The Association Between Amygdala Subfield-Related Functional Connectivity and Stigma Reduction 12 Months After Social Contacts: A Functional Neuroimaging Study in a Subgroup of a Randomized Controlled Trial.

Social contact is one of the best methods for reducing stigma, and the effect may be associated with emotional response and social cognition. The amygdala is a key region of these functions and can be divided into three subregions, each of which has a different function and connectivity. We investigated whether the amygdala subregion-related functional connectivity is associated with the effect of anti-stigma interventions on reducing mental health-related stigma in a randomized controlled trial (RCT) over 12 months. Healthy young adults [n = 77, age, mean (SD) = 21.23 (0.94) years; male, n = 48], who were subsampled from an RCT (n = 259) investigating the effect of anti-stigma interventions, using filmed social contacts (FSC) or internet self-learning (INS), on reducing stigma, underwent 10 min resting-state functional magnetic resonance imaging between the trial registration and 12 months follow-up. The extent of stigma was assessed at the baseline, post-intervention and 12 month follow-up surveys, using the Japanese-language version of the Social Distance Scale (SDSJ), to assess negative emotional attitude toward people with schizophrenia. We compared associations between amygdala subregion-related functional connectivity and changes in the SDSJ scores for 12 months across the control, INS, and FSC groups. Associations between the change in stigma for 12 months and the superficial (SF) subregion of the amygdala-related connectivity in the intracalcarine cortex [(x, y, z) = (-8, -66, 12), z = 4.21, P FWE-corrected = 0.0003, cluster size = 192] differed across groups. The post hoc analysis showed that the SF-intracalcarine cortex connectivity was negatively correlated with the change in stigma only in the FSC group. The current results indicate that greater SF-intracalcarine cortex connectivity is associated with a better response to the FSC interventions, suggesting that biological variability could underlie the long-term effect of anti-stigma interventions on stigma in the real world.

Development of Metacognition in Adolescence: The Congruency-Based Metacognition Scale.

INTRODUCTION: Previous studies on metacognitive ability were explored using self-report questionnaires that are difficult to adequately measure and evaluate when the capacity for self-reference is undeveloped. This study aimed to validate the Congruency-based Metacognition Scale (CMS) to measure metacognition and the feeling of confidence abilities and to investigate the development of metacognition during adolescence. METHODS: The CMS was administered to 633 child-parent pairs in Japan (child, mean age = 16.0 years, 46.0% female; parent, mean age = 48.3 years, 94.9% mother). The CMS metacognition score was assessed based on congruency scores between the self-report of the child from a third-person perspective (3PP) and the parent's report from the first-person perspective (1PP). The CMS self-judgment accuracy score was assessed by the congruency scores between the children's self-report from the 1PP and 3PP. For both measures, the more distant the 3PP on the self-report was from the 1PP on the parent's report and child self-report means low ability. An exploratory factor analysis (EFA) was conducted to examine construct validity and then a confirmatory factor analysis (CFA) was used. Criterion validity was examined by calculating Pearson's correlation coefficients with scores on the Beck Cognitive Insight Scale (BCIS) and Autism Quotient (AQ). We used intraclass correlation and Cronbach's alpha to examine the test-retest and internal consistency reliability. RESULTS: Based on the results of the EFA and CFA, we adopted one factor structure with five items. The CMS metacognition and CMS self-judgment accuracy showed evidence criterion validity, exhibiting significant correlations with the BCIS self-reflectiveness (r = 0.16) and self-certainty scores (r = 0.17), respectively. Regarding to the AQ, only the CMS metacognition score had significant correlations with the social skills (r = 0.22) and total scale score (r = 0.20). The test-retest reliability showed adequate (intraclass correlation coefficient 0.70-0.81 and the Cronbach's alpha coefficient 0.63-0.59). Adolescents were found to have significantly lower metacognitive ability compared to young adults. CONCLUSION: CMS could be a valid and reliable measure to examine metacognitive abilities for adolescents.

Effects of biomedical messages and expert-recommended messages on reducing mental health-related stigma: a randomised controlled trial.

AIMS: Mental health-related stigma is a major challenge associated with the huge mental health treatment gap. It has remained unclear what kind of educational content is effective in reducing the stigma. Whether biomedical messages (BMM) about mental illness are effective or harmful in decreasing stigma is controversial. To investigate whether BMM can improve practically useful knowledge of mental illness, comparably to recommended messages (RCM) advocated by experts, of types such as 'recovery-oriented', 'social inclusion/human rights' and 'high prevalence of mental illnesses' through a randomised controlled trial (RCT). METHOD: This study is an individual-level RCT with a parallel-group design over 1 year, conducted in Tokyo, Japan. A total of 179 participants (males n = 80, mean age = 21.9 years and s.d. = 7.8) were recruited in high schools and universities, and through a commercial internet advertisement in June and July 2017, without any indication that the study appertained to mental health. Participants were allocated to the BMM and RCM groups. They underwent a 10-min intervention, and completed self-report questionnaires during baseline, post-test, 1-month follow-up and 1-year follow-up surveys. The primary outcome measures were practically useful knowledge of mental illness at the post-test survey using the Mental Illness and Disorder Understanding Scale (MIDUS). Analysis was conducted in October 2018. RESULTS: Both groups demonstrated improved MIDUS score in the post-test survey, and showed similar intervention effects (F(1, 177) = 160.5, p < 0.001, η2 = 0.48). The effect of the interventions continued until the 1-year follow-up survey (B [95% CI] = -2.56 [-4.27, -0.85], p < 0.01), and showed no difference between groups. The reported adverse effect that BMM increase stigma was not confirmed. CONCLUSIONS: BMM may have a positive impact on stigma, comparable to RCM. These findings may encourage reconsideration of the content of messages about mental health, as it is indicated that combining BMM and RCM might contribute to an effective anti-stigma programme.

Long-term effects of filmed social contact or internet-based self-study on mental health-related stigma: a 2-year follow-up of a randomised controlled trial.

PURPOSE: There is a critical need to clarify the long-term effects of anti-stigma interventions. The study aimed to assess the long-term effects of repeated filmed social contact or internet-based self-study on mental health-related stigma through a randomised controlled trial with 2-year follow-up. METHODS: We randomly allocated 259 university or college students to a filmed social contact group, an internet-based self-study group, or a control group. The filmed social contact and internet-based self-study groups each received a 30-min initial intervention followed by emailed interventions every 2 months over a 12-month period. The Japanese version of the Reported and Intended Behaviour Scale (RIBS-J) and the Mental Illness and Disorder Understanding Scale (MIDUS) were used to assess behaviour, behavioural intentions (attitudes), and knowledge regarding mental health. RESULTS: Of the 259 original participants, 187 completed the 24-month follow-up assessment. Mean scores for the RIBS-J future domain and MIDUS peaked at 1 month after initial intervention. Compared with baseline, at 24-month follow-up, we found a significant difference in RIBS-J future domain scores between the filmed social contact and control groups at 24-month follow-up (B = 0.95, 95% CI = 0.01,1.90, p = 0.049), while MIDUS scores in the filmed social contact group (B = - 4.59, 95%CI = - 6.85, - 2.33, p < 0.001) and the internet-based self-study group (B = - 4.51, 95%CI = - 6.86, - 2.15, p < 0.001) significantly decreased compared with the control group. CONCLUSION: While outcome scores peaked at 1 month after initial intervention, results suggest that filmed social contact might have a long-term effect on behavioural intentions, and both filmed social contact and internet-based self-study may contribute to improved knowledge of mental health.

Electrophysiological evidence for abnormal glutamate-GABA association following psychosis onset.

Previous studies have shown glutamatergic dysfunction and γ-aminobutyric acid (GABA)-ergic dysfunction in schizophrenia. Animal studies suggest that N-methyl-D-aspartate receptor (NMDAR) dysfunction and GABA-ergic dysfunction interact with each other and lead to alterations in excitatory/inhibitory balance. The NMDAR and GABAergic-interneuron functions may be indexed by mismatch negativity (MMN) and auditory steady-state gamma-band response (ASSR), respectively. However, no previous studies have tested the hypothesis of an abnormal association between MMN and gamma-band ASSR in the same patients to identify the in vivo evidence of NMDAR-GABA association during the early stages of psychosis. Participants were individuals with recent-onset schizophrenia (ROSZ; N = 21), ultra-high risk (UHR; N = 27), and healthy controls (HCs; N = 24). The MMN amplitude was significantly impaired in ROSZ (p = 0.001, d = 1.20) and UHR (p = 0.003, d = 1.01) compared with HCs. The intertrial phase coherence (ITC) index of gamma-band ASSR was significantly reduced in ROSZ compared with HCs (p < 0.001, d = -1.27) and UHR (p = 0.032, d = -0.75). The event-related spectral perturbation (ERSP) index of gamma-band ASSR was significantly smaller in ROSZ compared with HCs (p < 0.001, d = -1.21). The MMN amplitude was significantly correlated with the ITC in ROSZ (r = -0.69, p < 0.001). These findings provide the first in vivo evidence that an abnormal association of the electrophysiological indices of NMDAR and GABA dysfunctions may be present in recent-onset schizophrenia.

Auditory gamma oscillations predict global symptomatic outcome in the early stages of psychosis: A longitudinal investigation.

OBJECTIVES: The gamma-band auditory steady-state response (ASSR) is thought to reflect the function of parvalbumin-positive γ-aminobutyric acid (GABA)-ergic interneurons and may be a candidate biomarker in early psychosis. Although previous cross-sectional studies have shown that gamma-band ASSR is reduced in early psychosis, whether reduced gamma-band ASSR could be a predictor of the long-term prognosis remains unknown. METHODS: In this longitudinal study, we investigated the association between gamma-band ASSR reduction and future global symptomatic or functional outcome in early psychosis. We measured 40-Hz ASSR in 34 patients with recent-onset schizophrenia (ROSZ), 28 ultra-high risk (UHR) individuals, and 30 healthy controls (HCs) at baseline. After 1-2 years, we evaluated the global assessment of functioning (GAF) in the ROSZ (N = 20) and UHR (N = 20) groups. RESULTS: The 40-Hz ASSR was significantly reduced in the ROSZ and UHR groups. The attenuated 40-Hz ASSR was correlated with the future global symptomatic outcome in the ROSZ, but not in the UHR groups. CONCLUSIONS: A reduction in the gamma-band ASSR after the onset of psychosis may predict symptomatic outcomes in early psychosis. SIGNIFICANCE: Gamma-band ASSR may be a potentially useful biomarker of the long-term prognosis in patients with recent-onset schizophrenia.

Mental-health-related stigma among Japanese children and their parents and impact of renaming of schizophrenia.

AIM: Mental-health-related stigma affects help-seeking behavior and service utilization among young people. Whether mental-health-related stigma is different or correlated between parents and their children is unknown. It is also unknown whether the name change of schizophrenia in 2002 has had long-term effects on reducing stigma for adults in the general population. METHODS: We recruited 143 parent-child pairs (mean ages [SD]: 51.5 [3.6] and 21.2 [1.2] years, respectively) to complete self-report questionnaires regarding mental-health-related stigma and experience. We also assessed negative stereotypes for three psychiatric disease names (old and new names of schizophrenia, and depression), and for diabetes mellitus as a physical illness comparison. The questionnaires also asked respondents to identify the old and new names of schizophrenia and dementia, respectively, among 10 names for mental and physical illnesses and conditions. RESULTS: Parents showed lower stigma levels toward mental illness and diabetes mellitus, but similar or greater stigma levels toward schizophrenia, compared with their children. Stigma levels toward mental illness in parents and their children were significantly correlated. The rate of correct identification of the old and new names for schizophrenia was higher in parents than in their children (64.7% vs 41.4%, P < 0.001). Parents who responded correctly endorsed more negative stereotypes toward the new name of schizophrenia compared with those who responded incorrectly (P = 0.049). CONCLUSION: The present findings suggest that stigma toward mental illness is shared between family members, and the name change of schizophrenia has effectively reduced stigma levels toward this disorder in adults of various ages.

Effect of Name Change of Schizophrenia on Mass Media Between 1985 and 2013 in Japan: A Text Data Mining Analysis.

BACKGROUND: Mass media such as newspapers and TV news affect mental health-related stigma. In Japan, the name of schizophrenia was changed in 2002 for the purposes of stigma reduction; however, little has been known about the effect of name change of schizophrenia on mass media. METHOD: Articles including old and new names of schizophrenia, depressive disorder, and diabetes mellitus (DM) in headlines and/or text were extracted from 23169092 articles in 4 major Japanese newspapers and 1 TV news program (1985-2013). The trajectory of the number of articles including each term was determined across years. Then, all text in news headlines was segmented as per part-of-speech level using text data mining. Segmented words were classified into 6 categories and in each category of extracted words by target term and period were also tested. RESULTS: Total 51789 and 1106 articles including target terms in newspaper articles and TV news segments were obtained, respectively. The number of articles including the target terms increased across years. Relative increase was observed in the articles published on schizophrenia since 2003 compared with those on DM and between 2000 and 2005 compared with those on depressive disorder. Word tendency used in headlines was equivalent before and after 2002 for the articles including each target term. Articles for schizophrenia contained more negative words than depressive disorder and DM (31.5%, 16.0%, and 8.2%, respectively). CONCLUSIONS: Name change of schizophrenia had a limited effect on the articles published and little effect on its contents.