- Email: [email protected]
0231 THE NATURE OF SCHIZOTYPY IN EARLY PSYCHOSIS
S88
Schizophrenia Research 86 (2006)
Results: Among students, the questions highly endorsed were on “telepathy-like experience” (28.1%), “derealization” (13.9%), “passivity phenomena” (12.9%). The questions highly endorsed among first-visited clinic outpatients were on “ideas of reference” (32.5%), “passivity phenomena” (30.9%), “telepathy-like experience” (30.1%). The questions seen higher in patients group than students group were on “illusion”, “ideas of reference”, “passivity phenomena”, “delusional mood”, “auditory hallucination”. There were less differences between two groups in items on “telepathylike experience”, “grandiosity”, “derealization”. Conclusions: These results suggest there are symptomatological differences in prodromal symptoms between general population and first-visited clinic outpatients. The more psychotic symptoms or those symptoms which affect daily life such as ideas of reference and passivity phenomena lead to treatment-seeking behaviour. 0197 VISUAL OBJECT PERCEPTION: A COMPARISON OF INDIVIDUALS PRODROMAL TO PSYCHOSIS, AND WITH EARLY AND LATER SCHIZOPHRENIA D. Kimhy1 *, C. Corcoran1 , J. Harkavy-Friedman1 , B. Ritzler2 , D. Malaspina1 . 1 Columbia University, New York, NY, United States, 2 Long Island University, Brooklyn, NY, United States Presenting author contact: [email protected] Background: Schizophrenia is associated with deficits in visual perception. However, there is scant information about the temporal development and stability of such deficits over the course of illness. We compared visual object perception among individuals Prodromal to psychosis, Early schizophrenia (2 yrs of onset), and Later schizophrenia (>3 yrs since onset). Methods: Twenty prodromal individuals were assessed using the Structured Interview for Prodromal Symptoms/Scale of Prodromal Symptoms (SIPS/SOPS). Fifty schizophrenia patients (16 Early, 34 Late) were diagnosed using the Diagnostic Interview for Genetic Studies (DIGS). Visual object perception was assessed using the Rorschach Comprehensive System’s (RCS) Form Quality variable which characterizes the degree of conventional visual perception. Responses are categorized into: Ordinary (X+), Unusual (Xu), and Minus (X−). Results: The mean X+% scores (% of Ordinary responses out of total number of responses) for Prodromal, Early, and Later schizophrenia groups were 0.46 (SD = 0.14), 0.50 (SD = 0.12), and 0.46 (SD = 0.13), respectively, indicating that all groups perceive visual objects in a conventional way less than half of the time. These data are substantially lower than findings from studies in healthy adults (mean = 0.77; SD = 0.09). A one-way ANOVA indicated no significant differences between the groups in their ability to perceive visual objects conventionally (F(2,68) = 0.80, p = 0.45). Conclusions: This study is the first to assess visual perception using the RCS among rigorously diagnosed individuals prodromal to psychosis and schizophrenia patients. Our results suggest that visual perception deficits are present among individuals prodromal to psychosis, and remain stable following the psychosis onset. Such deficits may serve as an endophenotype of vulnerability to develop psychosis.
Abstracts 0213 SUSTAINED ATTENTION IN YOUNG PEOPLE AT HIGH RISK OF PSYCHOSIS L. Harrison1 *, P. Patterson2 , A. Skeate2 , C. Jones3 , M. Birchwood2 . 1 Sandwell Mental Health NHS and Social Care Trust, Birmingham, United Kingdom, 2 Birmingham and Solihull Mental Health NHS Trust, Birmingham, United Kingdom, 3 University of Birmingham, Birmingham, United Kingdom Presenting author contact: [email protected] Introduction: Psychosis is a distressful disorder and costly to the health service. If individuals could be identified prior to developing the disorder, early interventions could be offered and such distress and cost might be alleviated, delayed or prevented. Such a preventative approach is contingent upon the accurate early detection of psychosis, which requires a valid profile of risk markers. Neurocognitive deficits, including impaired sustained attention, have been identified as a potential risk marker of psychosis. Aims: To compare performance on a sustained attention task, demonstrated by a group of participants at ultra-high risk of developing psychosis with that of a control group. Methods: Two groups of participants, ultra-high risk (n = 21) and control (n = 18), completed conditions on the Continuous Performance Test – Identical Pairs (CPT-IP) which assessed verbal and spatial processing capabilities, distractibility and the effect of exposure duration, at two time points (baseline and follow-up). The signal detection indices, d’ (a measure of discriminability and attentional capacity) and Log aˆ (a measure of response style and related to motivational state) are presented. The groups were matched for average age, pre-morbid IQ, years of education and gender. Results: A group difference was identified for attentional capacity (P = 0.05), with the ultra-high risk group demonstrating impaired performance. Both groups demonstrated greater attentional capacity and a more conservative response style for stimuli presented with a longer duration (P < 0.001 and P = 0.05 respectively) and for stimuli presented with distraction (P < 0.03 and P < 0.001 respectively). Discussion: Sustained attention, as measured by the CPT-IP may be an indicator of vulnerability to psychosis. 0231 THE NATURE OF SCHIZOTYPY IN EARLY PSYCHOSIS J. Hodgekins1 *, D. Fowler1 , D. Freeman2 , S. Coker1 , I. Macmillan3 , P. Jones4 . 1 University of East Anglia, Norwich, Norfolk, United Kingdom, 2 Institute of Psychiatry, London, United Kingdom, 3 Norfolk and Waveney Mental Health Partnership, Norwich, Norfolk, United Kingdom, 4 University of Cambridge, Cambridge, United Kingdom Presenting author contact: [email protected] Introduction: Cognitive models of psychosis suggest that lowlevel anomalous experiences form an important foundation for later psychotic symptoms to be built upon. However, prevalence studies of psychotic-like experiences in the general population reveal high levels of symptomatology (e.g. van Os et al, 2000). This makes distinguishing these individuals from first-episode psychosis samples difficult on the presence of symptoms alone. Experience per se is arguably neither pathological nor sufficient to highlight an individual as being at-risk of developing psychosis. There is a need to look more closely at the dimensions of these experiences. It is suggested that the frequency of low-level psychotic experiences is particularly important as this may drive the ‘search for meaning’ (Garety et
Posters, Theme 4: UHR population: characteristics al, 2001; Birchwood, 1996). This study investigates the notion that psychotic symptoms exist on a continuum of frequency. Method: Two groups of participants – a recovering early psychosis sample (N = 120) and a non-clinical student sample (N = 808) – completed a modified version of a self-report measure of schizotypy to assess low-level psychotic symptom frequency. Anxiety, depression and schema were also assessed in both samples. In addition, current psychotic symptoms were assessed in the clinical sample. Results: Schizotypal symptoms are common in both clinical and non-clinical populations. However, they appear to occur more frequently in clinical samples. Social anxiety and paranoia appear to be particularly important discriminators, as do anomalous symptoms, albeit to a lesser extent. In addition, whilst social anxiety and paranoia correlated strongly with emotional and psychological variables, anomalous experiences did not. These symptoms could be attributed to physiological/neuropsychological disturbances. Discussion: The fact that low-level psychotic symptomatology is common in the general population has a positive implication in normalising these experiences in clinical populations. Furthermore, social anxiety and paranoia are highlighted as important points of therapeutic focus and may be mostly related to emotional and schematic disturbances. Reference(s) Birchwood, M. (1996). Early intervention in psychosis. In: G. Haddock & P. Slade (Eds), Cognitive-Behavioural Interventions with Psychotic Disorders. London: Routledge. Garety, P.A., Kuipers, E., Fowler, D., Freeman, D., Bebbington, P.E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189−95. van Os, J., Hanssen, M., Bijl, R., Ravelli, A. (2000). Strauss (1969) revisited: a psychosis continuum in the general population? Schizophrenia Research 45, 11−20.
0242 PREMORBID ADJUSTMENT IN PATIENTS AT RISK OF PSYCHOSIS M.L.A. Heinimaa1 *, T. Laine1 , J. Rekola1 , L. Vaskelainen1 , T. Svirskis1 , A.-M. Heinisuo1 , J. Huttunen1 , T. Ristkari1 , J. Korkeila1 , R.K.R. Salokangas1 , J. Klosterk¨otter2 . 1 University of Turku, Turku, Finland, 2 University of Cologne, Cologne, Germany Presenting author contact: markus.heinimaa@utu.fi Introduction: Prospectively defined prodromal stage of psychosis is a novel clinical concept, and basic research on its biological, developmental, psychosocial and clinical determinants is necessary. Premorbid adjustment is a strong predictor of course in psychotic disorders and consequently of interest in prodromal studies, too. Methods: In connection to EPOS project, Turku centre collected out-patients at initial prodromal stage (G1, n = 55) and three control groups: patients with subthreshold symptoms (G3, n = 12), patients without prodromal symptoms (G2, n = 13) and population controls (PC, n = 30). All G1 patients fulfilled UHR and/or BSAPS criteria for initial prodromal phase. All subjects were given the PAS (Premorbid Assessment Scale). The total PAS scores from different developmental periods (childhood, early adolescence, late adolescence, adulthood) were studied in univariate model, with age, gender and familial risk as covariates. Results: Patients with familial risk functioned worse in early and late adolescence. No significant gender differences were detected. In childhood G1 differed for PCs. In early adolescence all patient groups differed from PCs, but there were no differences between
S89 patient groups. This situation persisted in late adolescence. In adulthood G1s still differed from PCs, but the differences between other patient groups had vanished. Conclusions: The patient group presenting with the picture of initial prodromal phase clearly differed from population controls throughout the developmental period. The effect of familial risk on adjustment was only manifest during adolescence. These data speak for the discriminant validity of prodrome concept and for the importance of recognising developmental history in clinical evaluation of psychosis risk. 0280 LIFE EVENTS AND THE INITIAL PRODROME OF SCHIZOPHRENIA H. Picker *, S. Ruhrmann, F. Schultze-Lutter, J. Klosterk¨otter. Department of Psychiatry and Psychotherapy at the University of Cologne, Cologne, Germany Presenting author contact: [email protected] Introduction: Stressful life-events were shown to play an important role in the development and course of mental illnesses. Thus the broadly accepted vulnerability-stress-coping-model of schizophrenia suggests an interaction between personal vulnerability and psychosocial stressors and should also apply to prodromal stages of the illness. Therefore we examined putatively prodromal patients (n = 21) and controls with depressive disorders (n = 21) for differences in quantity and quality of social stressors. Methods: Life-events were assessed with a self-rating version of the Munich Life Event List (MEL), a questionnaire for the retrospective assessment of negative and positive life events and life conditions in 11 areas of life. 42 patients seeking help at an Early Recognition and Intervention Centre were asked for life-events of the last three years and every event was evaluated on a 5-point rating scale for the subjective valuation and the degree of subjective burden. Results: Prodromal patients recalled significantly more events in general (p = 0.027) and reported more events in all areas of life except ‘health/illness’, ‘pregnancy/children’ and ‘court/violation of the law’. Yet, this became significant only for ‘social contacts/leisure activities’ (p = 0.006). Comparisons of subjective valuation of the events and subjective burden between groups showed a significant tendency to experience more severe stress (p = 0.007) and also a more negative valuation of the events (p = 0.039) in the prodromal group. Discussion: The results support the notion of a higher susceptibility to stress in prodromal patients. Furthermore, in line with findings of the ABC-study showing that social deficits seem to appear first in the area of social contacts, a significant accumulation of life-events in this area of life was reported by the putatively prodromal patients. 0312 SPECIFIC PERCEPTUAL AND THINKING DISTURBANCES OF VTP SUBJECTS T. Ilonen *, M. Heinimaa, J. Korkeila, T. Svirskis, R.K.R. Salokangas. University of Turku, Turku, Finland Presenting author contact: tuuilo@utu.fi Perceptual and thought disturbance has long been regarded as a hallmark feature of schizophrenia spectrum disorders. This study was designed to investigate Rorschach-derived measures for assessing perceptual and thought disturbance as applied to a clinical sample of 276 adolescents with schizophrenia (n = 13),
Schizophrenia Research 86 (2006)
Results: Among students, the questions highly endorsed were on “telepathy-like experience” (28.1%), “derealization” (13.9%), “passivity phenomena” (12.9%). The questions highly endorsed among first-visited clinic outpatients were on “ideas of reference” (32.5%), “passivity phenomena” (30.9%), “telepathy-like experience” (30.1%). The questions seen higher in patients group than students group were on “illusion”, “ideas of reference”, “passivity phenomena”, “delusional mood”, “auditory hallucination”. There were less differences between two groups in items on “telepathylike experience”, “grandiosity”, “derealization”. Conclusions: These results suggest there are symptomatological differences in prodromal symptoms between general population and first-visited clinic outpatients. The more psychotic symptoms or those symptoms which affect daily life such as ideas of reference and passivity phenomena lead to treatment-seeking behaviour. 0197 VISUAL OBJECT PERCEPTION: A COMPARISON OF INDIVIDUALS PRODROMAL TO PSYCHOSIS, AND WITH EARLY AND LATER SCHIZOPHRENIA D. Kimhy1 *, C. Corcoran1 , J. Harkavy-Friedman1 , B. Ritzler2 , D. Malaspina1 . 1 Columbia University, New York, NY, United States, 2 Long Island University, Brooklyn, NY, United States Presenting author contact: [email protected] Background: Schizophrenia is associated with deficits in visual perception. However, there is scant information about the temporal development and stability of such deficits over the course of illness. We compared visual object perception among individuals Prodromal to psychosis, Early schizophrenia (2 yrs of onset), and Later schizophrenia (>3 yrs since onset). Methods: Twenty prodromal individuals were assessed using the Structured Interview for Prodromal Symptoms/Scale of Prodromal Symptoms (SIPS/SOPS). Fifty schizophrenia patients (16 Early, 34 Late) were diagnosed using the Diagnostic Interview for Genetic Studies (DIGS). Visual object perception was assessed using the Rorschach Comprehensive System’s (RCS) Form Quality variable which characterizes the degree of conventional visual perception. Responses are categorized into: Ordinary (X+), Unusual (Xu), and Minus (X−). Results: The mean X+% scores (% of Ordinary responses out of total number of responses) for Prodromal, Early, and Later schizophrenia groups were 0.46 (SD = 0.14), 0.50 (SD = 0.12), and 0.46 (SD = 0.13), respectively, indicating that all groups perceive visual objects in a conventional way less than half of the time. These data are substantially lower than findings from studies in healthy adults (mean = 0.77; SD = 0.09). A one-way ANOVA indicated no significant differences between the groups in their ability to perceive visual objects conventionally (F(2,68) = 0.80, p = 0.45). Conclusions: This study is the first to assess visual perception using the RCS among rigorously diagnosed individuals prodromal to psychosis and schizophrenia patients. Our results suggest that visual perception deficits are present among individuals prodromal to psychosis, and remain stable following the psychosis onset. Such deficits may serve as an endophenotype of vulnerability to develop psychosis.
Abstracts 0213 SUSTAINED ATTENTION IN YOUNG PEOPLE AT HIGH RISK OF PSYCHOSIS L. Harrison1 *, P. Patterson2 , A. Skeate2 , C. Jones3 , M. Birchwood2 . 1 Sandwell Mental Health NHS and Social Care Trust, Birmingham, United Kingdom, 2 Birmingham and Solihull Mental Health NHS Trust, Birmingham, United Kingdom, 3 University of Birmingham, Birmingham, United Kingdom Presenting author contact: [email protected] Introduction: Psychosis is a distressful disorder and costly to the health service. If individuals could be identified prior to developing the disorder, early interventions could be offered and such distress and cost might be alleviated, delayed or prevented. Such a preventative approach is contingent upon the accurate early detection of psychosis, which requires a valid profile of risk markers. Neurocognitive deficits, including impaired sustained attention, have been identified as a potential risk marker of psychosis. Aims: To compare performance on a sustained attention task, demonstrated by a group of participants at ultra-high risk of developing psychosis with that of a control group. Methods: Two groups of participants, ultra-high risk (n = 21) and control (n = 18), completed conditions on the Continuous Performance Test – Identical Pairs (CPT-IP) which assessed verbal and spatial processing capabilities, distractibility and the effect of exposure duration, at two time points (baseline and follow-up). The signal detection indices, d’ (a measure of discriminability and attentional capacity) and Log aˆ (a measure of response style and related to motivational state) are presented. The groups were matched for average age, pre-morbid IQ, years of education and gender. Results: A group difference was identified for attentional capacity (P = 0.05), with the ultra-high risk group demonstrating impaired performance. Both groups demonstrated greater attentional capacity and a more conservative response style for stimuli presented with a longer duration (P < 0.001 and P = 0.05 respectively) and for stimuli presented with distraction (P < 0.03 and P < 0.001 respectively). Discussion: Sustained attention, as measured by the CPT-IP may be an indicator of vulnerability to psychosis. 0231 THE NATURE OF SCHIZOTYPY IN EARLY PSYCHOSIS J. Hodgekins1 *, D. Fowler1 , D. Freeman2 , S. Coker1 , I. Macmillan3 , P. Jones4 . 1 University of East Anglia, Norwich, Norfolk, United Kingdom, 2 Institute of Psychiatry, London, United Kingdom, 3 Norfolk and Waveney Mental Health Partnership, Norwich, Norfolk, United Kingdom, 4 University of Cambridge, Cambridge, United Kingdom Presenting author contact: [email protected] Introduction: Cognitive models of psychosis suggest that lowlevel anomalous experiences form an important foundation for later psychotic symptoms to be built upon. However, prevalence studies of psychotic-like experiences in the general population reveal high levels of symptomatology (e.g. van Os et al, 2000). This makes distinguishing these individuals from first-episode psychosis samples difficult on the presence of symptoms alone. Experience per se is arguably neither pathological nor sufficient to highlight an individual as being at-risk of developing psychosis. There is a need to look more closely at the dimensions of these experiences. It is suggested that the frequency of low-level psychotic experiences is particularly important as this may drive the ‘search for meaning’ (Garety et
Posters, Theme 4: UHR population: characteristics al, 2001; Birchwood, 1996). This study investigates the notion that psychotic symptoms exist on a continuum of frequency. Method: Two groups of participants – a recovering early psychosis sample (N = 120) and a non-clinical student sample (N = 808) – completed a modified version of a self-report measure of schizotypy to assess low-level psychotic symptom frequency. Anxiety, depression and schema were also assessed in both samples. In addition, current psychotic symptoms were assessed in the clinical sample. Results: Schizotypal symptoms are common in both clinical and non-clinical populations. However, they appear to occur more frequently in clinical samples. Social anxiety and paranoia appear to be particularly important discriminators, as do anomalous symptoms, albeit to a lesser extent. In addition, whilst social anxiety and paranoia correlated strongly with emotional and psychological variables, anomalous experiences did not. These symptoms could be attributed to physiological/neuropsychological disturbances. Discussion: The fact that low-level psychotic symptomatology is common in the general population has a positive implication in normalising these experiences in clinical populations. Furthermore, social anxiety and paranoia are highlighted as important points of therapeutic focus and may be mostly related to emotional and schematic disturbances. Reference(s) Birchwood, M. (1996). Early intervention in psychosis. In: G. Haddock & P. Slade (Eds), Cognitive-Behavioural Interventions with Psychotic Disorders. London: Routledge. Garety, P.A., Kuipers, E., Fowler, D., Freeman, D., Bebbington, P.E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189−95. van Os, J., Hanssen, M., Bijl, R., Ravelli, A. (2000). Strauss (1969) revisited: a psychosis continuum in the general population? Schizophrenia Research 45, 11−20.
0242 PREMORBID ADJUSTMENT IN PATIENTS AT RISK OF PSYCHOSIS M.L.A. Heinimaa1 *, T. Laine1 , J. Rekola1 , L. Vaskelainen1 , T. Svirskis1 , A.-M. Heinisuo1 , J. Huttunen1 , T. Ristkari1 , J. Korkeila1 , R.K.R. Salokangas1 , J. Klosterk¨otter2 . 1 University of Turku, Turku, Finland, 2 University of Cologne, Cologne, Germany Presenting author contact: markus.heinimaa@utu.fi Introduction: Prospectively defined prodromal stage of psychosis is a novel clinical concept, and basic research on its biological, developmental, psychosocial and clinical determinants is necessary. Premorbid adjustment is a strong predictor of course in psychotic disorders and consequently of interest in prodromal studies, too. Methods: In connection to EPOS project, Turku centre collected out-patients at initial prodromal stage (G1, n = 55) and three control groups: patients with subthreshold symptoms (G3, n = 12), patients without prodromal symptoms (G2, n = 13) and population controls (PC, n = 30). All G1 patients fulfilled UHR and/or BSAPS criteria for initial prodromal phase. All subjects were given the PAS (Premorbid Assessment Scale). The total PAS scores from different developmental periods (childhood, early adolescence, late adolescence, adulthood) were studied in univariate model, with age, gender and familial risk as covariates. Results: Patients with familial risk functioned worse in early and late adolescence. No significant gender differences were detected. In childhood G1 differed for PCs. In early adolescence all patient groups differed from PCs, but there were no differences between
S89 patient groups. This situation persisted in late adolescence. In adulthood G1s still differed from PCs, but the differences between other patient groups had vanished. Conclusions: The patient group presenting with the picture of initial prodromal phase clearly differed from population controls throughout the developmental period. The effect of familial risk on adjustment was only manifest during adolescence. These data speak for the discriminant validity of prodrome concept and for the importance of recognising developmental history in clinical evaluation of psychosis risk. 0280 LIFE EVENTS AND THE INITIAL PRODROME OF SCHIZOPHRENIA H. Picker *, S. Ruhrmann, F. Schultze-Lutter, J. Klosterk¨otter. Department of Psychiatry and Psychotherapy at the University of Cologne, Cologne, Germany Presenting author contact: [email protected] Introduction: Stressful life-events were shown to play an important role in the development and course of mental illnesses. Thus the broadly accepted vulnerability-stress-coping-model of schizophrenia suggests an interaction between personal vulnerability and psychosocial stressors and should also apply to prodromal stages of the illness. Therefore we examined putatively prodromal patients (n = 21) and controls with depressive disorders (n = 21) for differences in quantity and quality of social stressors. Methods: Life-events were assessed with a self-rating version of the Munich Life Event List (MEL), a questionnaire for the retrospective assessment of negative and positive life events and life conditions in 11 areas of life. 42 patients seeking help at an Early Recognition and Intervention Centre were asked for life-events of the last three years and every event was evaluated on a 5-point rating scale for the subjective valuation and the degree of subjective burden. Results: Prodromal patients recalled significantly more events in general (p = 0.027) and reported more events in all areas of life except ‘health/illness’, ‘pregnancy/children’ and ‘court/violation of the law’. Yet, this became significant only for ‘social contacts/leisure activities’ (p = 0.006). Comparisons of subjective valuation of the events and subjective burden between groups showed a significant tendency to experience more severe stress (p = 0.007) and also a more negative valuation of the events (p = 0.039) in the prodromal group. Discussion: The results support the notion of a higher susceptibility to stress in prodromal patients. Furthermore, in line with findings of the ABC-study showing that social deficits seem to appear first in the area of social contacts, a significant accumulation of life-events in this area of life was reported by the putatively prodromal patients. 0312 SPECIFIC PERCEPTUAL AND THINKING DISTURBANCES OF VTP SUBJECTS T. Ilonen *, M. Heinimaa, J. Korkeila, T. Svirskis, R.K.R. Salokangas. University of Turku, Turku, Finland Presenting author contact: tuuilo@utu.fi Perceptual and thought disturbance has long been regarded as a hallmark feature of schizophrenia spectrum disorders. This study was designed to investigate Rorschach-derived measures for assessing perceptual and thought disturbance as applied to a clinical sample of 276 adolescents with schizophrenia (n = 13),