Jym Tang

Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: a 3-year prospective follow-up study

BACKGROUND Cognitive impairment is a core feature of schizophrenia. Its relationship with duration of untreated psychosis (DUP), a potentially malleable prognostic factor, has been less studied, with inconsistent findings being observed in the literature. Previous research investigating such a relationship was mostly cross-sectional and none of those prospective studies had a follow-up duration beyond 2 years. Method A total of 93 Hong Kong Chinese aged 18 to 55 years presenting with first-episode schizophrenia-spectrum disorder were studied. DUP and pre-morbid adjustment were measured using a structured interview incorporating multiple sources of information. Psychopathological evaluation was administered at intake, after clinical stabilization of the first psychotic episode, and at 12, 24 and 36 months. Cognitive functions were measured at clinical stabilization, and at 12, 24 and 36 months. RESULTS DUP exerted differential effects on various cognitive domains, with memory deficits being the most related to DUP even when potential confounders including pre-morbid adjustment and sex were adjusted. Prolonged DUP was associated with more severe impairment in visual memory at clinical stabilization and verbal memory at 24 and 36 months. Further, patients with a long DUP were found to have worse outcomes on negative symptoms at 36 months. The effects of DUP on verbal memory remained significant even when negative symptoms were taken into consideration. CONCLUSIONS Our findings provided further supportive evidence that delayed treatment to first-episode psychosis is associated with poorer cognitive and clinical outcomes. In addition, DUP may specifically affect memory function and its adverse impact on verbal memory may only become evident at a later stage of the recovery process.

A 10-year outcome study of an early intervention program for psychosis in Hong Kong (EASY) compared with standard care service

This journal suppl. contain Abstracts for the 14th International Congress on Schizophrenia ResearchBackground: Adverse social circumstances in childhood and adolescence increase vulnerability for adult psychotic disorders. Children who have psychotic- like experiences (PLEs) are at higher risk to develop psychotic disorders later in life. If PLEs are considered potential precursors of psychotic disorders and the risk for psychotic disorders develops in early life, PLEs in childhood should be related to indicators of social disadvantage. Methods: A self-report study assessing a sample of 1545 schoolchildren (45% Dutch, 26% Moroccan, 11% Turkish, 5% Western and 13% other non-Western) was conducted in the Netherlands (age range: 9-16). PLEs were measured with 8 items from the psychosis section of the K-SADS. Additional questions addressed impact of the PLEs. Measures of parental socio-economic status, neighborhood deprivation, perceived discrimination, parental separation, housing stability and degree of urbanization were used as indicators of social disadvantage, based on which a cumulative index of social disadvantage was created (low, medium, high). Results: The overall prevalence of any PLE with high impact was 6% (N = 93). Neighborhood deprivation, perceived discrimination and an unstable housing situation were associated with risk for PLEs. Age- and sex-adjusted Odds Ratios for any PLE with high impact were 1.83 (95% CI, 0.92-3.69) for medium and 2.28 (1.11-4.69) for high cumulative social disadvantage, compared to low social disadvantage. The risk was higher for ethnic minority youth compared to Dutch (Odds Ratio = 2.6; 95% CI, 1.6-4.3). The increased risk remained after adjusting for social disadvantage. Conclusion: The risk for PLEs with high impact was associated with indicators of social disadvantage. PLEs with high impact were more prevalent in ethnic minority youth than in Dutch youth. The increased risk was not explained by cumulative social disadvantage.Background: The risk for psychotic disorders is increased for many immigrant groups in several countries, particularly for those who migrated in early life and for second-generation immigrants. Social factors are likely to contribute to this increase, but biological pathways have hardly been explored. Since immune activation has been associated both with schizophrenia and social stress in early life, it may be involved in the pathway of migration, ethnic minority status and psychosis. Methods: Case-control study of 11 Dutch and 14 immigrant patients with first episode psychosis, and 14 Dutch and 10 immigrant healthy controls. Quantitative polymerase chain reaction (Q-PCR) techniques were used to measure mRNA levels of 97 genes in isolated monocytes. These genes were selected for their association with schizophrenia, bipolar disorder, autoimmune or inflammatory disorders in previous genome wide association studies. Results: Compared to Dutch controls, 29 genes in monocytes of Dutch cases were upregulated (fold changes more than two standard deviations (sd)) and statistical significance was reached for 13 genes. Most of these genes are involved in inflammation pathways, including coding for the pro-inflammatory cytokines IL-8, IL-1 beta and IL-6. Immigrant cases had a similar gene expression profile to Dutch cases. Twenty-four of the upregulated genes in patients had an increased expression in immigrant controls as well. The fold changes of an additional 14 genes was more than two sd for immigrant controls compared with Dutch controls. Conclusion: Inflammatory genes in monocytes were upregulated both in Dutch and in immigrant patients with first episode psychosis. Immigrant controls showed similar inflammatory gene expression to both patient groups and differed from Dutch controls. The findings suggest that childhood migration and second generation immigrant status may result in a shift of the distribution of immune activation in immigrant populations, which may contribute to the higher rates of psychotic disorders in these groups.Background: Many people with schizophrenia (50-80%) demonstrate impaired insight. A number of interventions aiming to improve insight have been proposed and evaluated, for example cognitive behavioral therapy and psycho-education. Results of these interventions leave room for improvement. Therefore, we propose a new intervention to improve insight in people with schizophrenia (REFLEX). REFLEX focuses on insight in ones functioning in everyday life and changes in general functioning after psychosis by improving metacognitive acts necessary for insight (selfreflectiveness, idiosyncratic self-certainty) and reducing stigma-sensitivity. Methods: The primary objective is to improve insight. By improving insight, we hope to improve functional outcome and symptoms. Results: 120 patients diagnosed with schizophrenia with poor insight and sensitive are included in a randomized controlled trial): REFLEX was compared to an active control condition consisting of group wise drill and practice cognitive remediation training. Preliminary analysis show that while clinical insight measures with the SAI-E remains unchanged, while cognitive insight measured with the BCIS improves in the REFLEX condition (F 1,85 4,9, p

The first three years of pharmacotherapy in patients with psychotic disorders: a comparison between the early intervention programme and standard care service in Hong Kong

This journal suppl. entitled: Abstracts for the 12th International Congress on Schizophrenia Research (ICOSR)

Outcome of an early intervention programme for psychosis (EASY)

and Magical Thinking = 90%. In comparison, using the Comprehensive Assessment of At-Risk Mental States (CAARMS), less than half the sample (46%) rated for subthreshold psychotic symptoms. When looking at the specific subscales of the CAARMS, ‘Disorders of Thought’ was the most frequently endorsed scale (25%), followed by ‘Perceptual Abnormalities’ (24%) and ‘Disorders of Speech’ (10%). A clear discrepancy therefore exists between self-report vs. interview-report PLEs. It may be that young people under-report their unusual and potentially frightening experiences in an interview format. It is also possible that the questionnaire content is being frequently misinterpreted. Given the high reported frequency of selfreport PLEs, the latter is likely to be the case. The present study therefore aimed to determine the extent to which young people correctly interpret psychotic symptom items.