- Email: [email protected]
Poster #T163 ALTERED CONNECTIVITY IN THE HIPPOCAMPAL NETWORK AND HEIGHTENED COUPLING WITH THE SALIENCE NETWORK IN PEOPLE AT ULTRA-HIGH RISK FOR PSYCHOSIS
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
and APS+COGDIS. The hazard rates for the four risk classes ranged between 0.0 (both predictors absent) and 1.29 (both predictors present). Discussion: The combination of a processing speed deficit and at-risk criteria provides an optimized stratified risk assessment. Based on neurocognitive test norms, it can easily be applied in clinical practice.
Poster #T161 AN OPEN-LABEL TRIAL OF ADJUNCTIVE TOCILIZUMAB IN SCHIZOPHRENIA Brian J. Miller, James Dias, Peter Buckley Georgia Regents University Background: Schizophrenia is associated with impaired cognition, which persists despite current treatments, and is an important determinant of quality of life and overall function. Converging lines of evidence suggest that interleukin-6 (IL-6) may play a role in the pathophysiology of schizophrenia. We previously found that higher blood IL-6 levels were a significant predictor of greater cognitive impairment in schizophrenia after controlling for multiple potential confounding factors. We are conducting an 8-week open-label trial of adjunctive tocilizumab in schizophrenia. Tocilizumab is a humanized monoclonal antibody against the IL-6 receptor, approved by the US FDA for the treatment of adults with moderately to severely active rheumatoid arthritis. Tocilizumab is administered as an intravenous infusion every 4 weeks. Methods: Subjects in the trial are age 18–55, taking a non-clozapine antipsychotic, stable based on clinical judgment and no psychiatric hospitalizations in the past 3 months, and on the same psychotropic medications for at least 1 month. Following a screening visit, subjects receive a 4 mg/kg infusion of tocilizumab at baseline and again at 4 weeks. Cognition, as measured by the Brief Assessment of Cognition in Schizophrenia (BACS, using alternate forms) is assessed at baseline, and 2, 4, and 8 weeks. Results: In the first 3 subjects, tocilizumab infusions were well tolerated without significant adverse effects. The mean improvement was 11% on the BACS composite score, including a mean 32% improvement (11 points) on digit symbol coding. Discussion: These preliminary data suggest that anti-cytokine therapy may be a viable adjunctive treatment for cognitive impairment in schizophrenia.
Poster #T162 CAARMS IN THE COMMUNITY: ASSESSING THE PREVALENCE OF ULTRA-HIGH RISK SYMPTOMS IN THE GENERAL POPULATION John G. Mills 1 , Craig Morgan 2 , Philip McGuire 3 Department of Psychosis Studies, Institute of Psychiatry, King’s College London; 2 IOP; 3 King’s College London 1
Background: Over the past two decades, there has been increasingly interest in the definition, identification and treatment of individuals presenting with symptoms indicating an ultra-high risk of developing psychosis. However, current understanding of these ultra-high risk syndromes for psychosis is based almost entirely on studies of clinical populations and it is unclear whether there is another population that is experiencing similar symptoms but is not seen by mental health services. Motivated by the question of whether the OASIS clinical service represents the true extent of ultra-high risk individuals in South London, we aimed to estimate the prevalence of ultra-high risk symptoms within a general population sample. Methods: A random sample of 200 participants was obtained from within the South London boroughs of Lambeth and Southwark, using GP lists and the national postal address file as sampling frameworks. Clinical interviews were conducted, including the Comprehensive Assessment for the At Risk Mental State (CAARMS) to assess ultra high risk symptoms against the PACE clinic criteria and the nine-item Schizophrenia Proneness Instrument – Adult version (SPIA-9) to check for basic symptoms. Data relating to past psychotic experiences, common mental disorder, help-seeking behaviour, sociodemographic characteristics, and other potential confounders were also collected. Results: Preliminary findings have shown the overall unweighted prevalence of ultra-high risk subjects within our sample to be around 19%, with over 16% of subjects meeting PACE criteria and around 6% meeting Basic Symptom criteria. We expect the remaining analyses to show that:
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1. In accordance with the concept of a psychosis continuum, the prevalence of ultra-high risk symptoms in the general community is be in between that of subclinical psychotic experiences (approximately 17-25%) and diagnosable psychotic disorders (approximately 3%). 2. PACE criteria and Basic Symptom criteria tend to identify different individuals within this ultra-high risk group. 3. Not all of those meeting ultra-high risk criteria are in contact with clinical services. 4. Compared to patients using the OASIS service, subjects who meet ultra-high risk criteria but have not sought clinical help are likely to have: a. Higher levels of basic symptoms and/or affective symptoms, but lower levels of attenuated positive symptoms. b. A higher level of global functioning. Discussion: These findings are likely to have implications for clinical services, particularly in South London. Preliminary data support the idea that there may be a number of individuals within the general population who would meet ultra-high risk criteria in terms of symptoms but do not seek clinical help. Indeed the size of this group may even be higher than the predictions of previous studies. Any sociodemographic differences between community and clinical ultra-high risk groups may indicate a need for services to target particular areas of the community with more information, whereas differences in the symptomatic profile of clinical and community ultra-high risk groups may be seen as reassurance that OASIS is successfully meeting the demand of those who need it most. Follow-up studies of this general population group may be required to establish the true meaning of these criteria outside of clinical settings.
Poster #T163 ALTERED CONNECTIVITY IN THE HIPPOCAMPAL NETWORK AND HEIGHTENED COUPLING WITH THE SALIENCE NETWORK IN PEOPLE AT ULTRA-HIGH RISK FOR PSYCHOSIS Jun Miyata 1,2 , Toby Winton-Brown 3 , Nicolas Crossley 3 , Shitij Kapur 4 , Philip McGuire 5 1 Department of Psychiatry, Graduate School of Medicine, Kyoto University; 2 Department of Psychosis Studies, Institute of Psychiatry; 3 Institute of Psychiatry; 4 Institute of Psychiatry, King’s College London; 5 King’s College London Background: Dopamine dysfunction may lead to psychotic symptoms through an effect on salience processing (Kapur, 2003). It has been suggested that this dopamine dysfunction is driven by hippocampal overactivity, which influences midbrain dopamine neurons via inputs through the basal ganglia (Lisman and Grace, 2005). On the other hand, independent research suggests that there is a “salience network (SN)” comprising the insula and anterior cingulate cortex (ACC). Its activity is not task-specific, but involved in switching between the default mode (DMN) and central executive networks (CEN) (Sridharan et al, 2008). We used neuroimaging to investigate functional connectivity within and across these two different “salience” networks in people at ultra-high risk for psychosis (at risk mental state, ARMS). Methods: Resting state functional MRI (rsfMRI) data were acquired from 29 ARMS subjects and 25 age and gender matched healthy controls (HC), using T2*-weighted echo-planar sequences (TR=2s TE=31ms), on a 3T scanner. The rsfMRI data were analyzed by independent component analysis (ICA). Six networks of interest were identified: hippocampal network (HN), basal ganglia network (BGN), SN, CEN (right and left), and DMN. Group differences in intra-network connectivity analysis within each network were tested for both the ARMS > HC and HC < ARMS contrasts, using a clusterwise family wise error (FWE) correction across all 12 tests, yielding a threshold of p<0.0041667 for each contrast. Group differences in inter-network connectivity were calculated by partial correlation between the time series of each network, controlling for the effects of all the other networks. Results: ARMS participants had significantly decreased connectivity within the HN and within the dorsal prefrontal part of the right CEN, but increased connectivity within the ventral prefrontal part of the right CEN. ARMS participants showed a significantly increased partial correlation between the HN and the SN (p<0.05, FWE corrected). Discussion: The ARMS was associated with intra-network abnormalities in both the HN and right CEN, but not within the SN, and with heightened
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Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
coupling between the HN and SN. These data provide further support for the role of altered medial temporal connectivity in psychosis, but also implicate the insular-ACC salience network.
Poster #T164 EMOTION PROCESSING IN SCHIZOPHRENIA IS STATE-DEPENDENT Simone van Montfort, Arija Maat University Medical Centre Utrecht, the Netherlands Background: Substantial evidence exists about impairments on emotion processing (EP) in schizophrenia patients (Maat et al., 2013). However, whether this deficit is trait- or a state dependent in schizophrenia remains unclear. Methods: This is a 3 year longitudinal study, in a large sample of schizophrenia patients (N=521, age: 27.34±7.33, 77% men, IQ: 96.82±15,23) and healthy controls (N=312, age: 30.13±10.73, 50% men, IQ: 111,70±15.61). At baseline (T1) and at follow-up (T2) EP was assessed with the Degraded Facial Affect Recognition task (van ’t Wout et al., 2004) and remission was assessed using the PANSS remission tool (Andreasen et al., 2005). Patients were divided into 4 groups: remission T1 and remission T2 (RR); remission T1 and non-remission T2 (RN); non-remission T1 and non-remission T2 (NN) and non-remission T1 and remission T2 (NR). EP performance between patients and healthy controls was analysed using ANCOVA. Group × time interactions, using repeated measure analyses, were used to examine differences between the patient groups in EP performance over time. Age, gender and IQ were served as covariates. Results: Schizophrenia patients performed worse on EP compared to healthy controls at baseline (F(1,797)=10.272, p=0.001). Group × time interactions were found between RR and RN, F(1,235)=11.360, p=0.001, and between NR and RN, F(1,161)=4.202, p=0.042. No group × time interaction was found between NN and NR, F(1,248)=0.500, p=0.480. Discussion: Our study shows that EP performance in schizophrenia is not stable over time and relies heavily on the state of illness, i.e. remission or non-remission. This suggests that social cognition; in particular facial recognition is related to the symptomatology of schizophrenia and might be a target for novel (psychotherapeutic) interventions.
Poster #T165 ETHNICITY, SOCIAL DISADVANTAGE AND THE LONG-TERM COURSE AND OUTCOME OF PSYCHOSIS Craig Morgan 1 , Julia Lappin 1 , Margaret Heslin 2 , Tim Croudace 3 , Gillian Doody 4 , Kim Donoghue 2 , Peter B. Jones 5 , Robin M. Murray 1 , Paul Fearon 6 , Paola Dazzan 7 1 Institute of Psychiatry; 2 Institute of Psychiatry, King’s College London; 3 University of York; 4 University of Nottingham; 5 University of Cambridge; 6 Trinity College, Dublin; 7 Psychological Medicine, Institute of Psychiatry, King’s College London Background: In the UK, there is strong evidence that black Caribbean and black African populations have higher rates of psychosis and more negative interactions with specialist mental health services. In addition, it has been suggested that the clinical course and outcome of psychosis in these groups is more benign, with fewer individuals experiencing continuous and negative symptoms over time. We sought to test this in a ten-year follow-up of a large cohort of individuals with first-episode psychosis (n=557) (AESOP-10). Methods: ÆSOP-10 is a multi-centre follow-up study at 10 years of a cohort of 557 individuals with a first episode of psychosis. At baseline, extensive data were collected on a range of social and biological risk factors. At follow-up, detailed information was collated on clinical course and outcome, social function and disability, and service use during the 10 year period since inception into the study. Results: At follow-up, 39 (7%) had died and 30 (5%) had moved abroad. Of the remaining 488, we successfully followed and collated information on 392 (80%). In contrast to what we hypothesised, we found evidence that black Caribbean and, to a lesser degree, black African cases experienced worse outcomes across all domains compared with white British. For example, black Caribbeans took longer to first remission (Hazard Ratio 0.7, 95% CI 0.5–0.9), were over 3 times more likely to experience a continuous (vs.
episodic) course (Risk Ratio 3.4, 95% CI 1.6–6.9) and were over two times more likely to experience severe symptoms when unwell (Odds Ratio 2.4, 95% CI 1.3–4.8). With regard to service use, both black Caribbean and black African cases were more likely to be admitted to hospital (black Caribbean Incidence Rate Ratio [IRR] 1.3, 95% CI 1.2–1.5; black African IRR 1.3, 95% CI 1.1–1.5) and to be admitted compulsorily (black Caribbean IRR 2.2, 95% CI 1.8–2.6; black African IRR 2.3, 95% CI 1.9–2.8). Overall, at 10 years over 75% of black Caribbean and black African cases had been admitted to hospital compulsorily at least once, compared with around 50% of white British (p<0.001). When adjusted for an index of baseline social adversity, differences between ethnic groups across all domains were attenuated. Discussion: These analyses do not support the proposition that outcomes of psychosis are more benign in black minority ethnic groups in the UK. They do, in fact, suggest outcomes are worse and again show high levels of compulsory admissions in these groups. Tentatively, high levels of social disadvantage and isolation at first presentation may contribute to these more negative outcomes among black Caribbean and black African groups.
Poster #T166 CAN THE MOTOR THRESHOLD BE PREDICTIVE TO RESPONSE TO RTMS TREATMENT IN SCHIZOPHRENIC PATIENTS WITH AUDITORY HALLUCINATIONS? Clément Nathou 1 , Olivier Etard 2 , Grégory Simon 3 , Sonia Dollfus 2 Centre Esquirol, CHU de Caen, France; 2 CHU de Caen; 3 University of Paris Descartes
1
Background: The treatment of resistant auditory hallucinations in schizophrenia by repetitive transcranial magnetic stimulation (rTMS) shows a high interindividual variability in the response, without clearly identifiable predictor. The motor threshold is an individual variable which depends also on the state of excitability of the cortex of the subject at a given time. The purpose of our study is to test the existence of a link between the motor threshold as a reflection of the state of cortical excitability and efficacy of rTMS treatment in reducing hallucinations in schizophrenic patients. Methods: Sixteen schizophrenic patients whose hallucinatory symptoms were assessed by the scale Auditory Hallucinations Rating Scale (AHRS) before (D0) and after (D12) rTMS were included in this experiment. RTMS treatment consisted in a stimulation assisted by neuronavigation at 20 Hz, 80% of motor threshold of a functional target of the left temporal cortex in four sessions on two consecutive days (D1 and D2). We tested the existence of a correlation link between the motor threshold measured before treatment and the percentage change in the score of the AHRS as a reflection of the effectiveness of treatment. Results: We have highlighted a correlation between the motor threshold and decreased auditory hallucinations after treatment (r=−0.57, p<0.02). The higher the motor threshold was, the greater the treatment appears to be effective. Discussion: We demonstrated the existence of a link between clinical rTMS efficacy and motor threshold. This result could help to clarify the indications for the use of rTMS in the treatment of auditory hallucinations.
Poster #T168 BRAIN STRUCTURE IN SUBGROUPS OF PERSONS AT ULTRA HIGH-RISK (UHR) COMPARED TO FIRST-EPISODE SCHIZOPHRENIA AND HEALTHY PERSONS Igor Nenadic 1 , Raka Maitra 1 , Soumyajit Basu 1 , Maren Dietzek 1 , Nils Schoenfeld 1 , Carsten Lorenz 1 , Heinrich Sauer 1 , Christian Gaser 1 , Stefan Smesny 1,2 1 Jena University Hospital; 2 Department of Psychiatry, Jena University Hospital, Germany Background: The at-risk mental-state (ARMS) has become an established concept in early psychosis intervention research. While several MRI studies have identified brain structural changes in ultra-high-risk subjects (UHR), they have mostly divided subgroups based on later conversion to psychosis. There is, however, little research into the heterogeneity of subgroups of UHR subjects, who might enter the ARMS state through either genetic predisposition, attenuated symptoms, or brief limited psychotic symptoms.
and APS+COGDIS. The hazard rates for the four risk classes ranged between 0.0 (both predictors absent) and 1.29 (both predictors present). Discussion: The combination of a processing speed deficit and at-risk criteria provides an optimized stratified risk assessment. Based on neurocognitive test norms, it can easily be applied in clinical practice.
Poster #T161 AN OPEN-LABEL TRIAL OF ADJUNCTIVE TOCILIZUMAB IN SCHIZOPHRENIA Brian J. Miller, James Dias, Peter Buckley Georgia Regents University Background: Schizophrenia is associated with impaired cognition, which persists despite current treatments, and is an important determinant of quality of life and overall function. Converging lines of evidence suggest that interleukin-6 (IL-6) may play a role in the pathophysiology of schizophrenia. We previously found that higher blood IL-6 levels were a significant predictor of greater cognitive impairment in schizophrenia after controlling for multiple potential confounding factors. We are conducting an 8-week open-label trial of adjunctive tocilizumab in schizophrenia. Tocilizumab is a humanized monoclonal antibody against the IL-6 receptor, approved by the US FDA for the treatment of adults with moderately to severely active rheumatoid arthritis. Tocilizumab is administered as an intravenous infusion every 4 weeks. Methods: Subjects in the trial are age 18–55, taking a non-clozapine antipsychotic, stable based on clinical judgment and no psychiatric hospitalizations in the past 3 months, and on the same psychotropic medications for at least 1 month. Following a screening visit, subjects receive a 4 mg/kg infusion of tocilizumab at baseline and again at 4 weeks. Cognition, as measured by the Brief Assessment of Cognition in Schizophrenia (BACS, using alternate forms) is assessed at baseline, and 2, 4, and 8 weeks. Results: In the first 3 subjects, tocilizumab infusions were well tolerated without significant adverse effects. The mean improvement was 11% on the BACS composite score, including a mean 32% improvement (11 points) on digit symbol coding. Discussion: These preliminary data suggest that anti-cytokine therapy may be a viable adjunctive treatment for cognitive impairment in schizophrenia.
Poster #T162 CAARMS IN THE COMMUNITY: ASSESSING THE PREVALENCE OF ULTRA-HIGH RISK SYMPTOMS IN THE GENERAL POPULATION John G. Mills 1 , Craig Morgan 2 , Philip McGuire 3 Department of Psychosis Studies, Institute of Psychiatry, King’s College London; 2 IOP; 3 King’s College London 1
Background: Over the past two decades, there has been increasingly interest in the definition, identification and treatment of individuals presenting with symptoms indicating an ultra-high risk of developing psychosis. However, current understanding of these ultra-high risk syndromes for psychosis is based almost entirely on studies of clinical populations and it is unclear whether there is another population that is experiencing similar symptoms but is not seen by mental health services. Motivated by the question of whether the OASIS clinical service represents the true extent of ultra-high risk individuals in South London, we aimed to estimate the prevalence of ultra-high risk symptoms within a general population sample. Methods: A random sample of 200 participants was obtained from within the South London boroughs of Lambeth and Southwark, using GP lists and the national postal address file as sampling frameworks. Clinical interviews were conducted, including the Comprehensive Assessment for the At Risk Mental State (CAARMS) to assess ultra high risk symptoms against the PACE clinic criteria and the nine-item Schizophrenia Proneness Instrument – Adult version (SPIA-9) to check for basic symptoms. Data relating to past psychotic experiences, common mental disorder, help-seeking behaviour, sociodemographic characteristics, and other potential confounders were also collected. Results: Preliminary findings have shown the overall unweighted prevalence of ultra-high risk subjects within our sample to be around 19%, with over 16% of subjects meeting PACE criteria and around 6% meeting Basic Symptom criteria. We expect the remaining analyses to show that:
S347
1. In accordance with the concept of a psychosis continuum, the prevalence of ultra-high risk symptoms in the general community is be in between that of subclinical psychotic experiences (approximately 17-25%) and diagnosable psychotic disorders (approximately 3%). 2. PACE criteria and Basic Symptom criteria tend to identify different individuals within this ultra-high risk group. 3. Not all of those meeting ultra-high risk criteria are in contact with clinical services. 4. Compared to patients using the OASIS service, subjects who meet ultra-high risk criteria but have not sought clinical help are likely to have: a. Higher levels of basic symptoms and/or affective symptoms, but lower levels of attenuated positive symptoms. b. A higher level of global functioning. Discussion: These findings are likely to have implications for clinical services, particularly in South London. Preliminary data support the idea that there may be a number of individuals within the general population who would meet ultra-high risk criteria in terms of symptoms but do not seek clinical help. Indeed the size of this group may even be higher than the predictions of previous studies. Any sociodemographic differences between community and clinical ultra-high risk groups may indicate a need for services to target particular areas of the community with more information, whereas differences in the symptomatic profile of clinical and community ultra-high risk groups may be seen as reassurance that OASIS is successfully meeting the demand of those who need it most. Follow-up studies of this general population group may be required to establish the true meaning of these criteria outside of clinical settings.
Poster #T163 ALTERED CONNECTIVITY IN THE HIPPOCAMPAL NETWORK AND HEIGHTENED COUPLING WITH THE SALIENCE NETWORK IN PEOPLE AT ULTRA-HIGH RISK FOR PSYCHOSIS Jun Miyata 1,2 , Toby Winton-Brown 3 , Nicolas Crossley 3 , Shitij Kapur 4 , Philip McGuire 5 1 Department of Psychiatry, Graduate School of Medicine, Kyoto University; 2 Department of Psychosis Studies, Institute of Psychiatry; 3 Institute of Psychiatry; 4 Institute of Psychiatry, King’s College London; 5 King’s College London Background: Dopamine dysfunction may lead to psychotic symptoms through an effect on salience processing (Kapur, 2003). It has been suggested that this dopamine dysfunction is driven by hippocampal overactivity, which influences midbrain dopamine neurons via inputs through the basal ganglia (Lisman and Grace, 2005). On the other hand, independent research suggests that there is a “salience network (SN)” comprising the insula and anterior cingulate cortex (ACC). Its activity is not task-specific, but involved in switching between the default mode (DMN) and central executive networks (CEN) (Sridharan et al, 2008). We used neuroimaging to investigate functional connectivity within and across these two different “salience” networks in people at ultra-high risk for psychosis (at risk mental state, ARMS). Methods: Resting state functional MRI (rsfMRI) data were acquired from 29 ARMS subjects and 25 age and gender matched healthy controls (HC), using T2*-weighted echo-planar sequences (TR=2s TE=31ms), on a 3T scanner. The rsfMRI data were analyzed by independent component analysis (ICA). Six networks of interest were identified: hippocampal network (HN), basal ganglia network (BGN), SN, CEN (right and left), and DMN. Group differences in intra-network connectivity analysis within each network were tested for both the ARMS > HC and HC < ARMS contrasts, using a clusterwise family wise error (FWE) correction across all 12 tests, yielding a threshold of p<0.0041667 for each contrast. Group differences in inter-network connectivity were calculated by partial correlation between the time series of each network, controlling for the effects of all the other networks. Results: ARMS participants had significantly decreased connectivity within the HN and within the dorsal prefrontal part of the right CEN, but increased connectivity within the ventral prefrontal part of the right CEN. ARMS participants showed a significantly increased partial correlation between the HN and the SN (p<0.05, FWE corrected). Discussion: The ARMS was associated with intra-network abnormalities in both the HN and right CEN, but not within the SN, and with heightened
S348
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
coupling between the HN and SN. These data provide further support for the role of altered medial temporal connectivity in psychosis, but also implicate the insular-ACC salience network.
Poster #T164 EMOTION PROCESSING IN SCHIZOPHRENIA IS STATE-DEPENDENT Simone van Montfort, Arija Maat University Medical Centre Utrecht, the Netherlands Background: Substantial evidence exists about impairments on emotion processing (EP) in schizophrenia patients (Maat et al., 2013). However, whether this deficit is trait- or a state dependent in schizophrenia remains unclear. Methods: This is a 3 year longitudinal study, in a large sample of schizophrenia patients (N=521, age: 27.34±7.33, 77% men, IQ: 96.82±15,23) and healthy controls (N=312, age: 30.13±10.73, 50% men, IQ: 111,70±15.61). At baseline (T1) and at follow-up (T2) EP was assessed with the Degraded Facial Affect Recognition task (van ’t Wout et al., 2004) and remission was assessed using the PANSS remission tool (Andreasen et al., 2005). Patients were divided into 4 groups: remission T1 and remission T2 (RR); remission T1 and non-remission T2 (RN); non-remission T1 and non-remission T2 (NN) and non-remission T1 and remission T2 (NR). EP performance between patients and healthy controls was analysed using ANCOVA. Group × time interactions, using repeated measure analyses, were used to examine differences between the patient groups in EP performance over time. Age, gender and IQ were served as covariates. Results: Schizophrenia patients performed worse on EP compared to healthy controls at baseline (F(1,797)=10.272, p=0.001). Group × time interactions were found between RR and RN, F(1,235)=11.360, p=0.001, and between NR and RN, F(1,161)=4.202, p=0.042. No group × time interaction was found between NN and NR, F(1,248)=0.500, p=0.480. Discussion: Our study shows that EP performance in schizophrenia is not stable over time and relies heavily on the state of illness, i.e. remission or non-remission. This suggests that social cognition; in particular facial recognition is related to the symptomatology of schizophrenia and might be a target for novel (psychotherapeutic) interventions.
Poster #T165 ETHNICITY, SOCIAL DISADVANTAGE AND THE LONG-TERM COURSE AND OUTCOME OF PSYCHOSIS Craig Morgan 1 , Julia Lappin 1 , Margaret Heslin 2 , Tim Croudace 3 , Gillian Doody 4 , Kim Donoghue 2 , Peter B. Jones 5 , Robin M. Murray 1 , Paul Fearon 6 , Paola Dazzan 7 1 Institute of Psychiatry; 2 Institute of Psychiatry, King’s College London; 3 University of York; 4 University of Nottingham; 5 University of Cambridge; 6 Trinity College, Dublin; 7 Psychological Medicine, Institute of Psychiatry, King’s College London Background: In the UK, there is strong evidence that black Caribbean and black African populations have higher rates of psychosis and more negative interactions with specialist mental health services. In addition, it has been suggested that the clinical course and outcome of psychosis in these groups is more benign, with fewer individuals experiencing continuous and negative symptoms over time. We sought to test this in a ten-year follow-up of a large cohort of individuals with first-episode psychosis (n=557) (AESOP-10). Methods: ÆSOP-10 is a multi-centre follow-up study at 10 years of a cohort of 557 individuals with a first episode of psychosis. At baseline, extensive data were collected on a range of social and biological risk factors. At follow-up, detailed information was collated on clinical course and outcome, social function and disability, and service use during the 10 year period since inception into the study. Results: At follow-up, 39 (7%) had died and 30 (5%) had moved abroad. Of the remaining 488, we successfully followed and collated information on 392 (80%). In contrast to what we hypothesised, we found evidence that black Caribbean and, to a lesser degree, black African cases experienced worse outcomes across all domains compared with white British. For example, black Caribbeans took longer to first remission (Hazard Ratio 0.7, 95% CI 0.5–0.9), were over 3 times more likely to experience a continuous (vs.
episodic) course (Risk Ratio 3.4, 95% CI 1.6–6.9) and were over two times more likely to experience severe symptoms when unwell (Odds Ratio 2.4, 95% CI 1.3–4.8). With regard to service use, both black Caribbean and black African cases were more likely to be admitted to hospital (black Caribbean Incidence Rate Ratio [IRR] 1.3, 95% CI 1.2–1.5; black African IRR 1.3, 95% CI 1.1–1.5) and to be admitted compulsorily (black Caribbean IRR 2.2, 95% CI 1.8–2.6; black African IRR 2.3, 95% CI 1.9–2.8). Overall, at 10 years over 75% of black Caribbean and black African cases had been admitted to hospital compulsorily at least once, compared with around 50% of white British (p<0.001). When adjusted for an index of baseline social adversity, differences between ethnic groups across all domains were attenuated. Discussion: These analyses do not support the proposition that outcomes of psychosis are more benign in black minority ethnic groups in the UK. They do, in fact, suggest outcomes are worse and again show high levels of compulsory admissions in these groups. Tentatively, high levels of social disadvantage and isolation at first presentation may contribute to these more negative outcomes among black Caribbean and black African groups.
Poster #T166 CAN THE MOTOR THRESHOLD BE PREDICTIVE TO RESPONSE TO RTMS TREATMENT IN SCHIZOPHRENIC PATIENTS WITH AUDITORY HALLUCINATIONS? Clément Nathou 1 , Olivier Etard 2 , Grégory Simon 3 , Sonia Dollfus 2 Centre Esquirol, CHU de Caen, France; 2 CHU de Caen; 3 University of Paris Descartes
1
Background: The treatment of resistant auditory hallucinations in schizophrenia by repetitive transcranial magnetic stimulation (rTMS) shows a high interindividual variability in the response, without clearly identifiable predictor. The motor threshold is an individual variable which depends also on the state of excitability of the cortex of the subject at a given time. The purpose of our study is to test the existence of a link between the motor threshold as a reflection of the state of cortical excitability and efficacy of rTMS treatment in reducing hallucinations in schizophrenic patients. Methods: Sixteen schizophrenic patients whose hallucinatory symptoms were assessed by the scale Auditory Hallucinations Rating Scale (AHRS) before (D0) and after (D12) rTMS were included in this experiment. RTMS treatment consisted in a stimulation assisted by neuronavigation at 20 Hz, 80% of motor threshold of a functional target of the left temporal cortex in four sessions on two consecutive days (D1 and D2). We tested the existence of a correlation link between the motor threshold measured before treatment and the percentage change in the score of the AHRS as a reflection of the effectiveness of treatment. Results: We have highlighted a correlation between the motor threshold and decreased auditory hallucinations after treatment (r=−0.57, p<0.02). The higher the motor threshold was, the greater the treatment appears to be effective. Discussion: We demonstrated the existence of a link between clinical rTMS efficacy and motor threshold. This result could help to clarify the indications for the use of rTMS in the treatment of auditory hallucinations.
Poster #T168 BRAIN STRUCTURE IN SUBGROUPS OF PERSONS AT ULTRA HIGH-RISK (UHR) COMPARED TO FIRST-EPISODE SCHIZOPHRENIA AND HEALTHY PERSONS Igor Nenadic 1 , Raka Maitra 1 , Soumyajit Basu 1 , Maren Dietzek 1 , Nils Schoenfeld 1 , Carsten Lorenz 1 , Heinrich Sauer 1 , Christian Gaser 1 , Stefan Smesny 1,2 1 Jena University Hospital; 2 Department of Psychiatry, Jena University Hospital, Germany Background: The at-risk mental-state (ARMS) has become an established concept in early psychosis intervention research. While several MRI studies have identified brain structural changes in ultra-high-risk subjects (UHR), they have mostly divided subgroups based on later conversion to psychosis. There is, however, little research into the heterogeneity of subgroups of UHR subjects, who might enter the ARMS state through either genetic predisposition, attenuated symptoms, or brief limited psychotic symptoms.