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Impaired functional capacity is a core feature of schizophrenia and presents even in first-episode psychosis (FEP) patients. Impairments in daily functioning tend to persist despite antipsychotic therapy but their neural basis is less clear. Previous studies suggest that volume loss in frontal cortex might be an important contributor, but findings are inconsistent. We aimed to comprehensively investigate the brain structural correlates of functional capacity in FEP using MRI and a reliable objective measure of functioning [University of California, San Diego Performance-Based Skills Assessment (UPSA)]. In a sample of FEP (n = 39) and a well-matched control group (n = 21), we measured cortical thickness, gray matter volume, and white matter tract integrity (fractional anisotropy, FA) within brain regions implicated by previous work. The FEP group had thinner cortex in various frontal regions and fusiform, and reduced FA in inferior longitudinal fasciculus (ILF). In FEP, poorer functional capacity correlated with reduced superior frontal volume and lower FA in left ILF. Importantly, frontal brain volumes and integrity of the ILF were identified as the structural correlates of functional capacity in FEP, controlling for other relevant factors. These findings enhance mechanistic understanding of functional capacity deficits in schizophrenia by specifying the underlying neural correlates. In future, this could help inform intervention strategies.

Background Glioblastoma (GBM) is the most common and most lethal primary brain tumor in adults. Clinical trials in older patients with GBM have explored the use of single and multimodality treatment regimens with modest survival benefits; however, trial criteria are commonly based on chronological age and do not reflect the heterogeneity of this cohort. Geriatric assessment (GA) techniques predict survival and treatment tolerance in other tumor sites and thus may objectively guide the decision-making process, but data are lacking in the neuro-oncology cohort. Methods We performed a prospective, multicenter feasibility study involving patients age 65 years or older with newly diagnosed GBM. A modified GA was undertaken in the outpatient setting prior to starting treatment. Feasibility was determined primarily by recruitment rate, alongside data completeness, impact on clinic time, and acceptability to patients and staff. Factors associated with survival were explored using Cox regression models. Results Fifty patients were recruited within a prespecified time period with a recruitment rate of 82% (target 80%). Data completeness was greater than 80% in all except one assessment. Median overall survival was 9.5 months (95% confidence interval [CI] 5.0-14.0 months). Among the GA screening factors analyzed, a baseline impaired Montreal Cognitive Assessment (hazard ratio [HR] = 2.7, 95% CI 1.128-6.530) and impairment in instrumental activities of daily living (HR = 2.9 95% CI 0.983-8.541) were associated with poorer survival. Conclusion In the first study of this kind among elderly GBM patients, we have shown that undertaking a neurologically focused GA screen is feasible and may provide useful prognostic information.

Background Cognitive problems in people with schizophrenia predict poor functional recovery even with the best possible rehabilitation opportunities and optimal medication. A psychological treatment known as cognitive remediation therapy (CRT) aims to improve cognition in neuropsychiatric disorders, with the ultimate goal of improving functional recovery. Studies suggest that intervening early in the course of the disorder will have the most benefit, so this study will be based in early intervention services, which treat individuals in the first few years following the onset of the disorder. The overall aim is to investigate different methods of CRT. Methods This is a multicentre, randomised, single-blinded, controlled trial based in early intervention services in National Health Service Mental Health Trusts in six English research sites. Three different methods of providing CRT (intensive, group, and independent) will be compared with treatment as usual. We will recruit 720 service users aged between 16 and 45 over 3 years who have a research diagnosis of non-affective psychosis and will be at least 3 months from the onset of the first episode of psychosis. The primary outcome measure will be the degree to which participants have achieved their stated goals using the Goal Attainment Scale. Secondary outcome measures will include improvements in cognitive function, social function, self-esteem, and clinical symptoms. Discussion It has already been established that cognitive remediation improves cognitive function in people with schizophrenia. Successful implementation in mental health services has the potential to change the recovery trajectory of individuals with schizophrenia-spectrum disorders. However, the best mode of implementation, in terms of efficacy, service user and team preference, and cost-effectiveness is still unclear. The CIRCuiTS trial will provide guidance for a large-scale roll-out of CRT to mental health services where cognitive difficulties impact recovery and resilience. Trial registration ISRCTN, ISRCTN14678860, Registered on 6 June 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2553-3) contains supplementary material, which is available to authorized users.

Anomalous self-experiences have been described as a prerequisite for anomalous perceptual experiences. Later, these anomalous perceptual experiences may then be metacognitively appraised as distressing, maintaining these experiences and later leading to anomalous (delusional) beliefs. This model of anomalous events may potentially be driven by perceptual biases and metacognitive deficits. This cross-sectional study explored the association between perceptual biases, metacognition and anomalous self- and perceptual experiences and delusional beliefs in First Episode Psychosis (FEP) and a matched healthy control sample. Fifty-eight individuals with FEP and seventy-two healthy controls were included in the main analysis. Increased auditory perceptual biases were significantly associated with increased state and trait anomalous self-experiences, in particular alienation from surroundings and emotional numbing. No significant associations were found between metacognitive efficiency and anomalous experiences. These findings may be consistent with the minimal self-disturbance model of schizophrenia spectrum vulnerability, particularly with the hyperreflexivity concept.

BACKGROUND: An ageing population brings new challenges for oncologists in the management of older cancer patients. There is increasing use of a geriatric assessment (GA) to evaluate fitness for treatment and identify geriatric syndromes. GAs can predict for chemotherapy toxicity and overall survival however there is a paucity of data within the neuro oncology cohort. A criticism of GAs is that they are time and resource consuming. We conducted a feasibility study to assess whether a GA could be performed by members of the usual clinical staff in a UK NHS neuro oncology outpatient setting. MATERIAL AND METHODS: Patients aged ≥ 65 with a new diagnosis of GBM were prospectively recruited from neuro-oncology outpatient clinics across 3 UK centres. A modified GA was performed by the clinical nurse specialists and demographic, imaging and toxicity data collected. Feasibility was assessed primarily by recruitment rate. Secondary outcomes of completion rate, acceptability to staff and patients and overall survival were measured. After completion of the study, face to face semi-structured interviews with the nurses were performed; these were interpreted qualitatively using thematic analysis. RESULTS: Recruitment to the study completed within the 1 year study time. 22 women and 28 men were enrolled with a mean age of 71 (65–86). Median overall survival was 8.2 months. 41 patients received active treatment (17 palliative radiotherapy, 19 chemo radiation and 5 temozolomide alone). Of the 35 patients who were tested, 31% showed MGMT promoter methylation; no IDH mutations were detected. All centres achieved recruitment rates above the target of 80% (mean 92%, 95% CI 86%-96%). Mean assessment completion rate was 94% (95% CI 92–95%). The nurses reported that completing the assessment was manageable and that, in some cases, underlying patient factors were identified that led to changes in treatment plans. Univariable regression analysis showed the MoCA (HR 2.78, p=0.02), IADLs (HR 2.88, p=0.03), baseline mobility (HR 12.1 p=0.002), ECOG PS (HR 29.2 p=0.003) and level of anxiety (HR 3.5 p=0.001) were related to overall survival, alongside treatment received. Multivariate Cox regression modelling confirmed the MoCA score to be a significant independent predictive factor for overall survival. CONCLUSION: ASCO and SIOG promote the use of a GA in the management of older cancer patients and it is becoming widely used within other tumour groups. However, to the authors’ knowledge, this is the first study of a GA within the neuro oncology patient cohort, a group with its own particular symptom burden. We have shown that performing a GA is feasible within the confines of a busy UK outpatient clinic and that, within the accepted limits of the study size, the results can help predict overall survival irrespective of treatment received. Wider use of a neurologically focussed GA should now be explored with greater patient numbers.

Background Dissociative experiences, including depersonalization and derealisation, represent perturbations of consciousness and selfhood, and are commonly reported by patients during early stages of a psychotic illness. The continuity and integrity of a conscious sense of self is proposed to be grounded upon the control of internal physiological state and its predictive representation through interoception, i.e. the sensing of internal bodily changes. We tested the hypothesized relationship between dissociation and interoceptive deficits in patients with first episode psychosis (FEP), combining behavioural testing with functional neuroimaging. Methods Individuals with first episode psychosis (N=41) and matched community control participants (N=21) performed an interoceptive task (heart-tone synchrony judgments) during functional magnetic resonance imaging (fMRI). Trial-by-trial confidence ratings indexed subjective performance, and measures of metacognitive interoceptive awareness (insight) were derived from confidence-accuracy correspondence. We tested for regional brain activity relating to dissociative symptom scores and objective, subjective and metacognitive aspects of interoception. Results In patients with FEP, metacognitive impairments in interoception predicted magnitude of dissociative symptoms, accompanied by hypoactivation of right insula cortex. Other dimensions of interoception, and accuracy, confidence and metacognitive insight on an exteroceptive task were unrelated to dissociative symptoms and there were no group differences between FEP patient and control groups. Discussion Our findings suggest that symptoms of disturbed conscious integrity and selfhood in early psychosis arise through selective disruption of higher-order metacognitive representations of interoceptive signals. Brain systems supporting the conscious integration of bodily feelings may represent a target for interventions to enhance functioning and, speculatively, mitigate illness progression in psychosis.

Background: Anti-psychotic drugs are the cornerstone of the management of psychotic disorders but despite their ubiquity in clinical practice, many psychiatric patients lack knowledge about the medication that is prescribed to them. Education for out-patients does improve knowledge but these patients are relatively stable. In response to calls from users on a psychiatric intensive care unit (PICU), a medication education group was provided. Aims: To explore the effectiveness of a medication education group on knowledge about drug treatment, insight and treatment adherence. Method: Fifteen patients with psychotic disorders according to DSM-111-R criteria recruited from a psychiatric intensive care unit, received two sessions of medication education. Changes post education were compared to 15 comparison patients, who did not attend a medication education group but were individually matched for primary treatment team, age, sex, number of admissions and length of illness. Results: The experimental group improved significantly over time compared with the comparison group on knowledge about drug treatment. Sessions of education also led to an increase in insight, but there were no effects on compliance or attitudinal/behavioural factors that influence medication compliance. Symptom change did not account for the improved knowledge. Conclusions: Group education on drug issues was successful in increasing knowledge of medication and insight even in an acutely ill group. Declaration of interest: TW occasional sponsorship to conference and lectures for a variety of pharmaceutical companies.

2043Background: Malignant primary CNS tumors constitute less than 2% of all malignancies and carry a dismal prognosis. Treatment (tx) options at relapse are limited. First-in-human solid tumor stud...

2024 Background: Primary malignant brain tumours (PMBT) are a rare tumour group with a poor outcome and limited options at relapse. Despite recent incremental gains from multimodal therapy and an e...