Abstract
In the treatment of persons with schizophrenia the goal has gradually shifted from the reduction of symptoms and prevention of relapse to recovery. However, this goal is achieved for a ...minority of persons with schizophrenia, while for most of them the disorder still is a major cause of disability, poor quality of life and premature death, and presents considerable social and economic costs.
Studies aimed at identifying variables with a significant impact on schizophrenia outcome indicate that early intervention, shared decision making, treatment continuity, physical comorbidities, negative symptoms, deficits in cognitive functions and functional capacity account for most of the functional impairment of patients but are often neglected in current clinical practice.
In this presentation, I will illustrate the role of these variables and the need for an in-depth clinical characterization of persons with primary psychoses to implement personalized treatment plans and improve the care of people with schizophrenia.
Disclosure of Interest
None Declared
Abstract
A negative impact on mental health of Ukrainian people who will survive the war is very likely.
Those who leave are exposed to the trauma of leaving behind home, relatives, friends, job, ...habits, i.e., most of what they had built in their life, and to the unpleasant feeling of knowing nothing of what they will go through.
Mutual support and nurture problem-solving strategies, including favoring family reunion, restoring people dignity and control over the environment, help children recover a more positive social reality, are major protective factors in buffering the impact of war, displacement and related trauma.
By November 2022, Italy had hosted more than 170.000 Ukrainian refugees. The National Service intervention, coordinated by the Civil Protection Department, has developed a Plan for the reception and assistance of the population from Ukraine to uniform the response to the emergency on the national territory. The plan has focused on two aspects: humanitarian assistance and reception. The network for reception is composed of the CAS - Extraordinary Reception Centers and the SAI - Integration Reception System. The Plan also provides measures related to health care and education to ensure mandatory vaccination requirements and the access to the school system for unaccompanied foreign minors. As to plans aimed to address mental health issues, the right to care is guaranteed, but several issues can be identified that limit the impact of the national policies on the needs of this population.
Disclosure of Interest
None Declared
Abstract
To favor the implementation of alternatives to coercive practices, a WPA Taskforce and reference group on Minimizing Coercion in Mental Health Care was created within the WPA 2017-2020 ...Action Plan. It included several distinguished colleagues from different countries and cultural as well as experiential background, and representatives from patients and carers organizations. Task force members soon realized the presence of a significant diversity of views and experiences among mental health professionals, people with lived experience and their carers. All members agreed that the debate on minimizing versus eliminating coercion could be endless and unfruitful, while the opportunity to concentrate on improving the quality of mental health care in low-, middle- and high-income countries, and implementing alternatives to coercion as a key component of improving mental health care, was instead a shared goal that could make the task of the group feasible and productive. The General Assembly of the WPA in October 2020 approved a Position statement drafted by the Task Force aimed to set a direction and practical starting point for action. This presentation will illustrate contribution provided by the WPA Working Group for Implementing Alternatives to Coercion in Mental Health Care within the current WPA Action Plan (2020-2023).
Disclosure of Interest
None Declared
Abstract Body
The use of coercive measures in Medicine represents a controversial issue. Even when they comply with all rules and procedures and are enacted with the intention to address the health ...needs of the patient, and/or protect the patient and/or others, they always represent an infringement of fundamental personal rights and require strong ethical justification.
In Psychiatry the debate around coercive measures has led to a theoretical impasse, as the attempt to solve an ethical dilemma may expose mental health care to other ethical challenges and questions of competing rights. At the same time, the ongoing debate has contributed to raise the awareness that coercive practices are over-used, and mental health care is in need of a profound transformation towards recovery-oriented systems of care.
The implementation and dissemination of alternatives to coercive practices is an essential component of such transformation. Relevant research has provided tools and documented successful practices, and initiatives aimed at making these resources available and adapted to different contexts are being promoted by international organizations, professional associations and associations of users and carers.
1
The profound transformation of current mental health care towards recovery-oriented systems of care requires resources and shared goals among the different stakeholders. Integrated and personalised care pathways, respect of human rights, shared decision making, and involvement of users and carers are essential components of this transformation.
Disclosure
No significant relationships.
Abstract Body
Precision medicine is “an emerging approach for treatment and prevention that takes into account each person’s variability in genes, environment, and lifestyle” 1. The terminology is ...increasingly used in psychiatry, and especially in research relevant to the prediction of psychosis onset, response to treatment and functional outcome. While this is an important step-forward for the discipline, at this stage it is very important to promote the translation of research findings into clinical practice, as much as possible. Nowadays the availability of machine learning and artificial intelligence tools, together with advances in data storage and data security, enable the integration of neuroimaging, biological, clinical and cognitive data. By overcoming current limitations in multiple domain data analysis these tools may lead to the identification of reliable diagnostic, prognostic and therapeutic markers in routine clinical care, as well as to the prediction of clinically meaningful outcomes (e.g., psychosis onset, symptomatic and functional outcome, and treatment response). Precision medicine in psychiatry is a developing science, deserving further large-scale research, translational approaches and refinement that, hopefully, will soon be an integral part of every-day clinical practice. However, challenges in pursuing this strategy should not be underestimated, and efforts should be made to constantly advocate for more investments in human and financial resources in psychiatry, and to concentrate on the use of widely available and not too expensive and time-consuming methods.
1
Toward Precision Medicine. Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. Washington, DC: National Academies Press; 2011.
Disclosure
No significant relationships.
During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are ...primary and persistent.
In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice.
Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings.This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones.The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment.Several recommendations are provided for the identification of secondary negative symptoms in clinical settings.
The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.
Subjects at ultra high-risk (UHR) for psychosis have an enhanced vulnerability to develop the disorder but the risk factors accounting for this accrued risk are undetermined.
Systematic review of ...associations between genetic or environmental risk factors for psychosis that are widely established in the literature and UHR state, based on comparisons to controls.
Forty-four studies encompassing 170 independent datasets and 54 risk factors were included. There were no studies on association between genetic or epigenetic risk factors and the UHR state that met the inclusion criteria. UHR subjects were more likely to show obstetric complications, tobacco use, physical inactivity, childhood trauma/emotional abuse/physical neglect, high perceived stress, childhood and adolescent low functioning, affective comorbidities, male gender, single status, unemployment and low educational level as compared to controls.
The increased vulnerability of UHR subjects can be related to environmental risk factors like childhood trauma, adverse life events and affective dysfunction. The role of genetic and epigenetic risk factors awaits clarification.
Negative symptoms of schizophrenia remain a major therapeutic challenge. The progress in the conceptualization and assessment is not yet fully reflected by treatment research. Nevertheless, there is ...a growing evidence base regarding the effects of biological and psychosocial interventions on negative symptoms. The importance of the distinction between primary and secondary negative symptoms for treatment selection might seem evident, but the currently available evidence remains limited. Good clinical practice is recommended for the treatment of secondary negative symptoms. Antipsychotic treatment should be optimized to avoid secondary negative symptoms due to side effects and due to positive symptoms. For most available interventions, further evidence is needed to formulate sound recommendations for primary, persistent, or predominant negative symptoms.However, based on currently available evidence recommendations for the treatment of undifferentiated negative symptoms (including both primary and secondary negative symptoms) are provided. Although it has proven difficult to formulate an evidence-based recommendation for the choice of an antipsychotic, a switch to a second-generation antipsychotic should be considered for patients who are treated with a first-generation antipsychotic. Antidepressant add-on to antipsychotic treatment is an option. Social skills training is recommended as well as cognitive remediation for patients who also show cognitive impairment. Exercise interventions also have shown promise. Finally, access to treatment and to psychosocial rehabilitation should be ensured for patients with negative symptoms. Overall, there is definitive progress in the field, but further research is clearly needed to develop specific treatments for negative symptoms.
A renewal of interest in the cognitive assessment of people with schizophrenia was related to the increasing acknowledgement of the strong relationships of cognitive deficits with functional outcome. ...In the early 2000’s, research focused on those aspects of cognition that demonstrated a strong correlation with a variety of functional outcome measures (community functioning, functional capacity, social skills acquisition). Later on, social cognition, which was not included in neuropsychological batteries, became also a focus as it represents a mediator of the impact of neurocognition on functioning. The renewed interest and the association with functional outcome stimulated the development of batteries specifically devoted to the cognitive assessment of subjects with schizophrenia. The MATRICS Consensus Cognitive Battery (MCCB) is the instruments with the largest evidence of good psychometric properties and strong relationship with functional outcome. The MCCB has been proposed as the gold standard in assessing cognitive impairment in subjects with schizophrenia and has been translated into 24 languages and validated in many different countries. Different instruments are also available to assess emotional processing and theory of mind which should complement MCCB and similar batteries. The long administration time limits the use of batteries in everyday clinical routine and short-administered instruments were developed as screening tools. A brief, interview-based assessment of cognitive functioning, the Cognitive Assessment Interview, has also been developed and validated for use in clinical settings or as a co-primary measure in clinical trials. The development of a guidance paper might promote the routine assessment of cognition in subjects with schizophrenia.
Disclosure
Honoraria, advisory board, or consulting fees from Angelini, Astra Zeneca, Bristol-Myers Squibb, Gedeon Richter
Bulgaria, Innova-Pharma, Janssen Pharmaceuticals, Lundbeck, Otsuka, Pfizer, and Pierre Fabre, for services not related to this abstract
The concept of deficit schizophrenia is regarded as one of the most promising attempts to reduce heterogeneity within schizophrenia. This paper summarizes the clinical, neurocognitive, brain imaging ...and electrophysiological correlates of this subtype of schizophrenia. Attempts to identify genetic and non-genetic risk factors are reviewed. Methodological limitations of studies supporting the efficacy of atypical antipsychotics in the treatment of the syndrome are highlighted. Two decades of research on deficit schizophrenia have failed to prove that it represents the extreme end of a severity continuum in schizophrenia, while some findings support the claim that it may be a separate disease entity.
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