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Poster #S218 META-ANALYSIS SHOWS THAT THE LEVEL OF CANNABIS USE DETERMINES THE RISK OF PSYCHOSIS
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Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
White ethnicity. Forty-five percent (n=60) met criteria for Vitamin D deficiency, while a further 34% (n=44) were Vitamin D insufficient, leaving only 21% with levels in the sufficient range. Males had significantly lower serum Vitamin D levels at baseline (mean=11.8mcg/L (SD= 7.0) than female participants (mean vitamin D level=16.2mcg/L (SD=10.4) (t=−2.953. df=132, p=0.04). The mean PANSS score at 12 months was 50.7 (SD 15.5). There were significant negative correlation between baseline vitamin D levels at baseline and PANSS total scores at 12 months (r=−0.235, p=0.043). Vitamin D levels also showed a significant negative correlation with PANSS negative syndrome scale scores at 12 months (r=−0.244, p=0.036). The correlation between vitamin D levels at baseline didn’t persist once potential confounding factors of age, gender, ethnicity and season of vitamin D blood sampling were controlled for. Using the enter method of multiple regression analysis, a significant model emerged (F=2.448, df=5, p=0.042). None of the independent variables contributed significantly to the regression model (adjusted R2=0.075). Vitamin D levels at baseline were not a signficant predictor of illness severity at 12 months as measured by PANSS scores (B=−0.252, t=−1.124, df=1, p=0.265). None of the other variables in the regression equation reached statistical significance in their prediction of PANSS scores. Fifty six (32 males) individuals had serum Vitamin D levels measured at both baseline and 12 months. Mean Vitamin D levels at baseline in this sub-group were 13.5 mcg/L (SD=8.7; range 4-55 mcg/L) and at 12 months were 12.8 mcg/L (SD=8.1; range=4-32.2). Thirty nine percent (n=22) of individuals showed a rise in Vitamin D levels and 57% (n=32) showed a reduction in vitamin D levels at 12 months, with two showing no change. Males (n=32) had significantly lower mean vitamin D levels of 10.7 mcg/L (SD=7.3) at 12 months, compared to females (mean vitamin D level of 15.5 mcg/L (SD=8.5)) (t=−2.274, df=54, p=0.027). Of those participants who had reduction in their mean vitamin D levels over the 12 month period, females (n=13) had a significantly greater reduction (mean decrease in vitamin D levels =13.2mcg/L (SD=10.4)) than male patients (n=19) (mean reduction in vitamin D levels 5.77 (SD=4.4) (t=−2.699, df=30, p=0.011). There was a signifcant negative correlation between the change in serum vitamin D levels between baseline and 12 months and the PANSS score at 12 months (r=−0,311, p=0.02). Discussion: In this study we demonstrate a correlation between low serum vitamin D levels at first presentation and heightened illness severity at 12 months, both on total PANSS score and on the PANSS negative symptom score, but this effect disappeared when adjusted for age, sex ethnicity and season of sampling. The negative correlation noted between 12-month PANSS and change in Vitamin D may be mediated by reduced sun exposure. Further work is needed to explore whether intervention strategies using vitamin D supplementation may modify the course of the illness from illness onset.
Poster #S217 COMPARISON OF CHARACTERISTICS OF PSYHOSIS PATIENTS WITH AND WITHOUT HOSPITALIZATION AT FIRST EPISODE Edwin Lee 1 , Christy L.M. Hui 2 , W.C. Chang 2 , Sherry K.W. Chan 2 , Eric Y.H. Chen 2 1 Department of Psychiatry, The University of Hong Kong; 2 The University of Hong Kong Background: Hospitalization may cause psychological and social burden to patients and the society. One of the key aims of early intervention in psychosis is to reduce hospitalisation and promote recovery in the community. The current study compared the characteristics of psychosis patients with and without hospitalization at their first episode to explore the associated factors of hospitalization. Methods: Patients, aged 26-55, with a diagnosis of schizophrenia spectrum disorders were recruited from the Jockey Club Early Psychoss Project in Hong Kong. The sociodemographic and clinical characteristics, including gender, age, educational level, age of onset, duration of untreated psychosis, symptoms and side effect, of patients with and without hospitalization at their first episode were compared. Results: A total of 57.8% of patients with psychosis was hospitalized at their first episode. Baseline Hospitalization was associated with longer duration of untreated psychosis, higher dosage of antipsychotic treatment, more severe positive symptoms, less severe negative symptoms and more medication side effects.
Discussion: Inpatient treatment is common among patients with first episode psychosis in Hong Kong. Patients with hospitalization at their first episode of psychosis had different characteristics when compared to patients without hospitalization. Future study should explore the causal effect between these factors and hospitalization and its potential implication in early intervention services.
Poster #S218 META-ANALYSIS SHOWS THAT THE LEVEL OF CANNABIS USE DETERMINES THE RISK OF PSYCHOSIS Marta Di Forti 1 , Arianna Marconi 2,3 , Robin M. Murray 4 , Cathryn Lewis 5 , Evangelos Vassos 1 1 Institute of Psychiatry, King’s College London; 2 Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome; 3 Institute of Psychiatry, King’s College of London; 4 IOP; 5 MRC Social, Developmental and Genetic Psychiatry Centre, Institute of Psychiatry, King’s College London Background: A dose-response relationship between cannabis use and psychosis related outcomes has been reported, the extent of this relationship remaining uncertain. We performed a systematic review investigating the association between the degree of cannabis consumption and psychosisrelated outcomes and proceeded with a meta-analysis to quantify the magnitude of effect. Methods: A search of Medline, Embase and PsycInfo database (to January 2013) was supplemented by manual searches of bibliographies and relevant reviews. Studies were originally considered if they provided data on cannabis consumption following a dose criterion used validated clinical measures, and reported psychosis-related outcomes. From 500 references, 17 studies were considered for the systematic review and 10 were inserted in the meta-analysis, enrolling a total of 66,816 individuals. Results: We observed a consistent increase in the risk of psychosis related outcomes in all the included studies, corresponding to a 4-fold OR for the risk of schizophrenia and other psychosis-related outcomes among the most severe cannabis users compared to the non-users. Subgroup analyses by method or outcome measure gave remarkably similar results for each category. For a diagnosis of schizophrenia or psychotic disorder the OR reached the threshold of 5. Discussion: Our meta-analysis confirms a positive association between the degree of cannabis use and the risk for psychosis, providing the most accurate estimate of the effect size of cannabis use as a risk factor for psychosis using all the available published data. In addition, it confirms a dose-response relationship between the level of use and the risk for psychosis.
Poster #S219 THE RELATIONSHIP BETWEEN NEUROCOGNITION AND REAL LIFE FUNCTIONING IN FIRST-EPISODE SCHIZOPHRENIA: RESULTS FROM THE 2-YEAR FOLLOW-UP IN THE OSLO LONGITUDINAL RECOVERY STUDY Anne-Kari Torgalsboen 1 , Christine Mohn 2 , Nikolai Czajkowski 1 , Bjørn Rishovd Rund 1 1 Department of Psychology, University of Oslo; 2 Vestre Viken Hospital Trust Background: Substantial limitations of studies investigating the relationship between cognition and functional outcome have been identified. Among them are the lack of control of confounding variables, high attrition rate, and too few neurocognitive domains measured and completed at each assessment point. The Oslo longitudinal recovery study is one of very few long-term prospective studies of first-episode patients investigating the rate of recovery and the relationship between neurocognition and real life functioning in first-episode schizophrenia patients with multiple follow-up points during 10 years, using the MATRICS Consensus Cognitive Battery (MCCB). In studying the relationship between cognition and outcome, cognitive predictors should be weighed against other potential predictors of functional outcome, such as premorbid functioning, duration of untreated psychosis (DUP), sociodemographic variables, and baseline symptoms. It is also necessary for the MCCB to prove its usefulness in documenting longitudinal prospective relationships between cognition and functional outcome and to examine the contribution of specific cognitive domains.
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
White ethnicity. Forty-five percent (n=60) met criteria for Vitamin D deficiency, while a further 34% (n=44) were Vitamin D insufficient, leaving only 21% with levels in the sufficient range. Males had significantly lower serum Vitamin D levels at baseline (mean=11.8mcg/L (SD= 7.0) than female participants (mean vitamin D level=16.2mcg/L (SD=10.4) (t=−2.953. df=132, p=0.04). The mean PANSS score at 12 months was 50.7 (SD 15.5). There were significant negative correlation between baseline vitamin D levels at baseline and PANSS total scores at 12 months (r=−0.235, p=0.043). Vitamin D levels also showed a significant negative correlation with PANSS negative syndrome scale scores at 12 months (r=−0.244, p=0.036). The correlation between vitamin D levels at baseline didn’t persist once potential confounding factors of age, gender, ethnicity and season of vitamin D blood sampling were controlled for. Using the enter method of multiple regression analysis, a significant model emerged (F=2.448, df=5, p=0.042). None of the independent variables contributed significantly to the regression model (adjusted R2=0.075). Vitamin D levels at baseline were not a signficant predictor of illness severity at 12 months as measured by PANSS scores (B=−0.252, t=−1.124, df=1, p=0.265). None of the other variables in the regression equation reached statistical significance in their prediction of PANSS scores. Fifty six (32 males) individuals had serum Vitamin D levels measured at both baseline and 12 months. Mean Vitamin D levels at baseline in this sub-group were 13.5 mcg/L (SD=8.7; range 4-55 mcg/L) and at 12 months were 12.8 mcg/L (SD=8.1; range=4-32.2). Thirty nine percent (n=22) of individuals showed a rise in Vitamin D levels and 57% (n=32) showed a reduction in vitamin D levels at 12 months, with two showing no change. Males (n=32) had significantly lower mean vitamin D levels of 10.7 mcg/L (SD=7.3) at 12 months, compared to females (mean vitamin D level of 15.5 mcg/L (SD=8.5)) (t=−2.274, df=54, p=0.027). Of those participants who had reduction in their mean vitamin D levels over the 12 month period, females (n=13) had a significantly greater reduction (mean decrease in vitamin D levels =13.2mcg/L (SD=10.4)) than male patients (n=19) (mean reduction in vitamin D levels 5.77 (SD=4.4) (t=−2.699, df=30, p=0.011). There was a signifcant negative correlation between the change in serum vitamin D levels between baseline and 12 months and the PANSS score at 12 months (r=−0,311, p=0.02). Discussion: In this study we demonstrate a correlation between low serum vitamin D levels at first presentation and heightened illness severity at 12 months, both on total PANSS score and on the PANSS negative symptom score, but this effect disappeared when adjusted for age, sex ethnicity and season of sampling. The negative correlation noted between 12-month PANSS and change in Vitamin D may be mediated by reduced sun exposure. Further work is needed to explore whether intervention strategies using vitamin D supplementation may modify the course of the illness from illness onset.
Poster #S217 COMPARISON OF CHARACTERISTICS OF PSYHOSIS PATIENTS WITH AND WITHOUT HOSPITALIZATION AT FIRST EPISODE Edwin Lee 1 , Christy L.M. Hui 2 , W.C. Chang 2 , Sherry K.W. Chan 2 , Eric Y.H. Chen 2 1 Department of Psychiatry, The University of Hong Kong; 2 The University of Hong Kong Background: Hospitalization may cause psychological and social burden to patients and the society. One of the key aims of early intervention in psychosis is to reduce hospitalisation and promote recovery in the community. The current study compared the characteristics of psychosis patients with and without hospitalization at their first episode to explore the associated factors of hospitalization. Methods: Patients, aged 26-55, with a diagnosis of schizophrenia spectrum disorders were recruited from the Jockey Club Early Psychoss Project in Hong Kong. The sociodemographic and clinical characteristics, including gender, age, educational level, age of onset, duration of untreated psychosis, symptoms and side effect, of patients with and without hospitalization at their first episode were compared. Results: A total of 57.8% of patients with psychosis was hospitalized at their first episode. Baseline Hospitalization was associated with longer duration of untreated psychosis, higher dosage of antipsychotic treatment, more severe positive symptoms, less severe negative symptoms and more medication side effects.
Discussion: Inpatient treatment is common among patients with first episode psychosis in Hong Kong. Patients with hospitalization at their first episode of psychosis had different characteristics when compared to patients without hospitalization. Future study should explore the causal effect between these factors and hospitalization and its potential implication in early intervention services.
Poster #S218 META-ANALYSIS SHOWS THAT THE LEVEL OF CANNABIS USE DETERMINES THE RISK OF PSYCHOSIS Marta Di Forti 1 , Arianna Marconi 2,3 , Robin M. Murray 4 , Cathryn Lewis 5 , Evangelos Vassos 1 1 Institute of Psychiatry, King’s College London; 2 Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome; 3 Institute of Psychiatry, King’s College of London; 4 IOP; 5 MRC Social, Developmental and Genetic Psychiatry Centre, Institute of Psychiatry, King’s College London Background: A dose-response relationship between cannabis use and psychosis related outcomes has been reported, the extent of this relationship remaining uncertain. We performed a systematic review investigating the association between the degree of cannabis consumption and psychosisrelated outcomes and proceeded with a meta-analysis to quantify the magnitude of effect. Methods: A search of Medline, Embase and PsycInfo database (to January 2013) was supplemented by manual searches of bibliographies and relevant reviews. Studies were originally considered if they provided data on cannabis consumption following a dose criterion used validated clinical measures, and reported psychosis-related outcomes. From 500 references, 17 studies were considered for the systematic review and 10 were inserted in the meta-analysis, enrolling a total of 66,816 individuals. Results: We observed a consistent increase in the risk of psychosis related outcomes in all the included studies, corresponding to a 4-fold OR for the risk of schizophrenia and other psychosis-related outcomes among the most severe cannabis users compared to the non-users. Subgroup analyses by method or outcome measure gave remarkably similar results for each category. For a diagnosis of schizophrenia or psychotic disorder the OR reached the threshold of 5. Discussion: Our meta-analysis confirms a positive association between the degree of cannabis use and the risk for psychosis, providing the most accurate estimate of the effect size of cannabis use as a risk factor for psychosis using all the available published data. In addition, it confirms a dose-response relationship between the level of use and the risk for psychosis.
Poster #S219 THE RELATIONSHIP BETWEEN NEUROCOGNITION AND REAL LIFE FUNCTIONING IN FIRST-EPISODE SCHIZOPHRENIA: RESULTS FROM THE 2-YEAR FOLLOW-UP IN THE OSLO LONGITUDINAL RECOVERY STUDY Anne-Kari Torgalsboen 1 , Christine Mohn 2 , Nikolai Czajkowski 1 , Bjørn Rishovd Rund 1 1 Department of Psychology, University of Oslo; 2 Vestre Viken Hospital Trust Background: Substantial limitations of studies investigating the relationship between cognition and functional outcome have been identified. Among them are the lack of control of confounding variables, high attrition rate, and too few neurocognitive domains measured and completed at each assessment point. The Oslo longitudinal recovery study is one of very few long-term prospective studies of first-episode patients investigating the rate of recovery and the relationship between neurocognition and real life functioning in first-episode schizophrenia patients with multiple follow-up points during 10 years, using the MATRICS Consensus Cognitive Battery (MCCB). In studying the relationship between cognition and outcome, cognitive predictors should be weighed against other potential predictors of functional outcome, such as premorbid functioning, duration of untreated psychosis (DUP), sociodemographic variables, and baseline symptoms. It is also necessary for the MCCB to prove its usefulness in documenting longitudinal prospective relationships between cognition and functional outcome and to examine the contribution of specific cognitive domains.