Brief Psychiatric Rating Scale to confirm the diagnosis of schizophrenia and rate severity of symptoms respectively in them. In addition, the World Health Organisation Disability Assessment Scale II (WHODAS-II) was used to assess for disability in all participants. Different degrees of disability based on WHODAS-II mean score of 27.02±3.49 were noted among individuals with schizophrenia, and affectation of domains of disability like self care, getting along with others, life activities and participation in the society among others were observed. In addition, high level of disability was significantly associated with younger adults in the age group 18-44 years (P=0.007), unemployment status (P=0.003), remittance source of income (P=0.034) and ethnicity (P=0.017); conversely, less number of children (P=0.033), less amount spent on treatment (P<0.001) and lower BPRS score (P<0.001) correlated negatively with high level of disability. In spite of clinical stability following treatment, individuals with schizophrenia were disabled to varied degrees, and socioeconomic as well as illness-related factors constituted important correlates. Integration of rehabilitation along with social intervention into treatment design to reduce disability is implied, and further research is also warranted.

Considerable confusion surrounds the overlapping of autism and schizophrenia. This has significant implications for clinicians given that correct diagnosis is critical for treatment.

This paper sets out to clarify the position by reviewing the history and current status of the relationship between autism and schizophrenia. A general review was conducted using a chronological approach that focused on phenomenology, aetiology, genetic mechanisms and treatment.

Persons with autism are far more rigid, have difficulties set shifting and get far more upset and aggressive when their routines have changed. They have far more severe theory of mind and empathy deficits than those with schizophrenia.

Future diagnostic refinement by means of molecular genetic studies will alter the diagnostic categories. Further studies of the conditions of autism and schizophrenia are therefore necessary.

Both conditions need treatment both clinically and practically.

This paper elucidates the relationship between autism and schizophrenia from a historical and current perspective. It emerges that this confusion is likely to be resolved by molecular genetic studies that will alter the diagnostic categories.

Although first rank symptoms focus on positive symptoms of psychosis they are shared by a number of psychiatric conditions. The difficulty in differentiating bipolar disorder from schizophrenia with affective features has led to a third category of patients often loosely labeled as schizoaffective. Research in schizophrenia has attempted to render the presence or absence of negative symptoms and their relation to etiology and prognosis more explicit. A dichotomous population is a recurring theme in experimental paradigms. Thus, schizophrenia is defined as process or reactive, deficit or non-deficit and by the presence or absence of affective symptoms. Laboratory tests confirm the clinical impression showing conflicting responses to dexamethasone suppression and clearly defined differences in autonomic responsiveness, but their patho-physiological significance eludes mainstream theory. Added to this is the difficulty in agreeing to what exactly constitutes useful clinical features differentiating, for example, negative symptoms of a true deficit syndrome from features of depression. Two recent papers proposed that the general and specific cognitive features of schizophrenia and major depression result from a monoamine-cholinergic imbalance, the former due to a relative muscarinic receptor hypofunction and the latter, in contrast, to a muscarinic hypersensitivity exacerbated by monoamine depletion. Further development of these ideas will provide pharmacological principles for what is currently an incomplete and largely, descriptive nosology of psychosis. It will propose a dimensional view of affective and negative symptoms based on relative muscarinic integrity and is supported by several exciting intracellular signaling and gene expression studies. Bipolar disorder manifests both muscarinic and dopaminergic hypersensitivity. The greater the imbalance between these two receptor signaling systems, the more the clinical picture will resemble schizophrenia with bizarre, incongruent delusions and increasingly disorganized thought. The capacity for affective expression, by definition a non-deficit syndrome, will remain contingent on the degree of preservation of muscarinic signaling, which itself may be unstable and vary between trait and state examinations. At the extreme end of muscarinic impairment, a deficit schizophrenia subpopulation is proposed with a primary and fixed muscarinic receptor hypofunction.

The genomic profile of bipolar disorder and schizophrenia overlap and both have a common dopaminergic intracellular signaling which is hypersensitive to various stressors. It is proposed that the concomitant muscarinic receptor upregulation differentiates the syndromes, being marked in bipolar disorder and rather less so in schizophrenia. From a behavioral point of view non-deficit syndromes and bipolar disorder appear most proximate and could be reclassified as a spectrum of affective psychosis or schizoaffective disorders. Because of a profound malfunction of the muscarinic receptor, the deficit subgroup cannot express a comparable stress response. None -theless, a convergent principle of psychotic features across psychiatric disorders is a relative monoaminergic-muscarinic imbalance in signal transduction.

Several previous studies showed strong social stigma toward mental illness patients from the health-care providers (HCPs) in Saudi Arabia. This stigma affects the level of care provided by HCPs. Stigma is a major barrier in treating schizophrenia and obsessive-compulsive disorder (OCD) patients. Thus, it is important to clarify the difference regarding the social stigma between both diagnoses. This study aimed to identify and compare the existence of social stigma among HCPs towards schizophrenia patients compared to OCD patients.

A total of 283 HCPs from King Abdullah Medical City (KAMC), Makkah, Saudi Arabia, were enrolled in this cross-sectional questionnaire-based study between middle and end of January 2021. The scale included a demographic questionnaire plus two vignette cases reflecting OCD and schizophrenia patients’ symptoms without mentioning diagnosis. Each case was followed with 18 questions, which measured some of the thoughts and attitudes of the social stigma of mental illnesses including negative stereotypes, discrimination, social distancing and emotional and cognitive prejudices against mental illness patients. The scale was validated by a pilot study (which included 15 other participants) with acceptable validity and reliability (Cronbach’s alpha: 81.4%).

Most participants’ responses were “low” in the total score of their stigma score for both diagnosis [OCD (84.1%), mean ± SD (1.15  ±  0.366) and schizophrenia (74.2%), mean ± SD (1.25  ±  0.438)]. However, those who responded “high” in their stigma score regarding the schizophrenia section were higher in their number than those who responded “high” in the OCD section (25.8% vs 15.9%). Most participants had “low” total stigma scores for both diagnoses [OCD (84.1%), mean ± SD (1.15  ±  0.366) and schizophrenia (74.2%), mean ± SD (1.25  ±  0.438)]. However, of those with “high” stigma score responses, more were for the schizophrenia section compared to the OCD section (25.8% vs 15.9%). Being flexible to recruit any of them was more related to promoting them if they deserve promotion. The sample that answered wrong regarding OCD vignette diagnosis and had “high” stigma score was higher (n = 40) than the sample that answered correctly and had “high” stigma score (n = 5). In contrast, the sample that answered wrong regarding the schizophrenia case diagnosis and had “high” stigma score (n = 41) was not significantly different in terms of its number compared to the one that answered correctly and had “high” stigma score (n = 32).

One aspect that reduces the strength of this study is that the target number of the participants could not be reached, meaning a 95% confidence level with a ±5% margin of error could not be reached. Another limitation is the lack of contact between HCPs at the KAMC in Makkah with mental illness patients owing to lack of psychiatric inpatient departments. However, this limitation may be a strength for this study, as we were able to primarily measure medical HCPs rather than psychiatric HCPs. Although the vignette methodology in stigma studies has many benefits, the participants do not respond to real patients, and therefore miss appearance and other nonverbal cues that are typically present in real interactions.

The social stigma level among HCPs against schizophrenia patients is higher than that against OCD patients. The factor of knowing the diagnosis of the case has a positive effect on decreasing stigma toward OCD patients but not toward schizophrenia patients. Educational awareness about stigma against mental illness patients to HCPs, rather than focusing on increasing literature knowledge, may decrease stigma among HCPs.

Schizophrenia is a devastating illness with a chronic and relapsing course. While Western countries may endorse, biological and psychosocial causes more commonly than supernatural causes, non-western cultures like Nigeria in contrast, tend to endorse supernatural causes. Belief in supernatural causes has been reported to have consequences for treatment seeking behavior. This study aimed to examine the causes of schizophrenia reported by family members of outpatients with schizophrenia in a neuropsychiatric hospital in Midwestern Nigeria. In this study, we recruited a convenient sample of 200 consecutive caregivers of patients visiting the outpatient department of the Psychiatric Hospital, Benin City, Nigeria. These primary caregivers were unpaid relatives who provided support to patients. The patients were service users who fulfilled the diagnostic criteria of the International Classification of Disease [ICD-10; World Health Organization 1993] for schizophrenia and had been on treatment for at least two years. Majority (72.0%) of caregivers endorsed supernatural causes as most important in the etiology of schizophrenia, while 28.0% endorsed natural causes. Every participant without formal education endorsed supernatural attribution. In our study, it was evident that participants embraced multiple causal attributions for schizophrenia.

Impairments in social cognitions in schizophrenia are increasingly reported in the last decade but only a few studies have come from Asia. The objective of the study was to evaluated emotion perception, theory of mind and social knowledge in people with schizophrenia compared to healthy controls. Participants were 36 clinically stable outpatients with schizophrenia and 36 normal controls with comparable age and level of education. We administered general neurocognition test (the Addenbrooke's Cognitive Examination), emotion perception (the Faces Test), theory of mind (the Eyes Test) and social knowledge (the Situational Features Recognition Test; SFRT). Schizophrenia patients displayed obvious impairment in all three social cognition domains i.e. the Faces Test [13.7 (2.9) vs 15.7 (1.9), P=0.001], the Eyes Test [18.9 (4.4) vs 23.5 (4.4), P<0.001] and SFRT [0.85 (0.09) vs 0.9 (0.05), P=0.002]. The performances on three social cognition tests did not correlate with positive symptoms. Only the Faces Test seemed to be related to negative symptoms. The results demonstrated that there are deficits of social cognitions in schizophrenia even in a clinically stable population.

Historically, children with autism spectrum disorder (ASD) were sometimes diagnosed with schizophrenia or major psychosis. Although significant advancements in the process of differential diagnosis have been made since 1950s, there still exists a problematic delay in diagnosis due to overlap of symptoms. Negative symptoms of schizophrenia can mimic the social difficulties and stereotyped behaviors characteristic of ASD, whereas positive symptoms of schizophrenia can be perceived as restricted and repetitive behaviors, complicating the diagnostic process. The purpose of this paper is to present two clinical cases that highlight the complexities in differential diagnosis of early psychosis, schizophrenia and ASD.

Two females, 14 and 16 years of age, were referred to a free screening clinic in Southern California to be assessed for possible ASD. Both females were referred because of the presentation of restricted and repetitive behaviors and social communication difficulties. Both females and their families were administered a battery of measures to ascertain the youths’ cognitive functioning, adaptive living skills and severity of autism-related behaviors.

The 14-year-old presented with early-stage (prodromal or at-risk mental state) psychosis; 16-year-old met criteria for schizophrenia. Both were referred to clinics specializing in treatment for psychosis and/or schizophrenia. Neither met criteria for ASD.

More published studies are needed on the overlap of symptoms between ASD and schizophrenia to help prevent diagnostic overshadowing of autistic symptoms and promote treatment during the early stages of psychosis. This is particularly important given the strong evidence that early treatment for psychosis improves social, cognitive and functional outcomes.

The purpose of this paper is to fill in the gaps in the literature regarding health-care access for individuals with schizophrenia, with a focus on Ecuador, and how technology can enable health-care access during the pandemic.

To achieve this aim, the author reviewed peer-reviewed articles in English and Spanish (using, among other sources, Medline and ProQuest), the Ecuadorian Constitution, law projects on mental health and suicide and government reports.

The consensus seems to be that the Ecuadorian health-care system has failed in its constitutional mandate to provide essential care for mentally ill patients, such as those suffering from schizophrenia. The data supporting the use of the internet and smartphone technology for delivering health services during the pandemic are extremely clear, but substantive governmental responses have been lacking.

The major limitation of this study is the lack of data on schizophrenia in Ecuador and the use of technology.

This evaluation of the current literature on the effect of the pandemic on access to health care for patients suffering from mental illness is much-needed and should provide a welcome data source for research, practice and policymaking.

The purpose of this paper is to obtain perceptions of educated non‐professionals towards people with schizophrenia.

A social distance scale and a schizophrenia knowledge and attitude survey were administered to 330 undergraduates. It was predicted that knowledge and personal family experience would predict tolerance attitudes and social distance comfort towards persons with schizophrenia.

Knowledge about schizophrenia and personal family experience with mental illness had similar effects on tolerance scores. Specifically, those with higher knowledge and family members with schizophrenia reported higher levels of tolerance (i.e. less stigma). Conversely, participants with a family member diagnosed with a mental illness reported less social distance comfort to persons with schizophrenia as opposed to those without mental illness in the family. Finally, gender differences indicated that women held more tolerant attitudes towards schizophrenia compared with men.

Few studies have focused on educated non‐professional perceptions and attitudes towards the mentally ill.

This questionnaire survey was conducted to study the determinants of stigmatization toward schizophrenia in Japan. A total of 1003 persons living in Kumamoto Prefecture (mean age 25.5; SD=14.1) participated in this study through convenience sampling. They read one of four case vignettes about a person with mental illness and answered questions about their attitudes toward the case. Vignettes varied in terms of descriptions of symptoms (schizophrenia vs. depression) and presentation of the diagnostic label of schizophrenia (yes or no). A path analysis was performed to examine the effects of symptoms, diagnostic label, experience of education in psychiatry, and demographic features on stigmatizing attitudes. Results showed that schizophrenic symptoms, diagnostic label of schizophrenia, and experience of education in psychiatry were significantly associated with stigmatization toward the case. Interaction terms of these variables did not show significant association with stigmatization. These results highlight the importance of optimizing education techniques about mental illness so as to avoid cultivating stigmatizing attitudes toward schizophrenia.