IEPA 11: Full Schedule

8:30am EDT

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 EDT
American Ballroom-South Westin Copley Place, fourth floor

Ticketed Event

7:00pm EDT

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

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 →

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 EDT
Staffordshire Westin Copley Place, third floor

Reception

8:00am EDT

IEPA 11 Opening Session: "Prevention & Early Intervention: Broadening the Scope"

Chair

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 EDT
American Ballroom Westin Copley Place, fourth floor

Opening/Closing Session

8:45am EDT

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

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 EDT
American Ballroom Westin Copley Place, fourth floor

Plenary Session

9:25am EDT

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

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 EDT
American Ballroom Westin Copley Place, fourth floor

Plenary Session

10:05am EDT

Coffee Break

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

Coffee Break

10:30am EDT

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

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 EDT
American Ballroom Westin Copley Place, fourth floor

Plenary Session

11:15am EDT

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 EDT
American Ballroom Westin Copley Place, fourth floor

Awards Presentation

11:30am EDT

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 EDT
Essex Ballroom Westin Copley Place, third floor

Poster Session

1:00pm EDT

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

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

Iruma Bello

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

Thomas Nordahl Christensen

Mental Health Center Copenhagen, University of Copenhagen

Dawn Edge

The University of Manchester

Jennifer Humensky

Columbia University

Jacqueline Mayoral-van Son

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

Scott Teasdale

University of New South Wales, Australia

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

Oral Sessions

1:00pm EDT

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

Michelle L West

Harvard Medical School - Beth Israel Deaconess Medical Center

Speakers

Martina Brandizzi

Department of Mental Health, ASL Rome 1

Paolo Corsico

Emma Izon

Chantal Michel

Stefanie J Schmidt

University of Bern

Erich Studerus

University of Basel

Tianhong Zhang

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

Oral Sessions

1:00pm EDT

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

Srividya Iyer

McGill University

Speakers

Mary Cannon

DISCUSSANT, Royal College of Surgeons in Ireland

Colm Healy

Royal College of Surgeons in Ireland, Dublin

Joanna Henderson

University of Toronto

Sloon Huckabee

University of Massachusetts Medical School

Monday October 8, 2018 1:00pm - 2:30pm EDT
American Ballroom-North

Symposium Session

1:00pm EDT

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

Alan Breier

Indiana University School of Medicine

Indiana Psychotic Disorders Program, Prevention and Recovery Center for Early Psychosis

Speakers

Justin Baker

Assistant Professor of Psychology, Harvard Medical School

Tom Hummer

Indiana University School of Medicine

René Kahn

UMC Utrecht

Anil Malohtra

Zucker School of Medicine at Hofstra/Northwell

Martha Shenton

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

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

Symposium Session

1:00pm EDT

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

Aristotle Voineskos

University of Toronto

Speakers

Michael Birnbaum

The Zucker Hillside Hospital

George Foussias

University of Toronto

Nicole Kozloff

University of Toronto

Philip Tibbo

Dalhousie University

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

Symposium Session

1:00pm EDT

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

Amal Abdel-Baki

CHU Montreal, Canada

Philippe Conus

Lausanne University

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 1:55pm - 2:05pm EDT
St. George CD Westin Copley Place, third floor

Oral Presentation, Talk 6

2:05pm EDT

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

Jennifer Humensky

Columbia University

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

Oral Presentation, Talk 7

2:05pm EDT

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 2:15pm - 2:25pm EDT
St. George CD Westin Copley Place, third floor

Oral Presentation, Talk 8

2:25pm EDT

Oral 1: Q&A

Question & Answer period

Speakers

Jai Shah

McGill University

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

Oral Presentation, Discussion Period

2:25pm EDT

Oral 2: Q&A

Symposium 3: Q&A

DISCUSSANT

Speakers

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 EDT
American Ballroom-South Westin Copley Place, fourth floor

Symposium Presentation, Discussion Period

2:25pm EDT

Symposium 4: Q&A

Monday October 8, 2018 2:25pm - 2:30pm EDT
Staffordshire Westin Copley Place, third floor

Symposium Presentation, Discussion Period

2:30pm EDT

Coffee Break

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

Coffee Break

2:45pm EDT

Oral Session 3: PSYCHOSOCIAL TREATMENT: PSYCHOSIS

Chair

Tania Lecomte

Université de Montréal, Canada

Speakers

Daniel Anderson

Elizabeth Ann Barrett

Caragh Behan

Lauren Brooke

Jennifer Humensky

Columbia University

Jens Einar Jansen

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

Oral Sessions

2:45pm EDT

Oral Session 4: EPIDEMIOLOGY: PSYCHOSIS

Chair

Brian O'Donoghue

Orygen, The National Centre of Excellence in Youth Mental Health

Speakers

Jimmy Choi

Oliver Gil

Hannah Jongsma

Golam Khandaker

University of Cambridge

Donal O'Keeffe

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

Oral Sessions

2:45pm EDT

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

Jean Addington

University of Calgary

Matcheri Keshevan

IEPA Chair, Harvard University

Speakers

Kristin Cadenhead

University of California at San Diego

Michelle Friedman-Yakoobian

Harvard Medical School

Scott Woods

Yale University

Monday October 8, 2018 2:45pm - 4:15pm EDT
American Ballroom-North

Symposium Session

2:45pm EDT

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

Jessica Hartmann

Orygen, The National Centre of Excellence in Youth Mental Health

Barnaby Nelson

Orygen, The National Centre of Excellence in Youth Mental Health

Speakers

Marieke Wichers

University Medical Centre Groningen (UMCG)

Johanna Wigman

University Medical Centre Groningen (UMCG)

Hok Pan Yuen

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

Symposium Session

2:45pm EDT

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

Susan T. Azrin

National Institute of Mental Health

Speakers

Cameron S. Carter

University of California, Davis School of Medicine

Steven R. Lopez

University of Southern California

Leslie Marino

Columbia University Medical Center, New York State Psychiatric Institute

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

Symposium Presentation, Talk 1

2:50pm EDT

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

Steven R. Lopez

University of Southern California

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

Symposium Presentation, Talk 1

3:00pm EDT

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

Lauren Brooke

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

Oral Presentation, Talk 2

3:00pm EDT

Oral 4, Talk 2. CANCELLED

Talk 2 had been withdrawn at the request of the author.

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"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

Golam Khandaker

University of Cambridge

University of California at San Diego

Monday October 8, 2018 3:10pm - 3:30pm EDT
American Ballroom-North

Symposium Presentation, Talk 2

3:10pm EDT

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

Marieke Wichers

University Medical Centre Groningen (UMCG)

Orygen, The National Centre of Excellence in Youth Mental Health

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

Oral Presentation, Talk 4

3:30pm EDT

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.

Speakers

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

Oral Presentation, Talk 6

3:40pm EDT

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

Hannah Jongsma

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

Oral Presentation, Talk 6

3:50pm EDT

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

Jennifer Humensky

Columbia University

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

Oral Presentation, Talk 7

3:50pm EDT

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 4:10pm - 4:15pm EDT
American Ballroom-Center Westin Copley Place, fourth floor

Symposium Presentation, Discussion Period

4:15pm EDT

15 minute Break

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

4:30pm EDT

Oral Session 5: SERVICE DELIVERY

Chair

Helen Stain

Leeds Trinity University

Speakers

Shelly Ben-David

Khalima Bolden

Peter Gallagher

Kate Hardy

Walter Mathis

Giulia Signorini

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

Oral Sessions

4:30pm EDT

Oral Session 6: NEUROIMAGING

Chair

Masafumi Mizuno

Toho University School of Medicine

Speakers

Thomas Dunne

Kareen Heinze

Sameer Jauhar

Albert Powers

Hiromi Tagata

Xiaochen Tang

Junjie Wang

Jeffrey K. Yao

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

Oral Sessions

4:30pm EDT

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.

Chair

Wenche ten Velden Hegelstad

Stavanger University Hospital

Luana R Turner

UCLA

Speakers

Nanna Briem

Daniëlle van Duin

Eóin Killackey

Jaap van Weeghel

Tilburg University

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

Symposium Session

4:30pm EDT

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

Philippe Conus

Lausanne University

Sue Cotton

Centre for Youth Mental Health, The University of Melbourne

Craig Macneil

Aswin Ratheesh

Orygen Youth Healh

Monday October 8, 2018 4:30pm - 6:00pm EDT
American Ballroom-North

Symposium Session

4:30pm EDT

Symposium Session 9: YOUTH AT RISK FOR SERIOUS MENTAL ILLNESS: THE CANADIAN PSYCHIATRIC RISK AND OUTCOME STUDY (PROCAN)

Speakers

Helen Stain

Leeds Trinity University

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

Oral Presentation, Talk 1

4:35pm EDT

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

Lausanne University

Monday October 8, 2018 4:55pm - 5:15pm EDT
American Ballroom-North

Symposium Presentation, Talk 2

4:55pm EDT

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

Jean Addington

University of Calgary

University of Calgary

Centre for Youth Mental Health, The University of Melbourne

Monday October 8, 2018 5:35pm - 5:55pm EDT
American Ballroom-North

Symposium Presentation, Talk 4

5:35pm EDT

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

Paul Metzak

University of Calgary

Monday October 8, 2018 5:55pm - 6:00pm EDT
American Ballroom-North

Symposium Presentation, Discussion Period

5:55pm EDT

Symposium 9: Q&A

Question and answer period.

Speakers

Olga Santesteban-Echarri

University of Calgary

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

Symposium Presentation, Discussion Period

6:00pm EDT

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

Broad Institute png

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

Ticketed Event

Coffee Break

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

Coffee Break

10:30am EDT

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

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 EDT
American Ballroom Westin Copley Place, fourth floor

Plenary Session

11:15am EDT

Richard J. Wyatt Award Presentation

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

Awards Presentation

11:30am EDT

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 EDT
Essex Ballroom Westin Copley Place, third floor

Poster Session

12:30pm EDT

IEPA Annual General Meeting

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

Speakers

Peter B. Jones

Professor of Psychiatry & Deputy Head, School of Clinical Medicine, University of Cambridge, IEPA President

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

Board Meeting

1:00pm EDT

Oral Session 7: SUPPLEMENTS AND OTHER PHARMACOLOGICAL TREATMENTS

Chair

Shona Francey

Orygen, The National Centre of Excellence in Youth Mental Health

Speakers

Kelly Allott

Marco Armando

Maximus Berger

Orygen

Alan Breier

Indiana University School of Medicine

Indiana Psychotic Disorders Program, Prevention and Recovery Center for Early Psychosis

Dale DMello

Joseph Firth

Andrew Thompson

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

Oral Sessions

1:00pm EDT

Oral Session 8: PHENOMENOLGY: FIRST EPISODE PSYCHOSIS

Chair

Michael Birnbaum

The Zucker Hillside Hospital

Speakers

Rosa Ayesa Arriola

Daniel Cavalcante

Andrew Chanen

Boris Chaumette

Gerald Jordan

George Salaminios

Abigail Wright

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

Oral Sessions

1:00pm EDT

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

Olesya Ajnakina

Kings College London

Mary Cannon

DISCUSSANT, Royal College of Surgeons in Ireland

Speakers

Kristine Engemann Jensen

Hannah Jongsma

Andreas Meyer-Lindenberg

Central Institute for Mental Health

Robin Murray

Tuesday October 9, 2018 1:00pm - 2:30pm EDT
American Ballroom-North

Symposium Session

1:00pm EDT

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

Mark van der Gaag

VU University

Amy Hardy

King's College London

Speakers

David van den Berg

Parnassia Psychiatric Institute

Sandra Bucci

University of Manchester

Lucia Valmaggia

Senior Lecturer, King's College London, IEPA President Elect

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

Symposium Session

1:00pm EDT

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

Nikolai Albert

Copenhagen University

Merete Nordentoft

Copenhagen University

Speakers

Eric YH Chen

University of Hong Kong

Robert Heinssen

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

Jan Olav Johannessen

Stavanger University Hospital

Ashok Malla

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

Symposium Session

1:00pm EDT

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

Nikos Koutsouleris

Ludwig-Maximilians University Munich

Stephen Wood

School of Psychology, University of Birmingham

Speakers

Paolo Brambilla

Paola Dazzan

Kings College London

John Gillam

Indiana University School of Medicine

Indiana Psychotic Disorders Program, Prevention and Recovery Center for Early Psychosis

VU University

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

Symposium Presentation, Talk 3

1:45pm EDT

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

Eric YH Chen

University of Hong Kong

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

Symposium Presentation, Talk 3

1:45pm EDT

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.

Speakers

Rachel Upthegrove

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

Symposium Presentation, Talk 3

1:55pm EDT

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

Kelly Allott

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

Oral Presentation, Talk 6

1:55pm EDT

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

Gerald Jordan

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

Oral Presentation, Talk 6

2:05pm EDT

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 EDT
St. George AB Westin Copley Place, third floor

Oral Presentation, Talk 7

Symposium Presentation, Talk 4

2:05pm EDT

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

Ashok Malla

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

Symposium Presentation, Talk 4

2:05pm EDT

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

Paolo Brambilla

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

Symposium Presentation, Talk 4

2:15pm EDT

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 EDT
St. George AB Westin Copley Place, third floor

Oral Presentation, Talk 8

2:15pm EDT

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.

Speakers

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

Chair

Mark van der Gaag

VU University

Speakers

Synthia Guimond

Amy Hardy

King's College London

Rachel Loewy

Sophie Parker

Ahmed Jerome Romain

University of Montreal Hospital Research Centre

Andrew Thompson

Olina G Vidarsdottir

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

Oral Sessions

2:45pm EDT

Oral Session 10: NEUROCOGNTION

Chair

Kathryn Lewandowski

Harvard Medical School

Speakers

Kelly Allott

Louise Birkedal Glenthøj

Kathryn Hardin

Camilla Austa Jerlang Christiani M.Sc.

Chantal Michel

Lawrence Yang

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

Oral Sessions

2:45pm EDT

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

Ricardo Carrion

Hofstra Northwell School of Medicine

Susanna L. Fryer

University of California, San Francisco

Speakers

Ricardo E. Carrión

Sylvia B Guillory

Daniel Mathalon

University of California

Margaret Niznikiewicz

Harvard Medical School

Tuesday October 9, 2018 2:45pm - 4:15pm EDT
American Ballroom-North

Symposium Session

2:45pm EDT

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.

Chair

Byron J. Good

Harvard Medical School

Speakers

Nida Ul Hassanat

Carla Raymondaleas Marchira

M. A. Subandi

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

Symposium Session

2:45pm EDT

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.

Chair

Donald Addington

University of Calgary

Speakers

Janet Durbin

Eóin Killackey

Marianne Melau

Ilana Nossel

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

Symposium Session

2:45pm EDT

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

Sandra Bucci

University of Manchester

Amy Hardy

King's College London

Speakers

Andrew Gumley

Shon Lewis

John Torous

Harvard Medical School

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

Symposium Session

2:50pm EDT

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 - 3:10pm EDT
American Ballroom-South Westin Copley Place, fourth floor

Symposium Presentation, Talk 1

2:50pm EDT

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

Sandra Bucci

University of Manchester

Mark van der Gaag

VU University

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

Oral Presentation, Talk 6

3:40pm EDT

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

Kathryn Hardin

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

Oral Presentation, Talk 6

3:50pm EDT

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

Amy Hardy

King's College London

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

Oral Presentation, Talk 7

3:50pm EDT

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.

Speakers

Camilla Austa Jerlang Christiani M.Sc.

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

Oral Presentation, Talk 7

3:50pm EDT

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

Margaret Niznikiewicz

Harvard Medical School

Harvard Medical School

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

Symposium Presentation, Talk 4

4:00pm EDT

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

Ahmed Jerome Romain

University of Montreal Hospital Research Centre

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

Oral Presentation, Talk 8

4:00pm EDT

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

King's College London

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

Symposium Presentation, Discussion Period

4:15pm EDT

15 minute Break

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

4:30pm EDT

Oral Session 11: SERVICE REFORM

Chair

Emily Kline

Harvard Medical School

Speakers

Jackie Curtis

Manuela Ferrari

Harm Gijsman

Michelle Jamieson

Nev Jones

University of South Florida

Anika Maraj

Anna Meneghelli

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

Oral Sessions

4:30pm EDT

Oral Session 12: CHILDHOOD ADVERSITIES AND TRAUMA

Chair

Sarah Bendall

The Centre for Youth Mental Health, University of Melbourne

Speakers

Matthew Broome

Katharine Chisholm

Helen Coughlan

Ruchika Gajwani

Antonella Trotta

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

Oral Sessions

4:30pm EDT

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

Shaun Eack

Department of Psychiatry University of Pittsburgh

Michelle Friedman-Yakoobian

Harvard Medical School

Speakers

Christopher Bowie

Joseph Ventura

Sophia Vinogradov

University of Minnesota Medical School

Tuesday October 9, 2018 4:30pm - 6:00pm EDT
American Ballroom-North

Symposium Session

4:30pm EDT

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

Lucia Valmaggia

Senior Lecturer, King's College London, IEPA President Elect

Speakers

Sophie Browning

Charlotte Gayer-Anderson

Merete Nordentoft

Copenhagen University

Gary O' Reilly

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

Symposium Session

4:30pm EDT

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

Nev Jones

University of South Florida

Speakers

Stephanie Allen

Sascha DuBrul

Vanessa Klodnick

Tamara Sale

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

Symposium Session

4:30pm EDT

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

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 →

Alan Rosen

University of Sydney

Speakers

Katherine Boydell

University of Sydney

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

Symposium Presentation, Talk 1

4:45pm EDT

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

Jackie Curtis

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

Oral Presentation, Talk 2

4:45pm EDT

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

Sarah Bendall

The Centre for Youth Mental Health, University of Melbourne

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

Oral Presentation, Talk 2

4:55pm EDT

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

Nev Jones

University of South Florida

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

Oral Presentation, Talk 3

4:55pm EDT

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

Ruchika Gajwani

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

Oral Presentation, Talk 3

4:55pm EDT

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.

Speakers

Christopher Bowie

Tuesday October 9, 2018 4:55pm - 5:15pm EDT
American Ballroom-North

Symposium Presentation, Talk 2

4:55pm EDT

Symposium 20, Talk 2. "Validation of self-reported