Increasing prefrontal gray matter volume correlates with reduction of negative symptoms in psychosis
Poster No:
482
Submission Type:
Abstract Submission
Authors:
Dirk Wildgruber1, Klaus Hesse2, Kathrin Eckstein2, Janina Richter2, Mark-Christian Eberle2, Lina Hawlik2, Peter Martus3, Benjamin Kreifelts2, Michael Erb4, Stefan Klingberg2
Institutions:
1University Tuebingen, Germany, Tuebingen, Germany, 2Department of Psychiatry and Psychotherapy, University Tuebingen, Germany, Tuebingen, Germany, 3Institute for Clinical Epidemiology and Applied Biometry, University Tuebingen, Germany, Tuebingen, Germany, 4Department of Biomedical Magnetic Resonance, University Tuebingen, Germany, Tuebingen, Germany
First Author:
Co-Author(s):
Klaus Hesse
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Kathrin Eckstein
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Janina Richter
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Mark-Christian Eberle
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Lina Hawlik
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Peter Martus
Institute for Clinical Epidemiology and Applied Biometry, University Tuebingen, Germany
Tuebingen, Germany
Institute for Clinical Epidemiology and Applied Biometry, University Tuebingen, Germany
Tuebingen, Germany
Benjamin Kreifelts
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Michael Erb
Department of Biomedical Magnetic Resonance, University Tuebingen, Germany
Tuebingen, Germany
Department of Biomedical Magnetic Resonance, University Tuebingen, Germany
Tuebingen, Germany
Stefan Klingberg
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Department of Psychiatry and Psychotherapy, University Tuebingen, Germany
Tuebingen, Germany
Introduction:
Besides psychotic symptoms (hallucinations, delusions), cognitive deficits and negative symptoms may occur in patients with psychotic disorders. Negative symptoms (blunted affect, alogia, anhedonia, avolition, social withdrawal) are the most important predictors of long-term impairment in social functioning and quality of life. Moreover, negative symptoms respond poorly to pharmacological and psychotherapeutic intervention available to date.
This study evaluated the efficacy of an innovative cognitive behavioral therapy to reduce negative symptoms in patients with psychosis. The new approach (MOSAIC-therapy) combines individual sessions of cognitive behavioral therapy (CBT) and corresponding social skills group trainings. Change goals were identified in individual CBT sessions and corresponding interactions were practiced in the social environment of the group. In turn, experiences from group sessions were taken up in individual CBT to promote transfer to everyday life. In addition to changes in negative symptoms (PANSS-neg) and social functioning (SSPA, TBM) psychotherapy-related changes of gray matter volume were evaluated using voxel-based morphometry (VBM).
This study evaluated the efficacy of an innovative cognitive behavioral therapy to reduce negative symptoms in patients with psychosis. The new approach (MOSAIC-therapy) combines individual sessions of cognitive behavioral therapy (CBT) and corresponding social skills group trainings. Change goals were identified in individual CBT sessions and corresponding interactions were practiced in the social environment of the group. In turn, experiences from group sessions were taken up in individual CBT to promote transfer to everyday life. In addition to changes in negative symptoms (PANSS-neg) and social functioning (SSPA, TBM) psychotherapy-related changes of gray matter volume were evaluated using voxel-based morphometry (VBM).
Methods:
MOSAIC (30 sessions individual CBT & 30 group trainings within 8 months) was compared with SUPPORT (supportive talks and enjoyable group activities without specific therapeutic goals in the same timeframe) in a randomized controlled trial. Sixty patients with psychotic disorders with marked negative symptoms participated (PANSS negative syndrome > 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 before therapy initiation (T0) and after completion of the interventions (T2). The investigator was blind to information on which therapy the patient had received.
Specific treatment effects of MOSAIC as compared to SUPPORT were evaluated using t-tests, in which the differences in post- and pre-intervention data (T2-T0) were tested for mean differences (p < 0.05). In addition, both groups were tested separately for significant pre-post effects (p < 0.05).
Furthermore, pre- and post-interventional structural MRI data (3T) were assessed for therapy-related changes of gray matter volume using SPM12 (www.fil.ion.ucl.ac.uk/spm, CAT12-Toolbox, p < 0.05).
Specific treatment effects of MOSAIC as compared to SUPPORT were evaluated using t-tests, in which the differences in post- and pre-intervention data (T2-T0) were tested for mean differences (p < 0.05). In addition, both groups were tested separately for significant pre-post effects (p < 0.05).
Furthermore, pre- and post-interventional structural MRI data (3T) were assessed for therapy-related changes of gray matter volume using SPM12 (www.fil.ion.ucl.ac.uk/spm, CAT12-Toolbox, p < 0.05).
Results:
No significant differences were observed between MOSAIC and SUPPORT for PANSS-neg (p = 0.36, Cohen's d = 0.1), SSPA (p = 0.30, d = 0.14) and TBM (p = 0.07, d = 0.40). However, pre-post comparisons showed reduction of negative symptoms as well as increase of social functioning within each group with moderate to large effect sizes (Fig. 1):
MOSAIC: PANSS-neg (p < 0.001, d = 0.82), SSPA (p = 0.006, d = 0.52), TBM (p = 0.03, d = 0.37).
SUPPORT: PANSS-neg (p = 0.005, d = 0.53), SSPA (p = 0.007, d = 0.51), TBM (p = 0.28, d = 0.11).
Regarding VBM correlates of psychotherapy-related changes, no interaction between time (T2 vs. T0) and group (MOSAIC vs. SUPPORT) was observed, whereas the extent of individual reduction of negative symptoms (across both groups) correlated with increased gray matter volume (T2 > T0) in the bilateral ventromedial prefrontal cortex (vmPFC) and the left temporal pole (Fig. 2).
MOSAIC: PANSS-neg (p < 0.001, d = 0.82), SSPA (p = 0.006, d = 0.52), TBM (p = 0.03, d = 0.37).
SUPPORT: PANSS-neg (p = 0.005, d = 0.53), SSPA (p = 0.007, d = 0.51), TBM (p = 0.28, d = 0.11).
Regarding VBM correlates of psychotherapy-related changes, no interaction between time (T2 vs. T0) and group (MOSAIC vs. SUPPORT) was observed, whereas the extent of individual reduction of negative symptoms (across both groups) correlated with increased gray matter volume (T2 > T0) in the bilateral ventromedial prefrontal cortex (vmPFC) and the left temporal pole (Fig. 2).
Conclusions:
MOSAIC showed no significant difference in efficacy compared to SUPPORT. However, reduction of negative symptoms occured in both groups. These results indicate that patients with negative symptoms can benefit significantly from intensive psychotherapy combining individual sessions and group trainings that are focused on increase of motivation and social interaction.
The observed correlation between the extent of individual symptom reduction and increase of gray matter volume within the bilateral vmPFC and the left TP indicates a link between clinical improvement and neuroplastic changes presumably involving psychotherapy-related formation of new synaptic connections within regions underlying social motivational processing.
The observed correlation between the extent of individual symptom reduction and increase of gray matter volume within the bilateral vmPFC and the left TP indicates a link between clinical improvement and neuroplastic changes presumably involving psychotherapy-related formation of new synaptic connections within regions underlying social motivational processing.
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 1
Emotion, Motivation and Social Neuroscience:
Social Interaction
Emotion and Motivation Other
Learning and Memory:
Neural Plasticity and Recovery of Function 2
Keywords:
Emotions
Plasticity
Psychiatric Disorders
Schizophrenia
Therapy
1|2Indicates the priority used for review
·Fig. 1. Both therapy groups (MOSAIC and SUPPORT) showed a reduction in negative symptoms (PANSS-neg) and an increase in social functioning. Bar graphs show mean values and standard deviations.
·Fig. 2. Individual symptom reduction was correlated with an increase in gray matter volume (T2 > T0) within the bilateral ventromedial prefrontal cortex and the left temporal pole (p < 0.05, FWE corr)
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