Oral Presentations

OP001  COMMUNITY CARE FOR PEOPLE WITH PSYCHOSIS: INCLUSION AS A VALUED OUTCOME AND A HUMAN RIGHT

Helen Herrman, Carol Harvey, Prem Chopra

Department of Psychiatry, University of Melbourne, Australia

Advances in understanding recovery and effective community-based and balanced care leave a dilemma. A significant subgroup of people treated for psychosis in affluent countries remain severely disabled, take little part in community life and are socially isolated, as illustrated by recent work in Australia and the UK¹. Most of those with psychosis in poorly resourced countries receive no formal care despite successful demonstration of community rehabilitation approaches. What can be done to make better use of community resources and the hospital and other components of balanced care, and to avoid reinstitutionalisation in any form?

Clinical services can support recovery for people with psychotic disorders, including complex problems, and assist families. This is the exception, however. The social environment also has a strong influence on the symptoms and functioning of a person with schizophrenia. Interventions in supported housing, welfare, and vocational and social support, are the responsibility of sectors outside health, creating barriers to holistic recovery-oriented care. Stigma, unwarranted pessimism about outcomes, and inadequate resources further impede program development and evaluation.

The inadequate implementation of psychosocial interventions in clinical services, and disability inclusion approaches to greater community participation require action; and follow-up studies to assess a range of outcomes over several years in local settings. Subjective measures of functioning and quality of life are now recognized as important, distinct and measurable outcomes for individuals recovering from psychosis, and future work will benefit from this perspective.

¹Herrman H, Harvey C. Community care for people with psychosis. International Rev Psychiatry 2005; 17:89–95

OP002  THE FIRST CUT IS NOT THE DEEPEST: UNDERSTANDING THE LINK BETWEEN SELF-HARM AND SUICIDE

Allan House

Professor of Liaison Psychiatry, and Director, Leeds Institute of Health Sciences, United Kingdom. (http://www.leeds.ac.uk/lihs)

Hospital attendance following non-fatal self-harm is the biggest single known risk for suicide in developed countries. About a quarter of all suicides have had such an event in the 12 months before they die and nearly two thirds have a lifetime history. We know surprisingly little about the nature of the association. I will outline some research questions we need to answer: about the robustness of the idea of “suicidality” and the degree to which we can be confident in distinguishing acts of self-harm that are “attempted suicide” from those that are not; about the link between aggression, self-harm and suicide; about the adaptive and positive meanings of self-harm; and about the problem of self-harm and suicide in low-middle income countries. My aim in raising these issues will be to question the wisdom of an approach to suicide prevention that is focussed too narrowly on treating mental illness.

OP003  INCREASING THE COMPETENCE AND CONFIDENCE OF CLINICIANS TO CONDUCT MENTAL STATUS AND SUICIDE RISK ASSESSMENTS THROUGH INVOLVMENT IN A TRAINING PROGRAM

Maddy Phillips¹, Michelle Coleman¹, Aung Win¹, Laura Whitting¹, Jan Parr ¹

¹ Queensland Centre for Mental Health Learning

Background: In response to concerns raised at coroners enquiries regarding adequacy of client mental health assessment, a state wide pilot training program was instituted to provide a consistent approach to mental status examinations (MSE) and suicide risk assessment and management (SRAM).

Aims: This study assessed the learning outcomes of a state wide training program to increase clinicians’ competence and confidence in conducting an MSE and SRAM.

Method: Participants completed a pre- and post-training evaluation survey and a 3-months follow-up survey.

Results: A total of 242 mental health professionals attended the MSE training and at the completion of training demonstrated increased knowledge regarding MSE, increased ability to differentiate between mood and affect and increased ability to identify the components of a MSE. A similar number of participants attended SRAM training and reported an increased knowledge of SRAM, increased perceived confidence in background skills required for conducting SRAM and increased understanding of the SRAM Queensland Health guidelines. A reduced number of participants completed the 3-months follow-up surveys, resulting in the collection of qualitative data only.

Conclusion: Participating in a workshop specifically designed to teach competencies in conducting MSE and SRAM can result in increased confidence and competence in carrying out these assessments. Further study is required into delivering this form of training via alternate technology and assessing longer term outcomes.

OP004  ATTITUDES OF MENTAL HEALTH PROFESSIONALS FROM THE PUBLIC VERSUS PRIVATE SECTOR TOWARDS PATIENTS WHO DELIBERATELY SELF HARM

Deidre J. Smith ^1,2, Erica Neill¹, Christine Brooks¹, Isaac Schweitzer^1,2

¹ Department of Psychiatry, University of Melbourne

² The Melbourne Clinic

Background: Deliberate self-harm (DSH) behaviour may or may not be related to intention to die. Data shows previous suicide attempts give rise to higher risks of completing suicide. DSH is a significant problem in inpatient settings. In 2003–04, 24,087 cases of hospitalised self-harm were reported in Australia. This equates to 115.4 cases per 100,000 pop. Staff antipathy to DSH can both interfere with engagement in treatment and pose additional risk.

Previous studies of staff attitudes towards DSH have examined attitudes towards specific forms of self harm, the impact of attitudes on care, and predictors of positive and negative attitudes. Weiner (1980) proposed a model which theorised that attitudes and helping are based on perceptions of the patient's locus of control and stability.

Aim & Method: Using the Self-Harm Antipathy Scale and two alternative vignettes, (perceived controllability v perceived uncontrollability) based on Weiner's model, the current study aimed to examine DSH, staff perceptions and their relationship to attitudes and subsequent helping. Public versus private staff responses were compared.

Results: To-date, 38 private sector staff, 5 males/33 females; mean age 46 yrs have been studied. They were low on antipathy. It was demonstrated that length of professional experience and perceptions of patient controllability affected therapeutic approaches and decisions.

OP005  MANAGEMENT OF DELIBERATE SELF-HARM THROUGH ASSERTIVE ENGAGEMENT, BRIEF PSYCHOTHERAPY AND COMMUNITY LINKAGE

Nicole Hill ¹, Lynette Joubert¹, Carol Harvey², Sean Jespersen³, Enrico Cementon⁴, Graeme Hawthorne², Anne-Maree Kelly⁵, Anita Govindan⁶

¹ Social Work at Melbourne, Faculty of Medicine, Dentistry Health Sciences, University of Melbourne, Victoria Australia

² Department of Psychiatry, University of Melbourne, Victoria, Australia

³ Eastern Health Adult Mental Health Program, Victoria, Australia

⁴ Substance Use Mental Illness Treatment Team, DASWest, Victoria, Australia

⁵ Western Health, Victoria, Australia

⁶ Mercy Mental Health, Victoria, Australia

Background: In 2004, a pilot model of care for people presenting to hospital Emergency Departments (ED) after attempting suicide and/or deliberate self-harm was implemented, entitled The Western Area Suicide Prevention Strategy (WASPS). Analysis of uncontrolled longitudinal pilot data demonstrated improved quality of life and reduced levels of depression.

Aims: Funded by the Australian Research Council, Suicide Prevention in the Emergency Department (SPED) aims to evaluate the efficacy of a brief community linkage intervention for those who present to an ED having committed self-harm, suicidal ideation or suicide attempt.

Method: The clinical data-mining method of Epstein (2004) was used to examine patients’ psychosocial issues, referral pathways, and aspects of WASPS assessed as being effective in reducing self-harm.

Results: Analysis of data showed that psychosocial issues dominated presenters’ lives, and identified many levels at which targeted interventions may occur.

Conclusion: We will report on the development of an eco-systemic tool as an intervention and outcome measure with which to respond to the psychosocial issues of people presenting to EDs with deliberate self-harm and suicidal ideation.

OP006  PROBLEM SOLVING THERAPY FOR SELF HARM: TWELVE MONTH RESULTS FROM A RANDOMISED CONTROLLED TRIAL

Simon Hatcher¹

¹ University of Auckland

Aims: We wanted to answer the question, “is problem solving therapy plus treatment as usual better than treatment as usual, in people who present to a general hospital with self harm?”

Methods: We recruited patients from four centres in New Zealand into a Zelen randomised controlled trial. The intervention was 6 to 8 sessions of problem solving therapy after the episode of self harm. The main outcomes were measures of psychological distress, predictors of further self harm, quality of life and repetition of self harm. Patients have been followed up at three months and one year after their index episode of self harm.

Results: We recruited 594 people into the trial over two years. Of these 298 received treatment as usual and 229 problem solving therapy. After three months those who received the problem solving therapy were significantly less depressed, less suicidal and less hopeless. However at one year there was no difference between the groups on these measures. Preliminary analysis shows that those randomised to PST had fewer self harm attempts both at three months and one year.

Conclusions: Problem solving after self harm appears to be effective on several measures at three months and appears to decrease the number of self harm attempts. This could be a specific effect of the problem solving or an indication that any therapy is better than treatment as usual.

OP007  COMPARISON OF THE CIDI-AUTO WITH CLINICAL DIAGNOSIS IN A SUICIDAL POPULATION

Himali Jayasekera ^1,3, Gregory Carter², Kerrie Clover^2,3

¹ Board of Study in Psychiatry, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka

² Brain and Mental Health Priority Research Centre, University of Newcastle, NSW Australia

³ Hunter New England MHS, NSW, Australia

Aims: To examine the agreement between clinical diagnoses versus CIDI-AUTO interview, of DSM-IV mood disorders, anxiety disorders and substance related disorders, using clinician's diagnosis as the reference standard.

Method: 330 Deliberate Self Poisoning (DSP) patients at Calvary Mater Newcastle were interviewed by psychiatric clinicians and using CIDI-AUTO, Version 2.1, conducted by trained interviewers. Agreement between clinicians’ diagnoses and 1 month CIDI diagnoses were examined using kappa statistics, with sensitivity, specificity, positive and negative predictive values and likelihood ratios also calculated.

Results: Agreement was poor (kappa <0.40) for any anxiety, affective or substance related disorders. CIDI showed high sensitivity and low specificity for anxiety and depressive disorders; but low sensitivity and high specificity for substance related disorders. Overall, CIDI had high negative predictive value but low positive predictive values. There was only a slight shift from pre to post-test probabilities when CIDI was administered following clinical assessment.

Conclusion: The results of this study do not support the use of the CIDI-AUTO in place of clinical diagnosis by experienced psychiatrists in this clinical setting, as there are substantial discrepancies between clinician's diagnoses and those elicited by the computerized structured interview instrument.

OP008  INDIVIDUAL, HOUSEHOLD, AND COMMUNITY RISK FACTORS FOR SUICIDAL IDEATION AND ATTEMPT IN RURAL NSW: A PILOT ANALYSIS

Gina-Maree Sartore ¹, Helen J. Stain¹, Brian Kelly¹, Gregory Carter², Lyn Fragar³

¹ University of Newcastle, Centre for Rural and Remote Mental Health, Orange

² Brain and Mental Health Priority Research Centre, University of Newcastle

³ Australian Centre for Agricultural Health and Safety, Moree

Background: Suicide rates in rural and remote Australia are elevated compared to the population as a whole, particularly for certain groups such as young male farmers.

Aim: Preliminary analysis of the association between individual, household, and community factors and suicidal ideation in a randomly selected community sample of rural and remote residents.

Method: Data from 200 WHO-CIDI interviews (53% female) was matched with ARMHS survey data and univariate associations between lifetime suicidal ideation and attempt and factors such as remoteness, farm residence, drought impact, social connectedness, and past diagnosis of depression and/or substance use were evaluated using Chi-square tests.

Results: Lifetime suicidal ideation was significantly associated with inner regional location (ARIA remoteness category) and lower perceived adequacy of attachment (ISSI-SF) and past diagnosis by clinician of depression (p < 0.05). There were no associations with gender, farm residence, or current worry about drought.

Conclusions: These preliminary results will inform a detailed regression model of the full dataset for individual and community risk factors for lifetime and 12-month history of suicidal ideation and suicide attempt.

OP009  DISTINGUISHING SUICIDAL FROM NON-SUICIDAL DELIBERATE SELF-HARM EVENTS IN WOMEN WITH BORDERLINE PERSONALITY DISORDER

Gillian R. Maddock ¹, Gregory Carter², Elizabeth Murrell³, Terry J. Lewin⁴, Agatha Conrad⁵

¹ Honours Student Psychology, Charles Sturt University, Bathurst, NSW

² Conjoint Associate Professor, Principal Researcher, Centre for Brain and Mental Health Research, and Head, Suicide Prevention Unit, Centre for Mental Health Studies, University of Newcastle, NSW

³ Charles Sturt University, Bathurst, NSW

⁴ Research Manager, Hunter and New England Mental Health and the Centre for Mental Health Studies, University of Newcastle, NSW

⁵ Hunter and New England Mental Health and the Centre for Mental Health Studies, University of Newcastle, NSW

Aims: Deliberate self harm (DSH) is common in Borderline Personality Disorder (BPD). DSH may be associated with different degrees of suicidal intent and be due to a variety of reasons. Understanding the reasons for DSH in this population may be helpful in developing interventions to reduce the incidence of DSH or to assist in the clinical management after DSH has occurred.

Methods: The Parasuicide History Interview version 2 (PHI-2) was used to determine the reasons for DSH events in 70 Australian women diagnosed with BPD. Factor analysis of the responses identified four empirically derived component factors. Multivariate models were developed to identify the independent predictors of suicidal DSH (S-DSH) versus non-suicidal DSH (NS-DSH) events.

Results: Methods for the DSH event that involved self-poisoning, jumping or stabbing were significantly associated with a S-DSH, adjusted odds ratio 12.07 (CI 95% 2.17, 67.29), than the referent group, external harm to skin and no rescue contact being sought. Although no individual reason or grouping of reasons for DSH were significant, lower effectiveness of the DSH event to resolve the reasons for the DSH event, was associated with increased risk for S-DSH.

Conclusion: In clinical situations, any patient seeking help or medical attention, using any method of DSH other than superficial external injury to skin; and reporting a failure to effectively resolve the reasons for the DSH event, should be considered as more likely to have had a DSH event with suicidal intention. However, specific reasons for the DSH event do not meaningfully distinguish S-DSH from NS-DSH events.

OP010  ESTIMATING REPEAT RATES OF SELF-HARM: COMPARING OUTCOME AFTER VARIOUS METHODS OF SELF-HARM, TAKING ACCOUNT OF MULTIPLE REPEATS

David Owens ¹, Rachael Lilley¹, Judith Horrocks¹, Allan House¹, Rachael Noble¹, Helen Bergen², Keith Hawton², Deborah Casey², Sue Simkin², Elizabeth Murphy³, Jayne Cooper³, Navneet Kapur³

¹ Academic Unit of Psychiatry & Behavioural Sciences, University of Leeds, UK

² Centre for Suicide Research, University of Oxford, UK

³ Centre for Suicide Prevention, Division of Psychiatry, University of Manchester, UK

Aims: The presentation will use new findings from a large study based in three centres in England to put forward the case for adopting recurrent-event survival analysis as a preferred method for examining non-fatal repetition of self-harm.

Methods: In a multicentre cohort analytic study we studied 10,500 consecutive episodes of self-harm that had led to attendance at hospital over 18 months, by pooling data from three cities (Leeds, Manchester, Oxford), and we estimated rates of repetition. In the analysis we applied the statistical technique of recurrent-event survival analysis, taking account of all repeat episodes of self-harm during the 18 months of study. This method of analysis was unlike the usual procedure, which considers only the first repetition after the index episode. We used the procedure to examine repetition according to method of self-harm (self-poisoning, self-cutting, non-cutting injury, and combined injury and poisoning).

Results: We found that, when all the data from the repeat episodes are included, rates of repetition are very high. After an episode of self-poisoning the likelihood of a repeat in the following year is almost one in three; after an episode involving self-cutting, it is almost one in two.

Conclusion: The published research concerning the repeating of self-harm substantially underestimates the likelihood of repetition. We now believe that 16 per cent-our own previous estimate for repetition at one year, drawn from a systematic review of follow-up studies after self-harm-is likely to represent an unrealistically low estimate. Recurrent-event analysis of data about non-fatal repetition of self-harm offers clinicians and researchers more realistic analyses and more useful findings.

OP011  PSYCHOLOGICAL TREATMENT OF AUDITORY HALLUCINATIONS: THEMES AND EMERGING DIRECTIONS

John Farhall ¹, Frances Shawyer¹, Neil Thomas¹

¹ School of Psychological Science, La Trobe University, Bundoora, Australia

Background: Hallucinations of voices can persist despite medication treatments. Although there is empirical support for some psychological treatment approaches, symptom-specific interventions are few, and evidence regarding mechanisms of change is lacking.

Aims: To identify issues and emerging directions in researching psychological treatment of voices.

Method: In the context of wider literature, the paper reviews what has been learned from several treatment and related studies conducted in Melbourne over the past decade, and draws out themes. The studies cover phenomenology, risk, CBT and related treatments, and dissemination of treatments into routine practice.

Conclusions: Natural coping strategies are diverse but often ineffective. Some coping may be associated with distress; acceptance of voices may be associated with improved outcome. Enhancing of natural coping, focussed cognitive behaviour therapy (CBT) and Acceptance and Commitment Therapy (ACT), are promising interventions, but general application of CBT for psychosis regardless of patient goals may be misguided, and specialist training on the part of the therapist may be necessary. Response to command, and possibly other, hallucinations may be a product of interactions between appraisal and person characteristics. Promising research and intervention directions include: improving measures; better understanding appraisal processes and their link with personal characteristics; more carefully tailoring interventions; exploring acceptance and mindfulness techniques; and, learning from the strength of ‘control’ treatments.

OP012  PARALLEL AUDITORY PATHWAYS: A FRAMEWORK FOR UNDERSTANDING AUDITORY HALLUCINATIONS

Johanna C. Badcock¹

¹ Centre for Clinical Research in Neuropsychiatry, Graylands Hospital/School of Psychiatry & Clinical Neurosciences, University of Western Australia

Recent developments in auditory neuroscience have identified partially separate pathways for the identification (“what”) and localization (“where”) of auditory objects (eg. voices, environmental sounds). These developments provide a common neural framework for understanding both normal and abnormal auditory perception. The aim of this review is to examine the nature of auditory hallucinations in schizophrenia-and in the general population-using this parallel auditory pathways framework. First, the structural and functional organization of auditory what and where pathways is briefly described. Then, using recent functional neuroimaging data from healthy subjects and patients with schizophrenia, key phenomenological features of hallucinations are linked to abnormal processing both within and between these pathways. Finally, current cognitive explanations of hallucinations, based on intrusive cognitions and impaired context memory, are briefly outlined and set within this framework to provide an integrated cognitive neuropsychological model of auditory hallucinations.

OP013  IMMEDIATE SOURCE-MONITORING, SELF-FOCUSED ATTENTION AND THE POSITIVE SYMPTOMS OF SCHIZOPHRENIA

Mike Startup ¹, Sue Startup¹, Adele Sedgman¹

¹ School of Psychology, University of Newcastle, Australia

Background: Previous research suggests that tendencies to misattribute one's own thoughts to an external source, as assessed by an immediate source-monitoring test, are associated with auditory verbal hallucinations (AVHs). However, recent research suggests that such tendencies are associated instead with symptoms of thought interference.

Aims: To examine whether tendencies to externalise one's own thoughts are differentially associated with different types of thought interference, with AVHs, or with both, and to test whether emotionally salient and self-focused cognitions augment these tendencies.

Methods: The positive psychotic symptoms of 57 individuals with a diagnosis of schizophrenia were assessed and they then completed the Self-Focus Sentence Completion blank. Immediately after completing each sentence they were asked to indicate to what extent the sentence was their own. The number of sentences that were not rated as completely their own served as their externalisation score.

Results: Externalisation scores correlated with the severity of three symptoms: voices commenting, delusions of being controlled, and thought insertion. In a logistic regression analysis, all three of these symptoms were significantly and independently related to externalisation. Externalisation was not associated with either a negative or a neutral self-focus.

Conclusion: Tendencies to externalise one's own thoughts are associated with AVHs and some, but not all, symptoms of thought interference. The importance of self-focused attention and of the emotional salience of the elicited thoughts was not supported.

OP014  BINDING OF AUDITORY VERBAL INFORMATION AND GENDER IDENTIFICATION IN SCHIZOPHRENIA PATIENTS WITH AUDITORY HALLUCINATIONS

Flavie Waters ¹, Johanna Badcock¹

¹ School of Psychiatry and Clinical Neurosciences, The University of Western Australia; and Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Western Australia

Background: Auditory verbal memories of conversations are composed of what was said and also intrinsic information about the speaker's voice. Schizophrenia patients with verbal hallucinations tend to report hearing predominantly hallucinated male voices. One explanation might be that female voices contain more complex characteristics than male voices, and require greater integration. Memory binding impairments, documented in schizophrenia, may therefore result in degraded or incomplete representations of memory traces for female voices. We tested this proposal by examining whether patients with auditory hallucinations were able to retain a composite representation of voice gender identity in a verbal recognition task.

Methods: 41 schizophrenia patients (24 with, 17 without hallucinations) and 20 controls undertook a source memory paradigm, in which words were spoken in male or female voices. At recognition, participants made voice gender identity judgements.

Results: Patients were significantly less accurate when remembering female voices than controls, but there were no group differences on male voices. Patients also showed a higher tendency to say ‘yes’ on male voices. There were no significant differences between patients with and without hallucinations.

Conclusion: For the first time we show a dissociation in memory performance between male and female voices in schizophrenia, with patients showing greater difficulty in binding female voices with spoken words. Furthermore, this finding characterised schizophrenia patients as a group, indicating that it may be relevant for the formation of a range symptoms. The results provide evidence of selective binding deficits for intrinsic context features in schizophrenia.

OP015  A HISTORY OF STRUCTURAL AND FUNCTIONAL BRAIN CHANGES IN AUDITORY HALLUCINATIONS

Susan Rossell¹

¹ Monash Alfred Psychiatry Research Centre

Background & Methods: Auditory hallucinations (AH), the perception of sound in the absence of auditory stimuli, are among the most prominent and distressing symptoms of a psychotic episode. Evidence from neuroanatomical, neurophysiological and functional neuroimaging studies has indicated that patients prone to AHs have a number of structural and functional abnormalities. This paper will review this evidence.

Results: Heschl's gyrus (HG), in the primary auditory cortex (AC), is reported to be volumetrically smaller in the left hemisphere in AH patients. Whilst, functional neuroimaging studies have shown activation of HG during the experience of AH. In contrast, volumetric measurements of the Planum Temporale (PT), in the secondary AC, have shown marked inter-study variability, some studies showing smaller volume in AH patients, other studies reporting no differences. Cognitive neuroimaging has also shown that when AH patients have been asked to listen to speech there is a reduction in left auditory cortex activation and an increase in the right auditory cortex. A functional connectivity study has lastly shown interhemispheric differences in AH patients.

Conclusions: Structural and functional neuroimaging studies have suggested that the experience of AH may originate from at least three sources. (1) Smaller volume of the left AC, which reduces the cortical area available to process sound information. (2) Reversal of functional activation during speech processing, and (3) Desynchronous activity of left and right AC, further affected by reduced interhemispheric connectivity. This later finding will be addressed in the following presentation.

OP016  TRACKING THE DEVELOPMENT OF ABNORMAL NEUROANATOMY ASSOCIATED WITH AUDITORY HALLUCINATIONS

Marc L Seal ¹, Po Yin Tang¹, Damien Kennedy¹, Stephen J Wood¹, Lisa J Phillips², Mark Walterfang¹, Murat Yücel^1,3, Alison Yung³, Patrick McGorry³, Christos Pantelis¹

¹ Melbourne Neuropsychiatry Centre, The University of Melbourne, Victoria, Australia

² Department of Psychology, University of Melbourne

³ ORYGEN Research Centre, Parkville, Victoria, Australia

Background: It is believed that Auditory verbal hallucinations (AHs) may be caused by abnormal neurodevelopment and aberrant cortical connectivity, however, recent neuroimaging studies of AHs have produced inconclusive findings.

Aims: To present the findings of two recent neuroimaging investigations examining abnormal neurodevelopment and cortical connectivity believed to be associated with AHs.

Method: The first study examined cortical connectivity related to hallucination status using Diffusion Tensor Imaging (DTI) from two clinical and control samples of different duration of illness (First Episode & Chronic Schizophrenia). The second study estimated pre-morbid neuropathology of temporal lobe structures using T2 relaxation times in individuals at ultra-high risk (UHR) for the development of psychosis (n = 66).

Results: Individuals with AHs demonstrated substantial decreases in temporal lobe diffusivity with increasing duration of illness. While there were no significant differences between the comparison group and the UHR group as a whole with respect to T2 relaxation times, UHR patients with AHs demonstrated higher T2 relaxation times in the superior temporal gyrus but not for the hippocampus or amygdala when compared to control patients.

Conclusions: These investigations identified age-related changes in diffusivity in temporal lobe tracts bilaterally associated with experience of AHs in schizophrenia. Further, there is evidence the experience of hallucinations is associated with temporal lobe pathology in a pre-morbid cohort.

OP017  RELATIONSHIP BETWEEN SELF-REPORT AND INTERVIEWER-RATED LEVELS OF PSYCHOTIC-LIKE EXPERIENCES (PLEs): A COMPARION OF A CLINICAL vs. COMMUNITY SAMPLE

Joe A. Buckby ^1,2, Alison R. Yung^1,2, Elizabeth Cosgrave¹, Margaret Ross^1,2, Eoin Killackey^1,3, Gennady Baksheev^1,2

¹ ORYGEN Youth Health, Melbourne, Australia

² Department of Psychiatry, University of Melbourne, Australia

³ Department of Psychology, University of Melbourne, Australia

Background: Psychotic-Like Experiences (PLEs) are predictive of psychosis, yet are also commonly reported in community studies. It remains unclear why these same symptoms are endorsed by both people at imminent risk for psychotic disorder and also among people with no symptomatology or functional impairment. We hypothesised that PLEs, as measured through questionnaire, would be only moderately related to interview ratings of PLEs. Further, we hypothesise that there will be a stronger relation between these methods in clinical vs. community samples.

Methods: Two distinct samples were used in the present study: (1) 150 young help-seekers (mean age = 17.8 years) referred to a mental health service; (2) 651 adolescents (mean age = 15.8 years) recruited from secondary schools across Melbourne, Australia. Interview-PLEs were assessed by the Comprehensive Assessment of At-Risk Mental States (CAARMS) and questionnaire-PLEs by the Community Assessment of Psychic Experiences (CAPE).

Results: Self-report PLEs were reported by the majority of participants in both samples (Community: 99.1%, Help-Seekers: 98.6%). In comparison, interview-rated PLEs were endorsed less frequently (Community: 46.2%, Help-Seekers: 62%). There was a moderate relationship between interview- and self-report PLEs among help-seekers (r=.4–.6). However, there was a weaker relationship in the community sample (r=.2–.4).

Discussion: Self-reported and interview-rated PLEs showed a differential relationship across the distinct samples investigated in the present study. It may be that healthy young people are unfamiliar with the constructs tested in measures such as the CAPE and frequently misinterpret questions, leading to artificially inflated prevalences.

OP018  A COGNITIVE INVESTIGATION OF DELUSIONS: ARE POSITIVE SCHIZOTYPAL SYMPTOMS ASSOCIATED WITH COGNITIVE DYSFUNCTION AND BIASES?

Clare Cameron ¹, Susan Rossell^1,2, Lisa Phillips¹

¹ University of Melbourne

² Monash University, Victoria, Australia

Background: To date there has been no cognitive model to explain delusions independent of aetiology or phenomenological characteristics.

Aims: This study investigated whether abnormalities in cognitive processes associated with delusions are independent of diagnosis and/or phenomenology by examining a nonclinical population with delusion proneness. We hypothesised that delusions are the consequence of poorly formed semantic memories and deficient emotion perception. This model was compared to others in the literature: reasoning, attributional bias and theory of mind (TOM) problems.

Method: A community sample of people with high schizotypy (or delusion proneness; n = 19) and low schizotypy (n = 22) was recruited. Participants were given a task battery that included semantic memory, emotion perception, reasoning, attributional bias and TOM. Additionally, an assessment of symptoms, mood, levels of delusional thinking and general intelligence was undertaken.

Results: The results supported the newly proposed model of delusions. People with high schizotypy showed significantly longer reaction times when identifying fearful emotional expressions; showed no facilitatory effect of semantic priming and produced less words on a fluency task than those with low schizotypy. No significant group differences were found on any of the other tasks.

Conclusion: Abnormal perceptual experiences and poorly formed semantic memories were related to unusual beliefs in a non-clinical sample. Further work in clinical samples is needed to examine the dependence of this model.

OP019  2ND AUSTRALIAN NATIONAL SURVEY OF MENTAL HEALTH AND WELLBEING (NSMHWB2): INITIAL FINDINGS – PREVALENCE AND CORRELATES

Tim Slade ¹, Amy Johnston¹, Maree Teesson¹, Katherine Mills¹, Jane Pirkis², Philip Burgess³

¹ National Drug and Alcohol Research Centre, University of New South Wales

² Centre for Health Policy, Programs and Economics, University of Melbourne

³ School of Population Health, University of Queensland

Background: It has been over ten years since the 1^st Australian National Survey of Mental Health and Wellbeing (NSMHWB) was carried out. The findings of the 1^st NSMHWB have contributed greatly to mental health policy and practice in Australia. A 2^nd Australian NSMHWB was carried out in 2007 to gain a more detailed understanding of the epidemiology of mental disorders with a particular focus on the issue of health service utilisation.

Aims: To present preliminary descriptive findings from the 2^nd Australian NSMWHB. This will include one talk on the prevalence and correlates of the major ICD-10 mental and substance use disorders, one talk on the comorbidity amongst the major disorders, one talk on service utilisation, and one talk on suicidality.

Methods: The 2^nd Australian NSMHWB was carried out between August and December 2007. Data were collected via computerized personal interview using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). An extended service utilisation module assessed the extent of consultation with a range of health professionals and touched on aspects of pathways to care for people with mental disorders.

Results: Not yet available.

Conclusions: The results of the 2^nd Australian NSMHWB will be discussed both as a snapshot of the mental health of Australians circa 2007 as well as in the context of the findings from the first survey.

OP020  2ND AUSTRALIAN NATIONAL SURVEY OF MENTAL HEALTH AND WELLBEING (NSMHWB2): INITIAL FINDINGS – COMORBIDITY

Tim Slade¹, Amy Johnston¹, Maree Teesson ¹, Katherine Mills¹, Jane Pirkis², Philip Burgess³

¹ National Drug and Alcohol Research Centre, University of New South Wales

² Centre for Health Policy, Programs and Economics, University of Melbourne

³ School of Population Health, University of Queensland

Background: It has been over ten years since the 1^st Australian National Survey of Mental Health and Wellbeing (NSMHWB) was carried out. The findings of the 1^st NSMHWB have contributed greatly to mental health policy and practice in Australia. A 2^nd Australian NSMHWB was carried out in 2007 to gain a more detailed understanding of the epidemiology of mental disorders with a particular focus on the issue of health service utilisation.

Aims: To present preliminary descriptive findings from the 2^nd Australian NSMWHB. This will include one talk on the prevalence and correlates of the major ICD-10 mental and substance use disorders, one talk on the comorbidity amongst the major disorders, one talk on service utilisation, and one talk on suicidality.

Methods: The 2^nd Australian NSMHWB was carried out between August and December 2007. Data were collected via computerized personal interview using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). An extended service utilisation module assessed the extent of consultation with a range of health professionals and touched on aspects of pathways to care for people with mental disorders.

Results: Not yet available.

Conclusions: The results of the 2^nd Australian NSMHWB will be discussed both as a snapshot of the mental health of Australians circa 2007 as well as in the context of the findings from the first survey.

OP021  2ND AUSTRALIAN NATIONAL SURVEY OF MENTAL HEALTH AND WELLBEING (NSMHWB2): INITIAL FINDINGS – SERVICE UTILISATION

Tim Slade¹, Amy Johnston¹, Maree Teesson¹, Katherine Mills¹, Jane Pirkis², Philip Burgess ³

¹ National Drug and Alcohol Research Centre, University of New South Wales

² Centre for Health Policy, Programs and Economics, University of Melbourne

³ School of Population Health, University of Queensland

Background: It has been over ten years since the 1^st Australian National Survey of Mental Health and Wellbeing (NSMHWB) was carried out. The findings of the 1^st NSMHWB have contributed greatly to mental health policy and practice in Australia. A 2^nd Australian NSMHWB was carried out in 2007 to gain a more detailed understanding of the epidemiology of mental disorders with a particular focus on the issue of health service utilisation.

Aims: To present preliminary descriptive findings from the 2^nd Australian NSMWHB. This will include one talk on the prevalence and correlates of the major ICD-10 mental and substance use disorders, one talk on the comorbidity amongst the major disorders, one talk on service utilisation, and one talk on suicidality.

Methods: The 2^nd Australian NSMHWB was carried out between August and December 2007. Data were collected via computerized personal interview using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). An extended service utilisation module assessed the extent of consultation with a range of health professionals and touched on aspects of pathways to care for people with mental disorders.

Results: Not yet available.

Conclusions: The results of the 2^nd Australian NSMHWB will be discussed both as a snapshot of the mental health of Australians circa 2007 as well as in the context of the findings from the first survey.

OP022  2ND AUSTRALIAN NATIONAL SURVEY OF MENTAL HEALTH AND WELLBEING (NSMHWB2): INITIAL FINDINGS – SUICIDALITY

Tim Slade¹, Amy Johnston¹, Maree Teesson¹, Katherine Mills¹, Jane Pirkis ², Philip Burgess³

¹ National Drug and Alcohol Research Centre, University of New South Wales

² Centre for Health Policy, Programs and Economics, University of Melbourne

³ School of Population Health, University of Queensland

Background: It has been over ten years since the 1^st Australian National Survey of Mental Health and Wellbeing (NSMHWB) was carried out. The findings of the 1^st NSMHWB have contributed greatly to mental health policy and practice in Australia. A 2^nd Australian NSMHWB was carried out in 2007 to gain a more detailed understanding of the epidemiology of mental disorders with a particular focus on the issue of health service utilisation.

Aims: To present preliminary descriptive findings from the 2^nd Australian NSMWHB. This will include one talk on the prevalence and correlates of the major ICD-10 mental and substance use disorders, one talk on the comorbidity amongst the major disorders, one talk on service utilisation, and one talk on suicidality.

Methods: The 2^nd Australian NSMHWB was carried out between August and December 2007. Data were collected via computerized personal interview using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). An extended service utilisation module assessed the extent of consultation with a range of health professionals and touched on aspects of pathways to care for people with mental disorders.

Results: Not yet available.

Conclusions: The results of the 2^nd Australian NSMHWB will be discussed both as a snapshot of the mental health of Australians circa 2007 as well as in the context of the findings from the first survey.

OP023  FINANCIAL HARDSHIP, ENDURING DISADVANTAGE, DEPRESSION AND HIPPOCAMPAL VOLUME

Peter Butterworth ¹, Nicolas Cherbuin¹

¹ Centre for Mental Health Research; The Australian National University

Aim: Socio-economic disadvantage is associated with increased risk of psychiatric disorders including depression. This study seeks to examine possible neurological correlates of depression and social disadvantage, focusing on the medial temporal lobe since this brain region is particularly sensitive to early developmental and more proximal stressors. The aim is to use data from a large community-based survey to investigate whether current and enduring (childhood and current) disadvantage and severity of depression is associated with hippocampal and amygdalar volumes.

Method: Analysis of data from the second wave of the PATH through Life Study, a large community-based epidemiological survey conducted in Canberra and the adjacent town of Queanbeyan. The analysis considered measures of depression (the Patient Health Questionnaire and self reported lifetime experience of depression), measures of socio-economic circumstance (hardship/deprivation and childhood poverty) and demographic characteristics. This analysis is restricted to a subsample of participants that undertook a structural brain MRI scan (423 persons aged 44 to 48 years). Structural T1-weighted cerebral scans were acquired using a 1.5 Tesla Gyroscan MRI scanner. Automated processes (Freesurfer) were used to estimate brain volumes of neurological structures including the hippocampus and amygdala.

Results: Current financial hardship and childhood poverty were significantly associated with severity of depression symptoms, while childhood poverty was associated with lifetime history of depression. The right hippocampal and left and right amygdala volume of respondents reporting current financial hardship were significantly smaller than that of respondents who did not report financial hardship. The results also suggested that these volume estimates were smaller for respondents reporting enduring disadvantage (both current hardship and childhood poverty) than other subpopulations.

Conclusions: The association between social disadvantage and medial temporal lobe in mid adulthood is consistent with a role of psychosocial stressors. These results may contribute to better understanding of social differentials in the prevalence of psychiatric disorders.

OP024  SOCIAL CAPITAL AND MENTAL HEALTH IN A COASTAL COMMUNITY

Helen Louise Berry¹

¹ National Centre for Epidemiology & Population Health, The ANU

Introduction: Social capital comprises structural (participation in the community) and cognitive (social cohesion) components. It is protectively associated with mental disorders, and is important in health promotion. Recent research has identified fourteen separate types of participation. The aims of this study were to investigate (i) frequency of and perceptions about community participation, (ii) links between participation and cohesion and (iii) the relationship between social capital and mental health.

Methods: Participants were 963 randomly selected community members, aged 19–97, from coastal New South Wales, who completed an anonymous questionnaire. Measures included frequency of and perceptions about participation, social cohesion (belonging, trust, reciprocity, optimism and altruism) and psychological distress. The structure of participation was analysed via one-factor congeneric modelling, its relationship to distress via multiple hierarchical regression modelling, and the relationship between social capital and distress via structural equations modelling.

Results: Only seven types of participation were independently related to distress, perceptions about participation were more strongly related to mental health than was frequency of participation, frequency of and perceptions about community participation were components of a single underlying construct, “community participation”, as were components of “social cohesion”, and participation was related to mental health through its relationship with cohesion.

Conclusions: This study supported the hypothesis that personal social capital comprises community participation and social cohesion, with the latter strongly but not exclusive determined by levels of and, especially, perceptions about participation. Participation is strongly but indirectly related to mental health, through its relationship with personal social cohesion.

OP025  MENTAL HEALTH AND THE SOCIAL IMPACT OF DROUGHT: COMPARISONS OF FARMER AND NON-FARMER RURAL AND REMOTE RESIDENTS

Helen J. Stain ¹, Terry Lewin², Clare Coleman¹, Brian Kelly¹, Vaughan Carr², Lyn Fragar³, David Perkins⁴, Jeffrey Fuller⁵

¹ Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW Australia

² Centre for Brain and Mental Health Research, University of Newcastle, NSW Australia

³ Aust Centre for Agricultural Health and Safety, University of Sydney, Moree, NSW Australia

⁴ Broken Hill University Department of Rural Health, University of Sydney, NSW Australia

⁵ University of Sydney Lismore, NSW, Australia

Background: Despite increasing attention to the chronic adversity of drought on rural communities, there is limited research addressing its mental health impact.

Aim: To investigate psychological wellbeing, drought related concerns and mediating social and community factors in farming populations.

Method: 1075 randomly selected residents of rural and remote NSW (138 farmers and 937 non-farmers) completed measures of social connectedness, social support, “sense of place”, drought related adversity, psychological distress (K-10) and substance use.

Results: Farmers reported significantly higher social connectedness and “sense of place” (p<.01) than non-farmers but farmers reported less overall satisfaction with their community (p<.02), greater distress about drought impacts on themselves and their community, and recent financial adversity (p<.01), while non-farmers reported greater concern about loss of employment due to drought (p<.01). Psychological distress scores were equivalent between the two groups.

Conclusions: Drought presents multifaceted adverse effects on rural communities. Further analysis will explore mediating factors influencing the mental health impact of chronic adversity in farming populations.

OP026  WHAT IS THE ASSOCIATION BETWEEN WEALTH AND MENTAL HEALTH?

Sunny Collings ¹, Kristie Carter², Tony Blakely², Fiona Imlach Gunasekara², Ken Richardson²

¹ Social Psychiatry & Population Mental Health Research Unit, School of Medicine and Health Sciences, Otago University Wellington, New Zealand

² Health Inequalities Research Program, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand

Objective: To investigate the cross-sectional association between asset wealth and mental health in New Zealand and whether it is independent of other socioeconomic measures and baseline health status.

Methods: We used data from the first three waves of the Survey of Families, Income and Employment (SoFIE) conducted in New Zealand (2002–2004/05) (N = 15,340). The Kessler-10 was used as a measure of psychological distress. The effect of quintiles of wealth on psychological distress was investigated using logistic regression, controlling for confounders, socioeconomic variables and prior health status.

Results: The odds of high levels of psychological distress were greater in the lowest wealth quintile compared to the highest (OR 3.06, 95% CI 2.68–3.50). Adjusting for age and sex did not alter the relationship, however adjusting for income and area deprivation attenuated the odds ratio to 1.73 (1.48 to 2.04). Further controlling for baseline health status reduced the odds ratio to 1.45 (1.23 to 1.71), but the confidence interval still excluded the null.

Conclusions: Inequalities in wealth are strongly associated with psychological distress, over and above other confounding demographic variables and baseline health status. Only some of that association is confounded by adult socioeconomic position. These results are cross-sectional, so longitudinal data with enough time elapsed for asset wealth to change would be required to more accurately and precisely estimate any causal association of wealth with mental health status.

Future analyses of this data will examine the differential effects of financial wealth (savings) compared to household wealth (home ownership) on health mental health. Also once additional waves of the SoFIE data are collected we can investigate in more detail the causal pathway between wealth and mental health, by looking at the effects of changes in wealth on changes in mental health status.

OP027 THE MISMATCH NEGATIVITY (MMN) IN CLINICAL RESEARCH

Risto Näätänen

¹ Department of Psychology, University of Tartu, Tartu, Estonia

² Cognitive Brain Research Unit, Department of Psychology, University of Helsinki, Helsinki, Finland

³ Centre of Integrative Neuroscience (CFIN), University of Aarhus, Aarhus, Denmark

The mismatch negativity (MMN) is elicited by any discriminable change in repetitive auditory stimulation even in the absence of attention or behavioural task. Therefore, it can be used to study different patient groups including even comatose patients, and small infants who cannot give reliable behavioural responses. One of the most important uses of the MMN is in the prediction of coma outcome, where it currently is the best singe-measure predictor of the outcome of anoxic coma. Also, in case of vegetative-state patients, it permits one to monitor the gradual recovery of consciousness and to predict the recovery of cognitive abilities occurring in the next 2 years.

Furthermore, currently, there are approximately 40 studies showing MMN-amplitude attenuation in patients with schizophrenia. Besides abnormal auditory-cortex function, these studies also show the dampening of the frontal-cortex attention-switching mechanism. In addition, the MMN also enables one to monitor the gradual progress of the disease, in particular the decline of cognitive and functional abilities occurring in a large number of patients.

A further important clinical use of the MMN involves stroke causing aphasia where the MMN can be used to map the loss of central auditory function, and to monitor latent healing of the brain even during the first days from stroke onset, when reliable behavioural responses cannot yet be obtained.

In addition, the MMN can index the auditory-processing abnormalities in individuals with dyslexia in whom it can also be used in evaluating the effectiveness of different rehabilitation programs.

In addition to auditory discrimination, the MMN can also be used for determining the duration of auditory sensory-memory traces, which might provide a general index of brain plasticity. This duration gradually decreases with aging, which age-related decrease can be expedited by chronic alcoholism. Moreover, these traces are especially short in neurodegenerative diseases such as Alzheimer's disease.

OP028 SOURCE ANALYSIS OF MISMATCH NEGATIVITY IN SCHIZOPHRENIA

Ross Fulham ¹, Ulrich Schall^1,5, Patricia Michie^2,5, Phillip Ward^3,5, Matthew Hughes^2,5, Patrick Johnston⁴, Paul Rasser^1,5

¹ Centre for Brain and Mental Health Studies, Newcastle University

² School of Psychology, Newcastle University

³ University of NSW, Sydney

⁴ Swinburne University of Technology, Melbourne

⁵ Schizophrenia Research Institute, NSW

⁶ Hunter Medical Research Institute, Newcastle

Background: Mismatch Negativity (MMN) provides an ERP index of preattentive auditory function that is consistently reduced in schizophrenia.

Aims: Determine whether an MMN deficit occurs in recent-onset schizophrenia and identify its cortical source.

Method: EEG and MRI data were obtained from chronic (N = 19) and recent-onset (N = 12) patients with schizophrenia, and matched controls. A duration-deviant MMN paradigm was used. Participants heard an unattended random series of tones. High density MMN ERPs were recorded as the difference between deviants (8%, 100 ms) and standards (92%, 50 ms). For each individual, a realistic head model was constructed and cortically constrained (orientation and location) LORETA current source density analyses performed. These were mapped into MNI space to permit statistical analysis.

Results: MMN was reduced in recent-onset and chronic patients. Major cortical generators of MMN lie in the Superior and Middle Temporal Gyri. Only controls displayed right hemispheric dominance. Patients and controls differed in right middle frontal, inferior parietal, and secondary auditory cortex but not in primary auditory cortex.

Conclusion: The MMN deficit onsets early in the disorder and impacts secondary but not primary auditory cortex.

OP029 MISMATCH NEGATIVITY IS LINKED TO CEREBRAL GREY MATTER PATHOLOGY IN SCHIZOPHRENIA

Ulrich Schall ^1,2,3, Paul Rasser^1,2,3, Juanita Todd^1,2,3, Paul Thompson⁴, Philip Ward⁵, Patrick Johnston⁶, Vanessa Case¹, Patricia Michie^1,2,3

¹ Priority Research Centre for Brain & Mental Health Research, University of Newcastle, Newcastle, Australia

² Schizophrenia Research Institute, Sydney, Australia

³ Hunter Medical Research Institute, Newcastle, Australia

⁴ Laboratory of Neuro Imaging, University of California, Los Angeles, USA

⁵ Schizophrenia Research Unit, Liverpool Hospital, University of New South Wales, Sydney, Australia

⁶ Swinburne University of Technology, Melbourne, Australia

Background: Despite advances in treating schizophrenia, impaired day-to-day functioning remains one of its most debilitating outcomes.

Aims: Here we investigated a well-established reduction of an auditory event-related potential, termed ‘mismatch negativity’ (MMN), that correlates with impaired daily functioning rather than hallmark symptoms of the disorder.

Method: MMN in response to stimulus duration, frequency and intensity deviance was recorded from 18 schizophrenia subjects and 18 pair-wise age- and gender-matched healthy subjects. Patients were rank-ordered according to their level of disability and daily function level. High-resolution structural magnetic resonance scans were acquired to generate average cerebral cortex models using cortical pattern matching; a technique that maintains the relationship with the individual scan while allowing the accurate averaging of gyral structures across subjects.

Results: MMN amplitude was found to be reduced in schizophrenia patients and correlated with their impaired day-to-day function level. Only in patients, grey matter reduction in cortical areas subserving auditory processing, motor organization and executive function was correlated with reduced MMN amplitude in response to frequency deviance.

Conclusion: Our findings provide further evidence supporting the importance of MMN reduction in schizophrenia by linking fronto-temporal cerebral grey matter pathology to an automatically generated event-related potential index of daily functioning.

(Supported by NHMRC project grants 209828 & 252480)

OP030 THE RELATIONSHIP OF COGNITIVE FUNCTION AND STORY PRODUCTION IN FIRST EPISODE PSYCHOSIS

Helen Stain ¹, S. Hodne², I. Joa², J.O. Johannesen², W. ten Velden Hegelstad², T.K. Larsen²

¹ Centre for Rural and Remote Mental Health, University of Newcastle, Orange, New South Wales, Australia

² Stavanger University Hospital, Stavanger, Norway

Introduction: The focus of research on language in schizophrenia has overlooked a wide range of language parameters made possible by adopting linguistic theory. There is preliminary evidence for decreased use of verbs in response to the NMDA antagonist ketamine that is known to induce schizophrenia like symptoms and cognitive impairments¹. Given consistent findings for impaired verbal learning and fluency in schizophrenia now replicated in first episode psychosis (FEP) and ultra high risk (UHR) groups, this study aimed to investigate these verbal functions in relation to story production.

Method: Three groups of participants: FEP (N = 33), UHR (N = 9), healthy controls (HC, N = 21), completed measures of clinical status, social functioning, a series of neuropsychological tests targeting verbal functioning, and a story production task.

Results: FEP performed significantly poorer than HC on most indices of verbal learning and verbal fluency. Story results showed FEP produced significantly less words and corrections than HC (p<.01). Story production was positively associated with verbal learning memory for FEP (r=.43, p<.05) and with verbal fluency for both HC (r=.58, p<.01) and FEP (r=.40, p<.05).

Discussion: While groups did not differ in the time taken to complete a story, FEP produced significantly fewer words and less corrections per minute than HC. The FEP group showed significantly poorer performance on verbal learning memory and verbal fluency than HC. Results indicated a weak but positive relationship between verbal functioning and story production primarily for the FEP group. There was a trend for UHR scores across all domains to fall between the FEP and HC groups.

¹ Covington, M.A., Riedel, W.J., Brown, C., He, C., Morris, E., Weinstein, S., Semple, J. & Brown, J. (2007). Does ketamine mimic aspects of schizophrenia speech? Journal of Psychopharmacology, 21, 338–346.

OP031 IS AGING ASSOCIATED WITH CHANGE IN FUNCTIONAL ASYMMETRY FOR PROCESSING TIME CUES IN SOUND?

Juanita Todd ¹, Bill (Timothy W) Budd¹, Karen Drysdale¹, Patricia Michie¹

1. Functional Neuroimaging Laboratory, University of Newcastle, NSW, Australia

Background: There is evidence of a left-hemisphere advantage for processing temporal information in sound that is evident as a right-ear advantage (REA) on auditory discrimination tasks. This study was designed to determine whether an REA could be also observed in measures of brain electrical activity and the extent to which this is related to behavioural measures of temporal discrimination ability.

Method: Forty-five adults (18–73 years) completed behavioural and electroencephalographic (EEG) measures of temporal discrimination for sounds presented monaurally to the left and right ear. Temporal discrimination was assessed using between-channel gap detection – the ability to detect a gap between two different frequency bands of sound.

Results: Temporal discrimination performance showed a positive function of EEG-based measures of gap detection, where larger REA correlated with better temporal discrimination ability. Behavioural and electrophysiological measures also provided direct evidence of an age-related decline in temporal processing with the relationship being strongest for right-ear delivered sounds.

Conclusion: The association between an REA in electrophysiological measures and temporal discrimination ability may reflect the importance of the left-hemisphere in determining the resolution of auditory temporal processing. The stronger age-related decline in right-ear measures raises the question of whether groups that show impaired temporal processing (e.g. aged, schizophrenia, specific language disorders) also exhibit altered functional asymmetry in temporal processing, and altered functional and/or structural asymmetry in the auditory brain.

OP032 THE SPATIAL AND TEMPORAL CORRELATES OF COGNITIVE CONTROL IN SCHIZOPHRENIA: A MULTIMODAL INVESTIGATION OF TASK-SWITCHING

Sharna Jamadar ^1–3, Frini Karayanidis^1–3, Patricia Michie^1–3

¹ Centre for Brain and Mental Health Research, University of Newcastle, Australia

² Schizophrenia Research Institute, Darlinghurst, Australia

³ Hunter Medical Research Institute

Background: Patients with schizophrenia tend to perform worse than controls on a range of cognitive tasks, raising the possibility that behavioural differences between controls and patients are due to a failure to engage in the task, rather than some inherent disturbance in a brain region or system (Barch, 2005). Task-switching paradigms are useful in this regard in that they tend to show no behavioural differences between patients and controls (Karayanidis et al., 2006).

Aims: Behavioural, event-related potential (ERP) and fMRI indices were examined to determine if patients with schizophrenia employ similar cognitive control strategies to perform a switch in task.

Method: Patients (n = 12) and matched controls (n = 12) switched randomly between letter and digit tasks in a cued task-switching paradigm (cue-stimulus interval 700ms).

Results: Patient reaction time (RT) and switch cost did not differ significantly from controls. ERPs related to anticipatory preparation showed no difference between the groups; however ERPs related to stimulus processing were significantly reduced in patients relative to controls. Patients with schizophrenia tended to engage more posterior (parietal) regions for a switch in task, relative to controls, who employed more anterior (prefrontal) regions.

Conclusion: Although patients with schizophrenia did not differ from controls behaviourally, ERP and fMRI data suggested that they employed different strategies to achieve the same behavioural outcome as controls. Anticipatory preparation appears to be intact, however stimulus-related ERPs and fMRI suggests that patients employed different strategies in implementing the task-set.

Barch, 2005, Annu. Rev. Clin. Psychol; Karayanidis et al., 2006, Clin. Neurophys.

OP032.01 PSYCHOACOUSTIC EVIDENCE OF ALTERATIONS IN BINAURAL AND MONAURAL AUDITORY TEMPORAL PROCESSING IN SCHIZOPHRENIA

Bill (Timothy W) Budd¹²³

¹ School of Psychology, University of Newcastle, Ourimbah, NSW, Australia

² Priority Research Centre for Brain and Mental Health, University of Newcastle, Australia

³ Schizophrenia Research Institute, Sydney, NSW Australia

Background: Previous research has provided consistent evidence of deficits for both psychoacoustic and psychophysiological measures of auditory temporal processing in schizophrenia.

Aims: The aim of the present study was determine the extent to which auditory temporal processing deficits in schizophrenia reflects an alteration in both monaural and binaural auditory systems.

Methods: 24 individuals meeting DSMIV and ICD10 diagnostic criteria for schizophrenia and 30 healthy controls completed a battery of computerized psychoacoustic tasks designed to assess a listeners’ sensitivity to variations in monaural and binaural characteristics of sound. Audiometric and psychophysical thresholds for interaural phase difference (IPD), binaural masking level difference (BMLD) using narrow-band and wide-band masking stimuli, sinusoidal amplitude (SAM) and interaural correlation (IAM) modulation and binaural masking level differences were estimated using self-paced 3-interval 2-alternative forced choice PEST procedures.

Results: The results confirmed previous findings of no significant group differences for pure-tone audiometric with increased rate-dependent SAM thresholds in schizophrenia. Overall, binaural tasks showed a greater within-group variation in thresholds in schizophrenia. No main effect of group was found for IPD, however IPD lateralisation was increased in schizophrenia. IAM sensitivity revealed no significant group differences although thresholds could not be estimated in a subset of the schizophrenia group. Schizophrenia patients showed significantly reduced BMLDs where lower BMLDs were greatest for narrow relative to wide-band noise maskers.

Conclusions: The results reveal a complex pattern of deficits in both monaural and binaural temporal processing in schizophrenia and suggest alterations in auditory temporal processing may arise in midbrain and brainstem auditory structures.

OP033 BUILDING FAMILY SKILLS TOGETHER: EVALUATING THE IMPACT ON HEALTH AND WELL-BEING OF PEOPLE LIVING WITH SCHIZOPHRENIA AND THEIR FAMILIES OF AN EVIDENCE-BASED FAMILY INTERVENTION

Carol Harvey¹², Laura Hayes ¹, John Farhall²³, Brendan O'Hanlon³, Amaryll Perlesz³, Graeme Hawthorne¹, David Juriansz²

¹ University of Melbourne, Victoria, Australia

² NorthWestern Mental Health, Victoria, Australia

³ La Trobe University, Victoria, Australia

Background: Powerful evidence from over forty randomised trials supports the benefits of family interventions for people with schizophrenia and their families. However, these interventions are rarely provided. Building Family Skills Together is an innovative strategy for implementing an evidence-based family intervention in Australian public mental health.

Aims: As part of a larger evaluation of Building Family Skills Together, we aimed to assess the health, carer burden and experience, and quality of life of relatives of people with schizophrenia at baseline, before their involvement in Behavioural Family Therapy.

Method: Family carers of consumers attending community mental health services completed questionnaires regarding quality of life, social connectedness, caregiving and psychological distress.

Results: 60 relatives (mean age 51 years, SD = 2), 81% of whom were female joined the study. Fifty-three percent were parents of the consumer, 26% were partners. 31% reported being isolated or very isolated at base-line. 46% met criteria for probable depression/anxiety (GHQ-28). The majority were burdened by pre-occupation with their relative's situation.

Conclusion: Despite government policy emphasising provision of information and support to family carers, they continue to experience considerable psychological morbidity, social isolation and poor quality of life which should be addressed.

OP034 AN EVALUATION OF ‘REACH OUT CENTRAL’: AN ONLINE THERAPEUTIC GAMING PROGRAM FOR SUPPORTING THE MENTAL HEALTH OF YOUNG PEOPLE

Kerrie Shandley ¹, David Austin¹, Britt Klein¹

¹ National eTherapy Centre for Anxiety Disorders, Swinburne University, Australia

Background: Mental health disorders increase markedly during adolescence and young adulthood. However, few young people access or receive any form of mental health care. Consequently, there is need to be innovative and strategic in the delivery of information that will facilitate the prevention and early intervention of mental health disorders in young people.

Aims: The objective of this study was to conduct an evaluation of Reach Out Central: an online therapeutic mental health program for people aged 16–25. Specifically, the evaluation sought to determine the impact of ROC on psychological distress, use of coping strategies, satisfaction with life, alcohol use, problem solving and resilience. Changes in mental health stigma and willingness to seek help were also investigated.

Method: A single group, quasi-experimental repeated measures (pre, post, two month follow-up) design was employed.

Results: Overall, ROC was effective in reducing psychological distress, alcohol use and avoidance behaviour and improving life satisfaction, resilience, problem solving and help seeking behaviours. For females, significant positive changes were attained for life satisfaction, psychological distress, resilience, problem solving and help seeking. However, for males, the results were not as consistent with scores evidencing a (non-significant) worsening effect on life satisfaction at follow-up, resilience at post-program and avoidance behaviour at both post-program and follow-up.

Conclusion: Overall, ROC appears to have the capacity to be a useful primary and early intervention tool, enhancing protective factors in young people.

OP035 RANDOMISED CONTROLLED TRIAL OF COMPUTERISED COGNITIVE BEHAVIOUR THERAPY FOR DEPRESSION AND SUBSTANCE USE COMORBIDITY

Frances Kay-Lambkin ^1,2, Amanda Baker², Brian Kelly³, Terry Lewin², Vaughan Carr^2,4

¹ National Drug and Alcohol Research Centre, University of NSW, Australia

² Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, Australia

³ Centre for Rural and Remote Mental Health, Orange, Australia

⁴ Schizophrenia Research Institute, Australia

Background: It is important to focus efforts on developing treatments that target comorbid depression and substance use comorbidity and that also address the important issue of treatment accessibility.

Aims: To report on 12-month outcomes of the SHADE project (Self-Help for Alcohol/other drug use and DEpression).

Method: 300 people with current depression and co-existing problematic use of substances were recruited from the general community. Following a comprehensive assessment, participants received a one-session brief intervention, and were subsequently randomised to one of three treatment conditions: 9 sessions of face-to-face SHADE therapy, 9 sessions of computerised SHADE therapy, or 9 sessions of supportive counselling. Blind follow-up interviews were conducted at post-treatment, 6- and 12-months.

Results: Reductions in depression and substance use were evident at the post-treatment assessment. Improvements were maintained at 6- and 12-months in the two active SHADE therapy conditions.

Conclusion: People with co-existing depression and substance use problems will attend a program of psychological treatment and report benefit from therapy that integrates depression and AOD-related strategies. Therapist assisted computerised treatment may help people to reduce levels of depression and AOD use. Further implications will be discussed.

OP036 PARTICIPANTS’ PERCEPTIONS OF A RANDOMISED CONTROLLED TRIAL FOR PREVENTION OF DEPRESSION

Janie Busby Grant ¹, Andrew Mackinnon²

¹ Centre for Mental Health Research, Australian National University, ACT

² ORYGEN Research Centre, University of Melbourne, Vic

Background: Relatively little is known about participants’ perceptions of randomised controlled trials, particularly prevention trials conducted in a community setting. Such prevention trials are becoming more common. This raises ethical and recruitment dilemmas. Perceptions and motivation may also be linked to participants’ paths through a trial.

Aims: This study elicited prevention trial participants’ attitudes towards randomisation, ability to withdraw from the trial, and motivation for trial participation.

Method: Older adults (aged 60 to 74 years) at risk of clinically significant depression who had agreed to participate in a community-based randomised controlled trial (n = 900) completed a survey eliciting their level of agreement with positive or negative statements about randomisation, withdrawal and motivation with respect to the trial.

Results: Participants’ perceptions of the trial were generally favourable, demonstrating a sense of comfort with randomisation, a commitment to completing the trial, and a primarily altruistic motivation for participation. Most participants appeared to conceptualise themselves as ‘volunteers’ rather than ‘patients’ in the context of the trial. Factors such as gender and severity of depressive symptoms were associated with perceptions of trial participation. Motivation was not related to withdrawal or response.

Conclusion: These findings have implications for recruitment techniques adopted in future prevention trials and inform the wider ethical debate surrounding consent to participation in randomised controlled trials.

OP037 HARMONIZING DATA ACROSS NINE STUDIES: AN EXAMPLE OF DEPRESSION FROM THE DYNOPTA STUDY

Lesley Ross ¹, Kaarin J. Anstey¹, Scott Hofer², Peter Butterworth¹

¹ Ageing Research Unit, Centre for Mental Health Research, Australian National University, ACT, Australia

² Department of Human Development and Family Sciences, Oregon State University, OR, USA

Background: Depression has been linked to numerous cognitive and health-related outcomes. Several measures have been developed to assess depression and depressive symptoms and are commonly used in longitudinal studies.

Aims: This study harmonized data drawn from nine Australian Longitudinal Ageing Studies and five different measures from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project (N = 50,682).

Method: When possible, missing data were handled in accordance to each instrument's manual. A latent variable modelling approach was used to estimate a common depression construct across the Goldberg Anxiety and Depression Scale (GADS), the SF-36, the SF-12, the Center for Epidemiological Studies-Depression Scale (CES-D), and the Psychogeriatric Assessment Scale (PAS).

Results: The beta weights from the latent variable model were used to derive a comparable index of depression for all participants.

Conclusion: Data across studies with different, but sufficiently overlapping, measures of the same construct can be combined using a latent variable modelling approach. This method has utility for pooled data analysis and with design-related missing data due to different study measures.

OP037.01 BASELINE DEPRESSION PREDICTS END OF TREATMENT MALNUTRITION AND ECOG STATUS IN HEAD AND NECK CANCER RADIOTHERAPY PATIENTS

Ben Britton ¹, Kerrie Clover^1,2, Gregory Carter^1,2, Cathy Odelli¹, Karen Wenham¹, Lorna Bateman¹, Annette Zeman¹, Andrew Court¹

¹ Calvary Mater Newcastle, NSW, Australia

² University of Newcastle, NSW, Australia

Background: Malnutrition contributes to the relatively high mortality rate in Head and Neck cancers (HNC). Studies of wasting diseases demonstrate that malnutrition is influenced by psychological factors, particularly depression.

Aim: To explore the relationship between psychological factors and malnutrition in HNC patients receiving radiotherapy.

Method: This prospective cohort study assessed malnutrition and psychological status of 70 HNC patients receiving at least 20 fractions of radiotherapy at three time points: first week of treatment; final week of treatment; and after a four week recovery period. They underwent a nutritional assessment (PGSGA), an assessment of anxiety, depression, oncology coping style and nutritional self-efficacy.

Results: Linear Mixed Models analysis found that the best predictive model of developing malnutrition was made up of Time (p<.001), Tumour Site (p=.008) and Baseline Depression (p=.003). Similarly, ECOG at end of treatment and after post treatment recovery was best predicted by a model of Time (p=.016) and Baseline Depression (p=.004).

Conclusion: Baseline depression, as measured by the PHQ-9, coupled with tumour site was the best predictor of malnutrition and post-treatment ECOG in this sample. Number of fractions, live-in carer, age, sex, baseline self-efficacy, coping style and baseline dietetic assessment, were not as efficient in their prediction of future nutritional status.

OP038 DELUSIONS IN BIPOLAR DISORDER: SIMILARITIES AND DIFFERENCES WITH SCHIZOPHRENIA

Susan L. Rossell^1,2

¹ Monash-Alfred Psychiatry Research Centre, Melbourne, VIC, Australia

² University of Melbourne, Melbourne, VIC, Australia

Background: Delusions are common during acute psychotic periods in both schizophrenia and bipolar disorder. There has, however, been little research on the phenomenology of delusional beliefs in bipolar disorder, other than investigations that have suggested that delusional beliefs are mood-congruent in bipolar disorder.

Aims: This study sought to examine the phenomenology of delusions in bipolar disorder.

Methods: 40 patients with bipolar disorder, 54 schizophrenia patients and 44 healthy controls were administered the Peters Delusional Inventory (PDI), a 21 item questionnaire examining the endorsement rates of a range of delusional beliefs. Preoccupation, distress and convictional intensity were also recorded for each endorsed item. Additionally a full SCID interview was administered to the patients to obtain their other symptom characteristics.

Results: Acutely psychotic schizophrenia patients and bipolar patients endorsed the same number of delusional beliefs, and were equally distressed and preoccupied by them. Interesting when delusions subsided in bipolar disorder they were no longer convinced their delusional ideas were true, where this was not the case in schizophrenia who continued to show high conviction levels.

Conclusions: This study provides descriptive data regarding cross section frequency and phenomenological characteristics of delusions in bipolar disorder. Despite similarities to schizophrenia when acutely unwell, bipolar patients achieve better symptom remission.

OP039 TAMOXIFEN: A POTENTIAL TREATMENT FOR WOMEN IN THE MANIC PHASE OF BIPOLAR AFFECTIVE DISORDER?

Jayashri Kulkarni ¹, Ling Mu¹, Caroline Gurvich¹, Anthony de Castella¹, Paul Fitzgerald¹, Susan Davis²

¹ Monash Alfred Psychiatry Research Centre, The Alfred Hospital and the School of Psychology, Psychiatry and Psychological Medicine, Monash University, Melbourne Australia

² Department of Medicine, Alfred Hospital, Monash University, Melbourne, Australia

Background: 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.

Aims: 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: 51 women in the manic phase of BPAD or schizoaffective disorder were included in this 28-day, three-arm (40mg/day oral tamoxifen or 20mg/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.

Results: All groups improved over time with respect to symptoms of mania and psychopathology. The tamoxifen group showed a pattern of greater improvement at days 14 and 28.

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

OP040 A CLINICAL PROGRAM FOR JUVENILE BIPOLAR DISORDER: PRELIMINARY DATA AND FUTURE RESEARCH DIRECTIONS

Stephen J. Hirneth ¹, Philip L. Hazell², Tanya L. Hanstock³

¹ The Bipolar Program, Hunter New England Area Health Service, Newcastle, NSW, Australia

² Sydney South West Area Health Service, NSW, Australia

³ Greater Southern Area Health Service, Wagga Wagga, NSW, Australia

Background: The Bipolar Program (TBP) is a clinic specialising in assessing and treating Juvenile Bipolar Disorder (JBD).

Aims: To describe demographic, clinical, comorbid and functional characteristics of clients with JBD.

Method: Systematic assessment data were obtained for all clients of TBP diagnosed with JBD between May 2005 and May 2007 (40 female, 16 male, M = 13.9 years, SD = 2.7).

Results: From semi-structured interview data (WASH-U-KSADS), 19.6% met criteria for Bipolar I, 14.3% Bipolar II, and 66.1% Bipolar NOS. Mean age at diagnosis was 13.1 years (SD = 2.8), with no sex difference. Comorbidities included anxiety disorders (51.8%), ADHD (30.4%), psychosis (25%), ODD/CD (17.9%), ASD (12.5%), and eating disorders (5.4%). Most clients reported self-harm/suicidal behaviours (76.3%) and ideation (75.7%). Mean clinician-report scores were calculated for the Hamilton Depression Rating Scale (M = 8.2, SD = 5.5), Young Mania Rating Scale (M = 7.9, SD = 6.9), Children's Global Assessment Scale (CGAS; M = 55.9, SD = 11.3) and Health of the Nation Outcomes Scale for Children and Adolescents (M = 20.1, SD = 8.2). Males scored significantly lower on the CGAS (p<.05).

Conclusion: Clients with JBD at TBP tend to be female, presenting in early adolescence, and show profiles similar to previous studies, with high levels of psychiatric comorbidity (especially anxiety), and poor global functioning.

OP041 BLOOD CONCENTRATIONS OF OMEGA-3 IN PARTICIPANTS WITH JUVENILE BIPOLAR DISORDER COMPARED TO HEALTHY CONTROLS

Edward H. Clayton ¹, Tanya L. Hanstock², Stephen J. Hirneth², Colin J. Kable², Manohar L. Garg³, Philip L. Hazell⁴

¹ NSW Department of Primary Industries, Wagga Wagga Agricultural Institute, Wagga Wagga, NSW, Australia

² The Bipolar Program, Hunter New England Area Health Service, Newcastle, NSW, Australia

³ Nutraceuticals Research Group, University of Newcastle, Callaghan, NSW, Australia

⁴ Central Clinical School, University of Sydney, NSW, Australia

Background: A deficiency of long-chain omega-3 polyunsaturated fatty acids (LCn-3PUFA), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), has been reported in adults with depression and bipolar disorder (BD).

Aims: To examine LCn-3PUFA status in children and adolescents with juvenile BD (JBD) compared to healthy controls and the relationship with symptoms of mania and depression.

Method: Fifteen participants (9–18 yrs) with JBD and fifteen age and sex-matched controls were assessed for dietary intake and red blood cell (RBC) LCn-3PUFA.

Results: RBC EPA and DHA were significantly lower in participants with JBD compared to controls, but not after controlling for LCn-3PUFA intake. RBC DHA was also negatively related to clinician ratings of depression and participant ratings of aggression.

Conclusion: Lower RBC LCn-3PUFA in JBD was explained by lower intakes in the current study. Given previous evidence linking deficiencies of LCn-3PUFA to BD, a randomised placebo-controlled study examining supplementation with LCn-3PUFA as an adjunct to standard pharmacotherapy appears warranted in this participant population.

OP042 OMEGA-3 SUPPLEMENTATION IN JUVENILE BIPOLAR DISORDER

Tanya L. Hanstock ¹, Stephen J. Hirneth¹, Colin J. Kable¹, Manohar L. Garg², Philip L. Hazell³, Edward H. Clayton^2,4

¹ The Bipolar Program, Hunter New England Area Health Service, Newcastle, NSW, Australia

² Nutraceuticals Research Group, University of Newcastle, Callaghan, NSW, Australia

³ Central Clinical School, University of Sydney, NSW, Australia

⁴ NSW Department of Primary Industries, Wagga Wagga Agricultural Institute, Wagga Wagga, NSW, Australia

Background: Supplementation with long-chain omega-3 polyunsaturated fatty acids (LCn-3PUFA), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), may be beneficial in the treatment of depression in children and bipolar disorder (BD) in adults.

Aims: To examine the change in symptoms of mania and depression in participants with juvenile BD (JBD) following supplementation with LCn-3PUFA.

Method: Eighteen participants with JBD received supplements containing 1.92 g day⁻¹ LCn-3PUFA, including 360 mg day⁻¹ EPA and 1560 mg day⁻¹ DHA, for 6 weeks. Fasting Red Blood Cell (RBC) LCn-3PUFA, mania, depression and global function were measured before and after supplementation.

Results: RBC EPA and DHA increased significantly following supplementation. Symptoms of mania and depression were significantly lower and global functioning was significantly higher following supplementation. Changes in RBC LCn-3PUFA were not significantly related to changes in mania or depression.

Conclusion: Supplementation with omega-3 was associated with a reduction in mania and depression in participants with JBD when given in an open-label manner. A larger randomised controlled trial appears warranted in this participant population.

OP042.01 COGNITIVE EMOTION REGULATION IN BIPOLAR DISORDER

Melissa J. Green ^1,2, Charlotte James^1,2, Laila Tabassum^1,2, Peter R. Schofield³, Philip B. Mitchell^1,2

¹ School of Psychiatry, University of New South Wales, Sydney NSW 2031 Australia

² Black Dog Institute, Prince of Wales Hospital, Randwick NSW 2031 Australia

³ Prince of Wales Medical Research Institute, Randwick NSW 2031 Australia

Background: Effective emotion regulation is necessary for psychological health. Specific patterns of dysfunction in cognitive emotion regulation have been associated with unipolar depression and anxiety. We examined patterns of cognitive emotion regulation in bipolar disorder (BD).

Objective: We hypothesized that individuals with BD would report aberrant use of cognitive strategies for emotion regulation in association with levels of depression, anxiety, stress, and hypomanic personality traits.

Methods: 71 individuals with BD or schizoaffective disorder (bipolar type) completed questionnaire measures of depression, anxiety, stress, hypomanic personality, and the tendency to employ particular cognitive emotion regulation strategies when confronted with negative life events.

Results: Pearson's correlations revealed that levels of depression, anxiety, and stress were associated with increased ‘self-blame’, ‘rumination’, ‘catastrophizing’, and less ‘positive reappraisal’. In addition, levels of hypomania were associated with less ‘positive refocusing’, ‘refocus on planning’, and ‘putting into perspective’. Subsequent backward regressions with step-wise removal of non-significant predictors of clinical status removed ‘catastrophizing’ from all models; however, increased ‘self-blame’ predicted higher levels of anxiety and hypomanic traits, increased ‘rumination’ and decreased ‘positive reappraisal’ predicted greater depression and stress, and decreased ‘acceptance’ and ‘rumination’ predicted higher levels of hypomanic traits.

Conclusion: Cognitive emotion regulation strategies in association with depression, anxiety, and stress in BD overlap with those implicated in the development of unipolar depression. Hypomanic personality traits are associated with distinct strategies that may reflect poor executive function and inhibitory deficits.

Acknowledgements: This research was supported by NHMRC Program Grant 510135.

OP043 A COMPARISON OF RIGHT UNILATERAL ULTRA-BRIEF PULSE (0.3) ECT AND STANDARD RIGHT UNILATERAL ECT

Colleen Loo (1,2,3), K. Sainsbury (2), P. Sheehan (2), W. Lyndon (2)

(1) University of New South Wales, Sydney, Australia

(2) Northside Clinic, Sydney, Australia

(3) Black Dog Institute, Sydney, Australia

Electroconvulsive therapy (ECT) is a highly effective treatment for depression; however its widespread use is limited by the risk of cognitive and memory side effects. Thus, an important goal for researchers in the field has been to minimise the potential cognitive impairment associated with ECT while maintaining the efficacy of the treatment. This study explored the use of a novel approach, right unilateral ECT with an ultra-brief pulsewidth (0.3ms) (RUL-UB), in comparison with standard right unilateral ECT, with this aim. So far, formal assessments of mood and neuropsychological functioning over a course of ECT have been obtained in 75 depressed inpatients who received RUL-UB ECT at 6 times seizure threshold, and 22 patients who received standard right unilateral ECT (1.0ms pulsewidth) at 5 times seizure threshold. The two groups were equivalent on demographic and clinical characteristics at baseline. Assessments were conducted by a psychologist using a battery of neuropsychological tests and the Montgomery-Asberg depression rating scale, prior to beginning the ECT course, after 6 treatments and at the end of the ECT course. Efficacy was maintained using the ultra-brief pulsewidth, with equivalent numbers of responders and remitters in both groups. However, the RUL-UB group did require more ECT treatments on average than the right unilateral group, suggesting a slower speed of response. Seizure thresholds and initial treatment doses were significantly lower in the RUL-UB group. The results of the cognitive tests showed superior functioning in the RUL-UB group, particularly when patients were required to retain verbal or visual information over a period of delay.

OP044 A MAGNETIC RESONANCE IMAGING STUDY OF TIME COURSE CHANGES AFTER TRANSCRANIAL DIRECT CURRENT STIMULATION IN HEALTHY CONTROL SUBJECTS

Abraham P. Arul-Anandam ¹ , Caroline Rae ^2,3 , Colleen Loo ^3,4 , Melissa Pigot ^3,4 , Philip B. Mitchell ^3,4 , Perminder S. Sachdev ^3,5

¹ BSci(Med)Hons Student, University of New South Wales, NSW, Australia

² Prince of Wales Medical Research Institute, NSW, Australia

³ University of New South Wales, NSW, Australia

⁴ Black Dog Institute, NSW, Australia

⁵ Neuropsychiatric Institute, Prince of Wales Hospital, NSW, Australia

Background: No magnetic resonance spectroscopy (MRS) studies have been performed to examine neurochemical changes following transcranial direct current stimulation (tDCS) in humans. As tDCS is emerging as a potential treatment for Major Depressive Disorder (MDD), an improved understanding of its mechanisms is important.

Aims: This study investigates whether 20 minutes of tDCS, with anode placed over the left dorsolateral prefrontal cortex and cathode over right subraorbital region, produces changes in glutamate signal over 60 minutes, as measured by MRS.

Method: 10 healthy control subjects, screened to exclude psychiatric and systemic medical illness and use of psychotropic medications, were recruited. Subjects receive an initial MRS scan to measure baseline glutamate (30 minutes). Immediately post-tDCS, subjects are scanned again to detect changes (60 minutes). This procedure is repeated with sham tDCS stimulation, with active and sham sessions in randomised order.

Results: The study is in progress and results will be presented.

OP045 THE EFFECT OF DIFFERENT FORMS OF ECT ON ASYSTOLE AND BRADYCARDIA

Patrick Stewart ^1,2, Colleen Loo^1,2,3,4, Ross MacPherson^3,5,6

¹ UNSW, Sydney, Australia

² St George Hospital, Sydney, Australia

³ Northside Clinic, Sydney, Australia

⁴ Black Dog institute, Sydney, Australia

⁵ Sydney University, Sydney, Australia

⁶ Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, Australia

Background: There have been multiple case reports of asystole or cardiac arrest resulting from parasympathetic action following the ECT stimulus. The effects of different forms of ECT on asystole and bradycardia occurring during and immediately after the stimulus have not been systematically investigated.

Aims: This study investigates asystole and bradycardia during and immediately following the application of the ECT stimulus in four forms of ECT.

Methods: Approximately 300 ECG recordings will be collected during bitemporal, bifrontal, right unilateral and ultrabrief (0.3ms) pulsewidth right unilateral ECT. Heart rate before, during and after the electrical stimulus will be recorded. Asystole and changes in heart rate will be compared between treatment modalities. Other clinical and demographic variables that may affect the occurrence of asystole and bradycardia will be analysed.

Results: Preliminary observations indicate that asystole and bradycardia occur less frequently with right unilateral ECT and the use of an ultrabrief pulsewidth.

Conclusion: If confirmed that ultrabrief stimuli and right unilateral ECT are less likely to have adverse effects on cardiovascular function during ECT treatment, this will have important implications for the safe treatment of patients with cardiovascular risk factors who nevertheless require treatment with ECT.

OP046 ENHANCING RESPONSE TO REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN THE TREATMENT OF DEPRESSION

Paul Fitzgerald

Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Commercial Rd Melbourne, Victoria, Australia, 3004

Background: Transcranial magnetic stimulation (TMS) is a non-invasive means of stimulating nerve cells in superficial areas of the brain, utilising a pulsed magnetic field generated by a coil held close to the scalp. Over the last 12 years, repetitive TMS (rTMS) applied to the dorsolateral prefrontal cortex (DLPFC) has been actively investigated as an alternative intervention for patients with treatment resistant depression (TRD). Although rTMS has been shown to have antidepressant efficacy, the degree of clinical effect in many studies has been limited.

Aim: The aim of this research was to investigate several methods for enhancing rTMS response

Methods: Several randomised double-blind trials have been conducted investigating a number of methods for enhancing the effectiveness of rTMS in clinical depression.

Results: Both sequential bilateral rTMS and neuro navigational targeting of rTMS stimulation appear to provide substantially enhanced response rates compared to standard high-frequency left-sided stimulation. Priming stimulation but not changing stimulation frequency appears to enhance response to low frequency right-sided stimulation.

Conclusion: Recent research suggests that it appears possible to enhance rTMS treatment methods in ways that will make clinical utilization of the technique possible. This should lead to greater clinical applicability.

OP047 APPRAISAL OF SESSIONAL EEG FEATURES AS A CORRELATE OF CLINICAL CHANGES IN AN RTMS TREATMENT OF DEPRESSION

Gregory W. Price ^1,2, Joseph Lee^1,2, Carrie-Anne Garvey¹, Nathan Gibson³

¹ Clinical Research & Neurophysiology, North Metropolitan Area Health Service-Mental Health, Perth, WA, Australia

² Centre for Clinical Research in Neuropsychiatry/School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia

³ Graylands Hospital, North Metropolitan Area Health Service-Mental Health, Perth, WA, Australia

Background: Previous findings on electrophysiological features related to depression predict that these correlate with clinical assessment, and potentially act as proxy measures of state changes.

Aims: This study investigated selected electrophysiological features to evaluate their utility as proxies for clinical ratings and in prediction of treatment outcome.

Method: Using typical EEG data from an rTMS treatment regime, we analysed individual alpha power and frequency, and asymmetry index from 39 patients with treatment resistant depression. The prognostic utility of these features was assessed in terms of group identification, correlation with clinical rating, or association with the time course of treatment.

Results: There was no significant group difference in asymmetry between depression patients and normal and clinical controls. Background alpha was significantly less in depression patients than controls, with the schizophrenia group midway between. There was no significant group change in asymmetry index or background alpha activity with treatment. There is a weak effect of rTMS over each session on alpha power and on asymmetry, but in the opposite direction to predictions. There was weak evidence of predicted correlation between asymmetry index change and clinical rating change, as well as in final scores that was opposite to predictions. Finally there was no strong evidence that either feature fitted a linear or more complex model of daily treatment.

Conclusion: The findings are not sufficient, under our current clinical treatment regime, to support the use of background alpha activity or frontal asymmetry as proxies for clinical assessment. Several findings, however, provide support for further research in this direction.

OP048 VAUGHAN CARR – THURSDAY OPENING (ASPR FOUNDERS MEDAL PRESENTATION)

OP049 DIET QUALITY IS ASSOCIATED WITH DEPRESSIVE SYMPTOMS, MAJOR DEPRESSION AND DYSTHYMIA

Felice N. Jacka ¹, Julie A. Pasco¹, Lana J. Williams¹, Mark A. Kotowicz¹, Geoff C. Nicholson¹, Michael Berk¹

¹ The University of Melbourne, Department of Clinical and Biomedical Sciences: Barwon Health, Victoria, Australia

Aims: There is evidence of a role for diet and nutrition in depressive illnesses, however previous research in this field has focused on individual nutrients such as folate and n-3 PUFAs. This study investigated the association between overall diet quality and depressive symptoms, major depressive disorder (MDD) and dysthymia in a randomly-selected community sample of 1007 women aged 20–96yr.

Methods: A diet quality score (DQS), based on national dietary recommendations, was derived from a comprehensive validated food frequency questionnaire. Participants completed the GHQ-12, and the Structured Clinical Interview for DSM-IV-TR was administered to assess MDD, both current and lifetime, and dysthymia.

Results: In this sample, 225 (22.3%) women reported ever having a major depressive episode and 54 (5.4%) reported current MDD or dysthymia. There was a significant inverse association between DQS and GHQ-12 scores (both z-score standardised) that was not confounded by age, SES, education, alcohol consumption, current smoking, physical activity or energy intake (β = − 0.10, 95%CI = − 0.17 to −0.04, p = 0.004). DQS was also inversely related to current MDD/Dysthymia (OR = 0.72, 95%CI = 0.54 to 0.98, p = 0.034) after all adjustments. There was no association with lifetime MDD.

Conclusion: These data support a role for habitual diet quality in depressive illnesses and emphasise the need for prospective studies examining the role of nutrition in the aetiology of such illnesses. As psychiatry lacks primary prevention messages and treatment strategies based on lifestyle factors, these results may have may have both public health and treatment implications.

OP050 PATHWAYS TO RECOVERY IN A RANDOMISED TRIAL OF INTERPERSONAL PSYCHOTHERAPY AND COGNITIVE BEHAVIOUR THERAPY

Suzanne E. Luty ¹, Janet D. Carter^{1, 2}, Janice M. Mackenzie¹, Christopher M.A. Frampton¹, Roger T. Mulder¹, Peter R. Joyce¹

¹ Department of Psychological Medicine, University of Otago, Christchurch, New Zealand

² Department of Psychology, University of Canterbury, Christchurch, New Zealand

Background: No continuation studies compare Interpersonal Psychotherapy (IPT) with Cognitive Behaviour therapy (CBT).

Aims: This study aimed to explore the recovery of patients receiving six months of continuation IPT or CBT following a block course.

Method: 177 patients with a principal axis I diagnosis of major depression were randomised to IPT or CBT and received a sixteen-week block of therapy. 135 patients then continued with monthly sessions over a median of six months. Recovery was based on a priori defined criteria of four MADRS ratings of < 10. These were clinician rated at months 4, 5 and 6, and an independent rating at month 6. Recovery and pathways to recovery were analysed by therapy based on response at end of block treatment.

Results: There was no difference in recovery by therapy at the end of continuation therapy. When recovery was analysed by previous response/non response at the end of block treatment there were differences by therapy. Only continuing therapy with IPT non responders or CBT responders improved outcome.

OP051 DEPRESSION AND ANXIETY ARE NOT ASSOCIATED WITH 17-YEAR MORTALITY AFTER ADJUSTING FOR HEALTH STATUS

Philip J Batterham ¹, Helen Christensen¹, Andrew Mackinnon²

¹ Centre for Mental Health Research, The Australian National University, Canberra, Australia

² Orygen Research Centre, The University of Melbourne, Melbourne, Australia

Background: Three previous reviews have reported mixed findings on the association between high depression and increased mortality. Another review has reported little evidence for an effect of anxiety on mortality.

Aims: To examine the effects of depression and anxiety on all-cause mortality over 17 years.

Method: A community sample of 896 women and men aged 70 years and older from the Canberra region were assessed four times over 12 years, with mortality data collected over 17 years. Of these participants, 611 had follow-up data and were included in an analysis examining the effect of changes in depression and anxiety over time.

Results: While the intercept and slope coefficients for the Goldberg Depression Scale were univariately associated with mortality, the effects became non-significant after adjusting for age, gender and health status. Initial Goldberg Anxiety Scale scores and changes in anxiety over time were not significantly associated with mortality.

Conclusion: The relationship between depression and mortality found in this cohort can be attributed to the effect of poor physical health.

OP052 UNDERSTANDING PATIENTS’ DESIRE FOR LIFE SUSTAINING TREATMENTS

David M. Clarke ¹, Tom Trauer¹

¹ Psychological and Behavioural Medicine Unit, Monash University, Monash Medical Centre, Victoria

Background: Since Aaron Beck's initial formulation, it has been understood that hopelessness contributes independently to suicidal ideation over and above depression. In patients with medical illness we have identified anhedonic depression and hopelessness depression (demoralisation) as two distinct types of depression.

Aims: To examine the contribution of demoralisation and anhedonic depression to explain the desire of patients with advanced cancer or motor neuron disease for life sustaining treatment (LST).

Method: 125 patients with advanced cancer and 126 patients with motor neuron disease completed a structured interview and self-report questionnaires. Dimensions of anhedonic depression and demoralisation were identified by factor analysis (previously published). Multivariate analyses were used to examine the ability of a range of variables, but especially demoralisation and anhedonia, to explain Desire for LST.

Results: Demoralisation contributed significantly and substantially to reduced Desire for LST, and this was mediated through suicidal ideation. Anhedonia did not contribute significantly. Other factors that contributed significantly were dispositional optimism and belief in God, and these were mostly mediated via demoralisation.

Conclusion: Dispositional optimism and belief in God predict Desire for LST. However, the strongest and most direct effect is demoralisation, characterised by helplessness and hopelessness.

OP053 IS ADVANCED PATERNAL AGE ASSOCIATED WITH ALTERED BRAIN DEVELOPMENT? CLUES FROM EPIDEMIOLOGY

John McGrath ^1,2, Sukanta Saha¹, Adrian Barnett³, Claire Foldi², Thomas Burne^1,2, Stephen Buka⁴, Darryl Eyles^1,2

¹ Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol QLD 4076 Australia

² Queensland Brain Institute, University of Queensland, St Lucia QLD 4072 Australia

³ Institute of Health and Biomedical Innovation and School of Public Health, Queensland University of Technology, Kelvin Grove, QLD 4059 Australia

⁴ Department of Community Health, Brown University, Providence, Rhode Island 02806, USA

Aims: Advanced paternal age (APA) is associated with an increased risk of neurodevelopmental disorders such as autism and schizophrenia, as well as with dyslexia and impaired intelligence. The aim of this study was to examine the relationship between paternal age and neurocognitive measures of children using a large birth cohort from the USA.

Method: A sample of white singleton children (n = 25,131) was drawn from the US Collaborative Perinatal Project. The outcome measures were assessed at 8 months, 4 and 7 years (Bayley scales, Stanford Binet IQ, Graham-Ernhart test, Wechsler Intelligence Scale for Children, Wide Range Achievement Test). The main analyses examined the relationship between neurocognitive measures and paternal or maternal age when adjusted for age of the other parent, sex, duration of gestation, child's age-at-testing, maternal education, socioeconomic index and parental mental illness.

Results: Advanced paternal age showed significant linear associations with poorer scores on all measures of the neurocognitive measures. The findings were consistent in direction and effect size at all three ages. In contrast, advanced maternal age was generally associated with significantly better scores on these same measures.

Conclusions: The offspring of older fathers show subtle impairments on tests of neurocognitive ability during infancy and childhood. In light of secular trends related to delayed fatherhood, the mechanisms underlying these findings warrant closer scrutiny.

OP054 DETERMINANTS OF ELEVATED RISK OF INTELLECTUAL DISABILITY IN CHILDREN OF MOTHERS WITH PSYCHOSES

Vera Morgan ¹, Steve Zubrick², Carol Bower², Maxine Croft¹, Giulietta Valuri¹, Assen Jablensky¹

¹ Neuropsychiatric Epidemiology Research Unit, UWA School of Psychiatry & Clinical Neurosciences

² Institute for Child Health Research

Background: Previously, we found a significantly increased risk of intellectual disability and rare syndromes in children of mothers with psychoses.

Aims: To examine the relative contribution of parental general cognitive ability status, parental psychiatric status and exposure to obstetric complications to risk for intellectual disability in a cohort of children of women with psychoses.

Methods: We linked records for 79,599 women on the Western Australian psychiatric register to 308,022 births on the midwives database. Women with schizophrenia (382 mothers, 618 children), bipolar disorder (763 mothers, 1301 children) and unipolar depression (686 mothers, 1255 children) who had given birth 1980–1992 were identified. Comparison mothers (1831 mothers, 3129 children) were randomly selected from mothers with no record of psychiatric illness.

Results: Of the 6303 offspring, 129 had intellectual disability according to American Association on Mental Retardation criteria. Odds of intellectual disability were significantly elevated in all three groups of case children compared to comparison children: schizophrenia offspring 3.2 (CI 1.8–5.7); bipolar 3.1 (CI 1.9–4.9); unipolar 2.9 (CI 1.8–4.7). Multivariate analysis indicated that parental cognitive level, maternal psychosis, paternal psychiatric illness, and labour/delivery complications (neonatal encephalopathy, fetal distress) were independent risk factors for intellectual disability in offspring. Thirty eight children (29.5% of those with intellectual disability) had intellectual disability co-occurring with psychiatric illness. Co-occurrence was more likely in case than comparison children (p < 0.000).

Conclusion: Environmental insults and familial liability exert independent effects on risk for intellectual disability. Further investigation of multiply-affected families is in progress.

OP055 SELECTING TARGETS FOR PREVENTING ANXIETY DISORDERS: A PROSPECTIVE EPIDEMIOLOGICAL APPROACH

Andrew Mackinnon ¹, Janie Busby Grant², Helen Christensen²

¹ ORYGEN Research Centre, University of Melbourne

² Centre for Mental Health Research, Australian National University

Background: The epidemiology of common mental disorders has focused on prevalence. Estimating incidence and identifying factors which precipitate onset of illness are crucial both to the understanding of mental health disorders and to the identification of modifiable risk factors which might be effectively targeted in public health or more selective interventions.

Aims: To develop a method for estimating incidence of anxiety disorders from a multiple wave epidemiological study. To estimate the incidence of anxiety and the impact of a variety of risk factors on incidence.

Method: 5666 at-risk participants in the PATH study were studied. PATH compromises three narrow-age cohorts followed up every four years. Caseness was defined using ROC analysis of the Goldberg Anxiety Scale. Logistic regression identified risk factors. Attributable risk fractions and exposure impact numbers were calculated.

Results: The estimated incidence rate of anxiety disorders was 2% per annum. A range of demographic, social and psychological factors were significantly associated with risk to anxiety. Notable contributions to risk included sub-clinical anxiety, depression and neuroticism. Physical health was a factor in the oldest cohort. Few differences between males and females were found.

Conclusion: Sub-clinical anxiety constitutes the factor responsible of the greatest attributable fraction of risk to anxiety across all age groups. As a potentially modifiable risk it constitutes a primary target for intervention.

OP056 THE ASSOCIATION OF HIGH SENSITIVITY C-REACTIVE PROTEIN LEVELS WITH MAJOR DEPRESSION: A TEN-YEAR LONGITUDINAL STUDY

Julie A. Pasco ¹, Michael Berk¹, Margaret J. Henry¹, Lana J Williams¹, Felice N. Jacka¹, Mark A. Kotowicz¹, Hans G. Schneider², Geoff C. Nicholson¹

¹ Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Victoria, Australia

² Department of Medicine, Monash University, Victoria, Australia

Background: There is evidence that changes in the immune system are part of the pathophysiology of depression. There are cross-sectional reports of raised inflammatory cytokines, raised levels of positive acute phase proteins and lower levels of negative phase proteins in the plasma of depressed individuals.

Aim: To test the hypothesis that subclinical systemic inflammation is associated with an increased risk of developing MDD.

Method: We examined the association between serum levels of high-sensitivity C-reactive protein (hsCRP) and risk of de novo MDD in 641 randomly-selected women aged 20–84yr who were free of depression at baseline. Baseline hsCRP levels were measured immuno-turbidimetrically and MDD was diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP). Subjects were followed longitudinally for a decade, or until the onset of MDD. Cox proportional hazards regression was used to determine the association between hsCRP (log transformed, ln-hsCRP) and MDD, using age as the time axis.

Results: Median hsCRP was 1.92mg/L (IQR 0.89–3.90). During 5883 person-years of follow-up, 66 cases of de novo MDD were identified. Unadjusted HR for MDD increased by 30% for each SD increase in ln-hsCRP (HR = 1.30; 95%CI 1.03–1.65; p = 0.03). In multivariate models, adjustment for lifestyle factors, diet and medication failed to explain the observed increased risk for MDD.

Conclusion: Elevated hsCRP is an independent predictor of MDD in women. These results implicate subclinical systemic inflammation and oxidative stress as factors in the pathophysiology of depression.

OP057 RODENT EFFECTS OF MOTHERHOOD NOT REPLICATED IN HUMANS. RATS!

Helen Christensen ¹, Liana Leach¹, Andrew Mackinnon²

¹ The Centre for Mental Health Research, The Australian National University, Canberra, Australia

² Orygen Research Centre, Melbourne, Australia

Aims: Pregnancy and motherhood have been found to change the structure of the brain and to affect learning and memory in rodents. Mother rats compared to non-mother rats have been found to navigate mazes more efficiently, to have less anxiety and fear, and to excel at multiskilling. The effects of pregnancy and motherhood on cognitive capacity in humans are less well understood. To test whether pregnancy and mother hood make women smarter, longitudinal changes in cognitive performance and emotion were examined using a representative sample of young women.

Methods: 76 women pregnant at the time of the study, and 366 women who became mothers were compared to non-pregnant, non-mothers from the PATH Through Life Project. Changes in cognitive functioning on tests of Digit Span Backwards (DSB), Immediate and Delayed Memory and Processing Speed were measured. Changes in anxiety and depression were measured using the Goldberg Depression and Anxiety Scales.

Results: Education interacted with change in motherhood status, with those who became mothers gaining less education than those who did not become mothers. Digit Span Backwards (DSB) interacted with change in motherhood status. Those who became mothers improved on their DSB score more than those who did not. However, once anxiety and depression were controlled, this effect was no longer significant.

Conclusions: Limitations to this ratty study will be discussed in conjunction with findings from human and animal work.

OP058 PUBLIC ATTITUDES TOWARDS GENETIC TESTING FOR SUSCEPTIBILITY TO MAJOR DEPRESSION

Alex Wilde ¹, Bettina M. Meiser², Philip B. Mitchell¹, Peter R. Schofield³

¹ School of Psychiatry, University of New South Wales, Sydney, Australia

² Prince of Wales Clinical School, University of New South Wales, Sydney, Australia

³ Prince of Wales Medical Research Institute, Sydney, Australia

Background: Successful intervention in psychiatry based on genetic risk will depend on public understanding of and attitudes towards the complexity of risk prediction involving susceptibility genes and gene-environment interactions.

Aims: To qualitatively evaluate attitudes and beliefs regarding the psychosocial implications of genetic risk for major depression in an urban population.

Method: Participants (N = 36) of focus groups discussed their understanding of the role of genes in psychiatric disorders and their beliefs and attitudes towards genetic testing for risk for major depression.

Results: The majority (67%) of participants indicated interest in having a genetic test for susceptibility to major depression, if it was available. Having a family history of psychiatric disorders was given as a major reason for interest. After discussion of perceived psychosocial implications, only 42% still favoured having the test. Psychosocial implications influencing change of attitude included privacy issues and fear of genetic discrimination by insurance companies and employers. Participants were unanimously against independent genetic testing via the internet.

Conclusion: The study highlights the importance of public education about psychiatric genetics, potential risks and benefits of genetic testing and availability of appropriate support services in association with future genetic risk testing in psychiatry.

OP059 THE IMPACT OF PARENTAL RELATIONSHIPS IN A PHARMACOTHERAPY TRIAL FOR DEPRESSION

Jeanette Johnstone ¹, Sue Luty¹, Janet Carter², Roger Mulder¹, Peter Joyce¹

¹ Department of Psychological Medicine, University of Otago, Christchurch, New Zealand

² Department of Psychology, University of Canterbury, Christchurch, New Zealand

Background: Childhood neglect and abuse are recognized risk factors for depression. These factors have not been studied as predictors of treatment response in depression.

Aims: This study investigated whether childhood adversity impacted the response to treatment in a trial of pharmacotherapy for depression.

Method: Clinically depressed outpatients (n = 195) reported childhood experiences then were randomized to antidepressant treatment with either fluoxetine or nortriptyline. Treatment outcomes were measured from six weeks to six months.

Results: Patients reporting low paternal care, as measured by the Parental Bonding Instrument (PBI), were more likely to drop out, failing to complete an adequate six week trial of medication. Patients who reported high maternal protection (maternal overprotection) on the PBI had poorer treatment outcomes from 6 weeks to 6 months. These findings remained significant even when known confounding variables of age, medication and gender were included in the analyses as covariates. In addition, abuse considered by itself, whether sexual, physical or psychological in nature, did not predict response.

Conclusion: The experience of having an overprotective mother or a neglectful father was more predictive of response to treatment for depression than abuse, suggesting that the quality of ongoing, intrafamilial relationships have a greater impact on treatment outcomes for depression than experiences of discrete abuse in childhood.

OP060 ‘ABOUT HELEN’ – PSYCHOSIS AND PREGNANCY (A CASE REPORT)

Heather Gilbert ¹, Jayashri Kulkarni¹, Caroline Gurvich¹

¹ Monash Alfred Psychiatry Research Centre, The Alfred Hospital and School of Psychology, Psychiatry and Psychological Medicine, Monash University, Melbourne, Australia

Background: The desire to reproduce is 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 vulnerable 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. The National Register of Antipsychotic Medication in Pregnancy (NRAMP) has been established and is currently collecting information from female participants with a history of mental illness, who take antipsychotic medication and become pregnant.

Aims: To highlight some of the potential issues faced by women with a mental illness during pregnancy and the first postnatal year.

Method: Helen, a 39 year old woman with schizophrenia, is followed through her pregnancy and for one year postnatally.

Results: Helen's symptoms were exacerbated throughout her pregnancy, during which she was taking Clozapine. Her baby developed fetal abnormalities and Helen was deemed unfit to provide the necessary skills to care for her baby.

Conclusion: 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.

OP061 MEASURING THERAPEUTIC OPTIMISM

Stephen Elsom ¹, Kay McCauley-Elsom²

¹ Centre for Psychiatric Nursing, University of Melbourne

² School of Nursing & Midwifery, Monash University

Background: The need for health professionals to have an optimistic clinical stance when working with people who have mental illness has been recognised by the National Institute of Clinical Excellence and the Royal Australian and New Zealand College of Psychiatrists. Little work has been conducted to determine whether mental health professionals do have an optimistic approach to their patients.

Aims: This study aimed to measure the therapeutic optimism of mental health nurses and to investigate a range of demographic correlates of the nurses’ therapeutic optimism.

Method: A total of 256 mental health nurses attending two large mental health nursing conferences in 2007 completed a previously developed survey instrument, the Elsom Therapeutic Optimism Scale (ETOS).

Results: Significant differences were measured in the optimism scores of nurses attending the two conferences. These differences correlated with age and experience. The delegates to the two conferences also differed in whether they were practising in clinical roles or in education, academic or management positions.

Conclusion: This study revealed some important differences in levels of therapeutic optimism of mental health nurses and these differences appear to be related to the nurses’ age, experience and current work roles. Targeted interventions are required to improve clinicians’ optimism and to prevent the iatrogenic consequences of therapeutic nihilism.

OP062 THE OTAGO COMMUNICATION SCALE: A SHORT MEASURE OF COMMUNICATION STYLE FOR HEALTH WORKERS

Christopher Gale ¹, A. Gray², N. Swain-Campbell¹, A. Hannah¹

¹ Department of Psychological Medicine, Dunedin School of Medicine

² Department of Preventive and Social Medicine, Dunedin School of Medicine

Aims: Communication Skills Training improves the performance of medical students in clinical placements. An anxious and hurried communication style has been associated with increased risk of violence in a previous survey of 87 medical students [1]. The current study surveyed community support workers in Otago to ascertain their experience of violence while also asking them about their communication style This data was analysed to see what associations there were between experience of violence and communication style

Method: The 256 respondents to this survey were asked 28 questions relating to their communication style. An exploratory factor analysis using polychoric correlations and a parallel analysis supported a simple 2 factor solution. The Cronbach alphas for the entire scale and items loading on the first factor were estimated.

Results: The 28 questions were fairly consistent, with a standardised Cronbach alpha of 0.73. The first factor, containing 12 questions, accounted for almost 30% of the variation. These questions related to a confident and empathic style of communication, and the factor was associated with a decreased experience of violence. The standardised Cronbach alpha for this subscale was 0.83.

Conclusion: The 12 items provide a short scale which has reasonable face validity and robust psychometric properties. These items are associated, in the test population, with a decreased reported experience of violence. To our knowledge, no other scales that measure health care worker's communication style exist.

Hannah, A., MacKay, J. Gale, C.: Medical students' perception of patient aggression. European Congress on Violence in Clinical Psychiatry, Amsterdam. 26th October 2007.

OP063 A PROBABILITIES APPROACH TO EVALUATING ALGORITHMS FOR SCREENING FOR DISTRESS

Kerrie Clover, Gregory L Carter, Andrew Mackinnon, Catherine Adams

Psycho-Oncology Service, Calvary Mater Newcastle; Centre for Brain and Mental Health, University of Newcastle; Orygen Research Centre, University of Melbourne

Aims: To apply the concepts of likelihood ratios and post-test probabilities to the interpretation of distress screening instruments and to the development of an algorithm for screening for emotional distress in oncology patients.

Method: 340 oncology/haematology outpatients completed the Distress Thermometer (DT), the PSYCH subscale of the Somatic and Psychological Health Report (SPHERE), the Kessler-10 scale and a Quality of Life item. The Hospital Anxiety and Depression Scale (HADS) with a cutoff of 15 was used as the gold standard.

Results: The likelihood ratio showed that a score over threshold on the DT was 2.77 times more likely in patients who were cases on the HADS. These patients had a 53% probability of being cases on the HADS, compared with the pretest probability of 29%. Adding either the PSYCH (3 +) or the Kessler-10 (22 +) to the Distress Thermometer (4 +) significantly increased this probability to 94% and 92%, respectively. The significance of these improvements was confirmed by logistic regression analysis.

Conclusion. The sequential use of the Distress Thermometer followed by either the PSYCH or the K10 shows promise as a screening algorithm for emotional distress. Sequential administration of a very brief instrument followed by selective use of longer inventory may save time and increase acceptability.

OP064 DISCREPANCY BETWEEN SELF AND OBSERVER RATING OF DEPRESSION: THE RELATIONSHIP TO DEMOGRAPHIC, CLINICAL, COGNITIVE AND PERSONALITY VARIABLES

Janet Carter ¹, Christopher Frampton², Roger Mulder², Suzanne Luty², Peter Joyce²

¹ Department of Psychology, University of Canterbury, Christchurch, NZ

² Christchurch School of Medicine and Health Sciences, University of Otago

Aim Concordance between self-report and clinician rated depression is variable and even when almost totally corresponding expert rated and self-report scales are used the concordance is at best moderate. The reasons for this discrepancy are not clear. The aim of this study was to evaluate the importance of patient factors (demographic, clinical, cognitive & personality) in explaining the discrepancy between self and observer ratings of depression. To date, researchers examining the correlation between self and clinician rating have focused on the original version of the BDI and the HDRS. This study examines the revised BDI (BDI-II) and the Montgomery Asberg Depression Rating Scale (MADRS).

Method: The sample for this study consists of 177 adults with MDE participating in a randomised clinical trial comparing CBT and IPT. Self-report and clinician ratings of depression, and patient characteristics were assessed at baseline prior to treatment randomisation.

Results: The correlation between the BDI-II and the MADRS was .59. Age, sex, melancholic depression, severity of depression and rumination predicted the discrepancy between BDI-II and the MADRS. The research and clinical implications of these findings will be highlighted.

OP065 DSM-V & ICD-11: EXPLORING THE FEASIBILITY OF A META-STRUCTURE

Gavin Andrews ¹, David P. Goldberg², Robert F. Krueger³, William T. Carpenter⁴, Steven E. Hyman⁵, Perminder S. Sachdev¹, Daniel S. Pine⁶

¹ School of Psychiatry, UNSW

² King's College, UK

³ University of Minnesota, MN

⁴ University of Maryland, MD

⁵ Harvard University, MA

⁶ NIMH, MD

Background: The extant classificatory systems are too complex for many clinicians to use; many diagnostic thresholds are very sensitive to interpretative nuances; and the dimensional nature of mental disorders is not recognized. Ascertaining the validity of a disorder requires that it can be delimited from other disorders but comorbidity makes this difficult. We propose a meta-structure for DSM-V and ICD-11 which accounts for the etiological variance of major clusters of mental disorders.

Method: Most DSM-IV disorders were allocated to one of five clusters, usually on the basis of clinical similarity. Teams of experts then explored the literature to determine within-cluster similarity on 11 validating criteria.

Results: The final clusters were: Neurocognitive (identified principally by neural substrate abnormalities); Neurodevelopmental (identified principally by cognitive and emotional processing deficits); Psychotic (identified principally by biomarkers for information processing deficits); Emotional (identified principally by negative emotionality); and Externalizing (identified principally by disinhibition).

Conclusions: The adoption of such an organizing principle has advantages for clinical practice, public administration and research. Debate on the proposed meta-structure could lead to changes that have the potential to improve the clinical utility and validity of DSM-V and ICD-11.

OP066 DSM-V & ICD-11: THE EXTERNALIZING DISORDERS: CLUSTER 5 OF THE PROPOSED META-STRUCTURE

Robert F. Krueger ¹, Susan C. South¹

¹ Department of Psychology, University of Minnesota, Minneapolis, MN

Background: The extant major psychiatric classifications — DSM-IV and ICD-10 — are purportedly atheoretical and largely descriptive. While this achieves good reliability, the validity of a medical diagnosis is greatly enhanced by an understanding of etiology. In an effort to group mental disorders on the basis of etiology, five clusters have been proposed. We consider the validity of the fifth cluster, viz. Externalizing disorders, within this proposal.

Method: We reviewed the literature in relation to 11 validating criteria proposed by the Study Group of the DSM-V Task Force, in terms of the extent to which these criteria support the idea of a coherent externalizing spectrum of disorders.

Results: This cluster distinguishes itself by the central role of disinhibitory personality in mental disorders spread throughout sections of the current classifications, including substance dependence, antisocial personality disorder, and conduct disorder. Shared biomarkers, comorbidity and course offer additional evidence for a valid cluster of externalizing disorders.

Conclusion: Externalizing disorders meet many of the salient criteria proposed by the Study Group of the DSM-V Task Force to suggest a classification cluster.

OP067 DSM-V & ICD-11: WHERE SHOULD BIPOLAR DISORDER APPEAR IN THE META-STRUCTURE?

David P. Goldberg¹, Gavin Andrews², Megan J. Hobbs ²

¹ Institute of Psychiatry, King's College, UK

² School of Psychiatry, UNSW

Background: The extant major psychiatric classifications use symptom profiles as organising principles. While this achieves good reliability, the validity of a medical diagnosis is enhanced by an understanding of etiology. An etiologically driven classification of five clusters has been proposed for DSM-V and ICD-11.

Aims: The purpose of this research was to determine whether bipolar disorder should appear in the Psychosis cluster with the schizophrenic spectrum disorders or alternatively, with unipolar depression in the Emotional cluster.

Method: The literature was reviewed with respect to 11 validating criteria proposed by the DSM-V Task Force Study Group. The similarities and differences between bipolar and schizophrenia on the one hand, and unipolar depression on the other are discussed.

Results: There are differences, often substantial and never trivial, for each of the validators between unipolar and bipolar depression. The principle features of the Psychosis cluster appear in bipolar disorder; whereas the defining features of the Emotional cluster do not characterise bipolar disorder to the same extent as unipolar depression.

Conclusion: Bipolar has been classified previously with unipolar depression — but this is the least justifiable place for it. The shared etiological variance between bipolar and schizophrenia favours Psychosis cluster membership; alternatively, bipolar disorder could form an intermediate cluster — bipolar-I closer to schizophrenia, and bipolar-II closer to the Emotional disorders.

OP068 DSM-V & ICD-11: SIMPLIFYING DSM-IV CRITERIA SETS USING EPIDEMIOLOGICAL SURVEY DATA

Matthew Sunderland ¹, Gavin Andrews¹, Tim Slade²

¹ School of Psychiatry, University of New South Wales, Sydney, Australia

² National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia

Background: The DSM-IV is a complex classification system consisting of around 290 diagnoses with each diagnosis requiring multiple criteria to remember. It has been recently argued that the DSM-IV is too complex and it may be possible to reduce the amount of information required for a diagnosis by simplifying the criteria sets for use by clinicians.

Aims: To examine the feasibility of simplifying the DSM-IV disorder criteria using statistical methods and epidemiological survey data with specific focus on Criterion A of Major Depressive Episode.

Method: A combination of stepwise logistic regression and best subsets logistic regression was used to identify the most parsimonious number and type of symptoms required for a diagnosis of Major Depressive Episode. Revised symptom sets were created using reduced Criterion A symptoms and compared to the full DSM-IV definition.

Results: Evidence from the statistical modelling revealed that it is feasible to reduce the symptom criteria for depression based purely on a mathematical method, with high agreement between the simplified symptom sets and the full DSM-IV symptom set. However, the modelling does not provide a clinically relevant and meaningful conclusion.

Conclusion: Clinical opinions as well as statistical methods are required to generate brief and optimal criteria sets for DSM-IV disorders.

OP069 DSM-V & ICD-11: EXPLORING THE DISTINCTION BETWEEN ABUSE AND DEPENDENCE IN THE NOSOLOGY OF SUBSTANCE USE DISORDERS

Tim Slade ¹, Rachel Grove¹, Maree Teesson¹, Andrew Baillie²

¹ National Drug and Alcohol Research Centre, University of New South Wales

² Macquarie University

Background: Revisions to the two major psychiatric classification systems are currently underway. One of the major identified issues in the classification of substance use disorders concerns the diagnostic distinction (or lack thereof) between substance abuse and dependence.

Aims: To review the conceptual and empirical literature regarding this distinction and to provide further empirical findings from latent variable analyses of large-scale epidemiological data.

Methods: A review of the literature regarding the reliability and validity of both substance abuse and dependence was carried out with particular focus on studies employing factor analytic and other latent variable approaches. Alternative psychometric approaches, e.g. taxometric analysis, to assessing the validity of diagnostic criteria and disorders were also carried out using data from the 1997 Australian National Survey of Mental Health and Wellbeing.

Results: Evidence from factor analytic and other psychometric approaches is conflicting. There is some support for the distinction between abuse and dependence. However, other studies conclude that problems associated with substance use are best conceptualized along a single continuous dimension. This is supported by latent variable analyses that specifically test the competing categorical versus dimensional models of substance use disorder.

Conclusions: Empirically-based suggestions for refinements to DSM and ICD can be made. These can be informed by targeted analyses of large-scale epidemiological data.

OP070 DSM-V & ICD-11: DIAGNOSTIC ISSUES – DISCUSSION LED BY GAVIN ANDREWS

OP071 PSYCHIATRIC, PHYSICAL AND SOCIAL COMORBIDITY WITH DEPRESSIVE SYMPTOMS IN PRIMARY CARE: THE DIAGNOSIS, MANAGEMENT AND OUTCOMES OF DEPRESSIVE SYMPTOMS LONGITUDINAL (DIAMOND) STUDY

Jane Gunn ¹, Helen Herrman², Kelsey Hegarty¹, Grant Blashki¹, Dimity Pond³, Michael Kyrios⁴, Patty Chondros¹

¹ Department of General Practice, University of Melbourne

² ORYGEN Research Centre, University of Melbourne

³ University of Newcastle

⁴ Swinburne University

Objectives: To describe the diamond cohort and discuss the implications for depression care in general practice (GP).

Design: A GP based prospective longitudinal study beginning in 2005.

Participants and setting: Patients with depressive symptoms identified by screening with the Center for Epidemiologic Studies Depression Scale (CES-D ≥ 16) in 30 randomly selected Victorian GPs. Computer assisted telephone interviews (CATIs) were undertaken at baseline, 12 and 24 months and follow-up postal surveys were sent at three, six, nine, 12 and 24 months. Participants will also be followed-up at 36 months.

Main outcome measure: Patient Health Questionnaire (PHQ) to measure depression status.

Results: 789 patients form the cohort (71% female). At baseline 27% satisfied criteria for current major depressive syndrome (MDS) on the PHQ; 52% had ‘persistent’ depressive symptoms and 22% had ‘transient’ depressive symptoms, lasting at most a few weeks. Of those with MDS 49% were classified with an anxiety syndrome, 40% with childhood sexual abuse, 57% with childhood physical abuse, 42% were afraid of their partner and 72% reported a chronic physical condition. Of those satisfying criteria for MDS, 84% were receiving mental health care (either taking antidepressants or seeing a mental health professional or GP specifically for mental health care) compared with 66% of those with persistent depressive symptoms and 57% of those with transient depressive symptoms.

Conclusion: GP screening for depressive symptoms identifies a group of patients with substantial multi-morbidity: psychiatric, physical and social problems coexist with depressive symptoms raising challenges for the management of depression in GP.

Gunn J, Gilchrist G. Chondros P, Ramp M, Hegarty K, Blashki G, Pond D, Kyrios M, Herrman H for the diamond research team. Who is identified when screening for depression is undertaken in general practice? Findings from the diagnosis, management and outcomes of depressive symptoms (diamond) longitudinal study. Medical Journal of Australia. 2008, 188: S119–S125

OP072 ARE WE PUTTING OUR BEST FOOT FORWARD? RECOMMENDATIONS FOR THE PRIMACY OF PSYCHOLOGICAL MANAGEMENT IN THE TREATMENT OF MOOD DISORDERS

Danielle L. Adams ^1,2, Gin S. Malhi^1,2,3

¹ Northern Sydney Central Coast Mental Health Drug & Alcohol, Northern Sydney Central Coast Area Health Service, NSW, Australia

² CADE Clinic, Department of Academic Psychiatry, Royal North Shore Hospital, Sydney, Sydney, Australia

³ Discipline of Psychological Medicine, University of Sydney, Sydney, Australia

Background: Mood Disorders are a leading cause of disease burden to the community. Antidepressants are the most common treatment provided for depression with psychological interventions having long played a subsidiary role. This is surprising given that the evidence-base for pharmacotherapy in community-based depression barely partitions antidepressants from placebo and fails to differentiate medications from talking therapies. Further, psychological treatments are consistently rated as the preferred choice by patients.

Method: A systematic review of the evidence base for psychological interventions in the treatment of mood disorders was conducted. Findings formulated into recommendations for clinical practice are considered within the broader context of clinical management.

Results and Conclusion: The evidence for psychological interventions in mood disorders as monotherapy, and as adjuncts, is robust and growing to the point where there is sufficient justification for their promotion to first-line above and beyond antidepressants. Psychological treatments have become increasingly sophisticated in design and evaluation and have been progressively tailored to the nuances of clinical depression. This clearly is advantageous for patients and its implications for future service delivery will be discussed.

OP073 ESTABLISHING REFERRAL PATHWAYS AND ENGAGEMENT OF ULTRA HIGH RISK YOUTH IN A RURAL RESEARCH SETTING

Kylie Crittenden ^{1 2}, Helen J. Stain^{1 2 5}, Elaine Bennett^{1 2}, Jodie Fleming^{2 3}, Mike Startup^{2 3 5}, Vaughan J. Carr^{2 3 5}, Amanda Baker^{2 3 5}, Ulrich Schall^{2 3 5}, Brian Kelly^{1 2}, Sean Halpin³, Sandra Bucci³, Rebecca Sakrouge³

¹ Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia

² Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, Australia

³ Hunter Medical Research Institute, Newcastle, Australia

⁴ Psychological Assistance Service, Hunter New England Area Health Service, Newcastle, Australia

⁵ Schizophrenia Research Institute, Sydney, Australia

Background: Research has led to reliable identification of individuals at risk of developing a psychotic disorder and aided the development of preventative interventions in clinical settings⁽¹⁾. Research directed towards early intervention service delivery for rural youth has been lacking. The Detection, Evaluation and Psychological Therapy (DEPTh) project, a randomised controlled trial of cognitive behavioural therapy for ultra high risk (UHR) youths, began in 2006 across rural and urban sites. There are known difficulties in recruitment to ultra high risk studies⁽²⁾.

Aims: This paper aims to present findings regarding recruitment and retention in treatment for DEPTh, focusing on the unique characteristics of the rural site, where no early intervention service existed prior to the study.

Method: Recruitment at the rural site involved many non-health youth services. Rural recruitment strategies involved: referrer education about ultra high risk mental states; repeated promotion of the DEPTh project; extensive travel for staff; provision of comprehensive assessment reports to referring agencies; case management; and enhanced interaction between research staff and referring agencies.

Results: Strong rural referral rates from a wide range of agencies highlighted the need for early intervention services for this population in the area. Rural participants were generally marginalised youth, often disengaged from “main stream” services, families and education.

Conclusion: Preliminary results indicate the efficacy of rural provision of early intervention using videoconferencing and close linkage to existing mental health services. The paper provides the opportunity to further explore the specific needs of rural youth in providing early intervention services.

¹French P, Morrison AP. Early detection and cognitive therapy for people at high risk of developing psychosis: A treatment approach. London: Wiley 2004.

²Addington J, Cadenhead KS, Cannon TD, Cornblatt B, McGlashan TH, Perkins DO, et al. North American Prodrome Longitudinal Study: A collaborative multisite approach to prodromal schizophrenia research. Schizophrenia Bulletin. 2007;33(3):665–72.

OP074 GAMMA SYNCHRONY IN FIRST EPISODE PSYCHOSIS – A REPLICATION STUDY

Anthony Harris ^1,2, Marie Nagy², Jean Starling^1,3, Gary Flynn⁴, Lea Williams²

¹ Discipline of Psychological Medicine, University of Sydney, NSW 2006, Australia

² Brain Dynamics Centre, Westmead Millennium Institute, Westmead, NSW 2145 Australia

³ Children's Hospital at Westmead, NSW 2145, Australia

⁴ First Episode Psychosis Program, Liverpool Hospital, NSW, Australia

Gamma phase synchrony (GPS) has been suggested as a mechanism by which the brain can coordinate function. Our group has recently published findings of increased gamma phase synchrony, most prominent in the left fronto-temporal region, in young people with first episode psychosis in response to a selective attention task. This was conceptualized as a marker of the inability of subjects with schizophrenia to integrate percepts. In this study we seek to replicate this finding with a second group of subjects with first episode psychosis.

One hundred first episode psychosis subjects and matched normal controls will be divided into two samples on the basis of time of recruitment to the study. All subjects underwent an oddball paradigm as part of a battery of electrophysiological measurements. Recordings were time-locked to the stimulus onset and peak gamma phase synchrony established across the pre and post stimulus period and averaged separately for target and non-target stimuli.

Replication of our findings of raised peak gamma phase synchrony in young people with first episode psychosis is a necessary step in the substantiation of gamma phase abnormality as a potential mechanism for psychotic symptoms. These studies contribute to the understanding of psychosis as a widely distributed disorder of connectivity.

OP075 EMOTION-RELATED GAMMA SYNCHRONIZATION IN FIRST-EPISODE SCHIZOPHRENIA: TOWARDS A BIOLOGICAL MARKER OF SOCIAL COGNITIVE IMPAIRMENT

Leanne (Lea) Williams ¹, Marie Nagy¹, Steve Silverstein², Thomas Whitford¹, Anthony Harris¹

¹ Brain Dynamics Centre

² University of Medicine and Dentistry New Jersey, USA

Background: Schizophrenia may be understood as a disorder of neural synchrony. There is also increasing evidence that emotional and social cognitive impairments are central to this disorder (1). In first episode schizophrenia, we examined whether emotion perception is associated with disruptions to high frequency (40Hz Gamma) synchrony, and if these disruptions predict self-regulatory adaptive compensations, reflected in social cognitive behaviours (2).

Method: In 28 first-episode schizophrenia (FES) patients, and matched healthy controls, EEG recordings were undertaken during perception of facial emotion under both conscious and nonconscious conditions. Gamma-band synchrony was extracted from the EEG. Behavioural measures of emotion identification, emotional intelligence, negativity bias and social functioning were also employed, along with FES symptom ratings. Analysis of group differences, and prediction of social cognition, took account of the potential contribution of medication.

Results: FES patients showed alterations in Gamma synchrony during both conscious and nonconscious emotion perception, commencing within 200ms post-stimulus. Stimulus-locked synchrony was reduced in FES, particularly over the temporal cortex, while complementary enhancements in absolute Gamma synchrony (independent of stimuli) were more distributed over temporal and left parieto-occipital regions. This pattern of altered synchrony predicted poor performance on each measure of social cognition in FES. Medication dosage did not correlate significantly with either Gamma synchrony or behavioural measures in the FES group.

Conclusion: These findings suggest that disruptions in integrative processing of motivationally significant stimuli are present from the onset of schizophrenia, and may be a marker of the breakdown in self-regulation necessary for social cognitive adaption.

1. Williams LM, Whitford TJ, Flynn G, Wong W, Liddell BJ, Silverstein S et al, (2008). General and social cognition in first episode schizophrenia: Identification of separable factors and prediction of functional outcome using the IntegNeuro test battery, Schizophrenia Research 99:182–191.

2. Williams LM et al. (2008). The INTEGRATE model of Emotion, Thinking and Self Regulation: An application to the ‘Paradox of Aging’. J Integrative Neuroscience (in press, Sept. volume)

OP076 PROBABILISTIC CATEGORY LEARNING DEFICITS EXIST IN A SUBSET OF UNAFFECTED SIBLINGS OF PATIENTS WITH SCHIZOPHRENIA

Thomas W. Weickert ^1,4, Terry E. Goldberg^2,4, Michael F. Egan^3,4, Daniel R. Weinberger⁴

¹ University of New South Wales School of Psychiatry and the Prince of Wales Medical Research Institute, NSW Australia

² Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA

³ Clinical Neuroscience, Merck and Company, Inc., North Wales, PA, USA

⁴ Genes, Cognition and Psychosis Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

Background: While patients with schizophrenia display normal probabilistic category learning rate in conjunction with an overall performance deficit, the extent to which this deficit occurs in unaffected, first degree relatives of patients with schizophrenia is unknown.

Methods: A probabilistic category learning test was administered to 128 patients with schizophrenia, 114 unaffected siblings, and 165 healthy participants.

Results: There was no significant difference among groups regarding learning rate; however, patients differed significantly from siblings and healthy participants regarding overall performance. Application of a stringent learning definition enabled further classification into good and poor learners. There was no significant difference in learning rate or performance between sibling and healthy good learners. There were significant differences between the percentages of sibling and healthy poor learners: healthy (16%), siblings (34%), patients (48%), yielding a relative risk of 2.1, χ² (1) = 6.5, p<.01. Sibling and patient poor learners were significantly different from healthy poor learners during early trials; however, siblings improved during latter trials to the extent that they were significantly different from patients and indistinguishable from healthy participants.

Conclusions: Application of a stringent learning criteria revealed that half of the patients with schizophrenia fail to show normal probabilistic category learning rate and performance. One third of unaffected siblings of patients with schizophrenia display probabilistic category learning abnormalities during early learning. This distinction between good and poor learning siblings of patients with schizophrenia, who are otherwise unaffected by illness, may be used to inform genetic studies designed to detect schizophrenia risk alleles.

OP077 DO SEMANTIC DEFICITS UNDERLIE DELUSIONS?

Erica Neill ¹, Susan L. Rossell¹

¹ Alfred Psychiatry Research Centre, Monash University, VIC, Australia

Background: Semantic memory deficits (SMD) have been demonstrated to be a core dysfunction in schizophrenia. Some authors have suggested that SMD may explain the development of some psychotic symptoms, particularly thought disorder. Delusions have also shown a relationship with SMD but have been less well studied; this study investigates the relationship between SMD and the presence and severity of delusions.

Methods: Participants with schizophrenia were compared on a battery of tasks designed to assess semantic memory. Accuracy and reaction time to these tasks was correlated with the presence of delusions.

Results: The results demonstrated that delusions are associated with SMD. Delusions correlated with semantic memory tasks that examined language production, concept comprehension, and semantic priming. There were no correlations with thought disorder on these tasks.

Conclusions: There is evidence to suggest that delusional thinking is associated with SMD. Accurate semantic processing and the formation of semantic memories allows for culturally accepted interpretations of our environment. SMD suggest faulty processing of real world information, knowledge and language, which may lead to the development of delusional thinking.

OP078 SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS) – A POTENTIAL TREATMENT FOR THE PSYCHOTIC SYMPTOMS OF SCHIZOPHRENIA?

Jayashri Kulkarni¹, Emmy Gavrilidis ¹, Caroline Gurvich¹ Anthony de Castella¹, Paul Fitzgerald¹, Heather Gilbert¹, Susan Davis²

¹ Monash Alfred Psychiatry Research Centre, The Alfred Hospital and the School of Psychology, Psychiatry and Psychological Medicine, Melbourne, Australia

² Department of Medicine, Alfred Hospital, Monash University, Melbourne, Australia

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.

Aims: The current study examined the efficacy of a higher dose of raloxifene (120mg/day) in terms of psychopathology and cognitive functioning in postmenopausal women with schizophrenia.

Method: Post-menopausal women with a diagnosis of schizophrenia or schizoaffective disorder were invited to participate in 12-week two arm (adjunctive raloxifene 120mg/day; or adjunctive placebo), double-blind, placebo controlled study. Psychopathology, cognitive function and hormone assays were measured fortnightly.

Results: Preliminary findings will be presented.

Conclusion: While the findings of our pilot study indicated an improvement in aspects of cognition, 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.

OP079 5HT2C GENE POLYMORPHISMS, WEIGHT GAIN AND METABOLIC SYNDROME IN FIRST EPISODE PSYCHOSIS

Hannah D. Newall ¹, Philip B. Ward^{2, 3}, Jackie Curtis^{2, 4}, Paul A. Tooney^{3, 5}, Catherine Henry⁴, Andrew Watkins⁴, Maryanne O'Donnell^{2, 4},

¹ Faculty of Medicine UNSW

² School of Psychiatry UNSW

³ Schizophrenia Research Unit Sydney South West Area Health Service

⁴ Prince of Wales Mental Health Programme

⁵ School of Biomedical Sciences and HMRI, Faculty of Health, the University of Newcastle

Background: Carriers of the T-allele of the −759C/T polymorphism were found to experience reduced antipsychotic induced weight gain (Reynolds, Zhang et al. 2002). These findings have been replicated in patients from differing ethnic backgrounds; however there have been no studies in Australian first-episode psychosis populations to date. Previous patient studies have not systematically evaluated the association of weight gain with the clinical syndrome of metabolic syndrome, using criteria from the International Diabetes Federation.

Aims: This project will examine a single nucleotide polymorphism in the 5HT2c gene (−759C/T polymorphism) in relation to the degree of weight gain and incidence of metabolic syndrome in first episode psychosis patients referred to the early psychosis intervention program at the Prince of Wales Mental Health Program.

Method: A community sample of people meeting diagnostic criteria for first episode psychosis, who are started on second generation antipsychotic medications upon diagnosis, will be recruited. The participants will undergo a baseline screen for metabolic syndrome at admission. Following three months of antipsychotic therapy a follow-up metabolic screen will be taken as well as a saliva sample to extract DNA to determine the presence of the T-allele of the −759C/T polymorphism.

Results: This will be the first study to evaluate the utility of 5HT2C receptor polymorphisms as a predictor of weight gain in an Australian early psychosis sample. Additional findings on the occurrence of metabolic syndrome, and impacts on quality of life and functional outcomes will establish whether genotyping could be useful as part of standard clinical practice in first-episode services.

Reynolds, G. P., Z.-J. Zhang, et al. (2002). “Association of antipsychotic drug induced weight gain with a 5-HT2C receptor gene polymorphism.” The Lancet 359(9323): 2086–2087.

OP080 CLOZAPINE: AN INVESTIGATION OF CARDIAC RELATED ADVERSE EFFECTS

Joanna Fitzsimons ¹, Tim Lambert², Christos Pantelis³, Seetal Dodd⁴, Michael Berk^{1, 4}

¹ Department of Clinical and Biomedical Sciences: Barwon Health, University of Melbourne, Australia

² Discipline of Psychological Medicine, University of Sydney, Australia

³ Melbourne Neuropsychiatry Centre, University of Melbourne, Australia

⁴ Community and Mental Health, Barwon Health, Australia

Background: While clozapine remains the most effective antipsychotic for treatment refractory schizophrenia, clozapine-related serious cardiac adverse effects including myocarditis and cardiomyopathy continue to be reported. Agranulocytosis is a well-documented vulnerability for these patients, yet other serious risks such as myocarditis and cardiomyopathy are yet to be investigated as rigorously and a clear understanding of the aetiology and risk of developing either adverse event remains elusive.

Aims: The current study aims to investigate changes in cardiac functioning in a group of patients treated with clozapine.

Method: Transthoracic echocardiograms were conducted on one hundred and four clozapine naïve patients, prior to commencing clozapine treatment (Time 1) and were repeated after 6 to 12 months (Time 2) of treatment, as part of routine cardiac monitoring. Patient psychiatric and medication history were documented, as were full white blood count, troponin 1 and creatinine kinase results.

Results: Preliminary analyses of the data set indicate a decrease in left ventricular shortening, a measure of ventricular contractility, from Time 1 (pre clozapine) to Time 2. Further analyses will be presented.

Conclusion: While there appears to be a trend towards a worsening of cardiac function with clozapine treatment, further investigations need to be carried out taking into account confounding factors that are known to be implicated in cardiac dysfunction to such as age, BMI, smoking, medical history, familial history, amongst others. Establishing a clearer understanding of the link between the two will help patients and clinicians balance the risk of cardiac problems and improved psychopathology and help to institute cardiac monitoring guidelines for patients treated with clozapine.

OP081  NOVEL ENVIRONMENT EXPLORATION IN RODENTS AND PATIENTS WITH BIPOLAR MANIA OR SCHIZOPHRENIA

Mark A. Geyer, A. Minassian, J.W. Young, M.P. Paulus, W. Perry

Department of Psychiatry, School of Medicine, University of California, San Diego, U.S.A.

To differentiate the behavioral characteristics of schizophrenia (SCZ) and Bipolar Disorder (BD) and generate data suitable to validate putative animal models, we developed a human paradigm analogous to the rodent “open field”. The human open field is a room in an inpatient psychiatric ward containing a desk, file cabinet, bookcase, 10 engaging objects, and no chair. The subject is asked to wait in the room and is monitored for 15 min. As in our rodent Behavioral Pattern Monitor, we quantify the amount of exploratory behavior, the sequential patterns of activity, and object interactions. Acutely decompensated BD (N = 15) and SCZ (N = 16) subjects were compared to healthy volunteers (N = 26). Studies of mouse models included pharmacological treatments with amphetamine or the selective dopamine transporter inhibitor GBR12909, and genetic knockdown of the dopamine transporter. Manic BD subjects demonstrated a unique exploratory pattern, namely high motor activity and object exploration. SCZ subjects failed to exhibit the expected habituation of motor activity. In mice, selective genetic or pharmacological inhibition of the dopamine transporter matched the mania phenotype better than the “gold standard” model of mania (amphetamine). These findings validate the human open field paradigm and identify defining characteristics of BD that are distinct from SCZ, even during highly psychotic states when they may otherwise be indistinguishable. This cross-species paradigm offers an innovative approach to recording exploratory activity in a novel environment, using procedures and multivariate assessments that have been validated in extensive studies of open field behavior in rodents.

OP082 ROLE OF SEROTONIN-1A RECEPTORS IN THE ACTION OF ANTIPSYCHOTIC DRUGS ON PREPULSE INHIBITION IN MICE

Maarten van den Buuse, M. Bogeski, Andrea Gogos

Mental Health Research Institute, Melbourne, Australia

Aims: The serotonin-1A (5-HT_1A) receptor has been implicated in the pathogenesis of schizophrenia, and some antipsychotic drugs have high affinity for this receptor. However the exact involvement of the 5-HT_1A receptor in schizophrenia and antipsychotic action remain unclear. We previously assessed the effect of antipsychotics on disruption of prepulse inhibition (PPI) by 5-HT_1A receptor stimulation in rats (1). PPI is a model of sensory information processing which is deficient in schizophrenia patients. To extend species comparison and to allow future studies in genetically-modified animals, we aimed to further explore the involvement of 5-HT_1A receptors in the action of antipsychotic drugs in mice.

Methods: Mice (n = 7–10/group) were pretreated with the typical antipsychotics and selective dopamine D₂ receptor (D₂R) antagonists, haloperidol or raclopride (both 0.05 or 0.25 mg/kg), the atypical antipsychotics, clozapine, olanzapine or risperidone (all 0.2 or 1 mg/kg), or the third generation antipsychotic, aripiprazole (1 or 5 mg/kg), which has partial agonist activity at both 5-HT_1A and dopamine D₂ receptors. Thirty minutes later, the mice were treated with either 1 mg/kg of the 5-HT_1A receptor agonist (±)-8-hydroxy-dipropyl-amino-tetralin (8-OH-DPAT) or saline and PPI was assessed using automated startle boxes.

Results: Treatment with 8-OH-DPAT dose-dependently increased PPI in Balb/c mice, but not in C57Bl/6 mice. Haloperidol, raclopride and aripiprazole pretreatment dose-dependently blocked the effects of 8-OH-DPAT on PPI. The atypical antipsychotics, clozapine, olanzapine and risperidone, had only minor effects on the action of 8-OH-DPAT on PPI.

Conclusion: These data suggest that stimulation of 5-HT_1A receptors by 8-OH-DPAT causes downstream activation of dopamine D₂ receptors leading to modulation of PPI. This effect appears to be opposite in mice (increased PPI) compared to rats (PPI disruption) which may be related to the differential activation of pre- and postsynaptic 5-HT_1A receptors, respectively (2). The ensuing changes in PPI can be blocked directly with antipsychotic drugs which have high affinity for 5-HT_1A receptors or indirectly by drugs which have high affinity for dopamine D₂ receptors. Further research is required to elucidate the exact mechanism of action of 5-HT_1A receptors in antipsychotic drugs, PPI, and by extrapolation possibly in schizophrenia.

(1) Van den Buuse & Gogos, J Pharmacol Exp Ther 320, 1224–1236, 2007

(2) Gogos, Kusljic & Van den Buuse, Pharmacol Biochem Behav 81, 664–672, 2006

OP083  THE ROLE OF TNF IN AGING-ASSOCIATED COGNITIVE PERFORMANCE – A MOUSE MODEL

Jordan McAfoose ¹, H. Koerner², B.T. Baune^1,2

¹ Psychiatry & Psychiatric Neuroscience, School of Medicine & Dentistry, James Cook University, Australia

² Comparative Genomics Centre, James Cook University, Australia

Aims: Although the age-dependent neurobiological processes leading to cognitive decline in the elderly remains to be fully understood, there is now growing evidence to suggest that age-dependent increases in pro-inflammatory cytokines, such as tumour necrosis factor alpha (TNF), might play a role in such age-associated cognitive decline. The aim of this work was to examine, using a mouse model, the effect of a deficiency of TNF (TNF^{−/ −}) on cognitive function throughout aging.

Methods: A standardized survey on cognition-like behaviour assessing learning and retention, spatial learning/memory, and cognitive flexibility was used to measure the cognitive-behavioural profile of TNF knockout and wildtype mice, across three age periods; 3, 6 and 12 months of age, respectively.

Results: All studied mice strains demonstrated successful exploration and learning processes during the training phases of the tests, which made the specific cognition like tests valid in these mice strains. In the specific cognition-like tests, the B6.TNF^{−/ −} mice demonstrated, at 3 months of age, significantly poorer learning and retention in the novel object test as compared to B6.WT mice. In addition, spatial learning and learning effectiveness were significantly poorer in B6.TNF^{−/ −} mice, at 3 months of age, as compared to B6.WT mice. While the absence of TNF was correlated with poor cognitive functioning in early adulthood, over time the deletion of TNF resulted in better cognitive performance compared to B6.WT mice.

Conclusion: Low-levels of TNF under non-inflammatory immune conditions appear essential for normal cognitive function. Moreover, the absence of TNF with age appears to protect against age-associated cognitive decline. Collectively, these findings suggest a possible role for TNF in the molecular and cellular mechanisms subserving age-related changes in learning, memory and cognition.

OP084 INTERACTION OF ESTROGEN WITH CENTRAL SEROTONERGIC MECHANISMS IN SENSORY PROCESSING: MISMATCH NEGATIVITY AND LOUDNESS DEPENDENCE OF THE AUDITORY EVOKED POTENTIAL

Andrea Gogos ¹, Valerie Guille^1,2, Pradeep Nathan², Rodney Croft², Maarten van den Buuse¹

¹ Mental Health Research Institute Of Victoria, Parkville, VIC, Australia

² Brain Sciences Institute, Swinburne University of Technology, Hawthorn, VIC, Australia

Background and purpose: The sex steroid hormone, estrogen, has been proposed to be protective against schizophrenia. This study aimed to explore whether this effect of estrogen occurs via a modulation of the serotonin-1A (5-HT_1A) receptor, which is strongly implicated in the pathophysiology of schizophrenia. Schizophrenia is associated with impairments of sensory processing as measured using mismatch negativity (MMN). Further, the loudness dependence of the auditory evoked potential (LDAEP) has been suggested as a non-invasive electrophysiological marker of central 5-HT function, with reduced serotonergic activity thought to increase the LDAEP slope. This study aimed to examine the effect of estrogen treatment on modulation of MMN and LDAEP by the 5-HT_1A receptor partial agonist, buspirone, in healthy humans. We previously found (Gogos et al. 2006, Neuropsychopharmacology), in the same subjects, that buspirone caused a significant disruption of prepulse inhibition (a measure of sensory gating) and pretreatment with estrogen prevented this disruption.

Approach: In a double-blind, placebo-controlled, repeated-measures design, 16 healthy female volunteers were treated with placebo/placebo, estrogen (2 mg)/placebo, placebo/ buspirone (5 mg) and estrogen/buspirone. MMN was measured at the Fz electrode and LDAEP was measured using dipole source localization analysis.

Key Results: There was no significant effect of either drug treatment on MMN amplitude or latency. However, buspirone treatment significantly enhanced LDAEP slope in the placebo condition but was without any effect in the estrogen condition. Further, estrogen treatment alone resulted in a marked and significant increase of LDAEP slope.

Conclusion: These results suggest that buspirone treatment increased LDAEP by inhibiting 5-HT function and that this inhibition was prevented by estrogen pretreatment. In addition, estrogen was found to increase LDAEP, possibly by a direct action on cortical pyramidal cells or by an interaction with 5-HT_1A receptors. However, neither 5-HT_1A receptor activation nor estrogen is involved in the modulation of MMN. These results could be important for our understanding of the mechanism by which estrogen protects against schizophrenia.

OP085 IMPAIRED MISMATCH NEGATIVITY IN THE SCHIZOPHRENIA PRODROME

Rebbekah Atkinson ^1,2, Ulrich Schall^1,2,3, Wendy Stojanov¹, Raymond Inkpen¹, Sally Hunt¹, Katrin Helmbold¹, Sean Halpin^1,3, Vaughan Carr^1,2,3, Juanita Todd^1,2, Patricia Michie^1,2

¹ Priority Centre for Brain & Mental Health Research, University of Newcastle, Newcastle, Australia

² Schizophrenia Research Institute, Sydney, Australia

³ Hunter New England Health, New South Wales, Australia

Background: Mismatch negativity (MMN) to tone duration deviants has consistently been shown to be reduced in schizophrenia. Here we report on MMN data obtained from 19 healthy control subjects and 72 referrals to a specialized mental health service for the identification of individuals at ultra-high risk (UHR) of developing schizophrenia.

Methods: MMN was derived as subtraction waveforms of event related potentials (ERPs) to frequent short (50 ms) or long-duration (100ms) standard tones minus ERPs to infrequent long or short-duration deviant tones, respectively.

Results: The largest MMN amplitudes were recorded in control subjects compared with MMN from 12 referrals meeting criteria for first-episode psychosis and 27 UHR referrals with significant effects of duration type and group. Approaching significance, reduced MMN was recorded in 5 UHR individuals making a confirmed transition to schizophrenia one year after UHR identification in comparison to 13 UHR individuals who did not make such a transition.

Conclusion: Our preliminary findings suggest impaired MMN appears to be associated with prodromal schizophrenia.

OP086 INTACT SENSORIMOTOR GATING IN ADULT ATTENTION DEFICIT HYPERACTIVITY DISORDER

Mary-Claire Hanlon, Frini Karayanidis, Ulrich Schall

Priority Research Centre for Brain & Mental Health Research

Schizophrenia Research Institute

Hunter Medical Research Institute

Background: Disrupted sensorimotor gating has been found in various neuropsychiatric conditions which are characterised by impaired attention, poor impulse control, dysfunctional dopamine neurotransmission, and neurodevelopmental deficits.

Aims: Previous findings suggest disrupted sensorimotor gating in children diagnosed with attention deficit hyperactivity disorder (ADHD) which improved with stimulant treatment. The current study aimed to investigate sensorimotor gating by prepulse inhibition (PPI) of the acoustic startle eyeblink reflex in young adults diagnosed with ADHD as children and still symptomatic at the time of testing.

Method: Twenty-three ADHD subjects and 29 age-matched healthy volunteers participated in the study. Sensorimotor gating was assessed in a passive listening task and whilst participants were performing a two-tone auditory discrimination task on the prepulse.

Results: Our results indicate intact sensorimotor gating in drug-free adults with ADHD. However, PPI was reduced when ADHD participants were taken off their regular ongoing stimulant medication and when performing the two-tone auditory discrimination task on the prepulse.

Conclusion: Our findings are consistent with increased neural maturity and partially remitted symptomatology in adult ADHD. Our findings also suggest improved attention-modulated sensorimotor gating with ongoing stimulant treatment.

OP087 ROLE OF PREFRONTAL CORTEX GLUTAMATE AND METABOTROPIC GLUTAMATE RECEPTORS IN SCHIZOPHRENIA-LIKE COGNITIVE DEFICITS INDUCED BY PHENCYCLIDINE IN RATS

Athina Markou, Nurith Amitai and Ronald Kuczenski

Department of Psychiatry, School of Medicine, University of California, San Diego, U.S.A.

Abnormal glutamate neurotransmission is postulated to play a role in cognitive dysfunction in schizophrenia. Using in vivo microdialysis, we investigated in rats how glutamate levels in the prefrontal cortex (PFC) were affected by repeated phencyclidine (PCP) administration, a treatment that induces robust schizophrenia-like cognitive deficits. Further, we assessed how treatment with chronic clozapine, an atypical antipsychotic with partial effectiveness on cognitive impairment in schizophrenia, may alter PCP-induced changes in PFC glutamate. Finally, we examined how the metabotropic glutamate receptor 2/3 (mGluR_2/3) agonist LY379268 and the mGluR_2/3 antagonist LY341495 altered PCP-induced disruptions in performance in the 5-choice serial reaction time task (5-CSRTT), a test evaluating in rats multiple cognitive modalities that are affected in schizophrenia. Acute PCP increased extracellular PFC glutamate, and this increase was attenuated with repeated PCP pretreatment. Chronic clozapine blunted the PCP-induced glutamate increase. Acute LY379268 alone did not affect 5-CSRTT performance, with the exception of high doses that produced nonspecific response suppression. PCP-induced disruption of 5-CSRTT performance was exacerbated by acute LY379268 but unaltered by acute LY341495 administration. Chronic LY341495 impaired attentional performance in the 5-CSRTT by itself, but attenuated PCP-induced excessive timeout responding. The increase in PFC glutamate levels induced by repeated PCP administration and its attenuation by chronic clozapine suggest that increased cortical glutamate may underlie some cognitive deficits in schizophrenia. However, the mixed effects of mGluR_2/3 agonists and antagonists on cognitive performance under baseline conditions and after disruption with PCP indicate that additional mechanisms are involved in cognitive dysfunction in schizophrenia.

OP088 PHARMACOLOGICAL MODULATION DURING FMRI: MUSCARINIC AND NICOTINIC PROPORTIONS OF THE ATTENTION NETWORK ACCORDING TO POSNER

Renate Thienel ^1,2, B. Voß², M. Reske³, T. Kellermann², S. Halfter², A.J. Sheldrick², K. Radenbach⁴, U. Habel², F. Schneider², N.J. Shah⁵, T. Kircher²

¹ Centre for Rural and Remote Mental Health, University of Newcastle, Australia

² Dept. of Psychiatry and Psychotherapy, University of Aachen, Germany

³ Dept. of Psychiatry, Lab of Biolog. Dynamics & Theoretical Medicine, University of California, USA

⁴ Dept. of Psychiatry and Psychotherapy, Georg-August University of Göttingen

⁵ Institute of Neuroscience and Biophysics, Research Centre Jülich GmbH, Germany

Cognitive and attentional deficits occur with an incidence of 85% in patients suffering from schizophrenia. These deficits are considered as the most important predictor of patients social and occupational outcome. Alterations in the cholinergic system such as a reduced number of nicotinic and muscarinic receptors are associated with these cognitive deficits. In order to assess the specific contribution of nicotinic and muscarinic neurotransmission respectively to attentional processes (1) we used the nicotinic receptor blocker Mecamylamine and the muscarinic receptor blocker Scopolamine in healthy subjects performing an Attentional Network Task (ANT) during functional magnetic resonance imaging assessing the differential effect the two antagonists impose on Alertness, Orienting and Executive Control, the three attentional networks as described by Posner and Petersen (2).

Twelve healthy, male, right handed nonsmokers were assessed with fMRI in intervals of at least one week in a single blind, double dummy, cross-over-design three times. Prior to each scanning session they received in a randomized order either Mecamylamine or Scopolamine plus placebo or exclusively Placebo. The functional brain activation was assessed during the ANT as operationalised for the fMRI environment by Fan et al. (3).

During the placebo trial the orienting and executive control network activations were in line with Posner and Petersens hypothesis (2), resulting in bilateral activations in predominantly frontal and subcortical areas in the orienting trial and in bilateral activations in the anterior cingulum, the precuneus and occipital areas of the left hemisphere in the executive control trial. In both conditions both antagonists effectively disrupted these activation patterns with more extensive disruptions by the nicotinic antagonist.

This selective modulation has implications on cognitive enhancements in schizophrenia.

Supported by the Deutsche Forschungsgemeinschaft (KFO 112). Lit.: 1) Green et al., 2005 2) Posner & Petersen, 1990, 3) Fan et al., 2002

OP089 SMOKING CARE IN AUSTRALIAN PSYCHIATRIC FACILITIES: HEALTHCARE OR TRADITIONAL BEHAVIOUR MANAGEMENT?

Paula Wye ¹, Jenny Bowman¹, John Wiggers², Amanda Baker³, Jenny Knight⁴, Vaughan Carr³, Margarett Terry⁵, Richard Clancy⁵

¹ School of Psychology, University of Newcastle, Australia

² School of Medicine and Public Health, University of Newcastle, Australia

³ Centre for Brain and Mental Health Research, Faculty of Health, University of Newcastle, Australia

⁴ Population Health, Hunter New England Area Health Service, NSW Health

⁵ Hunter New England Mental Health Services, Hunter New England Area Health Service, NSW Health

Aims: To determine current smoking policies and practices in public mental health units in NSW, Australia; determine current smoking care in such units; and investigate what policies/practices might predict assessment of smoking status and provision of smoking care.

Method: A mailed cross-sectional survey.

Findings: Of 131 units, 123 completed questionnaires were returned (94%). Over one third (36%) of respondents reported instances of patients commencing smoking during their inpatient stay, and 39% reported some proportion of smoking patients were provided with cigarettes when their own supply was expended. While 50% of respondents reported ‘all’ smoking patients to be assessed for smoking status, 70% reported ‘no’ patients to be assessed for nicotine dependence. Few respondents reported quit advice was ‘always’ provided to patients who smoke. Respondents who reported their unit sometimes withheld patient's cigarettes to minimize tobacco-related harm had three times the odds of providing comprehensive smoking care than respondents who reported never doing so.

Conclusions: Inadequate reinforcement of a non-smoking environment and inconsistencies in smoking care procedures are apparent. The lack of associations between the provision of smoking care and unit characteristics suggest mental health services failure to provide smoking care is endemic and not related to particular types of services.

OP090 BECOMING A SMOKEFREE INPATIENT PSYCHIATRY WARD: THE STAFF EXPERIENCE

Sacha Filia ¹, Clare Shelton², Caroline Gurvich¹, Stuart Lee¹, Catherine Forrester², Chris Schaffer², Lisa Scarff², Sandra Keppich-Arnold², Lynda Katona², Jayashri Kulkarni¹

¹ Monash Alfred Psychiatry Research Centre (MAP-RC)

² Department of Psychiatry, The Alfred

Background: Due to the significant health risk that cigarette smoking poses health services are now enforcing mandatory smoking bans. The Alfred Psychiatry Inpatient Unit became a Smokefree facility in June 2008.

Aims: To evaluate staff attitudes, expectations and knowledge about becoming smokefree before and after the ban; and to describe the staff experience of the process.

Method: Staff (n = 49) attended training sessions before the ban. Attitudes, expectations and knowledge about going smokefree were assessed before and after the training session. This information will be reassessed 3 months post-ban.

Results: Almost one third of staff (32%) surveyed before the ban said they felt “unsure” about the Inpatient Unit becoming smokefree. More than 46% of staff expected physical and verbal aggression, seclusion and use of as required medication to moderately increase as a result of banning smoking. Attendance at the training session held before the ban positively influenced the expectations of staff. Knowledge about relevant topics (e.g. nicotine replacement therapy, assisting clients to manage cravings) and confidence in applying this information significantly improved after the training session (p<.01).

Conclusion: Smoking bans in the inpatient psychiatry ward are important to promote the health of clients, staff and visitors. The change can be challenging, and staff require appropriate support.

OP091 BECOMING A SMOKEFREE INPATIENT PSYCHIATRY WARD: THE CLIENT EXPERIENCE

Sacha Filia¹, Clare Shelton ², Anton Horvat ², Caroline Gurvich¹, Lynda Katona², Jayashri Kulkarni¹

¹ Monash Alfred Psychiatry Research Centre (MAP-RC)

² Department of Psychiatry, The Alfred

Background: Rates of smoking in people with mental health problems are double that of the general population,. Mandatory smoking bans provide an additional challenge for smokers admitted to an inpatient psychiatry ward. The Alfred Psychiatry Inpatient Unit became a Smokefree facility in June 2008.

Aims: To evaluate client attitudes before and after the smoking ban is introduced, and to describe how clients experience and manage this change.

Method: Prior to the smoking ban, clients (n = 46) completed a questionnaire about the ward going smokefree. Since the ban, staff have facilitated Smokefree Support Groups, with content themes recorded. Clients will be asked to complete another questionnaire about their experience and views 3 months post-ban.

Results: Over a third of clients surveyed before the smoking ban (37%) said they felt “very negative” about the Inpatient Unit becoming smokefree, whilst 20% said they felt “very positive.” Many clients describe smoking as an unwanted addiction. Some view the enforced abstinence as a positive opportunity to attempt to reduce or quit smoking and access nicotine replacement therapy (NRT).

Conclusion: Mandatory smoking bans in the inpatient psychiatry ward provide a challenge for smokers who experience mental illness. It is important that clients are appropriately supported, offered and encouraged to try NRT, and provided with alternative activities to smoking on the ward.

OP092 AN EXPLORATION OF DRUG ATTITUDES AND KNOWLEDGE AMONG PEOPLE WITH PSYCHOTIC DISORDERS

Louise Thornton ¹, Amanda Baker¹, Martin Johnson², Carmel Loughland³, Terry Lewin¹, Frances Kay-Lambkin⁴.

¹ Centre for Brain and Mental Health Research, The University of Newcastle

² School of Psychology, The University of Newcastle

³ Schizophrenia Research Institute

⁴ National Drug and Alcohol Research Centre, University of New South Wales

Background: Substance use disorders are extremely common among people with psychotic disorders and have been associated with a range of negative consequences and high treatment costs. There is evidence to suggest that among this population brief interventions may be relatively more effective for alcohol versus cannabis use problems. To allow for the development of new and more effective brief interventions it is important to understand why this disparity in intervention effectiveness exists. The attitudes and knowledge of this population regarding various substances may partially explain this disparity, however very little research has been conducted on these issues.

Aim: This study aims to address this gap in knowledge by examining the attitudes and knowledge of people with psychotic disorders regarding tobacco, alcohol and cannabis and to inform the development of future interventions.

Method: Improving on previous research this study employs a method triangulation design in which both quantitative and qualitative data is elicited. Questionnaires investigating participant's perceptions of harmfulness, addictiveness, knowledge, reasons for use, and exposure to public health campaigns regarding tobacco, alcohol and cannabis have been sent to 246 people with psychotic disorders. Eight semi-structured telephone interviews, to be analysed using interpretative phenomenological analysis, will also be conducted to supplement and enrich the quantitative research.

Results: The results of this study will be presented and their implications discussed. The results will have the potential to inform the development of future interventions, education and public health campaigns in this area.

OP093 VISUAL SCAN PATHS IN YOUNG ADULTS WITH VELO-CARDIO-FACIAL SYNDROME (22Q11.2 DELETION SYNDROME)

Linda E. Campbell ^1,2,3, Kathryn McCabe^1,2, Kathryn Leadbeater¹, Dominique Rich¹, Ulrich Schall^1,2,3, Carmel Loughland^1,2,3

¹ Priority Research Centre for Brain and Mental Health Research, University of Newcastle, NSW Australia

² Schizophrenia Research Institute, Australia

³ Hunter Medical Research Institute, Australia

Background: Velo-cardio-facial syndrome is one of the most common genetic disorders characterised by physical abnormalities such as cardiac/palatal defects. VCFS constitutes the third highest known risk factor for schizophrenia. It is well established that social interaction deficits are common in VCFS, presumably contributing much to the social dysfunction of this group. Little research has focused on the neurocognitive deficits underlying social problems.

Aims: The current study examines whether visuo-cognitive disturbances to faces are observed in VCFS.

Methods: Visual scanpaths to facial emotion stimuli were recorded (Eyelink1000). Scanpaths were recorded while subjects viewed facial expression stimuli depicting seven emotions (happy/sad/neutral/fear/disgust/surprise/anger). Recognition accuracy and Feature/non feature scanning parameters were also recorded.

Results: The data suggests that the VCFS group spend significantly longer looking at the mouth region and less time at the eyes compared to the control group. The VCFS group were also less accurate identifying the facial emotions.

Conclusions: The VCFS group do not use optimal strategies when looking at faces and consequently perform less well when trying to identify facial expressions. This might have an impact on the social abilities of people with VCFS.

Supported by NH&MRC ref 455624 and HMRI 07–03

OP094 DOES THE N170 REFLECT REDUCED STRUCTURAL ENCODING OF FACES IN SCHIZOTYPAL PERSONALITY?

Rachel Batty ¹, Susan Rossell¹, Andrew Francis²

¹ Alfred Psychiatry Research Centre, The Alfred Hospital, Monash University, Melbourne, Australia

² RMIT University, Bundoora, Australia

Background: It has been argued that deficits in facial affect discrimination in schizophrenia may reflect a more general underlying visual processing deficit, that is, inadequate configural processing.

Aims: Configural processing was assessed behaviourally using two stimuli types. Additionally, we recorded the N170 ERP component (the N170 is considered to reflect the process of encoding face information to form a structural representation). The aim was to examine whether configural processing was different in persons with high schizotypy.

Method: Two stimulus types were presented in both an upright and inverted orientation; Mooney stimuli which offer configural (holistic) information, and photographic stimuli which offer both featural and configural, these were compared with non-face stimuli. Participants were required to make face or non-face judgements. Healthy individuals (N = 28), who were assigned to either high or low schizotypy extremes defined by the Oxford Liverpool Inventory of Feelings and Experiences, were tested (O:LIFE; Mason, Claridge & Jackson, 1995).

Results: Accuracy and reaction times did not differentiate the schizotypy groups, however high schizotypy showed significantly reduced N170 amplitudes to both face orientations, relative to the low group.

Conclusion: These data suggest that the proposed generalised face processing deficiency in schizophrenia may be attributable to deficits at the structural encoding stage. Furthermore, this deficiency does not seem to be the result of inhibited featural or configural information processing in particular.

OP095 PERFORMANCE ON THE TILE MATRIX TASK PROVIDES FURTHER EVIDENCE OF VISUO-COGNITIVE DISTURBANCES IN THE FIRST-DEGREE RELATIVES OF SCHIZOPHRENIA PATIENTS

Carmel M. Loughland ^1,2, Kathryn McCabe^1,2, Patrick Johnston², Terry J. Lewin³, Vaughan J. Carr^1,2

¹ Schizophrenia Research Institute (SRI)

² Centre for Brain and Mental Health Research (CBMHR), University of Newcastle, NSW Australia

³ Hunter New England Health

Background: Schizophrenia is associated with abnormally ‘restricted’ visual scanpaths to facial expression stimuli and avoidance of feature regions (Loughland et al, 2002a, 2002b). Healthy first-degree relatives produce an attenuated form of this disturbance suggesting it may involve a familial transmission component (Loughland et al, 2004). This study examined whether scanpath disturbances to face stimuli in schizophrenia are associated with information sequencing or information retention/integration dysfunction, and whether a similar pattern of performance is observable in first-degree relatives of schizophrenia patients.

Method: Subjects consisted of 35 individuals with schizophrenia, 30 first-degree relatives and 40 healthy controls. There were two tile matrix task conditions. In each task, different stimuli were presented depicting the same seven emotions, overlaid by a five-by-five tile matrix. Subjects selected as few tiles as necessary to identify the facial expressions. In the retention/integration task condition, tiles were immediately masked as each new tile was selected. In the sequencing task condition, selected tiles remained unmasked.

Results: Schizophrenia subjects were as accurate as controls and relatives at identifying ‘congruent’ (happy) emotions, but had greater difficulty with complex emotions (fear, anger), and were more likely to misattribute disgust for anger and surprise for fear, which has implications for the community. Schizophrenia subjects and relatives removed significantly more tiles (with less saliency value) than controls, regardless of emotion. However, relatives used an adaptive strategy (by removing more tiles) in the harder information retention/integration tile task, whereas schizophrenia subjects displayed an inflexible strategy across tasks and did not change the number of tiles uncovered.

Conclusion: Schizophrenia and relative subjects show disturbances in their visuo-cognitive strategy that is compensated for in relatives but remains maladaptive in schizophrenia subjects.

OP096 RANDOMISED CONTROL TRIAL OF EMOTION PERCEPTION REMEDIATION AMONG PEOPLE WITH SCHIZOPHRENIA

Kathryn McCabe ^1,2, Carmel Loughland^1,2, Mick Hunter¹, Terry Lewin^{1,2 3} , Vaughan Carr^1,2,3

¹ Centre for Brain and Mental Health Research, University of Newcastle, NSW, Australia

² Schizophrenia Research Institute (SRI), NSW Australia

³ Hunter New England Mental Health Service, NSW Australia

Background: The inability to recognise emotion expression of others is one of the most common impairments observed among individuals with schizophrenia. Recent research has explored the potential clinical utility of cognitive remediation to improve emotion perception in patients with schizophrenia. While the results of this approach are promising, no research to date has addressed the visuo-cognitive deficits that may underlie emotion perception disturbances.

Aims: This study examined the efficacy of a randomised control trial aimed specifically at emotion perception, comparing a visual scanpath based remediation, and a direct emotion perception remediation program.

Method: Schizophrenia participants were randomly allocated to either the visual scanpath (REM/ATT) or emotion perception (REM/METT) condition. At baseline, post treatment and again at 6 weeks post treatment participants completed a battery of tasks (saccade, antisaccade, smooth pursuit (SPEM), emotion perception and weather perception). Visual scanpath (VSP) were recorded during each phase of the remediation. Recognition accuracy was recorded concurrently for the emotion perception and weather perception tasks.

Results: Both groups improved with training with participants performing similar to a matched control group on both emotion and weather perception. For the visual scanpath analysis, it is expected that REM/ATT participants will direct more eye movements within feature areas of faces (i.e., eyes, nose, mouth) compared to the METT group post treatment.

Conclusion: The clinical utility of targeted remediation programs to improve the psychosocial outcomes of people with schizophrenia will be discussed.

OP097 IS ADVANCED PATERNAL AGE ASSOCIATED WITH ALTERED BRAIN DEVELOPMENT? CLUES FROM ANIMAL MODELS

Thomas Burne, Claire Foldi, Emma Whitelaw, Darryl Eyles, John McGrath

Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol QLD 4076 Australia

Queensland Brain Institute, University of Queensland, St Lucia QLD 4072 Australia

Queensland Institute of Medical Research, Herston QLD 4029 Australia

Background: Evidence from epidemiology suggests that the offspring of older fathers have an increased risk of various adverse health outcomes, including schizophrenia and autism. With respect to biological mechanisms for this association, there are many more germline cell divisions in the life history of a sperm relative to that of an oocyte. Thus, there are more opportunities for copy errors in germ cells from older fathers. Our team has developed a mouse model to explore the impact of Advanced Paternal Age (APA) on various intermediate phenotypes related to neurodevelopmental disorders.

Methods: We examined the offspring of young versus older C57Bl/6J sires (4 versus 18 months). Adult mice were first subjected to a detailed screen to exclude gross morphological and neurological changes. They were then subjected to a variety of behavioural tests incorporating animal models of anxiety (elevated plus-maze), exploration (holeboard test), and sensorimotor gating (prepulse inhibition of the acoustic startle response, PPI), locomotion (open field test), working memory (8-arm radial maze) and spatial memory (Morris water maze). Brain anatomy was assessed using the 16.4 Tesla microimaging facility (Bruker BioSpin; Centre for Magnetic Resonance, University of Queensland).

Results: The adult offspring of the APA group differed significantly from the controls on a range of behaviours related to exploratory and ‘anxious’ phenotypes. For example, on the elevated plus-maze, the APA group had significantly fewer head dips and rearing, while on the holeboard test, the APA group had significantly increased head dips. In the open field, the APA group had significantly decreased rearing behaviour. There were no significant group differences for the other behavioural measures. Using MRI the male APA adult offspring had a significantly wider cerebral cortex compared to control male mice.

Discussion: Our pilot study identified subtle changes in behaviour and altered brain morphology. These findings are more reminiscent of animal models related to autism (anxiety, cortical overgrowth), rather than schizophrenia. Future animal studies will allow us to refine the behavioural and structural phenotype and explore genetic and epigenetic mechanisms that may underpin these changes.

OP098 BRAIN CORRELATES OF COGNITIVE IMPAIRMENT IN A LARGE COMMUNITY-BASED SAMPLE OF 65–70 YEAR-OLDS: THE PATH THROUGH LIFE STUDY

Nicolas Cherbuin ¹, Chantal Réglade-Meslin¹, Perminder S. Sachdev², Kaarin J. Anstey¹

¹ Centre for Mental Health Research, ANU

² Neuro Psychiatric Institute, Prince of Wales Hospital

Aims: Identify significant brain correlates of mild cognitive impairment (MCI) and any mild cognitive disorder (any-MCD) in a large community-based sample of young old individuals who were assessed for cognitive impairment. Investigate the association between cerebral volumetrics, anatomical asymmetry, and cognitive decline.

Method: Cortical and sub-cortical volumes were measured using a semi-automated method in 398 participants aged 65–70 years who were selected from a larger randomly sampled cohort and who agreed to undergo an MRI scan. Diagnoses were reached based on established protocols for MCI and any-MCD (AAMI, AACD, OCD, MNC, CDR). Logistic regression analyses were used to assess the relationship between volume and asymmetry of theoretically relevant cerebral structures (predictors) and MCI or any-MCD while controlling for age, sex, and intra-cranial volume.

Results: The main predictors of cognitive impairment assessed in multivariate analyses were left cerebellar cortex asymmetry (MCI: OR 1.51, 95%CI 1.13–2.01), lesser left lateral ventricle asymmetry (MCI: OR 0.95, 95%CI 0.91–0.99; MCD: OR 0.95, 95%CI 0.92–0.98), and greater right hippocampal asymmetry (MCI:OR 0.83, 95%CI 0.71–0.96; MCD: OR 0.86, 95%CI 0.77–0.97).

Conclusion: In this generally healthy and well-educated cohort the main brain predictors of cognitive decline were not as expected the atrophy but the asymmetry of particular cerebral structures.

OP099 COUNSELLING SPOUSES OF PEOPLE WITH ALZHEIMER'S DISEASE (AD): EFFECTS ON RATES OF INSTITUTIONALISATION AND MORTALITY IN THREE COUNTRIES

Henry Brodaty^1,2, Mary Mittelman³, Louisa Gibson², Katrin Seeher ², Alistair Burns⁴

¹ Primary Dementia Collaborative Research Centre, School of Psychiatry, University of NSW, Sydney, Australia

² Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia

³ Department of Psychiatry, New York University School of Medicine, NY, USA

⁴ Psychiatry Research Group, University of Manchester, Manchester, UK

Background: Caregiver counselling and donepezil treatment for patients may reduce caregiver burden and rates of institutionalisation and mortality in persons with dementia.

Aims: We investigated whether additional caregiver counselling to donepezil treatment for patients with AD delays their nursing home (NH) placement or death.

Method: 158 persons with AD and their spouses in Australia, United Kingdom and United States volunteered for this randomized controlled trial with 2 years of active treatment. Caregivers had 5 sessions of individual and family counselling and ad hoc counselling upon request versus usual care. Cox regression was conducted.

Results: Over a mean of 5.4 years, no differences in NH placement or mortality by intervention group were found. However there were differences by country, with Australian patients admitted to NHs earlier than US and UK patients.

Conclusion: NH admission of Australian earlier than UK and US patients may result from differences in health care, NH systems, availability and affordability. If these could be controlled for, caregiver counselling may yet prove beneficial in delaying NH admission.

OP100 RESPONDING TO THE DEPRESSED ELDERLY IN EMERGENCY: ESTABLISHING LINKAGES BETWEEN SUB-ACUTE, PRIMARY AND COMMUNITY CARE

Lynette Joubert¹

¹ St Vincent's Health, The University of Melbourne

Approximately one third of all patients who present to the ED at St. Vincent's Health, Melbourne, are aged 65 years and over. The problems with which this age group present are often associated with underlying or pre-existing conditions, including depression. Depression in the elderly has been linked to social isolation, carer stress, multiple health problems and barriers to effective access to community resources.

Aims: The aim of the study was to implement a protocol for the identification and management of depression in elderly patients with multiple problems who present to the emergency department at St. Vincent's Health.

Results: A questionnaire schedule consisting of the K-10 Depression Questionnaire, the MANSA Quality of Life Scale (Huxley 2001) the PIE Classification system (Karls and Wandrei 1995) and the MOS Social Support Scale was administered to patients in emergency. Of the 771 patients aged 65 years+ observed, 66 were eligible for recruitment.

Discussion: We have implemented a successful protocol around the detection of elderly depression in emergency as well as an intervention and management program that links patients with primary care and community resources. Patients who present to emergency with depressive symptoms have complex histories and multiple medical problems. Many patients commented that they would be much happier if they were able to ambulate freely and indulge in the activities and hobbies that they used to participate in on a regular basis. The complex nature of the issues presented by the elderly is a challenge for allied health practice in emergency. We propose a framework for responding to the elderly presenting with depression at emergency.

OP101 PREDICTORS OF SELF-ESTEEM IN A COMMUNITY SAMPLE OF ADOLESCENTS

Jaymee E. Ryan ^1,2, Joe A. Buckby^1,2, Margaret Ross^1,2, Kathryn Baker¹, Elizabeth M. Cosgrave¹, Gennady N. Baksheev^1,2, Alison R. Yung^1,2

¹ Orygen Youth Health Research Centre, Melbourne, Australia

² University of Melbourne, Melbourne, Australia

Background: Adolescence is a transitional and often vulnerable stage of life characterised by physical, psychological, and social development. Self-esteem may be predictive of future psychological well-being. It is therefore critical to identify predictors of both low and high self-esteem in order to minimise or promote their effect later in life.

Aims: The present study investigated the cross-sectional association between gender, depressive symptomatology, general well-being, functioning, and coping style on self-esteem in an adolescent sample.

Method: A community-based sample of Australian Year 10 students aged 15–16 years (n = 653) completed a battery of self-report questionnaires assessing self-esteem (Rosenberg Self-Esteem Scale, RSE), depressive symptoms, general psychological health, functioning (peer, family and general), and coping style (avoidant, emotion-oriented, distraction).

Results: Using standard multiple regression, gender, depression, general health, functioning, and coping style were independent variables predicting self-esteem. After accounting for gender, the remaining variables significantly accounted for 61% of the variance in RSE scores (R²=.611, p<.001). The strongest unique contributors of high self-esteem were general functioning (7.7%) and emotion-oriented coping style (5.7%).

Conclusion: The present findings indicate that general functioning and coping style during adolescence should be taken into account when considering the psychosocial promotion of high self-esteem and adaptive coping strategies in times of stress.

OP102 ASSESSMENT OF OUTCOME IN ADOLESCENT PSYCHIATRIC INTERVENTION

Jeffrey Cubis

Academic Unit of Psychological Medicine, Australian National University Medical School

Background: Diagnostic difficulties, a lack of certainty about the standard therapies in adolescent psychiatry and now coupled with the growth of services for this population, all pose challenges for the assessment of outcomes with any psychiatric intervention in adolescents. Studies have suggested that the most mentally ill may have very poor outcomes but assessments have been ad hoc and rarely replicable. Valid assessment and outcome measures are required.

Aims: A project to develop appropriate measures of adolescent mental illness outcomes is presented.

Method: The study will follow adolescents through induction into mental health services, interventions and course specifically to identify key elements of outcome in this population.

Results: The study will attempt to clarify the important elements of assessment and the instruments to measure outcomes when considering adolescent psychiatric interventions.

Conclusion: The results should allow some conclusions to be drawn about the outcome elements relationships to presentation features and identify valid outcome assessment procedures.

OP103 SOCIAL COGNITIVE SKILLS IN CHILDREN AND YOUNG ADULTS WITH VELO-CARDIO-FACIAL SYNDROME (22Q11.2 DELETION SYNDROME)

Lynne Cruickshank ¹, Kathryn Leadbeater¹, Rayna Azuma⁴, Angela Stevens⁴, Annette Karmiloff-Smith⁶, Robin Morris⁴, Kieran C. Murphy⁵, Declan GM. Murphy⁴, Ulrich Schall^1,2,3, Frini Karayanidis¹, Linda E. Campbell^1,2,3

¹ Priority Research Centre for Brain and Mental Health Research, University of Newcastle, NSW Australia

² Schizophrenia Research Institute

³ Hunter Medical Research Institute

⁴ King's College London, Institute of Psychiatry, UK

⁵ Royal College of Surgeons in Ireland

⁶ University of London, Birkbeck

Background: In the last decade research has found that people with Velo-cardio-facial syndrome (VCFS) have problems with social skills. However, little research has concentrated on investigating the cognitive components underlying social skills, for example face processing and theory of mind.

Aims: The current study aimed to identify some cognitive components which may underlie the social interactive problems observed in people with VCFS.

Methods: In the current pilot study we are investigating social cognition in young adults with VCFS and healthy controls using Theory of Mind tasks such as a picture sequencing task and emotion attribution tasks. Furthermore, face processing skills were investigated.

Results: We identified differences in how the young adults with VCFS performed on the tasks especially we found that the patients performed worse on facial processing and emotion recognition.

Conclusions: People with VCFS have problems with some basic social cognitive functions. Future studies are needed to determine if these problems are related to the behavioural phenotype.

Supported by NH&MRC NHMRC ref 455624 and HMRI 07–03

OP104 SOCIAL AND AFFECTIVE REASONING AND DECISION MAKING IN ADOLESCENTS WITH BIPOLAR DISORDER

Catherine M. Cahill ^1,2,3, Gin S. Malhi^1,2,4

¹ Discipline of Psychological Medicine, University of Sydney

² CADE Clinic, Royal North Shore Hospital

³ Traumatic Stress Clinic, Westmead Hospital

⁴ ARCHI, Northern Clinical School, University of Sydney

Background: Increasingly investigations into differences between cognitive performance of bipolar adolescents and controls focus less on traditional neuropsychological domains and more on social and affective domains. The aim of the present study is to follow this trend and examine the performance of adolescents with bipolar disorder on a task evaluating social reasoning and decision making.

Method: A group of adolescents with bipolar disorder and a group of control subjects completed a modified Wason Card Selection task, which involves reasoning and decision making skills. The task was modified to include affective and social content.

Results: Preliminary results show support for differences in reasoning and decision making, in response to specific types of task, between adolescents with bipolar disorder and controls.

Conclusion: Preliminary evidence indicates there are differences in cognitive functioning with regard to social and affective information processing in adolescents with bipolar disorder. The likelihood is that differences in these processes have effects in real world aspects of functioning for bipolar patients. Possible ways to give these processes consideration and their implications with regard to assessment and treatment will be discussed.

OP105 UNIVERSAL WEB-BASED ALCOHOL SCREENING AND BRIEF INTERVENTION FOR UNIVERSITY STUDENTS: A RANDOMISED CONTROLLED TRIAL

Kypros Kypri ^1,2, Jonathan Hallett³, Peter Howat^3,4,5, Alexandra McManus^3,4, Bruce Maycock^3,4,5, Steven Bowe,¹ Nicholas Horton⁶

¹ School of Medicine and Public Health, University of Newcastle, Australia

² Injury Prevention Research Unit, University of Otago, New Zealand

³ Western Australian Centre for Health Promotion Research, Curtin University of Technology, Australia

⁴ Centre for Behavioural Research in Cancer Control, Curtin University of Technology, Australia

⁵ National Drug Research Institute, Curtin University of Technology, Australia

⁶ Smith College, Massachussets, USA

Aims: University students drink more heavily than their non-student peers and are mostly unaware that their drinking is risky and exceeds normative levels. We tested the efficacy of universal web-based screening and provision of motivational feedback to reduce hazardous drinking.

Methods: We conducted a randomised controlled trial at an Australian university in 2007. One- and six-month follow-up assessments were conducted with observers and participants blinded to allocation. 13,000 undergraduates (17–24 years) were invited by letter and e-mail to complete a web-based Alcohol Use Disorders Identification Test (AUDIT). 7,237 responded; 2,435 scored in the hazardous/harmful range (≥8) and were randomised; 2,050 completed at least one follow-up assessment. Intervention was 10 minutes of web-based motivational assessment and personalised feedback. Controls received only screening. Outcome measures were: drinking frequency, typical occasion quantity, overall volume, number of personal problems, an academic problems score, and prevalence of risky drinking.

Results: Mean baseline AUDIT scores for control and intervention groups were 14.3 (SD 5.1) and 14.2 (SD 5.1). After one month, participants receiving intervention drank less often (rate ratio = 0.89; 95% confidence interval: 0.83 to 0.94), smaller quantities per occasion (0.93; 0.88 to 0.98), and less alcohol overall (0.83; 0.78 to 0.90), than did controls. Differences in alcohol-related harms were non-significant. At six months, intervention effects persisted for drinking frequency (0.91; 0.85 to 0.97) and overall volume (0.89; 0.82 to 0.96), but not for other variables.

Conclusion: Web-based screening and provision of motivational intervention reduces risky drinking in undergraduates and could be implemented in medical and community settings.

OP106 INTEGRATING MULTIMEDIA TREATMENTS INTO A DRUG AND ALCOHOL SERVICE IN NSW

Aaron Simpson ^{2, 3}, Frances Kay-Lambkin^{1, 2}, Steven Childs⁴, Jenny Bowman³

¹ National Drug and Alcohol Research Centre, University of NSW, Australia

² Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, Australia

³ School of Psychology, The University of Newcastle, Australia

⁴ Area Drug and Alcohol Service, North Sydney Central Coast Area Health Service

Background: Evidence suggests that computer-delivered treatments show promise as an adjunct to formal treatment. Although drug and alcohol professionals are generally amenable to delivering evidenced-based treatments, the largely ‘informal’ diffusion methods utilised when disseminating new treatment practices for substance disorders have meant that new technologies are not particularly well integrated into everyday clinical practice.

Aims: To report on the baseline data collected as part of a pilot study into the integration of evidence-based computer-delivered treatment modalities into existing Drug and Alcohol Services (DACS).

Method: Baseline, sessional and follow-up data will be collected from all clinicians and participating clients of a DACS. Clinical information includes qualitative data regarding the i) relative advantage; ii) compatibility; iii) simplicity; iv) trialability; and, v) observability of multimedia treatment (Rogers, 2003). Clients will provide mental health, substance use and quality of life data. Baseline data will be reported.

Results: Some apprehension toward the use of computer-delivered therapy and other multimedia approaches will be identified by clinicians and clients, and an approach developed to address these concerns.

Conclusion: A model for integrating multimedia treatment approaches into clinical practice of DACS will be developed.

OP107 SUBSTANCE USE, RISK BEHAVIOURS AND CONTEXT OF SUBSTANCE USE – GENDER DIFFERENCES IN YOUNG PEOPLE PRESENTING TO AN ADOLESCENT, RESIDENTIAL SUBSTANCE USE TREATMENT PROGRAM

Angela Dean ^1,2, Michelle McBride¹, Elspeth MacDonald¹, Brett McDermott^1,2

¹ Kids In Mind Research, Mater Child & Youth Mental Health Service

² Department of Psychiatry, School of Medicine, University of Queensland, Brisbane, Australia

Background: Substance use is widespread amongst adolescents. Substance use treatments are considered useful in this population, but little research has examined patterns of substance use and treatment needs in this population, and whether treatment needs may differ between males and females.

Method: Between March 2000 and September 2004, demographic and clinical characteristics were collected for all young people entering treatment within a residential substance use program. Demographics, drug use patterns and context of substance use were examined and compared between males and females.

Results: during the monitoring period, 262 young people were admitted to the residential treatment service (53.1% male, average age 16.8 years; age range 13–18). Most commonly used drugs were cannabis (81.7%) and amphetamines (61.8%). Initial bivariate comparisons indicated that females had significantly higher rates of homelessness; used a greater number of substances; were more likely to report psychostimulant use and heroin use, were more likely to inject and share injecting equipment; were more likely to use with a partner; and more likely to use in response to emotional stress or to self harm. Multivariate analysis examined whether gender independently predicted heroin use and psychostimulant use. Significant, independent predictors of heroin use included being female (OR 4.12; CI 1.87–9.09; p < 0.001), using a higher number of substances (OR 1.63; CI 1.18–2.25; p < 0.01) and not using to relieve emotional distress (OR 0.42; CI 0.20–0.90; p < 0.05). The only significant predictor of amphetamine use was the number of substances used (OR 5.76; CI 3.55–9.34; P < 0.001).

Conclusions: Patterns of substance use and treatment needs may differ between males and female adolescents. Treatment services for young people should consider treatment approaches that address gender-specific needs.

OP108 THE NEUROBIOLOGY OF DRUG RELAPSE: A ROLE FOR HYPOTHALAMIC ‘FEEDING’ PEPTIDES IN DRUG RELAPSE?

Christopher Dayas

University Of Newcastle

Significant advances have been made in our understanding of the brain pathways that control drug relapse. For example, altered signalling from glutamatergic projections originating from the prefrontal cortex onto nucleus accumbens neurons have been well characterized. There has also been renewed interest in the role of hypothalamic feeding-related peptides in drug addiction that spawned from recent demonstrations that antagonism of the hypothalamic orexin (hypocretin) system suppresses drug-seeking behaviour in rats. Presently however, we know very little about the involvement of other hypothalamic-feeding peptides in drug-motivated behaviours, the brain pathways via which these effects are mediated, and importantly, how these systems interact to promote drug-seeking. For example, the role of hypothalamic cocaine and amphetamine-related transcript (CART) in conditioned reinstatement of drug-seeking has not been determined, despite evidence that CART modifies the acute reinforcing effects of psychostimulant drugs. Interestingly, nucleus accumbens-projecting paraventricular thalamus neurons are apposed by CART and orexin terminals and may be a possible site of interaction between these peptide systems. In the present study therefore, we examined the recruitment patterns of dorsomedial hypothalamic (DMH), perifornical/lateral hypothalamic (PF/LHA) and arcuate nucleus CART neurons and the PVT in a conditioned reinstatement model of ethanol relapse. c-fos expression was used to gauge neural activation combined with dual-labelling for CART or orexin in male rats exposed to an ethanol predictive (S⁺) cue or a cue associated with non-reward (S⁻). Within the PVT, confocal microscopy was used to determine the potential association of activated PVT neurons with CART and orexin terminals. Results: The S⁺ only increased numbers of Fos-positive CART neurons within the arcuate nucleus. Within the PVT the numbers of Fos-positive neurons were increased by the EtOH/S⁺ and activated PVT neurons were observed to be closely associated with orexin and CART terminals. Together, these data suggest that CART and orexin might interact at the level of the PVT to promote ethanol-seeking behaviour.

OP109 PREVALENCE OF PROBLEM GAMBLING IN PEOPLE PRESENTING TO AN ACUTE AREA MENTAL HEALTH SERVICE

Anthony R. de Castella, J. Chow-Fairhall, D. Watkins, Jayashri Kulkarni

Monash Alfred Psychiatry Research Centre, Monash University & Alfred Hospital, VIC, Australia

Background: Problem Gambling (PG) affect an estimated 2% of the population, with those affected often suffering from co-morbid problems including mood disorders and substance abuse. Suicidal behaviour is a common and serious outcome for people with gambling problems. Understanding the prevalence of problem gambling and suicidality has important implications for clinicians’ knowledge.

Aims: To identify the prevalence of PG, the types of co-existing mental disorders and the prevalence of suicidality, in a sample of people presenting to an Area Mental health Service.

Method: Consecutive presentations of people (N = 848) who were seen either in the community by The Alfred's Crisis Assessment & Treatment Team or who were admitted to the Emergency Department of The Alfred and seen by The Alfred's Psychiatry Triage over a six-month period were screened for suicidal ideas/intent, and problem gambling.

Results: People with Gambling Problems = 71 (8.4%), (Males = 52, Females = 19). This is four times the reported prevalence rate in the general community. Only half of those identified with PG had sought help for PG = 37 (52%), (Males = 25, Females = 12). 39.4% of people identified with PG had suicidal ideas or behaviour (N = 71), which was similar to those presenting without problem gambling (41.4%)

Conclusions: Results of the project highlight that PG is present for a significant number of people who access Area Mental Health Services. Without concerted screening, many people with underlying problem gambling would not be detected and would thus go untreated.

OP110 CEREBROVASCULAR RISK FACTORS AND LIFE EVENTS AS ANTECEDENTS OF DEPRESSIVE SYMPTOMS IN MIDDLE AND EARLY-OLD AGE: THE PATH THROUGH LIFE STUDY

Karrin J. Anstey ¹, Richard Burns¹, Peter Butterworth¹, Tim D. Windsor¹, Helen Christensen¹, Perminder S. Sachdev²

¹ Centre for Mental Health Research, Australian National University, Australia

² School of Psychiatry, University of New South Wales, & Neuropsychiatric Institute, The Prince of Wales Hospital, Australia

The stress-vulnerability hypothesis suggests that cerebrovascular risk factors interact with life-events to increase the risk of depression in late life. We evaluated cerebrovascular risk factors and life-events as predictors of depressive symptoms in a mid-life and early late-life cohort to determine whether they had independent or interacting effects, and whether there were age differences in the effects. A cohort study of two cohorts aged 40–44 (n = 2530) and 60–64 (n = 2551) at Wave 1. Participants were followed-up after four years as part of the PATH Through Life Study based in Canberra and Queanbeyan Australia. Participants (N = 5081) were selected from the electoral rolls of Canberra and Queanbeyan (Australia). Hierarchical regression analyses evaluated demographic, cerebrovascular risk factors (diabetes, smoking, alcohol, BMI, cholesterol medication, hypertension) and life-events at Wave 1 and Wave 2 as predictors of depressive symptoms and depressive status in participants scoring < 5 on the Goldberg depression scale at baseline. At Wave 1, those with high levels of depressive symptoms were more likely to report smoking, using cholesterol-lowering medications, hypertension, diabetes, past stroke and higher BMI. Predictors of depressive symptoms at follow-up in the 40s cohort included diabetes, life-events and smoking. In the 60s cohort, diabetes, stroke, no alcohol consumption and life-events predicted depressive symptoms. Interactions between cohort and predictors showed that life-events were more salient in the 40s and cerebrovascular risk factors in the 60s. There was minimal evidence of interactions between cerebrovascular risk factors and life-events. Life-events and cerebrovascular risk factors are relatively independent sets of risk factors for depressive symptoms in the 40s and 60s with differential salience at different stages of the life course.

OP111 MANAGEMENT STRATEGIES FOR DEPRESSION AFTER STROKE

Maree L. Hackett ¹, Allan O. House², Craig S. Anderson¹

¹ The George Institute for International Health, NSW, Australia

² Leeds Institute of Health Sciences, Leeds University, UK

Background: Our Cochrane reviews from 2004 demonstrated the lack of evidence for the management of depression after stroke.

Method: We updated our reviews of randomised controlled trials comparing pharmaceutical agents (with placebo), or psychotherapy (with standard care/attention-control) to treat or prevent depression after stroke. The primary endpoint was the proportion of patients who met diagnostic criteria for depression applied in the trials at the end of treatment. Secondary outcomes included depression scores on standard scales, physical function, and adverse effects.

Results: Data were available for 25 pharmaceutical interventions and 8 psychotherapy trials involving 3170 participants. There was no clear effect of pharmacological therapy on the prevention of depression. A significant improvement in mood and the prevention of depression was evident for psychotherapy (OR 0.64; 95% CI 0.42–0.98). In the treatment trials there was evidence of benefit of pharmacotherapy: complete remission (OR 0.47, 95% CI 0.22–0.98) and improvement in scores on depression rating scales with evidence of an associated increase in adverse events. There was no evidence of benefit of psychotherapy in treating depression after stroke.

Conclusion: There is stronger evidence for psychotherapy (but not pharmacotherapy) for preventing depression after stroke. Pharmacotherapy (but not psychotherapy) should only be used with caution for treating depression after stroke in light of the increase in adverse events.

OP112 BRAVEHEART: GROUP COGNITIVE BEHAVIOUR THERAPY FOR CARDIAC DEPRESSION

Alyna Turner ^1,2, John Hambridge¹, Amanda Baker², Frances Kay-Lambkin², Jenny Bowman³, Stephanie Oak¹

¹ Liaison Psychiatry, John Hunter Hospital, Hunter New England Health Service, NSW, Australia

² Centre for Brain & Mental Health Research, the University of Newcastle, NSW, Australia

³ School of Psychology, the University of Newcastle, NSW, Australia

Background: Among people with existing heart disease, there is a need for routine screening to identify those with symptoms of depression and offer efficacious interventions when required. In a general medical hospital with limited mental health resources, a clinical need arose for an effective treatment for depression in cardiac rehabilitation patients.

Aims: The aim of the study was to develop and evaluate a specialized group 6-week group cognitive behaviour therapy (CBT) intervention (BraveHeart) for treatment of depression in people with cardiac disease.

Methods: Severity of depression and anxiety symptoms was measured by Beck Depression Inventory-II and Hospital Anxiety and Depression Scales scores. BraveHeart was piloted in 39 cardiac rehabilitation patients over 6 groups. A randomised controlled trial (RCT) was then conducted to compare BraveHeart to a brief intervention (BI) in 57 cardiac rehabilitation and community-dwelling cardiac patients. Inclusion criteria for both studies was a BDI-II score of >13.

Results: A significant reduction in levels of depression and anxiety symptoms occurred in 30 patients who completed the BraveHeart pilot program. For the RCT, 2-month follow-up data is available for 19 BraveHeart and 24 BI participants. A significant reduction in depression and anxiety symptoms again occurred, with no difference between BraveHeart and BI conditions.

Conclusion: Depression leads to worse outcomes among cardiac patients, and development of efficacious psychological treatments is indicated. While a group treatment results in a significant improvement in depression and anxiety symptoms, a BI has a similar impact and may play an important role in a treatment approaches.

OP113 SCREENING FOR DEPRESSION IN TYPE 2 DIABETES

Justin Kenardy ^1,2, M. McHale², J. Hendrikz¹, F. Dann²

¹ CONROD, School of Medicine, University of Queensland

² School of Psychology, University of Queensland

Objectives: The first aim of this study was to compare the effectiveness of four commonly used depression screening measures for medically ill populations in identifying depression within a diabetes sample. The second aim was to examine whether the inclusion of a measure for physical symptoms specific to diabetes is also necessary for a diagnosis of depression or alternatively whether any overlap would obscure the effect on the screening measure for depression.

Methods: 150 patients with Type 2 diabetes in two large public hospital outpatient clinics completed a questionnaire which included the Centre for Epidemiological Studies-Depression Scale, the Silverstone Concise Assessment for Depression, the Hospital Anxiety and Depression Scale, and the Depression in the Medically Ill questionnaire. Patient scores on these questionnaires were then assessed against their responses on the Composite International Diagnostic Interview Short Form and the Diabetes Symptom Checklist to determine their effectiveness as screens.

Results and Conclusions: Logistic regression and ROC analysis, including AUC, suggested selecting the CES-D, rather than the DMI-10, HADS or SCAD for screening for depression in a patient with type 2 diabetes. The CES-D performed well at predicting depression, had high sensitivity and specificity, and did not require the addition of diabetes symptoms to aid in diagnosis.

OP114 COPING STYLES, SEROTONIN TRANSPORTER GENOTYPE AND NEUROTICISM IN PATIENTS WITH DIABETES

Jaya Reddy¹, Liesbeth Geerligs ¹, Kay Wilhelm¹, Karen Baikie¹

¹ School of Psychiatry, University of NSW

Introduction: Diabetes Mellitus is a condition in which illness management skills are crucial. Understanding diabetic patients’ coping styles may enhance treatment programs. Both neuroticism and serotonin transporter genotype have been shown to influence coping in healthy populations and their effect on coping in the diabetic population requires consideration.

Aim: To determine the coping styles used by diabetic patients and the impact of neuroticism and serotonin transporter genotype on coping style.

Method: The 60-item COPE inventory and NEO-FFI were administered to 178 diabetic patients. Serotonin transporter genotype (s/s, s/l and l/l) was determined by cheek-swab analysis.

Results: Principal components analysis of the COPE revealed 4 main factors: (i) adaptive coping, (ii) maladaptive coping, (iii) humour-based coping and (iv) religion-based coping. The effect of genotype and neuroticism on each factor was assessed via a series of one-way ANOVAs. Genotype was not significantly related to any of the four coping styles. Neuroticism showed a main effect, with those high in neuroticism having significantly higher maladaptive coping scores (p<0.001) and significantly lower adaptive coping scores (p=0.007).

Conclusion: Diabetic patients within this sample used adaptive, maladaptive, humour-based and religion-based coping. Neuroticism was associated with higher maladaptive and lower adaptive coping. To improve illness management in Diabetic patients, clinicians should focus on enhancing adaptive coping skills in all patients, but particularly those high in neuroticism.

OP115 LIVING IN A RURAL COMMUNITY: DETERMINANTS AND OUTCOMES OF MENTAL HEALTH: AUSTRALIAN RURAL MENTAL HEALTH STUDY

Brian Kelly ¹, Helen J. Stain¹, Clare Coleman¹, David Lyle², David Perkins², Lyn Fragar³, Jeffrey Fuller⁴, Terry Lewin⁵, Vaughan Carr⁵, John Beard⁶

¹ Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW Australia

² Broken Hill University Department of Rural Health, University of Sydney, NSW Australia

³ Aust Centre for Agricultural Health and Safety University of Sydney, Moree, NSW Australia

⁴ University of Sydney Lismore, NSW, Australia

⁵ Centre for Brain and Mental Health Research, University of Newcastle, NSW Australia

⁶ New York Academy of Medicine, NY, USA

Background: Studies across diverse rural, regional and coastal communities provide an opportunity to investigate multilevel influences on mental health.

Aims: To investigate the determinants of mental health indices across diverse rural and remote regions of NSW, establishing a platform for longitudinal research to examine the individual, household and community factors influencing mental health outcomes.

Method: A community sample of randomly selected households (currently >1500 participants) has been recruited across rural and remote regions of NSW. Individual and household level measures of mental and physical health, health service utilization and community level factors are assessed (using a two stage screening with K10 and CIDI-3.0) with capacity for genetic studies. An overview of the study will be provided, introducing a set of papers from the initial analyses of novel community factors and mental health, factors associated with primary symptom groups (eg substance use, suicidal ideation) and psychological adaptation.

OP116 RURAL SOCIO-ENVIRONMENTAL FACTORS AND MENTAL HEALTH

Clare Coleman ¹, Brian Kelly¹, Helen J. Stain¹, Terry Lewin², David Lyle³, David Perkins³, Margaret Lesjak³, John Beard⁴

¹ Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW Australia

² Centre for Brain and Mental Health Research, University of Newcastle, NSW Australia

³ University of Sydney, Broken Hill, NSW Australia

⁴ New York Academy of Medicine, NY, USA

Aim: To investigate the role of community factors on the mental health of rural and remote residents.

Methods: Over 1000 adult residents of rural and remote regions of NSW were randomly selected for a postal and telephone-based survey. A set of measures of community characteristics was used (Social Connectedness, Social Support, Satisfaction with Community), including novel measures of community adversity. Psychological distress was measured using K-10 and PHQ-9.

Results: Psychological distress was significantly associated with lower social connectedness, lower satisfaction with one's community, and level of drought impact across a number of key domains (financial, family and community effects) (p<.001). Residents in remote regions reported lower levels of social connectedness (p<.05), greater levels of community adversity (p<.001) and greater psychological distress (p<.02).

Conclusion: A set of community level factors exhibited significant but diverse associations with psychological distress, and provide a basis for more detailed investigation of socio-environmental influences on mental heath.

OP117 ADOLESCENTS’ RESPONSES TO LIVING IN DROUGHT AFFECTED RURAL COMMUNITIES

John Dean ¹, Helen J. Stain²

¹ Greater Southern Area Health Service, Wagga Wagga, NSW, Australia

² Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW, Australia

Background: The focus of research on the impact of environmental adversity, such as drought on farming communities, has strong potential to elaborate on the multidimensional nature of social capital and further inform the role of ‘community’ in risk for mental health problems in rural areas¹. This study extends earlier research by the authors that explored the emotional impact of drought on children and adolescents in rural NSW². Study II included experiences of parents and a more comprehensive assessment of emotional functioning in adolescence.

Aim: To identify the social and emotional impact on adolescents of living in a drought affected rural community.

Method: Students (N = 111), aged 11–17 years, were recruited from Central Schools in the Greater Southern rural region of NSW. Students participated in focus groups and completed self report measures such as the Strengths and Difficulties Questionnaire (SDQ) and a Drought Survey utilised in the earlier study.

Results: The SDQ responses showed increased emotional problems for adolescents compared to Study I and Australian normative data. The positive association between perceived impact of the drought and emotional problems was strongest for the younger adolescent group while the older adolescents reported greater distress as a result of loss of friends from the area compared to the younger adolescents. Qualitative data from the focus groups supported findings from the Drought Survey.

Conclusion: The findings indicate that living in a rural community experiencing a prolonged drought is a chronic stressor for adolescents and this leads to emotional responses akin to grief and loss experiences.

1. Stain, H.J., Kelly, B., Lewin, T., Higginbotham, N., Beard, J. & Hourihan, F. (2008). Social networks and mental health among a farming population. Social Psychiatry and Psychiatric Epidemiology, online 23 May 2008.

2. Dean, J. & Stain, H.J. (2007). The impact of drought on the emotional well-being of children and adolescents in rural and remote New South Wales. The Journal of Rural Health, 23, 356–364.

OP118 DEPRESSION LITERACY AND REMOTENESS OF RESIDENCE

Kathleen M. Griffiths ¹, Helen Christensen¹, Anthony F. Jorm²

¹ Centre for Mental Health Research, The Australian National University

² Orygen Research Centre, University of Melbourne

Background: Although there have been many population studies of mental health literacy, little is known about the mental health literacy of rural residents.

Aims: This study aimed to determine the impact of remoteness on public knowledge of depression

Method: The depression literacy of residents of major cities and rural regions were compared using data from a 2003–04 Australian national survey of the mental health literacy of 3998 adults. Respondents rated the helpfulness of a range of people and interventions, and the causes and prognosis for vignettes describing depression and depression with suicidal ideation. Participant awareness of Australia's national depression initiative and depression stories in the media was also measured.

Results: Depression literacy was similar across remoteness categories. However, inner regional residents showed superior identification of the suicidal ideation vignette and were more likely to report having heard of Australia's national depression health promotion campaign. Conversely, inner regional residents were less likely to rate psychotherapy as helpful for depression. Both inner regional and outer regional and remote residents were more likely to rate psychologists as helpful for depression alone and to endorse drinking and painkillers for this condition.

Conclusion: Mental health awareness campaigns in rural and remote regions should focus on communicating that psychotherapy but not alcohol and pain killers are effective for depression.

OP119 FARM FAMILY MENTAL HEALTH: WHO ARE THE LOCAL HELPING AGENCIES?

Jeffrey Fuller ¹, Brian Kelly², Susan Law², Georgia Pollard², Lyn Fragar³

¹ Department of Rural Health, University Sydney, Lismore, NSW, Australia

² Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW Australia

³ Centre for Agricultural Health, University of Sydney, Moree, NSW, Australia

Aim: To describe how rural service networks are structured related to the mental health needs of farming families prior to a service improvement strategy.

Method: A network survey of mental health related links between agricultural support, health and other human services in 5 drought declared rural towns in NSW. Mental health links covered information exchange, referral recommendations and program development.

Results: 112 agencies from 149 that were identified (75%) completed a survey. 70% indicated that two thirds of their clients were in need of assistance for mental health related problems. The highest interagency mean links were about information exchange. The agricultural support sector rated these links with the health sector as less effective than the health sector rated them (p<.05). The highest linked agency across all towns across all mental health exchanges came from agricultural support (rural financial counselor), with community health centres, GPs and community mental health teams relatively well linked.

Conclusion: Networks that service the mental health needs of farming families should include agencies in close human service contact with them. This requires work to ensure that local service links are operational and effective and network descriptions provide a baseline for this work.

OP120 HIPPOCAMPAL VOLUMETRICS IN TREATMENT-RESISTANT SCHIZOPHRENIA AND DEPRESSION: THE IMPORTANCE OF THE TAIL

Jerome J. Maller, Jeff Z. Daskalakis, Faranack Farzan, Paul B. Fitzgerald

Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Commercial Rd Melbourne, Victoria, Australia, 3004,

Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada

Background: Studies of patients with major depression disorder (MDD) or schizophrenia (SCH) have usually revealed reduced hippocampal volumes, but findings have been inconsistent due to sample and measurement differences.

Aims: To measure this structure in a large sample of MDD, SCH and control subjects, using a strict measurement protocol, in order to elucidate morphological-specific volumetric differences.

Methods: Forty-five subjects with treatment-resistant MDD, 43 subjects with treatment-resistant SCH, and 26 controls underwent psychiatric assessments and brain MR imaging. Results: 1) MDD results in reduced hippocampal volume, particularly in the tail section, 2) SCH results in reduced hippocampal tail volume but the rest of the structure is significantly enlarged compared to controls, 3) specific ROI atrophy in treatment-resistant depression is influenced by sex.

Conclusions: Hippocampal volumes are differentially affected in treatment-resistant MDD and SCH, and Region of Interest estimation protocols and sample characteristics may help explain volumetric differences between previous MDD and SCH studies.

OP121 CANNABIS USE AND COGNITIVE FUNCTIONING IN SCHIZOPHRENIA

Antony F. Henderson ^1,2, Carissa M. Coulston^1,2, Jim Lagopoulos^1,2, Racheal J. Degabriele^1,2 and Gin S. Malhi^1,2

¹ CADE Clinic, Department of Academic Psychiatry, Royal North Shore Hospital, Sydney NSW, Australia

² Discipline of Psychological Medicine, Faculty of Medicine, University of Sydney, NSW Australia

Background: Research examining neuropsychological functioning in cannabis users with schizophrenia has steadily increased over the past decade, however, methodological limitations in studies to date have yielded mixed results. Of the most comprehensive research conducted (eg, Coulston et al., 2007a; 2007b), cannabis use appears to be associated with altered cognition in schizophrenia. The relationship of this to age and extent of use remains unclear.

Aims: This present study examines the relationship between neuropsychological performance and indices of cannabis use such as frequency and recency of use in persons with schizophrenia.

Method: The study will recruit 40 males with schizophrenia (SCZ) who have a history of cannabis use (FH +), 20 males with SCZ who do not have a history of cannabis use (FH-) and 10 healthy males. The groups are matched for age, years of education and premorbid IQ. Medical history, substance use and psychiatric symptoms are assessed. A neuropsychological battery is administered to assess memory, attention/processing speed and executive functions. Urine drug screening is performed to confirm reported substance use. This study has ethics committee approval and forms part of investigator AH's Institute of Psychiatry Fellowship.

Results: We hypothesise that subjects with schizophrenia who have a significant history of cannabis use will demonstrate altered cognitive functioning compared to non-users. We further propose that these neuropsychological changes are related to age and extent of use. Thus far, 16 subjects have been assessed from the SCH+ group and 8 from the SCH-group, but formal analyses have not been conducted because of relatively small numbers.

Conclusion: This study will progress our understanding of the neuropsychological sequelae of cannabis use in the schizophrenia population. Results will be presented at the conference.

1. Coulston, C.M., Perdices, M., Tennant, C.C., 2007a. The neuropsychology of cannabis and other substance use in schizophrenia: Review of the literature and critical evaluation of methodological issues. Australian and New Zealand Journal of Psychiatry, 41: 869–884.

2. Coulston, C.M., Perdices, M., Tennant, C.C., 2007b. The neuropsychological correlates of cannabis use in schizophrenia: Lifetime abuse/dependence, frequency of use, and recency of use. Schizophrenia Research, 96: 169–184.

OP122 A COMPARISON OF PHENOMENOLOGICAL QUALITIES OF INNER SPEECH AND VOICES IN PATIENTS WITH SCHIZOPHRENIA

Robyn Langdon ^1,3,4, Simon R. Jones², Emily Connaughton^1,4, Charles Fernyhough²

¹ Macquarie Centre for Cognitive Science, Macquarie University, Sydney, Australia

² Department of Psychology, Durham University, United Kingdom

³ Schizophrenia Research Institute, Australia

⁴ Schizophrenia Research Unit, Sydney South West Area Health, Sydney, Australia

Background: One popular cognitive account of auditory verbal hallucinations AVHs is that these arise when the origin of self-generated inner speech is misattributed to an external agent. Several predictions follow from this view (eg, less inner speech should be reported in voice-hearers than non-voice-hearing controls).

Aims: This study conducted a phenomenological survey to probe the everyday experience of inner speech in people with schizophrenia who hear voices and the non-voice-hearing general population. We also compared the phenomenological qualities of inner speech and voices in patients who experience AVHs.

Method: 29 patients who experience AVHs and 42 non-voice-hearing healthy controls responded to a semi-structured interview. The first half of the interview probed qualities of voices, if present (eg, number of voices, frequency, perceived gender, identity of voices, and terms of address). The second half of the interview probed analogous characteristics of inner speech.

Results: The inner speech of the two groups was almost identical in all respects. Moreover, the phenomenological qualities of AVHs in the patients did not relate to corresponding qualities of inner speech (eg, 3^rd-person pronouns are used as a term of address by ‘voices conversing’ but do not feature in inner speech).

Conclusions: No discernable differences were found between the inner speech reported by patients, who experience AVHs, and healthy controls. Implications for inner speech theories of AVHs are discussed.

OP123 DEFICIT AND NORMAL COGNITIVE PROFILES IN NEUROLEPTIC NAïVE FIRST-EPISODE PSYCHOSIS: NEURODEVELOPMENTAL IMPLICATIONS

Warrick J. Brewer ¹, Murat Yucel^1,2, Sue, M. Cotton¹, Christos Pantelis², Patrick, D. McGorry¹

¹ ORYGEN Research Centre, Dept of Psychiatry, University of Melbourne, Locked Bag 10, Parkville, Victoria, 3052 Australia

² Melbourne Neuropsychiatry Centre, Dept of Psychiatry, University of Melbourne, Parkville, Victoria, 3052 Australia

Background: Relationships between cognition, patterns of substance use and psychiatric symptoms have not been adequately explored from a neurodevelopmental perspective. Premorbid cognitive deficits are possible risk factors for adolescent decompensation.

Aims: To (i) determine whether cognitive performance blindly discriminates patients and controls (CTLs); (ii) investigate the nature of cognitive subgroups in neuroleptic-naïve first-episode psychosis (FEP); and (iii) explore relationships between cognition, substance use and psychopathology.

Method: Two-step Cluster analysis of a range of neuropsychological abilities in 74 FEP and 34 controls (CTL) revealed a ‘low’- and ‘normal-functioning’ FEP group (FE-Poor/FE-Norm) and a CTL cluster. Psychopathology and substance use across these groups were also compared.

Results: FE-Poor cluster had reduced premorbid/current IQ relative to CTLs. Trail Making Test B and WAIS-R Block Design (first function) were the best predictors for discriminating between groups. The best discriminant predictor between FE-Poor and the other two groups (second function) was WAIS-R Digit Symbol. Overall case classification into all groups using the two discriminant functions was 81.2%. Accuracy of prediction into FE-Poor/FE-Norm was 93.1% and 70.0% respectively; accuracy of prediction for CTLs was 84.4%. Both FEP clusters had significantly higher substance use relative to CTLs. FE-Poor had used alcohol for longer than FE-Norm. No clinical differences existed between the FE clusters except that FEP-Norm suffered higher degree of disorganisation symptoms.

Conclusion: Data-driven techniques have utility in identifying cognitive subgroups in the early stages of psychosis onset. Long term follow-up is required to determine the prognostic value of early identification of cognitive deficits.

OP124 EFFECTIVENESS OF COGNITIVE REMEDIATION THERAPY FOR SCHIZOPHRENIA IN MALAYSIA

Muhammad Najib Alwi ¹, Anthony W Harris¹, Philip Boyce¹, Mohd Razali Salleh²

¹ Discipline of Psychiatry, University of Sydney, NSW, Australia

² Department of Psychiatry, School of Medical Sciences, University Sains Malaysia, Malaysia

Background: Cognitive deficits are an important determinant of functional impairment in schizophrenia. Computer assisted cognitive remediation (CACRT) is an evidence based treatment for this problem; however it's use has been restricted to western settings. We report the initial findings of a randomized control trial of the effectiveness of CACRT in Malaysia which is expected to be completed in September 2008.

Aims: This study investigates whether 20 session of CACRT is more effective than a wait list (WL) in reducing cognitive deficits, improving psychosocial functioning and reducing psychopathology. It also investigates whether or not there is any benefit of adding four booster sessions (CRT-B) following completion of CACRT.

Method: Schizophrenia patients with cognitive deficits from five centres around Malaysia were recruited and randomly allocated into either CACRT (n = 25), CRT-B (n = 25) or WL (n = 25). They were assessed at baseline, post-treatment and at 7 weeks follow up using multiple measures of cognitive functioning, psychosocial functioning and psychopathology.

Results: Preliminary results have shown positive trends to the advantage of CACRT in some outcome measures when compared to WL but no significant benefit for CRT-B.

Conclusion: CRT is a promising treatment option for schizophrenia patients with cognitive deficits in Malaysia. Adding booster sessions does not appear to confer additional advantage.

OP125

HENRY JACKSON-FRIDAY OPENING

OP126

ELI LILLY ORATION

OP127 MicroRNAs REGULATE MOLECULAR AND BEHAVIORAL DEFICITS ASSOCIATED WITH DRUG DEPENDENCE AND SCHIZOPHRENIA

Paul J. Kenny

Laboratory for Behavioral and Molecular Neuroscience, Department of Molecular Therapeutics, The Scripps Research Institute, Jupiter, Florida, USA

For over half a century, the central dogma of molecular biology has stated that genetic information encoded in DNA is transcribed to form intermediary molecules of messenger RNA (mRNA), which in turn are translated into discrete proteins. This assumes that proteins are directly related to genes (“one gene → one protein”). Over recent years an appreciation of a more complex role of RNA has emerged independent of the dogmatic “mRNA → protein” paradigm. Notably, transcriptomics efforts have revealed that a large proportion of mammalian RNA transcripts do not encode for proteins, and are therefore referred to as noncoding RNAs (ncRNAs). Intriguingly, organismic complexity is better correlated with the amount of ncRNA than mRNA, supporting an important functional role for ncRNAs.

microRNAs, first discovered in 1993 by Victor Ambros and colleagues, are emerging as a class of intensely studied ncRNAs because of their ability to regulate gene expression levels. microRNAs are small (∼21–23 nucleotides) single-stranded ncRNA transcripts that control gene expression at the post-transcriptional level by binding to complementary sequences in the 3′ untranslated region (3′ UTR) of target mRNA transcripts to facilitate their degradation and/or inhibit their translation. Because microRNAs can promiscuously bind to the 3′UTRs of many mRNA transcripts they have the potential to simultaneously regulate expression levels of many genes and thereby exert pleiotropic effects. Emerging evidence suggests that microRNAs may play a key role in neuroplasticity and behaviour. Moreover, because of their ability to regulate molecular pathways critical for brain development and function, it has been speculated that microRNAs may play important roles in complex disorders such as drug addiction and psychiatric pathologies including schizophrenia. In this presentation I will discuss recent data from our laboratory revealing novel roles for microRNAs in the behavioural and molecular dysfunction associated with schizophrenia and drug dependence.

N-methyl-D-aspartate (NMDA) glutamate receptors are regulators of fast neurotransmission and synaptic plasticity in the brain. Disruption of NMDA-mediated glutamate signalling has been linked with behavioural deficits displayed in psychiatric disorders such as schizophrenia. I will present data showing that pharmacological (dizocilpine; MK-801) or genetic (NR1 hypomorphism) disruption of NMDA receptor signalling down-regulates the expression of a brain-specific microRNA in the prefrontal cortex (PFC) of mice. Consistent with a role for this microRNA in NMDA receptor signalling, we characterize the gamma subunit of calcium/calmodulin-dependent protein kinase (CaMKII), a component of the NMDA receptor signalling cascade, as a protein target regulated by this microRNA. I will show that the antipsychotic drugs haloperidol and clozapine prevent the effects of dizocilpine on the expression of this microRNA.

Finally, in vivo silencing of this microRNA by intracranial infusion of an “LNA-antagomiR” is shown to significantly attenuate the schizophrenia-like behavioural abnormalities associated with disrupted NMDA receptor transmission. Next, I will present data showing that the development of compulsive-like cocaine consumption in rats with extended daily access to the drug is associated with increased expression of microRNAs in the dorsal striatum. In particular, we observed increased expression of a microRNA known to be responsive to cyclic AMP response element binding protein (CREB) and brain-derived neurotrophic factor (BDNF) levels, two important regulators of drug-taking behaviours. Lentiviral-mediated overexpression of this microRNA in the striatum is shown to dramatically decrease the motivation to compulsively consume cocaine in rats. Intriguingly, the expression of this cocaineresponsive microRNA was decreased in striatum from human cocaine addicts compared with controls. These data reveal a novel microRNA regulator of CREB signalling that has a protective role against the development of compulsive cocaine-taking, a mechanism that may be compromised in the brains of human cocaine addicts.

Taken together, the above data support a central role for microRNAs in the behavioural and molecular deficits associated with schizophrenia and drug dependence. Further investigation may reveal mechanisms through which expression levels of discrete microRNAs may be controlled, thereby providing novel therapeutic approaches for the treatment of complex psychiatric illnesses.

The work described was supported by the National Institute on Drug Abuse (NIDA),

National Institute of Mental Health (NIMH), and The James and Esther King Biomedical Research Program from the Florida Department of Health.

OP128  BEYOND THE DORSAL HORN: THE USE OF ANIMAL MODELS TO DISCOVER NEW SITES FOR PAIN THERAPY

Robert J Callister, Alan M. Brichta, Brett A. Graham

School of Biomedical Sciences & Centre for Brain and Mental Health, The University of Newcastle, Callaghan, 2308 NSW

The phenomenon of “central sensitisation” underlies much of our thinking about the cellular mechanisms that drive chronic pain states. This phenomenon was originally discovered in neurons located in the rat spinal cord. Since the original discovery in the 1980s a large literature has developed on the mechanisms underlying central sensitisation, specifically in dorsal horn neurons. This focus has persisted for three reasons: 1) the dorsal horn represents the first region in the nervous system where potentially painful signals from the periphery undergo significant processing; 2) the dorsal horn permits detailed behavioural, biophysical and pharmacological analysis of pain mechanisms in both in vitro and in vivo preparations; and 3) sensitisation mechanisms are more easily examined in the dorsal horn compared to other sites in the ascending pain pathway. This talk will summarise recent findings that have increased our understanding of pain processing mechanisms in brainstem and cortical sites known to be important in pain behaviour. Data will be presented to show that central sensitisation can develop at multiple sites along the classic ascending pain pathway. These sites, outside the dorsal horn, provide potential targets for future treatment of chronic pain and its consequences.

OP129 THE ROLES OF CENTRAL HYPEREXCITABILITY AND PSYCHOLOGICAL DISTRESS IN WHIPLASH PAIN

Michele Sterling ^1,2, E. Hodkinson², C. Pettiford², M. Curatolo³

¹ Centre for National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland

² CCRE Spinal Injury, Pain and Health, The University of Queensland

³ University of Bern, Switzerland

Background: Sensory hypersensitivity, central hyperexcitability (lowered nociceptive flexion reflex (NFR) thresholds) and psychological distress are features of chronic whiplash. However relationships between these substrates are not clear.

Aims: This study investigated relationships between psychological factors (distress and catastrophization), sensory pain threshold responses and spinal cord excitability as assessed by the NFR responses. The former assessments are global pain responses to sensory stimuli as reported by the patient, whereas the latter, an objective measurement of spinal cord excitability.

Method: 30 individuals (23 female) with chronic whiplash and 30 asymptomatic controls participated. Pressure and thermal pain thresholds were measured at the cervical spine, upper and lower limb sites. The NFR (intensity of electrical stimulation of the sural nerve required to elicit reflex EMG activity of biceps femoris) was also measured. Psychological distress (GHQ-28) and catastrophisation (PCS) were measured in the whiplash group.

Results: Whiplash injured participants demonstrated lowered pain thresholds to pressure and cold (p < 0.05); lowered NFR thresholds (p = 0.003) and elevated levels of psychological distress (GHQ-28) and catastrophisation. There were no group differences for heat pain thresholds or pain at NFR threshold. In the whiplash group, PCS scores correlated moderately with cold pain threshold (r = 0.51, p = 0.01). In contrast there were no significant correlations between GHQ-28 scores and pain threshold measures or between psychological factors and NFR responses in whiplash participants.

Conclusion: Psychological factors have some association with sensory hypersensitivity in chronic whiplash but do not seem to influence spinal cord excitability. This suggests that psychological disorders are not the only determinants of central hypersensitivity in whiplash.

OP130 ANATOMICAL CHANGES IN BRAIN REGIONS LINKED TO EMOTIONAL PROCESSING IN SUBGROUPS OF PATIENTS WITH SPINAL CORD INJURY

Luke Henderson

Department of Anatomy and Histology, University of Sydney, NSW 2006, Australia & Pain Management Research Institute, Royal North Shore Hospital, St Leonard, NSW 2065, Australia

Animal investigations have revealed that chronic neuropathic pain is associated with neural death in the dorsal horn and in higher brain centres. Furthermore, recent human imaging studies have reported grey matter loss in a number of brain regions including the prefrontal cortex and thalamus. It has been hypothesized that these anatomical changes may evoke changes in activity within the pain neuromatrix and consequently an on-going perception of pain. The aim of this investigation was to assess changes in regional brain anatomy in chronic neuropathic pain patients using diffusion tensor imaging (DTI). DTI can be used to detect subtle changes in the molecular motion of water and has been used to detect changes in brain anatomy in a number of neurological conditions. We investigated 44 pain-free controls and 23 subjects with complete thoracic spinal cord injury (SCI), 12 of whom have chronic below level-neuropathic pain. In each subject, 4 DTI image set were acquired. These images were processed using SPM5 and custom software and significant changes in the movement of water (mean diffusivity [MD]) determined using a whole brain voxel-by-voxel approach. Chronic pain was associated with significant changes in MD in the posterior parietal, dorsolateral prefrontal, orbitofrontal and insular cortices. In addition, significant pain related changes occurred in the nucleus accumbens and ventral pons/midbrain. Although these changes may evoke pain, as they lie largely outside the classic “pain neuromatrix” we speculate that they may also represent changes associated with psychological factors know to influence pain processing such as reward and catastrophizing.

OP131 CONNECTING MIND AND BODY: EMERGING PARADIGMS IN PAIN

Chris Hayes

Director Hunter Integrated Pain Service, Newcastle, Australia

Early pain theory was based on Cartesian dualism and saw mind and body as separate. The clinical deficiencies of that biomedical approach prompted the shift to a broader biopsychosocial paradigm. However the default assumption of the biopsychosocial model still saw pain as primarily biological. Psychological and social factors simply modulated the underlying biology. This conceptualised biology, psychology and social as separate, although interacting, compartments. This interpretation underestimated the potential contribution of psychological and social factors to the causation of pain. It also underestimated the potential value of psychosocial treatment strategies.

The appearance of anomalies challenges prevailing wisdom. Several centres around the world have reported abolition of persistent pain in selected cases using interventions based on mindbody connection. The emerging whole person model sees underlying unity and dissolves the separate compartments of the biopsychosocial model. Whole person management includes biological and cognitive-behavioural interventions but also encompasses mindbody education and psychotherapeutic approaches.

OP132 PROSPECTIVE COHORT STUDY OF PSYCHODYNAMIC INTERPERSONAL THERAPY FOR PATIENTS WITH PERSISTENT PAIN

Matthew T. Pols¹ , Stephanie Oak¹

¹ Liaison Psychiatry Department, John Hunter Hospital, Newcastle, NSW, Australia

Background: In patients with somatoform disorders there is a growing body of evidence that short-term psychodynamic psychotherapies are effective treatments. One form of therapy which has demonstrated efficacy in this population is Psychodynamic Interpersonal Therapy (PIT). However, evaluation of the use of PIT in the treatment of chronic pain patients is limited.

Aims: This pilot study proposes to examine the feasibility and acceptability of an 8 session intervention of PIT in the treatment of outpatients with persistent pain.

Method: An outpatient sample of 10 patients with persistent pain will be recruited from a multidisciplinary pain clinic. A self-report questionnaire will be administered pre and post intervention, with measures including pain severity and impact, psychological distress, somatisation, as well as questions rating the acceptability and feasibility of the intervention.

Results: It is estimated that data from 4 to 6 patients will be available to be presented in this initial pilot study. Preliminary results will be presented.

OP133 STANDARDISING OUTCOME MEASURES IN PERSISTENT PAIN

Carolyn Arnold¹, Stephen Gibson¹, Chris Hayes², Meredith Jordan ²

¹ Caulfield Pain Management and Research Centre, Victoria, Australia

² Hunter Integrated Pain Service, Hunter New England Area Health Service, NSW Australia

Background: The use of outcome measures in evaluation of services provided to people with persistent pain is well established. However, significant variability exists between services in the particular constructs measured and outcome measures used.

Aims: The aim of this project was to develop a basic set of standardised outcome measures that could be used across at least two persistent pain services in Australia.

Method: With consideration of international recommendations and research (Dworkin et al., 2005) as to measurement of core constructs relevant to persistent pain clinics, the Hunter Integrated Pain Service and Caulfield Pain Management and Research Unit devised a core battery of measures.

Results: The Brief Pain Inventory (Cleeland et al, 1994), Kessler 10 (Kessler and Mroczek, 1992), Coping Strategies Questionnaire (Rosentiel & Keefe, 1983), and Medication Quantification Rating Scale III (Harden et al., 2005) were selected to measure constructs of pain intensity and pain interference, psychological distress, cognitive coping factors, and medication use. Five questions pertaining to health care use in the last 3 months were included to assess current health care use.

Conclusion: Collection of data across the two services has commenced with a view to comparing and improving quality and effectiveness of services for people with persistent pain.

OP134 REMOTE EXPOSURE: DESIGN CONSIDERATIONS IN INTERNET DELIVERY OF PHOBIC STIMULI

Kenneth C. Kirkby ¹, Allison Matthews¹, Zee Wong¹, Hakuei Fujiyama¹, Phillipa Cannan¹

¹ Psychiatry, University of Tasmania, TAS, Australia

Background: Many websites describe or provide instructions for exposure but hitherto there have been no sites delivering systematic desensitisation.

Aims: The ‘Feardrop’ project delivers online systematic desensitisation to phobic stimuli, with home based access. This required technical solutions to monitor treatment adherence, reduce the risk of unconstrained anxiety, ensure that treatment is patient-led rather than imposed, provide feedback for self monitoring of progress, and collect data for use in tailoring-algorithms and for process and outcome analyses.

Method: The program database stores phobic stimuli (pictures) which are downloaded to the interface program on the clients browser. Polls of anxiety levels, using Subjective Units of Distress Scale (SUDS), are taken at specified intervals. Adherence (visual attention to the phobic stimulus) is measured using a tracking task superimposed on the image. Exposure is initiated by commencing tracking of a circle with the computer mouse and fades out if tracking is not maintained, hence the subject voluntarily permits exposure at all times. The habituation curve is fed back to the user graphically after each stimulus presentation, based on the SUDS polls. Detailed records of stimulus presentation, SUDS ratings, and tracking trail are recorded to a results database throughout each session. A range of experimenter defined variables and algorithms are used to specify the ordering and presentation parameters of the phobic stimuli.

Results: The Feardrop program was launched in July 2008 and is in use for online exposure therapy research. This approach allows for more fine grained and replicable research into within- and between-session habituation than has been achieved in therapist delivered exposure research, and also has implications for population-based interventions in an area of high unmet need.

OP135 RESULTS OF THREE RANDOMISED CONTROLLED TRIALS OF INTERNET BASED TREATMENT FOR SOCIAL PHOBIA: THE SHYNESS PROGRAM

Nickolai Titov, Gavin Andrews, Genevieve Schwencke, Isabella Choi

CRUfAD, School of Psychiatry, UNSW at St Vincent's Hospital, Sydney, Australia

Background: Only 1/5^th of people with social phobia seek treatment in a 12-month period. We report the results of three randomised controlled trials (RCTs) exploring the efficacy of clinician-guided Internet-based treatment program for social phobia (the Shyness Program).

Aims: Shyness 1 tested the clinical efficacy of the Shyness Program (treatment (n=50) vs. waitlist control (n=49). Shyness 2 replicated that methodology (total n=81) to determine the reliability of those results. Shyness 3 explored the importance of clinician-guidance using a three-bar RCT design; Shyness (n=32) vs. Shyness minus clinician (n=32) vs. waitlist control (n=33).

Method: Participants were recruited via the study website. Online automatic screening was followed by a telephone-based structured diagnostic interview. Each 9-week Shyness program comprised 6 online lessons, homework assignments, email contact with a clinician (except in the non-clinician condition of Shyness 3), and participation in an online discussion forum.

Results: Treatment consistently revealed large effect sizes for changes in symptoms of social phobia (d>1.0). In Shyness 3, the usual Shyness program significantly outperformed the non-clinician version.

Conclusion: The clinical efficacy of Internet-based treatment programs for common mental disorders has been consistently demonstrated in these and other programs. Future research must consider the cost effectiveness, acceptability, and clinical effectiveness of such interventions.

OP136 THE YOUTHMOOD PROJECT: PREVENTATIVE SUB-SAMPLE ANALYSES

Alison L. Neil¹ , Helen Christensen¹, Andrew Mackinnon², Kathleen M. Griffiths¹, Richard O'Kearney³

¹ Centre for Mental Health Research, The Australian National University

² Orygen Research Centre, University of Melbourne

³ School of Psychology, The Australian National University

Background: Although a range of universal prevention programs have been evaluated in school students, these programs rarely report ‘true’ prevention effects- that is the effects of the intervention on individuals with non-clinical levels of symptoms at baseline.

Aims: The aim of the current study is to assess the effectiveness of the MoodGYM program in reducing the symptoms of anxiety and depression in a sub-sample of participants who did not exhibit clinical levels of anxiety or depressive symptoms at pre-intervention.

Method: A cluster randomised controlled trial was conducted with 30 schools from across Australia (N = 1,477). All participants completed a pre-intervention, post-intervention and 6-month follow-up questionnaire. Individuals were selected for sub-analysis if they scored below 19 on the RCMAS (n = 1,239) or below 24 on the CES-D (n=1,203) at pre-intervention.

Results: At post-intervention and follow-up sub-sample participants in the intervention condition had significantly lower levels of anxiety than participants in the wait-list control condition (d=0.17–0.23). The effects of the MoodGYM program on depressive symptoms were not as strong, with only male participants in the intervention condition exhibiting significant reductions in depressive symptoms at post-intervention and follow-up (d=0.27–0.41)

Conclusion: Universal school-based programs can be effective with a preventative sub-sample and can be successfully implemented in schools via the Internet.

OP137 DELIVERING MENTAL HEALTHCARE VIA MOBILE PHONES: A CLINICAL TRIAL OF THE MOBILETYPE PROGRAM AND WEBSITE INTERFACE FOR DETECTION AND MANAGEMENT OF ADOLESCENT MENTAL HEALTH

Sophie Reid ¹, Sylvia Kauer¹, Lena Sanci², George Patton¹

¹ Centre For Adolescent Health & Murdoch Children's Research Institute

² Department of General Practice, University of Melbourne

Background: The Mobile Tracking Young People's Experiences Program (mobiletype program) is a mobile phone mental health assessment and management tool designed specifically for young people 14–24 years to assist in detecting, managing, and treating mental health problems. With an early intervention focus, the mobiletype program is a daily monitor of mental health symptoms with a website interface which collates and synthesizes the data and produces individual reports for young people to share with their doctor or clinician.

Aim: The aim of this study was to trial the utility and feasibility of the mobiletype program as a mental health assessment and management tool in the clinical setting.

Methods: 47 young people aged 14–24 years were recruited from an outpatient clinic. Between medical appointments (2–4 weeks) participants completed the mobiletype program which assessed daily mood, stress, coping strategies, eating, sleeping and exercise patterns and alcohol and cannabis use. At the end of the monitoring period, participants and their doctor reviewed individualized mental health reports produced by the mobiletype website interface.

Results and Conclusions: Compliance with monitoring was high in the first two weeks, with 91% of reports completed in week 1 and 72% in week 2. 95% of participants reported that the mobiletype reports accurately reflected their experiences and 68% felt the information was helpful or useful to them. Importantly, 78% of the participants reported that the mobiletype program had lead to their doctor understanding them better, and 92% of doctors reported the mobiletype program assisted them to understand their patients functioning.

OP138 PRELIMINARY EVALUATION OF A NEW ONLINE SELF HELP PROGRAM

Kylie Bennett ¹, Kathleen Griffiths¹, Helen Christensen¹, Anthony Bennett¹

¹ Centre for Mental Health Research, The Australian National University, Canberra, Australia

Background: The depression stream of the online program e-couch has been released for free public use.

Aims: To conduct a preliminary investigation of the effect of the depression information module of e-couch on the personal stigma level and mental health literacy of spontaneous community users.

Method: Community users who registered on e-couch between 1^st December 2007 and 28^th June 2008, and who completed the initial assessment module, depression information module and subsequent assessment module were included in the evaluation (n = 417). Pre-test and post-test scores were recorded for personal stigma (9-item Depression Stigma Scale; maximum possible score = 35) and for knowledge of medical, psychological and lifestyle treatments for depression (21 item scale; maximum possible score = 21).

Results: There was a significant reduction in the mean personal stigma scores of users (Mean difference = 0.64; t(416) = 2.85 p = 0.005) and a significant increase in the knowledge of evidence-based treatments for depression (Difference in means = − 1.79; t(407) = 10.01 p < 0.001).

Conclusion: Preliminary, uncontrolled completer data suggests that the e-couch depression information module is associated with positive effects on the mental health literacy level and stigma of users and provides evidence to support its continued dissemination. Future work will involve the evaluation of the subsequent self-help modules in the depression stream of the e-couch program.

OP139 EMOTIONAL SELF-AWARENESS: A QUALITATIVE EXPLORATION OF THE MECHANISM UNDERLYING A MOBILE PHONE SELF-MONITORING PROGRAM (MOBILETYPE)

Sylvia Kauer, Sophie Reid, Tony Jorm, Henry Jackson, George Patton

Centre for Adolescent Health, Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital

Background: Self-monitoring is a behavioural technique often used in therapy to increase awareness about moods and stressful experiences. Self-monitoring has potential as an early intervention tool for young people at-risk of depression, particularly when combined with young people's favourite accessory, the mobile phone. To date, little research explores the mechanism underlying self-monitoring.

Aims: This study qualitatively explored the emotional self-awareness model using a mobile-phone self-monitoring tool (the mobiletype program) with young people at-risk of developing depression and other mood disorders.

Methods: Thirty-seven young people, presenting at a clinical setting with a range of illnesses, self-monitored their mood and stressors using the mobiletype program for 2–4 weeks. A 10-minute interview was conducted with the participants to explore their experiences using the program, specifically targeting emotional self-awareness. Directed content analysis was used to analyse the qualitative data.

Results: The data supports the model of emotional self-awareness with 95% of participants reporting an increase in awareness of emotions after self-monitoring. These responses fell under the five proposed subcategories of: (i) awareness, (ii) identification, (iii) communication (iv) contextualisation and (v) decision-making. Further refinements to the model are provided with descriptive evidence and examples.

Conclusions: These findings supported and refined the theory that self-monitoring via mobile phones increases emotional self-awareness. Nevertheless, the relationship to depressive symptoms is yet to be explored. Further research is needed to determine whether increasing emotional self-awareness is related to a decrease in depressive symptoms. Plans for a randomised controlled trial involving quantitative measures of emotional self-awareness are suggested.

OP140 THE EVOLUTION OF THE PREFRONTAL CORTEX IN THE MAMMALIAN AND AVIAN BRAIN: CONVERGENT SOLUTIONS TO COMMON COGNITIVE OPERATIONS

Onur Gunturkun

Institute of Cognitive Neuroscience, Ruhr University of Bochum, Germany

Both mammalian and avian brains have independently evolved the capacity to adapt behaviour over time. This ability is a prerequisite of executive functions and associated with the prefrontal cortex. The corresponding structure in birds is the nidopallium caudolaterale. Anatomical, neurochemical, electrophysiological, and behavioural research suggests that these structures have a high degree of similarity across species. Lamination, however, which is the common form of structural organisation in the mammalian neocortex, has not evolved in the avian brain. Since all other aspects of the neural architecture of the avian brain are comparable with the mammalian prefrontal cortex, the variability in the evolution of different neural architectures to generate common executive functions is limited.

OP141 NEURONAL PAS DOMAIN PROTEIN 3 (NPAS3) EXPRESSION IN THE POSTNATAL HUMAN PREFRONTAL CORTEX

Carlotta Duncan ¹, Maree Webster², Cynthia Shannon Weickert¹

¹ Schizophrenia Research Laboratory, Prince of Wales Medical Research Institute, Randwick, NSW, 2031

² Department of Psychiatry, Stanley Laboratory of Brain Research, Bethesda, MD, USA

Background: Neuronal PAS domain protein 3 (NPAS3) was located at a breakpoint of a chromosomal translocation in a mother and daughter affected with schizophrenia and subsequently genetically associated with schizophrenia and bipolar disorder in the general population.

Aims: To characterise the mRNA and protein expression of NPAS3 in the developing and adult human dorsolateral prefrontal cortex (DLPFC).

Method: Developmental microarray data was generated from RNA extracted from the DLPFC of 60 individuals aged between 6 weeks and 49 years, using the HG-U133 version 2.0+ GeneChips (Affymetrix CA, USA). Quantitative real-time RT-PCR (qPCR) was used to validate mRNA expression change and protein expression was quantified by Western blot analysis.

Results: Microarray analysis revealed NPAS3 expression is significantly correlated with age (r = − 0.533, p=0.0002) with highest expression in the neonate DLPFC, decreasing to half maximal expression in the first few years of life, after which it is constantly expressed into adulthood. QPCR analysis validated this result, revealing a strongly significant effect of developmental age group (F = 6.95; df = 6,54; p=1.64E-05) with an inverse correlation in protein expression in the first decade of life detected by Western blot analysis (F = 2.953; df = 6,53; p=0.015).

Conclusions: NPAS3 is highly expressed in the postnatal developing brain, indicating it may be important in neurodevelopmental vulnerability in schizophrenia.

OP142 MicroRNA CHANGES IN THE PREFRONTAL AND TEMPORAL CORTICES IN SCHIZOPHRENIA

Natalie J. Beveridge ^{1, 2}, Adam P. Carroll^{1, 2}, Erin J. Gardiner^{1, 2}, Paul A. Tooney^{1, 2}, Murray J. Cairns^{1, 2}

¹ Schizophrenia Research Institute, Darlinghurst NSW 2010

² School of Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Callaghan NSW 2308

Background: microRNA are small RNA molecules that are expressed in a developmental and tissue-specific manner, and are thought to regulate at least a third of all human genes through the sequence-specific base pairing with the 3′ untranslated region (3′-UTR) of specific target messenger RNAs (mRNA). Expression profiling experiments have shown that many mammalian microRNA appear to be crucial to the development of the brain and the nervous system. It has been suggested that abnormalities in the microRNA system could potentially alter brain structure and function, and may contribute to the development of disorders such as schizophrenia. Gene expression studies in our laboratory have identified a general trend toward gene down-regulation in schizophrenia, and it is possible that this could in part be a consequence of microRNA action.

Aims: To identify schizophrenia-associated microRNA expression in the prefrontal and temporal cortices and determine if these microRNA are capable of binding to, and regulating the expression of schizophrenia candidate genes.

Methods: microRNA expression was analysed in postmortem cortical grey matter of the superior temporal gyrus (STG) and dorsolateral prefrontal cortex (BA9; DLPFC); from both schizophrenia and control subjects using a high throughput microarray platform. Changes in microRNA expression were validated using a custom designed real-time RTPCR method.

Results: This study has identified distinct schizophrenia-associated microRNA expression in the STG and DLPFC. Using in silico target gene analysis, numerous schizophrenia candidate genes were found to have putative microRNA binding sites for these altered microRNA within the 3′-UTR of their mRNA (e.g. BDNF, RELN, HTR2A, DRD1, GRIN3A, GRM7, CHRM1 and PLEXNA2). A luciferase reporter gene assay was established and many microRNA binding sites were functionally validated.

Conclusion: This data suggests that alterations in the microRNA pathway may play a significant role in schizophrenia-associated changes in gene expression in the cerebral cortex.

OP143 IDENTIFICATION OF BIOLOGICALLY RELEVANT, SCHIZOPHRENIA-ASSOCIATED MicroRNA TARGETS

Adam P. Carroll, Natalie J. Beveridge, Erin J. Gardiner, Paul A. Tooney, Murray J. Cairns

School of Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia

Schizophrenia Research Institute, Darlinghurst, NSW, Australia

Background: Schizophrenia is considered to be neurodevelopmental in origin. With evidence accumulating to demonstrate roles for miRNA in neurodevelopmental processes, it is not surprising that microRNA (miRNA) dysregulation has been implicated in schizophrenia. Indeed, our laboratory has identified a number of candidate miRNA which may be involved in the pathogenesis of schizophrenia. To fully comprehend the significance of our findings, it is essential to identify the genes which these schizophrenia-associated miRNA are targeting.

Aims: To identify biologically relevant, schizophrenia-associated target genes for the schizophrenia-associated miRNA, miR-181b.

Methods: Expression of miR-181b was modulated in SH-SY5Y cells using either synthetic miRNA or antisense oligonucleotides. Whole genome expression arrays were used to analyse subsequent alterations in gene expression, thereby identifying potential miRNA target genes of biological relevance. This data was correlated against bioinformatic miRNA target-prediction algorithms, as well as schizophrenia candidate genes. A luciferase reporter gene assay was used to validate potential schizophrenia-associated miRNA targets.

Results: We identified miRNA target recognition elements for miR-181b within multiple genes. Importantly, this approach identified miR-181b target sites that were not conserved throughout evolution. The gene ontology pathways for these target genes show enrichment in neurodevelopmental processes, with a subset of these genes previously reported to associate with the pathophysiology of schizophrenia.

Conclusion: This methodology has established the means to readily identify multiple miRNA target genes of biological relevance. In this case, a schizophrenia-associated miRNA was investigated in a neuronal setting, and shown to possess the capacity to modulate the expression levels of a subset of schizophrenia-associated genes.

OP144 ABNORMAL DOPAMINE SIGNALLING IN DEVELOPMENTAL VITAMIN D DEFICIENT RATS

Xiaoying Cui ¹, James Kesby¹, Pauline Ko^1,2, Thomas Burne^1,2, John McGrath^1,2, Darryl Eyles^1,2

¹ Queensland Brain Institute, University of Queensland, Australia

² Queensland Centre for Mental Health Research, The Park, Wacol, Australia

Background: Developmental vitamin D (DVD) deficiency has been proposed as a risk factor for schizophrenia. DVD-deficient adult rats display increased locomotor response to the psychomimetic agents amphetamine and MK-801.

Aim: This study investigated dopaminergic signalling in adult rat brain at a structural level.

Method: Sprague-Dawley rats at two ages (10 and 20 weeks old) were used. Saturation radioligand binding assays were performed using synaptic membrane fractions from prefrontal cortex, striatum and nucleus accumbens (NAc). Expression of Catechol-O-methyl transferase (COMT), a key enzyme responsible for dopamine metabolism, was assessed by immunoblot (n = 8).

Result: In DVD-deficient female rats, DAT density and affinity were increased in striatum and NAc, respectively (P < 0.05). Both dopaminergic receptors were not altered in these regions but dopaminergic receptor D1 was reduced in DVD deficient male (P < 0.05). COMT levels were decreased in prefrontal cortex in DVD male rats (P < 0.05).

Conclusion: These behavioural results suggest that DVD deficiency is associated with a persistent alteration in dopaminergic systems associated with motor function. The increase in DAT function may be a crucial mechanism for the increased locomotor in response to amphetamine in DVD-deficient female rats.

OP145 COMMON POLYMORPHISMS IN NEUROBEHAVIOURAL GENES INFLUENCE THE EMOTIONAL RESPONSE TO ACUTE INFECTIOUS ILLNESS

Ute Vollmer-Conna ¹, Barbara Piraino ², Barbara Cameron ², Andrew Lloyd ²

¹ School of Psychiatry, University of NSW, Australia

² Centre for Infection and Inflammation Research, School of Medical Sciences, University of New South Wales, Australia

Background: An acute infectious illness constitutes a significant physical stressor that activates both immunological and behavioural host defense mechanisms. However, the potential importance of neurobehavioural genes in determining the substantial individual differences in the acute sickness response to infection has not been studied.

Aim: To examine the impact of common functional polymorphisms in neurobehavioural genes on the sickness response to acute infection.

Method: Subjects were 300 Caucasians enrolled in a large infection outcomes cohort study. DNA samples were genotyped for the variable tandem repeat polymorphisms in the 5HT transporter (5HTT) and the enzyme monoamine oxidase A (MAOA), and the common Val158Met polymorphism affecting the function of catecholamine-O-methyl transferase (COMT). Clinical data were used to derive indices of the emotional response to illness, as well as illness severity and duration.

Results: We found significant associations with the high activity MAOA gene promoter alleles (P=0.007), and the COMT Val158Met polymorphism (P=0.01) but not the 5HTT polymorphism and mood disturbance during acute infective illness. These genetic variants did not predict mood disturbance at 3 months post-infection.

Conclusion: Functional polymorphisms in neurobehavioral genes contribute to the manifestations of the acute sickness response by modulating the emotional response to the physical stressor of infection.

OP146 LIVING WITH OTHERS, DOING CROSSWORDS AND PLAYING MUSICAL INSTRUMENTS ARE ASSOCIATED WITH MORE FAVOURABLE COGNITIVE FUNCTION LEVELS IN WOMEN IN THE COMMUNITY

Sonal M. Shah ^1,2,4, R.J. Bell¹, D.P. McKenzie³, Jayashri Kulkarni², S.L. Davison¹, Susan R. Davis¹

¹ Women's Health Program, Department of Medicine, Monash University, Prahran, Victoria, Australia

² School of Psychology, Psychiatry and Psychological Medicine, Monash University, Prahran, Victoria, Australia

³ Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia

⁴ School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, WA, Australia

Background: Lifestyle variables such as living arrangements and leisure activities have been identified as factors that may delay cognitive decline in old age However, evidence that these variables are associated with optimal cognitive function before any signs of cognitive decline are lacking.

Aims: This study was undertaken to investigate whether living arrangements (living with others) and leisure activities (doing crosswords and playing musical instruments) independently contribute to aspects of cognitive function in women in the community.

Method: This is a cross-sectional study of 295 women, aged 21–77 years recruited from a community based data set. Women were excluded if they reported any health condition that might potentially adversely affect cognitive function. The main outcome measures were the individual scores of a comprehensive battery of tests of cognitive function.

Results: In the multiple linear regression analysis, living with others was significantly associated with better performance on visual memory and executive function. In terms of leisure activities, doing crosswords was associated with better performance on psychomotor speed and verbal fluency whilst playing musical instruments was associated with better performance on verbal memory and fluency. We also identified favourable independent associations between cognitive performance, education and dehydroepiandrosterone sulfate (DHEAS).

Conclusion: We have identified several factors that independently contribute to cognitive performance in women in the community. Living with others and participation in cognitively complex leisure activities are independently associated with cognition, suggesting that mental stimulation may have a beneficial effect on cognition.

OP147 IDENTIFYING THE FACTORS AFFECTING EMPLOYMENT FOR PEOPLE WITH BIPOLAR DISORDER

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

Alfred Psychiatry Research Centre, The Alfred and Monash University, School of Psychiatry, Psychology and Psychological Medicine

Background: Functional deficits lead to poor employment in Bipolar Affective Disorder (BPAD). The perception of barriers may influence employment outcomes however this has not been researched with a particular focus on BPAD.

Aims: This study aims to identify perceived barriers to employment, assess the impact of these on employment outcome and identify potential facilitators to employment as reported by people with BPAD.

Method: Participants with a diagnosis of BPAD Type I were assessed using a range of clinical rating scales. Current mood symptoms were assessed using the Young Mania Rating Scale and Hamilton Depression 21-item Rating Scales. Demographic information, illness history and employment information was obtained. Participants completed a questionnaire regarding factors related to maintaining or obtaining employment. Information regarding social and occupational functioning, social support, life satisfaction and self-esteem was collected. Participants were contacted three months post-initial interview to assess changes in illness and work status.

Results: 35 participants were recruited (19 employed, 16 unemployed). Common barriers perceived included the fear of becoming unwell again, poor employment histories and the potential loss of government assistance payments. Common facilitators included flexible work hours and support from family, friends and employers.

Conclusion: People with BPAD perceive numerous barriers as limiting employment.

OP148 EARNING OR LEARNING AMONG AUSTRALIAN COMMUNITY RESIDENTS WITH PSYCHIATRIC DISORDERS

Geoffrey Waghorn ¹, David Chant², Meredith Harris^1,3, Chris Lloyd¹

¹ Queensland Centre for Mental Health Research

² Private statistical consultant

³ The University of Queensland

Background: At a population level, the extent that psychiatric disorders and other health conditions disrupt participation in education and employment is rarely considered simultaneously and remains largely unknown. This is an important issue because policy makers are concerned with educational attainment, labour force participation, school to work transitions, and workforce skill levels. We investigated earning or learning among Australian community residents by age group and by category of psychiatric disorder.

Methods: Data files were provided by the Australian Bureau of Statistics (ABS) from a population survey conducted in 2003 using a multi-stage probability sample (N2 = 36,088). Adults with schizophrenia, depression, and anxiety disorders were compared to (1) working age adults with other non-psychiatric health conditions and disabilities; and (2) healthy adults of working age.

Results: Participation in formal education and employment were extensively disrupted by all health conditions and by psychiatric disorders in particular.

Conclusion: The disruption associated with psychiatric disorders and other long term health conditions, can be ameliorated and therefore represents new policy opportunities for improving participation in secondary and higher education, school to work transitions, labour force participation, and workforce skill development.

OP149 RESULTS OF A RANDOMIZED CONTROLLED TRIAL OF INDIVIDUAL PLACEMENT AND SUPPORT FOR VOCATIONAL REHABILITATION IN FIRST EPISODE PSYCHOSIS

Eóin Killackey ^1,2, Henry Jackson^1,2, Patrick McGorry^1,2

¹ Department of Psychology, The University of Melbourne

² ORYGEN Research Centre

Introduction: Increasingly functional recovery is seen as an equal focus of attention as symptomatic recovery. A key area of functioning for adults is vocational functioning. The Individual Placement and Support (IPS) model has been shown to be the most effective model of vocational rehabilitation for people with schizophrenia. However, psychotic illness often has onset in the period in which vocational development occurs and can derail this process, limiting later vocational options.

Method: 41 people with first-episode psychosis wanting to find work were randomized to IPS (n = 20) or treatment-as-usual (TAU, n = 21). The IPS group worked with an employment consultant collocated with the clinical team for a six month period. Those in TAU could access all normal clinical services and external vocational agencies. Assessments were at baseline and six months.

Results: More of those in the IPS group became employed or enrolled in courses than those in TAU (17 vs 6, p = 0.000). For employment only there was still a significant difference (IPS 13 vs TAU 2, p = 0.000). Those in the IPS had a higher median income ($2432 vs $0, p = 0.012) and worked more hours per week (median 38 vs 22.5 p = 0.006) and more weeks (median 5.0 vs 0, p = 0.021) than those in the TAU group. The IPS group also significantly reduced use of welfare benefits.

Conclusions: The IPS approach, previously found to be of use in populations with established schizophrenia, has great potential for those with early psychosis. This study shows that the results achieved at outcome are significantly better than high quality TAU. Further, these results indicate that early functional rehabilitation should form a key part of treatment approaches to schizophrenia.

OP150 DEPRESSION AND ANXIETY IN WORKING ADULTS: WHAT ARE THE POTENTIAL CONSEQUENCES OF WORKING WHILE ILL?

Kristy Sanderson ¹, Fiona Cocker¹, Nick Graves², Jan Nicholson³, Brian Oldenburg⁴

¹ Menzies Research Institute, University of Tasmania, Hobart

² Institute for Health and Biomedical Innovation, QUT, Brisbane

³ Murdoch Children's Research Institute, Melbourne

⁴ School of Public Health and Preventive Medicine, Monash University, Melbourne

Background: Continuing to work is an important goal for many people with depressive and anxiety disorders. Yet working while ill (“presenteeism”) can have adverse consequences for the individual, co-workers, and employer. There is very little evidence to guide clinical management and, for some individuals, current practice may be doing more harm than good.

Aims: To estimate the economic costs and health outcomes from continuing to work when ill versus taking an absence from work for Australians with depressive/anxiety disorders.

Method: An epidemiologic-based simulation study is being conducted for the Australian population using all available data including the 2007 National Survey of Mental Health and Wellbeing (when available). State-transition Markov models are being used to estimate lifetime costs (including lost productive time and job turnover) and health outcomes (expressed in population health units; QALYs).

Results: Expected outcomes include new data synthesizing costs and health outcomes from working while suffering from a depressive or anxiety disorder versus absenteeism. An evidence-based framework for how to balance positive and negative consequences of presenteeism is described.

Conclusion: Simulation models are a cost-effective way to guide investment in public health and clinical interventions in addition to prioritising future research directions.

OP151 ‘BLAZING SADDLES’: THERAPEUTIC HORSEBACK RIDING FOR YOUNG PEOPLE WITH MENTAL ILLNESS

Sue M. Cotton ¹, Marni Luxmoore¹, Lori Schell¹, Vivienne Pearson¹

¹ ORYGEN Youth Health Research Centre, Department of Psychiatry, University of Melbourne, Parkville, Australia

Background: Animal Assisted Therapy (AAT) has been used for centuries to facilitate physical and mental health in humans. Therapeutic horseback riding, one form of AAT, has been shown to be effective in reducing anxiety and levels of depression, improving self-esteem, self-confidence, self-image, mastery, interpersonal skills, and motivation, in psychiatric populations.

The ‘Blazing Saddles’ therapeutic horseback riding program has been created through a unique partnership between ORYGEN Youth Health (a mental health service for young people) and Riding for the Disabled – Victoria (RDAV).

Aims: The aim of this study is to evaluate both short- and long-term benefits of the 10-week ‘Blazing Saddles’ program for young people with mental illness with respect to psychological (reducing depression, anxiety, stress, self-esteem, mastery), functional (quality of life), and social well being (social connectedness).

Method: Participants were recruited through the Group Program at ORYGEN Youth Health and are aged between 15–25 years of age. There were two groups: ‘Blazing Saddles’ and a control group which comprised patients participating in other recreational and social groups run by the Group Program. ‘Blazing Saddles’ was conducted over a 10-week period at one of the RDAV's Centres. Participants develop their riding skills, and learn horsemanship (i.e., how to tack up a horse, grooming, health care). A battery of questionnaires was completed at baseline, at the end of the 10-week program, and at 6 months follow up.

Results: The ‘Blazing Saddles’ group improved significantly from baseline to end of 10-weeks in terms of reduced levels of stress, anxiety, depression, and a greater levels of mastery or self-control, positive affect, and psychological quality of life. These effects were not observed in the control group.

Conclusion: This study is unique and provides promising preliminary data about the therapeutic benefits of Blazing Saddles’, warranting larger-scale investigations.

OP152 THE NATIONAL REGISTER OF ANTIPSYCHOTIC MEDICATION IN PREGNANCY (NRAMP)

Jayashri Kulkarni ¹, Heather Gilbert¹, Natasha Marston¹, Caroline Gurvich¹, Kay McCauley¹

¹ Monash Alfred Psychiatry Research Centre, The Alfred Hospital and School of Psychology, Psychiatry and Psychological Medicine, Monash University, Melbourne

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

Aims: Establishment of The National Register of Antipsychotic Medication in Pregnancy (NRAMP) will provide evidence-based clinical guidelines for the best use of antipsychotic medication during pregnancy and for one year postpartum.

Method: NRAMP is an Australia-wide observational study involving female participants with a history of mental illness, who take antipsychotic medication and become pregnant. Information is collected via telephone or face to face interviews during the pregnancy and for the first year postpartum and includes demographic, medical, psychiatric, medication and obstetric history, as well as information on general health and wellbeing for both the mother and baby.

Results: This study is current and ongoing. Results to date will be presented in terms of medications and mother/baby outcomes at various time points: the antenatal period, post-delivery and for one year postnatally.

Conclusion: The resultant evidence-based guidelines arising from NRAMP have the potential to provide regular contemporary updates to clinical treating teams for evidence-based management of women in this vulnerable population group. We plan to fill a void in mental health services where currently there is a distinct lack of information available to treating clinicians, with regard to providing safe and timely care of women who take antipsychotic medication and become pregnant.

OP153 MENTAL HEALTH FIRST AID GUIDELINES FOR TRAUMATIC EVENTS: A DELPHI STUDY

Claire M. Kelly ¹, Anthony F. Jorm¹, Betty A. Kitchener¹

¹ ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, VIC, Australia

Background: Giving appropriate mental health first aid after someone has experienced a traumatic event may decrease the likelihood of further psychological injury such as the development of posttraumatic stress disorder or depression. After an individual has experienced a traumatic event such as an assault or an accident, a friend, family member or even a stranger may be the first person in a position to help.

Aims: To develop guidelines for post-trauma first aid which can be used by members of the public to assist after a traumatic event.

Method: The guidelines were developed using a consensus method (the Delphi methodology). Two expert groups (one of clinical and research experts and one of people who had experienced, or cared for someone who had experienced a traumatic event) were presented with statements sourced from the professional and lay literature, and asked to rate their suitability for inclusion in such guidelines.

Results: The guidelines have been developed and have been well received by the participants and other readers. Guidelines were developed separately for adults and children, with some important differences between them.

Conclusion: Future research will need to evaluate the use and effectiveness of these guidelines.

OP154 MHPOD: THE NATIONAL PRACTICE STANDARDS FOR AUSTRALIA'S MENTAL HEALTH WORKFORCE AS PROFESSIONAL ONLINE DEVELOPMENT

David W. Juriansz ^1,2, Carol Harvey^1,2,3, C. Kemmett⁴

¹ Psychosocial Research Centre, Melbourne, Australia

² Northwest Area Mental Health Service, Melbourne, Australia

³ University of Melbourne, Australia

⁴ CADRE design, Sydney, Australia

The knowledge, skills and attitudes of mental health professionals when they first join the workforce will vary depending on their discipline, professional experience and degree of additional education and training.

The National Practice Standards for the Mental Health Workforce which govern the professions of psychiatry, nursing, social work, psychology and occupational therapy, provide practical benchmarks for the knowledge, skills and attitudes required by all mental health professionals. Despite the Practice Standards being established in 2002, no formal mechanism yet exists to embed them in the professional mental health workforce.

This session reports on a 3 year federally funded project which aims to translate the 12 National Practice Standards into 70 hours of National “web based’ Curriculum. The Curriculum is designed to be completed by qualified professional staff within 2 years of entering the workforce.

This session will present the curriculum overview for consideration and outline its development via a National Expert Group, consultation with professional bodies, consumer and carer input and how this work will translate into e-learning modules.

The session will also feature an interactive simulation as a demonstration of the type of learning product that this project will produce and links to other relevant professional development initiatives.

Commonwealth Department of Health and Ageing, National Mental Health Strategy (2002) National Practice Standards for the Mental Health Workforce, National Mental Health Education and Training Advisory Group

OP155 THE NEW PUBLIC MANAGEMENT AND PUBLIC PSYCHIATRIC INSTITUTIONS IN QUEENSLAND: SOME EMPIRICAL RESULTS

D.P. Doessel^1,2, Ruth F.G. Williams ^3,1, Harvey Whiteford^1,2

¹ Queensland Centre for Mental Health Research, The Park-Centre for Mental Health, Sumner Park, Australia

² School of Population Health, The University of Queensland, Australia

³ School of Applied Economics, and Centre for Strategic Economic Studies, Victoria University, Melbourne, Australia

Aim: This study provides an empirical analysis of two intellectual or policy ‘fashions’ that affected the public sector in the latter half of the twentieth century. One policy development, deinstitutionalisation, is predominantly concerned with the location of care services for people with disability (mental, physical or intellectual). This article concentrates on deinstitutionalisation of the mentally ill. The second policy development, the New Public Management, arose from critiques of public sector behaviour and outcomes. This managerialist school of thought has been in ascendancy in the public sectors of many OECD countries since the late 1970s. Description of both movements in this study leads to the following testable hypothesis: if the NPM was implemented in Queensland Psychiatric Institutions, then one would expect that the share of administrative/management expenditures in total expenditures would fall through time.

Method: The following empirical question is asked: ‘Has administration/managerial expenditure in Public Psychiatric Institutions fallen, risen or stayed constant through time?’ The statistical analysis of time-series data on administrative/managerial expenses (Labour-related and Non-labour-related) provides an answer to that question. Our technique of analysis is Ordinary Least Squares regression, used to estimate an equation of best fit. The data are for the fourteen years from 1992–93.

Results: The statistical results reported here demonstrate clearly that something other than the (parsimonious) NPM occurred when that management strategy was introduced into Queensland Public Service provision of services in psychiatric institutions in the 1990s: in fact, the results indicate not a decrease in administrative costs, but an increase. Thus, there is empirical support here for anecdotal accounts of rising administrative tasks.

Conclusion: By 2005, three national inquiries into various aspects of mental health services had occurred, adverse media reports persisted about service provision for the mentally ill and dismay continued amongst the providers of mental health services that service delivery was inadequate. It is therefore timely to provide answers to a question posed by Whiteford and Buckingham (2005): ‘Is all the money that governments say they spend on mental health actually spent there?’ Whiteford and Buckingham point out that there is a ‘black hole’ in our knowledge of what goes on inside aggregate expenditures on psychiatric institution expenditure. This study assists with some empirical information.

OP156 IMPROVING LINKAGES BETWEEN WELFARE AND PSYCHIATRIC SERVICES TO BETTER ADDRESS THE NEEDS OF PEOPLE WHO HAVE A MENTAL ILLNESS AND ARE HOMELESS

Anthony R. de Castella¹, Stuart Lee ¹, C. Humphrey², H. Riseborough³, A. Kennedy⁴, J. Freidin⁴, R. Kerr³, Frances Biffin¹, Jayashri Kulkarni¹

¹ Monash Alfred Psychiatry Research Centre, Monash University, VIC, Australia

² Sacred Heart Mission (SHM), Melbourne, Australia

³ Hanover Welfare Service (HWS), Melbourne, Australia

⁴ Alfred Psychiatry HOPS Team, Melbourne, Australia

Background: Homelessness is a complex problem affecting a large proportion of people with serious mental illness. Coordinating services to address these consumers’ needs is difficult and challenging. The Victorian DHS recently invested in an initiative to enhance these services in Melbourne's inner south.

Aims: To evaluate the impact of the DHS initiative on service usage, service effectiveness, and perceptions of consumer and staff.

Method: Data was collected on the demographics, clinical characteristics, and levels of service usage of consumers over a 12 month period. Consumers and staff at HOPS, SHM and HWS, were also asked about their perceptions of the initiatives’ impact.

Results: There was a significant change in admissions from each service to the Alfred Psychiatry inpatient unit. Admissions from HWS reduced (26–2005, 12–2007), while admissions from SHM increased (SHM 4–2005, 12–2007). Average Length of Stay (days) for 2005–2007 was also longer: HWS (18.3)/SHM (19.8) compared to overall Alfred Psychiatry LOS (15.2) reflecting the complex nature of clients with accommodation issues. There was a significant reduction in referrals from both HWS & SHM for Crisis Assessment. Qualitative feedback from staff and consumers endorsed the positive impact of the initiative in integrating and enhancing service provision.

Conclusion: The DHS Homeless Mental Health Initiative has had a positive impact on the ability of key services to better detect and respond to the complex needs of people with mental illness who have insecure accommodation.

OP157 DEVELOPING AND TRIALLING INTERNET-BASED SELF-MANAGED PSYCHOLOGICAL INTERVENTION FOR CESSATION OF LONG-TERM BENZODIAZEPINE USE

Jannette M. Parr¹, David J. Kavanagh ², Ross McD. Young²

¹ School of Medicine, University of Queensland, Herston, Queensland, Australia, 4006

² Institute of Health & Biomedical Innovation, Queensland University of Technology, Queensland, Australia, 4034

Background: Psychological interventions are an effective adjunct to General Practitioner management of benzodiazepine withdrawal, however, access is limited.

Aims: This study pilots the delivery of a psychological intervention via the internet with email support and assesses its ability to assist individuals to reduce their benzodiazepine use.

Method: Individuals using benzodiazepines for longer than 3 months were recruited to participate and were assessed on multiple measures at pre-treatment, three and six months follow-up.

Results: At the 3-month follow-up (n = 22), there was a significant increase in self-efficacy, significant reduction in depression and benzodiazepine withdrawal symptoms, as well as a significant reduction in weekly benzodiazepine intake. Participants rated the resources as easy to read, useful and read the majority of each newsletter

Conclusion: Further research is required to refine the program and to build in increased feedback and self monitoring of benzodiazepine intake. Strategies are also required to improve engagement with General Practitioners.

OP158  WWW.MOODSWINGS : THE HIGHS AND LOWS OF AN ONLINE INTERVENTION FOR BIPOLAR DISORDER – PRELIMINARY FINDINGS

Sue Lauder ¹, Michael Berk¹, David Castle², Seetal Dodd¹, Andrea Chester³, Monica Gilbert⁴, Leon Piterman⁵, Britt Klein⁶, David Austin⁶, Greg Murray⁶, Carolynne Holdsworth⁴, James Chamberlain⁴, Lesley Berk¹

¹ Department of Clinical and Biomedical Science: Barwon Health, University of Melbourne, Geelong, Australia

² University of Melbourne, St Vincent's Health, Australia

³ RMIT University, Australia

⁴ Frameworks for Health, Integrated Care, St Vincent's Health, Australia

⁵ Monash University, Australia

⁶ Swinburne University of Technology, Australia

Background: The benefits of adjunctive psychosocial interventions in the treatment of bipolar disorder continue to gain an increasing evidence base. However, translating these benefits to real-life settings are hindered by issues of accessibility including, cost, geography and personal resources. This study has adapted an existing validated face-to-face program for bipolar disorder to an online self-help format with a small group moderated discussion board.

Aims: To evaluate the impact of an online intervention for bipolar disorder on symptom change, psychosocial functioning and relapse.

Method: An international sample meeting diagnostic criteria for bipolar disorder is being randomised to two arms, comparing a multi-modal cognitive behavioural therapy intervention with an information only control group.

Results: Recruitment for MoodSwings will conclude at the end of 2008. Preliminary findings (n = 48) highlight characteristics of users and site usage, changes in symptoms and symptom severity, medication use, quality of life and social support.

Conclusion: This online self-help program has a high level of user acceptability and preliminary results are encouraging.

OP159 WEB-BASED RELAPSE PREVENTION PROGRAM FOR BIPOLAR DISORDER: RESULTS OF A 12-MONTH RANDOMIZED CONTROLLED TRIAL

Caryl Barnes ^1,2, Dusan Hadzi-Pavlovic^{1 2},. Mike Smith³, Gavin Pinto³, Stacey Bosley³, Robin Harvey³, Dennis Tannenbaum³, Kay Wilhelm^1,2, Philip Mitchell^1,2

¹ School of Psychiatry, University of New South Wales, ² Black Dog Institute, Sydney, ³ Sentiens Pty Ltd, Perth, WA

Background: Web-based programs to deliver psychological interventions for bipolar disorder may be an effective means of providing greater access to these therapies.

Aims: To conduct a 12-month randomised control trial investigating the effectiveness of an online relapse prevention program.

Method: Recruitment after a general media release was via a web-based screening tool. This confirmed the bipolar disorder diagnosis and study inclusion criteria and enabled informed consent to be obtained. Each participant was allocated a secure ID number to access their study or control online-program. Both programs ran over 12 months, with 20 sessions delivered at set intervals. There was also a 12-month follow-up period.

Results: The screening instrument was accessed by 559 individuals: 67% completed it in full and provided an email address. Eighty percent were eligible for inclusion and invited to enrol. Total sample size was 233: study group =113, control =120. Eighty-five percent had Bipolar I disorder. Retention rates were high with 63% (study) and 62% (control) completing all 20 sessions.

Conclusion: Analysis of the treatment response is in progress and the results of the initial randomised phase will be presented. Feedback from participants was overwhelming positive, despite the need during course of the study to overcome some unique ethical and methodological problems.

OP160 PREDICTORS OF ADHERENCE TO A COGNITIVE BEHAVIOUR THERAPY WEBSITE

Philip J. Batterham ¹, Alison L. Neil¹, Kylie Bennett¹, Kathleen M. Griffiths¹, Helen Christensen¹

¹ Centre for Mental Health Research, The Australian National University, Canberra, Australia

Background: More information is needed about the predictors of adherence to websites delivering Cognitive Behaviour Therapy, in order to improve site usage.

Aims: To examine predictors of early- and late-dropout among community users of the MoodGYM website, a five module online intervention for reducing the symptoms of depression.

Method: Approximately 82,000 users accessed the site in 2006, of which 27% completed one module and 10% completed two or more modules. Adherence was categorised into non-starters (0 modules), early dropouts (1 module) and late dropouts (2–5 modules). Predictor variables included age, gender, education, location, referral source, depression severity, anxiety severity, dysfunctional thinking and symptom change.

Results: Better adherence was predicted by higher depression severity, higher anxiety severity, a greater level of dysfunctional thinking, younger age, higher education, being female, and being referred to the site by a mental health professional. Users whose depression had not deteriorated after the first intervention module had higher odds of completing subsequent modules.

Conclusion: While the effect of age was in accordance with prior adherence research, the significant effects of gender, education and depression severity were not, and may reflect user characteristics, the content of the intervention and unique aspects of online interventions. Further research directions are suggested to investigate the elements of open access online interventions that facilitate adherence.

OP161 EXPLORING ONLINE SELF-DISCLOSURE: SYNCHRONICITY, TRUST AND PERSONALITY

Melanie Nguyen, Andrew Campbell

University of Sydney, NSW, Australia

Background: Research on internet-based interventions have primarily focussed on using self-help packages as an adjunct to current face-to-face (FTF) therapy. Few studies have examined the therapeutic relationship online. Key to a successful therapeutic relationship is self-disclosure. Current research suggests that individuals disclose more online rather than offline.

Aims: The current study investigated the role of synchronicity, trust and personality in online self-disclosure, comparing coaching psychology contexts with social ones.

Method: A 2×3 factorial design comparing context (coaching/therapeutic) and media (FTF, online chat, online email) was used. Participants (randomly allocated to a condition) completed demographics and personality questionnaires and participated in a 4 week interaction with experimenters. Trust surveys were administered throughout the interactions.

Results: We are currently still in the data collection process. Very preliminary data has been collated and suggests differences in trust levels and frequency of self-disclosure between online and offline participants and coaching/therapeutic and social contexts.

Conclusion: Further analyses on incoming data are required before conclusive statements can be made.

OP162 THERAPIST ASSISTED INTERNET CBT FOR MAJOR DEPRESSION AND PANIC DISORDER

Sarah Perini ¹, Edward Wims¹

¹ Clinical Research Unit For Anxiety And Depression

The federal government's “Better Access to Mental Health Care” initiative was designed to address the unmet treatment needs of those with high prevalence psychiatric disorders. Meanwhile Andrews et al. (1997) have proposed a step care model to address mental health needs and identified a modest increase in expenditure would produce large health gains (Tolkien II). The difficulty with both projects has been the equitable distribution of resources and sadly the majority of services are provided in metropolitan areas. Additionally, stigma and a reluctance to seek help may also contribute to the large number of Australians who do not receive treatment for common mental disorders.

In order to address this shortfall and to improve access to empirically supported treatment, the Clinical Research Unit for Anxiety and Depression has developed www.climateclinc.tv. This website provides clinician-assisted cognitive behaviour therapy programs for social phobia, panic disorder and major depressive disorder. Each program consists of four components: animated lessons depicting the story of someone with the condition who recovers, and their process of recovery; home assignments at the end of each lesson; a forum attached to the program which only participants can access; and finally regular email contact with a clinician.

The program for social phobia has been subjected to two randomised control trials, and has demonstrated large effects sizes and good retention rates. The programs for major depressive disorder and panic disorder are currently being validated, and their results will be presented here. Data will be presented about the efficacy of internet programs, and the clinicians will speak about their experiences of treating patients over the internet as opposed to face-to-face.

OP163 MULTI-SITE TRIAL OF E-LEARNING PROFESSIONAL DEVELOPMENT FOR MENTAL HEALTH NURSES – CLIMATE MENTAL HEALTH

Luke J. Johnston ¹, Gavin Andrews¹

¹ Clinical Research Unit for Anxiety and Depression

Background: Barriers restricting mental health nurse access to professional development (e.g. time, cost, availability) may be overcome by using the internet. Currently, no e-learning services provide professional development for mental health nurses.

Aims: To provide access to empirically based content using e-learning.

Method: Clinical text content was derived from three texts with an empirical basis-The Management of Mental Disorders; Acute Inpatient Psychiatric Care; and the Tolkien II. Audio visual content was developed by CRUFAD clinicians, researchers and consumer consultants.

Results: Preliminary qualitative analysis suggests a high acceptability of the program. Quantitative data is expected to yield descriptive statistics confirming trends noted in the qualitative data.

Conclusion: Current research suggests proof of concept that cost-effective e-learning initiatives have a high level of acceptability within the workforce and effectively addresses barriers to PD for mental health nurses. Additional research is required to assess if e-learning programs impact upon clinical standards and service delivery.

OP164 CHARACTERISTICS OF BELIEFS IN ANOREXIA NERVOSA

Rachel L. Mountjoy ^{1, 2}, John Farhall^{1, 2}, Susan L. Rossell^{2, 3}

¹ School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia

² Mental Health Research Institute, Melbourne, Victoria, Australia

³ Monash-Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia

Background: Anorexia Nervosa (AN) is characterized by irrational beliefs about gaining weight and body image. Although these cognitive features constitute part of the diagnostic criteria, little is known about their phenomenological characteristics.

Aims: To investigate similarities and differences in unusual and body-related beliefs in people with AN, schizophrenia and healthy controls.

Method: Participants completed the Brown Assessment of Beliefs Scale (BABS), and the Psychotic Symptom Rating Scale (PSYRATS-Delusions) in relation to a prominent belief regarding body weight/shape (AN sample and controls) or a current persecutory/somatic delusion (schizophrenia sample). All groups completed the Peters Delusions Inventory (PDI) to screen for a wide range of delusion-like beliefs.

Results: The AN sample endorsed more unusual beliefs on the PDI than healthy controls, but fewer than the schizophrenia sample, and were more distressed by their beliefs than either group. The AN and schizophrenia samples had comparable ratings of preoccupation and disruption for prominent beliefs (PSYRATS), but the AN sample again experienced greater distress. The BABS illustrated the AN sample had better insight than the schizophrenia sample.

Conclusions: The beliefs of the AN sample displayed phenomenological similarities to delusions in schizophrenia. However, a major difference was the high degree of distress experienced. This distress may be explained by better illness insight.

OP165 AN EXAMINATION OF DELUSIONAL THINKING IN BODY DYSMORPHIC DISORDER (BDD)

Izelle Labuschagne¹, David J. Castle^2,3, Judy Dunai³, Susan L. Rossell ^1,3

¹ Monash University, Melbourne, Australia

² Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia

³ University of Melbourne, Melbourne, Australia

Background: Body Dysmorphic Disorder (BDD) is characterized by a severe dislike in ones appearance, resulting in a belief about an ‘imagined’ or minor defect. Previous research has suggested that BDD patients’ beliefs can be classified as delusional or non-delusional, with this distinction being represented by two separate disorders on the DSMIV. The current authors argue against this dichotomy and argue that delusional thinking should be considered on a continuum.

Aims: To examine the frequency and phenomenology of delusional thinking in BDD.

Methods: 14 BDD patients and 14 healthy controls were administered the Peters Delusional Inventory (PDI). The PDI examined the number of delusional beliefs endorsed, and levels of preoccupation, distress and conviction.

Results: As a group BDD patients endorsed three times as many delusional beliefs as healthy controls. However, an examination of the normal distribution of the two groups established that the BDD patients’ delusional ideas were indeed on a continuum: with some patients endorsing no or few delusional ideas and others up to 13 different delusional beliefs. There were not two discrete groups. BDD patients were more preoccupied and distressed by their delusional ideas.

Conclusions: This data demonstrates that BDD should not be dichotomized on the DSM on the basis of delusional thinking.

OP166 A RANDOMISED CONTROL TRIAL OF NONSPECIFIC SUPPORTIVE CLINICAL MANAGEMENT (NSCM) VERSUS COGNITIVE BEHAVIOUR THERAPY (CBT) IN LONGSTANDING ANOREXIA NERVOSA

Stephen Touyz ¹, Daniel Le Grange², Hubert Lacey³, Phillipa Hay⁴, Rebecca Smith¹, Gail Huon⁵, Elizabeth Rieger¹, Sarah Maguire¹, Janice Russell¹, Kathleen Pike⁶, Victoria Mountford³, Bryony Bamford³, Monica Ward¹, Carla Evans¹, Hendrik Hinrichsen³, Amy Brown³, James Roehrig²

¹ University of Sydney, NSW, Australia

² University of Chicago, Illinois, USA

³ St Georges, University of London, England, UK

⁴ University of Western Sydney, NSW, Australia

⁵ University of Newcastle, NSW, Australia

⁶ Columbia University, New York, USA

Background: Longstanding Anorexia Nervosa (L-AN), poses a heavy burden on health and social services and is resistant to traditional treatments. Those with L-AN are typically high achievers, but through their illness experience disproportionate levels of unemployment, multiple medical complications, repeat admissions to medical facilities, and are intensive users of GP services and the welfare system. They are a significant burden to parents, carers and the community. There are no proven effective treatments for L-AN, and despite its seriousness, no randomised control trial has been conducted on this group. However, two psychotherapeutic models; nonspecific supportive clinical management (NSCM) and cognitive behaviour therapy (CBT) have revealed promising early results.

Aims: This project aims to establish the first effective outpatient treatment for L-AN by comparing the capacity of CBT and NSCM to improve quality of life and to reduce depression and social isolation; by determining whether CBT or NSCM has a greater impact on core eating-disorder pathology; and by investigating whether the reduction in chronicity translates to a reduced burden on medical services.

Method: Participants will include 90 females over the age of 18 with a diagnosis of AN for more than 7 years. Those who meet eligibility criteria will be randomly assigned to either 30 individual sessions of CBT or NSCM over 6 months. This is the world's first treatment trial for L-AN and is being conducted at the University of Sydney, St Georges, University of London and the University of Chicago. The design of this study will be presented.

OP167 BARRIERS TO HELP-SEEKING IN COMMUNITY WOMEN WITH EATING DISORDERS: A LONGITUDINAL STUDY

Phillipa Hay ¹, Elizabeth Evans¹, Jonathan Mond², Susan Paxton², Bryan Rodgers³, Frances Quirk⁴

¹ School Of Medicine, UWS

² School of Psychology, La Trobe University

³ Australian National University

⁴ James Cook University

The study aims were to explore the treatment seeking of community women with disordered eating over four years. One hundred and twenty-two young women (mean age 28.5±6.3 years) identified in a general population based survey with eating disorder symptoms of clinical severity agreed to participate in a follow-up study. Eating disorder symptoms, health related quality of life, general psychological function, help-seeking, and defence style were assessed at baseline, and two and four years by questionnaire. A randomized controlled trial of an intervention designed to prompt help-seeking and improve mental health literacy was conducted at baseline and one half the sample were prompted to seek help at that time (1). At two and four years qualitative interviews were conducted, using the framework approach of proceeding until saturation, of large (50%) subsamples of the original 122 women. This present paper reports on the outcomes of these interviews. Themes analysis found that whilst help-seeking increased, it was not often sought from a health professional and was more often sought for depression or another mental health problem rather than an eating disorder. It was also seldom perceived to be helpful. Important barriers to seeking help that emerged included real and perceived stigma, cost and fear of a negative response from doctors. When professional help was sought, limitations in eating disorder health literacy and empathy were encountered in doctors. Interventions to promote health literacy need to target health providers as well as those seeking care.

1. Hay P, Mond J, Paxton S, Rodgers B, Darby, A, Owen C. What are the effects of providing evidence-based information on eating disorders and their treatments? A randomized controlled trial in a symptomatic community sample, Early Intervention in Psychiatry, 2007, Blackwell Synergy Publishers. 1(4):316–324.

OP168 THE RELATIONSHIP BETWEEN ANGRY-IMPULSIVE PERSONALITY TRAITS, BORDERLINE PERSONALITY DISORDER AND GENETIC POLYMORPHISMS OF THE DOPAMINE TRANSPORTER

Peter Richard Joyce ¹, Patrick C. McHugh², Katrina Jane Light¹, Sarah Rowe¹, Allison Miller², Martin Kennedy²

¹ Department of Psychological Medicine, University of Otago, Christchurch

² Department of Pathology, University of Otago, Christchurch

The 9-repeat VNTR allele of the dopamine transporter has recently been associated with borderline personality disorder (BPD) in depressed patients.

We investigated the association between the 9-repeat allele of the dopamine transporter and angry-impulsive personality traits in a family study on the molecular genetics of depression and personality.

Across the whole sample the 9-repeat allele of the dopamine transporter was associated with angry-impulsive personality traits (p = 0.002). This association was stronger in subjects with no history of mood disorders nor of BPD (OR = 4.85, p = 0.008), than in subjects with a history of mood disorders (OR = 1.73, p = 0.033). Angry-impulsive traits were also associated with lifetime mood disorder diagnoses and with BPD.

The associations reported in this paper suggest that the 9-repeat allele of the dopamine transporter is associated with angry-impulsive personality traits, independently of any link to mood disorder or BPD. This could form the basis of a dopaminergic neurobiological model of angry-impulsive personality traits.

OP169 REJECTION SENSITIVITY AND NEGATIVE SELF-VIEWS AS MEDIATORS OF ASSOCIATIONS BETWEEN THE NUMBER OF BORDERLINE FEATURES AND ATTACHMENT

Carol A. Hulbert, Jennifer M. Boldero, Jessica L. Mooney, Lisa Bloom, Jae Cooper, Jodie Salinger

The University of Melbourne, Australia

Aims: Based on dimensional models of BPD and using a non-clinical student sample, the two studies reported on in this paper aimed to investigate relationships between variables implicated in the aetiology and clinical presentation of BPD, including neuroticism, attachment style, sensitivity to rejection, and negative self views.

Specifically, the studies examined the associations between anxious and avoidant attachment style dimensions and the number of borderline personality disorder (BPD) features reported by non-clinical student samples. In addition, the mediating roles of rejection sensitivity (RS), the tendency to anxiously expect, readily perceive, and overreact to rejection (Studies 1 & 2) and self-view negativity (Study 2) on any associations, independent of the impact of neuroticism were examined.

Method: For Study 1, 101 participants, 30 males and 71 females, completed psychometrically sound self-report questionnaires targeting the number of borderline features [Borderline Personality Questionnaire (BPQ; Poreh, Rawlings, Claridge, Freeman, Faulkner, & Shelton 2006) Neuroticism [the International Personality Item Pool (Goldberg, 1999)] attachment style [The Experience in Close Relationships scale (ECR; Brennan et al., 1998)], sensitivity to rejection [Rejection Sensitivity Questionnaire (RSQ; Downey & Feldman, 1996)]. For Study 2, 131 students, 38 males and 93 females, completed the BPQ and a measure of negativity and positivity of self-views (Bell & Boldero, 2008).

Results: As predicted, in both studies reporting higher levels of anxious and avoidant attachment were associated were reporting more BPD features, and RS partially mediated these associations. In addition, in Study 2, self-view negativity, but not positivity, was an additional mediator. Together these two factors partially mediated the impact of anxious attachment and fully mediated the impact of avoidant attachment.

Conclusion: The results are consistent with models of BPD that highlight the role of attachment experiences and related internal working models of self, world views, and relationships with others as antecedents of the sensitivity to rejection seen in many individuals with BPD diagnosis. They also suggest that future research should explore the impact of other working models so that a fuller understanding of the impact of attachment experiences and perceptions of self and others in BPD is gained.

OP170 THE EFFECT OF PASSAGE OF TIME, NEUROTICISM AND DEPRESSION ON PERCEPTIONS OF INTIMATE RELATIONSHIPS

Kay Wilhelm¹, Liesbeth Geerligs ¹, Gordon Parker^1,2

¹ School of Psychiatry, University of NSW

² Black Dog Institute, NSW

Background: Intimate relationships predictably vary over time, and if a relationship measure is valid, it will quantify such variations. Other factors which may influence perceptions of intimacy include gender, personality and history of depression.

Aim: To assess changes in Intimate Bond Measure (IBM) ‘care’ and ‘control’ scores over a 20-year period, and their relationships to gender, neuroticism and depression.

Method: A non-clinical longitudinal cohort provided IBM scores at 1988, 1998 and 2008. DSM Major Depression caseness was determined with the Composite International Diagnostic Interview, and neuroticism was measured with the Eysenck Personality Inventory. Changes in IBM scores were assessed by repeated measures ANOVA and the influences of depression history and neuroticism were examined using regression analyses.

Results: Over the initial 10-year period, IBM care scores declined significantly (p < 0.001) without significant changes in control scores. Neuroticism accounted for a significant amount of variance in care change scores (p = 0.034). There was no impact of gender once controlling for neuroticism. Results did not differ between those with or without a diagnosis of Major Depression. In addition, 2008 data are currently being collected, and will be presented at the conference.

Conclusion: Subjects reported a substantive decrease in perceived partner care over time. While this may reflect the nature of subjects’ relationships over time, we did find a contribution from neuroticism levels.

OP171 SEX DIFFERENCES IN THE IMPACT OF INFERTILITY ON PSYCHOLOGICAL DISTRESS IN INDIVIDUALS LIVING WITH CANCER AND THEIR PARTNER

Jodie Fleming ¹, Martin Johnson¹

¹ School of Psychology, University of Newcastle, Australia

Background: Research suggests sex differences exist in the impact of infertility on psychological distress, coping style and social support satisfaction in individuals living with cancer and their partner.

Aims: The aim of this study was to develop a model to predict the relationship between infertility caused by cancer, coping style, use of social support and psychological distress.

Method: A path analysis was undertaken on a sample of cancer patients and carers, using the data describing satisfaction with social support, coping style, and psychological distress. Participants (N = 118) completed the self-report measures Brief Symptom Inventory (BSI), the Coping Responses Inventory (CRI), the Significant Others Scale (SOS), Marital Satisfaction Questionnaire (MSQ), and the revised version of the Stress Related Growth Scale (RSRGS). Multiple linear regressions were run for each variable for males, females, patients, partners, infertile couples and fertile couples.

Results: Results show that fertility status was not a predictor of anxiety or depression. Anxiety and psychological distress were predictors of avoidant coping for partners, patients, and males. Depression predicted social support satisfaction for fertile couples, partners and males. Anxiety predicted social support satisfaction for patients and females. Total social support satisfaction predicted a decline in psychological distress for males, partners and fertile couples.

Conclusion: Sex differences exist for social support satisfaction, coping style and negative psychological outcomes for couples experiencing cancer-related infertility.

OP172 DEPRESSION AND THE COMBINED ORAL CONTRACEPTIVE PILL: A RANDOMIZED CONTROLLED TRIAL INVESTIGATING THE EFFECTS OF DROSPIRENONE AND LEVONORGESTREL UPON MOOD STATE IN HEALTHY WOMEN

Jayashri Kulkarni¹, Natasha Marston ¹, Caroline Gurvich¹, Anthony de Castella¹, Paul Fitzgerald¹

¹ Alfred Psychiatry Research Centre, The Alfred Hospital and the School of Psychology, Psychiatry and Psychological Medicine, Monash University, Melbourne Australia

Background: Whilst physical risks associated with Combined Oral Contraceptives (COCs) are well described, knowledge about adverse psychological effects is insufficient. Limited evidence, including results from our pilot study, suggests COCs correlate with depressed symptomatology. A randomized controlled trial is necessary to determine whether COCs adversely affect mood in healthy women.

Aims: To compare the mood and menstrual health of women given one of two COCs with those receiving a placebo medication.

Method: 225 healthy women will be randomized (1:1:1) to receive either daily oral Drospirenone + ethinyl estradiol (Yasmin), or daily oral Levonoregestrel + ethinyl estradiol (Levlen), or daily oral placebo. Psychopathology measures and general health assessments will be completed before, during and after a 16 week period.

Results: After briefly outlining the outcomes from our pilot study, we intend to present preliminary findings from the randomized controlled trial.

Conclusion: Implications of the information generated by this trial may contribute to the development of prescriber guidelines for COCs, help identify women who may be more susceptible to depression following COC use, and deepen our understanding of the influence of hormones upon a serious and burdensome condition.

OP173 THE ECCO PROJECT: PRELIMINARY RESULTS OF A RANDOMISED CONTROLLED TRIAL OF AN INTERNET-BASED DEPRESSION INTERVENTION IN A TELEPHONE COUNSELLING SETTING

Louise Farrer ¹, Helen Christensen¹, Kathleen M Griffiths¹, Nicole Burgess¹, Andrew Mackinnon², Dawn O'Neil³

¹ Centre for Mental Health Research, The Australian National University, Canberra, Australia

² Biostatistics Unit, ORYGEN Research Centre, University of Melbourne, Melbourne, Australia

³ Lifeline Australia

Background: Lifeline provides 24 hour supportive telephone counselling and crisis intervention to members of the community, many of whom experience anxiety and depression. These callers may benefit from the introduction of an evidence-based web intervention, in addition to the support they receive from Lifeline.

Aim: This study investigates the effectiveness of a 6-week, self-administered, cognitive behavioural therapy (CBT) Internet intervention in reducing depression and anxiety symptoms in callers to a large, national telephone counselling service.

Method: A sample of callers to Lifeline's telephone counselling service, who met the criteria for moderate to high psychological distress (as measured by the K-10) were recruited. Participants were randomly assigned to one of four conditions (Internet CBT plus weekly telephone follow-up; Internet CBT only; weekly telephone follow-up only; and treatment as usual) and assessed on multiple outcomes at baseline, post-intervention, and 6 and 12 months post-intervention.

Results: Preliminary analyses will be presented on the pre and post intervention data collected to date.

Conclusion: Results from the trial will inform the use of evidence-based Internet interventions for depression in established community services with high mental health needs.

OP174 ATYPICAL DEPRESSION: RETROSPECTIVE SELF-REPORTING OF TREATMENT EFFECTIVENESS

Joanna G. Crawford ^1,2, Gordon B. Parker^1,2

¹ Black Dog Institute, Sydney, NSW, Australia

² School of Psychiatry, University of NSW, Sydney, NSW, Australia

Background: The majority of previous studies examining the treatment of atypical depression are randomized controlled trials of depressed patients with atypical features only, with the earlier studies focusing on the efficacy of MAOIs.

Aims: The current study compares ratings of effectiveness for a wide range of treatments for depression, amongst depressed subjects with and without atypical features.

Method: An on-line survey of individuals experiencing a likely episode of clinical depression was undertaken. Participants rated symptoms experienced when depressed, including ‘atypical features’, and rated the effectiveness of previous treatments for depression. Mean treatment effectiveness ratings were compared amongst 338 respondents classified as “atypical depressed” and 377 respondents classified as “non-atypical depressed”.

Results: There were few significant differences between the “atypical depression” and “non-atypical depression” groups in effectiveness ratings for drug treatments, and none for psychological treatments. The “atypical depression” group had a significantly lower mean effectiveness rating for SSRIs overall, and for two out of six individual SSRIs. There were no significant differences between the groups in mean effectiveness ratings for an SNRI, tricyclics or MAOIs. However, few respondents had trialed MAOIs or electroconvulsive therapy (ECT).

Conclusion: Our findings suggest that whilst MAOIs are rarely prescribed for atypical depression, a range of more commonly provided treatments, both pharmacological and psychological, are of some benefit for depressed patients with atypical features.

OP175 A RANDOMISED CONTROLLED TRIAL OF INTEGRATED AND SINGLE FOCUSED INTERVENTIONS FOR CO-MORBID DEPRESSION AND ALCOHOL USE DISORDERS

Sally Hunt ¹, Amanda Baker¹, David Kavanagh², Frances Kay-Lambkin¹, Terry Lewin¹, Vaughan Carr¹

¹ The University of Newcastle, Newcastle, Australia

² Queensland University of Technology, Brisbane, Australia

Background: Depression and alcohol use problems commonly co-occur and this co-morbidity has been shown to result in poorer outcomes than when the conditions are experienced independently. Despite this, effective evidenced-based psychological treatments have yet to be developed and evaluated for addressing the unique needs of people with co-existing depression and alcohol use problems. The DAISI project is one of the first in the world to do so.

Aims: To investigate whether an intervention that integrates treatment for depression and alcohol abuse was more efficacious in reducing alcohol use and symptoms of depression, than treatments that focus on alcohol or depression alone.

Method: A sample of people reporting a recent history of hazardous alcohol use and depression were recruited. Participants were randomly allocated to one of four CBT/motivational interviewing treatments. The first three conditions offered 10 sessions which focused on depression (n=71); alcohol use (n=68); or integrated depression and alcohol focus (n=75). The remaining group received a single case formulation and feedback session (n=70). Assessments took place at baseline, mid therapy and 15-weeks.

Results: Participants in all treatment conditions demonstrated a significant reduction in depression and alcohol use. A non-significant trend was evident such that those who received the integrated intervention had a greater reduction in depression scores than those in either of the single focused treatments.

Conclusions: These findings should be useful for clinicians and researchers in selecting appropriate treatments for people with depression and alcohol use co-morbidity. Ongoing follow-up will clarify the longevity of these treatment effects.