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Poster #90 MIGRATION, ETHNICITY AND PSYCHOSIS: EVIDENCE FOR A SOCIO-DEVELOPMENTAL PATHWAY
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Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
Poster #88 INCIDENCE OF PSYCHOTIC DISORDERS IN PALERMO: PRELIMINARY DATA Alice Mulè 1 , Lucia Sideli 2 , Caterina La Cascia 2 , Marta Di Forti 1 , Robin M.G. Murray 1 , Daniele La Barbera 2 1 Institute of Psychiatry, King’s College, London, United Kingdom; 2 Sezione di Psichiatria, Dipartmento di Biomedicina Sperimentale e Neuroscienze Cliniche, University of Palermo, Palermo, Italy Background: The incidence of psychotic disorders varies in different geographical areas (McGrath 2004). Recent data suggest that the incidence is higher in males, migrant minorities and in urban areas. There aren’t many available epidemiological data on the incidence of psychotic disorders in Italy. This is the first incidence study on psychotic disorders carried out in Palermo, the capital of Sicily. Methods: we screened all patients presenting with their first episode of psychosis to the mental health services of our catchment area (5 inpatient, 5 outpatient units and 3 private psychiatric hospitals) over a period of three years (2008-2011). The diagnosis of psychosis was defined using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN Wing, J. K., et al., 1990).The main socio-demographic data were collected using the MRC Social Data Schedule. When subjects were not available (did not consent) for interview, information was collected from clinical notes. The population at risk referred to the people aged from 18-65 who were resident in the same catchment area (Palermo Municipality) in the period considered, according to the data of the Statistic Office of Palermo Municipality). Results: we identified 216 patients affected by a first episode of psychosis (FEP): 135 M (62.5%) and 81 F (37.5%), mean age 31.42 years (SD: 11.44). 77.1% of FEP had a diagnosis of non affective psychosis, 12.8% of affective psychosis and 10.1% received a diagnosis of other psychosis. 204 subjects were Caucasian, 12 non Caucasian belonging to various ethnicities and they were all first generation migrants (4 Indian, 3 African, 2 Bangladeshi, and 3 Mixed). Population at risk is 425.194 people. The mean age of onset was lower in men than women M: 29.98 years (SD: 10.41) vs. F: 34.28 (SD:12.64) (p=0.013)The incidence of psychotic disorders in our catchment area is 16,9 per 100.000 person years. It was higher in men 21,9 per 100.000 than women 12,2 per 100.000. Discussion: Our study is the first epidemiological study in Sicily investigating the incidence of psychotic disorders. In our population men have a higher incidence of psychotic disorders than women and an earlier age of onset.
Poster #89 EMERGENCY CAESAREAN SECTION AS A RISK FACTOR FOR SCHIZOPHRENIA Alessandra Paparelli 1 , Muriel Walshe 1 , Ilaria Tarricone 1,2 , Jane Boydell 1 , Tawaliku Akib 1 , Gabriella Pollutri 2 , Simona A. Stilo 1 , Elvira Bramon 1 , Marta Di Forti 1 , Jhon Powell 1 , Robin Murray 1 1 Psychosis Studies, King’s College, Institute of Psychiatry, London, United Kingdom; 2 Bologna University, Institute of Psychiatry Bologna, Bologna, Italy Background: Schizophrenia is a highly heritable disorder with 20–30% of causation estimated to be environmental. Among these non-genetic causes, Obstetric Complications (OCs) are prime candidates (Cannon et al., 2002). In particular has been reported an increased incidence of emergency Caesarean section (C-section) in schizophrenic patients (Cannon et al., 2002). Animal studies also showed that C-section birth produce long-term over activity in mesolimbic dopamine systems, best known for his role in the pathophysiology of psychosis (El-Khodor and Boksa, 1998; Vaillancourt and Boksa, 2000). My aim is to look whether OCs in general and C-section in particular increase the risk for psychosis. Methods: We collected socio-demographic data (age, gender, self-rated ethnicity) on 206 psychotic patients and 160 controls. Prenatal and perinatal information has been retrospectively collected from mothers using a standard questionnaire developed from other published reports (Lewis et al., 1989; McCreadie et al, 1992; McNeil et al., 1995; Cannon et al., 2002). The Lewis-Murray Scale has been used as the principal measure of OCs (Lewis et al., 1987). It consists of 17 individual items and each participants have been evaluated as having had a “definite” OCs if they had suffered at least one significant complication (score 1), or “absent” if they had not (score 0)(Lewis et al., 1989).Logistic regression was used to analyse the
relationships between OCs in general and C- section in particular and case– control status. Associations are expressed as odds ratios. Results: Having suffered a “definite” OCs early in life increases the risk of psychosis of about 2 fold (OR= 1.826; CI 1.16 – 2.88; p=0.01). Regarding complication during delivery C-section seems to increase the risk of becoming psychotic of 3 fold when compared to vaginal delivery (OR= 3. 07; CI 0.99 – 9.49; p=0.05). Moreover the risk tend to increase up to 7.26 when the C-section has been done in emergency (CI 0.91-57.94; p=0.61). Discussion: As we expected from the literature OCs increases the risk of psychosis. In particular C-section delivery might contribute to the expression of psychotic symptoms possibly because its hypoxic effect in the brain.
Poster #90 MIGRATION, ETHNICITY AND PSYCHOSIS: EVIDENCE FOR A SOCIODEVELOPMENTAL PATHWAY Ulrich Reininghaus 1,2 , Tom Craig 1 , Helen Fisher 1 , Gerard Hutchinson 3 , Paul Fearon 4 , Kevin Morgan 5 , Paola Dazzan 1 , Gillian Doody 6 , Peter Jones 2 , Julian Leff 1 , Robin Murray 1 , Craig Morgan 1 1 Institute of Psychiatry, King’s College London, London, United Kingdom; 2 Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; 3 University of the West Indies, Trinidad, Trinidad and Tobago; 4 Trinity College Dublin, Dublin, Ireland; 5 Westminster University, London, United Kingdom; 6 University of Nottingham, Nottingham, United Kingdom Background: Many studies have shown that rates of psychosis are elevated in the Black Caribbean population in the UK. We have previously reported findings from the ÆSOP study that suggest that indicators of childhood (i.e., long-term separation from a parent) and adult (i.e., poor education, current disadvantage) adversity, which are associated with onset of psychosis, are more common in the Black Caribbean population and may, thereby, contribute to the elevated rates of psychosis in this population. A recent, integrated model of psychosis has proposed a socio-developmental pathway to psychosis. In this model, adverse social experiences in childhood create an enduring liability to psychosis that becomes manifest in the event of further cumulative stressors in adulthood. We sought to extend previous ÆSOP analyses by investigating the extent to which a pathway from indicators of childhood adversity through indicators of adult adversity to psychosis holds: a) across ethnic groups; and b) independent of markers of biological risk. Methods: ÆSOP is a multi-centre incidence and case-control study of first-episode psychosis. Cases were all individuals presenting to psychiatric services with a first episode of psychosis in defined catchment areas in London and Nottingham (UK). Controls were a group of population-based volunteers recruited from the same areas. We collected data on clinical presentation and indicators of childhood (i.e., separation from, and death of, a parent before the age of 16) and adult (i.e., education, indicators of current social disadvantage and isolation) adversity from 390 cases and 391 controls. Multiple mediation analysis was performed to test whether the indirect effects of parental separation through poor education and/or current disadvantage on case-control status: a) varied by ethnicity; and b) held after adjustment for pre-morbid IQ and neurological soft signs. Results: There was a significant specific indirect effect of parental separation through current disadvantage on case-control status (β=0.17, 95% CI 0.07 to 0.26, P=0.001) Further, we found a significant indirect effect of parental separation through poor education and current disadvantage on psychosis β=0.06, 95% CI 0.03 to 0.11, P=0.004) However, the indirect effect through poor education only was non-significant (P=0.087). When we adjusted findings for pre-morbid IQ and neuropsychological soft signs in a smaller sample, the strength of total indirect effects of parental separation remained broadly similar (β=0.15, 95% CI 0.01 to 0.30, P=0.045 and β=0.16, 95% CI -0.03 to 0.33, P=0.071, respectively). When inspecting the indirect effects of parental death, there was, again, a significant indirect effect through current disadvantage β=0.30, 95% CI 0.13 to 0.46, P=0.001) However, there was no evidence that the effects of parental death on psychosis were mediated through poor education β=-0.01, 95% CI -0.13 to 0.05, P=0.820). Total and specific indirect effects of parental separation did not significantly vary by ethnic group when comparing White British to Black Caribbean χ2 =4.99, P=0.661) subjects. Discussion: Our findings suggest that the effects of adverse social experiences in childhood on psychosis are mediated through experiences of adult adversity in both White British and Black Caribbean subjects. Therefore,
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
the greater prevalence of exposure to adversity in the Black Caribbean population that we have previously reported may push larger numbers in this population along a socio-developmental pathway to psychosis.
Poster #91 USE OF ANTIPSYCHOTIC MEDICATION AND SUICIDALITY – THE NORTHERN FINLAND BIRTH COHORT 1966 Ina Rissanen 1 , Erika Jääskeläinen 1,2 , Matti Isohanni 1,2 , Hannu Koponen 3 , Matti Joukamaa 4,5 , Antti Alaräisänen 1,2 , Jouko Miettunen 1,2,6 1 Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland; 2 Department of Psychiatry, Oulu University Hospital, Oulu, Finland; 3 Department of Psychiatry, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; 4 Social Psychiatry Unit, Tampere School of Health Sciences, University of Tampere, Tampere, Finland; 5 Department of Psychiatry, Tampere University Hospital, Tampere, Finland; 6 Inst. of Health Sciences, University of Oulu, Oulu, Finland Background: Antipsychotic medications are increasingly being used offlabel nowadays, e.g. to treat mood disorders. The increase inoff-label use has raised concern about the safety of antipsychotics when taken by people not having a psychosis. It has been reported previously that antidepressant and antiepileptic drugs may increase the risk of suicidality, but the data on antipsychotic medication are inconclusive. Antipsychotic drugs have many side effects, such as akathisia and weight gain, which detract from the quality of life and may increase the risk of depression and anxiety, even suicidality. Population based studies on the association between antipsychotic medication and suicidality are rare, although these are optimal for estimating the long-term effects of medication.We wanted to find out whether there is any association between the use of antipsychotic drugs and suicidality in cases of psychotic and non-psychotic disorders in population based sample. Methods: Our sample was the Northern Finland 1966 Birth Cohort. Information on the use of prescribed drugs wascollected in 1997 from the nationwide medication register and with a postal questionnaire (N=8,218). The presence of suicidal ideation was assessed using the Symptom Check List - 25 -questionnaire in 1997. We studied associations between suicidal ideation, adjusted for symptoms of depression and anxiety, and antipsychotic medication in different diagnostic groups (schizophrenia, other psychosis, no psychosis). We compared suicidality by dose (chlorpromazine equivalents) and type (typical/atypical) of antipsychotic medication. Results: According to the questionnaire 70 respondents (0.9%; 35; 50.0% males) were on antipsychotic medication; 41 (59%) of them had schizophrenia, 10 (14%) other psychoses and 19 (27%) did not have any diagnosed psychosis. Individuals receiving antipsychotic medication had in general more suicidal ideation regardless of diagnostic group, although the associations diminished when taking other symptoms into account. There were no statistically significant differences between those taking typical and atypical antipsychotics. The antipsychotic dose did not relate statistically significantly to suicidality among the individuals who had a diagnosis of schizophrenia (r=0.31, p=0.06) or other psychosis (r=-0.12, p=0.77), but among those non-psychotic persons who were receiving antipsychotics, however, higher doses correlated with more suicidal ideation (r=0.81, p<0.001). Discussion: Higher doses of antipsychotics are associated with suicidal ideation among individuals without a diagnosis of psychosis even after adjustment for other psychiatric symptoms. However, no such association was observed in the cases of schizophrenia or other forms of psychosis. Our results combined with those of other recent studies suggest that one should take suicidal ideation into account when prescribing antipsychotic medication, especially for off-label use.
Poster #92 PSYCHOPATHOLOGICAL SIGNIFICANCE OF AT-RISK CRITERIA OF PSYCHOSIS IN THE GENERAL POPULATION: PRELIMINARY RESULTS FROM A TELEPHONE SURVEY Benno G. Schimmelmann, Chantal Michel, Frauke Schultze-Lutter University Hospital of Child and Adolescent Psychiatry Bern, Bern, Switzerland
S313
Background: Based on findings in help-seeking samples at risk of psychosis for attenuated psychotic symptoms (APS), an Attenuated Psychosis Syndrome has been proposed for DSM-5. Yet, the prevalence and pathological value of APS and other at-risk criteria in the general population is still unclear. Therefore, we studied the prevalence of ultra-high risk (UHR) criteria as well as of the basic symptom at-risk criteria “cognitive-perceptive basic symptoms” (COPER) and “cognitive disturbances” (COGDIS) in a general population sample along with the co-morbidity, psychosocial functioning, quality of life, subjective description and evaluation of health status as well as the rate of help-seeking associated with them. Methods: UHR criteria were assessed with the Structured Interview for Psychosis-Risk Syndromes (SIPS), COPER and COGDIS with the Schizophrenia Proneness Instrument, Adult version (SPI-A) in a telephone interview by trained clinical psychologists. Subjects between 16 and 40 years of age were randomly drawn from the population register of the Canton Bern, Switzerland; first contact was made by an information letter. Next, subjects were contacted and interviewed by phone supported by “Computer Assisted Telephone Interviewing”. Exclusion criteria are communication problems (for language or intellectual reasons) as well as past or present psychosis. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was used for the assessment of present mental disorders according to DSM-IV and ICD-10, the Social and Occupational Functioning Assessment Scale (SOFAS) of DSM-IV for the symptom-independent assessment of psychosocial functioning and the Brief Multidimensional Life Satisfaction Scale (BMLSS) and the EQ-5D for assessing the subjective description and evaluation of health status. Results: As of October 2011, 793 had been reached by phone. Of these, 232 (29.2%) refused to participate, 26 (3.3%) participated but met exclusion criteria and 535 (67.5%) completed the interview. In all, 30.8% acknowledged lifetime-presence of any at-risk phenomenon irrespective of meeting any current at-risk criterion. Those with any lifetime at-risk phenomenon reported a significantly lower psychosocial functioning as measured by the SOFAS within the past year as well as present (Mann-Whitney: U≥15820.0, p<0.000, r=0.382). Further, the presence of any lifetime at-risk phenomenon was moderately related to present level of subjective anxiety/depressive mood (EQ-5D; χ2 (1)=45.913, p=0.000, V=0.293) and weakly but significantly related to the presence of any current axis-I disorder (χ2 (1)=22.307, p<0.000, V=0.204), to the person’s overall estimation of health (EQ-5D; U= 23665.0, p<0.000, r=0.182), to satisfaction with health (BMLSS; U=24846.0, p<0.000, r=0.162) and to life-time help-seeking for mental problems (χ2 (1)=6.833, p=0.009, V=0.113) but not to current level of subjective pains/somatic problems (EQ-5D; χ2 (1)=0.174, p=0.677, V=0.018) or to having a first-degree relative with psychosis (χ2 (1)=0.198, p>0.05, V=0.019). Discussion: The lifetime presence of at-risk phenomena irrespective of them meeting duration and frequency requirements of at-risk criteria was already moderately related to lower psychosocial functioning as well as higher level of anxiety and lower mood and weakly related to a current axis-I diagnosis, a lower estimation of current health, lesser satisfaction with health and lifetime help-seeking for mental problems. This indicates that these phenomena have psychopathological significance already by themselves even outside the strict time and frequency requirements of at-risk criteria.
Poster #93 AT-RISK CRITERIA OF PSYCHOSIS AND QUALITY OF LIFE IN THE GENERAL POPULATION: PRELIMINARY RESULTS FROM A TELEPHONE SURVEY Benno G. Schimmelmann, Chantal Michel, Frauke Schultze-Lutter University Hospital of Child and Adolescent Psychiatry, Bern, Switzerland Background: An “Attenuated Psychosis Syndrome” has been proposed for inclusion in DSM-5, and distress, disability and treatment seeking are discussed as one criterion of it. As lack of quality of life can be one source or expression of distress, we compared the influence of lifetime-presence of any at-risk phenomenon, current axis-I-disorder or at least subthreshold axis-I-phenomenon on quality of life in the general population, expecting that the most negative effect on quality of life should be observed when a full-blown disorder was present. Methods: An “Attenuated Psychosis Syndrome” has been proposed for inclusion in DSM-5, and distress, disability and treatment seeking are discussed as one criterion of it. As lack of quality of life can be one source or expression of distress, we compared the influence of lifetime-presence
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
Poster #88 INCIDENCE OF PSYCHOTIC DISORDERS IN PALERMO: PRELIMINARY DATA Alice Mulè 1 , Lucia Sideli 2 , Caterina La Cascia 2 , Marta Di Forti 1 , Robin M.G. Murray 1 , Daniele La Barbera 2 1 Institute of Psychiatry, King’s College, London, United Kingdom; 2 Sezione di Psichiatria, Dipartmento di Biomedicina Sperimentale e Neuroscienze Cliniche, University of Palermo, Palermo, Italy Background: The incidence of psychotic disorders varies in different geographical areas (McGrath 2004). Recent data suggest that the incidence is higher in males, migrant minorities and in urban areas. There aren’t many available epidemiological data on the incidence of psychotic disorders in Italy. This is the first incidence study on psychotic disorders carried out in Palermo, the capital of Sicily. Methods: we screened all patients presenting with their first episode of psychosis to the mental health services of our catchment area (5 inpatient, 5 outpatient units and 3 private psychiatric hospitals) over a period of three years (2008-2011). The diagnosis of psychosis was defined using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN Wing, J. K., et al., 1990).The main socio-demographic data were collected using the MRC Social Data Schedule. When subjects were not available (did not consent) for interview, information was collected from clinical notes. The population at risk referred to the people aged from 18-65 who were resident in the same catchment area (Palermo Municipality) in the period considered, according to the data of the Statistic Office of Palermo Municipality). Results: we identified 216 patients affected by a first episode of psychosis (FEP): 135 M (62.5%) and 81 F (37.5%), mean age 31.42 years (SD: 11.44). 77.1% of FEP had a diagnosis of non affective psychosis, 12.8% of affective psychosis and 10.1% received a diagnosis of other psychosis. 204 subjects were Caucasian, 12 non Caucasian belonging to various ethnicities and they were all first generation migrants (4 Indian, 3 African, 2 Bangladeshi, and 3 Mixed). Population at risk is 425.194 people. The mean age of onset was lower in men than women M: 29.98 years (SD: 10.41) vs. F: 34.28 (SD:12.64) (p=0.013)The incidence of psychotic disorders in our catchment area is 16,9 per 100.000 person years. It was higher in men 21,9 per 100.000 than women 12,2 per 100.000. Discussion: Our study is the first epidemiological study in Sicily investigating the incidence of psychotic disorders. In our population men have a higher incidence of psychotic disorders than women and an earlier age of onset.
Poster #89 EMERGENCY CAESAREAN SECTION AS A RISK FACTOR FOR SCHIZOPHRENIA Alessandra Paparelli 1 , Muriel Walshe 1 , Ilaria Tarricone 1,2 , Jane Boydell 1 , Tawaliku Akib 1 , Gabriella Pollutri 2 , Simona A. Stilo 1 , Elvira Bramon 1 , Marta Di Forti 1 , Jhon Powell 1 , Robin Murray 1 1 Psychosis Studies, King’s College, Institute of Psychiatry, London, United Kingdom; 2 Bologna University, Institute of Psychiatry Bologna, Bologna, Italy Background: Schizophrenia is a highly heritable disorder with 20–30% of causation estimated to be environmental. Among these non-genetic causes, Obstetric Complications (OCs) are prime candidates (Cannon et al., 2002). In particular has been reported an increased incidence of emergency Caesarean section (C-section) in schizophrenic patients (Cannon et al., 2002). Animal studies also showed that C-section birth produce long-term over activity in mesolimbic dopamine systems, best known for his role in the pathophysiology of psychosis (El-Khodor and Boksa, 1998; Vaillancourt and Boksa, 2000). My aim is to look whether OCs in general and C-section in particular increase the risk for psychosis. Methods: We collected socio-demographic data (age, gender, self-rated ethnicity) on 206 psychotic patients and 160 controls. Prenatal and perinatal information has been retrospectively collected from mothers using a standard questionnaire developed from other published reports (Lewis et al., 1989; McCreadie et al, 1992; McNeil et al., 1995; Cannon et al., 2002). The Lewis-Murray Scale has been used as the principal measure of OCs (Lewis et al., 1987). It consists of 17 individual items and each participants have been evaluated as having had a “definite” OCs if they had suffered at least one significant complication (score 1), or “absent” if they had not (score 0)(Lewis et al., 1989).Logistic regression was used to analyse the
relationships between OCs in general and C- section in particular and case– control status. Associations are expressed as odds ratios. Results: Having suffered a “definite” OCs early in life increases the risk of psychosis of about 2 fold (OR= 1.826; CI 1.16 – 2.88; p=0.01). Regarding complication during delivery C-section seems to increase the risk of becoming psychotic of 3 fold when compared to vaginal delivery (OR= 3. 07; CI 0.99 – 9.49; p=0.05). Moreover the risk tend to increase up to 7.26 when the C-section has been done in emergency (CI 0.91-57.94; p=0.61). Discussion: As we expected from the literature OCs increases the risk of psychosis. In particular C-section delivery might contribute to the expression of psychotic symptoms possibly because its hypoxic effect in the brain.
Poster #90 MIGRATION, ETHNICITY AND PSYCHOSIS: EVIDENCE FOR A SOCIODEVELOPMENTAL PATHWAY Ulrich Reininghaus 1,2 , Tom Craig 1 , Helen Fisher 1 , Gerard Hutchinson 3 , Paul Fearon 4 , Kevin Morgan 5 , Paola Dazzan 1 , Gillian Doody 6 , Peter Jones 2 , Julian Leff 1 , Robin Murray 1 , Craig Morgan 1 1 Institute of Psychiatry, King’s College London, London, United Kingdom; 2 Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; 3 University of the West Indies, Trinidad, Trinidad and Tobago; 4 Trinity College Dublin, Dublin, Ireland; 5 Westminster University, London, United Kingdom; 6 University of Nottingham, Nottingham, United Kingdom Background: Many studies have shown that rates of psychosis are elevated in the Black Caribbean population in the UK. We have previously reported findings from the ÆSOP study that suggest that indicators of childhood (i.e., long-term separation from a parent) and adult (i.e., poor education, current disadvantage) adversity, which are associated with onset of psychosis, are more common in the Black Caribbean population and may, thereby, contribute to the elevated rates of psychosis in this population. A recent, integrated model of psychosis has proposed a socio-developmental pathway to psychosis. In this model, adverse social experiences in childhood create an enduring liability to psychosis that becomes manifest in the event of further cumulative stressors in adulthood. We sought to extend previous ÆSOP analyses by investigating the extent to which a pathway from indicators of childhood adversity through indicators of adult adversity to psychosis holds: a) across ethnic groups; and b) independent of markers of biological risk. Methods: ÆSOP is a multi-centre incidence and case-control study of first-episode psychosis. Cases were all individuals presenting to psychiatric services with a first episode of psychosis in defined catchment areas in London and Nottingham (UK). Controls were a group of population-based volunteers recruited from the same areas. We collected data on clinical presentation and indicators of childhood (i.e., separation from, and death of, a parent before the age of 16) and adult (i.e., education, indicators of current social disadvantage and isolation) adversity from 390 cases and 391 controls. Multiple mediation analysis was performed to test whether the indirect effects of parental separation through poor education and/or current disadvantage on case-control status: a) varied by ethnicity; and b) held after adjustment for pre-morbid IQ and neurological soft signs. Results: There was a significant specific indirect effect of parental separation through current disadvantage on case-control status (β=0.17, 95% CI 0.07 to 0.26, P=0.001) Further, we found a significant indirect effect of parental separation through poor education and current disadvantage on psychosis β=0.06, 95% CI 0.03 to 0.11, P=0.004) However, the indirect effect through poor education only was non-significant (P=0.087). When we adjusted findings for pre-morbid IQ and neuropsychological soft signs in a smaller sample, the strength of total indirect effects of parental separation remained broadly similar (β=0.15, 95% CI 0.01 to 0.30, P=0.045 and β=0.16, 95% CI -0.03 to 0.33, P=0.071, respectively). When inspecting the indirect effects of parental death, there was, again, a significant indirect effect through current disadvantage β=0.30, 95% CI 0.13 to 0.46, P=0.001) However, there was no evidence that the effects of parental death on psychosis were mediated through poor education β=-0.01, 95% CI -0.13 to 0.05, P=0.820). Total and specific indirect effects of parental separation did not significantly vary by ethnic group when comparing White British to Black Caribbean χ2 =4.99, P=0.661) subjects. Discussion: Our findings suggest that the effects of adverse social experiences in childhood on psychosis are mediated through experiences of adult adversity in both White British and Black Caribbean subjects. Therefore,
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
the greater prevalence of exposure to adversity in the Black Caribbean population that we have previously reported may push larger numbers in this population along a socio-developmental pathway to psychosis.
Poster #91 USE OF ANTIPSYCHOTIC MEDICATION AND SUICIDALITY – THE NORTHERN FINLAND BIRTH COHORT 1966 Ina Rissanen 1 , Erika Jääskeläinen 1,2 , Matti Isohanni 1,2 , Hannu Koponen 3 , Matti Joukamaa 4,5 , Antti Alaräisänen 1,2 , Jouko Miettunen 1,2,6 1 Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland; 2 Department of Psychiatry, Oulu University Hospital, Oulu, Finland; 3 Department of Psychiatry, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; 4 Social Psychiatry Unit, Tampere School of Health Sciences, University of Tampere, Tampere, Finland; 5 Department of Psychiatry, Tampere University Hospital, Tampere, Finland; 6 Inst. of Health Sciences, University of Oulu, Oulu, Finland Background: Antipsychotic medications are increasingly being used offlabel nowadays, e.g. to treat mood disorders. The increase inoff-label use has raised concern about the safety of antipsychotics when taken by people not having a psychosis. It has been reported previously that antidepressant and antiepileptic drugs may increase the risk of suicidality, but the data on antipsychotic medication are inconclusive. Antipsychotic drugs have many side effects, such as akathisia and weight gain, which detract from the quality of life and may increase the risk of depression and anxiety, even suicidality. Population based studies on the association between antipsychotic medication and suicidality are rare, although these are optimal for estimating the long-term effects of medication.We wanted to find out whether there is any association between the use of antipsychotic drugs and suicidality in cases of psychotic and non-psychotic disorders in population based sample. Methods: Our sample was the Northern Finland 1966 Birth Cohort. Information on the use of prescribed drugs wascollected in 1997 from the nationwide medication register and with a postal questionnaire (N=8,218). The presence of suicidal ideation was assessed using the Symptom Check List - 25 -questionnaire in 1997. We studied associations between suicidal ideation, adjusted for symptoms of depression and anxiety, and antipsychotic medication in different diagnostic groups (schizophrenia, other psychosis, no psychosis). We compared suicidality by dose (chlorpromazine equivalents) and type (typical/atypical) of antipsychotic medication. Results: According to the questionnaire 70 respondents (0.9%; 35; 50.0% males) were on antipsychotic medication; 41 (59%) of them had schizophrenia, 10 (14%) other psychoses and 19 (27%) did not have any diagnosed psychosis. Individuals receiving antipsychotic medication had in general more suicidal ideation regardless of diagnostic group, although the associations diminished when taking other symptoms into account. There were no statistically significant differences between those taking typical and atypical antipsychotics. The antipsychotic dose did not relate statistically significantly to suicidality among the individuals who had a diagnosis of schizophrenia (r=0.31, p=0.06) or other psychosis (r=-0.12, p=0.77), but among those non-psychotic persons who were receiving antipsychotics, however, higher doses correlated with more suicidal ideation (r=0.81, p<0.001). Discussion: Higher doses of antipsychotics are associated with suicidal ideation among individuals without a diagnosis of psychosis even after adjustment for other psychiatric symptoms. However, no such association was observed in the cases of schizophrenia or other forms of psychosis. Our results combined with those of other recent studies suggest that one should take suicidal ideation into account when prescribing antipsychotic medication, especially for off-label use.
Poster #92 PSYCHOPATHOLOGICAL SIGNIFICANCE OF AT-RISK CRITERIA OF PSYCHOSIS IN THE GENERAL POPULATION: PRELIMINARY RESULTS FROM A TELEPHONE SURVEY Benno G. Schimmelmann, Chantal Michel, Frauke Schultze-Lutter University Hospital of Child and Adolescent Psychiatry Bern, Bern, Switzerland
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Background: Based on findings in help-seeking samples at risk of psychosis for attenuated psychotic symptoms (APS), an Attenuated Psychosis Syndrome has been proposed for DSM-5. Yet, the prevalence and pathological value of APS and other at-risk criteria in the general population is still unclear. Therefore, we studied the prevalence of ultra-high risk (UHR) criteria as well as of the basic symptom at-risk criteria “cognitive-perceptive basic symptoms” (COPER) and “cognitive disturbances” (COGDIS) in a general population sample along with the co-morbidity, psychosocial functioning, quality of life, subjective description and evaluation of health status as well as the rate of help-seeking associated with them. Methods: UHR criteria were assessed with the Structured Interview for Psychosis-Risk Syndromes (SIPS), COPER and COGDIS with the Schizophrenia Proneness Instrument, Adult version (SPI-A) in a telephone interview by trained clinical psychologists. Subjects between 16 and 40 years of age were randomly drawn from the population register of the Canton Bern, Switzerland; first contact was made by an information letter. Next, subjects were contacted and interviewed by phone supported by “Computer Assisted Telephone Interviewing”. Exclusion criteria are communication problems (for language or intellectual reasons) as well as past or present psychosis. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was used for the assessment of present mental disorders according to DSM-IV and ICD-10, the Social and Occupational Functioning Assessment Scale (SOFAS) of DSM-IV for the symptom-independent assessment of psychosocial functioning and the Brief Multidimensional Life Satisfaction Scale (BMLSS) and the EQ-5D for assessing the subjective description and evaluation of health status. Results: As of October 2011, 793 had been reached by phone. Of these, 232 (29.2%) refused to participate, 26 (3.3%) participated but met exclusion criteria and 535 (67.5%) completed the interview. In all, 30.8% acknowledged lifetime-presence of any at-risk phenomenon irrespective of meeting any current at-risk criterion. Those with any lifetime at-risk phenomenon reported a significantly lower psychosocial functioning as measured by the SOFAS within the past year as well as present (Mann-Whitney: U≥15820.0, p<0.000, r=0.382). Further, the presence of any lifetime at-risk phenomenon was moderately related to present level of subjective anxiety/depressive mood (EQ-5D; χ2 (1)=45.913, p=0.000, V=0.293) and weakly but significantly related to the presence of any current axis-I disorder (χ2 (1)=22.307, p<0.000, V=0.204), to the person’s overall estimation of health (EQ-5D; U= 23665.0, p<0.000, r=0.182), to satisfaction with health (BMLSS; U=24846.0, p<0.000, r=0.162) and to life-time help-seeking for mental problems (χ2 (1)=6.833, p=0.009, V=0.113) but not to current level of subjective pains/somatic problems (EQ-5D; χ2 (1)=0.174, p=0.677, V=0.018) or to having a first-degree relative with psychosis (χ2 (1)=0.198, p>0.05, V=0.019). Discussion: The lifetime presence of at-risk phenomena irrespective of them meeting duration and frequency requirements of at-risk criteria was already moderately related to lower psychosocial functioning as well as higher level of anxiety and lower mood and weakly related to a current axis-I diagnosis, a lower estimation of current health, lesser satisfaction with health and lifetime help-seeking for mental problems. This indicates that these phenomena have psychopathological significance already by themselves even outside the strict time and frequency requirements of at-risk criteria.
Poster #93 AT-RISK CRITERIA OF PSYCHOSIS AND QUALITY OF LIFE IN THE GENERAL POPULATION: PRELIMINARY RESULTS FROM A TELEPHONE SURVEY Benno G. Schimmelmann, Chantal Michel, Frauke Schultze-Lutter University Hospital of Child and Adolescent Psychiatry, Bern, Switzerland Background: An “Attenuated Psychosis Syndrome” has been proposed for inclusion in DSM-5, and distress, disability and treatment seeking are discussed as one criterion of it. As lack of quality of life can be one source or expression of distress, we compared the influence of lifetime-presence of any at-risk phenomenon, current axis-I-disorder or at least subthreshold axis-I-phenomenon on quality of life in the general population, expecting that the most negative effect on quality of life should be observed when a full-blown disorder was present. Methods: An “Attenuated Psychosis Syndrome” has been proposed for inclusion in DSM-5, and distress, disability and treatment seeking are discussed as one criterion of it. As lack of quality of life can be one source or expression of distress, we compared the influence of lifetime-presence