Psychosocial Treatment with a Focus on Recovery
Associate Professor of Department of Psychiatry,
Hokkaido University Graduate School of Medicine, Hokkaido, Japan

Antipsychotic treatment quickly became the standard
technique for treating schizophrenia since its development in 1950s, but over the following years it
became clear that improvement in positive symptoms did not necessarily lead to improvement insocial functioning. Studies in the late 1970s and1980s revealed an association between negative
symptoms and social functioning in patient withschizophrenia, and studies in the 1990s and 2000s
revealed an association between negative symptoms
and cognitive dysfunction. In the 2000s, it became
clear that negative symptoms and cognitive dysfunction were unmet needs in the treatment of schizophrenia and that overcoming these symptoms wasimportant to improve patient functioning and achieve
recovery.
In the 2000s, a series of conferences held at the National Institute of Mental Health (NMIH) in the UnitedStates proposed a roadmap for overcoming neurocognitive and social cognitive impairments and negative symptoms, including the identification of target
domains, the development of standardized testingmethods, and the development of therapeutic strategies. Standardized testing methods have been developed for neurocognitive dysfunction and negativesymptoms, but treatment has not yet been developed, and standardized testing methods for social
cognitive dysfunction are still in the process of being
established.
Cognitive impairment is a symptom that can be visualized as an objective value through measurement
and shared with the patient. This is an extremely important feature in the treatment of patients with psychiatric disorders, who may lack awareness of theirillness or may have difficulty in understanding their

Naoki Hashimoto MD, PhD
difficulties. Measuring cognitive function in daily clinical practice and sharing the results with patients isexpected to increase their motivation and adherence
to treatment, as well as to predict the effects of rehabilitation, social function, and functional prognosis.
For negative symptoms, new rating scales have beendeveloped that reflect research findings and are usedin both clinical and research settings. These newscales differ from conventional scales in that it
includes not only the patient's behavior but also hisor her internal experiences in its assessment, and isuseful for a deeper understanding of the patient'scondition.
At present, the efficacy of pharmacotherapy for cognitive impairment and negative symptoms is not sufficient, and various non-pharmacological therapies areused in combination. The most evidence has been
accumulated for cognitive rehabilitation for neurocognitive dysfunction, which has been shown to improve
cognitive function by about 0.2 to 0.4 on an effectsize scale. Evidence is also accumulating for exercise
and diet. Non-pharmacological treatments for negative symptoms include Social Skill Training (SST),Cognitive Behavioral Therapy (CBT), exercise, andcognitive remediation therapy, and their effectivenesshas been reported. Several non-pharmacological
techniques have been reported for the treatment ofsocial cognitive dysfunction, and Social Cognition
and Interaction Training (SCIT) is the most widelyused in Japan. In addition, treatment combining
these conventional techniques with the latest technologies, such as virtual reality, is beginning to be implemented, and its effectiveness is expected to beverified in the future.

CINP2024・JSNP-JSCNP2024
Joint Meeting

Co-sponsored Symposium 1To Achieve Personal Goals for Patientswith Schizophrenia in Patient Centered Care
DateThursday, May 23, 2024

Time

15:45-17:45
Room 1, Tokyo International Forum 4F Hall C

VenueChairs

Professor of Department of Neuropsychiatry,
Kyorin University School of Medicine, Tokyo, Japan

Koichiro Watanabe MD, PhD

Professor of Department of Psychiatry,
Fujita Health University School of Medicine, Aichi, Japan

Nakao Iwata MD, PhD

Lecture1Speaker

Professor of Psychiatry and Molecular Medicine Zucker School of Medicine at Hofstra/Northwell, New York, USA
Professor and Chair, Department of Child and Adolescent Psychiatry Charité University Medicine, Berlin, Germany

Christoph U Correll MD

Lecture2Optimizing Antipsychotic Treatment for Relapse Prevention
and Clinical Recovery in Schizophrenia
Speaker

Lecture3The Significance of Personal Goals in Schizophrenia Treatment:
Unmet Needs, Therapeutic Approaches, and Recovery Strategies

Associate Professor of Department of Neuropsychiatry,
Keio University School of Medicine, Tokyo, Japan

Hiroyoshi Takeuchi MD, PhD

Psychosocial Treatment with a Focus on Recovery
Speaker

Associate Professor of Department of Psychiatry,
Hokkaido University Graduate School of Medicine, Hokkaido, Japan

Naoki Hashimoto MD, PhD

Naoki Hashimoto MD, PhD
Naoki Hashimoto is a psychiatrist and researcher specializing in cognitive impairment and brain imaging. His research
primarily investigates neurocognitive and social cognitive impairments, as well as negative symptoms in patients withschizophrenia, with a focus on identifying their biological underpinnings. As a clinician, he is dedicated to practicing andpromoting cognitive rehabilitation for patients with schizophrenia and other psychiatric disorders.
Activities; The Mental Health First Aid Japan (MHFA-J)

General Discussion・The content of this session and the views expressed therein are those of the presenting entity and not of CINP.
・This session is not part of the scientific program and does not provide CME credit.

The Effectiveness of Guideline for Dissemination and Education in Psychiatric Treatment (EGUIDE) project
The Cognitive Genetics Collaborative Research Organization (COCORO).

CINP2024/JSNP-JSCNP2024 Joint Meeting
Co-sponsored by Otsuka Pharmaceutical Co., Ltd.

The Significance of Personal Goals in Schizophrenia Treatment:
Unmet Needs, Therapeutic Approaches, and Recovery Strategies
Professor of Psychiatry and Molecular Medicine Zucker School of Medicine at Hofstra/Northwell, New York, USA
Professor and Chair, Department of Child and Adolescent Psychiatry Charité University Medicine, Berlin, Germany

Schizophrenia poses significant challenges to individuals, often resulting in unmet needs related to recovery, quality of life, subjective satisfaction, and life engagement. This talk explores the profound impact of
personal goals in the treatment of schizophrenia,
shedding light on the critical elements of recovery
and outlining therapeutic strategies to address these
unmet needs. Patients with schizophrenia often facebarriers to achieving personal recovery, including therecurrence of symptoms and the potential forrelapse. The side effects of antipsychotic medications, such as dysphoria and amotivation, activation/sedation, motor slowing, cardiometabolic adverse effects, and sexual dysfunction, further complicate the pursuit of personal goals. To address thesecomplex challenges, a comprehensive and individualized treatment approach is needed. To address
unmet needs and enhance recovery, therapeutic alliance, shared decision-making, and motivationalinterviewing are critical ingredients. These approaches foster collaboration between patients and healthcare providers, allowing for a more personalized andpatient-centered treatment path. By actively involving
individuals in their care, clinicians can better understand and incorporate personal goals, ultimately improving subjective satisfaction as well as life engagement, a personal recovery concept that goes beyond
symptomatic and functional recovery, including
meaning, purpose and agency.
As part of the biopsychosocial management, psychosocial treatments and antipsychotic medications
are pivotal components in achieving functional recovery and enhancing quality of life for individuals withschizophrenia. Psychosocial interventions, including

Christoph U Correll MD

cognitive-behavioral therapy, social skills training,
cognitive remediation, and supported employment,
play a crucial role in addressing the multifaceted
challenges associated with the disorder. Additionally,
a careful balance between the benefits and side
effects of antipsychotic medications needs to besought, emphasizing the need for shared decision-making to tailor treatment regimens to individual
preferences and goals.
Furthermore, nuanced strategies exist that healthcare
providers can employ to navigate the barriers to personal recovery. This includes the importance of ongoing monitoring and management of symptoms, aswell as the proactive identification and mitigation ofside effects to optimize treatment outcomes. By
incorporating these strategies, clinicians can help
individuals with schizophrenia achieve their personalgoals, fostering a sense of agency and empowerment.
In conclusion, the significance of personal goals in
schizophrenia treatment extends beyond symptom
management, encompassing the broader spectrumof recovery, quality of life, and life engagement. This
talk provides a comprehensive overview of the unmet
needs in patients with schizophrenia, addresses themeans to achieve personal goals through therapeutic
alliance and shared decision-making, and explores
the barriers and therapeutic strategies that shape thejourney toward functional recovery. By recognizing
and actively working towards personal goals, individuals with schizophrenia can embark on a path of empowerment, resilience, and improved overall well-being.

Optimizing Antipsychotic Treatment for Relapse Prevention
and Clinical Recovery in Schizophrenia
Associate Professor of Department of Neuropsychiatry,
Keio University School of Medicine, Tokyo, Japan

Two distinct forms of recovery in individuals withschizophrenia are delineated: clinical and personal.
Personal recovery characterized as a patient-centered model, emphasizing the individual's journey
towards discovering in life. In contrast, clinical recovery necessitates both symptomatic remission andfunctional improvement, including work engagement.
Relapse prevention plays a crucial role in achieving
clinical recovery, as relapse not only undermines thesymptomatic improvement in acute antipsychotic
treatment but also compromise the long-term efficacy of antipsychotics in individuals with schizophrenia.
Consequently, ongoing antipsychotic treatment is essential for relapse prevention in the long-term man-

Hiroyoshi Takeuchi MD, PhD
agement of schizophrenia. Nonetheless, treatment
continuity faces challenges such as poor medication
adherence, often due to limited illness insight and adverse effects of antipsychotics. In this context,
long-acting injectable antipsychotics are essential forensuring ongoing treatment adherence. Therefore,
introducing an antipsychotic with a favorable tolerability profile and a long-acting formulation during theacute treatment phase and early stages of schizophrenia is recommended to support long-term therapeutic goals. Moreover, during the maintenancetreatment phase, optimizing the dose of antipsychotics is necessary to balance efficacy with tolerability.

Christoph U Correll MD

Hiroyoshi Takeuchi MD, PhD

2017–Present: Professor and chair of the Department of Child and Adolescent Psychiatry at Charité University Medicine

Hiroyoshi Takeuchi is Associate Professor at Department of Neuropsychiatry, Keio University School of Medicine. Afterin Berlin, Germany2013-Present: Professor of psychiatry at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in NewYork, USA
2011-Present: Professor of Psychiatric Neuroscience, Feinstein Institute for Medical Research in New York, USA
2006-2017:

Medical Director, The Zucker Hillside Hospital, Recognition and Prevention (RAP) Program in New York,USA

2003-Present : Staff Psychiatrist, The Zucker Hillside Hospital, Northwell Health, Division of Psychiatry Research

graduating from Chiba University School of Medicine in 2001, he joined Keio University School of Medicine as aclinician-researcher. After completing Ph.D. program at Keio University School of Medicine in 2012, he worked as a
postdoctoral/clinical fellow at Centre for Addiction and Mental Health in Toronto until 2017. His primary research interest isoptimizing antipsychotic treatment for schizophrenia across the illness stage (i.e., first-episode to treatment-resistantschizophrenia) and the treatment phase (i.e., acute to maintenance treatment) to improve cognitive impairment and negative
symptoms, core but treatment resistant features in schizophrenia, while minimizing side effects.