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Poster #T164 EMOTION PROCESSING IN SCHIZOPHRENIA IS STATE-DEPENDENT
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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
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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.
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.