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IntroductionNegative symptoms and cognitive impairments are both present in patients with an at risk mental state (ARMS) for psychosis and negatively affect functioning and outcome. According to previous studies in patients with first-episode psychosis, negative symptoms are negatively associated with cognitive functioning while positive symptoms do not seem to be associated. Yet, little is known about the specific relationship of negative symptoms and cognitive functioning in ARMS patients.ObjectiveTo evaluate, the relationship between negative symptoms and cognitive functioning in ARMS patients.MethodsData of 154 ARMS patients were collected within the prospective Basel early detection of psychosis (FePsy) study. Negative symptoms were assessed with the SANS, positive psychotic symptoms with the BPRS, cognitive functioning with an extensive neuropsychological test battery. Multiple regressions were applied and results were controlled for age and gender.ResultsRegression analyses showed a significant, negative association between negative but not positive psychotic symptoms and cognitive functioning, showing the strongest association with verbal fluency (see Fig. 1). However, results mainly did not withstand correction for multiple testing.ConclusionsThe association found between verbal fluency and negative symptoms may be indicative of an overlap between those constructs. Finally, verbal fluency might have a strong influence on the clinical impression of negative symptoms, especially on alogia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionIn the growing research field of early psychosis detection in patients with an at risk mental state (ARMS), most studies focus on the transition to frank psychosis. However, the majority of ARMS patients do not go on to develop frank psychosis and reported transition rates are declining. Little is known about the long-term outcome of these non-transitioned patients (ARMS-NT).ObjectivesTo investigate in preliminary analyses the long-term outcome of ARMS-NT patients with respect to persistence of ARMS signs and symptoms and the rates of late psychotic transition.MethodsThe ongoing study “FePsy-BHS-NT” follows up ARMS-NT without transition during at least the first two years for up to 15 years after their initial assessment. ARMS status is ascertained with the Basel Screening Instrument for Psychosis (BSIP). ARMS remission is defined as the absence of attenuated psychotic symptoms or brief limited intermittent psychotic symptoms for at least 12 consecutive months.ResultsIn this preliminary sample of 51 ARMS-NT, the majority of patients (70.6%) have remitted from their at risk mental state, 13.7% remain at risk and 15.7% have made a late psychotic transition during the course of long-term follow up (median = 5.75, range 4–11 years after initial assessment).ConclusionsThe considerable rates of ARMS persistence and late psychotic transition indicate that longer follow-up durations than commonly recommended should be contemplated in ARMS patients. Potential predictors of favorable long-term clinical outcome, as well as psychosocial, neurocognitive and other outcomes of ARMS-NT patients will be further evaluated in the present study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionNon-psychotic axis I diagnoses are highly prevalent in at-risk mental state (ARMS) and first episode psychosis (FEP) patients, the most common being affective and anxiety disorders. Few studies have examined differences between ARMS and FEP patients or gender effects regarding such diagnoses.ObjectiveTo examine current and lifetime comorbidities in ARMS and FEP patients. Furthermore, to examine gender differences, and differences between patients with (ARMS-T) and without later transition to psychosis (ARMS-NT).MethodsThis study was part of the Früherkennung von Psychosen (FePsy) study. Current and lifetime axis I comorbidities were assessed using the Structured Clinical Interview for DSM-IV (SCID-I).ResultsOne hundred and thirty-two ARMS and 98 FEP patients were included. Current comorbidities were present in 53.1% of FEP and 64.4% of ARMS patients, the most common being affective, anxiety and substance use disorders. Current affective disorders were significantly more common in ARMS than FEP. Lifetime comorbidities were diagnosed in 58.2% of FEP and 69.7% of ARMS patients, with significantly more affective and anxiety disorders in ARMS than FEP. Male FEP patients had more current and lifetime substance use disorders (across all substances) compared to female FEP. No differences emerged between ARMS-T and ARMS-NT.ConclusionsAs expected ARMS patients have many comorbidities, while clearly diagnosed FEP have less comorbidities. There were few gender differences in axis I comorbidities. Moreover, no differences between ARMS-T and NT emerged, suggesting that axis I comorbidities do not improve prediction of transition. Nevertheless, the high comorbidity prevalence is relevant for global functioning and clinical treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionClinical, epidemiological and basic research studies have confirmed that estradiol can have protective effects in schizophrenic psychoses. At the same time many patients with schizophrenic psychoses – even antipsychotic naïve at-risk mental state (ARMS) patients show hyperprolactinemia and gonadal dysfunction with estrogen deficiency in women and possibly testosterone deficiency in men.AimTo investigate the relation between the stress hormone prolactin and the sex hormones estradiol in women and testosterone in men in emerging psychosis.MethodsForty-seven antipsychotic-naïve ARMS (38 men and 9 women) and 17 antipsychotic-naive first episode psychosis (FEP) (14 men and 3 women) patients were recruited via the Basel Früherkennung von Psychosen (FePsy) study. Blood was taken under standardized conditions between 8 and 10 am after an overnight fast and 30 minutes of rest. We performed a linear regression model to evaluate the association between prolactin and sex hormones including age and current antidepressant use as covariates.ResultsIn women, estradiol was negatively associated with prolactin (β = −1.28, P = 0.01) whereas in men there was a positive association of testosterone with prolactin (β = 0.52, P = 0.031).ConclusionThe often observed estrogen deficiency in women with psychosis could therefore be explained by the stress hormone prolactin suppressing the gonadal axis already in very early untreated stages of the emerging disease.In ARMS or FEP men prolactin does not seem to influence the gonadal axis in the same way as in women.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPatients with a first episode psychosis (FEP) have repeatedly been shown to have gray matter (GM) volume alterations. Some of these neuroanatomical abnormalities are already evident in the at-risk mental state (ARMS) for psychosis. Not only GM alterations but also neurocognitive impairments predate the onset of frank psychosis with verbal learning and memory (VLM) being among the most impaired domains. Yet, their interconnection with alterations in GM volumes remains ambiguous.ObjectiveTo evaluate associations of different subcortical GM volumes in the medial temporal lobe with VLM performance in ARMS and FEP patients.MethodsData were collected within the prospective Früherkennung von Psychosen (FePsy) study, which aims to improve the early detection of psychosis. VLM was assessed using the California Verbal Learning Test (CVLT) and its latent variables Attention Span (AS), Learning Efficiency (LE), Delayed Memory (DM) and Inaccurate Memory (IM). Structural images were acquired using a 3 Tesla magnetic resonance imaging scanner.ResultsData from 59 ARMS and 47 FEP patients were analysed. Structural equation models revealed significant associations between the amygdala and AS, LE and IM; thalamus and LE and IM; and the caudate, hippocampus and putamen with IM. However, none of these significant results withstood correction for multiple testing.ConclusionsAlthough VLM is among the most impaired cognitive domains in emerging psychosis, we could not find an association between low performance in this domain and reductions in subcortical GM volumes. Our results suggest that deficits in this domain may not stem from alterations in subcortical structures.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction Schizophrenia is a severe and debilitating disorder compromising multiple aspects of everyday functioning and quality of life, such as independent living, interpersonal relations and vocational functioning. Apart from premorbid functioning and psychopathological symptoms, social and non-social cognitive factors negatively influence functional outcomes in patients. On the other hand, recent research implicates specific types of biased thinking styles (e.g. jumping-to-conclusions, liberal acceptance) in at least some clinical dimensions of schizophrenia. So far, the impact of such cognitive biases on the functional outcome of the disorder has not been investigated. Aims The present study aimed to assess the relative contribution of cognitive biases and other well established factors, including psychopathology and neuropsychological deficits, on functional outcomes in patients with schizophrenia. Method Participants were 160 inpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder, recruited from the inpatient units of two University hospitals (Hamburg and Heidelberg). Key exclusion criteria were current substance dependence, severe brain damage, and IQ (a) premorbid IQ, (b) psychopathology and severity of illness, (c) cognitive biases, (d) attention and verbal memory, and (e) social cognition/Theory of Mind. Functional outcome at six months consisted in a composite factor computed from a quality-of-life measure (WHOQOL), as well as information on marital, housing and vocational status. Results and conclusions A multiple linear regression analysis was performed with functional outcome as dependent variable and the above-mentioned factors assessed at baseline as predictors. Results will be discussed.

Introduction Neuropsychological deficits represent a core feature of schizophrenia that has been repeatedly associated with poor symptomatic outcomes. In recent years, there has been increased interest in higher-order cognitive biases (e.g. jumping-to-conclusions, liberal acceptance) as mediators of clinical symptoms, especially delusions, in patients with schizophrenia. So far, the impact of such cognitive biases on the symptomatic outcomes of the disorder has not been investigated. Aims The present study aimed to assess the contribution of cognitive biases and other well established factors, including severity of psychopathology and neuropsychological deficits, on symptomatic outcomes after an index hospitalization in patients with schizophrenia. Method Participants were 160 inpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder, recruited from the inpatient units of two University hospitals (Hamburg and Heidelberg). Key exclusion criteria were current substance dependence, severe brain damage, and IQ Results and conclusions Good- and poor-outcome patients were compared on severity of psychopathology at admission, cognitive biases, and neuropsychological performance, by means of a multiple analysis of covariance, with age, gender, and premorbid IQ serving as covariates. Results will be discussed.