Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384 S147

of psychosis and likely sets the stage for later social and occupational dys-

function (Malla&Payne, 2005; Cronblatt et al., 2012). Although adolescence

is a critical developmental period in which social and role skills crystallize,

few previous studies of prodromal phase or psychosis risk syndrome (PRS)

include young adolescents. Objective: To study the functional characteris-

tics of a sample of adolescents with PRS by: (1) comparing their social and

role functioning with an age and gender matched healthy controls (HC) and

(2) examining its clinical and cognitive correlates.

Methods: Sample included 37 PRS subjects (15.5±1.6 years, 41% males)

and 19 HC (15±1.3 years, 21% males) from a prospective longitudinal

study including help-seeking subjects who met PRS criteria (Child and

Adolescent Psychiatry and Psychology departments of Hospital Clínic and

Sant Joan de Déu, Barcelona, Spain). Inclusion criteria: age 10-17 years,

meeting criteria for 1) attenuated positive or negative symptoms in the

previous 12 months, 2) brief intermittent psychotic symptoms, 3) first or

second degree relative with schizophrenia or schizotypical disorder plus

impairment of functioning. Exclusion criteria: IQ<70 and a diagnosis of

neurodevelopmental disorder. For HC subjects, exclusion criteria were hav-

ing 1st or 2nd degree familiar with a psychotic disorder; a diagnosis of

neurodevelopmental disorder and/or IQ<70. The Semistructured Interview

for Prodromal Syndromes and Scale of Prodromal Symptoms (SIPS/SOPS)

were administered. The Social and Role Functioning Scales (GF:S and GF:R)

(Cornblatt et al., 2007) were also administered along with a clinical (K-

SADS-PL) and a cognitive evaluation. The GF:S and GF:R are two measures

of functioning specifically designed to address functioning in the prodromal

phase of the illness. For both scales, scores range from 1 to 10, with 10

indicating superior functioning and 1 representing extreme dysfunction,

with 7 as a cut-off point distinguishing subjects with poor to moderately

poor functioning (scores between 1-6) and scores of 7-10 reflecting good

functioning (Cornblatt et al., 2012).

Results: PRS and HC subjects did not significantly differ in age (t=1.03,

p=0.308) and sex (χ2=2.13, p=0.145). PRS subjects showed lower social

functioning scores than HC (6.19±1.33 vs 8.79±0.53, p<0.001) and worse

role functioning (5.32±1.11 vs 8.05±0.71, p<0.001). A 37.8% of PRS subjects

showed a poor to moderately poor social functioning (HC: 0%) and a 35.1%

a poor to moderately poor role functioning (HC: 0%). Current social func-

tioning of the PRS subjects were negatively correlated with the negative

SOPS subscale scores (r=−0.412, p=0.017) and with the SOPS total score

(r=−0.412, p=0.017), independently from IQ, global cognitive score and

number of current K-SADS diagnostics (partial correlations GF:S with SOPS

negative subscale: rp=−0.458, p=0.032; with SOPS total score: rp=−0.435,

p=0.043). No significant correlates were found with role functioning.

Discussion: Adolescents meeting criteria for PRS showed social deficits

and an impaired age-appropriate role functioning compared with controls.

Poor social functioning but not role difficulties was related to negative and

total prodromal symptoms, independently from other cognitive and clinical

factors. These findings are consistent with the increasing emphasis on func-

tional deficit decline as a critically important characteristic of prodromal

phase of the illness (Cornblatt et al., 2012) and highlight the importance of

early intervention in order to limit current and future functional disability.

Poster #S160

REVIEW OF FALSE NEGATIVES WITH THE COMPREHENSIVE ASSESSMENT

OF AT RISK MENTAL STATE (CAARMS) SCREENING

Sujatha Rao1,2, Lay Keow Lim3, Lye Yin Poon3, Spencer Yuen3,

Santha Pariyasami3, Sarah Ann Tay3, Swapna Verma3

1Department of Early Psychosis Intervention, Institute of Mental Health,

Singapore; 2Assistant Professor, DUKE-NUS Graduate Medical School;3Department of Early Psychosis Intervention, Institute of Mental Health

Background: The CAARMS has been used as a diagnostic tool in the Support

for Wellness Achievement Programme (SWAP), which was initiated in

March 2008 to treat individuals aged 16-30, with At Risk Mental State

(ARMS) in Singapore. This descriptive study evaluates the number of

individuals referred to SWAP, who were not correctly identified (false neg-

atives) as having ARMS who subsequently developed a psychotic disorder.

The sensitivity of CAARMS in predicting psychosis is 83%. Therefore, under-

standing the factors that lead to a false negative detection of ARMS will aid

in improving this screening process and correctly identifying those at risk.

Methods: All individuals referred to SWAP were screened using the

CAARMS and functioning was assessed using the Social and Occupa-

tional Functioning Assessment Scale (SOFAS). Sociodemographic data was

collected using a semi-structured questionnaire. False negatives on the

CAARMS were identified and a review of the medical case notes was done

to identify factors that contributed to a failure of identification of ARMS.

Diagnosis upon conversion to psychosis was assessed using the Structured

Clinical Interview for DSM IV (SCID).

Results: 510 clients were screened and 10 clients were found to be false

negative subsequently, on converting to psychosis. Factors such as age, gen-

der, education and assessing psychiatrist had not influenced the CAARMS

negative status. The 10 clients were aged from 19 to 30 years (mean:

22.8). In 5 clients, the presence of comorbid disorders such as Asperger’s

Syndrome, alcohol dependence, computer addiction and borderline or mild

intellectual disability appear to have clouded the presentation in addition

to a lack of attenuated psychotic symptoms (APS). However, there was a

poor baseline or decline in functioning although this was attributed to the

comorbidity during the assessments. One of these clients with borderline

intellectual disability had no decline in functioning or APS but had a history

of Schizophrenia in his parents and this client was subsequently diagnosed

with Schizophrenia. Two clients had APS and Brief Limited Intermittent

Psychotic Symptoms (BLIPS) but were deemed to be negative on CAARMS as

there was no functional decline. In 1 client, there was a lack of attenuated

psychotic symptoms and the functional decline was attributed to major

interpersonal family conflicts. In the remaining 2 clients, there was no APS,

BLIPS or functional decline. Out of the 10 clients, 6 were subsequently

diagnosed with Schizophrenia, 1 with Schizoaffective Disorder, 1 with

Bipolar Disorder, mania with psychotic symptoms and 2 with Psychosis Not

Otherwise Specified.

Discussion: The above findings indicate that comorbidity (5/10) often

clouds the presentation of ARMS through its symptomatology and effect

on functioning which may lead to a false negative finding on CAARMS.

Although functional decline in the absence of clear attenuated symptoms

(1/10) and BLIPS/APS in the absence of functional decline (2/10) do not

fulfill criteria for CAARMS, we may need to monitor these clients closely

particularly as the BLIPS subgroup is at highest risk of conversion. This

reflects that intact functioning may mask underlying symptoms in the early

phase of the prodrome. Therefore although the CAARMS is fairly effective

in indentifying ARMS, clients that do not meet the criteria may still need to

be monitored closely.

Poster #S161

A JOINT LATENT CLASS MODELLING APPROACH FOR THE PREDICTION OF

PSYCHOSIS BY BASIC SYMPTOM AND ULTRA-HIGH RISK CRITERIA

Stefanie J. Schmidt1, Stephan Ruhrmann2, Benno G. Schimmelmann1,

Joachim Klosterkötter2, Frauke Schultze-Lutter1

1University Hospital of Child and Adolescent Psychiatry and Psychotherapy

Bern, University of Bern; 2Department of Psychiatry and Psychotherapy,

University of Cologne, Cologne, Germany

Background: Basic symptom and ultra-high risk (UHR) criteria are com-

monly used for the prediction of psychosis. However, most studies have

assessed these criteria at one specific moment in time. Thereby, they ne-

glected that the dynamic pattern of at-risk criteria rather than their current

level may be most predictive for the onset of a first psychotic episode. We,

therefore, studied how the repeated marker and the risk of the event (i.e.

onset of psychosis) are linked, in order to propose a dynamic prognostic

tool for the prediction of first-episode psychosis.

Methods: In a naturalistic 24-month follow-up study, 146 patients at-risk

for psychosis according to UHR and/or basic symptom criteria were repeat-

edly examined in an early detection of psychosis service (FETZ Cologne) for

the conversion rate to first-episode psychosis (German version of the Struc-

tured Clinical Interview for DSM-IV; SCID-I), basic symptoms (Schizophrenia

Proneness Instrument, Adult version; SPI-A), and UHR criteria (Structured

Interview of Prodromal Syndromes; SIPS). Joint latent class analysis was

applied 1) to define a model for the time-to-event, 2) to define a model

for the marker trajectory, and 3) to link both models using a shared latent

structure.

Results: Results: The joint latent class model with the best fit to the

data included three latent classes (basic symptoms, attenuated psychotic

symptoms, and a combination of basic symptoms and attenuated psychotic