Indiana University-Purdue University Indianapolis (IUPUI) / Motivation deficits remain an unmet treatment need in schizophrenia. Recent preclinical research has identified novel mechanisms underlying motivation deficits, namely impaired effort-cost computations and reduced future reward-value representation maintenance, that may serve as more effective treatment targets to improve motivation. The main aim of this study was to test the feasibility and preliminary effectiveness of a translational mechanism-based intervention, MEMS (Mobile Enhancement of Motivation in Schizophrenia), which leverages mobile technology to target these mechanisms with text-messages. Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over eight-weeks. The MEMS group also received personalized, interactive text-messages each weekday to support motivation. Retention and engagement in MEMS was high: 92.6% completed 8 weeks of MEMS, with an 86.1% text-message response rate, and 100% reported that they were satisfied with the text-messages. Compared to the control condition, the MEMS group had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and obtained significantly more recovery-oriented goals at the end of the 8-week period. There were no significant group differences in performance-based effort-cost computations and future reward-value representations, self-reported motivation, quality of life, functioning, or additional secondary outcomes of positive symptoms, mood symptoms, or neurocognition. Results suggest that MEMS is feasible as a relatively brief, low-intensity mobile intervention that could effectively improve interviewer-rated motivation, anticipatory pleasure, and recovery goal attainment in those with schizophrenia-spectrum disorders.

I examined the effects of a residential treatment program on symptoms and mental health service use in 14 chronic schizophrenics. The clients chosen for this study were the most difficult clients in this population due to continued high service usage (i.e., time spent in locked facilities). All 14 clients had been in a locked facility at least 1 year immediately prior to treatment. The program included skills training, reinforcement for incompatible behavior, and a token economy. The clients' symptomology was recorded twice a day. My hypotheses were that symptoms would decrease due to the program, and clients mental health service use would also decrease in a 1 year follow-up. Mental health service use (time spent in a locked facility) did decrease dramatically after treatment. All 14 clients had a decrease in the amount of time spent in locked facilities after treatment. The total cost for these clients in locked facilities the year immediately prior to treatment was conservatively estimated at $776,500. The annualized figure of the total cost of these 14 clients after treatment was estimated at $44,775, saving San Joaquin County approximately $721,725 in 1 year. The results did not support the hypothesis that the program reliably decreases schizophrenic symptomology as we measured it.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment for the requirements for the degree of Master of Medicine in Psychiatry Johannesburg, 2017 / Introduction: Schizophrenia is a chronic mental illness, which is often characterized by a relapsing course with resultant effects on most areas of functioning due to the disability associated with it. The presence of any of the symptoms of schizophrenia can be extremely distressing for the families or caregivers who care for the patient. The term caregiver burden arose following the deinstitutionalization of mental health patients that was associated with integration of patients with severe mental illnesses into the community. Limited data of caregiver burden and its relationship with quality of life (QOL) is available in South Africa. The aim of the present study is to describe the nature of caregiver burden and to describe the relationship between caregiver burden and QOL. Methods: The study is descriptive and cross-sectional in nature and was conducted at Chris Hani Baragwanath Academic Hospital from February 2014 to October 2014. Data was collected from caregivers of patients with schizophrenia in the form of questionnaires. Caregiver burden was assessed by the use of a Caregiver Strain Index questionnaire with a score greater than 7 suggesting a high caregiver burden. Quality of life was assessed with the World Health Organization Quality of Life brief questionnaire; it is scored on six domains each of which contributes to the caregiver’s overall impression of their quality of life. Results: Of the 127 participants identified for the study, eight six participated. Significant factors associated with higher caregiver burden were as follows: increased number of admissions per year, caring for adults less within the ages of 46-55 years, caring for patients with psychosocial stressors and living in a household with 3 to 4 people. Conclusion: The relationship between caregiver burden and caregiver QOL suggested that as caregiver burden increases, QOL decreases. / MT2017

Accuracy in applying diagnostic concepts is one of the most important aspects of any mental health professional’s work. Inaccuracy in diagnosing, or misdiagnosing, can lead to numerous problems including inappropriate and potentially harmful treatment, inaccurate prognosis, stigma, and wasted or misutilized resources. For mental health professionals, inaccuracy in diagnosing can happen both intentionally and unintentionally. The severity of a person’s symptoms or the level of functional impairment the person is experiencing are two factors which can easily confound diagnostic accuracy. The present study sought to determine how each of these factors contribute to diagnostic accuracy independently and in conjunction with one another. Participants were invited the complete the current study online and were presented with two vignettes representing varying levels of symptom severity and functional impairment severity. We asked participants to rate the severity of each (symptoms and impairment), to provide diagnostic opinions, and to provide treatment recommendations. We found that in rating the severity of symptoms or impairment, and in providing diagnoses, the presence of one (symptoms or impairment) tended to overshadow the absence of the other. However, severity ratings of either symptom or impairment severity were predictive of rates in diagnosing and recommending treatment. Additionally, we found that regardless of the presence of a diagnosis, most participants believe that the person represented in the vignette would benefit from treatment. Based on these findings, it seems when conceptualizing case vignettes, professionals may be viewing symptoms and functional impairment as more interchangeable than as different components of a diagnosis.

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Schizophrenia is a neurological disorder found in approximately 1% of the population. It is estimated that as many as 88% of individuals diagnosed which schizophrenia smoke tobacco, a rate which is greatly increased compared to the general population. While increased use of nicotine-containing products such as cigarettes may be detrimental to the long-term health of individuals with schizophrenia, it has been hypothesized that nicotine use is a form of self-medication for these individuals who suffer from serious neurological and psychological symptoms such as hallucinations, delusions, anhedonia, and cognitive impairments. Understanding the biomolecular mechanisms which result in a higher propensity for smoking may lead to an overall better understanding of the disease and new treatment options. This study investigated the effects of nicotine in an epigenetic transmission model of schizophrenia. Rats were treated neonatally with the dopamine D2 agonist quinpirole or saline from P1 to P21 and then raised into adulthood. This paradigm has been previously shown to produce rats with symptoms similar to schizophrenia, including an enhanced response to nicotine. These neonatally treated rats were then bred to produce pups which were not neonatally treated to investigate whether schizophrenia-like symptoms would be transmitted to the untreated offspring of the quinpirole treated parents in the context of nicotine administration, similar to that of their parents. To examine the effects of nicotine, the rats that were the offspring of animals that were neonatally treated quinpirole were behaviorally tested on either a behavioral sensitization or conditioned place preference (CPP) paradigm, and animals received either nicotine or saline. Following behavioral testing, brain tissue was collected, and an ELISA for brain-derived neurotrophic factor (BDNF) was performed. Results revealed that these offspring demonstrated a heightened behavioral response to nicotine as well as increased expression of BDNF following nicotine administration if at least one parent rat was neonatally treated with quinpirole. This indicates that there may be epigenetic information passed from parents neonatally treated with quinpirole to the offspring.