- Email: [email protected]
Poster #S186 COGNITIVE PERFORMANCES OF JUVENILE OFFENDERS WITH SEVERE PSYCHIATRIC DISORDERS
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
ory (Digit span forward (t(28) = 1.254, p>0.05), episodic memory (CVLT: t(28) = −0.029, p>0.05), planning measured by the Zoo map test (t(28) = 0.556, p>0.05) and fluency (t(28) = −0.519, p>0.05). However, they significantly differed on symptoms (PANSS (positive): t(28) = −3.216, p=0.003, PANSS (negative): t(28) = −2.360, p=0.025, PANSS (general): t(28) = −2.955, p=0.006), social functioning (t(28) = 3.151, p=0.004) and working memory (Digit span backward (t(28) = 2.082, p=0.047). Discussion: Results of the present study confirm those of Brüne & Schaub (2012) showing that around 50% of the SZ patients present ToM impairments. SZ-U patients differed from SZ-I patients by the presence of more symptoms, poor social functioning and impaired working memory. It seems that whatever the ToM task used (the patients being involved or not in the social interaction) to assess the attribution of mental states to others, poor mentalisers exhibit the same profile.
Poster #S186 COGNITIVE PERFORMANCES OF JUVENILE OFFENDERS WITH SEVERE PSYCHIATRIC DISORDERS Stéphanie Charles 1 , Gaëlle Grajek 1 , Nelson Provost 2 , Audrey Pauwels 1 , Anu Raevuori 3 , Laurent Servais 2 1 Adolescent Department (CHJ Titeca, Brussels); 2 Adolescent Department (CHJ Titeca, Brussels, Belgium); 3 Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland Background: Cognitive deficits in adolescent-onset schizophrenia are welldocumented in literature. Major deficits in executive functioning, verbal episodic memory and sensory motor dexterity have been reported, as well as a reduced processing speed. As juvenile offenders also present inhibition deficits, our aim was to examine neuropsychological profiles among juvenile offenders with severe psychiatric disorders. Methods: This study was conducted in Brussels, Belgium in a 14-bedded unit of the C.H.J. Titeca. The unit treats adolescents (aged 15 to 18) with early-onset schizophrenia and/or major affective disorders, who are involved in severe delinquency. As a part of a multidisciplinary approach, we systematically evaluated the cognitive functioning (assessment one month after admission) of all patients admitted since November 2010. The obtained scores were converted to standardized z scores based on published norms for the tests. We used one sample t-tests to compare standardized scores with norms. Results: Compared to the norms, patients were significantly slower in D2 attention test and in Trail Making Test (all p<0.001), but their quality was within normal range. During interference subtask of the Stroop test, speed and quality in patients were significantly lower than norms. Among them, performances on WISC-III Mazes were also significantly lower than norms (p<0.001). Patients’ scores on verbal working memory were significantly lower than norms on forward and backward Digit Span (all p<0.001). Their performances on a verbal episodic memory task were not different from norms when evaluated with the California Verbal Learning Test, while they scored significantly lower than norms on the delayed recall (p=0.009) and delayed recognition (p=0.002) of the Stories CMS. Baddeley’s Doors test revealed performances lower than norms (Part A p=0.048; Part B p=0.001). Mean performances among patients in tests evaluating visuo-spatial processing (Rey’s Complex Figure, WISC-IV Picture Completion and WISC-IV Block Design, respectively, all p<0.001) and processing speed (WISC-IV Coding, p<0.001) were significantly lower compared to norms. Discussion: Juvenile offenders with severe psychiatric disorders have a reduced processing speed. Poor performances in D2 attention test and in Trail Making Test may have been influenced by this reduced processing speed. Stroop test showed inhibition deficits which could partially explain low performances on WISC-III Mazes, as most errors illustrate patient’s haste. Performances on memory tasks revealed impairments in verbal working memory and visual episodic memory, while verbal episodic memory seems partially preserved. Indeed, performances at California Verbal Learning Test suggest intact learning abilities. Nevertheless, difficulties to recall and recognize Stories (CMS) could be understood as an insufficient ability to structure information, or as a lack of comprehension. In this patient group, we observed presence of major cognitive impairments, and we emphasize the importance of integrating a cognitive approach into the multidisciplinary therapeutic process.
S157
Poster #S187 AT-RISK STATES IN PSYCHOSIS: SCHIZOPHRENIA PRONENESS INSTRUMENT (SPI-A/SPI-CY) AND ITS NEUROPSYCHOLOGICAL CORRELATES Diane N. Dvorsky 1,2 , Sibylle Metzler 1 , Mario Müller 1 , Christine Wyss 3 , Karsten Heekeren 4 , Susanne Walitza 5 , Wulf Roessler 6 , Anastasia Theodoridou 7,1 1 University Hospital of Psychiatry Zurich, The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Switzerland; 2 The Zurich Program for Sustainable Development of Mental Health Services, University Hospital of Psychiatry Zurich; 3 The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Switzerland; 4 University Hospital of Psychiatry Zurich; 5 Dept of Child and Adolescent Psychiatry; 6 The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric Hospital, University of Zurich, Switzerland; 7 University Hospital of Psychiatry Zurich, Switzerland Background: The at-risk state for developing psychosis is well established and there is a lot evidence for deficits in neuropsychological functioning already during the prepsychotic period. The purpose of this study was to compare the subjective perception of cognitive disturbances in individuals at risk for psychosis and objective variables according to neurocognitive measures. Methods: Subjects were recruited from the ZInEP-Study, a prospective longitudinal multidimensional study of individuals at risk for psychosis, from the area of Zurich, Switzerland. For the current study, we targeted individuals meeting criteria for a risk-state for psychosis (either high-risk according to the Schizophrenia Proneness Instrument, SPI-A, adult version, SPI-CY, child and youth version, respectively, or ultra high-risk criteria according to the Structured Interview for Psychosis-Risk Syndromes, SIPS). We examined the relationship of the “cognitive-attentional impediments” (CAI) and “cognitive disturbances” (CD) items from the SPI-A/SPI-CY with performance on cognitive tests from the neuropsychological battery. The SPI-A/SPI-CY are suggested to indicate a subjective view of the individual concerning its symptoms. Results: N=221 participants have fully completed the baseline examinations (incl. SPI-A/SPI-CY and neuropsychological battery). Using a latent class approach we empirically derived homogeneous subgroups that showed unique patterns of CAI and CD. Based on a three-class solution, a “low thought initiative level” (LTI) subgroup and a “low functioning in receptive speech” (LRS) subgroup was found. In subsequent regression models LTI was found linked to performance in verbal working memory and with perseveration-errors of the Wisconsin Card Test. The four-class solution derived another subgroup, “slowed down thinking” (SDT). SDT was associated with verbal fluency and associated with the Trail Making Test and the FAIR. Discussion: Our findings suggest differential subjective perceptions of neuropsychological functioning that can be subdivided into impaired thought initiative and disturbances of receptive speech. Specific associations with neurocognitive variables support this view. This raises the question of whether there are distinctive impairment subtypes as indicated by specific psychopathological and functional outcomes.
Poster #S188 THE ROLE OF COGNITIVE RESERVE IN PREDICTING NEUROPSYCHOLOGICAL OUTCOME IN SCHIZOPHRENIA Wanping Huang 1 , Jimmy Lee 1 , Max Lam 2 , Attilio Rapisarda 1 , Michael Kraus 3 , Richard Keefe 3 1 Institute of Mental Health; 2 Institute of Mental Health Singapore; 3 Duke University Background: The concept of cognitive reserve (CR) is applicable to any condition that impacts on brain function to aid understanding of prognosis (Stern, 2009). The relevance of applying the CR concept in schizophrenia and its clinical utility in predicting cognitive outcome is investigated. Cognitive impairment is one of the core features of schizophrenia. Barnett et al. (2006) posited that individuals with higher CR are hypothesized to have higher threshold to cognitive impairment than individuals with lower CR. This study builds on this proposition and takes a lifespan perspective
ory (Digit span forward (t(28) = 1.254, p>0.05), episodic memory (CVLT: t(28) = −0.029, p>0.05), planning measured by the Zoo map test (t(28) = 0.556, p>0.05) and fluency (t(28) = −0.519, p>0.05). However, they significantly differed on symptoms (PANSS (positive): t(28) = −3.216, p=0.003, PANSS (negative): t(28) = −2.360, p=0.025, PANSS (general): t(28) = −2.955, p=0.006), social functioning (t(28) = 3.151, p=0.004) and working memory (Digit span backward (t(28) = 2.082, p=0.047). Discussion: Results of the present study confirm those of Brüne & Schaub (2012) showing that around 50% of the SZ patients present ToM impairments. SZ-U patients differed from SZ-I patients by the presence of more symptoms, poor social functioning and impaired working memory. It seems that whatever the ToM task used (the patients being involved or not in the social interaction) to assess the attribution of mental states to others, poor mentalisers exhibit the same profile.
Poster #S186 COGNITIVE PERFORMANCES OF JUVENILE OFFENDERS WITH SEVERE PSYCHIATRIC DISORDERS Stéphanie Charles 1 , Gaëlle Grajek 1 , Nelson Provost 2 , Audrey Pauwels 1 , Anu Raevuori 3 , Laurent Servais 2 1 Adolescent Department (CHJ Titeca, Brussels); 2 Adolescent Department (CHJ Titeca, Brussels, Belgium); 3 Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland Background: Cognitive deficits in adolescent-onset schizophrenia are welldocumented in literature. Major deficits in executive functioning, verbal episodic memory and sensory motor dexterity have been reported, as well as a reduced processing speed. As juvenile offenders also present inhibition deficits, our aim was to examine neuropsychological profiles among juvenile offenders with severe psychiatric disorders. Methods: This study was conducted in Brussels, Belgium in a 14-bedded unit of the C.H.J. Titeca. The unit treats adolescents (aged 15 to 18) with early-onset schizophrenia and/or major affective disorders, who are involved in severe delinquency. As a part of a multidisciplinary approach, we systematically evaluated the cognitive functioning (assessment one month after admission) of all patients admitted since November 2010. The obtained scores were converted to standardized z scores based on published norms for the tests. We used one sample t-tests to compare standardized scores with norms. Results: Compared to the norms, patients were significantly slower in D2 attention test and in Trail Making Test (all p<0.001), but their quality was within normal range. During interference subtask of the Stroop test, speed and quality in patients were significantly lower than norms. Among them, performances on WISC-III Mazes were also significantly lower than norms (p<0.001). Patients’ scores on verbal working memory were significantly lower than norms on forward and backward Digit Span (all p<0.001). Their performances on a verbal episodic memory task were not different from norms when evaluated with the California Verbal Learning Test, while they scored significantly lower than norms on the delayed recall (p=0.009) and delayed recognition (p=0.002) of the Stories CMS. Baddeley’s Doors test revealed performances lower than norms (Part A p=0.048; Part B p=0.001). Mean performances among patients in tests evaluating visuo-spatial processing (Rey’s Complex Figure, WISC-IV Picture Completion and WISC-IV Block Design, respectively, all p<0.001) and processing speed (WISC-IV Coding, p<0.001) were significantly lower compared to norms. Discussion: Juvenile offenders with severe psychiatric disorders have a reduced processing speed. Poor performances in D2 attention test and in Trail Making Test may have been influenced by this reduced processing speed. Stroop test showed inhibition deficits which could partially explain low performances on WISC-III Mazes, as most errors illustrate patient’s haste. Performances on memory tasks revealed impairments in verbal working memory and visual episodic memory, while verbal episodic memory seems partially preserved. Indeed, performances at California Verbal Learning Test suggest intact learning abilities. Nevertheless, difficulties to recall and recognize Stories (CMS) could be understood as an insufficient ability to structure information, or as a lack of comprehension. In this patient group, we observed presence of major cognitive impairments, and we emphasize the importance of integrating a cognitive approach into the multidisciplinary therapeutic process.
S157
Poster #S187 AT-RISK STATES IN PSYCHOSIS: SCHIZOPHRENIA PRONENESS INSTRUMENT (SPI-A/SPI-CY) AND ITS NEUROPSYCHOLOGICAL CORRELATES Diane N. Dvorsky 1,2 , Sibylle Metzler 1 , Mario Müller 1 , Christine Wyss 3 , Karsten Heekeren 4 , Susanne Walitza 5 , Wulf Roessler 6 , Anastasia Theodoridou 7,1 1 University Hospital of Psychiatry Zurich, The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Switzerland; 2 The Zurich Program for Sustainable Development of Mental Health Services, University Hospital of Psychiatry Zurich; 3 The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Switzerland; 4 University Hospital of Psychiatry Zurich; 5 Dept of Child and Adolescent Psychiatry; 6 The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric Hospital, University of Zurich, Switzerland; 7 University Hospital of Psychiatry Zurich, Switzerland Background: The at-risk state for developing psychosis is well established and there is a lot evidence for deficits in neuropsychological functioning already during the prepsychotic period. The purpose of this study was to compare the subjective perception of cognitive disturbances in individuals at risk for psychosis and objective variables according to neurocognitive measures. Methods: Subjects were recruited from the ZInEP-Study, a prospective longitudinal multidimensional study of individuals at risk for psychosis, from the area of Zurich, Switzerland. For the current study, we targeted individuals meeting criteria for a risk-state for psychosis (either high-risk according to the Schizophrenia Proneness Instrument, SPI-A, adult version, SPI-CY, child and youth version, respectively, or ultra high-risk criteria according to the Structured Interview for Psychosis-Risk Syndromes, SIPS). We examined the relationship of the “cognitive-attentional impediments” (CAI) and “cognitive disturbances” (CD) items from the SPI-A/SPI-CY with performance on cognitive tests from the neuropsychological battery. The SPI-A/SPI-CY are suggested to indicate a subjective view of the individual concerning its symptoms. Results: N=221 participants have fully completed the baseline examinations (incl. SPI-A/SPI-CY and neuropsychological battery). Using a latent class approach we empirically derived homogeneous subgroups that showed unique patterns of CAI and CD. Based on a three-class solution, a “low thought initiative level” (LTI) subgroup and a “low functioning in receptive speech” (LRS) subgroup was found. In subsequent regression models LTI was found linked to performance in verbal working memory and with perseveration-errors of the Wisconsin Card Test. The four-class solution derived another subgroup, “slowed down thinking” (SDT). SDT was associated with verbal fluency and associated with the Trail Making Test and the FAIR. Discussion: Our findings suggest differential subjective perceptions of neuropsychological functioning that can be subdivided into impaired thought initiative and disturbances of receptive speech. Specific associations with neurocognitive variables support this view. This raises the question of whether there are distinctive impairment subtypes as indicated by specific psychopathological and functional outcomes.
Poster #S188 THE ROLE OF COGNITIVE RESERVE IN PREDICTING NEUROPSYCHOLOGICAL OUTCOME IN SCHIZOPHRENIA Wanping Huang 1 , Jimmy Lee 1 , Max Lam 2 , Attilio Rapisarda 1 , Michael Kraus 3 , Richard Keefe 3 1 Institute of Mental Health; 2 Institute of Mental Health Singapore; 3 Duke University Background: The concept of cognitive reserve (CR) is applicable to any condition that impacts on brain function to aid understanding of prognosis (Stern, 2009). The relevance of applying the CR concept in schizophrenia and its clinical utility in predicting cognitive outcome is investigated. Cognitive impairment is one of the core features of schizophrenia. Barnett et al. (2006) posited that individuals with higher CR are hypothesized to have higher threshold to cognitive impairment than individuals with lower CR. This study builds on this proposition and takes a lifespan perspective