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Poster #T42 DURABILITY OF REINFORCEMENT LEARNING CHANGES AFTER COGNITIVE REMEDIATION
S304
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
confer vulnerability to addiction. Our objective was to identify a deficit in schizophrenia patients on response to rewarding stimuli and see whether this deficit predicts cannabis use. Methods: 35 schizophrenia patients and 35 non-psychotic controls were divided into cannabis users and non-users. Response to emotional and cannabis-associated visual stimuli was assessed using self-report, eventrelated potentials (using the late positive potential, LPP), motivated behaviour, facial electromyography, and skin-conductance response. Frequency of cannabis self-administration over the prior month was assessed on the test day and one month later. Results: Schizophrenia-spectrum patients showed blunted LPP response to pleasant stimuli compared to controls (p=0.003) and blunted reward seeking of pleasant stimuli (p=0.046). Across measures, cannabis-using controls showed significantly greater response to pleasant stimuli than to cannabis stimuli whereas cannabis-using patients showed little bias towards pleasant stimuli. More frequent subsequent cannabis use was predicted by blunted LPP response to pleasant stimuli (beta = −0.24, p=0.034) and blunted reward seeking of pleasant stimuli (beta = −0.34, p=0.006). Discussion: Reward processing deficits identified in schizophrenia may promote substance use and explain in part the common comorbidity of these two disorders. The LPP in particular shows potential as a biomarker related to schizophrenia which may be able to help identify patients at risk of heavy cannabis use. Targeting reward processing deficits may be a promising avenue in the development of interventions for reducing cannabis use in schizophrenia.
Poster #T42 DURABILITY OF REINFORCEMENT LEARNING CHANGES AFTER COGNITIVE REMEDIATION Matteo Cella 1,2 , Anthony Bishara 3 , Clare Reeder 2 , Til Wykes 1 1 Department of Psychology, Institute of Psychiatry, Kings College London; 2 King’s College London; 3 College of Charleston Background: Converging evidence suggests that individuals with schizophrenia show a marked impairment in reinforcement learning. Recent research showed that cognitive remediation (CR) can improve reward learning by altering sensitivity to reward and punishment. The aim of this study is to explore whether these gains can be sustained once therapy is finished and compare them to individuals assessed at the same intervals to assess whether practice has effects. Methods: Using computational modelling, two reinforcement learning parameters based on the Wisconsin Card Sorting Test (WCST) trial-by-trial performance were estimated: R (reward sensitivity) and P (punishment sensitivity). The durability of the cognitive remediation (CR) improvements on these parameters was assessed 3-months after the end of therapy in a group of individuals with schizophrenia who received CR (n=37) and compared to a group receiving treatment-as-usual (TAU, n=34).Neuropsychological and symptom assessments were also conducted. Results: Individuals in the CR group showed a significant reduction in both P and R gains at follow-up compared to TAU. In the CR group 14 participants maintained or improved in R levels at follow-up while 12 maintained or improved in P levels. Participants who maintain P levels had higher premorbid and actual IQ at baseline and working memory levels at follow-up compared to those who did not. The R retention sub-group was not associated with any variable measured. Most individuals in the TAU still failed to improve on both parameters at follow-up despite practice. Discussion: Retaining reward learning gains after CR may be difficult if patients are not provided with additional support. Despite overall group worsening in the CR group about a third of the participants maintained R and P gains without additional interventions. Punishment sensitivity gains retention seems to be affected by IQ levels and working memory.
Poster #T43 AUTOMATIC SELF-STIGMA-RELEVANT ASSOCIATIONS IN PEOPLE WITH SCHIZOPHRENIA EXPERIENCING HABITUAL SELF-STIGMA: EVIDENCE FROM THE BRIEF IMPLICIT ASSOCIATION TESTS Kevin K.S. Chan 1 , Winnie W.S. Mak 2
1
The Hong Kong Institute of Education; 2 The Chinese University of Hong Kong, Hong Kong
Background: While self-stigmatizing thoughts constitute a cognitive vulnerability factor for poor mental health, dysfunctional coping (i.e., experiential avoidance and lack of mindfulness) with self-stigma may pose an additional risk factor for this propensity by leading to frequent activation of self-stigmatization, which may then make self-stigmatizing thinking habitual and automatic (namely, a mental habit). This concept of habitual self-stigma points to the importance of understanding the automatic, implicit aspects of self-stigma. The present study aims to investigate the possibility of a pattern of more automatic self-stigma-relevant associations among people with schizophrenia having habitual self-stigma. Methods: A community sample of 62 people with schizophrenia spectrum or other psychotic disorder was recruited in Hong Kong. Habitual selfstigma was assessed with the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) scale. Considering that self-stigma refers to internalizing the negative attributes associated with the mental illness (MI) identity for the self, three different Brief Implicit Association Tests (BIATs) were used to assess the automatic processing of the “self-MI” association (i.e., high centrality of the MI identity to the self), the “MI-negative” association (i.e., negative attitudes toward MI), and the “self–negative” association (i.e., low self-esteem). Results: The automatic “self-MI” association (r=0.342, p=0.006), but not the “MI-negative” association (r=0.196; p=0.126) and the “self-negative” association (r=−0.079; p=0.544), was correlated with stronger self-stigmatizing thinking habit. Repetitive self-stigma (r=0.341, p=0.007) and automatic self-stigma (r=0.324, p=0.01) were also correlated with more automatic processing of the “self-MI” association. Discussion: While there has been extensive research on the demographic, clinical, and psychosocial correlates of self-stigma, there has been little research on its cognitive or information-processing profile. This study provides a direct test of the relevance of automatic evaluation in understanding the nature of automatic cognitive processing in habitual self-stigma. Our findings suggest that the mental illness identity may be more central to the self-definition of participants with stronger self-stigmatizing thinking habit. The significant correlation between the STAR scale and the automatic quality of response latencies in the BIAT strengthens the assumption that the scale does have validity in reflecting cognitive processes that take place automatically.
Poster #T44 THREE-YEAR OUTCOME COMPARISON BETWEEN PATIENTS PRESENTING WITH FIRST-EPISODE PSYCHOTIC MANIA AND SCHIZOPHRENIA TO EASY PROGRAM IN HONG KONG Chung W. Chang 1 , Emily S.K. Lau 2 , L.M. Hui 3 , K.W. Chan 3 , H.M. Lee 3 , Eric Y.H. Chen 3 1 Department of Psychiatry, The University of Hong Kong; 2 Queen Mary Hospital; 3 The University of Hong Kong Background: Early intervention for first-episode psychosis has been the focus of mental health care development worldwide in the past two decades. A majority of previous research focused mainly either on outcomes of a cohort of broad-spectrum psychotic disorders (first-episode psychosis) or patients with a more specific diagnostic entity, mostly schizophrenia. Despite the fact that bipolar affective disorder frequently occurs in late adolescence or early adulthood, and is associated with poor long-term functional impairment, relatively few studies have been conducted to examine the early course of the illness. In this study, we aimed to compare the 3-year clinical and functional outcomes between first-episode psychotic mania (FEPM) and first-episode schizophrenia (FES) in the context of early intervention program in Hong Kong. Methods: Four hundred-twenty patients aged 15 to 25 years presenting with first-episode ICD-10 psychotic mania or schizophrenia to a territorywide early intervention service in Hong Kong, namely Early Assessment Service for Young people with psychosis (EASY) between July 2001 and August 2003 and completed 3-year follow-up were included in the study. Socio-demographics, baseline and follow-up variables were obtained via systematic retrospective medical record review following standardized protocol. Symptom (CGI-S) and functional outcome (SOFAS) measures were
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
confer vulnerability to addiction. Our objective was to identify a deficit in schizophrenia patients on response to rewarding stimuli and see whether this deficit predicts cannabis use. Methods: 35 schizophrenia patients and 35 non-psychotic controls were divided into cannabis users and non-users. Response to emotional and cannabis-associated visual stimuli was assessed using self-report, eventrelated potentials (using the late positive potential, LPP), motivated behaviour, facial electromyography, and skin-conductance response. Frequency of cannabis self-administration over the prior month was assessed on the test day and one month later. Results: Schizophrenia-spectrum patients showed blunted LPP response to pleasant stimuli compared to controls (p=0.003) and blunted reward seeking of pleasant stimuli (p=0.046). Across measures, cannabis-using controls showed significantly greater response to pleasant stimuli than to cannabis stimuli whereas cannabis-using patients showed little bias towards pleasant stimuli. More frequent subsequent cannabis use was predicted by blunted LPP response to pleasant stimuli (beta = −0.24, p=0.034) and blunted reward seeking of pleasant stimuli (beta = −0.34, p=0.006). Discussion: Reward processing deficits identified in schizophrenia may promote substance use and explain in part the common comorbidity of these two disorders. The LPP in particular shows potential as a biomarker related to schizophrenia which may be able to help identify patients at risk of heavy cannabis use. Targeting reward processing deficits may be a promising avenue in the development of interventions for reducing cannabis use in schizophrenia.
Poster #T42 DURABILITY OF REINFORCEMENT LEARNING CHANGES AFTER COGNITIVE REMEDIATION Matteo Cella 1,2 , Anthony Bishara 3 , Clare Reeder 2 , Til Wykes 1 1 Department of Psychology, Institute of Psychiatry, Kings College London; 2 King’s College London; 3 College of Charleston Background: Converging evidence suggests that individuals with schizophrenia show a marked impairment in reinforcement learning. Recent research showed that cognitive remediation (CR) can improve reward learning by altering sensitivity to reward and punishment. The aim of this study is to explore whether these gains can be sustained once therapy is finished and compare them to individuals assessed at the same intervals to assess whether practice has effects. Methods: Using computational modelling, two reinforcement learning parameters based on the Wisconsin Card Sorting Test (WCST) trial-by-trial performance were estimated: R (reward sensitivity) and P (punishment sensitivity). The durability of the cognitive remediation (CR) improvements on these parameters was assessed 3-months after the end of therapy in a group of individuals with schizophrenia who received CR (n=37) and compared to a group receiving treatment-as-usual (TAU, n=34).Neuropsychological and symptom assessments were also conducted. Results: Individuals in the CR group showed a significant reduction in both P and R gains at follow-up compared to TAU. In the CR group 14 participants maintained or improved in R levels at follow-up while 12 maintained or improved in P levels. Participants who maintain P levels had higher premorbid and actual IQ at baseline and working memory levels at follow-up compared to those who did not. The R retention sub-group was not associated with any variable measured. Most individuals in the TAU still failed to improve on both parameters at follow-up despite practice. Discussion: Retaining reward learning gains after CR may be difficult if patients are not provided with additional support. Despite overall group worsening in the CR group about a third of the participants maintained R and P gains without additional interventions. Punishment sensitivity gains retention seems to be affected by IQ levels and working memory.
Poster #T43 AUTOMATIC SELF-STIGMA-RELEVANT ASSOCIATIONS IN PEOPLE WITH SCHIZOPHRENIA EXPERIENCING HABITUAL SELF-STIGMA: EVIDENCE FROM THE BRIEF IMPLICIT ASSOCIATION TESTS Kevin K.S. Chan 1 , Winnie W.S. Mak 2
1
The Hong Kong Institute of Education; 2 The Chinese University of Hong Kong, Hong Kong
Background: While self-stigmatizing thoughts constitute a cognitive vulnerability factor for poor mental health, dysfunctional coping (i.e., experiential avoidance and lack of mindfulness) with self-stigma may pose an additional risk factor for this propensity by leading to frequent activation of self-stigmatization, which may then make self-stigmatizing thinking habitual and automatic (namely, a mental habit). This concept of habitual self-stigma points to the importance of understanding the automatic, implicit aspects of self-stigma. The present study aims to investigate the possibility of a pattern of more automatic self-stigma-relevant associations among people with schizophrenia having habitual self-stigma. Methods: A community sample of 62 people with schizophrenia spectrum or other psychotic disorder was recruited in Hong Kong. Habitual selfstigma was assessed with the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) scale. Considering that self-stigma refers to internalizing the negative attributes associated with the mental illness (MI) identity for the self, three different Brief Implicit Association Tests (BIATs) were used to assess the automatic processing of the “self-MI” association (i.e., high centrality of the MI identity to the self), the “MI-negative” association (i.e., negative attitudes toward MI), and the “self–negative” association (i.e., low self-esteem). Results: The automatic “self-MI” association (r=0.342, p=0.006), but not the “MI-negative” association (r=0.196; p=0.126) and the “self-negative” association (r=−0.079; p=0.544), was correlated with stronger self-stigmatizing thinking habit. Repetitive self-stigma (r=0.341, p=0.007) and automatic self-stigma (r=0.324, p=0.01) were also correlated with more automatic processing of the “self-MI” association. Discussion: While there has been extensive research on the demographic, clinical, and psychosocial correlates of self-stigma, there has been little research on its cognitive or information-processing profile. This study provides a direct test of the relevance of automatic evaluation in understanding the nature of automatic cognitive processing in habitual self-stigma. Our findings suggest that the mental illness identity may be more central to the self-definition of participants with stronger self-stigmatizing thinking habit. The significant correlation between the STAR scale and the automatic quality of response latencies in the BIAT strengthens the assumption that the scale does have validity in reflecting cognitive processes that take place automatically.
Poster #T44 THREE-YEAR OUTCOME COMPARISON BETWEEN PATIENTS PRESENTING WITH FIRST-EPISODE PSYCHOTIC MANIA AND SCHIZOPHRENIA TO EASY PROGRAM IN HONG KONG Chung W. Chang 1 , Emily S.K. Lau 2 , L.M. Hui 3 , K.W. Chan 3 , H.M. Lee 3 , Eric Y.H. Chen 3 1 Department of Psychiatry, The University of Hong Kong; 2 Queen Mary Hospital; 3 The University of Hong Kong Background: Early intervention for first-episode psychosis has been the focus of mental health care development worldwide in the past two decades. A majority of previous research focused mainly either on outcomes of a cohort of broad-spectrum psychotic disorders (first-episode psychosis) or patients with a more specific diagnostic entity, mostly schizophrenia. Despite the fact that bipolar affective disorder frequently occurs in late adolescence or early adulthood, and is associated with poor long-term functional impairment, relatively few studies have been conducted to examine the early course of the illness. In this study, we aimed to compare the 3-year clinical and functional outcomes between first-episode psychotic mania (FEPM) and first-episode schizophrenia (FES) in the context of early intervention program in Hong Kong. Methods: Four hundred-twenty patients aged 15 to 25 years presenting with first-episode ICD-10 psychotic mania or schizophrenia to a territorywide early intervention service in Hong Kong, namely Early Assessment Service for Young people with psychosis (EASY) between July 2001 and August 2003 and completed 3-year follow-up were included in the study. Socio-demographics, baseline and follow-up variables were obtained via systematic retrospective medical record review following standardized protocol. Symptom (CGI-S) and functional outcome (SOFAS) measures were