Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375 S349

Poster #190AUDITORY VERBAL HALLUCINATIONS IN PATIENTS WITH BORDERLINEPERSONALITY DISORDER ARE SIMILAR TO THOSE IN SCHIZOPHRENIA

Christina W. Slotema1, Kirstin Daalman2, Jan Dirk Blom1,3, KellyM. Diederen2, Hans W. Hoek1,3,4, Iris E. Sommer21Parnassia Bavo Psychiatric Institute, The Hague, Netherlands; 2Rudolf MagnusInstitute for Neurosscience, University Medical Centre, Utrecht, Netherlands;3University Medical Centre, Groningen, Netherlands; 4Colombia University,New York, USA

Background: Auditory verbal hallucinations (AVH) in patients with bor-derline personality disorder (BPD) are frequently claimed to be brief, lesssevere and qualitatively different from those in schizophrenia, hence theterm “pseudohallucinations”. In this study the phenomenology of AVHin BPD patients was compared to those in schizophrenia and to AVHexperienced by healthy individuals.Methods: In a cross-sectional setting, the phenomenological characteristicsof AVH in 38 BPD patients were compared to those in 51 patients withschizophrenia/schizoaffective disorder and to AVH of 66 healthy subjects,using the Psychotic Symptom Rating Scales (PSYRATS).Results: BPD patients experienced AVH for a mean duration of 18 years,with a mean frequency of at least daily during several minutes or more. Theensuing distress was high. No differences in the phenomenological char-acteristics of AVH were revealed among patients diagnosed with BPD andthose with schizophrenia/schizoaffective disorder, except for “disruption oflife”, which was higher in the latter group. Compared to healthy subjectsexperiencing AVH, BPD patients had higher scores on almost all items.Discussion: AVH in BPD patients are phenomenologically similar to thosein schizophrenia, and different from those in healthy individuals. As AVH inpatients with BPD fulfil the criteria of hallucinations proper, we prefer theterm AVH over “pseudohallucinations”, so as to prevent trivialization andto promote adequate diagnosis and treatment.

Poster #191TEMPERAMENT AND CHARACTER DIMENSIONS IN ULTRA-HIGH RISK FORPSYCHOSIS AND FIRST-EPISODE SCHIZOPHRENIA

Yun Young Song1,2, Jee In Kang1,2, Su Young Lee2,3, Eun Lee1,2, SukKyoon An1,2, Jun Soo Kwon41Department of Psychiatry, Yonsei University College of Medicine Seoul, Seoul,South Korea; 2Section of Affect and Neuroscience, Institute of BehavioralScience in Medicine, Yonsei University College of Medicine Seoul, Seoul, SouthKorea; 3Department of Psychiatry, Cheil General Hospital & Women’sHealthcare Center, Kwandong University College of Medicine Seoul, Seoul,South Korea; 4Department of Psychiatry, Seoul National University College ofMedicine Seoul, Seoul, South Korea

Background: Schizophrenia patients and their first-degree relatives werereported to show different personality profiles, especially harm avoidancefrom general populations. However, it is not well understood that thesedifferent profiles of temperament and character dimensions may havebeen already emerged in people at putative prodromal, ultra-high risk forpsychosis.Methods: Ultra-high risk people (n=40), first-episode schizophrenia pa-tients (n=26), and normal controls (n=91) were recruited. The personalityprofiles were assessed by using the Temperament and Character Inventory(TCI). Scales of the psychopathologies were conducted.Results: First-episode schizophrenia patients and ultra-high risk peopleshowed higher harm avoidance and lower reward dependence, persistenceand self-directedness than normal controls. Ultra-high risk people hadlower cooperativeness than normal controls and lower self-directednessthan first-episode patients. Some personality dimensions were found tobe correlated with psychopathologies of positive and negative symptoms,which correlations were similar in ultra-high risk group and first-episodeschizophrenia group.Discussion: These findings suggest that personality profiles including higherharm avoidance temperament may be a trait-like vulnerability factor ofschizophrenia.

Poster #192FROM INTRUSIONS TO OBSESSIONS TO PSYCHOSIS. MEDIATED BYDELUSIONS?

Frank Van Dael1, Jim van Os1,5, Roselind Lieb2,3, Hans-Ulrich Wittchen2,4,Inez Myin-Germeys11Department of Psychiatry and Neuropsychology, South Limburg MentalHealth Research and Teaching Network, EURON, Maastricht University MedicalCentre, Maastricht, Netherlands; 2Clinical Psychology and Epidemiology Unit,Max Planck Institute of Psychiatry, Munich, Germany; 3Epidemiology andHealth Psychology, Institute of Psychology, University of Basel, Basel,Switzerland; 4Institute of Clinical Psychology and Psychotherapy, TechnicalUniversity Dresden, Dresden, Germany; 5King’s College London, King’sHealthPartners, Department of Psychosis Studies, Institute of Psychiatry,London, United Kingdom

Background: There is a substantial comorbidity between psychotic disor-der and obsessive-compulsive disorder (OCD), but little is known aboutthe extended phenotypes impact on each other over time. Obsessionsmay originate from intrusive thoughts that are perceived as unwanted orunacceptable [1]. A particular metacognitive style may lead to increaseof personal significance and anticipated negative consequence of intrusivethoughts, thereby increasing distress [2-4]. Similarly, hallucinations mayresult from unwanted or unacceptable intrusive thoughts that are misat-tributed to an external source [5]. Hallucinations are frequently observedin combination with delusions, possibly because they give rise to aberrantattribution of salience [6]. This mechanism may as well be applicable tointrusive thoughts that have developed to obsessions.Methods: A prospective cohort study was conducted in a general popu-lation sample of 3021 adolescents, aged 14–17 years, (EDSP). Expressionof psychiatric symptoms was assessed 2 times (T0–T2) over a period of8.4 years. It is examined whether (1) baseline intrusive thoughts and 2)obsessive symptoms (a next stage on the pathway from intrusive thoughtsto OCD) c.q. hallucinations are associated with subsequent psychotic dis-order with need for care, and if so, (2) to what extent this association isfacilitated by a “delusional” appraisal. First, associations were investigatedwith regression analyses. Next, the mediating role of T1 incident obses-sions, hallucinations and delusions in the association between baselineintrusive thoughts and an outcome of T2 clinical psychosis was examinedin mediation analyses. Finally, interaction models were fitted between T0intrusive thoughts/T1 obsessions/hallucinations and T1 delusional ideationsas independent variables and T2 clinical psychosis as dependent variable.All analysis were conducted with exclusion of baseline clinical psychosisand adjustment for baseline delusions.Results: T0 intrusive thoughts were cross-sectionally associated with psy-chotic symptoms and longitudinally with T2 psychotic symptoms andclinical case of psychosis (with impairment and help-seeking)(OR=2.65;p<0.012; 95% CI: 1.24-5.69). This association was partially mediated (pro-portion of 0.27) by the development of T1 delusions, but also by incidentT1 hallucinations (0.29) and obsessions (0.48). Given the presence of T0intrusive thoughts, the risk (on an additive scale) for a T2 outcome ofclinical psychosis was higher in the group with incident T1 obsessions(risk difference 5.9%; p<0.040). For those with co-occurring T1 delusionalideation, this risk-increasing effect was higher than in those without T1obsessions (risk difference: 17%, p<0.05). Similarly, given the presence ofT0 intrusive thoughts, the presence of T1 hallucinations increased the riskof T2 clinical psychosis (risk difference: 7.3%, p> 0.051), and this increasein risk showed a trend to be higher in those with additional T1 incidentdelusional ideations (risk difference 12.7%; p<0.68).Discussion: The longitudinal association between intrusive thoughts andlater clinical psychosis is in part explained by the intermediate develop-ment of obsessions or hallucinations, and delusions. The evidence supportsthe hypothesis that intrusive thoughts can develop to obsessions as wellas to hallucinations, as an intermediate in the pathway to psychosis. De-velopment of superimposed delusional ideations may lead to a deepeningpsychotic state. These findings are compatible with the concept that OCDand psychosis may originate from a partial common pathway, and thereforeshow a higher comorbidity than expected by chance.