Gerard van de Willige

Changes in quality of life in chronic psychiatric patients: A comparison between EuroQol (EQ-5D) and WHOQoL

It has often been postulated that simple, short questionnaires are unable to reflect complex changes in well-being of individuals with chronic psychiatric disorders. To investigate these assumptions we included two recently developed instruments to measure quality of life (the WHOQoL-Bref and the EuroQoL EQ-5D) in a randomised control trial (RCT) in which two treatment conditions were compared. Aims of the study were to assess the sensitivity and validity of these quality of life (QoL)-instruments, to establish their relationship and to examine the predictors of changes in QoL. Subjective changes in QoL were measured on three assessments waves in a period of 18 months and compared to objective changes in psychopathology and social functioning in a sample of 76 chronic schizophrenic patients who participated in the RCT. Results indicated that both WHOQoL-Bref and EuroQoL EQ-5D are capable of detecting changes in QoL over time in physical and psychological well-being. The instruments partly measure the same aspects of QoL, indicated by 50% common variance on total scores. Reduction of positive psychotic symptoms appeared to be the most important factor in improving QoL. The weighted TTO-score of EuroQoL-5D, which is often used as an index in economic evaluations of health care, did however not correspond with these changes, which indicates that it is less sensitive to changes in social and psychological well-being. It’s use as the core measure in (economic) health evaluation in the field of psychiatry therefore seems less appropriate.

Prevalence and correlates of auditory vocal hallucinations in middle childhood

BACKGROUND Hearing voices occurs in middle childhood, but little is known about prevalence, aetiology and immediate consequences. AIMS To investigate prevalence, developmental risk factors and behavioural correlates of auditory vocal hallucinations in 7- and 8-year-olds. METHOD Auditory vocal hallucinations were assessed with the Auditory Vocal Hallucination Rating Scale in 3870 children. Prospectively recorded data on pre- and perinatal complications, early development and current problem behaviour were analysed in children with auditory vocal hallucinations and matched controls. RESULTS The 1-year prevalence of auditory vocal hallucinations was 9%, with substantial suffering and problem behaviour reported in 15% of those affected. Prevalence was higher in rural areas but auditory vocal hallucinations were more severe and had greater functional impact in the urban environment. There was little evidence for associations with developmental variables. CONCLUSIONS Auditory vocal hallucinations in 7- and 8-year-olds are prevalent but mostly of limited functional impact. Nevertheless, there may be continuity with more severe psychotic outcomes given the serious suffering in a subgroup of children and there is evidence for a poorer prognosis in an urban environment.

Course of auditory vocal hallucinations in childhood: 5-year follow-up study

BACKGROUND In a baseline study among 7- and 8-year-old children with auditory vocal hallucinations, only limited functional impact was observed. AIMS To assess 5-year course and predictors of auditory vocal hallucinations, as well as 5-year incidence and its risk factors. METHOD A sample of 337 children, 12 and 13 years of age, were reassessed on auditory vocal hallucinations and associated symptoms after a mean follow-up period of 5.1 years. RESULTS The 5-year persistence and incidence rates were 24% and 9% respectively, with more new cases arising in urban areas.Both persistent and incident auditory vocal hallucinations were associated with problem behaviour in the clinical range of psychopathology as measured with the Child Behavior Checklist, particularly at follow-up, as well as with other psychotic symptoms, particularly at baseline. Persistence was predicted by baseline auditory vocal hallucinations severity,particularly in terms of external attribution of voices and hearing multiple voices, and was associated with worse primary school test scores and lower secondary school level. CONCLUSIONS First onset of auditory vocal hallucinations in middle childhood is not uncommon and is associated with psychopathological and behavioural comorbidity. Similarly,persistence of auditory vocal hallucinations in childhood is not uncommon and is associated with psychopathological,behavioural and cognitive alterations.

Hitting Voices of Schizophrenia Patients May Lastingly Reduce Persistent Auditory Hallucinations and Their Burden: 18-Month Outcome of a Randomized Controlled Trial

Objective: This study aimed to investigate the outcome of an 18-month randomized controlled trial (RCT) on subjective burden and psychopathology of patients suffering from schizophrenia. Method: An RCT was used to compare hallucination-focused integrative treatment (HIT) and routine treatment (RT) in schizophrenia patients who persistently hear voices. We performed an intent-to-treat analysis on each of the 63 patients who were assessed at baseline, 9, and 18 months. On each of the 3 occasions, the differential effects of the treatment conditions were tested repeatedly. Sex, age, education, and illness (hallucination) duration were used as covariates. Results: Patients in the experimental group retained improvements over time. Improvements in hallucinations, distress, and negative content of voices remained significant at the 5% level. Conclusion: HIT seems to be an effective treatment strategy with long-lasting effects for treatment-refractory voice-hearing patients.

The Psychosis Recent Onset GRoningen Survey (PROGR-S): Defining Dimensions and Improving Outcomes in Early Psychosis

Psychotic disorders are among the most complex medical conditions. Longitudinal cohort studies may offer further insight into determinants of functional outcome after a psychotic episode. This paper describes the Psychosis Recent Onset in GRoningen Survey (PROGR-S) that currently contains data on 1076 early-episode patients with psychosis, including symptoms, personality, cognition, life events and other outcome determinants. Our goal in this report is to give an overview of PROGR-S, as a point of reference for future publications on the effect of cognition, personality and psychosocial functioning on outcomes. PROGR-S contains an extensive, diagnostic battery including anamnesis, biography, socio-demographic characteristics, clinical status, drug use, neuropsychological assessment, personality questionnaires, and physical status tests. Extensive follow-up data is available on psychopathology, physical condition, medication use, and care consumption. Sample characteristics were determined and related to existing literature. PROGR-S (period 1997–2009, n = 718) included the majority of the expected referrals in the catchment area. The average age was 27 (SD = 8.6) and two-thirds were male. The average IQ was lower than that in the healthy control group. The majority had been diagnosed with a psychotic spectrum disorder. A substantial number of the patients had depressive symptoms (479/718, 78%) and current cannabis or alcohol use (465/718, 75%). The level of community functioning was moderate, i.e. most patients were not in a relationship and were unemployed. The PROGR-S database contains a valuable cohort to study a range of aspects related to symptomatic and functional outcomes of recent onset psychosis, which may play a role in the treatment of this complex and disabling disorder. Results reported here show interesting starting points for future research. Thus, we aim to investigate long-term outcomes on the basis of cognition, personality, negative symptoms and physical health. Ultimately, we hope that this paper will contribute improving the health of patients with psychotic disorders.

Personality and coping in first episode psychosis linked to mental health care use

A body of literature focuses on associations of neuroticism, extraversion, passive coping and active coping with the course of psychotic illness. Less is known about other personality and coping variables - and underlying causal mechanisms between variables remain unclear. We explored causal effects from personality, coping and symptoms on mental health care consumption over two years in 208 first episode patients. Causal inference search algorithms lead to formation of a hypothetical causal model based on presumptions on (non-)mutuality between variables and consistent with data. Structural equation modelling estimated effect sizes conditionally on the causal model. Our observed model implies that none of the coping or personality variables have any effect on the number of days of hospitalisation, whereas general psychopathology symptoms do have a direct positive effect. For ambulatory care it is proposed that openness to experience, depressive symptoms and age have direct positive effects. Reassuring thoughts as a coping strategy seems to have a direct negative effect on the use of ambulatory care and mediates indirect effects of other personality and coping variables on ambulatory care. Furthermore, while previously established relations between personality and symptoms are confirmed by our model, it challenges traditional ideas about causation between personality and symptoms.

THE PSYCHOMETRIC EVALUATION OF THE AUDITORY VOCAL HALLUCINATION RATING SCALE (AVHRS)

differential association of neuroticism with individual schizotypy dimensions and the role it plays in the expression of schizophreniaspectrum phenomena. Methods: 204 nonclinically ascertained participants completed selfreport questionnaires assessing neuroticism and the positive and negative schizotypy dimensions, and underwent structured interviews assessing schizophrenia-spectrum psychopathology (psychotic-like experiences, negative symptoms, cluster A personality disorders), mood episodes, substance abuse, and global functioning. Results: Results indicated that neuroticism predicted positive symptoms of schizophrenia and depression, over and above the effects of both schizotypy dimensions. Also, neuroticism moderated the association of positive schizotypy with interview measures of psychopathology and functioning. Discussion: The results of this study support other research indicating that neuroticism is etiologically relevant for spectrum psychopathology and that it cannot be considered solely a ‘secondary effect’ of spectrum disorders. Current psychological models of psychosis can accomodate the finding of neuroticism being a shared vulnerability factor for affective and psychotic disorders.

Poster #S119 THE PSYCHOSIS RECENT ONSET GRONINGEN SURVEY (PROGR-S):DEFINING DIMENSIONS AND IMPROVING OUTCOME IN EARLY PSYCHOSIS

Edith Liemburg1, Stynke Castelein2,1, Ellen Visser1, Dick Smid3, Erna Van ’t Hag1, Frank Van Es4, Anne Neeltje Scholte1, Gerard Van de Willige1, Richard Bruggeman1, Henderikus Knegtering5 1University Medical Center Groningen; 2Lentis Mental Healthcare Center, University Medical Center Groningen, Groningen, The Netherlands; 3independent; 4University of Groningen, University Medical Center Groningen, Department of Psychiatry; 5Lentis