Elisabeth Haug

Selective aggregation of self-disorders in first-treatment DSM-IV schizophrenia spectrum disorders.

Abstract Converging evidence indicates that self-disorders (SDs) selectively aggregate in schizophrenia spectrum conditions. The aim of this study was to test the discriminatory power of SDs with respect to schizophrenia and nonschizophrenia spectrum psychosis at first treatment contact. SDs were assessed in 91 patients referred for first treatment through the Examination of Anomalous Self-experience (EASE) instrument. Diagnoses, symptoms severity, and function were assessed using the Structural Clinical Interview for the DSM-IV, Structured Clinical Interview for the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Young Mania Rating Scale, and Global Assessment of Functioning–Split Version. Most patients found it highly relevant to talk about SDs. EASE total score critically discriminated between schizophrenia, bipolar psychosis, and other psychoses. The EASE total score was the only clinical measure that showed a significant and robust association with the diagnosis of schizophrenia. Systematic exploration of anomalous self-experiences could improve differential diagnosis in first-treatment patients.

Examination of Anomalous Self-Experience in First-Episode Psychosis: Interrater Reliability

Background: The growing research focus on early detection of schizophrenia has fostered an increasing interest in the nonpsychotic experiential anomalies that may antedate schizophrenia spectrum disorders and assist early differential diagnosis. The Examination of Anomalous Self-Experience (EASE) is a phenomenologically inspired checklist, specifically designed to support the comprehensive assessment of these characteristic subjective experiences. Aim: To assess the interrater reliability of the EASE. Sampling and Methods: Twenty-five first-episode psychosis (FEP) patients were interviewed with the EASE. Videotaped interviews were blindly reevaluated. Internal consistency, overall interrater correlation and item interrater agreement (Cohen’s kappa) were estimated. Results: The EASE showed good to excellent internal consistency across the two raters (Cronbach’s alpha above 0.87) and an overall inter-rater correlation above 0.80 (Spearman’s rho, p < 0.001). The average kappa of the EASE was 0.65, ranging from 0.51 to 0.73 over the 5 domains; kappa values at an item level were very good in 9 items, good in 20 items, moderate in 11 items and fair in 4 items. Conclusion: The EASE provides a reliable and internally consistent clinical tool for the assessment of subjective experience in FEP patients, suggesting that this instrument could usefully supplement standard clinical assessments during the onset phase of psychosis.

Self-esteem is associated with premorbid adjustment and positive psychotic symptoms in early psychosis

BackgroundLow levels of self-esteem have been implicated as both a cause and a consequence of severe mental disorders. The main aims of the study were to examine whether premorbid adjustment has an impact on the subjects self-esteem, and whether lowered self-esteem contributes to the development of delusions and hallucinations.MethodA total of 113 patients from the Thematically Organized Psychosis research study (TOP) were included at first treatment. The Positive and Negative Syndrome Scale (PANSS) was used to assess present symptoms. Premorbid adjustment was measured with the Premorbid Adjustment Scale (PAS) and self-esteem by the Rosenberg Self-Esteem Scale (RSES).ResultsPremorbid social adjustment was significantly related to lower self-esteem and explained a significant proportion of the variance in self-esteem. Self-esteem was significantly associated with the levels of persecutory delusions and hallucinations experienced by the patient and explained a significant proportion of the variance even after adjusting for premorbid functioning and depression.ConclusionThere are reasons to suspect that premorbid functioning is an important aspect in the development of self- esteem, and, furthermore, that self-esteem is associated with the development of delusions and hallucinations.

Anomalous self-experiences contribute independently to social dysfunction in the early phases of schizophrenia and psychotic bipolar disorder.

BACKGROUND Psychotic disorders are associated with significant social dysfunction. Anomalous self-experiences (ASE) present in psychotic disorders could contribute to social dysfunction. AIM To investigate if ASE contribute to social dysfunction in the early phases of psychotic disorders after controlling for factors related to social functioning including diagnoses. METHODS ASE were assessed by means of the EASE (Examination of Anomalous Self-Experience) in 76 patients referred to their first adequate treatment for schizophrenia or psychotic bipolar disorder. Diagnoses, symptom severity, and functioning were assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Premorbid Adjustment Scale, Global Assessment of Functioning--Split Version, and Social Functioning Scale. Neurocognitive assessments included measures of psychomotor speed, working memory, executive and memory functions. Duration of untreated psychosis was also assessed. RESULTS High levels of ASE were significantly associated with poorer social functioning in the early phases of schizophrenia and psychotic bipolar disorder also after correcting for diagnosis. CONCLUSION This study demonstrates the significance of ASE for social dysfunction in patients with psychotic disorders, and contributes to the understanding of the complexity of illness-related factors that affect social functioning.

Anomalous self-experience and childhood trauma in first-episode schizophrenia

BACKGROUND Anomalous self-experiences (ASEs) are viewed as core features of schizophrenia. Childhood trauma (CT) has been postulated as a risk factor for developing schizophrenia. AIM The aim of this study is to investigate the relationships between CT, depression and ASEs in schizophrenia. METHOD ASEs were assessed in 55 patients in the early treated phases of schizophrenia using the Examination of Anomalous Self-Experience (EASE) instrument. Data on CT were collected using the Childhood Trauma Questionnaire, short form (CTQ-SF). This consists of 5 subscales: physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect. Assessment of depression was based on the Calgary Depression Scale for Schizophrenia (CDSS). RESULTS We found significant associations between EASE total score and CTQ total score and between EASE total score and emotional neglect subscore in women, but not men. We also found significant associations between CDSS total score and CTQ total score and between CDSS total score and emotional abuse, emotional neglect, and physical neglect subscores in women, but not men. In men we did not find any significant associations between EASE total score, CDSS total score and any CTQ scores. CONCLUSION CT was significantly associated with higher levels of ASEs in women in the early treated phases of schizophrenia, but not in men. This again associated with an increase in depressive symptoms.

High levels of anomalous self-experience are associated with longer duration of untreated psychosis.

To investigate the relationship between anomalous self‐experiences and duration of untreated psychosis in a sample of patients with first‐episode schizophrenia spectrum disorders.

Self‐reported symptoms and health service use in adolescence in persons who later develop psychotic disorders: A prospective case‐control study

To investigate self‐reported psychiatric and somatic symptoms and health service use at age 16 in persons who later developed a psychotic disorder compared with a control group from the same geographical areas.

Prevalence and management of patients with outpatient commitment in the mental health services

Background People with mental health problems are mostly treated within the community. The law allows for the use of compulsory mental health care both in hospital and in the community. Various forms of outpatient commitment (OC) have been adopted in much European legislation. To be subjected to OC is a serious intervention in a person’s life. Aim The purpose of this study is to gain knowledge about patients who undergo OC. The study explores the incidence and prevalence of OC in a geographical area, the central characteristics of the sample, and how the framework for follow-up treatment for patients to resolve OC works. Methods The data were collected from a review of electronic patient records. The statistical methods used in this study were descriptive analysis, with frequency analysis and cross-tabulation analysis. Results The main finding in the present study is that the use of OC has increased. An important finding is that most of the patients have a decision made for OC that is justified by the treatment criterion. The present study shows that there is insufficient documentation on statutory responsibilities for follow-up treatment of patients with an OC. Conclusions This study shows that the use of OC has increased. It should be considered whether implemented measures to reduce the use of coercion have the desired effect.

S217. SELF-DISTURBANCES AND DIAGNOSTIC STABILITY IN FIRST EPISODE PSYCHOSIS: A SEVEN YEAR FOLLOW-UP STUDY

Abstract Background Self-disturbances are considered core features of schizophrenia spectrum disorders, and are present in the prodromal, the early psychotic and in the chronic phase. Self-disturbances are also present at first treatment in some patients with psychotic disorders outside of the schizophrenia spectrum. There is limited knowledge about the stability of self-disturbances over time. The aim is to explore the stability of self-disturbances in a seven year follow-up of first episode patients and to examine the association between self-disturbances at start of treatment and diagnostic changes at follow-up. Methods Longitudinal study of 56 patients recruited at their first treatment for an affective or non-affective psychotic disorder. Self-disturbances were assessed by the Examination of Anomalous Self-Experience (EASE), while diagnostic categories, symptom severity, and functioning were assessed with standard clinical instruments. At baseline we registered life-time experiences of self-disturbances. At follow-up we focused on self-disturbances experienced the last two years Results At follow-up 35 patients were diagnosed with schizophrenia or a schizoaffective disorder (schizophrenia) and 21 with a bipolar, psychotic disorder or delusional disorder (non-schizophrenia). The level of self-disturbances was significant lower at follow-up than at baseline in patients with schizophrenia. Patients with schizophrenia had significantly higher levels of self-disturbances both at baseline and at follow up than patients in the non-schizophrenia group, who showed stable low levels of self-disturbances. In the schizophrenia group the EASE domain “Cognition and stream of consciousness”, was the most stable. There were no changes into or out of the schizophrenia group. The four patients in the non-schizophrenia group with relatively high EASE total scores at baseline (≥ 15) did not convert to schizophrenia at follow-up, as hypothesized. No patients in the non-schizophrenia group who increased their EASE score from baseline to follow-up converted to the schizophrenia group. Discussion EASE domain “Cognition and stream of consciousness”, have previously been described as some of the first self-disturbances appearing in the prodromal phase and are also found to be the most predictive of transition to full-threshold psychosis in an Ultra High Risk group. The results from the present study show that these phenomena are also the most stable over time. We did not find that patients outside the schizophrenia group, converted to schizophrenia, neither among those who had high level of self-disturbances at baseline nor those who had increased levels of self-disturbances at follow-up. The current study was conducted in rural areas with considerable distances to the specialized psychiatric health services, and consequently with long duration of untreated psychosis. The observed diagnostic stability is thus to be expected if symptomatic developments relevant for diagnosis take place early in the first episode, in this case before the first treatment contact.

S82. GOAL MANAGEMENT TRAINING OF EXECUTIVE FUNCTIONS FOR PATIENTS WITH SCHIZOPHRENIA OR HIGH RISK OF SCHIZOPHRENIA: BASELINE CHARACTERISTICS AND PRELIMINARY RESULTS FROM AN RCT

Abstract Background About 85% of patients with schizophrenia have cognitive impairments, executive functions being particularly affected. Executive dysfunctions are important predictors of functional outcomes. Unlike psychotic symptoms, cognitive deficits do not improve during periods of remission and change only minimally with antipsychotic medications. Thus, effective interventions aimed at improving executive functions in this population are needed. One of the most validated interventions for executive dysfunction is Goal Management Training (GMT). GMT is a compensatory intervention that relies on metacognitive strategies for improving participants’ ability to organize and achieve goals in everyday life. GMT has received empirical support in studies of other populations, such as people with neurological conditions and in healthy elderly. To our knowledge no previous studies have investigated the effect of group-based GMT in patients with schizophrenia spectrum disorders or with high risk of schizophrenia. Thus, this is the main objective of the study. Baseline characteristis and preliminary results from the first patients will be presented. Methods Participants (16–67 years, males and females, IQ >70) with executive dysfunction, will be recruited among patients referred for treatment at Innlandet Hospital Trust in Norway from 2017 to 2020. The study aims to include patients treated for psychotic disorder for less than 5 years and new patients who either have symptoms that meet the DSM-IV criteria for a diagnosis of broad schizophrenia spectrum disorder or who are considered at high risk of psychosis. We aim to recruit one hundred participants for the current randomized controlled trial (RCT), with efficacy of GMT (n = 50) being compared with results of subjects in a wait-list condition (WL, n = 50). Measurements include self-report of executive function, emotional health, and social- and everyday function. Informant reports of executive function will also be collected. Furthermore, neuropsychological tests designed specifically to measure areas of executive function will be utilized, as well as role-playing tasks thought to have good ecological validity. Symptoms of psychosis will also be assessed. GMT will be administered in 9 (twice weekly) x 2 hour sessions in accordance with the GMT research protocol. A general linear model with repeated measures analysis of variance (RM ANOVA) will be used to examine differential group treatment effects. A 2 x 3 mixed-design will be applied, with Group (GMT, WL) as between-subjects factor, and Session (baseline [T1], post-intervention [T2], and 6 months follow-up [T3]) as within-subjects factor. Interpretation of the strength of experimental effects will be provided with effect size statistics. Results Baseline characteristics and preliminary results from the first participants will be presented. Discussion Based on findings from previous GMT-studies, we hypothesize that post-intervention changes will be reflected in improved scores on self-reported and/or objective measures of executive functions (particularly in the areas of planning and attentional control) compared to patients in WL. We also expect that GMT participants will improve their goal attainment in everyday life and social functioning after the intervention. Additionally, we expect post-intervention changes to be reflected in improved scores on measures of emotional health.