Poster Presentations

PP01 PSYCHIATRIC SEQUELAE OF ACUTE CORONARY SYNDROME IN HOSPITAL UNIVERSITI SAINS MALAYSIA

Asrenee Ab Razak, Fazirah Abdullah, Suhairi Ibrahim, Zukurnai Yusof

Background: The occurrence of depression after myocardial infarction is common but to date, there is no published data on depression and/or anxiety following myocardial infarction in Malaysia.

Aims: To determine the prevalence of depression and/or anxiety following acute coronary syndrome in Hospital University Sains Malaysia, to identify association of sociodemographic factors and coronary artery disease risk factors with depression and to compare the rate of cardiac complications in depressed and non depressed groups.

Method: A cross sectional observational study conducted on acute coronary syndrome patients admitted to Hospital Universiti Sains Malaysia (HUSM). 96 subjects were interviewed using validated Malay version of Hospital Anxiety Depression Scale (HADS) questionnaire. The sociodemographic data, coronary artery disease risk factors and medical characteristics during the admission were also taken.

Results: The local prevalence of depression and anxiety following acute coronary syndrome were 38.5% and 42.7% respectively. The prevalence of both depression and anxiety amongst these patients was 19.8%.

Percentage of cardiac complications in depressed group following acute coronary syndrome were higher than non depressed group (64.9% vs 55.9%), however the difference was not statistically significant.

On simple logistic regression analysis, hypertension, anxiety and history of ischemic heart disease showed significant association with depression and with multiple logistic regression analysis, hypertension and anxiety remains statistically significant.

Conclusion: Local prevalence of depression following acute coronary syndrome was comparable with previous studies. We also found that depression following acute coronary syndrome showed a statistically significant association with hypertension and anxiety. Percentage of cardiac complications also was higher among subjects with depression following acute coronary syndrome but the difference was not statistically significant.

PP02 DIFFERENCE OF LIFE EVENTS: STRESS AND RELATION OF PERSONALITY IN PSYCHIATRIC AND MEDICAL ILLNESS

Asrenee Ab Razak, Mohd Razali Salleh, Suhairi Ibrahim

Objective: To compare the life event stress in psychiatric and medical illness; to assess the impact of stress to the illnesses and to determine the role of personality in both illness.

Methods: This is a cross-sectional study where total of 256 patients were recruited from psychiatric and medical groups. These patients were comprised from four subgroups: neurotic and psychotic (psychiatric) and coronary heart disease (CHD) and other medical diagnosis (medical). Interview for recent life event (IRLE), impact event scale (IES) and NEO five factor inventory (NEO-FFI) were used in the assessment. Multiple logistic regression analysis was used for final analysis.

Results: 206 patients reported at least one preceding life event with 179 (86.9%) reported independent event. Neurotic patients (30.2%) reported the highest number of independent event whereas psychotic patients (17.3%) were the lowest. Neurotic patients suffered most severe impact of stress with the highest mean of neuroticism score. Neuroticism trait was higher in neurosis than CHD patients. Openness trait mean score was significantly lowest in CHD subgroup. However, final multiple regression analysis did not reveal any significant relationship between life event stress, personality and onset of the illness.

Conclusion: There was no significant association between independent life event and onset of psychiatric and medical illness. Personality plays a vital role as a mediating factor between stress and illness. People with high neuroticism trait suffered the most severe (negative) impact of stress. Openness trait, which was significantly low in CHD patients probably related to suppression of emotion that predisposed to the illness.

PP03 INTER-OBSERVER AGREEMENT IN DIAGNOSING DEPRESSION AMONG ADOLESCENTS

Fairuz Nazri Abd Rahman, Rozanim Kamarudin, Tuti Iryani Mohd Daud, Jamaiyah Haniff, Fauzi Ismail, Khairani Omar, Sit Fong Loh, Sharon W. S. Chen, Zaharah Sulaiman, Susan M. K. Tan

Background: Locally, reliability of clinical diagnoses of adolescent depression has not yet been clarified.

Aims: To determine the inter-observer agreement in diagnosing depression among adolescents.

Methods: Videotapes of five adolescent cases were randomly arranged to be reviewed by 10 psychiatrists with various years of practice and clinical experience. Their diagnoses, made independently according to DSM-IV, were then compared with the designated ‘gold standard’. Kappa and proportion agreements were measured.

Results: The inter-observer agreement in diagnosing depression ranged from Kappa agreement of 0.62 to 1.00 except for two observers. However, there was substantial agreement between the entire group with the gold standard (κ = 0.64). Meanwhile, when each observer was paired to another observer, 88% of the pairs had a Kappa agreement >0.6.

Conclusion: In spite of the differences between the psychiatrists’ background, the diagnosis of depression in adolescents was made with substantial to almost perfect agreement levels of reliability.

PP04 SCHIZOPHRENIA AND THE FOLLOW UP OF MARITAL STATUS ON A FIVE YEAR FOLLOW UP STUDY IN A RURAL DISTRICT OF INDIA

Asis Krshna Acharya

Objective: Marital life in schizophrenia patients differs variedly in different sets of patients.

Method: A study was conducted with 300 patients diagnosed as schizophrenia (old or new), who came for treatment mostly during the period 2000 to 2001 in a rural district of Midnapore, about 124K.M.s from Calcutta. In the Psychiatry o.p.d of Midnapore Medical College Hospital they were diagnosed using I.C.D-10 criteria.

Chosen age group was between 20 to 30 years of age in both sexes.

Their marital cohesiveness were inquired and assessed with a simple questionnaire after each 3 months’ interval. Altogether 150 male and 150 female were taken into account.23 females and 11 male contracted marriage during the follow up period of 5 years. All of them followed up during the 5 year period. They were examined clinically and administered simple pan score.

Results: In the 5 year follow up period there were desertion/separation of 42 (66%) male patients and a 24 (36%) female patients.

Overall satisfactory marital harmony was observed in nearly 55%of both (male and female) patients. Those who were symptom free parents of multiple issues and economically sound shows a lesser desertion/divorce rates.

Conclusions: Schizophrenia in long term, affects the marriage in a big way.

PP05 ETIOLOGIES FOUND IN DELIRIUM IN A MEDICAL WARD

Asis Krshna Acharya

Objective: To ascertain delirium cases in a medical ward from where psychiatrists are often called to find out the causes.

Method: All referred cases from medical ward of Midnapore Medical College Hospital were noted and analysed through history, clinical and laboratory examinations as to their possible causative factors. One year follow up study was also undertaken to note any recurrences or any death.

Results: A total 164 cases were taken into account in one calendar year those were sought for psychiatrist's referral from the medical ward. Common causes of delirium found were, metabolic causes like hepatic coma and pre- hepatic coma, ureamea, hypertensive enchepalopathy, viral enchephalopathy, meningitis, hyperpyrexia, cerebral malaria, delirium on dementia in medically compromised old, post c.v.a state, one delirium in AIDS dementia and drug induced states. Commonly used drugs tose were observed for causation of delirium are quinolones like ciprofloxacin, oflaxacin, chloroquine, isoniazid, metcholoropromide inj. cimetidine, ranitidininj., atropineInj in large doses, steroids, digoxin etc. Substance abuse, intoxication, withdrawal as well as alcohol intoxication and withdrawal delirium were common. Metabolic causes are frequent in old ages and infective, drug induced, in younger. On follow up 21% shows a 2nd recurrence, and there were 12 deaths in 1 year.

Conclusion: Awareness of causes of delirium, its differential diagnosis with ac. psychotic state and organicity are often beneficial to the psychiatrists and other clinicians.

PP06 PSYCHIATRIC AND PSYCHOSOCIAL FACTORS IN CRIMINAL RECIDIVISM AMONG WOMEN PRISONERS IN PENINSULAR MALAYSIA: LITERATURE REVIEW

Muhammad Muhsin Ahmad Zahari, Cherrie Galletly, Kenneth O'Brien

The growing numbers of women prisoners are abreast with the overall increase in prisoners worldwide. In the past decade, the world has seen the higher rates of increase in women prisoners than male prisoners. In the UK, US and Australia women prisoners have increased as much as 173%, 57% and 85% respectively in 10 years. One of the reasons of this growth in women prison populations is criminal recidivism.

In Malaysia, criminal recidivism accounted for around one fifth of total women prisoners in 2005. In order to hinder these alarming trends in women prisoners it is crucial to investigate the roots of criminal recidivism among them. Since there are high rates of psychiatric disorders in women prisoners there are possible association between psychiatric disorders and criminal behaviours especially in relation to recidivism. There is also wide availability of literature on psychosocial dimensions of women prisoners. However there are still unanswered questions with regard to women prisoners in Malaysia particularly among recidivists. The questions are as follows: What are the common psychiatric disorders in them? Are there distinct patterns of the psychiatric disorders in them? Are there any similarities and differences in term of psychiatric disorders in these prisoners as compared to other parts of the world? Which one of psychiatric disorders or psychosocial factors is more important in determining criminal recidivism in these prisoners? Therefore, this presentation will look into literatures that addressing these concerns.

PP07 LIFE SKILL TRAINING WILL DECREASE AGGRESSION IN MENTAL RETARD ADOLESCENTS

Fahimeh Ahmadi, Zohreh Shamandi, Arezoo Khatibi, Parviz Sharifi Daramadi, Elham Gerami, Maryam Javanbakht, Maryam Alavirad, Soulmaz Azimi Alamdari

Background: Mental retard (MR) children are suffering from a range of physical and emotional problems. These children may show higher degree of aggression due to lack of social coping.

In our study we believed that some simple life skill elements can help them to improve their social compatibility and thus reducing aggression.

Methods and materials: Our study group consisted of 447 mild mental retarded adolescents (boys and girls) (14–18 yrs old).

To determine the aggressive adolescents we used an Eysenck questionnaire (pretest) and also considered the teacher's opinion about their aggressive behaviors.

The selected sample consisted of 40 girls and boys with aggressive behaviors which randomly were divided in to two groups.

After nine sessions of life skill training, two groups were compared, using the same Eysenck questionnaire as the post test.

Results: In the pretest boys showed more aggression than the girls. After life skill training the case group, (who were trained) showed significant decrease in aggressive behaviors.

(p-value = 0.0001), but the interaction of sex and life skill training was not significant.

In other words both boys and girls showed decrease in aggression after life skill training equally.

Conclusion: life skills training has significant effect on decrease aggression in mental retard adolescents.

This finding can help to implement better practical training to deal with problems in mental retard adolescents.

PP08 PERFORMANCE OF THE PATIENTS WITH SCHIZOPHRENIA IN THE REMISSION PHASE IN A NEUROPSYCHOLOGICAL TEST BATTERY, SHIRAZ, IRAN

Ali Alavi, Hasan Haghshenas, Seyyed Masoud Mousavi Nasab

Introduction: Schizophrenia is a clinical syndrome with very variable and disruptive manifestations, enormous treatment costs, and inconsistent neuro-cognitive profile. The objective of this study was to evaluate the performance of the patients with schizophrenia in the remission phase in a neuropsychological test battery.

Methods: In a descriptive analytical study, as a part of a larger study, performance of 22 patients with schizophrenia in the remission phase and 30 normal controls were evaluated with a Persian version of neuropsychological test battery by a laptop computer. The test battery included tests of reaction time (visual and auditory for each hand), word and figure recognition, visual field searching, tapping (for each hand), binary choice, Stroop's test, signal detection in visual field (words and figures), Raven's IQ, verbal IQ, and seashore rhythm recognition.

Results: There were significant differences in the performance between groups in tests of reaction time (except visual reaction time in left hand), word and figure recognition, visual field searching, tapping (right hand), Stroop's test, signal detection in visual field, verbal IQ, seashore rhythm recognition (in all of them P value <0.05)In the other tests there were not any significant differences between the two groups (P value >0.05).

Conclusion: The deficits in the executive functions (and therefore the deficiencies in frontal and temporal lobes of the brain) of the patients with schizophrenia exist also in their remission phase. These deficits may be integral parts of the disorder or may be its sequels.

PP09 CHANGES IN SERUM TRIGYCERIDE LEVELS IN EARLY-ONSET SCHIZOPHRENIA DURING TREATMENT WITH SECOND GENERATION ANTIPSYCHOTICS

G. Paul Amminger, Miriam R. Schäfer, Jana Becker, Konstantinos Papageorgiou

Background: Early-onset schizophrenia (EOS) has been defined as schizophrenia occurring before the age of 18 years. It is well established that schizophrenia patients are at increased risk to develop metabolic disturbances even without antipsychotic treatment. Recent reviews investigating the use of atypicals in young people reported weight gain to be a frequent problem. No study so far has addressed changes in blood lipids in individuals with EOS.

Aims: To investigate serum lipid changes and weight changes associated with atypical antipsychotics in an epidemiological sample of individuals with EOS.

Methods: We carried out a medical records study in individuals experiencing a first episode of EOS. Patients were unselected, drug-naïve, consecutive admissions to the Department of Child and Adolescent Psychiatry.

Results: Between 1/2001 and 12/2002, 44 patients were diagnosed with a first-episode schizophrenia. Of those, 34 (mean age = 15.8 years, SD = + 1.2) with information on weight and blood lipids were included in the present analysis. Median times between baseline and follow-up assessment were 53 days for BMI, and 100 days for serum triglycerides. Paired-samples t-test revealed a significant rise in fasting triglyceride levels (mean difference = 47.1 mg/dl, SD = 85.6; p = 0.05). No correlation was found between time of exposure to antipsychotics and rising triglyceride levels. The increase in BMI (1.13 kg/m², SD 1.25) and the rise in triglycerides were not correlated.

Conclusion: The substantial rise in triglycerides observed at this early stage of treatment emphasizes the need for further studies investigating this effect long-term in larger EOS-samples, given the long-term impact of untreated hyperlipidemia on cardiovascular mortality.

PP11 CHRONOBIOLOGICAL CHARACTERISTICS OF THERAPEUTIC DYNAMICS IN UNIPOLAR (RECURRENT) AND BIPOLAR DEPRESSION

Sergejus Andruskevicius, Alina Stigiene

Material: Forty-eight patients with depression (F 31.3–31.4, F 33.0–33.2). Mean age of subjects 46,9±1.7 years. Group I consisted of 21 patients with recurrent depressive disorders, and Group II included 27 patients with bipolar affective disorders. Spectral analysis was used for measuring the variability of the heart rhythm. Measurements were taken at 1.00 a.m., 7.00 a.m., 1.00 p.m., 7.00 p.m. in newly admitted patients, at the end of the first week of treatment with antidepressants, at the end of week three of treatment and at discharge from the hospital. Controls were presented by 15 mentally healthy persons (mean age 44,9±2.4 years). Depressive patients diagnosed as bipolar affective disorder had more pronounced circadian desynchronization problems in daytime and in the evening that persisted in the course of positive therapeutic dynamics. This fact suggests presence of a more profound systemic chronobiological disorder in bipolar disorder.

PP12 SOME CLINICAL PECULIARITIES AND DIAGNOSTIC DIFFICULTIES OF ALZHEIMER'S DISEASE DEBUTING WITH DEPRESSION

Mariana Arnaoudova, Stefan Todorov

Background: Dementia is the core symptom of Alzheimer's disease (AD). Behavioral and psychological symptoms (BPSD) are an integral part of the disease process and present serious diagnostic, therapeutic, social and economic issues. Symptoms of depression are reported to be common in AD, ranging from 20% to 60% in different epidemiological studies.

Aim: The aim of our study was to assess the clinical peculiarities of depression in the early stages of AD and to point out some diagnostic difficulties.

Method: 63 DSM-IV AD patients (39 females, 24 males), hospitalized for the first time at the gerontopsychiatric ward in the period 2000 – first half of 2006 have been the target of our study. The routine clinical examination and observation, as well as MMSE, HAM-D, HAM-A were used in our study.

Results and discussion: Depressive states were registered in 21 patients. Most common were depressive and depressive-anxious pictures, followed by depressive-paranoid syndromes, accompanied by short episodes of psychomotor agitation. In 13 AD patients the initial diagnosis at the hospital admission was depression in late life. We discuss some supporting points helping to differentiate depression in late life from dementia with secondary depression and from dementia debuting with depression.

Conclusion: AD in its onset may raise serious diagnostic problems, especially when the first manifestation is depression. The precise diagnosis is a prerequisite for an adequate therapeutic approach.

PP13 QUALITY OF LIFE IN MAJOR DEPRESSIVE DISORDER: A CROSS-SECTIONAL STUDY

Omer Aydemir, Hakan Ergun, Sermin Kesebir, Haldun Soygur

Objective: It is well-known that patients with major depressive disorder experience disability and impairment in daily life.

Aims: In this study it is aimed to assess quality of life in patients with major depressive disorder and its relation with severity of depression.

Method: The study was carried out with 74 outpatients diagnosed as major depressive disorder according to DSM-IV without any psychiatric and physical comorbidity. The mean age of the patients was 39.6 and 63.5% (n = 47) were female. For the assessment of quality of life, SF-36 and EQ-5D, and for the assessment of depression HAM-D were used in the study.

Results: The mean HAM-D score was found to be 23.5. The health utility index of EQ-5D was calculated to be 0.4. The mean score of VAS (EQ-5D) was 38.2.

In the assessment of SF-36, the mental and physical component summary scores of the patients were 22.6 and 51.9 respectively.

Both SF-36 and EQ-5D scores were statistically different than the Turkish population standards.

The correlation coefficients between HAM-D total score and mean scores of the domains of SF-36 were found to be between −0.211 and −0.540 (p = 0.05). On the other hand, total HAM-D score had a moderate correlation with EQ-5D health utility index (r = −0.54, p≈0.0001) and EQ-5D VAS score (r = 0.64, p≈0.0001).

Conclusion: In major depression, quality of life is negatively affected. However, the severity of depression is poorly to moderately correlated to the SF-36 which is mostly used, thus quality of life in depression should be measured with more specific instruments.

PP14 ASSOCIATION BETWEEN DELIBERATE SELF-HARM AND MENSTRUAL CYCLE

Norharlina Bahar

Objective: This is a case-control study examining the relationship between menstrual cycle in relation to deliberate self-harm (DSH), premenstrual symptoms and psychiatric diagnosis.

Method: All consecutive female patients (N = 86) who were admitted to Hospital Kuala Lumpur following an episode of DSH (defined by Hawton, 1999) and female controls who were admitted for minor medical problem, during a period from 1 March 2005 through 30 Jun 2005, who fulfilled the criteria are included in this study. The Mini International Neuropsychiatric Interview (M.I.N.I.), Suicide Intent Scale and Premenstrual Assessment Form were administered to diagnose psychiatric diagnosis, assess suicidal intensity and premenstrual symptoms respectively.

Results: DSH was significantly associated with follicular phase of menstrual cycle (p≈0.05), later onset of menarche (p≈0.05) and shorter duration of menses (p = 0.05). However, Depressive Disorder (p > 0.05) was not significantly related with any phases of menstrual cycle and Premenstrual symptoms (p > 0.05) except low mood/loss of pleasure subscale (p≈0.05) has no association with DSH.

Conclusion: The menstrual cycle factors including the follicular phase, late onset of menarche and shorter duration of menses were significantly associated with DSH. Finally, although DSH is significantly associated with follicular phase of menstrual cycle, it is not associated with premenstrual symptoms, and depressive disorders were not significantly associated with any phases of menstrual cycle.

PP15 HALLUCINATIONS IN NON-PSYCHOTIC STATES IN CHILDREN AND ADOLESCENTS – A CASE SERIES

Soumya Basu, Sandy Youren, Julie Stone, Jacqui Ward, Rhiannon Dow

Content: Early detection and intervention in psychosis is currently seen as a key to reduce long term disability. Psychosis can present with a variety of symptoms including hallucinations. However, in a young person hallucinations may not be pathognomonic symptoms of psychosis as it can be present in many other conditions as demonstrated in our case series.

Objective: We describe a series of five cases who presented in a short span of about three months in a CAMHS service of regional Victoria. All these patients presented with perceptual abnormalities and received an initial diagnosis of psychosis. However, after continuing therapeutic contact and in two cases, inpatient treatment, these patients were re-diagnosed variously as PTSD, dissociative disorder and OCD. Most of these patients were victims of neglect and abuse.

Key messages: 1. Emphasis on the need for comprehensive assessment and a broad-based approach in the understanding of the phenomenology of the symptoms of psychosis especially in young people. 2. Challenges faced by psychiatrist in the rural and regional areas who are often expected to give their opinion about these complex cases in a single cross-sectional assessment.

Conclusion: We hypothesize that perceptual abnormalities in a young person may signify a cry for help and not necessary psychosis. Increased awareness about the psychotic symptoms and a relative decrease in the stigma about of mental illness may have resulted in an increase in such presentations in non-psychotic states. We emphasize the need for more research in this area including epidemiological, longitudinal and cross-cultural studies.

PP17 CLINICAL OUTCOMES AND DISEASE BURDEN OF BIPOLAR AND SCHIZOAFFECTIVE DISORDER IN AN AUSTRALIAN COHORT: RESULTS AFTER 12 MONTHS

Michael Berk, Paul B. Fitzgerald, Anthony R. de Castella, Sacha Filia, S. Filia, Kate Filia, Seetal Dodd, L. Berk, Frances Biffin, Katarina Kelin, Meg Smith, A. Brnabic, R. E. Granger, William Montgomery, Jayashri Kulkarni

Background: The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year, observational study of participants with bipolar I or schizoaffective disorder.

Aims: The BCOS study aims to assess the clinical, functional, and economic outcomes associated with ‘real-life’ treatment and to determine predictors of these outcomes.

Method: Participants (n = 239) prescribed mood stabilisers were assessed every 3 months for a period of 12 months using various measures, including the Young Mania Rating Scale (YMRS), 21-item Hamilton Depression Rating scale (HAMD-21), and the Clinical Global Impressions-Bipolar Version scale (CGI-BP).

Results: The most commonly prescribed treatment was atypical antipsychotics combined with mood stabilisers (12.6%). At baseline, the majority of participants were moderately ill according to HAMD-21 (51% ≤13; 23% >13 and <19; 25% =19) and YMRS (81% <15) scores. After 12 months, most participants were mildly ill, with a significant reduction in CGI-BP overall scores ([mean + SE] 3.0±0.08 vs 3.8±0.09 baseline, p=.044). HAMD-21 Total (11.5±0.56 vs 13.4±0.55, p≈.001) and CGI-BP Depression scores (2.8±0.08 vs 3.2±0.09, p=.018) were reduced after 12 months. Mania scores were reduced as measured by CGI-BP Mania (2.2±0.08 vs 3.0±0.10, p=.003) but not via YMRS Total (6.0±0.45 vs 8.2±0.55, p=.094) scores. Predictors of mania and depression at study entry were also investigated. Overall, patients with clinical or subclinical depression (HAMD-21 >13) had poorer clinical and functional outcomes than asymptomatic patients (p≈.001), although mania severity predicted fewer differences.

Conclusion: Clinical outcomes scores improved overall after 12 months observation, with depression severity associated with poorer outcomes.

PP18 DUAL DIAGNOSIS WITHIN ITALIAN PRISONS

Daniele Berto

Dual diagnosis (DD) is a double pathology afflicting drug users that involves both addiction and psychiatric diseases. This specific condition is currently attracting attention from the scientific community. There are limited data available relating to this area and even less specifically relating to problematic drug use and addiction among prisoners and the general lack of adequate treatments and therapeutic tools that are required by this population.

A 2 years research highlighted that within Italian prisons there are a percentage between 40 to 70% of people with DD. Most of them are treated only for the addiction with no treatment for the psychiatric condition. This research shows the prevalence and the incidence of the DD and suggests that in cases of dual diagnosis, both clinical conditions must be addressed, or there is a risk that these prisoners will only be partially treated, and this will create further difficulties in their rehabilitation.

PP19 SIGNIFICANTLY DECREASED NRG-1alpha AND SIGNIFICANTLY INCREASED NRG-1beta EXPRESSION IN SCHIZOPHRENICS

Iris Bertram

In the central nervous system (CNS), neuregulin-1 proteins play roles in neuronal migration, differentiation and survival of oligodendrocytes. The NRG-1 gene codes for at least 15 different isoforms, which may be classified on basis of their molecular structure. At least four different haplotypes of the NRG-1 gene may be associated with schizophrenia. An abnormal expression pattern of NRG-1 mRNA was found in the prefrontal cortex of schizophrenic patients. We looked for the expression of the two NRG-1 isoforms α and β in schizophrenia.

For NRG-1a we studied brains of 22 schizophrenics and 22 matched controls, and for NRG-1b brains of seven schizophrenics and seven matched controls.

When using an antibody against NRG-1a we found a few immunopositive interneurons located in the prefrontal gray and white matter, whereas the use of an antiserum directed against NRG-1 β revealed a widespread immunoreactivity in pyramidal cells and interneurons in the gray matter of DLPFC and anterior cingulate cortex (ACC). Stereologic analysis showed a significant reduction of NRG-1 α cells in the white and gray cortical matter in schizophrenia. For NRG-1 β we found a statistically significant increased number of immunopositive pyramidal cells and neurons in DLPFC and ACC.

The diminished expression of NRG-1a in interstitial white matter neurons supports a neuro-developmental component to schizophrenia (disturbed migration).

For NRG-1 β we assume, that the increase of the immunopositive neurons in schizophrenics leads to a hypofunction of NMDA-receptors via enhanced binding of this NRG-1 isoform to its receptor, erbB4 (Hahn et al. 2006).

PP20 INDICATORS FOR PARTNERSHIP BETWEEN MENTAL HEALTH AND COMMUNITY REHABILITATION

William Boyce, Shoba Raja, Sudha Ramani, Chris Underhill

Context: Community interventions for people with physical disabilities and those with mental illness have evolved following similar trajectories, although at different periods of time. Ensuring successful integration of community based rehabilitation (CBR) and mental health (MH) services requires the readiness, capacities and needs of a CBR organization need to be assessed.

Objective: Conduct in-depth studies of two organizations in Sri Lanka and India that have successfully integrated CBR and Mental Health services, as well as two organizations in Nepal and Bangladesh, which are planning similar integration.

Key messages: Several indicators of readiness for CBR-MH integration were identified.

1. Willingness to work with mentally ill people 2. Existence of basic resources and infrastructure in the organization. 3. A very basic understanding of the mental health concept/problem 4. A match of context between current CBR activities and mental health and development activities.

A second set of indicators identified the long term viability of an integrated CBR-MH approach. 1. Ability to strategize and plan a mental health programme 2. Ability to make use of resources efficiently 3. Ability to network with stakeholders effectively.

Conclusion: A major implication of the study is the need of CBR organizations for training in the practical aspects of integration of MH interventions. Primary products of this study are tool sets that can be used by donors and by local organizations for assessing needs and readiness, as well as developing a strategy for the viable integration of community based MH interventions into existing CBR work.

PP21 EXTENDED MIND THEORY AND BORDERLINE PERSONALITY DISORDER

Amanda Bray

Context: Extended mind theory, a recent development in the field of cognitive philosophy, suggests that the information and processes contained in external objects such as notebooks and computers, which are used to supplement a person's cognitive hardware, should be considered as much a part of the person's mind as that generated by any of the lobes of the brain.

Objectives: This paper outlines this theory of the extended mind, and explores how it might be applied to an understanding of some key behaviours in borderline personality disorder (BPD).

Key messages: Those with BPD have a deficit in their ability to perform certain high level cognitive tasks such as regulation of affect, impulse control and the like. They use the brains of people close to them to supplement their ability to perform these tasks. Using an external object or person as part of one's own cognitive apparatus demands nearly constant proximity and an exceptionally intimate informational bond. This would account for the BPD sufferer's panic and despair in the face of abandonment by those to whom they are attached – when abandonment means literally losing one's mind, it could seem worth any effort or risk to avoid such a loss.

Conclusion: Extended mind theory offers an explanation for features of BPD such as the intense and unstable relationships, frantic efforts to avoid abandonment, and chronic anxiety and depression. Further application of this conceptual framework to other psychiatric phenomena could prove most interesting.

PP22 PSYCHODYNAMISM OF PARENTS OF CHILDREN WITH SERIOUS ASTHMA

Wilze Bruscato, Adriana Fregonese, Wilma Forte

Asthma is a chronic disease that affects 10% of the Brazilian population and is a public health problem, with high social cost due to hospitalizations, school absence, partial or total inability to work. Asthma is a chronic childhood disease that brings many issues to family life, interfering in child's and parents’ routine. There are many hospitalizations, besides the need of alimentation, hygiene and sports practice control. The clinical treatment provided by the health team is affected by parents′ adhesion problems, especially by the asthmatic children's mothers. Parents′ emotional issues jeopardize the children's maturation process, blocking medical and psychological treatments. Considering those aspects, this research purpose is to investigate motherhood and fatherhood meaning, besides the association between the parents′ psychodynamism and children's respiratory allergy. The investigation instruments used were semi-guided interviews and two boards of Thematic Apperception Test (TAT). Through the analysis of the data and qualitative evaluation was possible to conclude that both fathers and mothers have difficulty to express satisfaction or not with conjugal union. Regarding motherhood, it was noticed the permanence of immature and less elaborated conflicts that are difficult to be solved. They tend to see their children as fragile and provide an exaggerated protection that keep the child attached to them. Most fathers had emotional problems on finding their places as partners and parents. They act as supplying of material resources and keep an affective distance. The parents’ emotional issues affect the relationship with their children and the asthma assumes a communicative value for the parents-child triad. When the child realizes the parents’ weakness, it is possible to achieve everything that is desired, obtaining “gains” from the symptom.

PP23 EVALUATION OF THE BODY IMAGE IN CHILDREN AND TEENAGERS WITH PROMINENT EARS: A PRELIMINARY STUDY

Wilze Bruscato, Fernando Riibeiro, Adriana Fregonese, Sabrina Rahal

Introduction: The prominent ear is that which forms an angle of over 30^° with the head. It can be caused by an overdevelopment of the conchal cartilage or by the incomplete folding of the anti-helix. This deformity, that seems to cause psychological and/or social problems in school-age children, can be surgically corrected by otoplasty.

Objective: This paper aims to evaluate the psychological consequences of this deformity in children with prominent ears.

Method: Seventeen children from both sexes were evaluated, during the pre-surgery phase of the otoplasty, by means of interviews and psychological tests, which were submitted to an analytical descriptive statistic.

Results: To have a prominent ear for 88.2% of the participants is related to an emotional aspect, causing shame, discomfort and sadness and causes various disturbances to the carriers, which are frequently made fun at.

Conclusions: This study confirms that prominent ears cause a significant visual impact, compromising these children's self-image, hence interfering in their emotional development and in the establishment of their school and friendship relations.

PP24 COGNITIVE PERFORMANCE IN NORMAL-PRESSURE HYDROCEPHALUS – A PRELIMINARY STUDY

Wilze Bruscato, Ana Paula Braga, José Carlos Veiga, Maria Fernanda Mendes

Normal-Pressure Hydrocephalus (NPH) is a frequently reversible dementia. The aim of this study is evaluate cognitive functions associated with this pathology to determine the benefices of possible ventricular derivation, analyzing their impairments. A group of 13 patients (eight male and five female) have been evaluated before surgery, by a neuropsychologist who used a cognitive tracing protocol of six neuropsychological tests, to assess functions like attention, memory, language, visuospatial and executive functions. In this group, five patients were evaluated another time after the surgery. In the pre-operatory period, 10 (77%) patients revealed attention deficit and memory impairment. Language dysfunction were observed in four (30.7%), visualspatial impairments in three (23%) patients, and in the executive functions three (23%) revealed impairments. In these patients, four (30.7%) had results similar in dementia's patients in latest stages. The patients, who are evaluated after surgery, increased their results in tests that assess attention and short-term memory. In long-term memory, the results change very little. In the other functions weren't changes. In this study, the principal cognitive impairments in Normal-Pressure Hydrocephalus's patients were in attention and memory functions, in agreement with literature. And these functions were that increase with derivation procedure. Based on this data, the importance of neuropsychological evaluation on NPH's patients is noticed like a exam that to help the clinician to determine the better procedure to their patient.

PP25 NEUROPSYCHOLOGICAL ASSISTANCE FOR PATIENTS WITH SLEEP DISTURBANCES AT SANTA CASA DE SÃO PAULO

Wilze Bruscato, Ana Paula Braga

Chronic insomnia can decrease quality of life. This is motivated by attention and memory decrease. Studying these neuropsychological aspects we can better assist the insomniac patients. Through neuropsychological tests, to study the attention, memory, praxis, language e executive functions range of chronic insomniac patients. 32 insomniac patients were studied at sleep disturbance sector of Santa Casa de São Paulo. The cognitive function was scored through ten neuropsychological tests. We noticed decrease of attention in 26 (81,25%), short term memory in 10 (31,25%), long term memory in 19 (59,4%), disturbance in language in 2 (6,25%), constructive praxis in 10 (31,25%) and executive function in 6(18,25%). Only one patient (3%) was low intellectual index. For chronic insomnia, the main disturbance at neuropsychological tests was decrease of attention. Another disturbance was decrease of long term memory. The continued evaluation of this dysfunctions can be an auxiliary exam to increase the insomnia treatment.

PP26 APPROACH TO THE SLEEP DISTURBANCES AT SANTA CASA DE SÃO PAULO

Wilze Bruscato, Ana Paula Braga

We analyzed gender, age, marital status and the need for complementary results of 57 patients over 16 years. We excluded patients that were waiting complementary exams. Diagnosis were classified according The International Classification of Sleep Disorders (lCSD) 2005 and Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, Text Revision (DSM-IV-R). The range age is 45.3 years old; 22 are male (38,6%) and 35 are female (61,4%). 35 are married, 14 are only, five are divorced and three are widowed. For 52 (92%) patients polysomnography were requested. For 21 patients (37%) neuropsychological tests were requested. The main initial symptoms were: 50,8% insomnia, 19,3% excessive sleepiness, 12,3% snore, 3,5% apnea and 14,1% parassomnias. For 29 patients (51%) there were more than three sleep disturbances. Major depression disease was noticed at 21 patients (37%) and global anxiety disturbance was noticed at 13 patients (23%). nine patients (16%) had both symptoms. Insomnia was the most frequent symptom after excessive sleepiness. In 51% of the patients assisted was noticed more than one sleep disturbance. We noticed that there are so few epidemiologic studies in Brazil as well as others countries. This fact became so difficult to us to compare and connect the results of this presentation with the epidemiologic data. We believe that is so important the development of educational programs about sleep disturbances approaching them to health or general public.

PP27 QUALITY OF LIFE, DEPRESSIVE SYMPTOMS AND PHYSICAL CAPACITY OF PATIENTS AWAITING LIVER TRANSPLANTATION AND OF PATIENTS WHO HAVE ALREADY UNDERGONE LIVER TRANSPLANTATION

Wilze Bruscato, Rosana Rodrigues, Luís Antonio Nogueira-Martins, Ana Lúcia Horta

The liver transplant is an expensive and sophisticated resource and when the procedure is successful, it provides a significant physical improvement, even though it requests constant medical follow-up and use of immunosuppressive medications throughout life besides eventual complications associated to this use. Considering all the aspects of treatment, one of the greatest preoccupations of transplanting teams has been with the patients’ quality of life after transplant. To evaluate and compare QOL (quality of life), prevalence of depressive symptoms and degree of physical dependence of transplanted patients with chronic hepatic disease and those awaiting liver transplant. The sample showed thirty patients, 15 transplanted and 15 awaiting transplant. The results of transplanted patients’ QOL were better in the physical component domains of the SF-36: Functional Capacity (p = 0.031) and General Health Perceptions (p = 0.015) and worse in the SF-36 mental component domains: Emotional Aspects (p = 0.019) and Social Aspects (p = 0.010). The KPS results demonstrated a tendency of the transplanted patients to present a lower degree of physical dependency than patients in the waiting list, though statistical significance was not established (p = 0.168). The BDI results revealed a tendency of the transplanted patients to present higher depression scores than waiting list patients though statistical significance was not established (p = 0.786). The CTP presented a direct significant correlation with the SF-36 Pain domain and with the KPS. Regarding the MELD, a direct correlation was found only with the BDI. Transplanted patients showed an improvement in their physical capacity and quality of life regarding the physical component, even though they had higher depression scores, however, demonstrated a worsening regarding their psychosocial condition.

PP28 PSYCHOSOCIAL REPERCUSSIONS ON PATIENTS SUBMITTED TO TOTAL LARYNGECTOMY FOR LARYNX CANCER: A CLINIC-QUALITATIVE STUDY

Wilze Bruscato, Leopoldo Barbosa, Daniela Achette, Antonio Gonçalves

It is known that treatments on head and neck region cause some aesthetic and functional alteration. Those can have a repercussion on the performance of social rules, the emotional expression and the communication of the patients. Through a clinic and qualitative study, we seek to understand how these repercussions affect the patient who is submitted to the total laringectomy on the larynx cancer cases. It has become evident that the diagnosis of the cancer and the experience of the total laringectomy cause psychosocial repercussions, specially, the social contact damage, because of the voice losing and the presence of tracheostomal. Although this, the perception of the treatment allowed the individuals to continue alive with the chance to restart their projects. It has made possible a positive appreciation from the patients related to the surgery. We also have noticed a passive and resigned position across from their life, presented on the patients’ speech, and, on this context, aspects as religiousness, familiar support and handling of the interdisciplinary team had been considered as motivation for the treatment. The cancer presents multiples meanings and affects psychosocial aspects significantly on a patient's life. The team support, the clarification of doubts and the psychological support contribute for an anxiety relief and an emotional balance during the treatment and in the rehabilitation.

PP29 IMPACT OF PLAYING ON THE STRESS AND THE HEALTH OF HOSPITALIZED CHILDREN

Wilze Bruscato, Cláudia Mussa, Maria das Graças Lima, Fani Malerbi

The hospitalization for children can be considered a stress situation. Many groups have done activities to change the humour of hospitalized children. The objective of this study was weigh up the impact of playing, made by a group called Story Tellers, on the hospitalized children emotional situation and their pain complaining. The participants were 24 children with cancer, admitted to the Santa Casa's Pediatrics of São Paulo, and their parents. On the first part, the behaviour of nine children (5–16 years old) were observed during the time they received the Story Tellers visit and when this visit didn't happen. Based on this first part, the second part instruments were draw up. On the second part, the parents of the 15 children were interviewed and the children (5–10 years) were observed before, during and after the Story Tellers visit. Children also classified their pain in a Pain Scale, before and after the Story Tellers visit. The results showed that, after the Story Tellers visit, most part of children talked more than before with they parents, with other hospitalized children and with the health professionals; they were calmer than before, during the medical procedures. Children reduced their pain complaining, they growed up their movements in the ward, and their appetite was better than before the Story Tellers visit. It showed that the playing had a good effect of hospitalized children health.

PP30 PIERCING AND PSYCHOPATHOLOGY: A REVIEW

Eric Bui, Rachel Rodgers, Laurent Schmitt, Henri Chabrol

Background: Reports of a significant relationship between body piercing and high-risk behaviour are on the rise.

Aims: To review the medical literature investigating the relationship between body piercing and psychopathological symptoms.

Methods: We ran a search on Pubmed, PsychINFO and EBSCO crossing the term “body piercing” to “risk-taking”, “psychopathology” and “personality”. Our search was completed by studies hand-picked from the references of the selected articles.

Results: We selected 17 publications: 14 North-American, one Brazilian, one German and one Belgian. Four studies examined the general population, 10 adolescents or young adults, whereas the three last ones were respectively based on a sample of patients suffering from eating disorders, psychiatric patients and imprisoned adults. The prevalence of body piercing lay between 6 and 70%. Sample sizes went from 40 to 4337 participants. Body piercing was associated with addictions: alcohol, tobacco, cannabis, getaway and hard drugs. It was also associated with violent and anti-social behaviors, depressive symptoms, suicide attempts and several personality traits (psychopathy, sensation-seeking, poor self-esteem, extraversion and decreased conscientiousness).

Conclusion: Body piercing is often associated with behaviours similar to those classed as DSM-IV borderline personality symptoms. However, studies examining the link between personality and body piercing have adopted a dimensional approach. The aim of future research should therefore be to explore the associations with personality as a structure.

PP31 BODY PIERCING AND HIGH-RISK BEHAVIOURS AMONG STUDENTS

Eric Bui, Rachel Rodgers, Henri Chabrol, Laurent Schmitt

Background: Even if reports of a significant relationship between body piercing and high-risk behaviours are on the rise, to date no studies have examined associations with personality disorders.

Objective: To examine the association between high-risk behaviours, personality disorders, and body piercing in a sample of French college students.

Methods: Ninety-eight college students from Toulouse-Le-Mirail University (France) completed a survey. High risk behaviours assessed included: tobacco, alcohol and drugs consumptions (more than once a week), history of suicide attempt and sexual activity (more than two partners over the last 6 months). We assessed histrionic, antisocial and borderline personality disorders with the PDQ4. A question about body piercing was added for the purpose of this study. Statistical analyses were based on Chi⁻² tests comparing participants with at least two body piercings to those with only one or none.

Results: Mean (SD) age was 20.6(1.7), 65(66.3%) participants were female and 15(15.3%) had at least two body piercings. Prevalences of histrionic, borderline and antisocial personality disorders were respectively: 4.68%, 15.46% and 27.8% respectively. However, those with at least two body piercings were more likely to smoke (p = 0.02), drink alcohol (p≈0.01), marijuana use (p = 0.02). No difference was found in terms of gender, suicide attempts, cocaine and ecstasy use, sexual activity, histrionic, borderline or antisocial personality disorders.

Conclusion: Body piercing was not significantly associated with histrionic, borderline, or antisocial personality, which could be due to a lack of statistical power. However, this research replicated the previously described link between body piercing and substance use.

PP32 IMPROVING BEHAVIORAL COUNSELING FOR TREATMENT OF OPIATE DEPENDENCE IN MALAYSIA

Marek Chawarski, Mahmud Mazlan, Richard Schottenfeld

Injection drug use (IDU) and heroin dependence are driving the HIV/AIDS epidemic in many Asian countries, including Malaysia. Recent changes in health care policy in Malaysia provide an opportunity to disseminate effective behavioral counseling approaches to treat drug dependence and curtail the spread of HIV. We evaluated whether the efficacy of an agonist maintenance treatment is improved by providing manual-guided behavioral drug and HIV risk reduction counseling (BDRC). A 16 week pilot randomized clinical trial enrolling heroin dependent individuals (N = 24) was conducted in Muar, Malaysia. All study participants received brief, weekly visits with a physician. Participants in the BDRC group additionally received weekly individual counseling utilizing short-term behavioral contracts aimed at improved treatment adherence and lifestyle changes. All participants received buprenorphine maintenance as either non-contingent weekly take-home doses (Standard BUP) or as abstinent contingent take-home doses (BDRC + ACB). Based on documented abstinence, participants in the BDRC + ACB group could receive the maximum one-week supply of Subutex. Alternatively, if participants tested opioid-positive, directly observed doses were given. Participants were all male; mean (SD) age 41.1 (8.2) years. 12/12 (100%) of BDRC + ACB participants and 11/12 (92%) of PM + Standard BUP participants completed the entire protocol. Participants in BDRC + ACB achieved higher overall proportions of opiate negative urine toxicology tests (87% vs 69%) and longer periods of consecutive abstinence from opiates (10.3 vs 7.8 weeks). Both groups significantly reduced HIV risk behaviors during treatment. BDRC and ACB appear to be promising approaches for improving the efficacy of relatively minimal services.

PP33 ADOPTING NATURE-ASSISTED THERAPIES IN MENTAL HEALTH CARE: A BEGINNING IN TAIWAN

Chun-lin Chen, Wei-Tsuen Soong, Hao-wei Wang

Nature-assisted therapies include animal-assisted therapy (with live animals as media), horticultural therapy (through cultivating plants), adventure therapy (through challenging outdoor activities), and ecotherapy (through activities in nature environments encouraging ecological insights). These can be performed individually or in group. In Taiwan, these therapies are now growing.

Animal assisted therapy in Taiwan includes the use of dogs and dolphins in facilitating autistic children to learn and to form bonds of affection. Dogs are also used to promote general mental health in some elementary schools, geriatric care centers, and in some hospitals.

Horticultural therapy has been used in some schools and some psychiatric rehabilitation programs like in day cares or chronic wards. Horticultural activities have been used to support some refugees after a big earthquake in 1999.

Adventure therapy and wilderness therapy were adopted from the USA in the 1990s. Several therapeutically oriented experimental camps were tried on delinquent adolescents. Others were performed in order to empower adolescents of low self-esteem and low socio-economic status. Adventure programs are also used for staff enrichment training in corporations.

Nature exploration, although less challenging than in adventure therapy, has been used by a few therapists for many years. One program is reported to have been used in an adolescent day care unit in a psychiatric hospital. Programs for children or adult enrichment are sporadically seen.

Nature-assisted therapies enrich the possibility of mental health care. In addition, it may connect mental health care with the environmental movement to improve the welfare of human life simultaneously.

PP34 AMISULPRIDE AUGMENTATION ON CLOZAPINE-INDUCED HYPERSALIVATION IN CHINESE SCHIZOPHRENIA PATIENTS IN THREE-MONTH FOLLOW-UP: PRELIMINARY STUDY

Tzu-Ting Chen, Chin-Chi Liang, Jen-Yeu Chen, Kan-Yaun Cheng, Chao-Cheng Lin

Background: An amisulpride augmentation study revealed short-term ameliorating effect on clozapine-induced hypersalivation.

Aims: To evaluate the effect of amisulpride on the clozapine-induced hypersalivation in a randomized single –blind three months’ follow-up.

Methods: Seventeen patients (12 men, 5 women) refractory schizophrenia, receiving more than 6-month fixed dose of clozapine and having clozapine-induced hypersalivation, were enrolled. They were randomly assigned to add-on amisulpride group (nine patients; 400 mg/day, up-titrated from 200 mg/day over 2 weeks) or non-add-on group (eight patients) in ongoing clozapine treatment with a fixed dose during the 3-month trial period. Hypersalivation was evaluated with the five-point nocturnal hypersalivation rating scale (NHRS) at baseline, week 2, 4, 8, and 12. Other measures included the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale (CGI), Simpsom-Angus Scale (SAS), UKU side effects rating scale and plasma prolactin levels.

Results: Compared to non-add-on group, there was a significant improvement on the 10th SAS item (salivation) and the 10th UKU item (increased salivation) in add-on amisulpride treatment (p = 0.0143 and p = 0.0347, respectively) 3 months later, but not on NHRS, PANSS, CGI, total SAS and UKU. Increased plasma prolactin levels in add-on amisulpride group (from 17.18±15.93 ng/ml to 118.41±89.66 ng/ml) were noted and statistically significant higher compared to non-add-on group (p = 0.0040).

Conclusion: 3-month amisulpride augmentation has revealed a significant ameliorating effect on clozapine-induced hypersalivation by SAS and UKU rating scale (daytime effect), but not by NHRS (night-time effect) in our preliminary study.

PP35 THE NEUROPROTECTIVE EFFECT OF APOLIPOROTEIN E ON THE OXIDATIVE STRESS IN ALZHEIMER'S DISEASE

Woong Cho, Hancheol Yoon, Janghyun Lee, Minhye Gim, Soohyun Joe

Objectives: The aim of this study was to know whether apolipoprotein E (apo E) had neuroprotective effect against oxidative stress in Korean patients with dementia.

Methods: The subjects were consisted with 38 patients with dementia of the Alzheimer's type and 41 normal aged controls with age over 60. The clinical data were obtained by structured interview and medical records, plasma apo E levle and total antioxidant capacity (TAC) were measured, and the severity of dementia (MMSE, CDR, GDS), activities of daily living(ADL, IADL) and depression(Geriatric Depression Scale) were evaluated using various rating scales.

Results:

1) The mean (±S.D.) plasma level of apo E in dementia was 4.71±1.96 mg/dl, and that of TAC was 2.87±0.16 mmol/L.

2) The only factor influencing on the plasma apo E level in dementia was scores of the Geriatric Depression Scale (p = 0.05). However, variables such as age, severity of dementia, activities of daily living, and plasma TAC level did not correlate with apo E.

3) There were no statistically significant differences between variables with normal apo E and those with elevated apo E.

Conclusion: This study could not support that apo E had neuroprotective effect against oxidative stress in dementia.

PP36 ASSOCIATION STUDY OF SINGLE NUCLEOTIDE POLYMORPHISMS ON CATECHOL-O-METHYLTRANSFERASE GENE IN KOREAN SCHIZOPHRENICS

Byeong Moo Choe, Seong Hwan Kim, Dong Ki Lee

Objective: Catechol-O-methyltransferase (COMT) is the enzyme that plays an important role in metabolizing catecholamines including dopamine, and COMT gene has been investigated as a candidate gene for schizophrenia. A lot of association between several single nucleotide polymorphism(SNP)s on COMT gene and schizophrenia have been suggested. We carried out an association study to find out a genetic association between COMT gene and Korean schizophrenia.

Methods: I selected four SNPs through even spacing and minor allele frequency from 90 normal controls after abstracting DNAs from 366 patients diagnosed as schizophrenia and 359 normal controls matched with age and sex. Genetic analysis was done by using SNP stream 25K system. Allele frequencies, genotype frequencies and haplotype frequencies were compared between two groups. Moreover, subgroups were built on the basis of onset age, and allele frequencies and genotype frequencies were compared among subgroups individually.

Results: In rs2020917 of female patients among four SNPs which were found, significant difference (P = 0.0224) of genotype frequencies was noted, but that of haplotype frequencies in four SNPs was not noted between patients and controls. Significant difference of allele frequencies for rs1544325 according to onset age was noted, and significant difference of allele and genotype frequencies for rs 1544325 according to onset age in female patients were also noted.

Conclusion: Genetic association between four SNPs on COMT gene and Korean schizophrenics was generally not to be found in this study but my finding is suggestive of genetic components for sex-specificity and onset age in Korean schizophrenics.

PP37 COMPARISON OF FREQUENCIES OF ALDEHYDE DEHYDROGENASE 2 GENOTYPES AND A1 ALLELE OF DOPAMINE D2 RECEPTOR GENE IN ALCOHOL DEPENDENCE PATIENTS

Hae Gyung Chung

The purpose of this study is to evaluate the association of polymorphic patterns of Dopamine D2 Receptor (DRD2) and ALDH2 (Aldehyde Dehydrogenase 2) gene with alcohol dependence. The patient group consisted of 47 male patients with alcohol dependence and the control group consisted of 20 healthy male volunteers without alcohol dependence. Polymorphic patterns of ALDH2 gene and DRD2 gene were determined by PCR method. And then we compared allele frequencies of two loci between patient and control groups. The results were as follows: 1) The frequencies of ALDH2∗1/1 in patient group were significantly higher than those in the healthy controls. The frequencies of mutant ALDH2(ALDH2∗1/2 and ALDH∗2/2) were significantly lower in patient group than those in healthy controls. 2) There was no significant difference in A1A1, A1A2, A2A2 genotype frequencies in DRD2 gene between patient group and healthy controls. 3) In patient group with A1 allele, frequencies of ALDH2∗1/1, ALDH2∗1/2, ALDH2∗2/2 were 61.7%, 3%, 0%, respectively. In patient group without A1 allele, frequencies of ALDH genotypes were 29%, 2%, 0%, respectively. In conclusion, mutant ALDH2 genotype seems to have influence on the occurrence of alcohol dependence. The interaction of DRD2 A1 alleles and ALDH2 alleles should be studied to find some effect on pathogenesis of alcohol dependence.

PP38 SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS IN SHORT TERM HOSPITALIZATION UNIT: ARIPIPRAZOLE PRESCRIBING PRACTICES

Juan Jose De Frutos, Maria Belen Bardon Rivera, Alejandra Ana Garcia Rosales, Maria Benitez Alonso

Background: Aripiprazole, introduced in January 2005, is the most recent antipsychotic approved in Spain for the treatment of Psychotic disorders. Injection formulation is not yet available in Spain.

Aims: The objective of this work is to review the prescribing practices of Aripiprazole for patients diagnosed of schizophrenia and other psychotic disorders at discharge of La Paz University Hospital Psychiatry short-term hospitalization unit.

Methods: The authors reviewed clinical records of those patients diagnosed of schizophrenia and other psychotic disorders from January 2005 to November 2006. Patient's sex, age, number of days hospitalized, doses of Aripiprazole given at discharge and DSM-IV diagnosis (considering diagnosis in Axis I, diagnostic category of the disease, diagnosis in Axis II, presence of diagnose in Axis III and score in the Global Assessment of Functioning Scale) were considered. Statistical analysis was performed with SPSS version 11.0.2 on an iBook G4 computer.

Results: 58 patients diagnosed of schizophrenia or other psychotic disorders, 32 men and 26 women, received Aripiprazole as treatment as discharge. 18 were diagnosed of schizophrenia, paranoid type (31%), 14 (24%) of psychotic disorder non otherwise specified, 9 (15.5%) of delusional disorder and 8 (13.8%) of schizophrenia residual type. Analysis of the data didn't show statistical differences among doses prescribed to men/women, disease, personality disorder or axis III diagnoses. Aripirazole was prescribed as monotherapy in 21 of the patients.

Conclusion: Aripiprazol novel characteristics allow safety and efficient use in psychotic disorders including all types of schizophrenia. No down-dose regulation is required in patients with medical disorders.

PP39 MENTAL HEALTH OUTCOMES OF ABORTION FOR YOUNG WOMEN AGED 18–23 YEARS, FINDINGS FROM AN AUSTRALIAN LONGITUDINAL BIRTH COHORT STUDY

Kaeleen Dingle, Alexndra Clavarino, Gail Williams, Rosa Alati

Background: Few longitudinal studies have examined the mental health outcomes of women after abortion and the results are controversial. Despite falling birth rates, teenage pregnancies remain high and over half (53%) of teenage and a third (36%) of young adult (20–24 years) pregnancies are aborted. Recent findings from a New Zealand longitudinal birth cohort linked abortion and subsequent psychiatric disorders in young women. Limited Australian data is available examining this association.

Methods: Data were taken from the Mater-University Study of Pregnancy (MUSP). Running since 1981, this is a prospective birth cohort study of 7223 mothers and children. At the 21-year follow-up 3775 (52.3% of the original cohort) participants were surveyed, of these 1132 young women had complete data on pregnancy outcomes and psychiatric diagnoses from a structured interview. Binary logistic regression examined the association between five lifetime psychiatric disorders (nicotine, alcohol, cannabis, affective and anxiety disorders) and ever having an abortion or birth. Analyses adjusted for age, concurrent and maternal sociodemographic factors, and factors related to adolescent behaviour, previous mental health and family functioning.

Results: A quarter of the young women (n = 261) reported at least one pregnancy and 32.6% had an abortion. Abortion was significantly associated with age-adjusted OR for all the lifetime disorders. After full adjustment abortion remained significantly associated with nicotine (OR = 2.1, 1.2–3.6) and alcohol disorders (OR = 2.0, 1.3–3.3).

Conclusion: The findings suggest that abortion in young women is independently associated with an increased risk of nicotine and alcohol disorders.

PP40 NICOTINE DEPENDENCE AMONG ELDER PEOPLE

Malgorzata Dosiak, Ewa Wojtyna, Magdalena Zagrodnik

Background: 10–36% of elder people smoke cigarettes. Meanwhile smoking contributes to more frequent occurrences of tobacco diseases, especially coronary heart disease, respiratory disease and cancer. Important are also interactions between nicotine and medicines taken by elder persons. It seems very essential to recognize factors favourable smoking.

Aims: The goal of the research was characterizing the nicotine addiction among elder people.

Methods: The examination covered the 240 patients (70 with mental disorders [MD], 60 with chronic somatic disease [CSD] and 110 healthy smokers [HS]). In the research one used detailed interview, clinical research and questionnaires: Fagerström Test for Nicotine Dependence, Schneider Test of motivation for smoking cessation and test of stage of changes (in the basis of the Transtheoretical Model of Behavioural Change of Prochaska) and Geriatric Depression Scale (GDS).

Results: The outcomes indicate the higher degree of dependence and lower readiness to smoking cessation among mentally ill persons in comparison to the two others group (precontemplation: 80% MD, 19% CSD, 32% HS; contemplation: 18% MD, 61% CSD, 41% HS; preparation: 3% MD, 16% CSD, 22% HS). The research reveals negative correlation between motivation for smoking cessation and intensification of psychopathological symptoms (for depression: r = − 0,73; p≈0,05) and age (r = −0,26; p≈0,05).

Conclusions: Gained outcomes showed the need of creation the specific programs of smoking cessation for mentally ill elder people with particular consideration of the work on motivation to change and reduction psychopathological symptoms.

PP41 THE IMPACT OF SOCIAL SUPPORT ON THE COURSE OF DEPRESSION DISORDERS AMONG ELDER PEOPLE

Malgorzata Dosiak, Ewa Wojtyna, Jolanta Zycinska

Background: Prevalence of depression in the elderly is estimated at 15–30%. Social support is an important element to consider in the depression and functional disability association.

Aims: The goal of the research was creating the definition of the meaning of the perceiving emotional and instrumental support for the course of treatment of the inmates over 60 years, hospitalised because of depression disorders.

Methods: The examination covered the 133 patients (79 females, 54 males). From research excluded the inmates with the exclusion of dementia of medium and profound degree. The study were of linear character, including three measurements: in the first, fourth and tenth week of pharmacotherapy. In evaluating social support one used Berlin Social Support Scales (BSSS). In every measurement one scored the level of depression using Geriatric Depression Scale (GDS), basic activities of daily living (ADL) and instrumental activities of daily living (IADL).

Results: The analysis of variance with repeated measures revealed influence of both support types on decrease depression symptoms. Perceiving emotional support 26% of variance of that variable and instrumental support only 6%. Emotional support influenced on the treatment progress in first four weeks, however instrumental – in further treatment phase. The performance of independence and instrumental everyday activities was related only with emotional support.

Conclusions: Gained scores confirmed the essentiality of distinguishing emotional and instrumental support, because the fulfil different functions in succeeding stages of treatment. It seems purposeful involving close relatives in process of treatment and creating self-helping groups for elder people with depression disorders.

PP42 THE CLOZARIL CLINIC: A SUCCESSFUL MODEL FOR THE TREATMENT OF PSYCHOTIC DISORDERS

Catherine N. Dulmus, Bruce C. Nisbet

Clozaril (generic form Clozapine) is an atypical antipsychotic medication that is appropriate for use with a subset of individuals with psychotic disorders who have not benefited from conventional antipsychotic medications. This presentation provides an overview of an agency based integrated outpatient model for treating clients with Clozaril and reports on 12 years of outcome findings (n = 114). The “Clozaril Clinic” model is built on an interdisciplinary team approach that emphasizes the importance of regular peer interaction, at-site provision of ancillary services, and full coordination by the team of all other treatment, rehabilitation and support services, including specialized case management. Results indicate that Clozaril delivered within this model promotes an unusually high level of recovery from serious mental illness, including a dramatic level of relief from psychotic symptoms, shielding of suicidal impulses, and reduced outpatient hospitalizations.

PP43 A SHORT-MATRIX VERSION OF THE EDINBURGH DEPRESSION SCALE

Malin Eberhard-Gran, Anne Eskild, Sven Ove Samuelsen, Kristian Tambs

Introduction: Given the importance of depression as a world health problem, depression assessment should be standard practice in large-scale health surveys. The aim of the study was to construct a short matrix-version of the Edinburgh Depression Scale (EDS) that can be used in questionnaire studies.

Method: On the basis of the complete EDS scale of ten items, answered by 2 730 women, stepwise multiple regression analysis was used to find the combination of items that explains the maximum proportion of the variance of the full scale sum score. The selected EDS items were thereafter correlated with the Hopkins Symptom Check List (SCL-25) for external validation.

Results: The sum of five selected items from the EDS correlated at r = 0.96 with the full version. The EDS5 scores correlated strongly with the SCL-25 (r = 0.75).

Conclusion: The EDS-5 version shows good psychometric properties and may, for some scientific purposes, substitute the full EDS scale.

PP44 BENZODIAZEPINE RECEPTORS ABNORMALITIES IN ANXIETY DISORDERS: A POSITRON EMISSION TOMOGRAPHY STUDY

Steven Ellen, Phillip L. P. Morris, James Olver, Eric Constant, Trevor Norman, Henri J. Tochon-Danguy, Sophie Ignatiadis, Alexander C. McFarlane, Graham Burrows, David Reutens

Purpose: The GABA-Benzodiazepine receptor complex is an important modulator of stress responses in humans and it has been shown to have a key role in anxiety disorders. positron emission tomography (PET) has recently been used to estimate the density (Bmax), affinity (Kd) and binding potential (BP) of GABA-BZD receptors in vivo using the carbon labelled BZD antagonist, flumazenil.

This study compares the Bmax, Kd and BP of BZD receptors in subjects with PTSD, Panic Disorder, and normal control subjects.

Methods: 13 male subjects with war-related PTSD, 12 subjects with Panic Disorder and 13 control subjects were scanned. Regions of interest were chosen in 12 cortical and subcortical brain regions. Bmax and Kd values were calculated from Scatchard plots per pixel. Analysis of variance was used to determine significant changes in Bmax, Kd and BP between subject groups. A statistical parametric mapping (SPM) analysis was also performed as an analysis of the whole brain for areas of significant change that might have been missed in the region of interest analysis.

Results: The binding potential for BZ receptors was higher in the PTSD group than both the Panic and Control groups. The difference was greatest in the cerebellar, lateral temporal, occipital, and prefrontal areas. The increase in BP was primarily due to a greater receptor affinity in these areas. The Panic group had a similar BP to controls, but lower Bmax and Kd. The results of the SPM analysis supported the findings from the region of interest analysis. The differences were not explained by differences in other variables such as alcohol consumption or depression.

PP45 SUCCESSFULLY IMPLEMENTING CONSULTATION-LIAISON PSYCHIATRY IN THE COMMUNITY: THE INNER SOUTH EAST MELBOURNE PRIMARY MENTAL HEALTH AND EARLY INTERVENTION TEAM

Steven Ellen, Michael McGartland, Robert Selzer

As part of Victoria's response to the National Mental Health Plans, Primary Mental Health and Early Intervention Teams have been established in each of the 21 Area Mental health Services across the state to address high prevalence mental health disorders. While the teams all share common aims, the composition of the teams and their style of working have been allowed to develop to meet local demands and conditions. This poster outlines the consultation-liaison model successfully adopted by the Inner South East Melbourne Primary Mental Health and Early Intervention Team and describes the first 100 primary consultations seen by the team.

The team has five roles (primary consultation, secondary consultation, education and training, short term psychotherapy, and community work) which aim to increase the capacity of general practitioners and primary health care workers to identify and manage patients with high prevalence disorders, and to foster activities that strengthen communities and prevent the development of high prevalence disorders.

In the primary consultation role patients have been predominantly referred for issues of anxiety and depression and a biopsychosocial framework for recommendations has been adopted.

PP46 DEVELOPMENT OF A SEXUAL RISK BEHAVIOUR SCREENING TOOL: RAPID ASSESSMENT – PSYCHOLOGY, ALCOHOL AND DRUGS (RAPAD)

Steven Ellen, T. Gibbie, M. Hellard, T. Read, C. Fairley, A. Mijch

Since 1999, increases in HIV/STI in Victoria have been a major concern. Previous research has shown that mental health problems such as mood disorder and drug/alcohol use may lead to increased sexual risk taking behaviours. Although many validated tools exist to measure mental health problems, drug/alcohol use and sexual risk taking behaviour, no tools currently exist which incorporate all three domains.

Aims: To examine the predictors of risk taking behaviours for HIV/STI transmission in men who have sex with men (MSM); and to develop a practical clinic based assessment tool that will identify MSM at risk of HIV/STI transmission.

Methods: Participants completed a structured diagnostic interview (Mini International Neuropsychiatric Interview [MINI]), depression screen, personality measures and a sexual risk behaviour questionnaire. STI test results acted as a biological measure of sexual risk behaviour. A five minute follow-up phone call three months after the initial interview is currently measuring sexual risk behaviour and drug/alcohol use since baseline.

Baseline results: 150 MSM have completed baseline assessment, having an average age of 36 years, with 35% of the cohort being HIV positive. Twenty-three percent have been diagnosed with a major depressive episode and a further 4% with dysthymia. Of the 124 participants who were sexually active, 41.9% met the criteria for sexual risk behaviour. Alcohol use and personality characteristics were found to be significantly correlated with sexual risk behaviour (p≈0.05).

Summary: A high prevalence of depression was identified in the cohort and 41.9% of sexually active participants met the criteria for sexual risk behaviour. Risk behaviour was significantly correlated with alcohol use and sexual sensation seeking scores.

PP47 HOPELESSNESS AS A PREDICTOR FOR DISCHARGE AGAINST MEDICAL ADVICE

Ashraf Elshafei

At metropolitan hospital/New York medical college we began screening all of the patients entering our detoxification unit using the Beck Hopelessness scale to identify patients at risk for signing out AMA. Of the 78 patients (17 were female and 61 were male), 37 patients (47%) were Hispanic, 21 patients (27%) were African-American,16 patients (21%) were Caucasian and four patients (5%) were other. The patients ranged in age from 24–36 years. 26% of the patients had psychiatric co-morbidities. On admission, 25 patients 32% were homeless and had significant medical co-morbidities. Out of 78 patients,15 signed out AMA (47% Hispanic, 33% African American and 20% were Caucasian. five additional patients with mild Hopelessness score attempted to sign out AMA but due to aggressive staff intervention they remained. On the Beck Hopelessness Scale, seven patients scored as modrate. all of these patients left AMA. 24 patients scored within the mild hopelessness range and of these, eight left AMA. 47 patients scored as minimal hopelessness and none of them signed out AMA. Beck inventory was introduced to the patients in 72 hours after the admission.

PP48 ALTERNATIVE SPLICING, METHYLATION STATE, AND EXPRESSION PROFILE OF TRKB IN FRONTAL CORTEX OF SUICIDE COMPLETERS

Carl Ernst, Gustavo Turecki

While much of the effort to understand the neurobiology of depressive states and suicide has focused on neuronal processes, recent studies suggest that astroglial dysfunction may play an important role. TrkB.T1 is expressed in astrocytes and BDNF/TrkB signaling has been linked to mood disorders. We tested the hypothesis that TrkB.T1 expression is downregulated in suicide completers and that this downregulation is mediated by an epigenetic process. We used 2 independent samples for initial screening and replication. Sample 1 (N = 20) was initially screened using the HG-U133A,B chipset, while sample 2 (N = 19) was investigated using the HG-U133plus2 chip. Initial studies focused on dorsolateral frontal cortex using a microarray screening approach for extreme expression differences across subjects. Results were validated by qRT-PCR and Western Blot. Animal experiments were performed to control for drug and alcohol effects. Genetic and epigenetic studies were carried out by direct sequencing and bisulfite mapping. We found that 35% of suicides from both samples demonstrated significant decreases in three different probe sets specific to TrkB.T1. These findings were generalizable to other frontal regions, but not to the cerebellum. The decrease in TrkB was specific to the T1 splice variant. Our results were not accounted for by substance comorbidity or by reduction in astrocyte number. We found no effect of variation in a 2500 bp promoter region or at relevant splice junctions, however, we detected an effect of methylation state at particular CpG dinucleotides on TrkB.T1 expression. These results demonstrate a reduction of TrkB.T1 in a subpopulation of suicide completers.

PP49 ADAM (A DISINTEGRIN AND METALLOPROTEASE) 12-IMMUNOPOSITIVE OLIGODENDROCYTES ARE DECREASED IN SCHIZOPHRENIA

Nadine Farkas

ADAM12 is a member of the permanent growing family of multidomain metalloprotease-disintegrins which possess cell-binding, cell-signaling and proteolytic properties. This metalloprotease is localized in mesenchymal cells, heart and skeletal muscle, bone, certain tumors. In the brain the enzyme is mainly found in oligodendrocytes. A disruption of the function of this cell type and/or loss of oligodenrocytes is regarded a key facet in schizophrenia studies.

In the current report we investigated the expression of ADAM12 in oligodendrocytes of nine schizophrenics and seven matched controls. Using immunohistochemical techniques (antibody SA-378, Biomol) the number of ADAM12-immunoreactive oligodendrocytes was counted in dorsolateral prefrontal cortex and anterior cingulate cortex and white matter.

We found significantly decreased ADAM12-immunopositive oligodendrocytes in both gray and white matter in schizophrenics compared to controls (p≈0,028; ANCOVA).

ADAM12 is a sheddase for heparin-binding EGF-like growth factor (HB-EGF).

The regulation of HB-EGF/ EGF receptor system is of special interest, because it has been shown that the EGF receptor is elevated in schizophrenia (Futamura et al. 2002, Bernstein et al. 2004).

It is also known that ADAM12 cleaves insulin-like-growth-factor-2 binding protein-3. This growth factor play an essential role in the development of oligodendrocytes and the formation and regeneration of myelin. Thus, the diminished expression of ADAM12 may contribute to a dysregulation of myelin, which is observed in schizophrenia.

Supported by Stanley Foundation and NBL-3 Magdeburg.

PP50 CLINICAL AND DEMOGRAPHIC VARIABLES ASSOCIATED WITH SMOKING CESSATION IN MILITARY VETERANS IN THE USA

Antony Fernandez, Justin Pfeifer, Demetrios Julius, Victor Vieweg

Introduction: The McGuire VAMC Smoking Cessation program was started in 2002 to better address smoking cessation in our mental health and addiction treatment settings. US Congress in 1996 defined eligibility criteria for medical care and priority groups based on variables, which included low income. We sought to investigate relationships among smoking and SES as defined by priority groups.

Methods: The Smoking Cessation database was reviewed. Variables assessed included (1) age, (2) decade of life, (3) sex, (4) race, (5) priority groups (6) Fagerstrom score (7) cigarettes per day (8) Lung Age and (9) Carbon monoxide score. Statistical analysis was conducted using SPSS for windows.

Results: Of the 191 veterans 104 (54.5%) were African American, and 87 (45.5%) were Caucasian. Mean age was 54.11±10.15. Males 171 (91%) outnumbered Females 17 (8.9%). Mean cigarettes per day was 2.38±1.17. The mean Lung age at visit was 72.51±19.42. The mean Fagerstrom score was 4.95±2.37. Combining Priority Groups 1–3 into a single group and Groups 4–6 into a single group and Groups 7 and 8 into a single group revealed that priority grouping 1–3 was associated with less severe smoking.(df = 2, F = 2.952, p = 0.055). The population was predominantly male and African American limiting generalization of our findings.

Conclusions: These results are limited by the cross sectional design. Smoking cessation services were being accessed by smokers who were moderately and highly dependant on nicotine. Veterans in lower priority groups had less severe smoking than veterans in higher priority groups.

PP51 BUILDING THE BRIDGE

Gavin Foster, Sarah Ward, Heather Gassert, Hannah Bloom, Marek Turski-szendzielarz, Gideon Dubow

Context: As a new initiative, the Department of Human Services Mental Health Branch, is providing extra funding for Victorian Mental Health Programs to establish youth-focussed Early Psychosis Services (Early Psychosis Service Program Description, 2004). Their specific aim is to promote optimal recovery from first episode psychosis during a significant psychological, social and vocational developmental stage (Jackson et al, 1999) by enhancing service provision for those young people aged 16–25 years. Objectives: The Eastern Health Early Psychosis Service has developed a model of care that aims to promote recovery from psychosis through ensuring accessibility to a range of evidenced-based treatment modalities for the young person and their family. To be successful it has been necessary to challenge traditional practices associated with the service gap between Child and Adolescent (CAMHS) and Adult Mental Health Services (AMHS).

Key messages: The establishment of the Eastern Health Early Psychosis Services have involved the collaboration of the CAMHS multi-systemic, behavioural and psychosocial approach with the AMHS focus on diagnosis, risk and biological treatment. The primary aim is to increase the breadth of interventions available to engage the young person and their family and provide consumer focussed treatment, whereas historically there has been the potential for significant variation in service provision.

Conclusion: Eastern Health via the Early Psychosis Service is building the bridge between the CAMHS and Adult Mental Health Services by providing a model of care for youth that utilises engagement, innovation and inclusion as key concepts within this model of recovery.

PP52 ENVIRONMENTAL FACTORS AND EMERGENCE OF PSYCHOSIS AND PERSONALITY DISORDERS IN A SPANISH FAMILY

Alejandra Ana García Rosales, Juan José De Frutos, María Belén Bardón Rivera, Mariano Hernández Monsalve, Pilar Nieto Degregori, Manuel López Perdiguero, María Fe Bravo Ortiz

Background: In the G.C. family based in Madrid, five of the seven GC siblings suffer from psychotic disorders. Other family members suffer from personality disorders, alcoholism and substance abuse. Several family members have been or are being treated by the different psychiatry teams belonging to the Hospital La Paz.

Aims: Analyse, from the environmental viewpoint the pathoplasty and the emergence of psychopathology in this family.

Methods: The authors have recollected thoroughly all the information on this family: clinical histories, family visit and individual interviews. On one hand, they have then analysed the data focusing especially on the relationship between environmental factors and the sprouting of psychopathology all the way to psychosis and personality disorders. On the other hand, they have examined the sex differences as far as diagnostic categories are concerned. They have reviewed the current literature regarding these two topics.

Results: Precarious socioeconomic conditions (low income and overcrowding in the household), alcohol and drug abuse, the chronic poor and traumatic interactions between family members have contributed greatly to the flourishing and perpetuation of psychopathology, in this family.

Women have more personality disorders, whereas men suffer predominantly from psychotic disorders.

Conclusion: This family exemplifies strikingly the relevance of all these intricate environmental factors in psychosis and personality disorders. Intervention strategies appear only to be palliative, at this point in time, even within a multidisciplinary team. Prevention strategies must be implemented in order to avoid these distressing conundrums as far as family and health professionals are concerned.

PP53 PREVALENCE OF DEPRESSIVE DISORDER IN A PATIENTS' SAMPLE WITH CANCER OF COLON, BREAST AND LUNG

Alejandra Ana García Rosales, Isabel Mirapeix, Guadalupe Torres, Ana Hospital, Pablo Orgaz, Ángela Palao, Carmen Bayón, Beatriz Rodríguez Vega

Background: In previous studies in general oncologic population has been found a high prevalence of anxiety and depression disorders. The prevalence, however, varies widely by study and is often attributable to differences in assessment procedures and sociodemographic variables. Prevalence of Major Depression in oncologic patients is still infradiagnosed

This study is included on a more wide one (FIS PI n °: 050737; FIS PI05/2062)

Aims: The aim of the present study is to determine both the prevalence of depressive symptoms in our sample and the percentage of possible cases in which depression diagnosis were confirmed through a clinical interview employing DSM-IV criteria.

Methods: We selected a sample of 667 patients diagnosed of colon (n = 258), breast (n = 332) and lung (n = 77) cancer on ambulatory treatment. In order to detect depressive symptoms we've employed Hospital Anxiety and Depression Scale (HADS) and to confirm diagnosis of depression, a clinical interview

We obtained a 14.39% (n = 96) of patients with a HADS depression rate over eight. From these patients, 6.29% (n = 42) of the sample had a HADS depression rate over 11 and a 8.09% (n = 54) of the sample had a HADS rate between 8 and 10. In those possible cases with a HADS rate equal or over 8 diagnosis were confirmed Depressive Disorder in a 93.75% (n = 90).

Conclusions: We conclude that our information supports a high degree of depressive disorders in a sample of patients with colon cancer and that HADS appeared as a good scale for the screening of depressive disorders in our sample.

PP54 A SUMMARY OF A PATIENT SATISFACTION QUESTIONNAIRE DONE IN THE OUTPATIENT CLINIC IN A MENTAL HEALTH TEAM

Arunima Ghosh Nodiyal, Hermarette Van Den Bergh, Sunil Nodiyal

Background: Considering it is crucial to tailor service development to the needs of service users, a survey was done to evaluate patient satisfaction.

Aims: To assess Patient Satisfaction with care in Outpatient clinics, the outcome to be used to address issues identified

Methods: The questionnaire is self administered. It included standard demographic variables, 13 closed questions, 4 Likert-like closed responses and 3 opportunities for comment. The areas covered by questions included satisfaction with information provided, length, frequency of appointments, additional support and general care. The population included all patients attending clinics with the Consultant or SHO from November to December 2006. The questionnaires were distributed in the clinics, and filled by agreeable patients.

Results: 89.6% said that the side effects were explained.93% were explained their diagnosis.45% received information leaflets, 55% received driving advice and 75% about alcohol. 93% were satisfied by frequency of appointments. However, 75.6% did not receive additional support and 55% did not receive any psychotherapeutic input. Out of those 50% sought psychotherapy.

Conclusions: All patients were satisfied by the information they received. Majority were satisfied by the explanation of their diagnosis, medications, frequency and length of appointments. However, the following shortcomings were identified: more people wanted additional support, and half wanted psychotherapeutic intervention. About half the population were over the age of 46, more than half were unemployed.

PP55 A STUDY ON ADOLESCENTS ADMITTED IN ADULT MENTAL HEALTH WARDS OVER FOUR YEARS IN A MENTAL HEALTH TRUST IN THE UK

Arunima Ghosh Nodiyal, Barry Chipchase, Angela Robinson

Background: There have been concerns about the practise of adolescents being admitted in adult mental health inpatient wards, due to infrastructural deficits.

Aims: To study the pattern of admission of adolescents into adult mental health inpatient wards.

Methods: Data was collected from all patients under 18 years who were admitted to adult wards in NTW trust from 2002 to 2006. The age, length of admission, ICD 10 diagnosis, source of referral and follow up to Young People's Unit was noted.

Results: There were 70 adolescents admitted to adult wards. 56% were 17, 24% were 16, while 4% were 15 year olds. 18% were diagnosed with Mental Disorders Not Otherwise specified, 6% had Acute and Transient psychotic Disorders unspecified and 10% had Adjustment disorders. Source of referral was unknown in 53%. 4% were referred by the adolescent unit. 14% had been considered unsuitable for admission by the adolescent unit and 4% were to be picked up by them following discharge. 38.5% were admitted for less than 6 days, 17% for 6–10 days and 8.5% for more than 40 days.

Conclusions: There were 25 between 2002–2003, 17 between 2003–2004, 10 between 2004–2005 and 17 adolescents between 2005–2006 admitted in adult wards. Adolescents continue to be inappropriately admitted in adult wards. To enable good practise there is an urgent need for resources for adolescent services.

PP56 DESCRIPTIVE STUDY OF THE PATIENTS ATTENDED IN AN EMERGENCY PSYCHIATRIC SERVICE DURING FIVE YEARS

Jose Gines, Alfredo Gurrea, Ricard Navines, David Corcoles, Carrie Garnier, Angeles Malagon, Carles Garcia-Ribera, Antoni Bulbena

Background: Knowing the specific cases attended in an emergency psychiatric service, it is very important to be able to adapt the existing resources, maximizing the clinical effectiveness.

Aim: To study the sociodemographic and clinical variables of patients assisted in an emergency psychiatric service. To evaluate possible differences between the immigrant population and the native population.

Methods: We used a sample of 11962 visits made in the psychiatric emergency service of a general hospital throughout five consecutive years. Sociodemographic data and relevant clinical variables were studied. Data were analyzed with the SPSS statistical tool.

Results: Mean age is 40,29 + 15,4, with a 52,4% of women. The most frequent syndromic diagnosis is affective disorders, followed in frequency order by anxiety, psychosis, substance use disorders and personality disorders. Drug abuse is detected in 21.7% of the patients, being diagnosed of dual pathology 14,9% of the sample. 78,9% of the patients have psychiatric antecedents. 13.2% are immigrants and 28% of the sample have social problems. When we compared the immigrant population with non-immigrant we found statistically significant differences in all the variables studied except in the substances use.

Conclusion: The existence of clear differences in the variables that define the immigrant population shows the necessity to modify the existing clinical resources to adapt them to the new situation.

PP57 PATIENT OR CONSUMER

Gemma Griffin

Context: Recently the term “consumer” has been preferred over “patient” to describe people receiving mental health services.

Objectives: This paper will analyse these terms and advocate for a return to using “patient” in mental health policies and practice.

Key messages: The current fashion of using “consumer” has mainly been driven by concerns that “patient” emphasises the power imbalance held by health professionals. Many suggest “patient” evokes images of a weak and passive actor, whereas “consumer” emphasises the active role played in the treatment relationship. This is questionable at best. In any event, concerns about power imbalances cannot be addressed by simply changing a word, and to do so risks neglecting such issues by allowing people to ignore the actual problem.

“Consumer” tempts one to see patients as objects of the economic interests of the pharmaceutical and health industries, and implies an element of free choice which is entirely absent for many. The term “consumer” often has the effect of marking mental health patients as different from patients in the remainder of the health system. It is a euphemism that avoids acknowledging someone is unwell and is antithetical to building partnerships. Further, the definition of a consumer as someone who has, or had, a mental illness is hardly hope-inspiring and permanently labels those with mental illness of a single-episode nature.

Above all, “consumer” is just another label put upon mental health patients and one which many do not understand or identify with.

Conclusion: The term “patient” should replace “consumer” in mental health policies and practice.

PP58 RECOGNISING SELF-CONCEPT AND IDENTITY ISSUES POST-DIAGNOSIS

Gemma Griffin

Context: Many public health campaigns focus on external stigma and discrimination towards those with mental health issues, however internalised or self stigma is also recognised. Yet there appears to be little recognition of the difficulty some patients face with self-concept and/or identity following diagnosis.

Objectives: This paper will encourage recognition of patients who experience self-concept/identity problems upon diagnosis, and the potential for the effects of this to be misattributed to internalised stigma or to be considered a symptom of illness rather than a reaction to diagnosis.

Key messages: For some, being diagnosed with a mental illness is traumatic not because they are particularly concerned by the label of being a mental health patient, but because the many realisations that come with diagnosis cause them to doubt who they are. Their insistence that “I'm not a mental health patient” may not relate to a lack of insight, or to the impact of the prejudices addressed by the stigma and discrimination campaigns. They may know and accept they have been diagnosed. They may not care what others might think of them. They may rather be stating that the diagnosis is inconsistent with their existing self-concept or has triggered an identity crisis. This may have many effects, including confusion and lack of confidence or self-esteem. This change or loss of self-concept or identity, even if only transitory, is an additional trauma that needs to be considered and addressed at an individual level.

Conclusion: Loss or change of self-concept/identity is an important issue to recognise when treating patients who have recently received a diagnosis.

PP59 THE CHILD WHO PULLS HIS LITTLE BROTHERS’ HAIR: A DIFFERENT TRICHOTILLOMANIA CASE

Demet Güleç öyekçin, Mehmet Murat Demet

Background: Trichotillomani in child and adolescent populations has not been extensively studied, and the etiology, natural course, and best treatment approaches for the disorder are not known.

Case report: This is a case report about 8 year old male child, with a 4 years history of hair pulling. He began to pull his little brothers’ hair during the last 2 years. He did not referred to any psychiatry clinic. There is no history of any psychiatric disorders in the family.

Violence, serious economical and family problems present in the history. The frontal scalp and vertex were the most common sites affected Associated findings included nail-biting.

Attention disorder, anxiety symptoms during the interview, insomnia and learning problems were determined. He did not have any obsessive-compulsive symptoms in the past history. Chest X-ray used to exclude trikobezoar. IQ (intelligence questionnaire) test result showed border mental retardation.

Discussion: Of special interest is the possible relationship between family chaos experienced during childhood and the onset of trichotillomani. Without the establishment of object constancy an individual requires visible evidence that the object/person capable of gratifying basic security needs is present.

Conclusion: In this case reveal an impaired affective interpersonal communication between mother and child, physical and emotional neglect and childhood trauma may play a role in the development of this disorder and are very important factors.

PP60 THE ALEXITHYMIA SCORES OF SOMATOFORM DISORDERED PATIENTS WHO LIVE IN RURAL AREAS

Demet Güleç öyekçin, Selin Mızrak

Background: Somatic symptoms have been conceptualized in many different ways in literature. Normal visceral phenomena and the personality trait of alexithymia are factors in the process of somatization, whereby somatic symptoms become metaphors for emotional distress.

Aim and method: The purpose of this study is to examine the alexithymia rates among somtoform disordered patients who referred to two rural government hospital psychiatry out-patient clinic.

Thirty-two subjects included in the study. All subjects completed the Toronto Alexithymia Scale (TAS) and a demographic questionnaire, using SCID interviews diagnoses were assessed.

Results: Thirty-two patients 90.6% (n = 29) female, 9.4% (n = 3) male, the mean age was 37.06±10.78, Toronto alexithymia scores was 64.34±10.75, 43.8% (n = 14) of the patients were conversion disorder, 21.9% (n = 7) bta somatoform disorder,%18.8 (n = 6) somatization disorder, there was no significant relation between the diagnosis and the alexithymia scores.(p = 0.05)

Discussion and conclusion: Alexithymic patients were found to use significantly more words to describe their pain, we found the alexithimia scores lower in the somatoform group patients was not as high as expected. Somatoform disorders are the most diagnosed psychiatric illness especially in rural areas. In this study, we found lower alexityhimia scores in the somatoform group patients. The most determined diagnose was conversion disorder and bta somatoform disorders. The small amount of the study is one of the most important limitations of this study.

PP61 TUBEROUS SCLEROSIS WITH EARLY ONSET PARANOID SYMPTOMS: A CASE REPORT

Demet Güleç öyekçin, Selin Mızrak

Background: Tuberous Sclerosis (TSC) is a genetic disorder characterised by abnormal growths in a wide range of organs. In the brain, abnormalities of differentiation, proliferation and migration can produce a range of neuropsychiatric features.

Case: We report a case of 17-year-old male, diagnose of TSC when he is 6 years, without any presenting with facial angiofibromas and epilepsy.

Psychiatric findings: Flat affect, lack of speech, auditory hallucinations, persecutor delusions, agitations and paranoid behaviours begins when he is 6 years. The neurological and psychiatric symptoms began at the same period.

Treatment: Psychotic symptoms disappeared after 600 mg per day ketiapin treatment.

Laboratory findings: Magnetic resonance imaging findings; multiple hamartoms on the left frontal cortex, right occipital cortex, bilateral parietal cortex and bilateral multiple subependimal noduls. EEG finding is normal.

Discussion: The most frequent CNS manifestations were seizures and mental abnormality. In this case we determined psychotic features initially, the interesting thing is the lack seizure which disappeared after 6 years. The major clinical sign is psychiatric manifestations with early onset. The localization of the hamartoms may contribute to the psychotic features.

Conclusion: In this case, the major clinical signs are psychiatric, we know that frontal brain system mostly disrupted by tuberous sclerosis complex which play a very important roll in the psychotic symptoms. In early onset paranoid features we should investigate the neurological organic causes.

PP62 DEPRESSIVE SYMPTOMS AND PREFRONTAL HYPOPERFUSION IN PATIENTS WITH DAT DEMONSTRATED BY eZIS

Hiroshi Hashimoto, Hisanori Akiyama, Joji Kawabe, Shigeaki Higashiyama, Kouhei Kataoka, Aiko Shimada, Toshihiro Kai, Koki Inoue, Susumu Shiomi, Nobuo Kiriike

Background: Depressive symptoms are common in Alzheimer's disease (AD) and contribute to clinical morbidity. Previous studies have suggested that hypoperfusion in the prefrontal cortex and anterior cingulate gyrus are involved in the pathophysiology of depression.

Aims: Using eZIS, we investigated the relationship between depressive symptoms and prefrontal hypoperfusion in AD.

Methods: 99mTc-ECD-SPECT and Neuropsychiatric Inventory (NPI) were performed in forty-four patients diagnosed as having Dementia of Alzheimer's Type (DAT) based on DSM-IV. These patients were divided into the Depression group (D groups: n = 26) and the Non depression group (ND groups: n = 18) based on NPI depression items. All data from SPECT images were analyzed using eZIS software. We investigated the highest z-values on each side of the prefrontal cortex and anterior cingulate gyrus. We compared the mean z-values between the D group and ND group.

Results: The mean z-values of the bilateral prefrontal cortex for the D groups were significantly higher (p≈0.05) than those of the ND groups. There were no significant differences in z-values of the bilateral anterior cingulate gyrus between these two groups.

Conclusion: These findings suggest that hypoperfusion in the prefrontal area contributes to the expression of depressive symptoms in patients with DAT.

PP63 ABNORMALITIES OF THE SUPERIOR TEMPORAL LOBE ACTIVATION DURING THE PERCEPTION OF BIOLOGICAL MOTION IN SCHIZOPHRENIA – A FUNCTIONAL MRI STUDY

Naoki Hashimoto, Atsuhito Toyomaki, Tamaki Miyamoto, Masahiro Hirai, Itiro Kusumi, Tsukasa Koyama

Background: Biological motion perception, the recognition of human action depicted in sparse dot displays, is a kind of social perceptions supported by a network of brain areas including the superior temporal sulcus (STS). The deficits of biological motion perception have been showed in schizophrenia but there are no studies which test this finding using functional imaging methods.

Object: The main object of this study is to investigate the deficits of the biological motion perception in schizophrenia patients by using fMRI. We hypothesized that schizophrenia patients should show reduced activation of STS by biological motion stimulus.

Methods: Subjects were six schizophrenia patients and twelve healthy control subjects matched the age and gender. Data for the fMRI time series were acquired under three task conditions: biological motion condition in which seventeen point lights depicting fifteen different human actions were presented, scrambled motion condition in which scrambled motion made by scrambling positions of the point lights depicting biological motions were presented, and static condition in which the first frames of biological motions were presented. Positive and Negative Symptom Scales, several general cognitive tasks, and Empathy Quotient were also assessed.

Results: In biological motion condition vs. scrambled motion condition contrast, normal controls showed activation of STS but schizophrenia patients did not.

Conclusion: Our findings suggest that STS were involved in the deficits of the biological motion perception in schizophrenia patients.

PP64 SMOKING TO FORGET: DOES SMOKING IN TEENAGERS AFFECT THEIR EVERYDAY PROSPECTIVE MEMORY PERFORMANCE?

Thomas Heffernan, Terence O'Neill, Janice Bartholomew, Jon Ling, Steve Holroyd

Background: This study was designed to assess what impact long-term smoking has upon everyday prospective memory (PM: memory for future events) in teenagers. Heffernan et al., (2005) found that older smokers reported a greater number of long-term PM errors than non-smokers on the self-reported Prospective Memory Questionnaire (PMQ).

Aims: The present study extends this research to focus on a teenage cohort and to extend the research paradigm to include the PMQ and an objective measure of PM.

Methods: A non-experimental design was used. Thirty-eight smokers and 38 non-smokers were tested, all of whom were college/university students studying in the North-East of England. Each participant was asked to complete the PMQ – a self-rating scale used to gauge the number of errors in short-term, long-term, and internally-cued aspects of everyday PM, as well as strategy-use, and a video-based prospective memory task – during which the person has to remember particular activities at particular locations as they appear on the video. A drug-use questionnaire determined how many cigarettes were smoked per week, as well as other drug use.

Results: A series of one-way ANOVAs revealed that the smokers were older, drank more alcohol and used more cannabis, than the non-smokers, with no difference on strategy use. A MANCOVA revealed that, after controlling for age, alcohol use and cannabis use, the smokers reported more lapses in their long-term PM and recalled less on the video-based PM task, than the non-smokers.

Conclusion: Self-reported and objective deficits in everyday PM are associated with smoking in teenagers.

PP65 PROSPECTIVE MEMORY IMPAIRMENTS ASSOCIATED WITH CANNABIS USE: A COMPARATIVE STUDY OF USERS AND NON-USERS

Thomas Heffernan, Janice Bartholomew, Steve Holroyd, Andy Parrott, Mary Screech

Background: This study investigated whether regular use of cannabis has a detrimental effect upon everyday prospective memory (PM: memory for future events/actions). Only one study has looked at this possibility. Rodgers et al., (2001) found that cannabis use was associated with reports of ‘here-and-now’ cognitive problems in short-term and internally-cued PM on the self-reported Prospective Memory Questionnaire (PMQ).

Aims: The present study extends this area by comparing cannabis users and non-users on both self-report and a video-based prospective memory measures.

Methods: 234 undergraduates were accessed by opportunity sampling for the study. A non-experimental design was used, utilising pre-existing groups of 77 cannabis users and 157 non-users. Each participant was completed a video-based prospective memory task – during which he/she had to remember particular activities at particular locations as they appeared on a video and the self-report PMQ – which measures everyday memory lapses (eg how often one forgets to post a letter, lock one's door, etc.), a Substance Use Questionnaire – which was used to measure weekly cannabis use and other substance use, and the Hospital Anxiety and Depression Scale (HADS) – which was used to measure mood.

Results: A series of ANCOVAs revealed that cannabis users recalled significantly fewer action-location combinations on the video-based prospective memory task than non-users, with no significant differences in the number of self-reported prospective memory failures. These findings were observed after controlling for age, strategy use and the use of other recreational drugs.

Conclusion: This research confirms that everyday prospective memory deficits associated with frequent use of cannabis.

PP66 EVALUATION OF THERAPEUTIC RESPONCE TO DONEPEZIL IN PATIENTS WITH DAT BY 3DSRT

Shigeaki Higashiyama, Joji Kawabe, Hiroshi Hashimoto, Hisanori Akiyama, Etsushi Kawamura, Ai Oe, Takehiro Hayashi, Hiroko Kurooka, Koki Inoue, Nobuo Kiriike, Susumu Shiomi

In a quantitative evaluation of the therapeutic response in Alzheimer type Dementia (DAT), comparing pre- and post-treatment regional cerebral blood flows, uptake in certain types of cerebral regions of interests (ROIs) were previously measured. However, ROI analysis is associated with problems, such as poor reproducibility and a lack of objectivity. The aim was to investigate the evaluation of a therapeutic response by a three-dimensional stereotaxic ROI template (3DSRT), using fully automated ROI analysis software, capable of objectively estimating rCBF. So we compared the effect of the therapeutic response of three-dimensional stereotactic surface projections (3D-SSP). Brain perfusion single photon emission tomography (SPECT) studies and Alzheimer's Disease Assessment Scale Japan cognitive Subscale function test ADAS-Jcog tests were performed for 22 patients (16 female, 6 male of mean age = 73.6) who were diagnosed as DAT before treatment. On 3DSRT, we compared the ratios of the rCBF values of the parietal lobes, temporo-occipital lobes, hippocampus, corpus callosum and the frontal lobes/cerebellar hemispheres before and after treatment. On 3DSSP, we examined the cinguli gyrus bilaterally, and scored the change in Z value there. During the ADAS-Jcog inspection, while improvement was noted in 10 patients, the remaining 12 showed no improvement in the ADAS-Jcog score. In 10 patients who had recognitive improvement following ADAS-Jcog inspection, eight patients showed improvement in 3DSSSP and seven patients in 3DSRT respectively. In the other 12 patients, no improvement was revealed by ADAS-Jcog inspection, while 11 patients showed no improvement in 3DSSP and 3DSRT respectively.

PP67 THE ROLE OF NOREPINEPHRINE TRANSPORTER GENE IN PATIENTS WITH ALCOHOL DEPENDENCE

San-Yuan Huang, Ru-Band Lu, Mee-Jen Shy, Wei-Wen Lin

Several studies have suggested that the norepinephrine transporter (NET) may play an important role in the pathogenesis of alcohol dependence. Additional studies have shown that the polymorphisms of T-182C (rs2242446) and G1287A (rs5569) in NET gene (hSLC6A2) may affect the NET function. Therefore, in this study, we examined whether these hSLC6A2 gene polymorphisms are a susceptibility factor for alcohol dependence or its clinical subgroup(s). A total of 690 Han Chinese subjects (408 alcohol dependent patients and 282 controls) in Taiwan were recruited for this study. Individuals with alcohol dependence were classified into several clinical subgroups to reduce the clinical heterogeneity. All subjects were interviewed with identical methods, and the mental disorders were diagnosed according to DSM-IV criteria. The polymorphisms of T-182C and G1287A in hSLC6A2 gene were analyzed by using a standard method. No significant differences in genotype and allele frequencies of hSLC6A2 polymorphisms were found between controls and total alcohol dependence or between more homogeneous subgroups with alcohol dependence and controls. This study suggests that the polymorphisms of T-182C and G1287A in hSLC6A2 gene are not major risk factors in increasing susceptibility to either alcohol dependence or its clinical subtypes; however, additional replication studies with ethnically homogeneous samples in distinct populations are needed.

PP68 DOSE THE MAOA POLYMORPHISMS ASSOCIATED WITH MAJOR DEPRESSIVE DISORDERS IN THE HAN CHINESE POPULATION?

San-Yuan Huang, Wei-Wen Lin, Mee-Jen Shy, Cheng-Chang Huang, Ming-Teng Lin, Ru-Ban Lu

Monoamine oxidase A (MAO-A) is an important enzyme associated with the metabolism of biogenic amines, and it has been suggested that an MAOA abnormality is an important factor in the development of major depressive disorder (MDD). Moreover, various polymorphisms of the MAOA gene have been investigated for possible associations with mood disorders, but results have been inconsistent, especially with less MDD subgroups. The goal of the present study was to investigate whether polymorphisms of the MAOA gene are associated with either total MDD or with different clinical subgroups of MDD. A total of 590 Han Chinese subjects in Taiwan (312 controls and 278 MDD patients) were recruited. Among the males, there were no associations with MAOA polymorphisms. Among the females, an association was found between MAOA polymorphisms and severe MDD (p = 0.041 for uVNTR and 0.017 for EcoRV (rs1137070), respectively). But, in analyses of haplotype frequencies and multiple logistic regression, MAOA polymorphisms were not associated with either MDD or its subgroups. Our results suggest that MAOA polymorphisms do not play a major role in the pathogenesis of MDD or its subgroups. However, there could still be a minor association with some specific subgroups and further studies should be done with different ethnic samples.

PP69 IS SCHIZOPHRENIA A METABOLIC DISEASE?

Victoria Irimia

Background: The central nervous system is the richest tissue in lipoproteins, substances having a specific major structural and functional importance in the brain.

It is obvious that the same lipoproteins are also found in blood.

Aims: We proposed to study the lipoproteins’ equilibrium in the blood serum at the schizophrenic patients.

Method: We periodically evaluated the lipoproteins’ electrophoresis curves in the blood serum on a 560 schizophrenic patients cohort compared to 150 healthy subjects and 120 cases of uni and bipolar affective disorders. The tests were done at least once every six months on each subject from the three groups for over 8 years.

Results: We observed, only at schizophrenic patients, an anomaly of the lipoproteins’ factions meaning the lowering of alpha lipoproteins’ level compared to pre beta lipoproteins persisting under treatment for years. The concentration of lipoproteins’ factions in the blood serum changed dynamically, according to the evolution of the disease.

Conclusion: There is a specific aspect of the lipoproteins’ electrophoresis in the blood serum, with a constancy of over 88% in the case of schizophrenic patients different from the healthy subjects and also from people with severe affective disorders.

The dynamic of lipoproteins’ equilibrium in the blood serum could represent a marker regarding the diagnostic and the treatment's efficiency at schizophrenic patients.

PP70 COMPARISON OF THE DIFFERENCES IN DEPRESSED MOOD RESPONSE STYLE BETWEEN NON-DEPRESSIVE GROUP AND DEPRESSIVE GROUP

Se-Heon Jang

Background: Nolen-Hoeksema asserted that people have a consistent and unique response style to depression. The interpersonal differences in vulnerability and persisting time of depression can be explained by such a variability of interpersonal response style to depressive mood.

Aim: We compared the differences of depressed mood response style between acutely remitted non-depressive group (n = 28) and currently depressive group (n = 18). We tried to investigate what kind of response style is most responsible for the remission and persisting of depression.

Methods: We divided patients who were diagnosed as depression with ICD-10 criteria and being treated by pharmacotherapy into two groups by KDS (Korean Depression Scale). One is acutely remitted non-depressive group and another is currently depresssive group. And we checked depressed mood response style questionnaire (DMRQ).

Results: There were significant differences in DMRQ subscales between two groups. Non-depressive group showed more problem-solving (t = 2.325, sig.=.026), more mood-controlling (t = 2.054, sig.=.046) and less ruminative (t = − 3.619, sig.=.001) response style subscale than depressive group. There was no significant difference in the mood-avoiding response style. (t = − 1.406, sig.=.167)

Conclusion: We concluded that problem-solving and mood controlling response styles can act as a mediator that decrease the severity of depression during treatment of depressive patients. On the while, the ruminative response style can be a mediator that persist depressive symptom and prohibit the recovery of patient from depression.

PP71 EVALUATION OF MENTORING PROGRAMS IN PSYCHIATRIC SETTINGS

Kym Jenkins

Background: In 2003, on a background of increasing concern about the mental and physical health of junior doctors I was given the task of setting up a mentoring program for junior doctors who were doing postgraduate training in psychiatry.

Aims: The primary rationale behind this paper is a need to look beyond the obvious face validity of such a mentoring program and to more formally evaluate it. This paper then attempts to answer the question.

“What is the best way of evaluating this existing mentoring program for psychiatric trainees, in the psychiatric department where I work?”

Methods: The data presented comes a reflection on the strengths and weaknesses of the established mentoring program, followed by a review of literature obtained through a search of both medical and educational databases.

Results: There has been an increase in publications pertaining to mentoring in medical contexts in recent years, however most literature still comes from business, nursing and educational contexts. Because of the lack of constant definition of mentoring and the diversity of mentoring programs any evaluation has to be tailored to the specific program.

Conclusion: To be comprehensive any evaluation must include the perspectives of mentors and mentees, together with a. consideration of systemic and organizational issues. Qualitative methodologies are probably the most appropriate but under-utilised in this area.

PP72 TEMPERAMENT AND CHARACTER IN HOMICIDAL SCHIZOPHRENIC PATIENTS

Woon Jin Jeong, Jong Ik Park

Objectives: The aim of this study was to assess dimensions of temperament and character as defined by Cloninger's biosocial model using the temperament and character inventory (TCI) in a sample of homicidal schizophrenic patients.

Subjects and methods: 84 homicidal schizophrenic patients and 100 non-homicidal schizophrenic patients and 61 normal controls participated in this study. We used the Korean version of the TCI to compare these three groups. Comparison of TCI scores was performed by two tailed t-test and analysis of variance (ANOVA). Diagnostic evaluation was made with Structured Clinical Interview for DSM-IV (SCID), and symptom evaluation was made with Positive And Negative Syndrome Scale (PANSS), and violent behavior was assessed with Life History of Aggression (LHA).

Results: Novelty seeking (NS) was lower in homicidal schizophrenic patients (HS) than non-homicidal schizophrenic patients (NHS) (p = 0.01). Harm avoidance (HA) and Self-transcendence (ST) were higher in two schizophrenic patients groups (HS, NHS) than normal control (p≈0.001). In two schizophrenic patients groups (HS, NHS) Reward dependence (RD) and Self-directedness (SD) and Cooperativeness (C) were lower than normal control (p≈0.001, p≈0.005, p≈0.001). There were no significant difference in PANSS total scores and demographic variables.

Conclusion: We found that higher NS was not a characteristic of homicidal schizophrenic patients comparing with non-homicidal schizophrenic patients. This study replicates the results of previous studies suggesting that schizophrenic patients have high HA and high ST.

PP73 DEINSTITUTIONALISATION AND SOMATIC COMORBIDITY IN SCHIZOPHRENIA

Matti Joukamaa, Anna-Maija Koivisto, Helena Rantanen, Hannu Oja, Raimo K. R. Salokangas

Objective: Rapid deinstitutionalization in mental hospitals in Western countries has diminished hospital treatment of schizophrenia. The somatic comorbidity in schizophrenia has been underestimated and poorly recognized.

Aims: We studied these phenomena among new schizophrenia patients in Finland, where a rapid deinstitutionalization cut the mental hospital beds to a quarter during twenty years time (1985–2005).

Methods: New schizophrenia patients (N = 27000) in years 1980–2003 were identified with two ways: 1. first hospital admission due to schizophrenia (Finnish Hospital Discharge Register [=FHDR]), and 2. Disability pension due to schizophrenia (registers of the Social Insurance Institution). Somatic comorbidity was operationalised with general hospital treatments due to different somatic diagnoses.

Results: During three first time periods (1980–84, 85–89, 90–94) the proportion of schizophrenia patients with somatic hospital treatments were at similar level (hospitalizations due to cancers, respiratory, cardiovascular, gastrointestinal and other somatic diagnoses) but after that the proportions rose in other diagnostic categories expect cancers. Parallel findings were found in the length of hospitalizations.

Conclusion: These preliminary findings suggest that diminishing mental hospital treatment may weaken the treatment of somatic diseases among schizophrenia patients leading to at least some increase of hospital treatment due somatic reasons. During the study period many different changes happened in the Finnish society and especially in health legislation, which should be taken into account as intervening factors. The first new atypical antipsychotic drugs came to Finland only at the end of this study period, so their use does not affect our results.

PP74 INVESTIGATION OF THE INFLUENCE OF CHILD AND ADOLESCENT ABUSE ON PSYCHIATRIC DISORDERS AND CRIMINAL BEHAVIOR IN ADULT WOMEN

Margarita Kachaeva, Tatyana Dmitrieva, Tomash Chichenkov

Researchers on female offenders have indicated a high degree of psychiatric morbidity amongst women. A cohort of 53 females with diagnosis of personality disorders was examined. All of them have committed crimes of violence. In the majority of the sample women had a previous history of psychiatric admissions (child psychiatric hospitals, adolescent units). The retrospective review revealed that the majority of women in their childhood were exposed to emotional, physical and sexual abuse in their families. Our results point that maltreatment may distort personality formation and social adjustment and contribute to behaviour problems, negative relation to socialization and criminal behaviour in adulthood. Thus the study revealed that psychiatric disorders in childhood and adolescence are predictive of adult criminality in females. These findings may be used as prognostic indicators of development of aggression in female forensic patients.

PP75 ASSESSMENT AND TREATMENT OF FIRST-TIME PSYCHIATRIC PATIENTS IN AGE 18–25 YEARS

Ljiljana Kaleb, Klas Attrell, Annika Bloom, Birgitta Borgström, Lisa Hugoson, Marianne Julin

In Partille psychiatric out-patients unit could we during the last three years note an significant increase of patients in age 18–25. One third of references during one year were in this age. Those patients suffer from mental dysfunction during the most productive period in their lives and we know that untreated disturbances in this age can later with crisis and stress result in prolonged chronic symptoms. There is a large amount of evidence that there is a long delay between experienced difficulties and searching for help and our assumption was that adapted interdisciplinary assessment and early treatment with high intensity can reduce this risk for development of chronic states.

Objectives:

Short waiting time for interdisciplinary assessment.

Begin early with appropriate and intensive treatment.

Co-operation with the professional network in community.

Results: First-time patients in age 18–25 years were identified early in referral handling. Majority of patients (71%) could describe having problems from early adolescence. Depressive episode and anxiety were most common diagnosis. 43% of patients had a variety of traumatic experiences in their life history. Abuse/conflicts in families and mentally ill parent were most common.

We could offer 3–5 meetings for assessment. Treatment contained medication, 10–20 psychotherapy sessions and additional contribution from social worker.

Conclusions: There were a lot of difficulties to offer interdisciplinary assessment and intensive treatment within the ordinary psychiatric sector. There is need to increase continuity in assessment process and develop methods for evaluation of treatments effects.

PP76 PERCEPTION OF COERCION TO BE TREATED IN THE GROUP OF INVOLUNTARILY ADMITTED PATIENTS

Lucie Kalisova, Jiri Raboch, Thomas W. Kallert, Eunomia team

Background: There exist 5–35% of the patients with acute mental disorder that are admitted to psychiatric facilities involuntarily in the Czech Republic. The Eunomia international project focused on coercive treatment in psychiatry [1].

Aims: To find out how involuntarily admitted patients perceive coercion in relation to their admission, hospitalization and whether they feel some pressure to adhere treatment after discharge.

Methods: Included patients were asked at three time points-up to 7 days, 1 month and 3 months after admission. Questions were created by the EUNOMIA group; partly on the base of McArthur perception scale [2] and Monahan's questionnaire [3]

Conclusion: Majority of the patients in the Czech Republic feels to be admitted under duress of their family members, physicians and also the police. The majority of the patients felt certain danger that in case of non-observance of the treatment they would be restricted in some way (most often hospitalized again). Possible pressure is felt by them from the side of their family and of their out-patient psychiatrist.

PP77 AGE OF ONSET OF SCHIZOPHRENIA AND EXECUTIVE FUNCTIONS IN LATE CATAMNESIS AFTER 29 YEARS

Agnieszka Kalwa, Malgorzata Rzewuska, Alina Borkowska, Agnieszka Balcerzak, Malgorzata Luks, Janina Skalska

The aim of work was to assess the relationship between age of onset of schizophrenia and level of executive functions measured with Wisconsin Card Sorting Test after 29 years from the first episode. The sample consisted of 33 patients with chronic schizophrenia and 33 healthy controls, matched according to age and gender. Subjects with chronic schizophrenia were involved in 29 year-long catamnestic research. In the assessment of cognitive functions following neuropsychological tests were used: WCST, Trial Making Test, Stroop Test and Verbal Fluency Test. We also used BPRS rating scale and Social Adjustment Scale. Our results show that in investigated group later age of onset was associated with lower level of executive functions: higher percent of perseverative and nonperseverative errors, more trials to make 1st category, less categories completed and worst logical conception. We found also significant correlation between later age (at present) and higher number of nonperseverative errors in WCST. There were no significant associations between age of onset and performance of other neuropsychological tests in group of subjects with chronic schizophrenia, however there were significant correlations between higher number of hospitalizations and worst psychomotor speed (measured with TMT A) and worst visuospatial working memory (TMT B). We also found significant correlations between worst present mental state (BPRS) and worst level of visuospatial working memory. Present adjustment was associated with psychomotor speed and verbal fluency.

PP78 HARA-KIRI: THE EXPLORATION OF FACTORS IN RELATION TO THE SUICIDE BY SELF-STABBING

Michiko Kamiya, Kenji Yamamoto, Yumi Iwamitsu, Shingo Miyaji, Seiichi Tatematsu, Ayako Ide, Yoshito Kamijo, Kazui Soma, Hitoshi Miyaoka

Background: Hara-kiri is a form of self-inflicting a wound in the abdomen using a sharp object, and it has been known as a Japanese traditional form of suicide.

Aims: The aim of this study was to explore the factors that might be associated with the suicide by self-stabbing.

Methods: A retrospective study was conducted on the medical records of 102 patients (44 male, 58 female, 41.7±18.4 years old) who had committed suicide, and had been treated at the Kitasato University Hospital, Emergency Medical Center between September 2006 and March 2007. The information about the patients regarding demographics, clinical features, and social and cultural histories were collected by means of the medical records and used for analyses.

Results: Ten patients (7 male; 3 female, 51.0±18.9 years old) who deliberately stabbed themselves were identified, of which 4 (3 male; 1 female, 62.8±8.3 years old) patients stabbed themselves in the abdomen. The one-way analysis of variance revealed the significant differences between the methods of suicide in age of the patients. Also, the chi-square comparison revealed the significant differences for the methods of suicide in psychiatric disorders, survival, history of suicide attempts, psychiatric history, occupation, marital status, and presence of housemate.

Conclusion: Our study indicated that the method of committing suicide by self-stabbing was an apparent, and to identify patients’ clinical, social, and cultural factors in relation to the suicide by self-stabbing might benefit from future prevention of suicides in Japan.

PP79 PSYCHIC TRAUMA AND PARENTAL REARING PATTERNS IN PATIENTS WITH PERSONALITY DISORDERS WITH AND WITHOUT MAJOR DEPRESSION: PRELIMINARY FINDINGS

Hara Karamanolaki, Stamatia Vondikaki, Stavroula Alevizou, Agelliki Iliadou, Thomas Nikiforou, Grigoris Vaslamatzis

Objective: The purpose of this study is to examine the relationship of traumatic life time events and parental rearing patterns in adults with personality disorder and a history of depression. We compared a group of 20 patients with PD and life time depression to a group of 20 patients with PD without depression.

Method: Our sample were 40 outpatients. All the subjects were between 20 and 40 years old, with one or more diagnosed PDs, based on the Structured Clinical Interview for the DSM-IV (SCID II). 20 of them had been diagnosed with life time depression according to the Structured Clinical Interview for the DSM-IV (CIDI), while the other 20 did not meet the criteria of this disorder. All patients completed the self-report Traumatic Antecedents Questionnaire (TAQ) for the assessment of traumatic life time events and the self-report EMBU for the assessment of parental rearing patterns.

Results: There were no statistically significant differences between the two groups in all trauma and parental rearing factors assessed in our study.

Conclusion: Our preliminary findings suggest that the appearance of depression in patients with PD is not connected to the severity and quality of psychic trauma and to specific patterns of parental rearing.

PP80 THE EFFECT OF PSYCHOTROPIC DRUGS ON MICROGLIAL ACTIVATION INDUCED BY INTERFERON-GAMMA

Takahiro Kato, Akira Monji, Hideki Horikawa, Yoshito Mizoguchi, Bian Qian, Sadayuki Hashioka, Shigenobu Kanba

Background: An accumulating body of evidences point to the significance of neuroinflammation and immunogenetics in schizophrenia or depression, characterized by increased serum concentration of several pro-inflammatory cytokines. In the central nervous system (CNS), the microglial cells are the major immunocompetent cells which release pro-inflammatory cytokines, nitric oxide (NO) and reactive oxygen species to mediate the inflammatory process.

Methods: In the present study, we thus investigated the effects of psychotropic drugs such as antipsychotics and antidepressants on the generation of nitric oxide and inflammatory cytokines by interferon -gamma-activated microglia by using Griess assay and ELISA, respectively.

Results: Most psychotropic drugs examined significantly inhibited NO generation or cytokine release from activated microglia.

Conclusion: Psychotropic drugs may have an anti-inflammatory effect via the inhibition of microglial activation, which is not only directly toxic to neurons but also has an inhibitory effect on neurogenesis and oligodendrogenesis, both of which have been reported to play a crucial role in the pathology of schizophrenia or depression.

PP81 ESTIMATING THERAPEUTIC RESPONSE TO DONEPEZIL IN PATIENTS WITH DAT USING eZIS

Joji Kawabe, Shigeaki Higashiyama, Hiroshi Hashimoto, Hisanori Akiyama, Etsushi Kawamura, Ai Oe, Takehiro Hayashi, Hiroko Kurooka, Koki Inoue, Nobuo Kiriike, Susumu Shiomi

Donepezil is not effective for all patients with dementia of Alzheimer type (DAT). Estimation of therapeutic response to Donepezil before the start of treatment is anticipated.

eZIS is a new statistical imaging analysis system permitting brain standardization. In this study, we examined the estimating therapeutic response to Donepezil in patients with DAT using eZIS.

Sixteen patients of DAT were recruited. They received daily oral doses of Donepezil (5 mg/d). Each patient underwent the ADAS-Jcog test (recognition function test) and brain perfusion SPECT examination at the time of initial evaluation and was clinically followed by a second ADAS-Jcog test 12 weeks later. All data of SPECT images were analyzed by the eZIS software. By Z-values for each side of the posterior part of the cingulate gyrus, parietal lobe, the posterior part of the temporal lobe and hippocampus, scores of these eight regions are determined. The total numbers of scores are compared with changes in the results of ADAS-Jcog tests before to after Donepezil medication.

The total scores for 7 patients in whom improvements in ADAS-Jcog tests were found ranged from 0 to 8 (mean 3.7). The total scores for the other nine patients in whom improvement was not observed ranged from 5 to 11(mean 8.8). A significant difference (p≈0.05) was recognized between these two groups (Mann-Whitney U-test).

PP82 TEMPERAMENTAL FEATURES IN DEPRESSIVE ADOLESCENCE

Sermin Kesebir, Seher Akbas

Objective: The aim of present study was to investigate the temperamental features in depressive adolescence with or without suicide attempt and their mothers. Relationship of affective temperaments and clinical features in bipolar disorder. Testing the relationships with dominant phenomenological features and course patterns would clarify the reliability and validity of temperamental descriptions.

Methods: Patients with depressive disorder were recruited from consecutive admission and evaluated with their mothers. Affective temperaments were evaluated with TEMPS-A Turkish version. Information about characteristics of each patient's illness was obtained by using three main sources; interview with patient (SCID-I), interview with their mothers and patient records. We compared the temperamental features between depressive patients and their mothers who have a suicide attempt and have not.

Results: Depressive, cyclothymic, hyperthymic, irritable and anxious temperaments scores were similar in depressive patients with or without suicide attempt. Two important findings of the present study were (1) depressive and anxious temperament scores were more higher in depressive adolescence with planned suicide attempt; (2) irritable temperament score was more higher in mothers of patient with suicide attempts.

Conclusion: These findings suggest that beyond the predisposing role in depression, affective temperaments have significant clinical implications and importance for suicide attempt in adolescence. Temperament features of mothers were important in depressive adolescence for suicide attempt too.

PP83 CHANGES IN SOCIAL SUPPORT OVERTIME AND PSYCHOLOGICAL DISTRESS IN EAST LONDON ADOLESCENTS

Yasmin Khatib, Kamaldeep Bhui, Stephen Stansfeld

Background: Some authors suggest that there is a shift in social support during adolescence from family to an increased reliance on friends. However, there is little evidence that examines the impact of a change in support overtime on psychological distress or whether this association differs by ethnicity.

Aims: The aims of the study are (i) to investigate whether a change in social support overtime is associated with psychological distress at follow-up and (ii) to explore whether the association between changes in social support overtime and psychological distress varies by ethnicity

Method: A longitudinal questionnaire survey assessed 1125 pupils, aged 11–16 years in an East London sample. Social Support was measured using the Multidimensional Scale of Perceived Social Support at baseline and follow-up. Psychological distress was measured using the Strengths and Difficulties Questionnaire at follow-up and the Moods and Feelings Questionnaire.

Results: A decrease in family support overtime was associated with an increased risk of depressive symptoms at follow-up for female pupils only (OR = 2.62, 95% CI 1.61,4.26). Bangladeshi pupils who reported an increase in special person support were more likely to report higher levels of psychological distress at follow-up.

Conclusions: Although there was no gender differences in levels of family support overtime, gender differences in the perception of family support warrant further investigation. Furthermore, negative aspects of close relationships may be evident amongst Bangladeshi pupils.

PP84 A RISK FACTOR OF POST-ICTAL DELIRIUM AFTER ELECTROCONVULSIVE THERAPY

Atsuhiro Kikuchi, Akira Fujii, Norio Yasui-Furukori, Hiroshi Katagai, Sunao Kaneko

Background: Although electroconvulsive therapy (ECT) often causes post-ictal delirium, there has been no information about specific risk factors of post-ictal delirium.

Aims: To seek risk factors of post-ictal delirium.

Methods: An informed consent was obtained from each patient or, where necessary, the appropriate relative. The protocol of this study was approved by Ethical Committee of Hirosaki University Hospital. ECT was conducted in 37 patients. All patients were treated with more than four sessions. This study was performed from February, 2005 to March, 2007. General anesthesia was induced with propofol. The electroshock stimulus was delivered by well-trained psychiatrists using a sine-wave ECT instrument or a brief-pulse square wave ECT instrument. After convulsions, we monitored the patient's deliriums for 30 minutes. Various factors including age, gender, diagnosis, symptoms, difference of the ECT instrument and seizure duration were investigated prospectively.

Results: Post-ictal deliriums during the ECT sessions developed in 10 patients (27%). Six of all patients had had stupor before the ECT, four of the six patients had depressive stupor and the remains had catatonic stupor. Five stupor patients developed post-ictal delirium, and the incidence was 83% in all stupor patients. The incidence of post-ictal delirium in stupor patients was significantly larger than in non-stupor patients (p≈0.05, Fisher's exact probability test). No other risk factors were specified in this study.

Conclusion: This study suggests that presence of stupor before ECT is one of the risk factors of post-ictal delirium.

PP85 PSYCHOPATHOLOGICAL, STRESS CHARACTERISTICS AND OUTCOMES OF HOUSEWIFE DEPRESSION AND HWA-BYUNG IN KOREA

Sie-kyeong Kim, Chul-jin Shin, Jung-woo Son, Sang-ick Lee, Sung-Min Hong

Objectives: This study aimed to examine the characteristics of married women complaining of depressive symptoms by assessing their psychopathology, life event stress, stress perception and coping skills, and to analyze the effects of those characteristics on outcomes after 12 months. The results are expected to provide basic data for testing the diagnostic validity of housewife depression and Hwa-byung, the Korean traditional culture-bound syndrome.

Method: The subjects were 52 housewives who visited the Psychiatric Outpatient Clinic of Chungbuk National University Hospital with depressive symptoms during March to August 2005. After a psychiatric interview, the subjects filled a Korean version of symptom checklist-90-revision, life experience survey and stress perception questionnaire and ways of coping skills I checklist, and they were compared with a control group of 60 healthy women. After 12 months, the changes of subjective depressive feelings were evaluated through face to face and telephone interviews.

Results: Depression group had higher academic qualifications than before, and while the symptoms of Hwa-byung such as conversions or somatizations decreased but core emotional symptoms such as anxiety and depression increased. Major stressors had been diversified from family problems to social problems. Although active coping skills increased, passive coping skills did not decreased.

Conclusions: With the development of society, stress factors and the psychopathology of housewives with depression are being modernized. However, the stress perception and coping skills look to follow the characteristics of traditional society. The progress of housewife depression was significantly affected mainly by early psychopathology and negative life event.

PP86 QUALITY OF SLEEP AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH MAJOR PSYCHIATRIC DISORDERS

Hee-Cheol Kim, Kyoo-Man Bang

This study was performed to investigate the association between quality of sleep and health-related quality of life in patients with major mental disorders including schizophrenia, major depressive disorder, and primary insomnia. Ninety three patients were recruited from inpatient and outpatient psychiatric clinics of Keimyung University Dongsan Medical Center in Daegu City, Korea. Assessment instruments included the Pittsburgh Sleep Quality Index; the Korean health-related Quality of Life Scale; the Beck Depression Inventory; and the State-Trait Anxiety Inventory of Spielberg. The mean scores of global PSQI in three groups were greater than five. Primary insomnia group recorded the highest score of global PSQI. Major depressive disorder group had lower scores in spiritual health, pain, vitality, health status perception, and health status change domains of KQOLS than psychosis group. Primary insomnia group had lower scores in pain and health status change domains of KQOLS than psychosis group. There were no significant differences in the scores of all domains of KQOLS between major depressive disorder group and primary insomnia group. Poor sleepers reported lower mean scores on all domains of KQOLS and they were more anxious and depressed. After controlling for anxiety and depression, the domains of KQOLS associated with quality of sleep were psychological health, pain, and vitality. This study showed that the qualities of sleep in patients with psychosis, major depression, and primary insomnia were poor and their poor qualities of sleep were associated with lower health-related qualities of life in them. We suggest that intensive therapeutic interventions for sleep problems are needed to improve the quality of life in major mental disorders.

PP87 INSTRUMENTAL ACTIVITIES OF DAILY LIVING IN MILD COGNITIVE IMPAIRMENT

Yang Rae Kim, Han Yong Jung, So Young Irene Lee, Ji Hae Hong

Background: Mild cognitive impairment (MCI) is separated from mild dementia by an absence of global intellectual deterioration and the preservation of activities of daily living (ADL). But, recent study report some MCI patients have impaired instrumental activities of daily living (IADL).

Aims: To examine whether patients with amnestic and non-amnestic MCI (aMCI and naMCI) have impaired IADL as compared to healthy controls, and which items of IADL are particularly involved.

Methods: The sample consisted of 53 community-dwelling older adults in a welfare center of the aged, which was divided into three diagnostic categories: cognitively normal (N = 31), aMCI (N = 15, memory domains below −1.5 SD) and naMCI (N = 15, other cognitive domains below −1.5 SD, except memory domains). The three groups were compared on IADL and measures of cognitive function including Seoul Verbal Learning test (SVLT), Rey Complex Figure Test (RCFT), Korean-Boston Naming Test (K-BNT), Stroop test, and Korean-Mini Mental Status Examination (K-MMSE).

Results: There were significant differences in four items of 15 areas on IADL and IADL total score between aMCI and cognitively normal, but not naMCI. Items of shopping [F(2,50) = 4.20, p = 0.020], transportation [F(2,50) = 4.481, p = 0.016], medicine [F(2,50) = 3.99, p = 0.025], keeping track of current events [F(2,50) = 4.96, p = 0.011] and IADL total score [F(2,50) = 4.251, p = 0.020] in aMCI were higher than cognitively normal.

Conclusion: aMCI may be restricted on IADL compared to healthy control group. Complex of ADL of naMCI was not significantly differed from aMCI and cognitively normal. It was suggested that naMCI would be distinguished from aMCI in characteristics and prognosis.

PP88 CHILDHOOD RISK FACTORS IN KOREAN WOMEN WITH ANOREXIA NERVOSA AND BRITISH WOMEN WITH ANOREXIA NERVOSA

Youl-Ri Kim

Background: Little is known about differences in childhood risk factors for anorexia nervosa across cultures.

Aims: To compare the developmental risk factors in Korean anorexia nervosa (AN) with British AN.

Methods: 48 Korean women and 71 British women with a lifetime diagnosis of AN (restricting or binge purging subtype) were participated in this study. All participants came from volunteer database of each country, Seoul Paik Hospital in South Korea and Institute of Psychiatry in United Kingdom. Measurement of the developmental risk factors was developed from an adapted form of the McKnight Risk Factor Scale. Comprehensive assessments were performed retrospectively to identify which features were prominent in each cultural background.

Results: Those Koreans with AN were more likely to have lived with dieting vulnerability. They also reported they had more supportive family environments than British subjects did in childhood.

Conclusion: Acknowledging differences in developmental risk factors can assist us more targeted approaches for the prevention of potential eating disorders in each culture.

PP89 EFFECT OF MIRTAZAPINE FOR INSOMNIA IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER

Hyun Kim, Kang-Joon Lee, Seung-hwan Lee

Sleep disturbances are a common feature in major depressive disorder patients. Polysomnographic study has revealed that disrupted sleep continuity, altered REM sleep and reduced slow wave sleep (SWS) are common in patients with major depressive episode. It has been reported that mirtazapine improves sleep quality in normal sleepers. This study was aimed to determine the effect of mirtazapine on the polysomnographic sleep in patients with major depressive episode. Twenty-one patient, meeting DSM-IV for a diagnosis of major depressive episode, who reported symptom of sleep disturbances were enrolled in this study. They all had given their consent to take part in study. The patients were aged 18 years and over. At a 7 day of wash-out period, they were evaluated with polysomnography. After polysomnography had taken, they had received mirtazapine 15–45 mg per day for the duration of 8 weeks. After a mean of 8 weeks, they were re-evaluated with polysomnography. All polysomnographic recordings were carried out in the Sleep Research and Laboratory Unit, Ilsan Paik Hospital, Inje University. In total twenty-one subjects fourteen were female and seven subjects were male. Their mean age (± SD) of this group was 39.57±11.99. Mean duration of their depressive illness (± SD) was 1.78±1.24. After 8 weeks of mirtazapine medication, polysomnography in this major depressive disorder group showed decrease in sleep latency (P≈0.001). We also find that the percentage of REM sleep (P≈0.001) was decreased. Stage 1 sleep (P≈0.001) was also decrease. On the other hand, the percentage of slow wave sleep (P≈0.001) was increased. The results suggest that mirtazapine is useful as a treatment for insomnia in patients with major depressive disorder.

PP90 CORRELATION BETWEEN COGNITIVE DOMAINS AND INSTRUMENTAL ACTIVITIES OF DAILY LIVING IN MCI

Yang Rae Kim, Han Yong Jung, So Young Irene Lee

Objective: To estimate the effect of cognitive function on instrumental activities of daily living (IADL) details in mild cognitive impairment (MCI), compared with normal aged group (NC).

Methods: 69 community-dwelling older adults were divided into three diagnostic categories: 19 amnestic MCI (aMCI), 19 non-amnestic MCI (non-aMCI), and 31 cognitively normal (NC). IADL and Geriatric Depression Scale (GDS) were measured, and cognitive function was assessed by Seoul Neuropsychiatric Screening Battery. Stepwise multiple linear regression analysis was performed, after controlling of GDS score.

Results: In aMCI, IADL details were significantly affected by each cognitive function; shopping (language: ß = −.66, p=.002; executive function: ß = −.60, p=.004), meal-preparation(executive function: ß = −.65, p=.017), housework(executive function: ß = −.53, p=.029; visuospatial: ß = −.45, p=.046), transportation(verbal memory: ß = −.53, p=.035; non-verbal memory: ß = −.43, p=.047), transports (verbal memory: ß = −.56, p=.025; non-verbal memory: ß = −.45, p=.032), medication (executive function: ß = −.64, p=.016), finances (executive function: ß = −.82, p<.001; language: ß = −.47, p=.006), dressing (non-verbal memory: ß = −.51, p=.032), home appliances (verbal memory: ß = −.56, p=.025; non-verbal memory: ß = −.45, p=.032), locking doors (non-verbal memory: ß = −.64, p=.010), total score of IADL (executive function: ß = −.60 p<.010; language: ß = −.46, p=.038). In non-aMCI, two details of IADL were significantly affected by cognitive functions; keeping promises (visuospatial: ß = −.54, p=.044), hobbies (executive function: ß = −.56, p=.044). In NC, keeping promises was significantly affected by verbal memory (ß = −.44, p=.038).

Conclusion: In aMCI, a number of details of IADL were affected by cognitive functions, particularly executive function. In a case of decline of social-occupational function of MCI patients, executive function would be focused.

PP91 CHANGES IN REGIONAL CEREBRAL BLOOD FLOW AFTER LOW-FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION OF THE RIGHT DORSOLATERAL PREFRONTAL CORTEX IN THE TREATMENT-RESISTANT DEPRESSION

Shinsuke Kito, Kenichi Fujita, Yoshihiko Koga

Background: High-frequency repetitive transcranial magnetic stimulation (TMS) of the left dorsolateral prefrontal cortex (DLPFC) is effective in the treatment-resistant depression. Recently several studies have also proved low-frequency TMS of the right DLPFC showed the antidepressant effect, although its mechanism is still not completely elucidated.

Aims: The aim of the present study was to clarify the neuroanatomical alteration of function elicited by low-frequency TMS of the right DLPFC in the treatment-resistant depression.

Methods: Single photon emission computed tomography with 99mTc-ECD was performed on right-handed male inpatients with treatment-resistant unipolar depression within 48 hours before and after low-frequency TMS of the right DLPFC. Five 60-second trains were applied at 1 Hz (total of 300 stimuli per session) and twelve treatment sessions were administered within a 3-week period. The Hamilton Rating Scale for Depression was administered and regional cerebral blood flow (rCBF) changes were analyzed with statistical parametric mapping (SPM 2).

Results: After TMS treatment, the score of the Hamilton Rating Scale for Depression decreased significantly and a significant decrease of rCBF occurred bilaterally in the DLPFC, orbitofrontal cortex, anterior insula, and the right subgenual cingulate. There was no significant increase of rCBF. The areas of rCBF difference between responders and nonresponders were observed in the left DLPFC, orbitofrontal cortex, subgenual cingulate, and the left temporal lobe including parahippocampus and amygdala.

Conclusion: These results suggest that the manifestation of the antidepressant effect of low-frequency TMS of the right DLPFC is associated with cortical-subcortical neural pathways and, the rCBF difference in the left hemisphere of the brain may be a predictor of TMS treatment response in the treatment-resistant depression.

PP92 DO MENOPAUSAL WOMEN DIFFERENTLY RESPOND TO ANTIDEPRESSANT MEDICATION? COMPARISON OF THE EFFECT OF MIRTAZAPINE TREATMENT BETWEEN PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN WITH DEPRESSION

Young-Hoon Ko, Sook-Haeng Joe, In-Kwa Jung, Seung-Hyun Kim, Moon-Soo Lee

Objectives: Female gonadal hormones are implicated in the psychopathology of the depression. Menopausal state may affect the response to antidepressant medication but treatment options for menopause have not been investigated extensively. Thus, authors evaluated the efficacy and tolerability of mirtazapine between in pre- and post-menopause female patients with major depression during 4 weeks.

Methods: Seventy-five female patients with major depression were included. 46 patients were assigned to post-menopause group and 29 patients to pre-menopause group. Efficacy was assessed with twelve's 7-point scales modified from subscales in HAM-D-17 and with Clinical Global Severity Scale, and tolerability was assessed from adverse events. Mirtazapine was administered at the flexible dose from 7.5 to 30 mg during 4 weeks.

Results: The post-menopause group showed significantly more reduction in scores on somatization scale (p = 0.029) and shows a tendency to reduce scores on anxiety/agitation scale (p = 0.071). Significant differences between two groups were not shown in the proportion of patients classified as responders (50% decrease from baseline) in each scale. However, the post-menopause group showed the tendency to be more the proportion of responders than that of the pre-menopause group in anxiety/agitation (p = 0.050) and somatization symptoms (p = 0.084) scales. The proportion of responders (score <1 or 2) in CGI-S was not significantly different between two groups.

Conclusion: Anxiety/agitation and somatization symptoms in post-menopause female patients with major depression would be more likely susceptible to treatment with mirtazapine. The postmenopausal women with depression may differently respond to antidepressant medication compared with premenopausal women.

PP93 CLINICAL FACTORS RELATED TO GAINS IN BODY MASS INDEX AMONG PATIENTS UNDER LONG-TERM ANTIPSYCHOTIC TREATMENT

Minako Koga, Shiori Nakamura, Kazuhiko Nakayama

Aims: We conducted a retrospective investigation on the process of BMI increase in patients treated with antipsychotic agents and on the clinically relevant factors contributing to weight gain.

Methods: The subjects were 66 outpatients (35 males, 31 females) who satisfied the F2 category, and who were on antipsychotic drugs (2–15 years). The odds ratio was computed by using a logistic regression model with the mean of the changes in BMI during treatment as a dependent variable and clinically related factors, gender, age, diagnosis, clinical outcome, duration of treatment, baseline BMI, and type and dose of antipsychotic drugs as independent variables, to determine those factors contributing to the gain in BMI.

Results: Three factors-gender, age, and complete remission in clinical outcome-were found to have significant difference. The odds ratio was significantly higher in the female subjects (4.94; 95%CI: 1.42–17.27) and significantly lower in older subjects (0.93; 95%CI: 0.88–0.99), and in those subjects who were in complete remission (0.081; 95%CI: 0.007–0.954). No other factors produced statistically significant differences.

Conclusion: The gain in BMI was greater in female patients than in male patients. 2) Age was inversely related to the gain in BMI; therefore special care must be taken after administering antipsychotic drugs because younger patients may gain excessive weight and develop weigh- related complications at an earlier stage 3) The increase in BMI was minimal for patients in complete remission suggesting that these patients were better adapted socially and aware of maintaining an optimum BMI.

PP94 EXISTENTIALISM: AS A PHILOSOPHICAL FRAMEWORK FOR PRACTICING PSYCHIATRY

Devashish Konar

Philosophy has to be a Concern of Psychiatrist. Philosophy's job is to simplify. Existentialism has not received as much attention as it deserves. In this paper evolution of philosophy will be dealt with briefly. Phenomenology as a context of existentialism will be elaborated upon. Concepts consummated by Jean-Paul Sartre, e.g. absurdity of being, existence vs. essence, free choice, bad faith etc. will be dealt with in detail. De-mystification of consciousness as dealt with in existentialism will be taken into account. Being truthful to oneself is a tough job. In therapy, self actualization remains the top priority job for psychiatrist. Freedom from dogma is not easy. Need a lot of intellectual exercise and struggle with oneself. Once free, life is more forceful and fulfilling. Existentialist equivalent in literature like Notes From Underground by Fyodor Dostoevsky, The Metamorphosis by Franz Kafka, The Outsider by Albert Camus and Nausea by Jean-Paul Sartre will be touched upon.

Man does not have bird's eye view. So, what? The world seems as beautiful and informative. The dog does not know how to handle computer. But, life is as charming. Do not set standards, crossing which, man will be happy. ‘Being’ itself should give happiness. Achieving may be essential for one's identity in the society, but one should learn to enjoy simple things related to being.

Existentialism needs to be studied by psychiatrist more avidly. In my opinion Sartre's assimilation in psychiatric thinking is overdue.

PP95 ASSESSING PSYCHOLOGICAL DISTRESS IN GYNAECOLOGICAL CANCER PATIENTS DURING CHEMOTHERAPY

Akane Kondo, Kazumi Takahashi, Taro Sugiyama, Takeshi Hirasawa, Toshinari Muramatsu, Mikio Mikami

Background: Screening for psychological distress in cancer patients is important, considering the high prevalence of psychiatric disorders responsive to treatment. However, it is underestimated even we observe psychological distress frequently.

Aims: Searching facile methods to evaluate psychological distress in gynaecological cancer patients during chemotherapy.

Methods: Thirty gynaecologic cancer patients were assessed by using Self-Rating Depression Scale (SDS) and The Public Health Research Foundation Stress Check List (PHRF-SCL) which is easy and does not need considerable time. We also measured the concentration of Chromogranin A (CgA) and Cortisol with saliva four times during their hospital stay for chemotherapy. Examination points were “a day before chemotherapy”, “the day of chemotherapy”, “a day after the chemotherapy” and “the day they discharged”.

Results: By SDS and SCL, about 15% patients showed high score which indicate their needs of supportive care. CgA increased on the day of chemotherapy remarkably but cortisol did not show any significant changes depend on chemotherapy. As a marker for distress caused by chemotherapy, especially nausea and depression, CgA was 90.0% sensitivity and 72.7% specificity. The PHRF-SCL also showed parallel change to side-effects of chemotherapy chronologically.

Conclusions: This study showed that PHRF-SCL and Salivary CgA are facile and could be good indicator for patient's distress in the future. Both markers represented actual symptom of distress caused by chemotherapy adequately.

PP96 NEUROPSYCHOLOGICAL ASPECTS OF FETAL ALCOHOL SYNDROME

Krzysztof Krysta, Jacek Przybylo, Adam Klasik, Irena Krupka-Matuszczyk

Background: Children of alcohol addicted mothers often present deficits of memory, attention, hyperactivity, difficulties in understanding abstract terms, low control of impulses.

Aims: The aim was to assess the cognitive dysfunction level, and following that to estimate the optimal adjustment of the school environment for particular patients.

Methods: We recruited to our study patients aged between 9 and 18, being taken care of by a psychiatrist, and, partly, from a group of patients participating in a special adjustment rehabilitation program for children with FAS and FAE. The patients were examined with a computerized tests included in the VTS (Vienna Test System): COGNITRON, CORSI, RT (REACTION TEST) and, additionally SIGNAL and DAUF in patients matching age requirements.

Results: Qualitative and quantitative deficits were found. In most patients the most significant were deficits in COGNITRON and CORSI tests, which presented a highly disturbed resistance to distractors, and deficits in working memory. The less characteristic were deficits in the RT test measuring reaction time to simple and complex stimuli. The most difficult to perform turned out to be SIGNAL and DAUF tests. Most of the patients did not manage to do the whole task because of a too low resistance to distractors.

Conclusions: The results of the studies confirmed the reports of teachers and caregivers about great problems that this group had with concentration, sustained attention, and vigilance. However they did not confirm or sometimes contradicted the reports concerning the problems with memory presented in school conditions, and when learning at home.

PP97 COGNITION AND ANXIETY IN PATIENTS WITH SCHIZOPHRENIA

Krzysztof Krysta, Kinga Jeczminska, Anna Krawiec, Agnieszka Kozmin, Joanna Dusik, Justyna Jarnot, Agnieszka Piwowarczyk

Background: Cognitive deficits and anxiety are common symptoms in patients suffering from schizophrenia.

Aims: The aim of the research was to find a relationship between selected cognitive functions and intensity of anxiety as state and trait in people suffering from schizophrenia.

Method: 18 patients (9 women and 9 men) with a diagnose of paranoidal schizophrenia (according to ICD-10) were recruited to the study. The battery of cognitive neuropsychological tests used to assess cognitive functions included: trail making tests, part A and B, and Stroop test, part RCNb and NCWd. The intensity of anxiety as state and trait was assessed by means of the Spielberger State-Trait Anxiety Inventory (STAI).

Results: In the examined group statistically significant relation was found between the results of trail making test, part A and B (measuring psychomotor speed and visual spatial working memory), as well as part RCNb of the Stroop test (measuring reading speed), and the intensity of anxiety as state measured with STAI. Another statistically significant correlation was found between results of trail making test, part A (measuring psychomotor speed) and anxiety as trait measured with STAI. No other significant correlations between results of the applied cognitive tests and anxiety as state and trait were found.

Conclusions: The above correlations between cognitive tests results and intensity of anxiety indicate that there must be a modulating impact of emotions on some of measured cognitive functions. The awareness of these correlations may be important in the process of constructing rehabilitation programmes for patients.

PP98 PATIENTS WITH DEPRESSION AND ACCOMPANYING SLEEP DISORDERS

Krzysztof Krysta, Debska Ewa, Michal Musiol, Agnieszka Flis, Irena Krupka-Matuszczyk

Background: Most of people suffering from both depression and sleep disturbances often require a specialist treatment. Depression and accompanying sleep disorders are a significant problem in society which need attention.

Aims: The main aim of the study is showing the correlation between the extent of depression and the intensification of sleep disorders in its course.

Methods: A group of 33 patients with diagnosed depression was examined, 20 women aged 39–68 and 13 men aged 47–63. The whole group was examined considering the period of the last month of patients’ life before starting taking medicaments. In the carried out research Beck Scale was used to estimate the extent of depression whereas Athens Insomnia Scale is utilized for describing the intensification of sleep disturbances.

Results: In the group of men the average score of Beck's depression was 27,2 while the average score in insomnia scale was 16. In the group of women the following average scores were received, 32 in the Beck Scale and 14,17 in the Insomnia Scale. In order to show the extent of correlation between depression and sleep disorders the Spearman's coefficient of correlation was calculated and amounted to 0,27.

Conclusions: According to received results along with increase of the extent of the depression there is a slight increase of the intensification of sleep disorders. The research is still ongoing with the target group of 100 examined patients.

PP99 PATIENTS WITH DEPRESSION AND ACCOMPANYING ANXIETY AND COGNITIVE DISORDERS

Krzysztof Krysta, Agnieszka Kozmin, Joanna Dusik, Justyna Jarnot, Anna Krawiec, Kinga Jeczminska, Agnieszka Piwiwarczyk, Irena Krupka-Matuszczyk

Background: In patients suffering from depression, neuropsychological deficiencies of attention, memory, psychomotor speed and executive functions are observed.

Aims: The aim of this study is to find relationship between selected cognitive functions, and intensity of depression and anxiety as state and trait in depressed patients.

Methods: 16 Patients meeting the ICD 10 criteria of depressive disorders (F32, F33) were recruited. Patients with mild-to-moderate depression as measured by Beck Depression Inventory (BDI) score were included in the study. The battery of cognitive neuropsychological tests used to assess cognitive functions included: trail making test, part A and B, and Stroop test, part RCNb and NCWd. The intensity of anxiety as state and trait was assessed with the use of the Spielberger State-Trait Anxiety Inventory (STAI). The results were analyzed statistically.

Results: In the examined group no statistically significant relation between the results neuropsychological tests (trail making test, part A and B, Stroop test) and the intensity of depression measured with BDI, and the intensity of anxiety as state and trait, measured with STAI was found. Interestingly a statistically significant relation was found between intensity of depression and intensity of anxiety.

Conclusions: It seems interesting that no co-relation between the clinical symptoms and cognitive functions was found. It may be consistent with some of the observations, according to which a pharmacological treatment of depression causes an improvement in cognitive functioning of the patients which is independent of the clinical improvement.

PP100 SELF-FEELING AND QUALITY OF LIFE IN SCHIZOPHRENIA

Krzysztof Krysta, Joanna Kafel, Malgorzata Derejczyk, Lena Cichon, Aleksandra Arczynska, Irena Krupka-Matuszczyk

Background: In the treatment of patients with schizophrenia on of the most important goals is achieving a proper quality of life. It is interesting what is the relation between the self-feeling of the patients in terms of their psychopathological symptoms, and the quality of their lives.

Aims: The purpose of our research was establishing the degree of satisfaction with their lives among patients suffering from schizophrenia. We have also analyzed correlation between the intensity of clinical symptoms and satisfaction with life.

Methods: Fifteen patients participated in our research, among them eight were male and seven were females, the age scope was from 22 to 63 years old and the average age was 40.

The patients were asked to fill in the Quality of Life Scale (Q Scale). They filled in also the questionnaire of the Frankfurt Self-feeling Scale (FBS).

Results: Correlation between intensity of clinical symptoms and life quality: The patients assessed the intensity of each of 36 clinical symptoms on the scale from 0 to 3. The results varied from 1 to 108 with the middle score of 80. The correlation degrees between intensity of clinical symptoms and general satisfaction with life were calculated for every symptom. Strong negative correlation was observed between satisfaction with life and: emotional withdrawal, lack of emotion, losing one's self control, lack of concentration, oversensitivity and apathy.

Conclusions: It seems interesting that there is a strong correlation between satisfaction of life and those of the psychopathological symptoms, which are referred to as negative symptoms.

PP101 KNOWLEDGE ON ADDICTION PROBLEMS AMONG STUDENTS IN TWO POLISH CITIES

Krzysztof Krysta, Joanna Borucka, Anna Wolna, Mariusz Cichon, Przybylo, Irena Krupka-Matuszczyk

Background: According to the studies drug addiction is an increasing problem affecting especially children and young people. It is assumed that about 60% of the drug addicts are found in the age range between 10 and 24.

Aims: The aim of this study were to estimate the general knowledge about drug addiction among secondary and vocational schools students in Zabrze, Poland and Tomaszów Lubelski, Poland, to compare the scales of the problem between studied schools, and to appreciate the level of drug abuse prevention.

Methods: 280 students were included into the study. A two-part anonymous inquiry was implemented. The first part included questions about age, sex, living conditions, family and knowledge on drug abuse phenomenon. In the second part the questions regarded psychoactive substances.

Results: The results show that secondary school graduates have a better knowledge about drugs than vocational school students, the scale of drug addiction problem is higher in schools of Tomaszów Lubelski than in Zabrze, the young people use drugs despite their knowledge of their harmful effects on human organism, boys use drugs more frequently than girls, and the drug abuse prevention in schools is not sufficient.

Conclusions: The analysis of the knowledge on addiction among students in two Polish cities may be useful in creating proper prevention programs.

PP102 PROCOGNITIVE EFFECT OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN DEPRESSION

Hana Kucerova, Radovan Prikryl, Petra Navratilova, Michal Cernik, Tomas Kasparek, Eva Ceskova

Deficit of cognitive and executive function is very often mentioned in depression. There have been only a few authors to deal with assessing the level of cognitive functions in depressive patients in the course of rTMS therapy. The current understanding of rTMS allows us to regard it as a safe method of treating depression. The potential of influencing individual parameters of cognitive deficit in depression by rTMS has not been explored in detail yet.

The group was formed by 20 men. Parameters of the stimulation: intensity of the stimulation 110% of motoric threshold, frequency of the stimulation (15 Hz), continuation of the pulse set (10 sec.), interspace among the sequences (30 sec.) and total number of the applied stimuli (1500), length 3 weeks. Patients were examined by the set of neuropsychological tests, the interval test – retests was 4 weeks.

We found out statistically significant improvement in the part of A of TMT, in VFT, in all index numbers of WMS and in categories of perseverative errors and responses in WCST. In other tests there were not any increase of the achievement statistically significant. Only in the CPT test there appeared by some patients moderate decrease of the achievement.

With regard to number of examined patiens we can not generalize our findings though we can regard this research as a benefit for the exploration of the problematics of positive, procognitive effect of rTMS.

This project was supported by IGA MZ CR IGA (NR 8472-3/2005) and by exploratory programme of Ministry of Education of CR (MSM0021622404).

PP103 LONGITUDINAL STUDY OF DISABILITY ASSOCIATED WITH BIPOLAR AFFECTIVE DISORDER

Nand Kumar, Rajesh Sagar, Sujata Minhas

Background: Disability related to mental disorder accounts for quarter of the world's disability and bipolar affective disorder is one of the five leading cause of mental disability. In India it is estimated that about 60 million people are suffering from one or other type of disability of various degree.

Aims: To study the disability associated with bipolar affective disorder and compare the nature and degree of disability in one year on different disability instruments.

Methods: This study is part of WHO study in India from August 2003 to December 2004. Total no of 36 patients of bipolar affective disorder as per ICD-10 was included for the study.

After Informed consent WHODAS II, Indian disability evaluation assessment scale (IDEAS), London Handicap scale (LHS) were administered by research psychologist and SCAN, YMRS and HAMDRS research psychiatrist on baseline then subsequently at 6 months and 1 year.

Results: The mean age of the patients was 32.81±12.95 years. Male patients constituted 52.8 percent of sample. Approximately 1/3 of patients were employed with 9.17 mean years of education on baseline assessment. On prospective disability assessment (baseline, 6 months and 1 year) statistically significant difference was observed in all the domain of IDEAS and WHODAS II except domain V.2.of WHODAS II. The LHS and IDEAS also reflected significant improvement in disability in the entire domain except domain 5 and domain 6.of LHS.

Conclusion: There is significant improvement in disability score on IDEAS, WHODAS- II, LHS and marked reduction in severity of symptoms with pharmacotherapy on longitudinal assessment.

PP104 ASSOCIATION STUDY OF ADRA1A GENE AND OBESITY IN PEOPLE WITH SCHIZOPHRENIA

Tsuo-Hung Lan, Hsien-Jane Chiu, El-Wui Loh, Fan-Chin Kung, Bo-Jian Wu, Tsung-Ming Hu

The aim of this study is focused on the association between ADRA1A gene and antipsychotics induced obesity among schizophrenic patients. We recruited 400 participants with schizophrenia based on DSM-IV criteria, who took antispychotics for more than 2 years. After consent form completed, demographic information and related clinical observations were collected followed by their genomic DNA extraction from peripheral lymphocytes. The 3 major SNPs within the coding region of ADRA1A gene we proposed plus the other 16 extra SNPs chosen from NCBI and HapMap database with almost equal distance were appropriately genotyped by high-through output platform in laboratory. The linkage disequilibrium was tested by the public program, of Haploview (v 3.32). The regression model were performed by using STATA (v 8.2) and Unphased (v 2.404). We found that SNPs ADRA1A-09 (OR = 0.42, p = 0.04) and ADRA1A-10 (OR = 0.41, p = 0.02) still held the significant association with antipsychotics induced obesity among our schizophrenic patients. We will investigate more on the possible clinical prediction ability of ADRA1A genotype before medication and its underlying mechanism in the future studies.

PP106 CHARACTERIZATION OF HYPONATREMIA CASES IN A NATURAL SETTING OF ELDERLY PSYCHIATRIC INPATIENTS

Christian Lange-Asschenfeldt, Tillmann Supprian, Flavia Braisch, Ingo Blaeser

Background: Hyponatremia (HN) is a recognized and potentially deleterious side effect in psychopharmacological treatment. Age is one of the most important risk factors for HN.

Aims: To evaluate incidence, risk factors, and possible causes of HN in elderly psychiatric patients receiving psychopharmacological treatment in a natural setting.

Methods: Cases of HN (serum sodium level <135 mmol/L) in psychiatric inpatients of = > 55 years during a 18-month period (July 2005 through December 2006) were identified using an electronic laboratory database. Demographic, diagnostic, and treatment data (drugs, doses, combinations) were obtained by a consecutive chart review.

Results: HN occurred in 74 of 1334 patients (5.5%, aged 71.5±10.3 yrs, 86% female). The spectrum of diagnoses in these patients comprised mainly depression (46 cases), dementia (26), and schizophrenia/schizoaffective disorders (18). Sixty-one patients received treatment with a drug potentially associated with hyponatremia as a side effect. The most prevalent psychotropic drug class were antidepressants (36 cases) and HN occurred most often with mirtazapine (9 cases), venlafaxine (7), and duloxetine (5). Other potentially contributing drugs were the mood stabilizer carbamazepine (14), antihypertensives such as loop diuretics (33), and ACE inhibitors (22). The lowest tertile of sodium plasma levels was most often associated with combination therapy of two or more of the mentioned substances.

Conclusions: In this natural setting of elderly psychiatric inpatients, female gender, antidepressant (not necessarily serotonin reuptake inhibiting drugs alone) and combination drug therapy were the most prevalent risk factors for treatment emergent HN.

PP107 PREVALENCE RATE OF DEPRESSION AND BIRTH WEIGHT. A REGISTER STUDY

Jens Larsen, Birgitte Bjerg Bendsen, Povl Munk-Jørgensen

Background: The prevalence of depression and mania seems to increase with every new generation, a pattern of considerable importance for the health services. Among the reasons for this fact, recent findings suggested an increased susceptibility to depression due to impaired neurodevelopment during foetal life.

Aims: To test the hypothesis that low birth weight or low birth weight corrected for gestational age is a risk factor for developing major depression.

Methods: A nested population-based case control design was conducted on Danish longitudinal register data-bases, including the Danish Central Psychiatric Research Register, the Danish Medical Birth Register and the Danish Civil Register. All individuals born from January 1st 1974 to December 31st 2001 and diagnosed according to ICD-10 were identified and screened for birth weight, birth length and gestational age.

Results: Generally birth weight increased slightly from 1974 and onwards. Mean birth weight was significant lower in the ICD-10 F2 and ICD-10 F3 groups compared with normal controls, also when corrected for gestational age. The risk of developing affective disorders was more likely to occur in subpopulations below 2500 g and gestational age less than 37 weeks at delivery.

Conclusion: Poor foetal growth and low birth weight in infants genetically predisposed to depression may explain part of the increase in the prevalence of depression.

PP109 THE FEMALE SEX AS A POSSIBLE RISK FACTOR IN TD OCCURRENCE IN TREATMENT WITH ATYPICAL ANTIPSYCHOTICS

Klara Latalova, Vladimir Pidrman

Background: tardive dyskinesia is a chronic extrapyramidal symptom which may arise as an undesirable effect of treatment with antipsychotics. Female sex is one the most widely discussed risk factors in the occurrence of tardive dyskinesia (TD) when undergoing treatment with antipsychotics.

Aims: the objective of our monitoring was to compare the rate of TD under treatment with A1G and A2G in female patients and to ascertain whether the female sex is a risk factor in TD occurrence when under treatment with A2G.

Methods: we conducted prospective monitoring on 98 patients. These candidates were divided into two basic groups (patients treated with A1G and A2G). Each group was subdivided into 2 groups- female and male patients. The internal structures of all groups were comparable with respect to length of the therapy which preceded initiation of the monitoring. The monitored antipsychotics of the A1G group included the following: flufenazin, flupentixol, haloperidol, chlorpromazin, levomepromazin, perfenazin and zuclopentixol. The monitored antipsychotics of the A2G group included the following means: olanzapine, quetiapine, risperidone and clozapine. Evaluation was conducted by the: scale for evaluation of involuntary movements- Abnormal Involuntary Movement Scale (AIMS) and Schooler-Kane criteria for TD.

Results and conclusion: from the monitoring follows that the risk of TD occurrence in the treatment with A2G is only at 10–20% level compared with the treatment using the A1G group. The female sex cannot be considered as a risk factor for TD occurrence even under treatment with A2G.

PP110 ONLINE PSYCHSOCIAL INTERVENTION FOR BIPOLAR DISORDER: www.moodswings.net.au

Sue Lauder, Michael Berk, David Castle, Seetal Dodd, Andrea Chester

Context: Bipolar disorder is a high prevalence chronic disorder. Specialised psychosocial interventions have shown efficacy as an adjunctive treatment with medication. Access to such interventions however is limited. Constraints of cost, travel, and personal resources, mean that few people have access to such treatments. The Internet provides a mechanism to overcome these barriers. A range of psychosocial interventions has been developed online, including in the areas of unipolar depression and anxiety. The results of these studies are encouraging.

Objectives: This study explores the development of MoodSwings an online intervention for people with bipolar disorder. The program is based on a successful face-to-face group intervention shown to reduce episodes of illness.

Key messages: The use of online technology can be used to overcome accessibility issues associated with specialised interventions. Online interventions can be interactive and apply those elements used in effective face-to-face studies. MoodSwings is currently recruiting and will evaluate how participants use and engage with the site. Outcome evaluations on relapse, mood symptoms, functionality and quality of life will also be assessed.

Conclusions: The application of psychosocial tools to an online format will be highlighted. One of the research team will be available to provide a tour of the MoodSwings website.

MoodSwings was funded by beyondblue: the national depressive initiative.

PP111 YOUTH EXPERIENCES OF LIVING WITH MENTAL HEALTH PROBLEMS: EMERGENCE, LOSS, ADAPTATION AND RECOVERY

JoAnn Elizabeth Leavey

Context: Current understanding of the lived experiences of youth aged 15–24 experiencing mental health problems is limited.

Objectives: Through a qualitative analysis of the subjective experiences of 13 young people aged 15–24 (7 male and 6 female); 4 core categories emerged as stages that described the participants' process of experiencing the emergence of mental health problems: emergence, loss, adaptation, and recovery.

Key messages: Results showed that youth experiencing mental health problems felt stigmatized and labeled, and experienced multiple losses of identity, family, career choices, and educational and social standing. Participants reported that having mental health problems disrupted their transition from adolescence to young adulthood; however, these data reveal how youth adapt and recover.

Conclusion: Implications of the findings in this study will be useful in identifying youth-focused interventions that may help professionals assist youth in their recovery processes.

PP112 BECOMING AWARE: AT WHAT AGE DO CHILDREN KNOW THEY HAVE A MENTAL HEALTH PROBLEM?

JoAnn Elizabeth Leavey

Context: This research describes the subjective bio-psychosocial information of fifty-three young people diagnosed and living with mental health problems.

Objectives: Semi-structured interviews were conducted with fifty-two youth aged 15–27 experiencing mental health problems in three countries: Canada n(22), Washington State n(6), Australia n(25). Qualitative methodology was used to analyze and code results.

Key messages: A preliminary analysis includes information revealing youth being aware of “being different” or that “something was wrong” as early as 4, 5 and 6 years of age; yet these youth were classified as first episode clients with their official age of onset being documented at 15 years of age (and up).

Conclusions: What should we consider as potential implications gained from this information?

PP113 CLINICAL VARIABLES, HLA-DQB1∗0602 AND HYPOCRETIN OF NARCOLEPSY WITH CATAPLEXY

Sung-Pil Lee, Jong-Hyun Jeong, Seung-Chul Hong, Yoon-Kyung Shin, Jin-Hee Han

Objectives: This study was designed to investigate the clinical features, frequency of DQB1∗0602 and CSF hypocretin levels in Korean narcoleptics with cataplexy to compare with those who have not cataplexy.

Methods: From August 2003 to July 2005, we selected 72 patients who have narcolepsy confirmed by nocturnal polysomnography and multiple sleep latency test(MSLT) as well as their history and clinical symptoms at Sleep Disorders Clinic of St. Vincent's Hospital, the Catholic University of Korea. The patients were divided into 56 cataplexy-positive group(narcolepsy with cataplexy group) and 12 cataplexy-negative group(narcolepsy without cataplexy group). All patients have done HLA typing for the presence of DQB1∗0602 and received spinal tapping for measuring the level of CSF hypocretin.

Results:

Cataplexy-positive group, compared with cataplexy-negative group, reported more frequent hypnagogic hallucinations (36 subjects, 64.3% vs. 4 subjects, 25.0%) (P = 0.005).

In cataplexy-positive group, compared with cataplexy-negative group, the frequency of HLA-DQB1∗0602 was found to be significantly increased (50 subjects, 89.3% vs 8 subjects, 50.0%) (P = 0.000).

In 48 out of 56 cataplexy-positive patients (85.7%), hypocretin levels were decreased (≤110 pg/ml) or below the detection limit of assay (<40 pg/ml). However, only six out of 16 cataplexy-negative patients (37.5%) exhibited decreased hyopcretin level. And the difference between two groups were statistically significant (P = 0.000).

Conclusions: Higher frequency of HLA-DQB1∗0602, and lower hypocretin levels in cataplexy-positive groups, than catapelxy-negatives, suggest that narcoleptics with cataplexy might be a etiologically different disease entity from narcoleptics without cataplexy. Additionally, Current criteria prevail for the diagnosis of narcolepsy need to be reclassified according to the presence of cataplexy or not.

PP114 CHANGE OF COGNITIVE FUNCTIONS IN THE GERIATRIC DEPRESSION LIVING IN THE INSTITUTION

Jungsik Lee Lee, Eun Mi Park, Hong Seok Oh

Objectives: Cognitive impairment often occurs with geriatric depression, and may persist despite remission of depression. The authors investigated change of cognitive functions in geriatric depression according to time interval to identify whether cognitive impairment may persist or not.

Methods: At baseline and one-year follow-up, Total 85 non-demented participants living in the asylum for the aged had a clinical examination that included depression assessment (SGDS-K: Short Geriatric Depression Scale of Korean version) and neuropsychological test(frontal lobe function test and CERAD-K: the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease). We divided the elderly into two groups (depressed: 25, non-depressed: 60) and evaluated the differences in change of cognitive functions.

Results: Depressed group had lower scores on the executive function test and word delayed recall test than non-depressed group at one-year follow-up like the baseline results. Except executive function, there was no significant difference between two groups in change of cognitive functions according to time interval. In total subjects, baseline MMSE, digit span forward, SADL (Scale of activities of daily living), and SIADL (Scale of instrumental activities of daily living) variables were predictors of cognitive decline at follow-up.

Conclusion: These results support previous observations that cognitive impairment in geriatric depression may persist, especially in the executive function and the MMSE and activities of daily living may be an important prognostic factor in the cognitive decline of the elderly. Timely identification of cognitive impairments and activities of daily living in depressed older adults may lead to coping strategies that will improve the prognosis of geriatric depression.

PP115 CHANGE OF OBJECTIVE FUNCTIONS IN SUBJECTIVE MEMORY COMPLAINERS LIVING IN THE INSTITUTION

Jungsik Lee Lee, Tae Hak Kim, Woo Kyeong Lee, Hong Seok Oh

Objectives: There are inconsistent results about relationships between the subjective memory complaints (SMC) and objective cognitive functions and clinical implication that SMC was a significant part of Mild Cognitive Impairment (MCI) criteria associated with early stage of Alzheimer's disease. The authors tried to investigate change of cognitive functions in subjective memory complainers according to time interval to identify whether SCM is related with cognitive decline or not.

Methods: At baseline and one-year follow-up, Total 144 participants living in the asylum for the aged had a clinical examination and neuropsychological test (frontal lobe function test and CERAD-K: the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease). All of them were evaluated by four specific questions about everyday memory function. We divided the elderly into two groups (SMC+ group: 87, SMC- group: 57) and evaluated the differences in change of cognitive functions.

Results: SMC+ group had lower scores on the recognition test than SMC- group at one-year follow-up (MANCOVA: age and education variables were controlled). There was no significant difference between two groups in change of cognitive functions according to time interval. In SMC+ group, baseline digit span forward and Construction recall were predictors of cognitive decline at follow-up.

Conclusion: These results suggested that there was no difference in cognitive decline between two groups according to time interval. It is questionable and needs more investigations that SMC is a significant part of MCI criteria.

PP116 ANGER AND ALEXITHYMIA IN WOMEN WITH PREMENSTRUAL SYNDROME

Sang Hyuk Lee, Tae Kyu Choi

Objective: Anger and Alexithymia are known to be associated with various psychosomatic disease. This study was intended to explore the relationships between anger, alexithymia and premenstrual syndrome.

Methods: Daily Record of Severity of Problems (DRSP) and Shortened Premenstrual Assessment Form (SPAF), Anger Expression Scale, Toronto Alexithymia Scale was administered to 377 women. According to DRSP, SPAF score, we divided subjects into 2 groups (premenstrual syndrome: PMS, no premenstrual syndrome: no-PMS). We compared the scores of anger, alexithymia between PMS group and no-PMS group).

Results: The mean scores of anger in (p = 0.04), anger total (p = 0.01) were significantly higher in women with premenstrual syndrome compared to control subjects. And the mean scores of alexithymia (p = 0.04) were also significantly higher in women with premenstrual syndrome compared to control subjects. The level of anger was higher in single women with PMS than in married women with PMS.

Conclusions: This study showed that the level of anger and alexithymia could be higher in women with premenstrual syndrome compared to control subjects. In treating and evaluating women with premenstrual syndrome, It can be better for us to consider the level of anger and alexithymia.

PP117 EFFICACY AND SAFETY OF ACAMPROSATE IN THE TREATMENT OF ACUTE ALCOHOL WITHDRAWAL

ByungOok Lee, Kee Namkoong, Eun Lee, Young-Chul Jung, JeongHoon Kim

Background: Anti-craving agent, Acamprosate (Calcium homotaurine) has been postulated to act by restoring the alcohol-induced neurotransmission imbalance of inhibition-excitation inputs believed to underlie alcohol dependence. The postulated mechanism of action of acamprosate is blockade of the glutaminergic NMDA receptor and activation of the GABAA receptor. In animal study, acamprosate reduced alcohol-induced physical signs of withdrawal and reduced the hypermotility during ethanol withdrawal directly by reducing the nucleus accumbens glutamate concentration or indirectly by increasing the taurine and GABA brain level.

Aims: The aim of this study was to investigate the efficacy and safety of acamprosate in alcohol dependence patients during acute alcohol withdrawal.

Methods: In this, single-open, prospective study, 15 alcohol dependent inpatients who were intoxicated on admission were participated. Treatments (6 tablets of 333 mg acamprosate t.i.d.) were initiated immediately after admission and continued during the 7 days. Withdrawal symptoms and adverse effects were assessed on the day treatment started and on days 7 daily.

Results: Acamprosate has been relatively well tolerated during alcohol withdrawal period in human alcohol dependent patients. The score of Clinical Institute Withdrawal Assessment Scale for Alcohol-Revised (CIWA-Ar) was decreased statistically significant (p≈0.01).

Conclusion: This study suggests that the early use of acamprosate in alcohol withdrawal might be safe and effective. However, this study was single open study. Further randomized double-blind placebo controlled study should be needed to confirm the efficacy and safety of acamprosate in treatment of alcohol withdrawal.

PP118 CATECHOL-O-METHYLTRASFERASE GENE POLYMORPHISM IN SYMPTOMATOLOGY OF SCHIZOPHRENIA

Chung Tai Lee, Hae Kook Lee

Objectives: Catechol-O-Methyltranferase (COMT) gene is involved dopamine metabolism, which has been implicated to have putative role in the pathogenesis schizophrenia and aggressive behaviors. Although evidence exists for an association between aggression and schizophrenia, the pathogenesis of aggression in schizophrenia has not been established. We carried out this study to evaluate the association between schizophrenia, its psychopathologies (positive symptom, negative symptom, aggression) and COMT gene polymorphism.

Method: One hundred and twenty four patients with schizophrenia by DSM-IV who admitted to Uijongbu St. May's hospital and 94 normal controls were participated in this study. The evaluation of patients was accomplished by positive and negative syndrome scale (PANSS) and overt aggression scale (OAS). The analysis of COMT gene polymorphism was performed using PCR method with RFLP.

Results: There were no statistically significant differences between frequencies of COMT genotype in patients and controls. Although the average of positive and negative subscale of PANSS and OAS were not significantly different between the COMT variants, there was tendency that patients with COMT L/L have higher negative subscale of PANSS than other group.

Conclusion: This result suggests that COMT gene polymorphism was not associated with development and symptomatology of schizophrenia. However, further studies with larger subjects would be required to better understand the association of COMT gene polymorphism and schizophrenia.

PP119 A STUDY OF ANDROGEN DEFICIENCY AND ITS RELATIONSHIP WITH PSYCHOLOGICAL FACTORS IN HONG KONG

Antoinette M. Lee, Tai-Pong Lam, Catherine Shiu Yin Chong, Leung-Wing Chu, Sze Yan Chan

Background: There has been abundant research on menopausal distress. The problems experienced by climacteric males are much less recognized. “Androgen Deficiency in the Aging Male (ADAM)” has been proposed to characterize the problems associated with the male climacteric. However, most of the literature concerning ADAM focussed on the hormonal aspect and ignored the psychological context in which ADAM occurs.

Aims: Our study aims at documenting the prevalence of ADAM in Hong Kong, and examining the interrelationship among androgen deficiency, male climacteric symptoms and psychological factors in middle-aged and elderly men.

Methods: A sample of 311 men aged 40–80 attending a primary care clinic in Hong Kong was surveyed. The ADAM questionnaire was used to screen for androgen deficiency. Climacteric symptoms were assessed with the modified Greene Climacteric Scale. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale, and stress was measured with the Perceived Stress Scale.

Results: A total of 87.8% of the participants were screened ADAM positive. Not surprisingly, prevalence of ADAM increased significantly with age. Length of marriage, number of children, occupation, household income and medical problems were found to be significant predictors of androgen deficiency. Those who were ADAM positive scored significantly higher in all subscales of the Greene Climacteric Scale except the vasomotor subscale. They were also more likely to be depressed and anxious, and had higher levels of stress.

Conclusion: ADAM is a prevalent yet largely neglected condition. It is associated with general climacteric symptoms and psychological problems. Clinicians should place ADAM in a wider context, attending to the multiple and diverse problems that these patients are facing. Interdisciplinary management may be beneficial.

PP120 NEURAL CORRELATES OF SECOND GENERATION ANTIPSYCHOTICS RELATED TO FOOD CRAVING IN SCHIZOPHRENIC PATIENTS AFTER MEAL

Changhwa Lee, Bum Seok Jeong, Sung Kyoon Hong, Jee Wook Choi, Ji-Woong Kim, Sun Woo Lee

Objective: To explore the neural correlates of antipsychotic related food craving in schizophrenic patients.

Methods: A T2-weighted echoplanar imaging sequences obtained were used to collect 120 BOLD images during passive seeing of food paradigm after meal. The food paradigm was consisted of three blocks of food pictures and three blocks of pictures of natural thing in both ten healthy volunteers and schizophrenic patients having second generation antipsychotics. The imaging data were investigated to find differences in the food cue and craving related network between healthy volunteers and schizophrenic patients after meal. The relationship between food cue or craving related neural activity and clinical variables were explored.

Results: Less extensive food cue and craving related regions were activated in schizophrenic patients having second generation antipsychotics after meal. Neural activities of both hypothalamus and thalamus were correlated with the prescribed duration of current antipsychotics.

PP121 TAIWANESE PSYCHIATRISTS' VIEWS ON CLINICAL APPLICATIONS OF ICD-10 AND DSM-IV: A QUESTIONNAIRE SURVEY

Chao-Cheng Lin, Yen-Kuang Yang, Chiao-Chicy Chen, Hai-Gwo Hwu

Aims: ICD-10 and DSM-4 are now widely used in Asia as standard tool for psychiatric diagnose. However, the extent of actual use and constraints encountered are not well documented in Taiwan. In order to understand the daily practice needs of these classification systems and the opinions from psychiatrists, we conducted a survey among Taiwanese psychiatrists.

Methods: The study was done as a part of an international collaborative study. A questionnaire, designed by Prof. Mellsop, was used to assess perceptions of psychiatrists towards diagnostic systems. This questionnaire was translated into Mandarin and mailed to the members of Taiwanese Society of Psychiatry in Jan 2007. The questionnaire was sent to the members by e-mail in Apr 2007 to get additional response.

Results: We obtained response from 227 psychiatrists. The frequency of routine use of DSM-IV Axis I was high (95.7%), but those for other axes and ICD-10 were below 50%. The aspect of classification systems which they valued the most was reliable inter-clinician communication (49.8%), followed by conveying information about etiology/pathogenesis (23.8%). Most of the psychiatrists (44.2%) thought that a diagnostic classification system should be used by any member of a multidisciplinary team. About sixty-eight percent of them reported that they sometimes felt difficult to apply them across culture. Ninety percent prefer to use the present DSM-IV multiaxial system.

Conclusion: Most Taiwanese psychiatrists routinely used DSM, but not ICD as their diagnostic system. The challenge of the cross-cultural application is worthy of notice for future diagnostic classification systems.

PP122 BRIDGING SERVICES AND RESEARCHES: A SPECIAL CLINIC FOR STUDY ON PSYCHOPATHOLOGICAL PROGRESS OF EARLY SCHIZOPHRENIA-LIKE DISORDER (SOPRES) IN TAIWAN

Chen-Chung Liu, Yen-Nan Chiu, Mong-Chuan Lai, Hai-Gwo Hwu

Context: To establish a research infrastructure for study on early schizophrenia-like disorder (ESLD), eight community channels for case recruitment have been developed and a special clinic for “cognitive perceptual disturbance of adolescent and young adult” was launched by the study hospital in Nov. 2006.

Objectives: To describe the characteristics of subjects attended to the special clinic and to assess the feasibility of such a strategy: using a special clinic providing services yet aiming at recruiting subjects for researches.

Key message: By far 48 new subjects, referred from six of the eight channels, attended to the special clinic, some of them received follow-up services at this clinic thus tallied for 102 visits. Clinical impressions included first episode schizophrenia, prodrome of schizophrenia, schizotypy, panneurotic state, other psychiatric disorders, and no psychiatric diagnosis. Around two thirds of the new subjects agreed to participate in the SOPRES. The first episode and the prodromal patients were more likely to participate in the study and received continuous services. For those who continued being followed up for more than three times, not necessarily in this special clinic and regardless of their diagnoses, their short-term outcomes seemed to be better.

Conclusion: A special clinic providing services to the at-risk group of subjects can facilitate their motivation to participate in a longitudinal prospective study. The short-term outcome of such a service model is promising and warrant further observations. An updated and more detailed analysis of more subjects attended in next a few months will be presented at the conference.

PP123 GAMBLING AMONG THE CHINESE: RESEARCH THUS FAR

Jasmine Loo, Namrata Raylu, Tian Po Oei

Gambling and gambling problems among the Chinese have long been noted and discussed. Despite being a major problem among the Chinese, there is a lack of literature on gambling and problem gambling in this area. This paper will attempt to close the gap by reviewing the current knowledge of gambling among the Chinese. Major psychological databases were used to locate both quantitative and qualitative research papers. The analysis of literature showed that social gambling is a popular form of entertainment in Chinese communities but prevalence estimates for problem gambling varied from 2.5% to 4.0% in the studies reported here. Among the important issues identified in this review relate to Chinese problem gamblers having difficulty admitting the issue and seeking professional help for fear of losing respect. There is also a lack of understanding in problem gambling among community members. Some studies have documented reliable methods of measuring gambling correlates in this population, while others have developed Chinese versions of diagnostic instruments. Despite limited research in this area, the studies reported here suggest cultural differences in patterns of gambling—attitudes, behaviours, and treatment receptiveness. At present most of the theories and treatments methods developed in the West are used to explain and treat gambling among the Chinese. Future research in the area of treatments built upon existing knowledge on Chinese gambling and extrapolations of Western gambling literature will be beneficial in developing cohesive and effective intervention plans specifically for Chinese problem gamblers. Greater attention to more theoretical based systematic study of all forms of gambling and successful interventions among the Chinese seems necessary.

PP124 COGNITIVE ASSESSMENT BY MEANS OF IMAGES: THE ERGONOMIC TEST OF BASIC CONCEPTS – USEFULNESS AT COLLECTIVE AND INDIVIDUAL LEVELS

Rosa López Mongil, Jose Antonio Lopez Trigo, Juan Antonio Alonso Bravo, Xoan Gonzalez Gonzalez, Beatriz Mongil López, Rebeca García Nieto, Fatima Mongil Jorrin

Objectives: To implement a new assessment tool: the ETBC, correlating it with the MMSE, useful for elderly people, low-cultured and illiterate people. To apply it in order to assess the cognitive ability of elderly people residing in two nursing homes: CM and V.

Method: 174 residents: 99 residing in a mixed nursing home and 75 in an assisted one, are studied using MMSE and ETBC. The cognitive impairment is classified into mild (MMSE score: 19–23), moderate (10–18) and severe (1–9). They are also assessed with ETBC which includes 25 questions in which the resident is asked to tick the right answer among three drawings in each assessed concept. Language, memory, orientation, attention, concentration, visuoconstructive skills, abstract thinking, understanding and praxias are assessed. Data are analysed by means of SPSS 14.0.

Results: Women (N = 96): 82.51 years (mean). Men (N = 78): 78.21 years (mean). Mild dementia symptoms appears in 26,4% (mean age = 79.89), moderate dementia in 31,6% (mean age = 81,15), severe dementia in 8% (mean age = 82,71). Score obtained in CM: ETBC 21 (18–23), MMSE 21 (15–25). In V score were: ETBC 19 (12–22), MMSE 20 (12–25). These results were statistically significant (p≈0,005).

Conclusions: 66% of the residents present cognitive impairment/dementia. The ETBC may be a practical method to assess the cognitive functions in elderly people because it correlates with the MMSE and it is not influenced by cultural or educational aspects. Other advantages are its simplicity and the little training needed for the staff to apply it. To sum up, it has proven useful both in the detection of cognitive impairment and the classification of patients according to their impairment degree.

PP125 GERIATRIC AGE-PSYCHIATRIC AGE: MENTAL ILLNESS IN SPANISH NURSING HOMES – THE RESYDEM STUDY

Rosa López Mongil, Jose Antonio Lopez Trigo, Javier Castrodeza Sanz, Teresa León Colombo, Rebeca García Nieto, Beatriz Mongil López

Objectives: To deepen in the knowledge of some mental illnesses in the elderly (dementias, delirium – Acute Confusional Syndrome–, Depression, Anxiety and Sleeping Disorders) in order to prevent or reduce dependence.

Method: In April 2005, a multicenter, cross-sectional observational survey was carried out so as to detect the cognitive impairment/dementia and Delirium, Depression, Anxiety and Sleeping Disorders. 55 nursing homes in all the Spanish Autonomous Communities took part. The residents were randomised and assessed with the clinical record, complementary assessment, MMSE (adjusted to age and educational level), Hodkinson's AMT, Cumming's NPI, Clinical Dementia Rating (CDR) and DSM-IV diagnostic criteria for dementia. The study was approved by the Ethics and Clinical Research Committee of the University of Valladolid.

Results: 1020 residents were recruited, 852 randomised, 66% women (mean age = 84.8 years). The prevalence of dementia was 61.7% (CI 95%: 58.4–65.1). Regarding the distribution of dementia for stages: CDR1: 15%; CDR2: 31.1%; CDR3: 53.8%. With regard to the distribution for age group: <80: 50%; 80–90: 62.7%; >90: 73.9%. 18.8% of the patients with dementia were being specifically treated: Delirium: 27%; Depression: 33.2%; Anxiety: 30.7% and Sleeping Disorders: 41.9%. 64.3% of the patients with dementia also suffered from psychological and behavioural symptoms.

Conclusions: Prevalence of dementia in Spanish nursing homes is high, representing one of the greatest psychogeriatric syndromes and often manifests itself together with psychological and behavioural symptoms. After dementia, sleeping disorders represent the most frequent pathology in geriatric psychiatry in the Spanish nursing homes, followed by depression, anxiety and delirium.

PP126 PSYCHOMETRIC ASSESSMENT OF THE ACTIVITIES OF DAILY LIVING: THE CM98 Of BADLs

Rosa López Mongil, Jose Antonio Lopez Trigo, Jose Luis Elguero Angulo, Rebeca Garcia Nieto, Paz Redondo del Río, and Nurse Group

Objectives: To assess function from a psychometric point of view and to know the prevalence of geriatric symptoms: immobility (I), problems for feeding, urinary incontinence (UI) in a psychogeriatric hospital.

Method: In order to carry out the functional assessment of Basic Activities of Daily Living (BADL) 144 patients were assessed with CM98 test of BDAL. It assesses: Eating, Toileting, Dressing, Walking, transfers bed/chair, Bathing, Going upstairs and downstairs, Urinary and Fecal Continence. Each item scores 0 if patient is autonomous, 1 if they need help and 2 if they are dependent. Total score is obtained by adding partial score of each item. Scores classifies into categories: 0, autonomous; 1–7 mild dependence; 8–11 moderate dependence; 12–15 severe dependence; 16–20: total dependence. Data are analysed by SPSS 14.0 Prevalence for main parameters studied (immobility, feeding and incontinence) is estimated.

Results: 38.4% of patients present mild dependence; 9.4% moderate dependence; 15.2% severe dependence and 31.9% total dependence. The results are similar to those obtained with Barthel Index (BI).

The prevalence of problems with eating 51.0% (30.6 need assistance, 10.4 are dependant). Prevalence of relative immobility (measured as the addition of walking, going up/down stairs, transfers bed/chair) is 44% and absolute (score 6) is 22.7%. Prevalence of urinary incontinence is 71.9%.

Conclusions: CM98 test of BADLs solves some of the application problems of the BI (excessive score, asymmetry of item's estimations). Rapidity and simplicity are advantages (classifying the items standardizedly). CM98 is a useful alternative to other assessment tools. The implementation of this test provides us with useful information, which often remains hidden or overlooked.

PP127 COMPARATIVE EFFECTIVENESS OF RAPID-ACTING INTRAMUSCULAR OLANZAPINE AND SHORT-ACTING TYPICAL INTRAMUSCULAR ANTIPSYCHOTICS

Amanda Lowry, Tamas Treuer, Murat Atmaca, Sang Yeol Lee, Peter Pregelj, Mete Saylan, Annu Thakur, Sergio Villaseñor

Background: This is a prospective, observational study of patients from Africa and the Middle East, Australia, Canada, Central and Eastern Europe, Korea, and Mexico.

Aim: To compare the effectiveness of RAIM olanzapine with short-acting typical IM antipsychotics using the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) and the Clinical Global Impressions-Severity (CGI-S) scale at 2, 24, 72 hours and 7 days post initial injection.

Methods: Inpatients aged at least 18 requiring injection of a short-acting IM antipsychotic, and with a diagnosis of agitation of acute mania and/or schizophrenia were included. Analyses were adjusted for potential baseline confounders using linear, logistic or Cox regression. Patient groups were based on the first study injection administered, regardless of subsequent medications.

Results: Patients were enrolled from 15 countries; olanzapine n = 1294 (64.3%), other IM antipyschotics n = 717 (including haloperidol n = 436, 21.7% and zuclopenthixol acetate n = 107, 5.3%). Baseline agitation scores (mean + SD) were 24.6 + 5.88 (PANSS-EC), and 5.4 + 0.91 (CGI-S). Olanzapine patients experienced a significantly greater decrease in PANSS-EC and CGI-S scores at 2 hours compared with the other IM group (olanzapine-other IMs, LS mean [95% CI] PANSS-EC: −0.81 [−1.29, −0.34] p≈.001, CGI-S: −0.12 [−0.19, −0.04] p=.002). This trend was observed at all assessments (p≈.05). Olanzapine patients also experienced significantly greater symptom improvement at the point of transition to orals (PANSS-EC: p=.010, CGI-S: p≈.001). Extrapyramidal symptoms and anticholingeric use were less common for olanzapine patients (10.0% vs 21.3%, p≈.001, and 13.9% vs 42.5%, p≈.001).

Conclusion: RAIM olanzapine provided more effective acute control of agitation than other short-acting IM antipsychotics in this trans-regional observational study.

PP128 DOUBLE-BLIND, RANDOMIZED, PROSPECTIVE STUDY OF OLANZAPINE AND RISPERIDONE TREATMENT OF SCHIZOPHRENIA

Bartosz Loza, Andrzej Czernikiewicz, Agata Roszkowska

Leading contemporary hypotheses suggest that the most prominent task of schizophrenia treatment, attributed specifically to atypical antipsychotics, is to activate patients’ prosocial abilities. In this multi-center, double-blind, randomized, prospective study, 79 patients with schizophrenia, aged 18–65, all initially hospitalized (less than 4 weeks), with no history of antipsychotic treatment-resistance, were randomized into two groups treated in a double-blind manner with olanzapine (N39; 5–20 mg) or risperidone (N40; 2–8 mg) over 8 weeks. All patients were assessed repeatedly with clinical scales: Positive and Negative Syndrome Scale, PANSS; Clinical Global Impression-Severity, CGI-S; Calgary Depression Rating Scale, CDRS; Simpson-Angus Scale, SAS, cognitive scales: Wisconsin Card Sorting Test, WCST; Trial Making Test, TMT-A, TMT-B, insight scales: Scale to Assess Unawareness of Mental Disorder, SUMD-past and SUMD-present, and quality of life scales: Schizophrenia Quality of Life, SQOL and Psychological General Well-Being, PGWB. Paired t-tests were calculated. The results favoured olanzapine comparing to risperidone in PANSS (except for PANSS-negative syndrome), CGI-S, CDRS, SAS, SUMD-past (almost significantly: p≈0.056), SUMD-present, SQOL, and PGWB. Olanzapine-treated schizophrenic patients experienced greater improvement in total psychopathology, awareness and quality of life over 8-week treatment. No significant, clinically relevant differences occurred in neurocognitive tests between olanzapine and risperidone. This study highlights differences among leading atypical agents and does not corroborate their homogenous “prosocial efficacy”. Because the start and the initial type of antipsychotic medication is critical for the whole functional prognosis, the further investigations are warranted over a longer period of time.

PP129 A CEREBRAL BLOOD FLOW STUDY ON VERBAL FLUENCY IN PATIENTS WITH ALZHEIMER'S DISEASE

Shinichiro Maeshima, Shigeru Makita, Ryusei Uchida, Eri Sekiguchi, Aiko Osawa, Nobuko Ota, Takako Yoshimura, Fumihiko Takajo

Objectives: The aim of this study was to clarify the characteristics of verbal fluency and regional cerebral blood flow (rCBF).

Methods: Subjects were 82 senile patients having amnesia as a complaint including 51 Alzheimer's disease (AD), 17 mild cognitive impairment (MCI) and 17 control subjects (CS). We examined cognitive function using the category fluency test (CFT) and the letter fluency test (LFT). The rCBF was measured with using the three-dimensional stereotaxic ROI template method (3DSRT) that was a quantitative method simplified and less invasive for 99mTc-labeled bicisate (ECD) single-photon emission tomography (SPECT). It was composed of 259 regions of interest (ROIs) in 11 segment on each side.

Results: In both CFT and LFT, the score of AD was lower than those of MCI and CS. Those scores were correlated with severity of dementia.

CFT scores were correlated with rCBF in left thalamus, right precentral region and hypocampus. LFT scores correlated highly with rCBF in left precentral and pericallosal regions, hippocampus and thalamus.

Conclusion: We suggested that verbal fluency with CFT may be caused in a mechanism different from that caused with LFT. The verbal fluency is efficient tool to distinguish the process of cognitive impairment.

PP130 MOBBING: RELATIONSHIP BETWEEN MENTAL DISORDERS AND COPING IN BRASIL-BOLÍVIA GAS PIPELINE WORKERS

Liliana Magalhães Guimarães, Éveli Vasconcelos, Paulo Renato Andrade, Ignez Charbel Stephanini

Background: Mobbing or psychological harassment in the workplace has been considered an important psychosocial risk factor, bringing harmful effects to the worker's physical/mental health. Researches have demonstrated that characteristics of the workplace/worker are associated with the development of Mobbing.

Aim: This study aims to investigate the frequency and level of Mobbing and its relationship with Mental Disorders and Coping.

Method: a sample of 74 workers of the Brazil-Bolivia gas pipeline replied to the Leymann Inventory Psychological Terrorization (LIPT), the Adult Psychiatric Morbidity Questionnaire (QMPA) and the Billings and Moos Coping Scale (BMCS).

Results: High prevalence of Suspected Cases of Mental Disorders (SCMD) (30.9%) and Mobbing (19.1%) was found. Most of the participants (80.9%) used the Cognitive-active Coping Method Focusing on the Problem.

Conclusion: Mobbing was significantly associated with SCMD (p = 0.001) which indicates that the former is a psychosocial risk factor for Mental Disorders.

PP131 ROLE OF PSYCHIATRIC CASE MANAGEMENT IN A TERTIARY PSYCHIATRIC HOSPITAL

Rathi Mahendran, Margaret Hendricks

Introduction: Case Management (CM) has been described as the'coordination, integration and allocation of individualized care within limited resources’. CM was introduced in the acute general psychiatric inpatient service in late 2003.

Aim: To provide comprehensive quality care, eliminate fragmented care and inappropriate service utilization. A brokerage model of CM was adopted.

Method: An audit of the service was done for the three year period, 2004 to 2006. The number of cases and clinical and service outcomes were reviewed.

Findings: There was an increase in the referrals to the service from 1021 in 2004 to 2185 in 2006 and an increase in the number of cases accepted for CM, 185 in 2004 to 1631 in 2006.

The service had significant clinical outcomes in reductions in unplanned readmissions, suicide attempts, forensic complications and admissions requiring police assistance for patients on CM.

Service indicators monitored showed a 3.4 times increase in linkages to community services such as community nurses, ACT teams and services provided by VWOs. These were significant as linkages promote continuity of care. Psychoeducation and counselling sessions for patients and family/carers increased four fold.

Conclusion: Our CM service has provided comprehensive and coordinated support for patients over a continuum of care. While there are already improvements in the quality of care and clinical outcomes, the service is continuing to expand and improve as we review quality of life and patients experiences of the service.

PP132 DOES PROCESS IMPACT OUTCOMES? EVALUATING THE EFFECT OF THE LEARNING ENVIRONMENT ON OUTCOMES FOLLOWING AN INTERVENTION TO DECREASE STIGMA ABOUT EPILEPSY

Alexandra Martiniuk, Mary Secco

Background: Process evaluations may help in our understanding of how and why interventions achieve or do not achieve their effects, how best to conduct intervention programs to maximize effects, and how to improve the internal and external validity of studies. One previously published process evaluation involving school-based health education found teacher characteristics and program fidelity had independent effects on knowledge and intention regarding cardiovascular health.

Aims: This study aimed to assess the impact of process variables (educator, environment, audience) on knowledge and attitude change following the delivery of the “Thinking about Epilepsy” program. It was hypothesized that lower scores on process variables would impede the acquisition of knowledge and positive attitudes about epilepsy.

Methods: Several process variables were assessed including: educator (eg ill), timing (eg after recess), environmental (eg hot), classroom teacher (eg not present). Multiple regression models, adjusted for clustering by school, were used to investigate the effect of process variables on epilepsy knowledge and attitudes following an epilepsy education program.

Results: Information on deviations from idealized program delivery due to “real life noise” will be discussed. Only knowledge was significantly predicted by process variables; no process variables significantly predicted attitudes on either study arm.

Conclusions: Data on compliance to program delivery can be crucial in understanding the degree of school-based health education program effectiveness, as well as in identifying areas where the program delivery requires modification. In this study, knowledge was influenced more by the process of delivery of the epilepsy education program than attitudes.

PP133 A STUDY OF DIAGNOSTIC CONTRADICTION BETWEEN CHRONIC FATIGUE SYNDROME AND MENTAL DISORDERS IN DSM-IV

Tokuzo Matsui, Nobuo Kiriike, Hirohiko Kuratsune, Seiki Tajima, Sanae Fukuda, Yasushi Hano, Kouhei Kataoka, Yaunori Matsuda, Yoshiki Nishizawa, Yasuyoshi Watanabe

Objective: Chronic fatigue syndrome (CFS) is a controversial but significant issue in the medical practice. There are few medical facilities or outpatient clinics that specialize in CFS in Japan. We launched a clinical center for fatigue in our hospital in 2005, and we mainly care for chronic fatigue patients, including patients with CFS. We have elucidated comorbid psychiatric disorders among CFS patients.

Methods: We enrolled 384 subjects who visited our clinical center for fatigue. After excluding clearly explained chronic fatigue case, we have performed structured clinical interview for DSM-IV axis I disorders to 105 patients. All subjects gave written informed consent after the study plan was fully explained to them. This study was approved by the institutional review board of Osaka City Univ. Graduate School of Medicine.

Results: Among 105 chronic fatigue patients, there were 49 subjects meeting the 1994 CDC research case definition of CFS. Among them, there were 20 pure CFS patients and 29 CFS with any mental disorder patients including 20 MDD patients. There were one case for dysthymic disorder and no case for undifferentiated somatoform disorder if CFS is included into general medical condition in DSM-IV, however unless CFS is included into general medical condition, there would be 19 case and 45 case alternatively.

Conclusion: MDD was the most prominent psychiatric disorder among CFS patients, however repositioning of CFS in general medical condition in DSM-IV is essential to make a precise comorbid psychiatric diagnosis for CFS patients.

PP135 BURNOUT SYNDROME AND QUALITY OF LIFE RELATED TO WORK IN THE MILITARY POLICE IN CAMPO GRANDE/ MS, BRAZIL

Vania Mayer, Liliana Guimarães

Background: It is well-known the high level of risks that leads to occupational stress and Burnout Syndrome (SB) which the military police (PM) are subject to leading to severe damage to their physical and mental health, as well as to the Quality of their general lives and work.

Aims: To characterize the occurrence, levels of the Burnout Syndrome (SB) and the Quality of Life in the Work (QVT) of the military police in Campo Grande, MS (Brazil).

Method: The sample consisted of n = 240 policemen (148 M; 92 F) from a population N= 2.321. The MBI – Maslach Burnout Syndrome was used as well as QVP–35 – Questionnaire of the Professional Life Quality. The sample was formed by military policemen of all ranks, married, from both sexes and most of them having finished High school.

Results: The Military Police from both sexes presented: moderate level of SB in three dimensions; high QVT the dimension of which got a higher score was Intrinsic Motivation while the one with a lower score was Organizational Support; policewomen usually notice their QVT as being worse, indicating that their Load of Work is higher and Discomfort while performing their job, consequently referring to Organizational Support. The marital status (single) points out perception in relation to Load of Work, which is excessive for both sexes.

Conclusion: These findings show the need of modernization of the institutional culture, policies and strategies of the management of Human Resources, trying to decrease the levels of emotional wearing down and the improvement of QVT.

PP136 EFFICACY AND SAFETY OF HIGH DOSE VENLAFAXINE AND ITS ACTIVE METABOLITE O-DESMETHYLVENLAFAXINE IN REFRACTORY DEPRESSION

Patrick Mbaya, Faouzi Alam, Aung Tint, Edgar Spencer

Background: 40% of depressed patients fail to respond to antidepressants. Venlafaxine and ODV (active metabolite) block serotonin (5 HT) and norepinephrine (NE) and weekly dopamine (DA). There is evidence that SNRIs are more effective in major depressive disorder than SSRIs.

Aims: To assess safety and efficacy of Venlafaxine and ODV in refractory depressed patients treated with high dose Venlafaxine XL.

Methods: 50 patients with refractory depression who had been on at least 12 months on high dose Venlafaxine XL were assessed. All patients had not responded to an adequate dose of at least one antidepressant and 50% had been on more than two antidepressants prior to Venlafaxine. One assessment of Global Assessment of Functioning Scale (GAS), and self-rating for mood and general functioning were done. Safety measures included ECG and blood pressure measurements. Venlafaxine and ODV serum levels were done 8–10 hours post dose. Non-parametric tests were use.

Results: Venlafaxine XL dose correlated with both Venlafaxine (p≈0.01) and ODV (p≈0.03) levels .82% of patients had a level of functioning of between 70% to 100% (mild impairment to full functioning). ODV levels correlated with mood (p≈0.04) and general feeling (p≈0.02) while Venlafaxine levels correlated with patient functioning (p≈0.03).

There was no correlation between high dose Venlafaxine with side effects and ECG parameters.

Conclusion: High dose Venlafaxine is effective and safe in refractory depressed patients.

PP137 THE STUDY OF EFFECT OF COGNITIVE BEHAVIORAL COUNSELING ON BODY IMAGE ALTERATIONS IN WOMEN UNDERWENT MASTECTOMY

Tayebeh Mehrabi, Simin Fadaei, Moggan Janighorban

Introduction: Breast cancer is the most common cancer in women throughout the world. The alteration in body image as a result of the disease, surgery or treatment, painful scar, hair loss, weight alteration, premature menopause, loss of role, or function at work or in the family causes psychosocial problems. For body image to remain healthy it must accurately incorporate the actual physical changes of surgery, that is, the person accept the body as it has become.

Methods: This research is a quasi experimental study and consists of two group and two stages. The samples included 72 patients underwent mastectomy that were randomly by convenience sampling put into experimental and control group. The objective of this study was to determine effect of counseling on mean of body image score in women underwent mastectomy. The experimental group participated in six sessions which include Ellis's rational emotive therapy, problem solving, adaptation skills and relaxation training. Body image was assessed with questionnaire and data were analyzed with paired t test and independent t-test using SPSS soft ware.

Results: The results showed a significant difference between mean of body image score before and after counseling in experimental group. (P≈0.001) also a significant difference was seen between mean of body image score after counseling in two groups. (P≈0.001).

Discussion: At the final of this study improvement in body image was seen in women underwent mastectomy, so psychotherapeutic treatment especially supportive and cognitive behavioral therapies in group setting are recommended.

PP138 THE PUP AND THE PERP

Hannah Mendelson

Context: Animal assisted therapy is becoming more popular in a variety of healthcare settings. However, the evidence-based literature on the practice is still very sketchy, particularly in the psychiatric literature.

Objectives: To explore the role of animal assisted therapy in a corrections setting, focusing on rehabilitation issues.

Key messages: The human-animal bond is powerful, and could be usefully therapeutically exploited in offender rehabilitation, as well as other settings.

Conclusion: There likely is a role for animal assisted therapy in corrections, but rigorous studies are required to properly evaluate any benefits from such an intervention.

PP139 INTERNATIONAL TRAINING PROGRAM TO BUILD CAPACITY IN COMMUNITY MENTAL HEALTH CARE

Bronwen Merner, Chee Ng, Margaret Goding, Jenny Smith, Julia Fraser

Context: Community mental health services in many parts of the world, including Asia, are generally inadequately developed, especially where there is severe resource constraint. Without trained staff who can properly assess and manage mental health problems in the community, appropriate care cannot be delivered. Programs aimed at capacity building and skills transfer are likely to be the most cost-efficient method to alleviate the high human cost and disease burden associated with mental illness in low-resource countries.

Objectives: This poster aims to describe a collaborative program that enhances local expertise in mental health care in Asia-Pacific countries and promotes best clinical practice in community mental health care.

The Postgraduate Overseas Specialists Training (POST) program at St. Vincent's Mental Health provides ‘hands-on’ clinical training and transfer of expertise in service development to clinicians from low resource countries in the Asia-Pacific region.

Key messages: Direct clinical training programs, like the POST program, can contribute to building the capacity of the mental health workforce in low-resource countries. Due to diverse cultures and resource contexts, exposing clinicians to the principles and practice of community care models used is more beneficial than adopting a specific model.

Conclusion: In low-resourced countries, a key barrier to mental health reform is the lack of appropriately trained staff. Clinical training programs that are collaboratively planned and delivered, such as the POST program, provide a means for international efforts to contribute to the development of sustainable mental health workforces and services in ways appropriate to their local context.

PP140 A WEIGHT MANAGEMENT BEHAVIORAL PROGRAM FOR PATIENTS WITH SEVERE MENTAL ILLNESS: PILOT PROJECT IN A GENERAL HOSPITAL SETTING

Marhani Midin, Nik Ruzyanei Nik Jaafar, Ruzanna Zam Zam, Abdul Hamid Abd Rahman, Osman Che Bakar

Introduction: Weight gain and obesity among patients with severe mental illness (SMI) is a major concern. Locally, we lack evidence on weight management strategy specifically for psychiatric patients.

Aims: To describe the setting up of a weight management behavioral program for patients with severe mental illness in a general hospital setting and evaluate the pilot project on its potential benefits to the patients and its potential sustainability.

Method: A multidisciplinary team was formed to plan and implement the programme, which utilized the facilities and expertise already available in the hospital. Six patients with SMI volunteered to participate in this 16-week programme. Patients attended weekly physical exercise and 2-weekly group discussion covering the topics of diet and physical activity. Physical assessments on BMI and weight circumference were done 2-weekly.

Results: Patients achieved a mean weight loss of 0.89 (SD + 1.78 kg). The mean reduction of waist circumference from baseline to endpoint was 3.4 (SD + 6.8 cm). Factors associated with positive health outcome were higher baseline BMI, higher session attendance rates, higher educational level or committed family members.

Conclusions: A simple behavioural intervention can be developed in a hospital setting using available resources at minimum additional time and cost. Overall positive health changes can be achieved in motivated psychiatric patients. Potentially, psychosocial interventions of weight loss will help with compliance and self-esteem.

PP141 EIGHT-YEAR ALCOHOL RELATED MORTALITY IN A RURAL COMMUNITY IN SOUTH KOREA

Seongho Min, Tae Hui Kim, Samuel Noh, Jongho Shin, Kyo Jung Shin, Jong-ku Park

Objectives: This study is to demonstrate the effect of alcohol intake and alcohol dependency on mortality over eight years in a rural community in South Korea.

Method: Among 1,058 men and women (mean age, 55.0±16.87) in a rural community who reported their alcohol use status in 1998, 150 men and women died during eight years of follow-up. We performed the descriptive analysis of the dead with the basic demographic data, alcohol related data such as daily alcohol amount consumed, Severity of Alcohol Dependence Questionnaire (SADQ), drinking behaviors and smoking behaviors. In order to detect odds ratio (OR) for alcohol related mortality, we controlled various confounding factors using binary logistic regression.

Results: Those who are above 15 of SADQ showed higher mortality rate with an odds ratio (OR) of 1.74 [95% confidence interval (CI) = 0.86–3.51]. Those who had no more than 12 g of daily alcohol showed lower mortality than non-drinker or drinker of above 12 g per day.

Conclusion: The results showed the J-shaped relationship between alcohol intake and intermediate-term mortality as in Western countries.

PP142 WHERE DOES FAITH HEALING STAND IN TREATMENT SEEKING BEHAVIOUR?

Arun Misra, Vijoy Varma, Parmanand Kulhara

Faith healing is always a non-specific entity in today's psychiatric practice. Nevertheless, the importance of knowing this phenomenon at times helps psychiatrists to plan how to make their intervention important.

Aim: To explore help seeking from faith healers for some common psychiatric conditions by patients from urban and rural areas in relation to helps from other help seeking agencies.

Methods: 80 patients of Schizophrenia, Affective Disorder, Anxiety Neurosis and Depressive Neurosis were selected by incidental sampling method from the psychiatric outpatient of the department. Each of the patients' relative/relatives was interviewed using Treatment Seeking Behaviour Schedule. Treatment Seeking Behaviour of patients at first contact, immediate preceding contact before contacting our center and maximum no. of contacts in relation to treatment sought from different help care agencies were noted and analyzed as to where the faith healing stands in overall treatment seeking behavior in different disease groups.

Results: Comparison of psychotic and neurotic subjects with regard to their treatment seeking behaviour shows that significantly greater number of psychotic patients had their first contact and maximum number of contacts with faith healers. The study shows that more rural patients of all psychiatric conditions had their first contact with faith healers than their urban counterparts. The urban patients of schizophrenia, however, had more contact with faith healers immediately before seeking help from our services.

Conclusion: Faith healing still continues to remain a significant folk treatment approach not only in rural area but in the urban, more educated segment of the population.

PP143 ASSOCIATION BETWEEN DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH SCHIZOPHRENIA AND THE OUTCOME IN A PSYCHIATRIC DAY-HOSPITAL TREATMENT

Shingo Miyaji, Kenji Yamamoto, Nana Morita, Tomomi Tsubouchi, Syunya Hoshino, Hiroaki Yamamoto, Yoshiro Sakai, Hitoshi Miyaoka

Background: The Japanese Day-Hospitals for psychiatric patients was established in 1970′s, and there are more than 1,000 facilities in Japan. However, there are only few reports associated with the effects of the Day-Hospital on the treatment outcomes of the patients.

Aims: The aim of this study was to investigate what characteristics of patients with schizophrenia were associated with the outcome in a Day-Hospital Treatment.

Methods: The subjects of this study were 400 schizophrenic outpatients who registered for the Day-Hospital Treatment program between 1986 and 2004. A retrospective study was conducted on demographic and clinical information of the patients. The patients were divided into four groups according to the accomplishment and the durations of the Day-Hospital Treatment: the short-term completed group, N = 112; the long-term completed group, N = 100; the short-term discontinued group, N = 113; and the long-term discontinued group, N = 75.

Results: Chi-square test was conducted for categorical variables, and significant differences between the groups were found for educational levels (p≈.001) and outcome after the Day-Hospital Treatment (p≈.001). Also, an analysis of variance was conducted for continuous variables, and there were significant differences between the groups for age of onset. Post hoc comparisons revealed significant differences between the long-tem completed and short-tem discontinued groups, and between the long-term completed and the long-term discontinued groups.

Conclusion: The results from the present study suggested that among patients with schizophrenia, age of onset, educational levels may fluctuate the accomplishment and the durations of Day-Hospital Treatment.

PP144 SUBSTANCE MISUSE AMONG ADOLESCENTS IN SCHOOLS AND INDUSTRIAL AREAS

Hafidh Mohammad Frahan

Background: The prevalence of the substance misuse has been poorly studied in Iraq. This study was undertaken to examine the prevalence of misuse of smoking, alcohol drinking, and some types of illicit drug among adolescents in Baghdad City.

Method: The total 620 of 14–21 year old male and female adolescents (320 from 8 secondary school, 300 from 2 different industrial areas) in Baghdad City was studied. Investigation was done by using semistructured interview schedule based on DSM-IV for SUD, AD, DD, CD, and ASPD. Series of nonparametric procedure were conducted to explored the characteristic of past month smoker, drinker and illicit drug abusers, as well as investigated the determinants of SUD among respondents were characterized in terms of comorbidity and some sociodemographic data.

Result: The past month prevalence of smoking 31.5%, alcohol drinking 12.4%, and for any illicit drug 27.9%. Substance misuse is common in adolescents of industrial area 27% as compared to adolescents of secondary school 13.3%. The comorbidity are common in males 64.8% than females 5.7% substance abusers, while polysubstance use are common in adolescents of industrial area 42.4% than adolescents of secondary 26%. The most common illicit drug abuse is diazepam 29.2% of drug abusers and the main source of any illicit drug come from street 70%. Nearly 2/3 of substance abusers are reported leaving school and 68% of those used substance is due to relief tension.

Conclusion: Substance misuse has appeared among adolescents in Baghdad. The rates of smoking and illicit drug use among males and adolescents of industrial area were substantially higher than in females and adolescents of secondary school.

PP145 FACTORS PREDICTING BULLYING BEHAVIOUR AMONG SIXTH-GRADE STUDENTS ATTENDING HIGH-RISK SCHOOLS IN KUALA LUMPUR

Tuti Iryani Mohd. Daud, Wan Salwina Wan Ismail, Shamsul Azhar Shah, Nik Ruzyanei Nik Jaafar

Background: Bullying in schools in Malaysia has resulted in few but serious and fatal injuries in the recent years. It is critical to understand the factors contributing to bully for strategic prevention and intervention measures.

Aims: This study aimed to determine the factors that predict bullying behaviour.

Methods: This is a cross-sectional study of 410 sixth-grade students from seven randomly selected high risk national primary schools situated in Kuala Lumpur, Malaysia, conducted from April to June 2006. The students completed Bullying Questionnaire on bullying behaviour. ADHD symptoms of the students were assessed from multiple informants consisted of the students, teachers and parents using Conners-Wells’ Adolescent Self-report Scale (CASS), Conner's Teachers Rating Scale (CTRS) and Conner's Parents Rating Scale (CPRS) respectively. Parents also completed Child Behavioural Checklist (CBCL) to assess internalizing behaviour of the students.

Results: Factors that predicted bullying behaviour as tested by multiple logistic regression include: boys, number of siblings more than six, ADHD symptoms-hyperactive reported by students and ADHD symptoms-inattentive reported by students.

Conclusion: Bullying requires comprehensive assessment, one of which is identification of ADHD symptoms. This shows that bullying is a psychosocial issue that is in need of mental health intervention. It is recommended that schools need to be equipped with psychosocial resources that enable better awareness and effective identification of ADHD. Gender and large number of siblings are other factors that are worthy of attention.

PP146 BAHASA MELAYU TRANSLATION OF CHILDREN'S DEPRESSION INVENTORY

Tuti Iryani Mohd. Daud, Jamaiyah Haniff, Rozanim Kamaruddin, Fairuz Abd. Rahman, Fauzi Ismail, Zaharah Sulaiman, Loh Sit Fong, Sharon W. S. Chen, Susan M. K. Tan, Khairani Omar

Background: Although there is a large amount of literature on the various translations of Children's Depression Inventory (CDI), a Bahasa Melayu version has not been developed. Such instrument is needed to enable quality research on depressed children and adolescents in Malaysia.

Aims: This study aimed to produce a Bahasa Melayu version of CDI.

Methods: The CDI was translated by using a back-translation technique. Twenty bilingual adolescents participated in the first pre-test by completing the English and Bahasa Melayu version consecutively. Proportion agreement, weighted kappa, correlation coefficient, and verbatim responses from the participants were used to assess the equivalence between the two versions. Modifications were subsequently made. The pre-test procedure was repeated on another forty adolescents.

Results: Analyses of each item from the first pre-test revealed six problematic items (weighted Kappa < cutoff point 0.4, correlation coefficient <0.5). Weighted Kappa values from the second pre-test improved after modifications were made to the items. Two items however, were still below 0.4. Nevertheless, weighted Kappa (0.50–0.76), proportion agreement (>69%), correlation coefficient (>0.64) for both pre-tests were moderate to good when the equivalence were analyzed by total score and domain.

Conclusions: The Bahasa Melayu version of CDI produced in this study is an acceptable translation. Although there were problems with individual items, analyses performed according to domain showed satisfactory results. This is in accordance to general translation guidelines which emphasizes on semantic equivalence. Further study to establish the psychometric properties of Bahasa Melayu version of CDI is under progress.

PP148 BIPOLAR DISORDER: PRESCRIPTION PATTERNS AND THE EFFECTS OF PHARMACOTHERAPY ON QUALITY OF LIFE

Yee Ming Mok

Background: Studies have shown that people with bipolar illness have a poorer quality of life (QOL) but few studies looked at the effects of pharmacotherapy on QOL.

Aims: A cross sectional study was conducted to investigate the prescription patterns of patients with bipolar disorder at the Institute of Mental Health (IMH), Singapore and to evaluate for differences in (QOL) amongst individuals on different pharmacotherapeutic regimes.

Methods: This study targeted all stable, inpatients and outpatients, with a diagnosis of bipolar disorder, on lithium, sodium valproate, an antipsychotic or a combination thereof, between April 2006 and January 2007. Inclusion criteria included patients between 21 and 65 years of age and with the DSM IV diagnosis of bipolar disorder. The patients completed the WHOQOL-BREF and the YMRS, the HAM-D and the DSM-IV GAF.

Results: A total of 47 participants (23 males) with a mean age of 48.81 years (SD = 12.17 years) were recruited for this study. Patients on lithium have lower self-reported scores on all four QOL domains compared to patients on sodium valproate. However, significant differences between the two groups emerged only for Domain 2. Comparisons of patients on typical versus atypical antipsychotics and patients on monotherapy versus a mood stabilizer and antipsychotic combination did not reveal any significant differences between the patients groups on all domain scores.Conclusion: Whilst the results are only preliminary and further studies are required to establish its reliability and replicability, it does have possible implications for the prescription of medications for patients with bipolar disorder.

PP149 MENTAL HEALTH OF HIGH SCHOOL STUDENTS IN JAPAN AND SENSE OF COHERENCE

Naoyasu Motomura

Background: Antonovski has found that about 30% of victims in Nazi concentration camps were mentally healthy and studied the feature of survivors of the concentration camp. He coined the feature of survivors as sense of coherence (SOC) and there are not a few studies of SOC and mental health. However, there are not any studies of SOC in high school students in Japan. Cultural difference of SOC is still a controversial issue. Therefore, we conducted SOC to high school students and studied the relationships between SOC, self-esteem and GHQ.

Aim: To clarify the mental health of high school students and study the relationships between SOC, self-esteem and GHQ in Japanese high school students.

Subjects and method: Subjects were 338 high school students in local high school in Japan. To these subjects we conducted three questionnaire, that is, GHQ-28, Self-esteem scale (Rosenberg) and Sense of coherence scale (SOC).

Results and conclusion: Results indicated that 47.6% of subjects were mentally unhealthy. Negative correlation between GHQ points and SOC points or SE. There was high correlation between SOC and SE. These results suggest that SOC may be one of the factors for mental health of high school students in Japan.

PP150 MODULATING RATE AND RHYTHMICITY OF PERCEPTUAL ALTERNATION IN BINOCULAR RIVALRY BY 5-HT1A AGONIST TANDOSPIRONE

Masanori Nagamine, Aihide Yoshino, Masaki Miyazaki, Yoshitomo Takahashi, Soichiro Nomura

Background: When dissimilar figures are presented to each eye individually, perception alternates spontaneously between each monocular view. This phenomenon, called binocular rivalry, has been used by many researchers as a tool for investigating visual awareness. Since slow perceptual alternation rates in bipolar disorder patients have been reported, this phenomenon has drawn attention in the field of psychiatry as well. Some recent studies have suggested the involvement of serotonergic neural systems in this phenomenon.

Aims: To investigate the relationship between binocular rivalry and serotonergic neural systems in more detail.

Methods: Fifteen healthy volunteers were tested under placebo and 5-HT1A agonist Tandospirone (60 mg) conditions with the single blind method. The perceptual alternation rate and rhythmicity of binocular rivalry were measured at pre-administration, 90-, 180-, 360-min post-administration. Subjects’ state anxiety levels were also monitored by a self-rating scale.

Results: The perceptual alternation rate under tandospirone at 90 and 180 min post administration was significantly lower than that under placebo. Similarly, coefficient of variance (CV), which represents the rhythmicity, showed the same fluctuation; CV under the tandospirone condition was significantly greater than that under the placebo condition at 90 and 180 min post administration. State anxiety levels did not change during the experiment.

Conclusions: The present results suggest that the 5-HT1A neural pathways mainly located in the mesolimbic system are involved in binocular rivalry and the brainstem may play a crucial role as an oscillator in perceptual rivalry alternations.

PP151 SPIRITUALITY FROM PHILOSOPHY TO SCIENCE

Nahla Nagy

Spirituality, which is typically defined as “the need for finding satisfactory answers to ultimate questions about the meaning of life, illness and death”, can help provide a framework that helps someone gain an understanding of him- or herself and cope with unpleasant or unavoidable circumstances. Religion, on the other hand, denotes an organized system of beliefs, practices, and ways of worship. The serotonin system may serve as a biological basis for spiritual experiences. The variability in 5-HT1A receptor density may explain why people vary greatly in spiritual zeal. Physiological research found that 5-HT1A binding potential correlated inversely with scores for self-transcendence, a personality trait covering religious behavior and attitudes. Having a belief system in common with a patient can be an asset or a liability depending on what that belief system means to each and how they handle it in the therapeutic setting while dealing with patients with mood changes, obsessions and substance use disorders.

PP152 EXPERIENCES AND ATTITUDES TOWARD TREATMENT OF CRIME VICTIMS AMONG PSYCHIATRISTS IN JAPAN

Satomi Nakajima, Kyoko Hashizume, Bunri Tatsuno, Takako Konishi

Background: A high prevalence of mental disorders has been reported among victims of crime. How many of such victims are treated by psychiatrists in Japan, however, remains unclear.

Aim: This survey assessed the experiences and attitudes towards the treatment of crime victims among psychiatrist in Japan to clarify the facilitating and interfering factors associated with the use of mental health services by crime victims.

Method: Between June and July 2006, self-administered questionnaires were distributed by mail to the senior assistants at 2,879 psychiatric clinics. A total of 840 responses were received (response rate, 29.2%).

Results: A total of 50.9% (n = 419) of the respondents had treated crime victims during the past one year. The experience of treating crime victims was significantly associated with the characteristics of the psychiatric clinic (e.g., outpatient clinic, adoption of psychosomatic internal medicine, and the number of outpatients), and the characteristics of the psychiatrist (e.g., cooperation and experience working with crime victim-related agencies, and participation in workshops on victim support). Psychiatrists with experience treating crime victims felt significantly less hesitant and anxious about treating victims or having an insufficient knowledge of treatment skills and criminal systems and were also more interested and motivated to work in this area than those who had no experience.

Conclusion: Training with regard to treatment skills and criminal systems and cooperation with other agencies working with crime victims should be promoted among the psychiatric community.

PP153 A SEVEN-YEAR FOLLOW-UP ON THE ELDERLY WITH CDR 0.5 IN A JAPANESE RURAL AREA

Shiori Nakamura, Masahiro Shigeta, Norifumi Tsuno, Makoto Iwamoto, Tomohide Sugimura, Minako Koga, Yu Kawamuro, Kazuhiko Nakayama, Rie Niina, Akira Homma

Background: Mild cognitive impairment (MCI) is considered the borderline condition between normal aging and dementia. The Clinical Dementia Rating (CDR) is a very important part of the concept of MCI. We conducted a 7-year follow-up of the subjects whose CDR levels were 0.5.

Methods: We initiated a dementia survey in Itoigawa city, a rural area of Japan in 1997. There were 7,847 people aged 65 years and older. The first phase included medical history, activity of daily living, psychiatric and behavioral symptoms, and Mini-Mental State Examination. We screened 1,114 subjects who were suspected of dementia. In the second phase, pairs of psychiatrists and nurses made house-to-house visits and examined them in detail. Clinical diagnoses were based on CERAD and DSM-IV. We found 271 demented people and the prevalence rate of dementia was 6.2%. In the survey, we found 252 elderly with CDR 0.5, 100 were judged to have progressive cognitive decline but not meet dementia criteria, and 152 were judged to be stable. In 2004, we investigated these CDR 0.5 people.

Results: Of 252 CDR 0.5 people, 79 were dead. We investigated 111 subjects, 64.2% of the 173 survivors. Of the 39 “progressive” people, 34 subjects developed dementia (87%). In comparison, of the 72 “stable” people, 44 subjects developed dementia (61%).

Conclusions: Subjects of the “progressive” group developed dementia at a higher rate than those of the “stable” group. In the case of subjects with CDR 0.5, the existence of progressive cognitive decline could be a predictor of developing dementia.

PP154 SUBJECTIVE MEMORY IMPAIRMENTS DURING THE COURSE OF ELECTRO CONVULSIVE THERAPY IN DEPRESSED PATIENTS

Ritu Nehra, Subho Chakrabarti, Nitasha Khehra, Rajni Sharma, Nitesh Painuly

Background: Memory impairment is one of the common side effects of electro convulsive therapy (ECT). Apart from objective impairment, subjective complaints of memory loss are also quite common in ECT and a major source of distress for the patients. Investigating the nature and extent of such subjective memory complaints thus becomes an important endeavour with major implications on practice of ECT.

Aim: To examine the short term subjective and objective memory impairments in depressed patients during the course of ECT.

Method: Patients with severe depression (n = 32) were followed up while they were receiving ECT's, and up to a month after that. They were rated independently and blindly on the MMSE for global cognitive dysfunction, the PGI Memory Scale (PGIMS; Pershad, 1979) for objective memory loss, Self Rating Scale of Memory Functions (SRSMF; Squire et al., 1979) for subjective memory loss and the Montgomery-Asberg Depression Rating Scale (MADRS) for severity of depression.

Results: MMSE and PGIMS (objective memory) scores dipped during the course of ECT, but picked up in the week and month following cessation of treatment. MADRS scores registered a gradual decline as patients improved throughout the course of ECT. The SRSMF (subjective memory) scores also showed a gradual improvement during the course of ECT. However, subjective memory scores did show consistent correlations with MMSE, MADRS and objective memory.

Conclusions: There is considerable subjective memory impairment during a course of ECT, even in the short term. However, subjective memory scores do improve with treatment.

PP155 EXECUTIVE FUNCTIONS IN PATIENTS WITH PERSISTENT DELUSIONAL DISORDER

Ritu Nehra, Gaurav Bhateja, Parmanand Kulhara, Suresh Kumar

Background: Patients with persistent delusional disorder and paranoid schizophrenia resemble clinically. There is paucity of research data concerning neurocognitive functioning of patients with Delusional Disorder; although there is ample data on this aspect of schizophrenia. Such research would have implications in terms of understanding aetiopathogenesis and planning management.

Aims: To compare the executive functions in patients with persistent delusional disorder, paranoid schizophrenia and normal controls and correlation between executive functions, socio demographic and clinical variables.

Methods: Patients diagnosed with persistent delusional disorder and paranoid schizophrenia as per ICD-10 DCR criteria, within the age range of 20–60 years, of either sex, and with duration of illness of minimum 1 year were matched with normal controls. They were assessed on clinical parameters using Montgomery Depression Rating Scale, Brief Psychopathology Rating Scale and General Health Questionnaire and administered neuropsychological tests of executive functioning including Wisconsin Card Sorting Test for set shifting and Tower of London for planning.

Results: Patients with persistent delusional disorder performed significantly worse on all the categories of WCST; they made significantly more percent errors, perseveratory responses and perseveratory errors. Patients with paranoid schizophrenia completed more categories than subjects with persistent delusional disorder. Patients with paranoid schizophrenia performed significantly poorly on WCST as compared to normal controls. No significant differences were found on executive functions of planning i.e., on Tower of London test.

Conclusion: On set shifting, the persistent delusional disorder patients were significantly more impaired compared to patients with paranoid schizophrenia as well as normal controls.

PP156 ARE YOU LOOKING AT ME? A RETROSPECTIVE CASE SERIES AND LITERATURE REVIEW OF PSYCHOSIS AND PRE-EXISTING SOCIAL PHOBIA

Karen O Connor, Paul Scully

Aims: Described are three patients with Social Phobia who later developed psychosis.

Three hypotheses are proposed to explain this occurrence.

(1) This is simply a chance finding of the co-occurrence of 2 separate illnesses. (2) Social Phobia and Paranoid Psychosis represent two manifestations with the same cause. (3) Social Phobia and Paranoid Psychosis are different parts of the same spectrum of illness.

Method: A literature review of Embase, Pubmed and PsychLit was performed. This literature was then separated into psychological and biological explanations.

Results: No literature on social phobia as a pre-existing diagnosis to an episode of psychosis was found.

Psychological explanations include Freud's theory of defence mechanisms and theories re attributional bias.

From a biological perspective there has been a surge of interest in the role of Oxytocin in the pathogenesis of Social Phobia. Oxytocin has been shown to work at the level of the amygdala to reduce fear. Evidence exists that Oxytocin dysregulation is a feature of psychosis and recently Oxytocin-like chemicals have been proposed as novel antipsychotics.

Conclusion: Statistics indicate that the chance occurrence of social phobia and psychosis as two unrelated illnesses is unlikely.

Whether they are one dimension of the same illness or two categorical manifestations of underlying pathology of the subcortical nuclei is unclear. However there is increasingly strong evidence that the amygdala, oxytocin and monoamine regulation are altered in both.

Could Oxytocin-like chemicals benefit the ‘fear’ dimension in Social Phobia and Psychosis?

PP157 HAPPY PILLS? A LITERATURE REVIEW OF CORTICOSTEROID INDUCED PSYCHIATRIC SYMPTOMS

Karen O'Connor, Paul Scully

Background: Corticosteroids are frequently prescribed medications whose psychiatric complications have been reported since the very first year they came into general medicinal use.

Aims: We use two cases to demonstrate the diversity of psychiatric adverse events and then a literature review was performed to:

(1) Clarify the prevalence and nature of corticosteroid induced psychiatric adverse events (2) Outline the associated risk factors (3) Outline the management strategies.

Methods: Pubmed and PsychInfo were searched using the words corticosteroid, steroid, prednisolone, psychosis, mood, cognitive, memory, psychiatric. Considering the prevalence of use a surprisingly sparse literature was found.

Results: Corticosteroid induced psychiatric events are seen in 6–57% of pts and exist on a spectrum from mild/moderate to severe effects classically referred to as'Steroid Psychosis'. The mild/moderate effects impact on daily living but don't reach level of diagnosable axis 1 illness. Severe effects'Steroid Psychosis' occur with an incidence of 6–10%. Steroid Psychosis itself is a somewhat misleading term which actually represents a collection of serious psychiatric outcomes including Mania, Depression, Mixed states, Psychosis and Steroid Dementia.

Risk factors for steroid-induced psychiatric events are discussed. Furthermore evidence based management strategies are described.

Conclusion: Steroid Psychosis is a misleading umbrella term, which encapsulates Mania, Depression, Mixed States, Psychosis and Cognitive changes- a term which I believe we should consign to history. The literature in this area is sparse and there is a serious need for large controlled trials.

PP158 MOOD, ANXIETY AND ADJUSTMENT DISORDERS IN PATIENTS WITH LEUKEMIA AND LYMPHOMA

Sepideh Omidvari, Ali Shahidzadeh Mahani, Ali Montazeri, Ali Azin, Amir Hossein Emami, Mohammad Mohammadi, Amir Mahmood Harirchi, Hamid Soori, Hajieh Jaafari, Fetemeh Goodarzi

Background: Among chronic medical conditions, cancer shows an especially strong association with psychiatric disorders. Effective treatment for mental disorder has been found to affect the course and outcome of cancer, the patient's adjustment, severity of somatic symptoms, cost of care, patient's quality of life, and return to work.

Aims: To determine the prevalence of mood, anxiety and adjustment disorders in patients with leukemia or lymphoma.

Methods: A descriptive study was carried out on 96 leukemia and lymphoma patients in their first episode of hospitalization in a teaching hospital in Tehran, Iran. We used semi-structured clinical interviews based on the DSM-IV criteria and performed by a psychiatrist.

Results: Overall, the study showed mood, anxiety or adjustment disorders in 62 (64.6%) of patients. More specifically, mood disorders were detected in 32 (33.3%), anxiety disorders in 36 (37.5%) and adjustment disorders (adjustment disorders with anxiety, adjustment disorders with depressed mood, and adjustment disorders with mixed anxiety and depressed mood) in 28 (29.1%) subjects. Fourteen (14.6%) patients had been informed of the diagnosis of cancer. Only 1 (1.0%) of those we diagnosed as psychiatric cases had received a diagnosis of mental disease upon hospitalization. Past history of mood, anxiety or adjustment disorders was positive in 48 (50.0%) patients. No more than 8.3% of those with a positive history had actually sought treatment.

Conclusion: Mood, anxiety and adjustment disorders are common in patients with leukemia or lymphoma. There is a need to identify and treat concurrent psychiatric disorders in cancer patients.

PP159 ACCURACY OF THE HOSPITAL ANXIETY AND DEPRESSION SCALE TO DETECT MOOD PROBLEMS IN PATIENTS WITH LEUKEMIA AND LYMPHOMA

Sepideh Omidvari, Ali Shahidzadeh Mahani, Ali Montazeri, Ali Azin, Amir Hossein Emami, Mohammad Mohammadi, Amir Mahmood Harirchi, Hamid Soori, Fatemeh Goodarzi, Hajieh Jaafari

Background: There is a strong association between cancer and psychiatric disorders. Despite the importance of psychiatric disorders in the patients, it has been reported that mental illness is not detected in many of patients with cancer. Using appropriate instruments to screen for mental problems in patients with cancer may improve case-finding.

Aims: To determine the accuracy of HADS for detection of mood problems in patients with leukemia and lymphoma.

Methods: A descriptive study was carried out on 96 leukemia and lymphoma patients in their first episode of hospitalization in a teaching hospital in Tehran, Iran. We used semi-structured clinical interviews based on the DSM-IV criteria and performed by a psychiatrist as the gold standard to detect mood and adjustment disorders and HADS to measure psychological morbidity. HADS has two subscales, each comprising seven items to assess depression or anxiety separately. Each item is scored from 0 to 3, and the maximum total score on each subscale is 21. After excluding patients with diseases that were not detectable by HADS (e.g. manic episode), the accuracy of HADS for detecting mood problems was examined.

Results: Using a Receiver Operating Characteristic (ROC) Curve, cases of HADS-defined depression were identified by a score of >6 on HADS-D. This cut-off level was found to give an optimal balance between sensitivity and specificity on ROC Curve (0.64 and 0.84, respectively).

Conclusion: It seems using HADS as a primary measure may improve the detection of cancer patients with depressive problems, by referring patients with scores above 6 to psychiatric services.

PP160 STRESS AND ITS CAUSES IN MEDICAL STUDENTS

Sepideh Omidvari, Ali Azin, Hamid-Reza Baradaran

Aims: There is little doubt that medical students are subject to considerable amounts of physical and mental stress, resulting in high rates of depression and anxiety problems as well as alcohol and drug abuse. This cross-sectional study – conducted from June to August 2006 – looks at the problem of stress among Iranian medical students and the potential causative factors.

Subjects and methods: A total of 742 medical students in five State-run and private universities filled questionnaires dealing with personal and demographic characteristics, physical and mental stress symptoms, social relations and perceived job perspective as well as problems faced at home and on the campus. For each participant, a total stress score was computed and its association with putative risk factors examined using Mann-Whitney tests, non-parametric correlations and logistic regression analysis.

Results: The following factors were found to have significant, independent associations with a high degree of stress: female gender, living in a large family, low income, training in clinical rotations and internship, and separation from the family. The most important problems faced by the students included crowding on the campus and in dormitories, abuse and humiliation from staff and faculty, poor learning facilities and excessive workload.

Conclusion: Addressing the financial needs of the students (e.g. easier access to student loans), developing better communication skills, education in various relaxation and stress reduction techniques, and measures to reduce workload are recommended to mitigate the effects of physical and mental stress on medical students.

PP161 NEUROPSYCHOLOGICAL PROBLEM IN MILD COGNITIVE IMPAIRMENT

Aiko Osawa, Shinichiro Maeshima

Aim: Mild cognitive impairment (MCI) is hypothesized to be very early stage of dementia. Diagnosis of MCI is important to treat and prevent the development of dementia. The aim of this study is to clarify the neuropsychological impairment of MCI.

Subjects and methods: Subjects were 96 elder patients having amnesia as a complaint, but living independently. We assessed neuropsychological aspect using the Mini-mental State (MMS), Kana-hiroi Test, Auditory verbal learning test (AVLT), a word fluency test (WFT) and Raven's colour progressive matrices. Then, we categorize MCI into subgroups and compared neuropsychological score in these groups.

Results: They were divided into 4 groups; 54 amnestic type (15 amnestic MCI, 39 multidomain MCI) and 19 non-amnestic type (8 multidomain MCI non-amnestic type, 11 single nonmemory MCI). 23 patients had no impairment (Control subjects; CS). In AVLT, the score in amnestic type was lower than non-amnestic type and CS. There was significant difference between two types of MCI (multidomain MCI and single nonmemory MCI) and CS. In kana-hirioi test, patients of multidomain MCI had lower score than CS. Finally, in WFT, the scores of all types of MCI were lower than CS.

Conclusion: Our results indicated that MCI had various kind of impairment not only amnesia and we could categorize some types of MCI depend on their neuropsychological problems. In fact, some report investigated MCI was not to be only Alzheimer's disease. We suggest that we have to diagnose the types of MCI correctly in early stage and treat it not to develop their problems.

PP162 EFFECTS OF THE RIVASTIGMINE IN COGNITIVE IMPAIRMENT OF PATIENTS WITH SCHIZOPHRENIA: CONTROLLED CLINICAL STUDY

Jose Lisandro Pabon Davila, Alberto Colina Rodiz

A controlled clinical study randomized was made, with the objective to evaluate the effect of the Rivastigmine on the cognitive impairments of patients with Schizophrenia. We evaluated a total of 38 patients during the lapse November 2004–May 2006, selecting finally a total of 34 withdrawn originating patients of the consultation of the hospitalization of Psychiatry of Military Hospital “Dr. Carlos Arvelo”, who presented the diagnosis of Schizophrenia, in addition to demonstrate Cognitive Disorder by neuropsychiatrics tests. The used instruments to evaluate the cognitive functions were the Mini-Mental test, Test of the Clock, Trail Making and Escale of Social Cognition for the Psychosis. Further the probable adverse effects associate to Rivastigmine were evaluated with the Scale of Adverse Effect (UKU). The patients (18) of the group with Rivastigmine were treated during 24 weeks. The group control (16) did not receive inhibitor of acetylcholinesterase. The obtained results allow to conclude that the Rivastigmine produced progressive a therapeutic effect, without excellent adverse effects. The clinical assessments of cognitive function demonstrated difference statistic significative (p≈0.05) between groups. The changes in the cholinergic function in schizophrenic patients provide the effectiveness of cholinesterase inhibitor in treating cognitive impairment in schizophrenia.

PP163 ASSOCIATION BETWEEN MOOD STATUS OF NURSES WITH PERSONAL AND SOCIAL CHARACTERISTICS

Saeid Pahlavanzadeh, Mehdi Roostazadeh, Mahmoud Nasiri, Akbar Hasanzadeh

Background: All of us tend to happy and pleasure intrinsically. However, there are some situations that make someone feel sad. Nursing is a stressful profession. Thus, effect of different factors of nurses and their environment, on nurses mood, seems to have enough importance to study.

Aims: In this study we intend to determine mood status in nurses and the relationship between personal and social characteristics with mood status.

Methods: This is a descriptive– analytical study, that 490 nurses who work in the different wards(such as ICU, CCU, medical, surgical,…) of Al-Zahra hospital of Isfahan Medical Sciences University answered a two parts questionnaire consisted of personal and social data and Zung self rating depression scale. Data were analyzed with ANOVA and Mantel-Hanzel.

Results: Findings resulted from Statistical analysis showed that there are significant relationships between mood status and sex, ward, income, sleep satisfaction, job satisfaction, spouse communication and two types of spending leisure time (book study and family meeting).

Conclusion: With regard to the importance and the impact of happiness in recovery of patients and other clients, it is necessary for nurses and managers to have a complete knowledge about effects of related factors to nurses mood and, if necessary, choose appropriate policy to avoid unpleasant results of it.

PP164 ASSOCIATION BETWEEN WORKING MEMORY DYSFUNCTION AND STRUCTURAL ATROPHY IN SCHIZOPHRENIA

In-Ho Paik, Seung-Kyu Bang, Woong Ham, Hyun-Kook Lim, Chul Lee, Chang-Uk Lee

In this study we performed fMRI studies to compare the activation regions between the schizophrenic patients and normal controls. Gray matter loss between these two groups was compared using the voxel based morphometry (VBM) analysis. The brain regions showing differences in fMRI and VBM studies were compared to investigate the consequence of structural atrophy on functional activation.

This study included 14 schizophrenic patients and 10 normal. The fMRI employed an echo planar imaging sequence using a 2-back WM test. The VBM analysis was performed using the AnCova model with sex, age, disease onset age, duration and MMSE.

The working memory of schizophrenic patients was significantly impaired compared to controls. In fMRI schizophrenic patients showed decreased activity in middle frontal and superior temporal, insula, caudate, hippocampus, parahippocampal gyrus, and fusiform gyrus compared to controls. On the other hand, the patient group showed increased activity in the inferior frontal and inferior parietal brain. The VBM results showed GM reductions in Schizophrenic patients in the middle frontal, medial frontal, inferior frontal, inferior parietal, middle temporal, superior temporal brain, and parahippocampal gyrus, lingual, fusiform gyrus.

The WM impairment was related to the differences in functional activation in fMRI studies, and was associated with structural differences in the VBM analysis. The results suggest that in order to perform the working memory task, a higher neuronal activity is needed to compensate for the volumetric loss.

PP165 EFFECT OF AIRCRAFT NOISE ON ATTENTION, COGNITION AND PERFORMANCE IN CHILDREN

Ki-Chung Paik, Myung Ho Lim, Hyun Woo Kim, Kyung Kyu Lee

Background: It has been known that chronic noise exposure causes various influences on early childhood development, school performance and health.

Aims: This study was focused on the influence of chronic aircraft noise exposure to the certain functional areas like attention, cognition, and performance in children.

Methods: 586 children in the 4th∼6th grade of 7 elementary schools (2 helicopter noise exposed schools, three military aircraft noise expose schools, and 2 control schools) in a certain city in Korea participated in this study. We measured visual and auditory continuous performance test by using computerized Attention Deficit System (ADS) program in addition to intelligence test items like digit symbol, digit span, block design by Korean-Wechsler Intelligence Scale for Children-III. Reading vocabulary tests were also applied.

Results: Those variables that showed significantly worse values in the both types of noise exposed group than in the control group were as follows: commission error in the visual performance test, omission and commission errors in the auditory performance test, variability in the auditory performance test, and reading test. There were no significant differences between helicopter and aircraft noise exposed group in all variables in post-hoc analysis. Other variables did not show any statistically significant differences.

Conclusion: Chronic aircraft noise might have something to do with attention difficulty, and especially auditory related continuous performance function impairment which could be associated with reading problem.

PP166 PREVALENCE OF MENTAL DISORDERS IN CATALONIA PRIMARY CARE: RESULTS FROM THE DIAGNOSTIC AND ASSESSMENT STUDY OF MENTAL DISORDERS IN PRIMARY CARE

Diego J. Palao, Antoni Serrano, Josep Ma Haro, Alejandra Pinto-Meza, Leila Lujan, Merce Mercader, Myriam Cavero

Background: This study presents estimates of the lifetime and 12-month prevalence of affective, anxious and others DSM-IV-TR mental disorders in an adult primary care population from the Catalan Study of Mental Disorders in Primary Care, the first one-phase survey administering a structured psychiatric interview to a probability sample in Catalonia (Spain).

Aims: To describe the lifetime and 12-moth prevalences of mental disorders and to evaluate the diagnostic and treatment practices in real-world primary care settings.

Method: One phase cross-sectional survey. A randomized sample of selected subjects (n = 3821), aged 18 years or older, from eighty Primary Care Centres representatives of Catalonia (Spain) was performed using the SCID-I and the M.I.N.I.-interview between November 2005 and February 2006.

Results: More than 45% of respondents reported at least one lifetime mental disorder, and close to 30% reported at least one 12-month mental disorder. The rate of mental disorders recognized by the general practitioner (GP) was 21–24%. Mental disorders most commonly seen in primary care were major depression, panic disorder, specific phobia, generalized anxiety disorder and alcohol use related disorders.

Conclusions: The DASMeD-PC study is one of the most comprehensive surveys of mental disorders performed in primary care in a representative sample of a regional area in Europe. The results show a high prevalence and comorbidity of mental disorders in general practice setting. In spite of the increasing interest of GP for support strategies from Mental Health Community Centres, a great proportion of patients with mental disorders were under-recognized and under-treated.

PP167 MENTAL HEALTH PROBLEMS AMONG CHILDREN WHO LOST SIGNIFICANT ONES FROM TSUNAMI

Benjaporn Panyayong, Jirarat Nuanmai, Sauyah Jehna

Context: On December, 2004, an earthquake from Sumatra triggered a giant wave that swept through the coastal areas of Thailand. This wave affected 29,800 children; and nearly 1,500 children were orphanages.

Objectives: To study mental health problems among children who lost significant ones from tsunami and to study factors associated with these problems.

Method: Mental health assessment were conducted among children 6–17 years old who lost parents, family members, and/or significant others. Data was collected ten months after tsunami from children in schools that located in Phang Gna and Ranong provinces. Measurements included Berleson Depression Scale and UCLA PTSD Reaction Index.

Results: 326 children were enrolled in this study. Prevalence of depression was 28.8% (94/326) and PTSD was 9.5% (31/326). Older children, sex, and tsunami experiences were associated with mental health problems.

Conclusion: The children who lost significant ones were at-risk group of mental health problems. This data may be useful for intervention plan and follow-up.

PP168 RELATIONSHIP BETWEEN THE COMPUTER GAME STYLE AND EMOTIONAL AND BEHAVIORAL CHARACTERISTICS OF UPPER CLASS ELEMENTARY SCHOOL CHILDREN

Taewon Park, Moon-Sook Lee, Ik-Keun Hwang, Eun Cheong Cho, Young-Chul Chung, Sang-Keun Chung, Ja-Young Lee, Si-Ha Shim

Objectives: The purpose of this study is to investigate the relationship between the computer game style and emotional and behavioral characteristics of senior grade elementary school children.

Methods: Randomly selected 5th and 6th graders of the two elementary schools (N = 413) in JeonJu City were participated in the study. They completed self-report questionnaires containing questionnaires designed by author, Computer Game Addiction Scale, Children Depression Inventory of Korean version, Piers-Harris Children's Self-esteem Scale of Korean version and Children Behavior Check Scale.

Results: There was positive relationship between computer game style (game year, game hours per one time, game hours per 1 day, frequency per a week) and game addiction.(girls, χ²=21.304, p≈.05, χ²=63.613, p≈.05, χ²=88.242, p≈.05, χ²=66.656, p≈.05, boys, χ²=18.879, p≈.05, χ²=72.571, p≈.05, χ²=68.472, p≈.05, χ²=57.191, p≈.05). There was positive relationship between the psychopathology (depression, trait anxiety, state anxiety, self esteem) and game addiction(girls, r=.299, p≈.01, r=.291, p≈.01, r=.265, p≈.01, r = −.331, p≈.01, boys, r=.463, p≈.01, r=.538, p≈.01, r=.404, p≈.01, r = −.461, p≈.01). But significant relationship between the psychopathology (attention deficit, attention deficit hyperactivity disorder) and game addiction was found in only girls (r=.233, p≈.01, r=.183, p≈.05).

Conclusion: This paper shows positive correlations between game addiction scores and game years, game hours per one time, game hours per a day and frequency per a week. And this shows a significant relationship between game addiction scales and such psychopathology as depression, trait anxiety, state anxiety and the lower self esteem. But significant relationship between game addiction scores and attention deficit hyperactivity disorder was found in only girls.

PP169 EFFECT OF SOCIAL SKILLS TRAINING IN CHILDREN WITH EMOTIONAL AND BEHAVIORAL PROBLEMS: A PART OF ‘WE START’ OR A KOREAN COMMUNITY-BASED SUPPORT FOR ECONOMICALLY DISADVANTAGED CHILDREN AND FAMILIES

Seok Jun Park, In-ki Sohn, In Chul Choi

Background: ‘We Start’ is a Korean support program for children and their low-income families has been fulfilled by public and private agencies to provide children with comprehensive developmental care. Social skills training in ‘We Start’ program was executed for children with problematic behaviors in a local district.

Aims: This study was conducted to explore the effect of SST program. The SST was applied to modify the emotional and behavioral problems of economically disadvantaged children.

Methods: Participants were 15 children who were assigned by staffs in the'We Start' and psychiatrists in the community. We performed the 8 session program with the modified Pfiffner and McBurnett's program (1997), and assessed the changes of behaviors and social skills.

Results: This study showed that social skills training proved to be effective for improvement in the problematic behavior. The participants, the 15 children showed improvement in 6 month and 1 year follow-up after the SST programs were completed. Especially the effect of SST programs in the lower grade children is greater than the upper grade.

Conclusion: The social skills training programs should be combined in comprehensive treatment programs for children. Detecting children early with problematic behaviors would be better and community-based social skills training programs must be executed as early as possible.

PP170 STRUCTURAL AND NEUROPSYCHOLOGICAL CHANGES IN MAJOR DEPRESSIVE DISORDER

Jong-Ik Park, Kang-Uk Kang-Uk, Sam-Su Kim

Background: Multiple brain regions are reported to be affected in patients with major depressive disorder.

Aims: The aim of this study is to investigate if the structural changes in limbic regions exist and those changes are associated with neuropsychological changes, which are frequently observed in patients with MDD.

Methods: Twenty female MDD patients according to DSM-IV criteria and age-matched 20 female normal volunteers were enrolled respectively. After 3-Dimensional (3D) T1 volume images were obtained using coronal turbo field echo (TFE) technique, manual segmentation and volume measures were conducted for the hippocampus and caudate nucleus. Further automatic measurements of volume and cortical thickness were also tried for anterior cingulate gyrus using FreeSurfer v3.0.4. In addition, neuropsychological tests were conducted for evaluation of cognitive dysfunctions.

Results: Among various regions analyzed, right anterior cingulate gyrus showed most prominent abnormality in MDD such that both relative volume and cortical thickness were reduced in patients compared to normal control group after removing the confounding effects of age. Further repeated measures ANOVA showed significant interaction between diagnosis and side of hemisphere such that volume reduction on the right side was much greater than that on the left side in patients with MDD. In partial correlation analyses after controlling the effect of age and education, right anterior cingulate volume showed inverse association with percent of conceptual response in Wisconsin Card Sorting Test.

Conclusion: Abnormality in right anterior cingulate gyrus may be associated with the decreased function in the concept forming capacity in MDD.

PP171 SELF-REPORTED DEPRESSIVE SYMPTOMS IN A SCHOOL SAMPLE OF KOREAN CHILDREN

Jong-Ik Park

Background: The Children's Depression Inventory (CDI) is one of the most widely used self-report instruments to assess childhood depression, and it has been especially valid for epidemiological purposes.

Aims: The aim of our study is to assess self-reported depressive symptoms in a school sample of Korean children, according to gender, using the Korean version of the CDI. A factorial analysis was performed on the 27 items of CDI in the subjects in order to identify possible composite dimensions.

Methods: All the participants were 5th-grade 2,293 students in elementary schools (1,148 males and 1,145 females). The initial factors were extracted by means of principal component analysis and then rotated according to promax criteria in order to achieve a simple structure. Only those items with a loading of .40 or greater were included in the identified factor.

Results: The CDI mean score was 13.95±7.11. There was no significant difference between boys and girls. Factorial analysis yielded five factors, such as discomfort, social problem, externalization, poorer school performance and self-blame, and somatic preoccupation. The girls had different factors composite from those of boys, which account for high variability in girls were discomfort and self-blame in comparison to school and social problem in boys.

Conclusion: Despite of insignificant difference in the CDI score, the gender difference should be considered to assess child depression.

PP172 EFFECTS OF FOOD ON ABSORPTION OF ZIPRASIDONE

Bruce Parsons, Kuan Gandelman, Jeffrey Miceli, Jeffrey Alderman, Paul Glue, Mark Versavel, Ilise Lombardo, Keith Wilner, Anil Jina, Sheldon Preskorn

Background: Oral ziprasidone shows increased bioavailability in the presence of food, which may be necessary to achieve plasma levels associated with 60% D2 receptor occupancy.

Aims: We explored the influence of food on bioavailability of ziprasidone, under various conditions, in three clinical pharmacokinetic studies.

Methods: Studies 1 and 2 involved healthy volunteers. The first study examined absorption of varying single doses of ziprasidone (20–80 mg) while the second compared the FDA standard meal (60% fat content) with a lower-fat meal (30% fat) on absorption of ziprasidone (40 mg). Study 3 involved patients with schizophrenia and examined the effects of total calories (250–1000 kcal) and fat content (15 or 50%) on steady-state (80 mg bid) serum concentrations of ziprasidone.

Results: In study 1, area under the serum ziprasidone concentration-time curve (AUC) was greater in fed than fasting states (20 mg, +48%; 40 mg, +87%; 80 mg, +101%). Increases in AUC with dose were linear only in the fed state. In study 2, AUC increased 104% for the 60% fat meal and 79% for the 30% fat meal compared with the fasting state. In study 3, substantial increases (∼85%) in ziprasidone exposure above the fasting condition occurred following 500- and 1000- but not 250-kcal meals. Variability in exposure was reduced in all studies by food. The fat content of the meal did not impact exposure.

Conclusion: Ziprasidone exposure is enhanced, and variability is reduced, when administered following meals =500 kcal, independent of fat content.

PP173 LONG-TERM EFFICACY OF ZIPRASIDONE IN TREATMENT-RESISTANT SCHIZOPHRENIA: RESULTS FROM THE ONE-YEAR, OPEN-LABEL MOZART EXTENSION STUDY

Bruce Parsons, Emilio Sacchetti, Alessandro Galluzzo, Barbara Gorini, Anil Jina, Fabio Romeo

Background: The randomized, double-blind, 18-week MOZART core study showed that ziprasidone has efficacy comparable to that of clozapine with an improved safety profile with regard to weight, fasting glucose, and lipid parameters in treatment-resistant and/or treatment-intolerant schizophrenic patients.

Aims: To determine the long-term efficacy of ziprasidone in treatment-resistant schizophrenic patients.

Methods: Subjects who completed the MOZART core study and who responded to treatment with ziprasidone (=20% reduction in PANSS total score) were enrolled in a 1-year, open-label, flexible-dose extension study. Subjects initially received the same dosage of ziprasidone (80–160 mg/d), upon which they completed the double-blind core study.

Results: Of the 45 patients who completed the core study, 42 were enrolled in the extension phase. The mean change from core study baseline in PANSS total score was −37.0 (95% CI, −41.8 to −2.2; p≈0.001; ITT-LOCF n = 42) for patients treated with ziprasidone on entry to the extension study. Following 1 year of oral ziprasidone, the mean change in PANSS total score from core study baseline was −32.2 (95% CI, −39.1 to −25.3; p < 0.001; n = 42). Of the 40 ITT patients who entered the extension study, 28 (70%) maintained =20% reduction in PANSS total score (vs core study baseline) at the extension phase end point. The safety evaluation showed no clinically significant detrimental effects.

Conclusion: The efficacy of ziprasidone observed during an 18-week, double-blind core study of treatment-resistant or treatment-intolerant schizophrenic patients was generally maintained during a 1-year follow-up period.

PP174 EFFICACY OF ZIPRASIDONE IN DYSPHORIC MANIA: POOLED ANALYSIS OF TWO DOUBLE-BLIND STUDIES

Bruce Parsons, Stephen Stahl, Ilise Lombardo, Antony Loebel, Francine Mandel, Anil Jina

Background: Dysphoric mania is a common and often difficult-to-treat subset of bipolar mania that is associated with significant depressive symptoms. In addition to improving mania, ziprasidone has been found to reduce HAM-D scores in subjects with mixed mania.

Aims: To evaluate, in a post-hoc analysis, the efficacy of ziprasidone in the treatment of depressive and other symptoms in patients with dysphoric mania.

Methods: Pooled data were examined from 2 similarly designed, 3-week, placebo-controlled trials in acute bipolar mania. Subjects were considered to have dysphoric mania if they scored ≥2 on at least 2 items of the extracted HAM-D scale (dysphoric mood, worry, self-reproach, and negative self-evaluation). Changes in HAM-D scores from baseline to days 2, 4, 7, 14, and 21 were evaluated by a mixed-model analysis of variance. Additional assessments included changes in the MRS, CGI-S, PANSS, and GAF scores.

Results: Starting on day 4, HAM-D scores were significantly lower at all visits in subjects treated with ziprasidone compared with those treated with placebo (p < 0.05). Mean (± SD) improvement in HAM-D score in subjects treated with ziprasidone at study end point was 4.2±0.7, a reduction of 44% from baseline. Ziprasidone-treated subjects also demonstrated significant and persistent improvements on the MRS, CGI-S, PANSS, and GAF scores compared with placebo, starting at days 2, 2, 7, and 7, respectively.

Conclusion: In placebo-controlled trials, ziprasidone significantly improved depressive and other symptoms associated with dysphoric mania.

PP175 ZIPRASIDONE IN HOSPITALIZED PATIENTS WITH SCHIZOPHRENIA: EVIDENCE FOR RAPID DOSE TITRATION

Bruce Parsons, Anil Jina, Ruoyong Yang, Antony Loebel

Background: Trials of ziprasidone in bipolar mania and schizophrenia suggest a target dose range of 120–160 mg/d and that rapid titration to this level provides maximum symptom improvement.

Aims: This pooled analysis explored the efficacy and tolerability of rapid titration to 120–160 mg/d of ziprasidone in the treatment of acute schizophrenia.

Methods: Data from two fixed-dose, placebo-controlled clinical studies of ziprasidone (rapidly titrated to the target dose of 40, 80, 120, or 160 mg/d) in patients with acute schizophrenia or schizoaffective disorder were pooled. A total of 369 patients received ziprasidone and 171 patients received placebo. Efficacy was assessed using the PANSS at 1 week and week 6 (LOCF end point) of treatment. Tolerability was assessed by discontinuations (all cause and due to AEs) at the relevant visits.

Results: This analysis demonstrated a significant linear relationship between ziprasidone dose and improvement in PANSS total score (F = 16.04, p ≤ 0.001) at week 1, as previously demonstrated at week 6. All ziprasidone doses produced statistically significant improvement in PANSS total score; the largest effect size was observed for the 160 mg/d group (0.52). At week 1 (LOCF), least-squares mean PANSS total score decreases from baseline were 6.2, 5.7, 7.8, and 9.0 for the 40, 80, 120, and 160 mg/d groups, respectively. The corresponding placebo decrease was 0.8. Tolerability of ziprasidone 160 mg/d was comparable to that of lower doses.

Conclusion: Rapid titration of ziprasidone to 160 mg/d was associated with greater efficacy compared to lower doses, and was well tolerated in these studies.

PP176 WEIGHT EFFECTS ASSOCIATED WITH ANTIPSYCHOTICS

Bruce Parsons, Antony Loebel, Kathryn Williams, Anil Jina, Cynthia Siu

Background: Available data on atypical antipsychotic-induced weight gain is limited by a number of methodological factors.

Aims: To evaluate short-term and long-term weight effects in patients receiving amisulpride, haloperidol, olanzapine, risperidone, ziprasidone, and placebo using randomized placebo-controlled, parallel-group studies from an integrated ziprasidone database.

Methods: Post-hoc analyses of weight change using well-defined treatment time windows to control for potential exposure bias. Weight change was compared across treatment groups using ANCOVA and chi-square test, with Tukey-Kramer correction for multiple comparisons. Weight gain, weight loss or no weight change was defined using a 7% threshold.

Results: During short-term (4–12 weeks) and long-term treatment (1 year: 330–390 days), weight gain for the ziprasidone (9% and 15%) and haloperidol (9.6% and 33%) groups was not significantly different from placebo (4.3% and 10%). In contrast, significantly greater weight gain was observed for olanzapine (48% and 53%) and risperidone (17% and 38%) groups compared to placebo. In the 1-year cohort (N = 470), median weight gain was significantly greater for olanzapine (+1.5 lb/month of treatment) and risperidone (+0.6 lb/month) compared to placebo (−0.3 lb/month) or ziprasidone (−0.2 lb/month) treatment. At 1 year, the proportion of subjects with weight loss was higher than those with weight gain for ziprasidone and placebo-treated subjects, a trend not observed in the other treatment groups.

Conclusions: This post-hoc analysis utilized stratification based on treatment days to evaluate exposure-adjusted weight effects across treatment groups. Our results confirm significant differences in weight effect among atypical antipsychotics, consistent with findings from the CATIE schizophrenia study.

PP177 EARLY ONSET OF ANTIPSYCHOTIC ACTION AND TIME COURSE IN THE TREATMENT OF ACUTE BIPOLAR MANIA

Bruce Parsons, Terence Ketter, Lewis Warrington, Antony Loebel, Anil Jina, Cynthia Siu

Background: Recent research indicates intramuscular ziprasidone produces a significant, early (within 24 hours) improvement in psychotic symptoms.

Aims: To evaluate the potential for an early antipsychotic response to oral ziprasidone in subjects with acute bipolar mania.

Methods: We conducted a pooled analysis of two 3-week, randomized, double-blind, placebo-controlled ziprasidone studies (40–160 mg/d) in hospitalized patients (N = 415) with bipolar I disorder, and a current manic (N = 257) or mixed episode (N = 158), with (N = 167) or without (N = 248) psychotic features. Efficacy assessments included the Mania Rating Scale (MRS, derived from the SADS-C), administered at baseline and Days 2, 4, 7, 14, and 21 (or early termination). Improvement in psychosis was evaluated by the SADS-C psychosis subscale (delusions, hallucinations, and suspiciousness). MMRM analysis was used to estimate the response time course.

Results: Significant improvement in the SADS-C psychosis subscale was observed in the ziprasidone group (versus placebo) as early as Day 4 (p < 0.05) in both the subgroup with psychotic symptoms at baseline and in all subjects. This early response in psychosis was significant after adjusting for improvement in agitation symptoms (non-mania related, assessed using the SADS-C agitation items) associated with ziprasidone treatment (p < 0.05). The magnitude of effect on improvement increased by visit (p < 0.05, Weeks 1, 2 and 3) with significant treatment-by-visit interaction (p < 0.05).

Conclusions: Ziprasidone is associated with a rapid onset of response in psychotic symptoms associated with acute bipolar mania. These findings support the hypothesis that onset of antipsychotic action can occur early in treatment, with the magnitude of response increasing over time.

PP178 LEPTIN IN DEPRESSED WOMEN: CROSS-SECTIONAL AND LONGITUDINAL DATA FROM AN EPIDEMIOLOGIC STUDY

Julie Pasco, Felice Jacka, Lana Williams, Margaret Henry, Geoffrey Nicholson, Mark Kotowicz, Michael Berk

Background: There is conflicting evidence regarding levels of leptin in depression.

Aim: In this study we aimed to investigate the relationship between serum leptin level and depression in a community sample of women using both cross-sectional and longitudinal data from the Geelong Osteoporosis Study.

Methods: From among 510 women aged 20–78 years, 83 were identified with a lifetime history of depressive disorder or dysthymia, ascertained using the Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition (SCID-I/NP). Serum leptin levels were measured by radioimmunoassay. Medication use and lifestyle were self-reported and body mass index (BMI) was determined from measures of height and weight.

Results: Using multiple linear regression, serum leptin levels were greater among women with a lifetime history of depression compared to women without any history of depression, independent of BMI. Adjusted geometric mean values of serum leptin were 16.37 (95%CI 14.70-18.23) ng/mL for depressed and 14.46 (95%CI 13.79-15.16) ng/mL for non-depressed women (P = 0.039). The hazard ratio (HR) for a de novo major depressive disorder over five years increased 2.56-fold for each standard deviation increase in log-transformed serum leptin among non-smokers and this was not explained by differences in BMI, medications or other lifestyle factors (HR = 2.56, 95%CI 1.52-4.30). No association was observed for smokers.

Conclusion: Women with a lifetime history of depression have elevated levels of serum leptin and elevated serum leptin predicts subsequent development of a depressive disorder.

PP179 IMPROVEMENT IN FUNCTIONING, WELL BEING, AND PAIN IN YOUNGER, MIDLIFE, AND OLDER WOMEN AND MEN WITH MAJOR DEPRESSION TREATED WITH DESVENLAFAXINE SUCCINATE

Albena Patroneva, Claudio Soares, Michael Thase, Susan Kornstein, Claudine Brisard, Lucia Septien-Velez, Jean-Michel Germain, Bruno Pitrosky, Brook Zitek, Qin Jiang

Background/aims: A pooled analysis of data from randomized controlled trials in depressed outpatients treated with desvenlafaxine succinate (DVS) or placebo was conducted to evaluate functioning, well being, and pain outcomes.

Methods: Data from the Sheehan Disability Scale (SDS), 5-item World Health Organization Well-Being Index (WHO-5), and Visual Analog Scale–Pain Intensity (VAS-PI) were pooled from 6 double-blind, placebo-controlled DVS clinical trials conducted in patients with major depressive disorder (MDD). Three age groups were analyzed for women: the 18–39 and >55 years of age groups were chosen as proxies for pre- and postmenopausal status; an intermediate group of 40–55 years (likely to include perimenopausal women) was also evaluated. Male patients were similarly grouped to differentiate effects of menopausal status from those related to age.

Results: Patients were randomized to receive double-blind treatment with DVS 100–400 mg (N = 1048; 18–39 years [n = 451]; 40–55 years [n = 457]; >55 [n = 140]) or placebo (N = 718; 18–39 years [n = 306]; 40–55 years [n = 310]; >55 [n = 102]) for 8 weeks. The final SDS, WHO-5, and VAS-PI overall pain change from baseline scores for the total population were significantly greater in the DVS group compared to the placebo group (P≈0.001). Mean differences from placebo on the SDS in women were as follows: 18–39: −2.1, 40–55: −2.1, >55: −3.2. Results were consistent across the age groups of men (18–39: −2.9, 40-55: −3.4, >55: +2.6). Results were similar with the WHO-5 and VAS-PI.

Conclusions: DVS effectively improves functioning, well being, and painful physical symptoms in depressed men and women across the age groups studied.

PP180 WEIGHT CHANGE DURING SHORT- AND LONG-TERM TREATMENT OF MAJOR DEPRESSIVE DISORDER WITH DESVENLAFAXINE SUCCINATE

Albena Patroneva, Brook Zitek, Philip Ninan, Karen Tourian, Claire Leurent, Jay Graepel, Saeed Ahmed

Background/aims: Patients receiving pharmacotherapy for psychiatric disorders have an increased risk of weight gain. This analysis characterized weight change with short- and longer-term treatment with desvenlafaxine succinate (DVS).

Methods: Data were pooled from 7 short-term, double-blind, placebo-controlled studies and 1 longer-term relapse prevention trial. In the short-term studies, adult outpatients with major depressive disorder (MDD) received DVS 100 mg/d-400 mg/d or placebo for 8 weeks. In the long-term study, responders to 12 weeks of open-label DVS treatment were randomized to double-blind treatment with DVS or placebo for 6 months. The incidence of potentially clinically important changes (±7% from baseline) and mean weight changes were analyzed.

Results: In the short-term studies (N = 2014 [DVS: n = 1211; placebo: n = 803]), small but statistically significant reductions from baseline in mean body weight were observed (–1.0 kg DVS vs +0.1 kg placebo; P≈0.001). Less than 1% of DVS-treated patients experienced potentially clinically important weight gain. There was no apparent indication of dose response for this effect. During the relapse prevention study (open-label n = 594; double-blind n = 375 [DVS: n = 190; placebo: n = 185]), small but statistically significant mean reductions from baseline (–0.8 kg) occurred in the 12-week open-label phase. Throughout the course of the 6-month relapse prevention period, small mean increases in weight were observed with both DVS and placebo. The weight change with DVS across the entire exposure period was comparable to placebo (<1 kg increase in each group).

Conclusions: In patients administered DVS in short and long-term treatment, enduring weight changes were not observed.

PP181 PHARMACOKINETICS OF VENLAFAXINE EXTENDED RELEASE AND DESVENLAFAXINE SUCCINATE IN EXTENSIVE AND POOR CYTOCHROME P450 2D6 METABOLIZERS

Albena Patroneva, Sheldon Preskorn, Alice Nichols, Heather Silman, Ron Pedersen, Jennifer Isler, Jeff Paul, Saeed Ahmed

Background: Genetic polymorphisms of the cytochrome P450 (CYP) 2D6 enzyme can affect the metabolism of antidepressants, which may lead to drug-drug interactions, impaired efficacy, and decreased tolerability. In contrast to venlafaxine, desvenlafaxine metabolism is not dependent on 2D6.

Aims: To evaluate the pharmacokinetics of single doses of venlafaxine extended release (XR) and desvenlafaxine succinate in healthy adults who are extensive (EMs) or poor (PMs) CYP2D6 metabolizers.

Methods: This was an open-label, crossover, study in subjects (19–36 years of age) receiving, in randomized sequence, single doses of venlafaxine XR 75 mg/d and desvenlafaxine succinate 100 mg/d. CYP2D6 genotyping was performed using 14 allele designations. Fourteen participants were enrolled (7 EMs, 7 PMs). Plasma drug levels were measured using validated liquid chromatography/tandem mass spectrometry. Genotype comparisons were calculated with ANOVA using logarithms of AUC and Cmax. The least squares geometric mean and 90% CI for AUC and Cmax were calculated.

Results: Following administration of venlafaxine ER, mean Cmax and AUC for venlafaxine were significantly greater in PMs compared to EMs (P < 0.001); conversely, mean Cmax and AUC of desvenlafaxine were significantly higher for EMs (P < 0.001). The mean Cmax and AUC of desvenlafaxine following administration of desvenlafaxine succinate were comparable between EMs and PMs.

Conclusions: Exposure to desvenlafaxine following administration desvenlafaxine succinate is not affected by CYP2D6 polymorphisms. This reduced pharmacokinetic variability would be expected to translate into more uniformity in response (both efficacy and tolerability) in comparison to antidepressants dependent on CYP2D6 metabolism.

PP182 CAREGIVER AND FAMILY BURDEN IN DEMENTIA PATIENTS

Manuela Pereira, Zaida Pires, Susana Mendes, Susana Fernandes, Margarida Lobo

Context: Families caring for a patient with dementia are prone to significant physical, psychological and social stress, and have been studied by several authors.

Nevertheless, the assessment of the major difficulties and needs are yet to be completely defined.

Objectives: The authors, using a Portuguese version if the “Family problem questionnaire” (FPQ), assess effects of the total burden of caregiving on a geriatric psychiatry consult in a districtal hospital.

These analyses will contribute to better assessment of the dementia patients and their caregivers, hopefully resulting in better support for them.

Key message: Family burden must be a major concern for mental health professionals.

Conclusions: Strategies as psychoeducation groups, family support groups and family therapy seem to be essential when dealing with family and caregivers of dementia patients.

PP183 LONG-TERM TREATMENT OF ALZHEIMER'S DISEASE. TOLERABILITY AND BODY WEIGHT

Vladimir Pidrman, Klara Latalova

Authors present results of a 1-year open follow-up of galantamine efficacy and tolerability in the outpatient treatment of Alzheimer's disease. Patients with the diagnosis of Alzheimer's disease without other serious disease, including hypertension, participated in the follow-up. Tolerability was evaluated based on the assessment of blood pressure, heart rate and body weight changes; spontaneous patient/caregiver complaints of adverse effects during the treatment were also recorded. Active questioning was used to look for anticipated adverse effects – headache, dizziness, fatigue, sleeping disturbances, GIT adverse symptoms. Evaluation of body weight between responders/nonresponders showed significantly higher number of patients with unaltered or increased body weight in the group of responders and significantly higher number of patients with weight loss in the group of non-responders. One year open follow-up confirmed good efficacy and tolerability of galantamine. The whole sample showed significant improvement. Difference between responders and non-responders was significant after the 6th month of therapy for both cognitive functioning and activities of daily life. According to our findings, examination in the 6th month has a predictive value. In the group of responders, there were significantly more patients who did not loose their weight. On the contrary, the significant majority of non-responders were loosing their weight. Adverse effects affected one fourth of patients, but did not require any pharmacological assistance or reduction of galantamine dosage. No patient had to be excluded as a result of adverse effects.

PP184 FIDELITY OF MODEL AND READMISSION OUTCOME OF ASSERTIVE COMMUNITY TREATMENT IN SINGAPORE

Weng Cheong Poon, Cheng Lee

Assertive Community Treatment (ACT) is a case management model that has a multi-disciplinary team and low caseload to support people with serious chronic mental illness. There is a list of criteria to fulfill the model (DACTS scale). The closer it is to the model, the more effective is the model.

In Singapore, ACT was started in 2003. The team comprises of a consultant psychiatrist, a medical doctor, a social worker, an occupational therapist and six community psychiatric nurses. The team provides island-wide services such as mental state examination, psychosocial rehabilitation and case management on a five-day workweek.

The study aimed to know the effectiveness of reducing the admission rates of all cases being accepted into ACT. The team also aimed to find out the level of fidelity to the DACTS.

The team recorded the readmission rates of all cases for the last one year before being accepted to ACT. One-year later, the readmission rates were compared to the previous year. Other measures were also used to capture improvement in quality of life, psychiatric status and daily functioning.

The team scored moderate fidelity to the model. The main differences were:

The team did not provide 24 hours services.

Each case manger held 40 cases.

The readmission rates were reduced. There were also improvements in psychiatric status, quality of life and daily functioning.

ACT was effective in reducing the readmission rates in a moderate fidelity model. Modifying the model to fit the local culture may not affect the effectiveness of the model.

PP185 IMPROVING MEDICAL OUTCOMES IN PATIENTS WITH BIPOLAR DISORDER: A RANDOMIZED, CONTROLLED TRIAL

Edward Post, Amy Kilbourne, Agnes Nossek, Larry Drill, Susan Cooley, Mark Bauer

Background: Bipolar disorder is highly disabling, and associated with disproportionate medical comorbidities such as cardiovascular disease (CVD) and suboptimal quality of care. Manual-based models such as the Chronic Care Model (CCM) can address CVD risk and may be cost-efficient in improving care.

Aims: We pilot-tested a medical CCM for bipolar disorder (“BCM”) and determined whether, compared to usual care, patients randomized to BCM had improved outcomes.

Methods: Patients (N = 60) with bipolar disorder and a CVD-related condition in a large VA mental health program were randomized to receive BCM or usual care. The BCM consisted of 1) self-management sessions based on the Bauer Life Goals program, focused on bipolar symptom control and modified to address diet/exercise habits and provider engagement, 2) telephone management to coordinate medical/psychiatric care, and 3) guideline dissemination focused on medical issues. Patients completed assessments at baseline, 3 and 6 months.

Results: Among participants (mean age = 55, 9% female, 9% African-American), 52% had > = 2 CVD-related conditions. Six-month outcomes revealed that changes in SF-12 physical health scores were greater for BCM than usual care (F = 2.01, p = 0.04). Overall patient satisfaction with BCM was high, and telephone contacts may have mitigated barriers to medical care (e.g., provider, transportation).

Conclusion: Patients with bipolar disorder are at medical risk because of alternating manic and depressive symptoms that lead to nonadherence, overeating, and sedentary behavior. The BCM may improve outcomes in CVD-related conditions, and is a promising model for psychiatric settings that cannot afford co-locating medical providers.

PP186 INHALANT ABUSE IN INDIA

Sanjeev Prasad

Context: Inhalant abuse in Street Children and other population in Delhi (India).

Objective: Pattern of use of Inhalants i.e. types of inhalants from the well known ones to the lesser known as camphor, rubificients, matchsticks, floor sanitisers, crackers.

Pattern of distribution as per Age, sex, education, economic status, alive parents. etc.

Factors responsible for maintaining drug taking behaviour as poverty, gang decorum, no social support, ignorance.

Key message: Vulnerable population street children, school children, call centre staff, clerical, menial workers. Chemicals used are innumerable, easily available, Damage is incalculable. Social awareness of such addictions is required. Need to be proactive to tackle this emergency.

Conclusion: This is a major problem which cannot be dealt by a single discipline. It requires a joint co-ordinated effort of Government bodies, NGOs, private sector, media, health care professionals- aimed at awareness generation, imparting treatment, training personnel in this field, making laws etc. for the marginalised (street children taking inhalant/drug) government can also have programmes to take them into main stream social life.

PP187 HIGH FREQUENCY rTMS OVER THE LEFT PREFRONTAL CORTEX LEADS TO THE REDUCTION OF NEGATIVE SYMPTOMS OF SCHIZOPHRENIA

Radovan Prikryl

Objective: To verify whether high–frequency rTMS over the left prefrontal cortex is able to modify the negative symptoms of schizophrenia.

Methods: Twenty-two schizophrenic patients on stable antipsychotic medication with prominent negative symptoms were included in the trial. They were divided into two groups: eleven of them were treated with effective rTMS and eleven with ineffective “sham” rTMS. Stimulation was applied to the left dorsolateral prefrontal cortex. The stimulation frequency was 10 Hz. Each patient received 15 rTMS sessions on 15 consecutive working days. Each daily session consisted of 15 applications of 10-second duration and 30-second intervals between sequences.

Results: During real rTMS treatment a statistical significant decrease of negative symptoms was determined (about 29% in negative subscale PANSS and 50% in SANS). No adverse events occurred during therapy except for a mild headache. In sham rTMS treatment a decrease of negative symptoms was also identified, but to a lesser extent than in real rTMS (about 7% in negative subscale PANSS and 13% in SANS). The change in SANS achieved statistical significance. Mutual comparison revealed a greater decrease of negative symptoms in favor of real rTMS in contrast to sham rTMS.

Conclusion: The augmentation of rTMS enabled patients to experience a significant decrease in the severity of the negative symptoms. The explanation for this can be seen in the ability of the rTMS to influence the pathophysiologic basis of negative symptoms in a different way than is achieved by antipsychotics.

Supported by the Ministry of Education Czech Republic (Project MSM 0021622404).

PP188 PATHOGENESIS OF DEPRESSION: COGNITIVE CONFLICT, LIMBIC IRRITABILITY AND NONLINEAR ANALYSIS

Jiri Raboch, Petr Bob, Marek Susta

Background: Stressful and conflicting experiences during childhood development, like child sexual abuse may result to defects in inhibitory functions. Its neurobiological consequences emerging as “limbic irritability” may be related to epileptic-like phenomena and may contribute to pathogenesis of depressive symptoms. It is also known that epileptiform activity seems to be related to specific nonlinear chaotic changes of the neural signal.

Aims: The aim of this study was to perform nonlinear analysis of autonomic responses assessed by psychophysiological measures during conflict related activation and compare the results with psychometric measures of limbic irritability.

Methods: Stroop word-colour test was used as an experimental approach to psychophysiological study of cognitive conflict in connection with heart rate variability assessment calculated as beat to beat R-R intervals (RRI). In nonlinear data analysis of RRI time series calculation of largest Lyapunov exponents (LLE) was performed in 35 patients (mean age 32.0) with depressive episode according to ICD 10. The results were then compared with limbic irritability measured by Limbic System Checklist (LSCL-33).

Results: Significant correlation (r = 0.62) between LLE and LSCL-33 indicates that a defect of neural inhibition during conflicting Stroop test characterized by LLE is closely related to limbic irritability.

Conclusions: These results might represent useful information regarding therapy of treatment resistant patients with depression.

PP189 POSTTRAUMATIC STRESS DISORDER: PREVALENCE AND RISK FACTORS AMONG BAM EARTHQUAKE SURVIVORS

Reza Radgoodarzi, Afarin Rahimi Movaghar, Ali Farhoudian, Vandad Sharifi, Mohammad-Reza Mohammadi, Masoud Younesian

Background: The city of Bam is located in south west Iran. On 26 December 2003, an earthquake (6.3 on the Richter scale) occurred in the city, which led to the death of 30000 and the injury of 50000 people.

Aims: The aims were to assess the prevalence of lifetime PTSD, current PTSD, PTSD related to the earthquake, and predictive factors of PTSD.

Methods: This study was carried out about eight months after the earthquake among survivors (>15 Y.O.). Desert sampling was used as the closest method to random sampling. Structured questionnaires were used to evaluate demographic characteristics, the experience of the trauma, stressful life events, social support, history of receiving psycho-social services, and drug abuse. CIDI (Version 2.1) was used to assess lifetime, current, and Bam earthquake related PTSD. Data were collected through face to face interview and analyzed using SPSS 11.5 and STATA 8 softwares.

Results: There was a prevalence of 59.1% lifetime PTSD, 51.9% current PTSD and 58% prevalence of PTSD related to the recent Bam earthquake. Being married (p = 0.006), having lost a spouse due to the earthquake (p = 0.009), being below the poverty line (before the earthquake) (p = 0.017), sustaining serious injuries in the earthquake (paresis, paralysis, or limb amputation) (p = 0.014), and feeling of receiving weak support from family and friends (p = 0.000), were predictors of PTSD related to the recent Bam earthquake in the multivariate logistic regression model.

Conclusion: These results are indicative of a bad prognosis for the course of this disorder and show the importance of early diagnosis of PTSD for psychological interventions.

PP190 EFFECTS OF WRITTEN EMOTIONAL EXPRESSION ON ANXIETY INDEX OF PATIENTS WITH MULTIPLE SCLEROSIS

Fatemeh Ranjbar Kouchaksaraei, Sepideh Herizchi Ghadim, Mohammad Zakaria Pezeshki, Mahnaz Talebi, Nosratollah Pourafkary, Alireza Farnam

Background: Multiple Sclerosis (MS) is an acquired chronic neurological disorder. Studies showed that prevalence of MS is more in some areas of Iran like as Azarbaijan and Isfahan. Psychological problems such as anxiety are prevalent in MS patients. Written Emotional Expression (WEE) is one of the cost-effective self helpers' methods that its efficacy has been studied on mental health, but this method is not studied on MS patients in Iran.

Aims: Aim of this study was to evaluate efficacy of WEE on anxiety index of MS patients.

Methods: With experimental study, 40 (8 male, 32 female) MS patients who completed informed written consent and filled General Health Questionnaire (GHQ) and Zung anxiety scale asked to write their negative feeling 30 minute daily for 4 consecutive days. After 15 days they filled GHQ and Zung anxiety scale again. Statistical analysis was done finally.

Results: Anxiety index was high in MS patients. After WEE anxiety index decreased in patients with moderate to severe anxiety disorder (p < 0.01) but in patients with mild anxiety, index increase significantly.

Conclusion: WEE may increase anxiety index in mild anxiety in MS patients, but effective in MS patients with moderate to severe anxiety.

PP191 PRAMIPEXOLE AUGMENTATION IN TREATMENT-RESISTANT DEPRESSION

Debashis Ray, Dipesh Bhagabati, Tindivanam Sudhir

Background: Various psychopharmacological agents are being advocated as being adjunctive treatments in refractory depression. The authors hypothesize that pramipexole would be effective in non-psychotic unipolar depression.

Aims: The study was conducted to determine the efficacy of pramipexole in treatment-resistant depression.

Method: 30 treatment-resistant depressed patients who had failed multiple previous antidepressant trials were administered pramipexole 1.5 mg/day in divided doses for 6 weeks. Depression and its response to pramipexole were assessed by Montgomery-Ashberg Depression Rating Scale before pramipexole l administration, and every week after introduction of pramipexole. Clinical Global Impressions-Improvement scores were also maintained.

Results: Nine patients dropped out of the treatment.36.66% (11/ 30) showed significant improvement. The improvement negatively correlated with Thase-Rush staging of treatment resistance. GAF scores also showed a significant improvement.

Conclusion: Pramipexole may be an effective agent in refractory depression in highly treatment-resistant patients who had failed multiple psychopharmacological trials.

PP192 MAJOR DEPRESSIVE DISORDER, SSRIs AND SERUM TESTOSTERONE

Debashis Ray

Context: SSRIs have been the first-line pharmacological options in primary care management of Major Depressive Disorder. However, issues like remission as a treatment goal, advent of SNRIs, trials with triple receptor antidepressants have been putting their efficacy into question.

Objectives: The present prospective study aimed to explore the relationship of the antidepressant efficacy of 2 established SSRIs, viz., fluoxetine and sertraline vis-a-vis the change in the serum testosterone level caused by them.

Key messages: Serum testosterone appeared to be an important predictor in the short-term and the long-term treatment response to fluoxetine but not to sertraline.

Conclusions: The possibility of a pharmacological heterogeneity in the “SSRI SPECTRUM” is discussed.

PP193 PRAMIPEXOLE IN ESSENTIAL TREMOR: A CASE REPORT

Debashis Ray

Context: Pramipexole is a dopamine agonist used in the treatment of bipolar depression, treatment-resistant depression and Parkinson's disease. The association of Parkinson's disease and Mood Disorders, essentially depressive disorders is well-established. The introduction of pramipexole becomes an interesting excuse to review the interface between PD and mood disorders.

Objectives: This paper was conceived retrospectively after pramipexole (PRAMIPEX: Symbiosis; INDIA) was found “serendipitiously” effective in a female patient of bipolar depression with essential tremors.

Key messages and conclusions: 1. The relationship between mood disorders and movement disorders is more pluralistic than is apparent now. 2. There maybe a commonality in the neropsychopharmacology between the two. 3. A greater exploration of the pharmacodynamics of pramipexole may improve our understanding of this neurocircuitry and neurochemistry.

PP194 DYSTONIA INDUCED BY RISPERIDONE LONG ACTING INJECTION

Debashis Ray

Atypical antipsychotics are the first-line treatments in various psychotic disorders due to low incidence of adverse effects. Risperidone Long Acting Injection (RLAI) is a depot neuroleptic with several unique characteristics viz., aqueous base, novel drug delivery system facilitating improved therapeutic efficacy.

An 18-year-old male patient is described who had acute dystonia and akathisia after two doses of Risperdal Consta. Extrapyramidal side-effects have rarely been reported with depot risperidone.

The implications are discussed.

PP195 RATING SCALE FOR SCHIZO-OBSESSIVE DISORDER

Debashis Ray, Partha Dutt

Context: Obsessive Compulsive symptoms (OCS), as suggested by literature, occur in 7.8–46% of patients with schizophrenia. There is a growing consensus of recognizing schizo-obsessive disorder as a separate diagnostic entity.

Objectives: The authors attempted to devise a rating instrument to diagnose schizo-obsessive disorder in 30 patients. The inter-rater reliability was tested by Kohen's kappa.

Key message: A valid and reliable rating scale for schizo-obsessive disorder is possible and feasible.

Conclusion: The demographics, results and implications are discussed.

PP196 A NEUROPSYCHIATRIC SEQUELAE OF TEMPORAL LOBE INFARCTION

Rosdinom Razali

Context: Herpes Simplex encephalitis causing temporal lode infarction can result in changes in intellectual functioning and personality.

Objective: This is a case report of a 41 year-old woman who developed an acute onset of cognitive impairment and behavioral changes following an upper respiratory tract infection. Patient developed fever, headaches and vomiting before becoming forgetful, confused and talking irrelevantly. Mental state assessment revealed presence of persecutory delusions, auditory and visual hallucinations, and marked cognitive impairment. Patient also had nominal and expressive aphasia, prosopagnosia, echolalia, difficulty with comprehension and memory impairment. Central nervous system examination, VDRL and virology studies were unremarkable. Lumbar puncture was not done as patient's family refused consent. Repeated neuropsychological assessments revealed evidence of dementia. She subsequently developed compulsive micturition and depression. EEG on admission did not reveal any abnormality but a repeat CT scan 4 months later revealed a left temporal lobe infarction, probably due to Herpes Simplex infection. Now, after 7 years later, her psychotic symptoms have improved but her cognitive impairment and depression have remained the same despite treatment.

Key message: It is important to rule out organic causes for acute onset of psychotic symptoms in patients with no prior psychiatric history.

Conclusion: Schizophrenic-like symptoms and cognitive changes are significant neuropsychiatric manifestations of temporal lobe infarction.

PP197 CLINICAL EVIDENCE THAT ASPERGER'S DISORDER IS A MILD FORM OF AUTISM

Edward Ritvo, Riva Ariella Ritvo, Donald Guthrie, Max Ritvo

Objective: To obtain clinical evidence to test the hypothesis that Asperger's Disorder (AD) is a mild form of autism (AU).

Method: A 78-item Likert scale (the RAADS) was administered to 25 AD and 19 AU adults (ages 18–65) to assess presence, type, and duration of symptoms.

Results: (a) AD and AU subjects have similar symptoms throughout adulthood (responses to 72 of 78 questions were not significantly different); (b) AD subjects had a significantly fewer total number of symptoms; (c) AD subjects reported non significantly fewer symptoms in the DSM-IV-TR domains of social interaction and repetitive patterns of behavior; and (d) AD subjects had significantly fewer symptoms in the communication domain.

Conclusions: The data support the hypothesis that AD is a mild form of AU, and the corollary hypothesis that they share a common etiology and developmental neuropathology. It appears warranted in future diagnostic manuals to incorporate AU and AD into one diagnostic category such as, “Autism Spectrum Disorder, (with modifiers, severe, moderate, mild, atypical and Asperger's type).”

PP198 DO CHINESE MEDICAL STUDENTS RECOGNISE DEPRESSION DIFFERENTLY FROM AUSTRALIAN MEDICAL STUDENTS?

Ye Rong, Ian Hickie, Georgina Luscombe, Morag Bell, Yueqin Huang

Background: Depression is one of the most common and disabling diseases in the Asia Pacific region. Most people with depression initially seek help from a non-psychiatric health professional, and only the minority of cases are recognised and treated properly. This is possibly associated with a lack of knowledge or sensitivity towards depression amongst health professionals.

Aims: To assess levels of knowledge about depression and identify any differences between medical students from different countries.

Methods: Medical students (>18 yrs) at The University of Sydney, Australia and The Peking University, China were invited to complete the International Depression Literacy Survey.

Results: 177 Australian and 220 Chinese students returned surveys. Significant differences were found between the groups in perceptions of the major health issues facing people in their countries, with 67% of Australian students recognising depression compared with only 14% of Chinese students. When students were asked to nominate signs or symptoms they believed to be typical of depression, the most frequently recognised by each group was feeling “sad, down and miserable” (66% of Australian and 72% of Chinese students), thinking “life is not worth living” was recognised by a significantly greater proportion of Chinese (53%) than Australian students (31%).

Conclusion: Although depression is the leading cause of disability in both Australia and China, it was rarely recognised as an important health issue among the Chinese medical students. The influence of curricula in psychiatry for medical students and level of emphasis on mental health in the two countries could partially explain these dissimilarities.

PP199 TEN-YEAR GHQ-28 FOLLOW-UP STUDY OF MENTAL HEALTH IN PATIENTS WITH THALIDOMIDE EMBRYOPATHY – IN THE CASE OF THE LIMB DEFORMITIES GROUP

Takamasa Saito, Mitsuyo Sato

Background: Thalidomide caused a worldwide epidemic of serious birth defects about forty-five years ago. It is currently approved for the treatment of complications of leprosy and under study for various other conditions.

Objective: The purpose of this study was to conduct a 10-year GHQ-28 follow-up study on the mental health of patients with thalidomide embryopathy in Japan.

Methods: The Japanese Ministry of Health and Welfare registered 309 thalidomide victims. Our initial survey in 1994 by mail used questionnaires including the GHQ-28, and was followed up in 2000, and 2005. The response rate was 57.4% with a mean age of 31.7 (SD: 1.1) in the initial survey, and 60.1%, 38.0 (SD: 1.0) and 59.7%, 42.5 (SD: 1.0) respectively in the follow-up studies. Eighty two victims responded successively three times. However, we analyzed only 69 subjects (male 30, female 39), the limb deformities group, because the other group was few in number.

Results: 1) There were significant differences in total GHQ scores among the respondents in 1994, 2000 and 2005. 2) According to the multiple-comparison test, there was a significant decrease over time in total GHQ scores between 1994 and 2000. But, there was no significant difference in total GHQ scores between 2000 and 2005. 3) There was a significant decrease over time in GHQ scores on the ‘somatic symptoms’ and ‘anxiety and insomnia’ subscales between 1994 and 2000.

Conclusions: These results suggested that respondents had better mental health conditions in their early forties than in their early thirties.

PP200 NURSES PERCEPTION OF PATIENT TEACHING, ENHANCING AND INHIBITING FACTORS ON PATIENT TEACHING

Asieh Salahshoorianfard, Leila Mardanian, Jaleh Mohammadaliha, Fatemeh Hosieni

Background: Patient education is a critical component of nursing roles and nurses engagement in patient education is effected by nurses perception of their role as educators, educational preparation and environmental and resource issues.

Objective: The Purpose of this study was to describe the nurses’ perception of patient education, inhibiting and enhancing factors on patient teaching.

Design: In a cross sectional study 259 nurses selected by stratified sampling method contributed, and all completed questionnaire as the data-gathering instrument.

Results: 95.8 percent of nurses perceived that patient education is an important part of every nurse's responsibility and 95 percent of them said that patient education is a top priority in their career. But they reported that the time consuming of nursing duties such as patient care, charting and administering medications, didn't leave enough time for patient teaching. The top three factors inhibiting patient teaching were staff, time and unavailability of resource material. The top three enhancers were designation of one or two nurses to do teaching, providing time for nurses to do so and develop more inclusive information guidance sheets to assist them in teaching a specific topic.

Conclusion: As the nurses reckoned patient education is a valuable part of their practice, but many factors impede this nursing function. Providing essential resources and in-service education enhance patient teaching. Also direct observation of nurses in clinical area, as they are engaged in patient education, is clearly needed. This will enable better understanding of the extant to which nurses are able to fulfil their professional mandate in providing perception teaching.

PP201 ST. JOHN'S WORT AND KAVA IN TREATING MAJOR DEPRESSIVE DISORDER WITH COMORBID ANXIETY

Jerome Sarris, David J. Kavanagh, Gary Deed, Kerry M. Bone

Background: St John's Wort (SJW) has similar efficacy to synthetic medication in managing major depressive disorder (MDD), with fewer adverse events. In treating anxiety, kava is the herbal medication with the greatest evidence of efficacy. As MDD often occurs with anxiety, management of their co-occurrence should be considered.

Aims: To conduct a 10-week, placebo-controlled, double-blind, crossover trial, testing the combined efficacy of SJW and kava, for treatment of MDD with comorbid anxiety.

Methods: After 2 weeks of placebo, participants received 4 weeks of placebo or SJW + kava, before a crossover of conditions for a further 4 weeks. Participants were English speakers with a confirmed diagnosis of MDD and significant levels of anxiety on standard self-report instruments, who responded to media advertisement or were referred by medical or herbal practitioners. Exclusions included a history of psychosis or bipolar disorder, recent suicidal ideation or substance misuse, poor liver function, previous non-response to SJW or kava, concurrent psychological or pharmacological management of depression or anxiety, and use of medications that may interact with SJW or kava. Effects on depression, anxiety and quality of life were assessed, as were treatment side-effects.

Results: The combined medications are expected to show superior effects on depression and anxiety at 6 weeks. By 10 weeks, participants receiving delayed herbal treatment are expected to show similar effects to those receiving early treatment. Results will be available for presentation at the congress.

Conclusion: Plans for further research, and for development of an integrated holistic treatment for MDD will be presented.

PP202 EDUCATIONAL EFFECTS OF NEW RESIDENCY PROGRAM IN JAPAN

Ryoko Sato, Takahiro Kato, Takami Suenaga, Daisuke Fujisawa, Kumi Uehara

Background: To detect mental disorders earlier, it is important that all future doctors are enlightened on and understand psychiatric problems. In 2006, new postgraduate residency program, which was focused onto primary care and with at least one-month mandatory psychiatric training, was implemented. However, training system was not structured and unified.

Aims: To investigate actual situation of new residency program and assess the residents' attitude towards the program or mental illness. This is a multi-center survey carried out throughout Japan by Japan Young Psychiatrists Organization (JYPO).

Methods: The participants were the residents who received mandatory psychiatry training during July 2005 to December 2005. A questionnaire asking attitude towards mental illness and asking of self-evaluation of psychiatric knowledge was handed out to the participants before and after the training.

Results: Twenty-six facilities joined the study. Two hundred forty-seven residents consisted of 154 men and 93 women participated. Most residents preferred to learn communication skills with patients, primary care of mental disorders, and psychopharmacology. In the question asking degree of anxiety for seeing patients with mental illness, 73% of the respondents answered that they became less anxious after the training. Residents tended to be unfamiliar with somatoform disorder, alcoholism, and anxiety disorder, even after the training.

Conclusion: The new program may change residents' attitude towards mental illnesses into more positive one. Improvement of teaching ways may be needed for future residents to gain more accurate knowledge about common mental disorders.

PP203 OVERVIEW OF ACUTE PHASE TREATMENT IN ZIKEI HOSPTAL

Soichiro Sato, Toshihiko Takeda, Hidenori Mori, Naofumi Nakamura

Background: In Japan, acute phase treatment for mental disorder at mental hospital had been reported not to be adequate in the use of agents.

However, the stream for adequate pharmacotherapy has changed the situation in some mental hospitals to use adequate pharmacological treatment.

We would like to report the current situation and the facing problems in Zikei hospital.

Method: All the newly admitted inpatients were diagnosed with SCID.

Those who were diagnosed schizophrenia were rated with PANSS.

Psychiatrists in outpatient clinic in our hospital set the choice of and the dose of agent independently.

We used the Zikei Algorism of Pharmacotherapy (ZAP) to treat schizophrenia.

Result: In our hospital, all the patients with schizophrenia have been treated with one antipsychotic agent and about 80% with novel antipsychotics.

And almost 80% of newly admitted inpatients had been discharged within 3 months.

Discussion: The treatment skills with novel antipsychotic agents in Japan have been developed remarkably. There is almost no difference in treating acute phase of schizophrenia compared with other developed countries.

By analyzing our data, we would like to consider the more effective ways of treating and preventing relapse of schizophrenia.

PP204 CLIENT SATISFACTION OF THE USERS OF CHILD AND ADOLESCENT PSYCHIATRIC UNIT

Yutaro Setoya, Kazuhiko Saito, Kyota Watanabe, Masaki Kodaira, Masahide Usami, Kyoko Yagishita, Akio Kiyota

Introduction: Research into outcomes of child and adolescent psychiatric inpatient treatment is scarce, especially in Japan. This longitudinal study investigated the client satisfaction of inpatient treatment and identified factors associated with that.

Method: Children admitted to a child and adolescent residential psychiatric unit (n = 90) were assessed at baseline and at discharge by three different classes of observers: the ward psychiatrist in charge of the child, the main caregiver of the child, and the child him/herself. Assessment questionnaires comprised measuring scales of psychiatric symptoms, quality of life, and family factors, and client satisfaction at discharge. Factors associated with changes client satisfaction were examined.

Results: Client satisfaction was high, and children rated their inpatient treatment as helpful. Client satisfaction was associated with the child's subjective assessment of functioning and with the helpfulness of a number of aspects of inpatient treatment, and with family factors.

PP205 EFFICACY AND SAFETY OF ADD-ON GINKGO BILOBA (GINKGO TD) TREATMENT FOR PTSD: RESULTS OF A 12-WEEK DOUBLE-BLIND PLACEBO-CONTROLLED STUDY

Jamal Shams, Shahrokh Sardar Pour Gudarzi, Ali Reza Noruzi, Behzad Ghorbani, Mohammad Taghi Yasami

Introduction: Exposures to traumatic stressors lead to activation of arousal responses mediated by the serotonergic and noradrenergic systems and to change in numerous neurotransmitters and neuroendocrine systems. There is ample experimental and clinical evidence to suggest Ginkgo biloba extract has neuroprotective and antioxidant properties and can restore stress-induced elevation in brain levels of catecholamines, 5-HT and plasma corticosterone to normal level.

Methods: In a 12-week, double-blind, placebo-controlled the efficacy and safety of adding-on a fixed-dose (200 mg) of Ginkgo TD to previous treatment regime in adults with PTSD were examined. Subjects were forty male and female outpatients from a governmental psychiatric clinic who met criteria for PTSD. Changes in five symptom domains including posttraumatic stress, anxiety and affective symptoms, general health and subjective stress after trauma were assessed at weeks 1, 12 and 16 to examine effectiveness of added-on Ginkgo TD and stability of its effects.

Results: Ginkgo TD was associated with a significantly greater improvement than placebo in PTSD patients, as measured by five symptom domain scales include GHQ-28, Watson PTSD Scale, HAM-D, HAM-A and IES. Four week after discontinuation of intervention the significant difference between two groups in five outcome measures did not resolve. There was not significant difference between two groups in side effects.

Conclusion: We found Ginkgo TD to be superior to placebo as an adding-on in the treatment of PTSD. Although we did not examine comparative efficacy of Ginkgo TD on three main elements of PTSD, beneficial effects both on specific PTSD symptomatology, and general conditions including anxiety, depression, general health and perceived stress were indicated.

PP206 EXPLORATORY CLINICAL STUDY OF ADULT ADHD FROM NORTHERN INDIA

Swapnil Sharma, Prabhat Sitholey, Vivek Agarwal

Objective: The authors sought to identify adult ADHD cases in a medical university in Northern India and elicit their phenomenology and comorbidities.

Method: 292 subjects from four different sources were screened on the Adult ADHD Self-Report Scale-v1.1 screener. Detailed evaluation was carried in 25 screen positive subjects who were then assessed for symptoms of ADHD using the ASRSv1.1 symptom checklist. Present and past comorbidities were assessed using WMH-CIDI. The DSM-IV-TR and the Wender-Utah criteria for adult ADHD were used to make the diagnosis of adult ADHD wherever possible.

Results: Patients of adult ADHD most commonly presented with complaints of loosing temper, poor academic performance, incomplete response to previous treatment, subjective difficulties in memory or concentration and problems of alcohol/drug use. Majority of the patients of adult ADHD had a comorbid Psychiatric illness. The most common ones were Oppositional defiant disorder, Major depressive disorder, Substance abuse/dependence, and social phobia.

Conclusions: The data from the current study suggests that adult ADHD can be diagnosed in an Indian academic department of psychiatry using standardized tools and diagnostic criteria. The clinical presentation of adult ADHD and the rates and patterns of the comorbid disorders in the current study were similar to those mentioned in the western literature. The patients of adult ADHD rarely presented with the core symptoms of the disorder and had high psychiatric comorbidity rates; hence, the correct diagnosis of the disorder requires the clinician to be alert and vigilant for any clues that point towards the disorder.

PP207 CORRELATES OF SLEEP-ONSET REM PERIODS DURING THE NOCTURNAL POLYSOMNOGRAPHY IN NARCOLEPSY

Yoon-Kyung Shin, Seung-Chul Hong, Jong-Hyun Jeong, Jin-Hee Han, Sung-Pil Lee

Introduction: There is a little study of that between nocturnal sleep and the characteristics of narcolepsy.

Aim: To investigate correlation between nocturnal REM latency of equal to or less than 20 minutes (nocturnal SOREMP) and other clinical and laboratory characteristics of narcolepsy.

Methods: We studied 72 narcoleptic patients who were diagnosed through revised International Classification of Sleep Disorders (ICSD-2). The subjects had clinical interviews, and underwent nocturnal polysomnography (NPSG) followed by multiple sleep latency test (MSLT), HLA typing for identifying the frequency of DQB1 allele and spinal tapping for measuring the level of cerebrospinal fluid hypocretin. The subjects were divided into two groups: one group with nocturnal SOREMP and another group without nocturnal SOREMP.

Results: The narcoleptic patients with nocturnal SOREMP had higher body mass index than those without nocturnal SOREMP. Sleep paralysis was observed more frequently in the narcoleptic patients with nocturnal SOREMP. Cataplexy was also observed more frequently in the narcoleptic patients with nocturnal SOREMP. The narcoleptic patients with nocturnal SOREMP had shorter sleep latency and higher percentage of REM sleep on both NPSG and MSLT. HLA-DQB1∗0602 allele and low concentration of hypocretin-1 were more frequently observed in the narcoleptic patients with nocturnal SOREMP.

Conclusions: SOREMP during nocturnal polysomnography is one of the characteristics of narcolepsy associated with HLA-DQB1∗0602 allele and low concentration of hypocretin-1, that is the genetic and neuroendocrine characteristics.

PP208 EFFECTS OF ASSERTIVE COMMUNITY TREATMENT ON FAMILIES OF PEOPLE WITH SEVERE MENTAL ILLNESS IN JAPAN – AN ANALYSIS OF SELF-REPORT QUESTIONNAIRE USING A QUASI-EXPERIMENTAL METHOD

Tamaki Sono, Masaaki Nishio, Yuriko Suzuki, Iwao Oshima, Hiroi Fukaya, Kentaro Horiuchi, Hikaru Ogawa, Fumie Hisanaga, Nobuyuki Niekawa, Juichiro Itou

Background: May 2003, ACT-J (Assertive Community Treatment Japan) project was launched at National Center of Neurology and Psychiatry Japan. In Japan, The rate of people with SMI (Severe Mental Illness) living with their family is high, family support should be an essential service element in Japan. But there are few preceding researches on family outcome of ACT, or systematic evaluation about relationship between outcome and process quantitatively.

Aims: The aims of this study is to investigate the Effects of ACT-J on families of people with SMI using measures of family-functions scale, identify the effective service elements, and to find the suggestions for implementation of ACT in Japan.

Methods: Using self-report questionnaire, quasi-experimental method was conducted. Intervention group were the families of people receiving ACT services, and comparison group were the members of the family association of the mentally ill. We evaluated family burden, cooperative behavior, and client satisfaction as an outcome index, and analyzed the process measures using computerized service log of ACT-J.

Results: Cooperative behaviors, family burden, anxiety about future were decreased in intervention group significantly. Direct services provided by ACT-J (“Symptom management” or “Support for Daily living”) increases the service satisfaction of family members. Environment arrangement services (“Employment support” or “Coordination of other recourses”) decreases Cooperative behavior, Family burden, and Anxiety about future.

Conclusion: ACT-J deceases family cooperative behaviors, anxiety about future, and family burden. This study indicates the importance of arrangement of the environment of clients and their family.

PP209 COMPOSITIONAL AND CONTEXTUAL EXPLANATIONS FOR CROSS-CULTURAL DIFFERENCES IN REPORTED DISABILITY AMONG OLDER PEOPLE IN LOW INCOME COUNTRIES

Renata Sousa, Martin Prince, Cleusa Ferri and 10/66 Dementia Reserch Group

There is a growing consensus regarding the need for more research into ageing in developing countries. The effect of the rapid demographic transition in the developing world is such that predictions show that by 2025 about three-quarters of the estimated 1200 million people aged 60 years and older will be living in these countries.

The aim was to compare the independent contribution of physical, mental and cognitive disorders to overall disability scores across a variety countries with different cultures included in the 10/66 population based studies.

A secondary data analysis of the 10/66 Dementia Research Group population-based surveys will be carried out. Eight developing countries were included with 2000 participants aged 65 years and over in each centre. An informant was also interviewed. Analysis showed here used a sub-sample of 9.000 participants. The 10/66 DRG included in its protocol the WHODAS II which measures functioning and disability.

Standardised WHODAS II scores can vary from 0 (non disabled) to 100 (maximum disability). In the 10/66 centres, mean WHODAS II disability scores were, generally low (ranging from 8.0 to 16.6) with the exception of rural India where the mean score was 26.9. When we divided the WHODAS II scores into quarters for better comprehension of the degrees of disability, rural India is the only centre with a high percentage in the most disabled quarter (the fourth).

Further analysis will be carried out to describe how compositional factors surrounding an elderly person's life can contribute to his/her level of disability and self-perceived health.

PP210 EFFECTS OF INITIAL SYMPTOM TRENDS ON OUTCOMES OF ACTIVE AND NON-ACTIVE TREATMENTS FOR MAJOR DEPRESSIVE DISORDER

C. Richard Spates, Sherry Pagoto, Kei Nakamura

Background: One question concerning efficacious treatments for Major Depressive Disorder (MDD) concerns the assignment of patients to maximize treatment effects. While initial severity has been chosen in some studies, this simple approach has proved only modestly successful.

Aims: The aim of this study was to examine another approach entailing initial symptom trends regardless of severity.

Methods: Data from four published and unpublished experimental investigations that addressed the treatment of MDD were combined and outcomes analyzed by initial symptom trends. Included in the analysis were studies that tested the effects of No treatment, Pill Placebo, Group Behavioral Activation treatment, Individual Behavioral Activation treatment, and Antidepressant Medications (N = 92). Each data-set included an early treatment period of repeated standardized assessments of symptoms, permitting a classification of patients based on whether symptoms were improving or worsening before intervention took effect. Common measures and criteria were used for classifying patients' initial trends and end state functioning.

Results: When these initial trends were taken into account outcomes were contrasted to the conclusions reached in the original reports. Results revealed that participants who were initially getting better, continued to get better regardless active treatments or placebo. Among those patients who were not improving, only Individual Behavioral Activation Therapy had a significant impact on patient end-state functioning over No Treatment/Placebo.

Conclusions: The application of this approach to clinical decision-making is both appropriate and timely in the age of evidence-based practice. Implications for further research and for differential assignment of patients to treatments are discussed.

PP211 CROSS-CULTURAL VALIDATION AND INTER-RATER RELIABILITY OF THE PERSONAL AND SOCIAL PERFORMANCE SCALE, THAI VERSION

Manit Srisurapanont, Suwanna Arunpongpaisal, Sunanta Chuntaruchikapong, Chatchawan Silpakit, Vira Khuangsirikul, Nipatt Karnjanathanalers, Umpaikanit Samanwongthai

Aims: To minimize the language and cultural barriers of this instrument, the authors proposed to cross-culturally validate and examine the inter-rater reliability of the Personal and Social Performance scale (PSP), Thai version (Thai-PSP).

Methods: The authors translated, back translated, and conducted a panel review on the source, translated, and back translated version of the PSP. After nine psychiatrists, who were new to the PSP or the Thai-PSP, had received a three-hour session of training, they jointly watched four tape-recorded interviews and used the Thai-PSP for independent rating of the patients’ functioning.

Results: The score ranges for items 1 (socially useful activities), 2 (personal/social relationships), and 3 (self-care) were between 0 (absent) and 4 (severe). The score range was between 0 (absent) and 3 (marked) for item 4 (disturbing /aggressive behavior). The total scores of four patients were rated between 2 (21–30 points) and 8 (81–90 points). The intraclass correlation coefficients (95% confidence intervals) of each item and total score were as follows: 0.63 (0.28–0.96) for item 1, 0.75 (0.42–0.98) for item 2, 0.69 (0.35–0.97) for item 3, 0.52 (0.17–0.94) for item 4, and 0.75 (0.41–0.98) for the total score.

Conclusion: The results of this study confirm the reliability of PSP and Thai-PSP, as well as the ease of training.

PP212 INHIBITORS OF CYCLOOXYGENASE-2 AND 12-LIPOXYGENASE PROTECT AGAINST AMYLOID BETA PEPTIDES EVOKED ALTERATION OF NITRIC OXIDE SIGNALING AND MEMORY IMPAIRMENT

Joanna Strosznajder, Magdalena Cakala

Context: Amyloid prekursor protein (APP) is processed into soluble APP and Aβ peptides. Oligomers of Aβ liberated in high amount in Alzheimer Disease (AD) lead to synaptosis and memory disturbances. However the molecular mechanism of AD is not fully understood.

Objectives: We have investigated the role of nitric oxide (NO) in Aβ evoked alteration of cyclooxygenases (COX) and lipoxygenases (LOX) in neurons and they involvement in Aβ (1–42) evoked memory impairment in mice. Moreover, the systemic inflammation on Aβ evoked disturbances has been evaluated.

Key message: Using PC12 control cells and transfected with APP we have demonstrated that Aβ enhances NO synthase activity and that NO by GMP/PKG is responsible for activation of phospholipase A2 (PLA2) and for enhancement of arachidonic acid and its metabolism by COX and LOX. This Aβ induced metabolic pathway is decreased by inhibitors of ? secretase, NOS and cPLA2. Inhibitor of COX-2 (NS-398) and 12-LOX (baicalein) protect also the cells against NF-kB translocation and death. Aβ enhanced COX-2 and also12-LOX protein level and decreased locomotion and memory in mice C57B16 injected (iv) with Aβ (1–42) alone or together with lipopolysaccharide (ip). Systemic inflammation elevated COX-2 protein in early stage and modulated behavioral disturbances depending on the time of administration.

Conclusion: The COX-2 and 12-LOX inhibitors protect neurons against death and mice against memory deficit and locomotor disturbances.

PP213 COMPARISON OF ANXIETY BETWEEN PRIMGRAVIDAS AND PREGNANT WOMEN WITH THE HISTORY OF PREVIOUS FETAL OR NEONATAL DEATH, VISITED IN MESHED UNIVERSITY HEATH CENTER IN YEAR 2006

Simin Taavoni, Mina Aahadie, Tahereh Ghanjie, Fatemeh Hoseinie

Pregnancy needs physiological and psychological coping but it is a normal phase of woman's life. The previous history of fetal or neonatal death can have a negative effect on this coping, and it can also increase anxiety during current pregnancy and produce irretrievable effects.

Aim: To assess and comprise anxiety in primgravidas and pregnant women with history of previous fetal or neonatal death.

Methods: A two group comparative design and nonrandomized sampling method (sequential) was used. We collected 120 Iranian pregnant women with a basic education, who were in 3 rd trimester of their planed current pregnancy (20–40 years old age).

40 of samples had previous history of fetal or neonatal death (without any live child) and 80 of them were prim gravidas. The tools, which was used for this study had two main parts: personal characteristic, and pregnancy outcome questionnaire (POQ of Theut et. al. 1988).

Results: In this study we only found significant difference in 8 of 15 statements of POQ between tow groups. The average of anxiety during pregnancy in the pregnant women with previous fetal or neonatal death was more than second group. The independent t-test also showed a significant difference between tow groups (p = 0/000).

Conclusion: Due to the increase of anxiety in pregnant women with previous history of fetal or neonatal death, it sounds it is necessary to plan supportive, educational and counseling program for the mentioned high risk group of women.

PP214 EFFECT AND EVALUATION OF A MENTAL HEALTH EDUCATION PROGRAM ON JUNIOR HIGH SCHOOL STUDENTS FOR EARLY INTERVENTION AND PREVENTION

Soichi Takamura, Iwao Oshima, Takuro Motonaga, Koji Yoshida, Michiko Fukuda, Shin-ichi Yoshioka, Tetsuaki Inamitsu, Natsume Kondo, Mitsuo Kuno, Toru Kurashima

Aims: Mental maladjustments have been frequently seen in junior high school students. However, adolescents tend not to seek help from parents or teachers because they have a poor understanding and a negative image of mental disorders. The aim of this study was to evaluate the effect of mental health education on their concept and behavior concerning mental health.

Subjects and methods: The education program was applied to three classes totaling 113 first-year students (12 or 13 years old) at a junior high school. The program consisted of 3 lectures and a visit to one of several psychiatric institutions. The subjects were randomly divided into 2 groups by class; an intervention group (n = 75) and a control group (n = 38).

Subjects of both groups were assessed before and after intervention using questionnaires based on the Attitudes towards Seeking Professional Psychological Help Scale (ASPH), the Hope of Consultation Attitudes Scale (HCAS), as well as scales of our design. We used ANOVA for statistical analysis.

Results: Knowledge of mental disorders and understanding of the need for consultation concerning mental problems increased significantly through education. Our own probability scale indicated that the effects of education on the capacity to sympathize and self-evaluation of mental disorder were small. The General Health Questionnaire (GHQ) indicated self-evaluation of mental health status was moderate. ASPH and HCAS indicated small to moderate effectiveness.

Conclusions: Our mental health education program was effective in increasing knowledge of mental disorder and help-seeking behavior in junior high school students.

PP215 STUDY OF ANXIETY, DEPRESSION AND NEGATIVE THOUGHTS IN PSYCHO-PHYSIOLOGICAL DISORDERS: TENSION HEADACHE AND HYPERTENSION

Sharad Man Tamrakar, Murari Regmi, Bharat Rawat, Naba Raj Koirala, Kishor Adhikari

Background: Influence of mind on the healthy biological functioning has always been acknowledged through out history. Particularly, some illnesses called psycho-physiological disorders have been alleged to be casually associated with stress, anxiety and depressive symptoms.

Aims: This study attempts to study the association between negative symptoms and two such disorders: Tension Headache and Hypertension.

Methods: This is an open study with 102 subjects divided into 3 legs: tension headache, hypertension, and healthy control. Scores on Beck Anxiety Inventory (BAI), Beck Depressive Inventory (BDI-II), and Inventory of Negative Thoughts (IONT) were compared among the groups. Correlation calculation was also performed between three psychometric scales.

Results: There was significantly higher frequency and intensity of anxiety and depressive symptoms and negative automatic thoughts in patients with tension headache and hypertension. There is significant clustering of anxiety and depressive symptoms with negative thoughts.

Conclusion: Stress symptoms may be causally related, or may be contributing as triggering or maintaining factors for the development of “Tension Headache” or “Hypertensive Disorders”. On the other hand, especially with tension headache, there is a possibility that conceptualization of Nepali patients that doctors trained in western/modern medicine would not entertain emotional symptoms, compel them to make somatic presentation for psychological distress.

PP216 USEFULNESS OF WOMEN'S OUTPATIENT CLINICS IN MENTAL HEALTH IN JAPAN

Hitomi Tatsuta, Hiromi Hosino, Mikiko Kamijo, Tomoko Akai, Mako Yoshida

The first Women's Outpatient Clinic in Japan was established in 2001. Currently, there are 356 such facilities, and five facilities were established by the Japan Labour Health and Welfare Organization.

Object: In order to estimate the usefulness of Women's Outpatient Clinic, the present study evaluated the rate and characteristics of patients with mental disorders.

Method: This study was carried out through a questionnaire survey of the patients who came to these five clinics between April 2005 and November 2006.

Result: The findings revealed are as follows. 1. The number of mental disorder patients was 204. (The total number of patients was 529.) 2. The rate of mental disorder patients, who had previously consulted other clinics, was 64.7%. 3. The most common reason a patient did not seek medical consultation was an unawareness of where to go, and the rate was 64.7%. 4. Seventy nine point four percent of patients with mental disorder felt that their physical illness was caused by stress. 5. There was little difference in satisfaction with Women's Outpatient Clinics between patients with mental disorder and others.

Conclusion: Women's Outpatient Clinics play an important part for patients with mental disorder in giving them the time to consult with a psychiatrist, because one third of patients who come to Women's Outpatient Clinic have mental disorders.

PP217 HOW IS PSYCHOLOGICAL DISTRESS ASSOCIATED WITH DISABILITY AND FELT NEEDS AMONG INTERNALLY DISPLACED PERSONS DURING AN ARMED CONFLICT IN NEPAL?

Suraj Bahadur Thapa, Edvard Hauff

Most internally displaced persons (IDPs) live in low-income countries experiencing a war; their psychosocial problems, needs and disability have not been studied well.

Aims: To make a comprehensive assessment of psychosocial problems, and correlate these problems with needs and disability among IDPs in Nepal.

Methods: A cross-sectional survey was conducted among 290 IDPs in Nepal in 2003. We used the Hopkins Symptom Checklist-25 (HSCL-25) to assess depression and anxiety symptoms, and the Posttraumatic Stress Disorder Checklist Civilian Version (PCL-C) to assess posttraumatic stress disorder (PTSD) symptoms. All these instruments were validated against local corresponding syndromes and Composite International Diagnostic Interviews (CIDI) diagnoses as well. We used the World Health Organizations Disability Assessment Schedule-12 (WHO DAS-12) and additional local items separately for men and women to assess disability symptoms, and a checklist to know about their needs.

Results: Almost everyone reported trauma and reported PTSD symptomatology. The rates of PTSD, anxiety and depression symptomatology were 53.4%, 80.7% and 80.3%, respectively where as the disability rate was 31.8% among IDPs. Different factors independently associated with anxiety, depression and PTSD symptomatology were identified. Female gender, depression and PTSD were independent factors associated with disability.

Conclusion: Given the higher rates of psychological distress and the lower disability and felt needs among IDPs in Nepal, it is not always sufficient to report merely the psychological distress or disorders without assessing the level of functioning and psychosocial needs.

PP218 ARIPIPRAZOLE FOR MALADAPTIVE BEHAVIOR IN MENTAL RETARDATION

Ahmet Tiryaki, Ebru Cengel Kultur, Esra Tasgın

Background: Atypical antipsychotics have been tried to treat aggression, hyperactivity, agitation, irritability, stereotypy and self-injurious behaviors in children and adolescents with mental retardation (MR), pervasive developmental disorders (PDD) and conduct disorder. Aripiprazole is a new psychotropic agent that possesses a unique pharmacologic profile. The drug demonstrates mixed dopamine and serotonin agonist-antagonist activity and has been labeled a third-generation antipsychotic and dopamine-serotonin system stabilizer.

Aims: We report on the use of aripiprazole in the treatment of maladaptive behaviors in three individuals with mental retardation.

Methods: Three adolescent (two was diagnosed as mental retardation and pervasive developmental disorder, one was diagnosed as mental retardation) received an open-label trial of aripiprazole (mean dosage, 6.7 mg/day; range, 5–10 mg/day). Drug response was evaluated by using Aberrant Behavior Checklist, Conners Parent Rating Scale and Clinical Global Impressions- Improvement Scale first month after treatment. Side effects were followed by UKU) Side Effect Rating Scale.

Results: Aripiprazole was well tolerated and effective in one of the cases and appears to be a safe and efficacious alternative in the management of patients with both intellectual disabilities and pervasive developmental disorders.

Conclusion: These results with aripiprazole in this difficult-to-treat population suggest that this medication warrants controlled studies of its effectiveness and safety.

PP219 PSYCHOLOGICAL DISTRESS IN BREAST CANCER PATIENTS

Ahmet Tiryaki, Evrim Ozkorumak, Filiz Civil, Melek Yavuz

Background: There is considerable evidence suggesting that patients suffer from substantial and long-term physical and psychological distress associated with breast cancer.

Aims: The aim of the study was to evaluate physical and psychological symptoms and their correlation during the phases of breast cancer.

Methods: Participants were recruited from the patients who were in treatment and in remission phases of breast cancer. In treatment group 41 and remission group 40 patients were interviewed. All the participants had been underwent unilateral mastectomy, chemotherapy and radiotherapy. Global psychological distress was examined by Brief Symptom Inventory. Additionally, Beck Depression and Anxiety Inventories, The Appraisal of Body Cathexis, Rosenberg Self-esteem Scale, Somatosensory Amplification Scale, State Trait Anger Scale, Attributions of Common Somatic Symptoms were used to assess related variables which might have an effect on the symptoms and EORTC QLQ-C30 for quality of life.

Results: Breast cancer patients have severe psychological symptoms like anxiety, anger, hostility, phobic anxiety and obsessive-compulsive symptoms during the treatment phase. At this stage of the disease somatic symptoms were more common along with a higher distortion in body appraisal. Patients in the treatment phase were using higher somatized and normalized attributions to their somatic symptoms. Irrespective of being in treatment or remission phases depression and anxiety symptoms were correlated with the level of anger, distorted body appraisal, attributions to somatic symptoms and quality of life.

Conclusion: These data would have implications in the future management of symptom control in breast cancer patients from a psychiatric point of view.

PP220 COGNITIVE DEFICIT IN ALCOHOLISM

Alexandru Tiugan, Claudia Radut

The etiopathogenic mechanism of alcohol consumption implies multiple neurotransmitters lines, bringing forward the paths for dopaminergic reward and the balance Gamma Amino-Butiric Acid and Glutamate. In time, acting on the dopaminergic receptors from the accumpen, putamen and palidum nuclei, by stimulating the dopaminergic discharge in the subcortical floor, the feed-back mechanism induces a cortical-subcortical disconectivity. This sets an imprint on cognition through the hypofrontality phenomena.

The activation of glutamate against the GABA makes a convergent contribution in inducing the cognitive deficit.

The modification of the balance between saturated and non-saturated fatty acids, induced by alcohol in the cell membrane, and the decrease of its fluidity, reduces the receptors functionality for the chemical mediator, stressing its deficit. The smaller the age for the beginning of alcohol consumption, the more frequent are the abstinence episodes and the greater the intensity of the psychological and somatic manifestation, the more frequent is the cognitive deficit.

The imagistic modifications (ventriculomegalic, the moderate cerebral atrophy and the modifications in the cerebral circulation dinamics are highlighted in the majority of these patients.

The above mentioned factors, in accordance with the imagistic elements, are predictive factors for the cognitive deficit and can direct the beginning of the neuro-protective therapy, eventually with cholino-mimetic substances.

PP221 SIGMUND FREUD'S PRACTICE AND PRESENT-DAY PSYCHOANALYSIS IN GERMAN-SPEAKING COUNTRIES

Christfried Toegel

The paper provides an overview of the quantitative side of the systematic records kept by Freud on his practice. He has left precise records of the duration, frequency and fees of analytic treatments.

These figures are compared with the treatment duration and frequency customary in present-day psychoanalytic practice.

1. In German-speaking countries psychoanalyses are considered long-lasting and highly frequent in cases where the patient sees an analyst four or five times a week over the span of several years or at least 300 therapy hours. However, such treatment is applied with less than 10% of patients.

Result: 8% of Freud's patients were treated longer than 300 hours, with a frequency of at least 4 hours weekly, i.e. hours there is absolutely no difference between today's treatment practice and that of Freud.

2. Recent research suggests a correlation between frequency and duration of treatment – highly frequent therapies lead to longer-lasting duration. How does this relate to Freud's practice? This question was tested by investigating the classic correlation coefficient (Pearson) between the total number of therapy hours and the number of hours per week.

Result: The test yielded a significant correlation between duration of treatment and frequency of Freud's patients (.58, p<.01).

Conclusion: Regarding frequency and duration and their relation there is no difference between Freud's psychoanalytic practice and present-day practice in German-speaking countries. That is highly interesting and points to fairly stable factors with respect to duration and frequency of treatment.

PP222 COMPARISON OF ATTITUDES OF PRIMARY CARE PHYSICIANS VERSUS MENTAL HEALTH PHYSICIANS IN SINGAPORE TOWARDS AT RISK MENTAL STATES

Phern Chern Tor, Hon Yee Lee

Objectives: To compare the attitudes of Singaporean primary care physicans vs psychiatrists/psychiatry trainees regarding the diagnosis and management of at risk mental states (ARMS)/the schizophrenia prodrome.

Methods: An anonymous survey containing a clinical vignette and questions related to the diagnosis and management of ARMS was sent out to all physicians in one (of two) government primary healthcare groups as well as all registered psychiatrists and psychiatry trainees in Singapore.

Results: For the psychiatrists and primary health care survey there was a response rate of 62.1% (87/140) and 72.3% (107/148) respectively. For the psychiatrists 44.8% vs. 43.7% diagnosed ARMS vs. psychosis respectively for the patient in the clinical vignette. Among primary care physicians the corresponding proportion was 54.2% vs 40.2%. The difference between the diagnosis choices of the two groups did not reach statistical significance. Among psychiatrists 74.4% (29/39) of respondents who diagnosed ARMS would treat the patient with active management. Of these 79.3% (25/29) would treat the patient with atypical antipsychotics and only 13.8% (4/29) would treat with typical antipsychotics. 100% of primary care physicians who diagnosed ARMS would refer the patient to a psychiatrist. 64.4% of psychiatrists felt that there was no consensus regarding the management of ARMS.

Conclusions: There is currently clinical equipoise with regards to both diagnosis and management of ARMS in Singapore. Primary care physicians may be more likely to diagnose psychosis vs ARMS when compared to psychiatrists. Most psychiatrists would manage ARMS actively rather than with watchful waiting. Atypical antipsychotics were most commonly used in active treatment.

PP223 BLOOD FLOW OF CAROTID ARTRIES IN SCHIZOPHRENIC PATIENTS

Shahin Toubaei, Alireza Rasekhi

Background: Based on new imaging, some results have led to the hypothesis, indicating left hemispheric dysfunction in schizophrenic patients,

One evidence of these hypotheses is similarity of some symptoms in schizophrenia, to those observed in patients with temporal lobe epilepsy. Association between some symptoms and abnormality of blood flow of particular brain regions is also demonstrated. Transcranial color Doppler sonography also showed significant blood flow velocity changes in schizophrenic patients.

Our study tried to clarify possible differences between carotid blood flow of each side, in symptom positive and symptom negative schizophrenic patients, as well as differences of blood flow between schizophrenic patients versus control cases.

Methods: 31 schizophrenic patients which had been selected randomly were divided in two separate groups of symptom positive (14 cases) and symptom negative (17 cases) patients, according to PANSS test. Then carotid color Doppler sonography was performed for them and for 32 control cases.

Velosities (PSV, DV) and Doppler indices (RL, PI) were measured to be compared statistically in patients and control cases.

Results: According to P-value <0.05 as level of significance in all comparisons, no evidence of any significant differences is seen between two sides of patients (positive symptoms and negative symptoms) as though between control cases and patients. No positive conclusion also derived based on sex interference.

Conclusion: So examination reveals no differences between carotid blood flows of two sides in schizophrenic patients (positive and negative symptom).

There are no differences between carotid blood flow of patients and control group, even when sex interfered as a variety.

PP224 USING THE TRIPARTITE MODEL OF DEPRESSION AND ANXIETY TO PREDICT HOSPITAL READMISSION AFTER CORONARY ARTERY BYPASS SURGERY

Phillip Tully, Robert Baker, Deborah Turnbull, Helen Winefield

Background: Negative emotions such as depression and anxiety increase the risk for adverse cardiac outcomes among patients undergoing coronary artery bypass surgery (CABG) to treat coronary artery disease (CAD).

Aims: To determine whether shared or unique depressive and anxiety symptoms are predictive CAD/CABG readmissions using the tripartite model of anxiety and depression as a theoretical framework.

Methods: The readmission outcomes of 226 CABG patients were analysed using Cox proportional hazard models in this study. Preoperative and postoperative self-reported distress on the Depression Anxiety and Stress Scale (DASS) was used to predict readmission using Clark and Watson's tripartite model (1991). The dependent variable was the time in days to the first readmission related to CAD or CABG procedure within 6 months of surgery.

Results: Postoperative depression was found to increase risk of CAD/CABG readmission in adjusted multivariate analyses, Risk Ratio = 2.87 (95% CI 1.22–6.77), p=.02.

Conclusion: When interpreted according to the tripartite model, unique depressive symptoms characterised by anhedonia, but neither non-specific negative affectivity nor anxiety, are associated with CAD or CABG related readmission. This suggests the tripartite model is a useful way of conceptualising negative emotion, and further highlights the need to continue to find interventions to treat depressive symptoms in patients undergoing CABG.

PP225 IDEAS OF PSYCHIATRIC TRAINING IN KANAGAWA, JAPAN

Kumi Uehara, Takahiro Kato, Naoki Hashimoto, Daisuke Fujisawa, Ryoko Sato, Yayoi Koizumi, Atsuo Nakagawa, Kanna Sugiura

Recently, the qualifications for Japanese psychiatrists are changing dramatically. In 2006, the Japanese Society of Psychiatry and Neurology started a new nationwide comprehensive training system for young psychiatrists and created a formal guideline for required knowledge and clinical skills. Japan Young Psychiatrists Organization (JYPO), with the support of Kanagawa Society of Psychiatry, has conducted surveys to identify opinions on psychiatric training in several areas and age groups. This survey is to determine the characteristics of psychiatrists in different situations.

Method: Self rating questionnaire sheets were mailed to 400 members of Kanagawa Society of Psychiatry in October 2006.

Result: There were 102 respondents (78 males and 24 females) from wide variety of age groups (19.2 practice years in average). Among respondents, 73.5% of psychiatrists, with fewer than 20 years in practice, had been trained in university hospitals within 3 years after graduation. A smaller number of psychiatrists with fewer than 12 years in practice are working in psychiatric hospitals in Kanagawa than Hokkaido (Kanagawa = 66%, Hokkaido = 84%). University departments benefit psychiatrists in different ways for each age group. There were several differences between Kanagawa and Hokkaido including rates of violence, job satisfaction and identities as psychiatrists.

Discussion: Concerning psychiatric training, experiences and attitude; different characteristics were identified depending on areas and generations. For the development of our training system, we need further research to identify the current situation and attitude of psychiatrists. JYPO is beneficial to identify ourselves and to broaden our minds.

PP226 DOES QUETIAPINE IMPROVE NEUROCOGNITIVE FUNCTIONS IN BORDERLINE PERSONALITY?

Frederique Van den Eynde, Vesile Senturk, Caroline Vogels, Cornelis van Heeringhen, Kurt Audenaert

Introduction: To date, there are no data available on the effect of antipsychotics on neurocognition in borderline personality disorder (BPD) patients.

Methods: BPD patients (DSM-IV-TR) were included in a 12-week open-label study with a flexible dose of quetiapine (100–800 mg). Patients had no antipsychotic treatment 8 weeks prior to the study, but a stable antidepressant (SSRI, NSRI) dose was allowed.

The following neuropsychological battery was administrated: Verbal Fluency (VF), Stroop Color Word Task (SCWT, card 2, 3 and 4), Trail Making Task (TMT, part A and B) and Tower of London (TOL).

Data were analysed with a linear mixed model, correcting for age, gender and education.

Results: Thirty-two (25 females; 7 males, mean age 28,4 years) completed the trial.

Patients’ performance improved significantly on the VF [phonological (16.4; SD 2.9; p≈0.001) and semantic (9.8; 1.7; p≈0.001) subtest]; on the SCWT [card 2 (−12.1; 2.1; p≈0.001), card 3 (−43.3; 7.8; p≈0.001) and card 4 (−47.6; 8.4; p≈0.001) and interference (−31.2; 7.2; p≈0.001)]; on the TMT [part A (−11.7; 2.1; p≈0.001), part B (−51.8; 9.2; p≈0.001) and time difference between part A and B (−40.1; 7.1; p≈0.001)], and on the TOL [total moves (−29.5; 5.2; p≈0.001) and total execution time (−87.9; 15.6; p≈0.001)].

Discussion: The results of our study show an important improvement in a broad range of neurocognitive functions in BPD patients treated with quetiapine. The limitations of the open-label study design should be taken into account. Further investigations are needed to confirm these results.

PP227 A COMPARATIVE STUDY OF NEGATIVE SYMPTOMS IN SCHIZOPHRENIA AND RECURRENT DEPRESSIVE DISORDER

Joe A. Varghese, Reni Rajan, John Mathai, K. Krishnamurthy

Historically, the study of negative symptoms in Schizophrenia has shown to be quite relevant in predicting the course and outcome of the illness. Since they are not specific to any one illness, it is worthwhile to see if certain negative symptoms are specific or occur more frequently in any one particular illness.

Objectives: To compare negative symptoms in Schizophrenia and Recurrent Depressive Disorder.

Method: This was a cross-sectional study conducted during the period Dec 2000 – Jan 2003 in Fr. Muller Medical College, India, which is a tertiary care university hospital. 60 consecutive patients diagnosed with Schizophrenia and Recurrent Depressive Disorder (ICD – 10 DCR) was chosen for the study. Patients were assessed on the Scale for Assessment of Negative Symptoms, and Positive and Negative Symptom Scale.

Results: Mean score on the PANSS was significantly higher in the Schizophrenia group (p=.001). Affective flattening was seen to be the only statistically significant negative symptom (p=.005).

Conclusions: This paper highlights the significant presence of negative symptoms in Depression as in Schizophrenia. It is important for clinicians to look for these symptoms as they could help to understand the chronic or refractory type of Depression better. A comprehensive management of Depression would include adopting strategies to address these deficits.

PP228 TELEPSYCHIATRY: USERS' PROFILE

Muthukrishnan Vedarethinam

Tele-psychiatric service was started in India in the year 2000.

Apollo Hospitals was the first among a very few others to have a large tele-networking facility. It has more than 78 telemedicine centers spread all over the sub continent including neighbouring countries. These are connected through one of the three alternative systems, namely: VSAT, ISDN and IP to the consultation centers. To-date, more than 20,000 telemedicine consultations have been done. One fifth of these were tele-psychiatric consultations.

The users are from distantly placed locations ranging from 300 Kilometers to 3,000 Kilometers. The users are mostly from middle aged, middle income group and have approached privately for higher specialty care. Men predominate over women.

Their motivation for getting followed up is very high. Majority of them are suffering either from anxiety disorders or mild to moderate depression.

Their follow up frequency ranges from three to six times in 1 year. They have high satisfaction in real time video conferencing follow up service and its cost effectiveness.

PP229 ETHNICITY AND ACCESS TO PSYCHOTHERAPY

Josep Vilanova

Background: Leicester is a city with a large ethnic minority population. There has been some anecdotal evidence of Psychotherapy being used less frequently by people from ethnic minorities but there have not been any clear data to demonstrate this.

Aims: The purpose of this survey is to compare the ethnicity of all the referrals to the Psychotherapeutic services in Leicester, UK, using the local Psychiatric Trust database, and compare them with the ethnicity of the whole of the referrals to the Trust and then to the ethnicity of the population in that area.

Methods: The database has been searched for the number of referrals to the three Psychotherapy services and to the trust as a whole, for all patients aged between 16 and 65, during the years 2004 and 2005. The local Population Census has been also searched. The resulting data has been analyzed using Pearson Chi-Square, the Likelihood-ratio Chi Square, Cramer's V and Goodman-Krustal tau.

Results: The data shows a statistically significant lower number of referrals for Psychotherapy for clients from Asian and Black ethnicities. Asian people form 12% of the population of the census and only 5% of the psychotherapy referrals are Asian. Blacks are 3.7% of the census and only 1.6% access to psychotherapy.

Conclusions: Now that a difference in the number of referrals has been detected a literature search is being done searching for different strategies to increase number of referrals for psychotherapy for people from ethnic minorities.

PP230 COMPREHENSIVE CARE PATH PLAN FOR THE TREATMENT OF PERSONS WITH BORDERLINE PERSONALITY DISORDER

Larisa Volman, Colleen Clairmont, Michelle Carroll, Judi Santone

St. Joseph's Healthcare, Hamilton has implemented a strategic plan to provide clients with borderline personality disorder (BPD) an empirically validated treatment across all service areas. These service areas include COAST (a crisis support team), Emergency Psychiatry Services, four acute inpatient mental health programs, and two outpatient clinics. The goal of this innovative service model was to improve quality of treatment delivery, shorten inpatient length of stay and emergency room visits for this population. This was accomplished by training staff in each service area, across both nursing and allied health staff in Dialectical Behaviour Therapy (DBT) as well as implementing a DBT model (i.e., groups and individual treatment) as appropriate to each service area. DBT was developed by Marsha Linehan as an outpatient treatment for BPD. Individuals with this diagnosis are considered to be some of the most difficult to treat clients. DBT has received considerable empirical support and is recognized to be best practice with this population. This presentation will highlight how DBT has been incorporated into each service modality and the steps outlined to ensure that each client receives the most appropriate treatment as they move from one service area to another.

PP231 NEED ADOPTED TRANSCULTURAL TRAINING IN SWEDEN

Henrik Wahlberg, Anne Johansson Olsson, Inger-Johanne Larsson

Sweden has become multicultural. 50 years ago Sweden was ethnically homogenous with one language and a St Claus for all. The share of the population with a foreign background has increased from 4% to 16%.

The County Council of Stockholm, in charge of all the health services for 2 million, has founded the Transcultural Center (TC) for postgraduate training and consultation of the staffs.

To adopt the training curricula to the needs of the staffs, 2 investigations were carried out, one targeting the Primary health care and the other one Psychiatry. Information was gathered from all professions through randomized telephone interviews using a structured form.

The need of Cultural competence is obvious. Many units use interpreters daily, written material translated to different languages is rare and 80% of the staff states that they need more knowledge about cultural aspects in their work.

All patients – also newly immigrated – are served by the units in the vicinity. Anyone of the staffs may receive a patient with a different cultural background. Thus all the staffs require cultural competence focused on practical knowledge and clinical skills.

The staff, who themselves have a different cultural background, was frequently assigned to patients from other cultures. They were perceived as “experts on cultures” just because of their own different background.

There is a huge need for training – not always recognized – in transcultural issues to ensure high quality services for all. The investigations will lead to a reformulation of the TC's training curricula.

PP232 CURRENT STATUS OF FOREIGN PATIENTS IN OKAYAMA PREFECTURE WHERE IS THE COUNTRYSIDE OF WESTERN JAPAN

Yosuke Wake, Soichiro Sato, Masaru Onishi, Shigetoshi Kuroda

The vast majority of foreigners in Japan live in big cities such as Tokyo and Osaka. Presently, approximately 370,000 foreign residents live in Tokyo. Since 1986, a group of Asian nationals (mainly from the Philippines) have settled in the agricultural areas of northern Japan such as Yamagata prefecture, to marry, to work and so on. In these areas, many psychiatrists have been interested in cross-cultural psychiatry since the late 1980′s. However, most psychiatrists living in the countryside of western Japan, such as Okayama prefecture, have had very limited contact with foreign patients because the foreign population was quite small. And, psychiatrists living in countryside of western Japan might have not been interested in transcultural psychiatry until preceding period of 1990′s. Recently, the number of foreign residents has been increasing even at Okayama, and the need for cross-cultural perspectives is more apparent in Okayama. At this congress, I will present some data about foreign residents living in Okayama (countryside of western Japan) and introduce four cases of typical foreign patients who had some psychiatrical and cross-cultural problems to discuss cross-cultural psychiatry via situation at the Okayama prefecture in Japan.

PP233 OUTPATIENT ANXIETY MANAGEMENT PROGRAMS IN THE TREATMENT OF VETERANS WITH CHRONIC POST-TRAUMATIC STRESS DISORDER

Klaire Wallace, Tanya Uren, Tony McHugh

Context: In addition to the symptoms of hyperarousal and avoidance that characterise a diagnosis of post-traumatic stress disorder (PTSD), veterans with chronic PTSD also experience high rates of co-morbid anxiety disorders, such as panic, and social phobia. However, it has been observed that current CBT-based treatment modalities, which frequently include exposure tasks and the processing of traumatic memories, may not adequately address the complex and diverse range of anxiety symptoms experienced by veterans.

Objectives: The primary goal of the study was to evaluate the benefits of a ten-week outpatient Anxiety Management Program on measures of anxiety, and core PTSD symptoms, in a sample of veterans with chronic PTSD. A secondary goal of the study was to explore the effect of program participation on levels of co-morbid depression and alcohol use.

Outcomes: In a sample of 20 veterans with chronic PTSD, a comparison of pre- and end-program measures revealed a significant reduction in core PTSD symptoms, depression, alcohol use, and state and trait anxiety. The major outcomes were a significant reduction in total PTSD symptoms, as measured by the PCL (pre-program M = 66.25, end-program M = 57.90: p=.001), and trait anxiety (pre-program M = 60.74, end-program M = 52.75: p≈.001).

Conclusion: Despite the small sample size, and absence of available longer term follow-up measures, it is suggested that an intervention strategy targeted towards the management of anxiety may result in specific short-term benefits for veterans with chronic PTSD.

PP234 TARGETING THE PSYCHO-SOCIAL NEEDS OF VETERANS WITH TREATMENT REFRACTORY CHRONIC POST-TRAUMATIC STRESS DISORDER

Klaire Wallace, Anne Linsten, Boyce Felstead, Simon Howard

Context: The aim of ‘First Generation’ treatment programs for veterans with post-traumatic stress disorder (PTSD) is to address and process the core symptoms of PTSD. However, among war veterans, the prevalence of treatment-resistant PTSD has led to an interest in ‘Second Generation’ programs, which focus primarily on improving the quality of life of clients with multiple clinical needs. In light of the need for psycho-social skills training in veterans with PTSD, Austin Health's Veterans’ Psychiatry Unit (VPU) developed an outpatient Rehabilitation Program, which aims to assist in the development of life skills, and reintegrate the veteran into wider familial and social networks. The program is of 12 months duration, involving initially weekly, then fortnightly, two hour skills-based sessions.

Objectives: The aim of the study was to investigate the effectiveness of the Rehabilitation Program in reducing PTSD-specific and co-morbid symptomatology.

Outcomes: Outcome data reveal that levels of depression, anger, and PTSD symptomatology were significantly reduced among program participants (N = 78). The major outcomes were a reduction in core PTSD symptoms, as measured by the PCL (pre-program M = 58.98, end-program M = 54.76: p<.001), and depression, as measured by the BDI (pre-program M = 29.18, end-program M = 24.02: p≈.001).

Conclusion: It is suggested that participation in an outpatient program that is directed towards the development of life skills, rather than trauma-focused symptomatology, would appear to have a significant, though modest, impact on a range of trauma-related and co-morbid symptoms among veterans with chronic PTSD.

PP235 TREATMENT SITE IN POST-TRAUMATIC STRESS DISORDER TREATMENT PROGRAM OUTCOMES

Klaire Wallace, Catherine Cox, Anthony McHugh

Context: Austin Health's Veterans’ Psychiatry Unit (VPU) offers both on-site and community-based treatment programs for veterans with post-traumatic stress disorder (PTSD). While program content is essentially the same, the on-site program involves an intensive residential treatment phase, while the veteran lives at home throughout the course of the community-based program.

Objectives: Given the increasing promotion of community-based treatment for PTSD, the aim of the study was to conduct a preliminary investigation of the role of treatment site in program efficacy, and long term treatment outcomes.

Outcomes: In a comparison of baseline measures by treatment site, it was found that the on-site treatment group (N = 285) scored significantly higher on measures of PTSD than the community sample (N = 37) (p<.001). The two groups did not differ in measures of alcohol use (p=.394). Despite such differences, a comparison of nine month post-program outcome data revealed that neither PCL-M (p=.103), nor AUDIT (p=.981) scores varied with treatment site. In a repeated measures analysis, there was a significant main effect of both time and group across a linear combination of the two variables. However, further analysis revealed that such changes were primarily due to the change in PCL-M score over time, and the difference in PCL-M score changes between groups.

Conclusions: Results support the effectiveness of both on-site and community programs, while also suggesting that veterans who demonstrate more severe symptoms benefit from receiving treatment on-site.

PP236 MAJOR DEPRESSION AND MORPHOLOGY OF MESIAL TEMPORAL STRUCTURES IN TEMPORAL LOBE EPILEPSY?

Klaire Wallace, Regula Briellmann, Graeme Jackson

Purpose: Refractory temporal lobe epilepsy (TLE) is often associated with mood disorders. We investigate the morphology of mesial temporal structures in TLE patients with and without major depression.

Methods: We identified 47 TLE patients that had detailed psychiatric assessment and a 3T MRI as part of pre-surgical epilepsy investigations between 1/2003 and 10/2004. Current or past major depression, and presence or absence of hippocampal sclerosis (HS) was noted. MRI comprised of a 3D T1-weighted sequence and whole brain T2-relaxometry. Manual measurement of bilateral hippocampal and amygdaloid volumes and T2-relaxation times were performed blinded to the depression status.

Results: Major depression (current or past) was more frequent in HS (53% of 32 patients) than in other TLE (20% of 15 patients, p = 0.03, Chi square). There was no difference between depressed and not depressed HS patients in the hippocampal and amygdaloid volumes. However, HS patients with current or past major depression had normal contralateral amygdaloid signal (contra 95±10 msec), whereas not depressed HS patients had bilaterally increased amygdaloid signal (contra 103±8, p = 0.02). HS patients with current depression had relatively less signal change in the ipsilateral hippocampus, and ipsilateral and contralateral amygdala (depressed 91±11; not depressed 103±8, p = 0.01).

Conclusion: Major depression is particularly frequent in HS. Volume deficit is attributed to neuron cell loss, whereas signal increase to gliosis. Our results suggest that depressed HS patients have less severe gliosis in the mesial temporal structures. The integrity of the contralateral amygdala may be important for the development of major depression.

PP237 POLYMORPHISM OF GLUTAMATE N-METHYL-D-ASPARTATE RECEPTOR SUBUNIT 2B IN METHAMPHETAMINE DEPENDENCE

Paritat Watiktinkorn, Rachanee Chanasong, Samur Thanoi, Paritat Watilktinkorn, Sutisa Nudmamud-Thanoi

Background: Glutamate N-methyl-D-aspartate receptor 2B (NMDAR2B) is a subunit of NMDA receptors. Polymorphism of NMDAR2B gene has been demonstrated in patients of schizophrenia, Alzheimer's disease, Parkinson's disease, and alcoholic dependence.

Aims: To investigate NMDAR2B polymorphism in METH dependence and its association with symptom of METH dependence.

Methods: The subjects in this study comprised of 50 male METH dependence, with dependent symptoms according to DSM IV criteria, and 50 controls which matched sex and age. The genotypic study of NMDAR2B gene was carried out by PCR from dried- blood samples collected with FTA cards, followed by a restriction fragment length polymorphism (RFLP) analysis of the amplified products. Association of genotype frequencies and allele frequencies between addicts and controls were then analyzed using Fischer's exact test.

Results: The genotype frequency of NMDAR2B gene and allele frequency between control and METH dependence were significantly different (P < 0.05); allele T presence to T absence of control group and METH dependence were 0.63:0.37 and 0.58: 0.42 respectively. In details, statistical differences were also found between control and METH dependence with withdrawal, excessive use or prolonged use greater than was intended manifestation, and reduced social activity manifestation (P < 0.05).

Conclusion: The polymorphism of NMDAR2B might have been associated with METH dependence. The observed difference in T allele between control and METH dependence might play a role in genetic susceptibility to METH dependence. Further study with larger sample size, and female group are needed.

PP238 THE MEDICINE AWARENESS PROJECT

Kathryn Weedon

This presentation will highlight the preliminary results from a consumer led research project called the Medicine Awareness Project (MAP).

The Medicine Awareness Project was funded in 2006 by a Victorian Department of Human Services Mental Health Fellowship grant. This project has been investigating and exploring barriers that might prevent people with serious mental illness from obtaining comprehensive information about their medicines.

A lack of medication information has been identified as a known problem area in the recently released “National safety priorities in mental health: a national plan for reducing harm” (National Mental Health Working Group, 2005).

Three groups of people – consumers, psychiatrists and community pharmacists (local chemists) – were surveyed about their attitudes and behaviours around seeking or providing comprehensive information about the medicines used to treat serious mental illness.

Early results suggest that while having similar medicine information needs as other health consumers, people with serious mental illness face some unique barriers to obtaining the information they want about their medicines.

With a commitment to building better mental health through promoting empowerment, the voices and experiences of the consumers surveyed will be highlighted in this paper.

PP239 NEUROIMAGING OF EARLY AND CHRONIC PSYCHOSIS LINKS MENTAL HEALTH WITH PHYSICAL HEALTH LIFESTYLE AND WELLBEING

Michael Wong

Context: Volumetric analysis of MRI brain images allows analysis of psychoses at different stages with different symptoms.

Objectives: Using these findings as the starting point hypotheses that involve genetic risk, psychological and physical development, at risk behaviour, nutritional style and various neurobiological mechanisms are examined.

Key messages: Volumetric analysis of MRI brain images in psychoses at different stages with different symptoms shows various structural profiles-Bilateral reduction in hippocampal volume is noted in chronic schizophrenia. Unilateral reduction in hippocampal volume is observed in first episode schizophrenia. First episode non-schizophrenia psychosis characterised with affective symptoms is associated with increase in amygdala volume. No measurable volume changes are observed in subjects with ultra-high risk in developing psychosis.

These brain changes have been shown by various studies to be associated with cognitive impairment, psychotic symptoms, social disabilities, genetics, neurodevelopmentand neurochemistry.

Conclusion: It is argued that mental health is not different from physical health in its nature and deserves equal attention and support from service and research. Active health education and promotion program, user-friendly pathways of referral and assessment and proactive clinical protocols of early detection and intervention will reduce disability and promote wellbeing.

PP240 CLINICAL CHARACTERISTICS AND OUTCOME OF ACUTE CLOZAPINE INTOXICATION IN CHINA

Yu-Tao Xiang, Jia-Li He, Gabor Sandor Ungvari

Background and aims: No systematic study has focused on the characteristics and outcome of acute clozapine intoxication even though clozapine is the most widely used antipsychotic agent in China. The study reported herein examined the features of clozapine intoxication and its management.

Methods: In a retrospective chart review the notes of 47 patients who attempted suicide by ingesting large amounts of clozapine and were treated at the only psychiatric emergency service in Beijing were analyzed. Of the 20 unconscious patients with plasma clozapine concentrations of more than 2000 ng/ml, 14 received a combination of hemoperfusion (HP) and symptomatic treatment, while the other six and the remaining 27 patients received only symptomatic treatment. Patients’ psychiatric conditions and both plasma clozapine and norclozapine concentrations were closely monitored and registered.

Results: One patient died of pulmonary edema and subsequent heart failure, but the rest of the patients recovered without any sequelae. Patients who received HP regained consciousness significantly faster than their counterparts who presented with the same severity of intoxication in the non-HP group.

Conclusion: A combination of HP and symptomatic treatment is the best therapeutic option when plasma clozapine concentration is high.

PP241 ADJUSTMENT DISORDERS IN PSYCHIATRIC LIAISON SERVICES

Kenji Yamamoto, Shingo Miyaji, Shunya Hoshino, Yoshiro Sakai, Hiroaki Yamamoto Michiko Kamiya, Yumi Iwamitsu, Hitoshi Miyaoka

Background: The Psychiatric Liaison Service (PLS) in the Kitasato University Hospital was established in 1971, and more than 500 patients have been referred to the PLS in each year. Those patients had a high tendency to have F0 (Organic including symptomatic, mental disorders) and/or F4 (Neurotic, stress-related and somatoform disorders) based on the ICD-10 criteria, and the adjustment disorder was the most frequent diagnosis in the F4 category.

Aims: The aim of this study was to explore the clinical aspects and outcomes of patients with adjustment disorder referred to the PLS.

Methods: Medical records of one hundred eighty-four patients with adjustment disorder, who had been admitted to the Kitasato University Hospital between the year of 2001 and 2005, were analyzed (i.e. age of admission to hospital, sex, age of onset, physical illness etc.). Additionally, the outcomes of patients at one year after the first contact with PLS psychiatrists were examined.

Results: The mean age of the onset was 51.8 (16.8 SD), and 57.5% of patients were the years of 40s to 60s. The proportion of male was 52.5% and the prevalence of cancer was 42.5%. Within a year, more than 30% of cases presented either changed or added new psychiatric diagnoses. The majority of changed or added diagnoses were delirium and mood disorders.

Discussion: These results suggested that we should be cautious to make diagnosis, because mental condition of the patient with physical diseases may easily fluctuate depending on the prognosis of the disease.

PP242 SEVEN SLEEPERS: A FOLIE A DEUX CASE THAT WAS ORIGINATED FROM A RELIGIONAL-CULTURAL BELIEF

Menekse Sıla Yazar, Evrim Erbek, Latif Alpkan, Nezih Eradamlar, Erdogan Ozmen

Context: Folie a deux is a rare psychiatric syndrome in which a symptom of psychosis, mostly a delusional belief, is shared by two or more than two people.

Objective: In this manuscript, we presented a folie a deux case which had been originated from a religious-cultural belief, related with a married couple. They socially isolated themselves and their children by excluding all their relatives and friends which was resulted in confinement in a room. The husband said that they retired to a room in their relative's house after they randomly opened the Koran and read Sure 18 which was about seven sleepers who retired to a cave in order to protect themselves from the enemies. After few months relatives entered the room without their permission because the couple had not left the room for two weeks and they recognized a stinky odour. The wife was found pregnant and dead and children were malnutrioned. The husband said that his wife was being tested and would revive again in order to give birth.

The wife had no psychiatric history and the husband only had an episode three years ago that had been characterized by auditory hallucination and delusion of persecution. He presented total remission with neuroleptic treatment.

Key messages and conclusion: Seven sleepers is a myth in various Middle East cultures and a religious event that appeared in Koran and Bible. This is a unique folie a deux case as it contains both a delusion originated from a myth and a forensic event.

PP243 AGENESIS OF CORPUS CALLOSUM, COLPOCEPHALY AND LATE ONSET SCHIZOPHRENIA WITH FIRST-EPISODE

Menekse Sıla Yazar, Hülya Akar, Erdogan Özmen, Latif Alpkan, Nezih Eradamlar

Context: The role of structural abnormalities in the etiology of schizophrenia is a popular study subject. The relationship between schizophrenia and structural and functional abnormalities of corpus callosum (CC) which is the most functional connection structure between two brain hemispheres were reported by several authors. The common characteristics of these psychotic disorders are dominance of positive symptoms, absence of EEG pathologies, borderline IQ, normal connection test results, and the presence of other concomitant abnormalities.

Objective: The case illustrates the relationship between developmental abnormalities of CC and psychotic disorders.

A 57-year old male admitted with auditory hallucination, grandiose and mystic delusion, delusion of persecution, bizarre delusion, and delusion of reference which started suddenly two years ago. Limited affect and loosening associations were presented. There was nothing specific in his psychiatric records. No pathologies were observed during the neurological examination. Agenesis of Corpus Callosum and colpocephaly were observed in cranial MRI of the patient with schizophrenia. He presented total remission of positive symptoms with neuroleptic treatment.

Key messages: Determining the presence of structural abnormalities belonged to basic cerebral structures makes an important contribution to understand the etiopathology of schizophrenia. The relationship between developmental abnormalities of CC and psychotic disorders could not be accepted as causal but at least the presence of structural abnormalities in a small group of patients with schizophrenia could be related with the process of the disease.

Conclusion: We discussed this case in order to clarify the late onset schizophrenia which accompanied with structural abnormality and contribute the better understanding of this probable relationship.

PP244 AN EFFECTIVE ARIPIPRAZOLE TREATMENT IN A CASE WITH TOURETTE SYNDROME

Menekse Sıla Yazar, Emre Tan, Latif Alpkan, Nezih Eradamlar

Context: Gille de la Tourette Syndrome (GTS) is a chronic, familial disorder, characterized by involuntary motor and vocal tics that wax and wane in severity. GTS is frequently accompanied by behavioral, emotional and cognitive problems. The treatment of the GTS is often challenging.

Objective: The case illustrates that a new neuroleptic, aripiprazole, may be an effective treatment for the motor and vocal tics of Tourette syndrome.

Our patient is a 27 year old man GTS patient whose disorder began when he was 5 years-old charachterized by typically vocal and motor tics. He was admitted to our outpatient clinic with vocal and motor tics charachterized by explosive shouting and arm movement which exaggareted in clastrophobic situations. He had neuroleptic treatments with typical and atypical neuroleptics (haloperidol, sülpiride, pimozide and risperidone) and hospitalizations for several times before his admission. All of these treatments were ineffective. We began to use aripiprazole treatment 10 mgr per day, his vocal and motor tics resolved partially after four weeks. However, he had mild akathisia, we added lorazepam 2 mgr per day to treat akathisia. Aripirazole dose was increased to 15 mgr per day after eighth weeks from the beginning of the treatment and the symptoms totally improved.

Key messages and conclusion: We suggest that aripiprazole may well be useful for individuals with GTS as response to it is often dramatic, sustained and with generally mild side effects.

PP245 ASSOCIATION BETWEEN OCCUPATIONAL STRESS FACTORS AND MENTAL HEALTH IN NURSES

Mohsen Yazdani, Tayebeh Mehrabi, Neda Parvin

Background: Nursing is one of the stressful occupations and because of these stresses, multiple negative consequences especially psychological consequences can develop on them.

Aims: So regarding to the role of nurses' general health especially their mental health in nursing services, the aim of present research was determine of association between occupational stress factors and mental health in nurses.

Methods: This study is a kind of correlative research that performed on 170 nurses in Isfahan Medical Sciences hospitals. Sampling method was stratified randomization. The tools for gathering data were Toft-Anderson Nurses Stress Scale and GHQ28. Data analysis was done by spearman correlation statistical test, by SPSS software.

Results: The findings have shown that 88.8% participants were female and 11.2% male; also level of stress was moderate among nurses (76.5%). So the level of anxiety in 43% participants and the level of depression in 18.8% of them were moderate.

Overall, the findings showed significant and positive association between occupational stress and mental health in nurses (P≈001).

Conclusion: According to these findings, and because of the nature of nursing occupation, nurses are at risk for many stresses. This problem can affect on quality of nursing services and improvement of public health. Therefore in order to improve general health state especially mental health in nurses, we suggest some necessary interventions in individual and organizational aspects.

PP246 TEMPERAMENT AND CHARACTER DIFFERENCES AMONG PATIENTS WITH ANXIETY DISORDERS

Beyazit Yemez, Dogan Isik

Background: It is well established that personality disorders are frequently comorbid with anxiety disorders. Cloninger's biyopsychosocial theory is a subject of interest in the area of personality and mood disorders.

Aim: To investigate temperament and character differences of patients with anxiety disorders including adjustment disorders with anxiety.

Methods: Drug free patients who were referred to the psychiatric outpatient clinic of our hospital were diagnosed with Mini International Neuropsychiatric Interview. Among those whose principal diagnoses were any anxiety disorder or adjustment disorder with anxiety completed Temperament and Character Inventory. Altogether 184 patients responded. Patient groups were classified as PD (panic disorders with and without agoraphobia, n = 23), SAD (social anxiety disorder and basic phobia, n = 25) OCD (n = 19), GAD (n = 40), AD, NOS (anxiety disorder not otherwise specified, n = 36) and AdD (adjustment disorder with anxiety, n = 34).

Results: There were significant differences between groups only on Harm Avoidance (HA) and Self-directedness (SD) scales. Post hoc analysis revealed that patients with GAD had higher scores on HA than patients with AD, NOS (p = 0,002). Group GAD also had lower scores on SD than groups PD (p = 0,024), AD, NOS (p = 0,001) and AdD (p < 0,001). Patients with OCD scored lower on SD than patients with AD (p = 0,032).

Conclusion: Although HA dimension of temperament has been shown to have association with anxiety and anxiety disorders in several previous research. This study suggests that it is particularly high among GAD. On the other hand personality difficulties might be most prevalent in GAD within anxious patients.

PP247 PREFRONTAL CORTEX AND AMYGDALA VOLUME IN FIRST MINOR OR MAJOR DEPRESSIVE EPISODE AFTER CANCER DIAGNOSIS

Eisho Yoshikawa, Yutaka Matsuoka, Hidenori Yamasue, Masatoshi Inagaki, Tomohito Nakano, Tatsuo Akechi, Makoto Kobayakawa, Maiko Fujimori, Kiyoto Kasai, Yousuke Uchitomi

Background: Major and minor depressive episodes in cancer patients are frequent and are frequently seen as the first depressive episode in a patient's life. However, the neurological basis of these depressive episodes remains largely unknown.

Methods: Subjects were 51 breast cancer survivors (BCS) who had no history of any depressive episode before the cancer diagnosis (11 BCS with a history of a first minor depressive episode after cancer diagnosis, 11 BCS with a history of a first major depressive episode after cancer diagnosis, and 29 BCS with no history of any depressive episode after cancer diagnosis). We analyzed the prefrontal cortex (PFC) and amygdala volumes in a 1.5-Tesla Magnetic Resonance Imaging scanner. We characterized the structural correlates of depression using two complementary approaches. The first was voxel-based morphometry (VBM) that allowed us to scan the entire brain for reactive gray matter deficit. The second was classical volumetry focusing on the amygdala.

Results: Voxel-based morphometry revealed no brain region, including PFC, for which volume was significantly different among the three groups. There were trend-level differences in the left amygdala volume in the manual tracing method among the three groups. The left amygdala volumes in the subjects with a first minor and/or major depressive episode were significantly smaller than in those with no history of any depressive episode.

Conclusions: It might be suggested that amygdala volume was associated with a first minor and/or major depressive episode after cancer diagnosis.

PP248 CASE REPORT OF NORMAL PRESSURE HYDROCEPHALUS PRESENTING AS DELUSIONAL JEALOUSY

Anna Yusim, Carlos Saavedra, Jean-Pierre Lindenmayer, Istvan Boksay, Carol Bernstein

Introduction: Normal pressure hydrocephalus (NPH), an obstruction to the flow of cerebrospinal fluid though the subarachnoid space, typically presents with the classic triad: cognitive impairment, ataxia, incontinence. We report a case of NPH presenting as delusional jealousy.

Case: A 71 y.o. female with no prior psychiatric history, who has been happily married to her 76 y.o. husband for fifty years, presented to our psychiatric unit with a chief complaint of, “My husband sleeps with every woman he sees!” Over the past year, she began to see every younger woman as a threat to her marriage, voiced angry accusations at her husband, and even threatened divorce. There existed no evidence to substantiate her claim.

Several months after the onset of her jealous delusions, the patient began to notice gait impairment and urinary incontinence. MRI revealed NPH secondary to a subarachnoid cyst. The patient underwent ventriculoplasty, which led to improvement in her incontinence and ataxia, but no resolution of her delusions. Despite multiple medication trials including olanzapine, valproate, ziprasidone and pimozide, the patient's jealous delusions continue to this day. She and her husband are presently in couples’ therapy.

Conclusion: The temporal association between the onset of delusions and diagnosis of NPH, the presence of the classic NPH triad, and the absence of significant personal or family history of psychiatric illness all suggest an organic etiology for this presentation. Although its incidence is low, the presence of delusions in NPH must not be overlooked because of the potential for treatment.

PP249 EFFECT OF UNEMPLOYMENT ON SUICIDES AMONG UNEMPLOYED INDIVIDUALS IN POLAND

Pawel Zagozdzon

Background: So far the relationship between unemployment and suicides has not been investigated in East European countries.

Aim: The aim of this study was to assess the effect of unemployment on suicide risk in a population of unemployed inhabitants of northern part Poland.

Methods: To analyse the association between the unemployment and mortality we collected survival data on a cohort of 47 247 subjects registered as unemployed ones at the Office of Employment in Gdansk for the period of 1999 and 2004. Mortality rates were compared with similar data gathered from matched general population. Cause-specific mortality was analysed based on the data from deaths certificates.

Results: Mean observation time was 38 months. The mortality from suicides in the cohort of registered unemployed subjects was 0.49 per 1000 person-years. Age standardized suicide rate was 0.31 per 1000, 95% confidence interval (CI) 0.23–0.39 in unemployed subjects and 0.17 per 1000, 95% CI 0.15–0.19 in age matched general population. In men unemployment was associated with two times higher age standardized suicide rate than in general population and was 0.59 per 1000, 95% CI 0.43–0.75. Age standardized mortality rate in unemployed women did not significantly differ from reference population: 0.06 per 1000, 95% CI 0.02–0.11 compared to 0.05 per 1000, 95% CI 0.03–0.06.

Conclusions: Male individuals who experienced unemployment had statistically significant higher risk of suicide than matched men in general population. The excess risk of suicides associated with unemployment could be attributed mainly to psychosocial and economic factors.

PP250 DEFINING MEAN SCORESE OF ACADEMIC MEMBER, PREPRTION IN COOPRATIVE MANAGEMENT IN ONE OF NURSING AND MIDWIFERY SCHOOL

Zahra Zandiyeh, Heidarali Abedi

Introduction: In many cases condition and position of performing participation has been the indicator of successful participation management. A manager, in order to perform the action of participative management, needs to study the readiness of organization and then programs performing plans on the basis of this reality.

Methods: This study is methodological triangulation (a several – dimensional way of methodology) which has been performed on the staff of nursing college at Isfahan university as a research society (n = 100). The method of sampling facts and the ways of collecting data is using a questionnaire and the analysis was done by descriptive and statistical statistic.

Conclusions: The findings of this research indicated that the readiness of organization on the basis of its components, include the readiness of academic member. Also, on the basis of average of questions scores of every dimension of organizational readiness, the factors revealing the presence of readiness at this college include the positive and clear personnel policies, acceptable hierarchy relations, no intervention of upper organizations in making decisions of the manager, the importance of, Health and needs of the accademic memberm has had the most scores which have many effects on the rate of the readiness of organization. In addition, there is a meaningful relation between the age and educational condition, management position and the background of staff and organization readiness.

Discussion: According to the medium rate of organizational readiness at this college, it is recommended to the managers of this college and other organizations to emphasize on the positive paints improve negative points and eliminate the preventions of participative management.

PP251 PATTERNS OF DRUG PRESCRIPTION IN A PSYCHIATRIC OUTPATIENT CARE UNIT – THE MEANING OF POLYPHARMACY

Marc Ziegenbein, Hermann Egeti, Bernd Ruediger Brueggemann

Background: In psychiatry, polypharmacy is more the rule than the exception. The present study investigates the frequency and type of polypharmacy in various diagnostic groups amongst patients of a psychiatric outpatient care unit at the Hanover Medical School.

Methods: Patients’ medical records were used to collect data on the last psychopharmacological medication prescribed in the first and second half of 2005 for all patients at the outpatient care unit (N = 429). For the entire group of patients treated in 2005, the last medication of the year was relevant. Patients with an initial diagnosis of schizophrenic psychosis were most frequently treated, followed by patients with affective disorders.

Results: 57% of the patients received at least one psychotropic drug. 20% of the patients received monotherapy and 36% combination therapy. Patients with a schizophrenic psychosis most frequently received a combination therapy, followed by patients with affective disorders. Atypical anti-psychotic drugs were most often prescribed. The anti-psychotic drugs held the greater importance in the combination therapy.

Conclusions: The chronic and severely ill patients in our sample represent a high-risk population for whom a polypharmacy of psychotropic substances might be advisable. When polypharmacy becomes necessary, it should only be administered, whenever possible, according to evidence-based data or at least after a good deal of rational consideration given to the pharmacokinetic and dynamic interactions. Due to the widespread use of polypharmacy in psychiatric care units, we are in urgent need of controlled studies further investigating combinations of substances.

PP252 POLYPHARMACY IN PATIENTS WITH SCHIZOPHRENIC DISORDERS TREATED IN A PSYCHIATRIC OUTPATIENT CARE UNIT

Marc Ziegenbein, Hermann Egeti, Bernd Ruediger Brueggemann

Background: We investigated the frequency and type of polypharmacy in patients with a schizophrenic disorder at the Psychiatric Outpatient Care Unit of the Hanover Medical School.

Methods: The last medication of the year was recorded for all patients treated in 2005 for a schizophrenic disorder (N = 172). In the further evaluations, only patients were included who were prescribed medication in our outpatient care unit (n = 136).

Results: On average, patients received 2.1 psychotropic drugs. 64% received a combination therapy. 65% of the patients received an atypical antipsychotic drug, and 40% a conventional high-potency antipsychotic drug. Conventional high-potency antipsychotics were combined in 18% of the patients with a low-potency antipsychotic drug, in 12% with an anticholinergic, in 7% with a mood stabilizer and in 6% with an atypical antipsychotic drug. Atypical antipsychotics were combined in 23% of the patients with a low-potency antipsychotic drug, in 9% with an anticholinergic, in 10% with a mood stabilizer and in 7% with an additional atypical antipsychotic.

Conclusions: Among patients with a schizophrenic disorder treated in the outpatient care unit, polypharmacy is more the rule than the exception, and various drug classes are of importance. When polypharmacy becomes necessary, it should only be administered, whenever possible, according to evidence-based data or at least after a good deal of rational consideration given to pharmacokinetic and dynamic interactions. Due to the widespread use of polypharmacy in psychiatry, there is an urgent need for controlled studies further investigating combinations of substances.

PP253 PERSONALITY DISORDERS IN A CROSS-CULTURAL PERSPECTIVE

Marc Ziegenbein, Wielant Machleidt, Iris Tatjana Calliess

Background: The diagnosis of personality disorders is highly dependent on how a society views certain behavior. Self concept, adaptation and social context are important aspects of the cultural dimensions of personality disorders. However, the relevance and implications of the influence of sociocultural factors are seen differently. Accordingly, there are very distinct conceptional, nosological and diagnostic approaches for classifying personality dispositions and personality disorders in a cross-cultural perspective.

Methods: The present paper describes the social, demographical and political context of migration in Europe and attempts to define the needs and mental health problems of immigrants. A review of the literature on mental health risk in immigrants is given, and special focus is placed on the impact of culture on the development of personality in general and on the emergence and manifestation versus prevention of personality disorders in specific. This work also aims to confront the problems of health policy concerning immigrants and their access to mental health care services for immigrants in Europe.

Results and conclusions: Due to globalization and migration processes clinicians and therapists are increasingly called upon to evaluate and differentiate the level of personality functioning, not only in patients from different cultures and ethnic groups, but also in traumatized refugees and migrants. Multiple social and cultural factors have an influence on each level of the diagnostic and therapeutic process. In addition to thorough background knowledge concerning trauma, migration and culture specific issues, skills such as cultural sensitivity and cultural competence are requisite for clinicians and therapists.

PP254 ASSESSING MENTAL HEALTH TRANSCULTURALLY: VALIDATION OF PSYCHOMETRIC INSTRUMENTS IN BRAZIL

Carlos Zubaran Jr, Juan Mezzich

Background: Research on migration and mental health emerged in the 19th century when immigrants were depicted as people “without friend in a strange land” for whom “hope yields to anxiety”. Ødegard (1932) observed high rates of breakdown among migrants adapting to a host society. Individuals from minority groups tend to experience distress due to their status of subordinate and may present themselves with different symptoms of mental and physical illnesses. In effect, minority patients tend to receive distinct psychiatric diagnosis. Unfortunately, the majority of psychometric tools are not adequately standardized for clinical and research use in different cultures.

Aims: These are results of an international study developed to test and validate in Brazil three instruments designed to evaluate personal health status (PHS), quality of life (MCQI) and bicultural issues (MEBS).

Methods: Instruments were translated to Portuguese taking into account semantic and cultural equivalence. Sample: 120 volunteers (90 patients and 30 health care professionals). RESULTS: All instruments yelled significant internal consistency. A significant difference (p < 0,001) was detected between the means of patients and health professionals. A ROC analysis established a cut-off score of 6 for the Portuguese version of PHS (PHS-Pt). MQLI-Pt was well accepted by patients and health professionals alike. A significant Pearson correlation was attained between the MQLI-Pt and the PHS-Pt. Significant results were obtained with the Portuguese version of MEBS as well.

Conclusion: The psychometric tools designed to evaluate health status, quality of life and biculturality can be adapted efficiently to different languages and cultures.

PP255 THE LAY CONCEPTS OF SCHIZOPHRENIA BY THE BASOGA IN UGANDA: A PILOT STUDY

Catherine Abbo

Background: Studies in primary health care in Africa, Uganda inclusive, show that patients with functional psychosis do not spontaneously go to primary health care facilities; instead they go for traditional healing practices. However, there is limited documented literature about the traditional healer's concept of schizophrenia in Uganda.

Aim: To describe the lay concepts of schizophrenia. Particularly to answer the following questions: How do traditional healers in Busoga region call schizophrenia? What do they say causes schizophrenia and how do they manage it?

Method: A case Vignette depicting schizophrenia was used to achieve the above objectives. Two focus group discussions of traditional healers were held. Responses to the above questions were recorded and a manual content analysis done.

Results: The traditional healers in Busoga seemed not to have specific name for schizophrenia illness, instead they lumped all severe mental illnesses into one-“Kazole” to mean madness that is chronic. They seemed to say that this ‘kazole’ illness is caused by supernatural powers, evil spirits, ancestral spirits related to clan issues. They believed the remedy for this illness lies with the traditional healer who is has the knowledge and powers to treat.

Conclusion: These findings may provide insight into the concepts of schizophrenia by the local people in Uganda. Further research needs to be carried out in this area in regard to the present move towards primary mental health care and community psychiatry in order to forge a meaningful collaboration and/or integration with traditional healers.

PP256 CAN WE OFFER WHAT'S NEEDED? A MODEL FOR TRIAGE, ASSESSMENT AND ACUTE PHASE CARE IN A YOUTH MENTAL HEALTH SERVICE

Philippe Ray, Frances Foster

The early recognition of mental disorders in youth is known to be crucial, but the literature is very scarce around mental health service delivery for young people. One team, The Youth Access Team (YAT), is described using a framework suggested by Burns and Priebe (1996). YAT is the front end of ORYGEN Youth Health, a mental health service for people aged 15–25 years presenting with a broad range of potentially serious disorders. The clinical and organisational difficulties faced during the development of YAT over the past 15 years and the strategies used to overcome them are presented. Case examples and service description are used to illustrate the complexities of the team's functions and operations. This enables the reader to understand the rationale behind the development of the current model. Discussion about the past and current struggles in providing a tertiary clinical service in a way that is attractive to young people allows the reader to compare this model to their own, potentially preventing the reader from traversing the same long and arduous road. This article also aims to provide a basis for further research in that particular field of early intervention in youth mental health allowing comparisons between different settings.