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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S8–S52


literature review and additional analyses of SFBN



BD usually begins with a depressive episode. SFBN-data

reveal that an earlier AoO is associated with a less favourable

prospective illness course (more depression, mood instability and

rapid cycling), longer delay to first treatment, past history of sui-

cide attempts, being abused in childhood abuse, more psychiatric

and medical comorbidities. Comparison of the US sample with the

European sample of SFBN showed an earlier onset in US patients.


and early AoF of BD is associated with a poorer long-

term outcome, despite adequate current treatment.

Disclosure of interest

The author has not supplied his declaration

of competing interest.


Age at the onset of a first episode of

psychotic mania: Does it have an

impact on outcome?

P. Conus

1 ,

, S.M. Cotton


, P.D. McGorry



Lausanne University, Department of Psychiatry, Prilly, Switzerland


Orygen Youth Health, Psychiatry, Melbourne, Australia

Corresponding author.


Studies conducted in child psychiatry suggest that

patients with earlier onset of psychosis have poorer outcome.

Similar findings have been published regarding onset of bipolar dis-

order. However, few studies have been conducted in youth mental

health program where these patients may actually receive treat-

ment. Identification of subgroups with distinct need and outcome

among first episode mania patients would facilitate the develop-

ment of specific treatment strategies better suited to the actual

needs of patients.


Sixty-seven patients with a first episode of psychotic

mania were followed up over 12 months after recovery from this

initial episode. Syndromic and symptomatic outcome were deter-

mined with the brief psychiatric rating scale, functional outcome

with the quality of life scale and premorbid adjustment scale sub



While 90% of patients achieved syndromic recovery (dis-

appearance of manic syndrome) at 6 and 12 months, 40% had not

recovered symptomatically, still presenting with depression and

anxiety. Return to previous level of functioning was achieved only

by 34% of patients at 6 months and 39% at 12 months. Age at the

time of first manic episodewith psychotic features was a significant

predictor of recovery of functional level.


While manic symptoms reduce quickly in most

patients after a first episode of psychotic mania, an important num-

ber of patients still display symptoms of depression and anxiety

after 12 months and 2/3 do not reach functional recovery. Younger

age at first episode predicts risk of poorer functional outcome.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

Symposium: Negative symptoms:

phenomenology, clinical aspects and



Clinical psychopathology of negative

symptoms: A phenomenological


A. Raballo

University of Oslo, Norwegian Centre for Mental Disorder Research

NORMENT, Oslo, Norway

Negative symptoms encompass a broad constellation of psycho-

behavioral phenomena, including affective flattening, poverty of

speech, alogia, avolition, social withdrawal, apathy and anhedonia.

These phenomena obviously exert a substantial impact on per-

sonal autonomy, quality of life and broad functional outcomes,

ultimately being an important challenge for clinical decision-

making and therapeutic support. In recent years, the attention to

negative symptoms in schizophrenia has revamped, boosting the

development of newrating tools aswell as a broader conceptualiza-

tion of derivative constructs (e.g. apathy, amotivation, anhedonia).

However, despite its behavioral expressivity, the in-depth phe-

notypic characterization of negative symptoms remains partly

unaddressed. Similarly, their clinical intertwining with other non-

productive clinical features (e.g. anomalous subjective experiences,

cognitive-perceptual basic symptoms and schizotypal features) is

generally overlooked. Therefore, the current presentation specifi-

cally offers a stratified overview of the phenomenology of negative

symptoms filtered through lens of clinical psychopathology.

Disclosure of interest

The author has not supplied his declaration

of competing interest.


The Evolution of negative symptom


A. Mucci

, S. Galderisi

University of Campania “Luigi Vanvitelli”, Department of Psychiatry,

Naples, Italy

Corresponding author.


Negative symptoms represent a separate dimension

of schizophrenia psychopathology, distinct from positive symp-

toms, disorganization and cognitive impairment. It is increasingly

acknowledged that negative symptoms are associated with poor

functional outcome and represent an unmet need in schizophre-

nia treatment. Improvement in definition of their phenomenology,

assessment instruments and experimental models are needed in

order to improve schizophrenia prognosis.


The presentation will review key aspects of the evolution

of negative symptom constructs. In particular, findings concerning

phenomenology, clinical assessment, association with functional

outcome and brain imaging correlates will be presented.


We searched PubMed for English full-text publications

with the keywords

Schizophrenia AND “negative symptoms”/“primary negative

symptoms”/“deficit schizophrenia”/“persistent negative symp-

toms”/“affective flattening”/alogia/“expressive deficit”/apathy/

asociality/“social withdrawal”/anhedonia/“anticipatory anhedo-



The distinction between secondary negative symptoms

(i.e., those due to identifiable factors, such as drug effects, psy-

chotic symptoms or depression), andprimary or persistent negative

symptoms (i.e., those etiologically related to the core pathophysi-

ology of schizophrenia) is grounded on solid research evidence and

might have major implications for both treatment development

and clinical care. The evidence that negative symptoms cluster in

motivation- and expressive-related domains is founded on large

consensus and empirical evidence and will foster pathophysio-

logical modeling. The motivation-related domain is a stronger

predictor of functional outcome than the expressive one.


An improved definition and assessment of negative

symptoms needs to translate in large-scale studies to advance

knowledge. In the short-term, the improved identification of treat-

able causes of secondary negative symptoms can translate into

better care for people with schizophrenia.