ultra high risk (uhr) for psychosis groups: are there different levels of risk for transition to...

Poster 260SALIENCE, ANHEDONIA, AND THE INTERMEDIATE PHENOTYPESOF SCHIZOPHRENIA

Richard J. Linscott1,2, Sarah E. Morton1, Lucy M. Devlin1, Chew WueiChong1, Neil McNaughton1

1Department of Psychology, University of Otago Dunedin, NewZealand; 2Department of Psychiatry and Psychology, MaastrichtUniversity, Maastricht, The Netherlands

Background: Elevated presynaptic striatal dopamine is thought tobe a final common effect of multiple specific aetiologies, which inturn gives risk to psychosis through the disruption of incentivesalience. In contrast to psychosis, negative symptoms are thought toemerge from the disruption of multiple neurophysiological systems(Howes & Kapur, 2009, Schizophr. Bull., 35, 549-62). We tested thismodel by examining the relationship of an ecologically validmeasure of reward learning with anhedonia and intermediatephenotypes of schizophrenia, while controlling for neuropsycholo-gical impairment.Methods: Undergraduates (n=84) completed the stimulus chasetask (SCT), which provided a measure of sensitivity to reward, self-report measures of hedonic capacity, and self-report (SchizotypalPersonality Questionnaire [SPQ]) and performance (psychobabbletask) measures of intermediate phenotypes of schizophrenia. Motorreaction time, attention, and frontal functions were assessed with asmall battery of neuropsychological tests.Results: After controlling for neuropsychological functioning, high-er cognitive-perceptual SPQ scores predicted poorer performanceon the SCT (r=-0.27, p<0.01). Higher interpersonal SPQ scores alsopredicted poorer SCT performance (r=-0.26, p<0.01). However,anhedonia and disorganization features were not associated withSCT scores.Discussion: The theoretical link between salience, or the efficacyof reward learning, and psychosis is evident at the level of theintermediate phenotypes of schizophrenia reported by ostensiblyhealthy individuals. However, an equally strong association ofsalience with intermediate phenotypes of negative symptomscomplicates this picture. The observed associations are notattributable to neuropsychological impairment or anhedonia.

doi:10.1016/j.schres.2010.02.755

Poster 261SPECIFIC PROGRAM FOR INTERVENTION IN INCIPIENT PSYCHOSISINTRODUCED IN CATALONIA(SPAIN)

Montse S. Moix, Teresa F. Garcia, Monica A. Sentis, Xavier L. Grau,BarceloJoan F. Barceló, Francisca M. BoschUniversity Rovira i Virgili Reus, Tarragona, Spain

Background: The prodrome of psychotic disorders is awell-describedentity that manifests as a decline in social and occupationalfunctioning along with increasingly bizarre behavior. The mainobjective of this communication describes the theoretical Background,origins and development of a new clinical service/ program foridentifying and intervention in the prodromal phase and in firstepisode of schizophrenia and other psychotic disorders.Methods: The specific program for young people with prodromalpsychosis and first episode of schizophrenia emerges by the healthDepartment of Catalonia(Spain). Specifically in health region ofTarragona(Catalonia). To describe the two-year follow up of aprogram introduced in Catalonia through the development of amultidisciplinary group of professionals. To review and discuss the

issues and challenges involved in the treatment of first-episode inyoung patients , including facilitating access and early identifica-tion, comprehensive assessment, treatment, psychosocial supportsand family education and support.Results: Describe the key components of the program that arerequired to develop an appropriate and individualized treatment plan.An assessment involves: medication; psychoeducation provided toconsumers and the family, counselling, case management / carecoordination ,cognitive behavioural therapy (CBT) substance abuse /use treatment, supports crisis intervention and psychosocial supports.Other important areas are research and public education. Severalvariables had been studied to analyze themethodology of the programsuch us demographic, social and clinical characteristics.Discussion: Finally, the principal objectives of our program pretends:reducing the duration of untreated psychosis(DUP) through early andappropriate detection and response, thereby potentially reducing theseverity of the illness. Minimizing the disruption in the lives of youngpeople who experience psychosis such that educational, vocational,social and other roles can be maintained. Minimizing the societalimpact of psychosis including reducing demand in other areas of themental health, health and social service systems and reducingdisruption in the lives of families.

doi:10.1016/j.schres.2010.02.756

Poster 262ULTRA HIGH RISK (UHR) FOR PSYCHOSIS GROUPS: ARE THEREDIFFERENT LEVELS OF RISK FOR TRANSITION TO PSYCHOSIS?

Barnaby Nelson, Kally Yuen, Hok Pan Yuen, Alison YungCentre for Youth Mental Health Melbourne, Victoria, Australia

Background: Over the last fifteen years, there has been increasedinterest in the prodromal phase of schizophrenia and other psychoticdisorders. Several strategies have been introduced in order to identifyindividuals in the putatively prodromal phase of psychotic disorder.The most widely used of these approaches is the "ultra-high risk"(UHR) approach. The UHR approach consists of identifying three help-seeking groups: 1. Individuals with attenuated positive psychoticsymptoms (APS), 2. Individuals with brief limited intermittentpsychotic symptoms (BLIPS), 3. Individuals with a trait vulnerabilitydue to schizotypal personality disorder or psychotic disorder in a firstdegree relative combined with a recent deterioration in functioning(Trait). These criteria have been found to reliably predict onset ofpsychotic disorder over a 1-2 year period. However, it remains unclearwhether a particular UHR group, or combination of these groups, has ahigher risk of transition to psychosis than other groups. In this study,we investigated whether particular UHR groups, or combinations ofgroups, has a higher risk of transition than other UHR groups over asix-month follow up period. We a priori hypothesized that thetransition rate would be BLIPS > APS > Trait.Methods: 817 UHR subjects were recruited from the PACE clinic,Orygen Youth Health, Melbourne. Transition to psychosis within6 months was established through research follow up and con-sultation of PACE clinic and State medical records.Results: Of the 817 subjects, 72 subjects (8.8%) transitioned topsychosis within 6 months. Three combinations of intake groupswere defined: 1. Subjects in the Trait group alone, 2. Subjects in theAPS group, either with or without also meeting the Trait groupcriteria, 3. Subjects in the BLIPS group, regardless of whether theyalso met criteria for other intake groups. After adjusting for sex, age,antipsychotic medication, year of presentation and type of interven-tion, intake group remained a significant factor (p=.024), with, ashypothesized, the BLIPS group having the highest rate of transition,

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followed by the APS group and the Trait group. For each level increasein the intake group (1-3), the risk was two-fold of that associatedwith the immediate level below.Discussion: Although the UHR criteria as a whole have been found toreliably identify peopleat risk of imminent transition to frankpsychosis,the current data indicate that particular combinations of these groupsare at higher risk than others. Specifically, subjects with BLIPS are athighest risk, followedbysubjectswithAPS, followedby thosewhomeetthe Trait group alone. This stratification of risk may provide a means offurther "closing in" on those at highest risk of psychotic disorder andinform indicated prevention efforts in this population.

doi:10.1016/j.schres.2010.02.757

Poster 263METACOGNITIVE THINKING AND AUDITORY HALLUCINATIONS INULTRA-HIGHRISK INDIVIDUALS: ANEXPERIENCESAMPLING STUDY

Jasper E. Palmier-Claus, Shon W. Lewis, Graham D. Dunn,Tony A. Morrison, Hannah E. TaylorUniversity of Manchester, Manchester, UK

Background: A wealth of literature now suggests an associationbetween metacognitive beliefs, auditory hallucinations (AH) andrelated distress (e.g. Lobban et al., 2002). However, little researchhas investigated the temporal relationship between metacognitivethinking (e.g. examining ones own thoughts) and AH in real-worldeveryday settings. This relationship might best be studied in theearly stages of psychosis, without the potential confounds ofinstitutionalisation or prolonged medication.Methods: 30 individuals who have met ultra-high risk (UHR) criteriain the last year, according to the Comprehensive Assessment of at RiskMental State, are being recruited from early detection services and theEarly Detection and Intervention Evaluation Two trial. Participantscomplete a self-assessment booklet at 10 random times a day, for sixdays,whenprompted by an electronicwristwatch. Questionnaires andinterviews are also being employed.Results: Preliminary multilevel modelling analyses were carried outon data from six hallucinating participants. A significant relation-ship was found between metacognitive thinking (t0) and AH at thefollowing time point (t1; p=.038). Graphing the data shows this tooccur in a dose-dependent fashion. A similar relationship was foundbetween metacognitive thinking (t0) and distress from AH (t1;p=.011).Discussion: Initial findings suggest that increased metacognitivethinking occurs prior to the onset of AH in UHR individuals. Intensepreoccupation with thoughts may be misattributed as originatingexternally resulting in subsequent AH. Future analyses of the completedatasetwill investigatewhether belief systems, perceived social support,perceived control and certain contexts moderate this relationship. Wewill also examine whether everyday-stress triggers metacognitivethinking.

doi:10.1016/j.schres.2010.02.758

Poster 264THE COGNITIVE BIASES QUESTIONNAIRE FOR PSYCHOSIS (CBQP)

Emmanuelle Peters1, Steffen Moritz2, Zoe Wiseman1,Kathryn Greenwood1, Elizabeth Kuipers1, Mathias Schwannauer3,Catherine Donaldson1, Ruth Klinge2, Kerry Ross1, Rebecca Ison1,Sally Williams1, Jan Scott1, Aaron Beck4, Philippa Garety1

1King's College London, Institute of Psychiatry, London, UK; 2UniversityMedical Centre, Hamburg-Eppendorf, Hamburg, Germany; 3EdinburghUniversity, UK; 4University of Pennsylvannia, Philadelphia, USA

Background: A body of research has demonstrated a number ofcognitive biases in psychosis. Reasoning biases such as Jumping ToConclusions (JTC) and intentionalising are well established in theparanoia literature, but other Beckian thinking biases such asdichotomous thinking and emotion-based reasoning are oftenprevalent in individuals with psychosis presenting to CognitiveBehaviour Therapy (CBT). CBT for psychosis (CBTp) often concen-trates onprocess rather than content, for instanceworkingwithwaysinwhich day to day evidence is evaluated rather than challenging thecontent of delusions. New approaches have advocated specifictraining procedures for thinking biases as a complement to CBTp(eg Metacognitive Training; Moritz & Woodward, 07). Currentmethods of assessing cognitive biases consist of experimental tasks(such as the Beads Task) or time-consuming measures (such as theAttributional Style Questionnaire), each tapping a specific bias,which are not practical to use in clinical settings.Methods: The Cognitive Biases Questionnaire for psychosis (CBQp)was developed to measure five biases (JTC, intentionalising, catastro-phising, emotion-based reasoning and dichotomous thinking) that areconsidered to be important in psychosis, and delusions specifically. Itwas based on the Cognitive Style Test (Blackburn et al., 86), whichmeasures common thinking biases in depression, and the vignetteswere adapted to be relevant to psychosis (relating to 'anomalousexperiences' and 'threatening events'). Datawas collected on two sites(Hamburg, Germany, and South London, UK) on 190 patients withpsychosis, and on depressed and healthy controls.Results: TheCBQphas goodpsychometric properties. The5biaseswerehighly correlatedwith each other, although confirmatory factor analysisshowedequal goodness of fit indices for 1-factor and5-factor scales. TheCBQpwas related tohallucinations, delusions anddepression, and therewas preliminary evidence that it is sensitive to change following CBTp.None of the biases were related to existing experimental tasks,suggesting the CBQp measures a different construct.Discussion: The CBQp is a potentially useful tool in both research(on cognitive biases in psychosis) and clinical (CBTp outcome)arenas.

doi:10.1016/j.schres.2010.02.759

Poster 265SOCIAL COGNITION IN SCHIZOPHRENIA: A QUANTITATIVEREVIEW OF THE LITERATURE

Danijela Piskulic1, Jean Addington1, Paul Maruff2,31University of Calgary, department of Psychiatry Calgary, Alberta,Canada; 2University of Melbourne, Centre for Neuroscience Melbourne,Victoria, Australia; 3CogState Ltd Melbourne, Victoria, Australia

Background: Impairments in social cognition are considered animportant feature of schizophrenia and related disorders, particularlyin light of their established association with cognition and socialfunctioning. Impairments in some aspects of social cognition arethought to lead tomisinterpretations andmisperceptions of the socialenvironment, ultimately resulting in impairments in social functioningand even social withdrawal. Empirical evidence suggests performancedeficits across a range of social cognitive processes (i.e. TheoryofMind,emotion processing, social knowledge and social perception).Methods: In the current study, a total of 98 publications (publishedbetween 1995 and 2009) on social cognitive impairments in

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