- Email: [email protected]
FC10B ELEVATED HOMOCYSTEINE AND DECREASED FOLATE LEVELS IN AFFECTIVE AND NON-AFFECTIVE PSYCHOTIC DISORDERS WITHIN A FIRST EPISODE PSYCHOSIS COHORT
S60
Schizophrenia Research 86 (2006)
a recovery group. Twelve people (mean age 34 years), who were within 5 years of onset of their difficulties, completed one of two groups. The groups ran weekly in a community venue for six weeks and were facilitated by two clinical psychologists and a service user (who had graduated from a previous pilot group). Ideas from the recovery model were discussed and worked on e.g. harnessing a sense of hope and optimism, active participation and collaboration, goal setting, relapse prevention, making informed choices and taking personal responsibility for the consequences of that choice, reducing stigma and searching for meaning and purpose in one’s symptoms and life as a whole. The results of this small study showed that there was a significant pre-post improvement in self esteem as measured by the Rosenberg Self Esteem Scale (1965) (p < 0.44), a significant improvement in perceived control over illness as measured by Personal Beliefs about Illness Questionnaire (Birchwood et al, 1993) (p < 0.004) and a significant improvement in sense of ‘empowerment’ as measured by the Making Decisions Questionnaire (Rogers et al, 1997) (p < 0.004). Attitudes about recovery, measured by the Recovery Attitudes Questionnaire (Barkin et al, 2000) however, did not change. The results are encouraging and warrant further controlled outcome FC6D COMPASSIONATE MIND TRAINING WITH PEOPLE WHO HEAR MALEVOLENT VOICES: A CASE SERIES REPORT S.L. Mayhew *, P. Gilbert. Derbyshire Mental Health NHS Trust, Derby, United Kingdom
Abstracts
Oral Session FC10: Interventions, markers and processes in the first episode FC10A PRE-ATHEROSCLEROTIC LESIONS IN UNTREATED FIRST EPISODE PATIENTS WITH SCHIZOPHRENIA J.H. Thakore *, L. Spelman. St. Vincent’s Hospital, Dublin 3, Ireland Presenting author contact: [email protected] Aim: To measure intima media thickness (IMT) and flow mediated dilatation (FMD) in untreated first episode patients with schizophrenia and healthy volunteers Methods: This was a cross-sectional case-control study. Patients (n = 20; age 26.3±3.6 yr) and controls (n = 20; age 27.2±4.5 yr) were matched in terms of BMI (22.5±4.6 kg/m2 vs. 21.6±3.3 kg/m2 ; respectively), smoking status and various lifestyle parameters. The IMT (structural anatomy) of both the left and right common & internal carotid arteries was measured by a longitudinal B-mode (US) image. A marker of endothelial dysfunction, FMD was measured by both high-resolution B-mode US and Doppler US. Results: Neither group of subjects were obese or hadtype 2 diabetes. However, patients had greater IMT in both the right and left internal and common carotid arteries than matched controls. Variable
Patients
Controls
p value
Right CCA (mm) Right ICA (mm) Left CCA (mm) Left ICA (mm)
0.62±0.08 0.0625±0.01 0.65±0.1 0.072±0.02
0.54±0.06 0.045±0.02 0.56±0.09 0.056±0.02
<0.01 <0.01 <0.05 <0.05
Presenting author contact: [email protected]
This study evaluated compassionate mind training (CMT) with psychotic voice hearers. We investigated whether voice hearers were able to access and use the positive emotions of ‘warmth’ and ‘contentment’ to become more self-compassionate. We also evaluated how CMT affected participants’ hostile voices and their levels of anxiety and paranoia. We explored how participants felt about CMT and obtained suggestions for tailoring this approach to use with others. The study was discussed with members of The Hearing Voices Network and ideas raised by members were incorporated into the design and method. A case series design was chosen as the most appropriate methodology. Participants aged 16−65 yrs diagnosed with schizophrenia, who experienced malevolent auditory hallucinations were identified from CMHTs and invited to collaboratively explore CMT. Those experiencing a relapse, those who had symptoms severe enough to impede their ability to provide informed consent or who did not speak English were excluded. 7 people consented to participate, of these 3 completed CMT. Participants completed 6 questionnaires before and after CMT: The BAVQ, a shortened version of the Forms of Criticism/Self Attacking & SelfReassuring Scale, a shortened version of the Functions of SelfCriticism/Attacking & Self-Reassuring Scale, the SCL-90, the Voice Rank Scale and the Self Compassion Scale. Participants also kept a weekly diary of voice activity, self-critical and self-compassionate thoughts. CMT was provided on a 1:1 basis over 12 one-hour sessions. The results (currently under analysis), participants’ experiences of CMT and important implications for future research & practice will be discussed.
Discussion: This is the first study to show that untreated first episode patients with schizophrenia have early markers of atherosclerosis in the absence of frank type 2 diabetes. This is in keeping with the higher SMR (1.40) for cardioavscular disease (CVD) in those with schizophrenia. Furthermore, these findings support the recent calls for patients with schizophrenia to be screened for CVD. FC10B ELEVATED HOMOCYSTEINE AND DECREASED FOLATE LEVELS IN AFFECTIVE AND NON-AFFECTIVE PSYCHOTIC DISORDERS WITHIN A FIRST EPISODE PSYCHOSIS COHORT A. Papas *, C. O’Donnell, M. O’Regan, R. Purcell, P.D. McGorry. ORYGEN Research Centre and The University of Melbourne, Melbourne, Victoria, Australia Presenting author contact: [email protected] Background: Evidence of increased homocysteine in people with schizophrenia prompted an investigation of homocysteine levels in a first episode psychosis (FEP) cohort. The aim of the study was to determine whether homocysteine levels are not only elevated in individuals with non-affective psychotic disorders but also in those with affective diagnoses, for example, bipolar and depression with psychotic features. Folate, a constituent in homocysteine metabolism, is inversely related to homocysteine. A secondary objective of the
Oral Session FC10: Interventions, markers and processes in the first episode study was to determine whether folate levels are decreased in this population. Method: Participants were recruited from the Early Psychosis Prevention and Intervention Centre (EPPIC), a subdivision of ORYGEN Youth Health. EPPIC serves a geographical catchment area of approximately 900,000 (North-Western Melbourne metropolitan region) and provides treatment for 15−25 year olds. Criteria for entry into the study included a SCID-IV Axis I diagnosis. Age and sex-matched healthy controls with no family history of psychosis were also recruited as a comparison group. Homocysteine, B12, and folate levels were ascertained. Methods including genetic blood samples and dietary questionnaires were also employed to assess confounding variables such as MTHFR polymorphisms and dietary vitamin intake. Results: Analyses showed both affective and non-affective groups had significantly elevated homocysteine levels compared to controls, p < 0.03. There was no significant difference in homocysteine levels between affective and non-affective groups. Serum folate was significantly lower in both affective and non-affective groups compared to controls, p < 0.001, however there was no significant difference in folate levels between the two patient groups. Conclusion: Homocysteine is elevated and folate is decreased in both affective and non-affective psychotic disorders, but not in healthy controls. Lowering homocysteine levels through the use of folate may have beneficial effects on cognition and symptomatology in first episode psychosis. A randomized controlled trial investigating folate augmentation on such outcomes in FEP is currently in progress. FC10C MISPERCEPTION IN FIRST-EPISODE PATIENTS WITH SCHIZOPHRENIA AND THEIR HEALTHY YOUNG SIBLINGS O.M. de Wilde1 *, P.M. Dingemans1 , L.J. Bour2 , T. Boeree2 , D.H. Linszen1 . 1 Academic Medical Center, department of psychiatry, Amsterdam, Netherlands, 2 Academic Medical Center, department of neurology/neurophysiology, Amsterdam, Netherlands Presenting author contact: [email protected] Background: Communication Deviance (CD) is a measure of subclinical thought disorder expressed in speech. It has been found in patients with schizophrenia and was found to be associated with a family history of schizophrenia spectrum disorders among patient’s parents and siblings. CD therefore has been suggested CD to be a genetic vulnerability factor for schizophrenia. An important factor of CD is misperception. We hypothesized misperception to be present in first-episode patients with schizophrenia as well as their healthy young siblings. Methods: We included fifty-two patients who met DSM-IV criteria for schizophrenia, twenty-seven of their healthy unaffected siblings, and thirty-four non-psychiatric healthy controls of similar ages and educational level. Misperception was measured using the communication deviance protocol for the Thematic Apperception Test. Results: The presence of misperception was a robust finding in patients with schizophrenia and their healthy siblings when compared to healthy controls (p = 0.001). Conclusions: The results suggest that misperception can be a valuable endophenotype for schizophrenia and could be used as such in future genetic association studies.
S61
FC10D THE AMSTERDAM CRITICAL PERIOD INTERVENTION IN THE EARLY PHASE OF SCHIZOPHRENIA-LIKE PSYCHOSES D. Linszen *, L. De Haan, P. Dingemans, R. Lenior, T. Van Amelsvoort, L. Wouters. Academic Medical Center/De Meren, University of Amsterdam, Amsterdam, Netherlands Presenting author contact: [email protected] Background: Early recognition and intervention of florid psychosis in schizophrenia and related disorders in studies in England, America and Australia have shown earlier symptom remission, a high rate of remission, delay of psychotic relapse and prevention of psychosocial deterioration in one to two years intervention study. Pharmacological and psychosocial studies with first-episode psychotic patients in Europe and America have also shown a beneficial effect on the relapse rate and psychosocial functioning. However, after five year follow-up all studies have shown a tendency to the unfavourable long-term course patterns of schizophrenia, including suiced. Methods: A 5 year randomized intervention study with young patients examined the role of continuity of care by the same staff and the effect of parent groups. Risk and protective factors were assessed of 183 randomized patients at the start of the study and at 6 months intervals with the Life Chart Schedule (WHO, 1992). Results: Results after 5 year intervention showed a beneficial non relapsing effect of early and sustained intervention in approximately 50% of the first episode patients. Also a group of 50% young patients emerged, who relapsed once or more or developed continuous psychosis. Main poor outcome predictors turned out to be lack of insight, cannabis abuse and non-compliance as assessed during the first six months to the intervention. The early course stabilised after 2−3 years. 4% of the patients commited suicide. Conclusions: These results differ from long-term treatment results from schizophrenia in a favourable way: in contrast with long-term follow-up studies intervention in the critical period can prevent deterioration in half the patients. Alternative interventions for patients with a relapsing or chronic course will be presented. FC10E MODELLING THE ECONOMIC IMPACT OF EARLY INTERVENTION SERVICES P. McCrone1 *, S. Dhanasiri1 , M. Knapp1,2 . 1 King’s College London, Institute of Psychiatry, 2 Personal Social Services Research Unit, LSE Health and Social Care, London School of Economics and Political Science, London, United Kingdom Economic questions are being asked with increasing frequency in mental health and other systems. In particular, decision markers want to know whether new treatment modes, service configurations and policy initiatives are affordable and represent good value for money. This presentation will describe recent research that has addressed some of these questions in relation to early intervention services in England. The aim was to estimate the economic impact of early intervention services as compared to standard treatment. A Markov decision analytical model was constructed to compare early intervention and standard care, reflecting the normal care pathways in both options. Transition probabilities for different care pathways and service costs were estimated to populate the model. The model was analysed for 1-year and 3-year periods to estimate the final costs. Sensitivity analyses were performed to test the robustness of the model.
Schizophrenia Research 86 (2006)
a recovery group. Twelve people (mean age 34 years), who were within 5 years of onset of their difficulties, completed one of two groups. The groups ran weekly in a community venue for six weeks and were facilitated by two clinical psychologists and a service user (who had graduated from a previous pilot group). Ideas from the recovery model were discussed and worked on e.g. harnessing a sense of hope and optimism, active participation and collaboration, goal setting, relapse prevention, making informed choices and taking personal responsibility for the consequences of that choice, reducing stigma and searching for meaning and purpose in one’s symptoms and life as a whole. The results of this small study showed that there was a significant pre-post improvement in self esteem as measured by the Rosenberg Self Esteem Scale (1965) (p < 0.44), a significant improvement in perceived control over illness as measured by Personal Beliefs about Illness Questionnaire (Birchwood et al, 1993) (p < 0.004) and a significant improvement in sense of ‘empowerment’ as measured by the Making Decisions Questionnaire (Rogers et al, 1997) (p < 0.004). Attitudes about recovery, measured by the Recovery Attitudes Questionnaire (Barkin et al, 2000) however, did not change. The results are encouraging and warrant further controlled outcome FC6D COMPASSIONATE MIND TRAINING WITH PEOPLE WHO HEAR MALEVOLENT VOICES: A CASE SERIES REPORT S.L. Mayhew *, P. Gilbert. Derbyshire Mental Health NHS Trust, Derby, United Kingdom
Abstracts
Oral Session FC10: Interventions, markers and processes in the first episode FC10A PRE-ATHEROSCLEROTIC LESIONS IN UNTREATED FIRST EPISODE PATIENTS WITH SCHIZOPHRENIA J.H. Thakore *, L. Spelman. St. Vincent’s Hospital, Dublin 3, Ireland Presenting author contact: [email protected] Aim: To measure intima media thickness (IMT) and flow mediated dilatation (FMD) in untreated first episode patients with schizophrenia and healthy volunteers Methods: This was a cross-sectional case-control study. Patients (n = 20; age 26.3±3.6 yr) and controls (n = 20; age 27.2±4.5 yr) were matched in terms of BMI (22.5±4.6 kg/m2 vs. 21.6±3.3 kg/m2 ; respectively), smoking status and various lifestyle parameters. The IMT (structural anatomy) of both the left and right common & internal carotid arteries was measured by a longitudinal B-mode (US) image. A marker of endothelial dysfunction, FMD was measured by both high-resolution B-mode US and Doppler US. Results: Neither group of subjects were obese or hadtype 2 diabetes. However, patients had greater IMT in both the right and left internal and common carotid arteries than matched controls. Variable
Patients
Controls
p value
Right CCA (mm) Right ICA (mm) Left CCA (mm) Left ICA (mm)
0.62±0.08 0.0625±0.01 0.65±0.1 0.072±0.02
0.54±0.06 0.045±0.02 0.56±0.09 0.056±0.02
<0.01 <0.01 <0.05 <0.05
Presenting author contact: [email protected]
This study evaluated compassionate mind training (CMT) with psychotic voice hearers. We investigated whether voice hearers were able to access and use the positive emotions of ‘warmth’ and ‘contentment’ to become more self-compassionate. We also evaluated how CMT affected participants’ hostile voices and their levels of anxiety and paranoia. We explored how participants felt about CMT and obtained suggestions for tailoring this approach to use with others. The study was discussed with members of The Hearing Voices Network and ideas raised by members were incorporated into the design and method. A case series design was chosen as the most appropriate methodology. Participants aged 16−65 yrs diagnosed with schizophrenia, who experienced malevolent auditory hallucinations were identified from CMHTs and invited to collaboratively explore CMT. Those experiencing a relapse, those who had symptoms severe enough to impede their ability to provide informed consent or who did not speak English were excluded. 7 people consented to participate, of these 3 completed CMT. Participants completed 6 questionnaires before and after CMT: The BAVQ, a shortened version of the Forms of Criticism/Self Attacking & SelfReassuring Scale, a shortened version of the Functions of SelfCriticism/Attacking & Self-Reassuring Scale, the SCL-90, the Voice Rank Scale and the Self Compassion Scale. Participants also kept a weekly diary of voice activity, self-critical and self-compassionate thoughts. CMT was provided on a 1:1 basis over 12 one-hour sessions. The results (currently under analysis), participants’ experiences of CMT and important implications for future research & practice will be discussed.
Discussion: This is the first study to show that untreated first episode patients with schizophrenia have early markers of atherosclerosis in the absence of frank type 2 diabetes. This is in keeping with the higher SMR (1.40) for cardioavscular disease (CVD) in those with schizophrenia. Furthermore, these findings support the recent calls for patients with schizophrenia to be screened for CVD. FC10B ELEVATED HOMOCYSTEINE AND DECREASED FOLATE LEVELS IN AFFECTIVE AND NON-AFFECTIVE PSYCHOTIC DISORDERS WITHIN A FIRST EPISODE PSYCHOSIS COHORT A. Papas *, C. O’Donnell, M. O’Regan, R. Purcell, P.D. McGorry. ORYGEN Research Centre and The University of Melbourne, Melbourne, Victoria, Australia Presenting author contact: [email protected] Background: Evidence of increased homocysteine in people with schizophrenia prompted an investigation of homocysteine levels in a first episode psychosis (FEP) cohort. The aim of the study was to determine whether homocysteine levels are not only elevated in individuals with non-affective psychotic disorders but also in those with affective diagnoses, for example, bipolar and depression with psychotic features. Folate, a constituent in homocysteine metabolism, is inversely related to homocysteine. A secondary objective of the
Oral Session FC10: Interventions, markers and processes in the first episode study was to determine whether folate levels are decreased in this population. Method: Participants were recruited from the Early Psychosis Prevention and Intervention Centre (EPPIC), a subdivision of ORYGEN Youth Health. EPPIC serves a geographical catchment area of approximately 900,000 (North-Western Melbourne metropolitan region) and provides treatment for 15−25 year olds. Criteria for entry into the study included a SCID-IV Axis I diagnosis. Age and sex-matched healthy controls with no family history of psychosis were also recruited as a comparison group. Homocysteine, B12, and folate levels were ascertained. Methods including genetic blood samples and dietary questionnaires were also employed to assess confounding variables such as MTHFR polymorphisms and dietary vitamin intake. Results: Analyses showed both affective and non-affective groups had significantly elevated homocysteine levels compared to controls, p < 0.03. There was no significant difference in homocysteine levels between affective and non-affective groups. Serum folate was significantly lower in both affective and non-affective groups compared to controls, p < 0.001, however there was no significant difference in folate levels between the two patient groups. Conclusion: Homocysteine is elevated and folate is decreased in both affective and non-affective psychotic disorders, but not in healthy controls. Lowering homocysteine levels through the use of folate may have beneficial effects on cognition and symptomatology in first episode psychosis. A randomized controlled trial investigating folate augmentation on such outcomes in FEP is currently in progress. FC10C MISPERCEPTION IN FIRST-EPISODE PATIENTS WITH SCHIZOPHRENIA AND THEIR HEALTHY YOUNG SIBLINGS O.M. de Wilde1 *, P.M. Dingemans1 , L.J. Bour2 , T. Boeree2 , D.H. Linszen1 . 1 Academic Medical Center, department of psychiatry, Amsterdam, Netherlands, 2 Academic Medical Center, department of neurology/neurophysiology, Amsterdam, Netherlands Presenting author contact: [email protected] Background: Communication Deviance (CD) is a measure of subclinical thought disorder expressed in speech. It has been found in patients with schizophrenia and was found to be associated with a family history of schizophrenia spectrum disorders among patient’s parents and siblings. CD therefore has been suggested CD to be a genetic vulnerability factor for schizophrenia. An important factor of CD is misperception. We hypothesized misperception to be present in first-episode patients with schizophrenia as well as their healthy young siblings. Methods: We included fifty-two patients who met DSM-IV criteria for schizophrenia, twenty-seven of their healthy unaffected siblings, and thirty-four non-psychiatric healthy controls of similar ages and educational level. Misperception was measured using the communication deviance protocol for the Thematic Apperception Test. Results: The presence of misperception was a robust finding in patients with schizophrenia and their healthy siblings when compared to healthy controls (p = 0.001). Conclusions: The results suggest that misperception can be a valuable endophenotype for schizophrenia and could be used as such in future genetic association studies.
S61
FC10D THE AMSTERDAM CRITICAL PERIOD INTERVENTION IN THE EARLY PHASE OF SCHIZOPHRENIA-LIKE PSYCHOSES D. Linszen *, L. De Haan, P. Dingemans, R. Lenior, T. Van Amelsvoort, L. Wouters. Academic Medical Center/De Meren, University of Amsterdam, Amsterdam, Netherlands Presenting author contact: [email protected] Background: Early recognition and intervention of florid psychosis in schizophrenia and related disorders in studies in England, America and Australia have shown earlier symptom remission, a high rate of remission, delay of psychotic relapse and prevention of psychosocial deterioration in one to two years intervention study. Pharmacological and psychosocial studies with first-episode psychotic patients in Europe and America have also shown a beneficial effect on the relapse rate and psychosocial functioning. However, after five year follow-up all studies have shown a tendency to the unfavourable long-term course patterns of schizophrenia, including suiced. Methods: A 5 year randomized intervention study with young patients examined the role of continuity of care by the same staff and the effect of parent groups. Risk and protective factors were assessed of 183 randomized patients at the start of the study and at 6 months intervals with the Life Chart Schedule (WHO, 1992). Results: Results after 5 year intervention showed a beneficial non relapsing effect of early and sustained intervention in approximately 50% of the first episode patients. Also a group of 50% young patients emerged, who relapsed once or more or developed continuous psychosis. Main poor outcome predictors turned out to be lack of insight, cannabis abuse and non-compliance as assessed during the first six months to the intervention. The early course stabilised after 2−3 years. 4% of the patients commited suicide. Conclusions: These results differ from long-term treatment results from schizophrenia in a favourable way: in contrast with long-term follow-up studies intervention in the critical period can prevent deterioration in half the patients. Alternative interventions for patients with a relapsing or chronic course will be presented. FC10E MODELLING THE ECONOMIC IMPACT OF EARLY INTERVENTION SERVICES P. McCrone1 *, S. Dhanasiri1 , M. Knapp1,2 . 1 King’s College London, Institute of Psychiatry, 2 Personal Social Services Research Unit, LSE Health and Social Care, London School of Economics and Political Science, London, United Kingdom Economic questions are being asked with increasing frequency in mental health and other systems. In particular, decision markers want to know whether new treatment modes, service configurations and policy initiatives are affordable and represent good value for money. This presentation will describe recent research that has addressed some of these questions in relation to early intervention services in England. The aim was to estimate the economic impact of early intervention services as compared to standard treatment. A Markov decision analytical model was constructed to compare early intervention and standard care, reflecting the normal care pathways in both options. Transition probabilities for different care pathways and service costs were estimated to populate the model. The model was analysed for 1-year and 3-year periods to estimate the final costs. Sensitivity analyses were performed to test the robustness of the model.