- Email: [email protected]
0468 IMPLICIT MEMORY AND SCHIZOPHRENIA
S110
Schizophrenia Research 86 (2006)
115 consecutive referrals to CAMEO, a specialist early intervention service in South Cambridgeshire. Subjects were included if they were diagnosed as having either mania with psychotic symptoms (n = 45) or schizophreniform psychosis(n = 70). Groups were compared by diagnostic type, as well as by nature of psychotic symptoms (mood congruent/incongruent). Results: Patients’ cognitive functions were heterogenous. There was no significant groupwise difference between those with manic psychosis and those with schizophreniform psychosis in cognitive functioning. However when groups were compared by nature of psychotic symptoms (mood congruent/incongruent) there was significant difference, with those with mood incongruent psychotic symptoms performing worse on measures of the CANTAB subtests. Discussion: Our findings in this sample of young, first episode psychotic patients support the hypotheses that subjects with bipolar disorder and incongruent psychotic symptoms are a distinct diagnostic group, with cognitive functioning more akin to those with schizophrenia than those with bipolar disorder and mood congruent psychotic symptoms. Further follow up of this group is required to establish diagnostic stability in these patients over time, and illness course. 0402 PREMORBID ASSESSMENTS OF PATIENTS WITH FIRST EPISODE PSYCHOSIS N. Salesian *, J. Alaghband-rad, J. Mahmoudi. Roozbeh Hospital, Tehran, Iran Presenting author contact: [email protected] Introduction: We have done the premorbid assessments of our patients to compare premorbid patterns of first episode non-affective and affective psychoses. Methods: Consecutive patients with first-episode psychosis are assessed using the Premorbid Adjustment Scale (PAS). Data are collected from patient interviews after recovery from the psychotic episode (or at follow-up visits), families, and chart reviews. Results: As of now, twenty-two patients have been assessed. Patients were divided into non-affective [schizophrenia/schizoaffective (n = 9), brief psychosis (n = 1), delusional disorder (n = 1)] and affective [bipolar I disorder (n = 10), major depressive disorder with psychotic features (n = 1)] based on DSM-IV diagnoses at discharge. Mean ages of the non-affective and affective groups were 27.5 and 24.8 years, respectively; 63.6% in each group were male. Average PAS scores of Childhood (C), Early Adolescence (EA), Late Adolescence (LA), and Adulthood (A) were respectively 0.17, 0.25, 0.39 (n = 10), 0.46 (n = 6), in the non-affective group. Average PAS scores C, EA, LA, and A were respectively 0.24, 0.19, 0.29 (n = 8), 0.11 (n = 5) in the affective group. Discussion: Despite some difference between the preliminary PAS scores of the non-affective and affective groups, due to the small number of patients, results are still inconclusive. Findings are very likely to change as the study is in progress. 0433 PSYCHOMETRIC PROPERTIES OF THE CLINICAL AND PATIENT VERSION OF THE APATHY EVALUATION SCALE A. Faerden *, R. Nesv˚ag, I. Agartz, E. Barreth, A. Finseth, S. Friis, I. Melle. 1 Ullev˚al University Hospital, Oslo, Norway,
Abstracts 2 Diakonhjemmet
Hospital, Oslo, Norway, 3 University of Oslo, Oslo, Norway, 4 Aker University Hospital, Oslo, Norway Presenting author contact: [email protected] The different symptoms of the negative syndrome have received attention lately, and apathy has been one of interest. Apathy has been difficult to study because of the lack of a specific rating scale. The Apathy Evaluation Scale (AES) was developed by Marin for people with Alzheimer’s disease, and has been used to measure apathy in different neuropsychiatric diseases. It was recently used in a study of people with schizophrenia but has never been used in a population of first episode patients. The purpose of this study is to show the psychometric properties of the Apathy Evaluation Scale in first episode patients. Material and Methods: Material: This study reports the first 58 patients with first episode non-organic psychosis participants in the TOP study, a multi-site Norwegian study. Methods: The AES is an 18-item scale that defines apathy as a simultaneous diminution in the overt behavioural, cognitive and emotional components of goal directed behaviour. The AES consists of three versions. Clinical (C), self rated (S) and informant (I). The AES-C is based on a clinical interview and criteria with a 4-point likert scale resulting in a sum score of 18−72; higher score indicating more apathy. Principal factor analysis will be performed to study the psychometric properties, using the SPSS version 13. Results: The AES in this study showed good internal consistency, with a Cronbach’s a = 0.91 for the C version and a = 0.83 for the S version. There was good correlation between AES-C and AES-P (r = 0.681, p < 0.000). Discussion: The AES has good psychometric properties. It can be used to measure apathy in people with first episode psychosis. Data are preliminary; more will be presented at the meeting. 0468 IMPLICIT MEMORY AND SCHIZOPHRENIA M.-J. Dubuc, J. Forget, J.-P. Mottard *, M. Lassonde, A. Breault, N.C. Bedwani, R. Godbout, N. Lessard. Hˆopital Sacr´e-Coeur, Montreal, Quebec, Canada Presenting author contact: [email protected] Individuals with schizophrenia show relatively intact implicit memory compared to a perturbed declarative memory. Skill learning as well as priming are the most frequently used tasks to assess implicit memory. According to the model developed by Squire (1992), distinct neural networks are involved in skill learning and priming. While priming is thought to involve storage changes in the posterior neocortex (Schacter & Buckner, 1998), various forms of skill learning may depend upon the integrity of the corticostriatal pathway in association with structures of the extrapyramidal system (Gaffan, 1996) and the cerebellum (Doyon et al., 1996). Since schizophrenia underly fronto-striatal dysfunctions we hypothesized that schizophrenic patients should exhibit disturbance in skill learning and preserved priming. This was tested in 21 patients (11 first psychotic episode; 10 schizophrenic) and 10 matched controls using two visuoperceptual tasks. The procedural learning task consisted of 5 training sessions each including 32 pictures that appeared as a series of fragmented images, each image containing 8 levels of completion: level 1 was the most fragmented and level 8 represented the most complete picture. Subjects were asked to identify the picture and the procedural learning score were obtained by a reduction of identification level throughout sessions. The priming task consisted in the presentation of 32 images randomly selected from the 160
Posters, Theme 8: Cognitive functioning in first episode psychosis (FEP) seen in the 5 previous sessions, combined with 32 new images. Priming effect was measured by a reduction of identification level on previously seen pictures as compared to new pictures. Patients and controls showed a comparable priming effect but the patients were impaired on the skill learning task. These results indicate that visuoperceptual implicit memory is impaired in schizophrenia and suggest that the corticostriatal network may be involved. 0533 PREMORBID AND PRODROMAL COGNITION IN PSYCHOTIC ILLNESSES: PRELIMINARY RESULTS OF A META-ANALYSIS K.A. Woodberry1 *, A.J. Giuliano2 , M.K. Nock1 , L.J. Seidman2 . 1 Harvard University, Cambridge, MA, United States, 2 Harvard Medical School, Department of Psychiatry at Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Boston, MA, United States Presenting author contact: [email protected] Cognitive deficits are characteristic of a number of psychotic illnesses and increasingly considered a core feature of schizophrenia. Although they often appear years before the onset of acute psychotic symptoms and account for much of the disability associated with psychotic illnesses, very little is understood of their developmental course or relationship to psychosis onset. The purpose of this meta-analysis is to summarize current findings on premorbid cognition to improve understanding of the timing and nature of both global and specific deficits and the potential protective function of general intelligence. The magnitude of effects are reviewed from birth and conscript cohort studies, twin studies, genetic high risk samples, follow-back designs of individuals with schizophrenia-spectrum disorders, estimates of premorbid intellect in individuals with psychosis, and existing studies of cognition in clinical high risk or prodromal samples. Potential sources of heterogeneity in findings are discussed in relation to methodological issues as well as age of testing and age of symptom onset. Furthermore, we summarize the evidence for associations between premorbid cognition and diagnostic and functional outcomes. A developmental psychopathology perspective guides the discussion of implications for etiological models and future research. 0537 FEAR/SADNESS RECOGNITION IS IMPAIRED IN ADOLESCENTS WITH FIRST-EPISODE SCHIZOPHRENIA AND FIRST DEGREE RELATIVES G.P. Amminger1 *, M. Schoegelhofer1 , S. Werneck-Rohrer1 , H.N. Aschauer2 , J.E. Edwards3 . 1 Department of Child & Adolescent Psychiatry, Medical University Vienna, Austria, 2 Department of General Psychiatry, Medical University Vienna, Austria, 3 ORYGEN Research Centre, Parkville, VIC, Australia Presenting author contact: [email protected] Introduction: Individuals with schizophrenia experience problems in the perception of emotional material. Genetic factors contribute to the aetiology of schizophrenia however it is unclear if affect perception deficits represent an endophenotype for schizophrenia. Methods: We examined the capacity to recognize facially expressed emotion in 30 adolescents with first-episode schizophrenia (mean age 16.8, SD = 1.4 years), assessed as outpatients during the early recovery phase of illness, 27 first degree relatives of schizophrenic patients (14 siblings, 13 parents) (mean age 32.5, SD = 15.9 years), and 30 unaffected normal comparisons (mean age 15.6, SD = 2.0
S111
years). Facial tasks were computerised modifications of the Feinberg et al. (1986) procedure. Emotion expressions included fear, sadness, happiness, surprise, disgust, anger, and neutral. Results: One-way ANOVAs revealed significant group differences for fear, anger, and a combined fear-sadness score. Post hoc tests indicated that compared to the control group both, individuals with first-episode schizophrenia and first degree relatives of schizophrenic patients, were characterized by a significant deficit in the recognition of fear, as well as a significant impairment on the combined fearsadness score, but not for anger. Conclusions: The findings in first degree relatives corroborate the assumption that specific emotion recognition deficits for fear and sadness might represent a trait marker and endophenotype for schizophrenia. 0545 DELUSIONS AND CREATIVITY N. Zavala *. verbar;United Kingdom Presenting author contact: [email protected] Delusions are unreal beliefs which are out of the boundaries of logic and are not shared by the members of a given culture (APA, 1997). Henry Ey (1998) classified them into two general groups: sharp delusions and chronic delusions. This paper is focused in chronic delusions, which are divided according to different phenomenological features in paranoid, fantastic, and schizophrenic. Paranoid delusions are mainly characterized by its high systematization, its persecutory theme, and its absence of disintegration of the cognitive and personality functions. Fantastic delusions are mainly composed by a great imaginative content that contrasts with the maintenance of objective reality, conservation of cognitive functions, and absence of personality disintegration. Finally, schizophrenic delusions are shaped by its incoherence, its level of personality disintegration, and cognitive worsening. When delusions are orally expressed, its narrative structure can be analyzed. Siegel (1999), defined narrative as a description that joins internal and external experiences; it contrasts histories that give coherence and understanding to an individual living in the world and in time. Ramos (1998) stated that narrative is comprised by several elements: theme, order, structure, and an identifiable narrative voice. We suggest that when narrating their experiences, the delusional patients try to give coherence to his internal and external worlds, which have been transformed to the extent that other human beings see it as unreal. We also say that in their reconstruction of the world, the individual uses his creativity, and that creativity is influenced by the psychotic process or the very own creative qualities of the individual. Chavez (1999), defined creativity as the process of generating something, transforming or transcending the existing. This process comprises three overlapping phases: (A) Association-integration: the person makes associations between elements of the external world and the own subjectivity. During this phase occurs a perceptual, sensorial, cognitive and affective integration. Different levels of consciousness are involved in this phase. (B) Elaboration: the person works with the association building a product, using her or his particular talents and abilities. This phase is conscious and involves volition. (C) Communication: by sharing the work the associations are transmitted and reproduced in others, as well the sensorial and emotional experience. Communication ends the process at the
Schizophrenia Research 86 (2006)
115 consecutive referrals to CAMEO, a specialist early intervention service in South Cambridgeshire. Subjects were included if they were diagnosed as having either mania with psychotic symptoms (n = 45) or schizophreniform psychosis(n = 70). Groups were compared by diagnostic type, as well as by nature of psychotic symptoms (mood congruent/incongruent). Results: Patients’ cognitive functions were heterogenous. There was no significant groupwise difference between those with manic psychosis and those with schizophreniform psychosis in cognitive functioning. However when groups were compared by nature of psychotic symptoms (mood congruent/incongruent) there was significant difference, with those with mood incongruent psychotic symptoms performing worse on measures of the CANTAB subtests. Discussion: Our findings in this sample of young, first episode psychotic patients support the hypotheses that subjects with bipolar disorder and incongruent psychotic symptoms are a distinct diagnostic group, with cognitive functioning more akin to those with schizophrenia than those with bipolar disorder and mood congruent psychotic symptoms. Further follow up of this group is required to establish diagnostic stability in these patients over time, and illness course. 0402 PREMORBID ASSESSMENTS OF PATIENTS WITH FIRST EPISODE PSYCHOSIS N. Salesian *, J. Alaghband-rad, J. Mahmoudi. Roozbeh Hospital, Tehran, Iran Presenting author contact: [email protected] Introduction: We have done the premorbid assessments of our patients to compare premorbid patterns of first episode non-affective and affective psychoses. Methods: Consecutive patients with first-episode psychosis are assessed using the Premorbid Adjustment Scale (PAS). Data are collected from patient interviews after recovery from the psychotic episode (or at follow-up visits), families, and chart reviews. Results: As of now, twenty-two patients have been assessed. Patients were divided into non-affective [schizophrenia/schizoaffective (n = 9), brief psychosis (n = 1), delusional disorder (n = 1)] and affective [bipolar I disorder (n = 10), major depressive disorder with psychotic features (n = 1)] based on DSM-IV diagnoses at discharge. Mean ages of the non-affective and affective groups were 27.5 and 24.8 years, respectively; 63.6% in each group were male. Average PAS scores of Childhood (C), Early Adolescence (EA), Late Adolescence (LA), and Adulthood (A) were respectively 0.17, 0.25, 0.39 (n = 10), 0.46 (n = 6), in the non-affective group. Average PAS scores C, EA, LA, and A were respectively 0.24, 0.19, 0.29 (n = 8), 0.11 (n = 5) in the affective group. Discussion: Despite some difference between the preliminary PAS scores of the non-affective and affective groups, due to the small number of patients, results are still inconclusive. Findings are very likely to change as the study is in progress. 0433 PSYCHOMETRIC PROPERTIES OF THE CLINICAL AND PATIENT VERSION OF THE APATHY EVALUATION SCALE A. Faerden *, R. Nesv˚ag, I. Agartz, E. Barreth, A. Finseth, S. Friis, I. Melle. 1 Ullev˚al University Hospital, Oslo, Norway,
Abstracts 2 Diakonhjemmet
Hospital, Oslo, Norway, 3 University of Oslo, Oslo, Norway, 4 Aker University Hospital, Oslo, Norway Presenting author contact: [email protected] The different symptoms of the negative syndrome have received attention lately, and apathy has been one of interest. Apathy has been difficult to study because of the lack of a specific rating scale. The Apathy Evaluation Scale (AES) was developed by Marin for people with Alzheimer’s disease, and has been used to measure apathy in different neuropsychiatric diseases. It was recently used in a study of people with schizophrenia but has never been used in a population of first episode patients. The purpose of this study is to show the psychometric properties of the Apathy Evaluation Scale in first episode patients. Material and Methods: Material: This study reports the first 58 patients with first episode non-organic psychosis participants in the TOP study, a multi-site Norwegian study. Methods: The AES is an 18-item scale that defines apathy as a simultaneous diminution in the overt behavioural, cognitive and emotional components of goal directed behaviour. The AES consists of three versions. Clinical (C), self rated (S) and informant (I). The AES-C is based on a clinical interview and criteria with a 4-point likert scale resulting in a sum score of 18−72; higher score indicating more apathy. Principal factor analysis will be performed to study the psychometric properties, using the SPSS version 13. Results: The AES in this study showed good internal consistency, with a Cronbach’s a = 0.91 for the C version and a = 0.83 for the S version. There was good correlation between AES-C and AES-P (r = 0.681, p < 0.000). Discussion: The AES has good psychometric properties. It can be used to measure apathy in people with first episode psychosis. Data are preliminary; more will be presented at the meeting. 0468 IMPLICIT MEMORY AND SCHIZOPHRENIA M.-J. Dubuc, J. Forget, J.-P. Mottard *, M. Lassonde, A. Breault, N.C. Bedwani, R. Godbout, N. Lessard. Hˆopital Sacr´e-Coeur, Montreal, Quebec, Canada Presenting author contact: [email protected] Individuals with schizophrenia show relatively intact implicit memory compared to a perturbed declarative memory. Skill learning as well as priming are the most frequently used tasks to assess implicit memory. According to the model developed by Squire (1992), distinct neural networks are involved in skill learning and priming. While priming is thought to involve storage changes in the posterior neocortex (Schacter & Buckner, 1998), various forms of skill learning may depend upon the integrity of the corticostriatal pathway in association with structures of the extrapyramidal system (Gaffan, 1996) and the cerebellum (Doyon et al., 1996). Since schizophrenia underly fronto-striatal dysfunctions we hypothesized that schizophrenic patients should exhibit disturbance in skill learning and preserved priming. This was tested in 21 patients (11 first psychotic episode; 10 schizophrenic) and 10 matched controls using two visuoperceptual tasks. The procedural learning task consisted of 5 training sessions each including 32 pictures that appeared as a series of fragmented images, each image containing 8 levels of completion: level 1 was the most fragmented and level 8 represented the most complete picture. Subjects were asked to identify the picture and the procedural learning score were obtained by a reduction of identification level throughout sessions. The priming task consisted in the presentation of 32 images randomly selected from the 160
Posters, Theme 8: Cognitive functioning in first episode psychosis (FEP) seen in the 5 previous sessions, combined with 32 new images. Priming effect was measured by a reduction of identification level on previously seen pictures as compared to new pictures. Patients and controls showed a comparable priming effect but the patients were impaired on the skill learning task. These results indicate that visuoperceptual implicit memory is impaired in schizophrenia and suggest that the corticostriatal network may be involved. 0533 PREMORBID AND PRODROMAL COGNITION IN PSYCHOTIC ILLNESSES: PRELIMINARY RESULTS OF A META-ANALYSIS K.A. Woodberry1 *, A.J. Giuliano2 , M.K. Nock1 , L.J. Seidman2 . 1 Harvard University, Cambridge, MA, United States, 2 Harvard Medical School, Department of Psychiatry at Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Boston, MA, United States Presenting author contact: [email protected] Cognitive deficits are characteristic of a number of psychotic illnesses and increasingly considered a core feature of schizophrenia. Although they often appear years before the onset of acute psychotic symptoms and account for much of the disability associated with psychotic illnesses, very little is understood of their developmental course or relationship to psychosis onset. The purpose of this meta-analysis is to summarize current findings on premorbid cognition to improve understanding of the timing and nature of both global and specific deficits and the potential protective function of general intelligence. The magnitude of effects are reviewed from birth and conscript cohort studies, twin studies, genetic high risk samples, follow-back designs of individuals with schizophrenia-spectrum disorders, estimates of premorbid intellect in individuals with psychosis, and existing studies of cognition in clinical high risk or prodromal samples. Potential sources of heterogeneity in findings are discussed in relation to methodological issues as well as age of testing and age of symptom onset. Furthermore, we summarize the evidence for associations between premorbid cognition and diagnostic and functional outcomes. A developmental psychopathology perspective guides the discussion of implications for etiological models and future research. 0537 FEAR/SADNESS RECOGNITION IS IMPAIRED IN ADOLESCENTS WITH FIRST-EPISODE SCHIZOPHRENIA AND FIRST DEGREE RELATIVES G.P. Amminger1 *, M. Schoegelhofer1 , S. Werneck-Rohrer1 , H.N. Aschauer2 , J.E. Edwards3 . 1 Department of Child & Adolescent Psychiatry, Medical University Vienna, Austria, 2 Department of General Psychiatry, Medical University Vienna, Austria, 3 ORYGEN Research Centre, Parkville, VIC, Australia Presenting author contact: [email protected] Introduction: Individuals with schizophrenia experience problems in the perception of emotional material. Genetic factors contribute to the aetiology of schizophrenia however it is unclear if affect perception deficits represent an endophenotype for schizophrenia. Methods: We examined the capacity to recognize facially expressed emotion in 30 adolescents with first-episode schizophrenia (mean age 16.8, SD = 1.4 years), assessed as outpatients during the early recovery phase of illness, 27 first degree relatives of schizophrenic patients (14 siblings, 13 parents) (mean age 32.5, SD = 15.9 years), and 30 unaffected normal comparisons (mean age 15.6, SD = 2.0
S111
years). Facial tasks were computerised modifications of the Feinberg et al. (1986) procedure. Emotion expressions included fear, sadness, happiness, surprise, disgust, anger, and neutral. Results: One-way ANOVAs revealed significant group differences for fear, anger, and a combined fear-sadness score. Post hoc tests indicated that compared to the control group both, individuals with first-episode schizophrenia and first degree relatives of schizophrenic patients, were characterized by a significant deficit in the recognition of fear, as well as a significant impairment on the combined fearsadness score, but not for anger. Conclusions: The findings in first degree relatives corroborate the assumption that specific emotion recognition deficits for fear and sadness might represent a trait marker and endophenotype for schizophrenia. 0545 DELUSIONS AND CREATIVITY N. Zavala *. verbar;United Kingdom Presenting author contact: [email protected] Delusions are unreal beliefs which are out of the boundaries of logic and are not shared by the members of a given culture (APA, 1997). Henry Ey (1998) classified them into two general groups: sharp delusions and chronic delusions. This paper is focused in chronic delusions, which are divided according to different phenomenological features in paranoid, fantastic, and schizophrenic. Paranoid delusions are mainly characterized by its high systematization, its persecutory theme, and its absence of disintegration of the cognitive and personality functions. Fantastic delusions are mainly composed by a great imaginative content that contrasts with the maintenance of objective reality, conservation of cognitive functions, and absence of personality disintegration. Finally, schizophrenic delusions are shaped by its incoherence, its level of personality disintegration, and cognitive worsening. When delusions are orally expressed, its narrative structure can be analyzed. Siegel (1999), defined narrative as a description that joins internal and external experiences; it contrasts histories that give coherence and understanding to an individual living in the world and in time. Ramos (1998) stated that narrative is comprised by several elements: theme, order, structure, and an identifiable narrative voice. We suggest that when narrating their experiences, the delusional patients try to give coherence to his internal and external worlds, which have been transformed to the extent that other human beings see it as unreal. We also say that in their reconstruction of the world, the individual uses his creativity, and that creativity is influenced by the psychotic process or the very own creative qualities of the individual. Chavez (1999), defined creativity as the process of generating something, transforming or transcending the existing. This process comprises three overlapping phases: (A) Association-integration: the person makes associations between elements of the external world and the own subjectivity. During this phase occurs a perceptual, sensorial, cognitive and affective integration. Different levels of consciousness are involved in this phase. (B) Elaboration: the person works with the association building a product, using her or his particular talents and abilities. This phase is conscious and involves volition. (C) Communication: by sharing the work the associations are transmitted and reproduced in others, as well the sensorial and emotional experience. Communication ends the process at the