Long-term Schizophrenia Research Articles

Reduced auditory segmentation potentials in first-episode schizophrenia

Auditory scene analysis (ASA) dysfunction is likely an important component of the symptomatology of schizophrenia. Auditory object segmentation, the grouping of sequential acoustic elements into temporally-distinct auditory objects, can be assessed with electroencephalography through measurement of the auditory segmentation potential (ASP). Further, N2 responses to the initial and final elements of auditory objects are enhanced relative to medial elements, which may indicate auditory object edge detection (initiation and termination). Both ASP and N2 modulation are impaired in long-term schizophrenia. To determine whether these deficits are present early in disease course, we compared ASP and N2 modulation between individuals at their first episode of psychosis within the schizophrenia spectrum (FE, N=20) and matched healthy controls (N=24). The ASP was reduced by >40% in FE; however, N2 modulation was not statistically different from HC. This suggests that auditory segmentation (ASP) deficits exist at this early stage of schizophrenia, but auditory edge detection (N2 modulation) is relatively intact. In a subset of subjects for whom structural MRIs were available (N=14 per group), ASP sources were localized to midcingulate cortex (MCC) and temporal auditory cortex. Neurophysiological activity in FE was reduced in MCC, an area linked to aberrant perceptual organization, negative symptoms, and cognitive dysfunction in schizophrenia, but not temporal auditory cortex. This study supports the validity of the ASP for measurement of auditory object segmentation and suggests that the ASP may be useful as an early index of schizophrenia-related MCC dysfunction. Further, ASP deficits may serve as a viable biomarker of disease presence.

Mismatch negativity to pitch pattern deviants in schizophrenia.

Simple mismatch negativity (MMN) to infrequent pitch deviants is impaired in individuals with long-term schizophrenia (Sz). The complex MMN elicited by pattern deviance often manifes is cut from here]->ts later after deviant onset than simple MMN and can ascertain deficits in abstracting relationships between stimuli. Sz exhibit reduced complex MMN, but so far this has only been measured when deviance detection relies on a grouping rule. We measured MMN to deviants in pitch-based rules to see whether MMN is also abnormal in Sz under these conditions. Three experiments were conducted. Twenty-seven Sz and 28 healthy matched controls (HC) participated in Experiments 1 and 2, and 24 Sz and 26 HC participated in Experiment 3. Experiment 1 was a standard pitch MMN task, and Sz showed the expected MMN reduction (~115ms) in the simple pitch deviant compared to HC. Experiment 2 comprised standard groups of six tones that ascended in pitch, and deviant groups where the last tone descended in pitch. Complex MMN was late (~510ms) and significantly blunted in Sz. Experiment 3 comprised standard groups of 12 tones (six tones ascending in pitch followed by six tones descending in pitch, like a scale), and deviant groups containing two repetitions of six ascending tones (the scale restarted midstream). Complex MMN was also late (~460ms) and significantly blunted in Sz. These results identify a late pitch pattern deviance-related MMN that is deficient in schizophrenia. This suggests specific deficits in later more complex deviance detection in schizophrenia for abstract patterns.

退院の意向をもつ長期入院統合失調症患者に対する精神科看護師の「退院調整の障壁」 : 精神科看護師の態度からの一考察

退院の意向をもつ長期入院統合失調症患者に対する精神科看護師の「退院調整の障壁」 : 精神科看護師の態度からの一考察

Complex mismatch negativity to tone pair deviants in long-term schizophrenia and in the first-episode schizophrenia spectrum

Mismatch negativity (MMN) is an event-related potential to stimulus change. MMN to infrequent deviant tones that differs in a simple physical parameter from repetitive standard tones is reduced in patients with long-term schizophrenia (Sz; d=~1). However, this simple MMN is not uniformly reduced at the first-episode of schizophrenia-spectrum psychosis (FESz; d<0.1 for pitch; <0.4 for duration). Deviant stimuli that violate pattern rules also evoke MMN. This complex MMN is evoked by deviations in the relation of sounds to each other. The simplest pattern involves tone pairs. Although the pitch of first tone in the pair varies, the second tone's pitch always follows a rule (e.g., always 3 semitones higher). We measured complex MMN to deviant tone pairs that descended in pitch among standard tone pairs that ascended in pitch, never before examined in Sz or in FESz. Experiment 1 showed significant reductions in complex MMN in 20 Sz compared to 22 matched controls. Experiment 2 replicated smaller complex MMN in a shorter protocol in 24 Sz compared to 21 matched controls, but showed no significant complex MMN reduction in 21 FESz compared to 21 matched controls. Although reduced in Sz, indicating deficits in generation of a simple acoustic pattern rule, the tone pair complex MMN was within normal limits in FESz. This suggests that more complex perceptual pattern analysis processes are, at least partially, still intact at the first break. Future work will determine at what point of pattern complexity subtle auditory perception pathophysiology will be revealed in FESz.

883. Is Categorical Perception of Syllables Intact in Long-Term and First-Episode Schizophrenia?

883. Is Categorical Perception of Syllables Intact in Long-Term and First-Episode Schizophrenia?

The predictive role of insight for the evolution of the disease in Romanian patients diagnosed with schizophrenia

IntroductionSchizophrenia is a serious disorder that influences all life aspects of the patients. The most important goals in schizophrenia are remission, recovery, improving psychosocial functioning and quality of life, which can be influenced by different factors, especially insight.ObjectivesTo evaluate the awareness of illness in Romanian patients diagnosed with schizophrenia and to determine the predictive role of insight.AimsThis study wants to highlight the importance of the evaluation of insight in psychotic patients, taking into account that awareness leads to compliance with treatment, decreased rate of relapses and rehospitalization and a better prognosis.Material and methodsOverall, 80 patients (44 males and 36 females) recruited from first and second psychiatric clinic Cluj-Napoca, diagnosed according to ICD-10 and DSM-V criteria with schizophrenia and acute psychotic disorder participated in this study. A semi-structured interview collected demographical data. Psychotic symptoms were evaluated using PANSS, severity of the disease using CGI and insight using SUMD.ResultsOur results showed that the most important predictive factors for the evolution were: level of insight (r = −0.41 P &lt; 0.01), presence of family history (r = 0.24 P &lt; 0.05) and belonging to urban areas (r = 0.23 P &lt; 0.05). The level of insight explained 16% of variance of improving psychotic symptoms during hospitalization.ConclusionsThe awareness of illness is one of the predictive factors for long-term schizophrenia and the best predictive model of disease progression is composed of variables SUMD total and PANSS total on admission.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neurocognitive function in clinically stable individuals with long-term bipolar I disorder: Comparisons with schizophrenia patients and controls

This study compared the levels of the five domains of neurocognitive function—executive function, attention, memory, verbal comprehension, and perceptual organization—among clinically stable individuals with long-term bipolar I disorder, individuals with long-term schizophrenia, and a group of controls. We recruited a total of 93 clinically stable individuals with bipolar I disorder, 94 individuals with schizophrenia, and 106 controls in this study. Their neurocognitive function was measured using a series of neurocognitive function tests: the Wechsler Adult Intelligence Scale—Third Edition (WAIS-III), Line Cancellation Test, Visual Form Discrimination, Controlled Oral Word Association Test, Wisconsin Card Sorting Test, Continuous Performance Task, and Wechsler Memory Scale—Third Edition. Neurocognitive function was compared among the three groups through a multivariate analysis of variance. The results indicated that when the effect of age was controlled, clinically stable individuals with bipolar I disorder and those with schizophrenia demonstrated poor neurocognitive function on all tests except for the WAIS-III Similarity and Information and the Line Cancellation Test. The individuals with bipolar I disorder had similar levels of neurocognitive function compared with the schizophrenia group, but higher levels of neurocognitive function on the WAIS-III Comprehension, Controlled Oral Word Association Test, and Wechsler Memory Scale—Third Edition Auditory Immediate and Delayed Index and Visual Immediate and Delayed Index. The conclusions of this study suggest that compared with controls, individuals with long-term bipolar I disorder and those with long-term schizophrenia have poorer neurocognitive function, even when clinically stable. Individuals with long-term bipolar I disorder and those with long-term schizophrenia have similar levels of deficits in several domains of neurocognitive function.

125. Deficits in Complex Deviance Detection in First-Episode Schizophrenia

Abstract Complex pattern deviance may be more suitable for elucidating subtle deficits in auditory perception at first-episode compared to single-tones deviance detection and may be a useful biomarker for presence the of schizophrenia. We measured MMN to an extra tone among standard groups of 3 tones (1 kHz, 50 ms duration, 5 ms rise/fall, 80 dB, 330 ms SOA, 800 ms ITI) in 24 individuals at their first episode of schizophrenia (within 6 months of first-episode; FE), 23 healthy controls matched to the FE group (HCFE), 24 individuals with long-term schizophrenia (minimum 5 years of diagnosis; SZ), and 23 healthy controls matched to the SZ group (HCSZ). For the complex extra tone MMN, all groups produced an early MMN (more sensory-driven; ~140 ms after deviant onset), but the late MMN (more cognitively driven, ~400 ms after deviant onset) was significantly blunted in SZ ( = .043) and in FE ( = .003) compared to their matched controls. Together, this suggests deficits in top-down deviance detection in FE, and relatively intact sensory-driven deviance detection, by contrast with SZ, where sensory and cognitive MMN are impaired. Complex late MMN may be a more powerful biomarker for indicating disease presence. To verify this, the next step will be to measure complex MMN in prodromal individuals.

SU66. Pilot Study on the Effects of Withania Somnifera on Electrophysiological Measures of Sensory and Cognitive Processing in Schizophrenia

Abstract Oxidative stress and neuroinflammation may contribute to decreased neuronal activity in schizophrenia by affecting the high metabolic demand parvalbumin-containing fast-spiking cortical interneurons. We measured the effects of the antioxidant and anti-inflammatory Ashwagandha (Withania Somnifera; WSE) on event-related potentials (ERPs). Eleven patients with long-term schizophrenia participated in a pilot double-blind adjunctive medication study: 6 took WSE, 5 placebo. Participants heard pitch (10%) and duration deviants (10%) among standard tones (80%) in a mismatch negativity (MMN) task while watching a silent movie. They also performed 2 auditory oddball tasks, either counting rare pitch deviants (15%) or ignoring sounds. For the oddball tasks, a 500-ms duration 40-Hz click train was presented between tones. ERPs were measured before administration of WSE or placebo (T1) and 3 months later (T2). Preliminary analyses indicated improvements in duration MMN with WSE ( = 1.28) but not with placebo ( = 0.27). In the oddball task, the WSE group showed a larger P3 from T1 to T2 (attend = 0.47; ignore = 0.69) compared to placebo (attend = 0.24; ignore = 0.29). Gamma-band steady-state potentials in the WSE group displayed greater attention-related amplitude increase at T2 ( = 0.59) than the placebo group ( = 0.07). WSE intake appears to recover some of the impaired early sensory/cognitive potentials in schizophrenia, possibly by reversing oxidative stress and neuroinflammation. These pilot data indicate further investigation into such adjunctive target pharmacotherapy is warranted.

Abnormal auditory pattern perception in schizophrenia

Mismatch negativity (MMN) in response to deviation from physical sound parameters (e.g., pitch, duration) is reduced in individuals with long-term schizophrenia (Sz), suggesting deficits in deviance detection. However, MMN can appear at several time intervals as part of deviance detection. Understanding which part of the processing stream is abnormal in Sz is crucial for understanding MMN pathophysiology. We measured MMN to complex pattern deviants, which have been shown to produce multiple MMNs in healthy controls (HC). Both simple and complex MMNs were recorded from 27 Sz and 27 matched HC. For simple MMN, pitch- and duration-deviants were presented among frequent standard tones. For complex MMN, patterns of five single tones were repeatedly presented, with the occasional deviant group of tones containing an extra sixth tone. Sz showed smaller pitch MMN (p=0.009, ~110ms) and duration MMN (p=0.030, ~170ms) than healthy controls. For complex MMN, there were two deviance-related negativities. The first (~150ms) was not significantly different between HC and SZ. The second was significantly reduced in Sz (p=0.011, ~400ms). The topography of the late complex MMN was consistent with generators in anterior temporal cortex. Worse late MMN in Sz was associated with increased emotional withdrawal, poor attention, lack of spontaneity/conversation, and increased preoccupation. Late MMN blunting in schizophrenia suggests a deficit in later stages of deviance processing. Correlations with negative symptoms measures are preliminary, but suggest that abnormal complex auditory perceptual processes may compound higher-order cognitive and social deficits in the disorder.

Suicide in the Early Stage of Schizophrenia.

Suicide is a relevant leading cause of death among patients affected by schizophrenia. Even if suicidal ideation may be present in different stages of disease, some differences have been described between the risk of suicide in patients experiencing first episode of psychosis and those with long-term schizophrenia. It is particularly higher during the first year of illness and reaches a steady decline over the following years. Suicidal ideation and attempts may also be common among subjects with subthreshold psychotic experiences. Factors associated with the risk of suicide in the early phase of schizophrenia are previous suicidal attempts and social aspects: the lack of social support and stable relationships, social drift after the first episode, and social impairment. Also, several psychotic symptoms (suspiciousness, paranoid delusions, mental disintegration and agitation, negative symptoms, depression and hopelessness, and command hallucinations) and substance abuse are associated with higher risk of suicide. It has been described that perfectionism and good levels of insight among individuals who have recently developed psychotic symptoms are significantly associated with higher numbers of suicidal attempts. Moreover, recent evidences show that prefrontal cortex-based circuit dysfunction may be related to suicide in the early stage of schizophrenia. This narrative review summarizes available evidences on suicide in the early stage of schizophrenia and deals with issues to be further studied and discussed.

Psychosis-related polydipsia and chronic hyponatremia – A case report

IntroductionPsychogenic polydipsia has an estimated prevalence of 6–20% in psychiatric population. Although first described in the 1930s, there are few studies addressing this problem and its management. The high water intake can lead to severe hyponatremia with a mortality rate high enough to merit clinical concern.AimsReport a case of a schizophrenic patient with psychogenic polydipsia and hyponatremia.MethodsRetrospective review of the clinical file and literature research on this topic.ResultsA 41-year-old man with a long-term schizophrenia presented to the emergency room (ER) with exacerbation of psychotic symptoms. In the prior 24 months, he had stopped medication and began excessive water intake (5 to 10 L/day). He presented with auditory hallucinations, passivity phenomena and persecutory and other delusional thoughts that justified this behavior – “The water will end; I have to stock it, like camels do”. Presently he had an asymptomatic hyponatremia (128 mg/dL), but 6 months before he had been admitted in the ER with vomiting, altered state of consciousness and convulsions secondary to severe hyponatremia (108 mg/dL). During the present hospitalization, organic causes of hyponatremia were excluded and he was started on behavioral measures and antipsychotics. The psychotic symptoms improved and there was no need for water restriction after the first week, with restored natremia values on discharge.ConclusionsWith this case report we intended to raise awareness on this potentially fatal condition that despite its prevalence has no defined diagnostic criteria, nor established controlled trials concerning the effectiveness of treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Voxel-based magnetic resonance imaging investigation of poor and preserved clinical insight in people with schizophrenia.

AIMTo define regional grey-matter abnormalities in schizophrenia patients with poor insight (Insight-), relative to patients with preserved clinical insight (Insight+), and healthy controls.METHODSForty stable schizophrenia outpatients (20 Insight- and 20 Insight+) and 20 healthy controls underwent whole brain magnetic resonance imaging (MRI). Insight in all patients was assessed using the Birchwood Insight Scale (BIS; a self-report measure). The two patient groups were pre-selected to match on most clinical and demographic parameters but, by design, they had markedly distinct BIS scores. Voxel-based morphometry employed in SPM8 was used to examine group differences in grey matter volumes across the whole brain.RESULTSThe three participant groups were comparable in age [F(2,57) = 0.34, P = 0.71] and the patient groups did not differ in age at illness onset [t(38) = 0.87, P = 0.39]. Insight- and Insight+ patient groups also did not differ in symptoms on the Positive and Negative Syndromes scale (PANSS): Positive symptoms [t(38) = 0.58, P = 0.57], negative symptoms [t(38) = 0.61, P = 0.55], general psychopathology [t(38) = 1.30, P = 0.20] and total PANSS scores [t(38) = 0.21, P = 0.84]. The two patient groups, as expected, varied significantly in the level of BIS-assessed insight [t(38) = 12.11, P < 0.001]. MRI results revealed lower fronto-temporal, parahippocampal, occipital and cerebellar grey matter volumes in Insight- patients, relative to Insight+ patients and healthy controls (for all clusters, family-wise error corrected P < 0.05). Insight+ patient and healthy controls did not differ significantly (P > 0.20) from each other.CONCLUSIONOur findings demonstrate a clear association between poor clinical insight and smaller fronto-temporal, occipital and cerebellar grey matter volumes in stable long-term schizophrenia patients.

Brain Structural Abnormalities in a Group of Never-Medicated Patients With Long-Term Schizophrenia.

This study investigated brain morphometry in chronically ill but never-medicated schizophrenia patients and whether the relation of age to morphometric abnormalities differed from that in healthy subjects. In a cross-sectional design, high-resolution T1-weighted images were acquired from 25 schizophrenia patients with untreated chronic illness lasting 5 to 47 years and 33 matched healthy comparison subjects. Cortical thickness and gray matter volume were compared in the two groups. In regions with significant group differences, nonlinear modeling of age-related effects was used to test for accelerated decline in the patients. Schizophrenia patients had less cortical thickness in the bilateral ventromedial prefrontal cortices, left superior temporal gyrus, and right pars triangularis, relative to comparison subjects, and greater cortical thickness in the left superior parietal lobe. The relation of age to cortical thickness indicated faster age-related cortical thinning in the right ventromedial prefrontal cortex, left superior temporal gyrus, and right pars triangularis in patients than in comparison subjects, but slower thinning in the left superior parietal lobe. Gray matter volume was greater in the putamen bilaterally and smaller in the right middle temporal gyrus and right lingual gyrus of the patients, but age-related effects did not differ from those of the comparison subjects. The accelerated age-related decline in prefrontal and temporal cortical thickness in never-medicated schizophrenia patients suggests a neuroprogressive process in some brain regions. Slower age-related cortical thinning of the superior parietal cortex and striatal volumetric abnormalities unrelated to age suggest different pathological processes over time in these regions.

Cultural translation and Tunisian validation of the Drug Attitude Inventory (DAI-30) in outpatients with schizophrenia

BackgroundNon-adherence to treatment in patients with schizophrenia is associated with increased hospitalization, higher health care costs, and poorer long-term outcomes in terms of relapse rates. It is established that a negative drug attitude was a risk factor for non-adherence in long-term schizophrenia. The scale “Drug Attitude Inventory" is one of the scales designed to assess this concept. It has been translated and validated in different languages. However, its psychometric properties have not yet been studied in our sociocultural context. ObjectivesThe aims of this study were to translate into Tunisian Arabic dialect the scale “Drug Attitude Inventory" with 30 dichotomous items (DAI-30) and validate it in Tunisian sociocultural context in patients with schizophrenia. Materials and methodsThis study was performed in 234 outpatients with schizophrenia, recruited through a random drawing. These patients are in remission and meet remission criteria proposed by “The Remission in schizophrenia Working Group". We recruited 30 patients for pretest and 204 patients for linguistic validation.Forward and backward translation of the DAI-30 was performed according to the protocol of the “MAPI Research Institute". This final version was submitted to 24 experts and followed by a pretest.Construct validity has been established by performing a principal component analysis factor on a sample of 204 patients. Internal consistency was assessed by Cronbach alpha coefficient and inter-rater reliability was assessed by the use of Intra-Class Correlation coefficient (ICC). For the test–retest reliability evaluation, the “r” Pearson's coefficient was used between the DAI scores obtained in the initial evaluation and those obtained at 15 days. ResultsRegarding construct validity, factor analysis revealed seven factors that were responsible for 59.9% of the variance. The study of internal consistency between the 30 items was rated good (α=0.88). The test–retest reliability was satisfactory (r=0.99, p<10−3), as well as inter-rater reliability (ICC=0.99). ConclusionIn the Tunisian cultural context, the DAI-30 presented seven factors with good consistency and an inter-rater reliability.

Poster #S79 EFFECTIVENESS OF INTEGRATED COGNITIVE REMEDIATION THERAPY FOR SCHIZOPHRENIA OUTPATIENTS: EARLY VERSUS LONG-TERM COURSE OF ILLNESS – RESULTS FROM AN INTERNATIONAL RCT

Background Nowadays there is extensive evidence available showing the efficacy of cognitive remediation therapies. Integrative approaches seem superior regarding the maintenance of proximal outcome at follow-up as well as generalization to other areas of functioning. To date, only limited evidence about the efficacy of CRT is available concerning elder schizophrenia patients. The Integrated Neurocognitive Therapy (INT) represents a new developed cognitive remediation approach. It is a manualized group therapy approach targeting all 11 NIMH-MATRICS dimensions within one therapy concept. In this study we compared the effects of INT on an early course group (duration of disease 15 years). Methods An international multicenter study carried out in Germany, Switzerland and Austria with a total of 90 outpatients diagnosed with Schizophrenia (DSM-IV-TR) were randomly assigned either to an INT-Therapy or to Treatment-As-Usual (TAU). 50 of the 90 Patients were an Early-Course (EC) group, suffering from schizophrenia for less than 5 years (Mean age=29 years, Mean duration of illness=3.3 years). The other 40 were a Long-term Course (LC) group, suffering from schizophrenia longer than 15 years (Mean age= 45 years, Mean duration of illness=22 years). Treatment comprised of 15 biweekly sessions. An extensive assessment battery was conducted before and after treatment and at follow up (1 year). Multivariate General Linear Models (GLM) (duration of illness x treatment x time) examined our hypothesis, if an EC group of schizophrenia outpatients differ in proximal and distal outcome from a LC group. Results Irrespective of the duration of illness, both groups (EC & LC) were able to benefit from the INT. INT was superior compared to TAU in most of the assessed domains. Dropout rate of EC group was much higher (21.4%) than LC group (8%) during therapy phase. However, interaction effects show that the LC group revealed significantly higher effects in the neurocognitive domains of speed of processing (F>3.6) and vigilance (F>2.4). In social cognition the EC group showed significantly higher effects in social schema (F>2.5) and social attribution (blame; F>6.0) compared to the LC group. Regarding more distal outcome, patients treated with INT obtained reduced general symptoms unaffected by the duration of illness during therapy phase and at follow-up (F>4.3). Discussion Results suggest that INT is a valid goal-oriented treatment to improve cognitive functions in schizophrenia outpatients. Irrespective of the duration of illness significant treatment, effects were evident. Against common expectations, long-term, more chronic patients showed higher effects in basal cognitive functions compared to younger patients and patients without any active therapy (TAU). Consequently, more integrated therapy offers are also recommended for long-term course schizophrenia patients.

Studies of the Parvocellular and Magnocellular Visual Channels in Health and Psychopathology

Susceptibility to the Muller-Lyer illusion was studied in healthy subjects and patients with schizophrenia. The experiments used images subjected to wavelet filtration and containing spectra consisting of high or low spatial frequencies. Patients at the initial state of the clinical manifestations of schizophrenia were more susceptible to the Muller-Lyer illusion than normal observers on presentation of images with spectra consisting of high spatial frequencies, to which neurons in the parvocellular pathway are more sensitive. At the same time, there was no difference in the susceptibility to the Muller-Lyer illusion on presentation of images with spectra consisting of low spatial frequencies, to which neurons in the magnocellular pathway are more sensitive. Patients with long-term schizophrenia were more susceptible to illusions on presentation of all Muller-Lyer illusion images. These data are interpreted as evidence for impairments to the functioning of the parvocellular visual channels at the stage of the early clinical manifestations of schizophrenia, with preservation of the functioning of the magnocellular channel. Patients with long-term schizophrenia were characterized by impairments to both the parvocellular and magnocellular visual channels.

Exploring the Economic Implications of a Group-Based Lifestyle Intervention for Middle-Aged Adults with Chronic Schizophrenia and Co-Morbid Type 2 Diabetes

Objective: People with schizophrenia are at elevated risk of having type 2 diabetes, compared to the general population. Although there is a growing body of literature on the effectiveness of behavioural interventions to improve physical activity levels and healthy eating habits, there are very few economic evaluations conducted for people with severe mental illness and physical health problems. The aim of this study is to explore the cost-effectiveness of group-based lifestyle interventions for middle-aged adults with enduring long-term schizophrenia and co-morbid type 2 diabetes. Methods: Deterministic decision analytical modelling techniques are applied to explore cost-effectiveness based on the findings from a systematic review on this population. The intervention refers to a group-based lifestyle intervention, which is a combination of exercise, diet and diabetes education over 6 months. The intervention costs are estimated to reflect the UK local context. Results: From the UK National Health Service perspective, the group-based lifestyle intervention is potentially cost-effective, relative to usual care. It costs £80 to achieve an additional unit of Body Mass Index (BMI) lost and the incremental cost-effectiveness ratio is just below £700 to gain an extra Quality Adjusted Life Year, which lies well within the conventionally acceptable threshold values in the UK. Conclusions: Group based life style intervention for this population is effective and can be cost-effective in reducing BMI and improving diabetes knowledge, at least in the short-term. More co-ordinated policies among relevant sectors are required to facilitate behavioural change and better maintain an improved lifestyle. An integrated approach is needed to make this more sustainable in the long-term.

Optimisation of prescription in patients with long-term treatment-resistant schizophrenia

The aim of this clinical review was to investigate the effectiveness and safety of the practice of antipsychotic poly-pharmacy (AP) in the long-term management of hospitalised patients with insufficient response to antipsychotic monotherapy. The databases Medline, PsycINFO, Embase and Scopus were searched. Studies were required to include inpatients with long-term, treatment-resistant schizophrenia on maintenance AP. The search was restricted to systematic review studies. The review yielded four studies of interest that showed no categorical advantage for maintenance AP for the population of interest. However, clozapine combination faired marginally well. Particular weaknesses of the present literature are low number of participants, and inadequate monitoring of potential adverse effects. The evidence on the risks and benefits of maintenance AP is not generally considered adequate to warrant a recommendation for its use in routine clinical practice in psychiatry. This review provides a synthesis of the evidence on the maintenance use of AP for hospitalised patients with long-term, treatment-resistant schizophrenia. The results show both no support for AP with some marginal benefit for clozapine combination therapy, and methodological weaknesses of the included studies. These findings have clinical implications for treatment decisions and suggest that sufficiently powered studies are needed.

Cognitive remediation in schizophrenia: efficacy and effectiveness in patients with early versus long‐term course of illness

We examined the efficacy and effectiveness (transfer to functional competence and everyday functioning) of cognitive remediation in early-course (within 5 years of first episode) and long-term (more than 15 years of illness) schizophrenia. Treatment lasted 12 weeks and included computerized exercises, strategic monitoring and methods to transfer cognition to behaviour. Assessments included a standard battery of neurocognition, performance-based measures of social and adaptive competence, and case manager ratings of real-world functional behaviour. Changes from baseline to post-treatment were examined with repeated measures analysis of variance and estimated premorbid intelligence and total months in hospital as covariates. The early-course group had larger improvements in measures of processing speed and executive functions, as well as larger improvements in adaptive competence and real-world work skills. Duration of illness was inversely associated with improvement in neurocognition and real-world work skills. Treatment of cognitive impairments is feasible in both early-course and chronic schizophrenia, but the clinical meaningfulness and generalization to functioning appear to be more substantial when delivered early. Cognitive remediation should be considered a tool for early intervention in schizophrenia.