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Poster #T225 FAILURE TO FIND ADDITIVE INTERACTION BETWEEN SOCIAL ADVERSITY IN CHILDHOOD AND FAMILY RISK OF PSYCHOSIS
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
Results: This study is currently in the recruitment phase. This presentation will address study rationale, objectives, and preliminary follow-up data. Currently, 118 (68%) participants have been followed up. Discussion: We anticipate that this study will validate previous findings that Axis I comorbidity poses an ongoing problem for those identified as being at UHR for psychosis (Lin et al., 2012). However, in contrast to the limited research on Axis II disorders in this population, our preliminary findings indicate a lower prevalence of Axis II disorders than previously reported. Improved understanding of the relationship of Axis I and II disorders to functional outcomes will inform treatment options and facilitate management of illness in the UHR population. Acknowledgement: This research project is supported by a National Health and Medical Research Council Project Grant (APP1027741).
Poster #T224 TACKLING STIGMA: DEVELOPING NEIGHBOURHOOD INTERVENTIONS BY MEANS OF FOCUS GROUPS Esther Sportel 1 , Gerdina Pijnenborg 2 , Johan Arends 1 1 Dept of Psychotic Disorders GGZ Drenthe, Assen; 2 Dept of Clinical Psychology and Experimental Psychopathology, University of Groningen Background: People with psychiatric problems are often confronted with stigmatisation. This can take place at home or in their neighbourhood, with friends or family, at the gym or at work. Stigma is characterised by limited knowledge, prejudice, and discrimination. To effectively change stigma contact with the stigmatised group is essential, as well as increasing the current knowledge concerning mental health problems. Given the trend of clients living in residential areas in the Netherlands, it seems essential to tackle stigma concerning mental health right now. Especially since in general residents associate psychiatric problems with violence, irresponsible behaviours and think they should be “kept in hospitals”. Methods: Focus groups will be formed in Assen to investigate the role of stigmatisation in neighbourhoods, both mental health care clients and residents will be invited to participate in separate groups. Each group will consist of 5-15 participants and a moderator. Within these groups a structured discussion will be held concerning the following topics: For clients: 1. experience of stigmatisation, 2. most affected parts of life, 3. possible solutions; for residents the following topics will be addresses: 1. experience of stigmatisation, 2. most stigmatised groups, 3. possible solutions. Neighbourhoods have been selected based on: 1. number of mental health service clients, 2. comparable demographic characteristics, 3. overall satisfaction of residents regarding their living environment. Clients will be invited in the mental health facility to participate if they live in one of the selected residential neighbourhoods in Assen, residents will be invited to participate from the same residential neighbourhoods, and they will be invited through community workers. Based on the results of the focus groups interventions will be developed aiming at a reduction of stigmatisation and an improvement of quality of life the neighbourhood. Two areas will be compared, one neighbourhood will be in the active condition and receive interventions, the other will serve as control neighbourhood. Results: Results of the focus groups will be presented on the poster. Outcomes will be presented of the neighbourhood focus group and the client focus group. Discussion: Results of the focus groups will be discussed on the poster. This will include recommendations with regard to interventions on a local level.
Poster #T225 FAILURE TO FIND ADDITIVE INTERACTION BETWEEN SOCIAL ADVERSITY IN CHILDHOOD AND FAMILY RISK OF PSYCHOSIS Simona A. Stilo 1 , Matteo Bonomo 1 , Francesca Bianconi 1 , Conrad Iyegbe 1 , Charlotte Gayer-Anderson 1 , Kathryn Hubbard 2 , Stephanie Beards 1 , Helen Fisher 3 , Marta Di Forti 1 , Robin M. Murray 3 , Craig Morgan 3 1 Institute of Psychiatry, King’s College London; 2 Centre for Epidemiology and Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London; 3 Institute of Psychiatry, London Background: There is robust evidence that early adversities are associated
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with an increased risk of psychosis (Fisher et al. 2010). However, no etiological theory for psychosis may hope to be comprehensive without taking in consideration genetic factors. We hypothesized that early social adversities (defined as presence of separation and/or loss from one or both parents before age of 17) interact with psychosis family history as proxy of genetic risk in increasing the risk of psychosis. Methods: As part of the GAP, CAPsy, and EU-GEI studies, we collected information on social adversity from a sample of first episode psychosis patients (n=507) and in a control sample (n=425) recruited from the areas in South-East London covered by the South London and Maudsley NHS Foundation Trust. To assess the additive interaction we constructed a logistic model that took into consideration 3 variables, each taking on two values: social adversity in childhood (no/yes) psychosis family history in first relatives (no/yes), and outcome status (case/control). Confidence intervals and p-values for the Interaction Contrast Ratio [ICR] were calculated using the nlcom procedure in STATA 12. Results: Compared to controls, cases were 2.3 times (95% CI 1.6–3.2) more likely to report only adversity in childhood, 5.2 times (95% CI 2.3–11.7) more likely to report only psychosis family history, 4 times (95% CI 2–7.7) more likely to report both. However, our preliminary data do not support a synergistic relationship between early adversities and genetic risk. The combined effect was lower than the sum of the individual effects (Interaction Contrast Ratio [ICR] −2.56, 95%CI −7.3–2.2). Discussion: In contrast with our hypothesis, there was no evidence that early adversities and psychosis family history combined synergistically to increase odds of psychotic disorder beyond the effect of each individually. Further analyses need to be conducted to understand if and how early adversities and psychosis genetic risk combine to create vulnerability for psychosis.
Poster #T226 SOCIAL ANXIETY DISORDER IN RECENT-ONSET SCHIZOPHRENIA SPECTRUM DISORDERS: THE RELATION WITH SYMPTOMOLOGY, ANXIETY, AND SOCIAL RANK Stephanie A. Sutliff 1,2 , Marc-André Roy 2,3 , Amélie Achim 4 Centre de recherche de l’Institut Universitaire en Santé mentale de Québec, Canada; 2 Université Laval, Canada; 3 Institut universitaire en santé mentale de Québec, Canada; 4 Centre de recherche de l’Institut Universitaire en Santé mentale de Québec; Département de Psychiatrie et neurosciences, Université Laval, Canada 1
Background: Social anxiety disorder (SAD) represents a common comorbidity in schizophrenia. However, to date few studies have focused on the specific ways that individuals with schizophrenia and a comorbid diagnosis of SAD are affected in distinct psychotic symptoms, as well as how such symptoms relate to social rank, a key concept of social anxiety. Methods: Forty-two patients with recent-onset schizophrenia were evaluated for SAD comorbidity using a comprehensive clinical interview which included the Structured Clinical Interview for the DSM-IV (SCID) and the Liebowitz Social Anxiety Scale (LSAS). All participants were also assessed with the Positive and Negative Syndrome Scale (PANSS) and the Social Comparison Scale (SCS). Results: Eighteen patients met the full criteria for comorbid diagnosis of SAD (SZ+), and 24 patients did not meet all criteria for such comorbidity (SZ−). The SZ− group showed more severe impairments in cognitive symptoms on the PANSS as compared to SZ+, including conceptual disorganization (t(40)=2.11, p=0.041), difficulty in abstract thinking (t(40)=2.51, p=0.016), and poor attention (t(40)=2.18, p=0.007); conversely, the SZ+ group showed higher levels of suspiciousness/persecution (t(40)=−2.92, p=0.006), active social avoidance (t(40)=−2.62, p=0.012), and anxiety (t(40)=−3.23, p=0.001). Patients with SZ+ showed higher scores of social anxiety on the LSAS (t(40)=−2.88, p=0.006), but social anxiety only correlated with specific psychotic symptoms in the SZ− group. The SZ+ group demonstrated reduced social rank compared to SZ− (t(40)=2.90, p=0.006). The two groups also displayed differing patterns of correlations between social rank and psychotic symptoms: in patients with SZ+, a negative correlation between social rank and delusions was present (r=−0.505, p=0.033), whereas in the SZ− group, a positive correlation between the two was present (r=0.432, p=0.035). The SZ− group also had a positive correlation of social rank with grandiosity (r=0.484, p=o.016) and passive/apathetic social
Results: This study is currently in the recruitment phase. This presentation will address study rationale, objectives, and preliminary follow-up data. Currently, 118 (68%) participants have been followed up. Discussion: We anticipate that this study will validate previous findings that Axis I comorbidity poses an ongoing problem for those identified as being at UHR for psychosis (Lin et al., 2012). However, in contrast to the limited research on Axis II disorders in this population, our preliminary findings indicate a lower prevalence of Axis II disorders than previously reported. Improved understanding of the relationship of Axis I and II disorders to functional outcomes will inform treatment options and facilitate management of illness in the UHR population. Acknowledgement: This research project is supported by a National Health and Medical Research Council Project Grant (APP1027741).
Poster #T224 TACKLING STIGMA: DEVELOPING NEIGHBOURHOOD INTERVENTIONS BY MEANS OF FOCUS GROUPS Esther Sportel 1 , Gerdina Pijnenborg 2 , Johan Arends 1 1 Dept of Psychotic Disorders GGZ Drenthe, Assen; 2 Dept of Clinical Psychology and Experimental Psychopathology, University of Groningen Background: People with psychiatric problems are often confronted with stigmatisation. This can take place at home or in their neighbourhood, with friends or family, at the gym or at work. Stigma is characterised by limited knowledge, prejudice, and discrimination. To effectively change stigma contact with the stigmatised group is essential, as well as increasing the current knowledge concerning mental health problems. Given the trend of clients living in residential areas in the Netherlands, it seems essential to tackle stigma concerning mental health right now. Especially since in general residents associate psychiatric problems with violence, irresponsible behaviours and think they should be “kept in hospitals”. Methods: Focus groups will be formed in Assen to investigate the role of stigmatisation in neighbourhoods, both mental health care clients and residents will be invited to participate in separate groups. Each group will consist of 5-15 participants and a moderator. Within these groups a structured discussion will be held concerning the following topics: For clients: 1. experience of stigmatisation, 2. most affected parts of life, 3. possible solutions; for residents the following topics will be addresses: 1. experience of stigmatisation, 2. most stigmatised groups, 3. possible solutions. Neighbourhoods have been selected based on: 1. number of mental health service clients, 2. comparable demographic characteristics, 3. overall satisfaction of residents regarding their living environment. Clients will be invited in the mental health facility to participate if they live in one of the selected residential neighbourhoods in Assen, residents will be invited to participate from the same residential neighbourhoods, and they will be invited through community workers. Based on the results of the focus groups interventions will be developed aiming at a reduction of stigmatisation and an improvement of quality of life the neighbourhood. Two areas will be compared, one neighbourhood will be in the active condition and receive interventions, the other will serve as control neighbourhood. Results: Results of the focus groups will be presented on the poster. Outcomes will be presented of the neighbourhood focus group and the client focus group. Discussion: Results of the focus groups will be discussed on the poster. This will include recommendations with regard to interventions on a local level.
Poster #T225 FAILURE TO FIND ADDITIVE INTERACTION BETWEEN SOCIAL ADVERSITY IN CHILDHOOD AND FAMILY RISK OF PSYCHOSIS Simona A. Stilo 1 , Matteo Bonomo 1 , Francesca Bianconi 1 , Conrad Iyegbe 1 , Charlotte Gayer-Anderson 1 , Kathryn Hubbard 2 , Stephanie Beards 1 , Helen Fisher 3 , Marta Di Forti 1 , Robin M. Murray 3 , Craig Morgan 3 1 Institute of Psychiatry, King’s College London; 2 Centre for Epidemiology and Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London; 3 Institute of Psychiatry, London Background: There is robust evidence that early adversities are associated
S369
with an increased risk of psychosis (Fisher et al. 2010). However, no etiological theory for psychosis may hope to be comprehensive without taking in consideration genetic factors. We hypothesized that early social adversities (defined as presence of separation and/or loss from one or both parents before age of 17) interact with psychosis family history as proxy of genetic risk in increasing the risk of psychosis. Methods: As part of the GAP, CAPsy, and EU-GEI studies, we collected information on social adversity from a sample of first episode psychosis patients (n=507) and in a control sample (n=425) recruited from the areas in South-East London covered by the South London and Maudsley NHS Foundation Trust. To assess the additive interaction we constructed a logistic model that took into consideration 3 variables, each taking on two values: social adversity in childhood (no/yes) psychosis family history in first relatives (no/yes), and outcome status (case/control). Confidence intervals and p-values for the Interaction Contrast Ratio [ICR] were calculated using the nlcom procedure in STATA 12. Results: Compared to controls, cases were 2.3 times (95% CI 1.6–3.2) more likely to report only adversity in childhood, 5.2 times (95% CI 2.3–11.7) more likely to report only psychosis family history, 4 times (95% CI 2–7.7) more likely to report both. However, our preliminary data do not support a synergistic relationship between early adversities and genetic risk. The combined effect was lower than the sum of the individual effects (Interaction Contrast Ratio [ICR] −2.56, 95%CI −7.3–2.2). Discussion: In contrast with our hypothesis, there was no evidence that early adversities and psychosis family history combined synergistically to increase odds of psychotic disorder beyond the effect of each individually. Further analyses need to be conducted to understand if and how early adversities and psychosis genetic risk combine to create vulnerability for psychosis.
Poster #T226 SOCIAL ANXIETY DISORDER IN RECENT-ONSET SCHIZOPHRENIA SPECTRUM DISORDERS: THE RELATION WITH SYMPTOMOLOGY, ANXIETY, AND SOCIAL RANK Stephanie A. Sutliff 1,2 , Marc-André Roy 2,3 , Amélie Achim 4 Centre de recherche de l’Institut Universitaire en Santé mentale de Québec, Canada; 2 Université Laval, Canada; 3 Institut universitaire en santé mentale de Québec, Canada; 4 Centre de recherche de l’Institut Universitaire en Santé mentale de Québec; Département de Psychiatrie et neurosciences, Université Laval, Canada 1
Background: Social anxiety disorder (SAD) represents a common comorbidity in schizophrenia. However, to date few studies have focused on the specific ways that individuals with schizophrenia and a comorbid diagnosis of SAD are affected in distinct psychotic symptoms, as well as how such symptoms relate to social rank, a key concept of social anxiety. Methods: Forty-two patients with recent-onset schizophrenia were evaluated for SAD comorbidity using a comprehensive clinical interview which included the Structured Clinical Interview for the DSM-IV (SCID) and the Liebowitz Social Anxiety Scale (LSAS). All participants were also assessed with the Positive and Negative Syndrome Scale (PANSS) and the Social Comparison Scale (SCS). Results: Eighteen patients met the full criteria for comorbid diagnosis of SAD (SZ+), and 24 patients did not meet all criteria for such comorbidity (SZ−). The SZ− group showed more severe impairments in cognitive symptoms on the PANSS as compared to SZ+, including conceptual disorganization (t(40)=2.11, p=0.041), difficulty in abstract thinking (t(40)=2.51, p=0.016), and poor attention (t(40)=2.18, p=0.007); conversely, the SZ+ group showed higher levels of suspiciousness/persecution (t(40)=−2.92, p=0.006), active social avoidance (t(40)=−2.62, p=0.012), and anxiety (t(40)=−3.23, p=0.001). Patients with SZ+ showed higher scores of social anxiety on the LSAS (t(40)=−2.88, p=0.006), but social anxiety only correlated with specific psychotic symptoms in the SZ− group. The SZ+ group demonstrated reduced social rank compared to SZ− (t(40)=2.90, p=0.006). The two groups also displayed differing patterns of correlations between social rank and psychotic symptoms: in patients with SZ+, a negative correlation between social rank and delusions was present (r=−0.505, p=0.033), whereas in the SZ− group, a positive correlation between the two was present (r=0.432, p=0.035). The SZ− group also had a positive correlation of social rank with grandiosity (r=0.484, p=o.016) and passive/apathetic social