- Email: [email protected]
0085 CHILDHOOD ADVERSE EVENTS, EARLY SUBSTANCE USE AND FIRST EPISODE PSYCHOSIS
S98
Schizophrenia Research 86 (2006)
phase of schizophrenia and other psychotic disorders should, therefore, not have major side effects. It is generally acknowledged that most psychosocial impairment develops in the prodromal and onset phase, the question, however, if treatment of subthreshold symptoms should be initiated before a psychotic disorder as currently defined by DSM-IV or ICD-10 is controversial. It also remains unclear if effective treatments for schizophrenia (e.g., antipsychotics) prevent the onset of psychosis and minimize or reverse processes of neurodegeneration and cell death which potentially occur during a first psychotic episode. Bioactive lipids are molecules that have both intra- and intercellular roles, including mediation, modulation and control of neurobiological processes, such as ion channel and receptor activity, neurotransmitter release, synaptic plasticity, second messenger pathways and neuronal gene expression. Abnormal membrane glycerol-phospholipids essential fatty acid (EFA) metabolism has been suggested to contribute to the etiopathophysiology of schizophrenia. EFA have been shown effective treatments for both, mood and psychotic symptoms, and they are neuroprotective. When considered, together, with the controversy concerned with the extent to which an intervention is intrusive or may produce harm which outweighs the benefits, EFA can be considered prime candidates for evaluation in individuals with prodromal symptoms. We report on the first randomized placebo controlled trial investigating omega-3 fatty acids in 80 prodromal individuals aged 13 to 24 years which recently complete the 3-months intervention period. 0552 IS IT FEASIBLE TO CONDUCT A RCT IN ULTRA-HIGH RISK INDIVIDUALS AT A CHILD AND ADOLESCENT PSYCHIATRIC SERVICE? G.P. Amminger1 *, M.R. Schafer2 . 1 ORYGEN, Melbourne, Australia, 2 University of Vienna, Vienna, Austria Presenting author contact: [email protected] Introduction: Individuals at ultra-high risk (UHR) for psychosis are hard to find. It is even harder to engage them in randomized controlled trials (RCT) concerning pharmacological interventions. Data regarding screening and recruitment of UHR individuals into RCT are sparse and no previous intervention study has been carried out within a generic child and adolescent psychiatric service. Methods: We report on screening and recruitment in a RCT investigating the effects of Omega-3 fatty acids (1.5 gram per day EPA/DHA) versus placebo in addition to standard care in individuals at UHR (as classified by Yung et al.1998) for psychosis conducted at the Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria. Results: Between May 1, 2004 and March 31, 2006, 240 (10%) individuals of 2397 total referrals to the outpatient facility of the department were referred for screening for suspected UHR state. Of those, 109 (45%) individuals met UHR criteria, 28 (11%) were found with first-episode psychosis at initial presentation, and 103 (43%) individuals did not meet criteria for UHR or DSM-IV psychotic disorder. 75 (69%) of 109 UHR individuals consented to participate in the proposed EPA/DHA treatment trial. Conclusion: Compared to other clinical and research settings the rate of patients meeting UHR criteria among referrals was relatively high (about 1 to 2). The rate of consent to the proposed RCT was also high which might be related to the benign nature of the intervention.
Abstracts
Theme 7: Substance use and psychosis 0045 SUBSTANCE USE AND ABUSE IN FIRST-EPISODE PSYCHOSES J.H. Barnett1 *, U.E. Werners1 , S.M. Secher1 , K.E. Hill2 , K. Masson2 , D.E. Pernet1 , J.B. Kirkbride1 , G.K. Murray2 , E.T. Bullmore1 , P.B. Jones1 . 1 University of Cambridge Department of Psychiatry, Cambridge, United Kingdom, 2 CAMEO, Cambridgeshire and Peterborough Mental Health Trust, Cambridgeshire, United Kingdom Presenting author contact: [email protected] Introduction: High rates of substance use are implicated in both the causes, and courses, of psychotic disorders. This study aimed to characterize substance and alcohol use in an epidemiologicallyrepresentative treatment sample of people experiencing a firstepisode psychosis. Methods: Current and lifetime substance use was recorded for 123 consecutive referrals to CAMEO, a specialist early intervention service based in South Cambridgeshire, England, between June 2002 and June 2005. Substance use was compared with general population prevalence estimates from the British Crime Survey. Results: Substance use among first-episode psychotic patients was double that of the general population, and more common in men than women. Cannabis abuse was reported in more than half of patients (n = 62) and alcohol abuse in 43% (n = 53). Class A drugs (opiates, ecstasy, cocaine and hallucinogens) had been used by 55% of patients compared with 13% of the general population. Polysubstance abuse was common: 38% of patients abused more than one substance. Onset of substance use increased dramatically after age 11 and was significantly associated with age at first psychotic symptom. Discussion: Substance abuse is present in the majority of patients presenting with first-episode psychosis; this has major implications for early intervention services. The association between age of onset of substance use and age at first psychotic symptom has public health implications. 0085 CHILDHOOD ADVERSE EVENTS, EARLY SUBSTANCE USE AND FIRST EPISODE PSYCHOSIS S.M. Secher *, H.M. Hayhurst, J. Barnett, P. Jones, E. Bullmore. University of Cambridge, Cambridge, United Kingdom Presenting author contact: [email protected] Introduction: We aimed to explore associations between first episode psychosis, adverse events in childhood and substance abuse. Method: 146 cases aged 15−39 referred to CAMEO, a specialist early intervention service in South Cambridgeshire, were assessed with the Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID). Information was also collected on childhood adverse events: physical or sexual abuse, bullying at school, parent problems (physical or psychiatric illness, substance abuse or violence), parent loss before age 16, and physical trauma (accident, physical illness, birth trauma). Results: Fifty-nine percent (n = 87) were diagnosed with schizophrenia or other psychotic disorder, 35% (n = 51) with affective disorder (two-thirds psychotic); 82% (n = 119) experienced psychotic symptoms; non-psychotic cases were ARMS or did not meet SCID criteria. Twenty-six percent (n = 38) suffered from depression be-
Posters, Theme 7: Substance use and psychosis fore age 16. Seventy-five (51%) abused alcohol and 53% (n = 78) cannabis. The commonest childhood adverse events were parent problems, reported by 59% (n = 86). Only 18% (n = 26) reported none of the childhood adverse events, 31% (n = 45) experiencing three or more. Childhood adverse events and substance abuse were not associated. Statistically significant findings were the following: cases experiencing more adverse events, and those who first used cannabis before age 16 were more likely to suffer depression before age 16 (1.5 and 3 times respectively); those with early depression were about 3 times more likely to be diagnosed with affective disorder. Males and cases with parent problems were 2.5 times more likely to be diagnosed with schizophrenic disorder. Cases experiencing more adverse childhood events and those abusing cannabis were about 3 times more likely to experience psychosis; parent problems were the most important of those childhood events. Discussion: Early cannabis use and childhood adverse events, although not associated with each other, both predict psychosis. Negative experiences in childhood, particularly parent problems, appear related to both affective and schizophrenic disorders. 0089 ALCOHOL AND CANNABIS USE IN URBAN, AFRICAN AMERICAN, FIRST-EPISODE PSYCHOSIS PATIENTS: ASSOCIATIONS WITH POSITIVE AND NEGATIVE SYMPTOMS M.T. Compton *, N.E. Whicker, K. Hochman. Emory University School of Medicine, Atlanta, Georgia, United States Presenting author contact: [email protected] Introduction: Based on limited prior research on correlations between symptoms and substance use in first-episode psychosis, two hypotheses were tested: (1) alcohol use prior to admission is associated with the presence of positive symptoms, and (2) cannabis use prior to admission is associated with the absence of prominent negative symptoms. Methods: Eligible patients included those admitted for the first time for a first episode of psychosis in a public-sector, universityaffiliated hospital that hospital serves a predominantly African American, socially-disadvantaged, urban population. Patients included in the analysis (n = 72) were 18–40 years of age, and all were African American. Using a structured data collection instrument, discharge summaries from charts of consecutively-admitted patients were reviewed to extract data on: basic demographic and clinical characteristics, alcohol and cannabis use within six months prior to hospitalization, and the presence of 11 symptoms. Results: Compared to those not using alcohol, first-episode patients using alcohol were significantly more likely to experience four symptoms: auditory hallucinations, visual hallucinations, delusions, and paranoia. Patients using cannabis in the six months prior to hospitalization were less likely to have prominent negative symptoms compared to those not using cannabis. These associations remained even after controlling for relevant covariates in logistic regression models. Discussion: In this relatively homogenous study sample, alcohol use was associated with the presence of positive symptoms, and cannabis use was associated with the absence of prominent negative symptoms. These findings may be explained by an attempt at selfmedication with alcohol in patients with prominent positive symptoms, and a social/interpersonal deficit accounting for the association between prominent negative symptoms and lack of cannabis use.
S99 Further research is needed to elucidate the progression of substance use and symptoms during the early course of schizophrenia. 0104 PHYSICAL HEALTH AND SUBSTANCE ABUSE OF SUBJECTS VULNERABLE TO PSYCHOSIS (VTP) J.K. Korkeila *, T. Svirskis, M. Heinimaa, T. Ristkari, J. Huttunen, T. Ilonen, Th.H. McGlashan2 , R.K.R. Salokangas1 . 1 University of Turku, Turku, Finland, 2 University of Yale, New Haven, CT, United States Presenting author contact: jyrki.korkeila@turku.fi Introduction: Patients with psychosis have been found to suffer from physical illnesses and abuse substances more commonly than the general population. This paper seeks to determine the prevalence and determinants of physical ill health and substance use disorders (SUD), and association between physical ill health and abuse among a sample of first degree relatives of schizophrenia patients (n = 70), help-seekers (n = 29) and control subjects (n = 34). Methods: SCID was used for diagnoses, SIPS for estimation of VTP and 13 items of the SCL scale were used to measure perceived health. Self-reported illnesses and use of substances were inquired separately. Results: Perceived physical health was poorer among subjects with minor symptoms on the SIPS and VTP subjects than among those without symptoms (p < 0.001, one-way ANOVA). Those at current risk of psychosis had a significantly higher SCL-13 mean score (mean = 21.1) than others did (mean = 9.6) (p = 0.013). Having physical symptoms or a self-reported physician-diagnosed illness was significantly associated with VTP (OR = 3.05). The subjects with a mood disorder (OR = 4.33; 95% CI: 1.24−15.21) had more commonly physician-diagnosed illnesses than those who had no diagnosis or any other diagnosis. The VTP subjects reported significantly more life-time alcohol abuse and had more commonly a SUD than controls. The OR for those vulnerable to psychosis for having a SUD was 6.33 (95% CI: 1.77−22.73) compared to controls. There was no significant association between physical ill health and abuse. Discussion: Vulnerability to psychosis, physical ill health and abuse seem to co-occur quite frequently. 0156 HOW CAN I HELP THE PSYCHOTIC PATIENT WHO USES ALCOHOL OR DRUGS? L. Alexandre, R. Labrie *, P. Rouillard. Centre Hospitalier Robert-Giffard, Qu´ebec, Canada Presenting author contact: [email protected] We work with young adults who are in the beginning stages of psychosis, 60% of whom use alcohol and drugs. We have developed expertise in the field of comorbidity. “My Life, My Choices” is a clinical tool that guides professionals in their interventions. The approach is person-centred and based on partnership. The goal of this approach is to accompany the patient in a process aimed at solving his/her problem with consumption, and thus reducing the harmful effects on his/her health. The book has two components: motivational and cognitive-behavioural. No specialized training is required to use the book. Consumption interferes with medication treatment and has numerous consequences: psychotic relapse, hospitalization, and legal and psycho-social problems, resulting in serious financial costs. Mental health workers are confronted with patients exhibiting comorbidity,
Schizophrenia Research 86 (2006)
phase of schizophrenia and other psychotic disorders should, therefore, not have major side effects. It is generally acknowledged that most psychosocial impairment develops in the prodromal and onset phase, the question, however, if treatment of subthreshold symptoms should be initiated before a psychotic disorder as currently defined by DSM-IV or ICD-10 is controversial. It also remains unclear if effective treatments for schizophrenia (e.g., antipsychotics) prevent the onset of psychosis and minimize or reverse processes of neurodegeneration and cell death which potentially occur during a first psychotic episode. Bioactive lipids are molecules that have both intra- and intercellular roles, including mediation, modulation and control of neurobiological processes, such as ion channel and receptor activity, neurotransmitter release, synaptic plasticity, second messenger pathways and neuronal gene expression. Abnormal membrane glycerol-phospholipids essential fatty acid (EFA) metabolism has been suggested to contribute to the etiopathophysiology of schizophrenia. EFA have been shown effective treatments for both, mood and psychotic symptoms, and they are neuroprotective. When considered, together, with the controversy concerned with the extent to which an intervention is intrusive or may produce harm which outweighs the benefits, EFA can be considered prime candidates for evaluation in individuals with prodromal symptoms. We report on the first randomized placebo controlled trial investigating omega-3 fatty acids in 80 prodromal individuals aged 13 to 24 years which recently complete the 3-months intervention period. 0552 IS IT FEASIBLE TO CONDUCT A RCT IN ULTRA-HIGH RISK INDIVIDUALS AT A CHILD AND ADOLESCENT PSYCHIATRIC SERVICE? G.P. Amminger1 *, M.R. Schafer2 . 1 ORYGEN, Melbourne, Australia, 2 University of Vienna, Vienna, Austria Presenting author contact: [email protected] Introduction: Individuals at ultra-high risk (UHR) for psychosis are hard to find. It is even harder to engage them in randomized controlled trials (RCT) concerning pharmacological interventions. Data regarding screening and recruitment of UHR individuals into RCT are sparse and no previous intervention study has been carried out within a generic child and adolescent psychiatric service. Methods: We report on screening and recruitment in a RCT investigating the effects of Omega-3 fatty acids (1.5 gram per day EPA/DHA) versus placebo in addition to standard care in individuals at UHR (as classified by Yung et al.1998) for psychosis conducted at the Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria. Results: Between May 1, 2004 and March 31, 2006, 240 (10%) individuals of 2397 total referrals to the outpatient facility of the department were referred for screening for suspected UHR state. Of those, 109 (45%) individuals met UHR criteria, 28 (11%) were found with first-episode psychosis at initial presentation, and 103 (43%) individuals did not meet criteria for UHR or DSM-IV psychotic disorder. 75 (69%) of 109 UHR individuals consented to participate in the proposed EPA/DHA treatment trial. Conclusion: Compared to other clinical and research settings the rate of patients meeting UHR criteria among referrals was relatively high (about 1 to 2). The rate of consent to the proposed RCT was also high which might be related to the benign nature of the intervention.
Abstracts
Theme 7: Substance use and psychosis 0045 SUBSTANCE USE AND ABUSE IN FIRST-EPISODE PSYCHOSES J.H. Barnett1 *, U.E. Werners1 , S.M. Secher1 , K.E. Hill2 , K. Masson2 , D.E. Pernet1 , J.B. Kirkbride1 , G.K. Murray2 , E.T. Bullmore1 , P.B. Jones1 . 1 University of Cambridge Department of Psychiatry, Cambridge, United Kingdom, 2 CAMEO, Cambridgeshire and Peterborough Mental Health Trust, Cambridgeshire, United Kingdom Presenting author contact: [email protected] Introduction: High rates of substance use are implicated in both the causes, and courses, of psychotic disorders. This study aimed to characterize substance and alcohol use in an epidemiologicallyrepresentative treatment sample of people experiencing a firstepisode psychosis. Methods: Current and lifetime substance use was recorded for 123 consecutive referrals to CAMEO, a specialist early intervention service based in South Cambridgeshire, England, between June 2002 and June 2005. Substance use was compared with general population prevalence estimates from the British Crime Survey. Results: Substance use among first-episode psychotic patients was double that of the general population, and more common in men than women. Cannabis abuse was reported in more than half of patients (n = 62) and alcohol abuse in 43% (n = 53). Class A drugs (opiates, ecstasy, cocaine and hallucinogens) had been used by 55% of patients compared with 13% of the general population. Polysubstance abuse was common: 38% of patients abused more than one substance. Onset of substance use increased dramatically after age 11 and was significantly associated with age at first psychotic symptom. Discussion: Substance abuse is present in the majority of patients presenting with first-episode psychosis; this has major implications for early intervention services. The association between age of onset of substance use and age at first psychotic symptom has public health implications. 0085 CHILDHOOD ADVERSE EVENTS, EARLY SUBSTANCE USE AND FIRST EPISODE PSYCHOSIS S.M. Secher *, H.M. Hayhurst, J. Barnett, P. Jones, E. Bullmore. University of Cambridge, Cambridge, United Kingdom Presenting author contact: [email protected] Introduction: We aimed to explore associations between first episode psychosis, adverse events in childhood and substance abuse. Method: 146 cases aged 15−39 referred to CAMEO, a specialist early intervention service in South Cambridgeshire, were assessed with the Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID). Information was also collected on childhood adverse events: physical or sexual abuse, bullying at school, parent problems (physical or psychiatric illness, substance abuse or violence), parent loss before age 16, and physical trauma (accident, physical illness, birth trauma). Results: Fifty-nine percent (n = 87) were diagnosed with schizophrenia or other psychotic disorder, 35% (n = 51) with affective disorder (two-thirds psychotic); 82% (n = 119) experienced psychotic symptoms; non-psychotic cases were ARMS or did not meet SCID criteria. Twenty-six percent (n = 38) suffered from depression be-
Posters, Theme 7: Substance use and psychosis fore age 16. Seventy-five (51%) abused alcohol and 53% (n = 78) cannabis. The commonest childhood adverse events were parent problems, reported by 59% (n = 86). Only 18% (n = 26) reported none of the childhood adverse events, 31% (n = 45) experiencing three or more. Childhood adverse events and substance abuse were not associated. Statistically significant findings were the following: cases experiencing more adverse events, and those who first used cannabis before age 16 were more likely to suffer depression before age 16 (1.5 and 3 times respectively); those with early depression were about 3 times more likely to be diagnosed with affective disorder. Males and cases with parent problems were 2.5 times more likely to be diagnosed with schizophrenic disorder. Cases experiencing more adverse childhood events and those abusing cannabis were about 3 times more likely to experience psychosis; parent problems were the most important of those childhood events. Discussion: Early cannabis use and childhood adverse events, although not associated with each other, both predict psychosis. Negative experiences in childhood, particularly parent problems, appear related to both affective and schizophrenic disorders. 0089 ALCOHOL AND CANNABIS USE IN URBAN, AFRICAN AMERICAN, FIRST-EPISODE PSYCHOSIS PATIENTS: ASSOCIATIONS WITH POSITIVE AND NEGATIVE SYMPTOMS M.T. Compton *, N.E. Whicker, K. Hochman. Emory University School of Medicine, Atlanta, Georgia, United States Presenting author contact: [email protected] Introduction: Based on limited prior research on correlations between symptoms and substance use in first-episode psychosis, two hypotheses were tested: (1) alcohol use prior to admission is associated with the presence of positive symptoms, and (2) cannabis use prior to admission is associated with the absence of prominent negative symptoms. Methods: Eligible patients included those admitted for the first time for a first episode of psychosis in a public-sector, universityaffiliated hospital that hospital serves a predominantly African American, socially-disadvantaged, urban population. Patients included in the analysis (n = 72) were 18–40 years of age, and all were African American. Using a structured data collection instrument, discharge summaries from charts of consecutively-admitted patients were reviewed to extract data on: basic demographic and clinical characteristics, alcohol and cannabis use within six months prior to hospitalization, and the presence of 11 symptoms. Results: Compared to those not using alcohol, first-episode patients using alcohol were significantly more likely to experience four symptoms: auditory hallucinations, visual hallucinations, delusions, and paranoia. Patients using cannabis in the six months prior to hospitalization were less likely to have prominent negative symptoms compared to those not using cannabis. These associations remained even after controlling for relevant covariates in logistic regression models. Discussion: In this relatively homogenous study sample, alcohol use was associated with the presence of positive symptoms, and cannabis use was associated with the absence of prominent negative symptoms. These findings may be explained by an attempt at selfmedication with alcohol in patients with prominent positive symptoms, and a social/interpersonal deficit accounting for the association between prominent negative symptoms and lack of cannabis use.
S99 Further research is needed to elucidate the progression of substance use and symptoms during the early course of schizophrenia. 0104 PHYSICAL HEALTH AND SUBSTANCE ABUSE OF SUBJECTS VULNERABLE TO PSYCHOSIS (VTP) J.K. Korkeila *, T. Svirskis, M. Heinimaa, T. Ristkari, J. Huttunen, T. Ilonen, Th.H. McGlashan2 , R.K.R. Salokangas1 . 1 University of Turku, Turku, Finland, 2 University of Yale, New Haven, CT, United States Presenting author contact: jyrki.korkeila@turku.fi Introduction: Patients with psychosis have been found to suffer from physical illnesses and abuse substances more commonly than the general population. This paper seeks to determine the prevalence and determinants of physical ill health and substance use disorders (SUD), and association between physical ill health and abuse among a sample of first degree relatives of schizophrenia patients (n = 70), help-seekers (n = 29) and control subjects (n = 34). Methods: SCID was used for diagnoses, SIPS for estimation of VTP and 13 items of the SCL scale were used to measure perceived health. Self-reported illnesses and use of substances were inquired separately. Results: Perceived physical health was poorer among subjects with minor symptoms on the SIPS and VTP subjects than among those without symptoms (p < 0.001, one-way ANOVA). Those at current risk of psychosis had a significantly higher SCL-13 mean score (mean = 21.1) than others did (mean = 9.6) (p = 0.013). Having physical symptoms or a self-reported physician-diagnosed illness was significantly associated with VTP (OR = 3.05). The subjects with a mood disorder (OR = 4.33; 95% CI: 1.24−15.21) had more commonly physician-diagnosed illnesses than those who had no diagnosis or any other diagnosis. The VTP subjects reported significantly more life-time alcohol abuse and had more commonly a SUD than controls. The OR for those vulnerable to psychosis for having a SUD was 6.33 (95% CI: 1.77−22.73) compared to controls. There was no significant association between physical ill health and abuse. Discussion: Vulnerability to psychosis, physical ill health and abuse seem to co-occur quite frequently. 0156 HOW CAN I HELP THE PSYCHOTIC PATIENT WHO USES ALCOHOL OR DRUGS? L. Alexandre, R. Labrie *, P. Rouillard. Centre Hospitalier Robert-Giffard, Qu´ebec, Canada Presenting author contact: [email protected] We work with young adults who are in the beginning stages of psychosis, 60% of whom use alcohol and drugs. We have developed expertise in the field of comorbidity. “My Life, My Choices” is a clinical tool that guides professionals in their interventions. The approach is person-centred and based on partnership. The goal of this approach is to accompany the patient in a process aimed at solving his/her problem with consumption, and thus reducing the harmful effects on his/her health. The book has two components: motivational and cognitive-behavioural. No specialized training is required to use the book. Consumption interferes with medication treatment and has numerous consequences: psychotic relapse, hospitalization, and legal and psycho-social problems, resulting in serious financial costs. Mental health workers are confronted with patients exhibiting comorbidity,