PP01
DOES SIZE MATTER? THE RELATIONSHIP BETWEEN HIPPOCAMPAL VOLUME AND MEMORY ABILITY IN PATIENTS WITH TREATMENT RESISTANT MDD
Kate Hoy, Jerome J. Maller, Sally Herring, Susan McQueen, Rebecca Segrave, Paul Fitzgerald
Alfred Psychiatry Research Centre, Monash University School of Psychology, Psychiatry and Psychological Medicine
Background: While it is generally accepted that memory is unlikely to be localised to a specific brain region, there is considerable evidence that the medial temporal lobe (MTL) is crucial for aspects of episodic memory. One such MTL structure shown to be heavily involved in memory is the hippocampus; a finding which has lead to numerous investigations examining the relationship between memory performance and hippocampal volume. These studies have been conducted in participants with known memory deficits, i.e., those with psychiatric disorders, with highly divergent findings.
Aims: to directly examine the relationship between hippocampal volume and the retention of verbal memory in a specific group of patients – treatment resistant major depressive disorder (MDD).
Method: Twenty Nine subjects with treatment-resistant MDD underwent neuropsychological assessment and brain MR imaging.
Results: There were a number of significant negative correlations between measures of hippocampal volume, with the exception of measures of hippocampal tail volume alone, and verbal memory retention.
Conclusions: Given the known memory deficits in this patient population, the current results appear to support the contention that a larger hippocampus does not necessarily indicate better memory. Such a finding might in fact be indicative of inefficient memory, a conclusion which has been suggested by recent meta-analyses of hippocampal volume-memory studies.
PP02
SUPERIOR TEMPORAL GYRUS SUBVOLUMES IN TREATMENT-RESISTANT SCHIZOPHRENIA WITH AUDITORY HALLUCINATIONS
Paul Fitzgerald, Jerome Maller, Faranak Farzan, Jeff Z. Daskalakis
Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Melbourne, Victoria, Australia, 3004
Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
Background: It has been suggested that treatment-resistant auditory hallucinations (TR-AH) in schizophrenia (SCZ) are associated with abnormalities of the superior temporal gyrus, specifically Heschl's gyrus (HG) and Planum temporale([PT). However, few studies have investigated this region in patients with SCZ and TR-AH.
Aim: To measure the HG and PT in SCZ patients with TR-AH and healthy controls.
Method: Forty-three patients with SCZ with TR-AH and 25 matched healthy controls underwent psychiatric assessments and neuroimaging. Regions of interest (ROIs) volumetrics were determined by manual segmentation.
Results: In SCZ, raw HG volumes on the right were significantly smaller but not when normalized by intracranial or total brain volume (TBV). By contrast, left TBV-normalized HG volumes were significantly larger in females with SCZ. Right and left mean PT volumes were significantly reduced in both sexes but not in males when normalized.
Conclusions: Right and left PT and right HG volumes were reduced in patients with TR-AH SCZ, although the reduction was greatest in the PT and among females. Left HG volumes in males were similar between controls and the clinical group and significantly larger in SCZ females. Reduced left PT and preserved HG symmetry may be a marker of SCZ with TR-AH.
PP03
MULTIMODAL ASSESSMENT OF AUDITORY PREPULSE INHIBITION IN PARKINSON'S DISEASE AND SCHIZOPHRENIA
Linda E. Campbell, Ross Fulham, Matthew Hughes, Alexander Provost, Bill (Timothy, W) Budd, Patrick Johnston, Mary-Claire Hanlon, Kathryn McCabe, Frini Karayanidis, and Ulrich Schall
Priority Research Centre for Brain & Mental Health Research, University of Newcastle; Australia, Schizophrenia Research Institute, Australia; Hunter Medical Research Institute, Australia
Background: Disrupted sensorimotor gating has been found in various neuropsychiatric conditions which are characterised by dysfunctional dopamine neurotransmission.
Aims: Previous findings suggest disrupted sensorimotor gating in schizophrenia (SCZ) and facilitated sensorimotor gating in Parkinson's Disease (PD). The current study aimed to investigate the neural networks underlying sensorimotor gating by multimodal recordings of auditory prepulse inhibition (PPI).
Method: PPI was assessed electromyographically (startle eyeblinks), electroencephalographically (P300) and by functional magnetic resonance imaging (Blood oxygen level-dependent brain activation) in 17 SCZ subjects, 23 PD subjects, and age-matched healthy volunteers.
Results: Multiple regression analysis of blood oxygenation level-dependent contrasts identified activation in the pons, thalamus, caudate nuclei, left angular gyrus and bilaterally in anterior cingulate, associated with electromyographically recorded sensorimotor gating. Subsequent planned contrasts also confirmed increased superior frontal and decreased superior temporal gyri activation for PPI that was not associated with electromyographically recorded sensorimotor gating.
Conclusion: Our findings are consistent with a primary pontine circuitry of sensorimotor gating that interconnects with inferior parietal, superior temporal, frontal and prefrontal cortices via thalamus and striatum while PPI processes in the prefrontal, frontal and superior temporal cortex were functionally distinct from sensorimotor gating.
Supported by NH&MRC 351129
PP04
THE ORIGINS OF ANXIETY?: FMRI IN CHILDREN WITH ANXIETY DISORDERS UNDERGOING PSYCHOLOGICAL TREATMENT
Mariam Alexander
1,2, Jim Lagopoulos1,2, Pritha Das1,2, Nicholas Kowalenko3, Steven Spielman3, Julie Braithwaite3, Emma Gallagher3, Gin S. Malhi1,2
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
3
Department of Child and Adolescent Psychiatry, Royal North Shore Hospital, Sydney, NSW Australia
Background: Anxiety is the most common of the childhood emotional disorders and is associated with health and social problems both in childhood and adulthood. Psychological treatments for anxiety are preferred by patients of all ages as compared to pharmacological interventions. However, the neural mechanisms of psychological treatment are poorly understood.
Aims: This study that I (Mariam Alexander) have undertaken as part of my NSW Institute of Psychiatry Fellowship aims to identify the neurobiological mechanisms of anxiety in childhood, by providing an insight into the neural networks involved in generating and maintaining anxiety states. We also aim to correlate putative changes with treatment outcome.
Method: Anxious children and adolescents from RNSH Child and Adolescent Anxiety Clinic are being recruited for this study and compared against age-matched non-anxious controls. Prior to commencing psychological treatment, both anxious children and healthy controls undergo a full clinical and neuropsychological assessment to determine the nature and degree of the anxiety. Both groups then have a research fMRI scan involving an executive function and facial emotion recognition task. At the end of the prescribed psychological treatment, subjects have a repeat clinical evaluation in order to determine their response to treatment.
Results: We have initiated the study and scanned subjects as young as 8 years old. Preliminary data indicates the anticipated engagement of fMRI stimuli. Complete data and inferences will be presented at the meeting
PP05
THEORY OF MIND (TOM) IN SCHIZOPHRENIA: A FUNCTIONAL MRI STUDY
Pritha Das
1, Jim Lagopoulos1, Antony Henderson2, Carissa M. Coulston1, Oddbjørn Sæther2, Gin S. Malhi1
1
Academic Discipline of Psychological Medicine, Northern Clinical School, University of Sydney, Australia
2
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
Background: Converging behavioural and neuroimaging evidence using high-level verbal or visual ToM stimuli suggests that the ability to represent one's own and another persons’ mental states is impaired in patients with schizophrenia.
Aim: In this study we investigate whether these purported ToM deficits in patients with schizophrenia in ‘dedicated’ mentalizing networks can be further defined using complex, nonverbal stimuli that are designed to evoke mental state attribution.
Methods: Functional fMRI were acquired in 20 schizophrenia and 20 healthy control subjects during the presentation of ToM and random-motion animated sequences. Both within- and between-group analyses were performed on fMRI data using Statistical Parametric Mapping software.
Results: Consistent with earlier findings control subjects exhibit activations within a specialised network including the middle and inferior frontal gyri, middle temporal gyrus, inferior parietal lobule and occipital cortex. Schizophrenia patients on the other hand show activity primarily in the occipital and temporal cortices but have diminished prefrontal cortical activation.
Conclusion: The primary findings from this study suggest that schizophrenia patients’ deficit in making inferences about other people's mental state may in part be a consequence of a failure to activate the prefrontal cortex. The implications and in particular the emotional connotations will be presented and discussed.
PP06
FUNCTIONAL BRAIN IMAGING OF RECOGNITION OF INTENTION TO COMMUNICATE
Mary-Claire Hanlon, Gavin Cooper, Robyn Langdon, W. Ross Fulham, Sandra Bucci, Ulrich Schall
Priority Research Centre for Brain & Mental Health Research
Schizophrenia Research Institute
Hunter Medical Research Institute
Background: Theory of Mind is the capacity to recognise, interpret and predict identity, perception, emotion and belief of other people in social interaction. A particular element of this social cognition is the recognition of the “intention to communicate”.
Aims: We aimed to compare brain activation associated with two tasks: (1) discriminating brief video clips showing well-known gestures versus incidental movements by an actor and (2) discriminating brief audio clips of communicative sounds versus noise.
Method: Video clips were taken from Bucci et al. (Br. J. Psychol. 47: 232-334; 2008). Auditory stimuli were selected from a novel data set based on ratings on familiarity, source type, emotional salience, and meaningfulness, thus leading to a subset of 30 stimuli where the intention to communicate was either evident, absent, or ambiguous. Both sets of stimuli were presented whilst collecting functional magnetic resonance imaging data.
Results: The identification of gestures was closely associated with activation in left-hemispheric language processing areas while differential auditory cortex activation was associated with the identification of intentional versus to non-intentional auditory stimuli.
Conclusion: Our preliminary findings suggest a distinct pattern of brain activation for each of the two tasks.
PP07
BASIC NUMERICAL CAPACITIES IN VELO-CARDIO-FACIAL SYNDROME (22Q11.2 DELETION SYNDROME)
Luke Reeves
1, Rayna Azuma3, Angela Stevens3, Annette Karmiloff-Smith5, Robin Morris3, Kieran C. Murphy4, Declan G.M. Murphy3, Ulrich Schall1,2, Frini Karayanidis1, Linda E. Campbell1,2,3
1
Priority Research Centre for Brain and Mental Health Research, University of Newcastle, NSW Australia
2
Schizophrenia Research Institute
3
King's College London, Institute of Psychiatry, UK
4
Royal College of Surgeons in Ireland
5
University of London, Birkbeck
Background: Velo-cardio-facial syndrome (VCFS) is one of the most common genetic syndromes with a documented prevalence of 1:4000 live births. People with VCFS often have palatal and cardiac abnormalities, learning difficulties and a high prevalence of mental health problems, such as autism, ADHD and psychosis. In the last decade research has found that people with VCFS have specific cognitive profiles with particular difficulties in e.g., mathematics. However, very little research has systematically investigated the basic numerical abilities in people with VCFS.
Aims: The current study aims to investigate the underlying mechanisms of mathematical deficits in VCFS.
Methods: The current study investigated numerical abilities in 50 children and adolescents with VCFS and 31 of their age-matched siblings. The participants completed a battery of tests including, intellectual functioning, academic achievement tasks and also basic tests of numeracy, such as tests of the symbolic distance effect, number processing and calculations. The study aims to investigate if people with VCFS have a general impairment of mathematics or if the observed difficulties are associated with specific deficits of underlying numerical skills.
Results: We found that people with VCFS have mathematical disorders with specific numerical deficits.
Conclusions: Mathematical impairments in VCFS are associated with basic numerical deficits. Further analyses will investigate the relationship between these deficits and brain anatomy.
PP08
AUSTRALIAN ESTIMATES OF PROBABLE DEMENTIA AND COGNITIVE IMPAIRMENT: THE DYNOPTA STUDY
Kaarin J. Anstey1, M.A. Luszcz2, L. Ross-Meadows1, Kim Kiely
1, David Steel3, Carole Birrel3, and the Dynopta Investigators
1
Australian National University, Canberra, Australia
2
Flinders University, Adelaide, Australia
3
University of Wollongong
This project aimed to estimate rates of cognitive impairment/probable dementia in the Dynopta study. The Dynopta datafile is a newly derived dataset based on 9 contributing Australian Longitudinal Studies of Ageing. MMSE Data were available for 8835 participants (51.5% female) between the years 1991 and 2004. The ages ranged from 50 to 103 years, with a mean age of 71.6 (SD = 9.2). The data were drawn from Canberra, Adelaide, the Blue Mountains, Melbourne and Sydney. Rural participants were underrepresented. Probable dementia was classified as a score of <= 24 on the MMSE. Possible cognitive impairment was classified as a score of 24-26 on the MMSE. Results showed that below the age of 65, 5.6% were cognitively impaired. The unweighted probable dementia rates of participants aged 65-69, 70-74, 75-79, 80-84, 85-89 and 90+ were 4%, 9.6%, 15.5%, 21.8%, 31.1%, and 51.3% respectively. The unweighted possible cognitive impairment rates for the same age groups were 5.7%, 11.3%, 12.8%, 17.3%, 19.8%, and 15.3% respectively Males were overrepresented in each age group. Regional and sampling differences were evaluated and weighted estimates will also be reported. These estimates are compared with other published Australian and International estimates of the prevalence of dementia and cognitive impairment.
PP09
AUSTRALIAN ESTIMATES OF PROBABLE DEMENTIA AND COGNITIVE IMPAIRMENT: THE DYNOPTA STUDY
Kaarin J. Anstey1, M.A. Luszcz2, L. Ross-Meadows1, Kim Kiely
1, David Steel3, Carole Birrel3, and the Dynopta Investigators
1
Australian National University, Canberra, Australia
2
Flinders University, Adelaide, Australia
3
University of Wollongong
This project aimed to estimate rates of cognitive impairment/probable dementia in the Dynopta study. The Dynopta datafile is a newly derived dataset based on 9 contributing Australian Longitudinal Studies of Ageing. MMSE Data were available for 8835 participants (51.5% female) between the years 1991 and 2004. The ages ranged from 50 to 103 years, with a mean age of 71.6 (SD = 9.2). The data were drawn from Canberra, Adelaide, the Blue Mountains, Melbourne and Sydney. Rural participants were underrepresented. Probable dementia was classified as a score of <= 24 on the MMSE. Possible cognitive impairment was classified as a score of 24-26 on the MMSE. Results showed that below the age of 65, 5.6% were cognitively impaired. The unweighted probable dementia rates of participants aged 65-69, 70-74, 75-79, 80-84, 85-89 and 90+ were 4%, 9.6%, 15.5%, 21.8%, 31.1%, and 51.3% respectively. The unweighted possible cognitive impairment rates for the same age groups were 5.7%, 11.3%, 12.8%, 17.3%, 19.8%, and 15.3% respectively Males were overrepresented in each age group. Regional and sampling differences were evaluated and weighted estimates will also be reported. These estimates are compared with other published Australian and International estimates of the prevalence of dementia and cognitive impairment.
PP10
ANXIETY AND BONE MINERAL DENSITY IN COMMUNITY SAMPLES OF MEN AND WOMEN
Lana J. Williams
1, Ottar Bjerkeset2, Siri Forsmo3, Arnulf Langhammer2, Berit Schei3, Julie A. Pasco1, Michael Berk1
The University of Melbourne, Department of Clinical and Biomedical Sciences: Barwon Health, Australia
HUNT Research Centre, Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Norway
Background: Previous research has demonstrated reduced bone mineral density (BMD) in individuals with depression. This is yet to be examined among individuals with anxiety.
Aims: This study investigated the association between case level anxiety and BMD in a population-based sample of men (n = 1181) and women (n = 7471) participating in the second Nord-Trøndelag Health Study (HUNT 2), Norway.
Method: Anxiety symptoms were self-reported using the Hospital Anxiety and Depression Scale (HADS-A), and caseness was defined as a score ≥ 8. BMD was measured at the forearm using single-energy x-ray bone absorptiometry. Information on lifestyle factors and medication use was obtained via questionnaire.
Results: 124 men (10.5%) and 1180 women (15.8%) were identified with anxiety. In men, age-weight-smoking-adjusted BMD was 3.0% lower at the ultradistal forearm for those with anxiety (p = 0.01). BMD tended to be lower at the distal forearm (p = 0.18). In women, weight was an effect modifier in the association between anxiety and BMD. Age-weight-smoking-activity-HT-calcium adjusted BMD at the distal (p = 0.03) and ultradistal (p = 0.02) forearm was lower for heavier women with anxiety but this relationship diminished with decreasing weight.
Conclusion: BMD was lower among men and women with anxiety. This was not explained by anthropometry or lifestyle factors and was independent of co-morbid depression.
PP11
SUCCESSFUL AGEING AND AGEING-IN-PLACE: MINIMISING UNMET NEED
Natalie Chan
1, Kaarin J. Anstey1, Tim D. Windsor1, Mary A. Luszcz2
1
Centre for Mental Health Research, The Australian National University, Australia
2
School of Psychology, Flinders University, Australia
Many industrialised nations are currently experiencing a growing demand to ensure that their community care policies (i.e., services that enable older adults to remain living independently in their own homes for as long as feasible) are both effective and financially sustainable. Important components of community care policies include the provision of formal services; supporting informal carers and minimising unmet need. The latter has been found to be related to a range of negative outcomes including poorer mental health, lower quality of life and an increased risk of institutionalisation (1,2). This paper aims to address a research gap by examining whether certain support combinations (i.e., whether assistance is received from informal and/or formal sources) are more effective than others in minimising unmet need. Data were drawn from Wave 1 of the Australian Longitudinal Study of Ageing. The sample comprised 1961 community-dwelling older adults. Contrary to expectations, binary logistic regression analyses indicated that receipt of any type of support (informal only, formal only, or both informal and formal support) was related to a higher likelihood of unmet need. In addition, whilst increasing functional limitation was related to a higher likelihood of unmet need for those receiving no support, for those receiving any type of support, increasing functional limitation was related to a lower likelihood of unmet need. We discuss our findings in relation to theories of successful ageing and current community care policies.
1. Tennstedt, S., McKinlay, J., & Kasten, L. (1994). Unmet need among disabled elders: A problem in access to community long term care. Social Science and Medicine, 38(7), 915-924.
PP12
GENDER DIFFERENCES IN SCHIZOPHRENIA: RESULTS FROM THE AUSTRALIAN SCHIZOPHRENIA CARE AND ASSESSMENT PROGRAM (SCAP)
Sacha Filia1
, Kate Filia1, Paul B. Fitzgerald1, Anthony de Castella1, William Montgomery2, Jayashri Kulkarni1
1
Alfred Psychiatry Research Centre, The Alfred and Monash University, SPPPM
2
Eli Lilly Australia
Background: The experience of schizophrenia differs between genders. Gender differences are evident in age at onset, symptom expression, illness course and outcomes.
Aims: To examine gender differences in the demographic, clinical and outcome variables in an Australian cohort of people with schizophrenia.
Method: The Schizophrenia Care and Assessment Program (SCAP) is a prospective longitudinal observational study of people with schizophrenia and related disorders. 350 participants were seen 6-monthly for 3-years. Assessments included clinical measures such as the Positive and Negative Symptom Rating Scale (PANSS) and the Montgomery-Asberg Depression Rating Scale (MADRS). Other clinical variables including medications, side-effects, and hospitalisations were recorded. Outcome variables were assessed using the Quality of Life Scale (QLS), the Global Assessment of Functioning (GAF) and the SCAP Health Questionnaire. The economic impact of the condition was assessed using direct and indirect methods.
Results: 347 people (132 females, 215 males) participated. Female participants were significantly older than their male counterparts (mean overall age 33.8±11 years). Despite significantly lower overall psychopathology, females with schizophrenia were more expensive to treat in the inpatient setting. Compared to males, the females in SCAP reported significantly higher levels of functioning and quality of life.
Conclusion: Gender differences in schizophrenia exist with important clinical implications for the assessment and treatment of the condition.
PP13
STRESS RELATED GROWTH AND NEGATIVE OUTCOMES WITH FAMILIES DEALING WITH INFERTILITY CAUSED BY CANCER: A CO-OCCURRENCE MODEL
Jodie Fleming
1, Martin Johnson1
1
School of Psychology, University of Newcastle, Australia
Background: Research suggests that stress related growth can co-occur with negative psychological experiences. However, to date there is little empirical evidence of this.
Aims: The aim of the present study was to explore the co-occurrence model within the context of couples coping with infertility caused by cancer and/or its treatment.
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 using each variable for males, females, patients, partners, infertile and fertile couples.
Results: Results indicated that stress related growth (SRG) predicted psychological distress for males and fertile couples and depression for fertile couples. Depression was able to predict a decline in SRG for fertile couples. Anxiety was able to predict SRG for fertile couples in a positive linear direction. Psychological distress was able to predict SRG for males.
Conclusion: It is possible that both positive and negative psycho-social outcomes can co-occur for individuals experiencing cancer and its treatment effects. Anxiety is able to lead to an increase in stress related growth.
PP14
THE ROLE OF SOCIAL SUPPORT SATISFACTION AS A MODERATOR OF PSYCHOLOGICAL DISTRESS IN THE CONTEXT OF CANCER
Jodie Fleming, Martin Johnson
School of Psychology, University of Newcastle, Australia
Background: Coping literature emphasises the importance of social support satisfaction as a mechanism for moderating the stress experience.
Aims: The current study examined the role of social support satisfaction in negative outcomes including anxiety, depression 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 indicate that it is social support satisfaction and not the total number of social supports that is able to predict anxiety, depression and psychological distress. Satisfaction with spousal social support was a predictor of total social support satisfaction across all groups. Familial social support was a predictor of total social support satisfaction for females and fertile couples.
Conclusion: Satisfaction with social support, not the total number of social supports, is the active component in the moderation of psychological distress in the context of cancer.
PP15
HOPES REVISITED – INTRODUCING A 12-ITEM SCALE FOR MEASURING PERSONAL HOPEFULNESS (HOPES-12)
Terry J. Lewin
1,2, Kenneth P. Nunn1, Vaughan J. Carr1,2, Brian Kelly3, Helen J. Stain2,3, Clare Coleman3, Ketrina A. Sly1
1
Centre for Brain and Mental Health Research, The University of Newcastle and Hunter New England Mental Health, Australia
2
Schizophrenia Research Institute, Australia
3
Centre for Rural and Remote Mental Health (Orange), The University of Newcastle, Australia
Background: In the 1980's we developed a 20-item self-administered measure of global personal hopefulness (the Hunter Opinions and Personal Expectations Scale, HOPES-20). Recently, we have produced an abbreviated version (HOPES-12), with a modified scoring scheme, for potential use in epidemiological and clinical research.
Aims: To introduce the HOPES-12 and outline its properties, using data from the original HOPES-20 community studies (N = 770), two schizophrenia studies (N = 283), and the current Australian Rural Mental Health Study (ARMHS) (approx. N = 350).
Method: Item and factor analyses will be reported, together with a variety of subgroup comparisons.
Results: The HOPES-12 is performing satisfactorily. For example, within the schizophrenia samples, the Hope (H12_HS) and Despair Subscales (H12_DS) correlate −0.36 and have acceptable Cronbach alphas (0.78, 0.72), with 0.94 correlations between the H20 and H12 versions. For Global Personal Hopefulness (H12_GPH), the corresponding values are 0.79 and 0.96.
Conclusion: Trait measures, such as personal hopefulness, have been shown to be potentially useful predictors of psychopathology and other responses to adverse events. Simplifying the instrument should increase its utility (and uptake).
PP16
ACCOMMODATION STATUS, SYMPTOM SEVERITY AND THE IMPACT ON INPATIENT PSYCHIATRY LENGTH OF STAY AND READMISSION RATE
Adiel Bonett1, Steven Tahtalian1,2, Stuart Lee
2, Frances Biffin2, Jayashri Kulkarni1,2, Julian Freiden1, Brent Hayward1, Yitzchak Hollander1,2
1
Department of Psychiatry, Alfred Hospital, Victoria, Australia
2
Monash Alfred Psychiatry Research Centre, Monash University, Victoria, Australia
Background: Stability of accommodation is closely linked to outcomes for people with mental illness. Chronic stress associated with accommodation instability can exacerbate psychiatric symptoms. Frequently moving also disrupts social networks, removing supports that can prevent or minimize relapse rate and severity. Living homeless is particularly traumatizing and socially disruptive, and often associated with itinerancy and poor engagement with mental health support. Coupled with increased risk of comorbid substance abuse, homelessness often results in a cycle of crisis medical presentations. Stabilizing accommodation has however become more difficult, with the past decade witnessing reductions in Victoria of available crisis or temporary accommodation impacting psychiatric inpatient discharge planning.
Method: To explore the impact of accommodation status and symptom severity on inpatient length of stay (LOS) and readmission rate, pre- and post-admission accommodation status, demographics and symptom severity (Brief Psychiatric Rating Scale-BPRS) were collected for consenting consecutively admitted patients of The Alfred Psychiatry Inpatient Unit.
Results: Many psychiatry inpatients experienced highly unstable accommodation pre-admission, which was related to LOS and risk of readmission. This resulted in inpatient staff often arranging discharge accommodation that was not ideal, complicating ongoing community mental health follow-up. Symptom severity and dual diagnosis were also complicating factors, highlighting the need to consider accommodation within a holistic approach to care delivery.
Conclusion: Stabilization of accommodation plays a key role in supporting the mental health and psychosocial outcomes of psychiatric patients.
PP17
QUALITATIVE RESEARCH IN PSYCHIATRY
Shona Crabb
1, Anna Chur-Hansen1
1
Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia
Background: There are a number of different qualitative research methods which can offer significant benefits to psychiatric research. These include thematic analysis, discourse analysis, interpretative phenomenological analysis, ethnography, case studies and grounded theory.
Aims: The aim here is to outline and review some of the qualitative approaches that can be of use in psychiatric research, with reference to examples of such research.
Conclusion: Qualitative research methods are currently under-utilised in psychiatric research, and can bring a range of benefits to research conducted in this field. Furthermore, psychiatrists are well placed to apply to qualitative methodologies the skills that they acquire through training. Such skills include interview techniques, case write-ups, mental status examinations, history taking, and phenomenological formulations.
PP18
IMPROVING THE PSYCHOLOGICAL WELLBEING OF FAMILY CAREGIVERS OF HOME BASED PALLIATIVE CARE PATIENTS: A RANDOMISED CONTROLLED TRIAL
Peter Hudson1, Brian Kelly2, Lynn Oldham3, Tom Trauer4, Denika Novello
2, Kristina Thomas1, Ruth Jones5
1
Centre for Palliative care Education and Research, Melbourne
2
Centre for Rural and Remote Mental Health, University of Newcastle, Orange
3
WA Centre for Cancer and Palliative Care, WA
4
St Vincent's Hospital, Melbourne
5
Greater Western Area Health Service, NSW
Aims: This study will examine the effectiveness of an intervention aimed at improving psychological outcomes for caregivers of home based palliative care patients. The study is being conducted across three community-based sites-Melbourne Citymission Palliative Care (VIC), Silver Chain Hospice (WA), and Greater Western Area Health Service Oncology and Palliative Care Service (NSW).
Method: An RCT with approximately 100 participants per site is being conducted. Participants (carers of people receiving home based palliative care) are randomly allocated to either a control group or an intervention group, each continuing usual care. The 3 session intervention is delivered in the home and via telephone by a palliative care nurse. A rural version of the intervention is being trialed at the NSW site. Data is collected three times: pre-intervention; post intervention; and three months following bereavement. Measures include emotional wellbeing, social support, optimism, grief, caregiver confidence, appraisal of caregiving, rewards of caregiving, preparedness for caregiving, and unmet needs.
Conclusions: Analyses will be conducted to examine differences across conditions and sites.
PP19
OUTDOOR ADVENTURE CAMPS FOR YOUNG ADULTS WITH MENTAL ILLNESS
Sue M. Cotton
1, Liz Leorke2
1
ORYGEN Youth Health Research Centre, Department of Psychiatry, University of Melbourne, Parkville, Australia
2
YMCA Victoria, Fairfield, Australia
Background: Advances in psychopharmacology improve symptom outcomes for young adults with mental illness, however, functioning and social participation can still be affected. Alternative models such as outdoor adventure programs, encourage engagement and increase functioning. This has led to the development of Mental Health Access and Participation Project.
Aims: The aim of the current study was to evaluate the program model and outcomes of an outdoor adventure camping program for young adults (18-25 years) with mental illness.
Method: An outdoor adventure camping program was developed by YMCA Victoria in partnership with Sport and Recreation Victoria, and mental health service agencies. ORYGEN was commission to evaluate the camping program.
Results: Data of the evaluation of the logistics of the program will be presented. Also presented will be preliminary outcomes pertaining to self-esteem, mastery of skill, social connectedness, and quality of life.
Conclusion: This project has demonstrated that utilizing the expertise of mental health services and a community recreation provider benefits young adults experiencing mental illness.
PP20
VALIDATION OF THE ‘DIFFICULTIES IN EMOTION REGULATION SCALE’ (DERS) IN TWO SAMPLES: SCHIZOPHRENIA AND CO-EXISTING DEPRESSION AND ALCOHOL PROBLEMS
Marianne Ayre
1,2, Amanda Baker2,3, Vaughan Carr2,3, Terry Lewin1,3
1.
Hunter New England Health
2.
University of Newcastle, Australia
3.
Centre for Brain and Mental Health Research, Newcastle, Australia
Background: Emotional dysregulation is a central feature in many mental health disorders such as co-existing depression and alcohol problems and schizophrenia. However, there are few measures designed to capture the construct. Recently Gratz & Roemer (2004) developed a scale that assessed four domains of emotional regulation: (a) awareness and understanding of emotions; (b) acceptance of emotions; (c) ability to control impulsive behaviours and to behave in accordance with desired goals when experiencing negative emotions; and (d) ability to use situational-appropriate emotion regulation strategies flexibly. Empirical evidence supports the distinct but related nature of these four domains. The utility of the DERS in clinical populations remains unclear.
Aim: To determine the utility of the DERS in two clinical populations; individuals diagnosed with schizophrenia, and individuals with co-existing depression and alcohol problems.
Method: A total of 550 subjects will be recruited; 200 healthy controls, 130 volunteers diagnosed with schizophrenia, and 220 volunteers diagnosed with co-existing depression and alcohol problems. Participants will be asked to complete general socio-demographics and the DERS measure. Control participants will also be asked to complete a re-test on the DERS.
Results: Item and factor analyses will be reported, together with subgroup comparisons.
Conclusion: Having a simple measure of emotional dysregulation across a number of domains that highlights clinical problems will allow specific targets for intervention.
PP21
AN ANALYSIS OF SUICIDE DATA IN CURRENT PATIENTS OF THE HUNTER NEW ENGLAND MENTAL HEALTH SERVICE: SOME INTERESTING RURAL URBAN DIFFERENCES
Anoop Sankaranarayanan
1, Gregory Carter1,2, Terry J. Lewin1
1
Centre for Brain and Mental Health Research, Hunter New England Mental Health Service and the University of Newcastle, Australia
2
Calvary Mater Newcastle Hospital
Background: There is a higher community rate of suicide in rural versus urban populations and mental health patients have a differential suicide attempt rate by service type in Australia.
Aims: This study compared rural versus urban rates of suicide death in current patients of a large area mental health service in NSW, Australia.
Method: Suicide deaths were identified from compulsory Root Cause Analyses of patients who died by suicide in a 5 year period, 2003 to 2007. Age standardised rates of suicide were calculated for 2 groups; rural versus urban mental health service (at the last service contact). Rates were compared using Variance of Age standardised rates with 95% CIs.
Results: There were a total of 44 suicides. There was a male preponderance (73%), more with inpatient treatment (75%) and the majority were rural (62%). The commonest method was hanging (60%) with firearm suicides (11%) exclusive to rural subjects. Rural mental health patients had a 2.7 times higher Age standardised rate. There was a significant different in rates; rural suicides 3.09 /100,000/year (1.86-4.31CI 95%) and urban suicides 1.15 /100,000/year (0.54-1.75CI 95%), p < 0.05. Rural rates were higher than urban rates in all age groups.
Discussion: Rural rates of suicide are greater in rural than urban mental health populations, which is a similar pattern to rural versus urban differentials for community suicide in Australia. These differences in mental health populations may simply be a reflection of the underlying community rates; or differences in access to treatment, hospitalisation, after-care for inpatients, or socioeconomic levels; or accounted for by ascertainment biases, in the identification of cases or allocation of rural-urban status.
PP22
EFFECT OF SSRIs ON HUMAN OSTEOCLAST FORMATION AND FUNCTION
Jason Hodge,1
Lana Williams,1 Seetal Dodd,1 Geoffrey Nicholson,1 Michael Berk,1,2,3
1
Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong
2
Orygen Research Centre, Parkville
3
MHRI, Parkville
Background: SSRIs regulate serotonin (5-HT) signalling in bone cells and thus may influence bone metabolism.
Aims: To investigate if SSRIs can influence human osteoclast (OC) formation and function in vitro.
Method: Human OC generation and function was assessed on dentine substrate. Cultures were treated with citalopram, sertraline, paroxetine, fluvoxamine or fluoxetine at 0.3 and 3.0 µM and incubated for 14 days.
Results: At 3.0 µM, sertraline and paroxetine decreased OC number (−23% and −28%) whereas citalopram increased OC number (+26%). Sertraline, fluoxetine and paroxetine increased OC size (+83%, +70 and +40%) but there was no effect on nuclei number per cell, indicating that size increases were due to cytoplasmic spreading and not cell fusion. Fluoxetine and paroxetine decreased resorption (−28% and −29%), whereas sertraline decreased resorption by 60%. Only sertraline decreased resorption per osteoclast (−47%) suggesting that the decreases in total resorption seen for fluoxetine and paroxetine may reflect a reduction in OC number, whereas sertraline may not only inhibit OC formation but also affect mature OC resorptive function.
Conclusion: SSRIs directly effect human OC formation and function and may alter bone homeostasis in vivo, however the nature and clinical significance of this effect is poorly understood. Considerable differences in effect on OC were observed between different SSRIs.
PP23
ABNORMAL RESPONSE TO EMOTIONAL STIMULI IN DEPRESSION: THE CLINICAL IMPLICATIONS
Katie Douglas, Richard Porter
Department of Psychological Medicine, University of Otago – Christchurch, New Zealand
Background: Neuropsychological studies of depression consistently reveal biases towards negatively valenced stimuli (Murphy et al., 1999) and abnormal responses to negative feedback (Beats, Sahakian, & Levy, 1996; Elliott et al., 1996).
Aims: To examine further the nature of this impairment and its clinical significance. The aim of our first study was to investigate the ‘catastrophic response to failure’ in depression. Unlike most previous studies, latency of response and delay condition data were included in the analysis. Our second study is being conducted currently and investigates the use of two facial emotion perception tasks in early treatment of severe depression.
Method: In Study 1, 44 unmedicated outpatients with a primary diagnosis of major depression and an equal number of matched healthy controls performed the simultaneous/delayed matching to sample task (S/DMTS). In Study 2, severely depressed inpatients and matched controls completed facial emotion recognition (or perception) tasks on admission to hospital, 10-14 days later, and at 6 weeks.
Results: In Study 1, depressed patients performed significantly worse than controls on the S/DMTS task. Furthermore, the overall probability of making an error following feedback indicating that an error had been made on the directly preceding trial was significantly greater in the depressed group (t=−2.60, d.f. = 69.44, P=0.01). Preliminary results from the second study will be presented.
Conclusion: Overall, the findings from Study 1 show support for the concept of abnormal response to negative feedback in depressed patients. The ability of facial perception tasks to predict response to treatment will be discussed for Study 2.
PP24
TRANSFERRED TO AN ORAL PRESENTATION
PP25
ACUTE EFFECTS OF HYPERVENTILATION DURING ELECTROCONVULSIVE THERAPY ON COGNITION, QUANTUM OF ANTIDEPRESSANT RESPONSE, THRESHOLD AND ICTAL-EEG QUALITY. A RANDOMIZED DOUBLE-BLIND STUDY
Prashanth Mayur, Amanda Bray, Joe Fernandez
Cumberland Hospital, Westmead, NSW, Australia
Hyperventilation is an often used procedure to augment seizure induction during electroconvulsive therapy. Studies so far have shown that when hyperventilation is provided passively after the usual anaesthetic induction, seizure length increases. Distinct physiological changes i.e. reduction of alveolar CO2 have been shown with hyperventilation. However, its effect on other seizure and clinical parameters such as seizure threshold and quality, cognitive and antidepressant effects are yet to be systematically studied.
In this study, consecutive consenting patients (n = 25) over a two year period (June 2006 to June 2008) who were referred to ECT for treatment of Major depression entered the study. All patients received Right Unilateral ECT. During the first ECT, threshold stimulus dose was measured using standard Duke University protocol. From the second ECT onwards, the stimulus dose was three times the threshold dose. Patients were randomized using the SNOSE method into Hyperventilation or No Hyperventilation at the second, third and the fourth ECT sessions. In this study, passive Hyperventilation is defined as passive hyperventilation of 25 breaths given between induction and electrical stimulation. Thresholds were re-determined at the fifth ECT session. Baseline demographic details were collected. Clinical, cognitive and ictal-EEG quality ratings were collected at baseline and during the course of the ECT. The results are being analyzed and will be duly discussed.
PP26
THE INTERACTION BETWEEN IVF HORMONE TREATMENT AND MOOD
Suzi Riess
1, Diana Korevaar2, Jayashri Kulkarni1
1
Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University School of Psychology, Psychiatry and Psychological Medicine, VIC, Australia
2
Albert Road Clinic
Background: Fertility-enhancing hormones have neuroendocrine consequences, and may affect women's mood states via numerous pathways, including alterations in oestrogen and progesterone levels, which in turn influence serotonergic systems. IVF therapy involves numerous hormones, generally including gonadotrophin-releasing agonists, gonadotrophins, human chorionic gonadotrophin and progesterone. Research investigating psychological side effects of IVF hormones is limited in scope, and interpretation of results is difficult due to study heterogeneity and methodological problems.
Aims: This study aims to examine the dynamic interplay between fertility hormones and women's mood states, particularly depression and anxiety, and to assess whether women with differing baseline levels of pyschopathology react differently to fertility hormones and to IVF's outcome.
Method: A community sample of women (25 to 45 years) are currently being recruited. Participants complete psychological questionnaires (including Beck depression (BDI-II) and anxiety (BAI) inventories, and a recent life events survey) at three time points over an IVF cycle: pre-treatment, during treatment and post-treatment.
Results: Data is still being gathered and will be analysed using repeated measures ANOVAs to compare women with varying baseline levels of depression/anxiety. Final results will be presented.
Conclusion: This study's results will further understanding of fertility hormones’ psychological impact during the IVF cycle and will have clinical implications regarding development of sensitive screening tools and tailored psychological interventions.
PP27
THE IMPACT OF GENERAL PRACTITIONER GENDER ON THE MANAGEMENT OF A DEPRESSED PATIENT
Gordon Parker1,2, Matthew Hyett
1,2
1
School of Psychiatry, UNSW
2
Black Dog Institute, New South Wales, Australia
Aims: In Australia, up to a quarter of all primary care presentations involve mental disorders (1). High rates of depression mean that general practitioners (GPs) play a particularly important role in providing adequate treatment. Several studies have identified that GPs fail to detect depression in up to 50% of cases (2), raising the question as to the level of care provided for patients inherently in need. It has been previously reported that male and female GPs differ in the length of time they spend in consultation with their general patients (3). These findings, in addition to anecdotal claims of gender differences in the treatment of depression by GPs led to the current study being undertaken. We first sought to determine whether differing levels of care existed in practice. Further, if there were any differences, what was their nature?
Methods: First, referral letters from 100 GPs to a specialised psychiatric depression clinic were analysed by word count and gender of referrer. Second, a web-based survey of 517 participants inquired as to how they perceived their first encounter for depression with a GP in terms of levels of management nuances. The interpersonal style of the practitioner was also assessed.
Results: Our first study established that female practitioners wrote distinctly longer referral letters. Our second study identified that female practitioners were seen as distinctly more caring over a range of parameters including being more likely to listen to the patient. Other practitioner/patient gender differences were also observed, including female patients being less likely to return to their male practitioner and male practitioners being more likely to prescribe antidepressant monotherapy.
Conclusion: Reasons why female practitioners are viewed as more caring – and any impact on the management of those with a depressive disorder – as well as prescribing practices across practitioner gender would benefit from refined investigation.
1. Wilhelm et al. (2008). MJA; 188: S114-S118.
2. Clarke et al. (2008). MJA; 188: S110-S113.
3. Britt et al. (2005). MJA; 183: 68-71.
PP28
EARLY AGE OF ONSET IS ASSOCIATED WITH HIGH RATES OF ANXIETY COMORBIDITY IN BIPOLAR I AND SCHIZOAFFECTIVE DISORDERS
Seetal Dodd,2 Felicity Ng,2 Lesley Berk,2 Paul B Fitzgerald,
1
Anthony de Castella,
1
Sacha Filia,
1
Kate Filia,
1
Frances Biffin,
1
Katarina Kelin,3 Meg Smith,4 Bill Montgomery,
3
Jayashri Kulkarni,
1
Michael Berk,2,4,5
1
APRC, The Alfred and Monash University, Prahran
2
Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong
3
Eli Lilly Australia, West Ryde
4
School of Applied Social and Human Sciences, University of Western Sydney, Penrith South
4
Orygen Research Centre, Parkville
5
MHRI, Parkville
Background: The Bipolar Comprehensive Outcomes Study is a 2-year observational study, which tracked illness and functional outcomes of patients with bipolar I disorder (n = 176) or schizoaffective disorder, bipolar type (n = 63).
Aims: As a substudy, the relationship between comorbid diagnoses and age at onset of the first symptoms of mental illness was investigated.
Method: Participants were assessed by structured clinical interview at study entry. Primary and comorbid diagnoses were determined using the Mini-International Neuropsychiatric Interview Version 5. Information on the history of illness of participants prior to study entry was obtained by administration of a questionnaire.
Results: Comorbidities consisted mainly of anxiety, alcohol and substance disorders. In bipolar I disorder, an association was found between co-morbid anxiety disorders and early age of bipolar illness onset.
Conclusion: This study demonstrates high rates of comorbidities in bipolar I and schizoaffective disorders, and suggests an association between anxiety and early onset bipolar illness.
PP29
TRANSFERRED TO AN ORAL PRESENTATION
PP30
MINDFULNESS BASED COGNITIVE THERAPY FOR BIPOLAR DISORDER
Vijaya Manicavasagar, Tania Perich, Philip Mitchell, Jillian Ball, Justine Corry
School of Psychiatry, University of NSW and Black Dog Institute, Australia
Background: Bipolar disorder is a recurrent and disabling condition that can result in impairment in many areas of functioning. Anxiety disorders are also prevalent and anxiety has been found to predict poorer outcome amongst those with the disorder. Mindfulness programs have been shown to be an effective intervention for managing anxiety and stress and may assist in reducing these symptoms for patients with bipolar disorder.
Aims: We describe a recently-commenced randomised-controlled trial designed to evaluate the efficacy of Mindfulness Based Cognitive Therapy (MBCT) versus treatment as usual (TAU) to assist in the management of bipolar disorder and to examine its effects on co-morbid anxiety.
Method: Patients will be allocated to either to MBCT or TAU. Patients allocated to the MBCT program will receive 8 weekly sessions of group therapy based on the MBCT treatment manual developed by Segal, Williams and Teasdale (2000). The TAU group will receive their usual care from their practitioner and written educational material about bipolar disorder. Participants will be assessed at baseline, treatment mid-point, post-group and then at 3 months, 6 months, 9 months and 12 months on psychiatric symptomatology associated with bipolar disorder, anxiety and measures relating to social and occupational function.
Results: Initial results will be presented at the meeting.
PP31
TWO-YEAR TREATMENT OUTCOMES OF AN AUSTRALIAN OUTPATIENT COHORT WITH BIPOLAR I OR SCHIZOAFFECTIVE DISORDER
Jayashri Kulkarni,1 Michael Berk,2,3,4 Paul B. Fitzgerald,1 Anthony de Castella,
1
Seetal Dodd,2 Sacha Filia,
1
Kate Filia,
1
Frances Biffin,
1
Lesley Berk,2 Bill Montgomery,
5
Meg Smith,6 Alan Brnabic,7 Amanda Lowry,7 Katarina Kelin5
1
APRC, The Alfred & Monash University, Melbourne
2
Dept of Clinical and Biomedical Sciences, University of Melbourne, Geelong
3
Orygen Research Centre, Parkville
4
MHRI, Parkville
5
Eli Lilly Australia, West Ryde
6
Social Justice Social Change Centre, University of Western Sydney, Penrith
7
ICIS, Eli Lilly, Macquarie Park
Background: The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year observational study of participants with bipolar I (n = 175) or schizoaffective disorder (n = 64).
Aim: To explore clinical and functional outcomes associated with ‘real-life’ treatment.
Method: Participants prescribed olanzapine (n = 84) or conventional mood stabilizers (n = 155) were assessed every 3 months. Twenty-four month longitudinal clinical, pharmacological, functional and socio-economic data are presented.
Results: At study entry, 51% participants smoked daily, 29% were unemployed, and 63% had considered suicide in the previous month. Overall, 44% of participants required hospitalisation during the study, spending a cumulative median of 21 days (range 1-345). By the end of the study, 68%(n = 41/60) of participants who reported severe depression at baseline were mildly depressed; 17%(n = 30/176) became severely depressed (from mild/moderate baseline symptoms); 29%(n = 29/99) lost their paid employment; 73%(n = 33/45) who were manic at baseline had no mania and 11%(n = 21/192) developed mania.
Conclusion: BCOS provides important insight into the clinical and functional outcomes associated with long-term treatment for bipolar and schizoaffective disorders.
PP32
ELECTROPHYSIOLOGICAL CORRELATES OF FACE PROCESSING IN BIPOLAR DISORDER: AN ERP STUDY
Racheal Degabriele
1,2 Jim Lagopoulos1,2,3, Antony Henderson1, Carissa M. Coulston1,2, Gin S. Malhi1,2,3
1
Department of Psychological Medicine, Northern Clinical School, University of Sydney, Sydney Australia
2
CADE Clinic, Royal North Shore Hospital, Sydney Australia
3
Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Sydney Australia
Aims: Electroencephalogram (EEG) studies have detected differences in Event-Related Potentials (ERPs) in subjects with bipolar disorder and schizophrenia in comparison to normal controls. The goal of the present study was to identify key ERP markers that correspond to the functional deficits evident in these illnesses.
Methods: Face- and emotion-specific ERPs (N170) were elicited using the go/no-go inhibition task. Twenty subjects each diagnosed (DSM IV criteria) with schizophrenia, bipolar disorder, and 20 age- and sex-matched controls were presented with visual face stimuli (240 images) depicting either a happy or sad emotion. An equal number of both happy and sad faces were displayed in quick succession (500ms), and subjects were instructed to respond to one expression only by pressing the response pad and to ignore/inhibit a response to the other. Part way through the paradigm the instructions were changed, requiring identification of the alternate expression. Twelve sets in total requiring six of each expression were presented. Electrophysiological data were obtained from 36 channels.
Results: The N170 component was significantly decreased in amplitude in both schizophrenia and bipolar groups to both facial expressions. In contrast, the control group exhibited robust component amplitudes in response to both emotions but in addition demonstrated a modulation in the amplitude of the N170 that was specific to facial expression.
Conclusion: Both patients with bipolar disorder and schizophrenia demonstrated impairments in their neural coding of faces as reflected by blunted N170 waveforms. The capacity to discriminate between emotions also appears to be impaired in both patient groups.
PP33
EMOTION RECOGNITION IN SCHIZOPHRENIA – WHAT DOES THE WHOLE FACE TELL US THE EYES CANNOT?
Nicole Joshua
1,2, Susan Rossell1,3
1
Department of Cognitive Neuropsychiatry, Mental Health Research Institute, Parkville VIC, Australia
2
Department of Psychiatry, The University of Melbourne, VIC, Australia
3
Cognitive Neuropsychiatry Laboratory, Monash –Alfred Psychiatry Research Centre, VIC, Australia
Background: Emotion recognition deficits are well documented in schizophrenia and impaired emotion processing is related to poor social functioning. Evidence suggests schizophrenia patients do not use information from a whole visual scene rather process individual elements separately.
Aims: This study investigated differences in emotion recognition between control participants and schizophrenia patients while responding to whole faces or information from the eyes of a face.
Method: Schizophrenia patients (n = 29) and control participants (n = 29) completed an emotion recognition task involving five emotion categories; happy, sad, neutral, angry, fearful. The task was completed once while viewing whole faces and again when viewing just the eye region, the presentation order was counterbalanced.
Results: Overall control participants performed better than schizophrenia patients. When presented with the eyes alone, the pattern of performance between groups was the same over the five emotions. When presented with the whole face however, schizophrenia patients differed in their pattern of performance compared to controls with less accurate recognition of negative emotions specifically.
Conclusion: Unlike schizophrenia patients, control participants utilised more information from the whole face to consistently aid in recognition of all five emotions. Findings are discussed with reference to the relationship between poor perceptual organisation and emotion processing.
PP34
MIRTAZAPINE ADD-ON THERAPY IN THE TREATMENT OF SCHIZOPHRENIA WITH ATYPICAL ANTIPSYCHOTICS: A DOUBLE-BLIND, RANDOMISED, PLACEBO-CONTROLLED CLINICAL TRIAL
Seetal Dodd
1, Michael Berk1,2,3, Russell D'Souza4, Harry Hustig4, Les Koopowitz6, Andrew Monkhouse5, Fiona Bole4, Suma Sathiya4, Danijela Piskulic4
1
Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong
2
Orygen Research Centre, Parkville
3
MHRI, Parkville
4
Northern Psychiatry Research Centre, Department of Psychiatry, University of Melbourne
5
Glenside Campus, Royal Adelaide Hospital
6
University of Adelaide
Background: Negative symptoms are a core part of the phenomenology of schizophrenia, and are inadequately treated by existing antipsychotics. Some studies have reported improvement in negative symptoms when antidepressants are administered as an adjunct to antipsychotics
Aims: To investigate the efficacy of mirtazapine, adjunctive to antipsychotics, as treatment for the negative symptoms of schizophrenia
Method: A 6-week, double-blind, placebo-controlled, randomised trial of mirtazapine (30 mg/day) or placebo as adjunctive treatment with atypical antipsychotics was conducted. Outcome measures included the PANSS, CGI, SAS and HAMD.
Results: There were no significant differences between mirtazapine and placebo treated groups at baseline or from baseline to 6-week endpoint for any of the outcomes measures. For the PANNS-ve there was a general tendency for patients on Mirtazapine and those on Placebo to “improve” at both sites with little difference between the two treatments. Overall, the difference in slopes between Mirtazapine and Placebo was not significant (p = 0.465).
Conclusion: In this study mirtazapine was not superior to placebo as adjunctive therapy for negative symptoms of schizophrenia.
PP35
LONG-TERM MEMORY IMPAIRMENT IN SCHIZOPHRENIA: INVESTIGATING A RETRIEVAL DEFICIT FOR WORDS AND FACES
Nicole Reece, Andrew Heathcote, Patricia Michie, Kerry Chalmers, Martin Cohen
Centre for Brain and Mental Health Research, and School of Psychology, University of Newcastle, NSW, Australia
Episodic memory impairment in schizophrenia is one of the most consistently reported cognitive deficits (LePage, 2007) and the best predictor of functional outcomes (Green, 2000); however its precise nature, and possible remediation strategies, is yet to be elucidated (Fletcher & Honey, 2006). This research investigates cued-recall and recognition memory impairment in schizophrenia. Previous research suggests people with schizophrenia have difficulty spontaneously organising new information (Cirillo & Seidman, 2003). We test whether memory impairment in schizophrenia is due to encoding deficits affecting words and faces. We attempted to remove encoding deficits by facilitating optimal encoding using highly structured lists and strategic direction during study and retrieval. This was successful, with patients not provided with direction performing significantly worse, particularly with faces stimuli, both immediately and after a one week delay. A surprise test of memory for stimuli used as foils in the one-week recognition test (Jacoby et al, 2005) suggested that patients also tended to have an encoding deficit affecting test as well as study. These findings indicate memory dysfunction in schizophrenia may benefit from cognitive remediation. Ongoing research with control participants will provide a baseline for comparison with effects in patients.
PP36
HALLUCINATIONS IN THE GENERAL POPULATION AND MEMORY BINDING
Saruchi Chhabra
1
, Johanna C. Badcock2, Murray T. Maybery
1
1
School of Psychology, University of Western Australia, Crawley, WA 6009, Australia
2
Centre for Clinical Research in Neuropsychiatry, Graylands Hospital/School of Psychiatry & Clinical Neurosciences, University of Western Australia, Claremont, WA 6910, Australia
Background: A combination of deficits in memory binding and intentional inhibition has been proposed to underpin auditory hallucinations in schizophrenia. Healthy individuals in the general population also report hallucinations suggesting a continuum of underlying cognitive processes. However, this continuity model may overlook important differences in the phenomenology of hallucinations in the general population (versus psychosis), which may indicate important differences in aetiology.
Aim: To examine the frequency of hallucinations and strength of memory binding in healthy individuals predisposed to hallucinations.
Method: A modified version of the Launay-Slade Hallucination Scale-Revised, including an assessment of the frequency of hallucination experiences, was completed by 615 undergraduates, from which sub-samples of high (n = 25) and low (n = 27) scorers were drawn. Participants were tested on memory binding using a voice-location binding task.
Results: The frequency of hallucinations experienced in predisposed individuals was much less than that reported for individuals with schizophrenia. Furthermore, no group differences in memory binding were observed and no association between hallucination frequency and binding ability was found.
Conclusion: The current results suggest that some different mechanisms may exist in healthy individuals predisposed to hallucinations relative to schizophrenia patients experiencing hallucinations.
PP37
INVESTIGATION OF miRNA INFLUENCE ON RGS4 AND NRG1 GENE EXPRESSION IN SCHIZOPHRENIA
Erin J. Gardiner
1,2, Adam P. Carroll1,2, Natalie J. Beveridge1,2, Paul A. Tooney1,2, Murray J. Cairns1,2
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: RGS4 and NRG1 are schizophrenia candidate genes with altered expression in the brains of patients with schizophrenia. RGS4 and NRG1 are predicted targets of several micro RNA (miRNA), a class of small non-coding RNA with important roles in the regulation of neurodevelopment, that also show altered expression in schizophrenia. These miRNA may be involved in the dysregulation of these genes in schizophrenia by post-transcriptional gene silencing.
Aims: To investigate whether altered miRNA target and regulate the expression of schizophrenia candidate genes RGS4 and NRG1.
Method: Constructs were generated by inserting putative miRNA recognition elements (MRE) from the RGS4 and NRG1 genes, and mutant versions of these MRE, into the 3’-UTR of a firefly luciferase reporter gene in the pMIR-Report vector. These constructs were then used to co-transfect HEK-293 cells with either synthetic miRNA or antisense oligonucleotide inhibitors of these miRNA for bi-directional modulation. Luciferase expression was measured in a dual luciferase assay.
Results: Preliminary data supports the hypothesis that RGS4 and NRG1 are targets of post-transcriptional gene silencing mediated by miRNA that show altered expression in the brains of patients with schizophrenia.
Conclusions: miRNA may play a significant role in regulating the expression of RGS4 and NRG1 and alterations to this regulation may underlie a genetic predisposition to schizophrenia.
PP38
ADOLESCENT INTERPRETATION OF SELF-REPORTED PSYCHOTIC-LIKE EXPERIENCES (PLEs)
Joe A. Buckby
1,2, Margaret Ross1,2, Jaymee Ryan1,2, B. Nelson1,2, Gennady Baksheev1,2, Alison R. Yung1,2
1
ORYGEN Youth Health, Melbourne, Australia
2
Department of Psychiatry, University of Melbourne, Australia
Background: The use of questionnaires in psychiatric research allows for a cost-effective way to acquire large samples. Much of the research into subclinical expressions of psychotic symptoms, or psychotic-like experiences (PLEs) has been done with self-report instruments such as the Community Assessment of Psychic Experiences (CAPE). However, despite having good psychometric properties, these instruments evidence high false positive rates with respect to the prediction of psychosis. Additionally, there is only moderate agreement between interview-rated and self-reported PLEs. It is therefore important to determine the extent to which questionnaire-elicited PLEs accurately reflect the constructs we seek to measure.
Methods: 112 young people (Mean age = 18.6 years) completed a diagnostic interview plus questionnaire battery. In addition, participants completed a semi-structured interview that assessed their interpretation of the 20 positive symptom items of the CAPE.
Results: On average, participants only correctly interpreted two thirds of CAPE items (65.5%). There was a significant range however, with some items showing good interpretation (eg. ‘believing in witchcraft’, 99.1%) while others were misinterpreted by the majority of the sample (eg. ‘people are not what they seem to be’, 26.8%). There were no significant demographic predictors of the proportion of items correctly interpreted.
Discussion: Adolescents do not interpret self-reported PLEs as well as needed by researchers. There is a clear need to develop measures that are specifically targeted to young people and which will be well interpreted in order to gain a more thorough understanding of the prevalence and sequelae of PLEs.
PP39
THE CLINICAL SPECTRUM OF CLOZAPINE-INDUCED MYOCARDITIS
K.J. Ronaldson1, J.J. McNeil1, A.J. Taylor2, D.J. Topliss3, Paul B. Fitzgerald4
1
Department of Epidemiology & Preventive Medicine, Monash University
2
The Heart Centre, The Alfred
3
Department of Endocrinology & Diabetes, The Alfred
4
Alfred Psychiatric Research Centre, The Alfred
Serious adverse effects, including myocarditis, limit the use of clozapine, an exceptionally effective treatment for schizophrenia. No systematic studies have been conducted of the clinical history of clozapine-related myocarditis.
Aim: To identify trends in a case series with significance for monitoring and diagnosis of clozapine-related myocarditis.
Methods: A case definition was developed by a multidisciplinary group using reports of clozapine-induced myocarditis submitted to the Australian Therapeutic Goods Administration. Potential cases of myocarditis with clozapine and a comparative group comprising long term clozapine users were documented from the patients’ medical records.
Results: 30 of 48 potential cases met the case definition. Two patients died and the diagnosis for these was confirmed on cardiac histology. Nearly all of the remaining patients had persistent tachycardia and elevated troponin. The time to onset was 14-21 days in all except two patients. Of the patients who survived, 68% had eosinophilia occurring 0-7 (mean 3.5) days after the peak in troponin. C reactive protein (CRP) was elevated to above 100 mg/L in 83% and some had elevation in CRP when troponin was still normal. 30% of the control group developed eosinophilia.
Conclusion: Monitoring of patients starting clozapine for myocarditis should be conducted with added intensity during the third week of therapy. Eosinophil counts should not be relied on for diagnosis, but elevated CRP may be an early indicator of developing myocarditis.
PP40
EMOTION RECOGNITION TRAININING IN SCHIZOPHRENIA: FUNCTIONAL PREDICTORS AND GENERALIZABILITY
Pamela Marsh
1, Melissa Green2,3, Anthony Harris5,, Tamara Russell1,4, Max Coltheart1
1
Macquarie Centre for Cognitive Science, Macquarie University
2
School of Psychiatry & Black Dog Institute, University of New South Wales
3
National Alliance for Research on Schizophrenia and Depression, USA
4
Schizophrenia Research Institute, Australia
5
Discipline of Psychological Medicine, University of Sydney
Background: Impaired emotion perception is associated with poor social functioning in schizophrenia. Emotion recognition training (ERT) improves recognition of facial emotions for up to one month. We investigated whether baseline neurocognitive and social functioning predicted ERT efficacy, and whether improvements generalise to face stimuli not used in training.
Method: Thirty-nine participants with schizophrenia received ERT using the Micro-Expression Training Tool (METT; Ekman, 2003); twenty-two completed followed-up assessments at one week and one month post-training. Emotion recognition was assessed pre- and post-training using METT faces and other faces not used in training. Measures of social functioning (including researcher-scored and self-report measures) and working memory (WM) were assessed at baseline (pre-training).
Results: Recognition of METT faces improved immediately post-ERT; Improved recognition of other faces was evident at one week and one month post-training (n = 22). Improved recognition of METT faces was associated with better WM and higher (researcher-scored) interpersonal functioning; improved recognition of other faces was associated with higher (self-rated) interpersonal functioning.
Conclusions: Improved emotion recognition generalises to faces not used in ERT. Improvements continue for one month post-training. Baseline social and cognitive functioning predicts the efficacy of METT training.
PP41
WITHDRAWN
PP42
ADEPT: A DEFINITIVE ESTROGEN PATCH TRIAL
Jayashri Kulkarni
1, Caroline Gurvich1, Ling Mu1, Stella Chaviaras2, Saji Damodaran2, Kathrine Roberts3, Michael Berk3, Anthony de Castella1, Paul Fitzgerald1, Henry Burger4
1
The Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Melbourne, Australia
2
Department of Clinical and Biomedical Sciences, Barwon Health and University of Melbourne, Melbourne, Australia
3
Clinical Trials Research Group, Dandenong Hospital and Monash University School of Psychology, Psychiatry and Psychological Medicine, Melbourne, Australia
4
Prince Henry's Institute, Monash Medical Centre, Melbourne, Australia
Background: Accumulating evidence suggests estrogens may have therapeutic effects in severe mental illnesses, including schizophrenia, via neuromodulatory and neuroprotective activity.
Aims: The aim of the current study was to compare the effectiveness of adjunctive transdermal estradiol to adjunctive placebo in the treatment of acute psychotic symptoms. Method: Women of childbearing age with a diagnosis of schizophrenia or schizoaffective disorder were invited to participate in this 8-week three-arm (100mcg/day adjunctive transdermal estradiol, 200mcg/day adjunctive transdermal estradiol, or adjunctive transdermal placebo) double-blind, placebo controlled study. All patients continued to receive standard antipsychotic treatment whilst in the trial. Psychopathology, mood and cognition were assessed at baseline then at weekly, fortnightly or monthly intervals using the PANSS, MADRS and RBANS. Estrogen, progesterone, and gonadotropin levels were assessed at baseline and days 28 and 56.
Results: Preliminary results will be presented.
Conclusions: Our previous studies have indicated that women receiving 100mcg transdermal estradiol improved significantly more than women receiving placebo, in terms of positive, negative and general psychopathology symptoms. The findings from this multisite ‘proof-of-concept’ study will determine whether estradiol can be used as an adjunctive treatment of psychotic symptoms in women with schizophrenia.
This research is supported by The Stanley Medical Research Institute.
PP43
NEONATAL CAPSAICIN TREATMENT PRODUCES BRAIN CHANGES IN ADULT RATS SIMILAR TO THOSE FOUND IN SCHIZOPHRENIA
Penny Newson
1, Maarten van den Buuse2, Vaughan Carr1, Loris A. Chahl1
1
Schizophrenia Research Institute, University of Newcastle, Australia
2
Mental Health Research Institute, University of Melbourne, Victoria, Australia
Treatment of neonatal rats with capsaicin results in reduced brain weight, reduced hippocampal and cross-sectional area, reduced cortical thickness and increased neuronal density at 5-7 weeks of age (1). The aim of the present study was to determine whether these changes persist and are present in adult rats. Wistar rats under ice anaesthesia were treated on neonatal day 2 with capsaicin 50mg/kg s.c. or vehicle. At 8-14 weeks of age one cohort of rats was given a lethal dose of sodium pentobarbitone, brains removed, fixed in formalin and coronal sections, 50 µm, cut and Nissl stained. In another cohort of rats, cutaneous plasma extravasation responses to intracutaneous methylnicotinate (5×10−8 to 5×10−6 mol) were measured in animals anaesthetized with sodium pentobarbitone, 40mg/kg, and given Evans blue, 50mg/kg, into a tail vein. In a further cohort locomotor behaviour and pre-pulse inhibition (PPI) to acoustic startle were tested. It was found that the structural brain changes previously observed in capsaicin treated rats at 5-7 weeks (1) were maintained into adulthood, with the exception of the motor cortex where neuronal density was not increased. Furthermore, plasma extravasation responses to methylnicotinate were reduced in capsaicin treated rats (P < 0.05). However, the behaviour of capsaicin treated rats was similar to controls and PPI was not disrupted. It is concluded that the structural brain changes and reduced plasma extravasation responses to methylnicotinate suggest that the capsaicin treated rat is a potential animal model of aspects of schizophrenia.
(1) Newson, P. Et al (2005). Br. J. Pharmacol., 146, 408-418.
PP44
ARE VERBAL AUDITORY HALLUCINATIONS ASSOCIATED WITH DEFICITS IN RECALLING CONTEXTUAL ELEMENTS OF CONVERSATIONS?
Simone Field
1, Greg Savage1,2, Susan Rossell1,3,4, Paul Fitzgerald1,4
1
School of Psychology, Psychiatry and Psychological Medicine, Monash University, Melbourne, Australia
2
Macquarie Centre for Cognitive Science, Macquarie University, Sydney, Australia
3
Mental Health Research Institute; Melbourne, Australia
4
Alfred Psychiatric Research Centre, Alfred Hospital, Melbourne, Australia
Background: It has been suggested that an inability to accurately recall contextual elements of conversations may be associated with verbal auditory hallucinations (VAH) in schizophrenia.
Aims: To investigate whether VAH differentiated participants’ ability to recall the location where previously heard sentences had been spoken.
Method: Patients with (n = 14) and without (n = 18) VAH, diagnosed with a schizophrenia spectrum disorder, were compared with aged-matched healthy controls (n = 14). Participants listened to three trials of a male voice speaking sentences each accompanied by very distinguishable background sounds (e.g., seaside, traffic). After each trial participants heard a series of sentences spoken without accompanying background sounds. Following each sentence, participants were asked: 1) had they heard it before? and if so, 2) where had it been spoken?
Results: All groups were equally able to recognise those sentences heard previously, however the patients had significantly greater difficulty than controls accurately recalling the location of recognised sentences. VAH did not differentiate patient performance.
Conclusion: Patients with schizophrenia have a deficit in their ability to accurately bind contextual elements of an auditory scene, however this deficit is not associated with the presence of VAH.
PP45
FACIAL EXPRESSION PROCESSING IN SCHIZOPHRENIA: ASSOCIATIONS WITH PSYCHOPATHY, SYPTOMATOLOGY AND EMOTION RECOGNITION
Ketrina Sly
1, Carmel Loughland1,2, Terry Lewin1,2, Mick Hunter1
1
Centre for Brain and Mental Health Research, Hunter New England Mental Health & University of Newcastle
2
Schizophrenia Research Institute (SRI), Australia
Background: Individuals with schizophrenia are known to exhibit marked deficits in facial expression perception. Similarly, people with a history of psychopathy exhibit emotion recognition difficulties, particularly in the recognition of negative valanced emotions, such as fear and anger. However, the relative contribution of psychosis and psychopathy traits to visual processing deficits remains unclear.
Aims: To extend previous research on emotion processing deficits in schizophrenia by assessing the contribution of coexisting psychopathy traits, as well as relationships with symptomatology, emotion dysregulation, and overall cognitive functioning. It is hypothesized that subjects with schizophrenia would exhibit a more restricted pattern of visual scanning, poorer overall emotion recognition accuracy and lower emotion responsivity, and that psychopathic traits would make an independent contribution to performance deficits.
Method: Participants with a history of offending behaviour and a major mental illness were recruited through a Mental Health Court Liaison service. Facial affect processing was assessed in terms of visual scanning, emotion recognition and emotion induction, using two separate visuo-cognitive eye tracking tasks. Both tasks involve the presentation of face stimuli, consisting of colour pictures of male and female actors depicting specific expressions.
Results: Pilot findings will be presented. It is expected that current symptoms, emotion dysregulation and overall cognitive function will be associated with facial emotion perception performance, but that the hypothesised group differences would remain after these factors were taken into account.
Conclusion: This study is one of the first to examine the relationship between schizophrenia and the impact of psychopathy on face processing deficits using visual scanning techniques.
PP46
QUALITY OF LIFE ON RISPERDAL CONSTA: BASELINE RESULTS
Jayashri Kulkarni, Anthony R. de Castella, Paul B. Fitzgerald, K. Sinclair, S. Olsen, Frances Biffin, Kate Filia
Monash Alfred Psychiatry Research Centre, Monash University & Alfred Hospital, VIC, Australia
Background: Risperdal Consta is the first depot atypical antipsychotic on the market. This study follows up 51 people who were commenced on Risperdal Consta over a two year period to characterise their illness, quality of life and functioning, and to investigate changes in these parameters over time.
Aims: To measure changes in psychopathology, quality of life, occupational functioning, and treatment parameters among clients treated with Risperdal Consta.
Method: Demographic and clinical data was collected directly from 51 participants at study entry. Additional information was extracted from their medical record for the previous two years. Participants were followed-up every 6 months for 2 years, and assessed on a range of QoL and clinical measures. The study is currently in the follow-up phase.
Results: At baseline, the majority of subjects were males (62.7%), and had a diagnosis of schizophrenia (72.5%). The overall average age of participants was 39.94 years, with an average duration of illness of 14.1 years. Participants had an average PANSS score of 65.7 (35-112). Their average overall health state on the EuroQol was 62.71 (range = 2-100, best imaginable health = 100).
Conclusion: The sample enrolled in this prospective two year follow up study had moderate levels of illness severity at baseline, but had above average self reported overall health states. Results provide a characterisation of the types of clients treated with Risperdal Consta within an inner city Area Mental Health Service.
PP47
AUDITORY HALLUCINATION CONTENT AND SCHEMAS ABOUT SELF AND OTHERS
Neil Thomas1,2, John Farhall
2, Fran Shawyer1,2, Susan Rossell1,3, David Castle3
1
Monash University, Victoria, Australia
2
La Trobe University, Victoria, Australia
3
University of Melbourne, Victoria, Australia
Background: Auditory hallucinations frequently have negative themes, especially derogatory content, threatening content and harmful commands. The origins of negative themes in psychotic material have not been widely studied in cognitive research. Although hallucinations are usually regarded as arising from cognitions being misperceived, there has been little study of the relationships between voice content and schemas reflecting beliefs about oneself and other people.
Aims: To explore associations between types of negative voice content and beliefs about self and others.
Method: 30 patients attending a specialist psychological treatment clinic for auditory hallucinations completed measures of positive and negative beliefs about self and others. Hallucinations were coded for the presence of derogatory content, threatening content and harmful commands.
Results: Results did not support a simple model in which critical voices reflect low self-esteem and threatening voices reflect concepts of others as threatening. However more detailed analysis suggested that critical voices were associated with perceptions of self as vulnerable, threatening voices with self as weak, and harmful commands with self as bad.
Conclusions: The implications for further research and psychological treatments for auditory hallucinations are considered.
PP48
SMOKING IN SCHIZOPHRENIA: IMPACT OF NICOTINE ON COGNITIVE FUNCTION AND RELATIONSHIP TO SELF-REPORTED MOTIVES FOR SMOKING
Alison Beck
1,2, Juanita Todd1,2, Amanda Baker2,3
1
Functional Neuroimaging Laboratory, University of Newcastle, NSW, Australia
2
Schizophrenia Research Institute
3
Centre for Brain and Mental Health Research, University of Newcastle, NSW, Australia
Background: Schizophrenia is associated with a higher prevalence and unique topography of smoking. The self-medication hypothesis attributes this to beneficial effects of nicotine on illness-related deficits (e.g. cognitive function). Significant effects of nicotine have been observed on sustained attention (e.g. Continuous Performance Test-Identical Pairs, CPT-IP), visual spatial working memory (VSWM) and prepulse inhibition (PPI).
Aims: This study assessed self-reported smoking motivations amongst outpatients with schizophrenia and non-psychiatric controls, and the relative impact of smoking abstinence and re-instatement on three indices of cognitive function (CPT-IP, VSWM, PPI).
Method: Cognitive function was assessed after ‘typical’ smoking and overnight nicotine abstinence. Self-reported smoking motivation was measured using the Modified Reasons for Smoking Scale (MRSS), updated to include potential cognitive motivators.
Results: There were no significant differences in the profile of smoking motivations across groups. In this pilot sample (n = 14 schizophrenia, n = 7 control), evidence for nicotine enhancement of cognitive function was found for VSWM in schizophrenia and PPI in controls. Smoking status affected several CPT-IP indices. Hit rates were differentially affected across groups – higher in controls when smoking (↑ bias) and in schizophrenia when abstinent (↑ sensitivity).
Conclusion: Results highlight the utility of cognitive indices in determining contributions to continued nicotine use in different groups.
PP49
DO PATIENTS WITH AUDITORY HALLUCINATIONS HAVE AUDITORY PROCESSING DEFICITS?
Dougal S. Phillips
1,2, Susan L. Rossell1,2,3, Neil McLachlan1, Sarah J. Wilson1
1
University of Melbourne, VIC, Australia
2
Mental Health Research Institute, VIC, Australia
3
Monash University, VIC, Australia
Background: Recent studies have shown that patients with auditory hallucinations (AH) have significant affective prosody deficits. However, the potential contribution of auditory processing deficits to AH and affective prosody difficulties has not been investigated.
Aims: This study aimed to investigate whether AH patients have auditory processing deficits using established auditory tasks focusing on pitch judgment, auditory streaming and affective prosodic identification.
Method: A community sample meeting DSM-IV criteria for schizophrenia or schizoaffective disorder (9 with current AH, 5 with no significant history of AH (NAH)) and a matched healthy control group (n = 9) has completed the auditory tasks and measures assessing current psychiatric symptoms.
Results: An ANOVA on preliminary data has established that AH patients showed significant pitch judgment deficits. The accuracy scores for the three groups were as follows; AH 64%, NAH 82%, Control 81% (significance level p < 0.001). Analyses of all auditory task data will be presented in this paper.
Conclusion: Even at this preliminary stage of testing, our data supports the hypothesis that auditory processing deficits are part of the cognitive profile of AH patients. Analyses of the full data set will provide evidence on the extent to which bottom-up, perceptual anomalies contribute to the genesis of auditory hallucinations and affective prosody difficulties.
PP50
THE AUSTRALIAN SCHIZOPHRENIA RESEARCH BANK (ASRB) COMPUTER-BASED CLINICAL ASSESSMENT SOFTWARE (CAS): DEVELOPMENT AND APPLICATION
Jaci Richards
2, Carmel M. Loughland1,2, Mukta Aphale1,2, Frans Henskens1,2, Vaughan J. Carr1,2, Stanley V. Catts2,4, Assen Jablensky2,3, Patricia T. Mitchie1,2, Bryan J. Mowry2,4, Christos Pantelis2,5, Ulrich Schall1,2, Rodney J. Scott1,2, Terry J. Lewin1,2
1
Schizophrenia Research Institute, NSW 2010, Australia
2
University of Newcastle, NSW 2308, Australia
3
University of Western Australia, WA 6009, Australia
4
University of Queensland, Queensland 4072, Australia
5
University of Melbourne, Victoria 3010, Australia
Background: The Australian Schizophrenia Research Bank (ASRB) is a national resource, encompassing clinical, neuropsychological, genetic and anatomical cross-referenced data. ASRB's aim is to collect data from 2,000 case and 2,000 controls. A clinical assessment battery (CAB) is administered over 3 hours and involves a diagnostic interview (DIP; Castle et al., 2006), measures of neuropsychological and cognitive performance, clinical and family history, symptom and general functioning rating. Instruments were selected following exhaustive consultation with ASRB investigators and clinicians. The large scale data collection across multiple sites has necessitated the development of a quality-controlled, time and cost effective data collection strategy. To this end, the ASRB has developed an electronic version of the CAB (i.e., eCAB)
Method: SQL programming was used to develop eCAB. Scoring formulae were embedded into the program to calculate raw and factor scores for the neuropsychological evaluations and rating scales. Data is entered directly into the software by assessment officers using a tablet computer. The program allows navigation through questions with comment boxes for note taking. Quality control parameters for data input and a checking mechanism at the end of the assessment were included to ensure all questions are appropriately answered. Raw scores are converted to standard scores and the OPCRIT algorithm (Craddock et al., 2006) is used to derive diagnostic confirmation based on DIP answers. Assessment data is then uploaded to the ASRB central server in encrypted format.
Conclusions: The system is time and cost efficient by omitting paper and pen assessments, as well as saving scoring and data entry time through automatic score calculations.
Castle, D. J., Jablensky, A., McGrath, J. J., Carr, V., Morgan, V., Waterreus, A., Valurig, G., Stain, H., McGuffin, P. & Farmer, A. (2006). The diagnostic interview for psychoses (DIP): development, reliability and applications. Psychological Medicine 36(1), 69-80.
Craddock, M., Asherson, P., Owen, M. J., Williams, J., McGuffin, P. & Farmer, A.E. (2006). The OPCRIT Webpage. The British Journal of Psychiatry, 169, 58-63.
PP51
THE AGGRESSIVE BEHAVIOUR QUESTIONNAIRE (ABQ) – AN INFORMANT BASED QUESTIONNAIRE FOR AGGRESSIVE BEHAVIOUR IN PEOPLE WITH A PSYCHOTIC ILLNESS
Anthony Harris
1, Matthew Large2, Olav Nielssen3, Josephine Anderson4, John Brennan5
1
Senior Lecturer, Discipline of Psychological Medicine, University of Sydney, Brain Dynamics Centre, Westmead Hospital, Westmead, NSW, 2145, Australia
2
Private Practice, 326 South Dowling Street Paddington, NSW, 2021, Australia
3
Clinical Research Unit for Anxiety Disorders, School of Psychiatry, UNSW at St Vincent's Hospital, 299 Forbes Street, Darlinghurst, Sydney, NSW 2010, Australia
4
Director, Child and Adolescent Services, Sydney West Area Health Service, Parramatta 2150, Australia
5
Director Child and Adolescent Mental Health Services, Sydney Children's Hospital, Randwick 2031, Australia
Introduction: Aggression is an area of great concern in mental health, however the literature that investigates aggression has tended to use information from patient report, medical records, or forensic/criminal reports. All three methods of gaining information are inherently biased towards under-reporting or towards the reporting of high-violence incidents whilst ignoring the low level aggression that may precede later aggressive behaviour. Little use has been made systematically of the accounts of family or carers. This study reports the initial psychometric properties of a scale developed to assess aggressive behaviour in a population of young people coming to services with their first episode of psychosis.
Method: Of the 104 young people referred to the Western Sydney First Episode Psychosis Project, 85 had family to which the 10 item Aggressive Behaviour Questionnaire was administered. The internal reliability of the questionnaire was initially investigated with Chronbach's alpha. A subsequent cluster analysis was performed and examined. This was compared with an approach based on reported serious aggression based on the criteria of the Macarthur Violence Risk Assessment Study.
Results: The internal reliability of the ABQ was good (Chronbach Alpha = 0.728). The cluster analysis identified 2 distinct clusters of Non-Serious vs Serious Aggressive Behaviour. These clusters closely matched those identified by the Macarthur approach. Younger age, manic symptoms and cannabis abuse predicted aggressive behaviour.
Conclusion: The ABQ is potentially a useful tool to examine aggressive behaviour. Further investigation in other clinical populations and replication of these results in a first episode psychosis group is needed before the questionnaire can be more widely adopted.
PP52
CLINICAL AND COGNITIVE FEATURES OF EARLY ONSET PSYCHOSIS: PILOT DATA FROM AN EARLY PSYCHOSIS STUDY
Jean Starling
1,2, Anthony Harris2,3, Cassandra Smith1, Marie Nagy3, Lea Williams2,3
1
The Children's Hospital at Westmead
2
University of Sydney
3
Brain Dynamics Centre
Background: Schizophrenia and other psychotic disorders are a major cause of disability world wide. Much of this burden is due to cognitive impairments, which predict functional outcome better than acute symptoms. The outcome is worse for younger patients, perhaps because they are more likely to have neurocognitive abnormalities at presentation. Possible deficits include impaired social cognition and working memory, and reduced gamma phase synchrony.
Aims: To describe the clinical and neurocognitive features of a small pilot cohort with early onset psychosis and to identify differences in cognitive functioning in comparison with normal children of the same age.
Method: The subjects for this pilot study (early PhD data for JS) are twelve children and adolescents diagnosed with psychosis and twelve normal controls matched for age, gender and years of education. The clinical group have data from questionnaires on symptoms and premorbid functioning (SCID, PSAS, RFS, PANSS, DASS, CDI, and YMRS). Subjects and controls have data from the BRID battery of tests, including cognitive and EEG measures.
Results: The average age at diagnosis was 14, and 75% were female. 50% had affective psychosis and the other 50% schizophrenia spectrum disorders. The results of their performance on the BRID battery of tests compared to controls is still being analysed and will be presented in this poster.
PP53
DOES DIAGNOSIS WITH SUBSTANCE-INDUCED PSYCHOTIC DISORDERS AFFECT LONG-TERM CARE IN PSYCHIATRY?
Danielle L. Winch, Anthony Harris
University of Sydney, Australia
Acute psychotic presentations are often diagnosed as Substance-Induced Psychotic Disorders (SIPD). We aimed to investigate whether a diagnosis that includes substance use affects long-term follow-up in psychiatry and which features of the patient and presentation will predispose to a diagnosis of SIPD. We reviewed hospital records of patients presenting with psychosis for the first time. Patients with a discharge diagnosis of SIPD [n = 50] were compared with a control group with a discharge diagnosis of a schizophrenia-spectrum disorder [n = 50]. We gathered demographic and phenomenological data to investigate which features contribute to diagnosis. Community follow-up was recorded using community mental health team records, to assess duration of follow-up and services accessed. Change of diagnosis during the follow-up period was used as a measure of the strength and validity of the original diagnosis. A diagnosis of SIPD was more likely in those with lower levels of education (χ2=8.193; df = 3; p = 0.042) and homelessness (8% vs18%; χ2=7.987; df = 3; p = 0.046). Patients diagnosed with SIPD more often required high dependency care during admission (32% vs 62%; χ2=9.033; df = 1; p = 0.003). Delusions of reference were more common in schizophrenia cases (49% vs 14%; χ2=13.636; df = 1; p = < 0.001), as were passivity phenomena (31% vs 12%; χ2=4.909; df = 1; p = 0.027) and thought insertion (18% vs 4%; χ2=5.018; df = 1; p = 0.025). By contrast, persecutory delusions were more common amongst SIPD cases (71% vs 90%; χ2=5.288; df = 1; p = 0.021). In the community, patients with schizophrenia were more likely to be allocated a case manager as part of follow up (52% vs 16%; χ2=15.059; df = 2; p = 0.001) and the schizophrenia group had less loss to follow-up (74% vs 90%; χ2=4.336; df = 1; p = 0.037). 7 patients in the SIPD group who were retained for some degree of follow up received a revised diagnosis of a schizophrenia-spectrum disorder or other major mental illness that caused them to change diagnostic categories (χ2=7.527; df = 1; p = 0.006). The converse did not occur in patients with schizophrenia. In conclusion, SIPDs are diagnoses that emphasis substance use as the patients’ primary problem and negatively impact prognosis. Patients with an SIPD diagnosis less often receive adequate community follow-up care. SIPD if often an inappropriate diagnosis that is later revised, delaying the care pf patients with major mental illness.
PP54 WITHDRAWN
PP55
WITHDRAWN
PP56
PSYCHIATRIC CHARACTERISTICS AND SCHIZOTYPAL PERSONALITY TRAITS IN YOUNG ADULTS WITH VELO-CARDIO-FACIAL SYNDROME
Kathryn Leadbeater
1, Ulrich Schall1,2,3, Linda E. Campbell1,2,3
1
Priority Research Centre for Brain and Mental Health Research, University of Newcastle, NSW Australia
2
Schizophrenia Research Institute
3
Hunter Medical Research Institute
Background: Velo-cardio-facial syndrome is a common genetic syndrome and the third highest known risk factor for schizophrenia. Approximately 30% of the VCFS population develops schizophrenia in early adulthood. However, many behavioural problems are present in the population.
Aims: This data was collected as part of an ongoing study seeking to identify predictors of psychosis and other psychiatric disorders in young people with VCFS.
Methods: Behavioural and psychiatric data (including DSM-IV interviews, quality of life and Raine's Schizotypal Personality Questionnaire (SPQ)) for 17 subjects with VCFS and 10 healthy controls were analysed.
Results: In the VCFS group, most (12 out of 17) were diagnosed with a mild intellectual disability according to the DSM-IV criteria. Several met thresholds for diagnosis with attention deficit (hyperactivity) disorder (5), oppositional defiant disorder (3), obsessive compulsive disorder (3), trichotillomania (1), panic disorder (1), generalized anxiety disorder (1), and schizophrenia (1). Many also had sub-threshold psychiatric comorbidities. The VCFS group had significantly lower GAFs and higher schizotypal scores than controls.
Conclusions: The VCFS group had a wide range of behavioural and psychiatric problems. Future analyses will relate this information to structural brain anatomy, cognition and genotype in order to attempt to identify any potential precursors of psychoses. All participants will be followed up annually to track their mental health status.
Supported by NH&MRC NHMRC ref 455624
PP57
CLINICAL OUTCOMES ASSOCIATED WITH DEPRESSION, ANXIETY AND SOCIAL SUPPORT AMONG CARDIAC REHABILIATION ATTENDEES
Lisa Phillips1,2, Alyna Turner
1,3, John Hambridge1, Amanda Baker1, Jenny Bowman2, Kim Colyvas4
1
Centre for Brain & Mental Health Research, the University of Newcastle, NSW, Australia
2
School of Psychology, the University of Newcastle, NSW, Australia
3
Liaison Psychiatry, John Hunter Hospital, Hunter New England Health Service, NSW, Australia
4
School of Mathematical and Physical Sciences, the University of Newcastle, NSW, Australia
Background: Strong and consistent evidence has emerged linking certain psychological and social factors with the development and expression of CHD. This study examined associations between depression, anxiety, levels of social support and clinical outcomes by utilising data from the existing hospital records of cardiac rehabilitation patients.
Aims: The aim of the present evaluation was to determine levels of depression and anxiety symptoms among cardiac rehabilitation patients and to link those scores with demographic, lifestyle and medical variables.
Methods: 322 records for cardiac rehabilitation patients were accessed. Hospital Anxiety and Depression Scale scores obtained during participation in a cardiac rehabilitation program were linked to details of the admission that preceded their rehabilitation and to any subsequent admissions. Clinical outcome measures were: number of hospital admissions; length of stay in hospital and mortality.
Results: Over a quarter of patients were experiencing clinically significant symptoms of depression and/or anxiety. Higher depression scores were associated with longer length of stay and higher anxiety scores were associated with more hospital admissions after controlling for other established prognostic risk factors. Depression and anxiety symptoms and levels of social support were not associated with mortality in this sample.
Conclusion: Results support prior research suggesting significant levels of emotional distress exist among cardiac rehabilitation participants. Depression is known to lead to worse outcomes among this patient population, and development of efficacious psychological treatments is indicated.
PP58
SEROTONIN TRANSPORTER GENE AND GENDER-SPECIFIC PSYCHOLOGICAL DISTRESS IN DIABETES PATIENTS
Kay Wilhelm1,2, Inika Gillis
2, Jaya Reddy2, Phillip B. Mitchell2, Peter R. Schofield3
1
St Vincent's Hospital, Sydney, NSW
2
School of Psychiatry, UNSW, Sydney, NSW
3
Prince of Wales Medical Research Institute, Sydney, NSW; Faculty of Medicine, UNSW, Sydney, NSW
Background: Research has shown a relationship between s/s serotonin transporter genotype and greater psychological distress in patients with chronic medical illnesses such as coronary artery disease and Parkinson's disease.
Aims: This study examined the relationship between serotonin transporter genotype and psychological distress in patients with Type I and Type II Diabetes Mellitus.
Method: 232 patients with Diabetes (58% male, 29% Type I) from St Vincent's Hospital, Sydney were recruited and administered the Kessler-10 (K10), a 10 item measure of psychological distress. Patients were classified as S individuals with two short alleles of the serotonin transporter gene (s/s), or L individuals with at least one long allele (s/l or l/l), using cheek-swab analysis.
Results: There was no effect of genotype on K10 scores. However when gender was included as a factor, a two-way between subjects ANOVA revealed a significant gender × genotype interaction (F(1, 228) = 4.889, p=0.028). Females with s/s alleles showed significantly higher psychological distress than females with at least one long allele (F(1, 228) = 5.480, p=0.020) whereas males showed no difference based on genotype.
Conclusion: Findings suggest gender differences in the role of the serotonin transporter gene in promoting psychological distress in those with Diabetes. Individual differences including gender should be considered when providing psychological interventions for this population.
PP59
THE INFLUENCE OF SEROTONIN TRANSPORTER GENOTYPE AND PERSONALITY ON DIABETES OUTCOMES
Kay Wilhelm
1,2, Jennifer Nicholas1, Karen Baikie1, Jaya Reddy2, Philip Mitchell1
1
School of Psychiatry, UNSW, Sydney, NSW
2
St Vincent's Hospital, Sydney, NSW
Background: Polymorphisms of the serotonin transporter gene and personality subtypes such as neuroticism and conscientiousness have been found to differentially influence health outcomes in chronic illnesses. To our knowledge no studies have considered both personality and 5HTT genotype as possible predictors of health outcomes in diabetes mellitus.
Aim: To examine whether genotype and personality factors influence illness outcomes in patients with diabetes mellitus.
Method: The NEO-FFI was administered to 274 patients with diabetes (providing neuroticism and conscientiousness scores). DNA swabs were also taken to obtain serotonin transporter genotype (l/l, s/l and s/s). Health outcomes were measured using the Problem Areas in Diabetes scale (PAID) and patients most recent glycosylated hemoglobin value (HbA1c) which indicates glucose control.
Results: There was a relationship between genotype and HbA1c levels (p=0.017) but not PAID scores. Patients with l/l and s/l had significantly higher glycosylated haemoglobin levels than s/s. Neuroticism was positively correlated with PAID scores (r = 0.555, p=0.01), conversely conscientiousness was negatively correlated with PAID (r = −0.17, p=0.05). Neuroticism was also significantly correlated with HbA1c (r =0.219 p=0.01).
Conclusion: For patients with Diabetes a poorer outcome was related to high neuroticism, low conscientiousness, and the ‘l’ allele of the serotonin transporter gene. Early identification of such patients and their needs provides an insight into mechanisms for improving health outcomes in vulnerable patients.
PP60
“MIND AND BODY”: A LIFESTYLE PROGRAM FOR PEOPLE ON ANTIPSYCHOTIC MEDICATION
Amanda Jones1, Anthony Benson1, Sarah Griffiths1, Michael Berk2, Seetal Dodd
2
1
Barwon Health, Community and Mental Health, Surfcoast Clinic, Torquay, Victoria, Australia
2
Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong, Australia
Background: Both psychiatric illnesses such as schizophrenia and their treatments have consequences in terms of lifestyle, diet and weight. ‘Mind and Body’ is a 10-week programme of weekly sessions aimed to improve health status of people treated with second generation antipsychotic medications. The programme focuses on a range of lifestyle strategies including diet and exercise and was conducted at a Community Health Centre by professionally qualified staff.
Aims: To evaluate the Mind and Body programme.
Method: Measures of body weight, health status (Short Form-36) and blood markers (plasma glucose, haemoglobin A1c and lipid profile) were collected at commencement and completion of the programme. Scores were compared using a student's t-test.
Results: Between 2002 and 2006, 50 participants enrolled in, and 30 completed the programme. All measures
changed from baseline in the direction required for improvement to health, with the exception of HDL cholesterol, suggesting a trend towards improvement. Obese patients remained obese at study end.
Conclusion: A modest improvement was demonstrated in mean values for the majority of measures collected. Significant changes could not be expected from a short term program however patients may have benefited by participating in the Mind and Body programme.
PP61
INDEPENDENT PREDICTORS OF 17-YEAR MORTALITY IN AN ELDERLY COMMUNITY SAMPLE
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: A wide range of physical health, mental health, cognitive and sociodemographic variables are associated with mortality status.
Aims: To identify variables that strongly and independently predict mortality.
Method: A community sample of 896 women and men aged > = 70 from the Canberra region were assessed four times over 12 years, with mortality data collected over 17 years.
Results: Older baseline age, male gender, poorer self-rated health, poorer subjective wellbeing, history of heart attack, greater disability, weaker grip strength, less activity and poorer cognitive performance were significantly associated with greater mortality. Depression, anxiety, marital status, pain, social network and several measures of physical wellbeing did not significantly predict mortality in multivariate survival analyses.
Conclusion: Self-rated health, grip strength and cognitive performance tend to be better independent predictors of long-term mortality than disability or disease status.
PP62
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PP63
FOLLOW-UP OF MILD COGNITIVE IMPAIRMENT AND RELATED DISORDERS OVER 4 YEARS IN ADULTS IN THEIR SIXTIES: THE PATH THROUGH LIFE STUDY
Kaarin J. Anstey
1, Nicolas Cherbuin1, Helen Christensen1, Richard Burns1, Chantal Réglade-Meslin1, A. Salim1, R. Kumar2, Anthony F. Jorm2, Perminder Sachdev3
1
Australian National University, Canberra, Australia
2
University of Melbourne, Melbourne, Australia
3 University of New South Wales, Sydney, Australia.
This study aimed to estimate incidence rates of Mild Cognitive Impairment and related disorders, and conversion to dementia. The data are drawn from the PATH Through Life Study. Baseline assessment in 2001-2002 included 2551 60-64 year-olds with 2222 participating in a four-year follow-up. Those screened positive with a cognitive assessment received clinical assessment for diagnoses of mild cognitive disorders or dementia using established clinical criteria. Prevalence and incidence rates for the cohort were estimated with predictive regression models. Annual incidence of dementia was 0.25%. Prevalence of Mild Cognitive Impairment was 4.2%, Age Associated Memory Impairment was 2.4%, Age-Associated Cognitive Decline was 7.6%, Mild Neurocognitive Disorders was 12.87% and other cognitive disorder was 7.3%. The prevalence of any diagnosis of any mild cognitive disorder (Any-MCD) was 29.5% and the annual incidence rate for Any-MCD was 5.7%. Agreement for specific diagnoses between Waves 1 and 2 was fair to poor (0 to 47.0%) but agreement for Any-MCD over 4 years was 89.0%. Diagnoses of mild cognitive disorders do not predict dementia at four year follow-up in young-old adults. Prevalence rates for mild cognitive disorders vary greatly depending on criteria and time of assessment.
PP64
COGNITIVE CONTROL DECLINE DURING NORMATIVE AGING: EVIDENCE FROM BEHAVIORAL AND ELECTROPHYSIOLOGICAL MEASURES
Lisa R. Whitson, Frini Karayanidis, Patricia T. Michie
Functional Neuroimaging Laboratory, The University of Newcastle, Australia
Background: Task-switching paradigms have been used to show age-related decline in different aspects of cognitive control where participants complete single task and mixed task blocks. RT mixing cost [(repeats in switch blocks) – (single task trials) reflects working memory load, and RT switch cost [(switch – repeat trials)] reflects active task-set reconfiguration processes. Studies show varied results with greater consistency of increased mixing but not switch cost with age. Aims: We examined mixing and switch cost in four age groups (18-80 years) during a cued task-switching paradigm using behavioural and event-related potential (ERP) measures.
Results: Mixing cost was larger for the Older group, due to a disproportionate increase in repeat trial RT. Switch costs were found across all age groups, and were reduced with increasing CSI. Early differences in cue-locked waveforms reflected processes related to mixing cost, whereas later differences were associated with processes relating to switch cost. Age differences in ERPs associated with task-switching became apparent from 30 years, however did not affect behavioural performance before 60 years. The effects of age on ERPs paralleled behavioural findings indicating large age differences in the early positivity associated with mixing cost, but little age differences on the later positivity associated with switch cost.
Conclusions: Together behavioural and electrophysiological results are consistent with older adults requiring greater activation of executive resources for task completion.
PP65
PRELIMINARY FINDINGS FROM AN AUDIT OF CLIENTS PRESENTING TO A COMMUNITY-BASED SERVICE FOR YOUNG PEOPLE AT INCREASED RISK FOR PSYCHOSIS
Agatha M. Conrad, Terry J. Lewin, Vaughan J. Carr, Ulrich Schall, Sean Halpin, Ketrina A. Sly
Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, PO Box 833, NEWCASTLE, NSW, 2300, and the Psychological Assistance Service, Hunter New England Mental Health
Introduction: The early detection and treatment of psychosis has been associated with a shorter duration of untreated psychosis and better clinical outcomes. The Psychological Assistance Service (PAS) is a community-based service in Newcastle for young people at increased risk of developing a psychotic disorder.
Service Audit: Recently, we commenced a layered service audit of all presentations to PAS during the past ten-years. This project will: document the socio-demographic and clinical characteristics of the PAS clients, together with their estimated risk status; document patterns of service use in the years subsequent to PAS presentation (e.g., service contact patterns and admissions), together with any evidence of psychosis ‘transition’; and examine relationships between baseline psychosis risk status and service level outcomes.
Aims/Methods: Preliminary findings from our service audit will be reported, based initially on paper-based records that we have collated in a database, which will subsequently be matched against local and regional electronic clinical records.
Results: There were 2,073 clients from January 1997 to December 2007, 22.5% were self or family referrals and 42.1% were referred by mental health services. One-quarter (25.4%) of presentations completed a full review (i.e. using the comprehensive assessment of at risk mental states, CAARMS, or an equivalent, earlier assessment). Socio-demographic, risk, referral and clinical profiles will be reported and discussed.
Conclusions: This project provides a unique opportunity to examine service level outcomes among clients with different patterns of risk for psychosis, and to help to optimise future assessment and intervention strategies at PAS and elsewhere. We thank the Australian Rotary Health Research Fund (ARHRF) for their support.
PP66
A COMPREHENSIVE RETROSPECTIVE AUDIT OF THE USE OF RISPERDAL CONSTA IN AN AREA MENTAL HEALTH SERVICE IN MELBOURNE, AUSTRALIA
Anthony R. de Castella, C. Furtado, A. Nicol, K. Sinclair, Pamela Williams, S. Olsen, Frances Biffin, Paul B. Fitzgerald, Jayashri Kulkarni
Monash Alfred Psychiatry Research Centre, Monash University & Alfred Hospital, VIC, Australia
Background: Risperdal Consta is the first depot atypical antipsychotic on the market. Early use of new medications is often a matter of trial and error, until real world usage data becomes available.
Aims: To investigate how Risperdal Consta has been used during the 1st 12 months after release on the PBS in patients with schizophrenia, and to describe patient outcomes.
Method: Medical records of all clients initiated on RC during the first 6 months after approval on the PBS were reviewed for 12 months pre RC, and 12 months post RC. Data captured pre and post RC included; pharmacotherapy, hospitalisations, adherence, substance use, reason for switch to RC, start dose of RC, location of initiation, and length of treatment on RC.
Results: 141 files were identified and reviewed. Mean age was 40.4 years. Two thirds were men. Mean duration of illness was 12 years. 85% had been hospitalised in the 2 years prior to RC, 29% of clients switched to RC from risperidone (52%), 70% of clients were initiated on RC while inpatients, 80% of clients had 2 or less dose changes of RC in the 1st 12 months, more than 30% of clients continued on RC after 12 months, 81.5% of clients received concomitant oral antipsychotics medications during the 1st 12 months, most commonly risperidone (76%), 11.2% of clients were recorded to have good adherence pre RC compared with 74.2% post RC, most common reason for discontinuation of RC was inadequate response, most common AP post RC was clozapine.
Conclusion: This study provides real world data into the use of RC in an Area Mental Health Service which will help guide clinicians in the use of this medication in treating patients with schizophrenia.
PP67
BUILDING LIFE PERFORMANCE: EVALUATION OF THE RESILIENCE ONLINE PROGRAM FOR SALES MANAGERS
Jo Abbott
1, Britt Klein1, Catherine Hamilton2, Andrew Rosenthal3
1
National eTherapy Centre For Anxiety Disorders (NeTCAD), Swinburne University, VIC, Australia
2
BP Australia, VIC, Australia
3
Reflective Learning, Pennsylvania, USA
Background:
ResilienceOnline is an internet-based program developed from research at the University of Pennsylvania, designed to enhance resilience, or a person's ability to persevere in the face of challenges, setbacks and conflicts. The program contains about 10 hours of training in how to master seven skills of resilience and includes three telephone-based coaching sessions.
Aims: To evaluate whether online resilience training will improve the psychological health, wellbeing and work performance of lubricant sales managers from BP Australia.
Methods: ResilienceOnline will be compared to a waitlist control condition using a randomised control trial design at pre-, post- and follow-up assessment periods. Participants will be assessed on measures of quality of life, happiness, depression, stress, anxiety and work performance.
Results: This paper will report on the pre- and post-program findings.
Conclusion: The results of this randomised controlled trial will guide the nature of online programs for facilitating workplace wellbeing and performance.
PP68
BIPOLAR DISORDER: PSYCHO-EDUCATION FOR PATIENTS WITH NEW DIAGNOSES
Judy Proudfoot
1,2, Gordon B. Parker1,2, Amisha Jayawant1,2, Jennifer Nicholas1,2, Vijaya Manicavasagar1,2, Meg Smith3
1
Black Dog Institute, Sydney, NSW, Australia
2
School of Psychiatry, University of NSW, Sydney, NSW, Australia
3
University of Western Sydney
Background: Research into the effectiveness of psycho-education programs for patients with bipolar disorder has primarily examined group face-to-face formats. However, access to such programs is limited by geographic, financial and transport restrictions. For individuals with new diagnoses in particular, prompt access to psycho-education about the condition is important to help them gain a sense of control over the condition.
Aims: To evaluate the effectiveness of online psycho-education for patients recently diagnosed with bipolar disorder and to explore the role of ‘expert patients’ who provide online support to participants in the program.
Method: A psycho-education program for individuals diagnosed with bipolar disorder within the last 12 months is delivered over 8 weeks via the internet. In a randomised controlled trial, the program, with and without additional online support from expert patients, who themselves have bipolar disorder, is compared to an online attention control condition. Participants’ symptoms, illness perceptions, work and social adjustment, self esteem and life satisfaction, were assessed at baseline, post-intervention, 3 and 6 month follow-up. In addition, interviews were conducted with the expert patients to ascertain their approach to and experiences of their role, and its impact on the management of their own condition.
Results: The randomised controlled trial is currently underway. Preliminary findings will be presented at the conference in terms of whether psycho-education delivered via the internet is beneficial for both patients and the expert patients providing them online support.
PP69
THE SHYNESS PROGRAM: THE EFFECT OF COMORBID DEPRESSION AND GAD ON OUTCOMES
Matthew Gibson, Nickolai Titov, Gavin Andrews, Genevieve Schwencke, Isabella Choi
CRUfAD, School of Psychiatry, UNSW at St Vincent's Hospital, Sydney, Australia
Background and Aims: Social phobia is a common anxiety disorder affecting more than 200 000 Australian adults each year. Approximately 80% of these people also experience a comorbid mental disorder, most commonly an anxiety or depressive disorder. While comorbidity is know to increase disability and service utilization less is known about its effects on treatment outcomes. Data is now available from 3 recent RCTs on a large number of Australian adults with social phobia who have completed the Shyness Program, a clinician-guided Internet-based treatment program for social phobia (n=210). These data include results of questionnaires measuring the severity of symptoms of generalised anxiety disorder (GAD) and of depression, both pre and post-treatment. These pre-treatment data will be used to identify cohorts of participants with elevated symptoms of social phobia + GAD and/or depression, and analyses will be conducted to determine whether these groups experience a different treatment trajectory.
Results: The results of these analyses will be reported at the ASPR meeting in December, 2008.
Conclusion: It is expected that these results will help inform clinicians about the likely outcomes of treating patients with different comorbid disorders. In turn, this will inform clinical decisions about the appropriateness of different treatment combinations to match patient's needs.
PP70
PATIENT EDUCATION PRACTICES AND E-TECHNOLOGY IN PSYCHIATRIC HOSPITALS – A NATIONAL SURVEY IN FINLAND
Heli Hätönen
1,2, Lauri Kuosmanen1, Marita Koivunen1, Maritta Välimäki1,3
1
University of Turku, Department of Nursing Science
2
Municipality of Imatra
3
Hospital District of South-West Finland
Background: Patients’ right to receive information is a priority in high quality psychiatric services. Although in Finland an eHealth policy was adopted in the 1990's, e-technology is not systematically used in patient education in psychiatric hospitals.
Aims: To describe how systematically e-technology has been used in patient education in adult acute psychiatric hospitals in Finland.
Method: A descriptive questionnaire survey was conducted including all adult acute psychiatric wards in Finland (n = 55, response rate 60%).
Results: A range of different methods was used to inform acute patients about their own illness and its treatment: oral communication (100%), leaflets (100%), books (78%), Internet (71%), DVD (22%), CD-ROM applications (16%). Out of the 55 study wards, over a quarter (26%) had systematic procedures for patient education, and only 6% had written instructions how to do it. Less than one fifth of the units (17%) had offered staff on-the-job training related to patient education.
Conclusion: Specific patient education guidelines and instructions might be useful in ensuring the use of e-technology for patient education. The guidelines should take comprehensive account of the various domains of patient education. Moreover, there is a need to develop on-the-job personnel training in delivering patient education using different methods, including e-technology, in clinical practice.
PP71
BARRIERS AND FACILITATORS TO MENTAL HEALTH HELP-SEEKING IN ELITE ATHLETES: THE DESIGN OF AN ONLINE INTERVENTION
Amelia Gulliver
1, Kathleen M. Griffiths1, Helen Christensen1 Michael Martin2
1
Centre for Mental Health Research, The Australian National University, ACT, Australia
2
Performance Psychology, Australian Institute of Sport, ACT, Australia
Background: Despite comparable rates of mental disorders to the general population, research indicates that athletes tend not to seek help for mental health problems. However, little is known about the reasons for low rates of mental health help-seeking amongst this group, and their perceived barriers and facilitators to seeking help.
Aims: To describe the methodology and preliminary findings of a study of factors that may influence mental health help-seeking behaviour in elite athletes.
Method: A series of focus groups with young elite athletes from the Australian Institute of Sport in Canberra, Australia designed to elicit the barriers and facilitators for seeking help for mental health problems among elite athletes.
Results: The study methodology and preliminary results from a thematic analysis of the focus group transcripts will be presented along with the implications of the findings for the development of an online intervention to increase help-seeking.
Conclusion: This research is the first formal study of the views of Australian elite athletes on ways to increase mental health help-seeking. It will provide an important foundation for designing an online intervention to increase help-seeking behaviour in this group.
PP72
THE UTILITY OF PSYCHIATRIC SCREENING TOOLS IN A METHADONE MAINTENANCE POPULATION
Kristi-Ann Villagonzalo,1 Felicity Ng,1 Seetal Dodd,1 Stephen Mihaly,2 Anthony Flynn2
1
Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong
2
Drug and Alcohol Services, Barwon Health, Geelong
Background: Psychiatric disorders are more prevalent among substance-abusing populations than in the general population, but are often undetected in substance abuse treatment (SAT) settings. The use of validated, self-administered screening tools may assist in improving detection rates.
Aims: To test the practical utility of psychiatric screening tools in the SAT setting; to estimate the prevalence of psychiatric disorders using these tools; and to examine the relationship between patterns of substance use and possible psychiatric disorders.
Method: Clients of the methadone programme at Barwon Health (n=528) were invited to participate in the study at their scheduled outpatient appointments. Participants completed the Kessler Psychological Distress Scale (K10), Mood Disorder Questionnaire (MDQ), Post-traumatic Stress Disorder Checklist (Civilian Version; PCL-C) and a substance use questionnaire consisting of questions on age at first substance use, number and type of substances used, amount and frequency of substance use, and continuing substance use during treatment.
Results: Approximately 100-150 clients are expected to participate in the study. The prevalence of depression, bipolar disorder and post-traumatic stress disorder in this population will be estimated using the screening tools, which will be compared to prevalence rates obtained in studies using full psychiatric assessments. Participants who screen for zero, one or more psychiatric disorders will be compared on substance use measures.
PP73
THE RELATIONSHIP BETWEEN SUBSTANCE USE AND FUNCTIONING IN ADOLESCENTS
Marija Strmota1
1
Orygen Youth Health: Research Centre, Melbourne, Australia
Background: Substance use disorder (SUD) is an escalating problem with young people between the ages of 12-18 conferring the greatest estimated risk for developing an alcohol or cannabis use disorder. These findings are concerning as adolescence and young adulthood is a critical developmental period and substances such as these may have severe and negative consequences for their progression. This study aims to examine the relationship between substance misuse and functioning in adolescents.
Method: The study is a prospective community survey. A total of 845 Year 10 students from 34 schools in the Western Metropolitan Region of Melbourne participated in the study. Each participant was required to complete a survey at baseline and a 12 month follow-up. The survey included measures such as the Coping Inventory for Stressful Situations and Revised Multidimensional Assessment of Functioning Scale and a substance use questionnaire.
Results: Results presented will show whether there is any correlation between substance use and global functioning, measured both at baseline and at 12 month follow up. In particular, results will indicate whether SUD at baseline is predictive of poorer functioning at follow-up.
Conclusion: There is an increasing need for more information about the potential risks associated with substance use, especially in youth where development may be affected. Findings from this study will add to existing evidence about these risks. This would be of use when considering prevention and intervention programs.
PP74
TOWARDS DSM-V: A TAXOMETRIC EXPLORATION OF ALCOHOL PROBLEMS IN A COMMUNITY SAMPLE
Tim Slade1, Rachel Grove
1, Maree Teesson1
1
National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
Background: There is growing evidence that problems associated with alcohol use disorders (e.g. dependence and abuse) are most appropriately conceptualised using one or more continuous dimensions rather than as categorical “yes/no” entities. This has implications for the way in which substance use disorders are characterised in upcoming versions of the major psychiatric classification systems, DSM-V and ICD-11.
Aims: To explore the nature of alcohol use disorders with the aid of taxometric analysis, a statistical technique specifically designed to test whether a construct is best conceptualised as one single latent dimension, or two distinct latent categories.
Method: DSM-IV symptoms associated with alcohol dependence and abuse were subjected to two different taxometric analyses using data from a large nationally representative epidemiological survey of psychiatric and substance use disorders in the general population.
Results: Consistent evidence was found for a single, continuous latent dimension ranging from mild to severe underlying the symptoms of alcohol abuse and dependence.
Conclusion: These findings have implications for the way in which the problems associated with alcohol use are measured. The results also highlight the need to incorporate continuous measures of substance use disorders with the traditional categorical representations in DSM-V.
PP75
PREVALENCE OF RISKY ALCOHOL CONSUMPTION IN A COMMUNITY SAMPLE OF MEN
Carolyn E. Coulson, Lana J. Williams, Margaret J. Henry, Michael Berk, Julie A. Pasco
The University of Melbourne, Department of Clinical and Biomedical Sciences, Barwon Health Australia
Background: While the harms of excess alcohol consumption receive frequent media attention, a discrepancy still exists between the guidelines for low risk drinking and the consumption patterns of the population. Identification of the proportion of men who adhere to the current NHMRC guidelines may provide insight into the likely success of the more stringent guidelines currently under consideration.
Aims: To describe the distribution of different levels of alcohol consumption in a randomly-selected age-stratified community sample of men aged 20-97 yr (median age 56.7yr, IQR 40.0-73.4) participating in the Geelong Osteoporosis Study.
Method: Alcohol consumption was self-reported using a validated food frequency questionnaire1. Consumption was categorised according to the NHMRC Australian alcohol guidelines where high-risk consumption is defined as >40g of ethanol per day. Prevalence data was age-standardised to the 2006 Australian population.
Results: Of 1382 men, 10.8% reported no alcohol consumption in the last 12 months. For mean daily consumption, 72.8% of men consumed within the guidelines for low risk and 16.4% consumed alcohol at risky levels according to the NHMRC guidelines. Age-standardised prevalence of risky drinking for each age group was 15.0% for 20-29yr, 16.0% for 30-39yr, 19.7% for 40-49yr, 17.2% for 50-59yr, 17.0% for 60-69yr, 14.9% for 70-79yr and 5.0% for 80+ yr.
Conclusion: A large proportion of men report alcohol consumption at levels considered to be risky. This is especially true among those aged between 40-69 years. In light of the current revisions of the NHMRC guidelines for alcohol consumption this investigation into how well the current guidelines are adhered to within the community is timely.
1 Giles GG, Ireland PD. Dietary Questionnaire for Epidemiological Studies (Version 2), Melbourne: The Cancer Council Victoria, 1996.
PP76
MANAGEMENT OF LOW LEVEL PSYCHOTIC DISORDERS IN STIMULANT USERS PARTICIPATING IN AMBULATORY TREATMENT
Liz Knock
1,2, Sally Cleworth2, Russel Davies2, Susie Hudson3, Bill Robertson1, Allison Salmon1,4, Adrian Dunlop1,2, Amanda Baker1,2, Rebecca McKetin4
1
Hunter New England Area Health Service, Australia
2
University of Newcastle, Australia
3
St Vincent's Hospital Sydney, Australia
4
National Drug and Alcohol Research Centre, Australia
Amphetamine related psychosis is a significant complication of amphetamine use. Psychosis can occur along a continuum from acute and severe, requiring emergency treatment, to subacute and less severe but still requiring treatment. Both psychosocial therapies [1], including cognitive behavioural therapy [2], and pharmacotherapeutic approaches [3] have been used to manage amphetamine users who experience psychosis. However, the literature remains less clear on the optimal response for stimulant users with mild levels of psychosis.
In 2006, the NSW Department of Health funded two pilot shopfront clinics (Stimulant Treatment Programs, or STPs) to treat methamphetamine users experiencing mental health problems [4]. The clinics are based in Newcastle and inner city Sydney. The STPs work within a stepped care framework [5] and provide a range of interventions from brief interventions to comprehensive assessment, drug counselling and withdrawal management.
Aims: To describe a model of care for management of low level psychotic disorders in stimulant users participating in ambulatory treatment.
Methods: A literature review of the management responses for stimulant users experiencing mild levels of thought or perceptual disorder has been conducted, demonstrating the need for a developing evidence base for the management of amphetamine related psychosis. This literature review will be discussed. A chart review will be conducted of patients attending the STP clinic in Newcastle, NSW from inception to October 2008.
Conclusion: Recommendations regarding optimal models of care will be made.
1. Cleary, M., et al., Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database of Systematic Reviews, 2008(1).
2. Baker, A. and N.K. Lee, A review of psychosocial interventions for amphetamine use. Drug & Alcohol Review, 2003. 22(3): p. 323-35.
3. Srisurapanont, M., P. Kittiratanapaiboon, and N. Jarusuraisin, Treatment for amphetamine psychosis. Cochrane Database of Systematic Reviews., 2001(4).
4. Dunlop, A., et al., Preliminary Evaluation of the NSW stimulant treatment program. 2008, NSW Department of Health: North Sydney.
5. Baker, A., et al., A Brief Cognitive Behavioural Intervention for Regular Amphetamine Users. 2003, Australian Government Department of Health and Ageing: Canberra.
PP77
ALCOHOL, TOBACCO, AND MENTAL HEALTH IN A RURAL SAMPLE
Adam Bode
1, Helen L. Berry1, Brian Kelly2, Clare Coleman2, Helen J. Stain2
1
National Centre for Epidemiology and Population Health, Australian National University, ACT, Australia
2
Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW, Australia
Aim: Characterise patterns of alcohol and tobacco use, mental health, and health service utilisation in rural areas to inform the development of targeted mental health strategies.
Method: Participants were respondents to the Australian Rural Mental Health Study (N = 551; female = 56.3%) with an average age of 57.1 years (SD = 14.6; range = 18-87) from across three ARIA+ rural categories: inner regional (32.7%); outer regional (37.9%); and remote or very remote (29.4%). Mean Kessler-10 psychological distress scores were 11.28 (SD = 1.4; range = 10-23) and 13.4% of participants had ever been diagnosed with a mental health-related problem. Mean AUDIT scores for alcohol use were 3.9 (SD = 4.4; range = 0-39), 18.7% reported hazardous alcohol use, 13.4% had moderate or high levels of alcohol-related problems, and 14% were regular smokers. A two-step cluster analysis will be conducted to group respondents based on socio-demographic characteristics, alcohol and tobacco use, mental health, and health service utilisation. Factorial analysis of variance and Chi-square distributions will be used to compare groups according to factors which influence access to mental health services.
Conclusion: Results will be presented outlining correlates of alcohol misuse, tobacco smoking, mental health, and health service utilisation characteristic of a rural and remote geographic population.
PP78
BODY DYSMORPHIC DISORDER: A REVIEW OF CURRENT NOSOLOGICAL ISSUES AND ASSOCIATED COGNITIVE DEFICITS
Wei Lin Toh
1, Susan Rossell2, David Castle1
1
The University of Melbourne, VIC, Australia
2
Alfred Psychiatry Research Centre, Monash University, VIC, Australia
Background: Recent study into body dysmorphic disorder (BDD) has raised questions about the validity of its current diagnostic classification as well as categorical division into ‘psychotic’ and ‘non-psychotic’ variants. Furthermore, though individuals with the disorder are believed to experience cognitive difficulties, the precise nature of these deficits remains unclear.
Aims: This paper aims to provide a comprehensive review of existing knowledge of BDD in terms of its nosology and cognitive deficits. We will evaluate arguments in relation to its inclusion within the obsessive-compulsive spectrum disorders (OCSDs), consider how delusionality is coded in BDD, and also examine recent studies suggesting which specific cognitive deficits may underlie the disorder.
Results: There appears to be a sound rationale for considering BDD as part of the OCSDs, though current findings indicate that it is not a mere subtype of obsessive-compulsive disorder (OCD). Evidence also suggests that the degree of delusional beliefs in BDD would be more appropriately theorised on a dimensional basis. In terms of cognitive deficits, research to date has implied that attentional biases and/or abnormalities in basic visual processing may be especially significant.
Conclusion: Further research is needed to elucidate an inclusive profile of the underlying cognitive deficits in BDD. In turn, these insights would help to clarify current nosological debates surrounding the disorder.
PP79
PAIRED PULSE TRANSCRANIAL MAGNETIC STIMULATION TO INVESTIGATE CORTICAL INHIBITION
Paul Fitzgerald, Jerome Maller, Faranak Farzan, Jeff Z. Daskalakis
Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Commercial Rd Melbourne, Victoria, Australia
Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
Background: A paired pulse paradigm using transcranial magnetic stimulation (TMS) may be able to demonstrate cortical inhibition (CI), hence the GABAergic system, which has been suggested to be dysfunctional in people with major depressive disorder (MDD) or schizophrenia (SCH).
Aims: To investigate CI in a short-intercortical-interval (SICI) TMS protocol. Method: TMS was applied to 13 healthy subjects with no history of MDD or SCH or any psychiatric disorder. Paired pulses were 100ms apart, and single and paired pulses were separated by 5 second intervals. Subjects wore a 64-channel EEG cap whilst TMS was administered. Targeted regions were the left motor cortex (M1) and left dorsolateral prefrontal cortex (DLPFC) located by using MRI-based stereotaxy.
Results: Mean area under the curve of the second of the paired pulses was significantly less than of the first pulse in all subjects, in both regions tested.
Conclusions: Administration of a SICI TMS protocol in healthy people over M1 and left DLPFC demonstrates cortical inhibition of the second pulse by the first. It now needs to be investigated as to whether the same pattern applies in people with MDD or SCH and whether the degree of cortical inhibition is similar to those in healthy individuals.
PP80
LOWERED SELF ESTEEM IN SCHIZOPHRENIA: THE ROLE OF AUDITORY HALLUCINATIONS AND PERCEIVED STIGMA
Christopher J. Groot
1, Susan Rossell2
1
The University of Melbourne, Victoria, Australia
2
Monash University, Victoria, Australia
Background: The relationship between stigma, self-esteem and auditory hallucinations (AH) is of recent interest in schizophrenia research. Relevant authors purport that low self-esteem is causal in the experience and severity of current AH. However, this conclusion may be premature.
Aims: The current research further examined the relationship between stigma, self-esteem and AH. It was hypothesised that the perceived stigma associated with one's experience of AH reduces self-esteem.
Method: 56 patients with a diagnosis of schizophrenia or schizo-affective disorder and 44 healthy controls participated in the study. Assessment of AH was performed with the Scale for the Assessment of Positive Symptoms (SAPS). The patient group was divided by AH status, i.e., current AH (n = 21); past history of AH (n = 15); and those having never experienced AH (n = 20). Examination of cognitive styles was performed using Rosenberg's Self Esteem Questionnaire (RSE).
Results: The experience of AH correlated significantly with lower self-esteem. Thus, both past voice hearers and current voice hearers had lower scores on the RSE than patients who had never heard a voice and healthy controls. This reduction in self-esteem was not related to the frequency or severity of the voices.
Conclusion: This suggests that current self-esteem is adversely affected by the experience of AH; whether past or present. Contrary to previous conclusions, this finding lends credence to the hypothesis that patients’ perceived stigma and stereotyped beliefs about mental illness (here, one's experience of AH) may influence the observed reduction of self-esteem. Given these findings, CBT strategies for AH should target perceived stigma, stereotyped beliefs and reduced self-esteem.
PP81
DOES THE CONTRACEPTIVE PILL AFFECT COGNITION?
Andrea Gogos
1, Maarten van den Buuse1, Susan Rossell1,2
1
Mental Health Research Institute, VIC
2
Monash University, VIC
Background: Oestrogen has been shown to affect cognition, particularly memory. Less is known about the effect of the oral contraceptive pill on cognition. Prepulse inhibition (PPI) is a measure of information processing that is greater in men than women.
Aim: To examine PPI and higher-order cognitions in women during different hormonal stages.
Method: We tested healthy women at different stages of the menstrual cycle (early-follicular n = 17, mid-luteal n = 16), women taking the pill (n = 16) and men (n = 14). PPI included 115dB pulses and prepulse-pulse trials (prepulse: 74, 78, 86dB) at 2 inter-stimulus intervals (60, 120ms). Cognitive measures included memory, attention, language, visuospatial ability, executive function and emotion processing.
Results: Men had the highest PPI and women in the mid-luteal phase the lowest, albeit not significant, while women on the pill and in the early-follicular stage had similar PPI to men. Women performed better than men on all the cognitive measures, however, the only significant group differences were in attention and memory (p<0.03); post-hoc analysis revealing women on the pill perform better than men.
Conclusion: Women perform better than men on some cognitive measures, particularly women on the pill. There were however, no differences between the three groups of women in PPI or the higher-order cognitive measures. Thus, in women, different hormonal states, whether natural or induced with the contraceptive pill, do not cause major changes in cognition.
PP82
CHANGES IN trkB EXPRESSION IN THE PREFRONTAL CORTEX IN PATIENTS WITH SCHIZOPHRENIA
Jenny Wong
1, Debora A. Rothmond1 and Cynthia Shannon Weickert1
1
Schizophrenia Research Laboratory, Prince of Wales Medical Research Institute, University of New South Wales, Sydney, 2031, Australia
Background: TrkB exists as three isoforms, as a full length receptor containing a catalytic tyrosine kinase domain (trkB-TK +), a truncated receptor (trkB-TK-) lacking the catalytic tyrosine kinase domain and a Sarc Homology Collagen (SHC) containing receptor (trkB-SHC) also lacking the tyrosine kinase domain. Previous studies of schizophrenic vs control patients have reported reductions in trkB-TK+ mRNA expression across all cortical layers of the prefrontal cortex. As yet, we do not know if trkB-TK+ receptor protein is altered in the brains of patients with schizophrenia and hypothesize this to be reduced.
Aims: We determined if changes in trkB-TK+ may relate to potential changes in trkB isoforms within the same tissue samples.
Method: Using a cohort of n = 37 schizophrenics and n = 37 controls (from the TRC, Sydney) we measured trkB-TK+ (140kD), trkB-TK- and trkB-SHC (90kD) protein expression in the DLPFC by western blotting.
Results: Similar to mRNA expression, the 140kD band representing the trkB-TK+ showed a 17% reduction in schizophrenic brains (p = 0.046). No change was observed for the 90kD band which is consistent with the sizes of trkB-TK- and trkB-SHC.
Conclusion: The activity of neurotrophins is dependent on the ratios between trkB-TK+ and trkB-TK-, a reduction in trkB-TK+ and no change in trkB-TK-protein expression may compromise neurotrophin-trkB-TK+ signalling in a biological context.
PP83
CHARACTERISATION AND CELLULAR SPECIFICITY OF THE ▵FOSB RESPONSE TO CHRONIC SOCIAL STRESS IN RAT INFRALIMBIC CORTEX
Madeleine Hinwood, Rohan Walker, Trevor A. Day
School of Biomedical Sciences, The University of Newcastle
Background: Chronic social stress plays a role in the onset and maintenance of psychiatric disorders. Elucidating the neural response resulting from exposure to chronic social stress may offer insights into pathways operating in mood disorders. Recently, ▵FosB, a member of the Fos family of proteins which accumulates in the brain with chronic stimulation, has been used to examine long-term neuronal adaptation to chronic stress.
Aims: In the current study, we characterised levels ▵FosB expression in the forebrain of rats exposed to chronic social stress. Additionally, where levels of ▵FosB were significantly higher in stressed animals compared to controls we determined further features of these cells.
Method: Three experimental groups were used, (i) chronic social stress (n = 6), (ii) a matched sham control group (n = 4), and (iii) a nonhandled control group (n = 4).
Results: Analysis of ▵FosB immunoreactivity revealed significantly higher levels of ▵FosB in the infralimbic cortex of the experimental group compared to sham controls. Colocalisation with NeuN showed that these cells were neurons located in layers 2/3 and 5 of the cortex. Further labelling showed that the activated neurons are likely to be glutamatergic pyramidal neurons.
Conclusion: These results are the first to fully characterise the cells that are adapting to chronic social stress in the mPFC. This highlights the active role played by the mPFC in responding to chronic social stress.
PP84 SENSE OF CONTROL, VOLUNTARY MOVEMENT AND THE SENSE OF SELF: A TMS PILOT STUDY
Bryan Paton
1,2, Jakob Hohwy1, Vladimir Dubaj1, David Reutens1
1
Neurosciences Research Group, School of Medicine, Monash Medical Centre, Victoria, Australia
2
Mind & Brain Laboratory, School of Philosophy and Bioethics, Monash University, Victoria, Australia
Background: The sense of willed, self-initiated movement is crucial to body control and to a sense of self and conscious awareness. Problems in the forward modelling of this process may underlie the positive symptom of delusions of alien control in schizophrenia.
Aims: We aim to investigate the role of the inferior parietal cortex (IPC) in the sense of having voluntarily initiated arm movements using TMS excitation and inhibition protocols.
Method: We have recruited six controls for a pilot with the aim of recruiting an additional twenty. Initial structural and functional MRI sessions will allow for spatial localisation of maximal activation following voluntary arm movement. TMS sessions will follow to modulate the temporal causal contribution of the IPC to the perception of self-initiated arm movements.
Results: We intend to show that TMS induced excitation and inhibition of the IPC during participant-initiated and passive will make the sense of control alternate between feeling that it is voluntary and involuntary.
Conclusion: This study will allow us to assess the impact modulation of the IPC has on voluntary motor control and in turn may give us insight into one aspect of schizophrenia.
