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Poster #191 TEMPERAMENT AND CHARACTER DIMENSIONS IN ULTRA-HIGH RISK FOR PSYCHOSIS AND FIRST-EPISODE SCHIZOPHRENIA
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
S349
Poster #190 AUDITORY VERBAL HALLUCINATIONS IN PATIENTS WITH BORDERLINE PERSONALITY DISORDER ARE SIMILAR TO THOSE IN SCHIZOPHRENIA
Poster #192 FROM INTRUSIONS TO OBSESSIONS TO PSYCHOSIS. MEDIATED BY DELUSIONS?
Christina W. Slotema 1 , Kirstin Daalman 2 , Jan Dirk Blom 1,3 , Kelly M. Diederen 2 , Hans W. Hoek 1,3,4 , Iris E. Sommer 2 1 Parnassia Bavo Psychiatric Institute, The Hague, Netherlands; 2 Rudolf Magnus Institute for Neurosscience, University Medical Centre, Utrecht, Netherlands; 3 University Medical Centre, Groningen, Netherlands; 4 Colombia University, New York, USA
Frank Van Dael 1 , Jim van Os 1,5 , Roselind Lieb 2,3 , Hans-Ulrich Wittchen 2,4 , Inez Myin-Germeys 1 1 Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, Netherlands; 2 Clinical Psychology and Epidemiology Unit, Max Planck Institute of Psychiatry, Munich, Germany; 3 Epidemiology and Health Psychology, Institute of Psychology, University of Basel, Basel, Switzerland; 4 Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany; 5 King’s College London, King’s HealthPartners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
Background: Auditory verbal hallucinations (AVH) in patients with borderline personality disorder (BPD) are frequently claimed to be brief, less severe and qualitatively different from those in schizophrenia, hence the term “pseudohallucinations”. In this study the phenomenology of AVH in BPD patients was compared to those in schizophrenia and to AVH experienced by healthy individuals. Methods: In a cross-sectional setting, the phenomenological characteristics of AVH in 38 BPD patients were compared to those in 51 patients with schizophrenia/schizoaffective disorder and to AVH of 66 healthy subjects, using the Psychotic Symptom Rating Scales (PSYRATS). Results: BPD patients experienced AVH for a mean duration of 18 years, with a mean frequency of at least daily during several minutes or more. The ensuing distress was high. No differences in the phenomenological characteristics of AVH were revealed among patients diagnosed with BPD and those with schizophrenia/schizoaffective disorder, except for “disruption of life”, which was higher in the latter group. Compared to healthy subjects experiencing AVH, BPD patients had higher scores on almost all items. Discussion: AVH in BPD patients are phenomenologically similar to those in schizophrenia, and different from those in healthy individuals. As AVH in patients with BPD fulfil the criteria of hallucinations proper, we prefer the term AVH over “pseudohallucinations”, so as to prevent trivialization and to promote adequate diagnosis and treatment.
Poster #191 TEMPERAMENT AND CHARACTER DIMENSIONS IN ULTRA-HIGH RISK FOR PSYCHOSIS AND FIRST-EPISODE SCHIZOPHRENIA Yun Young Song 1,2 , Jee In Kang 1,2 , Su Young Lee 2,3 , Eun Lee 1,2 , Suk Kyoon An 1,2 , Jun Soo Kwon 4 1 Department of Psychiatry, Yonsei University College of Medicine Seoul, Seoul, South Korea; 2 Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine Seoul, Seoul, South Korea; 3 Department of Psychiatry, Cheil General Hospital & Women’s Healthcare Center, Kwandong University College of Medicine Seoul, Seoul, South Korea; 4 Department of Psychiatry, Seoul National University College of Medicine Seoul, Seoul, South Korea Background: Schizophrenia patients and their first-degree relatives were reported to show different personality profiles, especially harm avoidance from general populations. However, it is not well understood that these different profiles of temperament and character dimensions may have been already emerged in people at putative prodromal, ultra-high risk for psychosis. Methods: Ultra-high risk people (n=40), first-episode schizophrenia patients (n=26), and normal controls (n=91) were recruited. The personality profiles were assessed by using the Temperament and Character Inventory (TCI). Scales of the psychopathologies were conducted. Results: First-episode schizophrenia patients and ultra-high risk people showed higher harm avoidance and lower reward dependence, persistence and self-directedness than normal controls. Ultra-high risk people had lower cooperativeness than normal controls and lower self-directedness than first-episode patients. Some personality dimensions were found to be correlated with psychopathologies of positive and negative symptoms, which correlations were similar in ultra-high risk group and first-episode schizophrenia group. Discussion: These findings suggest that personality profiles including higher harm avoidance temperament may be a trait-like vulnerability factor of schizophrenia.
Background: There is a substantial comorbidity between psychotic disorder and obsessive-compulsive disorder (OCD), but little is known about the extended phenotypes impact on each other over time. Obsessions may originate from intrusive thoughts that are perceived as unwanted or unacceptable [1]. A particular metacognitive style may lead to increase of personal significance and anticipated negative consequence of intrusive thoughts, thereby increasing distress [2-4]. Similarly, hallucinations may result from unwanted or unacceptable intrusive thoughts that are misattributed to an external source [5]. Hallucinations are frequently observed in combination with delusions, possibly because they give rise to aberrant attribution of salience [6]. This mechanism may as well be applicable to intrusive thoughts that have developed to obsessions. Methods: A prospective cohort study was conducted in a general population sample of 3021 adolescents, aged 14–17 years, (EDSP). Expression of psychiatric symptoms was assessed 2 times (T0–T2) over a period of 8.4 years. It is examined whether (1) baseline intrusive thoughts and 2) obsessive symptoms (a next stage on the pathway from intrusive thoughts to OCD) c.q. hallucinations are associated with subsequent psychotic disorder with need for care, and if so, (2) to what extent this association is facilitated by a “delusional” appraisal. First, associations were investigated with regression analyses. Next, the mediating role of T1 incident obsessions, hallucinations and delusions in the association between baseline intrusive thoughts and an outcome of T2 clinical psychosis was examined in mediation analyses. Finally, interaction models were fitted between T0 intrusive thoughts/T1 obsessions/hallucinations and T1 delusional ideations as independent variables and T2 clinical psychosis as dependent variable. All analysis were conducted with exclusion of baseline clinical psychosis and adjustment for baseline delusions. Results: T0 intrusive thoughts were cross-sectionally associated with psychotic symptoms and longitudinally with T2 psychotic symptoms and clinical case of psychosis (with impairment and help-seeking)(OR=2.65; p<0.012; 95% CI: 1.24-5.69). This association was partially mediated (proportion of 0.27) by the development of T1 delusions, but also by incident T1 hallucinations (0.29) and obsessions (0.48). Given the presence of T0 intrusive thoughts, the risk (on an additive scale) for a T2 outcome of clinical psychosis was higher in the group with incident T1 obsessions (risk difference 5.9%; p<0.040). For those with co-occurring T1 delusional ideation, this risk-increasing effect was higher than in those without T1 obsessions (risk difference: 17%, p<0.05). Similarly, given the presence of T0 intrusive thoughts, the presence of T1 hallucinations increased the risk of T2 clinical psychosis (risk difference: 7.3%, p> 0.051), and this increase in risk showed a trend to be higher in those with additional T1 incident delusional ideations (risk difference 12.7%; p<0.68). Discussion: The longitudinal association between intrusive thoughts and later clinical psychosis is in part explained by the intermediate development of obsessions or hallucinations, and delusions. The evidence supports the hypothesis that intrusive thoughts can develop to obsessions as well as to hallucinations, as an intermediate in the pathway to psychosis. Development of superimposed delusional ideations may lead to a deepening psychotic state. These findings are compatible with the concept that OCD and psychosis may originate from a partial common pathway, and therefore show a higher comorbidity than expected by chance.
S349
Poster #190 AUDITORY VERBAL HALLUCINATIONS IN PATIENTS WITH BORDERLINE PERSONALITY DISORDER ARE SIMILAR TO THOSE IN SCHIZOPHRENIA
Poster #192 FROM INTRUSIONS TO OBSESSIONS TO PSYCHOSIS. MEDIATED BY DELUSIONS?
Christina W. Slotema 1 , Kirstin Daalman 2 , Jan Dirk Blom 1,3 , Kelly M. Diederen 2 , Hans W. Hoek 1,3,4 , Iris E. Sommer 2 1 Parnassia Bavo Psychiatric Institute, The Hague, Netherlands; 2 Rudolf Magnus Institute for Neurosscience, University Medical Centre, Utrecht, Netherlands; 3 University Medical Centre, Groningen, Netherlands; 4 Colombia University, New York, USA
Frank Van Dael 1 , Jim van Os 1,5 , Roselind Lieb 2,3 , Hans-Ulrich Wittchen 2,4 , Inez Myin-Germeys 1 1 Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, Netherlands; 2 Clinical Psychology and Epidemiology Unit, Max Planck Institute of Psychiatry, Munich, Germany; 3 Epidemiology and Health Psychology, Institute of Psychology, University of Basel, Basel, Switzerland; 4 Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany; 5 King’s College London, King’s HealthPartners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
Background: Auditory verbal hallucinations (AVH) in patients with borderline personality disorder (BPD) are frequently claimed to be brief, less severe and qualitatively different from those in schizophrenia, hence the term “pseudohallucinations”. In this study the phenomenology of AVH in BPD patients was compared to those in schizophrenia and to AVH experienced by healthy individuals. Methods: In a cross-sectional setting, the phenomenological characteristics of AVH in 38 BPD patients were compared to those in 51 patients with schizophrenia/schizoaffective disorder and to AVH of 66 healthy subjects, using the Psychotic Symptom Rating Scales (PSYRATS). Results: BPD patients experienced AVH for a mean duration of 18 years, with a mean frequency of at least daily during several minutes or more. The ensuing distress was high. No differences in the phenomenological characteristics of AVH were revealed among patients diagnosed with BPD and those with schizophrenia/schizoaffective disorder, except for “disruption of life”, which was higher in the latter group. Compared to healthy subjects experiencing AVH, BPD patients had higher scores on almost all items. Discussion: AVH in BPD patients are phenomenologically similar to those in schizophrenia, and different from those in healthy individuals. As AVH in patients with BPD fulfil the criteria of hallucinations proper, we prefer the term AVH over “pseudohallucinations”, so as to prevent trivialization and to promote adequate diagnosis and treatment.
Poster #191 TEMPERAMENT AND CHARACTER DIMENSIONS IN ULTRA-HIGH RISK FOR PSYCHOSIS AND FIRST-EPISODE SCHIZOPHRENIA Yun Young Song 1,2 , Jee In Kang 1,2 , Su Young Lee 2,3 , Eun Lee 1,2 , Suk Kyoon An 1,2 , Jun Soo Kwon 4 1 Department of Psychiatry, Yonsei University College of Medicine Seoul, Seoul, South Korea; 2 Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine Seoul, Seoul, South Korea; 3 Department of Psychiatry, Cheil General Hospital & Women’s Healthcare Center, Kwandong University College of Medicine Seoul, Seoul, South Korea; 4 Department of Psychiatry, Seoul National University College of Medicine Seoul, Seoul, South Korea Background: Schizophrenia patients and their first-degree relatives were reported to show different personality profiles, especially harm avoidance from general populations. However, it is not well understood that these different profiles of temperament and character dimensions may have been already emerged in people at putative prodromal, ultra-high risk for psychosis. Methods: Ultra-high risk people (n=40), first-episode schizophrenia patients (n=26), and normal controls (n=91) were recruited. The personality profiles were assessed by using the Temperament and Character Inventory (TCI). Scales of the psychopathologies were conducted. Results: First-episode schizophrenia patients and ultra-high risk people showed higher harm avoidance and lower reward dependence, persistence and self-directedness than normal controls. Ultra-high risk people had lower cooperativeness than normal controls and lower self-directedness than first-episode patients. Some personality dimensions were found to be correlated with psychopathologies of positive and negative symptoms, which correlations were similar in ultra-high risk group and first-episode schizophrenia group. Discussion: These findings suggest that personality profiles including higher harm avoidance temperament may be a trait-like vulnerability factor of schizophrenia.
Background: There is a substantial comorbidity between psychotic disorder and obsessive-compulsive disorder (OCD), but little is known about the extended phenotypes impact on each other over time. Obsessions may originate from intrusive thoughts that are perceived as unwanted or unacceptable [1]. A particular metacognitive style may lead to increase of personal significance and anticipated negative consequence of intrusive thoughts, thereby increasing distress [2-4]. Similarly, hallucinations may result from unwanted or unacceptable intrusive thoughts that are misattributed to an external source [5]. Hallucinations are frequently observed in combination with delusions, possibly because they give rise to aberrant attribution of salience [6]. This mechanism may as well be applicable to intrusive thoughts that have developed to obsessions. Methods: A prospective cohort study was conducted in a general population sample of 3021 adolescents, aged 14–17 years, (EDSP). Expression of psychiatric symptoms was assessed 2 times (T0–T2) over a period of 8.4 years. It is examined whether (1) baseline intrusive thoughts and 2) obsessive symptoms (a next stage on the pathway from intrusive thoughts to OCD) c.q. hallucinations are associated with subsequent psychotic disorder with need for care, and if so, (2) to what extent this association is facilitated by a “delusional” appraisal. First, associations were investigated with regression analyses. Next, the mediating role of T1 incident obsessions, hallucinations and delusions in the association between baseline intrusive thoughts and an outcome of T2 clinical psychosis was examined in mediation analyses. Finally, interaction models were fitted between T0 intrusive thoughts/T1 obsessions/hallucinations and T1 delusional ideations as independent variables and T2 clinical psychosis as dependent variable. All analysis were conducted with exclusion of baseline clinical psychosis and adjustment for baseline delusions. Results: T0 intrusive thoughts were cross-sectionally associated with psychotic symptoms and longitudinally with T2 psychotic symptoms and clinical case of psychosis (with impairment and help-seeking)(OR=2.65; p<0.012; 95% CI: 1.24-5.69). This association was partially mediated (proportion of 0.27) by the development of T1 delusions, but also by incident T1 hallucinations (0.29) and obsessions (0.48). Given the presence of T0 intrusive thoughts, the risk (on an additive scale) for a T2 outcome of clinical psychosis was higher in the group with incident T1 obsessions (risk difference 5.9%; p<0.040). For those with co-occurring T1 delusional ideation, this risk-increasing effect was higher than in those without T1 obsessions (risk difference: 17%, p<0.05). Similarly, given the presence of T0 intrusive thoughts, the presence of T1 hallucinations increased the risk of T2 clinical psychosis (risk difference: 7.3%, p> 0.051), and this increase in risk showed a trend to be higher in those with additional T1 incident delusional ideations (risk difference 12.7%; p<0.68). Discussion: The longitudinal association between intrusive thoughts and later clinical psychosis is in part explained by the intermediate development of obsessions or hallucinations, and delusions. The evidence supports the hypothesis that intrusive thoughts can develop to obsessions as well as to hallucinations, as an intermediate in the pathway to psychosis. Development of superimposed delusional ideations may lead to a deepening psychotic state. These findings are compatible with the concept that OCD and psychosis may originate from a partial common pathway, and therefore show a higher comorbidity than expected by chance.