The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

The author has not supplied his declaration of competing interest.

Avolition represents an important domain of negative symptoms in schizophrenia with a strong impact on functional outcome. Primary and persistent avolition is refractory to available pharmacological and psychological treatments. A better understanding of its pathophysiological mechanisms is fundamental to promote development of new treatments. Recent models of avolition converge on dopaminergic circuits involved in motivation and its translation in goal-directed behavior. Deficits in task-related activation or connectivity within mesolimbic and mesocortical dopamine circuits were reported in schizophrenia but the relationship with avolition was not fully established.

The present study aimed to investigate resting-state functional connectivity (RS-FC) within the motivation circuits in schizophrenia patients and its relationships with primary and persistent avolition.

RS-FC, using VTA as a seed region, was investigated in 22 healthy controls (HC) and in 26 schizophrenia patients (SCZ) divided in high (HA) and low avolition (LA) subgroups. Avolition was assessed using the Schedule for the Deficit Syndrome.

HA, in comparison to LA and HC, showed significantly reduced RS-FC with the right ventrolateral prefrontal cortex (R-VLPFC), right insula (R-INS) and right lateral occipital cortex (R-LOC). The RS-FC of these regions was negatively correlated to avolition.

Our findings demonstrate that avolition in schizophrenia is linked to dysconnection of VTA from key cortical regions involved in retrieval of outcome values of instrumental actions to motivate behavior.

AM received honoraria or advisory board/consulting fees from the following companies: Janssen Pharmaceuticals, Otsuka, Pfizer and Pierre Fabre. SG received honoraria or advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter. All other Authors declare no potential conflict of interest.

AA received speaker fees from Lundbeck.

Alterations in the mesolimbic dopamine system play a crucial role in the pathophysiology of schizophrenia. However, 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 endogenous 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. Neurofeedback learning was correlated with the self-reported negative symptoms.

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 training improves self-regulation using positive mental imagery in HC, this method might not be suitable as a potential treatment strategy in SZ. The present findings provide new insights to the to the association between negative symptoms and dopaminergic dysfunction and highlight the strengths and limitation for the use of rtfMRI neurofeedback in schizophrenia.

The author has not supplied his declaration of competing interest.

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 professionals 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 modified 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, policymakers and members 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 need.

The authors have not supplied their declaration of competing interest.

Cortical brain abnormalities are frequently observed in adults with psychotic disorders, but few studies have investigated adolescents with early-onset psychosis (EOP). A previous magnetic resonance imaging (MRI) study from the NORMENT group in Norway, found widespread cortical thinning and smaller subcortical volumes in adult patients with psychotic disorders, particularly schizophrenia, compared to healthy controls.

Participants from the ongoing NORMENT adolescent EOP-study, 30 patients (age: 13.3–18.3 years, mean age: 16.5, 66% female) and 45 healthy adolescents (age: 13.6–18.8 years, mean age: 16.2, 58% female), underwent 3 T MRI on the same scanner. Surface-based morphometric analyses were performed using FreeSurfer version 5.3.0. Group differences in vertex-wise cortical volume, thickness and surface area were investigated by fitting general linear models at each vertex on the surface. Age, sex and group were entered as covariates, and a non-parametric cluster-wise correction method for multiple comparisons was applied and cluster-forming and cluster-wise threshold set at 0.05.

Preliminary results show thinner cortex in the left medial frontal lobe and smaller surface area in the left temporoparietal junction in EOP patients compared to healthy controls after correction for multiple comparisons.

Surface-based analysis is sensitive to alterations in cortical morphology in an adolescent EOP sample. The regions exhibiting reduced cortical thickness and area in EOP overlap with findings in an adult psychosis sample. Large-scale studies are warranted to better identify the pattern of abnormalities and clarify effects of age, diagnosis and medication.

The authors have not supplied their declaration of competing interest.

Adolescent-onset schizophrenia (AOS) is associated with cognitive impairment and poor clinical outcome. Cognitive dysfunction is thought to reflect functional dysconnectivity between the frontal cortex and the striatum, Previous work [1] has shown frontostriatal dysconnectivity in large WM tracts explain core cognitive deficits, with processing speed, which is affected by alterations in WM connectivity, being an intermediary variable.

To undertake a follow-up MRI study using whole-brain structural connectomics to track topological changes in the follow-up (1st episode versus follow-up), in order to characterize the early stages (evolution of the first two years) of the disorder.

A follow-up study of 25 AOS subjects and 25 age and sex-matched healthy subjects.

Network theory will be applied to identify topological alterations in structural networks, including frontostriatal white matter (WM) tracts in relation to cognition and outcome measures.

The authors have not supplied their declaration of competing interest.

Smaller auditory cortex volume in schizophrenia patients with auditory hallucinations (AH) may be a result of reduced cortical surface area and/or cortical thickness. A neuro–imaging study from our group demonstrated that adult schizophrenia spectrum patients with AH had significantly thinner cortex in the left side Heschl's gyrus (HG), compared to patients without AH, and healthy controls (HC).

This study aims to investigate if adolescents with early-onset psychosis (EOP) and AH demonstrate thinner cortices in HG, as found in Mørch-Johnsen et al. in 2016, compared to EOP patients without AH, and HC.

EOP patients (schizophrenia spectrum, psychotic disorder not otherwise specified) (n = 29) underwent MRI. Mean volume, cortical thickness and surface area in auditory cortex regions (HG, superior temporal gyrus [STG]) were compared between patients with AH (n = 20) and without AH (n = 9), measured with item P3 from the Positive And Negative Syndrome Scale (PANSS), and 48 HC.

Preliminary results show no significant differences between patients with and without AH and HC in mean volume, cortical thickness, or surface area in HG or STG. There were no significant side differences across hemispheres for these structures.

AH in EOP were not related to smaller volume, thinner cortex or reduced surface area in auditory cortex regions. To overcome the limitation of having a relatively small sample size, the sample will be expanded with other EOP cohorts. Investigations into HG structure variation in relation to AH in EOP will also be conducted.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Early-onset first-episode psychosis (FEP) and high functioning autism spectrum disorders (ASD) are complex neuro–developmental disorders that share symptomatology but it is not clear if they also share neurobiological abnormalities (Chisholm et al., 2015). We examined thickness, surface area and volume in a direct comparison of children and adolescents with FEP (onset before 18 years), high-functioning ASD, and healthy subjects.

Magnetic resonance imaging scans of 85 participants (30 ASD, 29 FEP, 26 healthy controls, age range 10–18 years) were obtained from the same MR scanner using the same acquisition protocol. The FreeSurfer analysis suite was used to quantify vertex-wise estimates of the metrics thickness, surface area, and volume.

ASD and FEP had spatially overlapping insular deficits for each metric. The transdiagnostic overlap of deficits was greatest for volume (55% of all insular vertices) and smallest for thickness (18%). Insular thickness and surface area deficits did not overlap in ASD and overlapped only in 8% of all insular vertices in FEP.

Morphological insular deficits are common to FEP and high functioning ASD when compared to healthy participants. The pattern of deficits was similar in both disorders, i.e. a largely non-overlap of insular thickness and surface area. The non-overlap provides further evidence that these metrics represent two independent outcomes of corticogenesis, both of which are affected in FEP and ASD.

The authors have not supplied their declaration of competing interest.

The ENIGMA-EOP collaboration aims to identify structural phenotypic markers that robustly discriminate adolescents with early-onset psychosis (EOP) from healthy controls through mega- or meta-analysis of magnetic resonance imaging (MR) data. Through larger samples we will obtain sufficient power to detect the brain structural correlates, overcome some of the clinical heterogeneity and characterize the developmental trajectories.

Multiple linear regression was used to investigate structural brain differences in two Scandinavian adolescent EOP cohorts (altogether 50 patients; ages 12.1-18.3 years (mean 16.4 years), 60% female; 68 controls; ages 12.0-18.8 years (mean 16.2 years), 62% female) acquired on two different 3 T GE MRI scanners. The statistical analysis included site as a covariate in addition to age, sex and intracranial volume (ICV). The results are presented by p-values, Cohens's-d effect size and with an indication of directionality. MRI scans were processed following the ENIGMA (http://enigma.ini.usc.edu/) structural image processing protocols using FreeSurfer (Fischl 2012) version 5.3.0 to measure subcortical brain volumes.

Preliminary results show significant or trend-significant group effects on right amygdala (P = 0.001, d = 0.33, patients < controls), total grey matter volume (P = 0.037, d = 0.21, patients < controls), ICV (P = 0.028, d = 0.22, patients < controls) and third ventricle (P = 0.067, d = 0.19, patients > controls). Sub-analyses in the two individual groups show overlapping findings in right amygdala. Previously reported enlarged lateral and 4th ventricles, and caudate, from a similar Scandinavian adolescent EOP cohort (Juuhl-Langseth, 2012) were not replicated.

There is a need for larger subject samples in EOP to better capture disease mechanisms. Research groups interested in participating can join ENIGMA-EOP through: http://enigma.ini.usc.edu/ongoing/enigma-eop-working-group/.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.e

The authors have not supplied their declaration of competing interest.

Among patients with major depression, increased inflammatory markers at baseline may predict an anti-depressant response. Reducing inflammation may augment response to psychotropic medications. Few studies have investigated an association between Leukocyte Telomere Length (LTL) and therapeutic response in depression, reporting mixed results. No studies assessed LTL and treatment response with PPAR-γ agonists.

(1) LTL as a predictor of anti-depressant response to PPAR-γ agonist in patients with unremitted depression.

(2) the correlation between LTL and insulin resistance (IR) status.

We aimed to assess LTL as a predictor of antidepressant response to Pioglitazone in groups of insulin resistant and insulin-sensitive subjects using surrogate markers of IR.

Medically stable men and women (n = 42) ages 23–71 with non-remitted depression participated in double-blind placebo controlled add-on of Pioglitazone to treatment-as-usual. Oral glucose tolerance tests were administered at baseline and at 12 weeks.

At baseline, no differences in LTL were detected by depression severity, duration or chronicity. LTL was also not significantly different between insulin-resistant and insulin-sensitive subjects. Subjects with longer telomeres exhibited greater declines in depression severity in the active arm, but not in a placebo arm. LTL also predicted improvement in insulin sensitivity in the group overall and did not differ between the active and placebo arm.

LTL may emerge as a viable predictor of antidepressant response. An association between insulin sensitization and LTL regardless of the baseline IR status points to potential role of LTL as a non-specific moderator of metabolic improvement in these patients.

I, Dr. Natalie Rasgon, am a consultant for Shire Pharmaceuticals and Sunovion Pharmaceuticals.

The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

The author has not supplied his declaration of competing interest.