A. Aissa

F98. HYPOVITAMINOSIS D IN SCHIZOPHRENIA: ASSOCIATED CARDIOVASCULAR RISK

Abstract Background Vitamin D modulate the course of many neurologic diseases and conditions. Moreover, the prevalence of vitamin D deficiency might be higher in psychiatric patients, in particular with schizophrenia. Likewise, there is an inverse relationship between vitamin D levels and several cardiovascular risk factors, including the metabolic syndrome, that patients with schizophrenia are predisposed to develop. It is within this framework that this study aims to explore the relationship between vitamin D levels in a cohort of Tunisian patients with schizophrenia and to determine the cardiovascular risk according to whether they had hypovitaminosis D or not. Methods A cross-sectional and retrospective descriptive study was conducted at the “F” psychiatry department at the Razi Hospital, Manouba over a twelve-month period from June 1st, 2015 to May 31st, 2016, including 80 patients with schizophrenia in period of clinical remission. The evaluation focused on anthropometric parameters and cardiovascular risk factors. A dosage of vitamin D was performed. Results The patients had an average age of 42.5 years and 70% were male. 25 patients had metabolic syndrome. 49% of patients had vitamin D insufficiency and 51% had vitamin D deficiency. Vitamin D levels had not been affected by the clinical characteristics of the disease. However, there was no significant association between vitamin D levels and metabolic syndrome. A significant negative correlation was found between the total sum of the various cardiovascular risk factors and the vitamin D deficiency (p <0.001). Discussion In our study, all patients had vitamin D levels below the recommended levels. 25 patients (31%) met the criteria for metabolic syndrome. All our patients had at least one cardiovascular risk factor. The majority (33% and 27%) had respectively three or four FRCV. 10% had more than five concurrent FRCVs. This result has been described in many studies. Indeed, in patients with schizophrenia, the cardiometabolic risk seems to increase continuously. Several European studies have reported a prevalence of metabolic syndrome ranging from 28% to 37% in patients with schizophrenia. Higher rates of 43% and 46% were reported respectively in the United States and Canada. Moreover, with schizophrenia have an increased risk of sudden death and are 2 to 4 times more likely to die prematurely compared to the general population. These results have been explained with a multicausal model focusing on genetics, lifestyle, smoking, diet and sedentary behavior as well as by the side effects of antipsychotics known to induce weight gain and aggravate symptoms. risk factors for cardiometabolic disease, although studies in naïve patients reflect various abnormalities early on. However, several studies confirm that certain metabolic abnormalities may occur in schizophrenic patients naive to any antipsychotic treatment. This result is consistent with current literature data that highlight increased metabolic and cardiovascular risk in vitamin D deficiency. Indeed, in the general population, vitamin D deficiency is an important risk factor for cardiometabolic disease. The majority of cohort studies have reported an increase in the incidence of cardiovascular disease in people with low vitamin D levels.

S248. RELATION BETWEEN CHILDHOOD TRAUMA AND PSYCHOTIC SYMPTOMS IN SCHIZOPHRENIA

Abstract Background There is renewed interest in the relationship between early childhood trauma and risk of psychosis in adulthood. Trauma and stressful events in childhood and adolescence are known to be more prevalent among individuals with schizophrenia and other psychotic disorders than in the general population. Furthermore, other findings support the role of childhood trauma as a socio-environmental risk factor for psychotic symptoms, and research on the potential etiological relationship between trauma/stressful events in childhood/adolescence and psychotic disorders is evolving. The aim of the current study was to examine relations among all items and domains of childhood trauma and schizophrenic symptoms in patients with schizophrenia. The relationship between types of trauma and their association with psychotic symptoms was analysed. Methods In this study, we collected data from 50 schizophrenic patients (39 males and 11 females). All patients met the DSM 5 criteria for schizophrenia. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale (PANSS). Trauma and stressful events in childhood and adolescence were assessed using the Childhood Trauma Questionnaire (CTQ). Results We found significant correlations between emotional and sexual abuse, emotional neglect and denial scale in CTQ with positive symptoms of the PANSS (p<0,05). Meanwhile, no correlations were found between CTQ domains neither with negative symptoms nor with general psychopathology scale of the PANSS. Discussion This study showed that childhood trauma could be a predictor factor for developing positive symptoms in schizophrenia. Most studies found similar results, showing a correlation between childhood trauma and hallucinations in schizophrenia. A correlation between childhood trauma and agressive behaviours was also described in litterature. These results went along with the stress sensitization model where the HPA axis is over-active and excessively reactive to the subsequent environemental stressors causing positive symptoms of the disease.

S120. FACTORS ASSOCIATED WITH SUICIDE ATTEMPTS AMONG PATIENTS WITH SCHIZOPHRENIA

Abstract Background Suicide is the leading cause of surmortality among patients with schizophrenia. Despite efficient antipsychotic treatments, suicide rates reaches up to 15% of death causes and near half of the patients had at least once attempted suicide. Thereby, the early identification of clinical profiles and risk factors is important for the development of management strategies. Methods A cross-sectional and retrospective descriptive study was conducted at the “F” psychiatry department at the Razi Hospital, Manouba including 56 patients with schizophrenia in period of clinical stability. The evaluation focused on sociodemographic and clinical characteristics (using the positive and negative syndrome scale (PANSS); The Calgary Depression Scale for Schizophrenia (CDSS); The Global Assessment of Functioning (GAF); The Clinical Global Impression (CGI) rating scales). Personal history of suicidal attempts was assessed. Results In this study, fourteen patients with schizophrenia (25%) never attempted suicide. 58 % (N=32) committed one or two suicide attempts. Only 8.5% (N= 5) had 3 and 4 attempts each. Number of suicide attempts was negatively correlated with the age of onset (p=0.024, r=-0.442) and the GAF score (p= 0.002, r=- 0.483). An association was found between the personal history of suicidal attempts and the existence of a triggering factor of the onset (p=0.03). A positive correlation was found with the number of hospitalization (p=0.14, r=0.663), with the PANSS items: delusions (p=0.41, r=0.358), hallucinations (p=0.12, r=0.402), Suspiciousness/persecution (p=0.35, r= 0.342) and Somatic concern (p=0.048, r=0.322); with the CDSS guilty ideas of references (p=0.008, r=0.426) and with the CGI efficacy index (p=0.32, r=0.348). Discussion The rates of suicide are the highest among patients with schizophrenia. Previous studies have estimated the prevalence of suicide attempts in individuals with schizophrenia up to 50%. The increase in suicide attempts is associated with depressive symptoms which are very common within schizophrenia. The risk of suicide is not constant during the evolution of schizophrenia: it is the highest during the first years. A meta-analysis of 29 studies (Hawton et al., 2005) related that risk factors for suicide was higher in schizophrenic Caucasian men, those who live alone, who have recently experienced a loss, who have a family history of depression, who are more educated and have a higher IQ. Alteration of the abnormality the serotonin system may provide a biologic base to this phenomenon. It is essential to try to early detect and carefully assess the demographic and clinical profiles of patients with high risk of suicide.

S200. HYPOVITAMINOSIS D IN SCHIZOPHRENIA: PREVALENCE AND ASSOCIATED CLINICAL CHARACTERISTICS

Abstract Background Schizophrenia is an invalid and severe neurodevelopmental disorder. The implication of vitamin D in the etiopathogenesis of schizophrenia shows through the activation of cellular and inflammatory pathways. It is especially vitamin D deficiency that has been associated with schizophrenia. It is within this framework that this study aims to explore the relationship between vitamin D levels and the clinical characteristics in a cohort of Tunisian patients with schizophrenia. Methods A cross-sectional and retrospective descriptive study was conducted at the “F” psychiatry department at the Razi Hospital, Manouba over a twelve-month period from June 1st, 2015 to May 31st, 2016, including 80 patients with schizophrenia in period of clinical remission. The evaluation focused on sociodemographic and clinical characteristics. A dosage of vitamin D was performed. Results The patients had an average age of 42.5 years and 70% were male. The average vitamine D level was 10,57ng/ml ±5,9. 49% of patients had vitamin D insufficiency (between 10 and 30 ng/ml) and 51% had vitamin D deficiency (<10 ng/ml). Vitamin D levels had not been affected by the clinical characteristics of the disease. A negative correlation with the total score of the negative scale (p <0.001) as well as with the severity item of the clinical global impression scale (p = 0.01) were found. Discussion A large number of research studies in immunogenetics and molecular biology have highlighted the involvement of vitamin D in the etiopathogenesis of schizophrenia through its role in the ontogenesis of dopaminergic systems and also through its intervention in the processes of neuro-protection, immunomodulation and the reduction of oxidative stress. In addition, it has been established that people with psychotic disorders have a high prevalence of vitamin D deficiency, but the correlates and relevance of this deficiency remain unclear.

T124. CLINICAL DIFFERENCES BETWEEN URBAN AND RURAL SCHIZOPHRENIA

Abstract Background Schizophrenia is a highly heritable disease; yet heritability rate could never exceed 80% in most studies. Genetic factors could never then, by their own, account for the whole risk for developing schizophrenia. Thus, environmental factors co-play a major role. Urbanity is now well established to be one of the most influential environmental factors for developing severe mental illnesses. A strong association between exposure to urban environment and the risk of developing schizophrenia, was demonstrated and several studies have shown that living in an urban environment increases the risk for developing schizophrenia. The aim of this study was to examine the clinic biological characteristics of patients with schizophrenia according to their rural or urban condition. Methods This study was based on 106 patients with a DSM 5 diagnosis of schizophrenia in period of remission. Sociodemographic and clinical characteristics were assessed. PANSS scale, Calgary depression scale, CGI scale were used to assess different features of the disease and biological variables (CBC, renal and liver markers, inflammatory markers: CRP and CRP hs) were evaluated. Two groups were formed according to the patient’s urban or rural birth and early living. Results There were 71 urban and 35 rural patients. The mean age was 42,7 years in the urban group and 42,3 years in the rural group. Socio demographic characteristics were similar between the two groups. Patients with urban background had a higher score on the negative subscale (p=0,01) and the general psychopathology subscale (P=0,025) of the PANSS compared with rural patients. Otherwise, compared to patients with a rural birth and early living, urban patients showed more depressive symptoms on the Calgary depression scale (p=0,039). There were no significant differences between the two groups regarding the biological variables tested. Discussion The association between urban upbringing and risk for developing schizophrenia is well established. Nevertheless, relationship between epidemiological factors and different symptom dimensions is still poorly understood. Our study found a significant association between patients’ urban background and negative as well as disorganization and depressive symptoms. Most of published studies found a correlation between urban upbringing and positive psychotic symptoms in schizophrenia. To our knowledge, no similar result has ever been found before. Otherwise, there were several studies showing an association between disorganization and depressive symptoms with urban upbringing of the patients.

La résistance à la sectorisation : exemple du gouvernorat de Nabeul en Tunisie.

Sectorisation was introduced in Tunisia in 1999. The objective of this study was to examine the difficulties and resistance to the sectorisation of psychiatric care in the state of Nabeul. A transversal study was conducted over a period of 5 months from 1 November 2014 to 31 March 2015 on 96 patients resident in the state of Nabeul and treated at Razi hospital. Patients were aged between 18 and 69 years old ( sex ratio equal to one), 55.2% were single and 46% had a low socioeconomic level (n=44). Chronic psychotic disorder was diagnosed in 64.3% , depression in 12.3%, bipolar disorder in 18.8% and mental retardation in 3% of cases. Most of them refused to continue psychiatric treatment in the second or the first line of care. Resistance to sectorisation was associated with a low socioeconomic level (P = 0.039), availability of a companion (P = 0.04), celibacy (P = 0.04), gender (P = 0.05) and negatively correlated to psychotic disorder diagnosis. It was concluded that the environment plays an important role in the choice of the place of care. Subjects treated for mental illness were found to have greater trust in the structures that treated the acute episode of their illness, and paradoxically felt less stigmatized in Razi hospital.