Oral Presentation: O10. Treatment and clinical service: no. O10.8published_or_final_versio

Chan, KW

Chan, SWY

Chang, WC

Chen, EYH

Hui, CLM

Lee, EHM

npj Schizophrenia

HKU Scholars Hub

Title12-year follow-up student of mortality due to suicide among first-episode psychosis cohort: Is the early intervention programmore effective in reducing excess mortality due to suicide inpsychosisAuthor(s) Chan, KW; Chan, SWY; Hui, CLM; Chang, WC; Lee, EHM; Chen,EYHCitationThe 5th Biennial Conference of the Schizophrenia InternationalResearch Society (SIRS 2016), Florence, Italy, 2-6 April 2016. InNPJ Schizophrenia, 2016, p. 32-33, abstract no. O10Issued Date 2016URL http://hdl.handle.net/10722/236561Rights This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.O10.6 How many psychiatric beds per capita do we need?Richard O'Reilly*1, John Gray1, Jerry Shum11University of Western Ontario, Faculty of Medicine, Ontario, CanadaBackground: Since the 1950s, psychiatric services in most developedcountries have undergone radical change from a system almostexclusively hospital-based to one that now operates primarily incommunity settings. The decline in the absolute number of psychiatricbeds has been accentuated by signiﬁcant population expansion inmany countries. As bed numbers have decreased, there are fewer bedsavailable to treat people experiencing acute exacerbations of schizo-phrenia and other psychotic illnesses. Few attempts have been made toidentify a minimal or optimal number of psychiatric beds per capita.Many administrators reasonably contend that the optimal number ofpsychiatric beds depends on the quantity and quality of the communitypsychiatric services. However, we should at least have a range for therequired minimum and optimum number of beds in a similar way thatwe have for other elements of the service system such as numbers ofpsychiatrists and community-based teams. In this study, we make ourﬁrst attempt to put parameters around what these ranges might be.Methods: We extracted reported psychiatric bed numbers for nationsin the databases of the World Health Organization and theOrganization for Economic Cooperation and Development. TheCanadian data from the above databases was ﬁrst veriﬁed using datain the Canadian Institute for Health Information (CIHI) database. Wefurther veriﬁed the Canadian data, which is hospital speciﬁc, bycontacting each hospital in three Canadian provinces. We establishedthe cause of all noted inconsistencies in hospital speciﬁc data. Theseprocedures identiﬁed several areas that are likely to be a source ofconfusion when comparing data within and between jurisdictions.Finally, we polled Canadian jurisdictions to determine if there wereestablished targets for psychiatric beds.Results: Remarkable variation exists in bed numbers amongst similarnations. Germany, Canada and Italy have respectively 87, 35, and 10psychiatric beds/100,000 population. We will focus our further analysison these three nations as representative examples of countries with ahigh, medium and, low rate of psychiatric beds per capita. The initialdue diligence comparison of the CIHI data with ﬁgures obtaineddirectly from hospitals yielded hospital speciﬁc differences as great as20%. Uncertainty over whether to include beds used for detoxiﬁcationand those used for more formal addictions treatment accounted formuch of these variances. In Canada, only the province of Ontario hasestablished a psychiatric bed target (35/100,000). In contrast, theCanadian Psychiatric Association recommended 50 acute beds and 15long-stay beds/100,000.Discussion: Countries with similar levels of development appear tohave markedly differing amounts of inpatient services for people withpsychiatric disorders. We are currently undertaking a more detailedanalysis of the types of services included in the reported bed numbersin Germany and Italy to ensure that they are comparable with Canada.In view of the degree of the variances found thus far, it seems likelythat there are real differences. If there are, it would raise importantquestions of how Italy manages the types of individual who aretreated as inpatients in Germany and Canada and whether theoutcomes are equivalent.O10.7 An investigation of the potential speciﬁcity of childhoodmaltreatment trauma in patients with non-affective psychosis ascompared to other mental health disordersNina Mørkved*1, Mathilde Endsjø2, Dagﬁnn Winje2, Erik Johnsen3, Anders Dovran4,Kjersti Arefjord2, Rune Kroken3, Siri Helle5, Liss-Gøril Anda-Ågotnes6, MariaRettenbacher7, Nathalie Huber7, Else-Marie Løberg81Mosjoen District Psyciatric Centre, Helgeland Hospital, 2University ofBergen, Bergen, Norway, 3University Hospital; University of Bergen,4University of Bergen; Sørlandet Hospital Health Enterprise, 5HaukelandUniversity Hospital, Bergen, Norway, 6Stavanger University Hospital,Stavanger, Norway, 7Innsbruck Medical University, Innsbruck, Austria,8University of Bergen; Haukeland University HospitalBackground: Childhood maltreatment trauma (CMT) might be apotential risk factor in psychosis, and the prevalence of CMT may behigher in patients with psychosis as compared to other mental healthdisorders. However, research also shows an increase in generalpsychopathology and a variety of mental health disorders followingCMT, raising the question of speciﬁcity between CMT and psychoticdisorders. The aim of the study was to investigate the potentialspeciﬁcity of CMT in psychosis. We hypothesized that there would bemore CMT in patients with non-affective psychosis as compared toother mental health disorders.Methods: The sample consisted of 52 patients with non-affectivepsychosis and 52 matched patients with other mental healthdisorders. All patients in the psychosis group (n= 52) met theICD-10 diagnostic criteria for non-affective psychosis (F20–F29;Schizophrenia, schizotypal, and delusional disorders), and had a scoreof&4 on at least one of the items Delusions, Hallucinatory behavior,Grandiosity, Suspiciousness/Persecution, or Unusual thought contenton the PANSS. The non-psychosis group consisted of ICD-10 diagnosisF10–19 Mental and behavioral disorders due to psychoactivesubstance use, F30–39 Mood disorders, F40–48 Neurotic, stress-related and somatoform disorders, F50–59 Behavioral syndromesassociated with physiological disturbances and physical factors, F60–69 Disorders of adult personality and behavior, and F80–89 Disordersof psychological development. CMT was measured by the ChildhoodTrauma Questionnaire Short-Form (CTQ-SF) assessing physical, emo-tional and sexual abuse, and physical and emotional neglect. Wecompared the two groups on CTQ-SF sum score and subscale scoresindicating rates of CMT, in addition to rates of none/low vs. moderate/severe levels of CMT.Results: The psychosis group had signiﬁcantly higher CTQ-SF sumscores U=893.50, P= 0.003, r=− 0.29, and scored signiﬁcantly higheron three of ﬁve subscales; physical abuse, U= 1069.50, P= 0.039,r=− 0.20, sexual abuse, U= 1043.50, P=0.004, r=− 0.28, and physicalneglect, U=773.50, P=0.000, r=− 0.38. Patients in the psychosisgroup were more likely to have experienced moderate/severe levels ofCMT. Emotional neglect and emotional abuse were no more frequentin the psychosis group than in the non-psychosis group. In thepsychosis group, 67.3% had cut-off scores for one or more subtypes ofCMT as compared to 38.5% in the non-psychosis group, and 9.6% hadcut-off scores for four or more subtypes of CMT compared to 0% inthe non-psychosis group.Discussion: Patients with psychosis reported a history of more CMT,both in terms of severity and frequency, compared to non-psychoticpatients. Thus, our results mainly conﬁrmed our hypothesis of a linkbetween CMT and psychosis. However, the prevalence of some CMTalso in the non-psychosis group, as well as non-signiﬁcant differencesin two subtypes of CMT indicated a graded speciﬁcity of CMT inpsychosis. Our results are consistent with previous research on CMTand psychosis. Limitations regarding the present study relate to fairlysmall sample sizes and retrospective data. Strengths of the studyinclude the use of matched pairs and the comparison of CMT inpsychosis to other mental health disorders instead of the generalpopulation. Future research is needed to explore possible causaldirections, developmental sequences and mediating or moderatingfactors on the relationship between CMT and psychosis, as well as aprospective and longitudinal design. We conclude that CMT mighthave an especially strong effect on the development of psychosis, andassessment of trauma history should be included in psychosisinterventions.O10.8 12-Year follow-up study of mortality due to suicide among ﬁrstepisode psychosis cohort: is the early intervention program moreeffective in reducing excess mortality due to suicide in psychosisKit Wa Sherry Chan*1, Wing Yan Stephanie Chan1, Lai Ming Christy Hui1,Wing Chung Chang1, Ho Ming Edwin Lee1, Yu Hai Eric Chen11The University of Hong Kong, Hong Kong¸ ChinaBackground: The mortality gap between the general public and peoplewith psychotic disorders remains large. Despite the excess mortalityparticularly due to suicide observed in people with psychosis, little hasbeen done to investigate measures that may effectively preventpremature deaths. It remains unclear if early intervention (EI) forpsychosis can have sustainable effect to prevent excess mortality. Thisstudy compared the mortality rates at 12-year between ﬁrst-episodeAbstracts32npj Schizophrenia (2016) 16010 © 2016 Schizophrenia International Research Society/Nature Publishing Grouppsychosis patients from the EI program, and those who receivedstandard care service.Methods: Seven hundred consecutive patients who received the EIservice between 2001 and 2003 in Hong Kong, and 700 matchedpatients who received the standard care (SC) service between 1998and 2001 were traced over a 12-year period following their ﬁrstpresentation. The EI service in Hong Kong (EASY) provides phasespeciﬁc intervention to patients with ﬁrst episode psychosis of age15–25. All deaths within the cohort were identiﬁed via the centralizeddigital patient records system. Ofﬁcial verdict on cause of death wasthen obtained from the Coroner’s Court.Results: Of all 1,400 patients, 80 (5.7%) people had died within thefollow-up period, 74 (5.3%) cases committed suicide. There were 4.1%(N= 29) among the EI group and 7.3% (N= 51) among the SC group.The difference of suicide rates between the two groups wasstatistically signiﬁcant, χ2 (1) = 4.71, Po0.03. Multivariate Cox-proportional hazards regression analysis revealed that, EI patientswere at reduced risk of mortality than those in the SC group (adj. rateratio [RR] 1.68, 95% CI 1.05–2.69). However, when suicide occurredwithin the ﬁrst three years following the initial onset were excluded,there was no signiﬁcant difference between the two groups (adj. rateratio [RR] 1.08, 95% CI.60–1.97), with 1.5% (N=21) from the EI groupand 1.5% (N= 22) from the SC group. Compared with the generalpopulation, the standardized mortality ratios for suicide [SMR] for EI(SMR 31.5, 95% CI 21.52–44.71) and SC (SMR 51.4, 95% CI 38.64–66.99)were both very high.Discussion: This study investigated mortality among 1,400 individualswith ﬁrst-episode psychosis at 12-year follow-up. Signiﬁcantly moredeaths were observed within people in the EI program than in thosewho received the SC service. After controlling for the genderdifference, the analyses revealed that the EI program is more effectivethan the SC service in reducing mortality rates in psychosis patients,especially for the ﬁrst three years of illness. However, the excessmortality in psychosis patients yet remains large. These points to theneed in reﬁning the EI service in targeting the tractable clinical andsocial risk factors that underlie excess mortality in psychosis.O11. Brain imaging-ii: molecules, structures, and functionsO11.1 Aberrant salience and dysfunctional neural processing of self-reference in unmedicated schizophrenia patientsTeresa Katthagen*1, Jakob Kamniski1, Norbert Kathmann2, Henrik Walter1,Andreas Heinz1, Florian Schlagenhauf31Campus Charité Mitte, Charité - Universitätsmedizin, Berlin, Germany,2Humboldt-Universität zu Berlin, Berlin, Germany, 3Campus Charité Mitte,Charité - Universitätsmedizin; Max Planck Institute for Human Cognitiveand Brain SciencesBackground: A disturbed sense of self is a core symptom inschizophrenia and can be experimentally probed via self-referentialprocessing (Kelley et al., 2002; Nelson, Whitford, Lavoie, & Sass, 2014).The latter process is accompanied by activation in the cortical midlinestructures (van der Meer, Costafreda, Aleman, & David, 2010). Previouswork revealed blunted ventromedial prefrontal cortex/anterior cingu-late cortex (vmPFC/ACC) activation during self-referential processingcorrelated with aberrant salience attribution towards irrelevant eventsin patients with schizophrenia (Pankow, et al., 2015). However, sincethese patients were medicated studies in unmedicated patients arewarranted. To our knowledge, this is the ﬁrst study to investigateaberrant salience and the neural correlates of self-referential proces-sing in unmedicated schizophrenia patients.Methods: In the present study, 18 schizophrenia patients (mean age:34.83 years, 6 females) who did not receive antipsychotic medicationas well as 18 healthy controls (mean age: 33.44 years, 6 females)completed the self-referential paradigm during fMRI. In this task, theyapplied trait words to themselves (self) or to Angela Merkel (other).Outside the scanner, they completed the Salience attribution test(SAT; Roiser et al., 2009), an instrumental learning paradigm probingaberrant salience. The latter was deﬁned as the individual reactiontime difference between trials of equally irrelevant cue features.Parameter estimates from the t-contrast self4other were extractedusing an ACC/vmPFC mask and correlated with aberrant saliencescores in each group.Results: Schizophrenia patients displayed increased aberrant saliencecompared to healthy controls (t(32) = 3.132, P=0.004). In the fMRIparadigm, the t-contrast self4other revealed the typical responsepattern comprising the anterior cortical midlines structures and themidbrain (at pFWE corrected o .05). In this contrast, groups differed intheir vmPFC response ([338–2], F (1, 68) = 17.20, pSVC for bilateralACC/vmPFC= 0.026). Post hoc t-test revealed that unmedicatedschizophrenia patients displayed reduced vmPFC activation comparedto healthy controls ([338–2], t (1, 68) = 4.15, pSVC for bilateral ACC/vmPFC= 0.013). There was a statistical trend for the negativecorrelation between vmPFC/ACC activation and aberrant salience inschizophrenia patients (r=− 0.411, P= 0.09).Discussion: Similar to results in medicated patients (Pankow et al.,2015), unmedicated schizophrenia patients showed increased aber-rant salience and dysfunctional self-referential processing in thevmPFC/ACC. Thus, the differentiation of relevance attribution duringself-compared to other-referencing might be blunted in unmedicatedschizophrenia patients. In line with the aberrant salience hypothesis(Heinz, 2002; Kapur, 2003, 2005), unmedicated patients attributedmeaningfulness to irrelevant events. However, the associationbetween aberrant salience and self-referential processing did notapproach signiﬁcance which might have been due to the relativelysmall sample size. Our results stress the importance of investigatingschizophrenia related concepts at varying clinical stages of thedisorder. Future studies should focus on the idionsycratic aspects andunderlying mechanisms of aberrant salience and self-reference.O11.2 Single dose of cannabidiol attenuates neurofunctionalabnormalities present in individuals at high risk of psychosisSagnik Bhattacharyya*1, Cathy Davies1, Robin Wilson1, Elizabeth Appiah-Kusi1,Matthijs Bossong1, Paul Allen1, Vincent Giampietro1, Philip McGuire11King's College London, London, UKBackground: Cannabidiol (CBD), a major ingredient in the extract ofcannabis, may have antipsychotic and anxiolytic properties.1–3 It mayalso protect from impairments in memory induced by delta-9-tetrahydrocannabinol and has been shown to modulate the neuralsubstrates of verbal memory in healthy individuals.2 However, theprecise mechanism underlying the potential antipsychotic-like effectsof CBD is unclear. Here, we investigate this in individuals at ultra-highrisk of psychosis (UHR), using a combination of acute pharmacologicalchallenge and functional magnetic resonance imaging (fMRI). UHRindividuals experience low-grade psychotic symptoms and have avery high-risk of making a transition to frank psychosis. Our objectivewas to test whether an acute oral dose of CBD can modulatefunctioning of the neural substrates of verbal memory in individuals atUHR of psychosis using functional magnetic resonance imaging (fMRI).Methods: We employed a randomized, double-blind, placebo-con-trolled, parallel-arm, between-subject design to examine the acuteeffect of CBD in 28 UHR individuals who were randomized to receiveeither an acute oral dose of CBD (600 mg; UHR-CBD) or placebo (UHR-Placebo; n= 14 per arm). A separate healthy control group (n= 19) wasstudied under identical conditions but without any drug administra-tion. Each participant was studied on one occasion using fMRI whilstperforming a verbal paired associates learning task.The outcome measures of interest were regional brain activation(blood-oxygenation-level-dependent response) during encodingand recall conditions of the verbal paired associates learning task,recall performance in the task, and levels of positive psychoticsymptomology.Results: Relative to healthy controls, UHR subjects under placeboconditions displayed enhanced engagement (Po0.005) in theparahippocampal gyrus, inferior parietal lobule, precuneus andcaudate head during the encoding condition, and attenuation ofengagement (Po0.005) of the parahippocampal gyrus and inferiorfrontal gyrus during cued recall. Severity of psychotic symptoms in theUHR individuals under placebo condition were correlated with recalltask performance (r=0.7, P= 0.002) and functional alterations in theparahippocampal gyrus (rho = 0.58, P=0.018) and caudate (rho = 0.53,P= 0.031). Acute Cannabidiol treatment in UHR individuals modulatedactivation in each of these regions (Po0.005), such that activationin the UHR-CBD group was intermediate between that of healthyAbstracts33© 2016 Schizophrenia International Research Society/Nature Publishing Group npj Schizophrenia (2016) 16010

12-year follow-up student of mortality due to suicide among first-episode psychosis cohort: Is the early intervention program more effective in reducing excess mortality due to suicide in psychosis

12-year follow-up student of mortality due to suicide among first-episode psychosis cohort: Is the early intervention program more effective in reducing excess mortality due to suicide in psychosis

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