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S234 Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1S384 Poster #M122 PREVALENCE OF INFECTIONS IN PATIENTS WITH SCHIZOPHRENIA: APILOT STUDY Monika E. Pankiewicz-Dulacz 1,2 , Elsebeth Stenager 3 , Egon Stenager 4 , Ming Chen 5 1 Psychiatric Hospital of Southern Jutland; Dept. Neurology, Hospital of Southern Jutland; Dept. of Infectious Diseases, Hospital of Southern Jutland; 2 Psychiatric Hospital of Southern Jutland, Institute of Regional Research; 3 University Hospital Odense, Department of Psychiatry; 4 University of Southern Denmark, Dept. Neurology: Institute of Regional Health Research; 5 Dept. 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 immunodeciency 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 suciently 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 Classications 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 identied 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. Pedersen 1,2 1 Aarhus University; 2 The 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 identied persons who had their rst diagnosis with schizophrenia spectrum disorder from 1971 to 2007. To account for the general mobility of the Danish population, for each case we identied 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 ve 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 rst 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 rst 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 THOUGHTDISORDER: ASYSTEMATIC EPIDEMIOLGICAL REVIEW Eric Roche 1 , Lisa Creed 2 , Donagh MacMahon 1 , Daria Brennan 3 , Brendan Kelly 4 , Kevin Malone 5 , Mary Clarke 1 1 DETECT Early Intervention in Psychosis Service; 2 Cluain Mhuire Community Mental Health Service; 3 St John of God Hospital; 4 Mater Misericordiae University Hospital; 5 University College Dublin Background: Formal thought disorder (FTD) is a core diagnostic symptom of schizophrenia and yet much remains unknown about it. The clinical im-

Poster #M124 FORMAL THOUGHT DISORDER: A SYSTEMATIC EPIDEMIOLGICAL REVIEW

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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.