- Email: [email protected]
Poster #82 COMPARISON OF EARLY EPISODE AND CHRONIC PATIENTS DIAGNOSED WITH SCHIZOPHRENIA: SYMPTOMS AND CHILDHOOD TRAUMA
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
investigating associative learning, spatial memory, perception and social functioning. A subset of participants underwent neuroimaging and provided blood samples for DNA and other forms of biomarker evaluation at regular intervals. Results: To date, 113 CAARMS positive participants and 480 CAARMS negative controls were recruited into LYRIKS. In the CAARMS positive sample, the mean age was 21.3 years (SD 3.6), and the ethnic distribution was 70% Chinese, 18% Malays and 8% Indians. There were no significant differences in age and ethnic distribution between the CAARMS positive and negative groups. There was a significantly lower level of education, and higher proportion of Axis I disorders in the CAARMS positive group. 4 CAARMS positive participants developed psychosis at 6 months, and 7 converted at 12 months. Preliminary analysis of baseline data collected from 75 CAARMS positive and 463 CAARMS negative participants in the ongoing study revealed a significantly lower performance of the former group in the domains of short-term verbal learning and working memory, semantic fluency, motor and processing speed. Social competence, stereo-acuity, sustained attention, spatial memory and associative learning skills were also significantly lower in the CAARMS positive participants. Discussion: Our findings from an Asian sample demonstrated that significant neurocognitive deficits exist in CAARMS positive participants. Additional analyses will examine the changes in neurocognitive functioning over time and its ability in predicting development of psychosis.
Poster #80 FAMILIAL AND GENETIC FACTORS IN THE COURSE AND TRAJECTORIES OF SERIOUS MENTAL ILLNESS: A NATIONAL POPULATION-BASED TWIN STUDY Stephen Z. Levine 1 , Rinat Yoffe 2 , Inna Pugachova 2 , Avi Reichenberg 3 1 Department of Community Mental Health, University of Haifa, Haifa, Israel; 2 Ministry of Health, Jerusalem, Israel; 3 Institute of Psychiatry, London, United Kingdom Background: Understanding etiological factors contributing to the course of psychotic disorders has important clinical implications. Both genetic and environmental factors have been implicated, and have not been systematically examined. This study aims to examine the role of genetic and environmental factors in the course of psychotic disorders using a population based study design. Methods: The study population consisted of all twins in the Israeli National Psychiatric Case Registry hospitalized at any in-patient psychiatric facility with a last discharge diagnosis of a psychotic disorder. Twin (N=232) were born between 1900 and 1993 and hospitalized from 1964 to 2001. Variance in the course was decomposed into genetic and environmental components. Based on the number of hospitalized days at each age, trajectory groups were empirically identified and distinguished by zygosity and diagnostic concordance. Results: Across diagnostic groups there was no evidence for an effect of genetic factors on variance in the course of hospitalization. Shared environmental factors accounted for 41% to 44%, and individual-specific environmental factors accounted for 56% to 59% of the variance in the course of hospitalization. Trajectory analysis identified three course groups. Group I twins (5.2%) were significantly (p<0.05) more likely than the remaining groups to be concordant for schizophrenia (OR=4.79, 95% CIs: 1.02, 22.62). Group II twins (73.3%) were significantly (p<0.05) more likely to have discordant diagnoses and spend less days in hospital over the course of illness. Group III twins (21.6%) were statistically significantly (p<0.05) younger at first psychiatric hospitalization and more diagnostically concordant. Discussion: In twins with psychotic illness followed for up to three decades, the course of illness is predominantly effected by environmental factors, suggesting important opportunities for intervention and modification.
Poster #81 SUBDOMAINS OF NEGATIVE SYMPTOMS IN SCHIZOPHRENIA: A TWOFACTOR MODEL CONFIRMED BY CONFIRMATORY FACTOR ANALYSIS Edith J. Liemburg 1,2 , Stynke Castelein 2,3 , Roy Stewart 4 , Mark van der Gaag 5,6 , André Aleman 1,7 , Group Investigators 8 , Henderikus Knegtering 1,2,3
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1
Department of Neuroscience, University Medical Center Groningen, and BCN Neuroimaging Center, University of Groningen, Groningen, Netherlands; 2 Rob Giel Research Centrum, University Medical Center Groningen, Groningen, Netherlands; 3 Lentis Research, Center for Mental Health, Groningen, Netherlands; 4 Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; 5 Parnassia Psychiatric Institute, The Hague, Netherlands; 6 VU University Amsterdam and EMGO, and Institute of Health and Care Research Amsterdam, Department of Clinical Psychology, Amsterdam, Netherlands; 7 Department of Psychology, University of Groningen, Groningen, Netherlands; 8 Collaborators: René Kahn, MD, PhD, Don Linszen, MD, PhD, Jim van Os, MD, PhD, Durk Wiersma, PhD, Richard Bruggeman, PhD, Wiepke Cahn, PhD, Lieuwe de Haan, MD, PhD, Lydia Krabbendam, PhD, Inez Myin-Germeys, PhD, Groningen, Netherlands Background: Negative symptoms of schizophrenia are normally grouped into a single category. However, the diversity of negative symptoms may suggest that they actually constitute multiple dimensions reflecting different neural, social or psychological backgrounds. Knowledge about symptom structure is important as it may have implications for treatment strategies. This study investigated whether negative symptoms of schizophrenia consist of one or multiple dimensions. Methods: First an exploratory factor analysis was carried out based on interviews with the Positive and Negative Syndrome Scale (PANSS) (n=664). The analysis was restricted to PANSS items that had been described as negative symptoms in previous factor analyses. The acquired symptom structure was subsequently tested for stability by confirmatory factor analysis on PANSS interviews in a separate cohort of 2172 patients. Results: Item selection and exploratory factor analysis resulted in a twofactor structure of negative symptoms. The first factor consisted of PANSS items N1 Flat affect, N3 Poor rapport, N6 Lack of spontaneity, G5 Mannerisms and posturing, G7 Motor retardation and G13 Avolition. The second factor consisted of items N2 Emotional withdrawal, N4 Passive/apathetic social withdrawal and G16 Active social avoidance. Discussion: We interpreted the first factor as being related to “core negative symptoms” of schizophrenia, reflecting loss of initiative. The second factor could be described as a “socio-emotive withdrawal” factor related to interaction with the community. This structure is consistent with earlier findings. The distinction of two negative symptom factors may well be relevant for pathophysiology and treatment, which should be established by future research.
Poster #82 COMPARISON OF EARLY EPISODE AND CHRONIC PATIENTS DIAGNOSED WITH SCHIZOPHRENIA: SYMPTOMS AND CHILDHOOD TRAUMA Wang Zheng 1 , Xuezhi Min 1 , Puwei Dan 1 , Yang Bo 1 , Li Li 1 , Yiwen Ying 1 , Wang Peng 1 , Liu Hang 1 , Wuguo Wei 1 , Liuzhe Ning 1 , Robert A. Rosenheck 2 1 Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; 2 Department of Psychiatry, Yale University, New Haven, Connecticut, United States Background: There has been considerable interest in identifying and addressing the specific needs if early episode patients diagnosed with schizophrenia in the hope that by addressing such needs early, chronic disabilities can be avoided. Methods: This study is based on 699 consecutive inpatients diagnosed with schizophrenia who were admitted to four University hospitals in Changsha, China: 128 early episode (duration of illness less than 18 months) and 571 chronic patients (duration of illness greater than 24 months). Analysis of t test, chi square and logistic regression data are used to compare these groups on socio-demographic characteristics, clinical symptoms, and history of childhood trauma. Symptoms were measured with the Positive and Negative Syndrome Scale (PANSS), and trauma with the short version of the Childhood Trauma Questionnaire (CTQ). Results: Early episode patients scored 9.3% higher than chronic patients on the PANSS positive symptom scale and 16.3% lower on the PANSS negative symptom scale but did not differ on the PANSS total score and the general psychopathology score. More early episode patients reported childhood sexual abuse (27.3% versus 19.8%, chi sq=4.566, df =1, p=0.033), however, fewer early episode patients reported childhood emotional neglect (25.8%
S310
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
versus 37.8%, chi sq=4.566, df =1, p=0.01).Moreover, fewer of their parents were living alone (i.e. without a partner – single, divorced, or widowed) (7.0% versus 16.1%, chi sq=6.975, p=0.008). On multiple logistic regression the parents of early episode patients were less likely to be married (odds ratio 1.3 recalculate for first episode), had higher PANSS positive symptoms scores (odds ratio 0.959 recalculate) and lower PANSS negative symptoms scores (odds ratio 1.504 recalculate), more childhood sexual abuse (odds ratio 0.714 recalculate), and less childhood emotional neglect (odds ratio 1.443 recalculate). Discussion: More positive symptoms, fewer negative symptoms, less isolated parents who may be more supportive, greater risk of childhood sexual abuse, may be distinctive features of early episode schizophrenia and perhaps should be a focus for the development of targeted interventions.
Poster #83 AT-RISK CRITERIA OF PSYCHOSIS AND HELP-SEEKING BEHAVIOUR IN THE GENERAL POPULATION: PRELIMINARY RESULTS FROM A TELEPHONE SURVEY Chantal Michel, Benno G. Schimmelmann, Rebecca Wyler, Frauke Schultze-Lutter University Hospital of Child and Adolescent Psychiatry Bern, Bern, Switzerland Background: An “Attenuated Psychosis Syndrome” has been proposed for inclusion in DSM-5, and help-seeking is discussed as one criterion of it. Although help-seeking itself has been considered an important factor possibly determining the validity of at-risk criteria to a significant extent, its constituting factors have never been studied. The aim of this study was therefore to examine (non-)help-seeking for mental problems including attenuated psychotic symptoms and other at-risk phenomena in the general population. Methods: As of October 2011, 799 (61%) randomly chosen persons of the general population of the Canton Bern between 16 and 40 years of age were contacted by phone. Of these, 236 (29.5%) refused to participate, 28 (3.5%) participated but met exclusion criteria (communication problems, past or present psychosis) and 535 (67.9%) completed the interview. Ultrahigh risk (UHR) criteria were assessed with the Structured Interview for Psychosis-Risk Syndromes (SIPS), basic symptom at-risk criteria with the Schizophrenia Proneness Instrument, Adult version (SPI-A), axis-I disorders with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and helpseeking was assessed with a modified version of the WHO pathway-to-care questionnaire in a telephone interview by trained clinical psychologists. Results: 121 persons (22.6%) reported any life-time help-seeking for mental problems; of these, 49 (9.2%) had also reported symptoms included in the at-risk criteria for first-episode psychosis, irrespective of them fulfilling the respective time and frequency criteria. Average number of contacts reported by these 49 persons was 1.5 (range: 1-5). First contact was mainly made with a psychiatrist/psychologist (44.9%) or a general practitioner (16.3%). 29 (59.2%) persons sought help on their own initiative, in only eight cases (16.3%) help-seeking was mainly suggested by a first-degree relative. Main reasons for seeking help were familial problems (33.3%), depression (31.1%) and anxiety (26.7%). Of the 49 persons with any lifetime at-risk phenomenon, only two named these as the main reason for helpseeking, in both cases these were cognitive basic symptom. One of them initiated help-seeking himself, the other was told to seek help by a teacher. Main reasons for delays in help-seeking for mental problems were hope for spontaneous remission (36.4%), lack of perceived seriousness of symptoms (22.7%) and lack of time (13.6%). Discussion: In line with earlier findings, a large proportion of persons experiencing mental problems do not or only with considerable delay seek help – not least because they do not know if their symptoms require professional help or not. This illustrates the necessity of raising awareness of mental problems and their treatment as well as of encouraging earlier professional help-seeking for diagnostic clarification and prevention of an exacerbation of problems. In terms of at-risk phenomena of psychosis, comorbidity with depression and anxiety are frequent and a main reason for help-seeking. Because basic symptoms are only subjective perceived and not observable, awareness programs for first contact professionals seem reasonable for sensitizing them to ask patients especially about such mental disturbances.
Poster #84 YOUNG PEOPLE AT RISK FOR PSYCHOSIS: CASE FINDING AND SAMPLE CHARACTERISTICS OF THE OULU BRAIN AND MIND STUDY Juha Veijola 1 , Pirjo Maki 1 , Erika Jaaskelainen 1 , Jenni Koivukangas 1 , Irma Moilanen 1 , Anja Taanila 1 , Tanja Nordstrom 1, Tuula Hurtig 1 , Vesa Kiviniemi 1 , Sari Mukkala 1 , Markus Heinimaa 2 , Paivi Lindholm 1 , Peter Jones 3 , Jenny Barnett 3 , Graham Murray 3 , Jouko Miettunen 1 1 University of Oulu, Oulu, Finland; 2 University of Turku, Turku, Finland; 3 University of Cambridge, Cambridge, United Kingdom Background: The Oulu Brain and Mind Study has been designed to follow young individuals at risk for psychosis and to explore the causes and pathogenesis of psychosis. Its setting within the Northern Finland Birth 1986 Birth Cohort allows the study of young people at risk for psychosis due to either a family history of psychosis or due to clinical features. Methods: We used prospectively collected data from earlier follow-ups together with register data. The study groups were individuals with familial risk (FR, N=272), symptomatic risk (SR, N=117), psychosis (N=78), ADHD (N=103), and random sample of controls (N=193). The Structured Interview for Prodromal Syndromes (SIPS) was used to detect symptomatic cases. Additional questionnaires measuring psychosis vulnerability and schizotypal traits were also completed. Results: Twenty-nine participants (10%) were current prodromal cases. Criteria for current prodromal syndrome were fulfilled by 12% of the FR group 12% and 19% of the SR group, compared with 5% of the ADHD group and 4% of controls. Discussion: We were able to detect young people with prodromal syndrome for psychosis in the general population birth cohort. Combining methods drawn from familial, clinical, and psychometric high-risk approaches provides a tractable method for studying risk of psychosis in the general population. Nonetheless, relatively few of these high-risk individuals met criteria for the prodromal syndrome.
Poster #85 TEMPERAMENT IN INDIVIDUALS WITH PSYCHOTIC DISORDERS BEFORE AND AFTER THE ONSET OF ILLNESS Jouko Miettunen 1,2,3 , Pauliina Juola 1 , Eka Roivainen 1,4 , Juha Veijola 1,2 , Antti Alaräisänen 1,2 , Matti Isohanni 1,2 , Erika Jääskeläinen 1,2 1 Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Oulu Province, Finland; 2 Department of Psychiatry, Oulu University Hospital, Oulu, Oulu Province, Finland; 3 Institute of Health Sciences, University of Oulu, Oulu, Oulu Province, Finland; 4 Cognitive Neuropsychology Laboratory, Verve Research, Oulu, Oulu Province, Finland Background: The Temperament and Character Inventory (TCI) is used to measure novelty seeking (NS), harm avoidance (HA), reward dependence RD), and persistence (P). There are not many longitudinal studies of temperament among individuals with psychosis. We were able to study the stability of temperament in individuals with psychotic disorders (with onset of illness before and after first follow-up) and in healthy controls. Methods: As part of the 31-year follow-up survey of the prospective population based Northern Finland 1966 Birth Cohort, the TCI was filled by a large sample of individuals. A subsample of psychotic individuals, with the onset of illness before (n=16) or after (n=15) the 31-year follow-up, and healthy controls (n=117) filled in these scales again at the age of 43. We studied also the association between psychotic symptoms (measured with Positive and Negative Syndrome Scale, PANSS) and temperament (at 31 and 43 years). Results: The 31-year and 43-year temperament scores correlated strongly among controls (Pearson’s r: NS 0.68, HA 0.60, RD 0.56, P 0.54), whereas correlations among psychotic individuals with the onset of psychosis before first follow-up were weaker (NS 0.38, HA 0.50, RD 0.17, P 0.53). Individuals who had their onset of psychosis after the first follow-up had a significant (p=0.02) increase in HA from age 31 to 43-years when compared to controls. High HA before the onset of illness (at age of 31 years) associated significantly with a lower likelihood of remission and with more negative, disorganization and total symptoms in the PANSS. High NS before illness associated with a higher likelihood of remission according to the PANSS. At the age of 43 years, HA correlated highly positively with the
investigating associative learning, spatial memory, perception and social functioning. A subset of participants underwent neuroimaging and provided blood samples for DNA and other forms of biomarker evaluation at regular intervals. Results: To date, 113 CAARMS positive participants and 480 CAARMS negative controls were recruited into LYRIKS. In the CAARMS positive sample, the mean age was 21.3 years (SD 3.6), and the ethnic distribution was 70% Chinese, 18% Malays and 8% Indians. There were no significant differences in age and ethnic distribution between the CAARMS positive and negative groups. There was a significantly lower level of education, and higher proportion of Axis I disorders in the CAARMS positive group. 4 CAARMS positive participants developed psychosis at 6 months, and 7 converted at 12 months. Preliminary analysis of baseline data collected from 75 CAARMS positive and 463 CAARMS negative participants in the ongoing study revealed a significantly lower performance of the former group in the domains of short-term verbal learning and working memory, semantic fluency, motor and processing speed. Social competence, stereo-acuity, sustained attention, spatial memory and associative learning skills were also significantly lower in the CAARMS positive participants. Discussion: Our findings from an Asian sample demonstrated that significant neurocognitive deficits exist in CAARMS positive participants. Additional analyses will examine the changes in neurocognitive functioning over time and its ability in predicting development of psychosis.
Poster #80 FAMILIAL AND GENETIC FACTORS IN THE COURSE AND TRAJECTORIES OF SERIOUS MENTAL ILLNESS: A NATIONAL POPULATION-BASED TWIN STUDY Stephen Z. Levine 1 , Rinat Yoffe 2 , Inna Pugachova 2 , Avi Reichenberg 3 1 Department of Community Mental Health, University of Haifa, Haifa, Israel; 2 Ministry of Health, Jerusalem, Israel; 3 Institute of Psychiatry, London, United Kingdom Background: Understanding etiological factors contributing to the course of psychotic disorders has important clinical implications. Both genetic and environmental factors have been implicated, and have not been systematically examined. This study aims to examine the role of genetic and environmental factors in the course of psychotic disorders using a population based study design. Methods: The study population consisted of all twins in the Israeli National Psychiatric Case Registry hospitalized at any in-patient psychiatric facility with a last discharge diagnosis of a psychotic disorder. Twin (N=232) were born between 1900 and 1993 and hospitalized from 1964 to 2001. Variance in the course was decomposed into genetic and environmental components. Based on the number of hospitalized days at each age, trajectory groups were empirically identified and distinguished by zygosity and diagnostic concordance. Results: Across diagnostic groups there was no evidence for an effect of genetic factors on variance in the course of hospitalization. Shared environmental factors accounted for 41% to 44%, and individual-specific environmental factors accounted for 56% to 59% of the variance in the course of hospitalization. Trajectory analysis identified three course groups. Group I twins (5.2%) were significantly (p<0.05) more likely than the remaining groups to be concordant for schizophrenia (OR=4.79, 95% CIs: 1.02, 22.62). Group II twins (73.3%) were significantly (p<0.05) more likely to have discordant diagnoses and spend less days in hospital over the course of illness. Group III twins (21.6%) were statistically significantly (p<0.05) younger at first psychiatric hospitalization and more diagnostically concordant. Discussion: In twins with psychotic illness followed for up to three decades, the course of illness is predominantly effected by environmental factors, suggesting important opportunities for intervention and modification.
Poster #81 SUBDOMAINS OF NEGATIVE SYMPTOMS IN SCHIZOPHRENIA: A TWOFACTOR MODEL CONFIRMED BY CONFIRMATORY FACTOR ANALYSIS Edith J. Liemburg 1,2 , Stynke Castelein 2,3 , Roy Stewart 4 , Mark van der Gaag 5,6 , André Aleman 1,7 , Group Investigators 8 , Henderikus Knegtering 1,2,3
S309
1
Department of Neuroscience, University Medical Center Groningen, and BCN Neuroimaging Center, University of Groningen, Groningen, Netherlands; 2 Rob Giel Research Centrum, University Medical Center Groningen, Groningen, Netherlands; 3 Lentis Research, Center for Mental Health, Groningen, Netherlands; 4 Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; 5 Parnassia Psychiatric Institute, The Hague, Netherlands; 6 VU University Amsterdam and EMGO, and Institute of Health and Care Research Amsterdam, Department of Clinical Psychology, Amsterdam, Netherlands; 7 Department of Psychology, University of Groningen, Groningen, Netherlands; 8 Collaborators: René Kahn, MD, PhD, Don Linszen, MD, PhD, Jim van Os, MD, PhD, Durk Wiersma, PhD, Richard Bruggeman, PhD, Wiepke Cahn, PhD, Lieuwe de Haan, MD, PhD, Lydia Krabbendam, PhD, Inez Myin-Germeys, PhD, Groningen, Netherlands Background: Negative symptoms of schizophrenia are normally grouped into a single category. However, the diversity of negative symptoms may suggest that they actually constitute multiple dimensions reflecting different neural, social or psychological backgrounds. Knowledge about symptom structure is important as it may have implications for treatment strategies. This study investigated whether negative symptoms of schizophrenia consist of one or multiple dimensions. Methods: First an exploratory factor analysis was carried out based on interviews with the Positive and Negative Syndrome Scale (PANSS) (n=664). The analysis was restricted to PANSS items that had been described as negative symptoms in previous factor analyses. The acquired symptom structure was subsequently tested for stability by confirmatory factor analysis on PANSS interviews in a separate cohort of 2172 patients. Results: Item selection and exploratory factor analysis resulted in a twofactor structure of negative symptoms. The first factor consisted of PANSS items N1 Flat affect, N3 Poor rapport, N6 Lack of spontaneity, G5 Mannerisms and posturing, G7 Motor retardation and G13 Avolition. The second factor consisted of items N2 Emotional withdrawal, N4 Passive/apathetic social withdrawal and G16 Active social avoidance. Discussion: We interpreted the first factor as being related to “core negative symptoms” of schizophrenia, reflecting loss of initiative. The second factor could be described as a “socio-emotive withdrawal” factor related to interaction with the community. This structure is consistent with earlier findings. The distinction of two negative symptom factors may well be relevant for pathophysiology and treatment, which should be established by future research.
Poster #82 COMPARISON OF EARLY EPISODE AND CHRONIC PATIENTS DIAGNOSED WITH SCHIZOPHRENIA: SYMPTOMS AND CHILDHOOD TRAUMA Wang Zheng 1 , Xuezhi Min 1 , Puwei Dan 1 , Yang Bo 1 , Li Li 1 , Yiwen Ying 1 , Wang Peng 1 , Liu Hang 1 , Wuguo Wei 1 , Liuzhe Ning 1 , Robert A. Rosenheck 2 1 Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; 2 Department of Psychiatry, Yale University, New Haven, Connecticut, United States Background: There has been considerable interest in identifying and addressing the specific needs if early episode patients diagnosed with schizophrenia in the hope that by addressing such needs early, chronic disabilities can be avoided. Methods: This study is based on 699 consecutive inpatients diagnosed with schizophrenia who were admitted to four University hospitals in Changsha, China: 128 early episode (duration of illness less than 18 months) and 571 chronic patients (duration of illness greater than 24 months). Analysis of t test, chi square and logistic regression data are used to compare these groups on socio-demographic characteristics, clinical symptoms, and history of childhood trauma. Symptoms were measured with the Positive and Negative Syndrome Scale (PANSS), and trauma with the short version of the Childhood Trauma Questionnaire (CTQ). Results: Early episode patients scored 9.3% higher than chronic patients on the PANSS positive symptom scale and 16.3% lower on the PANSS negative symptom scale but did not differ on the PANSS total score and the general psychopathology score. More early episode patients reported childhood sexual abuse (27.3% versus 19.8%, chi sq=4.566, df =1, p=0.033), however, fewer early episode patients reported childhood emotional neglect (25.8%
S310
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
versus 37.8%, chi sq=4.566, df =1, p=0.01).Moreover, fewer of their parents were living alone (i.e. without a partner – single, divorced, or widowed) (7.0% versus 16.1%, chi sq=6.975, p=0.008). On multiple logistic regression the parents of early episode patients were less likely to be married (odds ratio 1.3 recalculate for first episode), had higher PANSS positive symptoms scores (odds ratio 0.959 recalculate) and lower PANSS negative symptoms scores (odds ratio 1.504 recalculate), more childhood sexual abuse (odds ratio 0.714 recalculate), and less childhood emotional neglect (odds ratio 1.443 recalculate). Discussion: More positive symptoms, fewer negative symptoms, less isolated parents who may be more supportive, greater risk of childhood sexual abuse, may be distinctive features of early episode schizophrenia and perhaps should be a focus for the development of targeted interventions.
Poster #83 AT-RISK CRITERIA OF PSYCHOSIS AND HELP-SEEKING BEHAVIOUR IN THE GENERAL POPULATION: PRELIMINARY RESULTS FROM A TELEPHONE SURVEY Chantal Michel, Benno G. Schimmelmann, Rebecca Wyler, Frauke Schultze-Lutter University Hospital of Child and Adolescent Psychiatry Bern, Bern, Switzerland Background: An “Attenuated Psychosis Syndrome” has been proposed for inclusion in DSM-5, and help-seeking is discussed as one criterion of it. Although help-seeking itself has been considered an important factor possibly determining the validity of at-risk criteria to a significant extent, its constituting factors have never been studied. The aim of this study was therefore to examine (non-)help-seeking for mental problems including attenuated psychotic symptoms and other at-risk phenomena in the general population. Methods: As of October 2011, 799 (61%) randomly chosen persons of the general population of the Canton Bern between 16 and 40 years of age were contacted by phone. Of these, 236 (29.5%) refused to participate, 28 (3.5%) participated but met exclusion criteria (communication problems, past or present psychosis) and 535 (67.9%) completed the interview. Ultrahigh risk (UHR) criteria were assessed with the Structured Interview for Psychosis-Risk Syndromes (SIPS), basic symptom at-risk criteria with the Schizophrenia Proneness Instrument, Adult version (SPI-A), axis-I disorders with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and helpseeking was assessed with a modified version of the WHO pathway-to-care questionnaire in a telephone interview by trained clinical psychologists. Results: 121 persons (22.6%) reported any life-time help-seeking for mental problems; of these, 49 (9.2%) had also reported symptoms included in the at-risk criteria for first-episode psychosis, irrespective of them fulfilling the respective time and frequency criteria. Average number of contacts reported by these 49 persons was 1.5 (range: 1-5). First contact was mainly made with a psychiatrist/psychologist (44.9%) or a general practitioner (16.3%). 29 (59.2%) persons sought help on their own initiative, in only eight cases (16.3%) help-seeking was mainly suggested by a first-degree relative. Main reasons for seeking help were familial problems (33.3%), depression (31.1%) and anxiety (26.7%). Of the 49 persons with any lifetime at-risk phenomenon, only two named these as the main reason for helpseeking, in both cases these were cognitive basic symptom. One of them initiated help-seeking himself, the other was told to seek help by a teacher. Main reasons for delays in help-seeking for mental problems were hope for spontaneous remission (36.4%), lack of perceived seriousness of symptoms (22.7%) and lack of time (13.6%). Discussion: In line with earlier findings, a large proportion of persons experiencing mental problems do not or only with considerable delay seek help – not least because they do not know if their symptoms require professional help or not. This illustrates the necessity of raising awareness of mental problems and their treatment as well as of encouraging earlier professional help-seeking for diagnostic clarification and prevention of an exacerbation of problems. In terms of at-risk phenomena of psychosis, comorbidity with depression and anxiety are frequent and a main reason for help-seeking. Because basic symptoms are only subjective perceived and not observable, awareness programs for first contact professionals seem reasonable for sensitizing them to ask patients especially about such mental disturbances.
Poster #84 YOUNG PEOPLE AT RISK FOR PSYCHOSIS: CASE FINDING AND SAMPLE CHARACTERISTICS OF THE OULU BRAIN AND MIND STUDY Juha Veijola 1 , Pirjo Maki 1 , Erika Jaaskelainen 1 , Jenni Koivukangas 1 , Irma Moilanen 1 , Anja Taanila 1 , Tanja Nordstrom 1, Tuula Hurtig 1 , Vesa Kiviniemi 1 , Sari Mukkala 1 , Markus Heinimaa 2 , Paivi Lindholm 1 , Peter Jones 3 , Jenny Barnett 3 , Graham Murray 3 , Jouko Miettunen 1 1 University of Oulu, Oulu, Finland; 2 University of Turku, Turku, Finland; 3 University of Cambridge, Cambridge, United Kingdom Background: The Oulu Brain and Mind Study has been designed to follow young individuals at risk for psychosis and to explore the causes and pathogenesis of psychosis. Its setting within the Northern Finland Birth 1986 Birth Cohort allows the study of young people at risk for psychosis due to either a family history of psychosis or due to clinical features. Methods: We used prospectively collected data from earlier follow-ups together with register data. The study groups were individuals with familial risk (FR, N=272), symptomatic risk (SR, N=117), psychosis (N=78), ADHD (N=103), and random sample of controls (N=193). The Structured Interview for Prodromal Syndromes (SIPS) was used to detect symptomatic cases. Additional questionnaires measuring psychosis vulnerability and schizotypal traits were also completed. Results: Twenty-nine participants (10%) were current prodromal cases. Criteria for current prodromal syndrome were fulfilled by 12% of the FR group 12% and 19% of the SR group, compared with 5% of the ADHD group and 4% of controls. Discussion: We were able to detect young people with prodromal syndrome for psychosis in the general population birth cohort. Combining methods drawn from familial, clinical, and psychometric high-risk approaches provides a tractable method for studying risk of psychosis in the general population. Nonetheless, relatively few of these high-risk individuals met criteria for the prodromal syndrome.
Poster #85 TEMPERAMENT IN INDIVIDUALS WITH PSYCHOTIC DISORDERS BEFORE AND AFTER THE ONSET OF ILLNESS Jouko Miettunen 1,2,3 , Pauliina Juola 1 , Eka Roivainen 1,4 , Juha Veijola 1,2 , Antti Alaräisänen 1,2 , Matti Isohanni 1,2 , Erika Jääskeläinen 1,2 1 Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Oulu Province, Finland; 2 Department of Psychiatry, Oulu University Hospital, Oulu, Oulu Province, Finland; 3 Institute of Health Sciences, University of Oulu, Oulu, Oulu Province, Finland; 4 Cognitive Neuropsychology Laboratory, Verve Research, Oulu, Oulu Province, Finland Background: The Temperament and Character Inventory (TCI) is used to measure novelty seeking (NS), harm avoidance (HA), reward dependence RD), and persistence (P). There are not many longitudinal studies of temperament among individuals with psychosis. We were able to study the stability of temperament in individuals with psychotic disorders (with onset of illness before and after first follow-up) and in healthy controls. Methods: As part of the 31-year follow-up survey of the prospective population based Northern Finland 1966 Birth Cohort, the TCI was filled by a large sample of individuals. A subsample of psychotic individuals, with the onset of illness before (n=16) or after (n=15) the 31-year follow-up, and healthy controls (n=117) filled in these scales again at the age of 43. We studied also the association between psychotic symptoms (measured with Positive and Negative Syndrome Scale, PANSS) and temperament (at 31 and 43 years). Results: The 31-year and 43-year temperament scores correlated strongly among controls (Pearson’s r: NS 0.68, HA 0.60, RD 0.56, P 0.54), whereas correlations among psychotic individuals with the onset of psychosis before first follow-up were weaker (NS 0.38, HA 0.50, RD 0.17, P 0.53). Individuals who had their onset of psychosis after the first follow-up had a significant (p=0.02) increase in HA from age 31 to 43-years when compared to controls. High HA before the onset of illness (at age of 31 years) associated significantly with a lower likelihood of remission and with more negative, disorganization and total symptoms in the PANSS. High NS before illness associated with a higher likelihood of remission according to the PANSS. At the age of 43 years, HA correlated highly positively with the