Poor Social Functioning Research Articles

Rural-urban differences in health-related quality of life: patterns for cancer survivors compared to other older adults.

Health-related quality of life (HRQOL) among older cancer survivors can be impaired by factors such as treatment, comorbidities, and social challenges. These HRQOL impairments may be especially pronounced in rural areas, where older adults have higher cancer burden and more comorbidities and risk factors for poor health. This study aimed to assess rural-urban differences in HRQOL for older cancer survivors and controls. Data came from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS), which links cancer incidence from 18 U.S. population-based cancer registries to survey data for Medicare Advantage Organization enrollees (1998-2014). HRQOL measures were 8 standardized subscales and 2 global summary measures. We matched (2:1) controls to breast, colorectal, lung, and prostate cancer survivors, creating an analytic dataset of 271,640 participants (ages 65+). HRQOL measures were analyzed with linear regression models including multiplicative interaction terms (rurality by cancer status), controlling for sociodemographics, cohort, and multimorbidities. HRQOL scores were higher in urban than rural areas (e.g., global physical component summary score for breast cancer survivors: urban mean = 38.7, standard error [SE] = 0.08; rural mean = 37.9, SE = 0.32; p < 0.05), and were generally lower among cancer survivors compared to controls. Rural cancer survivors had particularly poor vitality (colorectal: p = 0.05), social functioning (lung: p = 0.05), role limitation-physical (prostate: p < 0.01), role limitation-emotional (prostate: p < 0.01), and global mental component summary (prostate: p = 0.02). Supportive interventions are needed to increase physical, social, and emotional HRQOL among older cancer survivors in rural areas. These interventions could target cancer-related stigma (particularly for lung and prostate cancers) and/or access to screening, treatment, and ancillary healthcare resources.

Negative Symptoms and Functioning in Youth at Risk of Psychosis: A Systematic Review and Meta-analysis.

After participating in this activity, learners should be better able to:• Evaluate the relationship between negative symptoms and functioning in youth at clinical high risk for psychosis. Youth at CHR for psychosis often demonstrate significant negative symptoms and poor functioning, though the magnitude and direction of the relationship between the two remains unknown. The objective of this systematic review is to summarize the relationship between negative symptoms and functioning in CHR samples. Electronic databases CINAHL, EBM, Embase, MEDLINE, and PsycINFO were searched from inception. Studies were selected if they included any study that reported a relationship between negative symptoms and functioning in youth at clinical high risk (CHR). The correlation coefficient r was converted to Cohen's d, and all random-effects meta-analyses were performed using the transformed values. Forty-one studies met the inclusion criteria, including a total of 4574 individuals at CHR for psychosis. Negative symptom total scores were significantly associated with poorer global functioning (d, -1.40; 95% CI, -1.82 to -0.98; I = 79.4%; p < .001 [9 studies, n = 782]), social functioning (d, -1.10; 95% CI, -1.27 to -0.93; I = 10.40%; p < .001 [12 studies, n = 811]), and role functioning (d, -0.96; 95% CI, -1.17 to -0.76; I = 41.1%; p < .001 [9 studies, n = 881]). In addition, negative symptoms were consistently associated with poor premorbid functioning. When examining negative symptom domains, avolition, anhedonia, and blunted affect were each significantly and independently associated with poorer social functioning and role functioning. In terms of prediction models, negative symptoms contributed to the prediction of lower functioning across multiple studies. This meta-analysis demonstrates a strong relationship between negative symptoms and functioning in youth at clinical high risk for psychosis.

Can reduced leftward asymmetry of white matter integrity be a marker of transition to psychosis in at-risk mental state?

As a biomarker for the degree of psychosis development, the lateral asymmetry of white matter (WM) integrity in each area of the cerebrum has been investigated; as a result, a reduced leftward asymmetry of WM integrity has been reported in patients with schizophrenia. Although individuals with an at-risk mental state for psychosis (ARMS) who subsequently develop psychosis are believed to have poorer social functioning, only a few studies have actually examined the associations between WM abnormalities and social functioning. The aim of the present study was to clarify the possibly predictive association between a reduced asymmetry of WM integrity and impairments in social functioning in patients with ARMS. Thirty ARMS subjects underwent MRI scanning and were assessed using the Social Functioning Scale (SFS). We examined the fractional anisotropy (FA) values in the cingulum bundle (CB) and the uncinate fasciculus (UF) using a tract-specific analysis. Lateral asymmetry was assessed using the laterality index (LI). The LI of the FA value was positive (leftward) in the CB and negative (rightward) in the UF. Although the LI was not correlated with the Scale of Prodromal Symptoms (SOPS) score, the LI in the CB was positively correlated with the SFS score. In ARMS patients, the degree of reduced leftward asymmetry in the CB might affect deteriorations in social functioning and may be useful as a biomarker for predicting future outcomes at an early stage of psychosis.

Dysfunction of categorization of emotional faces in people with schizophrenia

People with schizophrenia often show deficits in recognizing facial emotions, which contributes to poor social functioning. In this experiment we directly investigated how 20 people being treated for schizophrenia categorized emotional faces. In a control group of healthy people who had no mental illness, happy faces were classified faster than sad faces, that is, there was a positive classification advantage. However, this phenomenon was not present for inverted faces. Compared with the control group, the people with schizophrenia categorized emotional faces more slowly, with less accuracy, and without a positive classification advantage, except for an overall delayed response for inverted rather than right-way-up conditions. Although face inversion delayed the categorization of neutral faces in the group with schizophrenia, inversion effects for both happy and sad faces did not differ between the 2 groups. These results suggest a dysfunction of categorization of emotional faces in people with schizophrenia, although these individuals could adopt the same criterion pattern emotions as the control group did on faces shown inverted and the right way up. Our findings provide new evaluation evidence for practitioners treating people with schizophrenia.

Using machine learning of computerized vocal expression to measure blunted vocal affect and alogia

Negative symptoms are a transdiagnostic feature of serious mental illness (SMI) that can be potentially “digitally phenotyped” using objective vocal analysis. In prior studies, vocal measures show low convergence with clinical ratings, potentially because analysis has used small, constrained acoustic feature sets. We sought to evaluate (1) whether clinically rated blunted vocal affect (BvA)/alogia could be accurately modelled using machine learning (ML) with a large feature set from two separate tasks (i.e., a 20-s “picture” and a 60-s “free-recall” task), (2) whether “Predicted” BvA/alogia (computed from the ML model) are associated with demographics, diagnosis, psychiatric symptoms, and cognitive/social functioning, and (3) which key vocal features are central to BvA/Alogia ratings. Accuracy was high (>90%) and was improved when computed separately by speaking task. ML scores were associated with poor cognitive performance and social functioning and were higher in patients with schizophrenia versus depression or mania diagnoses. However, the features identified as most predictive of BvA/Alogia were generally not considered critical to their operational definitions. Implications for validating and implementing digital phenotyping to reduce SMI burden are discussed.

Trends in generalised anxiety disorders and symptoms in primary care: UK population-based cohort study

Generalised anxiety disorder and symptoms are associated with poor physical, emotional and social functioning and frequent primary and acute care visits. We investigated recent temporal trends in anxiety and related mental illness in UK general practice. The aims of this analysis are to examine temporal changes in recording of generalised anxiety in primary care and initial pharmacologic treatments. Annual incidence rates of generalised anxiety diagnoses and symptoms were calculated from 795 UK general practices contributing to The Health Improvement Network (THIN) database between 1998 and 2018. Poisson mixed regression was used to account for age, gender and general practitioner practice. Subsequent pharmacologic treatment was examined. Generalised anxiety recording rates increased in both genders aged 18-24 between 2014 and 2018. For women, the increase was from 17.06 to 23.33/1000 person years at risk (PYAR); for men, 8.59 to 11.65/1000 PYAR. Increases persisted for a composite of anxiety and depression (49.74 to 57.81/1000 PYAR for women; 25.41 to 31.45/1000 PYAR for men). Smaller increases in anxiety were seen in both genders age 25-34 and 35-44. Anxiety rates among older patients remained stable, although a composite of anxiety and depression decreased for older women. About half of drug-naïve patients were prescribed anxiety drugs within 1 year following diagnosis. The most common choice was a selective serotonin reuptake inhibitor. Benzodiazepine prescription rate has fallen steadily. We observed a substantial increase in general practitioner consulting for generalised anxiety and depression recently, concentrated within younger people and in particular women.

Do we understand the pathophysiology of GERD after sleeve gastrectomy?

Gastroesophageal reflux disease (GERD), a prevalent problem among obese individuals, is strongly associated with obesity and weight loss. Hence, bariatric surgery effectively improves GERD for many patients. Depending on the type of bariatric procedure, however, surgery can also worsen or even cause a new onset of GERD. As a consequence, GERD remains a relevant problem for many bariatric patients, and especially those who have undergone sleeve gastrectomy (SG). Affected patients report not only a decrease in physical functioning but also suffer from mental and emotional problems, resulting in poorer social functioning. The pathomechanism of GERD after SG is most likely multifactorial and triggered by the interaction of anatomical, physiological, and physical factors. Contributing factors include the shape of the sleeve, the extent of injury to the lower esophageal sphincter, and the presence of hiatal hernia. In order to successfully treat post-sleeve gastrectomy GERD, the cause of the problem must first be identified. Therapeutic approaches include lifestyle changes, medication, interventional treatment, and/or revisional surgery.

Defeatist performance beliefs in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia.

Prior studies indicate that defeatist performance beliefs (DPBs) are elevated in those in the chronic phase of schizophrenia (SZ) and associated with negative symptoms, functional outcome and neurocognitive impairment. However, it is unclear whether these same patterns of results hold in participants at clinical high-risk (CHR) for psychosis. Two studies were conducted to determine whether prior results in SZ could be replicated and extended to CHR. Participants included 184 healthy controls (CN) and 186 outpatients with chronic SZ for Study 1, and 30 CN and 35 CHR in Study 2. In both studies, participants completed the DPB scale and measures of negative symptoms, psychosocial functioning and neurocognition. Both chronic SZ and CHR participants had elevated DPBs compared to CN (p's < .01). In SZ, higher DPBs were associated with greater negative symptoms (r's=.31-.37, p's < .01), poorer social functioning and impaired social cognition (r = -.40, P < .001). In CHR, greater DPBs were associated with poorer social functioning (r = -.52, P < .05) and impairments in the neurocognitive domains of reasoning (r = -.48, P < .05) and processing speed (r = -.41, P < .05). Models testing whether DPBs mediated links between negative symptoms and functioning, negative symptoms and cognition and cognition and functioning were nonsignificant in SZ and CHR samples. Findings generally provide support for the cognitive model of negative symptoms and functioning and suggest that DPBs are an important clinical target across phases of psychotic illness.

Neurophysiological Correlate of Emotion Regulation by Cognitive Reappraisal and Its Association With Psychotic Symptoms in Early Psychosis

Emotion dysregulation is crucial to both poor social functioning and psychotic symptom formation in patients with schizophrenia. The efficient use of emotion regulation strategies, such as cognitive reappraisal, has been less frequently observed in the early phases of psychotic disorder. It is unknown whether neurophysiological responses related to emotion regulation by cognitive reappraisal are altered in early psychosis. Fifty-four patients with first-episode psychosis (FEP), 34 subjects at clinical high risk (CHR) for psychosis, and 30 healthy controls (HCs) participated in event-related potential recordings during a validated emotion regulation paradigm to measure the effect of cognitive reappraisal on emotion regulation. Late positive potentials (LPPs), which reflect emotional arousal, were compared across the groups and the 3 conditions (negative, cognitive reappraisal, and neutral). The relationship among LPP modulation by cognitive reappraisal and social/role functioning and severity of psychotic symptoms was investigated in the early psychosis group. The FEP and CHR participants showed comparably larger LPP amplitudes in the negative and cognitive reappraisal conditions than in the neutral condition, whereas the HCs presented larger LPPs in the negative condition than in the cognitive reappraisal and neutral conditions. LPP modulation by cognitive reappraisal was negatively correlated with positive symptom severity in the FEP patients and with disorganization severity in the CHR subjects. Inefficient use of cognitive reappraisal may be related to the impaired emotion regulation and psychotic symptoms from the very beginning of psychotic disorder. This study provides the first neurophysiological evidence regarding current concepts of emotion regulation in early psychosis.

Autobiographical memory as a latent vulnerability mechanism following childhood maltreatment: Association with future depression symptoms and prosocial behavior.

Childhood maltreatment is associated with altered neural reactivity during autobiographical memory (ABM) recall and a pattern of overgeneral memory (OGM). Altered ABM and OGM have been linked with psychopathology and poorer social functioning. The present study investigated the association between altered ABM and subsequent socio-emotional functioning (measured two years later) in a sample of adolescents with (N = 20; maltreatment group, MT) and without (N = 17; non-MT group) documented childhood maltreatment histories. At baseline, adolescents (aged 12.6 ± 1.45 years) were administered the Autobiographical Memory Test to measure OGM. Participants also recalled specific ABMs in response to emotionally valenced cue words during functional MRI. Adolescents in both groups underwent assessments measuring depressive symptoms and prosocial behavior at both timepoints. Regression analyses were carried out to predict outcome measures at follow-up controlling for baseline levels. In the MT group, greater OGM at baseline significantly predicted reduced prosocial behavior at follow-up and showed a trend level association with elevated depressive symptoms. Patterns of altered ABM-related brain activity did not significantly predict future psycho-social functioning. The current findings highlight the potential value of OGM as a cognitive mechanism that could be targeted to reduce risk of depression in adolescents with prior histories of maltreatment.

The psychosocial impact of facial palsy: A systematic review.

Facial palsy is a condition which can lead to significant changes in facial function and appearance. People with facial palsy often report psychosocial difficulties, including withdrawal from social activities, anxiety, negative body image, and low mood. This paper aimed to review all published research investigating the psychosocial impact of facial palsy on adults. A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, and AMED databases was performed. The quality of included studies was assessed, and data were extracted with regard to characteristics of participants; study methodology and design; outcome measures used; and psychosocial outcomes. Twenty-seven studies met inclusion criteria. A high proportion of people with facial palsy reported clinically significant levels of anxiety and depression, with greater difficulties typically reported by females, compared to males. Other difficulties consistently reported include low quality of life, poor social function, and high levels of appearance-related distress. Objective severity of facial palsy was consistently shown to not be associated with anxiety or depression, with psychological factors instead likely mediating the relationship between the severity of facial palsy and psychosocial well-being. Irrespective of objective symptom severity, facial palsy has the potential to have a significant impact on psychosocial well-being and quality of life. The various methodological limitations of the included studies are discussed, along with clinical implications, including the need for greater access to psychological screening and interventions for people with facial palsy.

Development and Usability Testing of SOMO, a Mobile-Based Application to Monitor Social Functioning for Youth at Clinical High-Risk for Psychosis

Background: Youth at clinical high-risk (CHR) for developing psychosis are characterized by long-standing social deficits and isolation compared to healthy youth. Because poor social functioning is predictive of transition to psychosis, it is important to monitor its fluctuations.&#x0D; Objective: To describe the development of a mobile application to monitor social functioning for CHR youth.&#x0D; Methods: App development was divided in two phases. In Phase 1, three focus groups with up to 10 CHR participants were conducted to discuss (i) content, (ii) graphic design, and (iii) user experience of the app. A working prototype was developed, debugged, and systematically tested by developers. In Phase 2, 13 participants evaluated the app through a usability testing for one week. Feedback was gathered through the 23-item Mobile Application Rating Scale user-version (uMARS). Focus groups and MARS’ qualitative data were audio-recorded, transcribed verbatim, and analyzed through an inductive approach.&#x0D; Results: The app was named SOMO and incorporated five features: 1) home screen; 2) goal setting; 3) 13 daily questions; 4) a calendar; and 5) feedback. The application monitored number of daily in-person and online interactions, meaningfulness and time spent with each person, conflict and conflict resolution, activities performed, subjective perception of socialization, and loneliness. SOMO received a good overall score in the uMARS, with an excellent score in functionality; followed by good scores in information, aesthetics, and safety; and adequate scores for subjective quality, and engagement.&#x0D; Conclusion: Co-design with youth through focus groups provided effective feedback for developing SOMO, which demonstrated initial usability and acceptability.

Reductions in Complex Mismatch Negativity to Extra Tone Gestalt Pattern Deviance in First-Episode Schizophrenia.

Although “simple” mismatch negativity (sMMN) to stimulus parameter changes is robustly reduced in long-term schizophrenia (Sz), it is much less reduced in individuals at their first psychotic episode in the schizophrenia-spectrum (FESz). “Complex” MMN (cMMN) reflecting pre-attentive acoustic pattern analysis is also markedly reduced in Sz, but is little studied in FESz. The computational complexity of pattern analysis reflected in cMMN may more greatly stress auditory processing, providing a more sensitive measure of auditory processing deficits at first break. If so, cMMN would provide information about the underlying pathophysiology early in disease course, and may serve as a biomarker for pathology in the Sz prodrome. Twenty-two FESz individuals were compared to 22 volunteer healthy controls (HC) on sMMN and cMMN tasks. For sMMN, pitch- and duration-deviants were presented among standard repetitive tones. For cMMN, repeated groups of 3 identical tones were presented with occasional (14%) groups including an extra identical 4th tone deviant. FESz did not show reductions of pitch-deviant (Cohen's d = 0.08) or duration-deviant MMNs (d =-0.02), but showed large reduction in extra-tone cMMN (d = 0.83). Reduced cMMN was associated with poor social functioning. Reduction in cMMN but not in sMMNs in FESz suggests impairments in late perceptual pattern processing. cMMN is sensitive to subtle pathology and functioning early in disease course which may, in turn, impact social functioning. Future studies in clinical high risk individuals are needed to determine whether this putative biomarker of disease presence is sensitive to the prodromal stage of schizophrenia.

Sleep Problems and Social Impairment in Psychosis: A Transdiagnostic Study Examining Multiple Social Domains.

Psychotic disorders are characterized by profound social impairment. An accumulation of research has explored the contribution of symptoms, cognitive functioning, and behavioral skills deficits to this social dysfunction. Recent research indicates that sleep disturbance has significant social implications in nonclinical populations—this research suggests that sleep problems may also be relevant to understanding social impairment in psychosis. This study adopted a symptom-oriented dimensional approach to examine how sleep disturbance and sleep-related impairment are related to multiple social domains within a transdiagnostic sample (N = 90). This sample included individuals with a variety of psychotic disorders (n = 75) along with healthy non-clinical participants (n = 15) to ensure sampling across the full range of sleep problems and social functioning. Social domains spanned self-reported perceptions of social relationships, social functioning in the community, and behavioral assessments of social competence. We hypothesized that greater sleep disturbance and sleep-related impairment would be associated with more negative or problematic perceptions of social relationships (i.e., less social support, less companionship, and greater distress), poorer social functioning in the community, smaller social networks, and poorer behavioral ratings of social competency. Results supported these hypotheses indicating that sleep disturbance and sleep-related impairment have widespread deleterious impacts on perceptions of social relationships, social functioning, and competence. Sleep disturbance retained associations with perceptions of social relationships, social functioning, and social competence even after controlling for total symptoms or cognitive functioning. These findings indicate that sleep problems may have important implications for fully understanding the causes of social impairment in psychosis.

Determining the key childhood and adolescent risk factors for future BPD symptoms using regularized regression: comparison to depression and conduct disorder.

Research has yielded factors considered critical to risk for borderline personality disorder (BPD). Yet, these factors overlap and are relevant to other disorders, like depression and conduct disorder (CD). Regularized regression, a machine learning approach, was developed to allow identification of the most important variables in large datasets with correlated predictors. We aimed to identify critical predictors of BPD symptoms in late adolescence (ages 16-18) and determine the specificity of factors to BPD versus disorders with putatively similar etiology. We used a prospective longitudinal dataset (n=2,450) of adolescent girls assessed on a range of clinical, psychosocial, and demographic factors, highlighted by previous research on BPD. Predictors were grouped by developmental periods: late childhood (8-10) and early (11-13) and mid-adolescence (14-15), yielding 128 variables from 41 constructs. The same variables were used in models predicting depression and CD symptoms. The best-fitting model for BPD symptoms included 19 predictors and explained 33.2% of the variance. Five constructs - depressive and anxiety symptoms, self-control, harsh punishment, and poor social and school functioning - accounted for most of the variance explained. BPD was differentiated from CD by greater problems with mood and anxiety in BPD and differences in parenting risk factors. Whereas the biggest parenting risk for BPD was a punitive style of parenting, CD was predicted by both punitive and disengaged styles. BPD was differentiated from MDD by greater social problems and poor behavioral control in BPD. The best predictors of BPD symptoms in adolescence are features suggesting complex comorbidity, affective activation, and problems with self-control. Though some risk factors were non-specific (e.g., inattention), the disorders were distinguished in clinically significant ways.

M224. LONGITUDINAL DETERIORATION OF GESTURE PERFORMANCE IN SCHIZOPHRENIA IS UNRELATED TO SYMPTOM TRAJECTORIES

BackgroundGesture deficits in patients with schizophrenia are highly pronounced, and often linked to poor social functioning, motor abnormalities, and frontal lobe dysfunction. Although gesture performance has been associated to both negative and positive symptoms, its relationship to the severity of these symptoms is still unclear. Here, we examine how gesture performance varies as symptoms change. Furthermore, we aimed to compare gesture performance at two time points to healthy controls and first-degree relatives of schizophrenia patients. Gesture performance in relatives may indicate whether the deficits are associated with genetic liability to schizophrenia. We hypothesize that gesture performance in controls and relatives would be stable; while we expect improvement in patients when symptom severity declines.MethodsThe present study included 36 patients with schizophrenia (DSM-5 criteria; mean age 35.5 years), 28 unaffected first-degree relatives of schizophrenia patients (mean age 49.9 years) and 38 healthy controls (mean age 39.9 years). All three groups performed the Test for Upper-Limp Apraxia (TULIA), which includes pantomime (performance on verbal command) and imitative (performance upon demonstration) gestures, at two different time points, baseline and re-test (between 1–4 weeks). TULIA performance is recorded on videos and rated blind to diagnosis and stage. In addition, 22 of the 36 patients performed the TULIA at a follow-up session 6-months after baseline. Symptom severity was assessed with the Positive And Negative Syndrome Scale (PANSS). Analysis between the three groups and within patients across the different time points was done using repeated measures ANOVA in R.ResultsSymptom severity in patients declined between baseline and week 4 (T = 6.7, p<0.001, PANSS total). A 3x2x2 repeated measures ANOVA revealed significant main effects of Group, Type of Gestures, as well as, a significant interaction between Group and Time Point (all F > 3.8; p<0.5) Post hoc analysis, bonferroni corrected, revealed that patients underperformed in both pantomime and imitative gestures compared to healthy controls (p<0.0001) and relatives of schizophrenia patients, although this effect did not reach significance (p=0.26). Performance of pantomime gestures was poorer compared to imitative gestures. Interestingly, this pattern was also observed during the re-test time point (p<0.0001), though gesture performance for imitative gestures significantly declined compared to baseline in patients (p<0.05). In contrast, healthy controls performed better than both patients (p<0.0001) and relatives (p-0.09) and remained stable during the re-test. Likewise, relatives performed intermediate between patients and healthy controls at both time points with scores reaching significance only at re-test (p<0.001). At baseline, imitation was better than pantomime in relatives, but with re-test imitation scores declined while pantomime scores remained stable. Finally, at the 6-month follow-up patients still exhibited lower gesture performance compared to baseline (F=22.25; p<0.05).DiscussionGesture performance in schizophrenia patients remained significantly impaired across time-points, suggesting an extended effect on poor social functioning despite symptom change. In addition, schizophrenia patients and their relatives showed a significant impairment when performing imitative gestures during the re-test compared to baseline. These results call for interventions specifically targeting gesture and social cognition, which would greatly improve patients’ quality of life. Finally, our findings suggest a trait component to gesture behavior that might be linked to genetic liability to psychosis.

O3.4. PSYCHOSIS PHENOTYPES FROM B-SNIP FOR CLINICAL ADVANCES: BIOTYPE CHARACTERISTICS AND TARGETS

BackgroundPsychiatry aspires to disease understanding and precision medicine. Biological research supporting such missions in psychosis may be compromised by continued reliance on clinical phenomenology in the search for pathophysiological mechanisms. A transdiagnostic deep phenotyping approach, such as that used by the Bipolar-Schizophrenia Network for Intermediate Phenotypes (B-SNIP), offers a promising strategy for discovery of biological mechanisms underlying psychosis syndromes. The B-SNIP consortium has identified biological subtypes of psychosis, Biotypes, which outperform conventional DSM diagnoses when accounting for variance of multiple external validating measures. While these biological distinctions are scientifically remarkable, their resulting clinical manifestations and potential utility in clinical practice is of paramount importance.MethodsApproximately 1500 psychosis cases and 450 healthy persons were administered the B-SNIP biomarker battery (including MRI, EEG, ocular motor, and cognition measures). Psychosis cases were also clinically characterized using multiple measures, including MADRS, PANSS, YMRS, and Birchwood. Numerical taxonomy approaches were used for identifying biologically homogenous psychosis subgroups (gap and TWO-STEP cluster identifications, k-means clustering, and canonical discriminant analysis). ANOVA models were used to analyze external validating measures. Multivariate discriminant models were used to identify clinical features differentiating conventional psychosis syndromes and psychosis Biotypes.ResultsThere was remarkable similarity between previously published biomarker profiles for DSM psychosis syndromes and a new sample of psychosis cases (average r=.92). Numerical taxonomy on biomarker data recovered three subgroups (replicating previous findings), and the biomarker profiles were highly similar to previous results (average r=.87). Schizoaffective cases were both the most diverse and the most clearly differentiated from schizophrenia and bipolar cases (on conative negative symptoms, depression, and mania) in clinical feature space. The only feature that uniquely distinguished schizophrenia was social-relational negative symptoms. Biotype-1 was characterized by accentuations on clinical features consistent with their biomarker deviations (relational negative symptoms, poor social functioning, and dysfunction of cognition). Alternatively, Biotype-2, also consistent with their biomarker deviations, had clinical features indicating neurophysiological dysregulation (most specifically physiological and behavioral dysregulation). Biotype-3 cases, the most normal across biomarkers, were noticeably absent of Biotype-1 clinical features and had more restricted clinical manifestations than any other Biotype or DSM subgroup. We illustrate three possible Biotype-specific treatment targets.DiscussionReplication of B-SNIP psychosis Biotypes indicates the possible utility and importance of neurobiological subtyping within psychosis that can yield specific treatment targets. In an analysis of clinical features, B-SNIP found that Biotypes have unique and defining clinical features that are consistent with their neurobiological profiles. Biotypes and DSM psychosis subgroups are neither neurobiologically nor clinically redundant. Specific treatment targets for psychosis Biotypes are not derivable from conventional clinical psychosis diagnoses. B-SNIP outcomes provide a background for future work that could establish psychiatry as a laboratory discipline, at least with regard to care of psychosis patients. This path is hypothetical at the moment but aspirational for the field.

S106. MONITORING SOCIAL FUNCTIONING THROUGH A MOBILE-BASED APPLICATION FOR YOUTH AT-RISK OF PSYCHOSIS: 2-MONTH FEASIBILITY STUDY

BackgroundYouth at clinical high-risk (CHR) for developing psychosis are characterized by long-standing social deficits and isolation compared to healthy youth. Because poor social functioning is predictive of transition to psychosis, it is important to monitor its fluctuations. Objectives: 1) To test initial usability of an app (SOMO); and 2) to confirm that SOMO is acceptable, feasible, and safe to monitor daily social functioning among youth at clinical high-risk (CHR) for developing psychosis.MethodsParticipants: 24 CHR participants (12–30 years old) used SOMO for 2 months to test its initial feasibility to monitor social functioning. Measures: 1) SOMO comprises 13 daily questions regarding social interactions in-person or online covering: type of relationship, time spent together, quality of the interaction, activities done, conflict and resolution, meaningfulness of the interaction, subjective opinion of the socialization, and level of loneliness. 2) Social functioning was assessed with the Social Functioning Scale (GF:S), which assesses peer relationships, peer conflict, age-appropriate intimate relationships, and involvement with family members. 3) Qualitative data of the SOMO was gathered through the 23-item Mobile Application Rating Scale (MARS) covering questions about engagement, functionality, aesthetics, information provided, and subjective quality of SOMO. Analyses. a) Descriptive information of 1) usability data (i.e., loggings, social relationships, ad meaningfulness) and 2) the app quality ratings (i.e., engagement, functionality, aesthetics, and information) was collected.ResultsThere were 750 loggings over the 2-month testing period, with 50% of participants logging in at least every other day. Participants had 690 in-person interactions and 497 online interactions. The most meaningful interactions were considered the ones with their partner, followed by interactions with friends, casual friends, family, others and strangers in-person respectively. Participants reported conflict in 18.2% of their interactions. SOMO obtained a high overall score on the MARS (M=4.38). Ratings for engagement (M=3.91), functionality (M=4.54), aesthetics (M=4.56), information (M=4.51), subjective score (M=3.89), and perceived impact in behavior (M=3.52) were higher than other relevant mHealth apps. All participants rated SOMO as safe. Social functioning did not change significantly after using SOMO.DiscussionSOMO demonstrated initial acceptability, feasibility, and safety among CHR participants.

S121. OPUS 20, 20 YEAR FOLLOW-UP ON THE OPUS TRIAL

BackgroundSince the first OPUS trial 20 years ago, structured clinical assessments have been collected from a cohort of first episode psychosis patients at 2, 5 and 10 years follow-up. They found that the symptomatology of patients clustered in distinct groups, and they were able to determine stable long-term trajectories of positive and negative symptoms. The Suffolk County Medical health project has followed patients after a first episode psychosis for 20 years. They also found a stable course of trajectories but with an overall significant worsening of symptom severity over time. The 20 year OPUS follow-up will give us the first opportunity to assess the long term outcome in a large representative cohort treated within modern mental health services with treatment available for all.MethodsFrom 1998 to 2000 578 participants were randomized to OPUS or TAU. Baseline characteristics of the cohort were as follows: mean age 26.6 years, 59% were males, 66% had a diagnosis of schizophrenia and 27% had a secondary diagnosis of alcohol or substance abuseAt the 20 year follow-up the investigators will be blinded to the original treatment allocation. The patients who wish to participate will be assessed using SAPS, SANS, SCAN, PSP and GAF. Socio-demographic factors and suicidal ideation will be register via self report. Cognitive function will be tested using BACS and all participants will be asked to fill out a number of self-rating questioners including WHO quality of life-BREF, self-perceived health, strengths and difficulties, the parenting scale and self-perceived negative symptoms.Using national Danish registers we can collect information on all former participants regarding the use of psychiatric and general healthcare services, medication, supported housing or homelessness, employment status, substance abuse and mortality.ResultsThe OPUS 20 study started collecting data in Jan 2018. We are attempting to contact as many patients as possible from the 578 participants in the original OPUS cohort. At the time of writing we had included data and attempted contact to 322 participants. Overall 104 people (31,7%) have agreed to participate in the interviews. In the follow-up 10 years ago, the participation-rate was 60% so this is a big drop in participation rate. 41 (14%) have died, 31 (9,5%) were lost due to emigration, homelessness or hidden identity and/or disempowerment. 70 (21,3%) didn’t wish to participate and 76 (23,2%) never responded.DiscussionPsychotic disorders and schizophrenia in particular are associated with progressive worsening of symptoms and profound social impairment, and as such are still very stigmatized. Results from the 10 year OPUS follow-up found stable trajectories of positive and negative symptoms over time, with a tendency of reduction and stabilization of positive symptoms but less variation of negative symptoms. They found poor but stable social functioning with a mean GAF score of 55 after 10 years. The Suffolk County mental health project also found stable trajectories of psychopathology measured with SAPS and SANS. They however found progressive worsening of GAF scores declining form 49 points at the beginning to 36 after 20 years.So far we have seen stable GAF scores and SAPS and SANS scores compared to OPUS 10. This gives rise to some optimism about the prognosis for schizophrenia compared to the findings of the Suffolk study.In our study the extensive interviews combined with the data collected form Danish registers give us a unique opportunity to look at the long term course of illness after FEP. The ability to test if previous findings are robust over time will be essential to the development of targeted interventions, differentiated to the needs of different patient groups.

T227. VIRTUAL REALITY SOCIAL SKILLS TRAINING IMPROVES SOCIAL ATTENTION IN INDIVIDUALS WITH SCHIZOPHRENIA

BackgroundSocial impairment is a core feature of schizophrenia presenting a major barrier to recovery. Although antipsychotic medications can reduce psychotic symptoms, social impairments often persist, contributing to poor outcome. Validated interventions, such as Social Skills Training (Bellack et al., 2004), target a broad range of social domains but they yield only modest effect sizes for social outcome (Pfammatter et al, 2006). Moreover, conventional social interventions suffer from high burden on the clients and therapists, low adherence, lack of personalization, and low generalizability. Importantly, social interventions are not widely available. Virtual reality (VR) offers a viable alternative to conventional therapies with several advantages including high acceptability, an extensive repertoire of stimuli, low-burden, low-cost and safety (Strickland, 1997). Importantly, VR allows for a precise targeting of social cognitive mechanisms. Social attention, the fast orientation and allocation of resources to social stimuli can be indexed by tracking eye movements. Abnormal eye scanning behavior during social interactions has been linked to poor social functioning in schizophrenia (Brunet-Gouet & Decety, 2006). We designed a VR-based social skills training game to directly target social attention in schizophrenia.MethodsEighteen individuals with schizophrenia (SZ) participated in the VR training game twice a week for 5 weeks. Eye movement patterns were recorded throughout the training. Subjects were required to solve social “missions” (e.g., obtain personal information through conversations with avatars) in different naturalistic scenarios. To start a mission, participants had to fixate on the chosen avatar. The latency to engage in a social interaction was indexed by the fixation time (social engagement latency). Each session consisted of 12 missions. We compared social engagement latency and eye gaze patterns pre- and post-training to assess the efficacy of the VR social skills training program.ResultsSocial engagement latency significantly decreased after 10 sessions (d=0.78). This result suggests that prosocial attention benefitted from VR training. We also found that the standard deviation of dwell time (i.e., proportion of time spent looking at the avatar’s face during a conversation) significantly increased across training sessions (d=0.56). This result suggests an increased modulation of interpersonal engagement during social interaction. Additionally, participants’ emotion recognition ability significantly increased (η2 = 0.27), and negative symptoms significantly decreased (η2=0.34) from pre- to post- training. Importantly, these changes in social attention correlated with improvement in negative symptoms.DiscussionSimulated and targeted social interactions with avatars in VR significantly improved social attention in individuals with schizophrenia. Importantly, improvements in negative symptoms and emotion perception after training suggest that this training protocol has an impact on a broad range of social functions. VR training is a promising alternative to traditional psychosocial interventions to target specific mechanisms underlying social functioning in schizophrenia.