- Email: [email protected]
TC9B AFFECTIVE PROCESSES IN THE ONSET AND PERSISTENCE OF PSYCHOSIS
Symposium 15: The utility of the Affective–Non-Affective distinction in first-episode schizophrenia first-episode psychosis we trialled IPS with young people attending a specialist early psychosis service. Method: Participants were identified on the basis of expressing a desire to seek employment. They were randomised to either the IPS condition (treatment as usual +IPS), or to treatment as usual. 40 young people were randomised between October 2005 and March 2006. Participants were assessed at baseline and at 6 months with a battery measuring symptoms, general functioning and vocational functioning. The fidelity of the intervention to the IPS model was also assessed. Results: Preliminary results will be presented showing the effectiveness of the IPS intervention compared to treatment as usual in finding employment in this population. The effect of employment on other domains will also be presented. Discussion: Meaningful functional recovery has not attracted as much attention as it deserves in approaches to first episode psychosis. Employment interventions such as the one presented have the ability to deliver wide ranging, ongoing benefits to individuals with first episode psychosis. TC8D APPROACHES TO IMPROVE SOCIAL OUTCOME IN AN EARLY PSYCHOSIS MULTIMODAL PROGRAM IN LOMBARDY, ITALY (PROGRAMMA 2000) A. Meneghelli *, A. Cochhi. Milan, Lombardy, Italy Presenting author contact: [email protected] Social recovery and early rehabilitation should be the key element of any early intervention program, with the general objective of maintaining and promoting social and affective links and enhancing individual autonomy and responsibility in subjects’ own recovery and life project. This objective could be pursued by specific activities and translated in the complex whole of a multi-element program, inspiring every moment of treatment. In PROGRAMMA 2000, specifically addressed to psychotic onset and to high-risk situations in a Mental Health Department of Milan (catchment area: 200,000 inhabitants), the social support project (SIS) is strictly linked with psycoeducational, psychotherapeutic, pharmacological individual and group interventions. As well as integrating approaches that derive from both British (cognitive behaviour therapy) and American (social and vocational skills training) influences, we will discuss the specific features of our programme that have evolved from our clinical experience and from the Italian social context. 89 subjects (46 onset, 43 at-risk), at onset and at-risk (evaluated by ERIraos instruments, DAS, HoNOS, BPRS, SAT-P, CBA, GAF and neuropsychological tests) are currently followed with multimodal and individualized treatments in which clinical and social recovery goals are fully interconnected. Actually the analysis of variance concerning the 18-months and 24-months follow-ups shows significant and often correlated improvements both in clinical and in social areas, as well as in satisfaction in different domains of the quality of life.
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Symposium 15: The utility of the Affective– Non-Affective distinction in first-episode schizophrenia Chair: R. Upthegrove TC9A DEPRESSION IN ACUTE FIRST EPISODE SCHIZOPHRENIA R.A. Upthegrove *, M. Birchwood, K. Ross, K. Burnett. University of Birmmingham, Birmingham, United Kingdom Presenting author contact: [email protected] Introduction: We put forward and investigate cognitive models which look at the development of depression in the acute phase of first episode psychosis, and propose that depression may in part arise due to (1) negative appraisals of psychosis in those who retain or acquire a degree of insight or (2) be linked to appraisals of the power of supposed persecutors and patients perceived ability to escape this threat. Method: New referrals to an inner city early intervention service were recruited in to the study and completed a range of semistructured and structured interviews and questionnaires, including the Calgary depression scale for schizophrenia and those detailing voices, persecutory beliefs safety behaviours, and belief about illness. Follow up interviews at 18 months investigate the predictive value of these appraisals in first episode psychosis in terms of postpsychotic depression Results: 52% of patients with first episode psychosis were significantly depressed, (57% in non affective psychosis and 62% in those reaching diagnostic criteria for schizophrenia) which was not explained by symptom severity. Of those who were depressed, the appraisal of threat by voices, persecutors and perception of illness itself were important factors. Significant results were seen with apparent threat from voices, threat from persecutors and threat posed by the diagnosis itself. Depression in the Acute first Episode predicts later depression. Discussion: Depression in the acute first episode psychosis is common, and this holds true for non-affective psychosis and those meeting criteria for schizophrenia. Those patients presenting with significant depression have more negative appraisals and are more likely to have depressive symptoms at follow up, in contrast to previous work in established cases. TC9B AFFECTIVE PROCESSES IN THE ONSET AND PERSISTENCE OF PSYCHOSIS L. Krabbendam *, J. van Os. Maastricht University, Maastricht, Netherlands Presenting author contact: [email protected] Introduction: General population studies have found that the positive symptoms of psychosis are prevalent in the general population. The majority of the individuals experiencing these “symptoms” are not in need of care. However, longitudinal studies indicate that they may nevertheless have an increased risk of developing a clinical disorder. It is crucial to understand the mechanisms that mediate transition from having one or two psychotic symptoms to becoming a patient with a psychotic disorder. Cognitive models suggest that beliefs and appraisal processes are crucially important in the onset
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Schizophrenia Research 86 (2006)
and persistence of psychosis. This study investigated whether (i) neuroticism increases the risk for development of psychotic symptoms, and (ii) a delusional interpretation and/or a depressed response to hallucinatory experiences predicts the onset of psychotic disorder. Method: A general population sample with no lifetime evidence of any psychotic disorder was interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify onset of psychotic disorder. Results: Baseline level of neuroticism increases the risk for incident psychotic symptoms. Given the presence of hallucinatory experiences at baseline, the increase in risk of having the psychosis outcome was much higher in the group with delusional ideation or depressed mood at year 1 than in those without delusional ideation or depressed mood. Conclusion: A cognitive style characterised by a tendency to worry increases the risk for newly developed psychotic symptoms. Individuals who report hallucinatory experiences and react to these with a delusional interpretation and/or negative emotional states have an increased risk for developing clinical psychosis. TC9C MOLECULAR GENETICS AND THE KRAEPELINIAN DICHOTOMY N. Craddock *. Cardiff University, Cardiff, United Kingdom Presenting author contact: [email protected] It has been conventional for psychiatric research, including the search for predisposing genes, to proceed under the assumption that schizophrenia and bipolar disorder are separate disease entities with different underlying aetiologies. These represent Emil Kraepelin’s traditional dichotomous classification of the so-called “functional” psychoses and form the basis of modern diagnostic practice as defined operationally in DSMIV and ICD10. However, findings emerging from many fields of psychiatric research do not fit well with this model. The direct study of genetic variation in datasets across the schizophrenia-bipolar spectrum provides a powerful tool to inform understanding of the nosological relationship between these diagnostic categories. Over the last 2−3 years replicated positive findings have been emerging from genetic studies of schizophrenia and bipolar disorder samples. A striking finding is that there is increasing evidence for an overlap in genetic susceptibility across the traditional classification systems – most notably with association findings at (DAOA(G72), DISC1 and NRG1. As psychosis susceptibility genes are identified over the next few years, this will have a major impact on our understanding of disease pathophysiology and will lead to changes in classification and the clinical practice of psychiatry. The current data and the clinical implications will be presented and discussed during this presentation. Reference(s) Craddock N, O’Donovan MC, Owen MJ. Genes for schizophrenia and bipolar disorder? Implications for psychiatric nosology. Schizophr Bull. 2006 Jan; 32(1): 9−16. Craddock N, O’Donovan MC, Owen MJ. The genetics of schizophrenia and bipolar disorder: dissecting psychosis. J Med Genet. 2005 Mar; 42(3): 193–204. Craddock N, Owen MJ. The beginning of the end for the Kraepelinian dichotomy. Br J Psychiatry. 2005 May; 186: 364−6. Green EK, Raybould R, Macgregor S, Hyde S, Young AH, O’Donovan MC, Owen MJ, Kirov G, Jones L, Jones I, Craddock N. Genetic variation of
Abstracts brain-derived neurotrophic factor (BDNF) in bipolar disorder: case-control study of over 3000 individuals from the UK. Br J Psychiatry. 2006 Jan; 188: 21−5. Hamshere ML, Bennett P, Williams N, Segurado R, Cardno A, Norton N, Lambert D, Williams H, Kirov G, Corvin A, Holmans P, Jones L, Jones I, Gill M, O’Donovan MC, Owen MJ, Craddock N. Genomewide linkage scan in schizoaffective disorder: significant evidence for linkage at 1q42 close to DISC1, and suggestive evidence at 22q11 and 19p13. Arch Gen Psychiatry. 2005 Oct; 62(10): 1081−8. Green EK, Raybould R, Macgregor S, Gordon-Smith K, Heron J, Hyde S, Grozeva D, Hamshere M, Williams N, Owen MJ, O’Donovan MC, Jones L, Jones I, Kirov G, Craddock N. Operation of the schizophrenia susceptibility gene, neuregulin 1, across traditional diagnostic boundaries to increase risk for bipolar disorder. Arch Gen Psychiatry. 2005 Jun; 62(6): 642−8.
Symposium 16: Violence and criminality among patients experiencing their first episode of schizophrenia Chairs: S. Hodgins TC10A CRIMINAL BEHAVIOUR IN FIRST ONSET PSYCHOSIS: AN EXAMINATION OF TYPE AND TEMPORAL PATTERN OF OFFENDING A. Williams *, K.H. Naudts, S. Hodgins, P. Dazzan, J. Zanelli, C. Morgan, K. Morgan, P. Fearon, J. Leff, P.B. Jones, R.M. Murray. Institute of Psychiatry, London, United Kingdom Presenting author contact: [email protected] Introduction: The aim of the present study was to characterize criminal behaviour in relation to the onset of psychotic illness. Methods: We examined the criminal convictions of 332 subjects who presented with their first episode of psychosis. Questions were addressed by examining the various relationships between age at first conviction, age at first onset of psychosis, and the nature of the convictions held. Results: Among the male subjects, 30% had acquired at least one conviction, over half of whom had acquired a violent conviction. A small subgroup of five male offenders held over half of the 503 convictions seen overall. This subgroup had a mean age at first conviction of 16.0. Among the female subjects, 8.5% had acquired at least one conviction, of whom over a quarter had acquired a violent conviction. Male and female subjects differed in terms of the types of offences committed, with the most common offence in men being violence against the person, and the most common offence in women being theft. Among the men, a lower age at first conviction was highly associated with a greater subsequent level of criminal activity. Men who acquired their first conviction up to and including age 16 were at increased risk of subsequent violent conviction. The median age at first conviction preceded that of the mean age at illness onset in both men and women by more than 10 years. Discussion: These findings support previous studies which suggest that in a significant proportion of persons with psychotic disorders, criminal activity precedes the onset of psychosis. At first presentation to services, patients with a history of early-onset persistent antisocial behaviour should receive interventions to reduce future criminal and antisocial behaviour.
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Symposium 15: The utility of the Affective– Non-Affective distinction in first-episode schizophrenia Chair: R. Upthegrove TC9A DEPRESSION IN ACUTE FIRST EPISODE SCHIZOPHRENIA R.A. Upthegrove *, M. Birchwood, K. Ross, K. Burnett. University of Birmmingham, Birmingham, United Kingdom Presenting author contact: [email protected] Introduction: We put forward and investigate cognitive models which look at the development of depression in the acute phase of first episode psychosis, and propose that depression may in part arise due to (1) negative appraisals of psychosis in those who retain or acquire a degree of insight or (2) be linked to appraisals of the power of supposed persecutors and patients perceived ability to escape this threat. Method: New referrals to an inner city early intervention service were recruited in to the study and completed a range of semistructured and structured interviews and questionnaires, including the Calgary depression scale for schizophrenia and those detailing voices, persecutory beliefs safety behaviours, and belief about illness. Follow up interviews at 18 months investigate the predictive value of these appraisals in first episode psychosis in terms of postpsychotic depression Results: 52% of patients with first episode psychosis were significantly depressed, (57% in non affective psychosis and 62% in those reaching diagnostic criteria for schizophrenia) which was not explained by symptom severity. Of those who were depressed, the appraisal of threat by voices, persecutors and perception of illness itself were important factors. Significant results were seen with apparent threat from voices, threat from persecutors and threat posed by the diagnosis itself. Depression in the Acute first Episode predicts later depression. Discussion: Depression in the acute first episode psychosis is common, and this holds true for non-affective psychosis and those meeting criteria for schizophrenia. Those patients presenting with significant depression have more negative appraisals and are more likely to have depressive symptoms at follow up, in contrast to previous work in established cases. TC9B AFFECTIVE PROCESSES IN THE ONSET AND PERSISTENCE OF PSYCHOSIS L. Krabbendam *, J. van Os. Maastricht University, Maastricht, Netherlands Presenting author contact: [email protected] Introduction: General population studies have found that the positive symptoms of psychosis are prevalent in the general population. The majority of the individuals experiencing these “symptoms” are not in need of care. However, longitudinal studies indicate that they may nevertheless have an increased risk of developing a clinical disorder. It is crucial to understand the mechanisms that mediate transition from having one or two psychotic symptoms to becoming a patient with a psychotic disorder. Cognitive models suggest that beliefs and appraisal processes are crucially important in the onset
S30
Schizophrenia Research 86 (2006)
and persistence of psychosis. This study investigated whether (i) neuroticism increases the risk for development of psychotic symptoms, and (ii) a delusional interpretation and/or a depressed response to hallucinatory experiences predicts the onset of psychotic disorder. Method: A general population sample with no lifetime evidence of any psychotic disorder was interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify onset of psychotic disorder. Results: Baseline level of neuroticism increases the risk for incident psychotic symptoms. Given the presence of hallucinatory experiences at baseline, the increase in risk of having the psychosis outcome was much higher in the group with delusional ideation or depressed mood at year 1 than in those without delusional ideation or depressed mood. Conclusion: A cognitive style characterised by a tendency to worry increases the risk for newly developed psychotic symptoms. Individuals who report hallucinatory experiences and react to these with a delusional interpretation and/or negative emotional states have an increased risk for developing clinical psychosis. TC9C MOLECULAR GENETICS AND THE KRAEPELINIAN DICHOTOMY N. Craddock *. Cardiff University, Cardiff, United Kingdom Presenting author contact: [email protected] It has been conventional for psychiatric research, including the search for predisposing genes, to proceed under the assumption that schizophrenia and bipolar disorder are separate disease entities with different underlying aetiologies. These represent Emil Kraepelin’s traditional dichotomous classification of the so-called “functional” psychoses and form the basis of modern diagnostic practice as defined operationally in DSMIV and ICD10. However, findings emerging from many fields of psychiatric research do not fit well with this model. The direct study of genetic variation in datasets across the schizophrenia-bipolar spectrum provides a powerful tool to inform understanding of the nosological relationship between these diagnostic categories. Over the last 2−3 years replicated positive findings have been emerging from genetic studies of schizophrenia and bipolar disorder samples. A striking finding is that there is increasing evidence for an overlap in genetic susceptibility across the traditional classification systems – most notably with association findings at (DAOA(G72), DISC1 and NRG1. As psychosis susceptibility genes are identified over the next few years, this will have a major impact on our understanding of disease pathophysiology and will lead to changes in classification and the clinical practice of psychiatry. The current data and the clinical implications will be presented and discussed during this presentation. Reference(s) Craddock N, O’Donovan MC, Owen MJ. Genes for schizophrenia and bipolar disorder? Implications for psychiatric nosology. Schizophr Bull. 2006 Jan; 32(1): 9−16. Craddock N, O’Donovan MC, Owen MJ. The genetics of schizophrenia and bipolar disorder: dissecting psychosis. J Med Genet. 2005 Mar; 42(3): 193–204. Craddock N, Owen MJ. The beginning of the end for the Kraepelinian dichotomy. Br J Psychiatry. 2005 May; 186: 364−6. Green EK, Raybould R, Macgregor S, Hyde S, Young AH, O’Donovan MC, Owen MJ, Kirov G, Jones L, Jones I, Craddock N. Genetic variation of
Abstracts brain-derived neurotrophic factor (BDNF) in bipolar disorder: case-control study of over 3000 individuals from the UK. Br J Psychiatry. 2006 Jan; 188: 21−5. Hamshere ML, Bennett P, Williams N, Segurado R, Cardno A, Norton N, Lambert D, Williams H, Kirov G, Corvin A, Holmans P, Jones L, Jones I, Gill M, O’Donovan MC, Owen MJ, Craddock N. Genomewide linkage scan in schizoaffective disorder: significant evidence for linkage at 1q42 close to DISC1, and suggestive evidence at 22q11 and 19p13. Arch Gen Psychiatry. 2005 Oct; 62(10): 1081−8. Green EK, Raybould R, Macgregor S, Gordon-Smith K, Heron J, Hyde S, Grozeva D, Hamshere M, Williams N, Owen MJ, O’Donovan MC, Jones L, Jones I, Kirov G, Craddock N. Operation of the schizophrenia susceptibility gene, neuregulin 1, across traditional diagnostic boundaries to increase risk for bipolar disorder. Arch Gen Psychiatry. 2005 Jun; 62(6): 642−8.
Symposium 16: Violence and criminality among patients experiencing their first episode of schizophrenia Chairs: S. Hodgins TC10A CRIMINAL BEHAVIOUR IN FIRST ONSET PSYCHOSIS: AN EXAMINATION OF TYPE AND TEMPORAL PATTERN OF OFFENDING A. Williams *, K.H. Naudts, S. Hodgins, P. Dazzan, J. Zanelli, C. Morgan, K. Morgan, P. Fearon, J. Leff, P.B. Jones, R.M. Murray. Institute of Psychiatry, London, United Kingdom Presenting author contact: [email protected] Introduction: The aim of the present study was to characterize criminal behaviour in relation to the onset of psychotic illness. Methods: We examined the criminal convictions of 332 subjects who presented with their first episode of psychosis. Questions were addressed by examining the various relationships between age at first conviction, age at first onset of psychosis, and the nature of the convictions held. Results: Among the male subjects, 30% had acquired at least one conviction, over half of whom had acquired a violent conviction. A small subgroup of five male offenders held over half of the 503 convictions seen overall. This subgroup had a mean age at first conviction of 16.0. Among the female subjects, 8.5% had acquired at least one conviction, of whom over a quarter had acquired a violent conviction. Male and female subjects differed in terms of the types of offences committed, with the most common offence in men being violence against the person, and the most common offence in women being theft. Among the men, a lower age at first conviction was highly associated with a greater subsequent level of criminal activity. Men who acquired their first conviction up to and including age 16 were at increased risk of subsequent violent conviction. The median age at first conviction preceded that of the mean age at illness onset in both men and women by more than 10 years. Discussion: These findings support previous studies which suggest that in a significant proportion of persons with psychotic disorders, criminal activity precedes the onset of psychosis. At first presentation to services, patients with a history of early-onset persistent antisocial behaviour should receive interventions to reduce future criminal and antisocial behaviour.