- Email: [email protected]
Poster #S74 INCREASED RISK OF SCHIZOPHRENIA SPECTRUM DISORDERS AFTER ALL CHILDHOOD PSYCHIATRIC DISORDERS – NATIONWIDE STUDY
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
gap by assessing differences in the outcomes of youth with schizophreniaspectrum disorders (SCZ-S) and psychotic disorder NOS (PsyNOS) during early antipsychotic treatment. Methods: Prospective, naturalistic, inception cohort study of youth <18 years old with SCZ-S (schizophrenia, schizoaffective disorder, schizophreniform disorder) or PsyNOS (PsyNOS, brief psychotic disorder) and <24 months of lifetime antipsychotic treatment receiving clinician’s choice antipsychotic treatment. Baseline demographics, illness and treatment variables, and effectiveness outcomes were compared at 12-week lastobservation-carried-forward endpoint across SCZ-S and PsyNOS patients, adjusting for significantly different baseline variables. Linear and ordered regression analyses were conducted on the outcome measures. CGI-I endpoint scores and CGAS scores categorized as good, moderate or poor outcome served as primary outcomes. All statistical analyses were carried out using Stata11. Results: Altogether, 131 youth with SCZ-S (n=41) or PsyNOS (n=90), mean age of 15.4±2.9 years, mostly antipsychotic-naïve (77.1%), were initiated on risperidone (48.9%), olanzapine (16.8%), aripiprazole (16.0%), quetiapine (11.5%) or ziprasidone (6.9%). Compared to PsyNOS, SCZ-S youth were older (16.4±2.1 vs. 14.9±3.2, p=0.0090), more likely African-American (63.4% vs. 28.1%, p=0.0001), and less likely White (17.1% vs 42.7%, p=0.004). At baseline, SCZ-S patients were more severely ill than PsyNOS subjects: SCZ-S patients had significantly higher Clinical Global Impression-Severity (CGI-S) scores (6.0±0.8 vs. 5.5±0.8, p=0.0022), lower Children’s Global Assessment of Functioning (CGAS) scores (29.7±9.2 vs 36.0±8.8, p=0.0002), were more likely inpatients (87.8% vs. 67.8%, p=0.015) and were more likely in the severely ill CGAS group (i.e., CGAS<40). More patients with SCZ-S had a second degree family member with SCZ-S disorders (33.3% vs. 13.2%, p=0.046). During 12 weeks of naturalistic treatment, SCZ-S responded less well to naturalistic antipsychotic treatment than PsyNOS: While SCZ-S and PsyNOS did not differ regarding all-cause discontinuation (51.2% vs. 43.7%, p=0.49), more SCZ-S patients discontinued treatment for inefficacy (22.5% vs. 7.0%, p=0.011). CGI-S and CGAS scores improved significantly in both diagnostic groups during the 12 weeks of treatment (p=0.0001). However, adjusting for baseline differences, PsyNOS patients experienced significantly better CGI-I improvement (p=0.033) and scored better in the categorical CGAS groups (p=0.030) than SCZ-S patients. Discussion: Both youth with SCZ-S and PsyNOS experienced significant improvements during 12 weeks of clinician’s choice antipsychotic treatment. However, treatment discontinuation was common within 12 weeks, with greater inefficacy-related discontinuation in the SCZ-S group, while CGI-I and CGAS score-based improvements were greater in the PsyNOS group, indicating the need for early acute and maintenance treatment in youth with non-affective psychotic disorders.
Poster #S74 INCREASED RISK OF SCHIZOPHRENIA SPECTRUM DISORDERS AFTER ALL CHILDHOOD PSYCHIATRIC DISORDERS - NATIONWIDE STUDY Cecilie F. Maibing 1 , Michael Eriksen Benros 1 , Merete Nordentoft 2 , Søren Dalsgaard 3 , Carsten Bøcker Pedersen 3 1 Mental Health Centre Copenhagen; 2 Mental Health Services - Capital Region of Denmark, Mental Health Centre; University of Copenhagen - Faculty of Health and Medical Sciences; 3 Centre for Integrated Register-based Research Background: Previous studies have shown associations between prior childhood psychiatric disorders and development of schizophrenia spectrum disorders, particularly after specific diagnoses of autism and attentiondeficit/hyperactivity-disorder. However, large-scale prospective studies are lacking on the association between schizophrenia spectrum disorders and previous diagnoses of a broad range of childhood psychiatric disorders considered individually and in aggregate. Methods: Danish nationwide registers were linked to establish a cohort consisting of all persons born during 1990-2000 conducting the largest study to date. Individuals with childhood psychiatric disorders were identified and the cohort was followed for a first-time psychiatric contact for schizophrenia spectrum disorder until December 31st 2012. Data were analyzed using survival analyses and adjusted for calendar year, age, and gender. Results: The results presented are preliminary. In the entire cohort a total of 25,139 persons were diagnosed with a childhood psychiatric disorder
S115
and 3,085 people had a first-time diagnosis with schizophrenia spectrum disorders. 1,420 was first diagnosed with a childhood psychiatric disorder and then secondly with a schizophrenia spectrum disorder corresponding to 5.6%. The risk of later being diagnosed with schizophrenia spectrum disorders was highly elevated and remained significantly elevated with an incidence rate ratio (IRR) of 5.57 (95% CI: 4.93-6.27) more than 5 years after the childhood psychiatric disorder had been diagnosed. The cumulative incidence of persons being diagnosed with schizophrenia spectrum disorders after the first diagnosis with a childhood psychiatric disorder was within the first year 2.56%, within the first to second year 0.60% and within the second to fifth year 1.22%. More than five years after the first diagnosis with a childhood psychiatric disorder was given the cumulative incidence was 1.38%. Discussion: The risk of being diagnosed with a schizophrenia spectrum disorder was highly elevated after any childhood psychiatric disorder and remained significantly increased more than 5 years after the first diagnosis with a childhood psychiatric disorder.
Poster #S75 COPING, PSYCHOTIC SYMPTOMS AND FUNCTIONING IN ADOLESCENTS WITH MENTAL ILLNESS Johanna Wigman 1 , Nina Devlin 2 , Ian Kelleher 3 , Aileen Murtagh 2 , Michelle Harley 2 , Anne Kehoe 4 , Carol Fitzpatrick 5 , Mary Cannon 6 1 Maastricht University and Groningen University; 2 RCSI Dublin; 3 Royal College of Surgeons in Ireland, Karolinska Institutet, Stockholm, Sweden; 4 Queen’s University, Belfast; 5 University College Dublin; 6 Royal College of Surgeons in Ireland, Department of Psychiatry, Beaumont Hospital, Dublin Background: Psychotic symptoms in the context of psychiatric disorders are associated with poor functional outcomes. Environmental stressors are important in the development of psychosis; however, distress may only be pathogenic when it exceeds an individual’s ability to cope with it. Therefore, one interesting factor regarding poor functional outcomes in patients with psychotic symptoms may be poor coping. Methods: In a clinical case-clinical control study of 106 newly-referred adolescent patients with non-psychotic psychiatric disorders, coping was investigated using the Adolescents Coping Scale. Severity of impairment in socio-occupational functioning was assessed with the Children’s Global Assessment Scale. Results: Patients (N=106) with non-psychotic psychiatric disorders and additional psychotic symptoms had poorer functioning and were more likely to use avoidance-oriented coping. No differences were found with respect to approach-oriented coping. When stratifying for poor/good coping, only those adolescent patients with psychotic symptoms who applied poor coping (i.e. less use of approach-oriented coping styles [OR 0.24, p<0.015] and more use of avoidance-oriented coping [OR 0.23, p<0.034]) had poorer functioning. However, these interactions were not significant, probably due to too small subgroups. Discussion: Non-adaptive coping and poorer functioning were more often present in adolescents with non-psychotic psychiatric disorders and additional psychotic symptoms. Due to small subgroups, our analyses could not give definitive conclusions about the question whether coping moderated the association between psychotic symptoms and functioning. Improvement of coping skills may form an important target for intervention that may contribute to better clinical and functional outcomes in patients with psychotic symptoms.
Poster #S76 A RANDOMIZED TRIAL ADMINISTERING RALOXIFENE VS PLACEBO AS ADD-ON TO ANTIPSYCHOTICS IN POST-MENOPAUSAL FEMALE PATIENTS WITH SCHIZOPHRENIA OR SCHIZOAFFECTIVE DISORDER Shimon Burshtein 1,2 , Michael Davidson 2 , Mark Weiser 2 1 Resident; 2 Sheba Medical Center Background: Epidemiological evidence shows a potentially protective role for estrogen in women with schizophrenia. The onset of schizophrenia is later in woman than in men, with generally a less severe course until after the menopause, when for many women, reductions in estrogen levels
gap by assessing differences in the outcomes of youth with schizophreniaspectrum disorders (SCZ-S) and psychotic disorder NOS (PsyNOS) during early antipsychotic treatment. Methods: Prospective, naturalistic, inception cohort study of youth <18 years old with SCZ-S (schizophrenia, schizoaffective disorder, schizophreniform disorder) or PsyNOS (PsyNOS, brief psychotic disorder) and <24 months of lifetime antipsychotic treatment receiving clinician’s choice antipsychotic treatment. Baseline demographics, illness and treatment variables, and effectiveness outcomes were compared at 12-week lastobservation-carried-forward endpoint across SCZ-S and PsyNOS patients, adjusting for significantly different baseline variables. Linear and ordered regression analyses were conducted on the outcome measures. CGI-I endpoint scores and CGAS scores categorized as good, moderate or poor outcome served as primary outcomes. All statistical analyses were carried out using Stata11. Results: Altogether, 131 youth with SCZ-S (n=41) or PsyNOS (n=90), mean age of 15.4±2.9 years, mostly antipsychotic-naïve (77.1%), were initiated on risperidone (48.9%), olanzapine (16.8%), aripiprazole (16.0%), quetiapine (11.5%) or ziprasidone (6.9%). Compared to PsyNOS, SCZ-S youth were older (16.4±2.1 vs. 14.9±3.2, p=0.0090), more likely African-American (63.4% vs. 28.1%, p=0.0001), and less likely White (17.1% vs 42.7%, p=0.004). At baseline, SCZ-S patients were more severely ill than PsyNOS subjects: SCZ-S patients had significantly higher Clinical Global Impression-Severity (CGI-S) scores (6.0±0.8 vs. 5.5±0.8, p=0.0022), lower Children’s Global Assessment of Functioning (CGAS) scores (29.7±9.2 vs 36.0±8.8, p=0.0002), were more likely inpatients (87.8% vs. 67.8%, p=0.015) and were more likely in the severely ill CGAS group (i.e., CGAS<40). More patients with SCZ-S had a second degree family member with SCZ-S disorders (33.3% vs. 13.2%, p=0.046). During 12 weeks of naturalistic treatment, SCZ-S responded less well to naturalistic antipsychotic treatment than PsyNOS: While SCZ-S and PsyNOS did not differ regarding all-cause discontinuation (51.2% vs. 43.7%, p=0.49), more SCZ-S patients discontinued treatment for inefficacy (22.5% vs. 7.0%, p=0.011). CGI-S and CGAS scores improved significantly in both diagnostic groups during the 12 weeks of treatment (p=0.0001). However, adjusting for baseline differences, PsyNOS patients experienced significantly better CGI-I improvement (p=0.033) and scored better in the categorical CGAS groups (p=0.030) than SCZ-S patients. Discussion: Both youth with SCZ-S and PsyNOS experienced significant improvements during 12 weeks of clinician’s choice antipsychotic treatment. However, treatment discontinuation was common within 12 weeks, with greater inefficacy-related discontinuation in the SCZ-S group, while CGI-I and CGAS score-based improvements were greater in the PsyNOS group, indicating the need for early acute and maintenance treatment in youth with non-affective psychotic disorders.
Poster #S74 INCREASED RISK OF SCHIZOPHRENIA SPECTRUM DISORDERS AFTER ALL CHILDHOOD PSYCHIATRIC DISORDERS - NATIONWIDE STUDY Cecilie F. Maibing 1 , Michael Eriksen Benros 1 , Merete Nordentoft 2 , Søren Dalsgaard 3 , Carsten Bøcker Pedersen 3 1 Mental Health Centre Copenhagen; 2 Mental Health Services - Capital Region of Denmark, Mental Health Centre; University of Copenhagen - Faculty of Health and Medical Sciences; 3 Centre for Integrated Register-based Research Background: Previous studies have shown associations between prior childhood psychiatric disorders and development of schizophrenia spectrum disorders, particularly after specific diagnoses of autism and attentiondeficit/hyperactivity-disorder. However, large-scale prospective studies are lacking on the association between schizophrenia spectrum disorders and previous diagnoses of a broad range of childhood psychiatric disorders considered individually and in aggregate. Methods: Danish nationwide registers were linked to establish a cohort consisting of all persons born during 1990-2000 conducting the largest study to date. Individuals with childhood psychiatric disorders were identified and the cohort was followed for a first-time psychiatric contact for schizophrenia spectrum disorder until December 31st 2012. Data were analyzed using survival analyses and adjusted for calendar year, age, and gender. Results: The results presented are preliminary. In the entire cohort a total of 25,139 persons were diagnosed with a childhood psychiatric disorder
S115
and 3,085 people had a first-time diagnosis with schizophrenia spectrum disorders. 1,420 was first diagnosed with a childhood psychiatric disorder and then secondly with a schizophrenia spectrum disorder corresponding to 5.6%. The risk of later being diagnosed with schizophrenia spectrum disorders was highly elevated and remained significantly elevated with an incidence rate ratio (IRR) of 5.57 (95% CI: 4.93-6.27) more than 5 years after the childhood psychiatric disorder had been diagnosed. The cumulative incidence of persons being diagnosed with schizophrenia spectrum disorders after the first diagnosis with a childhood psychiatric disorder was within the first year 2.56%, within the first to second year 0.60% and within the second to fifth year 1.22%. More than five years after the first diagnosis with a childhood psychiatric disorder was given the cumulative incidence was 1.38%. Discussion: The risk of being diagnosed with a schizophrenia spectrum disorder was highly elevated after any childhood psychiatric disorder and remained significantly increased more than 5 years after the first diagnosis with a childhood psychiatric disorder.
Poster #S75 COPING, PSYCHOTIC SYMPTOMS AND FUNCTIONING IN ADOLESCENTS WITH MENTAL ILLNESS Johanna Wigman 1 , Nina Devlin 2 , Ian Kelleher 3 , Aileen Murtagh 2 , Michelle Harley 2 , Anne Kehoe 4 , Carol Fitzpatrick 5 , Mary Cannon 6 1 Maastricht University and Groningen University; 2 RCSI Dublin; 3 Royal College of Surgeons in Ireland, Karolinska Institutet, Stockholm, Sweden; 4 Queen’s University, Belfast; 5 University College Dublin; 6 Royal College of Surgeons in Ireland, Department of Psychiatry, Beaumont Hospital, Dublin Background: Psychotic symptoms in the context of psychiatric disorders are associated with poor functional outcomes. Environmental stressors are important in the development of psychosis; however, distress may only be pathogenic when it exceeds an individual’s ability to cope with it. Therefore, one interesting factor regarding poor functional outcomes in patients with psychotic symptoms may be poor coping. Methods: In a clinical case-clinical control study of 106 newly-referred adolescent patients with non-psychotic psychiatric disorders, coping was investigated using the Adolescents Coping Scale. Severity of impairment in socio-occupational functioning was assessed with the Children’s Global Assessment Scale. Results: Patients (N=106) with non-psychotic psychiatric disorders and additional psychotic symptoms had poorer functioning and were more likely to use avoidance-oriented coping. No differences were found with respect to approach-oriented coping. When stratifying for poor/good coping, only those adolescent patients with psychotic symptoms who applied poor coping (i.e. less use of approach-oriented coping styles [OR 0.24, p<0.015] and more use of avoidance-oriented coping [OR 0.23, p<0.034]) had poorer functioning. However, these interactions were not significant, probably due to too small subgroups. Discussion: Non-adaptive coping and poorer functioning were more often present in adolescents with non-psychotic psychiatric disorders and additional psychotic symptoms. Due to small subgroups, our analyses could not give definitive conclusions about the question whether coping moderated the association between psychotic symptoms and functioning. Improvement of coping skills may form an important target for intervention that may contribute to better clinical and functional outcomes in patients with psychotic symptoms.
Poster #S76 A RANDOMIZED TRIAL ADMINISTERING RALOXIFENE VS PLACEBO AS ADD-ON TO ANTIPSYCHOTICS IN POST-MENOPAUSAL FEMALE PATIENTS WITH SCHIZOPHRENIA OR SCHIZOAFFECTIVE DISORDER Shimon Burshtein 1,2 , Michael Davidson 2 , Mark Weiser 2 1 Resident; 2 Sheba Medical Center Background: Epidemiological evidence shows a potentially protective role for estrogen in women with schizophrenia. The onset of schizophrenia is later in woman than in men, with generally a less severe course until after the menopause, when for many women, reductions in estrogen levels