Schizophrenia Cognition Rating Scale Research Articles

Effect of Computer-Assisted Cognitive Remediation Therapy on Cognition among Patients with Schizophrenia: A Pilot Randomized Controlled Trial

In schizophrenia, cognition is closely linked to social competence and influences long-term prognosis. Thus, treatment should target cognitive improvement to enhance the patient’s societal adaptation. This study evaluated the effects of computer-assisted cognitive remediation therapy (CR) using RehaCom® on cognition in patients with schizophrenia. Thirty patients were randomized, with 15 assigned to the CR and treatment as usual (TAU) group and 15 to the TAU-alone group. Over 12 weeks, patients received CR twice weekly, including two computer sessions and one verbal session. The outcomes measured were cognition using the Brief Assessment of Cognition in Schizophrenia and Schizophrenia Cognition Rating Scale, intrinsic motivation using the Quality of Life Scale and Intrinsic Motivation Inventory, psychiatric symptoms using the Positive and Negative Syndrome Scale, negative symptoms using the Scale for the Assessment of Negative Symptoms, and functional level using the modified Global Assessment of Functioning scale for Functioning. The CR + TAU group demonstrated considerable improvements in cognition, intrinsic motivation, and functional level compared to the TAU-alone group. These findings indicate that the CR using RehaCom® enhances cognition and other outcomes in schizophrenia.

The effects of life review-based collage book making on psychosocial functioning and discrepancy between patients' and hospital staff's perception of daily functioning in long-term hospitalized patients with schizophrenia: A randomized controlled trial

The purpose of this study was to investigate the psychosocial effects of life review-based collage book making on long-term inpatients with schizophrenia, and to verify the effectiveness of this program in reducing the discrepancy between self-perception and others' evaluation of patients' day-to-day functioning. Participants were randomly assigned to intervention or control group. The intervention group participated in an individual program of life review-based collage book making. At three evaluation points (pre-and post-intervention and at 3-month follow-up) the patients rated their subjective difficulties, and the staff rated the objective severity of the patient's day-to-day functioning, using the Schizophrenia Cognition Rating Scale Japanese version (SCoRS-J). The Profile of Mood Status-Brief Form (POMS), Recovery Assessment Scale, and Life Skills Profile were used to assess psychosocial functioning, and the changes in scores on the scales were compared between the two groups. In addition, for those with large discrepancy between patient and staff rating scores on the SCoRS-J at baseline, the change in the discrepancy scores were compared between the two groups. As a result, there was a significant group main effect and interaction between the two groups in the changes in the Confusion subscale scores of the POMS, indicating an alleviation of confusion in this program. In addition, for those with large discrepancy scores on the SCoRS-J, there was a significant group main effect and interaction between the two groups in discrepancy scores, indicating that this program can contribute to the reduction of discrepancies in the perceptions, and to the collaborative approach to treatment.

Psychometric evaluation of the patient-reported experience of cognitive impairment in schizophrenia (PRECIS) scale.

Cognitive impairment associated with schizophrenia (CIAS) represents a distinct, persistent, and core group of schizophrenia symptoms. Cognitive symptoms have been shown to have an impact on quality of life. There are several published CIAS measures, but none based on direct patient self-report. It is important to capture the patient's perspective to supplement performancebased outcome measures of cognition to provide a complete picture of the patient's experience. This paper describes additional validation work on the Patient-Reported Experience of Cognitive Impairment in Schizophrenia (PRECIS) instrument. Data from two large, international, pharmaceutical clinical trials in medically and psychiatrically stable English-speaking patients with schizophrenia and 88 healthy controls were analyzed. An exploratory factor analysis (EFA) was conducted in one trial (n = 215), using the original 35-item PRECIS. The factor structure suggested by EFA was further evaluated using item response theory (IRT; Samejima's graded response model), and tested using confirmatory factor analysis (CFA). Both EFA and CFA results were tested in a second trial with similar inclusion/exclusion characteristics (n = 410). Additional statistical properties were evaluated in healthy controls. EFA suggested that the best solution after item reduction suggested a factor structure of 6 factors based on 26 items (memory, communication, self-control, executive function, attention, sharpness of thought), supporting a total score, with an additional 2-item bother score (28 items in all). IRT analysis indicated the items were well-ordered within each domain. The CFA demonstrated excellent model fit, accounting for 69% of the variance. The statistical properties of the 28-item version of the PRECIS were confirmed in the second trial. Evidence for internal consistency and test-retest reliability was robust. Known-groups validity was supported by comparison of healthy controls with patients with schizophrenia. Correlations indicated moderate associations between PRECIS and functioning instruments like the Schizophrenia Cognition Rating Scale (SCoRS), but weak correlations with performance-based outcomes like MATRICS Consensus Cognitive Battery (MCCB). Using two clinical trial samples, we identified a robust factor structure for the PRECIS and were able to replicate it in the second sample. Evaluation of the meaningful score difference (MSD) should be repeated in future studies, as these samples did not show enough change for it to be evaluated. This analysis provides strong evidence for the reliability and validity of the PRECIS, a 28-item, patient-reported instrument to assess cognitive impairment associated with schizophrenia. The correlation with functioning and the weak correlation with performance on cognitive tasks suggests that patient reports of cognitive impairment measure a unique aspect of patient experience.

Relationships between erythrocyte membrane mono- and poly- unsaturated fatty acid composition and clinical/cognitive indices in antipsychotic-free schizophrenia patients.

Membrane phospholipid abnormalities are considered a pathophysiological background for schizophrenia. The aim of the study was to explore in detail the fatty acid (FA) composition in patients with antipsychotic-free schizophrenia and its association with clinical symptoms and cognitive function. Erythrocyte membrane FAs were measured in 29 antipsychotic-free patients with schizophrenia (male/female = 11/18; mean [standard deviation] age=26.7 [7.9] years) and age and sex-matched 32 healthy volunteers. Clinical symptoms and cognitive function were assessed using the Positive and Negative Syndrome Scale (PANSS), Brief Assessment of Cognition in Schizophrenia (BACS), and the Schizophrenia Cognition Rating Scale (SCoRS). Eicosapentaenoic acid levels were lower in the schizophrenia group than in the healthy control group. In contrast, arachidonic acid and nervonic acid levels were higher in the schizophrenia group than in the control group. Nervonic acid levels were significantly associated with depression scores as measured by the PANSS. No FA levels were correlated with BACS score; however, oleic acid levels were significantly related to cognitive dysfunction, as measured by the SCoRS. These findings suggest that depressive symptoms along with cognitive dysfunction in daily living in schizophrenia may be linked to the FA composition abnormalities. Further studies will be needed to examine potential longitudinal FA changes during the course of schizophrenia as well as disease specificity.

The Effectiveness of Meloxicam Adjuvant Therapy to Improve Cognitive Function of Schizophrenic Patients

Highlights:1. Schizophrenic patients have cognitive dysfunction.2. Meloxicam, as an adjuvant therapy, can improve cognitive function in schizophrenic patients. AbstractIntroduction: Schizophrenia is a chronic psychotic disorder triggered by genetic and environmental factors such as an inflammatory response. The inflammatory response in schizophrenic patients increases with cognitive decline. Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) group with Cyclo-oxygenase (COX-2) inhibitory activity and can suppress the production of inflammatory cytokines. This study aimed to determine the efficacy of Meloxicam as an adjuvant therapy to improve cognitive function in schizophrenic patients.Methods: This was a quasi-experimental study using a single-blind, pretest–post-test design. The sample size in this study was 34 subjects who had met the inclusion and exclusion criteria. All samples were divided into two groups, namely the treatment group, with as many as 17 subjects receiving additional therapy with Meloxicam 15 mg/day for 4 weeks, and the control group, with 17 subjects. The score of the Schizophrenia Cognition Rating Scale (ScoRS) was assessed before and after therapy. Data analysis used SPSS 25.0. In both groups, the SCoRS score was different.Results: In the treatment group, there was a decrease in the SCoRS score that was greater than in the control group. There was a statistically significant difference with p = 0.002 in decreasing SCoRS scores.Conclusion: In the treatment group, there was a decrease in the SCoRS score that was greater than in the control group. There was a statistically significant difference with p = 0.002 in decreasing SCoRS scores.

Analysis of polyunsaturated fatty acids in antipsychotic-free individuals with at-risk mental state and patients with first-episode schizophrenia.

Abnormalities in membrane phospholipids are considered one of the pathophysiological backgrounds for schizophrenia. This study, explores the fatty acid composition of erythrocyte membranes and its association with clinical characteristics in two groups: individuals with an at-risk mental state (ARMS) and patients experiencing their first-episode of schizophrenia (FES). This study measured erythrocyte membrane fatty acids in 72 antipsychotic-free individuals with ARMS, 18 antipsychotic-free patients with FES, and 39 healthy volunteers. Clinical symptoms and cognitive and social functions were assessed using the Positive and Negative Syndrome Scale (PANSS), Brief Assessment of Cognition in Schizophrenia (BACS), Schizophrenia Cognition Rating Scale (SCoRS), and Social and Occupational Functioning Assessment Scale (SOFAS). Eicosapentaenoic and docosapentaenoic acid levels were lower in the ARMS and FES groups than in the healthy control group. In contrast, nervonic acid (NA) levels were markedly higher in the ARMS and FES groups than in the controls, while only the FES group showed higher levels of arachidonic acid. Oleic acid and NA levels were significantly associated with PANSS scores in both the FES and ARMS groups, particularly for the negative and general subscores. However, the patient groups had no significant associations between the fatty acid composition and the BACS, SCoRS, and SOFAS scores. Furthermore, the baseline fatty acid composition did not differ between the ARMS individuals who later developed psychosis (N = 6) and those who were followed for more than 2 years without developing psychosis onset (N = 30). The findings suggest that abnormal fatty acid compositions may be shared in the early stages of schizophrenia and the clinical high-risk state for psychosis and may serve as vulnerability markers of psychopathology.

Societal Utilities for Cognitive Impairment in Schizophrenia: Developing a Preference-Based Scoring Algorithm Based on the Schizophrenia Cognition Rating Scale.

Loss of cognitive function is a common feature in schizophrenia. However, generic measures of health-related quality of life favored by decision-makers, such as the EQ-5D, are not designed to detect changes in cognitive function. We report the valuation of the Schizophrenia Cognition Rating Scale (SCoRS), a schizophrenia-specific measure of cognitive impairment. Expert opinion and psychometric analysis of the SCoRS from clinical trial data was undertaken to select 5 key items from the measure. These items were combined orthogonally to develop health-state vignettes. Vignettes were valued using composite time trade-off (cTTO) in one-on-one video calls. Several econometric models were fitted to the data to estimate disutilities. Performance of EQ-5D- and SCoRS-based utilities were compared in the trial data. The SCoRS items selected for the valuation study represented attention, learning, processing speed, social cognition and memory. Four hundred respondents participated in the valuation study. The best observed health state was valued at 0.855 [standard deviation (SD)=0.179] and the worst at 0.152 (SD=0.575). At the most severe levels, 'social cognition' received the largest disutility followed by 'learning' and 'memory'. The final model to estimate utilities had 15 parameters. SCoRS-based utilities were sensitive to change in cognition, but the EQ-5D was not. It is feasible to value different dimensions of cognition separately using a validated instrument for proxy assessment. The resulting utilities indicate loss of quality of life due to reduced cognitive functioning.

Validation of the Persian Version of Measure of Insight into Cognition Self-report (MIC-SR) in Patients with Schizophrenia

Background: Measure of insight into cognition self-report (MIC-SR) has been designed for the assessment of insight into cognitive deficits in schizophrenia, focusing on the areas with known impairment, including memory, problem solving, and attention. Objectives: The current work strives to put the concurrent validity and reliability of the Persian version of MIC-SR to the test. Methods: The standard forward-backward method was utilized for translating the MIC-SR from English to Persian. In total, 66 individuals received the Persian version of the MIC-SR (33 schizophrenia patients), the interview-based cognition assessment (Schizophrenia Cognition Rating Scale (SCoRS)), and a standardized performance-based cognitive battery (the brief assessment of cognition in schizophrenia (BACS)). Coronbach’s alpha was used for the calculation of internal consistency, while intercorrelations among the MIC-SR subscales were calculated as well. Then, Pearson correlations were calculated between the MIC-SR subscales and SCoRS and BACS for the purpose of examining the validity. Results: The Cronbach’s alpha value obtained for the Persian MIC-SR was 0.83. The entirety of Persian MIC-SR measures was considerably correlated with the SCoRS patient’s rating. Moreover, considerable correlations were found among the WHO-quality of life and Persian MIC-SR subscales of attention and problem solving. However, none of the correlations between the BACS subscales and MIC-SR were significant. Conclusions: The Persian version of the MIC-SR demonstrated satisfying psychometric properties that can assess awareness of cognitive impairments in patients with schizophrenia.

Combining Iclepertin (BI 425809) With Computerized Cognitive Training in Patients With Schizophrenia: Baseline Data From an Ongoing Phase II Trial

AbstractIntroductionThere are currently no approved pharmacotherapies to treat cognitive impairment associated with schizophrenia (CIAS). Iclepertin (BI 425809) is a novel glycine transporter-1 inhibitor under development for treatment of CIAS. A previous study demonstrated pro-cognitive effects of iclepertin in patients with schizophrenia; however, concurrent cognitive stimulation could in theory enhance any pro-cognitive pharmacological effects on neuroplasticity. We present preliminary demographics and baseline data from a trial exploring the efficacy of iclepertin together with at-home computerized cognitive training (CCT).MethodsThis is an ongoing Phase II, double-blind, placebo-controlled, parallel-group trial in patients with schizophrenia on stable antipsychotic therapy across ~58 centers in 6 countries. Patients aged 18–50 years, compliant with CCT during the run-in period (completing ≥2 hours/week for 2 weeks), were randomized (1:1) to receive once-daily iclepertin 10 mg or placebo together with CCT for 12 weeks. Thereafter, minimum compliance for at-home CCT is 1 hour/week, with a target of ~30 hours across 3–5 sessions totaling 2.5 hours/week. Patients have been stratified to balance potential effects of age (18–40; 41–50 years). Primary endpoint is change from baseline (CfB) in neurocognitive composite T-score of the MATRICS Consensus Cognitive Battery (MCCB) at Week 12. Secondary endpoints include CfB in the Schizophrenia Cognition Rating Scale (SCoRS) total score, MCCB overall composite T-score, and Positive and Negative Syndrome Scale (PANSS) total scores. Novel exploratory endpoints include the Virtual Reality Functional Capacity Assessment Tool to assess daily functioning and the Balloon Effort Task to assess motivation in cognitive performance.ResultsOf the planned sample of 200 randomized patients, the overall treated population currently includes 183: 67% (n=122) are male; mean (standard deviation [SD]) age and time since first diagnosis are 38.2 (7.9) years and 13.5 (8.5) years. Overall, 49% (n=89) are White and 43% (n=79) are Black or African American; 80% (n=147) are from North America, 15% (n=28) from Europe, and 4% (n=8) from Australia/New Zealand. Mean (SD) baseline MCCB neurocognitive composite and overall T-scores (n=178) are 33.7 (11.9) and 32.5 (12.6). Mean (SD) baseline SCoRS total score (n=167) is 35.2 (8.7). Mean (SD) baseline PANSS total and negative symptom scale scores (n=183) are 64.7 (14.6) and 17.3 (5.4). Median (Q1, Q3) CCT compliance over the on-treatment period for patients who have completed or discontinued early is 2.00 (1.21, 2.51) hours/week.ConclusionThis trial is, to our knowledge, the largest of its kind combining daily pharmacotherapy for CIAS with at-home CCT. It will indicate whether iclepertin together with concurrent cognitive stimulation provides enhanced cognitive benefit, and whether any improvements in neurocognition can translate into improved measures of daily functioning in patients.FundingBoehringer Ingelheim International GmbH (NCT03859973/1346-0038)

Efficacy and Safety of Iclepertin (BI 425809) in Patients With Schizophrenia: CONNEX, A Phase III Randomized Controlled Trial Program

AbstractIntroductionCognitive impairment is a major determinant of poor functional outcome in schizophrenia and there are currently no available pharmacotherapies. Deficits in glutamatergic signaling play a key role in the neuropathology of cognitive symptoms. Iclepertin (BI 425809), an inhibitor of glycine transporter-1, enhances glutamatergic signaling by increasing synaptic levels of the N-methyl-D-aspartate receptor co-agonist, glycine. A 12-week, Phase II trial (NCT02832037) in 509 patients with schizophrenia demonstrated that iclepertin was well tolerated and significantly improved cognition. The Phase III CONNEX program aims to confirm the efficacy, safety, and tolerability of iclepertin in improving cognition and functioning in a larger cohort of patients.MethodsCONNEX consists of three replicate randomized, double-blind, placebo-controlled parallel-group trials in patients with schizophrenia (NCT04846868, NCT04846881, NCT04860830) currently stable on antipsychotic treatment. Each trial aims to recruit ~586 patients, 18–50 years old, treated with 1–2 antipsychotic medications (≥12 weeks on current drug; ≥35 days on current dose prior to treatment), who have functional impairment in day-to-day activities, and interact ≥1 hour per week with a designated study partner. Patients with cognitive impairment due to developmental, neurological, or other disorders, or receiving cognitive remediation therapy within 12 weeks prior to screening, will be excluded. Patients will be recruited from multiple centers across 32 countries in Asia, North and South America, and Europe, and randomized 1:1 to receive either oral iclepertin 10 mg (n=293), or placebo (n=293) once daily over 26 weeks. The primary efficacy endpoint is change from baseline (CfB) in the MATRICS Consensus Cognitive Battery overall composite T-score. Key secondary efficacy endpoints are CfB in Schizophrenia Cognition Rating Scale total score and CfB in the adjusted total time in the Virtual Reality Functional Capacity Assessment Tool. Long-term safety and tolerability data will be collected in an open-label safety extension study (CONNEX-X).ResultsThe studies are currently recruiting (first patients enrolled Aug–Sept 2021), with completion expected in Q2 2024. Here we present an overview of the current study status, including any information relating to screening failures, and the experience of collecting these data as part of a large multi-country, multi-center study.ConclusionTo date, most large, industry-sponsored studies testing various compounds to address cognitive function have failed to show proof-of-clinical concept. Demonstration of efficacy of iclepertin in improving cognition in this Phase III program would provide important insight into the role of glutamate in cognitive symptoms that may also have relevance for other cognitive disorders. Iclepertin may represent the first efficacious medication for cognitive impairment associated with schizophrenia.FundingBoehringer Ingelheim International GmbH (1346-0011, NCT04846868; 1346-0012, NCT04846881; 1346-0013, NCT04860830)

Effect of individualized occupational therapy on social functioning in patients with schizophrenia: A five-year follow-up of a randomized controlled trial

This study aimed to evaluate the long-term effects of adding individualized occupational therapy (IOT) to a three-months group occupational therapy (GOT) on social functioning in inpatients with schizophrenia or schizoaffective disorder at a follow-up investigation five-years after discharge. Initially, patients were randomly assigned to GOT + IOT or GOT alone, with 102 patients, 48 in GOT + IOT and 54 in GOT alone, completing the five years follow-up. The primary outcome was change in social functioning assessed by the Social Functioning Scale (SFS) from baseline to five-year follow-up. Other outcomes included Brief Assessment of Cognition in Schizophrenia (BACS), Schizophrenia Cognition Rating Scale (SCoRS), Intrinsic Motivation Inventory (IMI), Global Assessment of Functioning (GAF), Positive and Negative Syndrome Scale (PANSS), and Client Satisfaction Questionnaire-8 (CSQ-8). There were significant improvements for the GOT + IOT group over GOT in the SFS total score, which could be explained by improvements in withdrawal/social engagement, interpersonal communication, pro-social activities, recreation, and independence-competence. Multiple regression analysis showed that the period from hospitalization to commencing occupational therapy, type of occupational therapy, BACS motor speed, BACS executive function, and IMI interest/enjoyment were significantly associated with SFS total score. Our findings suggest that adding IOT to GOT may improve the long-term outcome on social functioning in schizophrenic patients. However, the long time period between intervention and follow-up and the unavailability of treatment information during the follow-up period has to be mentioned as a limiting factor of this study.

Comparing Cognitive Functions in Patients with Schizophrenia and Methamphetamine-Induced Psychosis with Healthy Controls.

There are similar findings about the similarities and differences of cognitive dysfunctions in patients with schizophrenia and methamphetamine-induced psychosis (MIP). This study aimed to compare cognitive functioning in schizophrenia and MIP patients, using a performance-based cognitive assessment battery and an interview-based assessment of cognition. Three groups participated in this study including, (a) 30 patients with MIP, (b) 30 patients with schizophrenia, and (c) 30 healthy individuals. All participants received the Brief Assessment of Cognition in Schizophrenia (BACS), a standardized performance-based cognitive battery, the Schizophrenia Cognition Rating Scale (SCoRS), and the interview-based assessment of cognition. Both groups of patients with schizophrenia and MIP performed poorly on all the BACS cognitive domains compared with the healthy controls. The two patient groups were significantly different on the three BACS subscales including verbal fluency, verbal memory, and speed of information processing. Schizophrenia patients performed worse than the MIP group concerning these three subscales. However, the two patient groups were similar in executive function, working memory, and motor speed. Moreover, the SCoRS-informant, SCoRS-global, and PANSS-negative significantly differed between schizophrenia and MIP patients. Although cognitive dysfunctions are mostly similar in patients with MIP and schizophrenia, there are some differences especially in the functions related to prefrontal and temporal lobes.

"Efficacy of intensive bilateral Temporo-Parietal Continuous theta-burst Stimulation for Auditory VErbal hallucinations (TPC-SAVE) in schizophrenia: A randomized sham-controlled trial"☆.

Transcranial magnetic stimulation (TMS) is a non-invasive tool that moderates specific brain regions to ameliorate auditory verbal hallucinations (AVH) in schizophrenia. Citing the critical involvement of temporoparietal cortex (TPC) in AVH, our study aimed to evaluate the effect of continuous theta burst stimulation (cTBS) targeting bilateral TPC in schizophrenia subjects with AVH, on a randomized rater blinded placebo control trial. 59 patients were randomly allocated to active and sham groups. They received 20 cTBS sessions (2 per day: first right TPC, then left TPC) 5 days a week for 2 weeks. PANSS (Positive and Negative Syndrome Scale), AVHRS (Auditory vocal hallucination rating scale), PSYRAT-AH (Psychiatric symptoms rating scale- Auditory hallucinations scale), CDSS (Calgary depression scale for schizophrenia), SCoRS (Schizophrenia cognition rating scale) and CGI-S (Clinical global impression-severity) were rated at baseline, immediately post 20th session and 2 weeks post-TBS. 50 patients (25-active, 25-sham) completed the study. Conducting an intention to treat analysis, we found a significant group*time effect for PANSS, AVHRS, PSYRAT-AH, CDSS, SCoRS, CGI-S but when controlled for confounding variables and multiple comparisons, only PANSS-PS (F=26.617, p<0.001), PANSS-TOTAL (F=23.671, p<0.001), AVHRS (F=17.779, p<0.001), PSYRAT-AH (F=11.385, p<0.001) and CGI-S (F=28.462, p<0.001) retained significance. We conclude that cTBS over TPC is safe and has efficacy in treating AVH in schizophrenia. Limited sample size and lack of integrity assessment for blinding in the study participants are major limitations of the study.

Validation of the Chinese Version of the Schizophrenia Cognition Rating Scale.

Objective The Schizophrenia Cognition Rating Scale (SCoRS) is an interview-based assessment tool for evaluating the cognitive deficit and daily functioning of patients with schizophrenia. Methods Sixty-eight patients with schizophrenia and 68 age- and sex-matched healthy individuals were recruited to validate the Chinese version of SCoRS in this study. All participants underwent cognitive assessment using the SCoRS, which was verified by the Brief Assessment of Cognition in Schizophrenia (BACS), and the UCSD Performance-based Skills Assessment, Brief Version (UPSA-B). Patients with schizophrenia were additionally assessed using the Positive and Negative Syndrome Scale (PANSS). Results SCoRS ratings reported by patients (SCoRS-S), those reported by the interviewer (SCoRS-I), and SCoRS global scores (SCoRS-G) showed significant correlation with all subscales of the BACS and the UPSA-B. On receiver operating characteristic curve analysis, SCoRS-S, SCoRS-I, and SCoRS-G significantly differentiated patients with schizophrenia from healthy controls. Moreover, SCoRS-S and SCoRS-I ratings showed positive correlation with the negative symptoms and general symptoms of PANSS. Conclusion The Chinese version of SCoRS showed good discriminant, concurrent, and external validity, suggesting that it is a useful and convenient tool for assessment of cognitive function among Mandarin-speaking patients with schizophrenia in clinical practice.

BPSS Award

Trans-cranial magnetic stimulation (TMS) can noninvasively modulate specific brain regions to dissipate auditory verbal hallucinations (AVH) in schizophrenia. Citing critical involvement of temporoparietal cortex (TPC) in AVH, we aimed to study the effect of continuous theta burst stimulation (cTBS) targeting bilateral TPC in schizophrenia subjects with AVH, on a randomized rater blinded placebo control trial. 59 patients were randomly allocated to active and sham groups. They received 20 cTBS sessions (2 per day: first right TPC, then left TPC) 5 days a week for 2 weeks. PANSS (Positive and Negative Syndrome Scale), AVHRS (Auditory vocal hallucination rating scale), PSYRAT-AH (Psychiatric symptoms rating scale- Auditory hallucinations scale), CDSS (Calgary depression scale for schizophrenia), SCoRS (Schizophrenia cognition rating scale), CGI-S (Clinical global impression-severity) were assessed at baseline, immediately post 20th session and 2 weeks post-TBS. 50 patients (25-active, 25-sham) completed the study. Conducting an intention to treat analysis, we found a significant group*time effect for PANSS, AVHRS, PSYRAT-AH, CDSS, SCoRS, CGI-S but when controlled for confounding variables, only PANSS-PS (F=26.617, p<0.001), PANSS-TOTAL (F=23.671, p<0.001), AVHRS (F=17.779, p<0.001), PSYRAT-AH (F=11.385, p<0.001) and CGI-S (F=28.462, p<0.001) retained significance. We conclude that cTBS over TPC is safe and has efficacy in AVH in schizophrenia.

POSB424 Valuation of Cognitive Impairment in Schizophrenia

Preference-based measures of health are used in economic evaluation as a measure of health benefit. The commonly used EQ-5D may not be very sensitive to cognitive impairment in schizophrenia compared to interview-based cognitive functioning measures such as the Schizophrenia Cognition Rating Scale (SCoRS). The purpose of this study was to select and value key dimensions of cognitive impairment described by the SCoRS to estimate utilities.

Cognitive dysfunction and disability in people living with schizophrenia.

ABSTRACTBackground:Schizophrenia is a major mental disorder characterized by positive, negative, and cognitive symptoms. Cognitive impairment is a central and enduring feature of schizophrenia and is associated with disability. It has a devastating consequence on the individuals, families, and the society. Our aim was to assess cognitive functioning, disability, and their association with sociodemographic and illness-related variables.Methodology:In an outpatient department of psychiatry, 82 adult patients with a diagnosis of schizophrenia were recruited. Schizophrenia Cognition Rating Scale (SCoRS), Positive and Negative Syndrome Scale (PANSS), and Indian Disability Evaluation and Assessment Scale (IDEAS) were used to assess cognitive function, psychopathology, and disability respectively. Socio-demographic and illness-related details were collected using a semi-structured questionnaire. Data were analyzed using STATA version 16.0 using appropriate statistical tests.Results:Approximately 93.9% of patients had at least one cognitive symptom even though not severe. The status of being married was associated with better cognitive outcome. No other socio-demographic factor was associated with cognitive dysfunction. Negative symptoms and general psychopathology scores of PANSS were positively correlated with SCoRS scores and IDEAS score. Cognitive dysfunction and disability were significantly associated suggesting higher the cognitive deficit in schizophrenia greater is the likelihood of patient experiencing disability.Conclusion:Cognitive deficits are commonly seen in patients with schizophrenia and are associated with disability. Therefore, treatment programs of schizophrenia should have a component to address these deficits using evidence-based cognitive remediation therapies. Family Physicians caring for those with schizophrenia should factor the cognitive deficits and simplify dosage regime and engage caregivers for supervision.

Duration Mismatch Negativity Predicts Remission in First-Episode Schizophrenia Patients.

Objective: Remission in schizophrenia patients is associated with neurocognitive, social, and role functioning during both the early and chronic stages of schizophrenia. It is well-established that the amplitudes of duration mismatch negativity (dMMN) and frequency MMN (fMMN) are reduced in schizophrenia patients. However, the potential link between MMN and remission has not been established. In this study, we investigated the relationship between MMNs and remission in first-episode schizophrenia (FES) and their association with neurocognitive and social functioning.Method: dMMN and fMMN were measured in 30 patients with FES and 22 healthy controls at baseline and after a mean of 3 years. Clinical symptoms and cognitive and social functioning in the patients were assessed at the time of MMN measurements by using the Positive and Negative Syndrome Scale (PANSS), modified Global Assessment of Functioning (mGAF), Schizophrenia Cognition Rating Scale (SCoRS), and the Brief Assessment of Cognition in Schizophrenia (BACS). Remission of the patients was defined using the criteria by the Remission in Schizophrenia Working Group; of the 30 patients with FES, 14 achieved remission and 16 did not.Results: Baseline dMMN amplitude was reduced in FES compared to healthy controls. Further, baseline dMMN in the non-remitters had decreased amplitude and prolonged latency compared to the remitters. MMN did not change during follow-up period regardless of parameters, diagnosis, or remission status. Baseline dMMN amplitude in FES was correlated with future SCoRS and PANSS total scores. Logistic regression analysis revealed that dMMN amplitude at baseline was a significant predictor of remission.Conclusions: Our findings suggest that dMMN amplitude may be a useful biomarker for predicting symptomatic remission and improvement of cognitive and social functions in FES.

Subjectively-assessed cognitive impairment and neurocognition associations in schizophrenia inpatients

Cognitive impairment affects real-world functioning in people with schizophrenia who often face difficulties in their activities of daily living. Subjectively-assessed cognitive impairment can be evaluated through data on the patient's daily difficulties, as reported by the patient. However, the specific neurocognitive functions responsible for these cognitive impairments have not been clarified. We examined cognitive functioning in patients with schizophrenia using the Schizophrenia Cognition Rating Scale Japanese version (SCoRS-J) and the Brief Assessment of Cognition in Schizophrenia Japanese version (BACS-J). This study aimed to investigate the relationship between subjectively-assessed cognitive impairment and objectively assessed neurocognition in patients with schizophrenia. The results showed that patients' global rating scores of the SCoRS-J were significantly correlated with the BACS-J attention scores (r = −0.376, p < 0.008), which indicates that the difficulties patients perceived in their daily lives are due to deficits in attentional functioning, as measured by neurocognitive testing. Thus, our findings indicate that improving attentional functioning may also alleviate difficulties in patients' daily lives.

Nociceptive Reflex in Patients With Schizophrenia: A Case-Control Study

Background: Diminished pain sensitivity has been reported in patients in the acute phase of psychosis, as well as in stable patients. The cause of hypoalgesia in those patients is unknown. The aim of this study was to investigate the sensory thresholds, pain modalities, or other factors contributing to the perception or expression of physical pain in patients with schizophrenia (SCZ). Methods: This case-control study was conducted on 24 patients with SCZ and 12 healthy controls. Patients with SCZ were assessed by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Positive and Negative Symptom Scale and Schizophrenia Cognition Rating Scale. All participants were subjected to full medical and neurological examination and nociceptive reflex. Results: There was no significant difference between cases and controls in nociceptive threshold, while it showed a significant difference at the subjective pain threshold as the case group needed a higher intensity of current to perceive as painful. There was a significant positive correlation between age, duration of SCZ and number of episodes and the nociceptive reflex. Also, there was a significant positive correlation between the negative symptoms of SCZ and cognitive impairment on one arm and the subjective pain threshold on the other arm. Conclusion: The pain insensitivity in patients with SCZ is not related to physiological changes in the nociceptive pathway, but rather may be related to change in the experience and expression of pain. Older age, longer duration of disease, more frequent episodes, negative symptoms, and cognitive impairment, but not antipsychotic medications, all are positively correlated with the increase in subjective pain threshold. J Neurol Res. 2021;11(1-2):20-26 doi: https://doi.org/10.14740/jnr656