European Psychiatry - Volume 41 - April 2017

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S58 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S53–S68
W017
Reward circuits and apathy in
schizophrenia: neuroimaging and
treatment strategies
A. Aleman
Department of neuroscience, university of Groningen, university
medical center Groningen, Groningen, The Netherlands
Approximately 50% of patients with schizophrenia shows deficits
in motivation and initiation of goal-directed behavior, which are
suggestive of reward system dysfunction. We conducted a meta-
analysis of neuroimaging studies reporting on the neural correlates
of reward processing and negative symptoms in schizophrenia. A
significant mean weighted correlation was observerd, revealing
deficits in activation of reward neurocircuitry. Amore specific find-
ings is comprised activation of the ventral striatum, involved in
anticipation of reward, and structures that play a critical role in the
ability to represent the value of outcomes and plans. In a study of
VTA connectivity in the resting state in a large group of patients
with schizophrenia, we found reduced connectivity with lateral
prefrontal, temporal and parietal regions to be associated with
higher degrees of apathy. Apathy belongs to the most debilitat-
ing symptoms of schizophrenia and represents a significant unmet
need in its treatment. Quantitative integrationof publishedfindings
suggests that treatment with noninvasive magnetic brain stimula-
tion can improve negative symptoms. Previous PET-studies have
shown that such stimulation may target circuits with dopaminer-
gic innervation. A behavioral treatment approach that may also
target reward-related circuits will also be discussed briefly. It can
be concluded that recent results regarding reward and motivated
behavior in schizophrenia have clinical implications and may help
develop novel treatment strategies.
Disclosure of interest AA received speaker fees from Lundbeck.
W018
Self-regulation of the dopaminergic
reward system via real time fmri
neurofeedback in schizophrenia
M. Kirschner
Department of psychiatry- psychotherapy and psychosomatics,
Switzerland
Introduction Alterations in the mesolimbic dopamine system
play a crucial role in the pathophysiology of schizophrenia. How-
ever, little is known about potential disturbance in endogenous
regulation of neural activity due to cognitive control. Recent
research on real-time fMRI (rtfMRI) revealed a novel method to
stimulate the substantia nigra and ventral tegmental area (SN/VTA),
using positive mental imagery. Importantly, this self-regulation
ability could be improved with rtfMRI neurofeedback. For the
first time, we applied this innovative method in patients with
schizophrenia (SZ) to investigate potential alterations in endoge-
nous regulation of the reward system.
Methods 14 (SZ) and 14 healthy controls (HC) were included
in this ongoing study. Participants performed a rtfMRI task with
abstract visual feedback of neural activity in the SN/VTA. In
the active condition, we instructed participants to voluntary
up-regulate SN/VTA activity by recalling rewarding scenes. Neuro-
feedback learning was correlated with the self-reported negative
symptoms.
Results In contrast to HC, SZ were not able to actively self-
regulate SN/VTA activity. Furthermore, they failed to improve
self-regulation with rtFMRI neurofeedback. Importantly, impaired
neurofeedback learning was associated with negative symptoms,
in particular diminished expression.
Discussion Our preliminary results show that self-regulation of
SN/VTA activity is impaired in SZ. Although neurofeedback train-
ing improves self-regulation using positive mental imagery in HC,
this method might not be suitable as a potential treatment strat-
egy in SZ. The present findings provide new insights to the to the
association between negative symptoms and dopaminergic dys-
function and highlight the strengths and limitation for the use of
rtfMRI neurofeedback in schizophrenia.
Disclosure of interest The author has not supplied his declaration
of competing interest.
Workshop: psychiatry in a globalised world:
challenges and possibilities of global mental
health
W019
Core competencies for health
professionals in global health
M. Casanova Dias ∗, H. Ryland
1 Cardiff university school of medicine, mrc centre for
neuropsychiatric genetics and genomics, Cardiff, United Kingdom
2 South West London and St George’s mental health NHS trust,
London, United Kingdom
∗ Corresponding author.
Introduction The world is becoming increasingly globalised and
this has a major impact on the delivery of healthcare. Issues such as
conflict, migration, climate change and technological advances all
contribute to this. But are we equipped to deal with the challenges
of Global Health?
Objectives To discuss the core competencies that health profes-
sionals should have in Global Health.
Methods The UK’s Global Health Curriculum Group (GHCG),
a group of healthcare professionals, was commissioned by the
Academy of Medical Royal Colleges to lead a consultation on global
health competencies. The consultation took the form of a modi-
fied Policy Delphi which involved an online survey and face-to-face
and telephone interviews over three rounds. Over 250 stakeholders
participated, including doctors, other health professionals, policy-
makers andmembers of the public from all continents of the world.
Results This study demonstrated broad agreement that global
health competence is essential for postgraduate doctors and other
health professionals. It identified five core competencies, relevant
to the UK and applicable to other parts of the world: (1) diversity,
human rights and ethics; (2) environmental, social and economic
determinants of health; (3) global epidemiology; (4) global health
governance; and (5) health systems and health professionals.
Conclusions This framework of five core competencies aims to
equip psychiatrists and other doctors with the skills, knowledge
and attitudes necessary to practice in a globalised world.
In the workshop we will harness the international nature of the
delegates attending the congress to enable a lively debate about
the meaning of global mental health and the skills psychiatrists
need.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.