The effects of long-term antipsychotic medication on cognition in schizophrenia are unclear (Husa A.P. et al., Schizophr. Res. 2014).

Understanding how long-term antipsychotic treatment affects cognition is crucial for the development of safe, evidence-based treatment of schizophrenia.

To analyse the association between cumulative lifetime antipsychotic dose and cognition in schizophrenia at age 43 years in a general population sample.

Sixty (33 males) schizophrenia spectrum subjects from the Northern Finland Birth Cohort 1966 were assessed at age 43 years by California Verbal Learning Test, Visual Object Learning Test, Abstraction Inhibition and Working Memory task, Verbal fluency, Visual series, Vocabulary, Digit Span and Matrix reasoning. Cumulative lifetime antipsychotic dose-years were collected from treatment records and interviews. A factor analysis based on the cognitive tests resulted in one cognitive factor. The association between this cognitive composite score and antipsychotic dose-years was analysed by linear regression.

Higher lifetime antipsychotic dose-years were statistically significantly associated with poorer cognitive composite score at age 43 years (B=-0.32, p>0.001), also when adjusted for gender, onset age, remission and number of hospital treatment days (B=-0.42, p=0.008).

To our knowledge, this is the first report of an association between cumulative lifetime antipsychotic dose and cognition in midlife in schizophrenia. Based on this data, the use of high antipsychotic doses may relate to poorer cognitive functioning in schizophrenia after twenty years of illness. These results do not support the view that antipsychotics prevent cognitive decline or promote cognitive recovery in schizophrenia.

This double-blind (DB), relapse prevention, phase-3 study was designed to evaluate the efficacy and safety of paliperidone palmitate long-acting 3-monthly formulation (PP3M) versus placebo in delaying time-to-relapse of schizophrenia symptoms.

Adults (18-70 years old) with schizophrenia (DSM-IV-TR) were treated with PP (17-week, open-label [OL] transition phase: 50, 75, 100, or 150 mg eq, once-monthly, [PP1M]; 12-week OL maintenance phase: 3.5-fold PP1M stabilized dose, single injection), and then randomized (1:1) to PP3M fixed doses (175, 263, 350 or 525 mg eq.) or placebo.

305/506 patients enrolled were randomized (PP3M: n=160; placebo: n=145); majority were men (75%), white (59%), mean age 38.4 years. Interim analysis results favored PP3M vs. placebo (p = 0.0002, two-sided log-rank test; HR: 3.45, 95% CI: 1.73; 6.88); median time-to-relapse was 274 days in placebo and not estimable in PP3M group. Final results were consistent with interim analysis. Both PANSS total score and CGI-S score showed a significant effect over time in PP3M- vs. placebo-treated patients (p>0.001). 330/506 (65.2%) patients in OL phase and 183/305 (60.0%) in DB phase (PP3M: 61.9% vs. placebo: 57.9%) had ≥1 treatment-emergent adverse event (TEAE). The TEAEs noted more frequently in PP3M-vs. placebo (DB phase) were nasopharyngitis (5.6% vs. 1.4%), weight gain (8.8% vs. 3.4%), headache (8.8% vs.4.1%) and akathisia (4.4% vs. 0.7%).

Compared with placebo, PP3M significantly delayed time to first relapse in patients with schizophrenia, previously treated for 4 months with PP1M. PP3M was tolerable with a safety profile generally consistent with other marketed formulations of paliperidone.

Our aim was to investigate how age of achieving early motor developmental milestones differ among subjects with and without a history of parental psychosis and whether parental psychosis may alter the effects of the age of achievement on the risk of schizophrenia.

The study sample comprised 10,307 individuals from the prospective Northern Finland Birth Cohort 1966. A total of 139 (1.3%) cohort members suffered from schizophrenia by the age of 46 years. Out of them 19 (13.7%) had a parent with a history of psychosis, while among the non-psychotic cohort members this figure was 524 (5.2%).

Out of eight different motor milestones investigated, parental psychosis associated (p>0.05) with later learning of holding head up, grabbing object, and walking without support. In the parental psychosis group, significant risk factors for schizophrenia included later learning of holding head up and touching thumb with index finger. In the non-parental psychosis group risk estimates were lower and statistical significant milestones were different i.e. turning over, sitting without support, standing up, standing and walking without support. Interactions between parental psychosis and touching thumb with index finger and walking without support was found.

Although parental psychosis associated with delays in motor milestones in the first year of life, it does not explain the association between late achievement of motor milestones and later risk for schizophrenia

Individuals with epilepsy have commonly comorbid psychiatric disorders but only a few studies have focused on psychotic disorders.

To study the possible comorbidity between epilepsy and psychotic disorders.

To investigate how epilepsy and non-organic psychotic disorders associate in a large population based birth cohort.

The study sample comprised 10,933 individuals from the prospective Northern Finland Birth Cohort 1966. Cox regression analysis (Hazard Ratios, HR) was used to study risk of psychotic disorders among those with and without epilepsy. Gender, mental retardation and family history of psychosis were used as covariates. Epilepsy diagnoses were based on various nationwide registers and questionnaires. Information on psychoses (ICD-10) was based on nationwide registers.

A total of 373 (3.4%) cohort members suffered from non-organic psychotic disorders and 386 (3.5%) of epilepsy by the age of 46 years. Members with epilepsy had 2.0-fold risk for psychosis when compared to those without (adjusted HR 2.0; 95% Confidence Interval 1.4-2.9). The risk was high for non-schizophrenic psychoses (adjHR 4.0; 2.4-6.6), whereas epilepsy did not associate with schizophrenia spectrum diagnoses (adjHR 1.1; 0.6-2.0). Especially individuals with focal epilepsies developed commonly (12 of 87, 13.8%) psychotic disorders.

Epilepsy increases risk for subsequent non-schizophrenic psychoses even when adjusted with other factors. Those with focal epilepsies were especially in risk. There are several possible etiologies and pathomechanisms, including genetic, structural, functional and metabolic factors. Common comorbidity between epilepsy and psychoses demands active and extensive clinical care by the multidisciplinary team.

Pragmatic abilities play a crucial role in daily functioning and have been suggested to be impaired in schizophrenia. Nevertheless, patterns of such deficits at the onset of the illness still needs to be elucidated.

To outline pragmatic abilities in the first episode of psychosis (FEP).

To evaluate pragmatic verbal performance and its relationship with pre-frontal abilities in FEP subjects recruited in a large randomized multi-center controlled study (GET UP).

58 FEP (mean age±SD:34±9 years; 46% males) and 58 1:1 matched healthy controls (HC) were assessed on the metaphor and idiom comprehension subtask of the MEC Protocol and with WCST. A PAF Analysis with Promax rotation of open (=spontaneous explanations) and closed (=multiple choice) metaphors/idioms and WCST variables was conducted.

A 3-factor latent structure emerged in both groups but partially different patterns emerged. As for FEP, open metaphor/idiom explanations loaded into Factor 1 (Self-generated inferences); Factor 2 (Feedback-generated inferences) was loaded by WCST perseverative errors and by closed metaphor explanations. Finally, closed metaphors/idioms loaded into Factor 3 (Inhibition). As for HC, Factor 1 was similarly loaded but explained less variance; Factor 2 was qualitatively different (Reasoning, self+feedback-generated inferences), being loaded by the WCST number of categories and by open metaphors/idioms. Factor 3 was loaded by closed metaphors.

Findings suggest a shared underlying cognitive construct in self-generating perceptual inferences both for verbal pragmatics and pre-frontal skills in HC and patients, while a failure to integrate different sources of perceptual evidence is found only in FEP.

A majority of the studies on cognition in schizophrenia have been conducted in drug-treated patients. In healthy subjects, administration of antipsychotic medication has been found to have a negative impact on cognitive performance in domains such as speed of processing and attention. Antipsychotic drugs occupy the D2-dopamine receptor, a receptor subtype that has been related to cognitive function. Studies employing Positron Emission Tomography have shown that poor performance in several cognitive domains is associated to low D2-receptor binding. It is therefore crucial to examine cognition in drug-naïve patients with schizophrenia.

In FES patients: To examine the profile of cognitive impairments in the absence of antipsychotic medication and compare with the cognitive profile of patients who are on antipsychotic medication.

To study cognition in FES.

The Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery was administered to 60 patients with early schizophrenia and 30 healthy controls, 50% of the patients were drug-naïve. This research is ongoing and a part of the Karolinska Schizophrenia Project (KaSP), a multidisciplinary research consortium that examines the pathophysiology of schizophrenia.

Preliminary findings show that patients perform worse than healthy controls in all cognitive domains, with no significant differences between drug-naïve and medicated patients. Attention and Visual memory were the domains with the greatest impairments. The results are compared with our previous meta-analytic findings in drug-naïve patients.

These preliminary findings confirm the existence of cognitive impairments at the early stage of schizophrenia in the absence of antipsychotic medication.

A 28 year old Malawian man, experiencing his first psychotic episode and subsequently diagnosed with Schizophrenia was also identified as having Alpha-Thalassaemia Zero Trait (ATZT). This poster will include the aetiology of his presentation, chromosomal basis of both illnesses and the possible link between psychosis and thalassaemia.

Case-report, Literature review and Discussion.

Mr.X was admitted via A&E after walking through a pane of glass and leaping from the roof of his home. He had a 3-year history of social withdrawal, religious obsession and increasingly bizarre behaviour. This progressively worsened the week prior to his admission. He refused to leave his house, became paranoid about being attacked, did not eat or drink, and walked around naked. He presented with paranoid, persecutory delusions, third person auditory hallucinations and poor insight. He was treated with Risperidone and recovered well.

To the best of our knowledge, this is the first case report on Schizophrenia in a person with ATZT in the UK. We propose that ATZT may have been associated with the development of Schizophrenia. Our literature review revealed studies that suggested micro-deletions on Chromosome 16 increased the risk of Schizophrenia as well as ATZT. We hypothesise that the presence of one abnormality on Chromosome 16 increases the likelihood of other chromosomal abnormalities leading to the risk of developing Schizophrenia.

Further studies are required on the prevalence of schizophrenia in those with ATZT. We recommend increased awareness amongst clinicians about the potential risk of Schizophrenia associated with ATZT.

Patients affected by schizophrenia have deficits in social cognition, functioning and in properly interpreting facial expression. These disabilities contribute to global impairment in social and relational skills. Data started being collected in the context of the Italian-Network-of-Research-on-Psychosis, headed by Mario Maj and Silvana Galderisi, in our centre;collection went on also after the conclusion of the national project.

To compare social inference and facial emotion identification in schizophrenic patients and healthy controls.

We recruited 50 patients with Schizophrenia and 50 healthy controls (HCs) matched for sex, age and level of education. Socio-demographic characteristics were gathered;assessment of both patients and HCs included The Awareness of Social Inference Test (TASIT) and the Facial Emotion Identification Test (FEIT);furthermore patients were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS).

Some differences in socio-demographic variables emerged (patients are more often unemployed and single). Moreover, the preliminary analyses highlight several differences between schizophrenic patients and HCs at TASIT and FEIT:patients performed significantly worse than HCs in both tests, with longer reaction times.

As expected schizophrenic patients showed social skills deficits and difficulties in identifying facial emotions. Our preliminary results point out disabilities in understanding social messages and interpreting human behaviour;these features underlie poor and limited social relationships proper to schizophrenia.

1. 1 Galderisi S et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia;WorldPsychiatry2014,13(3):275-287

2. 2 Mucci A et al. The Specific Level of Functioning Scale: Construct validity, internal consistency and factor structure in a large Italian sample of people with schizophrenia living in the community Schizophr Res.2014Oct;159(1):144-50

BMI, EDI-2, EAT, BDI-13, BITE, STAI Ya/Yb, le Ruminative Response Scale for Eating Disorder (RRSED), l’Acceptance and Action Questionnaire-II (AAQ-II), le Five Facets Mindfulness Questionnaire (FFMQ), le Mindfulness Attention Awareness Scale (MAAS), le Kentucky Inventory of Mindfulness Skills (KIMS), le Body Shape Questionnaire (BSQ), l’Impulsive Behavior Scale : Urgency, Premeditation, Perseverance, and Sensation Seeking (UPPS), le Cambridge Exeter Repetitive Thinking Scale (CERTS) et le Three Factor Eating Questionnaire (TFEQ). Nous présenterons les résultats préliminaires de cette recherche ainsi que le projet de suite de ce travail de recherche clinique.

Negative symptoms are the psychopathological domain most associated to poor outcome in patients with schizophrenia (SCZ). Insight into their pathophysiology might contribute to develop innovative treatments for the syndrome. Recently, it has been hypothesized that avolition is related to a difficulty in anticipating reward or integrating value and action.

Our study aimed to investigate abnormalities of reward anticipation in SCZ and evaluate associations of negative symptoms dimensions with the same abnormalities using electrophysiological indices.

ERPs were recorded during the execution of 'Monetary Incentive Delay' task in 30 SCZ patients stabilized on second generation antipsychotics and 23 and healthy controls (HC). Measures of anticipatory and consummatory pleasure, trait anhedonia and motivation were obtained in all subjects. A measure of avolition independent of anhedonia was obtained in patients.

Patients did not differ from HC with respect to trait anhedonia and experience of pleasure but showed a deficit of motivation. Unlike HC, P3 amplitude in patients did not discriminate stimuli relevance in the early interval and was higher for the anticipation of loss in the late interval. In SCZ, early P3 amplitude for loss and reward anticipation was inversely related to social anhedonia but not to avolition.

Patients with preserved experience and anticipation of reward seem unable to integrate the relevance and rewarding value of future events in the context of their ongoing task. Our results indicate that anhedonia and avolition are partially independent constructs and that SCZ might integrate better loss than reward.

Long duration of untreated psychosis (DUP) predicts poor short- and long-term outcome in schizophrenia. It may also be a marker of resilience and associate with lower doses or shorter periods of using antipsychotic medication which may or may not be correlated with the association between DUP and outcome.

To study the association between DUP and the use of antipsychotic medication in long-term follow-up.

To find out whether the delayed treatment in first-episode psychosis associates with using less antipsychotic medication during the course of illness

In the prospective Northern Finland 1966 Birth Cohort length of DUP and information on lifetime use of antipsychotic medication for 60 individuals with schizophrenia was assessed from medical records from the first episode until age 34 years. Association between length of DUP and cumulative dose-years of antipsychotics was analysed using linear regression analysis. Logarithmic transformations of DUP and dose years were used.

Mean DUP was 227 days (SD 359) and mean of cumulative dose years was 2.41 (SD 1.29). Symptoms measured using PANSS ranged from 30 to 122, mean 53 (SD 21). Duration of untreated psychosis did not associate with the use of antipsychotic medication (beta = −0.124, p = 0.343).

There was no evidence of an association between DUP and the use of antipsychotic medication. Although long DUP has long-term association with poor outcome, it does not have an association with the use of antipsychotic medication based on the population-based long-term follow-up.