- Email: [email protected]
0312 SPECIFIC PERCEPTUAL AND THINKING DISTURBANCES OF VTP SUBJECTS
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),
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other psychosis (n = 53), vulnerability to psychosis (VTP; n = 23), mood disorder without psychotic features (n = 87), anxiety disorder (n = 30), behavioral disorder (n = 50), and other (n = 20). VTP was assessed with the Structured Interview for Prodromal Symptoms. Participants were administered the Rorschach test according to the standard procedure of the Comprehensive System (CS). In addition to the Rorschach CS, all participants were administered the WISC-III or WAIS-R, and the Wisconsin Card Sorting Test. Patients with schizophrenia were significantly more impaired than patients with other psychotic conditions or those without psychotic symptoms in logical thinking, comprehension and memory but they did not differ from other patients in executive function. Actually, all patient groups appeared to have mild to moderate difficulties in executive function. Patients with VTP as well as psychotic patients significantly differed from other patient groups in inaccurate perception (X−%) and disordered thinking (WSum6) as assessed by the Rorschach CS. The scores increased in the pathological direction across the spectrum of severity in a graduated fashion. The abstract problem-solving nature and the high cognitive demand aspects of the performance-based Rorschach test yields specific information regarding the type of perceptual and thinking problems that occur within psychotic disorders but also in patients at risk of developing psychosis. 0320 COGNITIVE FUNCTIONING IN PATIENTS AT ULTRA HIGH RISK FOR PSYCHOSIS: RELATION WITH DAILY LIFE FUNCTIONING H.E. Becker *, D.H. Nieman, J.R. van de Fliert, P.M. Dingemans, D.H. Linszen. AMC/De Meren, Amsterdam, Netherlands Presenting author contact: [email protected] Introduction: Neuropsychological abnormalities are a common finding in first episode schizophrenia as well as in chronic schizophrenia. They seem to be fairly stable in time. Numerous studies have demonstrated a strong association between executive functioning and verbal memory and community functioning. A direct relation between neurocognitive functioning and daily live functioning in both first episode schizophrenia patients and chronic psychosis has also been found. The aim of the present study was to investigate the relationship between cognitive functioning and daily life functioning in a group of subjects at ultra high risk of developing a psychosis (UHR-patients). Methods: Neuropsychological functioning was assessed with a comprehensive neuropsychological test battery. Overall functioning was assessed with the Global Assessment of Function scale. Daily life functioning was evaluated with the World Health Organization Disability Assessment Schedule, Version II (WHO-DAS-II). WHO-DAS-II was designed to measure restrictions actually experienced by an individual, irrespective of diagnosis. It has six major domains, encompassing activities that are considered important in many cultures. Results: Poorer performance on verbal fluency (categories) was associated with domain 4: getting along with other people(r = −0.41, p < 0.006), 5: life activities (r = −0.38, p = 0.012) and 6: participation in society (r = −0.34, p = 0.026) of the WHO-DAS-II. Performance on the CLVT and WCST was associated with domain 3 (selfcare). Conclusion: Overall functioning was low in the UHR group. Poorer performance on verbal fluency tasks was associated with more impairments in daily life functioning in area’s that require interactions with other people. Poorer performance on the WCST and CVLT was
Abstracts associated with selfcare. These findings seems to mirror findings in first episode schizophrenia and could help clinicians in making treatment plans for UHR patients. 0342 COGNITIVE DEFICITS IN YOUNG, UNAFFECTED RELATIVES OF SCHIZOPHRENIA PROBANDS B.C. Ho *. Dept of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States Presenting author contact: [email protected] Introduction: Cognitive dysfunction, a core feature of schizophrenia, has been consistently demonstrated in relatives of schizophrenia probands. However, most previous studies have involved relatives who were already beyond the age range at high-risk for developing schizophrenia, or have included relatives with schizotypy. The aim of this study is to examine cognitive performance in relatives of schizophrenia probands who are still within the age range for developing schizophrenia and who have no schizophreniaspectrum disorders. Method: Thirty young, unaffected first- or second-degree relatives of schizophrenia probands completed a comprehensive battery of standardized neuropsychological tests. Their test performances were contrasted against two comparison groups with equivalent age, educational attainment and parental socioeconomic status: schizophrenia patients and healthy volunteers without family history of schizophrenia. Results: Unaffected relatives showed performance that was intermediate between schizophrenia patients and healthy controls. They performed significantly better than schizophrenia patients on tests assessing visuomotor speed, executive functioning and verbal memory. Although cognitive performance in unaffected relatives did not differ significantly from healthy controls without family history of schizophrenia, these differences in IQ, visuomotor speed and executive functioning were of moderate to large effect sizes. Conclusion: Impaired cognition, including visuomotor speed, executive functioning and verbal memory deficits, represent potential endophenotypes that may be useful for the early identification of schizophrenia. 0345 OLFACTORY DYSFUNCTION IN INDIVIDUALS AT RISK FOR SCHIZOPHRENIA AND IN FIRST EPISODE SUBJECTS: A CROSS-SECTIONAL ANALYSIS T. Kaur *, K.M. Shafer, K.S. Cadenhead. University of California, San Diego, La Jolla, CA, United States Presenting author contact: [email protected] Background: Olfactory identification deficits have been well documented amongst schizophrenia patients. Even first degree relatives of patients with schizophrenia display partial deficits compared to patients and normal controls. Olfactory deficits have also been identified in populations “at risk” for schizophrenia and may serve as endophenotypic markers suggesting a predisposition towards psychosis. Method: The University of Pennsylvania Smell Identification Test40 (UPSIT) was administered birhinally to 10 individuals identified as “at risk” for schizophrenia based on subsyndromal psychotic symptoms and/or a family history of schizophrenia, as well as to 6 first episode patients with schizophrenia and 7 normal comparison subjects.
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),
S90
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other psychosis (n = 53), vulnerability to psychosis (VTP; n = 23), mood disorder without psychotic features (n = 87), anxiety disorder (n = 30), behavioral disorder (n = 50), and other (n = 20). VTP was assessed with the Structured Interview for Prodromal Symptoms. Participants were administered the Rorschach test according to the standard procedure of the Comprehensive System (CS). In addition to the Rorschach CS, all participants were administered the WISC-III or WAIS-R, and the Wisconsin Card Sorting Test. Patients with schizophrenia were significantly more impaired than patients with other psychotic conditions or those without psychotic symptoms in logical thinking, comprehension and memory but they did not differ from other patients in executive function. Actually, all patient groups appeared to have mild to moderate difficulties in executive function. Patients with VTP as well as psychotic patients significantly differed from other patient groups in inaccurate perception (X−%) and disordered thinking (WSum6) as assessed by the Rorschach CS. The scores increased in the pathological direction across the spectrum of severity in a graduated fashion. The abstract problem-solving nature and the high cognitive demand aspects of the performance-based Rorschach test yields specific information regarding the type of perceptual and thinking problems that occur within psychotic disorders but also in patients at risk of developing psychosis. 0320 COGNITIVE FUNCTIONING IN PATIENTS AT ULTRA HIGH RISK FOR PSYCHOSIS: RELATION WITH DAILY LIFE FUNCTIONING H.E. Becker *, D.H. Nieman, J.R. van de Fliert, P.M. Dingemans, D.H. Linszen. AMC/De Meren, Amsterdam, Netherlands Presenting author contact: [email protected] Introduction: Neuropsychological abnormalities are a common finding in first episode schizophrenia as well as in chronic schizophrenia. They seem to be fairly stable in time. Numerous studies have demonstrated a strong association between executive functioning and verbal memory and community functioning. A direct relation between neurocognitive functioning and daily live functioning in both first episode schizophrenia patients and chronic psychosis has also been found. The aim of the present study was to investigate the relationship between cognitive functioning and daily life functioning in a group of subjects at ultra high risk of developing a psychosis (UHR-patients). Methods: Neuropsychological functioning was assessed with a comprehensive neuropsychological test battery. Overall functioning was assessed with the Global Assessment of Function scale. Daily life functioning was evaluated with the World Health Organization Disability Assessment Schedule, Version II (WHO-DAS-II). WHO-DAS-II was designed to measure restrictions actually experienced by an individual, irrespective of diagnosis. It has six major domains, encompassing activities that are considered important in many cultures. Results: Poorer performance on verbal fluency (categories) was associated with domain 4: getting along with other people(r = −0.41, p < 0.006), 5: life activities (r = −0.38, p = 0.012) and 6: participation in society (r = −0.34, p = 0.026) of the WHO-DAS-II. Performance on the CLVT and WCST was associated with domain 3 (selfcare). Conclusion: Overall functioning was low in the UHR group. Poorer performance on verbal fluency tasks was associated with more impairments in daily life functioning in area’s that require interactions with other people. Poorer performance on the WCST and CVLT was
Abstracts associated with selfcare. These findings seems to mirror findings in first episode schizophrenia and could help clinicians in making treatment plans for UHR patients. 0342 COGNITIVE DEFICITS IN YOUNG, UNAFFECTED RELATIVES OF SCHIZOPHRENIA PROBANDS B.C. Ho *. Dept of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States Presenting author contact: [email protected] Introduction: Cognitive dysfunction, a core feature of schizophrenia, has been consistently demonstrated in relatives of schizophrenia probands. However, most previous studies have involved relatives who were already beyond the age range at high-risk for developing schizophrenia, or have included relatives with schizotypy. The aim of this study is to examine cognitive performance in relatives of schizophrenia probands who are still within the age range for developing schizophrenia and who have no schizophreniaspectrum disorders. Method: Thirty young, unaffected first- or second-degree relatives of schizophrenia probands completed a comprehensive battery of standardized neuropsychological tests. Their test performances were contrasted against two comparison groups with equivalent age, educational attainment and parental socioeconomic status: schizophrenia patients and healthy volunteers without family history of schizophrenia. Results: Unaffected relatives showed performance that was intermediate between schizophrenia patients and healthy controls. They performed significantly better than schizophrenia patients on tests assessing visuomotor speed, executive functioning and verbal memory. Although cognitive performance in unaffected relatives did not differ significantly from healthy controls without family history of schizophrenia, these differences in IQ, visuomotor speed and executive functioning were of moderate to large effect sizes. Conclusion: Impaired cognition, including visuomotor speed, executive functioning and verbal memory deficits, represent potential endophenotypes that may be useful for the early identification of schizophrenia. 0345 OLFACTORY DYSFUNCTION IN INDIVIDUALS AT RISK FOR SCHIZOPHRENIA AND IN FIRST EPISODE SUBJECTS: A CROSS-SECTIONAL ANALYSIS T. Kaur *, K.M. Shafer, K.S. Cadenhead. University of California, San Diego, La Jolla, CA, United States Presenting author contact: [email protected] Background: Olfactory identification deficits have been well documented amongst schizophrenia patients. Even first degree relatives of patients with schizophrenia display partial deficits compared to patients and normal controls. Olfactory deficits have also been identified in populations “at risk” for schizophrenia and may serve as endophenotypic markers suggesting a predisposition towards psychosis. Method: The University of Pennsylvania Smell Identification Test40 (UPSIT) was administered birhinally to 10 individuals identified as “at risk” for schizophrenia based on subsyndromal psychotic symptoms and/or a family history of schizophrenia, as well as to 6 first episode patients with schizophrenia and 7 normal comparison subjects.