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PERSONALITY IN THE SPECTRUM: THE ELUSIVE FACE OF VULNERABILITY
Abstracts
description. The present review focuses on studies featuring neurobiological, neuropsychological and phenomenological paradigms on the nature of these phenomena once postulated to be pathognomonic for schizophrenia. Methods: We conducted a semi-structured literature review. 374 references were obtained using the key words "ego disorder/ (psycho)pathology", "thought insertion", "alien control", "passivity symptoms/phenomena/experiences", "first rank symptoms", "schneiderian" and "self disorders". We distinguished two major fields of research: (1) fundamental research including neurobiological and neuropsychological studies based on phenomenological or neurocognitive paradigms; (2) studies on diagnosis and nosology, outcome and prognostic value (reviewed in a different paper). Results: Neurocognitive models postulating defects in self-monitoring, metarepresentation and sense of agency have been partly validated by neuropsychological experiments. Neuroimaging studies based on said models have identified the inferior parietal lobule (IPL) and the dorsolateral prefrontal cortex (DLPFC) as potential areas of interest for the emergence of self-disorders. Phenomenological paradigms, examining the structure of the patients' subjective experience, describe basic defects such as hyperreflexivity, distrurbed ipseity or the loss of natural self-evidence. They have produced valid assessment instruments and a foundation for further clinical research. Discussion: Although they do not contradict each other, phenomenological and neurocognitive paradigms have not been integrated in clinical research on the nature of self-disorders. Since selfdisorders remain ill-defined and inconsistently included into diagnostic criteria, clinical studies are limited through issues of patient selection and symptom assessment, perhaps therefore producing inconsistent results. The present review stresses the importance of a sound psychopathological foundation of neuroimaging and neurocognitive studies.
doi:10.1016/j.schres.2010.02.772
Poster 12 PERSONALITY IN THE SPECTRUM: THE ELUSIVE FACE OF VULNERABILITY Andrea Raballo1,2,3, Josef Parnas1,2 1 Danish National Research Foundation: Center for Subjectivity Research Copenhagen, HS, Denmark; 2Department of Psychiatry, Psychiatric Center Hvidovre Copenhagen, HS, Denmark; 3Department of Mental Health, Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, ER, Italy Background: Despite the profusion of candidate phenotypes, the delineation of informative Schizophrenia Spectrum vulnerability traits is still a vexing issue. Indeed, model based on the analysis of extreme clinical conditions (such as schizophrenia or psychotic disorders) might overlook those traits that are more likely to be associated with the familial transmission of the liability to the disorder. In this respect, exploring the distribution of candidate traits among unaffected subjects sourced from genetically high risk populations could be a rational and parsimonious screening strategy. Methods: We extracted a sample 247 genetically high risk subjects (i.e. members of six extended multiplex families, previously assessed during the Copenhagen Schizophrenia Linkage Study). Participants were categorised in three groups: Schizophrenia Spectrum Personality Disorders (SSPD), Other Personality Disorders (OPD) and No detectable Personality Disorder (NPD). Psychopathological assessment included subclinical positive symptoms (PS), formal
421
thought disorder (FTD), negative symptoms (NS) as well as personality features (paranoid-obsessive (PO) and impulsive-dramatic (ID) dimensions) and neurocognitive vulnerability (via Continuous Performance Test, CPT). We evaluate the trait distribution and the classificatory power with respect to the experimental subgroups. Results: The expected quantitative pattern, SSPD > OPD > NPD, was confirmed for negative symptoms and paranoid-obsessive features. Subclinical positive symptoms and formal thought disorder followed the pattern SSPD > OPD, NPD, whereas impulsive-dramatic features resulted SSPD, OPD > NPD. CPT was not significantly different across the subgroups. The multivariate model revealed an overall good classificatory power (77.2%). Discussion: A combined, multidimensional phenotype, including subclinical psychopathology (positive, negative and formal thought disorder) and personality features (paranoid-obsessive and impulsive-dramatic) is a promising platform to characterise the unexpressed genetic vulnerability to schizophrenia.
doi:10.1016/j.schres.2010.02.773
Poster 13 FIRST RANK SYMPTOMS IN FIRST EPISODE PSYCHOSIS AND THEIR RELATIONSHIP TO THE DURATION OF UNTREATED ILLNESS Nicolas M. Ramperti1, Mansoor Anwar1, Niall Turner1, Sharon Foley1, Stephen McWilliams1, Deirdre Jackson1, Laoise Renwick1, Caragh Behan1, Marie Sutton1, Niall Turner1, Anthony Kinsella1, Eadbhard O'Callaghan1,2 1 DETECT Dublin, Co Dublin, Ireland; 2University College Dublin, Belfield, Dublin 4, Ireland Background: First Rank Symptoms (FRS) are integral to the diagnosis of schizophrenia in both DSM-IV and ICD-10, yet, most studies of FRS are based on cross-sectional inpatient samples at various stages of illness. We sought to examine the prevalence of FRS in a representative sample of all first episode psychotic (FEP) patients from a defined geographical region and determine if those with a prolonged duration of untreated illness were more likely to exhibit FRS at first presentation. Methods: Over 3 years we examined all people from a defined geographical region with a suspected psychosis using the SCID-IV and the Schedule for Assessment of Positive Symptoms (SAPS) to determine FRS. We derived the DUP and DUI from the Beiser Scale. Results: The overall prevalence of FRS among the entire group was 52.5%, with the highest rate among those with schizophrenia (69%) and the lowest among those with a Major Depressive Disorder (29.4). "Thought Broadcasting" was the only FRS that occurred more commonly (p = 0.03) among those with schizophrenia compared to other non-affective psychoses. "Voices Commenting" was the only FRS symptom associated (p= 0.04) with non-affective psychotic disorders. There was no significant relationship between the duration of untreated illness or duration of untreated psychosis and FRS. Discussion: First rank symptoms are common across all psychotic disorders in both the inpatient and outpatient settings. Thought broadcasting and voices commenting appear to have the most clinical relevance in terms of diagnosis. FRS do not seem to be the end stage of a progressive deterioration of psychotic illness.
doi:10.1016/j.schres.2010.02.774
description. The present review focuses on studies featuring neurobiological, neuropsychological and phenomenological paradigms on the nature of these phenomena once postulated to be pathognomonic for schizophrenia. Methods: We conducted a semi-structured literature review. 374 references were obtained using the key words "ego disorder/ (psycho)pathology", "thought insertion", "alien control", "passivity symptoms/phenomena/experiences", "first rank symptoms", "schneiderian" and "self disorders". We distinguished two major fields of research: (1) fundamental research including neurobiological and neuropsychological studies based on phenomenological or neurocognitive paradigms; (2) studies on diagnosis and nosology, outcome and prognostic value (reviewed in a different paper). Results: Neurocognitive models postulating defects in self-monitoring, metarepresentation and sense of agency have been partly validated by neuropsychological experiments. Neuroimaging studies based on said models have identified the inferior parietal lobule (IPL) and the dorsolateral prefrontal cortex (DLPFC) as potential areas of interest for the emergence of self-disorders. Phenomenological paradigms, examining the structure of the patients' subjective experience, describe basic defects such as hyperreflexivity, distrurbed ipseity or the loss of natural self-evidence. They have produced valid assessment instruments and a foundation for further clinical research. Discussion: Although they do not contradict each other, phenomenological and neurocognitive paradigms have not been integrated in clinical research on the nature of self-disorders. Since selfdisorders remain ill-defined and inconsistently included into diagnostic criteria, clinical studies are limited through issues of patient selection and symptom assessment, perhaps therefore producing inconsistent results. The present review stresses the importance of a sound psychopathological foundation of neuroimaging and neurocognitive studies.
doi:10.1016/j.schres.2010.02.772
Poster 12 PERSONALITY IN THE SPECTRUM: THE ELUSIVE FACE OF VULNERABILITY Andrea Raballo1,2,3, Josef Parnas1,2 1 Danish National Research Foundation: Center for Subjectivity Research Copenhagen, HS, Denmark; 2Department of Psychiatry, Psychiatric Center Hvidovre Copenhagen, HS, Denmark; 3Department of Mental Health, Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, ER, Italy Background: Despite the profusion of candidate phenotypes, the delineation of informative Schizophrenia Spectrum vulnerability traits is still a vexing issue. Indeed, model based on the analysis of extreme clinical conditions (such as schizophrenia or psychotic disorders) might overlook those traits that are more likely to be associated with the familial transmission of the liability to the disorder. In this respect, exploring the distribution of candidate traits among unaffected subjects sourced from genetically high risk populations could be a rational and parsimonious screening strategy. Methods: We extracted a sample 247 genetically high risk subjects (i.e. members of six extended multiplex families, previously assessed during the Copenhagen Schizophrenia Linkage Study). Participants were categorised in three groups: Schizophrenia Spectrum Personality Disorders (SSPD), Other Personality Disorders (OPD) and No detectable Personality Disorder (NPD). Psychopathological assessment included subclinical positive symptoms (PS), formal
421
thought disorder (FTD), negative symptoms (NS) as well as personality features (paranoid-obsessive (PO) and impulsive-dramatic (ID) dimensions) and neurocognitive vulnerability (via Continuous Performance Test, CPT). We evaluate the trait distribution and the classificatory power with respect to the experimental subgroups. Results: The expected quantitative pattern, SSPD > OPD > NPD, was confirmed for negative symptoms and paranoid-obsessive features. Subclinical positive symptoms and formal thought disorder followed the pattern SSPD > OPD, NPD, whereas impulsive-dramatic features resulted SSPD, OPD > NPD. CPT was not significantly different across the subgroups. The multivariate model revealed an overall good classificatory power (77.2%). Discussion: A combined, multidimensional phenotype, including subclinical psychopathology (positive, negative and formal thought disorder) and personality features (paranoid-obsessive and impulsive-dramatic) is a promising platform to characterise the unexpressed genetic vulnerability to schizophrenia.
doi:10.1016/j.schres.2010.02.773
Poster 13 FIRST RANK SYMPTOMS IN FIRST EPISODE PSYCHOSIS AND THEIR RELATIONSHIP TO THE DURATION OF UNTREATED ILLNESS Nicolas M. Ramperti1, Mansoor Anwar1, Niall Turner1, Sharon Foley1, Stephen McWilliams1, Deirdre Jackson1, Laoise Renwick1, Caragh Behan1, Marie Sutton1, Niall Turner1, Anthony Kinsella1, Eadbhard O'Callaghan1,2 1 DETECT Dublin, Co Dublin, Ireland; 2University College Dublin, Belfield, Dublin 4, Ireland Background: First Rank Symptoms (FRS) are integral to the diagnosis of schizophrenia in both DSM-IV and ICD-10, yet, most studies of FRS are based on cross-sectional inpatient samples at various stages of illness. We sought to examine the prevalence of FRS in a representative sample of all first episode psychotic (FEP) patients from a defined geographical region and determine if those with a prolonged duration of untreated illness were more likely to exhibit FRS at first presentation. Methods: Over 3 years we examined all people from a defined geographical region with a suspected psychosis using the SCID-IV and the Schedule for Assessment of Positive Symptoms (SAPS) to determine FRS. We derived the DUP and DUI from the Beiser Scale. Results: The overall prevalence of FRS among the entire group was 52.5%, with the highest rate among those with schizophrenia (69%) and the lowest among those with a Major Depressive Disorder (29.4). "Thought Broadcasting" was the only FRS that occurred more commonly (p = 0.03) among those with schizophrenia compared to other non-affective psychoses. "Voices Commenting" was the only FRS symptom associated (p= 0.04) with non-affective psychotic disorders. There was no significant relationship between the duration of untreated illness or duration of untreated psychosis and FRS. Discussion: First rank symptoms are common across all psychotic disorders in both the inpatient and outpatient settings. Thought broadcasting and voices commenting appear to have the most clinical relevance in terms of diagnosis. FRS do not seem to be the end stage of a progressive deterioration of psychotic illness.
doi:10.1016/j.schres.2010.02.774