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SIRS 2020 Abstracts
S228 Poster Session II
Discussion: The current study examined the associations between race,
trauma, PEs, discrimination, and psychiatric treatment-seeking in col-
lege students with high levels of psychosis-like experiences. Self-reported
PE scores and race were signicantly associated with all treatment-seeking
variables, while experiences of discrimination were not signicantly asso-
ciated with help-seeking. Results suggest race-related disparities in help-
seeking patterns among college-educated youth and young adults. These
ndings have implications for engaging racial and ethnic minorities in mental
health treatment who are experiencing psychosis-like symptoms to alleviate
these symptoms and any associated functional impairments or distress.
M242. PREDICTORS OF CRIMINAL SENTIMENTS
SCALE (CSS-M) SCORES AMONG OUTPATIENTS
WITH PSYCHOTIC DISORDERS
Adria Zern*1, Luca Pauselli2, MichaelT. Compton3
1College of Physicians and Surgeons, Columbia University/New
York State Psychiatry; 2Icahn School of Medicine at Mount Sinai;
3Columbia University
Background: Individuals with serious mental illness (SMI) are over-represented
in the criminal justice system. One factor that impacts likelihood of incarcera-
tion is criminal thinking, and the Criminal Sentiments Scale – Modied (CSS-
M) has been shown to predict recidivism. However, no one has examined the
CSS-M in outpatients with schizophrenia and other psychotic disorders, and
little is known about what predicts high CSS-M scores.
Methods: The data for the current investigation comes from a larger sample
of individuals with SMI receiving services from outpatient mental health
clinics who were enrolled in a randomized-controlled trial. The CSS-M
was verbally administered to everyone during a baseline assessment. The
264 individuals in the sample all have a diagnosis of schizophrenia or an-
other psychotic disorder, and all had been arrested in the last ve years. We
rst explored the impact of demographic factors and adverse childhood
experiences (ACE) on CSS-M scores. For the 258 participants with com-
plete data for all ve sub-scales (attitudes towards law, attitudes towards
courts, attitudes towards police, tolerance for law violations, and identi-
cation with criminal others), we conducted a hierarchical analysis using
Ward’s method to explore and dene the number of clusters. We deter-
mined the number of clusters using the Elbow method. We then repeated
the cluster analysis using a non-hierarchical method with the K-means
technique and xing the number of clusters tothree.
Results: The current sample exhibited considerably higher CSS-M scores
than those previously published (mean=32.0±14.4). The total CSS-M score
demonstrated high reliability (alpha= 0.898), and four of the sub-scales
exhibited moderate to high reliability (α,Law= 0.741; α,Courts =0.808;
α,Police=0.762; α,TLV=0.696). When controlling for age, race, gender,
and ACE score, the multiple linear regression model accounted for 8.6% of
the variability in total CSS-M score (p < 0.001), though only ACE score and
age were signicant predictors (β=0.218, p=0.001; β=-0.167, p=0.008,
respectively). The cluster analysis produced three clusters. Given that the
ICO sub-scale had the lowest Cronbach’s alpha (α=0.328), we repeated the
cluster analysis process with the four other sub-scales, which conrmed the
three clusters. An ANOVA with the four sub-scales and total CSS-M score
showed that the three clusters could be dened as those with low, medium,
and high scores on the scales. Conrming the results from the MLR, an
ANOVA of the three clusters with ACE scores (F= 4.49, p=0.012) and age
(F=3.77, p=0.024) were both signicant.
Discussion: The average total CSS-M score is considerably higher than pre-
vious investigations. Both high ACE scores and younger age signicantly
predicted higher CSS-M scores. Because CSS-M scores have been shown
to predict recidivism, it is critical to further understand the foundation of
these negative attitudes towards the criminal justice system to prevent the
continued over-representation of people with serious mental illness in the
criminal justice system.
M243. EFFECTIVENESS AND SATISFACTION
WITH ASCHIZOPHRENIA RECOVERY DAY
PROGRAM
Lisa Murata*1, Jaime Jones1, Alexandra Baines1,
Carrie Robertson1, Karen Daley1
1Royal Ottawa Mental Health Centre
Background: Schizophrenia is a complex disorder typically dened by the
presence of positive symptoms that include hallucinations, delusions, and
disorganisation in speech and behaviour, negative symptoms of avolition and
social withdrawal, and a decline in functioning. Despite an ability to treat clin-
ical symptoms, functional recovery in schizophrenia remains poor. The Recovery
Day Program at the Royal Ottawa Mental Health Centre is a multi-disciplinary
intervention tailored to help people living with schizophrenia attain recovery
goals, lead more satisfying lives, engage in activities, develop a social network and
assist in community reintegration. Eligibility criteria are: 18years of age or older,
meet DSM V criteria for Schizophrenia Spectrum illness, have clinical needs that
cannot be met in the community, have housing, require intensive recovery sup-
port/integration into community, be able to engage in day hospital programming
and develop recovery goals. Maximum number of day clients in Day Program is
20. Client admissions began in June 2016. As of November 2019, there have been
50 admissions with 29 discharges. Age range of clients was 20–60years (mean
36.5). Clients were invited to provide feedback on their experience with the Day
Program for program evaluation and improvement of service.
Methods: A qualitative and quantitative evaluation of functional outcomes and
patient satisfaction was conducted. Measures were administered at admission
and discharge: The Illness Management and Recovery Scale (IMRS), a custom-
generated activity and goal attainment scale, Quality of Life Scale, The World
Health Organization Disability Assessment Schedule 2.0, the Modied Global
Assessment of Functioning Scale and the Clinical Global Impression Scale. The
Ontario Perception of Care Survey for Mental Health and Addictions (OPOC)
was administered during a two month period from January2019.
Results: Discharge results were available for 29 individuals out of 50
admissions. Clients identied goals in areas including vocational, social,
educational, symptom management, optimizing independence, minimizing
substance use, managing nances and stable housing; group and individual
interventions targeted these areas. Interventions occur at the hospital and in
the community. Results of the activity summary identify signicant change
in community integration in the following areas: employment (admission 5%
and discharge 47%), unpaid/volunteer work (admission 11% and discharge
42%), course or study (admission 0% and discharge 32%), social/recreation/
group activities (admission 63% and discharge 100%). Results show a signif-
icant increase in IMRS scores over time. Goal achievement was statistically
signicant according to the goal attainment scale (mean at intake 3.4 and at
discharge 8.6). Results show that goal importance did not change overtime.
Open ended questions about day programming were added to the OPOC. Of
15 respondents, the average length of time in the Program was 16 months.
Majority of respondents attended as much as they liked, while those unable
to attend as much as they wanted, identied that increased attendance may
have been helpful to achieving theirgoals.
Discussion: Overall, clients were very satised with services provided. There were
signicant achievements in goal attainment over time with targeted interventions
provided in functional domains including employment, unpaid/volunteer work,
course of study and social/recreation activities. Our data suggest that a medium
term, intensive day program increases functional outcomes and personal satis-
faction for individuals with a Schizophrenia Spectrum disorder. Further study
would be important to assess how these changes are sustained overtime.
M244. PENNSYLVANIA FIRST-EPISODE PROGRAM
EVALUATION OF COORDINATED SPECIALTY
CARE: SIX- AND 12-MONTH OUTCOMES
Monica Calkins*1, Megan Westfall1, Irene Hurford1
1University of Pennsylvania
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SIRS 2020 Abstracts
Poster Session II S229
Background: Interest in early intervention for rst-episode psychosis (FEP)
has increased globally in recent decades in response to evidence that multi-
component programs may reduce individual and societal burden of psy-
chotic disorders. In 2016, the Pennsylvania (PA) Ofce of Mental Health
and Substance Abuse Services (OMHSAS) provided funding to develop a
statewide Program Evaluation (PE) initiative. PA-FEP-PE assesses benets
of nine PA coordinated specialty care (CSC) programs both individu-
ally and in aggregate. We previously (SIRS 2019)presented preliminary
data from initial participants. We now present data from 598 participants
enrolled acrossPA.
Methods: Our CSC programs serve youth age 12–34 experiencing early
psychosis onset between 12–24 months before admission. Services, in-
cluding pharmacotherapy, CBT-based psychotherapy, case management,
supported employment and education, peer support, and multi-family
groups and psychoeducation, are offered for >=2years. Participant char-
acteristics at referral, admission, follow-up and discharge are collected
via standardized computerized (REDCap) forms. The computerized
clinical battery, administered at admission and at 6-month follow-up
intervals, is composed of measures selected for domain coverage, clin-
ical utility, reliability/validity (from the PhenX toolkit), practical utility,
low burden, and high utility to multiple stakeholders. Domains include
symptoms and diagnosis (Brief Psychiatric Rating Scale, Beck Depression
Inventory-7, Hopelessness Scale, Self-Esteem-Scale-Revised, Loneliness
Scale, Defeatist Beliefs Scale, Post-Traumatic Stress Disorder Symptom
Scale), psychosocial functioning and recovery (Global Function Role
and Social Scales, Psychosis Recovery Assessment Questionnaire,
Quality of Life Functional Assessment, Systematic Clinical Outcome
Routine Evaluation), medication side effect monitoring (Extrapyramidal
Symptom Rating Scale, Glasgow Antipsychotic Side Effect Scale), and
service quality and satisfaction (Youth Services Survey).
Results: Between 1/1/17-7/1/19, 1,917 referrals were received, of whom 598
participants (mean age=21.1 SD=4.5; 35% female; 45% Caucasian, 41%
African-American) were enrolled. Unspecied/other psychotic disorder
was the most common diagnosis at admission (48%). Mean age at psy-
chosis onset was 20.2years (SD=4.6). An average 13.7 (SD=21.8) months
lapsed between symptom onset and admission. The majority (78%) of
participants had prior hospitalizations. At admission, participants
showed moderate severity of psychiatric symptoms, serious impairment
in global role and social functioning, and 72% reported experiencing >=1
traumatic events. At 6-month follow-up, participants (n=142) exhibited
several signicant improvements, including decreased hospitalizations
and hospitalization days, suicidal ideation, substance use, overall psycho-
pathology, and positive psychosis symptoms, and increased employment
and school enrollment, global role and social function, self-rated quality
of life, medication side effects, and satisfaction with mental health serv-
ices. Individuals who engaged for 12months (n=60) continued to main-
tain signicant improvement in clinical features.
Discussion: PA-FEP-PA is a comprehensive model yielding clinical and
functional improvements after 6 and 12 months of CSC participation.
Continued data collection will enable increased power to analyze popu-
lation and site differences to illuminate mediators and moderators under-
lying individual variations and improve personalized prediction of salient
outcomes. Further, the PA-FEP-PE model offers PA CSC programs a col-
laborative learning network for ongoing quality improvement.
M245. AN RCT PROTOCOL OF HYBRID-ECT FOR
SCHIZOPHRENIA
Han Rong*1
1Shenzhen Kangning Hospital
Background: Electroconvulsive therapy (ECT) is an rapid and effective
treatment for schizophrenia patients, ECT may achieve signicant anti-
psychotic effects in the several initial sessions, but signicant side effects
limit its use. However, our low-charge electrotherapy (LCE) pilot trial
demonstrated antipsychotic effects with signicantly fewer side effects. The
aim of this trial is to propose a novel two-step charge set strategy for ECT
treatment, referred to as Hybrid-ECT, try to decrease side effects by using a
lower charge while preserving treatment efcacy.
Methods: A randomized, double-blinded, standard-controlled, parallel-group
design will be used. We plan to enroll 62 inpatients diagnosed with acute
schizophrenia and randomly assign them to routine ECT (control group) or
to Hybrid-ECT (treatment group, 3 ECT sessions followed by LCE sessions
(approximately half of seizure threshold per session)). The primary outcome
measure is the change in total PANSS score after the last ECT/LCE session.
The secondary outcome measures include the response rate, remission rate,
CGI, auditory hallucination rating scale, and everyday memory questionnaire
(EMQ) scales. Neuropsychological metrics include the repeatable battery for
the assessments of neuropsychological status (RBANS) and the stroop test,
and detailed side effects will be evaluated. Structure and functional magnetic
resonance imaging (MRI) assessments during treatment will be performed to
explore brain changes between ECT and hybrid-ECT groups. The follow-up
phase is set at the one-month after the last ECT/LCE session
Results: No results.
Discussion: This research will propose a simple but completely novel ECT
strategy that aims to rapidly relieve psychosis symptoms and minimize side
effects. If Hybrid-ECT is found to have the potentiality mentioned above,
this could have important implications for future ECT strategies in treating
schizophrenia patients in the acute phase. In addition, by using the detailed
neuropsychological assessments and MRI scanning, this study may im-
prove the knowledge of ECT-related antipsychotic mechanisms.
M246. DIGITAL SELF-MONITORING AND
EMBODIMENT IN FIRST EPISODE PSYCHOSIS:
ETHICAL CONSIDERATIONS
Susan Berkhout*1, Juveria Zaheer2, Gary Remington1
1University of Toronto; 2Centre for Addiction and Mental Health,
University of Toronto
Background: Smartphone technology has seen expanding interest across nearly
all areas of medicine, including psychiatry, where app-based technologies fre-
quently function as proxies for digitized behavioural phenotypes (Firth and
Torous 2015). In the area rst episode psychosis especially, there has been a
rising interest in the use of digital platforms for patient self-management as well
as for assessment of symptom domains (Ben-Zeev etal. 2014; Bell etal.2018).
Methods: This paper discusses ndings from a 3year-long ethnographic
study carried out within a rst episode psychosis program in Toronto,
Canada, in combination with a discourse analysis of the clinical and re-
search literature relating to the use of self-monitoring technologies within
rst episode psychosis contexts. The qualitative data consists of formal
and informal interviews with psychiatric service users, family members,
and clinicians (n=45 interviews), in addition to observational eld work
within the clinical setting. Data were analyzed thematically within an
interpretivist-constructivist frame, and triangulated through reexive eld
notes, member-checking, and the authors’ clinical experience within the
eld. Themes were reviewed with senior clinicians in the rst episode clinic
setting as well as psychiatric service users for reliability and delity.
Results: Self-monitoring technologies are increasingly used in both research
and clinical care settings, most frequently related to the management of med-
ication side effects and the tracking of the phenomenological aspects of psy-
chotic and psychotic-like experiences. The uptake of these technologies by
psychiatric service users in this setting was varied: at times, symptom and side
effect tracking faciliated conversations about uncomfortable topics such as
sexual side effects of antipsychotics, while in other instances the use of self-
monitoring technologies was intrusive. Challenges with self-monitoring were
likely to arise when issues relevant to understanding complex phenomena such
as medication adherence were prematurely narrowed or when experiential
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