bluuebunny/crossref_metadata_2025 huggingface dataset:
On Frege’s Assimilation of Sentences with Names*
Authors: Kim Dongwoo
Published: May 2020

I shall discuss some of the issues concerning a notorious doctrine of Frege that sentences are names of truth-values. I am interested in a problem raised by Kripke that the doctrine obscures the distinction between judgeable and unjudgeable contents. I shall present what I take to be Frege’s account of judgeable content: a proper expression of a judgeable content is susceptible to an analysis into a predicate and an argument-word, where a predicate is understood as a concept-word used to attribute a certain property to the referent of the argument-word. In the light of this analysis, I shall argue that the doctrine does not obscure the distinction. The problem will also be discussed within the formal context of Grundgesetze. A new light will be shed on his rather peculiar conception of the symbol ‘ ${\boldsymbol \vdash}$’.
Role of Magnetic Resonance Imaging in Evaluation Of Anterior Knee Pain
Authors: Abbas Y A , Abdulkhalik Y I , Motlaq Y H
Published: May 2020

Background

The knee joint is one of the most commonly injured joints in the body. Because of its complex structure, this joint is subjected to numerous pathologies and due to the recent increase in various sport activities, there has been a parallel increase in sport-induced internal derangements of the knee. The main strength of knee MRI is the assessment of articular and Peri-articular diseases. The specific structures best suited for MRI assessment include tendons, muscles and ligaments, as well as peri-articular soft tissue masses.

Objective

The purpose of this study is to detect the accuracy of MR imaging as a diagnostic tool in the evaluation of different knee joint pathologies that cause anterior knee pain, with emphasis on some of their grades and types for better assessment.

Methodology

This study included 20 patients (6 female and 14 male). Their ages range between 10-60 years (average age 30 years). All presented by anterior knee pain and were referred to radiology department of Ain Shams University hospital or private centers for MRI examination after orthopedic consultation.

Results

5% of the patients presented with anterior knee pain showed MRI evidence of patellar tendinopathy (66% below the age of 30 years and more in females). In all cases the hyperintense focal thickening was at the proximal third of the tendon, with the AP diameter of the patellar tendon greater than 8mm. In our results about 10% of the patients in the study sample, had MRI evidence of tear in the anterior horn of lateral knee meniscus with a female equal to male (50% females and 50% males). Cartilage injuries were detected in 5% of the study sample, showing male predominance (100% were male and 0% were female) with average age 32 years. All have a past history of trauma.

Conclusion

MRI is generally safe, accurate, and specific modality which has been proven to be the modality of choice in the diagnosis of different knee pathologies that cause anterior knee pain in different age groups. Also, it has a high specification in detecting the grades and types of some of these diseases.
Utility of C-Arm CT in Detection Hepatocellular Carcinoma during Trans Arterial Chemoembolization
Authors: Ghazy M S , Soliman A H , Abdelmaksoud M H K , Morsy N M E
Published: May 2020

Background

Transcatheter arterial chemoembolization is one of the effective therapeutic options for hepatocellular carcinoma (HCC). Ultraselective chemoembolization is an alternative approach to improve local control, and is associated with a reduced incidence of adverse effects.

Objective

It was to evaluate the sensitivity of cone beam computed tomography (CBCT) in detecting HCC tumors and their feeding vessels during transarterial chemoembolization (TACE).

Patients and Methods

All patients were suspected of having or confirmed to have HCC on the basis of clinical history, underlying liver disease and/or viral infection, the diagnosis of HCC was made by imaging findings. Between January 2016 and January 2018, Dyna CT was retrospectively used in 19 consecutive patients with HCC tumor with HCC tumor.

Results

The detectability of the tumor with DSA obtained at the common, proper, right, or left hepatic artery (i.e., nonselective DSA) and cone-beam CT was compared as taking pre imaging as a gold standard. Tumor stain and feeding branches were evaluated. The detectability of the tumor-feeding branch with non-selective DSA and Dyna CT HA images was compared.

Conclusion

Tumor detectability on cone-beam CT was significantly greater than on non-selective. Cone beam HA taking pre imaging as a gold standard was (94.4%) and its specificity (71.6%) with accuracy (76.97%). The sensitivity of DSA in detection of additional tumor as taking the pre imaging (CT/MRI) as a gold standard was (88.9%) and its specificity (84.5%) with accuracy (85.53%). Cone-beam CT has satisfactory ability to detect tumors; the detectability of tumor-feeding branches with Dyna CT was significantly higher than that with nonselective DSA (P less than 0.001). We believe the technical success rates of ultraselective transcatheter arterial chemoembolization may be improved by chemoembolization guidance software that uses cone-beam CT technology.
T77. ASSOCIATION BETWEEN INTRACELLULAR INFECTIOUS AGENTS AND SCHIZOPHRENIA
Authors: Kwon Young-Joon , Yoon Bo-Hyun , Lee Kwanghun , Kim Moon-Doo , Nam Beomwoo , Shim Se-Hoon , Lim Eunsung
Published: May 2020

Background

A number of studies have reported association between Toxoplasma gondii (T. gondii) and Chlamydia infection and the risk of schizophrenia. The aim of the present study was to compare the prevalence of T. gondii and Chlamydia infection between the schizophrenia and normal control subjects and to compare the clinical features between seropositive and seronegative schizophrenia patients.

Methods

The rate of serum reactivity to T. gondii, Chlamydia trachomatis (C. trachomatis), Chlamydia pneumonia in 96 schizophrenia and 50 control subjects was investigated using enzyme-linked immunosorbent assay and indirect fluorescent antibody technique. The clinical symptoms of the schizophrenia patients were scored with Positive and Negative Syndrome Scale and a comparative analysis was carried out.

Results

A significant positive association between immunoglobulin G (IgG) antibodies to T. gondii and C. trachomatis in schizophrenia was found, and the odds ratio of schizophrenia associated with IgG antibody was found to be 3.22 and 2.86, respectively. The Toxoplasma-seropositive schizophrenia patient had higher score on the negative subscale N1 and N7 and general psychopathology subscale G13, while C. trachomatis-seropositive schizophrenia patient had higher score on the general psychopathology subscale G10.

Discussion

The results from the present study suggest significant association between T. gondii, C. trachomatis infection and schizophrenia. In future, further studies are needed to elucidate the correlation between the two types of infection and schizophrenia.
T88. VALIDATION OF THE KOREAN VERSION OF THE 15-ITEM COMMUNITY ASSESSMENT OF PSYCHIC EXPERIENCES (CAPE-15) IN A COLLEGE POPULATION
Authors: Kim Sung-Wan , Jin Kim Jung , Kim Yeonghyeok , Jo Anna , Kim Jae-Kyeong , Kim Jae-Min , Chul Chung Young , Yoon Jin-Sang
Published: May 2020

Background

The Community Assessment of Psychic Experiences-Positive 15-items scale (CAPE-15) is another brief, valid screening tool used to identify people at high risk of psychosis in the community. This study examined the reliability and validity of the Korean version of the CAPE-15 in university students.

Methods

This study had two stages: initial screening with self-report questionnaires including the CAPE-15, and semi-structured interviews to investigate the instrument’s diagnostic validity. The initial screening involved 1,749 college students. The modified Korean version of Prodromal Questionnaire-16 item (mKPQ-16) was also administered. The criteria for ultra-high risk (UHR) of psychosis in the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis.

Results

Twelve of the interviewed subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve was highest (0.936) for the CAPE-15 distress score (p<0.001). The use of 6 as the cutoff for the CAPE-15 distress score resulted in the best balance of sensitivity (91.7%) and specificity (85.2%), with a favorable positive predictive value of 32.4%. The coefficients of correlation between the CAPE-15 and mKPQ-16 were significant.

Discussion

This study showed that the CAPE-15 is a good screening instrument for use in community and school settings. In particular, the better validity of the CAPE-15 suggests that it is a promising alternative to other brief self-report screening tools that are currently used to detect UHR. This validation of a questionnaire with a small number of items may make it feasible to screen large numbers of young adults in the community and shorten the duration of untreated psychosis through prompt early intervention.
T123. RISK FACTORS FOR PSYCHOTIC DISORDERS WITHIN MIGRANT GROUPS IN CANADA
Authors: Anderson Kelly , Edwards Jordan
Published: May 2020

Background

Although there is a large evidence base suggesting elevated rates of psychotic disorder for some migrant groups, relative to the non-migrant host population, less is known about factors that modify the risk of psychosis within migrant groups. Our objective was to assess whether pre-migration, migration-related, and post-migration factors were associated with an elevated risk of psychotic disorder among first-generation migrants in Ontario, Canada.

Methods

Using linked population-based health administrative data, we constructed a retrospective cohort of first-generation migrants to Ontario over a 20-year period between 1992 and 2012. We identified first onset non-affective psychotic disorders using a validated algorithm. Pre-migration factors included sex, country of origin, education, occupation, marital status, and language. Migration-related factors included age at migration, year of migration, duration of residence, and migrant class. Post-migration factors included rural place of residence and neighbourhood-level indicators of marginalization. We used Poisson regression models to compute incidence rate ratios for each pre-migration, migration-related, and post-migration factor to assess its magnitude of effect on the risk of developing psychosis, relative to migrants who did not develop psychotic disorder.

Results

Our cohort included over two million first-generation migrants over the 20-year period. Preliminary findings suggest that males, refugees, and people who set up residence in urban centres have higher rates of psychotic disorder, and people who are older at the time of migration and those who set up residence in high-income areas have lower rates of psychotic disorder. Full results for pre-migration, migration-related, and post-migration risk factors will be presented.

Discussion

Migrant status is one of few well-established risk factors for psychotic disorder, yet we have limited understanding of the underlying etiology. The findings from this study help to identify high-risk groups to target for intervention. Improving our understanding of key risk factors for psychotic disorders within migrant groups is crucial for informing prevention and early intervention efforts.
T126. PSYCHIATRIC PREDICTORS FOR BECOMING HOMELESS AND EXITING HOMELESSNESS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Nilsson Sandra , Nordentoft Merete , Hjorthøj Carsten
Published: May 2020

Background

Homelessness is an increasing societal problem in high-income countries and often linked to psychiatric disorders. However, a study compiling the existing literature is lacking.

The aim was to identify individual-level predictors for becoming homeless and exiting homelessness in a systematic review and meta-analysis.

Methods

We searched PubMed, EMBASE, PsycINFO, and Web of Science (up to January 2018). Becoming homeless and exiting homelessness were the outcomes. Observational studies with comparison groups from high-income countries were included. The Newcastle Ottawa Quality Assessment Scale was used for bias assessment. Random effects models were used to calculate pooled odds ratios (ORs). In all, 116 studies of predictors for becoming homeless and 18 for exiting homelessness were included.

Results

Psychiatric problems, especially drug use problems (OR 2.9, 95% confidence interval (CI) 1.5–5.1) and suicide attempts (OR 3.6, 95% CI 2.1–6.3) were associated with increased risk of homelessness. However, the heterogeneity was substantial in most analyses (I2>90%), and the estimates should be interpreted cautiously. Adverse life-events, including childhood abuse and foster care experiences, and past incarceration were also important predictors of homelessness. Psychotic problems (95% CI 0.4, 0.2–0.8; I2=0) and drug use problems (OR 0.7, 95% CI 0.6–0.9; I=0) reduced the chances for exiting homelessness. Female sex and having a partner increased the changes of exiting homelessness.

Discussion

Evidence for several psychiatric predictors for becoming homeless and exiting homelessness was identified. Additionally, socio-demographic factors, adverse life-events, and criminal behavior were important factors. There is a need for more focus on psychiatric vulnerabilities and early intervention to reduce the risk of homelessness.
T129. PHARMACOLOGICAL INTERVENTIONS IN TRIALS OF PEOPLE WITH SCHIZOPHRENIA: A REGISTER-BASED CLASSIFICATION OF SEVENTY YEARS OF RESEARCH
Authors: Shokraneh Farhad
Published: May 2020

Background

Drug development is a billion dollar business globally. It is crucial to stay up to date on drug developments all over the world any repetition will be irreversible waste of resources. The only way to keep up with all the development is to keep a living database of all trials running for each condition and covering all studies from every country in any language. An Information Specialist collects and classifies all pharmacological interventions from all schizophrenia trials.

Methods

Cochrane Schizophrenia’s Study-Based Register was developed and used as the source of trials, Emtree and MeSH for synonyms, AdisInsight and CT.gov for research drugs and WHO ATC for marketed drugs. This research took four years from 17 December 2014 and 6 January 2019 and involved 18,500 randomized controlled trial from 90 countries in 23 languages.

Results

One third of tested interventions on patients with schizophrenia are pharmacological (816; belonging to 106 clinical classes) with antipsychotic drugs being the most researched (15.1%). Only 528 of these medications are listed in WHO ATC. Around one third of these drug interventions are seen only in research (236; from 21 pharmacological/biochemical classes). Within the pharmacological evaluations we identified 28 ‘qualifiers’ including dose, route, and timing of drug delivery. Using Data Science approaches, this research revealed unique antipsychotic drugs that are being prescribed only in certain countries such as Japan but the West is not aware of them. This research is also revealed all the research drugs and current trends in developing drugs in pharmaceutical companies.

Discussion

Classification of medication interventions from trials requires use of many sources of information none of which are inclusive of all drugs. Without a global search in all languages the pharmaceutical companies and researchers are missing important successful developments from non-English speaking world. The cycle of developing research/withdrawn drugs does not stop and may end in veterinary medicine, doping agents in sports, and illicit drug market.
T159. STRUCTURAL BRAIN ABNORMALITIES IN SCHIZOPHRENIA IN ADVERSE ENVIRONMENTS: EXAMINING THE EFFECT OF POVERTY AND VIOLENCE IN SIX LATIN AMERICAN CITIES
Authors: Crossley Nicolas , Zugman Andre , Reyes-Madrigal Francisco , Czepielewski Leticia , Castro Mariana , Diaz-Zuluaga Ana María , Pineda-Zapata Julián , Reckziegel Ramiro , Gadelha Ary , Jackowski Andrea , Noto Cristiano , Serra Luz Maria Alliende , Iruretagoyena Bárbara , Ossandon Tomas , Ramirez-Mahaluf Juan Pablo , Paz Castañeda Carmen , Gonzalez-Valderrama Alfonso , Nachar Ruben , León-Ortiz Pablo , Undurraga Juan , Lopez-Jaramillo Carlos , Guinjoan Salvador M , Gama Clarissa , de la Fuente-Sandoval Camilo , Bressan Rodrigo
Published: May 2020

Background

Social and environmental factors such as poverty or violence, modulate the risk and course of schizophrenia, but how they affect the brain in patients with psychosis remains unclear. We here studied how they are related to brain structure in schizophrenia and healthy controls in Latin America, where these factors are large and unequally distributed.

Methods

This is an MRI multi-center study in patients with schizophrenia and healthy controls from six Latin American cities: Buenos Aires, Medellin, Mexico City, Santiago, Sao Paulo and Porto Alegre. Total and voxel-level gray matter volumes obtained from T1-weighted MRI images and their relationship with income and homicide rates were analyzed using a general linear model.

Results

334 patients with schizophrenia and 262 controls were included. Income was differentially related to total gray matter volume in the two groups (P=0.006). Controls showed a positive correlation between total gray matter volume and income (R=0.14, P=0.02). Surprisingly, this relationship was not present in schizophrenia (R=-0.076, P=0.17). Voxel-level analysis confirmed that this interaction was widespread across the cortex. After adjusting for global brain changes, income was positively related to prefrontal cortex volumes only in controls. Conversely, the hippocampus in patients, but not in controls, was relatively larger in affluent environments. There was no significant correlation between environmental violence and brain structure.

Discussion

Our results highlight the interplay between the environment, particularly poverty, and individual characteristics in psychosis. This is particularly important for harsh environments such as those from low and middle-income countries: potentially less brain vulnerability (less gray matter loss) is sufficient to become unwell in adverse (poor) environments. The development of algorithms exploring clinically-useful information from structural brain images in psychosis should include representative samples from low and middle-income countries.
T163. STRUCTURAL AND CONNECTIVITY CHANGES IN THE CEREBELLUM CONTRIBUTE TO EXPERIENCING AUDITORY VERBAL HALLUCINATIONS
Authors: Pinheiro Ana , Bouix Sylvain , Makris Nikos , Schwartze Michael , Shenton Martha , Kotz Sonja
Published: May 2020

Background

Auditory verbal hallucinations (AVH) have been explained in the context of the forward model, giving the cerebellum a prominent role. However, research utilizing multiple neuroimaging modalities has rendered results on the specificity of cerebellar contribution to AVH unclear.

Methods

To examine the reliability and regional specificity of cerebellar changes in AVH, a systematic search of electronic databases through October 2019 was conducted to identify neuroimaging studies of the cerebellum in psychotic patients or nonclinical participants reporting AVH, focusing on structural MRI, diffusion tensor imaging, and resting state functional connectivity studies. Twenty-two studies were selected, including 892 participants with AVH (792 psychotic patients; 100 at-risk subjects) and 775 healthy controls. Activation likelihood estimate analysis (ALE) examined the reported coordinates for reduced volume, fractional anisotropy (FA) or connectivity (control participants > participants with AVH) and increased volume, FA or connectivity (participants with AVH > control participants). The consistency of cerebellar changes and their relationship with sociodemographic and clinical measures were meta-analyzed.

Results

The ALE meta-analysis revealed changes in both anterior and posterior cerebellar lobes, with opposite patterns: whereas decreased volume or connectivity was identified in the right anterior cerebellum (lobule IV/V), increased volume or connectivity was identified in the bilateral posterior cerebellum (Crus I and II). A random-effects model with small sample corrections identified consistent changes in both volume and functional connectivity of the cerebellum in participants with AVH (g = .84; SE = .24, 95% CI [.33, 1.34]), which were enhanced in Crus I (g = 1.52, SE = .28, p = .006, 95% CI [.73, 2.31]) but not moderated by age, sex, medication, or illness duration.

Discussion

The ALE meta-analysis confirms cerebellar structural and connectivity changes in psychotic and nonclinical participants reporting AVH. These changes may contribute to AVH due to altered sensory feedback and consequently to erratic prediction as described by the forward model. The current findings also indicate that not all cerebellar regions are equally affected by AVH: the most pronounced changes were observed in Crus I. Specifically, altered communication between Crus I and neocortical network nodes, including the prefrontal cortex, may contribute to ineffective cognitive control in AVH, leading to external misattributions of auditory feedback and a reduced sense of control over events in the environment.
T193. THE ROLE OF METACOGNITION ON NEGATIVE SYMPTOMS: A PSYCHOLOGICAL MODEL FOR DIMINISHED EXPRESSION IN SCHIZOPHRENIA
Authors: García-Mieres Helena , Lundin Nancy , Minor Kyle , DiMaggio Giancarlo , Cheli Simone , Popolo Raffaele , Ochoa Susana , Lysaker Paul
Published: May 2020

Background

The resistance of negative symptoms to pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. However, little is understood about the psychological processes that reinforce and sustain the negative symptoms domain of diminished expression. Prior research has shown that higher levels of diminished expression relate to deficits in metacognitive capacity. We propose a more complex model in which diminished expression occurs when impairments in metacognitive self-reflectivity, alterations in higher-order language structure, and cognitive deficits interact and thus interfere with persons’ ability to understand and express emotions in ways others can recognize.

Methods

Individuals with schizophrenia-spectrum disorders (N=201) provided personal narratives including their life story and reflections regarding their mental illness and a clinician-rated interview of psychotic symptoms (i.e., Positive and Negative Syndrome Scale; PANSS). Self-reflectivity was measured with the Metacognition Assessment Scale-Abbreviated, and situation models were extracted from participants’ personal narratives via Coh-Metrix 3.0, an automated program that calculates basic and complex language indices. Diminished expression and cognitive symptoms were measured with the PANSS. Structural equation models (SEM) examined whether self-reflectivity mediated the impact of cognitive deficits and situation models on diminished expression.

Results

SEM revealed that self-reflectivity partially mediated the impact of situation models on diminished expression (β = -.083, p = .005, ±95% CI [-.141, -.026]) and fully mediated the influence of cognitive symptoms in diminished expression (β = .099, p = .001, ±95% CI [.038, .160]). Findings persisted after controlling for educational level.

Discussion

This study is the first of its kind to utilize a mediational model including higher-order linguistic structures, cognitive impairment and metacognition to explain diminished expression in psychosis. Results suggest that self-reflectivity, situation models and cognitive symptoms may be useful targets for intervention in efforts to decrease diminished expression.
T200. METABOLIC SIDE EFFECTS OF ANTIPSYCHOTIC DRUGS – PROTOCOL OF A SYSTEMATIC REVIEW AND NETWORK- METAANALYSIS
Authors: Schneider-Thoma Johannes , Bighelli Irene , Siafis Spyridon , Leucht Stefan
Published: May 2020

Background

Antipsychotic drugs are the mainstay of the pharmacological treatment of schizophrenia, used in the acute episode of the disorder and for prevention of relapses. Unfortunately, antipsychotics cause side effects. Weight gain is one of the most prominent side effects. In line with weight gain, also alterations of lipid- and glucose homeostasis can occur and increase the risk for cardiovascular disorders. So far, the differences between the multiple antipsychotics in propensity to cause these alterations have not been examined based on data from randomized controlled trial. Therefore, we are conducting a systematic review and network-metaanalysis on metabolic side effects of antipsychotic drugs.

Methods

Systematic review and network-metaanalysis.

Population

Patients with schizophrenia.

Interventions

Antipsychotic drugs and placebo.

Comparator

In network-metaanalysis all interventions are compared with each other. For presentation of Results:, placebo will be used as reference.

Outcomes

The primary outcomes will be continuous change of body weight. Additional outcomes will be continuous change of blood glucose, triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol as well as dichotomous values of these outcomes (i.e. number of patients with a clinically relevant increase over pathological thresholds).

Study design

Randomized controlled trials.

Statistical analysis

Network-metaanalysis.

Planned network-metaregression-, subgroup- and sensitivity-analyses will address the role of the potential effect modifiers baseline weight, study duration, age, gender, ethnicity, previous antipsychotic exposure, antipsychotic dose, sponsorship, and use of enriched-design.

Results

Funding for this project has been received from the German Ministry of Education and Research.

At the time of abstract submission, the project has just started and is currently in the stage of protocol development.

Discussion

At the time of the conference the protocol of the study will be developed further and the literature search will have started. Thus, on the poster, details of the analytic approach can be presented and challenges discussed. Moreover, results of the search process can be presented.
T201. EFFECTS OF PALIPERIDONE PALMITATE ON HEALTHCARE UTILIZATION AND COSTS FOR PATIENTS WITH SCHIZOPHRENIA: A CLAIM-BASED MIRROR-IMAGE STUDY IN SOUTH KOREA
Authors: Hun Jung Myung , Jon Duk-In , Yi Jung-Seo , Chul Lee Boung
Published: May 2020

Background

Long-acting injectable (LAI) antipsychotics, such as paliperidone palmitate (PP), are known to improve treatment adherence in patients with schizophrenia, which can lead to reductions in relapse and hospitalization rates. However, relatively few studies have demonstrated the economic impact of LAIs, especially in Asian populations.

Methods

We conducted a claim-based mirror-image study to explore changes in healthcare utilization and associated costs, among 1,272 South Korean patients with schizophrenia (ICD-10-CM code F20), between the 1-year periods before and after the initiation of PP treatment.

Results

The results showed that patients accessed outpatient services more frequently after versus before starting PP treatment, with the number of prescription days increasing by 133.45 (p < .0001) and the associated costs increasing by USD 1,497.15 (p < .0001). In contrast, the number of admission days was reduced by 11.33 after starting PP treatment (p < .0001) and the associated costs were reduced by USD 1,220.75 (p < .0001).

Discussion

Although the high acquisition cost of PP has been regarded as an obstacle to its clinical use, our results imply that the high prescription costs for PP may be counterbalanced by the reduced admission costs associated with its use. Economic outcomes for patients treated with LAIs should be investigated further to help healthcare decision-makers and providers to determine the value of LAIs relative to other treatment medications.
T216. VARIATION IN SIDE EFFECTS TO ANTIPSYCHOTIC TREATMENT ACROSS SCHIZOPHRENIA SPECTRUM DISORDERS
Authors: Susanne Neumeier Maria , Winkelbeiner Stephanie , Kane John , Seifritz Erich , Huhn Maximilian , Leucht Stefan , Homan Philipp
Published: May 2020

Background

Adverse effects of antipsychotic drugs play a key role in non-compliance and discontinuation of treatment in Schizophrenia Spectrum Disorders (SSD). Precision medicine aims to minimize such adverse effects by selecting the right treatment for the right patients. To determine the need for precision medicine we need to estimate the amount of variation in adverse effects between patients. While clinical experience suggests that such variation is considerable, analyzing how variation differs between treated and untreated patients can answer this question. Here, we hypothesized to find larger variation in treatment compared to control groups of patients treated with second generation antipsychotics.

Methods

We included double-blind, placebo-controlled, randomized trials of adults with a diagnosis of schizophrenia spectrum disorders and prescription for licensed antipsychotic drugs. Means and variances of the pretreatment and posttreatment outcome differences of weight gain, prolactine levels, and corrected QTC times were extracted. Data quality and validity were ensured by following the PRISMA guidelines. The outcome measure was the overall variability ratio of treatment to control across RCTs. Individual variability ratios were weighted by the inverse-variance method and entered into a random-effects model.

Results

We included N = 13 282 patients for weight gain, N = 11 767 for prolactine levels, and N = 7 203 for QTC time. For all the measured adverse effects, variances were greater in treatment compared to control. Specifically, variance ratios were increased for weight gain (VR = 1.13, 95% CI: 1.06, 1.20), prolactine levels (VR = 1.38, 95% CI: 1.13, 1.68) and QTc time (VR = 1.06, 95% CI: 1.01, 1.12).

Discussion

We found increased variability in the major side effects that patients with SSD had under treatment with second generation antipsychotics. Indeed, some patients were more susceptible than others to weight gain, prolactine level increase, and QTC time increase, suggesting that precision medicine in antipsychotic treatment should be informed by individual differences in side effects rather than treatment effects. Future studies should aim at finding biological predictors of such individual differences in side effects.
T219. REAL LIFE FUNCTIONING IN 22Q11 DELETION SYNDROME (DS) IN COMPARISON TO SCHIZOPHRENIA SUBJECTS: STUDY ON PSYCHOSES VULNERABILITY FACTORS. DATA FROM THE MULTICENTER STUDY OF THE ITALIAN NETWORK FOR RESEARCH ON PSYCHOSES
Authors: Carlone Luca , Frascarelli Marianna , Buzzanca Antonino , Accinni Tommaso , Ghezzi Francesco , Fanella Martina , Putotto Carolina , Girardi Nicoletta , Pasquini Massimo , Di Fabio Fabio , Biondi Massimo , Frascarelli Marianna
Published: May 2020

Background

22q11DS is the most common microdeletion with an incidence of 1:4000 live births. It is considered a genetic biological model for psychosis vulnerability: 25–28% of 22q11DS adults is affected by a psychotic disorder. Few data are available regarding functioning in 22q11DS. Our aim was to test the hypothesis that functioning is similar in 22q11DS psychotic and non-psychotic patients, and idiopathic schizophrenic subjects. We expected also a correlation between negative symptoms and functioning.

Methods

Data come from Italian Network for Research on Psychoses for the Schizophrenic (SCZ, N=252) and Control groups (HC, N=110). 22q11DS psychotic (22q11DS_SCZ, N=21) and non-psychotic patients (22q11DS, N=23) were enrolled at Policlinico Umberto I, in Rome. The SLOF scale (Specific Levels of Functioning) and the Brief Negative Symptom Scale interview (BNSS) were employed.

Results

The Global Functioning was significantly different between all groups but not between 22q11DS groups and SCZ. The multivariate analysis of variance showed the higher effect size for the Interpersonal Functioning, in which differences resulted significant between all groups, except for the comparison between 22q11DS-SCZ and SCZ. Differences between groups in BNSS were significant except for the post-hoc 22q11DS-SCZ vs SCZ. Global and Interpersonal Functioning showed a significant negative correlation with BNSS scores in the three clinical groups.

Discussion

22q11DS-SCZ showed a severe deficit in Interpersonal Functioning, similar to that of idiopathic schizophrenia. 22q11DS showed a deficit in Interpersonal Functioning respect to control group, but less severe than psychotic groups. Our data suggest a common impairment shared among the clinical groups, that may be the functional correlate of an underlying neurobiological mechanism.
M106. VIRTUAL-REALITY COGNITIVE TRAINING AND ASSESSMENT IN SCHIZOPHRENIA
Authors: Porffy Lilla , Mouchlianitis Elias , Joyce Dan W , Szentgyorgyi Timea , Whomersley Gabriella , Patchitt Joel , Brett Jack , Shergill Sukhi S
Published: May 2020

Background

It is widely accepted that neurocognitive performance is linked to functional outcomes in schizophrenia (Green, Kern, Braff, & Mintz, 2000). Research, however, shows that this relationship is likely to be mediated by other factors such as social competence (Brekke, Kay, Lee, & Green, 2005). Indeed, performance on cognitive tasks only explain 20% of the variance in work related skills (Bowie et al., 2008). Furthermore, the composite score generated by the gold standard neurocognitive measure, the MATRICS Consensus Cognitive Battery (MCCB), fails to predict work or education related functioning and independent living (August, Kiwanuka, McMahon, & Gold, 2012). To address these limitations, we developed a novel and ecologically valid virtual reality (VR) task with the aim to simultaneously measure cognition and functional capacity in schizophrenia. The assessment is set in a minimarket environment where participants are required to buy selected items from a shopping list. In this study, our objective was to establish the construct validity of the VR task in relation to the MCCB, and test whether it can predict functional outcomes. In addition, we tested whether app-based cognitive training can improve cognition and/or functional outcomes at follow-up as an exploratory objective.

Methods

Thirty patients with a diagnosis of schizophrenia or schizoaffective disorder were recruited from South London. At baseline, participants completed the VR task and MCCB, the Positive and Negative Syndrome Scale (PANSS), and various functional capacity/outcome measures including the Global Assessment of Functioning (GAF), Social and Occupational Functioning Assessment Scale (SOFAS), UCSD Performance-Based Skills Assessment-Brief (UPSA-B), and World Health Organization Disability Assessment Schedule II (WHODAS-II). A subset of participants was randomly allocated to receive a 4-week long, app-based training; either playing with an immersive or a 2D spatial memory training game. Those who completed the training were invited back for a follow-up visit. Construct validity of the VR task will be assessed through a series of bivariate correlations. The predictive ability of the VR task for functional outcomes will be tested through linear regression models. Finally, the efficacy of spatial memory training will be assessed using repeated measures ANOVA.

Results

Data analysis is currently ongoing, and results will be presented at the conference.

Discussion

This study will provide the first indication whether VR can be employed to test cognition and functional capacity simultaneously in patients with schizophrenia. Given the current lack of reliable and ecologically valid functional outcome measures, new assessments that are sensitive to clinically meaningful cognitive improvements are desperately needed.
M116. A SYSTEMATIC REVIEW OF THE PSYCHOLOGICAL AND BIOLOGICAL MEDIATORS BETWEEN ADVERSITY AND PSYCHOSIS: POTENTIAL TARGETS FOR TREATMENT
Authors: Alameda Luis , Rodriguez Victoria , Aas Monica , carrr Ewan , Trotta Giulia , Marino Paolo , Vorontsova Natasha , Herane-Vives Andres , Di Forti Marta , Morgan Craig , Murray Murray Robin
Published: May 2020

Background

Various psychological and biological pathways have been proposed as mediators between childhood adverse events (CA) and psychosis. A systematic review of the evidence in this domain is needed; open new venues for treatment interventions in traumatized patients with psychosis.

The aim of the current work is to systematically review the evidence on clinical and biological mediators between CA and psychosis across the psychosis spectrum.

Methods

This systematic review followed PRISMA guidelines. Articles published between 1979 and July 2019 were identified through a literature search in OVID (PsychINFO; Medline and Embase). The direction of the evidence by each analysis and each study was presented by group of mediator categories found in the review; the percentage of total effect mediated was calculated and whether the mediation was partial, total or null (if it was absent) was reported.

Results

47 studies were included, with a total of 72286 GP subjects and 2800 from clinical samples. The quality of studies was judges as “fair”. We found (i) solid evidence of mediation between CA and psychosis by negative cognitive schemas about the self, the world and others (NS); by dissociation and other PTSD symptoms; (ii) evidence of a partial mediation through an affective pathway (affective dysregulation, anxiety and depression) in GP; (iii) that feeling of loneliness appeared as an important mediator that should be further explored; (iv) lack of studies exploring biological mediators; (v) little evidence supporting the mediating role of dysfunctional attachment between CA and psychosis.

Discussion

Experiences of adversity, alongside with all relevant mediators such as PTSD and mood related symptoms and NS should be routinely assessed in patients with psychosis. Targeting such mediators through cognitive behavioural approaches such as trauma-focused therapy and/or pharmacological means could be a beneficial add on to the traditional treatment of positive symptoms.
M149. THE TOPOGRAPHY OF STRIATAL DOPAMINE AND SYMPTOMS IN PSYCHOSIS: AN INTEGRATIVE PET AND MRI STUDY
Authors: McCutcheon Rob , Jauhar Sameer , Pepper Fiona , Nour Matthew , Rogdaki Maria , Veronese Mattia , Turkheimer Federico , Egerton Alice , McGuire Philip , Mehta Mitul , Howes Oliver
Published: May 2020

Background

Striatal dopamine dysfunction is proposed to underlie symptoms in psychosis, yet it is not known how changes in a single neurotransmitter could underlie the heterogenous presentations that are seen clinically. One hypothesis is that the symptomatic consequences of aberrant dopamine signalling may depend on where within the striatum dysfunction occurs. Positron emission tomography (PET) allows for the measurement of dopamine function across the striatum. However, when using typical atlas-based parcellation methods, the collinearity between measures of dopamine function within each striatal subdivision precludes investigation of this hypothesis.

Methods

We use a novel and data-driven parcellation method to address the above, and investigate relationships between spatial variability in dopamine synthesis capacity and psychotic symptoms. We employ a multimodal imaging approach combining 18F-DOPA PET and resting state MRI in 29 unmedicated and minimally-treated patients with first episode psychosis and 21 healthy controls. In each participant, we use resting state functional connectivity maps to quantify the functional connectivity of each striatal voxel to cortical networks. Network-specific striatal dopamine synthesis capacity (Kicer) was calculated for the resulting connectivity defined parcellations.

Results

Connectivity defined parcellations generated Kicer values with equivalent reliability, and significantly greater orthogonality to standard anatomical parcellation methods. Dopamine function within striatal areas connected to the default mode network is strongly associated with negative symptoms (p<0.001).

Discussion

These findings suggest that individual differences in the topography of striatal dopamine dysfunction contribute to shaping psychotic symptomatology.
M177. THE PROTEOME OF OLIGODENDROCYTES DIFFERENTIATED FROM NEURAL STEM CELL DERIVED FROM SCHIZOPHRENIA PATIENTS
Authors: Teles Rodrigues Caroline , Martins-De-Souza Daniel
Published: May 2020

Background

Oligodendrocytes constitute the majority of the cells in white matter and alterations in this region have been reported in patients with schizophrenia. The myelin sheath is produced exclusively by mature oligodendrocytes. Thus, a dysfunction during the maturation of these cells could lead to a change in normal myelination processes, causing the hypomyelination observed in patients with schizophrenia. In this manner, functional studies are needed for a better connection of these different aspects of the disease in order to understand the pathophysiology of schizophrenia in an integrated manner. Thus, our aim was to evaluate the differences between the proteome of oligodendrocytes derived from neural stem cells (NSCs) from patients with schizophrenia and controls.

Methods

The cells were differentiated using the protocol described by Yan, Shin, Jha and collaborators (Yan, Shin, Jha, et al., 2013). After 14 days, the proteins were extracted and proteomic analyses were performed in a two-dimensional microUPLC coupled to nano ESI-Q-IM-TOF mass spectrometer. Progenesis® QI software was used in order to identify and quantify the proteins.

Results

On average, 2046 proteins were identified and 444 had alterations in the expression levels. These differentially expressed proteins were related most with metabolism, RNA transport, spliceosome machinery, vesicular transport, and signal transduction.

Discussion

The proteins and canonical pathways found here may contribute to understanding the biochemical mechanisms involved in the disorder, which may provide new targets for the development of more effective treatments, improving the schizophrenic patient’s quality of life.
M209. TO WHOM WE PRESCRIBE LONG ACTING ANTPSYCHOTICS AT DISCHARGE FROM HOSPITAL?
Authors: Ucok Alp , Şenay Olcay , Mursalova Zhala , Gadimov Shahriyar
Published: May 2020

Background

Although the growing evidence show the advantages of long acting injectable (LAI)antipsychotics on treatment of psychotic disorders, characteristics of the patients with psychotic disorders using LAI is not studied enough. The aim of this retrospective study is to understand the clinical characteristics of the patients with psychotic disorders to whom any LAI was prescribed at discharge from hospital

Methods

We screened the files of 400 inpatients with psychosis spectrum disorders who were treated in inpatient units of Istanbul Faculty of Medicine, Department of Psychiatry between 01.01.2014-01.016.2019. We recorded the last admission if the patient had more than one hospitalization. We compared the variables including illness duration, diagnosis, presence of involuntary hospitalization, insight, substance/alcohol abuse, forensic problems between those who were prescribed LAI and others. We also applied logistic regression analysis to detect the independent predictors of LAI prescription.

Results

Thirty-nine percent of the patients were given LAI at discharge. Patients with schizophrenia and schizoaffective disorders were more common compared to psychotic disorder NOS/schizophreniform disorder in LAI group (p<0.001). Those who prescribed LAI were older and had longer duration of psychotic disorder. Poor insight at admission, past and present noncompliance, involuntary admission (64,5% vs 35,5%, p=0.003) and history of forensi problems (63% vs 37%, p=0.01)were more common in LAI group. Past ECT treatment, antipsychotic polypharmacy and LAI treatment in past were more common in LAI group. Lack of insight at admission, history of LAI treatment before and noncompliance to medications before hospitalization were appeared as predictors of LAI prescription at discharge in logistic regression. We found no relationship between LAI prescription and drug abuse, treatment resistance and psychiatric comorbidity.

Discussion

Our findings suggest that LAIs were prescribed to chronic and older inpatients with lack of insight, and compliance at admission. The patients who were prescribed LAI also had indirect indicators of poor outcome, like previous ECT and polypharmacy. Contrary to previous reports, we found no difference in alcohol/substance abuse between those who were prescribed LAI and others.
S133. DIAGNOSED SPEECH, SCHOLASTIC AND MOTOR DISORDERS AS PREDICTORS FOR NON-AFFECTIVE PSYCHOSES
Authors: Gyllenberg David , Arrhenius Bianca , Suominen Auli , Sourander Andre
Published: May 2020

Background

Premorbid cognitive impairments are associated with schizophrenia, but little is known about the risk of developing psychoses among children with diagnosed speech, scholastic and motor disorders. Our aim was to study if children diagnosed with these are at increased risk of non-affective psychoses in adolescence and early adulthood.

Methods

We identified all children born 1996–2001 that were diagnosed with a speech disorder (ICD-10 code F80), scholastic disorder (F81), motor disorder (F82) or mixed developmental disorder (F83) before age 15 in outpatient and inpatient specialized services in Finland by using nationwide registers (n=17,038). A control cohort of children without these disorders was identified (n=63,745). The outcome was non-affective psychoses (F20-F29) diagnosed between age 15 years and the end of year 2017 (maximum age at end of follow-up: 16.0–21.9 years). We used Cox regression to study the association between speech, scholastic and motor disorders and psychoses and adjusted for sex, urbanicity and comorbid depression and conduct disorders.

Results

A total of 216 and 251 subjects were diagnosed with non-affective psychoses during follow-up in the cohort of speech, scholastic and motor disorders and the control-cohort, respectively. The cumulative incidence of psychoses from age 15.0 to 21.9 years was 2.4 % (95% confidence interval [CI] 2.0 - 2.8 %) in the cohort of speech, scholastic and motor disorders compared to 0.8 % (95% CI 0.7 % - 1.0 %) in the control-cohort (adjusted hazard ratio [aHR] 2.6, 95% CI 2.2 - 3.2). When stratified by a pure or a combination of at least two speech, scholastic and motor disorders, all categories were significantly associated with psychoses with the highest HR for motor disorders (aHR 3.6, 95% CI 2.0 - 6.4), followed by the combination of different speech, scholastic and motor disorders (3.3, 2.4 - 4.4), pure scholastic disorders (2.4, 1.5 - 3.7) and pure speech disorders (1.7, 1.2 - 2.6).

Discussion

Non-affective psychoses in late adolescence and early adulthood are associated with speech, scholastic and motor disorders diagnosed in childhood, in particular motor development disorders.