T213. THE EFFECT OF ACUTE STRESS ON PARANOID THINKING AND CORTISOL DURING SOCIAL INTERACTION IN HIGH AND LOW SCHIZOTYPES

Abstract Background Paranoid thinking, a common symptom of psychosis and schizophrenia, manifests as a sense of threat and may also be indexed by a lack of trust. Stress, in turn, exacerbates psychosis and paranoia, and is a well-established risk factor for schizophrenia as well as a component in several models of psychosis. The present study aimed to determine the impact that acute stress has on paranoid thinking during social interaction in vivo in high (HSZ) vs low (LSZ) schizotypy using an iterated social reciprocity game. The main hypothesis was that HSZ would anticipate grerater social threat and paranoia at baseline compared to LSZ, and moreover that experimentally-induced stress would exacerbate those differences, and thus show that stress differentially modulates how HSZ model the intentions of others. Methods Matched healthy participants were stratified into HSZ (N=17) and LSZ (N=17) groups and were administered a non-financial, social-reciprocity game against benevolent and malevolent opponents under both stress and no-stress conditions. Stress was manipulated using the MIST (Dedovic et al., 2005) stress paradigm. Cortisol was measured from saliva samples acquired before and after the MIST stress task. Anticipation of threat and trust scores were derived from the social interaction task. Results At baseline, cortisol levels were not significantly different between HSZ and LSZ but were significantly raised by the stressor task in HSZ (p<.05) but not in LSZ. Higher cortisol at baseline (pre-stress) predicted greater initial and average anticipation of threat (both r=.5, p<.05) (no-stress) to other players; and lower initial trust ratings of malevolent, but not benevolent, players. The MIST task significantly elevated stress ratings compared to baseline (p<.001) and following stress, greater change in cortisol from baseline to post-MIST was associated with lower trust ratings (r=.51, p<.05). In HSZ greater stressor-related cortisol levels correlated with greater anticipation of threat (r=.58, p<.05) and lower trust levels (r=.57, p<.05) which was not apparent in low schizotypes. Discussion Acute stress elevates cortisol and paranoia in HSZ – in the form of greater anticipation of threat, and lower trust compared to LSZ. The study adds evidence to the role of stress in exacerbating schizophrenia-like experiences in those who are sub-threshold for schizophrenia and psychosis.


T212. THE INTRINSIC ORGANIZATION OF SYMPTOMS MARKS TRANSITION FROM HIGH-RISK STATE TO EARLY PSYCHOSIS: A PHENOMENOLOGICAL CONNECTIVITY STUDY
Lena Palaniyappan* ,1 , Tushar Das 1 , Fabienne Harrisberger 2 , Undine E. Lang 2 , Anita Riecher-Rössler 2 , André Schmidt 2 , Stefan Borgwardt 2 1 University of Western Ontario; 2 University of Psychiatric Clinics Basel (UPK) Background: In psychiatric practice, when symptoms "come together" we call the resulting construct as a diagnosis. We believe that there is a disease process that binds together, enabling co-occurrence of varied symptoms. We use either diagnostic or syndromic labels to describe this construct (e.g. positive syndrome, negative syndrome, schizophrenia, at-risk mental state). An emerging idea, promoted by network theorists, is that symptoms may relate by their own intrinsic nature, with no external constructs bringing them together e.g. paranoia leads to social withdrawal, loss of appetite leads to loss of weight etc. This intrinsic organisation of symptom relationships can be studied using network models by applying graph theory to symptom data. Methods: We recruited 63 subjects with at-risk mental state [on the basis of Melbourne PACE criteria] but no transition (ARMS-NT), 16 that later developed psychosis (ARMS-T) and 38 drug-naïve patients with first-episode psychosis (FEP) from Basel, Switzerland. Symptoms were measured using Brief Psychiatric Rating Scale. Clinical symptoms can be construed as a system of individual elements (24 nodes) and their relationship (24x23 possible edges) within a group. We estimate each individual's contribution to the intrinsic organisation of symptoms using a jack-knife bias estimation procedure. Bias values for each pair of symptoms in an individual subject quantified the contribution of that subject to the overall within-group relationship for that symptom pair. Higher values meant greater relationship between the two given nodes in that subject, relative to the rest of the group. We then used Graph Analysis Toolbox, with a range of binarization thresholds based on cost-density of connectivity to extract adjacency matrices.
Results: None of the 24 individual symptoms of BPRS significantly differentiated ARMS-NT from ARMS-T, though a number of symptoms (suspiciousness, hallucinations, disorganisation, motor retardation, hostility and suicidality) showed a gradient of FEP>ARMS-T>ARMS-NT (F test, FDR corrected p<0.05). The small-worldness (F=4.8, p=0.01) and the clustering coefficient (F=10.9, p<0.001) and modularity (F=10.9, p<0.001) of the symptom networks were notably different among the 3 groups, with a gradient of FEP>ARMS-T>ARMS-NT (except for modularity where FEP=ARMS-T). Post-hoc tests revealed significantly high clustering (Hedges's g = 0.60, p<0.05) and high modular organisation (Hedges's g = 0.81, p<0.01) of symptoms in ARMS-T compared to ARMS-NT. There were no differences between ARMS-T and FEP groups. In both ARMS-T and FEP groups, anxiety was the most central symptom. In addition to anxiety, the FEP group also had unusual thought content emerging as a central feature. Discussion: To our knowledge, this is the first study to investigate the intrinsic phenomenological connectivity and its relevance to psychosis in the clinical high-risk population. Risk of transition to psychosis relates to the consolidation of relationship among symptoms (clustering and modularity), but appears unrelated to the severity of symptoms per se. First episode of psychosis could be thought of as a state of high modular clustering among otherwise sparsely connected symptoms. Incongruent clustering (e.g. blunting with anxiety) is reminiscent of Bleuler's concept of ambivalence being a fundamental feature of psychosis. Deconsolidation of symptom clustering could be the key to prevent transition to frank psychosis in high-risk individuals. Reducing the bridging symptoms (esp. anxiety) could weaken the clinical core of a psychotic episode, complementing the pharmacological approaches of reducing dopamine transmission.

T213. THE EFFECT OF ACUTE STRESS ON PARANOID THINKING AND CORTISOL DURING SOCIAL INTERACTION IN HIGH AND LOW SCHIZOTYPES
James Gilleen* ,1 1 Institute of Psychiatry Background: Paranoid thinking, a common symptom of psychosis and schizophrenia, manifests as a sense of threat and may also be indexed by a lack of trust. Stress, in turn, exacerbates psychosis and paranoia, and is a well-established risk factor for schizophrenia as well as a component in several models of psychosis. The present study aimed to determine the impact that acute stress has on paranoid thinking during social interaction in vivo in high (HSZ) vs low (LSZ) schizotypy using an iterated social reciprocity game. The main hypothesis was that HSZ would anticipate grerater social threat and paranoia at baseline compared to LSZ, and moreover that experimentally-induced stress would exacerbate those differences, and thus show that stress differentially modulates how HSZ model the intentions of others. Methods: Matched healthy participants were stratified into HSZ (N=17) and LSZ (N=17) groups and were administered a non-financial, socialreciprocity game against benevolent and malevolent opponents under both stress and no-stress conditions. Stress was manipulated using the MIST (Dedovic et al., 2005) stress paradigm. Cortisol was measured from saliva samples acquired before and after the MIST stress task. Anticipation of threat and trust scores were derived from the social interaction task. Results: At baseline, cortisol levels were not significantly different between HSZ and LSZ but were significantly raised by the stressor task in HSZ (p<.05) but not in LSZ. Higher cortisol at baseline (pre-stress) predicted greater initial and average anticipation of threat (both r=.5, p<.05) (nostress) to other players; and lower initial trust ratings of malevolent, but not benevolent, players. The MIST task significantly elevated stress ratings compared to baseline (p<.001) and following stress, greater change in cortisol from baseline to post-MIST was associated with lower trust ratings Poster Session I (r=.51, p<.05). In HSZ greater stressor-related cortisol levels correlated with greater anticipation of threat (r=.58, p<.05) and lower trust levels (r=.57, p<.05) which was not apparent in low schizotypes. Discussion: Acute stress elevates cortisol and paranoia in HSZ -in the form of greater anticipation of threat, and lower trust compared to LSZ. The study adds evidence to the role of stress in exacerbating schizophrenia-like experiences in those who are sub-threshold for schizophrenia and psychosis. Background: Schizophrenia is possibly the most stigmatised of all mental disorders. It has been argued that the label of schizophrenia itself has become stigmatically charged through over a century of association with misleading and sensationalist representations in news media and popculture. There has, therefore, been considerable recent debate on the topic of changing the label of schizophrenia. Label change advocates argue that public stigma about schizophrenia would be reduced should the label be replaced with either an eponymous or descriptive alternative. However, few empirical studies to date have directly investigated this possibility. Moreover, no known single study has investigated the effects of descriptive and eponymous relabelling of schizophrenia on public stigma as a function of symptomatology and illness phase. The current study aimed to fill this gap in the literature. Methods: Australian university students (m = 181, f = 176, other/unspecified = 4, Mage = 19.58 years, age range 17-60 years) participated in the study by reading a brief vignette depicting a protagonist with schizophrenia, and by subsequently completing a number of stigma measures. Participants were randomly allocated to vignette conditions that varied systematically by disorder label (schizophrenia vs eponymous label vs descriptive label), symptoms (positive vs negative symptoms), and illness phase (active vs remittent symptoms). Stigmatised thoughts, attitudes, and behaviour were measured using the Social Distance Scale (SDS; Link et al., 1987) and selected items forming six factors (Fear/Dangerousness, Help/ Interaction, Responsibility, Forced Treatment, Pity, and Anger;Brown, 2008) from the Attributional Questionnaire (AQ; Corrigan et al., 2004). Socially desirable response bias and familiarity with mental illness were controlled using the Marlow-Crowne Social Desirability Scale (Crowne & Marlow, 1960), and Level-of-Contact Report (Holmes, Corrigan, Williams, Canar & Kubiak (1999). Results: Data was analysed with a series of ANCOVA and ANOVA analyses. No group differences in either SDS or AQ scores were observed as a function of disorder label. Positive symptoms were observed to elicit significantly greater levels of fear/dangerousness responses and endorsement of forced treatment when compared to negative symptoms. However, negative symptoms elicited significantly greater anger responses. While only these isolated differences on stigma measures were observed for symptom profile contrasts, vignettes depicting an active illness phase elicited significantly greater levels of stigma on the SDS and most AQ factors when compared with vignette conditions depicting a symptomatically remittent protagonist. Lastly, no statistically significant interactions were observed between labels, symptomatology and illness phase. Discussion: The results suggest that diagnostic label change may not be an effective strategy to reduce public stigma about schizophrenia in western countries. It is important to note, however, that public stigma elicitation is just one of the numerous considerations as regards the utility of label change, and that others, such as consumer perspectives, hold value independent of the current findings. The current findings also highlight that the symptomatology and illness phase of schizophrenia are likely to be implicated in eliciting public stigma about the disorder, and are worthy of further attention. While the current study investigated these phenomena at the broad symptom profile level, future research should investigate individual symptoms and their subtypes discretely, in order to inform a comprehensive, symptom-focussed model of elicited public stigma pertaining to schizophrenia.

Universidad Politecnica
Background: Some naturalistic longitudinal studies of first psychotic episodes of the last 50 years have suggested associations between psychopathology and the remission of symptoms and the clinical course of disease. 1 A recent study in a large sample of patients with schizophrenia has obtained significant results using the number of hospitalizations as outcome variable. 2 The main objective of this study is to know if clinical and sociodemographic variables predict the number of hospitalizations after the first psychotic episode Methods: Naturalistic, longitudinal follow-up study in a sample of 212 patients of first-episode psychosis attending public mental health service in Area 5 of Valencia (Spain) in a period between 2010-2017. Of 212 patients, a total of135 were included, excluding patients lost due to abandonment and death. The study included a) baseline variables: sociodemographic, risk factors (Cannnabis use), clinical scales; PANSS, CGI (clinical global impression) and GAF (global assessment of functioning scale) and kind of treatment (oral versus injectable). b) outcome variables: number of visits to the emergency room, hospitalizations, and outpatient consultations. Results: None of the psychopathological or treatment variables at baseline were significantly associated with the outcome variables. The younger patients have a significant (p < 0.01) higher number of emergencies room visit in the follow up. Discussion: In contrast with previous reports 1,2 Tihonen J et al2017)) we were not able to find any relationship between severity of illness (at baseline) or the kind of treatment (oral versus injectable) with the emergency rooms visits or number of hospitalizations. The only significant result was related with the age of the patients. Younger patients have more probability of having more visit to the emergency room. References: 1. Capdeville D. A multi-dimensional approach to insight and its evolution in first-episode psychosis: a 1 -year outcome naturalistic study. Psychiatry

Sefako Makgatho Health Sciences University
Background: Schizophrenia is a debilitating mental illness that affects people from all walks of life. Individuals attach meaning to their illness based on their cultural point of view; for some traditional black South Africans, causes of ill health are ascribed to culturally laden inferences. Some patients seek spiritual help before consulting medical doctors. This study aimed to