Abstracts for the Royal Australian and New Zealand College of Psychiatrists Joint CINP/ASPR Scientific Meeting

102

ANTIDEPRESSANTS AS IMMUNOMODULATORS

Brian Leonard

Pharmacology Department National University of Ireland and Institute for Brain and Behaviour Research, University of Maastricht, The Netherlands

Epidemiological studies have implicated chronic depression as an important predisposing factor for dementia. Furthermore, chronic inflammatory diseases such as rheumatoid arthritis are frequently associated with depression. The therapeutic use of inflammatory cytokines such as interferon, used to treat chronic hepatitis, frequently cause depressive episodes in psychiatrically normal patients.

More direct evidence shows that in patients with major depression, the pro-inflammatory cytokines are raised in the plasma and cerebrospinal fluid (CRF). Other inflammatory mediators such as prostaglandin E2 are also raised in the plasma and CSF. In addition to the increase in inflammatory mediators that correlate with the major symptoms of depression (and which forms the basis for the macrophage theory of depression) the brain microglia and astrocytes, as well as the blood macrophages and monocytes, are overactive in depression. Hypercortisolaemia is also a common feature of major depression and while cortisol would be expected to attenuate the inflammatory changes, this mechanism would not appear to be functional in such patients. As a consequence of these immune and endocrine changes, there is an impairment of neuronal repair and neurogenesis.

Recently it has become apparent that in depression the activity of the tryptophan-kynurenine pathway increases, the activity of key enzyme, indoleamine dioxygenase being increased by the pro-inflammatory cytokines. As a consequence, the synthesis of serotonin is impaired while the end products of this pathway, 3-hydroxykynurenine and quinolinic acid, activate the NMDA glutamate receptors in the brain to cause neuronal damage. Such neurotoxic damage initiates neurodegeneration, an event that could predispose to dementia.

As most effective antidepressants attenuate the inflammatory changes, it seems possible that antidepressants could have a neuroprotective role. There is also evidence that, in patients in the early phase of the disorder, antidepressants reverse the accumulation of the neurodegenerative mediators of the kynurenine pathway. However, in those with chronic depression, antidepressants no longer appear to be neuroprotective. This hypothesis helps to explain not only the psychopathology of depression but also the possible reasons for the link between depression and chronic inflammatory disorders.

103

ALCOHOL, WINE AND MENTAL HEALTH

Roger M Pinder

Pharma Consultant, The Netherlands

Alcohol is both a poison and a tonic. It all depends upon the dose. The beneficial effects of regular consumption of modest levels of alcohol (<24g/day) have been amply demonstrated in the prevention of coronary heart disease (CHD). The evidence points to wine being better than beer or distilled spirits because it contains grape-derived polyphenols with antioxidant properties, more so in red than in white wine. There is much emerging data, mainly from population-based epidemiological studies, that the risks of stroke, dementia and cognitive decline in the elderly are also reduced by regular consumption of alcohol particularly (red) wine. The risks for CHD, stroke, cognitive decline and dementia follow a J-shaped curve-modest drinkers fare better than both abstainers and heavy drinkers. Plausible biological mechanisms for the beneficial influence of alcohol and wine upon diverse disease states include effects upon glucose metabolism as well as anti-thrombotic, anti-inflammatory and anti-atherosclerotic effects. Wine also uniquely increases heart rate variability and has important antioxidant properties. For Alzheimer's disease, where 5 studies from geographically diverse populations (Denmark, France, Italy, the Netherlands and the USA) have suggested reduced risk in modest and regular drinkers, it is highly likely that the antioxidant and anti-inflammatory properties of red wine in particular play major roles.

104

MATERNAL DEPRIVATION AND CORTICOSTERONE ADMINISTRATION IN RATS AS A NEURODEVELOPMENTAL MODEL OF SCHIZOPHRENIA: EFFECT ON PREPULSE INHIBITION

Maarten van den Buuse

Mental Health Research Institute, Australia

It has been hypothesized that schizophrenia is caused by at least two disruptions during the lifespan. The first disruption is genetic or occurs during an early developmental stage and increases vulnerability to the disease. The second stressful disruption occurs later in life and triggers the onset of overt symptoms. We have investigated this model in rats by combining maternal deprivation and ‘adolescent’ treatment with the stress hormone, corticosterone. Initial studies compared different ages of maternal deprivation and of corticosterone treatment. From these studies, we chose a protocol consisting of 24 hour maternal deprivation on postnatal day 9, followed by implantation of a 100 mg corticosterone pellet from 8 to 10 weeks of age. Controls were briefly handled (nondeprived) or implanted with cholesterol control pellets, respectively. Rats were tested at 10 or 12 weeks of age for psychotropic druginduced locomotor hyperactivity, a model of psychosis, and for prepulse inhibition (PPI), a model of sensorimotor gating.

We did not observe changes in the locomotor hyperactivity response of the animals to amphetamine or phencyclidine treatment at either 10 or 12 weeks of age. In contrast, while apomorphine treatment disrupted PPI in rats that either underwent maternal deprivation or were treated with corticosterone, there was no effect of apomorphine on PPI in rats with the combined neonatal and ‘adolescent’ stress hormone treatment. This effect was seen both at 10 weeks and 12 weeks of age. The disruption of PPI by treatment with the serotonin-1A receptor agonist, 8-OH-DPAT, was similar in all groups. This suggests prolonged and selective changes in dopaminergic regulation of PPI in rats by two disruptions along the neurodevelopmental axis. Current studies are addressing the neurochemical and molecular mechanisms by which maternal deprivation and corticosterone treatment alter behavioural responses.

105

FETAL AND NEONATAL ORIGINS OF ALTERED BRAIN DEVELOPMENT: IMPLICATIONS FOR NEUROLOGICAL DISORDERS

Sandra M Rees

Department of Anatomy and Cell Biology, University of Melbourne, Australia

Purpose: Abnormal development of the brain during fetal and early postnatal life is now thought to contribute to the aetiology of many neurological disorders including schizophrenia and cerebral palsy. Our aim is to develop animal models of adverse intrauterine conditions that mimic events which occur in human pregnancy in order to determine whether they cause alterations in brain structure and function which parallel the situation seen in patients with neurological disorders.

Methods: Models to be discussed include: ovine models of acute preterm hypoxia(term ∼147 days) and inflammation induced by endotoxin in the second trimester; a guinea pig model of chronic placental insufficiency induced during the second half of gestation (term ∼67 days). Brains have been assessed for alterations in cell number, dendritic and axonal growth, synaptogenesis and myelination.

Results: Acute hypoxia resulted in neuronal death, a slowing of neural migration in the hippocampus and damage in the white matter. The growth of neural processes was significantly reduced in the long term in neurons that were immature at the time of the insult but recovered after an initial delay if process growth was well established. Chronic placental insufficiency did not cause overt white matter damage although myelination was reduced. Ventriculomegaly was present at birth and persisted into adulthood. The growth of neural processes was compromised globally. Chronic inflammation resulted in white matter damage ranging from cystic lesions to diffuse injury.

Conclusions: The timing and nature of intrauterine insults are critical in determining the pattern of injury and thus the extent to which neurological function will be affected postnatally. Both acute hypoxic and inflammatory insults produce white matter injury with characteristics similar to damage seen in cerebral palsy. Chronic placental insufficiency results in alterations which parallel changes observed in the brains of some schizophrenic patients. Thus it is possible that adverse events in utero disrupt normal brain development and cause damage and/or create a vulnerability of the brain that disposes an already at-risk individual to develop a particular disorder later in life.

106

GENE–ENVIRONMENT INTERACTIONS AND EXPERIENCE-DEPENDENT CORTICAL PLASTICITY IN MOUSE MODELS OF PSYCHIATRIC DISORDERS

Anthony J Hannan

Howard Florey Institute, University of Melbourne, Australia

Huntington's disease (HD) is caused by an expanded trinucleotide (CAG) repeat encoding an extended polyglutamine tract in the huntingtin protein. Affected individuals display progressive motor, cognitive and psychiatric symptoms (including depression and psychosis), leading to terminal decline. Given that transgenic HD mice have decreased hippocampal cell proliferation, and that a deficit in neurogenesis has been postulated as an underlying cause of depression, we hypothesised that decreased hippocampal neurogenesis contributes to depressive symptoms and cognitive decline in HD. Fluoxetine, a serotonin reuptake inhibitor commonly prescribed for the treatment of depression, is known to increase neurogenesis in the dentate gyrus of wild-type mouse hippocampus. We have shown that hippocampal-dependent cognitive and depressive-like behavioural symptoms occur in HD mice, and that the administration of fluoxetine produces a marked improvement in these deficits. Furthermore, fluoxetine was found to rescue deficits of neurogenesis and volume loss in the dentate gyrus of HD mice. We have also recently demonstrated that specific environmental manipulations can have similar effects.

We are also focusing on specific glutamate, serotonin and muscarinic acetylcholine receptors, and associated G protein-coupled signalling pathways, which mediate experience-dependent changes in the structure and function of neurons in the postnatal neocortex and hippocampus. We know that some of the genes we are examining have been recently linked to schizophrenia, and we are attempting to understand how disruption of these molecular signalling pathways can lead to the abnormal cortical maturation seen in this disease. These molecular changes have now been compared with behavioural changes in knockout mice, suggesting that these signalling pathways are crucial for development of various cognitive functions, including working memory and sensorimotor gating, which are known to be disrupted in schizophrenia. We have identified specific behavioural deficits that can be rescued by increased levels of environmental stimulation, providing evidence for gene-environment interactions of relevance to the pathogenesis of schizophrenia.

107

DEVELOPMENTAL VITAMIN D DEFICIENCY AND BRAIN DEVELOPMENT: AN INFORMATIVE ANIMAL MODEL OF SCHIZOPHRENIA

Tom H Burne

Queensland Centre for Mental Health Research (QCMHR), Australia

John J McGrath

Queensland Centre for Mental Health Research (QCMHR), Australia

Alan Mackay-Sim

Griffith University, Australia

Darryl W Eyles

Queensland Centre for Mental Health Research (QCMHR), Australia

There is growing evidence that vitamin D is active in the brain but until recently there was a lack of evidence about its role during brain development. Guided by certain features of the epidemiology of schizophrenia, we have explored the role of vitamin D in the developing brain and behaviour using whole animal models. Prenatal vitamin D deficiency results in subtle alterations in maternal behaviour as well as long lasting effects on the adult offspring, despite a return to normal vitamin D levels during postnatal life. These affects are specific to transient prenatal vitamin D depletion as adult vitamin D depletion, combined prenatal and chronic postnatal vitamin D depletion, or ablation of the vitamin D receptor in mice lead to markedly different outcomes. The developmental vitamin D (DVD) model now draws strength from epidemiological evidence of schizophrenia and animal experiments. Although the DVD model does not replicate every aspect of schizophrenia, it has several attractive features: (1) the exposure is based on clues from epidemiology; (2) it reproduces the increase in lateral ventricles; (3) it reproduces well-regarded behavioural phenotypes associated with schizophrenia (e.g. MK-801 induced hyperlocomotion and impaired LI); and (4) it implicates a disturbance in dopamine signaling. In summary, low prenatal levels of vitamin D can influence critical components of orderly brain development and that this has a long lasting effect on the adult brain.

108

ANIMALS MODELS OF DEPRESSION: DO THEY EXIST?

Trevor Norman

Department of Psychiatry, University of Melbourne, Austin Hospital, Australia

Studies in animals are widely used for the screening of new molecules as potential antidepressants in man. Additionally, examination of biochemical and physiological changes occurring in animals after acute and chronic administration of existing clinically proven antidepressant molecules have been used to advance an understanding of their mechanism of action. The ability of such studies to predict, with few false positives, drugs which have already been shown to be antidepressant in the clinic has been used to advance the case for a particular model to be one of depression. From such studies a number of models of depression have been developed with predictive validity. Rarely have such models been used to understand the pathophysiology of certain aspects of the depression. For this latter application models need to demonstrate face and construct validity as well as predictive validity. This presentation focuses on two models of depression developed from different perspectives: the bilateral olfactory bulbectomised rat and the chronic mild stress model. Face, construct and predictive validity will be compared and contrasted for the two models and their relative contributions to understanding the neuro-chemical basis of depression presented. The bulbectomised rat, a neuronal damage model, relies heavily on predictive validity, where it has been successful in demonstrating antidepressant properties of novel agents. A series of studies in recent years has suggested that the model also demonstrates both construct and face validity. The chronic mild stress model, an aetiological model, also has high predictive validity for antidepressant drugs. Both face and construct validity are also demonstrated by this model. However the usefulness of this model is limited by the difficulties in establishing it in different laboratories.

109

THE 2ND AUSTRALIAN NATIONAL SURVEY OF MENTAL HEALTH AND WELL-BEING: OVERVIEW AND FUTURE DIRECTIONS

Tim Slade

University of New South Wales, Australia

Jane Pirkis

University of Melbourne, Australia

In 2007 a second survey of the mental health of the Australian adult general population will be conducted. The planning for this second mental health survey is just underway. The current presentation will provide background information about the aims and purposes of the second survey along with a more detailed discussion of the issues associated with developing the instrument to be used in the survey. The strengths and weaknesses of the first survey will be discussed with the aim of identifying gaps in knowledge regarding the epidemiology of mental disorders. The presentation will conclude by describing some potential research questions that will be answered with the new survey.

Keywords: Work and Voc Rehab, Social Psychiatry

110

DEVELOPMENT AND EVALUATION OF A YOUTH MENTAL HEALTH COMMUNITY AWARENESS CAMPAIGN – THE COMPASS STRATEGY

Annemarie Wright

ORYGEN Research Centre, University of Melbourne, Australia

Anthony F Jorm

ORYGEN Research Centre, University of Melbourne, Australia

Meredith G Harris

ORYGEN Research Centre, University of Melbourne and School of Population Health, University of Queensland, Australia

Patrick D McGorry

ORYGEN Research Centre, University of Melbourne, Australia

Kerryn Pennell

ORYGEN Research Centre, University of Melbourne, Australia

Purpose: To describe the application of a health promotion model to the development, implementation and evaluation of a community awareness campaign designed to improve mental health literacy and early help seeking amongst young people. The impact of the program on population mental health literacy will be a particular focus.

Method: The Compass Strategy was implemented in western metropolitan Melbourne and Barwon regions of Victoria. The Precede-Proceed model for health promotion planning and evaluation was applied to guide the population assessment, campaign strategy development and evaluation. A key aspect of the evaluation was a crosssectional telephone survey undertaken before and after 14 months of the campaign using structured interviews based on a mental health literacy questionnaire. Randomly selected independent samples of 600 young people aged 12–25 years from an experimental region and another 600 from a comparison region were interviewed at each time point. Participants were presented with vignettes of a person with either depression or psychosis followed by questions related to recognition of disorder, best forms of treatment, perceived outcomes and exposure to the disorder and related media.

Results: The program was judged to have an impact on the following variables as they revealed significant region-by-time interaction effects (p < 0.05): awareness of mental health campaigns, self-identified depression, help for depression sought in the previous year, correct estimate of prevalence of mental health problems, increased awareness of suicide risk, and a reduction in perceived barriers to help seeking.

Conclusions: We believe this is the first study of its kind to apply the rigorous standards of a health promotion model to a mental health community awareness campaign. The program achieved many of its aims despite the relative short duration and moderate intensity of the campaign.

Keywords: Work and Voc Rehab, Social Psychiatry

111

CHALLENGES IN THE EPIDEMIOLOGICAL STUDY OF INTELLECTUAL DISABILITY COMORBID WITH PSYCHIATRIC MORBIDITY. DATA FROM A WESTERN AUSTRALIAN RECORD LINKAGE STUDY

Vera A Morgan

School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Australia

Helen Leonard

Institute for Child Health Research, The University of Western Australia, Australia

Assen Jablensky

School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Australia

In 1919, Kraepelin used the term “pfropfschizophrenie” to describe schizophrenia comorbid with intellectual disability. In recent years, there has been a renewed interest in studying the relationship between psychiatric morbidity and intellectual disability in general, and between schizophrenia and intellectual disability specifically. Research findings have not been consistent, with the variation in prevalence estimates reflecting methodological, diagnostic and administrative issues. However, it is estimated that some 3% of persons with intellectual disability will have schizophrenia compared to a population figure of around 1%. In Western Australia, we had an opportunity to study intellectual disability comorbid with psychiatric morbidity using whole-of-population data. We linked 11,576 individuals on the Western Australian intellectual disability register to the statewide mental health register in order (i) to get estimates of comorbidity and (ii) to describe the profile of persons with comorbid illness.

Our results highlight the importance of using both psychiatric and disability registers to study comorbidity. We found that psychiatric morbidity is poorly recorded in disability services records and intellectual disability is poorly recorded in mental health services records. Using the linked dataset, psychiatric morbidity affected up to 1 in 5 persons with an intellectual disability. The prevalence of psychotic episodes was high (4% of all disability services clients) but may be underestimated unless we also use psychiatric registers to identify cases.

The challenges of researching comorbid disorders will be discussed. However, despite the difficulties, our estimates are in line with some of the more reliable estimates in the literature and, for the first time in Western Australia, we are able to describe the clinical profile of this group of people and characterise their use of services. The linked database also provides a rare opportunity to test specific hypotheses on the association between intellectual disability and psychiatric disorders and our ongoing work is focusing specifically on intellectual disability comorbid with psychotic disorders.

Keywords: Epidemiology, Aetiology, Other

112

PERFORMANCE OF THE SF-12 AND RAND-12 PHYSICAL AND MENTAL HEALTH SUMMARY SCALES IN A POPULATION-BASED SAMPLE OF 20–24, 40–44 AND 60–64 YEAR-OLDS: THE PATH THROUGH LIFE PROJECT

Timothy D Windsor

Australian National University, Australia

Bryan Rodgers

Australian National University, Australia

Peter Butterworth

Australian National University, Australia

Kaarin J Anstey

Australian National University, Australia

Anthony F Jorm

University of Melbourne, Australia

Aims/methods: Recent research indicates that the SF-12 summary measures of physical and mental health may be less accurate than the RAND-12 scales, which are calculated from the same items using a different approach to scoring. The aim of this paper was to compare the performance of SF-12 and RAND-12 summary scales by examining their relationships within and across physical and mental health domains using measures of chronic physical illness and psychological distress, in a population-based sample of young, middle-aged and older adults.

Results: Results indicated that the RAND-MHC was more strongly associated with psychological distress than the MCS-12, while both RAND summary scales showed stronger relationships with crossdomain measures of physical and mental health relative to the SF-12 summaries.

Conclusions: It was concluded that the RAND-12 provides a more readily interpretable approach to deriving summary measures of physical and mental health than the SF-12.

Keywords: Work and Voc Rehab, Social Psychiatry

113

THE IMPORTANCE OF THE HOUSEHOLD IN PSYCHIATRIC EPIDEMIOLOGY

Peter Butterworth

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

Purpose: To assess social and contextual influences on psychiatric illness including differences in the prevalence of common mental health problems across areas and households, household-level characteristics of the population, and consideration of how the social context can moderate the effect of individual risk factors.

Methods: Analysis of data from the first wave of the Household, Income and Labour Dynamics in Australia Survey: a large representative survey of Australian households. Analysis techniques include multilevel modelling. Common mental disorders were assessed using the mental health scale from the SF-36. Respondents with scores less than 50 were classified with a mental health problem (10.5% of population).

Results: Very little variance in mental health scores occurred at the area level (1.5%), whereas there was significant and substantial variance at the household level (23.0%). The household effects were not explained by individual-level risk factors. Persons living alone reported higher rates of mental health problems than those living with others. Nonetheless, there was substantial clustering of mental health problems within households. Overall 18.6% of adults were residing in a household in which at least one person had a mental health problem, while 16.5% of Australian households included a person with a mental health problem. Further, 17.9% of Australian children live in a household in which an adult experiences mental health problems.

Conclusions: The results are consistent with recent international research that has demonstrated little variation in common mental disorders at the area-level, but highlights the importance of considering the household (largely family units) and the impact of mental health within the family. Given the limitations of available measures, there is a need for population surveys using structured diagnostic instruments to use survey and sampling methodologies that capture data from multiple household members.

Keywords: Epidemiology, Aetiology, Other

114

PARTNERSHIPS FOR WELLBEING: THE RURAL RAP PROGRAM

Tracy E Robinson

Charles Sturt University, Australia

Paul Burnett

Charles Sturt University, Australia

Brian Kelly

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

Michael Kiernan

Charles Sturt University, Australia

Aim: Develop and implement an effective and culturally sound program for building resilience in rural adolescents.

Background: There is a paucity of research on effective school based programs that aim to build resilience and emotional well being in young people in rural areas. In particular, studies that involve collaboration with local Aboriginal communities are scant and the current study aims to help fill this gap in prevention efforts. The study has focussed on collaborating with local Aboriginal workers to adapt and implement the Resourceful Adolescent Program for students in western NSW. The RAP program has been identified by the Commonwealth Government as an evidence based intervention that is effective at preventing adolescent depression in the short and medium term. This presentation will recount the strategies used to adapt and implement RAP in Bourke, Dubbo and Wellington in 2005.

Method: The study involves 168 young adolescents in three rural locations in NSW. It incorporates both qualitative and quantitative methods and overall, has relied on an inductive framework that allows for regular feedback from local Aboriginal Education Consultants, Assistants, Tutors and Health workers who continue to assist with the development of appropriate resources and strategies for supporting RAP in western NSW.

Results: Results to date support the efficacy of RAP delivery for Aboriginal adolescents and the program has been welcomed by local Aboriginal workers. Qualitative results suggest we need to include cultural identity as an important component of self esteem strategies and that we can incorporate cognitive behavioural techniques when working with young people from diverse cultures.

Conclusions: Results suggest that collaboration with local Aboriginal communities is essential for effective mental health promotion in rural areas. Programs can be modified in concert with local workers to ensure they are culturally sound.

Keywords: Work and Voc Rehab, Social Psychiatry

115

THE RELATIONSHIP BETWEEN THERAPEUTIC ALLIANCE AND RECOVERY ORIENTED BEHAVIOUR IN CLIENTS WITH SEVERE MENTAL ILLNESS AND HIGH SUPPORT NEEDS

Robert J King

The University of Queensland, Australia

Frank Deane

Australia

Lindsay Oades

Australia

Trevor Crowe

Australia

Pete Kelly

Australia

The Aim Hi project (High Support Stream) is an NHMRC funded multisite trial of collaborative mental health service provision using evidencebased procedures within a recovery oriented framework. Mental health practitioners from state operated clinical services in Victoria, NSW and Queensland and non clinical support workers from non-government services in NSW and Queensland were trained in a model of service delivery that emphasised alliance building, collaborative goal setting and client homework. Services were allocated to either an immediate training or a delayed training condition so as to enable evaluation of training impact, having reference to therapy process and client outcome. Standardised process and client outcome measures were used and participating practitioners were required to maintain detailed records of client goal setting and recovery oriented tasks. It was hypothesised that training would promote stronger collaboration and alliance resulting in greater commitment to recovery goals and increased participation in agreed tasks, including homework activities. This paper reports on early data from a sample of approximately 120 clients and examines the relationship between therapy process and active engagement in goal setting and recovery oriented behaviour.

Keywords: Work and Voc Rehab, Social Psychiatry

116

HELP-SEEKING BY RURAL RESIDENTS FOR MENTAL HEALTH PROBLEMS: THE IMPORTANCE OF AGRAGARIAN VALUES

Fiona Judd

Centre for Rural Mental Health, Bendigo Health Care Group and Monash University, Australia

Angela Komiti

Centre for Rural Mental Health, Bendigo Health Care Group and Monash University, Australia

Henry Jackson

The University of Melbourne, Australia

Greg Murray

Swinburne University, Australia

Caitlin Fraser

Centre for Rural Mental Health, Bendigo Health Care Group and Monash University, Australia

Objective: To examine the role of stoicism, self-efficacy, perceived stigma and mental health literacy, in predicting help-seeking for mental health problems, amongst residents of rural communities.

Method: A cross-sectional survey of residents of rural and remote regions of Victoria and NSW, Australia. Self-report questionnaires were posted to the sample assessing current levels of symptomatology, functional disability, perceived stigma, self-efficacy, stoicism, mental health literacy, attitudes towards seeking professional help, and experience of seeking help for mental health problems.

Results: Four-hundred and sixty-seven individuals (58.0% females; mean age (SD) of 56.3 (12.8) years) responded to the survey. Approximately one-third of the sample reported having sought help in the past for psychological problems. A hierarchical logistic regression predicting help-seeking from GPs and/or mental health professionals showed that greater stoicism and self-efficacy, and lower levels of distress were associated with greater likelihood of not seeking professional help. Contrary to expectations, gender, perceived stigma and positive attitudes towards seeking help did not independently predict help-seeking.

Conclusions: In this sample of residents of rural and remote communities, current distress levels and attitudinal variables were associated with help-seeking behaviour for mental health problems. The practical implications in terms of improving attitudes towards help-seeking and actual help-seeking are discussed.

117

INCIDENCE AND OUTCOME OF PSYCHIATRIC DISORDER IN A LONGITUDINAL RURAL COMMUNITY STUDY (NoRMHS)

John Beard

Public and Environment Health University of Sydney, Australia

Brian Kelly

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

Kathy Heathcote

Centre for Rural and Remote Mental Health, University of Newcastle, Southern Cross University and Department of Rural Health, Australia

Robert Brooks

Centre for Population Mental Health, Liverpool Hospital, Australia

Arul Earnest

Department of Rural Health (Northern Rivers), University of Sydney, Australia

Aim: To investigate the patterns and predictors of psychiatric disorder in a longitudinal study of a rural community sample (The Northern Rivers Mental Health Survey-NoRMHS).

Methods: A randomly selected community sample of 1407 adults from a rural district of Northern NSW were surveyed using a two phase screening for psychiatric disorder using the CIDI, with follow-up face-to-face assessment at 2 years.

Results: 1407 subjects were interviewed at baseline (493 with a positive psychiatric diagnosis). 968 subjects were re-interviewed (68.8% follow-up). Of those with least psychiatric disorder at baseline (n = 493), 27.4% were disorder free at 2 year followup. After adjusting for sampling, the 12 month incidence of mental disorders (as classified by ICD 10) among subjects who had been disorder free two years previously was 9.95%. Of the total sample with a psychiatric diagnosis at followup, 25.7% met criteria for more than one disorder. The most common comorbid disorders were anxiety and mood disorders (64%). Substance use disorders co-existed with mood and/or anxiety disorders in the remaining 36% of those with comorbid psychiatric illnesses. The number of conditions at baseline was predictive of co-morbidity at 2 year follow-up (p <.001). On multivariate analysis the predictors of any psychiatric disorder at followup (p <.01) were the presence of disorder at initial assessment (OR = 2.01; 95% CI 1.27–3.18) recent adverse life events (OR = 1.23; 95% CI: 1.10–1.38) and neuroticism scores (OR = 1.09; 95% CI: 1.02–1.17).

Conclusions: The presence of psychiatric disorder at followup was associated with prior psychiatric illness, environmental (life events) and predispositional factors (neuroticism). Patterns of psychiatric comorbidity were identified. Co-morbidity at entry was predictive of comorbidity at follow-up, although diagnoses displayed a high variability over time.

Keywords: Epidemiology, Aetiology, Other

118

AUSTRALIAN NEWSPAPER JOURNALISTS BELIEFS ABOUT DISCRIMINATION: DO THEY HAVE THE WRITE IDEA?

Lara M Bishop

Centre for Mental Health Research, Australian National University, Australia

Kathleen M Griffiths

Centre for Mental Health Research, Australian National University, Australia

Helen M Christensen

Centre for Mental Health Research, Australian National University, Australia

Louise Farrer

Centre for Mental Health Research, Australian National University, Australia

Purpose: Despite the major potential role played by the media in determining the mental health attitudes of the public, there has been little investigation into the attitudes and beliefs of journalists. This paper investigates journalist's beliefs about the discrimination of individuals with mental health problems.

Methods: A mental health literacy survey was sent to Australian newspaper journalists in 2003/2004 and responses were received from 636 journalists. Journalists received a survey with a vignette of “Mary” who was experiencing postnatal depression, depression or schizophrenia. The survey investigated their knowledge and beliefs about mental disorders, stigma and discrimination, help seeking preferences and the role of the media in Australia. The items of interest for the present paper relate to the following questions “Do you think that Mary would be discriminated against by others in the community, if they knew about her condition?” and if they answered yes, then “In what way/s would she be discriminated against?”

Results: Thirteen categories of discrimination were identified from the open ended question. These categories were work, reduced opportunities, caretaker role, social, lowered expectations, burden, lack of trust, feared, not a real illness, target of aggression, labelled, general stigma and other. Answers were coded independently by two coders and reliability of categories showed good to very good agreement (κ.61–κ.94). Journalists believed that discrimination was most likely to occur in work environments (43%) and social situations (37%) and that people were more likely to be discriminated against if they had schizophrenia (85%). Women with postnatal depression were much more likely to be discriminated against as caretakers (e.g. seen as a bad or incompetent mother) (21%).

Discussion: Beliefs about the probability of discrimination as a result of a mental health problem are high among Australian journalists. These beliefs do not necessarily reflect individual journalists beliefs about discrimination, but are what journalists think other people believe in relation to discrimination. The results suggest that workplaces may be a key area to target for programs designed to reduce stigma and discrimination.

Keywords: Work and Voc Rehab, Social Psychiatry

119

A FLEXIBLE MODEL OF PERSONALITY TRAITS ASSOCIATED WITH DEPRESSION: THE BLACK DOG INSTITUTE'S MODEL

Gordon Parker

School of Psychiatry, University of New South Wales and Black Dog Institute, Australia

Lucy A Tully

School of Psychiatry, University of New South Wales and Black Dog Institute, Australia

Joanna Crawford

School of Psychiatry, University of New South Wales and Black Dog Institute, Australia

Vijaya Manicavasagar

School of Psychiatry, University of New South Wales and Black Dog Institute, Australia

Background: The Black Dog Institute has developed a Temperament and Personality Questionnaire for determining the personality traits that increase the risk to depression. This Questionnaire has allowed us to examine the utility of employing a flexible as opposed to a finite model (two-factor Eysenckian or Five-Factor Model) of personality style associated with depression. This study reports on the development of an aborising model to illustrate the utility of such a flexible approach.

Methods: Two samples of subjects completed the Temperament and Personality measure. The first sample comprised 529 subjects attending their general practitioner (a community sample) and the second sample comprised 903 subjects who had experienced depression and who completed the measure on the web.

Results: Exploratory and confirmatory factor analyses, imposing twoto eight-factor solutions, were used to create a seven-tiered model of personality dimensions. Analyses identified how molar personality constructs aborised into lower-order tiers and presumed facets, and demonstrated the differential relevance of the personality constructs to depression in the two groups.

Conclusions: The findings demonstrate that there are potential advantages to a flexible model of personality traits associated with depression. This aborising model has implications for research examining the relationship between broad and narrow personality dimensions and depression, such as risk to disorder and prediction of treatment response.

Keywords: Epidemiology, Aetiology, Other

120

ARE CHANGES IN ROLE STRAIN AND RUMINATION ASSOCIATED WITH CHANGES IN DEPRESSION AS A FUNCTION OF GENDER?

Holly A Mack

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

Helen Christensen

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

Ruth A Parslow

ORYGEN Research Centre, Department of Psychiatry, The University of Melbourne, Australia

It is well established that women experience depression more than men, but it is not completely understood why women are more vulnerable to depressive symptoms. Explanations for this vulnerability have been that women experience greater role strain and rumination than men, which leads to an increase in anxiety and depression. The present study investigates the relationship between changes in role strain and rumination and changes in depression as a function of gender.

The analyzed sample comprised subjects from an ongoing Australian epidemiology study entitled “The PATH Through Life” project (PATH), randomly selected from electoral rolls in the ACT. Initial data collection began in 1999, with follow-up data collected four years later, resulting in a total sample size of 7,485 adults in three age groups (20–24, 40–44, 60–64). Data on the youngest age group (20–24) concerns the current analyses, with 1,162 males and 1,242 females. Goldberg's scales were utilized to measure symptoms of depression and anxiety experienced in the last month. Factors evaluated for possible gender differences in depression and anxiety included education, martial status, employment status, number of children, personality, role strain, mastery, and ruminative style. Latent change models were utilized to evaluate these relationships.

Preliminary results show a significant difference between the number of depression and anxiety symptoms experienced by males and females, with females having higher scores at both time points. For females, there was a significant difference in anxiety between the two time points.

Keywords: Work and Voc Rehab, Social Psychiatry

121

EXECUTIVE DYSFUNCTION PREDICTS POOR PSYCHOSOCIAL OUTCOME THREE MONTHS AFTER RECOVERY FROM MAJOR DEPRESSIVE DISORDER

Adrienne Withall

School of Behavioural and Community Health Sciences, University of Sydney, Australia

Lynne Harris

School of Behavioural and Community Health Sciences, University of Sydney, Australia

Steve Cumming

School of Behavioural and Community Health Sciences, University of Sydney, Australia

Background: Depressed patients often report poor concentration, decision-making and organisation; symptoms that are frustrating and disheartening, can persist after discharge and cause functional impairment. This study was conducted to examine longitudinal neuropsychological function in depressed patients, with a focus on executive function. This study also aimed to examine the relationship between clinical and neuropsychological variables and psychosocial outcome.

Methods: Psychiatric (HRSD-17, DASS, FrSBe, SOFAS) and neuropsychological assessments (NART, Reaction Time, Digit Span, CVLT, COWAT, WSCT, Stroop, WISC-III Mazes, Prospective memory, Six Elements Test) were administered at admission and 3-months post-discharge, to 48 patients and 30 age, sex and IQ-matched controls. Patients, aged 20–60 years and with a primary diagnosis of MDD, were recruited from the Royal North Shore Hospital and Northside Clinic, NSW.

Results: At follow-up, there were no significant differences between patients and controls on structured tests (Digits-forward, COWATsemantic, Mazes, CVLT, Stroop). Significant deficits were evident in the SET, Digits-backward, WCST-perseverations, prospective memory and COWAT-phonemic. These tests require patients to organise, monitor and review their performance. Using hierarchical regressions, poor psychosocial outcome was associated with worse performance on prospective memory and with more WCST perseverative errors at admission.

Conclusions: Depressed patients showed impairments in executive function that persisted beyond clinical recovery. Furthermore, executive impairment at admission predicted those with later poorer social and occupational functioning. This may allow for the identification of “at-risk” individuals at the time of admission, providing for targeted treatment and lessening future disability.

Keywords: Epidemiology, Aetiology, Other

122

UNDERSTANDING FLIGHT OF IDEAS IN MANIA

Susan L Rossell

Mental Health Research Institute of Victoria, Australia

Characteristically, patients with mania show pressure of speech, rapidly and involuntarily flitting from one topic to the next, which although logical and possible to follow, is often inappropriate. This is called flight of ideas. There have been no previous empirical investigations to uncover the underlying cognitive basis for this symptom. This study predicted that flight of ideas is the result of an associative processing abnormality. 28 patients with mania, 32 patients with schizophrenia and 32 matched normal controls performed eight associative/semantic processing tasks. It was predicted that mania participants would have difficulty performing tasks that required accurate processing of associations (for example deciding whether synonyms are associated or not) but other semantic processing skills would be intact, i.e. fluency and meaning generation. The data supported our hypothesis. We consequently further examined whether the deficits reported in mania were the result of an access or storage difficulty by using task manipulations of consistency, frequency and hyperpriming. It is generally assumed that a storage deficit is signalled by item-specific consistent performance, an exaggerated effect of word frequency, and the occurrence of hyperpriming; an access deficit is signalled by the absence of these effects. The data, in general, supported an access difficulty. In conclusion, individuals with mania have specific controlled associative processing difficulties that are the result of impaired search and retrieval of information.

Keywords: Epidemiology, Aetiology, Other

123

DETERMINANTS OF PSYCHOSOCIAL IMPAIRMENT IN BIPOLAR DISORDER

Philip B Mitchell

University of New South Wales, The Black Dog Institute, Australia

Justine C Corry

Black Dog Institute, Prince of Wales Hospital, Australia

Gin S Malhi

The University of New South Wales, Australia

Dusan Hadzi-Pavlovic

Department of Human Behaviour, School of Psychiatry, The University of New South Wales, Australia

Amy K Johnston

School of Psychiatry, The University of New South Wales, and The Black Dog Institute, Australia

Purpose: The ongoing psychosocial impairment in bipolar disorder, despite adequate pharmacological intervention, is well recognized. This study aims to better understand the role of both frank episodes of depression and sub-syndromal depression in determining psychosocial outcome.

Method: Patients meeting DSM-IV criteria for Bipolar I or II Disorder (N = 217) were recruited from the Black Dog Institute Bipolar Disorders Clinic, a tertiary referral centre for the assessment and treatment of bipolar disorder. The presence or absence of 10 commonly occurring inter-episodic symptoms and number of bipolar episodes was ascertained. The degree of impairment in the domains of paid occupation, studies, relationships, grooming/self-care, housekeeping/home maintenance, and parenting ability was also assessed. Latent class analysis was conducted to examine patterns in the types of inter-episodic symptoms reported. Logistic regression was used to examine the relationship between inter-episodic symptoms, number of bipolar episodes and psychosocial impairment.

Results: No latent classes related to type of symptoms were found in the sample. Instead, classes relating to number of symptoms were apparent. Number of inter-episodic symptoms significantly predicted unemployment, financial difficulties and impairment in relationships. Total number of episodes significantly predicted impairment in housekeeping, grooming, relationships and parenting. Number of depressive episodes significantly predicted impairment in these areas while the number of manic episodes only predicted impairment in parenting and housekeeping.

Conclusion: As the number of inter-episodic symptoms and episodes increased patients were more likely to report impairment in key areas of functioning. This has implications for the treatment of bipolar illness indicating a need for improved intervention for inter-episodic symptomatology, in addition to the historical focus on depressed and manic episodes.

Keywords: Work and Voc Rehab, Social Psychiatry

124

BIPOLAR DISORDER IN AUSTRALIA: ASSESSMENT OF CLINICAL OUTCOMES AND DISEASE BURDEN

Jayashri Kulkarni

Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia

Michael Berk

Department of Clinical and Biomedical Sciences, The University of Melbourne, Australia

Fitzgerald B Paul

Alfred Psychiatry Research Centre, The Alfred and Monash University, Department of Psychological Medicine, Australia

Anthony R de Castella

Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia

Dodd Seetal

Department of Clinical and Biomedical Sciences, The University of Melbourne, Australia

Katarina Kelin

Eli Lilly Australia Pty Ltd, Australia

Alan Brnabic

Clinical Outcomes and Research Institute, Eli Lilly Australia Pty Ltd, Australia

William Montgomery

Eli Lilly Australia Pty Ltd, Australia

Purpose: An Australian observational study of 2 years duration, the Bipolar Comprehensive Outcomes Study (BCOS) aims to examine the effectiveness of available medications for patients diagnosed with bipolar I or schizoaffective disorder (DSM-IV-TR). Here we describe the demographic and clinical status of patients at study entry.

Methods: Longitudinal clinical, pharmacological, functional, social, and economic data are being collected for 240 patients. Clinical measures include the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale (HAMD21), Clinical Global Impressions Scale– Bipolar Version (CGI-BP), and the Current Major Depressive/Manic Episode Checklist. These data are the baseline assessment for the first 120 patients.

Results: The average age of patients at enrolment was 40.4 + 12.3 years (mean+SD). Just over half of this patient cohort are female (57%, n = 68), and the majority have a diagnosis of bipolar I disorder (76%, n = 91). While 31% of patients were unemployed, 8% had a fulltime job and a further 28% part-time employment. Based on CGI-BP scores, more women were markedly ill (38%; n = 26 vs. 25%; n = 13), however, as a greater proportion of men were moderately ill (33%; n = 17 vs. 21%; n = 14), the mean overall CGI-BP score was not affected by gender (3.9 + 1.3, mean+SD). Irrespective of gender, on average, patients were suffering only mild depression (HAMD21 total score 12.7 + 8.4, mean+SD). Despite an average YMRS Total score of 7.8 + 8.1 (mean+SD), the range (0 − 37) indicates that some patients exhibited symptoms of mania. In the 3 months prior to enrolment, 37% of patients had spent at least one day in hospital for psychiatric treatment. Of those hospitalised, the majority (89%) were single admissions.

Conclusion: Continued assessment of these patients will help to improve the understanding, treatment, and outcomes of patients diagnosed with bipolar I and schizoaffective disorder.

Keywords: Work and Voc Rehab, Social Psychiatry

125

FACTORS DISTINGUISHING SUICIDE IDEATORS FROM SUICIDE ATTEMPTERS IN A COMMUNITY SAMPLE: SOCIAL ISSUES AND PHYSICAL HEALTH PROBLEMS

Alicia K Fairweather

Centre for Mental Health Research, Australian National University, Australia

Kaarin J Anstey

Centre for Mental Health Research, Australian National University, Australia

Bryan Rodgers

National Centre for Epidemiology and Population Health, Australian National University, Australia

Peter Butterworth

Centre for Mental Health Research, Australian National University, Australia

Objectives: The four objectives of the study were to (i) assess the current prevalence of suicide attempts among suicide ideators within a community sample, (ii) explore demographics, employment status, mental and physical conditions, personality, life stresses and social environment as factors that may distinguish suicidal ideators from suicide attempters, (iii) examine the effect of age and gender upon suicide attempts and associated factors, and (iv) investigate the increase in suicide attempts when multiple factors related to this behaviour are present.

Method: The data was drawn from the PATH Through Life Project, a community survey of 7,485 people in Canberra, Australia. A subsample of 522 was used for this study.

Results: Logistic regression analyses were used to calculate the odds ratios (ORs) of suicide attempts in association with factors previously shown to be related to suicidal actions. Not being in the labour force (OR = 2.83), being chronically ill (OR = 1.92) and experiencing negative interactions with friends (OR = 1.20) were all found to relate to an increased likelihood of suicide attempts among suicide ideators. Our analysis indicated that there are important age and gender interaction effects for suicide attempts that should also be acknowledged, especially involving physical ill health and mastery among men (OR = 3.72, and 0.83, respectively) and employment status for those aged 40–44 years old (OR = 10.58). Cumulative risk analysis highlighted that when multiple factors associated with suicide attempt are present, the probability an attempt is significantly elevated.

Conclusions: This study has shown that the antecedents of attempted suicide among suicide ideators are not necessarily mental disorders, but more commonly involve the ability to earn an income, physical health and relationship difficulties with people who are considered important.

Keywords: Epidemiology, Aetiology, Other

126

UNDERSTANDING SUICIDE IN AUSTRALIAN FARMERS

Henry Jackson

University of Melbourne, Australia

Fiona K Judd

Centre for Rural Mental Health, Monash University, Australia

Caitlin E Fraser

Centre for Rural Mental Health, Bendigo Health Care Group and Monash University, Australia

Greg Murray

Swinburne University, Australia

Garry Robbins

University of Melbourne, Australia

Angela Komiti

University of Melbourne, Australia

Male farmers in Australia have an elevated risk of suicide. In this paper we report the findings of a study examining this serious public health issue. The aims of the study were to investigate the rate of mental health problems, in particular depression, an important factor contributing to suicide, amongst farmers compared to non-farmer rural residents. The study also investigated additional factors that might contribute to an increased risk of suicide amongst farmers. The study used a combination of quantitative and qualitative approaches.

In the study quantitative we found no support for the proposition that farmers experience higher rates of mental health problems than nonfarmer rural residents, but identified potentially important personality differences between farmers and non-farmers. Participants in the study also indicated that farming is an environment in which individuals experienced a range of stressors, but have limited capacity to acknowledge or express these. In addition, there appeared to be significant attitudinal barriers to help seeking for those who may have mental health problems, particularly male farmers.

The study concluded that the elevated rate of suicide amongst farmers does not seem to be simply explained by an elevated rate of mental health problems. Individual personality, gender and community attitudes which limit a person's ability to acknowledge or express mental health problems and seek help for these may be significant risk factors for suicide in farmers.

Keywords: Epidemiology, Aetiology, Other

127

EVALUATION OF THE TOWARDS-WELL-BEING SUICIDE MONITORING PROGRAMME

Pete M Ellis

Wellington School of Medicine and Health Sciences, University of Otago, New Zealand

Don AR Smith

Wellington School of Medicine and Health Sciences, University of Otago, New Zealand

Suicide rates among young people in New Zealand have been among the highest in the OECD. These rates were particularly high among young people under statutory supervision by the Child Youth and Family (Welfare) Service. Guidelines to reduce the rate of suicidal behaviour had been commissioned specifically for this service, but had not led to early change. The Towards Well-Being suicide monitoring programme sought to formally implement these guidelines using a network of clinical advisers supported by an electronic clinical decision support system. Welfare social workers used brief rating scales and their own judgement to refer at risk youth to the programme. The programme provided a low threshold, rapid response and proactive detection of youth at risk from daily reports of social worker screening. Clinical advisers provided consultation-liaison support to assist the social worker plan and carry though appropriate management and provided support in accessing mental health services, but had no direct contact with the young people involved. The implementation of the management plan was monitored electronically and weekly review of the young person's social work casenotes.

The aims of the programme were to reduce deaths by suicide, reduce suicide attempts and to increase appropriate referrals to mental health services.

As this was a national cohort study with no control group, evaluation is against historical control data and the non-welfare group. Over a three-year period the number of young people in CYF care increased by 80%, there was an increase in hospitalisation for suicide attempts and the national rate of death by suicide increased significantly. The rate of suicide attempts and deaths among youth in the welfare group remained stable.

Keywords: Work and Voc Rehab, Social Psychiatry

128

METABOLIC ABNORMALITIES IN BIPOLAR PATIENTS ON SODIUM VALPROATE

Richard J Porter

Christchurch School of Medicine & Health Sciences, University of Otago, New Zealand

Jane Elmslie

Christchurch School of Medicine & Health Sciences, University of Otago, New Zealand

Peter R Joyce

Christchurch School of Medicine and Health Sciences, University of Otago, New Zealand

Andrea Bartram

Christchurch School of Medicine & Health Sciences, University of Otago, New Zealand

Penny Hunt

Christchurch School of Medicine & Health Sciences, University of Otago, New Zealand

Introduction: The incidence of metabolic syndrome is increased in patients with bipolar disorder. This problem may be worsened by treatment with psychotropic drugs. It has been suggested that a change from sodium valproate to lamotrogine in bipolar patients may improve metabolic parameters (Isojarvi et al., [1998]).

Methods: Sixty patients suffering from bipolar affective disorder and who had experienced significant weight gain while on sodium valproate were recruited to a study investigating treatments to aid weight reduction. At baseline they were screened for metabolic parameters including BMI, waist circumference, blood pressure and fasting insulin, glucose, HDL cholesterol and triglycerides. The percentage of patients suffering from metabolic syndrome by a variety of definitions was determined.

Results: The average age of the patient group was 42 with a BMI of 34 and waist circumference 104cm. Thirty percent were taking atypical antipsychotics. According the NECP definition 45% met criteria for metabolic syndrome. Calculating insulin resistance using the McCauley equation gave a rate of 44%. Using the same calculation a general population in another New Zealand South Island city mean age 47 and BMI 27, had a rate of insulin resistance of 42% (McAuley et al., [2001]).

Conclusions: Given the fact that the subjects in this study had bipolar disorder, that they were selected to have a high BMI and that 30% were taking atypical antipsychotics this is a surprisingly low rate of insulin resistance.

Keywords: Biological Psychiatry, Neuropsychiatry