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Poster #154 THE COMPARATIVE STRENGTH OF MULTIPLE PREDICTORS OF REAL WORLD FUNCTIONING IN PATIENTS WITH SCHIZOPHRENIA
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
Methods: 24 adolescents with EOS (mean age: 13.4±0.57), 14 adolescents with High Functioning Autism (HFA) (mean age: 12.3±0.74) and 18 adolescents with Asperger Syndrome (AS) (mean age: 12.3±0.65) matched on age, general IQ, performance IQ, were compared. Diagnostics were made according to DSM-IV criteria. All patients were evaluated by the Autism Diagnostic Interview – Revised (ADI-R) but only schizophrenic patients were evaluated by the Positive and Negative Syndrome Scale (PANSS). Pragmatics capacities were explored by the Children’s Communication Checklist, a parental report of language and communication in naturalistic context. The ability to attribute intentions to others were explored by a First order theory of mind task; the comprehension of figurative language was explored by a task which requires to disambiguate the figurative meaning of idioms in context. Cognitive functions were explored by the Wechsler Intelligence Scale and by several executive tasks: mental flexibility and working memory (TMT and WCST), verbal fluency and inhibition (Stroop). Results: 1)Compared to adolescents with EOS, adolescents with HFA and adolescents with AS exhibited the same performance on the ability to attribute intentions to others. 2) Compared to adolescents with AS and adolescents with EOS, HFA had more impaired figurative comprehension. 3) Compared to adolescents with EOS, adolescents with AS and adolescents with HFA exhibited the same capacity to inhibit figurative meaning to interpret idiomatic expression on literal context. Furthermore, no difference appeared on the subtest of Wechsler Intelligence Scale and on executive tasks between EOS and ASD. Compared to adolescents with EOS, adolescents with HFA and adolescents with AS exhibited more severe pragmatic impairments in naturalistic context. Discussion: Our findings provide further support for some similarities in social cognition between EOS, HFA and AS. Only HFA had difficulties to understand figurative language compared to EOS and AS. Furthermore, results showed that classical neuropsychological tests are not sensitive to reveal the distinctions that may highlight disorder-specific mechanisms underlying by disorganization syndrome, a core feature of schizophrenia. Future research that examines how differential cognitive functioning impact social cognitive abilities in EOS and ASD is warranted.
Poster #154 THE COMPARATIVE STRENGTH OF MULTIPLE PREDICTORS OF REAL WORLD FUNCTIONING IN PATIENTS WITH SCHIZOPHRENIA David Loewenstein 1 , Sara Czaja 1 , Phlip Harvey 1,2 Department of Psychiatry, University of Miami School of Medicine, Miami, Florida, USA; 2 Department of Veterans’s Affairs, Miami, Florida, USA 1
Background: There is growing recognition of the need to identify predictors of real-world functional outcomes in Schizophrenia. While performances on performance-based measures of functional capacity are associated with real-world outcomes, predictive power is insufficient at the individual level. The purpose of this study was to examine other factors that might allow for the prediction of functional deficits in the everyday environment. Methods: Methods: The real-world performance of 140 schizophrenic patients residing in the community was evaluated using the Specific Levels of Functioning Scale (SLOF). Predictors of real-world functioning were scores on the Brief Version of the UCSD Performance Based Skills Assessment (UPSA-B), Positive and Negative Syndrome Scale (PANSS), a neurocognitive composite score and the Beck Depression Inventory (BDI). Linear regression as well as logistic regression was employed to examine the contribution of the predictor variables to outcome and to classify those with high (upper 25th percentile) versus low performance (lower 25th percentile) on the SLOF. Results: SLOF scores were most associated with reported depression on the BDI (r=-0.36; p<0.001), PANSS Total (r=- 30; p<0.001), neurocognitive composite score (r=0.25; ≤0.001) and the UPSA (r=0.23: p<0.005). When entered in the model together, these variables resulted in a total R=0.62 (p<0.001) which explained 38% of the total variability in the model. Logistic regression analyses were applied in an attempt to distinguish the top 25% of performers from the bottom 25% of performers on the SLOF. The most powerful predictor in the model was the BDI (Sensitivity=73.3%; Specificity=0.80; Overall classification = 76.9%). When neuropsychological performance was added to the model, overall classification was increased to 80.0% (Sensitivity=70.0%; Specificity=88.6%). Discussion: Real world everyday function as assessed by expert inter-
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viewer ratings on the SLOF could be predicted individually by BDI scores, PANSS score, functional performance on the UPSA and global neurocognitive scores. Taken together, a combination of BDI and the neurocognition could distinguish between highest and lowest levels of SLOF performance with 80% accuracy. It appears that real world functional performance is related to multiple factors. Although everyday functional performance was associated with underlying cognitive and functional abilities, measures of subjective distress as well severity of schizophrenia symptoms may exert even more influence on real world function.
Poster #155 THEORY OF MINDAND CONTEXT PROCESSING IN SCHIZOPHRENIA: THE ROLE OF SOCIAL KNOWLEDGE Maud Champagne-Lavau 1 , Anick Charest 2 , Guy Blouin 3 , Jean-Pierre Rodriguez 3 1 CNRS UMR 6057, Aix-en-Provence, France; 2 University of Montreal, Montreal, QC, Canada; 3 Hopital du sacré-Coeur de Montréal, Montreal, QC, Canada Background: A deficit in social cognition is one of the most disabling clinical characteristics of schizophrenia including theory of mind, emotion processing, social perception and attributional bias (Couture et al., 2006). For this reason, social cognition has become a high priority domain of research to study schizophrenia (Green et al., 2008).The inability to infer intentions and beliefs of others has been supposed to result from their inability to use contextual information (Hardy-Baylé et al., 2003; Green et al., 2005). However, despite increasing evidence for impaired context processing, there has been little research into the relevance of these deficits for an understanding of social cognition, particularly ToM, in schizophrenia.It was also suggested that several factors such as level of incongruity between context and speaker’s utterance, prosody, or character’s features set in the stimulus situation cue the comprehension of the ironic intent among healthy subjects (Ivanko and Pexman, 2003). The aim of this study was to determine whether stereotypes (type of speaker’s occupation) were social factors that cue comprehension of ironic intent in schizophrenia. Methods: Thirty individuals with a DSM-IV diagnosis of schizophrenia (SZ) and thirty healthy control (HC) participants matched for age and educational level were recruited.They were asked to read 48 stories in which the speaker’s occupation had been manipulated according to 3 conditions of occupation: occupation that cues ironic intent, occupation that does not cue ironic intent and no occupation. Participants were asked to judge on a7-point scale (1=not at all, 7=extremely) if the speaker was ironic, if he was mocking someone, if he was polite and if told something positive. The first two questions were used to assess attribution of mental states to the speaker while the last questions were used to assess social perception. Results: The data were analyzed using 2 groups (SZ, HC) × 2 statements (ironic, literal) × 2 speaker’s occupations (ironic, non ironic) repeatedmeasures ANOVAs. Main results showed that SZ participants were not sensitive to stereotypes (type of speaker’s occupation) by contrast to healthy control participants. They also performed differently from healthy control participants concerning attribution of ironic intent to the protagonist. Indeed, they judged ironic statements as less ironic than HC participants, and they judged mockery in the same way whatever the type of statement and the type of speaker’s occupation. However, no difference was found between the two groups regarding social perception ability. Discussion: Such results are in line with those of Uhlhaas et al. (2006) and Green et al. (2007), showing inefficient integration of social contextual information in schizophrenia (Green et al., 2008). However, our results concerning social perception (e.g. politeness) in schizophrenia are not consistent with the literature (Couture et al., 2006).
Poster #156 NEUROCOGNITIVE IMPAIRMENTS IN ADOLESCENTS WITH AT-RISK STATES OF PSYCHOSIS Chantal M. Michel, Benno G. Schimmelmann, Nicole Leibundgut, Frauke T. Schultze-Lutter University Hospital of Child and Adolescent Psychiatry Bern, Bern, Switzerland Background: In the early detection of psychosis, the “ultra high risk” (UHR)
Methods: 24 adolescents with EOS (mean age: 13.4±0.57), 14 adolescents with High Functioning Autism (HFA) (mean age: 12.3±0.74) and 18 adolescents with Asperger Syndrome (AS) (mean age: 12.3±0.65) matched on age, general IQ, performance IQ, were compared. Diagnostics were made according to DSM-IV criteria. All patients were evaluated by the Autism Diagnostic Interview – Revised (ADI-R) but only schizophrenic patients were evaluated by the Positive and Negative Syndrome Scale (PANSS). Pragmatics capacities were explored by the Children’s Communication Checklist, a parental report of language and communication in naturalistic context. The ability to attribute intentions to others were explored by a First order theory of mind task; the comprehension of figurative language was explored by a task which requires to disambiguate the figurative meaning of idioms in context. Cognitive functions were explored by the Wechsler Intelligence Scale and by several executive tasks: mental flexibility and working memory (TMT and WCST), verbal fluency and inhibition (Stroop). Results: 1)Compared to adolescents with EOS, adolescents with HFA and adolescents with AS exhibited the same performance on the ability to attribute intentions to others. 2) Compared to adolescents with AS and adolescents with EOS, HFA had more impaired figurative comprehension. 3) Compared to adolescents with EOS, adolescents with AS and adolescents with HFA exhibited the same capacity to inhibit figurative meaning to interpret idiomatic expression on literal context. Furthermore, no difference appeared on the subtest of Wechsler Intelligence Scale and on executive tasks between EOS and ASD. Compared to adolescents with EOS, adolescents with HFA and adolescents with AS exhibited more severe pragmatic impairments in naturalistic context. Discussion: Our findings provide further support for some similarities in social cognition between EOS, HFA and AS. Only HFA had difficulties to understand figurative language compared to EOS and AS. Furthermore, results showed that classical neuropsychological tests are not sensitive to reveal the distinctions that may highlight disorder-specific mechanisms underlying by disorganization syndrome, a core feature of schizophrenia. Future research that examines how differential cognitive functioning impact social cognitive abilities in EOS and ASD is warranted.
Poster #154 THE COMPARATIVE STRENGTH OF MULTIPLE PREDICTORS OF REAL WORLD FUNCTIONING IN PATIENTS WITH SCHIZOPHRENIA David Loewenstein 1 , Sara Czaja 1 , Phlip Harvey 1,2 Department of Psychiatry, University of Miami School of Medicine, Miami, Florida, USA; 2 Department of Veterans’s Affairs, Miami, Florida, USA 1
Background: There is growing recognition of the need to identify predictors of real-world functional outcomes in Schizophrenia. While performances on performance-based measures of functional capacity are associated with real-world outcomes, predictive power is insufficient at the individual level. The purpose of this study was to examine other factors that might allow for the prediction of functional deficits in the everyday environment. Methods: Methods: The real-world performance of 140 schizophrenic patients residing in the community was evaluated using the Specific Levels of Functioning Scale (SLOF). Predictors of real-world functioning were scores on the Brief Version of the UCSD Performance Based Skills Assessment (UPSA-B), Positive and Negative Syndrome Scale (PANSS), a neurocognitive composite score and the Beck Depression Inventory (BDI). Linear regression as well as logistic regression was employed to examine the contribution of the predictor variables to outcome and to classify those with high (upper 25th percentile) versus low performance (lower 25th percentile) on the SLOF. Results: SLOF scores were most associated with reported depression on the BDI (r=-0.36; p<0.001), PANSS Total (r=- 30; p<0.001), neurocognitive composite score (r=0.25; ≤0.001) and the UPSA (r=0.23: p<0.005). When entered in the model together, these variables resulted in a total R=0.62 (p<0.001) which explained 38% of the total variability in the model. Logistic regression analyses were applied in an attempt to distinguish the top 25% of performers from the bottom 25% of performers on the SLOF. The most powerful predictor in the model was the BDI (Sensitivity=73.3%; Specificity=0.80; Overall classification = 76.9%). When neuropsychological performance was added to the model, overall classification was increased to 80.0% (Sensitivity=70.0%; Specificity=88.6%). Discussion: Real world everyday function as assessed by expert inter-
S241
viewer ratings on the SLOF could be predicted individually by BDI scores, PANSS score, functional performance on the UPSA and global neurocognitive scores. Taken together, a combination of BDI and the neurocognition could distinguish between highest and lowest levels of SLOF performance with 80% accuracy. It appears that real world functional performance is related to multiple factors. Although everyday functional performance was associated with underlying cognitive and functional abilities, measures of subjective distress as well severity of schizophrenia symptoms may exert even more influence on real world function.
Poster #155 THEORY OF MINDAND CONTEXT PROCESSING IN SCHIZOPHRENIA: THE ROLE OF SOCIAL KNOWLEDGE Maud Champagne-Lavau 1 , Anick Charest 2 , Guy Blouin 3 , Jean-Pierre Rodriguez 3 1 CNRS UMR 6057, Aix-en-Provence, France; 2 University of Montreal, Montreal, QC, Canada; 3 Hopital du sacré-Coeur de Montréal, Montreal, QC, Canada Background: A deficit in social cognition is one of the most disabling clinical characteristics of schizophrenia including theory of mind, emotion processing, social perception and attributional bias (Couture et al., 2006). For this reason, social cognition has become a high priority domain of research to study schizophrenia (Green et al., 2008).The inability to infer intentions and beliefs of others has been supposed to result from their inability to use contextual information (Hardy-Baylé et al., 2003; Green et al., 2005). However, despite increasing evidence for impaired context processing, there has been little research into the relevance of these deficits for an understanding of social cognition, particularly ToM, in schizophrenia.It was also suggested that several factors such as level of incongruity between context and speaker’s utterance, prosody, or character’s features set in the stimulus situation cue the comprehension of the ironic intent among healthy subjects (Ivanko and Pexman, 2003). The aim of this study was to determine whether stereotypes (type of speaker’s occupation) were social factors that cue comprehension of ironic intent in schizophrenia. Methods: Thirty individuals with a DSM-IV diagnosis of schizophrenia (SZ) and thirty healthy control (HC) participants matched for age and educational level were recruited.They were asked to read 48 stories in which the speaker’s occupation had been manipulated according to 3 conditions of occupation: occupation that cues ironic intent, occupation that does not cue ironic intent and no occupation. Participants were asked to judge on a7-point scale (1=not at all, 7=extremely) if the speaker was ironic, if he was mocking someone, if he was polite and if told something positive. The first two questions were used to assess attribution of mental states to the speaker while the last questions were used to assess social perception. Results: The data were analyzed using 2 groups (SZ, HC) × 2 statements (ironic, literal) × 2 speaker’s occupations (ironic, non ironic) repeatedmeasures ANOVAs. Main results showed that SZ participants were not sensitive to stereotypes (type of speaker’s occupation) by contrast to healthy control participants. They also performed differently from healthy control participants concerning attribution of ironic intent to the protagonist. Indeed, they judged ironic statements as less ironic than HC participants, and they judged mockery in the same way whatever the type of statement and the type of speaker’s occupation. However, no difference was found between the two groups regarding social perception ability. Discussion: Such results are in line with those of Uhlhaas et al. (2006) and Green et al. (2007), showing inefficient integration of social contextual information in schizophrenia (Green et al., 2008). However, our results concerning social perception (e.g. politeness) in schizophrenia are not consistent with the literature (Couture et al., 2006).
Poster #156 NEUROCOGNITIVE IMPAIRMENTS IN ADOLESCENTS WITH AT-RISK STATES OF PSYCHOSIS Chantal M. Michel, Benno G. Schimmelmann, Nicole Leibundgut, Frauke T. Schultze-Lutter University Hospital of Child and Adolescent Psychiatry Bern, Bern, Switzerland Background: In the early detection of psychosis, the “ultra high risk” (UHR)