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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S53–S68


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.


Self-regulation of the dopaminergic

reward system via real time fmri

neurofeedback in schizophrenia

M. Kirschner

Department of psychiatry- psychotherapy and psychosomatics,



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.


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



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.


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



Core competencies for health

professionals in global health

M. Casanova Dias

1 ,

, H. Ryland



Cardiff university school of medicine, mrc centre for

neuropsychiatric genetics and genomics, Cardiff, United Kingdom


South West London and St George’s mental health NHS trust,

London, United Kingdom

Corresponding author.


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?


To discuss the core competencies that health profes-

sionals should have in Global Health.


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.


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.


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


Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.