bluuebunny/crossref_metadata_2025 huggingface dataset:
Unlived Lives, Imaginary Widowhood and Elizabeth Bowen’s A World of Love
Authors: Bryan Rachel
Published: May 2020

This article reads Elizabeth Bowen’s 1955 novel A World of Love as exploring the legacy of certain highly imaginative coping mechanisms that were adopted by women in response to wartime losses. Acknowledging how Bowen’s mid-century works exhibit a curious return to the lot of those who came of age amidst the demographic imbalances that followed the Great War, it suggests that A World of Love interrogates the psychological draw of ‘imaginary widowhood’: a form of counterfactual self-fashioning that saw many single women of Bowen’s generation elect to view themselves not as spinsters, but as those who would have been married were it not for the conflict. Noting parallels between the novel’s depiction of a girl whose sexuality is awakened by the letters of a long-dead soldier from the Great War and the various forms of appropriation that were encouraged around the body of the Unknown Warrior—including the 1918 literary hoax The Love of an Unknown Soldier: Love Letters Found in a Trench—the article offers a new account of A World of Love as a text which registers the ambivalent and creatively rich qualities of a psychological climate that was at work throughout the twentieth century. Bowen’s novel, it argues, is propelled by a profound interest in the forces which induced successive generations of British women to forge intimate counterfactual relationships with those lives rendered unliveable, and the loves that were denied them, on account of world war.
Literature and the Culture of Elections and Electioneering in
Eighteenth-Century England
Authors: Packham Kendra
Published: May 2020

The seventeenth and eighteenth centuries witnessed the rise of contested elections as an important aspect of political life, and an outpouring of literary texts concerned to represent, and intervene in, the electoral process. This article recovers this rich, wide-ranging, and ideologically diverse genre, and argues that, interacting and overlapping with other forms, literature both reflected and helped to shape electoral culture. Popular literary varieties (from ballad opera to mock-heroic verse) were reworked to serve topical electoral purposes. This literature contributed to the culture of elections, making available particular, generically shaped representations and potentially increasing forms of electoral participation and partisanship. Like election rituals and other forms, literary texts encouraged engagement with elections among voters and non-voters. Indeed, through their formal qualities and modes of dissemination, literary texts could have pronounced power to engage varied audiences, and fuel a culture of contested elections, even when many seats were not contested and many could not vote. The election miscellany highlights links between election literature and regional printing, political, and literary cultures, and the growth of a market for this writing. At the same time, the authorship of election literature afforded diverse individuals a form of political expression and participation. Furthermore, the article considers the significance of the divergent, generically inflected views of candidates, elections, and the electoral activity of particular groups such literature advanced—for wider political culture, as well as specific elections. It proposes that texts from rousing ballads to vividly critical satires energized the divisions key to adversarial electoral culture, and could play into different calls for ‘reform’.
O2.1. LOCAL AND LONG-RANGE CONNECTIVITY PATTERNS OF AUDITORY PERCEPTUAL DISTURBANCE IN SCHIZOPHRENIA
Authors: Hare Stephanie , Adhikari Bhim , Chiappelli Joshua , Du Xiaoming , Chen Shuo , Kochunov Peter , Elliot Hong L
Published: May 2020

Background

Auditory hallucinations are a prevalent, debilitating symptom of schizophrenia (Sz). Lack of detailed phenomenological assessments of perceptual disturbances in large psychiatric imaging datasets limits our ability to disentangle the underlying neural mechanisms of hallucinations. Our study investigates how changes in local functional communication dynamics may be associated with wide-ranging auditory disturbances in Sz.

Methods

Local functional connectivity was estimated using regional homogeneity (ReHo) analysis of resting fMRI data, which quantifies synchronization of fMRI activity of a voxel to its neighboring voxels. Resting fMRI data of 99 Sz patients was analyzed (mean age=36.2±13.3 y, sex=71/28 m/f); Auditory perceptual disturbance in the past week was estimated using the auditory perception state (APS) subscale score of the recently validated Auditory Perceptual Trait and State Scale (http://www.mdbrain.org/APTS.pdf). Voxelwise regression analysis of ReHo was performed including APS score as a regressor of interest. Significant results were thresholded using AFNI’s 3dClustSim with autocorrelation function option to yield corrected p<0.05, corresponding to cluster-size threshold of 49 voxels at voxelwise p=0.001.

Results

Higher APS scores were associated with reduced ReHo in clusters in left putamen, right putamen, left temporoparietal junction, and right hippocampus. In a follow-up analysis using these clusters as seeds in whole-brain resting-state functional connectivity analysis (rsFC) analysis, higher APS scores were significantly associated with reduced rsFC between the right putamen seed and clusters in the contralateral putamen and auditory cortex.

Discussion

Our findings are consistent with those of a prior study that reported abnormal ReHo in left and right putamen of a unmedicated first-episode Sz patients (Cui et al. 2016). However, in that small sample (n=32), striatal ReHo was elevated relative to controls, and AH severity was not significantly correlated with striatal ReHo measures. Our study investigated ReHo in a large sample of chronic, medicated patients (all except 4 were taking antipsychotic medication at time of study). While it is widely accepted that striatal signaling is disrupted in Sz, future work is needed to better understand how striatal signaling deficits may change over the course of illness and how this relates to particular symptoms such as hallucinations. Implications for development of novel therapies that account for these nuanced findings will be discussed.
O2.2. EVALUATION OF THE RELATIONSHIP BETWEEN GLUTAMATE AND BRAIN CONNECTIVITY IN ANTIPSYCHOTIC-NAïVE FIRST EPISODE PATIENTS – A COMBINED MAGNETIC RESONANCE SPECTROSCOPY AND RESTING STATE FUNCTIONAL CONNECTIVITY MRI STUDY
Authors: Maximo Jose , Briend Frederic , Armstrong William , Kraguljac Nina , Lahti Adrienne
Published: May 2020

Background

Schizophrenia is thought to be a disorder of brain dysconnectivity. An imbalance between cortical excitation/inhibition is also implicated, but the link between these abnormalities remains unclear. The present study used resting state functional connectivity MRI (rs-fcMRI) and magnetic resonance spectroscopy (MRS) to investigate how measurements of glutamate + glutamine (Glx) in the anterior cingulate cortex (ACC) relate to rs-fcMRI in medication-naïve first episode psychosis (FEP) subjects compared to healthy controls (HC). Based on our previous findings, we hypothesized that in HC would show correlations between Glx and rs-fMRI in the salience and default mode network, but these relationships would be altered in FEP.

Methods

Data from 53 HC (age = 24.70 ±6.23, 34M/19F) and 60 FEP (age = 24.08 ±6.29, 38M/22F) were analyzed. To obtain MRS data, a voxel was placed in the ACC (PRESS, TR/TE = 2000/80ms). Metabolite concentrations were quantified with respect to internal water using the AMARES algorithm in jMRUI. rs-fMRI data were processed using a standard preprocessing pipeline in the CONN toolbox. BOLD signal from a priori brain regions of interest from posterior cingulate cortex (default mode network, DMN), anterior cingulate cortex (salience network, SN), and right posterior parietal cortex (central executive network, CEN) were extracted and correlated with the rest of the brain to measure functional connectivity (FC). Group analyses were performed on Glx, FC, and Glx-FC interactions while controlling for age, gender, and motion when applicable. FC and Glx-FC analyses were performed using small volume correction [(p < 0.01, threshold-free cluster enhancement corrected (TFCE)].

Results

No significant between-group differences were found in Glx concentration in the ACC [F(1, 108) = 0.34, p = 0.56], but reduced FC was found on each network in FEP compared to HC (pTFCE corrected). Group Glx-FC interactions were found in the form of positive correlations between Glx and FC in DMN and SN in the HC group, but not in FEP; and negative correlations in CEN in HC, but not in FEP.

Discussion

While we did not find significant group differences in ACC Glx measurements, ACC Glx modulated FC differentially in FEP and HC. Positive correlations between Glx and FC were found in the SN and DMN, suggesting long range modulation of the two networks in HC, but not in FEP. Additionally, negative correlations between Glx and FC were found in CEN in HC, but not in FEP. Overall, these results suggest that even in the absence of group differences in Glx concentration, the long-range modulation of these 3 networks by ACC Glx is altered in FEP.
O3.1. CLUSTER ANALYSIS FINDS THREE CLINICALLY-RELEVANT SUBGROUPS OF TRAIT EMOTIONAL EXPERIENCE IN SCHIZOPHRENIA OUTPATIENTS
Authors: Cowan Henry , Mittal Vijay , Allen Daniel , Gold James , Strauss Gregory
Published: May 2020

Background

Previous research shows that trait emotion is more affected than state emotion in schizophrenia. This literature is also somewhat inconsistent, particularly in terms of specific links between affective traits and clinical symptoms. The current study examined whether subgroups of trait emotional experience predict symptom presentation and functional outcome in schizophrenia.

Methods

In this cross-sectional observational study, 192 outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ) and 149 matched healthy controls completed the trait version of the Positive and Negative Affect Scale and symptom and functional outcome assessments. Cluster and discriminant function analyses identified distinct profiles of trait affect, which were then compared on clinical and functional variables.

Results

Three SZ clusters reflected normative affect (n = 80, 42%), low trait positive affect (PA; n = 54, 28%), and high trait negative affect (NA; n = 58, 30%), compared to controls. Symptom profiles differentiated the three subgroups. Compared to the Normative Affect cluster, the Low PA cluster had more severe negative symptoms; the High NA cluster had more severe positive symptoms, disorganization, anxiety, and depression; and both the Low PA and High NA cluster had poorer overall functioning. Diagnostic and medication status also differentiated the three subgroups. The Low PA subgroup was most likely to be prescribed 1st-generation antipsychotics, while the High NA subgroup was most likely to be diagnosed with schizoaffective disorder.

Discussion

Distinct subgroups with unique trait affect profiles can be identified within the broader diagnosis of schizophrenia. These subgroups show meaningful clinical differences in presentation, with theoretical and clinical implications.
O5.1. STRIATAL DOPAMINE AND REDUCED REWARD PREDICTION ERROR SIGNALING IN UNMEDICATED SCHIZOPHRENIA PATIENTS
Authors: Katthagen Teresa , Kaminski Jakob , Heinz Andreas , Buchert Ralph , Schlagenhauf Florian
Published: May 2020

Background

Increased striatal dopamine synthesis capacity (DSC) has consistently been reported in patients with schizophrenia (Sz). However, the functional mechanism translating this into behavior and symptoms remains unclear. It has been proposed that heightened striatal dopamine may blunt dopaminergic reward prediction error (RPE) signaling during reinforcement learning.

Methods

In this study, we investigated striatal DSC and RPEs and their association in unmedicated Sz and healthy controls. 23 healthy controls (HC) and 20 unmedicated Sz took part in an FDOPA-PET scan measuring DSC and underwent fMRI scanning, where they performed a reversal learning paradigm. We compared groups regarding DSC und neural RPE signals and probed the respective correlation (23 HC and 16 Sz for both measures).

Results

There was no significant difference between HC and Sz in DSC. Taking into account comorbid alcohol abuse revealed that only patients without such abuse showed elevated DSC in the associative and sensorimotor striatum, while those with abuse did not differ from HC. Patients performed worse during learning, accompanied by a reduced RPE signal in the ventral striatum. In HC, the DSC in the limbic striatum correlated with higher RPE signaling, while there was no significant association in patients. DSC in the associative striatum correlated with higher positive symptoms, and blunted RPE signaling was associated with negative symptoms.

Discussion

Our results suggest that dopamine modulation of RPE is impaired in schizophrenia. Furthermore, we observed a dissociation with elevated DSC in the associative and sensorimotor striatum contributing to positive symptoms and blunted RPE in the ventral striatum to negative symptoms.
O7.3. EXPLORING COMORBIDITY BETWEEN MENTAL DISORDERS AND GENERAL MEDICAL CONDITIONS
Authors: Momen Natalie , Plana Ripoll Oleguer , Prior Anders , McGrath John
Published: May 2020

Background

A large body of evidence shows that comorbidity is pervasive among individuals being treated for mental disorders, including schizophrenia. Those with mental disorders have been found to have higher rates of comorbidity and associated mortality due to a range of general medical conditions. However much of the evidence relies on surveys, cross-sectional studies and retrospectively collected data.

Methods

Using the Danish registers, we identified those born in Denmark (1900–2015) and who resided there during the study period (2000–2016). Information was obtained on ten groups of mental disorders (MDs), including “Schizophrenia spectrum disorders” (corresponding to ICD-10 F20-F29 codes). We compared the rate of diagnosis with nine general medical conditions (GMC) categories between those exposed and unexposed to each MD. Overall and lagged hazard ratios, with 95% confidence intervals, were calculated using Cox proportional hazards models. Absolute risks were estimated by competing risks survival analyses.

Results

The cohort followed 5.9 million individuals for 83.9 million person years. For the majority of prior MD-later GMC pairs, receiving a MD diagnosis increased the risk of subsequent GMC diagnosis; however, there were some exceptions. Focusing on those diagnosed with schizophrenia, elevated rates of diagnosis were observed for circulatory, endocrine, pulmonary, gastrointestinal, urogenital and hematological GMCs, and cancers. Various patterns were seen for lagged HRs. Results for schizophrenia generally showed hazard ratios for GMC diagnoses were most elevated the first couple of years after schizophrenia diagnosis. Cumulative incidence proportions for each GMC category 15 years after diagnosis with schizophrenia varied between 3.4% (for urogenital GMCs, 95% CI 3.2, 3.6) and 34.0% (for circulatory GMCs, 95% CI 33.51, 34.57).

Discussion

This study provides a comprehensive picture of GMC comorbidity among those with diagnosed with MDs in Denmark. It is the first study, to our knowledge, to provide both relative and absolute measures of the risk of such comorbidity. We hope that our findings related to specific MD-GMC comorbidity pairs will stimulate future research to explore mechanisms of action underlying of the observed associations. The provision of absolute risk estimates may aid in identifying those at greater need of primary prevention of GMC comorbidity. As MDs typically have a younger age of onset than many GMCs, natural critical windows exist for the reduction of secondary comorbidity.
O10.4. THE ROLE OF CONTEXTUAL FACTORS AND ASSESSMENT STRATEGIES IN THE ACCURATE SCREENING OF PSYCHOSIS-RISK SYMPTOMS
Authors: Schiffman Jason , Rakhshan Rouhakhtar Pamela , Millman Zachary , Thompson Elizabeth , Phalen Peter
Published: May 2020

Background

Falsely observing symptoms of psychosis risk in youth is a critical limitation to pluripotent prevention efforts. Factors including race, age, and measurement construction may affect the validity of semi-structured interviews and self-report screening tools designed to identify symptoms. Consideration of different constructs measured within a single screening tool, what a screening tool can offer beyond prediction of psychosis-like symptoms, and how to maximize efficiency may all influence the ability to effectively identify people who would benefit from services.

Methods

Help-seeking adolescents (N=134) ages 12–25 completed various screening tools for psychosis risk, and the Structured Interview for Psychosis-risk Syndromes (SIPS). The influence of race and age on screen scores and SIPS (CHR) symptoms were examined. We also evaluated alternatives to CHR symptom screening beyond conventional CHR screening tools.

Results

Higher Prime Screen scores increased the probability of clinician assessed symptoms among White participants, but not Black participants (interaction: b = -0.50 Wald χ2[1] = 4.63, p = .03, Exp[B] = 0.60), and 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[1] = 3.75, p = .05, Exp[B] = 0.96). Given discrepancies across groups, we attempted to expand screening strategies. First, to better understand the Prime Screen, factor analysis suggested two distinct factors that appear to measure different constructs. Additionally, an IRT model of several CHR screening tools suggested the value of an ultra-brief two-item measure. Finally, analyses of the BASC-2, a more comprehensive measure of behavior that includes, but is not limited to, psychosis risk items, also demonstrated accurate prediction of psychosis symptoms, as well as more pluripotent conceptualizations of symptoms.

Discussion

Results suggest that contextual or individual factors influence the accurate identification of individuals exhibiting psychosis-risk symptoms. Tailored approaches to screening based on an awareness of context, identity, setting, and preferences of clients are possible, and customizing assessment efforts accordingly may be useful for the accurate identification of a variety of people who might benefit from services.
O10.5. CLINICAL HIGH RISK (CHR) CRITERIA IN CHILDREN AND ADOLESCENTS NOT SUSPECTED TO DEVELOP PSYCHOSIS: NO TRANSDIAGNOSTIC SEVERITY MARKER OF MENTAL HEALTH PROBLEMS
Authors: Schultze-Lutter Frauke , Michel Chantal , Schimmelmann Benno G , Franscini Maurizia , Traber-Walker Nina , Walger Petra
Published: May 2020

Background

Compared to adults, children and adolescents of the community more frequently report clinical high risk of psychosis (CHR) criteria. Yet, little is known about the prevalence of CHR criteria in clinical children and adolescents’ samples. Thus, we studied the prevalence of CHR criteria and symptoms in 8- to 17-year-old inpatients with disorders that have been associated with greater odds to develop psychosis in adulthood, i.e., attention-deficit hyperactivity disorder, social and specific phobia, and obsessive-compulsive disorder, eating disorders and Asperger’s disorder.

Methods

As part of the multicenter naturalistic Bi-national Evaluation of At-Risk Symptoms in children and adolescents (BEARS-Kid) study, 8- to 17-year-olds of the community (N=235) and 8- to 17-year-old inpatients with any one of the above main diagnoses who were not suspected to be at increased risk of psychosis (N=306) were examined for CHR symptoms and criteria with the Schizophrenia Proneness Instrument, Child & Youth version and with the Structured Interview for Psychosis-Risk Syndromes.

Results

At 6.4%, the prevalence rate of CHR criteria in the community sample did not significantly differ from the 8.2%-rate in the inpatient sample. CHR criteria and symptoms were generally associated with age but not with group membership.

Discussion

This indicates that, irrespective of their mental health status, children and adolescents present more frequently with CHR criteria compared to young adults of the community for whom a 2.4%-rate of CHR criteria had earlier been reported. Furthermore, these findings contradict assumptions that CHR criteria might be diagnostically puripotential or merely severity markers of mental illness. Yet, more research into these symptoms and their cause and meaning in children and adolescents is needed to understand their significance in this age group and to detect factors that convey their clinical relevance in adulthood.
T2. ADVERSE CHILDHOOD EXPERIENCES IN PEOPLE WITH SCHIZOPHRENIA
Authors: Klaunig Mallory , du Plessis Stefan , Kilian Sanja , Cicero David , Schiffman Jason , Emsley Robin
Published: May 2020

Background

Adverse childhood experiences (ACEs) pose a public health concern worldwide (Anda, Tietjen, Schulman, Felitti, & Croft, 2010). Prevalence rates of ACEs appear to vary widely among countries (Finkelhor, Hotaling, Lewis, & Smith, 1990). ACEs are associated with increased likelihood of developing a mental illness (Green et al., 2010), including schizophrenia (Gibson, Alloy, & Ellman, 2016). Although this is a well-established finding in Western samples, it has only been addressed in a South African sample in one study (Kilian et al., 2017). In the current study, we aimed to examine the association between ACEs and schizophrenia in a South African sample.

Methods

Participants included 34 individuals with schizophrenia spectrum disorders and 33 non-psychiatric control participants. Schizophrenia and control participants did not differ on mean age (t(65) = 1.16, p = .251) or ethnicity (X2 (3, N = 66) = 4.27, p = .234). Schizophrenia participants were recruited as part of a larger research protocol within the Department of Psychiatry at the University of Stellenbosch in Stellenbosch, South Africa. ACEs were assessed using the short form of the Childhood Trauma Questionnaire (CTQ; Bernstein et al., 2003).

Results

Separate independent t-tests were used to compare CTQ total and subscale scores between groups. Scores on the CTQ total and all subscales did not differ significantly between schizophrenia participants and controls (ps > .05)). Additional independent t-tests were used to compare CTQ scores in females with schizophrenia against female control subjects and males with schizophrenia against male controls. Females differed significantly between groups on one subscale, Physical Abuse, with female controls experiencing higher levels of physical abuse (t(65) = -2.33, p = .028). Males with schizophrenia scored significantly higher on the Emotional Neglect subscale (t(65) = 2.73, p = .010) and showed higher scores on the Physical Neglect subscale at a trend level of significance (t(65) = 2.03, p = .055). Males with schizophrenia also scored significantly higher on overall Neglect total (t(65) = 2.83, p = .008). Separate independent t-tests were used to compare groups on the number of types of traumas experienced in childhood. Number of types of trauma did not differ significantly between groups (t(64) = .228, p = .820).

Discussion

In the current study, we found no differences in the overall number of ACEs in people with schizophrenia as compared to non-psychiatric control participants. As well, we did not find overall differences in ACEs in females and males with schizophrenia. These findings are in contrast to most previous research. This study may highlight limitations in measuring ACEs across cultures using the CTQ.
T8. ANTIPSYCHOTIC TREATMENT AND EYE MOVEMENT ABNORMALITIES IN SCHIZOPHRENIA
Authors: Takahashi Junichi , Miura Kenichiro , Morita Kentaro , Fujimoto Michiko , Hashimoto Ryota
Published: May 2020

Background

In previous studies of eye movement abnormalities, it was showed that patients with schizophrenia had significant abnormalities in saccade control and smooth pursuit, suggesting that eye movement abnormalities are useful as a biomarker. However, many patients participating in clinical trials are receiving antipsychotic treatment and it is important to examine the effects.

Methods

Eighty-five patients with schizophrenia were recruited and free-viewing, fixation stability and smooth pursuit tests were performed. First, multiple regression analysis was performed using the obtained parameters as the dependent variables, antipsychotics, illness severity, and duration of illness as independent variables. Secondly, patients were grouped into tertiles by antipsychotic dose (CPZ equivalents), then we conducted a group comparison with each parameter between the three groups.

Results

A multiple linear regression was calculated to predict each parameter based on CPZ equivalents, illness severity and duration of illness. There was no significance in the free-viewing and fixation stability test after Bonferroni correction. In smooth pursuit test, a significant regression equation was found with the horizontal gain (F (1,81) = 15.1, p < 0.00, R2 = 0.15) and vertical gain (F (1,81) = 12.5, p = 0.02, R2 = 0.12), and both were accounted only for CPZ equivalents. In a group comparison, there were significant effects of the horizontal gain (F (2,80) = 5.32, p = 0.07) and the vertical gain (F (2,80) = 3.31, p = 0.41), but both did not survive Bonferroni correction.

Discussion

It was found that antipsychotic treatment affects smooth pursuit eye movement. Eye movement abnormalities in schizophrenia can be a useful biomarker from previous studies, but the effects of antipsychotics must be considered.
T10. BIOMARKERS IN TREATMENT-RESISTANT SCHIZOPHRENIA; THE BITS STUDY (A STUDY PROTOCOL)
Authors: Hilker Rikke , Nielsen Jimmi , Nielsen Mette Ødegaard
Published: May 2020

Background

Approximately 30% of patients diagnosed with schizophrenia do not respond to conventional antipsychotic therapy, however, around 30% of these patients will respond to treatment with clozapine. The remaining clozapine non-respondent patients can be defined as ultra-treatment resistant. Special characteristics (biomarkers) may be found in this subgroup of ultra-treatment resistant patients.

Recent evidence points to a central role of altered immunological and anti-inflammatory response in schizophrenia. Studies have found that antipsychotic medication affect the immune system and alter levels of different cytokines, but no clear relation between the effect on cytokine levels and improvement in symptoms has been documented.

Also increased permeability of the blood brain barrier (BBB) have been linked to psychosis, and a dysfunctional BBB may lead to structural changes in the white matter and neurochemical changes (glutamatergic abnormalities) in CNS.

The longitudinal course of BBB alterations in psychosis and how this may influence changes in neuronal structure and function and relate to fluctuation in symptoms have not been examined. The aim of this study is to establish a database with the purpose of identifying biomarkers for treatment resistant schizophrenia (TRS), containing measures of psychopathology and function, treatment variables, brain imaging data, immunological markers from blood and cerebrospinal fluid, BBB-permeability and genetic material. The database will consist of a group of ultra-treatment resistant patients and a group of patients responding to clozapine matched on sex, age and duration of illness (±3 years).

Specific aims:

Hypothesis

Methods

The study is a naturalistic longitudinal study including patients with TRS. We plan a thorough examination twice with a three months interval and ultra-treatment resistant patients will be compared with patients stable on clozapine. Between examinations there will be no planned interference with the antipsychotic treatment, but antipsychotic treatment may be changed during the period in the intention to improve symptoms.

The primary longitudinal outcome is comparing changes in BBB-permeability along with symptom-fluctuations. This will be done by comparing changes in qAlb, which is the gold standard technique measuring the CSF:serum albumin ratio (QAlb).

Results

The study has been approved by the regional ethical committee and data collection will begin in 2020.

Discussion

We expect the obtained results will contribute to a better pathophysiological understanding about illness markers and their progression over time and in relation to functional outcome.
T16. SCHIZOPHRENIA SPECTRUM DISORDER: DEPRESSION TRAJECTORIES AND IMMUNE MARKERS
Authors: Hoprekstad Gunnhild , Gjestad Rolf , Kjelby Eirik , Skrede Silje , Johnsen Erik , Kroken Rune A
Published: May 2020

Background

Genetic findings imply a role of the immune system in the complex psychopathology of schizophrenia, and elevated serum levels of pro-inflammatory cytokines have been found in patients. Altered levels of cytokines are linked to severe depression and cognitive dysfunction, both of which are common among patients suffering from schizophrenia. Depression is important to diagnose in this patient population as consequences of untreated depression can be severe. In this study we will investigate if the level and change of immune markers in blood are related to depression in patients with schizophrenia spectrum disorders.

Methods

The study is part of the Bergen-Stavanger-Innsbruck-Trondheim study (BestIntro) which is a multicenter randomized controlled trial comparing treatment with amisulpride, aripirazole and olanzapine. The study included patients with schizophrenia spectrum disorders (ICD-10 F20-F29) above 18 years with a score of 4 or more one of the following items on the Positive and Negative Syndrome scale (PANSS): Delusions, hallucinations, grandiosity, suspiciousness/persecution and unusual thought content. Participants were followed throughout one year, and for this sub-study participants from all treatment arms were analyzed together. Blood samples were drawn at week 0, 1, 3, 6, 12, 26, 39 and 52. Depression was measured with the Calgary Depression Scale (CDSS) which distinguishes depression from negative symptoms. A panel of 9 immune markers were analyzed: interferon gamma (IFN-γ), interleukin 1-β (IL-1β), interleukin 10 (IL-10), interleukin 12p70 (IL-12p70), interleukin 17A (IL-17A), interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α). We examined whether the level and change in inflammation parameters could be predicted by latent classes describing CDSS trajectories.

Results

The preliminary results suggest three different CDSS trajectories: high, moderate and low level of depression. In the three class model, the different groups were found to be related to some differences in level and change in the inflammation parameters. Baseline differences were found with higher IL-10 in the high depression group. In the 0–1 week interval, the low depression trajectory group reduced their IL1-beta, while the other two groups did not.

Discussion

Different courses of change in depression were identified suggesting that trajectories exist. With regard to temporal patterns of inflammatory parameters, findings point in the opposite direction of the established links between pro-inflammatory cytokines and depression. Further studies should explore if cytokine alterations in schizophrenia per se can explain this difference, or if depression in schizophrenia differs in its underlying biology from regular depressive states.
T17. GLUTAMATE IN DORSOLATERAL PREFRONTAL CORTEX IN PATIENTS WITH SCHIZOPHRENIA: A META-ANALYSIS OF 1-HMRS STUDIES
Authors: Kaminski Jakob , Mascarel-Maricic Lea , Katthagen Teresa , Heinz Andreas , Schlagenhauf Florian
Published: May 2020

Background

Glutamate especially in frontal cortical areas was proposed to be altered in patients with schizophrenia. In the dorsolateral prefrontal cortex (DLPFC), glutamate levels might serve as functional markers of schizophrenia since this region is involved in working memory function which is impaired in schizophrenia patients. To date, there is no systematic overview on glutamate in dorsolateral prefrontal cortex at high-field intensities. We here meta-analyze magnetic resonance spectroscopy (1-HMRS) studies comprising measurement in dorsolateral prefrontal cortex (DLPFC).

Methods

Preregistration of the study was performed on September 20th 2019 (osf.io/5uyr6). Predefined literature search on pubmed comprised articles with search terms: (Magnetic Resonance Spectroscopy OR MRS) AND (Glutamate OR Glut* OR GLX) AND (schizophrenia OR psychosis OR schizophren*). We screened for case-control studies comprising glutamate levels as measured by 1-HMRS in DLPFC. Meta-analysis with a fixed and random effects model with inverse variance method, DerSimonian-Laird estimator for tau2 and Cohen’s d were estimated.

Results

329 studies were initially screened. 13 Studies were included into quantitative analysis comprising n=436 patients and n=365 controls. The random effects model revealed no difference between patients and controls (d=0.033 [-0.19; 0.26], z=0.29, p=0.77). The test for heterogeneity shows a moderate amount of heterogeneity (tau2=0.096, I2=57.4%). Subsequent sensitivity analysis reveals significant between group effect for medication status (Q=7.94, p=0.0473) i.e. an increased glutamate level in antipsychotic naïve patients (d=0.46 [0.08; 0.84], z=2.37, p=0.018).

Discussion

We conclude that care has to be taken when evaluating metabolite levels in such a heterogeneous group and interpret that increase cortical glutamate in antipsychotic naïve patients with schizophrenia might be due to possible allostatic mechanisms.
T27. COGNITIVE RESERVE IN CHILD AND ADOLESCENT OFFSPRING OF PATIENTS DIANOSED WITH SCHIZOPHRENIA OR BIPOLAR DISORDER
Authors: De la Serna Elena , Camprodon-Boadas Patricia , Sugranyes Gisela , Torrent Carla , Sole Brisa , Montejo Laura , Ilzarbe Daniel , Baeza Inmaculada , Romero Soledad , Castro-Fornieles Josefina
Published: May 2020

Background

Cognitive Reserve (CR) is defined as the ability of the brain to cope and deal with physiological or pathological brain injuries. In the field of psychiatry, higher levels of CR have been associated with lower levels of psychotic symptoms, higher psycho-social functioning and higher cognitive performance, suggesting that CR should be considered as a protective factor (Barnett et al., 2006; Amoretti et al., 2016). This study aims to compare CR levels in a sample of adolescents and young adult offspring of patients with schizophrenia or bipolar disorder who are at high risk of developing these disorders (HR) and compared them with a group of healthy controls (HC). We also assess the utility of CR in predicting clinical and cognitive variables.

Methods

Participants were 85 HR and 45 HC. A CR proxy was calculated based on premorbid IQ, socio-occupational attainment and social activities. Clinical assessment included: the Structured Interview for Prodromal Symptoms (SOPS), the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS). Neuropsychological assessment included: Working Memory, Processing Speed, Verbal Memory, attention and executive functioning. A factorial analysis was conducted in order to obtain a single CR measure. Differences between groups in CR were assessed via MANCOVA and linear regressions were conducted to check the effectiveness of CR in predicting clinical and neuropsychological variables.

Results

No significant differences were observed in age or gender between HR and HC groups. Socioeconomic status was lower in HR subjects (F=8.100, p=0.005).CR was significantly lower in the HR group than in the HC group (F=17.522; p<0.001). Moreover, the CR proxy was able to correctly classify 72.7% of the sample as either HR or HC. Our proxy was able to predict the following clinical variables in the HR group: negative (F=9.269; p=0.002), and total (F=7.290; p=0.009) prodromal symptoms, the YMRS (F=11.597; P<0.001) and the HDRS (F=12.761; p<0.001). In terms of neuropsychological variables, RC predicted WM (F=9.738; p=0.003), PS (F=4.557; p=0.037) and verbal memory [immediate (F=6.999; p=0.010) and delayed recall (F=10.990; P=0.002)] in the HR sample.

Discussion

HR subjects have lower CR than controls. CR is associated with clinical and neuropsychological variables. To our knowledge no previous studies have assessed CR in high risk samples. Nevertheless, studies conducted in adult first episode psychotic samples have shown an association between CR and the severity of symptoms.
T37. PREPULSE INHIBITION IN UNAFFECTED SIBLINGS OF SCHIZOPHRENIA AND CLINICAL-HIGH RISK WITHOUT FAMILY HISTORY OF PSYCHOSIS
Authors: Zhen Mao , Bo Qijing , Tian Qing , Dong Fang , Li Xianbin , Wang Chuanyue
Published: May 2020

Background

It is reported that prepulse inhibition (PPI) deficiency of startle reflex in schizophrenia is associated with positive symptoms and is hereditary. In this study, the perceived spatial separation (PSS) induced-prepulse inhibition paradigm based on the priority effect effectively was used to explore PPI levels of genetically high-risk (GHR) of schizophrenia and clinical high risk (CHR) without family history of psychosis

Methods

We examined startle magnitude and PPI in38 CHR (No family history of psychosis), 28 GHR (Siblings or children of schizophrenia), and 44 healthy controls (HC). Modified acoustic PPI paradigm included PSS-PPI and perceived spatial co-location PPI (PSC-PPI) with inter-stimulus interval (ISI) of 60 or 120ms. The Structured Interview for Psychosis risk Syndromes (SIPS) and MATRICS Consensus Cognitive Battery (MCCB) was used to measure psychotic symptom and neuropsychological state of individuals

Results

Using gender, age, and smoking as covariates, Covariance analysis for modified PPI level results revealed that there were significant differences in PSSPPI60 (F = 6.25, p = 0.03) and PSSPI120 (F = 6.57, p = 0.03) paradigm between the three groups. Compared with HC, PSSPPI paradigm detected PPI defects of CHR individuals at 60ms ISI (F = 14.25, p ＜0.001) and 120ms ISI (F = 14.01, p ＜0.001). PPI deficiency was not detected in GHR individuals. PPI level in both groups were unrelated to demographics, clinical characteristics, and cognition. Using GLM analysis, the interaction between grouping and experimental paradigm had no significant effect on PPI level at 60ms (F = 1.88, P = 0.16) and 120ms (Z = 1.66, P = 0.19).

Discussion

It seems that mere heritability of psychosis is not enough to produce PPI defects, which may be related to the progression of psychosis
T45. THE EFFICACY AND HETEROGENEITY OF ANTIPSYCHOTIC RESPONSE IN SCHIZOPHRENIA: A META-ANALYSIS
Authors: McCutcheon Rob , Pillinger Toby , Mizuno Yuya , Montgomery Adam , Pandian Haridha , Vano Luke , Reis Marques Tiago , Howes Oliver
Published: May 2020

Background

Antipsychotics are more effective than placebo in reducing symptoms in schizophrenia. However, response to treatment appears to vary, and as such it has been proposed that different subtypes of schizophrenia exist, defined by treatment-response. This has not been formally examined using meta-analysis.

Methods

Randomised controlled trials comparing placebo and antipsychotics for the acute treatment of schizophrenia published between January 1 1950 and November 30, 2018 were examined. Mean change and variance of change in symptoms were extracted from each study, alongside publication year, participant age and gender, baseline symptom severity, antipsychotic dose, and use of placebo lead-in. Relative variability of symptomatic improvement in antipsychotic-treated individuals compared to placebo-treated individuals was quantified using coefficient of variation ratio (CVR). Mean difference in symptom change was quantified using Hedges’ g. The significance of potential moderating factors was assessed using meta-regression and sensitivity analyses. In addition, individual patient data from two clinical trials (N=522) was examined in terms of both the distribution of total symptom change, and the variability of individual symptoms and symptom factors.

Results

11,006 articles were identified. 66 met inclusion criteria, reporting on 17,202 participants. Compared with placebo, antipsychotic-treated patients demonstrated both greater symptomatic improvement (g=0.47, p<0.001) and reduced variability in symptomatic improvement (CVR=0.86, p<0.001). Lower variability in antipsychotic-response was associated with studies including younger patients (z=3.07, p=0.002), those published earlier (z=3.98, p<0.001), with higher dose treatments (z=-2.62, p=0.009), and greater mean-difference in symptom-change (z=-5.70, p<0.001). In the individual patient data antipsychotic treated patients did not show significantly increased variability for any individual symptom, and there was no evidence of a bimodal distribution of response.

Discussion

Compared to placebo, in addition to a greater mean change, antipsychotic treatment shows lower variability of change in total, positive, and negative symptoms. This is contrary to the hypothesis that there exists a subtype of antipsychotic non-responsive schizophrenia, instead providing evidence for a relatively homogeneous effect of antipsychotic treatment in improving symptoms of schizophrenia.
T57. IMPAIRED FACIAL EMOTION RECOGNITION IN INDIVIDUALS AT ULTRA-HIGH RISK FOR PSYCHOSIS: CORRELATIONS WITH SCHIZOTYPY AND PARANOID LEVEL
Authors: Seo Eunchong , Eun Min Jee , Yoon Park Hye , Young Lee Su , Lee Eun , Kyoon An Suk
Published: May 2020

Background

Schizophrenia patients and individuals at ultra-high risk for psychosis(UHR) have shown impaired facial emotion recognition(FER). Previous studies have reported lower accuracy and negative bias of FER in schizophrenia and UHR. These impairments have been studied with various factors such as schizotypy and paranoid level, but the results were inconsistent. This study aimed to identify the impairments of FER in UHR individuals and further to examine how these impairments relate to schizotypy and paranoid level.

Methods

orty-three UHR individuals and 57 normal controls (NC) were requested to perform the facial emotion recognition(FER) task that consist of 60 facial photographs selected from standardized photographs of Ekman and Friesen series. For exploratory correlation analysis, schizotypy (Revised physical anhedonia scale, Magical ideation scale) and paranoid level (Paranoia scale, Persecution/suspicious item of Positive and Negative Syndrome Scale) were also examined in UHR individuals.

Results

The UHR individuals showed lower accuracy rate for total FER task (70.6% vs. 75.6%, p=0.010) and more “fear” responses for neutral faces (14.5% vs. 6.0%, p=0.003) than NC. In exploratory correlation analysis for UHR individuals, the total accuracy rate of FER task showed significant correlation with both scales for schizotypy, but not with both scales for paranoid level. Among threat-related emotion response rates for neutral face, only “Disgust” response rate for neutral face was correlated with all scales for paranoid level, but not with scales for schizotypys in UHR individuals.

Discussion

In this study, we could identify inaccuracy and negative bias of FER in UHR individuals, Furthermore, we found that inaccuracy and negative bias were associated with schizotypy and paranoid level, respectively. These findings imply that inaccuracy and negative bias of FER in UHR individuals are of different nature. Future studies on the clinical implications of these findings would be needed.
T61. FEELINGS OF SHAME AND GUILT IN INDIVIDUALS AT ULTRA-HIGH RISK FOR PSYCHOSIS
Authors: Yoon Park Hye , Seo Eunchong , Jun Koo Se , Lee Eun , Kyoon An Suk
Published: May 2020

Background

Self-conscious emotions, such as shame and guilt, play a key role in one’s thoughts and behaviors. Our study investigated how shame and guilt were different concerning multiple aspects of social cognitive abilities, and we evaluated the self-conscious emotions in individuals at ultra-high risk (UHR) for psychosis.

Methods

Firstly, one hundred and sixty-six healthy youths were assessed for shame and guilt using the test of self-conscious affect, for empathy using interpersonal reactivity index (IRI), and for Theory of Mind (ToM) ability using the ToM picture stories task. Multiple linear regression analysis was performed to predict shame and guilt from the social cognitive variables. Secondly, twenty-four UHR and 24 age- and sex-matched normal controls were compared for shame, guilt, empathy, and ToM ability.

Results

Results in healthy youths, regression analysis with shame revealed that fantasy (t=3.0, p=0.003, β=0.22) and personal distress (t=5.8, p<0.001, β=0.42) of IRI and affective ToM (t=2.0, p=0.044, β=0.14) were significant determinants. In the regression model of guilt, there were independent predictors including perspective taking (t=3.5, p=0.001, β=0.28) and empathic concern (t=2.1, p=0.040, β=0.17) of IRI and cognitive ToM (t=2.1, p=0.037, β=0.15). In UHR individuals, higher levels of shame (t=-2.4, p=0.021), fantasy (t=-2.3, p=0.028), and personal distress (t=-3.4, p=0.001) and lower levels of perspective taking (t=4.0, p<0.001) and cognitive ToM (t=4.2, p<0.001) were observed. Moreover, high levels of shame was correlated with increased personal distress (r=0.78, p<0.001) in UHR for psychosis.

Discussion

These findings suggest that empathy and ToM ability predict persons’ shame- or guilt-proneness in healthy youths, and heightened personal distress in UHR individuals may possibly influence the level of shame which could lead to socially maladjustment behaviors. Dealing with social cognitive function would be helpful for reparation to UHR individuals.