Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384 S169

Given their link to functional outcome, the domains executive functioning,

verbal memory and attention seem particularly relevant for longitudinal

studies. The study is ongoing, and here we present the results from the

2-year follow up assessment. We address the following research question:

Is cognition significantly and independently predictive of social and role

functioning after controlling for non-cognitive baseline factors?

Methods: 28 (17 men, 11 women, mean age 21.0, SD 2.6 years) individuals

with first-episode schizophrenia and receiving a combination of medica-

tion and case management were assessed with the Positive and Negative

Syndrome Scale (PANSS), the MCCB and a scale measuring social and role

functioning at baseline and two years later.

Results: At 2-year follow-up 71.4% was in remission, out of which 60% had

sustained their remission. Fourteen percent fulfilled criteria for full recov-

ery, i.e. sustained improvement in both symptoms and social/vocational

functioning for 2 years or longer. The attrition rate was 10.7%. No sig-

nificant relationship was found between verbal memory and functional

outcome. Attention/Vigilance (β=0.55, p<0.05) and executive function

(β=0.46, p<0.05) at baseline were significant predictors of social func-

tion at follow up. Baseline positive symptoms (β=0.46, p<0.01), years

of education (β=0.61, p<0.01), attention (β=0.24, p<0.05) and executive

function (β=0.41, p<0.01) were all significantly related to role function at

follow up. Assuming that these variables are intercorrelated, they were

entered into new regression analyses with social and role function as

dependent variables. Then only attention (β=0.63, p<0.001) and years of

education (β=0.47, p<0.01) kept their significant contribution to social

and role function, respectively. However, baseline attention and executive

function explain nearly 47% of the variance in social function, and 48% of

the variance in role function is explained by baseline positive symptoms,

executive function, years of education and attention.

Discussion: The cognitive domain attention was predictive of both role and

social functioning 2 years later. When controlling for other non-cognitive

baseline factors, years of education was found to play a significant role

in predicting social and role functioning, although the cognitive domain

executive function alone explained nearly 50% of the variance in real life

functioning. The results from the present study demonstrate the importance

of a tailored design and good methods, showing that isolated univariate

analyses of the relationship between cognition and outcome are inadequate.

Poster #S220

PREMORBID CANNABIS USE AND EARLIER AGE AT ONSET OF PSYCHOSIS:

FINDINGS FROM TWO STUDIES IN THE U.S.

Michael T. Compton1, Mary Kelley2, Beth Broussard3, Claire Ramsay Wan2

1Department of Psychiatry, Lenox Hill Hospital; 2Emory University; 3Lenox Hill

Hospital, Department of Psychiatry, New York, NY

Background: Schizophrenia is currently conceptualized as a disorder caused

by both genetic predispositions and exposure to stressors or environmen-

tal factors, the latter being particularly influential when they occur during

childhood and early adolescence. One such environmental factor is cannabis

use, especially use occurring prior to the onset of clinically evident psychi-

atric symptoms, particularly in early adolescence. Cannabis is commonly

used by adolescents and is the most frequently used illicit drug in the

context of schizophrenia. Several studies have indicated that premorbid

cannabis use may be associated with an earlier age at onset among those

who develop a psychotic disorder. We conducted two consecutive studies

to gather more definitive evidence of the association between premorbid,

adolescent cannabis use and age at onset of psychosis.

Methods: In two consecutive National Institute of Mental Health (NIMH)-

funded studies, we thoroughly characterized age at onset of psychosis

in hospitalized first-episode psychosis patients (n=109 and n=252, respec-

tively), as well as lifetime history of substance use. Analyses determined the

association between premorbid cannabis use and age at onset of psychosis.

Results: In 109 first-episode patients in Atlanta, Georgia, analyses involving

change in frequency of use prior to onset indicated that progression to daily

cannabis and tobacco use was associated with increased risk of onset of

psychotic symptoms. Similar or even stronger effects were observed when

onset of illness/prodromal symptoms was the outcome. The effects of pre-

morbid, adolescent cannabis use were confirmed and further characterized

in the second, independent sample of 252 first-episode patients in Atlanta,

Georgia and Washington, D.C.

Discussion: Several first-episode psychosis studies document that the initi-

ation of substance use and abuse typically precedes the onset of psychosis.

A number of epidemiological studies have suggested that cannabis use in

adolescence is an independent risk factor for the later development of a

psychotic disorder; as such, premorbid, adolescent cannabis use is thought

to be a component cause of schizophrenia and other psychotic disor-

ders. Convincing evidence now exists showing that premorbid, adolescent

cannabis use also hastens the onset of psychosis among those developing a

psychotic disorder. Age at onset is a crucial early-course feature as an earlier

age at onset is associated with poorer clinical and functional outcomes, and

the other known predictors of age at onset are not modifiable (e.g., family

history of psychosis, gender). Based on the cumulative evidence, preventing

or reducing cannabis use among adolescents, particularly those at elevated

risk of developing psychosis, may delay the onset of psychotic disorders, or

prevent it altogether.

Poster #S221

SUICIDALITY IN SCHIZOPHRENIA SPECTRUM DISORDERS: RELATION TO

HALLUCINATIONS AND PERSECUTORY DELUSIONS

Eirik Kjelby1, Igne Sinkeviciute2, Rolf Gjestad2, Rune Andreas Kroken2,

Else-Marie Løberg3, Hugo A. Jørgensen4, Erik Johnsen3

1PhD-student; 2Haukeland University Hospital; 3University of Bergen, Norway

and Haukeland University Hospital; 4University of Bergen, Norway

Background: Hallucinations, most often auditory in nature, are highly

prevalent in schizophrenia and related psychotic disorders. Hallucinations

in this context can be dramatic and may have severe impact in affected

individuals and are sometimes associated with suicide risk. Indeed suici-

dality is highly relevant in schizophrenia as up to 40% attempt suicide

and 5% complete suicide. Depressed mood, hopelessness and previous sui-

cide attempts are well established as risk factors for suicidal behavior in

schizophrenia.The relationship between hallucinations and suicidality, on

the other hand, is not extensively described and existing results are some-

what inconsistent, making the case for more research on hallucinations and

associations with suicidal behaviour. The identification of hallucinations

or particular aspects of hallucinations being more closely associated with

suicidality could have major clinical impact by contributing to a more

focused suicidality screening procedure.

Methods: We present baseline findings from the Bergen psychosis project

1 (BP1), a prospective study including patients with psychosis across tra-

ditional diagnostic categories. A total of 124 patients with schizophrenia

spectrum disorders were included in the statistical analysis. An ordinal

regression analysis was conducted with item 8: Suicidality, in The Cal-

gary Depression Scale for Schizophrenia (CDSS) as the dependent variable.

Explanatory variables were Depression (CDSS), Hopelessness (CDSS), Lack

of insight (the Positive And Negative Syndrome scale for Schizophrenia-

PANSS), Suspiciousness/persecution (PANSS), Hallucinations (PANSS), Gen-

der, Age, Anxiety (PANSS) and Drug use (Clinical Drug Use Scale-CDUS).

Results: The following variables were significantly associated with suicidal-

ity: PANSS item G6 Depression (0.646, p<0.000), PANSS P3 Hallucinations

(0.300, p<0.000) and PANSS item G2 Anxiety (−0.128, p<0.048). The size

of the association was largest for depression, followed by hallucinations.

A structural model using Structural equation modelling (SEM) will also

be presented. This SEM-model explores associations between variables in

predetermined pattern in a clinically probable model. Even though Sus-

piciousness/persecution in the regression analysis did not directly predict

Suicidality, it was significantly associated with Anxiety in the structural

model. Anxiety in its own term predicted Depression which was strongly

associated with Suicidality, indicating a more indirect path for the relation-

ship between Paranoid delusions and Suicidality.

Discussion: In conclusion, Hallucinations were associated with suicidal

thoughts, plans or attempts. There were indications from the SEM-analysis

that Depression, Hopelessness and Anxiety could be seen as intermediate

phenomena connecting Positive psychotic symptoms and Suicidality. De-

spite former heterogeneous results these results contribute to an increasing

evidence base supporting thorough consideration of hallucinations as a

vital part of the mental state examination and assessment of suicide risk.

In future research we aim to analyse the prospective data of the presented

study and in an on-going study to include data on qualitative aspects of

auditory verbal hallucinations and their impact on suicidality in patients

S170 Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384

suffering from schizophrenia including a more detailed history of suicidal

attempts and non-suicidal self-harm.

Poster #S222

DISTURBED BODILY EXPERIENCES IN PATIENTS WITH FIRST-EPISODE

SCHIZOPHRENIA

Lene Nyboe1,2, Poul Videbech2

1Aarhus University Hospital, Risskov; Research; 2Aarhus University Hospital,

Risskov

Background: Patients with schizophrenia often have disturbed bodily ex-

periences that might hinder their engagement in physical activities. In

the research project “Metabolic syndrome in patients with first-episode

schizophrenia” the correlation between disturbed bodily experiences and

physical activity is investigated.

Methods: The study was a clinical, prospective, observational study. All

patients consecutively assigned to The OPUS project and inpatients in

The Central Region, Denmark having an ICD-10 diagnosis of first –episode

schizophrenia (18–45 years) was the population of interest (N=100). For

all participants the disturbed bodily experiences, comprising morphological

changes, bodily estrangement, cenesthic disturbances, bodily disintegra-

tion, hypochondrias,and motor disturbances, were assessed using items

from “Examination of Anomalous Self Experience” and “The Body Aware-

ness Scale”. Each item is score 0-4 based on severity and intensity (“0” =

absent and “4” = severe). Patients were asked if their bodily disturbances

had equally, more or less physically active.

Results: In all, 101 patients with first-episode schizophrenia were included

in the study. Disturbed bodily experiences were prevalent in 75% of the

patients. There was a significant correlation between severity of disturbed

bodily experiences and low levels of physical activity. Results from the

specific analyses will be presented.

Discussion: Disturbed bodily experiences were common in patients with

first-episode schizophrenia and negatively correlated to patient’s physical

activity-level. Although negative symptoms as well as sedative sideeffects

might also contribute to this it would be benefically to address dis-

turbed bodily experiences specifically in health promoting programmes for

schizophrenia.

Poster #S223

ASSOCIATION BETWEEN SUBTLE DYSKINESIA AND SCHIZOTYPY IN

SUBJECTS WITH AUDITORY VERBAL HALLUCINATIONS AND HEALTHY

CONTROLS

Anne E. Willems1, Diederik Tenback1, Jeroen Koning2, Peter van Harten3

1GGz Centraal; 2Altrecht; 3Maastricht University, GGz Centraal

Background: Spontaneous dyskinesia is associated with non-affective psy-

chosis, however not much research has been done on its relation with

subclinical psychotic experiences. The concept of psychosis as a continuous

phenomenon suggests similar associations at the non-clinical end of the

psychosis spectrum. We examined (subtle) spontaneous dyskinesia and

schizotypy in subjects without a psychiatric diagnosis who experience au-

ditory verbal hallucinations (AVH), patients with a non-affective psychotic

disorder, and healthy controls. We hypothesized that 1. subjects with AVH

may show more (subtle) spontaneous dyskinesia than healthy controls, and

2. (subtle) spontaneous dyskinesia may correlate positively with schizotypy

in the combined group of subjects with AVH and healthy controls.

Methods: Subjects with AVH and healthy controls were recruited by

means of a website with information about hearing voices (www.

verkenuwgeest.nl). Patients with a non-affective psychotic disorder were

recruited from the University Medical Centre Utrecht. To be included in

the study, subjects with AVH and patients with a non-affective psychotic

disorder had to hear voices at least once a month, and voices had to be

distinct from thoughts and had to have a “hearing” quality. Dyskinesia was

measured with a mechanical instrument that has been shown to be more

sensitive and reliable than clinical rating scales. Participants had to exert a

constant pressure of 3 Newton on a button, first with the index finger of

their dominant hand and then with their non-dominant hand. Mean force

variability (FV) in the 0-3 Hz range was taken as a proxy for dyskinetic

movements. Schizotypy was measured with the Schizotypal Personality

Questionnaire (SPQ)

Results: Subjects with AVH (n=36), patients with a non-affective psychotic

disorder (n=28) and healthy controls (n=32) did not differ with regard

to age and gender. Testing the subjects with AVH against the healthy

controls using a Mann Whitney test yielded FVs with an average rank of

38.1 and 30.5, respectively (U=704.0 and p=0.116). The difference between

patients with a non-affective psychotic disorder and healthy controls was

significant (ranks 40.3 and 21.9, respectively with U=723.0 and p=0.000).

In the combined group of subjects with AVH and healthy controls, FV was

positively correlated with total SPQ score (Spearman’s r=0.31 p=0.005).

Discussion: The findings were that 1. the FV in subjects with AVH was non-

significantly higher than in healthy controls. The inconclusive results may

be due to the small sample size; 2. the FV in patients with a non-affective

psychotic disorder was significantly higher than in healthy controls; and 3.

the positive association between (subtle) dyskinesia and schizotypy in the

combined group of subjects with AVH and healthy controls is in accordance

with two previous studies. Our results provide a strong argument for the

hypothesis that dyskinesia and schizotypy share neuropathology within a

psychosis continuum.

Poster #S224

CORTISOL LEVELS IN EARLY PSYCHOSIS: SYSTEMATIC REVIEW AND

META-ANALYSIS

Boris Chaumette1,2, Oussama Kebir3, Thérèse Jay4, Marie-Odile Krebs5

1INSERM, U894, Laboratory “Pathophysiology of psychiatric disorders”,

GDR3557, Centre of psychiatry and neurosciences, Paris, France; 2University

Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes,

Service Hospitalo-Universitaire, Centre Hospitalier Sainte-Anne, Paris, France;3INSERM U894, University Paris Descartes, Centre Hospitalier Sainte-Anne;4INSERM U894; 5Centre hospitalier Sainte-Anne, Service

Hospitalo-Universitaire, Paris, France

Background: Schizophrenia is a complex disorder with interaction between

genetic vulnerability and environmental factors. Some of these latter, such

as childhood adversity, urbanicity, daily hassles, minority group position,

are known to dysregulate the hypothalamo-pituitary-adrenal axis (HPA)

and lead to modifications of the cortisol level. The cortisol modulates

many neurotransmission systems, including serotoninergic, dopaminergic

and glutamatergic systems and induces long-acting effects by modifying

the epigenome. Some publications suggest that cortisol is increased in

schizophrenic patients but this finding is not well-etablished at onset of

the disease. We aimed to perform a meta-analysis of the differences seen

in salivary basal cortisol level in early psychosis (ultra-high risk subjects

(UHR) and first-episode psychosis (FEP)) compared to controls.

Methods: We performed a systematic bibliographic search using the key-

words “cortisol”, “glucocorticoid”, “HPA” with “UHR”, “CHR”, “at-risk mental

state”, “first episode psychosis”, “schizotypal”, “prodromal schizophrenia”

in Medline, Web of Knowledge (WOS), EBSCO. Then, we screened the bib-

liography to identify other studies not selected by our primary search. We

included in the meta-analysis only the case-control studies with salivary

dosage of morning cortisol. We excluded the non-original studies and we

removed duplicates. We conduct a meta-analysis from these results using

MIX and OpenMetaAnalysis softwares.

Results: We identified eleven original studies reporting on salivary basal

cortisol measures in UHR and controls. Scores of heterogeinety between

studies are highly significant. One study reports an inverse trend compared

to all other studies. When excluding this study, we observed a significant

elevation of the salivary basal cortisol rate in UHR subjects compared to

controls. Four studies comparing cortisol level between FEP and controls

were included in the meta-analysis. When excluding the same cohort, also

discordant in FEP compared to all other studies, we found that basal cor-

tisol rate is more elevated in FEP than in controls. No study was designed

to directly compare salivary basal cortisol levels in UHR and FEP in the

literature. Nevertheless the meta-analysis’ Mean Difference in the FEP was

more important than the Mean Difference in the UHR.

Discussion: The meta-analysis of previous studies indicates higher basal

cortisol levels in UHR and in FEP compared to controls. It further suggests

a more elevated basal cortisol in the FEP compared to UHR, which could

reflects a worsening of cortisol dysregulation during conversion to psy-