- Email: [email protected]
Poster #84 LONGITUDINAL ASSOCIATION OF STRESS MEASURES WITH SYMPTOMS IN YOUTHATCLINICALHIGHRISKFORPSYCHOSIS
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
the global severity of symptoms on the basis of psychometric results and number of hospitalizations during the last three years. We correlated psychometric scores with familiarity for a psychiatric disease. Results: We confirmed a higher prevalence of psychiatric diagnoses among patients’ families compared to the general population: 29% of our patient sample was found to have at least one parent or brother with a reliable psychiatric diagnosis. Surprisingly, we found that patients with a positive familiarity did not show a worse psychopathological profile compared to patients with a silent familiar history: BPRS and PANSS scores were significantly lower (*) in the schizophrenic group with at least one parent or brother affected by a defined psychiatric diagnosis compared to the schizophrenic subgroup with a silent familiar psychiatric history (p value <0,05). SWN, NRS and Number of hospitalizations scores were found to be similar between groups. Discussion: Psychiatric outpatient services all along strive to coordinate care provided by a multi-disciplinary team of mental health professionals, within the context of a trusting and respectful therapeutic relationship. Families with a complex psychiatric history, in which more than one component attends our services, are strictly supervised in order to prevent stressful life events, generally more frequent in problematic families. This accurate monitoring may have contributed to the slighter intensity of symptoms found in schizophrenic patients with a positive familiarity for psychiatric diagnoses.
Poster #83 ARE IMMIGRANTS TO CANADA AT INCREASED OR DECREASED RISK FOR SCHIZOPHRENIA? Marie-Jose Dealberto Queen’s University, Kingston, Ontario, Canada Background: That immigrants have an increased risk for schizophrenia is well known in Europe: two recent meta-analyses (Cantor-Graae & Selten 2005, Bourque et al. 2011) estimated that immigrants were two to three times more at risk than native-born subjects. The risk remained similarly increased in the second generation of immigrants, i.e. in those born in the host country to immigrant parents. Although Canada is a country of immigration (first- and second-generation immigrants represent 40% of its adult population) little is known concerning the risk for schizophrenia in immigrants to Canada. The aim of the present study was to systematically review Canadian data on schizophrenia and immigration and to examine the evolution over time of the risk associated with immigrant status in relation with schizophrenia rates. Methods: Electronic searches of published articles were complemented by cross-references from retrieved articles and reviews. Studies were included when they used recognised criteria of schizophrenia, provided rates plus the number of cases and the population examined and, for studies on immigration, when they provided risk ratios associated with immigrant status. Evolution of risk ratios and rates over time was tested by the Spearman rank correlation coefficient (r), as were correlations of risk ratios with prevalence and incidence rates. Results: Six population and hospital admission studies provided rate ratios for schizophrenia in foreign-born compared to native-born persons. None considered second-generation immigrants. Three studies found an increased risk for schizophrenia in immigrants: 1.5 in 1902-1913 (Smith et al. 2006), 1.8 in 1950-1952 (Malzberg 1963), and 1.2 in 1961 (De Hesse 1967), with risk estimates lower than those observed in European studies. One study found similar rates of schizophrenia in 1978 (Bland & Orn 1981). Two studies reported a lower risk: 0.79 in 1979 for schizophrenia (Morgan & Andrushko 1977), and 0.54 in 2002 for schizophrenia and other psychoses (Menezes et al. 2011) in immigrants. The risk for schizophrenia associated with immigrant status decreased with time (r=0.89, df=4, p<0.05). Prevalence rates of schizophrenia increased over time in Canada, doubling from 3 to 6 per 1 000 between 1983-1986 and 1995-2006 (r=1, df=3, p<0.01), as did incidence rates, tripling from 14 to 42 per 100 000 between 1963 and 1995-2006 (r=0.77, df=4, p<0.10) (Dealberto, submitted). The risk associated with immigrant status and rates of schizophrenia over time were inversely correlated (for prevalence, r=–0.70, df=3, p<0.20; for incidence r=-0.90, df=3, p<0.05). Discussion: This systematic review of Canadian data found that the risk for schizophrenia associated with immigration decreased over time. This
S215
decrease was inversely correlated with the increase over time of prevalence and incidence rates of schizophrenia. The most recent Canadian data suggest that currently foreign-born subjects have a paradoxical lower risk for schizophrenia than native-born subjects. The higher level of education of immigrants to Canada could partly explain the decrease of the risk associated with immigrant status over time, but it does not explain the increase of schizophrenia rates. It is more likely that schizophrenia rates are increasing over time in Canada due to its high northern latitude and the large proportion of immigrants and descendants of immigrants in its population. No Canadian study provided data on the risk for schizophrenia and psychosis in the second and later generations of immigrants. This lack underlines the need for epidemiological studies in Canada assessing the risk for schizophrenia and psychosis according to the generation of immigration.
Poster #84 LONGITUDINAL ASSOCIATION OF STRESS MEASURES WITH SYMPTOMS IN YOUTH AT CLINICAL HIGH RISK FOR PSYCHOSIS Jordan E. DeVylder 1 , Shelly Ben-David 2 , Scott Schobel 3 , David Kimhy 4 , Cheryl M. Corcoran 2 1 Columbia University School of Social Work, New York, NY, USA; 2 Division of Cognitive Neuroscience, New York State Psychiatric Institute at Columbia University, New York, NY, USA; 3 Division of Translational Imaging, New York State Psychiatric Institute at Columbia University, New York, NY, USA; 4 Department of Psychiatry, Columbia University, New York, NY, USA Background: Impaired stress tolerance and major life events have been associated with psychotic symptoms and relapse in schizophrenia. Likewise, in patients at clinical high risk for psychosis, impaired stress tolerance has been associated with concurrent and later positive symptom severity. We build on this literature by examining the temporal associations of stress measures and symptom severity over time in a prospective clinical high risk cohort, hypothesizing that impaired stress tolerance covaries over time with positive symptom severity. Methods: A combined cross-sectional and longitudinal design was used to examine self-reported life events and impaired stress tolerance. Stress measures and symptoms were examined in clinical high risk patients (n=65) and age- and sex-similar controls. Stress measures included exposure to major life events and the experience of impaired tolerance to normal stress, such as daily hassles. Symptoms included attenuated positive and negative symptoms, as well as depression, anxiety, and global function. The high risk cohort and healthy controls were compared at baseline on measures of symptom severity and stress, and generalized estimating equation analyses were used to examine covariation between stress measures and symptoms in high risk patients assessed quarterly for up to 4 years. Results: Clinical high risk patients reported greater impaired tolerance to normal stress, which was associated over time with positive symptoms (unusual thought content, suspiciousness, conceptual disorganization, and total positive), as well as negative symptoms, depression and poor global function. Associations between impaired stress tolerance and symptoms remained when controlling for demographic variables, medications, and substance use. By contrast, reported number of life events did not differ between groups at baseline, and bore no association with any symptoms over time. There was a trajectory of general improvement in stress tolerance, positive symptoms, depression, and function, but not in negative symptoms or anxiety, which remained relatively stable. Discussion: Self-reported impaired stress tolerance was associated with a wide range of “prodromal” symptoms and functioning, consistent with it being a core feature of the psychosis risk state. Impaired stress tolerance may therefore be a potential target for early intervention. Self-reported life events were not relevant as a correlate of clinical status. As in other treated clinical high risk cohorts, most patients improved over time across symptom domains.
the global severity of symptoms on the basis of psychometric results and number of hospitalizations during the last three years. We correlated psychometric scores with familiarity for a psychiatric disease. Results: We confirmed a higher prevalence of psychiatric diagnoses among patients’ families compared to the general population: 29% of our patient sample was found to have at least one parent or brother with a reliable psychiatric diagnosis. Surprisingly, we found that patients with a positive familiarity did not show a worse psychopathological profile compared to patients with a silent familiar history: BPRS and PANSS scores were significantly lower (*) in the schizophrenic group with at least one parent or brother affected by a defined psychiatric diagnosis compared to the schizophrenic subgroup with a silent familiar psychiatric history (p value <0,05). SWN, NRS and Number of hospitalizations scores were found to be similar between groups. Discussion: Psychiatric outpatient services all along strive to coordinate care provided by a multi-disciplinary team of mental health professionals, within the context of a trusting and respectful therapeutic relationship. Families with a complex psychiatric history, in which more than one component attends our services, are strictly supervised in order to prevent stressful life events, generally more frequent in problematic families. This accurate monitoring may have contributed to the slighter intensity of symptoms found in schizophrenic patients with a positive familiarity for psychiatric diagnoses.
Poster #83 ARE IMMIGRANTS TO CANADA AT INCREASED OR DECREASED RISK FOR SCHIZOPHRENIA? Marie-Jose Dealberto Queen’s University, Kingston, Ontario, Canada Background: That immigrants have an increased risk for schizophrenia is well known in Europe: two recent meta-analyses (Cantor-Graae & Selten 2005, Bourque et al. 2011) estimated that immigrants were two to three times more at risk than native-born subjects. The risk remained similarly increased in the second generation of immigrants, i.e. in those born in the host country to immigrant parents. Although Canada is a country of immigration (first- and second-generation immigrants represent 40% of its adult population) little is known concerning the risk for schizophrenia in immigrants to Canada. The aim of the present study was to systematically review Canadian data on schizophrenia and immigration and to examine the evolution over time of the risk associated with immigrant status in relation with schizophrenia rates. Methods: Electronic searches of published articles were complemented by cross-references from retrieved articles and reviews. Studies were included when they used recognised criteria of schizophrenia, provided rates plus the number of cases and the population examined and, for studies on immigration, when they provided risk ratios associated with immigrant status. Evolution of risk ratios and rates over time was tested by the Spearman rank correlation coefficient (r), as were correlations of risk ratios with prevalence and incidence rates. Results: Six population and hospital admission studies provided rate ratios for schizophrenia in foreign-born compared to native-born persons. None considered second-generation immigrants. Three studies found an increased risk for schizophrenia in immigrants: 1.5 in 1902-1913 (Smith et al. 2006), 1.8 in 1950-1952 (Malzberg 1963), and 1.2 in 1961 (De Hesse 1967), with risk estimates lower than those observed in European studies. One study found similar rates of schizophrenia in 1978 (Bland & Orn 1981). Two studies reported a lower risk: 0.79 in 1979 for schizophrenia (Morgan & Andrushko 1977), and 0.54 in 2002 for schizophrenia and other psychoses (Menezes et al. 2011) in immigrants. The risk for schizophrenia associated with immigrant status decreased with time (r=0.89, df=4, p<0.05). Prevalence rates of schizophrenia increased over time in Canada, doubling from 3 to 6 per 1 000 between 1983-1986 and 1995-2006 (r=1, df=3, p<0.01), as did incidence rates, tripling from 14 to 42 per 100 000 between 1963 and 1995-2006 (r=0.77, df=4, p<0.10) (Dealberto, submitted). The risk associated with immigrant status and rates of schizophrenia over time were inversely correlated (for prevalence, r=–0.70, df=3, p<0.20; for incidence r=-0.90, df=3, p<0.05). Discussion: This systematic review of Canadian data found that the risk for schizophrenia associated with immigration decreased over time. This
S215
decrease was inversely correlated with the increase over time of prevalence and incidence rates of schizophrenia. The most recent Canadian data suggest that currently foreign-born subjects have a paradoxical lower risk for schizophrenia than native-born subjects. The higher level of education of immigrants to Canada could partly explain the decrease of the risk associated with immigrant status over time, but it does not explain the increase of schizophrenia rates. It is more likely that schizophrenia rates are increasing over time in Canada due to its high northern latitude and the large proportion of immigrants and descendants of immigrants in its population. No Canadian study provided data on the risk for schizophrenia and psychosis in the second and later generations of immigrants. This lack underlines the need for epidemiological studies in Canada assessing the risk for schizophrenia and psychosis according to the generation of immigration.
Poster #84 LONGITUDINAL ASSOCIATION OF STRESS MEASURES WITH SYMPTOMS IN YOUTH AT CLINICAL HIGH RISK FOR PSYCHOSIS Jordan E. DeVylder 1 , Shelly Ben-David 2 , Scott Schobel 3 , David Kimhy 4 , Cheryl M. Corcoran 2 1 Columbia University School of Social Work, New York, NY, USA; 2 Division of Cognitive Neuroscience, New York State Psychiatric Institute at Columbia University, New York, NY, USA; 3 Division of Translational Imaging, New York State Psychiatric Institute at Columbia University, New York, NY, USA; 4 Department of Psychiatry, Columbia University, New York, NY, USA Background: Impaired stress tolerance and major life events have been associated with psychotic symptoms and relapse in schizophrenia. Likewise, in patients at clinical high risk for psychosis, impaired stress tolerance has been associated with concurrent and later positive symptom severity. We build on this literature by examining the temporal associations of stress measures and symptom severity over time in a prospective clinical high risk cohort, hypothesizing that impaired stress tolerance covaries over time with positive symptom severity. Methods: A combined cross-sectional and longitudinal design was used to examine self-reported life events and impaired stress tolerance. Stress measures and symptoms were examined in clinical high risk patients (n=65) and age- and sex-similar controls. Stress measures included exposure to major life events and the experience of impaired tolerance to normal stress, such as daily hassles. Symptoms included attenuated positive and negative symptoms, as well as depression, anxiety, and global function. The high risk cohort and healthy controls were compared at baseline on measures of symptom severity and stress, and generalized estimating equation analyses were used to examine covariation between stress measures and symptoms in high risk patients assessed quarterly for up to 4 years. Results: Clinical high risk patients reported greater impaired tolerance to normal stress, which was associated over time with positive symptoms (unusual thought content, suspiciousness, conceptual disorganization, and total positive), as well as negative symptoms, depression and poor global function. Associations between impaired stress tolerance and symptoms remained when controlling for demographic variables, medications, and substance use. By contrast, reported number of life events did not differ between groups at baseline, and bore no association with any symptoms over time. There was a trajectory of general improvement in stress tolerance, positive symptoms, depression, and function, but not in negative symptoms or anxiety, which remained relatively stable. Discussion: Self-reported impaired stress tolerance was associated with a wide range of “prodromal” symptoms and functioning, consistent with it being a core feature of the psychosis risk state. Impaired stress tolerance may therefore be a potential target for early intervention. Self-reported life events were not relevant as a correlate of clinical status. As in other treated clinical high risk cohorts, most patients improved over time across symptom domains.