Course Of Psychotic Disorders Research Articles

The clinical course of individuals with 22q11.2 deletion syndrome converting to psychotic disorders: a long-term retrospective follow-up.

This retrospective study aims to investigate the evolution and clinical course of psychotic disorders from three large international cohorts of individuals with 22q11.2 deletion syndrome (22q11.2DS) (Tel Aviv, Philadelphia, and Geneva). We followed 118 individuals with 22q11.2DS from several years before the onset to several years after the onset of psychotic disorders. Data from structured baseline assessment of psychiatric disorders, symptoms of prodrome, indicators and types of psychotic disorders were collected. Additionally, cognitive evaluation was conducted using the age-appropriate Wechsler Intelligence Scale. Electronic medical records were reviewed for medication usage, occupational status, living situation, and psychiatric hospitalizations. At baseline evaluation, the most common psychiatric disorders were anxiety disorder (80%) and attention/deficit hyperactivity disorder (50%). The age of onset of prodromal symptoms and conversion to psychotic disorders were 18.6 ± 6.8 and 20.3 ± 7.2, respectively. The most common prodromal symptoms were exacerbation of anxiety symptoms and social isolation. Of the psychotic disorders, schizophrenia was the most common, occurring in 49% of cases. History of at least one psychiatric hospitalization was present in 43% of participants, and the number of psychiatric hospitalizations was 2.1 ± 1.4. Compared to the normalized chart, IQ scores in our cohort were lower after vs. before conversion to psychosis. Following conversion there was a decrease in the use of stimulants and antidepressants and an increase in antipsychotics use, and most individuals with 22q11.2DS were unemployed and lived with their parents. Our results indicate that 22q11.2DS psychosis is like non-22q11.2DS in its course, symptoms, and cognitive and functional impairments.

Aberrant salience in cannabis-induced psychosis: a comparative study.

Natural Cannabis (NC) and Synthetic Cannabinoids (SCs) use can increase the risk and exacerbate the course of psychotic disorders. These could be influenced by the Aberrant Salience (AS) construct. It refers to an excess of attribution of meaning to stimuli that are otherwise regarded as neutral, thereby transform them into adverse, dangerous, or mysterious entities. This leads the patient to engage in aberrant and consequently incorrect interpretative efforts concerning the normal perception of reality and its relationship with our analytical abilities. AS appears to play a significant role in the onset and perpetuation of psychotic disorders. The internal conflict arising from aberrant attributions of significance leads to delusional thoughts, ultimately culminating in the establishment of a self-sustaining psychosis. To examine the differences between psychoses course not associated with cannabis use and those associated with NC-use and SCs-use, in terms of psychotic and dissociative symptoms, AS, global functioning and suicidal ideation. A sample of 62 patients with First Episode Psychosis (FEP) was divided into 3 groups: non cannabis users (non-users, N = 20); NC-users or rather Delta-9-tetrahydrocannabinol (THC) users (THC-users, N = 21); SCs-users, commonly referred to as SPICE-users (SPICE-users, N = 20). Each group underwent assessments at the onset of psychotic symptoms, as well as at the 3 months and 6 months marks, utilizing a range of psychopathological scales. These included the Positive and Negative Syndrome Scale (PANSS) for investigating psychotic symptoms, the Global Assessment of Functioning (GAF) scale for assessing overall functioning, the Dissociative Experiences Scale (DES-II) for measuring dissociative symptoms, the Scale for Suicide Ideation (SSI) for evaluating suicidal ideation and the Aberrant Salience Inventory (ASI) scale for gauging AS. SPICE-users showed more severe and persistent positive symptoms, while negative symptoms were mostly represented among non-users. Non-users showed better recovery than SPICE-users in global functioning. All groups showed a decrease in both ASI scores and subscale scores. SPICE-users exhibited higher global AS scores and less improvement in this aspect compared to other groups. This study may help understanding the role of AS in both non-substance-related and substance-induced psychosis. This knowledge may lead clinician to a better diagnosis and identify patient-tailored psychopharmacological treatment.

Clinical characteristics of psychotic disorders in patients with childhood trauma.

Childhood trauma is an important predictor of psychotic disorders, with special emphasis on physical and sexual abuse. It influences the clinical picture and course of psychotic disorders. This study was conducted in the Department of Psychiatry of the University Clinical Hospital Mostar. The sample consisted of 135 participants, aged 18 to 65 years. The screening instrument to examine cognitive status was the short version of MMSE-2. Patients' background information was collected using a sociodemographic questionnaire constructed for this study. To determine childhood trauma, the Child Abuse Experience Inventory was used to examine physical, sexual, and emotional abuse, neglect and domestic violence. The positive and negative syndrome scale scale was used to evaluate the clinical profile of psychoticism, the SSI questionnaire was used to evaluate the severity of suicidality, and the functionality of the participants was evaluated using the WHODAS 2.0. Results indicate that a significant number of participants with psychotic disorders experienced childhood trauma, an important determinant of their illness. Participants who had witnessed abuse had more severe clinical presentations (earlier onset and longer duration of illness) and more pronounced psychotic symptomatology and a lower degree of functionality. Decreased functionality is associated with witnessing abuse and physical abuse. During the civil war, a significant percentage of the participants were in childhood and adolescent development (26.7%) and exposed to frequent emotional abuse and domestic violence. As 1 traumatic event in childhood makes a person more susceptible to more traumatic experiences during life. Childhood trauma is a serious and pervasive problem that has a significant impact on the development, course, and severity of the clinical presentation of psychotic disorders. Accordingly, it is necessary to provide continuous education to mental health workers, primarily psychiatrists, regarding childhood trauma so that treatment may be approached more systematically and a plan of therapeutic interventions may be more adequately designed, which would necessarily include psychosocial support in addition to pharmacotherapy.

73 Identification of 24-Month Cognitive Trajectories Among Clinical High Risk for Psychosis (CHR-P) Using Latent Class Mixture Modeling

Objective:Cohort studies demonstrate that people who later develop schizophrenia, on average, present with mild cognitive deficits in childhood and endure a decline in adolescence and adulthood. Yet, tremendous heterogeneity exists during the course of psychotic disorders, including the prodromal period. Individuals identified to be in this period (known as CHR-P) are at heightened risk for developing psychosis (~35%) and begin to exhibit cognitive deficits. Cognitive impairments in CHR-P (as a singular group) appear to be relatively stable or ameliorate over time. A sizeable proportion has been described to decline on measures related to processing speed or verbal learning. The purpose of this analysis is to use data-driven approaches to identify latent subgroups among CHR-P based on cognitive trajectories. This will yield a clearer understanding of the timing and presentation of both general and domain-specific deficits.Participants and Methods:Participants included 684 young people at CHR-P (ages 12–35) from the second cohort of the North American Prodromal Longitudinal Study. Performance on the MATRICS Consensus Cognitive Battery (MCCB) and the Wechsler Abbreviated Scale of Intelligence (WASI-I) was assessed at baseline, 12-, and 24-months. Tested MCCB domains include verbal learning, speed of processing, working memory, and reasoning & problem-solving. Sex- and age-based norms were utilized. The Oral Reading subtest on the Wide Range Achievement Test (WRAT4) indexed pre-morbid IQ at baseline. Latent class mixture models were used to identify distinct trajectories of cognitive performance across two years. One- to 5-class solutions were compared to decide the best solution. This determination depended on goodness-of-fit metrics, interpretability of latent trajectories, and proportion of subgroup membership (>5%).Results:A one-class solution was found for WASI-I Full-Scale IQ, as people at CHR-P predominantly demonstrated an average IQ that increased gradually over time. For individual domains, one-class solutions also best fit the trajectories for speed of processing, verbal learning, and working memory domains. Two distinct subgroups were identified on one of the executive functioning domains, reasoning and problem-solving (NAB Mazes). The sample divided into unimpaired performance with mild improvement over time (Class I, 74%) and persistent performance two standard deviations below average (Class II, 26%). Between these classes, no significant differences were found for biological sex, age, years of education, or likelihood of conversion to psychosis (OR = 1.68, 95% CI 0.86 to 3.14). Individuals assigned to Class II did demonstrate a lower WASI-I IQ at baseline (96.3 vs. 106.3) and a lower premorbid IQ (100.8 vs. 106.2).Conclusions:Youth at CHR-P demonstrate relatively homogeneous trajectories across time in terms of general cognition and most individual domains. In contrast, two distinct subgroups were observed with higher cognitive skills involving planning and foresight, and they notably exist independent of conversion outcome. Overall, these findings replicate and extend results from a recently published latent class analysis that examined 12-month trajectories among CHR-P using a different cognitive battery (Allott et al., 2022). Findings inform which individuals at CHR-P may be most likely to benefit from cognitive remediation and can inform about the substrates of deficits by establishing meaningful subtypes.

Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Survival of patients with severe mental disorders: Influence of social functioning.

Patients with severe mental disorders have a high risk of premature death due to the interaction of various factors. Social functioning is a strategic functional factor in understanding the course of psychotic disorders. Analyze the relationship between social functioning and its various dimensions and survival during a 10-year follow-up. The Social Functioning Scale (SFS) was administered to 163 close relatives of patients under treatment at a Community Mental Health Unit. Survival was described by Kaplan-Meier analysis and any differences in survival by level of social functioning were found by long-rank analysis. Finally, Cox regression was used to predict premature mortality. Significant differences in mortality were identified in the interpersonal behavior dimension of social functioning, while there were no significant gender or diagnostic differences in the rest of the dimensions. The interpersonal behavior dimension and age were found to be factors predicting premature death. These findings show the protective effect of social functioning retained by patients with psychotic disorders on their survival, and the need to apply evidence-based psychotherapy focused on recovery of social functioning in the early stages of the disorder.

Facial affect recognition in first-episode psychosis is impaired but not associated with psychotic symptoms

IntroductionSocial dysfunction is a key feature of psychotic disorders such as schizophrenia linked to disability. Less is known about social functioning in the early stages of the disorder and if there is an association to psychotic symptoms. AimsInvestigate if antipsychotic drug-naïve or briefly medicated individuals with first-episode psychosis (FEP), have impaired facial affect recognition (FAR) compared to control participants and if psychotic symptoms are associated with the FAR ability. MethodIndividuals with FEP (n = 67) and control participants (n = 51) performed a computer-aided FAR task on basic emotions. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Group performances were compared using age and gender as covariates. The associations between FAR and performance on the subscales of PANSS were analyzed. ResultsCompared to control participants, individuals with FEP were impaired in general FAR (Beta = -2.04 [95 % conf: -3.75/-1.62], p < 0.001) and FAR of negative emotions (Beta = -1.74 [95 % conf: -3.08/-1.22], p < 0.001), driven by difficulties in recognition of anger and disgust. In both groups, there was a pattern of mistaking negative emotions for other negative emotions. There were no significant group differences in FAR of happiness. No significant associations between FAR and psychotic symptoms were observed. DiscussionThe results indicate that FAR, an underlying mechanism of social functioning is impaired early in the course of psychotic disorders. Current findings do not support the hypothesis that misinterpretation of facial expressions in individuals with FEP underlies or contributes to symptoms of psychosis.

Insula volumes in first-episode and chronic psychosis: A longitudinal MRI study

BackgroundAlterations in insular grey matter (GM) volume has been consistently reported for affective and non-affective psychoses both in chronic and first-episode patients, ultimately suggesting that the insula might represent a good region to study in order to assess the longitudinal course of psychotic disorders. Therefore, in this longitudinal Magnetic Resonance Imaging (MRI) study, we aimed at further investigating the key role of insular volumes in psychosis. Material and Methods68 First-Episode Psychosis (FEP) patients, 68 patients with Schizophrenia (SCZ), 47 Bipolar Disorder (BD) patients, and 94 Healthy Controls (HC) were enrolled and underwent a 1.5 T MRI evaluation. A subsample of 99 subjects (10 HC, 23 BD, 29 SCZ, 37 FEP) was rescanned after 2,53 ± 1,68 years. The insular cortex was manually traced and then divided into an anterior and posterior portion. Group and correlation analyses were then performed both at baseline and at follow-up. ResultsAt baseline, greater anterior and lower posterior insular GM volumes were observed in chronic patients. At follow-up, we found that FEP patients had a significant GM volume increase from baseline to follow-up, especially in the posterior insula whereas chronic patients showed a relative stability. Finally, significant negative correlations between illness severity and pharmacological treatment and insular GM volumes were observed in the whole group of psychotic patients. ConclusionsThe longitudinal assessment of both chronic and first-episode patients allowed us to detect a complex pattern of GM abnormalities in selective sub-portions of insular volumes, ultimately suggesting that this structure could represent a key biological marker of psychotic disorders.

Environmental Risk Factors and Cognitive Outcomes in Psychosis: Pre-, Perinatal, and Early Life Adversity.

Risk for psychosis begins to accumulate as early as the fetal period through exposure to obstetric complications like fetal hypoxia, maternal stress, and prenatal infection. Stressors in the postnatal period, such as childhood trauma, peer victimization, and neighborhood-level adversity, further increase susceptibility for psychosis. Cognitive difficulties are among the first symptoms to emerge in individuals who go on to develop a psychotic disorder. We review the relationship between pre-, perinatal, and early childhood adversities and cognitive outcomes in individuals with psychosis. Current evidence shows that the aforementioned environmental risk factors may be linked to lower overall intelligence and executive dysfunction, beginning in the premorbid period and persisting into adulthood in individuals with psychosis. It is likely that early life stress contributes to cognitive difficulties in psychosis through dysregulation of the body's response to stress, causing changes such as increased cortisol levels and chronic immune activation, which can negatively impact neurodevelopment. Intersectional aspects of identity (e.g., sex/gender, race/ethnicity), as well as gene-environment interactions, likely inform the developmental cascade to cognitive difficulties throughout the course of psychotic disorders and are reviewed below. Prospective studies of birth cohorts will serve to further clarify the relationship between early-life environmental risk factors and cognitive outcomes in the developmental course of psychotic disorders. Specific methodological recommendations are provided for future research.

Pecularities of mental pathology at psychiatric patient with the comorbid somatic disorders

The paper presents the results of a comprehensive clinical and psychopathological examination of patients with schizophrenia comorbid with somatic pathology. The etiological factors and preconditions for the formation of schizophrenia combined with somatic pathology, general clinical and dynamic characteristics, and features of mental disorders, severity and specificity of clinical and psychopathological manifestations of schizophrenia are analyzed. It was found that the combination of schizophrenia with somatic diseases is more "malignant" variants of the course of psychotic disorders, including an increase in the number of hospitalizations, earlier manifestation, significant increase duration and greater severity of psychopathological symptoms.&#x0D; The specificity of mental disorders in patients with schizophrenia with somatic disorders was manifested by a predominance of disorders of sensation and perception in the form of senestopathy (schizophrenia with CVD and F 20 with obesity), hyperesthesia (schizophrenia with diabetes 2) and complex hallucinations.&#x0D; An important characteristic of mental disorders in patients with schizophrenia with somatic pathology is the presence of emotional disorders in the form of rigidity (in schizophrenia with CVD and obesity) and explosiveness (in schizophrenia with diabetes 2) emotional reactions, as well as depressive and anxiety (schizophrenia with CVD) and dysphoric (in schizophrenia with diabetes 2 and obesity) mood disorders. According to the frequency analysis of clinical-biological and social factors of formation, as well as features of clinical-psychopathological structure of schizophrenia in patients of the examined groups, diagnostic clinical-psychopathological signs (risk markers) of combination of schizophrenia with specific variants of somatic disorders are established.&#x0D; The obtained results show that the combination of schizophrenia with somatic disorders is reflected in the deepening and peculiarities of psychopathological symptoms, reducing the level of social realization of patients and requires the attention of clinicians in developing treatment strategies.

Impaired error-related processing in patients with first-episode psychosis and subjects at clinical high risk for psychosis: An event-related potential study.

Impaired event-related potential (ERP) indices reflecting performance-monitoring systems have been consistently reported in patients with schizophrenia. However, whether these impairments exist from the beginning of the early phase of psychosis, such as in first-episode psychosis (FEP) patients and individuals at clinical high risk (CHR) for psychosis, has not yet been clearly ascertained. Thirty-seven FEP patients, 22 CHR subjects, and 22 healthy controls (HC) performed a visual go/no-go task so that three ERP components associated with performance monitoring-error-related negativity (ERN), correct response negativity (CRN), and error positivity (Pe) -could be assessed. Repeated-measures analysis of variance (ANOVA) with age and sex as covariates was used to compare ERN, CRN, and Pe across the groups. Repeated-measures ANOVA with age and sex as covariates revealed that compared with HC, FEP patients and CHR subjects showed significantly smaller ERN amplitudes at the Fz (F=4.980, P=0.009) and FCz (F=3.453, P=0.037) electrode sites. Neither CRN nor Pe amplitudes showed significant differences across the FEP, CHR, and HC groups. These findings suggest that performance monitoring is already compromised during the early course of psychotic disorders, evident in FEP patients and CHR subjects, as reflected in the reduced ERN amplitude. Considering these findings, ERN could serve as a potential indicator of early-stage psychosis.

Rethinking the course of psychotic disorders: modelling long-term symptom trajectories.

The clinical course of psychotic disorders is highly variable. Typically, researchers have captured different course types using broad pre-defined categories. However, whether these adequately capture symptom trajectories of psychotic disorders has not been fully assessed. Using data from AESOP-10, we sought to identify classes of individuals with specific symptom trajectories over a 10-year follow-up using a data-driven approach. AESOP-10 is a follow-up, at 10 years, of 532 incident cases with a first episode of psychosis initially identified in south-east London and Nottingham, UK. Using extensive information on fluctuations in the presence of psychotic symptoms, we fitted growth mixture models to identify latent trajectory classes that accounted for heterogeneity in the patterns of change in psychotic symptoms over time. We had sufficient data on psychotic symptoms during the follow-up on 326 incident patients. A four-class quadratic growth mixture model identified four trajectories of psychotic symptoms: (1) remitting-improving (58.5%); (2) late decline (5.6%); (3) late improvement (5.4%); (4) persistent (30.6%). A persistent trajectory, compared with remitting-improving, was associated with gender (more men), black Caribbean ethnicity, low baseline education and high disadvantage, low premorbid IQ, a baseline diagnosis of non-affective psychosis and long DUP. Numbers were small, but there were indications that those with a late decline trajectory more closely resembled those with a persistent trajectory. Our current approach to categorising the course of psychotic disorders may misclassify patients. This may confound efforts to elucidate the predictors of long-term course and related biomarkers.

Childhood maltreatment and social functioning in psychotic disorders: a systematic review protocol

ABSTRACT Background: Childhood maltreatment (CM) is thought to play a key role in the etiology and course of psychotic disorders (PD). In addition, CM is related to neurobiological and clinical characteristics that can lead to poor social functioning. However, the extent to which CM and social functioning are directly associated in individuals with PD, is unclear. Therefore, we aim to systematically review the literature to provide an estimate on the strength of the association between CM and different domains of social functioning in PD and to summarize potential moderators and mediators of this association. Methods and analysis: To identify relevant studies, we will systematically search the following databases: Pubmed (Medline), PsycInfo, Embase, Web of Science (Core Collection), and Pilots (trauma), manually search reference lists and contact experts in the field. Studies will be included if they investigate and report on the association between CM (exposure) and social functioning (outcome) in adults with PD. Two independent reviewers will screen titles, abstracts and full texts according to eligibility criteria, perform data extraction and assess study quality according to a modified version of the Newcastle–Ottawa Scale. Analysis: Effect estimates will be pooled in a meta-analysis. Heterogeneity and publication bias will be assessed and the effects of potential moderators (genetic factors, type of diagnosis, duration of illness, type of CM and age at the time of CM exposure) will be analyzed using meta-regressions. Candidate moderators and mediators (neurocognition, cognitive schemas, comorbidities, stress sensitivity, attachment) will be also examined qualitatively. Ethics and dissemination: Because this review will make use of already published data, ethical approval will not be sought. This work has the potential to inform upcoming investigations on the association between the exposure to CM in PD and social functioning. PROSPERO registration number CRD42020175244.

Dynamic interplay between life events and course of psychotic disorders: 10-year longitudinal study following first admission.

Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders. However, the impact of LEs on specific symptoms - namely reality distortion, disorganization, negative symptoms, depression, and mania - remains unclear. Moreover, the differential effects of negative v. positive LEs are poorly understood. The present study utilizes an epidemiologic cohort of patients (N = 428) ascertained at first-admission for psychosis and followed for a decade thereafter. Symptoms were assessed at 6-, 24-, 48-, and 120-month follow-ups. We examined symptom change within-person and found that negative events in the previous 6 months predicted an increase in reality distortion (β = 0.07), disorganized (β = 0.07), manic (β = 0.08), and depressive symptoms (β = 0.06), and a decrease in negative symptoms (β = -0.08). Conversely, positive LEs predicted fewer reality distortion (β = -0.04), disorganized (β = -0.04), and negative (β = -0.13) symptoms, and were unrelated to mood symptoms. A between-person approach to the same hypotheses confirmed that negative LEs predicted change in all symptoms, while positive LEs predicted change only in negative symptoms. In contrast, symptoms rarely predicted future LEs. These findings confirm that LEs have an effect on symptoms, and thus contribute to the burden of psychotic disorders. That LEs increase positive symptoms and decrease negative symptoms suggest at least two different mechanisms underlying the relationship between LEs and symptoms. Our findings underscore the need for increased symptom monitoring following negative LEs, as symptoms may worsen during that time.

M136. PSYCHOSIS POLYRISK SCORE (PPS): IMPROVING DETECTION OF INDIVIDUALS AT-RISK AND PREDICTION OF CLINICAL OUTCOMES

BackgroundPrimary prevention in Clinical High Risk for psychosis (CHR-P) can ameliorate the course of psychotic disorders. Further advancements of knowledge have been slowed by the standstill of the field, which is mostly attributed to its epidemiological weakness. This underlies the limited identification power for at-risk individuals and the relatively modest ability of CHR-P interviews to rule-in a state of risk for psychosis. One potential avenue for improving identification of individuals at risk for psychosis is a Psychosis Polyrisk Score (PPS) integrating genetic and non-genetic risk and protective factors for psychosis. The PPS hinges on recent findings that risk enrichment in CHR-P samples is accounted for by the accumulation of non-genetic factors e.g. parental and sociodemographic risk factors, perinatal risk factors, later risk factors, and antecedents.MethodsA prototype of the PPS has been developed encompassing 26 non-genetic risk and protective factors, utilising Relative Risks (RR) from an umbrella review of risk and protective factors for psychosis onset in the general population. This was combined with prevalence data to ensure positive scores indicated increased psychosis risk and negative scores indicated decreased psychosis risk. To pilot this, patients referred for a CHR-P assessment (n=15) and healthy controls (n=66) were recruited and assessed with the PPS. Additionally, to investigate the range and distribution of these scores in the general population, 10,000,000 permutations were run utilising prevalence data to produce a simulated dataset.ResultsIn the simulated general population data, scores ranged from -15 (least risk, equivalent RR = 0.03) to 39.5 (highest risk, RR = 8912.51). 50% of individuals had an RR < 1 (PPS < 0), 26.7% of individuals had an RR > 3 (PPS > 5), and 2.7% RR > 30 (PPS > 15). Patients referred for a CHR-P assessment had higher PPS scores (median=9, IQR=12.75) than healthy controls (median=-1.75, IQR=8.875). PPS scores in the simulated general population dataset (median=0, IQR=9.5) were similarly lower than patients.DiscussionThe PPS has potential for improving identification of individuals at risk for psychosis. Its distribution in a simulated general population is reflective of expected psychosis risk, with the vast majority of people not being at-risk and very few being at high risk. In addition to supplementing current assessments for CHR-P, this could be implemented at an earlier stage to stratify individuals based on psychosis risk and inform prognoses and clinical decision-making. This promise warrants further research to ascertain its prognostic accuracy and optimal thresholds for clinical intervention.

M6. REDUCED READINESS POTENTIAL AS A NEUROPHYSIOLOGICAL CORRELATE OF SELF-DISTURBANCES IN EARLY–COURSE PSYCHOSIS: PRELIMINARY FINDINGS FROM A HIGH–DENSITY EEG STUDY

BackgroundSelf-disturbances reflect a core dimension of Schizophrenia that can be identified before disease onset and might underlie the development of typical psychotic symptoms. The Sense of Agency (SoA) can be conceptualized as the pre-reflective sensation of being the one who is causing or generating an action or thought. Passivity phenomena, such as the reported feeling and belief that one’s thoughts or actions are generated and/or controlled by an external agent, are exquisite examples of SoA disturbances observed in Schizophrenia. Despite intensive research, the neurobiological pathogenetic mechanisms underlying such disturbances remain unclear.Among several putative neurophysiological brain abnormalities, a reduction of the Bereitschaftspotential, also called pre-motor or Readiness Potential (RP), was described in chronic, medicated patients with Schizophrenia. Given its anticipation of voluntary movement by 1 – 2 seconds over the motor cortex and supplementary motor area contralateral to the effector, RP has previously been proposed to be a neural signature of volition to initiate movement. Interestingly, higher RPs among healthy subjects have been recently associated with stronger intentional binding, suggesting increased SoA in subjects exhibiting stronger premovement activity. The objective of our work was to study RP abnormalities in patients with a psychotic illness of recent onset and to relate them to self disturbances, in order to clarify the relationship between known neurophysiological and psychopathological abnormalities.MethodsWe employed high-density electroencephalography (64-channel BrainAmp, Brain Products GmbH, Gilching, Germany) to record scalp potentials during a self-paced movement task in a group of seven early–course psychosis patients (mean age = 24,5, range 20–33) and an equal group of age– and gender– matched (mean age =25,3, range 19 – 36) healthy control subjects. Patients were recruited during an acute stage of their disorder requiring hospitalization and were treated with low–dose atypical antipsychotics. Exclusion criteria included major medical or neurological illness affecting the CNS and any intellectual developmental disorder. Several parameters related to the elicited RP were recorded, including maximum amplitude and slope. The Examination of Anomalous Self Experience (EASE) scale was chosen to assess Self disturbances in the patient group by an experienced clinician who was blind to the neurophysiological outcome.ResultsRP was found to be reduced in patients, compared to healthy control subjects, in both its amplitude and slope (p < 0,005) despite comparable EMG activity. EASE scores of items ‘EASE-10’ (a comprehensive item that reflect most prototypically the disorders of self-experience) and ‘EASE-2’ (“Self-Awareness”) appeared to increase monotonically with the decrease of RP slope (p < 0,05).DiscussionOur preliminary data show that disturbances of RP are present since the early course of psychotic disorders. They also suggest that such abnormalities may reflect the severity of self-disturbances in these patients. If confirmed in a larger, medication-naïve samples, our findings might clarify the underlying neural mechanisms of such abnormalities and provide a solid basis for further investigation of RP disturbances as an early biological marker for Schizophrenia spectrum disorders.

T241. INCIDENCE AND SOCIO-DEMOGRAPHIC/CLINICAL CHARACTERISTICS OF PSYCHOTIC DISORDERS IN INDIA, NIGERIA AND TRINIDAD: PRELIMINARY BASELINE FINDINGS FROM INTREPID II

BackgroundThe incidence, presentation, and course of psychotic disorders are highly variable across populations. A recent review noted a lack of evidence from low- and middle-income countries in the global South, where around 85% of the world’s population lives. Robust population-based data from these contexts are needed to better understand the sources of variation in psychotic disorders. INTREPID II is a multi-country programme comprising incidence, case-control, and follow-up studies of psychotic disorders in three diverse catchment areas with populations at risk of ~ 500,000 in Tamil Nadu (India), Oyo state (Nigeria), and northern Trinidad. Here, using baseline data from the initial 15 months, we present findings on variations in incidence and clinical presentation.MethodsBaseline recruitment and assessment is ongoing. In each site individuals with an untreated psychotic disorder are identified through a comprehensive case detection system that includes professional, folk, and popular sectors. Inclusion criteria are age of 18–64, resident in catchment area, presence of a ICD-10 psychotic disorder, and no more than one continuous month of treatment with antipsychotic medication prior to the start of case identification. At baseline, detailed data on demographic and clinical characteristics and putative risk factors are collected using established tools.ResultsIn the first 15 months, we identified 614 cases (199 in India, 92 in Nigeria, and 264 in Trinidad).There was wide variation in where cases were identified: In India, 9% via professional services and 91% via the popular sector (i.e., in the community); In Nigeria, 33% via professional services and 63% via the folk sector (traditional and religious service providers); In Trinidad, 98% via professional services.Further, there were notable variations in incidence and sociodemographic and clinical characteristics. Age-adjusted rates were highest in Trinidad (men: 47.1, 95% CI 39.8–55.4; women: 38.7, 95% CI 32.0–46.3) compared with India (men: 23.0, 95% CI 18.4–28.4; women: 30.2, 95% CI 24.9–36.4) and Nigeria (men: 13.0, 95% CI 9.5–17.2; women: 12.4, 95% CI 9.0–16.6). The proportion with age of onset before 29 years was higher in Trinidad (74%) compared to Nigeria (45%) and India (36%).Among those on whom full data are currently available (n, 327), more in Nigeria were assigned a diagnosis of schizophrenia (63%) than in India (46%) and Trinidad (42%). Median duration of untreated psychosis was was longer in India (5.1 years, IQR 1.9–13.6) than in Nigeria (1.5 years, IQR 0.1–4.1) and Trinidad (2.6 years, IQR 0.3–15.2). However, an insidious onset (i.e., gradual emergence of symptoms over several months) was more common in Trinidad (50% of cases) than in India (28%) and Nigeria (14%).Education levels were lower in India (31% completed secondary education or higher) than in Nigeria (74%) or Trinidad (68%). However, the proportion of cases who were married or in a steady relationship was similar in all sites (India: 42%, Nigeria: 38%, Trinidad: 38%), as was the proportion who were unemployed (India: 48%, Nigeria: 55%, Trinidad: 51%).DiscussionIn initial analyses, we found evidence that the incidence and presentation of psychoses varied by site, findings that both further highlight the heterogeneity of psychoses across contexts and challenge assumptions about the basic epidemiology based on findings from the global North. For example, the data from our India site suggest higher rates among women and a later age of onset than commonly supposed. Our findings also show that many people with psychotic disorders in these settings are untreated for long periods, indicating an urgent need to develop more accessible services.

S44. NEUROBIOLOGICAL FINGERPRINTS OF COGNITIVE SUBTYPES IN RECENT ONSET PSYCHOSIS PATIENTS

BackgroundNeurocognitive impairment plays a central role in pathogenesis and course of psychotic disorders. Patients suffering from psychosis or psychosis-related diseases show general and specific neurocognitive impairments that often precede the onset of manifest symptoms. Neurocognitive impairments are frequently associated with reduced psychosocial functioning along with altered brain morphology and function. Quantifying neurocognitive heterogeneity in impairment in schizophrenia patients, cluster analytic approaches differentiated several cognitive subtypes, including a generally impaired and generally spared subgroup. An independent set of findings provided evidence that neurocognitive subgroups of cognitively spared and impaired SZ patients can also be differentiated based on their brain morphology. The current study aims to (1) subtype a first episode psychosis sample based on neurocognitive performance using cluster analysis and (2) investigate grey matter (GM) differences between the obtained cognitive subtypes and healthy volunteers.Methods121 recent onset-psychosis (ROP) patients and 201 healthy controls (HC) were recruited within the framework of the Personalized Prognostic Tool for Early Psychosis Management (PRONIA) project. Patients fulfilled DSM-IV-TR criteria of a first affective or non-affective psychotic episode in the last 3 month with onset in the last 24 months. Cognitive subtypes of the ROP patients were derived from 83 variables of 10 neurocognitive tasks using a kmeans clustering algorithm. A resampling approach implemented in R was used to assess the statistical stability of the results. Neuropsychological and clinical cluster characteristics were assessed using t tests. GM volume of the obtained patient clusters was compared by means of intracranial volume corrected t tests with age, sex and site matched HCs using SPM.ResultsThe analysis reveals a stable two-cluster solution: A higher cognitive performance cluster (HCP; N=71) and a lower cognitive performance cluster (LCP; N=39). Patients assigned to HCP performed significantly (p < 0.01) worse in 4 out of 10 neuropsychological tasks. Patients assigned to LCP performed significantly (p < 0.01) worse in 9 out of 10 neuropsychological tasks. LCP patients show significantly lower premorbid IQ (p < 0.001) and General Assessment of Functioning score (GAF; p < 0.01), lower occupational functioning (p < 0.01) and higher values on the negative component of the Positive and Negative Syndrom Scale (PANSS; p < 0.05). They show no demographical differences regarding age, sex, education years and study site. LCP patients reveal widespread GM reductions in bilateral temporal, parietal and frontal brain regions as compared to healthy controls. GM reductions of the HCP cluster are more restricted and evident in temporal, occipital regions and in the anterior cingulum.DiscussionTwo homogeneous, neurocognitive subgroups of patients suffering from a recent psychotic episode were identified and show distinctive psychopathological and neuroanatomical patterns. The obtained GM reductions in LCP go in line with the neuro-developmental origin of the disease affecting premorbid cognitive and occupational functioning as well as the STG which was reported to be decreased in the early course of the disease. Finding subgroups within early stage psychotic patients with minimal intake of antipsychotic medication, suggests different underlying patho(-physio)logical mechanisms predating manifest illness expression. This evidence offers the opportunity for personalizing interventions like neurocognitive trainings to enhance patients’ odds for recovery after psychosis.

S46. IMPAIRED ERROR-PROCESSING IN PATIENTS WITH FIRST-EPISODE PSYCHOSIS: AN EVENT-RELATED POTENTIAL STUDY

BackgroundImpaired error/conflict monitoring as reflected in the event-related potentials (ERPs) has consistently reported in patients with schizophrenia. However, whether this impairment exist from the early phase of psychosis such as first-episode psychosis (FEP) is not yet been clearly reported. To investigate the presence of error/conflict monitoring deficit in early psychosis, we examined the error-related negativity (ERN), error-related positivity (Pe), and correct-response negativity (CRN) during the Go/Nogo task in the patients with FEP.Methods25 patients with and 25 age, sex matched healthy controls (HCs) were participated in electroencephalographic recording during the Go/Nogo task. Trials with error response was analyzed to define ERN at Fz electrode site and Pe at Pz electrode site. Trials with correct response was used for CRN analysis at Fz electrode site. Independent samples t-test was used to compare the amplitudes of ERP components between FEP and HC groups. Pearson’s correlation analysis was performed to reveal the relationship of altered ERP component with symptomatic severity in patients with schizophrenia.ResultsFEP patients showed significantly smaller ERN amplitude at Fz electrode site compared to HCs (t=-3.294, p=0.002). However, there was no difference of CRN (t=0.017, p=0.986) and Pe (t=1.806, p=0.077) amplitudes between FEP and HC groups. There was no significant correlation of symptomatic severity and ERN amplitude at Fz electrode site in FEP patients.DiscussionThese findings suggest that impairments in error/conflict monitoring as reflected by ERN amplitude exist from the early course of psychotic disorder. Future study with larger sample size and subjects at earlier phase such as clinical high risk for psychosis would be needed to confirm the findings of current study.

Childhood maltreatment and treatment outcome in psychotic disorders: a systematic review and meta-analysis.

Childhood maltreatment (CM) plays an important role in the aetiology and course of psychotic disorders and is associated with characteristics that could be relevant for treatment. We aimed to conduct a systematic review and meta-analysis on the association between CM and treatment outcome in psychotic disorders. Treatment outcome was defined as change in psychotic symptoms or in social or occupational functioning between first and last reported measurement in the course of a pharmacological and/or psychological treatment. Twelve treatment results from seven studies (636 patients, average treatment duration: 59.2weeks) were included. CM was related to poorer treatment outcomes in psychotic disorders (OR=1.51, 95% CI=[1.08, 2.10]). There is evidence that this association might increase with illness duration and increasing age and might be stronger in schizophrenia samples. Childhood maltreatment is highly understudied with regard to treatment outcome in psychotic disorders. The need for more studies is emphasized by the fact that this meta-analysis reveals evidence for a poorer treatment response in patients with CM. If this association is confirmed, the identification of patients with CM and the consideration of associated clinical and biological conditions could contribute to improve treatment outcome in psychotic disorders.