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NEUROPSYCHOLOGICAL DEFICITS IN FIRST EPISODE PATIENTS WITH SCHIZOPHRENIA OR AFFECTIVE PSYCHOTIC DISORDERS
Abstracts / Schizophrenia Research 102/1–3, Supplement 2 (2008) 1–279
276 – DIFFERENCES IN PSYCHOPATHOLOGY WITH DISRUPTED INSIGHT IN FIRST-EPISODE PSYCHOSIS: THE GAP STUDY Ben Wiffen, Sarah Masson, Monica Aas, Rowena Handley, Nilay Hepgul, Tiago Marques, Corinne Prescott, Claire Sloane, Poonam Sood, Heather Taylor, Arshia Seddigh, Marta DiForti, Carmine Pariante, Valeria Mondelli, Paola Dazzan, Kathy Aitchison, Robin Murray, Tony David Institute of Psychiatry, London, UK [email protected] Introduction: Previous research estimates that between 50% and 80% of people with psychotic illnesses lack insight into their condition (Amador & Gorman, 1998). Whilst several studies have shown relationships between PANSS subscale scores, fewer have investigated specific symptoms. Measuring insight can often be confounded by previous contacts and with psychiatric services and illness duration. Testing patients in early illness reduces this confound, providing a more reliable measure of psychopathology. It was predicted that strongest relationships will be seen between insight and positive behavioural symptoms, particularly delusions. Methods: Pilot data were collected from 61 first-episode psychotic patients, including PANSS and demographics. Patients from the South London and Maudsley NHS Trust were tested as part of the GAP (Genetics And Psychosis) study. Results: The sample was split into 2 groups on the basis of clinically relevant (N=31) or clinically non-relevant (N=30) scores on PANSS. Significant differences between groups were shown using independent-samples t-tests for 6 (of 7) positive, 2 (of 7) negative and 3 (of 15) general measures. When controlling for overall PANSS score using MANCOVA (data available for N=47), differences remained for 5 positive (delusions, conceptual disorganisation, excitement, suspiciousness/persecution and hostility (all p<0.01)), 1 negative (stereotyped thinking (p=0.011)) and 2 general (preoccupation (p=0.024) and active social avoidance (p=0.024)). For all measures, the low-insight group was more severely affected. Conclusions: Insight has specific and divergent psychopathological correlates, regardless of severity. The majority of these are positive symptoms. References [1] Amador, XF. & Gorman, JM. (1998) Psychopathologic domains and insight in schizophrenia. Pyschiatr. Clin. North Am. 21, 27-42
277 – AGE AND SEX DIFFERENCES IN INSIGHT IN A LARGE SAMPLE OF STABLE PATIENTS WITH SCHIZOPHRENIA Ben Wiffen 1 , Jonathan Rabinowitz 2 , Wolfgang Fleischhacker 3 , Anthony David 1 1 Institute of Psychiatry, London; UK; 2 Bar Ilan University, Ramat Gan, Israel; 3 Innsbruck University Clinics, Innsbruck, Austria [email protected] Introduction: Lack of insight into their condition is a common occurrence in schizophrenia. The literature is inconsistent in reporting differences in insight between demographic groups. While some studies report better awareness in older and female patients (McEvoy et al., 2006), this is not consistent. These demographic insight differences are tested here in a large sample. Prediction: There will be no sex differences in levels of insight, but that there will be an increase in insight in older patients. Methods: 667 patients (435 male) with schizophrenia were assessed for psychopathology and insight with the Positive and Negative Syndrome Scale (PANSS) at the baseline of a trial of long-acting second-generation antipsychotic (see Fleischhacker et al., 2003). Results: There were no significant differences in the mean insight scores of male and female participants with schizophrenia (Male mean PANSS G12=2.64, female=2.61; p=0.74). There were, however, differences in insight at different ages. Insight deficit was g reatest in the oldest group (age>56: mean=2.99). The deficit decreased in the
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two younger groups (age 42-56: mean=2.52; age 28-42: mean=2.36), but increased (though lower than the oldest group) in the youngest group (age 18-28: mean=2.63). These differences between age groups were significant (p<0.0001). Conclusions: In this group of schizophrenic patients, there were no sex differences in insight. However, there were age differences. The oldest group had the worst insight, followed by the youngest, with the two intermediate age groups in between. References [1] Fleischhacker, W., Eerdekens, M., Karcher, K., Remington, G., Llorca, P., Chrzanowski, W., Martin, S. & Gefvert, O. (2003). Treatment of Schizophrenia with Long-acting injectable Risperidone: A 12-Month open-label trial of the firsst long-acting secondge neration antipsychotic. J Clin Psychiatry 64,1250-1257 [2] McEvoy, J.P., Johnson, J., Perkins, D., Lieberman, J.A., Hamer, R.M., Keefe, R.S., Tohen, M., Glick, I. & Sharma, T. (2006) Insight in First Episode Psychosis. Psychological Medicine. 36, 1385–1393.
278 – NEUROPSYCHOLOGICAL DEFICITS IN FIRST EPISODE PATIENTS WITH SCHIZOPHRENIA OR AFFECTIVE PSYCHOTIC DISORDERS Caroline Zanelli 1 , Abraham Reichenberg 1 , Kevin Morgan 2 , Paul Fearon 1 , Paola Dazzan 1 , Craig Morgan 1 , Bo-Hyun Yoon 3 , Peter Jones 4 , Gillian Doody 5 , Robin M. Murray 1 1 Institute of Psychiatry, London, UK; 2 Westminster University, London, UK; 3 Department of Psychiatry, Naju National Hospital, Naju, Jeonnam; 4 Cambridge University, Cambridge; 5 Nottingham University, Nottingham, UK Introduction: Mounting evidence suggests compromised neuropsychological function is frequently observed in schizophrenia. However, it is not clear if similar deficits are also present in other psychotic disorders, especially those with affective symptoms. Methods: Data came from the AESOP study, comprising a large epidemiological cohort of first-onset psychosis patients. We compared patients with schizophrenia (n=65), schizoaffective (n=13), bipolar/manic (n=37), depressive psychosis (n=39), other psychotic p atients (n=46) to healthy controls (n=177) on 18 neuropsychological measures selected to assess six domains: (1) memory (verbal and visual) (2) WAIS-R academic verbal abilities (3) attention, concentration and mental speed (4) executive functions and working memory (5) language (6) visual constructual/perceptual abilities. Additionally, premorbid intelligence (NART), current full-scale IQ, performance IQ and verbal IQ were assessed. Results: The performance of the total patient sample was significantly worse than that of the control group on every europsychological measure. However, there was no significant difference between patients with bipolar disorder and controls. Schizophrenia a nd schizoaffective patients performed significantly worse than controls but were not different from each other. The groups with psychotic depression and schizophrenia patients were indistinguishable. But subjects with bipolar/manic disorder performed significantly better than those with schizophrenia. In comparison to controls, the performance of bipolar/manic patients was very similar except for verbal memory, block design, digit symbol and category fluency. Conclusions: Early in the course of disease schizophrenia is distinguishable from bipolar/manic psychosis but not from depressive psychosis by global and specific neuropsychological functioning. References [1] Hoff AL, Kremen WS. (2003). Neuropsychology in schizophrenia: un update. Current opinion in psychiatry. 16, 149-155dberg TE, Gold JM. Neurocognitive functioning in patients with schizophrenia [2] Gilvarry CM. Barber JA. van Os J. Murray RM. UK700 Group. (200 1). Neuropsychological performance of psychotic patients in community care: results from the UK700 study. Acta Psychiatrica Scandinavica, Supplementum. (408):81-91
276 – DIFFERENCES IN PSYCHOPATHOLOGY WITH DISRUPTED INSIGHT IN FIRST-EPISODE PSYCHOSIS: THE GAP STUDY Ben Wiffen, Sarah Masson, Monica Aas, Rowena Handley, Nilay Hepgul, Tiago Marques, Corinne Prescott, Claire Sloane, Poonam Sood, Heather Taylor, Arshia Seddigh, Marta DiForti, Carmine Pariante, Valeria Mondelli, Paola Dazzan, Kathy Aitchison, Robin Murray, Tony David Institute of Psychiatry, London, UK [email protected] Introduction: Previous research estimates that between 50% and 80% of people with psychotic illnesses lack insight into their condition (Amador & Gorman, 1998). Whilst several studies have shown relationships between PANSS subscale scores, fewer have investigated specific symptoms. Measuring insight can often be confounded by previous contacts and with psychiatric services and illness duration. Testing patients in early illness reduces this confound, providing a more reliable measure of psychopathology. It was predicted that strongest relationships will be seen between insight and positive behavioural symptoms, particularly delusions. Methods: Pilot data were collected from 61 first-episode psychotic patients, including PANSS and demographics. Patients from the South London and Maudsley NHS Trust were tested as part of the GAP (Genetics And Psychosis) study. Results: The sample was split into 2 groups on the basis of clinically relevant (N=31) or clinically non-relevant (N=30) scores on PANSS. Significant differences between groups were shown using independent-samples t-tests for 6 (of 7) positive, 2 (of 7) negative and 3 (of 15) general measures. When controlling for overall PANSS score using MANCOVA (data available for N=47), differences remained for 5 positive (delusions, conceptual disorganisation, excitement, suspiciousness/persecution and hostility (all p<0.01)), 1 negative (stereotyped thinking (p=0.011)) and 2 general (preoccupation (p=0.024) and active social avoidance (p=0.024)). For all measures, the low-insight group was more severely affected. Conclusions: Insight has specific and divergent psychopathological correlates, regardless of severity. The majority of these are positive symptoms. References [1] Amador, XF. & Gorman, JM. (1998) Psychopathologic domains and insight in schizophrenia. Pyschiatr. Clin. North Am. 21, 27-42
277 – AGE AND SEX DIFFERENCES IN INSIGHT IN A LARGE SAMPLE OF STABLE PATIENTS WITH SCHIZOPHRENIA Ben Wiffen 1 , Jonathan Rabinowitz 2 , Wolfgang Fleischhacker 3 , Anthony David 1 1 Institute of Psychiatry, London; UK; 2 Bar Ilan University, Ramat Gan, Israel; 3 Innsbruck University Clinics, Innsbruck, Austria [email protected] Introduction: Lack of insight into their condition is a common occurrence in schizophrenia. The literature is inconsistent in reporting differences in insight between demographic groups. While some studies report better awareness in older and female patients (McEvoy et al., 2006), this is not consistent. These demographic insight differences are tested here in a large sample. Prediction: There will be no sex differences in levels of insight, but that there will be an increase in insight in older patients. Methods: 667 patients (435 male) with schizophrenia were assessed for psychopathology and insight with the Positive and Negative Syndrome Scale (PANSS) at the baseline of a trial of long-acting second-generation antipsychotic (see Fleischhacker et al., 2003). Results: There were no significant differences in the mean insight scores of male and female participants with schizophrenia (Male mean PANSS G12=2.64, female=2.61; p=0.74). There were, however, differences in insight at different ages. Insight deficit was g reatest in the oldest group (age>56: mean=2.99). The deficit decreased in the
149
two younger groups (age 42-56: mean=2.52; age 28-42: mean=2.36), but increased (though lower than the oldest group) in the youngest group (age 18-28: mean=2.63). These differences between age groups were significant (p<0.0001). Conclusions: In this group of schizophrenic patients, there were no sex differences in insight. However, there were age differences. The oldest group had the worst insight, followed by the youngest, with the two intermediate age groups in between. References [1] Fleischhacker, W., Eerdekens, M., Karcher, K., Remington, G., Llorca, P., Chrzanowski, W., Martin, S. & Gefvert, O. (2003). Treatment of Schizophrenia with Long-acting injectable Risperidone: A 12-Month open-label trial of the firsst long-acting secondge neration antipsychotic. J Clin Psychiatry 64,1250-1257 [2] McEvoy, J.P., Johnson, J., Perkins, D., Lieberman, J.A., Hamer, R.M., Keefe, R.S., Tohen, M., Glick, I. & Sharma, T. (2006) Insight in First Episode Psychosis. Psychological Medicine. 36, 1385–1393.
278 – NEUROPSYCHOLOGICAL DEFICITS IN FIRST EPISODE PATIENTS WITH SCHIZOPHRENIA OR AFFECTIVE PSYCHOTIC DISORDERS Caroline Zanelli 1 , Abraham Reichenberg 1 , Kevin Morgan 2 , Paul Fearon 1 , Paola Dazzan 1 , Craig Morgan 1 , Bo-Hyun Yoon 3 , Peter Jones 4 , Gillian Doody 5 , Robin M. Murray 1 1 Institute of Psychiatry, London, UK; 2 Westminster University, London, UK; 3 Department of Psychiatry, Naju National Hospital, Naju, Jeonnam; 4 Cambridge University, Cambridge; 5 Nottingham University, Nottingham, UK Introduction: Mounting evidence suggests compromised neuropsychological function is frequently observed in schizophrenia. However, it is not clear if similar deficits are also present in other psychotic disorders, especially those with affective symptoms. Methods: Data came from the AESOP study, comprising a large epidemiological cohort of first-onset psychosis patients. We compared patients with schizophrenia (n=65), schizoaffective (n=13), bipolar/manic (n=37), depressive psychosis (n=39), other psychotic p atients (n=46) to healthy controls (n=177) on 18 neuropsychological measures selected to assess six domains: (1) memory (verbal and visual) (2) WAIS-R academic verbal abilities (3) attention, concentration and mental speed (4) executive functions and working memory (5) language (6) visual constructual/perceptual abilities. Additionally, premorbid intelligence (NART), current full-scale IQ, performance IQ and verbal IQ were assessed. Results: The performance of the total patient sample was significantly worse than that of the control group on every europsychological measure. However, there was no significant difference between patients with bipolar disorder and controls. Schizophrenia a nd schizoaffective patients performed significantly worse than controls but were not different from each other. The groups with psychotic depression and schizophrenia patients were indistinguishable. But subjects with bipolar/manic disorder performed significantly better than those with schizophrenia. In comparison to controls, the performance of bipolar/manic patients was very similar except for verbal memory, block design, digit symbol and category fluency. Conclusions: Early in the course of disease schizophrenia is distinguishable from bipolar/manic psychosis but not from depressive psychosis by global and specific neuropsychological functioning. References [1] Hoff AL, Kremen WS. (2003). Neuropsychology in schizophrenia: un update. Current opinion in psychiatry. 16, 149-155dberg TE, Gold JM. Neurocognitive functioning in patients with schizophrenia [2] Gilvarry CM. Barber JA. van Os J. Murray RM. UK700 Group. (200 1). Neuropsychological performance of psychotic patients in community care: results from the UK700 study. Acta Psychiatrica Scandinavica, Supplementum. (408):81-91