MRI correlates of psychotherapy-related improvement in negative symptoms in psychotic disorders
Poster No:
433
Submission Type:
Abstract Submission
Authors:
Dirk Wildgruber1, Stefan Klingberg1, Klaus Hesse1, Benjamin Kreifelts1, Michael Erb1
Institutions:
1University of Tübingen, Tübingen, Germany
First Author:
Co-Author(s):
Introduction:
In addition to delusions and hallucinations, patients with psychotic disorders may also present with negative symptoms and cognitive deficits. Negative symptoms (blunted affect, alogia, anhedonia, avolition, social withdrawal [1]) are the most important predictors of long-term impairments in social functioning and quality of life [2-3]. Furthermore, negative symptoms respond poorly to the pharmacological and psychotherapeutic interventions available to date [4-5]. This study investigated the efficacy of a psychotherapy specifically designed to reduce negative symptoms in patients with psychotic disorders. The new approach (MOSAIC) combines individual cognitive behavioral therapy and group training in social skills and cognition to improve negative symptoms, social cognition, and social functioning. Besides assessment of negative symptoms (PANSS-neg [6-7]), social skills (SSPA [8]), and social functioning (TBM [9]), treatment-related changes in resting-state network activation and gray matter volume were evaluated.
Methods:
MOSAIC (30 sessions individual CBT & 30 group training sessions within 8 months) was compared to SUPPORT (supportive talks and pleasant group activities in equal duration and frequency) in a randomized controlled trial. Sixty patients with psychotic disorders with marked negative symptoms participated (PANSS negative > 10), of which 54 patients completed the intervention (27 per group). Assessments for the primary (PANSS-neg) and secondary endpoints (SSPA, TBM) were carried out at baseline (T0) and after the 8-month treatment (T1). The investigator was blind to information on which therapy the patient had received. Furthermore, pre- and post-interventional structural MRI data (3T, Siemens Prisma) and resting-state activation (10 min) were evaluated for treatment-related changes using SPM12 (www.fil.ion.ucl.ac.uk/spm, CONN-Toolbox, CAT12-Toolbox, p < 0.05).
Results:
Statistical analysis revealed no significant differences between MOSAIC and SUPPORT regarding improvement in negative symptoms (p = 0.36, Cohen's d = 0.1). However, pre-post comparisons showed reduction in negative symptoms with medium to large effect sizes within each group (see Fig. 1). Mean PANSS negative scores decreased by 4.7 ± 5.8 points for MOSAIC (p < 0.001, d = 0.82) and by 4.1 ± 7.7 points for SUPPORT (p = 0.005, d = 0.53). Moreover, significant dose-response relationship with the intensity of therapy emerged in both groups (MOSAIC: r = 0.61, p < 0.001; SUPPORT: r = 0.35, p = 0.04). At neural level, improvement in negative symptoms correlated with increased resting-state mean activity in the medial orbitofrontal cortex (Fig. 2) and an elevation of resting-state connectivity to the left Nucleus Caudatum associated to improvement of negative symptoms (r = 0.27, p = 0.03). In addition, increasing resting-state connectivity to the right Nucleus Accumbens was correlated to improvement in social functioning (Time Budget Measure: r = 0.36, p = 0.007).
Conclusions:
MOSAIC showed no significant superiority to SUPPORT. However, both groups experienced relevant improvements in negative symptoms with medium to large effect sizes. Furthermore, the observed dose-response relationships complement the evidence for the efficacy of both treatments. The observed increase in resting-state network activation indicates a link between clinical improvement and neuroplastic changes, presumably involving reshaping of synaptic connections [10] in brain regions known to contribute to social cognition, motivation, and emotion processing [11]. In conclusion, the results of the current study suggest that intensive psychotherapy may help to reduce negative symptoms and induce therapy-related neuroplasticity.
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 1
Novel Imaging Acquisition Methods:
BOLD fMRI 2
Keywords:
Behavioral Therapy
Cortex
DISORDERS
FUNCTIONAL MRI
Limbic Systems
Plasticity
Psychiatric Disorders
Schizophrenia
1|2Indicates the priority used for review
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