Non-psychotic Psychiatric Disorders Research Articles

Effect of onset age on the long-term outcome of early-onset psychoses and other mental disorders: a register-based Northern Finland Birth Cohort 1986 study.

Psychiatric illnesses can affect the social transitions of adolescence and young adulthood, such as completing education and entering working life and relationships. However, associations between earlier onset age and long-term outcomes among those with early-onset psychoses (EOP) are unclear, as are the long-term outcomes of EOP compared to non-psychotic disorders. We used national register data of the Northern Finland Birth Cohort 1986 to detect persons with EOP and other early-onset psychiatric disorders. The long-term clinical and work-family outcomes of persons with onset age before 18 years (n = 41 psychoses, n = 495 non-psychoses) or between 18-22 years (n = 61 psychoses, n = 377 non-psychoses) were compared. Individuals with the onset of psychosis between 18-22 years had significantly more unfavourable long-term outcomes when compared to those with psychosis onset before 18 years. Persons with psychosis onset before the age of 18 years had similar outcomes to those with non-psychotic psychiatric disorder onset before 18 years regarding educational level, marital status, having children, and substance use disorders. Individuals with EOP were more often on a disability pension compared to those with other early-onset mental disorders. Adjusting for sex, educational level and substance use only slightly diluted these results. Unexpectedly, later onset age of EOP was associated with worse outcomes. Those with psychosis onset between 18-22 years of age are in a critical period, which underlines the importance of investing on interventions in this age group. Further studies on the effect of the onset age on later outcomes in EOP are needed.

Brain structure and function link to variation in biobehavioral dimensions across the psychopathological continuum.

In line with the Research Domain Criteria (RDoC), we set out to investigate the brain basis of psychopathology within a transdiagnostic, dimensional framework. We performed an integrative structural-functional linked independent component analysis, to study the relationship between brain measures and a broad set of biobehavioral measures in a sample (n = 295) with both mentally healthy participants and patients with diverse non-psychotic psychiatric disorders (i.e. mood, anxiety, addiction, and neurodevelopmental disorders). To get a more complete understanding of the underlying brain mechanisms, we used gray and white matter measures for brain structure and both resting-state and stress scans for brain function. The results emphasize the importance of the executive control network (ECN) during the functional scans, for the understanding of transdiagnostic symptom dimensions. The connectivity between the ECN and the frontoparietal network in the aftermath of stress, was correlated with symptom dimensions across both the cognitive and negative valence domains, and also with various other health related biological and behavioral measures. Finally, we identified a multimodal component that was specifically associated with the diagnosis of autism spectrum disorder (ASD). The involvement of the default mode network, precentral gyrus and thalamus across the different modalities of this component, may reflect the broad functional domains that may be affected in ASD, like theory of mind, motor problems and sensitivity to sensory stimuli respectively. Taken together, the findings from our extentensive, exploratory analyses emphasize the importance of a dimensional and more integrative approach for getting a better understanding of the brain basis of psychopathology.

The impact of nonpsychotic postpartum psychiatric disorders (NPPDs) on offspring

IntroductionNon-psychotic postpartum psychiatric disorders (NPPDs) are among the most common underdiagnosed mental disorders with a preserved reality test after delivery.ObjectivesNPPDs have been shown to have an association with infant growth, attachment, sleep, temperament and ultimately offspring’s emotional, behavioural, cognitive and social development.MethodsMost prevalent NPPDs are postpartum mood and anxiety disorders, as well as obsessive–compulsive disorder, post-traumatic stress disorder and eating disorders.ResultsThe high methodological quality of the reviewed studies strengths the association between NPPDs and different disorders in the neurodevelopmental period with a negligible impact on mental status in adolescence and adulthood. NPPDs showed an effect on offspring’s emotional, behavioural, cognitive and social development, due to common developmental mechanisms.ConclusionsTimely accurate identifying and treating NPPDs, by using NPPDs symptoms screening tools could reduce the incidence of mental disorders in offspring. Although neurodevelopmental disorders and mental disorders related to pregnancy as separate diagnostic categories have been insufficiently researched, the potential impact of postpartum mental disorders on children’s development is an extremely unexplored field that should be focused on in further scientific research.Disclosure of InterestNone Declared

Experience delivering an integrated service model to people with criminal justice system involvement and housing insecurity

BackgroundPeople returning to communities from prison or jail face stressors related to securing housing, including discrimination, restrictions based on prior felony convictions, and limited economic and social resources. Existing housing programs can effectively reduce housing instability but often do not fully address the needs of people involved in the criminal justice system experiencing homelessness who often have co-occurring chronic medical issues, and psychiatric and substance use disorders.MethodsProject CHANGE is an ongoing program to deliver person-centered, integrated care and services to individuals involved with the criminal justice system and experiencing homelessness. Applying a Screening, Brief Intervention, (Referral to) Treatment framework, a comprehensive needs assessment is followed by delivery of intensive housing and vocational case management; and psychiatric, substance use, and medical services in a single location by an interdisciplinary team. Participants are followed with study interviews for 12 months. The current analysis was designed to assess the baseline characteristics and needs of the sample population, and the intensity of contact required for integrated service delivery.ResultsBetween November 2019 and September 2021, 86 participants were enrolled, of whom 64% had been released from prison/jail in the past 6 months; the remainder were on parole, probation, or intensive pretrial supervision. Participants were unstably housed (64%) or residing outdoors (26.7%) or in a shelter (24.4%). Most participants had high medical need and frequent healthcare engagement through outpatient and emergency department visits. Most participants were at-risk for clinical depression, and half were diagnosed with anxiety, dissociative, stress-related, somatoform, and other non-psychotic psychiatric disorders. Over 12-month follow-up, the interdisciplinary team made over 500 contact encounters, over half of which resulted in direct services provided, including obtaining vital documents for homelessness verification, housing applications, and employment coaching.ConclusionNavigation of services can be particularly challenging for individuals experiencing criminal justice involvement, homelessness, and co-occurring medical, psychiatric, and substance use issues, which can be addressed holistically in an integrated service model. Integrated service delivery was time-, resource-, and staffing-intensive, and challenged by the COVID-19 pandemic, requiring innovative solutions to sustain participant engagement.

Specific adolescent prodromal symptoms associated with onset of psychosis in the Northern Finland Birth Cohort 1986.

Several psychological symptoms in adolescence associate with later development of psychosis. However, it is unclear which symptoms specifically predict psychotic disorders rather than psychiatric disorders in general. We conducted a prospective study comparing how specific adolescent psychotic-like symptoms, predicted psychotic and non-psychotic hospital-treated psychiatric disorders in the population-based Northern Finland Birth Cohort 1986 (NFBC1986). At age 15-16 years, 6632 members of the NFBC1986 completed the PROD-screen questionnaire. New hospital-treated mental disorders of the NFBC1986 participants were detected between age 17 and 30 years from the Finnish Care Register for Health Care. Multiple covariates were used in the analysis. During the follow-up, 1.1% of the participants developed a psychotic and 3.2% a non-psychotic psychiatric disorder. Three symptoms were specifically associated with onset of psychosis compared to non-psychotic psychiatric disorders: 'Difficulty in controlling one's speech, behaviour or facial expression while communicating' (adjusted OR 4.00; 95% CI 1.66-9.92), 'Difficulties in understanding written text or heard speech' (OR 2.25; 1.12-4.51), and 'Difficulty or uncertainty in making contact with other people' (OR 2.20; 1.03-4.67). Of these, the first one remained statistically significant after Bonferroni correction for multiple comparisons. To our knowledge, this is the first general-population-based prospective study exploring psychiatric symptoms predicting the onset of hospital-treated first-episode psychosis in comparison to non-psychotic disorders. We found three symptoms related with difficulties in social interaction which predicted onset of psychosis. This is a novel finding and should be replicated.

Comorbidity Between Recent Diagnosis of Type 2 Diabetes and Non-Psychotic Psychiatric Disorders: Metabolic Characteristics and Clinical Correlates.

PurposeTo describe the metabolic status and clinical characteristics associated with NPPD in patients with less than five years of T2D diagnosis and explore the role of age in the presentation of psychiatric comorbidities.Patients and MethodsThis was a cross-sectional study of subjects who attended a comprehensive care program. Patients were assessed using the Mini-International Neuropsychiatric Interview, and clinical and metabolic characteristics were registered. Multivariate logistic regression analyses were conducted to identify risk and protective factors for psychiatric disorders. We performed an analysis to further explore age’s influence on our results.ResultsWe included 1953 patients, and 40.1% had any psychiatric disorder. Younger age, female sex, and personal psychiatric history were associated with NPPD. The use of insulin was reported as a protective factor for eating disorders. Body mass index was associated with any psychiatric disorders and eating disorders. The analysis of age reported that patients younger than 45 years had the worst metabolic parameters and increased odds for NPPD, while patients older than 65 years had the best metabolic measures and decreased odds for psychiatric comorbidity.ConclusionNPPD were frequent comorbidities in our sample; younger age, female sex, and personal psychiatric history were the most important factors associated with psychiatric comorbidities. Younger subjects experience a higher risk for psychiatric disorders and worst metabolic control.

Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET): Protocol for a Cross-sectional Comorbidity Study From a Research Domain Criteria Perspective.

It is widely acknowledged that comorbidity between psychiatric disorders is common. Shared and diverse underpinnings of psychiatric disorders cannot be systematically understood based on symptom-based categories of mental disorders, which map poorly onto pathophysiological mechanisms. In the Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET) study, we make use of current concepts of comorbidity that transcend the current diagnostic categories. We test this approach to psychiatric problems in patients with frequently occurring psychiatric disorders and their comorbidities (excluding psychosis). The main aim of the MIND-SET project is to determine the shared and specific mechanisms of neurodevelopmental and stress-related psychiatric disorders at different observational levels. This is an observational cross-sectional study. Data from different observational levels as defined in the Research Domain Criteria (genetics, physiology, neuropsychology, system-level neuroimaging, behavior, self-report, and experimental neurocognitive paradigms) are collected over four time points. Included are adult (aged ≥18 years), nonpsychotic, psychiatric patients with a clinical diagnosis of a stress-related disorder (mood disorder, anxiety disorder, or substance use disorder) or a neurodevelopmental disorder (autism spectrum disorder or attention-deficit/hyperactivity disorder). Individuals with no current or past psychiatric diagnosis are included as neurotypical controls. Data collection started in June 2016 with the aim to include a total of 650 patients and 150 neurotypical controls by 2021. The data collection procedure includes online questionnaires and three subsequent sessions with (1) standardized clinical examination, physical examination, and blood sampling; (2) psychological constructs, neuropsychological tests, and biological marker sampling; and (3) neuroimaging measures. We aim to include a total of 650 patients and 150 neurotypical control participants in the time period between 2016 and 2022. In October 2021, we are at 95% of our target. The MIND-SET study enables us to investigate the mechanistic underpinnings of nonpsychotic psychiatric disorders transdiagnostically. We will identify both shared and disorder-specific markers at different observational levels that can be used as targets for future diagnostic and treatment approaches.

Sexual Dysfunction in Women with Nonpsychotic Disorders: A Cross-sectional Hospital-based Study.

Background:Sexual dysfunction among female psychiatric patients is zcommon and can be affected by various bio-psycho-social factors. The clinician’s or patient’s reluctance to actively inquire or spontaneously report these sexual difficulties creates a lacuna in our understanding of this association. This study aimed to assess the proportion of women with nonpsychotic psychiatric disorders reporting sexual dysfunction and evaluate its association with sociodemographic and clinical variables.Methods:This cross-sectional study conducted over six months included 113 women attending the psychiatry outpatient department of a tertiary care hospital. Sociodemographic and clinical variables, including diagnosis based on International Classification of Diseases 10th version (ICD 10) criteria, were assessed using a specially designed proforma. Sexual functioning was measured by Female Sexual Functioning Index (FSFI) and the Change in Sexual Functioning Questionnaire-Female Version (CSFQ-FV).Results:Sexual dysfunction was reported by 67.3% of patients. Among patients on psychotropics, 49% reported worsening of sexual dysfunction after treatment initiation. Sexual dysfunction was associated with increasing age (χ2 = 7.86, P = 0.04), lower educational qualification (χ2 =3.41, P = 0.04), skilled occupation (χ2 = 4.49, P = 0.03), lower socioeconomic status (χ2 = 4.27, P = 0.03) and presence of ongoing psychosocial stressor (χ2 = 4.49, P = 0.03).Conclusions:Difficulties in different domains of sexual functioning are prevalent among women with nonpsychotic disorders. Sociodemographic and relational factors, along with treatment status, can influence sexual dysfunction in these patients. Clinicians should be vigilant of this association and should plan treatment to enhance compliance and outcome.

Sociodemographic and substance characteristics among adolescents with psychotic disorders

Background Over the preceding time, there is a significant bidirectional relationship between substance use and the development of psychiatric disorders during the adolescent stage. The comorbidity of substance use among adolescents with mental disorders is a major challengeable public health concern. This study examined the sociodemographic correlates and substance-use patterns among adolescents with psychotic disorders versus nonpsychotic psychiatric disorders (controls).Patients and methods This is a case–control study on 76 adolescents diagnosed with different psychotic disorders and another group of 76 adolescents with nonpsychotic psychiatric disorders using Mini-Plus International Neuropsychiatric Interview (MINI), Positive And Negative Syndrome Scale, and Alcohol, Smoking, Substance Involvement Screening Test and urine test.Results Substantial sociodemographic differences were found among the adolescents with psychotic disorders (case) (72.4% nonemployed, 71.1% rural areas, and 2.6% governmental healthcare services) compared with controls (60.5% nonemployed, 39.5% rural areas, and 28.9% governmental healthcare services), also, there was a significant difference in substance-use pattern among cases (lifelong use of tobacco 81.6%, cannabis 80.3%, and opioids 90.8%, with more substance-related problems) compared with controls (lifelong use of tobacco 61.8%, cannabis 55.3%, and opioids 73.7%, with less substance-related problems).Conclusion The sociodemographic variables related to rural residence, nonemployment, less approach to governmental health service, and positive family history of psychiatric disorders were the major contributing factors for psychotic disorders in adolescents with substance use. The lifetime use of cannabis and opioids was the major risk of developing psychosis among adolescents.

A Randomized Controlled Trial Evaluating the Effectiveness of Supported Employment Integrated in Primary Care.

Mental health issues can cause serious problems in occupational functioning, including higher rates of unemployment. Individual placement and support (IPS) is an evidence-based supported employment intervention that is typically integrated within a mental health setting; however, many primary care patients view referral to a mental health clinic as stigmatizing. Thus, this study examined whether delivery of IPS in a primary care setting provides an effective treatment option and avoids unnecessary delays in obtaining competitive employment. U.S. military veterans (N=119) who had a diagnosis in a broad range of nonpsychotic psychiatric disorders and who were receiving care from Veterans Health Administration (VHA) patient-aligned care teams were prospectively randomly assigned to IPS (N=58) or standard VHA non-IPS vocational rehabilitation (VR) (N=61). The primary outcome was achievement of steady worker status, defined as holding a competitive job for ≥6 months of the 12-month follow-up. As hypothesized, a significantly greater proportion of IPS participants achieved steady worker status (45%), compared with VR participants (25%) (p=0.02; odds ratio=2.49, 95% confidence interval=1.14-5.43). On average, the IPS participants worked significantly more weeks (p=0.003) and earned significantly more income (p=0.033) from competitive jobs, compared with VR participants. The results provide supporting evidence for offering IPS within primary care with the aim of restoring meaningful and sustained competitive employment for veterans living with a mental disorder. Such modifications could improve veterans' vocational outcomes, moving a significantly greater number of disabled veterans back to full and productive lives in the community.

Emotional Exhaustion, Depersonalization, and Mental Health in Nurses from Huelva: A Cross-Cutting Study during the SARS-CoV-2 Pandemic.

Currently, healthcare professionals are particularly vulnerable to the impact of the SARS-CoV-2pandemic since they directly deal with patients suffering from this disease and are in the first line of fire, which increases their risk of contagion. This research examines the prevalence of emotional exhaustion, depersonalization, and possible non-psychotic psychiatric disorders in 48 male and 270 female nursing professionals of Huelva during the COVID-19 pandemic. To this end, we analyzed the relationship between these dependent variables and considered various sociodemographic variables. The nursing staff of public hospitals in Huelva who have had contact with cases of SARS-CoV-2 in their work environment showed a poorer state of mental health than that of others of this same professional category who have not had contact with this type of situation.

Stability in Mental Health Among Medical Students During COVID-19 Quarantine: A 3-Year Prospective Study

Background: Due to the COVID-19 pandemic, Brazil's government implemented quarantine in March 2020, leading to the closure of schools. This has caused changes in daily routines, such as social distancing and distance learning, which could impact mental health. This study aims to prospectively evaluate mental health in medical students in 2018, 2019, and 2020, during the COVID-19 quarantine.Methods: Students from Jundiai Medical School were invited to participate in this study in the years of 2018, 2019, and 2020 (from March to June, during COVID-19 quarantine). The Self-Reporting Questionnaire (SRQ-20), created by the World Health Organization to investigate nonpsychotic psychiatric symptoms, was used as a measure to evaluate mental distress. The questionnaire was made available online and contained two different sections: sociodemographic information and SRQ-20.Outcomes: In the years 2018, 2019 and 2020 a total of 860 SRQ-20 questionnaires were completed. Overall, SRQ-20 mean scores were 8·2±4·6 and SRQ-20≥7 frequency - above cut-off - was 60·5%. When comparing the years 2018, 2019 and 2020, no differences were found for both SRQ-20 scores (8·4±4·7, 8·2±4·6, and 7·8±4·4, respectively; p=0·351) and SRQ-20≥7 frequency (62·2%, 60·9%, and 59·2%, respectively; p=0·762).Interpretations: Along the three studied years, there was no indication of changes in prevalence of nonpsychotic psychiatric disorders as measured by SRQ-20. The maintenance of daily routines through remote learning for students attending first to fourth-year classes in 2020, and the continuation of adapted internship activities for students attending fifth or sixth-year classes in 2020 could have contributed to these results. Funding: Funding was provided by CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico)Declaration of Interests: The authors declare no conflict of interest.Ethics Approval Statement: This research has Ethics committee approval.

Return to the labour market in schizophrenia and other psychoses: a register-based Northern Finland Birth Cohort 1966 study.

The prospects and predictors of returning to the labour market after long-term work disability in psychoses are unclear. Our aim was to study the proportion and characteristics of persons with schizophrenia and other psychoses who return to the labour market after receiving a disability pension. In this 50-year follow-up study in the Northern Finland Birth Cohort 1966 (NFBC1966), national registers on demographics, care, and disability pensions were used to detect and characterize individuals who had been on a disability pension for psychiatric reasons. We compared individuals with schizophrenia (SZ, n = 223) or other psychoses (OP, n = 200) to those with non-psychotic psychiatric disorders (NP, n = 1815) regarding demographics and end of pension by cross-tabulations and logistic regression. Of the 170 (74%) persons with SZ who had been on disability pension for a psychiatric reason, 15 (9%) returned to the labour market. Corresponding percentages were 19% for OP and 28% for NP. In SZ, being married, a later onset age of psychosis, and better school performance, and in OP and NP, having children predicted returning to the labour market. In all groups, a shorter length of the latest disability pension associated with returning to the labour market. Although rare, it is possible to return to the labour market after a disability pension due to psychosis. Factors predicting a return to the labour market could be taken into account when planning rehabilitation.

DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders.

Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis.Methods: Interviewing help-seeking, hospitalized adolescents (aged 12–18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS.Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = −0.17 to −0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6–2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2–2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1–1.7, p = 0.002) (r2 = 0.315, p < 0.001).Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.

Psychiatric comorbidity in individuals at-risk for psychosis: Relationships with symptoms, cognition and psychosocial functioning.

Psychiatric comorbidity frequently occurs with at-risk mental state (ARMS) for psychosis. Its relationships with psychopathology, cognition and functioning, however, remain to be further clarified. We aimed to examine prevalence and correlates of psychiatric comorbidity, and its associations with psychosocial functioning and subjective quality-of-life (QoL) in a representative sample of Chinese ARMS individuals. One hundred ten help-seeking participants aged 15 to 40 years with ARMS were recruited from a specialized early psychosis service in Hong Kong. ARMS status was verified by comprehensive assessment of at-risk mental state (CAARMS). Comorbid Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition non-psychotic psychiatric disorders at baseline were ascertained using diagnostic interview and medical record review. Assessments encompassing symptom profiles, psychosocial functioning, subjective QoL and a brief cognitive battery were conducted. Forty-nine (44.5%) ARMS participants were diagnosed as having comorbid non-psychotic psychiatric disorders at baseline, primarily depressive and anxiety disorders. Binary multiple logistic regression analysis revealed that female gender, more severe depressive symptoms, higher suicidality and poorer global cognitive functioning were independently associated with comorbid diagnosis status. ARMS participants with psychiatric comorbidity displayed significantly more limited extended social networks and poorer subjective QoL than those without psychiatric comorbidity. Comorbid disorders were frequently observed in Chinese ARMS individuals, and were linked to poorer cognition and higher suicide risk. Our findings underscore a potential critical role of psychiatric comorbidity in determining social functioning and subjective QoL in at-risk individuals. Further longitudinal research is required to clarify trajectories of comorbid disorder status and its prospective impact on clinical and functional outcomes in ARMS populations.

T67. TRAUMA IN AFFECTIVE AND NONAFFECTIVE PSYCHOSIS: ASSOCIATIONS AND DISSOCIATIONS WITH COGNITIVE FUNCTIONING IN CHILDHOOD AND ADULTHOOD

BackgroundChildhood trauma and cognitive impairment are important risk factors for psychotic disorders. However, the relationship between trauma and psychosis throughout the lifespan, as well as between lifetime trauma and cognitive functioning, remain unclear.MethodsUsing data from a case-control study of African-American adults with psychotic disorders, we examined childhood and adult trauma, as well as their interaction with cognitive functioning, in adults with affective psychotic disorders (n=101), nonaffective psychotic disorders (n=109), non-psychotic psychiatric disorders (n=105), compared to controls (n=211). Childhood trauma was measured using the Childhood Trauma Questionnaire (CTQ), which produces dimensional measures of physical neglect, emotional neglect, physical abuse, emotional abuse, and sexual abuse. Adult trauma was measured using the Trauma History Questionnaire (THQ), which ascertains the presence of death-, and personal-related traumas throughout adulthood. Cognitive functioning was measured using a comprehensive computerized battery (‘Charlie’, https://github.com/sammosummo/Charlie).ResultsAll three psychiatric groups showed greater childhood trauma compared to controls, but the affective psychosis group showed the most trauma (Cohen d=0.97–1.29, p<0.001), followed by the nonaffective psychosis group (d=0.54–0.72, p<0.001), and then the non-psychotic group (d=0.05–0.16, p<0.04). Despite the fact that childhood trauma was significantly associated with adult trauma (OR=0.67–2.08,p<0.002), only the affective psychosis group showed a significantly increased likelihood of experiencing both death- and personal-related traumas in adulthood (OR=0.86–2.14, p<0.01), while the nonaffective psychosis group showed an increased likelihood of experiencing personal-related traumas (OR=1.00, p=0.003). Significant childhood-trauma-by-group interactions on cognitive functioning showed that greater childhood neglect was associated with better performance in the affective psychosis group on measures of processing speed (d=0.52, p=0.011), social processing (d=0.57, p=0.020), and executive functioning (d=0.50–0.71,p<0.020). A similar pattern emerged in the affective psychosis group with both death- and personal-related adult traumas on measures of processing speed (d=0.67–0.74, p<0.010), memory (d=0.67–0.68, p<0.014), and emotional processing (d=0.79, p=0.008). In the domain of complex reasoning, on the other hand, increased childhood sexual abuse in the affective psychosis group, and personal-related adult traumas in the psychosis group, showed a deleterious effect (d=–0.44, p=0.025; d=–0.65, p=0.010).DiscussionIndividuals with psychotic disorders, especially affective psychoses, experienced more childhood and adult trauma than controls, and also individuals with non-psychotic psychiatric disorders. However, both childhood neglect and adult trauma were associated with better cognitive functioning in the affective psychosis group. One explanation for this seemingly paradoxical finding may be that traumatic experiences in childhood and adulthood lead to increased cognitive vulnerability, as typically seen in psychotic disorders. Thus, individuals who experience more lifetime trauma may follow a different pathway to psychosis, involving less neurodevelopmental impairment, but greater environmental stress, leading to more affective, rather than nonaffective, manifestations of psychosis.

M29. SPECIFIC SYMPTOMS IN ADOLESCENCE PREDICT PSYCHOSIS IN THE NORTHERN FINLAND BIRTH COHORT 1986

BackgroundA number of psychological symptoms have been found to predict psychosis. Many studies have found no specificity to separate symptoms predicting non-psychotic psychiatric disorders from those predicting psychotic disorders. Prodromal symptoms are non-specific problems often preceding frank psychosis. Previously prodromal symptoms have been studied mainly retrospectively or in high-risk clinical populations. We were able to conduct prospective study comparing adolescent symptoms predicting non-psychotic psychiatric disorders and psychotic psychiatric disorders.MethodsMembers of the Northern Finland Birth Cohort 1986 were asked to fill in PROD-screen questionnaire at age 15–16 years. PROD-screen includes 21 items both measuring positive prodromal symptoms, negative prodromal symptoms and general symptoms.We were able to follow 5,368 participants using Finnish Hospital Discharge Register detecting new hospital treated mental disorders till 30 years.ResultsSubjects who developed psychosis had significantly more commonly positive and negative symptoms than subjects without psychiatric disorder or subjects who developed non-psychotic disorder.When comparing separate symptoms in those having psychiatric hospital treatments, we found three positive symptoms and three negative symptoms predicting specifically psychotic disorders.After adjusting for confounders, the symptoms predicting psychosis were: Difficulty in controlling one’s speech, behavior or facial expression while communicating, Difficulties in understanding written text or speech heard, Feelings, thoughts or behaviors that could be considered weird or peculiar. Three of the negative symptoms also predicted psychosis: Difficulty or uncertainty in making contact with other people, Lack of initiative or difficulty in completing tasks, Difficulties in carrying out ordinary routine activities (at least one week).DiscussionIn this large prospective population sample both positive and negative symptoms in adolescence associated specifically with development of first episode psychosis compared to hospital treated non-psychotic disorders. This finding is in line with the other prospective general population follow-up studies. The main contribution of our study to the literature is that we had the possibility to compare the subjects who developed clinically real hospital-treated psychosis not only to healthy comparison subjects but also to subjects who developed non-psychotic psychiatric disorder.

M131. RETURN TO LABOUR MARKET IN SCHIZOPHRENIA AND OTHER PSYCHOSES – THE NORTHERN FINLAND BIRTH COHORT 1966

BackgroundPeople with psychotic disorders typically have the poorest rate of employment compared to other mental disorders. However, the chances of returning back to labour market and work after long-term work disability is unclear. Aim of this study was to study proportion of persons who can return to labour market after they have received disability pension. We also aim to study potential predictors for return to work.MethodsThe study was based on the Northern Finland Birth Cohort 1966 (NFBC1966) (N=12 058) which is an unselected, general population-based sample. NFBC1966 offers us a unique way to examine return to labour market and its predictors in general population sample with true prospectively collected data with 50-years follow-up. Different national registers were utilized in the study (information about psychiatric diagnoses and occupational outcomes). Occupational outcomes until end of the 2016 were measured by information about disability pension, disability benefits and employment contracts. The sample included 232 schizophrenia patients, 208 persons with other psychosis and 1927 persons with non-psychotic psychiatric disorder diagnosed until the end of 2016. There is also large amount of predictor data (for occupational outcomes) collected since birth until recent years.ResultsOf the 141 (61%) persons with schizophrenia who had been on disability pension due to psychiatric reason, disability pensions of 16 (11%) persons had ended due to return to labour market. Of the 74 (32%) persons in the other psychosis subgroup and 180 (9%) in the non-psychotic psychiatric disorder subgroup who had been on disability pension due to psychiatric reason, corresponding numbers of pension’s ending due to return to labour market were 18 (24%) and 56 (31%), respectively. Disability pensions of 14 (10%) persons in schizophrenia group, 3 (4%) persons in other psychosis subgroup and 4 (2%) persons in non-psychotic psychiatric disorder subgroup had ended due to death. Disability pensions of 111 (79%) persons in schizophrenia group, 53 (72%) persons in other psychosis subgroup and 120 (67%) persons in non-psychotic psychiatric disorder subgroup were still running. Later, also sociodemographic information, psychiatric and somatic comorbidity and age at the onset of disease as predictors for the good occupational outcome (i.e. return to work) will be analysed and presented.DiscussionOur results indicate that having schizophrenia diagnosis often means relatively poor occupational outcome compared to other psychiatric disorders and ending up on disability pension. Besides of that some people with psychosis manage to maintain their working ability, some people also manage to return to labour market after being on disability pension. Finding the predictors for returning back to labour force in long-time follow-up can help us to cut off the long-term disability periods and support people back to work in the future.

Job distress and burnout among Tanzanian and Sudanese health professionals: a comparative study

The purpose of this study was to explore and compare the levels of distress and burnout among Sudanese and Tanzanian health professionals. Cluster random sampling was used to select 72 nurses and physicians of both genders from each country. The participants’ age range was 21 years to 55 years ( Mage = 31.51, SD = 7.22). The Maslach Burnout Inventory-Human Services Survey and the General Health Questionnaire were used to collect data. Nonpsychotic psychiatric disorders were more prevalent among Tanzanian health professionals compared to their Sudanese counterparts. T-test results revealed that Tanzanian health professionals experienced significantly higher levels of distress, somatic symptoms, depression, and social dysfunction than their Sudanese counterparts. ANOVA and MANOVA results indicated significant demographic differences in distress and burnout between health professionals from both countries. In addition, Sudanese participants reported higher levels of emotional exhaustion and lower personal accomplishment, while Tanzanians reported higher levels of depersonalisation. It was concluded that nurses from both countries were more prone to distress, while physicians were more susceptible to burnout. Our findings may assist researchers and administrators to improve the mental health of health professionals, particularly in Africa, and enhance their ability to provide better services.

Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy.

Background and ObjectivesSubstance use disorders are highly prevalent among individuals with psychotic disorders and are associated with negative outcomes. This study aims to explore differences in characteristics and treatment outcomes for individuals with psychotic disorders when compared with individuals with other nonpsychotic psychiatric disorders enrolled in treatment for opioid use disorder (OUD).MethodsData were collected from a prospective cohort study of 415 individuals enrolled in outpatient methadone maintenance treatment (MMT). Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview. Participants were followed for 12 months. Participant characteristics associated with having a psychotic disorder versus another nonpsychotic psychiatric disorder were explored by logistic regression analysis.ResultsAltogether, 37 individuals (9%) with a psychotic disorder were identified. Having a psychotic disorder was associated with less opioid-positive urine drug screens (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95, 0.99, P = .046). Twelve-month retention in treatment was not associated with psychotic disorder group status (OR = 0.73, 95% CI = 0.3, 1.77, P = .485). Participants with psychotic disorders were more likely to be prescribed antidepressants (OR = 2.12, 95% CI = 1.06, 4.22, P = .033), antipsychotics (OR = 3.57, 95% CI = 1.74, 7.32, P = .001), mood stabilizers (OR = 6.61, 95% CI = 1.51, 28.97, P = .012), and benzodiazepines (OR = 2.22, 95% CI = 1.11, 4.43, P = .024).Discussion and ConclusionsThis study contributes to the sparse literature on outcomes of individuals with psychotic disorders and OUD-receiving MMT. Rates of retention in treatment and opioid use are encouraging and contrast to the widely held belief that these individuals do more poorly in treatment. Higher rates of coprescription of sedating and QTc-prolonging medications in this group may pose unique safety concerns.