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ADVERSE LIFE EVENTS IN HELP-SEEKING AND NON-HELP-SEEKING UHR INDIVIDUALS
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Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
at high risk of psychotic disorder, particularly of schizophrenia spectrum disorders, thus supplementing the UHR identification approach. Bechdolf et al. (Germany) report on 128 people at risk of psychosis in which axis II cluster A was significantly correlated with higher PANSS scores ratings and lower GAF scores as well as higher conversion rates at 12 month follow up. This finding indicates early intervention efforts need to specifically address recent comorbidity issues. Armando and colleagues (Italy/UK) will present on differences in prodromal phases between Adult Onset and Early Onset Psychosis. Yung et al (Australia) report the functional outcome of 268 people at-risk of psychosis who were interviewed between 2.4 to 14.9 years. Although transition to psychosis was a significant predictor of poor functioning, the likelihood of having poor outcome if a UHR individual “transitions” was less than 40%. These findings are consistent with the theory that negative symptoms and negative schizotypy are closer to the underlying basis of schizophrenia than positive symptoms. M. Weiser (Israel) will discuss the results in regard to the recent DSM V debate and future research implications.
ADVERSE LIFE EVENTS IN HELP-SEEKING AND NON-HELP-SEEKING UHR INDIVIDUALS Lucia Valmaggia, F. Day, M. Jarrett, C. Pariante, A. Papadopoulos, I. Papadopoulos, T. Craig, A. Forrester, P. Garety, D. Freeman, P. McGuire Institute of Psychiatry, King’s College London, & OASIS, South London & Maudsley Trust, London, United Kingdom There is increasing evidence that aetiological models of psychosis need to incorporate the role of social, psychological and biological factors, and to clarify how they interact. In this symposium we will discuss the psychological effect of adverse life events in help-seeking individuals at high risk of psychosis and in a non-help-seeking high risk population recruited in a prison setting. Help-seeking UHR participants (N=60) were compared with non-help-seeking (N=40) and healthy control participants (N=40) on measures of exposure to psychosocial stressors. Both help-seeking and non-help-seeking UHR participants were exposed to greater levels of psychosocial stress than healthy control participants. Specifically, UHR participants were more likely to have been separated from their parents, report severe parental antipathy, and have been bullied while growing up. Positive correlations were found between current stress and number of life events and attenuated psychotic symptoms in the UHR participants. Adverse life events were associated with less functional coping styles. This study shows that people at high risk of developing psychosis experience greater levels of psychosocial stress than matched healthy control participants throughout the lifetime, and that current stress is associated with psychotic symptomatology.
BASIC SELF-DISTURBANCE PREDICTS PSYCHOSIS ONSET IN THE ULTRA HIGH RISK FOR PSYCHOSIS (“PRODROMAL”) POPULATION Barnaby Nelson, A. Thompson, A.R. Yung Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Australia Over the last fifteen years, there has been increased interest in the early phase of schizophrenia and other psychotic disorders. The focus was initially on the first episode of psychosis but soon reached further back to the pre-onset or prodromal phase. Several strategies have been introduced to identify individuals in the putatively prodromal phase of psychotic disorder. The most widely used of these approaches is the “ultra-high risk” (UHR) approach, which combines known trait and state risk factors for psychotic disorder. Theoretical and empirical research in the phenomenological tradition indicates that disturbance of the basic sense of self may be a core phenotypic marker of psychotic vulnerability, particularly of schizophrenia spectrum disorders. Disturbance of the basic self involves a disruption of the sense of ownership of experience and agency of action and is associated with a variety of dissociative symptoms and anomalous cognitive and bodily experiences. In this study, we investigated the presence of basic self-disturbance in a UHR group compared to a healthy control group and whether it predicted transition to psychotic disorder. Method: 49 UHR subjects (mean age = 19.22 years, 44.9% males) were recruited from the
PACE clinic, Orygen Youth Health, Melbourne. 52 matched healthy control subjects (mean age = 20.1 years, 48.1% males) were recruited from the community. Subjects were assessed for basic self-disturbance using the Examination of Anomalous Self Experience (EASE) instrument.A range of other clinical variables were also measured. Subjects were assessed at baseline and followed for a mean of 569 days. Results: Levels of self-disturbance (total score and all sub-scales) were significantly higher in the UHR sample compared to the healthy control group (p<0.001). 13/49 cases (26.5%) transitioned to psychosis over the follow-up period. Cox regression, controlling for duration of symptoms prior to clinic entry and functioning levels (SOFAS score), indicated that total EASE score significantly predicted time to transition (p<0.05).This was mainly due to the effect of the first two subscales of the EASE – Cognition and Stream of Consciousness and Self Awareness and Presence. Exploratory analyses indicated that basic self-disturbance scores were higher in schizophrenia spectrum cases, irrespective of transition to psychosis, than non-schizophrenia spectrum cases. Discussion: The results indicate that identifying basic self-disturbance in the UHR population may provide a means of further “closing in” on individuals truly at high risk of psychotic disorder, particularly of schizophrenia spectrum disorders, thus supplementing the UHR identification approach. This may be of practical value by reducing inclusion of “false positive” cases in ultra-high risk samples, and of theoretical value by shedding light on core phenotypic features of schizophrenia spectrum pathology.
AXIS I AND II COMORBIDITY IN PEOPLE AT-RISK OF PSYCHOSIS IN THE EARLY INITIAL PRODROMAL STATE: CORRELATIONS WITH SYMPTOMS, FUNCTIONING AND TRANSITION TO PSYCHOSIS Andreas Bechdolf, Tanja Tecic, Berenike Schulz, Verena Pützfeld, Ralf Pukrop, Anke Brockhaus-Dumke, Julia Berning, Birgit Janssen, Petra Decker, Ronald Bottlender, Hans-Jurgen Moller, Wolfgang Gaebel, Wolfgang Maier, Joachim Klosterkotter Department of Psychiatry, University of Cologne, Cologne, Germany Up to 80% of young people at risk for first episode psychosis fulfill criteria of a DSM IV axis I and up to 50% for axis II disorder. The aim of the present study was to explore whether patients with or without comorbidity differ as regards symptoms, functioning or transition to psychosis. 113 helpseeking outpatients in the early initial prodromal state of psychosis (EIPS, primarily defined by psychosis predictive basic symptoms) were assessed with the SCID for axis I and II diagnoses and provided psychopathology and functioning data at intake and transition data at 12 months follow-up. 62.1% of the population fulfilled at least one axis I and 49.1% at least one axis II diagnosis. Axis I comorbidity was significantly associated with higher PANSS scores and on a tendency level with lower GAF scores at intake but not related to conversion at 12 months follow-up. As regards axis II cluster A was significantaly correlated with higher PANSS scores ratings and lower GAF scores as well as higher conversion rates at 12 month follow up (has to be interpreted with caution because of very small numbers). Axis I and II comorbidity in EIPS is associated with higher levels of symptoms lower levels of functioning and higher conversion rates. Early intervention efforts should therefore be designed to specifically address recent comorbidity issues.
THE RELATIONSHIP BETWEEN TRANSITION TO PSYCHOSIS, AND FUNCTIONAL OUTCOME IN A GROUP AT ULTRA HIGH RISK FOR PSYCHOTIC DISORDER Barnaby Nelson, A.R. Yung, A. Lin, S.J. Wood, A. Thompson University of Melbourne, Melbourne, Australia Transition to psychosis, defined exclusively by positive symptoms, has traditionally been the outcome of interest in Ultra High Risk/Clinical High Risk (UHR/CHR) studies. However using only positive symptoms to define psychotic disorder may miss some people who are markedly functionally impaired yet diagnose someone as disordered who has only briefly experienced full threshold positive symptoms and who may be functionally well. We speculate that poor functional outcome may be closer to an underlying neurodevelopmental schizophrenia substrate rather than transition per se. We therefore aimedto investigate (1) whether transition status was a de-
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
at high risk of psychotic disorder, particularly of schizophrenia spectrum disorders, thus supplementing the UHR identification approach. Bechdolf et al. (Germany) report on 128 people at risk of psychosis in which axis II cluster A was significantly correlated with higher PANSS scores ratings and lower GAF scores as well as higher conversion rates at 12 month follow up. This finding indicates early intervention efforts need to specifically address recent comorbidity issues. Armando and colleagues (Italy/UK) will present on differences in prodromal phases between Adult Onset and Early Onset Psychosis. Yung et al (Australia) report the functional outcome of 268 people at-risk of psychosis who were interviewed between 2.4 to 14.9 years. Although transition to psychosis was a significant predictor of poor functioning, the likelihood of having poor outcome if a UHR individual “transitions” was less than 40%. These findings are consistent with the theory that negative symptoms and negative schizotypy are closer to the underlying basis of schizophrenia than positive symptoms. M. Weiser (Israel) will discuss the results in regard to the recent DSM V debate and future research implications.
ADVERSE LIFE EVENTS IN HELP-SEEKING AND NON-HELP-SEEKING UHR INDIVIDUALS Lucia Valmaggia, F. Day, M. Jarrett, C. Pariante, A. Papadopoulos, I. Papadopoulos, T. Craig, A. Forrester, P. Garety, D. Freeman, P. McGuire Institute of Psychiatry, King’s College London, & OASIS, South London & Maudsley Trust, London, United Kingdom There is increasing evidence that aetiological models of psychosis need to incorporate the role of social, psychological and biological factors, and to clarify how they interact. In this symposium we will discuss the psychological effect of adverse life events in help-seeking individuals at high risk of psychosis and in a non-help-seeking high risk population recruited in a prison setting. Help-seeking UHR participants (N=60) were compared with non-help-seeking (N=40) and healthy control participants (N=40) on measures of exposure to psychosocial stressors. Both help-seeking and non-help-seeking UHR participants were exposed to greater levels of psychosocial stress than healthy control participants. Specifically, UHR participants were more likely to have been separated from their parents, report severe parental antipathy, and have been bullied while growing up. Positive correlations were found between current stress and number of life events and attenuated psychotic symptoms in the UHR participants. Adverse life events were associated with less functional coping styles. This study shows that people at high risk of developing psychosis experience greater levels of psychosocial stress than matched healthy control participants throughout the lifetime, and that current stress is associated with psychotic symptomatology.
BASIC SELF-DISTURBANCE PREDICTS PSYCHOSIS ONSET IN THE ULTRA HIGH RISK FOR PSYCHOSIS (“PRODROMAL”) POPULATION Barnaby Nelson, A. Thompson, A.R. Yung Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Australia Over the last fifteen years, there has been increased interest in the early phase of schizophrenia and other psychotic disorders. The focus was initially on the first episode of psychosis but soon reached further back to the pre-onset or prodromal phase. Several strategies have been introduced to identify individuals in the putatively prodromal phase of psychotic disorder. The most widely used of these approaches is the “ultra-high risk” (UHR) approach, which combines known trait and state risk factors for psychotic disorder. Theoretical and empirical research in the phenomenological tradition indicates that disturbance of the basic sense of self may be a core phenotypic marker of psychotic vulnerability, particularly of schizophrenia spectrum disorders. Disturbance of the basic self involves a disruption of the sense of ownership of experience and agency of action and is associated with a variety of dissociative symptoms and anomalous cognitive and bodily experiences. In this study, we investigated the presence of basic self-disturbance in a UHR group compared to a healthy control group and whether it predicted transition to psychotic disorder. Method: 49 UHR subjects (mean age = 19.22 years, 44.9% males) were recruited from the
PACE clinic, Orygen Youth Health, Melbourne. 52 matched healthy control subjects (mean age = 20.1 years, 48.1% males) were recruited from the community. Subjects were assessed for basic self-disturbance using the Examination of Anomalous Self Experience (EASE) instrument.A range of other clinical variables were also measured. Subjects were assessed at baseline and followed for a mean of 569 days. Results: Levels of self-disturbance (total score and all sub-scales) were significantly higher in the UHR sample compared to the healthy control group (p<0.001). 13/49 cases (26.5%) transitioned to psychosis over the follow-up period. Cox regression, controlling for duration of symptoms prior to clinic entry and functioning levels (SOFAS score), indicated that total EASE score significantly predicted time to transition (p<0.05).This was mainly due to the effect of the first two subscales of the EASE – Cognition and Stream of Consciousness and Self Awareness and Presence. Exploratory analyses indicated that basic self-disturbance scores were higher in schizophrenia spectrum cases, irrespective of transition to psychosis, than non-schizophrenia spectrum cases. Discussion: The results indicate that identifying basic self-disturbance in the UHR population may provide a means of further “closing in” on individuals truly at high risk of psychotic disorder, particularly of schizophrenia spectrum disorders, thus supplementing the UHR identification approach. This may be of practical value by reducing inclusion of “false positive” cases in ultra-high risk samples, and of theoretical value by shedding light on core phenotypic features of schizophrenia spectrum pathology.
AXIS I AND II COMORBIDITY IN PEOPLE AT-RISK OF PSYCHOSIS IN THE EARLY INITIAL PRODROMAL STATE: CORRELATIONS WITH SYMPTOMS, FUNCTIONING AND TRANSITION TO PSYCHOSIS Andreas Bechdolf, Tanja Tecic, Berenike Schulz, Verena Pützfeld, Ralf Pukrop, Anke Brockhaus-Dumke, Julia Berning, Birgit Janssen, Petra Decker, Ronald Bottlender, Hans-Jurgen Moller, Wolfgang Gaebel, Wolfgang Maier, Joachim Klosterkotter Department of Psychiatry, University of Cologne, Cologne, Germany Up to 80% of young people at risk for first episode psychosis fulfill criteria of a DSM IV axis I and up to 50% for axis II disorder. The aim of the present study was to explore whether patients with or without comorbidity differ as regards symptoms, functioning or transition to psychosis. 113 helpseeking outpatients in the early initial prodromal state of psychosis (EIPS, primarily defined by psychosis predictive basic symptoms) were assessed with the SCID for axis I and II diagnoses and provided psychopathology and functioning data at intake and transition data at 12 months follow-up. 62.1% of the population fulfilled at least one axis I and 49.1% at least one axis II diagnosis. Axis I comorbidity was significantly associated with higher PANSS scores and on a tendency level with lower GAF scores at intake but not related to conversion at 12 months follow-up. As regards axis II cluster A was significantaly correlated with higher PANSS scores ratings and lower GAF scores as well as higher conversion rates at 12 month follow up (has to be interpreted with caution because of very small numbers). Axis I and II comorbidity in EIPS is associated with higher levels of symptoms lower levels of functioning and higher conversion rates. Early intervention efforts should therefore be designed to specifically address recent comorbidity issues.
THE RELATIONSHIP BETWEEN TRANSITION TO PSYCHOSIS, AND FUNCTIONAL OUTCOME IN A GROUP AT ULTRA HIGH RISK FOR PSYCHOTIC DISORDER Barnaby Nelson, A.R. Yung, A. Lin, S.J. Wood, A. Thompson University of Melbourne, Melbourne, Australia Transition to psychosis, defined exclusively by positive symptoms, has traditionally been the outcome of interest in Ultra High Risk/Clinical High Risk (UHR/CHR) studies. However using only positive symptoms to define psychotic disorder may miss some people who are markedly functionally impaired yet diagnose someone as disordered who has only briefly experienced full threshold positive symptoms and who may be functionally well. We speculate that poor functional outcome may be closer to an underlying neurodevelopmental schizophrenia substrate rather than transition per se. We therefore aimedto investigate (1) whether transition status was a de-