S183 SU60. RISK AND PROTECTIVE FACTORS ...

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Mar 4, 2018 - Donna Lang1, Alasdair Barr1, Tari Buchanan1,. William MacEwan1, William Panenka1, Allen Thornton2, and. William Honer1. 1The University ...
Posters (Sunday) S183

SU60. RISK AND PROTECTIVE FACTORS ASSOCIATED WITH PSYCHOTIC SYMPTOM PROFILES OF MARGINALLY HOUSED ADULTS Andrea Jones*,, Kristina Gicas2, Ric Procyshyn1, Geoff Smith1, Fidel Vila-Rodriguez1, Olga Leonova1, Verena Langheimer1, Emma Mitchell1, Arun Dhir1, Taylor Willi1, Toby Schmitt1, Donna Lang1, Alasdair Barr1, Tari Buchanan1, William MacEwan1, William Panenka1, Allen Thornton2, and William Honer1 1 The University of British Columbia; 2Simon Fraser University Background: This study examined the characteristics and associated risk and protective factors of distinct psychotic symptom profiles exhibited by marginally housed adults. Methods: The Hotel Study is a longitudinal observational study of adults living in marginalized housing. Five psychosis symptoms (delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content) from the Positive and Negative Syndrome Scale (PANSS) were assessed monthly. Sociodemographic, psychiatric, medical, developmental, social, and substance use factors were also assessed. Two-step cluster analysis was employed to identify groups of people that shared similar symptom profiles at the time of their maximum (MaxTime) and minimum (MinTime) total symptom severity (PANSS) in 1 year. Multinomial logistic regression analysis was used to estimate the associations between factors and cluster membership. Paired Wilcoxon and McNemar’s tests were used to compare substance use at MaxTime and MinTime within each cluster. Results: In the first year of study, 404 participants had at least three 5-item PANSS assessments. Cluster analysis of the PANSS scores identified 3 clusters at MaxTime. The Severe Cluster (n  =  74) endorsed severe psychosis symptoms, while the Variable Cluster (n  =  147) endorsed supra-threshold delusions and hallucinations only. The Low Cluster (n = 183) did not endorse psychosis at MaxTime. Variable Cluster membership was associated with methamphetamine (OR, 95% CI: 2.28, 1.26–4.10) and cannabis use in the past week (OR, 95% CI: 2.69, 1.39–5.24), a history of traumatic brain injury (OR, 95% CI: 3.14, 1.41–7.01), and low social support at study entry (OR, 95% CI: 0.79, 0.63–0.99). The Variable Cluster experienced frequent transitions between psychotic and nonpsychotic states (median, IQR: 3, 1–5; P < .001), possibly exacerbated by methamphetamine (X2 = 6.86; P = .009) and alcohol use (X2 = 7.90; P = .005). Severe Cluster membership was associated with antipsychotic treatment (OR, 95% CI: 7.34, 3.21–16.81), methamphetamine (OR, 95% CI: 2.84, 1.36–5.90) and cannabis use in the past week (OR, 95% CI: 2.69, 1.39–5.24), and low social support at study entry (OR, 95% CI: 0.73, 0.53–0.99). The Severe Cluster had high rates of primary psychosis diagnosis (P < .001) and poorer psychosocial functioning (P < .001) than the Low Cluster. Symptoms may be exacerbated by recent cannabis (X2 = 5.06; P = .024), opioid (X2 = 4.00; P = .046), or alcohol use (X2 = 4.65; P = .031), but may be unaffected by methamphetamine (X2 = 0.44; P = .505) and antipsychotic use (X2 = 0.00; P = 1.000) in the Severe Cluster. Conclusion: A subset of marginally housed adults living with complex multimorbid illness experience severe psychotic symptoms that may be unresponsive to both antipsychotic treatment and methamphetamine use. These individuals may need alternative or additional forms of mental health care and rehabilitation support.

SU61. RACE/ETHNICITY AND PREMATURE MORTALITY IN SEVERE MENTAL ILLNESS: COHORT STUDY Jayati Das-Munshi*,, Chin Kuo Chang1, Rina Dutta1, Craig Morgan1, James Nazroo2, Robert Stewart1, and Martin Prince1 1 King’s College London; 2University of Manchester

Background: Excess mortality in severe mental illnesses (SMI) (schizophrenia-spectrum and bipolar disorders) is well described. Little is known about this inequality in ethnic minorities. The aim of this study was to assess mortality in SMI by ethnicity (White British, Black African, Black Caribbean, South Asian, Irish) and assess social and clinical risk factors for excess mortality. Methods: We identified a cohort of 25 871 individuals with a valid SMI diagnosis (January 1, 2007 to December 31, 2014), using a case registry from a secondary mental health care provider covering 1.36 million people in the UK. All-cause and cause-specific mortality by ethnicity, standardized by age and gender to the population of England and Wales in 2012, was determined. Risk factors for mortality in SMI were assessed using regression methods. Results: There were 1767 deaths within the cohort (14.6%). Compared to the general population, age and gender-standardized mortality ratios (SMRs) in the SMI population were high; SMRs by cause for the full sample were— Suicide: SMR 7.65, 95% CI: 6.43–9.04; nonsuicide unnatural-cause mortality: SMR 4.01, 95% CI: 3.34–4.78; respiratory disease: SMR: 3.38, 95% CI: 3.04–3.74; cardiovascular disease: SMR 2.65, 95% CI: 2.45–2.86; and neoplasms: SMR 1.45, 95% CI: 1.32–1.60. SMRs were broadly similar when stratified by ethnicity, although a lower SMR for neoplasm-mortality in the South Asian SMI group (SMR 0.49, 95% CI: 0.21–0.96) was evident. Within the SMI cohort, hazard ratios (HRs) for all-cause mortality and sub-hazard ratios for natural/unnatural-cause mortality were lower in most ethnic minority groups relative to the White British group. For example, relative to the White British group with SMI (reference), HRs for all-cause mortality by ethnicity were 0.67 (95% CI: 0.56, 0.81) (Black Caribbean), 0.43 (95% CI: 0.30, 0.64) (Black African), 0.73 (95% CI: 0.51, 1.04) (South Asian), and 0.88 (95% CI: 0.62, 1.25), after adjusting for age, gender, marital status, area-level deprivation, diagnosis, and comorbid substance use. There were similar trends by ethnicity for natural-causes mortality and unnatural-causes mortality (including suicide and deaths from other external causes). Conclusion: Relative to the general population, people with SMI experience excess mortality, irrespective of ethnicity. Within a cohort of people with severe mental illness, some ethnic minorities experienced reduced mortality compared to the reference White British population. This may be due to socioenvironmental factors that require further exploration.

SU62. THE 40-HZ AUDITORY STEADY-STATE RESPONSE: A SENSITIVE AND PREDICTIVE BIOMARKER OF PERCEPTUAL LEARNING DURING COGNITIVE TRAINING Wen Zhang*,, Alexandra Shiluk2, Sonia Rackelmann1, Melissa Tarasenko2, Michael Thomas1, Andrew Bismark2, Yash Joshi1, Joyce Sprock1, Amy Taylor1, Cassandra Kauffman3, Lauren Cardoso3, Aria Nisco4, Janet Hsiao5, Neal Swerdlow1, and Gregory Light2 1 University of California, San Diego; 2VA San Diego Healthcare System; University of California, San Diego; 3Alpine Special Treatment Center, Inc.; 4University of San Diego; 5University of Hong Kong Background: Disturbances of auditory perception are characteristic features of schizophrenia (SZ) and contribute to cognitive and functional disability. Targeted Cognitive Training (TCT) of the auditory system has shown great promise for remediating cognitive impairments in SZ, but training-associated gains vary across individuals and are difficult to predict in the early stages of treatment. The Auditory Steady State Response (ASSR) to gamma-frequency stimulation is increasingly used as a functional biomarker of central auditory system plasticity in translational

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