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Sunday, October 7
 

8:30am

Pre-conference Event: Advancing Early Psychosis Clinical Care in the U.S.: Innovations from the Field
Evidence-based treatment programs for first episode psychosis (FEP) have increased 20-fold since 2008, with over 200 Coordinated Specialty Care (CSC) teams operating in 49 states.



Advancing Early Psychosis Clinical Care in the U.S.: Innovations from the Field 
Sunday, October 7, 2018
The Westin Copley Place
Boston, MA

A one-day educational conference to coincide with the 11th International Conference on Early Intervention in Mental Health. We will draw together national experts in CSC implementation along with clinicians from newly established community programs.

REGISTER HERE

Registration includes coffee and lunch. Continuing Education credits are available for an additional fee; participants must purchase accreditation in order to receive certification for the course.

Early Registration (through 6/15/18) $105/person
Regular Registration (6/15 - 9/5/18) $150/person
Late Registration (9/6-10/7/18) $175/person

CEU Accreditation* fee  $50/ 5 credits
*Continuing Education credits are available for psychologists, nurses, social workers and mental health counselors.

PROGRAM AGENDA

The agenda will focus on issues related to sustaining evidence-based CSC, including fidelity monitoring and feedback, measurement-based treatment, strengthening interdisciplinary collaboration, achieving rapid and enduring client engagement, and employing shared decision-making principles.

A panel of FEP researchers and policy makers from Australia, Canada, Denmark, and the UK will comment on recent U.S. progress, and share “lessons learned” from those countries’ efforts to implement early intervention services on a national level.

Featured Speakers Include:
 - Robert Heinssen, National Institutes of Mental Health
 - Tamara Sale, Portland State University & EASA Center for Excellence
 - Lisa Dixon, Columbia University Medical Center & Center for Practice Innovations
 - Patrick McGorry, University of Melbourne & Orygen Youth Health
The meeting will enhance interaction among stakeholders in early psychosis research and clinical care and will build additional support for the EPINET concept of high fidelity, measurement-based care for FEP.





Sunday October 7, 2018 8:30am - 5:00pm
American Ballroom-South Westin Copley Place, fourth floor

7:00pm

Welcome Reception
The city of Boston is honored and delighted to host the 11th IEPA Early Intervention in Mental Health international conference with the theme “Prevention & Early Intervention: Broadening the Scope.”

Chair
avatar for Matcheri Keshevan

Matcheri Keshevan

IEPA Chair, Harvard University
Matcheri S. Keshavan, M.D.Stanley Cobb Professor of PsychiatryHarvard Medical SchoolVice-Chair of PsychiatryBeth Israel Deaconess Medical CenterBoston, MADr. Keshavan is a licensed physician and board certified psychiatrist, and is Professor of Psychiatry in the Department of Psychiatry... Read More →
avatar for Kristen A Woodberry

Kristen A Woodberry

IEPA Co-chair, Harvard Medical School
Kristen A. WoodberryAssistant ProfessorHarvard Medical SchoolDirector, Program for Psychosocial Protective MechanismsBeth Israel Deaconess Medical Center Dr. Woodberry is a clinical social worker and licensed clinical psychologist in the Commonwealth Research Center at Beth Israel Deaconess Medical Center, director of the Program for Psychosocial Protective Mechanisms, and assistant professor of psychology at Harvard Medical Scho... Read More →

Sunday October 7, 2018 7:00pm - 9:00pm
Staffordshire Westin Copley Place, third floor
 
Monday, October 8
 

8:00am

IEPA 11 Opening Session: "Prevention & Early Intervention: Broadening the Scope"
Chair
avatar for Peter B. Jones

Peter B. Jones

Professor of Psychiatry & Deputy Head, School of Clinical Medicine, University of Cambridge, IEPA President
Peter qualified in medicine at Westminster Medical School. Having first worked as a physician at The Whittington Hospital and KCH, he trained in psychiatry at the Maudsley Hospital and epidemiology at the London School of Hygiene. He has been Professor of Psychiatry at Cambridge since... Read More →

Monday October 8, 2018 8:00am - 8:45am
American Ballroom Westin Copley Place, fourth floor

8:45am

Plenary Session 1: "Sculpting the Teenage Brain - Neuroscience and Behaviour"
The adolescent transition from childhood to young adulthood is an important phase of human brain development and a period of increased risk for incidence of psychotic symptoms and disorders. I will review some of the recent neuroimaging discoveries concerning adolescent development, focusing on an accelerated longitudinal study of 300 healthy young people (aged 14-25 years) each scanned twice using MRI. Structural MRI, including putative markers of myelination, indicates changes in local anatomy and connectivity of association cortical network hubs during adolescence. Functional MRI indicates strengthening of initially weak connectivity of subcortical nuclei and association cortex. To link these imaging phenotypes of normal brain development to psychosis, I will also discuss the relationship between intra-cortical myelination, schizotypy and anatomical patterns of expression of risk genes for schizophrenia.  

Speakers
avatar for Edward T. Bullmore

Edward T. Bullmore

Head of the Department of Psychiatry, University of Cambridge
Ed Bullmore, MB, PhD, FRCP, FRCPsych, FMedSci, trained in medicine at the University of Oxford and St Bartholomew’s Hospital, London; then in psychiatry at the Bethlem Royal & Maudsley Hospital, London. He moved to Cambridge as Professor of Psychiatry in 1999 and is currently Co-Chair... Read More →


Monday October 8, 2018 8:45am - 9:25am
American Ballroom Westin Copley Place, fourth floor

9:25am

Plenary Session II: "Beyond the Clinic: Re-imagining Early Intervention through the Lens of Structural Competency and Co-Production"
Arguably a legacy of more traditional models of symptom/disease-focused healthcare, clinical development and research in early psychosis services have tended to prioritize problem-focused, individual-level interventions and associated research. This plenary is designed to serve as a call to simultaneously deepen and diversify our engagement with the structural and social contexts of psychosis onset, the interpretation of psychotic symptoms, client and family service utilization, and longer-term trajectories of recovery and/or disability. Frameworks developed within the structural competency and participatory research literatures will be invoked as powerful, if still largely unrealized, mechanisms for shifting the foci of both services and research away from individuals towards the complex social systems in which they are embedded.

Speakers
avatar for Nev Jones

Nev Jones

Assistant Professor, Department of Mental Health Law & Policy; Clinical Assistant Professor, Yale University School of Medicine, Program for Recovery and Community Health (PRCH), University of South Florida
University of South Florida


Monday October 8, 2018 9:25am - 10:05am
American Ballroom Westin Copley Place, fourth floor

10:05am

Coffee Break
Monday October 8, 2018 10:05am - 10:30am
American Ballroom Westin Copley Place, fourth floor

10:30am

Plenary Session III: "Using Online Social Media to Foster Long-term Recovery in Youth Mental Health"
Can new technologies address old problems in youth mental health treatment? How novel online social media and mobile technologies can address poor access to treatment and long-term outcomes.

Early intervention is now seen as the most promising and evidence-based approach to improve the long-term outcomes of mental disorders. Despite these advancements, current youth mental health services and services have major limitations. First, many young people with mental-ill health do not receive the mental health care they need, and access to effective interventions remains a lottery for families. Second, treatment for young people is often time-limited, and up to 70-80% of young people with psychosis or complex depression will experience relapses from their mental health conditions over the longer term. Likewise, engagement rates with effective interventions (either face to face or online) remain disappointingly low, limiting their ability to address long-term recovery. Finally, while current interventions are effective in reducing clinical symptoms, long-term social functioning deficits remain one of the most treatment resistant and costly aspect of mental health conditions such as psychosis.

In the context of high level of unmet need and limitations of existing treatments, we need to design and evaluate novel treatment approaches and modes of delivery. In this presentation we will present the latest work undertaken at Orygen (The National Centre of Excellence in Youth Mental Health, The University of Melbourne) on ehealth (eOrygen) to address these critical issues.

Speakers
avatar for Mario Alvarez-Jimenez

Mario Alvarez-Jimenez

Associate Professor and Head of E-Health, Orygen, The National Centre of Excellence in Youth Mental Health; University of Melbourne
Associate Professor Mario Alvarez-Jimenez is Head of e-health at Orygen, The National Centre of Excellence in Youth Mental Health, and the Centre for Youth Mental Health, The University of Melbourne. A/Prof Alvarez-Jimenez leads a large multidisciplinary team focused on bringing about... Read More →


Monday October 8, 2018 10:30am - 11:15am
American Ballroom Westin Copley Place, fourth floor

11:15am

Larry J. Seidman Award for Outstanding Mentorship presentation
This award is in honor of Dr. Lawrence J. Seidman, an eminent neuropsychologist and Professor of Psychiatry at Harvard Medical School. Dr. Seidman passed away on September 7, 2017 at the age of 67. His initial work was in the area of temporal lobe epilepsy, and his life-long work was focused on cognitive deficits, which are a core aspect of schizophrenia, the course and outcome of these impairments, and on their genetic, developmental and neurobiological underpinnings. His work also spanned other neurodevelopmental disorders, including attention deficit disorder.

Dr. Seidman was a leader in the area of early intervention and prevention of serious mental illness. His work was instrumental in the development of innovative clinical services for early course psychotic disorder patients, as well as for those at clinical high risk for these illnesses in Massachusetts. He was an astute clinician, and a highly sought-after teacher and mentor. Scores of scientists and clinicians around the world owe their accomplishments to his tutelage. Many of his mentees are leading scientists, professors or department heads around the world.
What is the Larry J. Seidman Award for Outstanding Mentorship?
To recognize this special talent in others, and with the support of the Seidman family, the IEPA is establishing this new prize to be awarded for the first time during the IEPA 11 conference to be held October 7-10, 2018 in Boston, Massachusetts, USA.

Nominations from three IEPA members, at least one being a full professor or established clinician in early intervention, and one at an early career stage, should outline the case for the nominee in up to 500 words. Examples of the ways in which the nominee has enhanced and developed the careers of others through mentorship will strengthen the case.

Nominations will be judged by five members of the IEPA executive board and the winner announced during the conference in Boston.

Nominations must be received by 15th April 2018 by email attachment sent to secretariat@iepa.org.au and marked as LJ Seidman Award Nomination 2018 in the subject.

Monday October 8, 2018 11:15am - 11:30am
American Ballroom Westin Copley Place, fourth floor

11:30am

Poster Session A | Lunch
Topics:
Comorbid Conditions
Diagnosis and Phenomenology
Eating Disorders
Electrophysiology
Ethical Issues
First Episode Psychosis
Psychopharmacology
Substance Use


Monday October 8, 2018 11:30am - 1:00pm
Essex Ballroom Westin Copley Place, third floor

1:00pm

Oral Session 1: EARLY PSYCHOSIS TREATMENT TRIALS
Chair: Jai Shah, Department of Psychiatry, McGill University, PEP Montréal, Douglas Mental Health University Institute, Integrate Program in Neuroscience, McGill University, Montréal, Canada
    

Speakers: Jai Shah, Jacqueline Mayoral-van Son, Dawn Edge, Iruma Bello, Thomas Nordahl Christensen, Scott Teasdale, Jennifer Humensky, Jennifer Humensky 

Chair
JS

Jai Shah

McGill University
Department of Psychiatry, McGill University, Montréal, Canada, 2PEPP-Montréal, Douglas Mental Health University Institute, Montréal, Canada, 3Integrate Program in Neuroscience, McGill University, Montréal, Canada

Speakers
IB

Iruma Bello

New York State Psychiatric Institute, 2Department of Psychiatry, Columbia University College of Physicians and Surgeons
TN

Thomas Nordahl Christensen

Mental Health Center Copenhagen, University of Copenhagen
DE

Dawn Edge

The University of Manchester
JH

Jennifer Humensky

Columbia University
JM

Jacqueline Mayoral-van Son

Department of Psychiatry, Sierrallana Hospital,Cantabria. Spain, School of Medicine. University of Cantabria. Spain and CIBERSAM. IDIVAL
ST

Scott Teasdale

University of New South Wales, Australia


Monday October 8, 2018 1:00pm - 2:30pm
St. George AB Westin Copley Place, third floor

1:00pm

Oral Session 2: PHENOMENOLOGY: CLINICAL HIGH RISK
Chair: Michelle L West, Harvard Medical School - Beth Israel Deaconess Medical Center, CEDAR Clinic, Massachusetts Mental Health Center
    

Speakers: Michelle L West, Erich Studerus, Martina Brandizzi, Stefanie J Schmidt, Emma Izon, Tianhong Zhang, Paolo Corsico, Chantal Michel 

Chair
ML

Michelle L West

Harvard Medical School - Beth Israel Deaconess Medical Center

Speakers
MB

Martina Brandizzi

Department of Mental Health, ASL Rome 1
SJ

Stefanie J Schmidt

University of Bern
ES

Erich Studerus

University of Basel


Monday October 8, 2018 1:00pm - 2:30pm
St. George CD Westin Copley Place, third floor

1:00pm

Symposium Session 1: ILL AND IDLE: EXPLORING THE NEXUS BETWEEN FUNCTIONAL DISENGAGEMENT AND MENTAL ILLNESS IN ADOLESCENTS AND YOUNG ADULTS
Though the vulnerabilities and disadvantages of youths not in employment, education or training (NEET) are widely acknowledged, little mental health research has focused on the conditions that precede youths disengaging from school or work; how and to what extent such disengagement intersects with mental illness; and how early functional disengagement impacts overall outcomes. This symposium addresses these knowledge gaps. Sloan describes the post-secondary outcomes of young adults with emotional and behavioral disorders. Using data from an American longitudinal epidemiological study, she illustrates the interplay of sociodemography, diagnoses and outcomes in youths who had psychiatric disorders by age 16. Healy presents an Irish community-based investigation of the effects of childhood psychotic experiences on global functioning. Compared to children who reported no psychotic experiences, those who did had poorer functioning that persisted into early adulthood. Notably, their underlying global vulnerability extended beyond diagnosable disorders. Henderson shows that NEET youths presenting at Canadian clinical and non-clinical services were likelier to have concurrent mental health and substance use concerns, legal troubles and crime/violence problems; be in unstable housing situations; and need welfare aid. Iyer paints a picture of NEET youths at a Canadian early psychosis program having longer prodromes characterised by unrelenting illness and plummeting premorbid adjustment. This, along with longer durations of untreated psychosis, suggests that NEET youths follow a distinct trajectory of clinical and functional decline. Finally, Cannon (discussant) will situate these findings within what is currently known about youth mental illness and functioning, and highlight their services, research and policy implications.

Chair
SI

Srividya Iyer

McGill University

Speakers
MC

Mary Cannon

DISCUSSANT, Royal College of Surgeons in Ireland
CH

Colm Healy

Royal College of Surgeons in Ireland, Dublin
JH

Joanna Henderson

University of Toronto
SH

Sloon Huckabee

University of Massachusetts Medical School


Monday October 8, 2018 1:00pm - 2:30pm
American Ballroom-North Westin Copley Place, fourth floor

1:00pm

Symposium Session 2: DISCOVERING NEW BRAIN CIRCUITS IN EARLY PSYCHOSIS
Disruptions in brain circuits is a primary process that appears to underlie the pathophysiology of psychotic disorders. Recent developments in connectome imaging provide powerful tools to interrogate the functional and structural integrity of circuits that exist both within and between brain networks. New information from connectome imaging has promise for elucidating new circuits, treatment approaches and genetic risk for early psychosis. This symposium will focus on new functional and structural brain circuit findings in early psychosis. Anil Malhotra will present resting state (rsfMRI) and structural data from two cohorts of first episode schizophrenia patients participating in double blind clinical trials involving the second generation antipsychotics (SGAs) aripiprazole and risperidone to identify neuroimaging predictors of treatment response. Dost Unger will focus on rsfMRI data and compare within and between network connectivity in early stage bipolar and schizophrenia. Tom Hummer will distinguish brain circuit characteristics of functional connectivity within and between distinct brain networks in patients with early-phase psychosis. Rene Kahn will examine genetic predisposition by assessing connectome organization in children at familial high risk for bipolar and schizophrenia. Together, these presentations will further illuminate the altered brain organization responsible for early psychosis.


Chair
AB

Alan Breier

Indiana University School of Medicine
Indiana Psychotic Disorders Program, Prevention and Recovery Center for Early Psychosis

Speakers
JB

Justin Baker

Assistant Professor of Psychology, Harvard Medical School
TH

Tom Hummer

Indiana University School of Medicine
RK

René Kahn

UMC Utrecht
AM

Anil Malohtra

Zucker School of Medicine at Hofstra/Northwell
MS

Martha Shenton

DISCUSSANT, Brigham & Women's Hospital, Harvard Medical School


Monday October 8, 2018 1:00pm - 2:30pm
American Ballroom-Center Westin Copley Place, fourth floor

1:00pm

Symposium Session 3: CHALLENGES AND OPPORTUNITIES IN QUALITY OF CARE IN EARLY PSYCHOSIS: IMPROVING OUTCOMES AT THE SYSTEM LEVEL AND PATIENT LEVEL
Research evidence continues to point to the need for accessible, comprehensive care for young people with psychotic disorders in order to improve their long-term trajectories. In this 90-minute symposium, we review challenges and opportunities to improve quality at various points along pathways to care for youth with psychosis. Michael Birnbaum will present on the role of the internet and social media in early identification, outreach, and engagement of youth and families in psychosis treatment. Nicole Kozloff will present on the care youth with psychosis receive following a first presentation to the emergency department, exploring factors associated with access to timely follow-up. George Foussias will present on implementation and outcomes of standardized, measurement-based care protocols in a large early psychosis intervention program, including a qualitative exploration of youth and family experiences of this style of care. Phil Tibbo will present on the development of order sets for treating early phase psychosis at the national level and their implementation. Each presenter will allow a few minutes for audience questions. Finally, John Kane, an expert in researching and implementing comprehensive care for first episode psychosis, will facilitate a group discussion on how the presentations can guide patient-, program- and system-level improvements to increase the reach and effectiveness of early psychosis intervention.


Chair
AV

Aristotle Voineskos

University of Toronto

Speakers
MB

Michael Birnbaum

The Zucker Hillside Hospital
GF

George Foussias

University of Toronto
NK

Nicole Kozloff

University of Toronto
PT

Philip Tibbo

Dalhousie University


Monday October 8, 2018 1:00pm - 2:30pm
American Ballroom-South Westin Copley Place, fourth floor

1:00pm

Symposium Session 4: IDENTIFYING PATIENT SUB-GROUPS WITH SPECIFIC NEEDS WITHIN EARLY INTERVENTION PROGRAMS: DEVELOPING PERSONALIZED INTERVENTION ON THE BASIS OF DATA STEMMING FROM CLINICAL PROGRAMS AROUND THE WORLD
There are many early intervention programs around the world and most of them aim at providing specific care for the early phase of psychotic disorders. While this is a valid focus, early psychosis samples are composed of a wide variety of patient profiles and subgroups of patients may have distinct needs. Although generic elements of early intervention programs may fit most of the patients, clinicians should adapt treatment to these specific needs and develop personalized intervention. Data stemming from clinical naturalistic prospective follow-up often provide very detailed information on which it is possible to base the identification of such cinical sub-groups of patients. In this symposium we will present the results of clinical researched based on the prospective follow up of various early intervention programs in Canada, Switzerland and Australia. These data allow the identification of subgroups of patients defined on the basis of premorbid or clinical characteristic and who have specific needs in terms of clinical intervention.

Chair
AA

Amal Abdel-Baki

CHU Montreal, Canada
PC

Philippe Conus

Lausanne University

Speakers
PG

Philippe Golay

Lausanne University


Monday October 8, 2018 1:00pm - 2:30pm
Staffordshire Westin Copley Place, third floor

1:05pm

Oral 1, Talk 1. "The Importance of Smoke Before Fire: Treatment Outcomes in Psychosis With and Without a Prior Clinical High-Risk Phase"
Jai Shah1,2,3, Rachel Rosengard3, Sarah McIlwaine1,2, Srividya Iyer1,2, Sally Mustafa1, Ridha Joober1,2, Martin Lepage1,2,3, Ashok Malla1,2; 1Department of Psychiatry, McGill University, Montréal, Canada, 2PEPP-Montréal, Douglas Mental Health University Institute, Montréal, Canada, 3Integrate Program in Neuroscience, McGill University, Montréal, Canada
               
PURPOSE: The widespread operationalization of the clinical high-risk (CHR) phase and its clear vulnerability for a first episode of psychosis (FEP) have led to a much-needed focus on factors related to conversion from CHR to FEP. Yet they have also resulted in an assumption which has gone largely unexamined: that CHR invariably precedes FEP. We examined this assumption, and whether key treatment and service outcomes in FEP services vary depending on whether or not subjects experienced a pre-onset CHR state.  METHODS: Retrospective information was systematically extracted regarding sociodemographic characteristics, psychiatric/behavioral changes, and help-seeking in 200 FEP patients (aged 14-35) receiving specialized early intervention services in Montreal, Canada. Individuals were then followed for 1 year in order to assess individual- and service-level outcomes.  RESULTS: At intake to FEP services, 68% of youth recalled a pre-onset CHR syndrome while 32% did not; these groups showed no sociodemographic or clinical differences at baseline. However, duration of untreated psychosis was significantly longer in those with prior CHR syndromes (U=3315, p=0.043). Furthermore, symptomatic and functional outcomes were poorer for the prior CHR subgroup in positive symptoms (SAPS group effect, F[1,198]=4.79, p=0.03), with significant group-by-time interactions for negative symptoms (SANS, F[1,198]= 5.67, p=0.018), global functioning (GAF, F[1,198]=7.96, p=0.005), and social/occupational functioning (SOFAS, F[1,198]=4.392, p=0.037).  CONCLUSIONS: Most FEP patients experience pre-onset CHR syndromes, enduring greater delays in accessing treatment and poorer longitudinal outcomes than those without prior CHR symptoms. These findings strongly argue for the personalization of early intervention efforts based on knowledge regarding trajectories to FEP.


Speakers
JS

Jai Shah

McGill University
Department of Psychiatry, McGill University, Montréal, Canada, 2PEPP-Montréal, Douglas Mental Health University Institute, Montréal, Canada, 3Integrate Program in Neuroscience, McGill University, Montréal, Canada


Monday October 8, 2018 1:05pm - 1:15pm
St. George AB Westin Copley Place, third floor

1:05pm

Oral 2, Talk 1. "Overlap in Clinical High Risk and Borderline Personality Disorder Symptoms in a Specialized Clinic"
Michelle L West1,2, Ryan Guest1, Michelle Friedman-Yakoobian1,2; 1Harvard Medical School - Beth Israel Deaconess Medical Center, 2CEDAR Clinic @ Massachusetts Mental Health Center
               
Background: Research and clinical observation supports an overlap between clinical high risk (CHR) for psychosis and borderline personality disorder (BPD) symptoms. Adults with BPD may experience psychotic symptoms that appear phenomenologically similar to those in schizophrenia. Relatively less research has explored this overlap in CHR, characterized by newly developing symptoms. Initial evidence suggests that BPD symptoms are common in CHR samples (e.g., 64% with CHR plus likely or certain BPD pathology; Ryan et al., 2017) and may not be associated with risk of conversion (Thompson et al., 2012). This study aims to review relevant literature on CHR and BPD symptoms and present initial data from a specialized CHR clinic. Methods: The CEDAR Clinic collects assessment data, with these analyses focusing on the Structured Interview for Psychosis Risk Syndromes (SIPS) and a self-report measure of BPD symptoms (BSL-23). The BSL-23 has differentiated between BPD (M= 2.05, SD=.90) and other diagnoses including schizophrenia, but has not been investigated in CHR samples. Analyses included the subset (N=15) of clients who completed the BSL-23 and met broad CHR criteria. The sample size will increase with ongoing data collection. Results: BSL-23 scores were lower on average (M=1.41, SD=0.81) than BPD validation samples. BSL-23 scores significantly correlated with SIPS mean P symptoms scores (r=.661, p=.007), and were particularly associated with unusual thought content (r=.734, p=.002). Discussion: These analyses support that BPD and CHR symptoms overlap in a CHR clinical sample. Improved understanding of the overlap in CHR and BPD symptoms may inform diagnostic and treatment considerations.


Speakers
ML

Michelle L West

Harvard Medical School - Beth Israel Deaconess Medical Center


Monday October 8, 2018 1:05pm - 1:15pm
St. George CD Westin Copley Place, third floor

1:05pm

Symposium 1, Talk 1. "Young adult outcomes for youth with emotional and behavioral disorders with impairment by the age of 16 years"
Sloan Huckabee1, William E Copeland2, Maryann Davis3; 1Transitions to Adulthood Research Center, University of Massachusetts Medical School, 2Psychiatry and Behavioral Sciences, Duke University Medical Center, 3Department of Psychiatry, University of Massachusetts Medical School

The poor post-secondary outcomes reported for students with emotional and behavioral disorders (EBDs) have included high rates of school dropout and low rates of participation in post-secondary education and post-school employment. While some studies have used longitudinal datasets to examine this group’s outcomes in youth, several questions remain. To address these, we analyzed a subset of data (collected at the 26-year mark) from the Great Smoky Mountains Study of Youth (GSMS). GSMS is an ongoing longitudinal epidemiological study of the development, need for, and use of mental health services in children in North Carolina. We calculated the sociodemographic characteristics of youths without psychiatric disorders who had emotional disturbances, behavioral disturbances, or both emotional and behavioral disturbances. We also examined the young adult outcomes of individuals identified with psychiatric disorders by age 16. The subgroup identified as having EBDs by age 16 (27.5% of GSMS participants) was broken down by type of disorder. In line with previous studies, more males than females had EBDs by 16. Low socioeconomic status, having a step parent, coming from a single-parent family and spending time in foster care were significantly related to EBD occurrence, with the latter two being particularly strong influences. There were statistically significant differences between youths with and without EBDs by age 16 in high school completion rates, working less than part-time hours, not contributing to rent and being poor at age 26. We also noted sociodemographic and outcome differences based on disorder types. These observations and their implications will be discussed.


Speakers
SH

Sloon Huckabee

University of Massachusetts Medical School


Monday October 8, 2018 1:05pm - 1:25pm
American Ballroom-North Westin Copley Place, fourth floor

1:05pm

Symposium 2, Talk 1. "Detection and Replication of Neuroimaging Biomarkers of Treatment Response in First Episode Schizophrenia"
Anil Malohtra1, Philipp Homan1, Deepak Sarpal2, Miklos Argyelan1, Lauren Hanna1, Jaun Gallego3, Philip Szeszko4, Todd Lencz1, Delbert Robinson1; 1Zucker School of Medicine at Hofstra/Northwell, 2University of Pittsburgh, 3Weill Cornell Medical College, 4Icahn School of Medicine
           
The first episode of psychosis may be the most critical period in the life of an individual with schizophrenia, and remains the most opportune time for the study of key mechanisms that influence treatment response and outcome. We have assessed two cohorts of first episode schizophrenia patients participating in double blind clinical trials involving the second generation antipsychotics (SGAs) aripiprazole and risperidone to identify neuroimaging predictors of treatment response. For our analyses, we utilized 1) seed-based rs-fMRI analysis to examine the relationship between pretreatment functional connectivity and response to SGA treatment and 2) hierarchical linear modeling (HLM) to model individual symptom trajectories and tested for a relationship between parahippocampal thickness and treatment response. In our first analysis, a striatal connectivity index was established as a predictor of SGA treatment response in first episode patients (n=41) and replicated in a second sample (n=40). The HLM work yielded a model in which parahippocampal thickness successfully predicted response to SGA treatment in first episode patients (n=37) as well as in an independent replication data set of first episode patients treated with risperidone (n=33). As both resting state MRI measures and measures of cortical thickness significantly predicted antipsychotic drug response in discovery data sets, as well as in two independent replication cohorts, these data suggest that identification of biomarkers of antipsychotic drug response is feasible in first episode patient populations. Next steps will include combining modalities to more robustly predict response to help develop more effective intervention strategies for first episode psychosis.


Speakers
AM

Anil Malohtra

Zucker School of Medicine at Hofstra/Northwell


Monday October 8, 2018 1:05pm - 1:25pm
American Ballroom-Center Westin Copley Place, fourth floor

1:05pm

Symposium 3, Talk 1 "Factors Influencing the Duration of Untreated Psychosis: Patient and Family Perspectives"
Michael Birnbaum1,2,3, Asra Rizvi1,2,3, Keren Faber1,2,3, Aristotle Voineskos4,5, John Kane1,2,3; 1The Zucker Hillside Hospital, 2The Zucker School of Medicine at Hofstra/Northwell, 3The Feinstein Institute for Medical Research, 4Centre for Addiction and Mental Health, 5University of Toronto
           
The emphasis on reducing the duration of untreated psychosis has highlighted the complex barriers to expeditiously accessing appropriate services.  The internet and social media may prove to be critical resources for expediting help-seeking and facilitating treatment initiation in prospective patients and families with first-episode psychosis. 269 participants between the ages of 15-35 were interviewed with the Pathways to Care for Psychosis Questionnaire designed to retrospectively explore trajectories to care emphasizing online resources used to obtain information about emerging psychiatric symptoms and inform the decision to seek care. Ninety-four percent (n=253) use social media regularly and spend approximately 2 hours online daily. Social media use predates illness onset and continues throughout illness emergence. The Internet was the most used resource for information gathering while symptoms were emerging. A minority (22.9%) shared their concerns over social media. Seventy-nine percent state that they would like to receive mental health help via the internet and social media. Internet based resources are part of daily life for youth with first-episode psychosis. Information gathered online plays a role in help-seeking and may represent a proactive step towards treatment initiation. Online activity continues throughout the duration of untreated psychosis offering the prospect for earlier intervention. Youth with and without mental illness express positive attitudes towards novel internet and social media based outreach and engagement efforts.


Speakers
MB

Michael Birnbaum

The Zucker Hillside Hospital


Monday October 8, 2018 1:05pm - 1:25pm
American Ballroom-South Westin Copley Place, fourth floor

1:05pm

Symposium 4, Talk 1. "Interventions for comorbid addiction disorders within early psychosis program: using results from a prospective longitudinal study to improve services for specific needs"
Clairélaine Ouellet-Plamondon1, Amal Abdel-Baki1; 1CHU Montreal, Canada
           
Background: Co-occurring substance use disorders (SUD) are very common (about 60%)  in first episode psychosis and associated with poor symptomatic and functional outcomes. After 2 years of follow up in early intervention service (EIS), about a third of FEP patients have persistent SUD despite motivational and harm reduction philosophies. Homelessness history, borderline personality and the severity of SUD at baseline have been associated with persistent misuse at 2-year follow up. Methods: Based on SUD trajectories and factors associated with SUD persistence in FEP,  we developed and integrated FEP-SUD program within our EIS including evidence-based interventions targeting SUD and its associated factors. Results: We will describe the different components of this ‘à la carte’ program tailored to offer interventions corresponding to each patient characteristics and needs at different time points in their trajectory.  Preliminary results and pilot data of different interventions of this program (including pharmacological strategies as well as psychosocial treatments) will be presented. Outreach case management interventions, injectable antipsychotic medication, peer support, supervised housing as well as “housing first” program, manualised individual intervention (including motivational and CBT strategies) as well as group and family systemic psychotherapy and, for the more severe cases, treatment orders for mandatory inpatient therapy for SUD will be described. Conclusions: Treating comorbid SUD with FEP is challenging. However different strategies must be offered early in the course of illness to help modify their trajectory.  Although it is an heterogeneous group, personalized addiction treatment plans can be built to improve FEP  outcome.


Speakers

Monday October 8, 2018 1:05pm - 1:25pm
Staffordshire Westin Copley Place, third floor

1:15pm

Oral 1, Talk 2. "Analyzing Direct and Indirect costs of an Intensive First Episode of Psychosis Program (PAFIP) of Cantabria, in the first year of intervention"
Jacqueline Mayoral-van Son1,3,6, Maria Juncal Ruiz1, Victor Ortiz-García de la Foz6, David Cantarero4, Carla Blázquez4, María Paz5, Paula Paras5, Benedicto Crespo-Facorro2,3,6; 1Department of Psychiatry, Sierrallana Hospital,Cantabria. Spain., 2Department of Psychiatry, University Hospital Marqués de Valdecilla, Santander. Spain, 3School of Medicine. University of Cantabria. Spain., 4School of Economics. University of Cantabria, GIECONPSALUD., 5Nursing School, University of Cantabria. Spain, 6CIBERSAM. IDIVAL

Objective. Early-intervention psychiatric services in patients with psychosis aim to limit the most damaging outcomes, and reduce the risk of social drift of the patient, decreasing illness severity and hence contain healthcare costs. There is a scarcity of studies which focuses on FEP, and those ones published, only looked for direct health costs but not for indirect costs, which are the bulk of the budget. Our study aims to explore the economic cost of a First Episode of Psychosis Program in short term (1 year follow up) including direct and indirect costs. Methods     The study is a retrospective data collection from clinical records of  157 patients included in PAFIP (Programa Atención Fases Iniciales de Psicosis), from the University Hospital Marqués Valdecilla, Santander. Our data collection sheet included data from direct and indirect costs associated to the illness. Data were also extracted from the Cantabria Health Service Records. STATA 15.0 was used for statistical analysis. Results     On average, the total costs during the first year were €48,277.51 being Direct Health Care costs €13,729.47 (28.45%) , direct non-medical costs €108.6( 0.22%) and indirect costs €34,439.44 (71.3%).     We found that hospitalization costs were higher in males (p=0.081), cannabis use increased hospitalization costs (p=0.032). The number of relapses increased both, hospitalization and treatment costs (r=0.40 and p=0.000; r=0.24 and p=0.067). Conclusions     Intensive Early Intervention Programs in psychosis may result in cost savings by decreasing hospitalization, premature mortality, disability, unemployment, and legal problems although first year after diagnosis would represent the one which higher costs.


Speakers
JM

Jacqueline Mayoral-van Son

Department of Psychiatry, Sierrallana Hospital,Cantabria. Spain, School of Medicine. University of Cantabria. Spain and CIBERSAM. IDIVAL


Monday October 8, 2018 1:15pm - 1:25pm
St. George AB Westin Copley Place, third floor

1:15pm

Oral 2, Talk 2. "The relationship between change in (attenuated) positive psychotic symptoms over time and risk of transition to psychosis in clinical high risk patients: An investigation using a joint modelling approach:
Erich Studerus1, Katharina Beck1, Anita Riecher-Rössler1; 1Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
               
Improved prediction of transition to psychosis in those with a clinical high risk (CHR) has become an important goal in psychosis research. However, previously developed prediction models almost exclusively rely on baseline data. Thus, their risk prediction cannot be dynamically updated during the follow-up period when new information becomes available. Furthermore, they do not reveal the specific relationship between symptoms during the follow-up and risk of transition. To solve these problems, the present study made use of so called joint models, a relatively recent statistical innovation that allows studying the association between a longitudinal process (i.e. change in symptoms over time) and a time-to-event outcome (i.e. time to transition to psychosis). We fitted three different joint models in which the hazard for transition at any time t was assumed to be related to 1) the absolute level, 2) the average absolute value since baseline, and 3) the velocity of change of (attenuated) positive psychotic symptoms at the same time point t. Data were obtained as part of the “Basel Früherkennung von Psychosen” (FePsy) study and included 191 CHR patients, of whom 42 transitioned to psychosis during follow-up. Although in all three models the association between longitudinal process and time-to-event outcome was statistically significant, the association was strongest in model 3. Our results therefore suggest that the risk of developing psychosis at any time t during follow-up is most strongly predicted by how fast (attenuated) positive psychotic symptoms are increasing at the same time point.


Speakers
ES

Erich Studerus

University of Basel


Monday October 8, 2018 1:15pm - 1:25pm
St. George CD Westin Copley Place, third floor

1:25pm

Oral 1, Talk 3. "Developing e-learning resources for families of African and Caribbean people diagnosed with schizophrenia: A qualitative approach to co-production"
Dawn Edge1, Henna Lemetyinen1; 1The University of Manchester, Division of Psychology and Mental Health, Manchester, United Kingdom

African & Caribbean people in the UK are more likely than other groups to be diagnosed with schizophrenia. They report high levels of stigma, contributing to delayed help-seeking and worse outcomes, including high rates of relapse and hospital readmission. Psychoeducation could improve family outcomes. However, there is no culturally-appropriate psychoeducation for Africans & Caribbeans in the UK. Our aims were to explore whether African & Caribbean people perceive a need for a culturally-appropriate resource, and what such a resource should contain to meet families’ needs. We conducted focus groups comprising patients, relatives and community members (n=25). To inform resource development, we explored four themes: ‘perceived need for an e-learning resource’, ‘content for the resource’, ‘delivery of the resource, and ‘internet use and social media’. Framework Analysis was conducted to elicit participants’ responses to themes. All groups perceived the need for a culturally-appropriate resource. Family and community members prioritised raising awareness about schizophrenia. They emphasised the need to counteract stigma. Only former patients regarded ‘relationships’ as the most important topic. Topics mentioned by other groups, e.g. ‘Raising awareness’ did not emerge as important for patients. Our findings demonstrate that African & Caribbean people perceive the need for culturally-appropriate schizophrenia resources. Our findings highlight these communities’ desire to participate in developing psychosocial interventions to reduce stigma and improve family outcomes. Generalisability of these findings should be approached cautiously due to the sample size. These findings can be applied to inform other interventions for schizophrenia for these communities.


Speakers
DE

Dawn Edge

The University of Manchester


Monday October 8, 2018 1:25pm - 1:35pm
St. George AB Westin Copley Place, third floor

1:25pm

Oral 2, Talk 3. "Going beyond transition: functional outcome and its predictors in youths with attenuated psychotic symptoms"
Martina Brandizzi1, Masillo Alice2, Liliana Todini3, Juliana Fortes Lindau3, Nella Lo Cascio4, Riccardo Saba5, Elena Monducci3, Ludovica Telesforo5, Paolo Girardi6, Paolo Fiori Nastro3, Christoph U. Correll7,8; 1Department of Mental Health, Asl Rome 1, Rome Italy, 2Department of Mental Health, Asl Rome 2, Rome Italy, 3Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy, 4MD, PhD, Psychiatrist, 5MD, Psychiatrist, 6Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy, 7Recognition and Prevention (RAP) Program, Department of Psychiatry, The Zucker Hillside Hospital, New York, US, 8Charité - Universitätsmedizin Berlin Augustenburger Platz 1,  Berlin, Germany
               
Objective: Psychosocial functioning impairment is a typical feature of early stages of many mental disorders. A critical research goal is to identify modifiable risk factors leading to poor social and role functioning in young people with subtle psychotic symptoms.  The aim of the present study was to investigate the longitudinal psychosocial functional outcome of a sample of young individuals with attenuated psychotic symptoms and the predictive role of baseline psychopathological characteristics. Methods: The sample consisted of 95 young subjects (mean age=16.43) involved in the follow-up assessment of the early detection project “Liberiamo il Futuro” (LIF). Baseline data on socio-demographic and psychopathological characteristics, psychosis risk status, and functional levels were collected. A binary logistic regression model was performed to predict poor social and role functioning at follow-up as defined by a score <7 in the Global Functioning: Role scale and Global Functioning: Social scale. Results: Psychosocial functioning at follow-up was moderately impaired: 44% of the sample (n=37) had poor role and social functional outcome. Decreased expression of emotion, poorer premorbid social and role functioning, and less change in overall psychopathology symptom severity significantly predicted poor role functioning (R2=0.531; Model Chi square: 39.37, P≤0.0001). Decreased expression of emotion, poorer premorbid social functioning, and presence of stressful life events between baseline and follow-up predicted poorer social functioning (R2=0.573; Model Chi square: 45.85,  P≤0.0001). Conclusion: These findings suggest that taking into account the severity of negative symptoms, in particular disruption of affectivity levels, the premorbid functioning and the severity of the overall psychopathology has the potential to identify individuals with low psychosocial functional outcome independent of attenuated positive symptoms and transition to psychosis. Psychotherapeutic interventions especially targeting negative symptoms, poor role an social functioning and effects of stressful life events should be developed and provided to individuals with attenuated  psychotic symptoms.


Speakers
MB

Martina Brandizzi

Department of Mental Health, ASL Rome 1


Monday October 8, 2018 1:25pm - 1:35pm
St. George CD Westin Copley Place, third floor

1:25pm

Symposium 1, Talk 2. "Childhood psychotic experiences are associated with persistently poorer global functioning throughout adolescence and into early adulthood"
Colm Healy1, Donal Campbell1, Mary Clarke1, Ian Kelleher1, Mary Cannon1; 1Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin

Psychotic experiences (PEs) are commonly reported in childhood and have been associated with mental disorder and poorer global functioning. While it is understood that individuals who report PE in childhood appear susceptible to future mental disorder, little is known about the effects of childhood PEs on future functioning. We investigated the effects of childhood PEs on global functioning from childhood into early adulthood. 52 participants from a community sample completed all three waves of the ‘Adolescent Brain Development’ study (T1x̄Age:11.69, T2x̄Age:15.80 T3x̄Age:18.80). At each phases, participants completed a clinical interview assessing PEs, mental disorder and global function. Fixed-effects repeated measures models, adjusting for mental disorder and gender were used to investigate differences in current (C-GAF) and most sever past (MSP-GAF) global functioning between those with and without childhood PEs. The analyses revealed that those with history of PEs had significantly poorer C-GAF scores (p<.001) and MSP-GAF scores (p<.001) than controls. Simple-effects analysis indicated that poorer functioning was evident during childhood (C-GAF: p=.002; and MSP-GAF: p<.001), adolescence (C-GAF: p<.001; and MSP-GAF: p=.011) and early adulthood (C-GAF: p=.002; and MSP-GAF: p=.095). There was no significant effect of time or interaction. The results demonstrate that children who report PEs have persistently poorer functioning and this is evident up to at-least early adulthood. The long-term association between childhood PEs and global functioning highlights the underlying global ‘vulnerability’ in children reporting PEs which extends beyond diagnosable mental disorder. Children who report PEs should be monitored closely throughout adolescence and young adulthood.


Speakers
CH

Colm Healy

Royal College of Surgeons in Ireland, Dublin


Monday October 8, 2018 1:25pm - 1:45pm
American Ballroom-North Westin Copley Place, fourth floor

1:25pm

Symposium 2, Talk 2. "Resting State Functional MRI Studies of Early Psychosis:
Dost Ongur1; 1McLean Hospital, Harvard Medical School
           
Brain connectivity abnormalities have been reported in individuals with psychotic disorders both in first episode and chronic illness.  But it is not clear how these abnormalities emerge and progress and how they relate to symptom formation.  To address these questions, our group has been collecting resting state functional MRI (rsfMRI) data on a 3 Tesla Siemens Trio scanner from patients with first episode psychosis at McLean Hospital’s early psychosis clinic McLean OnTrack as well as from matched healthy comparison subjects. Participants are men and women between the ages of 18 and 30.  We recruit patients with bipolar disorder with psychosis, schizoaffective disorder, and schizophrenia and assess them clinically and with cognitive testing at each visit.  Most patients in our studies are receiving antipsychotic medications. All are scanned at baseline and at 1 and 2 years follow up.  To date, we have scanned over 50 patients at baseline as well as over 30 healthy controls.  30 patients have returned for 1 year and 15 for 2 year scans.  Initial analyses indicate that first episode patients show the same reduction of connectivity in the frontoparietal control network we previously reported in chronic psychosis (Baker et al JAMA Psychiatry 2014).  The pattern is similar in individuals with schizophrenia and bipolar disorder.  We observe a significant correlation between mania severity and reduced connectivity within the ventral attention network.  In ongoing analyses, we are conducting sliding window analyses and single-subject based cortical parcellation.


Speakers
JB

Justin Baker

Assistant Professor of Psychology, Harvard Medical School


Monday October 8, 2018 1:25pm - 1:45pm
American Ballroom-Center Westin Copley Place, fourth floor

1:25pm

Symposium 3, Talk 2. "Care for Youth with Psychosis following Acute Presentation: A Population-Level Study"
Nicole Kozloff1,2, Binu Jacob1,3, Aristotle Voineskos1,2, Paul Kurdyak1,2,3, Nicole Kozloff; 1Centre for Addiction and Mental Health, 2University of Toronto, 3Institute of Clinical and Evaluative Sciences
           
Given the importance of reducing barriers to treatment for young people with psychosis, we review recent population-level data on access to care and present findings on care received by youth first presenting to acute services for psychotic disorders. We identified youth aged 16-24 across Ontario, Canada with a first emergency department (ED) presentation for psychotic disorder between 2010 and 2013. Following discharge from the ED, we examined psychiatrist visits, mental health-related primary care visits, ED revisits, and psychiatric admissions over 1 year. We modelled time to outpatient psychiatry visit using Kaplan-Meier curves and predictors of care within 30 days and 1 year using Cox proportional hazard regression. 2875 youth had a first presentation to the ED over the study period and 812 (28.2%) were discharged to the community. Among discharges, 325 (40.0%) received no outpatient mental healthcare within 30 days; factors associated with psychiatric aftercare included neighbourhood income (highest vs. lowest income, HR = 1.48, 95% CI 1.05-2.09), rural residence (HR = 0.46, 95% CI 0.31-0.70), and recent mental healthcare (outpatient psychiatrist visit: HR = 1.89, 95% CI 1.50-2.37; psychiatric admission: HR = 0.71, 95% CI 0.52-0.98). One year following first ED visit for psychosis, 105 (12.9%) youth still had not received any outpatient mental healthcare, 416 (51.2%) had returned to the ED and 334 (41.1%) had a psychiatric admission. Many youth first presenting with psychotic disorders to acute services do not receive timely mental health follow-up. These findings may guide improvements in pathways to care for youth with psychosis.


Speakers
NK

Nicole Kozloff

University of Toronto


Monday October 8, 2018 1:25pm - 1:45pm
American Ballroom-South Westin Copley Place, fourth floor

1:25pm

Symposium 4, Talk 2. "Homeless first episode psychosis youth may benefit from a specialised assertive community intervention team"
Amal Abdel-Baki1, Virginie Doré-Gauthier1, Isabelle-Sarah Lévesque1; 1CHU Montreal, Canada
           
Background:  Psychosis is associated with homelessness and conversely homelessness increases psychosis risk, the young being at higher risk. In Montreal inner city early intervention service (EIS), 29% of the first episode psychosis (FEP) cohort experienced homelessness.  Non-affective psychosis, male gender, lower education, drug abuse and cluster B personality disorder were associated with homelessness. Homeless participants had worse symptomatic and functional outcomes, longer hospitalisations and were more likely to use emergency services despite regular EIS services. The Centre Hospitalier de l’Université de Montréal created in 2012, an intensive assertive community intervention team (AICIT) offering specialized care for homeless FEP (HFEP), aiming to offer to this clientele, individualized treatment integrating specialized and intensive care for early psychosis, housing support as well as substance use disorder (SUD) and outreach interventions. Objectives: Explore the impact of the addition of an IACIT to an EIS. Methods: 2 years-longitudinal study comparing the outcome of HFEP followed by both the EIS and IACIT since 2012 to a historical cohort of HFEP followed only by the EIS between 2005 and 2011. Results: HFEP followed by the EIS+IACIT attained housing stability more quickly and spent less time hospitalised than HFEP followed only by the EIS (RR 2.38, p=0.017).  HFEP with cocaine misuse  were less likely to attain housing stability (RR 0.25, p=0.04). Symptomatic, functional and SUD outcomes between the two groups were similar. Conclusion: HFEP outcome may be improved by the addition of IACIT to EIS as they have special expertise in quitting homelessness in collaboration with community organisations.


Speakers
AA

Amal Abdel-Baki

CHU Montreal, Canada


Monday October 8, 2018 1:25pm - 1:45pm
Staffordshire Westin Copley Place, third floor

1:35pm

Oral 1, Talk 4. "OnTrackNY: Utilizing Assertive Outreach to Promote Participant Engagement"
Iruma Bello1,2, Hong Ngo1,2, Rufina Lee3, Lisa Dixon1,2; 1New York State Psychiatric Institute, 2Department of Psychiatry, Columbia University College of Physicians and Surgeons, 3Silberman School of Social Work, Hunter College, City University of New York

Purpose: Evidence suggests that connecting individuals to coordinated specialty care programs shortly after experiencing a first episode of psychosis improves outcomes. The inability to engage individuals with outpatient mental health services has been consistently identified as a primary barrier to providing treatment to this population. OnTrackNY, a coordinated specialty care (CSC) treatment model, emphasizes and trains teams on initial engagement strategies designed to encourage people to enroll in the program and assertive outreach strategies to reduce drop out rates. We will describe these specific engagement strategies and present data reflecting OnTrackNY’s initial engagement and retention rates. Methods: Teams report data on number of referrals, participants enrolled and length of stay in the program to a centralized data repository. Individual and aggregate rates of enrollment and retention were calculated. Results: To date, there are 21 OnTrackNY teams across the state of New York. Since August 2015, teams have received 3,294 referrals, determined that 25% are eligible, and successfully enrolled 88% of those (n= 734). The program is designed to provide services for an average of two years. Statewide, teams are currently able to retain 78% of participants at 12-month follow-up and 54% of participants at 24-month follow-up. The mean length of stay for all program participants is 12.3 months. Conclusions: There appear to be significant advantages to utilizing strategies for enhancing initial and ongoing engagement with young adults to ensure that the CSC model can be delivered. Data are limited by the relative age of each program, affecting current census.


Speakers
IB

Iruma Bello

New York State Psychiatric Institute, 2Department of Psychiatry, Columbia University College of Physicians and Surgeons


Monday October 8, 2018 1:35pm - 1:45pm
St. George AB Westin Copley Place, third floor

1:35pm

Oral 2, Talk 4. "Negative symptoms as a mediator between neurocognition, social cognition and social functioning in individuals at clinical high risk for psychosis"
Stefanie J Schmidt1,2, Frauke Schultze-Lutter3, Ana Cerne1, Benno G Schimmelmann1,4, Jochen Kindler1, Daniela Hubl5, Michael Kaess1,6, Chantal Michel1; 1University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland, 2Clinical Psychology for Children and Adolescents, University of Bern, Switzerland, 3Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Düsseldorf, Germany, 4University Hospital of Psychiatry and Psychotherapy, University of Bern,  Switzerland, 5University Hospital Hamburg-Eppendorf, Hamburg, Germany, 6Section for Translational Psychobiology in Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany
               
Poor social functioning is highly prevalent in subjects at clinical high risk (CHR) for psychosis and predictive of conversion to manifest psychosis. Neuro-cognitive and social-cognitive domains have found to be important predictors of social functioning in patients with psychosis. Some evidence also suggests that the relationship between neurocognition and functioning is mediated by social-cognitive domains and negative symptoms. However, these relationships are still poorly understood in CHR-subjects. Therefore, the aim of this study was to use structural equation modeling to estimate the relationships between neurocognitive domains, empathy as a specific social-cognitive domain, social functioning and positive as well as negative CHR-symptoms. The sample comprised 96 individuals (9-35 years), who sought help at the “Early Recognition and Intervention Center for mental crisis” (FETZ) Bern. CHR-symptoms were assessed using the Structured Interview for Psychosis-Risk Syndromes; social functioning by the social and occupational functioning assessment scale (SOFAS) and neurocognition by a comprehensive assessment-battery. The German version of the Interpersonal Reactivity Index (IRI) was used to assess empathy. Both neurocognitive domains and empathy were significantly associated with social functioning. Moreover, these relationships were significantly mediated by negative symptoms. No evidence for a mediating role through empathy or positive CHR-symptoms could be detected. The model showed a good fit to the data (RMSEA=0.04, CFI=0.96, TLI=0.95). This suggests that deficits in empathy as well as negative symptoms should be monitored carefully and treated as early as possible to prevent a negative cascading effect and to optimize generalization effects of neurocognitive remediation on social functioning.


Speakers
SJ

Stefanie J Schmidt

University of Bern


Monday October 8, 2018 1:35pm - 1:45pm
St. George CD Westin Copley Place, third floor

1:45pm

Oral 1, Talk 5. "Vocational outcomes of individual placement and support, cognitive remediation and work-related social skills training for people with severe mental illness in Denmark: Results from a randomized controlled trial"
Thomas Nordahl Christensen1, Iben Gammelgaard Nielsen2, Merete Nordentoft1, Lene Falgaard Eplov1; 1Mental Health Center Copenhagen, University of Copenhagen, 2Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark
               
Individual Placement and Support (IPS) is an effective vocational intervention. However, the effects of IPS has not yet been demonstrated in a Danish welfare model and it has been suggested that the vocational effects can be further enhanced by supplementing IPS with cognitive remediation and work-related social skills training. The aim of the trial was to investigate the effects of 1) IPS; 2) IPS enhanced with cognitive remediation and work related social skills training (IPSe); and 3) service as usual (SAU). The trial was designed as an investigator-initiated, randomized, three-arm parallel, assessor-blinded, multi-center trial. A total of 720 patients with severe mental illness, recruited from early intervention teams (OPUS) or community mental health centers, were randomly assigned into the three groups at three sites in Denmark. Over the 18-month follow-up period 59.9% in the IPS group, 59.1% in the IPSe group and 46.5% in the SAU group worked competitively or were enrolled in education. IPS vs SAU (OR=1.79 (95% CI 1.14,2.81) P=0.014) and IPSe vs. SAU (OR=1.76 (95% CI 1.11,2.81), P=0.036). The IPSe group also worked or studied significantly more hours than SAU (OR= 1.76 (95% CI 1.15, 2.67), p= 0.005). The difference between IPS and SAU was (OR= 1.53 (95% CI 1.02,2.31), p =0.018). In conclusion, IPS and IPS supplemented with cognitive remediation and work-related skills training can be implemented in a Danish welfare model and demonstrate vocational effects in a Danish context.


Speakers
TN

Thomas Nordahl Christensen

Mental Health Center Copenhagen, University of Copenhagen


Monday October 8, 2018 1:45pm - 1:55pm
St. George AB Westin Copley Place, third floor

1:45pm

Oral 2, Talk 5. "Expressed Emotion (EE) in families of individuals at-risk of developing psychosis: A Systematic Review"
Emma Izon1,2, Katherine Berry1, Heather Law2, Paul French1,2; 1Division of Psychology & Mental Health, The University of Manchester, Manchester, United Kingdom, 2Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
               
The At-Risk Mental State (ARMS) for psychosis describes a state that confers a high but not inevitable risk for developing a psychotic disorder in the near future. The distressing experiences for individuals with an ARMS may impact on themselves; their sense of wellbeing, their psychosocial functioning as well as on their family. Understanding what variables may lead to poorer outcomes may help to further reduce transition rates. Expressed emotion (EE) looks at the environment and communication style of relatives to their family member and can be considered an important potential explanatory variable in the ARMS. Following PRISMA guidelines, a systematic review of EE in relatives of ARMS was conducted. We identified 15 studies investigating the relationship between EE in the ARMS population. Approximately one third of ARMS relatives had high-EE. The results suggest that greater levels of criticism and hostility are associated with higher levels of symptoms and poorer functioning. In contradiction to psychosis literature, the construct Emotional-Over-Involvement (EOI) was found to be an adaptive response, where family members’ worries of the individuals made no negative impact on symptoms. Environments that included warmth and positive remarks, combined with optimal family involvement were associated with improved functioning and reduced symptoms. Limitations of the quality of the studies includes small sample sizes, and over-represented samples of Caucasian, young males and middle-aged mothers. Although approximately half of the studies included were longitudinal, only two measured EE over time, therefore, future research should include larger studies measuring EE at more than one time point.


Speakers

Monday October 8, 2018 1:45pm - 1:55pm
St. George CD Westin Copley Place, third floor

1:45pm

Symposium 1, Talk 3. "Disengagement from employment, education and training in a multi-sectoral sample of service-seeking Canadian youth: Mental health and substance use profiles"
Joanna Henderson1,2, Lisa D. Hawke1,2, Gloria Chaim1,2; 1Centre for Addiction and Mental Health, 2University of Toronto, Department of Psychiatry
           
Background. Youth who are not engaged in employment, education or training (NEET) are vulnerable to a diversity of health, economic and psychosocial challenges. While the NEET metric is widely used internationally, there is a lack of research describing Canadian NEET youth. Objective. This study explored the characteristics of NEET youth in a cross-sectoral sample of service-seeking youth in Canada, across clinical and non-clinical service sectors. Aspects examined included the proportion of NEET youth, their mental health and addictions concerns, gender differences, and other factors distinguishing them from their non-NEET peers. Method. A total of 2,576 youth were assessed using the GAIN-Short Screener and a sociodemographic information form. Results. Among youth seeking services across a diversity of sectors, 26.8% were NEET. NEET youth demonstrated a greater risk of unstable housing situations, more legal system involvement, and more reliance on government financial assistance. They were also more likely to endorse crime/violence problems, substance use problems, and concurrent mental health and substance use concerns than their non-NEET counterparts. Gender-based differences were also observed. Discussion. Since many youth presenting for services across both clinical and non-clinical sectors are NEET, youth-serving agencies within and outside of the mental health and addictions sectors should be prepared to offer a wide range of services to address their diverse needs. Further research should examine interventions and integrated models of care to address the youth’s mental health and addictions needs, their lack of engagement in employment, education and training, and their other diverse areas of need.


Speakers
JH

Joanna Henderson

University of Toronto


Monday October 8, 2018 1:45pm - 2:05pm
American Ballroom-North Westin Copley Place, fourth floor

1:45pm

Symposium 2, Talk 3. "Abnormal Functional Network Connectivity in Early Phase Psychosis"
Tom Hummer1,2, Matthew Yung1,2, Joaquin Goni3, Michael Francis1,2, Susan Conroy1,2, Nikki Mehdiyoun1,2, Alan Breier1,2; 1Department of Psychiatry, Indiana University School of Medicine, 2Indiana University Psychotic Disorders Program, 3Purdue University
           
Characterizing dysconnectivity in psychosis patients can be advanced by understanding the interactions of functional networks. This investigation aims to distinguish network characteristics of functional connectivity in patients with early-phase psychosis (EPP) both within and between distinct brain networks. EPP subjects (n=56, within four years of treatment initiation) and matched controls (n=32) underwent resting-state fMRI. Time-series data underwent advanced processing and scrubbing methods to minimize noise. For each subject, gray matter was segmented into 278 regions, and organized into nine distinct a priori networks: visual, somatomotor, dorsal attention, ventral attention, limbic, frontoparietal, default mode, subcortical, and cerebellum networks. Network connectivity properties were defined by the mean and variance of correlations of all regions within the same network (e.g. visual-visual) and between distinct networks (e.g. visual-limbic). Connectome measures, including global efficiency and within-module z-scores, were also calculated. Global efficiency was higher in the control group, reflecting consistently stronger connectivity. The control group had higher connectivity between limbic and default mode networks and multiple other networks, but no within-network connectivity differences were found. The variance of between-network connections was generally higher in patients, particularly for connections with ventral attention network regions. In addition, patients with longer illness duration had greater variability in their network connectivity patterns. Thus, lower functional connectivity in EPP, relative to controls, was largely present between distinct networks, suggesting poor inter-network communication. Higher variance of between-network connectivity in patients suggests disorganized communication patterns that align inconsistently with typical functional networks, disruptions that may increase as the disorder progresses.


Speakers
TH

Tom Hummer

Indiana University School of Medicine


Monday October 8, 2018 1:45pm - 2:05pm
American Ballroom-Center Westin Copley Place, fourth floor

1:45pm

Symposium 3, Talk 3. "Standardized Measurement Based Care in Early Psychosis: Effects on Care in Hospital, Service Utilization, and Engagement"
George Foussias1,2, Juveria Zaheer1,2, Janaki Joshi1, Steve Hawley1, Rebecca Metcalfe1, Dielle Miranda1, Crystal Baluyut1,2, Saima Aiwan1, Aristotle Voineskos1,2; 1Centre for Addiction and Mental Health, 2University of Toronto
           
Consistent delivery of comprehensive early psychosis intervention (EPI) in real-world clinical services remains a challenge despite established EPI practice standards.  Across other areas of medicine, integrated care pathways (ICPs) that provide a multidisciplinary outline of coordinated measurement-based care have been associated with better patient outcomes.  ICPs, however, are rarely employed in mental health services.  To address this, our team developed an ICP for early psychosis that was implemented in a real-world first episode psychosis outpatient clinic (FEPC) in an academic tertiary care mental health centre.  This study evaluated the implementation and effectiveness of this early psychosis ICP, as well as the experience of patients and their families of such an ICP. Of 74 patients admitted to the FEPC over a 13-month period, 55 patients (74%) received at least one ICP assessment. Significantly fewer patients dropped out of care after enrollment in the ICP compared to those patients that did not (15% versus 37%, chi2 = 4.34, p = .037). Patients enrolled in the ICP also exhibited lower emergency department presentations (9% vs 18%) and rehospitalizations (5% vs 18%) although these differences were non-significant.  A qualitative exploration of patient (n=15) and family (n=8) experiences of this ICP identified a highly integrated service as a key component in engagement and recovery, and revealed positive attitudes toward scales and measures, with formalized assessment tools enabling the tracking of treatment progress.  These findings suggest that such ICPs for early psychosis care are implementable and acceptable in real-world settings, and may improve EPI outcomes.


Speakers
GF

George Foussias

University of Toronto


Monday October 8, 2018 1:45pm - 2:05pm
American Ballroom-South Westin Copley Place, fourth floor

1:45pm

Symposium 4, Talk 3. "Migration in patients with early psychosis is a two-sided coin: findings from a three year prospective study"
Philippe Golay1, Philipp Baumann1, Laure Jaton1, Romeo Restellini1, Nadir Mebdouhi1, Philippe Conus1; 1TIPP program, Département de Psychiatrie CHUV, Lausanne University, Switzerland
           
Aim: Most early psychosis programs treat high ratios of migrants, given they display higher rates of psychosis than the indigenous population. There are however limited studies on this topic in early psychosis programs (EP) and less is known about outcomes. The aim of this study was to compare the premorbid, baseline and outcome profile of patients according to migration (M) and migration in psychosocial adversity (MIA) in order to explore if there were differences suggesting particular needs in terms of treatment in these patients group. Methods: 257 early psychosis patients aged 18-35 years old were followed-up prospectively over 36 months. MIA (29.6%) and M (17.9%) were compared to patients who were born in Switzerland (NM). Results: The profile of MIA was characterized by lower socio-economical level for equal level of education, higher unemployment and forensic history rates, high prevalence of trauma and worse functioning at baseline. MIA patients also had lower global functioning during the follow-up. M patients had a better premorbid adjustment and experienced similar outcomes as the NM group. Conclusions: Results are compatible with the hypothesis that migration in adversity is a potential determinant of functional impairment in early psychosis. The fact that patients who migrated in other contexts have a better outcome is consistent with evidence showing that some migrants are more resilient. Patients who experienced migration in adversity may have specific needs in terms of intervention considering they are more vulnerable, less integrated and have a higher likelihood to have been exposed to trauma.


Speakers
PG

Philippe Golay

Lausanne University


Monday October 8, 2018 1:45pm - 2:05pm
Staffordshire Westin Copley Place, third floor

1:55pm

Oral 1, Talk 6. "Food addiction, nutrition knowledge and dietary intake in young people experiencing mental illness"
Scott Teasdale1,2, Tracy Burrows3, Tegan Hayes4, Yoland Hsia4, Philip Ward2,5, Katherine Samaras6,7, Jackie Curtis1,2; 1Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Australia, 2School of Psychiatry, University of New South Wales, Australia, 3School of Health Sciences, University of Newcastle, Australia, 4Nutrition and Dietetics Department, University of Sydney, Australia, 5Schizophrenia Research Unit, South Western Sydney Local Health District, Australia, 6Diabetes and Metabolism Division, Garvan Institute for Medical Research, Australia, 7Department of Endocrinology, St Vincent's Hospital, Australia
               
Background and Aims. Young people experiencing serious mental illness (SMI) are prone to poor physical health and a reduced life expectancy. Unhealthy dietary intake and food addiction are thought to be a key driving factors but remain unexplored. This study aims to comprehensively assess dietary intake, nutrition knowledge and food addiction, in young people with SMI.   Method. This three-arm cross sectional study of 16-25 year olds has a target sample size of n=30. Study arms include; (i) depression/anxiety, (ii) ultra-high risk for psychosis, and (iii) first-episode of psychosis. Participants self-completed three validated questionnaires, (i) Australian Eating Survey, (ii) General Nutrition Knowledge Questionnaire – Revised, (iii) Yale Food Addiction Score Questionnaire.  Results. To date, 25 participants (mean age 19.6 ± 2.5 years) have completed the study. Diet quality was poor in all study arms, falling within the lowest scoring category (29 ± 13 out of 73). 43% of dietary intake was coming from ultra-processed, non-nutritive ’junk’ foods. Mean nutrition knowledge score was 51 ± 10, similar to mean scores in studies in other populations. Prevalence of food addiction was 36%, more than twice the rate found in the general population (16%). No between group differences were found in this sample.  Conclusions. This study demonstrates that unhealthy dietary intake is present in the early stages of illness likely seeding future poor physical health and should be a target for preventative intervention. Research is needed to further explore food addiction in this population, including effective intervention methods.


Speakers
ST

Scott Teasdale

University of New South Wales, Australia


Monday October 8, 2018 1:55pm - 2:05pm
St. George AB Westin Copley Place, third floor

1:55pm

Oral 2, Talk 6. "Applying the NAPLS-2 Psychosis Risk Calculator to a Chinese High Risk Cohort in Shanghai: Results from the SHARP project"
Tianhong Zhang1, HuiJun Li2, Lihua Xu1, Kristen A. Woodberry3, Daniel I. Shapiro4, Margaret A. Niznikiewicz5, Martha E. Shenton6, Matcheri S. Keshavan5, William S. Stone3, JiJun Wang1, Robert W. McCarley5, Larry J. Seidman3; 1Shanghai Mental Health Center, 2Florida A & M University, Department of Psychology, Tallahassee, Florida 32307, USA, 3Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, MA 02115, USA, 4Emory University, Department of Psychology; Dekalb Community Service Board Prevention & Early Intervention Program, Atlanta, Georgia, 5Harvard Medical School Department of Psychiatry, Veteran’s Administration Medical Center, Boston, MA 02130, 6Brigham and Women’s Hospital, Departments of Psychiatry and Radiology, and Harvard Medical School, and VA Boston Healthcare System, Boston, MA, USA

Objective: As with other serious diseases, individuals at risk of psychosis really want to know how much specific risk have for developing a psychotic disorder. To this end, a web-based risk calculator(http://riskcalc.org:3838/napls/) for clinical high risk(CHR) population was developed from NAPLS-2 project. The present study aims to validate the predictive accuracy of the NAPLS-2 psychosis risk calculator in a CHR sample from the SHARP(ShangHai At Risk for Psychosis) program in Shanghai, China using comparable inclusion/exclusion criteria and assessments. Method: Three hundred CHR individuals were identified by the Chinese version of the Structured Interview for Prodromal Symptoms. Of these, 228(76.0%) completed neuro-cognitive assessments at baseline and 199(66.3%) had at least a one-year follow-up assessment. Six key predictors were entered into the NAPLS-2 model to generate a psychosis risk estimate for each case. The area under the receiver operating characteristic curve(AUC) was used to test the effectiveness of this discrimination. Results: The NAPLS risk calculator showed moderate discrimination of subsequent transition to psychosis in the SHARP sample with an AUC of 0.631(p=0.007). Whether discriminating either transition or poor treatment/clinical outcomes, the AUC of the model increased to 0.754(p<0.001). A risk estimate of 30% or higher had moderate sensitivity(53%) and excellent specificity(86%) for prediction of poor treatment/clinical outcome. Conclusions: The NAPLS-2 risk calculator largely generalizes to a Shanghai CHR sample but is meaningfully improved when predicting an individual’s poor clinical outcome as well as conversion as outcome states. Our findings provide a critical step in the implementation of CHR risk calculation in China.


Speakers

Monday October 8, 2018 1:55pm - 2:05pm
St. George CD Westin Copley Place, third floor

2:05pm

Oral 1, Talk 7. "Long-Term Education and Employment Trajectories for Individuals with Psychosis: The Suffolk County Mental Health Project"
Jennifer Humensky1,2, Roman Kotov3, Lisa Dixon1,2, Evelyn Bromet3; 1Columbia University, 2New York State Psychiatric Institute, 3Stony Brook University School of Medicine
               
Background: Evidence-based coordinated specialty care (CSC) for early psychosis treatment has grown rapidly in the United States. Since programs are relatively new, findings on long-term functioning after treatment ends derive only from pre-CSC research. The Suffolk County Mental Health Project (SCMHP) has followed a cohort of individuals diagnosed with recent-onset psychosis in the early 1990s, thus permitting examination of the long-term (20-year) vocational patterns in the cohort.  The current analysis focuses on the subsample of the SCMHP who appears to have met the criteria for enrollment in OnTrackNY, the state’s CSC intervention, had it been available (n=153). Methods:  Assessments were conducted at baseline, and at 6 months and 2, 4, 10 and 20 year follow-ups. Random effects models examine trends in vocational participation over time. Results: Baseline vocational (education and employment) participation for those who would have met OnTrackNY enrollment criteria is similar to published estimates of OnTrackNY, namely, 47% (n=71) for SCMHP and 44% (n=144) for OnTrackNY. Overall, vocational participation in the SCMHP declined, particularly by the 20-year follow-up (OR=0.41[95% CI: 0.17-0.98]), and especially for full-time vocational participation (OR=0.02 [95% CI:0.004-0.09]. Rates of part-time participation increased (OR=6.39[95%CI:2.09-19.52], as did public assistance enrollment. Baseline vocational participation was the strongest predictor of subsequent vocational participation; other key predictors were baseline educational attainment, race/ethnicity, and illness severity. Conclusions: While baseline rates are similar, vocational participation declined over time in SCMHP; in contrast, it doubled to over 80% for OnTrackNY enrollees. Future research should examine how participation changes after CSC treatment ends.


Speakers
JH

Jennifer Humensky

Columbia University


Monday October 8, 2018 2:05pm - 2:15pm
St. George AB Westin Copley Place, third floor

2:05pm

Oral 2, Talk 7. "Identifying Youth at Risk of Psychosis. From Translational Research to Ethics Appraisal"
Paolo Corsico1; 1School of Law, the University of Manchester
               
Identification of individuals at high risk of psychosis has usually been performed by means of a clinical interview, such as the Structured Interview for Prodromal Syndromes (SIPS), and the Comprehensive Assessment of At-Risk Mental State (CAARMS). Yet, the relatively low transitions rates of individuals identified as being at risk of psychosis have sparked great attention for neuroscientific measures of psychosis risk. Particularly, neuroimaging and machine learning could soon support the identification of individuals at high risk of psychosis, and ameliorate diagnosis and prediction of psychosis transition in high-risk populations. In this presentation, I address the ethical issues that arise from the attempt to identify youth at risk of psychosis via neuroimaging and machine learning methods. First, I outline the ethical issues that arise from involving young (help-seeking) individuals in neuroimaging research. Along with issues of research and data governance, I shall focus on the lack of immediate clinical utility, and on the challenges of communicating psychosis risk in a research setting. Second, I outline the ethical issues that may derive from the translation of neuroimaging and machine learning as predictive and diagnostic tools in the clinical setting. Here, I shall focus on the risk to reinforce neuro-essentialist thinking in young individuals. Overall, I argue that the clinical benefits gained by translating novel predictive tools in the clinical setting ought to be weighed against potential risks for young populations.


Speakers

Monday October 8, 2018 2:05pm - 2:15pm
St. George CD Westin Copley Place, third floor

2:05pm

Symposium 1, Talk 4. "A NEET distinction: Youths not in employment, education or training follow different pathways to illness and care in psychosis"
Srividya Iyer1,2,3, Sally Mustafa3, Jai Shah1,2,3, Ridha Joober1,2,3, Martin Lepage1,3, Ashok Malla1,2,3; 1Department of Psychiatry, McGill University, 2ACCESS Open Minds/Esprits ouverts, Douglas Mental Health University Institute, 3Prevention and Early Intervention Program for Psychosis (PEPP-Montreal)
           
Among youths presenting at specialised early intervention (SEI) services for psychosis, those Not in Employment, Education or Training (NEET) may have experienced longer periods of functional decline and mental health problems. They may also have difficulties accessing SEIs due to disadvantages associated with being NEET. These issues have not been investigated in first-episode psychosis. Our aims were therefore to document the prevalence of NEET status in a first-episode psychosis sample, and to investigate baseline differences between NEET and non-NEET groups in terms of demographics, symptomatology, pre-psychosis illness course and treatment delays. Data for 416 youths entering a catchment-based Canadian SEI service were analysed. NEET and non-NEET groups were compared on demographics (e.g. gender); symptomatology (e.g., negative symptoms); pre-psychosis course (i.e., premorbid adjustment, prodrome); and duration of untreated psychosis (DUP). NEET individuals (39% of sample) were likelier to be male, have schizophrenia-spectrum psychosis and have higher negative symptom scores than non-NEET individuals. They had longer prodromes and were likelier to remain ill after the first psychiatric change, until the onset of psychosis. Although both groups had similar premorbid adjustment earlier, the NEET group’s adjustment dropped in late adolescence. NEET youths had longer DUPs despite making more help-seeking attempts. In conclusion, NEET status was thrice as prevalent in our sample as in the Canadian populace. The NEET group followed a distinct trajectory of persistent symptoms and functional decline towards an eventual intersection of psychosis and NEET status. The systemic delays that NEET youths encounter indicate a need for better-targeted early identification efforts


Speakers
SI

Srividya Iyer

McGill University


Monday October 8, 2018 2:05pm - 2:25pm
American Ballroom-North Westin Copley Place, fourth floor

2:05pm

Symposium 2, Talk 4. "The Connectome in Young Offspring of Patients with Schizophrenia and Bipolar Disorder"
René Kahn1,2, Guusje Collin1, Lianne Scholtens1, Manon Hillegers1,3, Martijn van den Heuvel1; 1UMC Utrecht, 2Icahn School of Medicine, 3Erasmus MC
           
Background: Emerging evidence suggests disruptions in the wiring organization of the brain’s network in schizophrenia and bipolar disorder. As the importance of genetic predisposition has been firmly established in these illnesses, children (offspring) of patients constitute an at-risk population. This study examines connectome organization in children at familial high risk for psychosis. Methods: Diffusion-weighted MRI scans were collected from 127 non-psychotic offspring, aged 8 to 18 years (13.5 years on average), of a parent diagnosed with schizophrenia (SZ-offspring; N = 28) or bipolar disorder (BD-offspring; N = 60), and community controls (N = 39). Resting-state fMRI scans were available for 82 subjects. Anatomical and functional brain networks were reconstructed and examined using graph theoretical analysis. Results: SZ-offspring were found to show connectivity deficits of the brain’s central rich club system relative to both controls and BD-offspring. The disruption in anatomical rich club connectivity in SZ-offspring was associated with increased modularity of the functional connectome. In addition, increased coupling between structural and functional connectivity (SC-FC coupling) of long-distance connections was observed in both SZ- and BD-offspring. Conclusions: This study shows lower levels of anatomical rich club connectivity in non-psychotic young offspring of schizophrenia patients. This finding suggests that the brain’s anatomical rich club system is affected in at-risk youths, reflecting a connectome signature of familial risk for psychotic illness. Moreover, finding no rich club deficits in offspring of bipolar disorder patients suggest a differential effect of genetic predisposition for schizophrenia versus bipolar disorder on the developmental formation of the connectome


Speakers
RK

René Kahn

UMC Utrecht


Monday October 8, 2018 2:05pm - 2:25pm
American Ballroom-Center Westin Copley Place, fourth floor

2:05pm

Symposium 3, Talk 4. "Adoption and Utilization of Order Sets for Early Psychosis: A National Experiment in Standardization"
Philip Tibbo1, Thomas Hastings2, Andrea Bardell3, Nicola Banks4, Howard Margolese5; 1Dalhousie University, 2McMaster University, 3University of British Columbia, 4Canadian Consortium for Early Intervention in Psychosis, 5McGill University
           
Successful treatment of early phase psychosis (EPP) requires an organized, recovery oriented mental health system with clear standards, policies and coordinated services. The Canadian Consortium for Early Intervention in Psychosis (CCEIP), a national organization of clinicians and researchers dedicated to improving quality of care in EPP, have developed two clinician order sets based on international, national and provincial standards, guidelines and quality based procedures, to be used in outpatient or inpatient settings.  Order sets are evidence-based checklists which translate the latest medical information into a structured and actionable document that clinicians can put into practice at the point of care. Using a cloud-based platform, CCEIP developed and tested order sets for: 1) Initiation of Treatment for and 2) Optimization of Treatment for Early Phase Psychotic Disorders.  These order sets are aimed to improve adherence to best practice, treatment outcomes, quality of care through data tracking and feedback, consistency and efficiency of care, in addition to reducing cost of care and medical errors. A discussion around the use of order sets, presentation of the 2 developed order sets and their referenced tools, and data from a national accredited performance assessment program on use of these orders sets will be presented. This data will include dashboard results of widespread usage, quantifiable insights into EPP health care practice including real-time use data on ordering (care) trends as well as implications/assumptions.


Speakers
PT

Philip Tibbo

Dalhousie University


Monday October 8, 2018 2:05pm - 2:25pm
American Ballroom-South Westin Copley Place, fourth floor

2:05pm

Symposium 4, Talk 4. "Personality disorder among youth with first episode psychotic mania: An important target for specific treatment?"
Philippe Conus1,2, Melissa Hasty2, Craig Macneil2, Sue M Cotton2, Michael Berk3, Linda Kader2, Aswin Ratheesh2, Andrew Chanen2,4; 1Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry CHUV, Lausanne University, Switzerland, 2Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 3Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, 4Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
           
Objectives: Personality disorder (PD) comorbidity is common among patients with bipolar disorder and has been shown to negatively impact on outcome. However, little is known about this comorbidity in the early phases of BD. We aimed to examine the prevalence and impact of PD comorbidity on outcome in a cohort of youth with first episode mania (FEM) with psychotic features. Methods: Seventy-one patients with FEM aged 15 to 29 and treated at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia, were assessed at baseline, 6, 12, and 18 months as part of a randomized controlled trial of olanzapine and chlorpromazine as add-on to lithium in FEM with psychotic features. This study involved secondary analysis of trial data.  Results: A comorbid clinical PD diagnosis was made in 16.9% of patients, antisocial and narcissistic PD being the most common sub-types. Patients with PD comorbidity had higher rates of readmission to hospital, lower rates of symptomatic recovery and poorer functional levels at 6 months, but these differences were not maintained after 12 and 18 months. Conclusions: In the early phase of bipolar disorders, patients with PD comorbidity display a delay in reaching symptomatic and functional recovery and are more likely to need hospital readmissions. These observations suggest specific intervention might be needed in order to improve short-term treatment efficacy in this subgroup.


Speakers
PC

Philippe Conus

Lausanne University


Monday October 8, 2018 2:05pm - 2:25pm
Staffordshire Westin Copley Place, third floor

2:15pm

Oral 1, Talk 8. "Education and Employment Among Young Persons with Early Psychosis Participating in OnTrackNY
Jennifer Humensky1,2, Lisa Dixon1,2; 1Columbia University, 2New York State Psychiatric Institute
               
Introduction: Onset of psychosis occurs most commonly at ages 15-25, the ages at which young people are developing adult identities – education, employment and career development are crucial in this process. Coordinated specialty care (CSC) programs provide coordinated access to team based early invention services for psychosis, including supported education and employment (SEE) services. This study prospectively evaluated education and employment outcomes over time within New York State’s CSC program, OnTrackNY.  Methods: Assessment data are collected by clinical staff at admission, quarterly, and at discharge. Trajectories of education and employment status are assessed using generalized estimating (population averaged) models with an autoregressive covariance structure to account for within-subject correlations over time. Participants (n=779) were enrolled in OnTrackNY from October 2013 to September 2017. Results: 41% (SD 49%) were in school/work at baseline, rising to 62% (SD 48%) at 3 months, and 75% (SD 43%) at 12 months. Work/school participation at baseline was the strongest predictor of subsequent work/school participation (OR=24.8 [95% CI: 16.4-37.7], as were higher GAF symptom scores (less severe symptoms) (OR=1.01 [1.00-1.02]) and longer time in program, (OR=1.34 [1.27-1.42]. Older participants had lower odds of work/school participation (OR=0.93 [0.88-0.98]), as did males relative to females (OR=0.70 [0.49-0.99]), Hispanics compared to non-Hispanic whites (OR=0.66 [0.45-0.98], and those with high school/GED compared to those with less than high school (OR=0.48 [0.31-0.75]).   Conclusion: CSC participants achieve significant improvements in education and employment. CSC teams should support vocational efforts, particularly among those at risk of poor performance, to help participants achieve their goals.


Speakers
JH

Jennifer Humensky

Columbia University


Monday October 8, 2018 2:15pm - 2:25pm
St. George AB Westin Copley Place, third floor

2:15pm

Oral 2, Talk 8. "Association of Clinical High risk Symptoms with General Health and Well-Being in the Community"
Chantal Michel1,2, Iljana Käufeler1, Nina Schnyder1, Rahel Flückiger1, Michael Kaess1, Benno G. Schimmelmann1,3, Frauke Schultze-Lutter1,4; 1University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, 2Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland, 3University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany, 4Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
               

The understanding of factors related to poor subjective quality of life (sQoL) in clinical high risk (CHR) of psychosis is important for both research and clinic. We investigated sQoL together with health status and axis-I disorders in a general population sample with CHR symptoms of psychosis. In total, 2,683 individuals of the Swiss Canton Bern (16–40 years old, response rate of 63.4%) were interviewed by telephone for CHR symptoms using established psychosis-risk instruments (Schizophrenia Proneness Instrument, Adult version for basic symptoms and the Structured Interview for Prodromal Syndromes for ultra-high risk symptoms), for current axis-I problems/disorders using the Mini-International Neuropsychiatric Interview, for sQoL using the  Brief Multidimensional Life Satisfaction Scale, and for health status using the EQ-5D. CHR symptoms were associated with current axis-I disorders (especially depressive and anxiety disorders), a lower general, intrinsic and health related sQoL as well as a lower evaluation of health status. For comorbid disorders and the general sQoL ultra-high risk symptoms were more important. Basic symptoms were more important for the intrinsic and health related sQoL and the evaluation of health status. Our findings confirm that CHR symptoms in the community are already a subjective burden for the individuals experiencing them and therefore are clinically relevant, even if the strict criteria for a CHR state are not fulfilled.


Speakers

Monday October 8, 2018 2:15pm - 2:25pm
St. George CD Westin Copley Place, third floor

2:25pm

Oral 1: Q&A
Question & Answer period

Speakers
JS

Jai Shah

McGill University
Department of Psychiatry, McGill University, Montréal, Canada, 2PEPP-Montréal, Douglas Mental Health University Institute, Montréal, Canada, 3Integrate Program in Neuroscience, McGill University, Montréal, Canada


Monday October 8, 2018 2:25pm - 2:30pm
St. George AB Westin Copley Place, third floor

2:25pm

Oral 2: Q&A
Question and Answer Period.

Chair
ML

Michelle L West

Harvard Medical School - Beth Israel Deaconess Medical Center

Monday October 8, 2018 2:25pm - 2:30pm
St. George CD Westin Copley Place, third floor

2:25pm

Symposium 1: Q&A
Speakers
MC

Mary Cannon

DISCUSSANT, Royal College of Surgeons in Ireland


Monday October 8, 2018 2:25pm - 2:30pm
American Ballroom-North Westin Copley Place, fourth floor

2:25pm

Symposium 2: Q&A
Speakers
MS

Martha Shenton

DISCUSSANT, Brigham & Women's Hospital, Harvard Medical School


Monday October 8, 2018 2:25pm - 2:30pm
American Ballroom-Center Westin Copley Place, fourth floor

2:25pm

Symposium 3: Q&A
DISCUSSANT

Speakers
avatar for John M. Kane

John M. Kane

Senior Vice President, Behavioral Health Services, Northwell Health
John M. Kane, MD, is Senior Vice President for Behavioral Health Services at Northwell Health in New Hyde Park, New York. He is Professor and Chairman of Psychiatry at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He also serves as Chairman of Psychiatry at... Read More →


Monday October 8, 2018 2:25pm - 2:30pm
American Ballroom-South Westin Copley Place, fourth floor

2:25pm

Symposium 4: Q&A
Monday October 8, 2018 2:25pm - 2:30pm
Staffordshire Westin Copley Place, third floor

2:30pm

Coffee Break
Monday October 8, 2018 2:30pm - 2:45pm
American Ballroom Westin Copley Place, fourth floor

2:45pm

Oral Session 3: PSYCHOSOCIAL TREATMENT: PSYCHOSIS

Monday October 8, 2018 2:45pm - 4:15pm
St. George AB Westin Copley Place, third floor

2:45pm

Oral Session 4: EPIDEMIOLOGY: PSYCHOSIS
Chair
BO

Brian O'Donoghue

Orygen, The National Centre of Excellence in Youth Mental Health

Speakers

Monday October 8, 2018 2:45pm - 4:15pm
St. George CD Westin Copley Place, third floor

2:45pm

Symposium Session 5: TREATMENT FOR YOUTH AT CLINICAL HIGH RISK FOR PSYCHOSIS: WHAT NEXT?
The main focus of treatment for youth at clinical high risk (CHR) of psychosis has been to prevent transition to full-blown psychosis. However, there are other targets that have been considered less often such as attenuated psychotic symptoms, negative symptoms, social functioning, and cognition. Although the literature is promising there are many areas that are not impacted by current treatments in particular social functioning which is of concern since many of these young people continue to have poorer social functioning even when they do not make the transition to psychosis and attenuated psychotic symptoms have remitted. The first presentation (Addington) will present a critical overview of some of the promising areas of psychosocial treatment (such as cognitive behavior therapy, social skills training, cognitive remediation, and family focused therapy) and pharmacotherapy. The other three presentations will review the most recent research, highlight the features of the interventions and describe future goals for making the intervention more effective. The second presentation (Cadenhead) will focus on group-based CBT and social skills training to address social functioning. The use of cognitive remediation will be addressed in the third presentation (Friedman-Yakoobian). The fourth presentation will offer a critical examination of the current use of antidepressants in the CHR population (Woods). Finally, the discussant (Keshavan) will summarize the extant findings and propose a potential treatment algorithm for CHR.

Chair
JA

Jean Addington

University of Calgary
avatar for Matcheri Keshevan

Matcheri Keshevan

IEPA Chair, Harvard University
Matcheri S. Keshavan, M.D.Stanley Cobb Professor of PsychiatryHarvard Medical SchoolVice-Chair of PsychiatryBeth Israel Deaconess Medical CenterBoston, MADr. Keshavan is a licensed physician and board certified psychiatrist, and is Professor of Psychiatry in the Department of Psychiatry... Read More →

Speakers
KC

Kristin Cadenhead

University of California at San Diego
MF

Michelle Friedman-Yakoobian

Harvard Medical School
SW

Scott Woods

Yale University


Monday October 8, 2018 2:45pm - 4:15pm
American Ballroom-North Westin Copley Place, fourth floor

2:45pm

Symposium Session 6: FROM STATIC TO DYNAMIC MODELS OF THE ONSET OF MENTAL DISORDER
Prediction studies in early psychosis and related research has generally relied on one-off sampling of cross-sectional data (i.e., a "snapshot" of clinical state and other risk markers at study entry). A new approach is emerging based on the view that psychopathology is an evolving, dynamic picture, particularly in the early stages of disorder, and that predictive modelling may therefore be maximised by taking these temporal changes into account. This approach to prediction research in psychopathology draws on cross-disciplinary models of complex systems and advances in statistical modelling. This symposium consists of presentations illustrating this emerging paradigm in prediction research, consistent with the “broadening the scope” theme of the conference. Hok Pan Yuen will present joint modeling analysis of longitudinal clinical variables in an ultra high risk for psychosis cohort. Dr Wichers will present novel empirical support for the presence of early warning signals in anticipation of critical transitions in depressive symptomatology. Dr Hartmann will present data relating to early warning signals (psychopathology and circadian activity) from a cohort study of young people at risk of a range of mental disorders. Dr Wigman will present findings from a new diary study (daily recordings of psychopathology) mapping individual symptom networks and the predictive value of these for course/outcome. This next generation of prediction studies may more accurately identify people at highest risk of disorder progression or relapse, which clearly has important treatment implications, such as stratifying patients to particular treatments and introducing methods for identifying early warning signs of mental state deterioration.


Chair
JH

Jessica Hartmann

Orygen, The National Centre of Excellence in Youth Mental Health
BN

Barnaby Nelson

Orygen, The National Centre of Excellence in Youth Mental Health

Speakers
MW

Marieke Wichers

University Medical Centre Groningen (UMCG)
JW

Johanna Wigman

University Medical Centre Groningen (UMCG)


Monday October 8, 2018 2:45pm - 4:15pm
American Ballroom-Center Westin Copley Place, fourth floor

2:45pm

Symposium Session 7: FINDINGS ON STRATEGIES FOR REDUCING THE DURATION OF UNTREATED PSYCHOSIS IN THE UNITED STATES
The World Health Organization recommends that treatment for psychosis begin within 3 months of symptom onset. However, dozens of studies worldwide have observed an average delay of 2 years between appearance of psychotic symptoms and treatment initiation. Two meta-analyses and the U.S. Recovery After an Initial Schizophrenia Episode-Early Treatment Program have established that duration of untreated psychosis (DUP)—the time from psychosis onset to treatment initiation—is correlated with poor clinical and functional outcomes. Early psychosis treatment programs are increasingly available in the U.S., but many in need are missing this critical opportunity. Accordingly, the National Institute of Mental Health (NIMH) launched a research program to identify sources of early psychosis treatment delay and test practical and innovative strategies for reducing DUP in the U.S. This symposium features findings from a selection of these studies. Steven Lopez will report on the impact of a community-based, multi-level, bilingual psychosis communication campaign for U.S. Latinos on help seeking, DUP and treatment continuation. Vinod Srihari will report findings from the trial of Mindmap—a population-based, multi-element, early psychosis detection campaign—on help seeking and DUP. Cameron Carter will present results from his trial assessing whether adding a novel, technology-enhanced early psychosis screening tool to standard provider education for early psychosis increases early psychosis identification and reduces DUP. Leslie Marino will present findings on a comprehensive set of DUP predictors for nearly 800 individuals enrolled in early psychosis treatment programs. Susan Azrin will discuss these findings and implications for developing practical DUP reduction strategies.


Chair
ST

Susan T. Azrin

National Institute of Mental Health

Speakers
CS

Cameron S. Carter

University of California, Davis School of Medicine
SR

Steven R. Lopez

University of Southern California
LM

Leslie Marino

Columbia University Medical Center, New York State Psychiatric Institute


Monday October 8, 2018 2:45pm - 4:15pm
American Ballroom-South Westin Copley Place, fourth floor

2:50pm

Oral 3, Talk 1. "What about love? Developing romantic relationships in early psychosis"
Tania Lecomte1, Catherine Hache Labelle1, Martin Lepage2, Amal Abdel Baki1; 1Université de Montréal, Canada, 2McGill University
               
Recovery from mental illness is not solely about mental health, work, independent living, and community integration - it also includes engaging in romantic relationships. Previous work from our team has enabled us to determine obstacles to romantic relationships in young heterosexual men with psychosis (see Pillay et al., 2016; Latour-Desjardins et al., 2018). These obstacles include: self-stigma, poor self-esteem, lack of social skills, social cognitive deficits, insecure attachment issues, lack of information regarding intimacy and sexuality, and difficulties in conflict resolution. We developed a twelve-session group intervention called 'Two is better than one', focusing on these topics in a cognitive behavioural and relational context. Objective: The purpose of this presentation is to describe the novel group intervention (using CBT, social cognitive, psychoeducation and social skills training) and to present preliminary quantitative and qualitative results on a pilot study. Method: 8 heterosexual male participants with psychosis, aged between 18 and 25, took part in this study. They each completed a battery of measures at 5 time points: baseline, 4 weeks, 8 weeks, 12 weeks ,16 weeks, and 18 weeks, with the treatment being offered at 4 weeks, once a week for 12 weeks. We measured symptoms (BPRS), romantic and intimacy functioning (RRFS, FESFS), self-esteem (SERS-SF), self-stigma (ISMIS) and theory of mind (Stories task). We also included an open-ended interview regarding their experience in the group. The preliminary results will be discussed in detail. Overall, the group was considered very useful and increased prosocial and dating behaviors in the participants.


Speakers
TL

Tania Lecomte

Université de Montréal, Canada


Monday October 8, 2018 2:50pm - 3:00pm
St. George AB Westin Copley Place, third floor

2:50pm

Oral 4, Talk 1. "Childhood Infection, IQ and Risk of Non-Affective Psychosis in Adulthood: a Swedish population-based longitudinal cohort and co-relative study"
Golam Khandaker1, Christina Dalman2,3, Nils Kappelmann1, Jan Stochl1, Henrik Dal3, Kyriaki Kosidou2,3, Peter Jones1, Håkan Karlsson2; 1University of Cambridge, 2Karolinska Institutet, 3Stockholm County Council
               
Using population-based longitudinal Swedish data (N=647,515), we tested (1) association of childhood infection with IQ and adult non-affective psychosis (NAP); (2) whether shared familial confounding explains the infection-NAP and IQ-NAP relationships; (3) whether IQ mediates and/or moderates the infection-NAP relationship. IQ was assessed at conscription around age 18 years. Data on hospitalisation with any infection from age 0–13 years, and hospitalisation with an ICD diagnosis of NAP in adulthood were retrieved from admission register. Exposure to infections particularly in early-childhood was associated with lower IQ (adjusted mean difference for infection at 0-1y: -1.61; 95% CI, -1.74, -1.47), and with increased risk of adult NAP (adjusted hazard ratio for infection at 0-1y: 1.19; 95% CI, 1.06-1.33). There was a linear association between lower premorbid IQ and adult NAP, which persisted after excluding prodromal cases (adjusted hazard ratio per 1-point increase in IQ: 0.976; 95% CI, 0.974-0.978). The infection-NAP and IQ-NAP associations were similar in the general population and in full-sibling pairs discordant for exposure. IQ both moderated (P=0.02 and P=0.001) and mediated (P<0.001) the association between infection and NAP. Early-childhood is a sensitive period for the effects of infection on IQ and NAP. The associations of adult NAP with early-childhood infection and adolescent IQ are not fully explained by shared familial factors, so may be causal. Lower premorbid IQ in psychosis arises from unique environmental factors, such as early-childhood infection. Early-childhood infections may increase risk of NAP by affecting neurodevelopment and by exaggerating the effects of cognitive vulnerability to psychosis.


Speakers
GK

Golam Khandaker

University of Cambridge


Monday October 8, 2018 2:50pm - 3:00pm
St. George CD Westin Copley Place, third floor

2:50pm

Symposium 5, Talk 1. "Meta-analytic Review of Treatment Options for CHR youth"
Jean Addington1, Daniel Devoe1; 1University of Calgary
           
The main focus of psychological treatment for youth at clinical high risk (CHR) of psychosis has been to prevent transition to full-blown psychosis and less often attenuated psychotic symptoms. However, in addition to the attenuated psychotic symptoms, these young people often present with negative symptoms, as well as other comorbid disorders. They typically have cognitive difficulties that are intermediate to healthy controls and individuals with full-blown psychosis. Many have poor social and role functioning. Through a series of network and pairwise meta-analyses this presentation reviews all treatment studies to date including cognitive behavior therapy (CBT), family intervention, cognitive remediation, integrated psychological treatment and a range of pharmacotherapies and includes outcomes such as transition, attenuated psychotic symptoms, negative symptoms, cognition and social and role functioning. There are some positive results in support of CBT in preventing transition to psychosis and reducing attenuated psychotic symptoms. None of the treatments reviewed appear to have an impact on negative symptoms or social functioning, which is of concern since many of these young people continue to have poorer social functioning even when they do not make the transition to psychosis and attenuated psychotic symptoms have remitted


Speakers
JA

Jean Addington

University of Calgary


Monday October 8, 2018 2:50pm - 3:10pm
American Ballroom-North Westin Copley Place, fourth floor

2:50pm

Symposium 6, Talk 1. "A Novel Approach to Developing A Prediction Model of Transition to Psychosis: Dynamic Prediction Using Joint Modelling"
Hok Pan Yuen1, Andrew Mackinnon2, Patrick McGorry1, G. Paul Amminger1, Jessica Hartmann1, Miriam Schäfer 
1, Connie Markulev1, Suzie Lavoie1, Barnaby Nelson1; 1Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, 2Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne
           
Introduction Joint modelling (JM) is a promising new statistical methodology which can use data from both study entry and subsequent follow-up assessments to develop prediction models of psychosis onset in ultra-high risk (UHR) individuals. The practical implication is that the prediction provided by these models could be updated as new information about patients’ clinical state is obtained and appropriate treatment could be implemented accordingly. This study aimed to test the potential benefits of joint modelling to dynamically predict the onset of psychosis in UHR individuals. 
 Method Data from the NEURAPRO intervention study was used. This study was a multi-centre placebo-controlled randomized trial of the effect of omega-3 polyunsaturated fatty acids on risk of transition to psychotic disorder in UHR individuals. The sample size was 304. Study assessments were conducted monthly during the first 6 months and then at months 9 and 12. There were in total 40 known cases of transition to psychosis. Candidate predictor variables consisted of demographic characteristics assessed at intake as well as repeated measurements of clinical variables. Results Compared with the conventional approach of using only baseline data for prediction of psychosis, JM prediction showed significantly better sensitivity, specificity and likelihood ratios. The JM approach yielded sensitivity of 82.8%/specificity 72.4%, whereas the baseline-data only model yielded sensitivity of 69.0%/specificity 73.8%. 
 Conclusions Incorporating time-dependent variables into predictive models has the potential to improve the prediction of onset of psychosis and hence to help in providing timely and personalized treatment to patients.


Speakers

Monday October 8, 2018 2:50pm - 3:10pm
American Ballroom-Center Westin Copley Place, fourth floor

2:50pm

Symposium 7, Talk 1. "Towards Decreasing the Duration of Untreated Psychosis in a Minority Community: The Case of US Latinos"
Steven R. Lopez1, Alex Kopelowicz2, Jodie Ullman3, Maria Santos1, Maya Kratzer1; 1University of Southern California, 2University of California Los Angeles, 3California State University San Bernardino
           
We conducted a 2-year, multifaceted bilingual communication campaign for US Latinos regarding psychosis.  We assessed whether the duration of untreated psychosis (DUP) decreased during the campaign more than during the 15-month historical control condition preceding the campaign. Patients with first episode psychosis were recruited from a public outpatient and inpatient mental health unit in the Los Angeles area.  Inclusion criteria were:  ages 16-65, having a psychotic disorder not due to a medical condition or substance use, and self-identifying as Latino.  Exclusion criteria were: having taken antipsychotic medication for more than a year or not understanding the informed consent procedures. Three DUPs were measured:  onset to first seeking any services for the disorder (DUP1), first prescription for antipsychotic medication (DUP2), and taking medication for at least 3 months (DUP3).  The DUPs were highly skewed; therefore, analyses were conducted on transformed measures.   We found no significant mean differences between the campaign condition (n=57) and the control condition (n=46) for the DUP measures.  Significant differences in the variance of DUP1, but not for DUP2/DUP3, were found.  There was a significantly smaller variance for the campaign than for the control.  The variance of DUP1 was also smaller for those residing within the targeted community than in surrounding communities, and for those born in the US versus Latin America.  That the variance differed for DUP1 but not DUP2/DUP3 suggests that the campaign influenced families’ contribution to DUP but not professional networks.  Recommendations to increase the impact of DUP reduction campaigns for minority communities are discussed.


Speakers
SR

Steven R. Lopez

University of Southern California


Monday October 8, 2018 2:50pm - 3:10pm
American Ballroom-South Westin Copley Place, fourth floor

3:00pm

Oral 3, Talk 2. "A Qualitative Investigation of Perceived Barriers to and Enablers of Sport Participation for Young People with First Episode Psychosis"
Lauren Brooke1, Daniel Gucciardi1, Ashleigh Lin2, Nikos Ntoumanis3; 1School of Physiotherapy and Exercise Science, Curtin University, 2Telethon Kids Institute, The University of Western Australia, Perth, WA, 3School of Psychology, Curtin University
               
Dynamic interventions that provide opportunities for physical activity, social interaction, and skill development are important for the functional recovery of young people with first-episode psychosis (FEP). As such, sport (encompassing physical activity, group dynamics, and physical and life-skill development) is an ideal intervention platform for this population, yet has been rarely utilised in this context. The aim of this study was to improve our knowledge of the perceived barriers and enablers of sport participation for young people (aged 16-25) presenting with FEP. We conducted semi-structured interviews and focus groups with young people with FEP (n=10) and their clinicians (n=33). Questions focused on barriers and facilitators (e.g., psychological, environmental, logistical) to participation in a sport program designed specifically for young people with FEP, as well as general feedback on program design options. A thematic analysis of the transcribed interviews and focus groups revealed five predominant themes across both clinicians and young people: 1) barriers (e.g., anxiety, amotivation), 2) enablers (e.g., others’ support, close proximity), 3) perceived benefits (e.g., sense of belonging, distraction), 4) psychological safety (e.g., clinical support, understanding individual mental health history), and 5) program design recommendations (e.g., sport preferences). General reactions of both the clinicians and young people to the idea of a sport program were supportive, yet the clinicians were also cautionary in regards to the needs of the specific population and the challenges of engagement. The results provide valuable insight into how to bring sport to this population in a way that is engaging, appropriate, and safe.


Speakers

Monday October 8, 2018 3:00pm - 3:10pm
St. George AB Westin Copley Place, third floor

3:00pm

Oral 4, Talk 2. CANCELLED
Talk 2 had been withdrawn at the request of the author.

******************************************************************************************************************
"Systemic Inflammation and Intelligence in Early Adulthood and Subsequent Risk of Schizophrenia and Other Non-Affective Psychoses: A Longitudinal Cohort and Co-Relative Study"

Golam Khandaker1, Nils Kappelmann1, Henrik Dal2, Jan Stochl1, Kyriaki Kosidou2,3, Peter Jones1, Christina Dalman2,3, Håkan Karlsson2,3; 1University of Cambridge, 2Stockholm County Council, 3Karolinska Institutet
               
We examined associations between erythrocyte sedimentation rate (ESR), a marker of systemic inflammation, IQ, a measure of general intelligence, and subsequent schizophrenia and other non-affective psychoses (ONAP) to elucidate potential role of neurodevelopment and inflammation in pathogenesis of psychosis. Population-based data on ESR and IQ from 638,213 Swedish men assessed during military conscription between 1969 and 1983 were linked to National Hospital Discharge Register for hospitalisation with schizophrenia and ONAP. The associations of ESR with IQ (cross-sectional) and psychoses (longitudinal) were investigated using linear and Cox-regression. Co-relative analysis was used to examine effects of shared familial confounding. We examined mediation and moderation of effect between ESR and IQ on psychosis risk. Baseline IQ was associated with subsequent risk of schizophrenia (adjusted HR per 1-point increase in IQ=0.961; 95% CI: 0.960-0.963) and ONAP (adjusted HR=0.973; 95% CI: 0.971-0.975). Higher ESR was associated with lower IQ in a dose-response fashion. High ESR was associated with increased risk for schizophrenia (adjusted HR=1.14; 95% CI: 1.01-1.28) and decreased risk for ONAP (adjusted HR=0.85; 95% CI: 0.74-0.96), although these effects were specific to one ESR band (7-10mm/hr). Familial confounding explained ESR-IQ but not ESR-psychoses associations. IQ partly mediated the ESR-psychosis relationships. Low-grade systemic inflammation is associated with increased risk of schizophrenia in adulthood. Inflammation may influence schizophrenia risk by affecting neurodevelopment.


Speakers
GK

Golam Khandaker

University of Cambridge


Monday October 8, 2018 3:00pm - 3:10pm
St. George CD Westin Copley Place, third floor

3:10pm

Oral 3, Talk 3. "Intervening in mental health has effects beyond the health service – education and employment as outcomes for early intervention services"
Caragh Behan1,2, Eric Roche1,2, Sarah Masterson1, Laoise Renwick3, Catherine McDonough4, Brendan Kennelly5, Paul McCrone6, Mary Clarke1,7; 1DETECT, 2Cluain Mhuire Community Mental Health Services, 3School of Nursing, University of Manchester, 4Louth Mental health Services, 5Department of Economics, NUI Galway, 6King's Health Economics, London, 7University College Dublin
               
The economic cost of schizophrenia in Ireland was estimated to be over €461 million in 2006, with the bulk of these costs located in the labour market due to lost employment, and lost productivity. Early intervention in psychosis (EIP) aims to reduce the proportion of people not in education or employment or further training to levels no more than peer population rates. Methods An incidence based cohort of people with first episode psychosis was followed up at one year (n=205). One cohort received EI; the other received best practice TAU. Joint costs and effects were examined using the net benefit approach. The value of lost productivity was calculated using the human capital approach. The incremental net benefit (INB) to society of avoiding a relapse and of a healthy day at home (HDAH), and the differences in the proportions in education and employment were calculated. Results The value of lost productivity was €32,706 more in the TAU sample (p<0.001). More people entered employment in the EI cohort. The INB to society was €14,282 (SE €10,364), and this was robust to sensitivity analysis. Conclusion EI has a societal benefit that is captured when examining outcomes outside the health sector.  Funding for mental health comes from the health budget, but benefits can accrue to sectors outside health.  Examining the effects of interventions outside of the health service can show where these benefits accrue, and inform where funders and policy makers can collaborate to look outside the health budget for funding.


Speakers

Monday October 8, 2018 3:10pm - 3:20pm
St. George AB Westin Copley Place, third floor

3:10pm

Oral 4, Talk 3. "20 Year Outcome in Psychotic Illness: Initial Findings of the iHOPE-20 First Episode Psychosis Incidence Cohort Follow up Study"
Donal O'Keeffe1,2, Ailish Hannigan3, Roisin Doyle1, Anthony Kinsella4, Ann Sheridan5, Aine Kelly6, Kevin Madigan4,7, Elizabeth Lawlor1, Mary Clarke1,5; 1DETECT Early Intervention in Psychosis Service, Dublin, Ireland, 2Trinity College Dublin, Dublin, Ireland, 3University of Limerick, Limerick, Ireland, 4Royal College of Surgeons in Ireland, Dublin, Ireland, 5University College Dublin, Dublin, Ireland, 6Saint John of God Hospitaller Services, Ireland, 7Saint John of God Community Services, Dublin, Ireland
               
Purpose: Although long term (8–20 year) follow ups of FEP cohorts exist; there is a paucity of very long-term (i.e. ≥ 20 years) epidemiologically representative studies of FEP incidence cohorts. While very long term data has been collected from recent onset, prevalence, first admission psychosis, and first episode schizophrenia cohorts; this research may not fully account for the heterogeneity of psychotic illness. Materials and Methods: To address these issues, we conducted a prospective 20 year follow up of a FEP incidence cohort (N=171), between 2014 and 2017, in Ireland (Irish Health Outcomes in Psychosis Evaluation - 20 year follow up: iHOPE-20). In this conference paper, we report on (i) the remission, clinical recovery, personal recovery, and resilience levels found; (ii) the interrelationship between outcomes; and (iii) baseline predictors. Results: At 20 years, we classified 20/171 cohort members (11.70%) as deceased and assessed 80/151 alive cohort members (53% recruitment rate). 65% were in remission, 35.2% were in Full Functional Recovery, and 53.7% confirmed they were fully recovered according to their personal definition of recovery. Resilience levels were markedly less than general population norms. A multifaceted interrelationship between outcomes was found. Baseline predictors varied depending on the outcome variable measured. Conclusion: Personally defined recovery and full remission in FEP is not just achievable but probable in the very long term. However, helping service users develop resilience and attain positive functional outcomes (e.g. relationships outside of family; vocational functioning/role achievement; and basic living task engagement) remain important challenges for treatment in FEP.


Speakers

Monday October 8, 2018 3:10pm - 3:20pm
St. George CD Westin Copley Place, third floor

3:10pm

Symposium 5, Talk 2. "Cognitive Behavioral Social Skills Training for Youth at Clinical High Risk for Psychosis: Recovery Through Group (ReGroup)"
Kristin Cadenhead1, Jean Addington2, Barbara Cornblatt3; 1University of California at San Diego, 2University of Calgary, 3Zucker Hillside Hospital, New York
           
The majority of youth at clinical high-risk (CHR) for psychosis do not develop a psychotic syndrome but rather continue to have fluctuating subthreshold symptoms, poor social and role functioning.  There are no specific treatments for these functional difficulties. However, Cognitive Behavioral and Social Skills Training (CBSST) significantly increases the frequency of social functioning activities compared to treatment as usual or supportive therapy in chronic schizophrenia.  The ReGroup study is a three-site, longitudinal study aimed at testing the effectiveness and feasibility as well as mediators and mechanisms of action of a manualized CBSST intervention targeting functional difficulties associated with CHR for psychosis.  The goals of the study are 1) to examine whether CBSST compared to a psychoeducation improves functioning and 2) to determine whether reduction in defeatist beliefs and improvement in social competence mediate change in psychosocial functioning. Participants are randomized to: CBSST, an 18-week group comprised of three modules; 1) Cognitive Skills; 2) Social Skills; 3) Problem Solving, or a psychoeducation group. We have demonstrated the feasibility of CBSST treatment in CHR youth and determined that it is easy to train therapists and assure reliability of the intervention through weekly supervision.  Participants enjoy the intervention and are less likely to drop out of the study after starting group. CBSST can be readily disseminated to clinical community practice with proper training and supervision. This study will provide insights into approaches to halt or mitigate the pathological process and advance our understanding of risk prediction


Speakers
KC

Kristin Cadenhead

University of California at San Diego


Monday October 8, 2018 3:10pm - 3:30pm
American Ballroom-North Westin Copley Place, fourth floor

3:10pm

Symposium 6, Talk 2. "Can we obtain personalized early warnings for symptom transitions? Novel empirical support for a complex system approach in psychopathology"
Marieke Wichers1, Marieke Schreuder1, Arnout Smit1, Evelien Snippe1; 1Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
           
Introduction: Clinically, it is highly relevant to be able to foresee sudden rises in psychopathology. However, person-specific symptom transitions are extremely difficult to predict. Complex system theory offers a novel possibility to estimate the likelihood of such transitions and expects the presence of rising early warning signals (EWS) in anticipation of sudden symptom transitions.  We aimed to replicate the first study1 that revealed empirical support for this and, second, to further translate this idea to personalized models. Methods: Adolescent participants were recruited via the East Flanders Twin register. This novel sample consisted of 239 participants with SCL-90 baseline and follow-up measures. At baseline they underwent  experience sampling (ESM). Second, a set of ESM case-studies were conducted in patients tapering their antidepressant medication. These were followed for > 4 months with >5 measurements per day to capture possible sudden transitions in symptoms  and the precise period before those transitions. Results:  We replicated the results of the first group-level study1. The level of EWS in ESM items on depressed mood states was associated with follow-up increases in symptom severity (down: β=0.10, SEβ=0.03, p<0.001; listless: β=0.09, SEβ=0.04, p<0.001). Furthermore, in the individual time-series cases,  rising EWS were observed in anticipation of sudden transitions. Conclusions: The current group-level and individual-level studies supported the hypothesis that critical transitions in psychopathology can be foreseen by observing changes in EWS, also in individual time-series of data. This has major relevance for applications in clinical practice. 1 Leemput, Wichers et al. Proc Natl Acad Sci USA 111(1):87–92.


Speakers
MW

Marieke Wichers

University Medical Centre Groningen (UMCG)


Monday October 8, 2018 3:10pm - 3:30pm
American Ballroom-Center Westin Copley Place, fourth floor

3:10pm

Symposium 7, Talk 2. "Mindmap – A Quasi-Experimental Test of Early Detection of Psychosis in the U.S."
Vinod H. Srihari1,2, Maria Ferrara1,2, Fangyong Li3, Shadie Burke1,2, Emily Kline4,5, Jessica M. Pollard1,2, John D. Cahill1,2, Sinan Guloksuz6, Glen McDermott7, Scott W. Woods1, Larry Seidman4,5, Matcheri Keshavan4,5; 1Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA, 2Program for Specialized Treatment Early in Psychosis (STEP), New Haven, CT, USA, 3Yale Center for Analytical Sciences, Yale School of Public Health, 4Harvard Medical School, 5Program for Prevention and Recovery in Early Psychosis (PREP), Boston, MA, USA, 6Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, the Netherlands, 7Red Rock Branding, New Haven, CT, USA
           
BACKGROUND: The Specialized Treatment Early in Psychosis (STEP) program has delivered coordinated team-based first-episode services (FES) since 2006 in New Haven. In 2015, STEP launched a 4-year early detection (ED) campaign (Mindmap), adapted from the Scandinavian TIPS approach, to shorten Duration of Untreated Psychosis (DUP) in a 10-town catchment (population 400,000). METHODS: Mindmap’s social-ecological model targets demand (delays in identifying illness and help-seeking) and supply (delays in referring to and providing FES) side constituents of DUP. Mindmap uses mass and social media messaging, professional detailing, and rapid triage of referrals. DUP is classified as the time between the onset of psychosis and initiation of antipsychotic treatment (DUP1) and FES care (DUP2). A control FES (PREP, Boston) supports the quasi-experimental design. The campaign was launched in 2015, after a one-year baseline. A selective interim analysis follows. RESULTS: The number of help-seeking attempts (HSAs) varied between 1-24, without a statistically significant reduction at STEP: median (Quartile 1- Quartile 3): 2 (1-3) at baseline vs. 1 (1-2) at 32mos (p=0.19). DUP1 trended downward at STEP: median (Q1-Q3):  153 (17 – 339) days at baseline to 40 (15-141) days at 32mos (p=0.06). No significant reduction in DUP2 at STEP is yet evident: median (Q1-Q3): 332 (52 – 521) days at baseline to 184 (62-470) days at 32mos (p=0.70). At PREP both DUP1 & DUP2 remain unchanged and comparable to baseline levels at STEP. CONCLUSION: Mindmap has shown promise in reducing delays to care. Additional measures of impact with comparisons across sites will be presented.


Speakers

Monday October 8, 2018 3:10pm - 3:30pm
American Ballroom-South Westin Copley Place, fourth floor

3:20pm

Oral 3, Talk 4. "NYC START, A New Model for Securing Needed Services for People Hospitalized with Early Psychosis"
Daniel Anderson1, Tsering Choden1, Tracy Sandseth1, Tricia Teoh1, Susan Essock2, Myla Harrison1; 1New York City Department of Health and Mental Hygiene, 2Columbia University
               

Objective: The New York City (NYC) Board of Health amended the City’s Health Code, requiring that hospitals report to the Department of Health and Mental Hygiene when individuals aged 18 - 30 are hospitalized for a first episode of psychosis (FEP).  This study describes the implementation of NYC START, a program that meets patients while hospitalized to enroll in and provide a voluntary 3-month critical time intervention services utilizing social workers (SWs) and peer specialists (PSs) to connect individuals hospitalized with FEP to appropriate community mental health services post-discharge.  Methods: Program staff service logs were summarized to determine mean number of contacts per week received by clients over time, types of services provided by SWs and PSs, survival analyses of time to discharge from NYC START, and connection rates with community mental health services.  Results: Of the 285 clients who accepted NYC START services in 2016, 222 (78%) completed at least three months of the program.  Contacts were most frequent in clients’ first week in NYC START with a mean of 2.5 ± 1.4 contacts, 1.9 of which were with SWs and 0.5 of which were with PSs. SWs provided a mean of 17.3 ± 4.4, and PSs provided a mean of 8.5 ± 3.5 client-specific activities per week.  Overall, 249 clients (87%) attended an initial mental health appointment after hospital discharge while receiving care coordination services from NYC START.  Conclusions: NYC START serves as a critical time intervention to connect people hospitalized with FEP to community mental health treatment.


Speakers

Monday October 8, 2018 3:20pm - 3:30pm
St. George AB Westin Copley Place, third floor

3:20pm

Oral 4, Talk 4. "Risk of first episode psychosis amongst first generation migrants in an Australian cohort"
Brian O'Donoghue1,2,3, Linglee Downey1,2, Scott Eaton1,2, Aswin Ratheesh1,2,3, Patrick McGorry1,2; 1Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 2Centre for Youth Mental Health, University of Melbourne, Australia, 3Orygen Youth Health, Melbourne, Australia
               
Background: Certain migrant groups have an increased risk of psychosis compared to the native population, however the majority of these studies have originated from Europe and the Americas and it is not yet known whether migrants to Australia have an increased risk of developing a psychotic disorder.   Objectives: This study aims to determine the incidence rate of treated first-episode of psychosis (FEP) in a defined catchment area of north-west Melbourne in young people aged 15 to 24 years; whether first-generation migrants have an increased risk of developing a psychotic disorder; and to establish whether migrants from certain countries have an increased risk of psychosis. Methods: A retrospective epidemiological cohort study was conducted at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne and included all young people aged 15 to 24 with a first episode of psychosis between 01.01.2011 and 31.12.2013. The at-risk population was determined from census data and incidence rates and incidence rate ratios were calculated. Findings: A total of 527 individuals with FEP were included, 393 were Australian-born (74.6%) and 134 (25.4%) were first-generation migrants. Migrants from Kenya (IRR=9.81), Ethiopia (IRR=5.17), Somalia (IRR=3.78), and Sudan (IRR=3.57), had significantly increased risk of having a psychotic disorder. Conversely, migrants from India and China had significantly decreased risk of having psychosis.  Conclusions: First-generation migrants from East Africa and the Horn of Africa have significantly high rates of psychosis. Migrants from these countries may have faced substantial stressors pre-, during, and post-migration, predisposing them to psychosis.


Speakers
BO

Brian O'Donoghue

Orygen, The National Centre of Excellence in Youth Mental Health


Monday October 8, 2018 3:20pm - 3:30pm
St. George CD Westin Copley Place, third floor

3:30pm

Oral 3, Talk 5. "Promoting strength, resilience and self-compassion in persons with psychosis: A systematic review and meta-analysis of positive interventions"
Jens Einar Jansen1,2, John Gleeson3, Sarah Bendall4,5, Miguel Alcazar-Corcoles6, Simon Rice4,5, Erik Simonsen2,7, Patrick McGorry4,5, Mario Alvarez-Jimenez4,5; 1Mental Health Center Copenhagen, Capital Region, Copenhagen, Denmark, 2Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark, 3School of Psychology, Australian Catholic University, Melbourne, Australia, 4Centre for Youth Mental Health, The University of Melbourne, Australia, 5Orygen: the National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 6Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid (UAM), Spain, 7Institute of Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Denmark
               
Background: Recent years have seen a renewed optimism regarding recovery in persons with psychosis. However, it has been argued that interventions aimed at reducing symptoms and dysfunction not necessarily leads to improvements in resilience, well-being and more subjective forms of recovery, which may be associated with more complete and enduring recovery.  Objective: A systematic review and meta-analysis of the effects of specific positive psychology interventions for people with schizophrenia spectrum disorders.  Methods: A systematic literature search according to the PRISMA guidelines using relevant databases and manual searches. The outcome measures used were positive emotions, compassion, mindfulness and subjective well-being. Interventions included individual therapy, group training and group therapy. Results: Twelve studies, comprising 411 persons with a schizophrenia spectrum disorder met inclusion criteria. For controlled studies, overall between- group Hedge’s g was 0.67 (p < .001, 95% CI = 0.33 – 1.02). For uncontrolled studies there was an overall pre-post Hedge’s g of .44 (p < .001, 95% CI = 0.19 – 0.69). Heterogeneity was low to moderate, but there were important variations in terms of methodological quality.    Conclusion: The positive psychology interventions showed promise in increasing positive emotions, positive behaviors, or positive cognitions for persons with schizophrenia spectrum disorders. However, notable methodological limitations and heterogeneity needs to be taken into consideration when interpreting the findings, and more controlled studies are needed. This warrants further research into the mechanisms by which these interventions can promote recovery beyond symptom reduction and thus expand on existing evidence-based interventions.



Monday October 8, 2018 3:30pm - 3:40pm
St. George AB Westin Copley Place, third floor

3:30pm

Oral 4, Talk 5. "Incidence of first episode of psychosis in an Australian cohort and the association with neighbourhood characteristics"
Brian O'Donoghue1,2,3, Scott Eaton1,2, Linglee Downey1,2, Aswin Ratheesh1,2,3, Patrick McGorry1,2; 1Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 2Centre for Youth Mental Health, University of Melbourne, Australia, 3Orygen Youth Health, Melbourne, Australia
               
Background: The incidence of psychotic disorders varies between geographical areas and is associated with neighbourhood characteristics. However, the research to date has been mainly confined to Northern European and North American populations. This study will determine whether the incidence of first episode psychosis (FEP) is associated with neighbourhood characteristics, specifically social deprivation, unemployment, social fragmentation and social capital.  Methods: This study was conducted at the Early Psychosis Prevention and Intervention Centre (EPPIC) which provides specialist treatment to all young people aged 15-24 diagnosed with a FEP residing in a defined geographical catchment area within western and northwestern Melbourne. Census data was used to code postcodes for neighbourhood characteristics and determine the at-risk population of people aged 15-24 living within the catchment area. Incidence rate ratios were calculated. Results: 527 young people treated for a FEP over a three-year period met inclusion criteria. This represents an annual incidence rate of 105.34 per 100,000 persons aged 15-24 per year. There was an increased incidence of FEP in neighbourhoods of greatest social deprivation (IRR=1.60, p=0.003), highest unemployment (IRR=1.67, p=0.001), least social capital (IRR=1.32, p=0.06) and above average social fragmentation (IRR=1.57, p=0.005). All these associations were stronger for non-affective psychoses and absent for affective psychoses. There was variation between sexes, with association only present for social fragmentation in women and social deprivation in men. Conclusion: Resources should be allocated to services according to the incidence of psychotic disorders to ensure that the expected incidence can be effectively managed.


Speakers
BO

Brian O'Donoghue

Orygen, The National Centre of Excellence in Youth Mental Health


Monday October 8, 2018 3:30pm - 3:40pm
St. George CD Westin Copley Place, third floor

3:30pm

Symposium 5, Talk 3. "Cognitive Remediation for Youth at Clinical High Risk for Psychosis"
Michelle Friedman-Yakoobian1; 1Harvard University
           
Cognitive difficulties, including deficits in psychomotor speed, memory, attention, reasoning, and social cognition are key rate-limiting factors to functional recovery from psychotic disorders.  These deficits appear to be present, in milder form, in children and adolescents who later go on to develop schizophrenia, as well as in individuals who are identified as being at clinical high risk (CHR) for psychosis.  Compelling evidence for effectiveness of psychosocial approaches to cognitive remediation in schizophrenia gives rise to the question of whether these approaches could be useful in ameliorating and/or preventing cognitive deficits in youth at CHR for psychosis.  To date, a handful of studies using various cognitive remediation approaches in individuals at CHR have begun.  This talk will provide an overview of extant literature in this area and will discuss current and future directions for the role of cognitive remediation in treatment for youth at CHR.


Speakers
MF

Michelle Friedman-Yakoobian

Harvard Medical School


Monday October 8, 2018 3:30pm - 3:50pm
American Ballroom-North Westin Copley Place, fourth floor

3:30pm

Symposium 6, Talk 3. "Tipping points – predicting transitions to mental illness and remission in at-risk young people"
Jessica Hartmann1, Marieke Wichers2, Patrick McGorry1, Barnaby Nelson1; 1Orygen, the National Centre of Excellence in Youth Mental Health, University of Melbourne, 2Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
           
With more than half of mental disorders emerging by the age of 24, it is of utmost importance to be able to predict which help-seeking young people are at greatest risk of mental health deterioration. Mental health has increasingly been conceptualised as a complex system characterised by phase transitions, preceded by early warning signals. The aim of the current study is to predict ‘tipping points’ in mental health in at-risk young people by means of an early warning signal called ‘critical slowing down’. Using ecological momentary assessment in combination with actigraphy, N=10 help-seeking young people aged 12-24 are followed for four months to capture transitions to full-threshold disorder in real-time. The young people, part of a larger cohort study, are at pluripotential risk for developing full-threshold disorder (depression, psychosis, mania and borderline personality disorder) within a short (12-month) time frame. We present on this ongoing pilot study investigating critical slowing down in psychopathology (mood states and attenuated psychotic symptoms) and actigraphy preceding transitions from at-risk state (stage 1b) to full-threshold state (stage 2) or to remission (State 0). We expect to find an increase in temporal autocorrelation at-lag-1, variance and skewness in mood states and circadian activity prior to a transition. Data collection is expected to be completed by time of presentation. This new framework may represent a paradigm shift from static prediction approaches to dynamic, individualised models of psychosis prediction and may inform the development of new clinical identification tools and early and individualised interventions to prevent such transitions.


Speakers
JH

Jessica Hartmann

Orygen, The National Centre of Excellence in Youth Mental Health


Monday October 8, 2018 3:30pm - 3:50pm
American Ballroom-Center Westin Copley Place, fourth floor

3:30pm

Symposium 7, Talk 3. "A Technology-enhanced Intervention to Reduce the Duration of Untreated Psychosis through Rapid Identification & Engagement"
Cameron S. Carter1, Tara A. Niendam1, Rachel Loewy2, Mark Savill2, Monet Meyer1, Adi Rosenthal1, Kevin Delucchi2, Tyler A. Lesh1, Haley Skymba1, Daniel Ragland1, Howard H. Goldman3, Richard L. Kravitz4; 1Department of Psychiatry, University of California, Davis School of Medicine, Sacramento, CA, USA, 2Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, CA, USA, 3Department of Psychiatry, University of Maryland School of Medicine, USA, 4Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA
           
The present cluster-randomized controlled trial assesses whether adding a novel technology-enhanced screening using the Prodromal Questionnaire-Brief version (PQ-B) to standard provider education identifies more individuals with first episode psychosis (FEP), earlier in their illness. Twenty-two sites were randomized within 3 strata [community mental health, CMH (N=10), middle/high schools, SCH (N=8), primary care, PC (N=4)] to an Education alone (TAU) vs Education + Electronic Screening (Active)]. Active sites screened individuals ages 12-30 referred those who passed a liberal PQ-B cut off score for phone evaluation. TAU sites referred individuals for phone evaluation based on clinician judgment. Phone evaluations assessed eligibility for FEP services and duration of untreated psychosis (DUP).  Active sites effectively implemented electronic screening. Of the 822 individuals screened at Active sites between June 2015 and July 2017, 43.2% scored above the cutoff (mean ±SD PQ-B score=21.25±20.75).  One in 8 individuals who completed the tablet were identified with threshold psychosis. Across Active and TAU sites, 511 individuals were identified, 422 agreed to be referred, and 319 completed a phone interview: 33.23% reported attenuated and 36.68% fully psychotic symptoms.  Active sites identified significantly more individuals with threshold psychosis (p<.001) than TAU. DUP was relatively short in both groups (186 days in Active and 195 days in TAU). No difference in days of DUP was observed across arms. Preliminary results show the feasibility of electronic screening across various community settings and a 3.5 times higher identification rate for electronic screening of self-reported psychosis spectrum symptoms than clinician-based identification alone.


Speakers
CS

Cameron S. Carter

University of California, Davis School of Medicine


Monday October 8, 2018 3:30pm - 3:50pm
American Ballroom-South Westin Copley Place, fourth floor

3:40pm

Oral 3, Talk 6. "Opening the Curtains for Better Sleep in Psychotic Disorders"
Elizabeth Ann Barrett1, Sofie Ragnhild Aminoff1,2, Carmen Simonsen1, Kristin Lie Romm1,2; 1Division of Mental Health and Addiction, Oslo University Hospital Trust, Norway, 2NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital & University of Oslo, Norway.
               
Sleep disturbances are prevalent in psychotic disorders and have negative effects on symptoms, cognition, functioning, and well-being. Disturbed sleep may contribute to the onset of psychosis and is thus an important target for early intervention. Patients welcome sleep treatment, but knowledge about the use of evidence-based sleep interventions is lacking. This study aimed to investigate clinicians’ views on sleep disturbances and their use of assessment and treatment approaches in psychotic disorders. An online survey was emailed to clinicians in in- and outpatient mental health clinics. A total of 203 clinicians working with patients with psychotic disorders completed the survey. All clinicians reported sleep problems in this patient group. The most prevalent sleep complaints were insomnia (87%), circadian rhythm disorders (87%) and hypersomnia (48%). A vast majority of clinicians thought that sleep disturbances had negative effects on patients’ mood, symptoms, and functioning, and that sleep disturbances and psychotic symptoms exacerbate each other. As many as 77% of the clinicians assessed sleep problems by informal dialogue, instead of using structured assessment tools. The most prevalent interventions were sleep hygiene (88%) and medications (86%). Antipsychotics (34%) and antihistamines (29%) were most commonly used. However, recommended interventions like light therapy for circadian rhythm disorders (8%) and CBT for insomnia (19%) were rarely used. Recurrent obstacles to improve sleep were patients’ non-adherence to treatment and clinicians’ lack of knowledge about sleep interventions. In conclusion, clinicians acknowledge the importance of sleep in psychotic disorders. However, sleep problems are assessed informally, and evidence-based interventions are used infrequently.



Monday October 8, 2018 3:40pm - 3:50pm
St. George AB Westin Copley Place, third floor

3:40pm

Oral 4, Talk 6. "A global systematic review and meta-analysis of the incidence of psychotic disorders"
Hannah Jongsma1, Caitlin Turner2, Peter Jones1,3, James Kirkbride4; 1Department of Psychiatry, University of Cambridge, Cambridge, England, 2Cambridge Institute of Public Health, University of Cambridge, Cambridge, England, 3CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, England, 4PsyLife Group, Division of Psychiatry, UCL, London, England
               
Incidence rates of psychotic disorders are known to vary between settings. Research interest in studies investigating this has increased substantially, also outside Northwestern Europe, North America and Australia where research efforts were traditionally concentrated. It is therefore timely to synthesize incidence findings in a new systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase and Web of Science databases, and included studies published between 2002 and 2017 if they reported original data on the incidence of non-organic adult-onset psychotic disorders. Quality of the yield was assessed. Data were synthesized by narrative review, and heterogeneity assessed. Data were evaluated by visual interpretation of funnel plots and univariate random-effects meta-analysis. Our search yielded 183 citations for inclusion in the review. Preliminary results suggest that heterogeneity was high: incidence of psychotic disorders varied ten-fold (incidence rates from 6.3 to 58.6 per 100,000 person-years) across settings. Incidence appeared to be higher in men (incidence rate ratio [IRR]:1.5 (95%CI:1.3-1.7), in migrants and their descendants (IRR:2.1, 95%CI:1.8-2.3) and in younger age groups. Rates of non-affective disorder varied from 1.4 to 76.7 per 100,000 person-years and followed similar demographic patterns. Rates of affective disorder varied from 0.7 to 16.9 per 100,000 person-years, and didn’t differ by sex (IRR:1.0, 95%CI:0.8-1.2). Insufficient citations were available to synthesize results by age group and migrant status. Only 23 citations were (partially) conducted in Latin and South America, Asia, Africa and the Middle East, underscoring the need to carry out research in non-Western settings. Full results will be presented at the conference.


Speakers

Monday October 8, 2018 3:40pm - 3:50pm
St. George CD Westin Copley Place, third floor

3:50pm

Oral 3, Talk 7. "Time Required by Supported Education and Supported Employment Services for Individuals in Early Psychosis Treatment"
Jennifer Humensky1,2, Luana Turner3, Lisa Dixon1,2, Keith Nuechterlein3; 1Columbia University, 2New York State Psychiatric Institute, 3University of California Los Angeles
               
Background: The Individual Placement and Support (IPS) model of supported education and employment is effective in improving vocational outcomes, and the use of IPS in early psychosis treatment is increasing. Little is known about the time use, and correspondingly cost, required to conduct effective IPS. Methods: We reviewed chart records of IPS services provided in a UCLA early psychosis intervention from 2000 to 2006. The total minutes spent per client and the frequency of individual services were recorded. We analyzed differences between supported education and employment services, using linear regression and population-averaged random effects models. N=44 used IPS services. Results: N= 26 used IPS for supported education, 16 for supported employment and 2 for both. On average, the IPS specialist spent 97 (SD 60) minutes per client per week: 88 (SD 58) for supported employment and 101 (SD 60) for supported education, p<0.05.  Overall, 47% (46/97 minutes) were spent in direct contact, 14% (14/97) indirect contact, 15% (15/97) talking with treatment team, 14% (14/97) supervision and 33% (33/97) driving. Total time required per visit did not change significantly over the first year, but was significantly lower in the second year. Supported education required a greater variety of tasks than supported employment. Conclusions: IPS services required an average of 97 minutes per client per week, with about half in direct patient contact. Overall, supported education requires more time per visit and a greater variety of tasks than supported employment. Programs implementing IPS should effectively budget for the range of tasks required.


Speakers
JH

Jennifer Humensky

Columbia University


Monday October 8, 2018 3:50pm - 4:00pm
St. George AB Westin Copley Place, third floor

3:50pm

Oral 4, Talk 7. "Teen Suicide and Psychosis"
Jimmy Choi1, Jennifer Callaghan1, Melissa Deasy1, Linda Durst1, David Tolin1, Michael Stevens1, Godfrey Pearlson1; 1The Institute of Living at Hartford Hospital, Hartford, Connecticut, USA
               
The risk for self-harm in teenagers experiencing psychotic symptoms is an urgent clinical matter, as adolescents in this population are at much greater risk for suicide compared to the same group in the general population.  Researchers have called for investigations into clinical markers specific to psychosis and this age group in hopes of developing therapeutic targets to mitigate suicide risk. In this cross-sectional study, we examined the prevalence of suicidality and predictors associated with recent suicidal ideation and past attempts in 58 adolescents ages 12 to 18 enrolled in the Connecting Adolescents with Psychosis (CAP) Program, an intensive day program for youth diagnosed with psychotic spectrum disorders. Results: Similar to other studies in this young population, a little more than half (n=30) reported mild to moderate suicidal ideation at intake, with nearly a third reporting a past attempt (n=19).  Teenagers who endorsed delusions were 5 times more likely to endorse suicidal ideation (odds ratio[OR]=5.22; 95% CI, 3.27-9.81; p<0.01), while those with obsessive-compulsive symptoms were almost 4 times more likely to do so.  Teenagers who endorsed “not true” on item 6 of the Maryland Assessment of Recovery Scale (“I feel accepted as who I am”) were 12 times more likely to report suicidal ideation. Notably, teenagers who endorsed all three items--delusions, OCD symptoms, and not feeling accepted by others--were 31 times more likely to endorse SI and report at least one past suicide attempt. Delusions, OCD symptoms, and perceptions of identity were robust predictors of suicide risk in teenagers with psychosis.


Speakers

Monday October 8, 2018 3:50pm - 4:00pm
St. George CD Westin Copley Place, third floor

3:50pm

Symposium 5, Talk 4. "Antidepressant Medication Use in Attenuated Psychosis Syndrome: Community Selection and Outcome"
Scott Woods1, Jean Addington2, Carrie Bearden3, Kristin Cadenhead4, Tyrone Cannon1, Barbara Cornblatt5, Daniel Mathalon6, Diana Perkins7, Larry Seidman8, Ming Tsuang4, Elaine Walker9, McGlashan Thomas1; 1Yale University, 2University of Calgary, 3UCLA, 4UCSD, 5Zucker Hillside Hospital, 6UCSF, 7UNC, 8Harvard University, 9Emory University
           
Antidepressants (ADs) are commonly used in DSM-5 Attenuated Psychosis Syndrome (APS) and other clinical high-risk syndrome (CHR) patients (Woods et al Schizophr Res 2013), but there is a dearth of efficacy data. The observational NAPLS-2 study offered an opportunity to investigate outcomes of community practice in this population. NAPLS-2 CHR patients were evaluated at baseline and six-monthly intervals with the Scale Of Psychosis-risk Symptoms (SOPS), SCID, the Calgary Depression Scale for Schizophrenia (CDSS), and the Global Assessment of Functioning (GAF). Six-month outcomes were described according to a “course specifier” classification (Woods et al Schizophr Res 2014). 360 CHR patients enrolled in the first half of NAPLS-2; 106 met APS criteria, were AD-naive at baseline, and completed 6-month assessment. 27 of these began AD during the first six months; average AD duration was 3.1±2.5 months. AD starters had higher baseline scores on CDSS (p<0.001) and were somewhat more likely to have comorbid current major depression (p=0.105). Six-month outcomes for AD starters vs nonstarters were: psychosis 4 vs 10%, progression 52 vs 53%, persistence 30 vs 19%, and remission 15 vs 18% (gamma=0.134, p=0.466). CDSS change did not differ between groups (F=0.1, p=0.806), nor did SOPS or GAF scores. Available data from the full NAPLS-2 and partial NAPLS-3 samples will be presented. Community selection of APS patients to begin AD medication appeared driven by depression severity and diagnosis, but AD starts seemed to confer little benefit. Randomized studies are needed.


Speakers
SW

Scott Woods

Yale University


Monday October 8, 2018 3:50pm - 4:10pm
American Ballroom-North Westin Copley Place, fourth floor

3:50pm

Symposium 6, Talk 4. "Mirorr Mirorr on the wall, who’s the most ‘at risk’ of all?"
Johanna Wigman1, Sanne Booij1; 1Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
         
 Background: Course and outcome of early psychotic symptoms are difficult to predict, hampering timely intervention. Research relies heavily on diagnostic categories, group-level comparisons and assessment of static symptom levels. However, symptoms may wax, wane, change individually or cross diagnostic borders. Adding a more personalized as well as a more transdiagnostic dimension to the model may provide a valuable step forwards.  Methods: The new Mirorr study investigates this. Mirorr follows N=100 individuals (age 18-35), divided over four subgroups with increasing psychopathological severity (i.e. subsequent clinical stages). Mirorr is a diary study, assessing a broad range of transdiagnostic symptoms for 90 consecutive days that are then mapped into individual networks of interacting symptoms.  Comparison of these networks across different stages as well as within-person comparison of symptom networks over time are investigated. Network characteristics will be used to predict clinical and functional outcome after one, two and three years. Mirorr is currently running and results of the study so far will be presented.  Results: Preliminary results indicate differences in symptom networks between subgroups. Characteristics of these symptom networks of individuals in different clinical stages will be presented, and associations with psychopathology and functioning. Of particular interest are structure (e.g. density) of the symptom networks, differences therein and the specific role of psychotic experiences.  Discussion: Research and clinical practice may benefit from a more personalized, dynamic, transdiagnostic perspective. Mirorr exemplifies how this may help to capture the complex nature of psychopathology and its development.


Speakers
JW

Johanna Wigman

University Medical Centre Groningen (UMCG)


Monday October 8, 2018 3:50pm - 4:10pm
American Ballroom-Center Westin Copley Place, fourth floor

3:50pm

Symposium 7, Talk 4. "Pathways to Care for Young Adults with First Episode Psychosis in a Coordinated Specialty Care Program"
Leslie Marino1,2, Melanie Wall1,2, Jennifer Scodes1,2, Hong Ngo1,2, Ilana Nossel1,2, Iruma Bello1,2, Thomas Smith1,2, Lisa Dixon1,2; 1Columbia University Medical Center, 2New York State Psychiatric Institute
           
PURPOSE: Substantial research has demonstrated that a longer duration of untreated psychosis (DUP) is associated with poorer outcomes among young adults with early non-affective psychosis. As federal funding has expanded access to evidence-based coordinated specialty care (CSC) in the US, little is known about factors influencing the pathway to care and DUP in non-research treatment settings. This study explores the pathway to care and predictors of time to OnTrackNY, New York state’s CSC program.  METHODS: The sample includes 779 individuals ages 16-30 within two years of onset of non-affective psychosis enrolled in OnTrackNY at 19 sites as of September 2017. Multivariate analyses tested the association between the primary outcome of time from onset of psychosis to intervention (OnTrackNY) and a comprehensive list of predictors within the admission assessment domains of demographic and clinical characteristics; social and occupational functioning; suicidality/violence/legal problems; service utilization; family characteristics; and prior mental health contacts.  RESULTS: The mean time to treatment was 231.18 days (SD=187.66) with a median of 169 days (5.63 months). In multivariate analyses, current school participation (p=.005) and at least one psychiatric hospitalization (p<.001) were associated with shorter time to intervention, whereas when first service contact is hospitalization (p=.006) or an outpatient visit (p<.001), compared to ER visit, time to intervention is longer. CONCLUSIONS: Engagement in school and the early mental health service contacts can predict the pathway to care and time to early intervention services in a cohort of young adults with early psychosis. This has implications for efforts to reduce DUP.


Speakers
LM

Leslie Marino

Columbia University Medical Center, New York State Psychiatric Institute


Monday October 8, 2018 3:50pm - 4:10pm
American Ballroom-South Westin Copley Place, fourth floor

4:00pm

Oral 3, Talk 8. "The Role of Supported Education and Employment in Promoting Engagement For Young People with Early Psychosis in the OnTrackNY Program"
Jennifer Humensky1,2, Lisa Dixon1,2; 1Columbia University, 2New York State Psychiatric Institute
               
Background: Early intervention services provide access to coordinated services for young people with early psychosis. A key component is access to supported education and employment (SEE) services, which are generally not available in standard outpatient mental health treatment. Previous studies have shown that employment is a primary goal for young people in early psychosis treatment and, in qualitative interviews, participants stated that access to SEE services is a key motivator for program engagement. We examine predictors of SEE use and whether SEE use was associated with greater use of OnTrackNY services in subsequent time periods.  Methods: OnTrackNY serves individuals ages 16-30 who are within two years of a first episode of psychosis. Assessment and service utilization data are collected at admission, quarterly, and discharge (n=779). Analyses utilized generalized estimating equations (population averaged models). Results: Predictors of using the SEE specialist included having lower work/school participation at admission (OR: 0.62 [95% CI: 0.44-0.87]), younger age (OR: 0.91 [95% CI: 0.86-0.97]), and not being prescribed antipsychotic medication (OR: 0.59 [95% CI: 0.40-0.87]). Use of the SEE specialist was associated with higher odds of engaging any team members in the subsequent period (OR:8.77 [95% CI: 1.76-43.58]); visits with no other team member were significantly associated with probability of subsequent engagement. Models control for time in program, program site, gender, age, race/ethnicity, educational attainment, education/employment participation and symptoms at admission, duration of untreated psychosis, substance use and medication adherence. Conclusion: Access to SEE specialists is an important lever for engagement in early psychosis treatment.


Speakers
JH

Jennifer Humensky

Columbia University


Monday October 8, 2018 4:00pm - 4:10pm
St. George AB Westin Copley Place, third floor

4:00pm

Oral 4, Talk 8. "Violence in First-Episode Psychosis Patients: What Do We Know?"
Oliver Gil1, Amal Abdel-Baki1,2, Alexandre Dumais1,3; 1Université de Montréal, 2Clinique des Jeunes Adultes Psychotiques, Centre Hospitalier de l'Université de Montréal, 3Institut Universitaire en Santé Mentale de Montréal
               
Introduction: Very few studies have been conducted to investigate the prevalence of  of violent behaviour (VB) and factors associated with  it, in FEP patients before and after treatment initiation. Objective:  To describe the prevalence before and after treatment initiation, factors associated to VB, and the evolution of violence in first-episode psychosis (FEP)  Methods: Systematic literature review performed using Pubmed with the following key words:  [first episode psychosis OR first episode schizophrenia OR early psychosis OR early schizophrenia] AND [violence OR aggression OR assault OR battery OR homicide OR criminality].  Some additional studies were located by hand searching the reference lists of included studies. Inclusion criteria: FEP population or results presented for the sub-group of FEP, VB prevalence, VB evolution, VB measures, factors associated with VB, Results: Of the 707 articles responding to search criteria, 22 articles were retained.  The prevalence of VB before and at admission /after treatment initiation varies between 6.7 - 67.5% / 9.4 - 31.0%. Variable methodologies (eg. various definitions of VB, different measures,, populations, etc) could explain these discrepancies. Some factors were repeatedly associated with VB such as male gender, young age, unemployment, drug use, past violence, manic symptoms. Most studies have a follow-up duration of less than 3 years. Conclusion: Though the association between untreated first-episode psychosis and violence is well established, more longitudinal data pertaining to the long term evolution and factors associated with VB, following the initiation of treatment, is needed.


Speakers

Monday October 8, 2018 4:00pm - 4:10pm
St. George CD Westin Copley Place, third floor

4:10pm

Oral 3: Q&A
Question & Answer period.

Speakers
TL

Tania Lecomte

Université de Montréal, Canada


Monday October 8, 2018 4:10pm - 4:15pm
St. George AB Westin Copley Place, third floor

4:10pm

Oral 4: Q&A
Question and answer period.

Speakers
GK

Golam Khandaker

University of Cambridge


Monday October 8, 2018 4:10pm - 4:15pm
St. George CD Westin Copley Place, third floor

4:10pm

Symposium 5: Q&A
DISCUSSANT

Speakers
avatar for Matcheri Keshevan

Matcheri Keshevan

IEPA Chair, Harvard University
Matcheri S. Keshavan, M.D.Stanley Cobb Professor of PsychiatryHarvard Medical SchoolVice-Chair of PsychiatryBeth Israel Deaconess Medical CenterBoston, MADr. Keshavan is a licensed physician and board certified psychiatrist, and is Professor of Psychiatry in the Department of Psychiatry... Read More →


Monday October 8, 2018 4:10pm - 4:15pm
American Ballroom-North Westin Copley Place, fourth floor

4:10pm

Symposium 7: Q&A
DISCUSSANT

Speakers
ST

Susan T. Azrin

National Institute of Mental Health


Monday October 8, 2018 4:10pm - 4:15pm
American Ballroom-South Westin Copley Place, fourth floor

4:10pm

Sympsoium 6: Q&A
DISCUSSANT

Speakers
BN

Barnaby Nelson

Orygen, The National Centre of Excellence in Youth Mental Health


Monday October 8, 2018 4:10pm - 4:15pm
American Ballroom-Center Westin Copley Place, fourth floor

4:15pm

15 minute Break
Monday October 8, 2018 4:15pm - 4:30pm
American Ballroom Westin Copley Place, fourth floor

4:30pm

Oral Session 5: SERVICE DELIVERY

Monday October 8, 2018 4:30pm - 6:00pm
St. George AB Westin Copley Place, third floor

4:30pm

Oral Session 6: NEUROIMAGING

Monday October 8, 2018 4:30pm - 6:00pm
St. George CD Westin Copley Place, third floor

4:30pm

Symposium Session 10: CAREER DEVELOPMENT: KEY FOR RECOVERY IN YOUNG PEOPLE WITH FIRST EPISODE PSYCHOSIS BUT CAN AN INTEGRATED IPS MODEL OF SUPPORTED EDUCATION AND EMPLOYMENT WORK?
The exploration of career goals is a natural part of youth development, yet this period is often delayed and even bypassed for many young people who experience psychosis. Further, how can a career come to fruition without the corresponding educational attainment? Thus, focusing on supported education (Sed), as part of career development and recovery is an essential next step in early intervention. The Individual Placement and Support (IPS) Model is the most evidenced-based model of supported employment. Accordingly, testing the integration of Sed within this model has merit. At IEPA 10 in Milan, Italy an international pilot study was formed to assess the feasibility and validity of an integrated fidelity scale for supported employment and education (SEE) using the current IPS fidelity scale. This symposium will, first, report on the preliminary results of this collaboration including the successes and challenges. Second, it will report on potential reasons for poorer outcomes using IPS for Sed, validity issues regarding the adapted integrated scale, and possibilities for improving validity. Third, it will describe the coordination of the international collaboration between Norway, The Netherlands, Australia, Iceland, the U. K., Germany, Chile and the U. S. while navigating different public policy and regulations. Finally, this symposium aims to highlight the importance of collaboration to improve career outcomes and recovery in first episode psychosis. To conclude, there will be a discussant period at the end exploring future directions of Sed and relevant clinical needs to help youth effectively reach their career goals.


Monday October 8, 2018 4:30pm - 6:00pm
American Ballroom-South Westin Copley Place, fourth floor

4:30pm

Symposium Session 8: EARLY INTERVENTION IN BIPOLAR DISORDER
Bipolar Disorder can be a serious, ongoing and recurrent mental health difficulty that can impact considerably on individuals, families and society. This symposium will focus on some of the challenges presented while working with individuals that have this diagnosis, while focussing also on the significant potential opportunities of early intervention with this population. Specific challenges to early intervention work in bipolar disorder include; lack of guidelines for early intervention, difficulties in the development of engagement and insight, and limitations to the evidence base for psychosocial therapies for this population. However, the symposium will also discuss the development of guidelines for early intervention in bipolar disorder, techniques to improve insight and engagement, and the development of RECOVER, a randomised controlled trial of a specialised psychological intervention for bipolar disorder.

Speakers
PC

Philippe Conus

Lausanne University
SC

Sue Cotton

Centre for Youth Mental Health, The University of Melbourne
AR

Aswin Ratheesh

Orygen Youth Healh


Monday October 8, 2018 4:30pm - 6:00pm
American Ballroom-North Westin Copley Place, fourth floor

4:30pm

Symposium Session 9: YOUTH AT RISK FOR SERIOUS MENTAL ILLNESS: THE CANADIAN PSYCHIATRIC RISK AND OUTCOME STUDY (PROCAN)
In the early psychosis field there has been a major focus on those at clinical high risk for psychosis. Despite the fact that the majority of mental illnesses arise in youth, and early treatment of mental health issues is vital to reducing poor outcomes, less attention has been paid to understanding the risk for serious mental illness (SMI), which includes psychotic disorders, bipolar disorder and recurrent major depression. The Canadian Psychiatric Risk and Outcome Study (PROCAN) is a longitudinal study investigating the clinical, social, and neurobiological factors that may lead to SMI in youth, with the aim of developing an algorithm that can predict which youth will move from undifferentiated symptoms to a diagnosable mental illness. PROCAN is currently following 243 young people (aged 12-25) who may be at risk for the later development of SMI. This symposium will present various aspects of PROCAN. The first talk presents the staging model developed by McGorry and Hickie, used in PROCAN and the recruitment and retention strategies to identify these young at-risk individuals. The second talk presents the baseline differences in clinical symptomatology, neurocognition and social and role functioning between youth in the different stages and how they compare to healthy controls. The third talk discusses the impact of familial relationship styles on mental health and examines the stage-related differences in family functioning and communication. The fourth talk outlines the functional brain imaging measures that have been used in PROCAN and presents data outlining differences in brain activity at baseline.


Chair
PM

Paul Metzak

University of Calgary
OS

Olga Santesteban-Echarri

University of Calgary

Speakers
JA

Jean Addington

University of Calgary


Monday October 8, 2018 4:30pm - 6:00pm
American Ballroom-Center Westin Copley Place, fourth floor

4:35pm

Oral 5, Talk 1. "Implementation of UHR clinical guidelines in England"
Helen Stain1, Lauren Mawn2, Stephanie Common3, Marie Pilton4, Andrew Thompson5; 1Leeds Trinity University, 2Newcastle University, United Kingdom, 3Tees Esk Wear Valleys NHS Foundation Trust, Durham, United Kingdom, 4Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom, 5University of Warwick, United Kingdom
               
Aim Evidence from meta-analyses of randomised clinical trials show interventions for young people at ultra high risk (UHR) of developing psychosis are effective both clinically and economically. While research evidence has begun to be integrated into clinical guidelines, there is a lack of research on the implementation of these guidelines. This paper examines service provision for UHR individuals in accordance with current clinical guidelines within the National Health Service (NHS) in England. Method A self-report online survey was completed by clinical leaders of Early Intervention in Psychosis (EIP) teams (N=50) within the NHS across the UK. Results Of the 50 EIP teams responding (from 30 NHS Trusts), 53% reported inclusion of the UHR group in their service mandate, with age range predominantly 14-35 years (81%) and service provided for at least 12 months (53%). Provision of services according to NICE clinical guidelines showed 50% of services offered cognitive behavioural therapy (CBT) for psychosis, and 42% offered family intervention. Contrary to guidelines, 50% of services offered antipsychotic medication. Around half of services provided training in assessment by CAARMS, psycho-education, CBT for psychosis, family work and treatment for anxiety and depression. Conclusions Despite clear evidence for the benefit of early intervention in this population, current provision for UHR within EIP services in England does not match clinical guidelines. While some argue this is due to a lack of allocated funding, it is important to note the similar variable adherence to clinical guidelines in the treatment of people with established schizophrenia.


Speakers
HS

Helen Stain

Leeds Trinity University


Monday October 8, 2018 4:35pm - 4:45pm
St. George AB Westin Copley Place, third floor

4:35pm

Oral 6, Talk 1. "Correlations of Increased Oxidative Stress with Altered Brain Structure in First-Episode Antipsychotic-Naive Patients with Schizophrenia"
Jeffrey K. Yao1,2,3, Paulo L. Lizano4, Xiang Zhou1,3, Ravinder D. Reddy5, Gretchen L. Haas1,2, Debra M. Montrose2, Olivia Lutz4, Kiranpreet Dhaliwal4, Matcheri S. Keshavan2,4; 1VA Pittsburgh Healthcare System, Pittsburgh, PA, 2University of Pittsburgh School of Medicine, Pittsburgh, PA, 3University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 4Beth Israel Deaconess Medical Center and Harvard University, Boston, MA, 5University of California San Diego, San Diego, CA
               
In human plasma, levels of total antioxidant status (TAS) and malondialdehyde (MDA) often serve as biomarkers for studying antioxidant defense system (AODS) in psychiatric disorders. Increased oxidative stress has been linked to the schizophrenia (SZ) pathology. However, it is not clear whether changes in these peripheral markers are also related to structural changes in brain. Using enzyme immunoassay, we compared TAS and MDA in plasma among healthy controls (HC, n=62), first-episode antipsychotic-naïve patients with schizophrenia (FEAN-SZ, n=85) and patients with other first-psychosis (POFP, n=24). Comparisons were also made in frontal and temporal regional gray matter volume and thickness, white matter volume, as well as hippocampal and caudate volume between HC (TAS n=14, MDA n=10) and FEAN-SZ (TAS n=26, MDA n=23) groups using 1.5T T1-weighted MRI. In accordance with previously published data, significantly lower levels of TAS (p=0.0001) and higher levels of MDA (p=0.0111) were found in FEAN-SZ compared to HC and POFP groups. TAS levels were inversely correlated with MDA levels (p<0.0001) in all groups. In addition, brain volume/thickness trajectories were positively correlated with plasma TAS levels, but inversely correlated with plasma MDA levels in HC group. However, such correlations were not present in the FEAN-SZ group.  Together, the present data showing inverse correlations suggest that both TAS and MDA are useful biomarkers to predict homeostatic imbalance of AODS. Moreover, our MRI findings lend further support that increased oxidative stress during early course of illness may confer vulnerability to reduced brain volume/thickness in SZ patients.


Speakers

Monday October 8, 2018 4:35pm - 4:45pm
St. George CD Westin Copley Place, third floor

4:35pm

Symposium 10, Talk 1. "School-and JobPrescription: An Approach Integrating IPS for Employment and Education for People with First Episode Psychosis"
Wenche ten Velden Hegelstad1, Inge Joa1,2, Lena Heitmann3, Jan Olav Johannessen1,2, Johannes Langeveld1; 1TIPS Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway, 2Network for Medical Sciences, University of Stavanger, Stavanger, Norway, 3School and JobPrescription, Stavanger University Hospital, Stavanger, Norway
           
Background: Individual Placement and Support (IPS) is an effective intervention for supported employment (SE), however, less so for education (Sed). School and JobPrescription in Norway are part of an international collaborative adapting the original IPS intervention and fidelity scale to include Sed. Method: This study was a quasi-experimental historical matched controls (N=33+33) study with a one–year intervention and two-year follow-up.  The IPS-team was trained in educational facilities, curriculums, regulations, and financial resources and was rated on fidelity (April 2016, October 2017). Primary outcomes were hours enrolled in employment or education. Results: Thirty participants completed the intervention. SE scores remained stable (99 and 98 of 125) whilst Sed scores dropped (102 and 99 of 125). Fourteen participants (47%) attained competitive employment  >20hrs/week post intervention, compared to 2 in the control group. Fifteen (50%)were in education >20hrs/week compared to 5 (17%) in the control group. However, 1-year post termination differences had waned. The control group had attained the same level of education, however had missed one year. Conclusion: Time-unlimited support was restricted due to funding. This may explain why results waned over time.


Speakers
WT

Wenche ten Velden Hegelstad

Stavanger University Hospital


Monday October 8, 2018 4:35pm - 4:55pm
American Ballroom-South Westin Copley Place, fourth floor

4:35pm

Symposium 8, Talk 1. "Does guideline concordant care improve the outcomes for youth with early stage bipolar disorders?"
Aswin Ratheesh1,2, Ming Fang, Christopher Davey, Michael Berk3, Patrick McGorry, Sue Cotton2; 1Orygen Youth Health, 2Orygen, the National Centre of Excellence in Youth Mental Health, 3Deakin University
           
Background: Youth with early stage Bipolar Disorders (BD) typically receive care in generic mental health services or youth early psychosis services. The lack of specific guidelines for their care could lead to heterogeneous and non-standardised care. We aimed to examine whether concordance with available guidelines was associated with better outcomes over 10-24 months of prospective follow-up. Methods: We conducted a file-audit study of all participants aged 15-25 years with BD I or II referred to a tertiary youth mental health service in Melbourne, Australia between 01/01/2014 and 30/06/2015. Concordance with three guidelines were established using a checklist developed for this purpose. All items relating to youth, early stage BD and care within an early intervention service were selected. A guideline concordance score was developed for each file. The primary outcome selected was the Global Assessment of Functioning scale score at the point of discharge (10-24 months from initial referral). We propose to examine the relationship between the discharge GAF scores and guideline concordance scores using linear regressions, controlling for a) age, b) gender, c) baseline illness severity, d) baseline GAF score and e) type of BD diagnosis.  Results: Of the 90 participants selected, half had a BD I diagnosis and were treated in the early psychosis clinic, while the remaining had a BD II diagnosis and received care from the mood disorders clinic. Results from the regression analyses will be presented. The results could have implications for the development of a specific guideline for youth with early stage BD.


Speakers
AR

Aswin Ratheesh

Orygen Youth Healh


Monday October 8, 2018 4:35pm - 4:55pm
American Ballroom-North Westin Copley Place, fourth floor

4:35pm

Symposium 9, Talk 1. "Overview of and Referral Pathways to the Canadian Psychiatric Risk and Outcome Study (PROCAN)"
Kali Brummitt1, Jean Addington1; 1University of Calgary, Calgary, Alberta, Canada
           
This presentation will first present the clinical staging model used in PROCAN. Secondly, an overview of the study which includes demographics of the sample and measures used will be given. Since the project is focused on adolescents and young adults who may be presenting with mixed symptom patterns or brief or undifferentiated symptoms several months or even years before the development of a diagnosable mental illness, it is important to find ways to identify these young people early so that we can learn more about the factors that may predict later mental illness and offer early intervention. Studies in the clinical high risk for psychosis population have identified strategies on recruitment, but there is little to help with a more general at-risk population. Thus, thirdly, we will present tracking data of the referral sources of all PROCAN participants and compare them by age and by the clinical stage. Referrals were evenly split by gender and age. Most referrals, however, were in stage 1b, individuals who met criteria for an attenuated syndrome, the majority of which were referred by community mental health services. In contrast stage 1a participants with distress, mild anxiety and depression were more often self- or family referred.  Implications of referral pathways for identifying youth at risk will be discussed.


Speakers

Monday October 8, 2018 4:35pm - 4:55pm
American Ballroom-Center Westin Copley Place, fourth floor

4:45pm

Oral 5, Talk 2. "Mental Health Service Use Decision-Making Among Young Adults at Clinical High-Risk for Developing Psychosis"
Shelly Ben-David1, Andrea Cole2, Gary Brucato2, Ragy R Girgis2, Michelle R Munson3; 1University of British Columbia, 2New York State Psychiatric Institute, 3New York University
               
Research has shown high rates of underutilization of mental health services in young adults at clinical high-risk (CHR) for developing psychosis. The purpose of this qualitative study was to explore how such individuals make decisions about staying engaged with services through the application of the Unified Theory of Behavior (UTB) (Jaccard et al., 2002), a decision-making framework. Purposive sampling was utilized to recruit 30 CHR participants, ages 18-30, at the Center of Prevention and Evaluation (COPE) research clinic at the New York State Psychiatric Institute and Columbia University Medical Center. All were assessed via semi-structured interviews. Content analysis was completed by three analysts. Sample demographics included mean age 23 (SD=3.41), 60% male, 34% White, 23% Black, 20% Hispanic, 20% Bi-Racial, 3% Asian. The most salient UTB determinants which emerged from the data were behavioral beliefs, image considerations, and emotions. Most participants reported advantages of remaining engaged with services, described peers who may use the clinic as “someone who wants help”, and those peers who would choose not to access the clinic “lacking insight”, or “experiencing stigma”. Participants described positive, negative, and mixed emotional reactions when thinking about attending the clinic. Differences in UTB responses emerged depending on whether a participant was engaged in clinical services at the time of interview or just participating in research. Treatment engagement strategies that target beliefs about seeking services, image considerations, emotions, and type of engagement with services may help raise the low rates of service engagement among this vulnerable population.


Speakers

Monday October 8, 2018 4:45pm - 4:55pm
St. George AB Westin Copley Place, third floor

4:45pm

Oral 6, Talk 2. "Conditioned Hallucinations: Toward Development of Computational Markers for Early Diagnosis and Personalized Treatment"
Albert Powers1, Christoph Mathys2, Philip Corlett1; 1Yale University, 2SISSA, International Advanced Studies Institute, Trieste, Italy
               
Perception is an active process, characterized by the building of an internal model of our environment, blending incoming sensory evidence with prior beliefs.  Within this framework, hallucinations may result from increased weighting of these prior beliefs during perception. To test this, we adapted a classic sensory conditioning paradigm to functional MRI:  participants were exposed to repeated pairings of a visual stimulus with an auditory stimulus.  They subsequently reported the perception of the auditory stimulus even when it was absent, contingent on the presence of the visual—a conditioned hallucination.  We recruited four groups:  those with psychosis, both with hallucinations and without, healthy voice-hearers, and healthy controls. Conditioned hallucinations occurred with markedly increased frequency in those who had hallucinations outside the laboratory, regardless of psychosis status.  They activated tone-responsive regions of auditory cortex and other regions active during clinical hallucinations.  Computational modeling demonstrated an increased reliance on strong priors in voice-hearers (encoded by insula and superior temporal gyrus), regardless of psychosis status.  By contrast, those with psychosis, regardless of hallucination status, were slow to update beliefs (cerebellum and hippocampus). Recently published in Science, these results may signify a means of distinguishing people with hallucinations from those without, and, orthogonally, people with a need for treatment from those without.  Ongoing work focuses on applying these measures to risk stratification of people at clinical high risk of psychosis (CHR).  Preliminary data suggest this approach holds promise for early detection of illness in CHR.  Ongoing work aims to use these computational approaches hallucination-specific treatment selection.


Speakers

Monday October 8, 2018 4:45pm - 4:55pm
St. George CD Westin Copley Place, third floor

4:55pm

Oral 5, Talk 3. "Consumer and Family Perspectives on Reducing the Duration of Untreated Psychosis"
Kate Hardy1, Caroline Dickens2, Teal Mackintosh2, Erika Roach1, Vicki Harrison1, Douglas Noordsy1, Steven Adelsheim1; 1Stanford University, 2PSGP-Stanford PsyD Consortium
               
Longer duration of untreated psychosis (DUP) has been shown to have long-term deleterious effects on outcomes. In the United States, the RAISE study reported a median DUP of 74 weeks, which is far longer than the 12 weeks recommended by the World Health Organization. Research has focused on identifying factors contributing to an extended DUP and creating associated initiatives to reduce the length of time it takes for individuals to access treatment. Stigma is one of the factors seen to contribute to a delay in accessing treatment. However, there has been little exploration of the experience of stigma, and the impact of stigma on accessing treatment, as reported by consumers and family members. The Prodromal and Early Psychosis Program Network (PEPPNET) Lived Experience workgroup identified a need to explore the impact of stigma on decisions to seek care. A survey was developed and distributed through the PEPPNET listserv. This survey consisted of questions designed to elicit quantitative and qualitative data relating to the experience of accessing care at the onset of psychosis. 193 respondents completed the survey with respondents including consumers (21%), family members (70%), and other respondents (9%). Qualitative analysis yielded themes related to the impact of stigma on accessing care, stigma resulting in negative perceptions of outcomes, and approaches to reduce stigma. Results will be discussed and recommendations developed from this study, by the members of the Lived Experience workgroup, will be presented.


Speakers

Monday October 8, 2018 4:55pm - 5:05pm
St. George AB Westin Copley Place, third floor

4:55pm

Oral 6, Talk 3. "Analyses of NMDA-receptor co-agonists in serum among individuals with at-risk mental state for psychosis"
Hiromi Tagata1, Naohisa Tsujino1,2, Mayu Onozato3, Naoyuki Katagiri1, Taiju Yamaguchi1, Takahiro nemoto1, Takeshi Fukushima3, Masafumi Mizuno1; 1Toho University School of Medicine, 2Saiseikai Yokohamashi Tobu Hospital, 3Faculty of Pharmaceutical Sciences, Toho University
               
Aim: Individuals who meet the criteria for at-risk mental state for psychosis (ARMS) have a high risk of developing psychosis. However, useful predictors for the onset of psychosis in individuals with ARMS remains unclear. Therefore, the establishment of reliable biomarkers to predict development of psychosis in ARMS patients is urgently needed. Recently, N-methyl-D-aspartate (NMDA) receptor co-agonists abnormalities in serum of patients with schizophrenia have been reported. In this study, we examined NMDA-receptor co-agonists as biomarkers for the development of psychosis in individuals with ARMS. Method: We examined serum levels of NMDA-receptor co-agonists including glutamate, cysteine, glycine, γ-glutamylcysteine, glutathione, D-serine and L-serine in antipsychotic-naïve ARMS patients. We compared these levels with those in healthy controls. We also examined correlations between clinical scores and serum levels of NMDA-receptor co-agonists in individuals with ARMS. Results: A total of 24 individuals with ARMS and 42 healthy controls were enrolled in this study. The levels of γ-glutamylcysteine, glutathione and D-serine were significantly lower, but the glutamate level was higher in ARMS individuals compared to healthy controls. These results were equivalent to those of patients with schizophrenia. There were no correlations between clinical scores and serum levels of NMDA-receptor co-agonists in individuals with ARMS.     Conclusion: The present study revealed that the levels of some NMDA-receptor co-agonists of individuals with ARMS were different from those of healthy controls, and was equivalent to those of patients with schizophrenia. The detection of abnormal levels of NMDA-receptor co-agonists may be useful for early diagnosis of psychosis.


Speakers

Monday October 8, 2018 4:55pm - 5:05pm
St. George CD Westin Copley Place, third floor

4:55pm

Symposium 10, Talk 2. "Does Cognitive Remediation Enhance the Vocational Recovery of Young People with First Episode Psychosis Using Individual Placement and Support? Results of the CREW Study: A Multisite Randomized Controlled Trial in The Netherlands"
Daniëlle van Duin1,2,3, Hans Kroon2,3, Wim Veling4, Jaap van Weeghel1,3; 1Phrenos Center of Expertise, 2Trimbos Institute, 3Tilburg University, 4University of Groningen, University Medical Center Groningen
           
Background: Young people with psychosis have similar vocational ambitions as their healthy peers. However, psychosis and related problems make their vocational participation lower (Hendriksen et al, 2012). Individual Placement and Support (IPS) can improve vocational functioning in this group. However, 40-50% motivated to participate vocationally cannot succeed when offered IPS. Cognitive impairments may be one obstacle (McGurk et al., 2004). Cognitive remediation (CR) has demonstrated improvement in cognitive functioning for first episode psychosis (FEP). Some studies also indicate the efficacy of CR in daily functioning, provided that CR is combined with psychiatric rehabilitation to boost effects (Wykes et al, 2011; McGurk et al, 2007). The present multisite-study investigated whether CR can enhance the effect of vocational rehabilitation using IPS in competitive employment and mainstream education for FEP. Method: Seventy-three people with FEP either received IPS-enhanced with computerized CR (Circuits), or IPS in combination with an active control intervention (computer games). Follow-up assessments were conducted at 6 and 18 months to see whether patients improved vocationally (hours worked in regular employment or education), in cognitive functioning, symptoms, empowerment and self-stigma. Results: Preliminary results of the study will be presented.



Monday October 8, 2018 4:55pm - 5:15pm
American Ballroom-South Westin Copley Place, fourth floor

4:55pm

Symposium 8, Talk 2. "The Challenges of Engagement and Insight in Bipolar Disorder: Data and Recommendations:
Philippe Conus1; 1Centre Hospitalier Universitaire Vaudois, Switzerland 

Over the last 20 years, numerous programs for early intervention in psychosis have developed. Although their structure may differ according to the context in which they are implanted, mental health professionals working in these setting are usually faced with very similar challenges. There are globally 2 main issues to be resolved. The first one is to engage young patients, including those with a diagnosis of bipolar disorder, who are often reluctant to receive treatment. We suggest that this this can be assisted though organizational strategies, specific engagement techniques, and by providing interventions that target factors known to be linked with increased risk of disengagement. The second is to promote the development of insight, which is not only an aim but also a subtle therapeutic process. In this talk we will describe these various strategies through the example of TIPP, an early intervention program implanted in Lausanne, Switzerland in 2004. TIPP has treated more than 600 patients, over a three-year treatment period, many of whom have experienced mania, having achieved a disengagement rate of less than 5%.

Speakers
PC

Philippe Conus

Lausanne University


Monday October 8, 2018 4:55pm - 5:15pm
American Ballroom-North Westin Copley Place, fourth floor

4:55pm

Symposium 9, Talk 2. "Clinical Symptoms and Functioning of Youth at Risk for Serious Mental Illness"
Jean Addington1; 1University of Calgary, Calgary, Alberta, Canada
           
In the Canadian Psychiatric Risk and Outcome Study (PROCAN), using McGorry and Hickie’s clinical staging model, our sample included 42 healthy controls (HCs), 41 youth with a family risk of mental illness (stage 0), 52 distressed youth with mild depression and anxiety and 108 with attenuated psychiatric syndromes, the majority of whom met criteria for being at clinical high risk for psychosis. In order to determine if the criteria for these different stages were useful and made sense, the groups were first compared on a range of clinical measures and secondly on social, and neurocognitive functioning. Stage 0 participants did not differ from healthy controls on any clinical measure.  Stage 1a differed from HCs and Stage 0 in anxiety, depression, rumination, anhedonia, negative symptoms and negative beliefs about the self.  Stage 1b participants presented with significantly more severe symptoms than all other groups in anxiety, depression, anhedonia, attenuated psychotic symptoms, negative symptoms and negative beliefs about the self and from HCS and stage 0 in anhedonia and rumination. These results suggest that the clinical staging of our sample was a good fit. In terms of social functioning, Stage 1a and 1b participants both differed from the HCs and stage 0 participants. Interestingly, in examining neurocognition, only the stage 1b group differed significantly from the HCs and stage 0 participants in IQ and in the speed of processing, attention, working memory domains from the MATRICS. Thus, the staging model is further supported with neurocognitive and social functioning performance.


Speakers
JA

Jean Addington

University of Calgary


Monday October 8, 2018 4:55pm - 5:15pm
American Ballroom-Center Westin Copley Place, fourth floor

5:05pm

Oral 5, Talk 4. "The Interface Between Child and Adolescent Mental Health Services and Adult Mental Health Services in Europe: a 28 Countries Survey"
Giulia Signorini1, Giovanni de Girolamo1; 1Saint John of God Clinical Research Center, Brescia, Italy
               
The current service configuration, with distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS), is considered a weak link where the care pathway needs to be most robust and a major socioeconomic and societal challenge. In the framework of the MILESTONE project this study aims to map current services and transitional policies across Europe, highlighting current gaps and the need for innovation in care provision. An online mapping survey was directed at expert(s) in each of the 28 EU countries. The survey systematically collected data about CAMHS organization and characteristics, with a specific focus on actual national transition policies and practice.  The characteristics and activities of CAMHS (ie, availability of services, inpatient beds, clinicians and organisations, delivery of specific CAMHS services and treatments) varied considerably between countries, as did funding sources and user access. Between 25 and 49% of CAMHS service users will need transitioning to AMHS, whereas 20–30% of AMHS users aged under 30 years had previous contact with CAMHS. Written policies for managing the interface were available in only four countries and half (14/28) indicated that no transition support services were available.  This survey provides important information for the evaluation and planning of CAMHS in Europe, highlighting important areas of concern in service planning, availability of standardised outcome assessment, stakeholders’ involvement, interdisciplinary CAMHS and adult mental health care provision. The heterogeneity in resource allocation did not seem to match epidemiological burden. Policymaking on transitional care clearly needs special attention and further elaboration.


Speakers

Monday October 8, 2018 5:05pm - 5:15pm
St. George AB Westin Copley Place, third floor

5:05pm

Oral 6, Talk 4. "Lower GABA levels in Prefrontal Cortex in Individuals at Clinical High Risk for Psychosis who did not remit"
Junjie Wang1, Yingying Tang1, Tianhong Zhang1, Lihua Xu1, Huiru Cui1, Yu Li1, Zhenying Qian1, Yanyan Wei1, Yan Wang1, Xiaochen Tang1, Huan Huang1, Jijun Wang1,2; 1Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China, 2CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science
               
Objective:  We aimed to investigated whether GABA levels in clinic high risk (CHR) for psychosis were associated with subsequent clinical outcome. Method: GABA levels referenced to water were measured in the medial prefrontal cortex (mPFC) with MEGA-PRESS sequence using 3-Tesla proton magnetic resonance spectroscopy in 94 CHR participants and 52 healthy controls, the severity of prodromal psychotic symptoms and cognitive function were assessed with SIPS and MCCB, respectively. Clinical assessment was repeated in 85 CHR subjects at about one-year follow-up. The clinical outcomes of CHR subjects were remission (no longer meeting CHR criteria) and non-remission (still meeting CHR or converting to psychosis). Results: At 1 year follow up, 50 CHR subjects belong to the remission group and 35 belong to the non-remission group. The baseline GABA levels in the mPFC in the non-remission CHR were significantly lower than that in healthy control subjects (non-remission CHR vs. HC: 2.25±0.039 vs. 2.46±0.049, p =0.022), and there was no significant difference between the remission CHR and healthy control subjects (remission CHR vs. HC:2.42±0.05 vs. 2.46±0.049, p =0.10). In addition, baseline mPFC GABA levels were positively correlated to speed of processing performance in MCCB (rho =0.384,p =0.023) within non-remission CHR, which was absent in subjects at remission CHR or healthy controls subjects. Conclusions: An abnormally lower GABA level in the medial prefrontal cortex could suggest a worse prognosis among CHR subjects. The finding supported the key role of GABAergic dysfunction in the pathophysiology of developing psychosis.


Speakers

Monday October 8, 2018 5:05pm - 5:15pm
St. George CD Westin Copley Place, third floor

5:15pm

Oral 5, Talk 5. " The PEPPNET Training and Technical Assistance (TA) Workgroup: Coordinating National Training and Technical Assistance efforts in the United States"
Kate Hardy1, Tamara Sale2; 1Stanford University Department of Psychiatry and Behavioral Sciences, 2Oregon Health & Science University- Portland State University School of Public Health
               
There has been increased awareness in the United States of the need to develop specialist early psychosis services. Concurrent to this increase in awareness is dedicated federal funding to support the development of Coordinated Specialty Care (CSC) services. This recent growth has resulted in an increased demand for training and technical assistance specific to service models and interventions for early psychosis. However, associated with this increased demand is the challenge of training a workforce distributed across a large geographical area and the need to coordinate training efforts and technical assistance dissemination to avoid duplication. The Prodromal and Early Psychosis Program Network (PEPPNET) was founded in 2014 to support widespread growth of early psychosis care in the community. It consists of several different working groups all related to the dissemination and implementation of early psychosis services. The Training and Technical Assistance (TA) workgroup meets on a monthly basis and is comprised of professionals who offer training and TA nationally. The workgroup was formed in recognition of the challenges associated with widespread dissemination and the desire to coordinate training efforts to ensure sustainability. This symposium will present the National Early Psychosis Training and TA Guidelines and will highlight practices that have evolved to reduce duplication of training and TA efforts nationally. In addition, efforts to ensure sustainability of practice, as the demand for early psychosis service development continues in the United States, will be discussed.


Speakers

Monday October 8, 2018 5:15pm - 5:25pm
St. George AB Westin Copley Place, third floor

5:15pm

Oral 6, Talk 5. "Auditory Verbal Hallucinations In First Episode Psychosis – An FMRI Symptom Capture Study"
Thomas Dunne1, Pavan Mallikarjun1,2, Renate Reniers1, Baldeep Farmah5, Matthew Broome4, Femi Oyebode1,2, Stephen Wood1,3, Rachel Upthegrove1,2; 1The University of Birmingham, UK, 2Birmingham and Solihull Mental Health NHS Foundation Trust, 3The University of Melbourne, Australia, 4The University of Oxford, UK. Oxford Early Intervention in Psychosis Service, 5Worcester Health and Care NHS Trust
               
Introduction Neurobiological models of auditory verbal hallucination (AVH) have been advanced by symptom capture functional magnetic resonance imaging (fMRI), where participants self-report hallucinations during scanning. To date, regions implicated are those involved with language, memory and emotion. However, previous studies focus on chronic schizophrenia, thus are limited by factors such as medication use and illness duration. Studies also lack detailed phenomenological descriptions of AVHs. This study investigated the neural correlates of AVHs in patients with first episode psychosis (FEP) using symptom capture fMRI with a rich description of AVHs. We hypothesised that intrusive AVHs would be associated with dysfunctional salience network activity.  Methods 16 FEP patients with frequent AVH completed four psychometrically validated tools to provide an objective measure of the nature of their AVHs. They then underwent fMRI symptom capture, utilising general linear models analysis to compare activity during AVH to the resting brain.  Results Symptom capture of AVH was achieved in nine patients who reported intrusive, malevolent and uncontrollable AVHs. Significant activity in the right insula and superior temporal gyrus (cluster size 141mm3), and the left parahippocampal and lingual gyri (cluster size 121mm3), p<0.05 FDR corrected, were recorded during the experience of AVHs. Conclusions These results suggest salience network dysfunction (in the right insula) together with memory and language processing area activation in intrusive, malevolent AVHs in FEP. This finding concurs with others from chronic schizophrenia, suggesting these processes are intrinsic to psychosis itself and not related to length of illness or prolonged exposure to antipsychotic medication.


Speakers

Monday October 8, 2018 5:15pm - 5:25pm
St. George CD Westin Copley Place, third floor

5:15pm

Symposium 10, Talk 3. "Individual Placement and Support In ICELAND: Collaboration Between Landspitali University Hospital and VIRK Vocational Rehabilitation Fund"
Nanna Briem1, Hlynur Jónasson2, Hildur Ævarsdóttir1, Halldora Jonsdottir1; 1Landspitali University Hospital, Reykjavik, Iceland, 2VIRK Vocational Rehabilitation Fund, Reykjavik, Iceland
           
Background: In 2012 a project began to implement the Individual Placement & Support (IPS) model into vocational rehabilitation for young people with psychosis in Reykjavik. The study was a collaborative project between Laugarasinn; a specialized unit for early intervention in psychosis and VIRK-Vocational Rehabilitation Fund, a private foundation where all the major unions and employers of the Iceland labor market are members. In November 2013 the first client began competitive employment via IPS and the project has gradually developed into one of the most important aspects of the rehabilitation-program for young people with first onset psychosis. In the last year the project has expanded to an inpatient psychosis unit and a dual diagnosis program. Method: Eighty-seven clients have received IPS services with an IPS team of three IPS workers from VIRK and IPS supervisors from three teams at Landspitali University Hospital. Integration of supported education (Sed) services is currently underway using the original IPS fidelity scale adapted for Sed. Results: Fifty-three of 103 clients (50%) are currently receiving IPS services and preliminary results regarding outcomes from the project will be presented.


Speakers

Monday October 8, 2018 5:15pm - 5:35pm
American Ballroom-South Westin Copley Place, fourth floor

5:15pm

Symposium 8, Talk 3. "Early Intervention for Bipolar Disorder: The Role of Psychological Interventions"
Craig Macneil1, Melissa Hasty1, Kate Filia2, Aswin Ratheesh1, Philippe Conus3, Michael Berk4, Sue Cotton2,5; 1Early Psychosis Prevention & Intervention Centre, Orygen Youth Health, 35 Poplar Road, Parkville, VIC 3052, Melbourne, Australia, 2Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia, 3Treatment & Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland, 4IMPACT Strategic Research Centre, School of Medicine, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia, 5Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia, 3052
           
Bipolar disorder generally has its onset when an individual is in their late teens, a critical developmental phase. While the research evidence often suggests that outcomes can be poor in bipolar disorder, some emerging evidence indicates that psychological interventions may be at their most effective early in the course of the disorder.  This paper will report on the limited evidence base for early intervention in bipolar disorder, and describe the development of a specialised psychosocial intervention designed for young people following a first manic episode. This intervention is currently being tested in a National Health & Medical Research Council-funded, randomised controlled trail (RECOVER). Specifically, RECOVER aims to examine the efficacy of a six month, manualised psychological intervention on symptomatic and functional outcomes of young people immediately following a first manic episode. It focusses on engagement, shared formulation, balancing sleep and activity, engaging families, and supporting functioning, while also attending specifically to unhelpful schema that may maintain bipolar symptoms.  Challenges in working with this population, and developmental modifications that may be required will be discussed, while acknowledging the strengths and opportunities presented when working with young people early in the course of bipolar disorder.


Speakers

Monday October 8, 2018 5:15pm - 5:35pm
American Ballroom-North Westin Copley Place, fourth floor

5:15pm

Symposium 9, Talk 3. "Family Communication and Family Functioning in Youth at Risk for Serious Mental Illness"
Olga Santesteban-Echarri1; 1University of Calgary, Calgary, Alberta, Canada
           
Family flexibility and cohesion are at times impaired in families of first-episode psychosis patients compared to healthy controls (HCs). Furthermore, family functioning may be important even before the onset of illness. A positive family environment may be related to a decrease in symptoms and improved functioning in youth at clinical high-risk for psychosis. However, little is known about earlier stages of risk and the importance of the family environment for youth at-risk for serious mental illness (SMI).In the PROCAN study, we examined family functioning from the Circumplex Model of Family Systems in a large sample of youth at-risk for SMI. Family functioning was evaluated with the Family Adaptability and Cohesion Evaluation Scales-IV (FACES-IV) for 41 youth with a family history of SMI (Stage 0), 52 distressed youth with early mood and anxiety symptoms (Stage 1a), 105 youth with subthreshold psychotic symptoms (Stage 1b), and 42 HCs. Results from multivariate linear regression analyses showed that participants in Stage 1a and Stage 1b significantly differ from HCs in all the family functioning scales. Furthermore, participants in Stage 0 differed from participants in Stage 1b; and similarly, participants in Stage 1a differed in all the scales from participants in Stage 0. Therefore, family functioning appears to be impaired in youth at-risk for SMI who present with early signs of mood, anxiety or subthreshold psychotic symptoms.


Speakers
OS

Olga Santesteban-Echarri

University of Calgary


Monday October 8, 2018 5:15pm - 5:35pm
American Ballroom-Center Westin Copley Place, fourth floor

5:25pm

Oral 5, Talk 6. "Filters or Barriers? Quantitative Analysis of Pathways to Care and Durations of Untreated Psychosis for a Population Based First-Episode Service"
Walter Mathis1,2, Maria Ferrara1,2,3, Shadie Burke1,2, Fangyong Li4, John Cahill1,2, I-Hsin Lin4, Jessica Pollard1,2, Scott Woods1, Vinod Srihari1,2; 1Yale University School of Medicine, 2Program for Specialized Treatment Early in Psychosis (STEP), 3AUSL Modena, 4Yale School of Public Health
               
Specialized services for first episode psychosis(FES) continue to observe prolonged durations of untreated psychosis(DUP). Extant knowledge about pathways to care(PTC) for FES offers little testable guidance on modifiable factors for reducing DUP. There is an urgent need to quantitatively understand contributors to delay regionally, as well as how treatment site delays are moderated by patient characteristics. A semi-structured scale was used to detail PTC for 50 consecutive enrollees to an FES targeting a defined geographic catchment. All contacts and dates were digitally coded. Sub-units of delay, including marginal delays attributable to healthcare providers, were computed and analyzed across patient demographics.  Contact with outpatient psychiatric care had the highest attributable delay(mean=52.35±62.81days, p<0.001) and higher parental income increased time from first antipsychotic prescription to FES enrollment(p=0.04). Delay attributable to treatment sites varied with some patient factors.  The mean delay from an inpatient admission was twice as long for the oldest quartile than the youngest three quartiles. In local emergency departments, men experienced over four times the delay as women(mean=9.86±53.80 vs. mean=2.33±5.60), and African-Americans experienced three times the mean delay of other racial categories. For outpatient psychiatric settings, the highest quartile of parental education experienced a little over half the mean delay of the lower three quartiles. These findings show delay varies across treatment site and by patient characteristics. While specific to the regional system of care and sample analyzed, the results validate an approach to measuring factors that influence delay, giving FES actionable ways to test DUP reduction strategies.


Speakers

Monday October 8, 2018 5:25pm - 5:35pm
St. George AB Westin Copley Place, third floor

5:25pm

Oral 6, Talk 6. "Brain network structural covariance in youth at high familial risk for bipolar disorder"
Kareen Heinze1, Andrew McIntosh2, Stephen Wood1,3,4, Mat Harris2, Emma Hawkins2, Heather Sibley2; 1University of Birmingham, UK, 2University of Edinburgh, UK, 3Orygen, the National Centre of Excellence in Youth Mental Health, Australia, 4Centre for Youth Mental Health, University of Melbourne, Australia
               
Background. Large-scale brain networks have been used to examine the functional organisation of the brain in individuals at genetic high risk for bipolar disorder. While it has been reported that functional connectivity alterations subtly extend to structural brain networks in individuals at ultra-high risk for psychosis, it is unclear whether this applies to the genetic high risk for bipolar disorder. Methods. Whole-brain structural covariance patterns of 121 individuals at genetic high risk (HR) for bipolar disorder (of whom 27 developed major depressive and two bipolar disorder), and 89 healthy controls (HC) were studied. The mean signal in seed regions in the visual, auditory, motor, speech, semantic, executive, salience and default-mode network were extracted and voxel-wise analyses of covariance were conducted to compare the association between whole brain signal and each seed region for HR and HC individuals, and HR participants who transitioned and those who did not, and HC.  Results. Significantly reduced structural covariance was observed in the HR sample compared to HC for the auditory and semantic network. Those who transitioned to affective disorder displayed reduced structural covariance in the speech network compared to those who did not, and comparison of transitioned cases with HC revealed aberrant structural covariance in the default-mode, salience, executive control, auditory, speech, and semantic network. Conclusions. Structural covariance analyses revealed subtle changes of connectivity of auditory and semantic networks in individuals at genetic risk for bipolar disorder. Although we found significant differences, these are small changes, and tend to reflect largely intact structural networks.


Speakers

Monday October 8, 2018 5:25pm - 5:35pm
St. George CD Westin Copley Place, third floor

5:35pm

Oral 5, Talk 7. "‘Small goals but big impact’: A mixed method evaluation of a healthy activity programme for people encountering mental health difficulties"
Peter Gallagher1,2, Aisling McClenaghan1,3, Mary Clarke1,3,4,5; 1DETECT Early Intervention in Psychosis Service, Blackrock, Dublin, Ireland., 2Saint John of God Hospitaller Ministries, Dublin, Ireland., 3Saint John of God Community Services, Dublin, Ireland., 4University College Dublin, Ireland., 5Royal College of Surgeons in Ireland, Dublin, Ireland.
               

Physical health is becoming more important in mental health care partly due to the physiological and metabolic effects of some anti-psychotic medications and unhealthy lifestyle factors such as reduced physical activity and high levels of sedentary behavior (Williams et al, 2016). Aim; The aim of this study was to evaluate a 12 week healthy activity programme, including simple dietary advice and cookery demonstrations, for people with mental health difficulties, whose healthcare professionals had referred them due to concerns regarding their unhealthy lifestyles. Methods; This was a mixed methods pre and post study. Participants were 35 patients who attended a community mental health service and had mental health difficulties allied with an unhealthy lifestyle. The primary outcome measure was the level of physical activity using the EPIC-Norfolk Physical Activity Questionnaire (epaq2), quality of life (EQ5D), levels of self-esteem (Rosenberg Self-Esteem Scale) and levels of anxiety Hospital and Depression Scale (HADS). A qualitative interview from an Interpretative Phenomenological Analysis perspective, explored 8 participants’ experiences. Results; There was a significant improvement in the mean MET activity levels of 129%, and significant improvements on Rosenberg Self-esteem scale, HADS and EQ5D visual scale. There was a small reduction in mean BMI of 0.44 which was statistically significant. Qualitative findings revealed the Superordinate theme “Increased self-confidence and self-esteem” supported by themes ‘Reduction of isolation’ and ‘Reduction of perceived stigma’. Conclusion; The healthy lifestyles changes promoted by this programme significantly improved activity levels. The qualitative findings included increased self-confidence and self-esteem in participants.


Speakers

Monday October 8, 2018 5:35pm - 5:45pm
St. George AB Westin Copley Place, third floor

5:35pm

Oral 6, Talk 7. "Examining the presynaptic dopamine system and antipsychotic response in first episode psychosis"
Sameer Jauhar1, Matthew M Nour1, Mattia Veronese1, Maria Rogdaki1,2,3, Federico Turkheimer1, Alice Egerton1, Janmes Stone1, Philip McGuire1, Oliver D Howes1,2,3; 1King's College, London, 2Psychiatric Imaging Group MRC London Institute of Medical Sciences, Hammersmith Hospital, London, 3Institute of Clinical Sciences, Faculty of Medicine, Imperial College, Hammersmith Hospital, London
               
Studies suggest the presynaptic dopamine system is altered in schizophrenia, meta-analytic evidence suggesting elevation in striatum. There are few studies examining whether these abnormalities are trans-diagnostic. Cross-sectional data also suggests nuances related to antipsychotic response, with elevated presynaptic dopamine synthesis capacity (DSC) in people with schizophrenia who respond to antipsychotics, and those resistant to antipsychotics have similar DSC to controls. In this oral presentation I will present data on people with first episode psychosis who underwent F-DOPA PET imaging (bipolar, n=22, schizophrenia n=16), scanned at onset of illness, predominantly free of antipsychotic medication (antipsychotic naïve or free n=32), a proportion of whom were involved in a subsequent study, examining baseline DSC and antipsychotic response (n=40, healthy controls, n=14). The aims were to ascertain whether elevated striatal DSC was associated with positive psychotic symptoms (using PANSS) at baseline, whether baseline striatal DSC was related to antipsychotic response, and if people could be stratified as responders/non-responders (d prior to antipsychotic treatment. We found elevated striatal DSC in bipolar psychosis and schizophrenia, compared to matched healthy controls (F2,57 = 6.80, P = .002), and in people experiencing a current psychotic episode, DSC was related to positive psychotic symptoms (n = 32, r = 0.52, P = .003). In the subsequent study we found an association between baseline striatal DSC and subsequent antipsychotic response (n=26, r=r=0.64, p<0.01), and that initial DSC discriminated at group level between responders, non-responders and healthy controls (F(2, 37)=7.9, p=0.001). I will then discuss the possible clinical utility of F-DOPA PET imaging in psychosis.


Speakers

Monday October 8, 2018 5:35pm - 5:45pm
St. George CD Westin Copley Place, third floor

5:35pm

Symposium 10, Talk 4. "Solid Foundations for Career: IPS, Education and Youth Mental Health"
Eóin Killackey1,2, Kelly Allott1,2, Gina Woodhead4, Judy Ring3; 1Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, 2Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, 3Travencore School, Department of Education and Training, Parkville, Victoria, 4Orygen Youth Health, Parkville, Victoria
           
Background: Individual Placement and Support (IPS) is a proven intervention in helping people with psychotic illness return to, or enter into, work. In applying IPS to younger populations with First Episode Psychosis (FEP), education was seen as an equally valid outcome. However, educational outcomes were not significantly better in IPS groups compared to controls. This has been confirmed in meta-analyses of IPS in FEP. Hence, we conducted a pilot study of IPS adapted so as to have only education as a focus (IPSed).  Method: 19 young people attending Orygen Youth Health in Melbourne were recruited and given access to IPSed. Results: 18 of the 19 participants had a positive outcome and either completed their course or completed prerequisite units to continue to the next level of their course.  Conclusion: IPS has not been superior for education. There are a number of possible reasons for this. Firstly, that IPS was designed as an employment intervention and the IPS Fidelity scale reinforces this. Secondly, IPS workers often come from employment backgrounds and may not have the expertise to address educational goals. Finally, it may be that youth mental health services have historically included education as part of their developmental world-view, and so finding an effect above this is difficult. Results of our pilot study suggest that a singular focus on education may produce excellent outcomes. This result needs to be replicated but also raises questions about IPS for education in populations of young people with mental illness.

Speakers

Monday October 8, 2018 5:35pm - 5:55pm
American Ballroom-South Westin Copley Place, fourth floor

5:35pm

Symposium 8, Talk 4. "RECOVER: a randomised controlled trial of a tailored psychological intervention for first episode bipolar disorder"
Sue Cotton1,2, Craig Macneil1,2,3, Henry Jackson4, Greg Murray5, Aswin Ratheesh1,2,3, Michael Berk1,2,6,7,8, Andrew Chanen1,2,3, Kate Filia1,2, Melissa Hasty1,2,3, Christopher Davey1,2,3, Barnaby Nelson1,2,3; 1Centre for Youth Mental Health, The University of Melbourne, 2Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia, 3Orygen Youth Health, Parkville, Australia, 4Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia, 5Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Australia, 6School of Medicine, Deakin University and Barwon Health, Geelong, Australia, 7The Florey Institute of Neuroscience and Mental Health, Parkville Australia, 8Department of Psychiatry, The University of Melbourne, Parkville Australia
           
Background: People with bipolar disorder too commonly experience deficits in functional recovery, despite symptomatic recovery and exemplary school performance. The outcome of this is poor long-term functional outcomes. Applying psychological therapies alongside pharmacology may be useful in improving functional outcomes. Our group has led growing international interest in a staged approach to understanding illness trajectories of bipolar disorder with different psychological and pharmacological therapies required for the different stages of illness. Intervention in the early stages may potentially reduce the burden and risk associated with the disorder, and mitigate its impact on normal developmental trajectories. To date, however, there is a limited evidence base psychological therapies available to young people with early BD. Methods: RECOVER is an RCT of a refined existing psychological intervention, to be delivered in addition to treatment as usual at two specialist early intervention services in Melbourne. 122 young people in the early stages of BD-I will be recruited. The RECOVER intervention will be delivered over a 6 month period. Assessments will be conducted at baseline, 3, 6, 9, 12, 15, and 18 months. Results: The trial design will be discussed in depth.  Conclusion: To date, there is a limited evidence base for psychological therapies available to young people with early BD. Therefore, the findings of this project will provide definitive evidence that early psychological intervention in the course of BD can reduce the symptomatic, vocational, relationship and psychological impact that is seen in entrenched disorder.


Speakers
SC

Sue Cotton

Centre for Youth Mental Health, The University of Melbourne


Monday October 8, 2018 5:35pm - 5:55pm
American Ballroom-North Westin Copley Place, fourth floor

5:35pm

Symposium 9, Talk 4. "Overview of the Functional Neuroimaging Measures in the PROCAN Study"
Paul Metzak1, Signe Bray1, Glenda MacQueen1; 1University of Calgary, Calgary, Alberta, Canada
           
Although the onset of serious mental illness (SMI) primarily occurs in youth, there have been few studies examining the neurobiological correlates of SMI prior to a formal diagnosis. In the PROCAN study we have employed McGorry and Hickie’s clinical staging model as the basis for assessing changes in brain activity in youth at risk for SMI. As SMI is a broad category encompassing multiple discrete illnesses, the functional MRI tasks that we have selected activate multiple brain networks that are known to be impacted in psychiatric illness. The three tasks selected were: 1) a monetary incentive delay task, which targets reward networks, 2) an N-back working memory task, which targets cognitive control and dorsal attention networks, and 3) an emotional Go-NoGo task, which targets emotional and inhibitory control networks. Participants also underwent a resting state scan, which enables a task free assessment of multiple brain networks. Each participant performs these tasks upon recruitment, twelve months after recruitment, and upon conversion to a diagnosable SMI. Preliminary results from the Anhedonia task indicate that symptomatic participants display differences in basal ganglia activity relative to healthy volunteers and those at familial high risk.


Speakers
PM

Paul Metzak

University of Calgary


Monday October 8, 2018 5:35pm - 5:55pm
American Ballroom-Center Westin Copley Place, fourth floor

5:45pm

Oral 5, Talk 8. "Holes in the pipeline: Barriers to accessing specialty care in early psychosis"
Khalima Bolden1, Rosenthal Adi1, Monet Meyer1, Sarah Gobrial1, Krista Lane1, Ruth Shim1, Tyler Lesh1, J. Daniel Ragland1, Loewy Rachel2, Savill Mark2, Carter Cameron1, Niendam Tara1; 1University California - Davis, Sacramento, CA, 2University California - San Francisco, San Francisco, CA
               
The duration between onset of psychosis and accurate diagnosis and treatment is a significant predictor of outcome, making rapid linkage to care imperative. Barriers such as stigma, difficulty navigating the system, and financial burden lengthen this process. The current study investigates the effect of these barriers on clinic engagement (i.e. completion of initial early psychosis eligibility assessment). We operationalized logistical (e.g. trouble contacting client), attitudinal (e.g. stigma), systemic (e.g. barriers associated with the healthcare system), structural (e.g. economic barriers), and illness-related barriers (e.g. extreme paranoia) coded from phone logs of 196 individuals referred to specialty early psychosis (EP) services in Sacramento, CA (age=17.6, female=55.1%, Caucasian=31.1%, Hispanic=36.2%). Barriers were coded as present/absent for each interaction; analyses examined the proportion of total interactions where barriers were present. Individuals who completed the initial assessment (n=141) experienced an average of 6.9 barriers during the linkage period, while noncompleters (n=55) experienced an average of 10.2 barriers.  For completers, logistic barriers were the most common (39.1% of interactions), followed by systemic (1.9%), structural (1.8%), attitudinal (1.3%), and illness-related (0.2%) barriers. For noncompleters, logistic barriers were the most common (69.0% of interactions), followed by attitudinal (6.3%), systemic (5.3%), structural (4.6%), and illness-related (0.9%) barriers. Noncompleters experienced proportionally more barriers overall (80.7%) than completers (43.0%) (p<.001), as well as increased logistic (p<.001), attitudinal (p<.001), structural (p=.04), systemic (p=.002), and illness-related barriers (p=.022). Understanding the barriers individuals face in accessing specialty care is an essential step in improving the linkage process and reducing the duration of untreated psychosis.


Speakers

Monday October 8, 2018 5:45pm - 5:55pm
St. George AB Westin Copley Place, third floor

5:45pm

Oral 6, Talk 8. "Biotypes of individuals at clinical high risks for psychosis based on resting state functional connectivity features"
Xiaochen Tang1, Tianhong Zhang1, Yingying Tang1, Lihua Xu1, Junjie Wang1, Margaret Niznikiewicz2, Hui Li3, Martha E. Shenton4,5,6, Susan Whitfield-Gabrieli7, Matcheri Keshavan8, William S. Stone8, JiJun Wang1; 1Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;, 2Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, MA, USA;, 3Department of Psychology, Florida A&M University, Tallahassee, FL, USA;, 4Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;, 5Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;, 6Research and Development, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, MA, USA;, 7McGovern Institute for Brain Research and Poitras Center for Affective Disorders Research, Massachusetts Institute of Technology, Cambridge, MA, USA;, 8Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;
               
Individuals at clinical high risk (CHR) for psychosis are defined primarily by the presence of clinical symptoms such as attenuated positive symptoms or brief intermittent psychotic symptoms. The heterogeneity in CHR subjects is likely as striking as is observed in schizophrenia, bipolar disorders, and/or major depressive disorders. To detect potential biotypes with distinct neurophysiological features, we performed a canonical correlation analysis to select linear combinations of MRI resting state functional connectivity indicators associated with clinical symptoms, as identified by Structured Interview of Psychosis-risk Syndromes (SIPS). This analysis yielded two sets of symptoms with negative and disintegration (loadings = 0.995, 0.427), and positive (loadings = 0.971). In terms of connection features, both sets of connectivity combinations include network-wide connections between fronto-parietal and salience networks. Furthermore, the first connectivity component defines functional connections between the default mode network and other networks, while the second component defines distinct connection combination between the default mode network and the visual network to other networks. Based on the two corresponding combinations of functional connectivity characteristics, cluster analysis was performed to classify 138 CHR subjects from the Shanghai At Risk Psychosis Project (SHARP) into 4 biological subtypes, with percentages of 10.8%, 16.7%, 14.5% and 60.1% respectively. These results demonstrate that individuals at CHR states can be classified into four biotypes defined by distinct patterns of connectivity primarily in default mode networks. Validation and further inquiry into clinical significance of these four biotypes in CHR is ongoing.


Speakers

Monday October 8, 2018 5:45pm - 5:55pm
St. George CD Westin Copley Place, third floor

5:55pm

Oral 5: Q&A
Question and answer period.

Speakers
HS

Helen Stain

Leeds Trinity University


Monday October 8, 2018 5:55pm - 6:00pm
St. George AB Westin Copley Place, third floor

5:55pm

Oral 6: Q&A
Question and answer period.

Speakers
avatar for Masafumi Mizuno

Masafumi Mizuno

Toho University School of Medicine


Monday October 8, 2018 5:55pm - 6:00pm
St. George CD Westin Copley Place, third floor

5:55pm

Symposium 10: Q&A
Question and answer period.

Speakers
JV

Jaap van Weeghel

Tilburg University


Monday October 8, 2018 5:55pm - 6:00pm
American Ballroom-South Westin Copley Place, fourth floor

5:55pm

Symposium 8: Q&A
Question and answer period.

Speakers

Monday October 8, 2018 5:55pm - 6:00pm
American Ballroom-North Westin Copley Place, fourth floor

5:55pm

Symposium 9: Q&A
Question and answer period.

Speakers
OS

Olga Santesteban-Echarri

University of Calgary


Monday October 8, 2018 5:55pm - 6:00pm
American Ballroom-Center Westin Copley Place, fourth floor

6:00pm

Early Intervention Partnerships with People with Lived Experience
6-6:45 Dinner
Musical Guest Tunefoolery
Art —99 Faces of our Mental Health by Lynda Cutrell


6:45-6:50           Welcome and Introduction, Michelle West, PhD
6:50-7:30           Panel 1: Consumer Partnership with Treatment
                                 PREP-West: Joshua Cairns & Melissa Weise
                                 OnTrackNY: Sascha DuBrul & Loren Dent
7:30-8:10          Consumer Partnership with Research
                                 Glasgow: Stephanie Allen & Andrew Gumley
                                CAB: Raquelle Mesholam-Gately, Ph.D., Christian Rosa Baez, & Nathan Schwirian
8:10-8:55          Keynote Address, Elyn Saks, J.D., Ph.D.
9:00 pm              Adjourn


Monday October 8, 2018 6:00pm - 9:00pm
Staffordshire Westin Copley Place, third floor
 
Tuesday, October 9
 

8:15am

Opening Session
Speakers
avatar for Lucia Valmaggia

Lucia Valmaggia

Senior Lecturer, King's College London, IEPA President Elect
Dr. Valmaggia works as Senior Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London she leads the Virtual Reality Lab, and is a Consultant Clinical Psychologist at the South London and Maudsley NHS Trust.During her career Cr. Valmaggia has sought... Read More →


Tuesday October 9, 2018 8:15am - 8:30am
American Ballroom Westin Copley Place, fourth floor

8:30am

Plenary Session IV: "Mechanisms Underlying Critical Periods of Brain Development: Implications for Psychiatric Disorders"
Brain function is largely shaped by experience in early life, creating windows of both great opportunity and vulnerability. Our work has focused on the biological basis for such critical periods, identifying both “triggers” and “brakes” on plasticity. Strikingly, the maturation of particular inhibitory circuits is pivotal for the onset timing of these windows. Manipulations of their emergence can either accelerate or delay developmental trajectories regardless of chronological age. Notably, many neurodevelopmental disorders are linked to alterations in excitatory-inhibitory balance, suggesting shifted critical period timing as part of their etiology. Closure of critical periods in turn reflects an active process, rather than a purely passive loss of plasticity factors. Lifting these brakes allows the reopening of plastic windows later in life, but may also underlie instability in disease states. Thus, understanding how brain plasticity and stability are balanced throughout life offers new insight into mental illness and novel therapeutic strategies for recovery of function in adulthood.

Speakers
avatar for Takao Hensch

Takao Hensch

Professor of Molecular and Cellular Biology and Professor of Neurology, Harvard University
Takao K. Hensch, PhD, is joint professor of Neurology, Harvard Medical School at Boston Children’s Hospital, and professor of Molecular and Cellular Biology at Harvard’s Center for Brain Science. He currently directs the NIMH Silvio O. Conte Center at Harvard, and conducts basic... Read More →


Tuesday October 9, 2018 8:30am - 9:15am
American Ballroom Westin Copley Place, fourth floor

9:15am

Plenary Session V: "Development of the Brain and Social Cognition in Adolescence"
Social cognitive processes involved in navigating an increasingly complex social world continue to develop throughout human adolescence. Adolescence is a period of life often characterised by behaviours that, prima facie, are irrational, such as seemingly excessive risk-taking and impulsivity. However, these behaviours can be interpreted as adaptive and rational if one considers that a key developmental goal of this period of life is to mature into an independent adult in the context of a social world that is unstable and changing. In the past 20 years, neuroscience research has shown that the human brain develops both structurally and functionally during adolescence. Areas of the social brain undergo significant reorganization during the second decade of life, which might reflect a sensitive period for adapting to the social environment.

Speakers
avatar for Sarah-Jayne Blakemore

Sarah-Jayne Blakemore

Deputy Director, UCL Institute of Cognitive Neuroscience
Sarah-Jayne Blakemore is Professor in Cognitive Neuroscience at UCL. She is Leader of the Developmental Cognitive Neuroscience Group and Deputy Director of the UCL Institute of Cognitive Neuroscience. Her group's research focuses on brain development in human adolescence. Professor... Read More →


Tuesday October 9, 2018 9:15am - 10:00am
American Ballroom Westin Copley Place, fourth floor

10:00am

Coffee Break
Tuesday October 9, 2018 10:00am - 10:30am
American Ballroom Westin Copley Place, fourth floor

10:30am

Plenary Session VI: "Emerging Psychosis in Daily Life: Momentary Assessment and Intervention"
Psychopathological symptoms are natural experiences emerging in the realm of ordinary daily life, often in interaction with contextual factors. In the mental health field, there is a growing awareness that the study of these symptoms in the context of everyday life, using Experience Sampling Methodology, may provide a powerful and necessary addition to more conventional research approaches. In my talk, I will work out two examples to demonstrate how using ESM may help in deepening our understanding of the actual processes related to the onset of symptoms as well as in improving interventions at an early stage.

In the first part of my talk, I will focus on the capacity for social interaction as an important factor in the development of psychopathology in adolescence. I will report data of the SIGMA study, an ongoing large-scale study currently including over a thousand adolescents, where we used both Experience Sampling Methodology to examine real-life social interactions and experimental and questionnaire measures of social capacity and attunement to examine how these relate to early symptoms.
In the second part of my talk, I will discuss whether real-life interventions may provide an acceptable and feasible tool for patients at the early stages of psychotic disorder. I will present the first results of the INTERACT study, a randomized clinical trial of Acceptance and Commitment Therapy in Daily Life in 150 individuals with an At Risk Mental state for psychosis or in a first episode of psychosis.

Speakers
avatar for Inez Myin-Germeys

Inez Myin-Germeys

Professor of Contextual Psychiatry, KU Leuven
Inez Myin-Germeys is a professor of Psychiatry and has founded the Center for Contextual Psychiatry at KU Leuven in Belgium. Her research is focusing on the interaction between the person and his/her environment in the development of psychopathology, using experience sampling methodology... Read More →


Tuesday October 9, 2018 10:30am - 11:15am
American Ballroom Westin Copley Place, fourth floor

11:15am

Richard J. Wyatt Award Presentation
Tuesday October 9, 2018 11:15am - 11:30am
American Ballroom Westin Copley Place, fourth floor

11:30am

Poster Session B | Lunch

Topics:
Epidemiology
Mood Disorders
Neurocognition
Neurodevelopmental
Neuroimaging
Personality Disorders
Stress Responsivity
Transdiagnostic Approaches
Trauma
Ultra High Risk / Prodromal Research
Other


Tuesday October 9, 2018 11:30am - 1:00pm
Essex Ballroom Westin Copley Place, third floor

12:30pm

IEPA Annual General Meeting
All members are invited to attend the IEPA Annual General Meeting.

Speakers
avatar for Peter B. Jones

Peter B. Jones

Professor of Psychiatry & Deputy Head, School of Clinical Medicine, University of Cambridge, IEPA President
Peter qualified in medicine at Westminster Medical School. Having first worked as a physician at The Whittington Hospital and KCH, he trained in psychiatry at the Maudsley Hospital and epidemiology at the London School of Hygiene. He has been Professor of Psychiatry at Cambridge since... Read More →



Tuesday October 9, 2018 12:30pm - 12:55pm
American Ballroom-South Westin Copley Place, fourth floor

1:00pm

Oral Session 7: SUPPLEMENTS AND OTHER PHARMACOLOGICAL TREATMENTS
Chair
SF

Shona Francey

Orygen, The National Centre of Excellence in Youth Mental Health

Speakers
AB

Alan Breier

Indiana University School of Medicine
Indiana Psychotic Disorders Program, Prevention and Recovery Center for Early Psychosis


Tuesday October 9, 2018 1:00pm - 2:30pm
St. George AB Westin Copley Place, third floor

1:00pm

1:00pm

Symposium Session 11: HOW CAN WE PREVENT PSYCHOSIS? AN EXAMINATION OF PRIMARY VS SECONDARY APPROACHES TO PREVENTION
Mental health has lagged behind physical health in terms of focus on prevention. To date, the emphasis has been on secondary approaches to prevention of psychosis using early detection and early intervention models. But is this really the most effective approach? It may be time to move to a primary or population-based prevention focus. This symposium will present new data relating to both primary (population-based) and secondary (early intervention) approaches to prevention of psychosis. Data will be presented from epidemiological studies of first episode psychosis and large population-based and register-based studies. Hannah Jongsma will present data from the EU-GEI study showing an association between greater owner-occupancy levels and lower incidence of psychosis and increased risk for psychosis among minority groups. Hannah also will show that risk for psychosis incidence extends beyond young adulthood. Olesya Ajnakina will show that “At risk mental state” approach may not be as useful for prevention of psychosis as had been originally hoped. Kristine Engemann Jensen will report that childhood exposure to green space is a novel protective factor for psychosis, showing the importance of the built environment for mental health. Sir Robin Murray argues that we should harness public health and political measures to prevent psychosis. He shows that 24% of psychosis cases could theoretically be prevented by eliminating use of high-potency cannabis use in the population. Professor Andreas Meyer-Lindenberg will draw on these findings, and insights from his own work, in discussing how we can develop a new prevention-focused paradigm of research on psychosis.


Chair
OA

Olesya Ajnakina

Kings College London
MC

Mary Cannon

DISCUSSANT, Royal College of Surgeons in Ireland

Speakers

Tuesday October 9, 2018 1:00pm - 2:30pm
American Ballroom-North Westin Copley Place, fourth floor

1:00pm

Symposium Session 12: TRAUMA AND PSYCHOSIS: WHAT WE KNOW AND HOW TO MOVE FORWARD
Childhood adversities are associated with psychosis, and empirical evidence investigating the causal mechanisms underlying this association is accruing (Bentall et al, 2014; Gibson et al, 2016; Hardy, 2017; Varese et al, 2012). People with psychosis are at an increased risk of revictimisation and are more likely to experience a range of post-traumatic stress difficulties, which negatively influences functional and clinical outcomes. In line with these findings, best practice guidelines recommend trauma and PTSD are routinely assessed in psychosis services, including Early Intervention, and that therapy is offered when indicated. Unfortunately, it is rare for trauma and PTSD to be recognised in psychosis services, preventing access to psychological treatments. The challenge is to effectively disseminate trauma-informed practice within frontline EIP services to ensure people’s needs are met. This symposium will reflect on progress and challenges in the area, illustrating our current theoretical understanding, clinical trial evidence, and routine service developments. Sandra Bucci will provide an overview of research highlighting the complex and multiple pathways from trauma to psychosis. David van den Berg will present the long-term results of a randomised controlled trial of trauma-focused treatment (TFT) for PTSD in psychosis. Mark van der Gaag will present on cost-effectiveness of TFT in psychosis. Amy Hardy will describe initiatives aiming to implement and build on these research findings in the early intervention in psychosis services of a National Health Service Trust in inner city London. The discussion will focus on how to move forward into the realm of early intervention and prevention.

Chair
MV

Mark van der Gaag

VU University
AH

Amy Hardy

King's College London

Speakers
DV

David van den Berg

Parnassia Psychiatric Institute
SB

Sandra Bucci

University of Manchester
avatar for Lucia Valmaggia

Lucia Valmaggia

Senior Lecturer, King's College London, IEPA President Elect
Dr. Valmaggia works as Senior Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London she leads the Virtual Reality Lab, and is a Consultant Clinical Psychologist at the South London and Maudsley NHS Trust.During her career Cr. Valmaggia has sought... Read More →


Tuesday October 9, 2018 1:00pm - 2:30pm
American Ballroom-Center Westin Copley Place, fourth floor

1:00pm

Symposium Session 13: SPECIALIZED EARLY INTERVENTION SERVICES AND DURATION OF UNTREATED PSYCHOSIS – IS THERE AN INTERACTION?
The focus of the early intervention services developed across the globe has been to improve the treatment and outcome of patients with a first episode of psychosis. There are ideally two complementary strategies for achieving this, I.e, providing a comprehensive phase specific specialized treatment and actively reducing duration of untreated psychosis through multiple systemic interventions. Unfortunately only a few programs have been able to do both while for majority of jurisdictions have failed to integrate the two components. As a result patients in areas that have concentrated on reduction of DUP may still be treated in community health centers and patients in areas where specialized early intervention teams are operating are still experiencing a long DUP prior to treatment. Logically it should be possible to integrate the two components of EI; however, systemic barriers may be difficult to break down. In this symposium we will explore if there might be a positive mediating effect on the effect of the specialized early treatment by DUP reduction. The early intervention hypothesis suggested that the early years of illness were especially receptive to interventions, and in this symposium we want to explore if this hypothesis is supported by examining the role of DUP as a moderator of treatment effect. This symposium will bring together an international field of experts presenting data from some of the largest trials in the world. • JCEP, Prof. Eric Chen • PEPP-Montréal, Prof. Ashok Malla • RAISE prof. Robert Heinssen • OPUS II Ph.D. Nikolai Albert


Chair
NA

Nikolai Albert

Copenhagen University
MN

Merete Nordentoft

Copenhagen University

Speakers
EY

Eric YH Chen

University of Hong Kong
avatar for Robert Heinssen

Robert Heinssen

Director, Division of Services and Intervention Research, National Institute of Mental Health
JO

Jan Olav Johannessen

Stavanger University Hospital


Tuesday October 9, 2018 1:00pm - 2:30pm
American Ballroom-South Westin Copley Place, fourth floor

1:00pm

Symposium Session 14: COMPUTER-AIDED DIAGNOSTIC AND PROGNOSTIC TOOLS IN THE EARLY RECOGNITION OF PSYCHOSIS: FINDINGS FROM THE MULTI-SITE EUROPEAN PRONIA STUDY
Despite five decades of quantitative research into early phases of psychoses, early recognition still depends on a human expert. Unfortunately, the availability of clinical services that provide this expert knowledge is not the only limitation. Early recognition is also a unique clinical challenge - accurately estimating the risk profile of an individual with diverse, frequently nonspecific psychopathology, leading to biased reasoning given different clinical traditions and gut feeling. Recently, opportunities to address the clincial challenge have emerged with machine learning, multi-site prospective study designs and international collaborations merging into a powerful methodology for precision psychiatry. Previous studies have provided preliminary evidence regarding the feasibility of stratifying at-risk and first-episode patients according to the odds of adverse outcomes by extracting candidate predictive models from diverse data. Candidate models are under further validation and analysis based on multi-site datasets collected within the NAPLS, PRONIA, PsySCAN and PNC projects. Should candidate markers generalize well, the outcomes would translate into significant increases in predictive and prognostic certainty. Such progress would allow for individualized risk-based stratification of patients and clinical trials, novel targets for drug development and tools for individualized neuromonitoring of preventive treatments. The symposium will present new data from the PRONIA project which has collected clinical, neurocognitive, blood-based and MRI data from 1600 persons in at-risk and early stages of psychoses and mood disorders, and healthy controls. PRONIA is currently generating machine-learning markers intended to predict clinically relevant outcomes, identify vulnerable subgroups and combine data for diagnosis and prediction across heterogeneous domains.

Chair
NK

Nikos Koutsouleris

Ludwig-Maximilians University Munich
SW

Stephen Wood

School of Psychology, University of Birmingham

Speakers

Tuesday October 9, 2018 1:00pm - 2:30pm
Staffordshire Westin Copley Place, third floor

1:05pm

Oral 7, Talk 1. "Baseline Omega-3 Fatty Acids in Erythrocytes as Predictors of Functional and Clinical Outcomes in People at Ultra-High Risk for Psychosis"
G. Paul Amminger1, Barnaby Nelson1, Connie Markulev1, Hok Pan Yuen1, Miriam R Schäfer1, Nilufar Mossaheb2, Monika Schlögelhofer2, Stefan Smesny3, Ian B Hickie4, Gregor E Berger5, Eric Y H Chen6, Lieuwe de Haan7, Dorien H Nieman7, Merete Nordentoft8, Anita Riecher-Rössler9, Swapna Verma10, Maximus Berger1, Andrew Thompson11, Alison R Yung12, Patrick D McGorry1; 1Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 2Department of Psychiatry, Medical University of Vienna, Vienna, Austria, 3Department of Psychiatry, University Hospital, Jena, Germany, 4Brain and Mind Research Institute, University of Sydney, Sydney, Australia, 5Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland, 6Department of Psychiatry, University of Hong Kong, Hong Kong, 7Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands, 8Psychiatric Centre Bispebjerg, Copenhagen, Denmark, 9Psychiatric University Clinics Basel, Basel, Switzerland, 10Institute of Mental Health, Singapore, Singapore, 11Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, England, 12Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
               
The NEURAPRO multicentre RCT of long-chain omega-3 polyunsaturated fatty acids (n3PUFA) vs. placebo demonstrated no clinical benefits for n3PUFA (‘fish oil’) supplementation in individuals with At-Risk Mental State (ARMS) for psychosis. However, adherence in this trial was low and n3PUFA were also available outside the study through diet or non-study supplements. Therefore, we examined if pre-treatment n3PUFA levels measured in erythrocytes and their change during the trial were related to outcomes.  Data from 285 of 304 (94%) NEURAPRO participants were analysed. PUFA levels were measured at baseline and after supplementation (6 months). The n3-index, a biomarker of n3PUFA status, was calculated as the combined relative abundance of eicosapentaeonic acid and docosahexaenoic acid. Outcome measures included psychosis transition, clinical improvement (CGI-I), general psychopathology (BPRS), depressive symptoms (MADS), negative symptoms (SANS) and functioning (SOFAS).  The median n3-index in the sample at baseline was 3%, approximately 40% lower than in the (Australian) general population (5%). Adjusting for relevant baseline factors, the change (increase) of the n3-index from baseline to 6 months predicted better functional and symptomatic outcomes for the majority of applied measures at 6 and 12 months. Participants with an n3-index <3% at baseline were significantly more likely to show substantial clinical improvement from n3PUFA supplementation at 6 months. In contrast, in the group with n3-index ≥3%, n3PUFA supplementation was unrelated to outcomes. This analysis provides crucial evidence to support beneficial effects of fish oil supplementation in individuals with ARMS for psychosis, in particular in those with low n3PUFA levels at baseline.


Speakers

Tuesday October 9, 2018 1:05pm - 1:15pm
St. George AB Westin Copley Place, third floor

1:05pm

Oral 8, Talk 1. " Identifying Psychotic Symptoms and Predicting Relapse Through Social Media"
Michael Birnbaum1, Asra Rizvi1, Munmun De Choudhury2, Sindhu Ernala2, Guillermo Cecchi3, John Kane1; 1Northwell Early Treatment Program, 2Georgia Institute of Technology, 3IBM Research
               
Objective: The internet and social media provide an unprecedented opportunity to transform early psychosis intervention services. This study aimed to capture concerning patterns of social media activity associated with the onset and persistence of psychotic symptoms.  Methods: Facebook and Twitter archives were extracted from over 150 participants with psychotic disorders, mood disorders and healthy controls. Machine learning was used to build classifiers aiming to identify patterns and distinguish between groups.   Results: Linguistic analysis of Twitter commentary identified significantly increased use of interpersonal pronouns (p < 0.001), decreased emphasis on friendship (p < 0.001) and increased emphasis on health (p < 0.001) in individuals with psychosis. Preliminary classifiers correctly recognized participants with psychotic disorders (n=62) from healthy controls (n=24) with an average accuracy of 80% and distinguished participants with psychosis from those with mood disorders (n=39) with an average accuracy of 70%. Further analysis identified shifts in language use of participants with psychosis who experience a relapse (n=18) including significant increases in the use of swearing (p<0.05), first-person pronouns (p<0.05) and negations (p<0.05). We additionally identified significant differences in the profile pictures (p<0.005) and structure of messages posted (p<0.005) by youth with psychosis who experienced a psychotic relapse. Conclusion: Identifying markers in social media activity associated with worsening psychotic symptoms offers the prospect that social media may be a clinically useful tool to identify patients in the earliest phases of relapse.


Speakers
MB

Michael Birnbaum

The Zucker Hillside Hospital


Tuesday October 9, 2018 1:05pm - 1:15pm
St. George CD Westin Copley Place, third floor

1:05pm

Symposium 11, Talk 1. "Preventing psychosis: what can we learn from a large multicentre European incidence study?"
Hannah Jongsma1, Craig Morgan2, Peter Jones1, James Kirkbride3; 1Department of Psychiatry University of Cambridge, 2Society and Mental Health Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK, 3PsyLife Group, Division of Psychiatry, University College London
           
The incidence of psychotic disorders varies across social and environmental gradients at both an individual and a population level. However, the factors underpinning this are unclear. We conducted a population-based study of the incidence of non-organic adult ICD-10 psychotic disorders across the 17 catchment areas in the six countries (England, France, Italy, Netherlands, Spain, Brazil). Crude incidence rates were standardised to the 2011 England and Wales Census population to account for population differences in age, sex and ethnicity. Multilevel Poisson regression was carried out to investigate variance in incidence between catchment areas by latitude, population density, and percentage of unemployment, owner-occupied houses and single-person households. We identified a total of 2,774 cases over 12.94 million person-years at risk, leading to a crude incidence of 21.4 per 100,000 person-years (95%CI=19.4-23.4). By age 35, 68% of male cases had presented to services, compared with 51% of female cases. Poisson regression revealed higher rates of all psychotic disorders in minority groups (IRR=1.6, 95%CI=1.5-1.7), and an association between greater catchment area-level owner-occupancy and lower incidence (IRR for a 10% increase: 0.8, 95%CI=0.7-0.8). A higher population density was associated with an increased incidence of psychosis in England (IRR=1.2, 95%CI=1.1-1.2) and Netherlands (IRR=1.9, 95%CI=1.4-2.6), and was associated with a lower incidence in Italy (IRR=0.7, 95%CI=0.6-0.8). Services focused on early intervention should not have an upper age limit as half of all female (and 32% of male) cases present after age 35; future examinations of variance should be locally informed and take socioenvironmental risk factors into account.


Speakers

Tuesday October 9, 2018 1:05pm - 1:25pm
American Ballroom-North Westin Copley Place, fourth floor

1:05pm

Symposium 12, Talk 1. "Psychological mediators of the association between childhood adversities and psychosis"
Sandra Bucci1, Jessica Williams1, Filippo Varese1, Katherine Berry1; 1Division of Psychology and Mental Health, University of Manchester, U.K.
           
Background: Risk for psychosis has been linked to a range of adverse life experiences and circumstances. Particular interest has been given to the relationship between psychosis and exposure to potentially traumatic life events in childhood to identify the impact of socio-environmental precursors to psychosis. This talk will report on a series of studies our group have conducted exploring psychological mediators of the relationship between childhood adversities and psychosis. Methods: We present findings from a systematic review, which identified 36 papers, comprising 9,057 participants with psychotic disorders and 58,782 non-clinical participants. Results: Despite great variation in the mediators considered and the methodological and analytic quality of the primary studies, our synthesis suggests the relationship between childhood adversity and psychosis is mediated by a several “families” of mediating variables including post-traumatic sequelae (e.g. dissociation, PTSD symptoms), affective dysfunction and dysregulation, and maladaptive cognitive factors (e.g. self-esteem and beliefs and concepts about the self and others; and miscellaneous (neuroticism and mastery; mindfulness; proximal life stressors). We have also conducted a series of studies investigating mechanisms involved in explaining the trauma-psychosis link, including attachment, particularly the role of disorganised attachment, and dissociative processes, and present findings from these studies in this talk. Discussion: The importance of the five different (but not independent or mutually exclusive) families of mediators considered in our work should be examined by future research employing appropriate modelling methods to better disentangle the contribution of these different processes.


Speakers
SB

Sandra Bucci

University of Manchester


Tuesday October 9, 2018 1:05pm - 1:25pm
American Ballroom-Center Westin Copley Place, fourth floor

1:05pm

Symposium 13, Talk 1. "The Effect of Duration of Untreated Psychosis and Treatment Delay on the Outcomes of Prolonged Early Intervention in Psychotic Disorders - a subgroup analysis of the OPUS II trial"
Nikolai Albert1, Marianne Melau1, Heidi Jensen1, Lene Halling Hastrup2, Carsten Hjorthøj1, Merete Nordentoft1,3; 1Copenhagen Mental Health Centre, 2Psychiatric Research Unit, Region Zealand, 3University of Copenhagen
           
The duration of untreated psychosis (DUP) has been shown to have an effect on outcome after first episode psychosis. The premise of specialized early intervention (SEI) services is that intervention in the early years of illness can affect long-term outcomes. In this study we investigate whether DUP affects treatment response after 5 years of SEI treatment compared to 2 years of SEI treatment.  As part of a randomized controlled trial testing the effect of prolonged SEI treatment 400 participants diagnosed within the schizophrenia spectrum were recruited. In the main trial, we did not find an effect on the main outcome, negative symptoms, of prolonging the SEI treatment from 2 to 5 years. In this post-hoc analysis, participants were dichotomized based on DUP, treatment delay and time from first symptom until start of SEI treatment.   The participants with a short DUP (< 3 months) showed a tendency to respond better to the prolonged treatment with regards to disorganized and negative dimension. For participants with short duration from first symptom until start of SEI treatment (<6 months) there was a significant difference on the negative dimension favoring the prolonged OPUS treatment.  The finding of an effect of prolonged treatment for participants with a short total treatment delay could mean that prolonged SEI treatment is more beneficial than treatment as usual so long as it is provided in the early years of illness and not just in the early years after diagnosis.


Speakers
NA

Nikolai Albert

Copenhagen University


Tuesday October 9, 2018 1:05pm - 1:25pm
American Ballroom-South Westin Copley Place, fourth floor

1:05pm

Symposium 14, Talk 1. "Using neuroimaging data to predict functional outcome in early spectrum psychosis"
Lana Ilankovic-Kambeitz1; 1Ludwig-Maximilian-University

The growing knowledge about enduring functional impairment and disability in psychosis and in high risk (CHR) patients encouraged us to search for prognostic biomarkers to individually predict functional and clinical outcome independent of a subsequent transition to full-blown psychosis or remission of symptoms after psychosis. We aim to elucidate structural and functional brain determinants and potential modifiers of functional outcome trajectories in early stages of psychosis. We have employed Multivariate Pattern Analysis (MVPA) in the PRONIA discovery sample to predict functional outcomes of recent onset psychosis (ROP) patients and CHR patients after 12 months of naturalistic treatment, based on the patients' structural neuroimaging measures. The Global Functioning: Social and Role scale (GF:S, GF:R) were used to determine good or poor outcome status at the follow up examination. Volume-based pattern classification predicted good vs. poor outcome status at follow-up in CHR patients with accuracy levels of up to 77% as determined by leave-site out cross-validation. The neuroanatomical prediction signature mapped to volume increments in cortical areas pertaining to the default-mode and central executive network whereas volume reductions were located in hub regions of the salience network and the temporal cortices. The detection of CHR and psychosis individuals with specific brain alterations associated with poorer outcome at follow-up may help identifying a critical group of at-risk persons, who irrespective of diagnostic thresholds require clinical treatment and therapeutic support. In the next step, we are planning to employ functional resting state (rs) analysis to predict functional outcome in the same group of patients.



Tuesday October 9, 2018 1:05pm - 1:25pm
Staffordshire Westin Copley Place, third floor

1:15pm

Oral 7, Talk 2. "Omega-3 and Omega-6 Fatty Acids and Risk of Psychotic Symptoms in the ALSPAC Birth Cohort"
Andrew Thompson1, Hannah Jones2, Jon Heron2, Sarah Sullivan2, Joseph Hibblen3, Stan Zammit2,4; 1University of Warwick, UK, 2University of Bristol, UK, 3National Institute for Health, US, 4University of Cardiff, UK
               
Background: Long Chain Polyunsaturated Fatty Acid (PUFA) levels have been implicated in the pathology of psychotic disorders. We investigated the relationship between PUFA levels in childhood and later psychotic experiences in a large UK birth cohort (ALSPAC). Methods: Plasma levels of specific Ω-3 and Ω-6 fatty acids were collected at ages 7 and 16. Psychotic experiences were assessed at age 12 and 18 years using a semi-structured interview. Primary outcome was any psychotic experiences at 18 years; secondary analyses examined psychotic experiences at 18 years but not at 12 years, persistent psychotic experiences at 12 and 18 years and psychotic disorder at 18 years. Results: Lower levels of the Ω-6 fatty acids AA, OA and AdA at age 7 years, and the Ω-3 fatty acid DHA at age 16 years were associated with an increased risk for psychotic experiences at 18 years; however, evidence of association only persisted for OA after adjustment for potential confounders.  Higher levels of total Ω-6 at 16 years was associated with an increased odds of developing a psychotic disorder at 18 years. There was no association between Ω-6/Ω-3 ratio and psychosis outcomes nor with genetic instruments of total Ω-3 or Ω-6 levels. Conclusions: There was no strong evidence that total plasma Ω-3 or Ω-6 fatty acid levels or ratios in childhood and mid adolescence are associated with increased risk for psychotic experiences or disorder but some suggestion that specific alterations in the Ω-6 and Ω-3 pathways at different time points in development might influence risk.


Speakers

Tuesday October 9, 2018 1:15pm - 1:25pm
St. George AB Westin Copley Place, third floor

1:15pm

Oral 8, Talk 2. "Three-year longitudinal study exploring metacognition and function in First Episode Psychosis"
Abigail Wright1, Geoff Davies3, David Fowler1, Kathryn Greenwood1,2; 1University of Sussex, 2Sussex Partnership NHS Foundation Trust, 3University of Surrey
               

Background: Functional outcome in psychosis may be predicted by many factors including cognition, functional capacity, symptoms and, importantly, metacognition. Metacognition was recently demonstrated to mediate between cognition and functional outcome in First Episode Psychosis. Given previous research, metacognition may predict long-term functioning after first-episode. This study aimed to assess whether cognition, functional capacity, and metacognition in the early stages of psychosis may predict functional outcome later on. Methods: 80 individuals with First Episode Psychosis were re-contacted after average of 36-months later (range: 26-45 month follow-up). 26 participants completed measures for neurocognition, metacognition (Metacognitive Assessment Interview), functional capacity, functional outcome (hours spent in structured activity per week), and psychotic symptoms at baseline and follow-up. Results: Firstly, regression analyses demonstrated neurocognition, functional capacity and metacognition at baseline significantly predicted functional outcome at follow-up (p<.011, .001, .005). Next, regression analyses, with baseline functional outcome as a covariate, demonstrated metacognitive ability was a significant predictor of change in functional outcome from baseline to 36-month follow-up, F(3, 25) 19.22, p<.001. This model explained 72% (adjusted r² = .69) of the variance in change functional outcome between baseline and follow-up. Therefore, good metacognitive ability at baseline predicted improvement in engagement of structured activity at 36-months. Including negative symptoms did not change the model. Discussion: This highlights the importance of intervening to enhance metacognitive ability, over neurocognition or functional capacity, in order to improve functioning later on, and to target interventions to improve functioning in those with the poor metacognition in the early stages of psychosis.


Speakers

Tuesday October 9, 2018 1:15pm - 1:25pm
St. George CD Westin Copley Place, third floor

1:25pm

Oral 7, Talk 3. "Omega-3 polynsatured fatty acids improve neurocognitive functions and reduce the conversion rate of psychosis in patients with 22q11.2 deletion syndrome"
Marco Armando1, Maria Carmela Padula1, Franco De Crescenzo2, Maude Schneider1, Paul Amminger3, Marie Schaer1, Stephan Eliez1; 1Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland, 2Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart, Rome, 3Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
               
Background: Preliminary investigations supported the role of omega-3 polynsatured fatty acids (PUFAs) in reducing the conversion rate of psychosis. However, a recent DBRCT failed to replicate these results. A possible explanation is the heterogeneity of the population being studied. Differently, 22q11.2 deletion syndrome (22q11DS) is a neurogenetic disorder considered as a homogeneous model of schizophrenia. The aim of this study was to verify the efficacy of PUFAs in this homogeneous, genetically-at risk population. Methods: 74 22q11DS subjects (age range: 5 to 28 years) were included in the analysis, 33 were taking PUFAs (Omega+) and 41 were not (Omega-). Several neurocognitive measures and clinical measures were compared between the two groups. Changes in neurocognitive and psychotic symptoms scores after a 3-years follow up were further assessed. Results: Omega+ subjects showed higher IQ, working memory and verbal fluency than omega-, which in turn showed higher distractibility and impulsivity. These effects remained significant at follow up. A significant treatment-by-time interaction was evident for positive and disorganised symptoms scores, which decreased with time only in omega+ subjects. Moreover, omega+ group showed a lower risk of developing a UHR status (11% vs. 20% in omega-) and lower conversion rates (0% vs. 6.7%) than omega-. Conclusion: Our study represents the first investigation of the effect of PUFAs in subjects with 22q11DS. We detected preliminary evidences for a positive, long-term effect of PUFAs on neurocognitive functions and psychotic symptoms scores as well as their efficacy in reducing the risk of conversion to psychosis.


Speakers

Tuesday October 9, 2018 1:25pm - 1:35pm
St. George AB Westin Copley Place, third floor

1:25pm

Oral 8, Talk 3. "Sex-based differences in outcomes of early intervention in psychosis at 10-year follow-up"
Rosa Ayesa Arriola1, Esther Setién-Suero1, Diana Tordesillas-Gutierrez1, Benedicto Crespo-Facorro1; 1IDIVAL, Valdecilla Biomedical Research Institute. School of Medicine, University of Cantabria. CIBERSAM, Biomedical Research Networking Center for Mental Health Network
               
Specialized early intervention (EI) programs are efficient in treating patients with a first episode of psychosis (FEP) at least after 2 years. However, the question of whether gains are long-term maintained and particularly sex-based prognostic implications needs larger and longer trials. Data for the present work were obtained from FAFIP and PAFIP-10, which are incidence and 10-year follow-up studies, respectively, of all individuals with a FEP presenting for the first time to specialist mental health in the defined catchment area of Cantabria (Spain) once EI was established in this area in February 2001. A total of 305 referrals to PAFIP between 2001-2007 received specialized EI during 3 years, and all these patients were invited for a reassessment 10 years after.  Women and men were longitudinally compared on demographic, positive, negative, depressive, functional, and neurocognitive variables, and antipsychotic treatment. Our results show that the effects of PAFIP early intervention continue 10 years after first contact, particularly in female. When women were compared to men, the data demonstrate that women who suffered a FEP have better courses of illness and global outcomes than men. Women have better responses to antipsychotics, fewer negative symptoms and better functioning. Both men and women showed a period of recovery, particularly in women using minimal antipsychotic doses, between 1 and 3 year follow-up. However, that vanished at some point after PAFIP discharge from specialized intervention towards community-based services. These data helps to put the question of targeted sexes and lengthen interventions in FEP.



Tuesday October 9, 2018 1:25pm - 1:35pm
St. George CD Westin Copley Place, third floor

1:25pm

Symposium 11, Talk 2: "Is the At Risk Mental State approach an effective method of preventing psychosis onset? A retrospective study of a UK mental health programme"
Olesya Ajnakina1, Craig Morgan2, Charlotte Gayer-Anderson2, Sherifat Oduola3, François Bourque2, James MacCabe1, Paola Dazzan1, Robin Murray1, Anthony David1; 1Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK, 2Society and Mental Health Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK, 3David Goldberg Building, Institute of Psychiatry, Psychology & Neuroscience, Kings College London
           
Little is known about patients with a first episode of psychosis (FEP) who had first presented to prodromal services with an “at risk mental state” (ARMS) before making the transition to psychosis. We set out to identify the proportion of patients with a FEP who had first presented to the prodromal services in the ARMS state. We further sought to compare FEP patients with and without prior contact with prodromal services. In this study 338 patients aged ≤37 years who presented to mental health services between 2010 and 2012 with a FEP were employed. The data on pathways to care, clinical and socio-demographic characteristics were extracted from the Biomedical Research Council Case Register for South London and Maudsley NHS Trust. Over 2 years, 55 (16.3% of 338) young adults presented with FEP and had been seen previously by the prodromal services. Of these, 14 (4.1% of 338) had met criteria for the ARMS when seen in a prodromal service and 41 (12.1% of 338) were already psychotic. The true ARMS patients were more likely to enter their pathway to care via referral from General Practice, be born in the UK and to have had an insidious mode of illness onset than FEP patients without prior contact with the prodromal services. In the current pathways to care configuration, prodromal services are likely to prevent only a few at-risk individuals from transitioning to psychosis even if effective preventative treatments become available.


Speakers
OA

Olesya Ajnakina

Kings College London


Tuesday October 9, 2018 1:25pm - 1:45pm
American Ballroom-North Westin Copley Place, fourth floor

1:25pm

Symposium 12, Talk 2. "Long-term outcomes of long overdue trauma-focused treatment in psychosis"
David van den Berg1, Paul de Bont2, Berber van der Vleugel3, Carlijn de Roos4, Ad de Jongh5,6, Agnes van Minnen7,8, Mark van der Gaag1,9; 1Parnassia Psychiatric Institute, The Hague, Netherlands, 2Mental Health Organisation GGZ Oost Brabant, The Netherlands, 3Community Mental Health Service GGZ Noord-Holland Noord, 4Mental Health Organisation Rivierduinen, Leiden, The Netherlands, 5Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, 6School of Health Sciences, Salford University, Manchester, UK, 7Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands, 8PSYTREC Psychotrauma Expertise Center, Bilthoven, The Netherlands, 9VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology,
           
Background: Both childhood trauma and posttraumatic stress increase the odds of developing psychosis. Trauma focused treatments were found to reduce PTSD at 6-month follow-up in individuals who had, on average, been suffering from psychosis for 17.7 years and from PTSD for 21 years (van den Berg et al, 2015). In this RCT, participants in the control condition received their TFT of choice after the 6-month follow-up assessment. The prolonged exposure (PE) and eye movement desensitization and reprocessing (EMDR) groups were also assessed at 12-month follow-up. Methods: we compared the long-term outcomes for PE and EMDR with the 6-month outcomes to test whether the effects endured on the long term (n=85, = 78.8%). Results: Positive effects of both PE and EMDR on clinician-rated PTSD, self-rated PTSD, depression, paranoid-referential thinking, and remission from schizophrenia were maintained up to 12-month follow-up. Negative posttraumatic cognitions declined further in PE and were stable in EMDR. A significant decline in social functioning was found, whereas reductions in the interference of PTSD symptoms with social functioning were maintained. Discussion: Treating posttraumatic stress symptoms after 21 years is feasible and has long-term neutral to positive side-effects on symptoms of psychosis. Many factors other than PTSD, influence social functioning in this group and 8 sessions of therapy are not enough to enhance social recovery.  A next step is to attend to symptoms of posttraumatic stress in young people with emerging symptoms of psychosis.  As societies, we should invest more in the primary prevention of childhood trauma.


Speakers
DV

David van den Berg

Parnassia Psychiatric Institute


Tuesday October 9, 2018 1:25pm - 1:45pm
American Ballroom-Center Westin Copley Place, fourth floor

1:25pm

Symposium 13, Talk 2. "Duration of Untreated Psychosis Moderates Clinical Outcomes and Cost-Effectiveness in First Episode Psychosis Treatment Programs"
Robert Heinssen1; 1National Institute of Mental Health
           
The Recovery After an Initial Schizophrenia Episode initiative evaluated the feasibility, effectiveness, and scalability of a multi-element, team-based approach to first episode psychosis care in the United States. The Early Treatment Program comparative effectiveness trial (RAISE-ETP) enrolled 404 participants from 34 community centers in 21 states; clinics were randomly assigned to provide specialized early intervention services (NAVIGATE; N=17) or usual community care (N=17). The median duration of untreated psychosis (DUP) among participants was 74 weeks. After 24 months, NAVIGATE recipients experienced greater improvements in quality of life, psychopathology, and involvement in work or school compared with patients in community care. In addition, NAVIGATE was more cost-effective than typical treatment. Median DUP was a significant moderator of treatment effects on quality of life and overall symptoms, but not on employment or school attendance. Patients with shorter DUP derived substantially more benefit from NAVIGATE compared to those with longer DUP, and participants in community care. For NAVIGATE patients with DUP <74 weeks, average annual treatment costs were 15 percent lower compared to the annual cost of typical care. Together these findings underscore the importance of complementary approaches for improving FEP outcomes. In 2013, the National Institute of Mental Health launched research initiatives to test feasible strategies for reducing DUP and achieving rapid referral of persons with FEP to specialized treatment programs. The focus, methods, and preliminary findings from 10 funded projects will be presented, along with implications for reducing DUP in ~200 specialized early intervention clinics now established in the United States.


Speakers
avatar for Robert Heinssen

Robert Heinssen

Director, Division of Services and Intervention Research, National Institute of Mental Health


Tuesday October 9, 2018 1:25pm - 1:45pm
American Ballroom-South Westin Copley Place, fourth floor

1:25pm

Symposium 14, Talk 2. "Data fusion and prediction of outcome in early psychosis"
John Gillam1,2; 1Orygen, 2University of Melbourne
           
In order to extract the most powerful predictive models from data collected within the PRONIA study, diverse information sources must be combined. For each subject, neurocognitive, neuroimaging and clinically observed data has been collected that is intended to provided the basis for the development of predictive models for use in individualised diagnosis and prediction.  While a number of approaches may be considered in the combination of data from a diverse range of sources, here, we investigate a two-stage learning approach. An initial step produces a single (probabilistic) outcome for each modality and a second step combines these outcomes to generate a final estimate of the target class. Neurocognitive and neuroimaging data, collected as part of PRONIA, were considered as features for prediction of clinically observed global function, measured at the same time-point. Each neurocognitive test was considered as an independent modality, as were each of a range of MRI-based neuroimaging measures. Using the same target-class (a global assessment of function score less than 65), different approaches to model generation were conducted for each modality using repeated, nested, cross-validation in both stages in order ensure robust estimates of generalisation. The framework of the two-stage learning process is described, and initial results are presented for each approach to classifier-learning considered for both the first and second layer of learning outcomes. An exploration of the contribution to the final prediction from each of the input data streams is discussed and the extension of this approach to structured data-fusion and prediction is considered.


Speakers

Tuesday October 9, 2018 1:25pm - 1:45pm
Staffordshire Westin Copley Place, third floor

1:35pm

Oral 7, Talk 4. "Nutrient Deficiencies and Potential Benefits of Nutritional Interventions in Early Psychosis: Systematic development of a targeted adjunctive treatment for improving recovery"
Joseph Firth1; 1NICM Health Research Institute, University of Western Sydney, Sydney, Australia
               
Background: Extensive research has established that nutritional deficiencies are common in long-term schizophrenia. Randomised controlled trials (RCTs) also demonstrate that adjunctive nutritional interventions can improve outcomes in long-term schizophrenia. Therefore, we examined nutritional deficiencies and clinical correlates in first-episode of psychosis (FEP), in order to design a nutritional intervention for young patients in early stages of illness. Methods: We reviewed all studies examining blood nutrient levels and outcomes of supplementation in FEP: Meta-analytic techniques compared nutrient levels in FEP to healthy controls, and systematic synthesis was applied to all clinical correlates of nutritional deficiencies in FEP. Additionally, we conducted an independent systematic review of all nutrient-based treatment trials in FEP to date. Results: A total of 28 studies examined blood levels of six vitamins and ten dietary minerals in FEP, across 2,612 individuals. Random effects meta-analyses comparing FEP to healthy control groups showed large, significant deficits for Vitamin-D, Vitamin-C, and folate. Lower levels of folate and vitamin-D were associated with more severe symptoms in FEP. Our separate systematic review of 8 experimental studies indicated that supplementation with certain amino acids and antioxidants may also improve treatment outcomes in FEP. Conclusion: Our meta-analysis was the first to examine the extent and clinical correlates of nutritional deficits in FEP. Results showed that vitamin D and folate deficits exist from illness onset, even prior to antipsychotic treatment - and are associated with more severe psychiatric symptoms. Our upcoming RCT (the 'NATURE' trial) will assess if targeting these deficiencies can improve recovery in FEP.


Speakers

Tuesday October 9, 2018 1:35pm - 1:45pm
St. George AB Westin Copley Place, third floor

1:35pm

Oral 8, Talk 4. "Genetic factors associated with early cognitive deficits in psychosis"
Boris Chaumette1, Sarojini Sengupta1, Martin Lepage1, Ashok Malla1, Srividya Iyer1, Guy Rouleau1, Marie-Odile Krebs2, Jai Shah1, Ridha Joober1; 1McGill University, Montreal, Canada, 2Inserm U894 - Ste Anne Hospital, Paris (France)
               
Background Schizophrenia is a progressive illness and cognitive impairments occur since the early phases of the disease and are unresponsive to actual medication. Glutamatergic receptors are good candidates for cognition in psychosis and are targetable by drugs. Methods In a discovery cohort of 144 first-episode of psychosis patients (FEP) recruited in Montreal (Canada), we have genotyped 58 candidate Single Nucleotide Polymorphisms (SNPs) located in NMDA and metabotropic glutamatergic receptors. These SNPs were tested for association with intelligence quotient (IQ) in our cohort. For replication, we used the ICAAR cohort including 121 ultra-high-risk patients (UHR) recruited in Paris (France). Results A polymorphism located in GRM7 gene was significantly associated with performance IQ in the discovery cohort of FEP under an additive model. This association was replicated in the UHR cohort as well as in the merged dataset where this SNP was significantly associated with VIQ, PIQ, and FIQ. The association was significant for the arithmetic subtest of the WAIS and close to significance for the block design and the information subtests. Conclusions This polymorphism seems to be significantly associated with cognitive impairment in early phases of psychosis only. The cognitive decline during later phases of schizophrenia could be linked to other factors. If confirmed, this genetic association may shed light on the biological factors leading to cognitive deficits in early phases of psychosis and could open the way to new therapeutic interventions targeting the glutamatergic pathway.


Speakers

Tuesday October 9, 2018 1:35pm - 1:45pm
St. George CD Westin Copley Place, third floor

1:45pm

Oral 7, Talk 5. "Does N-Acetyl Cysteine (NAC) Improve Negative Symptoms and Cognition in Schizophrenia?"
Alan Breier1,2,3, Jenifer Vohs1,2,3, Bethany Leonhardt1,2,3, Nicole Mehdiyoun1,2, Tom Hummer1,2, Emily Liffick1,2,3,4, Michael Francis1,2,3; 1Department of Psychiatry, Indiana University School of Medicine, 2Indiana University Psychotic Disorders Program, IUSM, 3Eskenazi Health Midtown Community Mental Health Center, 4Eli Lilly and Company
               
Background: Negative and cognitive symptoms are core features of schizophrenia and contribute to the marked functional deficits and poor quality of life associated with this illness. Currently approved medications for schizophrenia, however, are relatively ineffective for these symptom domains. N-Acetyl Cysteine (NAC) is a neuroprotective agent that mitigates the deleterious effects of oxidative stress, inflammation and glutamatergic toxicity. Because of its unique mechanisms of action, NAC has been investigated in several clinical trials in schizophrenia. While there is agreement that NAC appears ineffective for positive symptoms, the outcomes data for negative symptoms and cognitive impairment are conflicting. Methods: In this paper, we assessed the effects NAC (3600 mg/day) in a 52-week, double-blind, placebo controlled trial in early phase schizophrenia spectrum disorders (N=60). Results: NAC significantly improved (time x group) PANSS negative symptoms (F=5.1, p=0.024), as well as PANSS total (F=14.7, p<0.001) and disorganized thought (F=13.7, p<0.001) symptom scores. NAC failed to improve BACS cognitive total composite and individual cognitive test scores, as well as PANSS positive symptom scores. Baseline right (r= -0.48, p=0.041) and left (r= -0.45, p=0.018) total cortical thickness, and thickness in other cortical regions, were associated with NAC related improvement in symptom scores. Conclusions: These results replicate some but not all previous findings of NAC efficacy. The discrepancies among NAC studies for negative and cognitive symptom results will be addressed with suggestions to reconcile these differences.


Speakers
AB

Alan Breier

Indiana University School of Medicine
Indiana Psychotic Disorders Program, Prevention and Recovery Center for Early Psychosis


Tuesday October 9, 2018 1:45pm - 1:55pm
St. George AB Westin Copley Place, third floor

1:45pm

Oral 8, Talk 5. "Interpersonal schema and beliefs about voices in youth with borderline personality disorder or first episode schizophrenia spectrum disorder"
Andrew Chanen1,2,3, Marialuisa Cavelti1,2,4,5, Carol Hulbert4, Shona Francey1,2, Jennifer Betts1,2, Katherine Thompson1,2; 1Orygen, the National Centre of Excellence in Youth Mental Health, 2Centre for Youth Mental Health, The University of Melbourne, 3Orygen Youth Health, 4School of Psychological Sciences, The University of Melbourne, 5Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
               
Auditory verbal hallucinations (AVH) occur in up to 50% of adults with borderline personality disorder (BPD). AVH in BPD are phenomenologically similar to voices in schizophrenia, but are more emotionally distressing, evoke greater emotional resistance, and are a risk factor for suicide and hospitalisation. The cognitive model of AVH predicts that voice-related distress (i.e., depressed mood and anxiety) arises from the negative appraisal of voices (e.g., power and supremacy) and that this appraisal mirrors the voice hearer’s interpersonal relationships. This model has never been studied early in the course of BPD, the same period of life when schizophrenia spectrum disorders usually emerge. This study examined, for the first time, appraisals of voices, interpersonal schema and voice-related distress among youth with BPD and AVH in comparison to youth with first episode psychosis (FEP) and AVH. Sixty-seven outpatients, aged 15-25 years, were recruited from Orygen Youth Health in Melbourne, Australia. Following assessment for mental state and personality disorder, they were grouped into ‘BPD+AVH’, ‘FEP+AVH without BPD’, and ‘BPD without AVH’. Data analysis is currently underway, comparing these groups in terms of appraisals of voices, interpersonal schema, and anxiety and depressive symptoms. Further, the associations between appraisals of voices, interpersonal schema, and anxiety and depressive symptoms will be examined and discussed in the context of the extant models of voice-related distress. The findings will improve understanding of the nature of AVH in youth with BPD and provide potential targets for psychological interventions to reduce voice-related distress.


Speakers

Tuesday October 9, 2018 1:45pm - 1:55pm
St. George CD Westin Copley Place, third floor

1:45pm

Symposium 11, Talk 3. "Experiencing childhood closer to green space is linked to lower schizophrenia risk"
Kristine Engemann Jensen1,2, Carsten Pedersen2,3,4, Constantinos Tsirogiannis5, Preben Bo Mortensen2,3,4, Jens-Christian Svenning1; 1Section for Ecoinformatics & Biodiversity, Department of Bioscience, Aarhus University, Denmark, 2Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Fuglsangs Alle 4, 8210 Aarhus V, Denmark, 3National Centre for Register-based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, Fuglsangs Alle 4, 8210 Aarhus V, Denmark, 4The Lundbeck Foundation Iniative for Integrative Psychiatric Research, iPSYCH, Aarhus University, Fuglsangs Alle 4, 8210 Aarhus V, Denmark, 5Center for Massive Data Algorithmics, MADALGO, Aarhus University, Department of Computer Science, Aarhus University, The IT-park, Åbogade 34, DK-8200 Aarhus N, Denmark
           
Background Less green space in urbanized areas, where schizophrenia risk is high, could point to green space as an important factor. Green space is hypothesized to positively influence mental health and could mediate schizophrenia risk through noise and particle pollution removal, stress relief or other unknown mechanisms. However, the effect of green space on schizophrenia risk has not been disentangled from that of urbanization and it is unclear if different measures of green space associate differently with risk. Methods We used satellite data from the Landsat program to quantify green space for Denmark in 30×30m resolution for the years 1985-2013. The effect of quantity and heterogeneity of green space and urbanization at place of residence on schizophrenia risk was estimated using cox regression from a longitudinal population-based sample of the Danish population (943027 persons). Schizophrenia risk was controlled for age, sex, parental education, salary, and employment status. Results Living at the lowest amount of green space was associated with a 1.52-fold increased risk of developing schizophrenia compared to persons living at the highest level of green space. The strongest protective association was observed during the earliest childhood years and closest to place of residence. Conclusion Green space decreases schizophrenia risk independent of urbanization - consequently pointing to green space as a new environmental risk factor for schizophrenia. This study supports findings from other studies highlighting the natural environment as an important factor for human health, and points to a new methodological framework that combines epidemiological studies with big data approaches.



Tuesday October 9, 2018 1:45pm - 2:05pm
American Ballroom-North Westin Copley Place, fourth floor

1:45pm

Symposium 12, Talk 3. "Cost-effectiveness and cost-utility for treating trauma in psychosis"
Mark van der Gaag1,2, Paul de Bont3, Berber van der Vleugel4, Carlijn de Roos5, Ad de Jongh6,7, Agnes van Minnen8,9, David van den Berg2; 1VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology,, 2Parnassia Psychiatric Institute, Den Haag, The Netherlands, 3Mental Health Organization (MHO) GGZ Oost Brabant, The Netherlands, 4Community Mental Health Service GGZ Noord-Holland Noord, 5MHO Rivierduinen, Leiden, The Netherlands, 6Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, 7School of Health Sciences, Salford University, Manchester, UK, 8Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands, 9PSYTREC Psychotrauma Expertise Center, Bilthoven, The Netherlands
           
Background: The treatment of posttraumatic stress disorder (PTSD) in patients with a psychotic disorder is feasible, effective and safe. But the costs and benefits of trauma-focused treatment (Eye Movement and Desensitization Reprocessing therapy (EMDR) or Prolonged Exposure (PE) therapy) from a health economics and a societal perspective are unknown. Methods: All costs were recorded and both therapy conditions EMDR and PE were compared to the waiting list condition on “losing the classification of PTSD” according to DSM-IV-TR and on “gaining one Quality Adjusted Life Year (QALY)”. Results: Both therapies are cost-saving in losing the diagnosis of PTSD and in gaining one QALY. This is true for the health care costs and for the societal costs. Detailed outcomes will be presented at the conference. Discussion: The treatment of PTSD in people with psychosis has now been recommended in guidelines as being effective and safe. Policymakers, health care providers and insurance companies are encouraged to implement the therapies as they are also cost-saving in most cases, even in the short term of six months.


Speakers
MV

Mark van der Gaag

VU University


Tuesday October 9, 2018 1:45pm - 2:05pm
American Ballroom-Center Westin Copley Place, fourth floor

1:45pm

Symposium 13, Talk 3. "4-year outcome of a specialized early intervention treatment for adult onset psychosis (JCEP): a randomized controlled trial"
Eric YH Chen1, Christy LM Hui1, Sherry KW Chan1, WC Chang1, Edwin HM Lee1; 1Department of Psychiatry, The University of Hong Kong, Hong Kong
           
Despite advances in treatment of psychotic disorders, functional decline remains a prominent obstacle in the recovery pathway. Early intervention (EI) services worldwide have focused timely treatment on the first few years (i.e. critical period) of the disorder to prevent patients from developing long-term disabilities. However, the optimal intervention model and length remain unknown. The Jockey Club Early Psychosis (JCEP) Project delivered a specialized EI service for adult-onset first-episode psychosis patients aged 26 and 55 in Hong Kong. Using a randomized controlled trial, 360 patients were randomly assigned to receive either 4-year of EI treatment (n=120), 2-year of EI treatment (n=120), or 4-year of standard care (n=120). Clinical, functional and neurocognitive assessments were conducted at baseline, 6 months, and yearly until 4 years. By 4 years, it was found that the 4-year EI group had better cognitive outcome than the standard care group; and also better functional and cognitive outcome than the 2-year EI group. Subgroup analysis revealed that patients with longer duration of untreated psychosis (DUP) (≥94 days) benefited substantially more from 4-year EI, compared to 2-year EI. Patients with longer DUP who received 4-year EI had better functioning and cognitive outcome, while no additional benefit was observed in patients who had shorter treatment delay. JCEP evaluated the impact of EI by extending its duration to the entire 4 years. The consequence and implication of prolonged treatment to cover a longer hypothesized critical period will be discussed in this presentation.


Speakers
EY

Eric YH Chen

University of Hong Kong


Tuesday October 9, 2018 1:45pm - 2:05pm
American Ballroom-South Westin Copley Place, fourth floor

1:45pm

Symposium 14, Talk 3. "Specificity of depression phenomenology, and neurobiology, in clinical high-risk and first episode psychosis"
Rachel Upthegrove1,2; 1University of Birmingham, 2Forward Thinking Birmingham & Birmingham and Solihull Mental Health Foundation Trust
           
Major depressive disorder (MDD) is one of the most common mental disorders and is also the most common co-morbidity seen with other mental disorders. In schizophrenia the prevalence of depressive disorder is around 40%, reaching over 50% in groups at clinical high risk (CHR) for psychosis. It is unclear whether these expressions of depression are distinct from MDD without co-morbidity. To further understand the symptom profile of depression in emerging mental disorders, we present data from the PRONIA study (an EUFP7 funded 8 centre study; n=716) to compare CHR, recent onset psychosis (ROP), and recent onset depression (ROD). Using clinical, demographic, and neuroimaging data, and machine learning with Neurominer®, we attempted to classify participants on the basis of their depressive presentation. Data from BDI-II symptom endorsement suggests a 'classical depression phenotype' corresponding to Becks 'cognitive triad'; "life is pointless, future hopeless, self as worthless" may separate depression in ROD from that seen in ROP. Data will also be presented on the CHR group, together with analysis of structural MRI examining correlates with highly weighted classifying symptoms in and across all three groups. When given early in the course of illness, interventions have the greatest potential impact, and characterization and accurate diagnosis of depression in emerging mental disorders is an important goal. This study suggests it may be possible to accurately identify depression in different diagnostic categories, including major depressive disorder, psychosis and clinical high risk, and that neuroimaging holds potential to add to diagnostic accuracy in complex co-morbid disorders.



Tuesday October 9, 2018 1:45pm - 2:05pm
Staffordshire Westin Copley Place, third floor

1:55pm

Oral 7, Talk 6. "A randomised, double-blind, placebo-controlled trial of the effects of vitamin B12, B6 and folic acid on cognition and symptoms in first-episode psychosis. The Vitamins in Psychosis Study"
Kelly Allott1,2, Patrick McGorry1,2, Hok Pan Yuen1,2, Colin O'Donnell3; 1Orygen, The National Centre of Excellence in Youth Mental Health, Australia, 2Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia, 3Department of Psychiatry, Donegal Mental Health Service, Letterkenny University Hospital. Co. Donegal, Republic of Ireland
               
Vitamin B12, vitamin B6 and folic acid are homocysteine-reducing agents. Supplementation in chronic schizophrenia has shown that folate plus vitamin B12 can improve cognition and clinical symptoms. This study investigated whether adjunctive vitamin B12, B6 and folic acid lowers homocysteine and improves symptomatology and cognition in first-episode psychosis (FEP). This was a randomised, double-blind, placebo-controlled trial conducted at the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. One hundred FEP patients aged 15-26 were randomised to receive folic acid 5mg, vitamin B12 0.4mg, and vitamin B6 50mg (N=52) or placebo (N=48), taken once-daily for 12 weeks, adjunct to anti-psychotics. Co-primary outcomes were change in composite cognition measured via a battery of 11 tests and total symptomatology (PANSS) over 12 weeks. Secondary outcomes included additional cognitive, symptom, functioning, tolerability and safety measures. Vitamin supplementation reduced homocysteine levels in the vitamin group over 12 weeks. The homocysteine lowering effects of the vitamins did not confer a major advantage over placebo therapy in improving the co-primary PANSS (p=.75) or composite cognition (p=0.79). There was no significant group difference in secondary symptom domains. There was a significant group difference in the attention/vigilance domain (p=.024), whereby the vitamin group remained stable in their performance, whereas the placebo group declined. Vitamin supplementation appears well tolerated and safe and lowers homocysteine levels in  in FEP. While supplementation may not offer extra benefits with respect to psychopathology and global cognition, folic acid, B12 and B6 may benefit the cognitive domain of attention/vigilance in people with FEP.


Speakers

Tuesday October 9, 2018 1:55pm - 2:05pm
St. George AB Westin Copley Place, third floor

1:55pm

Oral 8, Talk 6. “It's brought me like a lot closer to who I am”: aspects and facilitators of positive change following a first episode of psychosis"
Gerald Jordan1, Ashok Malla1, Srividya Iyer1; 1McGill University; Prevention and Early Intervention Program for Psychoses; ACCESS Open Minds/Esprits ouverts
               
A first episode of psychosis (FEP) is often a severe and highly negative experience. However, FEP may also present an opportunity for positive change. While positive changes have been reported following various physical illnesses (e.g., HIV) or traumatic events (e.g., war), very little research has investigated positive changes following FEP. To address this knowledge gap, this presentation will address two research questions: 1) What are the positive changes persons experience following FEP, and 2) What factors or processes may facilitate such changes? A qualitative descriptive design guided the project. Data were gathered through semi-structured interviews conducted with twelve purposefully sampled service users receiving treatment for FEP at an early intervention service. Interviews were transcribed verbatim and analyzed using thematic analysis using inductive and deductive approaches. Participants described how they experienced declines and difficulties following FEP. Yet, participants also developed improved mental health; a stronger sense of self and improved personality; greater levels of, and a better approach to, spirituality; improved relationships with others; as well as improved lifestyles and new goals for the future. Participants described how their positive changes were facilitated through care received by mental health services; drawing on resources to help them cope with the FEP; experiencing healing and recovery; and finding meaning in their experiences. These findings can inform early intervention services seeking to better provide positive, hopeful, strengths-based services to persons experiencing FEP. The findings also validate the experiences of persons who have experienced positive change as a result of their experience of FEP.


Speakers

Tuesday October 9, 2018 1:55pm - 2:05pm
St. George CD Westin Copley Place, third floor

2:05pm

Oral 7, Talk 7. "Antipsychotic Medication in First-Episode Psychosis: An RCT to Assess the Risk-Benefit Ratio"
Shona Francey1, Barnaby Nelson1,2, Graham Jessica1, Baldwin Lara1, Hok Pan Yuen1,2, Brian O'Donoghue1,2, Alex Fornito3, Mario Alvarez-Jimenez1,2, Susy Harrigan1, Pat McGorry1,2; 1Orygen, The National Centre of Excellence in Youth Mental Health, 2Centre for Youth Mental Health, University of Melbourne, Victoria, Australia, 3Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Science and Monash Biomedical Imaging, Monash University, Victoria, Australia
               
There are risks associated with the use of antipsychotic medication (AP). These include adverse neurological and metabolic effects and measurable changes in brain structure. APs may even be associated with poorer functional recovery. The STAGES Study is a non-inferiority design randomised double blind placebo controlled study that examines whether a subgroup of people with FEP can recover without AP, and considers the effects on functioning, physical health, cognition, and brain structure of AP versus withholding AP. Young people with FEP were screened for study eligibility and recruited if they met stringent inclusion criteria indicating low-risk of harm to self or others, and adequate social support. Participants were randomly assigned to receive either low dose AP (MIPT group) or placebo (PIPT group) for six months, and all participants received intensive psychosocial treatment. Ninety young people (mean age 18.5 years) were randomised and 81 commenced trial medication. Thirty-four percent of participants completed the six month medication phase and there were more completers in the placebo group than the medication group. On the primary outcome measure of SOFAS there was significant evidence that the placebo group was not inferior to the medication group (SOFAS: MIPT mean = 61.5, SD = 13.4; PIPT mean = 61.7, SD = 16.8). The two groups were found to be very similar on all psychopathology assessments and measures of functioning at both baseline and following treatment, suggesting that the outcomes of the two treatment regimes were not different with respect to symptoms and functioning.


Tuesday October 9, 2018 2:05pm - 2:15pm
St. George AB Westin Copley Place, third floor

2:05pm

Oral 8, Talk 7. "Duration of Untreated Psychosis is related to worse outcomes in antipsychotic naïve patients at first episode of psychosis"
Daniel Cavalcante1, Luccas Coutinho1, Bruno Ortiz1, Mariane Noto1, Quirino Cordeiro1, Vanessa Ota1, Sintia Belangeiro1, Rodrigo Bressan1, Ary Gadelha1, Cristiano Noto1; 1UNIVERSIDADE FEDERAL DE SÃO PAULO
               
The duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcome in psychosis. In low- and middle-income countries, despite the advances in the mental health assistance, there are still few studies addressing this issue. We aimed to verify if DUP can predict worse symptom severity and treatment response in a Brazilian cohort of antipsychotic naïve patients in first episode of psychosis (FEP). Our sample comprised 145 patients admitted to a psychiatric emergency service. Diagnosis was established according to the Structured Clinical Interview for DSM-IV (SCID). Symptom severity was measured with the Positive And Negative Symptoms Scale (PANSS) considering five dimensions (positive, negative, depressive, disorganized and excitement), and the functionality was assessed with the Global Assessment of Functioning Scale (GAF). We performed multivariated linear regressions using DUP to predict the treatment outcomes, controlling for possible confounders as sex, age, income and living arrangement. All patients were treated with risperidone and 79 patients were reassessed after 10 weeks of treatment. The DUP’s median was 61 days (interquartile range: 170; min=0; max=1770). At baseline, we have not found a significant prediction, but after 10 weeks, DUP predicted worse scores on positive dimension (p<0.001, R²=0.279, β=0.012), negative dimension (p=0.001, R²=0.262, β=0.012), functionality (p=0.005, R²=0.175, β=1.848) and response to treatment (p<0.001, R²=0.325, β=0.042). Our findings indicate that DUP does not influence the baseline status of the patients, but can predict the treatment outcomes in a short-term follow-up, even accounting for premorbid clinical and sociodemographic factors.



Tuesday October 9, 2018 2:05pm - 2:15pm
St. George CD Westin Copley Place, third floor

2:05pm

Symposium 11, Talk 4. "It is time to take a Public Health Approach to Prevention of Psychosis"
Robin Murray1, Marta Di Forti2, Evangelos Vassos2, Harriet Quicgley1, Antonella Trotta2, Diego Quattrone2, Victoria Rodrigues1, Craig Morgan; 1Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, 2MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, 3Society and Mental Health Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
           
Background. The main attempt to prevent the development of psychosis has been through clinics for people at clinical high risk. Such an approach is useful for research but can never reach the majority of individuals who will become psychotic. Biological markers could be used to identify individuals with unusual vulnerabilities e.g. those with copy number variations. However, identifying those with such markers is unlikely to impact on the majority of cases, and as yet no useful interventions are available. How therefore to prevent psychosis? Methods Data will be presented from 3 studies of first onset psychosis which used similar methods of ascertainment and assessment of cases and controls across 16 sites in 5 European countries. Results The polygenic risk score accounted for the greatest variance in caseness; those with scores in the highest quintile were 7 times more likely to be a psychotic case than those in those lowest quintile. Attributable fraction analyses indicated that if no one was exposed to child abuse and use of high potency cannabis, then 16% and 24% respectively of psychosis in South-London could be prevented. There are differences in the incidence of psychosis between Northern and Southern Europe. Conclusions Similarly to preventive approaches for hypertension or obesity where members of the general population are encouraged to take exercise and reduce their calorie intake, attempts should be made to influence society’s patterns of consumption of high-potency cannabis and educate them on impact of childhood abuse in a bid to prevent development of psychosis.


Speakers

Tuesday October 9, 2018 2:05pm - 2:25pm
American Ballroom-North Westin Copley Place, fourth floor

2:05pm

Symposium 12, Talk 4. "The ‘Talking Trauma’ project: Implementation of trauma-informed care in Early Intervention in Psychosis services"
Amy Hardy1,2, Sarah Swan2, Jonathan Bradley2, Claire Thompson2, Suzanne Jolley1,2; 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, 2South London & Maudsley NHS Foundation Trust
         
Background: The United Kingdom’s National Institute for Health and Care Excellence guidelines for psychosis and schizophrenia recommend that trauma and PTSD should be routinely assessed in Early Intervention for Psychosis services and, when indicated, therapies for posttraumatic stress disorder and other reactions to trauma provided (NICE, 2014). This is based on research indicating higher rates of trauma and posttraumatic stress reactions in this clinical group compared to the general population, and emerging evidence of the effectiveness of trauma-focused talking treatments (de Bont et al, 2015; van den Berg et al, 2015). However, effective implementation of the guidance is dependent on addressing barriers and opportunities from a range of stakeholder perspectives, multidisciplinary staff training and supervision, and an audit cycle to evaluate trauma-informed practice.  Methods: The ‘Talking Trauma’ audit aims to address these needs, using interviews and surveys with service users and staff, together with case note review, and is being conducted across the psychosis services of a National Health Service Trust in inner city London. Results: A summary of the audit findings to date will be provided, followed by plans for further service development.   Discussion: Implementation in early intervention in psychosis services is challenging but feasible. Attention needs to be directed towards establishing and maintaining a culture of trauma-informed care, to support effective case management and access to trauma-focused therapy.


Speakers
AH

Amy Hardy

King's College London


Tuesday October 9, 2018 2:05pm - 2:25pm
American Ballroom-Center Westin Copley Place, fourth floor

2:05pm

Symposium 13, Talk 4. "Delay in initial treatment may limit the benefit of even extended early intervention service: results from a RCT"
Ashok Malla1,2, Jai Shah1,2, Manish Dama1,2, Srividya Iyer1,2, Ridha Joober1,2, Amal Abdel-Baki3,4, Sherezad Abadi2; 1McGill University, 2Douglas Mental Health University Institute, 3Université de Montréal, 4Centre Hospitalier Universtaire de Montréal
           
Longer duration of untreated psychosis (DUP) has a negative influence on short and long term outcome in first episode psychosis (FEP) and may limit benefits of specialized early intervention services. It is not clear if this effect would persist even when the early intervention service is extended beyond the initial two years. We report here post-hoc analysis of the results of a large RCT comparing effectiveness of an extended early intervention service (EEIS) to Regular Care, following two years of initial EIS. The results of the principal analyses on the primary outcome (length of positive, negative and total remission) favoured the EEIS. Using a DUP ≤ 12 weeks (as per the literature) cut-off 217 patients were split into two groups and examined if longer remission in patients randomized to an EEIS was associated with shorter DUP. Patients with DUP ≤ 12 weeks (median for the sample), treated in an extended EIS experienced significantly longer remission for positive (β = 0.35; p <0.01), negative (β = 0.38; p <0.01), and total symptoms (β = 0.36; p = 0.01) compared to regular care. However, for patients with DUP > 12 weeks, no such difference emerged between the two treatment conditions. For those with DUP between 12-24 weeks, only length of remission for positive symptoms (but not negative) showed a borderline significance (β = 0.37; p = 0.05). These findings suggest that reducing DUP may be essential to getting the most benefit from a specialized EI service even in an extended EI service.


Speakers

Tuesday October 9, 2018 2:05pm - 2:25pm
American Ballroom-South Westin Copley Place, fourth floor

2:05pm

Symposium 14, Talk 4. "Prediction of functioning using neurocognitive features in subjects with clinical high risk (CHR), recent onset psychosis (ROP) and recent onset depression (ROD)"
Paolo Brambilla1,2; 1University of Milan, 2The University of Texas Health Science Center at Houston
           
In this work, a relationship between functioning and neurocognitive evaluations has been investigated using machine learning. The analyses were carried out on the neuropsychological scores in 707 subjects with clinical high risk (CHR), recent onset psychosis (ROP), recent onset depres-sion (ROD) and healthy controls (HC). Subjects were not divided in classes but the prediction has been considered as dealing with a continuum in terms of global functioning. Subjects with incomplete data were excluded from the analysis. The measures of Global Functioning (GF) social and role, which quantify how effectively the person is functioning in their everyday life, were used to predict the difference in functioning at baseline (T0) and at 9 months follow up (T1) in respect to lifetime. Then, 38 features drawn from the PRONIA cognitive battery (PCB) on the basis of a priori knowledge were entered into a model that was evaluated with machine learning methods implemented with Neurominer. The non-informative features were pruned and the data were scaled. The model under-went 10x10 cycles of internal cross-validation (CV1) and 10x10 cycles of cross-validation against an outer portion of the sample (CV2) that, at each cycle, did not enter the CV1. The results showed that the model could reliably predict a drop in social and role functioning at T0 with respect to both life and past year (p<0.01), and GF social could be predicted (p=0.03).


Speakers

Tuesday October 9, 2018 2:05pm - 2:25pm
Staffordshire Westin Copley Place, third floor

2:15pm

Oral 7, Talk 8. "The Role of Long-Acting Injectable Antipsychotics in Preventing Relapse in Early Psychosis with Concurrent Cannabis Use Disorder"
Dale D'Mello1, Emily Rozin1, Vivek Vanaharam1, Cathy Adams, Scott Palazollo; 1Department of Psychiatry, Michigan State University
               
Introduction: A third of adverse outcomes associated with cannabis use in early psychosis may be mediated by medication noncompliance. Few, if any, studies have examined the role of long-acting injectable antipsychotics (LAIA) in this group. Objective: To examine the role of LAIA in preventing relapse in patients with early psychosis and concurrent cannabis use. Methods: A retrospective chart review was performed of all patients diagnosed with early psychosis, defined as a duration of 18 months or less, at the Early Treatment & Cognitive Health Program in East Lansing in 2017. Sources of data included the Navigate Patient Self-Rating Form (NPSRF), electronic medical records (EMR), and hospitalization logs. Data were anonymously entered into MYSTAT statistical software. Differences in the mean value of relapse between patients maintained on LAIA were compared to those maintained on oral antipsychotics. Results: Of 51 total patients, 24 (47%) were cannabis users. Eleven (46%) of the cannabis users were hospitalized versus 5 (19%) of the non-users. The differences were statistically significant: Chi-square=4.403, df=1.000, p=0.036. Of the 10 cannabis users who were maintained on LAIA, only 2 (20%) were hospitalized. By comparison, 9 (64%) of 14 cannabis users on either oral or no antipsychotics were hospitalized. Differences in relapse rate were significant: Chi-square=4.608, df=1.000, p=0.032. Discussion: Cannabis users were more likely to be hospitalized than non-users. LAIA were associated with a lower rate of relapse in this cohort.


Tuesday October 9, 2018 2:15pm - 2:25pm
St. George AB Westin Copley Place, third floor

2:15pm

Oral 8, Talk 8. "Schizotypal Trait Expression and Mentalizing in Adolescence"
George Salaminios1, Larisa Morosan2,3, Elodie Toffel2, Stephan Eliez2,3, Martin Debbané1,2,3; 1Research Department of Clinical, Educational and Health Psychology, University College London, 2Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, 3Department of Psychiatry, Developmental Imaging and Psychopathology Lab, University of Geneva
               
Contemporary research suggests that clinical psychosis is proximally linked with the breakdown of higher-order cognitive processes pertaining to mentalizing – the capacity to understand the intentional mental states driving one’s own and others’ behaviours. Importantly, subtle mentalizing difficulties have been identified among youths in the context of high psychometric schizotypy, prior to the emergence of clinical symptoms, suggesting a pathway towards illness expression. However, little is known about the relationship between schizotypal personality dimensions and disruptions in mentalizing processes across adolescence. Thus, we examined the extent to which schizotypal traits contributed to mentalizing difficulties in a sample of non-clinical youths (N=105; Mean Age=15.72). Self-report measures were used to assess schizotypal traits [Schizotypal Personality questionnaire (SPQ)], mentalizing difficulties [Reflective Functioning Questionnaire (RFQ)], metacognitive beliefs [Metacognitions Questionnaire (MCQ)] and symptoms of anxiety and depression [Youth Self-Report (YSR)].  We run a stepwise multiple regression model, controlling for the effects of metacognitive beliefs and anxiety/depression, to assess the unique contribution of SPQ dimensions on mentalizing difficulties. The interpersonal dimension of schizotypy significantly accounted for mentalizing difficulties pertaining to increased uncertainty about mental states (β=0.24, p<0.05). The cognitive-perceptual and disorganization dimensions did not account for variance in mentalizing scores. Adolescents who withdraw from interpersonal contact in the context of negative schizotypy encounter less social interaction opportunities, essential for developing a capacity to understand mental states, thereby compromising their resilience to psychosis risk. Mentalization-based treatment may be applied preventatively to sustain social-cognitive functioning in youths who present schizotypal manifestations, prior to the development of clinical symptoms.



Tuesday October 9, 2018 2:15pm - 2:25pm
St. George CD Westin Copley Place, third floor

2:25pm

Oral 7: Q&A
Question and answer period

Speakers
SF

Shona Francey

Orygen, The National Centre of Excellence in Youth Mental Health


Tuesday October 9, 2018 2:25pm - 2:30pm
St. George AB Westin Copley Place, third floor

2:25pm

Oral 8: Q&A
Question and answer period.

Speakers
MB

Michael Birnbaum

The Zucker Hillside Hospital


Tuesday October 9, 2018 2:25pm - 2:30pm
St. George CD Westin Copley Place, third floor

2:25pm

Symposium 11: Q&A
Question and answer period.

Speakers
AM

Andreas Meyer-Lindenberg

Central Institute for Mental Health


Tuesday October 9, 2018 2:25pm - 2:30pm
American Ballroom-North Westin Copley Place, fourth floor

2:25pm

Symposium 12: Q&A
Question and answer period.

Speakers
avatar for Lucia Valmaggia

Lucia Valmaggia

Senior Lecturer, King's College London, IEPA President Elect
Dr. Valmaggia works as Senior Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London she leads the Virtual Reality Lab, and is a Consultant Clinical Psychologist at the South London and Maudsley NHS Trust.During her career Cr. Valmaggia has sought... Read More →


Tuesday October 9, 2018 2:25pm - 2:30pm
American Ballroom-Center Westin Copley Place, fourth floor

2:25pm

Symposium 13: Q&A
Question and answer period.

Speakers
JO

Jan Olav Johannessen

Stavanger University Hospital


Tuesday October 9, 2018 2:25pm - 2:30pm
American Ballroom-South Westin Copley Place, fourth floor

2:25pm

Symposium 14: Q&A
Question and answer period.

Speakers
PD

Paola Dazzan

Kings College London


Tuesday October 9, 2018 2:25pm - 2:30pm
Staffordshire Westin Copley Place, third floor

2:30pm

Coffee Break
Tuesday October 9, 2018 2:30pm - 2:45pm
American Ballroom Westin Copley Place, fourth floor

2:45pm

Oral Session 09: COGNITIVE REMEDIATION, CBT AND OTHER INNOVATIVE TREATMENTS
Chair
MV

Mark van der Gaag

VU University

Speakers

Tuesday October 9, 2018 2:45pm - 4:15pm
St. George AB Westin Copley Place, third floor

2:45pm

2:45pm

Symposium Session 15: ELECTROPHYSIOLOGICAL MARKERS OF PSYCHOSIS RISK AND CONVERSION: A VIEW FROM THE NORTH AMERICAN PRODROME LONGITUDINAL STUDY (NAPLS 2)
Identifying biologically-based predictors and mechanisms related to the development of psychosis is critical to early detection and disability prevention efforts. The multi-site North American Prodrome Longitudinal Study combined baseline neurobiological assessment with longitudinal clinical follow-up of adolescents and young adults identified as clinical high risk (CHR) for developing psychosis. This session will present data on electrophysiology studies from the NAPLS 2 cohort with a focus on highlighting baseline electrophysiological markers that relate to 24-month clinical outcomes including, but not limited to, transition to psychotic spectrum disorders. Dr. Fryer from the University of California, San Francisco (UCSF) will present data from the mismatch negativity (MMN) paradigm, focusing on the relationship between measures of predictive coding at baseline and clinical outcomes 24 months later. Dr. Carrión from Hofstra Northwell School of Medicine will present a study on the functional impact of these MMN deficits by discussing interrelationships among MMN, negative symptoms, and cognitive and social functioning. Dr. Guillory from the Ichan School of Medicine at Mount Sinai will present a study comparing MMN and P300 functioning in CHR individuals with and without comorbid autism spectrum diagnoses including the extent to which this comorbidity influences biomarker relationships to conversion status. Dr. Niznikiewicz from Harvard Medical School will present findings on the gamma-band auditory steady-state response in youth at CHR for psychosis compared to healthy controls and conversion-based analyses within CHR. Dr. Mathalon from UCSF is the electrophysiology lead for NAPLS and will serve as the session’s discussant.


Chair
RC

Ricardo Carrion

Hofstra Northwell School of Medicine
SL

Susanna L. Fryer

University of California, San Francisco

Speakers

Tuesday October 9, 2018 2:45pm - 4:15pm
American Ballroom-North Westin Copley Place, fourth floor

2:45pm

Symposium Session 16: CULTURAL INFLUENCES ON CARE FOR FIRST EPISODE PSYCHOSIS IN YOGYAKARTA, INDONESIA
This panel grows out of two decades of collaboration between researchers from Harvard Medical School and Gadjah Mada University in Yogyakarta, Indonesia, focusing on first episode psychotic illness. Studies range from epidemiological research on the incidence and nature of onset of first episode/first contact psychoses; intensive ethnographic studies of individual cases followed over time, family responses and care for illness, and interaction with traditional healers; clinical studies, linking cultural phenomenology with clinical rating scales, and intervention studies focused on developing, evaluating, then scaling up psycho-educational interventions for families caring for a person with psychotic illness. Rather than addressing individual studies, this panel will provide a brief overview of the context and history of this program of research, followed by four presentations examining specific issues, drawing from the larger body of research: 1) the social and cultural influences on onset and long-term outcomes of illness, with a particular focus comparing very rapid and slow onset psychoses; 2) cultural phenomenology and care-seeking, providing both case studies and quantitative data; 3) the social course of illness, based on intensive longitudinal studies; and 4) evaluation of psycho-educational interventions for families of persons with psychotic illness, designed for the local social and cultural setting, and preliminary efforts to scale up such interventions through the primary health care system. The panel thus links studies of cultural phenomenology and psychosocial interventions of first episode psychosis. Though not generalizable to all of Indonesia, this research provides important data from Indonesia, the world’s fourth most populous nation.



Tuesday October 9, 2018 2:45pm - 4:15pm
American Ballroom-Center Westin Copley Place, fourth floor

2:45pm

Symposium Session 17: INTERNATIONAL APPLICATION OF FIDELITY SCALES FOR FIRST EPISODE PSYCHOSIS SERVICES
First episode psychosis services have been shown to be effective in several large randomized controlled studies in different health care systems. There is a growing consensus as to the essential components of such services and fidelity scales have been developed to assess the degree to which services deliver the essential evidence based components. Fidelity scales can be used for assessing implementation of new programs, ensuring quality of existing programs and by funders for setting standards. The international health challenge is now to broaden access to first episode psychosis services and to ensure that existing services continue to deliver evidence based care. Fidelity scales are one of the tools that can be used to support access to quality services, but their application is challenging. Several fidelity scales are now available, and are being applied in the United States, Italy, Canada, Denmark, and Australia. In this symposium we will examine the challenges of large scale application of fidelity scales. Speakers will illustrate how these challenges are being overcome and fidelity scales are being applied in the United States, Canada, Australia, and Denmark. Mental health services have been slower to measure access and quality of services than other health services. Developing the systems required to support evidence based quality assessment for first episode psychosis services can lead to broader application in other aspects of mental health services.



Tuesday October 9, 2018 2:45pm - 4:15pm
American Ballroom-South Westin Copley Place, fourth floor

2:45pm

Symposium Session 18: IMPLEMENTATION AND INTEGRATION OF DIGITAL THERAPIES IN SECONDARY CARE MENTAL HEALTH SERVICES
The acceptability of digital tools in secondary mental healthcare appears acceptable, with promising results regarding efficacy. However, implementation of digital tools within mental health services is problematic. Without considering issues around implementation during the early stages of the development and delivery of digital tools, it is unlikely that these approaches will be disseminated beyond research studies and into mental healthcare services. This symposium brings together some of the world’s key research centres currently engaged in research evaluating integration of digital tools into secondary care mental health services. Bucci will present findings from qualitative and quantitative work regarding mental health staff and service user views on the facilitators and barriers to implementing digital tools into secondary care services. Lewis will then present findings from the ClinTouch/CareLoop trial, a smartphone software system built into the electronic care records of two large UK NHS Trusts targeting active symptom monitoring, symptom self-management and early detection of relapse in early psychosis. When built into clinical management workflows to enable personalised alerts of symptom deterioration, the system has the potential to promote earlier intervention for relapse. Gumley will present the protocol for EMPOWER, an end-to-end self-management system for psychosis being trialled in the UK and Australia. Gumley will discuss issues regarding medical device registration and engaging clinical teams in using the self-management system. Finally, using normalisation process theory, Lobban will report on a study identifying critical factors impacting on the implementation of an online peer supported self-management intervention for relatives of people with SMI.


Chair
SB

Sandra Bucci

University of Manchester
AH

Amy Hardy

King's College London

Speakers

Tuesday October 9, 2018 2:45pm - 4:15pm
Staffordshire Westin Copley Place, third floor

2:50pm

Oral 09, Talk 1. "Mobile Cognitive Training in Individuals at Clinical High Risk for Psychosis and with Recent-Onset Schizophrenia"
Rachel Loewy1, Melissa Fisher2, Cameron Carter3, J. Daniel Ragland3, Tara Niendam3, Barbara Stuart1, Danielle Schlosser1,4, Sophia Vinogradov2; 1University of California San Francisco, Department of Psychiatry, 2University of Minnesota, Department of Psychiatry, 3University of California Davis, Department of Psychiatry, 4Verily Life Sciences
               
Cognitive deficits in early psychosis predict functional outcomes and should be aggressively targeted for early intervention. We have recently conducted two parallel studies of targeted cognitive training of auditory/verbal processing in early psychosis: one with adolescents and young adults at clinical high risk (CHR) for psychosis and a second with young adults with recent-onset schizophrenia (ROS). Both studies were double-blind randomized controlled trials in which participants performed 40 hours of auditory training (AT) or commercial computer games (CG) via laptop computer. They were assessed on symptoms, functioning and an abbreviated MATRICS-recommended neurocognitive battery at baseline, post-training and 6-month follow-up. In a modified Intent-To-Treat (ITT) analysis with 147 randomized ROS participants there were significant condition-by-time interactions for Global Cognition (p = 0.007), Verbal Memory (p =. 042) and a trend towards significance for Problem Solving (p = .054). Planned contrasts revealed gains for the AT group compared to CG group from baseline to follow-up in Global Cognition (p=.001) and PANSS Positive symptoms (p=.0017). In a similar modified ITT analysis, 83 randomized CHR participants demonstrated a significant condition-by-time interaction in Verbal Memory, with the AT group showing more improvement from baseline to post-training than the CG group (p=.04). Analysis of the CHR 6-month follow-up data is currently underway. Neuroscience-informed cognitive training represents a promising treatment approach for cognitive dysfunction in adolescents and young adults in the early phases of psychosis.  Future research should focus on personalization, improving training adherence, and combination with coordinated specialty care interventions to more strongly impact real-world functioning.


Speakers

Tuesday October 9, 2018 2:50pm - 3:00pm
St. George AB Westin Copley Place, third floor

2:50pm

Oral 10, Talk 1. "Cognitive Heterogeneity over the First Year of Illness"
Kathryn Lewandowski1,2, Dost Ongur1,2; 1McLean Hospital, 2Harvard Medical School
               
Cognitive dysfunction is a core symptom dimension in psychosis and associated with poor functioning even by the early phase of illness. However, considerable cognitive heterogeneity exists; some findings suggest cognitive stability after the first episode, and others show continued cognitive change. One possible explanation is that patients may follow heterogeneous cognitive trajectories. Cluster analysis has identified profiles of cognition in psychosis, which map to clinical, functional and neurobiological measures. How these clusters predict cognitive trajectories is unclear. Thus, we aimed to evaluate cognitive subtypes in FEP at baseline and over a one-year follow up. Patients within one year of an initial episode of psychosis (n=75) were assessed at baseline and at 1-year follow up (n=35) using the MATRICS battery, clinical and functional measures.  Cluster analytic techniques were run on baseline cognitive data. Clusters were then compared on baseline and follow-up clinical and functional measures, and cognitive trajectory. A 3-cluster solution best fit the data, reflecting Intact (T=55), Moderately Impaired (T=39) and Significantly Impaired (T=28) groups.  Groups differed in terms of clinical and functional measures at baseline; diagnoses were distributed across all three clusters. Clusters 1 and 3 showed relatively stable cognitive course (Intact and Significantly Impaired, respectively). Cluster 2 showed cognitive improvement from baseline to follow up. Cognitive trajectories were associated with functional outcomes. Cognitive heterogeneity is evident at the time of a first episode and associated with clinical and functional measures, and cognitive trajectories.  Leveraging cognitive heterogeneity may inform individualized prediction and treatment implementation for patients with psychosis.


Speakers
KL

Kathryn Lewandowski

Harvard Medical School


Tuesday October 9, 2018 2:50pm - 3:00pm
St. George CD Westin Copley Place, third floor

2:50pm

Symposium 15, Talk 1. "Experience-dependent strengthening of auditory prediction signals in youth at clinical high risk for psychosis: Effects of clinical outcome and conversion"
Susanna L. Fryer1,2, Peter Bachman3, Aysenil Belger4, Ricardo Carrión5, Erica Duncan6, Jason Johannesen7, Margaret Niznikiewicz8, Brian Roach2, Jean Addington9, Kristin Cadenhead10, NAPLS Consortium, Daniel H. Mathalon1,2; 1University of California, San Francisco, 2San Francisco VA Healthcare System, 3University of Pittsburgh, 4University of North Carolina, 5Zucker Hillside Hospital, 6Emory University, 7Yale University, 8Harvard Medical School, 9University of Calgary, 10University of California, San Diego
           
The mismatch negativity (MMN) event-related potential (ERP) is an auditory prediction error signal elicited by the violation of the expectation that a standard, frequent sound will repeat.  Repetitions of standards strengthen this prediction signal, and produce an increasing electrophysiological signature, the “repetition positivity” (RP).  The RP reflects strengthening of experience-dependent short-term plasticity.  Here, we examine the RP elicited by a MMN paradigm in youth at clinical high risk for psychosis (CHR; n=450) and healthy controls (HC; n=241) from the North American Prodromal Longitudinal Study-2.  After 24 months of clinical follow-up, CHR participants (n=244) were categorized by clinical outcome status into subgroups that:  i) transitioned to psychosis (CHR-Transition, n = 54), ii) did not transition but remained symptomatic (CHR-Symptomatic, n = 112), and iii) did not transition and reached symptom remission (CHR-Remission, n = 78).  The RP (100-200 ms post-stimulus) to successive standards (2, 3, 4-5, 6-7, 8-10, >10 repetitions) was assessed at baseline.  Significant group differences in RP amplitude were detected based on clinical outcome (Group*Standard interaction, p <.001).  Follow-up tests revealed CHR-Transition had significantly smaller baseline RPs to late standards (>10 repetitions), relative to HC and CHR-Remission participants, who did not differ from each other.  Similarly, the CHR-Symptomatic group, which did not differ from the CHR-Transition group, had smaller baseline RPs to late standards relative to HC and CHR-Remission groups (all follow-up p’s <.05, FDR-corrected for multiple comparisons).  These results implicate deficits in short-term auditory cortex plasticity as a risk factor for psychosis that is sensitive to clinical outcome.


Speakers
SL

Susanna L. Fryer

University of California, San Francisco


Tuesday October 9, 2018 2:50pm - 3:10pm
American Ballroom-North Westin Copley Place, fourth floor

2:50pm

Symposium 16, Talk 1. "The Place of Acute Onset in the Cultural Patterning of First Episode Psychosis in Java"
Byron J. Good1, M. A. Subandi2, Carla Marchira2, Mary-Jo DelVecchio Good1; 1Harvard Medical School, 2Gadjah Mada University
           
From the beginning of our ethnographic and clinical research in 1996, the Yogyakarta team began identifying very rapid onset psychoses as unexpectedly common.  This led to a series of studies investigating their cultural phenomenology, prevalence, the nature of prodromal features, and eventually to the relationship between acuteness of onset and long-term outcomes.  Purpose: The overall aim of paper will be to present data about the nature and prevalence of acute onset illness among first episode first contact psychoses in Java, and to ask how the nature of onset relates to care-seeking and long-term course of illness. Methods: Data are drawn from ethnographic studies, an epidemiological study (of 304 first episode psychoses appearing for treatment in Yogyakarta in 6 months), an intensive set of 30 in-depth interviews with individuals and their care providers, and a 12 year follow-up of the 30 intensive cases. All data are retrospective studies of persons in first episode who have already contacted services. Findings: Our findings indicate that this is a real phenomenon, that as many as 36% of cases escalate from first appearance of psychotic symptoms to acute psychosis in a two week period, and that rapidity of seeking treatment is directly related to rapidity of onset. Small case studies indicate diversity in outcomes on follow-up.  A 12 year follow-up of 30 intensive cases will be reported. Conclusion: Relevance of these studies for diagnostic issues, for studies of DUP and outcomes, and for the importance of cross-cultural research will be discussed.


Speakers
BJ

Byron J. Good

Harvard Medical School


Tuesday October 9, 2018 2:50pm - 3:10pm
American Ballroom-Center Westin Copley Place, fourth floor

2:50pm

Symposium 17, Talk 1. "Introducing program fidelity scales for Specialized Early Intervention in Denmark"
Marianne Melau1, Nikolai Albert1, Merete Nordentoft1; 1Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark
           
The evidence-based Specialized Early Intervention (SEI) has in Denmark grown to be a nationwide service for young adults’ experiencing a first episode psychosis. The implementation of the program was carried out without the use of fidelity measures. To rectify this, we developed and tested out a Danish fidelity scale for SEI teams, and for the first time we did a nationwide assessment of the quality and program fidelity of the SEI teams in Denmark. We found the fidelity scale to be a feasible and easy manageable tool for collecting fidelity data, and by using a multimodal approach we got a good understanding of how multidisciplinary teams interact and manage various aspects of a patient's treatment. Totally 96% (n = 22) of the SEI teams participated and all in all 59 % (n = 13) fulfilled the criteria for program fidelity in a satisfactory level.  We found that there was high variability between SEI teams according to the structural domain of the fidelity scale. By contrast, we found great homogeneity between the teams in terms of item referring to treatment. This mapping of SEI teams’ program fidelity in Denmark makes it obvious that at a national level, there is an urgent need for a more systematic approach to training and supervision, with a centralized development of educational material, provision of training and organization of supervision.  The study revealed a fragile organization of the educational activities. Models for implementation of continuous fidelity measurements will be discussed.


Speakers

Tuesday October 9, 2018 2:50pm - 3:10pm
American Ballroom-South Westin Copley Place, fourth floor

2:50pm

Symposium 18, Talk 1. "Staff and service user perspectives of digital technology for early psychosis"
Sandra Bucci1, Rohan Morris1, Christine Barrowclough1, Natalie Berry1, Gillian Haddock1, Shon Lewis1, Dawn Edge1; 1Division of Psychology and Mental Health, University of Manchester
           
Digital technology has the potential to transform the way people engage with mental health services. Findings from trials suggest that digital tools are feasible, with promising findings regards efficacy. However, research to date has largely ignored stakeholder and service user perspectives of these systems. Our group has explored both early psychosis service users' and staff subjective views of the use of mobile technology in the mental health setting. Framework analysis revealed a variety of barriers and facilitators to implementation of digital tools into the secondary care setting, including issues regarding the acceptability of technology in mental health, technology increasing access to, and augmenting, mental health support, issues around data protection, privacy and security of information, whether digital interventions are used as an adjunct to, or replacement for, usual care, and factors related to digital tools affording greater empowerment, control and choice than routine care. More specifically, service users' views said digital tools could enhance access to care by extending the reach of services to one’s natural environment and facilitating open and honest communication. Digital systems were also viewed as progressive, modern and relevant and potentially de-stigmatising. Digital tools were perceived as facilitating empowerment, affording patients meaningful choice and the opportunity to take active control of their healthcare. While staff share some of these views, they expressed more concerns around data security, risk management and workload flows. This talk will conclude with findings on the acceptability of a randomised controlled trial of a smartphone app used within UK early intervention services.


Speakers
SB

Sandra Bucci

University of Manchester


Tuesday October 9, 2018 2:50pm - 3:10pm
Staffordshire Westin Copley Place, third floor

3:00pm

Oral 09, Talk 2. "A randomized, controlled trial on Integrated Cognitive Remediation for early psychosis: Effectiveness and factors associated with treatment response"
Olina G Vidarsdottir1,2, Brynja B Magnusdottir2,3, David Roberts4, Elizabeth W Twamley5, Engilbert Sigurdsson1,2, Berglind Gudmundsdottir1,2; 1Landspitali Haskolasjukrahus, 2Landspitali University Hospital, 3Reykjavik University, 4The University of Texas Health Science Center at San Antonio, 5University of California, San Diego and VA San Diego Healthcare System
               
Introduction: Cognitive remediation, combined with evidence based psychiatric rehabilitation programs, is effective for improving cognitive deficits found in psychosis but generalization to everyday functioning remains a challenge. The objective of this study was to integrate three cognitive remediation approaches: Neuropsychological Educational Approach to Remediation (NEAR), Compensatory Cognitive Training (CCT), and Social Cognition and Interaction Training (SCIT), and evaluate the effects on cognition, functional outcome, and clinical symptoms.  Method: We conducted a randomized, wait-list control trial of an Integrative Cognitive Remediation (ICR) in 49 patients with primary psychotic disorder seeking service at an early intervention center in Iceland (mean age: 24; 86% males). Participants were randomized to receive standard treatment (N=24) or standard treatment plus a 12-week group-based ICR (N=25). Neurocognition (verbal memory, reasoning, working memory, processing speed, cognitive flexibility, inhibition, planning), social cognition (theory of mind, emotion recognition and attributional style), functional outcome, and clinical symptoms were assessed at baseline and post-treatment.  Results: The ICR group showed significant improvements in verbal memory, cognitive flexibility, theory of mind and a significant reduction in hostile attributional style, compared to those receiving standard treatment alone. No significant ICR associated effects were seen in functional outcomes or clinical symptoms. Post-hoc analyses suggest a dose-response effect. ICR was well tolerated and received high treatment satisfaction ratings.  Conclusions: ICR is feasible and effective in improving neurocognition and social cognition in psychosis. Findings will be discussed in context of continuing to improve comprehensive cognitive remediation interventions for early psychosis with discussion on factors associated with treatment response.



Tuesday October 9, 2018 3:00pm - 3:10pm
St. George AB Westin Copley Place, third floor

3:00pm

Oral 10, Talk 2. "Neurocognitive Deficits according to Norms in Adolescents with and without Clinical High Risk States of Psychosis"
Chantal Michel1,2, Nina Schnyder1, Petra Walger3, Maurizia Franscini4, Benno G. Schimmelmann1,5, Frauke Schultze-Lutter1,6; 1University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland, 2Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland, 3University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Cologne, Germany, 4University Hospital of Child and Adolescent Psychiatry, Zurich, Switzerland, 5University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany, 6Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
               
In the early detection of psychosis, neurocognitive predictors have been suggested to enhance predictive accuracy of clinical high risk (CHR) criteria. While mainly sample-dependent means of adult samples were used so far, a recent study of an adult sample used neurocognitive deficits defined according to test norms in order to facilitate individual prediction. Yet, data on child and adolescent samples are missing. We investigated the discriminative power of neurocognitive deficits defined according to norms in 8-17-year-olds. 160 CHR outpatients (AtRisk; mean age=15.02±2.20, 39% male), 270 non-psychotic inpatients (ClinS; mean age=14.46±2.43, 38% male) and 220 subjects of a general population sample (GPS; mean age=13.91±2.78, 48% male) had been assessed with a neurocognitive battery, including a verbal fluency (VF) test, the Digit-Symbol Test, TMT A and B, the Auditory Verbal Learning Test (AVLT) and the Subject Ordered Pointing Task. GPS were slightly younger than AtRisk and ClinS (Chi2(2)=7.656, p=0.022); no differences were found with regard to gender and premorbid IQ. Compared to ClinS and GPS, AtRisk more frequently exhibited deficits according to norms in verbal memory (AVLT learning capacity; 22.4% vs. 10.7%; OR=2.4, 95% CI: 1.3-4.6) and VF (48.8% vs. 34.1%; OR=1.8, 95% CI: 1.1-3.0), while ClinS and GPS did not differ. Partly in line with findings from adult samples, deficits in verbal memory and VF might be specifically associated with a CHR state in children and adolescents – even when compared to a more severely ill inpatient group. Yet, these findings need further examination in larger samples and longitudinal studies.


Speakers

Tuesday October 9, 2018 3:00pm - 3:10pm
St. George CD Westin Copley Place, third floor

3:10pm

Oral 09, Talk 3. "Cognitive Enhancement Therapy for Early Course Schizophrenia: Functional Connectivity Associated with Improvement in Social Cognition"
Synthia Guimond1,2, George Ling2, Betzamel Lopez2, Rachel Templeton2, Roscoe Brady1,2, Heidi Thermenos1,2, Shaun Eack3, Matcheri Keshavan1,2; 1Harvard Medical School, 2Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center, 3University of Pittsburgh
               
Social cognition is a key determinant of functional outcomes in early course schizophrenia. The goal of our study was to examine the impact of cognitive enhancement therapy (CET) on social cognition and on functional connectivity in early course schizophrenia. Eighty-four participants were randomly assigned to either treatment groups (CET, n=49; Enriched Supportive Therapy (EST), n=35). Resting state scans and social cognition performance, as measured by the MATRICS battery, were collected at baseline, 9, 18 and 30 months. We conducted mixed linear model analyses to investigate the impact of treatment (CET vs. EST) on social cognition and on the dorsolateral prefrontal cortex (DLPFC) functional connectivity to the right and left amygdala. CET group showed significant improvement over time in social cognition in comparison to the EST group (p<.05). Change in functional connectivity over time did not significantly differ between treatments. However, we observed a significant positive correlation between increased right DLPFC functional connectivity to the right amygdala and social cognition performance in the CET group (p<.05). Our results replicate previous work demonstrating that CET is effective at improving social cognition in schizophrenia. In addition, we found evidence that this improvement could be reflected in the DLPFC-amygdala circuit connectivity. This neural circuit potentially provides a mechanistic link between the biology of emotion regulation and more complex social cognition processes that can be improved in early stage of the illness.


Speakers

Tuesday October 9, 2018 3:10pm - 3:20pm
St. George AB Westin Copley Place, third floor

3:10pm

Oral 10, Talk 3. "Emotion recognition deficits in individuals at ultra-high risk for psychosis"
Louise Birkedal Glenthøj1,2, Birgitte Fagerlund2,3, Nikolaj Bak2,3, Carsten Hjorthøj1, Tina Dam Kristensen1,2, Christina Wenneberg1,2, Joseph Ventura4, Jens Richardt Møllegaard Jepsen2,3,5, Merete Nordentoft1,2; 1Mental Health Centre Copenhagen, University of Copenhagen, 2Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, 3Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, 4UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, CA, 5Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, University of Copenhagen
               
Objective: Emotion recognition is an aspect of social cognition that may be a key predictor of functioning and transition to psychosis in individuals at ultra-high risk (UHR) for psychosis. UHR individuals exhibit deficits in accurately identifying facial emotions, but other potential anomalies in facial emotion recognition are largely unexplored. This study aimed to extend current knowledge on emotion recognition deficits in UHR individuals by examining 1) whether UHR would display significantly slower facial emotion recognition than healthy controls, 2) whether an association between emotion recognition accuracy and emotion recognition latency is present in UHR, 3) the relationships between emotion recognition accuracy, neurocognition and psychopathology in UHR, 4) the relation between emotion recognition accuracy, latency, and real life functioning in UHR. Results: UHR did not display impairments in speed of emotion recognition compared to healthy controls. Correlational analyses revealed significant, negative correlations between emotion recognition accuracy and response latency on the emotions happiness (r=-.47, p˂.01) and sadness (r=-.33, p˂.01) in UHR. A multiple regression analysis demonstrated sustained attention to be associated with overall emotion recognition ability along with level of attenuated psychotic symptoms in UHR. Lastly, we found emotion recognition processing speed, but not accuracy, to be consistently related to functioning measures. Conclusion: Our findings indicate that impairments in sustained attention may be an important contributor to emotion recognition deficits in UHR. Additionally, training of social cognitive processing speed may be of particular relevance in cognitive remediation programs aimed at improving real life functioning in UHR individuals.



Tuesday October 9, 2018 3:10pm - 3:20pm
St. George CD Westin Copley Place, third floor

3:10pm

Symposium 15, Talk 2. "Determinants of Poor Social Functioning in Individuals at Clinical High Risk for Psychosis: Modeling the impact of Early Auditory Processing Deficits, Neurocognition, Social Cognition, and Negative Symptoms"
Ricardo E. Carrión1, Barbara A. Cornblatt1, Peter Bachman2, Aysenil Belger3, Erica Duncan4, Jason Johannesen5, Margaret Niznikiewicz6, Brian J. Roach7, Jean Addington8, Kristin Cadenhead9, NAPLS Consortium, Daniel H. Mathalon7,10; 1Zucker Hillside Hospital, 2University of Pittsburgh, 3University of North Carolina, 4Emory University, 5Yale University, 6Harvard Medical School, 7San Francisco VA Healthcare System, 8University of Calgary, 9University of California, San Diego, 10University of California, San Francisco
           
Recent research in patients with schizophrenia has demonstrated complex relationships between early auditory processing deficits, neurocognition, social cognition, negative symptoms, and social functioning. However, the interrelationships and impact of these variables on social (i.e., interpersonal relationships) functioning impairments prior to the onset of the illness is unclear. The present study used a structural equation modeling (SEM) approach to integrate these factors to determine the specific determinants and pathways that lead to poor functioning in a large sample of treatment-seeking individuals at clinical high-risk (CHR) for psychosis.  Participants were 765 CHR individuals enrolled and prospectively followed in the North American Prodrome Longitudinal Study (NAPLS2).  We evaluated several theoretically based models with pathways starting from mismatch negativity (MMN) deficits to functioning. The intervening variables included neurocognitive performance, social cognition, and negative symptom levels. Social functioning was assessed with the GF:Social scale. Prodromal symptoms were assessed using the Scale of Prodromal Symptoms (SIPS/SOPS). Model estimation was performed using AMOS v16.  A final trimmed model revealed that early auditory information processing (MMN) had a direct effect on neurocognition, neurocognition had a direct effect on negative symptoms, and both neurocognition and negative symptoms had direct effects on social functioning. The direct effect from social cognition to functioning was not significant.  Our findings reveal a complex relationship between MMN reductions, neurocognition, negative symptoms and social outcomes in individuals at CHR for psychosis. These results may have implications for early intervention strategies that aim to improve functional trajectories in young individuals at high risk of developing psychosis.


Speakers
RC

Ricardo Carrion

Hofstra Northwell School of Medicine


Tuesday October 9, 2018 3:10pm - 3:30pm
American Ballroom-North Westin Copley Place, fourth floor

3:10pm

Symposium 16, Talk 2. "Cultural Understandings of Illness and Care-Seeking Behavior among Caregivers of First Episode Psychosis in Java, Indonesia"
M. A. Subandi1, Carla Marchira1, Mary-Jo DelVecchio Good2, Byron J Good2; 1Gadjah Mada University, 2Harvard Medical School
           
The cultural understanding of illness among caregivers of first episode psychotic persons is a crucial issue. Not only does it influences caregivers’ care-seeking behavior and length of time until receiving medical treatment (known as DUP, the Duration of Untreated Psychosis), but also in turn predicts outcome of illness. Purpose: This paper aims to explore cultural understanding and care-seeking behavior among caregivers of psychotic patients in Java Indonesia. Methods:  Data for this paper were taken from several studies conducted by our research group in Yogyakarta, Indonesia. Methods of data collection include an epidemiological survey, ethnographic fieldwork, in depth interviews, and an intervention program. Findings: Results of analyses within and across studies indicate that caregivers employed diverse cultural explanatory model in understanding psychotic illness. Local cultural understandings, including possession and forms of black magic, were among the most common initial concepts used by family members in relation to psychosis. This echoes broader cultural beliefs in Java. However, it was not uncommon that caregivers also understood illness in psychological terms (frustration, dissapointment, and stress) and using medical explanations. Caregivers’ understanding of illness also changed over time, following the changing course of illness.  Both models of illness and rapidity of care-seeking is also related to acuteness of onset. Conclusion: It is important for mental health providers, as well as those designing systems of care, to understand the diversity and changing nature of caregivers cultural understandings of psychotic illness.


Speakers

Tuesday October 9, 2018 3:10pm - 3:30pm
American Ballroom-Center Westin Copley Place, fourth floor

3:10pm

Symposium 17, Talk 2. "Assessing Fidelity to the OnTrackNY Coordinated Specialty Care Model"
Ilana Nossel1, Sarah Piscitelli,1, Susan Essock2, Franco Mascayano2, Lisa Dixon1; 1New Yoirk State Psychiatric Institute, 2Columbia University
           
OnTrackNY, New York State’s coordinated specialty care (CSC) program, has grown rapidly to 22 sites, highlighting the importance of scalable fidelity assessments. Our approach evolved in phases, using three information sources. We first relied on findings from high-touch training activities. Second, we used client- and program-level data on care processes and outcomes solicited quarterly from teams which are tabulated centrally, generating reports that teams receive. Third, building on Addington’s FEP Fidelity Scale, we added site visits, including chart reviews, team meeting observation and staff, participant and family member interviews. Our scale has 25 domains, comprised of 94 sub-items, 48 from data and 46 from site visit. Each domain includes one “critical sub-item” essential for fidelity. We completed a pilot study (2 sites) focusing on assessing the incremental value of site visits. Both programs had high fidelity, meeting expectations in 23/25 domains. Data items addressed team functioning and outcomes over the past year. Raters identified items that were sub-threshold, required clarification, or had gaps; these were validated and supplemented with information from the site visit. Ten domains were heavily or solely scored based on site visit including assertive outreach, treatment planning, client preferences/ shared decision making, and trauma.  Eligibility and enrollment, crisis services, care processes, metabolic monitoring, and peer services had critical items that relied on site visit. Final scores reflect all information sources; raters discussed discrepancies between sources and reached consensus.  Conclusion:  Site visits can be a useful adjunct to regular summaries of administrative data used to monitor implementation fidelity.


Speakers

Tuesday October 9, 2018 3:10pm - 3:30pm
American Ballroom-South Westin Copley Place, fourth floor

3:10pm

Symposium 18, Talk 2. "Smartphone-enhanced symptom management and relapse prevention: A randomised controlled trial"
Shon Lewis1, Paolo Fraccaro1, Matthew Machin1, Richard Hopkins1, Caroline Sanders1, Zhimin He2, Charlotte Stockton-Powdrell1, John Ainsworth1, Pauline Whelan1, Til Wykes2; 1Division of Psychology and Mental Health, University of Manchester, 2Institute of Psychiatry, Psychology & Neuroscience
           
Improving recovery from acute symptoms and preventing relapse are two major challenges in psychosis. We previously developed a smartphone-based personalised technology to monitor symptoms in real time, which showed good acceptability, reliability and validity for active remote monitoring of symptoms. We now report an RCT testing its efficacy when embedded into the ICT systems of mental health services. Participants with early psychosis/SMI received a semi-random beep 2-4 times per day on their smartphone app and answer 14 key symptom rating items using a touchscreen slider. Responses are uploaded wirelessly in real time to a central server and build into a graphical readout on the handset. This was built into an end-to-end system in two NHS Hospital Trusts to stream data into ECRs and enable detection by the clinical team of SMI EWS when key symptoms exceeded a personalised severity threshold. 81 people were randomised to either active symptom monitoring or TAU. PANSS positive subscale score showed a significant mean reduction in treatment over 12 weeks in the early psychosis group. EWS alerts generated by the system occurred in 92% of cases and blind comparison with electronic case record data suggested good sensitivity and lower specificity, with clear indications of how to adjust the gain of the system to improve future event-detection efficiency. When the symptom-monitoring system was built into clinical management workflows to enable personalised alerts of symptom deterioration, it was shown to have potential use in promoting earlier intervention for relapse.


Speakers

Tuesday October 9, 2018 3:10pm - 3:30pm
Staffordshire Westin Copley Place, third floor

3:20pm

Oral 09, Talk 4. "Using Virtual Worlds to Deliver Social Cognitive Therapy in Psychosis"
Andrew Thompson1, Farah Elahi1, Alba Realpe1,2, Sandra Bucci3, David Taylor4, Ivo Vlaev1, Fiona Leahy1, Caroline Falconer5, Max Birchwood1; 1University of Warwick, k, 2University of Bristol, UK, 3University of Manchester, UK, 4Imperial College, London, UK, 5University College London, UK
               
Introduction Problems with social cognition are common in people with a diagnosis of psychosis. We have previously developed a group intervention to improve these skills in young people with early psychosis. However, there were barriers to people attending a group and interacting with others in this environment. We aimed to adapt this intervention and deliver it in a widely used computer virtual world (Second Life) to see if this is acceptable and feasible in this population. Method We co-designed a virtual world environment and the intervention (SCIT or Social Cognition Interaction Training) with user consultants and software designers. The resulting intervention was delivered over 5 weeks to groups of 4 individuals with Early Psychosis. Our outcomes of interest were measures of engagement and acceptability. Acceptability was measured by group attendance rates and by information derived from post intervention qualitative interviews. We also measured social cognition and social functioning and measures of immersion in the virtual world. We planned to recruit 5 groups over a 6-month period. Results Preliminary results and details of outcome of the co-design process will be discussed. Preliminary results on recruitment and feasibility will be presented. The potential benefits and risks of using such technology to treat difficulties in social cognition in this patient group will be discussed. Conclusions With the initial results we will be able to consider the benefits and risks of using virtual worlds in therapy and how this may be used in other disorders or for other therapeutic approaches in psychosis.


Speakers

Tuesday October 9, 2018 3:20pm - 3:30pm
St. George AB Westin Copley Place, third floor

3:20pm

Oral 10, Talk 4. "Neurocognitive Functioning in Depressed Young People: A Systematic Review and Meta-Analysis"
Kelly Allott1,2, Joanne Goodall1,3, Caroline Fisher4, Sarah Hetrick5, Emma Parrish6, Lisa Phillips3; 1Orygen, The National Centre of Excellence in Youth Mental Health, Australia, 2Centre for Youth Mental Health, The University of Melbourne, Australia, 3School of Psychological Sciences, The University of Melbourne, Australia, 4Department of Psychology, Royal Melbourne Hospital, Melbourne Health, Australia, 5Department of Psychological Medicine, University of Auckland, New Zealand, 6Department of Psychology, Northeastern University, Boston, MA, USA
               
Depression is among the most common mental health problems for young people. In adults, depression is associated with neurocognitive deficits that reduce the effectiveness of treatment and impair educational and vocational functioning. Compared to adults, less is known about the neurocognitive functioning of young people with depression, and existing research has reported inconsistent findings. This systematic review and meta-analysis synthesized the literature on neurocognitive functioning in currently depressed youth aged 12-25 years in comparison to healthy controls. Following a systematic review of the literature, 23 studies were included in the meta-analysis. Poorer performance in the domains of attention (SMD: .50, 95% CI: .18-.83, p=.002), verbal memory (SMD: .78, 95% CI: .50-1.0, p<.001), visual memory (SMD: .65, 95% CI: .30-.99, p<.001), verbal reasoning/knowledge (SMD: .46; 95% CI: .14-.79; p <0.001) and IQ (SMD: .32; 95% CI: .08-.56; p=0.01) were identified in depressed youth. Relative weaknesses in processing speed/reaction time and verbal learning were also evident; however these findings disappeared when the quality of studies was controlled for. Moderator analysis showed a tendency for poorer set-shifting ability in younger depressed participants relative to controls (although non-significant; p=.05). Moderator analysis of medication status showed taking medication was associated with poorer attentional functioning compared to those not taking medication. The findings suggest that currently depressed young people display a range of neurocognitive weaknesses which may impact treatment engagement and outcome. The findings support the need to consider neurocognitive functioning when treating youth with depression.


Speakers

Tuesday October 9, 2018 3:20pm - 3:30pm
St. George CD Westin Copley Place, third floor

3:30pm

Oral 09, Talk 5. "Cognitive behavioural therapy in comparison to treatment as usual in adults at high risk of developing bipolar disorder (Bipolar At Risk): A feasibility study (BART)"
Sophie Parker1,2, Paul French1,3, Rory Byrne1, Rchard Bentall4, David Shiers1,2, Linda Davies2, Graham Dunn2; 1Greater Manchester Mental Health NHS Foundation Trust, 2University of Manchester, 3Liverpool University, 4Sheffield University
               
Research has demonstrated the ability to identify and treat individuals at high risk of developing psychosis and more recently that it is possible to utilise a similar strategy to identify people who have an emergent risk of Bipolar Disorder (BD). BD can be a severe, recurrent and disabling condition with significant consequences for individuals, families and society. Criteria have been established to identify individuals considered to be at high risk for developing BD (Bipolar At Risk; Bechdolf et. al., 2012; 2014). Identifying this group and offering an intervention may reduce transition to a full expression of BD and offer the possibility of prevention. The overall aim was to identify people who were considered to be at high risk of developing Bipolar Disorder (BD) according to the criteria, and to investigate whether a psychological intervention is an acceptable, feasible and potentially effective treatment option. This feasibility study applied a randomised design to test the acceptability of a psychological intervention (CBT) in people considered to be at high risk of developing BD (Bipolar At Risk). 76 Individuals were randomised to one of two conditions (CBT plus treatment as usual versus treatment as usual alone). All participants were monitored for 1 year to assess levels of transition to full BD. The CBT intervention was aimed at minimising transition to BD, reducing distress and increasing quality of life. Assessments were carried out at baseline, 6 and 12 month follow-up. Data from the trial will be presented and the implications of the trial discussed.


Speakers

Tuesday October 9, 2018 3:30pm - 3:40pm
St. George AB Westin Copley Place, third floor

3:30pm

Oral 10, Talk 5. "Longitudinal cognitive performance in individuals at ultra-high risk for psychosis: A 10-year follow-up"
Kelly Allott1,2, Stephen Wood1,2,3, Hok Pan Yuen1,2, Alison Yung4, Barnaby Nelson1,2, Warrick Brewer1,2, Christos Pantelis5, Patrick McGorry1,2, Ashleigh Lin6; 1Orygen, The National Centre of Excellence in Youth Mental Health, Australia, 2Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia, 3School of Psychology, University of Birmingham, UK, 4University of Manchester, UK, 5Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Australia, 6Telethon Kids Institute, WA, Australia
               
It remains unclear whether the onset of psychosis is associated with deterioration in cognitive performance. The aim of this study was to determine the course of cognitive performance over the transition from ultra-high risk (UHR) to psychosis, and in relation to functional outcome. Consecutive admissions to PACE between May 1994 and July 2000 who had cognitive data (including IQ and specific cognitive tests) at baseline and follow-up were eligible (N=80). Follow-up ranged from 7.3 and 13.4 years (M=10.4 years; SD=1.5). In the whole sample, significant improvements were observed on the Similarities (p=.03), Information (p<.01), Digit Symbol Coding (p<.01), and Trail Making Test-B (p=.01) tasks, whereas performance on the Rey Auditory Verbal Learning Test (Trials 1-3) declined significantly (p<.01) over the follow-up period. Change on all cognitive measures was not significantly associated with transition status. Taking time of transition into account (within or after 1 year), there was a significant finding in relation to change on Digit Symbol Coding (p=.01), with those who transitioned after 1 year having a decline in score, whereas those who did not transition had an improved score (ES=0.85). Small positive correlations were observed between improvements in functioning and improvements in performance on Digit Symbol Coding and Arithmetic (0.24, p=0.03 and 0.28, p=0.01, respectively). The onset of psychosis was not associated with deterioration in cognitive ability. However, specific findings suggest that immediate verbal learning and processing speed may be important domains for future risk models and early intervention research in UHR.


Speakers

Tuesday October 9, 2018 3:30pm - 3:40pm
St. George CD Westin Copley Place, third floor

3:30pm

Symposium 15, Talk 3. "Atypical P300, but not MMN, amplitude differentiates conversion patterns in psychosis prodrome with versus without comorbid autism spectrum disorder"
Sylvia B Guillory1, Eva Velthorst1, Peter Bachman2, Aysenil Belger3, Ricardo Carrión4, Erica Duncan5, Jason Johannesen6, Margaret Niznikiewicz7, Kristin Cadenhead8, Jennifer Foss-Feig1, NAPLS Consortium, Daniel H. Mathalon9; 1Icahn School of Medicine at Mount Sinai, 2University of Pittsburgh, 3University of North Carolina, 4Zucker Hillside Hospital, 5Emory University, 6Yale University, 7Harvard Medical School, 8University of California, San Diego, 9University of California, San Francisco
           
Autism spectrum disorder (ASD) and schizophrenia are distinct disorders. However, atypical sensory and attentional processing characterizes both, and psychosis symptoms exist disproportionally in ASD. Electrophysiological markers that characterize schizophrenia, including P300 and mismatch negativity (MMN) amplitude reductions, are present in individuals at clinical high-risk (CHR) for psychosis. Whether these markers are: present in ASD individuals showing CHR profiles and/or predictive of conversion is unknown. We investigated P300 and MMN response and sensitivity to psychosis conversion across CHR groups with (CHR/ASD+) and without(CHR/ASD−) comorbid ASD. Electrophysiological data were analyzed from 305 NAPLS-2 CHR patients (14 CHR/ASD+; 291 CHR/ASD−). We examined P300 amplitude to infrequent Target(10%) and Novel distractor(10%) stimuli from visual and auditory oddball tasks, and MMN response for duration(5%), frequency(5%), and duration+frequency(5%) deviants.  P300 amplitude to Novel visual stimuli was smaller in CHR/ASD− converters(n=71) than CHR/ASD− non-converters(n=220), but larger in CHR/ASD+ converters(n=4) than CHR/ASD+ non-converters(n=10) (Modality×ASD×Converter Interaction, F=3.57;p=.06). For auditory and visual Target stimuli, whereas P300 amplitude was similar for CHR/ASD+ non-converters and all CHR/ASD− individuals, CHR/ASD+ converters had larger P300 amplitudes (ASD×Converter interaction, F=12.12;p=.001). For MMN, there were no significant amplitude differences between groups (Conversion,p=0.31; ASD,p=0.57) or deviant type (p=0.56).  Results revealed dissociable P300 amplitude profiles to visual and auditory target and novel stimuli in CHR patients that differentially predicted conversion to psychosis, depending on ASD status. MMN did not differ by ASD status. These findings suggest attentional orienting is differentially affected in CHR patients with ASD, whereas pre-attentive sensory memory is similar in CHR with and without ASD.



Tuesday October 9, 2018 3:30pm - 3:50pm
American Ballroom-North Westin Copley Place, fourth floor

3:30pm

Symposium 16, Talk 3. "The “Social Course” of the Early Phase of Psychotic Illness in Yogyakarta, Indonesia"
Nida Ul Hassanat1, Mahana Sofiati Utami1, Carla Marchira1, M. A. Subandi1, Mary-Jo DelVecchio Good2, Byron J. Good2; 1Gadjah Mada University, 2Harvard Medical School
           
The concept “course of illness” for schizophrenia has primarily focused on clinical course. Social experience and cultural interpretations are also critical to understanding the course of schizophrenia. Purpose: This paper introduces the concept of “social course of illness,” as distinct from clinical course, to focus attention on what factors influence the development over time of the experience of psychotic illness, social functioning and social impairment, and family experiences, and uses the concept to explore the diverse courses of illness of a small cohort of persons with first episode psychosis in Yogyakarta, a center of Javanese culture in Indonesia. Methods: Eight patients with first-episode psychosis were interviewed approximately eight times each over three years, beginning 2001. Narrative data about illness experiences and care-seeking, cultural understandings of the illness, clinical ratings, data on social functioning, and qualitative data on stigma and social response, were all recorded. A follow-up study of these patients is currently underway. Results: Data from this study suggest that clinical symptoms and social processes influence each other, and that "clinical course” and “social course” may follow different patterns. It also suggested that both clinical course and social course vary widely from one individual to another, and that clinical impairment and social impairment are not always directly related. Conclusion:  This research suggests the importance of reconceptualizing the early course of schizophrenic illnesses, and that culturally sophisticated social interventions should accompany clinical interventions to limit social impairment associated with psychotic illness and contribute to recovery.


Speakers

Tuesday October 9, 2018 3:30pm - 3:50pm
American Ballroom-Center Westin Copley Place, fourth floor

3:30pm

Symposium 17, Talk 3. "Conducting Fidelity Assessments in Ontario Early Psychosis Intervention Programs: Evaluation of a Pilot Implementation Initiative"
Janet Durbin1, Avra Selick1, Gordon Langill2, Donald Addington3, Chiachen Cheng4; 1Centre for Addiction and Mental Health, 2Canadian Mental Health Association, 3University of Calgary, 4Northern Ontario School of Medicine
           
Ontario Canada is home to about 50 Early Psychosis Intervention (EPI) programs, and a sector wide network of providers (EPION - Early Psychosis Intervention Ontario Network) who work collaboratively to improve quality of care.  Ontario released EPI program standards in 2011 but adherence is unknown. In the fall of 2016, EPION partnered with Centre for Addiction and Mental Health (CAMH) to pilot a novel fidelity review process using the First Episode Psychosis Fidelity Scale (FEPS-FS). Three-person assessor teams of volunteer EPI staff (2) and CAMH implementation specialists (1) conducted 2-day site visits to assess fidelity. Assessor teams were supported through training, tailored data collection tools and post-visit rating consensus meetings with an expert. Fidelity reports included quality improvement suggestions as well as fidelity ratings and related explanations. Nine programs were reviewed.  Qualitative data were collected from assessors and sites to assess value, feasibility, and quality of this fidelity assessment process. Overall feedback was positive. Assessor team members brought complimentary skills to the process. Programs valued having front line assessors who understood the clinical experience, and assessors valued learning about and from peer programs. The process required a steep learning curve, but assessor confidence increased with their second review. Using a validated, standardized scale gave weight to the assessment although some adaptations may be needed for Ontario context. Some rating challenges were encountered, and the time commitment was greater than expected. In our presentation we will further discuss Ontario-specific challenges and explore feasibility of continuing this approach.


Speakers

Tuesday October 9, 2018 3:30pm - 3:50pm
American Ballroom-South Westin Copley Place, fourth floor

3:30pm

Symposium 18, Talk 3. "Implementation of a digital software system for recovery from psychosis early signs"
Andrew Gumley1, Simon Bradstreet1, Stephanie Allan1, John Farhall2, John Gleeson3, Matthew Machin4, Maria Lambrou2; 1Institute of Health and Wellbeing, University of Glasgow, 2La Trobe University, Melbourne, Australia, 3Australian Catholic University, School of Psychology, Melbourne, Australia, 4University of Manchester
           
The detection and prevention of relapse in people who experience psychosis is important. EMPOWER is a complex intervention which is harnessing digital technology to identify risk of relapse in psychosis, and establish a pathway towards relapse prevention. This talk will report on findings from three stakeholder groups. Staff across Community Mental Health services in NHS Greater Glasgow and Clyde, UK and NorthWestern Area Mental Health, Melbourne, Australia were invited to participate, as well as service users with experience of psychosis and families and carers. The constructivist grounded theory approach was utilised to address the aims of the study. In total we conducted 25 Focus Groups (7 with service users, 5 with carers and 13 with staff). These Focus Groups comprised 23 service users, 38 carers and 86 mental health staff. All three groups reported the utility of early warning signs as a tool towards relapse prevention. However, each group differed in their conceptualisation of risk and their relative power to manage perceived risk. These perceptions of risk were closely linked to their roles and relationships with each other. Barriers and facilitators to implementation were conceptualised as existing at the level of service provision (e.g. staffing levels), fit with existing practice (e.g. potential relationships changes) and personal level of acceptability and making sense (e.g. access to one's own wellbeing data is useful). Results suggest several important factors for consideration when implementing self-monitoring via mobile phones for psychosis.


Speakers

Tuesday October 9, 2018 3:30pm - 3:50pm
Staffordshire Westin Copley Place, third floor

3:40pm

Oral 09, Talk 6. "Latest developments of psychological psychosis prevention strategies in the Netherlands"
Mark van der Gaag1,2, Helga Ising2; 1VU University, 2Parnassia Psychiatric Institute
               
Objective: Present the implementation strategies in the Netherlands to implement CBT for UHR in mental health services Methods: Overview of the literature that has led to the Evidence Based status of detection and treatment of UHR patients. Results: CBT in UHR patients has proven effective in EDIE-NL, but also meta-analyses. The risk reduction is about 40% at twelve months and still 36% at 24-48-months follow-up. The four-year follow-up was also cost-saving. Budget Impact Analysis showed a 10 million cost saving in direct costs each year and a reduction of 15% of psychotic patients in the long term. The detection and treatment of UHR patients is now standard treatment in the Netherlands and national implementation is about to begin. The European guidelines on detection and implementation that reached the same conclusions. The PQ-16 is used to screen for potential UHR patients in all help-seeking patients. The CAARMS is the gold standard to detect the UHR patients and CBT therapists are being trained to do the preventive treatment. At the same time, it is clear that UHR is a risk profile for long-term treatment trajactories and treatment should also target multi-morbid disorders and preserve the social functioning at home, with friends, in school and at the workplace.


Speakers
MV

Mark van der Gaag

VU University


Tuesday October 9, 2018 3:40pm - 3:50pm
St. George AB Westin Copley Place, third floor

3:40pm

Oral 10, Talk 6. "Kelly Allott1,2, Stephen Wood1,2,3, Hok Pan Yuen1,2, Alison Yung4, Barnaby Nelson1,2, Warrick Brewer1,2, Christos Pantelis5, Patrick McGorry1,2, Ashleigh Lin6; 1Orygen, The National Centre of Excellence in Youth Mental Health, Australia,
Kathryn Hardin1, Danielle Beaudette1, Alan Breier1, Kyle Minor1; 1Indiana University - Purdue University Indianapolis
               
In first episode psychosis (FEP) populations, neurocognitive deficits and negative symptoms are both significant predictors of functioning. Some studies have shown that neurocognition is a stronger predictor of functioning than psychotic symptoms. In clinical high risk populations, neurocognition mediates the relationship between negative symptoms and functioning and there is concern that some negative symptoms items (e.g., emotional and social withdrawal) overlap with social and role functioning, complicating this relationship. This study aimed to determine if, after accounting for neurocognition, negative symptoms predict variance in social and role functioning in FEP. A secondary aim was to explore the differing ability of social vs. non-social items on a negative symptom scale to predict functioning, after accounting for neurocognition. Twenty FEP young adults were evaluated on social and role functioning, negative symptoms, and neurocognition.  Stepwise regression tested for 1) predictive value of neurocognition and 2) added predictive value of negative symptoms for social and role functioning individually. In both models, neurocognition and negative symptoms were not significant predictors. Secondary analyses tested if social items on the negative symptoms scale predict additional variance over 1) neurocognition and 2) non-social negative items. Neurocognition, non-social, and social negative symptoms were not significant predictors for role functioning. However, social negative symptoms predicted significant additional variance over neurocognition and non-social symptoms. Future studies should further explore the differing relationships between neurocognition, social, and non-social negative symptoms in both social and role functioning.


Speakers

Tuesday October 9, 2018 3:40pm - 3:50pm
St. George CD Westin Copley Place, third floor

3:50pm

Oral 09, Talk 7. "Mo: development and feasibility testing of a mobile therapy app for transdiagnostic early intervention"
Amy Hardy1, Philippa Garety1; 1Institute of Psychiatry, Psychology & Neuroscience, King's College London
               

Difficult emotions and life stressors are ubiquitous, but access to psychological interventions is limited meaning that timely, early interventions are rare (Haller et al, 2014). Even when available, people can be reluctant to take up therapy (O’Dea et al, 2015).  Standalone therapy apps show promise in improving the provision of early intervention, although need to be sensitively designed if they are to meet implementation challenges (Greenhalgh et al, 2017).  In response to this concern, we have developed Mo, an app to support managing emotions and stress, which has the potential to address obstacles to therapy availability, uptake and adherence.  Our team of industrial engineers, clinicians and researchers combined the ‘Double Diamond’ methodology (Design Council, 2015) with agile working with developers (Dybå, Dingsøyr et al, 2008).  Insights were gained through interviews and workshops with young adults.  Personas were built up from these insights, informing subsequent co-creation sessions.  Mo’s key functions and concepts were created, along with the visual language and branding, and refined following feasibility testing.  Users define Mo’s look and role (i.e. friend, therapist or coach) who then supports users to manage problems and find solutions.  Mo draws on second and third wave cognitive-behavioural principles including cognitive restructuring (SlowMo), relaxation and mindfulness (FlowMo) and activity scheduling and distraction (GoMo).  It is envisaged that the broad focus of Mo will lend itself to user testing with diverse groups, with insights iteratively incorporated into future versions.


Speakers
AH

Amy Hardy

King's College London


Tuesday October 9, 2018 3:50pm - 4:00pm
St. George AB Westin Copley Place, third floor

3:50pm

Oral 10, Talk 7. "Social cognition, language, social skills, and social functioning in 7-year-old children at familial high risk for schizophrenia or bipolar disorder – The Danish High Risk and Resilience Study – VIA 7"
Camilla Austa Jerlang Christiani; M.Sc.1,3, Jens Richardt Moellegaard Jepsen; Ph.D.2,3,8, Anne Thorup, MD., Ph.D.1,3, Nicoline Hemager, M.Sc.1,2,3, Ditte Ellersgaard, MD.1,3, Birgitte Klee Burton, MD., Ph.D.2,3, Katrine Soeborg Spang, MD.2,3, Aja Greve, M.Sc.3,5, Ditte Gantriis, Ph.D.3,5, Maja Gregersen, M.Sc.1,3, Anne Soendergaard, M.Sc.1,3, Gry Poulsen, Ph.D.3,6, Jamal Uddin, Ph.D.3,6, Larry Seidman, Ph.D.†7,9, Ole Mors, MD., Ph.D.3,5, Kerstin Plessen, MD., Ph.D.2,3,4, Merete Nordentoft, MD, Ph.D.1,3,4; 1Mental Health Services – in the Capital Region of Denmark, Mental Health Centre Copenhagenh.d student, 2Mental Health Services – in the Capital Region of Denmark, Child and Adolescent Mental Health Centre,, 3The Lundbeck Foundation Initiative for Integrative Psychiatric Research,, 4University of Copenhagen - Faculty of Health and Medical Sciences, 5Psychosis Research Unit, Aarhus University Hospital, 6University of Copenhagen, Department of Public Health – Section of Biostatistics, 7Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, 8Mental Health Services - Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, 98Department of Psychiatry, Harvard Medical School at Massachusetts General Hospital, Boston
               
Background To characterize social cognition, language, social skills, and social functioning in children at familial high risk for schizophrenia or bipolar disorder compared to children without familial high risk for these two mental disorders.  Methods The Danish High Risk and Resilience Study – VIA 7 is a prospective cohort study of 522 children, age seven, at familial high risk for developing schizophrenia (FHR-SZ, N=202) or bipolar disorder (FHR-BP, N=120) compared to a population-based control group (PBC, N=200). The cohort was stratified from the Danish National Registers. Children at FHR-SZ were matched on age, gender, and urbanicity to the PBC group. The children at FHR-BP were a non-matched group. All children were assessed with comprehensive, well-validated tests and questionnaires using multiple sources. Social cognition was measured on two dimensions, theory of mind and emotion recognition, including social cognitive processing speed. Also, receptive and pragmatic language, creative generativity, social skills and social functioning were investigated. Results Children FHR-SZ showed significant deficits in their theory of mind, receptive and pragmatic language as well as in their social skills and social functioning compared to the PBC group. Children at FHR-BP showed significant social skills impairments. None of the familial high risk groups presented with deficits in emotion recognition or in social cognitive processing speed. Discussion Early in neurodevelopment children at FHR-SZ present with impairments within the social cognitive and language domain as well as in their social skills and social functioning. These results enhance the importance of early detection and preventive interventions.



Tuesday October 9, 2018 3:50pm - 4:00pm
St. George CD Westin Copley Place, third floor

3:50pm

Symposium 15, Talk 4. "40 Hz-centered ASSR measures distinguish between healthy control and clinical high risk individuals in the NAPLS sample"
Margaret Niznikiewicz1,2, Peter Bachman3, Aysenil Belger4, Ricardo Carrión5, Erica Duncan6, Jason Johannesen7, Brian J. Roach8, Jean Addington9, Kristin Cadenhead10, NAPLS Consortium, Daniel H. Mathalon8,11; 1VA Boston Healthcare System, 2Harvard Medical School, 3University of Pittsburgh, 4University of North Carolina, 5Zucker Hillside Hospital, 6Emory University, 7Yale University, 8San Francisco VA Healthcare System, 9University of Calgary, 10University of California, San Diego, 11Univeristy of California, San Francisco
           
Purpose: Abnormalities in gamma-band auditory steady-state response (ASSR) are an index of dysfunction in neural oscillations associated with GABAergic interneuron function and related to cognitive dysfunction in schizophrenia (SZ).  A robust finding in SZ, they are regarded as one of its biomarkers.  However, it is not clear if this abnormality is present already in individuals at clinical high risk for psychosis (CHR) and whether it distinguishes between those who will convert to schizophrenia and those who will not.  As part of the NAPLS study we examined ASSR at both baseline and post-stimulus time-windows to address this important question.   Materials and Methods.  439 CHR and 236 healthy controls (HC) were tested on the ASSR paradigm using 20, 30, and 40 Hz click-trains.  Baseline power was examined within -200-0 msec window. The inter-trial phase coherence (ITC) was examined within 1. 0-200 msec post-stimulus latency window to interrogate early gamma-band response and 2. 200-500 msec post-stimulus window, to interrogate late gamma-band response. Results: For 40Hz click stimulation but not for 20 or 30 Hz, the baseline power was larger in CHR than in HC at both Fz (p=.04) and Cz (p=.04).  In contrast, reduced ITC was observed for 40 Hz click-trains for latency windows of 200-300 msec (p=0.006), 300-400 msec (p=0.023) and 400-500 (p=0.34), (i.e., late gamma-band response).  No measure distinguished between CHR-converters and non-converters.  Conclusions: These results suggest that measures of baseline power and of ITC at 40 Hz distinguish between HC and CHR but are not sensitive to the conversion status.


Speakers
MN

Margaret Niznikiewicz

Harvard Medical School


Tuesday October 9, 2018 3:50pm - 4:10pm
American Ballroom-North Westin Copley Place, fourth floor

3:50pm

Symposium 16, Talk 4. "The Effectiveness of a Brief Interactive Psychoeducational Intervention for Persons Living with First Episode Psychosis and Family Caregivers in Yogyakarta, Indonesia"
Carla Raymondaleas Marchira1, Iran Suprianto1, M. A. Subandi1, Mary-Jo DelVecchio Good2, Byron J. Good2; 1Gadjah Mada University, 2Harvard Medical School
           
Psychoeducation of persons living with psychotic illness and their family caregivers is a long-standing and effective means of providing information and support that benefits both families and those living with illness. However, cultural adaptation of psychoeducation and integration into routine care in settings with very low mental health resources is rare. Purpose:  This presentation aims to describe outcomes of an investigation of the effectiveness of a culturally-adapted, brief interactive psychoeducation intervention for family caregivers in Java, and to study the feasibility of integrating such interventions into routine mental health services provided by primary health care providers. Methods:  An experimental study was conducted with pre-test and post-test assessments with 100 persons living with first episode psychotic illness and their family caregivers.  Families were randomly assigned to intervention and control groups, and psychiatric residents were trained to administer 4 weekly interactive psychoeducation sessions with modules adapted for the local cultural setting.  When the intervention was found to be feasible and effective, a program was developed to train staff in three primary health centers to provide a similar intervention for individuals and families registered with the primary health care center. Findings:  The initial intervention was found to be feasible and effective, particularly in increasing Knowledge of Schizophrenia of family members and reducing rehospitalization. Training of primary health care workers was found to be feasible and effective. Conclusion: Adapting psychoeducation for individuals with psychotic illness and family caregivers is feasible and can be integrated into primary health services in low resource settings.



Tuesday October 9, 2018 3:50pm - 4:10pm
American Ballroom-Center Westin Copley Place, fourth floor

3:50pm

Symposium 17, Talk 4. "Challenges, initial outcomes and results from the application of a fidelity model to first episode psychosis services in Australia"
Eóin Killackey1, Kristi van der El1, Heather Stavely1, Patrick McGorry1; 1Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
           
Background: In the 2010 Australian Federal Budget funding was committed to establish a first episode psychosis (FEP) service system based on the EPPIC model. This system was established by 2016. A fidelity scale, the EPPIC Model Integrity Tool (EMIT), was developed to measure the adherence to the model of the 6 clusters delivering the FEP services. Method: The EMIT is an 80-item assessment tool that maps onto the 16 core components of the EPPIC model. The tool is administered via on-site interviews with staff and young people as well as accessing documents, policies and data around client flow and service. Results: The first two rounds of fidelity assessments occurred in June/July and September/October 2017. Brief results around these assessments will be presented. These data give an initial snapshot of the adherence of the sites to the EPPIC model. The implementation of the tool cast light on a number of challenges that need to be addressed and these will also be discussed. The utility of the feedback from assessment as a means to identify areas in need of improvement will also be discussed. Conclusions: Model fidelity is an increasingly recognised way to ensure that programs based on evidence continue to deliver high quality outcomes, and avoid drift from the model. This presentation will demonstrate the outcomes from the first two rounds of application of the EMIT, associated challenges and ways in which fidelity testing can help services to improve their support of young people with early psychosis.


Speakers

Tuesday October 9, 2018 3:50pm - 4:10pm
American Ballroom-South Westin Copley Place, fourth floor

3:50pm

Symposium 18, Talk 4. "Integrating smartphone tools into clinical care: evolving regulatory, legal, and clinical workflow issues"
John Torous1, Luis Sandoval1, Matcheri Keshavan1; 1Harvard Medical School, Boston, Massachusetts, USA
           
While efforts to improve the engagement and efficacy of smartphone app and sensors for psychosis patients continue to increase their clinical utility and validity, real world uptake remains lows. Drawing upon recent literature searches, consultation with attorneys, monitoring of healthcare legislation, and our team’s experience piloting smartphone apps for early course psychosis patients, this session will explore current barriers and opportunities to increase uptake of these digital tools in clinical care. While a review of United States case law reveals no legal precedent for mental health app liability, recent federal legislation offers insights into new means to certify apps as healthcare devices and differentiate clinical apps from a plethora of general wellness apps. Reviewing qualitative feedback our team’s three-month pilot of smartphone monitoring for patients with psychosis, we will discuss the resulting consensus on a need for better integration of app data with electronic medical records, better clinical summaries of data, and further education on mobile health technologies. Reviewing recent survey data from 100 patients with psychosis, we will also discuss the views and concerns of service users regarding privacy and safety for smartphone apps. Finally, we will review our team's  smartphone ongoing research and integration efforts that aim to incorporate the principles  discussed in this talk.


Speakers
JT

John Torous

Harvard Medical School


Tuesday October 9, 2018 3:50pm - 4:10pm
Staffordshire Westin Copley Place, third floor

4:00pm

Oral 09, Talk 8. "Effect of interval training on metabolic risk factors in overweight individuals with psychosis: a randomized controlled trial"
Ahmed Jerome Romain1, Cedine Fankam1, Antony D. Karelis2, Elaine Letendre3, Gladys Mikolajacks1, Emmanuel Stip1,3,4, Amal Abdel-Baki1,3,4; 1University of Montreal Hospital Research Centre, 2University of Quebec at Montreal, 3University Hospital of Montreal (CHUM), 4University of Montreal
               
Background: Physical activity (PA) has been suggested to reduce the high prevalence of metabolic syndrome and obesity in psychosis population but interval training (IT) which is efficacious in other populations is poorly studied among people with psychosis. Objective: To determine the effects of a 6-month supervised IT program on metabolic, anthropometric, and psychiatric/functional outcomes. Methods: Randomized controlled trial comparing the effects of a bi-weekly 30 minutes IT to a waiting list of overweight individuals with psychosis. Body composition and metabolic risk factors were compared at baseline and 6 months using repeated-measures mixed linear models with the restricted maximum of likelihood method of estimation. Results. 66 individuals (62% men, 30.7 ± 7.2 years old; BMI: 32.7 ± 5.7 kg/m², waist circumference: 107.4 ± 13.3 cm) were randomised. Mean attendance to IT sessions was 64%. PA dropout rate was 50%. Among completers (>64% of prescribed IT sessions), IT was associated with significant improvements on waist circumference (-3.09 cm, SE = 1.4; p = 0.03), negative symptoms (-3.7, SE = 1.4; p = 0.01), social (SOFAS) (+6.16, SE = 1.76; p = 0.001) and global functioning (+5.38, SE = 2.3; p = 0.02). The effects of exercise in the first-episode psychosis (FEP) sub-group were similar to those of the entire cohort along with specific effects on fat free mass, fat mass and general PANSS psychopathology. Conclusion. IT contributes to improve metabolic complications and social functioning in obese individuals with psychosis. Further studies on prevention of metabolic complications are warranted.


Speakers
AJ

Ahmed Jerome Romain

University of Montreal Hospital Research Centre


Tuesday October 9, 2018 4:00pm - 4:10pm
St. George AB Westin Copley Place, third floor

4:00pm

Oral 10, Talk 8. "Symptomatology and cognition in a Chinese sample with chronic untreated psychosis"
Lawrence Yang1,2, Michael Phillips2,3, Matcheri Keshavan4, Ezra Susser2, William Stone4, Hui Li5, Fei Deng3, Hanhui Chen3, Bing Cai3, Zhizhong Wang3, Margaux Grivel1, Debbie Huang2; 1New York University, 2Columbia University, 3Shanghai Mental Health Center, 4Harvard Medical School, 5Florida A&M
               
Introduction: Many individuals with chronic psychotic disorders in under-resourced settings have a prolonged duration of untreated psychosis (DUP) prior to their first contact with medical treatment. This ongoing study in a northwestern province of China (Ningxia) identifies such a cohort and conducts a detailed assessment of their cognitive functioning prior to initiation of medication. Methods: This NIMH-funded collaboration between the Shanghai Mental Health Center, Harvard Medical School, Columbia University  and New York University ascertained untreated individuals with psychosis from Ningxia Province who are enrolled in China’s national registry of community-dwelling individuals with major mental illnesses. After providing informed consent, their DSM-IV (or DSM-5) diagnosis was assessed using an adapted Chinese version of SCID, their current symptomatology using the Positive and Negative Syndrome Scale, and their cognitive functioning using the MATRICS Consensus Cognitive Battery. Results: These interim analyses compare the symptomatic and cognitive characteristics of earlier-onset cases (DUP<5 years) vs. medium (DUP 6-10 years) and long-onset cases (DUP >10 years) and also compare our findings to those from first-contact studies in high-income countries. Discussion:  The identification and treatment of individuals with untreated chronic psychotic disorders is a high priority in low- and middle-income countries worldwide. Detailed cognitive assessment of these individuals with widely varying DUP prior to initiating treatment provides a detailed picture of the cognitive trajectory of untreated psychosis. This can then be compared to the cognitive trajectory of treated psychosis to assess the possible influence of antipsychotic medication on the natural history of cognitive decline in schizophrenia.


Speakers

Tuesday October 9, 2018 4:00pm - 4:10pm
St. George CD Westin Copley Place, third floor

4:10pm

Oral 09: Q&A
Question and answer period.

Speakers
MV

Mark van der Gaag

VU University


Tuesday October 9, 2018 4:10pm - 4:15pm
St. George AB Westin Copley Place, third floor

4:10pm

Oral 10: Q&A
Question and answer period.

Speakers
KL

Kathryn Lewandowski

Harvard Medical School


Tuesday October 9, 2018 4:10pm - 4:15pm
St. George CD Westin Copley Place, third floor

4:10pm

Symposium 15: Q&A
Question and answer period.

Speakers
DM

Daniel Mathalon

University of California


Tuesday October 9, 2018 4:10pm - 4:15pm
American Ballroom-North Westin Copley Place, fourth floor

4:10pm

Symposium 16: Q&A
Question and answer period.

Speakers
EY

Eric YH Chen

University of Hong Kong


Tuesday October 9, 2018 4:10pm - 4:15pm
American Ballroom-Center Westin Copley Place, fourth floor

4:10pm

Symposium 17: Q&A
Question and answer period.

Speakers
DA

Donald Addington

University of Calgary


Tuesday October 9, 2018 4:10pm - 4:15pm
American Ballroom-South Westin Copley Place, fourth floor

4:10pm

Symposium 18: Q&A
Question and answer period.

Speakers
AH

Amy Hardy

King's College London


Tuesday October 9, 2018 4:10pm - 4:30pm
Staffordshire Westin Copley Place, third floor

4:15pm

15 minute Break
Tuesday October 9, 2018 4:15pm - 4:30pm
American Ballroom Westin Copley Place, fourth floor

4:30pm

Oral Session 11: SERVICE REFORM
Chair
EK

Emily Kline

Harvard Medical School

Speakers
avatar for Nev Jones

Nev Jones

Assistant Professor, Department of Mental Health Law & Policy; Clinical Assistant Professor, Yale University School of Medicine, Program for Recovery and Community Health (PRCH), University of South Florida
University of South Florida


Tuesday October 9, 2018 4:30pm - 6:00pm
St. George AB Westin Copley Place, third floor

4:30pm

Oral Session 12: CHILDHOOD ADVERSITIES AND TRAUMA
Chair
SB

Sarah Bendall

The Centre for Youth Mental Health, University of Melbourne

Speakers

Tuesday October 9, 2018 4:30pm - 6:00pm
St. George CD Westin Copley Place, third floor

4:30pm

Symposium Session 19: NEW DIRECTIONS FOR COGNITIVE REMEDIATION IN EARLY PSYCHOSIS
Cognitive impairments begin early in the high risk period for psychosis and persist throughout the course of illness, leading to significant functional disability. Literature on interventions targeting neurocognition and social cognition in early course psychosis is growing and showing promising results. Effectiveness, predictors, mechanisms, and moderators of these interventions and how they relate to the pathophysiology of early course psychotic disorders is just beginning to be explored. Presenters will share emerging data on novel interventions designed to improve neurocognition and social cognition in patients with early psychosis or those at clinical high risk. Christopher Bowie will present on efficacy and effectiveness of cognitive remediation in patients with early versus long-term psychotic illness. Joseph Ventura will present data on the impact of cognitive remediation on social functioning, and negative and positive symptoms in first episode schizophrenia. Shaun Eack will present on 10-year follow-up data on cognitive enhancement therapy for early course schizophrenia. Michelle Friedman-Yakoobian will describe an adaptation of cognitive enhancement therapy for individuals at clinical high risk for psychosis. Sophia Vinogradov will be the discussant for this symposium and will comment on current progress and future directions for this work.


Chair
SE

Shaun Eack

Department of Psychiatry University of Pittsburgh
MF

Michelle Friedman-Yakoobian

Harvard Medical School

Speakers
SV

Sophia Vinogradov

University of Minnesota Medical School


Tuesday October 9, 2018 4:30pm - 6:00pm
American Ballroom-North Westin Copley Place, fourth floor

4:30pm

Symposium Session 20: USING SERIOUS GAMES AND VIRTUAL REALITY TO PREVENT AND TREAT MENTAL HEALTH PROBLEMS IN YOUNG PEOPLE
Being online has become an integral part of our daily life, and the majority of young people spend large part of their time interacting with new technologies, whether it is at school, to play games, to communicate with each other, or to relax. In this symposium, we explore how new technologies can be applied for the prevention and in the treatment of mental health problems. CUES-ED combines traditional teaching methods with new interactive technologies to build resilience in 7-10 years olds school children. The REACH study and the Danish High Risk study, have integrated Virtual Reality in the assessment of mental health problems to measure the real-time response to social interactions and to identify liability and resilience factors to emerging mental health problems in children and teenagers. To conclude we will present Pesky gNATs, a computer based intervention which integrates CBT with serious games to help children and young people experiencing anxiety and depression.
me that del

Chair
avatar for Lucia Valmaggia

Lucia Valmaggia

Senior Lecturer, King's College London, IEPA President Elect
Dr. Valmaggia works as Senior Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London she leads the Virtual Reality Lab, and is a Consultant Clinical Psychologist at the South London and Maudsley NHS Trust.During her career Cr. Valmaggia has sought... Read More →

Speakers

Tuesday October 9, 2018 4:30pm - 6:00pm
American Ballroom-Center Westin Copley Place, fourth floor

4:30pm

Symposium Session 21: YOUTH/PEER PARTICIPATION AND LEADERSHIP IN EARLY INTERVENTION SERVICES & RESEARCH: TOWARDS THE FUTURE
Across mental health services research, increasing emphasis has been placed on the importance of involving youth and young adults with lived experience across the areas of program development, service implementation and research. Both peer-led research and research on peer or youth-led service components in early intervention nevertheless remain under-researched and under-represented in both the scientific literature and academic conferences. The goal of this symposium is to showcase four exemplary peer-led and/or peer-involvement focused projects from the US and UK in order to increase the visibility of youth/peer research leadership and its transformative potential. These presentations span research on the underlying mechanisms of peer support for young adults (DuBrul), emerging best practices in young adult peer supervision (Klodnick), the role of service user involvement in addressing implementation gaps in early intervention services (Allen) and in seeding innovation (EASA Young Adult Leadership Council). The symposium chair will begin with a brief overview of the international landscape of peer involvement in research and program development, followed by the four presentations, and concluding with a group Q & A.
e EASA program

Chair
avatar for Nev Jones

Nev Jones

Assistant Professor, Department of Mental Health Law & Policy; Clinical Assistant Professor, Yale University School of Medicine, Program for Recovery and Community Health (PRCH), University of South Florida
University of South Florida

Speakers

Tuesday October 9, 2018 4:30pm - 6:00pm
American Ballroom-South Westin Copley Place, fourth floor

4:30pm

Symposium Session 22: MISSION CREEP: WILL WIDENING THE RANGE OF AGES AND DIAGNOSES IN EARLY INTERVENTION IN PSYCHOSIS TEAMS, WITHOUT NEW RESOURCES, UNDERMINE THEIR MISSION AND DILUTE THEIR METHODS, INTENSITY AND OUTCOMES TO THE POINT OF NO DIFFERENCE?
Does the evidence support having Early Intervention (EI) teams which cover wider diagnoses and age groups, or does it still only squarely support having discrete early intervention teams for young people with first episodes of psychosis? Meanwhile, triage and initial counselling services as a "one-stop-shop" or "clearing house" for assessing and assisting with all mental health disorders in young people, or exploratory programs for EI's of other disorders and other age-groups may be promising. However, they require further evaluation at this stage, for evidence of better outcomes. Should we enhance and resource EIP teams for young people to allocate a minority of extra places (say 10-15%) for severe high intensity disorders of a wider spectrum of psychiatric diagnoses which require a similar approach (as for psychosis) whether in ultra high risk states, acute early episodes requiring intensive mobile community care and assertive rehabilitative/recovery work? eg major affective disorders, disabling anxiety states, and severe eating disorders. This would not denature the clinical and functional teamwork protocols, and therefore should not diminish outcomes for first episode psychoses. Further, should trauma specific care be provided in common to most severe disorders? These approaches are consistent with Rosen, McGorry, Byrne and Goldstone chapter in Tasman A et al, eds, “Psychiatry” current 4th edition textbook, Wiley, 2016, on early Intervention across multiple disorders and age-groups, Byrne & Rosen, eds, "Early Intervention in Psychiatry : EI of nearly everything for better mental health" Blackwell-Wiley, 2014, and McGorry, EI: Mission Cramp Vs Mission Creep, ANZJP, 50, 11:1033-1035.


Chair
avatar for Patrick McGorry

Patrick McGorry

Executive Director, Orygen, IEPA Treasurer, Founder
Professor Patrick McGorry is an Irish-born Australian psychiatrist known world-wide for his development of the early intervention services for youth. He is executive director of Orygen, the National Centre of Excellence in Youth Mental Health, and founding editor of Early Intervention... Read More →
AR

Alan Rosen

University of Sydney

Speakers
avatar for Peter B. Jones

Peter B. Jones

Professor of Psychiatry & Deputy Head, School of Clinical Medicine, University of Cambridge, IEPA President
Peter qualified in medicine at Westminster Medical School. Having first worked as a physician at The Whittington Hospital and KCH, he trained in psychiatry at the Maudsley Hospital and epidemiology at the London School of Hygiene. He has been Professor of Psychiatry at Cambridge since... Read More →


Tuesday October 9, 2018 4:30pm - 6:00pm
Staffordshire Westin Copley Place, third floor

4:35pm

Oral 11, Talk 1. "Competencies and Training Needs of Massachusetts First Episode Psychosis Treatment Programs"
Emily Kline1,2, Nimita Iyer2, Margaret Guyer3, Matcheri Keshavan1,2; 1Harvard Medical School, 2Beth Israel Deaconess Medical Center, 3Massachusetts Department of Mental Health
               
There is accumulating evidence that coordinated specialty care for first episode psychosis (FEP) prevents disability, relapse hospitalization, suicide, and medical and substance use comorbidity, but implementation remains uneven. Federal agencies have rapidly increased funding for early intervention in FEP in the United States, leading to a proliferation of specialized FEP programs. To address workforce development and staff training needs in these programs, Massachusetts created a FEP Technical Assistance Center, now called the Massachusetts Psychosis Network for Early Treatment (MAPNET). The purpose of this study was to assess self-reported competencies and training needs amongst FEP providers across five clinical programs prior to participation in MAPNET activities. Respondents (N = 38) were asked to rank their skill as an individual and as a program in providing a number of evidence based and promising practices for FEP on a scale of 1 to 5 (5 representing high confidence). As individuals, providers identified their understanding of the rationale for FEP specialty care, ability to provide accurate diagnoses, and provision of individual psychotherapy as areas of strength. Areas of relative need (that is, low skill) included supported education/employment, peer counseling, and cognitive enhancement therapy. Program-level areas of strength and training needs mirrored individual-level results; however, there was substantial variation in inter-rater agreement with regard to identifying team strengths and weaknesses. Some programs demonstrated relative cohesion in their program-level assessments while others had poor agreement. The results of this survey were used to create a curriculum of learning activities that addressed clinician-identified training needs.


Speakers
EK

Emily Kline

Harvard Medical School


Tuesday October 9, 2018 4:35pm - 4:45pm
St. George AB Westin Copley Place, third floor

4:35pm

Oral 12, Talk 1. "Testing theories of the relationship between childhood trauma and hallucinations and delusions in early psychosis: The role of post-traumatic intrusions and trauma-related beliefs"
Sarah Bendall1,2, Natalie Peach Peach3, Simon Cropper4, Pamela Sun5, Mario Alvarez-Jimenez1,2; 1Orygen: The National Centre of Excellence in Youth Mental Health, 2The Centre for Youth Mental Health, University of Melbourne, 3University of New South Wales and National Drug and Alcohol Research Centre, 4School of Psychological Sciences, University of Melbourne, 5School of Psychological Sciences, Monash University
               
Objective. There is increasing evidence that childhood trauma plays a role in the aetiology of psychosis and in particular hallucinations and delusions. Cognitive models implicate post-traumatic intrusions as a mechanism by which childhood trauma leads to hallucinations. Model of delusions involve both post-traumatic intrusions and trauma-related beliefs as primary mechanisms. This study investigated relationships between childhood trauma, hallucinations and delusions, post-traumatic intrusions and trauma-related beliefs while accounting for comorbid symptoms. Methods. Sixty-six people with first episode psychosis aged between 15 and 24 years were assessed for hallucinations, delusions, childhood trauma, post-traumatic intrusions, post-traumatic avoidance, and trauma-related beliefs. Results. Fifty-three percent of the sample had experienced childhood trauma, and 27% met diagnostic criteria for post-traumatic stress disorder. Multiple regression analyses revealed that post-traumatic intrusions (but not childhood trauma, post-traumatic avoidance, or trauma-related beliefs) were independently associated with hallucination severity (β = .53, p = .01). Post-traumatic intrusions and trauma-related beliefs (but not childhood trauma or post-traumatic avoidance) were independently associated with delusion severity (β = .67, p < .01 and β = .34, p < .01 respectively). Conclusions. These findings support cognitive models that implicate post-traumatic intrusions in hallucination aetiology, and post-traumatic intrusions and trauma-related beliefs in delusion aetiology. This has implications for the treatment of trauma and post-traumatic stress disorder symptoms in people with psychosis. Research trialling interventions that specifically target post-traumatic intrusions and trauma-related beliefs in people with early psychosis who have experienced childhood trauma is recommended.


Speakers
SB

Sarah Bendall

The Centre for Youth Mental Health, University of Melbourne


Tuesday October 9, 2018 4:35pm - 4:45pm
St. George CD Westin Copley Place, third floor

4:35pm

Symposium 19, Talk 1. "Cognitive Remediation Can Improve Negative Symptoms and Social Functioning in First-Episode Schizophrenia: A Randomized Controlled Trial"
Joseph Ventura1, Kenneth Subotnik1, Denise Gretchen-Doorly1, Laurie Casaus1, Michael , Boucher1, Gerhard Hellemann1, Keith Nuechterlein1,2; 1Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 2Department of Psychology, University of California, Los Angeles
           
Background: Meta-analyses have reported that the effects of cognitive remediation might go beyond improvement in cognition to include additional benefits for schizophrenia patients such as negative and positive symptom reduction and improvements in functioning. Method: A RCT compared Cognitive Remediation (CR) to Healthy Behaviors Training (HBT) in 80 patients (78% male) with a mean age of 21.9 years and mean education of 12.3 years who had a first psychotic episode within two years of study entry. Participants were trained using CR programs or received HBT involving 50 sessions over 6 months and then booster sessions over the next 6 months. The SANS and BPRS were used to assess symptoms. The UCLA Social Attainment Survey assessed social functioning. Results: Using GLMM, improvements over 12 months were found favoring CR for SANS Expressive Symptoms (p<.01), which was composed of Affective Flattening (p<.01) and Alogia (p=.04), and for SANS Experiential Symptoms (p<.01), composed of Avolition /Apathy (p=.04) and Anhedonia / Asociality (p<.01). Improvements were also found for the BPRS Positive Symptom Factor (p=.04) composed mostly of reality distortion (p<.01). CR was associated with improvements in social functioning (p=.05) as compared to HBT. Discussion: We confirmed that the beneficial effects of CR appear to extend beyond cognition to improvements in negative and positive symptoms, and social functioning in early course schizophrenia patients. These results suggest that cognitive remediation might have an impact at an early point in the illness when the reduction of risk factors for chronicity is most critical for promoting recovery.


Speakers

Tuesday October 9, 2018 4:35pm - 4:55pm
American Ballroom-North Westin Copley Place, fourth floor

4:35pm

Symposium 20, Talk 1. "CUES-Ed: A universal early intervention programme for primary school children to promote wellbeing and resilience and to de-stigmatise mental health problems
Sophie Browning1, Debbie Plant1, Anna Redfern1, Karen Bracegirdle1, Suzanne Jolley2; 1South London and Maudsley NHS Foundation Trust, 2King's College London, Institute of Psychiatry, Psychology & Neuroscience
           
Difficulties meeting the need for mental health care amongst children and adolescents has led to increasing interest in resilience-building programmes delivered in public health settings. CUES-Ed is a universal clinician-led, school classroom-based programme for 7-10 year olds, rooted in cognitive behavioural therapy (CBT) and models. The central theme is ‘keeping our brains amazing’ by looking after our physical wellbeing; learning that thoughts, feelings and behaviour are interconnected; and building practical skills to help children manage life’s ups and downs. Uniquely, CUES-Ed also includes a focus on unusual perceptual experiences which have been associated with a range of adverse mental health outcomes. Sessions are delivered in a highly active and engaging way and the programme creatively utilises a range of innovative new technologies that help make abstract concepts more concrete and memorable. Our visually strong and recognisable branding and characters also help promote mental health in a positive way. Routine service evaluation has yielded promising findings in terms of pre-post improvements in general wellbeing, and in emotional and behavioural difficulties for those children scoring in the borderline or clinical ranges. Children self-reported an increased repertoire of coping strategies. Feedback from children, parents and teachers indicates that CUES-Ed is acceptable and subjectively helpful. Future developments include incorporating elements from our CUES (Coping with Unusual ExperienceS for Children) CBT manual, to adapt CUES-Ed for a clinical CAMHS population.


Speakers

Tuesday October 9, 2018 4:35pm - 4:55pm
American Ballroom-Center Westin Copley Place, fourth floor

4:35pm

Symposium 21, Talk 1. "What Makes a 'Peer'? Deconstructing Young People's Perceptions of Shared Experiences & Identities to Inform Peer Support in Early Intervention"
Sascha DuBrul1; 1New York State Psychiatric Institute, NY, NY, USA
           
Purpose:  In both the peer support literature and in practice, it is generally assumed that shared experience of specific diagnoses, mental health challenges and/or treatment are the primary basis for a shared "peer" identity and that these shared experiences in turn serve as primary drivers of the effectiveness of peer support.  The goal of the service user led project described in this presentation was to investigate the extent to which both young adult service users and peer specialists working in early intervention (EI) settings in fact center shared mental health experiences versus other potentially salient aspects of shared identity including age, shared interests, background adversity, race/ethnicity and sexual orientation or gender identity.  Methods:  We conducted a mixed methods research project including a survey (n = 50) and interviews (n = 15) with both young adult current/former service users and peer specialists working in EI.  Results: Our data suggest that there are a wide range of views on the perceived subjective importance of shared treatment or diagnostic experiences among young adults, with some interview participants expressing strong disidentification with their diagnoses or identities as a "service user" and a preference for relationships and mutual support premised on other (non mental health related) categories.  Conclusion:  We will discuss implications of our findings including the potential for mutual support interventions that foreground shared experiences, identities and/or interests unrelated to diagnosis, symptoms or treatment and propose next steps vis-a-vis both service development and research.


Speakers

Tuesday October 9, 2018 4:35pm - 4:55pm
American Ballroom-South Westin Copley Place, fourth floor

4:35pm

Symposium 22, Talk 1. "Will widening the range of ages and diagnoses in Early Intervention in Psychosis teams dilute their methods and outcomes? How specific, how focussed, how intensive, and how pure in diagnosis, purpose and age-group criteria do these
Alan Rosen1,2; 1Brain & Mind Centre, University of Sydney, Australia, 2Illawarra Institute of Mental Health, University of Wollongong, Australia
           
Does the evidence support having Early Intervention (EI)  teams which cover wider diagnoses and age groups, or at this stage does it still only squarely supports having discrete teams for early intervention teams for young people with first episodes of psychosis?  Meanwhile, triage and initial counselling services as a "one-stop-shop" or "clearing house" for assessing and assisting with all mental health disorders in young people, or exploratory programs for EI's of other disorders and other age-groups may be promising. However, they require further evaluation at this stage, for evidence of better outcomes. At the same time, perhaps we should consider EIP teams for young people reserving a minority of places (say 10-20%) for severe high intensity disorders of a wider spectrum of psychiatric diagnoses which require a similar approach (as for psychosis) whether in ultra high risk states, acute early episodes requiring intensive mobile community care and assertive rehabilitative/recovery work.  eg post-traumatic, major affective disorders, disabling anxiety states, and severe eating disorders.This would not denature the clinical and functional teamwork protocols and therefore should result in equivalent outcomes as for first episode psychoses. Training, working and supervising to evolving fidelity criteria for evidence based early interventions and service delivery systems, as well as contextual considerations, like agegroup specific and friendly facilities and practices, and home visits and social system intervention to engage, educate and elicit collaboration with both individuals and families, may be more crucial to success than procedural purity.


Speakers
AR

Alan Rosen

University of Sydney


Tuesday October 9, 2018 4:35pm - 4:55pm
Staffordshire Westin Copley Place, third floor

4:45pm

Oral 11, Talk 2. "Don't just screen, intervene: from margin to mainstream in Australia and England"
Jackie Curtis1,2, David Shiers3,4; 1University of New South Wales, Sydney, Australia, 2South Eastern Sydney Local Health District, Sydney, Australia, 3University of Manchester, UK, 4Psychosis Research Unit of Greater Manchester Mental Health NHS Trust, UK
               
Background: The iphYs international collaboration arose out of a shared concern over health system failures to proactively tackle cardiometabolic risk. The UK National Audit of Schizophrenia (NAS, 2012) and the Australian 2nd National Survey of Psychosis (2010) demonstrated the magnitude of this. Yet other than acknowledging social injustice, strategic response was lacking. Method: To assess mutual impacts of iphYs collaboration: i) Impact in England of adapting original NSW Positive Cardiometabolic Health algorithm (HETI, 2011) to create UK Lester resource; ii) Impact in Australia of adopting HeAL (Healthy Active Lives declaration), a rights-based approach to physical health from outset of psychosis and its treatment Results: ENGLAND: Impact from adopting NSW Don't just screen, intervene approach to cardiometabolic risk: 2014 UK Lester resource endorsed by NICE, professional Royal Colleges, NHS England and Public Health England, Diabetes UK and Rethink. Implementing the Lester resource is key objective of NHSEs quality improvement programme (CQUIN) and Care Quality Commission's regulatory assessment. Aligning with HeAL, service implementation of Lester resource features in national EIP self-assessment audit; latest CQUIN specifically incentivises EIP services to mitigate weight gain and reduce smoking. AUSTRALIA: The HeAL declaration principles have been endorsed by NSW Health, being embedded in statewide and national strategic documents (eg NSW Mental Health Commission; National Mental Health Commission) and the Positive Cardiometabolic health algorithm, alongside HeAL is acknowledged in the RANZCP clinical practice guidelines for Schizophrenia. Conclusion: Synergies resulting from eight years of international collaborations between Australia and England have influenced radical changes in policy and practice at state and national level.


Speakers

Tuesday October 9, 2018 4:45pm - 4:55pm
St. George AB Westin Copley Place, third floor

4:45pm

Oral 12, Talk 2. "Childhood Trauma Is Associated With Severity of Hallucinations and Delusions in Psychotic Disorders: Results of a Meta-Analysis and Implications for Early Psychosis Treatment"
Sarah Bendall1,2, Tom Bailey3, Carol Hulbert3, Ana Garcia-Sanchez4, Emma Barlow5, Mario Alvarez-Jimenez1,2; 1Orygen: The National Centre of Excellence in Youth Mental Health, 2The Centre for Youth Mental Health, University of Melbourne, 3School of Psychological Sciences, University of Melbourne, 4Hospital Universitario de Gran Canaria, 5Clinical Services, Port Phillip Prison
               
Introduction: Childhood trauma is a risk factor for the development of psychosis. Theories propose specific mechanisms by which childhood trauma may contribute to more severe positive and negative psychotic symptoms, some of which are supported empirically. The robustness of this evidence is unclear due to mixed results and methodological limitations of individual studies. A systematic review and meta-analysis of the evidence for associations between childhood trauma and severity of hallucinations, delusions and negative psychotic symptoms in groups with psychotic disorder is needed. Method: A systematic search was conducted. Reference lists of relevant review papers were hand-searched, and authors contacted for data and additional unpublished studies. Study reporting bias and quality was assessed. Results: In total, 6667 studies were identified and of these 41 studies met inclusion criteria. Of these, 29 studies (4680 participants) were meta-analysed. Among individuals with psychosis, childhood trauma was significantly correlated with severity of hallucinations (r = .199, p < .001) and delusions (r = .172, p < .001) but not correlated with severity of negative symptoms (r = .049, p = .095). Severity of childhood neglect was correlated with negative symptoms (r = .142, p = .005). Conclusion: The results have important implications for early psychosis treatment. Childhood trauma should be assessed for routinely in early psychosis and interventions developed to treat hallucinations and delusions using trauma-focussed interventions. More research and training in how to assess and treat the effects of trauma sensitively and effectively is essential to the delivery of trauma-informed services for early psychosis.


Speakers
SB

Sarah Bendall

The Centre for Youth Mental Health, University of Melbourne


Tuesday October 9, 2018 4:45pm - 4:55pm
St. George CD Westin Copley Place, third floor

4:55pm

Oral 11, Talk 3. "Deconstructing the Intersections of Race/ethnicity and Disadvantage on Family and Service User Disengagement from Early Intervention Services
Nev Jones1; 1University of South Florida
               
Purpose: A deeper understanding of the impact of structural disadvantage and/or minority cultural background on treatment engagement is a critically important but under-researched thread within the early intervention (EI) literature. This presentation weaves together both quantitative and qualitative data on disengagement from diverse community-based early psychosis programs in the US in order to deepen and complicate our current understanding of disengagement and raise critical questions for future research. Methods: We report findings from a mixed methods sequential-explanatory research project integrating analysis a large longitudinal quantitative dataset (n = 262) and in-depth interviews with young adults, family members and early intervention providers (n = 40). Findings: 44% of service users within the quantitative sample left EI prematurely (against the treatment team’s advice), with nearly 1/3 of these individuals disengaging within the initial three months of treatment. Both minority race/ethnicity and cumulative structural disadvantage were significantly associated with disengagement.   In-depth multi-stakeholder interviews help elucidate these findings, with key themes including perceived gaps in training and support for trauma-informed work, and client/family distrust stemming from prior child welfare, juvenile justice and children's mental health system involvement. Providers suggested a series of concrete strategies for addressing these concerns. Conclusions: Greater attention to cultural/ethnic/racial diversity and the impact of structural disadvantage in EI appears to be warranted. Implications vis-à-vis program design, assessment, provider training and fidelity will be discussed.


Speakers
avatar for Nev Jones

Nev Jones

Assistant Professor, Department of Mental Health Law & Policy; Clinical Assistant Professor, Yale University School of Medicine, Program for Recovery and Community Health (PRCH), University of South Florida
University of South Florida


Tuesday October 9, 2018 4:55pm - 5:05pm
St. George AB Westin Copley Place, third floor

4:55pm

Oral 12, Talk 3. "Adverse childhood experiences and neurodevelopmental disorders – a double jeopardy for juvenile mania?"
Ruchika Gajwani1, Lisa Dinkler2, Sebastian Lundström2,3, Paul Lichtenstein4, Christopher Gillberg1,2, Helen Minnis1; 1Institute of Health and Wellbeing, University of Glasgow, 2Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, 3Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
               
Objectives: The aims of the study were to understand the relative importance of the contribution of adverse childhood experiences (ACEs) and neurodevelopmental disorders (NDDs) to juvenile mania symptoms, and to investigate a model for the interaction between ACEs and NDDs that would explain why some adolescents at a greater risk of developing mania.  Methods: We used a prospective sample from a nationwide birth cohort study, comprising 3,348 twins born in Sweden between 1998 and 2001. Parents reported on ACEs and NDDs at age 9 and on symptoms of mania at age 15. Results: Having ACEs or NDDs at age 9 significantly increased number of mania symptoms at age 15. NDDs seemed to have a slightly higher risk effect on mania symptoms than ACEs (boys/girls: d = 0.23/0.28), although this difference was not statistically significant. Children who have experienced both ACEs and NDDs are at double jeopardy for juvenile mania as they showed significantly more mania symptoms than children with ACEs-only (d = 0.48/1.40) and girls with NDDs-only (d = 1.03). Males with both exposures did not differ significantly in mania symptoms from males with NDDs-only (d = 0.19). Conclusions: The study suggests that apart from ACEs, NDDs are an at least equally important factor to consider in the development of severe mental disorder. Families of children presenting with ACEs and/or NDDs need increased support.


Speakers

Tuesday October 9, 2018 4:55pm - 5:05pm
St. George CD Westin Copley Place, third floor

4:55pm

Symposium 19, Talk 2. "Training Cognition in Psychosis: Effects of Perceptual Training and Executive Functioning Training Methods as a Function of Age:
Christopher Bowie1, Michael Best1; 1Queen’s University
           
Several approaches to enhancing cognition have been used during the evolution of cognitive remediation for psychosis. The cognitive target of training differs across studies, from targeted to broad. Targeted training of perceptual skills has replicated effects on brain function, but less support for broader generalization than training of executive skills. Few studies have directly compared training across these dimensions.  In this study, patients with psychosis were randomized to receive either perceptual skills training or executive functioning training, three sessions per week for three weeks with a therapist, and daily for 12 weeks with independent at-home training. Pre- and post-treatment measures included neurophysiological functioning, cognitive abilities, functional competence, and everyday functioning outcomes. Data from 70 patients with psychosis, including a subgroup with first-episode psychosis, will be compared both across training modalities and length of illness. At the time of the abstract, all participants have been enrolled in the trial with a last assessment date in March 2018.



Tuesday October 9, 2018 4:55pm - 5:15pm
American Ballroom-North Westin Copley Place, fourth floor

4:55pm

Symposium 20, Talk 2. "Validation of self-reported paranoid thoughts amongst adolescents using Virtual Reality"
Charlotte Gayer-Anderson1, Gemma Knowles1, Stephanie Beards1, Maria Rus-Calafell1, Craig Morgan1, Lucia Valmaggia1,2; 1King's College London, Institute of Psychiatry, Psychology and Neursocience, 2South London and Maudsley NHS Foundation Trust
           
Background: Studies of suspiciousness about others in early adolescence have relied almost exclusively on self-report measures, with high resulting prevalence estimates (~30-45%). Virtual reality (VR) has successfully been used in adult samples to discriminate more precisely between potentially rational perceptions of threat, and unfounded paranoia. Using the first laboratory method for capturing the experience amongst adolescents, we are assessing the extent of agreement between self-report and interview measures of paranoia and low-level paranoia towards neutral avatars in a VR environment. Methods: Self-report and interview data on low-level paranoia are being collected from adolescents as part of a new cohort study, REACH (Resilience, Ethnicity and AdolesCent mental Health). Around 200 adolescents from REACH will be invited to enter a VR school canteen populated by neutral characters, and will be assessed on positive, neutral, and negative thoughts about the avatars. Results: Current pilot data (n=29) provides suggestive evidence that higher levels of negative thoughts towards the neutral characters was associated with feeling lonely (β 4.04, p 0.045), generalized anxiety (β 8.04, p 0.001), and depression (β 6.45, p 0.001). There was no association between VR-rated paranoid thoughts and self-report paranoia (β 0.27, p 0.851). Additional data will be available at the time of the conference. Conclusions: There is a need for simple and effective methods to accurately identify those with paranoia since these experiences are associated with increased distress and poor functioning in the short-term, and a range of severe mental health problems in the long-term. VR could be one such method.



Tuesday October 9, 2018 4:55pm - 5:15pm
American Ballroom-Center Westin Copley Place, fourth floor

4:55pm

Symposium 21, Talk 2. "Developing Effective Supervision Practices & Processes for Young Adult Peer Mentors in Massachusetts"
Vanessa Klodnick1; 1Thresholds Research, Chicago, IL, USA
           
Purpose: To boost engagement and ensure services are young person-informed, peer support is becoming increasingly common in transition-age youth mental health programs. Supervision is key for young adult peer support on-the-job success. However, what supervision looks like for young adult peers varies widely. Methods: Massachusetts successfully integrated Young Adult Peer Mentoring (a Medicaid reimbursable service) statewide for 14-21 year olds with mental health challenges. Through a partnership with the University of Massachusetts Transitions to Adulthood Center for Research and Thresholds in Chicago, supervision principles, practices, online and in-person trainings, and a guidebook were developed for Young Adult Peer Mentor supervisors. Results: Over 100 supervisors participated in on-line webinars, in-person trainings, and community of practice calls between 2015 and 2017. Participant feedback was exceedingly positive, calling for additional tools, which led to the development of a Young Adult Peer Supervision Guidebook. The trainings and guidebook help supervisors to effectively use the working alliance, reflective supervision, strategic use of self, and self-care in order to provide culturally attuned, developmentally focused supervision to peers.  The trainings and guidebook are available at: http://www.cbhknowledge.center/yapm-supervisor-tool-kit. Conclusions: Advances in young adult peer supervision theory, practice, and processes in Massachusetts have implications for child and adult serving systems and providers. Research is needed to evaluate the impact of supervisor development initiatives within transition-age youth serving programs in Massachusetts and beyond.


Speakers

Tuesday October 9, 2018 4:55pm - 5:15pm
American Ballroom-South Westin Copley Place, fourth floor

4:55pm

Symposium 22, Talk 2. "Women over 25+ years with first episode psychosis: A rationale for extending early intervention in psychosis services [or should we provide specific FEP teams for this age-group]?"
Katherine Boydell1,2; 1Black Dog Institute, School of Psychiatry, University of New South Wales, Australia, 2Child Health Evaluative Sciences, The Hospital for Sick Children, Department of Psychiatry, University of Toronto, Canada
           
Psychotic disorders are serious mental disorders resulting in significant human and economic impact. Early intervention for individuals with psychosis is effective in enabling better clinical and functional outcomes, however, most specialist services in early intervention in New South Wales, Australia work within an upper age limit of 25 years. We identify the need to explore help-seeking (pathways to care) and care-receiving narratives (experiences of services/supports) of 70% of women (in NSW, Australia) who experience a first episode of psychosis (FEP) when over 25 years of age and who are, therefore, frequently excluded from specialist early intervention. There is little research on this group and consequent lack of an evidence-base to inform service design and delivery. What is clear is that: 1) a significant proportion of women experiencing FEP are excluded from specialist early intervention services as they are over the arbitrary age limit, 2) these women’s specific needs are not addressed by general or youth services, and 3) the failure to provide specialist treatment has deleterious effects for them and their children. We provide an overview of the need to examine these women’s help-seeking and care-receiving experiences via mixed methods in order to understand how to best support women at home, school/work, and within their community, and inform practices in mental health, education/employment and welfare service settings. Specific evidence-based knowledge translation strategies will be suggested to ensure that findings meaningfully impact stakeholders and influence health-care practices and policy and redress the inequity of healthcare experienced by this group of women.



Tuesday October 9, 2018 4:55pm - 5:15pm
Staffordshire Westin Copley Place, third floor

5:05pm

Oral 11, Talk 4. "Lost in ‘practice’: Redefining engagement in early intervention for psychosis services"
Manuela Ferrari1, Tovah Cowan1, Kevin MacDonald1, Megan Pope1, Céline Villemus1, Ashok Malla1,2, Srividya Iyer1,2; 1Douglas Mental Health University Institute, 2Department of Psychiatry, McGill University
               
Rationale: Interest in service engagement in the early intervention for psychosis (EIP) literature has largely stemmed from the association between disengagement from services and poor clinical outcomes (e.g., relapse, increased hospital admissions). Research has mainly defined service engagement in terms of attendance to appointments and agreement with/adherence to treatment and/or medication recommendations. However, this definition is at odds with the EIP philosophy and guidelines, which emphasize service user and family engagement in treatment decision-making and service (re)design. There is thus a need to (re)theorize service engagement in EIP by exploring the perspectives of different stakeholders. Our qualitative study aimed to address this need. Method: Forty in-depth, semi-structured interviews were conducted with 24 service users and 16 service providers from a Canadian EIP program. Nineteen service users were currently receiving services and five had discontinued services. Informed by the grounded theory approach, interviews were analyzed comparing and contrasting service users’ and providers’ experiences and understandings of service engagement. Findings: Service users’ and providers’ definitions of service engagement fall on a spectrum ranging from adherence to treatment/services and recovery (symptoms remission), as defined clinically, to engagement and recovery, as defined more personally. Service engagement is shaped by multiple domains (e.g., symptoms/the illness experience; users’ versus providers’ treatment goals). Misalignment of these domains in clinical practice impairs communication and the therapeutic alliance, and, in some cases, leads to disengagement. Conclusions: Our findings offer a new model of service engagement. We propose several recommendations to support the implementation of this model in clinical practice.


Speakers

Tuesday October 9, 2018 5:05pm - 5:15pm
St. George AB Westin Copley Place, third floor

5:05pm

Oral 12, Talk 4. "Bullying Victimisation and Risk of Psychotic Phenomena"
Matthew Broome1, Gennaro Catone2,3, Guisi Moffa4,5, Jack Kuipers6, Elizabeth Kuipers7, Daniel Freeman8, Steven Marwaha9, Belinda Lennox8, Paul Bebbington4; 1Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK, 2Università della Campania Luigi Vanvitelli, Naples, Italy, 3Faculty of Educational Sciences, Suor Orsola Benincasa University, Naples, Italy, 4Division of Psychiatry, University College London, London, UK, 5Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland, 6D-BSSE, ETH Zurich, Basel, Switzerland, 7Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK, 8Department of Psychiatry, University of Oxford, Oxford, UK., 9Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
               
Introduction Being bullied is an aversive experience with short- and long-term consequences.  We used the 2000 and the 2007 British Adult Psychiatric Morbidity Surveys to test the hypothesis that bullying is associated with individual psychotic phenomena and with psychosis.  Methods Respondents were presented with a card listing stressful events to identify experiences of bullying over the entire lifespan. We assessed associations with the dependent variables persecutory ideation, auditory and visual hallucinations, and diagnosis of probable psychosis.  We used directed acyclic graphs (DAGs) to analyse data to assess putative mediators of the association between bullying victimization and psychosis. We compared results using DAGs and the Karlson-Holm-Breen (KHB) logistic regression commands in STATA.  Results We used data for 8580 respondents from 2000 and 7403 from 2007. Bullying was associated with presence of persecutory ideation and hallucinations. Bullying was associated with a diagnosis of probable psychosis. If reported at baseline, bullying predicted emergence and maintenance of persecutory ideation and hallucinations during 18 months of follow-up in the 2000 survey.  DAG analysis revealed a richer structure of relationships than could be inferred using the KHB commands. Bullying had direct effects on worry, persecutory ideation, mood instability, and drug use. Bullying led to hallucinations indirectly, via persecutory ideation and depression.  Conclusion Bullying victimisation increases the risk of individual psychotic symptoms and of a diagnosis of probable psychosis. DAGs indicate the complex interactions seen in psychiatry, including the mechanisms underpinning psychiatric symptoms. It may consequently be used to optimize the choice of intervention targets.


Speakers

Tuesday October 9, 2018 5:05pm - 5:15pm
St. George CD Westin Copley Place, third floor