Aberrant Learned Irrelevance in Patients with First-Episode Schizophrenia-Spectrum Disorder

Emerging evidence has indicated disrupted learned irrelevance (LIrr), a form of selective attention deficit that may contribute to psychotic symptom formation, in schizophrenia. However, previous research mostly focused on chronic patients. There is a paucity of studies on LIrr in first-episode schizophrenia-spectrum disorder (i.e., schizophrenia and schizophreniform disorder; FES), which were limited by small sample size and have produced mixed results. The current study examined a LIrr effect and its relationship with positive symptom severity in 40 briefly-medicated FES patients and 42 demographically-matched healthy controls using a well-validated computerized LIrr paradigm which has been applied in chronic schizophrenia sample. Positive symptoms were assessed by Positive and Negative Syndrome Scale (PANSS) and Psychotic Symptom Rating Scales (PSYRATS). Our results showed that controls demonstrated intact LIrr, with significantly faster learning about previously predictive (relevant) than previously non-predictive (irrelevant) cues. Lack of such normal attention bias towards predictive over non-predictive cues was observed in FES patients, indicating their failure to distinguish between relevant and irrelevant stimuli. Nonetheless, we failed to reveal any significant correlations between learning scores, in particular learning scores for non-predictive cues, and positive symptom measures in FES patients. Learning scores were also not associated with other symptom dimensions, cognitive functions and antipsychotic dose. In conclusion, our findings indicate aberrant LIrr with impaired allocation of attention to relevant versus irrelevant stimuli in briefly-medicated FES patients. Further prospective research is warranted to clarify the longitudinal trajectory of such selective attention deficit and its association with positive symptoms and treatment response in the early course of illness.

Cerebellar Activation Deficits in Schizophrenia During an Eyeblink Conditioning Task

The cognitive dysmetria theory of psychotic disorders posits that cerebellar circuit abnormalities give rise to difficulties coordinating motor and cognitive functions. However, brain activation during cerebellar-mediated tasks is understudied in schizophrenia. Accordingly, this study examined whether individuals with schizophrenia have diminished neural activation compared to controls in key regions of the delay eyeblink conditioning (dEBC) cerebellar circuit (eg, lobule VI) and cerebellar regions associated with cognition (eg, Crus I). Participants with schizophrenia-spectrum disorders (n = 31) and healthy controls (n = 43) underwent dEBC during functional magnetic resonance imaging (fMRI). Images were normalized using the Spatially Unbiased Infratentorial Template (SUIT) of the cerebellum and brainstem. Activation contrasts of interest were “early” and “late” stages of paired tone and air puff trials minus unpaired trials. Preliminary whole brain analyses were conducted, followed by cerebellar-specific SUIT and region of interest (ROI) analyses of lobule VI and Crus I. Correlation analyses were conducted between cerebellar activation, neuropsychological test scores, and psychotic symptom scores. In controls, the largest clusters of cerebellar activation peaked in lobule VI during early dEBC and Crus I during late dEBC. The schizophrenia group showed robust cortical activation to unpaired trials but no significant conditioning-related cerebellar activation. Crus I ROI activation during late dEBC was greater in the control than schizophrenia group. Greater Crus I activation correlated with higher working memory scores in the full sample and lower positive psychotic symptom severity in schizophrenia. Findings indicate functional cerebellar abnormalities in schizophrenia which relate to psychotic symptoms, lending direct support to the cognitive dysmetria framework.

The time course of psychotic symptom side effects of ketamine in the treatment of depressive disorders: a systematic review and meta-analysis

Objective: Ketamine is a potential rapid-acting treatment for depression. Studies have suggested that the side effects are minimal and temporary, but the psychotic symptom side effects have yet to be fully examined. This study investigated whether ketamine infusion in the treatment of mood disorders is associated with increases in positive symptoms and whether these symptom effects endure over time. Methods: A systematic review and meta-analysis of studies of ketamine in the treatment of depression. Embase and Medline databases were searched for studies including (a) participants with major affective disorders, (b) 0.4 or 0.5 mg intravenously administered ketamine, (c) measurement of positive symptoms using BPRS+, and (d) a within-subject repeated-measures design with participants serving as their own baseline. Results: Seventeen studies met the inclusion criteria, comprising 458 participants. The meta-analyses examined symptom change occurring within the first 4 h, after 1 day, and after 3 days. Results showed significant BPRS+ increases within the first 30–60 min in 72% of studies, followed by a return to baseline levels. Conclusion: Peak symptom change occurred within the first hour post infusion. There are limited data to determine if ketamine is safe in the longer term, but there were no indications that psychotic symptoms re-occurred after the first hour and in the days following administration.

STUDI KASUS AKTIVITAS MENGGAMBAR DALAM MENGONTROL GEJALA HALUSINASI DI RSJ PROF. DR. SOERODJO MAGELANG

Latar Belakang :halusinasi merupakan salah satu dari gejala gangguan jiwa yaitu dimana klien mengalami perubahan persepsi sensori : merasakan sensori yang tidak nyata berupa suara, penglihatan, pengecapan, perabaan, atau penghiduan. Intervensi pada halusinasi yaitu untuk mengontrol gejala pada halusinasi diantaranya dengan melakukan aktivitas menggambar. Tujuan : tujuan penelitian ini untuk mengetahui asuhan keperawatan jiwa dengan perubahan persepsi sensori : hausinasi pendengran dengan intervensi aktivitas menggambar Metode : penelitian ini menggunakan metode deskritif dengan menggunakan pendekatan proses keperawatan yang dilakukan selama 5 hari pada klien rawat inap di RSJ Prof. dr. Soerojo Magelang, yang telah didiagnosa skizofrenia dengan fokus perubahan persepsi sensori halusinasi. Teknik pengumpulan data dilakukan dengan wawancara, observasi, dokumen,. Instrumen penelitian menggunakan format PSYRAT (Psychotic Symptom Rating Scale) yang terdiri dari 11 pertanyaan dan format asuhan keperawatan jiwa. Hasil : dari penelitian terdapat penurunan gejala halusinasi setelah dilakukan aktivitas menggambar yang diukur dengan PSYRAT (Psychotic Symptom Rating Scale). Kesimpulan : dalam menerapkan aktivitas gambar efektif untuk mengontrol gejala halusinasi, namun terdapat faktor faktor yang mempengaruhi aktivitas menggambar

445 - The factors associated with the presence of psychotic symptoms in the HELIAD Greek community study of older adults

ABSTRACTBackground:The prevalence and associated factors related to psychotic symptoms in older adults are understudied. The objectives were to assess the prevalence, incidence and factors associated with psychotic symptoms in a representative Greek sample of community living older adults.Methods:This study includes older adults aged ≥ 65 years participating in the Hellenic Longitudinal Investigation of Aging and Diet. The analysis is based on n=1,904 participants with available data at baseline and n=947 participants at the 3-year follow-up. The presence of delusions and hallucinations in the past month was assessed on the grounds of the 17 symptoms of the Columbia University Scale for Psychopathology in Alzheimer's Disease and of the 14 symptoms of the Neuropsychiatric Inventory Questionnaire. An affirmative answer to any of these 31 symptoms defined the presence of psychotic symptoms. A comprehensive neuropsychological assessment for probable diagnosis of dementia and physical comorbidity was carried out by neurologists. Study factors included age, education, marital status, widowed in the past year, occupation, hearing impairment and number of chronic comorbidities. Penalized logistic regression analyses were carried out to assess the socio-demographic and clinical factors associated with the prevalence and incidence of psychotic symptoms.Results:The past-month prevalence of any psychotic symptom was 1.9% and 1.0% when excluding cases of dementia. The prevalence of any delusion and hallucination was 1.5% and 0.7%, and 0.8% and 0.3% when excluding cases with dementia. Paranoid delusions were the most prevalent. The incidence at the follow-up of any psychotic symptom was 2.1% and 1.3% when excluding dementia. Individuals not married had twice the odds and, farmers/breeders had three times the odds than public servants/teachers/executives of experiencing psychotic symptoms. Hearing impairment and the number of comorbidities increased the odds of the presence of psychotic symptoms. In addition to age and recent widowhood, these factors remained significantly associated with the presence of psychotic symptoms in cases without dementia.Conclusion:Dementia was not related to over half of the cases observed with psychotic symptoms. Paranoid delusions were the most prevalent. Socio-economic and health status factors are significant predictors of psychotic symptoms.

M98. IS THERE A DEVELOPMENTAL TRAUMAGENIC PHENOTYPE OF PSYCHOSIS?

Background Developmental trauma (DT) induces vulnerability to psychosis in adulthood. Adult survivors of DT with psychosis (ASDTP) have worse prognosis across a range of outcomes compared to individuals with psychosis without DT exposure. It has been suggested that this may reflect a developmental ‘traumatogenic’ psychosis phenotype, distinct from idiopathic schizophrenia. Given the implications for precision medicine, we therefore sought to test this hypothesis by conducting systematic reviews and meta-analyses of the literature comparing psychotic symptoms and neuroimaging findings between adults with psychosis diagnoses with and without developmental trauma. Methods We registered our search protocols in PROSPERO (CRD42018105021 and CRD42019131245). We systematically searched literature databases for relevant studies published up to July 2019. “Embase”, “MEDLINE”, and “PsychINFO” were systematically searched. Reference lists, OpenGrey, and Google scholar were hand-searched. Phenomenological outcomes of interests were quantitative and/or qualitative differences in psychotic symptom expression (primary outcome) and other domains of psychopathology (secondary outcome) between ASDTP and people with psychosis who did not report developmental trauma. Neuroimaging outcomes of interest including markers of brain volume and function (e.g. task-induced blood-oxygen dependent signal). Results Seventeen studies of symptomatology were included. Of these, four were meta-analysed. There was a relationship between DT and greater positive (Hedges g=0.53; p<0.001) and negative (Hedges g =0.41; p=0.001) symptom severity. ASDTP had greater neurocognitive deficits and symptom severity in other domains of psychopathology compared to individuals without DT. There was evidence that psychotic symptom content related to traumatic memories in those with experiences of DT. We identified twenty-seven imaging studies (n = 1,438 psychosis patients, n = 1,114 healthy controls or healthy siblings). DT was associated with global and regional differences in grey matter; corticolimbic structural dysconnectivity; a potentiated threat detection system; dysfunction in regions associated with mentalization; and elevated striatal dopamine synthesis capacity. Meta-analysis indicated that developmental trauma is associated with reductions of cortical thickness, global grey matter volume, and hippocampal volumes in patients with psychosis. Discussion Adult survivors of developmental trauma have more severe psychotic symptoms than those without developmental trauma histories. Alongside findings of differences in symptom expression and neuroimaging, the evidence suggests that there may be developmental traumatogenic psychosis phenotype. However, a key mechanistic gap remains how clinical and neuroimaging findings relate to each other. Nonetheless, alternative interpretations, such as an underdiagnosis of post-traumatic stress disorder, could also be plausible. These findings warrant further research to elucidate vulnerability and resilience mechanisms for psychosis in adult survivors of developmental trauma.