16

patients will be conducted using the Mf scale of the MMPI and a battery of neuropsychological tests. It is predicted that patients with a feminine profile on the MMPI will demonstrate more severe right hemisphere impairment, regardless of sex of subject. A 2 (sex)x2 (gender)x2 (hemisphere) analysis of variance will be used to analyze data.

SYMPTOM DIMENSIONS OF SCHIZOPHRENIA AND CANNABIS ABUSE: A L O N G I T U D I N A L STUDY

D.H. Linszen*, P.M. Dingemans, M.E. Lenior

Academic Medical Center, University of Amsterdam, Division of Psychiatry, Tafelbergweg 25, 1105 BC Amsterdam, The Netherlands

Recent studies have shown that symptoms of schizophrenia can best be described by three (positive, negative and disorgani- sation symptoms) or four dimensions (including depression- related symptoms). We sought to examine the relation between cannabis abuse and the course of these symptoms in recent onset schizophrenia and related disorders. In a prospective cohort study using monthly BPRS-E assessments over a year cannabis-abusing patients (n=24) were compared with non abusers (n = 69). Eleven patients were mild and thirteen heavy cannabis-abusing patients. A main effect of cannabis abuse for the course of disorganisation symptoms was found (p = 0.005). Heavy abusers had a higher score on this syndrome than mild and non-abusers (p=0.003). A trend was found for cannabis abuse and negative symptoms (p=0.08). A trend of intensity of cannabis abuse for the course of positive symptom scores was found (p=0.06). Cannabis abuse and particularly heavy abuse can be considered as eliciting the disorganisation syn- drome of schizophrenia and related disorders. Hypotheses about these findings will be discussed.

THE BEHAVIORAL CORRELATES OF DELUSIONS OF CONTROL IN SCHIZOPHRENIA

Brendan A. Maher* , Theo C. Manschreck, Florence Seung, Ming T. Tsuang

Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA

A group of carefully diagnosed schizophrenic subjects (n = 15) exhibiting delusions of control was compared with a group of similarly diagnosed subjects (n=35) who either did not exhibit any type of delusion, or exhibited delusions other than that of control. It was hypothesized that there would be differences between these two groups in the nature of the defects in performance; specifically, deluded patients would show defects in laboratory assessments of overt behavioral function, i.e., language and motor behavior. Significant differ-

ences were found in measures of derailment, tangentiality, incoherence and repetitiousness in language utterance. Similar analyses were performed between deluded (delusions of persecu- tion, jealousy, and somatic delusions) and non-deluded subjects. The laboratory performance specific to patients with delusions of control was not found to be associated with other types of delusions. These results are discussed in relation to the hypothe- sis that delusions of control may be understood as attempts to explain anomalous behavior.

CONTEXT MEMORY IN SCHIZOAFFECTIVE DISORDER AND SCHIZOPHRENIA

Theo C. Manschreck*, Brendan A. Maher, Scott Beaudette, D e b o r a h R e d m o n d

New Hampshire Hospital 105 Pleasant Street, Concord, NH03301, USA

DSM IV preserves the separation of schizoaffective disorder and schizophrenia, yet validation for this diagnostic distinction remains incomplete. The prevalent view that schizoaffective disorder is a less serious condition than schizophrenia suggests that cognitive disturbance should be less severe and possibly altogether different from that found in schizophrenia. We investigated a well-characterized and distinctive cognitive difficulty in schizophrenia, the relative lack of gain in recall of verbal material when context is increased, in a sample of patients and normal controls. Subjects with schizophrenia (n = 15) were individually matched for age, sex, and context free recall with patients diagnosed with schizoaffective disorder (n = 15) and major depression (n= 15); and with normal controls (n= 15). Patients were also matched on chronicity. The results indicate that schizophrenic subjects experience smaller gains in recall when context is increased compared to depressed and normal controls, a finding consistent with previous results. Schizophrenic and schizoaffective subjects, however, did not differ in recall gain on this task. We conclude that schizoaffective subjects cannot be distinguished from schizophrenic subjects on this characteristic cognitive feature of schizophrenia.

GENDER DIFFERENCES IN SCHIZOPHRENIA: FINDINGS FROM THE DSM-IV FIELD TRIALS

Lynn Marcinko*, Xavier Amador , Michael Flaum, T h o m a s McGlashen , A n a n d a Pandurangi , Delbert Robinson , Mauric io Tohen

Columbia University Department of Psychiatry, New York State Psychiatric Institute, Unit #2, 722 West 168th Street, New York, N Y 10032, USA

This study examined possible gender differences in socio- demographic variables, symptomatology, premorbid function-

17

ing and insight in 221 schizophrenia patients studied for the DSM-IV Field Trials.

The results indicated that males were more often single, unemployed, worked in unskilled labor, received income from SSI or their parents and exhibited impaired overall functioning. However, there were no significant differences in age of onset, duration of hospitalization or number of hospitalizations as has been reported previously. Positive and negative symptoms also differed between the sexes, but not in the manner previously reported. Specifically, men were more likely to have positive symptoms (i.e., thought withdrawal, auditory hallucinations). Interestingly, men also had more Schneiderian first rank symp- toms than women and more commonly showed impairment in goal directed activity than did women. With respect to premor- bid adjustment, the only significant difference was that females were rated as having better psycho-sexual adjustment than males during adolescence. These findings are considered in the context of key methodological problems (i.e., rater bias, medi- cation effects, etc.) associated with investigations of gender differences in schizophrenia. Methodological recommendations for future work are made based on the results found,

T H E R E L A T I O N S H I P B E T W E E N

S C H I Z O P H R E N I A A N D I R R I T A B L E B O W E L

S Y N D R O M E ( I B S )

S. Gup ta , P. Masand*, D. Kaplan , A. Bhanda ry

Department of Psychiatry, SUNY Health Science Center, 750 E. Adams Street, Syracuse, NY 13210, USA

Irritable Bowel Syndrome (IBS) has been reported in 10-22% of adults. Seventy to 90% of patients with IBS who seek medical attention have psychiatric comorbidity, most com- monly major depression. In contrast, very few studies have looked at the prevalence of IBS amongst psychiatric patients.

Methods: Using a semi-structured clinical interview to study the prevalence of IBS, we compared 47 patients seeking treat- ment for schizophrenia to an age and sex matched control group of patients who were seeking treatment in the general physicians office for other medical illnesses. The control group did not have any Axis I disorders. IBS was diagnosed according to the criteria of Drossman et al.

Results: Seventeen percent of patients with schizophrenia met criteria for IBS in contrast to 2.5% of the control group (p=0.02). Patients with schizophrenia and IBS were more likely to report symptoms of back pain, weakness, nocturnal bowel movements as well as a personal history of bowel disease. The onset of schizophrenia preceded the onset of bowel disease in 77.8% of patients with IBS,

T H E D I M E N S I O N S O F F I R S T E P I S O D E

P S Y C H O S I S - - A N E X P L O R A T O R Y F A C T O R

A N A L Y S I S

P.D. McGorry* , R. Bell, P. Dudgeon, H. Jackson

Department of Psychiatry, University of Melbourne, Royal Park Hospital Parkville, Australia 3052

Recent psychopathological research in psychosis has focused upon the syndromal or subdiagnostic level and aims to derive more valid subtypes of psychotic disorder. The present research uses a sample of first episode psychosis (n=369) to examine the syndromal pattern from first principles.

This sample, recruited from a defined catchment area, is not only broadly representative, but has also been very carefully assessed using the Multidiagnostic Instrument for Psychosis, a comprehensive procedure which prospectively collects the psy- chopathology of the first episode.

110 elemental items from the MIP were selected for inclusion in the exploratory factor analysis. A Scree test was employed to identify the optimal number of factors present in the data. A four factor solution was obtained which accounted for 47% of the variance. The factors comprised depression, mania and only two factors covering the remainder of the psychotic spectrum. The first of these was a composite of negative symptoms, motor symptoms and disorganisation, which closely reflected Bleuler's concept of schizophrenia. The second was a combination of Schneiderian first rank symptoms, hallucina- tions and delusions. The results failed to support the 3 syndrome model for non-affective symptoms in this population, and were more consistent with Andreasen's and Crow's original positive negative distinction. Given the size of the sample and the quality of the data this finding has important implications for the conceptualisation of early psychosis.

M I N O R P H Y S I C A L A N O M A L I E S I N T H E

F U N C T I O N A L P S Y C H O S E S : A S S O C I A T I O N S

W I T H C L I N I C A L A N D P U T A T I V E

A E T I O L O G I C A L V A R I A B L E S

J.J. McGra th* , J. van Os, C. Hoyos, P.B. Jones, I. Harvey, R.M. Mur ray

Genetics Section, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK

This study of patients with functional psychoses set out to examine associations between minor physical anomalies (MPAs) and demographic, clinical, CT scan measures, and putative aetiological variables. 157 psychotic patients had minor physical anomalies assessed using a modified Waldrop scale. RDC diagnoses for these patients were: schizophrenia (n = 79), schizoaffective disorder (n = 31 ), mania (n = 24), major depres- sion (n= 13), unspecified functional psychosis (n=8), other organic psychosis (n=2). 63 healthy white controls were also assessed with the modified Waldrop scale. MPAs were not associated with any particular diagnosis. For white subjects, patients had significantly more MPAs than well controls. Anomalies of the palate were the most frequent item reported in patients and controls. For males, there was a weak associa- tion between the presence of MPAs and positive family history of a major psychiatric disorder. Those with MPAs required more frequent and longer psychiatric admissions, and showed impaired ability on a test sensitive to left parietal system function. Within the patient group, there were no associations between MPAs and gender, age at onset, negative symptoms,