Family History Of Psychotic Disorder Research Articles

Prevalence and correlates of probable rapid eye movement sleep behavior disorder among middle-aged and older adults in a psychiatric outpatient clinic: A cross-sectional survey

ObjectiveRapid eye movement sleep behavior disorder (RBD) is often underdiagnosed among people living with mental disorders. The present study aimed to investigate the prevalence of probable RBD (pRBD) and its associated factors among middle-aged and older adults in a psychiatric outpatient clinic. MethodsWe conducted a cross-sectional survey among 2907 people aged 45–80 years who visited the outpatient clinic between March 1 and August 31, 2022 in a psychiatric hospital. A cutoff score ≥5 on the RBD Screening Questionnaire (RBDSQ) was used to indicate the presence of probable RBD (pRBD). Potential factors associated with pRBD were also assessed with a structured checklist. The association between these factors and the presence of pRBD was examined with logistic regression. ResultsThe response rate was 64.3 %. Among 1868 respondents [age 58.5 ± 9.6 years, male n = 738 (39.5 %), female n = 1130 (60.5 %)], 15.9 % (95 % CI 14.2–17.6 %) screened positive for pRBD. Occupational exposure to chemicals; positive family history of psychotic disorders; a late start of mental health care; a medical history of autonomic dysfunction; mood problems; and use of antidepressants, hypnotics, and acetylcholinesterase inhibitors were associated with an increased likelihood of having pRBD (P < 0.05 for all). ConclusionpRBD is common among outpatients with mental disorders, especially in mental disorders due to neurological diseases and physical conditions, mood disorders and anxiety or somatoform disorders. The findings highlight the importance of identifying sleep behavior disorders among people living with mental disorders in clinical practice.

Investigation of Siblings of Patients Diagnosed with Substance-Induced Psychotic Disorder in terms of Cognitive Functions and Clinical High-Risk State for Psychosis

Objective: This study aimed to investigate the influence of familial predisposition on substance-induced psychosis among healthy siblings of patients diagnosed with substance-induced psychotic disorder, who themselves lack any family history of psychotic disorders. Additionally, the study aimed to explore clinical high-risk states for psychosis, schizotypal features, and neurocognitive functions in comparison to a healthy control group. Method: The study compared healthy siblings of 41 patients diagnosed with substance-induced psychotic disorder with 41 healthy volunteers without a family history of psychotic disorders, matching age, gender, and education. Sociodemographic and clinical characteristics of participants were obtained using data collection forms. The Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Structured Interview for Schizotypy-Revised Form (SIS-R) scales were utilized to assess clinical high risk for psychosis. Neurocognitive functions were evaluated with digit span test (DST), trail making test part A-B (TMT), verbal fluency test (VFT), and Stroop test (ST). Results: Analysis using the CAARMS scale revealed that 39% of siblings and 7.3% of the control group were at clinically high risk for psychosis, indicating a significant difference in rates of psychotic vulnerability. Comparison between siblings and the control group showed significant differences in mean SIS-R subscale scores, including social behavior, hypersensitivity, referential thinking, suspiciousness, illusions, and overall oddness, as well as in mean neurocognitive function scores, including errors in TMT-A, TMT-B, and VFT out-of-category errors, with siblings exhibiting poorer performance. Conclusion: Our study suggests that healthy siblings of patients with substance-induced psychosis exhibit more schizotypal features and have a higher risk of developing psychosis compared to healthy controls. Additionally, siblings demonstrate greater impairment in attention, response inhibition, and executive functions compared to healthy controls, indicating the potential role of genetic predisposition in the development of substance-induced psychotic disorder.

Differences between substance-induced psychotic disorders and non-substance-induced psychotic disorders and diagnostic stability.

Several hypotheses have been proposed to explain the comorbidity between psychotic disorders and substance use, one of them being the capacity of some to induce psychotic symptoms, although the transition from psychotic episodes induced by substances to schizophrenia has been less studied. In this study, differential variables between patients with induced and non-induced psychosis are determined, and the evolution and change of diagnosis of those induced to schizophrenia in the follow-up is analyzed. This is an observational case-control study with 238 patients admitted to the acute care unit for psychotic episodes between December 2003 and September 2011. The group of non-substance-induced psychotic disorders (NSIPD) included 127 patients, with 111 in the substance-induced (SIPD) group, according to the International Classification of Diseases. Sociodemographic and clinical characteristics, personal and family history, substance use, diagnostic stability and progression were compared. The NSIPD group showed higher scores in severity and in negative symptoms and more family history of psychosis. The SIPD group presented more personal history of personality disorder and family history of addictions and more positive symptoms At 6 years of follow-up, 40.9% of ISDP changed to a diagnosis of schizophrenia, presenting more family history of psychotic disorders and worse progression with more visits to the emergency department and readmissions, than subjects who maintained diagnostic stability. Therefore, special attention should be paid to this group of patients because of the potential severity and the increased risk of developing a chronic psychotic disorder.

Autistic features and executive functions in first episode psychosis: Associations with functionality and quality of life.

The present study aimed at investigating the relationships between autistic features and cognitive deficits, functionality and quality of life in first episode psychosis (FEP) patients. Sixty FEP patients [mean age (SD)=32.53 (10.74), n=23 female, n=37 male] were enrolled in this cross-sectional study. Data was collected using a sociodemographic and clinical data form, the Positive and Negative Syndrome Scale (PANSS), the PANSS Autism Severity Score (PAUSS), the Personal and Social Performance Scale (PSP), the Frontal Assessment Battery (FAB), and the World Health Organization Quality of Life Scale Short Form in Turkish Version (WHOQOL-BREF TR). Autistic symptom severity was found to be higher in males than females, and higher in patients with a family history of psychotic disorder. An inverse relationship was found between the duration of education and the severity of autistic symptoms. While there was an inverse relationship between autistic symptom severity and executive functions and functionality, no significant correlation was found with quality of life. Negative symptom severity was a predictor of executive functions and functionality. No significant difference was observed between autistic and psychotic domains which were related to executive functions. Our study is the first to examine the relationship between autistic/psychotic symptoms and executive functions and functionality in patients with FEP. The results show that autistic symptoms are associated with worse social and personal functioning and worse executive functions in patients with FEP. Longitudinal follow-up studies with larger samples are required to determine the direction of the relations.

Clinical characteristics of familial schizophrenia.

A family history of psychiatric disorders is one of the strongest risk factors for schizophrenia. The characteristics of patients with a family history of psychiatric disorders have not been systematically evaluated. This multicenter study (26 centers, 2425 cases) was performed in a Chinese population to examine the sociodemographic and clinical characteristics of schizophrenia patients with a family history of psychotic disorders in comparison with those of patients with sporadic schizophrenia. Nineteen percent of patients had a family history of mental disease. Multiple logistic regression analysis revealed that ≥4 hospitalizations (OR=1.78, P=.004), tobacco dependence (OR=1.48, P=.006), alcohol dependence (OR=1.74, P=.013), and physical illness (OR=1.89, P=.001) were independently and significantly associated with a family history of mental disease. Patients with a family history of mental disorders present different demographics and clinical features than patients without a family history of psychiatric disorders.

Threat, hostility and violence in childhood and later psychotic disorder: population-based case-control study.

A growing body of research suggests that childhood adversities are associated with later psychosis, broadly defined. However, there remain several gaps and unanswered questions. Most studies are of low-level psychotic experiences and findings cannot necessarily be extrapolated to psychotic disorders. Further, few studies have examined the effects of more fine-grained dimensions of adversity such as type, timing and severity. Using detailed data from the Childhood Adversity and Psychosis (CAPsy) study, we sought to address these gaps and examine in detail associations between a range of childhood adversities and psychotic disorder. CAPsy is population-based first-episode psychosis case-control study in the UK. In a sample of 374 cases and 301 controls, we collected extensive data on childhood adversities, in particular household discord, various forms of abuse and bullying, and putative confounders, including family history of psychotic disorder, using validated, semi-structured instruments. We found strong evidence that all forms of childhood adversity were associated with around a two- to fourfold increased odds of psychotic disorder and that exposure to multiple adversities was associated with a linear increase in odds. We further found that severe forms of adversity, i.e. involving threat, hostility and violence, were most strongly associated with increased odds of disorder. More tentatively, we found that some adversities (e.g. bullying, sexual abuse) were more strongly associated with psychotic disorder if first occurrence was in adolescence. Our findings extend previous research on childhood adversity and suggest a degree of specificity for severe adversities involving threat, hostility and violence.

M26. CLINICAL CHARACTERISTICS OF CHILD AND ADOLESCENT OFFSPRING OF PATIENTS DIAGNOSED WITH SCHIZOPHERNIA: A COMPARATIVE STUDY WITH ADHD CHILDREN

BackgroundRecent studies have observed high rates of psychopathology in child and adolescent offspring of patients with schizophrenia (SZoff). Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent psychopathology in SZoff (Sanchez-Gistau, et al., 2015). The high prevalence of ADHD observed in SZoff can conceal the vulnerability characteristics specific to schizophrenia. The aim of this study is to analyze the clinical characteristics of a sample of child and adolescent SZoff diagnosed with ADHD (SZoff-ADHD) compared to a sample of children with ADHD without a family history of psychotic disorders and a sample of healthy controls. We hypothesize that SZoff-ADHD will show more psychopathology and more prodromal psychotic symptoms than the other two groups.Methodswe studied a sample of 22 SZoff-ADHD children, 15 children with ADHD with no familiar history of psychotic disorders and 40 healthy controls (HC) between 6 and 17 years old and we conducted a complete clinical assessment which included: Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Structured interview for Prodromal Symptoms (SOPS) and Global Assessment Functioning (GAF). In order to detect significant differences between groups, multilevel mixed-effect logistic regression models (categorical variables) or multilevel mixed-effect linear regression models (continuous variables) were performed with group as the fixed factor and the fact of having a sibling in the same study (identified by the family number) as the random variable.Resultssignificant differences between groups were found in socio-economic status which was lower in the SZoff-ADHD group than in the other two groups (F=15.886; p<0.001). Moreover the SZoff-ADHD also showed a higher percentage of males (90.9%) compared with the ADHD group (62.5%) and the HC (45%) (F=12.647; p=0.002). No significant age differences between groups were detected.Regarding clinical assessments, the SZoff-ADHD group showed a higher percentage of conduct disorders (F=3.720; p=0.039) than the ADHD group. No significant differences were observed in other psychopathological diagnoses. Furthermore the SZoff-ADHD group also obtained higher scores than the HC group on the following scales: YMRS, positive, negative, general and total sub-scales of the SOPS and lower scores in the GAF. The ADHD group obtained significantly higher scores than the HC group in the sub-scale of SOPS general prodromal symptoms and lower scores on the GAF. Significant differences were detected between SZoff-ADHD and ADHD in the YMRS and the positive and negative sub-scales of the SOPS where the SZoff-ADHD group showed higher scores than the ADHD group.DiscussionCompared with the HC group, the SZoff-ADHD displayed more manic, prodromal psychotic symptoms and worse psychosocial functioning. The ADHD group showed an intermediate pattern between the SZoff-ADHD and the HC group, with more general prodromal symptoms and lower psychosocial functioning than the HC group but lower scores than the SZoff-ADHD in the psychotic prodromal symptoms interview.

4.55 TRAUMA HISTORY AND CANNABIS USE ARE ASSOCIATED WITH POSITIVE SYMPTOMATOLOGY IN AN EARLY PSYCHOSIS POPULATION

Cannabis use, particularly in those with a family history of psychotic disorders, increases the likelihood of experiencing a psychotic episode and is associated with an earlier age of psychosis onset. It is unclear how this use affects symptoms in a first-episode psychosis population (FEP). Likewise, trauma is associated with an increased risk for psychosis, but the relationship between trauma and cannabis use on psychosis symptoms has not yet been elucidated. The present study aims to examine the relationship between trauma and cannabis use, as well as the effect of each on negative and positive symptoms in a FEP population.

Association of Schizophrenia Risk With Disordered Niacin Metabolism in an Indian Genome-wide Association Study

Genome-wide association studies (GWASs) in European populations have identified more than 100 schizophrenia-associated loci. A schizophrenia GWAS in a unique Indian population offers novel findings. To discover and functionally evaluate genetic loci for schizophrenia in a GWAS of a unique Indian population. This GWAS included a sample of affected individuals, family members, and unrelated cases and controls. Three thousand ninety-two individuals were recruited and diagnostically ascertained via medical records, hospitals, clinics, and clinical networks in Chennai and surrounding regions. Affected participants fulfilled DSM-IV diagnostic criteria for schizophrenia. Unrelated control participants had no personal or family history of psychotic disorder. Recruitment, genotyping, and analysis occurred in consecutive phases beginning January 1, 2001. Recruitment was completed on February 28, 2018, and genotyping and analysis are ongoing. Associations of single-nucleotide polymorphisms and gene expression with schizophrenia. The study population included 1321 participants with schizophrenia, 885 family controls, and 886 unrelated controls. Among participants with schizophrenia, mean (SD) age was 39.1 (11.4) years, and 52.7% were male. This sample demonstrated uniform ethnicity, a degree of inbreeding, and negligible rates of substance abuse. A novel genome-wide significant association was observed between schizophrenia and a chromosome 8q24.3 locus (rs10866912, allele A; odds ratio [OR], 1.27 [95% CI, 1.17-1.38]; P = 4.35 × 10-8) that attracted support in the schizophrenia Psychiatric Genomics Consortium 2 data (rs10866912, allele A; OR, 1.04 [95% CI, 1.02-1.06]; P = 7.56 × 10-4). This locus has undergone natural selection, with the risk allele A declining in frequency from India (approximately 72%) to Europe (approximately 43%). rs10866912 directly modifies the abundance of the nicotinate phosphoribosyltransferase gene (NAPRT1) transcript in brain cortex (normalized effect size, 0.79; 95% CI, 0.6-1.0; P = 5.8 × 10-13). NAPRT1 encodes a key enzyme for niacin metabolism. In Indian lymphoblastoid cell lines, (risk) allele A of rs10866912 was associated with NAPRT1 downregulation (AA: 0.74, n = 21; CC: 1.56, n = 17; P = .004). Preliminary zebrafish data further suggest that partial loss of function of NAPRT1 leads to abnormal brain development. Bioinformatic analyses and cellular and zebrafish gene expression studies implicate NAPRT1 as a novel susceptibility gene. Given this gene's role in niacin metabolism and the evidence for niacin deficiency provoking schizophrenialike symptoms in neuropsychiatric diseases such as pellagra and Hartnup disease, these results suggest that the rs10866912 genotype and niacin status may have implications for schizophrenia susceptibility and treatment.

Resting-State Functional Connectivity and Psychotic-like Experiences in Childhood: Results From the Adolescent Brain Cognitive Development Study

BackgroundPsychotic-like experiences (PLEs) during childhood are associated with greater risk of developing a psychotic disorder (and other mental disorders), highlighting the importance of identifying neural correlates of childhood PLEs. Three major cortical networks—the cingulo-opercular network (CON), default mode network (DMN), and frontoparietal network—are consistently implicated in psychosis and PLEs in adults. However, it is unclear whether variation in functional connectivity is associated with PLEs in school-aged children. MethodsUsing hierarchical linear models, we examined the relationships between childhood PLEs and resting-state functional connectivity of the CON, DMN, and frontoparietal network, as well as the other networks, using an a priori network parcellation, using data from 9- to 11-year-olds (n = 3434) in the ABCD (Adolescent Brain Cognitive Development) study. We examined within-network, between-network, and subcortical connectivity. ResultsDecreased CON and DMN connectivity, as well as cinguloparietal (CPAR) network connectivity, were associated with greater PLEs, even after accounting for family history of psychotic disorders, internalizing symptoms, and cognitive performance. Decreased DMN connectivity was more strongly associated with increased delusional ideation, whereas decreased CON connectivity was more strongly associated with increased perceptual distortions. Increased CON-cerebellar and decreased CPAR-cerebellar connectivity were also associated with increased PLEs, and CPAR-cerebellar connectivity was more strongly associated with increased perceptual distortions. ConclusionsConsistent with hypotheses about the dimensionality of psychosis, our results provide novel evidence that neural correlates of PLEs, such as reduced functional connectivity of higher-order cognitive networks, are present even in school-aged children. The results provide further validation for continuity of PLEs across the life span.

Comparison of cognitive functions between first-episode schizophrenia patients, their unaffected siblings and individuals at clinical high-risk for psychosis

Cognitive impairment is a core feature of schizophrenia and has been observed in both familial (FHR) and clinical high-risk (CHR) samples. Nonetheless, there is a paucity of research directly contrasting cognitive profiles in these two high-risk states and first-episode schizophrenia. This study aimed to compare cognitive functions in patients with first-episode schizophrenia-spectrum disorder (FES), their unaffected siblings (FHR), CHR individuals and healthy controls. A standardized battery of cognitive assessments was administered to 69 FES patients, 71 help-seeking CHR individuals without family history of psychotic disorder, 50 FHR participants and 68 controls. FES and CHR participants were recruited from territory-wide early intervention service for psychosis in Hong Kong. CHR status was ascertained using Comprehensive Assessment of At-Risk Mental State. Among four groups, FES patients displayed the largest global cognitive impairment and had medium-to-large deficits across all cognitive tests relative to controls. CHR and FHR participants significantly underperformed in most cognitive tests than controls. Among various cognitive tests, digit symbol coding demonstrated the greatest magnitude of impairment in FES and CHR groups compared with controls. No significant difference between two high-risk groups was observed in global cognition and all individual cognitive tests except digit symbol coding which showed greater deficits in CHR than in FHR participants. Clinical and familial risk groups experienced largely comparable cognitive impairment that was intermediate between FES and controls. Digit symbol coding may have the greatest discriminant capacity in distinguishing FES and CHR from healthy controls, and between two high-risk samples.

Assessment of the Prodromal Questionnaire–Brief Child Version for Measurement of Self-reported Psychoticlike Experiences in Childhood

Childhood psychoticlike experiences (PLEs) are associated with greater odds of a diagnosis of a psychotic disorder during adulthood. However, no known, well-validated self-report tools have been designed to measure childhood PLEs. To examine the construct validity and psychometric properties of a measure of PLEs, the Prodromal Questionnaire-Brief Child Version (PQ-BC). This validation study used data from the first wave of the Adolescent Brain and Cognitive Development (ABCD) Study, a prospective longitudinal study aimed at assessing risk factors associated with adverse physical and mental health outcomes from ages 9 to 10 years into late adolescence and early adulthood. The population-based sample of 3984 children within the ABCD data set was recruited from 20 research sites across the United States. Data for this study were collected from June 1, 2016, through August 31, 2017. The PQ-BC Total and Distress scores were analyzed for measurement invariance across race/ethnicity and sex, their associations with measures of PLEs, and their associations with known correlates of PLEs, including internalizing and externalizing symptoms, neuropsychological test performance, and developmental milestones. The study analyses included 3984 participants (1885 girls [47.3%] and 2099 boys [52.7%]; mean [SE] age, 10.0 [0.01] years). The results demonstrated measurement invariance across race/ethnicity and sex. A family history of psychotic disorder was associated with higher mean (SE) PQ-BC Total (3.883 [0.352]; β = 0.061; 95% CI, 0.027-0.094) and Distress (10.210 [1.043]; β = 0.051; 95% CI, 0.018-0.084) scores, whereas a family history of depression or mania was not. Higher PQ-BC scores were associated with higher rates of child-rated internalizing symptoms (Total score: β range, 0.218 [95% CI, 0.189-0.246] to 0.273 [95% CI, 0.245-0.301]; Distress score: β range, 0.248 [95% CI, 0.220-0.277] to 0.310 [95% CI, 0.281-0.338]), neuropsychological test performance deficits such as working memory (Total score: β = -0.042 [95% CI, -0.077 to -0.008]; Distress score: β = -0.051 [95% CI, -0.086 to -0.017]), and motor and speech developmental milestone delays (Total score: β = 0.057 [95% CI, 0.026-0.086] for motor; β = 0.042 [95% CI, 0.010-0.073] for speech; Distress score: β = 0.048 [95% CI, 0.017-0.079] for motor; β = 0.049 [95% CI, 0.018-0.081] for speech). These results provide support for the construct validity and demonstrate adequate psychometric properties of a self-report instrument designed to measure childhood PLEs, providing evidence that the PQ-BC may be a useful measure of early risk for psychotic disorders. Furthermore, these data suggest that PLEs at school age are associated with many of the same familial, cognitive, and emotional factors associated with psychotic symptoms in older populations, consistent with the dimensionality of psychosis across the lifespan.

S29. CONCORDANCE BETWEEN SELF-REPORT AT INTERVIEW-BASED RATINGS OF PSYCHOTIC EXPERIENCES IN PRE-ADOLESCENCE AND ASSOCIATED PSYCHOPATHOLOGY

BackgroundSelf-report measures are often used to assess psychotic experiences (PE) in large-scale epidemiological samples, and have contributed substantially to our knowledge on PE. However, different self-report PE (PE-S) measures have yielded particularly wide-spread prevalence-estimates of PE ranging from 21–66 % in 7–13 year old children, whereas interview based measures of PE (PE-I) vary less (10 -23 %). Especially PE-S have been criticized for being over-inclusive and not capturing the essence of low-grade psychosis. The current study is the first large-scale study to examine the psychometric properties of a PE-S measure in children, and the first to compare the clinical correlates of PE-S and PE-I in the same sample.MethodsAs part of the general population Copenhagen Child Cohort 2000 studies, 1571 children aged 11–12 years were independently assessed for both PE-I and PE-S. PE-I were assessed by trained professionals with 22 items on hallucinations and delusions from the Kiddie Schedule for Affective Disorders and Schizophrenia present and life-time version (Kiddie-SADS-PL). PE-S were assessed by 10 questions covering hallucinations, delusions and subjective thought disturbances ever in life, forming a new section of the diagnostic interview, the Development and Well Being Questionnaire (DAWBA).We assessed the psychometric properties of PE-S, using PE-I as the “gold-standard”. We analyzed the association between PE-S and emotional and neurodevelopmental DSM-IV disorders of the child as well as a history of psychotic disorders in 1st degree family members. Both have previously been examined in previous studies of the current cohort, and were significantly associated with PE-I.ResultsThe prevalence of PE-S was higher compared to PE-I, 28.1% and 10.2% respectively. The predictive values of any type of PE-S for any PE-I were: sensitivity = 73.8%, specificity = 77.1%, positive predictive value = 26.8% and negative predictive value = 96.3%.The association between PE and mental health disorders and a family history of psychotic disorders yielded slightly lower odds ratios (OR) for PE-S compared to PE-I. However, the associations remained statistically significant and had overlapping confidence intervals: For any emotional or neurodevelopmental DSM-IV disorder: PE-I OR 3.3 (CI95% 2.3–4.8) and PE-S OR 2.7 (CI95% 2.1–3.6), for a 1st degree family history of psychotic disorder; PE-I OR 4.9 (CI95% 1.9–12.5) and PE-S OR 2.6 (CI95% 1.1–6.3).DiscussionPE-S were almost 3 times more likely to be reported, compared to observer-rated PE-I. However, the associations with unfavorable clinical correlates were only slightly attenuated for PE-S when compared to PE-I. The study confirmed that PE-S are clinically relevant, and the DAWBA-section proved valuable as a screening tool for PE in the pre-adolescent general population.

T239. SINGLE-SUBJECT PREDICTION OF FUNCTIONAL OUTCOMES IN CLINICAL HIGH RISK SUBJECTS USING CLINICAL DATA

BackgroundPsychotic disorders are associated with serious deterioration in functioning even before the first psychotic episode. Also on clinical high risk (CHR) states of developing a first psychotic episode, several studies reported a decreased global functioning. In a considerable proportion of CHR individuals, functional deterioration remains even after (transient) remission of symptomatic risk indicators. Furthermore, deficits in functioning cause immense costs for the health care system and are often more debilitating for individuals than other symptoms. However in the past, CHR research has mostly focused on clinical outcomes like transition and therefore, functioning in CHR patients is under-investigated. The current study aims at predicting functioning at a single subject level applying multi pattern recognition to clinical data for the first time.MethodsPRONIA (‘Personalized Prognostic Tools for Early Psychosis Management’) is a prospective collaboration project funded by the European Union under the 7th Framework Programme (grant agreement n° 602152). Considering a broad set of variables (sMRI, rsMRI, DTI, psychopathological, life event related and sociobiographic data, neurocognition, genomics and other blood derived parameters) as well as advanced statistical methods, PRONIA aims at developing an innovative multivariate prognostic tool enabling an individualized prediction of illness trajectories and outcome. Seven university centers in five European countries and in Australia (Munich, Basel, Birmingham, Cologne, Melbourne, Milan/Udine, Turku) participate in the evaluation of three clinical groups (subjects clinically at high risk of developing a psychosis [CHR], patients with a recent onset psychosis [ROP] and patients with a recent onset depression [ROD]) as well as healthy controls.In the current study, we analysed data of 114 CHR patients. Functioning was measured by the ‘Global Functioning: Social and Role’ Scales (GF S/R). Features were derived from the large pool of clinical data that were assessed in PRONIA including questionnaires measuring CHR criteria as well as psychopathology, family history of psychotic disorders or treatment and various self-rating scales. Feature Elimination method of a strict Wrapper was used to identify most predictive variables from the multitude of clinical data included into the analysis.ResultsBalanced Accuracy of predicting social functioning in CHR patients was acceptable (pooled cross-validation: BAC = 74.3%, Sens = 72.8%, Spec = 60.3%; leave-site-out cross-validation: BAC = 69.9%, Sens = 84.3%, Spec = 55.6%). In contrast, applying the strict wrapper model revealed worse prediction performance for role functioning. Which might indicate that predicting level of role functioning requires more information than social functioning. As expected, prior functioning levels were identified as main predictive factor but also distinct protective and risk factors were selected into the prediction models.DiscussionIdentifying single predictive variables is in purpose of a much more efficient prognostic process. Moreover, understanding the mechanisms underlying functional decline and its illness related pattern might enable an improved definition of targets for intervention. Future research should aim at further maximisation of prediction accuracy and cross-centre generalisation capacity. In addition, other functioning outcomes as well as clinical outcomes need to be focused on.

T31. TEN YEAR CLINICAL FOLLOW-UP OF YOUTH WITH EARLY ONSET PSYCHOSIS

BackgroundEarly onset psychosis (onset prior to age 18) may be associated with poorer long-term outcomes than when onset takes place in adulthood. Studies so far prospectively following youth with early onset psychosis have suggested that only 20% of patients experienced a “good” outcome, and that nearly 50% experience a “poor” outcome. However, the major body of evidence so far has focused on cohorts recruited over 20 years ago, while a recent review (Clemmensen 2012) has noted that outcomes may be more favourable in more recent studies.We set out to update the evidence by prospectively assessing youth with a first episode of early onset psychosis after a 10 year follow-up period with clinical and functional measures.MethodsPatients were recruited from a child and adolescent psychiatry unit at a university hospital in Barcelona, Spain between 2003 and 2008. Inclusion criteria were: age 7 to 17 years and presence of positive psychotic symptoms of less than 6 months duration. Exclusion criteria: presence of a concomitant Axis I disorder that could account for the psychotic symptoms (e.g., substance abuse, autistic spectrum disorders, post-traumatic stress disorder, or acute stress disorder); learning disability according to DSM-IV criteria; neurological disorders. Occasional substance use was not an exclusion criterion. A sample of age matched healthy controls was recruited from the same geographical area. Controls had the same exclusion criteria in addition to no family history of psychotic disorders in first degree relatives. All participants were assessed with clinical (K-SADS, PANSS, GAF, CGI) measures by a psychologist and psychiatrist with experience with child and adolescent population at baseline and 10 year follow-up.ResultsSixty-nine patients and thirty-one controls were assessed at baseline; 36 patients (52%) and 24 controls (77%) were re-assessed at ten year follow-up. There were no differences in age (M=26.4 SD=1.4 vs. M=26.0 SD=2.0; t=.84; p=.41) or gender (47% vs. 46% females, Chi square=.011; p=.92). We were unable to locate 9 patients (13%) and 4 controls (12.5%). Two patients were deceased at follow-up (one committed suicide; one from metastasic cancer), one patient was in prison, and the rest declined participation. Patients who attended follow-up had trend-level baseline poorer functioning (17.85 vs. 22.4, p=.065), and significantly greater baseline clinical severity 6.44 vs 6.0, p=.017) than those who did not. Diagnoses at baseline were as follows: n=16 (23.2%) schizophrenia; n=20 (29%) affective disorders with psychotic symptoms; n=29 (42%) psychosis not otherwise specified. At follow-up: n=18 (50%) schizophrenia, n=11 (30.6%) affective disorders, n=1 (2.8%) personality disorder; n=1 (2.8%) eating disorder and n=5 (13.9%) had no psychiatric diagnosis. Twenty patients (58.8%) had been hospitalized during the follow-up period and thirty (88.2%) were currently receiving at least one antipsychotic drug. Seven patients (19.4%) were categorised as “poor outcome” (GAF < 50), 18 patients (50%) as “moderate” outcome (GAF 51–70) and 9 patients (26.5%) as “good outcome” (GAF >70). Seven patients (19.4%) were in full time employment and five (13.9%) were in full time education. The rest were either unemployed or working part time or in an assisted setting.DiscussionEarly onset psychosis is associated with poor long term outcomes in a portion of patients, although current functional outcomes in these patients may be comparatively better in relation to data from historical reports (Clemmensen 2012). Factors related to improved healthcare services, such as reduction in duration of untreated psychosis and new treatment modalities may potentially underlie these differences.

Clinical characteristics of primary psychotic disorders with concurrent substance abuse and substance-induced psychotic disorders: A systematic review

BackgroundDistinguishing between a primary psychotic disorder with concurrent substance abuse (PPD+SA) and a substance-induced psychotic disorder (SIPD) can be diagnostically challenging. We aimed to determine if these two diagnoses are clinically distinct, particularly in relation to psychopathology. In addition, we aimed to examine the specific clinical features of cannabis-induced psychotic disorder (CIPD) as compared to primary psychotic disorder with concurrent cannabis abuse (PPD+CA) and also to SIPD associated with any substance. MethodsA systematic review of SIPD literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ResultsUsing strict inclusion criteria, a total of six studies examining SIPD were included in the review (two of which only considered psychosis induced by cannabis alone). The findings did not reveal many consistent differences in psychopathology. However, we did find that that compared to PPD+SA, individuals with SIPD have a weaker family history of psychotic disorder; a greater degree of insight; fewer positive symptoms and fewer negative symptoms; more depression (only in CIPD) and more anxiety. ConclusionThere remains a striking paucity of information on the psychopathology, clinical characteristics and outcome of SIPD. Our review highlights the need for further research in this area.

Ayahuasca: what mental health professionals need to know

Abstract Background Ayahuasca is a psychoactive ethnobotanical concoction that has been used for decades by indigenous groups of the Northwestern Amazon and by syncretic religious organizations for ritual and therapeutic purposes. In the last two decades, it is being used worldwide in evolving practices. Ayahuasca seem to therapeutic effects, but controlled studies are lacking. Moreover, its safety and toxicity are not completely understood. Objectives To present an overview of the effects of ayahuasca based on the most recent human studies. Methods Narrative review. Results Ayahuasca administration in controlled settings appears to be safe from a subjective and physiological perspective, with few adverse reactions being reported. More frequent adverse reactions occur in non-controlled settings. Prolonged psychotic reactions are rare and seem to occur especially in susceptible individuals. Ayahuasca showed antidepressive, anxiolytic, and antiaddictive effects in animal models, observational studies, and in open-label and controlled studies. Discussion Ayahuasca administration in controlled settings appear to be safe. Moreover, ayahuasca seem to have therapeutic effects for treatment-resistant psychiatric disorders that should be further investigated in randomized controlled clinical trials. However, medical complications and cases of prolonged psychotic reactions have been reported, and people with personal or family history of psychotic disorders should avoid ayahuasca intake.

Migration and psychosis in acute inpatient psychiatry

We investigated the role of biological and psychosocial risk factors in the development of psychotic disorders with regards to immigrant status. Our hypothesis was that biological risk factors are more predictive of psychosis in non-immigrants, whereas psychosocial risk factors play a bigger role in immigrants. A retrospective audit of admissions between December 2013 and June 2014 in an Australian adult inpatient unit was conducted, focussing on patients with psychotic disorders. We analysed the association between immigrant status, and biological and psychosocial variables. For biological risk factors, non-immigrants had significantly more family history of psychotic disorders (p = 0.021), illicit drug use (p = < 0.001) and alcohol use (p = < 0.001). For psychosocial risk factors, immigrants were more likely to have experienced a traumatic event (p = 0.022). With regards to age of index presentation, age at onset of psychotic disorder, proportion of males and dysfunctional family background, there was no significant difference. Retrospective data in this report suggests that the development of psychotic disorders in immigrants and non-immigrants may be different.

Psychotic experiences and their significance.

Psychotic experiences and their significance.

Is it still correct to differentiate between early and very early onset psychosis?

ObjectiveIt remains unclear whether very early onset psychosis (VEOP; ≤12years of age) and early onset psychosis (EOP; onset 13–17years of age) are homogeneous in their clinical presentation. We investigated the predictive value of age of psychosis onset for severity, functioning and demographic variation by: 1) comparing groups based on traditional cut-offs for age of psychosis onset, and 2) using receiver operating characteristic (ROC)-curve calculations, without a priori age of onset cut-offs. MethodParticipants were 88 (45 female, 43 male) children and adolescents with a recent onset of psychosis (age range=6.7–17.5years; M=13.74, SD=2.37). ResultsThe VEOP group had significantly shorter duration of untreated illness and untreated psychosis, and lower functioning than the EOP group. The VEOP and EOP groups did not differ significantly on gender proportion, urbanicity, psychotic diagnosis, family history of psychotic disorder, psychotic, depressive and anxiety symptoms or IQ. When applying ROC-curves to the lowest three quartiles of positive psychotic symptoms scores, the optimal age-cut-off was 14.0years (sensitivity=0.62; specificity=0.75). For the highest quartile of functioning scores, the optimal differentiating cut-off for age of psychosis onset was 14.7years (sensitivity=0.71; specificity=0.70). ConclusionsLarger samples of patients, assessed at presentation and followed-up, are necessary to clearly examine clinical presentation and outcome as a function of social and neural development to better understand if the differentiation between VEOP and EOP is justified. This will aid the development of predictive diagnostic tools, more accurate prognosis prediction, and age-tailored therapeutic interventions.