- Email: [email protected]
Poster #161 TOWARDS RECOVERY: EMPOWERMENT AND QUALITY OF LIFE IN CHRONIC PSYCHIATRIC INPATIENTS
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Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
program facilitates the involvement of the patients with the task. We might also conjecture that the improvement in the participation and the amount of adequate answers are very associated to the improvement of clinical status, which is more evident in those cases with more preserved previous social functioning. The impressions about each case are reported to the other professionals in our nursery team meetings, performed once a week, thus contributing to the treatment decisions. Discussion: A social skills training group with psychotic inpatients using a ludical TV program might be helpful to evaluate their clinical improvements and contribute to the treatment decisions. At the moment, our main limitation is the lack of quantitative data, although one of our future goals is to control variables (such as time of exposure, percentage of errors, improvement rate) considering the peculiarities of a nursery context. We also assume that further studies are necessary to better explore the benefits of this type of training involving psychotic patients in an acute status.
day-to-day lives, supporting their ability to have rewarding and productive social relationships.
Poster #159 INITIAL TESTING OF A NOVEL SOCIAL COGNITIVE TREATMENT FOR SCHIZOPHRENIA
Background: Prepulse Inhibition (PPI), an objective measurement of sensorimotor gating disturbances, is widely used for discovering new antipsychotic agents. Here, we used siRNA expressing plasmids in the shell of nucleus accumbens in aim to knockingdown of dopamine D2 receptors, and studied its effects on apomorphine disruptive effects on PPI. Methods: Seventy two adult Wistar rats divided into nine groups (eight per group). Control group with no intervention, two Apomorphine groups (0 and 0.5 mg/kg), three siRNA groups (0, 250, and 500 ng/μl), and three groups treated with SiRNA (0, 250 and 500 ng/μl) and after 72 hours received apomorphine (0.5 mg/kg). siRNA expressing plasmids microinjected in nucleus accumbens shell (0.2 μl in each side)and apomorphine injected intraperitoneally. Startle and PPI were measured in three prepulse intensities (71, 74, and 80 db) using San Diego SR-LAB startle response system. The expression of dopamine D2 receptor in nucleus accumbens was measured using real time RT- PCR after PPI measurement. Results: Results of repeated measure ANOVA showed that apomorphine reduced significantly PPI in 74 and 80 prepulse intensities [F(2,19)=5.40, P=0.014],with no effect on startle response. siRNA had no effects on basal PPI [F(3,23)=0.60, P=0.621].Results also showed that reduced PPI after apomorphine reversed in prepulse intensities 74 and 80 in groups treated with siRNA 250 and 500 ng/μl (no significant difference compare to control group, p=0.198and p=0.727 respectively).Expression of D2 receptor mRNA in nucleus accumbens were also decreased in groups treated with siRNA (250 and 500ng/μl, 78 and 72 percent reduction compare to control, p=0.04 and 0.121 respectively). Discussion: In conclusion, our results showed that silencing dopamine D2 receptors in the shell of nucleus accumbens can reverse the PPI impairment induced by apomorphine. This finding may suggest use of siRNA against D2 receptors in the nucleus accumbens as a potentially therapeutic option in schizophrenia.
David L. Roberts 1 , Petra Kleinlein 2 , Jamie Stevens 3 1 University of Texas Health Science Center, San Antonio, TX, USA; 2 Yale University, New Haven, CT, USA; 3 Connecticut Mental Health Center, New Haven, CT, USA Background: Social cognition, the mental operations underlying social interaction, is impaired in schizophrenia, and this impairment is thought to contribute to social dysfunction. There is initial evidence that social cognitive treatments may improve social functioning, but treatment-related improvements have been modest. This limitation is due in part to the fact that patients with cognitive deficits have difficulty recalling and using social cognitive strategies in real life situations. Here we report on a new treatment called Mary/Eddie/Bill (MEB) that is designed to bypass cognitive deficits by teaching patients a social cognitive tool that is easy to remember and use in day-to-day life. We predicted that patients would experience MEB as easy to remember and use, and that MEB treatment would be associated with improvements in social cognition and social functioning. Methods: 24 outpatients with schizophrenia or schizoaffective disorder were recruited into an uncontrolled pre/post trial of a 6-session version of MEB. MEB teaches patients to make adaptive social cognitive judgments by imagining the perspectives of three prototypical fictional characters: My-fault Mary always blames herself for social problems and feels sad and worried; Easy Eddie never blames anybody for problems and feels content; Blaming Bill always blames others and feels angry and suspicious. At pre- and post-treatment, participants completed measures of social cognition (Theory of Mind [ToM], hostile attributional bias, and Jumping-to-Conclusions [JTC] bias) and a measure of social functioning. At post-treatment participants also provided feedback on the ease of MEB, and were tested on their recall for the MEB charactersand their ability to imagine the characters’ thoughts and feelings. Results: The 16 participants who attended at least 5 MEB sessions were called “treatment completers.” On a feedback survey, completers overwhelmingly rated MEB as easy to use, enjoyable and useful for improving their social cognition and social functioning. All completers recalled the names of the MEB characters at post-test, and nearly all were able to describe each character’s typical thoughts and feelings. Pre/post paired samples t-tests and conservative estimates of within-group effect size were computed on all outcome measures. Completers showed significant improvements in ToM (t=2.81, p<0.05; d=0.66), JTC bias (t=2.66; p<0.05); d=0.93), and self-reported social functioning (t=2.22; p<0.05; d=0.53), and a non-significant reduction in hostile attributional bias (d=0.32). Discussion: MEB takes a novel approach to social cognitive training in schizophrenia by teaching patients a simple and memorable heuristic strategy. The current findings suggest that MEB is indeed easy for patients to remember and use, and that patients found MEB to be enjoyable and useful. Moreover, results provide preliminary support for the potential efficacy of MEB in improving social cognition and social functioning. Although this pilot study is limited by small sample size, within-group design, and the use of a self-report measure of social functioning, results are sufficiently promising to justify larger, controlled investigation of MEB. It is hoped that MEB will help patients to make adaptive interpersonal judgments in their
Poster #160 SILENCING DOPAMINE D2 RECEPTORS BY USE OF SIRNA IN THE NUCLEUS ACCUMBENS SHELL REDUCED IMPAIRMENT OF PREPULSE INHIBITION INDUCED BY APOMORPHINE IN RAT Mohammad-Reza Noori-Daloii 1, Ali Shahbazi 2,3 , Siamak Alizadeh Zendehrood 2 , Fatemeh Zare Mehrgerdi 2 , Somayeh Niknazar 2 , Mohammad Mostawfi 2 , Hajar Hashemi Sotoobadi 2 , Asghar Korzehbor 1, Majid Mojarad 1 , Ali Rashidi Nejad 1 1 Department of Medical Genetics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; 2 Physiology Research Center, and Physiology Department, Faculty of Medicine, Tehran, Iran; 3 Institute for Cognitive Science Studies, Tehran, Iran
Poster #161 TOWARDS RECOVERY: EMPOWERMENT AND QUALITY OF LIFE IN CHRONIC PSYCHIATRIC INPATIENTS A.P.M. Stiekema 1 , L. van der Meer 1,2 , P.J. Quee 1,4,5 , F. Jörg 5,6 , R. Bruggeman 4,5 , H. Knegtering 5,7 , A.M. Dethmers 1 , C.M. Rietberg 1 , A. Aleman 2,3 , R.A. Schoevers 4,5 1 Department of Longterm Rehabilitation, Lentis Mental Health Care, Zuidlaren, Netherlands; 2 BCN-neuroimaging Center, Department of Cognitive Neuropsychiatry, University Medical Center Groningen, Groningen, Netherlands; 3 Department of Behavioral & Social Sciences, University of Groningen, Groningen, Netherlands; 4 Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands; 5 Rob Giel Research Center, University Medical Center Groningen, Groningen, Netherlands; 6 Department of Research and Education, Friesland Mental Health Services, Leeuwarden, Netherlands; 7 Research Department, Lentis Mental Healthcare, Groningen, Netherlands Background: Schizophrenia is considered one of the most disabling mental disorders; over 60% of the patients do not fully recover and in approximately 11% of the patients the disorder is chronic (Wiersma et al., 1998). Despite a variety of therapeutic efforts seeking to influence its prognosis,
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
the number of patients in need of long term and intensive care in the Netherlands has increased with 8% [from 1378 patients in 1991 to 1495 patients in 2004 (Wiersma, 2008; Wiersma & Pijl, 2008)]. In contrast, there is a striking paucity of research specifically investigating recovery in this group of patients with severe mental illness. Available studies are mainly limited to efficacy of medication treatment; interventions to enhance rehabilitation in this specific group are only minimally described in scientific publications. Moreover, many studies focus on single interventions, while combined interventions may be more reflective of clinical treatment and are hardly studied. Previous research suggests that rehabilitation is slow, but possible (e.g. Onken et al.2002; Farkas & Anthony, 2010). Earlier work from the Boston group also suggested that there is hardly a relationship between symptoms and rehabilitation success (Anthony et al., 1986). The current project aims to study the efficacy of an novel approach combining existing and new treatments in a randomized design. The primary outcome is recovery of chronic psychiatric inpatients defined as an increased empowerment and higher quality of life. Empowerment is defined as the process to gain control over one’s life and recovery process as well as efforts to achieve this (Rogers et al. 1997). Empowerment is inversely related to depression and increased empowerment contributes to a better quality of life (Sibitz et al., 2011). Thus, empowerment is an important target for improvement. Methods: In the current project, the efficacy of recovery and rehabilitation programs in chronic psychiatric inpatients will be investigated through a novel combination of interventions. These interventions follow three routes (1) compensating cognitive impairments, (2) improving physical fitness and (3) increasing activities of daily living. The first route is aimed at bypassing cognitive deficits through compensation training. Diminishing the impact of the cognitive impairment is targeted to increase empowerment and quality of life. The second route will target the patients’ lifestyle. Many patients suffer from obesity and metabolic syndrome, largely caused by antipsychotic medication. Improving lifestyle and physical fitness will not only increase physical health, but is also aiming at improving empowerment, quality of life and chances on recovery. Importantly, in both the first and second route, psychiatric nurses will carry out the intervention. As such, the training programs will not just improve the well being of patients, but will also contribute to nursing expertise. The third route will investigate the effects of “activities of daily living” on the well being of patients. Results: Providing patients with a useful daily routine and helping them rediscover strengths and abilities, may increase empowerment and quality of life and may improve chances on recovery and active participation in society. Primary outcome measures for all routes are subjective quality of life, empowerment and functional outcome. An additional primary outcome measure for the second route is reduction in cardiometabolic risk. The design and outcome measures of the study will be presented. Content of the interventions will be discussed. Discussion: In sum, the current project may offer a significant contribution to the scientific literature regarding the treatment of chronic psychiatric inpatients.
Poster #162 EFFECT OF SPORTS PARTICIPATION ON BRAIN ACTIVATIONS DURING SPORTS OBSERVATION IN SCHIZOPHRENIA Hidehiko Takahashi 1 , Tetsuya Suhara 2 , Yoshiro Okubo 3 1 Kyoto University Graduate School of Medicine Kyoto, Kyoto, Japan; 2 National Institute of Radiological Sciences Chiba, Chiba, Japan; 3 Nippon Medical School Tokyo, Tokyo, Japan Background: Obesity and weight gain have been identified as being responsible for increased morbidity and mortality rates of patients with schizophrenia. For the management of weight gain, exercise is one of the most acknowledged interventions. At the same time, exercise and sports have been recognized for their positive impact on treatment/rehabilitation and psychiatric symptomsof schizophrenia. However, the neurobiological basis for this remains poorly understood. Methods: A prospective cohort study of chronic schizophrenia patients who participated in a 3-month program including sports participation was conducted to examine the effect of sports participation on weight gain, psychiatric symptoms and brain activation. Thirteen schizophrenia patients (7 men and 6women) and 10 control schizophrenia patients (5
S339
men and 5 women) participated in the study. Body mass index, Positive and Negative Syndrome Scale (PANSS), brain activation during observation of sports-related actions measured by fMRI was assessed before and after the 3-month program. Results: BMI and general psychopathology scale of PANSS were significantly reduced in the program group but not in the control group after a 3-month interval. Compared to baseline, activation of the body-selective extrastriate body area (EBA) in the posterior temporal-occipital cortex during observation of sports-related actions was increased in the program group after the program. In this group, increase in EBA activation was associated with improvement in the general psychopathology scale of PANSS. Discussion: We demonstrated that sports participation had a positive effect not only on weight gain but also on psychiatric symptoms in schizophrenia. EBAmight mediate these beneficial effects of sports participation. Our findings merit further investigation of neurobiological mechanisms underlying the therapeutic effect of exercise/sports for schizophrenia.
Poster #163 NEUROPLASTICITY-BASED COGNITIVE TRAINING IN SCHIZOPHRENIA: A FINAL REPORT ON THE EFFECTS 6-12 MONTHS LATER Melissa Fisher 1,2 , Coleman Garrett 1,2 , Phillip Alexander 1,2 , Karuna Subramaniam 1,2 , Sophia Vinogradov 1,2 1 Department of Psychiatry, University of California, San Francisco, CA, USA; 2 San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA Background: We previously reported the interim effects of an innovative cognitive training approach for the improvement of verbal cognitive processes crucial for psychosocial functioning in schizophrenia (Fisher et al., 2009, 2010). The design of this “neuroplasticity-based” computerized cognitive training approach was guided by work demonstrating impaired early sensory processing and unstable cortical signal processing in schizophrenia. Here we report the results of an intent-to-treat analysis in the final sample. Methods: Eighty-seven outpatients with schizophrenia were randomly assigned to 100 hours of computerized targeted cognitive training (TCT) or 100 hours of a computer games (CG) control condition. In the TCT condition, subjects completed 50 hours of auditory training followed by 50 hours of training in visual and cognitive control processes. Subjects were assessed with MATRICS-recommended cognitive measures, symptom severity and quality of life measures at baseline, post 50-hours, post 100-hours, and at a 6-12 month follow-up. An intent-to-treat analysis was conducted using last-observation-carried-forward Repeated Measures ANOVA, and the association between change in cognition, duration from baseline to follow-up, and change in quality of life was tested. Results: From baseline to 50 hours of training, TCT subjects showed significant gains on measures of global cognition and verbal learning and memory. The second 50 hours of training did not provide additional benefit, and the results at follow-up were no longer significant. However, half of the subjects randomized did not complete the additional 50 hours of training. In the TCT group, change in cognition from baseline to follow-up and total days from baseline to follow-up showed significant correlations with change in quality of life. Discussion: Intensive training of auditory/verbal learning processes results in significant improvement in verbal memory functions crucial for longterm outcome in schizophrenia. Additional training of visual and cognitive control processes did not enhance these effects. The lack of significant between-group differences at follow-up may indicate that “booster” sessions are needed to maintain the gains in cognition (or may be related to power issues). However, the significant association between change in cognition and change in quality of life at follow-up indicates that successful cognitive training drives imporvements in functional outcome, and that the post-training period opens a critical window for aggressive adjunctive psychosocial rehabilitation. The follow-up results also suggest that it may take up to a year before functional gains are evident.
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
program facilitates the involvement of the patients with the task. We might also conjecture that the improvement in the participation and the amount of adequate answers are very associated to the improvement of clinical status, which is more evident in those cases with more preserved previous social functioning. The impressions about each case are reported to the other professionals in our nursery team meetings, performed once a week, thus contributing to the treatment decisions. Discussion: A social skills training group with psychotic inpatients using a ludical TV program might be helpful to evaluate their clinical improvements and contribute to the treatment decisions. At the moment, our main limitation is the lack of quantitative data, although one of our future goals is to control variables (such as time of exposure, percentage of errors, improvement rate) considering the peculiarities of a nursery context. We also assume that further studies are necessary to better explore the benefits of this type of training involving psychotic patients in an acute status.
day-to-day lives, supporting their ability to have rewarding and productive social relationships.
Poster #159 INITIAL TESTING OF A NOVEL SOCIAL COGNITIVE TREATMENT FOR SCHIZOPHRENIA
Background: Prepulse Inhibition (PPI), an objective measurement of sensorimotor gating disturbances, is widely used for discovering new antipsychotic agents. Here, we used siRNA expressing plasmids in the shell of nucleus accumbens in aim to knockingdown of dopamine D2 receptors, and studied its effects on apomorphine disruptive effects on PPI. Methods: Seventy two adult Wistar rats divided into nine groups (eight per group). Control group with no intervention, two Apomorphine groups (0 and 0.5 mg/kg), three siRNA groups (0, 250, and 500 ng/μl), and three groups treated with SiRNA (0, 250 and 500 ng/μl) and after 72 hours received apomorphine (0.5 mg/kg). siRNA expressing plasmids microinjected in nucleus accumbens shell (0.2 μl in each side)and apomorphine injected intraperitoneally. Startle and PPI were measured in three prepulse intensities (71, 74, and 80 db) using San Diego SR-LAB startle response system. The expression of dopamine D2 receptor in nucleus accumbens was measured using real time RT- PCR after PPI measurement. Results: Results of repeated measure ANOVA showed that apomorphine reduced significantly PPI in 74 and 80 prepulse intensities [F(2,19)=5.40, P=0.014],with no effect on startle response. siRNA had no effects on basal PPI [F(3,23)=0.60, P=0.621].Results also showed that reduced PPI after apomorphine reversed in prepulse intensities 74 and 80 in groups treated with siRNA 250 and 500 ng/μl (no significant difference compare to control group, p=0.198and p=0.727 respectively).Expression of D2 receptor mRNA in nucleus accumbens were also decreased in groups treated with siRNA (250 and 500ng/μl, 78 and 72 percent reduction compare to control, p=0.04 and 0.121 respectively). Discussion: In conclusion, our results showed that silencing dopamine D2 receptors in the shell of nucleus accumbens can reverse the PPI impairment induced by apomorphine. This finding may suggest use of siRNA against D2 receptors in the nucleus accumbens as a potentially therapeutic option in schizophrenia.
David L. Roberts 1 , Petra Kleinlein 2 , Jamie Stevens 3 1 University of Texas Health Science Center, San Antonio, TX, USA; 2 Yale University, New Haven, CT, USA; 3 Connecticut Mental Health Center, New Haven, CT, USA Background: Social cognition, the mental operations underlying social interaction, is impaired in schizophrenia, and this impairment is thought to contribute to social dysfunction. There is initial evidence that social cognitive treatments may improve social functioning, but treatment-related improvements have been modest. This limitation is due in part to the fact that patients with cognitive deficits have difficulty recalling and using social cognitive strategies in real life situations. Here we report on a new treatment called Mary/Eddie/Bill (MEB) that is designed to bypass cognitive deficits by teaching patients a social cognitive tool that is easy to remember and use in day-to-day life. We predicted that patients would experience MEB as easy to remember and use, and that MEB treatment would be associated with improvements in social cognition and social functioning. Methods: 24 outpatients with schizophrenia or schizoaffective disorder were recruited into an uncontrolled pre/post trial of a 6-session version of MEB. MEB teaches patients to make adaptive social cognitive judgments by imagining the perspectives of three prototypical fictional characters: My-fault Mary always blames herself for social problems and feels sad and worried; Easy Eddie never blames anybody for problems and feels content; Blaming Bill always blames others and feels angry and suspicious. At pre- and post-treatment, participants completed measures of social cognition (Theory of Mind [ToM], hostile attributional bias, and Jumping-to-Conclusions [JTC] bias) and a measure of social functioning. At post-treatment participants also provided feedback on the ease of MEB, and were tested on their recall for the MEB charactersand their ability to imagine the characters’ thoughts and feelings. Results: The 16 participants who attended at least 5 MEB sessions were called “treatment completers.” On a feedback survey, completers overwhelmingly rated MEB as easy to use, enjoyable and useful for improving their social cognition and social functioning. All completers recalled the names of the MEB characters at post-test, and nearly all were able to describe each character’s typical thoughts and feelings. Pre/post paired samples t-tests and conservative estimates of within-group effect size were computed on all outcome measures. Completers showed significant improvements in ToM (t=2.81, p<0.05; d=0.66), JTC bias (t=2.66; p<0.05); d=0.93), and self-reported social functioning (t=2.22; p<0.05; d=0.53), and a non-significant reduction in hostile attributional bias (d=0.32). Discussion: MEB takes a novel approach to social cognitive training in schizophrenia by teaching patients a simple and memorable heuristic strategy. The current findings suggest that MEB is indeed easy for patients to remember and use, and that patients found MEB to be enjoyable and useful. Moreover, results provide preliminary support for the potential efficacy of MEB in improving social cognition and social functioning. Although this pilot study is limited by small sample size, within-group design, and the use of a self-report measure of social functioning, results are sufficiently promising to justify larger, controlled investigation of MEB. It is hoped that MEB will help patients to make adaptive interpersonal judgments in their
Poster #160 SILENCING DOPAMINE D2 RECEPTORS BY USE OF SIRNA IN THE NUCLEUS ACCUMBENS SHELL REDUCED IMPAIRMENT OF PREPULSE INHIBITION INDUCED BY APOMORPHINE IN RAT Mohammad-Reza Noori-Daloii 1, Ali Shahbazi 2,3 , Siamak Alizadeh Zendehrood 2 , Fatemeh Zare Mehrgerdi 2 , Somayeh Niknazar 2 , Mohammad Mostawfi 2 , Hajar Hashemi Sotoobadi 2 , Asghar Korzehbor 1, Majid Mojarad 1 , Ali Rashidi Nejad 1 1 Department of Medical Genetics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; 2 Physiology Research Center, and Physiology Department, Faculty of Medicine, Tehran, Iran; 3 Institute for Cognitive Science Studies, Tehran, Iran
Poster #161 TOWARDS RECOVERY: EMPOWERMENT AND QUALITY OF LIFE IN CHRONIC PSYCHIATRIC INPATIENTS A.P.M. Stiekema 1 , L. van der Meer 1,2 , P.J. Quee 1,4,5 , F. Jörg 5,6 , R. Bruggeman 4,5 , H. Knegtering 5,7 , A.M. Dethmers 1 , C.M. Rietberg 1 , A. Aleman 2,3 , R.A. Schoevers 4,5 1 Department of Longterm Rehabilitation, Lentis Mental Health Care, Zuidlaren, Netherlands; 2 BCN-neuroimaging Center, Department of Cognitive Neuropsychiatry, University Medical Center Groningen, Groningen, Netherlands; 3 Department of Behavioral & Social Sciences, University of Groningen, Groningen, Netherlands; 4 Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands; 5 Rob Giel Research Center, University Medical Center Groningen, Groningen, Netherlands; 6 Department of Research and Education, Friesland Mental Health Services, Leeuwarden, Netherlands; 7 Research Department, Lentis Mental Healthcare, Groningen, Netherlands Background: Schizophrenia is considered one of the most disabling mental disorders; over 60% of the patients do not fully recover and in approximately 11% of the patients the disorder is chronic (Wiersma et al., 1998). Despite a variety of therapeutic efforts seeking to influence its prognosis,
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
the number of patients in need of long term and intensive care in the Netherlands has increased with 8% [from 1378 patients in 1991 to 1495 patients in 2004 (Wiersma, 2008; Wiersma & Pijl, 2008)]. In contrast, there is a striking paucity of research specifically investigating recovery in this group of patients with severe mental illness. Available studies are mainly limited to efficacy of medication treatment; interventions to enhance rehabilitation in this specific group are only minimally described in scientific publications. Moreover, many studies focus on single interventions, while combined interventions may be more reflective of clinical treatment and are hardly studied. Previous research suggests that rehabilitation is slow, but possible (e.g. Onken et al.2002; Farkas & Anthony, 2010). Earlier work from the Boston group also suggested that there is hardly a relationship between symptoms and rehabilitation success (Anthony et al., 1986). The current project aims to study the efficacy of an novel approach combining existing and new treatments in a randomized design. The primary outcome is recovery of chronic psychiatric inpatients defined as an increased empowerment and higher quality of life. Empowerment is defined as the process to gain control over one’s life and recovery process as well as efforts to achieve this (Rogers et al. 1997). Empowerment is inversely related to depression and increased empowerment contributes to a better quality of life (Sibitz et al., 2011). Thus, empowerment is an important target for improvement. Methods: In the current project, the efficacy of recovery and rehabilitation programs in chronic psychiatric inpatients will be investigated through a novel combination of interventions. These interventions follow three routes (1) compensating cognitive impairments, (2) improving physical fitness and (3) increasing activities of daily living. The first route is aimed at bypassing cognitive deficits through compensation training. Diminishing the impact of the cognitive impairment is targeted to increase empowerment and quality of life. The second route will target the patients’ lifestyle. Many patients suffer from obesity and metabolic syndrome, largely caused by antipsychotic medication. Improving lifestyle and physical fitness will not only increase physical health, but is also aiming at improving empowerment, quality of life and chances on recovery. Importantly, in both the first and second route, psychiatric nurses will carry out the intervention. As such, the training programs will not just improve the well being of patients, but will also contribute to nursing expertise. The third route will investigate the effects of “activities of daily living” on the well being of patients. Results: Providing patients with a useful daily routine and helping them rediscover strengths and abilities, may increase empowerment and quality of life and may improve chances on recovery and active participation in society. Primary outcome measures for all routes are subjective quality of life, empowerment and functional outcome. An additional primary outcome measure for the second route is reduction in cardiometabolic risk. The design and outcome measures of the study will be presented. Content of the interventions will be discussed. Discussion: In sum, the current project may offer a significant contribution to the scientific literature regarding the treatment of chronic psychiatric inpatients.
Poster #162 EFFECT OF SPORTS PARTICIPATION ON BRAIN ACTIVATIONS DURING SPORTS OBSERVATION IN SCHIZOPHRENIA Hidehiko Takahashi 1 , Tetsuya Suhara 2 , Yoshiro Okubo 3 1 Kyoto University Graduate School of Medicine Kyoto, Kyoto, Japan; 2 National Institute of Radiological Sciences Chiba, Chiba, Japan; 3 Nippon Medical School Tokyo, Tokyo, Japan Background: Obesity and weight gain have been identified as being responsible for increased morbidity and mortality rates of patients with schizophrenia. For the management of weight gain, exercise is one of the most acknowledged interventions. At the same time, exercise and sports have been recognized for their positive impact on treatment/rehabilitation and psychiatric symptomsof schizophrenia. However, the neurobiological basis for this remains poorly understood. Methods: A prospective cohort study of chronic schizophrenia patients who participated in a 3-month program including sports participation was conducted to examine the effect of sports participation on weight gain, psychiatric symptoms and brain activation. Thirteen schizophrenia patients (7 men and 6women) and 10 control schizophrenia patients (5
S339
men and 5 women) participated in the study. Body mass index, Positive and Negative Syndrome Scale (PANSS), brain activation during observation of sports-related actions measured by fMRI was assessed before and after the 3-month program. Results: BMI and general psychopathology scale of PANSS were significantly reduced in the program group but not in the control group after a 3-month interval. Compared to baseline, activation of the body-selective extrastriate body area (EBA) in the posterior temporal-occipital cortex during observation of sports-related actions was increased in the program group after the program. In this group, increase in EBA activation was associated with improvement in the general psychopathology scale of PANSS. Discussion: We demonstrated that sports participation had a positive effect not only on weight gain but also on psychiatric symptoms in schizophrenia. EBAmight mediate these beneficial effects of sports participation. Our findings merit further investigation of neurobiological mechanisms underlying the therapeutic effect of exercise/sports for schizophrenia.
Poster #163 NEUROPLASTICITY-BASED COGNITIVE TRAINING IN SCHIZOPHRENIA: A FINAL REPORT ON THE EFFECTS 6-12 MONTHS LATER Melissa Fisher 1,2 , Coleman Garrett 1,2 , Phillip Alexander 1,2 , Karuna Subramaniam 1,2 , Sophia Vinogradov 1,2 1 Department of Psychiatry, University of California, San Francisco, CA, USA; 2 San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA Background: We previously reported the interim effects of an innovative cognitive training approach for the improvement of verbal cognitive processes crucial for psychosocial functioning in schizophrenia (Fisher et al., 2009, 2010). The design of this “neuroplasticity-based” computerized cognitive training approach was guided by work demonstrating impaired early sensory processing and unstable cortical signal processing in schizophrenia. Here we report the results of an intent-to-treat analysis in the final sample. Methods: Eighty-seven outpatients with schizophrenia were randomly assigned to 100 hours of computerized targeted cognitive training (TCT) or 100 hours of a computer games (CG) control condition. In the TCT condition, subjects completed 50 hours of auditory training followed by 50 hours of training in visual and cognitive control processes. Subjects were assessed with MATRICS-recommended cognitive measures, symptom severity and quality of life measures at baseline, post 50-hours, post 100-hours, and at a 6-12 month follow-up. An intent-to-treat analysis was conducted using last-observation-carried-forward Repeated Measures ANOVA, and the association between change in cognition, duration from baseline to follow-up, and change in quality of life was tested. Results: From baseline to 50 hours of training, TCT subjects showed significant gains on measures of global cognition and verbal learning and memory. The second 50 hours of training did not provide additional benefit, and the results at follow-up were no longer significant. However, half of the subjects randomized did not complete the additional 50 hours of training. In the TCT group, change in cognition from baseline to follow-up and total days from baseline to follow-up showed significant correlations with change in quality of life. Discussion: Intensive training of auditory/verbal learning processes results in significant improvement in verbal memory functions crucial for longterm outcome in schizophrenia. Additional training of visual and cognitive control processes did not enhance these effects. The lack of significant between-group differences at follow-up may indicate that “booster” sessions are needed to maintain the gains in cognition (or may be related to power issues). However, the significant association between change in cognition and change in quality of life at follow-up indicates that successful cognitive training drives imporvements in functional outcome, and that the post-training period opens a critical window for aggressive adjunctive psychosocial rehabilitation. The follow-up results also suggest that it may take up to a year before functional gains are evident.