- Email: [email protected]
P.3.a.038 Computerized analyses of prosody in schizophrenia
S502
P.3.a Psychotic disorders and antipsychotics - Psychotic disorders (clinical)
to be identified or screened for eventually in the future on a routine basis. Reduced budgets allocated for psychiatric services obviously contribute to obstacles in clinical investigation making identification of laboratory markers on a routine screen hard to implement for large patient populations. Auto-immunity is an extremely interesting area in psychiatry and may lead to novel treatment approaches and possibly alter the clinical course
Ip.3.a.0381 Computerized analyses of prosody in schizophrenia S. Portuguese 1 " S. Piantadosi2 , E. Gibson2 , B.M. Cohen3 , D. Ongur4. 1McLean Hospital, Schizophrenia and Bipolar Program, Petah Tikva, Israel; 3McLean Hospital, Shervert Frazier Research Institute, Belmont MA, USA; 4 McLean Hospital, Schizophrenia and Bipolar Program, Belmont MA, USA Schizophrenia (SZ) is a mental disorder associated, in some cases, with characteristic changes of speech. These changes are currently described as the negative symptom domains Alogia and Blunted Affect. Negative signs are known to influence the social dysfunction in SZ (ie, inability to work) and recognized as treatment target by the American National Institute of Mental Health (NIMH) [1]. Negative signs consist of 5 domains including Alogia (diminished production of speech) and Blunted Affect (diminished ability to express emotions), Avolition, Anhedonia and Asociality. Prosody is currently measured by subjective rating scales requiring trained staff. Clinical ratings of negative signs tend to be skewed and range restricted in comparison to the computerized acoustic measures suggesting that global clinical impression creates a rating bias. Researchers attempted to discriminate between SZ and healthy subjects using structured tasks such as reading, counting and short monologues with discrimination rates ranging from 64% in SZ subjects right after hospitalization to 95% in chronically ill SZ subjects. We are not aware of acoustic analyses of schizophrenic free interactive speech in the psychiatric literature. The changes in SZ prosody include slowness of speech that can be described in terms of longer pauses and shorter utterances and monotonousness that can be described in terms of reduced pitch amplitude variability. We set to measure the acoustic characteristics in an objective, fully automated, low-priced method that utilizes free interactive speech. These objective measures might be used as a potential biomarker for SZ. The speech acoustic variables were compared to clinical rating scales extracted during the same interview of 20 clinically stable SZ patients (All paranoid type, 11 males, age 38.8±12.9y, education 13.7±2.2y), and 19 healthy controls (age 40.35±9.3y; 9 males; education 14.9±4.2y). The acoustic variables were highly correlated with the SANS Alogia and SANS Affect: Utterance Duration was correlated with both SANS alogia (R -0.44*) and SANS affect (R -0.58**), % Spoken in Utterance was correlated with SANS Alogia (R -0.75***) and SANS Affect (R -O.l2n). Pitch Variance was correlated with SANS Alogia (R -0.62**) and SANS Affect (R -0.64*). Pitch change was associated with SANS Alogia (R -0.54***) and SANS Affect (R -0.50*). Using acoustic variables we achieved a discrimination accuracy of 71 % between SZ and healthy subjects. Interactive free speech can be used to discriminate between SZ and healthy subjects.
The method is fully computerized hence could be easily applied real time in clinical setting. Our finding of a strong correlation between mean log duration of utterance and Alogia and Blunt Affect imply that this computerized model can be used to quantitY these domains instead of a human rater. The strong correlation between certain acoustic and socioeconomic variables implies that acoustic analysis could be used to assess certain aspects of community functioning in SZ. The limitations of the study include the small number of subjects, and no control for medications and past use of drugs. However, only stable outpatients were included. In the future we plan to investigate the method's potential for mass screening and evaluate its sensitivity to change including treatment response in both schizophrenia and depression. References [1] Alpert M, Shaw RI, Pouget ER, Lim KO. 2002. A comparison of clinical ratings with vocal acoustic measures of flat affect and Alogia J Psychiatr Res. Sep-Oct; 36(5):347-53. [2] Cannizzaro MS, Cohen H, Rappard F, Snyder PJ.2005. Bradyphrenia and bradykinesia both contribute to altered speech in schizophrenia: a quantitative acoustic study. Cogn Behav Neurol. Dec; 18(4):206-10. [3] Stassen HH, Albers M, Pusche1 J, Scharfetter C, Tewesmeier M, Woggon B. 1995. Speaking behavior and voice sound characteristics associated with negative schizophrenia. J Psychiatr Res. JuI-Aug; 29(4): 277-96.
1p.3.a.0391 Developing guidelines for the treatment of stable schizophrenia across primary and secondary care M. Agius 1 , S. Chapman2 , R. Zaman3 •. 1 University of Cambridge, Department of Psychiatry, Cambridge, United Kingdom; 2 University ofCambridge, Clinical School, Cambridge, United Kingdom; 3 University of Cambridge, Department of Psychisatry, Cambridge, United Kingdom Background: Commissioners of services are urging psychiatrists in the UK to return patients with stable mental health problems, including patients with a diagnosis of schizophrenia, to primary care. There is doubt whether primary care can adequately manage such patients. Aim: To conduct a literature search, taking into account more recent literature, as well as the NICE guidelines in order to investigate whether a shared care system can be developed in order to safely to return patients with stable mental health problems including schizophrenia to primary care. Method: A literature search using PUBMED, was carried out. Special attention was directed to large recent studies including CUTLASS(I), CATIE(2), SOHO, CAFE(3), and EUFEST. The studies were critically reviewed. The information gained from these papers was added to that on which NICE Guidelines are based, in order to update the present guidelines. Results: While patients with schizophrenia are under the care of the secondary care team, they will have a care- coordinator and a care plan supplied by that team, and in England will be subject to the Care Program Approach. While in secondary care, all patients should be assessed for risk factors, and should any be present, then the patients should be retained in the secondary care system. Once they have been discharged to primary care, it would be wise to arrange a shared care system to manage the patients. For schizophrenia, shared care should include review by a consultant psychiatrist at regular intervals, arrangement for a practice based health professional to implement a care plan, jointly
P.3.a Psychotic disorders and antipsychotics - Psychotic disorders (clinical)
to be identified or screened for eventually in the future on a routine basis. Reduced budgets allocated for psychiatric services obviously contribute to obstacles in clinical investigation making identification of laboratory markers on a routine screen hard to implement for large patient populations. Auto-immunity is an extremely interesting area in psychiatry and may lead to novel treatment approaches and possibly alter the clinical course
Ip.3.a.0381 Computerized analyses of prosody in schizophrenia S. Portuguese 1 " S. Piantadosi2 , E. Gibson2 , B.M. Cohen3 , D. Ongur4. 1McLean Hospital, Schizophrenia and Bipolar Program, Petah Tikva, Israel; 3McLean Hospital, Shervert Frazier Research Institute, Belmont MA, USA; 4 McLean Hospital, Schizophrenia and Bipolar Program, Belmont MA, USA Schizophrenia (SZ) is a mental disorder associated, in some cases, with characteristic changes of speech. These changes are currently described as the negative symptom domains Alogia and Blunted Affect. Negative signs are known to influence the social dysfunction in SZ (ie, inability to work) and recognized as treatment target by the American National Institute of Mental Health (NIMH) [1]. Negative signs consist of 5 domains including Alogia (diminished production of speech) and Blunted Affect (diminished ability to express emotions), Avolition, Anhedonia and Asociality. Prosody is currently measured by subjective rating scales requiring trained staff. Clinical ratings of negative signs tend to be skewed and range restricted in comparison to the computerized acoustic measures suggesting that global clinical impression creates a rating bias. Researchers attempted to discriminate between SZ and healthy subjects using structured tasks such as reading, counting and short monologues with discrimination rates ranging from 64% in SZ subjects right after hospitalization to 95% in chronically ill SZ subjects. We are not aware of acoustic analyses of schizophrenic free interactive speech in the psychiatric literature. The changes in SZ prosody include slowness of speech that can be described in terms of longer pauses and shorter utterances and monotonousness that can be described in terms of reduced pitch amplitude variability. We set to measure the acoustic characteristics in an objective, fully automated, low-priced method that utilizes free interactive speech. These objective measures might be used as a potential biomarker for SZ. The speech acoustic variables were compared to clinical rating scales extracted during the same interview of 20 clinically stable SZ patients (All paranoid type, 11 males, age 38.8±12.9y, education 13.7±2.2y), and 19 healthy controls (age 40.35±9.3y; 9 males; education 14.9±4.2y). The acoustic variables were highly correlated with the SANS Alogia and SANS Affect: Utterance Duration was correlated with both SANS alogia (R -0.44*) and SANS affect (R -0.58**), % Spoken in Utterance was correlated with SANS Alogia (R -0.75***) and SANS Affect (R -O.l2n). Pitch Variance was correlated with SANS Alogia (R -0.62**) and SANS Affect (R -0.64*). Pitch change was associated with SANS Alogia (R -0.54***) and SANS Affect (R -0.50*). Using acoustic variables we achieved a discrimination accuracy of 71 % between SZ and healthy subjects. Interactive free speech can be used to discriminate between SZ and healthy subjects.
The method is fully computerized hence could be easily applied real time in clinical setting. Our finding of a strong correlation between mean log duration of utterance and Alogia and Blunt Affect imply that this computerized model can be used to quantitY these domains instead of a human rater. The strong correlation between certain acoustic and socioeconomic variables implies that acoustic analysis could be used to assess certain aspects of community functioning in SZ. The limitations of the study include the small number of subjects, and no control for medications and past use of drugs. However, only stable outpatients were included. In the future we plan to investigate the method's potential for mass screening and evaluate its sensitivity to change including treatment response in both schizophrenia and depression. References [1] Alpert M, Shaw RI, Pouget ER, Lim KO. 2002. A comparison of clinical ratings with vocal acoustic measures of flat affect and Alogia J Psychiatr Res. Sep-Oct; 36(5):347-53. [2] Cannizzaro MS, Cohen H, Rappard F, Snyder PJ.2005. Bradyphrenia and bradykinesia both contribute to altered speech in schizophrenia: a quantitative acoustic study. Cogn Behav Neurol. Dec; 18(4):206-10. [3] Stassen HH, Albers M, Pusche1 J, Scharfetter C, Tewesmeier M, Woggon B. 1995. Speaking behavior and voice sound characteristics associated with negative schizophrenia. J Psychiatr Res. JuI-Aug; 29(4): 277-96.
1p.3.a.0391 Developing guidelines for the treatment of stable schizophrenia across primary and secondary care M. Agius 1 , S. Chapman2 , R. Zaman3 •. 1 University of Cambridge, Department of Psychiatry, Cambridge, United Kingdom; 2 University ofCambridge, Clinical School, Cambridge, United Kingdom; 3 University of Cambridge, Department of Psychisatry, Cambridge, United Kingdom Background: Commissioners of services are urging psychiatrists in the UK to return patients with stable mental health problems, including patients with a diagnosis of schizophrenia, to primary care. There is doubt whether primary care can adequately manage such patients. Aim: To conduct a literature search, taking into account more recent literature, as well as the NICE guidelines in order to investigate whether a shared care system can be developed in order to safely to return patients with stable mental health problems including schizophrenia to primary care. Method: A literature search using PUBMED, was carried out. Special attention was directed to large recent studies including CUTLASS(I), CATIE(2), SOHO, CAFE(3), and EUFEST. The studies were critically reviewed. The information gained from these papers was added to that on which NICE Guidelines are based, in order to update the present guidelines. Results: While patients with schizophrenia are under the care of the secondary care team, they will have a care- coordinator and a care plan supplied by that team, and in England will be subject to the Care Program Approach. While in secondary care, all patients should be assessed for risk factors, and should any be present, then the patients should be retained in the secondary care system. Once they have been discharged to primary care, it would be wise to arrange a shared care system to manage the patients. For schizophrenia, shared care should include review by a consultant psychiatrist at regular intervals, arrangement for a practice based health professional to implement a care plan, jointly