bluuebunny/crossref_metadata_2025 huggingface dataset:
M223. EXPLORING YOUR PERSONAL IDENTITY: USING USER-CENTRED-DESIGN FOR THE DEVELOPMENT OF A NEW INTERVENTION FOR SERVICE USERS WITH COMPLEX MENTAL HEALTH NEEDS
Authors: Van der Meer Lisette , Jonker Tessa , Wunderink Charlotte , van Weeghel Jaap , Pijnenborg Marieke (Gerdina) , van Setten Ellie
Published: May 2020

Background

Introduction: As a human being we give meaning to our stories, in relation to the social and physical context. For people with severe and complex mental health needs, who have been dependent on (intensive) residential psychiatric support for a long time, it is possible that talents and qualities disappear because this part of their identity has been buried under a long psychiatric history. This can result in people’s identity becoming limited to ‘patient’, and the experience of life as meaningless.

Objectives

For these service-users, few interventions aimed at personal recovery are available that match their cognitive and communicative skills. In this project, we developed a new psychosocial intervention to stimulate self-reflection and personal recovery.

Methods

The development of the intervention took place through a “user-centred-design process” (UCD). UCD is an iterative design process in which the needs and wishes of the user are the starting point, and they remain central in the product design circle. Throughout the whole design process, service users, significant others, mental health professionals, peer support workers, artists, and researchers collaborate in order to design a first testable prototype. For each step of design process, we organized focus group meetings and brainstorm sessions with all stakeholders as well as individual interviews with service users. Based on the input in these meetings and interviews, the design was adapted. This was done for each consecutive step, which made the whole design process iterative by nature.

Results

A new psychosocial intervention entitled “This Is Me” was developed as a “journey of discovery” through the lives of service users at both verbal and non-verbal levels. From the UCD process four basic principles underlying the intervention were disentangled that have been incorporated in the intervention: 1) “gaining new experiences”, 2) “attention for (self)stigma”, 3) “equal treatment as a person”, 4) “uniqueness of the individual”. This resulted in an intervention in which service-users, together with a teammate, engage in new experiences. Moreover, they are prompted to reflect on these experiences upon their return. With this process, we aim to support people in (re)discovering roles, talents and characteristics to broaden the identity from ‘patienthood’ to ‘personhood’.

Discussion

Conclusions: UCD was a useful method for the development of a new psychosocial intervention targeting identity for people with complex mental health needs. The process resulted into new knowledge about factors that are important in the (re)development of identity. In addition, we will present the first results of a pilot study in which we assessed the feasibility and effectiveness of the intervention.
M234. QUALITY OF LIFE IN SCHIZOPHRENIA: THE IMPACT OF RESIDUAL SYMPTOMS AND INTERNALIZED STIGMA
Authors: Hofer Alex , Frajo-Apor Beatrice , Kemmler Georg , Pardeller Silvia , Post Fabienne
Published: May 2020

Background

Quality of life (QOL) is seen as a key outcome variable in schizophrenia. Factors deemed relevant in this context include the severity of symptoms and internalized Stigma.

Methods

Patients with schizophrenia (ICD-10) between the ages of 18 and 65 from outpatient mental health services were included into a cross-sectional study. Apart from the registration of demographic data, various rating scales were used: the Positive and Negative Syndrome Scale (PANSS), the Internalized Stigma of Mental Illness (ISMI) Scale, and the German version of the Lancashire Quality of Life Profile, the Berliner Lebensqualitätsprofil (BELP).

Results

80 patients (47 males, 33 females) with a mean age of 43.0 ± 10.9 years took part in this study. The mean PANSS total score was 71.1 ±25.4, the mean ISMI score was 61.1 ± 14.7 (range: 29–116), and the BELP subscale overall QoL showed a mean score of 4.73 ± 1.17 (range 1–7). Statistical analysis showed a moderate correlation between QoL and internalized stigma (r=-0.468, correlation with general life satisfaction) and a weak correlation with the PANSS total score (r=-0.246, correlation with general life satisfaction). Internalized stigma but not residual symptoms of the disorder negatively predicted QoL

Discussion

Our results highlight the complex nature of QoL in individuals suffering from schizophrenia and indicate that outpatients’ quality of life correlates moderately with internalized stigma, whereas residual symptoms of the disorder play a secondary role. Accordingly, psychotherapeutic approaches should be applied to reduce internalized stigma, and, ultimately, to improve quality of life.
M236. AN ASSESSMENT OF THE DIMENSIONALITY OF A ROMANIAN TRANSLATION OF THE SCHIZOTYPAL PERSONALITY QUESTIONNAIRE AND ASSOCIATIONS WITH QUALITY OF LIFE, SELF-ESTEEM, AND LIFE SATISFACTION
Authors: Barron David , Vintila Mona , Swami Viren
Published: May 2020

Background

While the Schizotypal Personality Questionnaire (SPQ; Raine, 1991) is an established measure of self-reported schizotypy, the higher-order structure of its ratings has continued to be debated in numerous translations. Here, we examined the psychometric properties of a Romanian translation of the SPQ and assessed associations with quality of life, self-esteem, and satisfaction with life.

Methods

In total, 711 university students (488 women, 223 men) from Romania completed a novel translation of the SPQ online alongside measures of quality of life, self-esteem, and life satisfaction. All participants indicated no immediate family history relating to psychosis.

Results

Using confirmatory factor analysis, we suggest that a 4-dimensional model of SPQ scores had better fit to these data than alternative 3- and 4-factor models. The 4-factor model also demonstrated partial measurement invariance across sex, although sex differences on domain scores were negligible (ηp2 = .01-.02). The 4 SPQ domains were significantly and negatively correlated with all additional measures of quality of life, self-esteem, and satisfaction with life. Further, in predicting scores on these additional measures, the Negative SPQ domain emerged as the strongest predictor, with Paranoid and Disorganised scores also significant predictors.

Discussion

Romanian SPQ scores demonstrated adequate construct and predictive validity vis-à-vis quality of life, satisfaction with life, and self-esteem. Importantly, our findings highlighted the benefit of a Paranoid factor within the SPQ dimensionality, which provides support for a 4-factor conceptualisation of SPQ scores in a hitherto neglected linguistic group.
M245. AN RCT PROTOCOL OF HYBRID-ECT FOR SCHIZOPHRENIA
Authors: Rong Han
Published: May 2020

Background

Electroconvulsive therapy (ECT) is an rapid and effective treatment for schizophrenia patients, ECT may achieve significant antipsychotic effects in the several initial sessions, but significant side effects limit its use. However, our low-charge electrotherapy (LCE) pilot trial demonstrated antipsychotic effects with significantly fewer side effects. The aim of this trial is to propose a novel two-step charge set strategy for ECT treatment, referred to as Hybrid-ECT, try to decrease side effects by using a lower charge while preserving treatment efficacy.

Methods

A randomized, double-blinded, standard-controlled, parallel-group design will be used. We plan to enroll 62 inpatients diagnosed with acute schizophrenia and randomly assign them to routine ECT (control group) or to Hybrid-ECT (treatment group, 3 ECT sessions followed by LCE sessions (approximately half of seizure threshold per session)). The primary outcome measure is the change in total PANSS score after the last ECT/LCE session. The secondary outcome measures include the response rate, remission rate, CGI, auditory hallucination rating scale, and everyday memory questionnaire (EMQ) scales. Neuropsychological metrics include the repeatable battery for the assessments of neuropsychological status (RBANS) and the stroop test, and detailed side effects will be evaluated. Structure and functional magnetic resonance imaging (MRI) assessments during treatment will be performed to explore brain changes between ECT and hybrid-ECT groups. The follow-up phase is set at the one-month after the last ECT/LCE session

Results

No results.

Discussion

This research will propose a simple but completely novel ECT strategy that aims to rapidly relieve psychosis symptoms and minimize side effects. If Hybrid-ECT is found to have the potentiality mentioned above, this could have important implications for future ECT strategies in treating schizophrenia patients in the acute phase. In addition, by using the detailed neuropsychological assessments and MRI scanning, this study may improve the knowledge of ECT-related antipsychotic mechanisms.
M246. DIGITAL SELF-MONITORING AND EMBODIMENT IN FIRST EPISODE PSYCHOSIS: ETHICAL CONSIDERATIONS
Authors: Berkhout Susan , Zaheer Juveria , Remington Gary
Published: May 2020

Background

Smartphone technology has seen expanding interest across nearly all areas of medicine, including psychiatry, where app-based technologies frequently function as proxies for digitized behavioural phenotypes (Firth and Torous 2015). In the area first episode psychosis especially, there has been a rising interest in the use of digital platforms for patient self-management as well as for assessment of symptom domains (Ben-Zeev et al. 2014; Bell et al. 2018).

Methods

This paper discusses findings from a 3 year-long ethnographic study carried out within a first episode psychosis program in Toronto, Canada, in combination with a discourse analysis of the clinical and research literature relating to the use of self-monitoring technologies within first episode psychosis contexts. The qualitative data consists of formal and informal interviews with psychiatric service users, family members, and clinicians (n=45 interviews), in addition to observational field work within the clinical setting. Data were analyzed thematically within an interpretivist-constructivist frame, and triangulated through reflexive field notes, member-checking, and the authors’ clinical experience within the field. Themes were reviewed with senior clinicians in the first episode clinic setting as well as psychiatric service users for reliability and fidelity.

Results

Self-monitoring technologies are increasingly used in both research and clinical care settings, most frequently related to the management of medication side effects and the tracking of the phenomenological aspects of psychotic and psychotic-like experiences. The uptake of these technologies by psychiatric service users in this setting was varied: at times, symptom and side effect tracking faciliated conversations about uncomfortable topics such as sexual side effects of antipsychotics, while in other instances the use of self-monitoring technologies was intrusive. Challenges with self-monitoring were likely to arise when issues relevant to understanding complex phenomena such as medication adherence were prematurely narrowed or when experiential narratives were foreclosed by the structure imposed by the technologies themselves. Resistance to self-monitoring arose in novel and interesting ways.

Discussion

Engaging in self-monitoring, whether for side effect tracking or phenomenological analysis of moment-to-moment experiences have significant material effects on those engaged in such practices. When we consider the study findings through the lens of contemporary mental health ethics, we can appreciate how such technologies carry with them a potential for what has been termed “epistemic injustice” (Medina 2013; Fricker 2007), even at the same time as they offer potentially novel, meaningful forms of health care engagement. Grappling with this tension is of critical importance in light of the expansion of such platforms in both clinical and research environments
M247. PAST AND ANTICIPATED HUMILIATION MAY CONTRIBUTE TO ANXIETY AND PRONENESS TO PSYCHOSIS EXPERIENCES IN A COMMUNITY SAMPLE
Authors: Lee Stuart , Rancie Tim , Lin Toh Wei , Penita Phaybian , Moseley Peter , Rossell Susan
Published: May 2020

Background

Childhood adversity is a risk factor for psychosis. Bullying, abuse, neglect and family conflict can cause biological (e.g. stress hyper-reactivity) and psychological (e.g. negative beliefs about self and perceived threat from others) changes that may lead to psychopathology in adulthood. Past and anticipated humiliation is associated with proneness to persecutory ideation in non-clinical samples. However, whether this is associated with proneness to other positive psychosis symptoms is unclear. This study measured how humiliation is related to hallucination-like experiences (HLE) and intrusive thinking assessed via the Launay-Slade Hallucination Scale Extended and disorganisation assessed via the Schizotypal Personality Questionnaire-Brief Revised, and if increased anxiety mediates this relationship.

Methods

This cross-sectional study recruited a community sample of 92 adults (62% female; Mean [SD] age = 27.3 [10.8]) who completed measures of past/anticipated humiliation, risky family environment, family socioeconomic status, state anxiety and proneness to positive psychotic 1 2020 Congress of the Schizophrenia International Research Society symptoms. Serial mediation tested for direct and indirect relationships among study variables.

Results

Worse past and anticipated humiliation, risky family environments and state anxiety correlated with more severe intrusive thoughts, multisensory HLEs and disorganisation (r range 0.23–0.54). Serial mediation showed that of the historical factors, only past humiliation predicted anticipated humiliation (p < 0.001), which in turn was the only unique predictor of state anxiety (p = 0.004). The relationship then differed for proneness to different positive psychosis symptoms. Only state anxiety was a unique predictor of audio-visual HLEs (p = .03) and intrusive thoughts (p = .01), whereas both past humiliation and anxiety predicted disorganisation and multisensory HLEs (both p < .03).

Discussion

Anxious anticipation about potential harm in interpersonal interactions, likely caused by cumulative past humiliation, may increase proneness to positive psychosis experiences through increased difficulty controlling negative emotions and the frequency and content of worrying thoughts and memories.
S3. DOES SWITCHING OR AUGMENTING HELP WITH ANTIPSYCHOTIC-RELATED SEXUAL DYSFUNCTION: SYSTEMATIC REVIEW
Authors: Allen Kirsty , Baban Alan , Munjiza Jasna , Pappa Sofia
Published: May 2020

Background

Sexual dysfunction is one of the most frequently occurring side-effects of antipsychotic medication, impacting both quality of life and adherence to treatment. Despite this, limited evidence-based guidance on treatment options is available. The aim of this systematic review was to synthesize and analyze the evidence on the management of antipsychotic-related sexual dysfunction, specifically taking note of the more recently developed antipsychotics that have been incorporated

Methods

EMBASE, Medline, and PsychINFO databases were searched using search terms related to sexual or erectile dysfunction, treatments, and antipsychotics. 2 reviewers independently assessed papers for the inclusion criteria for randomized controlled trials (RCTs) of treatments for antipsychotic-related sexual dysfunction, including adjunctive medications and a switch of antipsychotic. Studies were excluded if participants did not have recorded sexual dysfunction at baseline.

Results

The primary outcome measure was any change in sexual function. Results 6 RCTs were identified, all of which investigated different interventions; hence, it was not possible to synthesize the data quantitatively. Results were overall limited by small sample size, brief treatment duration, and the potential for bias. 2 studies, one assessing adjunctive sildenafil and the other adjunctive aripiprazole, reported a reduction in antipsychotic-related sexual dysfunction.

Discussion

Due to the lack of high-quality data, no clinical recommendations can be made. Our findings highlight the paucity of high-quality research in this area, and conjecture that it may be difficult to recruit participants with antipsychotic-related sexual dysfunction. Future research may be necessary to unlock and address these difficulties. Furthermore, fully powered future studies should focus on the management of sexual dysfunction rather than the surrogate marker of hyperprolactinemia.
S5. DOES THE TIME OF DRUG ADMINISTRATION ALTER THE ADVERSE EVENT RISK OF LURASIDONE?
Authors: Hagi Katsuhiko , Tadashi Nosaka , Pikalov Andrei
Published: May 2020

Background

Lurasidone is once a day oral medication, which could be administered any time of the day, but the relationship between the timing of administration and the risk of developing adverse events has not been systematically evaluated.

The purpose of this study was to examine whether there is a difference in the risk of adverse events between lurasidone administration in the morning and at night in the treatment of adult schizophrenia.

Methods

Randomized placebo-controlled trials (RCTs) of lurasidone in adults with acute exacerbation of schizophrenia were analyzed for the incidence of akathisia, somnolence, and nausea.

We compared the risk of each adverse event and the risk differences (RDs) for each lurasidone dose versus placebo in patients taking lurasidone in the morning (AM dosing group) and those taking lurasidone at night (PM dosing group).

Results

Nine RCTs were included in the analysis (six RCTs with AM dosing and three RCTs with PM dosing). In the AM dosing group, lurasidone doses of 20, 40, 80, and 120 mg/day were evaluated, and in the PM dosing group, lurasidone doses of 20, 40, 80, and 160 mg/day were evaluated.

The risk of akathisia increased in a dose-dependent manner in AM dosing group, this tendency, however, was not observed in PM dosing group. In addition, RD tended to be larger in AM dosing group than in PM dosing group at the same dose [AM dosing group: 20 mg/day=-4.1%, no significantly different from placebo (ns); 40 mg/day=7.1%, p<0.001; 80 mg/day=9.1%, p<0.001; 120 mg/day=20.3%, p<0.001, PM dosing group: 20 mg/day=3.2%, ns; 40 mg/day=2.3%, ns; 80 mg/day=8,7%, p<0.001; 160 mg/day=6.5%, p<0.01].

Similarly, the risk of somnolence increased in a dose-dependent manner in AM dosing group, however, this tendency was not clearly observed in PM dosing group. RD tended to be larger in AM dosing group than in PM dosing group at the same dose (AM dosing group: 20 mg/day=0.1%, ns; 40 mg/day=3.6%, p<0.05; 80 mg/day=4.9%, p<0.01; 120 mg/day=9.3%, p<0.001, PM dosing group: 20 mg/day=-0.4%, ns; 40 mg/day=2.8%, p<0.05: 80 mg/day=0.2%, ns; 160 mg/day=5.8%, p<0.05).

There was no clear dose-dependent trend associated with nausea and RD was similar between AM and PM dosing group (AM dosing group: 20 mg/day=0.2% ns; 40 mg/day=3.8%, p<0.05; 80 mg/day=3.8%, ns; 120 mg/day=6.6%, ns, PM dosing group: 20 mg/day=-1.6%, ns; 40 mg/day=-1.7%, ns; 80 mg/day=5.5%, p<0.01; 160 mg/day=2.8%, ns).

Discussion

The risk of adverse events in the treatment of schizophrenia with lurasidone can vary depending on the timing of administration. In particular, for akathisia and somnolence, the incidence risks were reduced when lurasidone was administered in PM. Unlike with AM administration, the dose-dependence in the risks of these adverse events were not observed in lurasidone PM administration.

The timing of lurasidone administration could be considered in effort to minimize potential adverse events.
S20. LIFETIME PSYCHOPATHOLOGY IN CHILD AND ADOLESCENT OFFSPRING OF PARENTS DIAGNOSED WITH SCHIZOPHRENIA OR BIPOLAR DISORDER
Authors: De la Serna Elena , Ilzarbe Daniel , Sugranyes Gisela , Baeza Inmaculada , Moreno Dolores , Rodríguez Elisa , Espliego Ana , Ayora Miriam , Romero Soledad , Castro-Fornieles Josefina
Published: May 2020

Background

Having one parent diagnosed with a severe mental disorder is considered one of the main risk factors for developing that disorder in adulthood and it also increases the risk of a wide range of mental disorders in the offspring from early childhood and adolescence. The aim of this study is to analyze the prevalence of several psychopathological diagnoses, the presence of prodromal symptoms and global functioning in schizophrenia offspring (SZoff) or bipolar offspring (BDoff) compared to community control offspring (CCoff) at baseline and 2-year follow-up.

Methods

41 SZoff, 97 BDoff and 107 CCoff between 7 and 17 years were included. Clinical assessment consisted of a clinical evaluation using the following instruments: structured interview KSADS-PL or SCID-I, semi-structured Interview for Prodromal Syndromes (SIPS) and the Children’s Global Assessment Scale (CGAS). To test between-group differences in DSM-IV diagnoses multilevel mixed-effect logistic regression models (categorical variables) or linear (continuous variables) regression models were conducted with group (SZoff, BDoff and CCoff), time (baseline or 2-year follow-up), interaction time x group, age, gender and socio-economic status as fixed variables.

Results

Significant differences between groups were found in any lifetime axis I disorder (F=8.720; p<0.001), mood disorders (F=4.774; p=0.009), anxiety disorders (F=4.368; p=0.013), ADHD (F=21.593; p<0.001), disruptive behavioral disorders (F=10.788; p<0.001) and comorbidity (F=5.588; P=0.004). Significant differences between groups were also found in the positive (F=6.088; p=0.003), negative (F=4.423; p=0.015), disorganized (F=3.866; p=0.024) and total (F=6.394; p= 0.002) sub-scales of the SOPS and CGAS (F=11.613;p<0.001). Interestingly, mood disorders were more prevalent in BDoff and disruptive disorders were more prevalent in SZoff. Prodromal symptoms were higher in SZoff compared to CCoff, while the BPoff group showed an intermediate pattern. Finally, global functioning was lower in the SZoff group compared to BDoff and CCoff.

Discussion

Screening patients’ children is clinically relevant since, as a group, they have an elevated risk of developing a psychiatric disorder and of experiencing their first symptoms during childhood and adolescence.
S39. THE IMPACT OF THE GROUP FACTOR ON OUTCOME IN GROUP THERAPY: FINAL RESULTS OF RCT INCLUDING 127 SCHIZOPHRENIA OUTPATIENTS
Authors: Mueller Daniel , Steichen Conny , Schaller Kristin , Roder Volker
Published: May 2020

Background

Today, some evidence-based group therapy approaches focusing different treatment goals are available for the treatment of schizophrenia patients, e.g. psychoeducation, social skills training, CBTp or cognitive remediation. However, only few if any data are available regarding the impact of the group factor as an unspecific mechanism of change regarding outcome in schizophrenia patients. Does the participation in goal-oriented groups per se affect therapy outcome?

Methods

To bridge this gap, a cognitive remediation group approach (Integrated Neurocognitive Therapy, INT) developed in our lab has been compared with control patients not participating in therapy groups (Treatment as Usual, TAU). A total of 127 schizophrenia outpatients has been randomly assigned to INT (N=65) or TAU (n=62). INT was conducted twice a week over 15 weeks therapy duration. A comprehensive test battery was assessed before and after therapy as well as at 1-year follow up in both comparison groups. The group factor was assessed by the newly developed questionnaire “Experience and Behavior in Therapy groups EBIT”, a brief questionnaire including 13 items.

Results

The therapy group showed significantly better effects in EBIT outcome compared to controls regarding the global score (mean of all EBIT items) (GLM: F=4.23, p=.02) as well as regarding empirical 2-factor solution using factor analysis: factor 1 (affect and communication skills) (GLM: F=3.70; p=.03) and factor 2 (eye contact during communication) (F=3.35, p=.04). Additionally, EBIT scores are significantly associated with improvement in cognition and negative symptoms after treatment but not with positive symptoms.

Discussion

First of all, the group factor can be identified and measured using a brief questionnaire. Additionally, the group factor has a supplement positive effect on cognition and negative symptoms.
S43. ASSESSING THE VARIABILITY OF RESPONSE TO NON-INVASIVE BRAIN STIMULATION IN PSYCHOSIS
Authors: Winkelbeiner Stephanie , Muscat Whitney , Joanlanne Andrea , Marousis Nikolaos , Neumeier Maria , Dierks Thomas , Seifritz Erich , Malhotra Anil K , Homan Philipp
Published: May 2020

Background

Non-invasive brain stimulation has been introduced as add-on treatment for psychotic symptoms, not least because transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have a low risk profile. Yet, the initial excitement is wearing off and there is a lack of consistent evidence from randomized controlled trials (RCT) for the efficacy of brain stimulation. It is often claimed that this is because patients respond very differently to brain stimulation, with some benefiting much more than others. However, is there really strong evidence from RCTs that patients do respond differently? This question can be assessed by comparing the overall variability under active stimulation with the variability under sham stimulation across studies.

Methods

We included all double-blinded, sham-controlled RCTs and crossover studies of adults with a diagnosis of a schizophrenia spectrum disorder that used TMS or tDCS for the treatment of psychotic symptoms. We extracted a measure of variability (standard deviation, standard error, or confidence interval) of the primary outcome for active and sham stimulation, computed variance-weighted variability ratios for each study, and entered them into a random-effects model. In the case of individual differences in response to TMS or tDCS, we expected that the overall variability under active stimulation would be increased compared to sham stimulation (as evidenced by an overall variability ratio significantly larger than 1).

Results

A total of 39 RCTs and crossover trials with 1 352 patients were included. We found that the variability under active stimulation was not significantly larger than under sham stimulation (variability ratio = 1.07; 95% CI: 0.99, 1.16; P = 0.098).

Discussion

These results do not provide strong evidence for the presence of individual differences in response to non-invasive brain stimulation in patients with schizophrenia spectrum disorders. The search for subgroups and prognostic biomarkers may require more complex study designs including N-of-1 trials.
S48. INSIGHT VS COGNITION AND SYMPTOMATIC REMISSION AMONG PATIENTS WITH SCHIZOPHRENIA- THE INFLUENCE OF TRAIT VS STATE PHENOMENON?
Authors: Helldin Lars , Pontén Anna , Hawar Moradi , Olsson Anna-Karin
Published: May 2020

Background

A high ability to understand symptoms and conceptualize illness, schizophrenia, may play a central role for long-term outcome. This based on the assumption that better insight will promote increased adherence. In this work insight is defined as patients′ ability to experience symptoms and furthermore understand what causes them. Cognitive performance and symptomatic remission are analyzed to explore in what way they are contributing to the level of insight.

Methods

The study population is 294 patients with schizophrenia spectrum disorder. Two items with focus on insight, each 1 to 4 points, are used to decide level of insight. The first item “Experience of symptom” and the second item “Understanding the reason for symptoms”, where 1 point representing high and 4 point low level of insight and with a total of 8 points. Patients are then divided into three groups, Good (2 points), Moderate (3 – 5 points) and Poor (6 –8 points). Cognitive domains identified to be impaired in schizophrenia are analyzed related to the three groups of insight. Symptomatic remission is compared to the total score of insight with a Mann-Whitney test and then the different categories of insight in a cross-tabulation and Chi-square test.

Results

Differences were found in insight between patients in symptomatic remission and those who are not. This in contrast to when patients were divided into the three insights groups and compared on cognitive performance. Only working memory and neurocognitive flexibility showed significant differences to insight. However, crystalized intelligence, as an expression of over-all cognitive ability, did not.

Discussion

In conclusion, only symptomatic remission seems to be related to insight indicating more of a state than a trait phenomenon. Surprisingly could not different levels of insight be connected to differences in cognitive ability. As this is a cross-sectional study, further research are needed where insight and symptomatic remission are analyzed in longitudinal conditions. Such a study has to focus on if successful treatment promote insight or the other way around.
S53. DELINEATING SOCIAL COGNITION IN AUTISM AND PSYCHOSIS
Authors: Ziermans Tim , van Rijn Sophie , Geurts Hilde , De Haan Lieuwe
Published: May 2020

Background

Impaired social cognition represents a common feature in both the autism and psychosis spectrum, but direct comparisons are sparse and assessments typically restricted to a few tasks with limited ecological validity. The first aim of the present study was to compare the social cognitive profile of young individuals with autism spectrum disorder (ASD) or a first episode psychosis (FEP) with a group of typical comparisons (TC) on a comprehensive social cognition test battery. The second aim was to explore the relative contribution of autistic and psychotic traits to social cognitive performance across groups.

Methods

In total 90 young individuals (M = 21.9 y, SD = 3.1 y, range = 16–30 y, 67% male) were recruited. Groups (31 FEP, 21 ASD, 38 TC) were matched for age and sex. Social cognition assessment included measures for static and dynamic emotion recognition & social inference / Theory of Mind, social attention (eye-tacking), empathy and alexithymia. Autistic and psychotic traits were assessed with self-report questionnaires (AQ-28 & SPQ-br).

Results

Data collection is completed at the time of abstract submission and analyses are expected to be finalized in February 2020.

Discussion

Pending the outcome of our analyses, we expect our results will provide a more complete and detailed picture of shared and unique aspects in the social cognitive profile of autism and psychosis. In general we hypothesize that both ASD and FEP, on a group-level, will significantly underperform compared to TC, but that the respective trait dimensions will each explain a unique amount of variance in social cognitive performance.
S57. CHARACTERIZING COGNITIVE HETEROGENEITY IN INDIVIDUALS WITH A SCHIZOPHRENIA SPECTRUM DISORDER: A CLUSTER ANALYTIC APPROACH
Authors: Brand Bodyl
Published: May 2020

Background

Cognitive impairment is a core symptom of patients with schizophrenia, yet substantial heterogeneity in the degree of impairment exists within and between diagnoses of the schizophrenia spectrum, leading to sub-optimal understanding of the general and individual pathology of schizophrenia. By means of a cluster-analytic approach, individuals are grouped based on profiles of traits regardless of specific diagnoses. As this approach has already proven itself in decreasing cognitive heterogeneity within specific psychotic disorders, we investigated the structure of cognitive heterogeneity within a broader spectrum of psychotic disorders by including a large sample of schizophrenia patients and healthy individuals.

Methods

An agglomerative hierarchical clustering analysis was performed using cognitive data (patients n = 324, healthy controls n = 40). All patients were diagnosed with a DSM-IV-TR diagnosis of schizophrenia (SZ), schizoaffective (SZA) or schizophreniform (SZP) disorder or another psychotic disorder/psychosis not otherwise specified (PNOS). To measure cognitive function, the composite Z-score was calculated, based on six cognitive domains as defined by the Brief Assessment of Cognition in Schizophrenia (BACS).

Results

Four clusters emerged from the clustering analysis, gradually and significantly distinguishable in cognitive impairment. The first cluster (n=50) contained relatively intact individuals, the second cluster (n=122) consisted of individuals with minimal to mild cognitive impairment, the third cluster (n=114) contained individuals with moderate cognitive impairment and individuals with most severe cognitive impairment were placed in the fourth cluster (n=78). All six cognitive domains show similar differences between clusters. While symptom severity and educational attainment show the same classification patterns as the neurocognitive profiles do, cluster assignment was not affected by illness duration and antipsychotic intake.

Discussion

Results confirm that data-driven formed groups based on the clustering of neurocognitive profiles contain less cognitive heterogeneity compared to predefined diagnostic groups. Our results demonstrate that clustering patients with a schizophrenia spectrum disorder based on their neurocognitive profile decreases cognitive heterogeneity within the formed groups, creating more meaningful groupings and findings accentuate a cognitive continuum irrespective of a specific diagnosis, providing insight into the underlying pathology of clinical manifestation of schizophrenia.
S72. MCCB COGNITIVE PROFILE IN CHINESE FIRST EPISODE SCHIZOPHRENIA PATIENTS AND SUBJECTS AT CLINICAL HIGH RISK FOR PSYCHOSIS
Authors: Lei Zhao , Qijing Bo , Zhen Mao , Chuanyue Wang
Published: May 2020

Background

Cognitive dysfunction is acknowledged as one of the most pivotal symptoms in schizophrenia. Although many studies have assessed cognitive functioning in first-episode schizophrenia (FES), the pattern and severity of impairment across cognitive domains remain unclear. Moreover, few studies have directly compared the pattern of cognitive performance between FES and subjects at clinical high risk for psychosis (CHR). The objective of the study was to examine the cognitive profile of Chinese patients with FES and to compare that to the profile of patients with subjects at CHR and healthy controls (HC).

Methods

We applied the MATRICS Consensus Cognitive Battery to evaluate the cognitive function of 56 first-episode patients with schizophrenia aged between 19–32 years old), 42 cases of clinical high risk for psychosis (aged between 18–28 years old) and 62 healthy controls (aged between 21–29 years old).All data were analyzed using SPSS 20.0 statistical software.

Results

FES showed impaired performance across all MCCB domains relative to HC（P＜0.05）. With the exception of relative preservation of reasoning and problem solving (P=0.21) and social cognition （P=0.16）in CHR, the MCCB domain scores were similar in CHR and FES.

Discussion

The findings suggest that the pattern, magnitude, and distribution of severity of impairment in CHR were similar to that observed in FES. However, early in the illness, there may be relative sparing of reasoning and problem solving and social cognition.
S73. RELATIONSHIP OF COGNITIVE ABILITY AND PERSONALITY TRAITS WITH HOSTILE ATTRIBUTION BIAS IN NONCLINICAL SUBJECTS: THEORY OF MIND AS A MEDIATOR
Authors: Jun Koo Se , Jin Kim Ye , Seo Eunchong , Yoon Park Hye , Eun Min Jee , Bang Minji , Lee Eun , Kyoon An Suk
Published: May 2020

Background

Hostile attribution bias has been reported to be common from nonclinical population to serious mental illness such as schizophrenia and is known to be closely related to social cognition. The aims of this study was to investigate whether theory of mind (ToM) skills mediate the relationship between cognitive ability and personality traits and attribution bias by using the Korean version of Reading the Minds in the eyes test (K-RMET).

Methods

One hundred ninety-six (101 females) nonclinical youths were recruited. To assess general cognitive ability and ToM skills, participants were asked to complete the Raven’s Standard Progressive Matrices (SPM) and the K-RMET. For personality traits, the Eysenck Personality Questionnaire (psychoticism) and Interpersonal Reactivity Index (perspective taking) were administered. To evaluate the hostile attribution bias, the Ambiguous Intentions Hostility Questionnaire was also administered. Path analysis and the bias-corrected percentile bootstrap method were performed to estimate the parameters of mediating effects.

Results

Based on Akaike Information Criterion(AIC) the best model characterized 1) two direct pathways from psychoticism and the K-RMET to hostility attribution bias and 2) four indirect pathways, wherein SPM, perspective taking and psychoticism influence hostile attribution bias through the K-RMET. The K-RMET fully mediated the association between SPM (p=.028), perspective taking (p=.027), psychoticism (p=.041) and hostile attribution bias.

Discussion

The main findings suggested that ToM skill such as the RMET plays an important role in explaining the relationship between cognitive ability and personality traits and hostile attribution bias. The development of remediation strategy of theory of mind skills may be needed to balance the enhanced hostility bias which is underlying the paranoia.
S74. AEROBIC EXERCISE AND COGNITIVE REMEDIATION IN MULTIEPISODE SCHIZOPHRENIA AND SCHIZOAFFECTIVE DISORDER: PRELIMINARY RESULTS: FROM A RANDOMIZED CLINICAL TRIAL
Authors: Pujol Nuria , Sanchez-Tomico Georgina , Toll Alba , Polo-Velasco Javier , Cortizo Romina , Belmonte Elena , Salvador Teresa , Abellanas Adelina , Chamorro Jacobo , Perez Lucía , Perez-Solà Victor , Mane Anna
Published: May 2020

Background

Cognitive remediation (CR) is an evidence-based behavioral intervention for cognitive impairment in schizophrenia. Although the effectiveness of CR is well stablished, its effects are modest, especially in terms of functional outcome. There is an emerging literature suggesting that adding aerobic exercise to CR may exert synergistic effects. Despite these promising reports, the extent to which aerobic exercise in combination with CRT can improve cognitive and daily functioning in multiepisode schizophrenia and schizoaffective disorder remains unclear.

Methods

This is a single-blinded, randomized clinical trial (NCT02864576) with two different groups: 1) patients with multiepisode schizophrenia or schizoaffective disorder receiving 3-month Aerobic exercise plus CR treatment (three weekly sessions, 40min of Aerobic exercise and 90min of CR), and 2) patients with multiepisode schizophrenia or schizoaffective disorder receiving Healthy lifestyle promotion plus CR treatment (three weekly sessions, 40min of Healthy lifestyle promotion and 90min of CR). Primary outcome measures were the MATRICS Consensus Cognitive Battery (MCCB) and the Global Assessment of Functioning (GAF), which were assessed (among others) at baseline and immediately after treatment. For the present work, the sample included in the analysis were 34 patients for whom cognitive data were available. Treatment effects on neurocognition and functional outcome were analyzed by applying the multivariate general linear model (GLM) repeated measures.

Results

After treatment, both groups exhibited a significant improvement in MCCB visual learning memory (F=14.298, p= 0.001), working memory (F=6.626, p= 0.015) and speed of processing (F=16.344, p= 0.001) domains. However, no significant benefits were evidenced for problem solving (F=2.143, p= 0.153), verbal learning memory (F= 0.321, p= 0.575) and attention/vigilance (F=0.740, p= 0.397) domains. Functional outcome, as measured by the GAF, was more improved in the Aerobic exercise plus CR group than in the Healthy lifestyle promotion plus CR group (F=4.248, p= 0.047).

Discussion

Our preliminary findings indicate that combining aerobic exercise with cognitive remediation may promote a large impact on functional outcome in patients with multiepisode schizophrenia or schizoaffective disorder.
S76. PROACTIVE AND REACTIVE RESPONSE INHIBITION IN INDIVIDUAL WITH SCHIZOTYPY: AN ERP STUDY
Authors: Wang Ya , Jia Lu-xia , Qin Xiao-jing , Ye Jun-yan , Chan Raymond
Published: May 2020

Background

Schizotypy, a subclinical group at risk for schizophrenia, have been found to show impairments in response inhibition. Recent studies differentiated proactive inhibition (a preparatory process before the stimuli appears) and reactive inhibition (the inhibition of a pre-potent or already initiated response). However, it remains unclear whether both proactive and reactive inhibition are impaired in schizotypy and what are the neural mechanisms. The present event-related potential study used an adapted stop-signal task to examine the two inhibition processes and the underlying neural mechanisms in schizotypy compared to healthy controls (HC).

Methods

A total of 21 individuals with schizotypy and 25 matched HC participated in this study. To explore different degrees of proactive inhibition, we set three conditions: a “certain” go condition which no stop signal occurred, a “17% no go” condition in which stop signal would appear in 17% of trials, and a “33% no go” condition in which stop signal would appear in 33% of trials. All participants completed all the conditions, and EEG was recorded when participants completed the task.

Results

Behavioral results showed that in both schizotypy and HC, the reaction times (RT) of go trials were significantly prolonged as the no go percentage increased, and HC showed significantly longer go RT compared with schizotypy in both “17% no go” and “33% no go” conditions, suggesting greater proactive inhibition in HC. Stop signal reaction times (SSRTs) in “33% no go” condition was shorter than “17% no go” condition in both groups. Schizotypy showed significantly longer SSRTs in both “17% no go” and “33% no go” conditions than HC, indicating schizotypy relied more on reactive inhibition. ERP results showed that schizotypy showed larger overall N1 for go trials than HC irrespective of condition, which may indicate a compensation process in schizotypy. Schizotypy showed smaller N2 on both successful and unsuccessful stop trials in “17% no go” conditions than HC, while no group difference was found in “33% no go” conditions for stop trials, which may indicate impaired error processing.

Discussion

These results suggested that schizotypy tended to be impaired in both proactive control and reactive control processes.
S82. REINFORCEMENT LEARNING IMPAIRMENT IN PATIENTS WITH EARLY-STAGE PSYCHOTIC BIPOLAR DISORDER
Authors: Kwun Nam Chan Joe , Chung Man Ng Mary , Fei Wong Cheuk , Fung Wo Sui , Sau Man Wong Corine , Ming Hui Lai , Wa Chan Kit , Ming Lee Ho , Nam Suen Yi , Chen Eric , Chung Chang Wing
Published: May 2020

Background

Abnormal reward sensitivity is a biosignature to mood disorders spectrum. Recent data suggested either elevated or preserved positive but impaired negative reinforcement learning in patients with bipolar disorder. Functional MRI studies provided extra evidence on heightened reward sensitivity in manic patients. Of note, these investigations mostly rest on chronically ill samples, conditions of whom may have been confounded by prolonged exposure to medications. This study aims to examine reinforcement learning performance and its relationship with symptomology in patients with early-stage psychotic bipolar disorder (BDP).

Methods

This study is based on 38 patients with early-stage BDP (defined by having received psychiatric treatment for first-episode BDP within 3 years since service entry) who have been euthymic for at least eight weeks and 40 demographically-matched controls. Reinforcement learning performance was evaluated using Gain-vs-Loss-Avoidance Task (GLAT), which measured the correct responses in both gain and loss-avoidance pairs with reinforcement probability at either 90% or 80% across four blocks in the training phase and one block in the test/transfer phase. Comparison analyses on reinforcement learning performance were conducted on two groups. Associations of reinforcement learning measures with symptom scores, cognitive functions and functioning measures were also tested.

Results

There was no group difference in gender, age or education level. Repeated-measures analysis of variance (ANOVA) showed significant main effects of group (F=6.52, p=0.013), block (F=43.71, p<0.001), probability (F= 5.58, p<0.001), and block x group (F=2.87, p=0.040) interaction. Post-hoc tests revealed that controls performed better than patients across blocks (p<0.05). Patients also showed a lower lose-shift rate (t= 2.21, p=0.03) and punishment-driven learning accuracy rates (t=2.42, p=0.018) than controls. Marginally significant main effect of stimulus pair (F=3.98, p=0.05) was revealed in the test phase, with controls showing a significantly higher preference in Frequent Winner vs Frequent Loser (FWFL) pair than patients (t=-2.25, p=0.028). No significant correlations between learning measures and any of the symptom dimensions in patient sample.

Discussion

Our preliminary findings provided a brief evidence on the negative reinforcement learning impairment in early-stage BDP patients. Further investigation is required to verify and confirm our results of impaired negative reinforcement learning in the initial course of bipolar disorder.
S214. HEART RATE VARIABILITY PREDICTS CLOZAPINE PLASMA LEVEL IN PATIENTS WITH SCHIZOPHRENIA IN A POLYPHARMACY CONDITION
Authors: Mi Park Su , Yeon Jung Hee , Hoon Jeong Seong , Won Chung In , Hoon Yi Sang , Sik Kim Yong
Published: May 2020

Background

Clozapine (CLZ) is most specific suitable treatment of refractory schizophrenia; however, it might lead a variety of adverse reactions that cause drug non-compliance. Although it is necessary to conduct therapeutic drug monitoring through measuring psychoactive drug plasma concentration measurement, it has limitation in that it takes several days and it is invasive. Previous studies have suggested that the heart rate variability (HRV) might serves as non-invasive and fast marker to monitoring pharmacodynamic intra-individual effects of the drug. This study aimed to investigate whether and which HRV parameters predict CLZ plasma concentration in natural clinical and polypharmacy conditions.

Methods

Total 85 patients (Male = 49 and Female = 36; Mean age = 35.95±9.45 years old; Mean CLZ intake = 6.21±4.86 years old) with schizophrenia who had received clozapine without the change of clozapine dosage at least 7 days before blood sampling for TDM and electrocardiogram (ECG) measuring participated in this study. ECG data were collected during resting-state. Linear and nonlinear HRV analysis were ran.

Results

Based on significant results from correlational analysis with the CLZ plasma level, univerate generalized linear regression model (GLM) with gamma distribution were conducted with adjusting the effect of age and sex. As results, for linear parameters of HRV, pNN5, pNN10, and VLF were inversely associated with the CLZ plasma level (Ps<0.05). For nonlinear HRV, DFA2 and crossover were positively and CSE30 were inversely associated with the CLZ concentration (Ps<0.05). After that, step-wise multiple GLM was conducted and the result yield that pNN5 and crossover are best predictors of CLZ plasma level (β=-0.01, t=-3.85, P<0.001 and β=0.50, t=5.02, P<0.001, respectively). The final model with pNN5 and predicted 35.78% of CLZ concentration. Among dependent variables in this model, crossover were positively correlated with CLZ dose (r=0.48, P<0.001).

Discussion

HRV, especially for crossover, could be a candidate of a surrogate marker of CLZ concentration for drug-monitoring in patients with treatment-resistant schizophrenia in a polypharmacy condition. Findings of this study would helpful to make a clinical decision of CLZ dosage adjustment on site without the delay.