S25
Gastroenterology issues in schizophrenia: Why the gut matters
- E. Severance
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- 23 March 2020, pp. S25-S26
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Numerous risk factors for schizophrenia can be reconciled through a common enteric source. These risk factors include systemic and localized inflammation, compromised endothelial barriers, IgG sensitivities to food antigens, exposure to viral and parasitic pathogens, and autoimmunity. The gut in a homeostatic state equates with a functional digestive system, cellular barrier stability and properly regulated recognition of self and non-self antigens, as managed by a complex community of resident microbes. Our studies address how environmental and genetic factors relate to GI dysfunction, impact the resident gut microbiota and result in dysregulation of processes in the host central nervous system. We hypothesize that disturbance to GI equilibria activates peripheral immune factors including complement pathway components that function in synaptic pruning. We evaluate these issues with peripheral immune biomarkers and deep sequencing in a number of case-control psychiatric cohorts that include antipsychotic-naïve individuals. Although certain medications and lifestyle factors might affect GI functioning, our findings support a GI pathology inherent to the schizophrenia disease process and a role for the gut-brain axis in complex brain disorders. The identification of those individuals affected by GI-related risk factors will enable appropriate and individualized treatments to be designed and tested for efficacy of both gut and brain-related symptoms.
Disclosure of interestThe author has not supplied his declaration of competing interest.
S26
The role of the gut microbiota in mood and behaviour. Whether psychobiotics can become an alternative in therapy in psychiatry?
- S. Van Hemert, W. Marlicz, P. Szachta, E. Pekelharing, G. Ormel, I. Łoniewski, L. Ostrowska, J. Samochowiec
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- 23 March 2020, p. S26
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Introduction
Novel research concepts based on therapies aiming to modulate intestinal microbiota are emerging. The evidence is mounting that gut-brain axis plays an important role in the development of mood and depressive disorders [1]. The similarities between blood brain barrier (BBB) and gut vascular barrier (GVB) and their role in chronic diseases have been recently unraveled [2]. Especially convincing data come from animal models, where administration of probiotics and antibiotics in germ and pathogen free mice showed beneficial role in the regulation of behavior, cognition, pain, anxiety and mood.
Aims and resultsBased on available data as well as on studies looking at the effect of multispecies probiotics (Ecologic® Barrier containing B.bifidumW23, B.lactisW52, L.acidophilusW37, L.brevisW63, L.caseiW56, L.salivariusW24, L.lactisW19, L.lactisW58) on cognitive reactivity to sad mood in healthy volunteers [3] we designed the human trial aiming to compare microbiome alterations and response to therapy in patients with depression and schizophrenia. Moreover, in vitro and in vivo data support the notion that multispecies probiotics are capable of improving gut barrier function [4] and may alleviate disorders affecting mood and depressive-like behavior. We postulate that therapies modulating the microbiome-gut-brain axis warrant further investigations.
ConclusionMultispecies probiotics have the potential to influence the gut-brain axis and alleviate mental disorders. Ongoing clinical study in patients with depression and schizophrenia will help to further unravel the role of gut-brain axis in the treatment of patients with psychiatric disturbances.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S27
E-Mental Health and models of care: The evidence base and feasibility of picking one vs. another?
- D. Hilty
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- 23 March 2020, p. S26
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The patient-centered care features quality, affordable, and timely care in a variety of settings – technology is a key part of that – particularly among younger generations and child and adolescent patients. The consumer movement related to new technologies is nearly passing clinicians by, as new ways of communicating with others (text, email, Twitter, Facebook) revolutionizes how we experience life and access healthcare. This paper explores a continuum with healthy, innovative behavior on one end (e.g., social media) and pathological Internet use on the other end–and the range of self-help and e-mental healthcare options being used. Specifically, it focuses on how social media adds to, yet may complicate healthcare delivery, such that clinicians may need to adjust our approach to maintain therapeutic relationships, interpersonal/clinical boundaries, and privacy/confidentiality. We suggest planning ahead to discuss expectations about online communication between doctors and patients as part of the informed consent process, offer other do's and don’ts for patients and clinicians, and review applicable guidelines. More research is needed on consumer and patient use of technology related to healthcare, as is an approach to basic and advanced measurement of outcomes.
Disclosure of interestThe author has not supplied his declaration of competing interest.
S28
After all, is E-Mental Health capable of making a paradigm shift?
- M. Krausz
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- 23 March 2020, pp. S26-S27
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Only a very small percentage of adolescents and young adults with mental challenges is able to access specialized care. Access is limited due to a lack of capacity but also internal hurdles and stigma especially among young males. The web creates a new environment for them, which is defining a new culture of communication and interaction. The majority is using smart phones to access the Internet and make that their main communication device.
Walkalong is a web-based platform, which aims to provide a range of opportunities and tools for youth with especially mood challenges. These tools include screening and assessment, online resources and all kind of orientation and interaction for informed decision-making.
We are working on that to develop a framework for better online-based mental health care including useful tools beyond crisis based on the principles of empowerment and strength based approaches.
Disclosure of interestThe author has not supplied his declaration of competing interest.
S29
Treatment of schizophrenia using tablet and smartphone based applications (Polish Study)
- M. Krzystanek, D. Krzeszowski, K. Jagoda, B. Radzio, K. Krysta
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- 23 March 2020, p. S27
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Relapses, deterioration of cognitive functioning, negative symptoms, neuroleptic resistance are the examples of many consequences of noncompliance in schizophrenia. In order to improve the compliance, schizophrenic patients treated in an outpatient department in a traditional way have been given an additional possibility of contacting their doctors with the use of a special application on a portable electronic device. Other functions of this application are possibilities of PANSS, Calgary and CGI measurements and cognitive trainings for the patients. This type of a remote contact with patients can be an effective tool in the work in an outpatient setting. The compliance was assessed using a telepsychiatric system, sending reminders: 1 hour before the planned dose to remind them that drug intake is approaching, and at the moment of intake to check if they took the drug. In general the compliance in the group of schizophrenic patients in remission is very low, however the telemedicine system improves the compliance in this group of patients, in which the compliance is the worst.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S30
A study on the effectiveness of E-Mental Health in the treatment of psychosis: Looking to recovery
- F. Gucci, F. Marmo
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- Published online by Cambridge University Press:
- 23 March 2020, pp. S27-S28
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Introduction
An integrated program (Institutional Psychiatric Open Light Treatment) for psychosis and personality disorder was enriched with audiovisual functions provided through a dedicated website.
The aim of the present study was to observe how and if these added functions support the patients in their daily living, influencing the quality of the recovery process.
Recent studies highlighted how telemental health services are effective to provide access, improve basic outcome, facilitate empowerment of patients and be well-accepted (Hilty, 2013; Hailey, 2008) and how integrated community-based treatment, such as Community-Based Psychodynamic Treatment Program (Chiesa and Fonagy, 2009) or Assertive Community Treatment (Veldhuizen and Bahler, 2013) are effective in SMI.
Telemental health services may become factors improving real-life functioning, integrating community-based treatment for psychosis and bettering social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services, so positively affecting outcomes of psychosis treatment.
MethodsAll patients admitted (May 2010–April 2015) were included. Aged between 18 and 65, with schizophrenia, psychosis, schizoaffective disorder, bipolar disorder, personality disorder.
Some troubles with the website use (Voice2Voice) led to a second version, more friendly and simple to use (app2gether).
App2gether provided several functions: audio/video conference rooms for patients or family (synchronous virtual space to interact, at scheduled time, with a psychologist, a psychiatrist or a peer support worker, in free groups); chat (asynchronous virtual space for any question or information).
We considered primary outcomes proposed by Cochrane Collaboration (Shek, 2010): hospital admissions, days of hospitalization, day-hospital admissions, day-program attendance (e.g. weekly), treatment compliance (voluntary discharge or missing scheduled date).
We considered, as secondary outcomes, variables closely associated with real-life functioning (Galderisi, 2015): global functioning (Italian translation of Global Assessment of Functioning Scale), quality of life (Short Form 36 item), social relationships (Personal and Social Performance), internalized stigma (Internalized Stigma Mental Illness Inventory), empowerment (Empowerment Scale).
Patients were divided into four cohorts:
– 1-using “app2gether” functions in the follow-up, attending day treatment program (n = 35);
– 2-attending day treatment program (n = 52);
– 3-attending transitional day-hospital program (n = 171);
– 4-not included in the IPOLT-program (n = 188).
Patients were included in the first group only based on their basic computer skills and fast Internet availability.
ResultsAt first, we compared (2) and (3) with (4), as control group. For each patient, we considered an identical observation period before and after day-hospital admission (ANOVA, P < 0.05).
We found a significant improvement in primary outcomes and global functioning, but not in other secondary outcomes, for the groups (2) and (3) compared with (4).
Over 6-months observation, patients using “app2gether” functions in the follow-up showed:
– a significantly decrease in hospital admissions and hospitalization length, compared to non-IPOLT-program group;
– a reduction in day-hospital admissions and day-hospital attendance, compared to (2) and (3) groups;
– a notable effect on secondary outcomes, compared to all other groups.
ConclusionA dedicated website in the IPOLT-program supports patients in their living's place, does not interfere with daily activities, decreases social costs, encourages community integration and reduces stigma.
Synchronous telepsychiatry allow a professionally modulated intervention in “here and now”; asynchronous contacts with specialists combine professional intervention with chances of autonomy and autoregulation. These services reduce costs, in terms of FTE (Full Time Equivalent), but not the efficacy.
Future advances in the websites should be designed, simplifying the contact surface with the treating-team and reducing the social impact of therapeutic practice.
A better understanding of the complex variables influencing real-life functioning and new sensitive tools to detect it are needed.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S31
The impact of E-Mental Health on prevention and early detection of illness
- D. Hilty
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- Published online by Cambridge University Press:
- 23 March 2020, p. S28
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Our current healthcare system in the United States is characterized by problems with access to timely and evidence-based care, particularly for mental disorders. Telemental health improves access to care regardless of the point-of-service or barriers involved. Its effectiveness across age, population and disorders is as good as in-person care, though adjustments for some populations in the approach is necessary. Early intervention is an example of “Cadillac” care or a best evidence-based approach that is easier to distribute via telemedicine. Cadillac care delivered via TMH has the potential to bring evidence-based early intervention modalities to very young children and their families. However, early access to care is also critical for all populations, particularly those with cultural or medical disadvantages. It appears that telemental health may be preferable or better than in-person care in some instances.
Disclosure of interestThe author has not supplied his declaration of competing interest.
S32
The acceptability of web-care for patients with major depressive disorder
- M. Ladea, M. Bran
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- 23 March 2020, p. S28
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Introduction
With the extraordinary rate of development of E-health and widespread internet access in Romania, Inomedica decided to create a platform dedicated primarily to the patients and their families: depresiv.ro. According to Internet Live Stats there were 11,178,477 Internet users in Romania (representing 51.66% of the population) in 2014. Inomedica is a non-governmental organization founded by a multidisciplinary team (psychiatrists, sociologists, IT specialists).
The platforms provide rigorous and quality online information about depression as well as self-assessment tools and Q&A section.
The presentation will explore the development and effects of the first 16 months of operation of a web platform about depression.
MethodsThe depresiv.ro platform design is simple and user friendly. Mental health specialists contributed to the development of the content, which is easy to access and understand.
The platform also provides access to a self-evaluation tool, the Hospital Anxiety and Depression Scale (HADS), and thus helps the users identify possible problems and encourage them to seek professional help. The web application also included a demographic questionnaire, and a medical history questionnaire. A native iOS version of the application is available to download free on AppStore. The platform is supported by a Google grant program.
ResultsThe platform traffic increased from a few users per day at launch to more than 1000 unique visitors per day. Since 1st January 2015, about 178,000 unique visitors accessed the platform. All the metrics improved significantly during the last months: bounce rate (66.3%), average session duration (02:17 minutes), number of pages per session (2.4).
About 25,000 users accessed the HADS application since its release, from August 2014 until September 2015, showing the increasing need for free online self-evaluation tools.
The Q&A section is one of the most visited on the platform since many users try to find answers for their questions regarding depressive or anxiety symptoms.
ConclusionsAs new technologies are introduced and become more accessible, mental health specialists are developing new ways of providing services and collecting data. The traffic data/usage for both the depresiv.ro platform and the app are evidence for the widespread acceptability of web-based delivery methods.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S33
Digital healthcare: Fools gold or a promised land?
- M. Wise
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- 23 March 2020, p. S28
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Digital healthcare is the use of technology to deliver healthcare. There are many facets of it. The paradigm of care at a distance e.g. a live interface is the most understood, whether it is the old fashioned analog phone call or that of todays Millenial who ‘get’ Skype or see video calling as a day to day reality.
This has moved to non-live uses, asynchronous, the modern version of written communication, email, videomessage, Instagram, twitter or any one of a multitude of social media.
It has progressed beyond that though to a plethora of devices, apps and cross breeds that promise to maximise your patients health, and often your practice income! Grand claims, if not ones supported by the evidence.
They have broadened the range of providers from the plain vanilla (group) therapist to the Cyber support groups; from patient information sheets, to sophisticated hyperlinked, video embedded ‘hope box’, or manual on your phone. They have changed in vivo exposure from what was limited by travel time, to what is limited by the programmers imagination.
Telemdecine can connect patients and providers worldwide – how can that not be an amazing promise, today's truly outstanding goal – tomorrow commonplace event.
The promise of near infinite data; if only we can measure enough, we can treat better, may hold true for a physical paradigm such as mobile ECG or BP monitoring, but is it true for mental health?
Science is not a door to infinite wisdom, but a rescue from unending ignorance. The evidence is that technological innovations are not a magic solution but tools widening access, they are to travel what the motorway is to the dust track. They are an equaliser in that more people can be reached than ever before–but they do not replace human skill and ability.
By December 2015, 500 million smartphone users worldwide will be estimated to be using a health care application. Yet, there is no evidence of a systematic evaluation of a fraction of these apps. They may not be snake oil salesman, but has the placebo effect graduated from molecules to ones and zero's?
We will explore the evidence to understand some of the promises and the realities of what was once Tomorrows World, here today.
Disclosure of interestThe author has not supplied his declaration of competing interest.
S34
Medical students choice of psychiatry – an international survey
- D. Bhugra,
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- 23 March 2020, p. S29
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The appeal of psychiatry as a speciality varies around the globe for a number of reasons. In a majority of countries, medical students are reluctant to choose psychiatry and this has become a much more evident matter of concern in the past three decades. The factors, which affect the choice of psychiatry as a specialty by medical students include external and internal stigma, quality of teaching of the subject as well as research exposure and clinical experience during placements. In many countries, a placement may last only two weeks and the exposure is to patients in asylums, whereas a majority of psychiatric conditions are treated in primary care. In addition, personal factors such as the ability to deal with openness and ambiguity play a role in the choice of speciality. A study in 19 countries to explore factors prior to entering medical school, experiences in medical school and postgraduate in the choice of the subject showed that those medical students who are likely to choose psychiatry fall into three major categories:
– those who had decided prior to joining medical school that they wanted to choose psychiatry;
– those who decide during medical school placements and, finally;
– those who select the specialty after having finished their medical school training.
The latter group has two further subgroups: one, which falls passively into psychiatry and another who make an active choice to take it up. Among 2198 students who participated, 4.5% of the sample planned to become psychiatrists, with a further 15% considering it as a possible career. Women (21%) were more likely to consider psychiatry than men (16%). Key factors associated with choosing psychiatry were personal as well as based on teaching/learning experiences. In order to recruit into psychiatry, better teaching, exposure to common mental disorders and small research projects may prove to be helpful.
Disclosure of interestThe author has not supplied his declaration of competing interest.
S35
Papageno program: When learners collaborate for a safer coverage of suicide
- C.E. Notredame
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- 23 March 2020, p. S29
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Media coverage of suicide has been repeatedly shown to influence suicide rates. The Werther Effect (WE) qualifies the propensity of suicide stories to prompt imitative behaviors. By contrast, the Papageno effect (PE) was more recently identified as a way for journalists to contribute to suicide prevention through their productions. Crucially, both WE and PE depend on the quantitative (audience, redundancies, size of articles, etc.) and qualitative (type of story, editorial style, content, etc.) properties of the coverage.
In order to promote the PE and limit the WE, the World Health Organization (WHO) have edited a guideline for media professionals. For instance, journalists are advised to prohibit sensationalism, avoid pictures or details about the suicide method, and show due respect to the bereaved relatives. However, it is now clear that the only chance for these recommendations to be applied is to integrate their diffusion into a more general effort toward collaboration with journalists.
Papageno is a French national suicide prevention program that fully relies on learners to rise awareness about suicide and its coverage. It mainly consists in pair-meetings between psychiatry trainees and journalism students. Such an innovative formula breaks with the old top-down knowledge transmission model in order to foster personalized and sustainable sensitization. It aims at growing up a new generation of journalists who would be more aware of their responsibility concerning suicide and would more spontaneously resort to the WHO guidelines. Ultimately, the Papageno program strives for the creation of a new culture where journalists and psychiatrist would collaborate for a safer media coverage of suicide.
Disclosure of interestThe author has not supplied his declaration of competing interest.
S36
Youth leadership in mental health: Views from EFPT and IFMSA
- M. Pinto da Costa, D. Silva, S. Essafi, E. Frau, V. Berquist, K. Maceviciute
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- 23 March 2020, p. S29
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The world today is more challenging than ever before. Discrimination, stigma, and ever-changing lifestyles are just a few examples of elements that have a profound impact on the mental health status of our global population. Even though the burden of mental illness is well documented and increasing, mental health remains a neglected area of health worldwide.
Youth Associations, like the International Federation of Medical Students’ Associations (IFMSA) and the European Federation of Psychiatric Trainees (EFPT) recognize the importance of tackling this problem, taking an active role on promoting education in our communities, tackling stigma and advocating for more action. Medical students worldwide, from Slovenia, Australia, Lebanon, Brazil, Quebec and Grenada – among at least 42 other countries, organise expansive, creative and engaging mental health projects.
With particular interest we can mention the winner of the last Rex Crossley Award, attributed to a Slovenian project ‘in Reflection’: a suicide prevention project, which tackles the different factors associated with vulnerable groups through a series of workshops and campaigns that seek to destigmatize the mental health problems and offer the opportunity to high school students to get the help they need.
This talk will give an insight into strengths, weaknesses and challenges faced by youth in tackling mental health, specially in the role of the IFMSA, displaying some of our most interesting and innovative projects from future mental health leaders around the world, together with the initiatives of EFPT.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S37
Introducing PEEP: The psychiatry early experience programme
- H. Qureshi, C. Holt, R. Mirvis, S. Cross, O. Hussain, H. Hutchings, E. Marshall, F. Turner, C. Wilson Jones,
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- 23 March 2020, p. S30
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At Guy's King's and St Thomas’ School of Medicine, a unique initiative is the Psychiatry Early Experience Programme (PEEP), which allows students to shadow psychiatry trainees at work several times a year. The students’ attitudes towards psychiatry and the scheme are regularly assessed and initial results are already available.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S38
Methylome modifications in monozygotic twins and in depression
- L. Fañanás, A. Córdova-Palomera
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- 23 March 2020, p. S30
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Epigenetics is the study of gene expression changes that are produced by heritable, though potentially reversible, modifications of chromatin structure or DNA methylation. DNA methylation is interesting in epidemiological studies, due to its accessibility and since previous evidence indicates that large inter-individual differences in methylation levels at some loci may correlate with phenotypic plasticity in changing environments.
Prior genome-wide methylomic research on depression has suggested that, together with differential DNA methylation changes, affected co-twins of monozygotic twin pairs have increased DNA methylation variability, probably in line with theories of epigenetic stochasticity. However, the putative biological roots of this variability remain largely unexplored.
This study evaluate whether DNA methylation differences within MZ twin pairs were related to differences in their depressive status. Genome-wide DNA methylation levels were measured in peripheral blood of 34 twins (17 MZ pairs) using Illumina Infinium Human Methylation450 Beadchip. Two analytical strategies were used to identify differentially methylated probes (DMPs) and variably methylated probes (VMPs).
The majority of the DMPs were located in genes previously related to neuropsychiatric phenotypes, such as WDR26, a GWAS hit for MDD whose expression levels have been found altered in blood of depressed individuals.
VMPs were located in genes such as CACNA1C, IGF2 and the p38 MAP kinase MAPK11, showing enrichment for biological processes such as glucocorticoid signaling.
The findings expand on previous research to indicate that both differential and variable methylation may play a role in the etiopathology of depression, and suggest specific genomic loci of potential interest in the epigenetics of depression.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S39
Longitudinal study of methylome profiles in subjects with psychosis and/or schizophrenia
- O. Kebir, B. Chaumette, M.O. Krebs
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- 23 March 2020, p. S30
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Background
Schizophrenia is a complex disorder involving both genetic and environmental factors. Epigenetic is a growing theory to explain these interactions at a molecular level. It is well-known that schizophrenia begins with prodromal symptoms and patients undergoing subthreshold symptoms are named ultra-high risk (UHR) subjects. Therapeutic and prognostic attitude remain challenging for this population. According to the model of the gene-environment interactions, the psychotic transition in adolescence could be related to epigenetic changes during the psychotic transition.
MethodsWe designed and performed the first longitudinal study about whole-genome DNA methylation changes. Thirty-nine UHR patients were recruited in specialized center C’JAAD - Centre Hospitalier Ste Anne - Paris (France). During follow-up, 14 of them became psychotic (converters) according to the validated scale CAARMS. Initial and final methylation were investigated by Infinium Human Methylation450 BeadChip for 450,000 CpG after bisulfite conversion.
ResultsThe psychotic transition was not associated with global methylation changes. Linear models failed to identify CpG and genes significantly associated with psychotic transition after Bonferroni correction. Analyses of the top results provided a cluster, which could classify perfectly converters and non-converters. These genes of interest are over-represented in biological pathways with relevance for psychotic physiopathology. Individual analyses highlighted the biological heterogeneity of the psychotic transition.
ConclusionImproving physiopathological understanding of psychotic transition is a current challenge to identify biomarkers and to develop targeted preventive interventions available in clinical practice for UHR subjects. The epigenetic processes and in particular DNA methylation could be interesting factors.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S40
Epigenetic modifications in anorexia nervosa patients and remitters compared to healthy control women
- N. Ramoz, J. Clarke, P. Gorwood
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- Published online by Cambridge University Press:
- 23 March 2020, pp. S30-S31
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Introduction
Anorexia nervosa (AN) is the most severe in terms of morbidity psychiatric illness with the highest mortality rate increased by 23 fold. Treatments are limited effectiveness. AN has a strong genetic component with heritability at 70% but despite ∼ 200 studies no major gene was identified. Epigenetics, such as DNA methylation, is another component of heritability that could explain the high heritability. Methylation is poorly studied in AN from small samples, and is focused on few candidate genes among publications. Under publication, a first genome-wide methylation study investigated 10 restrictive type AN patients, 19 binging/purging type of AN patients and 15 normal eaters using DNAs from whole blood (Booij, 2015). Of the 480K CpG sites that can be methylated of Infinium Human Methylation450 BeadChip Kit, authors focused on 24,000 sites located close to genes and they identified candidate genes with a different profile of methylation between AN and controls.
ObjectivesOur work is to replicate the results of Booji and also to investigate the AN remitters.
AimsOur goal is to identify epigenetic signatures of the AN disorder and the prognostic of remission.
MethodsTwenty-four AN patients, 24 AN remitters will be compared to 48 healthy control women for methylation using the Infinium Human Methylation450.
ResultsAs Booji et al., we will compare methylation for 24,000 sites located close to genes for 24 AN, 24 remitters and 48 controls.
ConclusionsWe expected to replicate the published results of Booji and to identify genes with a methylation signature specific of the AN remission.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S41
Whole-genome epigenetic changes genome regarding childhood maltreatment in patients with borderline personality disorder or depression
- J. Prados, L. Stenz, P. Courtet, P. Prada, R. Nicastro, A. Wafae, S. Guillaume, E. Olié, J.M. Aubry, A. Dayer, N. perroud
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- 23 March 2020, p. S31
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Early life adversity plays a critical role in the emergence of borderline personality disorder (BPD) and this could occur through epigenetic programming. In this perspective, we aimed to determine whether childhood maltreatment could durably modify epigenetic processes by the means of a whole-genome methylation scan of BPD subjects. Using the Illumina Infinium® Human Methylation450 BeadChip, global methylation status of DNA extracted from peripheral blood leucocytes was correlated to the severity of childhood maltreatment in 96 BPD subjects suffering from a high level of child adversity and 93 subjects suffering from major depressive disorder (MDD) and reporting a low rate of child maltreatment. Several CpGs within or near the following genes (IL17RA, miR124-3, KCNQ2, EFNB1, OCA2, MFAP2, RPH3AL, WDR60, CST9L, EP400, A2ML1, NT5DC2, FAM163A and SPSB2) were found to be differently methylated, either in BPD compared with MDD or in relation to the severity of childhood maltreatment. A highly relevant biological result was observed for cg04927004 close to miR124-3 that was significantly associated with BPD and severity of childhood maltreatment. miR124-3 codes for a microRNA (miRNA) targeting several genes previously found to be associated with BPD such as NR3C1. Our results highlight the potentially important role played by miRNAs in the etiology of neuropsychiatric disorders such as BPD and the usefulness of using methylome-wide association studies to uncover such candidate genes. Moreover, they offer new understanding of the impact of maltreatments on biological processes leading to diseases and may ultimately result in the identification of relevant biomarkers.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S42
Community-based 4-level approach: Background, implementation and evidence for efficacy
- U. Hegerl, E. Arensman, C. van Audenhove, T. Baader, R. Gusmão, A. Ibelshäuser, Z. Merali, C. Rummel-Kluge, V. Peréz Sola, R. Pycha, A. Värnik, A. Székely
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- Published online by Cambridge University Press:
- 23 March 2020, pp. S31-S32
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The community-based 4-level-intervention concept developed within the “European Alliance against Depression” (http://www.eaad.net/) combines two important aims: to improve the care and treatment of patients with depression and to prevent suicidal behavior. It has been shown to be effective concerning the prevention of suicidal behavior [1–4] and is worldwide the most broadly implemented community-based intervention targeting depression and suicidal behavior. The 4-level intervention concept comprises training and support of primary care providers (level 1), a professional public relation campaign (level 2), training of community facilitators (teacher, priests, geriatric caregivers, pharmacists, journalists) (level 3), and support for self-help of patients with depression and for their relatives (level 4). In order to deepen the understanding of factors influencing the effectiveness of the intervention, a systematic implementation research and process analysis was performed within the EU-funded study “Optimizing Suicide Prevention Programs and Their Implementation in Europe” (http://www.ospi-europe.com/; 7th Framework Programme) [5]. These analyses were based on data from four intervention and four control regions from four European countries. In addition to intervention effects on suicidal behaviour, a variety of intermediate outcomes (e.g. changes in attitude or knowledge in different populations) were considered. Strong synergistic as well as catalytic effects were identified as a result of being active simultaneously at four different levels. Predictable and unpredictable obstacles to a successful implementation of such community-based programs will be discussed. Via the EAAD, the intervention concept and materials (available in eight different languages) are offered to interested region in and outside of Europe.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
S43
Hallucinations without delusions in patients with first-episode psychosis: Clinical correlates and implications for pathophysiological models
- I. Melle
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- 23 March 2020, p. S32
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Introduction
The symptomatic distribution in schizophrenia spectrum disorder is heterogeneous. Patients may experience hallucinations, delusions and combinations thereof, in addition to disorganized and negative symptoms. We have previously found that patients with monosymptomatic hallucinations exhibited a different clinical profile than patients with monosymptomatic delusions or combinations of the two; with an earlier age at onset and more suicidal symptoms.
AimsTo replicate findings in a new group of patients with schizophrenia spectrum disorders.
MethodsA total of 421 consecutive patients with schizophrenia spectrum disorders were included into the study. They were comprehensively assessed by specifically trained psychiatrists or clinical psychologists; using the SCID for DSM-IV for diagnostic purposes, the PANSS to assess current clinical symptoms and CDSS to assess current depression. Lifetime presence of different symptom types was ascertained during the diagnostic interview.
ResultsA total of 346 (82%) had experienced both hallucinations and delusion, 63 (15%) had experienced delusions without hallucinations, 10 (2.5%) had experienced hallucinations without delusions and 2 patients (0.5%) had neither but experienced negative and severely disorganized symptoms. Contrary to hypothesis, we did not find any statistically significant differences in age at onset and in clinical symptoms (including suicidality) between these groups. We also did not find any differences in the type of hallucinatory experiences between hallucinating groups.
ConclusionsIn a new sample of patients, we did not replicate previous findings of a different clinical profile in patients with monosymptomatic hallucinations. This type of psychotic disorder is relatively rare, which might pose a problem concerning statistical strength.
Disclosure of interestThe author has not supplied his declaration of competing interest.
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Abnormal time experience, bizarre delusions and verbal-acoustic hallucinations in schizophrenia
- G. Stanghellini
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- Published online by Cambridge University Press:
- 23 March 2020, p. S32
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The integrity of time consciousness is the condition of possibility of the identity through time of an object of perception as well as of the person who perceives it. I will present our findings about abnormal time experience (ATE) in people with schizophrenia. These data may support the following hypothesis: if the continuity of temporal experience disintegrates (of which ATE are experiential manifestations), overarching meaningful units are no longer available, thereby creating temporal gaps, e.g., in one's stream of consciousness. In some cases, thoughts that are no longer experienced as embedded in one's stream of thoughts are experienced as, e.g., thought interferences, blockages, insertion or withdrawal. These symptoms cannot be explained as a mere disturbance of attention or comprehension at the level of semantic combinations. Rather, the disturbance could be searched for at a more basic level where the temporal coherence of conscious awareness is constituted. A failure of the constitutive temporal synthesis may create micro-gaps of conscious experience. In the most severe cases, thoughts or other mental phenomena that are no longer embedded in the continuity of basic self-experience may appear in consciousness as “erratic blocks” and experienced as being inserted, or, if further externalized, as auditory hallucinations (“voices”). This coheres with the hypothesis that a breakdown of temporality may be bound up with the breakdown of prereflexive self-awareness.
Disclosure of interestThe author has not supplied his declaration of competing interest.