CERP – CENTRES OF EXCELLENCE IN RELAPSE PREVENTION. AN INTERNATIONAL EDUCATIONAL PROGRAMME TO ENHANCE RELAPSE PREVENTION IN SCHIZOPHRENIA

Abstracts

Methods: A prospective study of all MHA assessments conducted in one year (April 2009- March 2010) by the Birmingham and Solihull mental Health Foundation Trust (BSHMFT). The study sample consists of an estimated 85 to 100 assessments per month. The study will be reporting findings for the first six months. The research assessment includes data on sociodemographics, diagnosis, ethnicity, objective and subjective measures of risk, level of social support, outcome of assessment and the availability and use of community alternatives to detention. Results: Preliminary results (N = 322) show that the average age of those assessed is 40.13 (SD=14.95), with 58.3% men. The largest proportion of ethnic composition of those assessed was White British (44.9%), Black African-Carribean (11.4%), Pakistani (13.9%), Indian (5.3%) and Black African (5.1%). A significant association between ethnicity and gender was found, with more men assessed from Pakistani, Black African and Black African Carribean ethnicity. A significantly greater proportion of Black African and Black AfricanCarribean individuals assessed were living alone. Gender was a significant predictor of the outcome of the assessment, with significantly more men being put on a section 3 (detention for treatment) and a community treatment order (CTO). Discussion: A considerably large proportion of those assessed with the Mental Health Act (MHA) under the BSMHFT are from Black and Minority ethnic (BME) groups, with a significant proportion of the BME group being men and living alone. The gender differences with the outcome of the MHA assessment suggests that more women are likely to be detained under less restrivtive conditions (i.e. Section 2 or informal admission), as well as more men are being put on CTO's within the community. The risk factors associated with the outcomes will be presented and the implications of this research in improving outcomes for Black and Minority ethnic groups will be discussed.

doi:10.1016/j.schres.2010.02.492

Poster 265 ODOUR IDENTIFICATION ASSESSMENT IN SCHIZOPHRENIA PATIENTS USING A NEW OLFACTO-VISUAL TOOL: RELATIONS BETWEEN OLFACTORY DEFICIT AND SYMPTOMATOLOGY Marie-Line Hamtat1, Jack Doron1, Olivier Grondin1, Katia M'Bailara1, Alain Desage2, Vanessa Meyer1, Gilles Sicard3 1 University of Bordeaux 2 Bordeaux, Bordeaux, France; 2Hospital Center Charles Perrens Bordeaux, Bordeaux, France; 3European Center of taste sciences Dijon, Dijon, France Background: The study of olfactory function in schizophrenia reveals various deficits of patients in discrimination, in memory tasks, in hedonicity and in familiarity judgments. In this pathology, odor identification impairment is frequently observed (Brewer et al., 2007, Moberg et al., 2006). Moreover it has been shown that this deficit is correlated with negative symptoms as flat affect, social withdraw and poor personal hygiene. Its impact on daily life seems to be consistent. In order to assess the performance of olfactory identification in the schizophrenic patients, our objective was to test and standardize a new testing procedure. Using an olfacto-visual tool we can calculate a score evaluating their difficulties in the expression of sensory perceptions. The designed olfacto-visual tool is based on associations between images of odorant sources and odorant stimuli. In parallel, we study the relationship between olfactory identification performance and schizophrenic symptoms. Methods: We proposed several tenth of pleasant and unpleasant olfactory signatures of objects of the everyday life. The odorants and

295

their corresponding visual images have been selected and validated by the general population. The identification task consists in designating one of a 5 images corresponding with the presented odour (forced choice). A computerized tool has been tested by 100 participants from the general population. Then, we have compared the results of two matched samples, 30 controls and 30 chronic schizophrenia patients aged from 18 to 65 years. Results: The new olfactory-visual tool confirms that this pathological cohort shows an olfactory identification deficit. The patients identify less odorant items than controls and they spent more time to do it. In addition, we highlight the olfactory deficit correlation with schizophrenic symptoms. The effect is dependent on the hedonic value of odorants. Discussion: Later, the odour and image sets will be used as a basis for olfactory training to reduce the identification deficit. In this way, we aim an olfactory remediation (orthosmia) probably to improve symptoms and everyday life of patients.

doi:10.1016/j.schres.2010.02.493

Poster 266 CERP – CENTRES OF EXCELLENCE IN RELAPSE PREVENTION. AN INTERNATIONAL EDUCATIONAL PROGRAMME TO ENHANCE RELAPSE PREVENTION IN SCHIZOPHRENIA Tim J. Lambert1, John Kane2, Werner Kissling3, Eduard Parellada4 1 Sydney University Camperdown, NSW, Australia; 2The Zucker Hillside Hospital Queens, NY, USA; 3Technical University of Munich Munich Germany; 4Hospital Clínic Barcelona Barcelona Spain Background: CERP is a program initiated by an international group of expert psychiatrists, to address the worldwide issue of relapse among patients with psychotic disorders. It is a new forum for education and information sharing around the topic of relapse/ relapse prevention. The training curriculum builds on previous projects from around the world, but for the first time consolidates the most valuable features into one compact, comprehensive educational initiative. Methods: Educational Objectives – The main objectives of the international education programme include: examining how effective relapse prevention can be incorporated into modern clinical practice for patients with schizophrenia; exchanging experiences and discussing practical approaches to relapse prevention in schizophrenia; providing an open and interactive forum, and an opportunity to interact with colleagues; provide stimulus for individuals and services to join the CERP initiative by setting up their own centres as part of the global network. Further objectives – In addition the Australian CERP programme provides the following: relapse prevention clinical services; preceptorships for mental health workers from the AsiaPacific region (and beyond) wishing to set up regional services; the hub for the collaborative training-research network, and; the production of the bulk of the international educational materials, including a manual on how to set up modern CERP-influenced relapse prevention services, and DVD and on-line educational packages. The meeting programme is varied depending on which of the faculty is involved and the site of the workshop. The workshops may involve a number of highly interactive activities including: faculty presentations; practical workshops; group discussions; problem solving sessions, and; a tour of clinical facilities. The core curriculum is comprised of four modules: (I) Adherence and relapse prevention, (II) Assessing risks of nonadherence, (III) Solutions to nonadherence and relapse, (IV) Applied preclinical and clinical LAI pharmacology. The workshops are variably comprised of: (i)injection practice for participants using hi-tech gluteal

296

Abstracts

and deltoid dummies, (ii) practical tools for nonadherence (instruments, MEMS, etc), (iii) psychosocial methods of augmenting adherence and outcomes, (iv) specific programmes for reducing relapse (e.g. The Munich Compliance Program; shared care initiatives with general practitioners, and others), (v) expert software systems to aid in initiation, dosing, and switching to LAIs (e.g. the Switcha® software package), (vi) specific outcome tools for routine assessment and international collaboration (e.g. the Multidimensional Incomplete Recovery CGI). Results: In the first six months of the programme eight major training events have taken place on four continents (Sydney, Melbourne, Munich (twice), Barcelona, Seoul, Taipei, and Sao Paulo). Discussion: The CERP education programme aims to provide a Background for experienced clinicians to consider service delivery changes at either a micro or macro level, to improve patient outcomes. Out of each training session we hope that at least one or two clinicians might wish to join the international CERP outcomes research network we are forming. To date this has been moderately successful with a number of centres expressing a commitment to the programme. Evaluation from participants and future directions for the programme will be discussed. doi:10.1016/j.schres.2010.02.494

Poster 267 THE IMPACT OF A GENOME-WIDE SUPPORTED PSYCHOSIS VARIANT IN THE ZNF804A GENE ON MEMORY FUNCTION IN SCHIZOPHRENIA Ryota Hashimoto1,2, Kazutaka Ohi1,2, Yuka Yasuda1,2, Motoyuki Fukumoto1,2, Masao Iwase1, Naomi Iike1,2, Michiyo Azechi1, Koji Ikezawa1, Masahiko Takaya1, Hidetoshi Takahashi1, Hidenaga Yamamori1,2, Ryouhei Ishii1, Hiroaki Kazui1, Nakao Iwata3, Masatoshi Takeda1 1 Osaka University, Graduate School of Medicine, Suita, Osaka, Japan; 2CREST of JST, Kawaguchi, Saitama, Japan; 3Fujita Health University, School of Medicine, Toyoake, Aichi, Japan Background: Recent genome-wide association study demonstrated that a genetic variant (rs1344706) in the ZNF804A gene was associated with schizophrenia. An association study between functional magnetic resonance imaging and the risk ZNF804A variant in healthy controls has showed abnormal connectivity as a core neurogenetic mechanism. Disconectivity in the risk ZNF804A variant was found in reduced dorsolateral prefrontal cortex (DLPFC) and increased coupling with hippocampal formation, which could contribute to disturbed cognitive function in schizophrenia. Schizophrenia is associated with wideranging deficits in neurocognitive function and these deficits, in particular memory impairments, are considered to be a core symptom to the pathophysiology of the illness. The aim of this study is to investigate an impact of the ZNF804A polymorphism (rs1344706) on memory function. Methods: Subjects are 113 patients with schizophrenia and 184 healthy controls. They were biologically unrelated Japanese. Memory performance was measured by Wechsler Memory ScaleRevised in four major indices such as verbal memory, visual memory, attention/concentration and delayed recall. Genotyping was performed by the TaqMan method. The effect of the risk ZNF804A genotype, the effect of diagnosis and genotype-diagnosis interaction effects were analyzed by two way analysis of covariance (ANCOVA) with age, gender and education years as covariates. Results: Consistent with previous studies, patients with schizophrenia had lower performances on all indices compared with

healthy controls (p < .001). A significant ZNF804A genotypediagnosis interaction was found on visual memory performance (p = .0012). We further provided evidence that patients with the risk T/T genotype had significantly lower scores on visual memory performance than those in G-carriers (p = .018). In contrast, there was no genotype effect in any index in controls (p > .05). Discussion: These findings demonstrated that deficits in visual memory might be associated with a neurogenetic risk mechanism for schizophrenia. Our data also suggest that rs1344706 or variation in linkage disequilibrium may be functional in human cognitive function. doi:10.1016/j.schres.2010.02.1032

Poster 268 COMTVAL158MET POLYMORPHISM IN INTERACTION WITH DAILY STRESS: HOW COMT CONNECTS TO PSYCHOSIS Dina Collip1, Ruud van Winkel1, Odette Peerbooms1, Tineke Lataster1, Viviane Thewissen1,2, Marielle Lardinois1, Marjan Drukker1, Bart Rutten1, Jim Van Os1,3, Inez Myin-Germeys1 1 Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, Netherlands; 2Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands; 3Division of Psychological Medicine, Institute of Psychiatry, London, United Kingdom Background: It is widely acknowledged that neither genes nor environmental stress alone, but rather the interplay between genes and environmental stress, may sufficiently explain the development of psychosis. Primarily, the catechol-O-methyltransferase Val158Met polymorphism (COMT) is a promising candidate gene that might moderate the effects of stress on psychosis. Studies in general population samples predominantly found an increased risk for psychosis in carriers of two Val alleles, while a study in patients found a heightened stress-reactivity in Met/Met carriers. In the current study, a general population sample as well as a group of patients with psychosis was investigated to disentangle potential differential genetic effects in these groups. Specifically, we investigated i) whether group (control vs. patient) moderated the relationship between (affective and psychotic) reactivity to stress and the COMTVal158Met polymorphism; and in case of a significant interaction, ii) how the COMTVal158Met polymorphism moderated affective and psychotic reactivity to daily stress within the two groups. Methods: Patients with a non-affective psychosis (n=89) and control participants (n=127) were studied with the Experience Sampling Method (a structured diary technique) in order to assess stress, negative affect and momentary psychotic symptoms in the reality of daily life. Results: Multilevel analyses revealed a significant three-way interaction effect between group, COMT genotype and stress in the model of momentary psychosis (Χ2(2) = 6.92, p < 0.05) as well as in the model of negative affect (Χ2(2) = 13.26, p < 0.01). Thus, the moderating effect of the COMTVal158Met polymorphism on the effect of stress on negative affect and momentary psychosis differed between the groups. While there was no significant two-way interaction effect of COMT and stress in the control group, COMT was a significant moderator of the association between stress and negative affect and momentary psychosis in the patient group. Met/Met carriers of the patient group showed significantly increased psychotic and affective reactivity to stress in comparison to the Val/Met and Val/Val carriers. Discussion: It was shown that the immediate effect of daily stress on psychosis and negative affect is not only conditional on COMTVal158Met genotype, but also conditional on group. Only in the patient group, COMTVal158Met genotype seems to contribute to differential sensitivity for environmental stress. Interestingly, effect sizes for the Val/Val and