The study aimed to assess the impact of clinical symptoms and cognitive impairment on disability in patients with paranoid schizophrenia (PS). Methods: 108 patients with schizophrenia were included (66 male and 42 female). Their average age was 38.86 ± 10.02 years and the disease duration was 12.80 ± 8.20 years, with mean disease onset of 24 years. Clinical symptoms were assessed with the PANSS, and cognitive performance was measured using a seven-item neurocognitive battery. The disability level of the subjects was assessed using the World Health Organization—Disability Assessment Schedule 2.0 (WHO-DAS 2.0). The relation between the variables studied was assessed using Spearman’s rank correlation coefficient (r_s) at a probability level of p < 0.05. Results: An increase in symptom severity resulted in worsening of the “participation in society” (r = 0.56, p < 0.01), “life activities—household” (r = 0.55, p < 0.01), and “getting along with people” (r = 0.59, p < 0.01) WHO-DAS 2.0 domains. Positive symptoms (13.89 ± 3.48) correlated strongly with “getting along with people” (r = 0.55, p < 0.01), “life activities—household” (r = 0.58, p < 0.01), and “participation in society” (r = 0.62, p < 0.01), and negative symptoms (14.25 ± 4.16) with “participation in society” (r = 0.53, p < 0.01) and “life activities—household” (r = 0.48, p < 0.01). Symptoms of disorganization (15.67 ± 4.16) had the highest impact on “life activities—household” (r = 0.81, p < 0.01), “getting along with people” (r = 0.56, p < 0.05), and “participation in society” (r = 0.65, p < 0.01). Episodic memory (r = −0.28, p < 0.01) was remotely related to comprehension and communication. The information processing speed (r_s = 0.38, p < 0.01), visual memory (r_s = −0.30, p < 0.01), and focused executive functions showed moderate correlations with all domains on the WHO-DAS 2.0 scale (r_s = 0.38, p < 0.01). Attention (r_s = −0.33, p < 0.01) was moderately related to community activities. Semantic (r_s = −0.29, p < 0.01) and literal (r_s = −0.27, p < 0.01) verbal fluency demonstrated weak correlations with “cognition—understanding”, “getting along with people”, and “participation in society”. Conclusion: Symptoms of disorganization and disturbed executive functions contribute most to disability in patients with schizophrenia through impairment of real-world functioning, especially in social interactions and communication. Severe clinical symptoms (negative and disorganization-related ones) as well as deficits in executive function, verbal memory, and verbal fluency cause the biggest problems in the functional domains of interaction with other people and participation in society.

Summary: Schizophrenia is associated with basic neurocognitive deficit- ineffective space-time information assessment, leading to ineffective judgment and planning of behaviour. Our study aimed to examine and compare the psychomotor speed and number of errors in patients with paranoid schizophrenia (PS), first-degree relatives (FDR) and healthy controls (HC). One-hundred-eight patients with PS, 58 with FDR and 60 HCs were examined via Trail Making Tests (TMT) A and B. The influence of other additional factors as The Positive and Negative Syndrome Scale (PANSS), demographics and education were additionally assessed for PS. Statistical analysis was done using Excel 2010, Statgraphics 5.0+ and SPSS 20. All results were interpreted at 95% confidential level. PS showed most unsatisfactory performances on TMT A and B, as compared to others (p=0.0001). However, FDR differed from HC only in TMTB performance (p=0.0241). The most significant impact in PS group included ageing, education, PANSS and negative syndromes, and syndromes of disorganization. PS showed a significant decline of psychomotor speed and executive functioning, although FDR had average results in TMTB, compared to PS and HC. The above results determined both detentions as endophenotype markers for PS. Additional risk factors for decline include ageing, low education and high PANSS results.

Background: Examination of cognitive endo-phenotypes is a modern approach for establishing genetic risk for schizophrenia. Visual working memory (VWM) is significantly impaired in cases with paranoid schizophrenia (PSch). Benton Visual Retention Test (BVRT) is a standardized neurocognitive instrument for accessing VWM. The aim of the study was to access VWM in patients with PSch and their first-grade relatives (FGR) and to compare the results with healthy controls. Methods: We examined VWM in 108 patients with PSch - 66 males and 42 females; their mean age was 38.86±10.02 years and average disease severity 71,8±5,1 points measured on Positive and Negative Syndrome Scale. The FGR group included 30 males and 28 females with a mean age 36.71±11.74 years. The control group consisted of 37 males and 23 females aged 35.68±11.36 years. The VWM in all cases was measured by BVRT. The study was approved by the University of Pleven Ethical Committee. Mann-Whitney U and z-tests were used for between-group comparisons. All correlations were interpreted as significant at 95% confidence level. Data processing was performed by IBM SPSS Statistics v.24. Results: Patients with PSch showed lower correct answers and more total errors on BVRT as compared to their first-grade relatives (z= -6.482; p = 0.0001). They also made more omissions, distortions, perseverations, misplacement errors and had specific tendencies for changing angular figures with circles. First-grade relatives had greater total number of errors and more distortions, perseverations, misplacement errors and horizontal shifts compared to healthy controls. All differences were significant at p = 0.01 or even p = 0.001. Conclusions: Both PSch and FGR show difficulties in space organization and/or have restricted analysis of perception and poor scheme of getting information. This illustrates a deficit in the hierarchical organization, planning and strategy development for visual perception resulted from the frontal disfunction. Key messages: First-grade relatives of patients with paranoid schizophrenia show specific impairments of visual working memory which makes it suitable endo-phenotypic marker for paranoid schizophrenia. Visual working memory could be used in clinical scientific research for the purpose of differentiation of high-risk groups for schizophrenia.

Background: Executive dysfunctions have great impact on behavior and quality of life in elderly. They also play important role for post-stroke functional outcome. The aim of our study was to examine the frequency, severity and types of executive dysfunctions at the third month after the ischemic stroke. Methods: We examined 108 patients 3 months after ischemic stroke (66.67±9.03 years old, 66 males and 42 females) via 128-Wisconsin Card Sorting Test (WCST). WCST is a standardized instrument for detecting various executive dysfunctions. It is applicable for patients after stroke, because the test doesn’t require preserved arm motor functions. It measures global executive functioning (GEF), inhibitory control system (ICS), executive attention (EA), cognitive flexibility (CF) and working memory (WM). Our patients’ results were compared to the normal population test results. SPSS 24 was used for statistical analysis. Results: Impaired GEF were found in 46% of our patients, most of them had mild or moderate impairment. One fourth of them showed impaired ICS, although the impairment in most of the cases was mild. EA deficits were found in 43% of our cases (17% had mild, 15% mild to moderate, 7% moderate and 4% severe impairment). WM dysfunction was found in 1/3 of them (the average result was about 27 percentiles; 29% had mild and 5% had mild to moderate deficits) and about ¼ of our patients had borderline results. CF was impaired in 68% of our patients (11% had mild, 28% mild to moderate, 16% moderate and 13% severe impairment). Conclusions: GEF impairment is frequent after stroke. Patients had problems in ICS, EA, CF and WM. However, in most of the cases the dysfunction is mild or moderate and can be found only if it is actively searched and accessed. The most impaired functions were CF and EA. Patients with executive dysfunction require cognitive rehabilitation and specific social support. Key messages: • Executive dysfunctions are frequent after ischemic stroke. The impairment is mild or moderate, but however it impacts the quality of life, behavior, prognosis and outcome of post-stroke survivors. • Patients with executive dysfunctions require specific cognitive rehabilitation and social support.

Background: Suicide is an important medical and social problem responsible for nearly one million deaths per year globally. However, distal and proximal risk factors for suicide, expect being mentally diagnosed, are not enough studied. The aim of the study was to analyze the dynamics, structure, socio-demographic and clinical characteristics of all suicides committed by persons with mental disorder for 10-year period (2009-2018) in Pleven district. Methods: Retrospective analysis of medical records of all mentally ill persons who committed suicide was done. Data were extracted from the databases of all in- and outpatient mental health centers in the region. Data processing was performed by IBM SPSS Statistics v.25. Statistical associations between a number of socio-demographic and clinical characteristics and the age of suicide victims was studied by dispersion analysis and Mann-Whitney test. Statistical significance was set at p ≤ 0.05. Results: Among all 281 registered suicide cases during the studied period, 77 (28%) were with mental disorders. The most common were mood disorders (44%), followed by schizophrenia, anxiety disorders, substance abuse disorders and organic mental conditions. The mean age of all suicides was 55.62 years; significantly lower in males than in females (p = 0.042); lower in divorced or never married/single living persons compared to married or who had lived with a partner (F (2.74) =17.682, p < 0.001]; the lowest in patients with schizophrenia (44.62 years), and the highest in organic disorders (66.83 years). Higher educational degree was associated with lower age of suicide (U = 3.713, p < 0.01) and the earlier age of onset of the psychiatric disorder (r = 0.754, p < 0.001). Most of the suicide cases had occurred in March and September. Tuesdays and Fridays were most suicidal. Conclusions: Severe mental disorders are major risk factors for suicide with the additional contribution of certain socio-demographic and disease related characteristics. Key messages: • Suicide monitoring should be constant in all patients with chronic and severe mental disorders. • Suicide registration in Bulgaria needs to be improved in terms of collecting sufficient and reliable information about the mental health of suicide victims.