Abstract
BackgroundDeficits in mentalizing – i.e. the ability to understand one’s own and another’s behavior in terms of mental states such as beliefs, feelings and intentions – have been widely observed in patients with non-affective psychotic disorder (NAPD). In turn, robust evidence has shown these impairments to be related to social dysfunction and negative symptoms. However, few treatments have been developed to effectively treat impaired mentalizing, in spite of its increased recognition as an important treatment target. Mentalization based treatment (MBT) is a psychodynamic therapy rooted in attachment theory, originally developed and empirically found to be effective in treating borderline personality disorder. MBT for psychotic disorder aims to improve social functioning in NAPD patients by targeting impaired mentalizing.MethodsThe study is a multicenter, rater-blinded, randomized controlled trial. Ninety patients, who were diagnosed with NAPD by a psychiatrist and whose diagnosis was confirmed by researchers with the CASH, were recruited from community treatment teams in the Netherlands. They were randomly allocated to either treatment as usual plus MBT or to treatment as usual only. MBT consisted of 18 months of group therapy (one hour weekly) and individual therapy (30 minutes per two weeks). Patients had a mean age of 31.48 years (SD = 8.87) and a mean duration since onset of psychosis of 5.53 years (SD = 3.65). The primary outcome variable was social functioning (measured with the Social Functioning Scale). Other outcome variables were positive, negative, depressive, and anxious symptoms, as well as insight (PANSS), quality of life (MANSA), substance abuse, social stress reactivity (Experience Sampling Method), and mentalizing capacity (Social Cognition and Object-Relations System; Hinting Task).ResultsThis will be the first presentation of our trial results.DiscussionThe clinical implications of the results and limitations of the trial will be discussed. Theoretical considerations suggest that mentalization-based treatment could be an effective treatment for social dysfunction and impaired mentalizing in NAPD. If Mentalization-based treatment for psychotic disorders proves to be effective at improving social functioning and mentalizing, it may provide a valuable addition to treatment as usual.
Highlights
Lumateperone (ITI-007) is a first-in-class investigational agent in development for the treatment of schizophrenia
Given the previous observation that RG7203 enhanced reward functions in healthy volunteers who were not treated with D2 antagonist, the results of our study point to potentially deleterious effects of D2 blockade on reward functions and by extension on negative symptoms of schizophrenia
In all 3 studies, the primary endpoint was change from baseline on the Positive and Negative Syndrome Scale (PANSS) total score compared to placebo
Summary
S341 activity during the MID task and not related to the difference of BOLD activity during reward anticipation versus the control condition. Given the previous observation that RG7203 enhanced reward functions in healthy volunteers who were not treated with D2 antagonist, the results of our study point to potentially deleterious effects of D2 blockade on reward functions and by extension on negative symptoms of schizophrenia. They raise the question if the presence of D2 antagonistic treatment curtails the potential effects of any adjunctive treatment for negative symptoms. In the openlabel safety switching study statistically significant improvements from SOC were observed in body weight, cardiometabolic and endocrine parameters worsened again when switched back to SOC medication In this open-label study, symptoms of schizophrenia generally remained stable or improved. Vanover*,1, Alex Dmitrienko, Steven Glass, Susan Kozauer, Jelena Saillard, Michal Weingart, Andrew Satlin, Sharon Mates, Christoph Correll, Robert Davis1 1Intra-Cellular Therapies, Inc.; 2Mediana Research; 3The Zucker Hillside Hospital, Hofstra North Shore LIJ School of Medicine
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