- Email: [email protected]
P.3.f.015 Expressed emotion in relatives of patients with schizophrenia, bipolar disorder and diabetes: a comparison
S574
P.3.f. Psychotic disorders and treatment − Other (clinical)
Conclusions: The switch from oral to long-acting antipsychotic treatment seems to be an effective intervention in schizoaffective patients who have been previously stabilized on a single oral SGA. Our preliminary data suggest that LAI formulation of SGAs may provide considerable advantages in improving patients’ attitude, experience and beliefs about antipsychotic treatment. Part of the improvement in patients’ attitude towards treatment could be related with the better efficacy of LAI-SGAs on psychopathology and with its differential timing on different clusters of symptoms. References [1] Tiihonen, J., Wahlbeck, K., L¨onnqvist, J., Klaukka, T., Ioannidis, J.P., Volavka, J., Haukka, J., 2006. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ 333(7561), 224. [2] Kaplan, G., Casoy, J., Zummo, J., 2013. Impact of long-acting injectable antipsychotics on medication adherence and clinical, functional, and economic outcomes of schizophrenia. Patient Prefer Adherence 7, 1171–1180. [3] Nielsen, R.E., Lindstr¨om, E., Nielsen, J., Levander, S., 2012. DAI-10 is as good as DAI-30 in schizophrenia. Eur Neuropsychopharmacol 22(10), 747–750.
P.3.f.014 Trying to find medical factors that may predict quality of life for patients with schizophrenia in a Romanian sample Rosca1 ° ,
Tudose1
E. C. Bucharest, Romania
1 University
of Medicine, psychiatry,
The concept of quality of life has become an important part in psychiatric research and studies that focused on the effectiveness of particular interventions, making necessary to clarify the specific factors associated with a decrease/increase in quality of life. Study objective: To identify medical variables that can predict the quality of life in patients with schizophrenia and determining their predictive ability. Methods used: Identification the relationships between medical factors and scales of quality of life assessment instrument were performed using the Chi-square (X2) / Fisher. Binomial logistic regression was used to test the predictive models included in this study. We take into analysis medical variables as: number of hospitalizations, number of treatment regimens, current antipsychotic type, type of antipsychotic administration, treatment with typical antipsychotics in the past, family history of mental illness and others. Quality of life was assessed using standardized scale World Health Organization Quality of Life, 26-item form (WHOQOL − BREF). We included in the study 143 patients with ages between 18 and 65 years, hospitalized in the form of voluntary admission, with stable antipsychotic treatment for minimum 4 weeks and signed informed consent to participate with diagnosis of schizophrenia according to DSM-IV-TR and ICD-10. Results: The percentage of patients who appreciate the quality of life as good/very good varies depending on the form of administration of antipsychotic [X2(1,143) = 3.860, p < 0.05], such as patients with prolonged administration or depot register more weight high assessments on the quality of life as good or very good (41.2%) compared with those with daily dosage form (23.9%). Similarly, the percentage of patients who appreciate the quality of life as poor/very poor varies depending on the
number of hospitalizations [X2(1,143) = 6.577, p < 0.05] and the regression equation is: ln ODDS(Quality of life level low/very low) = −1.099 + (1.099 × number of hospitalizations). Percentage of patients who are very dissatisfied/dissatisfied with their health varies according to a number of medical factors: family history, mental [X2(1,143) = 7.846, p < 0.01], number of hospitalizations [X2(1.143) = 4.087, p < 0.05], the number of treatment regimens [X2(2,143) = 6.558, p < 0.05], and type of antipsychotic [X2(1,143) = 13.507, p < 0.001]. Conclusion: The probability of assessing health status at a good level and very good range between 28.6% for patients treated with a form of antipsychotic administered daily and 53.8% for patients treated with extended-release form or depot. Probability to appreciate health as a low or very low ranging between 10.79% for patients treated with atypical antipsychotic without family history of mental illness, with a reduced number of treatment regimens, and 88.76% for patients treated with atypical antipsychotic, with family history of mental illness, with a total of over 20 treatment regimens.
P.3.f.015 Expressed emotion in relatives of patients with schizophrenia, bipolar disorder and diabetes: a comparison S. Ben Nasr1 ° , A. Ben Romdhane1 , J. Nakhli1 , A. Braham1 , Y. El Kissi1 , B. Ben Hadj Ali1 1 Farhat Hached Hospital, Sousse, Tunisian Republic The expressed emotion (EE) is a concept including attitudes and behavioral patterns of relatives towards patients, has been shown to be a predictor of relapse in patients with schizophrenia and mood disorders [1,2]. Those mental disorder are severe and chronic, characteristics witch could explain the high expressed emotions in there relatives. This study investigates how the expressed emotions in family members are specific to chronic diseases or to mental diseases. The two aims of the study were to (1) investigate whether relatives of Schizophrenic and Bipolar patients differed from family members of Diabetic patients regarding to their Expressed Emotions (EE), and (2) whether EE subcategories (‘Criticism’ and ‘Emotional Over involvement’) of Schizophrenic and Bipolar relatives is related to relapse of patients. Methods: Forty-seven patients with schizophrenia, 36 patients with bipolar disorder (DSM-IV TR) and 30 patients with diabetes were included. All the patients are treated in the same hospital in Sousse. The EE of key relatives was assessed with the Family Questionnaire (FQ) (20 items and two subcategories: ‘Criticism’ and ‘Emotional Over involvement’) [2]. The three groups of patients did not differ significantly regarding the duration of the disease. Results were provided as descriptive statistics and the scores in the 3 groups were compared using ANOVA and Tukey tests. Probability (p) values less than 0.05 was considered statistically significant. Results: The three groups of relatives differ significantly regarding the two subcategories of the FQ. The mean score of Criticism in Schizophrenic, Bipolar and diabetic relatives was respectively of 27.74±6.02, 23.63±6.08 and 19.10±6.47 (p<10−3 ).
P.3.f. Psychotic disorders and treatment − Other (clinical) The mean score of Emotional Over involvement in the three groups was respectively of 31.12±4.71, 29.47±6.18 and 25.16±6.88 (p<10−3 ). Compared to Bipolar relatives the mean score of Criticism was higher in schizophrenic relatives (p = 0.009). There was no statistical difference in mean scores of Emotional Over involvement between schizophrenic and bipolar relatives. In schizophrenic and bipolar relatives, Criticism and Emotional Over involvement were higher when patients where in relapse phase. We noticed a positive and significant correlation between the number of depressive episodes and the score of Emotional Over involvement in bipolar relatives. Limitations: The Family Questionnaire (FQ) (20 items) has no validated Tunisian version, which could be a methodological bias in the assessment of Expressed Emotions. Conclusion: In our study the mean scores of Criticism and Emotional Over involvement were higher in Schizophrenia and Bipolar relatives then Diabetic relatives. Those results mean that high expressed emotions are not specific of chronic diseases but they are mental disorders-specific. High EE subcategories were related to relapse in both of schizophrenic and bipolar groups. Emotional Over involvement of relatives was related to the number of depressive episodes in bipolar patients. More attention should be given to Expressed Emotions in relatives of schizophrenic and bipolar patients to prevent relapses. References [1] Eunice Y. Kim, David J. Miklowitz. Expressed emotion as a predictor of outcome among bipolar patients undergoing family therapy. Journal of Affective Disorders 82 (2004) 343–352. [2] Georg Wiedemanna, Oliver Raykia, Elias Feinsteinb, Kurt Hahlwegc. The Family Questionnaire: Development and validation of a new selfreport scale for assessing expressed emotion. Psychiatry Research 109 (2002) 265–279.
P.3.f.016 Volumetric and morphological changes in hippocampus as a prognostic marker at first psychotic episode R.B. Sauras Quetcuti1 ° , A. Keymer1 , S. Duran-Sindreu2 , A. Alonso2 , S. Vieira3 , M. Portella2 , E. Alvarez2 , B. Gomez Anson4 , F. Nu˜nez4 , V. Perez Sola2 , M. Rabella2 , I. Corripio2 1 Institut d’Investigaci´ o Biom`edica Sant Pau, Psychiatry, Barcelona, Spain; 2 Centro de Investigaci´on Biom´edica en Red de Salud Mental CIBERSAM, Psychiatry, Barcelona, Spain; 3 Hospital Sant Pau, Psychiatry, Barcelona, Spain; 4 Hospital de Sant Pau, Neuroradiology, Barcelona, Spain Purpose: Reduced volume of the hippocampus has been implicated in the pathophysiology of hyperdopaminergic state in psychosis [1]. Moreover, it is suggested that physical tension arising from neurodevelopmental processes and neural connectivity may lead to shape variations of brain structures [2]. However, it is still unclear whether certain abnormalities are a pre-existing vulnerability factor, a sign of disease progression or a consequence of environmental factors, such as drug use or antipsychotic medication. Recently hippocampus has been suggested as a potential target for Deep Brain Stimulation in schizophrenia, although more studies in early stages and in refractory schizophrenia are necessary to establish these initial considerations [3].
S575
The aim of this study is to describe volumetric and morphological alterations in the hippocampus in a sample of patients with a first psychotic episode and to investigate the associations between hippocampus morphology and poorer outcomes after one year of follow-up. Methods: We analyzed a sample of 41 patients at first psychotic episode and 41 healthy subjects, paired for age, sex and educational level. 3 Tesla MRI was performed at the time of the inclusion in the study, within the first month of the onset of the illness. After one year of follow-up, patients were assigned into two groups according to diagnosis DSM IV criteria: schizophrenia (n = 19) versus non-schizophrenia group (n = 21). Registration, segmentation, morphologic and volume analysis of bilateral hippocampus was determined using the FIRST tools of the FSL 5.0 image analysis suite. Results: The schizophrenia group showed a significantly smaller left hippocampus volume than the control group (p < 0.05). No differences between morphology among first psychotic episodes and healthy controls were found. A significant difference in the morphology of the anterior region of the hippocampus (CA1) was found in those patients with a first psychotic episode who developed schizophrenia compared with patients who did not. Conclusions: These findings suggest that volumetric abnormalities of the hippocampus are greater in patients with poorer outcome after suffering a first psychotic episode. Consistent with some, but not all, previous studies we also found more pronounced anterior hippocampal shape differences in schizophrenia patients. Moreover, we found an interesting morphology difference between schizophrenia and non-schizophrenia patients in hippocampal CA1. CA1 is the hippocampal area which project to the medial prefrontal cortex and has been widely implicated in the schizophrenia pathophisiology. Both results are in agreement with the assumption that in schizophrenia there would be an hyperfunction of dopaminergic cortico-subcortical circuits which, in the course of the disease, has been linked with an atrophy of these subcortical structures, specifically in the hippocampus. Thus, hippocampus volume and morphology may serve as a prognostic marker of clinical outcome in patients with a first-episode psychosis. Moreover, taking into account the plasticity of this structure and its implication in the development of schizophrenia, we suggest that hippocampus could be considered as a target for Deep Brain Stimulation in schizophrenia. Studies with greater sample, including responders and no responders to treatment should be performed in order to strengthen these findings. References [1] Grace, A.A. Dopamine system dysregulation by the hippocampus: implications for the pathophysiology and treatment of schizophrenia. Neuropharmacology 62, 1342−8 (2012). [2] Van Essen DC. A tension-based theory of morphogenesis and compact wiring in the central nervous system. Nature. 1997 Jan 23; 385(6614): 313−8. [3] Ewing SG, Winter C. The ventral portion of the CA1 region of the hippocampus and the prefrontal cortex as candidate regions for neuromodulation in schizophrenia. Med Hypotheses. 2013 Jun; 80(6): 827−32.
P.3.f. Psychotic disorders and treatment − Other (clinical)
Conclusions: The switch from oral to long-acting antipsychotic treatment seems to be an effective intervention in schizoaffective patients who have been previously stabilized on a single oral SGA. Our preliminary data suggest that LAI formulation of SGAs may provide considerable advantages in improving patients’ attitude, experience and beliefs about antipsychotic treatment. Part of the improvement in patients’ attitude towards treatment could be related with the better efficacy of LAI-SGAs on psychopathology and with its differential timing on different clusters of symptoms. References [1] Tiihonen, J., Wahlbeck, K., L¨onnqvist, J., Klaukka, T., Ioannidis, J.P., Volavka, J., Haukka, J., 2006. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ 333(7561), 224. [2] Kaplan, G., Casoy, J., Zummo, J., 2013. Impact of long-acting injectable antipsychotics on medication adherence and clinical, functional, and economic outcomes of schizophrenia. Patient Prefer Adherence 7, 1171–1180. [3] Nielsen, R.E., Lindstr¨om, E., Nielsen, J., Levander, S., 2012. DAI-10 is as good as DAI-30 in schizophrenia. Eur Neuropsychopharmacol 22(10), 747–750.
P.3.f.014 Trying to find medical factors that may predict quality of life for patients with schizophrenia in a Romanian sample Rosca1 ° ,
Tudose1
E. C. Bucharest, Romania
1 University
of Medicine, psychiatry,
The concept of quality of life has become an important part in psychiatric research and studies that focused on the effectiveness of particular interventions, making necessary to clarify the specific factors associated with a decrease/increase in quality of life. Study objective: To identify medical variables that can predict the quality of life in patients with schizophrenia and determining their predictive ability. Methods used: Identification the relationships between medical factors and scales of quality of life assessment instrument were performed using the Chi-square (X2) / Fisher. Binomial logistic regression was used to test the predictive models included in this study. We take into analysis medical variables as: number of hospitalizations, number of treatment regimens, current antipsychotic type, type of antipsychotic administration, treatment with typical antipsychotics in the past, family history of mental illness and others. Quality of life was assessed using standardized scale World Health Organization Quality of Life, 26-item form (WHOQOL − BREF). We included in the study 143 patients with ages between 18 and 65 years, hospitalized in the form of voluntary admission, with stable antipsychotic treatment for minimum 4 weeks and signed informed consent to participate with diagnosis of schizophrenia according to DSM-IV-TR and ICD-10. Results: The percentage of patients who appreciate the quality of life as good/very good varies depending on the form of administration of antipsychotic [X2(1,143) = 3.860, p < 0.05], such as patients with prolonged administration or depot register more weight high assessments on the quality of life as good or very good (41.2%) compared with those with daily dosage form (23.9%). Similarly, the percentage of patients who appreciate the quality of life as poor/very poor varies depending on the
number of hospitalizations [X2(1,143) = 6.577, p < 0.05] and the regression equation is: ln ODDS(Quality of life level low/very low) = −1.099 + (1.099 × number of hospitalizations). Percentage of patients who are very dissatisfied/dissatisfied with their health varies according to a number of medical factors: family history, mental [X2(1,143) = 7.846, p < 0.01], number of hospitalizations [X2(1.143) = 4.087, p < 0.05], the number of treatment regimens [X2(2,143) = 6.558, p < 0.05], and type of antipsychotic [X2(1,143) = 13.507, p < 0.001]. Conclusion: The probability of assessing health status at a good level and very good range between 28.6% for patients treated with a form of antipsychotic administered daily and 53.8% for patients treated with extended-release form or depot. Probability to appreciate health as a low or very low ranging between 10.79% for patients treated with atypical antipsychotic without family history of mental illness, with a reduced number of treatment regimens, and 88.76% for patients treated with atypical antipsychotic, with family history of mental illness, with a total of over 20 treatment regimens.
P.3.f.015 Expressed emotion in relatives of patients with schizophrenia, bipolar disorder and diabetes: a comparison S. Ben Nasr1 ° , A. Ben Romdhane1 , J. Nakhli1 , A. Braham1 , Y. El Kissi1 , B. Ben Hadj Ali1 1 Farhat Hached Hospital, Sousse, Tunisian Republic The expressed emotion (EE) is a concept including attitudes and behavioral patterns of relatives towards patients, has been shown to be a predictor of relapse in patients with schizophrenia and mood disorders [1,2]. Those mental disorder are severe and chronic, characteristics witch could explain the high expressed emotions in there relatives. This study investigates how the expressed emotions in family members are specific to chronic diseases or to mental diseases. The two aims of the study were to (1) investigate whether relatives of Schizophrenic and Bipolar patients differed from family members of Diabetic patients regarding to their Expressed Emotions (EE), and (2) whether EE subcategories (‘Criticism’ and ‘Emotional Over involvement’) of Schizophrenic and Bipolar relatives is related to relapse of patients. Methods: Forty-seven patients with schizophrenia, 36 patients with bipolar disorder (DSM-IV TR) and 30 patients with diabetes were included. All the patients are treated in the same hospital in Sousse. The EE of key relatives was assessed with the Family Questionnaire (FQ) (20 items and two subcategories: ‘Criticism’ and ‘Emotional Over involvement’) [2]. The three groups of patients did not differ significantly regarding the duration of the disease. Results were provided as descriptive statistics and the scores in the 3 groups were compared using ANOVA and Tukey tests. Probability (p) values less than 0.05 was considered statistically significant. Results: The three groups of relatives differ significantly regarding the two subcategories of the FQ. The mean score of Criticism in Schizophrenic, Bipolar and diabetic relatives was respectively of 27.74±6.02, 23.63±6.08 and 19.10±6.47 (p<10−3 ).
P.3.f. Psychotic disorders and treatment − Other (clinical) The mean score of Emotional Over involvement in the three groups was respectively of 31.12±4.71, 29.47±6.18 and 25.16±6.88 (p<10−3 ). Compared to Bipolar relatives the mean score of Criticism was higher in schizophrenic relatives (p = 0.009). There was no statistical difference in mean scores of Emotional Over involvement between schizophrenic and bipolar relatives. In schizophrenic and bipolar relatives, Criticism and Emotional Over involvement were higher when patients where in relapse phase. We noticed a positive and significant correlation between the number of depressive episodes and the score of Emotional Over involvement in bipolar relatives. Limitations: The Family Questionnaire (FQ) (20 items) has no validated Tunisian version, which could be a methodological bias in the assessment of Expressed Emotions. Conclusion: In our study the mean scores of Criticism and Emotional Over involvement were higher in Schizophrenia and Bipolar relatives then Diabetic relatives. Those results mean that high expressed emotions are not specific of chronic diseases but they are mental disorders-specific. High EE subcategories were related to relapse in both of schizophrenic and bipolar groups. Emotional Over involvement of relatives was related to the number of depressive episodes in bipolar patients. More attention should be given to Expressed Emotions in relatives of schizophrenic and bipolar patients to prevent relapses. References [1] Eunice Y. Kim, David J. Miklowitz. Expressed emotion as a predictor of outcome among bipolar patients undergoing family therapy. Journal of Affective Disorders 82 (2004) 343–352. [2] Georg Wiedemanna, Oliver Raykia, Elias Feinsteinb, Kurt Hahlwegc. The Family Questionnaire: Development and validation of a new selfreport scale for assessing expressed emotion. Psychiatry Research 109 (2002) 265–279.
P.3.f.016 Volumetric and morphological changes in hippocampus as a prognostic marker at first psychotic episode R.B. Sauras Quetcuti1 ° , A. Keymer1 , S. Duran-Sindreu2 , A. Alonso2 , S. Vieira3 , M. Portella2 , E. Alvarez2 , B. Gomez Anson4 , F. Nu˜nez4 , V. Perez Sola2 , M. Rabella2 , I. Corripio2 1 Institut d’Investigaci´ o Biom`edica Sant Pau, Psychiatry, Barcelona, Spain; 2 Centro de Investigaci´on Biom´edica en Red de Salud Mental CIBERSAM, Psychiatry, Barcelona, Spain; 3 Hospital Sant Pau, Psychiatry, Barcelona, Spain; 4 Hospital de Sant Pau, Neuroradiology, Barcelona, Spain Purpose: Reduced volume of the hippocampus has been implicated in the pathophysiology of hyperdopaminergic state in psychosis [1]. Moreover, it is suggested that physical tension arising from neurodevelopmental processes and neural connectivity may lead to shape variations of brain structures [2]. However, it is still unclear whether certain abnormalities are a pre-existing vulnerability factor, a sign of disease progression or a consequence of environmental factors, such as drug use or antipsychotic medication. Recently hippocampus has been suggested as a potential target for Deep Brain Stimulation in schizophrenia, although more studies in early stages and in refractory schizophrenia are necessary to establish these initial considerations [3].
S575
The aim of this study is to describe volumetric and morphological alterations in the hippocampus in a sample of patients with a first psychotic episode and to investigate the associations between hippocampus morphology and poorer outcomes after one year of follow-up. Methods: We analyzed a sample of 41 patients at first psychotic episode and 41 healthy subjects, paired for age, sex and educational level. 3 Tesla MRI was performed at the time of the inclusion in the study, within the first month of the onset of the illness. After one year of follow-up, patients were assigned into two groups according to diagnosis DSM IV criteria: schizophrenia (n = 19) versus non-schizophrenia group (n = 21). Registration, segmentation, morphologic and volume analysis of bilateral hippocampus was determined using the FIRST tools of the FSL 5.0 image analysis suite. Results: The schizophrenia group showed a significantly smaller left hippocampus volume than the control group (p < 0.05). No differences between morphology among first psychotic episodes and healthy controls were found. A significant difference in the morphology of the anterior region of the hippocampus (CA1) was found in those patients with a first psychotic episode who developed schizophrenia compared with patients who did not. Conclusions: These findings suggest that volumetric abnormalities of the hippocampus are greater in patients with poorer outcome after suffering a first psychotic episode. Consistent with some, but not all, previous studies we also found more pronounced anterior hippocampal shape differences in schizophrenia patients. Moreover, we found an interesting morphology difference between schizophrenia and non-schizophrenia patients in hippocampal CA1. CA1 is the hippocampal area which project to the medial prefrontal cortex and has been widely implicated in the schizophrenia pathophisiology. Both results are in agreement with the assumption that in schizophrenia there would be an hyperfunction of dopaminergic cortico-subcortical circuits which, in the course of the disease, has been linked with an atrophy of these subcortical structures, specifically in the hippocampus. Thus, hippocampus volume and morphology may serve as a prognostic marker of clinical outcome in patients with a first-episode psychosis. Moreover, taking into account the plasticity of this structure and its implication in the development of schizophrenia, we suggest that hippocampus could be considered as a target for Deep Brain Stimulation in schizophrenia. Studies with greater sample, including responders and no responders to treatment should be performed in order to strengthen these findings. References [1] Grace, A.A. Dopamine system dysregulation by the hippocampus: implications for the pathophysiology and treatment of schizophrenia. Neuropharmacology 62, 1342−8 (2012). [2] Van Essen DC. A tension-based theory of morphogenesis and compact wiring in the central nervous system. Nature. 1997 Jan 23; 385(6614): 313−8. [3] Ewing SG, Winter C. The ventral portion of the CA1 region of the hippocampus and the prefrontal cortex as candidate regions for neuromodulation in schizophrenia. Med Hypotheses. 2013 Jun; 80(6): 827−32.