Special Lecture (SL)

  1. Special Lecture(SL)
  2. Symposium (S)
  3. CNP Paul Janssen Awards(PJ)
  4. Prize for Encouragement of the society(EN)
  5. Luncheon Seminar(LS)
  6. Oral Presentations(O)
  7. Poster Presentations(P)

SL-1

Assessment and treatment of cognition and disability across psychiatric conditions

Philip D. Harvey

  • University of Miami Miller School of Medicine, Miami, FL, USA

Cognitive impairments are now known to be a major contributor to functional outcomes across neurosychiatric conditions, including schizophrenia, major depression, and bipolar disorder. Rates of disability are generally correlated with persistent cognitive deficits, which vary from possible 90% in schizophrenia to 25% in major depression. Treatment efforts have included pharmacological and cognitive remediation interventions and assessment strategies have expanded to include assessments of both neurocognition and functional capacity.
This presentation will review the assessment and treatment of cognition and disability across neuropsychiatric conditions. Included will be recent data regarding successful pharmacological treatments of cognitive deficits in major depression and schizophrenia. These studies provided evidence of direct cognitive benefits of vortioxetine and lurasidone. Also, the modifications in assessment strategies that are required across conditions, based on the severity and persistence of impairment, will be discussed in the context of these treatment studies.
An additional recent development has been the success of various cognitive remediation interventions in these same conditions. These interventions have been shown to improve cognitive functioning and, when combined with psychosocial interventions, to be associated with improvements in everyday functioning. Several biomarkers of treatment response have been identified as well, suggesting that these interventions may induce neural plasticity and positive cortical changes. A most promising recent study has highlighted the connection between adherence to medication treatments, leading to clinical stability, and successful cognitive remediation interventions. In this study, high rates of functional recovery were found in adherent first episode schizophrenia patients receiving psychosocial interventions while patients who were nonadherent had poor outcomes despite the provision of psychosocial treatments.
A final consideration will be other factors that influence the results of treatment of cognition and disability. Medications with sedative or anticholinergic effects are associated with poorer treatment success. Motivation is required for success in cognitive remediation. Motivation is a central, biologically driven, and treatable feature of severe mental illnesses and motivation needs to be considered in treatment planning efforts. Motivation is a major predictor of resilience, which is a critical factor for recovery from multiple psychiatric conditions.

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SL-2

Pharmacological treatment of schizophrenia: Current issues and future perspectives

W. Wolfgang Fleischhacker

  • Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Austria

Four main topics have shaped research and clinical practice in the past decade. These have dealt with: 1) Early intervention in the prediagnostic stage, i.e. the attenuated psychosis syndrome; 2) Novel neurobiological treatment targets; 3) The introduction of alternative formulations; 4) Attempts to predict treatment response.
1) In a number of RCTs, researchers have investigated whether treating prodromal symptoms of schizophrenia helps to reduce the conversion risk to full-blown schizophrenia. Results are ambiguous and the discussion on whether or not an intervention at the stage is justified is ongoing.
2) Following the enhanced understanding of the pathophysiology of schizophrenia, also with respect to specific symptom domains, pharmacological targets beyond D2 receptor antagonism have been explored. Much work and enthusiasm has revolved around nicotinergic and glutamatergic compounds, so far with mostly discouraging results.
3) Several new generation antipsychotics have become available as long-acting depot formulations. All of them have demonstrated a significant positive impact on relapse rates in placebo controlled studies. Whether these compounds also have advantages over first generation depots and / or oral antipsychotics is still debated and investigated. The development of an inhalable antipsychotic has complemented the treatment options for the management of acutely agitated schizophrenia patients.
Lastly, attempts from various perspectives, including genetics and neuroimaging, have investigated whether it is possible to predict treatment response and drug safety. Although some look promising, they have not yet reached a stage in which they can be applied to everyday clinical practice. What has become clear though, is, that early non response predicts late non response, leading to the recommendation to switch antipsychotics much earlier than stated in most treatment guidelines.

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  1. Special Lecture(SL)
  2. Symposium (S)
  3. CNP Paul Janssen Awards(PJ)
  4. Prize for Encouragement of the society(EN)
  5. Luncheon Seminar(LS)
  6. Oral Presentations(O)
  7. Poster Presentations(P)