- Email: [email protected]
Poster #142 METACOGNITION OF AGENCY IN PATIENTS WITH SCHIZOPHRENIA
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Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
stimuli by using attentional control. Attentional control is impaired in schizophrenia and there is evidence suggesting that such impairment may be a mechanism contributing to the formation of hallucinations. The present study aims to investigate the effects that implicit emotional prosody exerts on involuntary attention in schizophrenia, using a dichotic listening paradigm which allows us to investigate lateralization of emotional prosody. Methods: Fifteen schizophrenia patients with hallucinations, 12 schizophrenia patients without hallucinations, and 16 healthy controls completed a dichotic listening paradigm, in which an emotional vocal outburst was paired with a neutral vocalization spoken in male and female voices. Baseline trials consisted in pairs of neutral vocalications presented to both ears. Participants were asked to attend to either the left or right ear and to report only the sex of the speaker. Results: All the groups respoded faster to the baseline trials in comparison to the emotional trials. Schizophrenia patients without hallucination and healthy controls revealed longer response times when emotional prosody was presented in the attended right ear than in the attended left ear. Responses were faster when the attended ear and the ear which received the emotional prosody differed. Schizophrenia patients with hallucinations, however, did not benefit from attending to one ear when the emotion was presented to the other ear. Discussion: The findings suggest that in healthy controls and schizophrenia patients without hallucinations, emotional prosody processing is lateralized to the right hemisphere as the right ear/left hemisphere present difficulties handling both, sex discrimination and emotional prosody processing. Schizophrenia patients with hallucinations on the other hand seem to have difficulties in top-down control, as reflected by selective attention, when interfered by automatic emotional processing (bottom-up input), as a result of aberrant lateralization in emotional prosody.
Poster #140 IMPAIRED SACCADIC ADAPTATION IN SCHIZOPHRENIC PATIENTS WITH HIGH NEUROLOGICAL SOFT SIGNS SCORES Isabelle Amado 2 , Anne Le Seac’h 1 , Hernan Picard 2 , Raphael Gaillard 2 , Marie-Odile Krebs 2 , Cecile Beauvillain 1 1 Paris Descartes University, Paris, France; 2 Sainte Anne Hospital, Inserm U894, Paris, France Background: Many motor and cognitive alterations in schizophrenia suggest the involvement of the cerebellum. Neurological soft signs (NSS) are frequent in patients with schizophrenia.Subtle neurological impairment in motor and sensory performance have been shown in patients related to NSS. NSS could reflect significant difference in cortical and subcortical brain volume reductions, and especially in the cerebellum. In this study we tested saccadic adaptation, a well-characterised oculomotor paradigm involving the cerebellum, in schizophrenic patients with high NSS scores. Methods: A group of twelve schizophrenic patients (DSM IV) with high NSS scores was compared to a group of thirteen matched healthy controls for age and years of study.We used a backward reactive saccade adaptation task, in which the target moves intrasaccadically toward from initial fixation, causing the saccade to complete with an endpoint error. After fixing a horizontal point, a target was illuminated in the right hemi-field. When the saccade velocity reached 40°/sec, the target was shifted back by 20% of the target displacement. Results: SZ patients showed smaller average amplitude reduction compared to controls (SZ=1.5±0.6°; C=2.04±1°; p<0.02). Moreover only 25% of the SZ subjects achieved the adaptation demanded by the target step compared to 62% of the control subjects. However, the general shape of the relation between saccadic amplitude and number of saccades was similar for patients and controls. Also patients showed lower saccadic peak velocity than controls (F(1-23) =77.78, p=10-4 ) with a longer duration in adapted saccades (F(1-23) =5.30, p=0.02). Discussion: Reduced saccade adaptation in patients with high NSS scores provides neurophysiological evidence of cerebellar dysfunction. The reduction of peak velocity and increase in saccade duration suggests a deficit in the control of saccade amplitude, with a failure in the updating of the internal feedback model. On the basis of clinical neurological lesions in humans, these findings are in favor of a dysfunction of the oculomotor vermis. This is the fist study that clearly states in a subgroup of patients
with schizophrenia, namely patients having high NSS scores, a cerebellar dysfunction. Further studies are warranted to contrast patients with high and low NSS scores, or to test the specificity of these alterations with other psychiatric diseases.
Poster #141 THE ZOO MAP TEST REVEALS HETEROGENEITY IN ACTION PLANNING PROFILES IN SCHIZOPHRENIA Alice Rampazzo 1,2,4 , Dominique Willard 1,2 , Aurélie Lagodka 2 , Raphaël Gaillard 2 , Nicolas Franck 3 , Marie-Odile Krebs 2 , Isabelle Amado 1,2 , Philippe Allain 4,5 1 Centre Référent Remédiation et Réhabilitation Psychosociale, Sainte-Anne Hospital, Paris, France; 2 University Department of Mental Health and Therapeutic, Inserm U894, Sainte-Anne Hospital, Paris, France; 3 Centre de réhabilitation C.H. Le Vinatier, Université Lyon 1 & CNRS UMR 5229, Lyon, France; 4 Laboratory of Psychology (UPRES EA 2646), University of Angers, Angers, France; 5 Department of Neurology, University Hospital of Angers, Angers, France Background: Cognitive impairments in schizophrenia have been widely studied during the past twenty years, showing an important variability of executive impairments (Chan et al., 2006). Methods: In this study, we compared the performance of 35 subjects suffering from schizophrenia (DSM-IV) to that of 35 healthy control subjects matched by age and educational level on an ecological action planning test, the “Zoo Map Test” (Wilson et al., 1996) divided in two parts. In the first part, the subject has to create a new temporary schema to solve the problem. In the second part, the action plan is given to the subject who must only follow the instructions. In both parts of the test, we measured planning time, execution time, sequencing score, and number of errors. Results: Results showed group effects for execution time (F=5.66; p<0.05), sequencing score (F=24.99; p<0.01), and for the total number of errors (F=9.59; p<0.01). Interaction effects (group × version) were observed for sequencing score (F=24.99; p<0.01) and for total number of errors (F=9.59; p<0.01). From multiple-single-case study analysis, 3 groups of patients were identified: (a) 11 patients showed no difficulty on the task, (b) 20 patients showed difficulties for creating a new temporary schema without execution abnormalities, (c) 4 patients showed difficulties for creating a new temporary schema and for executing it. The analysis of types of errors leads us to identify 2 subgroups in group (b): 84% of the patients committed breaking rules, and 14% of the patients forgot rules. Referring to the model developed by Shallice and Burgess (1998), it seems that breaking rules errors were associated with problem orientation impairments. On the opposite, forgotten rules were associated with impairments for delayed intention markers retrieval stocked in episodic memory and retrieved during the progressive deepening phase, without any orientation trouble. Discussion: To conclude, the Zoo Map Test seems to be a very relevant measure of planning impairments in schizophrenia. Our results lead us to differentiate the ability to mentally develop a logical strategy and/or the ability to execute a predetermined plan. This latter, could be a fine assessment of planning handicap in daily living. Some patients did not present any impairment, while most of them demonstrated an inability to elaborate a strategy, and few showed the inability to elaborate but also to execute the prearranged plan. These profiles of planning impairment do not have the same repercussion on daily living. In consequence, it would be very useful, in future studies, to focus on individual performances on ADL tasks, in order to improve individual cognitive remediation therapy.
Poster #142 METACOGNITION OF AGENCY IN PATIENTS WITH SCHIZOPHRENIA Elisabeth Bacon 1 , Janet Metcalfe 2 1 INSERM and UDS Strasbourg, Strasbourg, France; 2 Columbia University, New York, NY, USA Background: The feeling that we are agents, intentionally making things happen by our own actions, is foundational to our understanding of ourselves as humans. Schizophrenia patients suffer from bizarre delusions, particular delusions of control, and impairments of sense of agency. In most
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
studies devoted to agency with patients, agency was explored through attribution judgments. Methods: We investigated metacognition of agency. The feeling to be or not in control of a task was expressed quantitatively. Participants filled a computer task in which X’s and O’s streamed from the top of the screen, and participants moved the mouse to get the cursor to touch the X’s and avoid the O’s. After each trial, participants made judgments of agency and judgments of performance. Objective control was either undistorted, or distorted by either turbulence (i.e., random noise), a lag between the mouse and cursor movements (of 250 or 500 ms), or made easier (an increased radius around the X’s for which credit was given). Results: Patients exhibited good metacognitions about their performance on this task, and the sensitivity of their Judgment of agency was quite good. They knew that they were not in control when the mouse control was distorted by turbulence and by a lag. However, the one variable to which patients differed from healthy comparison subjects and in which they felt less in control was the control variable, which is in a way the “everyday life”, natural situation. Discussion: Patients felt when there was an external source that increased the difficulty of the task, but they did not feel as well than healthy subjects that they were themselves, intentionally acting in the normal situation. Such denial of feeling in control in the usual condition allowed us to get further light into the pathological disturbances of sense of agency in patients.
Poster #143 AT RISK FOR PSYCHOSIS: THE ROLE OF COGNITION Mark A. Colijn 1 , Mariapaola Barbato 1 , Richard S.E. Keefe 2 , Diana O. Perkins 3 , Scott W. Woods 4 , Jean Addington 1 1 Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; 2 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; 3 Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA; 4 Yale University, School of Medicine, New Haven, Connecticut, USA Background: Cognitive impairment has been observed in individuals at clinical high risk (CHR) of developing psychosis, although research suggests that there is greater impairment after the onset of psychosis than there is before. The aim of the current study was to characterize cognition longitudinally in a sample of individuals at CHR for psychosis, and to compare their cognitive functioning to a potential psychiatric comparison group. Methods: The participants were part of the NIMH funded study PREDICT, that was conducted from 2003 to 2008 at the University of Toronto, University of North Carolina, and Yale. The sample consisted of 172 CHR participants and 100 help seeking controls that were tested every six months for two years using a well-established cognitive test battery. Cognition was assessed using both a composite cognitive score derived from factor analysis and individual tests. Results: Using one way ANOVAs and ANCOVAs, there were no significant differences between the help seeking control group (N=90) and the CHR group (N=157) at baseline on the composite cognitive factor [F(1,239)=2.43, N.S.] nor on any of the individual cognitive tests, although both groups were significantly impaired on most tests for which normative data was available. Using a linear mixed-effects model, although we found stability of both this group and the control group on the cognitive factor, we found significant improvement of both groups on verbal fluency, the Stroop, Trail Making Test, letter number sequencing, finger tapping, spatial working memory, the Continuous Performance Test (CPT), and the Wisconsin Card Sorting Test. The control group alone improved on digit span distractibility. Individuals who later converted to psychosis declined on attention as assessed by the CPT between 6 and 24 months assessment (t=3.9; p<0.0005) and between 12 and 24 months assessment (t=4.11; p<0.0001). Discussion: The two groups did not differ significantly on cognition, and both groups most often performed significantly worse than published normative data. Our results suggest that cognitive impairment may be a characteristic of vulnerable individuals who have varying degrees of risk for psychosis. Moreover, results from the non-conversion group and the help seeking control group suggest that CHR individuals who do not develop psychosis do not cognitively deteriorate over time, but either remain stable or possibly improve. Furthermore, prior to developing psychosis, perfor-
S237
mance of the conversion group seems to remain relatively stable. Taken together, our results suggest that CHR individuals do not cognitively differ from individuals who are help seeking in response to recruitment efforts for those at CHR. It may be that impaired cognition exists in many groups vulnerable to psychosis, and not just those who meet the strict criteria for being at risk of developing psychosis.
Poster #144 CAN NEUROPSYCHOLOGICAL PROFILE (RBANS) PREDICT CO-MORBID TRAUMATIC BRAIN INJURY AND PSYCHOSIS? Rachel A. Batty 1,2 , Susan L. Rossell 1 , Neil Thomas 1 , Andrew J.P. Francis 2 , Malcolm Hopwood 3 1 Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; 2 RMIT University, Bundoora, Victoria, Australia; 3 Heidelberg Repatriation Hospital, Heidelberg West, Victoria, Australia Background: Traumatic insanity has been acknowledged since Meyer (1904), yet the relationship between traumatic brain injury (TBI) and psychosis remains poorly understood and relatively under-researched. To date, systematic and standardised neuropsychological research of psychosis following traumatic brain injury (PFTBI) has not been reported, with work relying on retrospective chart reviews, case studies, and loosely defined self-reported TBI. This is likely due to the difficulties associated with recruiting and assessing PFTBI cohorts given the severity of their illness. We aimed to conduct a standardised empirical investigation into the cognitive/neuropsychological profile of PFTBI, and determine if dual diagnosis can be predicted by scores. Methods: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was given to four groups; PFTBI (N=10), TBI (N=10), schizophrenia (N=23), and healthy controls (N=23). TBI was confirmed by patient records (or a first degree relative where no records were available). Psychosis was determined by a SCID interview and current symptoms were obtained using the PANNS. Participants were matched as closely as possible across demographic and injury related variables; importantly, no significant differences pertaining to injury were shown between the PFTBI and TBI groups with the exception of time since injury (TBI; M=9.80 yrs [SD=9.35], PFTBI; M=24.80 yrs [SD=10.89], t(18)=3.30, p=0.004, d=-1.56), and induced coma (TBI; 70%, PFTB;10%, χ2 (1,N=20)=7.50, p=0.006, Cramer’s V=0.61). RBANS scores were subjected to a linear regression analysis to determine whether PFTBI can be predicted by global neuropsychological scores. Results: Mean total RBANS scores were lowest for the PFTBI group, followed by the schizophrenia, TBI only, and healthy control groups. The RBANS global score was a significant predictor of group membership; R2 =0.29, F(1,63)=26.22, 95% CI -0.041 - -0.018, P <0.001. Discussion: This is the first empirical investigation of the neuropsychological profile of patients with PFTBI, with statistical comparisons made to matched TBI, schizophrenia, and healthy control groups. The data suggests that PFTBI dual diagnosis is characterised by a unique neuropsychological profile relative to individuals with a single diagnosis. Further research is warranted in larger samples.
Poster #145 ENHANCED VISUOSPATIAL IMAGERY MANIPULATION IN SCHIZOPHRENIA Taylor L. Benson, Sohee Park Department of Psychology, Vanderbilt University, Nashville, TN, USA Background: It is well established that patients with schizophrenia exhibit deficits in spatial working memory. Recent evidence indicates that schizophrenic patients experience enhanced mental imagery. The current study investigated the relationship between spatial working memory (SWM) and mental imagery (MI) in schizophrenia with a comprehensive behavioral battery of spatial imagery tasks. Methods: Medicated outpatients with schizophrenia (SZ) and healthy controls (HC) were matched for age, sex, IQ, and Edinburgh/handedness. Symptom severity ratings were collected for SZ patients. All participants completed a Spatial Delayed Response Working Memory Task (SWM task), Raven’s Standard Progressive Matrices (Raven’s), Paper Folding Test (PFT), and an imagery-based jigsaw puzzle task (JPT) that required the manip-
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
stimuli by using attentional control. Attentional control is impaired in schizophrenia and there is evidence suggesting that such impairment may be a mechanism contributing to the formation of hallucinations. The present study aims to investigate the effects that implicit emotional prosody exerts on involuntary attention in schizophrenia, using a dichotic listening paradigm which allows us to investigate lateralization of emotional prosody. Methods: Fifteen schizophrenia patients with hallucinations, 12 schizophrenia patients without hallucinations, and 16 healthy controls completed a dichotic listening paradigm, in which an emotional vocal outburst was paired with a neutral vocalization spoken in male and female voices. Baseline trials consisted in pairs of neutral vocalications presented to both ears. Participants were asked to attend to either the left or right ear and to report only the sex of the speaker. Results: All the groups respoded faster to the baseline trials in comparison to the emotional trials. Schizophrenia patients without hallucination and healthy controls revealed longer response times when emotional prosody was presented in the attended right ear than in the attended left ear. Responses were faster when the attended ear and the ear which received the emotional prosody differed. Schizophrenia patients with hallucinations, however, did not benefit from attending to one ear when the emotion was presented to the other ear. Discussion: The findings suggest that in healthy controls and schizophrenia patients without hallucinations, emotional prosody processing is lateralized to the right hemisphere as the right ear/left hemisphere present difficulties handling both, sex discrimination and emotional prosody processing. Schizophrenia patients with hallucinations on the other hand seem to have difficulties in top-down control, as reflected by selective attention, when interfered by automatic emotional processing (bottom-up input), as a result of aberrant lateralization in emotional prosody.
Poster #140 IMPAIRED SACCADIC ADAPTATION IN SCHIZOPHRENIC PATIENTS WITH HIGH NEUROLOGICAL SOFT SIGNS SCORES Isabelle Amado 2 , Anne Le Seac’h 1 , Hernan Picard 2 , Raphael Gaillard 2 , Marie-Odile Krebs 2 , Cecile Beauvillain 1 1 Paris Descartes University, Paris, France; 2 Sainte Anne Hospital, Inserm U894, Paris, France Background: Many motor and cognitive alterations in schizophrenia suggest the involvement of the cerebellum. Neurological soft signs (NSS) are frequent in patients with schizophrenia.Subtle neurological impairment in motor and sensory performance have been shown in patients related to NSS. NSS could reflect significant difference in cortical and subcortical brain volume reductions, and especially in the cerebellum. In this study we tested saccadic adaptation, a well-characterised oculomotor paradigm involving the cerebellum, in schizophrenic patients with high NSS scores. Methods: A group of twelve schizophrenic patients (DSM IV) with high NSS scores was compared to a group of thirteen matched healthy controls for age and years of study.We used a backward reactive saccade adaptation task, in which the target moves intrasaccadically toward from initial fixation, causing the saccade to complete with an endpoint error. After fixing a horizontal point, a target was illuminated in the right hemi-field. When the saccade velocity reached 40°/sec, the target was shifted back by 20% of the target displacement. Results: SZ patients showed smaller average amplitude reduction compared to controls (SZ=1.5±0.6°; C=2.04±1°; p<0.02). Moreover only 25% of the SZ subjects achieved the adaptation demanded by the target step compared to 62% of the control subjects. However, the general shape of the relation between saccadic amplitude and number of saccades was similar for patients and controls. Also patients showed lower saccadic peak velocity than controls (F(1-23) =77.78, p=10-4 ) with a longer duration in adapted saccades (F(1-23) =5.30, p=0.02). Discussion: Reduced saccade adaptation in patients with high NSS scores provides neurophysiological evidence of cerebellar dysfunction. The reduction of peak velocity and increase in saccade duration suggests a deficit in the control of saccade amplitude, with a failure in the updating of the internal feedback model. On the basis of clinical neurological lesions in humans, these findings are in favor of a dysfunction of the oculomotor vermis. This is the fist study that clearly states in a subgroup of patients
with schizophrenia, namely patients having high NSS scores, a cerebellar dysfunction. Further studies are warranted to contrast patients with high and low NSS scores, or to test the specificity of these alterations with other psychiatric diseases.
Poster #141 THE ZOO MAP TEST REVEALS HETEROGENEITY IN ACTION PLANNING PROFILES IN SCHIZOPHRENIA Alice Rampazzo 1,2,4 , Dominique Willard 1,2 , Aurélie Lagodka 2 , Raphaël Gaillard 2 , Nicolas Franck 3 , Marie-Odile Krebs 2 , Isabelle Amado 1,2 , Philippe Allain 4,5 1 Centre Référent Remédiation et Réhabilitation Psychosociale, Sainte-Anne Hospital, Paris, France; 2 University Department of Mental Health and Therapeutic, Inserm U894, Sainte-Anne Hospital, Paris, France; 3 Centre de réhabilitation C.H. Le Vinatier, Université Lyon 1 & CNRS UMR 5229, Lyon, France; 4 Laboratory of Psychology (UPRES EA 2646), University of Angers, Angers, France; 5 Department of Neurology, University Hospital of Angers, Angers, France Background: Cognitive impairments in schizophrenia have been widely studied during the past twenty years, showing an important variability of executive impairments (Chan et al., 2006). Methods: In this study, we compared the performance of 35 subjects suffering from schizophrenia (DSM-IV) to that of 35 healthy control subjects matched by age and educational level on an ecological action planning test, the “Zoo Map Test” (Wilson et al., 1996) divided in two parts. In the first part, the subject has to create a new temporary schema to solve the problem. In the second part, the action plan is given to the subject who must only follow the instructions. In both parts of the test, we measured planning time, execution time, sequencing score, and number of errors. Results: Results showed group effects for execution time (F=5.66; p<0.05), sequencing score (F=24.99; p<0.01), and for the total number of errors (F=9.59; p<0.01). Interaction effects (group × version) were observed for sequencing score (F=24.99; p<0.01) and for total number of errors (F=9.59; p<0.01). From multiple-single-case study analysis, 3 groups of patients were identified: (a) 11 patients showed no difficulty on the task, (b) 20 patients showed difficulties for creating a new temporary schema without execution abnormalities, (c) 4 patients showed difficulties for creating a new temporary schema and for executing it. The analysis of types of errors leads us to identify 2 subgroups in group (b): 84% of the patients committed breaking rules, and 14% of the patients forgot rules. Referring to the model developed by Shallice and Burgess (1998), it seems that breaking rules errors were associated with problem orientation impairments. On the opposite, forgotten rules were associated with impairments for delayed intention markers retrieval stocked in episodic memory and retrieved during the progressive deepening phase, without any orientation trouble. Discussion: To conclude, the Zoo Map Test seems to be a very relevant measure of planning impairments in schizophrenia. Our results lead us to differentiate the ability to mentally develop a logical strategy and/or the ability to execute a predetermined plan. This latter, could be a fine assessment of planning handicap in daily living. Some patients did not present any impairment, while most of them demonstrated an inability to elaborate a strategy, and few showed the inability to elaborate but also to execute the prearranged plan. These profiles of planning impairment do not have the same repercussion on daily living. In consequence, it would be very useful, in future studies, to focus on individual performances on ADL tasks, in order to improve individual cognitive remediation therapy.
Poster #142 METACOGNITION OF AGENCY IN PATIENTS WITH SCHIZOPHRENIA Elisabeth Bacon 1 , Janet Metcalfe 2 1 INSERM and UDS Strasbourg, Strasbourg, France; 2 Columbia University, New York, NY, USA Background: The feeling that we are agents, intentionally making things happen by our own actions, is foundational to our understanding of ourselves as humans. Schizophrenia patients suffer from bizarre delusions, particular delusions of control, and impairments of sense of agency. In most
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
studies devoted to agency with patients, agency was explored through attribution judgments. Methods: We investigated metacognition of agency. The feeling to be or not in control of a task was expressed quantitatively. Participants filled a computer task in which X’s and O’s streamed from the top of the screen, and participants moved the mouse to get the cursor to touch the X’s and avoid the O’s. After each trial, participants made judgments of agency and judgments of performance. Objective control was either undistorted, or distorted by either turbulence (i.e., random noise), a lag between the mouse and cursor movements (of 250 or 500 ms), or made easier (an increased radius around the X’s for which credit was given). Results: Patients exhibited good metacognitions about their performance on this task, and the sensitivity of their Judgment of agency was quite good. They knew that they were not in control when the mouse control was distorted by turbulence and by a lag. However, the one variable to which patients differed from healthy comparison subjects and in which they felt less in control was the control variable, which is in a way the “everyday life”, natural situation. Discussion: Patients felt when there was an external source that increased the difficulty of the task, but they did not feel as well than healthy subjects that they were themselves, intentionally acting in the normal situation. Such denial of feeling in control in the usual condition allowed us to get further light into the pathological disturbances of sense of agency in patients.
Poster #143 AT RISK FOR PSYCHOSIS: THE ROLE OF COGNITION Mark A. Colijn 1 , Mariapaola Barbato 1 , Richard S.E. Keefe 2 , Diana O. Perkins 3 , Scott W. Woods 4 , Jean Addington 1 1 Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; 2 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; 3 Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA; 4 Yale University, School of Medicine, New Haven, Connecticut, USA Background: Cognitive impairment has been observed in individuals at clinical high risk (CHR) of developing psychosis, although research suggests that there is greater impairment after the onset of psychosis than there is before. The aim of the current study was to characterize cognition longitudinally in a sample of individuals at CHR for psychosis, and to compare their cognitive functioning to a potential psychiatric comparison group. Methods: The participants were part of the NIMH funded study PREDICT, that was conducted from 2003 to 2008 at the University of Toronto, University of North Carolina, and Yale. The sample consisted of 172 CHR participants and 100 help seeking controls that were tested every six months for two years using a well-established cognitive test battery. Cognition was assessed using both a composite cognitive score derived from factor analysis and individual tests. Results: Using one way ANOVAs and ANCOVAs, there were no significant differences between the help seeking control group (N=90) and the CHR group (N=157) at baseline on the composite cognitive factor [F(1,239)=2.43, N.S.] nor on any of the individual cognitive tests, although both groups were significantly impaired on most tests for which normative data was available. Using a linear mixed-effects model, although we found stability of both this group and the control group on the cognitive factor, we found significant improvement of both groups on verbal fluency, the Stroop, Trail Making Test, letter number sequencing, finger tapping, spatial working memory, the Continuous Performance Test (CPT), and the Wisconsin Card Sorting Test. The control group alone improved on digit span distractibility. Individuals who later converted to psychosis declined on attention as assessed by the CPT between 6 and 24 months assessment (t=3.9; p<0.0005) and between 12 and 24 months assessment (t=4.11; p<0.0001). Discussion: The two groups did not differ significantly on cognition, and both groups most often performed significantly worse than published normative data. Our results suggest that cognitive impairment may be a characteristic of vulnerable individuals who have varying degrees of risk for psychosis. Moreover, results from the non-conversion group and the help seeking control group suggest that CHR individuals who do not develop psychosis do not cognitively deteriorate over time, but either remain stable or possibly improve. Furthermore, prior to developing psychosis, perfor-
S237
mance of the conversion group seems to remain relatively stable. Taken together, our results suggest that CHR individuals do not cognitively differ from individuals who are help seeking in response to recruitment efforts for those at CHR. It may be that impaired cognition exists in many groups vulnerable to psychosis, and not just those who meet the strict criteria for being at risk of developing psychosis.
Poster #144 CAN NEUROPSYCHOLOGICAL PROFILE (RBANS) PREDICT CO-MORBID TRAUMATIC BRAIN INJURY AND PSYCHOSIS? Rachel A. Batty 1,2 , Susan L. Rossell 1 , Neil Thomas 1 , Andrew J.P. Francis 2 , Malcolm Hopwood 3 1 Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; 2 RMIT University, Bundoora, Victoria, Australia; 3 Heidelberg Repatriation Hospital, Heidelberg West, Victoria, Australia Background: Traumatic insanity has been acknowledged since Meyer (1904), yet the relationship between traumatic brain injury (TBI) and psychosis remains poorly understood and relatively under-researched. To date, systematic and standardised neuropsychological research of psychosis following traumatic brain injury (PFTBI) has not been reported, with work relying on retrospective chart reviews, case studies, and loosely defined self-reported TBI. This is likely due to the difficulties associated with recruiting and assessing PFTBI cohorts given the severity of their illness. We aimed to conduct a standardised empirical investigation into the cognitive/neuropsychological profile of PFTBI, and determine if dual diagnosis can be predicted by scores. Methods: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was given to four groups; PFTBI (N=10), TBI (N=10), schizophrenia (N=23), and healthy controls (N=23). TBI was confirmed by patient records (or a first degree relative where no records were available). Psychosis was determined by a SCID interview and current symptoms were obtained using the PANNS. Participants were matched as closely as possible across demographic and injury related variables; importantly, no significant differences pertaining to injury were shown between the PFTBI and TBI groups with the exception of time since injury (TBI; M=9.80 yrs [SD=9.35], PFTBI; M=24.80 yrs [SD=10.89], t(18)=3.30, p=0.004, d=-1.56), and induced coma (TBI; 70%, PFTB;10%, χ2 (1,N=20)=7.50, p=0.006, Cramer’s V=0.61). RBANS scores were subjected to a linear regression analysis to determine whether PFTBI can be predicted by global neuropsychological scores. Results: Mean total RBANS scores were lowest for the PFTBI group, followed by the schizophrenia, TBI only, and healthy control groups. The RBANS global score was a significant predictor of group membership; R2 =0.29, F(1,63)=26.22, 95% CI -0.041 - -0.018, P <0.001. Discussion: This is the first empirical investigation of the neuropsychological profile of patients with PFTBI, with statistical comparisons made to matched TBI, schizophrenia, and healthy control groups. The data suggests that PFTBI dual diagnosis is characterised by a unique neuropsychological profile relative to individuals with a single diagnosis. Further research is warranted in larger samples.
Poster #145 ENHANCED VISUOSPATIAL IMAGERY MANIPULATION IN SCHIZOPHRENIA Taylor L. Benson, Sohee Park Department of Psychology, Vanderbilt University, Nashville, TN, USA Background: It is well established that patients with schizophrenia exhibit deficits in spatial working memory. Recent evidence indicates that schizophrenic patients experience enhanced mental imagery. The current study investigated the relationship between spatial working memory (SWM) and mental imagery (MI) in schizophrenia with a comprehensive behavioral battery of spatial imagery tasks. Methods: Medicated outpatients with schizophrenia (SZ) and healthy controls (HC) were matched for age, sex, IQ, and Edinburgh/handedness. Symptom severity ratings were collected for SZ patients. All participants completed a Spatial Delayed Response Working Memory Task (SWM task), Raven’s Standard Progressive Matrices (Raven’s), Paper Folding Test (PFT), and an imagery-based jigsaw puzzle task (JPT) that required the manip-