Current Psychiatric Diagnosis Research Articles

The effect of comorbid medical and psychiatric diagnoses on chronic fatigue syndrome

Objective: To determine if presence of co-existing medically unexplained syndromes or psychiatric diagnoses affect symptom frequency, severity or activity impairment in Chronic Fatigue Syndrome.Patients: Sequential Chronic Fatigue Syndrome patients presenting in one clinical practice.Design: Participants underwent a psychiatric diagnostic interview and were evaluated for fibromyalgia, irritable bowel syndrome and/or multiple chemical sensitivity.Main Measures: Structured Clinical Interview [SCID] for DSM-IV; SF-36, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Short Form; Patient Health Questionnaire-8; Multidimensional Fatigue Inventory (MFI-20), CDC Symptom InventoryResults: Current and lifetime psychiatric diagnosis was common (68%) increasing mental fatigue/health but no other illness variables and not with diagnosis of other medically unexplained syndromes. 81% of patients had at least one of these conditions with about a third having all three co-existing syndromes. Psychiatric diagnosis was not associated with their diagnosis. Increasing the number of these unexplained conditions was associated with increasing impairment in physical function, pain and rates of being unable to work.Conclusions: Patients with Chronic Fatigue Syndrome should be evaluated for current psychiatric conditions because of their impact on patient quality of life, but they do not act as a symptom multiplier for the illness. Other co-existing medically unexplained syndromes are more common than psychiatric co-morbidities in patients presenting for evaluation of medically unexplained fatigue and are also more associated with increased disability and the number and severity of symptoms.Key messagesWhen physicians see patients with medically unexplained fatigue, they often infer that this illness is due to an underlying psychiatric problem.This paper shows that the presence of co-existing psychiatric diagnoses does not impact on any aspect of the phenomenology of medically unexplained fatigue also known as chronic fatigue syndrome. Therefore, psychiatric status is not an important causal contributor to CFS.In contrast, the presence of other medically unexplained syndromes (irritable bowel syndrome; fibromyalgia and/or multiple chemical sensitivity) do impact on the illness such that the more of these that co-exist the more health-related burdens the patient has.

Body dysmorphic disorder and major depressive episode have comorbidity-independent associations with suicidality in an acute psychiatric setting

BackgroundThis study sought to examine whether mood, anxiety, and obsessive-compulsive spectrum disorders have unique (comorbidity-independent) associations with suicidal thoughts and behaviors in an acute psychiatric population. MethodsPatients (N = 498) were evaluated during admission to a partial hospital. Semi-structured interviews were used to assess current psychiatric diagnoses and past-month suicidal ideation and suicidal behaviors (e.g., suicide attempts). ResultsAfter adjusting for age, gender and other psychiatric disorders, body dysmorphic disorder (BDD) had a significant association with suicidal ideation (odds ratio [OR] = 6.62; 95% CI, 1.92–22.79) and suicidal behaviors (OR = 2.45; 95% CI, 1.05–5.71). Similarly, major depressive episode was associated with suicidal ideation (OR = 3.00; 95% CI, 1.95–4.63) and suicidal behaviors (OR = 2.11; 95% CI, 1.12–3.98). When unipolar and bipolar depression were analyzed separately, unipolar depression was associated with suicidal ideation (OR = 1.82; 95% CI, 1.20–2.74), but not suicidal behaviors, whereas, bipolar depression was associated with suicidal ideation (OR = 2.71; 95% CI, 1.36–5.40) and marginally with suicidal behaviors (OR = 2.02; 95% CI, 0.99–4.13). Anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder were unrelated to suicidality in this sample after controlling for comorbid disorders. LimitationsCross-sectional design and a relatively small sample for analyses of low base-rate conditions. ConclusionsMajor depressive episode and BDD are unique markers of suicidality in an acute psychiatric setting. BDD is a common but often underdiagnosed condition, and clinicians should be aware of high rates of suicidality among these patients.

The association of resilience on psychiatric, substance use, and physical health outcomes in combat trauma-exposed military service members and veterans

ABSTRACT Objective: Although Combat exposure is associated with a range of psychiatric outcomes, many veterans do not develop psychopathology. Resilience is a multifaceted construct associated with reduced risk of distress and psychopathology; however, few studies have examined the relationship of resilience with a broader spectrum of health outcomes following combat exposure. It also remains important to determine the association of resilience above and beyond other documented risk and protective factors. Method: In a sample of combat-exposed veterans (N = 1,046) deployed to Iraq and Afghanistan, we examined a quantitative method for exploring relative psychological resilience (discrepancy-based psychiatric resilience; DBPR) and tested the hypothesis that resilience would be associated with reduced risk for psychiatric diagnosis count, substance use, and physical health outcomes, above and beyond other known correlates (e.g. combat exposure, social support). Results: In the final model, results suggested an inverse association of discrepancy-based psychiatric resilience with current psychiatric diagnosis count (β = −0.57, p < .001), alcohol use (β = −0.16, p < .001), drug use (β = −0.13, p < .001), and physical health concerns (β = −0.42, p < .001) after accounting for other relevant risk and protective factors. Conclusions: Results extend the nomological net of this quantitative resilience construct to include other relevant health outcomes, and demonstrate that resilience may have more of a buffering relationship with psychiatric and physical health concerns compared to substance use outcomes.

The prevalence and risk of DSM-IV axis I disorder in adults with early-life earthquake stress: A cross-sectional study

ObjectivesTangshan earthquake which had a magnitude of 7.8 killed approximately 250,000 people in China in 1976. In the present study, we sought to determine the prevalence and risks of mental disorders in adults who experienced earthquake as an infant or in the prenatal period. MethodsThis cross-sectional cohort study recruited participants based on the urban resident registry of Tangshan, Hebei province, 2013 using a multistage stratified cluster sampling method with selection probabilities proportional to size. We recruited subjects who were born between July 29, 1975 and April 28, 1978 that was one year before and 1.9 years after the occurrence of Tangshan Earthquake, respectively. Current psychiatric diagnoses and lifetime psychiatric diagnoses were obtained through the Structured Clinical Interview for DSM-IV Axis I Disorders Patient Research Version. Unconditional logistic regression analysis was performed to analyze risk factors of mental disorders. ResultsTotally1380 subjects were included with 392 subjects exposed to the earthquake in the fetal period, 399 subjects who experienced the earthquake during their infancy, and 589 subjects who had no exposure to the earthquake. Twenty-one (2.7%; current 1.9%) subjects exposed to earthquake were diagnosed with major depressive disorderversus 2.3% (current 1.5%) in the non-exposure group. Five (0.6%; current 0.6%) subjects with exposure to earthquake had bipolar disorder versus 0.9% in the non-exposure group.Thirteen (1.6%; current 1.6%) subjects with exposure to earthquake had schizophreniaversus 0.2% in the non-exposure group (P=0.006). Furthermore, 5.2% (current 3.7%) subjects with exposure to earthquake had anxiety disorders versus 5.7% (current 3.9%) in the non-exposure group. Moreover, 8.1% (current 7.0%)subjects with exposure to earthquake had alcohol use disorders versus 7.1% (current 5.3%) in the non-exposure group. Furthermore, the prevalence of schizophrenia of the prenatal exposure group (2.3%) was significantly higher than the other two groups (χ2 = 10.273, P = 0.006); however, no statistically significant difference was found in the current and lifetime prevalence of other DSM-IV axis I disorders among the three groups (P > 0.05). Our multivariate regression analysis showed that prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders. ConclusionAdults who were exposed to earthquake in the prenatal period had a significantly higher rate of schizophrenia than those who were not exposed or who experienced earthquake in their infancy. No statistically significant difference was found in the current and lifetime prevalence of other DSM-IV axis I disorders between those exposed and those not exposed to earthquake. Furthermore, prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders.

Current Pattern of Psychiatric Comorbidity and Psychotropic Drug Prescription in Child and Adolescent Patients.

Background: In recent years, patterns of the use of psychotropic drugs vary with increasing rates of psychiatric presentation and diagnosis in children and adolescents. Purpose: In this study, we aimed to investigate distributions of current psychiatric symptoms and diagnosis, patterns of the use of psychotropic drugs, and differences according to age and gender in patients presented to a child and adolescent outpatient clinic. Methods: All patients aged between 0 and 18 years presenting to a child and adolescent psychiatry outpatient clinic between November 1, 2017 and November 1, 2018 were included in the study. Files of all patients were examined in detail, and patients’ demographic characteristics, symptoms, psychiatric diagnoses established according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), psychotropic drugs initiated, and side effect profiles were recorded. Psychiatric symptoms and diagnostic features of the patients were determined, and the differences were investigated according to gender. Clinical characteristics were compared between diagnosed and undiagnosed patients, and between patients with and without drug initiation. Results: Of the 2066 patients, 1298 (62.8%) were male and the mean age was 10.14 ± 4.42 years. The most common symptoms were hyperactivity (23.8%) and inattention (21.6%) in males, inattention (15.1%) and irritability (14.2%) in females, and 79% of the patients received one or more psychiatric diagnoses. The most common psychiatric diagnoses in both genders were attention-deficit hyperactivity disorder (ADHD), specific learning disorder (SLD), and conduct disorder, respectively. Of the patients who received a psychiatric diagnosis, 61.8% were using psychotropic drugs, with the majority of them (71.3%) receiving monotherapy. The most frequently initiated drugs included psychostimulants, antipsychotics, and antidepressants, with 28.7% of the drug user patients receiving multiple drug therapy. Conclusion: Our study indicates that rate of presentation to child and adolescent psychiatry outpatient clinics is increasing, and rates of diagnosis and initiation of psychiatry drugs are high among the presented children. The prevalence of ADHD shows an increase in males and females in our country, and psychiatric polypharmacy has reached significant rates.

Psychopathology and female detention at the “Pagliarelli” jail of Palermo: preliminary results

Most of the studies carried out on prisoners have considered male samples or they investigated specific psychiatric disorders. The present study aims to estimate the presence of current and lifetime psychiatric disorders among female inmates. Secondary aims are to evaluate the correlation between a current psychiatric disorder and other variables, and the association with a psycho-pharmacotherapy and a request for a clinical psychological interview. The study included 25 women with a final sentence at the “Casa Circondariale Pagliarelli” from October 2016 to July 2017. The Mini International Neuropsychiatric Interview (MINI) was used to assess the presence of any current or lifetime psychiatric disorder. Exact two-side Fisher test and independent samples Mann-U-Whitney test were used when appropriate to compare characteristics of people with and without a current or lifetime psychiatric history. Eleven inmates presented a psychiatric disorder at the time of the interview, nine of them had a history of past diagnosis. These percentages are higher than that expected in the general population but are lower than those found in previous studies on larger male samples. A major depressive disorder was predicted by a more extended period spent in prison, away from loved one people. Almost the totality of women with a current psychiatric diagnosis asked for psychological support and took medications, especially benzodiazepines alone or in combination with other drugs. The study suggests the need to determine the specific characteristics that differentiate men from women in the adaptation to the custodial regime. Keywords: female detention, prevalence, prison, psychiatric symptoms

Longitudinal changes in neuroimaging and neuropsychiatric status of post-deployment veterans: a CENC pilot study

ABSTRACTPrimary objective: The purpose of this study was to evaluate preliminary data on longitudinal changes in psychiatric, neurobehavioural, and neuroimaging findings in Iraq and Afghanistan combat veterans following blast exposure.Research design: Longitudinal observational analysis.Methods and procedures: Participants were invited to participate in two research projects approximately 7 years apart. For each project, veterans completed the Structured Clinical Interview for DSM-IV Disorders and/or the Clinician-Administered PTSD Scale, Neurobehavioral Symptom Inventory, and magnetic resonance imaging (MRI).Main outcomes and results: Chi-squared tests indicated no significant changes in current psychiatric diagnoses, traumatic brain injury (TBI) history, or blast exposure history between assessment visits. Wilcoxon signed-rank tests indicated significant increases in median neurobehavioural symptoms, total number of white matter hyperintensities (WMH), and total WMH volume between assessment visits. Spearman rank correlations indicated no significant associations between change in psychiatric diagnoses, TBI history, blast exposure history, or neurobehavioural symptoms and change in WMH.Conclusion: MRI WMH changes were not associated with changes in psychiatric diagnoses or symptom burden, but were associated with severity of blast exposure. Future, larger studies might further evaluate presence and aetiology of long-term neuropsychiatric symptoms and MRI findings in blast-exposed populations.

Psychological Aspects and Psychopharmacologic Treatment in the Very Early Period After Kidney Transplantation: Role of a Multidisciplinary Approach

BackgroundIn the context of kidney transplantation (KT), multidisciplinary interventions, including assessment and management of psychosocial aspects, are important to improve transplant's outcome. The aim of this study was to describe a multidisciplinary team approach to KT, with a specific focus on early detection and treatment of psychological distress and psychopathologic conditions in the early phase postsurgery. MethodsThe multidisciplinary team in kidney transplantation was implemented in January 2016. In this team approach, all transplant recipients are invited to 3 scheduled appointments for a multidisciplinary evaluation at 1, 3, and 6 months posttransplant, including a psychiatric interview, with the aim to assess the patient's adjustment after transplantation and provide support when necessary. ResultsThis pilot study involved all 41 KT recipients consecutively referred for the first multidisciplinary appointment after transplantation. Five subjects (12% of the study sample) presented with a current psychiatric diagnosis. Psychopharmacologic treatment was confirmed or introduced for all these patients. Further psychological support was suggested to 4 other patients (10%). ConclusionKT significantly improves patients' quality of life. However, the percentage of subjects receiving psychopharmacologic treatment and referred for further psychological and psychiatric support (22%) suggests the need for careful monitoring of psychosocial aspects over the long term.

161 Gender congruence and psychiatric morbidity after gender-affirming health care: Relation to childhood adversities and adult stressful life events

Studies have reported a high risk of psychiatric morbidity after gender-confirming health care, but there is a dearth of studies evaluating gender congruence after these interventions. The aims were to study gender congruence after gender-confirming health care and to evaluate whether childhood adversities or adult stressful life events predict psychiatric morbidity post transition. Sixty-five individuals (16 men assigned female at birth, and 49 women assigned male at birth) were evaluated after gender-confirming health care. The mean (SD) follow-up time was 7.2 (7.3) years with a median of 4.3 (range 0.75–30.5) years. We assessed experienced gender congruence, clinical global improvement (GCI-I), psychiatric morbidity, suicidal attempts, and experiences of childhood adversities and adult stressful life events. All 16 men felt gender congruent post transition as compared with 41 out of 46 (89.1%) women. The median GCI-I score was 6 (equals “much improved”), with no significant gender difference. In men and women combined, 23 out of 64 (35.9%) had made a suicide attempt prior to transition, and 8 out of 64 (12.5%) made a suicide attempt post transition. Sixteen out of 65 (24.6%) subjects met criteria for any current psychiatric diagnosis, and 27 out of 65 (41.5%) subjects met criteria for any lifetime psychiatric diagnosis. Fifty-nine out of 65 (90.8%) reported at least one childhood adversity and/or adult stressful life event. Some childhood adversities swas reported by more than three quarters of the participants. Childhood sexual abuse was reported by nine of 64 (14%). At least one adult stressful life event was reported by more than three quarters of the participants. Predictors (OR [95% CI]) of current psychiatric morbidity were being born abroad (18.3 [1.9–176]), childhood maltreatment and/or childhood sexual abuse (12.3 [2.0–78]), and not being accepted in the assigned gender (9.0 [1.5–52]).

Mental health of jail inmates within the prison of Ducos, Martinique – a cross-sectional descriptive study

BackgroundPrisoners’ sociocultural backgrounds and prison environments have an influence on detainees’ psychopathology; complex judicial and public policies are also to be taken into account in the dynamics of that environment. Scientific literature shows a wide range prison inmates’ profiles across the world. However, very little data about the mental health of Caribbean jail inmates has been published. Martinique is a French overseas administrative district in the Caribbean, with a population of about 400,000 inhabitants. Its only prison is located in the city of Ducos. Our study proposes a description of the psychiatric characteristics of jail inmates in Martinique with epidemiological tools. Its objectives are to highlight their specific features and compare them to mainland France's jail population. MethodsThe initial study was a multicenter cross-sectional survey conducted in 18 French prisons. The selection was done using a two-stage stratified sampling strategy. For the purpose of our study, two groups were defined and compared: the detainees from the prison of Ducos (n=100) were compared to inmates from mainland France (n=698). Current psychiatric diagnoses were rigorously collected, through clinical and semi-structured interviews. We conducted a multiple logistic regression for each assessed mental disorder. Each prisoner gave us his oral and written informed consent. ResultsIn terms of sociodemographic characteristics, we found more children per prisoner in the Martinican group and a better educational status in the mainland France group. The inmates from Martinique had significantly more adverse experiences in their childhood and the length of incarceration at the time of the interview was longer in the Martinique sample. Major depressive disorders (aOR=0.51; 95% CI=0.26–0.95) and psychotic disorders (aOR=0.24; 95% CI=0.08–0.57) were significantly less frequent in the Martinique sample. The data concerning substance-related disorders showed significant differences in bivariate analysis but this link was no longer statistically significant in the multiple logistic regression analysis. ConclusionEven if imprisonment conditions are extremely tough, the inmates carry the heavy burden of difficult family histories, and the use of cannabis seems to be a major problem, it appears that Martinique's jail inmates have lower rates of mental illness than their counterparts from mainland France. We think this could be due to the benefit of greater proximity to their relatives and a united community, both which may contribute to lower prevalence of mental disorders.

F168. PSYCHOTIC EXPERIENCE AND ADOLESCENT BRAIN TRAJECTORY: EVIDENCE FOR STRUCTURAL ALTERATIONS IN DOPAMINERGIC REGIONS

BackgroundPsychotic Experiences (PE) are often reported by children and adolescents and have a bidirectional association with mental disorders, both increasing subsequent risk for mental disorders and being more frequently reported among subjects with a current psychiatric diagnosis. The brain developmental trajectories associated with PE in children and adolescents and how PE may evolve to a full blown mental disorder remain largely unknown. We assessed PE effect on subcortical and cortical measures over a 3-year follow-up in a community cohort of children and adolescents.MethodsThis study is part of the Brazilian High-risk Cohort, a multi-site longitudinal study. A total of 2,512 youths (6–12 years old, mean age at baseline 9.7 years, SD = 1.92; 53,1% male) completed the baseline assessment and 2,012, the 3-year follow-up (T1). PE were assessed at the two time-points with The Community Assessment of Psychic Experience (CAPE). A confirmatory factor analysis (CFA) was used to generate a latent score for PE for baseline and follow-up, yielding good model fits.A subset of the sample (n=809) was scanned in a 1.5T scanner on either baseline or follow-up resulting in 1183 MRI scans. Structural images were processed using Freesurfer. Subcortical volumes for the amygdala, hippocampus, caudate, putamen and pallidum were entered as a dependent variable in a linear mixed effects model (lme) with age, sex, CAPE and CAPE by age interaction as fixed effects and site and subject as random effects. The same model was applied in a mass-univariate analysis for cortical thickness measure (CT). A smoothing kernel (FWHM = 10 mm) was applied to CT before statistical testing. False Discovery Rate was used to control for multiple comparisons in the mass-univariate analysis with a p<0.05 threshold.ResultsCAPE was significantly related to the right putamen (Beta: -0.30 p:0.03), right caudate (Beta: -0.32 p: 0.03) and left caudate (Beta: -0.32 p:0.02). The age by CAPE interaction was significant for the three regions (right putamen Beta: 0.001 p:0.04, right caudate Beta:0.002 p: 0.03 and left caudate Beta: 0.001 p:0.03).CAPE and CAPE by age interaction terms showed no effect on cortical thickness after correction for multiple comparisons.DiscussionPE report was associated with lower subcortical volumes of the caudate and putamen, regions of the striatum. The striatum receives important dopaminergic neurotransmission and have been previously implicated in the pathogenesis of schizophrenia. In line with the hypothesis in schizophrenia, the PE experienced by children and adolescents may relate to a dopaminergic imbalance, possibly due to developmental structure alterations of the striatum and its connections. Interestingly, neither the hippocampus nor the amygdala were related to PE. Taken together with the lack of findings related to cortical thickness, the results presented here suggests a probable dopaminergic role on PE in young people with no current psychotic disorder.

T18. MULTIVARIATE BRAIN ANATOMICAL DIFFERENCES IN POSITIVE AND NEGATIVE SCHIZOTYPY: PRELIMINARY RESULTS FROM THE TYPIA STUDY

BackgroundIn schizotypy, a factor structure similar to the one observed in schizophrenia has been unraveled, being the positive and negative the most consistently replicated dimensions. Despite this fact, most of the studies on brain volume patterns in schizotypy consider it as an unitary rather than a multidimensional construct. Hence, based on previous results showing that schizophrenia and schizotypal personality traits share common neurodevelopmental patterns, it is hypothesized that brain volumetric patterns in individuals with high positive schizotypy are intrinsically different to those observed in persons reporting high negative schizotypy and to individuals with overall low schizotypal traits. The present study aims to evaluate this hypothesis using novel machine learning techniques to address the multivariate nature of psychotic diseases and the brain itself.MethodsData from the TYPIA Study, an ongoing project conducted at the Ludwig-Maximilian University of Munich and the University of Bonn in Germany, was used to investigate whether brain volumetric patterns are distinct in healthy individuals with high positive (HPS) and high negative schizotypy (HNS) when compared to one another (HPS vs HNS) and to individuals with self-reported low schizotypy (LS vs HNS and LS vs HPS). A preliminary analysis on grey matter volumetric patterns from 29 LS (19 f., mean age: 24.6 y.), 28 HNS (20 f., mean age: 26.8 y.) and 23 HPS (17 f., mean age: 26.4 years) individuals from the general population without any current psychiatric diagnosis was performed. Group divisions were based on the introvertive anhedonia and unusual experiences subscales from the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE). Structural images were preprocessed with a standard voxel based morphometry pipeline using the SPM-based CAT12 toolbox in Matlab. After age, sex and grey matter intracranial volume and center corrections, a linear support vector classification (SVC) algorithm was used to assess separability between the groups.ResultsOur preliminary cross-validated results showed that LS and HNS can be separated with 56.0 % balanced accuracy (BAC), whereas LS vs HPS and HNS vs HPS allowed for only 42.87% and 48.8% BAC respectively. Interestingly, a post-hoc analysis comparing LS vs both high schizotypy groups merged together showed the highest BAC (59.2%). As expected, the brain differences between groups are rather small, since the sample consists fully of healthy controls. However, these results indicate that personality traits related to HNS are linked to more pronounced changes in the brain as compared to HPS. Nevertheless, schizotypy as a combination of the positive and negative dimensions allowed for a higher classification accuracy when compared to LS, supporting the notion of schizotypy as a unitary construct as observed from the post-hoc analysis. Furthermore, HNS and HPS were not separable by the algorithm, most likely due to the intrinsic heterogeneity of the construct.DiscussionOur results align with previous studies claiming that negative symptoms are associated with structural changes in the CNS whereas positive symptoms relate to changes in functioning and activation of the brain. A larger sample as well as using other data modalities will confirm the stability of our findings. Research on volumetric patterns of the brain areas related to negative symptoms in non-clinical samples might lead to a better understanding of the underlying causes of schizophrenia. Above all, our results show that investigating non-clinical expression of psychosis-like symptoms is a promising strategy to understand the prodromal stadium of schizophrenia.

F32. DIFFERENCES BETWEEN YOUTH AT CLINICAL HIGH-RISK FOR PSYCHOSIS WHO DO NOT TRANSITION TO PSYCHOSIS: THE NORTH AMERICAN PRODROME LONGITUDINAL STUDY (NAPLS-2)

BackgroundIn the clinical high risk (CHR) for psychosis literature, typically, the focus is on determining the risk of conversion to psychosis. However, between 70% and 85% of youth who meet CHR criteria do not develop psychosis during the follow-up period of the study in which they participate. The aim of this study is to focus on CHR youth who did not transition to psychosis and to determine whether there are differences amongst them.MethodsThe North American Prodrome Longitudinal Study (NAPLS-2) is an 8-site prospective, longitudinal study including 764 help-seeking youth, age 12–35, meeting criteria for a psychosis risk syndrome based on the Structured Interview for Psychosis-risk Syndromes (SIPS), and 279 healthy controls (HC). For this analysis, only youth who did not make a transition to psychosis and completed 2 years of follow-up (n=278, 154 males, 124 females; mean age 18.8) were included. At the 24-month final assessment, the sample was divided into 3 groups: 1) those in remission, determined by scores ≤2 on all 5 attenuated psychotic symptoms on The Scale of Psychosis-risk Symptoms (SOPS); 2) symptomatic, determined by still having a rating of 3–5 on any one of the 5 attenuated psychotic symptoms on the SOPS; 3) prodromal progression, determined by continuing to meet the Criteria of Psychosis-risk Syndromes (COPS). The groups were compared at baseline and at 24-month follow-up on: age, gender, the presence of a current and lifetime psychiatric diagnosis, and social and role functioning. The use of antipsychotic medication was examined across all assessments (baseline, 6-, 12-, 18- & 24 months) using Generalized Linear Models to examine differences among the 3 groups.ResultsAmong the participants, 110 (39.57%) were in-remission, 93 (33.45%) symptomatic, and 75 (26.98%) prodromal progression. At baseline there were no significant differences in age, gender, social and role functioning, or SCID diagnoses except on current PTSD (p=.001) with most cases in the prodromal progression group, and on current anxiety disorder (p=≤.0001) with most cases in the symptomatic group. The prodromal progression had significantly higher ratings on unusual thought content compared to the in-remission group and significantly higher ratings on suspiciousness than the symptomatic group. At 24-month follow-up there were significant differences in negative symptoms (p=≤.0001) between prodromal progression (M=9.19), symptomatic (M=8.84), and in remission (M=5.99) groups; and social functioning (p=≤.005; M=6.56, M=6.68, M=7.20 respectively). Although the in-remission group had the highest ratings on social functioning these were significantly lower in social (M=7.20) and role (M=6.68) functioning than HC (M=8.73, M=8.62 respectively). The groups did not differ on their use of antipsychotics over the course of their 2 years in the study.DiscussionThere were very few differences on baseline measures amongst the different two-year outcome groups. At 2 years, even though those in remission had improved social and role functioning relative to the other 2 groups, they still had lower social and role functioning than HC.

Are there any links among psychopathological symptoms, musical preferences and verbal working memory in female adults?

The question ‘Do psychopathology dimensions correlate with musical preferences in healthy individuals?’ still remains poorly investigated. Additionally, verbal working memory, psychopathology and music preferences have not been examined together. Participants consisted of ninety-three young women without a previous or current psychiatric diagnosis. All participants were examined with the Forward Digit Span Task, and completed a psychopathology symptom instrument along with a musical preferences question. Results revealed that the Global Score Index, Somatization, Hostility and Depression correlated in a statistically significant way with musical preferences in female adults. Hostility and Depression predicted classical music preferences. Depression, Obsessive/Compulsive, Somatization and Hostility predicted a pop preference, while Somatization and Psychoticism predicted a rock preference. No significant correlations were found between the above variables and verbal working memory, except for a significant correlation between age and the span of the working memory. Certain psychopathology dimensions do not influence cognition in the form of the verbal working memory in women, but can predict a specific choice of music genres. Findings suggest that music listening preferences may represent a field of inner experiences that could reveal easy-to-obtain information about the mental health of women who have not an official psychiatric diagnosis, but may be at risk of developing psychological problems due to high self-reported symptoms of psychopathology.

Psychological Correlates of Body Image Dissatisfaction Before and After Bariatric Surgery

Purpose: Identify psychological factors associated with body image dissatisfaction (BID) before, 3 months, and 6+ months after bariatric surgery. Methods: Bariatric patients (n = 444) completed a preoperative interview, 3 month and/or 6+ month postoperative psychology appointment, and Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Scales measuring generalized distress, depression, anxiety, and low self-esteem were examined. Medical records were reviewed for demographics and current psychiatric diagnoses. Results: Preoperative BID was associated with higher scores on MMPI-2-RF scales of Emotional/Internalizing Dysfunction, Demoralization, Low Positive Emotions, Dysfunctional Negative Emotions, Self-Doubt, Inefficacy, Anxiety, and Negative Emotionality/Neuroticism, in addition to a diagnosis of depression and eating disorder not otherwise specified. Patients who reported BID at 3 months scored higher on MMPI-2-RF scales of Emotional/Internalizing Dysfunction, Demoralization, Ideas of Persecution, Dysfunctional Negative Emotions, Self-Doubt, Inefficacy, and Negative Emotionality/Neuroticism, and were more likely to have a depression or anxiety diagnosis. No psychiatric diagnoses or MMPI-2-RF scales were predictive of BID 6+ months after bariatric surgery. Conclusions: Bariatric candidates experiencing symptoms of depression, anxiety, low self-esteem, and disturbed eating at preoperative evaluation are more likely to report BID before and after bariatric surgery. Future research should consider the limitations of long-term follow-up in this study to advance the field forward.

Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care.

BackgroundAntidepressant use has increased exponentially in recent decades, mostly due to long continuation.AimTo assess the effectiveness of a tailored recommendation to withdraw antidepressant treatment.Design & settingRandomised controlled trial in primary care (PANDA study) in the Netherlands.MethodLong-term antidepressant users (≥9 months) were selected from GPs prescription databases. Patients were diagnosed with the Composite International Diagnostic Interview (CIDI). Long-term users without indication for maintenance treatment (overtreatment) were selected. The intervention consisted of disclosure of the current psychiatric diagnosis combined with a tailored treatment recommendation. Patients were followed for 12 months.ResultsThe study included 146 participants from 45 family practices. Of the 70 patients in the intervention group, 34 (49%) did not comply with the advice to stop their antidepressant medication. Of the 36 (51%) patients who agreed to try, only 4 (6%) succeeded. These figures were consistent with the control group, where 6 (8%) of the 76 patients discontinued antidepressant use successfully. Patients who were recommended to discontinue their antidepressant medication reported a higher relapse rate than the control group (26% versus 13%, P = 0.05).ConclusionChanging inappropriate long-term antidepressant use is difficult.

A Virtual Reality Game to Assess Obsessive-Compulsive Disorder.

The retrospective and subjective nature of clinical interviews is an important shortcoming of current psychiatric diagnosis. Consequently, there is a clear need for objective and standardized tools. Virtual reality (VR) can be used to achieve controlled symptom provocation, which allows direct assessment for the clinician. We developed a video VR game to provoke and assess obsessive-compulsive disorder (OCD) symptoms in a standardized and controlled environment. The first objective was to evaluate if the VR game is capable of provoking symptoms in OCD patients as opposed to healthy controls. The second objective was to evaluate the tolerability of the VR game in OCD patients. The VR game was created using a first-person perspective and confronted patients with 15 OCD-specific items, while simultaneously measuring OCD symptoms, including the number of compulsions, anxiety, tension, uncertainty, and urge to control. In this pilot study, eight patients and eight healthy controls performed the VR game. OCD patients performed significantly more compulsions (U = 5, p = 0.003) during the VR game. The anxiety, tension, uncertainty, and urge to control in response to the specific items were also higher for OCD patients, although significance was not yet reached because of the small sample. There were no substantial adverse effects. The results of this pilot study indicate that the VR game is capable of provoking a variety of OCD symptoms in OCD patients, as opposed to healthy controls, and is a potential valuable tool to objectify and standardize an OCD diagnosis.

PB 4 Neural correlates of intent attribution and laughter processing in children and adolescents

Introduction The attribution of intent during social interaction is a cornerstone of the social adjustment process ( Crick and Dodge, 1994 ). In particular, the tendency to attribute hostile intent has consistently been associated with and argued to play a role in the development and maintenance of aggressive behavior in childhood and adolescence ( Dodge, 2006 ). However, little is known about the neural correlates of hostile intent attributions ( Erdley et al., 2010 ). We used fMRI and behavioral measures to investigate intent attributions and attention biases for hostile social stimuli using social laughter processing in children and adolescents under consideration of gender and age effects. Methods 35 girls and 28 boys in three age groups (9–12, 13–15 and 16–18y; mean 15.3, SD 2.39) without current psychiatric diagnoses rated 1.5s audiovisual laugh sequences in a 3T MRI scanner. 20 friendly, 20 tickling and 20 taunting sequences ( Szameitat et al., 2009 ) were rated as friendly or taunting on a four-point scale. Rating, reaction time (RT) and attention bias (RT friendly – RT taunting laughter) differences were calculated with three 2 (gender) × 3 (age group) × 3 (laughter type) mixed model ANOVAs. Participants with excessive movement or spurious responding were removed from analysis. Neural responses were calculated in SPM8 in a whole brain analysis of the BOLD response to each laughter type and the correlations to hostile intent rating, physical aggression ( Buss and Perry, 1992 ) and callous unemotional traits ( Frick, 2003 ). Results A significant main effect of laughter type ( F = 100.62, p F = 2.829, p = .068) and the main effect of age on attention bias ( F = 2.634, p = .083) approached significance, with younger participants showing attention bias to taunting and older participants to friendly laughter. Callousness and physical aggression correlated with hostile ratings of friendly ( r = .288, p r = .315, p r = −.404, p A broad network showed increased BOLD response during laughter processing, including bilateral medial and superior temporal gyri (MTG, STG), inferior and medial frontal gyri (IFG, MFG), caudate nuclei and left superior parietal lobe (whole brain FWE p Conclusions The current study found an extended neural network involved in laughter processing in children and adolescents, similar to that found in adults ( Szameitat et al., 2010 ). In addition, attribution of hostile intent in laughter was found to associate with changes in BOLD signal strength across these processing areas. This association strength was modulated by youth’s aggressive behavior and callous personality traits.

Psychometric properties of the short Warwick Edinburgh mental well-being scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders

BackgroundTo establish the validity and reliability of the Short Warwick Edinburgh Mental Well-being Scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders in Singapore and estimate SWEMWBS scores across socio-demographic and the three psychiatric diagnostic groups in the sample.MethodsThis secondary analysis was conducted using data from a study among outpatients of a tertiary psychiatric hospital. In addition to the SWEMWBS, socio-demographic data and current psychiatric diagnosis were collected. Service users were also administered the Global Assessment of Functioning (GAF), Patient Health Questionnaire (PHQ)-8, Generalised Anxiety Disorder (GAD)-7, Satisfaction with Life Scale (SWLS) and the Positive Mental Health (PMH) instrument. The SWEMWBS was tested for factorial validity, reliability and convergent and divergent validity.ResultsIn total, 350 service users with a mean (SD) age of 39.1 (11.1) years were included in this study of which 39.4%, 38.9% and 21.7% had schizophrenia, depression and anxiety spectrum disorders, respectively. The single factor structure of the SWEMWBS was confirmed by confirmatory factor analysis (CFI = 0.969, TLI = 0.954, RMSEA = 0.029). The internal consistency reliability was high (Cronbach’s alpha = 0.89). The convergent and divergent validity testing revealed that the SWEMWBS scores had significant moderate to high positive correlations with GAF, SWLS and PMH scores and moderate negative correlations with (PHQ)-8 and (GAD)-7 scores. SWEMWBS scores were higher in married participants (22.2 (5.4) versus never married: 20.7 (5.3) and divorced/separated/widowed: 20.4 (5.1), p = 0.049) and among those with schizophrenia (22.8 (5.5) versus depression:19.6 (4.7) and anxiety spectrum disorders 20.9 (5.2), p < 0.001).ConclusionThese results demonstrate adequate validity and reliability of the SWEMWBS in people with schizophrenia, depression and anxiety spectrum disorders in Singapore.

Current psychiatric disorders in patients with epilepsy are predicted by maltreatment experiences during childhood

PurposeChildhood maltreatment has been shown to be a risk factor for the development of psychiatric disorders. Although the prevalence of psychiatric disorders is high in epilepsy patients, it is unknown if childhood maltreatment experiences are elevated compared to the normal population and if early maltreatment is a risk factor for current psychiatric comorbidities in epilepsy patients. This is the main purpose of this study. MethodsStructured interviews were used to assess current Axis I diagnoses in 120 epilepsy patients from a tertiary Epilepsy Center (34 TLE patients, 86 non-TLE patients). Childhood maltreatment in the family and peer victimization were assessed with validated questionnaires. Patients’ maltreatment scores were compared with those of a representative matched control group. Logistic regression analysis was conducted to assess the potential impact of childhood maltreatment on current psychiatric comorbidity in epilepsy patients. ResultsCompared to a matched control group, epilepsy patients had higher emotional and sexual maltreatment scores. Patients with a current psychiatric diagnosis reported more family and peer maltreatment than patients without a psychiatric disorder. Family maltreatment scores predicted the likelihood of a current psychiatric disorder. TLE patients did not differ from non-TLE patients according to maltreatment experiences and rates of current psychiatric disorders. ConclusionOur findings suggest that in epilepsy patients emotional and sexual childhood maltreatment is experienced more often than in the normal population and that early maltreatment is a general risk factor for psychiatric comorbidities in this group.