History Of Psychotic Symptoms Research Articles

Validation of a youth suicide risk calculator in an adult sample with bipolar disorder

BackgroundBipolar disorder (BD) conveys the highest risk of suicide of all mental disorders. We sought to externally validate a risk calculator (RC) of suicide attempts developed in youth with BD from the Course and Outcome of Bipolar Youth (COBY) study in an adult sample. MethodsA prospective cohort of adults with BD from the National Institute of Mental Health Collaborative Depression Study (CDS; N = 427; mean (+/− SD) age at intake (36 +/− 13 years)) was secondarily analyzed to validate the COBY RC for one-year risk of suicide attempts/deaths. Nine of the ten predictor variables from the COBY RC were available in the CDS and used: age, age of mood disorder onset, first and second (partial) degree family history of suicide, history of psychotic symptoms, substance use disorder, prior suicide attempt, socioeconomic status, and non-suicidal self-injury (prospectively, incompletely at baseline). ResultsOver a mean (SD) follow-up of 19 (10) years, 29 % of the CDS sample attempted suicide. The RC predicted suicide attempts/deaths over one-year follow-up with an area under the receiver operating characteristic curve (AUC) of 0.78 (95 % CI 0.75–0.80). The RC performed slightly better in those with a younger age of mood disorder onset. LimitationsClinical samples may limit generalizability; the RC does not assess more acute suicide risk. ConclusionsOne-year risk of suicide attempts/deaths can be predicted with acceptable accuracy in youth and adults with BD, comparable to commonly used RCs to predict cardiovascular risk. This RC may help identify higher-risk individuals with BD for personalized treatment and research. https://cobysuicideattemptsrc.shinyapps.io/Shiny

Neurological and cerebellar soft signs in bipolar disorder: The role of staging, type and history of psychotic symptoms

AimBipolar disorder (BD) patients show neurological abnormalities in form of neurological and cerebellar soft signs (NSS and CSS). NSS represents heterogeneous group of symptoms representing i.a. deficits of motor coordination, sequencing of complex motor acts and sensory integration. CSS were introduced as group of the neurological deficits of posture, gait, kinetic functions, eye movements and speech, associated more specifically to cerebellar abnormalities than NSS. Studies show significant effect size variability of those symptoms in BD group suggesting the existence of differing subpopulations. The aim of our study was to evaluate the effect of BD type, stage and the history of psychotic symptoms (HoPS) on the severity of CSS and NSS as none of the previous studies had verified the role of those categories. MethodsThis study involved 181 participants: 116 euthymic BD patients (66 BD I, 50 BD II) and 65 healthy controls (HC). CSS was assessed with the International Cooperative Ataxia Rating Scale and NSS with Neurological Evaluation Scale. Patients were divided into early and late stage of the disorder according to Kapczinski's criteria. Rater was blind to patients' stage, type and HoPS. ResultsStaging was related to vast majority of CSS and NSS scores. HoPS was related to oculomotor deficits. The effect of BD type was the least significant. Late stage BD showed more severe CSS and NSS than HC in every measure. There were no differences between early stage BD and HC, apart of posture and gait disturbances. Except of sensory integration scores, late stage BD showed higher CSS and NSS rates than early stage patients. ConclusionIn this hitherto the largest study of neurological abnormalities in BD we have shown significant role of staging in CSS and NSS severity. Progression criteria based on inter-episode psychosocial functioning may stand as unrecognised factor responsible for variability observed in previous studies evaluating neurological abnormalities in BD. Our study suggests that in clinical practice NSS and CSS may be potentially used as easy-to-assess biological marker of BD staging. Observed severity of neurological impairments of BD patients may more likely correspond to the disease progression than to BD type and HoPS.

A naturalistic, 24-week, open-label, add-on study of vortioxetine in bipolar depression.

The efficacy of vortioxetine in major depressive disorder has been evaluated in many studies. However, there is a lack of studies assessing vortioxetine in bipolar depression. In 60 patients with bipolar depression, vortioxetine 10-20 mg daily was added to current mood stabilizing medication during 24-week, naturalistic, openlabel study. The most frequent mood stabilizers were lamotrigine, quetiapine, olanzapine, and valproates. The therapeutic efficacy was evaluated by the Clinical Global Impression - Improvement (CGI-I) and Clinical Global Impression - Severity (CGI-S) scales. Patients were classified as responding to vortioxetine when they achieved 1 or 2 points on the CGI-I scale at any stage of observation. The criterion of remission was defined as score 1 at the CGI-S. 73% of all patients (44/60) responded to vortioxetine and 52% (31/60) achieved clinical remission of depressive symptoms (in mean 8.97 ± 4.05 weeks). There were no significant associations between vortioxetine response/remission rates and: (1) the dose, (2) BD type, (3) clinical stage, (4) presence of rapid cycling, (5) history of psychotic symptoms, analyzed depressive symptoms, and (6) concomitantly used mood stabilizer. 4 patients (6.7%) stopped treatment due to adverse effects (nausea), and 7 patients (11.7%) discontinued treatment due to the phase switch. 14 patients (23%) experienced a loss of vortioxetine effectiveness after the initial response or remission. The results indicate relatively high rates of response and remission during 24-week treatment in depressed bipolar patients receiving vortioxetine concomitantly with a mood stabilizer. This may indicate that vortioxetine added to a mood stabilizer may constitute an efficient and well tolerated therapeutic option in bipolar depression.

Abstract- Poster

Background:Antipsychotic medications remain the mainstay in the treatment of schizophrenia. Haematological side effects of antipsychotics are not commonly reported. Neutropenia or agranulocytosis is commonly associated with Clozapine, though an increased risk for leukopenia/neutropenia have been suggested with Olanzapine, Risperidone and Chlorpromazine. We report a patient with schizophrenia who developed reversible neutropenia on treatment with Olanzapine.Case Presentation:A 30-year-old man, presented to the outpatient clinic, three years ago, with one year history of psychotic symptoms. A diagnosis of schizophrenia was considered and his symptoms remitted with Olanzapine 25 mg per day. He did not have any medical comorbidities. Following discontinuation of medications, he presented with a relapse of symptoms. In view of good response in the past, he was restarted on Olanzapine as baseline investigations were normal. During titration of Olanzapine, at 15 mg/day, his total white blood cell counts reduced to 2700/mm3 with absolute neutrophil count of 1215/mm3. In consultation with a haematologist, medical causes for neutropenia were ruled out. A possibility of Olanzapine induced neutropenia was considered. Olanzapine was stopped and Haloperidol trial was initiated, following which cell counts normalized in a week.Discussion:Various mechanisms have been proposed for Olanzapine associated neutropenia including direct toxicity or even immune mediated. A previous report has documented cross sensitization between Clozapine and Olanzapine. This patient developed neutropenia despite tolerating Olanzapine previously. Hence sensitization during the previous trial is a possibility. This report adds to the existing knowledge about haematological side effects of Olanzapine and should inform clinical practice.

Social cue recognition and attributional bias in remitted bipolar disorder: Impact on social functioning

The role of social cue recognition and attributional bias on social functioning has been sparsely studied in remitted bipolar disorder (BD). In view of this, we evaluated thirty subjects with BD (without a history of psychotic symptoms) who were in remission and thirty age and, gender-matched healthy controls for social cue recognition [using SoCueReTI (Social Cue Recognition Test- Indian Setting)], and attributional bias (using an Attributional style questionnaire). Social functioning was assessed in subjects with BD using the Functional assessment short test (FAST) - Interpersonal relationships. Subjects with BD had significant deficits in recognizing social cues in low-intensity and high-intensity vignettes when compared to healthy controls. Deficits in recognizing social cues in low-intensity vignettes were significantly correlated with the FAST scores, even after controlling for the number of episodes and duration of illness. Further replication studies are needed to ascertain the association between social cue recognition deficits and social functioning in BD.

Health-related quality of life among patients with bipolar disorder in rural southwestern Uganda: a hospital based cross sectional study

BackgroundBipolar disorder is a psychiatric disorder that alters mood and affects over 55 million people globally with an estimated lifetime prevalence of approximately 0.8–1.1%. In Africa, the lifetime prevalence of the bipolar spectrum disorders is slightly lower at 0.1–0.6%. Bipolar disorder is ranked the sixth leading cause of disability with high rates of morbidity and mortality and negatively impacts quality of life of those affected.MethodsThe aim of the study was to determine the health-related quality of life of patients with bipolar disorder attending a mental health clinic in south western Uganda. We enrolled a consecutive sample of 169 participants and evaluated their health-related quality of life using the medical outcomes health survey short form-36 (SF-36) scale. We used bivariate and multivariable logistic regression to determine associations between quality of life, sociodemographic and clinical factors setting the physical and mental component categories of quality life scale as the main outcome variables.ResultsThe mean age of the participants was 37.23 (12.83) and slightly over half (54.4%) were females. More than half (66.86%) of the participants had poor physical component summary (mean = 45.06, SD = 8.44) while 81% of the participants had poor mental component summary (mean = 41.95, SD = 8.45). Poor physical quality of life had a statistically significant association with history of suicidal thoughts (OR = 2.75, 95% CI = 1.14–6.63, P = 0.02), while poor mental quality of life had a statistically significant association with history of suicidal thoughts (OR = 3.94, CI = 1.22–12.71, P = 0.02) and history of psychotic symptoms (OR = 2.46, CI = 1.07–5.64, P = 0.03).ConclusionThe mental and physical quality of life of our participants was poor and history of suicidal thoughts and psychotic symptoms were associated with poor quality of life. There is need to address psychotic symptoms and suicidal thoughts in the management of patients with bipolar disorder to improve health related outcomes and quality of life.

Tourette disorder: A case report.

Tourette disorder: A case report.

The role of psychopathology in the relationship between history of maltreatment and suicide attempts among children and adolescent inpatients.

This retrospective chart review study investigates the relationship between the history of various forms of abuse and the presence of mood disorders and psychotic symptoms in predicting suicide attempts among psychiatrically hospitalized children and adolescents. A multi-mediation analysis was conducted with an archival dataset of 101 children and adolescents hospitalized predominantly for mood disorders and bipolar disorders with and without history of psychotic symptoms. Results showed that history of suicide attempts was directly associated with physical abuse and indirectly associated with sexual abuse (mediated by bipolar disorders). Emotional abuse was also indirectly related to history of suicide attempts, mediated by mood disorders for boys, and by psychotic symptoms for girls. This study is among the first to differentiate the unique effects of different types of early maltreatment on psychopathology, particularly mood disorders and psychotic symptoms, and histories of suicide attempts in psychiatrically hospitalized children and youth. Little is known about the relationships between histories of maltreatment, psychopathology, and suicide (considered simultaneously) among hospitalized children and adolescents. Different forms of abuse are associated with distinct psychopathology symptoms, and in turn, risk for suicide attempts. Only physical abuse is directly related to a history of suicide attempts, while sexual and emotional abuse are indirectly related (mediated by mood disorders and psychotic symptoms). These risk pathways are partly distinct for girls and boys. Identifying unique and cumulated risk factors can help prevent suicidality among hospitalized youth.

Depression with and without a history of psychotic symptoms in the general population: sociodemographic and clinical characteristics

Background: The aim of this study was to find the sociodemographic and clinical characteristics of major depressive episode (MDE) with (MDE-HPS+) and without a history of psychotic symptoms (MDE-HPS) in the general population. Methods: The Mental Health in the General Population survey interviewed 38,694 individuals in France by using the MINI. The prevalence and sociodemographic and clinical correlates of MDE-HPS+ were assessed. Results: Of the sample, 11.2% were diagnosed with current MDE and among them, 39.3% presented a history of at least one psychotic symptom (hallucination or delusion). Patients with MDE-HPS+ were younger with more severe social impairment than those with MDE-HPS-. We also found a higher proportion of three generations of migrants in the MDE-HPS+ group. Comorbid psychiatric disorders such as a history of a manic episode, alcohol use disorder, social anxiety, generalized anxiety disorder, and a personal history of a suicide attempt were more frequent in patients with MDE-HPS+ than in those with MDE-HPS-. Finally, we found a specific gradient of severity for psychiatric comorbid disorders depending on the number of psychotic symptoms lifetime in MDE. Limitations: The study also has an observational cross-sectional design that does not permit causal inferences, and it is difficult to eliminate recall bias and reporting errors. Conclusion: In the general population, patients with MDE-HPS+, when compared to MDE-HPS-, presented with a more severe clinical profile, with increased rates of psychiatric comorbidities, particularly a history of bipolar disorder and a history of a suicide attempt.

Risk factors predisposing to psychotic symptoms during levetiracetam therapy: A retrospective study

PurposeWhile levetiracetam (LEV) usage is a known risk factor for psychosis in epilepsy, the modulating effect of certain patient and treatment characteristics on the risk of psychosis has yet to be fully elucidated. MethodsIn our tertiary epilepsy center, 84 patients with psychotic symptoms during LEV usage and 100 controls without psychotic symptoms during LEV usage were selected. Patient records were reviewed including demographics, medical history, antiepileptic drug use, and cognitive abilities. Univariate comparisons were performed, and variables with p < 0.1 were selected for binary logistic regression analysis. ResultsThe total incidence of psychosis during LEV therapy in our population was 3.7%. The timing of psychotic symptoms was classified as postictal in 20 (19.8%), interictal in 14 (15.4%), postepilepsy surgery in 1 (1.1%), and unknown in 18 cases (19.8%). In 31 cases (34.1%), psychotic symptoms were classified as an antiepileptic drug-induced psychotic disorder (AIPD) as a result of LEV. In 7 cases (7.7%), AIPD occurred as a result of a different antiepileptic drug. A significant association was found between the experience of psychotic symptoms and status epilepticus (p = 0.002), a history of psychotic symptoms (p < 0.000), a history of psychiatric illness other than psychosis (p = 0.010), and concomitant phenytoin (PHT) usage (p = 0.044). Cotherapy with lamotrigine (LTG) was protective (p = 0.042). A separate analysis of controls and exclusively the 31 cases with LEV-induced AIPD yielded comparable results; a significant association was confirmed with status epilepticus (p = 0.021) and history of psychotic symptoms (p = 0.018), as well as with female gender (p = 0.047) and intellectual disability (p = 0.043). ConclusionOur retrospective study found that psychotic symptoms during LEV therapy were significantly associated with status epilepticus, a history of psychotic symptoms, a history of psychiatric illness other than psychosis, and concomitant PHT usage, whereas concomitant LTG usage was protective. Psychotic symptoms specifically as an adverse drug reaction to LEV were significantly associated with female gender, intellectual disability, status epilepticus, and a history of psychotic symptoms.

SA54 - DNA METHYLATION AND ADOLESCENT TRAJECTORIES OF PSYCHOTIC SYMPTOMS

Background Psychotic Symptoms (PS) are often distressing and can be predictive of schizophrenia, other psychiatric disorders and suicide attempts in adulthood, particularly if they persist during adolescence. Previous research in diagnosis-discordant monozygotic twin-pairs and patient-control samples has demonstrated that changes in epigenetic processes could be potential biomarkers of the emergence and persistence of PS. Investigation in large, pre-clinical population-based samples is urgently required. The aim of this study is to explore the association between DNA methylation and the emergence, persistence, and remission of PS in childhood and adolescence. Methods DNA methylation data (Illumina 450k) were obtained from the ARIES subsample of the ALSPAC birth cohort at birth, age 7, and age 15/17 (N=901). PS were assessed in private interviews with the participants at ages 12 and 18. EWAS were conducted to determine the association between DNA methylation at each time-point and reports of PS at ages 12 and 18, controlling for pregnancy and birth-related covariates and cell-type composition. Gene Ontology (GO) term enrichment analyses of the top probes were performed to identify important pathways. The top probes from each EWAS were used to investigate the role of DNA methylation in the persistence and remission of PS by comparing individuals with no history of PS, those whose symptoms persisted, and those whose symptoms remitted. Multilevel models were then constructed to test the association between the longitudinal methylomic trajectory of the top CpG sites and the trajectory of psychotic symptoms. Results from a replication of the top findings in an independent cohort will also be presented. Results A number of probes were differentially methylated (p Discussion Findings from this large, population-based study suggest that epigenetic processes at multiple stages of development may be associated with the emergence, remission, and persistence of PS in late childhood and adolescence. Research uncovering biomarkers associated with pre-clinical PS is important as it has the potential to facilitate early identification of individuals at increased risk and target preventive interventions.

Neurocognition and functional outcome in patients with psychotic, non-psychotic bipolar I disorder, and schizophrenia. A five-year follow-up

BackgroundBipolar disorder (BD) and schizophrenia (SZ) are characterized by neurocognitive and functional deficits with marked heterogeneity. It has been suggested that BD with a history of psychotic symptoms (BD-P) could constitute a phenotypically homogeneous subtype characterized by greater neurocognitive and functional impairments, or by a distinct trajectory of such deficits. The aim of this study was to compare the neurocognitive and functional course of euthymic BD-P, euthymic BD patients without a history of psychosis (BD-NP), stabilized patients with schizophrenia and healthy subjects, during a five-year follow-up. MethodsNeurocognitive and psychosocial function was examined in 100 euthymic patients with BD (50 BD-P, 50 BD-NP), 50 stabilized patients with schizophrenia (SZ), and 51 healthy controls (HC) at baseline (T1), and after a 5-year follow-up (T2). ResultsThe course of both neurocognitive performance and functional outcome of patients with SZ and BD (BD-P and BD-NP) is stable. The profile of neurocognitive impairment of patients with SZ or BD (BD-P and BD-NP), is similar, with only quantitative differences circumscribed to certain domains, such as working memory. The subgroup of patients with BD-NP does not show functional deterioration. ConclusionsWe have not found evidence of progression in the neurocognitive or psychosocial impairment in any of the three groups of patients, although it cannot be dismissed the possibility of a subset of patients with a progressive course. Other longitudinal studies with larger samples and longer duration are necessary to confirm these findings.

Bipolar features in major depressive disorder: Results from the Iranian mental health survey (IranMHS)

BackgroundPast research suggests that individuals suffering from depressive disorders with bipolar features might have different clinical outcomes resembling bipolar disorders. The objectives of this study are to determine the prevalence of bipolar features among individuals meeting the criteria for 12-month major depressive disorder (MDD) in the Iranian population and to examine the demographic and clinical characteristics associated with these features. MethodsData were drawn from the Iranian Mental Health Survey (IranMHS), a representative household survey of the Iranian population aged 15–64 years. The study sample consisted of all individuals with a 12-month MDD (n = 1014) ascertained by the Composite International Diagnostic Interview (CIDI 2.1) without a lifetime history of bipolar I or II disorders. Mood Disorder Questionnaire (MDQ) was used to screen for the lifetime history of bipolar features among participants with MDD. ResultsAmong participants meeting the 12-month MDD criteria, 22.1% (95% CI: 19.6–24.7) had a lifetime history of bipolar features. Compared with those without these features, participants with bipolar features had higher odds of endorsing suicidal ideations and suicide attempts, comorbid anxiety and substance use disorders, severe impairment, history of psychotic symptoms, some features of atypical depression and fewer depressive symptoms. Associations with comorbid anxiety disorders [Odds Ratio (OR) = 1.43; 95% confidence interval (CI): 1.00–2.03] and history of psychotic symptoms (OR = 2.63 95% CI: 1.81–3.81) persisted in multivariable models. LimitationRelying on self-reports of lifetime bipolar symptoms which is open to recall bias, and cross-sectional study design which limits interpretation of outcome and course of MDD are two major limitations of this study. ConclusionThe presence of bipolar features is associated with a distinct demographic and clinical profile in MDD. Identifying these cases would enhance the homogeneity of the depressive disorder phenotype in general population surveys. Identifying MDD patients with these features has potential clinical implications.

Duration of euthymia and predominant polarity in bipolar disorder

BackgroundThe concept of Predominant Polarity (PP) provides relevant information for clinical practice and has been widely described as course specifier for Bipolar Disorder (BD), however it has not been incorporated in DSM-5 yet. A descriptive study was conducted to identify clinical patterns associated with PP in outpatients attending a Mental Health Unit. MethodsClinical and socio-demographic characteristics were assessed from a sample of 118 euthymic outpatients fulfilling DSM 5 criteria for BDI or II recruited at a catchment area. According to their PP, patients were divided into three subgroups: depressive (DPP; 39.0%), manic (MPP; 32.2%) or indeterminate (IPP; 28.8%). Subgroups of PP were compared regarding a comprehensive set of demographic and clinical features. ResultsPP subgroups significantly differed in duration of euthymia, measured in months since the last episode (p < 0.04), with MMP patients showing longer periods (42.4 months) than those with DPP and IPP (18.6 and 18.1 months, respectively). Moreover, history of seasonal pattern was significantly higher in the DPP group compared with the PPM group (p < 0.001). There were no significant correlations between PP and type of last episode, length of illness, number of previous admissions, history of psychotic symptoms, or number of suicide attempts. LimitationsCross sectional design, relatively modest sample size. ConclusionsOur study showed similar results to previous literature regarding distribution of predominant polarity. The association found between PP and duration of euthymia represents a novel finding which awaits confirmation and adds further support to the usefulness of PP in clinical practice.

Impact of number of episodes on neurocognitive trajectory in bipolar disorder patients: a 5-year follow-up study.

The neurocognitive trajectory in bipolar disorder (BD) is variable, with controversial findings, and most evidence come from cross-sectional studies. We aimed to examine the course of neurocognitive functioning in a sample of euthymic BD patients in comparison with a control group during a 5-year follow-up. Ninety-nine euthymic bipolar patients and 40 healthy controls were assessed using a comprehensive neurocognitive battery (six neurocognitive domains) at baseline (T1) and then at 5-year follow-up (T2) in a longitudinal study. No evidence of a progression in neurocognitive dysfunction was found either in cognitive composite index or in any of the neurocognitive domains for the whole cohort. However, there was a negative correlation between number of manic episodes and hospitalisations due to manic episodes and change in neurocognitive composite index (NCI) during the follow-up. Moreover, patients with higher number of manic and hypomanic episodes have a greater decrease in NCI, working memory and visual memory. History of psychotic symptoms was not related to the trajectory of neurocognitive impairment. Our results suggest that, although the progression of cognitive decline is not a general rule in BD, BD patients who have a greater number of manic or hypomanic episodes may constitute a subgroup characterised by the progression of neurocognitive impairment. Prevention of manic and hypomanic episodes could have a positive impact on the trajectory of cognitive function.

Preparando el escenario para dejar de fumar en el paciente con Trastorno Bipolar: intervención breve en la práctica clínica

Tobacco consumption is the main preventable factor of mortality in smokers with bipolar disorder (BD), and any possible solutions are often blocked by prejudices over desire, and the possibilities and risks for these patients in giving up tobacco consumption. Adults with BD were recruited at 8 Mental Health Centres. Smokers were evaluated before and after a brief intervention based on the 3 A's and classified into a 'Stage of Change' (SOC) and their 'Readiness to Change' (RTC). A multiple linear regression was used to analyze the progression in their RTC and the independent effect of different variables (pharmacological treatment, history of psychotic symptoms, current anxiety symptoms, willingness, self-perceived capacity to quit smoking and subjective perception of cognitive functioning). Of 212 stable patients diagnosed with BD, current smokers (n=101; 47.6%) were included in the intervention phase, and 80.2% completed it. At baseline, 75.2% were considering the idea of giving up smoking and, after the brief intervention, 30.9% of the patients progressed in their SOC. A significant increase in the level of RTC was observed (53.3 vs 59.3, P=0.019). Perception of cognitive performance (β=-0.35;P=0.002), the degree of willing to quit (β=0.32;P=0.008), self-perceived capacity to quit tobacco smoking (β=-0.30;P=0.012), the patient's age (β=-0.72;P=0.004), the age of onset of smoking (β=0.48;P=0.022) and years as a smoker (β=0.48;P=0.025) were all factors that significantly influenced the chances of improving after the short intervention. Smokers with BD consider the idea of quitting and a brief intervention developed in the every day mental health care setting improves the level of readiness. The neurocognitive dysfunction associated with BD may limit patients' readiness to quit smoking.

Rapid antidepressant effect of S-ketamine in schizophrenia

Rapid anti-suicidal and antidepressant effects of ketamine have repeatedly been confirmed in unipolar and bipolar depression. Although meaningful antidepressant efficacy of ketamine has also been shown in depressed patients with a history of psychotic symptoms, its administration in psychotic disorders has largely been neglected due to its potential to exacerbate dissociative or psychotic symptoms. Presenting a case of a young female inpatient suffering from schizophrenia with a severe post-psychotic depression, we demonstrate a robust anti-suicidal and antidepressant effect of S-ketamine infusions administered thrice weekly for 3 weeks in total. Importantly, no relevant psychotic or dissociative symptoms occurred during the whole augmentation treatment period leading to a sustained remission of depressive symptoms and suicidality. Our safe and effective experience with intravenous S-ketamine might encourage researchers and clinicians to widen its administration range beyond the diagnosis of depression to enrich the current knowledge of ketamine effects in psychotic disorders.

S5. EFFECTS OF EARLY LIFE ADVERSITY ON IMMUNE FUNCTION AND COGNITIVE PERFORMANCE IN YOUTHS WITH AND WITHOUT EXPERIENCE OF PSYCHOTIC SYMPTOMS

BackgroundEarly life adversity (ELA), including physical abuse or neglect and emotional abuse or neglect, is a significant risk factor for schizophrenia. Changes in cognitive function, and in particular social cognition, are also associated with this disorder. In psychosis, ELA and cognitive deficits have, separately, been associated with an increased immune response. In this study we sought to determine whether ELA’s might affect cognitive performance and if so, whether these affects were mediated via an impact on immune response.MethodsWe investigated the relationship between ELA, immune response and cognition in the Avon Longitudinal study of parents and children (ALSPAC; n~5,000). ELA was defined in terms of the experience of physical abuse or neglect, emotional abuse or neglect, witnessing domestic violence, and harsh parenting before the age of 5 years. Social cognition was defined in terms of performance on theory of mind while general cognitive ability was defined in terms of IQ. Immune function was measured using C-reactive protein and Interleukin-6. Analysis was run both for the full sample and for individuals presenting with a history of psychotic symptoms at age 12.ResultsEarly life adversity was associated with poorer performance on a range of both general and social cognitive measures. Increased immune activation was associated with cognitive performance, but was not observed to mediate the effects of ELA on cognition. Comparable findings were observed in children presenting with and without psychotic symptoms.DiscussionWhile increased immune response has been associated with both early life adversity and cognitive impairment, this response was not observed to mediate the relationship between these two variables. Alternative hypothesis for the mechanism by which ELA may result in poorer cognitive performance, including attachment related effects, will be discussed.

Psychosocial functioning in patients with psychotic and non-psychotic bipolar I disorder. A comparative study with individuals with schizophrenia

BackgroundMore than 50% of individuals with bipolar disorder (BD) do not reach full psychosocial functioning, even during periods of euthymia. It has been suggested that history of psychotic symptoms is one of the factors which are associated with a worse functional outcome. The objective was to compare psychosocial functioning between patients with BD, with (BD-P), and without (BD-NP) a history of psychotic symptoms, and to examine whether the history of psychotic symptoms, or other clinical or neurocognitive variables predict psychosocial functioning. MethodsPsychosocial functioning and neurocognition were examined in 100 euthymic patients with bipolar I disorder (50 BD-P, and 50 BD-NP), compared to 50 stabilised patients with schizophrenia (SZ), and 51 healthy controls (HC). Results1) There were no differences between BD-P and BD-NP in the GAF-F score or in the FAST total score. 2) The two groups of patients with BD had better scores than SZ both in the GAF-F, and in all measures of the FAST, except for the subscale leisure time. 3) The neurocognitive composite index, verbal memory and subclinical depressive symptoms were the variables which explained a higher percentage of the variance of functional outcome. LimitationsThe cross-sectional design, and the relatively small sample size are the main limitations. ConclusionsA history of psychotic symptoms has no relevant impact on the level of psychosocial functioning in BD. Neurocognitive dysfunction and subclinical depressive symptoms are the variables that best explain the functional impairment. These findings have important clinical implications.

Psychosis Beyond the 22q11.2 Deletion: Do Additional Genetic Factors Play a Role?

Psychosis Beyond the 22q11.2 Deletion: Do Additional Genetic Factors Play a Role?