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Monday, October 8
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Oral Session 1
Monday, October 8, 1:00 - 2:30 pm, St. George AB
Early Psychosis Treatment Trials
Chair: Jai Shah, Department of Psychiatry, McGill University, PEP Montréal, Douglas Mental Health University Institute, Integrate Program in Neuroscience, McGill University, Montréal, Canada
Speakers: Jai Shah, Jacqueline Mayoral-van Son, Dawn Edge, Iruma Bello, Thomas Nordahl Christensen, Scott Teasdale, Jennifer Humensky, Jennifer Humensky
Talk 1: The Importance of Smoke Before Fire: Treatment Outcomes in Psychosis With and Without a Prior Clinical High-Risk Phase
Jai Shah1,2,3, Rachel Rosengard3, Sarah McIlwaine1,2, Srividya Iyer1,2, Sally Mustafa1, Ridha Joober1,2, Martin Lepage1,2,3, Ashok Malla1,2; 1Department of Psychiatry, McGill University, Montréal, Canada, 2PEPP-Montréal, Douglas Mental Health University Institute, Montréal, Canada, 3Integrate Program in Neuroscience, McGill University, Montréal, Canada
PURPOSE: The widespread operationalization of the clinical high-risk (CHR) phase and its clear vulnerability for a first episode of psychosis (FEP) have led to a much-needed focus on factors related to conversion from CHR to FEP. Yet they have also resulted in an assumption which has gone largely unexamined: that CHR invariably precedes FEP. We examined this assumption, and whether key treatment and service outcomes in FEP services vary depending on whether or not subjects experienced a pre-onset CHR state. METHODS: Retrospective information was systematically extracted regarding sociodemographic characteristics, psychiatric/behavioral changes, and help-seeking in 200 FEP patients (aged 14-35) receiving specialized early intervention services in Montreal, Canada. Individuals were then followed for 1 year in order to assess individual- and service-level outcomes. RESULTS: At intake to FEP services, 68% of youth recalled a pre-onset CHR syndrome while 32% did not; these groups showed no sociodemographic or clinical differences at baseline. However, duration of untreated psychosis was significantly longer in those with prior CHR syndromes (U=3315, p=0.043). Furthermore, symptomatic and functional outcomes were poorer for the prior CHR subgroup in positive symptoms (SAPS group effect, F[1,198]=4.79, p=0.03), with significant group-by-time interactions for negative symptoms (SANS, F[1,198]= 5.67, p=0.018), global functioning (GAF, F[1,198]=7.96, p=0.005), and social/occupational functioning (SOFAS, F[1,198]=4.392, p=0.037). CONCLUSIONS: Most FEP patients experience pre-onset CHR syndromes, enduring greater delays in accessing treatment and poorer longitudinal outcomes than those without prior CHR symptoms. These findings strongly argue for the personalization of early intervention efforts based on knowledge regarding trajectories to FEP.
Talk 2: Analyzing Direct and Indirect costs of an Intensive First Episode of Psychosis Program (PAFIP) of Cantabria, in the first year of intervention.
Jacqueline Mayoral-van Son1,3,6, Maria Juncal Ruiz1, Victor Ortiz-García de la Foz6, David Cantarero4, Carla Blázquez4, María Paz5, Paula Paras5, Benedicto Crespo-Facorro2,3,6; 1Department of Psychiatry, Sierrallana Hospital,Cantabria. Spain., 2Department of Psychiatry, University Hospital Marqués de Valdecilla, Santander. Spain, 3School of Medicine. University of Cantabria. Spain., 4School of Economics. University of Cantabria, GIECONPSALUD., 5Nursing School, University of Cantabria. Spain, 6CIBERSAM. IDIVAL
Objetive Early-intervention psychiatric services in patients with psychosis aim to limit the most damaging outcomes, and reduce the risk of social drift of the patient, decreasing illness severity and hence contain healthcare costs. There is a scarcity of studies which focuses on FEP, and those ones published, only looked for direct health costs but not for indirect costs, which are the bulk of the budget. Our study aims to explore the economic cost of a First Episode of Psychosis Program in short term (1 year follow up) including direct and indirect costs. Methods The study is a retrospective data collection from clinical records of 157 patients included in PAFIP (Programa Atención Fases Iniciales de Psicosis), from the University Hospital Marqués Valdecilla, Santander. Our data collection sheet included data from direct and indirect costs associated to the illness. Data were also extracted from the Cantabria Health Service Records. STATA 15.0 was used for statistical analysis. Results On average, the total costs during the first year were €48,277.51 being Direct Health Care costs €13,729.47 (28.45%) , direct non-medical costs €108.6( 0.22%) and indirect costs €34,439.44 (71.3%). We found that hospitalization costs were higher in males (p=0.081), cannabis use increased hospitalization costs (p=0.032). The number of relapses increased both, hospitalization and treatment costs (r=0.40 and p=0.000; r=0.24 and p=0.067). Conclusions Intensive Early Intervention Programs in psychosis may result in cost savings by decreasing hospitalization, premature mortality, disability, unemployment, and legal problems although first year after diagnosis would represent the one which higher costs.
Talk 3: Developing e-learning resources for families of African and Caribbean people diagnosed with schizophrenia: A qualitative approach to co-production
Dawn Edge1, Henna Lemetyinen1; 1The University of Manchester, Division of Psychology and Mental Health, Manchester, United Kingdom
African & Caribbean people in the UK are more likely than other groups to be diagnosed with schizophrenia. They report high levels of stigma, contributing to delayed help-seeking and worse outcomes, including high rates of relapse and hospital readmission. Psychoeducation could improve family outcomes. However, there is no culturally-appropriate psychoeducation for Africans & Caribbeans in the UK. Our aims were to explore whether African & Caribbean people perceive a need for a culturally-appropriate resource, and what such a resource should contain to meet families’ needs. We conducted focus groups comprising patients, relatives and community members (n=25). To inform resource development, we explored four themes: ‘perceived need for an e-learning resource’, ‘content for the resource’, ‘delivery of the resource, and ‘internet use and social media’. Framework Analysis was conducted to elicit participants’ responses to themes. All groups perceived the need for a culturally-appropriate resource. Family and community members prioritised raising awareness about schizophrenia. They emphasised the need to counteract stigma. Only former patients regarded ‘relationships’ as the most important topic. Topics mentioned by other groups, e.g. ‘Raising awareness’ did not emerge as important for patients. Our findings demonstrate that African & Caribbean people perceive the need for culturally-appropriate schizophrenia resources. Our findings highlight these communities’ desire to participate in developing psychosocial interventions to reduce stigma and improve family outcomes. Generalisability of these findings should be approached cautiously due to the sample size. These findings can be applied to inform other interventions for schizophrenia for these communities.
Talk 4: OnTrackNY: Utilizing Assertive Outreach to Promote Participant Engagement
Iruma Bello1,2, Hong Ngo1,2, Rufina Lee3, Lisa Dixon1,2; 1New York State Psychiatric Institute, 2Department of Psychiatry, Columbia University College of Physicians and Surgeons, 3Silberman School of Social Work, Hunter College, City University of New York
Purpose: Evidence suggests that connecting individuals to coordinated specialty care programs shortly after experiencing a first episode of psychosis improves outcomes. The inability to engage individuals with outpatient mental health services has been consistently identified as a primary barrier to providing treatment to this population. OnTrackNY, a coordinated specialty care (CSC) treatment model, emphasizes and trains teams on initial engagement strategies designed to encourage people to enroll in the program and assertive outreach strategies to reduce drop out rates. We will describe these specific engagement strategies and present data reflecting OnTrackNY’s initial engagement and retention rates. Methods: Teams report data on number of referrals, participants enrolled and length of stay in the program to a centralized data repository. Individual and aggregate rates of enrollment and retention were calculated. Results: To date, there are 21 OnTrackNY teams across the state of New York. Since August 2015, teams have received 3,294 referrals, determined that 25% are eligible, and successfully enrolled 88% of those (n= 734). The program is designed to provide services for an average of two years. Statewide, teams are currently able to retain 78% of participants at 12-month follow-up and 54% of participants at 24-month follow-up. The mean length of stay for all program participants is 12.3 months. Conclusions: There appear to be significant advantages to utilizing strategies for enhancing initial and ongoing engagement with young adults to ensure that the CSC model can be delivered. Data are limited by the relative age of each program, affecting current census.
Talk 5: Vocational outcomes of individual placement and support, cognitive remediation and work-related social skills training for people with severe mental illness in Denmark: Results from a randomized controlled trial
Thomas Nordahl Christensen1, Iben Gammelgaard Nielsen2, Merete Nordentoft1, Lene Falgaard Eplov1; 1Mental Health Center Copenhagen, University of Copenhagen, 2Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark
Individual Placement and Support (IPS) is an effective vocational intervention. However, the effects of IPS has not yet been demonstrated in a Danish welfare model and it has been suggested that the vocational effects can be further enhanced by supplementing IPS with cognitive remediation and work-related social skills training. The aim of the trial was to investigate the effects of 1) IPS; 2) IPS enhanced with cognitive remediation and work related social skills training (IPSe); and 3) service as usual (SAU). The trial was designed as an investigator-initiated, randomized, three-arm parallel, assessor-blinded, multi-center trial. A total of 720 patients with severe mental illness, recruited from early intervention teams (OPUS) or community mental health centers, were randomly assigned into the three groups at three sites in Denmark. Over the 18-month follow-up period 59.9% in the IPS group, 59.1% in the IPSe group and 46.5% in the SAU group worked competitively or were enrolled in education. IPS vs SAU (OR=1.79 (95% CI 1.14,2.81) P=0.014) and IPSe vs. SAU (OR=1.76 (95% CI 1.11,2.81), P=0.036). The IPSe group also worked or studied significantly more hours than SAU (OR= 1.76 (95% CI 1.15, 2.67), p= 0.005). The difference between IPS and SAU was (OR= 1.53 (95% CI 1.02,2.31), p =0.018). In conclusion, IPS and IPS supplemented with cognitive remediation and work-related skills training can be implemented in a Danish welfare model and demonstrate vocational effects in a Danish context.
Talk 6: Food addiction, nutrition knowledge and dietary intake in young people experiencing mental illness
Scott Teasdale1,2, Tracy Burrows3, Tegan Hayes4, Yoland Hsia4, Philip Ward2,5, Katherine Samaras6,7, Jackie Curtis1,2; 1Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Australia, 2School of Psychiatry, University of New South Wales, Australia, 3School of Health Sciences, University of Newcastle, Australia, 4Nutrition and Dietetics Department, University of Sydney, Australia, 5Schizophrenia Research Unit, South Western Sydney Local Health District, Australia, 6Diabetes and Metabolism Division, Garvan Institute for Medical Research, Australia, 7Department of Endocrinology, St Vincent's Hospital, Australia
Background and Aims. Young people experiencing serious mental illness (SMI) are prone to poor physical health and a reduced life expectancy. Unhealthy dietary intake and food addiction are thought to be a key driving factors but remain unexplored. This study aims to comprehensively assess dietary intake, nutrition knowledge and food addiction, in young people with SMI. Method. This three-arm cross sectional study of 16-25 year olds has a target sample size of n=30. Study arms include; (i) depression/anxiety, (ii) ultra-high risk for psychosis, and (iii) first-episode of psychosis. Participants self-completed three validated questionnaires, (i) Australian Eating Survey, (ii) General Nutrition Knowledge Questionnaire – Revised, (iii) Yale Food Addiction Score Questionnaire. Results. To date, 25 participants (mean age 19.6 ± 2.5 years) have completed the study. Diet quality was poor in all study arms, falling within the lowest scoring category (29 ± 13 out of 73). 43% of dietary intake was coming from ultra-processed, non-nutritive ’junk’ foods. Mean nutrition knowledge score was 51 ± 10, similar to mean scores in studies in other populations. Prevalence of food addiction was 36%, more than twice the rate found in the general population (16%). No between group differences were found in this sample. Conclusions. This study demonstrates that unhealthy dietary intake is present in the early stages of illness likely seeding future poor physical health and should be a target for preventative intervention. Research is needed to further explore food addiction in this population, including effective intervention methods.
Talk 7: Long-Term Education and Employment Trajectories for Individuals with Psychosis: The Suffolk County Mental Health Project
Jennifer Humensky1,2, Roman Kotov3, Lisa Dixon1,2, Evelyn Bromet3; 1Columbia University, 2New York State Psychiatric Institute, 3Stony Brook University School of Medicine
Background: Evidence-based coordinated specialty care (CSC) for early psychosis treatment has grown rapidly in the United States. Since programs are relatively new, findings on long-term functioning after treatment ends derive only from pre-CSC research. The Suffolk County Mental Health Project (SCMHP) has followed a cohort of individuals diagnosed with recent-onset psychosis in the early 1990s, thus permitting examination of the long-term (20-year) vocational patterns in the cohort. The current analysis focuses on the subsample of the SCMHP who appears to have met the criteria for enrollment in OnTrackNY, the state’s CSC intervention, had it been available (n=153). Methods: Assessments were conducted at baseline, and at 6 months and 2, 4, 10 and 20 year follow-ups. Random effects models examine trends in vocational participation over time. Results: Baseline vocational (education and employment) participation for those who would have met OnTrackNY enrollment criteria is similar to published estimates of OnTrackNY, namely, 47% (n=71) for SCMHP and 44% (n=144) for OnTrackNY. Overall, vocational participation in the SCMHP declined, particularly by the 20-year follow-up (OR=0.41[95% CI: 0.17-0.98]), and especially for full-time vocational participation (OR=0.02 [95% CI:0.004-0.09]. Rates of part-time participation increased (OR=6.39[95%CI:2.09-19.52], as did public assistance enrollment. Baseline vocational participation was the strongest predictor of subsequent vocational participation; other key predictors were baseline educational attainment, race/ethnicity, and illness severity. Conclusions: While baseline rates are similar, vocational participation declined over time in SCMHP; in contrast, it doubled to over 80% for OnTrackNY enrollees. Future research should examine how participation changes after CSC treatment ends.
Talk 8: Education and Employment Among Young Persons with Early Psychosis Participating in OnTrackNY
Jennifer Humensky1,2, Lisa Dixon1,2; 1Columbia University, 2New York State Psychiatric Institute
Introduction: Onset of psychosis occurs most commonly at ages 15-25, the ages at which young people are developing adult identities – education, employment and career development are crucial in this process. Coordinated specialty care (CSC) programs provide coordinated access to team based early invention services for psychosis, including supported education and employment (SEE) services. This study prospectively evaluated education and employment outcomes over time within New York State’s CSC program, OnTrackNY. Methods: Assessment data are collected by clinical staff at admission, quarterly, and at discharge. Trajectories of education and employment status are assessed using generalized estimating (population averaged) models with an autoregressive covariance structure to account for within-subject correlations over time. Participants (n=779) were enrolled in OnTrackNY from October 2013 to September 2017. Results: 41% (SD 49%) were in school/work at baseline, rising to 62% (SD 48%) at 3 months, and 75% (SD 43%) at 12 months. Work/school participation at baseline was the strongest predictor of subsequent work/school participation (OR=24.8 [95% CI: 16.4-37.7], as were higher GAF symptom scores (less severe symptoms) (OR=1.01 [1.00-1.02]) and longer time in program, (OR=1.34 [1.27-1.42]. Older participants had lower odds of work/school participation (OR=0.93 [0.88-0.98]), as did males relative to females (OR=0.70 [0.49-0.99]), Hispanics compared to non-Hispanic whites (OR=0.66 [0.45-0.98], and those with high school/GED compared to those with less than high school (OR=0.48 [0.31-0.75]). Conclusion: CSC participants achieve significant improvements in education and employment. CSC teams should support vocational efforts, particularly among those at risk of poor performance, to help participants achieve their goals.
Oral Session 2
Monday, October 8, 1:00 - 2:30 pm, St. George CD
Phenomenology: Clinical High Risk
Chair: Michelle L West, Harvard Medical School - Beth Israel Deaconess Medical Center, CEDAR Clinic, Massachusetts Mental Health Center
Speakers: Michelle L West, Erich Studerus, Martina Brandizzi, Stefanie J Schmidt, Emma Izon, Tianhong Zhang, Paolo Corsico, Chantal Michel
Talk 1: Overlap in Clinical High Risk and Borderline Personality Disorder Symptoms in a Specialized Clinic
Michelle L West1,2, Ryan Guest1, Michelle Friedman-Yakoobian1,2; 1Harvard Medical School - Beth Israel Deaconess Medical Center, 2CEDAR Clinic @ Massachusetts Mental Health Center
Background: Research and clinical observation supports an overlap between clinical high risk (CHR) for psychosis and borderline personality disorder (BPD) symptoms. Adults with BPD may experience psychotic symptoms that appear phenomenologically similar to those in schizophrenia. Relatively less research has explored this overlap in CHR, characterized by newly developing symptoms. Initial evidence suggests that BPD symptoms are common in CHR samples (e.g., 64% with CHR plus likely or certain BPD pathology; Ryan et al., 2017) and may not be associated with risk of conversion (Thompson et al., 2012). This study aims to review relevant literature on CHR and BPD symptoms and present initial data from a specialized CHR clinic. Methods: The CEDAR Clinic collects assessment data, with these analyses focusing on the Structured Interview for Psychosis Risk Syndromes (SIPS) and a self-report measure of BPD symptoms (BSL-23). The BSL-23 has differentiated between BPD (M= 2.05, SD=.90) and other diagnoses including schizophrenia, but has not been investigated in CHR samples. Analyses included the subset (N=15) of clients who completed the BSL-23 and met broad CHR criteria. The sample size will increase with ongoing data collection. Results: BSL-23 scores were lower on average (M=1.41, SD=0.81) than BPD validation samples. BSL-23 scores significantly correlated with SIPS mean P symptoms scores (r=.661, p=.007), and were particularly associated with unusual thought content (r=.734, p=.002). Discussion: These analyses support that BPD and CHR symptoms overlap in a CHR clinical sample. Improved understanding of the overlap in CHR and BPD symptoms may inform diagnostic and treatment considerations.
Talk 2: The relationship between change in (attenuated) positive psychotic symptoms over time and risk of transition to psychosis in clinical high risk patients: An investigation using a joint modelling approach
Erich Studerus1, Katharina Beck1, Anita Riecher-Rössler1; 1Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
Improved prediction of transition to psychosis in those with a clinical high risk (CHR) has become an important goal in psychosis research. However, previously developed prediction models almost exclusively rely on baseline data. Thus, their risk prediction cannot be dynamically updated during the follow-up period when new information becomes available. Furthermore, they do not reveal the specific relationship between symptoms during the follow-up and risk of transition. To solve these problems, the present study made use of so called joint models, a relatively recent statistical innovation that allows studying the association between a longitudinal process (i.e. change in symptoms over time) and a time-to-event outcome (i.e. time to transition to psychosis). We fitted three different joint models in which the hazard for transition at any time t was assumed to be related to 1) the absolute level, 2) the average absolute value since baseline, and 3) the velocity of change of (attenuated) positive psychotic symptoms at the same time point t. Data were obtained as part of the “Basel Früherkennung von Psychosen” (FePsy) study and included 191 CHR patients, of whom 42 transitioned to psychosis during follow-up. Although in all three models the association between longitudinal process and time-to-event outcome was statistically significant, the association was strongest in model 3. Our results therefore suggest that the risk of developing psychosis at any time t during follow-up is most strongly predicted by how fast (attenuated) positive psychotic symptoms are increasing at the same time point.
Talk 3: Going beyond transition: functional outcome and its predictors in youths with attenuated psychotic symptoms.
Martina Brandizzi1, Masillo Alice2, Liliana Todini3, Juliana Fortes Lindau3, Nella Lo Cascio4, Riccardo Saba5, Elena Monducci3, Ludovica Telesforo5, Paolo Girardi6, Paolo Fiori Nastro3, Christoph U. Correll7,8; 1Department of Mental Health, Asl Rome 1, Rome Italy, 2Department of Mental Health, Asl Rome 2, Rome Italy, 3Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy, 4MD, PhD, Psychiatrist, 5MD, Psychiatrist, 6Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy, 7Recognition and Prevention (RAP) Program, Department of Psychiatry, The Zucker Hillside Hospital, New York, US, 8Charité - Universitätsmedizin Berlin Augustenburger Platz 1, Berlin, Germany
Objective: Psychosocial functioning impairment is a typical feature of early stages of many mental disorders. A critical research goal is to identify modifiable risk factors leading to poor social and role functioning in young people with subtle psychotic symptoms. The aim of the present study was to investigate the longitudinal psychosocial functional outcome of a sample of young individuals with attenuated psychotic symptoms and the predictive role of baseline psychopathological characteristics. Methods: The sample consisted of 95 young subjects (mean age=16.43) involved in the follow-up assessment of the early detection project “Liberiamo il Futuro” (LIF). Baseline data on socio-demographic and psychopathological characteristics, psychosis risk status, and functional levels were collected. A binary logistic regression model was performed to predict poor social and role functioning at follow-up as defined by a score <7 in the Global Functioning: Role scale and Global Functioning: Social scale. Results: Psychosocial functioning at follow-up was moderately impaired: 44% of the sample (n=37) had poor role and social functional outcome. Decreased expression of emotion, poorer premorbid social and role functioning, and less change in overall psychopathology symptom severity significantly predicted poor role functioning (R2=0.531; Model Chi square: 39.37, P≤0.0001). Decreased expression of emotion, poorer premorbid social functioning, and presence of stressful life events between baseline and follow-up predicted poorer social functioning (R2=0.573; Model Chi square: 45.85, P≤0.0001). Conclusion: These findings suggest that taking into account the severity of negative symptoms, in particular disruption of affectivity levels, the premorbid functioning and the severity of the overall psychopathology has the potential to identify individuals with low psychosocial functional outcome independent of attenuated positive symptoms and transition to psychosis. Psychotherapeutic interventions especially targeting negative symptoms, poor role an social functioning and effects of stressful life events should be developed and provided to individuals with attenuated psychotic symptoms.
Talk 4: Negative symptoms as a mediator between neurocognition, social cognition and social functioning in individuals at clinical high risk for psychosis
Stefanie J Schmidt1,2, Frauke Schultze-Lutter3, Ana Cerne1, Benno G Schimmelmann1,4, Jochen Kindler1, Daniela Hubl5, Michael Kaess1,6, Chantal Michel1; 1University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland, 2Clinical Psychology for Children and Adolescents, University of Bern, Switzerland, 3Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Düsseldorf, Germany, 4University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland, 5University Hospital Hamburg-Eppendorf, Hamburg, Germany, 6Section for Translational Psychobiology in Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany
Poor social functioning is highly prevalent in subjects at clinical high risk (CHR) for psychosis and predictive of conversion to manifest psychosis. Neuro-cognitive and social-cognitive domains have found to be important predictors of social functioning in patients with psychosis. Some evidence also suggests that the relationship between neurocognition and functioning is mediated by social-cognitive domains and negative symptoms. However, these relationships are still poorly understood in CHR-subjects. Therefore, the aim of this study was to use structural equation modeling to estimate the relationships between neurocognitive domains, empathy as a specific social-cognitive domain, social functioning and positive as well as negative CHR-symptoms. The sample comprised 96 individuals (9-35 years), who sought help at the “Early Recognition and Intervention Center for mental crisis” (FETZ) Bern. CHR-symptoms were assessed using the Structured Interview for Psychosis-Risk Syndromes; social functioning by the social and occupational functioning assessment scale (SOFAS) and neurocognition by a comprehensive assessment-battery. The German version of the Interpersonal Reactivity Index (IRI) was used to assess empathy. Both neurocognitive domains and empathy were significantly associated with social functioning. Moreover, these relationships were significantly mediated by negative symptoms. No evidence for a mediating role through empathy or positive CHR-symptoms could be detected. The model showed a good fit to the data (RMSEA=0.04, CFI=0.96, TLI=0.95). This suggests that deficits in empathy as well as negative symptoms should be monitored carefully and treated as early as possible to prevent a negative cascading effect and to optimize generalization effects of neurocognitive remediation on social functioning.
Talk 5: Expressed Emotion (EE) in families of individuals at-risk of developing psychosis: A Systematic Review
Emma Izon1,2, Katherine Berry1, Heather Law2, Paul French1,2; 1Division of Psychology & Mental Health, The University of Manchester, Manchester, United Kingdom, 2Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
The At-Risk Mental State (ARMS) for psychosis describes a state that confers a high but not inevitable risk for developing a psychotic disorder in the near future. The distressing experiences for individuals with an ARMS may impact on themselves; their sense of wellbeing, their psychosocial functioning as well as on their family. Understanding what variables may lead to poorer outcomes may help to further reduce transition rates. Expressed emotion (EE) looks at the environment and communication style of relatives to their family member and can be considered an important potential explanatory variable in the ARMS. Following PRISMA guidelines, a systematic review of EE in relatives of ARMS was conducted. We identified 15 studies investigating the relationship between EE in the ARMS population. Approximately one third of ARMS relatives had high-EE. The results suggest that greater levels of criticism and hostility are associated with higher levels of symptoms and poorer functioning. In contradiction to psychosis literature, the construct Emotional-Over-Involvement (EOI) was found to be an adaptive response, where family members’ worries of the individuals made no negative impact on symptoms. Environments that included warmth and positive remarks, combined with optimal family involvement were associated with improved functioning and reduced symptoms. Limitations of the quality of the studies includes small sample sizes, and over-represented samples of Caucasian, young males and middle-aged mothers. Although approximately half of the studies included were longitudinal, only two measured EE over time, therefore, future research should include larger studies measuring EE at more than one time point.
Talk 6: Applying the NAPLS-2 Psychosis Risk Calculator to a Chinese High Risk Cohort in Shanghai: Results from the SHARP project
Tianhong Zhang1, HuiJun Li2, Lihua Xu1, Kristen A. Woodberry3, Daniel I. Shapiro4, Margaret A. Niznikiewicz5, Martha E. Shenton6, Matcheri S. Keshavan5, William S. Stone3, JiJun Wang1, Robert W. McCarley5, Larry J. Seidman3; 1Shanghai Mental Health Center, 2Florida A & M University, Department of Psychology, Tallahassee, Florida 32307, USA, 3Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, MA 02115, USA, 4Emory University, Department of Psychology; Dekalb Community Service Board Prevention & Early Intervention Program, Atlanta, Georgia, 5Harvard Medical School Department of Psychiatry, Veteran’s Administration Medical Center, Boston, MA 02130, 6Brigham and Women’s Hospital, Departments of Psychiatry and Radiology, and Harvard Medical School, and VA Boston Healthcare System, Boston, MA, USA
Objective: As with other serious diseases, individuals at risk of psychosis really want to know how much specific risk have for developing a psychotic disorder. To this end, a web-based risk calculator(http://riskcalc.org:3838/napls/) for clinical high risk(CHR) population was developed from NAPLS-2 project. The present study aims to validate the predictive accuracy of the NAPLS-2 psychosis risk calculator in a CHR sample from the SHARP(ShangHai At Risk for Psychosis) program in Shanghai, China using comparable inclusion/exclusion criteria and assessments. Method: Three hundred CHR individuals were identified by the Chinese version of the Structured Interview for Prodromal Symptoms. Of these, 228(76.0%) completed neuro-cognitive assessments at baseline and 199(66.3%) had at least a one-year follow-up assessment. Six key predictors were entered into the NAPLS-2 model to generate a psychosis risk estimate for each case. The area under the receiver operating characteristic curve(AUC) was used to test the effectiveness of this discrimination. Results: The NAPLS risk calculator showed moderate discrimination of subsequent transition to psychosis in the SHARP sample with an AUC of 0.631(p=0.007). Whether discriminating either transition or poor treatment/clinical outcomes, the AUC of the model increased to 0.754(p<0.001). A risk estimate of 30% or higher had moderate sensitivity(53%) and excellent speciﬁcity(86%) for prediction of poor treatment/clinical outcome. Conclusions: The NAPLS-2 risk calculator largely generalizes to a Shanghai CHR sample but is meaningfully improved when predicting an individual’s poor clinical outcome as well as conversion as outcome states. Our findings provide a critical step in the implementation of CHR risk calculation in China.
Talk 7: Identifying Youth at Risk of Psychosis. From Translational Research to Ethics Appraisal
Paolo Corsico1; 1School of Law, the University of Manchester
Identification of individuals at high risk of psychosis has usually been performed by means of a clinical interview, such as the Structured Interview for Prodromal Syndromes (SIPS), and the Comprehensive Assessment of At-Risk Mental State (CAARMS). Yet, the relatively low transitions rates of individuals identified as being at risk of psychosis have sparked great attention for neuroscientific measures of psychosis risk. Particularly, neuroimaging and machine learning could soon support the identification of individuals at high risk of psychosis, and ameliorate diagnosis and prediction of psychosis transition in high-risk populations. In this presentation, I address the ethical issues that arise from the attempt to identify youth at risk of psychosis via neuroimaging and machine learning methods. First, I outline the ethical issues that arise from involving young (help-seeking) individuals in neuroimaging research. Along with issues of research and data governance, I shall focus on the lack of immediate clinical utility, and on the challenges of communicating psychosis risk in a research setting. Second, I outline the ethical issues that may derive from the translation of neuroimaging and machine learning as predictive and diagnostic tools in the clinical setting. Here, I shall focus on the risk to reinforce neuro-essentialist thinking in young individuals. Overall, I argue that the clinical benefits gained by translating novel predictive tools in the clinical setting ought to be weighed against potential risks for young populations.
Talk 8: Association of Clinical High risk Symptoms with General Health and Well-Being in the Community
Chantal Michel1,2, Iljana Käufeler1, Nina Schnyder1, Rahel Flückiger1, Michael Kaess1, Benno G. Schimmelmann1,3, Frauke Schultze-Lutter1,4; 1University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, 2Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland, 3University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany, 4Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
The understanding of factors related to poor subjective quality of life (sQoL) in clinical high risk (CHR) of psychosis is important for both research and clinic. We investigated sQoL together with health status and axis-I disorders in a general population sample with CHR symptoms of psychosis. In total, 2,683 individuals of the Swiss Canton Bern (16–40 years old, response rate of 63.4%) were interviewed by telephone for CHR symptoms using established psychosis-risk instruments (Schizophrenia Proneness Instrument, Adult version for basic symptoms and the Structured Interview for Prodromal Syndromes for ultra-high risk symptoms), for current axis-I problems/disorders using the Mini-International Neuropsychiatric Interview, for sQoL using the Brief Multidimensional Life Satisfaction Scale, and for health status using the EQ-5D. CHR symptoms were associated with current axis-I disorders (especially depressive and anxiety disorders), a lower general, intrinsic and health related sQoL as well as a lower evaluation of health status. For comorbid disorders and the general sQoL ultra-high risk symptoms were more important. Basic symptoms were more important for the intrinsic and health related sQoL and the evaluation of health status. Our findings confirm that CHR symptoms in the community are already a subjective burden for the individuals experiencing them and therefore are clinically relevant, even if the strict criteria for a CHR state are not fulfilled.
Oral Session 3
Monday, October 8, 2:45 - 4:15 pm, St. George AB
Psychosocial Treatment: Psychosis
Chair: Tania Lecomte, Université de Montréal, Canada
Speakers: Tania Lecomte, Lauren Brooke, Caragh Behan, Daniel Anderson, Jens Einar Jansen, Elizabeth Ann Barrett, Jennifer Humensky, Jennifer Humensky
Talk 1: What about love? Developing romantic relationships in early psychosis
Tania Lecomte1, Catherine Hache Labelle1, Martin Lepage2, Amal Abdel Baki1; 1Université de Montréal, Canada, 2McGill University
Recovery from mental illness is not solely about mental health, work, independent living, and community integration - it also includes engaging in romantic relationships. Previous work from our team has enabled us to determine obstacles to romantic relationships in young heterosexual men with psychosis (see Pillay et al., 2016; Latour-Desjardins et al., 2018). These obstacles include: self-stigma, poor self-esteem, lack of social skills, social cognitive deficits, insecure attachment issues, lack of information regarding intimacy and sexuality, and difficulties in conflict resolution. We developed a twelve-session group intervention called 'Two is better than one', focusing on these topics in a cognitive behavioural and relational context. Objective: The purpose of this presentation is to describe the novel group intervention (using CBT, social cognitive, psychoeducation and social skills training) and to present preliminary quantitative and qualitative results on a pilot study. Method: 8 heterosexual male participants with psychosis, aged between 18 and 25, took part in this study. They each completed a battery of measures at 5 time points: baseline, 4 weeks, 8 weeks, 12 weeks ,16 weeks, and 18 weeks, with the treatment being offered at 4 weeks, once a week for 12 weeks. We measured symptoms (BPRS), romantic and intimacy functioning (RRFS, FESFS), self-esteem (SERS-SF), self-stigma (ISMIS) and theory of mind (Stories task). We also included an open-ended interview regarding their experience in the group. The preliminary results will be discussed in detail. Overall, the group was considered very useful and increased prosocial and dating behaviors in the participants.
Talk 2: A Qualitative Investigation of Perceived Barriers to and Enablers of Sport Participation for Young People with First Episode Psychosis
Lauren Brooke1, Daniel Gucciardi1, Ashleigh Lin2, Nikos Ntoumanis3; 1School of Physiotherapy and Exercise Science, Curtin University, 2Telethon Kids Institute, The University of Western Australia, Perth, WA, 3School of Psychology, Curtin University
Dynamic interventions that provide opportunities for physical activity, social interaction, and skill development are important for the functional recovery of young people with first-episode psychosis (FEP). As such, sport (encompassing physical activity, group dynamics, and physical and life-skill development) is an ideal intervention platform for this population, yet has been rarely utilised in this context. The aim of this study was to improve our knowledge of the perceived barriers and enablers of sport participation for young people (aged 16-25) presenting with FEP. We conducted semi-structured interviews and focus groups with young people with FEP (n=10) and their clinicians (n=33). Questions focused on barriers and facilitators (e.g., psychological, environmental, logistical) to participation in a sport program designed specifically for young people with FEP, as well as general feedback on program design options. A thematic analysis of the transcribed interviews and focus groups revealed five predominant themes across both clinicians and young people: 1) barriers (e.g., anxiety, amotivation), 2) enablers (e.g., others’ support, close proximity), 3) perceived benefits (e.g., sense of belonging, distraction), 4) psychological safety (e.g., clinical support, understanding individual mental health history), and 5) program design recommendations (e.g., sport preferences). General reactions of both the clinicians and young people to the idea of a sport program were supportive, yet the clinicians were also cautionary in regards to the needs of the specific population and the challenges of engagement. The results provide valuable insight into how to bring sport to this population in a way that is engaging, appropriate, and safe.
Talk 3: Intervening in mental health has effects beyond the health service – education and employment as outcomes for early intervention services
Caragh Behan1,2, Eric Roche1,2, Sarah Masterson1, Laoise Renwick3, Catherine McDonough4, Brendan Kennelly5, Paul McCrone6, Mary Clarke1,7; 1DETECT, 2Cluain Mhuire Community Mental Health Services, 3School of Nursing, University of Manchester, 4Louth Mental health Services, 5Department of Economics, NUI Galway, 6King's Health Economics, London, 7University College Dublin
The economic cost of schizophrenia in Ireland was estimated to be over €461 million in 2006, with the bulk of these costs located in the labour market due to lost employment, and lost productivity. Early intervention in psychosis (EIP) aims to reduce the proportion of people not in education or employment or further training to levels no more than peer population rates. Methods An incidence based cohort of people with first episode psychosis was followed up at one year (n=205). One cohort received EI; the other received best practice TAU. Joint costs and effects were examined using the net benefit approach. The value of lost productivity was calculated using the human capital approach. The incremental net benefit (INB) to society of avoiding a relapse and of a healthy day at home (HDAH), and the differences in the proportions in education and employment were calculated. Results The value of lost productivity was €32,706 more in the TAU sample (p<0.001). More people entered employment in the EI cohort. The INB to society was €14,282 (SE €10,364), and this was robust to sensitivity analysis. Conclusion EI has a societal benefit that is captured when examining outcomes outside the health sector. Funding for mental health comes from the health budget, but benefits can accrue to sectors outside health. Examining the effects of interventions outside of the health service can show where these benefits accrue, and inform where funders and policy makers can collaborate to look outside the health budget for funding.
Talk 4: NYC START, A New Model for Securing Needed Services for People Hospitalized with Early Psychosis
Daniel Anderson1, Tsering Choden1, Tracy Sandseth1, Tricia Teoh1, Susan Essock2, Myla Harrison1; 1New York City Department of Health and Mental Hygiene, 2Columbia University
Objective: The New York City (NYC) Board of Health amended the City’s Health Code, requiring that hospitals report to the Department of Health and Mental Hygiene when individuals aged 18 - 30 are hospitalized for a first episode of psychosis (FEP). This study describes the implementation of NYC START, a program that meets patients while hospitalized to enroll in and provide a voluntary 3-month critical time intervention services utilizing social workers (SWs) and peer specialists (PSs) to connect individuals hospitalized with FEP to appropriate community mental health services post-discharge. Methods: Program staff service logs were summarized to determine mean number of contacts per week received by clients over time, types of services provided by SWs and PSs, survival analyses of time to discharge from NYC START, and connection rates with community mental health services. Results: Of the 285 clients who accepted NYC START services in 2016, 222 (78%) completed at least three months of the program. Contacts were most frequent in clients’ first week in NYC START with a mean of 2.5 ± 1.4 contacts, 1.9 of which were with SWs and 0.5 of which were with PSs. SWs provided a mean of 17.3 ± 4.4, and PSs provided a mean of 8.5 ± 3.5 client-specific activities per week. Overall, 249 clients (87%) attended an initial mental health appointment after hospital discharge while receiving care coordination services from NYC START. Conclusions: NYC START serves as a critical time intervention to connect people hospitalized with FEP to community mental health treatment.
Talk 5: Promoting strength, resilience and self-compassion in persons with psychosis: A systematic review and meta-analysis of positive interventions
Jens Einar Jansen1,2, John Gleeson3, Sarah Bendall4,5, Miguel Alcazar-Corcoles6, Simon Rice4,5, Erik Simonsen2,7, Patrick McGorry4,5, Mario Alvarez-Jimenez4,5; 1Mental Health Center Copenhagen, Capital Region, Copenhagen, Denmark, 2Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark, 3School of Psychology, Australian Catholic University, Melbourne, Australia, 4Centre for Youth Mental Health, The University of Melbourne, Australia, 5Orygen: the National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 6Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid (UAM), Spain, 7Institute of Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Denmark
Background: Recent years have seen a renewed optimism regarding recovery in persons with psychosis. However, it has been argued that interventions aimed at reducing symptoms and dysfunction not necessarily leads to improvements in resilience, well-being and more subjective forms of recovery, which may be associated with more complete and enduring recovery. Objective: A systematic review and meta-analysis of the effects of specific positive psychology interventions for people with schizophrenia spectrum disorders. Methods: A systematic literature search according to the PRISMA guidelines using relevant databases and manual searches. The outcome measures used were positive emotions, compassion, mindfulness and subjective well-being. Interventions included individual therapy, group training and group therapy. Results: Twelve studies, comprising 411 persons with a schizophrenia spectrum disorder met inclusion criteria. For controlled studies, overall between- group Hedge’s g was 0.67 (p < .001, 95% CI = 0.33 – 1.02). For uncontrolled studies there was an overall pre-post Hedge’s g of .44 (p < .001, 95% CI = 0.19 – 0.69). Heterogeneity was low to moderate, but there were important variations in terms of methodological quality. Conclusion: The positive psychology interventions showed promise in increasing positive emotions, positive behaviors, or positive cognitions for persons with schizophrenia spectrum disorders. However, notable methodological limitations and heterogeneity needs to be taken into consideration when interpreting the findings, and more controlled studies are needed. This warrants further research into the mechanisms by which these interventions can promote recovery beyond symptom reduction and thus expand on existing evidence-based interventions.
Talk 6: Opening the Curtains for Better Sleep in Psychotic Disorders
Elizabeth Ann Barrett1, Sofie Ragnhild Aminoff1,2, Carmen Simonsen1, Kristin Lie Romm1,2; 1Division of Mental Health and Addiction, Oslo University Hospital Trust, Norway, 2NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital & University of Oslo, Norway.
Sleep disturbances are prevalent in psychotic disorders and have negative effects on symptoms, cognition, functioning, and well-being. Disturbed sleep may contribute to the onset of psychosis and is thus an important target for early intervention. Patients welcome sleep treatment, but knowledge about the use of evidence-based sleep interventions is lacking. This study aimed to investigate clinicians’ views on sleep disturbances and their use of assessment and treatment approaches in psychotic disorders. An online survey was emailed to clinicians in in- and outpatient mental health clinics. A total of 203 clinicians working with patients with psychotic disorders completed the survey. All clinicians reported sleep problems in this patient group. The most prevalent sleep complaints were insomnia (87%), circadian rhythm disorders (87%) and hypersomnia (48%). A vast majority of clinicians thought that sleep disturbances had negative effects on patients’ mood, symptoms, and functioning, and that sleep disturbances and psychotic symptoms exacerbate each other. As many as 77% of the clinicians assessed sleep problems by informal dialogue, instead of using structured assessment tools. The most prevalent interventions were sleep hygiene (88%) and medications (86%). Antipsychotics (34%) and antihistamines (29%) were most commonly used. However, recommended interventions like light therapy for circadian rhythm disorders (8%) and CBT for insomnia (19%) were rarely used. Recurrent obstacles to improve sleep were patients’ non-adherence to treatment and clinicians’ lack of knowledge about sleep interventions. In conclusion, clinicians acknowledge the importance of sleep in psychotic disorders. However, sleep problems are assessed informally, and evidence-based interventions are used infrequently.
Talk 7: Time Required by Supported Education and Supported Employment Services for Individuals in Early Psychosis Treatment
Jennifer Humensky1,2, Luana Turner3, Lisa Dixon1,2, Keith Nuechterlein3; 1Columbia University, 2New York State Psychiatric Institute, 3University of California Los Angeles
Background: The Individual Placement and Support (IPS) model of supported education and employment is effective in improving vocational outcomes, and the use of IPS in early psychosis treatment is increasing. Little is known about the time use, and correspondingly cost, required to conduct effective IPS. Methods: We reviewed chart records of IPS services provided in a UCLA early psychosis intervention from 2000 to 2006. The total minutes spent per client and the frequency of individual services were recorded. We analyzed differences between supported education and employment services, using linear regression and population-averaged random effects models. N=44 used IPS services. Results: N= 26 used IPS for supported education, 16 for supported employment and 2 for both. On average, the IPS specialist spent 97 (SD 60) minutes per client per week: 88 (SD 58) for supported employment and 101 (SD 60) for supported education, p<0.05. Overall, 47% (46/97 minutes) were spent in direct contact, 14% (14/97) indirect contact, 15% (15/97) talking with treatment team, 14% (14/97) supervision and 33% (33/97) driving. Total time required per visit did not change significantly over the first year, but was significantly lower in the second year. Supported education required a greater variety of tasks than supported employment. Conclusions: IPS services required an average of 97 minutes per client per week, with about half in direct patient contact. Overall, supported education requires more time per visit and a greater variety of tasks than supported employment. Programs implementing IPS should effectively budget for the range of tasks required.
Talk 8: The Role of Supported Education and Employment in Promoting Engagement For Young People with Early Psychosis in the OnTrackNY Program
Jennifer Humensky1,2, Lisa Dixon1,2; 1Columbia University, 2New York State Psychiatric Institute
Background: Early intervention services provide access to coordinated services for young people with early psychosis. A key component is access to supported education and employment (SEE) services, which are generally not available in standard outpatient mental health treatment. Previous studies have shown that employment is a primary goal for young people in early psychosis treatment and, in qualitative interviews, participants stated that access to SEE services is a key motivator for program engagement. We examine predictors of SEE use and whether SEE use was associated with greater use of OnTrackNY services in subsequent time periods. Methods: OnTrackNY serves individuals ages 16-30 who are within two years of a first episode of psychosis. Assessment and service utilization data are collected at admission, quarterly, and discharge (n=779). Analyses utilized generalized estimating equations (population averaged models). Results: Predictors of using the SEE specialist included having lower work/school participation at admission (OR: 0.62 [95% CI: 0.44-0.87]), younger age (OR: 0.91 [95% CI: 0.86-0.97]), and not being prescribed antipsychotic medication (OR: 0.59 [95% CI: 0.40-0.87]). Use of the SEE specialist was associated with higher odds of engaging any team members in the subsequent period (OR:8.77 [95% CI: 1.76-43.58]); visits with no other team member were significantly associated with probability of subsequent engagement. Models control for time in program, program site, gender, age, race/ethnicity, educational attainment, education/employment participation and symptoms at admission, duration of untreated psychosis, substance use and medication adherence. Conclusion: Access to SEE specialists is an important lever for engagement in early psychosis treatment.
Oral Session 4
Monday, October 8, 2:45 - 4:15 pm, St. George CD
Chair: Brian O’Donoghue, Orygen
Speakers: Golam Khandaker, Golam Khandaker, Donal O'Keeffe, Brian O'Donoghue, Brian O'Donoghue, Hannah Jongsma, Jimmy Choi, Oliver Gil
Talk 1: Childhood Infection, IQ and Risk of Non-Affective Psychosis in Adulthood: a Swedish population-based longitudinal cohort and co-relative study
Golam Khandaker1, Christina Dalman2,3, Nils Kappelmann1, Jan Stochl1, Henrik Dal3, Kyriaki Kosidou2,3, Peter Jones1, Håkan Karlsson2; 1University of Cambridge, 2Karolinska Institutet, 3Stockholm County Council
Using population-based longitudinal Swedish data (N=647,515), we tested (1) association of childhood infection with IQ and adult non-affective psychosis (NAP); (2) whether shared familial confounding explains the infection-NAP and IQ-NAP relationships; (3) whether IQ mediates and/or moderates the infection-NAP relationship. IQ was assessed at conscription around age 18 years. Data on hospitalisation with any infection from age 0–13 years, and hospitalisation with an ICD diagnosis of NAP in adulthood were retrieved from admission register. Exposure to infections particularly in early-childhood was associated with lower IQ (adjusted mean difference for infection at 0-1y: -1.61; 95% CI, -1.74, -1.47), and with increased risk of adult NAP (adjusted hazard ratio for infection at 0-1y: 1.19; 95% CI, 1.06-1.33). There was a linear association between lower premorbid IQ and adult NAP, which persisted after excluding prodromal cases (adjusted hazard ratio per 1-point increase in IQ: 0.976; 95% CI, 0.974-0.978). The infection-NAP and IQ-NAP associations were similar in the general population and in full-sibling pairs discordant for exposure. IQ both moderated (P=0.02 and P=0.001) and mediated (P<0.001) the association between infection and NAP. Early-childhood is a sensitive period for the effects of infection on IQ and NAP. The associations of adult NAP with early-childhood infection and adolescent IQ are not fully explained by shared familial factors, so may be causal. Lower premorbid IQ in psychosis arises from unique environmental factors, such as early-childhood infection. Early-childhood infections may increase risk of NAP by affecting neurodevelopment and by exaggerating the effects of cognitive vulnerability to psychosis.
Talk 2: Systemic Inflammation and Intelligence in Early Adulthood and Subsequent Risk of Schizophrenia and Other Non-Affective Psychoses: A Longitudinal Cohort and Co-Relative Study
Golam Khandaker1, Nils Kappelmann1, Henrik Dal2, Jan Stochl1, Kyriaki Kosidou2,3, Peter Jones1, Christina Dalman2,3, Håkan Karlsson2,3; 1University of Cambridge, 2Stockholm County Council, 3Karolinska Institutet
TALK 2 HAS BEEN CANCELLED
Talk 3: 20 Year Outcome in Psychotic Illness: Initial Findings of the iHOPE-20 First Episode Psychosis Incidence Cohort Follow up Study
Donal O'Keeffe1,2, Ailish Hannigan3, Roisin Doyle1, Anthony Kinsella4, Ann Sheridan5, Aine Kelly6, Kevin Madigan4,7, Elizabeth Lawlor1, Mary Clarke1,5; 1DETECT Early Intervention in Psychosis Service, Dublin, Ireland, 2Trinity College Dublin, Dublin, Ireland, 3University of Limerick, Limerick, Ireland, 4Royal College of Surgeons in Ireland, Dublin, Ireland, 5University College Dublin, Dublin, Ireland, 6Saint John of God Hospitaller Services, Ireland, 7Saint John of God Community Services, Dublin, Ireland
Purpose: Although long term (8–20 year) follow ups of FEP cohorts exist; there is a paucity of very long-term (i.e. ≥ 20 years) epidemiologically representative studies of FEP incidence cohorts. While very long term data has been collected from recent onset, prevalence, first admission psychosis, and first episode schizophrenia cohorts; this research may not fully account for the heterogeneity of psychotic illness. Materials and Methods: To address these issues, we conducted a prospective 20 year follow up of a FEP incidence cohort (N=171), between 2014 and 2017, in Ireland (Irish Health Outcomes in Psychosis Evaluation - 20 year follow up: iHOPE-20). In this conference paper, we report on (i) the remission, clinical recovery, personal recovery, and resilience levels found; (ii) the interrelationship between outcomes; and (iii) baseline predictors. Results: At 20 years, we classified 20/171 cohort members (11.70%) as deceased and assessed 80/151 alive cohort members (53% recruitment rate). 65% were in remission, 35.2% were in Full Functional Recovery, and 53.7% confirmed they were fully recovered according to their personal definition of recovery. Resilience levels were markedly less than general population norms. A multifaceted interrelationship between outcomes was found. Baseline predictors varied depending on the outcome variable measured. Conclusion: Personally defined recovery and full remission in FEP is not just achievable but probable in the very long term. However, helping service users develop resilience and attain positive functional outcomes (e.g. relationships outside of family; vocational functioning/role achievement; and basic living task engagement) remain important challenges for treatment in FEP.
Talk 4: Risk of first episode psychosis amongst first generation migrants in an Australian cohort
Brian O'Donoghue1,2,3, Linglee Downey1,2, Scott Eaton1,2, Aswin Ratheesh1,2,3, Patrick McGorry1,2; 1Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 2Centre for Youth Mental Health, University of Melbourne, Australia, 3Orygen Youth Health, Melbourne, Australia
Background: Certain migrant groups have an increased risk of psychosis compared to the native population, however the majority of these studies have originated from Europe and the Americas and it is not yet known whether migrants to Australia have an increased risk of developing a psychotic disorder. Objectives: This study aims to determine the incidence rate of treated first-episode of psychosis (FEP) in a defined catchment area of north-west Melbourne in young people aged 15 to 24 years; whether first-generation migrants have an increased risk of developing a psychotic disorder; and to establish whether migrants from certain countries have an increased risk of psychosis. Methods: A retrospective epidemiological cohort study was conducted at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne and included all young people aged 15 to 24 with a first episode of psychosis between 01.01.2011 and 31.12.2013. The at-risk population was determined from census data and incidence rates and incidence rate ratios were calculated. Findings: A total of 527 individuals with FEP were included, 393 were Australian-born (74.6%) and 134 (25.4%) were first-generation migrants. Migrants from Kenya (IRR=9.81), Ethiopia (IRR=5.17), Somalia (IRR=3.78), and Sudan (IRR=3.57), had significantly increased risk of having a psychotic disorder. Conversely, migrants from India and China had significantly decreased risk of having psychosis. Conclusions: First-generation migrants from East Africa and the Horn of Africa have significantly high rates of psychosis. Migrants from these countries may have faced substantial stressors pre-, during, and post-migration, predisposing them to psychosis.
Talk 5: Incidence of first episode of psychosis in an Australian cohort and the association with neighbourhood characteristics
Brian O'Donoghue1,2,3, Scott Eaton1,2, Linglee Downey1,2, Aswin Ratheesh1,2,3, Patrick McGorry1,2; 1Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 2Centre for Youth Mental Health, University of Melbourne, Australia, 3Orygen Youth Health, Melbourne, Australia
Background: The incidence of psychotic disorders varies between geographical areas and is associated with neighbourhood characteristics. However, the research to date has been mainly confined to Northern European and North American populations. This study will determine whether the incidence of first episode psychosis (FEP) is associated with neighbourhood characteristics, specifically social deprivation, unemployment, social fragmentation and social capital. Methods: This study was conducted at the Early Psychosis Prevention and Intervention Centre (EPPIC) which provides specialist treatment to all young people aged 15-24 diagnosed with a FEP residing in a defined geographical catchment area within western and northwestern Melbourne. Census data was used to code postcodes for neighbourhood characteristics and determine the at-risk population of people aged 15-24 living within the catchment area. Incidence rate ratios were calculated. Results: 527 young people treated for a FEP over a three-year period met inclusion criteria. This represents an annual incidence rate of 105.34 per 100,000 persons aged 15-24 per year. There was an increased incidence of FEP in neighbourhoods of greatest social deprivation (IRR=1.60, p=0.003), highest unemployment (IRR=1.67, p=0.001), least social capital (IRR=1.32, p=0.06) and above average social fragmentation (IRR=1.57, p=0.005). All these associations were stronger for non-affective psychoses and absent for affective psychoses. There was variation between sexes, with association only present for social fragmentation in women and social deprivation in men. Conclusion: Resources should be allocated to services according to the incidence of psychotic disorders to ensure that the expected incidence can be effectively managed.
Talk 6: A global systematic review and meta-analysis of the incidence of psychotic disorders.
Hannah Jongsma1, Caitlin Turner2, Peter Jones1,3, James Kirkbride4; 1Department of Psychiatry, University of Cambridge, Cambridge, England, 2Cambridge Institute of Public Health, University of Cambridge, Cambridge, England, 3CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, England, 4PsyLife Group, Division of Psychiatry, UCL, London, England
Incidence rates of psychotic disorders are known to vary between settings. Research interest in studies investigating this has increased substantially, also outside Northwestern Europe, North America and Australia where research efforts were traditionally concentrated. It is therefore timely to synthesize incidence findings in a new systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase and Web of Science databases, and included studies published between 2002 and 2017 if they reported original data on the incidence of non-organic adult-onset psychotic disorders. Quality of the yield was assessed. Data were synthesized by narrative review, and heterogeneity assessed. Data were evaluated by visual interpretation of funnel plots and univariate random-effects meta-analysis. Our search yielded 183 citations for inclusion in the review. Preliminary results suggest that heterogeneity was high: incidence of psychotic disorders varied ten-fold (incidence rates from 6.3 to 58.6 per 100,000 person-years) across settings. Incidence appeared to be higher in men (incidence rate ratio [IRR]:1.5 (95%CI:1.3-1.7), in migrants and their descendants (IRR:2.1, 95%CI:1.8-2.3) and in younger age groups. Rates of non-affective disorder varied from 1.4 to 76.7 per 100,000 person-years and followed similar demographic patterns. Rates of affective disorder varied from 0.7 to 16.9 per 100,000 person-years, and didn’t differ by sex (IRR:1.0, 95%CI:0.8-1.2). Insufficient citations were available to synthesize results by age group and migrant status. Only 23 citations were (partially) conducted in Latin and South America, Asia, Africa and the Middle East, underscoring the need to carry out research in non-Western settings. Full results will be presented at the conference.
Talk 7: Teen Suicide and Psychosis
Jimmy Choi1, Jennifer Callaghan1, Melissa Deasy1, Linda Durst1, David Tolin1, Michael Stevens1, Godfrey Pearlson1; 1The Institute of Living at Hartford Hospital, Hartford, Connecticut, USA
The risk for self-harm in teenagers experiencing psychotic symptoms is an urgent clinical matter, as adolescents in this population are at much greater risk for suicide compared to the same group in the general population. Researchers have called for investigations into clinical markers specific to psychosis and this age group in hopes of developing therapeutic targets to mitigate suicide risk. In this cross-sectional study, we examined the prevalence of suicidality and predictors associated with recent suicidal ideation and past attempts in 58 adolescents ages 12 to 18 enrolled in the Connecting Adolescents with Psychosis (CAP) Program, an intensive day program for youth diagnosed with psychotic spectrum disorders. Results: Similar to other studies in this young population, a little more than half (n=30) reported mild to moderate suicidal ideation at intake, with nearly a third reporting a past attempt (n=19). Teenagers who endorsed delusions were 5 times more likely to endorse suicidal ideation (odds ratio[OR]=5.22; 95% CI, 3.27-9.81; p<0.01), while those with obsessive-compulsive symptoms were almost 4 times more likely to do so. Teenagers who endorsed “not true” on item 6 of the Maryland Assessment of Recovery Scale (“I feel accepted as who I am”) were 12 times more likely to report suicidal ideation. Notably, teenagers who endorsed all three items--delusions, OCD symptoms, and not feeling accepted by others--were 31 times more likely to endorse SI and report at least one past suicide attempt. Delusions, OCD symptoms, and perceptions of identity were robust predictors of suicide risk in teenagers with psychosis.
Talk 8: Violence in First-Episode Psychosis Patients: What Do We Know?
Oliver Gil1, Amal Abdel-Baki1,2, Alexandre Dumais1,3; 1Université de Montréal, 2Clinique des Jeunes Adultes Psychotiques, Centre Hospitalier de l'Université de Montréal, 3Institut Universitaire en Santé Mentale de Montréal
Introduction: Very few studies have been conducted to investigate the prevalence of of violent behaviour (VB) and factors associated with it, in FEP patients before and after treatment initiation. Objective: To describe the prevalence before and after treatment initiation, factors associated to VB, and the evolution of violence in first-episode psychosis (FEP) Methods: Systematic literature review performed using Pubmed with the following key words: [first episode psychosis OR first episode schizophrenia OR early psychosis OR early schizophrenia] AND [violence OR aggression OR assault OR battery OR homicide OR criminality]. Some additional studies were located by hand searching the reference lists of included studies. Inclusion criteria: FEP population or results presented for the sub-group of FEP, VB prevalence, VB evolution, VB measures, factors associated with VB, Results: Of the 707 articles responding to search criteria, 22 articles were retained. The prevalence of VB before and at admission /after treatment initiation varies between 6.7 - 67.5% / 9.4 - 31.0%. Variable methodologies (eg. various definitions of VB, different measures,, populations, etc) could explain these discrepancies. Some factors were repeatedly associated with VB such as male gender, young age, unemployment, drug use, past violence, manic symptoms. Most studies have a follow-up duration of less than 3 years. Conclusion: Though the association between untreated first-episode psychosis and violence is well established, more longitudinal data pertaining to the long term evolution and factors associated with VB, following the initiation of treatment, is needed.
Oral Session 5
Monday, October 8, 4:30 - 6:00 pm, St. George AB
Chair: Helen Stain, Leeds Trinity University
Speakers: Helen Stain, Shelly Ben-David, Kate Hardy, Giulia Signorini, Kate Hardy, Walter Mathis, Peter Gallagher, Khalima Bolden
Talk 1: Implementation of UHR clinical guidelines in England
Helen Stain1, Lauren Mawn2, Stephanie Common3, Marie Pilton4, Andrew Thompson5; 1Leeds Trinity University, 2Newcastle University, United Kingdom, 3Tees Esk Wear Valleys NHS Foundation Trust, Durham, United Kingdom, 4Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom, 5University of Warwick, United Kingdom
Aim Evidence from meta-analyses of randomised clinical trials show interventions for young people at ultra high risk (UHR) of developing psychosis are effective both clinically and economically. While research evidence has begun to be integrated into clinical guidelines, there is a lack of research on the implementation of these guidelines. This paper examines service provision for UHR individuals in accordance with current clinical guidelines within the National Health Service (NHS) in England. Method A self-report online survey was completed by clinical leaders of Early Intervention in Psychosis (EIP) teams (N=50) within the NHS across the UK. Results Of the 50 EIP teams responding (from 30 NHS Trusts), 53% reported inclusion of the UHR group in their service mandate, with age range predominantly 14-35 years (81%) and service provided for at least 12 months (53%). Provision of services according to NICE clinical guidelines showed 50% of services offered cognitive behavioural therapy (CBT) for psychosis, and 42% offered family intervention. Contrary to guidelines, 50% of services offered antipsychotic medication. Around half of services provided training in assessment by CAARMS, psycho-education, CBT for psychosis, family work and treatment for anxiety and depression. Conclusions Despite clear evidence for the benefit of early intervention in this population, current provision for UHR within EIP services in England does not match clinical guidelines. While some argue this is due to a lack of allocated funding, it is important to note the similar variable adherence to clinical guidelines in the treatment of people with established schizophrenia.
Talk 2: Mental Health Service Use Decision-Making Among Young Adults at Clinical High-Risk for Developing Psychosis
Shelly Ben-David1, Andrea Cole2, Gary Brucato2, Ragy R Girgis2, Michelle R Munson3; 1University of British Columbia, 2New York State Psychiatric Institute, 3New York University
Research has shown high rates of underutilization of mental health services in young adults at clinical high-risk (CHR) for developing psychosis. The purpose of this qualitative study was to explore how such individuals make decisions about staying engaged with services through the application of the Unified Theory of Behavior (UTB) (Jaccard et al., 2002), a decision-making framework. Purposive sampling was utilized to recruit 30 CHR participants, ages 18-30, at the Center of Prevention and Evaluation (COPE) research clinic at the New York State Psychiatric Institute and Columbia University Medical Center. All were assessed via semi-structured interviews. Content analysis was completed by three analysts. Sample demographics included mean age 23 (SD=3.41), 60% male, 34% White, 23% Black, 20% Hispanic, 20% Bi-Racial, 3% Asian. The most salient UTB determinants which emerged from the data were behavioral beliefs, image considerations, and emotions. Most participants reported advantages of remaining engaged with services, described peers who may use the clinic as “someone who wants help”, and those peers who would choose not to access the clinic “lacking insight”, or “experiencing stigma”. Participants described positive, negative, and mixed emotional reactions when thinking about attending the clinic. Differences in UTB responses emerged depending on whether a participant was engaged in clinical services at the time of interview or just participating in research. Treatment engagement strategies that target beliefs about seeking services, image considerations, emotions, and type of engagement with services may help raise the low rates of service engagement among this vulnerable population.
Talk 3: Consumer and Family Perspectives on Reducing the Duration of Untreated Psychosis
Kate Hardy1, Caroline Dickens2, Teal Mackintosh2, Erika Roach1, Vicki Harrison1, Douglas Noordsy1, Steven Adelsheim1; 1Stanford University, 2PSGP-Stanford PsyD Consortium
Longer duration of untreated psychosis (DUP) has been shown to have long-term deleterious effects on outcomes. In the United States, the RAISE study reported a median DUP of 74 weeks, which is far longer than the 12 weeks recommended by the World Health Organization. Research has focused on identifying factors contributing to an extended DUP and creating associated initiatives to reduce the length of time it takes for individuals to access treatment. Stigma is one of the factors seen to contribute to a delay in accessing treatment. However, there has been little exploration of the experience of stigma, and the impact of stigma on accessing treatment, as reported by consumers and family members. The Prodromal and Early Psychosis Program Network (PEPPNET) Lived Experience workgroup identified a need to explore the impact of stigma on decisions to seek care. A survey was developed and distributed through the PEPPNET listserv. This survey consisted of questions designed to elicit quantitative and qualitative data relating to the experience of accessing care at the onset of psychosis. 193 respondents completed the survey with respondents including consumers (21%), family members (70%), and other respondents (9%). Qualitative analysis yielded themes related to the impact of stigma on accessing care, stigma resulting in negative perceptions of outcomes, and approaches to reduce stigma. Results will be discussed and recommendations developed from this study, by the members of the Lived Experience workgroup, will be presented.
Talk 4: The Interface Between Child and Adolescent Mental Health Services and Adult Mental Health Services in Europe: a 28 Countries Survey.
Giulia Signorini1, Giovanni de Girolamo1; 1Saint John of God Clinical Research Center, Brescia, Italy
The current service configuration, with distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS), is considered a weak link where the care pathway needs to be most robust and a major socioeconomic and societal challenge. In the framework of the MILESTONE project this study aims to map current services and transitional policies across Europe, highlighting current gaps and the need for innovation in care provision. An online mapping survey was directed at expert(s) in each of the 28 EU countries. The survey systematically collected data about CAMHS organization and characteristics, with a specific focus on actual national transition policies and practice. The characteristics and activities of CAMHS (ie, availability of services, inpatient beds, clinicians and organisations, delivery of specific CAMHS services and treatments) varied considerably between countries, as did funding sources and user access. Between 25 and 49% of CAMHS service users will need transitioning to AMHS, whereas 20–30% of AMHS users aged under 30 years had previous contact with CAMHS. Written policies for managing the interface were available in only four countries and half (14/28) indicated that no transition support services were available. This survey provides important information for the evaluation and planning of CAMHS in Europe, highlighting important areas of concern in service planning, availability of standardised outcome assessment, stakeholders’ involvement, interdisciplinary CAMHS and adult mental health care provision. The heterogeneity in resource allocation did not seem to match epidemiological burden. Policymaking on transitional care clearly needs special attention and further elaboration.
Talk 5: The PEPPNET Training and Technical Assistance (TA) Workgroup: Coordinating National Training and Technical Assistance efforts in the United States
Kate Hardy1, Tamara Sale2; 1Stanford University Department of Psychiatry and Behavioral Sciences, 2Oregon Health & Science University- Portland State University School of Public Health
There has been increased awareness in the United States of the need to develop specialist early psychosis services. Concurrent to this increase in awareness is dedicated federal funding to support the development of Coordinated Specialty Care (CSC) services. This recent growth has resulted in an increased demand for training and technical assistance specific to service models and interventions for early psychosis. However, associated with this increased demand is the challenge of training a workforce distributed across a large geographical area and the need to coordinate training efforts and technical assistance dissemination to avoid duplication. The Prodromal and Early Psychosis Program Network (PEPPNET) was founded in 2014 to support widespread growth of early psychosis care in the community. It consists of several different working groups all related to the dissemination and implementation of early psychosis services. The Training and Technical Assistance (TA) workgroup meets on a monthly basis and is comprised of professionals who offer training and TA nationally. The workgroup was formed in recognition of the challenges associated with widespread dissemination and the desire to coordinate training efforts to ensure sustainability. This symposium will present the National Early Psychosis Training and TA Guidelines and will highlight practices that have evolved to reduce duplication of training and TA efforts nationally. In addition, efforts to ensure sustainability of practice, as the demand for early psychosis service development continues in the United States, will be discussed.
Talk 6: Filters or Barriers? Quantitative Analysis of Pathways to Care and Durations of Untreated Psychosis for a Population Based First-Episode Service
Walter Mathis1,2, Maria Ferrara1,2,3, Shadie Burke1,2, Fangyong Li4, John Cahill1,2, I-Hsin Lin4, Jessica Pollard1,2, Scott Woods1, Vinod Srihari1,2; 1Yale University School of Medicine, 2Program for Specialized Treatment Early in Psychosis (STEP), 3AUSL Modena, 4Yale School of Public Health
Specialized services for first episode psychosis(FES) continue to observe prolonged durations of untreated psychosis(DUP). Extant knowledge about pathways to care(PTC) for FES offers little testable guidance on modifiable factors for reducing DUP. There is an urgent need to quantitatively understand contributors to delay regionally, as well as how treatment site delays are moderated by patient characteristics. A semi-structured scale was used to detail PTC for 50 consecutive enrollees to an FES targeting a defined geographic catchment. All contacts and dates were digitally coded. Sub-units of delay, including marginal delays attributable to healthcare providers, were computed and analyzed across patient demographics. Contact with outpatient psychiatric care had the highest attributable delay(mean=52.35±62.81days, p<0.001) and higher parental income increased time from first antipsychotic prescription to FES enrollment(p=0.04). Delay attributable to treatment sites varied with some patient factors. The mean delay from an inpatient admission was twice as long for the oldest quartile than the youngest three quartiles. In local emergency departments, men experienced over four times the delay as women(mean=9.86±53.80 vs. mean=2.33±5.60), and African-Americans experienced three times the mean delay of other racial categories. For outpatient psychiatric settings, the highest quartile of parental education experienced a little over half the mean delay of the lower three quartiles. These findings show delay varies across treatment site and by patient characteristics. While specific to the regional system of care and sample analyzed, the results validate an approach to measuring factors that influence delay, giving FES actionable ways to test DUP reduction strategies.
Talk 7: ‘Small goals but big impact’: A mixed method evaluation of a healthy activity programme for people encountering mental health difficulties.
Peter Gallagher1,2, Aisling McClenaghan1,3, Mary Clarke1,3,4,5; 1DETECT Early Intervention in Psychosis Service, Blackrock, Dublin, Ireland., 2Saint John of God Hospitaller Ministries, Dublin, Ireland., 3Saint John of God Community Services, Dublin, Ireland., 4University College Dublin, Ireland., 5Royal College of Surgeons in Ireland, Dublin, Ireland.
Physical health is becoming more important in mental health care partly due to the physiological and metabolic effects of some anti-psychotic medications and unhealthy lifestyle factors such as reduced physical activity and high levels of sedentary behavior (Williams et al, 2016). Aim; The aim of this study was to evaluate a 12 week healthy activity programme, including simple dietary advice and cookery demonstrations, for people with mental health difficulties, whose healthcare professionals had referred them due to concerns regarding their unhealthy lifestyles. Methods; This was a mixed methods pre and post study. Participants were 35 patients who attended a community mental health service and had mental health difficulties allied with an unhealthy lifestyle. The primary outcome measure was the level of physical activity using the EPIC-Norfolk Physical Activity Questionnaire (epaq2), quality of life (EQ5D), levels of self-esteem (Rosenberg Self-Esteem Scale) and levels of anxiety Hospital and Depression Scale (HADS). A qualitative interview from an Interpretative Phenomenological Analysis perspective, explored 8 participants’ experiences. Results; There was a significant improvement in the mean MET activity levels of 129%, and significant improvements on Rosenberg Self-esteem scale, HADS and EQ5D visual scale. There was a small reduction in mean BMI of 0.44 which was statistically significant. Qualitative findings revealed the Superordinate theme “Increased self-confidence and self-esteem” supported by themes ‘Reduction of isolation’ and ‘Reduction of perceived stigma’. Conclusion; The healthy lifestyles changes promoted by this programme significantly improved activity levels. The qualitative findings included increased self-confidence and self-esteem in participants.
Talk 8: Holes in the pipeline: Barriers to accessing specialty care in early psychosis
Khalima Bolden1, Rosenthal Adi1, Monet Meyer1, Sarah Gobrial1, Krista Lane1, Ruth Shim1, Tyler Lesh1, J. Daniel Ragland1, Loewy Rachel2, Savill Mark2, Carter Cameron1, Niendam Tara1; 1University California - Davis, Sacramento, CA, 2University California - San Francisco, San Francisco, CA
The duration between onset of psychosis and accurate diagnosis and treatment is a significant predictor of outcome, making rapid linkage to care imperative. Barriers such as stigma, difficulty navigating the system, and financial burden lengthen this process. The current study investigates the effect of these barriers on clinic engagement (i.e. completion of initial early psychosis eligibility assessment). We operationalized logistical (e.g. trouble contacting client), attitudinal (e.g. stigma), systemic (e.g. barriers associated with the healthcare system), structural (e.g. economic barriers), and illness-related barriers (e.g. extreme paranoia) coded from phone logs of 196 individuals referred to specialty early psychosis (EP) services in Sacramento, CA (age=17.6, female=55.1%, Caucasian=31.1%, Hispanic=36.2%). Barriers were coded as present/absent for each interaction; analyses examined the proportion of total interactions where barriers were present. Individuals who completed the initial assessment (n=141) experienced an average of 6.9 barriers during the linkage period, while noncompleters (n=55) experienced an average of 10.2 barriers. For completers, logistic barriers were the most common (39.1% of interactions), followed by systemic (1.9%), structural (1.8%), attitudinal (1.3%), and illness-related (0.2%) barriers. For noncompleters, logistic barriers were the most common (69.0% of interactions), followed by attitudinal (6.3%), systemic (5.3%), structural (4.6%), and illness-related (0.9%) barriers. Noncompleters experienced proportionally more barriers overall (80.7%) than completers (43.0%) (p<.001), as well as increased logistic (p<.001), attitudinal (p<.001), structural (p=.04), systemic (p=.002), and illness-related barriers (p=.022). Understanding the barriers individuals face in accessing specialty care is an essential step in improving the linkage process and reducing the duration of untreated psychosis.
Oral Session 6
Monday, October 8, 4:30 - 6:00 pm, St. George CD
Chair: Masafumi Mizuno, Toho University School of Medicine
Speakers: Jeffrey K. Yao, Albert Powers, Hiromi Tagata, Junjie Wang, Thomas Dunne, Kareen Heinze, Sameer Jauhar, Xiaochen Tang
Talk 1: Correlations of Increased Oxidative Stress with Altered Brain Structure in First-Episode Antipsychotic-Naive Patients with Schizophrenia
Jeffrey K. Yao1,2,3, Paulo L. Lizano4, Xiang Zhou1,3, Ravinder D. Reddy5, Gretchen L. Haas1,2, Debra M. Montrose2, Olivia Lutz4, Kiranpreet Dhaliwal4, Matcheri S. Keshavan2,4; 1VA Pittsburgh Healthcare System, Pittsburgh, PA, 2University of Pittsburgh School of Medicine, Pittsburgh, PA, 3University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 4Beth Israel Deaconess Medical Center and Harvard University, Boston, MA, 5University of California San Diego, San Diego, CA
In human plasma, levels of total antioxidant status (TAS) and malondialdehyde (MDA) often serve as biomarkers for studying antioxidant defense system (AODS) in psychiatric disorders. Increased oxidative stress has been linked to the schizophrenia (SZ) pathology. However, it is not clear whether changes in these peripheral markers are also related to structural changes in brain. Using enzyme immunoassay, we compared TAS and MDA in plasma among healthy controls (HC, n=62), first-episode antipsychotic-naïve patients with schizophrenia (FEAN-SZ, n=85) and patients with other first-psychosis (POFP, n=24). Comparisons were also made in frontal and temporal regional gray matter volume and thickness, white matter volume, as well as hippocampal and caudate volume between HC (TAS n=14, MDA n=10) and FEAN-SZ (TAS n=26, MDA n=23) groups using 1.5T T1-weighted MRI. In accordance with previously published data, significantly lower levels of TAS (p=0.0001) and higher levels of MDA (p=0.0111) were found in FEAN-SZ compared to HC and POFP groups. TAS levels were inversely correlated with MDA levels (p<0.0001) in all groups. In addition, brain volume/thickness trajectories were positively correlated with plasma TAS levels, but inversely correlated with plasma MDA levels in HC group. However, such correlations were not present in the FEAN-SZ group. Together, the present data showing inverse correlations suggest that both TAS and MDA are useful biomarkers to predict homeostatic imbalance of AODS. Moreover, our MRI findings lend further support that increased oxidative stress during early course of illness may confer vulnerability to reduced brain volume/thickness in SZ patients.
Talk 2: Conditioned Hallucinations: Toward Development of Computational Markers for Early Diagnosis and Personalized Treatment
Albert Powers1, Christoph Mathys2, Philip Corlett1; 1Yale University, 2SISSA, International Advanced Studies Institute, Trieste, Italy
Perception is an active process, characterized by the building of an internal model of our environment, blending incoming sensory evidence with prior beliefs. Within this framework, hallucinations may result from increased weighting of these prior beliefs during perception. To test this, we adapted a classic sensory conditioning paradigm to functional MRI: participants were exposed to repeated pairings of a visual stimulus with an auditory stimulus. They subsequently reported the perception of the auditory stimulus even when it was absent, contingent on the presence of the visual—a conditioned hallucination. We recruited four groups: those with psychosis, both with hallucinations and without, healthy voice-hearers, and healthy controls. Conditioned hallucinations occurred with markedly increased frequency in those who had hallucinations outside the laboratory, regardless of psychosis status. They activated tone-responsive regions of auditory cortex and other regions active during clinical hallucinations. Computational modeling demonstrated an increased reliance on strong priors in voice-hearers (encoded by insula and superior temporal gyrus), regardless of psychosis status. By contrast, those with psychosis, regardless of hallucination status, were slow to update beliefs (cerebellum and hippocampus). Recently published in Science, these results may signify a means of distinguishing people with hallucinations from those without, and, orthogonally, people with a need for treatment from those without. Ongoing work focuses on applying these measures to risk stratification of people at clinical high risk of psychosis (CHR). Preliminary data suggest this approach holds promise for early detection of illness in CHR. Ongoing work aims to use these computational approaches hallucination-specific treatment selection.
Talk 3: Analyses of NMDA-receptor co-agonists in serum among individuals with at-risk mental state for psychosis
Hiromi Tagata1, Naohisa Tsujino1,2, Mayu Onozato3, Naoyuki Katagiri1, Taiju Yamaguchi1, Takahiro nemoto1, Takeshi Fukushima3, Masafumi Mizuno1; 1Toho University School of Medicine, 2Saiseikai Yokohamashi Tobu Hospital, 3Faculty of Pharmaceutical Sciences, Toho University
Aim: Individuals who meet the criteria for at-risk mental state for psychosis (ARMS) have a high risk of developing psychosis. However, useful predictors for the onset of psychosis in individuals with ARMS remains unclear. Therefore, the establishment of reliable biomarkers to predict development of psychosis in ARMS patients is urgently needed. Recently, N-methyl-D-aspartate (NMDA) receptor co-agonists abnormalities in serum of patients with schizophrenia have been reported. In this study, we examined NMDA-receptor co-agonists as biomarkers for the development of psychosis in individuals with ARMS. Method: We examined serum levels of NMDA-receptor co-agonists including glutamate, cysteine, glycine, γ-glutamylcysteine, glutathione, D-serine and L-serine in antipsychotic-naïve ARMS patients. We compared these levels with those in healthy controls. We also examined correlations between clinical scores and serum levels of NMDA-receptor co-agonists in individuals with ARMS. Results: A total of 24 individuals with ARMS and 42 healthy controls were enrolled in this study. The levels of γ-glutamylcysteine, glutathione and D-serine were significantly lower, but the glutamate level was higher in ARMS individuals compared to healthy controls. These results were equivalent to those of patients with schizophrenia. There were no correlations between clinical scores and serum levels of NMDA-receptor co-agonists in individuals with ARMS. Conclusion: The present study revealed that the levels of some NMDA-receptor co-agonists of individuals with ARMS were different from those of healthy controls, and was equivalent to those of patients with schizophrenia. The detection of abnormal levels of NMDA-receptor co-agonists may be useful for early diagnosis of psychosis.
Talk 4: Lower GABA levels in Prefrontal Cortex in Individuals at Clinical High Risk for Psychosis who did not remit
Junjie Wang1, Yingying Tang1, Tianhong Zhang1, Lihua Xu1, Huiru Cui1, Yu Li1, Zhenying Qian1, Yanyan Wei1, Yan Wang1, Xiaochen Tang1, Huan Huang1, Jijun Wang1,2; 1Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China, 2CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science
Objective: We aimed to investigated whether GABA levels in clinic high risk (CHR) for psychosis were associated with subsequent clinical outcome. Method: GABA levels referenced to water were measured in the medial prefrontal cortex (mPFC) with MEGA-PRESS sequence using 3-Tesla proton magnetic resonance spectroscopy in 94 CHR participants and 52 healthy controls, the severity of prodromal psychotic symptoms and cognitive function were assessed with SIPS and MCCB, respectively. Clinical assessment was repeated in 85 CHR subjects at about one-year follow-up. The clinical outcomes of CHR subjects were remission (no longer meeting CHR criteria) and non-remission (still meeting CHR or converting to psychosis). Results: At 1 year follow up, 50 CHR subjects belong to the remission group and 35 belong to the non-remission group. The baseline GABA levels in the mPFC in the non-remission CHR were significantly lower than that in healthy control subjects (non-remission CHR vs. HC: 2.25±0.039 vs. 2.46±0.049, p =0.022), and there was no significant difference between the remission CHR and healthy control subjects (remission CHR vs. HC：2.42±0.05 vs. 2.46±0.049, p =0.10). In addition, baseline mPFC GABA levels were positively correlated to speed of processing performance in MCCB (rho =0.384，p =0.023) within non-remission CHR, which was absent in subjects at remission CHR or healthy controls subjects. Conclusions: An abnormally lower GABA level in the medial prefrontal cortex could suggest a worse prognosis among CHR subjects. The finding supported the key role of GABAergic dysfunction in the pathophysiology of developing psychosis.
Talk 5: Auditory Verbal Hallucinations In First Episode Psychosis – An FMRI Symptom Capture Study
Thomas Dunne1, Pavan Mallikarjun1,2, Renate Reniers1, Baldeep Farmah5, Matthew Broome4, Femi Oyebode1,2, Stephen Wood1,3, Rachel Upthegrove1,2; 1The University of Birmingham, UK, 2Birmingham and Solihull Mental Health NHS Foundation Trust, 3The University of Melbourne, Australia, 4The University of Oxford, UK. Oxford Early Intervention in Psychosis Service, 5Worcester Health and Care NHS Trust
Introduction Neurobiological models of auditory verbal hallucination (AVH) have been advanced by symptom capture functional magnetic resonance imaging (fMRI), where participants self-report hallucinations during scanning. To date, regions implicated are those involved with language, memory and emotion. However, previous studies focus on chronic schizophrenia, thus are limited by factors such as medication use and illness duration. Studies also lack detailed phenomenological descriptions of AVHs. This study investigated the neural correlates of AVHs in patients with first episode psychosis (FEP) using symptom capture fMRI with a rich description of AVHs. We hypothesised that intrusive AVHs would be associated with dysfunctional salience network activity. Methods 16 FEP patients with frequent AVH completed four psychometrically validated tools to provide an objective measure of the nature of their AVHs. They then underwent fMRI symptom capture, utilising general linear models analysis to compare activity during AVH to the resting brain. Results Symptom capture of AVH was achieved in nine patients who reported intrusive, malevolent and uncontrollable AVHs. Significant activity in the right insula and superior temporal gyrus (cluster size 141mm3), and the left parahippocampal and lingual gyri (cluster size 121mm3), p<0.05 FDR corrected, were recorded during the experience of AVHs. Conclusions These results suggest salience network dysfunction (in the right insula) together with memory and language processing area activation in intrusive, malevolent AVHs in FEP. This finding concurs with others from chronic schizophrenia, suggesting these processes are intrinsic to psychosis itself and not related to length of illness or prolonged exposure to antipsychotic medication.
Talk 6: Brain network structural covariance in youth at high familial risk for bipolar disorder
Kareen Heinze1, Andrew McIntosh2, Stephen Wood1,3,4, Mat Harris2, Emma Hawkins2, Heather Sibley2; 1University of Birmingham, UK, 2University of Edinburgh, UK, 3Orygen, the National Centre of Excellence in Youth Mental Health, Australia, 4Centre for Youth Mental Health, University of Melbourne, Australia
Background. Large-scale brain networks have been used to examine the functional organisation of the brain in individuals at genetic high risk for bipolar disorder. While it has been reported that functional connectivity alterations subtly extend to structural brain networks in individuals at ultra-high risk for psychosis, it is unclear whether this applies to the genetic high risk for bipolar disorder. Methods. Whole-brain structural covariance patterns of 121 individuals at genetic high risk (HR) for bipolar disorder (of whom 27 developed major depressive and two bipolar disorder), and 89 healthy controls (HC) were studied. The mean signal in seed regions in the visual, auditory, motor, speech, semantic, executive, salience and default-mode network were extracted and voxel-wise analyses of covariance were conducted to compare the association between whole brain signal and each seed region for HR and HC individuals, and HR participants who transitioned and those who did not, and HC. Results. Significantly reduced structural covariance was observed in the HR sample compared to HC for the auditory and semantic network. Those who transitioned to affective disorder displayed reduced structural covariance in the speech network compared to those who did not, and comparison of transitioned cases with HC revealed aberrant structural covariance in the default-mode, salience, executive control, auditory, speech, and semantic network. Conclusions. Structural covariance analyses revealed subtle changes of connectivity of auditory and semantic networks in individuals at genetic risk for bipolar disorder. Although we found significant differences, these are small changes, and tend to reflect largely intact structural networks.
Talk 7: Examining the presynaptic dopamine system and antipsychotic response in first episode psychosis
Sameer Jauhar1, Matthew M Nour1, Mattia Veronese1, Maria Rogdaki1,2,3, Federico Turkheimer1, Alice Egerton1, Janmes Stone1, Philip McGuire1, Oliver D Howes1,2,3; 1King's College, London, 2Psychiatric Imaging Group MRC London Institute of Medical Sciences, Hammersmith Hospital, London, 3Institute of Clinical Sciences, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, W12 0NN, UK 1 ABSTRACT
Studies suggest the presynaptic dopamine system is altered in schizophrenia, meta-analytic evidence suggesting elevation in striatum. There are few studies examining whether these abnormalities are trans-diagnostic. Cross-sectional data also suggests nuances related to antipsychotic response, with elevated presynaptic dopamine synthesis capacity (DSC) in people with schizophrenia who respond to antipsychotics, and those resistant to antipsychotics have similar DSC to controls. In this oral presentation I will present data on people with first episode psychosis who underwent F-DOPA PET imaging (bipolar, n=22, schizophrenia n=16), scanned at onset of illness, predominantly free of antipsychotic medication (antipsychotic naïve or free n=32), a proportion of whom were involved in a subsequent study, examining baseline DSC and antipsychotic response (n=40, healthy controls, n=14). The aims were to ascertain whether elevated striatal DSC was associated with positive psychotic symptoms (using PANSS) at baseline, whether baseline striatal DSC was related to antipsychotic response, and if people could be stratified as responders/non-responders (d prior to antipsychotic treatment. We found elevated striatal DSC in bipolar psychosis and schizophrenia, compared to matched healthy controls (F2,57 = 6.80, P = .002), and in people experiencing a current psychotic episode, DSC was related to positive psychotic symptoms (n = 32, r = 0.52, P = .003). In the subsequent study we found an association between baseline striatal DSC and subsequent antipsychotic response (n=26, r=r=0.64, p<0.01), and that initial DSC discriminated at group level between responders, non-responders and healthy controls (F(2, 37)=7.9, p=0.001). I will then discuss the possible clinical utility of F-DOPA PET imaging in psychosis.
Talk 8: Biotypes of individuals at clinical high risks for psychosis based on resting state functional connectivity features
Xiaochen Tang1, Tianhong Zhang1, Yingying Tang1, Lihua Xu1, Junjie Wang1, Margaret Niznikiewicz2, Hui Li3, Martha E. Shenton4,5,6, Susan Whitfield-Gabrieli7, Matcheri Keshavan8, William S. Stone8, JiJun Wang1; 1Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;, 2Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, MA, USA;, 3Department of Psychology, Florida A&M University, Tallahassee, FL, USA;, 4Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;, 5Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;, 6Research and Development, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, MA, USA;, 7McGovern Institute for Brain Research and Poitras Center for Affective Disorders Research, Massachusetts Institute of Technology, Cambridge, MA, USA;, 8Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;
Individuals at clinical high risk (CHR) for psychosis are defined primarily by the presence of clinical symptoms such as attenuated positive symptoms or brief intermittent psychotic symptoms. The heterogeneity in CHR subjects is likely as striking as is observed in schizophrenia, bipolar disorders, and/or major depressive disorders. To detect potential biotypes with distinct neurophysiological features, we performed a canonical correlation analysis to select linear combinations of MRI resting state functional connectivity indicators associated with clinical symptoms, as identified by Structured Interview of Psychosis-risk Syndromes (SIPS). This analysis yielded two sets of symptoms with negative and disintegration (loadings = 0.995, 0.427), and positive (loadings = 0.971). In terms of connection features, both sets of connectivity combinations include network-wide connections between fronto-parietal and salience networks. Furthermore, the first connectivity component defines functional connections between the default mode network and other networks, while the second component defines distinct connection combination between the default mode network and the visual network to other networks. Based on the two corresponding combinations of functional connectivity characteristics, cluster analysis was performed to classify 138 CHR subjects from the Shanghai At Risk Psychosis Project (SHARP) into 4 biological subtypes, with percentages of 10.8%, 16.7%, 14.5% and 60.1% respectively. These results demonstrate that individuals at CHR states can be classified into four biotypes defined by distinct patterns of connectivity primarily in default mode networks. Validation and further inquiry into clinical significance of these four biotypes in CHR is ongoing.
Oral Session 7
Tuesday, October 9, 1:00 - 2:30 pm, St. George AB
Supplements and Other Pharmacological Treatments
Chair: Shona Francey, Orygen, The National Centre of Excellence in Youth Mental Health
Speakers: Maximus Berger, Andrew Thompson, Marco Armando, Joseph Firth, Alan Breier, Kelly Allott, Shona Francey, Dale D'Mello
Talk 1: Baseline Omega-3 Fatty Acids in Erythrocytes as Predictors of Functional and Clinical Outcomes in People at Ultra-High Risk for Psychosis
Maximus Berger1, Barnaby Nelson1, Connie Markulev1, Hok Pan Yuen1, Miriam R Schäfer1, Nilufar Mossaheb2, Monika Schlögelhofer2, Stefan Smesny3, Ian B Hickie4, Gregor E Berger5, Eric Y H Chen6, Lieuwe de Haan7, Dorien H Nieman7, Merete Nordentoft8, Anita Riecher-Rössler9, Swapna Verma10, G. Paul Amminger1, Andrew Thompson11, Alison R Yung12, Patrick D McGorry1; 1Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 2Department of Psychiatry, Medical University of Vienna, Vienna, Austria, 3Department of Psychiatry, University Hospital, Jena, Germany, 4Brain and Mind Research Institute, University of Sydney, Sydney, Australia, 5Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland, 6Department of Psychiatry, University of Hong Kong, Hong Kong, 7Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands, 8Psychiatric Centre Bispebjerg, Copenhagen, Denmark, 9Psychiatric University Clinics Basel, Basel, Switzerland, 10Institute of Mental Health, Singapore, Singapore, 11Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, England, 12Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
The NEURAPRO multicentre RCT of long-chain omega-3 polyunsaturated fatty acids (n3PUFA) vs. placebo demonstrated no clinical benefits for n3PUFA (‘fish oil’) supplementation in individuals with At-Risk Mental State (ARMS) for psychosis. However, adherence in this trial was low and n3PUFA were also available outside the study through diet or non-study supplements. Therefore, we examined if pre-treatment n3PUFA levels measured in erythrocytes and their change during the trial were related to outcomes. Data from 285 of 304 (94%) NEURAPRO participants were analysed. PUFA levels were measured at baseline and after supplementation (6 months). The n3-index, a biomarker of n3PUFA status, was calculated as the combined relative abundance of eicosapentaeonic acid and docosahexaenoic acid. Outcome measures included psychosis transition, clinical improvement (CGI-I), general psychopathology (BPRS), depressive symptoms (MADS), negative symptoms (SANS) and functioning (SOFAS). The median n3-index in the sample at baseline was 3%, approximately 40% lower than in the (Australian) general population (5%). Adjusting for relevant baseline factors, the change (increase) of the n3-index from baseline to 6 months predicted better functional and symptomatic outcomes for the majority of applied measures at 6 and 12 months. Participants with an n3-index <3% at baseline were significantly more likely to show substantial clinical improvement from n3PUFA supplementation at 6 months. In contrast, in the group with n3-index ≥3%, n3PUFA supplementation was unrelated to outcomes. This analysis provides crucial evidence to support beneficial effects of fish oil supplementation in individuals with ARMS for psychosis, in particular in those with low n3PUFA levels at baseline.
Talk 2: Omega-3 and Omega-6 Fatty Acids and Risk of Psychotic Symptoms in the ALSPAC Birth Cohort
Andrew Thompson1, Hannah Jones2, Jon Heron2, Sarah Sullivan2, Joseph Hibblen3, Stan Zammit2,4; 1University of Warwick, UK, 2University of Bristol, UK, 3National Institute for Health, US, 4University of Cardiff, UK
Background: Long Chain Polyunsaturated Fatty Acid (PUFA) levels have been implicated in the pathology of psychotic disorders. We investigated the relationship between PUFA levels in childhood and later psychotic experiences in a large UK birth cohort (ALSPAC). Methods: Plasma levels of specific Ω-3 and Ω-6 fatty acids were collected at ages 7 and 16. Psychotic experiences were assessed at age 12 and 18 years using a semi-structured interview. Primary outcome was any psychotic experiences at 18 years; secondary analyses examined psychotic experiences at 18 years but not at 12 years, persistent psychotic experiences at 12 and 18 years and psychotic disorder at 18 years. Results: Lower levels of the Ω-6 fatty acids AA, OA and AdA at age 7 years, and the Ω-3 fatty acid DHA at age 16 years were associated with an increased risk for psychotic experiences at 18 years; however, evidence of association only persisted for OA after adjustment for potential confounders. Higher levels of total Ω-6 at 16 years was associated with an increased odds of developing a psychotic disorder at 18 years. There was no association between Ω-6/Ω-3 ratio and psychosis outcomes nor with genetic instruments of total Ω-3 or Ω-6 levels. Conclusions: There was no strong evidence that total plasma Ω-3 or Ω-6 fatty acid levels or ratios in childhood and mid adolescence are associated with increased risk for psychotic experiences or disorder but some suggestion that specific alterations in the Ω-6 and Ω-3 pathways at different time points in development might influence risk.
Talk 3: Omega-3 polynsatured fatty acids improve neurocognitive functions and reduce the conversion rate of psychosis in patients with 22q11.2 deletion syndrome.
Marco Armando1, Maria Carmela Padula1, Franco De Crescenzo2, Maude Schneider1, Paul Amminger3, Marie Schaer1, Stephan Eliez1; 1Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland, 2Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart, Rome, 3Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
Background: Preliminary investigations supported the role of omega-3 polynsatured fatty acids (PUFAs) in reducing the conversion rate of psychosis. However, a recent DBRCT failed to replicate these results. A possible explanation is the heterogeneity of the population being studied. Differently, 22q11.2 deletion syndrome (22q11DS) is a neurogenetic disorder considered as a homogeneous model of schizophrenia. The aim of this study was to verify the efficacy of PUFAs in this homogeneous, genetically-at risk population. Methods: 74 22q11DS subjects (age range: 5 to 28 years) were included in the analysis, 33 were taking PUFAs (Omega+) and 41 were not (Omega-). Several neurocognitive measures and clinical measures were compared between the two groups. Changes in neurocognitive and psychotic symptoms scores after a 3-years follow up were further assessed. Results: Omega+ subjects showed higher IQ, working memory and verbal fluency than omega-, which in turn showed higher distractibility and impulsivity. These effects remained significant at follow up. A significant treatment-by-time interaction was evident for positive and disorganised symptoms scores, which decreased with time only in omega+ subjects. Moreover, omega+ group showed a lower risk of developing a UHR status (11% vs. 20% in omega-) and lower conversion rates (0% vs. 6.7%) than omega-. Conclusion: Our study represents the first investigation of the effect of PUFAs in subjects with 22q11DS. We detected preliminary evidences for a positive, long-term effect of PUFAs on neurocognitive functions and psychotic symptoms scores as well as their efficacy in reducing the risk of conversion to psychosis.
Talk 4: Nutrient Deficiencies and Potential Benefits of Nutritional Interventions in Early Psychosis: Systematic development of a targeted adjunctive treatment for improving recovery
Joseph Firth1; 1NICM Health Research Institute, University of Western Sydney, Sydney, Australia
Background: Extensive research has established that nutritional deficiencies are common in long-term schizophrenia. Randomised controlled trials (RCTs) also demonstrate that adjunctive nutritional interventions can improve outcomes in long-term schizophrenia. Therefore, we examined nutritional deficiencies and clinical correlates in first-episode of psychosis (FEP), in order to design a nutritional intervention for young patients in early stages of illness. Methods: We reviewed all studies examining blood nutrient levels and outcomes of supplementation in FEP: Meta-analytic techniques compared nutrient levels in FEP to healthy controls, and systematic synthesis was applied to all clinical correlates of nutritional deficiencies in FEP. Additionally, we conducted an independent systematic review of all nutrient-based treatment trials in FEP to date. Results: A total of 28 studies examined blood levels of six vitamins and ten dietary minerals in FEP, across 2,612 individuals. Random effects meta-analyses comparing FEP to healthy control groups showed large, significant deficits for Vitamin-D, Vitamin-C, and folate. Lower levels of folate and vitamin-D were associated with more severe symptoms in FEP. Our separate systematic review of 8 experimental studies indicated that supplementation with certain amino acids and antioxidants may also improve treatment outcomes in FEP. Conclusion: Our meta-analysis was the first to examine the extent and clinical correlates of nutritional deficits in FEP. Results showed that vitamin D and folate deficits exist from illness onset, even prior to antipsychotic treatment - and are associated with more severe psychiatric symptoms. Our upcoming RCT (the 'NATURE' trial) will assess if targeting these deficiencies can improve recovery in FEP.
Talk 5: Does N-Acetyl Cysteine (NAC) Improve Negative Symptoms and Cognition in Schizophrenia?
Alan Breier1,2,3, Jenifer Vohs1,2,3, Bethany Leonhardt1,2,3, Nicole Mehdiyoun1,2, Tom Hummer1,2, Emily Liffick1,2,3,4, Michael Francis1,2,3; 1Department of Psychiatry, Indiana University School of Medicine, 2Indiana University Psychotic Disorders Program, IUSM, 3Eskenazi Health Midtown Community Mental Health Center, 4Eli Lilly and Company
Background: Negative and cognitive symptoms are core features of schizophrenia and contribute to the marked functional deficits and poor quality of life associated with this illness. Currently approved medications for schizophrenia, however, are relatively ineffective for these symptom domains. N-Acetyl Cysteine (NAC) is a neuroprotective agent that mitigates the deleterious effects of oxidative stress, inflammation and glutamatergic toxicity. Because of its unique mechanisms of action, NAC has been investigated in several clinical trials in schizophrenia. While there is agreement that NAC appears ineffective for positive symptoms, the outcomes data for negative symptoms and cognitive impairment are conflicting. Methods: In this paper, we assessed the effects NAC (3600 mg/day) in a 52-week, double-blind, placebo controlled trial in early phase schizophrenia spectrum disorders (N=60). Results: NAC significantly improved (time x group) PANSS negative symptoms (F=5.1, p=0.024), as well as PANSS total (F=14.7, p<0.001) and disorganized thought (F=13.7, p<0.001) symptom scores. NAC failed to improve BACS cognitive total composite and individual cognitive test scores, as well as PANSS positive symptom scores. Baseline right (r= -0.48, p=0.041) and left (r= -0.45, p=0.018) total cortical thickness, and thickness in other cortical regions, were associated with NAC related improvement in symptom scores. Conclusions: These results replicate some but not all previous findings of NAC efficacy. The discrepancies among NAC studies for negative and cognitive symptom results will be addressed with suggestions to reconcile these differences.
Talk 6: A randomised, double-blind, placebo-controlled trial of the effects of vitamin B12, B6 and folic acid on cognition and symptoms in first-episode psychosis. The Vitamins in Psychosis Study
Kelly Allott1,2, Patrick McGorry1,2, Hok Pan Yuen1,2, Colin O'Donnell3; 1Orygen, The National Centre of Excellence in Youth Mental Health, Australia, 2Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia, 3Department of Psychiatry, Donegal Mental Health Service, Letterkenny University Hospital. Co. Donegal, Republic of Ireland
Vitamin B12, vitamin B6 and folic acid are homocysteine-reducing agents. Supplementation in chronic schizophrenia has shown that folate plus vitamin B12 can improve cognition and clinical symptoms. This study investigated whether adjunctive vitamin B12, B6 and folic acid lowers homocysteine and improves symptomatology and cognition in first-episode psychosis (FEP). This was a randomised, double-blind, placebo-controlled trial conducted at the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. One hundred FEP patients aged 15-26 were randomised to receive folic acid 5mg, vitamin B12 0.4mg, and vitamin B6 50mg (N=52) or placebo (N=48), taken once-daily for 12 weeks, adjunct to anti-psychotics. Co-primary outcomes were change in composite cognition measured via a battery of 11 tests and total symptomatology (PANSS) over 12 weeks. Secondary outcomes included additional cognitive, symptom, functioning, tolerability and safety measures. Vitamin supplementation reduced homocysteine levels in the vitamin group over 12 weeks. The homocysteine lowering effects of the vitamins did not confer a major advantage over placebo therapy in improving the co-primary PANSS (p=.75) or composite cognition (p=0.79). There was no significant group difference in secondary symptom domains. There was a significant group difference in the attention/vigilance domain (p=.024), whereby the vitamin group remained stable in their performance, whereas the placebo group declined. Vitamin supplementation appears well tolerated and safe and lowers homocysteine levels in in FEP. While supplementation may not offer extra benefits with respect to psychopathology and global cognition, folic acid, B12 and B6 may benefit the cognitive domain of attention/vigilance in people with FEP.
Talk 7: Antipsychotic Medication in First-Episode Psychosis: An RCT to Assess the Risk-Benefit Ratio
Shona Francey1, Barnaby Nelson1,2, Graham Jessica1, Baldwin Lara1, Hok Pan Yuen1,2, Brian O'Donoghue1,2, Alex Fornito3, Mario Alvarez-Jimenez1,2, Susy Harrigan1, Pat McGorry1,2; 1Orygen, The National Centre of Excellence in Youth Mental Health, 2Centre for Youth Mental Health, University of Melbourne, Victoria, Australia, 3Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Science and Monash Biomedical Imaging, Monash University, Victoria, Australia
There are risks associated with the use of antipsychotic medication (AP). These include adverse neurological and metabolic effects and measurable changes in brain structure. APs may even be associated with poorer functional recovery. The STAGES Study is a non-inferiority design randomised double blind placebo controlled study that examines whether a subgroup of people with FEP can recover without AP, and considers the effects on functioning, physical health, cognition, and brain structure of AP versus withholding AP. Young people with FEP were screened for study eligibility and recruited if they met stringent inclusion criteria indicating low-risk of harm to self or others, and adequate social support. Participants were randomly assigned to receive either low dose AP (MIPT group) or placebo (PIPT group) for six months, and all participants received intensive psychosocial treatment. Ninety young people (mean age 18.5 years) were randomised and 81 commenced trial medication. Thirty-four percent of participants completed the six month medication phase and there were more completers in the placebo group than the medication group. On the primary outcome measure of SOFAS there was significant evidence that the placebo group was not inferior to the medication group (SOFAS: MIPT mean = 61.5, SD = 13.4; PIPT mean = 61.7, SD = 16.8). The two groups were found to be very similar on all psychopathology assessments and measures of functioning at both baseline and following treatment, suggesting that the outcomes of the two treatment regimes were not different with respect to symptoms and functioning.
Talk 8: The Role of Long-Acting Injectable Antipsychotics in Preventing Relapse in Early Psychosis with Concurrent Cannabis Use Disorder
Dale D'Mello1, Emily Rozin1, Vivek Vanaharam1, Cathy Adams, Scott Palazollo; 1Department of Psychiatry, Michigan State University
Introduction: A third of adverse outcomes associated with cannabis use in early psychosis may be mediated by medication noncompliance. Few, if any, studies have examined the role of long-acting injectable antipsychotics (LAIA) in this group. Objective: To examine the role of LAIA in preventing relapse in patients with early psychosis and concurrent cannabis use. Methods: A retrospective chart review was performed of all patients diagnosed with early psychosis, defined as a duration of 18 months or less, at the Early Treatment & Cognitive Health Program in East Lansing in 2017. Sources of data included the Navigate Patient Self-Rating Form (NPSRF), electronic medical records (EMR), and hospitalization logs. Data were anonymously entered into MYSTAT statistical software. Differences in the mean value of relapse between patients maintained on LAIA were compared to those maintained on oral antipsychotics. Results: Of 51 total patients, 24 (47%) were cannabis users. Eleven (46%) of the cannabis users were hospitalized versus 5 (19%) of the non-users. The differences were statistically significant: Chi-square=4.403, df=1.000, p=0.036. Of the 10 cannabis users who were maintained on LAIA, only 2 (20%) were hospitalized. By comparison, 9 (64%) of 14 cannabis users on either oral or no antipsychotics were hospitalized. Differences in relapse rate were significant: Chi-square=4.608, df=1.000, p=0.032. Discussion: Cannabis users were more likely to be hospitalized than non-users. LAIA were associated with a lower rate of relapse in this cohort.
Oral Session 8
Tuesday, October 9, 1:00 - 2:30 pm, St. George CD
Phenomenolgy: First Episode Psychosis
Chair: Michael Birnbaum, Northwell Early Treatment Program
Speakers: Michael Birnbaum, Abigail Wright, Rosa Ayesa Arriola, Boris Chaumette, Andrew Chanen, Gerald Jordan, Daniel Cavalcante, George Salaminios
Talk 1: Identifying Psychotic Symptoms and Predicting Relapse Through Social Media
Michael Birnbaum1, Asra Rizvi1, Munmun De Choudhury2, Sindhu Ernala2, Guillermo Cecchi3, John Kane1; 1Northwell Early Treatment Program, 2Georgia Institute of Technology, 3IBM Research
Objective: The internet and social media provide an unprecedented opportunity to transform early psychosis intervention services. This study aimed to capture concerning patterns of social media activity associated with the onset and persistence of psychotic symptoms. Methods: Facebook and Twitter archives were extracted from over 150 participants with psychotic disorders, mood disorders and healthy controls. Machine learning was used to build classifiers aiming to identify patterns and distinguish between groups. Results: Linguistic analysis of Twitter commentary identified significantly increased use of interpersonal pronouns (p < 0.001), decreased emphasis on friendship (p < 0.001) and increased emphasis on health (p < 0.001) in individuals with psychosis. Preliminary classifiers correctly recognized participants with psychotic disorders (n=62) from healthy controls (n=24) with an average accuracy of 80% and distinguished participants with psychosis from those with mood disorders (n=39) with an average accuracy of 70%. Further analysis identified shifts in language use of participants with psychosis who experience a relapse (n=18) including significant increases in the use of swearing (p<0.05), first-person pronouns (p<0.05) and negations (p<0.05). We additionally identified significant differences in the profile pictures (p<0.005) and structure of messages posted (p<0.005) by youth with psychosis who experienced a psychotic relapse. Conclusion: Identifying markers in social media activity associated with worsening psychotic symptoms offers the prospect that social media may be a clinically useful tool to identify patients in the earliest phases of relapse.
Talk 2: Three-year longitudinal study exploring metacognition and function in First Episode Psychosis.
Abigail Wright1, Geoff Davies3, David Fowler1, Kathryn Greenwood1,2; 1University of Sussex, 2Sussex Partnership NHS Foundation Trust, 3University of Surrey
Background: Functional outcome in psychosis may be predicted by many factors including cognition, functional capacity, symptoms and, importantly, metacognition. Metacognition was recently demonstrated to mediate between cognition and functional outcome in First Episode Psychosis. Given previous research, metacognition may predict long-term functioning after first-episode. This study aimed to assess whether cognition, functional capacity, and metacognition in the early stages of psychosis may predict functional outcome later on. Methods: 80 individuals with First Episode Psychosis were re-contacted after average of 36-months later (range: 26-45 month follow-up). 26 participants completed measures for neurocognition, metacognition (Metacognitive Assessment Interview), functional capacity, functional outcome (hours spent in structured activity per week), and psychotic symptoms at baseline and follow-up. Results: Firstly, regression analyses demonstrated neurocognition, functional capacity and metacognition at baseline significantly predicted functional outcome at follow-up (p<.011, .001, .005). Next, regression analyses, with baseline functional outcome as a covariate, demonstrated metacognitive ability was a significant predictor of change in functional outcome from baseline to 36-month follow-up, F(3, 25) 19.22, p<.001. This model explained 72% (adjusted r² = .69) of the variance in change functional outcome between baseline and follow-up. Therefore, good metacognitive ability at baseline predicted improvement in engagement of structured activity at 36-months. Including negative symptoms did not change the model. Discussion: This highlights the importance of intervening to enhance metacognitive ability, over neurocognition or functional capacity, in order to improve functioning later on, and to target interventions to improve functioning in those with the poor metacognition in the early stages of psychosis.
Talk 3: Sex-based differences in outcomes of early intervention in psychosis at 10-year follow-up.
Rosa Ayesa Arriola1, Esther Setién-Suero1, Diana Tordesillas-Gutierrez1, Benedicto Crespo-Facorro1; 1IDIVAL, Valdecilla Biomedical Research Institute. School of Medicine, University of Cantabria. CIBERSAM, Biomedical Research Networking Center for Mental Health Network
Specialized early intervention (EI) programs are efficient in treating patients with a first episode of psychosis (FEP) at least after 2 years. However, the question of whether gains are long-term maintained and particularly sex-based prognostic implications needs larger and longer trials. Data for the present work were obtained from FAFIP and PAFIP-10, which are incidence and 10-year follow-up studies, respectively, of all individuals with a FEP presenting for the first time to specialist mental health in the defined catchment area of Cantabria (Spain) once EI was established in this area in February 2001. A total of 305 referrals to PAFIP between 2001-2007 received specialized EI during 3 years, and all these patients were invited for a reassessment 10 years after. Women and men were longitudinally compared on demographic, positive, negative, depressive, functional, and neurocognitive variables, and antipsychotic treatment. Our results show that the effects of PAFIP early intervention continue 10 years after first contact, particularly in female. When women were compared to men, the data demonstrate that women who suffered a FEP have better courses of illness and global outcomes than men. Women have better responses to antipsychotics, fewer negative symptoms and better functioning. Both men and women showed a period of recovery, particularly in women using minimal antipsychotic doses, between 1 and 3 year follow-up. However, that vanished at some point after PAFIP discharge from specialized intervention towards community-based services. These data helps to put the question of targeted sexes and lengthen interventions in FEP.
Talk 4: Genetic factors associated with early cognitive deficits in psychosis
Boris Chaumette1, Sarojini Sengupta1, Martin Lepage1, Ashok Malla1, Srividya Iyer1, Guy Rouleau1, Marie-Odile Krebs2, Jai Shah1, Ridha Joober1; 1McGill University, Montreal, Canada, 2Inserm U894 - Ste Anne Hospital, Paris (France)
Background Schizophrenia is a progressive illness and cognitive impairments occur since the early phases of the disease and are unresponsive to actual medication. Glutamatergic receptors are good candidates for cognition in psychosis and are targetable by drugs. Methods In a discovery cohort of 144 first-episode of psychosis patients (FEP) recruited in Montreal (Canada), we have genotyped 58 candidate Single Nucleotide Polymorphisms (SNPs) located in NMDA and metabotropic glutamatergic receptors. These SNPs were tested for association with intelligence quotient (IQ) in our cohort. For replication, we used the ICAAR cohort including 121 ultra-high-risk patients (UHR) recruited in Paris (France). Results A polymorphism located in GRM7 gene was significantly associated with performance IQ in the discovery cohort of FEP under an additive model. This association was replicated in the UHR cohort as well as in the merged dataset where this SNP was significantly associated with VIQ, PIQ, and FIQ. The association was significant for the arithmetic subtest of the WAIS and close to significance for the block design and the information subtests. Conclusions This polymorphism seems to be significantly associated with cognitive impairment in early phases of psychosis only. The cognitive decline during later phases of schizophrenia could be linked to other factors. If confirmed, this genetic association may shed light on the biological factors leading to cognitive deficits in early phases of psychosis and could open the way to new therapeutic interventions targeting the glutamatergic pathway.
Talk 5: Interpersonal schema and beliefs about voices in youth with borderline personality disorder or first episode schizophrenia spectrum disorder
Andrew Chanen1,2,3, Marialuisa Cavelti1,2,4,5, Carol Hulbert4, Shona Francey1,2, Jennifer Betts1,2, Katherine Thompson1,2; 1Orygen, the National Centre of Excellence in Youth Mental Health, 2Centre for Youth Mental Health, The University of Melbourne, 3Orygen Youth Health, 4School of Psychological Sciences, The University of Melbourne, 5Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
Auditory verbal hallucinations (AVH) occur in up to 50% of adults with borderline personality disorder (BPD). AVH in BPD are phenomenologically similar to voices in schizophrenia, but are more emotionally distressing, evoke greater emotional resistance, and are a risk factor for suicide and hospitalisation. The cognitive model of AVH predicts that voice-related distress (i.e., depressed mood and anxiety) arises from the negative appraisal of voices (e.g., power and supremacy) and that this appraisal mirrors the voice hearer’s interpersonal relationships. This model has never been studied early in the course of BPD, the same period of life when schizophrenia spectrum disorders usually emerge. This study examined, for the first time, appraisals of voices, interpersonal schema and voice-related distress among youth with BPD and AVH in comparison to youth with first episode psychosis (FEP) and AVH. Sixty-seven outpatients, aged 15-25 years, were recruited from Orygen Youth Health in Melbourne, Australia. Following assessment for mental state and personality disorder, they were grouped into ‘BPD+AVH’, ‘FEP+AVH without BPD’, and ‘BPD without AVH’. Data analysis is currently underway, comparing these groups in terms of appraisals of voices, interpersonal schema, and anxiety and depressive symptoms. Further, the associations between appraisals of voices, interpersonal schema, and anxiety and depressive symptoms will be examined and discussed in the context of the extant models of voice-related distress. The findings will improve understanding of the nature of AVH in youth with BPD and provide potential targets for psychological interventions to reduce voice-related distress.
Talk 6: “It's brought me like a lot closer to who I am”: aspects and facilitators of positive change following a first episode of psychosis
Gerald Jordan1, Ashok Malla1, Srividya Iyer1; 1McGill University; Prevention and Early Intervention Program for Psychoses; ACCESS Open Minds/Esprits ouverts
A first episode of psychosis (FEP) is often a severe and highly negative experience. However, FEP may also present an opportunity for positive change. While positive changes have been reported following various physical illnesses (e.g., HIV) or traumatic events (e.g., war), very little research has investigated positive changes following FEP. To address this knowledge gap, this presentation will address two research questions: 1) What are the positive changes persons experience following FEP, and 2) What factors or processes may facilitate such changes? A qualitative descriptive design guided the project. Data were gathered through semi-structured interviews conducted with twelve purposefully sampled service users receiving treatment for FEP at an early intervention service. Interviews were transcribed verbatim and analyzed using thematic analysis using inductive and deductive approaches. Participants described how they experienced declines and difficulties following FEP. Yet, participants also developed improved mental health; a stronger sense of self and improved personality; greater levels of, and a better approach to, spirituality; improved relationships with others; as well as improved lifestyles and new goals for the future. Participants described how their positive changes were facilitated through care received by mental health services; drawing on resources to help them cope with the FEP; experiencing healing and recovery; and finding meaning in their experiences. These findings can inform early intervention services seeking to better provide positive, hopeful, strengths-based services to persons experiencing FEP. The findings also validate the experiences of persons who have experienced positive change as a result of their experience of FEP.
Talk 7: Duration of Untreated Psychosis is related to worse outcomes in antipsychotic naïve patients at first episode of psychosis
Daniel Cavalcante1, Luccas Coutinho1, Bruno Ortiz1, Mariane Noto1, Quirino Cordeiro1, Vanessa Ota1, Sintia Belangeiro1, Rodrigo Bressan1, Ary Gadelha1, Cristiano Noto1; 1UNIVERSIDADE FEDERAL DE SÃO PAULO
The duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcome in psychosis. In low- and middle-income countries, despite the advances in the mental health assistance, there are still few studies addressing this issue. We aimed to verify if DUP can predict worse symptom severity and treatment response in a Brazilian cohort of antipsychotic naïve patients in first episode of psychosis (FEP). Our sample comprised 145 patients admitted to a psychiatric emergency service. Diagnosis was established according to the Structured Clinical Interview for DSM-IV (SCID). Symptom severity was measured with the Positive And Negative Symptoms Scale (PANSS) considering five dimensions (positive, negative, depressive, disorganized and excitement), and the functionality was assessed with the Global Assessment of Functioning Scale (GAF). We performed multivariated linear regressions using DUP to predict the treatment outcomes, controlling for possible confounders as sex, age, income and living arrangement. All patients were treated with risperidone and 79 patients were reassessed after 10 weeks of treatment. The DUP’s median was 61 days (interquartile range: 170; min=0; max=1770). At baseline, we have not found a significant prediction, but after 10 weeks, DUP predicted worse scores on positive dimension (p<0.001, R²=0.279, β=0.012), negative dimension (p=0.001, R²=0.262, β=0.012), functionality (p=0.005, R²=0.175, β=1.848) and response to treatment (p<0.001, R²=0.325, β=0.042). Our findings indicate that DUP does not influence the baseline status of the patients, but can predict the treatment outcomes in a short-term follow-up, even accounting for premorbid clinical and sociodemographic factors.
Talk 8: Schizotypal Trait Expression and Mentalizing in Adolescence
George Salaminios1, Larisa Morosan2,3, Elodie Toffel2, Stephan Eliez2,3, Martin Debbané1,2,3; 1Research Department of Clinical, Educational and Health Psychology, University College London, 2Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, 3Department of Psychiatry, Developmental Imaging and Psychopathology Lab, University of Geneva
Contemporary research suggests that clinical psychosis is proximally linked with the breakdown of higher-order cognitive processes pertaining to mentalizing – the capacity to understand the intentional mental states driving one’s own and others’ behaviours. Importantly, subtle mentalizing difficulties have been identified among youths in the context of high psychometric schizotypy, prior to the emergence of clinical symptoms, suggesting a pathway towards illness expression. However, little is known about the relationship between schizotypal personality dimensions and disruptions in mentalizing processes across adolescence. Thus, we examined the extent to which schizotypal traits contributed to mentalizing difficulties in a sample of non-clinical youths (N=105; Mean Age=15.72). Self-report measures were used to assess schizotypal traits [Schizotypal Personality questionnaire (SPQ)], mentalizing difficulties [Reflective Functioning Questionnaire (RFQ)], metacognitive beliefs [Metacognitions Questionnaire (MCQ)] and symptoms of anxiety and depression [Youth Self-Report (YSR)]. We run a stepwise multiple regression model, controlling for the effects of metacognitive beliefs and anxiety/depression, to assess the unique contribution of SPQ dimensions on mentalizing difficulties. The interpersonal dimension of schizotypy significantly accounted for mentalizing difficulties pertaining to increased uncertainty about mental states (β=0.24, p<0.05). The cognitive-perceptual and disorganization dimensions did not account for variance in mentalizing scores. Adolescents who withdraw from interpersonal contact in the context of negative schizotypy encounter less social interaction opportunities, essential for developing a capacity to understand mental states, thereby compromising their resilience to psychosis risk. Mentalization-based treatment may be applied preventatively to sustain social-cognitive functioning in youths who present schizotypal manifestations, prior to the development of clinical symptoms.
Oral Session 9
Tuesday, October 9, 2:45 - 4:15 pm, St. George AB
Cognitive Remediation, CBT and Other Innovative Treatments
Chair: Mark van der Gaag, VU University, Parnassia Psychiatric Institute
Speakers: Rachel Loewy, Olina G Vidarsdottir, Synthia Guimond, Andrew Thompson, Sophie Parker, Mark van der Gaag, Amy Hardy, Ahmed Jerome Romain
Talk 1: Mobile Cognitive Training in Individuals at Clinical High Risk for Psychosis and with Recent-Onset Schizophrenia
Rachel Loewy1, Melissa Fisher2, Cameron Carter3, J. Daniel Ragland3, Tara Niendam3, Barbara Stuart1, Danielle Schlosser1,4, Sophia Vinogradov2; 1University of California San Francisco, Department of Psychiatry, 2University of Minnesota, Department of Psychiatry, 3University of California Davis, Department of Psychiatry, 4Verily Life Sciences
Cognitive deficits in early psychosis predict functional outcomes and should be aggressively targeted for early intervention. We have recently conducted two parallel studies of targeted cognitive training of auditory/verbal processing in early psychosis: one with adolescents and young adults at clinical high risk (CHR) for psychosis and a second with young adults with recent-onset schizophrenia (ROS). Both studies were double-blind randomized controlled trials in which participants performed 40 hours of auditory training (AT) or commercial computer games (CG) via laptop computer. They were assessed on symptoms, functioning and an abbreviated MATRICS-recommended neurocognitive battery at baseline, post-training and 6-month follow-up. In a modified Intent-To-Treat (ITT) analysis with 147 randomized ROS participants there were significant condition-by-time interactions for Global Cognition (p = 0.007), Verbal Memory (p =. 042) and a trend towards significance for Problem Solving (p = .054). Planned contrasts revealed gains for the AT group compared to CG group from baseline to follow-up in Global Cognition (p=.001) and PANSS Positive symptoms (p=.0017). In a similar modified ITT analysis, 83 randomized CHR participants demonstrated a significant condition-by-time interaction in Verbal Memory, with the AT group showing more improvement from baseline to post-training than the CG group (p=.04). Analysis of the CHR 6-month follow-up data is currently underway. Neuroscience-informed cognitive training represents a promising treatment approach for cognitive dysfunction in adolescents and young adults in the early phases of psychosis. Future research should focus on personalization, improving training adherence, and combination with coordinated specialty care interventions to more strongly impact real-world functioning.
Talk 2: A randomized, controlled trial on Integrated Cognitive Remediation for early psychosis: Effectiveness and factors associated with treatment response
Olina G Vidarsdottir1,2, Brynja B Magnusdottir2,3, David Roberts4, Elizabeth W Twamley5, Engilbert Sigurdsson1,2, Berglind Gudmundsdottir1,2; 1Landspitali Haskolasjukrahus, 2Landspitali University Hospital, 3Reykjavik University, 4The University of Texas Health Science Center at San Antonio, 5University of California, San Diego and VA San Diego Healthcare System
Introduction: Cognitive remediation, combined with evidence based psychiatric rehabilitation programs, is effective for improving cognitive deficits found in psychosis but generalization to everyday functioning remains a challenge. The objective of this study was to integrate three cognitive remediation approaches: Neuropsychological Educational Approach to Remediation (NEAR), Compensatory Cognitive Training (CCT), and Social Cognition and Interaction Training (SCIT), and evaluate the effects on cognition, functional outcome, and clinical symptoms. Method: We conducted a randomized, wait-list control trial of an Integrative Cognitive Remediation (ICR) in 49 patients with primary psychotic disorder seeking service at an early intervention center in Iceland (mean age: 24; 86% males). Participants were randomized to receive standard treatment (N=24) or standard treatment plus a 12-week group-based ICR (N=25). Neurocognition (verbal memory, reasoning, working memory, processing speed, cognitive flexibility, inhibition, planning), social cognition (theory of mind, emotion recognition and attributional style), functional outcome, and clinical symptoms were assessed at baseline and post-treatment. Results: The ICR group showed significant improvements in verbal memory, cognitive flexibility, theory of mind and a significant reduction in hostile attributional style, compared to those receiving standard treatment alone. No significant ICR associated effects were seen in functional outcomes or clinical symptoms. Post-hoc analyses suggest a dose-response effect. ICR was well tolerated and received high treatment satisfaction ratings. Conclusions: ICR is feasible and effective in improving neurocognition and social cognition in psychosis. Findings will be discussed in context of continuing to improve comprehensive cognitive remediation interventions for early psychosis with discussion on factors associated with treatment response.
Talk 3: Cognitive Enhancement Therapy for Early Course Schizophrenia: Functional Connectivity Associated with Improvement in Social Cognition
Synthia Guimond1,2, George Ling2, Betzamel Lopez2, Rachel Templeton2, Roscoe Brady1,2, Heidi Thermenos1,2, Shaun Eack3, Matcheri Keshavan1,2; 1Harvard Medical School, 2Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center, 3University of Pittsburgh
Social cognition is a key determinant of functional outcomes in early course schizophrenia. The goal of our study was to examine the impact of cognitive enhancement therapy (CET) on social cognition and on functional connectivity in early course schizophrenia. Eighty-four participants were randomly assigned to either treatment groups (CET, n=49; Enriched Supportive Therapy (EST), n=35). Resting state scans and social cognition performance, as measured by the MATRICS battery, were collected at baseline, 9, 18 and 30 months. We conducted mixed linear model analyses to investigate the impact of treatment (CET vs. EST) on social cognition and on the dorsolateral prefrontal cortex (DLPFC) functional connectivity to the right and left amygdala. CET group showed significant improvement over time in social cognition in comparison to the EST group (p<.05). Change in functional connectivity over time did not significantly differ between treatments. However, we observed a significant positive correlation between increased right DLPFC functional connectivity to the right amygdala and social cognition performance in the CET group (p<.05). Our results replicate previous work demonstrating that CET is effective at improving social cognition in schizophrenia. In addition, we found evidence that this improvement could be reflected in the DLPFC-amygdala circuit connectivity. This neural circuit potentially provides a mechanistic link between the biology of emotion regulation and more complex social cognition processes that can be improved in early stage of the illness.
Talk 4: Using Virtual Worlds to Deliver Social Cognitive Therapy in Psychosis
Andrew Thompson1, Farah Elahi1, Alba Realpe1,2, Sandra Bucci3, David Taylor4, Ivo Vlaev1, Fiona Leahy1, Caroline Falconer5, Max Birchwood1; 1University of Warwick, k, 2University of Bristol, UK, 3University of Manchester, UK, 4Imperial College, London, UK, 5University College London, UK
Introduction Problems with social cognition are common in people with a diagnosis of psychosis. We have previously developed a group intervention to improve these skills in young people with early psychosis. However, there were barriers to people attending a group and interacting with others in this environment. We aimed to adapt this intervention and deliver it in a widely used computer virtual world (Second Life) to see if this is acceptable and feasible in this population. Method We co-designed a virtual world environment and the intervention (SCIT or Social Cognition Interaction Training) with user consultants and software designers. The resulting intervention was delivered over 5 weeks to groups of 4 individuals with Early Psychosis. Our outcomes of interest were measures of engagement and acceptability. Acceptability was measured by group attendance rates and by information derived from post intervention qualitative interviews. We also measured social cognition and social functioning and measures of immersion in the virtual world. We planned to recruit 5 groups over a 6-month period. Results Preliminary results and details of outcome of the co-design process will be discussed. Preliminary results on recruitment and feasibility will be presented. The potential benefits and risks of using such technology to treat difficulties in social cognition in this patient group will be discussed. Conclusions With the initial results we will be able to consider the benefits and risks of using virtual worlds in therapy and how this may be used in other disorders or for other therapeutic approaches in psychosis.
Talk 5: Cognitive behavioural therapy in comparison to treatment as usual in adults at high risk of developing bipolar disorder (Bipolar At Risk): A feasibility study (BART)
Sophie Parker1,2, Paul French1,3, Rory Byrne1, Rchard Bentall4, David Shiers1,2, Linda Davies2, Graham Dunn2; 1Greater Manchester Mental Health NHS Foundation Trust, 2University of Manchester, 3Liverpool University, 4Sheffield University
Research has demonstrated the ability to identify and treat individuals at high risk of developing psychosis and more recently that it is possible to utilise a similar strategy to identify people who have an emergent risk of Bipolar Disorder (BD). BD can be a severe, recurrent and disabling condition with significant consequences for individuals, families and society. Criteria have been established to identify individuals considered to be at high risk for developing BD (Bipolar At Risk; Bechdolf et. al., 2012; 2014). Identifying this group and offering an intervention may reduce transition to a full expression of BD and offer the possibility of prevention. The overall aim was to identify people who were considered to be at high risk of developing Bipolar Disorder (BD) according to the criteria, and to investigate whether a psychological intervention is an acceptable, feasible and potentially effective treatment option. This feasibility study applied a randomised design to test the acceptability of a psychological intervention (CBT) in people considered to be at high risk of developing BD (Bipolar At Risk). 76 Individuals were randomised to one of two conditions (CBT plus treatment as usual versus treatment as usual alone). All participants were monitored for 1 year to assess levels of transition to full BD. The CBT intervention was aimed at minimising transition to BD, reducing distress and increasing quality of life. Assessments were carried out at baseline, 6 and 12 month follow-up. Data from the trial will be presented and the implications of the trial discussed.
Talk 6: Latest developments of psychological psychosis prevention strategies in the Netherlands
Mark van der Gaag1,2, Helga Ising2; 1VU University, 2Parnassia Psychiatric Institute
Objective: Present the implementation strategies in the Netherlands to implement CBT for UHR in mental health services Methods: Overview of the literature that has led to the Evidence Based status of detection and treatment of UHR patients. Results: CBT in UHR patients has proven effective in EDIE-NL, but also meta-analyses. The risk reduction is about 40% at twelve months and still 36% at 24-48-months follow-up. The four-year follow-up was also cost-saving. Budget Impact Analysis showed a 10 million cost saving in direct costs each year and a reduction of 15% of psychotic patients in the long term. The detection and treatment of UHR patients is now standard treatment in the Netherlands and national implementation is about to begin. The European guidelines on detection and implementation that reached the same conclusions. The PQ-16 is used to screen for potential UHR patients in all help-seeking patients. The CAARMS is the gold standard to detect the UHR patients and CBT therapists are being trained to do the preventive treatment. At the same time, it is clear that UHR is a risk profile for long-term treatment trajactories and treatment should also target multi-morbid disorders and preserve the social functioning at home, with friends, in school and at the workplace.
Talk 7: Mo: development and feasibility testing of a mobile therapy app for transdiagnostic early intervention
Amy Hardy1, Philippa Garety1; 1Institute of Psychiatry, Psychology & Neuroscience, King's College London
Difficult emotions and life stressors are ubiquitous, but access to psychological interventions is limited meaning that timely, early interventions are rare (Haller et al, 2014). Even when available, people can be reluctant to take up therapy (O’Dea et al, 2015). Standalone therapy apps show promise in improving the provision of early intervention, although need to be sensitively designed if they are to meet implementation challenges (Greenhalgh et al, 2017). In response to this concern, we have developed Mo, an app to support managing emotions and stress, which has the potential to address obstacles to therapy availability, uptake and adherence. Our team of industrial engineers, clinicians and researchers combined the ‘Double Diamond’ methodology (Design Council, 2015) with agile working with developers (Dybå, Dingsøyr et al, 2008). Insights were gained through interviews and workshops with young adults. Personas were built up from these insights, informing subsequent co-creation sessions. Mo’s key functions and concepts were created, along with the visual language and branding, and refined following feasibility testing. Users define Mo’s look and role (i.e. friend, therapist or coach) who then supports users to manage problems and find solutions. Mo draws on second and third wave cognitive-behavioural principles including cognitive restructuring (SlowMo), relaxation and mindfulness (FlowMo) and activity scheduling and distraction (GoMo). It is envisaged that the broad focus of Mo will lend itself to user testing with diverse groups, with insights iteratively incorporated into future versions.
Talk 8: Effect of interval training on metabolic risk factors in overweight individuals with psychosis: a randomized controlled trial
Ahmed Jerome Romain1, Cedine Fankam1, Antony D. Karelis2, Elaine Letendre3, Gladys Mikolajacks1, Emmanuel Stip1,3,4, Amal Abdel-Baki1,3,4; 1University of Montreal Hospital Research Centre, 2University of Quebec at Montreal, 3University Hospital of Montreal (CHUM), 4University of Montreal
Background: Physical activity (PA) has been suggested to reduce the high prevalence of metabolic syndrome and obesity in psychosis population but interval training (IT) which is efficacious in other populations is poorly studied among people with psychosis. Objective: To determine the effects of a 6-month supervised IT program on metabolic, anthropometric, and psychiatric/functional outcomes. Methods: Randomized controlled trial comparing the effects of a bi-weekly 30 minutes IT to a waiting list of overweight individuals with psychosis. Body composition and metabolic risk factors were compared at baseline and 6 months using repeated-measures mixed linear models with the restricted maximum of likelihood method of estimation. Results. 66 individuals (62% men, 30.7 ± 7.2 years old; BMI: 32.7 ± 5.7 kg/m², waist circumference: 107.4 ± 13.3 cm) were randomised. Mean attendance to IT sessions was 64%. PA dropout rate was 50%. Among completers (>64% of prescribed IT sessions), IT was associated with significant improvements on waist circumference (-3.09 cm, SE = 1.4; p = 0.03), negative symptoms (-3.7, SE = 1.4; p = 0.01), social (SOFAS) (+6.16, SE = 1.76; p = 0.001) and global functioning (+5.38, SE = 2.3; p = 0.02). The effects of exercise in the first-episode psychosis (FEP) sub-group were similar to those of the entire cohort along with specific effects on fat free mass, fat mass and general PANSS psychopathology. Conclusion. IT contributes to improve metabolic complications and social functioning in obese individuals with psychosis. Further studies on prevention of metabolic complications are warranted.
Oral Session 10
Tuesday, October 9, 2:45 - 4:15 pm, St. George CD
Chair: Kathryn Lewandowski, McLean Hospital, Harvard Medical School
Speakers: Kathryn Lewandowski, Chantal Michel, Louise Birkedal Glenthøj, Kelly Allott, Kelly Allott, Kathryn Hardin, Camilla Austa Jerlang Christiani; M.Sc., Lawrence Yang
Talk 1: Cognitive Heterogeneity over the First Year of Illness
Kathryn Lewandowski1,2, Dost Ongur1,2; 1McLean Hospital, 2Harvard Medical School
Cognitive dysfunction is a core symptom dimension in psychosis and associated with poor functioning even by the early phase of illness. However, considerable cognitive heterogeneity exists; some findings suggest cognitive stability after the first episode, and others show continued cognitive change. One possible explanation is that patients may follow heterogeneous cognitive trajectories. Cluster analysis has identified profiles of cognition in psychosis, which map to clinical, functional and neurobiological measures. How these clusters predict cognitive trajectories is unclear. Thus, we aimed to evaluate cognitive subtypes in FEP at baseline and over a one-year follow up. Patients within one year of an initial episode of psychosis (n=75) were assessed at baseline and at 1-year follow up (n=35) using the MATRICS battery, clinical and functional measures. Cluster analytic techniques were run on baseline cognitive data. Clusters were then compared on baseline and follow-up clinical and functional measures, and cognitive trajectory. A 3-cluster solution best fit the data, reflecting Intact (T=55), Moderately Impaired (T=39) and Significantly Impaired (T=28) groups. Groups differed in terms of clinical and functional measures at baseline; diagnoses were distributed across all three clusters. Clusters 1 and 3 showed relatively stable cognitive course (Intact and Significantly Impaired, respectively). Cluster 2 showed cognitive improvement from baseline to follow up. Cognitive trajectories were associated with functional outcomes. Cognitive heterogeneity is evident at the time of a first episode and associated with clinical and functional measures, and cognitive trajectories. Leveraging cognitive heterogeneity may inform individualized prediction and treatment implementation for patients with psychosis.
Talk 2: Neurocognitive Deficits according to Norms in Adolescents with and without Clinical High Risk States of Psychosis
Chantal Michel1,2, Nina Schnyder1, Petra Walger3, Maurizia Franscini4, Benno G. Schimmelmann1,5, Frauke Schultze-Lutter1,6; 1University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland, 2Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland, 3University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Cologne, Germany, 4University Hospital of Child and Adolescent Psychiatry, Zurich, Switzerland, 5University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany, 6Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
In the early detection of psychosis, neurocognitive predictors have been suggested to enhance predictive accuracy of clinical high risk (CHR) criteria. While mainly sample-dependent means of adult samples were used so far, a recent study of an adult sample used neurocognitive deficits defined according to test norms in order to facilitate individual prediction. Yet, data on child and adolescent samples are missing. We investigated the discriminative power of neurocognitive deficits defined according to norms in 8-17-year-olds. 160 CHR outpatients (AtRisk; mean age=15.02±2.20, 39% male), 270 non-psychotic inpatients (ClinS; mean age=14.46±2.43, 38% male) and 220 subjects of a general population sample (GPS; mean age=13.91±2.78, 48% male) had been assessed with a neurocognitive battery, including a verbal fluency (VF) test, the Digit-Symbol Test, TMT A and B, the Auditory Verbal Learning Test (AVLT) and the Subject Ordered Pointing Task. GPS were slightly younger than AtRisk and ClinS (Chi2(2)=7.656, p=0.022); no differences were found with regard to gender and premorbid IQ. Compared to ClinS and GPS, AtRisk more frequently exhibited deficits according to norms in verbal memory (AVLT learning capacity; 22.4% vs. 10.7%; OR=2.4, 95% CI: 1.3-4.6) and VF (48.8% vs. 34.1%; OR=1.8, 95% CI: 1.1-3.0), while ClinS and GPS did not differ. Partly in line with findings from adult samples, deficits in verbal memory and VF might be specifically associated with a CHR state in children and adolescents – even when compared to a more severely ill inpatient group. Yet, these findings need further examination in larger samples and longitudinal studies.
Talk 3: Emotion recognition deficits in individuals at ultra-high risk for psychosis.
Louise Birkedal Glenthøj1,2, Birgitte Fagerlund2,3, Nikolaj Bak2,3, Carsten Hjorthøj1, Tina Dam Kristensen1,2, Christina Wenneberg1,2, Joseph Ventura4, Jens Richardt Møllegaard Jepsen2,3,5, Merete Nordentoft1,2; 1Mental Health Centre Copenhagen, University of Copenhagen, 2Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, 3Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, 4UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, CA, 5Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, University of Copenhagen
Objective: Emotion recognition is an aspect of social cognition that may be a key predictor of functioning and transition to psychosis in individuals at ultra-high risk (UHR) for psychosis. UHR individuals exhibit deficits in accurately identifying facial emotions, but other potential anomalies in facial emotion recognition are largely unexplored. This study aimed to extend current knowledge on emotion recognition deficits in UHR individuals by examining 1) whether UHR would display significantly slower facial emotion recognition than healthy controls, 2) whether an association between emotion recognition accuracy and emotion recognition latency is present in UHR, 3) the relationships between emotion recognition accuracy, neurocognition and psychopathology in UHR, 4) the relation between emotion recognition accuracy, latency, and real life functioning in UHR. Results: UHR did not display impairments in speed of emotion recognition compared to healthy controls. Correlational analyses revealed significant, negative correlations between emotion recognition accuracy and response latency on the emotions happiness (r=-.47, p˂.01) and sadness (r=-.33, p˂.01) in UHR. A multiple regression analysis demonstrated sustained attention to be associated with overall emotion recognition ability along with level of attenuated psychotic symptoms in UHR. Lastly, we found emotion recognition processing speed, but not accuracy, to be consistently related to functioning measures. Conclusion: Our findings indicate that impairments in sustained attention may be an important contributor to emotion recognition deficits in UHR. Additionally, training of social cognitive processing speed may be of particular relevance in cognitive remediation programs aimed at improving real life functioning in UHR individuals.
Talk 4: Neurocognitive Functioning in Depressed Young People: A Systematic Review and Meta-Analysis
Kelly Allott1,2, Joanne Goodall1,3, Caroline Fisher4, Sarah Hetrick5, Emma Parrish6, Lisa Phillips3; 1Orygen, The National Centre of Excellence in Youth Mental Health, Australia, 2Centre for Youth Mental Health, The University of Melbourne, Australia, 3School of Psychological Sciences, The University of Melbourne, Australia, 4Department of Psychology, Royal Melbourne Hospital, Melbourne Health, Australia, 5Department of Psychological Medicine, University of Auckland, New Zealand, 6Department of Psychology, Northeastern University, Boston, MA, USA
Depression is among the most common mental health problems for young people. In adults, depression is associated with neurocognitive deficits that reduce the effectiveness of treatment and impair educational and vocational functioning. Compared to adults, less is known about the neurocognitive functioning of young people with depression, and existing research has reported inconsistent findings. This systematic review and meta-analysis synthesized the literature on neurocognitive functioning in currently depressed youth aged 12-25 years in comparison to healthy controls. Following a systematic review of the literature, 23 studies were included in the meta-analysis. Poorer performance in the domains of attention (SMD: .50, 95% CI: .18-.83, p=.002), verbal memory (SMD: .78, 95% CI: .50-1.0, p<.001), visual memory (SMD: .65, 95% CI: .30-.99, p<.001), verbal reasoning/knowledge (SMD: .46; 95% CI: .14-.79; p <0.001) and IQ (SMD: .32; 95% CI: .08-.56; p=0.01) were identified in depressed youth. Relative weaknesses in processing speed/reaction time and verbal learning were also evident; however these findings disappeared when the quality of studies was controlled for. Moderator analysis showed a tendency for poorer set-shifting ability in younger depressed participants relative to controls (although non-significant; p=.05). Moderator analysis of medication status showed taking medication was associated with poorer attentional functioning compared to those not taking medication. The findings suggest that currently depressed young people display a range of neurocognitive weaknesses which may impact treatment engagement and outcome. The findings support the need to consider neurocognitive functioning when treating youth with depression.
Talk 5: Longitudinal cognitive performance in individuals at ultra-high risk for psychosis: A 10-year follow-up
Kelly Allott1,2, Stephen Wood1,2,3, Hok Pan Yuen1,2, Alison Yung4, Barnaby Nelson1,2, Warrick Brewer1,2, Christos Pantelis5, Patrick McGorry1,2, Ashleigh Lin6; 1Orygen, The National Centre of Excellence in Youth Mental Health, Australia, 2Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia, 3School of Psychology, University of Birmingham, UK, 4University of Manchester, UK, 5Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Australia, 6Telethon Kids Institute, WA, Australia
It remains unclear whether the onset of psychosis is associated with deterioration in cognitive performance. The aim of this study was to determine the course of cognitive performance over the transition from ultra-high risk (UHR) to psychosis, and in relation to functional outcome. Consecutive admissions to PACE between May 1994 and July 2000 who had cognitive data (including IQ and specific cognitive tests) at baseline and follow-up were eligible (N=80). Follow-up ranged from 7.3 and 13.4 years (M=10.4 years; SD=1.5). In the whole sample, significant improvements were observed on the Similarities (p=.03), Information (p<.01), Digit Symbol Coding (p<.01), and Trail Making Test-B (p=.01) tasks, whereas performance on the Rey Auditory Verbal Learning Test (Trials 1-3) declined significantly (p<.01) over the follow-up period. Change on all cognitive measures was not significantly associated with transition status. Taking time of transition into account (within or after 1 year), there was a significant finding in relation to change on Digit Symbol Coding (p=.01), with those who transitioned after 1 year having a decline in score, whereas those who did not transition had an improved score (ES=0.85). Small positive correlations were observed between improvements in functioning and improvements in performance on Digit Symbol Coding and Arithmetic (0.24, p=0.03 and 0.28, p=0.01, respectively). The onset of psychosis was not associated with deterioration in cognitive ability. However, specific findings suggest that immediate verbal learning and processing speed may be important domains for future risk models and early intervention research in UHR.
Talk 6: Understanding the relationship between neurocognition, negative symptoms, and functioning in first episode psychosis
Kathryn Hardin1, Danielle Beaudette1, Alan Breier1, Kyle Minor1; 1Indiana University - Purdue University Indianapolis
In first episode psychosis (FEP) populations, neurocognitive deficits and negative symptoms are both significant predictors of functioning. Some studies have shown that neurocognition is a stronger predictor of functioning than psychotic symptoms. In clinical high risk populations, neurocognition mediates the relationship between negative symptoms and functioning and there is concern that some negative symptoms items (e.g., emotional and social withdrawal) overlap with social and role functioning, complicating this relationship. This study aimed to determine if, after accounting for neurocognition, negative symptoms predict variance in social and role functioning in FEP. A secondary aim was to explore the differing ability of social vs. non-social items on a negative symptom scale to predict functioning, after accounting for neurocognition. Twenty FEP young adults were evaluated on social and role functioning, negative symptoms, and neurocognition. Stepwise regression tested for 1) predictive value of neurocognition and 2) added predictive value of negative symptoms for social and role functioning individually. In both models, neurocognition and negative symptoms were not significant predictors. Secondary analyses tested if social items on the negative symptoms scale predict additional variance over 1) neurocognition and 2) non-social negative items. Neurocognition, non-social, and social negative symptoms were not significant predictors for role functioning. However, social negative symptoms predicted significant additional variance over neurocognition and non-social symptoms. Future studies should further explore the differing relationships between neurocognition, social, and non-social negative symptoms in both social and role functioning.
Talk 7: Social cognition, language, social skills, and social functioning in 7-year-old children at familial high risk for schizophrenia or bipolar disorder – The Danish High Risk and Resilience Study – VIA 7
Camilla Austa Jerlang Christiani; M.Sc.1,3, Jens Richardt Moellegaard Jepsen; Ph.D.2,3,8, Anne Thorup, MD., Ph.D.1,3, Nicoline Hemager, M.Sc.1,2,3, Ditte Ellersgaard, MD.1,3, Birgitte Klee Burton, MD., Ph.D.2,3, Katrine Soeborg Spang, MD.2,3, Aja Greve, M.Sc.3,5, Ditte Gantriis, Ph.D.3,5, Maja Gregersen, M.Sc.1,3, Anne Soendergaard, M.Sc.1,3, Gry Poulsen, Ph.D.3,6, Jamal Uddin, Ph.D.3,6, Larry Seidman, Ph.D.†7,9, Ole Mors, MD., Ph.D.3,5, Kerstin Plessen, MD., Ph.D.2,3,4, Merete Nordentoft, MD, Ph.D.1,3,4; 1Mental Health Services – in the Capital Region of Denmark, Mental Health Centre Copenhagenh.d student, 2Mental Health Services – in the Capital Region of Denmark, Child and Adolescent Mental Health Centre,, 3The Lundbeck Foundation Initiative for Integrative Psychiatric Research,, 4University of Copenhagen - Faculty of Health and Medical Sciences, 5Psychosis Research Unit, Aarhus University Hospital, 6University of Copenhagen, Department of Public Health – Section of Biostatistics, 7Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, 8Mental Health Services - Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, 98Department of Psychiatry, Harvard Medical School at Massachusetts General Hospital, Boston
Background To characterize social cognition, language, social skills, and social functioning in children at familial high risk for schizophrenia or bipolar disorder compared to children without familial high risk for these two mental disorders. Methods The Danish High Risk and Resilience Study – VIA 7 is a prospective cohort study of 522 children, age seven, at familial high risk for developing schizophrenia (FHR-SZ, N=202) or bipolar disorder (FHR-BP, N=120) compared to a population-based control group (PBC, N=200). The cohort was stratified from the Danish National Registers. Children at FHR-SZ were matched on age, gender, and urbanicity to the PBC group. The children at FHR-BP were a non-matched group. All children were assessed with comprehensive, well-validated tests and questionnaires using multiple sources. Social cognition was measured on two dimensions, theory of mind and emotion recognition, including social cognitive processing speed. Also, receptive and pragmatic language, creative generativity, social skills and social functioning were investigated. Results Children FHR-SZ showed significant deficits in their theory of mind, receptive and pragmatic language as well as in their social skills and social functioning compared to the PBC group. Children at FHR-BP showed significant social skills impairments. None of the familial high risk groups presented with deficits in emotion recognition or in social cognitive processing speed. Discussion Early in neurodevelopment children at FHR-SZ present with impairments within the social cognitive and language domain as well as in their social skills and social functioning. These results enhance the importance of early detection and preventive interventions.
Talk 8: Symptomatology and cognition in a Chinese sample with chronic untreated psychosis
Lawrence Yang1,2, Michael Phillips2,3, Matcheri Keshavan4, Ezra Susser2, William Stone4, Hui Li5, Fei Deng3, Hanhui Chen3, Bing Cai3, Zhizhong Wang3, Margaux Grivel1, Debbie Huang2; 1New York University, 2Columbia University, 3Shanghai Mental Health Center, 4Harvard Medical School, 5Florida A&M
Introduction: Many individuals with chronic psychotic disorders in under-resourced settings have a prolonged duration of untreated psychosis (DUP) prior to their first contact with medical treatment. This ongoing study in a northwestern province of China (Ningxia) identifies such a cohort and conducts a detailed assessment of their cognitive functioning prior to initiation of medication. Methods: This NIMH-funded collaboration between the Shanghai Mental Health Center, Harvard Medical School, Columbia University and New York University ascertained untreated individuals with psychosis from Ningxia Province who are enrolled in China’s national registry of community-dwelling individuals with major mental illnesses. After providing informed consent, their DSM-IV (or DSM-5) diagnosis was assessed using an adapted Chinese version of SCID, their current symptomatology using the Positive and Negative Syndrome Scale, and their cognitive functioning using the MATRICS Consensus Cognitive Battery. Results: These interim analyses compare the symptomatic and cognitive characteristics of earlier-onset cases (DUP<5 years) vs. medium (DUP 6-10 years) and long-onset cases (DUP >10 years) and also compare our findings to those from first-contact studies in high-income countries. Discussion: The identification and treatment of individuals with untreated chronic psychotic disorders is a high priority in low- and middle-income countries worldwide. Detailed cognitive assessment of these individuals with widely varying DUP prior to initiating treatment provides a detailed picture of the cognitive trajectory of untreated psychosis. This can then be compared to the cognitive trajectory of treated psychosis to assess the possible influence of antipsychotic medication on the natural history of cognitive decline in schizophrenia.
Oral Session 11
Tuesday, October 9, 4:30 - 6:00 pm, St. George AB
Chair: Emily Kline, Harvard Medical School, Beth Israel Deaconess Medical Center
Speakers: Emily Kline, Jackie Curtis, Nev Jones, Manuela Ferrari, Anika Maraj, Anna Meneghelli, Harm Gijsman, Michelle Jamieson
Talk 1: Competencies and Training Needs of Massachusetts First Episode Psychosis Treatment Programs
Emily Kline1,2, Nimita Iyer2, Margaret Guyer3, Matcheri Keshavan1,2; 1Harvard Medical School, 2Beth Israel Deaconess Medical Center, 3Massachusetts Department of Mental Health
There is accumulating evidence that coordinated specialty care for first episode psychosis (FEP) prevents disability, relapse hospitalization, suicide, and medical and substance use comorbidity, but implementation remains uneven. Federal agencies have rapidly increased funding for early intervention in FEP in the United States, leading to a proliferation of specialized FEP programs. To address workforce development and staff training needs in these programs, Massachusetts created a FEP Technical Assistance Center, now called the Massachusetts Psychosis Network for Early Treatment (MAPNET). The purpose of this study was to assess self-reported competencies and training needs amongst FEP providers across five clinical programs prior to participation in MAPNET activities. Respondents (N = 38) were asked to rank their skill as an individual and as a program in providing a number of evidence based and promising practices for FEP on a scale of 1 to 5 (5 representing high confidence). As individuals, providers identified their understanding of the rationale for FEP specialty care, ability to provide accurate diagnoses, and provision of individual psychotherapy as areas of strength. Areas of relative need (that is, low skill) included supported education/employment, peer counseling, and cognitive enhancement therapy. Program-level areas of strength and training needs mirrored individual-level results; however, there was substantial variation in inter-rater agreement with regard to identifying team strengths and weaknesses. Some programs demonstrated relative cohesion in their program-level assessments while others had poor agreement. The results of this survey were used to create a curriculum of learning activities that addressed clinician-identified training needs.
Talk 2: Don't just screen, intervene: from margin to mainstream in Australia and England
Jackie Curtis1,2, David Shiers3,4; 1University of New South Wales, Sydney, Australia, 2South Eastern Sydney Local Health District, Sydney, Australia, 3University of Manchester, UK, 4Psychosis Research Unit of Greater Manchester Mental Health NHS Trust, UK
Background: The iphYs international collaboration arose out of a shared concern over health system failures to proactively tackle cardiometabolic risk. The UK National Audit of Schizophrenia (NAS, 2012) and the Australian 2nd National Survey of Psychosis (2010) demonstrated the magnitude of this. Yet other than acknowledging social injustice, strategic response was lacking. Method: To assess mutual impacts of iphYs collaboration: i) Impact in England of adapting original NSW Positive Cardiometabolic Health algorithm (HETI, 2011) to create UK Lester resource; ii) Impact in Australia of adopting HeAL (Healthy Active Lives declaration), a rights-based approach to physical health from outset of psychosis and its treatment Results: ENGLAND: Impact from adopting NSW Don't just screen, intervene approach to cardiometabolic risk: 2014 UK Lester resource endorsed by NICE, professional Royal Colleges, NHS England and Public Health England, Diabetes UK and Rethink. Implementing the Lester resource is key objective of NHSEs quality improvement programme (CQUIN) and Care Quality Commission's regulatory assessment. Aligning with HeAL, service implementation of Lester resource features in national EIP self-assessment audit; latest CQUIN specifically incentivises EIP services to mitigate weight gain and reduce smoking. AUSTRALIA: The HeAL declaration principles have been endorsed by NSW Health, being embedded in statewide and national strategic documents (eg NSW Mental Health Commission; National Mental Health Commission) and the Positive Cardiometabolic health algorithm, alongside HeAL is acknowledged in the RANZCP clinical practice guidelines for Schizophrenia. Conclusion: Synergies resulting from eight years of international collaborations between Australia and England have influenced radical changes in policy and practice at state and national level.
Talk 3: Deconstructing the Intersections of Race/ethnicity and Disadvantage on Family and Service User Disengagement from Early Intervention Services
Nev Jones1; 1University of South Florida
Purpose: A deeper understanding of the impact of structural disadvantage and/or minority cultural background on treatment engagement is a critically important but under-researched thread within the early intervention (EI) literature. This presentation weaves together both quantitative and qualitative data on disengagement from diverse community-based early psychosis programs in the US in order to deepen and complicate our current understanding of disengagement and raise critical questions for future research. Methods: We report findings from a mixed methods sequential-explanatory research project integrating analysis a large longitudinal quantitative dataset (n = 262) and in-depth interviews with young adults, family members and early intervention providers (n = 40). Findings: 44% of service users within the quantitative sample left EI prematurely (against the treatment team’s advice), with nearly 1/3 of these individuals disengaging within the initial three months of treatment. Both minority race/ethnicity and cumulative structural disadvantage were significantly associated with disengagement. In-depth multi-stakeholder interviews help elucidate these findings, with key themes including perceived gaps in training and support for trauma-informed work, and client/family distrust stemming from prior child welfare, juvenile justice and children's mental health system involvement. Providers suggested a series of concrete strategies for addressing these concerns. Conclusions: Greater attention to cultural/ethnic/racial diversity and the impact of structural disadvantage in EI appears to be warranted. Implications vis-à-vis program design, assessment, provider training and fidelity will be discussed.
Talk 4: Lost in ‘practice’: Redefining engagement in early intervention for psychosis services
Manuela Ferrari1, Tovah Cowan1, Kevin MacDonald1, Megan Pope1, Céline Villemus1, Ashok Malla1,2, Srividya Iyer1,2; 1Douglas Mental Health University Institute, 2Department of Psychiatry, McGill University
Rationale: Interest in service engagement in the early intervention for psychosis (EIP) literature has largely stemmed from the association between disengagement from services and poor clinical outcomes (e.g., relapse, increased hospital admissions). Research has mainly defined service engagement in terms of attendance to appointments and agreement with/adherence to treatment and/or medication recommendations. However, this definition is at odds with the EIP philosophy and guidelines, which emphasize service user and family engagement in treatment decision-making and service (re)design. There is thus a need to (re)theorize service engagement in EIP by exploring the perspectives of different stakeholders. Our qualitative study aimed to address this need. Method: Forty in-depth, semi-structured interviews were conducted with 24 service users and 16 service providers from a Canadian EIP program. Nineteen service users were currently receiving services and five had discontinued services. Informed by the grounded theory approach, interviews were analyzed comparing and contrasting service users’ and providers’ experiences and understandings of service engagement. Findings: Service users’ and providers’ definitions of service engagement fall on a spectrum ranging from adherence to treatment/services and recovery (symptoms remission), as defined clinically, to engagement and recovery, as defined more personally. Service engagement is shaped by multiple domains (e.g., symptoms/the illness experience; users’ versus providers’ treatment goals). Misalignment of these domains in clinical practice impairs communication and the therapeutic alliance, and, in some cases, leads to disengagement. Conclusions: Our findings offer a new model of service engagement. We propose several recommendations to support the implementation of this model in clinical practice.
Talk 5: Service Disengagement in Early Intervention for Psychosis: Where Do Language and Culture Fit In?
Anika Maraj1, Manuela Ferrari2, Jai Shah1,2, Srividya N Iyer1,2; 1McGill University, 2Douglas Mental Health University Institute
Background: Although specialized early intervention (EI) programs for psychosis invest in keeping clients engaged in treatment, (dis)engagement remains a concern. Service- and system-related factors, particularly language, used in the provision of care, are currently understudied. Given that language is known to broadly impact health care accessibility and perceived suitability, investigating the role of language in EI service disengagement is imperative. Methods: A mixed-methods sequential explanatory study was conducted at an EI program in the bilingual city of Montreal, Canada. 378 clients were included in a time-to-event analysis with Cox Proportional Hazards regression models. Preferred language (English or French), immigrant status, visible minority status, age, gender, education, substance abuse, family contact, social and material deprivation and medication non-adherence were investigated as predictors of 24-month service disengagement. Subsequently, two focus groups (1 English, n=7; 1 French, n=5) were conducted to explore quantitative findings and generate more knowledge. Results: Overall, about 28.6% (n = 108) of persons disengaged from the service. Those whose preferred language was English were more likely to disengage from services (n=57, 34.5%) than those whose preferred language was French (n= 51, 23.9%; p=0.017). In contrast, focus group participants did not identify language as a barrier in accessing or receiving care. Participants discussed the overall impact that client-provider communication and language, as the expression of culture, have in service (dis)engagement. Conclusion: Findings from this study highlight how language and culture impact service user engagement in EI programs; emphasizing that language is the mediator of social interactions –including therapeutic ones.
Talk 6: Fidelity to an evidence-based model of early intervention for psychosis in Italian early intervention programs
Anna Meneghelli1, Antonio Preti2; 1programma 2000 Milano, 2University of Cagliari
Implementation of fidelity to an evidence-based model is key to assure reproducibility of effectiveness of early intervention for youth and psychosis. The First-Episode Psychosis Services Fidelity Scale (FEPS-FS; Addington et al., 2016) is one of the most complete, reliable, and valid measure of adherence to evidence-based practices for first-episode psychosis services among those available in so far, and it can serve the purpose of assessing the actual implementation of a leading model of early intervention in psychosis. The AIPP (Italian Association of Early Intervention and Prevention in Mental Health; www.aipp-italia.com) has promoted the Italian translation and adaptation of the FEPS-FS for its use within the third Italian national survey on early intervention programs (EIPs). Initial validation of the Italian FEPS-FS in several North-Italy EIPs revealed good inter-rater reliability (intraclass correlation coefficient >0.70). In so far, about 25% of Italian public Departments of Mental Health have implemented an EIP. There is a wide variability in the distribution of EIPs across the Italian territory, and, as well, there is a wide variability in the fidelity to leading models of early intervention in psychosis as they are implemented in Italian EIPs. The offering of psychoeducation, involvement of family, assignment to a case manager, personalized treatment, and crisis management were the components of these models most often implemented in Italian EIPs. Improving adherence to evidence-based models is imperative to promote effectiveness of treatment in EIPs. Measurement of fidelity to model may contribute to this goal and should be routinely implemented in EIPs.
Talk 7: Early intervention psychosis by a recovery focussed ACT team with flexible duration of treatment: 10 years follow-up.
Harm Gijsman1, Marguerite Elfrink1, Bettina Jacobsen1, Stefan Geelen2, Thomas Oud2; 1Pro Persona Mental Health, 2Radboud University Medical School
Early intervention psychosis teams differ in their inclusion age range, caseload, focus on recovery, and duration of treatment. We present 10 year follow-up of an EIP team which included patients from 16 to 60 years, is ACT certified (caseload 1:15), specifically trained in recovery, and applied a flexible duration of treatment. Method: We included the first 67 patients of the team. We monitored at time of discharge: duration of treatment, diagnosis, reason for end of treatment, type of follow-up treatment; and at 10 years follow-up: type of current treatment and level of functional remission. Results: 7 patients (10.4%) dropped out during treatment, mainly in the first 2 years. Duration of treatment was on average 4.1 years (SD 2.44) and ranged from 0 to 10 years. Diagnosis at discharge was for 65 patients (97%) a psychotic disorder. At discharge 32 patients (47.8%) required further specialist mental healthcare, of which 4 patients were hospitalized. At 10 years follow-up 24 patients (35.8%) still required specialized mental healthcare, of which one patient was hospitalized. We obtained information on functional status of 34 patients, of which 10 (29.4%) were in remission. As far as we could retrieve, no patients had died at 10 years. Younger age at start treatment was related with poorer outcome measures in treatment at discharge and 10 year follow up. Discussion: Limited evidence gives an indication for better outcome than a less intensive and flexible approach. Especially patients under 21 may need additional interventions.
Talk 8: The Impact of Deprivation on the Health & Employment Opportunities of Individuals Living with Psychosis in Scotland
Michelle Jamieson1; 1University of Glasgow
It is estimated that only 8% of people with psychosis are in employment in the UK, and people with severe mental illness (including psychosis and schizophrenia) are six to eight times more likely to be unemployed than the general population (NICE, 2015). The low levels of employment for people with long-term mental health conditions are a major public issue in Scotland. They affect not only the national economy and public expenditure, but most importantly, individual welfare. Many efforts to raise employment rates for this group have been made, through employment service reform as well as health interventions. Access to health care and level of education may be important factors, which influence long-term health in various ways Employment in meaningful work can provide a purpose and structure in life that positivity affects self-esteem, wider community participation, and social inclusion. Equally, unemployment or unstable employment could limit opportunities and have a negative effect on physical health, social inclusion, health choices, and worsening mental health outcomes (Bouwmans et al, 2015). Reflecting on preliminary review findings and initial data analysis of longitudinal data sets on individual health and employment histories, as well as drawing from personal experience, this talk will explore ways in which personal, local and national deprivation may affect health choice and access, as well as the subsequent effect on employment opportunities, such as loss and return in individuals living with psychosis in Scotland.
Oral Session 12
Tuesday, October 9, 4:30 - 6:00 pm, St. George CD
Childhood Adversities and Trauma
Chair: Sarah Bendall, Orygen, University of Melbourne
Speakers: Sarah Bendall, Sarah Bendall, Ruchika Gajwani, Matthew Broome, Sarah Bendall, Katharine Chisholm, Helen Coughlan, Antonella Trotta
Talk 1: Testing theories of the relationship between childhood trauma and hallucinations and delusions in early psychosis: The role of post-traumatic intrusions and trauma-related beliefs
Sarah Bendall1,2, Natalie Peach Peach3, Simon Cropper4, Pamela Sun5, Mario Alvarez-Jimenez1,2; 1Orygen: The National Centre of Excellence in Youth Mental Health, 2The Centre for Youth Mental Health, University of Melbourne, 3University of New South Wales and National Drug and Alcohol Research Centre, 4School of Psychological Sciences, University of Melbourne, 5School of Psychological Sciences, Monash University
Objective. There is increasing evidence that childhood trauma plays a role in the aetiology of psychosis and in particular hallucinations and delusions. Cognitive models implicate post-traumatic intrusions as a mechanism by which childhood trauma leads to hallucinations. Model of delusions involve both post-traumatic intrusions and trauma-related beliefs as primary mechanisms. This study investigated relationships between childhood trauma, hallucinations and delusions, post-traumatic intrusions and trauma-related beliefs while accounting for comorbid symptoms. Methods. Sixty-six people with first episode psychosis aged between 15 and 24 years were assessed for hallucinations, delusions, childhood trauma, post-traumatic intrusions, post-traumatic avoidance, and trauma-related beliefs. Results. Fifty-three percent of the sample had experienced childhood trauma, and 27% met diagnostic criteria for post-traumatic stress disorder. Multiple regression analyses revealed that post-traumatic intrusions (but not childhood trauma, post-traumatic avoidance, or trauma-related beliefs) were independently associated with hallucination severity (β = .53, p = .01). Post-traumatic intrusions and trauma-related beliefs (but not childhood trauma or post-traumatic avoidance) were independently associated with delusion severity (β = .67, p < .01 and β = .34, p < .01 respectively). Conclusions. These findings support cognitive models that implicate post-traumatic intrusions in hallucination aetiology, and post-traumatic intrusions and trauma-related beliefs in delusion aetiology. This has implications for the treatment of trauma and post-traumatic stress disorder symptoms in people with psychosis. Research trialling interventions that specifically target post-traumatic intrusions and trauma-related beliefs in people with early psychosis who have experienced childhood trauma is recommended.
Talk 2: Childhood Trauma Is Associated With Severity of Hallucinations and Delusions in Psychotic Disorders: Results of a Meta-Analysis and Implications for Early Psychosis Treatment
Sarah Bendall1,2, Tom Bailey3, Carol Hulbert3, Ana Garcia-Sanchez4, Emma Barlow5, Mario Alvarez-Jimenez1,2; 1Orygen: The National Centre of Excellence in Youth Mental Health, 2The Centre for Youth Mental Health, University of Melbourne, 3School of Psychological Sciences, University of Melbourne, 4Hospital Universitario de Gran Canaria, 5Clinical Services, Port Phillip Prison
Introduction: Childhood trauma is a risk factor for the development of psychosis. Theories propose specific mechanisms by which childhood trauma may contribute to more severe positive and negative psychotic symptoms, some of which are supported empirically. The robustness of this evidence is unclear due to mixed results and methodological limitations of individual studies. A systematic review and meta-analysis of the evidence for associations between childhood trauma and severity of hallucinations, delusions and negative psychotic symptoms in groups with psychotic disorder is needed. Method: A systematic search was conducted. Reference lists of relevant review papers were hand-searched, and authors contacted for data and additional unpublished studies. Study reporting bias and quality was assessed. Results: In total, 6667 studies were identified and of these 41 studies met inclusion criteria. Of these, 29 studies (4680 participants) were meta-analysed. Among individuals with psychosis, childhood trauma was significantly correlated with severity of hallucinations (r = .199, p < .001) and delusions (r = .172, p < .001) but not correlated with severity of negative symptoms (r = .049, p = .095). Severity of childhood neglect was correlated with negative symptoms (r = .142, p = .005). Conclusion: The results have important implications for early psychosis treatment. Childhood trauma should be assessed for routinely in early psychosis and interventions developed to treat hallucinations and delusions using trauma-focussed interventions. More research and training in how to assess and treat the effects of trauma sensitively and effectively is essential to the delivery of trauma-informed services for early psychosis.
Talk 3: Adverse childhood experiences and neurodevelopmental disorders – a double jeopardy for juvenile mania?
Ruchika Gajwani1, Lisa Dinkler2, Sebastian Lundström2,3, Paul Lichtenstein4, Christopher Gillberg1,2, Helen Minnis1; 1Institute of Health and Wellbeing, University of Glasgow, 2Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, 3Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
Objectives: The aims of the study were to understand the relative importance of the contribution of adverse childhood experiences (ACEs) and neurodevelopmental disorders (NDDs) to juvenile mania symptoms, and to investigate a model for the interaction between ACEs and NDDs that would explain why some adolescents at a greater risk of developing mania. Methods: We used a prospective sample from a nationwide birth cohort study, comprising 3,348 twins born in Sweden between 1998 and 2001. Parents reported on ACEs and NDDs at age 9 and on symptoms of mania at age 15. Results: Having ACEs or NDDs at age 9 significantly increased number of mania symptoms at age 15. NDDs seemed to have a slightly higher risk effect on mania symptoms than ACEs (boys/girls: d = 0.23/0.28), although this difference was not statistically significant. Children who have experienced both ACEs and NDDs are at double jeopardy for juvenile mania as they showed significantly more mania symptoms than children with ACEs-only (d = 0.48/1.40) and girls with NDDs-only (d = 1.03). Males with both exposures did not differ significantly in mania symptoms from males with NDDs-only (d = 0.19). Conclusions: The study suggests that apart from ACEs, NDDs are an at least equally important factor to consider in the development of severe mental disorder. Families of children presenting with ACEs and/or NDDs need increased support.
Talk 4: Bullying Victimisation and Risk of Psychotic Phenomena
Matthew Broome1, Gennaro Catone2,3, Guisi Moffa4,5, Jack Kuipers6, Elizabeth Kuipers7, Daniel Freeman8, Steven Marwaha9, Belinda Lennox8, Paul Bebbington4; 1Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK, 2Università della Campania Luigi Vanvitelli, Naples, Italy, 3Faculty of Educational Sciences, Suor Orsola Benincasa University, Naples, Italy, 4Division of Psychiatry, University College London, London, UK, 5Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland, 6D-BSSE, ETH Zurich, Basel, Switzerland, 7Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK, 8Department of Psychiatry, University of Oxford, Oxford, UK., 9Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Introduction Being bullied is an aversive experience with short- and long-term consequences. We used the 2000 and the 2007 British Adult Psychiatric Morbidity Surveys to test the hypothesis that bullying is associated with individual psychotic phenomena and with psychosis. Methods Respondents were presented with a card listing stressful events to identify experiences of bullying over the entire lifespan. We assessed associations with the dependent variables persecutory ideation, auditory and visual hallucinations, and diagnosis of probable psychosis. We used directed acyclic graphs (DAGs) to analyse data to assess putative mediators of the association between bullying victimization and psychosis. We compared results using DAGs and the Karlson-Holm-Breen (KHB) logistic regression commands in STATA. Results We used data for 8580 respondents from 2000 and 7403 from 2007. Bullying was associated with presence of persecutory ideation and hallucinations. Bullying was associated with a diagnosis of probable psychosis. If reported at baseline, bullying predicted emergence and maintenance of persecutory ideation and hallucinations during 18 months of follow-up in the 2000 survey. DAG analysis revealed a richer structure of relationships than could be inferred using the KHB commands. Bullying had direct effects on worry, persecutory ideation, mood instability, and drug use. Bullying led to hallucinations indirectly, via persecutory ideation and depression. Conclusion Bullying victimisation increases the risk of individual psychotic symptoms and of a diagnosis of probable psychosis. DAGs indicate the complex interactions seen in psychiatry, including the mechanisms underpinning psychiatric symptoms. It may consequently be used to optimize the choice of intervention targets.
Talk 5: What stops young people from seeking help for the effects of trauma? A qualitative analysis of internet forums
Sarah Bendall1,2, Katherine Truss3, Jocelyn Liao3, Lisa Phillips3; 1Orygen: The National Centre of Excellence in Youth Mental Health, 2The Centre for Youth Mental Health, University of Melbourne, 3School of Psychological Sciences, University of Melbourne
Exposure to trauma is common in childhood and adolescence, and is associated with significant psychopathology including posttraumatic stress, mood and anxiety disorders, substance use, and personality disorders and psychosis. Despite being amenable to treatment, many young people suffering trauma-related distress do not seek professional help. Researching barriers to professional help-seeking is difficult as young people not engaged with services are difficult to access. Internet forums provide a solution as young people may access internet forums but not traditional services and they often describe their experiences in detail online. This study aimed to identify personal barriers young people perceived to seeking help for trauma in offline contexts. This study has a qualitative, netnographic design, following the six-step LiLEDDa framework, developed for the analysis of online forums. Posts from 76 threads about trauma (176 participants) written in 2016 from five internet forums targeting young people were included and analysed by thematic analysis. Barriers to offline help-seeking for trauma aligned with five key themes: questioning the validity of the trauma response; negative beliefs about the self; fears about a negative response; difficulties trusting others; and a lack of personal readiness. Understanding of these barriers gives information about targets for psycho-education for victims of trauma; those who support them; and professionals as to how to reduce barriers to access to trauma treatment. These results can be used to facilitate provision of services to vulnerable young people by directly targeting commonly difficulties early in the course of treatment to reduce distress and drop-out.
Talk 6: The role of resilience in mediating childhood trauma with symptoms and functioning in individuals with psychosis, risk for psychosis, depression, and healthy controls: A comparison of participants from the PRONIA Consortium dataset
Katharine Chisholm1, Alexandra Stainton1, Sian Griffiths1, Mariam Iqbal1, Stephen Wood2, Rachel Upthegrove1, The PRONIA Consortium3; 1Institute for Mental Health, University of Birmingham, 2Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne; Centre for Youth Mental Health, University of Melbourne, 3The PRONIA Consortium consists of 11 partners from five different EU member states as well as Switzerland and Australia
Childhood trauma has been found to play a role in development and severity for a wide range of psychopathology. Psychological resilience may represent a protective mechanism against the development of mental illness, and has been related to lower symptom severity and better functioning. The current study aimed to investigate the potential mediating role of resilience between childhood trauma, symptoms and functioning. Trauma was measured using the CTQ and resilience via the RSA. Psychotic-spectrum symptoms were measured using the SIPS. Depression was measured via the BDI-II. The GAF was used to measure functioning, including functional burden caused by symptoms, as well as disability/impairment. 710 participants aged 14-40 were included in the analysis. This included 155 first-onset psychosis (FOP), 137 clinical high-risk for psychosis (CHR), 145 first-onset depression (FOD), and 273 healthy controls (HC). Resilience was found to significantly mediate the relationship between childhood trauma and depression in all participant groups. For HC and ROD participants, resilience mediated the relationship between childhood trauma and both functioning subscales. For ROP and CHR, resilience mediated the relationship between childhood trauma with general and negative psychotic-spectrum symptoms. For the CHR group resilience mediated the relationship between childhood trauma and GAF disability/impairment. Resilience was not found to play a mediating role between childhood trauma and positive or disorganised psychotic-spectrum symptoms for any participant group. Interventions promoting resilience in individuals who have experienced childhood trauma may potentially help to protect against a variety of negative outcomes in later years, in particular those related to depression.
Talk 7: Archetypes of early adverse life experiences and their relationship with later life outcomes among young adults who reported hallucinatory and delusional phenomena in adolescence: a multiple case study analysis
Helen Coughlan1, Niamh Humphries2, Mary Clarke1, Mary Cannon1; 1Royal College of Surgeons in Ireland, 2Royal College of Physicians of Ireland
Background: Childhood adversity is associated with hallucinatory and delusional phenomena across the psychosis continuum. It is also associated with a range of unfavourable psychopathological and functional outcomes. To better understand the differential outcomes among young people who report early hallucinatory and delusional phenomena, novel exploratory research is needed to uncover the dynamic interplay between adverse and protective factors in childhood. Aim: Among a sample of young adults who reported hallucinatory and/or delusional phenomena during their early adolescent years, this study aimed to search for archetypal models of early adverse and protective life experiences within and across cases and to consider any emergent archetypes in the context of participants’ current mental health, wellbeing and functioning. Methods: This qualitative study used a multiple case study approach to examine the early life experiences of young adults aged 18-21 years who had reported hallucinatory and delusional phenomena during adolescence. Study participants were members of an existing population-based study cohort examining trajectories of mental health among Irish youth. Findings: All study participants reported adverse life experiences. Three primary archetypes of early life experiences emerged from the data: 1] Complex Adversity; 2] Needs Not Met; and 3] Needs Met. The archetypes were dynamic and did not, on their own, account for differences in outcomes across cases. The archetypes were used to develop a model of risk that incorporated additional risk and protective factors found. Those who were most at risk for poor outcomes had experienced complex adversity in the absence of corrective or protective experiences.
Talk 8: Associations between childhood adversity, C-Reactive Protein levels, and psychotic symptoms in childhood: a Longitudinal Twin Cohort Study
Antonella Trotta1, Louise Arseneault1, Andrea Danese1, Terrie Moffit1,2, Avshalom Caspi1,2, Helen Fisher1; 1Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 2Department of Psychology & Neuroscience, Duke University
Background: Both human and animal studies suggest that childhood exposure to stress can trigger a persistent inflammatory response, similar to the response the body has in the case of physical injury. A significant etiological role for immune-related processes and inflammation has been showed also in psychosis. We hypothesized that maltreated children who also experienced psychotic symptoms at the time of inflammation assessment would show elevated high-sensitivity (hs) CRP levels. Methods: The sample included 172 children from the E-Risk Longitudinal Twin Study. Childhood victimisation was measured prospectively from birth to age 12 years. Each child was privately interviewed at age 12 about seven psychotic symptoms pertaining to delusions and hallucinations. Inflammation at age 12 was assessed based on levels of hsCRP collected through blood spots. Independent samples t-tests were conducted to calculate mean differences in age-12 hsCRP in children exposed to severe victimisation with and without psychotic symptoms and children with no exposure to victimisation with and without psychotic symptoms. Results: We found significant mean differences in hsCRP between groups. Severely victimised children with psychotic symptoms showed a significant mean elevation in hsCRP levels compared with victimised children without psychotic symptoms [t(98)=3.04, p=0.003]. In contrast, non-victimised children with psychotic symptoms showed mean hsCRP levels similar to their peers without psychotic symptoms [t(70)=0.40, p=0.687]. Conclusions: Children experiencing severe victimisation and psychotic symptoms showed significantly elevated inflammation levels. The present study therefore provides the first evidence that the origins of these abnormalities in stress-sensitive systems could be traced back to the childhood years.
Oral Session 13
Wednesday, October 10, 1:00 - 2:30 pm, Staffordshire
Treatment with Antipsychotics
Chair: Marc-André Roy, Université Laval, CNDV/IUSMQ/CIUSSS-CN, Canadian Consortium for Early Intervention in Psychosis
Speakers: Marc-André Roy, Marie-Michelle Tremblay, Brian O'Donoghue, Amal Abdel-Baki, Sally Mustafa, Nikolai Albert, Donald Goff, Anne Katrine Pagsberg
Talk 1: The Impact of Clozapine Use in Early-Intervention: a Retrospective Chart Audit
Marc-André Roy1,2,3, Marie-France Demers2,3,4, Candice Crocker3,5, Nicola Banks3,6, Richard Williams3,7, Andrea Bardell3,7, Phil Tibbo3,5; 1Département de Psychiatrie et Neurosciences, Faculté de Médecine, Université Laval, Québec, PQ, Canada, 2CNDV/IUSMQ/CIUSSS-CN, Québec, PQ, Canada, 3Canadian Consortium for Early Intervention in Psychosis, 4Faculté de Pharmacie, Université Laval, Québec, PQ, Canada, 5Dalhousie University, Halifax, NS, Canada, 6Myelin, Toronto, ON, Canada, 7University of Victoria, Victoria, BC, Canada
To assess the impact of Clozapine in Early-Intervention Programs (EIP), we retrospectively reviewed the charts of 147 patients with a schizophrenia spectrum psychotic disorder consecutively admitted to either of 3 EIP. Subjects aged 18-30 had been followed for ≥3 years. We collected, for each antipsychotic trial, dosage, duration of trial and adherence, and CGI-S once the medication was judged optimal. 115/147 patients (78%) reached full remission (CGI-S ≤3) during the chart review interval. 29/147 (19.7%) were exposed to clozapine, after a mean of 2.89 antipsychotic trials; Clozapine was initiated on an outpatient setting in 55% of cases. Total remission was reached for 20/29 (69%) Clozapine patients and partial remission (CGI-S = 4) in 9/29 (31%). More clozapine exposed patients, in comparison to the others, were on community treatment order (41 vs 28%, respectively); had comorbid substance use disorder (83 vs 64%) or personality disorder (21 vs 6%). Besides treatment resistance, other reasons to prescribe Clozapine included prior EPS (6/29), substance use disorder (9/29), suicide or violence risk (4 for each). Among unremitted patients not on Clozapine, reasons not to prescribe clozapine were insufficient severity of symptoms (n=5), expectations of severe adherence problems (n=8), major substance use disorders (n=6). Interestingly, in a single case was patient’s refusal identified as a cause for not using Clozapine. Keeping in mind its limitations, this chart audit confirms that response rates to Clozapine may be particularly high in this population and it can be in some instances successfully used patients with a typical non-adherent profile.
Talk 2: Long-acting Aripiprazole in First-Episode Psychosis: does one size fit all?
Marie-Michelle Tremblay1,2, Sarah-Maude Rioux1,2, Charlie Fraser1,2, Geneviève Picher3, Chantal Mérette1,3, Anne-Pierre Bouffard1,2, Sophie L'heureux1,2, Marie-France Demers2,3,4, Marc-André Roy1,2,3; 1Département de Psychiatrie et Neurosciences, Faculté de Médecine, Université Laval, Québec, PQ, Canada, 2CNDV/IUSMQ/CIUSSS-CN, Québec, PQ, Canada, 3Centre de recherche CERVO, Québec, PQ, Canada, 4Faculté de Pharmacie, Université Laval, Québec, Canada
Recommendation on long-acting injectable (LAI) aripiprazole dosage based on phase II and phase III are that a 400mg dosage would be appropriate in 90% of patients and 300mg in 10%. Since these trials were performed in patients aged around 40, it is not known if they apply to first-episode psychosis (FEP). We are systematically reviewing extensive medical charts of all 61 patients from our FEP program who have been exposed to LAI Aripiprazole (average exposure: 15 months) and followed intensively by an inter-disciplinary team. Two trained psychiatry residents independently performed monthly ratings of efficacy (CGI-S) and tolerability (CGI-CB side effects subscale) and disagreements were reviewed to reach consensus and dosage was recorded. LAI dosage used was generally based on the following rules: patients were first stabilized on oral Aripiprazole to assess an optimal dosage; based on the latter, the first injection was either 400 or 300mg; the LAI dosage targeted at equilibrium was approximately 1mg oral for 20mg LAI and was adjusted based on response. 47.5% of patients were stabilized (CGI-S≤3; CGI-CB subscale ≤2 for ≥6 months) at dosages <300mg and 14.8% at dosages ≤200mg. 14/49 patients who received ≤300mg at some stage required lower dosage due to side effects. These preliminary results of our ongoing study suggest that it may be appropriate and/or needed to use LAI Aripiprazole dosage below 300mg in a significant proportion of FEP patients; hence, close monitoring of severity and tolerability may be required to “fine tune” LAI Aripiprazole dosage.
Talk 3: Predictors of outcomes following discontinuation of antipsychotic medication after a first episode of psychosis – findings from a systematic review and cohort study
Brian O'Donoghue1,2,3, Meghan Bowtell1,2, Aswin Ratheesh1,2,3, Eoin Killackey1,2, Patrick McGorry1,2; 1Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 2Centre for Youth Mental Health, University of Melbourne, Australia, 3Orygen Youth Health, Melbourne, Australia
Background: There is uncertainty about the required duration of long-term antipsychotic maintenance medication after a first episode of psychosis (FEP). While clinical guidelines recommend at least one year of maintenance treatment, individuals often cease their medication prior to this. Reliable predictors of outcome following discontinuation could assist clinicians in advising individuals about maintenance treatment. Findings on the predictors of outcome following discontinuation from a systematic review and a cohort study will be presented. Methods: A systematic review on predictors of outcome following discontinuation was performed with PubMed, CINAHL and PsychInfo databases. For the cohort study, a retrospective study of all individuals presenting to the Early Psychosis Prevention and Intervention Centre between 01/01/11 and 31/12/13 was conducted. A Cox regression analysis was conducted to identify predictors of relapse. Results For the systematic review, a total of eleven studies fulfilled the inclusion criteria and a range of predictors of relapse were identified, including male sex, unemployment, a diagnosis of schizophrenia and more negative symptoms. In the cohort study, 544 young people with a FEP were included and 61% underwent a trial of discontinuation was undertaken. Amongst those trialing discontinuation, 113 (34%) experienced relapse in a median follow-up time post discontinuation of 372 days. Predictors of relapse were cannabis abuse disorder and longer duration of antipsychotic medication. Conclusions: Antipsychotic discontinuation frequently occurs earlier than guidelines recommend. Individuals with a diagnosis of cannabis abuse are more likely to experience relapse and addressing this substance abuse prior to discontinuation could possibly reduce relapse rates.
Talk 4: Impact of early use of long-acting injectable antipsychotics on psychotic relapse and re-hospitalization in first-episode psychosis
Amal Abdel-Baki1, Sofia Medrano1, Catherine Maranda1, Martin Ladouceur2, Ramzan Tahir1, Emmanuel Stip1, Stéphane Potvin3; 1Centre Hospitalier Université de Montréal, 2Jewish General Hospital, 3Institut universitaire en santé mentale de Montréal
Background: Early relapse is frequent in first-episode psychosis (FEP), mainly because of poor adherence to medication. Previous studies have shown positive impacts of long-acting injectable antipsychotics (LAI-AP) on relapse rates, while others have discerned no differences. This discrepancy can be explained by dissimilar methodologies and non-representative samples (e.g. exclusion of substance use disorder (SUD)). Objectives: To describe the impact of early LAI-AP utilization on relapse and re-hospitalization rates in FEP. Methods: A 3-year, longitudinal, prospective, naturalistic study of all admissions of psychosis patients for early intervention services was conducted. In total, 416 patients were subdivided into 4 groups according to the route of antipsychotic administration. Results: Patients who received LAI-AP at first were more likely to be affected by poor prognostic factors (lower pre-morbid functioning, homelessness, SUD and schizophrenia spectrum diagnoses). However, their relapse rate over time was similar to those with good prognostic factors who only received oral antipsychotics (OAP). Patients who were initially prescribed OAP and eventually switched to LAI-AP were more likely to relapse and to be re-hospitalized (in a larger proportion and more rapidly), even if they manifested better functioning at baseline than those started on LAI-AP. However, they were younger and more likely to have SUD. Conclusion: Patients with poor prognosis and younger patients in the early stage of their disease seem to benefit from early prescription of LAI-AP. Since the latter are often still at school or at work at admission, relapse prevention seems particularly relevant to avoid functional deterioration.
Talk 5: Predictors of 'all cause discontinuation' of initial oral antipsychotic medication in first episode psychosis
Sally Mustafa1, Srividya Iyer1,2, Ridha Joober1,2, Jai Shah1,2, Martin Lepage1,2, Ashok Malla1,2; 1Douglas Mental Health University Institute, 2Department of Psychiatry, McGill University
Discontinuation of the initial oral antipsychotic prescribed for a first episode of psychosis (FEP) can derail outcome. Our objective was to examine the rate of and time to all-cause discontinuation of the first antipsychotic prescribed and the factors influencing such discontinuation. In a sample of 390 FEP patients, we estimated the rate of and time to discontinuation of the initial antipsychotic over a one-year period. The effects of a number of putative predictors of discontinuation were estimated using regression analyses. Rate of discontinuation of the first antipsychotic was 72%, with no difference between the 3 investigated antipsychotics (olanzapine (73%), risperidone (68%) and aripiprazole (75%)), (χ2 (2) =1.89, p=.388). Mean time to discontinuation was 7.2 (4.6) months and was not different among the three antipsychotics (Log-rank χ2 (2) = .257, p = .879). Binary logistic regression showed that higher positive and negative symptoms remission and baseline functioning were associated with lower rates of discontinuation (Nagelkerke R2 = .36, χ2 (10) = 66.9, p < .001). Multiple linear regression showed the same predictors, in addition to male gender and less weight gain per month of exposure to the initial antipsychotic, to be associated with longer time to discontinuation (adjusted R2 = .336, F (9, 219) = 13.8, p < .001). Discontinuation of the initial antipsychotic is a major concern in the course of treating FEP. Symptom relief, better functioning and lower side effects appear to be the major factors associated with continuing an antipsychotic medication.
Talk 6: Cognitive functioning following discontinuation of antipsychotic medication. A sub-group analysis from the OPUS II trial.
Nikolai Albert1, Lasse Randers1, Kelly Allott2,3, Heidi Dorthe Jensen1, Marianne Melau1, Carsten Hjorhøj1, Merete Nordentoft1,4; 1Copenhagen University Hospital, Mental Health Centre Copenhagen, 2Orygen, The National Centre of Excellence in Youth Mental Health, 3Centre for Youth Mental Health, The University of Melbourne, 4University of Copenhagen
Background - The effect of antipsychotics medication on cognitive functioning in patients diagnosed with schizophrenia is poorly understood. Some studies of second-generation antipsychotics indicated that they improved cognitive functioning while other studies have found that they decrease the level of cognitive functioning. Method - We included patients with schizophrenia who were in treatment with antipsychotics 1.5 years (baseline) after initiation of treatment and followed them up 3.5 years later (n=189). At follow-up 60 (32%) had discontinued their antipsychotic treatment and 129 (68%) were still taking antipsychotics. Using the Brief Assessment of Cognition in Schizophrenia (BACS) we assessed cognition at baseline and follow-up. Outcome - The patients who had discontinued their medication had a higher level of cognitive functioning in all domains at baseline, as well as Global cognitive function (mean z-score -1.50 (SD 1.24) vs. -2.27 (SD 1.30), p=.00015). After controlling for relevant confounders those who discontinued antipsychotic medication improved significantly more than those who remained on antipsychotic medication during the course of the follow-up on the Token Motor task, the Speed of Processing Domain and Global cognition. Interpretation - Due to the naturalistic design we cannot conclude on the direction of the relationship between antipsychotic medication and cognition. There is no evidence that discontinuation of medication had a negative effect on cognitive functioning. Rather, we find that that discontinuation of medication was associated with better cognitive functioning
Talk 7: Citalopram in first episode psychosis: the DECIFER Trial
Donald Goff1,2, Jijun Wang3, Oliver Freudenreich4, Chenxiang Li5, Andrea Troxel5, Botao Zeng6, Renrong Wu7, Corinne Cather5, Babak Ardekani1,2, Daphne Holt5, Iruma Bello8, Yingping Zhao7; 1Department of Psychiatry, New York University School of Medicine, New York, 2Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 3Shanghai Mental Health Center, Jiaotong University School of Medicine, Shanghai, China, 4Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, 5Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, 6Qingdao Mental Health Center, Qingdao, China, 7The Second Xiangya Hospital of Central South University, Changsha, China, 8Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York
To determine whether add-on citalopram would improve negative and depressive symptoms in individuals with nonaffective first episode psychosis (FEP), we conducted a 12 month, placebo-controlled trial at sites in Boston, New York, Shanghai and Changsha, China. Ninety five individuals with FEP treated with second generation antipsychotics for 4-16 weeks and without significant depressive symptoms (CDSS score < 7) were randomized to add-on treatment with citalopram 40 mg/day or placebo; all participants received 24 sessions of psychoeducation. Fifty-one participants (54%) completed the 12 month trial. Mixed effects area under the curve (AUC) analysis revealed a significant reduction in ratings of depression (CDSS) in the placebo group compared to citalopram (p= .02). Negative symptoms were reduced with citalopram compared to placebo (p=.04); among the four SANS subscales, only the avolition subscale significantly improved with citalopram versus placebo (p= .002). The effect size of citalopram versus placebo on negative symptoms (SANS total) was .32 for participants with a duration of untreated psychosis (DUP) of less than 18 weeks (median split) and .52 for participants with a DUP greater than 18 weeks. Sexual side effects were more common with citalopram than placebo, but the overall mean number of treatment-emergent side effects was not increased with citalopram. Conclusion: In FEP patients without clinically-significant depression at baseline, citalopram reduced levels of negative symptoms, particularly in participants with long DUP, but depressive symptoms improved more with placebo.
Talk 8: Early non-response to antipsychotic medication in adolescents with first-episode psychosis is a reliable predictor of ultimate non-response and non-remission: Results from the 12-week TEA trial
Anne Katrine Pagsberg1, Pia Jeppesen1, Dea Gowers Klauber1, Karsten Gjessing Jensen1, Ditte Rudå1, Jens Richardt M. Jepsen1, Birgitte Fagerlund1, Amanda Krogmann2, Laura von Hardenberg2, Anders Fink-Jensen1, Christoph U Correll2,3, Britta Galling2; 1Copenhagen University Hospitals, 2Charité Universitätsmedizin, 3Hofstra University
Objective: To evaluate whether early response/non-response (ER/ENR) to antipsychotics can predict ultimate response/non-response (UR/UNR) and remission/non-remission, and to compare the Positive and Negative Syndrome Scale (PANSS)-30-items to the PANSS-6-items and Clinical Global Impressions Scale (CGI) regarding prediction of response/non-response and remission/non-remission in youth with psychosis. Methods: Data from 12-week, double-blinded, randomized trial of aripiprazole (2.5-20 mg/day) versus quetiapine (50-600 mg/day) in adolescents with first-episode psychosis (age=12-17 years). Therapeutic antipsychotic doses were reached at day 9. ER definition: ≥20% symptom reduction (PANSS-30) at week-2 or week-4 (ER2/4) (or: “≥minimally improved” (CGI-I) and ≥20% symptom reduction (PANSS-6)). UR definition: ≥50% symptom reduction. Remission definition: “Andreasen criteria”. Analyses: positive/negative predictive values (PPV/NPV), and logistic regression to identify moderators/mediators of UR/UNR and remission/non-remission. Results: Patients (n=87; age=15.2±1.4 years; male=35.6%) had a mean 32.0±28.2% symptom decrease, most pronounced within the first two weeks. UR and remission rates were low (28.7%; 19.5%). ER2/ER4 could not predict UR (ER2: PPV=40.0%, ER4: PPV=38.2%) and remission (ER2: PPV=27.5%, ER4: PPV=27.3%), while ENR reliably predicted UNR (ENR2: NPV=80.0%, ENR4: NPV=87.5%) and non-remission (ENR2: NPV=84.4%, ENR4: NPV=90.6%). Besides ER/ENR-status, no significant demographic, illness or treatment variables were significant moderators/mediators of endpoint outcomes. PANSS-6 had similar predictive significance as PANSS-30 for non-response/non-remission. Outcomes were heterogeneous using CGI. Conclusion: Clinical treatment decisions should be informed by standardized assessments. A <20% reduction of PANSS-6-items at week-2 and, even more so, at week-4 is a feasible and clinically relevant alternative to PANSS-30 assessments to reliably predict 12-week non-response/non-remission. In patients with ENR4, consider antipsychotic switch.
Oral Session 14
Wednesday, October 10, 1:00 - 2:30 pm, St. George AB
Phenomenology: Identification in Early Psychosis
Chair: Jason Schiffman, University of Maryland, Baltimore (UMBC)
Speakers: Jason Schiffman, Dorien Nieman, Danny Koren, Benjamin Brodey, Andrea Polari, David Cotter, Danny Koren, LENA PALANIYAPPAN
Talk 1: Risk or Typical Development? The Impact of Race, Neighborhood Crime, and Age on Accurate Identification of Ultra High Risk States
Jason Schiffman1, Zachary B. Millman1, Pamela Rakhshan1, Nicole Andorko1; 1University of Maryland, Baltimore (UMBC)
Introduction: False positive identification of youth at Ultra High Risk (UHR) for psychosis is a critical limitation to psychosis prevention efforts. Contextual factors including race, neighborhood safety, and age may affect the validity of semi-structured interviews and self-report screeners designed to target this population. Methods: Help-seeking adolescents/young adults (N=134) ages 12-25 completed the Prime Screen and the Structured Interview for Psychosis-risk Syndromes (SIPS). A neighborhood crime index was calculated based on federal data and participant addresses. The influence of race, neighborhood crime, and age on Prime Screen scores, SIPS symptoms, and SIPS (UHR) diagnosis was examined. Results: Higher Prime Screen scores increased the probability of meeting UHR criteria for White participants, but not Black participants, even after controlling for age, household income, and mood disorder (interaction: b = -0.50 Wald χ2 = 4.63, p = .03, Exp[B] = 0.60). Neighborhood crime uniquely predicted suspiciousness scores over and above other UHR symptoms (b = 0.20, t = 2.14, p = .04, f2 = 0.08). Younger participants were more likely to use the Prime Screen as a dichotomous (yes/no) screener relative to older participants, reducing screener efficacy (b = -0.04, Wald χ2 = 4.69, p = .03, Exp[B] = 0.96). Discussion: The results collectively suggest that contextual factors influence the accurate identification of youth at UHR, through their effect on both screener- and interview-based assessment. Sensitivity to these and other individual differences is important for accurate identification and prevention of early psychosis.
Talk 2: From Clinical Staging and Profiling to Prevention in Mental Health Care
Dorien Nieman1, Stephan Ruhrmann2, Mirjam van Tricht1, Hans Koelman1, Lieuwe de Haan1; 1University of Amsterdam, 2University of Cologne
Accumulating evidence suggests that a blend of clinical staging and profiling, which naturally incorporates an clinical high-risk phase, might be a better guide for treatment of patients in different stages of psychiatric illness than the categorical DSM diagnostic system. The prognostic index (PI) is a well-established and widespread risk-modelling procedure that is used for multivariate clinical staging and profiling in somatic medicine. In a PI, individual prognostic scores are stratified into different risk classes for clinical usability. We investigated a PI in subjects at clinical high-risk for a first psychotic episode. Out of a comprehensive set of predictors, the P300 event related potential and premorbid adjustment were identified as the key elements in an individualized prognostic score. The individual prognostic scores were further stratified into three risk classes. In the class with the worst premorbid adjustment and P300 deficits, 74% of the subjects made a transition to a first psychosis whereas in the lowest risk class only 4% transitioned. Thus, compared with the overall transition rate of 29% predicted by the inclusion criteria, application of the PI improved individual risk estimation significantly. Research should focus on benign treatments to reduce P300 deficits in the early stages. Perhaps objective biomarkers such as the P300 combined with clinical symptoms, existential concerns and psychosocial functioning could be used in the future in a clinical staging model to assess a patients’ individual risk and need for particular types of care instead of the current general characterisation of the patients’ symptoms with respect to the broad DSM criteria.
Talk 3: Reducing the Stigmatizing Risks of the ‘At-risk’ State: Promising Pilot Results from Two Experimental Vignette Studies of the Effects of Labeling versus Symptoms Severity
Danny Koren1, Dana Carmi1; 1University of Haifa
Aim: The goal of this presentation is to introduce the notion that restructuring the ‘at-risk’ state for psychosis as ‘high-risk health’ has the potential to reduce the stigmatizing risks of this state, and to present pilot data that provide preliminary support for its validity. Method: In the first study, a sample of 125 adults from the general population read an experimental vignette describing an adolescent experiencing either mild or severe prodromal symptoms who were randomly assigned a ‘psychosis-risk’ or ‘high-risk reality testing’ diagnostic label and answered questions about public stigma. In the second study, a sample of 254 mental health professionals read the same experimental vignette who this time was randomly assigned an ‘attenuated psychosis’ or ‘reality-testing loss’ diagnostic label. Results: In the first study, the ‘high-risk reality testing’ label elicited significantly higher appraisals of self-image, hope, likelihood of seeking help, and need for care than the ‘psychosis risk’ label. Similarly, in the second study, the ‘reality-testing loss’ label elicited higher appraisals of self-image, hope, likelihood of seeking help, and importance of providing care than the ‘attenuated psychosis’ label. In both studies, no effects were found for symptom severity. Discussion: These pilot results provide first empirical support for the social and clinical potential of ‘high-risk health’ formulations in minimizing the potential stigmatizing harms of ‘at-risk’ diagnostic labels and improving help-seeking behaviors. Also, they lay the foundation for future studies that will replicate and extend the above findings using focus-groups and more ecologically valid manipulations among individuals at risk for psychosis.
Talk 4: The Early Psychosis Screener (EPS-SVM): a Practical Self-Report Tool using Machine Learning to Predict Psychosis
Benjamin Brodey1, Ragy Girgis2, Oleg Favorov3, Carrie Bearden4, Scott Woods5, Jean Addington6, Diana Perkins3, Elaine Walker7, Barbara Cornblatt8, Gary Brucato2, Susan Purcell1, Kristin Cadenhead9; 1TeleSage, Inc., 2New York State Psychiatric Institute, 3University of North Carolina at Chapel Hill, 4University of California Los Angeles, 5PRIME Psychosis Prodrome Research Clinic, Connecticut Mental Health Center, 6University of Calgary, 7Emory University, 8The Zucker Hillside Hospital, 9University of California, San Diego
Introduction: A more accurate self-report screener for early psychosis would help to promote early identification and intervention. Methods: Self-report Likert-scale survey items were administered to individuals being screened with the gold standard Structured Interview for Psychosis-risk Syndromes (SIPS) at eight specialty early psychosis clinics. An a priori analytic plan included Spectral Clustering Analysis (SCA) to reduce the item pool followed by development of Support Vector Machine (EPS-SVM) identification algorithms. Results: The cross-validated positive predictive value (PPV) of the EPS-SVM at the optimal cut-off (76.5%) exceeded that of the clinician administered SIPS (68.5%) at differentiating clients in specialty early psychosis clinics who would not convert to psychosis within 12 months from those who either would convert within 12 months or who had already converted. When used in tandem with the SIPS with CHR participants, the EPS-SVM increased the combined PPV to 86.6%. The SVM classified as FEP/converters only 1% of individuals in non-clinical and 4% of clinical control populations. Sensitivity of the EPS-SVM, however, was approximately 50%. Discussion: The EPS-SVM can identify, comparably to the SIPS but in far less time and with fewer resources, a group of individuals who are either at very high risk to develop a psychotic disorder within 12 months or who are already experiencing a FEP. Compared to the SIPS, however at the optimal cut-off, current or future psychotic cases are missed by EPS-SVM approximately 50% of the time. The cut-off can be selected based on purpose. A free on-line screening system, eps.telesage.org, is under development.
Talk 5: Clinical prediction besides transition to psychosis in the Ultra-High Risk for psychosis population
Andrea Polari1,2,3, Suzie Lavoie2,3, Hok Pan Yuen2,3, Paul Amminger2,3, Gregor Berger4, Eric Chen5, Lieuwe deHaan6, Jessica Hartmann2,3, Connie Markulev2,3, Dorien Nieman7, Merete Nordentoft8; 1Orygen Youth Health, 2Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 3Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia, 4Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland, 5Department of Psychiatry, the University of Hong Kong, Hong Kong, China, 6Academic Medical Centre, University of Amsterdam and Arkin Institute for Mental Health, Amsterdam, The Netherlands, 7Academic Medical Centre, Department of Psychiatry, Amsterdam, The Netherlands, 8Psykiatrisk Center København, Forskningsenheden, København, Denmark
Introduction Several prediction models have been introduced to identify young people at greatest risk of transitioning to psychosis but to date none have examined prediction of outcomes other than transition. Aims To examine associations between baseline clinical predictors and outcomes besides transition to psychosis and to develop a prediction model for those outcomes. Method Several evidence-based variables previously associated with transition to psychosis and some important clinical comorbidities experienced by Ultra-High Risk (UHR) individuals were identified in 202 UHR individuals. Analyses were conducted to investigate the associations between these variables and favourable (remission and recovery) or unfavourable (transition to psychosis, no remission, any recurrence and relapse) clinical outcomes, which were defined using the individuals' responses in terms of positive symptoms and functioning at months 3, 6, 9 and 12. Logistic regression, best subset selection, Akaike Information Criterion and Receiver Operating Characteristic curves were used to seek the best prediction model for clinical outcomes from all combinations of possible predictors. The baseline variables considered included MADRS, SANS, BPRS, Attenuated Psychotic Symptoms, SOFAS, Substance Use Disorders, Duration of Untreated Symptoms (DUS) and Borderline Personality Disorder. Results When considered individually, only higher Total BPRS (p=0.023) and increased DUS (p=0.042) were associated with unfavourable outcomes. Two best prediction models of clinical outcomes were identified: 1. Total BPRS and SOFAS and 2. Total BPRS, SOFAS and DUS. Discussion Although Total BPRS, SOFAS and DUS appear to be predictive of unfavourable outcomes, the predictive performance of the resulting model requires improvement and further research is needed.
Talk 6: Complement Pathway Changes at Age 11 Are Associated with Psychotic Experiences at Age 18 and with Persistence of Psychotic Experiences from Age 11 to Age 18; Evidence from a Nested Case Control Study of the ALSPAC Birth Cohort.
David Cotter1, Melanie Focking1, Glyn Lewis2, Lorna Lopez1, Jane English1, Pat Dicker1, Bart Rutten4, Mary Cannon1, Stan Zammit3; 1RCSI, 2University College London, 3University of Bristol & Univerisity Cardiff, 4University of Maastricht
Background: The complement cascade is a major component of the immune defence against infection, and there is increasing evidence for a role of dysregulated complement in major psychiatric disorders. Methods: We undertook a hypothesis-driven proteomic analysis of the complement signalling pathway (n=33 proteins). Participants were recruited from the UK ALSPAC cohort who participated in psychiatric assessment interviews at ages 11 and 18. Protein expression levels at age 11 among individuals who first reported psychotic experiences (PE Study) at age 18 (n=64) were compared with age-matched controls (n=67). Using the same methods we examined participants with Persistent Psychotic Experiences (PPE Study) and we compared complement protein expression between individuals who reported psychotic experiences at both age 11 and age 18 (n=38) compared to age-matched controls who only experienced PEs at age 11 (n=38). Results: In the PE study, 6 out of the 32 targeted complement proteins were significantly upregulated (C1RL↑, VTN↑, C8B↑, C8A↑, CFH↑, C5↑). In the PPE study, we observed that 5 of 32 targeted complement proteins were differentially expressed (C1RL↑,C2↑, C4BPB↑, C9↑ and CFD↑). Finally, we undertook a plasma proteomic analysis of mice exposed to stress and observed dysregulation of 11 complement proteins including 3 of which were altered in the same direction in psychosis (C1RL, CFH↑, C5↑, C9↑). Conclusion: Our findings indicate that the complement protein pathway is dysregulated in the blood at age 11 of those with PE and PPE at age 18 and suggest that these changes may reflect exposure to stress.
Talk 7: Basic Self-disturbance in Adolescence and Schizophrenia-spectrum Disorders in Young Adulthood: A 7-year Follow-up Study among Treatment-seeking Adolescents.
Danny Koren1,2, Yair Tzivoni1, Liat Schalit-Cohen1, Josef Parnad3,4; 1University of Haifa, 2Psychiatry Division, Rambam Medical Center, Haifa, Israel, 3Psychiatric Center, Glostrup-Hvidovre, Faculty of Health and Medical Sciences, University of Copenhagen, Brøndby, Denmark, 4Center for Subjectivity Research, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark.
Aim: The goal of this study was to replicate and extend these pilot findings by examining the long-term persistence of basic self-disturbance (SD) and the degree to which their level in adolescence predicts schizophrenia spectrum disorders (SSD) seven years later in young adulthood. Method: The 7-year stability of SD and their association with later in life SSD were explored in a sample of 40 young adults. SD was assessed with the Examination of Anomalous Self-Experience (EASE), present and lifetime diagnoses of schizophrenia-spectrum and other co-morbid disorders were assessed with the Operational Criteria (OPCRIT) checklist for psychotic and affective illness in young adulthood. Results: Forty young adults (Mean age=23.7, S.D.=1.3) out of the 82 who had participated seven years earlier in a study on the association between SD and attenuated psychosis symptoms (APS) were available and agreed to participate in the 7-year follow-up. Eight (20%) of the 40 participants in the present study met diagnostic criteria for an SSD. Consistent with our first hypothesis, the correlation between the total EASE score at baseline and 7-year follow-up was moderate and significant (r=0.59, p<.001). Similarly, consistent with our second hypothesis, SD at baseline was a significant predictor of an SSD diagnosis in young adulthood. Conclusions: These results provide further support for the temporal stability of SD over time. In addition, they provide further support for the notion that SD is a phenotypic indicator of risk for SSD.
Talk 8: The Organization of Symptoms in Early Psychosis: A Systems Approach to Phenomenology
LENA PALANIYAPPAN1, Tushar Das1, Fabienne Harrisberger2, Undine E. Lang2, Anita Riecher-Rössler3, André Schmidt3, Stefan Borgwardt3; 1University of Western Ontario, 2Psychiatric University Clinics Basel, 3University of Basel
In psychiatry, when symptoms “come together” we call the resulting construct as a diagnosis. We infer a disease process binding varied symptoms together, enabling their co-occurrence. We then use syndromic labels to describe this construct (e.g. schizophrenia, at-risk mental state). But how does the intrinsic relationship among symptoms change with transition from at-risk states to first episode psychosis? We recruited 63 subjects with at-risk mental state [PACE criteria] but no transition (ARMS-NT), 16 that later developed psychosis (ARMS-T) and 38 drug-naïve patients with first-episode psychosis (FEP) from Basel, Switzerland. Symptoms were measured using Brief Psychiatric Rating Scale. We estimated each individual’s contribution to the relatedness found among symptoms using a jack-knife bias estimation procedure. Higher values meant greater relationship between two given symptoms in that subject, relative to the rest of the group. None of the 24 individual symptoms of BPRS significantly differentiated ARMS-NT from ARMS-T, though the intrinsic organisation revealed significantly increased clustering (Hedges’s g = 0.60, p<0.05) and modularity (g = 0.81, p<0.01) in ARMS-T compared to ARMS-NT. There were no differences between ARMS-T and FEP groups. In both ARMS-T and FEP groups, anxiety was the most central symptom. In addition to anxiety, the FEP group also had unusual thought content emerging as a central feature. Risk of transition to psychosis relates to the consolidation of relationship among symptoms rather than the severity of symptoms per se. First episode of psychosis could be thought of as a state of high modular clustering among otherwise sparsely connected symptoms.
Oral Session 15
Wednesday, October 10, 1:00 - 2:30 pm, St. George CD
Risk for Psychosis and Other Disorders
Chair: Ilaria Tarricone, Bologna University
Speakers: Ilaria Tarricone, Joanne Newbury, Martin K. Rimvall, Caiying Huang, Ditte Ellersgaard, Ditte Ellersgaard, Alberto Forte, Anne Ranning
Talk 1: Migration History and Risk of Psychosis in the EU-GEI Study
Ilaria Tarricone1, Charlotte Gayer-Anderson2, Federico Suprani1, Domenico Berardi3, Marta Di Forti2, Robin M Murray2, Craig Morgan2; 1Bologna Transcutural Psychosomatic Team (BoTPT), Department of Medical and Surgical Sciences, Alma Mater Studiorum, Bologna University, 2Institute of Psychiatry, Psychology and Neuroscience, King's College London, 3DIBINEM , Alma Mater Studiorum, Bologna University
Introduction. The EUropean Network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study - the largest international incidence study of psychotic disorders in 40 years -confirmed marked heterogeneity in risk of psychosis by person and place, including markers of area-level socioeconomic stability. Rates were elevated in minority groups (IRR: 1.6; 95%CI: 1.5-1.7). Aims. To present findings from the EUGEI European Network of National Schizophrenia Networks Studying Gene Environment Interactions study on the interaction between migration history and risk of psychosis. Methods. The EU-GEI study is an international multi-site incidence study. Setting: England (N=2 catchment areas), France (N=3), Italy (N=3), the Netherlands (N=2), Spain (N=6) and Brazil (N=1). The Bologna Migration History and Social Integration interview was administered to all first generation migrants (FGM). Results. 250 FGM with first episode psychosis (FEP) and 250 FGM controls were evaluated. FGM with FEP were more often unemployed and unsatisfied for family and friends’ relationships in the pre-migration phase and moved from their country of origin more often for work reason compared to controls; in the post migration phase they received less social support from social services, acquired families and friends compared to healthy migrants. Cases are less satisfied in post migration phase for work, families and social relationships. Conclusion. The EUGEI study allows a deeper understanding on the relationship between the characteristics of the history of migration and the excess of FEP found among FGM in Europe. These preliminary results shape the scene for preventive interventions of the psychosis among migrants in Europe.
Talk 2: Elevated exposure to air pollution is associated with the emergence of psychotic experiences during adolescence
Joanne Newbury1, Louise Arseneault1, Candice Odgers2, Carmine Pariante1, Susanna Roberts1, Sean Beevers1, Frank Kelly1, Helen Fisher1; 1King's College London, 2University of California, Irvine
Psychotic experiences are twice as common among youth living in cities. Very little is currently known about the potential role of air pollution in the emergence of early psychotic phenomena, despite air pollution levels in cities regularly exceeding international health guidelines. Using data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a cohort of 2,232 UK-born children followed from birth age 18, the association between air pollution and adolescent psychotic experiences was examined. Participants were privately interviewed about psychotic experiences at ages 12 and 18. Extremely high-resolution annualized estimates of two key air pollutants (nitrogen dioxide [NO2] and particulate matter [PM2.5]) were linked to the home addresses of the participants at age 17. Analyses accounted for a range of potential confounders including family socioeconomic status, family psychiatric history, maternal psychosis, childhood psychotic symptoms, adolescent smoking, cannabis use and alcohol use, and neighbourhood deprivation, crime, and social conditions. After considering all potential confounders, levels of NO2 (but not PM2.5) at age 17 were significantly associated with adolescent psychotic experiences at age 18 (OR=1.57, 95% CI=1.18-2.09, p=0.002), and this toxic pollutant explained 60% of the association between urban residency and adolescent psychotic experiences. Elevated levels of NO2 – a marker of road traffic – partly explain the heightened rates of psychotic experiences among youth in cities. Both biological and psychosocial mechanisms are possible, such as inflammation as well as stress from noise pollution. Further research into the association between air pollution and early psychotic experiences is urgently needed to inform intervention strategies.
Talk 3: Psychotic Experiences are Associated with Suicidal Ideation and Non-Suicidal Self-Injury in Pre-adolescence
Martin K. Rimvall1,2, Jim van Os3,4,5, Charlotte Ulrikka Rask6,7, Else Marie Olsen8,9, Lars Clemmensen1, Anne Mette Skovgaard8,10, Frank Verhulst1,2, Pia Jeppesen1,2; 1Child and Adolescent Mental Health Services, Capital Region of Denmark, 2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark, 3Department of Psychiatry and Psychology at Maastricht University Medical Centre, Maastricht, The Netherlands, 4Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands, 5Institute of Psychology and Neuroscience, Department of Child and Adolescent Psychiatry, King's College London, UK, 6Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark, 7Child and Adolescent Psychiatric Centre Risskov, Aarhus University Hospital, Denmark, 8Department of Public Health, University of Copenhagen, Denmark, 9Centre for Clinical Research and Prevention, Capital Region of Denmark, 10National Institute of Public Health, University of Southern Denmark, Denmark
Subclinical psychotic experiences are common in the general population in adolescence, and indicate an increased risk of developing psychotic disorders later in life. Suicide is one of the most common causes of death in adolescence and young adulthood, and non-suicidal self-injury (NSSI) as well as suicidal ideation and behaviors are highly associated with psychotic experiences in adolescence. The current study examines the association between psychotic experiences and NSSI and suicidal ideation in pre-adolescents from the general population. A total of 1631 11-12-year old children from the Copenhagen Child Cohort 2000 were interviewed by trained professionals using the sections on psychotic and affective symptoms of the Kiddie-Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version. During their lifetime, 172 children (10.5%) had experienced psychotic experiences, 24 (1.5%) reported NSSI, and 55 (3.4%) reported suicidal ideation. PE were strongly associated with NSSI (OR 10.8 95%CI 4.7-24.4) and suicidal ideation (OR 9.5 95% CI 5.5-16.6). Adjustment for depressed mood, irritability and anhedonia reduced the associations, but still held significance: NSSI OR 5.3 (95%CI 2.2-12.7) and suicidal ideation 5.0 (95%CI 2.7-9.0). Only 6 individuals confided that they had attempted suicide. We found that psychotic experiences are significantly associated with NSSI and suicidal ideation already in pre-adolescence. Longitudinal studies of the Copenhagen Child Cohort 2000 will investigate the possible causal role of psychotic experiences and other clinical correlates which could guide future interventions to decrease NSSI and suicidal behavior in youngsters vulnerable to psychosis.
Talk 4: Psychosis Risk Syndrome in students of Junior Middle School in Zhongshan, china: prevalence and characteristics
Caiying Huang1, Kunxi Xue1, Yanzhen Ren1, Qingwei Li1, Jing Wan1, Jie Zhang1, Baoguo Du1; 1The Third People's Hospital of Zhongshan
Introduction: Emerging evidence suggest that clinical high-risk state for psychosis (CHR) has been increasingly recognized as a critical window for early detection and intervention for psychosis. Available data of prevalence and characteristics in adolescence with CHR from Han Chinese population is limited and variable. Objective: The primary aim of this study is to provide the prevalence and characteristics of Psychosis Risk Syndrome (PRS) in students from the junior middle school of Zhongshan city, Guangdong province, China. Methods: A total 2,157 middle school students aged 12-17 years were enrolled by random and stratified sampling method in Zhongshan. Two stages’ evaluation were employed in this study. In stage I, all participating students in randomly selected schools were recruited to complete the self-reported 16-item version of the Prodromal Questionnaire (PQ-16). In stage II, students met positive criteria (total item score ≧7 or distress score ≧8) were interviewed with the Structured Interview for psychosis-risk Syndromes (SIPS) by a trained psychiatrist. Results: The prevalence of PRS determined by SIPS was 2.7% with 53 of them met the criteria for Attenuated Positive Symptoms Syndrome (APSS) based on the SIPS. The constituent ratios of the most reported symptom in positive, negative and disintegration subscale were 59.3% with perceptual anomalies/hallucinations, 30.5% with learning impairment, and 13.6% with concentration difficulty respectively. Conclusion：It is the first study providing prevalence of PRS in Chinese adolescent populations. Specialized early intervention is warranted for the PRS adolescent populations.
Talk 5: Psychopathology in 7-year-old children with familial high risk of schizophrenia or bipolar disorder – The Danish High Risk and Resilience Study – VIA 7; a population-based cohort study
Ditte Ellersgaard1,2,3, Kerstin J Plessen2,4,5, Jens R M Jepsen1,2,5, Katrine S Spang2,3,5, Nicoline Hemager1,2,3, Birgitte K Burton2,3,5, Camilla Christiani1,2,3, Maja Gregersen1,2,3, Ole Mors2,6, Merete Nordentoft1,2,3, Anne A E Thorup2,3,5; 1Mental Health Services - Capital Region of Denmark, Mental Health Centre Copenhagen, 2The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), 3Faculty of Health and Medical Sciences, University of Copenhagen, Denmark, 4Division of Adolescent and Child Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland, 5Mental Health Services – Capital Region of Denmark, Child and Adolescent Mental Health Centre, 6Psychosis Research Unit, Aarhus University Hospital Risskov, Denmark
Introduction: For both schizophrenia and bipolar disorder the single largest risk factor for developing the disorder is a positive family history. Therefore early antecedents of schizophrenia and bipolar disorder can be identified by studying children of parents with these disorders. We aimed to compare psychopathological profiles of children aged 7 with familial high risk for developing schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP). Methods: Nationwide Danish registers were used to establish a population based cohort of 7-year-old children with FHR-SZ (N=202), FHR-BP (120) and controls (200). Psychopathology of the children was assessed both categorically and dimensionally and from multiple informants including children, parents and teachers. Lifetime diagnoses and psychotic like experiences (PLEs) were ascertained through the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL). Psychopathology was assessed dimensionally with the Child Behavior Checklist (CBCL), the Teacher’s Report Form (TRF), the ADHD-Rating Scale, the Test Observation Form (TOF) and the State-Trait Anxiety Inventory for Children (STAI-CH). Current level of functioning was assessed with the Children’s Global Assessment Scale (CGAS). Results: We found marked differences between the three groups in several domains of psychopathology including PLEs and level of functioning. Results will be presented at the meeting. Conclusion: Children with familial risk of especially schizophrenia but also bipolar disorder have a higher prevalence of a broad spectrum of psychiatric disorders and psychopathological symptoms including PLEs already at age 7 compared with controls. The results emphasize the need for research on early intervention strategies towards these children.
Talk 6: Quality of life and self-esteem in 7-year-old children with familial high risk of schizophrenia or bipolar disorder – Correlations with psychopathology and level of functioning in: The Danish High Risk and Resilience Study – VIA7; a population-based cohort study
Ditte Ellersgaard1,2,3, Maja Gregersen1,2,3, Jens R M Jepsen1,2,5, Anne Ranning1,2, Nicoline Hemager1,2,3, Camilla Christiani1,2,3, Ole Mors2,4, Kerstin J Plessen2,5,6, Anne A E Thorup2,3,5, Merete Nordentoft1,2,3; 1Mental Health Services - Capital Region of Denmark, Mental Health Centre Copenhagen, 2The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), 3Faculty of Health and Medical Sciences, University of Copenhagen, Denmark, 4Psychosis Research Unit, Aarhus University Hospital, Denmark, 5Mental Health Services – Capital Region of Denmark, Child and Adolescent Mental Health Centre, 6Division of Adolescent and Child Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
Background: Children with familial high risk of schizophrenia (FHR-SZ) and bipolar disorder (FHR-BP) are affected in many areas. They display more psychopathology and experience more social disadvantage compared with controls. Furthermore, children with FHR-SZ display impaired motor function and cognitive skills. However, little is known of how the genetic and environmental risk affects the quality of life and self-esteem of these children with familial high risk. We aimed to compare quality of life and self-esteem among children with FHR-SZ, FHR-BP and controls. Method: A representative cohort of 7-year-old children with FHR-SZ (N=202), FHR-BP (N=120) and controls (N=200) was retrieved using Danish nationwide registers. Children with FHR-SZ were matched to controls on age, sex and municipality. The child examiners were blind to parental diagnoses. Various domains of quality of life was assessed with the Health-related Quality of Life Screening Instrument, KIDSCREEN-27, in addition to the scale ‘Social Acceptance (Bullying)’ from the KIDSCREEN-52. Self-esteem was assessed with the self-report scale ‘I think I am’ by Pirjo Ouvinen-Birgerstam. Besides a total scale, ‘I think I am’ consists of the scales ‘Physical appearance’, ‘Skills and talents’, ‘Psychological well-being’, ‘Relationships with family’ and ‘Relationships with others’. Results: We found marked differences on some domains of quality of life and self-esteem among the three groups. Results will be presented at the meeting. Conclusion: The finding that quality of life and self-esteem are affected in children with familial high risk already at age seven calls for studies on early intervention towards this vulnerable group of children.
Talk 7: Developmental trajectories of childhood symptoms of hyperactivity/inattention and suicidal behavior during adolescence
Alberto Forte1, Massimiliano Orri2,3, Cedric Galera4, Maurizio Pompili1, Gustavo Turecki2, Richard E. Trembley5,6, Sylvana M. Côté3,7; 1Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy, 2McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada, 3Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France, 4Université de Bordeaux, Department of child and adolescent psychiatry, Centre Hospitalier Perrens, Bordeaux, France, 5Departments of Pediatrics and Psychology, University of Montreal, Montreal, Canada, 6School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland, 7Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
Background: Hyperactive/inattentive symptoms (HI-s) are associated with suicidal behavior in clinical studies, but there is still a lack of population-based longitudinal investigations on the developmental aspects of this association. Moreover, it is unclear whether the association is similar for boys and girls. Aims: To test the association between the HI-s during childhood and suicidal ideation and attempt during adolescence, and to investigate sex differences. Methods: 1407 children from the Québec Longitudinal Study of Child Development were followed up from 5 months to 17 years of age. We used teacher-reports of HI-s from 6 to 12 years, and self-report of suicidal ideation and attempt at 13, 15, and 17 years. Results: We identified 3 HI-s trajectories: low (boys: 32.2%, girls: 48.7%), moderate (boys: 44.6%; girls: 42.2%) and high (boys: 23.2%; girls: 9.1%). Compared to boys on a low trajectory, boys on a moderate trajectory were at higher risk for suicidal ideation (OR=4.2, 95%CI=1.2-14.8), and boys on a high trajectory were at higher risk for suicide attempts (OR: 4.5, 95%CI: 1.1-17.9). Girls on moderate or high HI-s trajectories were not at higher risk for suicidal ideation or attempts than girls on low trajectories. Conclusions: For boys, but not for girls, moderate-to-high HI-s increased the suicidal risk in adolescence. Interventions with pre-adolescent and adolescent boys showing HI-s symptoms should include a suicide prevention component. Population level suicide prevention for adolescents should particularly target boys with a history of HI-s problems.
Talk 8: Somatic diseases and mortality among offspring of parents with severe mental illness – a nationwide register-based cohort study in 2,000,669 individuals.
Anne Ranning1; 1Mental Health Center Copenhagen
OBJECTIVE: Being an offspring of parents with severe mental illness (SMI) is associated with increased risk of certain somatic illnesses, including epilepsy. We examined mortality and the full spectrum of somatic illnesses among offspring of parents with and without SMI born in Denmark between 1982 and 2012. METHODS: In a nationwide cohort study of all 2,000,669 individuals, including 47,516 individuals with a parental disposition to severe mental illness, we estimated mortality rate ratio (MRR), incidence rate ratio (IRR) and cumulative incidence fraction (CIF) of first hospital contact for a broad spectrum of somatic illnesses using Poisson’ regression adjusted for important confounders. RESULTS: During follow-up (8, 4 million person-years), exposure to severe mental illness in a parent was associated with significantly earlier first somatic contact (IRR 1.17; 95% CI 1.16-1.18) than found in those unexposed. The exposed group had higher risk of a broad spectrum of diagnoses with largest effect sizes for injuries, ill-defined conditions, infections, Central Nervous System (CNS) diseases, digestive system, circulatory system and respiratory diseases, endocrine and metabolic diseases and conditions originating in the perinatal period (all p<0.0001). Highest mortality was found for exposure to maternal bipolar disorder (MRR 2.03; 95% CI 1.50, 2.74) but significantly elevated offspring mortality was also found for parental depression. CONCLUSIONS: Our findings indicate that offspring of a parent with SMI have higher morbidity and mortality which should warrant heightened vigilance and support throughout infancy, childhood, and adolescence for families affected by severe mental illnesses.
Oral Session 16
Wednesday, October 10, 2:45 - 4:15 pm, Staffordshire
Chair: Robin M. Murray, King’s College London, The South London and Maudsley NHS Foundation Trust Biomedical Research Centre
Speakers: Mei-Hua Hall, Olivia Kirtley, Sharon Neufeld, Laurence Roy, Julieta Galante, Rachel Tribe, Andrew Gardner, Peter Gallagher
Talk 1: Longitudinal Trajectory of Early Functional Recovery in Patients with First Episode Psychosis
Mei-Hua Hall1, Kristina Holton2, Thomas Chittenden3, Dost Öngür1, Kevin Eklund4, Debra Montrose4, Matcheri Keshavan5; 1McLean Hospital, Harvard Medical School, MA, 2Department of Research Computing, HMS, Boston, MA, 3Division of Genetics and Genomics, Boston Children's Hospital, HMS, Boston, MA, 4Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, 5Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, HMS, Boston, MA
Characterization of neurophysiological changes in patients with first episode psychosis There is a large variability in the recovery trajectory and outcome of first episode of psychosis [FEP] patients. To date, individuals’ outcome trajectories at early stage of illness and potential risk factors associated with a poor outcome trajectory are largely unknown. This study aims to apply three separate predictors (positive symptoms, negative symptoms, and soft neurological signs) to identify homogeneous function outcome trajectories in patients with FEP using objective data-driven clustering methods, and to explore the potential risk /protective factors associated with each functional trajectory. A total of 369 FEP patients (93% antipsychotic naive) were assessed and followed-up at 4-8 weeks, 6 months, and 1 year. K means cluster modelling for longitudinal data (kml3d) was used to identify distinct, homogeneous clusters of functional outcome trajectories. The Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and Neurological examination abnormalities (NEA) were used as predictors against Global Assessment of Functioning Scale (GAF). In each of the three predictor models, four distinct functional outcome trajectories emerged: ‘‘Poor’’, ‘‘Intermediate’’, High” and “Catch-up”. Individuals with male gender; ethnic minority status; low premorbid adjustment; low executive function/IQ, low SES, personality disorder, substance use history may be risk factors for poor recovery following psychosis. Functioning recovery in individuals with FEP is heterogeneous across diagnoses, although distinct recovery profiles are apparent. Developing targeted intervention strategies might be able to alter unfavorable recovery trajectory.
Talk 2: Identifying targets for intervention in suicidal behaviour using the integrated motivational-volitional model
Olivia Kirtley1, Rory O'Connor2; 1KU Leuven, 2University of Glasgow
Purpose: Several reviews and meta-analyses have demonstrated that we are no better at predicting suicide than we were 50 years ago. Recently, ideation-to-action frameworks have emerged, that seek to differentiate between factors associated with suicidal thoughts (ideation) and those associated with suicidal behaviours (enactment), with the aim of predicting who will make the transition from ideation to enactment. Here we present the integrated motivational-volitional model (IMV; O’Connor, 2011; O’Connor & Kirtley, 2018) as a framework for identifying intervention targets for preventing suicidal behaviour. Methods: The IMV is a tripartite model comprised of the pre-motivational (background vulnerability factors), motivational (development of suicidal ideation), and volitional (transition from suicidal ideation to behaviour) phases. We review evidence testing the utility of volitional factors for differentiating between individuals with suicidal ideation vs. enactment and discuss motivational phase factors as potential targets for intervention in the escalation of suicidal ideation. Results: Volitional phase variables, including exposure to the self-harm of others and access to means represent important potential targets for interventions to prevent individuals making the transition from suicidal ideation to enactment. Targeting moderators of motivational phase variables, such as rumination and social support, may prevent the escalation of suicidal ideation. Conclusions: Factors in the volitional phase of the IMV are primary targets for developing interventions to prevent individuals moving from suicidal ideation to enactment. However, variables within the motivational phase of the model, which moderate the pathways between defeat/humiliation and entrapment, may also be useful targets to prevent the escalation of suicidal ideation.
Talk 3: Does Mental Health Treatment Help the Formation of Social Resilience to Emerging General Distress in Young People?
Sharon Neufeld1, Peter Jones1, Paul Wilkinson1, NSPN Consortium1,2, Ian Goodyer1; 1Department of Psychiatry, University of Cambridge, Cambridge, UK, 2Wellcome trust Center for Neuroimaging, University College London, London, UK
Recently we have shown that adolescent mental health service contact is related to a reduction in subsequent depression three years later. However, there remain questions as to what mechanisms may drive this effect. Whilst treatment was heterogenous, common features such as listening and being supportive may have had a role. Such qualities are common to supportive friendships and family environments, which have also been related to improved mental health. In a separate longitudinal cohort of adolescents and young adults aged 14-25 (n=2,403), we sought to determine whether current treatment for mental health problems at baseline (T1) was associated with reduced symptoms two years later (T3), and whether this operates by improving social resilience. Participants reported current treatment for any emotional, behavioural, or mental health problems. The outcome was general distress, the general factor from a bifactor model of 118 items from measures of depression, anxiety, antisocial behaviour, psychotic-like symptoms, obsessionality, and well-being. Mediators considered (obtained one year after baseline, T2) were family functioning and friendships. After adjusting for attrition and confounding variables, baseline current treatment significantly predicted lower general distress at T3. Good family functioning at T2, but not friendships, was predicted by baseline treatment. Therefore only family functioning was assessed as a potential mediator of subsequent general distress. This work shows that treatments given may have resulted in improvements in family functioning, and explores whether such improvements subsequently reduce general distress within young people.
Talk 4: Risk of homelessness and housing instability among first-time mental health service users
Laurence Roy1,2, Anne Crocker3,4, Amal Abdel-Baki5, Eric Latimer1,2, Luigi De Benedictis6, Marc-André Roy7; 1McGill University, 2Douglas Mental Health University Institute, 3Institut Philippe Pinel de Montréal, 4Université de Montréal, 5Centre hospitalier universitaire de Montréal (CHUM), 6Institut universitaire en santé mentale de Montréal, 7Institut universitaire en santé mentale de Québec
Rates of mental illness in the homeless population are high, ranging from 20% to 50%. Most of these individuals have received mental health services before becoming homeless, which indicates the possibility to detect and intervene early on the housing situation of mental health service users, particularly young adults. Objectives. The current study aims to: (1) examine housing characteristics and risk of homelessness among first-time mental health service users and (2) identify factors associated with increased risk of instability and homelessness in this population. Methods. A cross-sectional design was implemented in seven early intervention mental health clinics in urban and rural areas across Québec (Canada). Participants were 16 years of age or older and had received their first diagnosis of mental illness in the past six months. Demographic, housing, clinical, and community integration data were collected through face-to-face administration of questionnaires. Logistic regression models are used to investigate the effect of various factors on risk of housing instability and homelessness. Results. Preliminary analyses on the first participants (n=200, mean age 25.5) indicate that 24% are living in unstable housing situations, and 30% are at risk of homelessness or housing instability. Implications. Housing has been recognized as an important determinant of recovery and well-being for individuals with mental illness. The high rates of housing instability in a population of first-time service users calls for cross-sector action between health, social, and housing services, as well as for potential strategies to detect youth at risk of homelessness within clinical services.
Talk 5: Effectiveness of Providing University Students with a Mindfulness-Based Intervention to Increase Resilience to Stress: A Pragmatic Randomised Controlled Trial
Julieta Galante1,2, Géraldine Dufour1,4, Maris Vainre2, Adam P Wagner2,3, Jan Stochl1,2, Alice Benton1, Emma Howarth2, Peter B Jones1,2; 1University of Cambridge, 2National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, 3University of East Anglia, 4British Association for Counselling & Psychotherapy
Background: More young people are going to university, but there is concern about an increasing demand for student mental health services. We designed a pragmatic randomised controlled trial to test the hypothesis that providing mindfulness courses to university students would promote their resilience to stress. Methods: University of Cambridge students without severe mental illness or crisis were randomised to join an 8-week mindfulness course adapted for university students (MSS), or to mental health support as usual (SAU). The primary outcome was self-reported psychological distress during the examination period measured using the Clinical Outcomes in Routine Evaluation Outcome Measure. Intention-to-treat analysis was masked to allocation. Findings: In total, 616 students were randomised; 74% completed the primary outcome measure; 59% of the MSS arm participants completed at least half of the MSS course. MSS significantly reduced distress during the exam period compared with SAU (β=-0.44, 95%CI -0.60 to -0.29; p < 0.0001). 57% of SAU participants had distress scores above a validated clinical threshold level compared with 37% of MSS participants (number needed to treat=6). SAU distress worsened over the year whereas MSS scores improved after the course and were maintained during exams. Active monitoring revealed no adverse reactions related to self-harm, harm or suicidality. Other secondary outcomes were measured. Interpretation: Our results replicate evidence from several smaller trials conducted across a range of higher education institutions and countries. Mindfulness training appears an effective component of a wider student mental health strategy. Comparisons with alternative interventions would deepen the evidence.
Talk 6: Service Users Experiences of Peer-Supported Open Dialogue Informed Network Meetings
Rachel Tribe1, Abigail Moss2, Steven Livingstone3, Steve Pilling4, Josh Stott5; 1Research Department of Clinical, Educational and Health Psychology, University College London, 2Research Department of Clinical, Educational and Health Psychology, University College London, 3Haringey Early Intervention Service, St Ann’s Hospital, London, 4Research Department of Clinical, Educational and Health Psychology, University College London, 5Research Department of Clinical, Educational and Health Psychology, University College London
Background Peer-supported Open Dialogue, (POD) is a treatment that embraces a network perspective, bringing together both social and professional networks, to provide continuity of psychological care across the boundaries of services. Aims To better understand the experiences of service users receiving POD in an early intervention service and focus on the experience of network meetings. Method Eight service users were interviewed, the data was analysed using thematic analysis. Results Two superordinate themes and 10 subthemes were constructed from the data. The two superordinate themes reflect the grouping of the subthemes, which formed around implementation issues and communication within meetings. The first was ‘adjusting to a new way of working’, within this theme were the subthemes; old approach as unhelpful, purpose of meetings unclear and new approach as strange. The second theme of ‘communicating in new ways’, included the subthemes of openness Vs. Privacy, feeling listened to and understood, sharing multiple perspectives and increase in emotional expression. Conclusions The results suggested that participants experienced the network meetings as different from usual care in that they were unusual but positive. The data indicated that feeling listened to was the main explanatory factor in the positive responses to network meetings. POD advocates for both a way of being and a way of organising services - it seemed that clinicians were being with people in new and different ways, the potential of which is hard to evaluate within the existing structure as it had not been re-organised. A number of recommendations have been made.
Talk 7: The Social Inclusion of Young People with Serious Mental Illness: A Narrative Review of the Literature and Suggested Future Directions
Andrew Gardner1,2, Sue Cotton1,3, Kate Filia1,3, Eoin Killackey1,3; 1Orygen, the National Centre of Excellence in Youth Mental Health, Australia, 2School of Psychological Sciences, Monash University, Australia, 3Centre for Youth Mental Health, University of Melbourne, Australia
Background: Social inclusion involves objective participatory (e.g., education/employment) and subjective (e.g., belonging/acceptance) elements. It has been associated with enhanced wellbeing yet is a novel construct in the empirical literature (i.e., measures have not been sufficiently developed). Aims: Young people with serious mental illness (SMI) are reported to be socially excluded. It is unclear whether this is reflected in the social inclusion/exclusion literature. The aim of this narrative review is to determine whether such literature informs a comprehensive (i.e., multi-dimensional, objective and subjective) understanding of social inclusion for young people with SMI. Results: There is a paucity of research in the social inclusion literature involving young people with SMI as participants. Literatures exist in related independent areas (e.g., employment, social networks), but such studies employ heterogeneous methodologies. Conclusions: Multidimensional measures of social inclusion incorporating objective and subjective indicators must be developed for young people with and without SMI. This will enable the generation of normative and clinical data. Existing evidence for the social exclusion of young people with SMI comes from objective indicators in isolated domains (e.g., unemployment). The above-described measures must be employed to further understanding of these apparent discrepancies. This will elucidate the relationships between objective and subjective elements of social inclusion, and the relationships between these elements and the psychological distress that young people with SMI often experience. This has implications for intervention. A comprehensive range of candidate interventions to improve the social inclusion of this population has not been identified: scoping reviews of such interventions are indicated.
Talk 8: “A Sense of Hope”: A qualitative exploration of the family members experience of peer support in an Early Intervention program
Peter Gallagher1, Adele Kane1, Mary Kelleher4, Felicity Fanning1, Patrick Egan1, Mary Clarke1,3,5,6; 1DETECT Early Intervention in Psychosis Service, Blackrock, Dublin, Ireland., 2Saint John of God Hospitaller Ministries, Dublin, Ireland., 3Saint John of God Community Services clg, Dublin, Ireland., 4Health Service Executive, Dublin North, Ireland., 5University College Dublin, Ireland., 6Royal College of Surgeons in Ireland, Dublin, Ireland.
The importance of providing relevant, well timed information and education for family members of people experiencing first episode psychosis is well established in the literature. However qualitative enquiry has suggested a gap in the support needs of families. This study explores a peer support programme for family members set up in 2015. Designed and developed with input from a multi-stakeholder advisory group including service users and family members, the programme is offered to family members who have recently completed a first episode psychosis information and support course. Methodology; This study employed a Thematic Analysis qualitative methodology to explore the effectiveness of the program and the experiences of participants. Semi-structured face-to-face interviews were conducted with 7 supported family members. Verbatim transcribed data were checked by research team members to increase interrater reliability. Coding meetings were also employed for veracity. Findings; The data revealed overarching themes of “A Sense of Hope: Light at the end of the tunnel”, and “Feeling understood reduced the isolation felt by Carers”. The Flexibility of the support arrangement and the ability to talk to someone with a shared experience who was not a healthcare professional was also highly valued. Discussion; A uniquely valuable aspect of family member peer support is the shared lived experience. Talking to someone who has found a way through their difficulties engenders a sense of hope and promotes a model based on strengths and recovery. The equal nature of the relationship appeals to family members and is distinct from the expert patient relationship.
Oral Session 17
Wednesday, October 10, 2:45 - 4:15 pm, St. George AB
Substance Use and Other Comorbidities
Chair: Stephen Wood, Orygen, University of Melbourne, University of Birmingham
Speakers: Stephen Wood, Izemnur Arican, Katharine Chisholm, Javier-David Lopez-Morinigo, Rashmi Patel, Barbara Dooley, Carsten Hjorthøj, Suzanne Archie
Talk 1: Co-occurrence of autism and psychosis traits in young adolescents: impact on theory of mind
Stephen Wood1,2,3, Ahmad Abu-Akel4, Renate Reniers5, Katherine Chisholm3, Ashleigh Lin6; 1Orygen, the National Centre of Excellence in Youth Mental Health, 2Centre for Youth Mental Health, University of Melbourne, 3School of Psychology, University of Birmingham, 4Institute of Psychology, University of Lausanne, 5Institute of Clinical Sciences, University of Birmingham, 6Telethon Kids Institute
Co-occurrence of autism and psychosis traits is well-reported in the general population. The impact of these traits is less well understood, although there are several reports of diametric effects on measures of theory of mind. In contrast, work in clinical populations has been more likely to report additive impacts of these traits on measures of functioning and symptoms. In addition, although there are several reports in the general population, these samples tend to be young adults (frequently university psychology students). It is unclear to what extent similar relationships exist in younger samples prior to the main risk period for psychotic symptomatology, or in samples from less well educated backgrounds. We assessed 256 young people (mean age 15.6±1.6yrs) from secondary schools in and around Birmingham. Autism and psychosis traits were assessed with the AQ and CAPE respectively, while theory of mind was assessed with the Reading the Mind in the Eyes Test and the Yoni test. We found no evidence for a significant relationship between autism or psychosis traits and performance on either theory of mind test, after controlling for the effects of age. The previously reported diametric impact of these traits on theory of mind may only be apparent in adult populations.
Talk 2: The Prevalence of Attention Deficit Hyperactivity Disorder Symptoms in a Cohort of Patients with Schizophrenia, and the Impact on Their Executive Functions
Izemnur Arican1, Andrew McQuillin1, Giovanni Giaroli1; 1University College London
Introduction: The subgroup of patients with schizophrenia (SCZ) and an attention deficit hyperactivity disorder (ADHD) comorbidity experience a lack of recommended pharmacological therapies for their specific symptomatology. Our systematic review utilising the PRISMA statement criteria revealed that only 2 studies have measured the prevalence of adult ADHD in patients with SCZ. Objectives: To investigate a cohort of patients with SCZ for the prevalence of childhood and adult ADHD symptoms, and measure the relationship with executive functions (EF). Methods: Impairments of EF, adult ADHD and childhood ADHD symptoms were investigated using three self-report questionnaires in 126 patients with ICD-10 diagnoses of SCZ. The severity of ADHD symptoms in relation to EF were examined using regression models. Results: Lifetime ADHD symptoms were reported by 47% of patients with clinically diagnosed SCZ. Of these, 23% reached the cut off values in both the childhood and adult ADHD questionnaires, 11% in only the childhood and 13% in the adult ADHD questionnaire. Impairments in EF were reported by 54% of patients, and the linear regression of EF impairment scores was significant (p < 0.001) with both childhood ADHD and adult ADHD scores. Higher ADHD symptom scores were predictive of a history of substance abuse. Conclusions: The study suggests that there is a higher presence of ADHD symptomatology in SCZ compared to that reported for ADHD in the general population. A greater severity of ADHD symptoms was predictive of poorer EF, highlighting the necessity of correct and early diagnosis.
Talk 3: Autism and Psychosis; Implications for clinical symptoms, quality of life and functioning
Katharine Chisholm1, Mirabel Pelton1, Nikita Duncan1, Katherine Kidd1, Klaas Wardenaar2, Rachel Upthegrove3, Matthew Broome1,4, Stephen Wood1,5,6, Ashleigh Lin7; 1Institute of Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom, 2Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, The Netherlands, 3School of Psychiatry and Institute of Clinical Sciences, University of Birmingham. Forward Thinking Birmingham and Birmingham and Solihull Mental Health Foundation Trust, 4Department of Psychiatry, University of Oxford, UK; Faculty of Philosophy, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK, 5Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 6Centre for Youth Mental Health, University of Melbourne, Australia, 7Telethon Kids Institute, The University of Western Australia, Perth, Australia
There is increasing recognition of the co-occurrence of autism spectrum conditions (ASC) and psychosis, however, there is a lack of evidence regarding the clinical impact this may have. Psychosis and autism are both considered to exist on an extended phenotypic continuum, meaning co-occurrence and overlap at the trait level as well as at the diagnostic level may be important. 99 individuals experiencing a first episode of psychosis took part in the study. Traits of autism were found at elevated rates in the sample and 4 participants had a previous ASC diagnosis. 9.2% of participants had Autism Spectrum Quotient (AQ) scores of >32 (indicative that autism diagnosis is likely) and 28.7% scored >26 (indicative of high autism traits). Higher levels of autistic traits were associated with lower quality of life, lower functioning, and higher levels of current psychotic symptoms. Receiver operating characteristic (ROC) curve analyses indicated that even when autistic trait levels fall below what would be considered diagnostic for ASC, they may still have a significant impact on clinically relevant factors, including quality of life, functioning, and current psychotic symptoms. It is important that psychosis services have systems to adequately address the needs of individuals with higher autistic traits. In particular, it is important that clinical teams support autistic traits and treat psychotic symptoms.
Talk 4: Suicidal behaviour in early psychosis. The role of insight
Javier-David Lopez-Morinigo1, Olesja Ajnakina1, Benjamin DR Wiffen1, Kevin Morgan2, Gillian A Doody3, Peter B Jones4, Robin M Murray1,5, Paola Dazzan1,5, Craig Morgan5,6, Rina Dutta7, Anthony S David1,5; 1Institute of Psychiatry, Psychology and Neuroscience. King's College London. (London, UK), 2Department of Psychology, University of Westminster. (London, UK), 3Division of Psychiatry. University of Nottingham. (Nottingham, UK), 4Department of Psychiatry, University of Cambridge. (Cambridge, UK), 5National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. (London, UK), 6King’s College London. Institute of Psychiatry, Psychology and Neuroscience. Department of Psychological Medicine (London, UK), 7Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London, UK
Background: The role of insight dimensions – illness recognition (IR), symptoms relabelling (SR), treatment compliance (TC) - in suicide risk in first-episode psychosis (FEP) remains unclear. Methods: The AESOP (n=181) and GAP (n=112) FEP cohorts were followed-up over 10- and 5 years. Survival analysis modelled time to first suicidal event in relation to baseline insight levels (Schedule for Assessment of Insight), whilst adjusting for demographic, clinical, psychopathological and neuropsychological variables. Results: AESOP: those with previous suicide attempts scored higher on IR (7.6±1.9 vs. 5.9±3.0, p<0.01) and total insight (TI) (17.2±5.0 vs. 13.4±6.7, p=0.03). IR (r=0.23, p<0.01), SR (r=0.18, p=0.04) and TC (r=02.6, p<0.01) correlated with depression. Univariable analyses: IR (HR=1.14, 95%CI 0.98-1.34, p=0.09), TC (HR=1.30, 95%CI 0.99-1.71, p=0.06) and TI (HR=1.06, 95%CI 0.99-1.13, p=0.08) were linked with suicidal behaviour. Multivariable regression models: depression (HR=1.55, 95%CI 1.22-1.97, p<0.01) predicted suicidal behaviour. GAP: SR (6.4±3.1 vs. 4.5±3.4, p=0.03) and TI (16.8±6.4 vs. 12.8±7.4, p=0.03) were higher in those with suicidal antecedents. IR (r=0.32, p<0.01) and SR (r=0.27, p=0.01) correlated with depression. Univariable analyses: TC (HR=1.36, 95%CI 1.01-1.83, p=0.04) and TI (HR=1.06, 95%CI 0.99-1.14, p=0.08) were associated with suicidal behaviour. Multivariable regression models: previous suicide attempts (HR 5.17, 95%CI 1.32-20.29, p=0.02) and depression (HR 1.16, 95%CI 1.00-1.35, p=0.04) predicted suicidal behaviour. Conclusions: Suicide attempts prior to FEP and depression at that point, both of which were associated with baseline insight levels and risk of suicidal behaviour over the follow-up, appear to explain the apparent relationship between insight and suicidality in FEP.
Talk 5: Illicit substance use in first episode psychosis (FEP): a natural language processing (NLP) electronic health record study
Rashmi Patel1, Craig Colling2, Jyoti Jyoti2, Richard Jackson1, Robert Stewart1, Philip McGuire1; 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK, 2South London and Maudsley NHS Foundation Trust, London, UK
BACKGROUND: Cannabis use is associated with increased risk of developing psychosis and worse clinical outcomes. However, less is known about misuse of other illicit substances in first episode psychosis (FEP). We sought to compare the associations of cannabis, cocaine, amphetamines and MDMA with clinical outcomes in people with FEP using a large electronic health record (EHR) dataset. METHOD: Data were obtained from pseudonymised EHRs of 1,835 people with FEP in South London. Exposure to cannabis, cocaine, MDMA or amphetamines was identified using TextHunter NLP software. Data on subsequent hospital admission in the 5 years following presentation were obtained. Their relationship with illicit substance misuse was analysed using multivariable negative binomial regression with age, gender and ethnicity as covariates. RESULTS: Cannabis was the most frequently documented illicit substance (58.5% of patients) followed by cocaine (24.4%), amphetamines (3.7%) and MDMA (3.1%). Cannabis (IRR 1.58, 95% CI 1.37 to 1.83) and cocaine (1.36, 1.17 to 1.59) were significantly associated with increased number of hospital admissions while MDMA was associated with a reduction in number of hospital admissions (0.59, 0.40 to 0.86) and amphetamines with no significant difference (1.05, 0.77 to 1.45). CONCLUSION: Cannabis and cocaine use are associated with a significant increase in number of hospital admissions following presentation to mental health services with psychosis. These findings highlight the importance of illicit substances in determining clinical outcomes in psychosis and the need to address their use when planning treatment.
Talk 6: Dissociable psychosocial profiles of adolescent substance users
Barbara Dooley1, Amanda Fitzgerald1, Naoise Mac Giollabhui2, Louise Dolphin1, Robert Whelan3; 1University College Dublin, 2Temple University, 3Trinity College Dublin
TALK 6 HAS BEEN CANCELLED
Talk 7: Cannabis and other substance use predicts conversion from schizotypal disorder to schizophrenia
Carsten Hjorthøj1,2, Nikolai Albert1, Merete Nordentoft1,2; 1Copenhagen University Hospital, Mental Health Center Copenhagen, 2The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH
Objective To investigate whether substance use disorders, in particular cannabis use disorder, predict conversion to schizophrenia in people with schizotypal disorder. Methods Prospective cohort study in the nationwide, unselected Danish registers. We identified all people born since 1981 in Denmark with incident diagnosis of schizotypal disorder, without previous diagnosis of schizophrenia (n=2,539). We estimated hazard ratios for conversion to schizophrenia for cannabis and other substance use disorders and antipsychotic medication, and adjusted for parental history of mental disorders, sex, birth year, and calendar year Results After two years, 16.3% (95% CI 14.8%-17.8%) of the people with schizotypal disorder had converted to schizophrenia. After 20 years, the conversion rate was 33.1% (95% CI 29.3-37.3) overall, and 58.2% (95% CI 44.8%-72.2%) in those with cannabis use disorders. In fully adjusted models, any substance use disorder predicted conversion to schizophrenia (HR=1.34, 95% CI 1.11-1.63). Dividing by substances, cannabis use disorders (HR=1.30, 95% CI 1.01-1.68), amphetamine use disorders (HR=1.90, 95% CI 1.14-3.17), and opioid use disorders (HR=2.74, 95% CI 1.38-5.45) predicted conversion to schizophrenia. These associations were not explained by concurrent use of antipsychotic medication, functional level before incident schizotypal disorder, or parental history of mental disorders. Conclusions and relevance Substance use disorders, in particular cannabis, amphetamines, and opioids, are important predictors of conversion from schizotypal disorder to schizophrenia. However, conversion rates are high even in those without substance use disorders, indicating a need for both universal and substance-targeted prevention in people with schizotypal disorder.
Talk 8: Back to Reality Series Video Games: Translating Research Knowledge about Marijuana and Psychosis for Youth
Suzanne Archie1, Manuela Ferrari2, Peter Bzonek3; 1McMaster University, Hamilton, Canada, 2Douglas Mental Health University Institute, Montreal, Canada, 3Carlisle Medical Centre, Hamilton, Canada
Purpose: To test video games designed to raise awareness of link between weekly marijuana use among youth and psychosis. The Back to Reality Series (the Series trailer https://vimeo.com/140117271)) represents integrated knowledge translation (iKT) products. The Series was inspired by cannabis research and created by an iKT community of youth, youth with lived experiences, clinicians, researchers, and game designers. Methods: Fifty-five homeless and street-involved youth were interviewed after being randomly assigned in an open trial to play the Series versus a control game. Knowledge about marijuana use, harms, and psychosis was assessed using a quiz- the Psychosis Cannabis Test (PCT). Feedback was qualitatively analyzed for themes regarding gameplay and marijuana use. Results: The mean age for the whole sample was 17. 5 (SD=1.1) with 55% male, 9% gender fluid, and 36% female. Up to 24 % of respondents endorsed past experiences suggestive of psychotic symptoms. The mean PCT score was 5.5 (SD=1.9) for the 25 participants who played the control game and 6.8 (SD=1.6) for the 31 participants randomly assigned to the Series. The Series group obtained significantly greater scores (p< .05) on the PCT compared to the control group, indicating greater knowledge of the risks and harms. Most youth (90%) enjoyed playing the Series versus 75% for the control game. Youth believed the Series was educational and felt they could relate to the protagonist’s experiences. Conclusion: Pilot data provide preliminary evidence that interactive video games can educate youth about the harms associated with marijuana use.
Oral Session 18
Wednesday, October 10, 2:45 - 4:15 pm, St. George CD
Stress and Coping
Chair: Ashleigh Lin, Telethon Kids Institute, The University of Western Australia
Speakers: Ashleigh Lin, Walker Ladd, Ph.D., Sofie Ragnhild Aminoff, Thomas Vaessen, Stefanie J Schmidt, Stefanie J Schmidt, Stefanie J Schmidt, Danny Koren
Talk 1: The mental health of trans young people aged 14-25 years in Australia: findings from Trans Pathways
Ashleigh Lin1, Penelope Strauss1,2, Sam Winter3, Vanessa Watson4, Dani Wright Toussaint1, Angus Cook2; 1Telethon Kids Institute, The University of Western Australia, 2School of Popualtion and Global Health, The University of Western Australia, 3School of Public Health, Curtin University, 4YouthLink, Youth Mental Health, North Metropolitan Mental Health Services
Trans (transgender) young people experience mental health issues at higher rates than their cisgender (non-trans) peers. There is a lack of evidence on risk factors for poor mental health outcome. Trans Pathways is the largest study ever conducted on the mental health of trans young people in Australia. Methods: Trans Pathways was an online, mixed-methods survey conducted with trans young people aged 14-25 years (N=859). We measured current depressive and anxiety symptoms, self-reported psychiatric disorders, self-harm, suicidality, and risk factors for poor mental health. Binary logistic regression was used to explore associations between mental health outcomes and risk factors for poor mental health. Results: Trans young people in Australia experience extremely high levels of mental ill health and psychological distress, including lifetime prevalence of 74.6% for depressive disorders and 72.2% for anxiety disorders. 79.7% of the sample had self-harmed and 48.1% had attempted suicide. Negative experiences were common, including discrimination (68.9%), lack of parental support (65.8%), peer rejection (89.0%), issues at school, university or college (78.9%), and homelessness or issues with accommodation (22%). Negative experiences were strongly associated with poor mental health outcomes. Conclusions: Trans young people are at very high risk of poor mental health outcomes. We show that many of the experiences that contribute to poor mental health are external to the individual; therefore, they can be prevented through improved acceptance of gender diversity within educational, family, clinical and workplace environments.
Talk 2: Born Out of Fear: A Grounded Theory Study of the Stigma of Bipolar Disorder for New Mothers
Walker Ladd, Ph.D.1; 1University of Phoenix
Childbirth is an established trigger for the onset of bipolar disorders (BD) in the postpartum period, causing significant pathology and disability. Research demonstrates stigma of mental illness for new mothers is a powerful obstacle to care, preventing women from accessing critical treatment and social support. The majority of research has examined the relationship between the stigma and postpartum depression, leaving a gap in knowledge regarding stigma and postpartum bipolar disorder. The problem addressed in this grounded theory study was the lack of knowledge regarding the stigma of a diagnosis of bipolar disorder (BD) in the first year postpartum. A theoretical sample of 15 women given a clinical diagnosis of a BD in the first year postpartum participated in one, 60-90 minute recorded interviews using semi-structured questions. 275 pages of transcripts were analyzed in open, axial and selective order according to grounded theory methods. Emergent categories: Diagnosis, Experiencing Stigma and Lack of Understanding revealed the relief in the initial diagnosis, and the subsequent experience of stigma in the form of stigmatizing stereotypes, prejudicial attitudes and discrimination, and the development of the belief that stigma was caused by universal lack of understanding regarding BD. The core category of Born Out of Fear was identified. Selective coding confirmed that the stigma experienced by participants was consistent with existing models of stigma. Findings indicate that early psychosocial interventions regarding perinatal mental health may increase provider knowledge of disorders and decrease stigma formation.
Talk 3: Affective lability and polygenic risk in bipolar disorder
Sofie Ragnhild Aminoff1,2, Chantal Henry3,4,5,6,7, Francesco Bettella2, Bruno Etain3,5,8, Akiah O. Berg1,2, Trine V. Lagerberg1,2, Thomas Bjella1,2, Monica Aas1,2, Srdjan Djurovic1, Frank Bellivier3,5,8, Ole A. Andreassen1,2,4, Ingrid Melle1,2; 1Oslo University Hospital, 2University of Oslo, 3AP-HP- Hôpitaux Universitaires Henri Mondor, 4ENBREC, European Network of Bipolar Research Expert Centres, 5Fondation Fondamental, 6Inserm-U955, 7Université Paris Est Créteil Val de Marne, 8AP-HP- Hôpital Fernand Widal
Objectives: Affective lability in bipolar disorder (BD) is a potential prodrome in at-risk youth for BD (Hafeman et al., 2016), and is present in first episode patients (Aminoff et al., 2012). It is also higher in relatives of patients with BD than in the general population (Aas et al, 2015). Affective lability has previously been shown to be associated with experiences of childhood trauma, in particular emotional abuse (Etain et al., 2017). This study aims at investigating whether affective lability also could be a part of the genetic architecture of BD. Methods: Investigate the relationship between BD polygenic risk scores (PRS), affective lability (measured by Affective Lability Scale- short from), and emotional abuse (measured by Childhood Trauma Questionnaire) in a Norwegian discovery sample (N= 82) and a French replication sample (N=259). The samples have similar proportions of BDI (78%) and BDII (22%) patients. Results: Preliminary analyses point to significant bivariate associations between affective lability and emotional abuse in both the Norwegian (rs=0.343, p=0.002) and the French sample (rs=0.302,p≤0.001). We did not find an association between BD PRS and affective lability in either sample. Conclusions: Using BD PRS we did not find support to affective lability being part of the genetic architecture of BD.
Talk 4: Cortisol reactivity to daily-life stressors in psychosis
Thomas Vaessen1,2, Zuzana Kasanova1, Dennis Hernaus3, Johan Lataster2,4, Dina Collip2, Martine van Nierop1, Inez Myin-Germeys1; 1Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium, 2Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands, 3Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA, 4Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
Objective Results from experimental studies suggest that psychosis and psychosis liability are associated with increased cortisol levels and blunted cortisol reactivity, and that use of antipsychotics may reduce these aberrations. Here, we report on overall cortisol, diurnal slope, and cortisol stress reactivity in everyday life in psychosis and psychosis liability using the experience sampling method (ESM). Methods Our sample consisted of individuals diagnosed with psychotic disorder currently on (MPD; n=53) or off antipsychotic medication (NMPD; n=20), first-degree relatives of psychotic patients (REL; n=47), and healthy controls (HV; n=67). Saliva samples were collected throughout the day on six consecutive days and analyzed for cortisol levels. Simultaneously, stressfulness of the current activity was assessed with ESM questionnaires. Results We found no group differences in overall cortisol level between groups, but REL had a steeper diurnal slope than HV; in MPD a trend was found in the same direction. Regarding reactivity to stressful activities, results indicated attenuation of the cortisol response in both patient groups compared to HV. Conclusion These results do not confirm reports of increased cortisol levels in psychosis, but provide further evidence of stress-related blunting of cortisol and as such contribute to the development of an inclusive biomarker for psychosis.
Talk 5: Detecting distress in adolescents and young adults using big data analysis of social media
Stefanie J Schmidt1,2, Danilo Croce3, Niels Bugge2, Chantal Michel2, Valentina Bellomaria3, Roberto Basili3, Frauke Schultze-Lutter4; 1Clinical Psychology for Children and Adolescents, University of Bern, Switzerland, 2University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, 3Enterprise Engineering, AI Research Group, University of Rome, Tor Vergata, Italy, 4Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
The use of social media has grown exponentially in recent years, generating data that is a valuable source of information to detect potentially stressful events in an individual`s everyday-life. Thus, novel and interdisciplinary approaches are necessary to process this “big data” characterized by high volume, high velocity and high-variety information. Therefore, our study applied a combined support vector machine learning machine algorithm implemented within the Kernel-based Learning Platform (KeLP) and complex semantic language processing analysis to examine tweets written in English by adolescents and young adults between February 2017 and January 2018. Tweets were first classified according to 18 theory-derived life-event categories. Afterwards, a sentiment analysis was performed to identify a user`s attitudes towards this event (“positive”, “negative”, “neutral”, “ironic”). The dimension “experience” additionally captured each user`s emotional reaction related to this event (“distressful”, “helpful”, “neutral”). Furthermore, we examined potential gender-specific and socio-cultural differences. The automated classification process worked with sufficient accuracy of 76% and identified social relationships, hobbies/interests and interpersonal beliefs as the most prevalent events. Tweets related to mental health were experienced as being most distressful. Gender-differences were detected in that females tweeted more often about social and romantic relationships. With regard to socio-cultural differences, we identified primarily African-American Twitter-communities that more frequently discussed sociopolitical issues than other users. Thus, social big data mining is a promising analysis technique processing a huge amount of real-life data to identify stressors and supportive factors to promote mental health and well-being in adolescents and young adults.
Talk 6: A structural equation modeling meta-analysis of coping, locus of control, self-efficacy and mental health
Stefanie J Schmidt1,2, Nina Schnyder1, Michael Kaess1,3, Andjela Markovic1, Liz Rietschel4, Susann Ochenbein1, Chantal Michel1, Frauke Schultze-Lutter1,5, Nicola Groth1; 1University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland, 2Clinical Psychology for Children and Adolescents, University of Bern, Switzerland, 3Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany, 4Academy for Psychotherapy, SRH University Heidelberg, Germany, 5Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
Mental disorders are regarded as major causes of disability-adjusted life years. Thus, there is a clear need to investigate the impact of preventive and risk factors on mental health as they might be worthwhile targets for future psychosocial mental-health promotive interventions. A crucial step towards this goal is to synthesize findings and to develop a better understanding of the interplay of locus of control, self-efficacy and coping as important predictors of mental health. The aim of this study was to perform a two-staged structural equation modeling meta-analysis (TSSEM) to examine whether coping mediates the associations between locus of control, self-efficacy and mental health outcomes in the general population and clinical samples. TSSEM included 15 studies and using a pooled sample of 3986 respondents and 225 cross-sectional effect sizes indicated that maladaptive coping mediates the associations between maladaptive locus of control and poor mental health outcomes. In contrary, adaptive coping did not mediate this relationship, and was only significantly associated with self-efficacy and adaptive locus of control and unexpectedly not with mental health outcomes. Both maladaptive and adaptive locus of control but not self-efficacy had direct links to mental health that were independent from coping. Interventions should not only focus on enhancing adaptive coping as it might be more promising to diminish maladaptive locus of control, which may result in reduced maladaptive coping and finally improved mental health.
Talk 7: Direct and indirect effects of coping, self-efficacy and control beliefs to promote mental health and quality of life in a general population sample
Stefanie J Schmidt1,2, Chantal Michel1, Michael Kaess1,3, Nina Schnyder1, Frauke Schultze-Lutter4, Nicola Groth1; 1University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland, 2Clinical Psychology for Children and Adolescents, University of Bern, Switzerland, 3Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany, 4Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
Coping plays a crucial role in the development of mental disorders as well as in quality of life (QoL). Next to coping, competence beliefs (i.e. self-esteem/self-efficacy) and locus of control (i.e. external attributions) have been emphasized as risk factors to and promotors of mental health. However, the interplay of these factors and their relative contribution to mental health and QoL remains poorly understood. This study aimed to investigate whether coping mediates the associations between competence/control beliefs and mental health as well as QoL. Coping, competence/control beliefs and QoL were assessed in a representative general population sample of 468 participants living in the Swiss Canton Bern (n=784, 16–40 years, response rate of 69%) using established questionnaires. The sample was interviewed in a telephone survey for mental health outcomes (current axis-I problems/disorders). We used structural equation modeling (SEM) to estimate the relationships between model-variables. The resulting model had a good fit to the data and identified three significant mediation pathways. Dysfunctional competence/control beliefs were significantly associated with more negative coping strategies and more mental health problems (path 1) and lower QoL (path 2). Additionally, higher levels of positive competence/control beliefs were significantly associated with better mental health through more positive coping (path 3). Competence/control beliefs had a significant direct positive effect on QoL but no mediation effect. Our results indicate that interventions promoting mental health and QoL should not only focus on enhancing common positive coping strategies but also on reducing dysfunctional coping strategies and enhancing positive competence/control beliefs directly.
Talk 8: The Association between War-related Stress, PTSD Symptoms, and Sub-clinical Psychosis: A Cross-cultural Population-based Study among Palestinian and Israeli Youth.
Danny Koren1, Amjad Mussa1; 1University of Haifa
Aim: The goal of this study was to examine the relationship between exposure to terror/war-related events, PTSD symptoms and sub-clinical psychosis symptoms among Palestinian and Israeli youth with and without a history of genetic risk for psychosis. Method: Exposure to terror/war-related trauma, presence and severity of PTSD symptoms, perceived ability to cope with trauma, familial genetic-risk, and APS were assessed in a representative sample of 530 Israeli and 1100 Palestinian (451 from Israel, 264 from the West Bank, and 385 from the Gaza Strip) young adults with a mean age of 36.7 (SD=8.4). PTSD symptoms were assessed with the Post-traumatic Disorder Scale (PDS), perceived ability to cope with trauma with the Perceived Ability To Cope With Trauma Scale (PACT), and APS with the Community Assessments of Psychic Experiences (CAPE). Results: As hypothesized, there was a significant three-way interaction effect of exposure to terror-war-related trauma, religion, and familial genetic-risk on APS. The highest level of APS was among Palestinians who live in the Gaza strip, with no significant differences between Jews and Palestinians who live in Israel or in the West Bank. Also, consistent with our hypotheses, the three-way association between exposure to trauma, familial genetic risk and religion were mediated by PTSD symptoms and perceived ability to cope with trauma. Discussion: These findings provide further support for the link between exposure to trauma, familial genetic-risk, and APS. Also, it provides further support for the mediating role that PTSD symptoms play in this link. Finally, it suggests that religious background moderates the link between exposure to trauma and APS.