Active Psychotic Symptoms Research Articles

The Online Support System for Mental Health Problems After the Earthquake: A Prompt Response from The Psychiatric Association of Turkey

IntroductionPrevious research demonstrated that disasters have adverse mental health outcomes. Preventive mental health interventions in the golden hours/days after a disaster may reduce psychological harm by getting in the way of emerging mental disorders or alleviating existing ones. The widespread use of smartphones and broad internet access enabled remote mental health interventions during disasters. After the 2023 Turkey earthquake, observing the mental health burden of the earthquake, The Psychiatric Association of Turkey conducted an online platform for psychological first aid. The aim was to unite volunteer psychiatrists and disaster survivors.ObjectivesThis study presents the organization of an online mental health service during a disaster while reporting the characteristics of the service users.MethodsThe Psychiatric Association of Turkey called its members to volunteer for an Online Support System for Mental Problems After the Earthquake. The group regularly united to set standards of care. An action plan and algorithm were set up for applicants with acute suicidal, homicidal risk, or active psychotic symptoms in collaboration with local institutions and field volunteers. Volunteer psychiatrists were asked to collect information on the applicant’s sociodemographic characteristics, disaster experience, and mental health status.ResultsVolunteer psychiatrists collected data on 180 applications. Most cases applied for themselves (%95.5), and some asked for advice to care for their relatives (%4.5). Earthquake survivors have the highest psychopathology rate (%64.9), followed by healthcare workers and search and rescue personnel (%61.1). Figure 1 summarizes the subgroups of the service users. The earthquake survivors group had a mean age of 34.45, % and 76.1 of them were female. Only %15.7 of them had lower educational levels than high school. %75 cases reached safe places on the 5th day of the disaster. Applicants reported discrimination and aggression after the catastrophe, related to experiencing mental health problems, owning a pet, looting, and being seen as less traumatized since their relatives are alive.Image:ConclusionsThe present experience of the Psychiatric Association of Turkey is an example of a fast and collaborative response to a disaster regarding mental health. Our results also represent the characteristics of online mental health service users during a disaster.Disclosure of InterestNone Declared

Mental Illness and Parricide. A Case Report of Patricide

According to world-wide statistics, schizophrenia is the most common mental illness identified in people who commit this type of murder. Also, there are slight associations between matricide which is often committed by the sons and patricide which is often committed by daughters. Most of the perpetrators in cases of parricide are under the age of 30, with adolescents covering a big part of the chart. The age of schizophrenic debut, the psychiatric and social attendance of the patients, the active psychotic symptoms, with hallucinations and paranoid persecution ideas but also, the affective inversion towards close friends and family members are frequently found in people who commit parricide. Also, psychotic symptoms and schizophrenia-like clinical aspects can appear in other mental disorders such as mental retardation, dementia or bipolar disorder. The subject is extremely complex as it has to be understood through the characteristics of the mental illness, the basic family relations, the personality of the victims, and last, but not least, the discernment issue that gives more heaviness to the juridical and social involvements of these cases. We hereby present the case of a 17-year-old girl, from the forensic psychiatric board, diagnosed with mental retardation and psychotic symptoms that murdered her father by multiple strikes in vital areas with blunt and sharp objects. We will assess the familial, social and psychological aspects of the case, revealing the implications of mental illness and forensic psychiatry in law enforcement and social services.

Association between early suicidal trajectories in first-episode psychosis and 10-year follow-up: TIPS registry-linked study

Although the risk of suicidality is high in first-episode psychosis, patterns and individual variability in suicidal thoughts and behaviours over time are under-researched. We aimed to identify early trajectories of suicidality over a 2-year follow-up, assess their baseline predictors, and explore associations between those trajectories and later suicidality. This longitudinal follow-up study was a part of the Early Treatment and Intervention in Psychosis (TIPS)study. Participants, linked to Norwegian and Danish death registries, were recruited from four catchment areas (665 000 inhabitants) in Norway and Denmark (both inpatient and outpatient). We included participants aged 15-65 years, with an intelligence quotient of more than 70, willing to give informed consent, and with a first episode of active psychotic symptoms. Individuals with comorbid neurological or endocrinal disorders, or those with contraindications to antipsychotics, were excluded. Growth mixture modelling was used to identify trajectories of suicidal thoughts and behaviours over the first 2 years. Multinomial logistic regression was applied to examine the baseline predictors of those trajectories and their associations with suicidality at 10-year follow-up. A total of 301 participants were recruited from Jan 1, 1997, to Dec 31, 2000. Of the 299 with completed suicidality data at baseline, 271 participated in 1-year follow-up, 250 in 2-year follow-up, 201 in 5-year follow-up, and 186 at 10-year follow-up. At baseline, 176 (58%) were male, 125 (42%) were female. The mean age was 27·80 years (SD 9·64; range 15-63). 280 (93%) participants were of Scandinavian origin. Four trajectories over 2 years were identified: stable non-suicidal (217 [72%]), stable suicidal ideation (45 [15%]), decreasing suicidal thoughts and behaviours (21 [7%]), and worsening suicidal thoughts and behaviours (18 [6%]). A longer duration of untreated psychosis (odds ratio [OR] 1·24, 95% CI 1·02-1·50, p=0·033), poorer premorbid childhood social adjustment (1·33, 1·01-1·73, p=0·039), more severe depression (1·10, 1·02-1·20, p=0·016), and substance use (2·33, 1·21-4·46, p=0·011) at baseline predicted a stable suicidal ideation trajectory. Individuals in the stable suicidal ideation trajectory tended to have suicidal thoughts and behaviours at 10-year follow-up (3·12, 1·33-7·25, p=0·008). Individuals with a worsening suicidal trajectory were at a higher risk of death by suicide between 2 and 10 years (7·58, 1·53-37·62, p=0·013). Distinct suicidal trajectories in first-episode psychosis were associated with specific predictors at baseline and distinct patterns of suicidality over time. Our findings call for early and targeted interventions for at-risk individuals with persistent suicidal ideation or deteriorating patterns of suicidal thoughts and behaviours, or both. Health West, Norway; the Norwegian National Research Council; the Norwegian Department of Health and Social Affairs; the National Council for Mental Health and Health and Rehabilitation; the Theodore and Vada Stanley Foundation; the Regional Health Research Foundation for Eastern Region, Denmark; Roskilde County, Helsefonden, Lundbeck Pharma; Eli Lilly; Janssen-Cilag Pharmaceuticals, Denmark; a National Alliance for Research on Schizophrenia and Depression Distinguished Investigator Award and The National Institute of Mental Health grant; a National Alliance for Research on Schizophrenia & Depression Young Investigator Award from The Brain & Behavior Research Foundation; Health South East; Health West; and the Regional Centre for Clinical Research in Psychosis.

Acceptance and Commitment Therapy for individuals at risk for psychosis or with a first psychotic episode: A qualitative study on patients' perspectives.

The aim of this qualitative study is to explore patients' perspectives on Acceptance and Commitment Therapy for early stages of psychosis. Therefore, we interviewed participants of the INTERACT study, that quantitatively investigated Acceptance and Commitment Therapy in Daily Life (ACT-DL) in combination with treatment as usual, for early stages of psychosis, comparing it to treatment as usual. Within 6 months after finishing ACT-DL, we conducted semi-structured, individual interviews with 19 participants. All interviews were audio-recorded and transcribed. Thematic analysis was used for coding and analysis. Two overarching themes were formed: 'the meaning of ACT' and 'what to improve'. Considering the first, participants generally understood and connected with the meaning of ACT, noticing more awareness and acceptance of their thoughts and feelings, and living more in line with their personal values. The second theme included comments on the protocol not being personal or psychosis specific enough and some elements of ACT being too difficult to understand when having active psychotic symptoms. This study suggests that ACT is an acceptable and promising new form of treatment for early stages of psychosis, and it provides relevant information to further develop ACT for this group.

Clinical determinants of involuntary psychiatric hospitalization: A clinical profile approach.

The study examines the clinical determinants of involuntary psychiatric hospitalization. Specifically, it investigates whether distinct clinical profiles of hospitalized patients can be discerned, what other characteristics they are linked with, and which profiles predict involuntary admission. In this cross-sectional multicentre population study, data were collected for 1067 consecutive admissions in all public psychiatric clinics of Thessaloniki, Greece, during 12 months. Through Latent Class Analysis distinct patient clinical profiles were established based on Health of the Nation Outcome Scales ratings. The profiles were then correlated with sociodemographic, other clinical, and treatment-related factors as covariates and admission status as a distal outcome. Three profiles emerged. The "Disorganized Psychotic Symptoms" profile, combining positive psychotic symptomatology and disorganization, included mainly men, with previous involuntary hospitalizations and poor contact with mental health services and adherence to medication, indicating a deteriorating condition and chronic course. Τhe "Active Psychotic Symptoms" profile included younger persons with positive psychotic symptomatology in the context of normal functioning. The "Depressive Symptoms" profile, characterized by depressed mood coupled with nonaccidental self-injury, included mainly older women in regular contact with mental health professionals and treatment. The first two profiles were associated with involuntary admission and the third with voluntary admission. Identifying patient profiles allows the examination of the combined effect of clinical, sociodemographic, and treatment-related characteristics as risk factors for involuntary hospitalization, moving beyond the variable-centered approach mainly adopted to date. The identification of two profiles associated with involuntary admission necessitates the development of interventions tailored to chronic patients and younger persons suffering from psychosis respectively.

Long-lasting leukocytosis in patients with schizophrenia treated with clozapine after electroconvulsive therapy : ECT stabilizes white blood cell count.

The present study was conducted to investigate the possible hematologic impact of long-term electroconvulsive therapy (ECT) in patients with drug-resistant schizophrenia and receiving clozapine therapy. In this retrospective study, clinical charts of 57 hospitalized patients with schizophrenia who required clozapine therapy because of active psychotic symptoms resistant to other antipsychotics were examined. For 18 who underwent ECT, the first assessment was conducted at the end of that therapy (average two months after start, 7.68 sessions) and the second two months later. As for the 39 patients who did not undergo ECT, the first and second assessment points were at two and four months, respectively, after a randomly chosen time point. Multiple regression analysis revealed that modified ECT (m-ECT) (ß = 0.346, p = 0.005), gender (males showed greater increase) (ß = 0.273, p = 0.023), and disease duration (longer associated with greater increase) (ß = 0.258, p = 0.033) were correlated with a change in white blood cell (WBC) count (ΔR2 = 0.277, p < 0.001) at the first assessment point. At the second assessment point, multiple regression analysis showed that m-ECT (ß = 0.262, p = 0.039), gender (males showed greater increase) (ß = 0.264, p = 0.036), and disease duration (longer associated with greater increase) (ß = 0.234, p = 0.068) were again correlated with changed WBC count (ΔR2 = 0.203, p < 0.007). An increase in leukocytes may have a protective influence against the adverse myelosuppressive effects of clozapine. However, a simple mobilization of leukocytes from bone marrow to peripheral circulation may not enhance the immune system, leading to only a masking of the effects of a potential immuno-insufficient state in the treated patient. In either case, should leukocytosis be induced and then remain for an extended period, hematologists, as well as psychiatrists involved in electroconvulsive intervention for clozapine-treated patients, must keep this factor in mind.

Characterizing speech heterogeneity in schizophrenia-spectrum disorders.

Schizophrenia-spectrum disorders (SSD) are highly heterogeneous in risk factors, symptom characteristics, and disease course outcome. Although speech anomalies have long been recognized as a core symptom of SSD, speech markers are an unexplored source of symptom heterogeneity that may be informative in recognizing relevant subtypes. This study investigated speech heterogeneity and its relation to clinical characteristics in a large sample of patients with SSD and healthy controls. Speech samples were obtained from 142 patients with SSD and 147 healthy controls by means of open-ended interviews. Speech was analyzed using standardized open-source acoustic speech software. Hierarchical clustering was conducted using acoustic speech markers. Symptom severity was rated with the Positive and Negative Syndrome Scale, and cognition was assessed with the Brief Assessment of Cognition for Schizophrenia. Three speech clusters could be distinguished in the patient group that differed regarding speech properties, independent of medication use. One cluster was characterized by mild speech disturbances, while two severely impaired clusters were recognized (fragmented speakers and prolonged pausers). Both clusters with severely impaired speech had more severe cognitive dysfunction than the mildly impaired speakers. Prolonged pausers specifically had difficulties with memory-related tasks. Prolonged pausing, as opposed to fragmented speaking, related to chronic active psychosis and refractory psychotic symptoms. Based on speech clustering, subtypes of patients emerged with distinct disease trajectories, symptomatology, and cognitive functioning. The identification of clinically relevant subgroups within SSD may help to characterize distinct profiles and benefit the tailoring of early intervention and improvement of long-term functional outcome. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Challenges in Treating Cancer Patients With Unstable Psychiatric Disorder.

In this review, we first present a case of chronic myeloid leukemia with acute psychosis, and then we will discuss the incidence of cancer in patients with psychotic disorders, the manifestations of new-onset psychosis, and the prevalence of preexisting psychosis in cancer patients, coupled with their impact on the treatment, diagnosis, and prognosis of cancer. This was a case that presented with acute psychosis and was found to have an elevated white blood cell count upon admission to an inpatient psychiatric unit. He was diagnosed with chronic myeloid leukemia and successfully managed with imatinib/dasatinib therapy. Psychiatrically, he was stabilized on two long-acting injectable medications to help maintain adherence. We were able to eliminate his active psychotic symptoms and return him to normal functioning in affect and thinking, achieving sustained compliance with treatment. We identified multiple inconsistencies in screening for cancer of all types in these patients, masking of signs and symptoms that would typically clue physicians to the presence of cancers, underreporting of symptoms, and disparate access to healthcare resources in patients with mental disorders when compared to the general population. Treatment of cancer in these patients as compared to the general population has also been shown to be incongruent, which will be elaborated upon. Psychiatric interventions, as well as supportive measures, for treating patients who are facing challenges during active cancer treatment will be discussed.

Violent behavior by involuntarily committed female offenders with mental disorders: A population-based case series.

The goal of the current study was to investigate the socio-demographic, psychiatric, and criminological characteristics of female violent offenders with mental disorders involuntarily committed to a forensic psychiatric hospital. The present study was a population-based retrospective case series including all female offenders with mental disorders found not guilty by reason of insanity by the criminal courts in the state of Rio de Janeiro, Brazil, and involuntarily committed to a forensic psychiatric facility (n=27). Patients were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders and the Positive and Negative Syndrome Scale. We found that most offenders were Afro-Brazilian, uneducated unmarried women. Schizophrenia with active psychotic symptoms was the most common clinical condition. Relatives were the frequent victims of aggressive behavior. Most patients had already been diagnosed with a mental disorder and placed under psychiatric treatment, but poor adherence and treatment dropout were common. Violent behavior in psychiatrically ill female patients is associated with a specific socio-demographic and clinical profile and is thus potentially amenable to prevention particularly if the mental health and social services are to provide the much-needed support for economically, socially, and psychologically vulnerable women.

Biopsychosocial factors associated with disordered eating behaviors in schizophrenia

BackgroundRecent hypotheses have suggested that schizophrenic patients are more likely to consume unhealthy foods, causing increased rates of mortality and morbidity associated with metabolic syndrome. This raises the need for more in-depth research on disordered eating behaviors (DEBs) in schizophrenic patients. This study, therefore, aimed to investigate biopsychosocial factors associated with DEBs in schizophrenia.MethodsIn this cross-sectional study, a total of 308 participants (including 83 subjects in the active phase of schizophrenia, 71 subjects in the remission phase of schizophrenia, and 154 control subjects) were recruited through convenience sampling among patients who referred to the Baharan Psychiatric hospital in Zahedan, Iran. Patients were assessed through Eating Attitudes Test (EAT-26), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), and Positive and Negative Syndrome Scale (PANSS). Data were analyzed using SPSS v25 software. Further, the statistical significance level was set at p < 0.05.ResultsThe prevalence of DEBs was 41.5% in schizophrenic patients (vs. 10.3% in the control group, p = 0.012). No significant difference was observed in the EAT-26 scores based on gender and phases of schizophrenia. According to multiple linear regression analysis, lack of psychosocial rehabilitation, use of atypical antipsychotics, early stages of psychosis, high level of anxiety and depression, expression of more active psychotic symptoms, tobacco smoking, and suffering from type 2 diabetes were all associated with increased development of DEBs among schizophrenic patients.ConclusionsSince the occurrence of DEBs is independent of different phases of schizophrenia, the risk of DEBs is required to be evaluated during the entire course of schizophrenia especially at earlier stages of schizophrenia. Moreover, the use of psychosocial interventions, treatment of affective disorders (i.e., anxiety and depression), antipsychotic medication switching, treatment of tobacco smoking and type 2 diabetes may reduce the risk of DEBs among schizophrenic patients. However, further investigations are required to prove the actual roles of the above factors in developing DEBs among schizophrenic patients.

Effect of collaborative care between traditional and faith healers and primary health-care workers on psychosis outcomes in Nigeria and Ghana (COSIMPO): a cluster randomised controlled trial

Traditional and faith healers (TFH) provide care to a large number of people with psychosis in many sub-Saharan African countries but they practise outside the formal mental health system. We aimed to assess the effectiveness and cost-effectiveness of a collaborative shared care model for psychosis delivered by TFH and primary health-care providers (PHCW). In this cluster-randomised trial in Kumasi, Ghana and Ibadan, Nigeria, we randomly allocated clusters (a primary care clinic and neighbouring TFH facilities) 1:1, stratified by size and country, to an intervention group or enhanced care as usual. The intervention included a manualised collaborative shared care delivered by trained TFH and PHCW. Eligible participants were adults (aged ≥18 years) newly admitted to TFH facilities with active psychotic symptoms (positive and negative syndrome scale [PANSS] score ≥60). The primary outcome, by masked assessments at 6 months, was the difference in psychotic symptom improvement as measured with the PANSS in patients in follow-up at 3 and 6 months. Patients exposure to harmful treatment practices, such as shackling, were also assessed at 3 and 6 months. Care costs were assessed at baseline, 3-month and 6-month follow-up, and for the entire 6 months of follow-up. This trial was registered with the National Institutes of Health Clinical Trial registry, NCT02895269. Between Sept 1, 2016, and May 3, 2017, 51 clusters were randomly allocated (26 intervention, 25 control) with 307 patients enrolled (166 [54%] in the intervention group and 141 [46%] in the control group). 190 (62%) of participants were men. Baseline mean PANSS score was 107·3 (SD 17·5) for the intervention group and 108·9 (18·3) for the control group. 286 (93%) completed the 6-month follow-up at which the mean total PANSS score for intervention group was 53·4 (19·9) compared with 67·6 (23·3) for the control group (adjusted mean difference -15·01 (95% CI -21·17 to -8·84; 0·0001). Harmful practices decreased from 94 (57%) of 166 patients at baseline to 13 (9%) of 152 at 6 months in the intervention group (-0·48 [-0·60 to -0·37] p<0·001) and from 59 (42%) of 141 patients to 13 (10%) of 134 in the control group (-0·33 [-0·45 to -0·21] p<0·001), with no significant difference between the two groups. Greater reductions in overall care costs were seen in the intervention group than in the control group. At the 6 month assessment, greater reductions in total health service and time costs were seen in the intervention group; however, cumulative costs over this period were higher (US $627 per patient vs $526 in the control group). Five patients in the intervention group had mild extrapyramidal side effects. A collaborative shared care delivered by TFH and conventional health-care providers for people with psychosis was effective and cost-effective. The model of care offers the prospect of scaling up improved care to this vulnerable population in settings with low resources. US National Institute of Mental Health.

Transdiagnostic Mobile Health: Smartphone Intervention Reduces Depressive Symptoms in People With Mood and Psychotic Disorders.

BackgroundDepression is the most prevalent mental health problem. The need for effective treatments for depression far outstrips the availability of trained mental health professionals. Smartphones and other widely available technologies are increasingly being leveraged to deliver treatments for depression. Whether there are patient characteristics that affect the potency of smartphone interventions for depression is not well understood.ObjectiveThis study aimed to evaluate whether patient characteristics including clinical diagnosis, depression severity, psychosis status, and current use of antidepressant medications impact the effects of an evidence-based smartphone intervention on depressive symptoms.MethodsData were collected as part of a 2-arm randomized controlled trial comparing a multimodal smartphone intervention called FOCUS with a clinic-based intervention. Here, we report on 82 participants assigned to 12 weeks of FOCUS treatment. We conducted assessments of depressive symptoms using the Beck Depression Inventory-second edition (BDI-II) at baseline, postintervention (3 months), and follow-up (6 months). We tested for differences in the amount of improvement in BDI-II scores from baseline to posttreatment and 6-month follow-up between each of the following patient subgroups using 2 (group) × 2 (time) mixed effects models: diagnosis (ie, schizophrenia spectrum disorder vs bipolar disorder vs major depressive disorder), depression severity (ie, minimal-mild vs moderate-severe depression), psychosis status (ie, presence vs absence of psychotic symptoms), and antidepressant use (ie, taking antidepressants vs not taking antidepressants).ResultsThe majority of participants were male (60%, 49/82), African American (65%, 53/82), and middle-aged (mean age 49 years), with a high school education or lower (62%, 51/82). There were no differences in patient demographics across the variables that were used to stratify the analyses. There was a significant group × time interaction for baseline depression severity (F1,76.8=5.26, P=.02 [posttreatment] and F1,77.4=6.56, P=.01 [6-month follow-up]). Participants with moderate or severe depression had significant improvements (t42=3.20, P=.003 [posttreatment] and t42=4.20, P<.001 [6-month follow-up]), but participants with minimal or mild depression did not (t31=0.20, P=.84 [posttreatment] and t30=0.43, P=.67 [6-month follow-up]). There were no significant group × time interactions for diagnosis, psychosis status, or antidepressant medication use. Participants with minimal or mild depression had negligible nonsignificant improvements (<1 point on the BDI-II). Reduction in depression in all other groups was larger (range 1.7-6.5 points on the BDI-II).ConclusionsOur results suggest that FOCUS can be deployed to treat moderate to severe depressive symptoms among people with schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder, in concert with antidepressant medications or without them, in both people with and without active psychotic symptoms. The study results are consistent with research on transdiagnostic models in psychotherapy and extend our knowledge about the potential of transdiagnostic mobile health.Trial RegistrationClinicalTrials.gov NCT02421965; http://clinicaltrials.gov/ct2/show/NCT02421965 (Archived by WebCite at http://www.webcitation.org/76pyDlvAS)

Psychiatrists' reflections on a medication-free program for patients with psychosis.

Based on a collective action from a number of Norwegian user organizations for mental health, the Norwegian government demanded the regional health authorities to establish a medication-free treatment option for patients with severe mental illnesses. This change in governmental health policy has several direct implications, including making antipsychotic medication to a greater extent optional for patients with active psychosis. The sim of this study was to investigate psychiatrists' reflections on the public medication-free program and how they think it will affect patients' adherence to antipsychotics generally. We used a thematic analytic approach within an interpretative phenomenological framework. Consecutively semi-structured qualitative interviews were conducted with 23 psychiatrists (16 female, with 4-35 years of specialist experience). Thematic analysis revealed four main interrelated themes. Psychiatrists considered medication-free treatment as an unscientific option for a stigmatized patient group; they believed that the advent of such a program is due to proposals from some dissatisfied users and their supporters and not from the majority of patients; in spite of active psychotic symptoms and lack of insight, patients had a crucial impact on choice of treatment and accordingly on adherence to medication; and psychiatrists reported that they in spite of governmental instructions utilized professionalism against unscientific ideology. Despite all the internal and external pressure that the psychiatrists reported being exposed to, this did not affect their professional integrity in medical decisions based on guidelines, expertise and research studies. They believed that this treatment option would exacerbate negative attitudes towards medication and further worsen already existing adherence issues.

Disease modifying effects of antipsychotic drugs in schizophrenia: a clinical and neurobiological perspective.

Disease modifying effects of antipsychotic drugs in schizophrenia: a clinical and neurobiological perspective.

T164. STRUCTURAL COVARIANCE IN DRUG-NAïVE FIRST EPISODE PSYCHOSIS: AN ULTRA-HIGH FIELD MRI STUDY

BackgroundStructural neuroimaging studies report disrupted morphological relationship in the grey matter volume (structural covariance) in patients with schizophrenia, indicating an impairment in functional and/or developmental plasticity. To our knowledge, no studies have examined the alterations in structural covariance across the entire brain in drug-naïve first episode psychosis. TOPSY (Tracking Outcomes of Psychosis) is one of the first studies intending to track the neurobiological trajectory using ultra-high field (7T) imaging starting from a drug-naïve first episode state. Here, we report the initial findings from the structural covariance of grey matter volume. To our knowledge, this is the first structural covariance analysis being reported using a 7T anatomical MRI acquisition.MethodsWe used ultra-high field (7 Tesla) MRI in 28 patients with FEP (satisfying criterion A of DSM-5 schizophrenia) and 18 controls, to estimate grey matter volume in a voxelwise manner. FEP and controls were matched for age, sex and parental socioeconomic status. Patients were recruited at an early intervention unit (PEPP, London Ontario) and had active psychotic symptoms at the time of scanning. Morphometric analysis was done using SPM12, after DARTEL based registration and segmentation but without spatial smoothing on 160 brain regions (6mm spheres) obtained using Dosenbach’s atlas. Correlation matrix for each group was constructed from 160*160 pearson correlation coefficients, followed by estimation of a bias matrix for each subject using jack-knife bias estimation. Bias values for each pair of nodes in an individual subject quantified the contribution of that subject to the overall within-group covariance. Higher positive values meant greater covariance between the two given nodes in that subject, relative to the rest of the group. These bias matrices can be considered equivalent to demeaned and normalised matrices of structural covariance. Structural covariance across all possible regional pairwise connections was tested using 2-tailed voxelwise T-test with FDR correction (p=0.05, 5% rate for false positives).ResultsPatients had a significant reduction in structural covariance affecting between right posterior insula and right precentral gyrus (within sensorimotor network, t=3.86, Hedge’s g = 1.15); between right posterior insula and left ventral prefrontal cortex (between sensorimotor and salience network, t=3.71, Hedge’s g = 1.10); and between right anterior cingulate cortex and right dorsal prefrontal cortex (between sensorimotor and default-mode network, t=3.10, Hedge’s g = 0.92). There were no pairwise connections with increased structural covariance among FEP subjects compared to healthy controls.DiscussionOur findings suggest that (1) structural covariance is disrupted even by the time of first-episode of psychosis; thus, the disruptions in morphological relationships reported in schizophrenia are not explicable by antipsychotic usage or illness duration (2) sensorimotor network regions show a predominant disruption in structural covariance, affecting morphological relationships with both salience and default mode regions. The functional and developmental plasticity of sensorimotor networks may be crucial for the early trajectory of psychosis.

T165. ULTRA-HIGH FIELD MORPHOMETRY IN DRUG-NAïVE FIRST EPISODE PSYCHOSIS

BackgroundStructural neuroimaging studies report distributed grey matter volume (GMV) deficits in drug-naïve first episode psychosis (FEP), though their relevance to symptom burden and cognitive deficits is currently unclear. When compared to studies in medicated patients and/or patients with established later-stage of psychosis, the GMV deficits reported have been limited in both spatial distribution and effect size, indicating the possibility of stage-specific progression during the clinical course of psychosis. TOPSY (Tracking Outcomes of Psychosis) is one of the first studies intending to track the neurobiological trajectory using ultra-high field (7T) imaging starting from a drug-naïve first episode state. Here, we report the initial findings from the voxel-based morphometry (VBM) of GMV. To our knowledge, this is the first VBM report from drug-naïve FEP subjects obtained using a 7T MRI acquisition.MethodsWe used ultra-high field (7 Tesla) MRI in 28 patients with FEP (satisfying criterion A of DSM-5 schizophrenia) and 18 controls, to evaluate differences in the grey matter. Volume in a voxelwise manner. FEP and controls were matched for age, sex and parental socioeconomic status. Patients were recruited at an early intervention unit (PEPP, London Ontario) and had active psychotic symptoms at the time of scanning. We also obtained abbreviated PANSS (8 items) scores to index the severity of psychosis. Analysis was done using SPM12, after DARTEL based registration and segmentation but without spatial smoothing. 2-tailed voxelwise T-test with FDR correction (p=0.05, 5% rate for false positives) was used. We used multiple regression analysis to predict the scores from processing speed measure (modified Symbol Substitution Test) and the severity of Delusions and Unusual Thought Content (P1 and G9), the 2 symptoms for which most subjects sought treatment in the first place.ResultsPatients had a significant reduction in GMV in left fusiform gyrus (Hedge’s g = 1.98, T= 6.7), and increased GMV in the right precuneus (Hedge’s g = 1.63, T= 5.5) and lingual cortex (Hedge’s g = 1.19, T= 4.0). We did not find any other areas of significant GMV change. Of these 3 circumscribed GMV changes, reduced fusiform GMV was found among FEP patients with lower processing speed (ß=0.45, p=0.04), higher severity of delusions (ß=-0.43, p=0.049) and unusual thought content (ß=-0.59, p=0.01). Increased precuneus GMV was found among FEP patients with higher severity of delusions (ß=0.62, p=0.008) and unusual thought content (ß=0.50, p=0.03). Right lingual changes were not related to the severity of delusions or processing speed scores.DiscussionOur findings suggest that (1) GMV deficits are minimal in drug-naïve FEP subjects, with large effect-size changes concentrated around face processing (fusiform) region (2) GMV increases co-occur with GMV reduction especially in those with most severe delusions and cognitive deficits indicating a role for compensatory plasticity. Subtle early brain structural changes appear to predict symptom burden and cognitive deficits at the time of first clinical presentation with psychosis. Focusing on treatments that manipulate the structure of fusiform cortex could potentially reduce the severity of some of the early symptoms in FEP.

F169. BRAIN CONNECTIVITY DURING PSYCHOLOGICAL STRESS IN PATIENTS WITH SCHIZOPHRENIA

BackgroundIt is commonly accepted that in most patients with schizophrenia external factors act on genetic predisposition to produce active psychotic symptoms. In fact, we showed that patients with schizophrenia have an abnormal brain activation and peripheral autonomic response to psychological stress. We sought to characterize the brain connectivity networks of such response in schizophrenia.MethodsWe studied the pattern of brain connectivity in relation to mental arithmetic stress paradigm in 21 patients and 21 healthy subjects aged 18 to 50 years, using 3T-fMRI. A period of 6 minutes of resting state acquisition (PRE) were followed by a block design with three 1-minute CONTROL task (one digit sum), 1 minute STRESS task (two digit subtraction) and 1 minute rest after task (POST). Pairwise Pearson correlations were calculated between 90 regions of interest. Data were analyzed with MATLAB and SPSS software.ResultsPatients with schizophrenia showed a lower connectivity network between fronto-temporal limbic areas compared with control subjects during control and stress task.Moreover, we observed a great variability of link density during resting state in patients but not in controls, and it diminishes in response to task.DiscussionPatients present abnormalities in networks related to stress response showing an alteration in fronto-temporal connectivity, and a poor and random modulation of these networks at rest. Current and previous findings suggest abnormal fronto-temporal connectivity that ultimately would lead to psychotic symptoms emergency in response to an environmental stressor and, even, could be related to hypervigilance and misattribution feeding into the paranoid cognition characteristic of patients with schizophrenia.

Duration of active psychosis and functional outcomes in first-episode non-affective psychosis

BackgroundThe duration of untreated psychosis (DUP) has been associated with negative outcomes in psychosis; however, few studies have focused on the duration of active psychotic symptoms after commencing treatment (DAT). In this study, we aimed to evaluate the effect of DUP and DAT on functional long-term outcomes (3 years) in patients with early psychosis. MethodsWe evaluated the Scale for the Assessment of Positive Symptoms (SAPS) at frequent intervals for 3 years after presentation to determine the DAT for 307 individuals with first-episode psychosis together with DUP and clinical variables. The functional outcomes were assessed using the Disability Assessment Scale (DAS) at three years, and functional recovery was defined as minimal impairment and return to activity. Associated variables, DAT and DUP were included in logistic regression models to predict functional outcomes. Receiver operating characteristic curves and Youden’s index were applied to assess the best cut-off values. ResultsDAT, (Wald: 13.974; ExpB: 1.097; p < 0.001), premorbid adjustment, initial BPRS score, gender, age of onset and schizophrenia diagnosis were significant predictors of social functioning, whereas only premorbid adjustment (Wald: 11.383; ExpB:1.009), DAT (Wald: 4.850; ExpB: 1.058; p = 0.028) and education were significant predictors of recovery. The optimal cut-off of DAT for predicting social functioning was 3.17 months for DAT (sensitivity: 0.68; specificity: 0.64; Youden’s index: 0.314). ConclusionsDAT is strongly related to functional outcomes independent of the DUP period or other variables. As a modifiable variable, the reduction of the DAT should be considered a main focus of intervention from the onset of the illness to improve long-term outcomes.

The human cortex possesses a reconfigurable dynamic network architecture that is disrupted in psychosis

Higher-order cognition emerges through the flexible interactions of large-scale brain networks, an aspect of temporal coordination that may be impaired in psychosis. Here, we map the dynamic functional architecture of the cerebral cortex in healthy young adults, leveraging this atlas of transient network configurations (states), to identify state- and network-specific disruptions in patients with schizophrenia and psychotic bipolar disorder. We demonstrate that dynamic connectivity profiles are reliable within participants, and can act as a fingerprint, identifying specific individuals within a larger group. Patients with psychotic illness exhibit intermittent disruptions within cortical networks previously associated with the disease, and the individual connectivity profiles within specific brain states predict the presence of active psychotic symptoms. Taken together, these results provide evidence for a reconfigurable dynamic architecture in the general population and suggest that prior reports of network disruptions in psychosis may reflect symptom-relevant transient abnormalities, rather than a time-invariant global deficit.

Clinical Practice Guidelines for Management of Dementia.

Indian Psychiatric Society (IPS) published Clinical Practice Guidelines (CPGs) for management of dementia, in the year 2007. (http://www.indianjpsychiatry.org/cpg2007.asp). The current version of the CPG is an update of the earlier version of CPGs for management of dementia There were three separate CPGs for management of dementia, one each for Reversible Dementias, Alzheimer's Disease and Vascular Dementia, Please note that the present CPG on dementia deals all types of dementia together. The current version of the CPGs for dementia in elderly must be read in conjunction with the previous version of CPGs for dementia. The focus of the present CPG is to provide suggestions and clinical tips to differentiate dementia syndrome from other clinical conditions, identify the subtypes of dementia and then offer suggestions for management. These guidelines only provide a broad framework for assessment, management and follow-up of older people with dementia. While most of the recommendations are evidence based, these guidelines should not be considered as a substitute of professional knowledge and clinical judgment. The recommendations made as part of these guidelines should be tailored to address the clinical needs of the individual patient and the treatment setting.