The concept of schizophrenia only covers the 30% poor outcome fraction of a much broader multidimensional psychotic syndrome, yet paradoxically has become the dominant prism through which everything ...'psychotic' is observed, even affective states with mild psychosis labelled 'ultra-high risk' (for schizophrenia). The inability of psychiatry to frame psychosis as multidimensional syndromal variation of largely unpredictable course and outcome - within and between individuals - hampers research and recovery-oriented practice. 'Psychosis' remains firmly associated with 'schizophrenia', as evidenced by a vigorous stream of high-impact but non-replicable attempts to 'reverse-engineer' the hypothesized biological disease entity, using case-control paradigms that cannot distinguish between risk for illness onset and risk for poor outcome. In this paper, the main issues surrounding the concept of schizophrenia are described. We tentatively conclude that with the advent of broad spectrum phenotypes covering autism and addiction in DSM5, the prospect for introducing a psychosis spectrum disorder - and modernizing psychiatry - appears to be within reach.
To investigate gender-related differences in the connection between psychosis and exposome, we conducted a systematic review and retrieved 47 research publications in the PubMed database that ...examined the association of psychosis with childhood adversity, substance use, urbanicity, migration, season of birth, and obstetric complication. The results show that childhood abuse may be more significantly related with psychosis risk and an earlier age of onset in women than in men. In addition, childhood adversity has been linked to the severity of different symptom dimensions in men and women. Urban upbringing and immigration are much more strongly related to psychosis risk in men than in women. Despite the higher prevalence of substance abuse comorbidity in men with psychotic disorders, it seems that the relationship between substance abuse and psychosis risk is stronger in women. Due to several methodological limitations, the small number of studies, and the lack of consistency across studies, these findings should be regarded with care. Overall, although further research is required, it appears that there are gender-related differences in the relationships between environmental exposures and psychosis. There is an urgent need to gain insight into the gender-related patterns underlying the association between psychosis and exposome. Future studies should thus go beyond considering gender only as a covariate and study gender as a possible effect-moderating factor.Disclosure of InterestNone Declared
Abstract
In this interactive session, we will attempt to create a roadmap toward a research career in psychiatry, particularly in challenging settings. Participants will be able to share their ...experiences and ask questions. Through dialectical discourse, we will identify the essential skills and key competencies for a research career and how to develop them through key strategies and practical exercises. We will try to answer these questions and more. “I like research, but I don’t know where to start?” “I know writing is important, but how can I make the process less painful and even perhaps enjoy writing?” “There is no research tradition in my workplace; how can I find a mentor?” “How can I build confidence in presenting at scientific conferences?” “It’s important to master hard skills, but what could we do with soft skills?”
Disclosure of Interest
None Declared
Galvanized with the availability of sophisticated statistical techniques and large datasets, network medicine has emerged as an active area of investigation. Following this trend, network methods ...have been utilized to understand the interplay between symptoms of mental disorders. This realistic approach that may provide an improved framework into understanding mental conditions and underlying mechanisms is certainly to be welcomed. However, we have noticed that symptom network studies tend to lose sight of the fundamentals, overlook major limitations embedded in study designs, and make inferences that are difficult to justify with current findings. There is concern that disregarding these flaws may halt the progress of the network approach in psychiatry. Therefore, in this paper, we first attempt to identify the pitfalls: (1) a reductionist understanding of medicine and psychiatry, thereby inadvertently reintroducing the dichotomy of medicine (lung cancer) and psychiatry (depression), (2) a shortsighted view of signs and symptoms, (3) overlooking the limitations of available datasets based on scales with embedded latent class structures, (4) overestimating the importance of the current findings beyond what is supported by the study design. By addressing current issues, the hope is to navigate this rapidly growing field to a more methodologically sound and reproducible path that will contribute to our understanding of mental disorders and its underlying mechanisms.
IntroductionAutism spectrum disorder (ASD) is a heterogenous groups of neurodevelopmental conditions characterized by difficulties in social communication and the presence of restricted interests and ...repetitive behaviors. Autistic traits are distributed along a continuum in the general population and are negatively associated with social functioning also in non-autistic subjects. Several studies have evaluated the association between autistic traits and the quantity of social interaction; however, evidence on the relationship between autistic traits and quality of social interaction is still scarce.ObjectivesTo evaluate the association between autistic traits and the quality of social interactions in daily life in youths from the general population using the experience samplic method (ESM).MethodsDuring a six-day experience sampling period, 349 twins and 248 of their siblings aged between 15 and 34 reported the quality of their everyday social interactions. Autistic traits were assesed using the Autism Spectrum Quotient (AQ). The association between autistic traits and quality of social interaction was tested in separate multilevel linear and logistic regression models.ResultsWhen participants were alone, higher autistic traits were associated with a sense of being less safe (B=-0.02, p=0.02). When participants were in company, higher autistic traits were associated with a higher preference for being alone (B=0.02, p<0.001) and higher sense of being judged (B=0.03, p=0.001). Moreover, while in company, higher autistic traits were associated with a decreased pleasure of being in company (B=-0.03, p<0.001), a lower sense of being safe in company (B=-0.03, p<0.001), and a lower sense of belonging to a group (B=-0.02, p<0.001).ConclusionsThe preliminary results of the present study showed that autistic traits may influence the quality of social interactions in daily life. Future studies may clarify the mechanisms underlying this association. Assessing autistic traits in youth may help improve the outcome of psychosocial interventions of youths presenting difficulties in social interactions.Disclosure of InterestNone Declared
Evidence suggests that in affective, non-psychotic disorders: (i) environmental exposures increase risk of subthreshold psychotic experiences (PEs) and strengthen connectivity between domains of ...affective and subthreshold psychotic psychopathology; and (ii) PEs are a marker of illness severity.
In 3021 adolescents from the Early Developmental Stages of Psychopathology cohort, we tested whether the association between PEs and presence of DSM-IV mood disorder (MD)/obsessive-compulsive disorder (OCD) would be moderated by risk factors for psychosis (cannabis use, childhood trauma and urbanicity), using the interaction contrast ratio (ICR) method. Furthermore, we analysed whether the interaction between environment and PEs was mediated by non-psychotic psychopathology.
The association between PEs and MD/OCD was moderated by urbanicity (ICR = 2.46, p = 0.005), cannabis use (ICR = 3.76, p = 0.010) and, suggestively, trauma (ICR = 1.91, p = 0.063). Exposure to more than one environmental risk factor increased the likelihood of co-expression of PEs in a dose-response fashion. Moderating effects of environmental exposures were largely mediated by the severity of general non-psychotic psychopathology (percentage explained 56-68%, all p < 0.001). Within individuals with MD/OCD, the association between PEs and help-seeking behaviour, as an index of severity, was moderated by trauma (ICR = 1.87, p = 0.009) and urbanicity (ICR = 1.48, p = 0.005), but not by cannabis use.
In non-psychotic disorder, environmental factors increase the likelihood of psychosis admixture and help-seeking behaviour through an increase in general psychopathology. The findings are compatible with a relational model of psychopathology in which more severe clinical states are the result of environment-induced disturbances spreading through a psychopathology network.
Introduction Schizophrenia spectrum disorders (SSD) are frequently associated with disturbances in both neurocognition and social cognition. The patoetiology of SSD derives from a complex interaction ...between genes and environment. Exposome score for schizophrenia (ES-SCZ) is a cumulative environmental exposure score for schizophrenia which have shown potential utility in risk stratification and outcome prediction. Objectives To investigate whether ES-SCZ is associated with cognition in patients with SSD, unaffected siblings, and healthy controls. Methods The present cross-sectional study included 1141 patients with SSD, 1332 unaffected siblings, and 1495 healthy controls, recruited in the Netherlands, Spain, Serbia, and Turkey. The Wechsler Adult Intelligence Scale (WAIS) was used to evaluate neurocognition, while the Degraded Facial Emotion Recognition (DFAR) task was used to assess social cognition. ES-SCZ was calculated based on our previously validated method. Associations between ES-SCZ and cognitive domains were analyzed by applying regression models in each group (patients, siblings, and controls), adjusted by age, sex, and country. Results According to our preliminary analyses, no significant associations were found between ES-SCZ and cognition in patients with SSD. ES-SCZ was negatively associated with WAIS in unaffected siblings (B=−0.40, p=0.03) and controls (B=-0.63, p=0.004) and positively associated with DFAR in siblings (B=0.83, p=0.004). No significant association between ES-SCZ and DFAR was found in healthy controls. Conclusions Our findings show that neurocognition and social cognition are oppositely associated with ES-SCZ. Longitudinal studies may clarify whether there is a cause-effect relationship between ES-SCZ and cognition. Further research should investigate whether ES-SCZ interacts with molecular genetic risk for schizophrenia to improve clinical chcracterization and outcome prediction in people with SSD. Disclosure of Interest None Declared
Introduction
Social cognition refers to a complex set of mental abilities that support the construction of adequate social competence and adaptation. Impairments in social cognition can be found in ...several psychiatric disorders, particularly in psychoses. Polygenic Risk Scores (PRSs) represent single metrics of molecular genetic risk and are a predictor of the genetic susceptibility to diseases, although they explain only a small part of the risk.
Objectives
To explore the association between PRS for psychiatric disorders and social cognition.
Methods
We conducted a systematic search in PubMed and Scopus according to the PRISMA guidelines up to August 2021. We included papers evaluating PRS and social cognition with psychometric scales. Articles concerning single-nucleotide polymorphisms and biological measures of social cognition (e.g., neuroimaging, peripheral biomarkers) were excluded.
Results
We initially retrieved 150 articles. After removing duplicates, we screened 133 titles and abstracts and preliminary selected 19 papers. Participants recruited in the papers of interest were either people with schizophrenia, ASD or ADHD, their family members or healthy subjects. Articles evaluated the association between different psychometrical measures of social cognition and PRS for schizophrenia, Autism Spectrum Disorder and ADHD.
Conclusions
Literature regarding the association between PRS for psychiatric disorders and social cognition is heterogeneous in terms of populations, genetic risk evaluation, and outcome tools. Given the critical role played by social cognition in the onset and progression of mental disorders and its association with real-world functioning, future research should try to disentangle the complex genetic basis of this domain.
Disclosure
No significant relationships.
Alcohol consumption, smoking and mood disorders are leading contributors to the global burden of disease and are highly comorbid. Yet, their interrelationships have remained elusive. The aim of this ...study was to examine the multi-cross-sectional and longitudinal associations between (change in) smoking and alcohol use and (change in) number of depressive symptoms.
In this prospective, longitudinal study, 6646 adults from the general population were included with follow-up measurements after 3 and 6 years. Linear mixed-effects models were used to test multi-cross-sectional and longitudinal associations, with smoking behaviour, alcohol use and genetic risk scores for smoking and alcohol use as independent variables and depressive symptoms as dependent variables.
In the multi-cross-sectional analysis, smoking status and number of cigarettes per day were positively associated with depressive symptoms (
< 0.001). Moderate drinking was associated with less symptoms of depression compared to non-use (
= 0.011). Longitudinally, decreases in the numbers of cigarettes per day and alcoholic drinks per week as well as alcohol cessation were associated with a reduction of depressive symptoms (
= 0.001-0.028). Results of genetic risk score analyses aligned with these findings.
While cross-sectionally smoking and moderate alcohol use show opposing associations with depressive symptoms, decreases in smoking behaviour as well as alcohol consumption are associated with improvements in depressive symptoms over time. Although we cannot infer causality, these results open avenues to further investigate interventions targeting smoking and alcohol behaviours in people suffering from depressive symptoms.
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