ResearchPad - Psychiatry and Mental health https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Modafinil Dependence: A Case with Attention-Deficit/Hyperactivity Disorder]]> https://www.researchpad.co/product?articleinfo=5b58ef09463d7e5414116045

Modafinil is generally known as a drug with low addiction potential. There are few case reports in the literature demonstrating that Modafinil, stated being capable of diminishing symptoms of attention deficit/hyperactivity disorder (ADHD), causes addiction. In the present article a Modafinil addicted ADHD case, consuming usurious doses (5,000 mg/per day) of Modafinil is presented. The case presented to our psychiatry outpatient clinic due to: requirement of in taking high dose Modafinil in order to achieve the initial effects, difficulty in obtaining the drug, irritability, anxiousness, sleep irregularities, fatigue and unpleasant vivid dreams when he did not use the drug. It was realized that the patient, himself increased doses of Modafinil incrementally, in order to keep its effects on attention symptoms at the same level. It has to be kept in mind that ADHD patients can develop Modafinil addiction. It is necessary to carry out systemic studies on this subject.

]]>
<![CDATA[Incidence and Comorbidity of Reactive Attachment Disorder: Based on National Health Insurance Claims Data, 2010–2012 in Korea]]> https://www.researchpad.co/product?articleinfo=5b58a70f463d7e4da2d63a4d

Objective

We aimed to investigate the current diagnostic incidence, and medical and psychiatric comorbidities of reactive attachment disorder (RAD) using the National Health Insurance Review and Assessment (HIRA) claims data.

Methods

To examine the diagnostic incidence, we selected patients who were under 10-year-old and who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for RAD (F94.1 and F94.2) and who had not been diagnosed in the previous 360 days, from 2010 to 2012. In this study, we used the term ‘reactive attachment disorder’ representing for both RAD per se and Disinhibited social engagement disorder. Comorbid disorders were categorized according to ICD-10.

Results

Among 14,029,571, the total population under 10-year-old during 2010–2012, incident cases of RAD were 736. The mean diagnostic incidence of RAD was 5.25 per 100,000 annually. Language disorders (F80-84) were the most common psychiatric comorbidities in both boys and girls in age groups 0–3 years and 4–6 years, and attention deficit hyperactivity disorder was the most common in both sex aged 7–9 years. In non-psychiatric comorbidities, diseases of the respiratory system (J00–99) were the commonest in both sex in all age groups, and diseases of the digestive system (K00–99) were the next.

Conclusion

RAD was very rare in practice and would be disguised as other psychiatric disorders. Children with RAD might have more medical comorbidities than typically developed children.

]]>
<![CDATA[Association of Persistent and Severe Postnatal Depression With Child Outcomes]]> https://www.researchpad.co/product?articleinfo=5bfd4599d5eed0c48435f9aa

Key Points

Question

What is the association of differing levels of persistence and severity of postnatal depression with long-term child outcomes?

Findings

This observational study of 9848 women with varying levels of postnatal depression and 8287 children found that, compared with children of women with postnatal depression that did not persist, of either moderate or severe intensity, children of women with persistent and severe depression are at an increased risk for behavioral problems by age 3.5 years as well as lower mathematics grades and depression during adolescence. Furthermore, women with persistent postnatal depression are likely to experience significant depressive symptoms until at least 11 years after childbirth.

Meaning

Women with persistent and severe postnatal depression should be prioritized for treatment because they are likely to continue to experience high levels of depressive symptoms and because of the high risk of adverse child development.

]]>
<![CDATA[Negative Mood-Induced Alcohol-Seeking Is Greater in Young Adults Who Report Depression Symptoms, Drinking to Cope, and Subjective Reactivity]]> https://www.researchpad.co/product?articleinfo=5b5890c8463d7e4bbcb756e3

Acute negative mood powerfully motivates alcohol-seeking behavior, but it remains unclear whether sensitivity to this effect is greater in drinkers who report depression symptoms, drinking to cope, and subjective reactivity. To examine these questions, 128 young adult alcohol drinkers (ages 18–25) completed questionnaires of alcohol use disorder symptoms, depression symptoms, and drinking to cope with negative affect. Baseline alcohol choice was measured by preference to enlarge alcohol versus food thumbnail images in two-alternative forced-choice trials. Negative mood was then induced by depressive statements and music, before alcohol choice was tested. Subjective reactivity was indexed by increased sadness pre- to post-mood induction. Baseline alcohol choice correlated with alcohol dependence symptoms (p = .001), and drinking coping motives (ps ≤ .01). Mood induction increased alcohol choice and subjective sadness overall (ps < .001). The mood-induced increase in alcohol choice was associated with depression symptoms (p = .007), drinking to cope (ps ≤ .03), and subjective reactivity (p = .007). The relationship between mood-induced alcohol choice and drinking to cope remained significant after covarying for other drinking motives. Furthermore, the three predictors (depression, drinking to cope, and subjective reactivity) accounted for unique variance in mood-induced alcohol choice (ps ≥ .03), and collectively accounted for 18% of the variance (p < .001). These findings validate the pictorial alcohol choice task as sensitive to the relative value of alcohol and acute negative mood. The findings also accord with the core prediction of negative reinforcement theory that sensitivity to the motivational impact of negative mood on alcohol-seeking behavior may be an important mechanism that links depression and alcohol dependence.

]]>
<![CDATA[Automatic mining of symptom severity from psychiatric evaluation notes]]> https://www.researchpad.co/product?articleinfo=5b587837463d7e499e71c3c9

Abstract

Objectives

As electronic mental health records become more widely available, several approaches have been suggested to automatically extract information from free‐text narrative aiming to support epidemiological research and clinical decision‐making. In this paper, we explore extraction of explicit mentions of symptom severity from initial psychiatric evaluation records. We use the data provided by the 2016 CEGS N‐GRID NLP shared task Track 2, which contains 541 records manually annotated for symptom severity according to the Research Domain Criteria.

Methods

We designed and implemented 3 automatic methods: a knowledge‐driven approach relying on local lexicalized rules based on common syntactic patterns in text suggesting positive valence symptoms; a machine learning method using a neural network; and a hybrid approach combining the first 2 methods with a neural network.

Results

The results on an unseen evaluation set of 216 psychiatric evaluation records showed a performance of 80.1% for the rule‐based method, 73.3% for the machine‐learning approach, and 72.0% for the hybrid one.

Conclusions

Although more work is needed to improve the accuracy, the results are encouraging and indicate that automated text mining methods can be used to classify mental health symptom severity from free text psychiatric notes to support epidemiological and clinical research.

]]>
<![CDATA[F74. CLINICAL SYMPTOMS AND NOT OBJECTIVE COGNITIVE PERFORMANCE DRIVE SUBJECTIVE COGNITIVE COMPLAINTS IN PATIENTS WITH SCHIZOPHRENIA]]> https://www.researchpad.co/product?articleinfo=5b587049463d7e489147c597

Abstract

Background

The United States Food and Drug Administration (FDA) recommends that drugs that exert a pro-cognitive effect should be accompanied by measurable improvements in ‘real-world’ functioning. Patients with schizophrenia typically exhibit substantial impairments across a wide range of cognitive domains, representing an important target for therapeutic intervention. This has led to the development of several instruments specifically for use in this population that seek to capture the subjective experience and impact of cognitive dysfunction on daily living for use as co-primary endpoints in clinical trials. However, it remains unclear to what extent these accurately reflect objective cognitive performance.

Methods

We conducted a secondary analysis of data from 413 patients with schizophrenia who participated in a multi-national randomized, double-blind, placebo-controlled trial. During the trial, participants completed two different neurocognitive test batteries, the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the MATRICS Consensus Cognitive Battery (MCCB). They also completed two measures of subjective cognitive performance, the Schizophrenia Cognition Rating Scale (SCoRS) and the Patient Reported Experience of Cognitive Impairment in Schizophrenia (PRECIS). The severity of patient’s symptoms was also assessed at each time point using the Positive and Negative Syndrome Scale (PANSS). All assessments were conducted at baseline and at a 12-week follow-up assessment (end of treatment). We examined the associations between these variables using correlational and multivariable linear regression analyses.

Results

Scores on each of the subjective measures of cognition were weakly correlated in the expected direction with objective measures of cognitive performance across both the CANTAB and MCCB tasks. Scores on each of the subjective cognition measures were more strongly associated with severity of symptoms as assessed using the PANSS. Multivariable regression analyses suggested that clinical symptoms accounted for significantly greater variance in subjective cognition scores than either objective cognitive performance or demographic factors.

Discussion

Subjective appraisals of cognition are poor predictors of objective cognitive performance in patients with schizophrenia. The burden reported by patients on these instruments appears to be more closely associated with the severity of their clinical symptoms. This has important implications for the use of these measures as co-primary endpoints in clinical trials assessing pro-cognitive drug effects.

]]>
<![CDATA[5. RETHINKING THE TAXONOMY, COURSE, AND OUTCOME OF PSYCHOSES: DIMENSIONAL, LATENT TRAJECTORY, AND TRANSDIAGNOSTIC APPROACHES]]> https://www.researchpad.co/product?articleinfo=5b586fd6463d7e489147c595

Abstract

Overall Abstract: Evidence continues to accumulate on heterogeneity in phenomenology, course and outcome of non-affective and affective psychotic disorders. Both DSM and ICD classification systems have evolved to include a large number of categories of psychosis. However, doubt remains about this categorical approach because of high comorbidity, common etiological factors and the absence of zones of relative rarity between categorical diagnoses. Some authors have nevertheless argued that categorical representations of psychosis may still be of clinical utility if used in combination with dimensional indicators.

It is now widely accepted that psychotic symptoms partition into several symptom dimensions that would support the heterogeneity of psychotic disorders. However, there is no consensus on the exact number of these dimensions, with previous factor-analytic work pointing towards models with two to twelve specific symptom dimensions. However, recently, there has been evidence for a transdiagnostic dimension underlying affective and non-affective psychotic symptoms in schizophrenia, schizoaffective and bipolar disorder that challenges their classification as distinct diagnostic constructs. There is also considerable heterogeneity in clinical course and outcome of psychotic disorders, but how to best map and model this over time remains to be established. Taken together, this presents significant challenges for the classification of psychotic disorders as separate diagnostic entities.

This symposium brings together international researchers at the forefront of research into the phenomenology, course and outcome of psychotic disorders. Roman Kotov will present novel data on symptom dimensions and examines the course of these dimensions in an epidemiologic cohort of 628 first-admission inpatients with psychosis interviewed 6 times over two decades in the Suffolk County Mental Health Project. Craig Morgan will report new findings from the 10-year follow-up of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP-10) study, an epidemiological cohort of 552 patients with a first episode psychosis, using a data driven approach to identify latent trajectory classes to account for heterogeneity in patterns of change in psychotic symptoms over time and characterize these trajectories with the WHO classification, baseline demographic characteristics and diagnoses. Ulrich Reininghaus will present novel data from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium to investigate whether there is a transdiagnostic dimension cutting across symptoms of schizophrenia, schizoaffective disorder and psychotic bipolar I disorder. Diego Quattrone will report recent findings from EU-GEI Functional Enviromics Study on genetic and socio-environmental factors associated with transdiagnostic and specific symptom dimensions of non-affective and affective psychosis. Robin Murray will discuss these findings in the context of new challenges in the field and directions for future research.

]]>
<![CDATA[F56. IMPACT OF SIDE EFFECTS DUE TO SECOND-GENERATION ANTIPSYCHOTICS ON THE FUNCTIONING OF PATIENTS WITH SCHIZOPHRENIA: AN OBSERVATIONAL, PATIENT CENTERED, WEB SURVEY]]> https://www.researchpad.co/product?articleinfo=5b586f29463d7e489147c592

Abstract

Background

In patients with schizophrenia, antipsychotic medications, including second-generation antipsychotics, may cause many side-effects (SE) often leading to treatment discontinuation, and possible relapse as a consequence. The impact of treatments on patient-centered outcomes such as health-related quality of life (HRQOL) is less well understood. Even less well understood is the impact of side effects on patient-centered outcomes such as daily functioning and HRQOL. Therefore, the study’s primary goal was to gain a deeper understanding of the impacts of SEs of second generation antipsychotics on patients’ day to day functioning.

Methods

A cross-sectional, web-based, patient-reported survey was fielded in the United States between July and November 2017. The final survey included patient socio-demographics, a quality of life measure (Quality of Life Enjoyment and Satisfaction Questionnaire Short Form, Q-LES-Q-SF), questions on treatment satisfaction, SEs experienced (Glasgow Antipsychotic Side-Effect Scale, GASS), and questions about the impact of SEs on functioning and emotions. Patients were recruited through patient advocacy and support groups, and medical research panels. Patient inclusion criteria: Self-reported schizophrenia diagnosis; 18 to 65 years old; stable for at least one month at time of screening; prescribed a second-generation antipsychotic medication for 1–12 months; the final sample consisted of those individuals who reported experiencing one or more side-effects based on the GASS.

Results

The total sample (n=180) had a mean age of 35 (range 18–61) years old, of which 58.3% were females. Approximately a quarter (27.8%) of the sample had a college degree or higher; 69.4% identified as White, followed by 16.7% Black/ African American, and 6.1% Native Hawaiian/ Pacific Islanders. Most prevalent SEs reported on the GASS were ‘difficulty sleeping’ (81.1%), ‘feeling sleepy during the day’ (77.2%), ‘dry mouth’ (70.6%), and ‘feeling restless (60.6%). The SEs most commonly reported as distressing, for those patients experiencing that SE, were difficulty passing urine (23.3%), and feeling drugged/like a zombie (19.4%). The minimum impact from SEs on daily functioning was 53.2 on a 0–100 Visual Analogue Scale (higher number reflects more negative impact on daily functioning; 0=no impact and 100=very highly impacted). Across the SEs further probed about, the most severe impact was on one’s ‘ability to get or do a job’; specifically, for the SEs ‘shaky hands or arms’ the mean impact was 76.1, followed by 69.8 for restlessness. ‘Problems enjoying sex’ had the greatest effect on one’s ‘intimate relationships’ (mean 74.8), and feeling drugged/like a zombie had the greatest effect on one’s ‘ability to concentrate’ (mean 70.2).

Discussion

The study indicates the importance of incorporating the patient with schizophrenia’s perspective when assessing SE experiences and impact on functioning due to second generation antipsychotic agents. Findings suggest that both activating SEs (restlessness) and sedating SEs (feeling drugged and sleepiness) have pronounced undesirable impact on daily patient functioning.

]]>
<![CDATA[S157. NEURAL CORRELATES OF SMOOTH PURSUIT EYE MOVEMENTS IN POSITIVE AND NEGATIVE SCHIZOTYPY]]> https://www.researchpad.co/product?articleinfo=5b586f9c463d7e489147c594

Abstract

Background

Both schizophrenia patients and highly schizotypal individuals are known to perform worse in smooth pursuit eye movements (SPEM) as compared to healthy controls with low levels of schizotypy. However, little is known about the neural correlates of SPEM deficits in subjects with high levels of schizotypy. In a previous study, individuals with high total schizotypy levels showed reduced activation in motion processing and other visual areas during SPEM than low schizotypal controls. Interestingly, reduced activation in these areas is also observed in schizophrenia patients. This suggests that schizotypy and schizophrenia overlap not only at the behavioral, but also at the neural level. In the present study, we followed up on these intriguing results by differentiating between negative and positive schizotypal groups. We expected to find lower SPEM performance in both highly negative and highly positive schizotypes (HNS and HPS) as compared to low schizotypal controls (LS). Moreover, in the schizotypy groups, activation in the SPEM network was expected to be reduced in a similar way as previously reported for schizophrenia patients and highly schizotypal individuals.

Methods

In this ongoing, bi-center study, 88 healthy subjects (28 HNS, 23 HPS, 37 LS) underwent functional magnetic resonance imaging (fMRI) at 3T during a smooth pursuit task with concurrent oculographic measurement. Sinusoidal targets with frequencies of 0.2 Hz and 0.4 Hz were presented in a block design, with pursuit blocks alternating with blocks of fixation.

Results

At the level of performance, we found an interaction between target frequency and group for the root mean square error (RMSE) of eye position (p = .026). This result indicates greater performance detriments from low to high frequency in HPS, as compared to the other two groups. At the neural level, overall activations during pursuit across the entire sample were found in brain regions known to be part of the pursuit network, i.e. frontal and supplementary eye fields, lateral geniculate nucleus, and visual cortex including V5. However, none of these regions displayed activation differences between groups. With multiple regression analyses for each of the groups, we investigated associations between cluster peak voxel activations and performance. For the low target frequency, a negative association was found between visual area V5 in the left hemisphere and the total saccade frequency for HPS (β = –.462, p = .03). For the high target frequency, activation in left V5 was negatively associated with RMSE in the LS group (β = –.411, p = .01).

Discussion

We replicated previous findings of reduced SPEM performance in highly schizotypal individuals. In addition, a negative association between activation in area V5 and RMSE was only found among LS, but not for the two schizotypy groups. This is in line with previous findings of SPEM impairments in schizophrenia patients being associated to alterations in motion sensitive area V5 and underlines the importance of motion processing for SPEM deficits in the schizophrenia spectrum. However, we also found an association between activation in V5 and total saccade rate during pursuit in HPS, suggesting that V5 abnormalities may be restricted to negative schizotypy. Given the relatively small number of participants in this analysis, we expect to find broader and clearer group differences of neural mechanisms during pursuit with larger sample sizes.

]]>
<![CDATA[F9. ALTERATIONS OF NEURONAL METABOLISM IN PATIENT SUBGROUPS AT ULTRA-HIGH RISK FOR PSYCHOSIS ACCORDING TO PACE CRITERIA – A 1H/31P-MR-SPECTROSCOPY STUDY]]> https://www.researchpad.co/product?articleinfo=5b587010463d7e489147c596

Abstract

Background

Glutamatergic dysfunction, deregulated mitochondrial metabolism and alterations of membrane phospholipids have been extensively investigated in schizophrenic illness by using in vivo magnetic resonance spectroscopy (MRS). Findings in the ultra-high risk (UHR) phase of psychotic illness, however, are still rare and inconsistent. Combining both 1H- and 31P-MRS, this study investigates these aspects in the different UHR patient subgroups as defined by PACE (Personal Assessment and Crisis Evaluation) criteria.

Methods

We applied 3 T chemical shift imaging (3D 31P-MRS, 2D 1H-MRS) and hippocampal single-voxel MRS in 69 neuroleptic-naïve UHR patients (age: 26.2 ± 6.2y; males 59.4% 41/69, attenuated symptoms (AS) n=50, BLIPS n=5, genetic risk (GR) n=8, AS+GR n=6; transition rate 17.2%, all transitions in the AS or BLIPS group) and 61 healthy controls (age: 25.2 ± 4.8y; males 54.1% 33/61). 11 metabolite markers were investigated (neuronal/mitochondrial metabolism: glutamate (Glu), N-acetyl-aspartate (NAA), phosphocreatine (PCr), and adenosine triphosphate (ATP); phospholipid synthesis: phosphomonoester/-metabolites (PME, Peth, Pch); phospholipids breakdown: phosphodiester/-metabolites (PDE, Gpeth, Gpch); astrocyte activation: myo-Inositol (mI)) in 5 brain regions (dorsolateral prefrontal cortex, DLPFC; dorsomedial prefrontal cortex, DMPFC; dorsal anterior cingulate cortex, dACC; mediodorsal thalamus, Th; and hipoocampus, Hip). Psychopathology was assessed using the CAARMS-Interview as well as PANSS, BPRS-E and SCL-90-R ratings. Statistical analysis included multi-and univariate ANOVA, Kruskal-Wallis-tests and correlation analysis.

Results

(i) In all UHR individuals (and also in the AS and BLIPS subgroup), NAA was reduced in the left Th. There was no alteration of Glu. While PCr was increased in the left DLPFC, left dACC (right trend) and in the right Hip, ATP was not different from controls. PME were decreased in the right Hip, PDE did not differ from controls. mI was found increased in the left Hip. (ii) In the GR subgroup PCr was increased in the bilateral Th. The PME metabolite Peth was decreased in the right Th. PDE were increased in the left dACC. mI was increased in the left Th.

Discussion

While the observed pattern of metabolite abnormalities in the AS and BLIPS risk group suggests a pathology that affects the left thalamus (NAA decrease), left DLPFC, dACC and bilateral Hip (left: PCr increase, PME decrease; right mI increase), the pathology of the GR group appears more focussed on the bilateral Th (bil. PCr increase, right PME decrease, left mI increase) and left dACC (PDE increase). The results suggest a functional disturbance of networks including the left DLPFC, dACC, bilateral Hip and Th, whereby the latter might be more an expression of a genetic risk profile.

]]>
<![CDATA[F89. COGNITIVE IMPAIRMENT WORSENING ACROSS AFFECTIVE TO PSYCHOSIS SPECTRUM: A COHORT STUDY OF UNIPOLAR/BIPOLAR DEPRESSION AND BIPOLAR SCHIZOAFFECTIVE DISORDERS]]> https://www.researchpad.co/product?articleinfo=5b586eb6463d7e489147c590

Abstract

Background

Bipolar (BPD), schizoaffective bipolar (SAM) and major depressive disorders (MDD) reveal large heterogeneity in terms of symptom expression, course and treatment response. This heterogeneity could be the source of a large variance of cognitive performance observed in these subjects. The aim of the present analyses was to compare the cognitive performance of patients with BPD, SAM, MDD and medical controls with adjustment for a comprehensive array of potential confounders. To go a step further we will simultaneously test the effects of multiple clinical characteristics including lifetime history and duration of psychotic symptoms, manic/hypomanic and depressive episodes, age of onset of disorder, current GAF score, time since remission of the last episode and presence of a depressive episode at the time of the assessment on the cognitive performance.

Methods

Data stemmed from the Lausanne-Geneva Family and High-Risk study. Patients with BPD (n=62), SAM (n=22) and MDD (n=51) were interviewed every three years over a mean duration of follow-up of 12 years. All patients were assessed clinically with the semi-structured Diagnostic Interview for Genetic Studies (DIGS). The cognitive assessment was made with the MATRICS and the Victoria Stroop Test.

Results

The global cognitive index (excluding Stroop result) shows that SAM subgroup had the lowest global score with 40.6 (SD=8.5), BPD 47.4 (SD=7.8) and MDD 49.7 (SD=8.7). A multiple linear regression accounting for several confounders such as comorbid psychiatric disorders and medication confirms that only SAM and BPD are statistically different from controls (p<0.001 and p<0.01 respectively). MDD did not differ from controls (p>0.05). Overall, patients with BPD or SAM but not with MDD showed poorer cognitive performance than controls in terms of the global score and speed of processing, verbal learning, working memory, visual learning, attention/vigilance and inhibition.

Discussion

Our data confirm cognitive impairment in patients with BPD or SAM compared to controls after adjustment for a comprehensive array of potential confounder variables. We were able to evaluate the specificity of cognitive performance of psychotic, maniac and depressive dimensions of the major mood disorders within the same sample. Furthermore, these data stress that the presence of the “schizo dimension” concomitant to mania and depression contributes to worsening the cognitive performance in an additive manner.

]]>
<![CDATA[T216. THE CULTURAL EXPERIENCES OF PATIENTS DIAGNOSED WITH SCHIZOPHRENIA IN SOUTH AFRICA]]> https://www.researchpad.co/product?articleinfo=5b586e7c463d7e489147c58f

Abstract

Background

Schizophrenia is a debilitating mental illness that affects people from all walks of life. Individuals attach meaning to their illness based on their cultural point of view; for some traditional black South Africans, causes of ill health are ascribed to culturally laden inferences. Some patients seek spiritual help before consulting medical doctors. This study aimed to explore how black South Africans diagnosed with schizophrenia experience their illness from their cultural point of view.

Methods

The study followed a hermeneutic phenomenological approach. In-depth interviews were conducted with three patients diagnosed with schizophrenia and on medication for their illness. Their stories were analysed using thematic content analysis.

Results

Five themes emerged during the study. Theme 1 related to Naming Things. The name given to their illness significantly affected the meanings that were attached to the illness. Theme 2 referred to Being Without. Losses as well as gains became apparent. Participants had lost their roles, independence and intimacy; however, they developed other coping strategies and some relationships became stronger. Theme 3 pertained to Connections and Disconnections. While participants were connected to their families and their community, they also felt disconnected due to the stigma perceived. Theme 4 was the theme of Being Spiritual. Spirituality played a vital role in how participants attached meaning to their illness, and it helped them to cope with challenges. Theme 5 was Rainbow after the Rain. The negative connotation of having a mental illness turned into personal, inter-personal and spiritual growth. The devastating illness became a gift to all participants; they demonstrated immense levels of resilience and they found their own way of being and relating.

Discussion

Culture played a crucial role during the initial stages of the illness; all participants sought spiritual help and it determined the meanings attached to the illness. This study proposes a need for mental health workers to explore the challenges that hamper openness within families and communities in order to lessen the perceived stigma experienced by the patients, and to acknowledge and encourage different coping and meaning-making structures, such as spirituality.

]]>
<![CDATA[30.2 GENETIC VARIATION RELATED TO IMMUNE FUNCTION AND SCHIZOPHRENIA RISK: EVIDENCE FOR EFFECTS ON COGNITION]]> https://www.researchpad.co/product?articleinfo=5b586ef0463d7e489147c591

Abstract

Background

Altered immune response is associated with many psychiatric disorders, but whether and how these changes confer increased risk remains unclear. In schizophrenia, robust association between illness risk and the MHC region general, and complement component 4 (C4) specifically, has been demonstrated, along with evidence from both gene enrichment and other genetic analysis highlighting the broader role of genetic variation in additional immune related networks to schizophrenia risk.

Methods

In a series of recent studies from our group, we examined the effects of immune-related genetic variation, based on gene ontology, implicated in neural function both behaviourally in samples of ~1200 cases and controls, and cortically in samples of ~150 cases and controls.

Results

We found that (1) increased predicted C4A RNA expression predicted poorer performance on measures of memory recall (p=0.016, corrected) and a pattern of reduced cortical activity in middle temporal cortex during a measure of visual processing (p<0.05, corrected); (2) variation in a curated gene set associated with both increased Schizophrenia risk and immune function (CSMD1, DPP4, SRPK2, TRIM8, STAT6, FES, EP300, TNFRSF13c) were associated with both variation in both episodic memory and general cognitive ability.

Discussion

Based on these findings we conclude that schizophrenia risk associated with variation within immune related genes is likely to be conferred at least partly via effects on cognition, and the molecular mechanisms involved may include effects on inflammatory response.

]]>
<![CDATA[F142. THE USE OF NEUROIMAGING MARKERS IN STRATIFIED DIAGNOSIS AND THERAPY OF SCHIZOPHRENIC AND AFFECTIVE DISORDERS]]> https://www.researchpad.co/product?articleinfo=5b586e43463d7e489147c58e

Abstract

Background

Neuroimaging techniques have been developed as important tools to investigate brain dysfunctions that underlie mental disorders. In particular, modern functional magnetic resonance imaging (fMRI) holds the promise to provide neurofunctional biomarkers for improved diagnosis, prognosis, and optimized treatment of schizophrenic and affective disorders.

Methods

Neurofunctional connectivity MRI using advanced experimental paradigms permits targeted investigation of the functional integrity of brain systems involved in the pathomechanisms of schizophrenic and affective disorders. From these investigations, pathophysiologically relevant neuroimaging biomarkers can be derived for differential diagnosis and tailored treatment selection.

Results

Possible neuroimaging biomarkers will be presented for the prediction of development and clinical course of schizophrenic and affective disorders as well as for the prediction of individual treatment responses. Further, recent neuroimaging findings on possible pathophysiological subtypes of schizophrenic and affective disorders will be discussed.

Discussion

These findings from functional neuroimaging studies may help to foster the development of precision medicine in psychiatry.

]]>
<![CDATA[16.2 CHILDHOOD TRAUMA ENGAGES OXIDATIVE STRESS, HIPPOCAMPUS ALTERATIONS, AND POORER CLINICAL OUTCOME IN EARLY PSYCHOSIS PATIENTS]]> https://www.researchpad.co/product?articleinfo=5b586c3c463d7e489147c585

Abstract

Background

Exposure to childhood trauma (CT) is a global major public-health and social-welfare problem worldwide. CT increases the vulnerability to major psychiatric conditions including psychosis and is associated with poorer clinical outcome. CT affects the development of brain structures such as hippocampus, possibly through oxidative stress and neuroinflammation, two mechanisms linked to psychosis. We therefore hypothesized that there is an interplay between oxidative stress and CT in psychosis patients. We thus explored in early psychosis patients the relationships between CT and i) hippocampal volume, ii) antioxidant systems; and iii) clinical and cognitive outcomes.

Methods

We studied a cohort of 118 early psychosis patients, 36 were exposed to CT (experiences of physical, sexual, or emotional abuse/neglect before16 years old). In a subgroup of 48 patients (18 CT), hippocampal volume was determined by MRI. Antioxidant systems were quantified in blood for the whole cohort. Markers were: glutathione peroxidases (GPx) activity which appeared as a peripheral correlate of brain GSH levels (Xin &al, 2016); peroxiredoxine levels (Prx); Thioredoxine (Trx). Psychopathology (PANSS) and neuropsychology (MCCB) were assessed. The various groups were segregated by linear discriminant analysis.

Results

The previously observed decreased hippocampal volume in patients and association of small hippocampal volume with high blood GPx activity (reflecting high oxidative status) (Baumann &al, 2016) was due to the contribution of the traumatized group. Indeed, this association was absent in the no-trauma group, suggesting that the smaller hippocampus is linked to a redox dysregulation. To explore that point further, four groups were then formed, according to trauma and oxidative status: (i) noCT-lowGPx, (ii) noCT-highGPx, (iii) CT-lowGPx and (iv) CT-highGPx. Group CT-highGPx only had smaller hippocampi.

In CT patients, small hippocampal volume was associated with high GPx activity, while hippocampal volume was similar in CT patients with low GPx activity (CT-lowGPx) and in patients not exposed to CT. Interestingly, other antioxidant defense systems such as Trx and oxidized Prx levels correlated negatively with GPx in CT-lowGPx group, suggesting that the Trx/Prx system is able to compensate for changes/decreases in GPx activity. Moreover, CT-lowGPx patients perform better than the other patients on speed of processing, verbal memory and attention tests.

In contrast, hippocampal volume was decreased in CT patients with high GPx activity (CT-highGPx) compared with CT-lowGPx patients and patients not exposed to CT. There was no correlation between GPx and Trx/Prx system in this group. CT-highGPx patients had more severe positive, negative and disorganized symptoms than the other patients.

Discussion

We report that traumatized psychosis patients with high peripheral oxidation status (high GPx) had smaller hippocampal volumes and more severe clinical symptoms, while those with lower oxidation status (low GPx) had better cognition and appear to activate a compensatory antioxidant regulation by the Trx/Prx system.

These results suggest that, in early psychosis patients, traumatic experiences during childhood interact with different redox systems and have long term neuroanatomical and clinical impacts. Therefore, redox pathways such as GPx, Trx and Prx systems represent important translational biomarkers for patient selection and stratification in order to aid in diagnostics and treatment decision at early stages of the disease.

]]>
<![CDATA[O6.8. GLUTAMATERGIC DYSFUCTION AND TREATMENT RESPONSE IN MINIMALLY TREATED AND CHRONIC SCHIZOPHRENIA PATIENTS]]> https://www.researchpad.co/product?articleinfo=5b586d5c463d7e489147c58a

Abstract

Background

Glutamatergic dysfunction as a result of NMDA receptor hypofunction has been implicated in antipsychotic treatment-resistant schizophrenia, however its nature in very early stages and chronic stages of the disease is still unknown. Data on glutamate and treatment response are currently limited in two separate studies, one in first-episode patients (Egerton et al., 2012) and one in chronic patients (Mouchlianitis et al., 2016). Here we acquired proton magnetic resonance spectroscopy measures from a large sample of minimally treated first episode and chronic schizophrenia patients, and a group of matched healthy controls. Both first-episode and chronic schizophrenia groups were further stratified by treatment response. This allowed us to investigate glutamatergic dysfunction in both early and later stages of the diseases in relation to treatment-response.

Methods

We acquired proton magnetic resonance spectroscopy (1H-MRS) at 3 Tesla from bilateral anterior cingulate cortex (ACC) from 170 participants. 137 participants with a diagnosis of schizophrenia (according to ICD-10 criteria) and 33 healthy controls matched for age, sex, and socioeconomic background consented to participate in this study. The patient sample included 95 minimally treated first-episode patients, with illness duration less than 36 months, of which 65 has shown good response and 26 have shown persistent psychotic symptoms; and a group of 42 chronically-ill patients with illness duration over 3 years. The chronic group was classified into 21 antipsychotic treatment-resistant patients and 21 antipsychotic treatment-responsive patients. 1H-MRS data were analyzed using a standard basis function within LC-Model. Our primary measure was glutamate to creatine ratio (Glu/Cre) and its correlation to N-Acetylaspartic acid to creatine ratio (NAA/Cre).

Results

The main new finding is that first-episode patients with persistent psychotic symptoms show significantly higher Glu/Cr and NAA/Cr correlation R(23)=0.76, P<0.001.compared to first-episode patients in remission R(65)=0.43, P<0.00, Fisher’s r-to-z, Z=1.97, P<0.05, effect size d=0.48. Compared to healthy controls (who did not show any Glu/Cr to and NAA/Cr correlation R(33)=0.24, P=0.33) the FEP-resistant group showed a significant difference, Z=2.6, P<0.005, representing a large effect size of d=0.87 but not the FEP-responsive group, Z=0.97, P=0.17. Remarkably, when we examined first-episode patients with antipsychotic exposure of less than 6 months, we found an extremely high correlation in the non-responsive group R(5)=0.95, P=0.01, compared to the responsive-group,R(20)=0.44, P<0.05, which reflected a large effect size of d=0.99. Chronically-ill resistant patients showed a significant correlation R(21)=0.48, P<0.05 and responsive trend-level correlation R(21)=0.41, P=0.07, but neither group differed from healthy controls.

Discussion

Our study provides the first 1H-MRS evidence for acute metabolic perturbations in glutamatergic neurotransmission in minimally treated schizophrenia patients with persistent psychotic symptoms. These are absent in later stages of the disease for both treatment-resistant and treatment-responsive patients. It is likely that neurodegenerative processes resulting from excitotoxity due glutamatergic dysfuntion are most impactful within the first few months from illness onset. Our data point to the urgent need to identify reliable biomarkers for the prediction of antipsychotic treatment-response and the development of novel interventions to address glutamatergic perturbations at the beginning of their illness.

]]>
<![CDATA[F2. CHILDHOOD TRAUMA AND LACK OF CULTURAL IDENTITY AS RISK FACTORS OF ATTENUATED PSYCHOSIS SYMPTOMS AMONG AFRICAN AMERICAN YOUNG ADULTS]]> https://www.researchpad.co/product?articleinfo=5b586c02463d7e489147c584

Abstract

Background

Schizophrenia spectrum diagnosis is more commonly assigned to African Americans. Failing to understand and appropriately manage cultural differences will have significant mental health consequences for varied racial/ethnic groups in particular (Betancourt, Green, & Carrillo, 2002). The purpose of the present study was to examine risk factors of attenuated psychosis syndrome in a sample of African American young adults, specifically to investigate whether lack of ethnic identity and adverse childhood experiences (ACEs) put an individual at a higher risk of developing attenuated psychotic symptoms.

Adverse Childhood Experiences (ACE) as Risk Factor of APS:

The Comorbidity Survey (NCS) Part 2 data showed that the effects of neglect and sexual abuse, along with physical abuse similarly put a child at risk for psychosis. People who had suffered childhood adversity were 2.8 times more likely to develop psychosis than those who had not. Studies have also begun to look at gender differences in schizophrenia by way of ACEs.

Lack of Ethnic Identity as Risk Factors of APS:

The African worldview reflects psychological communal, spiritual, collective survival thrust as opposed to the European worldview of individualism and materialism. Cultural Misorientation (CM) represents that foreign psychological or psychopathological disposition in the African personality, which allows African Americans to unknowingly value and participate in European cultural indoctrination through the practice of European cultural values, rituals, and customs. The purpose of this study was to explore the roles that CM play on the overall presentation of attenuated psychotic symptoms, by way of ACE exposure.

Methods

Participants: Participants included 304 African American college students, 199 (65.46%) women and 105 (34.54%) men from a Historically Black College and University in the southeastern region of the United States. Participants were between 18 and 25 years of age.

Instruments

Adverse Childhood Experiences Scale measures the association of multiple types of abuse with different types of health outcomes. Prodromal Questionnaire- Brief (PQ-B) measures the presence of negative symptoms, perceptual abnormalities such as hallucinations, and unusual thought content like delusional ideas and paranoia. Cultural Misorientation - Short Form assesses the condition of cultural misorientation across 6 subscales-- materialism orientation, individualism orientation, alien-self orientation, anti-self orientation, self-destructive orientation, and integration orientation.

Results

The Pearson correlation analysis indicated no significant relationship (r = -.073, p = .206) between ACE exposure and APS total scores on PQ-B. However, an unexpected negative significant relationship between childhood abuse exposures and symptom severity was observed (r = -.126*, p = .028), indicating that participants who reported more instances of childhood abuse tended to report less symptom severity. In addition, Cultural Misorientation (CM) was significantly positively correlated to PBQ total scores r = .194**, p = .001) and the severity of those symptoms (r = .171**, p = .003). CM materialism and individualism subscales mediated the relationship between childhood abuse and PQ-B total scores and symptom severity.

Discussion

This study provides support that some aspects of cultural misorientation can be detrimental to African Americans. Helping to reduce material and individualistic desires that have become detrimental should also be a central focus of implemented mental health programs.

]]>
<![CDATA[5.3 EVIDENCE ON A TRANSDIAGNOSTIC PSYCHOSIS SPECTRUM OF SCHIZOPHRENIA, SCHIZOAFFECTIVE AND PSYCHOTIC BIPOLAR DISORDER IN THE BIPOLAR-SCHIZOPHRENIA NETWORK ON INTERMEDIATE PHENOTYPES (B-SNIP)]]> https://www.researchpad.co/product?articleinfo=5b586b54463d7e489147c581

Abstract

Background

The validity of the classification of non-affective and affective psychoses as distinct entities has recently been disputed in light of calls for a dimensional and transdiagnostic approach to diagnostic classification and evidence on shared aetiological factors. Despite the shifts in view, there remains a dearth of empirical efforts to clarify and identify a transdiagnostic spectrum of psychosis. Our recent research has demonstrated evidence for a transdiagnostic psychosis spectrum as detailed in a bifactor model with one transdiagnostic symptom dimension and five specific symptom dimensions of positive symptoms, negative symptoms, disorganization, mania, and depression in patients with schizophrenia, schizoaffective and bipolar disorder. The aim of the current study was to investigate whether there is a transdiagnostic dimension cutting across symptoms of schizophrenia, schizoaffective disorder and psychotic bipolar I disorder using widely established measures for assessing psychosis, mania and depression in the large multi-centre Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium in the United States.

Methods

This study analysed data from the B-SNIP Phenotyping Consortium, which included 933 patients with a diagnosis of schizophrenia (n=397), schizoaffective disorder (n=224), and bipolar disorder (n=312). Multidimensional item-response modelling was conducted on symptom ratings of the Positive and Negative Syndrome Scale (PANSS), the Young Mania Rating Scale (YMRS), and the Montgomery-Åsberg Depression Rating Scale (MADRS) using the mirt package of the R environment.

Results

A bifactor model with 1 transdiagnostic symptom dimension and 5 specific symptom dimensions of positive symptoms, negative symptoms, cognitive disorganization, mania, and depression best matched the B-SNIP sample data. The bifactor model with 1 transdiagnostic factor and 5 specific factors based on the PANSS 5-factor solution by Emsley et al. (2003) provided the best model fit (AIC=53209.8, BIC=53920.0, aBIC=53443.7), as compared with a unidimensional model (AIC=55583.1, BIC=56151.3, aBIC=55770.2), a pentagonal model based on the PANSS 5-factor solution by Emsley et al.3 (AIC=53452.6, BIC=54068.1, aBIC=53655.3) as well as pentagonal and bifactor models of other previously reported factor solutions. When we extended analyses to include YMRS and MADRS, again, the bifactor model with 1 transdiagnostic factor and 5 specific factors, again, provided the best model fit.

Discussion

Consistent with our previous findings, this study provides evidence on a transdiagnostic symptom dimension that cuts across traditional diagnostic boundaries of schizophrenia, schizoaffective disorder and psychotic bipolar disorder using three widely established measures for assessing psychosis, mania and depression. The best-fitting, bifactor model also included 5 specific symptom dimensions based on the PANSS 5-factor solution by Emsley et al. (2003), which reflects a direct replication of our previous findings on the dimensionality of the PANSS. Overall, our findings lend further support to a transdiagnostic psychosis spectrum encompassing schizophrenia, schizoaffective and bipolar disorder as we have previously proposed.

]]>
<![CDATA[F223. COMPARATIVE STUDY OF HEART RATE VARIABILITY AND EMOTIONAL RESPONSE TO POSITIVE AND NEGATIVE AUDIOVISUAL STIMULATION IN PATIENTS WITH CHRONIC SCHIZOPHRENIA AND HEALTHY CONTROL]]> https://www.researchpad.co/product?articleinfo=5b586d95463d7e489147c58b

Abstract

Background

This study was to investigate the Heart Rate Variability(HRV) and emotional response to positive and negative audiovisual stimulation in patients with chronic schizophrenia and healthy control group

Methods

Among 253 chronic schizophrenic patients admitted in 00 Hospital in 00 city by psychiatrist, 104 patients were informed about this research and consented. Those who met this study criteria were randomly selected. 35 healthy control consisted of peoples that did not have past and present history of mental and physical illness. Positive and negative affect and HRV were compared between chronic schizophrenia and healthy control groups, and positive and negative affect and HRV to positive and negative audiovisual stimulation were measured according to planed research process. Positive and negative audiovisual stimulation was defined by an art therapy professionalist and a psychiatrist as 10 positive and negative pictures. 3 positive and negative musics were shown to two groups for 4 minutes simultaneously. Positive and negative audiovisual stimulation were shown to two groups during 1-week intermission. HRV was measured with Ubpulse H3, an equipment for autonomic nervous system test made by Laxtha company and also analyzed by frequency domain analysis. Emotional Empathy Scale(EES) and Positive Affect and Negative Affect Schedule (PANAS) of two groups were measured at baseline and after positive and negative audiovisual stimulation. Global Assessment of Functioning Scale(GAF) and Positive and Negative Syndrome Scale(PANSS) of chronic schizophrenia group were measured by a psychiatrist.

Results

1) Positive affect of patients group were significantly lower than control group, negative affect of patients group were significantly higher than control group. Low Frequency(LF), High Frequency(HF), and Total Power(TP) of HRV in patients group were significantly lowered than control group at baseline.

2) 7 subscales of emotional empathy scale were lowered in patients group compared to control group.

3) Positive affect of patients group was significantly less increased compared to the control group after positive audiovisual stimulation, negative affect of patients group was significantly less decreased to the control group after positive audiovisual stimulation.

4) Positive affect of patients group was increased after negative audiovisual stimulation, but positive affect of control group was significantly decreased compared to the patients group after negative audiovisual stimulation. There was no significant difference in negative affect between two groups after audiovisual stimulation.

5) LF of patients group was significantly higher than control group after positive audiovisual stimulation, HF and TP of patients group were significantly lowered than control group after positive audiovisual stimulation.

6) LF of patients group was significantly higher than control group after negative audiovisual stimulation, HF and PT of patients were significantly lowered than control group after negative audiovisaul stimulation.

Discussion

Patients with schizophrenia showed lower positive affect, higher negative affect, and lowered HRV parameters compared to the control group. They also showed lower empathy ability and inappropriate and non-contexual response. Schizophrenic patients represented hypersensitive sympathetic nervous system activity and lowered parasympathetic nervous system activity to the audiovisual stimulation. These results suggested that schizophrenic patients would show higher negative affect, less adaptive autonomic nervous system and hypersensitive or sharp to audiovisual stimulation, and decreased relaxation ability after stimulation. Audiovisual stimulation in integrative arts therapy program for schizophrenia might have avoid overactive sympathetic stimulation and recommend activate parasympathetic stimulation. Integrative art therapy for schizophrenia must be sufficiently relaxed, empathetic, and promote positive affect during therapeutic process.

]]>
<![CDATA[F22. DYSLIPIDEMIA AND INFLAMMATORY MARKERS IN RELATION TO CLINICAL SYMPTOMATOLOGY IN PSYCHOTIC DISORDERS]]> https://www.researchpad.co/product?articleinfo=5b586dcf463d7e489147c58c

Abstract

Background

Although the role of lipid disturbances and inflammation in psychotic disorders have been demonstrated in a substantial body of research, the association between clinical symptomatology and these two important pathways has not been studied in detail. The main aim of this study was to investigate the associations between serum lipid levels [total cholesterol (TC), low density lipoprotein (LDL), triglyceride (TG)]; general or specific inflammatory markers [C-reactive protein (CRP), soluble tumor necrosis factor receptor 1(sTNF-R1), osteoprotegerin (OPG), interleukin 1 receptor antagonist (IL-1Ra)]; and clinical symptoms (positive, negative and depressive) in patients with psychotic disorders.

Methods

The sample is consisted of 652 participants divided in two groups: Schizophrenia, schizophreniform and schizoaffective, (schizophrenia group, N = 344); psychosis NOS, psychotic bipolar I, II and NOS, (non-schizophrenia group, N = 308) recruited consecutively between 2003 and 2015 from five major hospitals in Oslo, Norway, as part of Thematically Organized Psychosis (TOP) Study. The Regional Committee for Medical Research Ethics approved the study. Demographic, clinical and medications data were obtained by clinical interviews and from medical records. SCID-I was used for diagnosis in addition to Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS) to assess symptoms severity. Bivariate and multivariate analyses were performed to evaluate associations between symptom profiles, lipid levels and inflammatory markers.

Results

Schizophrenia group showed higher levels of TC and LDL compared to non-schizophrenia group after adjusting for age, gender, BMI, smoking, and medications. TC and LDL were positively correlated with depression, whereas TG and LDL were positively correlated with negative symptoms. CRP and OPG were significantly associated with higher levels of TC and LDL. While, sTNF-R1 showed significant positive correlation only with TG. In multivariate regression, higher LDL was significantly associated with higher age, BMI, depressive severity in addition to two inflammatory markers CRP and OPG.

Discussion

The findings of this study highlight the importance of understanding the interaction between inflammatory markers and lipid, and their relation to clinical profile especially depression in psychotic disorders

]]>