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4:30 PM CHILDHOOD TRAUMA AND PSYCHOSIS IN A PROSPECTIVE COHORT STUDY: CAUSE, EFFECT, AND DIRECTIONALITY
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
6:00 PM THE EXCESS OF NON-RIGHT-HANDEDNESS IN SCHIZOPHRENIA IS NOT THE RESULT OF METHODOLOGICAL ARTIFACTS AND BIASES – A METAANALYSIS Marco Hirnstein, Kenneth Hugdahl University of Bergen Background: The notion that schizophrenia is characterised by increased non-right-handedness is a cornerstone of the theory that schizophrenia arises from, and is genetically linked to, abnormal brain lateralisation. Reviews and meta-analyses have reported higher rates of non-right-handers in schizophrenia patients. However, this was suggested to be the result of a sex artefact or a hidden bias in self-report handedness questionnaires. The present study therefore investigated in a meta-analytical approach whether the excess of non-right-handedness is seen in both females and males and also when handedness is assessed behaviourally. Methods: Electronic databases were searched for studies that reported (1) the rate of female and male non-right-handers in schizophrenia compared to controls and (2) the rate of non-right-handers in schizophrenia (regardless of sex) based on behavioural handedness assessment. Results: The odds ratios (OR) for both females OR=1.63 (based on 621 patients, 3747 controls) and males OR=1.50 (based on 1213 patients, 3800 controls) differed significantly from 1.0, indicating both female and male schizophrenia patients were more often non-right-handed than controls. Moreover, there was an excess of non-right-handedness in schizophrenia patients when handedness was assessed behaviourally: OR=1.84 (1255 patients, 6260 controls). Even when both sex and behavioural handedness assessment were controlled for simultaneously, the excess of nonrighthandedness persisted. Discussion: The findings clearly demonstrate that the excess of non-righthandedness in schizophrenia does not result from a sex artefact or from biased handedness questionnaires. It is a true empirical effect and may indeed reflect a genetic link between schizophrenia and brain lateralisation.
Oral Presentations THERAPEUTICS Chairperson: Robert Zipursky Tuesday, 8 April 2014
4:15 PM – 6:15 PM
4:15 PM ANTIPSYCHOTIC MEDICATION AND REMISSION OF PSYCHOTIC SYMPTOMS. LONG TERM DEVELOPMENT AND CHARACTERISTICS Ditte R. Gotfredsen, Regitze Soelling Hansen, Carsten Hjorthøj, Stephen Austin, Merete Nordentoft Mental Health Centre Copenhagen Background: Randomised clinical trials on discontinuation of antipsychotic medication after a psychotic episode indicate that there is a risk of relapse when medication is discontinued. Therefore several national guidelines recommend continuous use of antipsychotic medication after a psychotic episode, in order to minimize the risk of relapse. However all antipsychotic medication have adverse effects such as extrapyramidal symptoms, weight gain and increased risk of metabolic syndrome. Some studies have identified a subgroup of patients who can obtain remission of psychotic symptoms without using antipsychotic medication on a long term basis. This study investigated the long term development and outcome of first episode psychotic patients and whether patients in remission of psychotic symptoms display certain characteristics. Methods: The study is based on the Danish Opus Trial which is a cohort study including 496 patients diagnosed with schizophrenia spectrum disorders. The patients were followed over a time period of 10 years and data regarding socio-demographic factors, psychopathology, level of functioning and medication was collected at 4 different follow-ups. Based on this data different characteristics and patient trajectories was identified. Results: At all follow-ups a proportion of patients who obtained stable remission without a use of antipsychotic medication was found. This proportion of remissioners increased at each follow-up and reached its’
S65
maximum at the 10 year follow-up, where it accounted for 30% of the patient population. A favourable outcome at the 10-year follow-up was associated with female gender, shorter duration of untreated psychosis and no substance. The results also revealed that patients tend to follow certain trajectories over time. From the 5 to 10-year follow-up 87% of the patients in remission, without antipsychotic medication, remained in remission. The tendency for stabilization was also found for the other patient groups. Discussion: A substantial proportion of patients with schizophrenia spectrum disorders were in remission without the use of antipsychotic medication at all follow-ups peaking at year 10 with 30%. These patients seem to differ from the rest in terms of different characteristics. Furthermore the majority of this subgroup remains in remission at each consecutive followup, indicating stability in the disease course especially on the long term basis. The results suggest that guidelines on antipsychotic medication do not pay sufficient attention to the patient subgroup in long term remission without a use of antipsychotic medication. These findings call for further trials on discontinuation.
4:30 PM CHILDHOOD TRAUMA AND PSYCHOSIS IN A PROSPECTIVE COHORT STUDY: CAUSE, EFFECT, AND DIRECTIONALITY Ian Kelleher 1 , Helen Keeley 2 , Paul Corcoran 2 , Hugh Ramsay 3 , Camilla Wasserman 4 , Vladimir Carli 5 , Marco Sarchiapone 6 , Christina Hoven 4 , Danuta Wasserman 5 , Mary Cannon 3 1 Karolinska Institutet, National Centre for Suicide Research and Prevention of Mental Ill-Health; 2 National Suicide Research Foundation, Cork, Ireland; 3 Royal College of Surgeons in Ireland; 4 Columbia University; 5 Karolinska Institutet; 6 University of Molise Background: A relationship between childhood trauma, psychotic experiences and psychotic disorder is well established. There is still much debate, however, as to whether the relationship is causal. A number of prospective cohort studies have addressed this issue but key epidemiological questions remain unanswered, including: 1. Is the relationship between childhood trauma and psychotic experiences uni- or bi-directional? 2. Does trauma predict newly incident psychotic experiences? 3. Does cessation of trauma predict cessation of psychotic experiences? Methods: Prospective cohort study of 1,112 school-based adolescents aged 13 to 16 years, assessed at baseline, 3-months, and 12 months for childhood trauma (physical assault and bullying) and psychotic experiences. Results: There was a bi-directional relationship between childhood trauma and psychotic experiences, with trauma predicting psychotic experiences over time and vice versa. However, even after accounting for this bidirectional relationship with a number of strict adjustments, looking only at newly incident psychotic experiences occurring over the course of the study following exposure to traumatic experiences, we found that trauma was strongly predictive of psychotic experiences. There was a dose-response relationship between severity of bullying and risk for psychotic experiences. What is more, cessation of trauma predicted cessation of psychotic experiences, with the incidence of psychotic experiences decreasing significantly in individuals whose exposure to trauma ceased over the course of the study. Discussion: After a series of conservative adjustments, we found that exposure to childhood trauma predicted newly incident psychotic experiences. We also report the first direct evidence that cessation of traumatic experiences in the population leads to a reduction in the incidence of psychotic experiences.
4:45 PM INTENTION-TO-HARM IS THE KEY COMPONENT LINKING CHILDHOOD TRAUMATIC EXPERIENCES TO PSYCHOSIS Martine M. van Nierop 1 , Tineke Lataster 1 , Feikje Smeets 1 , Catherine van Zelst 1 , Ron de Graaf 2 , Margreet ten Have 2 , Maarten Bak 1,3 , Inez Myin-Germeys 1 , Wolfgang Viechtbauer 1 , Jim van Os 1 , Ruud van Winkel 1 1 Maastricht University; 2 Trimbos; 3 Mondriaan Mental Hospital Background: A large number of studies have reported a link between
6:00 PM THE EXCESS OF NON-RIGHT-HANDEDNESS IN SCHIZOPHRENIA IS NOT THE RESULT OF METHODOLOGICAL ARTIFACTS AND BIASES – A METAANALYSIS Marco Hirnstein, Kenneth Hugdahl University of Bergen Background: The notion that schizophrenia is characterised by increased non-right-handedness is a cornerstone of the theory that schizophrenia arises from, and is genetically linked to, abnormal brain lateralisation. Reviews and meta-analyses have reported higher rates of non-right-handers in schizophrenia patients. However, this was suggested to be the result of a sex artefact or a hidden bias in self-report handedness questionnaires. The present study therefore investigated in a meta-analytical approach whether the excess of non-right-handedness is seen in both females and males and also when handedness is assessed behaviourally. Methods: Electronic databases were searched for studies that reported (1) the rate of female and male non-right-handers in schizophrenia compared to controls and (2) the rate of non-right-handers in schizophrenia (regardless of sex) based on behavioural handedness assessment. Results: The odds ratios (OR) for both females OR=1.63 (based on 621 patients, 3747 controls) and males OR=1.50 (based on 1213 patients, 3800 controls) differed significantly from 1.0, indicating both female and male schizophrenia patients were more often non-right-handed than controls. Moreover, there was an excess of non-right-handedness in schizophrenia patients when handedness was assessed behaviourally: OR=1.84 (1255 patients, 6260 controls). Even when both sex and behavioural handedness assessment were controlled for simultaneously, the excess of nonrighthandedness persisted. Discussion: The findings clearly demonstrate that the excess of non-righthandedness in schizophrenia does not result from a sex artefact or from biased handedness questionnaires. It is a true empirical effect and may indeed reflect a genetic link between schizophrenia and brain lateralisation.
Oral Presentations THERAPEUTICS Chairperson: Robert Zipursky Tuesday, 8 April 2014
4:15 PM – 6:15 PM
4:15 PM ANTIPSYCHOTIC MEDICATION AND REMISSION OF PSYCHOTIC SYMPTOMS. LONG TERM DEVELOPMENT AND CHARACTERISTICS Ditte R. Gotfredsen, Regitze Soelling Hansen, Carsten Hjorthøj, Stephen Austin, Merete Nordentoft Mental Health Centre Copenhagen Background: Randomised clinical trials on discontinuation of antipsychotic medication after a psychotic episode indicate that there is a risk of relapse when medication is discontinued. Therefore several national guidelines recommend continuous use of antipsychotic medication after a psychotic episode, in order to minimize the risk of relapse. However all antipsychotic medication have adverse effects such as extrapyramidal symptoms, weight gain and increased risk of metabolic syndrome. Some studies have identified a subgroup of patients who can obtain remission of psychotic symptoms without using antipsychotic medication on a long term basis. This study investigated the long term development and outcome of first episode psychotic patients and whether patients in remission of psychotic symptoms display certain characteristics. Methods: The study is based on the Danish Opus Trial which is a cohort study including 496 patients diagnosed with schizophrenia spectrum disorders. The patients were followed over a time period of 10 years and data regarding socio-demographic factors, psychopathology, level of functioning and medication was collected at 4 different follow-ups. Based on this data different characteristics and patient trajectories was identified. Results: At all follow-ups a proportion of patients who obtained stable remission without a use of antipsychotic medication was found. This proportion of remissioners increased at each follow-up and reached its’
S65
maximum at the 10 year follow-up, where it accounted for 30% of the patient population. A favourable outcome at the 10-year follow-up was associated with female gender, shorter duration of untreated psychosis and no substance. The results also revealed that patients tend to follow certain trajectories over time. From the 5 to 10-year follow-up 87% of the patients in remission, without antipsychotic medication, remained in remission. The tendency for stabilization was also found for the other patient groups. Discussion: A substantial proportion of patients with schizophrenia spectrum disorders were in remission without the use of antipsychotic medication at all follow-ups peaking at year 10 with 30%. These patients seem to differ from the rest in terms of different characteristics. Furthermore the majority of this subgroup remains in remission at each consecutive followup, indicating stability in the disease course especially on the long term basis. The results suggest that guidelines on antipsychotic medication do not pay sufficient attention to the patient subgroup in long term remission without a use of antipsychotic medication. These findings call for further trials on discontinuation.
4:30 PM CHILDHOOD TRAUMA AND PSYCHOSIS IN A PROSPECTIVE COHORT STUDY: CAUSE, EFFECT, AND DIRECTIONALITY Ian Kelleher 1 , Helen Keeley 2 , Paul Corcoran 2 , Hugh Ramsay 3 , Camilla Wasserman 4 , Vladimir Carli 5 , Marco Sarchiapone 6 , Christina Hoven 4 , Danuta Wasserman 5 , Mary Cannon 3 1 Karolinska Institutet, National Centre for Suicide Research and Prevention of Mental Ill-Health; 2 National Suicide Research Foundation, Cork, Ireland; 3 Royal College of Surgeons in Ireland; 4 Columbia University; 5 Karolinska Institutet; 6 University of Molise Background: A relationship between childhood trauma, psychotic experiences and psychotic disorder is well established. There is still much debate, however, as to whether the relationship is causal. A number of prospective cohort studies have addressed this issue but key epidemiological questions remain unanswered, including: 1. Is the relationship between childhood trauma and psychotic experiences uni- or bi-directional? 2. Does trauma predict newly incident psychotic experiences? 3. Does cessation of trauma predict cessation of psychotic experiences? Methods: Prospective cohort study of 1,112 school-based adolescents aged 13 to 16 years, assessed at baseline, 3-months, and 12 months for childhood trauma (physical assault and bullying) and psychotic experiences. Results: There was a bi-directional relationship between childhood trauma and psychotic experiences, with trauma predicting psychotic experiences over time and vice versa. However, even after accounting for this bidirectional relationship with a number of strict adjustments, looking only at newly incident psychotic experiences occurring over the course of the study following exposure to traumatic experiences, we found that trauma was strongly predictive of psychotic experiences. There was a dose-response relationship between severity of bullying and risk for psychotic experiences. What is more, cessation of trauma predicted cessation of psychotic experiences, with the incidence of psychotic experiences decreasing significantly in individuals whose exposure to trauma ceased over the course of the study. Discussion: After a series of conservative adjustments, we found that exposure to childhood trauma predicted newly incident psychotic experiences. We also report the first direct evidence that cessation of traumatic experiences in the population leads to a reduction in the incidence of psychotic experiences.
4:45 PM INTENTION-TO-HARM IS THE KEY COMPONENT LINKING CHILDHOOD TRAUMATIC EXPERIENCES TO PSYCHOSIS Martine M. van Nierop 1 , Tineke Lataster 1 , Feikje Smeets 1 , Catherine van Zelst 1 , Ron de Graaf 2 , Margreet ten Have 2 , Maarten Bak 1,3 , Inez Myin-Germeys 1 , Wolfgang Viechtbauer 1 , Jim van Os 1 , Ruud van Winkel 1 1 Maastricht University; 2 Trimbos; 3 Mondriaan Mental Hospital Background: A large number of studies have reported a link between