- Email: [email protected]
SUICIDAL BEHAVIOR IN CHILDREN AND ADOLESCENTS WITH FIRST EPISODE PSYCHOSIS
Abstracts / Schizophrenia Research 102/1–3, Supplement 2 (2008) 1–279 sexual abuse have higher scores (25.0±1.8) than patients without childhood sexual abuse (18.1±1.4; p<0.05). Conclusions: These findings suggest that childhood sexual abuse can be a risk factor for increased perception of stress in psychosis. References [1] Bebbington, P., Bhugra, D., Brugha, T., Singleton, N., Farrell, M., Jenkins, R., Lewis, G., Meltzer, H. Psychosis, victimisation and childhood disadvantage.
289 – SUICIDAL BEHAVIOR IN CHILDREN AND ADOLESCENTS WITH FIRST EPISODE PSYCHOSIS Tatiana Falcone, Leenu Mishra, Erin Carlton, Robert S. Butler, Barry Simon, Damir Janigro, Katlheen Franco Cleveland Clinic, Cleveland, Ohio, USA Introduction: Schizophrenia and first-episode psychosis increase risk for depression, self-harm and suicide. To date, most available reports focus on adult patients with schizophrenia and/or first episode psychosis. Objectives: Our hypothesis was that first episode psychosis, a prodromic event often leading to chronic schizophrenia, is associated with an increased risk for depression and suicidal behavior. Methods: We studied patients admitted to a pediatric inpatient psychiatric unit between 2003-2006. Patients (n=102) were diagnosed with new-onset psychosis using DSM-IV TR criteria for Psychosis NOS, schizophreniform disorder or schizoaffective disorder. Patients were matched for age, race and gender with non-psychotic inpatient controls within the same unit (n=102). Study participants were administered the BPRS-C to assess severity of psychiatric symptoms. The suicidality subscale was analyzed separately. An inventory of 127 variables established patient history, substance abuse, violence, legal history, psychiatric symptoms and medication, among other variables. Results: Thirty two percent of the patients had attempted suicide, 104 total suicide attempts in a group of 102 patients. Individuals with depression were found to be 2.8 times more likely to attempt suicide than those without. Duration of Untreated Psychosis increased the risk of the severity of the suicide attempt in our group. Conclusions: Our results are double of those identified in adult studies. Depression was the second most frequent comorbidity in this patients (n=36), and ADHD the first (n=49). It is imperative to address depressive symptoms in children and adolescents with first episode psychosis or schizophrenia to prevent potential suicidal behavior.
290 – TRANSITIONS OF PREPSYCHOTIC SYMPTOMS DURING THE ?EPRODROMAL?F PHASE Hiroyuki Kobayashi 1 , Ryoko Yamazawa 2 , Keiko Morita 3 , Takahiro Nemoto 2 , Kei Sakuma 4 , Masaaki Murakami 5 , Haruo Kashima 2 , Masafumi Mizuno 3 1 Tokyo-Musashino Hospital, Tokyo; 2 Keio University, School of Medicine, Tokyo; 3 Toho University, School of Medicine, Tokyo; 4 Asaka Hospital, Fukushima; 5 Meiji-Gakuin University, Tokyo, Japan [email protected] Introduction: For the early detection and intervention, evaluation of prepsychotic symptoms is necessary for individuals at risk for developing psychosis. The aims of this study were to detect early symptoms that could be specific for “prodroma” population and to examine the symptomatic changes during the prodromal phase. Methods: The PRIME Screen-Revised (PS-R), an 11-item self-report instrument for prodromal symptoms, was administered to 1024 subjects (496 college students and 528 outpatients aged 16-30 years who first approached a community mental health clinic). Of 528 outpatients, 115 were randomly recruited and administered the Structured Interview for Prodromal Symptoms. Factor analysis was conducted for the items of the PS-R and the distributions of each factor were examined among subgroups. Results: Four factors were identified; passivity phenomena, auditory distortion, perplexity and grandiosity. For the factor of auditory dis-
153
tortion, there was no significant difference between prodromal group and non-prodromal group (P=.133). The grandiosity factor was more highly distributed in the prodromal group than others (P<.001). The passivity phenomena and the perplexity factor scores were higher in help-seeking samples than in non-clinical samples (P<.001). Conclusions: These findings demonstrate that the positive symptomlike experience could not be discriminator for prodromal/nonprodromal dichotomy and that grandiosity could be more specific to the prodromal population. In spite of some limitations, our results might shed new lights on the process of loss of insight or the adequate use of neuroleptic medication for early psychosis. References [1] Hiroyuki Kobayashi,Takahiro Nemoto,Hiroki Koshikawa et al. A self-report instrument for prodromal symptoms of psychosis:Predictive validity of the PRIME Screen-Revised (PS-R) 2008 (submitted)
291 – SPONTANEOUS DYSKINESIA AND PARKINSONISM IN SCHIZOPHRENIA AND THEIR SIBLINGS. A SYSTEMATIC REVIEW AND META-ANALYSIS Jeroen Koning 1 , Peter van Harten 1 , Andre Aleman 2 , Rene S. Kahn 3 group, Utrecht; 2 University Medical Center Groningen, Groningen; 3 University Medical Center Utrecht, Utrecht [email protected]
1 Symfora
Introduction: Dyskinesia and parkinsonism have been associated with the use of antipsychotics, especially in addition to schizophrenia. However several studies report on movement disorders in antipsychotic naïve patients and their healthy siblings. So the question rises if movement disorders are only drug induced or can also be regarded as symptoms of schizophrenia and may be related to the risk to develop the disease. This first meta-analysis compared the prevalences of dyskinesia and parkinsonism in med ication naïve schizophrenia and in their healthy siblings versus healthy controls. Methods: A systematic Medline, EMBASE and PsychINFO search yielded 21 relevant studies from which data were extracted for calculation of pooled estimates using meta-analytic techniques. Results: Schizophrenia is strongly associated with spontaneous dyskinesia (OR 3.59; 95%CI: 1.53-8.41) and spontaneous parkinsonism (OR 5.32; 95% CI 1.75-16.23). In addition, the prevalence of spontaneous dyskinesia increased significantly with age, the durati on of untreated schizophrenia and age at onset. Spontaneous dyskinesia and parkinsonism are significantly more prevalent in siblings of patients with schizophrenia compared to healthy controls (SEM of 0,18; 95%CI: 0,02-0,33 and 0.21; 95%CI: 0.05-0.3 7 respectively). Conclusions: Dyskinesia and parkinsonism are both more prevalent in antipsychotic naïve patients with schizophrenia and in their siblings than in healthy controls. This suggests that abnormalities in the nigrotriatal pathway are not only associated with schizoph renia itself, but may also be related to the increased risk to develop schizophrenia. References [1] Tarbox SI, Pogue-Geile MF. Spontaneous dyskinesia and familial liability to schizophrenia. Schizophr Res. 2006 Jan 31;81(23):125-37. [2] McCreadie RG, Thara R, Kamath S, Padmavathy R, Latha S, Mathrubootham N, Menon MS. Abnormal movements in nevermedica ted Indian patients with schizophrenia. Br J Psychiatry. 1996 Feb;168(2):221-6. [3] Egan MF, Hyde TM, Bonomo JB, Mattay VS, Bigelow LB, Goldberg TE, Weinberger DR. Relative risk of neurological signs in siblings of patients with schizophrenia. Am J Psychiatry. 2001 Nov;158(11):1827-34. [4] Isamail B, Cantor-Graae E, McNeil TF. Neurodevelopmental origins of tardivelike dyskinesia in schizophrenia patients and their siblings.Schizophr Bull. 2001;27(4):629-41. [5] Chen YL, Chen YH, Mak KL. Soft neurological signs in schizophrenic patients and their nonpsychotic siblings. J Nerv Ment Dis. 2000 Feb;188(2):84-9.
289 – SUICIDAL BEHAVIOR IN CHILDREN AND ADOLESCENTS WITH FIRST EPISODE PSYCHOSIS Tatiana Falcone, Leenu Mishra, Erin Carlton, Robert S. Butler, Barry Simon, Damir Janigro, Katlheen Franco Cleveland Clinic, Cleveland, Ohio, USA Introduction: Schizophrenia and first-episode psychosis increase risk for depression, self-harm and suicide. To date, most available reports focus on adult patients with schizophrenia and/or first episode psychosis. Objectives: Our hypothesis was that first episode psychosis, a prodromic event often leading to chronic schizophrenia, is associated with an increased risk for depression and suicidal behavior. Methods: We studied patients admitted to a pediatric inpatient psychiatric unit between 2003-2006. Patients (n=102) were diagnosed with new-onset psychosis using DSM-IV TR criteria for Psychosis NOS, schizophreniform disorder or schizoaffective disorder. Patients were matched for age, race and gender with non-psychotic inpatient controls within the same unit (n=102). Study participants were administered the BPRS-C to assess severity of psychiatric symptoms. The suicidality subscale was analyzed separately. An inventory of 127 variables established patient history, substance abuse, violence, legal history, psychiatric symptoms and medication, among other variables. Results: Thirty two percent of the patients had attempted suicide, 104 total suicide attempts in a group of 102 patients. Individuals with depression were found to be 2.8 times more likely to attempt suicide than those without. Duration of Untreated Psychosis increased the risk of the severity of the suicide attempt in our group. Conclusions: Our results are double of those identified in adult studies. Depression was the second most frequent comorbidity in this patients (n=36), and ADHD the first (n=49). It is imperative to address depressive symptoms in children and adolescents with first episode psychosis or schizophrenia to prevent potential suicidal behavior.
290 – TRANSITIONS OF PREPSYCHOTIC SYMPTOMS DURING THE ?EPRODROMAL?F PHASE Hiroyuki Kobayashi 1 , Ryoko Yamazawa 2 , Keiko Morita 3 , Takahiro Nemoto 2 , Kei Sakuma 4 , Masaaki Murakami 5 , Haruo Kashima 2 , Masafumi Mizuno 3 1 Tokyo-Musashino Hospital, Tokyo; 2 Keio University, School of Medicine, Tokyo; 3 Toho University, School of Medicine, Tokyo; 4 Asaka Hospital, Fukushima; 5 Meiji-Gakuin University, Tokyo, Japan [email protected] Introduction: For the early detection and intervention, evaluation of prepsychotic symptoms is necessary for individuals at risk for developing psychosis. The aims of this study were to detect early symptoms that could be specific for “prodroma” population and to examine the symptomatic changes during the prodromal phase. Methods: The PRIME Screen-Revised (PS-R), an 11-item self-report instrument for prodromal symptoms, was administered to 1024 subjects (496 college students and 528 outpatients aged 16-30 years who first approached a community mental health clinic). Of 528 outpatients, 115 were randomly recruited and administered the Structured Interview for Prodromal Symptoms. Factor analysis was conducted for the items of the PS-R and the distributions of each factor were examined among subgroups. Results: Four factors were identified; passivity phenomena, auditory distortion, perplexity and grandiosity. For the factor of auditory dis-
153
tortion, there was no significant difference between prodromal group and non-prodromal group (P=.133). The grandiosity factor was more highly distributed in the prodromal group than others (P<.001). The passivity phenomena and the perplexity factor scores were higher in help-seeking samples than in non-clinical samples (P<.001). Conclusions: These findings demonstrate that the positive symptomlike experience could not be discriminator for prodromal/nonprodromal dichotomy and that grandiosity could be more specific to the prodromal population. In spite of some limitations, our results might shed new lights on the process of loss of insight or the adequate use of neuroleptic medication for early psychosis. References [1] Hiroyuki Kobayashi,Takahiro Nemoto,Hiroki Koshikawa et al. A self-report instrument for prodromal symptoms of psychosis:Predictive validity of the PRIME Screen-Revised (PS-R) 2008 (submitted)
291 – SPONTANEOUS DYSKINESIA AND PARKINSONISM IN SCHIZOPHRENIA AND THEIR SIBLINGS. A SYSTEMATIC REVIEW AND META-ANALYSIS Jeroen Koning 1 , Peter van Harten 1 , Andre Aleman 2 , Rene S. Kahn 3 group, Utrecht; 2 University Medical Center Groningen, Groningen; 3 University Medical Center Utrecht, Utrecht [email protected]
1 Symfora
Introduction: Dyskinesia and parkinsonism have been associated with the use of antipsychotics, especially in addition to schizophrenia. However several studies report on movement disorders in antipsychotic naïve patients and their healthy siblings. So the question rises if movement disorders are only drug induced or can also be regarded as symptoms of schizophrenia and may be related to the risk to develop the disease. This first meta-analysis compared the prevalences of dyskinesia and parkinsonism in med ication naïve schizophrenia and in their healthy siblings versus healthy controls. Methods: A systematic Medline, EMBASE and PsychINFO search yielded 21 relevant studies from which data were extracted for calculation of pooled estimates using meta-analytic techniques. Results: Schizophrenia is strongly associated with spontaneous dyskinesia (OR 3.59; 95%CI: 1.53-8.41) and spontaneous parkinsonism (OR 5.32; 95% CI 1.75-16.23). In addition, the prevalence of spontaneous dyskinesia increased significantly with age, the durati on of untreated schizophrenia and age at onset. Spontaneous dyskinesia and parkinsonism are significantly more prevalent in siblings of patients with schizophrenia compared to healthy controls (SEM of 0,18; 95%CI: 0,02-0,33 and 0.21; 95%CI: 0.05-0.3 7 respectively). Conclusions: Dyskinesia and parkinsonism are both more prevalent in antipsychotic naïve patients with schizophrenia and in their siblings than in healthy controls. This suggests that abnormalities in the nigrotriatal pathway are not only associated with schizoph renia itself, but may also be related to the increased risk to develop schizophrenia. References [1] Tarbox SI, Pogue-Geile MF. Spontaneous dyskinesia and familial liability to schizophrenia. Schizophr Res. 2006 Jan 31;81(23):125-37. [2] McCreadie RG, Thara R, Kamath S, Padmavathy R, Latha S, Mathrubootham N, Menon MS. Abnormal movements in nevermedica ted Indian patients with schizophrenia. Br J Psychiatry. 1996 Feb;168(2):221-6. [3] Egan MF, Hyde TM, Bonomo JB, Mattay VS, Bigelow LB, Goldberg TE, Weinberger DR. Relative risk of neurological signs in siblings of patients with schizophrenia. Am J Psychiatry. 2001 Nov;158(11):1827-34. [4] Isamail B, Cantor-Graae E, McNeil TF. Neurodevelopmental origins of tardivelike dyskinesia in schizophrenia patients and their siblings.Schizophr Bull. 2001;27(4):629-41. [5] Chen YL, Chen YH, Mak KL. Soft neurological signs in schizophrenic patients and their nonpsychotic siblings. J Nerv Ment Dis. 2000 Feb;188(2):84-9.