THE ROLE OF PERSONALITY DISORDER AND ACCENTUATION IN THE CONVERSION TO PSYCHOSIS

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Abstracts

Poster 14 PROVERBS AND NONLITERAL LANGUAGE IN SCHIZOPHRENIA: A SYSTEMATIC METHODOLOGICAL REVIEW OF ALL STUDIES PUBLISHED 1931-2010 Alexander Rapp, Phoebe Schmierer University of Tuebingen, Tuebingen, Germany Background: Deficits in the comprehension of non-literal language (i. e. proverbs, metaphors, irony, sarcasm, and metonymies) are a well-known symptom of schizophrenia. The aim of this systematic literature review is to evaluate current knowledge of this deficit and identify remaining research questions. Methods: Databases including PubMed and PsychINFO were systematically searched for articles reporting data on the comprehension of non-literal language in schizophrenic patients. Studies were screened for > 20 study quality and outcome criteria. Results: 128 studies with experimental data were identified. The first experimental study was published by Wegrocki et. al. 1940. Since that, N = 105 (82%) studies investigated proverbs, n = 10 metaphor, n = 3 idioms, n = 6 irony/sarcasm, n = 1 metonymy. 29 studies were published since 2000. Discussion: The Gorham proverb test (Gorham, 1956) is by far the most established test. Only 20 (predominatly older) studies generated longitudinal data (n = 19 with proverbs), so that future research should adopt a longitudinal perspective and investigate non-literal language comprehension over the course of the subjects' premorbid, acute and post-acute phases. Medication effects, especially for atypical antipsychotics, are largely unknown. 23 studies used DSM IV or ICD-10 diagnostic criteria, whereas 51% (5% > 1990) did not report diagnostic criteria for patients. Most studies have focused on proverb comprehension in English or German speaking subjects, wheras the data on transcultural comparisons is very limited. From a linguistic perspective, expressions with non-literal meaning are a heterogeneous entity. Newer linguistic research and neuroanatomical studies suggest that different types of non-literal language and different tasks involve different cognitive processes and possibly have distinct neural correlates. However, only 6 studies compared different types of NL language in schizophrenia and only 1 fMRI study is available. Stimulus salience is likewise an important factor, however so far studies predominantly investigated salient stimuli. The average number of patients included is 42,6 (between 4 and 211). Only very limited data is available for high risk and premorbid subjects.

doi:10.1016/j.schres.2010.02.775

Poster 15 BASIC SYMPTOM AND ULTRA-HIGH RISK CRITERIA IN THE PREDICTION OF FIRST-EPISODE PSYCHOSIS Stephan Ruhrmann1, Frauke Schultze-Lutter2, Joachim Klosterkötter1 1 Dept. of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; 2University Hospital of Child and Adolescent Psychiatry, Research Department, Bern, Switzerland Background: In early detection of psychosis, two approaches that have been developed independently of each other are currently mainly followed: the basic symptom (BS) and ultra-high risk (UHR) approach. And although it had been argued that they were complementary, only recently have they been together. Thus it was examined if combining the two criteria would increase predictive accuracy.

Methods: The prognostic value of single criteria (attenuated psychotic symptoms, APS; brief limited intermittent psychotic symptoms, BLIPS; risk factor plus functional decline; RISK; cognitive-perceptive basic symptoms, COPER; cognitive disturbances, COGDIS) and their combination was explored in two large samples. Sample I: 245 help-seeking participants of the multi-center, naturalistic field European Prediction of Psychosis Study (EPOS) included by UHR or COGDIS, followed up for 18 months. At baseline, 59.6% reported a combination of UHR and COGDIS, 30.2% UHR alone and 10.2% COGDIS alone; hazard rate was 19% after 18 month. Sample II: 247 participants of a follow-up study of patients having sought help in the FETZ between 1998 and 2003. At first examination, 13.4% had not met UHR or BS criteria, 20.2% only BS (incl. COPER, 4%) and 4.5% only UHR criteria, 61.9% met a combination of UHR and BS criteria. 87 (35.2%) had converted during the follow-up period that was on average 3.4 (SD = 2.2, MD = 3.6) years: 1.3 (SD = 1.2, MD = 0.8) in the conversion group with time of conversion serving as end point and 4.5 (SD = 1.7, MD = 4.5) in the non-conversion group with time of follow-up interview serving as end point. Results: Considering the two approaches separately, especially APS and COGDIS, respectively, yielded good predictive accuracy. Yet in both samples, the combination of APS and COGDIS outperformed single criteria or UHR and BS criteria alone. This result was robust against the exclusion of cases with BLIPS who have been argued to be no 'prodromal' but psychotic cases already. Discussion: The combination of APS and COGDIS is recommended as inclusion criteria for future early detection study and might serve as a reliable starting point for further risk assessments including also non-specific variables such as functional decline.

doi:10.1016/j.schres.2010.02.776

Poster 16 THE ROLE OF PERSONALITY DISORDER AND ACCENTUATION IN THE CONVERSION TO PSYCHOSIS Frauke Schultze-Lutter1, Joachim Klosterkötter2, Stephan Ruhrmann2 1 University Hospital of Child and Adolescent Psychiatry, Bern, Switzerland; 2University of Cologne, NRW, Germany Background: Schizophrenia spectrum disorders, i.e., cluster A personality disorders (PDs) according to DSM-IV and particularly schizotypal PD, were found to cumulate in patients with a symptomatically defined increased risk of developing first-episode psychosis, and increased prevalence rates of psychosis were reported in persons with schizotypal PD. As regards the 'ultra-high risk' (UHR) criteria, attenuated psychotic symptoms (APS), which phenomenologically resemble schizotypal symptoms but differ in course, are the most frequently reported symptomatic criterion in risk samples, and schizotypal PD in combination with a significant decline in psychosocial functioning is one of two 'vulnerability' conditions of the UHR criteria. Thus the role of PDs and personality accentuations (PAs) in the conversion to psychosis in a symptomatically defined atrisk sample was examined. Methods: PDs and PAs were compared between 50 at-risk patients with and 50 without conversion to psychosis; they were assessed by a self-rating questionnaire that had shown good consistency with clinical interview assessments. Groups were matched for intake criteria (16% symptomatic early initial prodromal state, EIPS, 84% late initial prodromal state, LIPS), gender (76% male) and age (24.2 ± 6.0; 16-38 years). Results: The number of patients with at least any one DSM-IV PD did not differ between those with and without conversion (50% vs.

Abstracts

46%; chi2 = .644, df = 1, p = .422); altogether 31% of patients fell above the threshold for any cluster B, 23% for any cluster C and 14% for any cluster A PD. Only for 'any one cluster A PD', a statistical trend showed towards a higher frequency in converters (20% vs. 8%; chi2 = 2.990, df = 1, p = .084), no group differences were found for any single PD. Comparisons of the severity of PAs (Mann-Whitney tests) showed a higher expression of schizoid features (U = 872.5, p = .006) and, though less clearly, of schizotypal features (U = 959.5, p = .043) in the conversion group. In stepwise regression analyses, schizoid PA was chosen as sole predictor of conversion (OR = 1.685; 95%CI: 1.134/2.504), classifying 62% of non-converters and 68% of converters correctly. A LIPS was positively albeit weakly correlated with schizotypal and paranoid, but not schizoid PAs. Discussion: Surprisingly, cluster A PDs were the least frequent PDs in both at-risk samples, yet significantly cumulating in the 'true prodromal' group of converters. The main role in this was not played– as expected – by schizotypal PA but by schizoid PA, which was unrelated to the prodromal state at intake. The deficient social skills and integration that shows in the more severe schizoid PA is in line with genetic high-risk studies, which have repeatedly shown premorbid social deficits in children of schizophrenia parents. It also supports the important protective role that good social functioning and skills might play in psychosis prevention.

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Discussion: Study observations confirm demonstrated decresased sense of smell in schizophrenia patients and suggest cautiously that smell impairment may be a potential marker of more serious illness as expressed in longer hospital stay. Several neurophysiological mechanisms may account for these findings which require further investigation in order to substantiate potential hypotheses. doi:10.1016/j.schres.2010.02.778

Poster 18 INHOMOGENEITY OF THE NONDEFICIT SYNDROME AMONG PATIENTS WITH SCHIZOPHRENIA Istvan Szendi1, Mihaly Racsmany2, Gabor Csifcsak2, Zoltan A Kovacs1, Nora Domjan1, Gyorgy Szekeres1, Csongor Cimmer1, Gabriella Galsi1, Krisztina Boda3, Gergely Gulyas4, Jozsef Dombi4, Zoltan Janka1 1 Department of Psychiatry, University of Szeged, Szeged, Hungary; 2 Department of Psychology, University of Szeged, Szeged, Hungary; 3 Institute of Medical Informatics, University of Szeged, Szeged, Hungary; 4Department of Computer Algorithms and Artificial Intelligence, University of Szeged, Szeged, Hungary

doi:10.1016/j.schres.2010.02.777

Poster 17 ASSESSMENT OF SMELL FUNCTION IN SCHIZOPHRENIA DURING ACUTE PSYCHOTIC EPISODE AND CORRELATION WITH CLINICAL SYMPTOMATOLOGY Rael Strous1,2, Netta Shoenfeld1, Nancy Agmon-Levin3, Revital Mann1, Bat-Sheva Katz Porat4, Yehuda Shoenfeld2,5 1 Beer Yaakov Mental Health Center, Beer Yaakov, Israel; 2Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv Israel; 3Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv Israel; 4Faculty of Agricultural, Food and Environmental Quality Sciences, The Hebrew University of Jerusalem, Jerusalem Israel; 5Sheba Medical Center, Tel-Aviv, Israel Background: Olfactory processing is becoming of increasing interest as a marker of disturbed cognitive function in schizophrenia. This has been paralleled by several consistent anatomical findings in the illness. Furthermore, olfactory processing is mediated by many of the same medial temporal lobe areas of the brain that have been implicated in schizophrenia. In this study we investigate a range of smell functions in a group of patients with schizophrenia during their first week of hospitalization for acute psychosis. In addition, we tested for correlations between smell scores and disease severity as well as for correlations between smell scores and clinical symptomatology. Methods: Olfactory function was assessed in 20 schizophrenia patients in their 1st week of hospital admission for acute psychosis and compared with matched controls. Olfaction was evaluated via three stages: threshold, discrimination and identification of different odors utilizing the Sniffin' Sticks Test Battery. Patients were rated for clinical symptomatology at the time of testing of smell by means of several clinical rating scales. Results: Schizophrenia patients scored significantly lower on total smell score, discrimination, and identification abilities. A significant association was observed between hospitalization duration and total smell score and smell discrimination. No significant associations between smell and clinical symptomatology were observed.

Background: We performed a robust cross-sectional study, including a systematic neuropsychological battery, on 50 outpatients with schizophrenia in their compensated states (Szendi et al., 2009). An explorative fuzzy cluster analysis revealed two subgroups in this sample that could be distinguished from each other on symptomatologic, cognitive and neurological levels. The analyses have demonstrated that cluster Z had more favorable, while cluster S had more unfavorable characteristics. We found a remarkable statistical correspondence between the S-Z clusters and the deficit-nondeficit categorization, which was detected by using SDS. It was an essential difference that, while the definition of deficit syndrome was based on clinical symptoms, our clusters were identified by a complex neuropsychiatric analysis from which the deficit syndrome as an attribute was omitted (because of its nominal value). We analyzed the homogeneity of groups identified by the two different grouping methods. Methods: All the fifty (27 male, 23 female) patients had a diagnosis of schizophrenia (DSM-IV), were outpatients in stable interepisodic state under antipsychotic medication. The average years in education was 11.00 (± 2.17), the average full-scale IQ (WAIS) was 100.17 (± 15.40). The average age at onset was 24.70 (± 7.84) years, the average duration of illness was 9.10 (±8.24) years, the average number of relapses was 4.84 (± 4.62). Clinical symptoms were assessed using PANSS, SANS, Schedule for the Deficit Syndrome, Neurological Evaluation Scale, SAS, AIMS, and BARS. Minor physical anomalies (MPAs) were also mapped with a modified form of the Waldrop-scale. Smell identification was also measured by the B-SIT. We measured verbal working memory capacity (Digit Span, Nonword Repetition Task), the visuo-spatial working memory (Corsi Blocks, Visual Patterns Test), the executive functions (WCST, Tower of Hanoi, Letter Fluency and Category Fluency Tasks). For measuring inhibitory control of memory we used the Directed Forgetting procedure. The mentalization abilities were assessed using firstorder and second-order mentalization tasks, and metaphor and irony tasks. The habituation of the P50 auditory evoked potential in a double click paradigm, the auditory mismatch negativity (MMN) and the auditory P300 wave were also analysed. We performed detailed analyses to explore the nature of the relationship between the two different divisions. To compare the three groups, the Kruskal-Wallis and chi-square tests were used for continuous