2. Phenomenology 25 NEUROLOGICAL SOFT SIGNS IN SCHIZOPHRENIA, SCHIZOAFFECTIVE AND BIPOLAR DISORDER: DIAGNOSIS, ASYMMETRY AND GENDER J. Quinn,* R J. Scully, A. Kinsella, J. M. Owens, J. L. Waddington Stanley Research Unit, St Davnet's Hospital, Monaghan, Co. Monaghan, Ireland Though neurological soft signs [NSS] have been studied widely in schizophrenia [SZ] as an index of neuronal dysfunction, less is known of their relative status in bipolar disorder [BP] and, particu- larly, in schizoaffective [SA] disorder. Clarification of these issues is predicated on systematically coIlected, comparative data within an epidemiologically complete population. We have previously identi- fied and assessed the cognition and psychopathology of "all" 214 cases of such psychosis [109 SZ, 32 SA, 73 BP] within a rural Irish catchment area, population 29, 542. Among this cohort, it was pos- sible to follow up 163 cases [83 SZ (age 55. l, SD 15.5), 28 SA (age 55.0, SD 15.3), 52 BP (age 51.8, SD 13.6)]. NSS were assessed using the Condensed Neurological Evaluation [CNE; Rossi Scale] and the Neurological Evaluation Scale [NES]; general cognitive function was assessed using the Mini-Mental State Examination [MMSE]. Principal component analysis of the CNE over all assessed cases, independent of diagnosis, revealed a polyfactorial solution: a pri- mary [P] factor on which loaded the majority of variables; particu- lar exceptions were Suck Reflex-left/right [SUC-L/R], Nystagmus- left/right [NYS-L/R] and Palmomental Reflex-left/right [PMT-L/R], each of which loaded as independent factors. In SZ, P, NYS-L/R, PMT-L/R and SUC-L were evident with SUC-R absent. In SA, P included SUC-L with SUC-R absent, PMT-L/R was evident but NYS-L/R was absent. In BE P included SUC-L/R, but NYS-L loaded with PMT-L/R while NYS/R loaded independently. Using the CNE and NES, NSS score was greater in SZ than in BP [P<0.05] with SA intermediate. However, among males, NSS score in SA was closer to that in SZ, while among females, NSS score in SA was closer to that in BR Using the MMSE, cognitive function score was lower in SZ than in SA or BP [P<0.05]. However, among males, MMSE score in SA was intermediate to SZ and BE while among females, MMSE score in SA was similar to that in BP and higher than that in SZ ]P<0.05]. NSS in SZ, SA and BP share "core" characteristics but also differ in aspects of detail, particularly in relation to asymme- tries in SUC, NYS and PMT. Whether NSS and MMSE scores in SA are more similar to SZ or BP appeared influenced by gender. Both asymmetry and gender may be relevant to how profiles of NSS dif- fer across psychotic diagnoses. These studies were supported by the Stanley Medical Research Institute. CLINICAL COURSE PATTERNS OF SCHIZOPHRENIA E. Radulescu,* E. Vlad, D. Ionescu Clinical I Department of Psychiatry, Hospital Pro~essor Al. Obregia, Bucharest, Romania The objective of the study was to identify clinical course patterns of schizophrenia. 86 patients with DSM-1V diagnosis of schizophrenia were assessed regarding several course characteristics: age at first hospitalization, years of evolution, number of admissions from onset to the index evaluation, pattern of illness onset - acute vs. insidious, presence and duration of a prodromal phase, and premorbid adjust- ment. A cluster analysis performed upon these characteristics iden- tified four clusters of patients. The symptoms at index evaluation were assessed as scores of five factors derived of principal compo- nent analysis of PANSS items (negative, disturbed relating, disor- ganization, positive and depression/anxiety). The patients were also characterized according to longitudinal course specifiers and cluster membership by longitudinal coarse was examined. The main results are presented in the table. Comparison of the PANSS factors scores between the clusters revealed significant differences between clus- ters I and II regarding disturbed relating (3.06 vs.2.28, p=0.044) and depression/anxiety (1.72 vs.2.25, p=0.038) and between clusters I1 and III, regarding the negative factor (4.11 vs.4.64, p=0.034) and depression/anxiety (2.25 vs. 1.76, p=0.046). The conclusions sup- ported by these results are: 1. Previously described course patterns are basically confirmed (clusters I, II and,excepting the poor pro- morbid adjustment, cluster III). 2. The course pattern suggested by cluster IV differs from expected patterns through high scores for dis- organization and depression/anxiety of PANSS factors. Reference: Schultz KS, Miller DD, Oliver SE, Arndt S, Flaum M, Andreasen N: The life course of schizophrenia, age and symptom dimensions, Schizophrenia Research, 23 (1997), 15-23. Cluster l Cluster II Ct~ste, III Cluster IV Nutllber of 22 40 15 9 patients Onset pntlern Acute late Insidious early Insidious late Insklious-late PIodroma] phase 0 05-1 years >2 ycills 1.5 yekllS duration Nunlber of admisxiolls 1 2/year < l/year [-2/yem > 2/year Average years ol 7,4 2 4 03) [0 evolution Preoaorbid Adjustment Scale 0.41 0.43 068 0,43 ~core Negative factor 431 4.1 I 4.64 4.5 score ])islurbed relatillL2 3,06 2,28 2.4 2.63 [actor score Disorganizatkm 326 2,88 3.1 I 3.43 factcir ~colc Positive factOl 3.53 3.2 3.72 3,35 seom Depression anxietyq Rotor 172 2.25 1.76 2.16 ~ct~re 61 '/~ with episc:dic 46% wittl fils~ 53% with 666~ wi~h episodic l,ol/gitudiual COtllSe and episode, 31 r f wilh conlP/tlouh COUlSe and COUlee inter-episodic episodic course and intci -episodic course deficit inter-episodic deficit deficit RISK FACTORS FOR COMPLIANCE WITH HARMFUL COMMAND HALLUCINATIONS IN PSYCHOTIC DISORDERS E Shawyer,* A. Mackinnon, J. Farhall, R Mullen, E. Sims, S. Blaney, E Yardley, M. Daly, D. Copolov Mental Health Research Institute, Parkville, V1C, Australia The aim of this study was to determine which traits or conditions predispose patients with psychotic disorders to compliance with harmful command hallucinations (CHs). Patients reporting a histo- ry of harmful CHs were recruited fi'om forensic (n = 25) and com- munity mental health services (n = 50). Diagnoses for psychotic dis- orders, substance use disorders and Cluster B personality disorders were established using appropriate sections of the Structured Clini- cal Interviewfor DSM-IV. Patients were interviewed in detail about their most serious CH using a structured interview developed by our group. Judgments of seriousness followed legal concepts of severi- ty. The MacA rthur Community Violence Instrument and personality measures including the State-Trait Anger Expression Inventory-2 and International Congress on Schizophrenia Research 2003