ASPR Poster Presentations

BASIC SCIENCE

APP001 TREATING GENERALIZED ANXIETY DISORDER: A RANDOMIZED CONTROL TRIAL COMPARING MINDFULNESS TRAINING WITH CBT

Maree Abbott, Ronald Rapee, Lexine Stapinski

Generalized Anxiety Disorder (GAD) is a common and complex disorder that has proved difficult to treat, with meta-analyses showing relatively poor outcomes. The present study sought to compare contemporary cognitive-behavioural treatment with Mindfulness meditation training for GAD; the active treatments were compared to a waitlist control group. Both treatments were presented in a group format of 12 sessions. All participants were assessed using the ADIS-IV and met the principal diagnostic criteria for GAD. Participants were assessed using self-report questionnaires and the ADIS-IV at pre treatment/waitlist, post treatment/waitlist, 6 and 18 month follow-up. Ninety-six participants completed the study. Data collection for self-report and diagnostic measures has been completed for the pre, post and 6 month follow-up data waves; 18 month follow-up data collection is continuing. Both active treatments made significant improvements in treating GAD, showing enhanced outcomes that were maintained at follow-up. However, mindfulness training produced significantly stronger outcomes in terms of diagnostic severity levels, the proportion of participants entering the non-clinical range and in reducing co-morbid depression. In addition, the active treatments showed no significant differences in drop-out rates or on levels of non-specific therapy factors endorsed by participants. These results show promise for enhancing outcomes and increasing treatment options for people with GAD.

APP002 RESPONDING THERAPEUTICALLY TO ACUTE AGRESSION IN CHILDREN AND ADOLESCENTS

Angela Dean

Behavioural problems in children and adolescents are the “new morbidities” in paediatrics; children in western countries are more likely to die from injuries, violence or suicide than infectious disease. Aggression is one of the most common symptoms in child and adolescent mental health clinics-approximately 50% of all young people presenting to mental health services exhibit aggressive behaviours. Aggression in childhood is associated with poor educational achievement, increased risk of psychopathology in later life, reduced employment, social isolation, crime and suicide. There is a growing body of evidence to support the effectiveness of specific psychological and pharmacological treatments for aggression in young people.

This presentation will review recent research findings on a little researched area-acute management of aggressive behaviour within an inpatient environment. Since fear of violence may impair access to inpatient services for aggressive young people, effective aggression management in this context is crucial. Findings from a series of studies will be presented, which have examined patterns of aggressive behaviour in an inpatient environment, identifying high risk patients, behavioural management and pharmacological management of aggression. These findings indicate that mental health interventions can improve outcomes for aggressive young people, and will be discussed within the broader context of optimising pharmacological treatments for aggressive young people.

APP003 EXAMINING AGE EFFECTS ON PROTOTYPIC MELANCHOLIC SYMPTOMS AS A STRATEGY FOR REFINING DEFINITION OF MELANCHOLIA

Matthew Hyett, Gordon Parker, Judith Proudfoot, Kathryn Fletcher

Introduction: Melancholic depression appears to have an intrinsically later age of onset than non-melancholic depression, and appears sensitive to phenomenological change with age. With differential treatment specificity observed previously in melancholic depression from middle-adulthood, the question remains as to whether such differences are a reflection of an intrinsically later onset or otherwise so explained.

Aim: With these factors in mind, the current study aimed to clarify the candidate features of melancholic depression across two age-bands, while attempting to identify an age at which ‘melancholic’ symptoms become more prototypic.

Method: Of 158 research participants receiving a diagnosis of unipolar depression (45 melancholic: 113 non-melancholic), 60 were ≤34 years of age (12 melancholic: 48 non-melancholic) while the remaining 98 were ≥35 years (33 melancholic: 65 non-melancholic). Individual DSM-melancholic candidate symptom construct scores were calculated to examine the effect of age on the differing expression of symptoms.

Results: Utilising the symptom-based constructs said to reflect DSM-melancholia, results suggested a distinct pattern of change in melancholic depression, a finding not observed in non-melancholic depression. Showing the greatest differential between ages in melancholic depression, were the candidate features of non-reactivity, psychomotor slowing and diurnal mood variation.

Conclusion: Determining the changing phenotypic expression of melancholic depression with respect to age may allow for identification of differing aetiologies and, importantly, may further allow for examination of the suggested treatment differential of narrow- and broad-action antidepressant strategies across different age groups in melancholic depression.

APP04 [3H]PIRENZEPINE BINDING IN BRODMANN's AREA 24 IN POSTMORTEM HUMAN BRAIN

Tammie Money, Elizabeth Scarr, Brian Dean

Introduction: Decreased [3H]pirenzipine binding to cortical M1 receptors has been demonstrated in subjects with schizophrenia, particularly in Brodmann's area (BA) 91. We have recently shown2 [3H]pirenzipine binding in BA 9 can be used to separate subjects with schizophrenia into two populations, one having extremely low levels of muscarinic receptors; which we have termed the muscarinic receptor deficit endophenotype (MRDE).

Aims: To determine if the MRDE phenotype can be detected in another cortical region.

Methods: We measured levels of [3H]pirenzepine binding using in situ radioligand binding and autoradiography in tissue from the anterior cingulate of three cohorts; controls, subjects with schizophrenia who are not part of MRDE and MRDE (n = 20 per diagnostic cohort).

Results: One-way ANOVA revealed a significant variance in [3H]pirenzepine binding with diagnosis (p < 0.0001). Tukey's multiple comparisons showed this difference was due to a significant decrease in [3H]pirenzepine binding in the MRDE (38.77±23.33; p < 0.001) compared to controls (117.9±27.92). There was also a significant difference in [3H]pirenzepine binding between the MRDE and the other subjects with schizophrenia (100.8±16.93; p < 0.001). There was no difference in [3H]pirenzepine binding between the other subjects with schizophrenia and controls (p > 0.05).

Conclusions: This data indicate that the MRDE consist of subjects that have decreased levels of cortical muscarinic receptors in multiple cortical regions.

APP005 DOES PARTICIPATION IN PSYCHIATRIC RESEARCH CAUSE DISTRESS? A SYSTEMATIC REVIEW

Amy Morgan, Anthony Jorm, Claire Kelly

Introduction: Psychiatric research has the potential to cause distress or worsen mental state in participants who undergo assessment or are asked about sensitive issues. Institutional ethics committees concerned about this may unjustifiably restrict potentially useful research.

Aim: To systematically review the evidence for whether psychiatric research causes distress in participants, in order to provide guidance for researchers and institutional ethics committees.

Methods: Studies were included if participants were assessed for a psychiatric disorder, symptoms, or associated risk factors; for the purpose of research; and their negative emotional reactions were systematically recorded. Forty-six studies between 1970 and 2006 were included from a search of PubMed, citations of known papers and reference lists of included papers.

Results: Most studies used weak designs making causal attributions difficult. A minority (generally <10%) of participants from community or clinical samples experience some form of distress. Prevalence of distress from studies of trauma or adverse experiences was generally higher. There was little consistency across studies in which research components were found to be distressing. Participants with mental disorders, symptoms or risk factors were more likely to become distressed. Most studies did not evaluate whether distress persisted, but the limited evidence suggests there is no longer-term harm. Positive reactions were also assessed in many studies, with these generally more common than, and largely independent of, negative reactions.

Conclusions: These findings may guide decision making by researchers and institutional ethics committees.

APP006 COMPLEMENTARY AND ALTERNATIVE MEDICINE USE FOR BIPOLAR DISORDER

Kirsteen Moss, Gin Malhi, Jim Lagopoulos

Introduction: Popularity of complementary and alternative medicine (CAM) as treatment for bipolar disorder continues to grow as patients search for holistic or natural alternatives to pharmacological treatment alone. Although research into the efficacy of CAM is also increasing, the focus is often on depression rather than bipolar disorder, with few controlled studies evaluating this specifically.

Aim: To review evidence of CAM as a treatment for bipolar disorder.

Method: Studies on the topic were identified in Medline, PsychInfo, and Embase using the terms bipolar disorder, mania, hypomania, and bipolar depression in conjunction with the terms complementary/alternative medicine, complementary/alternative therapy, as well as the names of specific treatments. Further articles were identified from the bibliographies of published articles.

Results: Results from studies of CAM and bipolar disorder are discussed with respect to treatment efficacy, methodological issues, and reported side effects.

Conclusion: Much of the evidence supporting the efficacy of CAM as treatment of bipolar disorder is methodologically flawed, thus controlled trials are required to expand knowledge and understanding of the benefits that it may provide. Future research must evaluate not only efficacy, but also the possible risks and side effects of CAM treatments as both monotherapy and adjunctive therapy.

APP007 NEUROMOTOR DYSFUNCTION IN AUTISM AND ASPERGER's DISORDER

Ashwini Nayate, Nicole Rinehart, John Bradshaw, Jenny McGinley, Bruce Tonge, Robert Lansek

Introduction: Autism and Asperger's disorder are currently diagnosed on the basis of the ‘clinical triad’ of social difficulties, stereotyped behaviours or circumscribed interests, and impaired communication. As yet, there is no single feature that fully accounts for the behavioural presentation of these disorders, or that can reliably distinguish between them. Although autism and Asperger's disorder are considered separate disorders in DSM-IV and ICD-10, there is controversy over the validity of their diagnostic distinction given the considerable overlap in clinical presentation. There is promising evidence for a neurobiological marker that may differentiate these disorders and may potentially assist in early detection.

Aim: This study investigated the neurobiological basis of autism and Asperger's disorder, through a neurobehavioural analysis of gait functioning.

Method: Eleven children with high-functioning autism, 11 children with Asperger's disorder, and 11 normally-developing controls completed a series of walking tasks of increasing complexity. Kinematic gait analysis was performed using the GAITRite™ system to measure gait.

Results: There was evidence of qualitatively distinct gait anomalies in autism and Asperger's disorder, with both groups displaying features of striatal and cerebellar gait that were differentially influenced by external demands.

Conclusion: These findings implicate both cerebellar and striatal involvement in autism and Asperger's disorder, but with subtle qualitative differences in their underlying neurobiology. Early brain maldevelopment may explain behavioural similarities in the two disorders, while subtle differences in the timing of this maldevelopment may explain the qualitative differences in neuromotor presentation, cognitive profile, and social functioning.

APP008 HEART RATE VARIABILITY AS A MEASURE OF AUTONOMIC FUNCTION IN DEPRESSION

Catherine Owen, Gordon Parker

Introduction: Research into heart rate variability (HRV) as a measure of cardiac autonomic tone is becoming increasingly popular for a wide range of conditions. Two of these conditions, depression and cardiac disease, are known to be strongly associated although the reasons for their co-occurrence are still unclear. Low HRV is a strong predictor of mortality following an acute coronary event and there is also some evidence that HRV tends to be lower in depressed patients. It has therefore been suggested that dysregulation of the autonomic nervous system indicated by low HRV, may underlie the association between these conditions.

Aim: To review studies examining the association between HRV and depression.

Results: There have been a large number of case-control studies of HRV in depressed patients both with and without co-morbid cardiac disease. The majority have found a modest reduction in HRV in those with depression but results have been highly heterogeneous. This is unsurprising given the wide variety of approaches to HRV assessment and the large number of covariates known to influence HRV. Given these limitations, the evidence from treatment studies is particularly interesting. A wide range of treatments including antidepressant medication, ECT, psychotherapy, expressive writing and acupuncture have been shown to lead to both improved mood and a corresponding increase in HRV.

Conclusion: It seems that low HRV may be a marker of depressive symptomatology and may underlie, to some degree, the association between depression and cardiac disease.

APP009 DURATION OF UNTREATED NEGATIVE SYMPTOMS (DUNS) AND DURATION OF ACTIVE NEGATIVE SYMPTOMS (DANS): PROOF OF CONCEPTS

Antonia Stuart, Brendan Murphy

Introduction: Negative symptoms are responsible for enormous burden in schizophrenia yet they remain under-recognised and under-treated. There is mounting evidence that early intervention is crucial and that response to treatment falls away with chronicity. Current measures of illness duration fail to adequately capture the true time course of negative symptoms and new concepts are required to correct this and to focus clinical attention.

Aim: The aim of this paper is to introduce accurate measures of negative symptom duration.

Method: Two new concepts, the duration of untreated negative symptoms (DUNS) and the duration of active negative symptoms (DANS), were trialled in a first-episode sample with primary negative symptoms.

Results: The new measures were easy to calculate and more accurately reflected the total duration of negative symptoms than currently available measures. The mean duration of untreated psychosis was 23 weeks, whereas the DUNS was 93.79 weeks.

Conclusions: Applicability of the concepts needs confirming by replication with a larger cohort. Introduction of these concepts may have widespread implications for the timely and efficient treatment of negative symptoms and the reduction of the total burden of illness of schizophrenia within society.

APP010 EFFICACY OF AMISULPRIDE IN TREATING PRIMARY NEGATIVE SYMPTOMS IN FIRST-EPISODE PSYCHOSIS: A PILOT STUDY

Antonia Stuart, Brendan Murphy, Darryl Wade, Sue Cotton, Patrick McGorry

Introduction: Negative symptoms are debilitating and associated with poor role functioning and reduced quality of life. There is a paucity of research on antipsychotic efficacy against on primary negative symptoms, particularly in first-episode psychosis (FEP).

Aim: To undertake a prospective, open-label pilot trial to investigate the use of amisulpride in the treatment of young people with FEP characterised by primary negative symptoms.

Method: Twelve male and two female first-episode patients with primary negative symptoms (aged 16 to 26) were commenced on low-dose amisulpride (mean 250 mg/day) and followed-up over a six-month period. Primary outcome measures were the Scale for the Assessment of Negative Symptoms (SANS), the Quality of Life Survey (QLS) and their respective subscales.

Results: For the twelve completers there was a statistically significant improvement in SANS summary score (p = 0.036), Affective Flattening subscale global score (p = 0.046), QLS total score (p = 0.021) and QLS subscales of Instrumental Role (p = 0.018) and Intra-psychic Foundations (p = 0.009) from baseline to week to 24.

Conclusions: Amisulpride appears to be associated with less severe negative symptoms and improved quality of life. Generalisabilty of the findings is limited by the small sample size and open-label design of our study, however the positive findings suggest that further controlled trials are warranted.

CLINICAL NEUROSCIENCE-IMAGING

APP011 REDUCED DURATION MISMATCH NEGATIVITY IN SCHIZOPHRENIA

Ross Fulham, Ulrich Schall, Patrica Michie, Phillip Ward, Matthew Hughes, Patrick Johnston, Paul Rasser

Reduced mismatch negativity (MMN) is a common finding in patients with Schizophrenia. This project examines the developmental time course of the deficit as well as exploring its neurological basis using a variety of imaging techniques. EEG, fMRI and structural MRI data were obtained from chronic patients with schizophrenia (>5 years duration, N = 19), recent-onset patients (<2 years duration, N = 12), and age and gender matched controls. A Duration Deviant MMN paradigm was used in which participants hear an unattended random series of tones consisting of standards (92%, 50 ms duration) and deviants (8%, 100 ms duration). High resolution MMN ERPs (64 channels) were obtained as the difference between the response to deviants and standards. Cortically constrained LORETA current source density analysis was performed using Curry V4.6. Structural MRIs were used to construct Realistic Head Models and cortical surfaces for each individual for the source analysis. fMRI analysis was performed comparing blocks of standards and deviants to blocks of standards. Reduced MMN amplitude was seen in recent-onset, but not in chronic patients. This is consistent with our previous findings. Current source density analysis suggests that the major cortical generator of the MMN lies in the Superior Temporal Gyrus (STG) as expected. Controls display marked right hemispheric dominance in the STG, which was absent in patients. The latter phase of the MMN and the P3a engage more anterior cortical regions including inferior frontal cortex. The results are consistent with a deficit that onsets early in the disorder.

APP012 STRUCTURE-FUNCTION DISSOCIATION AND REDUCED INTERHEMISPHERIC CONNECTIVITY IN THE AUDITORY CORTEX OF PATIENTS WITH AUDITORY HALLUCINATIONS

Maria Gavrilescu, Susan Rossell, Raka Maitra, David Copolov, Tracey Shea, Katherine Henshall, Colette McKay, Alex Sergejew, Gary Egan

Introduction: Previous studies indicated a role for the auditory cortices (AC) in the pathophysiology of schizophrenia. Our previous work demonstrated AC deficits in AHs patients that could be explained by interhemispheric pathway dysfunction. The aim of this study was to investigate the structure–function relationship and the interhemispheric connectivity separately for the primary (PAC) and secondary auditory cortices (SAC) in AHs patients.

Methods: Twenty-six schizophrenia patients (13 AHs) and sixteen controls were scanned while passively listening to semantically neutral words and at rest. PAC and SAC were manually delineated on the structural scans of all subjects in both hemispheres. Structural and functional laterality coefficients were estimated within the ROIs for each subject and compared across groups using ANOVA. Resting state interhemispheric functional connectivity was estimated for the same ROIs.

Results: The AH group demonstrated reduced leftwards structural laterality of the PAC when compared to controls while both patients groups showed rightward functional laterality. For the SAC the structural laterality was similar across groups while both patients groups showed symmetric activation.

The interhemispheric functional connectivity was reduced for the AHs group for both ROIs compared with the nonAHs and controls.

Conclusions: We have identified a structure-function dissociation for PAC in schizophrenia patients, with AHs patients showing more severe impairments than the nonAHs patients. Reduced interhemispheric connectivity indicates deficient integration of basic auditory information with higher order language processing. Our results suggest that the well documented higher order language functions deficits in schizophrenia might be explained via deficits in processing of basic acoustics.

APP013 EXAMINING AUDITORY PROCESSING AND AFFECTIVE PROSODY IN PATIENTS WITH SCHIZOPHRENIA AND THEIR RELATIVES: A BEHAVIOURAL AND NEUROIMAGING STUDY

Christopher Groot, Susan Rossell, Maria Gavrilescu

Introduction: Affective prosody conveys information about the emotional content of an utterance. Prosodic comprehension is lacking in schizophrenia, especially for patients experiencing auditory hallucinations. Though recognized as a robust higher-order linguistic faculty, receptive affective function is necessarily reliant upon the sensory and lower order cognitive processing of fundamental auditory components of affective prosody (frequency, amplitude, and duration). Recent research has identified deficits in fundamental auditory processing as well as abnormalities in the structural and functional neurobiology of auditory and emotion processing areas which may account for prosodic dysfunction observed in schizophrenia.

Aims: The current project aims to: 1) examine fundamental auditory processing substrates of prosodic dysfunction in schizophrenia; 2) investigate the relationship between fundamental auditory processing, affective prosody, and auditory hallucinations in schizophrenia; 3) identify the neurobiological substrates of prosody and fundamental auditory processing in schizophrenia using fMRI to investigate functional connectivity in auditory and emotion processing regions (i.e. primary and secondary auditory cortices, and amygdala).

Method: Three groups of fifty participants (schizophrenia patients, unaffected siblings and healthy controls) will perform three auditory tasks which examine auditory components of prosody (frequency, amplitude and duration). Additionally, participants will perform a prosody task which assesses ability to correctly label the emotion of a spoken sentence. A group of participants will perform the three auditory tasks and affective prosody task during an fMRI scan.

Results: Initial results will be reported in the ASPR poster presentation.

APP014 AN FMRI STUDY OF THEORY OF MIND IN BIPOLAR DISORDER

Gin Malhi, Jim Lagopoulos, Kirsteen Moss, Catherine Cahill

Introduction: Patients with bipolar disorder experience impairments of social functioning and the maintenance of relationships. This'compromise' is often accompanied by neuropsychological deficits across mood states. An area of executive functioning that has salience in this context is that of Theory of Mind (ToM). ToM underpins an individual's ability to comprehend and respond suitably by way of attributing mental states to others.

Aim: To investigate cognitive deficits in bipolar disorder using a novel functional magnetic resonance imaging (fMRI) compatible ToM paradigm.

Methods: Twenty adult right-handed euthymic bipolar patients and twenty age and gender-matched controls underwent clinical assessment and fMRI using a ToM paradigm. Subjects completed a 10 min block design experiment using alternating ToM and non-ToM conditions. fMRI volumes were acquired using a gradient echo planar imaging sequence and each volume contained 28-non-interleaved-4 mm thick slices. T1-weighted high-resolution images were also acquired. Concurrent eye-movement recording allowed psychophysiological measures to be acquired.

Results: Preliminary analysis indicates the presence of a differential pattern of prefrontal activation between the two groups. Both groups showed activation in occipital regions consistent with recognition of shape, colour and movement-however, only the control group had activation in the prefrontal cortex to the ToM condition.

Conclusions: A lack of activation to ToM in bipolar patients suggests dysfunction of fronto-limbic regulation that forms the substrate of social cognition. This study is important as real-world tests examining subtle neurocognitive impairment are likely to be more informative as regards clinical impairment and the social disability that patients experience when seemingly well.

APP015 ABNORMAL WHITE MATTER MICROSTRUCTURE IN SCHIZOPHRENIA: A TBSS VOXELWISE ANALYSIS OF AXIAL AND RADIAL DIFFUSIVITY

Marc Seal, Murat Yücel, Alex Fornito, Stephen Wood, Ben Harrison, Mark Walterfang, Gaby Pell, Christos Pantelis

Introduction: Diffusion Tensor Imaging (DTI) investigations in schizophrenia have provided evidence of diffuse impairment in white matter as indicated by reduced fractional anisotropy (FA). However, the neuropathological implications of abnormal FA in schizophrenia remain unclear.

Aim: In the current study, we conducted a voxelwise analysis of the constituent parameters of FA, axial (λ∣∣) and radial (λ?) diffusivity, in subjects with schizophrenia and healthy controls.

Method: DTI data was acquired from fourteen participants with schizophrenia and fourteen age-, gender-, education-, and premorbid intelligence-matched healthy controls. Using Tract-Based Spatial Statistics (TBSS), voxelwise comparisons were conducted between these groups on the key diffusivity measures (FA, λ∣∣, λ?) along major white matter pathways common to all individuals.

Results: Significantly reduced FA was observed in several major white matter tracts in the schizophrenia group. Furthermore, a number of these regions including the superior longitudinal fasiculi bilaterally were also identified as regions where the schizophrenia group demonstrated higher Radial Diffusivity (λ?). No between group differences were evident in Axial Diffusivity (λ∣∣).

Conclusions: The finding of spatially concurrent abnormal FA and radial diffusivity suggests that the loss of white matter integrity in schizophrenia is the result of demyelination and/or changes to the axonal cytoskeleton rather than gross axonal damage.

APP016 THE PARIETAL LOBE IS NEGLECTED IN ADHD RESEARCH: AN FMRI STUDY

Alasdair Vance, Ross Cunnington, Xavier Castellanos

Introduction: There is emerging fMRI evidence for widespread dysfunction in neural systems involving prefrontal, striatal and parietal brain regions in children and adolescents with ADHD. To date, response inhibition fMRI tasks that focus on fronto-striatal activation have been used in the majority of studies investigating ADHD. In contrast, our group has examined spatial working memory, an equally important candidate endophenotype for ADHD that is subserved by frontal, striatal and parietal neural circuits, in pre- and post-pubertal boys with ADHD.

Aim: In this study, we address known key limitations by using an fMRI spatial working memory activation task that is constrained by known specific brain behaviour relationships based on non-human primate data to examine twelve 8–12 year old pre-pubertal boys with ADHD, combined type (ADHD-CT) and twelve matched healthy control participants, who are more representative of the core of the disorder.

Method: A cross sectional case control study using an fMRI mental rotation paradigm.

Results: The control participants showed significantly greater activation in the right cuneus/precuneus (BA 19; 24,−70, 32) and inferior parietal lobe (BA 40; 36,−40,50), and also showed significantly greater activation in more frontal regions including the right caudate body (18,−12,22), extending to the caudate head. There were no regions of significantly greater activation in the boys with ADHD-CT than in the control participants.

Conclusions: Our results suggest that hypoactivation of the right cuneus/precuneus and inferior parietal lobe is a developmental stage independent finding in childhood and adolescent ADHD. The concordance of these findings with Castellanos' group's recent resting state network fMRI results will be further explored in this presentation.

APP017 MULTI-FREQUENCY PHASE SYNCHRONY ABNORMALITIES IN PATIENTS WITH FIRST-EPISODE SCHIZOPHRENIA

Thomas Whiteford, David Alexander, Gary Flynn, Wilson Wong, Anthony Harriss, Steven Silverstein, Cherrie Galletly, Christopher Rennie, Pritha Das, Peter Boord, Evian Gordron

Whilst phase synchrony in the gamma frequency band has consistently been implicated in the integration of sensory stimuli, recent research has indicated that synchrony in the lower frequency bands may play a role in integrating cognitive information. This study explored the changes in phase synchrony that occurred in 109 healthy participants and 47 patients with first-episode schizophrenia (FES) at 25 frequencies between 2 and 45Hz in response to the presentation of a neutral face stimulus. The time/frequency synchrony plots revealed a distinct ‘column of synchronization’ (hypersynchronization in the frontal regions, desynchronization elsewhere) for both groups, between approximately 150ms pre-stimulus to 200ms post-stimulus, at frequencies less than approximately 15Hz. The FES patients differed from the healthy participants in that they generally exhibited increased levels of phase synchronization, especially at frequencies >10Hz in the right centero-temporal region and <10Hz in the left frontal region. If neural synchronization is related to the mechanism underlying cognitive integration, then abnormally elevated levels of neural synchrony might underpin the cognitive dysmetria that is typically observed in patients with schizophrenia.

APP018 GENERAL AND SOCIAL COGNITION IN FIRST EPISODE SCHIZOPHRENIA: IDENTIFICATION OF SEPARABLE FACTORS AND PREDICTION OF FUNCTIONAL OUTCOME USING THE INTEGNEURO TEST BATTERY

Lea Williams, Thomas Whiteford, Gary Flynn, Wilson Wong, Belinda Liddell, Steven Silverstein, Cherrie Galletly, Anthony Harriss, Evian Gordon

Aims: It is increasingly recognized that cognitive assessment, unlike symptom ratings, provides a reliable predictor of functional outcome in schizophrenia. This study evaluated the utility of the ‘IntegNeuro’ computerized test battery for assessing cognition in first episode schizophrenia. We determined the presence of separable factors of general and social cognition, their equivalence to the consensus domains identified by the NIMH MATRICS project, and their effectiveness in predicting real world functional outcomes.

Method: Fifty six first episode schizophrenia (FES) patients and 112 matched healthy controls were assessed on the touchscreen-based ‘IntegNeuro’ cognitive test battery and FES patients for social functioning (SOFAS) and quality of life (WHOQOL-BREF).

Results: Principal components analysis identified i) six factors corresponding to MATRICS domains of general cognition (‘Information Processing Speed’, ‘Verbal Recall’, ‘Working Memory Capacity’, ‘sustained Attention/Vigilance’, ‘Verbal Processing’, ‘Executive Function’), ii) an ‘Emotional Intelligence’ factor corresponding to the MATRICS social cognition domain, and iii) an additional ‘sensori-Motor Function’ factor of general cognition and ‘Negativity’ factor of social cognition. Patients showed impairments relative to controls across all factors, but especially for Working Memory Capacity, followed by Verbal Memory, Sustained Attention/Vigilance and Negativity. These factors strongly predicted poorer social functioning in FES, along with poorer quality of life in psychological, social, and health satisfaction facets.

Conclusion: The IntegNeuro battery has utility for assessing separable domains of general and social cognition in FES, which are predictive of real world outcomes. Thus, it may be appropriate for clinical application, including in multi-centre trials targeting new treatments for cognition in schizophrenia.

CLINICAL NEUROSCIENCE-OTHER

APP019 IS IMPLICIT SEQUENCE LEARNING IMPAIRED IN SCHIZOPHRENIA?

Elliot Bell, Richard Siegert, Mark Weatherall

Introduction: Cognition in schizophrenia seems to be characterised by impaired performance on tests of explicit or declarative learning, alongside relatively intact performance on tests of implicit or procedural learning. However, there have been conflicting results for studies using the Serial Reaction Time (SRT) task to examine implicit learning in people with schizophrenia.

Aims: This presentation describes research using meta-analysis to clarify whether or not people with schizophrenia show impaired performance on the SRT task.

Methods: A systematic review found nine studies in peer review journals comparing the performance of people with schizophrenia with healthy controls on the standard SRT task or a variant of it. Five of these reported data in a form that could be used in a meta-analysis. The resulting meta-analysis represented the responses of 137 participants with schizophrenia and 88 healthy controls on the SRT task.

Results: The analysis found that participants with schizophrenia perform less well than controls reflected by a pooled effect size of 0.55. A secondary analysis of all nine studies found that eight reported a point estimate of the change in reaction time between sequence and random trials that was greater for the controls.

Conclusions: We conclude that there is a moderate impairment in implicit sequence learning among people with schizophrenia and speculate on the implications of this for understanding the disorder. Suggestions for improving the methodological quality and statistical reporting of studies of this topic are made.

APP020 IS VELO-CARDIO-FACIAL SYNDROME (VCFS) A USEFUL MODEL FOR UNDERSTANDING THE GENETICS AND PATHOGENESIS OF SCHIZOPHRENIA?

Stanley Catts, Vibeke Catts

Introduction: There is dispute as to how closely psychotic disorder secondary to VCFS resembles schizophrenia.

Aim: To compare characteristics of VCFS-related psychotic disorder with those of schizophrenia.

Method: Literature review.

Results: The sex-ratio, age-of-onset distribution, premorbid precursors, symptom profile, neurocognitive correlates, pattern of dysmorphisms, and treatment response show similarity with schizophrenia. High levels of developmental comorbidity observed in VCFS (autistic spectrum and attention deficit disorder; and cardiac, endocrine and immunological abnormalities) are not apparent in schizophrenia. Most studies involve small sample sizes.

Conclusions: The 22q11.2 microdeletion causing VCFS may represent a specific genetic predisposition to schizophrenia, along with a broader group of developmental disorders. Availability of excellent mouse models of VCFS, eg the df1/+ mouse, permits immediate neuroanatomical and molecular investigation of the associated pathogenesis.

APP021 F.A.S.H. SCORE: AN AFFECTOMETRIC TOOL FOR CLINICAL PRACTICE

Anthony Durrell

Introduction: The rating of mood and affect in the clinical setting is a challenging task given the inherently nebulous nature of the emotional dimension of the psyche.

Aim: This paper offers a psychoeducative mood model which extends to form the theoretical basis for a mood rating instrument that is time efficient, visuo-spatially orientated and easily translated to a simple numeric F.A.S.H. score.

Method: The F.A.S.H. score, an acronym, is based upon an analogy to colour theory in that the vast range of emotional states is hypothesised to be the variable mixture of four primary mood or affect states: Fear, Anger, Sad, Happy (F.A.S.H.). Patients and clinicians utilize a visuospatial pie chart tool to express, non-verbally, their mood/affect in terms of the mixture of primary moods.

Results: This affectometric F.A.S.H. score has proven valuable when utilized by psychiatrists, psychologists and general practitioners, therefore offering a sound interdisciplinary platform for efficient and valid communication of affect data.

Conclusions: The F.A.S.H. scoring method not only accommodates mood disorder ratings, but also delivers measurements which pertain to euthymic and mixed mood states. The F.A.S.H. system is useful in terms of treatment response monitoring, subtyping of mood disorders, mood goal setting and psychoeducation.

APP022 TRANSCRANIAL MAGNETIC STIMULATION IN AUTISM AND ASPERGER'S DISORDER: MOTOR FUNCTION AND MIRROR NEURONS

Peter Enticott, Nicole Rinehart, Paul Fitzgerald, Bruce Tonge, John Bradshaw

Introduction: Movement abnormalities are an associated feature of both autism and Asperger's disorder, but the neurobiology of such impairment is unclear.

Aim: Transcranial magnetic stimulation (TMS), a painless and non-invasive means of stimulating nerve cells in cortical regions, offers a unique method with which to investigate and perhaps improve motor-related brain function in autism spectrum disorders. The aim of this research is to explore the use of TMS in autism and Asperger's disorder.

Method: Children and adolescents with autism and Asperger's disorder were administered a range of TMS paradigms designed to investigate or alter motor cortical function.

Results: Our initial studies of TMS in children and adolescents reveal deficient motor cortical inhibition (reflecting disruption of activity at GABA A receptors) in autism, which could reflect both movement abnormalities and repetitive behaviours. At present, we are evaluating the use of repetitive TMS to improve movement-related EEG activity in autism spectrum disorders, and investigating the role of mirror neurons (i.e., premotor cortex neurons that fire during both action and observation) in core symptoms and associated features of autism spectrum disorders.

Conclusions: While enhancing our understanding of the neurobiology of autism spectrum disorders, TMS also provides a promising direction for neurobiological therapeutic intervention.

APP023 A STUDY OF THE EFFECTIVENESS OF BILATERAL TRANSCRANIAL MAGNETIC STIMULATION IN THE TREATMENT OF THE NEGATIVE SYMPTOMS OF SCHIZOPHRENIA

Paul Fitzgerald, Sally Herring, Kate Hoy, Susan McQueen, Rebecca Segrave, Jayashri Kulkarni, Zafiris J. Daskalakis

Background: Repetitive transcranial magnetic stimulation (rTMS) is increasingly being investigated as a potential treatment for a number of psychiatric disorders, including schizophrenia. Previous rTMS studies have targeted the left-side prefrontal cortex (PFC) in the treatment of negative symptoms, with inconsistent findings. Some imaging evidence suggests right-sided or bilateral PFC involvement in negative symptoms, areas yet to be investigated for rTMS treatment.

Aim: The study therefore aimed to assess the efficacy of bilateral high-frequency rTMS in the treatment of negative symptoms.

Method: A two-arm double-blind randomised controlled trial was conducted with 20 patients with a diagnosis of schizophrenia or schizoaffective disorder, and moderate to severe treatment-resistant negative symptoms. Participants received a three week course of high-frequency bilateral rTMS or sham. Twenty trains (5 seconds duration) of 10 Hz rTMS at 110% of the RMT were administered to each PFC daily, five days a week.

Results: No significant group or time differences in SANS scores or cognitive outcomes were evident. However, a trend for greater reduction in scores on the autistic preoccupation scale of the Positive and Negative Symptom Scale for the active group compared to the sham group was observed (p = 0.05).

Conclusions: No substantial benefit of high-frequency bilateral rTMS was seen in the treatment of the negative symptoms of schizophrenia. Further research is required to explore whether rTMS may have benefit specific to specific cognitive or symptom domains.

APP024 A PILOT STUDY EVALUATING THE EFFECT OF MASSAGE THERAPY ON STRESS, ANXIETY AND AGGRESSION ON A YOUNG ADULT PSYCHIATRIC INPATIENT UNIT

Belinda Garner, Lisa Phillips, Martin Schmidt, Connie Markulev, Jenny O'Connor, Stephen Wood, Gregor Berger, Peter Burnett, Patrick McGorry

Introduction: Psychiatric hospitalization is frequently associated with a high degree of stress and anxiety due to the controlled and confined nature of hospitalization and acute psychiatric symptoms, which can in turn exacerbate aggression.

Aims: This study examined the effectiveness of introducing a relaxation massage therapy program to reduce anxiety, stress and aggression on a young adult psychiatric inpatient unit.

Methods: Treatment as usual (TAU) was compared with TAU plus massage therapy intervention (MT). MT consisted of 20-minute massage therapy session offered daily during the period of hospitalisation in addition to standard treatment. The Nurses’ Observational Scale for Inpatient Evaluation, Symptom Checklist-90-Revised (SCL-90-R), State-Trait Anxiety Inventory (STAI) and stress hormone (cortisol) levels were used to measure patient outcomes at admission and discharge from the unit. The Staff Observation Aggression Scale-Revised (SOAS-R) was used to monitor aggressive incidents on the unit.

Results: Anxiety (STAI), resting heart rate and saliva cortisol levels were significantly lower immediately following the initial and final massage therapy sessions. Significant improvements in hostility and depression scores on the SCL-90-R were observed in both groups. There was no group by time interaction on any of the measures. Poor reliability of staff-reported incidents on the SOAS-R limited the validity of results in this domain.

Conclusions: Massage therapy had immediate beneficial effects on anxiety-related measures and may be a useful de-escalating tool for reducing stress and anxiety in hospitalized psychiatric patients. Study limitations preclude any definite conclusions on the effect of massage therapy on aggressive incidents in an acute psychiatric setting.

APP025 NEUROLOGICAL SOFT SIGNS ARE ASSOCIATED WITH GLOBAL COGNITIVE PERFORMANCE AND DELAYED WORD RECALL PERFORMANCE IN OLDER ADULTS WITHOUT DEMENTIA.

Kathryn Greenop, Osvaldo Almeida, Leon Flicker, Chris Beer, Frank Van Bockxmeer, Ralph Martins, Kevin Taddei, Nicola Lautenschlager

Introduction: Neurological soft signs (NSS) are non-localising neurological signs that have previously been associated with global cognitive performance, and may be associated with memory decline in older adults and genetic risk factors for dementia.

Aim: To investigate the association between NSS and cognitive performance and genetic risk factors for dementia in older adults.

Methods: 183 non-demented older adults (ages 65 and above) were assessed on the CERAD battery and CAMCOG. An experienced geriatrician or psychogeriatrician assessed each participant on the NSS checklist. APOE genotype and APOE −491 promoter polymorphisms were determined.

Results: Spearman's correlations found significant negative associations between NSS total score and performance on the CAMCOG (? = − 0.26, p = < 0.001) and the delayed word recall tasks from the CERAD (= − 0.27, p < 0.001). No association was found between NSS and the APOE −491 promoter polymorphism, although subjects with an APOE ?4 allele showed a non-significant trend towards higher NSS scores (p = 0.061). Logistic regression found that low NSS scores were significantly associated with high CAMCOG and word delayed recall performance when adjustments were made for age, sex, years of education and APOE genotype (OR = 0.34, (0.17–0.67) & OR = 0.39 (0.20–0.74)).

Conclusions: Neurological soft signs are associated with global cognitive and delayed word recall performance in older adults. Longitudinal follow-up of this sample may help determine the predictive value of NSS on cognitive decline in older adults.

APP026 INHIBITORY CONTROL AND SPATIAL WORKING MEMORY: A SACCADIC EYE MOVEMENT STUDY OF NEGATIVE SYMPTOMS IN SCHIZOPHRENIA.

Caroline Gurvich, Paul Fitzgerald, Nellie Georgiou-Karistianis, White Owen

Background: The negative symptoms of schizophrenia are perhaps the most unremitting and burdensome features of the disorder. Negative symptoms have been associated with distinct motor, cognitive and neuropathological impairments, possibly stemming from frontostriatal dysfunction. Ocular motor research is a particularly advantageous means of evaluating cognitive and motor functioning.

Aim: this study examined the ability of patients with schizophrenia, with and without prominent negative symptoms, to perform a variety of eye movement paradigms to investigate basic sensorimotor functions, inhibitory control and spatial working memory.

Methods: Twenty-one patients meeting DSM-IV criteria for schizophrenia (10 with high and 11 with low ratings of negative symptoms) and 14 controls participated. Tasks explored suppression of reflexive saccades during qualitatively different tasks, the generation of express and anticipatory saccades, and the ability to respond to occasional, unpredictable (“oddball”) targets that occurred during a sequence of well-learned, reciprocating saccades between horizontal targets. Spatial working memory was assessed using a single and a two-step memory-guided task (involving a visually guided saccade during the delay period).

Results: Results indicated significant increases in response suppression errors, as well as increased response selection impairments, during the oddball task, in schizophrenia patients with prominent negative symptoms. Schizophrenia patients with increased negative symptoms scores were also more variable in their performance and generated saccades with increased peak velocities.

Conclusions: Collectively, these findings provide further support for the proposed association between frontostriatal dysfunction and negative symptoms.

APP027 INTERHEMISPHERIC MOTOR CORTICAL EXCITABILITY AND INHIBITION MODULATION IN SCHIZOPHRENIA WITH A TMS PAIRED ASSOCIATIVE STIMULATION PARADIGM

Kate Hoy, Kylie Lloyd, Peter Enticott, Robin Laycock, Paul Fitzgerald

Introduction: Only transcranial magnetic stimulation (TMS) paradigms that induce decreased plasticity in the primary motor cortex (M1) have been used to assess TMS induced plasticity in schizophrenia. 25ms paired associative stimulation (PAS25) can also result in increased M1 plasticity. The purpose of the study is to investigate the effect of PAS25 on bilateral M1 excitability, inhibition and unilateral TCI in schizophrenia to help demarcate mechanism behind abnormal plasticity in schizophrenia.

Methods: 15 healthy and 15 subjects with schizophrenia were recruited. Bilateral pre-interventional muscle evoked potentials (MEP), a measure of M1 excitability, cortical silent period (CSP), and unilateral TCI were ascertained. 100 PAS pairs, where right median nerve stimulation at 300% of perceptual threshold was paired with TMS at 125% of the resting motor threshold over the left abductor pollicis brevis M1 region at interstimulus intervals 25ms, were applied. Bilateral MEP, CSP and unilateral TCI were ascertained post-PAS and pre- and post-interventional measures were compared.

Results: PAS25 resulted in a significant increase in stimulated M1 excitability in the control group, with no significance detected in the patients. No significance was found for CSP in the stimulated left hemisphere or for any measure in the right non-stimulated M1, with a lack of TCI variation also evident. The patients exhibited significantly shorter CSP when the data set was pooled.

Conclusions: PAS25 resulted increased plasticity in the control group; however, no M1 plasticity was detected in the patient group. The current experiment adds to the body of knowledge of abnormal plasticity in schizophrenia.

APP028 POSITIVE CORRELATION BETWEEN MORNING PLASMA LEVELS OF DHEAS AND HADS TOTAL SCORES, OR HADS ANXIETY SUB-SCALE TOTAL SCORES IN MEDICATION-FREE FEMALE PATIENTS EXPERIENCING A MAJOR EPISODE OF DEPRESSION

Cheng-Cheng Hsiao

Introduction: Although numerous studies have identified correlation between dehydroepiandrosterone sulfate (DHEAS) levels and anxiety or depression, those findings remain controversial.

Aim: This study attempted to determine whether a correlation exists between depression severity and anxiety severity and serum DHEAS concentrations in medication-free patients experiencing a major depression episode.

Method: Twenty-eight medication-free major depressive outpatients (Hamilton Rating Scale for Depression 17, HAM-D 17 score³ 17) were enrolled consecutively. Plasma DHEAS levels of all subjects were measured. Blood from subjects was drawn at 0900–1100h. Depression severity was assessed with the HAM-D 17 and the Hospital Anxiety and Depression Scale (HADS) depression sub-scale. Anxiety was assessed using the HADS anxiety sub-scale. Serum concentrations of DHEAS were measured immediately following the HAM-D 17 and HADS assessments.

Results: A significant, positive correlation was identified between HADS anxiety sub-scale total score and morning serum DHEAS concentration (p = 0.013) after controlling for age, gender and body mass index (BMI). No statistically significant correlations were found between depression ratings and morning serum DHEAS concentrations.

Conclusions: This preliminary study provides a pilot data that morning serum DHEA-S concentrations were positively correlated with HADS anxiety sub-scale score (anxiety severity) after controlling for age, gender and BMI in medication-free outpatients experiencing a major depression episode. It is not known if morning serum DHEA-S levels would show similar or dissimilar changes in non-depressed subjects. The result needs subsequent replication.

APP029 ANTISOCIAL BEHAVIOR: POTENTIAL TREATMENT WITH BIOFEEDBACK

Neha Khetrapal

Introduction: Psychopaths and people with conduct disorder cause considerable cost to society, both in financial and emotional terms.

Aim: It is therefore important to develop new treatment interventions for them.

Method: A comprehensive review of the papers investigating the disturbed psychophysiological mechanisms of psychopaths and people with conduct disorders was carried out. A review of literature of biofeedback research was also carried out to look at the mechanisms that can be potentially treated by biofeedback before determining whether the approach of biofeedback could be potentially applied as a new direction for the treatment of such disorders.

Results: The current article suggests that the psychophysiological approach of biofeedback offers a potential positive treatment intervention based on the various atypical underlying mechanisms that can serve to maintain the disorders.

Conclusions: It is not only important to develop suitable treatment approaches but also to evaluate the treatment outcomes on the basis of internationally acceptable guidelines.

APP030 SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)-A POTENTIAL TREATMENT FOR THE PSYCHOTIC SYMPTOMS OF SCHIZOPHRENIA

Jayashri Kulkarni, Paul Fitzgerald, Emorfia Gavrilidis, Anthony de Castella, Caroline Gurvich, Heather Gilbert, Susan Davis

Introduction: Several contemporary investigators have reported promising findings using adjunctive hormones in the treatment of psychosis and depressive symptoms, as well as the prevention of cognitive decline. To overcome the potential risks of breast/endometrial cancer and thromboembolic events associated with long term, unopposed estrogen treatment, Selective Estrogen Receptor Modulators (SERMs), such as raloxifene, were developed. Our pilot study demonstrated an improvement in aspects of cognition in post-menopausal women with schizophrenia who received adjunctive raloxifene 60mg/day.

Aim: The current study examined the efficacy of a higher dose of raloxifene (120mg/day) in the treatment of psychopathology in postmenopausal women with schizophrenia. Cognitive functioning and the impact on the hypothalamo-pituitary-gonadal axis were also investigated.

Method: The study employed a 12 week, double-blind, randomised, placebo-controlled, adjunctive treatment trial design. Post-menopausal women with a diagnosis of schizophrenia or schizoaffective disorder were invited to participate and randomised to receive adjunctive raloxifene 120mg/day or adjunctive placebo. Patients also received olanzapine (15 or 20mg/day, orally). Psychopathology, cognitive function and hormone assays were measured fortnightly.

Results: Preliminary findings will be presented.

Discussion: While the findings of our pilot study indicated an improvement in aspects of cognition (verbal recognition memory, psychomotor speed and inhibitory control), changes in psychopathology were not observed with a dose of 60mg/day raloxifene. The current study will extend these findings using an increased dose of raloxifene of 120mg/day.

APP031 DEPRESSION AND THE COMBINED ORAL CONTRACEPTIVE PILL: A RANDOMIZED CONTROLLED TRIAL INVESTIGATING THE EFFECTS OF DROSPIERNONE AND LEVONORGESTREL UPON MOOD STATE IN HEALTHY WOMEN

Jayashri Kulkarni, Natasha Marston, Caroline Gurvich, Anthony de Castella, Paul Fitzgerald, Robin Bell, Susan Davis

Introduction: Physical risks associated with Combined Oral Contraceptives (COCs) are well described, however knowledge surrounding a possible relationship between COC use and psychological health remain contentious. Limited evidence from observational studies suggests COCs might induce or exacerbate depressed symptomatology. Furthermore, lowered mood is commonly cited to explain why women discontinue COC utilization.

Aim: To conduct a pilot study to explore whether women who use a COC have a greater level of depressed symptoms compared to women not using COCs, and to establish a randomized controlled trial to explore whether COCs adversely affect mood in healthy women.

Method: 58 women took part in an observational study, which compared levels of depression between users and non users of COCs. A double blind trial has been recently launched, comparing the effects of two commonly prescribed COCs- daily oral Drospirenone + ethinyl estradiol (Yasmin), or daily oral Levonoregestrel + ethinyl estradiol (Levlen)- with daily oral placebo in 225 healthy women. Psychopathology measures and general health assessments, including menstrual cycle information will be compared between the 3 groups before, during and after a 16 week period.

Results: Pilot study findings, which indicated women using a COC had significantly lowered mood than those who were COC naive, we intend to present the establishment of and preliminary data from the randomized controlled trial.

Conclusion: Implications for the information generated by these studies are far reaching, and include contributing to the development of prescriber guidelines for COCs, identifying women who may be more susceptible to depression following COC use, and deepening our understanding of the influence of hormones upon a serious and burdensome condition.

APP032 TAMOXIFEN-A POTENTIAL TREATMENT FOR WOMEN IN THE MANIC PHASE OF BIPOLAR AFFECTIVE DISORDER

Jayashri Kulkarni, Ling Mu, Anthony de Castella, Caroline Gurvich, Paul Fitzgerald, Susan Davis

Introduction: Bipolar Affective Disorder (BPAD) is an illness with high morbidity and mortality. Lithium and other mood stabilisers are the main treatments for BPAD, despite little being known about their mechanisms of action. Recent attempts to elucidate the biochemical actions of these drugs have focussed on the Protein Kinase C (PKC) pathways. Another PKC inhibitor hypothesised to be effective in the treatment of mania is tamoxifen, a selective estrogen receptor modulator with estrogen receptor antagonist actions in the CNS.

Aim: The aim of the current study was to compare the effectiveness of two adjunctive antiestrogen agents (tamoxifen and progesterone) to placebo in the treatment of acute mania.

Method: Women in the manic phase of BPAD or schizoaffective disorder were included in this 28-day, three-arm (40 mg/day oral tamoxifen or 20 mg/day oral progesterone or oral placebo) double-blind, placebo controlled, adjunctive study. All patients also received a mood stabiliser as the baseline treatment. Manic, psychotic and depressive symptoms were measured weekly using the CARS-M, PANSS and MADRS rating scales respectively, as were estrogen, progesterone, and gonadotropin levels. Cognitive functioning (RBANS) was assessed in a sub-sample of participants at baseline and repeated on day 28.

Results: Results of 43 women indicated a decline in the symptoms of mania and psychopathology in the tamoxifen group, and to a lesser extent in the progesterone and control groups.

Discussion: The results suggest that tamoxifen may be a useful adjunct in the treatment of acute manic symptoms in women with BPAD.

APP033 CHANGE IN CLINICAL STATUS AND QOL OF PATIENTS TREATED WITH OLANZAPINE: 12-MONTH RESULTS OF THE POST MARKETING SURVEILLANCE IN JAPAN

Motoki Kuramochi, Naohiro Nakahara, Noriko Takagaki, Shinji Fujikoshi, Michihiro Takahashi

Introduction: The Olanzapine Post Marketing Surveillance in Japan (OPMS-J) is 12-month, prospective, observational study of the health outcomes associated with olanzapine treatment in Japan. Patient enrollment started before November 2003, and completed by July 2004. Aims: To present the 12-month change in clinical status and QOL score in patients with olanzapine treatment, and to describe the correlation between clinical status and QOL score.

Methods: A total of 1,955 out/in-patients were enrolled in the OPMS-J, of whom 1,849 were considered as qualified subjects for the analysis of effectiveness. Clinical status and QOL score were measured in the study: Clinical Global Impression-Schizophrenia scale (CGI-SCH) and EQ-5D. Regarding the correlation between with clinical status and QOL, Pearson's correlation coefficient was used to estimate the association between changes in CGI-SCH scores and change in EQ-5D score.

Results: CGI-SCH (positive symptoms, negative symptoms, depression, cognitive disorder and overall symptoms) scores and EQ-5D score significantly improved when the scores at the baseline were statistically compared with those at the endpoint of 12-month follow-up or the end of the surveillance (p < 0.001). Also, the deterioration rate of patients status was less than 5% in the group measured with CGI-SCH. The correlation between changes in CGI-SCH scores and EQ-5D score were moderate in positive symptoms, cognitive disorder and overall symptoms.

Conclusion: The improvement of patient-reported outcomes with respect to olanzapine was confirmed in the OPMS-J, a post marketing surveillance in Japan. Also, it was suggested that EQ-5D score should be supportive data for symptoms improvement with olanzapine in Japan.

APP034 INTRODUCTION OF AN ACUTE SEDATION PRACTICE GUIDELINE AND THE IMPACT ON CLINICAL PRACTICE AND SAFETY IN AN ACUTE PSYCHIATRY SERVICE

Stuart Lee, Karen Hirth, Yitzchak Hollander, Michael Dooley, Anthony Decastella

Introduction: Managing aggression in acute psychiatry is critical for ensuring a safe and therapeutic environment, and requires behavioural, pharmacological and/or containment interventions. A vast array of pharmacological options are available, with often little clear guidance about what, when, how much, and how frequently to use different options. To improve practice safety and consistency, Alfred Psychiatry implemented an acute sedation practice guideline (ASPG), outlining pharmacological and behavioural intervention recommendations.

Aim: Evaluate the impact of an ASPG on safety and use of medication for aggression.

Method: Safety and medication data during three time periods was compared: 1) six months before implementation 2) four months during implementation 3) six months after implementation. Safety and critical incident data represents the total number of critical incidents on two inpatient units (including seclusion rates). Medication and demographic data was from retrospective file audits of patients admitted to either inpatient unit who also spent time in high dependency (n = 313).

Results: Significant increases in oral Olanzapine use and decreases in oral Chlorpromazine use followed ASPG implementation. Use of IMI antipsychotics (Olanzapine and Zuclopenthixol Acetate) significantly increased with significant decreases in IMI benzodiazepine (Clonazepam and Midazolam) use suggesting improved treatment of underlying psychotic symptoms. Improved safety was also seen with significant reductions in falls, patient on patient assaults and staff injuries after implementation.

Conclusion: Implementing an ASPG significantly altered clinical practice and improved safety. With seclusion use not significantly increased, this improved safety is likely associated with better patient management and not increased use of restrictive interventions.

APP035 ANTISACCADE PERFORMANCE IN PATIENTS WITH SCHIZOPHRENIA, THEIR UNAFFECTED FIRST-DEGREE RELATIVES AND HEALTHY CONTROLS

Shahrzad Mazhari, Milan Dragovic, Peter Clissa, Greg Price, Flavie A. V. Waters, Assen Jablensky

Introduction: Saccadic eye movement dysfunction has been extensively investigated in schizophrenia patients, with the majority of studies reporting increased error rates and prolonged latencies to correct antisaccade. Relatively few studies have examined the saccadic performance in relatives of schizophrenia patients, and the results are inconsistent.

Aims: (i) To undertake a detailed comparison of saccadic performance in schizophrenia patients, their relatives and controls. (ii) To investigate the impact of attention, short-term memory and speed of processing on the antisaccade task performance.

Method: The performance of 92 schizophrenia patients, 98 unaffected relatives and 62 controls was assessed on a standard AS task. Stepwise multiple regression analysis was conducted to examine effects of attention (CPT-IP), memory (RAVLT) and the inspection time (IT) on antisaccade measures.

Results: Schizophrenia patients exhibited significant increases in AS errors, prolonged latencies to both error and correct responses. While relatives did not differ from controls on AS error rates, they had increased latencies to error responses. Self-correction time did not differ between schizophrenia patients, relatives and controls. Measures of attention, memory and speed of processing explained a small proportion of the variance in error rates in patients.

Conclusion: While the finding of an increased AS error rate in schizophrenia patients robustly replicates results reported by other studies, our finding of normal error rate but increased saccadic latencies in relatives is nove. The low level of impact of other cognitive measures on AS indicates that AS dysfunction is relatively independent of generalised cognitive deficit in schizophrenia patients.

APP036 CAN WE PREDICT PLACEBO/NOCEBO RESPONSE AND SIDE-EFFECT SENSITIVITY BASED ON ATTACHMENT STATE OF MIND?

Loyola McLean, Vicki Maddison, Christopher Tennant

Introduction: The ability of the mind to anticipate the outcome of help seems to underlie the placebo/nocebo response and is the focus of a small body of recent neurocognitive research. Attachment theory clearly outlines internal working models of relationship that predict the usefulness, consistency and the potential harmfulness of help.

Aims: Based on pilot data collected during a larger project on depression and coronary heart disease and in the context of recent literature we offer the hypothesis that the underlying state of mind with respect to attachment will help explain and potentially predict placebo vs nocebo response.

Method: In our NHMRC-funded study of Mood and Coronary Heart Disease following depressed participants longitudinally, we treated these patients with medication and/or psychotherapy. For many we attempted a clinical assessment of the predominant baseline attachment state/s of mind. We found a high prevalence of disorganised and/or incoherent attachment states of mind.

Results: Both anticipated and actual nocebo responses were uncommon but were significantly associated with an incoherent/disorganized attachment state of mind. An anticipated nocebo response significantly predicted an actual nocebo response.

Conclusions: If replicable, the implications for treatment go beyond the reassurances of pharmacological “no-harm” that have been suggested and may occasionally necessitate drug cessation or withholding until psychotherapy can shift the underlying cognitive schema. This model of the nocebo response now requires more rigorous testing.

APP037 IS TYPE D (DISTRESSED) PERSONALITY A LINK BETWEEN AFFECT DYSREGULATION, AND THE STRESS SYSTEM DISORDERS OF DEPRESSION AND CARDIOVASCULAR DISEASE?

Loyola McLean, Christopher Tennant, Christopher Ward, Geoffrey Berry, Vicki Maddison, Marie-Christine Morel-Kopp, Walter Chen, Geoffrey Tofler

Introduction: Depression is a risk factor for cardiovascular disease (CVD). The trait affect dysregulation of Type D (distressed) personality, a combination of the tendency to experience negative affects and the social inhibition of affective expression, has been associated with worse outcome in CVD and dysregulated HPA axis function.

Aims: We hypothesised that Type D would adversely impact on prothrombotic and inflammatory CVD risk factors.

Methods: In a longitudinal interventional case-control study of 103 clinically depressed outpatients and 46 controls without CVD where we found a prothrombotic/inflammatory profile associated with depression, we measured the presence of Type D personality and its impact on changes with intervention (medication and/or psychotherapy).

Results: We found a high prevalence of Type D personality in the depressed group (49%, χ²=21.90, p<.001). Post-treatment changes in the prothrombotic profile, adjusted for covariates (age, gender, O/non-O blood group, BMI change, ongoing antidepressants) showed that active treatment was associated with a relative fall in fibrinogen (p = 0.009), platelet count (p = 0.001) and vWFAg (p = 0.023), whereas Type D was associated with significant rises in fibrinogen (p < 0.001) and platelet count (p = 0.009). There was a significant interaction between Type D and non-treatment (p < 0.01), increasing fibrinogen and platelet levels. Results remained significant after adjustment for change in depression scores (p < 0.05).

Conclusions: Type D may be a risk factor for depression and CVD and a target for intervention.

APP038 THE ROLE OF NEUROCOGNITIVE FUNCTIONING ON MEDICATION ADHERENCE AND HEALTH BEHAVIOURS IN SCHIZOPHRENIA AND DEPRESSION

Ling Mu, Paul B. Fitzgerald, Felicity Allen

Introduction: There is an excess of physical morbidity and premature mortality in populations of the mentally ill. Individuals with schizophrenia and depression have specific characteristics that make them vulnerable to such risks, such as decreased participation in healthy behaviours, medication non-adherence and cognitive deficits.

Aim: To investigate the influence of neurocognitive function and medication adherence on health behaviours in schizophrenia and depression.

Method: 22 individuals with schizophrenia, 16 depression and 19 controls participated in the current cross-sectional study. Three executive function (Tower of London test; TMT-A & B; COWA) and two memory assessments (HVLT-R and the Digit Span subtest) were used. Health behaviours and medication adherence were assessed by the Health Behaviours Checklist and the Medication Adherence Scale respectively. Psychotic and depressive symptoms were assessed by the PANNS and MADRS respectively.

Results: There were no significant associations between cognitive functioning and medication adherence. In schizophrenia, poorer attentional processes were significantly correlated with decreased health strategy of managing stress. In depression, better planning and organisational abilities influenced better cognitive-affective health behaviours in managing emotional distress and negative feelings. Medication adherence was positively associated with a broad array of health behaviours. In schizophrenia, negative and general psychopathology symptoms negatively influenced dietary health behaviours, social support and stress management. In depression, symptom severity negatively influenced adequate sleep.

Conclusion: Specific executive functioning deficits and psychiatric symptoms may have important implications in the participation of health behaviours.

APP039 CHOLINERGIC FUNCTION AND ECT-RELATED MEMORY DYSFUNCTION

Melissa Pigot, Chittaranjan Andrade, Colleen Loo

Introduction: Recently, there has been interest in the role of cholinergic transmission in memory and cognition, with evidence to suggest that it plays a key role in the impaired cognitive functioning associated with Alzheimer's disease and electroconvulsive therapy (ECT). Electroconvulsive shock (ECS) (an animal model of ECT) dampens cholinergic neurotransmission and causes significant amnesia in animals, suggesting that cholinergic dysfunction may contribute to ECT-induced cognitive impairment.

Aims: To review the literature in this area and identify pharmacological agents/strategies that may protect against the development of memory impairment associated with ECT.

Method: A comprehensive PUBMED and MEDLINE search was conducted to identify studies examining cholinergic function after ECS/ECT.

Results: Two types of agents were identified as modulators of cholinergic neurotransmission that could improve memory outcomes in ECT: cholinesterase inhibitors (ChEIs) and thyroid hormone.

Two studies reported significantly better post ECT memory function in participants receiving a ChEI rather than a placebo. L-triiodothronine significantly improved both retrograde and anterograde memory outcomes after a course of ECT. Thyroid releasing hormone (TRH) however, did not appear to influence memory function post ECT.

Methodological issues (dose, timing, assessment of memory function) significantly affect outcomes and will be discussed.

Conclusion: Agents that reverse changes in cholinergic neurotransmission induced by ECT may improve memory outcomes after ECT. The use of thyroid hormones and ChEIs should be further investigated, as potential neuroprotective strategies in ECT.

APP040 TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) FOR THE TREATMENT OF DEPRESSION: COGNITIVE AND NEUROPSYCHOLOGICAL FINDINGS

Melissa Pigot, Colleen Loo, Perminder Sachdev, Gin Malhi, Jim Lagopoulos, Philip Mitchell

Introduction: Transcranial direct current stimulation (tDCS) uses a weak current applied across the scalp to non-invasively and focally stimulate targeted cortical regions. Studies have demonstrated that tDCS can have lasting effects on brain functioning, possibly antidepressant effects, and also the ability to enhance or impair neuropsychological functioning.

Aims: To test if single and repeated sessions of left prefrontal anodal tDCS have positive or negative effects on neuropsychological functioning.

Method: As part of a clinical trial testing the antidepressant efficacy and safety of tDCS in depression, subjects were randomly assigned to receive 5 sessions of sham or active tDCS. Anodal tDCS was given second daily for 20 minutes, at 1 mA intensity to the left prefrontal cortex. Neuropsychological functioning was tested immediately before and after a single session of tDCS (reaction time; Symbol Digit Modalities Test) and after 5 sessions (verbal learning; Digit Span; verbal fluency; Trails Making a & b). Changes in mood were also measured across the 5 sessions.

Results: Preliminary results in the first 16 subjects found no decline in neuropsychological functioning immediately after tDCS or after 5 sessions. It is possible that tDCS may enhance functioning (specifically in working memory), though in the current sample observed changes did not reach significant levels. This study is in progress and results from a larger sample will be presented, accounting also for associated changes in depression scores.

Conclusion: Left prefrontal anodal tDCS as an antidepressant treatment does not impair neuropsychological function.

APP041 SOURCE MONITORING IN PSYCHOSIS

Tracey Shea, Alex Sergejew, Denis Burnham, David Copolov, Gary Egan

Auditory hallucinations (AHs) and passivity experiences in psychosis reflect an apparent inability to recognise self-generated events as belonging to the self. Frith (1992) proposed that self-monitoring deficits might be associated with passivity symptoms in general rather than AHs in particular. Earlier studies of source monitoring for specific patient groups have been inconsistent, and may have been confounded by an association between source monitoring deficits and passivity phenomena in general, rather than specific symptoms such as AHs. This study hypothesised that source monitoring deficits would be present for: 1) AH patients compared to non-AH patients; and 2) high passivity patients compared low passivity patients. Both hypotheses were tested in the same study design of 22 controls and 37 patients. The patient group was dichotomised by the presence or absence of AHs, and also dichotomised into high and low passivity symptom groups. Participants completed a source monitoring task comprising of two word-association lists. The participant and the experimenter both generated 24 words for each list. Participants were tested on their ability to monitor the origin of the items in these lists. No significant differences for overall hit rates were found between AH (M=.76, SD=.07) and non-AH (M=.78, SD=.11) patient groups. In contrast, patients with high passivity symptoms (M=.27, SD=.11) were significantly more likely to misattribute self-generated items to the experimenter than low passivity (M=.17, SD=.11) patients (p<.05). This is consistent with Frith's assertion that errors of self-monitoring accord with passivity symptoms in general, rather than specific symptoms of psychosis.

APP042 PSYCHOTIC SYMPTOMS PRESENTING TO A PAEDIATRIC HOSPITAL: A PILOT STUDY OF EARLY ONSET PSYCHOSIS

Jean Starling, Anthony Harriss, Lea Williams

Introduction: There is a large literature on first episode psychosis, including early onset psychosis (before 18), but childhood onset schizophrenia (very early onset, before the age of 13) is rare. However, early onset cases in many branches of medicine often have more risk factors and can provide essential information in the search to understand the psychopathology or pathophysiology of a condition, and this is hypothesised to be the case for psychosis1.

Aim: This study was designed to determine the number and type of cases of possible early or very early onset psychosis presenting to a paediatric teaching hospital, to investigate the feasibility of a prospective study of these patients.

Methods: The medical records of patients over a two year period, identified from their discharge diagnosis, were reviewed looking for symptoms of early psychosis and associated features including previous psychiatric history.

Results: Ninety six patients were identified after medical record review. The average age was 13.6 and 60% were female. Just under half were experiencing their first episode with psychotic symptoms, but 80% had a previous episode of an emotional, behavioural, developmental or medical disorder. Symptoms included hallucinations (43%), delusions (30%), disorganised speech or behaviour (48%) and negative symptoms (36%). A third presented with self harm, suicidal ideation or a suicide attempt. All but one patient were admitted, for an average of 11 days.

Conclusion: A possible study population was identified. Although only a retrospective chart review was approved by the Ethics Committee, so the data is incomplete, some avenues for further exploration in a prospective study were suggested.

APP043 LIBET, CONSCIOUS DECISIONS, AND THE NATURE OF FREE WILL

Judy Trevena

Barring some major dysfunction, we generally feel as though we have free will – the ability to control our own actions and decide whether to take one course of action or another. Likewise, we hold other people morally and legally responsible for their actions, on the understanding that they too are free to choose what they do. But is this compelling impression of free will merely an illusion? The well-known experimental results of Professor Benjamin Libet (1916–2007) demonstrated that the brain starts to prepare for a voluntary hand movement half a second before the movement starts, well before the time that the participant reported that they had consciously decided to move. What role do our conscious decisions play in determining our actions? Do Libet's data imply that the existence of free will is in question, and if so, what are the implications of his findings?

APP044 BETTER VISUOSPATIAL MEMORY RETRIEVAL IN CHILDREN AND ADOLESCENTS WITH MEDICATION NAIVE MAJOR DEPRESSIVE DISORDER

Alasdair Vance, Nicole Hall

Introduction: Impaired concentration is a key diagnostic criterion of major depressive disorder (MDD), yet definitive deficits of attention and memory in MDD remain elusive. Currently, equivocal visuospatial recognition and recall memory findings are reported in young adults with MDD, with clear age and stage of illness effects evident across the adult life span. Yet, visuospatial memory has not been specifically studied in children and adolescents with MDD.

Aim: In this study, we address known key limitations by using a visuospatial memory task constrained by known specific brain behaviour relationships based on non-human primate data to examine 10–16 year old children and adolescents with MDD (N = 33), compared to a clinical control group of 27 dysthymic disorder participants and 21 age-, gender- and IQ-matched healthy control participants.

Method: A cross sectional case control study using the Cambridge Neuropsychological Test Automated Battery delayed matching to sample (DMTS) task.

Results: The children with MDD demonstrated better visuospatial memory performance as the length of the delay condition increased. This suggested better retrieval ability in the MDD participants compared to the clincial and healthy control groups.

Conclusions: Our findings suggest that early onset MDD may be associated with increased functioning of medial temporal linked neural networks known to subserve visuospatial memory retrieval ability. Clinical and neurobiological implications are explored in this presentation.

COGNITIVE SCIENCES

APP045 APPLICATIONS OF NEUROPSYCHOLOGY WITHIN YOUTH PSYCHIATRY

Kelly Allott, Tina-Marie Proffitt, Warrick Brewer

Introduction: Neuropsychology is the study of brain-behaviour relationships, specifically focussed on the assessment, identification and analysis of the impact of pathological brain states on cognition, affectivity and behaviour. Neuropsychology remains a relatively young discipline within psychiatry and more so within youth psychiatry.

Aim and method: The ORYGEN Neuropsychology Unit is embedded within a specialised youth mental health service, ORYGEN Youth Health. In this presentation we will explore the research and clinical applications of neuropsychology within this youth mental health setting.

Results: The onset of psychiatric illness peaks during adolescence/young adulthood, coinciding with a significant period of neurodevelopment. Psychiatric illness is frequently associated with cognitive impairments. These ‘impairments’ may: 1) reflect pre-existing neurodevelopmental compromise or vulnerability markers; 2) mediate the course of illness; and/or 3) be clear sequelae of psychiatric illness, possibly resulting from neurodegeneration. From a research standpoint, application of neuropsychological practices to healthy and clinical adolescent samples can assist in disentangling these impairments and refining knowledge regarding cognitive contributions to functional outcome. From a clinical perspective, neuropsychological formulations are useful in providing understanding of individual presentations during initial assessment and diagnostic phases, as well as over the course of psychiatric illness.

Conclusion: Neuropsychological assessment and intervention during emerging severe mental illness is particularly useful for helping young people gain an understanding of self, specifically their cognitive strengths and weaknesses and associated functioning, with the aim of assisting them in managing their illness and achieving/recovering role functioning.

APP046 ENCODING DEFICITS IN SPATIAL WORKING MEMORY IN SCHIZOPHRENIA REFLECT SLOWED PROCESSING RATHER THAN IMPRECISION OF SPATIAL LOCATION.

Johanna Badcock, David Badcock, Christina Read, Assen Jablensky

Introduction: Deficits in encoding of spatial working memory (SWM) have been proposed as a potential endophenotype for schizophrenia. It has been suggested that such deficits arise as a result of encoding imprecision rather than a critical deficit in maintenance.

Aim: The current study examined the influence of processing speed and fine-grained encoding accuracy on SWM performance in patients with schizophrenia and healthy controls.

Method: The VisuoSpatial Working Memory test was administered to forty two schizophrenia patients and forty eight healthy controls. This novel delayed-response test requires subjects to point, as accurately as possible, to the location of visual targets. An adaptive staircase procedure was also used to equate stimulus duration for each individual at the start of testing. Working memory accuracy for both distance (mm) and direction (deg) was examined either immediately or after a 4 sec (unfilled) delay.

Results: The results showed that target detection was markedly slower in patients than controls whilst accuracy of immediate distance and direction responses was not significantly different. In contrast, following a 4s delay patients were significantly less accurate than controls in both distance and direction responses.

Conclusions: These findings indicate that SWM deficits in schizophrenia largely reflect impairments in processing speed and maintenance of spatial location information rather than a loss of precision at encoding.

APP047 COGNITIVE COMPROMISE IN ADOLESCENTS WITH BIPOLAR DISORDER

Catherine Cahill, Tanya Hanstock, Gin Malhi

Introduction: There is a growing interest in the area of child and adolescent bipolar disorder. Researchers and clinicians are not agreed on whether the phenomenology of the disorder in younger populations is the same as in the adult version of the disorder.

Aim: In order to better describe the presentation of the disorder in young people, more specific and sensitive neuropsychological testing is required.

Method: An adolescent sample of patients with bipolar disorder completed a neuropsychological battery designed to assess general neuropsychological performance as well as more sensitive aspects of social cognition.

Results: Adolescents with bipolar disorder present with specific neuropsychological deficits. Some of these overlap with deficits found in adult bipolar populations.

Conclusions: The findings are discussed in light of difficulties with diagnostic specificity, comorbidity, heritability and cut-offs for age and disorder. Preliminary findings in studies of young people with bipolar disorder suggest they experience similar neuropsychological symptoms to those found in adults. Suggestions for future research directions will be discussed.

APP048 MISSING NART SCORES? UTILITY OF DEMOGRAPHIC EQUATIONS

Milan Dragovic, Flavie Waters, Prof Assen Jablensky

Introduction: Quantification of premorbid intellectual functioning is an essential aspect of research and clinical practice in schizophrenia, and is commonly estimated using the NART. However, it is not always possible or appropriate to use the NART (dyslexia, English as second language).

Aim: To develop demographically-based regression equations that will provide a useful and quick estimate of premorbid IQ.

Method: A regression analysis (stepwise procedure) was used to identify which of five demographic variables significantly predicted NART scores in schizophrenia patients. The new regression equation was subsequently assessed in an independent patient sample. The results were compared with scores obtained by an equation developed in healthy populations (Crawford & Allan, 1997).

Results: Age, occupation, and education contributed significantly to the equation, which accurately predicted NART scores in our patient sample. However, the equation developed in healthy people consistently underestimated NART scores.

Conclusion: Equations developed in healthy people are not accurate predictors of NART scores. By contrast, our new equation acknowledges the educational and occupational characteristics typical of individuals with schizophrenia. The equation should be used cautiously, but can be used as a rapid estimate when it is not possible to conduct a cognitive assessment using more traditional approaches.

APP049 INTELLECTUAL DISABILITY MODERATES GENDER DIFFERENCES IN PSYCHOPATHOLOGY

Louise Ellis, Stewart Einfeld, Bruce Tong, John Taffe, Sian Horstead

Introduction: Although gender differences in psychopathology among the general population appear to be well documented, there has been limited research into whether such differences exist among people with intellectual disability. Lunsky (2003) has made considerable progress in the adult intellectually disabled population in relation to depression; however, further investigations are required to fully understand gender and psychopathology in general, and not just depression, and its impact across the lifespan.

Aims: This study examined whether or not there are gender differences in the prevalence of psychopathology in an intellectually disabled population. Further, where differences between males and females were found, are there any mediating variables? Specifically, when intellectual disability and mental age are controlled for, do the gender differences still occur.

Methods: The Australian Child to Adult Development (ACAD) Study began in 1990 and has followed the development of emotional and behavioural problems in more than 1000 children and young people with intellectual/developmental disabilities. This study is based on four waves of longitudinal data that examine the development of behavioural and emotional disorders over a 12-year period.

Results: Gender differences in depression were found only in people with severe mental retardation, with females being reported to have higher levels of depression than their males. No further differences between the genders were found in relation to depression or anxiety. Total behaviour problem scores for the whole sample did not yield any gender differences.

Conclusions: This study failed to find consistent patterns of gender differences in psychopathology among young people with intellectual disability.

APP050 SCREENING FOR BIPOLAR DISORDER: THE UTILITY AND COMPARATIVE PROPERTIES OF THE MSS AND MDQ MEASURES

Kathryn Fletcher, Gordon Parker, Melissa Barrett, Howe Synnott, Michael Breakspear, Matthew Hyett, Dusan Hadzi-Pavlovic

Aim: To further determine the diagnostic utility of the Mood Swing Survey (MSS) in distinguishing bipolar and unipolar disorders, and draw comparisons between this measure and the widely-used Mood Disorder Questionnaire (MDQ).

Method: The MSS was administered to 247 patients attending the Black Dog Institute Depression Clinic Survey (MSS) as part of a computerized Mood Assessment Program (MAP). Independent diagnostic decisions by assessing psychiatrists and a research interview determining DSM-IV criteria for bipolar disorder were ascertained for a sub-sample of patients.

Results: MSS diagnoses embedded within the computerized program correctly classified 82.2% of cases when compared to clinician diagnosis. Comparable sensitivity and specificity were obtained when using pre-established cut-off scores for the MSS-46 and the MDQ (86.5% and 60.0% vs. 78.8% and 71.4%). Optimal cut-off scores calculated based on the current sample were ≥35 (Se = 88.5%, Sp = 60.0%) for the MSS-46, and ≥7 (Se = 78.8%, Sp = 71.4%) for the MDQ.

Conclusions: The diagnostic utility of the MSS requires testing in differing clinical and community samples to determine cut-off score stability. Comparisons between this measure and other established screening instruments such as the HCL-32 will be necessary to further refine the operating characteristics of the MSS.

APP051 GENDER DIFFERENCES IN SENSORY PROCESSING AND HIGHER-ORDER COGNITIVE FUNCTION IN SCHIZOPHRENIA AND BIPOLAR DISORDER

Andrea Gogos, Maarten van den Buuse, Susan Rossell

Introduction: Gender differences exist in schizophrenia and bipolar disorder (BD). The role of gender on cognitive deficits is unclear. Deficient early sensory processing may underpin dysfunction of higher cognitive abilities.

Aim: To examine gender differences in sensory processing and higher-order cognitive processes in schizophrenia and BD.

Method: Schizophrenia (16M:10F) and BD (11M:14F) patients were compared with age- and IQ-matched control participants (16M:15F). Sensory processing or gating was measured with prepulse inhibition (PPI). PPI included 21 pulses (115dB), and 21 prepulse-pulse trials (prepulse: 74, 78, 86dB) at 2 inter-stimulus intervals (ISI; 60, 120ms). Higher-order cognition measures included memory, attention, language, visuospatial ability, executive function and emotion processing.

Results: Schizophrenia patients tended to show lower PPI at 60ms ISI, particularly males. This trend was similar for BD males, however at 120ms ISI, BD females showed higher PPI than female controls. Schizophrenia patients showed significant deficits in all higher-order cognitive tasks (except attention and visuospatial). BD patients only showed deficits in immediate memory, language and executive function. A main effect of sex indicated women performed better than men on language tasks, however no sex×group interactions were evident.

Conclusions: Men with schizophrenia or BD had disrupted PPI compared to male controls. While women with schizophrenia showed slightly less PPI than female controls, women with BD showed increased PPI. Higher-order cognition was markedly reduced in schizophrenia patients, while BD patients showed fewer deficits, regardless of gender. In conclusion, gender plays a role in sensory processing but not higher-order cognitive function.

APP052 CLINICAL AND FUNCTIONAL PREDICTORS OF EFFECTIVE SOCIAL-COGNITIVE REMEDIATION IN SCHIZOPHRENIA

Pamela Marsh, Melissa Green, Tamara Russell, Anthony Harris, Max Coltheart

Introduction: Deficits in emotion perception are associated with poor social functioning in schizophrenia. Recent use of targeted remediation techniques has resulted in improved attentional strategies and recognition of facial emotions in schizophrenia. However, no studies have assessed whether clinical levels of interpersonal functioning or self-reported, broader social functioning skills at baseline are predictive of successful social-cognitive remediation.

Aims: We examined whether improved attention and recognition of facial emotion following targeted social-cognitive remediation would be associated with clinical levels of interpersonal functioning or self-reported levels of broader social functioning.

Methods: Forty two participants with schizophrenia undertook emotion remediation using the Micro-Expression Training Tool (METT; Ekman, 2003). METT training comprised video clips with verbal commentary directing attention to relevant facial features, and a practice with feedback regarding accuracy. Affect recognition and concurrent eye movement recordings were assessed pre- and post-training; difference scores between pre-and post training provided an index of the level of improvement attributable to remediation. We examined associations between the level of improvement and clinical ratings of interpersonal functioning, and a self-report measure of social functioning.

Results: Participants demonstrated improved attention and increased recognition of facial emotions following METT training. Higher levels of improvement in emotion perception were associated with decreased clinical ratings of interpersonal ‘asociality’.

Conclusions: Poor interpersonal functioning at baseline may predict reduced efficacy of emotion remediation in schizophrenia. Other potential predictors of successful remediation deserve further investigation with regard to the implementation of social-cognitive remediation in clinical settings.

APP053 THE KETAMINE MODEL OF SCHIZOPHRENIA AND SEMANTIC MEMORY

Erica Neill, Susan Rossell

Introduction: Ketamine is a drug capable of eliciting schizophrenia like symptoms. As such, it has been adopted as a possible drug model of schizophrenia.

Aim: To review published studies that investigate the ketamine model of schizophrenia in relation to semantic memory function.

Methods: The terms “ketamine, schizophrenia, and semantic memory” were used to search the PubMed and PsychINFO databases. Empirical investigations and reviews were included in our report.

Results: Research suggests that schizophrenia is associated with impairments in semantic memory. When using the ketamine model to explore cognitive deficits in schizophrenia however, most studies have focused on episodic and working memory functions. The small body of research which does examine the effect of ketamine on semantic memory suggests that ketamine can induce semantic memory impairments but does not make comparisons to schizophrenia. Other research has focused on the similarities between those cognitive deficits commonly seen in schizophrenia and the nature of the impairments exhibited by people under the influence of ketamine but has not examined semantic memory. As it stands there is no research that evaluates the nature of the semantic memory deficits under the influence of ketamine and compares those deficits to the ones seen in schizophrenia.

Conclusions: Future research should design experiments that will allow for a comparison of the semantic deficits that occur as a result of ketamine administration versus the semantic deficits found in schizophrenia.

APP054 EXPLORING SEMANTIC MEMORY DEFICITS IN ALZHEIMER'S DISEASE

David O'Connor, Susan Rossell

Though it has long been established that semantic memory deficits are common in Alzheimer's disease (AD), there is still uncertainty about the characteristics of these impairments. Semantic priming (SP) tasks are often employed to examine semantic memory deficits in Alzheimer's disease. Giffard et al (2001) obtained greater priming effects (hyperpriming) from coordinate word pairs (e.g. tiger – lion) compared to healthy aged controls, whereas pairs of words with attribute relationships (e.g. zebra – stripe) yielded priming effects equivalent to healthy aged controls. This distinction is hypothesised to be related to loss of attribute knowledge leading to a decreased ability to differentiate between concepts. For example, if both ‘table – chair’ had less attribute qualities they would simply be treated by the patient as the same (i.e. furniture – furniture), and would hence be responded to as a repetition prime.

Priming effects for word pairs with associative relationships have yet to be explored in this patient group. This could be achieved by using a SP task with associative word pairs (e.g. traffic-jam). These are linked only through linguistic usage and have no categorical connection. In contrast to SP which is an implicit task, an object matching task explicitly tests relationships between concepts. In our research these two tasks have been employed to examine semantic word associations. We are hypothesising that failures in semantic memory in AD are the result of loss of attribute knowledge, thus, both implicit and explicit word associations will not be affected in AD. This data will be discussed.

APP055 TIME PERCEPTION IN SCHIZOPHRENIA PATIENTS WITH FIRST-RANK SYMPTOMS: RELEVANCE FOR PSYCHOLOGICAL REPRESENTATIONS OF ACTIONS

Flavie Waters, Assen Jablensky

Introduction: In first-rank symptoms (FRS; Schneider, 1950), individuals with schizophrenia experience their actions, thoughts and feelings as controlled by external forces. One widely accepted explanatory model of FRS suggests that patients have deficits in the ability to predict the sensory consequence of their actions because of a failure in an internal monitoring system (Forward Model, Frith, 1992, 2005). Recent work has revealed the importance of timing precision underlying the Forward Model and in processes contributing to agency attribution.

Aims: To examine whether patients with FRS experience difficulties in judging the length of short temporal intervals.

Methods: We compared the performance of patients with (n = 15) and without (n = 20) FRS and healthy controls (n = 16) on a time discrimination task.

Results: The results showed that patients with FRS had difficulties in judging the length of temporal intervals, and that the presence and severity of FRS were associated with a pattern of performance that was consistent with an accelerated sense of time.

Conclusion: Patients with FRS experience impairments in timing precision which may contribute to confusion concerning the origins of movements because of disruptions in the functioning of the internal monitoring system, or/and because of excessive binding effects across psychological representations.

APP056 COGNITIVE AVOIDANCE OF INTRUSIVE MEMORIES IN DEPRESSION

Alishia Williams, Michelle Moulds

Although recent research demonstrates that intrusive memories represent an overlapping cognitive feature of depression and post-traumatic stress disorder (PTSD), there is still a general paucity of research investigating the prevalence and maintenance of intrusive memories in depression. The current study investigated the association between a range of cognitive avoidant mechanisms that characterize PTSD samples (i.e., suppression, rumination, emotional detachment, and an observer vantage perspective) and intrusive memories of negative autobiographical events in relation to dysphoria. Hypotheses were based on the proposition that employment of these cognitive mechanisms would hinder the emotional processing of the negative event, thus contributing to the maintenance of intrusions. Results supported an association between negative intrusive memories, dysphoria, and avoidant mechanisms. Significant differences were also found between field and observer memories and measures of emotional detachment and rumination. Implications relating to intrusive memory maintenance and treatment approaches are discussed.

APP057 INVESTIGATION OF THE INDULGENCE CYCLES HYPOTHESIS OF SUPPRESSION ON EXPERIMENTALLY-INDUCED VISUAL INTRUSIONS IN DYSPHORIA

Alishia Williams, Michelle Moulds

Wegner (1989) referred to the combined initial suppression and expression phases of thought control as an indulgence cycle which results in the rebound effect typically observed in suppression studies. Based on Ironic Process Theory (Wegner, 2004), this rebound leads to further attempts to suppress which is difficult due to the hyperaccessibility of the target thought which subsequently leads to a secondary rebound effect through a positive feedback system of indulgence cycles. A growing body of literature suggests that unwanted intrusions in the form of negative autobiographical memories are particularly associated with mental control strategies such as suppression (Starr & Moulds, 2006) and that this association is more marked in depressed individuals (Williams & Moulds, 2007).

To investigate the effects of repeated suppression by using a novel method to index the frequency, duration, and associated distress of an experimentally-induced visual intrusion. Also, to assess whether any observed effects are differentially linked to depressive symptomatology.

Separate 2×5 mixed ANOVA were conducted. Results supported a secondary rebound effect in those participants most successful at suppressing intrusions. The data indicated a trend for high dysphoric participants to report intrusions of longer duration that were rated as more distressing than those reported by low dysphoric participants.

The findings offer an important extension to the indulgence-cycle hypothesis of intrusion maintenance and highlight the relationship between maladaptive mental control strategies and the potential for elevated distress to perpetuate continued use of such strategies.

EPIDEMIOLOGY

APP058 PHENOMENOLOGICAL ETHNIC DIFFERENCES IN FIRST EPISODE SCHIZOPHRENIA SPECTRUM DISORDER PATIENTS

A. N. Amer Siddiq, O. H. Koh, N. Z. Zainal, J. S. Gill

Introduction: Malaysia is a multicultural country with diverse ethnicity, whereby mental illness as a health problem is often overlooked. Most are still deeply rooted in their cultural beliefs and present for treatment differently than those in the west. Presentation on first contact is often different between the races.

Aim: This study attempts to find any phenomenological differences among the major races in Malaysia and also explore their pathway to care.

Method: Patient pool was taken from both the inpatient and outpatient services in University Malaya Medical Center. Recruitment was over an 8 month period. Diagnosis was established using the Diagnostic and Statistical Manual (DSM-IV) while presenting symptoms was measured using the Structured Interview for prodromal Syndromes (SIPS): Version for Present Prodromal Syndromes. Analysis was done with the SPSS version 12 statistical software.

Result: A total of 66 patients were recruited for this study. Findings indicated that pathways to care were similar whereby generally all major races had no prior contact with psychiatric services. For those who did, it was noted that Malays tended to visit a traditional healer prior to contact while Chinese and Indians chose to visit a religious medium. There were also differences in presenting symptoms with Malays relating “dysphoric mood” (28%), Chinese with deterioration in role functioning (35%) and Indians with perceptual abnormalities (22%).

Conclusion: Findings suggest that ethnic, cultural and religious differences do have an effect on presenting symptoms.

APP059 THE IMPACT OF AGE AT ONSET OF BIPOLAR 1 DISORDER ON FUNCTIONING AND CLINICAL PRESENTATION – OUTCOMES AFTER 12 MONTHS

Frances Biffin, Steven Tahtalian, Kate Filia, Paul Fitzgerald, Anthony de Castella, Sacha Filia, Michael Berk, Seetel Dodd, Pam Callaly, Lesley Berk, Katarina Kelin

Background: Recent studies have proposed the existence of three distinct subgroups of Bipolar 1 based on age at onset (AAO). This is a 12 month follow up of an initial study, aimed at investigating clinical and functional differences between AAO subgroups.

Method: Participants (N = 240) were enrolled in the Bipolar Comprehensive Outcomes Study (BCOS), a 2 year longitudinal observational study. Assessment measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAMD21), Clinical Global Impressions Scale (CGI-BP), SF-36, SLICE/Life Scale, and the EuroQol (EQ-5D). Participants were also asked about age at first major affective episode.

Results: Comparisons between the early subgroup (AAO <20, mean = 15.5±2.72) 44.4% of participants; and the intermediate subgroup (AAO 20–39, mean = 26.1±4.8 48.14% of participants; at baseline and 12 months indicate that both groups were less symptomatic, and more satisfied with life at 12 months. Although the early AAO subgroup still experienced more severe symptoms and poorer self-rated Quality of Life, the ratings were not statistically significantly different from the intermediate subgroup.

Conclusion: Outcomes for both AAO subgroups were improved at 12 months. However, clinical and functional differences remain between the two groups. These differences will help guide management of this debilitating disorder.

APP060 SUPERIOR ANTIPSYCHOTIC EFFICACY OF OLANZAPINE COMPARED WITH RISPERIDONE: A BAYESIAN META-ANALYSIS

Carolyn Cameron, Kristina Coleman, Libby Lynch, Patrick Fitzgerald, Katarina Kelin, Alan Brnabic

Introduction: Various studies have shown there are distinct differences in the side effect profiles of olanzapine and risperidone; however, no clear consensus has been reached regarding their comparative efficacy. We compared the efficacy of olanzapine with risperidone using a Bayesian meta-analysis technique, adjusting for potential confounding factors including study duration, dose, patient age and baseline disease.

Methods: A systematic search of EMBASE, Medline, the Cochrane Library and data on file at Eli Lilly was conducted. Six RCTs were eligible for inclusion. Outcome data and study/patient characteristics were extracted. A Bayesian analysis using an unadjusted model, as well as models adjusting for study/patient characteristics, and a standard head-to-head meta-analysis were performed.

Results: Patients on olanzapine showed a significant improvement in PANSS negative score, compared to those on risperidone (WMD −1.46, (−2.91, −0.10)). Non-significant differences in favour of olanzapine were seen in PANSS total and PANSS positive scores. For each of the three outcomes, the results of the unadjusted and adjusted Bayesian analyses were consistent with the results obtained using standard meta-analysis techniques.

Conclusions: This analysis suggests that olanzapine is superior to risperidone at improving the negative symptoms of schizophrenia. Most antipsychotics produce only modest negative symptom improvement; however these symptoms are particularly debilitating for patients. This improvement is therefore clinically relevant as the more effective an antipsychotic is in controlling negative and depressive symptoms, the more beneficial it is for patients. The use of a Bayesian meta-analysis technique shows that this greater efficacy is consistent when differences in various study and patient characteristics are taken into account.

APP061 A META-ANALYSIS OF THE CANCER INCIDENCE IN PATIENTS WITH SCHIZOPHRENIA AND THEIR FIRST-DEGREE RELATIVES

Vibeke Catts, Stanley Catts, Aaron Frost, Brian O'Toole

Introduction: Whilst there is robust evidence of excess medical comorbidity in patients with schizophrenia, there are conflicting findings concerning cancer incidence rates in this population.

Aim: To carry out a meta-analysis of published studies on the cancer incidence in patients with schizophrenia and their first-degree relatives.

Method: Meta-analysis was performed on standardised incidence ratios (SIR) of cancer in patients with schizophrenia and first-degree relatives compared to general population samples.

Results: The pooled overall cancer incidence in patients was not significantly increased (SIR = 1.05, CI 0.95–1.15). Lung cancer incidence was slightly increased (SIR = 1.31, CI 1.01–1.71), but it was reduced after adjusting for smoking prevalence. The incidence of several cancers unrelated to smoking was reduced in patients. The pooled overall cancer incidence in siblings (SIR = 0.89, CI 0.84–0.94) and parents (SIR = 0.90, CI 0.88–0.93) was significantly reduced.

Conclusions: There is direct evidence of a discrepancy between cancer risk exposure and cancer incidence in patients with schizophrenia, and indirect evidence that this discrepancy is unlikely to result from confounding effects of medication or lower detection rates in patients.

APP062 ANALYSIS OF RECORD LINKED POPULATION DATABASES: DO WE KNOW ENOUGH ABOUT THE HEALTH OF PREGNANT WOMEN TO CHOOSE RISK FACTORS?

Maxine Croft, Vera Morgan, Assen Jablensky

Introduction: Evidence supports a significant gene/environment contribution to the aetiology of schizophrenia. In Western Australia, investigation of obstetric complications as an environmental risk factor for schizophrenia is possible using record-linked population health databases including psychiatric, morbidity and midwives registers. In an earlier study of 6303 births, we adapted a validated scale for scoring obstetric complications, originally designed for casenote reviews, for use with prospectively collected, electronic population data.

Aim: This work is being extended to encompass 472,733 births and to include the mother's prior medical history.

Method: Midwives records enable up to 44 maternal/foetal health conditions to be coded as present prior to or during pregnancy, and/or at birth. ICD9 codes for these conditions were extracted and scored electronically according to the scale's manual, and binary indicators of longitudinal maternal morbidity were created.

Results: Midwives records included 2,627 ICD9 codes for 181,898 mothers. However, 106,374 of these women had ICD9 codes not included in the algorithm developed for the earlier study. Of these, 172 three digit ICD9 groups were able to be scored according to the manual. Another 345 ICD9 groups were apparently not in the manual. These included maternal conditions potentially affecting foetal neurodevelopment, e.g. meningitis, encephalitis, pernicious anaemia, scurvy, peritonitis and renal failure.

Conclusions: A priori selection of risk factors derived from smaller studies could underestimate effects of maternal morbidity on offspring outcomes. Population databases allow full description of current and prior maternal illness and creation of longitudinal binary indicators of morbidity.

APP063 A DESCRIPTION OF THE USE OF ANTIPSYCHOTIC MEDICATIONS TO TREAT PATIENTS WITH SCHIZOPHRENIA IN AUSTRALIA

Anthony de Castella, Alex Nicol, Paul Fitzgerald, Sean Olsen, Jayashri Kulkarni

Introduction: The availability of six different “atypical” Antipsychotic Medications (AM's), in addition to a large number of ‘typical” AM's, provides clinicians with a range of treatment options, which should enhance outcomes for patient with schizophrenia. Choosing which medication or combination of medications is best for each patient can be a process of trial and error, resulting in polypharmacy and multiple switching of medications over time.

Aim: To improve our understanding of how AM's are being used in the ‘real world’ in a cohort of people with schizophrenia over a 12 month period.

Method: Medical records of 125 patients with schizophrenia or schizoaffective disorder were reviewed over a 12 month period following a hospitalisation. Information was extracted in relation to all pharmacotherapy treatments received.

Results: Mean age of the sample was 37.7 years and the majority were male (86/39). 80% had a diagnosis of schizophrenia while 20% had schizoaffective disorder. 37 patients (30%) were receiving multiple AM's at discharge from hospital.101 of the 125 patients (81%) received more than one antipsychotic medication over the 12 month period, with an average of 2.7 different AM's per patient. The mean time to switching of primary AM's after discharge was 157 days. The most commonly prescribed AM's at discharge were Clozapine (33), Olanzapine (29), Zuclopenthixol Depot (27) and Risperidone (13).

Conclusion: Despite the range of choice of AM's, most patients with schizophrenia/schizoaffective disorder have multiple changes made to their treatment regime over a 1 year period, suggesting that the current range of AM's on the market is not sufficient to adequately treat these illnesses. Future research is needed to evaluate which combinations of AM's, at which doses, in which subgroups of patients result in the most optimal outcomes for people with schizophrenia.

APP064 THE NATIONAL REGISTER OF ANTIPSYCHOTIC MEDICATION IN PREGNANCY (NRAMP)

Jayashri Kulkarni, Kay McCauley, Heather Gilbert, Caroline Gurvich, Anthony de Castella, Paul Fitzgerald

Introduction: Current data on antipsychotic use in pregnancy is limited.

Aim: The aim of this research is to establish the National Register of Antipsychotic Medication in Pregnancy, to provide evidence-based clinical guidelines for the best use of antipsychotic medication during pregnancy and for the first year of the baby's life.

Method: Participation will include women with a history of mental illness, who are taking antipsychotic medication and who become pregnant. Participants will be sought Australia-wide. Following provision of informed consent, data will be gathered via telephone and/or face to face interviews during pregnancy, following delivery, and for the first year of the baby's life. Information will include demographics, medical, psychiatric, medication and obstetric history, and information on general health and wellbeing for mother and baby. A standard database will be used to collate data and generate any trends.

Results: This study is current and ongoing, with a proposed target of 40–100 participants. Several time point analyses are possible and include the antenatal period, immediately postpartum, and at pre-detemined stages for the first year of the baby's life.

Discussion: The collection of ongoing data, and the resulting guidelines, have the potential to provide regular contemporary updates to clinical treating teams for evidence-based management of women in this population group. The overall benefit of this study goes far beyond any numerical reference. The Alfred Psychiatry Research Centre works to enhance and improve the quality of life for those among us who live daily with mental illness, both now and into the future.

APP065 HOSPITALISATION PATTERNS FOR PSYCHIATRIC DISORDERS ACROSS THE LIFESPAN IN AUSTRALIA 1999–2005

Lee-Fay Low, Brian Draper

Introduction: Hospitalisation patterns for psychiatric disorders across the age span may not mirror community psychiatric morbidity surveys.

Aim: To examine hospitalisation patterns for the primary psychiatric disorders in Australia.

Method: Data on separations involving specialised psychiatric care from Australia's National Hospital Morbidity Database from July 1998 to June 2005 were analysed by age, gender and diagnosis.

Results: The average rate of psychiatric separations per 1000 of the population was 12.12, and average length of stay was 12.2 per separation. Across the age range the rate of separations per 1000 decreased with age, and treatment days per separation increased with age. Overall, there were more psychiatric separations for women (13.18 per 1000) than for men (11.0 per 1000), however length of stay was longer for men (14.02 days) than for women (10.26 days). As expected there were high hospitalisation rates for schizophrenia and substance abuse in the young, alcohol and mood disorders in middle age, and organic disorders in the elderly. Less expected findings were an increase in hospitalisation for depressive and personality disorders in older men, and a midlife peak in stress, somatoform and neurotic disorders in men.

Conclusions: In Australia the rate of psychiatric separations was high and average length of stay was low relative to the UK. Planning for specialised psychiatric hospital services needs to take into account the differing needs of the population by diagnostic category, age and gender.

APP066 ASSOCIATIONS BETWEEN DEPRESSION AND CHRONIC CONDITIONS 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 chronic conditions 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, and chronic conditions such as asthma, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), diabetes, osteoporosis and arthritis.

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, responses to the CES-D, osteoporosis, arthritis and CVD prevalence were collected as part of a Computer Assisted Telephone Interviewing (CATI) survey, self-reported diabetes, asthma and COPD were determined from a self completed questionnaire and spirometry and blood glucose measurements were completed as part of the clinic assessment.

Results: Overall, 12.4% (95% CI 11.3–13.5) of participants reported depressive symptoms as measured by the CES-D. Depression was significantly associated with those reporting arthritis and cardiovascular disease but not with any other chronic condition. Those reporting three or more chronic conditions were also more likely to report depression.

Conclusion: Depression is associated with specific chronic conditions and also with having a higher number of chronic conditions.

APP067 ASSOCIATION BETWEEN RISK FACTORS FOR SUICIDE AND CURRENT DISTRESS IN REGIONAL, RURAL, AND REMOTE NSW: A PILOT ANALYSIS

Gina-Maree Sartore, Helen Stain, Brian Kelly

Introduction: Suicide rates in rural and remote Australia have been elevated in recent years compared to the population as a whole [1], particularly for certain groups [2]. Rural populations have experienced significant stressors due to the restructuring and in many cases decline of the agricultural sector.[3] Suicidal behaviour is known to be associated with negative life events and socioeconomic disadvantage and stressors. Factors contributing to suicide in young people in rural communities can be separated into structural or community factors and those relating to personal vulnerability. Current severe distress, whether due to socioeconomic stressor, life event, or mental illness symptomatology, is a proximal antecedent of attempted and completed suicide [4].

Aim: To investigate socioeconomic and psychosocial risk and protective factors operating in regional, rural, and remote NSW, and their association with current distress.

Method: The Australian Rural Mental Health Study (ARMHS) is a health survey of 4000 rural households in NSW. Current distress (measured by the K10) will be correlated with known risk factors for suicide such as low socioeconomic status, poor mental and/or physical health, negative life events, and depressive symptomatology.

Results: A regression model will determine the relative predictive value of known risk and protective factors for current distress.

Conclusions: These preliminary results will direct full-scale analysis of ARMHS data, including lifetime and 12-month history of suicidal ideation and suicide attempts.

APP068 MODELLING RISKS FROM CONCEPTION TO DISEASE FOR CHILDREN IN A WESTERN AUSTRALIAN POPULATION-BASED STUDY

Giulietta Valuri, Maxine Croft, Vera Morgan, Assen Jablensky

Introduction: In Western Australia, psychiatric register data can be linked to other Statewide health registers. As part of a population-based study of children born in Western Australia, 1980–2001, to mothers with schizophrenia or affective psychosis and mothers with no psychiatric illness, we developed a data model to manage the complexity of analysing linked data from diverse sources.

Aims: To examine genetic and environmental risk factors for schizophrenia and to use the longitudinal linked data to analyse health patterns and associations within family and/or sibling groups.

Methods: The resultant data model views all records as related to a person with one or potentially many ‘events’ recorded across health registers over the study period, and linked by a unique identifier. It allows for consideration of families and their health status from an intergenerational perspective.

Results: The database included 472,733 births to 249,119 women, 24% with at least one serious health condition on the midwives register. The percentage of women with two or more births was 36.4%; of these, 4.4% had four or more births. There were 272,257 children with hospital admissions and 23,463 with in- or outpatient psychiatric contacts; 303 had been diagnosed at some point with schizophrenia. Some 2,756 children had an intellectual disability, 16,383 a birth defect, 1,330 a cancer diagnosis, and 6,929 had died. Fathers’ physical and mental health data were included; 16,930 (6.5%) had a psychiatric record.

Conclusions: Our data model allows associations to be measured between the health status of mothers and fathers and their children's health outcomes.

PSYCHOSOCIAL

APP069 FACTORS AFFECTING READMISSION IN A TEACHING HOSPITAL IN MALAYSIA

Aida Syarinaz Ahmad Adlan, Amer Nordin Amer Siddiq, Chong Guan Ng, Nor Zuraida Zainal, Rahimah Abdul Kadir

Introduction: Readmission is a common problem encountered in psychiatric care today, and it is used as a performance indicator. Studies had suggested factors contributing to this phenomenon. Readmission rate is calculated as the number of readmitted patients over the number of discharged patients for a given period.

Aim: The aim of this study was to study the rate of readmission and look into the factors that may contribute to this.

Methods: This is a retrospective descriptive study of all patients who were discharged from the psychiatric ward of University Malaya Medical Centre (UMMC). Case notes of those discharged during the study period was retrieved and analyzed. Those fulfilling the inclusion criteria were recruited and subjected to a questionnaire.

Results: A total 107 patients were identified and only 95 participated. The readmission rate was 16.8%. Severity of illness was identified as the main risk factor for readmission in this study.

Conclusion: Our readmission rate was similar to some developed nations and indicated good quality of care in UMMC. There appears to be other factors that may influence the rate for readmission other than quality of in-patient care and outpatient community care.

APP070 AN EVALUATION OF PSYCHOLOGICAL, BEHAVIOURAL AND PHYSIOLOGICAL CHANGES DURING BEREAVEMENT: THE CARDIOVASCULAR EFFECTS OF BEREAVEMENT (CARBER) STUDY

Roger Bartrop

Introduction: Bereavement is associated with increased acute cardiovascular risk although the mechanism is not well understood.

Aim: To prospectively assess psychological, behavioural and physiological changes following bereavement.

Methods: Fifty-two subjects (35F/17M; age 65.2±13.1 years (mean±SD) were studied within 2 weeks of bereavement and at 6 months. The bereaved were compared to 43 non-bereaved controls (28F/15M; age 61.1±11.1 years). Data were compared between groups using repeated measures ANOVA or Mann-Whitney U.

Results: Compared to controls, bereaved subjects had higher scores for depression (CES-D) acutely (26.6 vs 5.9) and at 6 months (16.8 vs 6.2) [both p < 0.001], higher anxiety (Spielberger STAI) acutely (47.4 vs 29.0) and at 6 months (37.2 vs 28.5) [both p < 0.001] higher anger (STAI) acutely (17.8 vs 15.6) (p < 0.001]. Acutely, the bereaved slept less than controls (5.6 vs 7.2 hours, p < 0.001), felt less hungry (p = 0.003) and ate less (p < 0.001). Acutely, bereaved had lower total cholesterol (4.9 vs 5.4 mmol/l, p = 0.01) and T suppressor cell number (CD8 +) (406 vs 496 MFI, p = 0.02) but higher cortisol levels (340 vs 277 nmol/L (p = 0.007), white cell count (WBC) 7.1 vs 6.2 109/L (p < 0.001), and vWF-Ag 126% vs 116% (p = 0.04). Acutely, bereaved also had elevated 24 hour heart rate 76 vs 70 bpm (p = 0.04) and systolic BP load 41% vs 26% (p = 0.02). At 6 months, many of these changes tended to be no longer significant.

Conclusion: These psychophysiological changes may contribute to the increased cardiovascular risk during bereavement.

APP071 DOES INTERPERSONAL PSYCHOTHERAPY IMPROVE CLINICAL CARE FOR ADOLESCENTS WITH DEPRESSION ATTENDING A RURAL CHILD AND ADOLESCENT MENTAL HEALTH SERVICE? STUDY PROTOCOL FOR A CLUSTER RANDOMISED FEASIBILITY TRIAL

Cate Bearsley-Smith, Mark Oakley-Browne, Ken Sellick, Janice Chesters, Karen Francis, Elmer Villanueva, Prasuna Reddy

Introduction: There is little research regarding the effectiveness of treatment provided within Child and Adolescent Mental Health Services (CAMHS). This paper outlines the rationale and design for a CAMHS based research trial, focusing on treatment of the costly problem of adolescent depression.

Aim: The trial aims firstly to investigate the impact on clinical care of implementing Interpersonal Psychotherapy for the treatment of adolescent depression compared with Treatment as Usual (TAU). The second aim is to record the process and challenges (i.e. feasibility, acceptability, sustainability) associated with implementing and evaluating the evidence-based intervention.

Method: The study involves a cluster randomisation trial. All clinicians in the rural CAMHS will be invited to participate. Participating clinicians will be randomised via block design at each of four sites to (a) training and delivery of IPT, or (b) TAU. Participating adolescents with significant depressive symptomatology, aged 12 to 18 years, will complete assessment measures at Weeks 0, 12 and 24 of treatment, and complete a depression inventory once a month during that period. This study aims to recruit 60 adolescent participants and their parent/guardian/s. Qualitative data regarding process implementation will be collected quarterly from focus groups with participating clinicians over 18 months. The focus group qualitative data will be analysed using a Fourth Generation Evaluation methodology that includes a constant comparative cyclic analysis method.

Conclusion: This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting cluster randomised trials within community practice such as mental health services.

APP072 HOW EFFECTIVE ARE IMPROVED LINKAGES BETWEEN COMMUNITY SUPPORT AND PSYCHIATRIC SERVICES AT ADDRESSING NEEDS OF PEOPLE WHO ARE HOMELESS? AN EVALUATION OF THE INTEGRATED HOMELESS MENTAL HEALTH SERVICE

Frances Biffin, Cathy Humphrey, Helen Riseborough, Anthony Kennedy, Jayashri Kulkarni, Jon Kroschel, Stuart Lee, Anthony de Castella

Introduction: Many homeless people also suffer from mental illness, but most are reluctant to access mental health services. To improve mental health support for people living homeless, an integrated homeless mental health service (IHMHS) involving Alfred Homeless Outreach Psychiatry Service (HOPS) and two welfare services, Sacred Heart Mission (SHM) and Hanover Welfare Services (Hanover), enabled mental health professionals to work at each welfare service, providing improved identification and provision of onsite support to people with comorbid homelessness and mental illness, referral between mental health and welfare services, and improved welfare and mental health education for staff.

Aim: Evaluate the impact of the IHMHS for homeless people with a mental illness and staff of HOPS, SHM and Hanover.

Method: Demographics, service utilization and feedback from consumers engaged by IHMHS workers were collected. Rate of referral between SHM/Hanover and HOPS/Alfred Psychiatry was also compared 12 months before and after commencement. The experience of the IHMHS for staff of each service and consumers engaged by the IHMS was assessed through completion of anonymous questionnaires.

Results: With data collection still to be completed, initial results suggest increased referrals between Alfred Psychiatry Services and SHM/Hanover, with varying outcomes, including immediate hospitalization, gradual engagement and HOPS case management, ongoing management by SHM/Hanover only, or no mental health follow up. Staff feedback highlighted increased knowledge and confidence in managing mental health comorbidity.

Conclusion: While data collection is continuing, preliminary findings suggest the IHMHS supports closer mental health and welfare service collaboration and upskilling of staff at all services.

APP073 FAMILY FUNCTIONING AND PAEDIATRIC LIVER TRANSPLANTATION

Michael Bowden

Introduction: This is the first year of a PhD project. Recent studies have documented high rates of PTSD in the parents of children who have had a liver transplant as well as high rates of marital difficulty and sibling problems. Psychosocial variables may impact on physical health outcomes through parent stress, dysfunctional parent-child interactions, child behaviour problems and poor medication compliance.

Aims: This study aims to examine the relationship between parent and family variables and outcomes for children who have had a liver transplant.

Study hypotheses include:

Family functioning and/or levels of parental psychological symptoms, measured at the time of assessment for transplant, will affect the physical outcomes for children who have had a liver transplant; and

Identification of families and children at risk of poorer outcomes will have implications for service provision.

Method: A prospective cohort study, using a family functioning questionnaire and parental psychiatric symptoms questionnaire administered at the time of initial assessment for liver transplant. Individual outcomes for the transplant patients will be available from the treating team and medical records, 12 months post-transplant.

Results: This is a study in progress. Results of a pilot data-gathering study will be available at the time of presentation. Preliminary results show high levels of disturbed functioning in these families, especially in the areas of communication and affective responsiveness.

Conclusion: This area of research will have important implications for provision of mental health care to these children and families.

APP074 IN2SHAPE: INTERVENTION TO STAY HEALTHY AND PHYSICAL EVERYDAY

Jacqueline Brewer, Janine Walker

Introduction: Depression in youth creates considerable burden on individuals and at the population level, highlighting the need for effective prevention interventions. Physical activity has shown promise with adults and has many advantages, including few negative side-effects and minimal expense. There is limited published research with youth.

Aims: To conduct a randomized controlled trial (RCT) that will investigate whether a self-motivated physical activity intervention can increase activity in younger adolescents, and whether changes in physical activity impact on mental well-being.

Method: The RCT will be conducted in ACT schools with students aged 13–15. The trial will be targeted in its delivery, with two conditions: a self-motivated physical activity intervention, and a control condition targeting nutrition. The 10 week activity intervention will be delivered using two modes. An initial brochure will contain information about activity (e.g., recommended levels for health benefits), and electronic communication will continue over the school term with targeted messages weekly, and tailored feedback fortnightly. Students will be assessed at baseline and post intervention, with a 6 month follow-up. There will also be mini-assessments fortnightly throughout the intervention.

Results: The key outcome variables include depression and anxiety symptomatology. Intention-to-treat analysis will be used.

Conclusion: This will be the first trial of its kind to examine the effects of self-motivated physical activity on youth mental health, which may have important public health benefits for mental and physical health outcomes for younger adolescents.

APP075 IMPLEMENTATION AND EVALUATION OF THE YSHAREIT VIRTUAL YOUTH AMBASSADOR PROGRAM IN TASMANIA: A PILOT FOR A NATIONAL PROGRAM

Kate Briggs, Caroline Spiranovic, Ken Kirkby

There is a need to implement cost-effective programs for promoting mental health as well as preventing and treating mental health problems, in young people. The proposed Tasmanian pilot study will evaluate the efficacy of the Yshareit Virtual Youth Ambassador (Virtual YA) program, as a model for promoting mental health information across the whole state. The Virtual YA program is an online interactive game-based program that aims to increase young peoples’ awareness, sharing, and usage of reputable e-mental health resources through three interactive steps: 1) education regarding reputable Australian e-mental health sites, 2) activities to improve communication skills, and 3) strategies for broader sharing of the information learned from the program with the community. The online Virtual YA program draws on the resources of five reputable Australian e-mental health sites (Reach Out!, MoodGYM, Ybblue, BluePages, and Kids Help Line) via links provided on the www.yshareit.com website. In order to evaluate the effectiveness and sustainability of the Virtual YA program, the program will be presented to year 10 students of Tasmanian regional and rural high schools. Students undertaking the Virtual YA program will do so in groups via one of two methods: facilitated, in a workshop run by the study researchers, or self-directed, with technical assistance only from a school staff member. The outcomes of this study will indicate the requirements for, and demonstrate the feasibility of, a potentially sustainable and cost-effective model for promotion of e-mental health resources among young people that can be implemented at a national level.

APP076 WHO USES LIFELINE TELEPHONE COUNSELLING SERVICES?

Nicole Burgess, Louise Farrer, Helen Christensen, Liana Leach, Kathleen Griffiths

In Australia, telecounselling is a large, growing industry, which provides assistance to many individuals in the community. However, to date, there has been little quantitative research about the characteristics of people who seek telecounselling services. Such information is important since it can inform the development of telecounselling services that are most appropriate to the needs of users. Accordingly, a brief survey was administered to the users of a Lifeline telephone counselling Centre over a 4 week period. The survey, which was administered by the telephone counsellor at the end of a user's call, elicited information about the frequency of caller use of Lifeline, the caller's self-reported current problems and caller level of depressive and anxiety symptoms. Main findings of the survey were that many users experienced elevated symptoms of depression and anxiety, and that on average, callers accessed the service frequently. With this large mental health consumer base and recurring use of the service, these results highlight the potentially important role that telephone counselling services can play in providing preventive and early interventions to consumers with mental health problems.

APP077 COMPLICATED GRIEF- A NEW TRIAL AT THE TRAUMATIC STRESS CLINIC, WESTMEAD HOSPITAL

Catherine Cahill, Richard Bryant, Lucy Kenny

Introduction: Complicated grief as a diagnosis has been proposed for inclusion in the upcoming DSM-V. It describes a period of grieving following bereavement that is characterised by yearning for the deceased. In addition, four of eight of the following symptoms must also be present for diagnosis; difficulty accepting the death, inability to trust, bitterness, difficulty moving on, detachment from others, feeling that life is meaningless, hopelessness and agitation. Complicated grief seems more likely following a dependent relationship with the deceased and in cases with the death is sudden or unexpected.

Aim: There is initial evidence to support the role of cognitive behavioural therapy (CBT) in treating complicated grief.

Method: A randomised control trial of CBT for complicated grief was established and is underway at the Traumatic Stress Clinic. Patients receive group treatment comprising CBT, CBT and exposure or a control condition.

Results: Results support previous findings that there is a beneficial role fof psychological treatment in treating complicated grief.

APP078 REACHING STANDARDS FOR WEBSITE DISSEMINATION: A CASE STUDY

Helen Christensen, Kathleen Griffiths

Introduction: Policy makers and governments require guidelines for determining whether mental health websites are likely to yield positive public health outcomes. At what stage are web applications ready for dissemination? One set of guidelines, developed recently by the Society for Prevention Research (SPR), may be suitable for web applications designed as early intervention programs.

Aim: In this case study paper, we examine these standards criteria with reference to MoodGYM, an automated web application designed to reduce depression symptoms using cognitive behaviour therapy training.

Method: Flay et al., [2005] [1] provide a set of forty seven standards for efficacy, effectiveness and dissemination. These standards were distilled to 17. MoodGYM was evaluated on each standard.

Results: MoodGYM met 11, partially met 2, and failed to meet 4 standards.

Conclusions: Flay et al.'s prevention standards might be usefully applied to web/internet context. Web applications might be assessed for dissemination by the International Society for Research into Internet Interventions (ISRII), or some other professional organization to assist policy makers in making decisions about the funding, adoption and promotion of applications. Standard methods to evaluate public health impact need to be developed.

APP079 PATTERNS OF SERVICE USE AMONG PATIENTS WITH A DUAL DIAGNOSIS

Agatha Conrad, Terry Lewin, Vaughan Carr, Amanda Baker, Maragarett Terry, Andrew Taylor

Introduction: It is well recognised that there are high rates of comorbidity of mental illness and drug and alcohol use among psychiatric patients, with associated impacts on service use patterns.

Aims: This paper reports results from a 12-month audit of mental health clients with different patterns of presentation to mental health and drug and alcohol services.

Methods: Several care pathways were identified based on clients initial point of contact [general Mental Health (MH), non-MH, Drug and Alcohol (D&A), or Specialised Dual Diagnosis (DD) services] and their subsequent contact profiles [only MH, some D&A (but not DD), DD contacts]. Project data were extracted from the electronic Clinical Health Information Management Exchange (CHIME) system.

Results: Overall audit: 3,359 clients; 61,062 service contacts; average client age, 38.7 years; 49.7% male. Clients with only MH contacts had lower overall contact rates than those with a dual diagnosis, with clients receiving pharmacotherapy for their D&A problems averaging 36.3 contacts per service episode. With respect to individual problem profiles, psychosis (24.5 contacts), cognition-related (18.0 contacts), and physical health (16.8 contacts) problems were associated with the highest contact rates. Compared with clients with only MH contacts, dual diagnosis clients displayed lower rates of mood related problems (45.0% vs. 11.6%), while clients initially presenting to non-MH services revealed higher rates of physical (2.2% vs. 23.2%), psychosocial (7.1% vs. 16.5%) and service access problems (10.4% vs. 42.9%).

Conclusions: Routine service audits may assist in improving service delivery and planning for future services.

APP080 THE INVOLVEMENT OF FAMILIES: CONSIDERATION OF A RANGE OF EVIDENCE

Grace Couchman, Colin Riess, Amaryll Perlesz, Brendan O'Hanlon

Research conducted at The Bouverie centre, funded by Beyond-blue, has highlighted the efficacy of family involvement in the treatment of persistent depression in a randomised controlled trial. The study also examined the qualitative aspects of depression inhibited family and group involvement including challenges to self-identity and personal congruity. In this way the study provides an interesting insight into who can benefit from the group experience. The Bouverie research program was an extension of the internationally published Inner West multi-family group project, funded by VicHealth, which was a substantive study of group efficacy as an adjunct treatment for psychotic illness.

APP081 NON-ENGAGEMENT REASONS FOR DRUG AND ALCOHOL TREATMENT CLIENTS IN A COMMUNITY OUTPATIENT TREATMENT FACILITY: A PILOT STUDY

Carolyn Coulson, Felicity Ng, Seetal Dodd, Marjan Geertsema

Introduction: It is a reality of Drug and Alcohol treatment services that a significant proportion of clients either fail to engage or prematurely discontinue treatment, however there is a paucity of extant research examining client's reasons for their lack of engagement.

Methods: Clients who contacted a regional Drug and Alcohol Service over a six-month period were investigated; those who failed to attend a first or second appointment were contacted by phone to complete a structured questionnaire regarding their reason for non-attendance.

Results: Of those who contacted the service for assistance (n = 133), 53 people (40%) failed to attend their first or second appointment after completing the intake procedure. Of this group 5 were lost to follow-up, 40 completed the questionnaire and 8 stated their disengagement reason but declined to complete the questionnaire. Reasons for failing to engage were: 11 (25%) working, 6 (14%) able to cope without assistance, 6 (14%) were out of area, 6 (14%) were unhappy with the advice given or the service, 6 (14%) forgot their appointments, 5 (11%) were prevented by medical or mental illness and 5 (11%) stated they were not contacted by the service. Of the clients interviewed, 35 (88%) stated that they felt accepted and respected in their dealings with the service, while 33 people (83%) found the contact helpful.

Conclusions: Although the majority of clients reported high levels of service satisfaction, this did not prevent disengagement. This study provides the foundation for further investigation into improving treatment retention within drug and alcohol services.

APP082 WHAT DO YOUNG PEOPLE AND FAMILIES WANT TO KNOW ABOUT PSYCHOTROPIC MEDICATION? A REVIEW OF CALLS TO A CONSUMER MEDICATION INFORMATION SERVICE

Angela Dean, Merryn Kennaugh, Treasure McGuire

Background: Use of psychotropic medications for the treatment of emotional and behavioural problems in young people is increasing. Despite this, very little is known about the informational needs of young people and families.

Methods: The Medicine's Line is a national, consumer based medicines information services, funded by the National Prescribing Service. All calls received between September 2002 and December 2005 relating to psychotropic medications for children and adolescents were identified and examined (n = 286).

Results: The majority of callers were adults (95.4%), calling on behalf of either a child (73.4%). Two thirds of calls were for boys (65.7%), and mean ‘patient’ age was 12.6 years (range 4–18). Almost half of all calls involved questions about more than one medication. Stimulants were the most common medication enquired about (44.0%), followed by antidepressants (40.2%), antipsychotics (18.9%), and sedatives (11.9%).

Inadequate information was the most common reason for calling (50.3%), followed by a worrying symptom (16.1%), with one third of callers reported no prior information The majority of calls related to safety, specifically asking about side effects (22.3%), drug interactions (17.1%) risks vs benefits (12.9%) or withdrawal effects (4.9%). More than half of all calls (54%) were for medications which were not registered for paediatric use (“off-label”); these calls were more likely to be about safety issues (χ²=10.35, p < 0.01).

Conclusions: Safety is one of the key concerns regarding psychotropic information in young people. Young people and families receiving off-label medications may require additional safety information.

APP083 BARRIERS AND FACILITATORS TO EMPLOYMENT FOR PEOPLE WITH BIPOLAR AFFECTIVE DISORDER (BPDA)

Kate Filia, Frances Biffin, Sacha Filia, Jayashri Kulkarni, Paul Fitzgerald

Introduction: Bipolar affective disorder (BPAD) affects many important areas of a person's life. Functional recovery often lags behind symptomatic recovery, with a person's ability to gain and/or remain employed often significantly affected. This can have a drastic impact on a person's quality of life and is often associated with poorer outcomes.

Aims: The current study aims to identify barriers and facilitators to employment for people with BPAD, by comparing unemployed with employed participants on various measures.

Methods: 60 people with bipolar disorder will be included; 30 currently employed and 30 unemployed. All participants are interviewed using a range of clinical rating scales to confirm diagnosis and assess current mood symptoms (Mini International Neuropsychiatric Interview for Bipolar Disorder, Young Mania Rating Scale and Hamilton Depression 21-item Rating Scale). Demographics and details of illness history, education and work history are taken and participants complete a questionnaire regarding factors related to gaining, maintaining or obtaining employment. Information regarding social support and involvement, life satisfaction and self-esteem is collected. Social and occupational functioning are assessed. All participants are contacted three months post initial interview to assess any changes in illness and work status during that time.

Results and conclusion: Data collection is currently underway with preliminary results to be presented. The study is largely an exploratory study and results will include the elucidation of factors related to employment of people with BPAD. In addition, the relationship between these factors and others such as demographics, medication and social support will be investigated and findings presented.

APP084 SCREENING FOR MENTAL HEALTH PROBLEMS IN GENERAL PRACTICE: A COMPARISON OF THE CIDI AND THE SPHERE

Adam Finch, Kay Wilhelm, Ian Hickie

Introduction: The Somatic and Psychological HEalth REport (SPHERE), a screening tool for identifying common mental disorders in primary practice, has been criticised for being too over-inclusive. Conversely, measures with high thresholds (eg, DSM-IV criteria) may miss many patients considered needy of mental health treatment.

Aim: To compare case detection of the CIDI (with DSM-IV diagnoses) and the SPHERE relative to General Practitioners’ (GP) impression and management of patients for mental health problems.

Method: Patients (N = 319) completed the self-report SPHERE and the telephone-version of the CIDI-auto. The GP assessed patients’ emotional problems and indicated treatments provided.

Results: The SPHERE had a higher detection rate for patients identified by GP as having emotional problems; detecting 75.8% of those with ‘moderate’ or ‘severe’ emotional problems compared to 48.5% by the CIDI. However, the SPHERE also detected a much higher rate of cases among those without emotional problems. A similar pattern was found for SPHERE and CIDI case detection of patients relative to GPs' intentions for mental health management. The addition of the SF-12 was shown to improve the specificity and sensitivity of the SPHERE relative to GPs' impression.

Conclusion: Discrepancies between the DSM-IV diagnostic measure and GPs’ impressions suggest a need for screening instruments that cast a wider net. It is suggested that the SPHERE, which demonstrated considerably higher rates of case detection, may be a useful initial screening tool for primary care, particularly when employed alongside a measure of problem severity.

APP085 GROUP COGNITIVE BEHAVIOURAL THERAPY AND MINDFULNESS BASED COGNITIVE THERAPY AS TREATMENTS FOR NON-MELANCHOLIC DEPRESSION

Aimee Gayed, Gordon Parker, Vijaya Manicavasagar, Tania Perich, Joanna Crawford

Introduction: Cognitive Behavioural Therapy (CBT) has been established as an effective treatment for depression. Mindfulness Based Cognitive Therapy (MBCT) is a newer intervention which has yet to be tested as a treatment for current depressive episodes. Aim: This study compares group CBT and MBCT as effective treatments for current depression.

Method: Participants were recruited through advertisements displayed at Medical Centres, Psychiatrists’ Rooms and Community Health Centres. Participants who met criteria were randomly allocated to either the CBT or MBCT manualised 8-week group programs, which were facilitated by experienced, registered psychologists. Of the 81 subjects screened, 10 males and 20 females aged 19–62 years met eligibility criteria, participated in the group programs and attended the post group follow-ups at the completion of the 8-week programs.

Results: Preliminary findings from both completer and intent to treat analyses suggest that CBT and MBCT were effective in significantly reducing depressive symptoms for participants with current non-melancholic depression based on significant reduction in pre-to-post BDI-ii and Hamilton Depression Rating Scale scores. No statistical differences were found between the two types of group therapy.

Conclusions: These preliminary findings suggest that both group CBT and MBCT are effective forms of therapy for participants with current non-melancholic depression. Recruitment will continue, and follow up assessments will also be conducted at 6-months and 12-months post group to assess the long term effects of each of these treatments. This data will be included in future analyses.

APP086 ABOUT HELEN’-PSYCHOSIS IN PREGNANCY

Heather Gilbert, Jayashri Kulkarni, Caroline Gurvich, Anthony de Castella

Introduction: The desire to reproduce is both a powerful urge and a basic human right for women, regardless of mental health status. Currently, mental illness is treated with antipsychotic medication, however research is limited regarding the effect of this medication upon fetal development and maternal health. The challenge for clinicians, and women in this population group, is to balance the risk to the mother's mental health and wellbeing, against any possible risk of fetal abnormalities, and developmental problems in the infant.

Aim: We follow the pathway of one woman's pregnancy, delivery and first postnatal year, as she not only learns to cope with her mental illness, but also to accept that her baby will be put into foster care.

Method: Helen, a 39 year old woman with a history of paranoid schizophrenia, is observed on her journey through pregnancy, to gather information on psychiatric and medication history, including any side effects, family, medical and obstetric history; and her progress as her pregnancy advances. Observation continues at delivery, and into her baby's first year, noting maternal and infant health and wellbeing.

Results: The outcomes for Helen and her baby are not optimal; Helen becomes unwell, being deemed unfit to provide the necessary parenting skills required by her baby, while her baby has developed fetal abnormalities.

Conclusions: The combination of poor psychosocial history, existing involvement with child protection agencies, psychiatric diagnoses and admissions, medications and substance abuse, present many issues affecting outcomes for both mother and baby during the perinatal period.

APP087 ‘THE ROLLER COASTER RIDE’ IN VITRO FERTILISATION AND DEPRESSION

Heather Gilbert, Jayashri Kulkarni, Caroline Gurvich, Anthony de Castella

Introduction: Although recent studies show that infertile couples are generally well adjusted and stable in their relationships and psychological wellbeing, long term infertility is stressful in itself and IVF treatment is demanding for both women and men, although in different ways.

Aim: To highlight the stressors of cause and effect by following the pathway of one woman on her journey with in vitro fertilisation (IVF).

Method: Most couples present to an IVF clinic following 6–12 months of unprotected sex, without conception. IVF is not one procedure, but a series of timed steps over several weeks. A programme is structured for each patient, and includes stimulating the ovaries, collecting the eggs, fertilisation and embryo transfer and blood tests for pregnancy results.

Results: Literature in the area will be reviewed, and a case study will be presented to highlight key issues surrounding depression and IVF treatment.

Conclusion: If IVF treatment is unsuccessful, the couples face new decisions such as whether or not to undertake further treatment. Studies have shown that women who did not become pregnant showed higher levels of anxiety than their spouses, and that these women were also less positive than men, about their marital and sexual relationships.

APP088 BEING SEEN AND HEARD: LESSONS FOR THE IMPLEMENTATION OF CREATIVE ARTS THERAPIES IN INPATIENT PSYCHIATRY SERVICES

Pam Hellema, Jason Kenner, Stuart Lee

While research shows clear therapeutic benefits for psychiatry inpatients of participation in music and arts therapy (i.e. improved insight, socialisation and therapeutic engagement as well as reduced symptomatology), many inpatient staff see the role of creative therapies as providing distraction rather than therapy. Our project aimed to challenge this perception by exploring patient experiences of music and art therapy, and communicating these findings along with current research to staff of an inpatient psychiatry service. Education and discussion is expected to improve staff understanding and utilisation of music and arts therapy as part of a multidisciplinary therapy program.

The Alfred Adult Acute Psychiatric Unit offers art and music therapy sessions four days a week to 50 patients across 2 wards. Patient experience was captured using a Leichhardt Scale Questionnaire exploring statements relating to availability of therapies, symptom management, socialisation, enjoyment and treatment experience. Staff perceptions of art and music therapy were surveyed before and after an education program, that involved presentation of initial findings and dissemination of research evidence.

Findings revealed that patients participated in music and art therapy for a number of reasons including enjoyment, manage or control symptoms, social engagement and to alleviate boredom. Before the staff education program, while a number of staff reported a variety of benefits, diversion or distraction were still among the most commonly reported benefits. After education, there was an increase in reports by staff that art and music therapy not only had a therapeutic impact, but also supported their own work with patients.

APP089 THE EFFECTIVENESS OF AN INTEGRATED CBT INTERVENTION FOR CO-OCCURRING DEPRESSION AND SUBSTANCE MISUSE IN YOUNG PEOPLE: A PILOT STUDY

Leanne Hides, Dan Lubman, Steve Carroll, Lisa Catania, Frances Kay-Lambkin, Amanda Baker

Introduction: Adolescents with a substance use disorder are at two to three times the risk of experiencing concurrent anxiety or mood disorders. Whilst there is a well-established evidence base for the use of CBT in the treatment of depression in young people, the majority of these studies exclude adolescents with drug and alcohol problems, despite increasing evidence for the efficacy of CBT for such problems amongst young people. Two recent studies have reported positive outcomes for integrated CBT interventions for depression and alcohol dependence in adolescents. This study aims to determine the effectiveness of an integrated cognitive behaviour therapy (CBT) intervention for co-occurring depression and substance misuse in young people.

Methods: Participants consisted of 61 young people aged 15 to 26, with a major depressive disorder and concurrent substance misuse. Participants were provided with 10 sessions of CBT for co-occurring depression and substance misuse and case management over a maximum of 20 weeks.

Results: Preliminary results indicated positive outcomes on functioning and depression/anxiety symptoms but not substance use outcomes post treatment. Predictors of treatment response to the integrated CBT intervention at mid and post treatment will also be presented.

Conclusions: Preliminary evidence from recently published pilot studies have demonstrated the efficacy of integrated CBT interventions in alcohol dependent adolescents with co-existing depression. The current paper reports preliminary support for the effectiveness of integrated treatment for depression and substance misuse amongst young people.

APP090 DEVELOPMENT OF A PILOT ‘PEER ADVOCACY AND SUPPORT SERVICE’ (PASS) IN WESTERN AUSTRALIA

Mohan Isaac, Ann Bates, Vivien Kemp

Introduction: Consumer involvement in the overall provision of mental health services is being increasingly recognized and accepted as a significant element in improving mental health services. Reviews of consumer participation in service delivery show that persons with severe mental disorders can be involved in the delivery and evaluation of mental health services in a meaningful manner. There has so far, been negligible empirical work on consumer involvement in any aspect of mental health service delivery in Australia.

Aim: To develop and evaluate a pilot ‘peer advocacy and support service’ with special focus on trained peer supporters assisting persons with severe mental disorders to access appropriate care from primary care providers regarding their physical health.

Method: Six peer supporters were selected, trained, placed in three Perth sites and followed up for six months. The service was developed as a collaborative project involving the public mental health sector, Divisions of General Practice, mental health consumers and the non-government sector. An evaluation strategy was designed and implemented as an inbuilt component of the programme.

Results: The project was successful in two sites and not as successful in the third. Several barriers and enabling factors were identified. Clinician education about the value of peer support, addressing issues of confidentiality and role clarity are critical to the success of the programme.

Conclusion: There is a need to expand the programme with more peer supporters placed in a number of services and followed up for a longer period.

APP091 EVALUATION OF THE ALFRED PSYCHOLOGY CLINIC

Lynda Katona, Sacha Filia, Steven Tahtalian

The Alfred Psychology Clinic provides short-term psychological services to patients of the hospital and up until 2007 people in the local community.

Aim: To identify the characteristics of the people who attend the Clinic and evaluate the effectiveness of the treatment provided.

Method: Ninety adults were asked to complete 4 questionnaires at the start and end of treatment (The World Health Organisation Quality of Life; The Profile of Mood States; The Brief Symptom Inventory; The General Health Questionnaire). A fifth questionnaire was completed at the end (The Client Satisfaction Questionnaire). Demographic and clinical variables were recorded.

Results: The mean age was 43 years, and 51% were female. The main reasons for referral were anxiety (38%) and depression (31%). Almost half of the respondents had a physical health problem (49%). Pre- and post-treatment data was available for about 40 people. 85% reported being “very satisfied” with the service. At the end of therapy, participants reported a significant improvement in quality of life and health, t(39) = 4.87, p<.05 and t(39) = 3.43, p<.05. They also reported significant reductions in their level of mood disturbance t(36) = 8.78, p<.05, and psychological distress, t(38) = 5.33, p<.05. Significant improvements were noted for other symptoms, including anxiety and depression.

Conclusion: The Alfred Psychology Clinic predominantly treats people experiencing symptoms of anxiety and depression, many of whom also have a physical health problem. Patients are very satisfied with the service, and there are very positive outcomes, with a reduction in symptoms and distress. This highlights the significant worth and importance of such a service within the general hospital setting.

APP092 THE PHENOMENON OF INSIGHT AND PRELIMINARY FINDINGS FOR PREVENTING DEPRESSION: SELF-MONITORING VIA MOBILE-PHONES

Sylvia Kauer, Sophie Reid, Henry Jackson, Tony Jorm

Introduction: With 30% of teenagers experiencing depressive symptoms, it is critical that effective coping strategies that prevent the occurrence of depression are learnt early in life. Adolescence is an ideal target for prevention and early intervention of depression as coping strategies for everyday stresses and negative emotions are learnt during the teen years. One limitation to developing effective coping strategies is poor insight into emotions and responses to such emotions. New methods that enable young people to develop insight into emotions are necessary to promote better mental health and prevent mood disturbances.

Aim: This presentation aims to examine the concept of insight focusing on insight into mood, stress and coping strategies as it applies to young people at-risk of developing depression and other mood disorders.

Methods: Using a qualitative approach, the concept of insight was explored by conducting a literature review on research and theories that focus on insight. Next, feedback from 120 young people that completed a mobile phone self-monitoring program (the mobiletype program) in school and clinical settings was analysed to determine whether self-monitoring increases awareness and insight of emotions.

Results: Consistently across the mobiletype studies, participants reported that self-monitoring (1) helped recognise and express feelings and (2) helped understand the connections between feelings and responses.

Conclusions: Self-monitoring is likely to benefit young people by increasing their awareness and insight into their moods and coping responses. Further research is needed to determine if an increase in insight into moods and stressors helps prevent the occurrence of depression.

APP093 DEVELOPING MENTAL HEALTH FIRST AID GUIDELINES: SUICIDAL THOUGHTS AND BEHAVIOURS AND NON-SUICIDAL SELF-INJURY

Claire Kelly, Tony Jorm, Betty Kitchener, Robyn Langlands

Introduction: The Mental Health First Aid Program teaches members of the public how to help when someone is developing a mental illness or is experiencing a mental health crisis. Both suicide and non-suicidal self-injury are mental health crises.

Aim: To develop guidelines for first aid for both suicide and non-suicidal self-injury which can be used in this and other mental health first aid courses, and can be accessed by members of the public.

Method: The Delphi method, a way to reach consensus in an expert group, was used for these two studies. Medical and lay literature were searched for claims about what a person should do in either of these situations. Questionnaires were completed by an expert panel online, with each claim rated one or two times until consensus was reached. Experts on the panels included professionals, consumers and carers,

Results: The guidelines were developed and are available at www.mhfa.com.au. There were a number of tensions identified between groups, such as a conflict between the consumers' right to refuse treatment and the carers' and professionals' motivation to help.

Conclusions: It is possible and useful to develop guidelines for first aid for mental health crises which are acceptable to professionals, consumers and carers. Future, related programs will be discussed.

APP094 RELATIONSHIP BETWEEN PSYCHOPATHOLOGY, ACCEPTANCE INTO MENTAL HEALTH SERVICE AND TWO YEAR VOCATIONAL OUTCOMES IN HELP-SEEKING YOUNG PEOPLE

Eóin Killackey, Alison Yung, Elizabeth Cosgrave, Kathryn Baker

Introduction: While there has recently been some attention given to the vocational rehabilitation of young people with first episode psychosis, less is known about the vocational problems and outcomes of young people seeking help for other mental health problems.

Aims: To examine the effect of psychopathology and acceptance or rejection from mental health service on two year vocational outcomes.

Methods: 204 consecutive referrals to YouthScope, a public mental health service for young people with non-psychotic problems living in the north and western regions of metropolitan Melbourne, were approached to participate in a study examining the utility of categorical diagnoses in young people seeking help. 151 consented to participate (74%). They were assessed at baseline, six months and two years with a range of psychopathology, functioning and demographic measures. Participants were followed-up whether or not they were accepted into the service. Outcome data was available on 120 people.

Results: Data concerning the occupation status of participants and the relationship between this and acceptance into the service and psychopathology will be presented.

Conclusion: Evidence based approaches to vocational recovery in people with chronic mental illness are well established. This is not the case for young people with mental illness. This has begun to be addressed in the psychoses, but there is little data to guide the establishment of research and clinical efforts in non-psychotic illnesses. This presentation will be a first step towards addressing this deficit of knowledge.

APP095 EVALUATION OF SELF-HELP TREATMENTS FOR OBSESSIVE-COMPULSIVE DISORDER: COMPARISON OF COMPUTER-AIDED VICARIOUS EXPOSURE AND SELF-HELP LITERATURE

Ken Kirkby, Ross Menzies, Lisa Gilroy, Brett Daniels, Isaac Marks

This study compared the effectiveness of two self-help methods for the treatment of obsessive compulsive disorder (OCD); a Computer-Aided Vicarious Exposure (CAVE) program, which simulated exposure treatment in real life and a self-help book (Living with Fear: Marks, 2001), which included a specific instructional section on exposure and response prevention for OCD. Of the 292 potential participants who responded to the advertisements, 34 met study criteria and were randomly allocated to a CAVE, self-help book, or waitlist control condition. A treatment phase of eight weeks was specified for both treatment groups. The CAVE treatment group was instructed to undertake a minimum of three 45 minute treatment sessions. Thirty-one participants (Self-help book n = 13; CAVE n = 8; Waitlist n = 10) completed pre-treatment and one week post-treatment assessments and 17 participants (Self-help book n = 11; CAVE n = 6) completed both 4-month and 12-month post-treatment assessments. Efficacy ratings included Yale-Brown Obsessive Compulsive Scale, Padua Inventory-revised, Beck Depression Inventory-II (BDI-II), and Work and Adjustment Rating Scale. There was no difference between groups and no effect of time at one week post-treatment. Both self-help book and CAVE treatments reduced on a variety of OCD measures from pre- to 4 and 12 months post-treatment with small to moderate effect sizes. The study highlights diagnostic and logistical issues in remote delivery of community interventions. Further evaluation is required to ascertain the utility of self-treatment approaches in OCD.

APP096 A DISCUSSION OF THE HISTORY OF WOMEN, PSYCHIATRY AND PSYCHOSIS FROM AN AUSTRALIAN PERSPECTIVE

Jayashri Kulkarni, Natasha Marston, Caroline Gurvich, Heather Gilbert, Anthony de Castella, Paul Fitzgerald

Much can be gained from an exploration of the role of women in the history of psychiatry. The initial developments of psychiatric thought and practice largely overlooked views from female philosophers and clinicians as well as the specialised needs of female patients. Contemporary medicine has seen a reversal of many historic prejudices, which has led to innovative gender specific treatments and practices. This presentation will provide an historical perspective of the role of women from the inception of psychiatry to modern times, with an Australian focus. Gender specific psychiatric developments and interventions have improved the experience and acceptance of women with mental health concerns and extended our comprehension of the complex interaction between gender and illness.

APP097 BLOKEBOOSTER-CURING DEPRESSION IN MEN WITHOUT USING THE INTERNET

Andrew McKinnon

Obtaining funding to carry out randomized controlled trials of non-pharmacological treatments is increasingly difficult due to the level of competition for funds from sources such as the NHMRC and recognition of the need for greater sophistication and more rigorous approaches to the design, implementation and analysis of such trials.

This poster uses the example of a targeted intervention for a common mental health problem to illustrate the development of a grant proposal in this field. It showcases key facets of design and grantsmanship aimed at ensuring that your proposal achieves unique status in the minds of assessors and grant panel members.

APP098 THE IMPACT OF MEDICO-LEGAL MATTERS ON DOCTORS

Louise Nash, Carissa Coulston, Elizabeth Van Ekert, Michele Daly, Garry Walter, Chris Tennant, Maree Johnson, Merrilyn Walton

Introduction: The ‘threat of litigation’ is a major stressor in medical practice.

Aim: To describe the differences in psychological morbidity and personality factors between Australian General Practitioners (GPs) who have experienced a medico-legal matter and those who have not.

Method: 1239 GPs were sent the survey with 566 respondents (45.7% response rate to survey). There were two sources of data. First, a cross sectional survey which sought demographic information, personality traits using the Eysenck Personality Questionnaire (EPQ), history of a medico-legal matter with any medical defence organisation, and measures of psychological morbidity. Second, information was extracted from the UNITED Medical Protection database on medico-legal matters.

Results: Fifty-nine percent of respondents to the survey reported ever having a medico-legal matter, with 13% having a current medico-legal matter. Those with a current matter reported increased levels of disability (in work, social or family life) and higher prevalence of psychiatric morbidity (45% v 27% “case identification” rates), compared to those with no current matter. Those respondents with a history of past medico-legal matters reported increased levels of disability and depression subscores. Males consumed significantly more alcohol than females, and males with current or past medico-legal matters had significantly higher levels of alcohol use than males with no experience of medico-legal matters. Furthermore, males with higher neuroticism scores on the EPQ self- reported more medico-legal matters.

Conclusions: Doctors who have experienced medico-legal matters have a higher level of psychological morbidity. Neuroticism in doctors is also linked to number of reported medico-legal matters. The findings have implications for medical training, approaches to providing support to doctors and for medical indemnity organisations.

APP099 CONCRETE THINKING IN ADOLESCENT AMPHETAMINE ABUSERS

Prasert Palitponganpim

Introduction: Do adolescent amphetamine abusers have concrete thinking more than normal students with the same age?

Aim: To demonstrate the thinking process and develop a tool for mental status examination as a part of legal process for adolescent amphetamine abusers.

Methods: Comparing the answers to six questions about “difference” and “similarity” between 393 amphetamine abusers with the age not more than 18 years old (mean age = 16.71±1.77 years) to 298 grade 9 students (mean age = 15.82±0.99 years) to demonstrate how their thinking process has changed. The amphetamine abusers’ education run from grade 4 to grade 12 and have used amphetamines for not more than 5 years, and were arrested in northern Thailand during the Drug Wars year, 2003 AD. The three questions about differences are “what are the differences between day and night, children and dwarfs, tomato and Poh tree (A big tree in Buddhism)?”. Another three questions about similarity are “what is the similarity between bananas and oranges, mouses and cats, cars and boats?”. Answers are scoring to 0,1,2,3 points due to the degree of concrete words.

Results: The mean total scores and standard deviation of the selected amphetamine abusers are 9.67±3.40 points compared with the controlled grade 9 students 12.15±1.72 points which correlated independently to duration of use and education (p ≤ 0.05).

Conclusions: Adolescent amphetamine abusers have more concrete thinking than normal students.

APP100 HELPING PATIENTS ADJUST TO THE DIAGNOSIS OF BIPOLAR DISORDER: THE ROLE OF AN ONLINE PSYCHOEDUCATION PROGRAM

Judy Proudfoot, Gordon Parker, Vijaya Manicavasagar, Meg Smith

Bipolar disorder is typically poorly detected, with studies indicating that correct diagnosis can take up to 20 years in Australia. Patients often report feeling shocked on the one hand, but relieved on the other, when they receive a bipolar diagnosis. Others go through a period of disbelief during which they may fail to take prescribed medication. However, once patients accept their diagnosis, they start to develop helpful illness perceptions and strategies to control their condition, instead of it controlling them.

This paper presents preliminary data from an RCT evaluating an online psycho-education program to help individuals with newly-diagnosed bipolar disorder adjust to their diagnosis and learn to control of their illness. The 8-module online program is administered with and without email assistance from Informed Supporters, people with Bipolar Disorder who are effectively controlling their illness and trained to offer practical support to participants. The issues of concern raised by newly-diagnosed patients to their Informed Supporters will be profiled in the presentation.

APP101 DEMOGRAPHIC CORRELATES OF STIGMA AMONG MENTALLY PATIENTS IN PAKISTAN

Raza ur Rahman, Moin Ahmed Ansari, Irshad Ahmed Qazi, Aftab Sidiqui

Introduction: Stigma is attached to mental illness in different socio-cultural settings throughout the world, and that it is growing in strength and in its negative consequences.

Aims: To study the demographic distribution of stigma feeling among psychiatric patients & their relatives.

Methods: This is a retrospective study from record of patients attended psychiatric OPD or admitted at Isra University Hospital Hyderabad & Civil Hospital Karachi from January 2002 to February 2004. Information regarding presence of feeling of stigma was recoded on a structured performa containing demographic detail of the patients.

Results: The feeling of stigma towards psychiatric illness was present in about half (47.2%) of patient or their family member in sample size of 1208. The feeling of stigma was found to be more among patient with neurotic disorder than patient with psychotic disorder. In developing feeling of stigma male out number female but this difference was found to be statistically insignificant. Like gender the feeling of stigma was neither affected by marital status nor by family type (nuclear/joint). The result shows that feeling of stigma steadily increase with level of education (39% at primary level, 49% at high school level, 51% at graduate level & 52% at professional level). This finding correlate well with more stigma feeling among people belong to urban area then rural area as level of education is more in urban area.

Conclusion: Half of psychiatric patient & their relative develop stigma feeling & these feelings are not much affected by different demographic factors except educational level of patient.

APP102 PLEASE TURN YOUR MOBILES ON IN OUR CLINIC: A MOBILE PHONE MENTAL HEALTH MONITORING PROGRAM AND WEBSITE INTERFACE FOR DETECTION AND MANAGEMENT OF ADOLESCENT MENTAL HEALTH IN CLINICAL SETTINGS

Sophie Reid, Sylvia Kauer, Lena Sanci, George Patton

Introduction: Approximately 50% of mental disorders begin in adolescence. Delays between onset and effective help are associated with poor outcomes. Nevertheless, engaging, treating and retaining young people in treatment is challenging and it is estimated that general practitioners detect at most 50% of cases of depression. Low detection rates have been attributed to time pressures of GPs, young people's reluctance to report mental health problems, GPs’ lack of skills or training in detecting and dealing with mental health problems.

Aim: The aim of this study was to adapt and trial in a clinical setting the Mobile Tracking Young People's Experiences Program (mobiletype program) which assesses mood, stresses, coping strategies, alcohol and cannabis use, exercise, and eating patterns in real-time on mobile phones.

Design: Three adolescent physicians trialed the mobiletype program with 3 adolescent patients each. The young people completed the mobiletype program which started automatically and ran through a list of closed and open ended questions on their phones four times a day for 1–3 weeks. At the end of the study, the young person and their doctor reviewed individualized mental health reports produced by a website interface with the mobiletype program.

Results and conclusions: The young people reported that the mobiletype program is easy-to-use, youth-friendly and aided understanding of mental health and associated factors. The participating doctors reported that the program saved time, captured clinically useful data, increased rapport and aided narrowing in on particular difficulties. Overall, the mobiletype program and website interface is a promising clinical tool.

APP103 HOW YOUNG PEOPLE MANAGE DISTRESS: REAL-TIME DATA FROM THE MOBILE PHONE MOMENTARY SAMPLING PROGRAM (MOBILETYPE)

Sophie Reid, Sylvia Kauer, Lena Sanci, George Patton, Paul Dudgeon

Introduction: Our understanding of how young people manage and deal with feelings of distress is informed by retrospective questionnaires of they say they do. Little research has captured what young people actually do when distressed and the impact of these responses prospectively.

Aim: The aim of this study was to prospectively track the everyday mood, stresses and responses of adolescents as they happen, and evaluate the impact of these actions on later mood.

Design: 100 young people were randomly drawn from 4 schools to represent low, middle-low, middle-upper and upper socioeconomic-status completed a mobile phone momentary sampling program (mobiletype program) for 20 random days in 30. The program self-started 4 random times a day, and participants reported current activity, companions, mood, response to distress, stressors, alcohol and cannabis use. Within the assessment, young people were alerted if they were distressed and asked what they would do. In the following report, the implementation and the effect of their response to their earlier distress was assessed.

Results: More than 1000 occasions of distress and responses to the distress were captured. The most common responses to feeling distressed were, sleep (26%), study/school (12%), rest/relax (11%), nothing (7%), watch TV (6%), and eat (4%). The responses of depressed adolescents were similar to their non-depressed peers, but “nothing” and “don't know” were more frequent.

Conclusions: Capturing what young people do to manage distress at the time they are distressed provides a different picture of young people's “coping” compared with traditional models based upon retrospective data.

APP0104 THE YSHAREIT PROJECT: INCREASING AWARENESS AND USE OF E-MENTAL HEALTH RESOURCES IN YOUNG PEOPLE AGED 15–25 YEARS

Caroline Spiranovic, Kate Briggs, Ken Kirkby

Despite the recent growth in reputable Australian e-mental health websites, there has been little systematic effort to encourage the promotion and uptake of these resources. The yshareit project was developed to increase awareness of, and access to, reputable e-mental health resources for young people in Tasmania. There were two components to the yshareit project. The first was the development of the ‘triage’ website, www.yshareit.com, which provides links to five reputable Australian mental health websites for young people (Reach Out!, MoodGYM, Ybblue, BluePages, and Kids Help Line). The second was the Youth Ambassador e-mental health workshop program, attended by 135 young people aged 15–25 years. Workshop participants were encouraged to explore the usefulness of the triaged mental health resources with reference to case scenarios depicting common mental health issues for young people. Participants also engaged in a brainstorming activity aimed at improving communication skills when discussing mental health issues, so that participants could advocate the utility of the websites explored among their friends, family, and community. An e-mental health questionnaire was administered pre workshop and at six months follow-up and complete data was available for 53 participants. Analysis of the questionnaire data indicated that there was a significant increase in participants’ levels of awareness/knowledge, usage, and sharing with peers e-mental health resources, from pre to post workshop. The results of the current study indicate that the yshareit project achieved its aim of increasing knowledge and utilisation of e-mental health resources among young people in Tasmania.

APP105 THE ASSOCIATION BETWEEN BULLYING AND HEALTH-RISK BEHAVIOURS

Michelle Tollit, Sophie Reid, Lyndal Bond, Michael Sawyer, Susan Spence, Jeanie Sheffield, George Patton

Introduction: Bullying is a prominent problem in schools, which can cause physical and emotional harm to victims. It is important to explore the relationship between being bullied and participating in health-risk behaviours to better understand the impact of these factors on adolescents’ lives.

Aim: To explore the association between being bullied and engaging in health-risk behaviours such as substance abuse and socially disruptive behaviours.

Method: 5634 Year 8 students participated in the beyondblue schools project and were surveyed when they were in Year 8, 9 and 10. The sample was drawn from 50 schools in Victoria, SA and Queensland from Government, Catholic and Independent sectors. Each year students completed a questionnaire measuring severity of bullying, substance use and abuse, socially disruptive and antisocial behaviour, depressive and anxiety symptoms, school climate, and help-seeking behaviour.

Results: Logistic regression models (adjusted for clustering at the school level) indicated that being bullied in Year 8 was associated with increased risk of drinking alcohol (OR = 1.49 95%CI:1.28,1.74), smoking (OR = 1.80 CI:1.49,2.18), marijuana use (OR = 1.46 CI:1.18,1.81), and engaging in antisocial behaviour(s) on more than one occasion (OR = 1.76 CI:1.45,2.14), compared with not being bullied.

Being bullied in Year 10 was associated with increased risk of drinking alcohol (OR = 1.48 CI:1.27,1.72), drinking alcohol regularly (OR = 1.73 CI:1.33,2.26), smoking (OR = 1.99 CI:1.63,2.43), marijuana use (OR = 1.81 CI:1.53,2.15) and engaging in antisocial behaviour(s) on more than one occasion (OR = 2.27 CI:1.89,2.73), compared with not being bullied.

Conclusion: Results suggest that being bullied may increase the risk of engaging in antisocial behaviour and substance use.

APP106 SIBLINGS OF THE CHRONICALLY ILL: AN AT RISK GROUP?

Heidi Tranberg

Paediatric chronic illness affects the entire family system, however little research has examined the impact of this experience on healthy siblings, especially in relation to lesser known conditions, such as juvenile arthritis (JA). This project aims to explore the psycho-social adjustment of siblings of children with JA and the impact of various factors on their adjustment. Questionnaires were completed by 60 siblings of children with JA (who had been diagnosed for at least 3 months) and one parent of each sibling. Siblings also completed a semi-structured interview. Preliminary results indicate that healthy siblings are not at increased risk of psycho-social difficulties, however, negative feelings about the impact of JA on their life is common. These feelings often are not discussed with parents. Qualitative data suggests that psycho-social difficulties are more prominent at the time of diagnosis and that siblings feel affected by the condition in a range of ways (e.g. embarrassment, reduction in parental attention, change in nature of play with ill sibling), which can generate negative emotions. These results suggest that, unlike with numerous other illnesses, siblings of JA patients are not a group at risk of psycho-social difficulties, but that they do find the experience of living with a chronic illness difficult, particularly at the time of diagnosis and in relation to specific areas of life. Additional support to help them manage the associated feelings may be useful.

APP107 PATIENTS’ PERCEPTIONS OF LIFE AFTER DEPRESSION

Lucinda Wedgwood, Kay Wilhelm, Joanna Crawford, Gordon Parker

Introduction: While previous research has examined the effects of depression on patients’ quality of life, few studies have examined the process of recovery and the perceived consequences of no longer being depressed.

Aim: To investigate patients’ perceptions of the impact of depression, and to examine their perceptions on how life would be different if they were no longer depressed.

Method: Prior to attending a mood disorders clinic, 224 male and female patients who met DSM-III-R or DSM-IV criteria for current major depression provided data on sociodemographics, history of medical and psychiatric illness, the impact of depression on their lives and how their lives would be different if they were no longer depressed.

Results: The impact of depression was negatively felt across a wide range of domains, including financial, physical, and relations with family and friends. Little effect, however, was reported on patients’ spirituality. When patients were asked to consider how their lives would be different if they were no longer depressed, over one quarter of the sample held negative beliefs that nothing would change. Being older and male was associated with more negative cognitions of life without depression, while positive cognitions were associated with non-melancholic depression, and having experienced at least one previous episode.

Conclusions: While approximately three quarters of responses were positive and hopeful, a quarter seemed to have fears about resuming a depression free life. This has important clinical implications for treating depression and should assist with understanding some psychological factors that may impede recovery from depression.