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INCIDENCE AND PREVALENCE OF NON-AFFECTIVE PSYCHOSIS IN STOCKHOLM, SWEDEN
Abstracts / Schizophrenia Research 102/1–3, Supplement 2 (2008) 1–279
352 – INCIDENCE AND PREVALENCE OF NON-AFFECTIVE PSYCHOSIS IN STOCKHOLM, SWEDEN Lena Jörgensen 1 , Anders Ahlbom 3 , Peter Allebeck 2 , Anna Åberg Wistedt 4 , Christina Dalman 2 1 Social Medicine and Epidemiology, Stockholm Centre for Public Health, Stockholm, Sweden; 2 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 3 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 4 Department of Clinical Neuroscience St. Göran’s Hospital, Stockholm, Sweden [email protected] Introduction: There is a considerable variation in incide nce and prevalence estimates of schizophrenia and non-affective psychosis between various regions in the world. This is probably due to true variations, but also to different diagnostic criteria and methods of case finding. The aim of the present study is to estimate the incidence and prevalence in Stockholm by using in-and/or outpatient registers covering the whole population. Methods: A register of psychoses has been established in Stockholm, Sweden, covering the years 1997-2006. The re gister includes person identified data from both inpatient and outpatient care for persons with non-affective psychoses incl. schizophrenia (ICD10 F20-F29). Information about earlier hospitalizations (1973-1997) is also available. Validation studies of the diagnoses in the register and the methodology used to identify incident cases have been performed by scrutinizing psychiatric records. Results: The incidence of non-affective psychosis was 83/100 000 person years (18-44 years). The prevalence of non-affective psychosis was 0.6% and of schizophrenia 0.3% (18-64 years). The proportion of individuals with non-affective psychosis treated in outpatient care only (never inpatients), was 21%. The quality of the diagnoses was excellent, 9 4% agreement. For incident cases there was a high agreement in correctly identifying true new cases of non-affective psychoses (80%) but not for the subgroup schizophrenia (58%). Conclusions: The incidence of non-affective psychoses is relatively high in Stockholm but the prevalence is more similar to other studies. Not including outpatient care will substantially underestimate the prevalence as well as the incidence. This problem must be considered in epidemiological research work. References [1] Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005 May;2(5):e141. [2] McGrath J, Saha S, Welham J, El Saadi O, MacCauley C, Chant D. A systematic review of the incidence of schizophrenia: the distribu tion of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Med. 2004 Apr 28;2:13.
353 – CLINICAL STATES OF DEPRESSION IN SCHIZOPHRENIA PATIENTS Kuy Haeng Lee 1 , Hyun -Tae Jeon 2 1 Neuropsychiatric hospital, medical school, Wonkwang university, Iksan, Cheonbuk; 2 Hanmaum hospital, Seoul, Korea [email protected] Introduction: This presentation aimed to evaluate the clinical state of depression of schizophrenia patients. The depressive symptoms of schizophrenia patients were checked by clinical criteria. The relationships between the depression and some clinical factors were surveyed. Methods: The subjects were 56 patients with schizophrenia in psychiatric ward who accompanied depressive symptoms. The depression and anxiety were evaluated by the diagnostic criteria of major depressive disorder and generalized anxiety disorder in diagnosti c and statistical manuals of mental disorders (IV-TR). The adjustment state was checked by global assessment of functional scale. The somatic symptoms were surveyed by Wahler physical symptom inventory. The correlations were searched among the onset age, duration of education, duration of illness, frequency of admission, past and present adjust-
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ment, depression and anxiety. Pearson correlation was calculated by SPSS 11.5. Results: The degree of depression in admitted patients with schizophrenia showed positive correlation with the frequency of admission, anxiety, somatic symptoms and negative correlation with the duration of education, the present and past adjustment. The prominent depressive symptoms were diminished ability to think or concentrate, insomnia, diminished interest, fatigue or loss of energy, depressed mood, feelings of worthlessness-guilt, psychomotor agitation, loss of pleasure, interpersonal rejection sensitivity. Conclusions: In admitted schizophrenia patients, the higher tendency of depression were expected in the patients with frequent admission, anxiety and many somatic symptoms. More education and better previous adjustment decreased the possibility of depression. References [1] Zisook S, Nyer M, Kasckow J, Golshan S, Lehman D, Montross L.,2006. Depressive symptom patterns in patients with chronic schizophrenia and subsyndromal depression. Schizophr Res. 86(13),226-233. [2] Mulholland, C., Cooper, S.,2000. The symptom of depress ion in schizophrenia and its management. Advances in Psychiatric Treatment 6, 169-177.
354 – ARE THERE CLINICAL SUBGROUPS OF PATIENTS WITH AUDITORY VERBAL HALLUCINATIONS? Esther Lorente-Rovira Clinical Hospital, Valencia, Spain [email protected] Introduction: Due to the heterogeneity of Schizophrenia, alternative clinical phenotypes are needed. Auditory hallucinations are one of the core symptoms of psychosis and have been considered as a good phenotype (Rosenthal and Quinn, 1977). One etio pathological model for vulnerability to hallucinations in psychosis would imply, on one hand, vulnerability to hearing voices, and on the other hand, an anomalous emotional response to hallucinations (Sanjuan, 2006). Our aim is to explore whether these AH dimensions are useful to discriminate homogeneous groups of patients. Methods: 143 psychotic patients with AH were included: 87 with persistent AH and 56 with acute AH. All patients were assessed with the Psychotic Symptom Rating Scale (PSY RATS) for auditory hallucinations (Haddock et al, 1999). A cluster analysis considering the different dimensions of verbal hallucinations was carried out. Results: Cluster analysis discriminate four different groups attending to two main dimensio ns: the first group of patients (N = 81) showed high severity of AH and high anxiety; the second one (N = 23) showed low severity of AH and low anxiety. The third one (N = 23), high severity of AH but low anxiety. The last one (N = 16), patients wit h low severity of AH and high anxiety. Conclusions: Severity of hallucinations and anxiety response are crucial for discriminating homogeneous groups of patients. These two dimensions have relevant implication in treatment as well as in the under standing of the neurobiological basis of AH. References [1] Rosenthal, D. and Quinn, O.W. (1977). Quadruplet hallucinations. Phenotipic variations of a schizophrenic genotype. Archives of General Psychiatry, 34, 817-827. [2] Sanjuan, J. (2006). The aetiopathogenesis of auditory hallucinations in psychosis. Revista Ne urologia, 43 (5), 280-286. [3] Haddock, G., McCarron, J., Tarrier, N., Faragher, E.B. (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine, 29, 879-889.
352 – INCIDENCE AND PREVALENCE OF NON-AFFECTIVE PSYCHOSIS IN STOCKHOLM, SWEDEN Lena Jörgensen 1 , Anders Ahlbom 3 , Peter Allebeck 2 , Anna Åberg Wistedt 4 , Christina Dalman 2 1 Social Medicine and Epidemiology, Stockholm Centre for Public Health, Stockholm, Sweden; 2 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 3 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 4 Department of Clinical Neuroscience St. Göran’s Hospital, Stockholm, Sweden [email protected] Introduction: There is a considerable variation in incide nce and prevalence estimates of schizophrenia and non-affective psychosis between various regions in the world. This is probably due to true variations, but also to different diagnostic criteria and methods of case finding. The aim of the present study is to estimate the incidence and prevalence in Stockholm by using in-and/or outpatient registers covering the whole population. Methods: A register of psychoses has been established in Stockholm, Sweden, covering the years 1997-2006. The re gister includes person identified data from both inpatient and outpatient care for persons with non-affective psychoses incl. schizophrenia (ICD10 F20-F29). Information about earlier hospitalizations (1973-1997) is also available. Validation studies of the diagnoses in the register and the methodology used to identify incident cases have been performed by scrutinizing psychiatric records. Results: The incidence of non-affective psychosis was 83/100 000 person years (18-44 years). The prevalence of non-affective psychosis was 0.6% and of schizophrenia 0.3% (18-64 years). The proportion of individuals with non-affective psychosis treated in outpatient care only (never inpatients), was 21%. The quality of the diagnoses was excellent, 9 4% agreement. For incident cases there was a high agreement in correctly identifying true new cases of non-affective psychoses (80%) but not for the subgroup schizophrenia (58%). Conclusions: The incidence of non-affective psychoses is relatively high in Stockholm but the prevalence is more similar to other studies. Not including outpatient care will substantially underestimate the prevalence as well as the incidence. This problem must be considered in epidemiological research work. References [1] Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005 May;2(5):e141. [2] McGrath J, Saha S, Welham J, El Saadi O, MacCauley C, Chant D. A systematic review of the incidence of schizophrenia: the distribu tion of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Med. 2004 Apr 28;2:13.
353 – CLINICAL STATES OF DEPRESSION IN SCHIZOPHRENIA PATIENTS Kuy Haeng Lee 1 , Hyun -Tae Jeon 2 1 Neuropsychiatric hospital, medical school, Wonkwang university, Iksan, Cheonbuk; 2 Hanmaum hospital, Seoul, Korea [email protected] Introduction: This presentation aimed to evaluate the clinical state of depression of schizophrenia patients. The depressive symptoms of schizophrenia patients were checked by clinical criteria. The relationships between the depression and some clinical factors were surveyed. Methods: The subjects were 56 patients with schizophrenia in psychiatric ward who accompanied depressive symptoms. The depression and anxiety were evaluated by the diagnostic criteria of major depressive disorder and generalized anxiety disorder in diagnosti c and statistical manuals of mental disorders (IV-TR). The adjustment state was checked by global assessment of functional scale. The somatic symptoms were surveyed by Wahler physical symptom inventory. The correlations were searched among the onset age, duration of education, duration of illness, frequency of admission, past and present adjust-
173
ment, depression and anxiety. Pearson correlation was calculated by SPSS 11.5. Results: The degree of depression in admitted patients with schizophrenia showed positive correlation with the frequency of admission, anxiety, somatic symptoms and negative correlation with the duration of education, the present and past adjustment. The prominent depressive symptoms were diminished ability to think or concentrate, insomnia, diminished interest, fatigue or loss of energy, depressed mood, feelings of worthlessness-guilt, psychomotor agitation, loss of pleasure, interpersonal rejection sensitivity. Conclusions: In admitted schizophrenia patients, the higher tendency of depression were expected in the patients with frequent admission, anxiety and many somatic symptoms. More education and better previous adjustment decreased the possibility of depression. References [1] Zisook S, Nyer M, Kasckow J, Golshan S, Lehman D, Montross L.,2006. Depressive symptom patterns in patients with chronic schizophrenia and subsyndromal depression. Schizophr Res. 86(13),226-233. [2] Mulholland, C., Cooper, S.,2000. The symptom of depress ion in schizophrenia and its management. Advances in Psychiatric Treatment 6, 169-177.
354 – ARE THERE CLINICAL SUBGROUPS OF PATIENTS WITH AUDITORY VERBAL HALLUCINATIONS? Esther Lorente-Rovira Clinical Hospital, Valencia, Spain [email protected] Introduction: Due to the heterogeneity of Schizophrenia, alternative clinical phenotypes are needed. Auditory hallucinations are one of the core symptoms of psychosis and have been considered as a good phenotype (Rosenthal and Quinn, 1977). One etio pathological model for vulnerability to hallucinations in psychosis would imply, on one hand, vulnerability to hearing voices, and on the other hand, an anomalous emotional response to hallucinations (Sanjuan, 2006). Our aim is to explore whether these AH dimensions are useful to discriminate homogeneous groups of patients. Methods: 143 psychotic patients with AH were included: 87 with persistent AH and 56 with acute AH. All patients were assessed with the Psychotic Symptom Rating Scale (PSY RATS) for auditory hallucinations (Haddock et al, 1999). A cluster analysis considering the different dimensions of verbal hallucinations was carried out. Results: Cluster analysis discriminate four different groups attending to two main dimensio ns: the first group of patients (N = 81) showed high severity of AH and high anxiety; the second one (N = 23) showed low severity of AH and low anxiety. The third one (N = 23), high severity of AH but low anxiety. The last one (N = 16), patients wit h low severity of AH and high anxiety. Conclusions: Severity of hallucinations and anxiety response are crucial for discriminating homogeneous groups of patients. These two dimensions have relevant implication in treatment as well as in the under standing of the neurobiological basis of AH. References [1] Rosenthal, D. and Quinn, O.W. (1977). Quadruplet hallucinations. Phenotipic variations of a schizophrenic genotype. Archives of General Psychiatry, 34, 817-827. [2] Sanjuan, J. (2006). The aetiopathogenesis of auditory hallucinations in psychosis. Revista Ne urologia, 43 (5), 280-286. [3] Haddock, G., McCarron, J., Tarrier, N., Faragher, E.B. (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine, 29, 879-889.