bluuebunny/crossref_metadata_2025 huggingface dataset:
M1. INVESTIGATING THE RELATIONSHIP BETWEEN CHILDHOOD TRAUMA AND PSYCHIATRIC DISEASE USING MACHINE LEARNING TECHNIQUES
Authors: Haidl Theresa , Hedderich Dennis , Rosen Marlene , Lichtenstein Thorsten , Kaiser Nathalie , Seves Mauro , Ruef Anne , Schultze-Lutter Frauke , Upthegrove Rachel , Salokangas Raimo K R , Pantelis Christos , Meisenzahl Eva , Wood Stephen J , Brambilla Paolo , Borgwardt Stefan , Lencer Rebekka , Ruhrmann Stephan , Kambeitz Joseph , Koutsouleris Nikolaos
Published: May 2020

Background

Childhood trauma (CT) is associated with an increased risk for psychiatric disorders like major depression and psychosis. However, the pathophysiological relationship between CT, psychiatric disease and structural brain alterations is still unknown.

Methods

PRONIA (‘Personalized Prognostic Tools for Early Psychosis Mangement’) is a prospective collaboration project funded by the European Union under the 7th Framework Programme (grant agreement n° 602152). Considering a broad set of variables (sMRI, rsMRI, DTI, psychopathological, life event related and sociobiographic data, neurocognition, genomics and other blood derived parameters) as well as advanced statistical methods, PRONIA aims at developing an innovative multivariate prognostic tool enabling an individualized prediction of illness trajectories and outcome. Seven clinical centers in five European countries and in Australia participate in the evaluation of three clinical groups (subjects clinically at high risk of developing a psychosis (CHR), patients with a recent onset psychosis (ROP) and patients with a recent onset depression (ROD)) as well as healthy controls (HC). To investigate the high-dimensional patterns of CT experience, measured by the childhood trauma questionnaire (CTQ), in HC and our three patient groups (PAT) (n=643), we used a Support Vector Machine (SVM). Furthermore, we tested whether patient-specific CT exposure is associated with structural brain changes by VBM analyses.

Results

We found that patients and HC could be separated very well by their CTQ pattern, whereas the different patient groups showed no specific CTQ pattern. Furthermore, an association with extensive grey matter changes suggests an impact on brain maturation which may put individuals at increased risk for mental disease.

Discussion

We have demonstrated in this large multi-center cohort that adverse experiences in childhood contribute transdiagnostically to the riskr for developing a psychiatric disease. The observed association between CTQ scores and structural changes suggests an impact of adverse childhood experiences on brain development. Resulting alterations may add to a neurobiological vulnerability for depression and psychosis. A role of both features for other mental disorders could be assumed and warrants further investigation.
M11. ALTERED TRANSCRANIAL MAGNETIC STIMULATION ELECTROENCEPHALOGRAPHIC MARKERS IN SCHIZOPHRENIA
Authors: Voineskos Daphne , Zomorrodi Reza , Daskalakis Zafiris
Published: May 2020

Background

Cortical inhibition is a neurophysiological process in which cortical gamma-aminobutyric acid (GABA) inhibitory interneurons modulate the activity of pyramidal neurons in the cerebral cortex. Multiple lines of evidence, including neurophysiological and neuropathological, report that individuals with schizophrenia have deficits in cortical inhibition. Combining transcranial magnetic stimulation (TMS) with electroencephalography is a reliable approach to measure inhibitory processes in the cortex. The overall waveform produced by TMS-EEG may index cortical reactivity as a whole and previous investigations have linked the N45 component peak and the N100 component peak with GABA-A and GABA-B inhibitory neurotransmission, respectively. The aim of this study was to stimulate the DLPFC with TMS and examine resultant differences in the TMS-EEG waveform peaks between patients with schizophrenia and healthy subjects. We hypothesized that individuals with schizophrenia will have smaller TMS-evoked potentials, specifically the amplitudes of the N100 and N45 components, those previously related to GABA-ergic inhibition.

Methods

We applied TMS over the left DLPFC and recorded EEG activity in 48 healthy subjects (mean age: 33.8±5.3) and 46 patients with schizophrenia (mean age: 43.3±6.4). Monophasic TMS pulses were administered using a 7-cm figure-of-8 coil, and two Magstim 200 stimulators connected via a Bistim module. Single pulse TMS was administered over the left DLPFC with 100 total pulses, which were delivered every 5s. Resultant waveforms were extracted and analyzed through custom MATLAB scripts. The TMS-evoked potential waveform was examined through Global Mean Field Amplitude (GMFA) analysis of waveform peaks in each the two groups. Normality of the distribution of each variable was assessed and a Mann Whitney U test was then performed for each variable of interest to assess differences between groups.

Results

Individuals in the schizophrenia group demonstrated smaller measures of cortical inhibition in the DLPFC. Specifically, smaller amplitudes of the N45 (U=724.00, p=0.004) and N100 peaks (U=831.00, p=0.039), although the overall AUC of the waveform did not differ between groups (U=969.00, p=0.307). Further analysis is underway to examine medication and symptom cluster effects.

Discussion

These results demonstrate novel findings of deficits in both GABA-A and GABA-B associated measures of cortical inhibition as indexed by single pulse TMS-EEG. This reinforces previous evidence from different research modalities demonstrating overall GABAergic inhibitory deficits in schizophrenia, and specifically provides new support which confirms recent findings of aberrant GABA-Aergic inhibitory neurotransmission in schizophrenia.
M12. INCREASED SAFETY BEHAVIOR IN SUBJECTS WITH CHILDHOOD TRAUMA AND DELUSIONS
Authors: Conring Frauke , Gangl Nicole , Walther Sebastian , Wüthrich Florian , Schäppi Lea , Rüter Maximilian , Cantisani Andrea , Stegmayer Katharina
Published: May 2020

Background

Personal space is the safe area around us causing discomfort when violated by others. Previous research has shown that our need for personal space can be shaped by previous and current experiences. For instance, childhood maltreatment is associated with altered personal space in healthy controls. Additionally, space regulation is altered in schizophrenia (with personal space being increased in patients with paranoia). Whether childhood maltreatment and dimensions of delusions are associated with increased safety behaviour in patients with schizophrenia is unknown. We therefore aim to test the association of childhood trauma and delusions with interpersonal distance in schizophrenia patients and healthy controls.

Methods

We assessed childhood trauma (CT) in both, healthy subjects and schizophrenia patients (matched for age, gender and education) with the childhood trauma scale. This scale is a self-report screening tool for experiences of abuse & neglect during childhood. Additionally, we assessed delusions in schizophrenia patients, using the dimensions of delusional experience scale (DDE), which includes ‘conviction’, ‘extension’, ‘bizarreness’, ‘disorganization’, and ‘pressure’ dimensions. We compared the interpersonal distance (stop-distance test) and comfort ratings at predetermined distances (fixed-distance test) between subjects with low/medium and high CT ratings. Likewise, interpersonal distance and comfort ratings of patients with and without delusions were compared.

Results

In our preliminary data (n = 27), subjects with high CT ratings showed an increased need for interpersonal space compared to subjects with low/medium CT. Additionally, the high CT group showed reduced comfort ratings at varying fixed distances. Likewise, patients with delusions had an increased interpersonal space and reduced comfort at fixed distances. Moreover, interpersonal space was associated with the severity of childhood trauma, and in particular with emotional neglect. Finally, interpersonal distance was associated with the degree to which the delusional belief involves various areas of patients’ lives (‘extension’ dimension of the DDE).

Discussion

Our preliminary data suggests that childhood maltreatment and dimensions of delusions are associated with increased safety behaviour in patients with schizophrenia. These findings are in line with previous studies, which found associations of interpersonal distance and childhood maltreatment in healthy controls as well as paranoia in patients with schizophrenia. Our findings are of particular interest, as increased safety behaviour may impact social functioning (i.e. lead to more social withdrawal) in patients with schizophrenia.
M23. ALTERATION OF REGIONAL CEREBRAL BLOOD FLOW MEASURED BY ARTERIAL SPIN LABELING IN PATIENTS WITH TREATMENT-RESISTANT SCHIZOPHRENIA
Authors: Ogyu Kamiyu , Honda Shiori , Matsushita Karin , Noda Yoshihiro , Kato Hideo , Kusudo Keisuke , Kim Julia , Plitman Eric , Koizumi Teruki , Koreki Akihiro , Fujii Shinya , Mallar Chakravarty M , Uchida Hiroyuki , Graff-Guerrero Ariel , Onaya Mitsumoto , Mimura Masaru , Nakajima Shinichiro
Published: May 2020

Background

Approximately 30% of patients with schizophrenia do not respond to antipsychotics, which is called treatment-resistant schizophrenia (TRS). A recent systematic review showed decreased regional cerebral blood flow (rCBF) in the cerebral cortex and increased rCBF in the putamen in patients with schizophrenia. However, to date, no study has examined rCBF using arterial spin labeling (ASL) in patients with TRS. Thus, we compared rCBF between patients with TRS and those with non-TRS to investigate neural basis of this condition.

Methods

We acquired whole-brain rCBF measurements using 1.5T magnetic resonance imaging (MRI) with pseudo-continuous ASL in those with TRS and non-TRS. TRS was defined as 1) a Clinical Global Impression Severity (CGI-S) score of ≧ 4 (moderate) and 2) a score of ≧ 4 (moderate) on two Positive and Negative Syndrome Scale (PANSS) positive symptom items after optimal antipsychotic treatment. Non-TRS was defined as 1) a CGI-S score of ≦3, 2) scores of ≦ 3 on all positive symptom items of the PANSS, and 3) no symptomatic relapse during the previous 3 months. Optimal antipsychotic treatment was defined as ≧ 6 consecutive weeks with ≧ 400 mg of chlorpromazine (CPZ) equivalent daily dose antipsychotic treatment. The rCBF maps were subsequently derived from the proton-density-weighted reference images. Group differences in rCBF between the two groups (non-TRS vs. TRS) were tested using two sample t-test with age, gender, and PANSS positive scores as covariates. Multiple comparisons were corrected using familywise error (FWE) method with a significance threshold of P <.05.

Results

A total of 32 participants were included (13 TRS [6 females, age= 41.2±9.8, PANSS=80.3±9.7] and 19 non-TRS [6 females, age= 40.6±11.9, PANSS=58.9±10.0]). rCBF in the cerebellum was increased in the TRS group compared with the non-TRS group. In addition, there are inverse correlation between rCBF in the cerebellum and PANSS positive score in the non-TRS group.

Discussion

These preliminary results suggest that perfusion in the cerebellum may be implicated in the pathophysiology of TRS. This study will continue to enroll participants (our target sample is 30/each group). To identify the abnormal rCBF in patients with TRS will facilitate elucidating the pathophysiology of TRS and pave a way of developing novel treatment of this difficult-to-treat population.
M32. THE NATURE OF THE RELATIONSHIP OF SUICIDALITY WITH SCHIZOTYPY AND PSYCHOSIS EXPERIENCE
Authors: Linscott Richard , Wright Ellen , Parker Theresa , O’Hare Kirstie
Published: May 2020

Background

Meehl portrayed pervasive, chronic suicidality as a key sign of schizotypy. Consistent with this view, positive schizotypy predicts concurrent and future suicidality, is particularly predictive of greater lethality, and is a more potent predictor of suicidality than other psychopathology. Whereas the most prominent explanation for this relationship is that it is spurious, several possible causal connections have not been tested. Also, most existing evidence relates to positive schizotypy and psychosis experience. We describe three studies of the schizotypy – suicidality link.

Methods

In the first, we tested whether, as Meehl argued, schizotypy is associated with suicide dread. A general population sample (n = 350) of young adults (18 to 24 years) reported on schizotypy and suicidality, including efforts to avert suicide attempts. In univariate analyses, positive, negative, and disorganized components of schizotypy each significantly predicted persistent or frequent suicidal ideation in the past month (ORs from 2.10 to 3.71), history of attempts with intent to die (1.59 to 2.15), fear or dread of the possibility of making an attempt (1.58 to 1.63), and worry about acting on an unwanted impulse to attempt suicide (2.48 to 2.62). In fully-adjusted analyses (controlling for depression, anxiety, stress, and all schizotypy components), positive schizotypy predicted reporting of greater worry about impulsive suicidal behaviour (OR = 1.71, p = .009, 95% CI 1.15 to 2.56).

In the second, we tested whether the schizotypy – suicidality link can be understood using contemporary suicide theory. In a random sample of high school pupils (n = 177), schizotypy components predicted classification as an active suicidal ideator (R2 = 0.76, 95% CI 0.56 to 0.95). These effects were accounted by the influences of magical thinking, unusual perceptual experiences, and suspiciousness being mediated in part by perceived burdensomeness, as per the interpersonal theory of suicide. However, direct effects were also observed from social anxiety and magical ideation components of schizotypy.

In the third, we modelled latent growth mixtures of suicidality using data from five waves of the Dunedin Multidisciplinary Health and Development Study. We test how growth in suicidality (from 18 to 38 years) is related to psychosis experience (age 11 years) and schizotypy (age 13 and 15 years). Schizotypy predicted membership of a growth class characterised by chronically death- and suicidal-ideation that, in turn, predicted attempt behaviour.

Results

See above.

Discussion

The complexity of the observed links of schizotypy and psychosis experience with suicidality do not lend themselves to being discounted as spurious or due to common underlying causal factors. Research addressing possible causal connections is warranted, as are efforts to identify whether reduction of suicidality may result from interventions targeting features of subclinical psychosis.
M37. THERAPEUTIC EFFECT OF TRANSCRANIAL DIRECT CURRENT STIMULATION ON WORKING MEMORY OF PATIENTS WITH RECENT ONSET SCHIZOPHRENIA: A RANDOMIZED CONTROLLED STUDY
Authors: Farhang Sara , Hosseintirabi Behnaz , Edalatzadeh Golnaz , Reza Shafiee-Kandjani Ali , Bruggeman Richard
Published: May 2020

Background

Working memory is impaired in many patients with psychotic disorder and influence their daily living. This study aimed to evaluate therapeutic effect of transcranial direct current stimulation (tDCS) on working memory of patients with recent onset schizophrenia.

Methods

40 patients with schizophrenia randomized to either 6 sessions of add-on active (2 mA, 20min) or sham tDCS (anode: left DLPFC/F3; cathode: right supraorbital/F4, duration of 30 minutes and 72 hours in between). Patients with predominant negative symptoms were excluded. Primary outcome was improvement of working memory performance on letter-number sequencing test and secondary outcome was reduction in Positive and Negative Syndrome Scale (PANSS).

Results

Majority of patients (90%) were male. Mean age was 34.12 (±11.20) ranging from 27 to 59 years. Mean score of PANSS was 9.8±2.1 in negative, 17.4±4.0 in positive and 19.2±3.2 in general symptoms. Cognitive performance of patients receiving tDCS improved significantly (7.7±2.3 to 10.3±1.7, p=0.001) compared to the sham group (8.9±3.5 to 9.1±2.4). PANSS score did not change significantly and had the same trend in the two groups.

Discussion

The results of the present study indicate that prefrontal tDCS may be a promising intervention for cognitive rehabilitation in patients with recent onset schizophrenia with prominent positive symptoms.
M50. THE PERSIAN VERSION OF THE SCREEN FOR COGNITIVE IMPAIRMENT IN PSYCHIATRY (SCIP-P) AS A VALID SCREENING TOOL FOR COGNITIVE IMPAIRMENT IN SCHIZOPHRENIA
Authors: shirzad galin , Gomez Benito Juana , Guilera Georgina , Rojo Emilio , Pino Oscar
Published: May 2020

Background

The Screen for Cognitive Impairment in Psychiatry (SCIP; Purdon, 2005) is a screening tool of cognitive impairment that includes measures of verbal learning (immediate and delayed), working memory, verbal fluency, and psychomotor speed. The test has three alternative forms that require less than 15 minutes to complete.

The main objective of this preliminary study was to examine the Persian version of SCIP as a screening tool for cognitive dysfunction in schizophrenia.

Methods

Reliability and validity data were collected from a sample of 98 patients diagnosed with schizophrenia who completed three alternate forms of the Persian translations of the SCIP within a three-week period separated by a one-week delay.

Results

This study presents the first results of the Persian version of the SCIP in a sample of patients diagnosed with schizophrenia and compares the results with those derived from the English and Spanish versions.

Discussion

The SCIP-P scores were reliable and valid for the detection of cognitive impairment in schizophrenia. Analyses confirmed that the three forms of the SCIP-P are equivalent and may prove useful for the rapid screening during routine clinical evaluation of schizophrenia.
M54. ASSOCIATIONS BETWEEN MUSICAL ABILITY SUBSCALE PERFORMANCE, PSYCHIATRIC SYMPTOMS, AND COGNITIVE FUNCTIONING IN SCHIZOPHRENIA
Authors: Akagawa Yoshiki , Honer William , Sawada Ken
Published: May 2020

Background

Several studies showed that patients with schizophrenia have a lower musical ability that correlates with poorer cognitive functions and severer negative symptoms. Despite the strong relevance of musical ability to cognitive functions and psychiatric symptoms, little is known about the correlation of each subscale of musical ability to cognitive functions and psychiatric symptoms. Therefore, we sought to analyze the correlations of the subtests of musical ability to cognitive functions and psychiatric symptoms.

Methods

Sixty-four patients with schizophrenia (36 males, mean age = 48.6 ± 10.9 years old) and 80 healthy control subjects (44 males, mean age = 45.3 ± 12.3 years old) consented to participate. We measured musical ability, cognitive functions, and symptom severity using the Montreal Battery for Evaluation of Amusia (MBEA), Brief Assessment of Cognition in Schizophrenia (BACS), and Positive and Negative Syndrome Scale (PANSS), respectively. MBEA subscales include melody discrimination, rhythm discrimination, and musical memory. BACS subscales are comprised of verbal memory, working memory, motor speed, word fluency, attention/processing speed, and executive function. We used the Bonferroni correction for multiple comparisons. For the BACS six subscales, and the three musical subscales, we considered p < 0.00278 to be significant (18 tests), and for PANSS three symptom subscale scores and three musical subscales, we considered p < 0.0056 to be significant (9 tests).

Results

All musical subscale scores of patients were significantly lower than controls. Lower musical ability subscales were correlated with lower cognitive functions in both healthy controls and patients. In schizophrenia, as previously reported, there were associations between lower musical ability subscales, lower cognitive functions, and more severe psychiatric symptoms. In patients with schizophrenia, while melody discrimination was not correlated with cognitive functions, rhythm discrimination was correlated with verbal memory (beta = 0.378, SE= 0.010, t = 3.42, p = 0.0012) and attention/processing speed (beta = 0.433, SE= 0.013, t = 3.20, p = 0.0022) adjusted for age, gender, and years of musical education. PANSS negative symptoms were correlated with melody discrimination (beta = 0.346, SE= 0.051, t = -2.82, p = 0.0066) and rhythm discrimination (beta = 0.3259, SE= 0.045, t = -2.88, p = 0.0056), but not musical memory.

Discussion

This study revealed an association between performance on rhythm discrimination and both verbal memory and word fluency. Furthermore, more severe negative symptoms were associated with lower abilities in melody and rhythm discrimination. Rhythm discrimination could be associated with language disturbances, possibly providing a new insight into the language and musical deficits contributing to the pathophysiology of schizophrenia.
M60. EARLY VERSUS DELAYED PRESCRIPTION OF CLOZAPINE AND THE COGNITIVE PERFORMANCE ON SCHIZOPHRENIA
Authors: Amoretti Silvia , Garriga Marina , Mezquida Gisela , Mallorqui Andrea , Penadés Rafael , Oliveira Cristina , Parellada Eduard , Bernardo Miquel , Garcia-Rizo Clemente
Published: May 2020

Background

Patients with schizophrenia display a wide and characteristic array of cognitive deficits. A range of factors has been shown to influence cognition, including cognitive reserve (CR). Amongst antipsychotics only clozapine has shown positive results on cognition to date. Although it is known that delayed initiation of clozapine may be related to poor clinical psychotic response, no previous results have been tested on relation to cognitive improvements.

This study aimed to analyze the improvement in cognitive performance after starting clozapine treatment according to the early versus late treatment initiation after diagnosis.

Methods

41 patients with schizophrenia were enrolled. All subjects were assessed clinically, neuropsychologically and functionally at baseline and at the 18th week of clozapine treatment. Premorbid IQ was calculated with the vocabulary subtest of the WAIS-III and it was considered a measure of CR. For study purposes, sample was divided into early or late treatment initiation of clozapine (± 3 years after diagnosis). Lineal mixed model analyses were used while confounding from different factors.

Results

There were no differences between groups in terms of gender, functional, clinical and neuropsychological outcomes at baseline and follow-up. Neither clozapine dose, nor plasma concentration of nor-clozapine, have been found to be different at 18 weeks. Significant difference in age was found (p<0.001). In early initiation clozapine treatment group (n=22), improvements in working memory, attention, executive functions, and processing speed were found. Thus, CR was the only significant factor explaining these improvements in all cognitive domains, except in processing speed that was explained by time. Late onset group (n=19) improved their cognitive performance on working memory and executive functions, both explained by CR (not time or age).

Discussion

There were no differences between groups at baseline, except for age. Patients who started an early treatment of clozapine improved more cognitive domains at 18-week that those who started it later. In both cases, CR is a key factor in predicting cognitive improvement.

Reducing clozapine treatment delay might represent immediate prospective improvements on cognitive domains in comparison with delayed start. Time-wise cognitive monitoring and CR enhancement at early stages of the psychotic illness/treatment may be helpful in order to prevent cognitive impairment.
M95. DSM-5 CLINICIAN-RATED DIMENSIONS OF PSYCHOSIS SYMPTOM SEVERITY: PSYCHOMETRIC PROPERTIES
Authors: Liemburg Edith , Nienhuis Fokko , Veling Wim
Published: May 2020

Background

In DSM-5, a number of “emerging measures” are included for further research and clinical evaluation. These patient assessment measures were developed to be administered at the initial patient interview and to monitor treatment progress. One of these instruments is the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS). Using this instrument, a clinician can rate the severity of eight symptom dimensions of psychotic disorders. The psychometric properties and the applicability of the instrument in clinical practice have not yet been investigated. The current study aims to investigate the internal consistency, factor structure and external validity with other assessment instruments.

Methods

The CRDPSS measures eight symptom dimensions, namely Hallucinations, Delusions, Disorganized speech, Abnormal psychomotor behavior, Negative Symptoms, Impaired Cognition, Depression and Mania. Items are scored on a five-point scale ranging from “Not present” to “Present and Severe”. This interview has been applied in the Psychosis Recent Onset GRoningen Survey (PROGR-S), a diagnostic protocol for patients with a suspected recent-onset psychotic disorder (n = 164 in the current analysis). Besides the CRDPSS, scores on the Positive and Negative Syndrome Scale (PANSS), Health of Nations Outcome Measure (HoNOS), the Mongomery Asberg Depression Rating Scale (MADRS), Cambridge Cambridge Neuropsychological Test Automated Battery (CANTAB) and mini-Structural Clinical Assessment in Neuropsychiatry (mini-SCAN) were used for current analyses. The Crohnbach Alpha was calculated to investigate internal consistency, exploratory factor analysis was applied, and the convergent validity was investigated by calculating non-parametric correlations of the CRDPSS with similar items or subscales of the other instruments.

Results

The Cronbach’s alpha of the CRDPSS was 0.36, indicating low internal consistency. Factor analysis resulted in three Factors: 1. Delusions/Mania, 2. Abnormal psychomotor behavior/Negative Symptoms/Impaired cognition, 3. Hallucinations/Depression. For hallucinations, Delusions, and Depression a Kendall’s tau of 0.35 – 0.45 was observed with the other instrument scores and for Impaired cognition tau = 0.6, indicating a weak to moderate association. Negative symptoms resulted in tau < 0.2 and for the other instruments tau < 0.1, but in these cases the measure of the other instruments was of questionable quality.

Discussion

The internal consistency of the CRDPSS was poor and factor analysis resulted in factors that differed to some extent from previous findings. Moreover, the convergent validity with other instruments was poor to moderate. In conclusion, based on first analyses the reliability and clinical applicability of the CRDPSS appears limited. Future studies should investigate inter-rater reliability, test-retest reliability, use more optimal measures to investigate convergent validity and use larger samples.
M219. OVERESTIMATING FUNCTION – A RISK FACTOR FOR SUBOPTIMAL COMMUNITY AID IN SCHIZOPHRENIA
Authors: Pontén Anna , Helldin Lars , Moradi Hawar , Olsson Anna-Karin
Published: May 2020

Background

Patients with schizophrenia have difficulties in judging their own performance. Patients with no or little practical experience of demands from active performance in society tends to overestimate their ability. Research has also found that patients who overestimate their function also runs a risk to be perceived as better functioning than what they actually are when judged by caregivers. The aim with this study is to examine if patients who overestimate their ability will receive less community support compared to patients who have an accurate perception of their ability?

Methods

The study population was 184 patients with schizophrenia spectrum disorder. They were tested with the Swedish version of the UCSD Performance-based Skills Assessment–Brief Version (UPSA-B). Before the test they were asked how they thought their functioning were in four different domains covered in the UPSA-B. After the test they were divided into four groups: “Good functioning with realistic perception”, “Good functioning but underestimating their function”, “Impaired function with realistic perception” and “Impaired function but overestimating their performance”. The amount of received community support were investigated and related to patients′ actual performance and self-perception.

Results

Analyzes showed that patients who had an impaired function and a realistic view of their ability had more support than those who were impaired but overestimated their ability. Also, patients with good functioning but underestimating their performance had more support than those who had a good ability and a realistic perception. Finally, there were no difference in community support to the patients in the two groups “Good function with realistic perception” and “Impaired function but overestimating their performance”.

Discussion

Our results indicate that patients with impaired functioning who overestimate their ability risk an insufficient community support. This in combination with earlier findings, that staff-members in psychiatric out-patient settings are likely to base their judgement on patients′ report consequential leading to false positive conclusions, may have both short- and long-term implications. Not achieving symptomatic remission, as a consequence of inability to follow medical prescriptions, and sub-optimal social functioning with isolation are two possible implications. The findings once again raises the need for the testing of patients′ function instead of only conducting interviews.
M225. EXPRESSED EMOTIONS AND PSYCHOLOGICAL DISTRESS AMONG CAREGIVERS OF PATIENTS WITH CHRONIC MENTAL ILLNESS ATTENDING PSYCHIATRIC DEPARTMENT OF BPKIHS
Authors: Fyak Sanjita , Pradhan Nirmala , Lama Sami , Thapa Kriti , Kumar Rajesh
Published: May 2020

Background

Family expressed emotions had been shown to be predictive of outcome in mental illnesses in variety of cultural settings. Distressed caregivers who provide care to mentally ill relatives are at risk for developing mental health disorders.

Methods

A hospital based cross sectional study was conducted among 85 caregivers of chronic mental illness using purposive sampling technique. Caregivers were interviewed using Family Questionnaire (FQ) and Kessler Psychological Distress Scale (K10) to assess expressed emotions and psychological distress of caregivers respectively.

Results

More than half (55.3%) of the caregivers had low expressed emotions while 44.7% had high expressed emotions. More than half (55.3%) of the caregivers had low psychological distress, followed by medium risk (31.8%) and high risk (12.9%).

Study revealed significant association between caregiver’s expressed emotion with caregiver’s relationship to patient, area of residence, socioeconomic status, age and gender of patients. Caregiver’s psychological distress had a significant association with their relationships with patient and educational qualification of patient. There was positive correlation between caregiver’s expressed emotions and psychological distress.

Discussion

This study illustrated that more than half (55.3%) of the caregivers had low expressed emotions and 44.7% had high expressed emotions while caring their patients with chronic mental illness. This finding is contradictory to the findings of a study conducted in India which depicts that most of the caregivers were designated as high EE (56%) as compared to low EE (44%). Another study conducted in Thailand indicated that large number of caregivers have high expressed emotion (87.5%).Another descriptive quantitative exploratory study done in Saudi Arabia had shown that majority of caregivers had low EE (85%). This differences in the results related to expressed emotions could be possibly due to variations in the sample size and tools used for data collection among these studies.
M232. COORDINATED SPECIALTY CARE FOR FIRST EPISODE PSYCHOSIS IN MINNESOTA
Authors: Fischer Jamie , Mervis Joshua , Begnel Erin , Meyer-Kalos Piper
Published: May 2020

Background

People who are experiencing a First Episode of Psychosis (FEP) often have limited recovery from non-integrated treatment approaches in usual settings. Treatment of FEP typically entails high rates of non-adherence, disengaging from treatment, and increased rates of relapse (Mueser et al., 2015; Kane et al., 2016). NAVIGATE is an evidence-based approach implemented in the Recovery After an Initial Schizophrenia Episode treatment project.

Methods

The present study is a review of archival data with NAVIGATE model teams in Minnesota. Clinical information from 118 people with FEP was reviewed from the first 6-months of treatment, with a subset analyzed for the first 12-months. Individuals were assessed with clinician ratings of current needs, illness management, and global functioning. Self-report assessments addressed symptoms and illness management from the client’s perspective. Data was analyzed using repeated measures analysis of variance with post-hoc honest significant difference testing. Additional data analysis utilized McNemar’s test, a repeated measures test using counts and a chi-square distribution.

Results

Total current needs did not change significantly across time. All other domains assessed showed significant differences between intake and 6-months. All other domains except total needs showed significant differences between intake and 12-months. No domains showed significant differences between 6-months and 12-months. Substance use was not reduced over time. Antipsychotic medication use was not reduced over time. Hospitalizations were substantially reduced from intake to 6-months.

Discussion

Almost all symptoms improved from intake to 6-months. No additional treatment gains were observed from 6-months to 12-months. Improvements from intake were stable from 6-months to 12-months. Most symptoms improved from intake to 6-months but not beyond. The NAVIGATE model was a successful intervention as implemented in Minnesota. Overall, symptom reduction gains were durable at 12-months, hospitalizations were reduced from intake to 6-months, but the intervention did not improve substance use. Substance use, continued improvement of symptoms beyond the 6-month mark, and further improvements in symptoms or reduced hospitalizations are areas for future research and treatment development.
S7. INVESTIGATING THE LINK BETWEEN THE PERIPHERAL ENDOCANNABINOID SYSTEM AND CENTRAL GLUTAMATERGIC NEUROTRANSMISSION IN EARLY PSYCHOSIS: A 7T-MRS STUDY
Authors: Minichino Amedeo , Godlewska Beata , Cowen Philip , Burnet Philip , Lennox Belinda
Published: May 2020

Background

Meta-analytic evidence showed increased levels of peripheral endocannabinoid metabolites in psychotic illness. Alterations in the endocannabinoid system are believed to compromise glutamate and dopamine transmission, which play a central role in pathophysiological models of psychosis. I will present preliminary data from an ongoing high-field proton magnetic resonance spectroscopy (MRS) study aimed at investigating the association between peripheral levels of endocannabinoid system metabolites and central glutamate metabolism in individuals at their first non-affective psychotic episode (NA-FEP) and healthy controls.

Methods

We expect to recruit 17 NA-FEP and 20 healthy controls by January 2020. Currently, we recruited 12 NA-FEP and 18 healthy controls from two different research facilities (Imperial College London and University of Oxford) as part of a cross-sectional study. Participants underwent MRS scanning at 7-T with voxels placed in right dorsolateral prefrontal cortex (right-DLPFC), anterior cingulate cortex (ACC), and occipital cortex. Neuro-metabolites will be calculated using the unsuppressed water signal as reference. Endocannabinoid metabolites were quantified from serum samples, collected during the same imaging session.

Results

Analyses are ongoing. Based on previous evidence, expected findings are: (i) reduced glutamate levels in the ACC and right-DLPFC of NA-FEP compared to controls; (ii) increased peripheral endocannabinoid metabolites in NA-FEP compared to controls; and (iii) inverse association between peripheral endocannabinoid metabolites and glutamate levels in ACC and right-DLPFC in NA-FEP

Discussion

This study will help clarifying the contribution of peripheral endocannabinoid system to central brain mechanisms of key relevance for psychotic illness. It will also add further evidence on the limited literature on high-resolution characterisation of brain metabolites in early psychosis. Strengths of the study include: (i) use of high-field MRS, which allows the estimation of glutamate-related compounds at higher precision than at lower field strength; (ii) reduced heterogeneity of the clinical sample (only male and NA-FEP). Limitations: small sample size and cross-sectional design.
S17. GLOBAL DNA METHYLATION IN CURRENT AND EMERGENT SUICIDAL IDEATION: ANALYSIS IN SCHIZOPHRENIA
Authors: Bani-Fatemi Ali , Raymond Roger , Nobrega Jose , De Luca Vincenzo
Published: May 2020

Background

Several lines of evidence have shown that epigenetic mechanisms influence suicidal behavior, but do not indicate specific susceptibility variants. In a recent study, analysis of global methylation levels found that psychiatric patients with a history of suicide attempt (SA) had significantly higher levels of 5-methyl cytosine (5mC), suggesting that patients with a history of SA have global hypermethylation of their genome. However, there is no study investigated the link between global DNA methylation and suicidal ideation (SI) in schizophrenia. In this study, we analyzed global DNA methylation in suicide ideators and non-ideators in a sample of schizophrenia patients to find if global DNA methylation can predict SI in schizophrenia.

Methods

There are several methods of detecting total 5-methylcytosine content in the genome. We used Cell Biolabs’ Global DNA Methylation ELISA Kit, which is a competitive enzyme immunoassay developed for rapid detection and quantitation of 5’-methyl-2’-deoxycytidine (5MedCyd) in DNA extracted from white blood cells (WBC). We digested the genomic DNA, extracted from WBC, into single nucleotides and the quantity of 5MedCyd was determined by comparing its absorbance with that of a known 5MedCyd standard curve. We measured global DNA methylation in predicting current and emergent suicidal ideation.

Results

In the analysis of current SI in our schizophrenia patients, the average quantity of 5MedCyd was 7.56 ± 0.77 ng 5mC/µg DNA for suicide ideators and 8.72 ± 1.97 ng 5mC/µg DNA for non-ideators. There was no evidence of a significant difference between these two groups in our analysis (p=0.176). Also, we did not find a significant difference between global DNA methylation change (global DNA methylation change between baseline and three-month follow-up visits) in patients with and without emergent SI (p=0.121).

Discussion

This preliminary analysis did not find a predictive role of global DNA methylation in SI in patients with schizophrenia. The small sample size, used in this pilot study, is probably responsible for the fact that the results found here did not support those of previous research, showing that methylation levels are higher in patients with a history of a suicide attempt.
S19. THE ROLE OF ACE AS POSSIBLE BIOMARKER FOR TREATMENT RESISTANCE TO ANTIPSYCHOTICS IN FIRST EPISODE OF PSYCHOSIS
Authors: Luisa Longo , Sawa Akira
Published: May 2020

Background

Angiotensin I–converting enzyme (ACE) is a peptidase that converts angiotensin I into the vasoactive and aldosterone-stimulating peptide angiotensin II, a key protein in controlling blood pressure. Recently, several evidences have shown a role of ACE in psychosis. However, the role of ACE in psychosis is poorly characterized, and at last unknown. In this study we hypothesized that ACE blood and CSF levels are lower in patients at first episode of psychosis (FEP) compared to controls; that blood ACE levels can predict the response to antipsychotics; that low plasma ACE levels correlate with both severity of symptoms and cognitive performance.

Methods

This research used data from a longitudinal cohort study of FEP (N = 138) and controls (N = 115). First of all, we conducted a two-group comparison analyses to assess the differences between patients and controls in terms of ACE levels in both blood and CSF. As a second step, we divided our patients into treatment resistant (TR) and not treatment resistant t(non-TR) to investigate ACE blood levels in these two group. Finally, we evaluated the association between ACE blood levels and clinical phenotype and neurocognition.

Results

Two-group analyses showed lower levels of ACE in patients than controls, both in blood and CSF (p values< 0.05). The two-group analyses between TR and non-TR showed lower ACE blood levels in TRs compared to non-TRs (p value< 0.05). Finally, multiple regressions showed a continuous relationship between cognitive performance and ACE blood levels (p values < 0.05).

Discussion

In conclusion, these findings showed that those FEP with lower ACE blood levels were not only more likely to develop TR conditions, but they also had greater cognitive impairment. These results are very promising, as they suggest that ACE levels can be used as a peripheral biomarker to stratify patients at first episode of psychosis.
S51. ANALYSIS OF SOCIAL COGNITION AS A PREDICTIVE FACTOR OF PSYCHOSIS IN 22Q11 DELETION SYNDROME (DS). DATA FROM THE MULTICENTER STUDY OF THE ITALIAN NETWORK FOR RESEARCH ON PSYCHOSES
Authors: Accinni Tommaso , Frascarelli Marianna , Buzzanca Antonino , Carlone Luca , Ghezzi Francesco , Fanella Martina , Putotto Carolina , Girardi Nicoletta , Pasquini Massimo , Di Fabio Fabio , Biondi Massimo
Published: May 2020

Background

22q11DS is the most important genetic risk factor for schizophrenia: up to 28% of these subjects develop psychosis in adulthood. At present this syndrome represents the strongest biological model to investigate neurobiological underpinnings of schizophrenia. We expected Theory of Mind impairments in subjects at risk for psychosis (22q11DS) and more severe impairments in subjects with an established psychotic disorder. Furthermore we sought to investigate eventual correlations between social cognition and self-esteem levels, hypothesizing that both would be impaired in psychotic groups.

Methods

Data come from Italian Network for Research on Psychoses for the Schizophrenic (SCZ, N=260) and Control groups (HC, N=111). 22q11DS psychotic (22q11DS_SCZ, N=17) and non-psychotic patients (22q11DS, N=46) were enrolled at Policlinico Umberto I, in Rome. The Awareness and Social Inference Test (TASIT) and Self-Esteem Rating Scale (SERS) were administered.

Results

The three main TASIT variables, Emotion Recognition, Minimal Social Inference and Enriched Social Inference, showed no different scores between the three clinical groups, which were significantly lower respect to the control group. The SERS total score showed no significant differences between clinical groups but was for all three significantly lower than control group score. No significant correlation was observed between SERS and TASIT scores for clinical groups.

Discussion

Social Cognition impairments are present in 22q11DS at the same extent as in idiopathic schizophrenia, and thus they represent an endophenotype of psychosis. A low Self-Esteem, even though associated to psychosis, does not affect neurocognitive process, impaired on a neurobiological basis.
S85. MANAGEMENT OF PHYSICAL HEALTH FOR PEOPLE WITH SCHIZOPHRENIA IN PRIMARY CARE: A SYSTEMATIC REVIEW
Authors: Wiener Joshua , Rodrigues Myanca , Anderson Kelly
Published: May 2020

Background

We sought to determine how the physical health of people with schizophrenia is managed by family physicians in a primary care setting relative to those without schizophrenia.

Methods

A comprehensive literature search was conducted in three electronic databases for articles published in English up to January 2019. Studies were included if: (1) study design was observational; (2) population was patients receiving primary care from family physicians; (3) exposure was schizophrenia; (4) comparison was no schizophrenia; and (5) outcome was management of physical health condition. Study details, subject characteristics, methods, and results were extracted from each study and summarized in a qualitative manner. Risk of bias (RoB) for each study was assessed using the CLARITY tool.

Results

A total of 12 articles met inclusion criteria, including 9 retrospective cohort studies with low RoB and 3 case control studies with moderate RoB. Among patients with diabetes (5 studies), those with schizophrenia received lower rates of guideline-recommended monitoring. Among patients with cardiovascular disease (2 studies), those with schizophrenia received lower rates of guideline-recommended prescriptions (e.g., statins). Among patients at risk for cardiovascular disease (3 studies), those with schizophrenia received lower rates of guideline-recommended screening (e.g., serum cholesterol levels). Among patients at risk for cancer (2 studies), those with schizophrenia received lower rates of guideline-recommended screening (e.g., Papanicolaou test).

Discussion

Physical health management is an ongoing concern for individuals living with schizophrenia. These individuals often receive poorer care of their physical health by family physicians when compared to individuals without schizophrenia.
S86. THE RISK OF PHYSICAL HEALTH MULTIMORBIDITY IN PATIENTS WITH PSYCHOSIS: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Rodrigues Myanca , Wiener Joshua , Stranges Saverio , Ryan Bridget , Anderson Kelly
Published: May 2020

Background

Patients with psychotic disorders have a reduced life expectancy compared to those without psychosis, and this is primarily due to differences in physical illnesses. We aimed to assess the risk of developing multimorbidity or multiple chronic physical health conditions, and quantify its prevalence among this clinical population.

Methods

We identified studies through MEDLINE, EMBASE and PsycINFO from 1990 to September 2019, and reference scanning of included studies. Quantitative studies were included if proportions of 2+ and/or 3+ chronic physical health conditions were evaluated for patients with psychosis. Findings from all studies were descriptively summarized, and estimates for risk and prevalence of multimorbidity were meta-analyzed using random effects models.

Results

Fourteen studies were included, eight of which were meta-analyzed to determine the risk of developing 2+ chronic conditions for patients with psychosis. The pooled meta-analytic estimate suggests that persons with psychosis have an increased risk of developing multimorbidity than those without psychotic disorders (Risk ratio, RR=1.69, 95% CI 1.37, 2.08). All studies employed different operational definitions of multimorbidity, with respect to both the number and types of included chronic conditions. Evidence from included studies suggests gender and age as potential risk factors for developing multiple chronic conditions.

Discussion

Patients with psychosis are 69% more likely to develop multimorbidity than those without psychotic disorders. Clinicians responsible for the management of patients with psychosis should assess their risk for somatic illnesses. Future research examining multimorbidity should employ consistent definitions to better enable cross-study comparisons.