Prospective Naturalistic Study Research Articles

Treatment of depression and PTSD in primary care clinics serving uninsured low-income mostly Latina/o immigrants: A naturalistic prospective evaluation.

Uninsured immigrants to the United States are psychologically vulnerable due to limited access to mental health services. Latina/o immigrants from Central and South America are further at risk due to high levels of trauma exposure, both in their country of origin and their adopted country. Effective behavioral interventions in primary care are needed to address this services gap for common trauma-related mental disorders, including depression and posttraumatic stress disorder (PTSD). A naturalistic prospective study compared depression and PTSD outcomes for uninsured primary care patients, mostly Latina/o immigrants, in clinics with distinct models for integrating behavioral health services. One clinic had a collaborative care program, that is, a multicomponent, system-level intervention with the goals of facilitating increased screening, improving diagnostic accuracy, increasing uptake of evidence-based treatment, and utilizing measurement-based treatment to target. The other had colocated services, with an on-site therapist. One hundred thirty-eight patients with presumptive depression were interviewed at baseline. Follow-up data were collected 8 months later. Care received between the two assessments was ascertained by chart review. There was a significant decrease in depression symptoms regardless of clinic. Factors associated with improved depression outcomes included absence of comorbid PTSD and lack of additional trauma exposures. Although there was overall improvement in PTSD, there was significantly more improvement in the collaborative care clinic. Results suggest that both models were effective for depression and PTSD; however, the collaborative care model had added benefits for those patients with PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Risk assessment of imminent violence in acute psychiatry: a step towards an extended model

ABSTRACTAggression occurs frequently in mental health care settings, and studies have reported that 17% to 31% of patients admitted to acute psychiatric wards commit violence. Inpatients’ fluctuating mental states and behaviour patterns reinforce the need for an assessment instrument to predict potential violence in a timely manner. This naturalistic prospective inpatient study investigated whether an extended short-term risk assessment model that combines (a) short-term risk assessment with the Broset Violence Checklist (BVC), (b) patient’s own prediction of violence with the Self-Report Risk Scale (SRS) and (c) single items from the Violence Risk Screening 10 (V-RISK-10) provides better short-term predictive accuracy for violence than the BVC alone. All patients admitted to a psychiatric emergency hospital in Norway during one year were included (N = 508). Stepwise multivariate generalised linear mixed model analyses were conducted. When adjusting for repeated measurements, the results indicated that an extended model for short-term risk assessment, consisting of the BVC, SRS and Item 2 Previous and/or current threats from the V-RISK-10 explained more variance of imminent violence, compared to the BVC alone. Further studies are recommended to investigate whether the extended model provides a clinically better short-term risk prediction of imminent violence, compared to the BVC alone.

Rumination and problematic substance use among individuals with a long-term history of illicit drug use

BackgroundRumination is a cognitive process that is implicated in the development and maintenance of various forms of psychopathology, including problematic substance use. Most studies on the role of rumination in substance use have been conducted among community samples or individuals with alcohol use disorders and have predominately focused on overall rumination rather than differentiating between its subtypes, ruminative brooding and ruminative reflection. The current study therefore aimed to investigate i) whether rumination subtypes are associated with problematic substance use among people with a long-term history of illicit drug use independently of related psychological disorders (depression and post-traumatic stress disorder [PTSD]), and ii) whether gender moderates these relationships. MethodsThis cross-sectional study used data from the Australian Treatment Outcome Study (ATOS); a naturalistic prospective cohort study of people with heroin dependence. At the 11-year follow-up of ATOS, a total of 380 participants completed measures of rumination, depression, PTSD, and indices of problematic substance use. ResultsHierarchical logistic regression analyses indicated that higher brooding scores were associated with current heroin dependence (OR = 1.11, CI: 1.01–1.22), polydrug use (OR = 1.16, CI: 1.06–1.28) and experience of injection related health problems (OR = 1.08, CI: 1.00–1.17), independently of depression, PTSD, and other covariates. Reflection was not related to any of the substance use measures. These results were not moderated by gender. ConclusionsFindings indicate that ruminative brooding is related to a poorer substance use profile among people with long-term illicit drug use and highlight the potential benefits of targeting brooding during substance use treatment.

Violence after discharge from forensic units in the safe pilot study: a prospective study with matched pair design.

ObjectiveThis paper reports on a prospective naturalistic study of violent recidivism after discharge from forensic mental health. Main aims were to find predictors of violence and to test the feasibility of a matched pair design for this purpose.MethodsPatients from the Safe pilot project (n=18) and a group of controls (n=18) were matched on 10 variables, such as diagnosis, seriousness of violence, setting after discharge, and risk management plans. All the Safe pilot patients had been through repeated measurement of dynamic risk factors of violence the year before discharge to develop efficient risk management plans for use after discharge. We wanted to test whether violent recidivism during follow-up would be lower and less serious in the Safe pilot group.ResultsWe found no significant between-group difference concerning number of patients with violent recidivism. However, the Safe pilot patients had significantly lower rates of violence and fewer severe violent episodes. In the control group, there was a significant association between a high number of risk management plans and high rates of violence. There was a statistical trend for the opposite association in the Safe pilot group.ConclusionWe discuss this in terms of a possible gap between the development and implementation of plans.

Using network analysis to explore cognitive domains in patients with unipolar versus bipolar depression: a prospective naturalistic study.

Despite growing evidence in the field of cognitive function in mood disorders, the neurocognitive profiles of patients with unipolar and bipolar depression still need further characterization. In this study, we applied network analysis, hypothesizing this approach could highlight differences between major depressive disorder (MDD) and bipolar disorder (BD) from a cognitive perspective. The cognitive performance of 109 patients (72 unipolar and 37 bipolar depressed outpatients) was assessed through the Montreal Cognitive Assessment (MoCA), and a series of clinical variables were collected. Differences in cognitive performance between MDD and BD patients were tested using non-parametric tests. Moreover, a network graph representing MoCA domains as nodes and Spearman's rho correlation coefficients between the domains as edges was constructed for each group. The presence of mild cognitive impairment was observed in both MDD and BD patients during depression. No statistical significant difference was found between the two groups in terms of overall cognitive performance and across single domains. Nonetheless, network analytic metrics demonstrated different roles of memory and executive dysfunction in MDD versus BD patients: in particular, MDD network was more densely interconnected than BD network, and memory was the node with the highest betweenness and closeness centrality in MDD, while executive function was more central in BD. From a network analytic perspective, memory impairment displays a central role in the cognitive impairment of patients with unipolar depression, whereas executive dysfunction appears to be more central in bipolar depression. Further research is warranted to confirm our results.

Frequency of Sexual Dysfunction in Patients Treated with Desvenlafaxine: A Prospective Naturalistic Study.

Despite being clinically underestimated, sexual dysfunction (SD) is one of the most frequent and lasting adverse effects associated with antidepressants. Desvenlafaxine is an antidepressant (AD) with noradrenergic and serotonergic action that can cause a lower SD than other serotonergic ADs although there are still few studies on this subject. Objective: To check the frequency of SD in two groups of depressive patients: one group was desvenlafaxine-naïve; the other was made up of patients switched to desvenlafaxine from another AD due to iatrogenic sexual dysfunction. A naturalistic, multicenter, and prospective study of patients receiving desvenlafaxine (50–100 mg/day) was carried out on 72 patients who met the inclusion criteria (>18 years old and sexually active), who had received desvenlafaxine for the first time (n = 27) or had switched to desvenlafaxine due to SD with another AD (n = 45). Patients with previous SD, receiving either drugs or presenting a concomitant pathology that interfered with their sexual life and/or patients who abused alcohol and/or drugs were excluded. We used the validated Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) to measure AD-related sexual dysfunction and the Clinical Global Impression Scale for psychiatric disease (CGI-S) and for sexual dysfunction (CGI-SD) at two points in time: baseline and three months after the commencement of desvenlafaxine treatment. Results: In desvenlafaxine-naïve patients, 59.2% of the sample showed moderate/severe sexual dysfunction at baseline, which was reduced to 44% at follow-up. The PSexDQ-SALSEX questionnaire total score showed a significant improvement in sexual desire and sexual arousal without changes in orgasmic function at follow-up (p < 0.01). In the group switched to desvenlafaxine, the frequency of moderate/severe SD at baseline (93.3%) was reduced to 75.6% at follow-up visit. Additionally, SD significantly improved in three out of four items of the SALSEX: low desire, delayed orgasm, and anorgasmia at follow-up (p < 0.01), but there was no significant improvement in arousal difficulties. The frequency of severe SD was reduced from 73% at baseline to 35% at follow-up. The CGI for psychiatric disease and for sexual dysfunction improved significantly in both groups (p < 0.01). There was a poor tolerability with risk of treatment noncompliance in 26.7% of patients with sexual dysfunction due to another AD, this significantly reduced to 11.1% in those who switched to desvenlafaxine (p = 0.004). Conclusion: Sexual dysfunction improved significantly in depressed patients who initiated treatment with desvenlafaxine and in those who switched from another AD to desvenlafaxine, despite this, desvenlafaxine treatment is not completely devoid of sexual adverse effects. This switching strategy could be highly relevant in clinical practice due to the significant improvement in moderate/severe and poorly tolerated SD, while maintaining the AD efficacy.

Negative Schema and Rumination as Mediators of the Relationship Between Childhood Trauma and Recent Suicidal Ideation in Patients With Early Psychosis.

High rates of childhood trauma and adult suicidality have been reported in patients who have schizophrenia. This study sought to explore mediators between childhood trauma and suicidality in adulthood to help determine therapeutic approaches. This study included 314 adult patients with early psychosis who were participants in the Korean Early Psychosis Cohort Study, which was a prospective naturalistic observational cohort study started in December 2014. DSM-5 criteria were used to assign the diagnosis of schizophrenia spectrum and other psychotic disorders. Cross-sectional data obtained at baseline were used for analysis. The Early Trauma Inventory Self Report-Short Form and the Columbia Suicide Severity Rating Scale were employed to collect data on childhood trauma and suicidal ideation and attempts. Other measures were used to evaluate depression, empathy, psychopathology, and rumination. A total of 90.1% of the participants experienced at least 1 childhood traumatic event. The rates of significant` physical punishment, emotional abuse, and sexual events were 37.3%, 35.6%, and 6.4%, respectively. The rates of recent suicidal ideation and attempts were 32.0% and 10.0%, respectively. Independent predictors of recent suicidal ideation included depression, negative schema, and rumination. Furthermore, negative schema and rumination played partial or full mediating roles in the relationship between childhood trauma and recent suicidal ideation. These findings highlight the importance of performing careful evaluations of childhood trauma and suicidality and of developing effective strategies to reduce mediating factors that may be amenable to psychosocial approaches.

The course of neuropsychiatric symptoms in patients with dementia in primary care

During the course of dementia, most people develop some type of neuropsychiatric symptoms (NPS), which result in lower quality of life, high caregiver burden, psychotropic drug use and a major risk of institutionalization. Studies on NPS in people with dementia have been mainly conducted in clinical centres or psychiatric services. To investigate the course of NPS in people with dementia in primary care. Analysis of (cumulative) prevalence and incidence, persistence and resolution based on data collected during an assessment at home of a prospective naturalistic cohort study in primary care in a sample of 117 people with dementia and their informal caregivers. Subsyndromes of NPS were assessed with the Neuropsychiatric Inventory (NPI) and Cohen-Mansfield Agitation Inventory. Multivariate analyses were used to detect determinants for the course of NPS. The mean age of the people with dementia was 78.6 years, and 52% were female. Mean Mini-Mental State Examination total score was 19.5, mean NPI total score 15.7. The most prevalent clinically relevant subsyndromes of the NPI were hyperactivity and mood/apathy, and the most prevalent individual NPS were aberrant motor behaviour (28%), agitation/aggression (24%) and apathy/indifference (22%). Of the people with dementia, 72.3% had one or more symptoms of the mood/apathy and 75.3% of the hyperactivity subsyndrome. GPs should be aware of NPS in people with dementia and should actively identify them when they visit these patients or when informal caregivers consult them. Timely diagnosing facilitates adequate professional care.

Characterization of children and adolescents with psychosis risk syndrome: The Children and Adolescents Psychosis Risk Syndrome (CAPRIS) study.

Despite the interest in psychosis risk syndrome (PRS) in children and adolescents, information on the syndrome in this population is scarce. Prospective naturalistic multi-site study in which 10- to 17-year-old help-seeking subjects who met PRS criteria (positive or negative attenuated symptoms; brief limited intermittent psychotic symptoms; genetic risk or schizotypal personality disorder plus impairment in functioning) were included, along with 45 age and sex-matched healthy controls (HC). All subjects were clinically and functionally assessed. Ninety-one PRS subjects (PRSS) with a mean age of 15.5 ± 1.4 met inclusion criteria (IC). Compared with HC, PRSS presented worse global and academic functioning in the previous year, had experienced more psychiatric and psychological problems, and presented gestational ages outside the normal range. More than 80% of PRSS met ≥2 IC, with 65.9% having one Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision diagnosis, and 61.7% of those having ≥2 diagnoses. Some 49.5% of PRSS had a first- or second-degree family history (FH) of psychosis. Patients with first- and second-degree FH do not differ in their clinical expression. Children and adolescents with PRS are a patient group with a pattern of neurodevelopmental impairment and clinical complexity similar to patients with schizophrenia spectrum disorders, highlighting the importance of assessing these variables in child and adolescent samples. PRSS with first- and second-degree relatives with FH do not present differences in their clinical presentation, suggesting that including these two groups of patients in the genetic risk criteria would enrich knowledge of these criteria.

Multidisciplinary biopsychosocial rehabilitation in chronic neck pain: a naturalistic prospective cohort study with intraindividual control of effects and 12-month follow-up

In contrast to the large evidence of the effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) in chronic low back pain, little is known about the effects of MBR in chronic neck pain (CNP). To quantify short-term and 12-month effects of a 3-week CNP-specific MBR program. Naturalistic prospective observational cohort study with intraindividual control of effects. Outpatient clinic at a tertiary physical medicine and rehabilitation center. Consecutive patients with CNP (N.=81) who participated in a CNP-specific MBR. The intervention was a MBR outpatient clinic program. Primary Outcome was the North American Spine Society (NASS) questionnaire pain/function scale. Secondary outcomes included the NASS scale neurogenic symptoms, Short-Form 36 Health Survey (SF-36) and numerical rating scales (NRS) for maximum and average pain. Short-term changes of health were quantified using effect sizes (ES), which were corrected by the change during waiting time before MBR. At the end of treatment, the NASS pain/function scale showed significant improvement (P<0.001) by a moderate corrected ES (ES=0.59). Moderate significant improvements were also found for the NASS scale neurogenic symptoms (ES=0.65), the SF-36 scales bodily pain (ES=0.56) and mental health (ES=0.54), and the NRS maximum pain (ES=0.59). Significant small corrected ES were found for the SF-36 scales physical functioning (ES=0.32), physical role (ES=0.41), vitality (ES=0.42), social functioning (ES=0.41), emotional role (ES=0.41) and the NRS average pain (ES=0.48). The improvement on the SF-36 scale general health was not significant (ES=0.19). At the follow-up after 12 months, the NASS pain/function scale remained its moderate ES (ES=0.52, P value <0.001). Also, the NASS Scale neurogenic symptoms, the SF-36 scales bodily pain, general health, social functioning and mental health and both NRS pain scales showed significant benefits. This study showed that MBR may be effective in patients with CNP. Maintenance of moderate benefits in pain and function seems possible for at least 12 months. The findings support the concept of CNP-specific MBR.

Beyond the Walls: An Evaluation of a Pre-Release Planning (PReP) Programme for Sentenced Mentally Disordered Offenders.

Background: Prison mental health services have tended to focus on improving the quality of care provided to mentally disordered offenders at the initial point of contact with the prison system and within the prison environment itself. When these individuals reach the end of their sentence and return to the community, there is an increased risk of morbidity, mortality, homelessness and re-imprisonment. New models of care have been developed to minimize these risks.Objectives: The objective of this project was to establish a Pre-Release Planning (PReP) Programme with social work expertise, to enhance interagency collaboration and improve continuity of care for mentally disordered offenders upon their release. We aimed to evaluate the first 2 years of the programme by measuring its success at improving the level of mental health support and the security and quality of accommodation achieved by participants upon release in comparison to that reported at time of imprisonment. Additionally, we aimed to explore the impact of these outcomes on rates of re-imprisonment.Methods: A process of participatory action research was used to develop and evaluate the first 2 years of the programme. This was a naturalistic prospective observational whole cohort study.Results: The PReP Programme supported 43 mentally disordered offenders, representing 13.7%, (43/313) of all new assessments by the prison's inreach mental health service during the 2 years study period. When compared with that reported at time of reception at the prison, gains were achieved in level of mental health support (FET p < 0.001) and security and quality of accommodation (FET p < 0.001) upon release. Of those participants seen by the PReP Programme, 20 (46.5%, 20/43) were returned to prison during the 2-years study period. There was no significant relationship between re-imprisonment and gains made in mental health support (FET p = 0.23) or accommodation (FET p = 0.23).Conclusions: We have shown that compared to that reported at time of reception at prison, the level of mental health support and the security of tenure and quality of accommodation both improved upon release following the intervention of the programme. Improved mental health support and accommodation were not associated with lower rates of re-imprisonment.

Biopsychosocial multidisciplinary rehabilitation in low back pain: A comparison of effects after 12 months in patients older and younger than 65 years

In patients with chronic low back pain (cLBP) guidelines recommend multidisciplinary biopsychosocial rehabilitation (MBR) if other treatments were unsuccessful. However, little is known about the long-term effects of MBR in patients older than 65 years. The objective of this study was to compare the 12 months course of effects of MBR in patients older than 65 years to younger patients. In this naturalistic prospective observational cohort study, 118 participants of a 3-week MBR were included. The MBR comprised exercise therapy, hydrotherapy, occupational therapy, psychological interventions, patient education and instructions to home exercise programs. Outcome was assessed by the condition specific North American Spine Society (NASS) questionnaire pain/function scale and the generic Short-Form 36 Health Survey (SF-36). From the eight SF-36 scales only Physical Functioning (PF), Bodily Pain (BP) and Mental Health (MH) were included in the analyses. Data were collected at the beginning of treatment, after 3 months and after 12 months. Participants were grouped into “Old” or “Young” with the cut-off 65 years. Statistical differences between follow-up and baseline scores were tested by paired t-tests. Standardized Effect Size (ES) was calculated by dividing the difference between entry and follow-up by the standard deviation (SD) of the baseline score. In this study, 59 patients were older than 65 years and 59 were younger. The mean ages of the groups old/young were 70 years and 57years respectively. In the group old 64% of patients were female and in the young group 73% were female. The course of the outcomes and the statistical significance of changes are presented in Table 1 , Table 2 . This study shows that a MBR program in cLBP patients has similar beneficial long-term effects on pain and condition specific function in patients older than 65 years compared to younger patients.

A prospective naturalistic multicenter study on choice of parenteral medication in psychiatric emergency settings in Japan.

AimTo provide information about psychiatric emergency situations in Japan, we examined psychiatrists’ preference among parenteral medication since intramuscular (IM)‐olanzapine became available and clinical characteristics in patients given IM‐olanzapine compared to those given other parenteral medication.MethodsWe conducted a naturalistic study proceeding over a 1‐year period in 9 psychiatric emergency departments.ResultsAmong 197 patients, the distribution of IM‐injections (n = 89) was as follows: IM‐olanzapine, 66 patients (74.2%), IM‐levomepromazine, 17 patients (19.1%), IM‐haloperidol, 5 patients (5.6%), and IM‐diazepam, 1 patient (1.1%). The distribution of intravenous (IV)‐injections (n = 108) was as follows: IV‐haloperidol, 78 patients (72.2%), and IV‐benzodiazepines (diazepam, flunitrazepam, or midazolam), 30 patients (27.8%). Advantages of IM‐olanzapine over other parenteral medications in efficacy were found as follows: less frequent needs of an additional injection despite no difference in duration until a patient became cooperative for oral administration, and less frequent needs of restraint after the injection. Furthermore, advantages of IM‐olanzapine over other injections in safety were found as follows: less frequent appearance of extrapyramidal symptoms, no occurrence of ECG abnormality and other serious adverse events except a fall, less frequent needs of an adjunctive anticholinergic drug, and less frequent needs of another kind of drug additionally injected.ConclusionsOlanzapine has rapidly become the first choice of intramuscular medication in psychiatric emergency situations since it became available in Japan, probably due to the advantages in both efficacy and safety. This study reflecting psychiatric emergency practice in Japan may contribute to periodic international comparison of psychiatric emergency practice.

A Six-Year Prospective Study of the Prognosis and Predictors in Patients With Late-Life Depression

To examine the six-year prognosis of patients with late-life depression and to identify prognostic factors of an unfavorable course. The Netherlands Study of Depression in Older Persons (NESDO) is a multisite naturalistic prospective cohort study with six-year follow-up. Three hundred seventy-eight clinically depressed patients (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision criteria) and 132 nondepressed comparisons were included at baseline between 2007 and 2010. Depression was measured by the Inventory of Depressive Symptomatology at 6-month intervals and a diagnostic interview at 2- and 6-year follow-up. Multinomial regression and mixed model analyses were both used to identify depression-related clinical, health, and psychosocial prognostic factors of an unfavorable course. Among depressed patients at baseline, 46.8% were lost to follow-up; 15.9% had an unfavorable course, i.e., chronic or recurrent; 24.6% had partial remission; and 12.7% had full remission at six-year follow-up. The relative risk of mortality in depressed patients was 2.5 (95% confidence interval 1.26-4.81) versus nondepressed comparisons. An unfavorable course of depression was associated with a younger age at depression onset; higher symptom severity of depression, pain, and neuroticism; and loneliness at baseline. Additionally, partial remission was associated with chronic diseases and loneliness at baseline when compared with full remission. The long-term prognosis of late-life depression is poor with regard to mortality and course of depression. Chronic diseases, loneliness, and pain may be used as putative targets for optimizing prevention and treatment strategies for relapse and chronicity.

The long-term impact of post traumatic stress disorder on recovery from heroin dependence

The high prevalence of post traumatic stress disorder (PTSD) among people with heroin dependence and its impact on short term outcomes has been well established. The impact of PTSD on long-term recovery is, however, unknown. This paper examines the impact of current and lifetime PTSD on long-term recovery from heroin dependence among participants who took part in the 11-year follow-up of the Australian Treatment Outcome Study (ATOS), a prospective naturalistic longitudinal study of 615 people with heroin dependence recruited from Sydney, Australia, in 2001–2002. Seventy-one percent of the cohort (n = 431) were re-interviewed 11-years post study entry. Outcomes examined included heroin and other drug use, dependence, general physical and mental health, depression, PTSD, employment, and the incidence of trauma exposure, overdose, imprisonment, and attempted suicide over the 11- year follow-up. Despite having a poorer profile at baseline, individuals with current PTSD or a history of PTSD at baseline demonstrated similar levels of improvement to those without a history of PTSD in all outcome domains across the 11-year follow-up, PTSD was associated with consistently higher levels of major depression, and attempted suicide, subsequent trauma exposure, and poorer occupational functioning across the 11-year follow-up. These findings highlight the importance of interventions aimed at occupational rehabilitation, reducing the likelihood of retraumatisation, and addressing PTSD and associated comorbidities among people with heroin dependence.

T106. IMPROVING PSYCHIATRIC DIAGNOSIS BY ADDING MOTOR FUNCTION NEXT TO MENTAL HEALTH FUNCTION: A NETWORK APPROACH

BackgroundCurrently, the predictive value of psychiatric diagnosis is inadequate compared to other medical fields. It has been suggested that the use of a network model might aid in acquiring new insights into the underlying connections between symptoms (Bringmann et al., 2013). In addition, previous research (Bakker et al., 2012) has revealed associations between dysregulated mental- and motor function. As such, the network graphs might be enhanced by adding non-mental factors.MethodsBaseline data from a 4-year prospective naturalistic study (Bakker et al., 2012) was used to obtain data about 207 psychiatric long-stay patients. (i) Drug-induced movement disorders: tardive dystonia (TD), akathisia, parkinsonism, and dyskinesia. (ii) ratings of the clinical global impression-schizophrenia (CGI) scale, and (iii) age and total defined daily dose to account for potential confounders. Statistical programming environment R (Epskamsp, Cramer, Waldorp & Borsboom, 2012) was used to visualise several psychopathology-severity networks.ResultsInterpretation of the graphs is based on the “centrality” of the symptoms. Centrality indicates the influence of a symptom on the network. Parkinsonism scored a low centrality score in graphs depicting high psychopathology in contrast with the other levels. Dyskinesia scored a low centrality score in medium psychopathology contrary to the other levels. The network graphs show a consistent positive correlation between age and parkinsonism (0.25, 0.53, and 0.19 for low, medium, and high psychopathology, respectively.), and a negative correlation between age and akathisia (-0.32, -0.47, and -0.21, respectively). High severities of psychopathology negatively correlated with parkinsonism (-0.16) and positively correlated with high levels of TD (0.33).DiscussionThe usage of a network model including motor factors has provided useful information to take into consideration when examining psychopathology of a patient. TD and parkinsonism draw the most attention. More research with the dataset, combined with further developing the network architecture technique is needed to accurately map motor- and mental factors.

T250. CLINICAL CORRELATES OF SUBJECTIVE QUALITY OF LIFE IN INDIVIDUALS WITH AT-RISK MENTAL STATE FOR PSYCHOSIS IN HONG KONG

BackgroundSubjective quality of life (SQoL) is an important outcome domain in individuals with at-risk mental state (ARMS) for psychosis. In an effort to better understand and maximize SQoL in ARMS populations, an increasing number of research has been conducted to investigate factors determining SQoL. This study aimed to examine clinical, functional and cognitive correlates of SQoL in Chinese young people presenting with ARMS in Hong Kong.MethodsThis is a naturalistic prospective study examining the longitudinal course of ARMS and prediction of psychosis in Hong Kong. In total, 110 Chinese participants aged 15 to 40 years presenting with ARMS were recruited from a territory-wide specialized early intervention service for psychosis. ARMS status was verified using Comprehensive Assessment for At-Risk Mental State (CAARMS). Assessments encompassing symptom profiles (Positive and Negative Syndrome Scale, PANSS; Montgomery-Asberg Depression Rating Scale, MADRS; Brief Negative Symptom Scale, BNSS), functioning (Social and Occupational Functioning Rating Scale, SOFAS) and a brief battery of cognitive tests was conducted. A validated Chinese version of SF12 questionnaire was used to measure SQoL. The current analysis focused on data collected at baseline.ResultsOf 110 ARMS participants, 48.2% were male. The mean age and educational level of the sample was 20.9 years (S.D.=6.7) and 11.4 years (S.D.=2.6), respectively. Correlation analyses revealed that SF12 mental health score was correlated with MADRS total score, BNSS total score and SOFAS score, while SF12 physical health score was correlated with PANSS positive symptom score only (p<0.05). Multiple linear regression analysis showed that only MADRS total score was independently associated with SF12 mental health score (p<0.001). SQoL measures were not correlated with any cognitive functions.DiscussionOur results were consistent with the literature which indicates that psychological domain of SQoL is significantly related to depressive symptoms in ARMS individuals. Further analysis on the longitudinal data regarding our prospective ARMS cohort will clarify variables predictive of SQoL at follow-up.

Asymmetric Drug-Induced Parkinsonism and Psychopathology: A Prospective Naturalistic Study in Long-Stay Psychiatric Patients.

Drug-induced parkinsonism (DIP) is the most common movement disorder induced by antipsychotics. Although DIP is mostly symmetric, asymmetric DIP is reported in a substantial part of the patients. We investigated the frequency of motor asymmetry in DIP and its relationship to the severity of psychopathology in long-stay psychiatric patients. We obtained data from a cohort study of 207 long-stay psychiatric patients on the frequency and risk factors of tardive dyskinesia, akathisia, tardive dystonia, and DIP. From July 2003 to May 2007 (mean follow-up, 1.1 year) drug-induced movement disorders were assessed at least two times in each patient, with a frequency of persistent DIP of 56.2%. All patients who had at least one time parkinsonism in the upper/lower limb(s) were included for analyses (190 patients, 79 women; mean age, 48.0 ± 12.9 years). The Unified Parkinson Disease Rating Scale motor scale was used to calculate the frequency of asymmetric parkinsonism. Multilevel mixed models were built to explore the relationship between asymmetry in parkinsonism and the severity of psychopathology, measured on the Clinical Global Impression-Schizophrenia scale severity index (CGI-SCH SI). The frequency of asymmetric parkinsonism was 20.8%. Asymmetry in parkinsonism was associated with symptom severity on all CGI-SCH SI scales (β range, 0.37-3.74) and significantly associated with the positive symptom scale (β, 3.74; 95% CI, 0.35-7.31). DIP is asymmetric in a substantial part of patients. Asymmetric presentation of DIP is of clinical relevance as it is related to the severity of psychopathology and may alert the clinician of more severe psychopathology. Future research is recommended to provide insight into the neuropsychopathology and clinical value of asymmetric parkinsonism for psychiatric patients.

Use of Electroconvulsive Therapy in Dementia-Related Agitation: A Case Series.

This naturalistic prospective observation study examines the efficacy of electroconvulsive therapy (ECT) in treating dementia-related agitation. Patients with dementia-related agitation who received ECT were compared with patients with the same condition who did not receive ECT using Cohen-Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory (NPI)-nursing home version, and Clinical Global Impression Scale (CGI). Outcomes were compared between ECT-treated and non-ECT-treated patients. A total of 9 patients were included in the study. Six received ECT, and 3 did not. Patients in the ECT and non-ECT-treated groups had comparable baseline scores (CMAI, P = 0.880; NPI, P = 0.814; and CGI, P = 0.445). The CMAI, NPI, and CGI scores were lower on final assessment in both groups with no statistically significant difference (CMAI, P = 0.771; NPI, P = 0.243; and CGI, P = 0.519). Electroconvulsive therapy should be considered as a treatment option in the management of severe treatment refractory dementia-related agitation.

Injury talk: spontaneous parent–child conversations in the aftermath of a potentially traumatic event

BackgroundWhile talking about traumatic experiences is considered central to psychological recovery, little is known about how these conversations occur in daily life.ObjectiveWe investigated spontaneous injury talk among parents and children...