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Poster #228 AFFECTIVE PROSODY PERCEPTION IN REMITTED PATIENTS WITH SCHIZOPHRENIA COMPARED TO HEALTHY CONTROLS
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
with empathy and was very highly related to actual social skill performance. These findings support the value of object relations constructs in understanding the interpersonal impairments of schizophrenia.
Poster #228 AFFECTIVE PROSODY PERCEPTION IN REMITTED PATIENTS WITH SCHIZOPHRENIA COMPARED TO HEALTHY CONTROLS Falko Biedermann, Susanne Baumgartner, Alexandra Kaufmann, Christine Hoertnagl, Christian Georg Widschwendter, Nursen Yalcin, Wolfgang W. Fleischhacker, Alex Hofer Medical University of Innsbruck, Department for Psychiatry and Psychotherapy, Biological Psychiatry Division, Innsbruck, Tirol, Austria Background: Affective prosody perception is impaired in schizophrenia patients and is considered as an immament symptom of this devastating disease. This deficit is at least partially responsible for the poor functional outcome of these patients. Methods: In this cross sectional study we investigated social cognitive deficits in remitted patients suffering from schizophrenia compared to healthy controls. We enrolled outpatients between 19 and 65 years of age, who had been symptomatically stable for half a year under antipsychotic treatment. Remission criteria were defined following the recommendations of Andreasen et al. (2005). Affective prosody perception was investigated by using three subtests of the Comprehensive Affective Testing System (CATS). Results: Both groups were comparable regarding sociodemographic characteristics. So far, we enrolled 42 remitted patients with schizophrenia and 50 healthy controls. Patients were impaired in the differentiation of five vocal emotions (fear, anger, happiness, surprise, grief) (CATS 1). In addition, they were impaired in the recognition of the vocal emotion while ignoring the affective meaning of the sentences (CATS 2). On the other hand, patients and controls did not differ regarding the recognition of the affective meaningof test trials while ignoring the vocal emotion (CATS 3). CATS 2 test performance was positively correlated with the patients’ employment and partnership status, whereas a negative association was found between CATS 3 test performance and negative symptom scores. Neither PANSS positive-, general and total scores nor global assessment of functioning were associated with deficits of affective prosody perception. Discussion: Our results confirm earlier trials and demonstrate deficits in affective prosody perception in schizophrenia patients. We suggest that affect recognition is an important aspect of psychosocial functioning, not only in the acute phase of schizophrenia but also during remission.
Poster #229 PREDICTORS OF RECOVERY AND SOCIAL FUNCTIONING IN EARLY PSYCHOSIS Geneviève Bourdeau 1 , Tania Lecomte 1 , Paul H. Lysaker 2 Université de Montréal, Montréal, Québec, Canada; 2 Indiana University School of Medicine, Indiana, Indianapolis, USA
1
Background: Little is known about the recovery process of young people with early psychosis. From the consumers’ perspective, to recover is described as a growing process of self-redefinition and hope. Several studies have identified phases through which individuals typically evolve during their recovery thus identifying five different stages. It has also been proposed that narratives might be a good way to understand individuals’ recovery process as the reconstruction of personal narratives would be a critical element in the process. Otherwise, reaching a certain form of functional autonomy is also an important part of recovery. In people living with schizophrenia for several years, some variables are known to be associated with social functioning, among others: negative symptoms and cognitive functioning. Although some authors demonstrated that there was little relationship between the consumers’ subjective experience of recovery and clinical measures, we still lack knowledge regarding what predicts recovery in early psychosis and how it could be reflected in social functioning outcomes. Methods: Objectives: 1) to determine if the level of social functioning is correlated to the recovery stage (based on a 5-stage model of recovery); 2) to see if variables previously associated with functioning in studies with
S173
individuals more “experienced” with schizophrenia are similarly linked to social functioning and to recovery stage in an early psychosis sample. Participants met individually with a trained interviewer in order to complete the measures: PSR toolkit (sociodemographic information), Social Functioning Scale (Social Functioning), Brief Psychiatric Rating Scale (Psychiatric Symptoms), California Verbal Learning Test (Short-term verbal learning), Trail Making Test (Speed processing). Participants as well answered a qualitative interview (Indiana Psychiatric Illness Interview). Verbatim were coded for narrative richness (according to the Scale to Assess Narrative Development) and recovery stage (according to an analysis grid created by the first author). Results: Bivariate correlations were performed between all variables. Preliminary results with 50 participants reveal that the recovery stage was correlated to two of the subscales of the SFS (withdrawal/social engagement, employment/occupation). Furthermore, global symptoms, positive symptoms, negative symptoms, short-term verbal learning, speed processing, and narrative development were all correlated to one or more subscales of the SFS. However, only narrative development and total symptoms were correlated to the stage of recovery. Discussion: It seems that recovery is associated to specific aspects of social functioning, but not to social functioning in a global way. As for objective 2, social functioning and recovery were not similarly linked to potential predictive variables. It is worth mentioning that SFS total score was not correlated to any of our variables, underlining the importance to assess social functioning more specifically rather than using only a global score. Furthermore, it is interesting to note that recovery was associated to total psychiatric symptoms, but not to psychotic symptoms. The absence of symptoms is not a criterion for recovery from the consumer perspective, though perhaps a high level of distress linked to higher symptomatology is linked to an earlier stage of recovery. Finally, we should stress the fact that the employment/occupation subscale was associated with the most variables. It could be that regaining work is more demanding than others aspects of social functioning (ex. recreational activities) and therefore could be more influenced by symptoms and cognitive functioning.
Poster #230 ENHANCING ADHERENCE TO ANTIPSYCHOTIC MEDICATION: WHERE ARE WE GOING WRONG? Ellie Brown, Richard Gray 1 University of East Anglia, Norwich, United Kingdom Background: Nine out of ten patients with severe mental illness are partially or completely non-adherent with their medication. Whilst there are effective interventions to enhance adherence we don’t know whether these are routinely used in clinical practice. Methods: In this qualitative study, we interviewed 34 mental health professionals from three key groups involved in promoting adherence; pharmacists, psychiatrists and nurses. Interviews were audio-recorded, transcribed verbatim and then coded using Thematic analysis. Thematic analysis entails an integrative, interpretative process between the data and the researcher in order to “code” the data. These codes were then grouped into themes. Results: We identified 5 themes Theme 1 - It’s not okay to pay? When asked about the use of financial incentives to promote adherence, serious concern was expressed about the ethics of this strategy, even if it is shown to be effective. This was view was consistent across all 3 professional groups. Theme 2 - Professionals own thoughts about medication Clinician’s views about medication seemed to have a baring on the emphasise they place on medication when working with patients. Those who were more cynical seemed to downplay its importance. Theme 3 - Holding back the truth Participants expressed a tendency to hold off giving patients information about certain aspects of their treatment; this seemed to vary by professional groups. Pharmacists particularly expressed concern about giving too much information about medication side effects. Theme 4 - A misplaced belief in the value of information The importance of providing information to patients to improve adherence was highlighted by all professional groups. Pharmacists particularly emphasised the value of education. Other psychological techniques to enhance adherence; such as cognitive behavioural therapy and motivational enhancement, were not mentioned at all by participants Theme 5 - Gut instinct Asked directly if they ever
with empathy and was very highly related to actual social skill performance. These findings support the value of object relations constructs in understanding the interpersonal impairments of schizophrenia.
Poster #228 AFFECTIVE PROSODY PERCEPTION IN REMITTED PATIENTS WITH SCHIZOPHRENIA COMPARED TO HEALTHY CONTROLS Falko Biedermann, Susanne Baumgartner, Alexandra Kaufmann, Christine Hoertnagl, Christian Georg Widschwendter, Nursen Yalcin, Wolfgang W. Fleischhacker, Alex Hofer Medical University of Innsbruck, Department for Psychiatry and Psychotherapy, Biological Psychiatry Division, Innsbruck, Tirol, Austria Background: Affective prosody perception is impaired in schizophrenia patients and is considered as an immament symptom of this devastating disease. This deficit is at least partially responsible for the poor functional outcome of these patients. Methods: In this cross sectional study we investigated social cognitive deficits in remitted patients suffering from schizophrenia compared to healthy controls. We enrolled outpatients between 19 and 65 years of age, who had been symptomatically stable for half a year under antipsychotic treatment. Remission criteria were defined following the recommendations of Andreasen et al. (2005). Affective prosody perception was investigated by using three subtests of the Comprehensive Affective Testing System (CATS). Results: Both groups were comparable regarding sociodemographic characteristics. So far, we enrolled 42 remitted patients with schizophrenia and 50 healthy controls. Patients were impaired in the differentiation of five vocal emotions (fear, anger, happiness, surprise, grief) (CATS 1). In addition, they were impaired in the recognition of the vocal emotion while ignoring the affective meaning of the sentences (CATS 2). On the other hand, patients and controls did not differ regarding the recognition of the affective meaningof test trials while ignoring the vocal emotion (CATS 3). CATS 2 test performance was positively correlated with the patients’ employment and partnership status, whereas a negative association was found between CATS 3 test performance and negative symptom scores. Neither PANSS positive-, general and total scores nor global assessment of functioning were associated with deficits of affective prosody perception. Discussion: Our results confirm earlier trials and demonstrate deficits in affective prosody perception in schizophrenia patients. We suggest that affect recognition is an important aspect of psychosocial functioning, not only in the acute phase of schizophrenia but also during remission.
Poster #229 PREDICTORS OF RECOVERY AND SOCIAL FUNCTIONING IN EARLY PSYCHOSIS Geneviève Bourdeau 1 , Tania Lecomte 1 , Paul H. Lysaker 2 Université de Montréal, Montréal, Québec, Canada; 2 Indiana University School of Medicine, Indiana, Indianapolis, USA
1
Background: Little is known about the recovery process of young people with early psychosis. From the consumers’ perspective, to recover is described as a growing process of self-redefinition and hope. Several studies have identified phases through which individuals typically evolve during their recovery thus identifying five different stages. It has also been proposed that narratives might be a good way to understand individuals’ recovery process as the reconstruction of personal narratives would be a critical element in the process. Otherwise, reaching a certain form of functional autonomy is also an important part of recovery. In people living with schizophrenia for several years, some variables are known to be associated with social functioning, among others: negative symptoms and cognitive functioning. Although some authors demonstrated that there was little relationship between the consumers’ subjective experience of recovery and clinical measures, we still lack knowledge regarding what predicts recovery in early psychosis and how it could be reflected in social functioning outcomes. Methods: Objectives: 1) to determine if the level of social functioning is correlated to the recovery stage (based on a 5-stage model of recovery); 2) to see if variables previously associated with functioning in studies with
S173
individuals more “experienced” with schizophrenia are similarly linked to social functioning and to recovery stage in an early psychosis sample. Participants met individually with a trained interviewer in order to complete the measures: PSR toolkit (sociodemographic information), Social Functioning Scale (Social Functioning), Brief Psychiatric Rating Scale (Psychiatric Symptoms), California Verbal Learning Test (Short-term verbal learning), Trail Making Test (Speed processing). Participants as well answered a qualitative interview (Indiana Psychiatric Illness Interview). Verbatim were coded for narrative richness (according to the Scale to Assess Narrative Development) and recovery stage (according to an analysis grid created by the first author). Results: Bivariate correlations were performed between all variables. Preliminary results with 50 participants reveal that the recovery stage was correlated to two of the subscales of the SFS (withdrawal/social engagement, employment/occupation). Furthermore, global symptoms, positive symptoms, negative symptoms, short-term verbal learning, speed processing, and narrative development were all correlated to one or more subscales of the SFS. However, only narrative development and total symptoms were correlated to the stage of recovery. Discussion: It seems that recovery is associated to specific aspects of social functioning, but not to social functioning in a global way. As for objective 2, social functioning and recovery were not similarly linked to potential predictive variables. It is worth mentioning that SFS total score was not correlated to any of our variables, underlining the importance to assess social functioning more specifically rather than using only a global score. Furthermore, it is interesting to note that recovery was associated to total psychiatric symptoms, but not to psychotic symptoms. The absence of symptoms is not a criterion for recovery from the consumer perspective, though perhaps a high level of distress linked to higher symptomatology is linked to an earlier stage of recovery. Finally, we should stress the fact that the employment/occupation subscale was associated with the most variables. It could be that regaining work is more demanding than others aspects of social functioning (ex. recreational activities) and therefore could be more influenced by symptoms and cognitive functioning.
Poster #230 ENHANCING ADHERENCE TO ANTIPSYCHOTIC MEDICATION: WHERE ARE WE GOING WRONG? Ellie Brown, Richard Gray 1 University of East Anglia, Norwich, United Kingdom Background: Nine out of ten patients with severe mental illness are partially or completely non-adherent with their medication. Whilst there are effective interventions to enhance adherence we don’t know whether these are routinely used in clinical practice. Methods: In this qualitative study, we interviewed 34 mental health professionals from three key groups involved in promoting adherence; pharmacists, psychiatrists and nurses. Interviews were audio-recorded, transcribed verbatim and then coded using Thematic analysis. Thematic analysis entails an integrative, interpretative process between the data and the researcher in order to “code” the data. These codes were then grouped into themes. Results: We identified 5 themes Theme 1 - It’s not okay to pay? When asked about the use of financial incentives to promote adherence, serious concern was expressed about the ethics of this strategy, even if it is shown to be effective. This was view was consistent across all 3 professional groups. Theme 2 - Professionals own thoughts about medication Clinician’s views about medication seemed to have a baring on the emphasise they place on medication when working with patients. Those who were more cynical seemed to downplay its importance. Theme 3 - Holding back the truth Participants expressed a tendency to hold off giving patients information about certain aspects of their treatment; this seemed to vary by professional groups. Pharmacists particularly expressed concern about giving too much information about medication side effects. Theme 4 - A misplaced belief in the value of information The importance of providing information to patients to improve adherence was highlighted by all professional groups. Pharmacists particularly emphasised the value of education. Other psychological techniques to enhance adherence; such as cognitive behavioural therapy and motivational enhancement, were not mentioned at all by participants Theme 5 - Gut instinct Asked directly if they ever