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S234 Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
Poster #M122
PREVALENCE OF INFECTIONS IN PATIENTS WITH SCHIZOPHRENIA:
A PILOT STUDY
Monika E. Pankiewicz-Dulacz1,2, Elsebeth Stenager3, Egon Stenager4,
Ming Chen5
1Psychiatric Hospital of Southern Jutland; Dept. Neurology, Hospital of
Southern Jutland; Dept. of Infectious Diseases, Hospital of Southern Jutland;2Psychiatric Hospital of Southern Jutland, Institute of Regional Research;3University Hospital Odense, Department of Psychiatry; 4University of
Southern Denmark, Dept. Neurology: Institute of Regional Health Research;5Dept. of Infectious Diseases, Hospital of Southern Jutland
Background: Schizophrenia is associated with increased premature mortal-
ity, whereas the average decrease in lifespan is 15-20 years. Excess mortality
from diseases and medical conditions among persons with schizophrenia is
higher, compared to other psychiatric disorders like bipolar or depression.
Side effects of pharmacological treatment, unhealthy diet, as well as inade-
quate provision of health care have been pointed out as important possible
reasons for the excess mortality from natural causes within persons with
schizophrenia. The presence of medical comorbid conditions is high. Several
studies show an increased prevalence of cardiovascular diseases, obstet-
ric complications, respiratory, endocrinologic, and metabolic disorders in
schizophrenic patients. Regarding to infections, human immunodeficiency
virus, hepatitis, and other infections are common and associated with
substance abuse, homelessness and sexual risk behavior. Known problem
among persons with schizophrenia is poor dental status, which can be
source of infections and endocarditis. There are several lines of evidence
that schizophrenia is associated with immune abnormalities. Abnormal
blood levels of cytokines, C-reactive protein and changed immune cell
functions were found among persons with schizophrenia. Furthermore,
schizophrenia and infectious diseases have been associated with genetic
markers in the human leukocyte antigens which can give susceptibility for
genetic vulnerability in these individuals. Despite these immune abnormal-
ities and many factors that can suppress the immune system, prevalence
of infectious diseases among persons with schizophrenia has not been
sufficiently revealed. To contribute to the discussion about prevalence of
infections in individuals with schizophrenia, we investigated the prevalence
of different infections among persons with schizophrenia living in the South
Jutland County.
Methods: Data source and study population: We conducted a register-
based study using psychiatric hospital data from January 1, 2007 to De-
cember 31, 2012. This data is composed of inpatient and outpatient claims
submitted by psychiatrics health care providers in the South Jutland County
and includes International Classifications of Diseases (ICD-10) diagnostic
for patients with schizophrenia; F20.0 –F20.9 and patients with schizophre-
nia and substance abuse; F10.0-F.19.9. We included alcohol and substance
abuse/dependence conditions as comorbidities, given the likelihood of these
conditions to increase frequency of infections. Data of 694 patients with
schizophrenia was linked with microbiological register MADS from January
1, 2000 to December 31, 2010. We conducted the analysis about prevalence
of diverse infectious diseases among those patients, reasons of admitting
to Infectious Disease Department, the analysis of microbiological agents,
which have caused infections.
Results: Preliminary results: Overall, 266 women (38%) and 428 men
(62%) were identified with schizophrenia. In percentages, 31% men with
schizophrenia and 37% women with schizophrenia had infectious diseases.
For individuals under 30 year old prevalence of infections was further
increased – 39%. We have found 21% schizophrenia persons with substance
abuse, and 29% had infections. Skin infections, gynecological infections and
cystitis were common comorbidities. Staphylococcus Aureus and Hemolytic
Streptococcus occurred to be common microorganisms found in those pa-
tients. 82% of patients were admitted to the Infectious Disease Department
from General Practitioners
Discussion: This study is established as a 3-month pilot study with a
thought of developing it to the large cohort population- based nationwide
study. The strength of this study is that data on the presence or absence
of infections were based on analysis of biological material. Interestingly,
we found that young individuals under 30 years old have been more likely
to have infections compared to whole study population with prevalence
of 39%. Previous studies have revealed that skin infections and urogenital
infections were common co-morbidity prior to the diagnosis of schizophre-
nia, where our study can suggest that they are also common after diagnosis.
There are many limitations. This study is designed as a observational and
descriptive study with limited time of follow up on a homogeny selected
population. Due to the time limitation of the study control population
has not been chosen. This retrospective observational study reveals that
persons with schizophrenia are often admitted to the Infectious Diseases
Department and they have increased co-morbidity with skin infections,
gynecological infections and cystitis which is consistent with results from
previously studies.
Poster #M123
DO PERSONS WITH SCHIZOPHRENIA SELECTIVELY MIGRATE TOWARDS
CITY AREAS?
Carsten B. Pedersen1,2
1Aarhus University; 2The Lundbeck Foundation Initiative for Integrative
Psychiatric Research, iPSYCH, Denmark
Background: Background: It has been hypothesized that person with
schizophrenia migrate towards larger cities due to the development of their
disorder or its prodromata or fail to participate in the general movement of
mentally healthy persons away from larger cities (Freeman H. Schizophre-
nia and city residence. Br J Psychiatry Suppl 1994;39-50). Such selective
migration of persons with schizophrenia would tend to increase the oc-
currence of persons with schizophrenia in urban areas. However, no study
investigated this hypothesis in a nationwide population. We investigated
if persons with schizophrenia spectrum disorders (ICD10: F20-F29) more
often moved towards larger cities compared to healthy controls.
Methods: Methods: The study population consisted of all persons born in
Denmark 1973-1997 and whose both parents were also born in Denmark.
Within this population, we identified persons who had their first diagnosis
with schizophrenia spectrum disorder from 1971 to 2007. To account for
the general mobility of the Danish population, for each case we identified
10 controls with same sex, born within 15 days from the case, born in the
same degree of urbanization as the case, and who was alive, residing in
Denmark and not diseased at the time the case became case. For the cases
and controls separately, we contrast their degree of urbanization of place of
residence two years prior to the time the case became case with the degree
of urbanization five years after the case became case.
Results: Results: During the period of observation a total of 12,394 persons
were diagnosed with schizophrenia spectrum disorder for the first time in
their life. Among cases alive and resident in Denmark 5 years after onset,
77.2% stayed in the same degree of urbanization, 11.2% moved to a higher
degree of urbanization, and 11.7% moved to a lover degree of urbanization.
Among the 127,453 healthy controls alive and resident in Denmark 5 years
after the corresponding case became case, 81.1% remained in the same
degree of urbanization, 8,7% moved to a higher degree of urbanization,
and 10.2% moved to a lower degree of urbanization. We also observed
that persons with schizophrenia more often died and were less likely to
emigrate from Denmark.
Discussion: Conclusions This is the first nationwide study to investigate
the hypothesis that persons with schizophrenia selectively migrate towards
urban areas as a consequence of their disorder or its prodromate. Although,
we found support for selective migration of persons with schizophrenia
spectrum disorder, we found no support that persons with schizophrenia
were more likely to migrate towards urban areas compared to healthy
controls. Patients with schizophrenia more often drift towards rural areas
as compared to healthy controls.
Poster #M124
FORMAL THOUGHT DISORDER: A SYSTEMATIC EPIDEMIOLGICAL REVIEW
Eric Roche1, Lisa Creed2, Donagh MacMahon1, Daria Brennan3,
Brendan Kelly4, Kevin Malone5, Mary Clarke1
1DETECT Early Intervention in Psychosis Service; 2Cluain Mhuire Community
Mental Health Service; 3St John of God Hospital; 4Mater Misericordiae
University Hospital; 5University College Dublin
Background: Formal thought disorder (FTD) is a core diagnostic symptom
of schizophrenia and yet much remains unknown about it. The clinical im-
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384 S235
portance of FTD lies in helping to differentiate between different psychiatric
diagnoses although it has been documented in those without any mental
illness. Much research has examined possible biological markers associated
with FTD, with varying results. The association between functional capacity
and FTD is also unclear and this may be due to a lack of clear clinical con-
ceptualisation of this symptom. We aimed to carry out a clinically-oriented
review of FTD, to clarify its basic epidemiology and impact on outcome in
mental illness.
Methods: A systematic review of the literature on FTD, using PRISMA
guidelines to source all relevant articles published in the English language
cited on PubMed, Medline and Embase between the 1978-2013. Search
terms included “formal thought disorder”, “epidemiology”, “factor analysis”
and “outcome”.
Results: We reviewed 401 abstracts, of which 130 articles met inclusion cri-
teria. Articles reporting on FTD prevalence and longitudinal course (n=29),
influence on outcome (n=36), role in diagnosis (n=25), association with age
(n=26) and factor structure (n=14) were included. A range of different scales
are used to assess FTD in the research setting. Researchers refer to “negative
FTD”, a construct that clinicians would describe as “alogia”. Prevalence
estimates for FTD range from 27% to 91% in psychotic conditions, with a rate
of 6% quoted for normal controls. Lower rates are found in schizoaffective
disorder, mania, depression and personality disorders. FTD in mania may be
more severe than that seen in schizophrenia. It appears to be less prevalent
in children and is very rarely found in in late-onset psychotic illness (∼5%).
FTD tends to remain stable over time: the point prevalence rate in elderly
patients with early-onset psychosis is similar to that of their younger
counterparts. Factor analysis has shown that FTD is comprised of up to six
different factors. The disorganised domain corresponds most closely to the
construct of FTD described in the DSM. The type, severity and longitudinal
course of FTD can help distinguish between different diagnostic categories
with a high degree of accuracy. Co-morbid anxiety disorders appear to be
less likely when FTD is present whilst co-morbid cannabis abuse is asso-
ciated with greater severity of FTD. FTD may follow a remitted, episodic or
continuous course and it is associated with a number of adverse outcomes.
It is associated with longer hospital admissions, greater likelihood of
relapse, poorer insight and increased risk of transition to psychosis in the
at-risk mental state (OR 2-4). Poorer social functioning and worse occupa-
tional outcomes have been predicted by measures of “bizarre idiosyncratic
thinking” and “negative FTD” however the construct of “disorganised
thinking” does not show this association to as significant an extent.
Discussion: FTD is a common symptom of mental illness and may be
considered a marker of illness severity. A detailed assessment of FTD can
clarify differential diagnosis considerably and may help predict progno-
sis to a degree. Existing literature is limited by the lack of a coherent
conceptualisation of this symptom. The majority of FTD research to date
has been performed on inpatient samples, or chronically institutionalised
populations, thereby restricting the generalizability of results. There is a
need to perform detailed epidemiologic research of FTD using standardised
clinical assessment tools with mixed diagnostic populations which may
help to establish its impact on functional outcome.
Poster #M125
THE EFFECTS OF CANNABIS ON RELAPSE IN PSYCHOSIS
Tabea Schoeler1, Anna Monk2, Musa Sami2, Giulia Camuri2, Ruth Brown2,
Sagnik Bhattacharyya1
1Department of Psychosis Studies, Institute of Psychiatry, King’s College
London; 2Institute of Psychiatry
Background: The association between cannabis use and psychotic disorders
like schizophrenia is well-established in the literature (Arseneault et al.
2004). Although more than half of the patients experience a relapse after
the onset of the disorder (Caseiro et al., 2012), with cannabis representing
one potential factor that predicts relapse rates (Linszen et al., 1994), a
summary of the current evidence has yet to be conducted. For this reason,
a meta-analysis was conducted in order to estimate the magnitude of the
effects of cannabis on risk of relapse and symptoms in individuals with a
psychotic disorder.
Methods: 25 studies met the criteria for inclusion following a systematic
literature search. By using the statistical software R 3.0.1, the effect of
cannabis use in individuals with a psychotic disorder on rates of relapse (n=
4217 patients) and symptoms (n=3881 patients) was computed employing
established meta-analytic techniques.
Results: Random-effects analyses revealed moderate to large effects sizes
for the effects of cannabis on relapse (d=0.46, p<0.0001) and for cannabis
on positive symptomatology (d=0.56, p=0.0035), indicating that those pa-
tients using cannabis are at a higher risk of relapse and characterized by
more severe positive symptomatology compared to those who never used
or stopped using the substance. The analysis further revealed a substan-
tial degree of statistical heterogeneities among studies for the effects of
cannabis on outcome (I2 = 75% for relapse and I2 = 88% for pos. symptoms),
indicating that results vary across studies and that other, as yet unidentified
factors are likely to impact on the link between cannabis and outcome.
Discussion: The results implicate adverse effects of cannabis when uncon-
trolled for confounders and at a cross-sectional level. However, differences
in sample characteristics and methodological diversity across studies ap-
peared to impact on the effects of cannabis on outcome. Therefore, a more
systematic and prospective investigation of a larger cohort of patients with
a pre-existing psychotic disorder would help to estimate the precise mag-
nitude of the effects of ongoing cannabis use when controlled for potential
confounders.
Poster #M126
ATTITUDES TOWARDS PATIENTS WITH PSYCHOSIS AND DEPRESSION IN
THE GENERAL POPULATION: EFFECTS OF LABELING
Frauke Schultze-Lutter1, Chantal Michel2, Benno G. Schimmelmann1
1University Hospital of Child and Adolescent Psychiatry and Psychotherapy
Bern, University of Bern; 2University Hospital of Child and Adolescent
Psychiatry and Psychotherapy
Background: Good mental health literacy is thought to improve help-
seeking and compliance. Yet it was cautioned in psychosis that it might also
increase the desire for social distance, especially when linked to biological
causal explanations. Therefore, we investigated attitudes towards patients
with psychosis and depression in a general population sample in relation
to labeling.
Methods: 1’184 German-speaking participants of a telephone survey (age
16 to 40) were asked to answer a questionnaire on mental health literacy
and attitudes whose two versions vary in their diagnostically unlabeled case
vignette (schizophrenia or depression). 1’061 (89.6%) agreed to participate,
645 (60.8%) questionnaires were returned: 331 with a schizophrenia, 314
with a depression case vignette.
Results: The type of the depicted mental problem (case vignette) had signif-
icant small to moderate effects on the desire for social distance (Rosenthal’s
r: 0.115 (colleague) to 0.373 (looking after children). Both effect of the
vignette and desire for social distance increased with increasing closeness
of the suggested relationship for both vignettes, although persons depicted
by the depression vignette were generally much better received than per-
sons depicted by the schizophrenia vignette. Furthermore, the higher the
wish for social distance, the larger tended to be the effect of the vignette.
Correctly labeling the case vignette or adopting a biological illness model
had hardly any and, if any, only small effect on the desire for social distance.
As regards the effect of a biological causal attribution, no effect was found
in case of the depression vignette. For the schizophrenia vignette, only a
small, not quite significant effect towards an increase in the desire for social
distance in case of a biological illness model emerged when the care of one’s
own children was concerned (U=6647.0, p=0.077; Rosenthal’s r=0.101).
Discussion: While good mental health literacy seems to improve social ac-
ceptance of persons with depression, it seems to extend an opposite effect
on psychoses irrespective of a possibly biological main causal attribution.
This has major implications for public information campaigns in psychoses
that will have to be most carefully designed to avoid converse effects.