Biological Psychiatry Congress 2015

Abstract

Introduction. Disrupted perception, i.e. lack of self-awareness, in psychosis impacts required mental effort during information processing. Mental effort increases when demands of a task increase; previously this relationship has been identified by increased beta band activity over the left parietal cortex in healthy controls. In the current study we hypothesised that individuals with diagnosis of a psychotic disorder will not show this relationship, owing to their lack of self-awareness and insight when reporting subjective measures of mental effort. Methods. This study included 83 participants with one of three diagnoses: schizophrenia (SZ, n=29), bipolar I disorder psychosis (BPD, n=28), or methamphetamine-induced psychosis (MPD, n=24), and socio-demographic controls (n=32). All participants underwent electroencephalography (EEG) and relative band frequency activities were correlated with reported mental effort during three conditions: resting eyes open (REO), resting eyes closed (REC), and during an attention task, a continuous performance task (CPT). In addition several clinical scales were performed to address current symptom presentation. Results. First, perceived mental effort reported by the BDP group during REO was negatively correlated with relative alpha band power over the frontal and parietal cortices, and with relative beta band power over the cingulate cortex. Relative theta band power was positively correlated with perceived mental effort over the left frontal cortex, relative beta band power over the parietal cortex, and relative delta band power over the cingulate and parietal cortices during REO. Second, perceived mental effort reported by the MPD group was negatively correlated with their Positive and Negative Syndrome Scale (PANSS) scores. Conclusion. The BPD group showed strong relationships with EEG band frequency activity and perceived mental effort during relaxed wakefulness; we suggest that this may relate to the reported increase in psychosomatic awareness which is present in BPD. The MPD group reported lower perceived mental effort when their psychotic symptomatology was high, suggesting disrupted perception. Introduction. The purpose of the study was to assess the effect of a post-discharge, telephone-based intervention on readmissions for patients with severe mental illness in a developing country over a 1-year period. The study was conceptualised in an attempt to find a practical and affordable intervention that would be easy to im plement in an under-resourced setting and which could alleviate some of the pressure on inpatient beds. Interventions offering more comprehensive post-discharge support have been successful in reducing readmissions in high-frequency users in this same setting, but may not by justifiable and sustainable in the long run. Methods. This was a non-blinded, randomised control trial. A hundred patients with established diagnosis of schizophrenia, schizo-affective disorder or bipolar disorder were randomised into a facilitated care group and treatment-as-usual group, respectively. All participants were interviewed prior to discharge and again 12 months after discharge. The facilitated care group received a telephone-based intervention consisting of monthly structured telephonic interviews, motivating patients to attend appointments and offering telephonic support to patients and families. Data were collected for readmissions, and days spent in hospital (DIH), and the Clinical Global Impression (CGI) scale was completed. Results. Data were analysed for 43 patients in the facilitated care group and 39 patients in the treatment-as-usual group. There were no significant differences in readmissions (p=0.10) and days in hospital (p=0.44) between groups at 12-month follow-up. The Cochran Armitage test for trend was performed to compare CGI and admission experience between groups. To statistically test for significance between the groups for DIH and quality of life (QOL), the numerical scale was retained and the Kruskal-Wallis test was used. Reported use of illicit substance was high in both groups (64%), particularly use of methamphetamine, which was 44% in both groups. The Fisher's exact test was used to assess differences in demographic and substance use patterns between the two groups ABSTRACTS