S-60-01

Overview on the recruitment, sample characteristics, and distribution of inclusion criteria of the European Prediction of Psychosis Study (EPOS)

J. Klosterkötter, J. Klosterkoetter, M. Birchwood, D. Linszen, R. K.R. Salokangas, S, Ruhrmann, G. Juckel, A. Morrison, S. Lewis, H. Graf von Reventlow. Department of Psychiatry University of Cologne, Köln, Germany

Objective: Early detection and indicated early intervention in the initial prodromal phase should considerably improve the course of psychoses. Yet, the current data base is insufficient for a conclusive, evidence-based evaluation of the benefits of such programmes. This report presents an overview on the recruitment and numbers of subjects seen for inclusion, included into the study, the general sample characteristics and distribution of inclusion criteria of EPOS, an European 4-country na~ralistic field-study of the initial Prodrome.

Methods: Across six centres (Germany: Cologne, Berlin; Finland: Turku; The Netherlands: Amsterdam; United Kingdom: Birmingham, Manchester), 16 to 35 year old persons attending specialized services or general psychiatric services were examined. Inclusion criteria were the presence of APS, BLIPS, at least 2 of 9 Basic Symptoms (BS), and Familial risk or Schizotypal Personality Disorder plus reduced functioning (FR+RF). In addition, psychopathological, neurocognitive, neurobiological, psychosocial, and service and treatment-related assessments are carried out at baseline, 9- and 18-months follow-up.

Results: Shortly before the end of the inclusion period, more than 1500 persons had been seen for inclusion into EPOS, of whom almost 250 putatively prodromal persons had so far been included. A high percentage had presented themselves with BS and/or APS, a smaller percentage with BLIPS or FR+RF. However, the distribution of inclusion criteria remarkably varied among the different European regions.

Conclusion: These data will give a first sufficient foundation for an evaluation of the applicability and cost-benefit ratio of an integrative European early detection and intervention programme.

S-60-02

D. Linszen. Academic Medial Centre, Univer, Amsterdam, Netherlands

S-60-03

Quality of life ofpatients at risk of psychosis. Results of the EPOS study

R. K.R. Salokangas, R.K. R Salokangas, A.-M. Heinisuo, J. Klosterkrtter, S. Ruhrmann, D. Linszen, P. Dingemans, M. Birchwood, P. Patterson. Department of Psychiatry, Univ, Turku, Finland

Objective: The main aim of the European Prediction of Psychosis Study is to study a large sample of young patients who are at risk of psychosis and to estimate their conversion rate to psychosis during 18 months follow-up. The present presentation aims to describe quality of life (QOL) of the patients at risk of psychosis.

Methods: In six European centres, 16 to 35 year old patients attending psychiatric care have been examined. Inclusion criteria are basic symptoms, attenuated psychotic symptoms, brief, limited or intermittent psychotic symptoms or familial risk plus reduced functioning occurring during the past three months. Quality of life was assessed by the Modular System for Quality of Life (MSQL). Also, the Global Assessment of Functioning Score (GAF) and general functioning and interpersonal relationships were assessed. Results were compared with those from another sample of subjects vulnerable to psychosis.

Results: The patients at current risk of psychosis reported lower MSQL sum scores and their functioning was lower than those of the patients without prodromal symptoms. Major differences were found in mental state and emotions. In the comparative sample, subjects vulnerable to psychosis also revealed lower quality of life than healthy controls. Especially, difficulties in interpersonal relationships seemed to be related to vulnerability to psychosis.

Conclusion: Those of the psychiatric outpatients who are at risk of psychosis have lower quality of life than other psychiatric patients or healthy controls. Difficulties in interpersonal relationships seem to differentiate more specifically patient vulnerable to psychosis from other patients.

S-60-04

Pathways to care in the prodromal phase of psychosis

S. Ruhrmann, F. Schultze-Lutter, H. Picker, D. Kthn, K. Savic, H. Graf van Reventlow, M. Birchwood, D. Linszen, R.K.R. Salokangas, J. Klosterkftter, o. b. on the EPOS group. Depart. of Psychiatry & Psycho, Cologne, Germany

Objective: It was shown that only a minority of first-episode schizophrenia inpatients had sought help for mental problems during the initial prodromal phase, although the majority reported a prodrome of nearly five years on average. This lack of utilisation of either any potentially supportive contacts or even specialised services leads to a delay of appropriate treatment, which results in 9 substantial worsening of outcome. To improve this situation, it is necessary to analyse and optimise the existing pathways to care of persons at risk for psychosis. Moreover, mental health authorities need detailed information to plan and provide the appropriate service offers.

Methods: Within the European Prediction of Psychosis Study (EPOS), more than 200 persons with a putatively prodromal syndrome defined by attenuated positive symptoms, brief limited intermittent psychotic symptoms, a state/trait criterion or a cognitive basic symptom cluster were investigated in four European countries. Pathways to care and the delays are assessed with a specifically developed instrument based on the multicentre World Health Organization study on pathways to care in primary health care. The updated EPOS - Pathways to Care questionnaire is used to collect information on key issues related to previous contacts with helping agencies, such as: presenting symptoms, reasons for the decision to seek care and reasons for delay.

Results: First results of a comparison of the pathways in the four European countries will be presented.

Conclusion: In light of the diverse national health care systems, similarities and differences will be discussed. It is expected that these data will support the efforts of European health policy in preventing mental illness.

S-60-05

M. Birchwood. Early Intervention Service, Un, Birmingham, United Kingdom