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THE IMPACT OF CANNABIS USE ON AGE OF ONSET IN FIRST-EPISODE PSYCHOTIC PATIENTS
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
terminant of poor long-term functional outcome and (2) the predictors of poor long-term functional outcome. We hypothesized that transition would not be a strong predictor of poor functional outcome and that poor baseline functioning, negative symptoms, and schizotypy would predict poor functioning. We aimed to follow up all previous UHR research participants from the PACE clinic, Melbourne (n=416). The outcome of interest was level of functioning at follow up. This was assessed using the Quality of Life Scale (QLS) and the Social and Occupational Functioning Assessment Scale (SOFAS). Groups were defined as “good functioning” (n=214), and “poor functioning” (n=54) outcomes. Transition to psychosis was determined using the Comprehensive Assessment of At Risk Mental States (CAARMS). Other potential predictors of functional outcome were: baseline measures of: functioning, negative symptomsand mania as assessed by the Global Assessment of Functioning (GAF), Schedule for Assessment of Negative Symptoms (SANS) and Young Mania Rating Scale (YMRS) respectively; and follow up measures of:schizotypyand childhood trauma, as assessed by the Oxford-LiverpoolInventory of Feelings and Experiences (OLIFE), and the Childhood Trauma Questionnaire (CTQ). Results: 268 people (64.4% of the original sample)were interviewed between 2.4 to 14.9 years post baseline. 73 developed psychosis, 195 did not. 45 individuals transitioned but had good functioning at follow up, while 26 individuals did not transition but had poor functioning. Transition to psychosis was a significant predictor of poor functioning (OR 4.04 (95% CI: 2.2, 7.6), Chi square p<0.0001). However the positive predictive value of transition as a predictor of poor outcome was low at 0.383. That is, the likelihood of having poor outcome if a UHR individual “transitions” was less than 40%. Sensitivity of transition to detect low functioning was moderate at 0.519. That is, just over 50% of those with poor outcome could be identified through their transition status.
COMPARISON OF CLINICAL AND SOCIODEMOGRAPHIC RISK FACTORS BETWEEN ADULT AND EARLY ONSET PSYCHOSIS Marco Armando, Ashleigh Lin, Claudia Comazzetto, Riccardo Saba, Amanda Beavan, Stefano Vicari, Max Birchwood Research Hospital IRCCS Bambino Gesù, Rome, Italy 10 to 15% have an onset before the age of 18. These “early-onset psychoses” (EOP) are considered to have a poorer outcome than “adult-onset psychoses” (AOP). The aim of the present study is to compare the clinical and sociodemographic profile of EOP and AOP in their prodromal phases in order to find specific patterns of the prodromal phases of the EOP. Methods: This study was conducted on 237 (77 female, 160 male) individuals with a first episode of psychosis. Participants were recruited from two sites; AOP participants were recruited in Birmingham/Solihull as part of the National EDEN study, EOP participants were recruited from Child and Adolescent Neuropsychiatry Unit and in of the Clinical and Research Hospital Bambino Gesù of Roma. Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS); specific psychotic diagnosis was determined by the ICD-10; the severity of depressive symptoms was measured using the Calgary Depression Scale for Schizophrenia and Child Depression Inventory; social functioning was assessed using the Global Assessment of Functioning and the Childhood Global Assessment Scale; the Pre-morbid Functioning Scale was used to retrospectively assesses four major areas of pre-morbid functioning; prodromal symptoms, Duration of Untreated Psychosis and Illness were measured. Results: The mean age of onset was 14.3 for EOP and 23.9 for AOP. No significant differences in DUI and DUP were found between the two groups. Significantly higher scores were found for PANSS positive and negative in the EOP group. Level of functioning and level of promorbid functioning were found to be significantly lower in the EOP group. Higher levels of premorbid symptoms and social withdrawhal were found in the EOP group. Discussion: Even though no differences were found in DUI and DUP between the two groups, EOP was characterized by a worse prodromal phase with lower levels of premorbid functioning, higher levels of prodromal symptoms and higher levels of social withdrawal. These results suggest a specific diagnostic and therapeutic approach to prodromal phases of EOP, in order to reduce the worse prognosis of EOP compared to AOP.
S41
Symposium INTEGRATING SOCIAL AND BIOLOGICAL FACTORS TO PREDICT THE COURSE AND OUTCOME OF PSYCHOSIS: EVIDENCE FROM TWO LARGE EPIDEMIOLOGICAL FIRST EPISODE PSYCHOSIS COHORTS (AESOP AND PICOS) Chairpersons: Paola Dazzan and Mirella Ruggeri Discussant: Mirella Ruggeri Monday, 16 April 2012 4:15 pm – 6:15 pm Overall Abstract: For the last few decades, psychoses research has mostly focused on either environmental and social risk factors, or neurodevelopmental and biological factors to advance our understanding of the pathophysiology and course of these disorders. However, both lines of research, taken alone, have provided only limited contribution to our knowledge of how these disorders develop and how they progress. Specifically, with regards to outcome, it has become apparent that using “a priori” distinct prediction domains (for example, evaluating candidate prognostic markers from the biological or the social domain in isolation), is not an approach that can fully explain the many possible psychoses outcomes. More recently, evidence has suggested that a better understanding of psychoses can be achieved by studying both social and biological factors in the same individuals, and exploring how these factors interact with each other to increase the risk for psychoses and the risk of poorer clinical and functional outcomes. On the wave of this evidence, two large epidemiologically-based cohorts of individuals with a first episode of psychoses, and community based controls, have been recruited and assessed in Europe: the AESOP cohort in the United Kingdom, and the PICOS cohort in Italy. Both studies have evaluated social and environmental factors at the time of psychosis first onset in the same individuals, and have evaluated how these factors progress over time, and how they may influence early and late illness course. This symposium will present recent evidence from these studies on how social factors (such as disadvantage, ethnic group, premorbid adjustment), biological factors (such as neurological function and brain structure), and factors at the crossroad with either (such as cannabis use and duration of untreated psychosis), interact to predict early and later outcome after the first psychotic episode. Emphasis will be given to the implications of integrating these factors into a model of clinical utility that could promote individualized medicine in psychosis.
THE IMPACT OF CANNABIS USE ON AGE OF ONSET IN FIRST-EPISODE PSYCHOTIC PATIENTS Sarah Tosato University of Verona, Verona, Italy Considering the high rate of cannabis use among first episode psychotic patients and the possible negative consequences due to drug exposure (reduced compliance to treatment, worse outcome, higher rates of relapse), to detect and to counteract this behaviour is could be very important in a public health perspective. The present study, conducted in a first-episode psychotic sample, aims totest whether substance misuse, particularly cannabis use 1) is more frequent in patients than the general population, 2) is associated with a higher level of positive symptoms, a lower level of depressive symptoms and a worse premorbid adjustment at the onset, 3) is associated with an earlier age of onset and a better premorbid IQ. The study was conducted within the broader framework of the PICOS (Psychosis Incident Cohort Outcome Study), a multi-site collaborative research on incident cases of psychosis attending psychiatric services in the Veneto Region, Italy. A set of standardized instruments has been used to collect sociodemographic, clinical and drug use information. A total of 555 patients met the inclusion criteria over the 3-year recruitment period; of these, 517 had a ICD-10 diagnosis of psychosis; 397 (55% males; mean age: 32 yrs. ±9.5) were assessed at baseline. Out of 397 patients evaluated, 311 (78.3%) patients accepted to be interviewed on drug and alcohol misuse. Of these, 20.3% were positive for drug misuse: cannabis (19.0%), cocaine (3.9%), and hallucinogens (3.9%). As expected, the proportion of males was significantly higher among cannabis users (89.5%) compared with abstinent patients (44.4%). The mean age at onset was 26.12 (sd 6.18) among cannabis users and this value was significantly lower in comparison with
S42
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
non-users (33.54 sd 10.07). Moreover, cannabis misuse was associated with disadvantaged living conditions and less severe depressive symptoms. The influence of cannabis use on 2-year functional and clinical outcome will also be presented and discussed. Our results indicate a higher prevalence of drug use among psychotics than the general population, with some clinical characteristics correlating with cannabis use. The earlier age of onset of cannabis users suggests a possible causal role of this substance in triggering psychosis at least in some vulnerable subjects. Reducing cannabis use could delay or even prevent at least some new cases of psychosis.
PREDICTORS OF TWO-YEAR OUTCOMES IN FIRST-EPISODE PSYCHOTIC PATIENTS TREATED IN COMMUNITY MENTAL HEALTH SERVICES Antonello Lasalvia University of Verona, Verona, Italy A number of sampling and methodological issues have biased existing literature examining the outcome of first-episode psychosis (FEP) patients. The present study aims:1) to describe 2-year outcomes in a large clinical epidemiologic cohort of first-episode psychosis (FEP) patients,and 2) to explore the relative weight of premorbid adjustment (PA), duration of untreated psychosis (DUP), mode of onset, clinical and social characteristics at onset in predicting 2-year outcome. Study conducted in the context of the Psychosis Incident Cohort Outcome Study (PICOS), a multisite naturalistic research on FEP patients treated within the public psychiatric sector in the Veneto Region (Italy) and which aims to develop a comprehensive predictive model of outcome in FEP patients, by integrating clinical, social, genetic and MRI data.The PICOS covers a broad catchment area (3,8 million inhabitants) of the Veneto Region (Italy), one of the largest ever reported in the literature. A set of international standardised assessment measures were used. A total of 555 patients met the inclusion criteria over the 3-year recruitment period; of these, 517 had a ICD-10 diagnosis of psychosis; 397 (55% males; mean age: 32 yrs. ±9.5) were assessed at BL with the set of study measures. Of patients assessed, 24% had a diagnosis of schizophrenia, 55% of “non affective psychosis” and 21% of “affective psychosis”. Premorbid adjustmentwas at least moderately impaired in 40%, with schizophrenics being more compromised than others. The median DUP was 4 weeks (mean: 31±76), without significant differences between groups. A longer DUP was correlated with worse PA in adolescence (r=0.158; p<0.01) and worse social disability at BL (r=0.192; p<0.01) in the whole sample.At 2 year the majority of patients (n=204; 82%) were still in contact with services; patients with schizophrenia showed the highest rates of service engagement over the follow-up period, regardless the type of clinical course. Poorer PA in both childhood and adolescent predicted higher FU symptoms in most PANSS dimensions, whereas DUP predicted only disorganized symptoms. Further, higher positive and negative symptoms at BL predicted, respectively, higher symptoms’ levels in the same dimensions at FU. Moreover, having a diagnosis of schizophrenia predicted higher levels of positive and disorganized symptoms at FU. A multiwave analysis will be also presented. Overall, our findings point out the necessity for patients with schizophrenia to pursue continuity of care in order to gain significant improvement overtime. Moreover, the modest variance in outcome explained by PA and DUP and their low reciprocal correlation seems to suggest the potentially important role of other latent mediating variables in predicting outcome in FEP patients, such as diagnosis, which could reflect the underlying neurobiological process. More finely tuned analyses are however needed to address this important issue, together with a deeper understanding of the environmental and biological factors influencing the onset and course of psychosis.
BIOLOGICAL PREDICTORS OF CLINICAL OUTCOME AFTER THE FIRST PSYCHOTIC EPISODE: INITIAL FINDINGS FROM AESOP-10 Paola Dazzan Institute of Psychiatry, King’s College London, London, United Kingdom A number of “biological” risk factors have been implicated in the aetiopathogenesis of psychosis, and it has been suggested that they may represent indicators of poorer clinical and functional outcome. Among these, brain structural changes, neurological abnormalities, and minor
physical anomalies have been associated with a more continuous illness course, characterized by the presence of more negative symptoms and more social disability. These biological factors were explored in the AESOP10 study, a large epidemiological study that evaluated both social and biological risk factors in individuals presenting to psychiatric services with a first psychotic episode. Their association with clinical and functional outcome was explored in the 10-year follow up of the original cohort. The original AESOP cohort comprised 535 individuals with first-episode psychosis (AESOP-10), included at the time of their first presentation to psychiatric services in London, Nottingham, and Bristol (United Kingdom). At baseline, extensive data were collected on a range of neurodevelopmental indeces (neurological function, minor physical anomalies), and brain structure (using Magnetic Resonance Imaging, MRI). Brain structure and neurological function were evaluated again, 10 years later (7 years for brain structure), when detailed information on clinical course and outcome, social function and disability were also collected. Preliminary longitudinal analyses showed that by the end of the follow up, approximately 30% of the sample had developed a continuous illness course, 30% an episodic illness course, with periods of symptom remission of at least 6 months, and 40% had developed an illness course intermediate between the two. Most patients had been admitted to hospital at least once during follow up. In terms of biological predictors, patients who suffered more neurological dysfunction (p<0.001) and more brain changes over time (grey matter reduction, ventricular volume enlargement, p<0.001), were more likely to have a poorer type of outcome. This was indicated by not having had periods of remission, having spent more time in hospital, having had a higher exposure to antipsychotic medications, and having higher likelihood of being unemployed. Interestingly, this poorer outcome could have already been predicted from the baseline assessment of some of these factors. For example, from the MRI scan obtained at the time of baseline evaluation, patients who subsequently went on to have a continuous illness course with no symptom remission could already be distinguished from those patients who achieved remission (71% correctly classified; p=0.005). There is a large range of possible outcomes following a first psychotic episode. Some biological factors are indeed associated with these outcomes, and they may progress in parallel with these over time. However, there are biological factors that, already at illness onset, could help differentiate those individuals destined to develop a more incapacitating illness course, and could potentially be used clinically to identify which individuals could benefit from more assertive treatment interventions.
ETHNICITY AND THE LONG-TERM COURSE AND OUTCOME OF PSYCHOSIS: INITIAL FINDINGS FROM AESOP-10 Craig Morgan Institute of Psychiatry, King’s College London, London, United Kingdom 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. Underlying this is the idea that psychosis in these groups is more often brief, characterised by an acute onset and positive and manic symptoms, and caused by social stress (broadly construed). We sought to test this in a ten-year follow-up of a large cohort of individuals with first-episode psychosis (n=535) (AESOP-10). ÆSOP-10 is a multi-centre follow-up study at 10 years of a cohort of 535 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. Initial analyses have focused on comparisons between ethnic groups. In initial analyses, we found that there were no differences between ethnic groups in: a) clinical course and outcome, with, for example, similar proportions in all groups experiencing a continuous course (white British 24%, black Caribbean 28%, black African 24%; χ2 =0.2, df 2, p=0.92); and b) social function and disability, with, for example, similar scores on the Global Assessment of Function Disability Scale (Mean Disability Score: white British 59.6, black Caribbean 60.7, black African 52.4, f=0.76, p=0.47). There were, however, marked ethnic differences in patterns of service use. After ad-
terminant of poor long-term functional outcome and (2) the predictors of poor long-term functional outcome. We hypothesized that transition would not be a strong predictor of poor functional outcome and that poor baseline functioning, negative symptoms, and schizotypy would predict poor functioning. We aimed to follow up all previous UHR research participants from the PACE clinic, Melbourne (n=416). The outcome of interest was level of functioning at follow up. This was assessed using the Quality of Life Scale (QLS) and the Social and Occupational Functioning Assessment Scale (SOFAS). Groups were defined as “good functioning” (n=214), and “poor functioning” (n=54) outcomes. Transition to psychosis was determined using the Comprehensive Assessment of At Risk Mental States (CAARMS). Other potential predictors of functional outcome were: baseline measures of: functioning, negative symptomsand mania as assessed by the Global Assessment of Functioning (GAF), Schedule for Assessment of Negative Symptoms (SANS) and Young Mania Rating Scale (YMRS) respectively; and follow up measures of:schizotypyand childhood trauma, as assessed by the Oxford-LiverpoolInventory of Feelings and Experiences (OLIFE), and the Childhood Trauma Questionnaire (CTQ). Results: 268 people (64.4% of the original sample)were interviewed between 2.4 to 14.9 years post baseline. 73 developed psychosis, 195 did not. 45 individuals transitioned but had good functioning at follow up, while 26 individuals did not transition but had poor functioning. Transition to psychosis was a significant predictor of poor functioning (OR 4.04 (95% CI: 2.2, 7.6), Chi square p<0.0001). However the positive predictive value of transition as a predictor of poor outcome was low at 0.383. That is, the likelihood of having poor outcome if a UHR individual “transitions” was less than 40%. Sensitivity of transition to detect low functioning was moderate at 0.519. That is, just over 50% of those with poor outcome could be identified through their transition status.
COMPARISON OF CLINICAL AND SOCIODEMOGRAPHIC RISK FACTORS BETWEEN ADULT AND EARLY ONSET PSYCHOSIS Marco Armando, Ashleigh Lin, Claudia Comazzetto, Riccardo Saba, Amanda Beavan, Stefano Vicari, Max Birchwood Research Hospital IRCCS Bambino Gesù, Rome, Italy 10 to 15% have an onset before the age of 18. These “early-onset psychoses” (EOP) are considered to have a poorer outcome than “adult-onset psychoses” (AOP). The aim of the present study is to compare the clinical and sociodemographic profile of EOP and AOP in their prodromal phases in order to find specific patterns of the prodromal phases of the EOP. Methods: This study was conducted on 237 (77 female, 160 male) individuals with a first episode of psychosis. Participants were recruited from two sites; AOP participants were recruited in Birmingham/Solihull as part of the National EDEN study, EOP participants were recruited from Child and Adolescent Neuropsychiatry Unit and in of the Clinical and Research Hospital Bambino Gesù of Roma. Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS); specific psychotic diagnosis was determined by the ICD-10; the severity of depressive symptoms was measured using the Calgary Depression Scale for Schizophrenia and Child Depression Inventory; social functioning was assessed using the Global Assessment of Functioning and the Childhood Global Assessment Scale; the Pre-morbid Functioning Scale was used to retrospectively assesses four major areas of pre-morbid functioning; prodromal symptoms, Duration of Untreated Psychosis and Illness were measured. Results: The mean age of onset was 14.3 for EOP and 23.9 for AOP. No significant differences in DUI and DUP were found between the two groups. Significantly higher scores were found for PANSS positive and negative in the EOP group. Level of functioning and level of promorbid functioning were found to be significantly lower in the EOP group. Higher levels of premorbid symptoms and social withdrawhal were found in the EOP group. Discussion: Even though no differences were found in DUI and DUP between the two groups, EOP was characterized by a worse prodromal phase with lower levels of premorbid functioning, higher levels of prodromal symptoms and higher levels of social withdrawal. These results suggest a specific diagnostic and therapeutic approach to prodromal phases of EOP, in order to reduce the worse prognosis of EOP compared to AOP.
S41
Symposium INTEGRATING SOCIAL AND BIOLOGICAL FACTORS TO PREDICT THE COURSE AND OUTCOME OF PSYCHOSIS: EVIDENCE FROM TWO LARGE EPIDEMIOLOGICAL FIRST EPISODE PSYCHOSIS COHORTS (AESOP AND PICOS) Chairpersons: Paola Dazzan and Mirella Ruggeri Discussant: Mirella Ruggeri Monday, 16 April 2012 4:15 pm – 6:15 pm Overall Abstract: For the last few decades, psychoses research has mostly focused on either environmental and social risk factors, or neurodevelopmental and biological factors to advance our understanding of the pathophysiology and course of these disorders. However, both lines of research, taken alone, have provided only limited contribution to our knowledge of how these disorders develop and how they progress. Specifically, with regards to outcome, it has become apparent that using “a priori” distinct prediction domains (for example, evaluating candidate prognostic markers from the biological or the social domain in isolation), is not an approach that can fully explain the many possible psychoses outcomes. More recently, evidence has suggested that a better understanding of psychoses can be achieved by studying both social and biological factors in the same individuals, and exploring how these factors interact with each other to increase the risk for psychoses and the risk of poorer clinical and functional outcomes. On the wave of this evidence, two large epidemiologically-based cohorts of individuals with a first episode of psychoses, and community based controls, have been recruited and assessed in Europe: the AESOP cohort in the United Kingdom, and the PICOS cohort in Italy. Both studies have evaluated social and environmental factors at the time of psychosis first onset in the same individuals, and have evaluated how these factors progress over time, and how they may influence early and late illness course. This symposium will present recent evidence from these studies on how social factors (such as disadvantage, ethnic group, premorbid adjustment), biological factors (such as neurological function and brain structure), and factors at the crossroad with either (such as cannabis use and duration of untreated psychosis), interact to predict early and later outcome after the first psychotic episode. Emphasis will be given to the implications of integrating these factors into a model of clinical utility that could promote individualized medicine in psychosis.
THE IMPACT OF CANNABIS USE ON AGE OF ONSET IN FIRST-EPISODE PSYCHOTIC PATIENTS Sarah Tosato University of Verona, Verona, Italy Considering the high rate of cannabis use among first episode psychotic patients and the possible negative consequences due to drug exposure (reduced compliance to treatment, worse outcome, higher rates of relapse), to detect and to counteract this behaviour is could be very important in a public health perspective. The present study, conducted in a first-episode psychotic sample, aims totest whether substance misuse, particularly cannabis use 1) is more frequent in patients than the general population, 2) is associated with a higher level of positive symptoms, a lower level of depressive symptoms and a worse premorbid adjustment at the onset, 3) is associated with an earlier age of onset and a better premorbid IQ. The study was conducted within the broader framework of the PICOS (Psychosis Incident Cohort Outcome Study), a multi-site collaborative research on incident cases of psychosis attending psychiatric services in the Veneto Region, Italy. A set of standardized instruments has been used to collect sociodemographic, clinical and drug use information. A total of 555 patients met the inclusion criteria over the 3-year recruitment period; of these, 517 had a ICD-10 diagnosis of psychosis; 397 (55% males; mean age: 32 yrs. ±9.5) were assessed at baseline. Out of 397 patients evaluated, 311 (78.3%) patients accepted to be interviewed on drug and alcohol misuse. Of these, 20.3% were positive for drug misuse: cannabis (19.0%), cocaine (3.9%), and hallucinogens (3.9%). As expected, the proportion of males was significantly higher among cannabis users (89.5%) compared with abstinent patients (44.4%). The mean age at onset was 26.12 (sd 6.18) among cannabis users and this value was significantly lower in comparison with
S42
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
non-users (33.54 sd 10.07). Moreover, cannabis misuse was associated with disadvantaged living conditions and less severe depressive symptoms. The influence of cannabis use on 2-year functional and clinical outcome will also be presented and discussed. Our results indicate a higher prevalence of drug use among psychotics than the general population, with some clinical characteristics correlating with cannabis use. The earlier age of onset of cannabis users suggests a possible causal role of this substance in triggering psychosis at least in some vulnerable subjects. Reducing cannabis use could delay or even prevent at least some new cases of psychosis.
PREDICTORS OF TWO-YEAR OUTCOMES IN FIRST-EPISODE PSYCHOTIC PATIENTS TREATED IN COMMUNITY MENTAL HEALTH SERVICES Antonello Lasalvia University of Verona, Verona, Italy A number of sampling and methodological issues have biased existing literature examining the outcome of first-episode psychosis (FEP) patients. The present study aims:1) to describe 2-year outcomes in a large clinical epidemiologic cohort of first-episode psychosis (FEP) patients,and 2) to explore the relative weight of premorbid adjustment (PA), duration of untreated psychosis (DUP), mode of onset, clinical and social characteristics at onset in predicting 2-year outcome. Study conducted in the context of the Psychosis Incident Cohort Outcome Study (PICOS), a multisite naturalistic research on FEP patients treated within the public psychiatric sector in the Veneto Region (Italy) and which aims to develop a comprehensive predictive model of outcome in FEP patients, by integrating clinical, social, genetic and MRI data.The PICOS covers a broad catchment area (3,8 million inhabitants) of the Veneto Region (Italy), one of the largest ever reported in the literature. A set of international standardised assessment measures were used. A total of 555 patients met the inclusion criteria over the 3-year recruitment period; of these, 517 had a ICD-10 diagnosis of psychosis; 397 (55% males; mean age: 32 yrs. ±9.5) were assessed at BL with the set of study measures. Of patients assessed, 24% had a diagnosis of schizophrenia, 55% of “non affective psychosis” and 21% of “affective psychosis”. Premorbid adjustmentwas at least moderately impaired in 40%, with schizophrenics being more compromised than others. The median DUP was 4 weeks (mean: 31±76), without significant differences between groups. A longer DUP was correlated with worse PA in adolescence (r=0.158; p<0.01) and worse social disability at BL (r=0.192; p<0.01) in the whole sample.At 2 year the majority of patients (n=204; 82%) were still in contact with services; patients with schizophrenia showed the highest rates of service engagement over the follow-up period, regardless the type of clinical course. Poorer PA in both childhood and adolescent predicted higher FU symptoms in most PANSS dimensions, whereas DUP predicted only disorganized symptoms. Further, higher positive and negative symptoms at BL predicted, respectively, higher symptoms’ levels in the same dimensions at FU. Moreover, having a diagnosis of schizophrenia predicted higher levels of positive and disorganized symptoms at FU. A multiwave analysis will be also presented. Overall, our findings point out the necessity for patients with schizophrenia to pursue continuity of care in order to gain significant improvement overtime. Moreover, the modest variance in outcome explained by PA and DUP and their low reciprocal correlation seems to suggest the potentially important role of other latent mediating variables in predicting outcome in FEP patients, such as diagnosis, which could reflect the underlying neurobiological process. More finely tuned analyses are however needed to address this important issue, together with a deeper understanding of the environmental and biological factors influencing the onset and course of psychosis.
BIOLOGICAL PREDICTORS OF CLINICAL OUTCOME AFTER THE FIRST PSYCHOTIC EPISODE: INITIAL FINDINGS FROM AESOP-10 Paola Dazzan Institute of Psychiatry, King’s College London, London, United Kingdom A number of “biological” risk factors have been implicated in the aetiopathogenesis of psychosis, and it has been suggested that they may represent indicators of poorer clinical and functional outcome. Among these, brain structural changes, neurological abnormalities, and minor
physical anomalies have been associated with a more continuous illness course, characterized by the presence of more negative symptoms and more social disability. These biological factors were explored in the AESOP10 study, a large epidemiological study that evaluated both social and biological risk factors in individuals presenting to psychiatric services with a first psychotic episode. Their association with clinical and functional outcome was explored in the 10-year follow up of the original cohort. The original AESOP cohort comprised 535 individuals with first-episode psychosis (AESOP-10), included at the time of their first presentation to psychiatric services in London, Nottingham, and Bristol (United Kingdom). At baseline, extensive data were collected on a range of neurodevelopmental indeces (neurological function, minor physical anomalies), and brain structure (using Magnetic Resonance Imaging, MRI). Brain structure and neurological function were evaluated again, 10 years later (7 years for brain structure), when detailed information on clinical course and outcome, social function and disability were also collected. Preliminary longitudinal analyses showed that by the end of the follow up, approximately 30% of the sample had developed a continuous illness course, 30% an episodic illness course, with periods of symptom remission of at least 6 months, and 40% had developed an illness course intermediate between the two. Most patients had been admitted to hospital at least once during follow up. In terms of biological predictors, patients who suffered more neurological dysfunction (p<0.001) and more brain changes over time (grey matter reduction, ventricular volume enlargement, p<0.001), were more likely to have a poorer type of outcome. This was indicated by not having had periods of remission, having spent more time in hospital, having had a higher exposure to antipsychotic medications, and having higher likelihood of being unemployed. Interestingly, this poorer outcome could have already been predicted from the baseline assessment of some of these factors. For example, from the MRI scan obtained at the time of baseline evaluation, patients who subsequently went on to have a continuous illness course with no symptom remission could already be distinguished from those patients who achieved remission (71% correctly classified; p=0.005). There is a large range of possible outcomes following a first psychotic episode. Some biological factors are indeed associated with these outcomes, and they may progress in parallel with these over time. However, there are biological factors that, already at illness onset, could help differentiate those individuals destined to develop a more incapacitating illness course, and could potentially be used clinically to identify which individuals could benefit from more assertive treatment interventions.
ETHNICITY AND THE LONG-TERM COURSE AND OUTCOME OF PSYCHOSIS: INITIAL FINDINGS FROM AESOP-10 Craig Morgan Institute of Psychiatry, King’s College London, London, United Kingdom 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. Underlying this is the idea that psychosis in these groups is more often brief, characterised by an acute onset and positive and manic symptoms, and caused by social stress (broadly construed). We sought to test this in a ten-year follow-up of a large cohort of individuals with first-episode psychosis (n=535) (AESOP-10). ÆSOP-10 is a multi-centre follow-up study at 10 years of a cohort of 535 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. Initial analyses have focused on comparisons between ethnic groups. In initial analyses, we found that there were no differences between ethnic groups in: a) clinical course and outcome, with, for example, similar proportions in all groups experiencing a continuous course (white British 24%, black Caribbean 28%, black African 24%; χ2 =0.2, df 2, p=0.92); and b) social function and disability, with, for example, similar scores on the Global Assessment of Function Disability Scale (Mean Disability Score: white British 59.6, black Caribbean 60.7, black African 52.4, f=0.76, p=0.47). There were, however, marked ethnic differences in patterns of service use. After ad-