Lower Global Assessment Of Functioning Scores Research Articles

Baseline antipsychotic prescription and short-term outcome indicators in individuals at clinical high-risk for psychosis: Findings from an Italian longitudinal study

IntroductionThe prognostic prediction of outcomes in individuals at clinical high-risk for psychosis (CHR-P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta-analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR-P individuals. In particular, baseline AP exposure in CHR-P individuals may be considered as a functional equivalent of the psychometric transition to psychosis, as already postulated in the original ‘Ultra High-Risk’ model.ObjectivesThe main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR-P individuals with more severe psychopathology and worse prognostic trajectories along a 1-year follow-up period.MethodsThis research was settled within the ‘Parma At-Risk Mental States’ program. Baseline and 1-year follow-up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR-P individuals who were taking AP medications at entry were included in the CHR-P-AP+ subgroup. The remaining participants were grouped as CHR-P-AP-. The acquisition of drug and outcome information was collected both at baseline and across the follow-up period. Finally, logistic regression analyses with dichotomized 1-year outcome parameters (previously showing statistically significant differences in inter-group comparisons) as dependent measures and sociodemographic and clinical characteristics as independent variables were also performed.ResultsHundred and seventy-eight CHR-P individuals (aged 12–25 years) were enrolled (91 CHR-P-AP+, 87 CHR-P-AP-). Compared to CHR-P AP-, CHR-P AP+ individuals had older age, greater baseline PANSS ‘Positive Symptoms’ and ‘Negative Symptoms’ factor subscores and a lower GAF score. At the end of our follow-up, CHR-P-AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non-planned visits compared to CHRP- AP- individuals.ConclusionsThe current study suggests that AP need is a significant prognostic variable in cohorts of CHR-P individuals and should be included in the current risk calculators. In particular, the results of this study conducted in a realworld clinical setting indicate that the rate of CHR-P individuals who were already exposed to AP at the time of CHR-P status ascription was higher than those reported in recent meta-analyses on this topic. Moreover, our findings confirm that baseline AP prescription appears to increase psychotic transition risk.Disclosure of InterestNone Declared

Baseline antipsychotic prescription and short-term outcome indicators in individuals at clinical high-risk for psychosis: Findings from the Parma At-Risk Mental States (PARMS) program.

The prognostic prediction of outcomes in individuals at clinical high-risk for psychosis (CHR-P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta-analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR-P individuals. The main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR-P individuals with more severe psychopathology and worse prognostic trajectories along a 1-year follow-up period. This research was settled within the 'Parma At-Risk Mental States' program. Baseline and 1-year follow-up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR-P individuals who were taking AP medications at entry were included in the CHR-P-AP+ subgroup. The remaining participants were grouped as CHR-P-AP-. Hundred and seventy-eight CHR-P individuals (aged 12-25 years) were enrolled (91 CHR-P-AP+, 87 CHR-P-AP-). Compared to CHR-P AP-, CHR-P AP+ individuals had older age, greater baseline PANSS 'Positive Symptoms' and 'Negative Symptoms' factor subscores and a lower GAF score. At the end of our follow-up, CHR-P-AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non-planned visits compared to CHRP- AP- individuals. In agreement with increasing empirical evidence, also the results of the current study suggest that AP need is a significant prognostic variable in cohorts of CHR-P individuals and should be included in risk calculators.

Identifying transdiagnostic biological subtypes across schizophrenia, bipolar disorder, and major depressive disorder based on lipidomics profiles.

Emerging evidence has demonstrated overlapping biological abnormalities underlying schizophrenia (SCZ), bipolar disorder (BP), and major depressive disorder (MDD); these overlapping abnormalities help explain the high heterogeneity and the similarity of patients within and among diagnostic categories. This study aimed to identify transdiagnostic subtypes of these psychiatric disorders based on lipidomics abnormalities. We performed discriminant analysis to identify lipids that classified patients (N = 349, 112 with SCZ, 132 with BP, and 105 with MDD) and healthy controls (N = 198). Ten lipids that mainly regulate energy metabolism, inflammation, oxidative stress, and fatty acylation of proteins were identified. We found two subtypes (named Cluster 1 and Cluster 2 subtypes) across patients with SCZ, BP, and MDD by consensus clustering analysis based on the above 10 lipids. The distribution of clinical diagnosis, functional impairment measured by Global Assessment of Functioning (GAF) scales, and brain white matter abnormalities measured by fractional anisotropy (FA) and radial diffusivity (RD) differed in the two subtypes. Patients within the Cluster 2 subtype were mainly SCZ and BP patients and featured significantly elevated RD along the genu of corpus callosum (GCC) region and lower GAF scores than patients within the Cluster 1 subtype. The SCZ and BP patients within the Cluster 2 subtype shared similar biological patterns; that is, these patients had comparable brain white matter abnormalities and functional impairment, which is consistent with previous studies. Our findings indicate that peripheral lipid abnormalities might help identify homogeneous transdiagnostic subtypes across psychiatric disorders.

Overlap between general factors of psychopathology and personality: They share associations with daily life functioning and communication style

Previous studies have shown that specific personality dimensions, -e.g., the Big Five-, consistently intercorrelate, such that they form a general factor of personality (GFP). It has been hypothesized that the GFP reflects social effectiveness. Similarly, in the clinical domain, overlap between various psychopathological symptoms has also been reported, leading to a general factor of Psychopathology, or p factor. The aim of this study was to test the overlap between the higher-order factors in personality and psychopathology, and how they relate to daily life functioning and communication style. We tested a sample of 165 outpatients of a psychological therapy institute, using a multi-source approach that included self-reports and other ratings. The outpatients’ self-reports of personality, general psychological problems, and interpersonal problems were available. Psychotherapists rated the outpatients’ functioning in daily life with the well-known Global Assessment of Functioning (GAF) scale. A spouse or friend also rated the impact of the patient’s communication/social behavior. Patients with lower GFP scores and higher scores on general psychopathology, displayed more distress and daily functioning deficits (i.e., lower GAF scores) and, in terms of communication styles, were also rated as being less dominant, less in control socially, and more submissive and aggressive. We proposed that part of the overlap between the general factors (GFP, psychopathology factors) may relate to a lower general life functioning and less social effectiveness.

Prevalence of Circadian Rhythm Sleep-Wake Disorder in Outpatients with Schizophrenia and Its Association with Psychopathological Characteristics and Psychosocial Functioning.

The prevalence of circadian rhythm sleep-wake disorder (CRSWD) among patients with schizophrenia is not clear. The effect of comorbid CRSWD on such patients has also not been fully evaluated yet. Outpatients with schizophrenia in the maintenance phase who visited Tokyo Women’s Medical University Hospital between April 2018 and March 2019 participated in this study. The Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impressions–Severity Illness Scale (CGI-S), Global Assessment of Functioning (GAF), World Health Organization Disability Assessment Schedule II, Insomnia Severity Index (ISI), and Morningness–Eveningness Questionnaire (MEQ) were administered, and the patient responses with and without CRSWD were compared. Of the 105 patients with schizophrenia, 19 (18.1%) had CRSWD. There were trends toward higher BPRS and lower GAF scores in the CRSWD group than in the non-CRSWD group, although these did not reach statistical significance following a false discovery rate correction. Among the BPRS subitems, the anxiety scores were significantly higher in the CRSWD group than in the non-CRSWD group (p < 0.01). CRSWD was highly prevalent among patients with schizophrenia in the maintenance phase. Comorbidities of CRSWD may affect psychopathological characteristics and psychosocial functioning.

Real-world clinical features of and antidepressant prescribing patterns for outpatients with bipolar disorder

BackgroundSeveral evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were not sufficiently based on real-world clinical practice.MethodsThe MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. Psychiatrists were asked to complete a questionnaire about patients with bipolar disorder by performing a retrospective medical record survey. The questionnaire included patient characteristics (age, gender, height, weight, academic background, and occupational status), comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment.ResultsData on 2705 patients were included in this study. The proportion of patients receiving antidepressant prescriptions was 40.9%. The most commonly used antidepressant was duloxetine, and the most frequently used antidepressant class was selective serotonin reuptake inhibitors (SSRIs). Binomial logistic regression analysis and bivariate analysis revealed that the usage of antidepressants was correlated with low prescription rates for mood stabilizers, high prescription rates for anxiolytics and hypnotics, and low GAF scores. In addition, patients in a depressive state had a significantly higher rate of antidepressant prescriptions than patients with other mental states.ConclusionsApproximately 40% of patients in Japan with a diagnosis of bipolar disorder have received antidepressants. Antidepressants were most often prescribed in combination with mood stabilizers, antipsychotics or both. Patients who were prescribed antidepressants received fewer mood stabilizers, more anxiolytics, and more hypnotics than those who did not receive antidepressant prescriptions.

Mental Health and Psychosocial Functioning Over the Lifespan of German Patients Undergoing Cardiac Catheterization for Coronary Artery Disease.

Background: Psychological problems are common in patients with coronary artery disease (CAD) and are associated with poor outcome. However, data on the prevalence of distinct mental disorders and their relevance to patients' functioning in daily life are scarce.Method: In this retrospective study, a total of 514 German patients with CAD as diagnosed by cardiac catheterization were assessed using the Mini International Neuropsychiatric Interview 5.0.0 (M.I.N.I.) and psychosocial functioning was evaluated using the Global Assessment of Functioning (GAF) scale.Results: Twenty-nine percent of the participants suffered from at least one mental disorder after the onset of their CAD (mean time since onset = 10.86 years, SD = 8.15). In comparison to the period before onset of CAD, elevated prevalence rates were found for severe depressive episodes, agoraphobia, dysthymia, panic disorder, and hypochondria. Predictors of mental disorders after the onset of CAD were female gender, younger age at onset of CAD as well as mental disorders and low GAF scores before onset. GAF scores decreased after the onset of CAD, recovered only partially, and were influenced by mental disorders before onset in women but not in men.Conclusions: Mental disorders—especially depression and agoraphobia—are frequent in patients with CAD, with women, patients with a younger age at onset of CAD and patients with any history of mental disorders especially at risk. Regardless of whether patients meet any specific diagnostic criteria, psychosocial functioning is markedly impaired after the onset of CAD, underscoring the need for specific mental health programs for this patient population. Future research, ideally using a prospective design, is necessary to confirm these findings and to further the knowledge of prevalence rates of mental disorders and of modifiable risk factors for the development of mental disorders in patients with CAD.

Physical Activity of Patients with Chronic Schizophrenia and Related Clinical Factors.

ObjectiveThis study aimed to investigate clinical factors contributing to the low physical activity (PA) of patients with chronic schizophrenia. MethodsPA was measured in 50 outpatients with chronic schizophrenia using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Psychopathology, psychosocial functioning, and extrapyramidal symptoms were assessed using the 18 item-Brief Psychiatric Rating Scale (BPRS-18), Global Assessment of Functioning (GAF), and Drug-Induced Extrapyramidal Symptom Scale (DIEPSS), respectively. We examined differences in these clinical variables between “inactive,” “minimally active,” and “health enhancing physical activity” groups. Linear regression analysis was used to examine the clinical factors explaining low PA levels in patients with schizophrenia. ResultsSubjects spent an average of 130.18±238.89 min/wk on moderate/vigorous-intensity PA and only 26% of them met the recommended PA guideline of 150 minutes of at least moderate PA per week. The inactive group showed significantly higher BPRS-18 and DIEPSS scores, and a lower GAF score than the other groups. Linear regression analysis showed that DIEPSS scores independently explained the amount of total PA (p=0.001) and time spent being sedentary (p=0.028). ConclusionThis study provides preliminary evidence that extrapyramidal symptoms could be a major impediment to the PA of patients with schizophrenia.

T28. QUALITY OF PARENTAL BONDING AMONG INDIVIDUALS WITH ULTRA-HIGH RISK OF PSYCHOSIS AND SCHIZOPHRENIA PATIENTS

BackgroundA child’s parental bonding, measured using the Parental Bonding Instrument (PBI), has been found to be associated with psychiatric illnesses. In particular, a significantly higher proportion of patients with schizophrenia tend to report affectionless-controlling mothers as compared to healthy controls.This study aims to (i) investigate the applicability of the PBI tool in Singapore, using exploratory factor analysis, and (ii) explore the association between parental bonding, symptom severity and functioning across schizophrenia patients, individuals at ultra-high risk of psychosis (UHR), and healthy controls.MethodsData from 59 schizophrenia patients, 164 UHR, and 510 healthy controls (N = 733) were collected. The Structured Clinical Interview for DSM-IV (SCID) was used to ascertain any psychiatric diagnoses. Positive and Negative Symptoms of Schizophrenia (PANSS) and Global Assessment of Functioning (GAF) were administered on UHR and patients. Social and Occupational Functioning Assessment Scale (SOFAS) was administered on HC and UHR. Calgary Depression Scale for Schizophrenia (CDSS) was administered on UHR only.Two exploratory factor analyses of the PBI were conducted on maternal items and paternal items (oblimin rotation). PBI factor scores were calculated for each individual and compared across groups using one-way ANOVA. Multivariate backward regressions were conducted to elucidate the association(s) between parental bonding factors and the clinical scales.ResultsFactor analyses revealed three-factor solutions for both maternal and paternal items, with factors ‘care’, ‘autonomy’, and ‘overprotection’. All the original ‘care’ items loaded onto the ‘care’ factor for maternal and paternal analyses. The original ‘control’ items were split into ‘autonomy’ (the degree to which children were allowed to make their own decisions, e.g. ‘gave me as much freedom as I wanted’) and ‘overprotection’ (e.g. ‘felt I could not look after myself’). Fit statistics suggested a good fit for both maternal items and paternal items (CFI > 0.9, TLI > 0.9). UHR were 1.61 times as likely to report affectionless-controlling mothers (OR = 1.61, 95% CI: 1.13–2.30, p = .008) and 0.52 times as likely to report having optimal mothers (OR = 0.52, 95% CI: 0.29–0.93, p = 0.028). No significant differences in paternal styles were reported.Compared to HC, patients and UHR reported significantly lower maternal care (F(2,729) = 27.51, p < .001), higher maternal overprotection (F(2,729) = 17.00, p < .001) and paternal overprotection (F(2,711) = 9.30, p < .001) (bonferroni-corrected). Among UHR, higher paternal overprotection was significantly associated with higher total PANSS scores (β = .162, p = .045), higher PANSS general psychopathology subscores (β = .185, p = .022), lower GAF scores (β = -.188, p =.021), lower SOFAS scores (β = -.183, p = .024), and worse CDSS scores (β = .210, p = .009). Among patients, higher maternal overprotection (β = .444, p = .022) and paternal care (β = .400, p = .036) were associated with higher GAF functioning.DiscussionThis psychometric investigation of the PBI among Asian participants yielded three-factor models, which deviate from the original two factors. Our findings replicate previous evidence of higher proportion of affectionless-controlling mothers among UHR and patients. Lower maternal care, lower maternal and paternal overprotection were reported. Paternal overprotection was associated with worse positive and negative symptoms of schizophrenia, worse social, occupational, and psychological functioning, and more severe depressive symptoms among UHR. Our results highlight the importance of addressing childhood parental bonding issues in early intervention services for UHR.

The Impact of Comorbid Cannabis and Alcohol Use Disorders on the Functioning of College Students with Psychiatric Disorders

The objective of this study is to investigate the prevalence of substance use disorder among college youth receiving treatment for psychiatric illness and the impact of this comorbidity on educational disruption and functional outcomes. 113 college students treated at a hospital-based outpatient psychiatric program in Rhode Island from July 2012 to July 2013. Chart reviews yielded demographic information, psychiatric diagnoses, Global Assessment of Functioning (GAF) scores at initial evaluation, and occurrence of medical leave. Rates of medical leave and significant impairment (GAF ≤ 60) in participants with and without substance use disorders were analyzed with odds ratios adjusting for age and gender. Cannabis use (23.9%) and alcohol use (17.7%) disorders were significantly associated with lower GAF scores and medical leave for psychiatric illness. These associations were greater for cannabis use disorder. College students in psychiatric care could benefit from improved screening and treatment for both alcohol and cannabis use disorders.

Association between Global Assessment of Functioning scores and indicators of functioning, severity, and prognosis in first-time schizophrenia.

BackgroundAssessment of psychosocial functioning in people with schizophrenia is important. The Global Assessment of Functioning (GAF-F) scale represents a widely applied, easy, and quick tool, but its validity and reliability have been debated. The aim was to investigate whether GAF-F scores are associated with other indicators of functioning, severity, and hospitalization.MethodsA Danish population-based cohort study of adults (≥18 years) with a recorded GAF-F score at first-time schizophrenia diagnosis during 2004–2011 was performed. The internal validity of GAF-F was evaluated by assessing its association with other baseline measures of functioning and illness severity. Risk of schizophrenia hospitalization within 2 years was evaluated using Cox regression stratified by sex and adjusted for age, year of diagnosis, and inpatient/outpatient status at diagnosis.ResultsWe identified 2,837 cases of schizophrenia with a GAF-F score at first-time diagnosis (73.0% inpatients; 62.6% males). GAF-F was associated with several baseline measures of functioning and illness severity, such as female sex, being in work, and a longer baseline hospitalization. Lower GAF-F scores were associated with higher hospitalization risk among males (reference GAF-F 61–100): GAF-F 51–60: hazard rate ratio (HRR) =1.24 (95% confidence interval [CI] =0.89–1.75); GAF-F 41–50: HRR =1.31 (95% CI =0.97–1.77); GAF-F 31–40: HRR =1.36 (95% CI =1.01–1.82); GAF-F 21–30: HRR =1.50 (95% CI =1.09–2.06); and GAF-F 1–20: HRR =2.30 (95% CI =1.36–3.90), fitting a dose–response relationship (P=0.031). This association was not found in females.ConclusionGAF-F at first-time schizophrenia diagnosis showed good internal validity against other measures of functionality in a Danish hospital setting. Severe impairment (as measured by the GAF-F score) at first-time schizophrenia diagnosis was associated with a higher risk of 2-year hospitalization among males, which may indicate sex differences in the course of disease and treatment response.

Psychopathological Symptoms Assessed by a System-Specific Approach Are Related to Global Functioning in Schizophrenic Disorders

Background: By mostly using a positive-negative approach, several studies have identified factors that influence day-to-day functioning. We applied a different, system-specific approach to expand the knowledge of this issue. Sampling and Methods: We recruited a sample of 100 inpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder. Psychopathological characteristics were assessed with the Bern Psychopathology Scale (BPS) and functional characteristics with the Global Assessment of Functioning (GAF) scale. Linear regression analyses were performed with the GAF score as the dependent variable and the global values of the BPS subscores as independent variables. The model was controlled for confounding variables. Spearman rank correlation analyses were used to identify associations between the relevant BPS subdomains and global functioning. Results: Higher absolute global values of the BPS domains language (p = 0.038) and motor behavior (p = 0.049) were significantly associated with lower GAF scores. These findings remained stable after adjusting for potential confounding variables. A statistically significant negative correlation was found between both qualitative symptoms (r = -0.273, p = 0.006) and indirect signs (r = -0.269, p = 0.007) of the language domain and GAF scores. Also, quantitative (r = -0.211, p = 0.035) and qualitative symptoms (r = -0.214, p = 0.033) in the motor behavior domain were associated with poorer functioning. Conclusions: A system-specific approach can describe subgroups of patients with poor functioning. Identifying such subgroups could help to utilize targeted treatment opinions in a timely manner. Another goal of future research is to clarify the underlying neurobiological deficits.

Positive mental health in individuals with mental disorders

IntroductionGiven the emphasis on inclusion of well-being interventions in the treatment and rehabilitation of individuals with mental disorders, it is important to understand the level and determinants of positive mental health (PMH) among them.ObjectiveTo conduct a cross-sectional study among patients with schizophrenia, depression and anxiety spectrum disorders to estimate PMH.Aims(i) To estimate the level of PMH among patients with mental disorders and compare these with the established general population estimates; (ii) to identify socio-demographic and clinical determinants of PMH.MethodsFollowing ethics approval, 353 patients aged 21-65 years, receiving treatment at a psychiatric hospital in Singapore for schizophrenia, depression or anxiety spectrum disorders were included. Patients provided socio-demographic information and completed the multidimensional PMH instrument that provides total and domain-specific scores ranging from 1 to 6; higher scores indicate better PMH. Functioning was assessed with the Global Assessment of Functioning (GAF) scale and clinical data were obtained from administrative databases.ResultsSample comprised 142, 139 and 72 patients with schizophrenia, depression and anxiety spectrum disorders respectively, with a mean age of 39.2 years. Mean total PMH scores among them were 4.2, 3.7 and 3.8 respectively which were significantly lower than the general population mean of 4.5 (P &lt; 0.001). Patients of Chinese ethnicity, with lower education, depression or anxiety, and lower GAF scores were more likely to have lower PMH.ConclusionsThis study identified patient subgroups that are likely to have poorer PMH. Interventions facilitating PMH among these patient groups would be beneficial and are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The 23-Hour Observation Unit Admissions Within the Emergency Service at a National Tertiary Psychiatric Hospital: Clarifying Clinical Profiles, Outcomes, and Predictors of Subsequent Hospitalization.

We examined health care utilization, clinical profiles (such as sociodemographic features, clinical severity), and outcomes (inpatient admission, revisit within 24 hours of discharge) of patients who were admitted to a 23-hour observation unit within the emergency service of a tertiary psychiatric hospital and hypothesized that a specific clinical profile (greater clinical severity, lower psychosocial functioning) predicted subsequent inpatient hospitalization. The medical records of all patients admitted to the observation unit from February 5, 2007, to February 4, 2012 (N = 2,158) were assessed for relevant data. Clinical severity and level of psychosocial functioning were assessed using Clinical Global Impressions-Severity (CGI-S) and Global Assessment of Functioning (GAF) scales, respectively. Overall, the patients seen were predominantly Chinese males > 36 years old who had diagnoses including stress-related, anxiety, affective spectrum, and psychotic disorders. The clinical severity score (CGI-S) improved significantly following discharge from the observation unit (t 1,1848 = 23.316; P < .001). Logistic regression analyses revealed that self-referred (P = .001), older patients (P = .007) with past psychiatric history (P = .019), lower GAF scores (P = .025), and less improvement of CGI-S scores (P = .001) were associated with inpatient admission after a 23-hour stay in the observation unit. Our study findings affirmed our hypothesis and supported the utility of the observation unit in monitoring the overall clinical status of patients, which was linked with subsequent inpatient admissions. Better management of these patients at the outpatient level can potentially decrease unnecessary hospitalization and reduce health care cost as well as illness burden on patients and caregivers.

Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: A naturalistic study

BackgroundA number of data show the negative role of duration of untreated illness (DUI) on outcome in mood disorders, but no investigation has been carried out about the impact of this variable in bipolar disorder (BD) with psychotic symptoms. Clinical experience shows that many bipolar patients with psychotic symptoms receive other diagnoses and often are chronically treated with first generation antipsychotics, with the effect to reduce duration of untreated psychosis/untreated episode with psychotic symptoms (DUP), but not DUI. Purpose of the study was to define the rate of misdiagnosis and the impact of DUP/DUI on outcome of bipolar patients with psychotic symptoms. MethodClinical information (DUP, DUI, first received diagnosis) about bipolar outpatients with psychotic symptoms (N=240) were extrapolated through a retrospective review of the clinical charts, Lombardy database and, if necessary, through clinical interviews with patients and their relatives. Outcome measures included psychiatric and substance abuse comorbidity, occupational status, Global Assessment of Functioning (GAF), number of hospitalizations and of suicidal attempts, number of depressive/manic recurrences. Patients were divided in two groups according to the DUP (1 year) and DUI (8 years) median, and the groups were compared through analyses of variance (ANOVAs) for continuous variables or χ2 tests for dichotomous ones. Multivariate analysis of variance (MANOVA) with duration of illness as covariate was then performed to eliminate the effect of this variable. Finally, binary logistic regressions were performed considering age at onset, DUI, DUP as independent variables and outcome variables as dependent ones (presence of hospitalizations/suicidal attempts, GAF scores<50, occupational status). ResultsMost of patients (61.5%) received a first diagnosis different from BD with the most frequent DSM-diagnosis being delusional disorder (17.9%). Patients with longer DUP were not different in outcome measures with respect to patients with shorter DUP. Patients with a DUI >8 years presented higher number of hospitalizations (F=6.04, p=0.015), higher number of manic recurrences (F=5.25, p=0.023), higher number of depressive recurrences (F=7.13, p=0.008) and lower GAF scores (F=17.74, p<0.001). Statistical significance persisted for number of hospitalizations (p<0.001) and GAF scores (p=0.003) after MANOVA. Finally binary logistic regression showed that a longer DUI was predictive of GAF scores<50 (F=17.74, p<0.001). DiscussionMore than half of bipolar patients with psychotic symptoms receive a different diagnosis at first contact with psychiatric services. DUI (but not DUP) is a predictor of outcome in bipolar patients with psychotic symptoms. This indicates that an early diagnosis and proper treatment with a mood stabilizer (or an atypical antipsychotic with mood stabilizing effects) may improve long-term outcome of these patients. In the light of the naturalistic design of the present paper, these results have to be considered as preliminary and have to be confirmed by prospective controlled studies.

Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project

In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment. In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed. During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model. A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.

MRI Predicts Remission at 1 Year in First-Episode Schizophrenia in Females with Larger Striato-Thalamic Volumes

Background/Aims: The Remission in Schizophrenia Working Group has defined remission as ‘a low-mild symptom intensity level, maintained for a minimum of 6 months, where such symptoms do not affect an individual's behaviour' [Andreasen et al.: Am J Psychiatry 2005;162:441-449]. Since brain morphology relates to symptomatology, treatment and illness progression, MRI may assist in predicting remission. Methods: Thirty-nine patients newly diagnosed with DSM-IV schizophrenia underwent MRI brain scan prior to antipsychotic exposure. The Global Assessment of Functioning (GAF) score was entered into a voxel-based analysis to evaluate its relationship with cerebral grey matter volume from the baseline MRI. We entered age, total intracranial volume and intake GAF score as co-variates. Males and females were analysed separately because gender is a potent determinant of outcome. Results: Males had lower GAF scores than females, both at intake and at 1 year. Males comprised only 40% (12 out of 39) of the early remission group. For females only, early remission was strongly and positively correlated with bilateral lentiform and striatal volumes. For males, there was no such relationship. Conclusion: Larger striato-thalamic volume correlated with early remission in females only. These baseline MRI findings were unlikely to be confounded by antipsychotic treatment and chronicity. These brain morphological markers show gender dimorphism and may assist in the prediction of early remission in newly diagnosed schizophrenia.

EPA-0665 – Premorbid adjustment predicts functional outcome in clinical high-risk patients. Results of the epos project.

In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their premorbid adjustment. In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganized, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9- month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analyzed. During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 45% to 25%. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model. A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are executed.

EPA-1457 – Cognitive functioning in major psychoses: delineating diagnostic continuity and discontinuity

The Kraepelinian dichotomy posits that patients with schizophrenia (SCZ) and bipolar disorder (BD) present as two separate psychotic entities such that they differ in terms of clinical severity including neurocognitive functioning. Based on clinical impression within a tertiary psychiatric hospital context and extant data, we hypothesized that patients with SCZ had a similar level of neurcognitive impairment compared with BD. Forty-nine healthy controls (HC), 72 SCZ and 42 BD patients who were matched for age, gender, and premorbid IQ were administered the Brief Assessment of Cognition battery (BAC), the Positive and Negative Syndrome Scale for SCZ patients, the Young Mania Rating Scale (YMRS) for BD patients, and Global Assessment of Functioning (GAF) for both patients groups. Both BD and SCZ groups demonstrated similar patterns of neurocognitive deficits across several domains (verbal memory, working memory, semantic fluency, processing speed) compared with HC subjects. However, no significant difference was found in neurocognitive functioning between BD and SCZ patients, suggesting that both patient groups suffer the same degree of neurocognitive impairment. Moreover, patients with lower level of psychosocial functioning as indicated by lower GAF score (F(1,112) = 2.661, p = 0.009) and older age (F(1,112) = −2.625, p = 0.010), not diagnosis or doses of psychotropic medications, predicted were associated with poorer overall neurocognitive functioning as measured by the(lower BAC composite score). Our findings of comparable neurocognitive impairments between SCZ and BD affirm our hypothesis and support less the Kraepelinian concept of dichotomy but more of a continuum of psychotic spectrum conditions.

P.1.j.025 Abnormal cognitive salience but not WCST scores are associated with poor outcome in patients with schizophrenia

Purpose of study: Psychopathology and cognitive impairment are poor predictors of functional outcome in patients with schizophrenia. In contrast, recent data have demonstrated that dopamineassociated functions such as baseline motivational deficits and social cognition are more relevant to predict patient functionality. Social cognition is a complex entity that includes several information processes such as reasoning, attention and memory, all involved in social adjustment. These cognitive dimensions are known to be particularly impaired in schizophrenia patients. Among several components, it comprises cognitive salience, a measure of the aberrant dopamine signalling in brain. In the present study, functional outcome was correlated to (i) psychopathology, (ii) attention and frontal lobe executive function, and (iii) cognitive salience in a population of stabilised patients with schizophrenia (SCZ). Method: Chronic medicated patients with schizophrenia (n = 35) have been examined and compared to a healthy control population (n = 34). Clinical characteristics, prefrontal functioning, and cognitive salience were assessed using PANSS (Positive and Negative Syndrome Scale), CGI (Clinical Global Impression), WCST (Wisconsin Card Sorting Test), SAT, and CPTAX tests respectively. CPT-AX (Continuous Performance Test-AX version) and SAT (Salience Attribution Test) are two standardised and computerised tests to study cognitive salience. SAT: is a probabilistic reward learning game that employs cues that vary across task-relevant and task-irrelevant dimensions; it provides behavioural indices of adaptive and aberrant reward teaching. CPT-AX with salient stimuli doesn’t use words but colour stimuli and assesses working memory by varying inter stimulus interval. Global Assessment of functioning (GAF) evaluated the overall functioning of patients. Results: Compared to control subjects, 60% of SCZ patients showed a significant decrease in performance for WSCT (perseverative responses, perseverative and non-perseverative errors, and errors). SAT (Explicit Adaptive Salience) values were significantly different for 42% of subjects, while CPT-AX scores (Hit-score, False Alarm Rate, Response Time) were abnormal in only 27% of patients. Only the latter subgroup had abnormal scores in WSCT showing a possible participation of prefrontal involvement in this salience test. Interestingly and in accordance with data of literature, abnormal responses to WCST did not predict low GAF score in our study. In contrast, subjects with low SAT scores and CPT-AX separately were significantly (p< 0.05) more frequent in the group of patients with low GAF scores. We also tested the hypothesis that the CPTAX and SAT evaluate two different dimensions of salience. We reviewed patients with low scores on both SAT and CPT-AX. This subpopulation had indeed scores significantly (p = 0.02) lower in the GAF compared to patients without this combination. Conclusion: Alteration of the cognitive salience tests CPTAX and SAT is associated with functional outcome impairment in patients with schizophrenia. Preliminary data are indicating that these two tests can describe the activity of two separated neurobiological networks involved in cognitive salience.