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Poster #S193 SOCIAL COGNITION TRAINING FOR PEOPLE WITH SCHIZOPHRENIA: A RANDOMISED STUDY
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
working memory test (n=102 cases) and attention. (n=121 cases). The time required for administration of the MATRICS battery was on average 67 minutes and the time required for analysies of scores and classificaon 45 minutes. Individuals with classified as having congitive impairment had more greater severity of negative symptoms, and were slightly older than those without congitive impairment. Useing the Cognigram system, 162 cases of congitive impairment were classified in the schizophrenia sample with an agreement in classification of 94%. Time for admonoistraiton of the Cognigram system was 15 minutes and scoring was immediate. Discussion: These data suggest that it is possible to use a small battery of cognitive tests to identify the prsence of congitive impairment in indiviual patients with schizophrenia. Use of the Cognigram system to identify cognitive impairment provided a high degree wof agreement with conventional neuropsychological testing and analysis, yet was completed in much less time. Screening for congitive impairment in schizophrenia may be kimportant for identifying people who would benefit from treatment with putative cognitive enhancing drugs
Poster #S191 THE CHICKEN OR THE EGG? – AN INVESTIGATION OF COGNITIVE AND NON-COGNITIVE IMPAIRMENTS IN SCHIZOPHRENIA IN THE LIGHT OF GOAL-DIRECTED BEHAVIOURS’ IMPLEMENTATION Rinaldi Romina 1,2 , Lefebvre Laurent 3 Neuropsychology; 2 Cognitive Sciences; 3 UMONS
1
Background: For 20 years, deficits of goal-directed behaviours (GDB) have been considered a key feature in schizophrenia. GDB refer to behaviours generated following a given objective by building a plan and selecting actions. These actions should lead to the attended goal either immediately or within a longer period. These types of actions are involved in most of the complex or novel situation a subject may encounter, regardless of the cognitive, affective or social abilities this situation implies. Yet so far, few studies have attempted to investigate the clinical impact of these disorders. There is clearly a wide range of investigations in the field of the medical imagery; however, they do not capture the important relevance of these disorders in understanding cognitive and behavioural deficits in schizophrenia. Our study aims to address the question of GDB impairments from a clinical angle by investigating how constraints and instructions can impact the subject’s performances in cognitive and visuomotor tasks. Methods: 50 to 100 in- and outpatients are currently assessed with two programs: one using verbal fluency (semantic and letter fluencies), and the other using a visuomotor task (in which subjects have to hit targets on a touch screen). Those programs are built so as to vary the conditions for carrying out the task from the freer to the most constrained. To do so, in both of the tasks, the subjects have to complete a free condition task (“do however they want”) and then they are given contextual cues that are either words (for the verbal fluency) or instructions (for the visuomotor task) which are supposed to structure their responses. Three conditions are then proposed: one free, one fully cued (structured) and one with less directive or indirect cues (semi-structured). Besides, anamnestic (age, sex, schooling), clinical (PANSS, BPRS, LARS, neuroleptic dose, additional treatment and duration of illness) and cognitive (mental flexibility, inhibition, attentional shifting, sustained attention and verbal IQ) features are considered. Results: Preliminary data on 20 subjects (10 men and 10 women; age: 44±10.98; schooling: 10.8±1.79 school years completed) show that in verbal fluency, patients benefit from the structuring procedures in semantic fluency (number of words produced) as much as cueing is strong (structured fluency>classic fluency**; semi-structured fluency>classic fluency*); but also in letter fluency (structured fluency>classic fluency**) in which cues also help subjects in organizing their responses (clusters in structured letter fluency>clusters in classic letter fluency**). Results display the same pattern for the visuomotor task (number of hits) (structured condition>semi-structured condition>free condition**). Finally, among all the anamnestic, clinical and cognitive controlled features, only mental flexibility significantly correlates with the ability to benefit from cueing in the verbal, but also in the visuomotor task. Discussion: Preliminary data show that patients could benefit from cueing in cognitive and visuomotor tasks in terms of efficiency but also in terms of responses organization, regardless of their anamnestic, cognitive or clinical
S159
profile. This suggests that both cognitive and non-cognitive impairments found in a wide range of abilities in patients with schizophrenia could be underlined by the same deficit mechanism in the implementation of goal-directed behaviours; which could be offset by structuring procedures. Results of the entire sample (including subjects with schizophrenia and a control group) will be presented and the specific nature of the impaired mechanism (initiation versus planning) will be discussed. *p<0.05 **p<0.01
Poster #S192 EXAMINING THE IMPACT OF NEUROCOGNITIVE AND LANGUAGE IMPAIRMENTS ON FORMAL THOUGHT DISORDER IN SCHIZOPHRENIA Eric Tan 1 , Gregory Yelland 1 , Susan Rossell 2 Monash University; 2 Brain and Psychological Sciences Research Centre, Swinburne University
1
Background: Formal thought disorder (FTD) in schizophrenia has been associated with both cognitive and language impairments. However, there is still considerable debate regarding the degree to which each contributes to FTD. There has also been evidence that neurocognition is related to language processing abilities (Bagner et al., 2003). In this study, we chose to focus on receptive language impairments in schizophrenia. In particular, we investigated receptive language impairments at both the single word and sentence levels. This study had two aims: (i) to examine which cognitive impairments are related to FTD and, (ii) to explore if FTD has any language-specific symptoms, independent of neurocognition. Methods: 9 schizophrenia/schizoaffective patients with diagnosed FTD, 48 schizophrenia/schizoaffective disorder patients without diagnosed FTD and 48 healthy controls completed the MATRICS battery and D-KEFS Stroop task assessing general neurocognition and inhibition, as well as two language tasks assessing synonym identification (lexical semantics) and sentence meanings (syntax). Clinical symptoms were rated using the PANSS, and FTD was rated using the TLC (Andreasen, 1979) and PANSS P2. Results: Cognitive assessment results revealed FTD patients performed worse than non-FTD patients on measures of semantic and executive processing (p<0.05), with both groups poorer than controls (p<0.01). This supports indications of concurrent semantic and executive dysfunction, and suggests that a combination of both may relate to manifest FTD. Language assessment results revealed impairments in FTD compared to non-FTD patients and controls in the recognition of homophones (but not antonyms) and sentence comprehension (syntax). This supports language processing impairments at both the single word and sentence levels in FTD. A significant relationship between positive FTD symptoms and syntactic problems (p<0.001) was found to hold even after controlling for neurocognitive deficits (semantic and executive). The relationship between FTD and homophone choice did not hold. This provides evidence that a language-specific impairment of syntactic ability is present in schizophrenia, and exacerbated in FTD. Discussion: Overall, this study supports current cognitive and language theories of impairment in FTD, with evidence for concurrence of both. Syntactic impairments reflect a specific deficit in language processing; which contribute to FTD severity in combination with executive and semantic dysfunction.
Poster #S193 SOCIAL COGNITION TRAINING FOR PEOPLE WITH SCHIZOPHRENIA: A RANDOMISED STUDY Matteo Cella 1,2 , Rumina Taylor 2 , Emese Csipke 2 , Charles Heriot-Maitland 2 , Til Wykes 1 1 Department of Psychology, Institute of Psychiatry, Kings College London; 2 King’s College London Background: Social functioning deficits are common in people with schizophrenia and were shown to be important prognostic indicators. Social Cognition and Interaction Training (SCIT) is a manual-based treatment designed to improve social functioning in people with schizophrenia by enhancing social cognition. The aim of this study was to evaluate the feasibility, acceptability, and efficacy of SCIT in male inpatient forensic wards.
S160
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
Methods: The study is a randomised single blind controlled, crossover design, with 21 participants randomised to SCIT and 15 to treatment as usual (TAU). SCIT treatment consisted of eight-week therapy sessions twice per week. Participants were assessed before and after the intervention period with measures of symptoms, affect recognition, theory of mind and attributional style. Feasibility was assessed through group attendance. Participant acceptability was evaluated through post-group satisfaction and social goals achievement. Results: The group was well received by all participants and the majority reported their confidence had improved following the intervention. Almost two thirds of the SCIT participants agreed they had achieved their social goal as a result of the intervention. Participants in the SCIT group showed a significant improvement in affect recognition compared to TAU. However, the two groups did not differ in theory of mind and attributional style after therapy. Discussion: It is feasible to deliver SCIT in forensic ward setting and the intervention improved affect recognition. Some adaptations may be needed in order to accommodate for the reduced social contact of forensic wards.
Poster #S194 ROLL-OUT AND IMPACTS OF DJ’S CHOICES WORKSHOPS Marie-france Demers 1,2 , Julie Bourbeau 1 , Claudia Lévesque 1 , Lysanne Gauthier 1 , Marc-André Roy 3,1 1 Institut universitaire en santé mentale de Québec; 2 Centre de recherche de l’Institut universitaire en santé mentale de Québec; 3 Université Laval Background: Since 2010, in Quebec province, several teams are familiar with the DJ’s Choices program to promote treatment adherence in patients suffering from psychosis. In addition to a short introduction to the program, these teams have expressed a need for support and training to embrace an interdisciplinary approach combining psychosocial and medical perspectives. The goal of our communication is to describe our multicenter project that will assess the impact of DJ’s Choices approach roll-out in different settings. This project therefore pursues the following objectives: 1) To ensure the roll-out of DJ’s Choices workshops in their current format as resources for specialized and primary care teams. This means organizing and supporting the roll-out of such a program for teams caring for people with mental illness, including specialized and primary care teams from a representative selection of facilities within the Québec province; 2) To assess the impact of the distribution of this program on patients, care providers and the organization, using treatment adherence indicators in exposed individuals and satisfaction, skill enhancement and cross-sharing indicators in professionals involved in implementation. Methods: The roll-out of DJ’s Choices workshops will rely on INSPQ (Institut national de santé publique du Québec) theoretical model for knowledge transfer, including its eight stages (production/co-production of the support and training program content, program adaptation, distribution, reception, adoption, appropriation, use of knowledge and assessment of results). A first qualitative phase will be conducted through an initial telephone survey of key players (care providers already exposed to the program and individuals targeted to receive training) using a set questionnaire. Analysis of this data will provide a basis for creating a program targeting training and support for the DJ’s Choices workshops roll-out. A roll-out kit will then be developed to support DJ’s kit deployment in these identified settings Results: The impacts observed in care providers and individuals living with psychosis exposed to the program will be assessed before, during and after the program over a 3 years period. Nine sites will be included, some from university clinics, others, from community settings in the Quebec province. Several indicators of impact will be collected at three main levels: 1) In patients: Combined assessment measures for adherence (e.g., self-report adherence scales, prescription renewal at the pharmacy, overall clinical assessment according to care providers’ impressions, medication counting where possible) will be collected before, during and after program roll-out. 2) In health care providers: basic knowledge concerning psychopharmacology and facilitation techniques inspired by the motivational approach and cognitive behavioral therapy will be assessed throughout the three stages of the project. 3) In organizations: We will carefully describe the different organizational environments in which the program will roll out and will identify the factors that promote or restrict program roll-out in the different settings
Discussion: This project will include systematic assessment of the impacts of the DJ’s Choices roll-out in a representative sample of different psychiatric care settings in Quebec. In the long term, it aims to improve the efficiency of the distribution of this innovative treatment adherence support to all settings in the province
Poster #S195 PREVENTION OF WEIGHT GAIN IN EARLY PSYCHOSIS: A RANDOMIZED CONTROLLED CLINICAL TRIAL OF 16-WEEK STEPPED BEHAVIORAL INTERVENTION Rohan Ganguli 1,2 , Sabrina Hassan 3 , Mehreen Bhamani 3 , Todd Jenking 3 1 Psychiatry; 2 Professor of Psychiatry, University of Pittsburgh; 3 CAMH Background: Patients with serious mental disorders are at higher risk of being overweight and obese which increases their vulnerability to cardiovascular morbidities and mortalities. Along with unhealthy dietary habits and higher physical inactivity in patients with psychosis, the use of novel antipsychotic drugs is highly associated with weight gain especially in early phase of treatment. The degree of weight gain varies by the type of antipsychotic medications being used, with clozapine and olanzapine are most likely to cause weight gain, followed closely by risperidone and quetiapine. The higher prevalence of obesity in patients receiving antipsychotic treatment, directs our attention towards developing strategies to reduce weight gain in this high risk group. The aim of the study therefore, was to evaluate whether a “stepped behavioral intervention” is effective in preventing weight gain in early psychotic patients as compared to usual care. Methods: This was a parallel group randomized control trial (RCT) in which sixty participants diagnosed with an early psychotic illness (schizophrenia, schizoaffective disorder, bipolar disorder, psychosis NOS, within 5 years of illness-onset) were recruited for a 16-week intervention program. After providing informed consent, the participants who met the enrollment criteria were randomly assigned to either get a stepped behavioral intervention (SBI) (n∼30) or treatment as usual (TAU) (routine care, n∼30). The prevention of weight gain (increase over baseline) in two groups, using chi-square test, was the primary outcome measure, with mean change in weight as a secondary outcome (t test). Results: Sixty two percent of the participants were male, most were single and young with a mean age of 24.5 + 5.8 years. Fifty five percent of the participants were of European ancestry followed by 22% of African ancestry. Only 4 of the participants were employed. Out of 60 participants, regardless of treatment assignment, 12 did not gain any weight. And of these 83% were in SBI group as compared to only 17% in the control group (P value = 0.034). The mean change in weight was 2.27 + 4.7 in SBI group and 4.61 + 4.6in TAU group (P value= 0.08). Further, all participants gaining more than 20% over baseline weight were in the TAU group. Overall, the participants in the SBI were significantly less likely to gain weight and their mean weight gain was also lower (approaching significance) than for the TAU group. Discussion: The findings of our study have important public health implications. Weight gain in early psychosis, partly associated with the use of antipsychotic medications make the psychotic individual vulnerable to obesity related complications which may lead to inferior quality of life and decrease life expectancy. The SBI, evaluated in this clinical trial, shows promise in preventing weight gain in these individuals with a serious mental disorder. Such interventions not only increase the awareness about the benefits of healthy life style but also motivate the patients to adopt them as part of their daily routine. Numerous studies of patients with chronic illness and established obesity have demonstrated that behavioral interventions can be effective in inducing weight loss. However, prevention of weight gain is likely to be even more effective in reducing the risk of both diabetes and cardiovascular diseases in this population, and to also more effectively reduce disability and premature mortality.
working memory test (n=102 cases) and attention. (n=121 cases). The time required for administration of the MATRICS battery was on average 67 minutes and the time required for analysies of scores and classificaon 45 minutes. Individuals with classified as having congitive impairment had more greater severity of negative symptoms, and were slightly older than those without congitive impairment. Useing the Cognigram system, 162 cases of congitive impairment were classified in the schizophrenia sample with an agreement in classification of 94%. Time for admonoistraiton of the Cognigram system was 15 minutes and scoring was immediate. Discussion: These data suggest that it is possible to use a small battery of cognitive tests to identify the prsence of congitive impairment in indiviual patients with schizophrenia. Use of the Cognigram system to identify cognitive impairment provided a high degree wof agreement with conventional neuropsychological testing and analysis, yet was completed in much less time. Screening for congitive impairment in schizophrenia may be kimportant for identifying people who would benefit from treatment with putative cognitive enhancing drugs
Poster #S191 THE CHICKEN OR THE EGG? – AN INVESTIGATION OF COGNITIVE AND NON-COGNITIVE IMPAIRMENTS IN SCHIZOPHRENIA IN THE LIGHT OF GOAL-DIRECTED BEHAVIOURS’ IMPLEMENTATION Rinaldi Romina 1,2 , Lefebvre Laurent 3 Neuropsychology; 2 Cognitive Sciences; 3 UMONS
1
Background: For 20 years, deficits of goal-directed behaviours (GDB) have been considered a key feature in schizophrenia. GDB refer to behaviours generated following a given objective by building a plan and selecting actions. These actions should lead to the attended goal either immediately or within a longer period. These types of actions are involved in most of the complex or novel situation a subject may encounter, regardless of the cognitive, affective or social abilities this situation implies. Yet so far, few studies have attempted to investigate the clinical impact of these disorders. There is clearly a wide range of investigations in the field of the medical imagery; however, they do not capture the important relevance of these disorders in understanding cognitive and behavioural deficits in schizophrenia. Our study aims to address the question of GDB impairments from a clinical angle by investigating how constraints and instructions can impact the subject’s performances in cognitive and visuomotor tasks. Methods: 50 to 100 in- and outpatients are currently assessed with two programs: one using verbal fluency (semantic and letter fluencies), and the other using a visuomotor task (in which subjects have to hit targets on a touch screen). Those programs are built so as to vary the conditions for carrying out the task from the freer to the most constrained. To do so, in both of the tasks, the subjects have to complete a free condition task (“do however they want”) and then they are given contextual cues that are either words (for the verbal fluency) or instructions (for the visuomotor task) which are supposed to structure their responses. Three conditions are then proposed: one free, one fully cued (structured) and one with less directive or indirect cues (semi-structured). Besides, anamnestic (age, sex, schooling), clinical (PANSS, BPRS, LARS, neuroleptic dose, additional treatment and duration of illness) and cognitive (mental flexibility, inhibition, attentional shifting, sustained attention and verbal IQ) features are considered. Results: Preliminary data on 20 subjects (10 men and 10 women; age: 44±10.98; schooling: 10.8±1.79 school years completed) show that in verbal fluency, patients benefit from the structuring procedures in semantic fluency (number of words produced) as much as cueing is strong (structured fluency>classic fluency**; semi-structured fluency>classic fluency*); but also in letter fluency (structured fluency>classic fluency**) in which cues also help subjects in organizing their responses (clusters in structured letter fluency>clusters in classic letter fluency**). Results display the same pattern for the visuomotor task (number of hits) (structured condition>semi-structured condition>free condition**). Finally, among all the anamnestic, clinical and cognitive controlled features, only mental flexibility significantly correlates with the ability to benefit from cueing in the verbal, but also in the visuomotor task. Discussion: Preliminary data show that patients could benefit from cueing in cognitive and visuomotor tasks in terms of efficiency but also in terms of responses organization, regardless of their anamnestic, cognitive or clinical
S159
profile. This suggests that both cognitive and non-cognitive impairments found in a wide range of abilities in patients with schizophrenia could be underlined by the same deficit mechanism in the implementation of goal-directed behaviours; which could be offset by structuring procedures. Results of the entire sample (including subjects with schizophrenia and a control group) will be presented and the specific nature of the impaired mechanism (initiation versus planning) will be discussed. *p<0.05 **p<0.01
Poster #S192 EXAMINING THE IMPACT OF NEUROCOGNITIVE AND LANGUAGE IMPAIRMENTS ON FORMAL THOUGHT DISORDER IN SCHIZOPHRENIA Eric Tan 1 , Gregory Yelland 1 , Susan Rossell 2 Monash University; 2 Brain and Psychological Sciences Research Centre, Swinburne University
1
Background: Formal thought disorder (FTD) in schizophrenia has been associated with both cognitive and language impairments. However, there is still considerable debate regarding the degree to which each contributes to FTD. There has also been evidence that neurocognition is related to language processing abilities (Bagner et al., 2003). In this study, we chose to focus on receptive language impairments in schizophrenia. In particular, we investigated receptive language impairments at both the single word and sentence levels. This study had two aims: (i) to examine which cognitive impairments are related to FTD and, (ii) to explore if FTD has any language-specific symptoms, independent of neurocognition. Methods: 9 schizophrenia/schizoaffective patients with diagnosed FTD, 48 schizophrenia/schizoaffective disorder patients without diagnosed FTD and 48 healthy controls completed the MATRICS battery and D-KEFS Stroop task assessing general neurocognition and inhibition, as well as two language tasks assessing synonym identification (lexical semantics) and sentence meanings (syntax). Clinical symptoms were rated using the PANSS, and FTD was rated using the TLC (Andreasen, 1979) and PANSS P2. Results: Cognitive assessment results revealed FTD patients performed worse than non-FTD patients on measures of semantic and executive processing (p<0.05), with both groups poorer than controls (p<0.01). This supports indications of concurrent semantic and executive dysfunction, and suggests that a combination of both may relate to manifest FTD. Language assessment results revealed impairments in FTD compared to non-FTD patients and controls in the recognition of homophones (but not antonyms) and sentence comprehension (syntax). This supports language processing impairments at both the single word and sentence levels in FTD. A significant relationship between positive FTD symptoms and syntactic problems (p<0.001) was found to hold even after controlling for neurocognitive deficits (semantic and executive). The relationship between FTD and homophone choice did not hold. This provides evidence that a language-specific impairment of syntactic ability is present in schizophrenia, and exacerbated in FTD. Discussion: Overall, this study supports current cognitive and language theories of impairment in FTD, with evidence for concurrence of both. Syntactic impairments reflect a specific deficit in language processing; which contribute to FTD severity in combination with executive and semantic dysfunction.
Poster #S193 SOCIAL COGNITION TRAINING FOR PEOPLE WITH SCHIZOPHRENIA: A RANDOMISED STUDY Matteo Cella 1,2 , Rumina Taylor 2 , Emese Csipke 2 , Charles Heriot-Maitland 2 , Til Wykes 1 1 Department of Psychology, Institute of Psychiatry, Kings College London; 2 King’s College London Background: Social functioning deficits are common in people with schizophrenia and were shown to be important prognostic indicators. Social Cognition and Interaction Training (SCIT) is a manual-based treatment designed to improve social functioning in people with schizophrenia by enhancing social cognition. The aim of this study was to evaluate the feasibility, acceptability, and efficacy of SCIT in male inpatient forensic wards.
S160
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
Methods: The study is a randomised single blind controlled, crossover design, with 21 participants randomised to SCIT and 15 to treatment as usual (TAU). SCIT treatment consisted of eight-week therapy sessions twice per week. Participants were assessed before and after the intervention period with measures of symptoms, affect recognition, theory of mind and attributional style. Feasibility was assessed through group attendance. Participant acceptability was evaluated through post-group satisfaction and social goals achievement. Results: The group was well received by all participants and the majority reported their confidence had improved following the intervention. Almost two thirds of the SCIT participants agreed they had achieved their social goal as a result of the intervention. Participants in the SCIT group showed a significant improvement in affect recognition compared to TAU. However, the two groups did not differ in theory of mind and attributional style after therapy. Discussion: It is feasible to deliver SCIT in forensic ward setting and the intervention improved affect recognition. Some adaptations may be needed in order to accommodate for the reduced social contact of forensic wards.
Poster #S194 ROLL-OUT AND IMPACTS OF DJ’S CHOICES WORKSHOPS Marie-france Demers 1,2 , Julie Bourbeau 1 , Claudia Lévesque 1 , Lysanne Gauthier 1 , Marc-André Roy 3,1 1 Institut universitaire en santé mentale de Québec; 2 Centre de recherche de l’Institut universitaire en santé mentale de Québec; 3 Université Laval Background: Since 2010, in Quebec province, several teams are familiar with the DJ’s Choices program to promote treatment adherence in patients suffering from psychosis. In addition to a short introduction to the program, these teams have expressed a need for support and training to embrace an interdisciplinary approach combining psychosocial and medical perspectives. The goal of our communication is to describe our multicenter project that will assess the impact of DJ’s Choices approach roll-out in different settings. This project therefore pursues the following objectives: 1) To ensure the roll-out of DJ’s Choices workshops in their current format as resources for specialized and primary care teams. This means organizing and supporting the roll-out of such a program for teams caring for people with mental illness, including specialized and primary care teams from a representative selection of facilities within the Québec province; 2) To assess the impact of the distribution of this program on patients, care providers and the organization, using treatment adherence indicators in exposed individuals and satisfaction, skill enhancement and cross-sharing indicators in professionals involved in implementation. Methods: The roll-out of DJ’s Choices workshops will rely on INSPQ (Institut national de santé publique du Québec) theoretical model for knowledge transfer, including its eight stages (production/co-production of the support and training program content, program adaptation, distribution, reception, adoption, appropriation, use of knowledge and assessment of results). A first qualitative phase will be conducted through an initial telephone survey of key players (care providers already exposed to the program and individuals targeted to receive training) using a set questionnaire. Analysis of this data will provide a basis for creating a program targeting training and support for the DJ’s Choices workshops roll-out. A roll-out kit will then be developed to support DJ’s kit deployment in these identified settings Results: The impacts observed in care providers and individuals living with psychosis exposed to the program will be assessed before, during and after the program over a 3 years period. Nine sites will be included, some from university clinics, others, from community settings in the Quebec province. Several indicators of impact will be collected at three main levels: 1) In patients: Combined assessment measures for adherence (e.g., self-report adherence scales, prescription renewal at the pharmacy, overall clinical assessment according to care providers’ impressions, medication counting where possible) will be collected before, during and after program roll-out. 2) In health care providers: basic knowledge concerning psychopharmacology and facilitation techniques inspired by the motivational approach and cognitive behavioral therapy will be assessed throughout the three stages of the project. 3) In organizations: We will carefully describe the different organizational environments in which the program will roll out and will identify the factors that promote or restrict program roll-out in the different settings
Discussion: This project will include systematic assessment of the impacts of the DJ’s Choices roll-out in a representative sample of different psychiatric care settings in Quebec. In the long term, it aims to improve the efficiency of the distribution of this innovative treatment adherence support to all settings in the province
Poster #S195 PREVENTION OF WEIGHT GAIN IN EARLY PSYCHOSIS: A RANDOMIZED CONTROLLED CLINICAL TRIAL OF 16-WEEK STEPPED BEHAVIORAL INTERVENTION Rohan Ganguli 1,2 , Sabrina Hassan 3 , Mehreen Bhamani 3 , Todd Jenking 3 1 Psychiatry; 2 Professor of Psychiatry, University of Pittsburgh; 3 CAMH Background: Patients with serious mental disorders are at higher risk of being overweight and obese which increases their vulnerability to cardiovascular morbidities and mortalities. Along with unhealthy dietary habits and higher physical inactivity in patients with psychosis, the use of novel antipsychotic drugs is highly associated with weight gain especially in early phase of treatment. The degree of weight gain varies by the type of antipsychotic medications being used, with clozapine and olanzapine are most likely to cause weight gain, followed closely by risperidone and quetiapine. The higher prevalence of obesity in patients receiving antipsychotic treatment, directs our attention towards developing strategies to reduce weight gain in this high risk group. The aim of the study therefore, was to evaluate whether a “stepped behavioral intervention” is effective in preventing weight gain in early psychotic patients as compared to usual care. Methods: This was a parallel group randomized control trial (RCT) in which sixty participants diagnosed with an early psychotic illness (schizophrenia, schizoaffective disorder, bipolar disorder, psychosis NOS, within 5 years of illness-onset) were recruited for a 16-week intervention program. After providing informed consent, the participants who met the enrollment criteria were randomly assigned to either get a stepped behavioral intervention (SBI) (n∼30) or treatment as usual (TAU) (routine care, n∼30). The prevention of weight gain (increase over baseline) in two groups, using chi-square test, was the primary outcome measure, with mean change in weight as a secondary outcome (t test). Results: Sixty two percent of the participants were male, most were single and young with a mean age of 24.5 + 5.8 years. Fifty five percent of the participants were of European ancestry followed by 22% of African ancestry. Only 4 of the participants were employed. Out of 60 participants, regardless of treatment assignment, 12 did not gain any weight. And of these 83% were in SBI group as compared to only 17% in the control group (P value = 0.034). The mean change in weight was 2.27 + 4.7 in SBI group and 4.61 + 4.6in TAU group (P value= 0.08). Further, all participants gaining more than 20% over baseline weight were in the TAU group. Overall, the participants in the SBI were significantly less likely to gain weight and their mean weight gain was also lower (approaching significance) than for the TAU group. Discussion: The findings of our study have important public health implications. Weight gain in early psychosis, partly associated with the use of antipsychotic medications make the psychotic individual vulnerable to obesity related complications which may lead to inferior quality of life and decrease life expectancy. The SBI, evaluated in this clinical trial, shows promise in preventing weight gain in these individuals with a serious mental disorder. Such interventions not only increase the awareness about the benefits of healthy life style but also motivate the patients to adopt them as part of their daily routine. Numerous studies of patients with chronic illness and established obesity have demonstrated that behavioral interventions can be effective in inducing weight loss. However, prevention of weight gain is likely to be even more effective in reducing the risk of both diabetes and cardiovascular diseases in this population, and to also more effectively reduce disability and premature mortality.