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Poster #T240 CAN CHILDHOOD ADVERSITY PREDICT ONSET AND CLINICAL OUTCOMES OF PSYCHOTIC DISORDERS?
S374
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
Poster #T238 RELATION BETWEEN PSYCHOTIC-LIKE EXPERIENCES AND MAJOR DEPRESSION IN THE COMMUNITY BASED SAMPLE Ahmet Topuzo˘glu 1 , Tolga Binbay 2 , Hayriye Elbi 3 , Nesli Za˘glı 3 , Huseyin Onay 3 , Feristah ¸ Ferda Özkınay 3 , Jim van Os 4 , Köksal Alptekin 1 1 Dokuz Eylul University School of Medicine, Department of Psychiatry; 2 Dokuz Eylul University Medical Faculty; 3 Ege University Medical Faculty; 4 Psychosis Research Maastricht University Background: Psychotic-like experiences (PLEs) increase the risk of schizophrenia and other psychotic disorders in the community. There may be a relation between some PLEs and depression which may increase risk for developing both depression and psychosis. The aim of this study was to determine the prevalence of PLEs in a community based sample and to investigate whether any PLEs are associated with the depression diagnosis. Methods: Addresses were contacted in a multistage clustered area probability sampling frame of administrative neighborhoods and households, covering 9 districts and 302 neighborhoods in the Izmir metropolitan area between November 2007 and October 2008. One household member aged between 15 and 64 years and available to complete the interview was randomly selected using a within-household sampling method. 4011 (female: 57.3%) respondents were successfully interviewed with a response rate of 75.8%. The primary screening instrument was the Composite International Diagnostic Interview (CIDI) 2.1. The prevalence of MDD was based on diagnosed depression by physician, psychotic like experiences responses to systematic screening questions of the relevant questions (CIDI 2.1, G_16; assessment delusional PLE, G_23; assessment hallucinational PLE). Results: The prevalence of diagnosed MDD was 11.9%. Delutional and hallucinational PLEs prevalences were 20.2% and 11.9% respectively. Delutional PLEs and hallucinational PLEs associated with major depression respectively OR: 3.7 (95% C.I; 3.1-4.4) and OR:5,5 (95% C.I;4.5-6.8). Discussion: Delutional and hallucinational PLEs were strongly related to depression in the community sample. Both PLEs and depression in the community sample may play an important role in developing psychosis and probably depression.
Poster #T239 DIMENSIONAL EXPLORATION OF PERSONALITY DISORDERS IN SCHIZOPHRENIC PATIENTS AND THEIR FIRST-DEGREE RELATIVES USING THE SHEDLER-WESTEN ASSESSMENT PROCEDURE Maria Chiara Torti, Antonino Buzzanca, Fabio Di Fabio, Marianna Frascarelli, Alessia Mirigliani, Chiara Squarcione, Massimo Biondi Neurology and Psychiatry Department, Sapienza University of Rome Background: Epidemiological studies have shown that Cluster A, Avoidant, Dependent and Borderline Personality Disorders are associated with schizophrenia and psychotic episodes. In light of these data, it becomes important to identify maladaptive personality traits of psychotic patients and their relatives to detect the predisposing and protective factors.This study examined personality dimensions and identified personality subtypes of adults with DSM IV schizophrenia and their first-degree relatives. Previous work evaluating schizotypy in siblings of schizophrenic patients suggests that the Shedler-Westen Assessment Procedure (SWAP-200) is a useful diagnostic instrument not only to detect schizotypal traits but also for a global evaluation of the personality profiles. Methods: Trained and clinically experienced interviewers provided data on a sample of 144 subjects including 59 schizophrenic patients, 43 firstdegree relatives (parents and siblings) of these patients and 42 age-matched healthy controls. To verify the hypothesis of the difference between the profiles of the Personality Disorders we used two MANOVA (for Personality Disorders [PD T] and for Q Factors [Q T] scales) and subsequent planned comparisons for the three groups. Results: MANOVA are statistically significant (PD T Wilk’s Lambda(11, 131) <0.001; Q T Wilk’s Lambda(12, 130) <0.001 p<0.001). The multivariate tests of the planned comparisons are statistically significant for PD T scales (Patients vs Relatives, Wilk’s Lambda(11, 131) = 0.304 p<0.001; Patients vs Controls, Wilk’s Lambda(11, 131) = 0.253 p<0.001; Relatives vs Controls, Wilk’s Lambda(11, 131) = 0.712 p<0.001), as well as for Q T scales (Patients
vs Relatives, Wilk’s Lambda(12, 130) = 0.297 p<0.001; Patients vs Controls, Wilk’s Lambda(12, 130) = 0.233 p<0.001; Relatives vs Controls, Wilk’s Lambda(12, 130) = 0.652 p<0.001). In the univariate tests, for both the PD T and Q T scores, the three groups showed statistical significant differences not only, as expected, for Cluster A and High Functioning, but also for specific traits of Cluster B and C. On average, patients with schizophrenia scored higher than both their relatives and the controls on all SWAP-200 scales, with a few exceptions including the High Functioning scale. The PD T scores of the relatives of schizophrenic patients were higher than those of healthy controls for Cluster A scales, but lower for High Functioning scale. Moreover, relatives of schizophrenic patients showed statistical significant differences when compared with controls, reporting lower Q T scores on the dysphoric, obsessive and high functioning depressive dimensions, and higher Q T scores on the schizoid dimension. Discussion: Borderline, Dependent and Avoidant Personality Disorders, comorbid with Cluster A Personality Disorders, may have a specific relevance in the psychotic transition within the schizophrenia spectrum disorders. In our sample, patients scored statistically higher than both their relatives and the control group in all these scales, while the scores of their first-degree relatives compared to the control group were statistically higher for the Cluster A, but not for the other Personality Disorders. These results may indicate the features of the Cluster A as common phenotypes and traits of other Personality Disorders as predisposing to overt psychosis.
Poster #T240 CAN CHILDHOOD ADVERSITY PREDICT ONSET AND CLINICAL OUTCOMES OF PSYCHOTIC DISORDERS? Antonella Trotta 1 , Jennifer O’Connor 1 , Anna Kolliakou 1 , Marta Di Forti 1 , Paola Dazzan 2 , Carmine Pariante 2 , Anthony S. David 1 , Robin M. Murray 1 , Helen Fisher 1 1 Institute of Psychiatry, King’s College London; 2 Psychological Medicine, Institute of Psychiatry, King’s College London Background: Over the past decade, increasing interest has been shown in the relationship between childhood adversity and risk of psychosis in adulthood. However, it is not clear what the potential long-lasting impact of traumatic early experiences is on the clinical course of psychotic disorders. The aim of this study is thus to analyse the impact of childhood adversity on 1 year clinical outcomes in first-presentation psychosis patients. Methods: Data on exposure to childhood adversity prior to 17 years of age (separation from a parent for at least 6 months, death of a parent, taken into local authority care, physical and sexual abuse) was collected using the Childhood Experience of Care and Abuse Questionnaire from 319 psychosis patients at first presentation to mental health services and 254 healthy controls who participated in the Genetics and Psychosis study. Data on illness course (complete recovery, relapsing episodes, chronic illness), number of days on a psychiatric ward (median split of <48 and ≥48 days) and compliance with medication was collected for the year following first contact with mental health services for psychosis from clinical records using the Personal and Psychiatric History Schedule. Binary logistic regression models were used to investigate associations between baseline predictors and 1 year outcome variables. Statistical interactions were assessed using likelihood ratio tests. Analyses were conducted using SPSS version 21 and STATA version 10.1. Results: Over three-quarters of patients (69.9%) and around half of the controls (49.2%) reported at least one experience of childhood adversity before age 17. The odds of being a psychosis patient increased more than two times with the experience of at least one adversity during childhood (odds ratio [OR]=2.40, 95% CI 1.70–3.37, p<0.001) and the association held after adjusting for age, ethnicity and gender (adj. OR=2.44, 95% CI 1.72– 3.45, p<0.001). Follow-up data have so far been collected at 1 year for 208 first-presentation psychosis patients. No significant differences in illness course were observed between those who reported at least one experience of childhood adversity compared to those who did not. Patients with a lifetime history of childhood adversity tended to have longer psychiatric hospital stays (≥48 days) compared to those who did not (OR 1.79, 95% CI 0.93–3.45, p=0.082) and to be less compliant with medication at 1 year (OR 0.52, 95% CI 0.24–1.11, p=0.090), though these associations failed to reach conventional levels of significance. More specifically, history of separation from either parent was significantly associated with a higher number of
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
hospital admission days (OR 2.00, 95% CI 1.08–3.69, p=0.027) and lower compliance with pharmacological treatment throughout the year (OR 0.51, 95% CI 0.27–0.94, p=0.032). Stratifying by gender, a stronger association between history of parental separation and hospital admission days was observed for women (OR 2.50, 95% CI 0.91–6.86, p=0.075) compared to men (OR 1.61, 95% CI 0.72–3.57, p=0.243) but no statistical interaction by gender was found (Likelihood ratio χ2 = 0.45, p=0.501). No associations were found for other types of adversity. Discussion: Our data reveal a higher prevalence of childhood adversity in FEP patients and further extend previous research by suggesting that a history of parental separation during childhood is associated with longer hospitalisations and poorer medication compliance over the first year of treatment. More research is warranted to better understand mechanisms involved between adversity and clinical outcomes in psychosis.
Poster #T241 DOSE AND DOSING FREQUENCY OF LONG-ACTING INJECTABLE ANTIPSYCHOTICS: A SYSTEMATIC REVIEW OF PET AND SPECT DATA AND CLINICAL IMPLICATIONS Hiroyuki Uchida 1 , Takefumi Suzuki 2 Department of Neuropsychiatry, Keio University School of Medicine; 2 Keio University School of Medicine
1
Background: Brain imaging data of antipsychotics have mainly been derived from oral antipsychotic drugs, which hampers our understanding of the requirement of dose/dosing frequency of long-acting injectable (LAI) antipsychotics for the maintenance treatment of schizophrenia. The objectives of this systematic review are two-fold: (1) to characterize dopamine D2 receptor occupancy with LAI antipsychotics and (2) to examine the requirement of dose/dosing frequency of this formulation for the maintenance treatment of schizophrenia. Methods: A systematic literature search was performed to identify positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies that assessed dopamine D2 receptor occupancy levels with LAI antipsychotic drugs in humans, using PubMed, EMBASE, and PsycINFO (last search: September 2013). Results: An initial search identified 472 articles; of these 452 reports were excluded because of a lack of relevant data (e.g. review article, animal experiment, duplicate publication, lack of brain imaging data or antipsychotic treatment). Thus, 20 (15 PET and 5 SPECT studies) were found to be eligible and critically appraised in this review. The most investigated drug in these PET and SPECT studies was haloperidol decanoate (44 subjects; 11 studies), followed by risperidone LAI (24 subjects; 3 studies), olanzapine pamoate (14 subject; 1 study), and fluphenazine decanoate (12 subjects; 3 studies). The data have demonstrated high and continuous D2 receptor blockade with LAIs; effects of LAI first generation antipsychotics on the central nervous system may persist for several months. The prospective and cross-sectional studies showed that continuous dopamine D2 receptor blockade above 65% (i.e. lower end of the established “therapeutic window” for acute phase treatment) was not always necessary for maintenance treatment for at least some of the patients. Discussion: Because of the limited brain imaging data on LAI antipsychotics, we still do not know the best way to dose them. Still, the currently available brain imaging data raises a possibility that the dosing interval of LAI antipsychotics may be extended beyond the currently indicated range in some patients. Even though this tentative conclusion has to be confirmed in future well-designed trials, this notion could provide important clinical implications to optimize efficacy and to reduce side effects as we consider LAI antipsychotic dose/dosing frequency as well as future antipsychotic development.
Poster #T242 EXCEPTIONAL EXPERIENCES IN HEALTHY PEOPLE – EARLY WARNING SIGNALS OF PSYCHOSIS? Lui Unterrassner 1 , Thomas A. Wyss 1 , Peter Krummenacher 1 , Diana Wotruba 1 , Peter Brugger 2 , Helene Haker Rössler 3 , Gerd Folkers 1 , Wulf Rössler 4
S375
1
Collegium Helveticum, University of Zurich and ETH Zurich, Zurich, Switzerland; 2 Department of Neurology, Neuropsychology Unit, University Hospital Zurich, Zurich, Switzerland; 3 Collegium Helveticum, University of Zurich and ETH Zurich, Institute for Biomedical Engineering, University of Zurich and ETH Zurich; 4 University Hospital of Psychiatry Zurich, The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Switzerland Background: Exceptional experiences (EE) are widespread in the general population and comprise a whole set of different phenomena that deviate from the normal perceptual experiences in everyday life and are often interpreted as “paranormal”. From a psychiatric point of view such experiences can be described as “psychotic-like” since they overlap with, and exhibit parallels to positive symptoms observed in schizophrenia patients. However, most of the surveys assessing exceptional experiences are mainly aimed at quantifying beliefs or do not explicitly differentiate between beliefs and experiences. Therefore, we employed a survey that assesses the bare phenomenology of EE entailing a classification into four categories. We intended to elucidate the relationships of these categories with established measures of schizotypy and psychological distress. In terms of early detection and prevention of mental disorders, a phenomenological approach to EE might reveal more information about the exact relationships between mental disorders and EE. Methods: In this on-going study a population of 90 healthy subjects, representing a cross section of ordinary Swiss-German population with respect to age (20-60 years), gender and level of education, has been acquired from the population of a precedent study and through online advertisements. Participants with a past psychiatric treatment or a first-degree family history of mental illness were excluded from the study. The participants completed a survey assessing the phenomenology of past EE (Fragebogen zur Erfassung der Phänomenologie aussergewöhnlicher Erfahrungen), which incorporates a classification of EE according to four different possibilities (external, internal, dissociative and coincidental phenomena). Furthermore, the study subjects completed questionnaires assessing schizotypy (Schizotypal Personality Questionnaire, SPQ) and psychological distress (Symptom Checklist 90 revised, SCL). Results: An exploratory data analysis (Spearman’s rho, Bonferroni corrected) revealed that all of the four types of EE correlate positively with the SPQ sum score (rho 0.553–0.677, p<0.01), the global severity index (rho 0.444–0.620, p<0.01) and the positive symptom total (rho 0.467–0.623, p<0.01) of the SCL. Concerning the subscales of the SPQ, all EE correlate positively with scores for ideas of reference (0.409–0.543, p<0.01), odd beliefs (0.528–0.655, p<0.01), unusual perceptual experiences (0.578–0.689, p<0.01) and odd speech (0.372–0.453, p<0.05). Furthermore, with the SCL subscales somatisation (0.512–0.551, p<0.01), depression (0.373–0.534, p<0.05) and phobia (0.403–0.461, p<0.01). Correlations not including all types of EE are not listed for brevity. No significant correlations were found with the SPQ scales excessive social anxiety, no close friends, constricted affect and the SCL scales for aggression and unspecified complaints. Discussion: As expected, all four types of EE are positively linked to scales with similar content such as ideas of reference, odd beliefs or unusual perceptual experiences. More importantly, EE are also correlated with general psychological distress and the number of distressful symptoms. Hence, our data support the notion of a continuous distribution of psychotic experiences and their accompanying psychological features from mentally healthy to mentally ill with a purely phenomenological approach to EE in healthy people. Additional data and further analyses will shed more light onto the ambiguous relations between the four categories of EE and single subscales of the SPQ and SCL, respectively.
Poster #T243 [11C]GMOM AS NEW POTENTIAL PET RADIOTRACER TO IMAGE THE NMDA RECEPTOR IN VIVO Thalia F. van der Doef, Sandeep V.S. Golla, Pieter J. Klein, Robert C. Schuit, Bert D. Windhorst, Adriaan A. Lammertsma, Bart N.M. van Berckel, Ronald Boellaard Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam Background: Accumulating evidence shows that NMDA receptor hypo-
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
Poster #T238 RELATION BETWEEN PSYCHOTIC-LIKE EXPERIENCES AND MAJOR DEPRESSION IN THE COMMUNITY BASED SAMPLE Ahmet Topuzo˘glu 1 , Tolga Binbay 2 , Hayriye Elbi 3 , Nesli Za˘glı 3 , Huseyin Onay 3 , Feristah ¸ Ferda Özkınay 3 , Jim van Os 4 , Köksal Alptekin 1 1 Dokuz Eylul University School of Medicine, Department of Psychiatry; 2 Dokuz Eylul University Medical Faculty; 3 Ege University Medical Faculty; 4 Psychosis Research Maastricht University Background: Psychotic-like experiences (PLEs) increase the risk of schizophrenia and other psychotic disorders in the community. There may be a relation between some PLEs and depression which may increase risk for developing both depression and psychosis. The aim of this study was to determine the prevalence of PLEs in a community based sample and to investigate whether any PLEs are associated with the depression diagnosis. Methods: Addresses were contacted in a multistage clustered area probability sampling frame of administrative neighborhoods and households, covering 9 districts and 302 neighborhoods in the Izmir metropolitan area between November 2007 and October 2008. One household member aged between 15 and 64 years and available to complete the interview was randomly selected using a within-household sampling method. 4011 (female: 57.3%) respondents were successfully interviewed with a response rate of 75.8%. The primary screening instrument was the Composite International Diagnostic Interview (CIDI) 2.1. The prevalence of MDD was based on diagnosed depression by physician, psychotic like experiences responses to systematic screening questions of the relevant questions (CIDI 2.1, G_16; assessment delusional PLE, G_23; assessment hallucinational PLE). Results: The prevalence of diagnosed MDD was 11.9%. Delutional and hallucinational PLEs prevalences were 20.2% and 11.9% respectively. Delutional PLEs and hallucinational PLEs associated with major depression respectively OR: 3.7 (95% C.I; 3.1-4.4) and OR:5,5 (95% C.I;4.5-6.8). Discussion: Delutional and hallucinational PLEs were strongly related to depression in the community sample. Both PLEs and depression in the community sample may play an important role in developing psychosis and probably depression.
Poster #T239 DIMENSIONAL EXPLORATION OF PERSONALITY DISORDERS IN SCHIZOPHRENIC PATIENTS AND THEIR FIRST-DEGREE RELATIVES USING THE SHEDLER-WESTEN ASSESSMENT PROCEDURE Maria Chiara Torti, Antonino Buzzanca, Fabio Di Fabio, Marianna Frascarelli, Alessia Mirigliani, Chiara Squarcione, Massimo Biondi Neurology and Psychiatry Department, Sapienza University of Rome Background: Epidemiological studies have shown that Cluster A, Avoidant, Dependent and Borderline Personality Disorders are associated with schizophrenia and psychotic episodes. In light of these data, it becomes important to identify maladaptive personality traits of psychotic patients and their relatives to detect the predisposing and protective factors.This study examined personality dimensions and identified personality subtypes of adults with DSM IV schizophrenia and their first-degree relatives. Previous work evaluating schizotypy in siblings of schizophrenic patients suggests that the Shedler-Westen Assessment Procedure (SWAP-200) is a useful diagnostic instrument not only to detect schizotypal traits but also for a global evaluation of the personality profiles. Methods: Trained and clinically experienced interviewers provided data on a sample of 144 subjects including 59 schizophrenic patients, 43 firstdegree relatives (parents and siblings) of these patients and 42 age-matched healthy controls. To verify the hypothesis of the difference between the profiles of the Personality Disorders we used two MANOVA (for Personality Disorders [PD T] and for Q Factors [Q T] scales) and subsequent planned comparisons for the three groups. Results: MANOVA are statistically significant (PD T Wilk’s Lambda(11, 131) <0.001; Q T Wilk’s Lambda(12, 130) <0.001 p<0.001). The multivariate tests of the planned comparisons are statistically significant for PD T scales (Patients vs Relatives, Wilk’s Lambda(11, 131) = 0.304 p<0.001; Patients vs Controls, Wilk’s Lambda(11, 131) = 0.253 p<0.001; Relatives vs Controls, Wilk’s Lambda(11, 131) = 0.712 p<0.001), as well as for Q T scales (Patients
vs Relatives, Wilk’s Lambda(12, 130) = 0.297 p<0.001; Patients vs Controls, Wilk’s Lambda(12, 130) = 0.233 p<0.001; Relatives vs Controls, Wilk’s Lambda(12, 130) = 0.652 p<0.001). In the univariate tests, for both the PD T and Q T scores, the three groups showed statistical significant differences not only, as expected, for Cluster A and High Functioning, but also for specific traits of Cluster B and C. On average, patients with schizophrenia scored higher than both their relatives and the controls on all SWAP-200 scales, with a few exceptions including the High Functioning scale. The PD T scores of the relatives of schizophrenic patients were higher than those of healthy controls for Cluster A scales, but lower for High Functioning scale. Moreover, relatives of schizophrenic patients showed statistical significant differences when compared with controls, reporting lower Q T scores on the dysphoric, obsessive and high functioning depressive dimensions, and higher Q T scores on the schizoid dimension. Discussion: Borderline, Dependent and Avoidant Personality Disorders, comorbid with Cluster A Personality Disorders, may have a specific relevance in the psychotic transition within the schizophrenia spectrum disorders. In our sample, patients scored statistically higher than both their relatives and the control group in all these scales, while the scores of their first-degree relatives compared to the control group were statistically higher for the Cluster A, but not for the other Personality Disorders. These results may indicate the features of the Cluster A as common phenotypes and traits of other Personality Disorders as predisposing to overt psychosis.
Poster #T240 CAN CHILDHOOD ADVERSITY PREDICT ONSET AND CLINICAL OUTCOMES OF PSYCHOTIC DISORDERS? Antonella Trotta 1 , Jennifer O’Connor 1 , Anna Kolliakou 1 , Marta Di Forti 1 , Paola Dazzan 2 , Carmine Pariante 2 , Anthony S. David 1 , Robin M. Murray 1 , Helen Fisher 1 1 Institute of Psychiatry, King’s College London; 2 Psychological Medicine, Institute of Psychiatry, King’s College London Background: Over the past decade, increasing interest has been shown in the relationship between childhood adversity and risk of psychosis in adulthood. However, it is not clear what the potential long-lasting impact of traumatic early experiences is on the clinical course of psychotic disorders. The aim of this study is thus to analyse the impact of childhood adversity on 1 year clinical outcomes in first-presentation psychosis patients. Methods: Data on exposure to childhood adversity prior to 17 years of age (separation from a parent for at least 6 months, death of a parent, taken into local authority care, physical and sexual abuse) was collected using the Childhood Experience of Care and Abuse Questionnaire from 319 psychosis patients at first presentation to mental health services and 254 healthy controls who participated in the Genetics and Psychosis study. Data on illness course (complete recovery, relapsing episodes, chronic illness), number of days on a psychiatric ward (median split of <48 and ≥48 days) and compliance with medication was collected for the year following first contact with mental health services for psychosis from clinical records using the Personal and Psychiatric History Schedule. Binary logistic regression models were used to investigate associations between baseline predictors and 1 year outcome variables. Statistical interactions were assessed using likelihood ratio tests. Analyses were conducted using SPSS version 21 and STATA version 10.1. Results: Over three-quarters of patients (69.9%) and around half of the controls (49.2%) reported at least one experience of childhood adversity before age 17. The odds of being a psychosis patient increased more than two times with the experience of at least one adversity during childhood (odds ratio [OR]=2.40, 95% CI 1.70–3.37, p<0.001) and the association held after adjusting for age, ethnicity and gender (adj. OR=2.44, 95% CI 1.72– 3.45, p<0.001). Follow-up data have so far been collected at 1 year for 208 first-presentation psychosis patients. No significant differences in illness course were observed between those who reported at least one experience of childhood adversity compared to those who did not. Patients with a lifetime history of childhood adversity tended to have longer psychiatric hospital stays (≥48 days) compared to those who did not (OR 1.79, 95% CI 0.93–3.45, p=0.082) and to be less compliant with medication at 1 year (OR 0.52, 95% CI 0.24–1.11, p=0.090), though these associations failed to reach conventional levels of significance. More specifically, history of separation from either parent was significantly associated with a higher number of
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
hospital admission days (OR 2.00, 95% CI 1.08–3.69, p=0.027) and lower compliance with pharmacological treatment throughout the year (OR 0.51, 95% CI 0.27–0.94, p=0.032). Stratifying by gender, a stronger association between history of parental separation and hospital admission days was observed for women (OR 2.50, 95% CI 0.91–6.86, p=0.075) compared to men (OR 1.61, 95% CI 0.72–3.57, p=0.243) but no statistical interaction by gender was found (Likelihood ratio χ2 = 0.45, p=0.501). No associations were found for other types of adversity. Discussion: Our data reveal a higher prevalence of childhood adversity in FEP patients and further extend previous research by suggesting that a history of parental separation during childhood is associated with longer hospitalisations and poorer medication compliance over the first year of treatment. More research is warranted to better understand mechanisms involved between adversity and clinical outcomes in psychosis.
Poster #T241 DOSE AND DOSING FREQUENCY OF LONG-ACTING INJECTABLE ANTIPSYCHOTICS: A SYSTEMATIC REVIEW OF PET AND SPECT DATA AND CLINICAL IMPLICATIONS Hiroyuki Uchida 1 , Takefumi Suzuki 2 Department of Neuropsychiatry, Keio University School of Medicine; 2 Keio University School of Medicine
1
Background: Brain imaging data of antipsychotics have mainly been derived from oral antipsychotic drugs, which hampers our understanding of the requirement of dose/dosing frequency of long-acting injectable (LAI) antipsychotics for the maintenance treatment of schizophrenia. The objectives of this systematic review are two-fold: (1) to characterize dopamine D2 receptor occupancy with LAI antipsychotics and (2) to examine the requirement of dose/dosing frequency of this formulation for the maintenance treatment of schizophrenia. Methods: A systematic literature search was performed to identify positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies that assessed dopamine D2 receptor occupancy levels with LAI antipsychotic drugs in humans, using PubMed, EMBASE, and PsycINFO (last search: September 2013). Results: An initial search identified 472 articles; of these 452 reports were excluded because of a lack of relevant data (e.g. review article, animal experiment, duplicate publication, lack of brain imaging data or antipsychotic treatment). Thus, 20 (15 PET and 5 SPECT studies) were found to be eligible and critically appraised in this review. The most investigated drug in these PET and SPECT studies was haloperidol decanoate (44 subjects; 11 studies), followed by risperidone LAI (24 subjects; 3 studies), olanzapine pamoate (14 subject; 1 study), and fluphenazine decanoate (12 subjects; 3 studies). The data have demonstrated high and continuous D2 receptor blockade with LAIs; effects of LAI first generation antipsychotics on the central nervous system may persist for several months. The prospective and cross-sectional studies showed that continuous dopamine D2 receptor blockade above 65% (i.e. lower end of the established “therapeutic window” for acute phase treatment) was not always necessary for maintenance treatment for at least some of the patients. Discussion: Because of the limited brain imaging data on LAI antipsychotics, we still do not know the best way to dose them. Still, the currently available brain imaging data raises a possibility that the dosing interval of LAI antipsychotics may be extended beyond the currently indicated range in some patients. Even though this tentative conclusion has to be confirmed in future well-designed trials, this notion could provide important clinical implications to optimize efficacy and to reduce side effects as we consider LAI antipsychotic dose/dosing frequency as well as future antipsychotic development.
Poster #T242 EXCEPTIONAL EXPERIENCES IN HEALTHY PEOPLE – EARLY WARNING SIGNALS OF PSYCHOSIS? Lui Unterrassner 1 , Thomas A. Wyss 1 , Peter Krummenacher 1 , Diana Wotruba 1 , Peter Brugger 2 , Helene Haker Rössler 3 , Gerd Folkers 1 , Wulf Rössler 4
S375
1
Collegium Helveticum, University of Zurich and ETH Zurich, Zurich, Switzerland; 2 Department of Neurology, Neuropsychology Unit, University Hospital Zurich, Zurich, Switzerland; 3 Collegium Helveticum, University of Zurich and ETH Zurich, Institute for Biomedical Engineering, University of Zurich and ETH Zurich; 4 University Hospital of Psychiatry Zurich, The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Switzerland Background: Exceptional experiences (EE) are widespread in the general population and comprise a whole set of different phenomena that deviate from the normal perceptual experiences in everyday life and are often interpreted as “paranormal”. From a psychiatric point of view such experiences can be described as “psychotic-like” since they overlap with, and exhibit parallels to positive symptoms observed in schizophrenia patients. However, most of the surveys assessing exceptional experiences are mainly aimed at quantifying beliefs or do not explicitly differentiate between beliefs and experiences. Therefore, we employed a survey that assesses the bare phenomenology of EE entailing a classification into four categories. We intended to elucidate the relationships of these categories with established measures of schizotypy and psychological distress. In terms of early detection and prevention of mental disorders, a phenomenological approach to EE might reveal more information about the exact relationships between mental disorders and EE. Methods: In this on-going study a population of 90 healthy subjects, representing a cross section of ordinary Swiss-German population with respect to age (20-60 years), gender and level of education, has been acquired from the population of a precedent study and through online advertisements. Participants with a past psychiatric treatment or a first-degree family history of mental illness were excluded from the study. The participants completed a survey assessing the phenomenology of past EE (Fragebogen zur Erfassung der Phänomenologie aussergewöhnlicher Erfahrungen), which incorporates a classification of EE according to four different possibilities (external, internal, dissociative and coincidental phenomena). Furthermore, the study subjects completed questionnaires assessing schizotypy (Schizotypal Personality Questionnaire, SPQ) and psychological distress (Symptom Checklist 90 revised, SCL). Results: An exploratory data analysis (Spearman’s rho, Bonferroni corrected) revealed that all of the four types of EE correlate positively with the SPQ sum score (rho 0.553–0.677, p<0.01), the global severity index (rho 0.444–0.620, p<0.01) and the positive symptom total (rho 0.467–0.623, p<0.01) of the SCL. Concerning the subscales of the SPQ, all EE correlate positively with scores for ideas of reference (0.409–0.543, p<0.01), odd beliefs (0.528–0.655, p<0.01), unusual perceptual experiences (0.578–0.689, p<0.01) and odd speech (0.372–0.453, p<0.05). Furthermore, with the SCL subscales somatisation (0.512–0.551, p<0.01), depression (0.373–0.534, p<0.05) and phobia (0.403–0.461, p<0.01). Correlations not including all types of EE are not listed for brevity. No significant correlations were found with the SPQ scales excessive social anxiety, no close friends, constricted affect and the SCL scales for aggression and unspecified complaints. Discussion: As expected, all four types of EE are positively linked to scales with similar content such as ideas of reference, odd beliefs or unusual perceptual experiences. More importantly, EE are also correlated with general psychological distress and the number of distressful symptoms. Hence, our data support the notion of a continuous distribution of psychotic experiences and their accompanying psychological features from mentally healthy to mentally ill with a purely phenomenological approach to EE in healthy people. Additional data and further analyses will shed more light onto the ambiguous relations between the four categories of EE and single subscales of the SPQ and SCL, respectively.
Poster #T243 [11C]GMOM AS NEW POTENTIAL PET RADIOTRACER TO IMAGE THE NMDA RECEPTOR IN VIVO Thalia F. van der Doef, Sandeep V.S. Golla, Pieter J. Klein, Robert C. Schuit, Bert D. Windhorst, Adriaan A. Lammertsma, Bart N.M. van Berckel, Ronald Boellaard Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam Background: Accumulating evidence shows that NMDA receptor hypo-