M. Chieffi

The Brief Negative Symptom Scale (BNSS): Independent validation in a large sample of Italian patients with schizophrenia.

BACKGROUND The Brief Negative Symptom Scale (BNSS) was developed to address the main limitations of the existing scales for the assessment of negative symptoms of schizophrenia. The initial validation of the scale by the group involved in its development demonstrated good convergent and discriminant validity, and a factor structure confirming the two domains of negative symptoms (reduced emotional/verbal expression and anhedonia/asociality/avolition). However, only relatively small samples of patients with schizophrenia were investigated. Further independent validation in large clinical samples might be instrumental to the broad diffusion of the scale in clinical research. METHODS The present study aimed to examine the BNSS inter-rater reliability, convergent/discriminant validity and factor structure in a large Italian sample of outpatients with schizophrenia. RESULTS Our results confirmed the excellent inter-rater reliability of the BNSS (the intraclass correlation coefficient ranged from 0.81 to 0.98 for individual items and was 0.98 for the total score). The convergent validity measures had r values from 0.62 to 0.77, while the divergent validity measures had r values from 0.20 to 0.28 in the main sample (n=912) and in a subsample without clinically significant levels of depression and extrapyramidal symptoms (n=496). The BNSS factor structure was supported in both groups. CONCLUSIONS The study confirms that the BNSS is a promising measure for quantifying negative symptoms of schizophrenia in large multicenter clinical studies.

Neurocognitive individualized training versus social skills individualized training: A randomized trial in patients with schizophrenia

Rehabilitation programs integrating cognitive remediation (CR) and psychosocial rehabilitation are often implemented as they seem to yield greater improvements in functional outcome than stand alone treatment approaches. Mechanisms underlying synergistic effects of combining CR with psychosocial interventions are not fully understood. Disentangling the relative contribution of each component of integrated programs might improve understanding of underlying mechanisms. In the present study we compared the efficacy of two components of our rehabilitation program [the Neurocognitive Individualized Training (NIT) and the Social Skills Individualized Training (SSIT)]. Seventy-two patients with schizophrenia or schizoaffective disorder were randomly assigned to one of two treatment groups. Changes in cognitive, psychopathological and real-world functioning indices after 6 and 12 months were compared between the two groups. After both 6 and 12 months, NIT produced an improvement of attention, verbal memory and perseverative aspects of executive functioning, while SSIT produced a worsening of visuo-spatial memory and attention and no significant effect on the other cognitive domains. As to the real-world functioning, NIT produced a significant improvement of interpersonal relationships, while SSIT yielded a significant improvement of QLS instrumental role subscale. According to our findings, cognitive training is more effective than social skills training on several cognitive domains and indices of real-world functioning relevant to subjects relationships with other people. Integrated approaches might target different areas of functional impairment but should be planned carefully and individually to fully exploit the synergistic potential.

Pathways to functional outcome in subjects with schizophrenia living in the community and their unaffected first-degree relatives

RATIONALE Variables influencing real-life functioning have repeatedly been modeled in schizophrenia subjects but not systematically investigated in their unaffected first-degree relatives (SRs), in whom milder forms of deficits reported in schizophrenia have been observed, but confounders of clinical cohorts are not in play. Demonstrating that pathways to functional outcome are similar between patients and SRs would validate structural models developed in schizophrenia subjects. The present multicenter study aimed to explore whether variables associated with real-life functioning are similar in schizophrenia patients and their unaffected relatives. METHODS The study sample included 921 schizophrenia patients, 379 SRs and 780 healthy controls. Structural Equation Models (SEMs) were used in patients and SRs to test associations of psychopathological dimensions, neurocognition, social cognition, resilience, perceived stigma and functional capacity with real-life functioning domains, impaired in both patients and SRs. RESULTS Interpersonal Relationships and Work Skills were the only functional domains impaired in both patients and SRs. For both domains, functional impairment in patients was found to predict impairment in unaffected relatives, suggesting the involvement of similar illness-related vulnerability factors. In both groups variables significantly associated with Interpersonal Relationships included Social Cognition, Neurocognition, Avolition, Resilience, Disorganization, Perceived Stigma and Gender, and those significantly associated with Work Skills included Social Cognition, Neurocognition and Disorganization. CONCLUSIONS Pathways to functional outcome for Interpersonal relationships and Work skills are similar between schizophrenia patients and their unaffected first-degree relatives. These findings validate, in the absence of confounders of clinical cohorts, structural models of determinants of functional outcome in people with schizophrenia.

The relationships of personal resources with symptom severity and psychosocial functioning in persons with schizophrenia: results from the Italian Network for Research on Psychoses study

The relationships of personal resources with symptom severity and psychosocial functioning have never been tested systematically in a large sample of people with schizophrenia. We applied structural equation models to a sample of 921 patients with schizophrenia collected in a nationwide Italian study, with the aim to identify, among a large set of personal resources, those that may have an association with symptom severity or psychosocial functioning. Several relevant demographic and clinical variables were considered concurrently. Poor service engagement and poor recovery style, as well as older age and younger age at onset, were related to greater symptom severity and poorer social functioning. Higher resilience and higher education were related to better social functioning only. Poor problem-focused coping and internalized stigma, as well as male gender and depression, were related to symptom severity only. The explored variables showed distinctive and partially independent associations with symptom severity and psychosocial functioning. A deeper understanding of these relationships may inform treatment decisions.

2304 – Relationships between psychopathological dimensions, cognitive deficits and functional capacity/real-life functioning in patients with schizophrenia

An impairment of functional capacity and real-life functioning has widely been reported in patients with schizophrenia, even when clinical remission has been achieved. The relative contribution of negative symptoms and neurocognitive deficits to such an impairment is still debated. In the present study, we investigated the relationships of functional capacity and real-life functioning with psychopathology and cognitive deficits in 35 schizophrenia patients, all treated with new-generation antipsychotics. The MATRICS Cognitive Consensus Battery was used to assess cognitive functions. Real-life functioning was evaluated with the Quality of Life Scale (QLS). Functional capacity was assessed with the Performance-Based Skills Assessment-Brief (UPSA-B). Psychopathological dimensions were calculated from PANSS items. Multiple Regression Analyses (MRA) were conducted, in which dependent variables were the indices of functional capacity/real life functioning while independent variables were psychopathological dimensions, neurocognitive indices, general abilities and education. The results of MRA on the QLS indices showed the following percentages of variance explained: negative psychopathological dimension, 64% for “intrapsychic functions” and 46% for “interpersonal relationships”; speed of processing, 13% for “work functioning” and 11% for “interpersonal relationships”; visual learning, 12% for “work functioning”; positive psychopathological dimension, 11% for “intrapsychic functions” and 5% for “interpersonal relationships”; working memory, 7% for “intrapsychic functions”. As to the MRA on UPSA-B total score, working memory explained 57% of the variance while speed of processing explained 12% of it. Our findings suggest that both negative symptoms and cognitive impairment have a strong relationship with real-life functioning while cognitive impairment is the only aspect associated to functional capacity.

P-135 - Emotional Training (ET): a group psychotherapy to improve awareness and modulation of emotional experience

Introduction Several studies have highlighted a poor emotional processing in patients with Panic Disorder (PD). Difficulty to identify and manage emotional experience might contribute to the enduring vulnerability to panic attacks. Objectives We describe our implementation of a group psychotherapy program, the Emotional Training (ET), aimed at relapse prevention in patients with PD. Methods The ET group incorporates some elements of the so-called “emotion-focused therapies” in a cognitive-behavioral framework. In particular, it introduces elements of skills training to increase awareness of emotional states (including psychophysical reactions), their acceptance and adaptive modulation. The present study was designed to assess the feasibility and efficacy of ET group in healthy subjects. Results Nine participants completed this pilot study, which lasted 6 months, with weekly 2.5 hour sessions. General cognitive abilities, selective attention, cognitive flexibility, management of emotions, emotional expressivity, empathy, inhibition of interference from emotional stimuli (emotional Stroop test) and Theory of Mind were assessed before and at the end of the study. Significant differences at 6 months were found for the emotional Stroop test and the Emphaty Quotient, compared to baseline. Conclusions These results suggest that ET intervention increases the ability to perceive the emotional states in social contexts and to inhibit the interference from emotional stimuli. This pilot study provided encouraging results; a further step will be to verify, in patients with PD, the effectiveness of ET and its usefulness in relapse prevention.