AOP01 EATING DISORDERS AND HEALTH RELATED QUALITY OF LIFE: RESULTS OF A LONGITUDINAL STUDY OF AUSTRALIAN WOMEN
Phillipa Hay, Jonathan Mond, Petra Buttner, Susan Paxton, Bryan Rodgers, Frances Quirk
Introduction: Longitudinal studies of women with eating disorders report variable outcomes and there are few consistent predictors of outcome.
Aim: The study aims were to describe the course and putative predictors of outcome of community women with disordered eating.
Method: One hundred and twenty-two young women (mean age 28.5±6.3 years) identified in a general population based survey [1] with eating disorder symptoms of clinical severity agreed to participate in a follow-up study. The present paper reports on results at two years. Eating disorder symptoms, health related quality of life, general psychological function, help-seeking, and defence style were assessed at baseline, and two years by questionnaire.
Results: Eighty-seven women (71%) completed the two year follow-up. Multiple linear regression analyses were used to identify demographic and other characteristics related to the EDEQ global score and to the SF12 mental score at the two year follow-up. At two years of follow-up the mean EDEQ global score was 3.1, 59.8% of women had experienced at least one day out of role during the past four weeks, and the mean SF12 mental component score was 38.0. In the multivariate model, a higher level of immature defence style and baseline binge eating severity, significantly predicted higher levels of eating disorder symptom severity at two years. A higher level of immature defence style, higher general psychological disturbance, lower BMI, and not reporting home duties as main work, were associated with poorer quality of life.
Conclusions: The relevance of defence style to personality structure and as a main predictor of outcome outcome in women with eating disorders will be discussed.
AOP02 ALTERNATIVE MEASURES OF SUICIDE FOR SOCIETAL DECISIONS: AUSTRALIAN DATA FROM 1907
Darrel Doessel, Ruth F. G. Williams, Roman W. Scheurer, Harvey Whiteford
Introduction: In recent years a number of countries, e.g. Australia, New Zealand, Britain, the United States, have experienced rising suicide rates and in response, suicide prevention strategies have been adopted.
Aim: With this background in mind, we ask how the efficacy of these strategies can be determined. Although it may appear to be self-evident that ‘decreased suicide’ is the way to determine efficacy, this begs the question of the appropriate quantitative measure of suicide.
Method: We compare two measures of suicide, viz. the conventional count (number of suicides) and the potential years of life lost (PYLLs) from suicide. It is argued that the PYLL measure is more appropriate for the evaluation of policy as it is a weighted measure and incorporates more information than the unweighted count measure.
Results: Using published Australian data from 1907 for both males and females, we find that for the 98 years to 2004, suicide PYLLs averaged 4.35 per cent of all PYLLs for males, and 2.28 per cent of all female PYLLs. The comparable count percentages are 1.79 and 0.62 respectively. These differences have widened in more recent years due to the rising numbers of ‘young’ suicides: in 2004 suicide represented 3.03 per cent of all male deaths and 0.81 per cent of all female deaths using the count measure, whereas using PYLLs, 10.31 per cent and 4.70 per cent respectively.
Conclusion: Thus these results indicate that suicide is a quantitatively larger issue, using the PYLL measure, than is indicated by the count measure.
AOP03 COMMUNITY CONNECTEDNESS AND MENTAL HEALTH IN A FARMING POPULATION
Helen Stain, Brian Kelly, Terry Lewin, Nick Higginbotham Introduction: Research in rural health provides an opportunity to investigate the influence of geography, locality and community on health outcomes. There is consistent evidence of higher rates of suicide in rural areas, particularly for male farmers, compared to urban areas and yet mixed findings for patterns of mental disorders. Social capital research suggests that an investigation of potential moderating factors for rural mental health outcomes should include relationships between individuals and with the community.
Aim: To investigate the association between social environment and mental health outcomes among a farming community.
Method: A self report survey was mailed to 2000 adults randomly selected from the electoral roll using a stratified sampling strategy based on ARIA+ remoteness categories. The survey measured: socio-demographic characteristics; vulnerability; perceived support; and health behaviour factors. The Kessler-10 was the outcome measure of psychological distress.
Results and discussion: The sample (N = 449) was classified into three groups: farmers/farm workers; farm residents; and non farm persons. The regression model (gender, age, group based contrasts, neuroticism, life events, drought related stress, community support, sense of place, social support, alcohol use, physical functioning, and selected interaction terms) accounted for 58.5% of the variance in K10 scores. Neuroticism accounted for a large proportion of this variance (36.8%), life events and alcohol use also showed positive associations with K10 while age, community support and physical functioning revealed significant negative associations. A significant interaction effect suggested that community support exerted a greater influence on distress for non farm people compared to both farm workers and farm residents.
AOP04 A SYSTEMATIC REVIEW OF MORTALITY IN SCHIZOPHRENIA: IS THE DIFFERENTIAL MORTALITY GAP WORSENING OVER TIME?
Sukanta Saha, David Chant, John McGrath
Introduction: Despite improvements in mental health services in recent decades, it has not been clear whether the risk of mortality in schizophrenia has changed over time. Aim: The aim of this systematic review is to explore the distribution of Standardized Mortality Ratios (SMR) for schizophrenia.
Methods: Broad search terms were used in MEDLINE, PsychINFO, Web of Science, and Google Scholar to identify population-based studies that investigated mortality in schizophrenia, published between 1980 and 2006. References were also identified from review articles, reference lists and by writing to authors.
Results: We examined the distribution of SMRs, and pooled selected estimates using random-effect meta-analysis. We identified 36 papers drawn from 19 different nations. The median (10–90% quantiles) SMR for persons for ‘all-cause’ mortality was 2.58 (1.40–5.98) with a corresponding random-effects pooled SMR (95% CI) of 2.56 (2.18, 2.94). No sex difference was detected. Suicide was associated with the highest SMR (12.86), however most of the major causes of death categories were found to be elevated in schizophrenia. “Less developed” countries had significantly higher SMRs compared to “developed” countries (p=.007). The SMRs for ‘all-cause’ mortality have increased over recent decades (p=.02).
Conclusions: With respect to mortality, there is a substantial gap between the health of people with schizophrenia versus the general community. This differential mortality gap has worsened over recent decades. In light of the potential for second-generation antipsychotic medications to further adversely influence mortality rates in the decades to come, optimizing the general health of people with schizophrenia warrants urgent attention.
AOP05 MENTAL DISORDERS AND MENTAL HEALTH CARE IN CANADA AND AUSTRALIA: COMPARATIVE EPIDEMIOLOGICAL FINDINGS
Graham Meadows, Raymond Tempier, Karen Mosier, Helen-Maria Vasiliadis, Alain Lesage, Annette Graham, Anna Stiller
Introduction: Canada and Australia although geographically distant have similarities in human geography and history. Each has had a national mental health policy for some years, but Australia has driven policy implementation in this area harder than has Canada.
Aim: To explore relative rates of mental disorders in Australia and Canada and to compare estimates of use of mental health services.
Methods: We compare findings from the Australian National Survey of Mental Health and Wellbeing (1997) with those from the Canadian Community Health Survey on Mental Health and Well Being, cycle 1.2 (2003).
Results: Striking differences in prevalence rates and in service utilisation emerge between the two countries: Major Depressive Disorder, Alcohol Dependence and Drug Dependence each appear at least 1% higher in Australia than Canada and Anxiety Disorders are estimated as almost 2% higher in Canada than in Australia. More of the people with disorders in Australia than in Canada make use of mental health services. We acknowledge survey design differences as possible confounders but suggest these are unlikely to fully explain these differences.
Conclusions: Causation cannot be determined from this study but possible explanations for differences in prevalence include changes in global economic, political and security contexts and concerns between 1997 and 2003 and the possible role of greater availability of alcohol in Australia. The findings also provide encouragement that strenuously implementing a national mental health policy may have been of benefit to people with mental health problems in Australia.
AOP06 WHAT PREDICTS SHORTER DURATION OF (INITIALLY) UNTREATED PSYCHOSIS?
Stanley Catts, Meredith Harris, Brian O'Toole, Vaughan Carr, Amanda Neil, Aaron Frost, Belinda Schaefer, Kathryn Eadie, Russell Evans, Stanley Catts
Background: A substantial literature indicates that longer duration of initially untreated psychosis (DUP) is associated with poorer treatment response in early psychosis (EP). Therefore, it is important to identify what factors predict DUP to enable services to effectively intervene to reduce time between psychosis onset and service contact.
Aim: To identify predictors of time to service contact in a cohort of EP patients.
Method: The first 6-months treatment of a cohort of patients presenting for first time with psychotic disorder (n = 451) to 19 mental health teams in 8 area mental health services across three states was evaluated using routine measurement of baseline patient characteristics, treatment guideline concordance, and service models. Cox regression analyses were undertaken to identify predictors of time to service contact.
Results: The multivariate model revealed that, after controlling for all other variables, those patients with an acute mode of onset (as opposed to an insidious onset) experienced, on average, shorter delays into treatment, and those with a schizophrenia spectrum disorder (compared to having another psychotic disorder) experienced longer delays. Those patients treated by services with little or no EP implementation experienced longer DUP than those treated at services with either extensive EP intervention implementation or some EP intervention implementation.
Conclusion: Although services cannot intervene to alter some baseline patient characteristic predictors of DUP, our results suggest that support for a service focus on EP intervention predicts shorter time from psychosis onset to service contact.
AOP07 ELEVATED BRAIN SEROTONIN TURNOVER IN PATIENTS WITH DEPRESSION: EFFECT OF GENOTYPE AND THERAPY
Gavin Lambert, David Barton, Tye Dawood, Elisabeth Lambert, Richard Bayles, Florentia Socratous, Markus Schlaich, Celia Brenchley, Deepak Haikerwal, Murray Esler
Introduction: The aetiology of major depressive disorder (MDD) has been linked to brain monoaminergic neuronal dysfunction. Of particular interest is the role of brain serotonin in MDD.
Aim: To quantify brain serotonin turnover in patients with MDD.
Methods: Direct internal jugular venous blood sampling was used to directly quantify brain serotonin turnover. The effect of serotonin transporter genotype on brain serotonin turnover was evaluated, and the influence of SSRI therapy on serotonin turnover investigated. Patients with depression (n = 21) were studied both untreated and during administration of a selective serotonin reuptake inhibitor (SSRI) in an unblinded study of sequential design. Healthy volunteers (n = 40) were examined on only one occasion.Results: Brain serotonin turnover was significantly elevated in unmedicated patients with MDD compared to healthy subjects (4.4 + /-4.3 v 1.6 + /-2.4 nmol/l, P = 0.003). Analysis of the influence of 5-HTT genotype in MDD indicated that carriage of the s allele was associated with an over 2-fold increase in brain serotonin turnover (2.7 + /-2.9 v 6.5 + /-4.7 nmol/l, P = 0.04). Following SSRI therapy brain serotonin turnover was substantially reduced (6.0 + /-4.0 v 2.0 + /-3.3 nmol/l, P = 0.008).
Conclusion: Brain serotonin turnover is elevated in unmedicated patients with MDD and is influenced by 5-HTT genotype. The marked reduction in serotonin turnover following SSRI treatment and the accompanying improvement in symptoms suggests that high brain serotonin turnover may be a biological substrate of MDD.
AOP08 EMOTIONAL CONTEXT PROCESSING IN DEPRESSED AND EUTHYMIC BIPOLAR DISORDER
Melissa Green, E. Serap Monkul, Jennifer Robinson, Jennifer Barrett, David Glahn
Introduction: Recent studies demonstrate stable neurocognitive and generalised emotion perception deficits in bipolar disorder (BD), alongside aberrant processing of specific emotions during different phases of illness.
Aims: We examined whether euthymic and depressed BD patients differ from healthy controls when judging the level of emotional intensity displayed by target characters presented with and without social contextual information.
Methods: 41 outpatients with bipolar disorder (21 depressed, 20 euthymic) and 47 healthy participants viewed two sets of images, displaying target characters depicted within ‘context-free’ and ‘context-embedded’ conditions. For each image, participants rated the perceived intensity of single emotions (anger, disgust, happiness, sadness or fear) using 5-point Likert scales. Contrasting the rating from the initial ‘context-free’ observation with the ‘context-embedded’ viewing provided an index of the impact of social contextual information upon judgments of emotional intensity. Reaction times (RTs) for emotional intensity ratings, as well as a choice RT measure, were also obtained.
Results: The emotional intensity ratings of BD patients and healthy subjects did not differ across context conditions. Depressed BD patients were slower to judge the intensity of all emotion stimuli (regardless of context), compared to euthymic BD patients and healthy controls. However, when corrected for general cognitive slowing, this difference remained significant only for expressions of happiness, fear and disgust.
Conclusions: Patients with bipolar disorder are able to use contextual cues to moderate judgments of the intensity of facial emotions. Slowed processing of facial expressions of happy, fear and disgust in depressed may reflect mood-specific processing biases.
AOP09 ASSOCIATIONS BETWEEN DEPRESSION, RESPIRATORY CONDITIONS AND MEASURES OF OBESITY IN THE NORTH WEST ADELAIDE HEALTH STUDY
Nicholas Potts, Tiffany Gill, Anne Taylor, Geoff Schrader, David Wilson
Introduction: This abstract presents the associations between depression and respiratory disease and measures of obesity among participants in a cohort study conducted in the north western suburbs of Adelaide, South Australia.
Aims: To determine the association between depression, as measured by the CES-D, asthma and chronic obstructive pulmonary disease (COPD) and body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR).
Methods: The North West Adelaide Health Study is a representative longitudinal cohort study of people aged 18 years and over living in the northwest region of Adelaide, SA. The original sample (n = 4060) was randomly selected and recruited by telephone interview to participate in a clinic assessment. The second stage of data collection on this cohort was undertaken between mid 2004 and early 2006 and in this phase, participant's height, weight, waist circumference and waist to hip ratio and spirometry measures were determined during a clinic assessment. Responses to the CES-D were collected as part of a Computer Assisted Telephone Interviewing (CATI) survey, and self-reported asthma and COPD were determined from a self completed questionnaire.
Results: Overall, 12.4% (95% CI 11.3–13.5) of participants reported depressive symptoms as measured by the CES-D. Depression was associated with those classified as obese (as determined by BMI), with a high waist hip ratio or a high waist circumference, however depression was not associated with either asthma or COPD.
Conclusion: Chronic respiratory conditions such as asthma and COPD are not significantly associated with depression, in contrast to measures of obesity.
AOP10 THE CANNABINOID RECEPTOR 1 (CNR1) GENE PREDICTS ANTIDEPRESSANT TREATMENT RESPONSE AND EMOTION PROCESSING IN MAJOR DEPRESSION
Bernhard Baune, Udo Dannlowski, Bruce Lawford, Patricia Ohrmann, Jochen Bauner, Harald Kugel, Walter Heindel, Ross Young, Thomas Suslow, Katharina Domschke
The endocannabinoid system has been implicated in the pathogenesis of depression and anxiety, neurobiological activity during emotion processing as well as in the mediation of antidepressive pharmacological treatment efficacy.
Thus, 256 Caucasian patients with Major Depression (f = 145, m = 111) were genotyped for variants rs1049353 and rs12720071 in the cannabinoid receptor 1 gene (CNR1) (6q14–15). Response to antidepressive pharmacological treatment was assessed by weekly intra-individual changes of HAM-D-21 scores over six weeks. A subsample of 33 depressed patients was additionally scanned by means of fMRI at 3 T under visual presentation of emotional faces.
The CNR1 rs1049353 G allele conferred an increased risk of worse response to antidepressant treatment, particularly in patients with the melancholic subtype of Major Depression and the subgroup of female patients. This effect was most pronounced, when only patients with high anxiety were considered. Consistently, CNR1 rs1049353 G allele carriers demonstrated weaker bilateral amygdala, putamen, and pallidum activity as well as left lateralized caudate and thalamus activity in response to masked happy faces. This study provides preliminary support for a role of CNR1 gene variation in depression and anxiety. A subcortical hypo-responsiveness to social reward stimuli conferred by the G allele might be a potential neurobiological endophenotype of worse treatment response. Provided replication in independent studies, this finding may aid in evaluating novel pharmacological treatment options for depressive and anxiety-related symptoms targeting the endocannabinoid system.
AOP11 RUMINATION: A MECHANISM OF CHANGE IN BOTH CBT AND MINDFULNESS-BASED COGNITIVE THERAPY FOR DEPRESSION?
Joanna Crawford, Michelle Moulds, Gordon Parker, Vijaya Manicavasagar, Aimee Gayed
Introduction: Depressive rumination is defined as repetitive and passive thinking about one's symptoms of depression, and the possible causes and implications of these symptoms (Nolen-Hoeksema, 1991). Rumination contributes to the onset, maintenance and recurrence of dysphoria and depression (Papageorgiou & Wells, 2003). Thus, it has been proposed that a common mechanism of many effective forms of psychological treatments for depression is the reduction of rumination (Nolen-Hoeksema, 2004).
Aim: This study examines rumination, and positive meta-beliefs about rumination, as potential mechanisms of change in two psychological treatments for depression: cognitive behaviour therapy (CBT) and mindfulness-based cognitive therapy (MBCT).
Method: Participants (outpatients with current non-melancholic Major Depressive Disorder or Dysthymic Disorder) were randomly allocated to either the CBT or MBCT manualised 8-week group programs, each facilitated by psychologists. To date, 30 participants have completed pre-treatment and post-treatment assessment.
Results: Preliminary findings from both completer and intent to treat analyses suggest that CBT and MBCT were both effective in significantly reducing rumination and positive meta-beliefs about rumination at post-treatment. No statistical differences were found between the two types of group therapy (results regarding the significant reductions in pre-to-post depressive symptoms, assessed by the BDI-II and Hamilton, are reported independently by Parker, Manicavasagar and Gayed). Further analyses will examine mediating pathways involving rumination, beliefs about rumination and depressive symptoms.
Conclusions: Rumination, and positive beliefs about rumination, are both significantly reduced at post-treatment following CBT or MBCT. Further research is required to investigate the role of rumination as a potential mechanism of change in depression.
AOP12 PRIORITIES FOR DEPRESSION AND BIPOLAR DISORDER RESEARCH: A CONSUMER PERSPECTIVE
Michelle Banfield, Kathleen Griffiths, Helen Christensen
Introduction: There is growing acknowledgement of the importance of the consumer viewpoint in developing and carrying out mental health research. Previous studies have identified differences in research priorities for researchers and mental health consumers defined broadly. However, little is known about the research priorities of consumers with specific mental health conditions.
Aim: To set directions for future research on depression and bipolar disorder based on the perspectives of consumers.
Methods: Phase 1 of the study comprised focus groups of consumers with unipolar depression or bipolar disorder and individual telephone interviews with consumer advocates. Participants were asked to specify topics they believed were priorities for depression (or bipolar) research, which specific groups and settings should be targeted, their sources of information on depression (or bipolar disorder) research and the bases for their choice of priorities.
Results: The most frequently cited themes included the need for research on early diagnosis and on improved treatment. Key target groups for research included children and adolescents and the socially and economically disadvantaged while schools and the community were most often nominated as the priority settings. The Internet and the media were identified as the most common sources of information on research. Personal experience was the primary basis for the research priority ratings.
Conclusion: Consumers offered a wide variety of research areas as important to them and valued the opportunity to contribute to the study.
AOP13 COGNITIVE FUNCTIONING IN YOUNG PEOPLE WITH FIRST EPISODE PSYCHOSIS: A 2–3 YEAR FOLLOW-UP STUDY
Anthony Harris, Antoinette Redoblado-Hodge, Dianne Fitzgerald, Sara Lucas, John Brennan
Introduction: Cognitive deficits are established at the time of first presentation to services for a large proportion of young people with psychosis. These deficits predict outcome and community functioning as well if not better than symptom profile. However the change over time in groups of subjects with both first episode mood disorders as well as schizophrenia has not been well studied.
Aim: To describe the recovery in cognitive function over a 2–3 year follow-up period in a group of subjects with first epiosde psychosis.
Method: The Western Sydney First Episode Psychosis Project examined a cohort of young people with their first episode of psychosis, Subjects were examined at baseline with a detailed cognitive battery and followed up at 12 months and 2–3 years. Subjects were divided into two groups (schizophrenia vs mood disorders) and compared for level of cognitive functioning and improvement over the follow-up period.
Results: Whereas the two groups differed significantly at baseline on only one measure (similarities) at follow-up the two groups had diverged with the mood disorders group being significantly better in the areas of verbal fluency, Rey figure copy and delayed recall and RAVLT delayed recall.
Conclusions: Cognitive recovery in first episode mood disorders is significantly better than that seen in first episode schizophrenia. This has implications for continued care and treatment of schizophrenia.
AOP14 ESTROGEN AND COGNITION IN WOMEN WITH SCHIZOPHRENIA
Caroline Gurvich, Jayasrhi Kulkarni, Anthony de Castella, Fatima Mehmedbegovic, Heather Gilbert
Introduction: Estrogen receptors have been found in several brain areas including the hypothalamus, pituitary and limbic system, cerebral cortex, suggesting that this hormone has the potential to play an important role in a range of brain functions, including cognition. The relationship between estrogen and cognition has been investigated via exploratory studies of cognition and circulating estrogen, as well as epidemiological and experimental studies that have examined cognitive enhancing efficacy of hormone therapy (combined estrogen and progesterone) or estrogen therapy alone in women across their lifespan. There is also some evidence for a positive effect of estradiol on cognitive function in women with schizophrenia, although findings are limited and inconclusive.
Aim: The current studies aimed to investigate cognitive performance in women with schizophrenia before and after adjunctive estrogen therapy.
Methods: Women with a diagnosis of schizophrenia participated in one of two double-blind, randomised controlled trials of adjunctive estrogen. Women of child-bearing age received adjunctive transdermal estradiol (100mcg/day adjunctive transdermal estradiol, 200mcg/day adjunctive transdermal estradiol, or adjunctive transdermal placebo) for 8 weeks and women who were menopausal received adjunctive placebo or adjunctive raloxifen (a selective estrogen receptor modulator) for 12 weeks. All patients continued to receive standard antipsychotic treatment whilst in the trial. Cognitive functioning (RBANS), hormone assays and menstrual cycle phase were assessed at baseline and repeated at trial end.
Results and conclusion: Preliminary results will be presented on i) the relationship between cognition and menstrual cycle phase at baseline and ii) the impact of estrogen treatment on cognitive functioning.
AOP15 SOCIAL KNOWLEDGE AND SOCIAL COGNITION DISSOCIATE IN SCHIZOPHRENIA
Robyn Langdon, Emily Connaughton, Vince Polito
Introduction: There is a common view that social deficits in schizophrenia reflect a general impairment of social intelligence. This view fails to distinguish between knowledge and process, in particular, the knowledge of social rules versus the cognitive processes for inferring other people's thoughts (i.e. “theory of mind”: ToM).
Aims: This study used a novel Social Judgment Task to assess reasoning about social rules and reasoning concerning other people's thoughts in schizophrenia. We predicted social-rule reasoning to be intact in schizophrenia while reasoning about other people's thoughts would be impaired.
Methods: Forty-three patients and 28 healthy controls, matched group-wise on years of age, gender-ratio and NART-estimated IQ, completed the Social Judgment Task and verbal and non-verbal tests of ToM. On the Social Judgment Task participants judged whether actions described in story vignettes were normal or unusual in the circumstances. These actions could be appropriate according to social norms, violations of social norms or socially inappropriate but understandable if story characters’ thoughts were taken into account.
Results: Patients performed more poorly than controls on the verbal and the non-verbal ToM tasks. On the Social Judgment Task, the patients’ reasoning about social norms did not differ significantly from that of the controls, while the patients took less account of the story characters’ thoughts. These latter difficulties in the patients were associated with their performance deficits on the ToM tasks.
Conclusions: Knowledge and reasoning concerning social norms is generally intact in schizophrenia while social cognition, in particular ToM, is impaired.
AOP16 SENSORIMOTOR GATING IN ATTENTION DEFICIT HYPERACTIVITY DISORDER
Mary-Claire Hanlon, Frini Karayanidis, Ulrich Schall
Introduction: Disrupted sensorimotor gating has been found in various conditions, such as schizophrenia, obsessive-compulsive disorder, Gilles de la Tourette syndrome and pathological gambling, suggestive of impaired dopaminergic neurotransmission. Prepulse inhibition (PPI) of the acoustic startle response has commonly been used as an index of dopaminergic mechanisms in sensorimotor gating.
Aim: It has been suggested that dopaminergic dysfunction is also associated with attention deficit hyperactivity disorder (ADHD); however the mechanism of impairment has been questioned. Indirect dopamine agonists, such as d-amphetamine and methylphenidate, disrupt sensorimotor gating and are commonly used to treat ADHD. Therefore their effects on PPI in this condition are of particular interest.
Method: We investigated PPI of the acoustic startle eye-blink reflex in 24 adolescents and young adults diagnosed with ADHD and 29 matched healthy control subjects. A subset of patients was tested on and off stimulant treatment. PPI was assessed in a passive listening task and whilst participants were performing a two-tone auditory discrimination task on the prepulse.
Results: Patients showed similar PPI as healthy control subjects in the passive and attent listening task, regardless of stimulant treatment.
Conclusions: Our findings do not suggest impaired sensorimotor gating in ADHD. When tested on stimulant treatment however, patients’ PPI was unaffected suggestive of altered dopaminergic neurotransmission in this disorder.
AOP17 THE PREVENTION OF MENTAL DISORDERS: PART 2 – STRESS
Gavin Andrews, Helen Van Vliet, Maree Teesson, Laura Vogl
Background: We have embarked on the preparation and testing of web based curriculum consistent lessons for the reduction of risk for mental disorders in Personal Development, Health and Physical Education classes in high schools (www.climateschools.tv). The first course developed was on ‘Coping with alcohol’ and results of a cluster RCT showed, that at 12 months there was a retention of information about alcohol, improved attitudes to alcohol, and a reduction in binge drinking when the intervention school were compared to the control schools.
The present report concerns the efficacy of the second course ‘Coping with stress’.
Method: A phase 1 trial in 8 schools.
Results: Web based courses were acceptable to teachers and students. Virtually no investigator assistance was required. At three months post course there were significant improvements in knowledge, in coping styles, in psychological distress and in well being in year 8 students in the intervention schools but no change in students in the control schools.
Conclusions: Web based curriculum consistent courses for the prevention of the common mental disorders are practical and effective.
AOP18 CEREBRAL DYSFUNCTION UNDERLYING FIRST-RANK SYMPTOMS IN SCHIZOPHRENIA: A COGNITIVE EXAMINATION OF THREE EXPLANATORY MODELS
Flavie Waters, Johanna Badcock, Milan Dragovic, Assen Jablensky
Introduction: The neuropsychological basis of first-rank symptoms in schizophrenia (FRS) is still a matter of debate. Three broad explanatory models for FRS have been proposed, each arising from a different perspective: (i) medial temporal lobes pathology (Trimble, 1990); (ii) reduced cerebral lateralisation and interhemispheric transfer (Crow, 1997); and (iii) deficits in self-monitoring of intentions due to prefrontal inhibitory dysfunction (Frith et al, 2000).
Aims: To test whether patients with FRS would show deficits consistent with the above models.
Methods: A broad range of neuropsychological tests were administered to patients with and without FRS and to healthy controls, comprising tests of verbal and nonverbal memory, measures of cerebral lateralisation and interhemispheric communication, tasks of executive functioning, as well as tests of general cognitive abilities.
Results: On some cognitive tests, results were supportive of theories advocating reduced cerebral lateralisation and self-monitoring impairment. An unexpected finding was that, on many cognitive tasks, the performance of patients with FRS was better than that of patients without FRS, and not significantly different from that of controls. These results could not be accounted for by demographic features or medication effects.
Conclusion: The current study may be the most comprehensive examination of neuropsychological performance in patients with FRS to date. Our results suggest that broad cognitive impairment is not a necessary correlate of FRS. These findings are consistent with the hypothesis that the schizophrenia syndrome is heterogeneous and may involve distinct subtypes of the disorder.
A0P19 Internet based treatment for social phobia
Nick Titov, Gavin Andrews, Genevieve Schwencke
Introduction: Approximately 2% of the adult population meet criteria for social phobia each year. However, only approximately 20% seek treatment (Tolkien II, in press). CaCBT has been successfully used in Sweden and other countries to treat social phobia (e.g., Andersson et al, 2006; Carlbring et al, 2007).
Aim: The present study examined the efficacy of the CLIMATE-GP Internet-based computer assisted cognitive behavioural therapy (CaCBT) program for social phobia.
Method: 103 individuals with social phobia were randomly assigned to a 6 lesson cognitive-behavioural treatment program or to a waitlist control group. Treatment involved reading the 6 lessons, completing homework assignments involving practicing the cognitive behavioural techniques, regular email contact with a therapist, and reading and posting messages and homework assignments on a secure and confidential on-line discussion forum. An intention-to-treat analysis including all participants was employed. Measures of social phobia, generalized anxiety, symptoms of depression, general psychological distress, and disability were administered at application, immediately prior to commencement of the program, and at 1-week follow-up.
Results: From pre- to post-program significant differences were revealed between treatment and waitlist participants across all measured areas. In addition, treatment satisfaction was rated highly. Overall within- and between-group effect sizes of (Cohen's) d = 1.15, and 1.20 were obtained, respectively.
Conclusions: These results provide further positive data about the potential utility of Internet-based guided self-help treatment programs for people with social phobia.
AOP20 AUDITORY HALLUCINATIONS IN SCHIZOPHRENIA: AN INVESTIGATION OF ABNORMAL CORTICAL DIFFUSIVITY
Marc Seal, Po Yin Tang, Mark Walterfang, Murat Yücel, Stephen Wood, Andrew Zalesky, Christos Pantelis
Introduction: Auditory hallucinations (AH) are a common, severe and debilitating symptom of schizophrenia. While it is believed that AHs may be caused by abnormal cortical connectivity recent neuroimaging studies of AHs have produced inconclusive findings.
Aim: The aims of this investigation were to establish a protocol for assessing cortical connectivity in vivo using DTI and to determine if the experience of AH in schizophrenia is associated with abnormal diffusivity in the temporal lobes.
Method: DTI data was acquired from two clinical samples of different duration of illness: First Episode [n = 11 First Episode Psychosis (FEP) and n = 9 age-matched Healthy Control (HC FEP)] and Chronic [(n = 14 Chronic Schizophrenia (CHR) and n = 14 age-matched Healthy Control (HC CHR)]. All participants were male and right-handed. The groups were compared on four measures of diffusivity [Fractional Anisotropy (FA), Axial Diffusivity (AD), Radial Diffusivity (RD) and Intervoxel Coherence (IC)] to and from functional areas of the auditory cortex.
Results: Age-related differences in diffusivity were identified between diagnostic groups in measures of temporal lobe diffusivity (FA, AD and RD). No significant age-related changes were found in IC. Furthermore, individuals with AH demonstrated substantial decreases in FA and increases in IC with increasing duration of illness.
Conclusions: This investigation identified age-related changes in diffusivity in temporal lobe tracts bilaterally associated with experience of AHs in schizophrenia.
AOP21 NEURAL MECHANISMS UNDERLYING PROBABILISTIC CATEGORY LEARNING IN SCHIZOPHRENIA
Thomas Weickert, Terry Goldberg, Qiang Chen, Joseph Callicott, Jose Apud, Sumitra Das, Brad Zoltick, Michael Egan, Daniel Weinberger, Venkata Mattay
Introduction: Prior imaging studies have demonstrated activation of the caudate nucleus, prefrontal and parietal cortices during probabilistic category learning. Normal striatal function is believed to be critical to probabilistic category learning since illnesses associated with striatal dysfunction display impaired probabilistic category learning rates. Patients with schizophrenia show abnormal striatal binding and decreased prefrontal activation on tests of executive function, and normal learning rates with impaired overall performance during probabilistic category learning.
Aim: Identify neural substrate of probabilistic category learning in schizophrenia.
Method: Forty patients with schizophrenia on antipsychotic medication and 25 healthy participants were assessed on interleaved blocks of probabilistic category and control tasks while they underwent BOLD fMRI. Nine patients were excluded due to motion. Whole brain functional images were acquired using a GE 1.5T scanner with gradient echo EPI (3/1 mm, TR/TE = 3000/50msec). Imaging data were analyzed using second level random effects analyses (SPM2).
Results: Patients with schizophrenia displayed a normal learning rate in conjunction with an overall impaired performance. Patients displayed greater activation of bilateral orbital frontal cortex (BA 11) and left parahippocampal gyrus (BA 34–36) relative to healthy adults across the 4 quartiles. Healthy adults displayed greater bilateral caudate and dorsolateral prefrontal cortex activation relative to patients across the 4 quartiles.
Conclusion: Differential activation of the caudate nucleus, parahippocampal gyrus, orbital frontal and dorsolateral prefrontal cortices between patients with schizophrenia and healthy participants concurrent with normal learning reflects altered neural function that promotes normal learning rate in patients with schizophrenia.
AOP22 ADEPT: A DEFINITIVE ESTROGEN PATCH TRIAL
Jayashri Kulkarni, Caroline Gurvich, Fatima Mehmedbegovic, Anthony de Castella, Paul Fitzgerald, Henry Burger
Introduction: Accumulating evidence suggests estrogens may have therapeutic effects in severe mental illnesses, including schizophrenia, via neuromodulatory and neuroprotective activity.
Aim: The aim of the current study was to compare the effectiveness of adjunctive transdermal estradiol to adjunctive placebo in the treatment of acute psychotic symptoms.
Methods: Women of childbearing age with a diagnosis of schizophrenia or schizoaffective disorder were invited to participate in this 8-week three-arm (100mcg/day adjunctive transdermal estradiol, 200mcg/day adjunctive transdermal estradiol, or adjunctive transdermal placebo) double-blind, placebo controlled study. All patients continued to receive standard antipsychotic treatment whilst in the trial. Psychopathology and mood was assessed at baseline then at days 7, 14, 28 and 56 using the PANSS and MADRS rating scales. Estrogen, progesterone, and gonadotropin levels were assessed at baseline and days 28 and 56. Cognitive functioning (RBANS) was assessed at baseline and repeated on day 56.
Results: Preliminary results on psychopathology, hormone levels and cognitive ratings will be presented.
Conclusions: Our previous studies have indicated that women receiving 100mcg transdermal estradiol improved significantly more than women receiving placebo, in terms of positive, negative and general psychopathology symptoms. The findings from this multisite ‘proof-of-concept’ study will determine whether estradiol can be used as an adjunctive treatment of psychotic symptoms in women with schizophrenia.
AOP23 THE MIRROR NEURON SYSTEM IN SCHIZOPHRENIA
Peter Enticott, Kate Hoy, Patrick Johnston, Sally Herring, Jerome Maller, Paul Fitzgerald
Introduction: Deficits in social cognition are well documented in schizophrenia. Particular aspects of social cognitive development (including theory of mind and facial emotion processing) have been linked to the function of mirror neurons, which are cortical brain cells that fire when a particular motor activity is both performed and observed. Mirror neuron impairment is usually linked to the pathophysiology of autism, but there is speculation that the mirror neuron system may also be disrupted in schizophrenia.
Aim: This study aims to investigate whether there is evidence for mirror neuron impairment in schizophrenia, and to explore the link between mirror neurons and facial emotion processing, an important aspect of social cognition.
Method: Patients with schizophrenia or schizoaffective disorder and matched controls were administered transcranial magnetic stimulation (TMS) to the primary motor cortex (M1) during the presentation of motor-related visual stimuli. In this paradigm, mirror neuron activity is reflected in an enhanced motor-evoked potential (following TMS to M1) during action observation that involves the stimulated peripheral muscle. Participants also completed a facial emotion processing task, while clinical rating scales (i.e., PANSS, MINI, Simpson Angus, AIMS) were completed for clinical participants.
Results and conclusions: We evaluate the evidence for a specific mirror neuron impairment in schizophrenia, and discuss the relevance of this system to distinct aspects of social cognition and symptomatology.
AOP24 MISMATCH NEGATIVITY IN SCHIZOPHRENIA: CLINICAL AND NEUROPSYCHOLOGICAL CORRELATES
Philip Ward, Ulrich Schall, Patricia Michie, Paul Thompson, Juanita Todd, Patrick Johnston
Introduction and aims: As part of a multi-site collaborative study, we examined clinical and neuropsychological correlates of mismatch negativity (MMN) in patients with schizophrenia who had been ill for a relatively short time, and those with a more chronic illness course. We tested subjects using both the classic ‘oddball’ paradigm, and a novel paradigm in which the number of standards preceding a deviant varied systematically.
Methods: We tested patients meeting DSM-IV criteria for schizophrenia with a short duration of illness (DOI) (<2 years) and with a long DOI (>5 years) and age and gender matched healthy volunteers. Assessment of executive functions included the Hayling (Sentence Completion) and Brixton (Spatial Anticipation) Battery. EEG data were recorded from 64 scalp electrodes whilst subjects watched a silent movie, and tones were presented via headphones. MMN amplitudes at frontal electrodes were analysed using RMANCOVA. Relationships between MMN amplitude, neuropsychological test results and symptom severity scores were analysed using Spearman's correlations.
Results: There was a significant group effect for MMN amplitude, (p < 0.05) indicating lower MMN amplitudes for the short DOI patient group. In the short DOI patient group, smaller MMN amplitude was correlated with lower GAF scores (p < 0.05), and greater attentional impairment (p < 0.01). In the long DOI patients, smaller MMN amplitude was correlated with greater affective flattening (p < 0.01) on the SANS.
Conclusions: MNN amplitude reduction differs according to duration of illness in patients with schizophrenia, and there is evidence of different patterns of correlation with clinical ratings.
AOP25 OLFACTORY IDENTIFICATION DEFICITS REMAIN STABLE FOLLOWING A FIRST EPISODE OF PSYCHOSIS: WHAT THE EPPIC-MEDIUM TERM FOLLOW-UP STUDY TELLS US FURTHER ABOUT ORBITOFRONTAL FUNCTION THROUGH THE COURSE OF PSYCHOSIS
Warrick Brewer, Stephen Wood, Lisa Henry, Meredith Harris, Christos Pantelis, Patrick McGorry
Introduction: Previous investigation reveals stable olfactory identification deficits (OID) at 6 months following first onset of psychosis (Brewer et al, [2001]), and in an ultra-high-risk group that later developed schizophrenia (Brewer et al, [2003]). Olfactory naming tasks are a useful proxy measure of articulating language around emotional (limbic) material. Moreover, OID may implicate more generalised difficulties in affect regulation. As a potential premorbid marker schizophrenia tranistion, the utility of OID in mapping development and compromise of limbic-prefrontal pathways, particularly in orbitofrontal regions, is important for tracking the relative integrity of circuitry implicated early in the course of psychosis.
Method: In this study we sought to investigate longitudinal change in olfactory identification in first episode psychosis patients using the University of Pennsylvania Smell Identification Test (UPSIT).
Results: Preliminary data from 14 patients and 9 controls (mean time between assessments = 73.4 months, range = 61.4 – 85.2 months) showed no change in performance over time.
Conclusions: These data support our previous longitudinal study and suggest that there is no change in OFC mediated OID with continued psychotic illness. Interaction between OFC and other neural networks implicated in the degenerative aspects of schizophrenia requires further exploration. The findings are discussed in the context of utilising olfactory models of function to track emerging onset of psychopathology as stable OID may place patients at risk for ‘growing into deficit’ as neurodevelopmental arrest becomes more apparent with age.
AOP26 SCHIZOPHRENIA CO-OCCURRING WITH INTELLECTUAL DISABILITY: EVIDENCE OF A COMMON PATHOGENESIS
Vera A. Morgan, Helen Leonard, Assen Jablensky
Introduction: The epidemiology of intellectual disability co-occurring with schizophrenia and other psychiatric illness is poorly understood. The separation of mental health from intellectual disability services has led to a serious underestimation of the prevalence of dual diagnosis, with clinicians ill- equipped to treat affected individuals.
Aim: To estimate the prevalence of dual diagnosis and describe its clinical profile.
Method: The Western Australian population-based psychiatric and intellectual disability registers were cross-linked (total N = 245,749).
Results: Overall, 31.7% of persons with an intellectual disability had a psychiatric disorder; 1.8% of persons with a psychiatric illness had an intellectual disability. Schizophrenia, but not bipolar disorder and unipolar depression, were greatly over-represented among cases of dual diagnosis: depending on birth cohort, 3.7–5.2% of individuals with intellectual disability had co-occurring schizophrenia. Down syndrome was much less prevalent among dual diagnosis cases despite being the most predominant cause of intellectual disability. Dual diagnosis cases had higher mortality rates and were more disabled than those with psychiatric illness alone.
Conclusions: The facility to combine records across administrative jurisdictions has enhanced our understanding of the epidemiology of dual diagnosis, its clinical manifestations and aetiological implications. In particular, our results are suggestive of a common pathogenesis in intellectual disability co-occurring with schizophrenia.
AOP27 MAKING BRAIN FROM SKIN: PROPAGATION OF CANINE DERMIS-DERIVED NEUROPRECURSORS UNDER CONTROLLED CONDITIONS
Michael Valenzuela, Kuldip Sidhu, Sophia Dean, Perminder Sachdev
Introduction: There has been increasing interest in the feasibility of deriving neural stem (NSC)-like cells from both fetal and adult skin. These studies have used the neurosphere assay for propagation, a technique which readily propagates NSCs, however is limited by an inherent cellular heterogeneity. Neuronal yield after differentiation has varied from 6–30%.
Aim: To develop a system of skin-derived neural precursor (SKiNP) culture which includes the secondary step of adherent monolayer propagation and which leads to higher levels of in vitro uniformity and neuronal differentiation.
Method: Waste canine skin samples were obtained from opportunistic veterinary procedures in community dogs. Skin is processed by dissection and enzymatic digestion followed by induction of neural stem-like cells via the neurosphere assay in DMEM media under high mitogenic conditions (bFGF 40ng/ml, EGF 20 ng/ml). Primary neurospheres are then plated in coated flasks, attach and proliferate. Passaging by 2:1 split occurs every 7 days.
Results: SKiNPs have undergone more than 10 population doublings. PCR analysis confirms conservation of neuroprecursor mRNA including Nestin, CD133 and NCAM across passage number. IHC staining for Nestin and NCAM showed that a majority of cells are positive, indicative of a highly uniform neuroprecursor culture. Differentiation studies confirm that most cells acquire a mature neuronal phenotype.
Conclusions: Preliminary results suggest that our SKiNP culture system allows for the efficient generation of large numbers of uniform neuroprecursors which can then differentiate to a mature neuronal phenotype.
AOP28 CYTOKINES IN POST-INFECTIVE FATIGUE SYNDROME: TRIGGER OR DRIVER?
Ute Vollmer-Conna, Barbara Cameron, Dusan Hadzi-Pavlovic, Kristi Singletary, Tracey Davenport, Suzanne Vernon, William Reeves, Ian Hickie, Denis Wakefield, Andrew Lloyd
Introduction: Infection with certain pathogens, including Epstein-Barr virus trigger a debilitating post-infective fatigue syndrome (PIFS) in a significant proportion of individuals (30% at 3 months; 11% at 6 months). We have established a large cohort-the Dubbo Infection Outcomes Study (DIOS) to prospectively study the evolution of PIFS and its pathogenesis. Previous results from DIOS revealed a strong relationship between the severity of symptoms during the acute, febrile phase of the illness and levels of proinflammatory cytokines. Additionally, we have identified significant associations between cytokine polymorphisms and illness severity during acute infection.
Aim: To examine whether aberrant cytokine production drives PIFS after resolution of the febrile phase of acute infective illness.
Method: Peripheral blood and clinical data were collected over 12 months from subjects enrolled in the DIOS. Ex vivo production of eight different cytokines by peripheral blood mononuclear cells was examined in 22 subjects with PIFS and 42 controls who recovered uneventfully.
Results: PIFS status was associated with more severe symptoms in the domains of fatigue, pain, disturbed mood and neurocognitive functioning (P > 0.001for each). However, mixed-effects modelling did not reveal any between-group differences in cytokine levels over time. These results were consistent across all culture conditions (all P > 0.05).
Conclusion: The findings argue strongly against the notion of persistent immune activation and cytokine production in the pathogenesis of PIFS. Taken together findings from DIOD suggest that events occurring early in the acute infection, linked to severity of the acute illness, are critical to an understanding of PIFS.
AOP29 CLOZAPINE SIGNALS THROUGH THE EGF-ERK PATHWAY IN CORTICAL NEURONS. A THERAPEUTIC TARGET FOR REFRACTORY SCHIZOPHRENIA?
Avril Pereira, George Fink, Suresh Sundram
Introduction: The atypical antipsychotic drug clozapine is uniquely effective in treatment-resistant schizophrenia. This singular efficacy may incorporate interactions with a number of G-protein coupled receptors and subsequent targeting of intracellular pathways such as the mitogen activated protein kinase-extracellular signal regulated kinase (MAPK-ERK) cascade. This pathway is critical to early brain development and adult synapse formation, processes altered in schizophrenia. We previously reported that whilst a number of antipsychotic drugs including clozapine acutely inhibited ERK activation, only clozapine stimulated ERK with continued treatment. This stimulation however, was not mediated via Gi/o/q-coupled receptors and PKA/C signalling systems typically associated with these agents. Consequently we examined alternative signalling pathways that clozapine could mobilise to activate ERK including growth factor receptor systems.
Method: Phosphorylation of the MAPK isoforms, ERK1/2 by clozapine in the absence/presence of pathway specific inhibitors was measured in murine cortical cultures by immunoelectrophoresis.
Results: The epidermal growth factor (EGF) receptor inhibitor, AG1478 dose-dependently inhibited pERK1/2 (IC50 0.083 and 0.106uM, respectively) in the presence of clozapine whereas the platelet-derived growth factor receptor inhibitor, tyrphostin A9 did not. Immunofluoresence data then indicated that clozapine treatment increased EGF receptor phosphorylation (Tyr1068) commensurate with ERK signalling. Parallel studies in mice confirmed that clozapine treatment caused rebound cortical ERK activation.
Conclusions: This is the first evidence that clozapine action may be linked to the EGF signalling system. This presents a plausible mechanism by which treatment-resistant patients may be responsive to clozapine therapy and a focus for a new class of treatments unrelated to current antipsychotic drugs.
AOP30 FUNCTIONAL AND BIOCHEMICAL ALTERATIONS OF THE MEDIAL FRONTAL CORTEX IN OBSESSIVE-COMPULSIVE DISORDER
Murat Yücel, Ben J. Harrison, Stephen J. Wood, Alex Fornito, Robert M. Wellard, Jesus Pujol, Kerrie Clarke, Mike Kyrios, Dennis Velakoulis, Christos Pantelis
Introduction: The medial frontal cortex (MFC), including the dorsal anterior cingulate (dAC) and supplementary motor area (SMA), is critical for adaptive and inhibitory control of behaviour. Abnormally high MFC activity has been a consistent finding in functional neuroimaging studies of obsessive-compulsive disorder (OCD). However, the precise regions and the neural alterations associated with this abnormality remain unclear
Aim: To examine the functional and biochemical properties of the MFC in patients with OCD.
Method: Nineteen OCD patients and 19 carefully matched healthy controls were recruited from the general community. We combined volume localized proton-spectroscopy (1H-MRS) and fMRI with a task encompassing inhibitory control processes (the Multi-Source Interference Task; MSIT) designed to activate the MFC.
Results: MSIT behavioural performance did not differ between groups. Reaction-time interference and response errors were correlated with BOLD activation in the dAC region in both groups. Compared to control subjects, OCD patients showed greater activation of the SMA and deactivation of the rostral anterior cingulate (rAC) during high response-conflict relative to low response-conflict (interference > neutral) trials. OCD patients also showed reduced levels of neuronal N-acetylaspartate in the dAC region, which was negatively correlated with their BOLD activation of the region.
Conclusions: Hyperactivation of the MFC during high- relative to low-conflict conditions in OCD patients may be a compensatory response to a neuronal pathology in the region. This relationship may partly explain the nature of inhibitory control deficits that are frequently seen in this group and may serve as a focus of future treatment studies.
AOP31 HIPPOCAMPAL VOLUMETRICS IN TREATMENT-RESISTANT MAJOR DEPRESSION DISORDER AND SCHIZOPHRENIA
Jerome Maller, Jeff Zaskalakis, Paul Fitzgerald
Introduction: Studies of patients with major depression disorder (MDD) or schizophrenia (SCH) have usually revealed reduced hippocampal volumes, but findings have been inconsistent due to sample and measurement differences.
Aim: To measure this structure in a large sample of MDD, SCH and control subjects, using a strict measurement protocol, in order to elucidate morphological-specific volumetric differences.
Method: Forty-five subjects with treatment-resistant MDD, 43 subjects with treatment-resistant SCH, and 26 controls underwent psychiatric assessments and brain MR imaging.
Results: 1) MDD results in reduced hippocampal volume, particularly in the tail section, 2) SCH results in reduced hippocampal tail volume but the rest of the structure is significantly enlarged compared to controls, 3) specific ROI atrophy in treatment-resistant depression is influenced by sex.
Conclusions: Hippocampal volumes are differentially affected in treatment-resistant MDD and SCH, and Region Of Interest estimation protocols and sample characteristics may help explain volumetric differences between previous MDD and SCH studies.
AOP32 BRAIN GLUTATHIONE CONCENTRATION IN FIRST-EPISODE PSYCHOSIS: A MAGNETIC RESONANCE SPECTROSCOPY STUDY
Stephen Wood, Mark Wellard, Tina Proffitt, Mirabel McConchie, Dennis Velakoulis, Christos Pantelis, Patrick McGorry, Gregor Berger
Introduction: Glutathione (GSH) is the main antioxidant in the central nervous system, and plays a major role in protecting the brain from oxidative stress. Furthermore, GSH is an important indicator for amino acid as well as energy metabolism of astroglial cells. Previous work in chronic schizophrenia has demonstrated GSH reductions in CSF and post-mortem tissue, and up to a 52% reduction in prefrontal GSH using magnetic resonance spectroscopy (MRS). It remains unclear whether GSH reduction is present at first onset of psychosis.
Aim: Determine the concentration of GSH in the brains of patients with first episode psychosis.
Method: We assessed GSH concentration in the medial temporal lobes of 31 patients with first-episode psychosis, relative to 18 matched controls. Proton spectroscopy was performed at 3 T (TE = 30ms) and the data were analysed using LCModel.
Results: There was a significant elevation of GSH in the patient group of more than 22% (F1,47 = 5.1, p = 0.029). This was not a medication effect, since both treatment-naïve and treated patients had similar concentrations. However, the elevation was limited to patients who lacked the normal flush response to topical niacin, a proxy measure of cell membrane integrity (5% increase in those with a flush response, 41% increase in those without, F2,45 = 8.0, p = 0.001).
Conclusions: These data suggest that the reaction to oxidative stress in early psychosis is very different to that seen in chronic illness, and may be limited to a specific subpopulation. Determining how this finding relates to symptoms, neurocognition, and clinical outcome is a future research goal.
AOP33 MEDICATIONS ATTITUDES AND TREATMENT ADHERENCE
Chee Ng, Steven Klimidis, Isaac Schweitzer
Introduction: Medication non-adherence is a major obstacle to effective pharmacological treatment of major mental illnesses. Beliefs and attitudes in patients with mental illness can influence medication adherence behaviour which is a result of implicit and subjective assessment of the relative cost/ benefits of treatment. Further, it is necessary to assess medication attitudes and perceptions of psychotropic effects across diverse clinical groups and psychiatric disorders given the broad biopsychosocial factors that impinge on treatment adherence.
Aims: The study aims to measure attitudes towards psychotropic medications in relation to the probability of medication adherence in psychotic patients on antipsychotics and in a comparator group of depressed patients on psychotropics.
Method: Attitudes towards psychiatric medications were assessed using the culturally adapted version of drug attitudes inventory and drug adherence assessment was completed using the Brief evaluation of medication influences and beliefs. Two broad diagnostic groups of psychotic and affective disorders were included and the clinical severity was systematically evaluated with the PANSS and HAM-D in the respective groups. Further, quality of life and drug adverse reaction /side effects were also measured in both groups. In addition the psychotic group were also evaluated with the Barnes akathisia rating scale and Simpson and Angus scale for EPS.
Results: A total of 68 psychotic and 59 affective subjects have been recruited. The results of further analyses between attitude and clinical measures compared within each group and between the psychotic and affective groups will be presented.
Conclusion: Negative attitudes towards psychotropic medications are common among patients prescribed with psychotropics and are relevant in medication adherence.
AOP34 CHANGE IN PSYCHOPATHOLOGY FROM CHILDHOOD TO ADULTHOOD: THE AUSTRALIAN CHILD TO ADULT DEVELOPMENT (ACAD) STUDY
Bruce Tonge, Stewart Einfeld, Andrea Piccinin, Andrew Mackinnon, Scott Hofer, John Taffe, Kylie Gray, Daniel Bontempo, Trevor Parmenter
Comorbid severe mental health problems complicating intellectual disability are a common and costly public health problem. Although behavioral and emotional problems are known to begin in early childhood, we know little of how these problems evolve over time. We examined the course of psychopathology in a representative population of children and adolescents with intellectual disability followed over 14 years with 4 waves of data collection. The sample consisted of 470 children and adolescents with intellectual disability, aged 5–19.5 years at commencement of study. Eighty-four percent of Time 1 participants were followed up at Time 4 and relatively few of the participants received mental health interventions during the study period. Changes over time in behaviour and emotional problems were modeled with growth curve analysis. High initial levels of behavioral and emotional disturbance declined only slowly over time, remaining high into young adulthood. Overall severity of psychopathology was similar across the mild to severe range of intellectual disability. Psychopathology declined more in boys than girls over time, and more so in those with mild intellectual disability. This trend was observed in each area except social relating problems, which increased over time. Information on parental mental health and family functioning will also be reported. The findings provide a solid basis for planning to address the public health problem of behavioral and emotional disturbance complicating intellectual disability. To maximize optimal development of young people with intellectual disability, effective early interventions are needed, together with behavioral supports in educational and early vocational settings.
AOP35 THE COURSE OF POST TRAUMATIC STRESS DISORDER IN CHILDREN: AN EXAMINATION OF RECOVERY TRAJECTORIES FOLLOWING TRAUMATIC INJURY
Robyne Le Brocque, Justin Kenardy, Joan Hendrikz
Introduction: To date, research on post traumatic stress disorder (PTSD) has concentrated on identifying the prevalence and diagnostic assessment of PTSD in select groups. However, little is known about the course of PTSD in adults or children.
Aims: This paper focuses on identifying the trajectories of PTSD symptoms up to two years following traumatic injury in children and their parents. Predictors of different trajectories are explored. In addition, the trajectories identified for children and parents are compared.
Methods: Data for this study comes from a prospective study of 191 children aged between seven and fifteen years who had been admitted to paediatric intensive care units or general paediatric units in Brisbane, Australia, following accidental injury. Analysis utilises the group-based trajectory approach (Nagin, 1999) to identify the number and shape of trajectories which describe the course of PTSD following child trauma.
Results: Results showed three distinct trajectories for children's psychological response to traumatic injury. Parent response was also characterized by three trajectories. Risk factors for these trajectories are explored.
Conclusion: Research suggests that there is a close relationship between child and parent symptoms of distress following child injury. The ability to identify distinct PTSD trajectories post child trauma and the correlates of these trajectories has critical clinical implications for the early identification of children and their parents who may be at risk. The key to successful prevention is early detection of children and their parents who are at risk for the development of PTSD and symptoms.
AOP36 THE HEALTHY LIFESTYLES PROJECT: PILOT DATA FROM A MULTICOMPONENT RISK FACTOR INTERVENTION FOR PEOPLE WITH SEVERE MENTAL ILLNESS
Sacha Filia, Robyn Richmond, Amanda Baker, David Castle, Jayashri Kulkarni, Frances Kay-Lambkin, Rebecca Sakrouge, Rachel Taylor, Dianne Harris, Anthony de Castella
People who experience severe mental illness are more likely to experience cardiovascular disease and a shortened lifespan than the general population.
Aim: To assess the feasibility and effectiveness of conducting a multi-component intervention among people with psychosis across 4 sites in Australia, that focuses on smoking cessation, diet and physical activity.
Method: People experiencing psychosis, who smoked and had a body mass index (BMI) >30 participated in this study. Participants completed an initial assessment, followed by 9 therapy sessions over 13 weeks, and a final assessment at 15 weeks. The intervention included motivational interviewing, cognitive behavioural therapy (CBT) and provision of education and resources. Nicotine Replacement Therapy (NRT) was also offered to participants.
Results: Forty-seven participants with a mean age of 36 years were recruited across 4 sites. Of these, 57% (n = 27) were male, and 62% (n = 29) had a diagnosis of schizophrenia. There was a significant reduction in the number of cigarettes smoked per day and level of nicotine dependence at the final assessment, t(46) = 7.50, p<.001 and t(46) = 6.54, p<.001 respectively. Thirteen participants (28%) reduced their smoking by at least 50%, and eight participants (17%) were completely abstinent at follow-up. Although not statistically significant, there was a trend for reduction in weight and BMI post-treatment. Similarly, level of physical activity increased and diet improved. Ratings of depression and quality of life did not worsen over time. Participants were very satisfied with the intervention.
Conclusion: People with severe mental illness are interested, willing, and able to try and make positive lifestyle changes. This has been a successful and feasible study.
AOP37 OBSERVED MENTAL STATE (OMS) SCALE CHARACTERISTICS AND PROFILES
Ketrina Sly, Terry Lewin, Vaughan Carr, Agatha Conrad, Martin Cohen, Srinivasan Tirupati
Introduction: Relationships within acute psychiatric units between patient-level experiences and events and fluctuations in mental state have rarely been examined.
Aims: In the absence of suitable alternatives, a short observational measure of current mental state was developed – the Observed Mental State (OMS) scale. This paper details our initial experiences with this measure.
Methods: Data from a multi-centre service evaluation were used to examine mental state patterns and associations with clinical characteristics, shift-level events and adverse incidents. Nursing staff completed shift-based logs, including the OMS scale assessing active psychopathology (emotional distress; disinhibition; psychosis; cognitive impairment) and withdrawal.
Results: Day and afternoon shift OMS ratings were available from 54,285 logs completed for 2,467 patients over a 12-month period. The OMS scale appears to have adequate psychometric properties. For example, the active psychopathology factor demonstrated: acceptable internal consistency (0.72); short-term stability (r = 0.72); sensitivity to change (Adjusted Standardised Difference, ASD = 0.71); and evidence of concurrent validity, with respect to diagnostic profiles, associations with PRN medication (ASD = 0.76), reportable (ASD = 1.47) and less serious aggression (ASD = 1.44). Patients with more severe OMS ratings on admission averaged five days longer in hospital.
Conclusions: Routine monitoring of mental state may assist decision-making and evaluation, including decisions about when to switch the focus of inpatient treatment from crisis management to targeted interventions. A lower reporting threshold for the scale is probably desirable, potentially achievable through the provision of increased training around the number and severity of signs/symptoms required for each OMS level.
AOP38 EXPERIENCES OF AGGRESSION AND PTSD SYMPTOMS IN RELATIVES CARING FOR A PERSON WITH SCHIZOPHRENIA
Carmel Loughland, Gali Lawrence, Mick Hunter, Terry Lewin, Vaughan Carr
Introduction: Schizophrenia is a risk factor for aggression and violence. However, while research has investigated incidents of aggression and violence in treatment settings by schizophrenia patients, little research has examined such incidents with respect to domestic situations, particularly the home. This is despite the fact that a large proportions of people with schizophrenia are cared for at home by a relative.
Aims: This study examines relatives' reported experiences of aggression and violence over a 12 month period while caring for a person with schizophrenia, with respect to the levels of distress and trauma experienced, and the coping strategies employed.
Method: Subjects consisted of 108 relatives of schizophrenia patients recruited from the Schizophrenia Research Register. All participants received Pack 1, assessing socio-demographics, personality, psychosis proneness, and perceived prevalence of aggression. Only those reporting experiences of aggression/violence receive Pack 2, which included the Impact of Events Scale and the Ways of Coping Questionnaire.
Results: Two thirds (65.7%; n = 71) of relatives reported experiencing aggression/violence by their affected relative in the past 12 months. Of these, 21.3% (n = 21) reporting a perceived life threat as a result of the aggression/violence. A significant proportion of relatives (49.3%; n = 35) also reported posttraumatic stress symptoms within the clinical range and wishful thinking as their primary coping strategy for mediating the distress
Conclusions: This study provides further evidence that the experiences of relatives caring for a person affected by schizophrenia are often highly stressful, and that additional assistance is needed to support carers of people with schizophrenia.
