Safety and Effectiveness of Trastuzumab Biosimilar SB3 in Korean Patients, a Post-Marketing Surveillance Study.

INTRODUCTION: SB3 is a trastuzumab biosimilar approved in Australia, Brazil, Canada, the European Union, the Republic of Korea, Switzerland, and the United States. This real-world study evaluated safety and effectiveness of SB3 as part of the Korean post approval safety management system. METHODS: This post-marketing surveillance in Korea included patients in line with approved indications, i.e. patients with early or metastatic breast cancer or metastatic gastric cancer. Safety outcomes were adverse events and adverse drug reactions. Effectiveness outcomes were tumor response and event-free survival. RESULTS: 424 patients were evaluated: 366 patients (86%) with early breast cancer, 53 patients (13%) with metastatic breast cancer, and 5 patients (1%) with metastatic gastric cancer. Among patients with breast cancer, adverse events (mostly mild) and adverse drug reactions were reported by 158 (37.7%) and 57 (13.6%) patients, respectively. Most patients with an AE (141, 75.9%) had no change in treatment schedule. Treatment was temporarily suspended in 14 (8.2%) patients with an AE and completely discontinued in 7 (3.7%). Among patients with early and metastatic breast cancer who were evaluated for efficacy, objective response rates were 82.7% and 38.3%, respectively. Pathological complete response was 64.6% in patients with early breast cancer. DISCUSSION/CONCLUSION: Safety and efficacy of SB3 demonstrated in this real-world study were comparable with previous studies of reference trastuzumab.

Effects of a Metacognitive Smartphone Intervention With Weekly Mentoring Sessions for Individuals With Schizophrenia: A Quasi-Experimental Study.

Application (app)-based interventions using smartphones could provide effective alternatives to traditional treatment programs during and beyond the coronavirus disease 2019 pandemic. The current quasi-experimental study with a non-equivalent comparison group tested the effects of a smartphone app-based metacognitive intervention program with weekly mentoring sessions on the meta-cognitive beliefs, psychotic symptoms, and social functioning of individuals with schizophrenia from community psychosocial rehabilitation centers. The study was conducted with 20 participants with severe psychotic symptoms and low social functioning and 24 participants with relatively light psychotic symptoms and good social functioning as a comparison group. For the experimental group, the app-based intervention was combined with weekly contact mentoring sessions over 10 weeks. The comparison group received only the app-based intervention over 10 weekly sessions. No differences were observed between groups' total scores; however, the experimental group showed a tendency toward improved psychotic symptoms and social functioning over time, unlike the comparison group. These findings provide an empirical basis for managing schizophrenia symptoms with smartphone apps. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 27-37.].

Temporal trends in clinical characteristics and in-hospital mortality among patients with COVID-19 in Japan for waves 1, 2, and 3: A retrospective cohort study.

INTRODUCTION: Little information is available on the temporal trends in the clinical epidemiology and in-hospital mortality of patients with coronavirus disease 2019 (COVID-19) in Japan for waves 1, 2, and 3. METHODS: A national claims database was used to analyze the time trends in admission, medical procedure, and in-hospital mortality characteristics among patients with COVID-19. Patients who were ≥18 years and discharged from January 1, 2020 to February 28, 2021 were included. RESULTS: A multilevel logistic regression analysis of 51,252 patients revealed a decline in mortality in waves 2 and 3 (risk-adjusted mortality range = 2.17-4.07%; relative risk reduction = 23-59%; reference month of April 2020 = 5.32%). In the subgroup analysis, a decline in mortality was also observed in patients requiring oxygen support but not mechanical ventilation (risk-adjusted mortality range = 5.98-11.68%; relative risk reduction = 22-60%; reference month of April 2020 = 15.06%). Further adjustments for medical procedure changes in the entire study population revealed a decrease in mortality in waves 2 and 3 (risk-adjusted mortality range = 2.66-4.05%; relative risk reduction = 24-50%). CONCLUSIONS: A decline in in-hospital mortality was observed in waves 2 and 3 after adjusting for patient/hospital-level characteristics and medical treatments. The reasons for this decline warrant further research to improve the outcomes of hospitalized patients.

Cumulative Effects of Poverty on Children's Social-Emotional Development: Absolute Poverty and Relative Poverty.

This study examines the cumulative effects of poverty on children's socio-emotional outcomes from ages 5 to 12, using U.S. National Longitudinal Survey of Youth data (N = 6941). Two definitions of poverty were used: absolute poverty as defined by the federal poverty threshold, and relative poverty defined as income less than 50 percent of median household income. (1) Does cumulative poverty, measured in absolute and relative terms, have any impact on children's socio-emotional outcomes? (2) Does this association increase/decrease as children become older? Relative poverty had a stronger adverse effect on children's social-emotional development than absolute poverty, and the adverse effect of relative poverty was bigger when children were older. Child and maternal characteristics affected children's socio-emotional development. The income threshold for absolute poverty is lower than that for relative poverty; using a relative poverty threshold might better identify individuals with limited resources that are at risk of having adverse socio-emotional outcomes.

Effectiveness of a Metacognitive Intervention for Schizophrenia (MCI-S) Program for Symptom Relief and Improvement in Social Cognitive Functioning in Patients with Schizophrenia.

This study investigated the effectiveness of a metacognitive intervention program for symptom relief and improvement in social cognitive functioning among adults with schizophrenia. The program focused on enhancing metacognition to encourage self-awareness and step-by-step perspective expansion. There were 24 participants in the experimental group and 19 participants in the control group. Delusions decreased, and social cognition and social functioning improved in the experimental group compared to the control group. The program demonstrated utility as a treatment modality, which can be part of an overall program of a mental health promotion institution to improve functioning in patients with schizophrenia.

The Associations between Adverse Childhood Experiences and Social Services Use among Head Start-Eligible Low-Income Families.

This study examined the effects of adverse childhood experiences (ACEs) on parental social services use among Head Start-eligible low-income families. Based on the Head Start Impact Study data (N = 3,562), three questions were addressed: (1) Does the number of ACEs impact parental social services use? (2) Do family characteristics have any association with parental social services use? and (3) Does parental social services use differ between Head Start and non-Head Start parents? Regression indicated that parents with more ACEs tended to use more social services. Compared with parents with one ACE, parents with two ACEs and parents with three or more ACEs used more social services with income assistance, food and nutrition assistance, and housing and utility assistance programs. Parents with three or more ACEs tended to use more social services related to alcohol and drug use, mental health, and foster care payments than parents with one ACE. Barriers to social services use were identified and include racial disparities, native language, immigration status, and geographical location. Head Start was not found to have a significant impact on whether parents used more social services. Recommendations include increasing effective collaboration between social workers and services, assessing barriers to receiving services, and implementing ACE screenings.

Assessing the performance of a method for case-mix adjustment in the Korean Diagnosis-Related Groups (KDRG) system and its policy implications.

BACKGROUND: To evaluate the performance of the patient clinical complexity level (PCCL) mechanism, which is the patient-level complexity adjustment factor within the Korean Diagnosis-Related Groups (KDRG) patient classification system, in explaining the variation in resource consumption within age adjacent diagnosis-related groups (AADRGs). METHODS: We used the inpatient claims data from a public hospital in Korea from 1 January 2017 to 30 June 2019, with 18 846 claims and 138 AADRGs. The differences in the total average payment between the four PCCL levels for each AADRG was tested using ANOVA and Duncan's post hoc test. The three patterns of differences with R-squared were as follows: the PCCL reflected the complexity well (valid); the average payment for PCCL 2, 3, and 4 was greater than PCCL 0 (partially valid); the PCCL did not reflect the complexity (not valid). RESULTS: There were 9 (6.52%), 26 (18.84%), and 103 (74.64%) ADRGs included in the valid, partially valid, and not valid categories, respectively. The average R-squared values were 32.18, 40.81, and 35.41%, respectively, with an average R-squared for all patterns of 36.21%. CONCLUSIONS: Adjustment using the PCCL in the KDRG classification system exhibited low performance in explaining the variation in resource consumption within AADRGs. As the KDRG classification system is used for reimbursement under the new DRG-based prospective payment system (PPS) pilot project, with plans for expansion, there should be an overall review of the validity of the complexity and rationality of using the KDRG classification system.

Interference with daily functioning by breakthrough pain in patients with cancer.

PURPOSE: To investigate the association between quality of life (QOL) and breakthrough cancer pain (BTCP) intensity in patients who met the commonly accepted definition of BTCP. METHODS: This study was a subset analysis of a South Korean multicenter, non-interventional, cross-sectional, nationwide survey. Participants were recruited from March 2016 to December 2017. BTCP was defined as a controlled background pain of less than a numeric rating scale (NRS) of 3 and any flare-up pain intensity. Pain intensity data were collected using the Brief Pain Inventory (BPI), which includes an interference assessment of the affective and physical domains. Patients were categorized by BTCP intensity into mild (NRS 1-3), moderate (4-6), and severe (7-10) groups. RESULTS: Of the 969 screened patients with cancer, 679 had ≤ NRS 3 background pain, of whom 438 completed the BPI. Of these 438 patients, 40, 204, and 194 were in the mild, moderate, and severe BTCP groups, respectively. The median NRS of BTCP was 6.0 (interquartile range = 5.0-8.0). Patients with moderate-severe BTCP had significantly higher interference with daily functioning (IDF) scores than did mild BTCP patients (3.3 vs. 5.7; p < 0.01). Both domains of IDF were significantly hampered proportionally by increased BTCP intensity (p < 0.001). The median total IDF scores of the no, moderate, and severe BTCP groups were 3.3, 5.0, and 6.9, respectively. Furthermore, IDF depended on BTCP intensity, duration, and frequency (p < 0.01) but not on pain type and cause. CONCLUSION: An increase in BTCP intensity is likely to result in IDF, regardless of the cause or type of BTCP.

Anti-Adipogenic and Anti-Inflammatory Activities of (-)-epi-Osmundalactone and Angiopteroside from Angiopteris helferiana C.Presl.

Angiopteris helferiana C.Presl is a gigantic fleshy-type fern, belonging to Marattiaceae family. In previous study, we reported the potent anti-adipogenic and anti-inflammatory activities of ethylacetate (EtOAc) and n-butanol (BuOH) fractions of methanol extract of rhizomes of A. helferiana. In continuation, in this study, we report the isolation, characterization, and bioactivity analysis of principle bioactive compounds in these fractions. (-)-epi-Osmundalactone (1) and angiopteroside (2) were isolated from EtOAc and BuOH fractions, respectively. The structures of these compounds were established on the basis of NMR spectroscopic data. The quantification study using UPLC revealed the contents of compounds 1 and 2 in the dried rhizome to be 1.54% and 3.2%, respectively. These compounds were evaluated for their anti-adipogenic and anti-inflammatory activities using 3T3-L1 and RAW 264.7 cells, respectively. Compound 1 (2.5 µg/mL) and 2 (20 µg/mL) inhibited the lipid production by 35% and 25%, respectively. Regarding the anti-inflammatory activity, compound 1 (5 µg/mL) inhibited the nitrite production by nearly 82%. In conclusion, the presence of potent anti-adipogenic and anti-inflammatory compounds in A. helferiana indicate its potential role in the use of herb-based treatment for obesity and other related diseases.

Effect of Korean folk music intervention on schizophrenia inpatients' emotional behavior and interpersonal relationship functioning.

Schizophrenia can lead to inappropriate emotional behavior and issues with interpersonal relationship functioning as it becomes chronic. This study aimed to determine the effects of a Korean folk music therapy program on the emotional behavior and interpersonal relationship functioning of patients with schizophrenia. Twenty inpatients with schizophrenia in a psychiatric ward in Daegu and North Gyeongsang Province were included in the experimental group, and 24 in the control group. The experimental group participated in a 15-session music therapy program, with two 50-minute sessions per week. For hypothesis testing, Wilks' Lambda based on sphericity testing was used to perform repeated measures ANOVA. The experimental group showed statistically significantly higher levels of emotional behavior (F = 5.814, p < .020) and interpersonal relationship functioning (F = 21.72, p < .001) than the control group, indicating that the Korean folk music therapy program was an effective intervention.

Effects of therapeutic lifestyle change mentoring on cardio-metabolic factors for schizophrenia.

Considering that the prevalence of cardio-metabolic syndrome in patients with chronic schizophrenia is two or three times higher than the general population, this study aimed to provide patients with schizophrenia using community psychiatric rehabilitation services with therapeutic lifestyle change (TLC) mentoring using a smartphone application and provide inpatients in a psychiatric ward with structured TLC mentoring, to compare improvement in cardio-metabolic factors between the two groups. The home-based community service users using a TLC application were more likely to experience an improvement in their cardio-metabolic factors than the inpatients provided with the structured TLC program.

Social support and self-esteem on the association between stressful life events and mental health outcomes among college students.

The purpose of this research is to determine whether social support (informal and formal) and self-esteem can moderate the associations between life stress and mental health among college students.The research questions for the study are as follows: i) Does life stress affect mental health among college students? ii) Do social support (informal and formal) and self-esteem predict this association? iii) What are the characteristics of students predicting life stress, social support and self-esteem? Using a survey design (n = 184), respondents were asked about stressful life events, formal and informal social support, self-esteem, depression, anxiety, and baseline characteristics (age, sexual orientation, post graduate status, family size, income, employment status, participation in activities at school, and previous mental health diagnoses).Regression analysis found that students who experienced more stressful life events reported higher depression and anxiety. Informal social support and self-esteem significantly enhanced positive mental health. However, formal social support was not found to impact students' mental health. Younger students tend to have lower self-esteem and higher mental health problems. Students who worked part-time and participated in extra curriculum activities used more forma social services. Students who had previous mental health diagnoses had higher mental health problems.

Peripheral and central oxidative stress in chemotherapy-induced neuropathic pain.

Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse side effect of many anti-cancer chemotherapeutic treatments. CIPN often causes neuropathic pain in extremities, and oxidative stress has been shown to be a major contributing factor to this pain. In this study, we determined the site of oxidative stress associated with pain (specifically, mechanical hypersensitivity) in cisplatin- and paclitaxel-treated mouse models of CIPN and investigated the neurophysiological mechanisms accounting for the pain. C57BL/6N mice that received either cisplatin or paclitaxel (2 mg/kg, once daily on four alternate days) developed mechanical hypersensitivity to von Frey filament stimulations of their hindpaws. Cisplatin-induced mechanical hypersensitivity was inhibited by silencing of Transient Receptor Potential channels V1 (TRPV1)- or TRPA1-expressing afferents, whereas paclitaxel-induced mechanical hypersensitivity was attenuated by silencing of Aß fibers. Although systemic delivery of phenyl N-tert-butylnitrone, a reactive oxygen species scavenger, alleviated mechanical hypersensitivity in both cisplatin- and paclitaxel-treated mice, intraplantar phenyl N-tert-butylnitrone was effective only in cisplatin-treated mice, and intrathecal phenyl N-tert-butylnitrone, only in paclitaxel-treated mice. In a reactive oxygen species-dependent manner, the mechanosensitivity of Aδ/C fiber endings in the hindpaw skin was increased in cisplatin-treated mice, and the excitatory synaptic strength in the spinal dorsal horn was potentiated in paclitaxel-treated mice. Collectively, these results suggest that cisplatin-induced mechanical hypersensitivity is attributed to peripheral oxidative stress sensitizing mechanical nociceptors, whereas paclitaxel-induced mechanical hypersensitivity is due to central (spinal) oxidative stress maintaining central sensitization that abnormally produces pain in response to Aß fiber inputs.

Bioassay-guided isolation of active anti-adipogenic compound from royal jelly and the study of possible mechanisms.

BACKGROUND: Royal jelly (RJ) has been used traditionally for dietary, cosmetic and health purposes for a long time in different parts of the world. Scientific studies have also shown its numerous health-promoting properties including hypoglycemic and anti-hypercholesterolemic action. In this study, we investigated the anti-adipogenic activity of RJ in 3 T3-L1 cells and isolated the major responsible root component for the activity. METHODS: An active anti-adipogenic compound was isolated through bioassay-guided isolation process by successive treatment of RJ and its active fractions on 3 T3-L1 cell line. (E)-10-Hydroxy-2-decenoic Acid (10-HDA) was identified using NMR spectroscopy and ultra-performance liquid chromatography (UPLC). As 10-HDA showed significant anti-adipogenic activity with Oil Red O staining and TG content assay on 3 T3-L1 adipocytes, further study was carried out in molecular level for the expression of adipogenic transcription factors such as PPARγ, FABP4, C/EBPα, SREBP-1c, and Leptin. The effect of 10-HDA on preliminary molecules such as pAkt, pERK, C/EBPß, and pCREB were studied in the early stage of adipogenesis. The effect of 10-HDA on reactive oxygen species (ROS) production in fully differentiating adipocytes was measured by nitro blue tetrazolium (NBT) assay. RESULT: Results showed that triacylglycerol accumulation and ROS production was markedly suppressed by 10-HDA. Preliminary molecules such as pAkt, pERK, pCERB, and C/EBPß were found to be down-regulated by 10-HDA, which led to down-regulation of key adipogenic transcription factors such as PPARγ, FABP4, CEBPα, SREBP-1c, and Leptin on 3 T3-L1 adipocytes. CONCLUSION: Our results suggest that anti-adipogenesis of 10-HDA on 3 T3-L1 adipocyte takes place via two mechanisms: inhibition of cAMP/PKA pathway and inhibition of p-Akt and MAPK dependent insulin signaling pathway. So it is considered that 10-HDA, a major component of RJ, can be a potential therapeutic medicine for obesity.

Pisidium coreanum Inhibits Multinucleated Osteoclast Formation and Prevents Estrogen-Deficient Osteoporosis.

Mollusks have served as important sources of human food and medicine for a long time. Raw Pisidium coreanum, a freshwater bivalve of the phylum Mollusca, is used in traditional therapies in parts of Asia. However, the therapeutic effects of Pisidium coreanum on bone diseases are not known. We investigated the functional roles of Pisidium coreanum in osteoporotic bone diseases. Pisidium coreanum inhibited the differentiation of bone marrow-derived monocytic cells into mature osteoclasts in vitro. The ovariectomized mice that received oral administration of Pisidium coreanum showed improvements in both trabecular and cortical bones. This preventive activity of Pisidium coreanum against bone loss was due to limited osteoclast maturation with reduced osteoclast surface extent in trabecular bone tissue. The formation of large multinucleated osteoclasts in vitro was significantly decreased in response to Pisidium coreanum, consistent with the reduced expression levels of osteoclast markers and fusion-related genes, such as NFATc1, p65, integrin αvß3, DC-STAMP, OC-STAMP, Atp6v0d2, FAK, CD44, and MFR. These data suggest that Pisidium coreanum inhibits osteoclast differentiation by negatively regulating the fusion of mononuclear osteoclast precursors. Thus, our data demonstrate the ability of Pisidium coreanum to effectively prevent estrogen-deficient osteoporosis through inhibition of multinucleated osteoclast formation.

Willingness to use smartphone apps for lifestyle management among patients with schizophrenia.

Mobile technology is a popular intervention mode for patients with schizophrenia because of its accessibility and functionality. We examined patients' willingness to use smartphone apps for lifestyle management and its effect on self-reported lifestyle habits. Five hundred fifty-five inpatients from various mental health institutions participated. Willingness to use smartphone apps was associated with age, education, income, device type, and body mass index. Positive opinions on smartphone app use were significantly associated with willingness to use apps, which was significantly associated with dietary and living habits. Thus, improving willingness to use apps can help patients improve their lifestyle, potentially preventing relapse.

An intrinsically disordered domain in Polaribacter irgensii KOPRI 22228 CspB confers extraordinary freeze-tolerance.

Organisms living in extremely cold environments possess mechanisms to survive low temperatures. Among the known cold-induced genes, cold-shock proteins (Csps) are the most prominent. A csp-homologous gene, cspBPi, has been cloned from the Arctic bacterium Polaribacter irgensii KOPRI 22228, and overexpression of this gene greatly increased the freezing tolerance of its host. This protein consists of a unique N-terminal domain and a well conserved C-terminal cold shock domain. To elucidate the detailed mechanisms involved in the extraordinary freeze-tolerance conferred by CspBPi, we identified the responsible domain by mutational analysis. Changes of residues in the cold shock domain that are crucial for binding RNA or single-stranded DNA did not impair the ability of the host to survive freezing stress. All domain-shuffled CspBPi variants containing the N-terminal domain retained the ability to confer superior freeze-tolerance. Slow electrophoretic mobility and far-UV circular dichroism spectra of the N-terminal domain suggested an intrinsically disordered structure for this region. The N-terminal domain also bound to lipid vesicles in vitro. This lipid vesicle binding characteristic is shared with other intrinsically disordered proteins, such as α-synuclein and plant dehydrins, known to confer cold-tolerance when overexpressed, suggesting a mechanism for cold-survival through membrane binding.

Phase II study of oxaliplatin, irinotecan and S-1 therapy in patients with advanced gastric cancer: the Korean Cancer Study Group ST14-11.

BACKGROUND: Doublet chemotherapy of platinum and 5-fluorouracil is a standard first-line treatment for patients with unresectable gastric cancer. Although the addition of taxane or irinotecan to this regimen has yielded promising efficacy, its use has been limited due to severe toxicities. To overcome this limitation, we evaluated the efficacy and safety of the combination of irinotecan, oxaliplatin, and S-1 (OIS) for the treatment of advanced gastric cancer. METHODS: Chemotherapy-naïve patients with pathologically proven advanced gastric adenocarcinoma were assessed for eligibility. Irinotecan (135 mg/m2) and oxaliplatin (65 mg/m2) were administered intravenously on day 1, and S-1 (80 mg/m2/day) was administered orally on days 1-7 of every 2-week cycle. RESULTS: Forty-four patients (median age 57 years) were enrolled and all but one patient had a good performance status (ECOG 0 or 1). A total of 529 cycles were administered, with a median of 9.5 (range 1-31) cycles per patient. The overall response rate was 61.4% (95% confidence interval [CI] 46.6-74.3). The median progression-free survival and overall survival were 10.8 months (95% CI 7.6-14.0) and 15.4 months (95% CI 12.6-18.2), respectively. Major toxicities included grade 3/4 neutropenia (38.6%), febrile neutropenia (13.6%), abdominal pain (9.1%), and diarrhea (9.1%). CONCLUSION: These data suggest that the OIS regimen is effective and relatively well tolerated in patients with advanced gastric cancer. Given that all the patients treated, but one, had a good performance status, these results must be confirmed in a patient population more representative of regular clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02527785.

Roles of Mitogen-Activated Protein Kinases in Osteoclast Biology.

Bone undergoes continuous remodeling, which is homeostatically regulated by concerted communication between bone-forming osteoblasts and bone-degrading osteoclasts. Multinucleated giant osteoclasts are the only specialized cells that degrade or resorb the organic and inorganic bone components. They secrete proteases (e.g., cathepsin K) that degrade the organic collagenous matrix and establish localized acidosis at the bone-resorbing site through proton-pumping to facilitate the dissolution of inorganic mineral. Osteoporosis, the most common bone disease, is caused by excessive bone resorption, highlighting the crucial role of osteoclasts in intact bone remodeling. Signaling mediated by mitogen-activated protein kinases (MAPKs), including extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38, has been recognized to be critical for normal osteoclast differentiation and activation. Various exogenous (e.g., toll-like receptor agonists) and endogenous (e.g., growth factors and inflammatory cytokines) stimuli contribute to determining whether MAPKs positively or negatively regulate osteoclast adhesion, migration, fusion and survival, and osteoclastic bone resorption. In this review, we delineate the unique roles of MAPKs in osteoclast metabolism and provide an overview of the upstream regulators that activate or inhibit MAPKs and their downstream targets. Furthermore, we discuss the current knowledge about the differential kinetics of ERK, JNK, and p38, and the crosstalk between MAPKs in osteoclast metabolism.

Effects of motivation interviewing using a group art therapy program on negative symptoms of schizophrenia.

BACKGROUND: We investigated the effect of motivation interviewing using group art therapy on the negative symptoms of schizophrenia. METHODS: Participants were patients with chronic schizophrenia admitted to the D psychiatric wards in D city, Korea. There were 17 and 18 patients in the experimental and control groups, respectively. The data collection period was from November 28, 2016 to January 28, 2017. Motivation interviewing using group art therapy was conducted twice per week over 6 weeks (12 sessions in total). RESULTS: The significance of the intervention effects were confirmed via measures of negative symptoms, motivation and pleasure, interpersonal relationships, personal hygiene, and hospital program attendance. The experimental group exhibited significantly greater improvements in negative symptoms, motivation and pleasure, interpersonal relationships, personal hygiene, and hospital program attendance than did the control group. CONCLUSIONS: The results showed that the motivation interviewing using group art therapy was an effective nursing intervention for the negative symptoms of schizophrenia.