T98. THE EFFECT OF SUBSTANCE USE ON 10-YEAR OUTCOME IN FIRST EPISODE PSYCHOSIS – EARLY CESSATION RESULTS IN BETTER OUTCOMES

Abstract Background The pre-TIPS study in 1994–95 showed that the duration of untreated psychosis (DUP) was long in our region with a mean value of 2.1 years, and median 26 weeks. This set the stage for the TIPS-study (1997–2000), reducing DUP through information campaigns targeted to the general population and other referral agents (GP’s, schools and others) in Rogaland County (Norway). The information campaigns were launched together with a low threshold organization with direct access to an early detection team, for a diagnostic interview and help. No referral other than a phone call needed, and a guarantee of assessment within 24 hours if there was suspicion of psychotic symptoms. The hypothesis was that this could change help seeking behavior, awareness towards psychosis and thus reduce the DUP. The information campaigns and the early detection team were introduced in an early detection(ED) area (Rogaland county, Norway) comparing DUP with two usual-detection control sites in Oslo (Norway) and Roskilde (Denmark). As a result, DUP in the early detection area was reduced from 26 weeks median to 4 weeks median. All patients with First Episode Psychosis in the early detection area have been followed for ten years, and a twenty-year follow-up is to take place shortly. Symptom and function advantages of early detection and DUP reduction have been demonstrated as being significant throughout the follow-up period. Social and functional outcome have been increasingly emphasized as being key parameters, as these contribute to both quality of life and to financial costs in society. Substance use is common in first-episode psychosis (FEP) and has been linked to poorer outcomes with more severe psychopathology and higher relapse rates. Early substance discontinuation appears to improve symptoms and function. However, studies vary widely in their methodology, and few have examined patients longitudinally, making it difficult to draw conclusions for practice and treatment. Methods We aimed to investigate the relationship between substance use and early abstinence and the long-term course of illness in a representative sample of FEP patients. Out of 301 included patients, 266 could be divided into four groups based on substance use patterns during the first two years of treatment: persistent users, episodic users, stop-users and non-users. Differences in clinical and functional during the follow-up period were assessed using linear mixed effects (lme) models for the analysis of repeated measures data. Results Patients who stopped using substances within the first two years after diagnosis had outcomes similar to those who had never used with less symptoms than episodic or persistent users. Both episodic and persistent users had lower rates of symptom remission than non-users, and persistent users also had more negative symptoms than those who stopped using. Discussion Our findings emerge from one of very few long-term longitudinal studies examining substance use cessation in FEP with 10-year follow-up. The results convey hope that the detrimental effects of substance abuse on mental health may be significantly reversed if one stops the abuse in time. This can help patients who struggle with addiction with their motivation to embrace abstinence.


T97. CANNABIS USE IMPACTS SYMPTOM PRESENTATION IN ANTIPSYCHOTIC NAIVE PATIENTS IN FIRST EPISODE OF PSYCHOSIS (FEP)
Luccas Coutinho* ,1 , Cinthia Higuchi 1 , Daniel Azevedo Cavalcante 1 , Rodrigo Bressan 1 , Quirino Cordeiro 2 , Cristiano Noto 5 , Ary Gadelha 1 1 Universidade Federal de São Paulo; 2 Faculdade de Ciências Médicas da Santa Casa de São Paulo Background: Psychotic disorders induced by cannabis may present distinct symptomatic profile, course and underlying biology.Most studies on symptomatic effects of cannabis exposure are limited by examining patients after antipsychotic treatment.We investigated if antipsychotic naive FEP patients that reported cannabis use present higher symptom's severity and if affects deferentially any of standard psychosis dimensions (positive, negative, disorganized, excitement and depressive).Methods: The sample comprised 194 antipsychotic naive FEP individuals.The baseline assessment was performed right after the admission at the emergency room and the follow-up assessment two months after antipsychotic treatment.The cannabis exposure was measured by ASI-6 (Addiction Severity Index) and additional questions addressing the relation to onset of psychotic disorders and how many times cannabis has been used.Cannabis use was reported by 41,2% of patients, and 25.8% reported heavy use (more than 50 times).Dimensional psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS) and the symptom dimensions were constructed based on previous studies (positive, negative, disorganized, depressive, excitement).Considering cannabis use, we analyzed the following variables: 1 -Number of days of cannabis consumption in the last 30 days (Acute Use); 2 -Age of first cannabis use; 3 -Total cannabis use lifetime, categorized in no use, less than 50, more than 50 (total use).

Results:
The mean age was 25.52 (sd=7.17),mean duration of untreated psychosis was 176 days (sd= 291) and most of the subjects were male (63%).Acute use of cannabis was associated with higher scores in the positive symptom dimension (p =0.017, df= 40, R-squared = 0.132).Also, the earlier age of first cannabis use was related to higher presentation scores of the negative symptom dimension (p = 0.002, df = 33, R-squared = 0.238).No significant association was found between any cannabis exposure variable and other symptomatic dimensions excitement, depressive and disorganized symptoms´ dimensions.Cannabis use did not associate with duration of untreated psychosis (p=0.443,W= 2709.5).All the analyses were controlled by gender, age and duration of untreated psychosis.Discussion: Acute and total exposure to cannabis affected deferentially the symptoms dimensions in patients at first episode of psychosis.Previous studies on the relationship between cannabis use and negative symptoms produced mixed results.This may be biased by antipsychotic exposure prior to first assessment.We will investigate the course of the symptoms of those patients to verify if the symptomatic differences are maintained.

T98. THE EFFECT OF SUBSTANCE USE ON 10-YEAR OUTCOME IN FIRST EPISODE PSYCHOSIS -EARLY CESSATION RESULTS IN BETTER OUTCOMES
Melissa Weibell* ,1 , Ingrid Melle 2 , Inge Joa 1 , Jan Olav Johannessen 1 , Robert Jørgensen 1 , Wenche ten Velden Hegelstad 1 1 Stavanger University Hospital; 2 University of Oslo; 3 Background: The pre-TIPS study in 1994-95 showed that the duration of untreated psychosis (DUP) was long in our region with a mean value of 2.1 years, and median 26 weeks.This set the stage for the TIPS-study (1997TIPS-study ( -2000)), reducing DUP through information campaigns targeted to the general population and other referral agents (GP's, schools and others) in Rogaland County (Norway).The information campaigns were launched together with a low threshold organization with direct access to an early detection team, for a diagnostic interview and help.No referral other than a phone call needed, and a guarantee of assessment within 24 hours if there was suspicion of psychotic symptoms.The hypothesis was that this could change help seeking behavior, awareness towards psychosis and thus reduce the DUP.The information campaigns and the early detection team were introduced in an early detection(ED) area (Rogaland county, Norway) comparing DUP with two usual-detection control sites in Oslo (Norway) and Roskilde (Denmark).As a result, DUP in the early detection area was reduced from 26 weeks median to 4 weeks median.All patients with First Episode Psychosis in the early detection area have been followed for ten years, and a twenty-year follow-up is to take place shortly.Symptom and function advantages of early detection and DUP reduction have been demonstrated as being significant throughout the follow-up period.Social and functional outcome have been increasingly emphasized as being key parameters, as these contribute to both quality of life and to financial costs in society.Substance use is common in first-episode psychosis (FEP) and has been linked to poorer outcomes with more severe psychopathology and higher relapse rates.Early substance discontinuation appears to improve symptoms and function.However, studies vary widely in their methodology, and few have examined patients longitudinally, making it difficult to draw conclusions for practice and treatment.Methods: We aimed to investigate the relationship between substance use and early abstinence and the long-term course of illness in a representative sample of FEP patients.Out of 301 included patients, 266 could be divided into four groups based on substance use patterns during the first two years of treatment: persistent users, episodic users, stop-users and non-users.Differences in clinical and functional during the follow-up period were assessed using linear mixed effects (lme) models for the analysis of repeated measures data.Results: Patients who stopped using substances within the first two years after diagnosis had outcomes similar to those who had never used with less symptoms than episodic or persistent users.Both episodic and persistent users had lower rates of symptom remission than non-users, and persistent users also had more negative symptoms than those who stopped using.Discussion: Our findings emerge from one of very few long-term longitudinal studies examining substance use cessation in FEP with 10-year followup.The results convey hope that the detrimental effects of substance abuse on mental health may be significantly reversed if one stops the abuse in time.This can help patients who struggle with addiction with their motivation to embrace abstinence.

T99. LONG-TERM CANNABIS USE ASSOCIATED WITH ALTERED FUNCTIONING DURING VERBAL LEARNING
Grace Blest-Hopley* ,1 , Aisling O'Neill 2 , Robin Wilson 3 , Vincent Giampietro 4 , Sagnik Bhattacharyya 3 1 King's College London, Institute of Psychiatry, Psychology, & Neuroscience Background: Long-term use of cannabis has long been associated with changes in cognition, including memory and learning, particularly verbal learning in man.However, evidence regarding the neurobiological underpinnings of impairments in memory following long-term cannabis use has not been consistent.Furthermore, to our knowledge none of the studies published to date have specifically investigated whether brain function differed between cannabis users and non-users while learning new information as estimated over repeated trials.Therefore, we aimed to investigate this.Methods: Twenty-one predominantly cannabis users (CU) who started using cannabis during adolescence and 21 healthy non-using controls (NU), completed a block design verbal paired associates learning task whilst undergoing functional Magnetic Resonance Imaging.The task required participants to learn and recall a set of word-pairs over 4 repeated trials.We examined the interaction between repetition and group (CU vs NU) on brain activation during encoding and recall condition using nonparametric repeated measures analysis of variance.Results: There was no significant difference in total recall score between CU and NU.However, there was a significant effect of repetition (p<0.001) on recall score, suggesting that there was a significant improvement in recall score over repeated trials across the two groups of participants.Furthermore, there was a significant interaction between repetition and group on recall score such that the change in recall score over repeated trials significantly differed (p =0.032) between the CU and NU groups.This was associated with a significant interaction (p =0.009) between group and repetition on activation in the midbrain bilaterally, extending to the, parahippocampus, caudate and cingulate gyrus during the encoding condition.There was greater engagement of these regions in CU than in NU over repeated encoding trials.Discussion: These results suggest that verbal learning is slower and more effortful requiring greater engagement of critical brain areas involved in learning in cannabis users compared to non-users.

T100. NICOTINE USE IMPACTS NEGATIVE SYMPTOMS SEVERITY IN SCHIZOPHRENIA
Hianna Oliveira* ,1 , Luccas Coutinho 1 , Cinthia Higuchi 1 , Cristiano Noto 1 , Rodrigo Bressan 1 , Ary Gadelha 1 1 Universidade Federal de São Paulo Background: Nicotine use is higher among patients with schizophrenia (50-98%) than in general population (25-30%).This association can reflect a non-specific liability to substance use or specific effects of tobacco on symptoms severity or side effects.Studies about nicotine use and schizophrenia symptoms dimensions are controversial.Some of them showed a relation between severe nicotine use and higher positive symptoms and others presented a correlation between lower negative symptoms and nicotine use.That is why we aimed to verify whether nicotine use is associated with symptoms dimensions in patients with schizophrenia.Methods: Two hundred and seven outpatients were enrolled from the Programa de Esquizofrenia da Universidade Federal de São Paulo (PROESQ/ UNIFESP).Schizophrenia diagnosis was confirmed by Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I).Dimensional psychopathology was assessed with Positive and Negative Syndrome Scale (PANSS) and Fagerstrom Test for Nicotine Dependence.The PANSS items were grouped in five dimensions: positive, negative, disorganized/cognitive, mood/ depression and excitement/hostility.The total score of Fagerstrom Test for Nicotine Dependence was the index used for severity in nicotine dependence.We used Wilcoxon-mann-whitney test to compare the means of PANSS dimensions between nicotine users versus non nicotine use.Results: The patients mean age was 36.75 (SD 10.648), 69.1% were male, 48.3% reported lifetime tobacco use and 34.3% reported current tobacco use.Lower scores on negative dimension were associated with nicotine use (W = 5642.5,p-value = 0.046, effect size = 0.446).All p-values were corrected by Bonferroni test.Tests that evaluated the relationship between nicotine use and the total PANSS score or other dimensions were not statistically significant.Discussion: This study shows that nicotine use impacts negative symptoms of schizophrenia.Increase in hepatic metabolism leading to low antipsychotic blood levels has been previously documented in patients with schizophrenia.Thus, the observed results can either indicate effect on primary negative symptoms or indirect effects through reduced D2 blockade caused by lower antipsychotic levels.Future quantitative analyzes and Longitudinal studies may better inform on direction of the association between nicotine dependence and negative symptoms in schizophrenia.
T101.ENRICHING PSYCHOTIC DISORDER CLASSIFICATION USING NATURAL LANGUAGE PROCESSING Rashmi Patel* ,1 , Richard Jackson 1 , Robert Stewart 1 , Philip McGuire 1 1 King's College London Background: Advances in molecular biology, genetics and neuroimaging have the potential to improve our understanding of psychotic disorders.