129
LONG-TERM PATTERNS OF UTILIZATION OF HOSPITAL AND COMMUNITY MENTAL HEALTH SERVICES FOR PEOPLE WITH PERSONALITY DISORDER IN A VICTORIAN PUBLIC PSYCHIATRIC POPULATION
Carol A Hulbert
University of Melbourne, SPECTRUM Personality Disorder Service for Victoria, Australia
Rosemary Thomas
Spectrum Personality Disorder Service for Victoria, Australia
Philip Burgess
University of Queensland, Australia
Personality disorder (PD) diagnosis, particularly borderline personality disorder (BPD), is associated with significant psychiatric comorbidity, physical health problems and functional impairment (Jackson & Burgess, 2002). Despite recent empirical validation of the superiority of outpatient treatments, patients with PD have been found to make heavy use of acute hospital services (Paris, 2003). A Victorian public mental health initiative saw the establishment in 1998 of Spectrum, a statewide consultation, training, treatment and research service aimed at improving treatment outcomes for public psychiatry patients with a diagnosis of PD. A key goal for this initiative was that an emphasis on provision of treatment from community-based, rather than acute hospital, services. The paper reports patterns of service usage for that client group derived from routinely collected data relating to all people treated in Victorian public psychiatry facilities. Data collected by two centralized data management programs covering the period 1996/7–2004/5 are presented, including diagnosis, and rates of utilization of acute inpatient and community-based psychiatric services. Findings showing a significant increase in the use of community-based services, alongside a decrease in acute bed stay days, for patients diagnosed as having a personality disorder are discussed.
Keywords: Work and Voc Rehab, Social Psychiatry
130
ADAPTIVE FUNCTIONING AND PSYCHIATRIC SYMPTOMS IN ADOLESCENTS WITH BORDERLINE PERSONALITY DISORDER
Andrew Chanen
ORYGEN Research Centre, Australia
Martina Jovev
ORYGEN Research Centre, Australia
Henry Jackson
ORYGEN Research Centre and School of Behavioural Sciences, University of Melbourne, Australia
Objective: To examine adaptive functioning and psychopathology in adolescents with categorically defined DSM-IV borderline personality disorder (BPD).
Method: 177 psychiatric outpatients (31.6% male) aged 15–18 years (mean = 16 years) were assessed using a structured interview for personality disorder (PD) diagnoses. Participants were divided into 3 groups: 1) BPD (n = 46), 2) those with a PD other than BPD (n = 88) and 3) those without any PD (n = 43) and were compared on interview and self-report measures of psychiatric symptoms and a broad range of socio-demographic, interpersonal and occupational measures of functioning. Results: Participants with BPD were found to have significantly more psychiatric symptoms and functional impairment across a broad range of domains compared to those participants without PD. The other PD group was found to have an intermediate level of impairment, performing worse than the no PD group in many areas of functioning and psychopathology but not worse than the BPD group on any measure. BPD was a significant predictor over and above disruptive behaviour disorders, mood, anxiety and substance use disorders and other PD diagnoses for internalising & externalising problems, general functioning, peer relationships, self-care and family and relationship functioning.
Conclusion: These data underscore the concurrent validity of the PD and BPD diagnoses in adolescence, lending further support to making the diagnosis in this age group and developing specific interventions for these problems.
Keywords: Epidemiology, Aetiology, Other
131
BORDERLINE PERSONALITY DISORDER IN MAJOR DEPRESSION: CHARACTERISTICS, DIFFERENTIAL DRUG RESPONSE AND 18 MONTH OUTCOME
Roger T Mulder
Christchurch School of Medicine and Health Sciences, New Zealand
Peter R Joyce
Christchurch School of Medicine and Health Sciences, New Zealand
Sue E Luty
Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, New Zealand
Christopher MA Frampton
Christchurch School of Medicine & Health Sciences, New Zealand
Purpose: To compare depressed patients with a comorbid borderline personality disorder to those with other comorbid personality disorders and those with no personality disorder.
Methods: 183 depressed outpatients were followed prospectively over an 19 month treatment trial.
Results: Borderline personality disorder patients had an earlier age of onset of their depressions, more chronic depressions, more alcohol and drug abuse and higher incidence of suicide attempts and self-mutilation. Depressed patients with borderline personality disorder did more poorly if treated with nortriptyline rather than fluoxetine in the short term. The longer term outcome of those with borderline personality disorder was the same as those without borderline personality disorder. Comorbid borderline personality disorder symptoms reduced from a mean of 6 to 2.5 over the 18 months.
Discussion: The relationship between borderline personality disorder and depression is complex. Treating depression may be an effective way of reducing borderline personality disorder symptoms.
132
THE RELATIONSHIP OF BORDERLINE PERSONALITY DISORDER, LIFE EVENTS AND FUNCTIONING IN AN AUSTRALIAN PSYCHIATRIC SAMPLE
Martina Jovev
ORYGEN Research Centre, Australia
Henry Jackson
University of Melbourne, Australia
Objective: Studies have documented poor functioning and higher rates of negative life events in association with personality disorders (PDs), in particular with borderline personality disorder (BPD). The current study investigated the impact of recent life events, daily hassles and uplifts on psychosocial functioning in patients with PDs, while extending previous research by examining the role of perceived coping effectiveness and perceived stress of recent life events.
Method: 97 participants (Axis I group, N = 30; BPD group, N = 23; Other PD group, N = 44) completed measures of functioning, recent life events, daily hassles and uplifts. Results: Results indicated that the BPD group reported the poorest levels of functioning, especially interpersonal functioning. The BPD group also reported more negative life events, particularly in the interpersonal relationships, personal health, crime, and financial, domains. The BPD group experienced less uplifts, more hassles and found employment circumstances particularly stressful and difficult to cope with. Intensity of hassles was a predictor of functioning independent of a BPD diagnosis. A greater frequency of life events was closely associated with a non-BPD diagnosis in predicting a decrease in psychosocial functioning. Conclusions: The findings indicated that BPD individuals have lower levels of psychosocial functioning, perceive daily hassles as being more intense and experience more frequent life events, especially in the interpersonal relationships, personal health and law domains. The presence of recent life events does not appear to be directly related to psychosocial functioning in individuals diagnosed with BPD. Future studies should examine additional factors, such as appraisals of life events and emotional responding to life events, which may have an impact on psychosocial functioning.
133
AUDITORY HALLUCINATIONS IN BORDERLINE PERSONALITY DISORDER
Angela Papadimitriou
Monash University, SPECTRUM Personality Disorder Service for Victoria, Alfred Psychiatry Research Centre, Australia
Carol A Hulbert
University of Melbourne, SPECTRUM Personality Disorder Service for Victoria, Australia
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Kim Ng
Monash University, School of Psychology, Psychiatry and Psychological Medicine, Australia
Despite widespread clinical and research focus in Borderline Personality Disorder (BPD), empirical data regarding the role of psychosis in the syndrome remains limited. The debate is whether transient, stressrelated, true psychotic symptoms are part of BPD’s fundamental psychopathology, or attributable to comorbid disorders. Within the range of true psychotic symptoms, auditory hallucinations have been reported as more prevalent in BPD than delusions. The SPECTRUM Personality Disorder Service for Victoria reports that 49% of their clients, all with a primary diagnosis of BPD, experience auditory hallucinations. Despite some evidence of auditory hallucinations in BPD, the phenomenology of this symptom in BPD has not yet been examined. The study compared the phenomenology, attitudes and beliefs associated with auditory hallucinations of 60 female outpatients, 30 diagnosed with BPD and 30 with Schizophrenia. Diagnoses were derived from structured clinical interviews for DSM-IV Axis-I and II disorders (SCID-I and SCID-II respectively). Assessment of voices was based on a semi-structured interview, developed by the student researcher. Results indicate that the BPD group experienced non-factitious, predominantly malevolent and maladaptive voices that, for the most part, were not transient and stressrelated in nature. Findings also suggest that the BPD group experienced voices of longer duration, had less control over the symptom, and more command hallucinations than the Schizophrenic group.
134
SPECIFICITY OF LIMBIC-PREFRONTAL DISTURBANCES IN PTSD: IMPACT OF COMORBID CLINICAL DEPRESSION
Andrew Kemp
Brain Dynamics Centre, Westmead Hospital and Western Clinical School University of Sydney, Australia
Kim Felmingham
Brain Dynamics Centre, Westmead Hospital and Western Clinical School University of Sydney, Australia
Pritha Das
Brain Dynamics Centre, Westmead Hospital and Western Clinical School University of Sydney & School of Psychology, UNSW, Australia
Gerard Hughes
Department of Radiology, Westmead Hospital, Australia
Anthony Peduto
Brain Dynamics Centre and Department of Radiology, Westmead Hospital and Western Clinical School University of Sydney, Australia
Richard Bryant
Brain Dynamics Centre, Westmead Hospital and Western Clinical School University of Sydney & School of Psychology, UNSW, Australia
Leanne Williams
Brain Dynamics Centre, Westmead Hospital, Australia
Purpose: PTSD is the most common anxiety disorder following trauma and is characterised by an excessive fear response and hyperarousal. Brain imaging studies report that the amygdala-medial prefrontal (MPFC) network in PTSD is dysregulated such that amygdala activity is increased and MPFC activity is decreased relative to controls. Many PTSD patients have comorbid major depressive disorder (MDD) however, a disorder which has also been associated with a profile of activity akin to that in PTSD. The purpose of this study therefore was to determine the specificity of amygdala-MPFC disturbances in PTSD by comparing PTSD patients with and without depression using functional MRI.
Methods: 8 individuals diagnosed with PTSD without MDD comorbidity (PTSD-only) and 8 age, sex and trauma-matched PTSD patients diagnosed with comorbid MDD (PTSD-MDD) took part in the study, with support from the Brain Resource International Database (BRID). Clinical diagnoses of PTSD and MDD were made using the Clinician-Administered PTSD Scale (CAPS) and Structured Clinical Interview for DSM-IV Axis 1 Disorders respectively, while severity of symptoms were measured using the CAPS and Beck Depression Inventory (BDI). Blood-oxygen-level-dependent (BOLD) responses were elicited using an emotion perception task (fearful versus neutral facial expressions), known to elicit robust BOLD responses in amygdala and MPFC regions of interest (ROIs).
Results: Consistent with the comorbid clinical diagnosis of MDD, the PTSD-MDD group displayed significantly greater BDI scores than the PTSD-only group. PTSD-MDD patients also had greater PTSD severity (CAPS scores) than the PTSD-only group, which was controlled for in focal fMRI analyses. After controlling for PTSD severity, the PTSD-MDD group were found to display comparatively less MPFC and amygdala activity than the PTSD-only group.
Conclusions: This study is the first to examine amygdala-MPFC activity in PTSD patients without comorbid depression. Findings suggest that comorbid depression may 1) exacerbate the frequently reported finding of reduced MPFC activation in PTSD and 2) decrease amygdala activation to threat stimuli. This study illustrates the importance of controlling for depression comorbidity in PTSD. Further research is underway to investigate this issue in larger samples using complementary high temporal resolution brain imaging techniques.
Acknowledgements: This research was supported by a NHMRC Program Grant (300304), an Australian Research Council Linkage Grant (LP0212048), a NHMRC Peter Doherty Fellowship (358770), and a NHMRC Australian Clinical Research Fellowship (1040926).
135
PTSD AND COGNITIVE FUNCTIONING
Ruth A Parslow
ORYGEN Research Centre, Department of Psychiatry, The University of Melbourne, Australia
Tony F Jorm
Orygen Research Centre, University of Melbourne, Australia
Numerous studies have noted that individuals suffering from PTSD complain of memory impairment and perform poorly on tests measuring cognitive functioning. It has been hypothesized that such impairment is the consequence of specific PTSD symptoms, in particular experiencing intrusive thoughts, images and perceptions. It is thought that such symptoms result in disordered attention and affect working memory systems underpinning executive functioning.
Most studies examining this issue have compared cognitive functioning of individuals diagnosed or not diagnosed with PTSD after a traumatic event has occurred. To date, no study has had access to pre-trauma measures of cognitive functioning for those who have experienced a trauma and who have then either developed PTSD or remained free of such symptoms.
We have been able to examine the pre-trauma and post-trauma neuropsychological measures of 3500 participants who took part in a longitudinal study before and after experiencing a major natural disaster, the Canberra bushfires of January 2003. After this disaster, 216 (6.2%) participants screened positive for PTSD according to Brewin et al’s Trauma Screening Questionnaire. Measures of immediate and delayed verbal memory, working memory and perceptual speed were obtained from all participants before and after the bushfire.
We report our findings on the extent to which screening positive for PTSD and reporting re-experiencing and hyperarousal symptoms were associated with differences in neuropsychological measures before the trauma and with changes in neuropsychological measures after experiencing that trauma.
Keywords: Epidemiology, Aetiology, Other
136
THE ASSOCIATION BETWEEN PERSONAL TRAUMA AND PSYCHOTIC-LIKE EXPERIENCES: AN AUSTRALIAN COMMUNITY SAMPLE
James G Scott
Mater Child & Youth Mental Health Service, Australia
David Chant
Queensland Centre for Mental Health Research (QCMHR), Australia
Gavin Andrews
Clinical Research Unit for Anxiety and Depression (CRUfAD), Australia
Graham Martin
Department of Psychiatry, University of Queensland, Australia
John McGrath
Queensland Centre for Mental Health Research (QCMHR), Australia
Background: Psychotic-like experiences (PLE) have been reported in a number of large population based studies. These studies have described demographic correlates of PLE and an association between PLE and substance use. Clinical and small community studies have suggested an association between traumatic life events and psychotic symptoms. The aim of this study was to examine if traumatic life events were associated with the endorsement of psychotic-like experiences in a large community based sample.
Methods: The National Survey of Mental Health and Wellbeing interviewed 10,641 individuals living in private dwellings in Australia. As part of a diagnostic interview (the CIDI), respondents were asked between three and six items originally designed to screen for potential psychosis and ten items related to traumatic life events. We examined the impact of exposure to traumatic life events with and without subsequent PTSD on the endorsement of items of psychosis.
Results: An estimated 11.7% of the Australian population endorsed at least one psychosis-screening item. 5725 (53.8%) subjects reported they had been exposed to a traumatic event but did not meet criteria for PTSD. 379 (3.6%) subjects met DSM IV criteria for PTSD. Exposure to any traumatic event was associated with higher rates of endorsement of psychosis items. A diagnosis of PTSD further increased the likelihood of positive endorsement of an item of psychosis.
Conclusion: There is an association between psychotic-like experiences and traumatic life events. The pathway of causality needs further clarification. Further research is required to explain why some individuals with traumatic experiences demonstrate psychotic-like experiences.
Keywords: Epidemiology, Aetiology, Other
137
IMPROVEMENT IN FOLATE LEVELS ASSOCIATED WITH IMPROVED COGNITIVE FUNCTIONING IN FIRST EPISODE PSYCHOSIS
Colin O’Donnell
ORYGEN Research Centre, Australia
Michaela O’Regan
ORYGEN Research Centre, Australia
Timothy Stephens
ORYGEN Research Centre, Australia
Alicia Papas
ORYGEN Research Centre, Australia
Margaret Dell’Olio
ORYGEN Research Centre, Australia
Tina Proffitt
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Gregor Berger
ORYGEN Research Centre, Australia
Pat McGorry
ORYGEN Research Centre, Australia
Purpose: A survey of folate levels in a geographical catchment area psychiatric cohort (15–25 yrs) and a 12-week follow-up study of folate levels and cognitive functioning in a FEP cohort was carried out to assess folate status and its relevance.
Method: We conducted a survey of serum folate levels at ORYGEN Youth Health. Patients attended ORYGEN Youth Health, serving a geographical catchment area of 800,000, which encompasses a FEP service, a mood and anxiety disorder clinic and a clinic for young people at ultra high risk for psychosis (UHR). Normal healthy controls were recruited. An additional control sample was obtained from Gribbles pathology, which comprised general practitioner attendees, aged between 15 and 25. Both control groups were from the ORYGEN geographical catchment area. 30 first episode patients took part in the 12-week follow-up trial. Cognition and folate was assessed at baseline and week 12.
Results: Data on 1000 patients and 15,000 controls was collected. Folate levels are significantly reduced in young people with schizophrenia and depression but not bipolar affective disorder. There was a significant difference in folate levels between patients with schizophrenia (n = 250) and bipolar disorder (n = 110). Examining the UHR group, we found lower levels of folate before and after transition to psychosis and an improvement in folate status in those who did not make the transition. Lower folate levels were not a feature of those who made the transition to mania. In the 12-week followup cohort lower folate levels at baseline were correlated with poorer cognitive functioning. Improvement in folate status was associated with improvements in verbal learning and memory over the 12-weeks.
Conclusion: Serum folate levels are significantly reduced in young people with schizophrenia spectrum disorders and depression. Folate levels are lower in those who make the transition to psychosis compared to the non-transition group. Poorer cognitive functioning was correlated with lower folate levels at baseline. Improvement in folate status, over 12 weeks was associated with improved cognitive functioning. Folic acid supplementation may have an adjunctive role to play in the treatment of FEP and depression.
Keywords: Biological Psychiatry, Neuropsychiatry
138
OLFACTORY IDENTIFICATION DEFICITS REMAIN STABLE FOLLOWING A FIRST EPISODE OF PSYCHOSIS: DATA FROM THE EPPIC-MEDIUM TERM FOLLOW-UP STUDY
Warrick J Brewer
ORYGEN Research Centre, University of Melbourne, Australia
Christos Pantelis
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Casey L O’Brien
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Stephen J Wood
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Lisa P Henry
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Meredith G Harris
ORYGEN Research Centre, University of Melbourne, Australia
Dennis Velakoulis
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Patrick D McGorry
ORYGEN Research Centre, University of Melbourne, Australia
Objective: Previous investigation reveals stable olfactory identification deficits (OID) at 6 months following first onset of psychosis (Brewer et al., 2001), and more recently, in an ultra-high-risk group that later developed a schizophrenia spectrum disorder (Brewer et al., 2003). As a potential premorbid marker of transition to schizophrenia, the utility of OID in mapping development and compromise of limbic-prefrontal pathways, particularly in orbitofrontal regions, is important for tracking the relative integrity of circuitry implicated in the course of psychosis following early onset.
Method: In this study we sought to investigate longitudinal change in olfactory identification in first episode psychosis patients using the University of Pennsylvania Smell Identification Test (UPSIT).
Results: Our preliminary data from 12 patients and 9 controls (mean time between assessments = 73.4 months, range = 61.4–85.2 months) showed no change in performance over time.
Conclusions: These data support our previous longitudinal study and suggest that there is no change in OFC function with continued psychotic illness. Interaction between OFC and other neural networks implicated in the degenerative aspects of schizophrenia requires further exploration. The findings are discussed in the context of utilising olfactory models of function to track emerging onset of psychopathology.
Brewer et al., 2001, Am J Psychiatry, 158, p107–115
Brewer et al., 2003, Am J Psychiatry, 160, p1790–1794
Keywords: Epidemiology, Aetiology, Other
139
THE MAPK PATHWAY: THE MOLECULAR SUBSTRATE OF COGNITIVE DYSFUNCTION IN SCHIZOPHRENIA?
Suresh Sundram
Mental Health Research Institute of Victoria, Australia
Avril M Pereira
Mental Health Research Institute of Victoria, Australia
George Fink
Mental Health Research Institute of Victoria, Australia
Cognitive dysfunction, especially involving the prefrontal cortex, is a key feature of schizophrenia. It is also the major predictor of social and vocational performance and long-term functional outcomes in this disorder. Despite its importance there is a limited understanding of its molecular basis and this has hampered the development of pharmacological treatments. Current major molecular targets include dopaminergic, glutamatergic, muscarinic and cannabinoid systems all of which operate in the prefrontal cortex. It is implausible that these systems operate independently but more likely they converge upon intracellular pathways that signal to alter gene expression. One attractive candidate pathway is the mitogen activated protein kinaseextracellular signal regulated kinase cascade (MAPK-ERK). This pathway is central for cortical new learning and synaptic plasticity, processes postulated to be disrupted in schizophrenia. We investigated the regulation of this pathway in primary cortical neurons by a range of neurotransmitter agents. This was done by measuring activation of the two key kinases, pERK1 and 2, using Western immunoblotting normalised against non-drug and total ERK1 and 2 levels. Dopamine (1μM) transiently increased pERK1 levels in a dose dependent manner 3-fold, an effect less pronounced for pERK2. The D2R agonist quinpirole (213 ± 80%) and D1R agonist SKF38393 (416 ± 63%) increased pERK1 but only SKF38393 was significant (p = 0.04). The dopamine pERK1 effect was attenuated by the D2R antagonists raclopride (70 ± 3%; p < 0.01) and haloperidol (12 ± 3%; p < 0.0001). Stimulation of pERK1/2 was also observed with muscarinic and cannabinoid agonists and inhibition with glutamatergic ionotropic and metabotropic agents. These data provide preliminary evidence that the MAPKERK pathway may be a common pathway through which disparate neurotransmitter systems can converge to alter cognitive function in schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
140
APOPTOTIC MARKERS IN FIBROBLAST CULTURES FROM PATIENTS WITH SCHIZOPHRENIA, AFFECTIVE PSYCHOSIS AND HEALTHY CONTROLS
Vibeke S Catts
Queensland Brain Institute, University of Queensland, Australia
Stanley V Catts
Department of Psychiatry, University of Queensland, Australia
John McGrath
Queensland Centre for Mental Health Research (QCMHR), Australia
Alan Mackay-Sim
School of Biomolecular and Biomedical Science, Griffith University, Australia
Francois Feron
School of Biomolecular and Biomedical Science, Griffith University, Australia
Duncan McLean
Queensland Centre for Mental Health Research (QCMHR), Australia
Elizabeth J Coulson
Queensland Brain Institute, University of Queensland, Australia
Louise H Lutze-Mann
School of Biotechnology and Biomolecular Science, University of New South Wales, Australia
Purpose: Based on clues from epidemiology, it has been proposed that individuals with schizophrenia may have subtle alterations in apoptotic pathways. The aim of this study was to explore abnormalities in key apoptotic measures in fibroblast cell lines from three groups: patients with schizophrenia, affective psychoses, and healthy controls.
Methods: Experiments were carried out on untreated cell lines and cell lines treated with the protein synthesis inhibitor, cycloheximide. Cell cycle distributions were determined by propidium iodide staining and flow cytometric analysis. Levels of Bcl2, Bax and P53P392Ser protein were ascertained by Western blotting. Levels of caspase 3 activity were derived from a fluorometric assay involving the cleavage of the synthetic caspase 3 substrate, DEVD-AFC.
Results: There was a significant effect for diagnostic group (F = 2.120 (2, 59), p < 0.01) and cycloheximide exposure (F = 15.004 (1, 60), p < 0.01) on the biological measures. Tukey’s post hoc test revealed an increase in the proportion of sub-G0/G1 nuclei (p < 0.05) and a decrease in the proportion of G0/G1 cells (p < 0.01) in cell lines from patients with schizophrenia compared with cell lines from individuals with affective disorders. No statistically significant differences in protein levels were observed across the diagnostic groups. Caspase 3 activity was not significantly different across the three diagnostic groups.
Conclusions: This study provides preliminary evidence that measures related to cell cycle control and apoptosis may differentiate between schizophrenia and affective psychoses. The increased induction of apoptosis in patients with schizophrenia appears to be independent of caspase 3 activity.
Keywords: Biological Psychiatry, Neuropsychiatry
141
THE SPATIAL AND TEMPORAL DYNAMICS OF STOP-SIGNAL INHIBITION: AN ERFMRI AND ERP STUDY
Matthew E Hughes
University of Newcastle, Neuroscience Institute of Schizophrenia and Allied Disorders, Australia
Timothy W Budd
University of Newcastle, Neuroscience Institute of Schizophrenia and Allied Disorders, Australia
Gavin J Cooper
Neuroscience Institute of Schizophrenia and Allied Disorders, Australia
William R Fulham
University of Newcastle, Neuroscience Institute of Schizophrenia and Allied Disorders, Australia
Patricia T Michie
University of Newcastle, Neuroscience Institute of Schizophrenia and Allied Disorders, Australia
The ability to exert inhibitory executive control over the motor system is compromised in individuals with psychiatric disorders including schizophrenia and ADHD. Determining the characteristics of the neural networks underpinning inhibitory control is crucial for understanding these conditions. The aim of this research was to probe the spatial and temporal properties of the brain network underpinning executive motor control at different stages of response readiness using erfMRI and ERPs. A stop-signal paradigm was used as the procedures permit the estimation of two indices of inhibitory control: the speed of inhibition processes and the capacity to trigger these (covert) processes. Stopsignal paradigms consist of two tasks which are performed concurrently. The primary task involves making choice reaction time responses to alternate stimuli (Os and Xs) and constitutes the majority of trials. The secondary (stop-signal) task differs only in that a stop-signal (a tone) is presented at some predetermined time after the onset of a primary stimulus, but prior to the expected response latency of the participant. Sixteen volunteers with no personal or family history of psychiatric illness or brain trauma performed the stop-signal task during a functional MRI session and an ERP session. To examine the brain networks mediating motor inhibition at different stages of response readiness, six different stop-signal delays were set relative to median reaction time (MRT): MRT-255, MRT-235, MRT-155 ms. Successful and unsuccessful stop-signal trial events were collapsed into three conditions: EASY (MRT-255, MRT-235), MEDIUM (MRT-215, MRT-195) and HARD (MRT-175, MRT-155). Successful EASY, MEDIUM and HARD stops were individually contrasted with all unsuccessful stops. A parametric analysis was performed examining voxels and ERP components exhibiting linear increases in the BOLD signal and potentials, respectively, from successful EASY to MEDIUM to HARD stop-signal trial events.
Keywords: Biological Psychiatry, Neuropsychiatry
142
SYNCHRONOUS GAMMA OSCILLATIONS IN FIRST EPISODE PSYCHOSIS
Gary J Flynn
Liverpool Hospital Sydney, The Brain Dynamics Centre and University of Sydney, Australia
Anthony Harris
Westmead Hospital Sydney, The Brain Dynamics Centre and University of Sydney, Australia
Leanne Williams
Brain Dynamics Centre, Westmead Hospital, Australia
Thomas Whitford
Westmead Hospital Sydney, The Brain Dynamics Centre and University of Sydney, Australia
Evian Gordon
The Brain Resource Company and The University of Sydney, Australia
Introduction: Neuronal networks are able to create discreet and meaningful representations of objects from complex scenes in any sensory modality. Such processing of complex input requires flexible, reliable, and ubiquitous mechanisms to link multiple regions of the brain in a time frame of milliseconds. A proposed linking or binding mechanism is synchronous neural activity in the gamma frequency wave band. A disruption to this mechanism has been proposed as a possible result of the pathology underlying psychotic illnesses. This study examines the distribution of abnormal gamma synchrony in first episode psychosis.
Method: 36 subjects with first episode psychosis from age 14 to 24 years underwent a standard auditory oddball paradigm during electroencephalogram analysis. The data was analysed to produce a topographical distribution of abnormal synchrony to background and target stimuli. Symptom profile was assessed using PANSS. 98 age sex and education matched controls underwent the same procedure. Gamma synchrony measures were calculated for each background and target stimulus with a 128 sample Welch window moved along sample by sample, 500 ms prior to each stimulus (−500 ms) to 750 ms after the stimulus. At each sample position, the phase of the Gamma frequency component was computed by means of FFT, yielding a time series of Gamma phase from −500 to 750 ms for each single-trial from each site. Abnormal gamma findings within the psychosis group were determined with MANOVA, and the duration of treatment, drug dose and years of education were corrected for with MANCOVA.
Results: Abnormal gamma synchrony was most evident in left centrotemporal regions, and also apparent in dorsal frontal and left posterior regions. The findings are consistent with previous functional and structural imaging studies indicating the left temporal region as a key site of pathology in psychosis. The results support the notion that a deficiency in synchronous gamma oscillations may illustrate the dynamics underlying defective ‘binding’ in psychotic illness.
Keywords: Biological Psychiatry, Neuropsychiatry
143
AUDITORY MISMATCH NEGATIVITY, EXECUTIVE FUNCTIONING AND SYMPTOM SEVERITY IN SCHIZOPHRENIA
Emily B Stone
University of New South Wales, Australia
Lea Meyer
University of New South Wales, Australia
Philip B Ward
University of New South Wales, Sydney South West Area Health Service, Australia
Ulrich Schall
Centre for Mental Health Studies, University of Newcastle, Australia
Patricia T Michie
School of Behavioural Sciences, University of Newcastle, Australia
Juanita Todd
School of Behavioural Sciences, University of Newcastle, Australia
It is well known that people with schizophrenia demonstrate abnormalities in mismatch negativity (MMN), an ERP index of auditory sensory memory. Additionally this group consistently shows deficits in executive functions. We examined the relationship between MMN amplitudes and clinical ratings of positive and negative symptoms as well as neuropsychological test results (with specific attention to executive functions). We tested patients meeting DSM-IV criteria for schizophrenia with a duration of illness (DOI) greater than five years as part of a larger study assessing early auditory brain dysfunction and cortical grey matter volume loss in two groups of patients with different DOI’s. The assessment of executive function consisted of the Haylings Sentence Completion and Brixton Spatial Anticipation tests. MMN was assessed by presenting subjects with standard duration (50 ms) tones interspersed with deviant duration tones (100 ms) at a rate of eight percent. In preliminary analyses we found correlations between reduced MMN amplitude and the extent of perseveration and bizarre responding on the Brixton executive functioning task. Greater severity of affective flattening was also associated with lower MMN amplitudes. A second cohort of patients with a shorter duration of illness (<2 years) will be recruited for between group comparisons of these results.
Keywords: Biological Psychiatry, Neuropsychiatry
144
SOURCE ANALYSIS OF AUDITORY MISMATCH NEGATIVITY IN SCHIZOPHRENIA
Ross Fulham
Centre for Mental Health Studies, The University of Newcastle, Australia
Ulrich Schall
Centre for Mental Health Studies, The University of Newcastle, Australia
Patricia Michie
School of Behavioural Sciences, The University of Newcastle, Australia
Philip Ward
Schizophrenia Research Unit, Liverpool Hospital, Australia
Paul Thompson
School of Medicine, University of California, United States
Paul Rasser
Centre for Mental Health Studies, The University of Newcastle, Australia
Amy Richards
School of Behavioural Sciences, The University of Newcastle, Australia
People with schizophrenia consistently demonstrate abnormalities in mismatch negativity (MMN), an ERP index of auditory sensory memory. In this project, EEG, fMRI and structural MRI data are being obtained from chronic patients with schizophrenia (<5 years), first episode patients (<2 years), first degree biological relatives, and age and gender matched controls. A conventional Duration Deviant MMN paradigm is used in which participants hear an unattended random series of tones consisting of standards (92%, 50 ms duration) and deviants (8%, 100 ms duration). High resolution MMN ERPs (64 channels) are obtained as the difference between the response to deviants and standards. Equivalent dipole and current source density analysis is performed using Curry V4.6. Structural MRIs are used to construct Realistic Head Models and cortical surfaces for each individual for the source analysis. Using the LONI procedures, cortical gyri are identified as landmarks permitting the results to be mapped into a probabilistic brain space. Cortical grey matter density can also be estimated. Event-related fMRI contrasts between deviants and standard tones can be incorporated as priors into the current source density analyses or correlated with current source density analyses. Preliminary results are presented comparing patients (N = 15) to matched controls. A reduction in MMN amplitude is seen in the younger cohort of patients compared to controls, but no difference is present in older participants. This is consistent with our previous findings. Equivalent Current Dipole models of the early phase of the MMN are consistent with a cortical generator in the Superior Temporal Gyrus. Results from a distributed current source density analysis will be presented.
Keywords: Biological Psychiatry, Neuropsychiatry
145
A MULTIVARIATE ELECTROPHYSIOLOGICAL ENDOPHENOTYPE, WHEN USED AS A PRIMARY INDEX OF THE ILLNESS, RESULTS IN SIGNIFICANTLY GREATER GROUP HOMOGENEITY PRIOR TO GENETIC ANALYSIS
Gregory W Price
School of Psychiatry & Clinical Neuroscience, Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Australia
Patricia T Michie
School of Behavioural Sciences, The University of Newcastle, Australia
Assen V Jablensky
School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Australia
Introduction: Four electrophysiological features (from MMN, P50, P300 and antisaccade paradigms) were recorded from a single cohort of probands, family members, and control subjects, in an ongoing investigation into the genetics of schizophrenia. As apparently independent variables, there are two possible means of analysising these features. Firstly they could be used to divide the cohort into subgroups that are more electrophysiologically homogeneous. Secondly, they can be transformed into a single multivariate feature that is then used as a primary index of the illness. In this presentation, we detail analyses that support this second treatment of the data, as well as reporting the increase in power of a genetic analysis based on the multivariate feature.
Methods: A subgrouping strategy presupposes two aspects of the data that were tested. Firstly, that families co-segregate with each feature. Secondly, that membership of the different subgroups is derived from different genetic bases rather than random chance.
Results: Comparing deficits in Fm of a proband with or without the deficit does not indicate any familial segregation. Likewise, the distribution of deficits that was found, did not appear to represent distinct homogeneous subgroups. These new groups showed almost double the effect size when all subjects are reassigned compared with simple diagnostic reassignment. Similarly the observed risk ratio of 2.41 for the multivariate endophenotype was about twice that of any univariate value.
Conclusion: Reassigning subjects based on the multivariate model, therefore, results in significantly greater group homogeneity prior to genetic analysis. The analysis of a multivariate electrophysiological endophenotype, thus allows more powerful analysis of smaller data sets than diagnosis based or single-endophenotype based studies.
Keywords: Biological Psychiatry, Neuropsychiatry
146
MAPPING THE COMT GENOTYPE ONTO PHENOTYPES: IMPLICATIONS FOR PSYCHIATRIC DISORDERS OF COGNITION AND EMOTION
Stacey Kuan
The Brain Dynamics Centre, Australia
Justine Gatt
The Brain Dynamics Centre, Australia
Carol Dobson-Stone
The Garvan Institute of Medical Research, Australia
Kerri Brown
The Brain Dynamics Centre, Australia
Robert Paul
Brown Medical School, United States
Peter Schofield
Prince of Wales Medical Research Institute and Garvan Institute of Medical Research, Australia
Evian Gordon
The Brain Resource International Database (The Brain Resource Company), Australia
Lea Williams
The Brain Dynamics Centre, Australia
Objective: Following the mapping of the human genome, studies have begun to investigate phenotype-genotype relationships, and their implications for the cognitive and emotional functions impaired in psychiatric disorders. Catechol-O-methyltransferase (COMT) is one of several candidate genes with functional polymorphisms shown to have an allelic effect on brain function. COMT involves a substitution of methionine (met) with valine (val), and degrades the metabolism of prefrontal dopamine. The Val allele has been associated with impairment of prefrontal executive and working memory functions which may reflect faster dopamine metabolism, and vulnerability for dopamine-related disorders such as schizophrenia. While the Val allele may have a compensatory advantage in resilience for emotional dysfunction, the Met allele has been related to traits of anxiety and may reflect risk for mood disorder. Brain imaging has revealed highly heritable endophenotypes for both brain function and structure, which may mediate genotype-phenotype relationships. Using an integrative neuroscience approach, we examined the role of brain function/structure phenotypes in the association between COMT and cognitive and emotional behavior.
Method: In collaboration with the Brain Resource International Database 1000 healthy subjects provided data from cheek swabs, a battery of cognitive tests and questionnaires tapping emotion-related function and, from a smaller subset, structural MRI, and ERP and functional MRI during corresponding cognitive and emotional tasks.
Results: The Val allele was associated with a reduction in ventromedial prefrontal grey matter volume, consistent with a prefrontal locus of impact. By contrast, the Met allele was associated with excessive subcortical activity (amygdala, basal ganglia and midbrain), coupled with higher neuroticism, consistent with a sensitivity to emotional stimuli and anxiety-related traits.
Conclusion: Our findings provide new and complementary evidence supporting the role of brain function/structure endophenotypes in mediating the link between COMT variants and phenotype. The results highlight the impact of COMT on distinct components of the dopaminerelated prefrontal-limbic and basal ganglia systems involved in cognition and emotion. The distinct impact of COMT variants may contribute to the vulnerability for developing complex cognitive and mood disorders which involve changes in dopamine and its interactions with noradrenalin.
Acknowledgments: Supported by an ARC-Linkage grant (LP0455104).
147
ASSOCIATION BETWEEN COMT VAL158MET AND 5-HTTLPR FUNCTIONAL LOCI AND RISK OF ADOLESCENT ONSET ANXIETY: RESULTS OF A 12-YEAR LONGITUDINAL STUDY OF ADOLESCENT MENTAL HEALTH
Craig Olsson
Murdoch Childrens Research Institute, Australia
Graham Byrnes
Murdoch Childrens Research Institute, Australia
Veronica Collins
Murdoch Childrens Research Institute, Australia
Robert Williamson
University of Melbourne, Australia
George Patton
Murdoch Childrens Research Institute, Australia
Mehrnoush Lotfi
University of Melbourne, Australia
Richard Anney
Trinity College, Ireland
Purpose: Life course epidemiological studies may be better suited to investigating the in vivo effects of known functional variants (and interaction with environmental factors) than identifying novel functional loci per se. The rationale for this claim, and an overview of our interdisciplinary approach, are discussed in relation to three genetic association studies.
Methods: The Victorian Adolescent Health Cohort Study has followed the psychosocial development of 2000 young people from age 14-years (1992) to 26-years (2004). Using this resource we examined whether, and under what conditions, functional loci within the catechol-O-methyltransferase (COMT) and serotonin transporter (5-HTTLPR) genes might influence mental health outcomes.
Results: Single functional loci appear to play a limited role in creating mental health risk, but in interaction with other environmental or genetic influences, more substantial influences can be observed. Specifically, we have found (1) that additional copies of the Met158 allele increase risk of panic and phobic anxiety, but only among females (OR 1.5, 95%CI 1.1–2.1, p = 0.013), (2) that additional copies of the 5-HTTLPR short allele decrease risk of generalised anxiety, but only among those reporting insecure early childhood attachments (OR 0.77, 95%CI 0.62–0.97, p = 0.029), and (3) that biological interaction between COMT and 5-HTTLPR loci creates a composite genetic process that has sufficient effect to directly influence mental health outcomes independent of environmental effects (OR 0.50, 95%CI 0.29–0.80, p = 0.003).
Conclusion: We emphasise the importance of studying the combined effects of genetic and environmental influences, and discuss a general model of the intersection of epidemiology and molecular genetics that has clear implications for working across disciplines.
Keywords: Biological Psychiatry, Neuropsychiatry
148
THE LONG AND THE SHORT OF IT: THE CONTRIBUTION OF GENOTYPES TO COPING WITH STRESS
Kay A Wilhelm
University of New South Wales, Australia
Jennifer Siegel
University of New South Wales, Australia
Adam W Finch
University of New South Wales, Australia
Philip B Mitchell
University of New South Wales, The Black Dog Institute, Australia
Peter R Schofield
University of New South Wales, Australia
Purpose: Individuals with the ‘s’ allele in the promoter region of the serotonin transporter (5-HTT) gene appear to have heightened vulnerability to adverse life events, with increased rates of onset of DSM derived major depression (MD). Individual coping style ‘when stressed’ is likely to be an important factor influencing MD onset. We compared preferred coping styles and perceived social support between genotypes, and explored whether the methods used differed in their impact on the experience of depression.
Method: Members of a cohort have been followed at 5-yearly intervals since 1978 and at 25-year follow-up, genomic DNA was successfully extracted and genotypes for the 5-HTT gene-linked polymorphic region (SLC6A4) were determined for 127 members. Coping mechanisms used ‘when stressed’, perceived social support, and lifetime history of MD were recorded.
Results: When stressed, subjects with the ‘s’ allele tended to use less coping mechanisms overall and used significantly fewer problem solving mechanisms than the l/l carriers. Differences in perceived support were found between genotype groups, with higher ratings of support were found to be associated with the ‘s’ allele. When depression history was considered, the observed differences between genotypes in coping and support remained significant for those with a lifetime history of MD.
Conclusion: Problem-focussed strategies seem to be a more preferred way of coping with stress among individuals with the ‘l/l’ combination, whereas those with the ‘s’ allele tend to report higher quality of social support. Differences in coping and social support appear to be most pertinent for those with a lifetime history of MD. Together, these findings may give insight into why some ‘at risk’ individuals appear resilient to the effects of adversity and question whether specific interventions for stress reduction are equally applicable to the different genotypes.
Keywords: Biological Psychiatry, Neuropsychiatry
149
AN INTEGRATIVE APPROACH TOWARDS MAPPING THE BDNF GENOTYPE ONTO PHENOTYPES: THE IDENTIFICATION OF MOOD AND MEMORY PROFILES
Justine Gatt
The Brain Dynamics Centre, Australia
Stacey Kuan
The Brain Dynamics Centre, Australia
Carol Dobson-Stone
The Garvan Institute of Medical Research, Australia
Peter Schofield
Prince of Wales Medical Research Institute and Garvan Institute of Medical Research, Australia
Evian Gordon
The Brain Resource International Database (The Brain Resource Company), Australia
Robert Paul
Brown Medical School, United States
Kerri Brown
The Brain Dynamics Centre, Australia
Lea Williams
The Brain Dynamics Centre, Australia
Objective: The brain-derived neurotrophic factor (BDNF) is a neurotrophin expressed throughout the brain, especially in the prefrontal cortex and hippocampus, and is involved in the regulation/modulation of neuronal changes associated with learning and adaptive behaviours. The BDNF Val66Met polymorphism involves a Valine (Val) to Methionine (Met) substitution, which has been associated with both cognitive and mood-related impairments. The Val allele has been associated with higher anxiety and neuroticism, whereas the Met allele has been related to poorer verbal memory. However, both contrary and null findings have been reported, particularly within clinical samples. Variation in findings may reflect the indirect and small impact of genotype on complex behaviours. A more powerful approach might entail mapping genotypes onto endophenotypes (intermediate traits) which have high heritability, and may mediate the genotype-phenotype relationship. In this study we used brain function endophenotypes defined by direct measures of neural activity (which have up to 81% heritability) to examine cognitive and mood profiles associated with BDNF variants.
Method: A total of 299 healthy subjects from the Brain Resource International Database provided data from cheek swabs (for genotyping), cognitive tests, psychometric questionnaires of mood and personality, and both tonic and phasic measures of electrical activity: EEG (during resting conditions) and Event-related potentials (ERPs, during both cognitive-and emotion-related tasks), respectively.
Results: For the Met allele, a cognitive profile of poor mental coordination (reduced alpha and beta, raised theta) with poor memory updating and attention (delayed P300b during cognitive tasks) was found, in addition to a mood-related profile of higher depression (raised delta, delayed posterior N170 to positive stimuli). In contrast, the Val allele was associated with a mood-related profile of higher anxiety (raised alpha and beta, reduced theta) and a fronto-temporal dysregulation in emotion processing (e.g., faster temporal but slower frontal ERPs to fearful stimuli).
Conclusion: These findings extend previous links between BDNF genotypes and impairments in cognitive and emotion processing, suggesting that neurophysiological measures of neural activity may provide valuable endophenotypes for elucidating these relationships. More specifically, these findings are consistent with the hypothesis that BDNF variants may impact behaviour via varying levels of synaptic plasticity and arousal (as reflected by the EEG measures) in the cortical and subcortical regions. Ongoing research is investigating this proposal further in relation to the impact of stress and in psychiatric disorders of cognition and mood.
Acknowledgements: Dr Blossom Stephan, The Brain Resource International Database (The Brain Resource Company), Australia; Nick Cooper, The Brain Resource International Database (The Brain Resource Company), Australia; ARC-Linkage funding (LP0455104).
150
NO EVIDENCE FOR ASSOCIATION OF SCHIZOPHRENIA WITH THE DYSTROBREVIN BINDING GENE (DTNBP1) IN TWO AUSTRALIAN SAMPLES
Herlina Y Handoko
Queensland Institute of Medical Research, Australia
Elizabeth G Holliday
Queensland Centre for Mental Health Research (QCMHR), Australia
Dale R Nyholt
Queensland Institute of Medical Research, Australia
John J McGrath
Queensland Centre for Mental Health Research (QCMHR), Australia
Heather J Smith
Queensland Institute of Medical Research, Australia
Deborah A Nertney
Queensland Centre for Mental Health Research (QCMHR), Australia
Bryan J Mowry
Queensland Centre for Mental Health Research (QCMHR), Australia
Michael R James
Queensland Institute of Medical Research, Australia
Purpose: Several genetic association studies have implicated the gene encoding dystrobrevin binding protein (DTNBP1) in the aetiology of schizophrenia. To date, no obvious pathogenic variants or specific risk haplotypes have been identified by more than one study. In this study, we attempted to replicate previous findings in two Australian samples: a case-control sample of 180 cases and 190 controls, and a sample of 41 extended pedigrees. Cases had a diagnosis of schizophrenia or schizoaffective disorder.
Methods: We genotyped 16 single nucleotide polymorphisms (SNPs) within the DTNBP1 gene. Two-point marker-trait association analysis for individual SNPs, and sliding-window haplotypes constructed from adjacent markers was performed using the programs COCAPHASE and TDTPHASE. Multipoint marker-trait association analysis was performed using the program DISMULT and joint analysis of association and linkage was performed using the program PSEUDOMARKER.
Results: In this Australian sample, we found no evidence for association between schizophrenia and previously implicated SNPs or haplotypes within the DTNBP1 gene. Our sample had sufficient power to replicate SNPs and haplotypes of previously reported effect sizes. Lack of evidence for association in this sample may reflect the nature of our sample, population-specific differences in the effect size and/or frequency of DTNBP1 variants, or in schizophrenia aetiology.
Conclusions: Further studies will be required to determine the relative contribution of the DTNBP1 gene to schizophrenia in different populations, and to identify its precise pathogenic variants.
Keywords: Biological Psychiatry, Neuropsychiatry
151
NRG1 KNOCKOUT MICE–AN ANIMAL MODEL FOR SCHIZOPHRENIA?
Tim Karl
Neuroscience Institute of Schizophrenia and Allied Disorders, Garvan Institute of Medical Research, Australia
Liesl Duffy
Neuroscience Institute of Schizophrenia and Allied Disorders, Garvan Institute of Medical Research, Australia
Peter Schofield
Prince of Wales Medical Research Institute, Australia
Purpose: The risk of developing schizophrenia is associated with both genetic and environmental factors. However, neither of these factors is sufficient to cause the disorder in isolation. The genetic component is likely due to the combined effects of multiple genes. Neuregulin 1 (Nrg1) is a candidate gene for schizophrenia, which plays a central role in neural development and in regulating synaptic plasticity. Environmental factors have also been shown to impact on the etiology of schizophrenia. The aim of this study was to investigate the behavioural effects of genetic and environmental risk factors in a mouse model of schizophrenia in an interdisciplinary approach. The complexity of schizophrenia demands a comprehensive and multi-tiered strategy for behavioural phenotyping in animal models. This strategy is essential for the successful evaluation of any genetic animal model and excludes limitations of recent studies.
Methods: Using a multi-tiered approach, we screened different sets of heterozygous Nrg1 knockout (+/−) mice for general health, neurological reflexes, sensory abilities, and motor coordination followed by a variety of tests for motor activity, exploration, anxiety, and prepulse inhibition. Effects of age (<3 months vs. <3 months) and housing conditions (standard laboratory housing vs. environmental enrichment) were taken into consideration.
Results: We could confirm a potent effect of the absence of one copy of the Nrg1 gene on motor activity and exploration, which was age-and housing condition-dependent. Nrg1 heterozygous mice were hyperactive in tasks for motor activity and exploration (evident in animals <3 months). No abnormalities were detected in anxiety-related parameters or baseline prepulse inhibition. Importantly, housing conditions modified onset and intensity of the behavioural phenotype.
Conclusions: Here we show the complexity of behavioural animal phenotyping in its application as a potential animal model to aid schizophrenia research. We show that Nrg1 has an impact on schizophrenia-related behavioural domains but this influence is highly dependent on other factors such as age and housing conditions confirming the importance of multi-tiered strategies in this field.
Keywords: Biological Psychiatry, Neuropsychiatry
152
PANIC DISORDER: SYMPATHETIC NERVOUS MECHANISMS AND NET GENE EPIGENETICS UNDERLYING INCREASED CARDIAC RISK
Murray D Esler
Baker Heart Research Institute, Australia
Assam El-Osta
Baker Heart Research Institute, Australia
Marlies E Alvarenga
Baker Heart Research Institute, Australia
Elisabeth Lambert
Baker Heart Research Institute, Australia
Ciaran Pier
Monash University, Australia
David Barton
Baker Heart Research Institute and Monash University, Australia
Gavin Lambert
Baker Heart Research Institute, Australia
Ling Guo
Baker Heart Research Institute, Australia
Jeffrey C Richards
Monash University, Australia
Panic disorder serves as a clinical model for testing whether mental stress can cause heart disease. Our own cardiological management of panic disorder provides case material of recurrent emergency room attendances with angina and electrocardiogram ischemia, triggered arrhythmias (atrial fibrillation, ventricular fibrillation) and documented coronary artery spasm, in some cases with coronary spasm being complicated by coronary thrombosis.
Mechanisms of Cardiac Risk-During panic attacks there are large sympathetic nerve fibre bursts, recorded with sympathetic nerve recording (clinical microneurography), and increases in noradrenaline released from the sympathetic nerves of the heart, measured with coronary sinus venous sampling and isotope dilution methodology. There are accompanying surges of adrenal medullary epinephrine secretion. Our results indicate that potential neural mechanisms of cardiac risk are the sympathetic activation during panic attacks (and specifically neuropeptide Y, NPY, release in the heart, perhaps contributing to coronary artery spasm), release of adrenaline as a cotransmitter in the cardiac sympathetic nerves, impaired noradrenaline neuronal reuptake (augmenting the sympathoneural response to anxiety), and a newly discovered altered pattern of sympathetic single nerve firing (increased probability of multiple nerve firings per heart beat). Vascular mechanisms of cardiac risk, based on our preliminary evidence, include endothelial dysfunction and activation of inflammatory processes, indicated to us by increased plasma CRP.
Genetic and Epigenetic Predisposition to Panic Disorder?-Panic patients commonly demonstrate a phenotype of impaired neuronal noradrenaline reuptake, which can be demonstrated by the application of radiotracer catecholamine kinetics. This seems to be linked to "cardiac panicker" status, i.e. patients having predominantly cardiac symptoms, as might be expected from the effects of noradrenaline reuptake block in the heart. We have not found any loss of function mutations of coding regions of the norepinephrine transporter (NET) gene in panic disorder patients which could explain this. We do, however, detect epigenetic change in the NET gene, taking the form of hypermethylation of CpG islands in the NET gene promoter region, present in 9 of 24 panic disorder patients studied. This phenomenon of promoter region DNA methylation in other contexts has been demonstrated to cause gene silencing. Using chromatin immunoprecipitation methodology, we have documented the presence of the gene inhibitory transcription factor, MeCP2, which is bound to the methylated DNA of patients with panic disorder but absent in healthy people.
153
SPECIFIC SEROTONIN REUPTAKE INHIBITION IN MAJOR DEPRESSIVE DISORDER CHANGES BAROREFLEX SENSITIVITY, HEART RATE VARIABILITY AND C-REACTIVE PROTEIN LEVELS SUCH AS TO ADVERSELY AFFECT CARDIAC RISK
Gavin Lambert
Baker Heart Research Institute, Australia
Tye Dawood
Baker Heart Research Institute, Australia
Celia Brenchley
Baker Heart Research Institute, Australia
Elisabeth Lambert
Baker Heart Research Institute, Australia
Deepak Haikerwal
Baker Heart Research Institute, Australia
Murray D Esler
Baker Heart Research Institute, Australia
David Barton
Baker Heart Research Institute and Monash University, Australia
Background: There exists a growing body of evidence linking depression with cardiovascular events. Although the precise mechanisms are yet to be identified, it is likely that the autonomic nervous system and inflammation play a pivotal role. Whether treatment of depression modifies cardiac risk remains to be unequivocally elucidated.
Methods and Results: We examined cardiac baroreflex function, heart rate variability, pulse pressure and high sensitivity C-reactive protein (hsCRP), all of which impact on cardiac risk, pre-and post-treatment in patients with major depressive disorder (MDD), with no history of coronary heart disease (CHD), and in healthy subjects. Treatment consisted of selective serotonin reuptake inhibition for approximately 12 weeks. No significant differences were observed between untreated MDD and the healthy group in blood pressure, heart rate, baroreflex sensitivity or heart rate variability. Pulse pressure and hsCRP, however, were significantly elevated in patients with MDD prior to treatment (p = 0.023 and p = 0.025, respectively). Moreover, while pharmacotherapy was effective in alleviating depression, surprisingly, all of these parameters were modified (p < 0.05) in a manner likely to increase cardiac risk following SSRI.
Conclusions: Our study demonstrated higher pulse pressure and hsCRP in MDD, which might contribute to increased cardiac risk. During SSRI administration vagal activity was reduced, manifest in reductions in baroreflex sensitivity and heart rate variability, accompanied by increases in pulse pressure, hsCRP and Mic-1. Treatment of MDD to this point has not reduced CHD clinical event rates, perhaps due to the offsetting changes we describe. Mechanisms possibly responsible for generating cardiac risk in patients with SSRI-treated MDD may need to be therapeutically targeted to reduce CHD incidence in this population.
154
AUTONOMIC NERVOUS SYSTEM DYSFUNCTION IN DEPRESSION: A POSSIBLE MECHANISM FOR INCREASED CARDIAC RISK
David Barton
Baker Heart Research Institute and Monash University, Australia
Gavin Lambert
Baker Heart Research Institute, Australia
Deepak Haikerwal
Baker Heart Research Institute, Australia
Tye Dawood
Baker Heart Research Institute, Australia
Celia Brenchley
Baker Heart Research Institute, Australia
Elisabeth Lambert
Baker Heart Research Institute, Australia
Murray D Esler
Baker Heart Research Institute, Australia
Major Depression is an independent risk factor for development of coronary artery disease and is associated with increased mortality after an acute coronary event. As depression and cardiovascular disease will be the two leading causes of disability in the world by 2020 understanding the underlying mechanisms for this risk is of significant public health importance. The mechanism may involve autonomic nervous system dysfunction, platelet hyperactivity or immunologically mediated atherogenesis. Being able to identify clinically who may be at increased risk based upon the likelihood of the existence of underlying pathophysiology would be of significant interest clinically.
Methods: Using percutaneously inserted catheters coupled with noradrenaline isotope dilution methodology each depressive subjects’ cardiac autonomic function was examined. Peripheral artery, coronary sinus and jugular venous blood was obtained. Whole body and cardiac noradrenaline spillover which are measures of sympathetic activity were determined. Peripheral sympathetic nervous system activity was measured by peroneal nerve microneurography. All patients fulfilled DSMIV criteria Major Depressive Disorder and were on no treatment at baseline. They were then treated for approximately 10 weeks with an SSRI and the investigations were repeated.
Results: Sympathetic nervous system activity in depressed patients is bimodal in distribution with both very low and very high levels. The high values are at similar levels to those found in patients with heart failure. This contrasts to patients with untreated panic disorder where this bimodality is not evident. Depressed patients who also have suffered from panic disorder have high levels of noradrenalin spillover (p < 0.01). Effective treatment of the depression is associated with a decrease in elevated sympathetic nervous system activity (p < 0.0001). The cardiac extraction of titrated noradrenaline is significantly reduced in those with high levels of noradrenaline spillover (p < 0.001) whilst overall peripheral sympathetic activity is normal as measured by microneurography. Cardiac extraction is also not modified by treatment with an SSRI. This is consistent with a defect in cardiac noradrenaline reuptake.
Conclusions: Our studies confirm that sympathetic activity is raised in a subgroup of patients with major depression who are more likely to have suffered from comorbid panic disorder. This appears to be due to an abnormality of cardiac noradrenaline reuptake. High levels of noradrenaline spillover are associated with increased mortality in patients with heart failure and therefore this may account for the increased mortality associated with depression after a myocardial infarct. Resolution of the depression with SSRI treatment decreases sympathetic activity. Whether this is reflected in a decrease in risk requires further investigation.
155
EVIDENCE OF ALTERED PREFRONTAL-THALAMIC CIRCUITRY IN SCHIZOPHRENIA: AN OPTIMISED DIFFUSION MRI STUDY
Stephen E Rose
Centre for Magnetic Resonance, University of Queensland, Australia
Johnathan B Chalk
Centre for Magnetic Resonance, University of Queensland, Australia
Andrew L Janke
Centre for Magnetic Resonance, University of Queensland, Australia
Mark W Strudwick
Centre for Magnetic Resonance, University of Queensland, Australia
John J McGrath
Queensland Centre for Mental Health Research (QCMHR), Australia
Christos Pantelis
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Stephen J Wood
Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
Bryan J Mowry
Queensland Centre for Mental Health Research (QCMHR), Australia
MRI diffusion tensor imaging (DTI), optimised for measuring the trace of the diffusion tensor, was used to investigate microstructural changes in the brains of 12 individuals with schizophrenia compared with 12 matched control subjects. To control for the effects of anatomic variation between subject groups, all participants’ diffusion images were nonlinearly registered to standard anatomical space. Significant statistical differences in mean diffusivity (MD) measures between the two groups were determined on a pixel-by-pixel basis, using Gaussian random field theory. We found significantly elevated MD measures within temporal, parietal and prefrontal cortical regions in the schizophrenia group (p < 0.001), especially within the medial frontal gyrus and anterior cingulate. The dorsal medial and anterior nucleus of the thalamus, including the caudate also exhibited significantly increased MD in the schizophrenia group (p < 0.001). This study has shown for the first time that MD measures offer an alternative strategy for investigating altered prefrontal-thalamic circuitry in schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
156
A HIGH-FIELD FMRI STUDY OF AUDITORY MISMATCH PROCESSING IN HEALTHY VOLUNTEERS: IMPLICATIONS FOR AUDITORY SENSORY MEMORY DYSFUNCTION IN SCHIZOPHRENIA
Philip B Ward
University of New South Wales, Sydney South West Area Health Service, Australia
Greig de Zubicaray
Centre for Magnetic Resonance, University of Queensland, Australia
Katie McMahon
Centre for Magnetic Resonance, University of Queensland, Australia
Ulrich Schall
Centre for Mental Health Studies, University of Newcastle, Australia
Patrick Johnston
Centre for Mental Health Studies, University of Newcastle, Australia
Juanita Todd
School of Behavioural Sciences, University of Newcastle, Australia
Patricia T Michie
School of Behavioural Sciences, University of Newcastle, Australia
Smaller mismatch negativity (MMN) amplitude is one of the most reliable ERP findings in studies comparing patients with schizophrenia and healthy volunteers. Several fMRI studies have examined analogous BOLD responses using similar stimulus presentation methods (e.g. Schall et al., NeuroImage, 2003). Whilst all studies reported activation in the superior temporal plane, only a subset reported activation in lateral frontal cortical regions. The present study used a variant of the usual MMN duration deviant design to elicit mismatch-related activation using a 4T MRI scanner. Data were obtained from 12 healthy volunteers, (six male). Subjects watched a silent movie whilst they were presented with auditory stimuli (1000 Hz, 90 dB tones, SOA = 500 ms) that varied in stimulus duration (standards: 50 ms; deviants: 100 ms). Three runs were presented, each comprising 111 volumes of whole brain EPI data (36 4mm-thick axial slices, TR = 3000, TE = 30, FOV = 230 × 230 mm, 64 × 64 matrix). Each run comprised a randomised series of short blocks, which were comprised of 4, 8 or 16 standards followed by either another standard or a longer duration deviant. Data were analysed using SPM2, using an event-related design. A contrast of BOLD responses elicited by deviants versus the terminal standards across the three conditions showed significant activation in a network that included the left and right superior frontal cortex, superior temporal cortex and right posterior cingulate. We also found a linear increase in BOLD activation for deviants preceded by 4, 8 or 16 standards in areas in the superior temporal and anterior cingulate gyri. Results will be discussed in relation to convergent data supporting the role of the frontal cortex in mismatch perception and involuntary orienting of attention.
Keywords: Biological Psychiatry, Neuropsychiatry
157
‘MISSING LINKS’: LOSS OF FUNCTIONAL CONNECTIVITY IN THE EMOTIONAL BRAIN SYSTEMS IN SCHIZOPHRENIA
Lea M Williams
Brain Dynamics Centre, Westmead Millenium Institute and Psychological Medicine, University of Sydney, Australia
Pritha Das
Brain Dynamics Centre and NISAD, Australia
Gary Flynn
Brain Dynamics Centre, Westmead Millenium Institute and Liverpool Hospital, Australia
Anthony WF Harris
Brain Dynamics Centre, Westmead Millenium Institute and Psychological Medicine, University of Sydney, Australia
Objective: Schizophrenia is characterized by core breakdowns in emotional and motivational function: affective blunting, paranoid delusions, lack of volition and asocial behaviour. These breakdowns may reflect a lack of integration in the underlying limbic-prefrontal networks. Brain imaging studies have revealed reduced activity in the amygdala and medial prefrontal cortex in schizophrenia. This study undertook the first investigation of functional disconnections in these emotional brain networks in schizophrenia, using both high spatial and high temporal resolution techniques. By manipulating level of conscious awareness, we were able to examine the disconnections in cortically controlled versus automatically-elicited subcortical pathways.
Method: A total of 36 first episode schizophrenia patients and matched healthy controls were tested in collaboration with the Brain Resource International Database. In addition to clinical information, we acquired functional MRI (fMRI) and EEG data in response to an emotion perception task, in which facial expressions of fear (versus neutral) were presented under both conscious and nonconscious conditions. For the fMRI data, psychophysiological interaction (PPI) analysis was used to examine functional connectivity in cortical and subcortical amygdala pathways. From the EEG, we extracted stimulus-locked, high frequency (40 Hz Gamma) synchronous neural activity which provides temporal index of connectivity.
Results: Control subjects showed positive connections within the subcortical amygdala pathway (nonconscious), and negative connections within the cortical amygdala pathway (conscious), suggesting feedforward versus feedback modes of processing, respectively. Schizophrenia patients, by contrast, were characterized by a reversal of the normal modes of connectivity in these amygdala pathways. For Gamma synchrony data, healthy controls showed increased early synchrony (corresponding to feedforward processing) for nonconscious presentations, and a sustained enhancement of synchrony over cortical regions for conscious presentations (consistent with recurrent feedback). Schizophrenia patients showed a loss of synchrony compared to controls, according with the reversal of functional connectivity.
Conclusion: Our study provides new evidence for a breakdown in neural integration in schizophrenia, which underlies emotion-related as well as cognitive processing. This loss of integration may contribute to the misattributions and loss of motivation which characterize many symptoms of schizophrenia.
158
UNRAVELLING DYSFUNCTION IN CINGULATE NETWORKS IN SCHIZOPHRENIA: EVIDENCE OF SELECTIVE WHITE MATTER DIFFERENCES IN CHRONIC SCHIZOPHRENIA AS DETERMINED BY DIFFUSION TENSOR IMAGING
Marc L Seal
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Murat Yucel
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Kerrie Clarke
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Mark Walterfang
Melbourne Neuropsychiatry Centre, University of Melbourne, Victoria, Australia
Dennis Velakoulis
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Gaby Pell
Brain Research Institute, Austin & Repatriation Medical Centre, Australia
Stephen J Wood
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Christos Pantelis
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Previous research by our group has indicted that cingulate morphology and function are abnormal in schizophrenia. On the basis of these findings and others it is proposed that schizophrenia involves disruption of the cingulate network linking the dorsal anterior cingulate and the dorsolateral prefrontal cortex (DLPFC). In order to investigate this hypothesis we have examined differences in white matter structure in two major cingulate networks, the dorsal and rostral networks, using diffusion tensor imaging (DTI). DTI is a relatively new neuroimaging technique which provides an estimate of white matter integrity in vivo. DTI data was acquired from twelve participants with chronic schizophrenia and twelve age-matched healthy control participants on a 3T GE MRI scanner using a sequence optimised to collect diffusion weighted images. All participants were male and right handed. Fractional anisotropy (FA) maps were calculated to provide an estimate of diffusivity. A region of interest (ROI) approach was employed with ROIs placed on individual participant’s FA maps in the dorsal cingulate pathway to the DLPFC and the rostral cingulate pathway to the orbital frontal cortex (OFC) in both hemispheres. Placement of ROIs was informed by individual anatomy as revealed by DT imaging colour maps indicating direction and strength of white matter pathways. Significantly reduced FA was observed in the schizophrenia participants in the left dorsal cingulate pathway. No difference in mean FA was observed for the ROIs placed in the OFC. These data are consistent with our previous functional neuroimaging and behavioural findings and suggest that there is a selective loss of white matter integrity in the dorsal cingulate pathway to the prefrontal cortex in schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
159
MEDICATION ADHERENCE IN YOUNG PEOPLE RECEIVING PSYCHOTROPIC MEDICATIONS FOR MENTAL HEALTH PROBLEMS
Angela J Dean
Kids in Mind Research, Mater Child & Youth Mental Health Services, Australia
Clarissa Cham-Hang Yeung
Mater Pharmacy Services, Australia
Jillian Wragg
Mater Child and Youth Mental Health Services, Australia
Brett M McDermott
Mater Child & Youth Mental Health Services, Australia
Introduction: Medication adherence is typically poor in adult psychiatric populations, and in young people with chronic diseases, and is associated with poor treatment outcome. Little research has examined treatment adherence in young people receiving psychotropic medication for mental health problems in a naturalistic setting.
Methods: Participants were young people (18 years or under) or their parents who were accessing either Mater Pharmacy Services or Mater Child & Youth Mental Health Service (South Brisbane). A cross sectional assessment obtained demographics, diagnoses, medication history, The Brief Medication Questionnaire and The Medication Complexity Index.
Results: Preliminary data is available for 25 young people (80% male, mean age 13.9, range 9–18). The primary respondent was most commonly a parent (84%). 68% of participants were recruited from pharmacy outpatient services; the remainder were recruited from mental health inpatient and outpatient clinics. 56% of participants reported missing at least one dose of medication in the previous week. When measured as a proportion of doses, participants missed up to 29% of their prescribed doses (mean 8.4%). Missed doses occurred in a variety of circumstances including being away from home, patient wanting a break from the effects of the drug, and forgetfulness. Young people receiving antidepressant medication exhibited poorer adherence rates (83%) than young people receiving antipsychotics (95%) or stimulants (94%). Highest rates of adherence were reported when parents or carers took responsibility for ensuring medication was taken (98%) followed by parents in conjunction with schools (94%) compared to situations were young people took responsibility for taking medications either in conjunction with parents (80%) or alone (79%) (F = 14.9; p < 0.001). Adherence rates were unrelated to age, sex, medication regimen complexity or perceptions of medication effectiveness or medication-related problems.
Conclusion: Medication adherence may be suboptimal for young people receiving psychotropic medications, especially in young people who do not have parents or carers involved in ensuring medications are taken.
Keywords: Work and Voc Rehab, Social Psychiatry
160
OLFACTORY IDENTIFICATION DEFICITS IN CHILD ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Felicity Karsz
Department of Psychology, University of Melbourne, Australia
Warrick J Brewer
ORYGEN Research Centre, University of Melbourne, Australia
Vicki Anderson
Department of Psychology, Royal Children’s Hospital, Australia
Stephen J Wood
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Peter G Brann
Maroondah Hospital, Australia
Rebecca Barnett
Latrobe University, Australia
Joanne Sais
Latrobe University, Australia
Alisdair Vance
Department of Child Psychiatry, Royal Children’s Hospital, Australia
Objective: This study compared unilateral olfactory identification abilities in children with and without attention deficit hyperactivity disorder and evaluated the utility of the University of Pennsylvania Smell Identification test (UPSIT) as a potential screening tool for the diagnosis of ADHD.
Methods: Subjects comprised 44 children with ADHD (6 to 16 years) from two Melbourne hospital outpatient clinics and 44 healthy children matched for age and sex. The children were assessed for olfactory identification ability using the UPSIT and behavioural data was gathered using the Rowe Behavioural Rating Inventory (RBRI). Background and demographic data were also obtained through hospital records and parental interview.
Results: Children with ADHD demonstrated significantly poorer olfactory identification ability compared to healthy controls. A significant right nostril advantage for smell identification was evident in the Control group, whereas a significant right nostril impairment was evident among the children with ADHD. Children with ADHD and high levels of aggression displayed an additional impairment in left nostril odor identification but this trend was of borderline significance (p =.05). UPSIT scores combined with RBRI scores correctly classified 91% of cross validated cases.
Conclusion: The results provide the first evidence of olfactory identification deficits in children with ADHD. As olfactory identification is mediated by the orbitofrontal cortex, this finding is consistent with previous reports of prefrontal compromise in children with ADHD. The UPSIT in conjunction with the RBRI may provide a useful adjunct in the diagnosis of ADHD.
Keywords: Epidemiology, Aetiology, Other
161
THE COOL TEENS CD-ROM FOR ADOLESCENT ANXIETY - OPPORTUNITY AND CHALLENGE
Mike J Cunningham
Macquarie University, Australia
Ron M Rapee
Macquarie University, Australia
Heidi J Lyneham
Macquarie University, Australia
For many reasons, there is a significant treatment gap for anxiety disorders in adolescents. Attracting young people to traditional therapy is difficult and the Department of Health and Ageing suggests that this age group may require “creative and innovative treatment approaches that transcend many existing service boundaries.” Computer-based Cognitive Behavioural Therapy has been shown to be clinically effective and efficacious for various forms of anxiety in adults. However, as of late 2005, no such programs have been developed specifically for the standalone treatment of anxiety in adolescents. Yet this delivery mode has major potential strengths and is a great opportunity to reach this age group. Computerised self-help is likely to minimise stigma and to allow a tremendous degree of personal control and flexibility. The use of multimedia designed with adolescent input allows therapeutic materials to be delivered in a format that is familiar and comfortable. To respond to the need for better treatment options for adolescents with anxiety, the Macquarie University Anxiety Research Unit has developed Cool Teens, a multimedia self-help program specifically for this audience. This presentation discusses the program’s development, the opportunities and challenges it presents, and plans for its clinical evaluation.
Keywords: Epidemiology, Aetiology, Other
201
THE ROLE OF EPIGENETIC MODIFICATIONS IN THE DETERMINATION OF PHENOTYPE
Emma Whitelaw
Queensland Institute of Medical Research, Australia
It is well recognised that there is a surprising degree of phenotypic variation among genetically identical individuals even when the environmental influences, in the strict sense of the word, are controlled. Genetic textbooks acknowledge this fact and use different terms such as “intangible variation” or “developmental noise” to describe it. We believe that this intangible variation results from the stochastic establishment of epigenetic modifications to the DNA nucleotide sequence in early development. These modifications, which involve cytosine methylation and chromatin remodelling, result in alterations in gene expression which, in turn, affects the phenotype of the organism. Recent evidence from a number of labs suggest that the establishment of these epigenetic states can be influenced by the environment. We have recently identified some novel proteins involved in this process in the mouse and have identified some loci in humans which display variable epigenetic states in MZ twin pairs. At this stage, we do not know how extensive this phenomenon is in humans but it may turn out to be the explanation for some diseases that appear to be sporadic or show only weak genetic linkage.
204
EMERGING TREATMENT FOR MAJOR DEPRESSION
Trevor Norman
Department of Psychiatry, University of Melbourne, Austin Hospital, Australia
Antidepressant drugs represent the principal form of treatment for major depressive disorder. While there are a plethora of medications available for this task current drugs have many shortcomings. In the face of these deficiencies there is an ongoing search for new agents. The search has been guided, in part, by drug design based on existing agents and their putative mechanism of action. This has been less than fruitful in addressing inadequacies of existing medications since it has not produced compounds which are novel in terms of pharmacological mechanisms. Recent insights from molecular biological approaches hold promise for the discovery of novel compounds. A review of new agents for the treatment of major depression will be presented. Some have been recently marketed while others are in early phase development. Clearly the place of these agents in the treatment of depression is dependent on issues such as short and long term safety and efficacy. Several compounds which fit within the currently accepted hypotheses regarding antidepressant mechanism of action have been recently released. Although significantly modified over the years the monoamine hypothesis of depression and antidepressant drug action still remains an important driving force behind the development of new compounds. Thus duloxetine has been developed as a dual monoamine reuptake inhibitor. Agomelatine is a compound with major effects on the circadian system as well as effects on subtypes of the serotonin receptor system. While the mechanism of action of this compound is not certain recent evidence would suggest that the drug exerts its effects through antagonist actions at serotonin receptors. Compounds based on the hypothalamic pituitary adrenal axis, substance P antagonism and modification of neurotrophic factors have potential application for the treatment of depression but require further development before their therapeutic potential is realised.
205
THE HPA AXIS IN AFFECTIVE DISORDERS: A SUITABLE CASE FOR TREATMENT?
Allan H Young
University of Newcastle, School of Neurosciences and Psychiatry, United Kingdom
Background: Hypercortisolaemia has long been noted in severe mood disorders and may cause or exacerbate neurocognitive impairment and depressive symptoms. Antiglucocorticoid treatments may therefore be efficacious. At high doses mifepristone (RU-486) becomes an antagonist of the glucocorticoid receptor (GR). Preliminary reports have found that mifepristone/GR-antagonists have antidepressant effects in unipolar disorder. We therefore sought to establish proof-of-concept for the use of GR-antagonists in the treatment of bipolar disorder.
Methods: Twenty patients fulfilling DSM-IV criteria for bipolar disorder (with persistent depressive symptoms) were recruited. Following a baseline assessment, patients were randomly allocated in a doubleblind design to receive 600 mg mifepristone or placebo for 7 days. Assessments were performed at cessation of treatment and at weekly intervals. After 2 weeks, the groups crossed-over and the alternative treatment was administered, again with assessments at treatment cessation and at weekly intervals.
Results: After mifepristone, but not placebo, Hamilton-Depression-Rating-Scale scores were significantly reduced compared to baseline (5.1 points: 95%CI = 0.91–9.30; p = 0.020) as were Montgomery-Asberg-Depression-Rating-Scale scores (6.1 points: 95%CI = 0.75– 11.36; p = 0.028). A selective improvement in neurocognitive function was observed (spatial working memory; mean improvement over placebo = 19.8%, 95%CI = 4.3–35.2; p = 0.013). Other measures of ‘frontal’/executive function were also improved following mifepristone (verbal fluency, p = 0.044; spatial recognition memory, p = 0.040).
Conclusions: These data suggest that the GR-antagonist mifepristone may reverse neurocognitive impairment and be antidepressant in bipolar disorder. Previously, we found no effect of mifepristone on symptoms or neurocognition in schizophrenia, utilizing a similar design/paradigm. Our results provide initial proof-of-concept that GR-antagonists may be of clinical utility in the treatment of bipolar depression.
207
MUSCARINIC RECEPTORS: THEIR ROLES IN CNS FUNCTION RELEVANT TO MENTAL ILLNESS
Elizabeth Scarr
The Centre for Neuroscience, The University of Melbourne, Australia
In spite of the fact that over 15 years have passed since the existence of five muscarinic receptors was established, relatively little was known of their respective actions until recently. This was partially due to the fact that the receptors are structurally very similar, with the result that few pharmacologic tools are capable of distinguishing between them. Two developments have contributed significantly to our understanding of the respective roles played by the different muscarinic receptors. The creation of mice that are null for specific muscarinic receptors (knock out mice) has probably been the most significant contributor. However, the impact of isolating compounds from snake venom, which are more specific for muscarinic receptors than previously developed compounds, should not be underestimated. Information regarding the potential roles of the different receptors in the central nervous system, from a number of different approaches, will be presented and discussed with respect to psychiatric illnesses and the possible roles of these receptors in such disorders.
208
MUSCARINIC RECEPTORS: FINDINGS RELEVANT TO THE PATHOLOGY OF SCHIZOPHRENIA
Brian Dean
Mental Health Research Institute, Australia
Recent studies using the selective muscarinic receptor radioligand, [3H]pirenzepine, have consistently shown decreases in binding in the CNS from subjects with schizophrenia. These finding are consistent with a recent neuroimaging study which showed decreased in muscarinic receptors in a number of CNS regions in “drug-free” schizophrenic subjects. Limitations in the selectivity of radioligands do not allow binding studies to identify which of the 5 muscarinic receptors is altered in schizophrenia. By contrast, our more recent studies have used receptor specific antibodies to measure the levels of M1 and M4 receptors in postmortem CNS from subjects with schizophrenia, the two receptors targeted by [3H]pirenzepine. These studies have shown that the M1 receptor is decreased in Brodmann’s area (BA) 9, but not BA 40 or the thalamus from subjects with schizophrenia and that the levels of the M4 receptor was not altered in any of these regions. These data suggest that decreases in the M1 receptor may be of particular import in the dorsolateral prefrontal cortex from subjects with schizophrenia. Moreover, it is possible that both clozapine and olanzapine may act as antagonists at all muscarinic receptors, including the presynaptic M2 receptor. This means these drugs could produce some of their therapeutic effects by causing an increase efflux of acetylcholine from the innervating cholinergic neuron. The potential outcomes from such complex pharmacology will be discussed.
209
ALLOSTERIC MODULATORS OF G PROTEIN-COUPLED RECEPTORS: NOVEL DRUGS FOR THE CNS
Arthur Christopoulos
University of Melbourne, Australia
G protein-coupled receptors (GPCRs) account for 1–3% of the human genome, are abundantly expressed in the CNS, and represent the major targets for approximately 50% of all medicines on the market. Traditionally, optimizing the interaction of lead molecules with the binding site for the endogenous agonist (“orthosteric” site) has been viewed as the best means for receptor selectivity. It is now recognized, however, that many GPCRs possess additional, “allosteric” binding sites that modulate receptor activity; allosteric sites can offer advantages over orthosteric sites, including a greater potential for GPCR subtype selectivity. This is particularly pertinent to studies of muscarinic acetylcholine receptors (mAChRs), which generally lack selective agonists and antagonists due to high conservation within the orthosteric domain across all 5 mAChR subtypes. However, the detection, quantification and validation of allosteric drug effects represents a significant challenge for drug discovery. We and others have found that allosteric modulators of mAChRs profoundly affect the kinetics of orthosteric drug binding and unbinding, and this may lead to difficulties in screening for allosteric drugs. By combining mutagenesis and 3D homology modelling, we have mapped key residues on the M2 mAChR that likely constitute an allosteric site and mediate the observed effects on drug binding kinetics. Allosteric modulation of GPCRs is likely to be widespread throughout the CNS; we have now identified the first modulators of cannabinoid CB1 receptors, and found a striking dissimilitude between their effects on agonist binding, where they act as enhancers, and their effects on agonist-mediated signalling, where they act as inhibitors. This difference between binding and function represents another challenge for allosteric modulator-based drug discovery; the optimal detection of novel allosteric ligands thus requires combination of both functional and modulator-optimized binding assays.
212
TREATMENT ISSUES IN COMORBIDITY OF MENTAL HEALTH AND SUBSTANCE USE PROBLEMS
David J Kavanagh
University of Queensland, Australia
Approaches to concurrent disorders have often focussed on a pri-mary/secondary classification. An implication is that initial treatment of a primary disorder may avert the need to treat the secondary one. However, comorbid disorders are often in a relationship of mutual influence, and while current evidence on the management of these disorders is very limited, it favours integrated treatment. At this stage we do not know why this is the case. It may simply be that some treatment is received for both disorders, since people with comorbid disorders are often excluded from service. There may be less chance of inconsistent treatments, or treatment for each disorder may be better tailored for people with comorbidity. Perhaps integrated treatment better addresses aspects that maintain the comorbidity, or integrated treatments may be reduced to areas that impact on both conditions, so that participants are more able to gain key skills. These treatment characteristics could be applicable to well designed sequential approaches or parallel treatment by two treatment agents as well as to sound integrated treatment. The paper refers to research bearing on these hypotheses, and sketches some priorities for a new wave of studies in the area.
Keywords: Work and Voc Rehab, Social Psychiatry
213
CANNABIS USE HISTORY AND ONSET TO PSYCHOSIS IN AN ULTRA HIGH RISK GROUP
Renay L Greig
Psychological Assistance Service, Hunter New England Mental Health Service, Australia
Amanda L Baker
Centre for Mental Health Studies, University of Newcastle, Australia
Mike J Startup
School of Behavioural Sciences, University of Newcastle, Australia
Sean Halpin
Psychological Assistance Service, Hunter New England Mental Health Service, Australia
Vaughan J Carr
Neuroscience Institute for Schizophrenia and Allied Disorders and Centre for Mental Health Studies, University of Newcastle, Australia
Cannabis is the most widely used illicit drug in Australia with higher rates of use found among those with a mental disorder. The similarities of the effects of cannabis to symptoms of psychosis, and the observation that cannabis use is temporally linked to the development of schizophrenia symptoms in some people, and has led to a plethora of research investigating the relationship between cannabis use and psychosis. In several prospective studies, cannabis use has been found to be a risk factor for the later development of psychosis. However, contrary to hypotheses, recent research investigating cannabis use among an ‘ultra high risk’ for psychosis sample found that cannabis use/dependence in the year prior to recruitment was not associated with a heightened risk of developing psychosis over the following 12 month period. The current research was a similar, cross sectional, retrospective study of cannabis use among an ‘ultra high risk’ group, conducted at the Psychological Assistance Service, Newcastle, NSW, from June 2004. The study builds on previous research and incorporates a cannabinergic model of schizophrenia to guide methodological alterations. The purpose was to assess whether cannabis use history is associated with the onset of psychosis among an ultra high risk (for psychosis) group after controlling for age, gender, genetic liability, other neurodevelopmental insult and other substance use. It was hypothesized that: (i) that rates of transition to psychosis would be significantly positively associated with levels of cannabis use; (ii) cannabis use would contribute to a significant proportion of the variance in predicting onset to psychosis; and (iii) this result would be maintained, even after controlling for pre disposing vulnerabilities for psychosis and the use of other substances. The findings of this study are pending, and will be discussed at the time of the presentation.
Keywords: Epidemiology, Aetiology, Other
214
SUBSTANCE USE DISORDERS IN PATIENTS WITH FIRST-EPISODE PSYCHOSIS: 18-MONTH OUTCOMES
Dan I Lubman
ORYGEN Research Centre, University of Melbourne, Australia
Philippe Conus
Département Universitaire de Psychiatrie Adulte, Clinique de Cery, Prilly, Switzerland
Sue Cotton
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Patrick D McGorry
ORYGEN Research Centre, University of Melbourne, Australia
Martin Lambert
University Hospital Hamburg-Eppendorf, Hamburg, Germany
Objective: To examine the prevalence and course of substance use disorders (SUD) amongst a large cohort of young people with firstepisode psychosis (FEP).
Methods: Between 1998 and 2000, the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne admitted 786 FEP patients. Data was systematically collected from 668 patients’ medical records using the Early Psychosis File Questionnaire.
Results: 61% of the 668 FEP patients met criteria for a SUD (410 with SUD cf. 258 without SUD). The most prevalent SUD at baseline were cannabis-related (67%). 72% of patients with SUD fulfilled criteria for dependence, whilst 35% also met criteria for a secondary SUD. In the majority of cases, SUD preceded the onset of psychosis by several years. At baseline, FEP patients with SUD had significantly higher severity of illness scores and lower levels of functioning. After 18 months of treatment, SUD outcomes were highly correlated with increased rates of loss to follow-up, higher number of relapses during the treatment period, lower rates of remission, higher psychopathology scores at endpoint, increased suicidal attempts during treatment and lower level of functioning. Importantly however, patients who reduced or ceased using during the treatment period had comparable outcomes to those patients without SUD.
Discussion: SUD in FEP patients is an important clinical variable associated with increased morbidity and poor symptomatic and functional outcome. However, patients who reduce or cease using have improved outcomes. Early intervention strategies that target comorbid SUD in FEP are clearly warranted.
Keywords: Epidemiology, Aetiology, Other
215
THE SHADE PROJECT: SELF HELP FOR ALCOHOL/OTHER DRUG USE AND DEPRESSION
Frances J Kay-Lambkin
Centre for Mental Health Studies, The University of Newcastle, Australia
Amanda L Baker
Centre for Mental Health Studies, University of Newcastle, Australia
Terry J Lewin
Centre for Mental Health Studies, University of Newcastle, Australia
Brian Kelly
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Vaughan J Carr
Neuroscience Institute for Schizophrenia and Allied Disorders and Centre for Mental Health Studies, University of Newcastle, Australia
Background: The co-occurrence of depression and alcohol/other drug (AOD) misuse is more common than expected by chance alone. Despite this, an effective program of treatment is yet to be established for people experiencing this comorbidity. This is a concern, given rates of depression and AOD misuse are on the increase.
Aims: This paper will report on the 12-month outcomes of the SHADE pilot project, which was completed in March 2005.
Methods: SHADE participants were those with current levels of depression and current problematic use of alcohol, cannabis or amphetamines. Following an initial assessment, participants received one face-to-face case formulation session with a therapist and were subsequently randomised to receive no further treatment, nine sessions of SHADE therapy via a therapist or nine sessions of SHADE therapy via a computer. Follow-up occurred at post-treatment, 6-and 12-month follow-up.
Results: 110 people participated in the study over a three-year period. Reductions in depression and AOD use were evident across treatment conditions at the post-treatment assessment. These reductions were maintained at 6-and 12-month follow-up by the therapist-and computer-delivered treatment groups only.
Conclusions: Computerised treatment is not meant as a stand alone therapy. The results from this pilot suggest however that computerbased treatment can produce important gains for people with depression and AOD use comorbidity. Further implications will be discussed.
Keywords: Work and Voc Rehab, Social Psychiatry
216
COMPUTERISED COGNITIVE BEHAVIOUR THERAPY FOR DEPRESSION AND COMORBID SUBSTANCE MISUSE: RURAL AND REMOTE PERSPECTIVES
Victoria Clack
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Frances J Kay-Lambkin
Centre for Mental Health Studies, The University of Newcastle, Australia
Amanda L Baker
Centre for Mental Health Studies, University of Newcastle, Australia
Brian Kelly
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Terry J Lewin
Centre for Mental Health Studies, University of Newcastle, Australia
Leigh Underwood
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Background: It is widely accepted that rural/remote populations are disadvantaged by a lack of specialist mental health services despite there being no differences in prevalence rates of psychiatric disorders between rural and urban areas. The SHADE (Self Help for Alcohol/other drug use and Depression) program aims to address this disparity in access by offering an integrated psychological treatment for comorbid depression and substance misuse to a rural population, via a computer program.
Aim: This presentation will report on the progress to date with the SHADE trial in rural New South Wales. This includes a comparison of recruitment and retention rates across treatment conditions as an index of the acceptability and feasibility of computerized therapy.
Method: Participants complete an initial assessment with measures for depression and substance misuse. Participants are randomly assigned to one of the three treatment conditions, and are followed up at posttreatment, 6-and 12-months.
Results: A description of the patterns of participation of the 68 current SHADE recruits will be discussed. Client retention rates of over 65% support the qualitative data by indicating that the SHADE program has been well accepted by referring clinicians and by clients from several NSW rural areas.
Conclusions: Results indicate that the program offers an acceptable means of access to a new integrated psychological treatment of depression and co-occurring substance misuse to a population with limited specialist intervention options.
Keywords: Epidemiology, Aetiology, Other
217
COMBINED VERSUS SINGLE FOCUSED INTERVENTIONS FOR COMORBID DEPRESSION AND ALCOHOL PROBLEMS: INTRODUCTION TO THE DAISI PROJECT
Sally A Hunt
University of Newcastle, Australia
Amanda L Baker
University of Newcastle, Australia
David J Kavanagh
University of Queensland, Australia
Frances J Kay-Lambkin
The University of Newcastle, Australia
Terry J Lewin
University of Newcastle, Australia
Brian Kelly
Centre for Rural and Remote Mental Health, Australia
Vaughan J Carr
University of Newcastle, Australia
It has long been known that the comorbidity of alcohol problems and depression is common, and that people experiencing these conditions concurrently have poorer treatment outcomes than those experienced by people with single disorders, resulting in greater use of services and medications. Despite this, effective evidenced-based treatments have yet to be developed and fully tested for this unique group. There is a need to explore interventions which acknowledge the comorbidity and actively work to minimise the effect of both conditions. The DAISI study will be one of the first to explore whether an intervention that integrates treatment for depression and alcohol would be superior in reducing alcohol use and symptoms of depression, when compared with a treatment that focuses on alcohol alone or depression alone. Participants will be randomly allocated to one of four treatment conditions which combine CBT and Motivational Interviewing strategies. The first three conditions offer 10 sessions which focus on a) depression; b) alcohol use; or c) integrated depression and alcohol focus. The remaining group will receive a single case formulation and assessment feedback session. Outcomes will be compared over a 3-year period, with followup assessments taking place at post-treatment, 6-months, 12-months, 24-months and 36-months following initial assessment. It is predicted that this research will result in the development of an effective treatment program for people with alcohol and depressive disorders, and further, that the integrated CBT will produce greater, more sustainable reductions in both depressive and alcohol use outcomes relative to the other treatment conditions at the post-treatment follow-up assessments. The proposed assessments, including neuropsychological tests (to evaluate their utility in predicting responsiveness to MI/CBT and to detect change in cognitive functioning as part of the presenter’s PhD thesis), and methodology will be discussed.
Keywords: Work and Voc Rehab, Social Psychiatry
218
MENTAL HEALTH SCREENING AMONGST INJECTING DRUG USERS
Leanne Hides
Substance Use Research and Recovery Focused (SURRF) Program, ORYGEN Research Centre, University of Melbourne, Australia
Dan Lubman
Substance Use Research and Recovery Focused (SURRF) Program, ORYGEN Research Centre, University of Melbourne, Australia
Harriet Devlin
Burnet Institute for Medical Research and Public Health, Australia
Tania Gibbie
Burnet Institute for Medical Research and Public Health, Australia
Campbell Aitken
Burnet Institute for Medical Research and Public Health, Australia
Margaret Hellard
Burnet Institute for Medical Research and Public Health, Australia
Purpose: The aim of this study was to determine the reliability and validity of brief mental health screening tools for detecting mental health disorders amongst injecting drug users (IDU).
Methods: Participants were 103 IDUs with a current substance use disorder SUD accessing a needle and syringe (NSP) program in Footscray, Melbourne. Brief mental health screening tools included the Kessler 10 (K10), the Patient Health Questionnaire (PHQ), and a Psychosis Screener. The presence of a current DSM-IV mental health disorder was assessed using the Mini International Neuropsychiatric Interview (MINI).
Results: Just under 70% of IDU’s had at least one current DSM-IV mental health disorder according to the MINI. Depressive and anxiety disorders were the most common mental health conditions with 67% of participants meeting criteria for either disorder. Both the K10 and PHQ were valid and reliable predictors of a current mental health or depressive/anxiety disorder. A cut-off score of 26 on the K10 had optimal sensitivity and specificity for detecting a current mental health or depressive/anxiety disorder and an an overall accuracy of 81%. Participants with a positive screen on the PHQ were nearly 14 times more likely to have a current depressive or anxiety disorder on the MINI. The use of both the K10 and PHQ together or in combination did not improve the detection of current mental health disorders.
Conclusions: Both the K10 and PHQ were reliable predictors of a current mental health or depressive/anxiety disorder and are recommended for use as mental health screening tools amongst IDUs.
Keywords: Work and Voc Rehab, Social Psychiatry
219
COGNITIVE THERAPY IN RELAPSE PREVENTION IN DEPRESSION
Eugene Paykel
University of Cambridge, United Kingdom
This presentation will review recent advances in application of cognitive therapy to a therapeutic problem in depression. Modern follow-up studies indicate that, in spite of the efficacy of antidepressants, relapse and recurrence rates in some patients remain high. This does not appear due primarily to failure to receive medication, but to reflect intractability of the disorder. In acute treatment, psychological treatments, although beneficial, are not cost-effective compared with antidepressants, due to high costs of therapists. Benefit which lasts longer, particularly if combined with medication, may therefore be particularly valuable. There have now been five randomised controlled trials designed specifically to test relapse and recurrence prevention. All have shown significant benefit, which lasts beyond the cessation of therapy. The effect appears to be more on preventing symptom return than on lessening current symptoms, to summate well with continuation and maintenance antidepressant, and to not be due simply to enhanced medication adherence. Conclusions will be illustrated by findings from the large Cambridge-Newcastle controlled trial.
220
IS THERE A ROLE FOR PSYCHOTHERAPY IN BIPOLAR DISORDERS: DO THE THEORIES AND THE THERAPIES STACK UP?
Jan Scott
Institute of Psychiatry, Division of Psychological Medicine, United Kingdom
This paper will explore the evolution of psychotherapy for individuals with bipolar disorders (BP). Until recently, BP were widely regarded as a biological illness best treated with medications. This view is gradually changing for two reasons. First, in the past three decades, there has been a greater emphasis on stress-diathesis models. This has led to the development of new etiological theories of severe mental disorders that emphasise psychological and social aspects of vulnerability and risk. It has also increased the acceptance of brief psychological therapies, such as cognitive therapy (CT), as an adjunct to medication for individuals with treatment-resistant schizophrenia, and severe and chronic depressive disorders. Second, there is a significant efficacy-effectiveness gap for pharmacological treatments for BP. Mood stabilizer prophylaxis protects about 60% of individuals against relapse in research settings, but protects only 25–40% of individuals against further episodes in clinical settings. The introduction of newer medications has not improved prognosis. This has also increased interest in other treatment approaches in BP. However, early efficacy studies demonstrating significant benefits of psychological treatments may be overestimating the number of patients who will benefit. This paper explores psychological models of BP and the empirical support for these therapies. It comments on the clinical applicability of psychological therapies for BP and shows a systematic review of the outcome studies available. The presentation will then focus on the recent pragmatic effectiveness randomized multicentre treatment trial funded by the Medical Research Council in the UK. The results are important in helping clinicians develop a realistic appraisal regarding which patients with BP should receive adjunctive psychological therapies.
222
WHAT IS THE PLACE OF PSYCHOLOGICAL TREATMENTS IN MOOD DISORDERS?
Gordon Parker
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Logic would suggest that, for the depressive disorders, a psychotherapy might sometimes be the primary treatment, on other occasions an augmenting or secondary treatment (concurrent or sequential) and, on other occasions, irrelevant. However, the paradigms that have been used in recent decades to test the efficacy of many of the psychotherapies disallow any such model (and application rules) to be developed. While there has been an impressive amount of work pursuing the utility of the psychotherapies (and principally the manualised psychotherapies of CBT and IPT), study designs disallow clear judgments about their differential efficacy (compared to other psychotherapies), the circumstances when they might be necessary and sufficient, and the circumstances when they might work best as combination therapy. Thus, the ‘ecological niche’ of such therapies remains to be clarified.
Research over the last decade has established that most expressions of psychotherapy that have been tested have a role complementing drug therapy for those with bipolar disorder but again a model identifying how the synergies might best be promoted has yet to be explicated. The presentation will overview findings from a number of important studies, identify limitations to current models for testing the role of psychotherapy and suggest some ways in which research might advance the development of a matrix assisting clinicians to determine more explicit rules for the psychotherapies.
223
CURRENT TRENDS IN THE INTEGRATION OF THE INTERNET INTO CLINICAL CARE IN PSYCHIATRY
Dennis Tannenbaum
Sentiens Pty Ltd, Australia
Lucy Robertson
Sentiens Pty Ltd, Australia
James Tannenbaum
Sentiens Pty Ltd, Australia
Purpose: This paper aims to show the progression from simple paperbased systems that aim to enhance treatment adherence to computerbased clinical systems to the modern disease management companies, which now serve millions of patients online in the USA and Germany.
Methods: Three sources of information were reviewed: (1) papers in peer reviewed journals in psychiatry, (2) similar papers in the consultancy literature, and (3) companies identified by internet searches.
Results: Disease management spanning the continuum of care is a rapidly evolving system of care embracing the management of chronic illnesses in medicine and psychiatry. Such systems have been found to improve outcomes and reduce costs.
Conclusions: Clear dominant models of care using internet backbones are emerging and are being implemented in the USA and Europe on a massive scale. The peer reviewed literature is significantly behind the major trends in service delivery. The most valuable descriptions of health trends are in the consultancy literature and reports on company activities.
224
TACKLING NONADHERENCE: SUPPORT FOR THE USE OF CASE MANAGEMENT IN E-HEALTH
Holly Exeter-Kent
Sentiens Pty Ltd, Australia
Lucy Robertson
Sentiens Pty Ltd, Australia
Michael Smith
Sentiens Pty Ltd, Australia
Dennis Tannenbaum
Sentiens Pty Ltd, Australia
Purpose: Non-adherence to treatment presents a significant obstacle to achieving favourable health outcomes. We have studied consumers’ adherence to an online disease management system for depression, called RecoveryRoad. Similar disease management systems are being used within the US and Europe and have been found to improve outcomes and reduce costs. The research was partly funded by the WA Department of Health and the Commonwealth Department of Health and Ageing.
Method: RecoveryRoad was implemented on a pilot basis for mental healthcare in Western Australia. RecoveryRoad was available for use by consumers and clinicians to augment usual treatment. One hundred and forty-four consumers who had been diagnosed with major depression were enrolled. Consumers were provided with systematic online education, e-progress monitoring, e-consultation, e-diary and online evidenced-based therapy. Consumers received one of two levels of adherence reminders: (1) automated email reminders or (2) case management, which included automated email reminders plus personalised email and telephone follow-up in response to non-adherence.
Results: After the first eight sessions (approximately 4 months of use), adherence to RecoveryRoad was 84% in the case management group and 55% in the automated reminders group. Self-reported medication adherence amongst RecoveryRoad users was very high.
Discussion: Adherence rates to RecoveryRoad were high and compared favourably to adherence rates to other e-mental health interventions. The results suggest that case management increases adherence to online disease management systems.
225
WEB DELIVERY OF COGNITIVE BEHAVIOUR THERAPY: ONLINE RANDOMISED CONTROLLED TRIAL
Helen Christensen
Centre for Mental Health Research, The Australian National University, Australia
Kathy Griffiths
Centre for Mental Health Research, The Australian National University, Australia
Andrew Mackinnon
Centre for Mental Health Research, The Australian National University, Australia
Kylie Brittliffe
Centre for Mental Health Research, The Australian National University, Australia
Context: Online Cognitive Behaviour Therapy (CBT) interventions for depression are effective but it is not known how brief these website interventions need to be to effect symptom change.
Objective: To determine whether depression symptoms are reduced significantly following exposure to six versions of an online cognitive behaviour therapy program which differed in content and length.
Design, Setting, and Participants: An online randomized controlled trial conducted between 13th January 2005 and 26th of May 2005 (19 weeks =134 calendar days) using an open access website on the world wide web. 2794 registrants (1846 women and 948 men) median age category (35–44) with elevated scores on the Goldberg depression scale of 5.96 (SD = 2.09) elected to be randomized to one of six versions of a CBT website (www.moodGYM.anu.edu.au). 20.4% of participants completed the assigned intervention.
Interventions: Six variants of the program were compiled consisting of various components of brief CBT, extended CBT, behavior strategies, stress management and problem solving.
Main Outcome Measures: Goldberg Depression Scale.
Results: A single module of brief introductory CBT was not effective relative to the other versions in reducing depression symptoms. The full version of the program was associated with the highest attrition. Extended CBT with and without behavior strategies results in the greatest reduction of depression.
Conclusions: Extended CBT is associated with better outcomes than brief CBT. The addition of stress management and problem solving does not result in better outcomes. Longer interventions are associated with greater attrition. Brief web interventions are effective. Fully automatised online RCTs to evaluate research questions of this type are fast, efficient, cheap and feasible.
226
SUPPORT NETWORKS PROMOTING E-HEALTH IN YOUTH
Kenneth C Kirkby
University of Tasmania, Australia
Brett A Daniels
University of Tasmania, Australia
Caroline A Spiranovic
University of Tasmania, Australia
Jennifer M O’Connor
University of Tasmania, Australia
Purpose: The past five years have seen rapid development of internet based mental health sites, particularly in Australia. These are widely used, for example the beyondblue site has has more than a million visits. However there has been little systematic effort to encourage e-health participation across a range of reputable sites for the purposes of health promotion, education, prevention and early intervention. Young people are a target group of particular interest as they typically have limited experience of the health system, are living through an at times challenging stage of the life cycle, have dynamic peer networks, and have a high rate of internet use and access. We have therefore developed a program incorporating an e-health focussed workshop, emailed newsletters and online discussion-group support. The aim is to foster exchange of information about mental health internet sites between workshop paticipants and their broader peer and family networks. This strategy is based around a customised website containing links to a half dozen reputable Australian mental health websites and descriptors of each.
Methods: Ten workshops each with 15 to 20 participants are being conducted statewide in Tasmania in 2005. Participants are encouraged to share e-health tips with their peer and family networks by email, using the study website as a gathering point. Outcome measures includes questionnaire items pre-intervention and at follow-up, and records of use of the study website and resulting ‘referrals’ to the recommended websites.
Results: This is work in progress.
Conclusions: E-health supplements traditional services and offers opportunities to increase public preparedness and to improve triage where indicated to treatment services. This requires attention to enhancing the social environment in which health information is shared and distributed and support provided.
227
PREVENTING RELAPSE IN PEOPLE WITH BIPOLAR DISORDER USING THE WWW; INTERIM RESULTS OF A RANDOMISED CONTROLLED TRIAL
Caryl W Barnes
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Philip Mitchell
University of New South Wales, the Black Dog Institute, Australia
Kay Wilhelm
University of New South Wales, the Black Dog Institute, Australia
Purpose: A randomised controlled trial has been started which will investigate whether an adjunctive internet-based relapse prevention program developed for adults with bipolar disorder, ‘Bipolar Disorder Recovery Road’, can improve outcome when compared to a control group receiving an internet ‘attention placebo’ program called the ‘Virtual Highway for Bipolar Disorder’. This paper will focus on the implementation of this, a solely web-delivered, research trial.
Methods: A screening questionnaire was developed as a tool with which to recruit participants into the trial over the web. A small pilot was run to validate this questionnaire prior to commencement of main study. The control program was developed to act as an ‘attention placebo’. It consists of similar components to the study group’s Recovery Road program i.e. intervalised access to the internet and completion of a set of monitoring questionnaires. But did not contain what is believed to be the ‘active’ complements of this program. Outcome measures collected include: adherence to medication, contact with mental health clinicians and services, level of symptoms and day-to-day functioning. These were collected using both validated questionnaires (BDI-II, the Internal State Scale) and questionnaires developed as part of the Recovery Road program.
Results: The ethical issues that needed to be considered when conducting this research will be discussed. These include the process of obtaining informed consent over the internet and the issue of duty of care. The issues that arose in the development of a meaningful control program will also be discussed. We also hope to be able to present some preliminary results.
Conclusions: Research trials that are conducted using the internet present unique challenges to researchers. However, the established methodology for RTC’s provides a framework to work from and should remain the gold standard that researchers in this new but increasingly established area should strive to meet. It is vital that when new interventions are developed using new technology they continue to be assessed in a way that allow meaningful comparison of results.
228
A WEB-BASED PSYCHOSOCIAL INTERVENTION FOR BIPOLAR DISORDER
Terence W H Chong
Mental Health Research Institute, Australia
Carolynne Holdsworth
Mental Health Research Institute, Australia
Monica Gilbert
Mental Health Research Institute, Australia
Lesley Berk
Mental Health Research Institute, Australia
Sue Lauder
Mental Health Research Institute, Australia
Isaac Schweitzer
The University of Melbourne and The Melbourne Clinic, Australia
Michael Berk
The University of Melbourne, The Geelong Clinic and Barwon Health, Australia
David J Castle
Mental Health Research Institute, The University of Melbourne and Northwestern Mental Health, Australia
With the increasing use of the internet in Australia (Australian Bureau of Statistics ABS 2005) and evidence to suggest that in some instances, patients may prefer on-line help (Christensen & Griffiths 2003), further exploration of web-based services for people with mental illness is warranted. This symposium will describe the needs of this patient group and outline the potential utility of a web-based psychosocial intervention.
The prevalence of bipolar disorder (BD) is at least 1%. It is the 5th most disabling condition across physical and psychiatric disorders in those aged 15–44 years (World Health Organisation WHO 2001) and accounts for 12% of suicides in Australia (Access Economics 2003). Furthermore, the WHO identifies a significant treatment gap of 50.2% (Korn et al., 2004).
Whilst pharmacotherapy has a primary role in BD treatment (Geddes et al., 2004), relapse rates remain high, even when taking mood stabilisers (Gitlin et al., 1995). Consequently, the use of psychosocial interventions, as an adjunct to pharmacological treatment, maybe useful to further reduce symptoms, relapse rates and functional impairment. We have developed a psychosocial group intervention using the Collaborative Therapy Framework (Gilbert et al., 2003) and are currently evaluating its effectiveness with a randomised controlled trial.
To embrace opportunities enabled by technological advancement, we aim to investigate the potential utility and acceptability of a web-based version of this psychosocial intervention for BD, given the already encouraging results for programs to treat depression such as MoodGYM (Christensen et al., 2004). Such an intervention would aim to provide a cost effective and accessible treatment adjunct for patients and clinicians, especially in areas with limited access to specialist services. It is hoped this will help bridge the treatment gap and harness the increasing internet use in age groups with peak onset of BD.
229
AUDITORY HALLUCINATIONS IN PSYCHOSIS: ALTERED CORTICAL CONNECTIVITY AND “RELEASE” IN NEURAL SUBSTRATES OF EPISODIC VERBAL MEMORY AND CENTRAL AUDITORY PROCESSING
Alex A Sergejew
Maroondah Hospital & MHRI & Center for Neuroscience, Howard Florey Institute, University of Melbourne, Australia
David L Copolov
Mental Health Research Institute of Victoria, Australia
Melissa Wright
Mental Health Research Institute of Victoria, Australia
Tracey Shea
Mental Health Research Institute of Victoria and Center for Neuroscience, Howard Florey Institute, University of Melbourne, Australia
Gary Egan
Center for Neuroscience, Howard Florey Institute, University of Melbourne, Australia
Our novel model of the neurobiological basis of auditory-verbal hallucinations (AHs) in psychosis conceptualises these phenomena as driven by neurological "release" in the neural substrates of episodic verbal memory. Converging fMRI and EEG evidence suggests altered effective connectivity in these substrates and those of central auditory processing, however our model makes specific trait versus state-based predictions. Effective connectivity in these circuits was quantified using EEG techniques, and compared between groups of psychotic patients with and without AHs and normal controls. As predicted, connectivity was significantly reduced in the AH group compared to clinical and normal controls. This is interpreted as predisposing these individuals to CNS “release” in these circuits. Moreover, hallucinations were observed to be associated with increased connectivity compared to non-AH states. This finding is strongly consistent with the postulated “release.” Contemporary neurocognitive models of AHs are briefly reviewed in light of these new findings.
230
EXECUTIVE FUNCTION DEFICITS IDENTIFIED IN PEOPLE AT ULTRA-HIGH RISK FOR PSYCHOSIS: A PILOT STUDY
Penny Koutsouradis
Melbourne Neuropsychiatry Centre, Australia
Stephen J Wood
Melbourne Neuropsychiatry Centre, Australia
Alison R Yung
ORYGEN Research Centre, Australia
Lisa J Philips
ORYGEN Research Centre, Australia
Shona Francey
ORYGEN Research Centre, Australia
Warrick J Brewer
ORYGEN Research Centre, Australia
Patrick D McGorry
ORYGEN Research Centre, Australia
Christos Pantelis
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Aim: To examine the changes in cognitive performance of individuals at ultra high-risk (UHR) of developing psychosis on a variety tests measuring executive functioning skills.
Background: Executive function deficits have been identified prior to the onset of psychosis. Consistent with the neurodevelopmental hypothesis, these deficits are independent of any clinical symptomatology because of their stable and trait-like quality. Recently we have shown that UHR individuals who later developed first-episode (FE) psychosis have significant deficits in rapid processing of incoming information (Brewer et al.; Am J Psychiatry, 2005).
Methodology: Sixteen UHR participants recruited from the PACE Clinic (Melbourne, Australia) were compared with 17 healthy comparisons. Participants were interviewed using a number of neuropsychological assessments both at baseline and after a 12–18 month follow-up. Seven participants (5 male, 2 female) made the transition to psychosis (UHR-P) at follow-up.
Results: A significant Diagnosis x Time interaction was found for Visual Reproduction subtest of the WMS-R (F2,19 = 4.797, p =.021). Inspection of the data revealed a decline in performance for the UHR-P group only. Further, two other measures also showed a Diagnosis × Time interaction, although this only neared significance (Trails Making Test, F (2,17) = 3.377, p =.058; Verbal Fluency, F (1,17) = 3.278, p =.088). Again, the UHR-P group showed a decline in performance. Cognitive performance for the UHR-NP participants either remained stable or improved at follow-up on the above tests. Memory and intellectual functioning were statistically non-significant for both clinical groups.
Conclusion: Impairments in cognitive functioning were apparent before the onset of psychosis. More specifically, level of information processing (speed of response pattern), organisational capabilities, retention and recall were all severely compromised. These findings suggest dysfunction of the prefrontal lobe networks.
Keywords: Biological Psychiatry, Neuropsychiatry
231
THE EPPIC MEDIUM-TERM FOLLOW-UP STUDY: NEUROPSYCHOLOGICAL CHANGE AFTER EARLY PSYCHOSIS
Casey L O’Brien
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Stephen J Wood
Melbourne Neuropsychiatry Centre, Australia
Tina M Proffitt
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Lisa P Henry
ORYGEN Research Centre, Australia
Meredith G Harris
ORYGEN Research Centre, Australia
Dennis Velakoulis
Melbourne Neuropsychiatry Centre, Australia
Patrick D McGorry
ORYGEN Research Centre, Australia
Christos Pantelis
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Evidence suggests patients with schizophrenia are impaired on a range of neurocognitive functions including memory, attention, and processing speed. Due to the lack of long-term prospective research on firstepisode psychosis patients, the course of these cognitive deficits remains unclear. This study aimed to examine the longitudinal course of cognitive functioning following the onset of first-episode psychosis. Firstepisode psychosis patients and control participants completed measures of memory (Logical Memory and Visual Reproduction from the Wechsler Memory Scale), intelligence (Arithmetic, Similarities, Block Design, Digit-Symbol, and Picture Completion from the Wechsler Adult Intelligence Scale-Revised), and visuomotor tracking (Trail Making Task).
Preliminary data (average time between assessments = 7.3 years, range = 5.3–9.9 years) revealed that overall, patients (N = 37) performed significantly poorer on all cognitive tasks relative to controls (N = 22). There was no significant change in performance over time in tasks of visual memory, arithmetic, block design, picture completion, or visuomotor tracking. A significant overall improvement was observed for logical memory and digit-symbol tasks. Further analyses revealed that improvement was greater for remitted (N = 22) compared to nonremitted (N = 11) patients (Non-remitted; mean age-scaled score at baseline = 7.20, follow-up = 7.53: Remitted; mean age-scaled score baseline = 7.18, follow-up = 9.27) for digit-symbol (repeated measures ANOVA; Time × Group interaction F[2,54] = 3.3, p = 0.04). There was also a significant overall decline in performance on similarities, however the rate of decline did not differ between remitted and non-remitted patients.
Our results showed that aspects of attention might improve after early psychosis, particularly for patients with remitted psychotic symptoms. Findings also suggest that concept formation ability declines after early psychosis, and this decline does not appear to be specific to patients with continuing psychotic illness. Finally, this study found evidence to suggest that deficits in aspects of visual memory, intelligence, and visuomotor tracking may remain stable over time.
Keywords: Biological Psychiatry, Neuropsychiatry
232
VISUOSPATIAL ASSOCIATIVE MEMORY DECLINES FOLLOWING A FIRST EPISODE OF PSYCHOSIS: DATA FROM THE EPPIC MEDIUM-TERM FOLLOW-UP STUDY
Stephen J Wood
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Tina M Proffitt
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Casey L O’Brien
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Lisa P Henry
ORYGEN Research Centre, Australia
Meredith G Harris
ORYGEN Research Centre, Australia
Patrick D McGorry
ORYGEN Research Centre, Australia
Dennis Velakoulis
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Christos Pantelis
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
One of the strongest findings in neuropsychological studies of schizophrenia is memory impairment, but the timing of this impairment is still unclear. In addition, the tools used to assess memory function have been varied and may not have assessed functions dependent on plastic brain regions. Previously, we have shown that visuospatial paired associative learning (VSPAL) is not impaired in first episode schizophreniform psychosis patients, although there were severe deficits in patients with schizophrenia of more than two years duration compared to controls. Verbal paired associative learning (VPAL) however does seem to be affected earlier in the disorder, with little difference between first episode and chronic illness.
In this study we sought to investigate longitudinal change in associative memory in first episode psychosis patients, using both a verbal (paired associate learning from the Wechsler Memory Scale) and a visual (visuospatial paired associates from the CANTAB) associative learning test. Our preliminary data from 16 patients and 13 controls (mean time between assessments = 73.4 months, range = 61.4–85.2 months) showed a significant decline in VSPAL function in the patient group (repeatedmeasures ANCOVA; Time × Group interaction F[1,24] = 10.1, p = 0.004), but no change in VPAL (repeated-measures ANCOVA; Time × Group interaction F[1,25] = 0.01, p = 0.915). Repeating these analyses after dividing the patient group into remitted (n = 8) and non-remitted patients (n = 8) showed that the decline in VSPAL function was specific to the non-remitted group (Non-remitted; mean errors at baseline = 28.5, at follow-up = 44.25: Remitted; mean errors at baseline = 17.1, at follow-up = 17.9).
These data support our previous cross-sectional study, and suggest that there are cognitive functions that decline with continued psychotic illness. It remains to be seen whether these progressive impairments are associated with structural brain changes.
Keywords: Biological Psychiatry, Neuropsychiatry
233
“WITHDRAWN”
234
UNDERSTANDING PERCEPTUAL ORGANISATION IN PSYCHOSIS
Nicole Joshua
Mental Health Research Institute of Victoria, Australia
Alison McPhee
Mental Health Research Institute of Victoria, Australia
Susan L Rossell
Mental Health Research Institute of Victoria, Australia
Perceptual abilities have not been fully investigated in schizophrenia. Several studies have indicated that schizophrenia patients show performance deficits on perceptual organisation tasks. Typically it has been suggested the visual perception processes using Gestalt principles are impaired in schizophrenia. However, there are a small number of studies which have suggested that Gestalt processing is intact in schizophrenia. The current study investigated Gestalt perception in two patient groups with psychosis. The Gestalt principles of proximity, collinearity and similarity were investigated in groups of schizophrenia patients (n = 31), bipolar disorder patients (n = 24) and healthy controls (n = 32). Participants completed an Embedded Figures Task (EFT) and a Similarity Task. For both tasks, they were required to determine whether a figure was hidden within a more complex figure. These tasks involved both top-down and bottom-up processing. Neither patient group showed impairments on these tasks. It could be argued that the results suggest that patients are able to utilise Gestalt processes and thus perform the tasks in a similar way to control participants. However, we speculate that reaching such a conclusion is premature. There are additional cognitive abilities required to perform both these tasks, for example working memory, which mask differences in Gestalt processing between patients with psychosis and controls.
Keywords: Biological Psychiatry, Neuropsychiatry
235
INSIGHT IN SCHIZOPHRENIA: THE ROLE OF THEORY OF MIND
Robyn Langdon
Macquarie Centre for Cognitive Science, Macquarie University, Australia
Tonia Corner
Macquarie Centre for Cognitive Science, Macquarie University, Australia
Jennifer McLaren
Macquarie Centre for Cognitive Science, Macquarie University, Australia
Insight in psychiatric illness can be conceived of as the capacity “to see oursels as others see us” (David, 1999). According to this account, impairment of the general capacity to appreciate other people’s mental perspectives will cause poor insight. Theory-of-mind (ToM) tasks are the classic empirical test of a general capacity to appreciate other mental perspectives. In a classic ToM task, a participant must go beyond the objective facts of a situation, as presented to him or herself, in order to demonstrate awareness that another’s behaviour will be governed by that other’s view of the situation. Against this background, we examined the relationship between insight and ToM in schizophrenia. Thirty patients and 20 healthy controls, matched on age, sex and IQ, completed three ToM tasks selected to vary the nature of the eliciting stimuli (visual vs. verbal), response mode (nonverbal vs. verbal) and instruction type. These included a picture-sequencing task, a cartoon-based humour appreciation task, and a story comprehension task. Instructions varied with respect to how direct or indirect they were. Relatively more direct instructions referred to others’ thoughts or intentions, whereas indirect instructions made no reference to others’ mental states. Insight in patients was assessed using the Kemp and David (1996) Schedule for the Assessment of Insight, Expanded (SAIE). Results indicated that patients performed more poorly than controls on all ToM tasks. However, only the two indirect tasks (picture sequencing, humour appreciation) generated performance measures that intercorrelated significantly in the patients. Furthermore, it was deficits on these two indirect tasks, rather than deficits on the more direct story comprehension task, that predicted poor insight. Findings suggest that indirect ToM tasks may tap an unprompted, perhaps implicit, monitoring of other people’s mental perspectives that is compromised in schizophrenia, leading to poor insight.
Keywords: Epidemiology, Aetiology, Other
236
FAILURE TO INHIBIT CURRENTLY IRRELEVANT MEMORIES IN INDIVIDUALS PREDISPOSED TO HALLUCINATIONS
Georgie Paulik
School of Psychology, University of Western Australia, Australia
Johanna C Badcock
The Centre for Clinical Research in Neuropsychiatry, Graylands Hospital and School of Psychiatry and Clinical Neurosciences, Australia
Murray T Maybery
School of Psychology, University of Western Australia, Australia
Purpose: Intentional inhibition deficits have been found in hallucinating patients with schizophrenia using the Inhibition of Currently Irrelevant Memories (ICIM) task. The ICIM task requires participants to identify within-run repetitions across a sequence of pictures. Since the same pictures are presented in all three runs, accurate performance on runs 2 and 3 requires the inhibition of pictures seen in previous runs. The aim of this study was to investigate whether these inhibition deficits found in hallucinating patients using the ICIM task are also found in healthy individuals with a predisposition to hallucinations.
Method: The Launay-Slade Hallucination Scale-Revised (LSHS-R) was completed by 589 undergraduate students, and groups of high (n = 26) and low (n = 25) scorers were drawn from the upper and lower deciles. The number of false alarms (FA: pictures incorrectly identified as repetitions) was used to index intentional inhibition. Reaction times were also investigated.
Results: ANCOVA and signal detection analysis revealed that the high LSHS-R group were more inclined to say ‘yes’ to having previously seen a picture in runs 2 and 3 (and thus made more FAs and fewer misses) than the low LSHS-R group. The high LSHS-R group were also slower to make a correct rejection of an item on its first presentation in a run (requiring the inhibition of previous run presentations).
Conclusion: Individuals predisposed to hallucinations show subtle, but consistent, deficits in the ability to voluntarily suppress previously relevant but currently irrelevant memories. This impairment of intentional inhibition appears to be similar, though somewhat muted, to that previously demonstrated in schizophrenia patients with auditory hallucinations.
Keywords: Epidemiology, Aetiology, Other
237
SPATIAL WORKING MEMORY AND ATTENTIONAL SET-SHIFTING AFTER THE ONSET OF PSYCHOSIS: DATA FROM THE EPPIC MEDIUM TERM FOLLOW-UP STUDY
Tina M Proffitt
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Christos Pantelis
Melbourne Neuropsychiatry Centre, University of Melbourne, Australia
Stephen J Wood
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Australia
Casey L O’Brien
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Lisa P Henry
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Meredith G Harris
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Dennis Velakoulis
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Australia
Patrick D McGorry
ORYGEN Research Centre, University of Melbourne, Australia
Working memory deficits have been consistently identified in schizophrenia, with the available evidence indicating that they are present from illness onset, and relatively static. Cross-sectional studies suggest a decline in set-shifting ability after illness onset, but further high quality, prospective longitudinal studies are needed to address the question of decline in specific cognitive domains over the course of psychotic illness.
In this study we set out to examine change over time in aspects of visuospatial memory and executive functioning in a first-episode psychosis sample. The measures used were the Spatial Working Memory, Pattern Recognition Memory, and the Intra-/Extra-Dimensional Set-Shifting tests from the CANTAB. The study cohort was first tested from 1996 to 2001, and began re-assessment in 2002. Our preliminary data from 32 patients and 20 controls (mean time between assessments = 86.4 months, range = 63.5–120.9 months) showed no significant decline in the patient group on any of Spatial Working Memory Total Between-search Errors (repeated-measures (RM) ANCOVA; Time × Group interaction F[1,48] = 0.27, p = 0.61), Spatial Working Memory Strategy (RM ANCOVA; Time × Group interaction F[1,48] = 1.21, p = 0.28), Pattern Recognition Total Correct (RM ANCOVA; Time × Group interaction F[1,38] = 0.89, p = 0.35), and Set Shifting Total Errors (RM ANCOVA; Time × Group interaction F[1,48] = 0.33, p = 0.57). Further analysis of the Set-Shifting data revealed no differences between patients and controls in the percentage passing each stage at Time 1. At Time 2 the patients were significantly more likely than controls to fail the final extra dimensional shift reversal stage (Chi-square (1) = 4.62, p = 0.031), with the finding restricted to the non-remitted group.
These data support previous studies of working memory in schizophrenia, but further suggest that subtle losses in attentional set-shifting capacity occur following a first presentation, in association with ongoing illness.
Keywords: Biological Psychiatry, Neuropsychiatry
238
MECHANISMS OF ACTION OF SSRI AUGMENTATION OF ANTIPSYCHOTIC
Henry Silver
Molecular Neuropsychiatry Unit, Shaar Menashe Brain Behavior Laboratory, Shaar Menashe MHC & Technion, Faculty of Medicine, Israel
Yael Chertkow
Eve Topf and National Parkinson Foundation Centers of Excellence for Neurodegenerative Diseases Research, Israel
Orly Weinreb
Eve Topf and National Parkinson Foundation Centers of Excellence for Neurodegenerative Diseases Research, Israel
Moussa B H Youdim
Eve Topf and National Parkinson Foundation Centers of Excellence for Neurodegenerative Diseases Research, Israel
Clinical studies have demonstrated that selective serotonin reuptake inhibitor (SSRI) augmentation of antipsychotics can ameliorate negative symptoms of schizophrenia. We investigated the molecular mechanisms underlying this effect and tested the hypothesis that combining SSRI with antipsychotic produces chronic net effects unique to the combination and different from each drug alone.
Rats were allocated to five groups and received a daily intraperitoneal injection with one of the following: haloperidol (1 mg/kg), fluvoxamine (11 mg/kg), clozapine (11 mg/kg), haloperidol (1 mg/kg) plus fluvoxamine (11 mg/kg), or vehicle for 30 days.
The groups were compared on patterns of gene activations, protein expression and dopamine and serotonin metabolism parameters in the brain and on exploratory behavior.
The combined treatment resulted in unique changes in mRNA and protein expression in GABA system elements (glutamic acid decarboxylase (GAD67) and protein kinase Cb (PKCb) in the frontal cortex, parameters of DA and serotonin metabolism in some brain regions and in exploratory behavior. Some of the unique effects were similar to those following clozapine treatment. Brain concentrations of haloperidol and fluvoxamine were similar whether given alone or in combination. The findings support the hypothesis that augmentation treatment results in pharmacodynamic interactions with net effects different from the individual drugs. These unique effects may have relevance to the mechanism underlying the beneficial effect of SSRI augmentation in schizophrenia, particularly on negative symptoms.
239
HOW IMPORTANT IS WORK ENVIRONMENT IN UNDERSTANDING THE ASSOCIATION BETWEEN DEPRESSION/ANXIETY AND LOST PRODUCTIVITY?
Kristy Sanderson
Public Health, Queensland University of Technology, Australia
Elizabeth Tilse
Queensland University of Technology, Australia
Brian Oldenburg
Queensland University of Technology, Australia
Jan Nicholson
Queensland University of Technology, Australia
Nick Graves
Queensland University of Technology, Australia
Purpose: Numerous studies have demonstrated an association of depression and (to a lesser extent) anxiety with lost productivity/work disability, but less is known about the nature of this association. This study applies an environmental model of disability to investigate the role of work-related environmental factors in the association between depression and anxiety and lost productivity.
Methods: 436 call centre employees from 10 organisations completed a self-report survey assessing current DSM-IV depressive and anxiety symptoms (Patient Health Questionnaire), work disability (absent days, presenteeism–days at work ill, Work Limitations Questionnaire), and psychosocial work environment (Effort-Reward Imbalance, Organisational Justice). Six-month follow-up surveys have been collected and 12-month follow-up is underway.
Results: Lost productivity was common in this sample of call centre employees, with half absent at least one day in the prior month, half coming in to work while unwell on at least one day, and limitations in various work abilities for around 15% of the time. Ten percent reported a depressive or anxiety condition: probable major or minor depression, panic symptoms, or generalized anxiety symptoms. Persons with de-pression/anxiety (versus not) were more than twice as likely to report absenteeism and four times as likely to attend work while unwell, and were limited in work ability for 20% of the time. After adjusting for work-related environmental factors, these parameters were reduced by around 10% and 16% for absenteeism and presenteeism, respectively. These findings will be discussed in the light of preliminary data from the 6-month follow-up surveys.
Conclusions: Work-related environmental factors are a non-trivial correlate of work disability. Clinical interventions to reduce the impact of mental disorders in the workplace may need to be supplemented with public health interventions targeting psychosocial aspects of the workplace.
Keywords: Work and Voc Rehab, Social Psychiatry
240
A FIRST ANALYSIS OF CLINICAL VARIABLES AMONG PARTICIPANTS IN THE WORC PROJECT
Judith Sheridan
Queensland Centre for Mental Health Research (QCMHR), Australia
David C Chant
Queensland Centre for Mental Health Research (QCMHR), Australia
Alice Morgan
Queensland Centre for Mental Health Research (QCMHR), Australia
Michael F Hilton
Queensland Centre for Mental Health Research (QCMHR), Australia
Harvey Whiteford
Queensland Centre for Mental Health Research (QCMHR), University of Queensland, Australia
Introduction: The Work Outcomes Research Cost-Benefit (WORC) Project is a prospective Australia wide study evaluating the cost effectiveness of facilitating an increase in help seeking behaviour among employed people reporting depressive symptoms. People, who screened positive on the QIDS, are phoned by a psychologist. This interaction includes feedback and discussion of assessment results, barriers to appropriate help seeking and encouragement to contact a health professional. These participants are randomized into two groups; a single contact group who receive no further contact and a multiple contact group.
Method: The WORC Project has invited 342,000 employees to answer a General Health Questionnaire (GHQ), the Kessler 6 (K6) and the World Health Organisation Work Performance Questions (HPQ). Employees who screen positive for symptoms of depression on the K6 are further screened using the Quick Inventory of Depressive Symptoms (QIDS). People, who screened positive on the QIDS, are phoned by a psychologist and are randomized into either a single intervention or multiple contact groups. The QIDS is readministered at 6 weeks, 3, 6, 12 and 18 months from this call.
Results: Both groups of individuals classified as having depressive symptoms at baseline demonstrated reduced levels of depression at 6 weeks post baseline and following a single intervention from a psychologist, regardless of whether they had sought treatment. The group receiving multiple contacts, however, showed slightly more improvement in depressive symptoms than those who received only one contact. Differences between these groups will be presented, and discussed.
Conclusion: Help-seeking behaviour can be facilitated by addressing both lack of knowledge and obstructive beliefs about depression and its treatment. However, a single intervention results in a measurable decrease in depressive symptoms reported by participants regardless of whether they have accessed treatment or not.
Keywords: Work and Voc Rehab, Social Psychiatry
241
VOCATIONAL INTERVENTIONS IN FIRST-EPISODE PSYCHOSIS
Eoin J Killackey
Department of Psychology, The University of Melbourne & ORYGEN Research Centre, Australia
Henry J Jackson
Department of Psychology, The University of Melbourne, Australia
Patrick D McGorry
ORYGEN Research Centre, Australia
John Gleeson
Department of Psychology, The University of Melbourne, Australia
Gina Chinnery
ORYGEN Research Centre, Australia
Hok-Pan Yuen
ORYGEN Research Centre, Australia
Purpose: The purpose of this presentation is to highlight the need for vocational recovery in first episode psychosis.
Method: There is an increasing awareness that treatment of mental illness must encompass functional as well as symptomatic recovery. Vocational functioning is affected by the onset of mental illness at any life stage. However, this is particularly so when onset occurs in young people who are still to complete their vocational and educational development. The sequelae of an onset thus timed can include long-term unemployment, dependence on welfare payments, lack of independence and lack of engagement with society among many others. Studies consistently show an unemployment rate among those with schizophrenia of between 80% and 90%. Studies of first-episode groups show that there are unemployment rates between 30% and 60% in these populations.
Results: Developments in the area of vocational rehabilitation over the last decade have seen significant evidence garnered in support of an intervention called Supported Employment (SE). Typically this has been conducted with chronically unwell populations. The one published study using this approach with first episode clients reported very positive results. This presentation will present data from previous studies conducted at ORYGEN Research Centre that show our clients have levels of unemployment consistent with that of other first episode groups. Secondly it will discuss new research at ORYGEN Research Centre, now in a pilot phase, which is seeking to implement and evaluate a Supported Employment model with our clients. There have been some modifications made to the model in order to address the developmental needs of our population and these too will be discussed.
Conclusion: This presentation will make the case for Supported Employment as a vocational intervention for young people with first episode psychosis and outline a research project seeking to evaluate such an intervention.
Keywords: Work and Voc Rehab, Social Psychiatry
242
A PERSONAL ACCOUNT OF THE IMPORTANCE, CHALLENGES, AND BENEFITS OF EMPLOYMENT TO A PERSON WITH A PSYCHIATRIC DISORDER
Fay E Jackson
Open Minds Consultancy, Australia
Purpose: Clinicians, vocational rehabilitation specialists, and researchers often assume that they are working in the best interests of people with psychiatric disorders. However, personal accounts by individuals most affected are frequently omitted from meetings where employment and health service issues are discussed.
Method: The author and presenter, Fay Jackson, has extensive experience advocating for ‘psychologically diverse citizens’ and is herself a consumer of mental health and employment services. In this presentation Fay will share her personal perspective on the problem of helping people with severe mental illness to become established in the workplace.
Results and conclusions: The presentation will reveal her personal account of the importance of employment and having a career, and how for her, it all began with an informed employer and supervisor providing appropriate assistance to support rather than hinder her continuing employment. Fay discusses her personal, social, and clinical benefits of employment. She also provides a strong message of hope for others by outlining specific challenges and how these were overcome by creative and collaborative approaches to workplace accommodations. In this way she was able to accommodate fluctuating and idiosyncratic employment restrictions, to develop a very satisfying career in a management level position.
302
DEPRESSION AND WORK IMPAIRMENT: CAN ENHANCED TREATMENT BE COST-BENEFICIAL?
Philip Wang
Harvard Medical School, United States
Despite enormous associated economic burdens, few with depression receive adequate treatment. Interventions employing outreach and bestpractices treatment for depression have proven to be effective at reducing depression symptom severity and in some cases work impairments as well. However, there has been very little adoption of these enhanced depression treatment programs. Ongoing research initiatives, such as the Harvard/NIMH Work Outcomes Research and Cost-Effectiveness Study (WORCS) are seeking ways to address these barriers to uptake of enhanced depression treatment programs, thereby alleviating the enormous economic burdens from depression. This lecture will cover the rationale for the WORCS study and some preliminary results.
304
THE ECONOMIC BURDEN OF MENTAL HEALTH CONDITIONS IN THE WORKPLACE
Philip Wang
Harvard Medical School, United States
This presentation will briefly cover what is known concerning the enormous economic burdens from depression. Interest in the costs of illness, not only direct treatment costs, but the human costs as well, has increased dramatically as part of the larger movement to rationalize treatment resource allocation and maximize benefits in relation to costs. Much of the current interest in depression among health policy makers is based on the fact that depression has consistently been found to be among the most costly health problems in the world. As reviewed here, a number of factors account for these results that have important implications for the design of treatment programs for mood disorders.
305
THE WORK OUTCOMES RESEARCH COST-BENEFIT (WORC) PROJECT: THE RETURN ON INVESTMENT FOR FACILITATING HELP SEEKING BEHAVIOUR
Harvey A Whiteford
Queensland Centre for Mental Health Research (QCMHR), University of Queensland, Australia
Judith Sheridan
Queensland Centre for Mental Health Research (QCMHR), Australia
Catherine M Cleary
Queensland Centre for Mental Health Research (QCMHR), Australia
Michael F Hilton
Queensland Centre for Mental Health Research (QCMHR), Australia
Purpose: The WORC Project is an ongoing prospective Australia wide study evaluating the cost effectiveness of facilitating help seeking behaviour among employed people with symptoms of depression.
Methods: The WORC Project has screened 85,000 employees for depressive symptoms using the Kessler 6 (K6) and assessed their work performance (presenteeism) and absenteeism rates using the World Health organisation Performance at Work Questionnaire. Those positive for depressive symptoms are further screened using the Quick Inventory of Depressive Symptomatology (QIDS-SR). Employees with depressive symptoms on both surveys are telephoned phoned by a psychologist who provides a single counselling session, facilitates help seeking behaviour and mails the respondents information. Participants with depressive symptoms are tracked over the next 18-months to assess symptomatology and work performance.
Results: 6.7% of full-time employees screen positive for depressive symptoms on the K6. Sixty-five percent of these have not sought advice from a MHP in the last 12-months. Current data show that employees at high risk of depression on the K6 have an annual productivity decrement of $12,700 as compared to non-depressive symptoms decrement of $3,030 (P < 0.0001). Data also suggests that there is an average depression treatment effect increasing mean productivity by $7,800.
Conclusions: The prevalence of depression in employed people is higher than indicated in the 1997 and 2001 ABS surveys. Most individuals with current depression symptomatology do not seek treatment. Untreated depression results in a significant and substantial decrement in employee productivity. This productivity decrement can be reversed with appropriate treatments. The model of early identification of depression symptoms and encouragement to seek treatment is a cost effective method to increase employee mental well-being.
306
WORK-RELATED PSYCHOLOGICAL INJURIES
Peter Cotton
Health Services Australia, Australia
The incidence and profile of work-related ‘psychological injuries’ is not co-extensive with the incidence and profile of mental health disorders in occupational settings. Whilst there is evidently some overlap, the causal drivers are frequently different and the health outcomes for psychological injuries are generally worse than for non-compensable mental health disorders. This paper will provide an overview of the organisational health framework-an evidence-based approach that has underpinned a range of cross sectional and longitudinal studies examining the causes and consequences of work-related psychological injuries, conducted across a range of Australian industry sectors. Key findings will be summarised as well as the application of the organisational health approach in workplace prevention and early intervention programs.
309
MENTAL HEALTH FIRST AID TRAINING IN THE WORKPLACE
Betty A Kitchener
ORYGEN Research Centre, University of Melbourne, Australia
Anthony F Jorm
ORYGEN Research Centre, University of Melbourne, Australia
Purpose: Mental Health First Aid is a 12-hour training course for members of the public in how to provide assistance to someone with a mental health problem or in a mental health crisis situation. This talk will consist of two parts. The first gives a description of the content of the course and its dissemination nationally and internationally. The second will present the results of a randomized controlled trial carried out in a workplace setting.
Methods: In the trial, 301 participants from two workplaces were randomized to either participate immediately or to be wait-listed for 5 months. Questionnaires were given at baseline and at 5-month followup to evaluate outcomes.
Results: The trial found a number of benefits of the training, including greater confidence in providing help to others, greater likelihood of advising people to seek professional help, improved concordance with health professionals about treatments, and decreased stigmatizing attitudes. An additional unexpected benefit was an improvement in the mental health of the participants themselves.
Conclusions: Mental Health First Aid training in a workplace settings increases support provided to others and also improves the mental health of trainees.
310
IT’S OUR PROBLEM? - MANAGING DEPRESSION IN THE WORKPLACE
Nicole Highet
Beyondblue, Australia
Half a million full work days are lost every month and workers cut down their activity on another one million days in one month due to depression. Depression will touch everyone-including employers-either directly or indirectly in today’s world. Depression currently represents a major social and economic challenge, particularly in today’s workplace. Many employers realise the importance of staff retention and motivation in creating a harmonious work environment, but in today’s climate it is also important to monitor the mental health well being of staff. Lack of awareness and understanding about depression and related disorders in the workplace can result in prolonged absenteeism, reduced productivity, with additional implications for health and safety.
In response to this important issue, beyondblue; the national depression initiative has developed and extensively evaluated a workplace-based program. This presentation will highlight the key features of this program, and demonstrate its impact on increasing awareness and understanding, and importantly changing attitudes and improving managers and colleagues to ensure effective and efficient management of depression in a workplace environment.
311
IMPLEMENTING MENTAL HEALTH STRATEGIES IN SHELL AUSTRALIA: THE TRANSITION FROM DATA COLLECTION TO ORGANISATIONAL STRATEGY
Teri Lillington
Shell in Australia, Australia
Occupational Health and Safety and Rehabilitation and Compensation Law in Australia places the onus on companies to maintain safe systems of work for their employees, to protect their physical and mental health. Furthermore, the human cost of work-related distress is of considerable concern to employers as well as the financial cost of known mental health claims and the suspected cost of hidden mental distress in employees. Thus, substantial drivers are present for companies to pro-actively manage mental health. This paper discusses the methods used by Shell Australia to gather data related on mental health well being in the company. The conversion of mental health information into a feasible and equitable organisational strategy, along with the role of quantification of health and economic outcomes in response to mental health strategies, will be discussed.
312
HOW WORK-RELATED SUBJECTIVE EXPERIENCES AND WORK-RELATED SELF-EFFICACY FACILITATE CAREER LEARNING AMONG PEOPLE WITH SEVERE MENTAL ILLNESS
Geoffrey RM Waghorn
Queensland Centre for Mental Health Research (QCMHR) and The University of Queensland, Australia
David C Chant
Queensland Centre for Mental Health Research (QCMHR), Australia
Robert King
The University of Queensland, Australia
Purpose: Subjective experiences perceived to impact on employment, and self-efficacy for core employment activities, were investigated as alternative sources to diagnostic information for use in psychiatric vocational rehabilitation. The aim was to investigate the relationships among work-related subjective experiences, work-related self-efficacy, and vocational status after controlling for the influences of other known demographic and clinical correlates.
Methods: A measure of subjective experiences perceived to impact on employment was developed in two pilot studies. This, and a second measure of work-related self-efficacy, were then used in a 12 month longitudinal study of urban residents with schizophrenia or schizoaffective disorder. Work-related self-efficacy consisted of self-efficacy for 37 specific core activities required in vocational rehabilitation and employment. Baseline measures (n1 = 104) were repeated at 6 months (n2 = 94) and 12 months (n3 = 94).
Results: All three measures had adequate preliminary psychometric properties and promising utility. Work-related subjective experiences and work-related self-efficacy were consistently associated with current employment after controlling for known employment correlates. Workrelated self-efficacy appeared to mediate the relationship between workrelated subjective experiences and vocational status.
Conclusions: Work-related subjective experiences and work-related self-efficacy have promising practical and theoretical implications in psychiatric vocational rehabilitation. These measures reveal much about a person’s potential need for assistance which might otherwise go unnoticed. The use of these measures appears to facilitate career learning, and may help prevent disruption of important education and employment activities.
314
WHAT IS THE VALUE OF TREATING SCHIZOPHRENIA?
Vaughan J Carr
Centre for Mental Health Studies, University of Newcastle and NISAD, Australia
Terry J Lewin
Centre for Mental Health Studies, Hunter New England Health, and NISAD, Australia
Amanda L Neil
Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Australia
The cost of treating an individual with schizophrenia is many times that of treating someone with depression or an anxiety disorder, and with either current or optimal treatment the cost-effectiveness of treating schizophrenia is far inferior to that of treating depression or anxiety disorders. On purely cost-effectiveness grounds this suggests that the treatment of schizophrenia is not a ‘best buy’. However, conventional cost-effectiveness analysis does not take into account societal preferences for resource distribution to the more severely ill, differences in potential for health gain or society’s aversion to inequalities in health. When such principles are used to determine the societal value of health states, and these are translated into equity weights, a different picture emerges. We applied such equity weights to the data on current and optimal treatment for schizophrenia, depression and anxiety disorders published by Andrews and colleagues, to estimate the societal value of treating these disorders. The estimates reveal that treating a case of schizophrenia is equivalent in societal value to treating approximately 30 cases of depression or 50 cases of anxiety disorder. Furthermore, if cost efficiencies are calculated in terms of S-QALYs (i.e., adjusted for societal value), current and optimal treatment for schizophrenia is broadly equivalent in efficiency to treatment of depression and anxiety disorders. The methods and limitations of this re-evaluation of cost-effectiveness data will be presented and the policy implications discussed.
Keywords: Work and Voc Rehab, Social Psychiatry
315
THE EFFECTIVENESS OF EARLY PSYCHOSIS INTERVENTION: PRELIMINARY RESULTS FROM A MULTI-SITE PROSPECTIVE EVALUATION
Aaron DJ Frost
Royal Brisbane and Women’s Hospital, Australia
Stanley V Catts
University of Queensland, Royal Brisbane and Women’s Hospital, Australia
Vaughan Carr
Newcastle University, Australia
Brian O’Toole
Concord Hospital, Australia
Amanda Neil
Newcastle University, Australia
Terry Lewin
Hunter New England Mental Health Service, Australia
Meredith Harris
ORYGEN Youth Health Service, Australia
Purpose: To identify specific elements of treatment associated with improved outcome in early psychosis patients. The investigators responded to an expression of interest from the NHMRC to develop routine evaluation methods examining the effectiveness of Early Psychosis Intervention.
Method: Routine treatment interventions were recorded in multiple mental health services over a six month period. Interventions were then related to patient outcomes to determine the most effective components of early psychosis intervention. Services substituted standard progress notes with project designed service contact forms which enabled treatment interventions to be routinely recorded. These forms were used in the charts of all early psychosis patients in nine participating services from Victoria, Queensland, and New South Wales. Treatment interventions were then related to routine outcome measures, including the HoNOS and LSP, to determine the most effective treatment components.
Results: Preliminary analyses on the first 100 charts revealed significant improvements over the first 6 months of treatment (F = 10.57 (2), p < 0.01). Further results will be presented outlining the pattern of specific treatment characteristics most strongly predictive of this improvement.
Conclusions: The project demonstrates that treatment interventions can be measured routinely in services, thereby enabling identification of effective components of mental health care. Importantly, these data show that routine outcomes measures are sufficiently sensitive to change to be used in effectiveness evaluation. Furthermore, the complete dataset from the current project will identify specific treatment aspects that result in improved outcome for patients with early psychosis.
Keywords: Work and Voc Rehab, Social Psychiatry
316
PERFORMANCE CHARACTERISTICS OF THE NHMRC CLINICAL PRACTICE IMPROVEMENT NETWORK (CPIN) EARLY PSYCHOSISIINDICATOR
Russell W Evans
University of Queensland, Australia
Brian O’Toole
Concord Hospital, Australia
Aaron DJ Frost
Royal Brisbane and Women’s Hospital, Australia
Vaughan Carr
Newcastle University, Australia
Stanley V Catts
University of Queensland, Royal Brisbane and Women’s Hospital, Australia
Terry Lewin
Hunter New England Mental Health Service, Australia
Amanda Neil
Newcastle University, Australia
Meredith Harris
ORYGEN Youth Health, Australia
Purpose: In order to routinely evaluate the effectiveness of early psychosis intervention, it is first necessary to consistently flag patients early in their illness. Previous attempts to routinely flag early psychosis patients in Australia have been unable to produce data that is consistent across sites or comparable to the WHO benchmark. The World Health Organization has published data suggesting that the prevalence of first presentation psychosis should range between 15 and 24 per 100,000 of population per year in developed countries.
Method: Staff in nine mental health services were trained in the use of a simple decision tree to flag patients who were in the early stages of treatment. An early psychosis patient was a person who had received their first diagnosis of an Axis I disorder with psychotic symptoms within the previous 12 months or had experienced prodromal symptoms during the last 12 months.
Results: Across the eight participating services, the flagging rates for early psychosis patients were between 7.17 and 31.6 per 100,000 of population per year.
Conclusions: The Clinical Practice Improvement Network for Early Psychosis (C-PINEP) has developed criteria for flagging early psychosis patients that can be routinely used by clinicians. The method is a considerable improvement over existing methods in terms of ease, consistency, and comparability with the WHO benchmark. The Early Psychosis Indicator developed by C-PINEP requires further validation but could potentially be used as a standardised method of flagging early psychosis patients for in future research and service evaluation projects.
Keywords: Work and Voc Rehab, Social Psychiatry
317
PREDICTING DURATION OF UNTREATED PSYCHOSIS (DUP): PATIENT CHARACTERISTICS ASSOCIATED WITH DELAY IN TREATMENT
Belinda R Schaefer
University of Queensland, Australia
Renee Sichter
Bond University, Australia
Stanley V Catts
University of Queensland, Royal Brisbane and Women’s Hospital, Australia
Aaron DJ Frost
Royal Brisbane and Women’s Hospital, Australia
Purpose: The current research examines whether individual patient characteristics are able to reliably predict Duration of Untreated Psychosis (DUP). DUP research to date has focused at community levels rather than at patient levels with mixed results. Identification of specific patient characteristics may enable community based interventions to more intensively target individuals with these characteristics to ensure a more expedited pathway to care.
Method: This research was conducted using a chart audit methodology. Nine mental health services from around Australia participated by introducing a number of routine indicators into their clinical records. The first 100 charts were audited and individual patient characteristics were used as predictor variables in a regression equation predicting DUP.
Results: Significant predictions of DUP were able to be made accounting for approximately 27% of unique variance (F = 2.05, p < 0.05). The variables that contributed most to this prediction were family dysfunction, and patient aggression. While substance use appeared to relate to increased DUP based on inspection of correlations, the variance accounted for substance use was subsumed by these other variables.
Conclusions: This is a strong prediction model for this important variable. These results suggest that individual characteristics of the patient do contribute substantially toward how long it takes them to receive diagnosis and treatment. This raises the hope that perhaps programs aiming to reduce DUP at a community level, could focus their attentions on a more clearly defined group.
Keywords: Work and Voc Rehab, Social Psychiatry
318
THE USE OF SELECTIVE ESTROGEN RECEPTOR MODULATORS IN THE TREATMENT OF SCHIZOPHRENIA-A PILOT STUDY
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Suzette Sheppard
Alfred Psychiatry Research Centre, Australia
Jacqueline Wallace
Alfred Psychiatry Research Centre, Australia
Kathryn Garland
Alfred Psychiatry Research Centre, Australia
Anthony de Castella
Alfred Psychiatry Research Centre, Australia
Paul Fitzgerald
Alfred Psychiatry Research Centre, Deputy Director, Australia
Simon Stafrace
Caulfield General Medical Centre, Australia
Susan Davis
Jean Hailes Foundation, Australia
Background: Estrogen modulates rat brain dopamine and serotonin systems in a way that mimics atypical antipsychotic drugs. Following on from our work indicating that adjunctive estrogen can be a useful treatment in women of child-bearing age with schizophrenia, we are studying the use of a selective estrogen receptor modulator (SERM) in post-menopausal women with schizophrenia.
Aim: 1: To test and compare the effects of adjunctive use of a SERM (raloxifene) and standard hormone therapy (HT) on psychotic symptoms in post-menopausal women with schizophrenia. 2: To examine the effect of a SERM and HT on cognition in post-menopausal women with schizophrenia.
Method: A double blind 3-month placebo controlled adjunctive study of raloxifene (60 mg/day) versus HT (2 mg estradiol plus 10 mg dihydroprogesterone) versus placebo. All participants received standardised doses of olanzapine (or equivalent doses of similar atypical antipsychotics). Psychopathology was measured fortnightly using the PANSS rating scale. A cognitive test battery was administered monthly and sex hormone assays were conducted on four occasions across the 12 week study period.
Results: Preliminary data from 17 patients indicated that while the SERM or HT adjuncts did not result in an improvement in psychotic symptoms when compared to olanzapine alone, the use of adjunctive SERM resulted in improved cognitive performance on working and verbal memory tasks when compared to either the HT or olanzapine alone.
Conclusion: The use of adjunctive SERM at a dosage of 60 mg/day may induce a mild increase in cognitive performance in post-menopausal women with schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
319
DOES ATYPICAL ANTIPSYCHOTICS IMPROVE QUALITY OF LIFE OF SCHIZOPHRENIC PATIENTS IN REHABILITATION?
In-Won Chung
Department of Neuropsychiatry, Dongguk University International Hospital, Gyeonggi, Korea
Tongwoo Suh
The Korean Institute of Health and Social Affairs, Seoul, Korea
Jung-Woo Son
Department of Neuropsychiatry, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea
Objective: The purpose of this study was to demonstrate the association between the type of antipsychotic drug administered and the quality of life of schizophrenic patients attending rehabilitation programs in a community setting.
Methods: The sociodemographic and clinical information for individual patients attending rehabilitation programs in 16 mental health centers were gathered from questionnaires self-reported by patients and interviewed the patients by mental health center workers. The schizophrenic patients included in this study were categorized into two groups, depending on whether the drug they were prescribed was a conventional or atypical antipsychotic drug. The patients were selected by 1:1 matching for sex and age from two groups in order to explore the association of antipsychotics and quality of life (QoL) assessing with Quality of Life Scale (QLS). And confounding effects by some other sociodemographic factors which might directly influence the selection of antipsychotics and QoL were excluded by 1:1 matching for the variables.
Results: Out of 301 schizophrenic patients, a total of 226 individuals in 113 pairs comprising one person in each group were analyzed to identify the difference between two groups. The QoL of the patients treated with atypical antipsychotics was found to be higher than that of those treated with conventional antipsychotics, even after the results were adjusted for sex, age and sociodemographic variables such as insurance, education, family income per capita and psychiatric institution.
Conclusions: This result constitutes meaningful evidence that atypical antipsychotics provide a higher QoL than conventional antipsychotics among schizophrenic patients who are attending rehabilitation programs in mental health centers.
320
QUETIAPINE IN EARLY PSYCHOSIS: AN ACUTE INPATIENT AND COMMUNITY FOLLOW-UP EFFECTIVENESS STUDY
Stanley V Catts
University of Queensland, Royal Brisbane and Women’s Hospital, Australia
Aaron DJ Frost
Royal Brisbane and Women’s Hospital, Australia
Gifford P Shaune
Royal Brisbane and Women’s Hospital, Australia
James Scott
Mater Child & Youth Inpatient Unit, Australia
Purpose: To evaluate the effectiveness of quetiapine in the treatment of first episode psychosis in adolescents and adults in a 26-week openlabel trial.
Methods: Patients were recruited from consecutive acute psychiatric admissions. After consent quetiapine was increased to 750 mg. Baseline, 2, 4, 12, 16, 20, and 26 week measurement included: PANSS, BPRS, CGI, AIMS, Simpson-Angus Scale, Barnes Akathisia Scale, a sideeffect checklist, HR, BP, ECG, weight, eye exam, and haematology. Change was assessed with repeated measures ANOVA.
Results: Of 73 first admission patients with psychosis, 15 entered the study. All patients were retained for 4-weeks (ITT Analysis); 9 completed the 26-week protocol (Completers Analysis). Non-completers dropped out shortly after 4-weeks, 5 due to non-response and 1 due to non-compliance. In the ITT Analysis, there was significant improvement on Total PANSS (p <.05), PANSS Positive (p <.05), and BPRS and CGI (p <.01). In the Completers Analysis, onset of significant PANSS Negative score reduction occurred at 12-weeks. By 26-weeks all efficacy measures had substantially reduced; and, substance abuse was markedly less prevalent (p =.02). Adverse events were postural hypotension (worsened by co-use of risperidone) and drowsiness in the first 4 weeks of treatment, and significant weight gain, drowsiness and weakness (p <.05) over 26-weeks. No change in the 2-week Total BPRS score predicted subsequent non-response to quetiapine. Patients remained in hospital 24 +20 days after starting quetiapine.
Conclusions: Quetiapine is an effective well tolerated first line treatment in young early psychosis patients. Non-response was predictable by day 14 of treatment. Onset of acute response to quetiapine seemed slow and alternative dosage strategies or brief (14-day) augmentation with 2 mg haloperidol should be investigated in an acute inpatient study using retrospective consent.
Keywords: Biological Psychiatry, Neuropsychiatry
321
REMEDIATION OF POOR EMOTION PROCESSING IN SCHIZOPHRENIA
Tamara A Russell
Macquarie Centre for Cognitive Sciences, Macquarie University, Australia
Melissa Green
Macquarie Centre for Cognitive Sciences, Macquarie University, Australia
Mary L Phillips
Institute of Psychiatry, Kings College London, United Kingdom
Max Coltheart
Macquarie Centre for Cognitive Sciences, Macquarie University, Australia
Deficits in social functioning are a hallmark of schizophrenia. One aspect which has recently received much empirical attention is emotion processing; specifically facial emotion processing. Difficulties with this social skill are of particular importance as they impact on both the day-to-day functioning of the client and their quality of life. The aim of the present work was to determine the feasibility of an intensive, computer-based intervention for emotion recognition in schizophrenia. Two studies are reported, the first examines the performance of 20 stable, medicated, out-patients with schizophrenia compared to 20 healthy control participants on two tasks assessing emotion recognition (emotion labelling and emotion matching), before and after a visual/attention remediation package was administered. Accuracy on the two tasks was determined at baseline followed immediately by the computer intervention (Ekman’s Micro Expression Training Tool) and a post-test assessment. Patients with schizophrenia not only improved with training on both tasks but additionally were no longer significantly different from pre-trained healthy controls. The second study uses visual scan path technology to determine visual attention to facial emotional stimuli before and after training. Preliminary results are reported for N = 10 patients with schizophrenia and N = 10 healthy controls. Using a short computer-based intervention it is possible to improve the ability of patients with schizophrenia to decode facial expressions of emotion. Visual scan path methods can complement this training by showing the process by which improvements are made.
322
COGNITIVE REMEDIATION IN SCHIZOPHRENIA
Daniella Toscano
The University of Sydney, Australia
Anthony WF Harris
Discipline of Psychological Medicine, The University of Sydney, Australia
Antoinette Redoblado-Hodge
Brain Dynamics Centre, Westmead Hospital, Australia
Pam Rogers
Department of Child and Adolescent Psychiatry, Westmead Hospital, Australia
John Brennan
Prevention Early Intervention and Recovery Service, SWAHS, Australia
Alan Rosen
Discipline of Psychological Medicine, The University of Sydney, Australia
Christopher Tennant
Discipline of Psychological Medicine, The University of Sydney, Australia
Cognitive deficits are a significant problem for people with schizophrenia, predicting long term function more accurately than symptom profile. Despite this they have not formed a focus of therapy until relatively recently. Meta-analyses of pharmacological treatments for cognitive deficits suggest that only modest improvements are obtainable using medication. This study describes results from a multicentre randomised waitlist controlled trial of computer assisted cognitive remediation in 50 subjects with schizophrenia. Subjects after randomisation to either a waitlist control or immediate treatment were given from 20–30 sessions of computer assisted cognitive remediation. Treatment was scheduled twice a week. Follow-up continued for a further 15 weeks. At end of treatment significant improvements were found in executive functioning, speed of processing, and attention. These results suggest that cognitive deficits are remediable using psychological therapies over and above the effect found with pharmacological treatments.
Keywords: Biological Psychiatry, Neuropsychiatry
323
A RANDOMISED CONTROLLED TRIAL OF CBT FOR EARLY PSYCHOSIS WITH 1 YEAR FOLLOW-UP
Henry J Jackson
University of Melbourne and ORYGEN, Australia
Eoin Killackey
Department of Psychology, The University of Melbourne & ORYGEN Research Centre, Australia
Sarah Bendall
University of Melbourne and ORYGEN, Australia
Kelly Allott
University of Melbourne and ORYGEN, Australia
Paul Dudgeon
University of Melbourne, Australia
Susy Harrigan
University of Melbourne and ORYGEN, Australia
John Gleeson
University of Melbourne, Australia
Patrick D McGorry
ORYGEN Research Centre, University of Melbourne, Australia
Aim: The aim of this study was to compare Active Cognitive Therapy for Early Psychosis (ACE) against Befriending in the early phase of illness. The prediction was that ACE would accelerate symptom improvement and quality of life in the acute phase more than Befriending and these gains would be maintained at 1-year follow-up.
Method: 62 patients who were registered with the ORYGEN service were randomly assigned to either of the two conditions and either of two therapists. Patients were assessed on a range of symptom and adjustment/functioning domains at pretreatment, at mid-treatment (5– 6 weeks), at the end of treatment (12–14 weeks), and then at 1-year following the end of treatment. Patients were seen for up to 20 sessions over 14 weeks. The two therapists provided treatment in two conditions and therapy was manualised and fidelity checks made by an independent person.
Results: As previously presented, the two groups showed differences at the mid-treatment point-some of which were statistically significant (p <.05) but all were in the moderate to large effect range (.5–.7). However, there was a catch-up effect at the end of treatment which reduced differences to non-significance. Small effect sizes still favoured ACE (.2–.3). Both groups continued to improve. At 1-year follow-up the two groups did not differ although they both continued to evince sustained improvements on the majority of measures.
Conclusion: Although the sample size is small, the study was conducted within one site and is superior to the SOCRATES trial which drew on patients from multiple mental health sites. This is because there was greater control over background factors. The trial shows the benefit of ACE in accelerating remission in the acute phase although it raises the question about whether discrete CBT approaches are best employed for those patients who relapse, evince poor outcomes, or are medication treatment resistant.
Keywords: Biological Psychiatry, Neuropsychiatry
324
VISUAL HALLUCINATIONS IN DEMENTIA
Lisa Azizi
Clinical Psychology Unit, School of Psychology, The University of Sydney, Australia
Diana Caine
Clinical Psychology Unit, School of Psychology, The University of Sydney, Australia
Nicholas Cordato
Department of Geriatric Medicine, Westmead Hospital, Australia
Visual hallucinations are a distressing but poorly understood symptom experienced by some patients with dementia. It has been argued that visual hallucinations may be correlated either with fronto-parietal or temporal brain regions subserving visuospatial/visuo-attentional or semantic abilities respectively. Using an experimental factorial design, this study aimed to characterize visual hallucinations in dementia and to identify the neuropsychological profile associated with them. The study involved a questionnaire regarding the visual qualities, content and frequency of hallucinations, and a battery of standardised neuropsychological tests investigating the cognitive domains to which the experience of visual hallucinations has been putatively attributed. 13 dementia patients with visual hallucinations, 10 dementia patients without the hallucinations and 15 normal elderly controls participated. The research design, comprising both group comparisons and case series analyses, provided the opportunity to explore and compare the characteristics and neuropsychological correlates of visual hallucinations, between and within participant groups. This research lends insight into the cognitive deficits and therefore brain regions that give rise to visual hallucinations; it has the potential to contribute to better diagnosis of dementia; and by improving understanding it can ultimately aid in the management of a symptom that can be distressing to both patients and their carers.
Keywords: Biological Psychiatry, Neuropsychiatry
325
RECENT ADVANCES IN THE BIOPSYCHOSOCIAL TREATMENT AND PREVENTION OF COGNITIVE IMPAIRMENT AND DEMENTIA
David Burke
St Vincent’s Hospital, Sydney, Australia
Ian Hickie
University of Sydney, Australia
Michael Breakspear
Black Dog Institute, Australia
Juergen Gotz
Brain and Mind Research Institute, Australia
The human brain has the capacity for remarkable plasticity throughout life. Recent advances in neural science suggest that young, old and impaired brains are able to respond to the demands of activity, experience and environmental factors by creating new, functional neurons, synapses and networks. Such changes appear to result from the effects of a range of biological, cognitive, psychological and social factors acting through common pathways that stimulate the intimately related processes of angiogenesis and neural plasticity and neurogenesis.
There has been a recent convergence of evidence and opinion on the contribution of vascular disease to the aetiology of all forms of cognitive impairment. It appears that mild cognitive impairment, multi-infarct dementia, vascular dementia, Alzheimer’s disease, frontotemporal dementia, Lewy Body dementia and vascular depression are all be expressions of strikingly similar processes which involve the complex interplay of vascular risk factors, genes, diet, physical activity, cognitive activity, psychological functioning and social functioning.
In terms of intervention, at an individual and at a population level, this opens the door to promising, new directions in the treatment and prevention of these disorders, since all of these aetiological factors (except for genes) are amenable to direct intervention, and many of the available interventions will lead to effects on gene expression. Programs that promote effective cardiovascular treatment, healthy eating, dietary supplementation, exercise, life-long education, mental health, functional relationships and social engagement are likely to improve cognitive function.
Our paper will selectively review the relevant scientific advances in angiogenesis, neural plasticity and neurogenesis, and the relevant literature on currently available biopsychosocial interventions for the treatment and prevention of cognitive impairment and dementia.
Keywords: Work and Voc Rehab, Social Psychiatry
326
WHO DOES WELL AFTER A STROKE?
Adrienne Withall
Prince of Wales Hospital, University of Sydney, Australia
Henry Brodaty
Prince of Wales Hospital, University of New South Wales, Australia
Perminder Sachdev
Prince of Wales Hospital, University of New South Wales, Australia
Annette Altendorf
Prince of Wales Hospital, University of New South Wales, Australia
Background: There is little research addressing positive outcomes following stroke. Studies that have been performed have often not been longitudinal and have focused on outcome in the few days following a stroke. Studies that have followed patients over a longer time-course have focused on cognitive outcome.
Methods: 167 consecutive patients admitted to the stroke units of two university hospitals after an ischaemic stroke and 109 controls received extensive medical, psychiatric and neuropsychological assessments; a subset received magnetic resonance imaging (MRI) scans. Patients were assessed 3–6 months and 12–15 months after their stroke. The sample for this study comprised the 96 patients with complete adl+iadl and mmse ratings at both time points. Doing well was defined as either any improvement on the mmse and/or adl+iadl scale as long as there was no decline on the other scale or patients who had an mmse between 30 and 28 and an adl+iadl score above 11 at both time points.
Results: 52 patients were defined as doing well at 12–15 months poststroke and the remaining 19 were defined as not doing well. 25 people had mixed results. Those in the doing well group were significantly younger, had a higher premorbid IQ, less atrial fibrillation, less diabetes and less alcohol abuse. Logistic regressions also showed that this group had less apathy but not less depression (DSM-IV Major or Minor), less dementia and less total brain atrophy. Factors that were not significant included gender, years of education, stroke severity, previous stroke or aphasia.
Discussion: This study has revealed some important factors that determine who has better outcomes following a stroke. Importantly, number of previous strokes and current stroke severity had no relationship with outcome. Cognitive reserve appears to play some protective role. Apathy also appears to be an important factor and preventive treatment for this immediately post-stroke may improve outcomes.
Keywords: Epidemiology, Aetiology, Other
327
PHYSICAL HEALTH MAINTENANCE IN GENERAL PRACTICE PATIENTS WITH AND WITHOUT MENTAL HEALTH PROBLEMS IN REGIONAL QUEENSLAND
David J Kavanagh
University of Queensland, Australia
Matthew Bambling
University of Queensland, Australia
Heidi Sturk
University of Queensland, Australia
Helen Bartlett
University of Queensland, Australia
Cindy Gallois
University of Queensland, Australia
Merrill Turpin
University of Queensland, Australia
Robert King
University of Queensland, Australia
Chris Del Mar
Bond University, Australia
People with mental health problems tend to have worse health outcomes than people without these problems. This is thought to be partly because of high levels of risk behaviours, and partly because they receive less effective or timely treatment for physical disorder. This paper presents data from assessments of 905 unselected patients attending general practices in rural Queensland, together with a further sample that was collected some 18 months later. The surveys examined health maintenance behaviours and general practitioner interventions over the previous 12 months. We predicted that people with mental health problems would be more likely to smoke, and less likely to receive physical checks, and assessments or interventions for smoking and other behavioural risks than other patients. In the first survey, 22% reported a history of mental health problems, three quarters of whom reported depression. As expected, Kessler 10 scores showed significant distress in many patients who did not report a mental disorder history. More patients reporting mental disorders were female than those without problems, more were smokers (31%) and fewer were aged above 60 years. Contrary to prediction, people with and without mental health problems were equally likely to report receiving GP assessments of physical indices, and those with mental health problems reported more GP interventions for health risk behaviours. Patients had high confidence in talking to GPs about both physical and emotional issues, and 60% of those with a mental health problem said their GP had discussed ways to prevent recurrence of their problem in the last year. The paper examines the extent that these results are replicated in the follow-up survey. Implications of the results are discussed.
Keywords: Epidemiology, Aetiology, Other
328
BRAVEHEART: A NEW DEVELOPMENT IN CBT FOR CO-EXISTING DEPRESSION AND CORONARY HEART DISEASE
Alyna Turner
John Hunter Hospital, Hunter New England Health Service, The University of Newcastle, Australia
John Hambridge
John Hunter Hospital, Hunter New England Health Service, Australia
Amanda Baker
The University of Newcastle, Australia
Colleen Grace
John Hunter Hospital, Hunter New England Health Service, Australia
Frances Kay-Lambkin
The University of Newcastle, Australia
Jenny Bowman
The University of Newcastle, Australia
Purpose: The last decade has seen a growing body of evidence to support independent links between depression and coronary heart disease. Despite this evidence, depression is rarely assessed in cardiac rehabilitation programs and there are few published studies of psychological interventions for depression with this population. The aim of the present evaluation is to determine levels of depression and anxiety symptoms among cardiac rehabilitation patients in John Hunter Hospital (JHH), Newcastle. Additionally, it is aimed to develop and evaluate a group cognitive behaviour therapy (CBT) intervention (BraveHeart).
Methods: As part of routine clinical service, since July 2003 all cardiac rehabilitation patients at JHH have been screened using the Hospital Anxiety and Depression Scale (HADS) at week 4 of their program. Responders scoring above 7 on the anxiety or depression subscale were invited to participate in BraveHeart as part of usual service provision. Pilot data has been collected including basic demographic data, psychotropic medication status; and, at session 1, session 6, 1 and 6 months post group, HADS and Beck Depression Inventory-II (BDI-II) scores.
Results: Screening of the cardiac rehabilitation population has found that 26% and 16% of patients scored above 7 on the HADS anxiety and depression subscales respectively. To date, 26 patients have completed BraveHeart, with full data available on 16. Pilot data show a significant reduction in symptoms of depression in the group from pre-to onemonth follow-up, sustained at six months. Participant feedback has also been collected and has been positive.
Conclusions: Results from screening support prior research suggesting significant levels of emotional distress exist among cardiac rehabilitation participants. Pilot data provides support that a 6 session CBT program in this population can assist in reducing symptoms of depression. An RCT has been designed to more comprehensively examine the BraveHeart program.
Keywords: Biological Psychiatry, Neuropsychiatry
329
PHYSICAL ILLNESS AND MENTAL HEALTH/SUBSTANCE USE DISORDERS: PATTERNS OF CO-MORBIDITY AND TREATMENT IMPLICATIONS
Brian Kelly
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Background: The co-existence of physical illness and significant psychiatric symptoms or substance use disorders presents a common clinical problem. Despite the high prevalence of comorbid mental health problems and substance use disorders in individuals with physical illness (as high as 30% or more), these conditions are generally underrecognized and under-treated. Mental illness and substance use disorders carry greater risk of significant physical illnesses, and the presence of these disorders can have a significant adverse effect on the course and outcome of any physical illnesses, lead to greater health service utilization, and greater levels of disability
Aims: This paper aims to provide a brief clinically-focussed overview of the interaction between physical illness and mental health/substance use disorders, and current approaches to treatment.
Methods/Results: Risk factors to major mental health problems in physically ill, common diagnostic and assessment issues of such comorbidity, and recent develops in treatment models will be discussed.
Conclusions: Research findings indicate the potential benefits of specific psychological interventions in improving mental health and quality of life in individuals with physical illness. Nevertheless, specific considerations are needed in psychological treatment, with recognition of the interaction of the biological, psychological and social/interpersonal effects of physical illness in contributing to psychological symptoms, and the benefits of integrating treatment of mental health/substance use disorders with the treatment of any physical illness that is present.
Keywords: Epidemiology, Aetiology, Other
330
PARENTAL RESPONSE FOLLOWING INFANT ADMISSION TO A NEONATAL INTENSIVE CARE UNIT (NICU)
Janet D Carter
University of Otago, New Zealand
Roger T Mulder
Christchurch School of Medicine and Health Sciences, New Zealand
Brian A Darlow
Department of Psychological Medicine, University of Otago, New Zealand
Purpose: To compare the psychological status of parents of infants admitted to a neonatal intensive care unit with parents of full term healthy infants at birth and 9 months later, and to identify factors associated with status change.
Methods: In this prospective longitudinal study a random sample of 447 parents (242 mothers; 205 fathers) with an infant admitted to a NICU and 189 parents (100 mother: 89 fathers) with an infant born at term and not requiring NICU admission were recruited over a 1 year period. Parents were interviewed and completed self-report inventories assessing depression and anxiety symptoms shortly after their infant’s birth and 9 months later.
Results: The increased level of depression and anxiety symptoms evident in parents of NICU infants compared to control parents shortly after the birth of their infant were no longer apparent by 9 months. NICU mothers and fathers made large symptomatic improvements over the follow-up period while the status of control parents remained relatively stable. Higher initial symptom severity and perceived quality of the couple relationship were most commonly associated with improvement. Other factors related to change in symptoms at 9 months were number of baby hospitalisations for fathers and being in the NICU, age and living with the infant’s father for mothers.
Conclusions: The current findings indicate that having an infant admitted to a NICU does not result in ongoing psychological distress in either the mother or the father. Those NICU parents who did initially experience clinically relevant symptoms had recovered by 9 months
Keywords: Epidemiology, Aetiology, Other
331
CHALLENGING BIOMEDICAL MODELS OF DISABILITY IN CHRONIC ILLNESS: COMPARING BIOMEDICAL AND BIOPSYCHOSOCIAL MODELS OF DISABILITY IN YOUNG WOMEN WITH RHEUMATOID ARTHRITIS
Janine G Walker
Centre for Mental Health Research, The Australian National University, Australia
Geoff O Littlejohn
Centre for Inflammatory Diseases, Monash Medical Centre, Australia
Henry Jackson
School of Behavioural Science, The University of Melbourne, Australia
Paul Dudgeon
School of Behavioural Science, The University of Melbourne, Australia
Objective: To test competing biomedical and biopsychosocial models of physical adjustment, and determine their ability to account for pain and disability outcomes in young women with rheumatoid arthritis (RA). Further, we wanted to determine whether the linear relationship from basic through to more complex tasks often described by biomedical disability models are present after considering the effects of psychosocial functioning on pain and disability.
Method: 51 young women (mean age = 38.34) diagnosed with RA completed self-report surveys examining psychosocial and physical functioning, and bloods and 24-hour urine samples were collected to test disease activity, and neuroendocrine and immune function. Structural equation modelling (SEM) determined which model best fitted the data and which was the best predictor of disability outcomes.
Results: Standardised root mean square residuals indicated that both the biomedical and biopsychosocial models adequately fitted the data with 0.76 and 0.80, respectively. Prediction of pain and disability outcomes was substantially improved in the biopsychosocial model which accounted for 51% (p =.010) and 73% (p =.010), respectively, for basic activities of daily living (ADL) and work ability compared to 39% (p =.002) for basic ADLs and 63% (p =.002) for work ability in the biomedical model. The biomedical model accounted for only 4% (p =.659) of the variance for self-reported pain in comparison to 47% (p =.010) predicted by the biopsychosocial model. Further, the strong linear relationship from pain to basic activities then to more complex tasks was no longer evident after considering psychosocial functioning.
Conclusion: The biopsychosocial framework accounted for more variance for pain and disability, than a traditional biomedical framework. The traditional linear model of disability was challenged, with there being no linear relationship from basic to more complex tasks present in the biopsychosocial model.
Keywords: Epidemiology, Aetiology, Other
401
A RANDOMIZED CONTROLLED TRIAL OF SEQUENTIAL BILATERAL rTMS FOR TREATMENT RESISTANT DEPRESSION
Paul B Fitzgerald
Alfred Psychiatry Research Centre, Australia
Jessica Benitez
Alfred Psychiatry Research Centre, Australia
Anthony R de Castella
Alfred Psychiatry Research Centre, Australia
Z Jeff Daskalakis
Centre for Addiction and Mental Health Clarke Division, Canada
Tim L Brown
Alfred Psychiatry Research Centre, Australia
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Purpose: High frequency left sided repetitive transcranial magnetic stimulation (rTMS) (HFL-TMS) and low frequency stimulation to the right prefrontal cortex (LFR-TMS) have both been shown to have antidepressant effects but doubts remain about the magnitude of previously demonstrated treatment effects. We aimed to prospectively evaluate sequentially combined HFL-TMS and LFR-TMS in the therapy of treatment-resistant depression.
Method: We conducted a six week double blind randomized sham controlled trial in 50 patients with treatment-resistant depression. 3 trains of LFR-TMS of 140 seconds duration at 1Hz were applied daily followed immediately by 15 trains of 5 seconds duration of HFL-TMS at 10Hz. Sham stimulation was applied with the coil angled at 45 degrees from the scalp resting on the side of one wing of the coil. The primary outcome variable was scores on the Montgomery-Åsberg Depression Rating Scale (MADRS).
Results: There was a significantly greater response to active compared to sham stimulation at two weeks (F(1,25) = 25.5, p < 0.001) and across of the full duration of the study (F(5,44) = 3.9, p = 0.005). A significant proportion of the active study group met response (11/25 (44%)) and remission criteria (9/25 (36%)) by study end compared to the sham group (2 (8%) and 0).
Conclusions: Sequentially applying both HFL-TMS and LFR-TMS has substantial treatment efficacy in patients with treatment-resistant major depression. The treatment response accumulates to a clinically meaningful level over 4 to 6 weeks of active treatment.
Keywords: Biological Psychiatry, Neuropsychiatry
402
A METHOD FOR ADDRESSING SAFETY GUIDELINES IN A CLINICAL TRIAL OF rTMS IN DEPRESSION
Gregory W Price
Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Australia
Joseph Lee
Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Australia
The clinical trials unit at CCRN recently initiated protocols to investigate the clinical efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) in depression. There is a well-documented risk of provoking seizures in this method, which is exacerbated by the rTMS parameters used in one particular protocol in our study.
As would be expected, all parameters utilised in these studies are designed to adhere to the guidelines from the International Workshop (1998). These guidelines set down a recommended envelope of stimulus train duration for any given (integer) rate. The difficulty in our particular protocol was that the rate was not only non-integral, but was varying continuously throughout the train. The inter-stimulus interval (ISI) could be any value from 40–500 ms. How, then, could a safe duration of the train be reasonably estimated?
An algorithm was included in the stimulus delivery software to compute an estimate of the safe duration, which varied with every stimulus delivered. The safe train duration and stimulus rate defines a safe ISI. This ISI divided by the train duration gives an ISI%. For our application, we devolve the safety characteristic from the train to define a new safe ISI%. This new safety value, however, is defined for every single stimulus rather than the train as a whole. By summing these ISI% values, a train can be stopped when greater than 100(%). The method gives identical values to the original safe train duration when a single stimulus rate is used. It additionally, gives a means of estimating the safe train duration when the stimulus rate varies.
This implementation implicitly depends on the theoretical basis of seizure provocation through rTMS. It is acknowledged that this area is poorly understood, and we do not presume to claim the method is physiologically derived. However, the original guidelines were derived in a similar atheoretical manner, and our method is a reasonable adaptation to meet the needs of our protocol.
Keywords: Biological Psychiatry, Neuropsychiatry
403
EFFICACY OF TRANSCRANIAL MAGNETIC STIMULATION (TMS) IN DEPRESSION-EFFECT OF STIMULUS CONFIGURATION
Colleen Loo
School of Psychiatry, University of New South Wales, Black Dog Institute, Australia
JT Taylor
School of Medical Sciences, University of New South Wales, Australia
Aims: To investigate the effects of biphasic and monophasic stimulus configuration on the magnitude of lasting effects on cortical excitability with transcranial magnetic stimulation (TMS).
Background: Variable results have been reported for the efficacy of repetitive TMS (rTMS) in treating depression. These may in part be accounted for by the multiple differences in rTMS treatment parameters between studies. One aspect of this that has received little attention is the stimulus configuration, of which the two most common variations are biphasic and monophasic.
Methods: In 8 healthy subjects, we measured motor evoked potentials (MEPs) in a hand muscle after monophasic and biphasic rTMS (1 Hz for 15 min) over the motor cortex. Results/Conclusions: MEPs were significantly reduced after monophasic but not biphasic rTMS to the motor cortex. This study found that repetitive TMS with monophasic pulses produced more lasting changes in cortical excitability than biphasic rTMS, a result that may have important implications for clinical therapeutic uses of rTMS.
404
THE EFFECTS OF RIGHT FRONTAL 1HZ RTMS ON EVENT-RELATED DESYNCHRONIZATION OF THE HUMAN EEG AND IMPLICATIONS FOR THE TREATMENT OF DEPRESSION
Nicholas R Cooper
Monash University, Alfred Psychiatry Research Centre, Australia
Paul Fitzgerald
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Daniel Upton
Alfred Psychiatry Research Centre, Department of Psychological Medicine, Monash University, Australia
Rebecca Segrave
Alfred Psychiatry Research Centre, Department of Psychological Medicine, Monash University, Australia
Robin Laycock
Alfred Psychiatry Research Centre, Department of Psychological Medicine, Monash University, Australia
Z Jeff Daskalakis
Centre for Addiction and Mental Health Clarke Division, Canada
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Rodney Croft
Swinburne University of Technology, Australia
The investigation of repetitive Transcranial Magnetic Stimulation (rTMS) as a potential clinical treatment for major depression is becoming increasingly widespread. However, there has been little work to investigate the neurobiological mechanisms affected by rTMS in this domain. The purpose of the present pilot study is to address this issue, exploring the effects of 1 Hz rTMS applied to dorsal lateral prefrontal cortex (DLPFC) on an EEG index of cortical excitation and inhibition: event-related desynchronization/synchronization (ERD/S).
On two separate occasions, 18 normal participants received 15 minutes of 1 Hz rTMS at 110% of the resting motor threshold. On one occasion this stimulation was to the right DLPFC and on another to the left. ERD/S of theta, alpha and beta bands was measured during a responseinhibition task immediately before and after stimulation. Results will be presented and discussed within a context of cortical excitation and inhibition as reflected by the EEG, and in relation to the implications for disease models and treatment protocols.
Keywords: Biological Psychiatry, Neuropsychiatry
405
MEASURING PATIENTS’ BELIEFS AND ATTITUDES TOWARDS TRANSCRANIAL MAGNETIC STIMULATION (TMS)
Timothy L Brown
University of Melbourne, The School of Nursing, Australia
Paul B Fitzgerald
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Phil Maude
University of Melbourne, The School of Nursing, Australia
Background: There are several main attitude-behavioural relationship models that hold promise as a method for profiling patients’ beliefs and attitudes. However, no models have been used to explore treatmentresistant populations that have consented to clinical randomised trials of a new psychiatric treatment. The Brown Behaviour Clinical Outcome Model (BBCOM) was designed as an explanatory model and was an extension to previous relationship models; the aim of this model was to determine whether beliefs and attitudes were psychological predictors of TMS response.
Method: The patients had treatment-resistant symptoms and a diagnosis of either Major Depressive Disorder or Bipolar Affective Disorder. The Beck Depression Inventory and the Montgomery-Asberg Depression Rating Scale measured clinical improvement from TMS. Patients were divided into responders and non-responders as defined by =30% improvement in their depressive symptoms. A Belief and Attitudes TMS Questionnaire (BAT-Q) was designed to elicit patients’ beliefs and attitudes towards TMS, 100 patient answers were divided by the response criteria and statistical analysis was conducted to determine whether there were correlations between variables (before and after treatment).
Results: The BBCOM model showed that patients’ pre-treatment beliefs and attitudes did not predict clinical response, however there was a significant relationship between response and post-treatment attitudes. Overall, the BBCOM revealed treatment-resistant patients who respond to treatment can experience new salient beliefs and attitudes towards a psychiatric treatment.
Conclusion: The development of the BBCOM was a valuable component of this study and assisted in the exploration of patients’ beliefs and attitudes towards TMS. This study established a body of knowledge that may be utilised to educate clinicians and patients about beliefs and attitudes towards TMS.
406
“WITHDRAWN”
407
IMPACT OF DIAGNOSTIC DEFINITION ON REPORTED PREVALENCE OF MIXED EPISODES IN AN AUSTRALIAN COMMUNITY BIPOLAR COHORT
Michael Berk
The University of Melbourne, Australia
Paul Fitzgerald
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Seetal Dodd
Department of Clinical and Biomedical Sciences, The University of Melbourne, Australia
Pam Callaly
The University of Melbourne, Australia
Jane Opie
The University of Melbourne, Australia
Lesley Berk
The University of Melbourne, Australia
Anthony R de Castella
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Sacha Filia
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Kate Filia
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Steven Tahtalian
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Emily Owen
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
William S Montgomery
Eli Lilly Australia Pty Ltd, Australia
Katarina Kelin
Eli Lilly Australia Pty Ltd, Australia
Meg Smith
School of Applied Social and Human Sciences, University of Western Sydney, Australia
Rachel Henderson
Eli Lilly Australia Pty Ltd, Australia
Alan Brnabic
Clinical Outcomes and Research Institute, Eli Lilly Australia Pty Ltd, Australia
Elizabeth Pope
Clinical Outcomes and Research Institute, Eli Lilly Australia Pty Ltd, Australia
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Objectives: A mixed state diagnosis may have significant impact on treatment choice in bipolar I patients. This project aims to compare the prevalence of mixed state patients in an Australian community cohort using different diagnostic definitions.
Methods: The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year, prospective observational study of treatment and outcomes for patients with bipolar I, or schizoaffective disorder. Different mixed state definitions were applied to this cohort (n = 194), including the standard DSM-IV mixed episode, a definition focusing on mania in the presence of depression (Cassidy et al., [Citation2000]), and a definition focusing on depression in the presence of mania (Benazzi, [Citation2003]).
Results: A total of three patients (1.5%) satisfied DSM-IV mixed state criteria. Application of criteria by Cassidy et al. Citation[(2000)] identified 13.4% (n = 26) of patients as experiencing mixed episodes. Similarly, 13.9% (n = 27) of patients were identified as experiencing mixed episodes when Benazzi Citation[(2003)] criteria were used.
Conclusion: An accurate mixed state diagnosis is important for treatment choice. Application of different diagnostic criteria varied the reported prevalence of mixed state diagnoses in this cohort of bipolar patients.
408
EXPLORATION OF SYMPTOMATIC DIFFERENCES BETWEEN BIPOLAR AND UNIPOLAR DEPRESSION
Catherine M Cahill
School of Psychiatry, Black Dog Institute, Australia
Gin S Malhi
The University of New South Wales, Australia
Michael Berk
The University of Melbourne, Australia
Dusan Hadzi-Pavlovic
Department of Human Behaviour, School of Psychiatry, The University of New South Wales, Australia
Philip B Mitchell
University of New South Wales, The Black Dog Institute, Australia
Peter F Lovibond
Australia
Purpose: The present study seeks to extend the body of knowledge describing the differences between unipolar and bipolar depression.
Methods: The Bipolar Depression Rating Scale is a new measure for bipolar depression that has just been validated. It was used in this study to assess depressive symptomatology in a sample of bipolar and unipolar participants (Berk, Malhi, Mitchell et al., in preparation). The new measure includes some specific questions about symptoms of bipolar depression that are neglected by traditional measures of depression. Responses on the new clinician-rated measure will be compared with self report on the Beck Depression Inventory 2nd edition (Beck et al., 1988) to compare clinician ratings with self report and also to compare symptoms commonly assessed by both scales.
Results: Comparisons of the responses from the two groups indicated there were different patterns of response to the BDRS with social withdrawal having the highest item mean for the bipolar group whereas loss of enjoyment was more important for the unipolar group. The pattern of response to mixed symptoms was inconsistent and there was also variation between clinician’s rating and self report of symptoms.
Conclusions: Differences in response were found between the two groups. Although these findings are not conclusive due to the small sample size they indicate symptoms that may be useful in discriminating bipolar from unipolar depression. Further investigation would reveal if these findings are replicable in larger samples.
Keywords: Epidemiology, Aetiology, Other
409
EMOTIVE RESPONSES TO FOOD AND BODY IMAGE CONCERN IN ADULT WOMEN
Caroline J McNamara
James Cook University, Australia
Phillipa J Hay
James Cook University, Australia
Anna Chur-Hansen
University of Adelaide, Australia
Purpose: To investigate the emotive responses to food and relationship with body image concern and eating disorder features in adult women and compare these responses with schoolgirls.
Methods: Fifty-eight female university students (<17 years) viewed a slide show containing images of various foods and then recorded their level of happiness, anxiety and disgust on a visual analogue scale for each food image. The adults then completed the Body Dissatisfaction Subscale of the Eating Disorder Inventory (EDI), Rob-son’s self-esteem questionnaire and the Eating Disorder Examination Questionnaire (EDE-Q). Adult data were compared with data previously collected involving 173 schoolgirls (aged 10–15 years) in South Australia.
Results: Adult women had significantly lower levels of happiness, anxiety and disgust towards food and higher body image concern than schoolgirls. In adult women, there were positive correlations between an anxious response to foods and both body image concern (p = 0.01) and eating concern (p < 0.01). This was not found in the schoolgirls.
Conclusions: While emotive responses to foods are less in adult women, they are more likely to be modulated by body image concern and eating concern.
Keywords: Epidemiology, Aetiology, Other
410
AN EXPLORATION OF THE EMOTIVE RESPONSES TO FOOD IN ADULTS WITH AN EATING DISORDER: A QUALITATIVE STUDY
Caroline J McNamara
James Cook University, Australia
Anna Chur-Hansen
University of Adelaide, Australia
Phillipa Hay
James Cook University, Australia
Purpose: An exploration of the emotive responses expressed by adults with an eating disorder when viewing images of food.
Methods: Using a semi-structured interview format, eleven adults with a diagnosed eating disorder according to the DSM-IV criteria were asked to articulate their emotional responses to a slide show containing images of various foods. Data were analysed using the framework approach.
Results: The theme of control emerged as underlying the emotive responses to food. A concept map was derived that illustrated how the majority of themes related to both a positive and negative dimension of control.
Conclusions: This is the first report to link control more directly with negative emotive responses to foods and the first study to explore the emotive responses to food in adults from different eating disorder diagnostic groups. Furthermore, this study confirms existing literature that suggests that control is an important theme in eating disorders.
Keywords: Epidemiology, Aetiology, Other
411
IMPACT OF COMORBIDITY IN THREE CLINICAL SAMPLES: ANOREXIA NERVOSA, BULIMIA NERVOSA AND MAJOR DEPRESSIVE DISORDER
Jennifer Jordan
Christchurch School of Medicine, University of Otago, New Zealand
Peter R Joyce
Christchurch School of Medicine, University of Otago, New Zealand
Frances A Carter
Christchurch School of Medicine, University of Otago, New Zealand
Virginia VW McIntosh
Christchurch School of Medicine, University of Otago, New Zealand
Suzanne E Luty
Christchurch School of Medicine, University of Otago, New Zealand
Janice M McKenzie
Christchurch School of Medicine, University of Otago, New Zealand
Roger T Mulder
Christchurch School of Medicine, University of Otago, New Zealand
Cynthia M Bulik
University of North Carolina, United States
Purpose: To establish the impact of total comorbidity and different pairs of comorbid disorders on psychosocial functioning, distress and service utilisation in samples of women presenting for outpatient treatment for anorexia nervosa (AN), bulimia nervosa (BN) or major depressive disorder.
Methods: Prevalences of key Axis I and II comorbid disorders are described and compared between samples: AN (n = 56), BN (n = 132) and Depression (n = 100). A measure of the extent of comorbidity was obtained by counting mood, anxiety, substance use disorders and the presence of any Cluster A, B or C personality disorder.
Results: Both eating disorders samples had higher levels of comorbidity compared to the sample with major depression. As expected, increased levels of comorbidity were associated with poorer functioning on most but not all variables.
Conclusions: The extent, pattern and impact of comorbidity may differ between disorders.
Keywords: Epidemiology, Aetiology, Other
412
EXPLORING THE FAULTY BELIEFS OF PEOPLE WITH BODY DYSMORPHIC DISORDER: AN INVESTIGATION OF FOUR CASES
Izelle Labuschagne
Mental Health Research Institute of Victoria, Australia
Susan L Rossell
Mental Health Research Institute of Victoria, Australia
David J Castle
Mental Health Research Institute of Victoria, Australia
Mike Kyrios
Swinburne University, Australia
Body dysmorphic disorder (BDD) is an overvalued or a delusional belief of ‘imagined ugliness’. Its clinical presentation suggests there are impairments in perception and/or social processing, although surprisingly, there have been few studies to examine cognition in BDD. In this study, cognitive processing in BDD was investigated in four cases: two cases with overvalued non-delusional ideas and two with delusional beliefs. Their performance was compared to 10 healthy controls. The cognitive assessment examined visual perception, social affect perception, social cognition and semantic memory for somatic concepts. Clinical psychopathology was rated using measures of selfesteem, self-ambivalence, delusional thinking and creative experiences. All four BDD cases had poor self-esteem and greater self-ambivalence. Delusional thinking was more pronounced in all cases but particularly the two cases with the delusional variant of the disorder. The BDD patients showed cognitive deficits in the three distinct cognitive areas, general and affect perception and semantic memory, when compared to controls. These findings confirmed the importance of social affect perception in BDD (as reported Buhlmann, et al., 2002); the BDD cases perceived neutral faces more often as emotive. The data also suggested that memory for somatic information is impaired as the BDD cases displayed more idiosyncratic or nonsensical associations. The results further indicated an additional influence of delusional thinking on cognitive abilities; the delusional cases showed more pronounced deficits on the tasks. This is consistent with the notion that the delusional variant is a more severe form of the disorder. From this work, we are beginning to understand more about the cognitive aspects of BDD, and the potential relationships between cognition and phenomenology.
Keywords: Biological Psychiatry, Neuropsychiatry
413
DEVELOPMENT AND VALIDATION OF AN AFFECTIVE TEMPERAMENT QUESTIONNAIRE
Katrina J Light
Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, New Zealand
Peter R Joyce
Christchurch School of Medicine and Health Sciences, New Zealand
Purpose: Kraepelin (1921) described the existence of four fundamental states – depressive, manic, irritable and cyclothymic – which predispose some individuals to manic-depressive insanity, whilst others, commonly the family members of the former, present as extreme forms of personality. These subthreshold expressions are believed to comprise part of a mood disorder spectrum. Based on these descriptions and their clinical experience, Akiskal and Mallya (1987) proposed criteria defining four affective temperaments, which were operationalised in the form of the TEMPS. The research that has implemented this instrument has predominantly been conducted under the direction of Akiskal. Our research aims to validate an independently-developed alternative, which encompasses the criteria proposed by Akiskal and Mallya (1987) in the form of a 15-item questionnaire, with three-point rating scale.
Methods: The Affective Temperament Questionnaire (ATQ) was administered, adjunct to a clinical interview, within a family-based sample of 378 individuals, who either had a lifetime diagnosis of major depressive disorder, bipolar disorder (BPI, BPII and BP-NOS) or no mood disorder. Two personality measures (TCI and GBI) were completed. The factorial structure and concurrent validity of the ATQ were evaluated with respect to three measures – scale scores, presence/absence and dominant temperament.
Results: Our findings support the existence of three distinct factors – hyperthymia, cyclothymia and dysthymia – which have moderate-high internal consistency. ROC curves identified cut-off values for each scale. Evaluation of temperament relative to Axis I diagnosis and personality traits yielded findings concordant with that found using the TEMPS.
Conclusions: The internal reliability and concurrent validity of the ATQ supports the use of this questionnaire as a short alternative to the TEMPS for collecting descriptive and categorical information regarding affective temperament.
Keywords: Epidemiology, Aetiology, Other
414
A QUALITATIVE ANALYSIS OF RESPONSE AND NON RESPONSE IN INTERPERSONAL PSYCHOTHERAPY
Sue E Luty
Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, New Zealand
Aims: The aim of this study was to use qualitative analysis to explore the process of change during Interpersonal Psychotherapy (IPT).
Background: While there is considerable data supporting the efficacy of IPT for depression there has been very little qualitative research into the process of IPT. Analysis of other psychotherapy modalities using qualitative methodology has identified how researchers and therapists can understand and interpret the process of change. Since IPT is a brief focused psychotherapy it is possible to use qualitative analysis.
Methodology: The qualitative methodology chosen was thematic analysis which is a process for encoding qualitative information. Ten sets of 12 × one hour IPT sessions were transcribed from a larger randomized clinical trial designed to identify predictors of response to IPT and Cognitive Behavioural Therapy (CBT). The sets chosen were from females with a main focus on ‘interpersonal disputes’ as one of four possible problem areas. Thematic analysis initially identified statements which were categorized, named, grouped into themes, and then clustered into four core themes.
Results: 54 categories were grouped into 9 themes and 4 core themes emerged. The four core themes identified were – ‘struggling with the symptoms’, ‘identifying the interpersonal pattern’, ‘altering the pattern’, and ‘reconstructing a sense of self’. Two clear trajectories also emerged during the process of therapy, which were clearly associated with response or non-response to IPT. This presentation will discuss the differences in these two trajectories.
Conclusions: While preliminary, and there is need to extend to males and the other three IPT problem areas, these results can inform therapists and help them understand the pathways to response in IPT.
Keywords: Epidemiology, Aetiology, Other
415
THE VALIDITY AND UTILITY OF PATIENTS’ DAILY RATINGS OF MOOD AND IMPAIRMENT IN CLINICAL TRIALS OF BIPOLAR DISORDER
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
Amanda Olley
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Caryl Barnes
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Objective: Traditional cross-sectional clinician-rated measures are limited for use in clinical trials of bipolar disorder for a number of reasons. This study aimed to demonstrate the validity and utility of patients’ daily ratings of mood and functional impairment within the context of a treatment trial for Bipolar II Disorder.
Method: Ten subjects with Bipolar II Disorder completed daily ratings of the severity of depression, hypomania and functional impairment over a nine-month trial. Patient ratings were correlated with clinician-rated measures at nine time points to determine the validity of the ratings. The data from the patient mood ratings were contrasted with the data from the cross-sectional measures for one subject over the course of the study to determine the utility of the ratings.
Results: Moderate to large correlations were found between patients’ and clinician ratings of mood and impairment for most of the nine time points. Correlations were higher for ratings of depression and functional impairment than for hypomania. The utility of the patients’ ratings relative to clinician cross-sectional measures was demonstrated by changes in a number of parameters of mood and impairment for one subject over the course of the study.
Conclusions: This study provides support for the validity and utility of patients’ daily ratings of mood and discusses the benefits of utilizing such a measure in future treatment trials of bipolar disorder.
Keywords: Epidemiology, Aetiology, Other
416
DEPRESSION IN THE CHINESE: THE IMPACT OF ACCULTURATION
Gordon Parker
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Bibiana Chan
Black Dog Institute, Australia
Lucy Tully
Black Dog Institute, Australia
Maurice Eisenbruch
Institute for Health and Diversity, Victoria University, Australia
Background: Studies of depression in the Chinese have long identified low rates and a greater likelihood of somatization, findings which could reflect cultural influences or real differences. We report a study from a western region examining the impact of acculturation on depression to clarify the role of cultural factors.
Method: In a Sydney-based study, Chinese subjects (n = 385) and a matched control group of 143 non-Chinese subjects completed either a Chinese or English questionnaire assessing state and lifetime depression, acculturation, as well as attributional style, depression recognition and help-seeking. The impact of acculturation was examined by multiple strategies.
Results: Any tendency by the Chinese to somatize depression appeared to be attenuated by acculturation. State depression levels countered the view that Chinese necessarily deny depression. Lifetime depression rate differences were also attenuated by acculturation, with Chinese subjects being less likely than Controls to judge episodes as a distinct disorder and to seek professional help.
Conclusions: Results suggest that Australian Chinese do not differ intrinsically in recognizing and ascribing depressive symptoms, and that the greater the degree of acculturation, the greater the tendency for reporting persistent and impairing depressive episodes.
Keywords: Epidemiology, Aetiology, Other
417
THE MEANING OF SUFFERING – A CHINESE EXPLANATORY MODEL TOOL FOR DEPRESSIVE EPISODE
Maurice Eisenbruch
Institute for Health and Diversity, Victoria University, Australia
Bibiana Chan
Black Dog Institute, Australia
Gordon Parker
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Objectives: Chinese are the world’s largest ethnic group and depression the most disabling mental illness (Parker et al., 2001) with great variation in rates (Takeuchi et al., 1998) and symptoms (Lee, 1998). This study aims at exploring the concept of mental distress with particular reference to depressive episodes among Chinese in Australia since culture shapes an individual’s attributions of suffering. To facilitate accurate clinical diagnosis, we need to calibrate and measure such attributions.
Methods: A Mental Distress Explanatory Model Schedule (MDEMS) originally developed in English (by ME) by was transformed into Chinese version using a mixed method with stepwise qualitative (focus groups) and quantitative (test-retest) components (BC). In order to unveil the ‘meanings of suffering’ from the Chinese viewpoint, informants from various levels of acculturation were invited to offer their Explanatory Models (EMs) in response to two scenarios of ‘depressive episodes’ (young mother with mood swings; middle aged male with psychomotor retardation). A robust translation back-translation with triangulated communication between original author, translator and back-translator was adopted.
Results: Informants attributed mixed Western and non-Western concepts; ‘naturalistic’ and ‘supernatural’ causes for the two scenarios. Most items in MDEMS correspond to the spontaneous repertoire of the Chinese informants indicating psycholinguistic equivalence. Two items showing test-retest mismatch were replaced by phrases with indigenous constructs. This demonstrates the attention paid to preserve the original cognitive constructs yet respecting cultural differences.
Discussions: The results are consistent with the proposition that culture plays a significant role in how people explain suffering and sadness. The clinical implications are: it enables culturally competent diagnosis to be made by providing key information about patients’ explanatory models (EMs). In a globalised world with increasing migration flows, mental health workers need to employ tools like the MDEMS to provide culturally competent clinical management. Further studies are needed to evaluate the utility of this instrument.
Keywords: Work and Voc Rehab, Social Psychiatry
418
HELP-SEEKING AMONG CHINESE IN SYDNEY – DOES ACCULTURATION MAKE A DIFFERENCE?
Bibiana CW Chan
Black Dog Institute, UNSW, Australia
Gordon Parker
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Maurice Eisenbruch
Institute for Health and Diversity, Victoria University, Australia
Objectives: Acculturation is more than giving up the old culture to get a new one (Ryder et al., 2000); a direct relationship between acculturation and health is unclear due to the range of epistemologies, methods and samples (Salant & Lauderdale 2003). In Sydney, the Chinese span from the highly acculturated to recent arrivals – providing the opportunity to investigate the meaning of acculturation and the links with help-seeking strategies specific for emotional distress.
Method: Chinese from a range of socio-cultural backgrounds as well as a reference group of non-Chinese were recruited from GPs (with a sub-sample from Chinese herbalists included for further analysis) to complete questionnaires in their preferred language in four acculturation domains: English Self-confidence, Cultural knowledge, Self-identity and Social Association. Demographic data were obtained. Informants of matching SES were invited to focus group discussion about depression. Themes on help-seeking were documented.
Results: Mean scores of the social domains indicate ascending trend across groups with increasing acculturation. 1st-generation Chinese from China (CC) and ‘Herbalist’ group (HB) show the lowest language self-confidence compared to Hong Kong-born Chinese but did not differ in other domains. CC was the least likely (15.3%) to report a ‘depressive episode’. 40% of HB had talked to herbalist about emotional distress. 2nd-generation Chinese resembled Controls in all domains and reported similar percentage of ‘depressive episode’. However, they were less likely to consult GPs or had anti-depressant indicating a slow subscription to Western biomedical help-seeking. 1st-generation answering English questionnaires displayed bi-cultural characteristics. Focus group narratives support these observations.
Discussions: Language barriers draw the 1st-generation Chinese towards services that are culturally familiar. The results point to strategies for planning of service delivery to be alive to the diversity of acculturation within a given community. A culturally competent mental health system will see Chinese of every acculturation stripe utilising rather than eschewing mainstream psychiatric services.
Keywords: Work and Voc Rehab, Social Psychiatry
419
OMEGA-3 POLYUNSATURATED FATTY ACIDS AS A TREATMENT FOR MAJOR DEPRESSION
Anne-Marie Rees
The Black Dog Institute and the School of Psychiatry, University of New South Wales, Australia
Gordon B Parker
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Catherine A Owen
The Black Dog Institute and the School of Psychiatry, University of New South Wales, Australia
Rationale: Recent epidemiological studies have found that fish consumption (our dietary source of omega-3) correlates negatively with rates of depressive illness. Biochemical studies have demonstrated that omega-3 levels are lower in those people with major depression than in healthy matched controls. Several small clinical trials have found evidence that omega-3 is effective as an adjunct therapy for depression but, as yet, no study has demonstrated that Omega-3 is effective as an antidepressant it it’s own right. The Black Dog Institute will be conducting two stage-3 clinical trials of Omega-3 Polyunsaturated Fatty Acid supplements as a treatment for Major Depression.
Aims: The studies aim to investigate whether omega-3 supplementation (2 grams of EPA and 1.3 grams of DHA/ day) is 1) an effective adjunct therapy for major depression in combination with standard antidepressant treatment, 2) an effective monotherapy for Major Depression and 3) whether any improvement in mood is associated with an increase in red blood cell membrane omega-3 levels.
Adjunct Study: Participants with a first or new episode of major depression will be randomly allocated to receive 6 grams/day of fish oil (omega-3) or placebo for 4 weeks in addition to standard treatment with an antidepressant medication. Participants will commence treatment with antidepressant and omega-3/placebo simultaneously and the trajectory of improvement will be monitored.
Monotherapy Study: Participants who have major depression but are not currently on an antidepressant will be randomly allocated to receive fish oil or placebo for 6 weeks. Participants’ depressive symptoms will be assessed weekly and they will be asked to rate their mood daily for the 6 week study period. Blood samples will be taken pre and post treatment to measure change in omega-3 levels. At the end of 6 weeks all participants will receive a further 8 weeks supply of fish oil capsules.
Keywords: Biological Psychiatry, Neuropsychiatry
420
PANIC DISORDER: RELATIONSHIP BETWEEN NORADRENALINE SPILLOVER, POWER SPECTRAL ANALYSIS OF HRV AND PSYCHOLOGICAL VARIABLES
Marlies E Alvarenga
Baker Heart Research Institute, Australia
Jeffrey C Richards
Monash University, Australia
Gavin Lambert
Baker Heart Research Institute, Australia
Murray D Esler
Baker Heart Research Institute, Australia
Objectives: The hypothesised link between panic anxiety and the onset of heart disease was examined. It examined biochemical measurements of sympathetic nervous system (SNS) function to assess the functional integrity of the cardiac sympathetic nerves in panic disorder (PD). As well, heart rate variability (HRV) analyses were conducted to further quantify sympathetic activity and the activity of the vagus nerve in the heart. Biological and psychological variables were examined in a resting state to provide a picture of ongoing SNS activity in people with PD.
Methods: 19 people with PD and 19 healthy volunteers provided measures of adrenaline and noradrenaline plasma clearance and transcardiac fractional extraction of plasma titrated noradrenaline and adrenaline, all of which are primarily determined by the capacity for cathecholamine uptake by the neuronal noradrenaline transporter. 20 participants with PD and 20 healthy volunteers provided HRV measures only. Participants with PD completed measures of anxiety sensitivity, state and trait anger, depression, stress and anxiety.
Results: Adrenaline and noradrenaline extraction and clearance rates across the heart were significantly lower in PD than in normals pointing to a defect of the noradrenaline transporter in the cardiac sympathetic nerves. Of the psychological variables, inhibition of anger was related to a deficit in plasma clearance of catecholamines and anxiety sensitivity was related to increased sympathetic firing in the heart of people with PD. Although HRV was unrelated to biochemical indices of SNS functioning, high frequency heart rate spectral power was significantly lower in PD than in healthy volunteers.
Conclusions: A deficit in the neuronal reuptake mechanism of noradrenaline in people with PD, by sensitising the heart to sympathetic nerve stressors responses, might indicate a biochemical basis for increased cardiac symptomatology and perhaps for increased morbidity and mortality in PD.
Keywords: Biological Psychiatry, Neuropsychiatry
421
NEUROPSYCHOLOGICAL DEFICITS AND FUNCTIONAL IMPAIRMENT IN BIPOLAR DISORDER
Belinda Ivanovski
School of Psychiatry, UNSW & Black Dog Institute, POWH, Australia
Gin S Malhi
The University of New South Wales, Australia
Perminder Sachdev
School of Psychiatry, University of New South Wales & Neuropsychiatric Institute, POWH, Australia
Objective: To examine whether patients with bipolar disorder have subtle neuropsychological deficits that manifest clinically as cognitive and functional compromise and to determine the pattern of such cognitive deficits and their functional impact across all three phases of bipolar disorder. We hypothesised that euthymia does not equate with normal neuropsychological function and that each phase has a characteristic pattern of deficits, with disturbance in attention and memory being common across all phases of the illness.
Methods: Twenty-five patients with a diagnosis of bipolar I disorder underwent neuropsychological testing over a period of 30 months in the natural course of their illness whilst hypomanic, and/or depressed and/or euthymic. The results from these assessments were compared to findings from neuropsychological tests conducted on twenty-five age, sex, education, and handedness-matched healthy controls.
Results: Initial analyses revealed modest impairment in executive functioning, memory and attention in both hypomanic and depressed bipolar patients, with additional fine motor skills impairment in the latter. Memory deficits, also noted in euthymic patients, were non-significant after controlling for confounding variables, although bipolar depressed patients remained significantly impaired on tests of verbal recall. Bipolar depressed and hypomanic patients differed with respect to the nature of their memory impairment. Depressed patients were more impaired as compared to euthymic patients on tests of verbal recall and fine motor skills. Psychosocial functioning was impaired across all three patient groups, but only in depressed and hypomanic patients did this correlate significantly with neuropsychological performance.
Conclusions: The mood-state related cognitive deficits in both bipolar depression and hypomania compromise psychosocial function when patients are unwell. In euthymic patients, subtle impairments in attention and memory suggest that an absence of symptoms does not necessarily equate to ‘recovery’. The possibility of persistent cognitive deficits in bipolar disorder is an issue of profound clinical and research interest that warrants further investigation.
Keywords: Epidemiology, Aetiology, Other
422
ANTI-ESTROGENS – A POTENTIAL TREATMENT FOR WOMEN IN THE MANIC PHASE OF BIPOLAR AFFECTIVE DISORDER?
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Robyn Anderson
Alfred Psychiatry Research Centre, Australia
Suzette Sheppard
Alfred Psychiatry Research Centre, Australia
Kathryn Garland
Alfred Psychiatry Research Centre, Australia
Anthony de Castella
Alfred Psychiatry Research Centre, Australia
Paul Fitzgerald
Alfred Psychiatry Research Centre, Australia
Background: Bipolar Affective Disorder (BPAD) is an illness with high morbidity and mortality. Lithium and other anti-convulsant drugs are the main treatments for BPAD, despite little being known about their mechanisms of action. Recent attempts to elucidate the biochemical actions of these drugs have focussed on the Protein Kinase C (PKC) pathways. It has been hypothesised that Lithium and other such treatments stabilise mood by regulating PKC neurotransmission. Another PKC inhibitor hypothesised to be effective in the treatment of mania is Tamoxifen, a synthetic non-steroidal antiestrogen.
Aim: To test and compare the effectiveness of two adjunctive antiestrogen agents (tamoxifen or progesterone) in the treatment of acute mania.
Method: A 28-day 3-arm double-blind placebo controlled adjunctive study of 27 women with mania was conducted. The 3 arms of the study involved: (1) 40 mg per day of oral tamoxifen, (2) 20 mg per day of oral progesterone, and (3) oral placebo capsule. All patients also received lithium carbonate as the baseline treatment. Manic symptoms and psychopathology were measured weekly using the CARS-M and PANSS rating scales together with estrogen, progesterone, and gonadotropin levels.
Results: Results showed a decline in the symptoms of mania and psychopathology in the Tamoxifen group compared with the progesterone and placebo groups. The Tamoxifen group also had significant changes in DHEA and estrogen, with significant correlation between estrogen and mania ratings.
Conclusion: The results suggest that Tamoxifen may be a useful adjunct in the treatment of acute manic symptoms in women with BPAD.
Keywords: Biological Psychiatry, Neuropsychiatry
423
PILOT IMPLEMENTATION OF AN ONLINE DISEASE MANAGEMENT SYSTEM FOR DEPRESSION WITHIN AUSTRALIA
Holly Exeter-Kent
Sentiens Pty Ltd, Australia
Lucy Robertson
Sentiens Pty Ltd, Australia
Michael Smith
Sentiens Pty Ltd, Australia
Dennis Tannenbaum
Sentiens Pty Ltd, Australia
Purpose: Healthcare resources are under increasing pressure to meet the needs of consumers with chronic diseases. Innovative healthcare solutions are required to meet demand whilst maintaining quality and containing costs. Chronic disease management systems are being widely used within the US and Europe and have been found to improve outcomes and reduce costs. The preliminary findings of a disease management system implemented in the Australian context are described.
Method: An online disease management system for depression, called RecoveryRoad, was implemented within mental healthcare in Western Australia. RecoveryRoad was available for use by consumers and clinicians to augment usual treatment. RecoveryRoad provided online systematic education and progress monitoring questionnaires with feedback. Other features were online evidence-based therapy, adherence reminders, an e-diary, and e-consultation and medical record systems.
Results: Clinicians reported finding RecoveryRoad helpful, although they tended to under-utilise the online features of the system. Consumers’ reported finding RecoveryRoad helpful. Their adherence to RecoveryRoad was high and appeared to be enhanced by personalised encouragement and support to use the system. Medication adherence amongst RecoveryRoad users was very high and clinical outcomes were positive.
Conclusions: The findings suggest that consumers and clinicians have a favourable view of online healthcare systems such as RecoveryRoad and warrant further research to determine whether such systems costeffectively augment usual treatment.
Keywords: Work and Voc Rehab, Social Psychiatry
424
NO MELANCHOLIA AND NO RESPONSE: AN INVESTIGATION OF THE CAUSES OF TREATMENT RESISTANT DEPRESSION
Gin S Malhi
The University of New South Wales, Australia
Gordon B Parker
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Joanna G Crawford
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Objective: To examine the correlates of treatment resistance in nonmelancholic depressed patients referred to a specialist mood disorders unit.
Method: A range of clinical variables were examined in a sub-sample of outpatients referred to a specialist Mood Disorders Unit (MDU). All 135 patients had a clinical diagnosis of non-melancholic depression. Information was collected from patients, referrers and assessors over a period of 32 months, and included evaluations of treatments trialled, treatment resistance and psychosocial variables. Data was analysed across trichotomised ‘high’, ‘low’ and ‘no’ treatment resistance (TR) groupings of patients.
Results: The high TR group was associated significantly with psychosocial variables, such as the proportion of patients reporting childhood sexual abuse, psychiatrist-rated severity of stressors and lack of necessary social supports or interventions, and patient-rated anxiety and ongoing personality difficulties. While the high and low TR groups had received a greater number of medications than the no TR group, and from a wider range of classes, there was no significant association between TR groups and the proportion of patients who had tried any psychological treatment.
Conclusion: We suggest that the assessment and treatment of nonmelancholic depressed patients take into consideration a range of psychosocial factors, and that psychological treatments should be initiated earlier and trialled in addition to pharmacological treatment.
Keywords: Biological Psychiatry, Neuropsychiatry
425
DEPRESSIVE SYMPTOMS IN A ‘HIDDEN’ POPULATION OF HEROIN USERS – RELATIONSHIP WITH DEPENDENCE SEVERITY AND ATTITUDES TO TREATMENT
Angela J Dean
Kids in Mind Research, Mater Child & Youth Mental Health Service and Department of Psychiatry, University of Queensland, Australia
John B Saunders
Centre for Drug & Alcohol Studies, Department of Psychiatry, University of Queensland, Australia
Background: Depression is common in opioid users. However, much knowledge of heroin users relies on samples from treatment or criminal justice facilities where problem users are heavily represented. This study examined the relationship between depressive symptoms and factors associated with treatment seeking and attitudes, in heroin users with no history of treatment.
Methods: Current heroin users who had never sought treatment for their heroin use were interviewed. Demographics, drug use patterns, risk taking and psychological functioning were assessed. The Beck Depression Inventory (BDI), Severity of Dependence Scale (SDS), Attitudes to Treatment Questionnaire (AtTQ) were administered.
Results: 69 subjects participated (52% male; mean age 28 years). Frequency of current heroin use ranged from yearly to daily, with the most frequent response being 1–2 times per week (32%). Mean BDI score was 16.4 (range 0–36). BDI scores correlated with dependence severity (p < 0.001), poor social functioning (p < 0.05); and were higher in subjects a diagnosis of dependence (p < 0.01), and those with a history of needle sharing (p = 0.072). Most subjects stated that the reason they didn’t seek treatment was because they didn’t need it (71%). Subjects with a higher level of depressive symptoms rated treatments as more attractive for themselves (p < 0.05), more beneficial for other users (p < 0.05) and the wider community (p < 0.05). Subjects with higher BDI scores considered buprenorphine maintenance more favourably as an option for themselves (p = 0.071), and more beneficial for other heroin users (p < 0.001) and the community (p < 0.001) compared to those with lower depressive symptoms.
Conclusions: Depressive symptoms are not just important for opiate users in treatment, but also for heroin users with no treatment history. Depressive symptoms may identify higher-risk heroin users who are more sympathetic to treatment. Increasing treatment options for opiate users may engage a larger group of heroin users within treatment services.
Keywords: Epidemiology, Aetiology, Other
426
THE BLACK DOG INSTITUTE DEPRESSION CLINIC: A SUB-TYPING MODEL IN PRACTICE
Gordon Parker
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Kathryn Fletcher
Black Dog Institute, Australia
Melissa Barrett
Black Dog Institute, Australia
Vijaya Manicavasagar
Black Dog Institute, Australia
Background: The new Depression Clinic commenced operation in February 2005, providing a state-wide assessment service. It accepts referrals from general practitioners and psychiatrists who wish to obtain diagnostic clarification and management advice in relation to their patient’s mood disorder.
Aim: The clinic has a novel clinical service model that rejects a dimensional model of depression (e.g. major vs. minor depression), and argues for the importance of clinically defining separate mood disorders in order to demonstrate their differential treatment outcomes. This paper describes clinic nuances and the impact on diagnosis and management.
Method: Patient assessment comprises three components – firstly, patients complete a computerized structured assessment (the Mood Assessment Program or MAP), collecting details about their history and depressive disorder. Secondly, a semi-structured interview by a psychiatrist is undertaken to clarify issues identified by the MAP, sharpen diagnostic decisions, and obtain a ‘picture’ of the patient over time. Thirdly, the psychiatrist presents the history in a clinical consensus conference involving a senior psychiatrist, senior psychologist and a research assistant. Diagnostic decisions are formulated based on patient history and the MAP report. A detailed report with treatment recommendations, incorporating both psychiatric and psychological perspectives, is sent to the referring clinician.
Results: Data (forthcoming) are presented on the diagnostic characteristics of the first 100 patients attending the Clinic in 2005, including the extent to which differing mood disorders were not previously diagnosed (formally or informally), while the types of diagnostic and therapeutic paradigm failures are quantified.
Keywords: Epidemiology, Aetiology, Other
427
DISGUST DISSECTS EMOTION: AN FMRI STUDY OF EUTHYMIC BIPOLAR PATIENTS USING FACIAL DISGUST STIMULI
Jim Lagopoulos
School of Psychiatry, University of New South Wales, Australia
Gin S Malhi
The University of New South Wales, Australia
Belinda Ivanovski
School of Psychiatry, University of New South Wales, Australia
Catherine Cahill
School of Psychiatry, University of New South Wales, Australia
Background: Facial expression stimuli are used extensively in cognitive neuroscience to study the processing of emotion in the brain. It is well established that specific expressions that signal behavioural cues, draw upon distinct neural circuits that are specialised for their evaluation. Disgust putatively constitutes a basic emotion and is believed to evoke innate, automatic behaviour. The expression of disgust, which is a form of threat, related to physical contamination, activates circumscribed neural circuits, which overlap with networks involved in the generation and modulation of mood. Hence, elucidating disgust processing may provide insight into the modulation of mood in bipolar disorder, and ultimately into its pathophysiology.
Methods: We conducted an fMRI study in eleven euthymic bipolar patients and 11 healthy controls matched for age and sex using a 3T Philips Intera scanner. Blood Oxygenated Level Dependant fMRI was employed to detect areas of the brain activated in response to facial emotions. Galvanic Skin Response (GSR) was simultaneously acquired and was used to partition neural epochs associated with neurophysiological arousal.
Results: Sub-averaging neural epochs on the basis of whether or not a GSR was elicited produced a differential pattern of activation for both the patients and controls. In both sub-averages controls subjects exhibited significant activations in several key frontal regions (superior and inferior frontal gyri). In contrast, the patients with bipolar disorder displayed a differential pattern of activation in response to disgust – recruiting subcortical structures (parahippocampal gyrus and caudate nucleus) to a greater extent with a notable absence of frontal activation.
Conclusion: The results from this study suggest that euthymic patients with bipolar disorder have impaired prefrontal function in relation to the processing of emotional content, in particular that related to disgust.
Keywords: Biological Psychiatry, Neuropsychiatry
428
REGULATION OF PRECURSOR/STEM CELL ACTIVITY BY PHYSICAL EXERCISE AND FLUOXETINE
Vibeke S Catts
Queensland Brain Institute, University of Queensland, Australia
Perry F Bartlett
Queensland Brain Institute, University of Queensland, Australia
Elizabeth J Coulson
Queensland Brain Institute, University of Queensland, Australia
Purpose: Adult hippocampal neurogenesis is stimulated by running and administration of the antidepressant fluoxetine. The aim of this study was to determine whether hippocampal neurogenenic activity affects neurosphere formation by hippocampal and subventricular zone (SVZ) precursor/stem cells.
Methods: Mice were given access to a running wheel for 12 consecutive days or were IP injected daily with fluoxetine (5 mg/kg/day) for 3, 14 or 28 consecutive days. The sphere forming frequency (SFF) of hippocampal and SVZ cells was assessed by limiting dilution assay and clonal assay, respectively.
Results: Mice with access to a running wheel ran an average of 3.7 km/mouse/day. Running mice had an equivalent SVZ SFF and sphere size to control mice. Hippocampal cells from running mice had a two-fold reduction in the SFF compared with control mice in two independent samples and significantly larger hippocampal spheres. These differences were not observed in B6 NGFR P75 knock-out mice. Mice treated with fluoxetine for 3. 14 or 28 days had an equivalent SVZ SFF to control mice. There was also no difference in the SVZ sphere size between fluoxetine treated and control mice, nor in the hippocampal sphere size. Whilst there was no significant difference between fluoxetine treated and control mice in the hippocampal SFF at 3 days and at 28 days, there was a significant decrease in the SFF for fluoxetine treated mice at 14 days.
Discussions: These results demonstrate a loss of precursor/stem cell sphere forming ability after 12 days of running and 14 days of fluoxetine treatment. The data from the running mice suggests that the regulation of the number of precursor/stem cells occurs through the p75 receptor. The fluoxetine data suggests that the pool of precursor/stem cells in the hippocampus are reactivated or replenished after sustained treatment with fluoxetine for 28 days.
Keywords: Biological Psychiatry, Neuropsychiatry
429
THE ASSOCIATION BETWEEN FRACTURE AND DEPRESSION IN WOMEN
Lana J Williams
The University of Melbourne, Australia
Margaret J Henry
The University of Melbourne, Australia
Felice N Jacka
The University of Melbourne, Australia
Michael Berk
The University of Melbourne, Australia
Mark A Kotowicz
The University of Melbourne, Australia
Geoff C Nicholson
The University of Melbourne, Australia
Julie A Pasco
The University of Melbourne, Australia
High levels of disability, functional impairment and mortality are associated with both fracture and depression. The aim of this study was to investigate the relationship between fracture and depression in a community sample of women.
Two samples of women aged <35 yr were drawn from the Geelong Osteoporosis Study. Eligible women with fracture (n = 519) identified prospectively from radiology reports and non-fracture controls (n = 970) were randomly selected from the electoral roll 1994–6. Symptoms of depression for both groups during the 12-month period 2000–1 were identified by self-report questionnaire based on the DSM-IV. Response rates were 57% and 61%, for women with fracture (n = 296, median age 63.0 yr, range 35–87) and women without fracture (n = 590, median age 59.3 yr, range 35–91), respectively.
Depression was identified in 29 women with and 67 women without fracture. Associations between fracture and depression differed for women < 70 yr and those <70 yr. Unadjusted OR (95% CI) for depression following fracture were 0.60 (0.35–1.02, p = 0.06) and 4.0 (1.32–12.11, p = 0.01), respectively. Adjusting for age, weight, height and smoking status did not affect the OR significantly.
We acknowledge that both selection and response biases may have excluded frail women with concurrent comorbidities. These results indicate that among elderly women, risk of depression is increased after fracture. By contrast, among younger women, risk of depression is not increased and may be reduced. This possibly reflects a different response to fracture but could also indicate differences in pre-morbid state among younger women.
Keywords: Biological Psychiatry, Neuropsychiatry
430
CONCEPTUALISING RESILIENCE IN ADULTHOOD
Tara Showyin
Black Dog Institute, Prince of Wales Hospital, Australia
Kay Wilhelm
Black Dog Institute, Australia
Lucy Wedgwood
Black Dog Institute, Australia
Tania Perich
Black Dog Institute, Australia
Purpose: There is a wide range of literature examining resilience in childhood and adolescence which attempts to identify the protective factors that promote resilience. However, literature on resilience in adulthood is sparse and definitions of resilience are unclear and overlap with similar concepts, including hardiness and post traumatic growth. A lack of DSM-IV Axis I diagnosis, in particular anxiety and depression, has also been linked with resilience. Our aim is to define and operationalise definitions of resilience in adulthood. Method: Part I reviews current definitions of resilience and related constructs in adulthood. Part II uses data from the Teachers’ Study, a longitudinal cohort of adults (109 women and 56 men) who have been followed since 1978. Participants reported on their experience of significant life events and whether these events made them more resilient or more vulnerable.
Results and Conclusions: Results will be presented with reference to a number of definitions of resilience and the need for clarification of the different concepts and definitions of resilience. It is envisaged that this will provide a greater understanding and a more applicable framework for the investigation of resilience in adulthood.
Keywords: Work and Voc Rehab, Social Psychiatry
431
QUALITY OF LIFE FOR AN AUSTRALIAN COMMUNITY COHORT OF BIPOLAR PATIENTS
Anthony R de Castella
Alfred Psychiatry Research Centre, The Alfred and Monash University, Department of Psychological Medicine, Australia
Michael Berk
Department of Clinical and Biomedical Sciences, The University of Melbourne, Australia
Paul B Fitzgerald
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Seetal Dodd
Department of Clinical and Biomedical Sciences, The University of Melbourne, Australia
Katarina Kelin
Eli Lilly Australia Pty Ltd, Australia
William Montgomery
Eli Lilly Australia Pty Ltd, Australia
Alan Brnabic
Clinical Outcomes and Research Institute, Eli Lilly Australia Pty Ltd, Australia
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Purpose: Any treatment strategy for bipolar disorder needs to consider on quality of life (QoL). Here we describe the QoL for patients at entry to the Bipolar Comprehensive Outcomes Study (BCOS).
Methods: BCOS is a non-interventional, naturalistic study of bipolar I and schizoaffective disorder (DSM-IV-TR) in Australia. Patient QoL is assessed every 3 months for 2 years using the EuroQol Instrument (EQ-5D), the 36-Item Short Form Health Survey (SF-36), and SLICE/LIFE. Baseline data for the first 120 patients enrolled have been analysed.
Results: The average EQ-5D visual analogue score for patients entering the study was 66+20 (mean+SD, best imaginable health state score 100), with a utility score of 0.8+0.3 (mean+SD, perfect health score 1). However, a more detailed examination of mobility, self-care, performance of usual activities, pain/discomfort, and anxiety/depression revealed functional impairment.
Standardised SF-36 scores were 36.6+12.6 for overall mental score with a physical score of 46.8+10.5 (mean+SD, best possible score 100 for both). In the past 3 months, 43% of patients were satisfied with their life in general, and 32% were dissatisfied. Over the same period, mental illness prevented 19% of patients from working, and 6% from carrying out household duties.
Conclusion: Patients with bipolar disorder experience functional impairment and diminished QoL.
Keywords: Work and Voc Rehab, Social Psychiatry
432
ALCOHOL AND OTHER DRUG USE DISORDERS CO-MORBID WITH PSYCHOSIS, DEPRESSION AND ANXIETY: TREATMENT OUTCOMES (TOES PROJECT)
Agatha Conrad
Centre for Mental Health Studies, University of Newcastle, Australia
Terry Lewin
Centre for Mental Health Studies, University of Newcastle, Australia
Vaughan Carr
Centre for Mental Health Studies, University of Newcastle, Australia
Margarett Terry
Dual Diagnosis Service, Hunter New England Mental Health, Australia
Andrew Taylor
Dual Diagnosis Service, Hunter New England Mental Health, Australia
Amanda Baker
Centre for Mental Health Studies, University of Newcastle, Australia
Angela Dunbar
Centre for Mental Health Studies, University of Newcastle, Australia
Purpose: It is well recognised that there are high rates of comorbidity of mental illness and substance use disorders. The National Survey of Mental Health and Well-being reported a significant relationship between cannabis, alcohol dependence and anxiety disorders and depression. People who meet criteria for an anxiety disorder, depression or psychosis in addition to meeting criteria for alcohol and drug use disorders tend to have a poorer prognosis and greater utilisation of mental health services. The current service evaluation project examined the characteristics and patterns of movement of clients presenting to these services: conventional drug and alcohol services, community mental health services and a specialist dual diagnosis service.
Method: This project comprised three stages:
a) Client Surveys at service intake – ‘Client Self report Surveys’ were routinely collected prior to the initial individual clinical assessments.
b) Service Audit – a 12-month service audit was conducted which included data from across the mental health and drug and alcohol participating services from June 2003 to July 2004.
c) Three Month Interviews – follow-up interviews were conducted with a sample of patients who completed the self-report surveys and with a sample of patients (identified with dual diagnosis) seen by the services in the last two months of the audit (June–July, 2004). At the three-month interviews, components of the ‘Client Survey’ were re-administered, together with a semi-structured interview.
Results: There were 134 participants who completed the initial Client survey and 147 who were interviewed. Participant profiles will be reported including service retention and satisfaction patterns and correlates.
Conclusions: Findings from this project will allow us to better understand the pattern of movement of clients between services, their treatment needs and clinical characteristics.
Keywords: Biological Psychiatry, Neuropsychiatry
433
THE BLACK DOG INSTITUTE BIPOLAR DISORDERS CLINIC – DESCRIPTION OF A DATASET
Amy K Johnston
School of Psychiatry, The University of New South Wales, and The Black Dog Institute, Australia
Philip B Mitchell
University of New South Wales, The Black Dog Institute, Australia
Gin S Malhi
The University of New South Wales, Australia
Justine Corry
School of Psychiatry, UNSW & Black Dog Institute, Australia
Laila Tabassum
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Purpose: Bipolar disorder has been ranked as the world’s sixth greatest cause of medical disability. Given the disorder’s low population prevalence, specialist clinical services provide an excellent opportunity to collect the detailed data required to examine the phenomenology and course of this disabling condition. This report describes the major demographic and clinical features of a sample of bipolar patients seen in a tertiary, specialist clinic.
Methods: 264 patients were assessed at the Black Dog Institute Bipolar Disorders Clinic. Lifetime and current DSM-IV diagnosis of bipolar disorder was established by The Diagnostic Interview for Genetic Studies and the Structured Clinical Interview for DSM-IV. Patients provided detailed information through a self-report questionnaire and a clinician administered semi-structured interview. Blood was taken for genotyping and a proportion had structural MRI scans. Descriptive analysis was performed to elucidate key demographic and clinical features of the sample and to enable comparisons with other cohorts of bipolar patients.
Results: 217 (82.2%) patients assessed in the clinic had a confirmed DSM-IV lifetime diagnosis of bipolar disorder. Of this group, 55% were female, the mean age was 38.5 (SD 12.6) and 38% had never been married. 24% of patients were in full-time employment and a further 16% part-time. Over 60% of patients had some further education in addition to a higher school certificate. The mean age of onset was 22 years (SD 8.05). At the time of assessment a third of patients were experiencing major depression and a further 9% were experiencing hypomania, mania or a mixed episode. All but one of the patients was receiving pharmacological treatment. 41% of patients reported a lifetime suicide attempt and a further 9% reported self-harm without suicidal intent.
Conclusions: Data collected through the Black Dog Institute Bipolar Disorders Clinic comprises one of the largest specialist bipolar disorder clinical samples in the literature. Analyses indicate findings comparable to epidemiologic and clinical samples in terms of key demographic and clinical variables. This dataset provides a valuable resource for bipolar disorder research.
Keywords: Epidemiology, Aetiology, Other
434
LOW DOSE QUETIAPINE: A NEW APPROACH IN THE MANAGEMENT OF ANXIETY STATES
Peter D Norrie
Department of Health and Human Services Tasmania, Australia
There is proven benefit in the use of novel antipsychotics for treating schizophrenia – evidenced in improved quality of life, reduced side effect profile and patient satisfaction. Steadily these medications are being used successfully in psychotic conditions other than schizophrenia, or where psychotic symptoms reflect an alternative presentation to schizophrenia. Quetiapine, a novel antipsychotic with relatively strong histaminergic receptor affinity profiles as a medication, which can be used in situations where significant allied symptoms such as acute/chronic agitation or unremitting anxiety occur. This can be in the context of a psychotic illness or even possibly where the symptoms stand alone as part of another major psychiatric diagnosis.
Traditionally the management of anxiety and agitation has relied on the use of medications of the benzodiazepine class. Benzodiazepines (introduced in the early 1960s) have found both favour and disrepute. Their action is no doubt reliable and effective in the acute situation but tolerance often develops with lessening of efficacy. Subsequently problems of dependence and abuse can occur compounding the already disabling recurring symptoms of anxiety. Thus continuing use is uncommon and requires cautious review and monitoring. In the intermediate and long term, anxiety patients often have an unsatisfactory response with benzodiazepines.
This presentation highlights four different case scenarios where Quetiapine treatment has been useful. The descriptions are naturally subjective, as is the common feature of case reports. To this author’s knowledge there are no reports thus far in the literature of the evaluation of this treatment. The patients’ improvement however has been most encouraging.
Keywords: Biological Psychiatry, Neuropsychiatry
435
UNDER PRESSURE: COPING STRATEGIES USED FOR STRESS
Jennifer E Siegel
Black Dog Institute, Prince of Wales Hospital, Australia
Kay Wilhelm
St Vincents Hospital, Australia
Gordon B Parker
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Dusan Hadzi-Pavlovic
The University of New South Wales, Australia
Adam Finch
Black Dog Institute, Australia
Background: There are well established links between stress and the onset of major depression (MD). Some people appear more vulnerable to stress than others and it has been suggested that coping mechanisms might mediate stress and alter depression risk.
Aim: This study focuses on the coping strategies used to combat stress and the impact these have on MD.
Method: A longitudinal cohort of 165 participants, followed for over 25 years, recorded lifetime histories of MD. In 1993, an analysis was taken of the coping mechanisms used by these participants to ameliorate stress. An exploratory factor analysis was then carried out to categorise coping strategies. Analyses compared what coping strategies were used for those with and without MD.
Results: Analyses yielded four coping factors, problem solving, anger expression, internal emotional regulation, and distraction/changing focus. Non-MD groups used significantly more problem solving and less internal emotional regulation strategies compared to MD groups. Anger expression and distraction/changing focus use were not significantly different between these groups.
Conclusions: Not all coping strategies are the same. The affect stress has on MD seemed to be decreased by problem solving activities and increased by internal emotional regulation. Anger expression and dis-traction/changing focus demonstrated no influence on MD outcome. It is important to focus on successful coping strategies to combat the affects of stress on depression.
Keywords: Work and Voc Rehab, Social Psychiatry
436
USING EMOTIONALLY EXPRESSIVE WRITING AS AN INTERVENTION FOR SELF-HARMING PATIENTS
Adam W Finch
Black Dog Institute, University of New South Wales, Australia
Kay Wilhelm
Black Dog Institute, University of New South Wales, Australia
Karen Baikie
Black Dog Institute, UNSW, Australia
Purpose: Studies employing non-clinical populations have consistently shown that writing about one’s thoughts and feelings associated with stressful or traumatic experiences leads to improvements in psychological and physical health. Patterns of word use in writing have been found to predict changes in health and have also been linked to certain personality styles. However there have been relatively few investigations on the use of expressive writing in psychiatric populations, with those available providing mixed results. This study aimed to examine the physical and psychological health benefits of expressive writing, associated word use and personality, in patients referred for psychiatric intervention following an episode of deliberate self-harm (DSH). Prevalence of DSH, the risk of eventual suicide and high non-compliance rates highlight the need for brief and available interventions for this group.
Method: Participants were recruited from a patient population who were referred to a hospital-based psychiatric clinic for follow up intervention after presenting to the emergency department with DSH. The DASS-21 and SF-12 measures and the Personality and Temperament Questionnaire (short version) were completed at first consultation and participants were asked to explore their feelings in writing for 15 minutes on four consecutive days about a stressful or traumatic experience of their choice.
Results: To date, more than half (n = 42) of all DSH patients attending the clinic agreed to participant in the study. Twenty-five participants returned their writing entries at second session and seven have completed third session post measures of the DASS-21 and SF-12. Results will be presented, and the use of expressive writing as an intervention following DSH and the relationship between writing and personality will be discussed.
Keywords: Work and Voc Rehab, Social Psychiatry
437
SPATIAL WORKING MEMORY AND OLFACTORY IDENTIFICATION IN MONOZYGOTIC TWINS DISCORDANT FOR BIPOLAR DISORDER: PRELIMINARY RESULTS
Alex Fornito
Melbourne Neuropsychiatry Centre, Department of Psychiatry & Department of Psychology, School of Behavioural Science, University of Melbourne, Australia
Stephen Wood
Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
Murat Yücel
Melbourne Neuropsychiatry Centre and Orygen Research Centre, Department of Psychiatry, The University of Melbourne, Australia
Carlyn Muir
Melbourne Neuropsychiatry Centre, Dept. of Psychiatry, The University of Melbourne and QCMHR, The University of Queensland, Australia
Karen Shaw
Melbourne Neuropsychiatry Centre, Dept. of Psychiatry, The University of Melbourne and QCMHR, The University of Queensland, Australia
Lauren Hoiles
Melbourne Neuropsychiatry Centre, Dept. of Psychiatry, The University of Melbourne and QCMHR, The University of Queensland, Australia
Louisa Windus
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, The University of Queensland, Australia
Dominique Hannah
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, The University of Queensland, Australia
Deb Nertney
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, The University of Queensland, Australia
John McGrath
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, The University of Queensland, Australia
Bryan Mowry
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, The University of Queensland, Australia
Christos Pantelis
Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
Recent research identifying common susceptibility genes for schizophrenia and bipolar disorder (BPD) suggests the disorders may have common endophenotypic markers. Spatial Working Memory (SWM) and olfactory identification deficits have previously been identified as potential endophenotypes for schizophrenia, but have not been well investigated in BPD. Studying monozygotic (MZ) twins discordant for bipolar disorder provides an excellent opportunity to identify candidate endophenotypes, as abnormal performance in the unaffected co-twin of a patient may represent a marker of genetic vulnerability to the illness. We administered the SWM subtest of the CANTAB and the University of Pennsylvania Smell identification Test (UPSIT) to 6 pairs of MZ twins discordant for BPD and 6 MZ healthy control twin pairs. For the SWM task, both the BPD patients and their unaffected cotwins performed significantly worse than controls, with no significant within-twin pair differences. This suggests that SWM deficits vary with genetic liability to BPD, with minimal additional impairments caused by illness onset. No significant performance differences were identified on the USPIT, suggesting olfactory identification has limited sensitivity as an endophenotypic marker for BPD. These preliminary data indicate that SWM performance may be a marker of genetic susceptibility to BPD.
Keywords: Biological Psychiatry, Neuropsychiatry
438
WHAT DO WE KNOW ABOUT SUICIDE INTERVENTION? A DELPHI STUDY
Claire M Kelly
ORYGEN Research Centre, University of Melbourne, Australia
Anthony F Jorm
ORYGEN Research Centre, University of Melbourne, Australia
Betty A Kitchener
ORYGEN Research Centre, University of Melbourne, Australia
Background: There a great many difficulties associated with doing randomised controlled trials to determine effective strategies for intervening while someone is suicidal. While suicide is a rare event, thoughts of suicide and suicide attempts are not. There are a number of courses teaching suicide intervention, aimed at the public, as well as social workers, counsellors and the like. These courses are generally developed based on unproven models and best guesses, in the absence of strong evidence.
Aim: To develop consensus guidelines for a member of the public intervening when someone is suicidal, in order to register standards for use in mental health first aid, suicide first aid and other relevant courses designed for the public.
Method: For this Delphi study, the author has gathered claims made both in the medical literature and in lay literature such as commonly accessed websites, carers’ manuals and self help books. Content analysis was applied to the wording of the claims and recommendation. Questionnaires were developed to elicit the opinions of participants on the acceptability and likely benefit of the described interventions.
Participants: Experts including clinicians, researchers, consumers and carers from English-speaking western cultures.
Results: Preliminary results will be discussed.
Keywords: Work and Voc Rehab, Social Psychiatry
439
PSYCHOLOGICAL STRESS ENHANCES THE ANTIDEPRESSANT-LIKE EFFECT OF BUSPIRONE
Noppamars Wongwitdecha
Department of Pharmacology, Faculty of Science & Institute of Science & Technology for Research & Development, Mahidol University, Thailand
Paungpayom Panya
Department of Pharmacology, Faculty of Science & Institute of Science & Technology for Research & Development, Mahidol University, Thailand
Psychologiacal stress such as social isolation in the early stages of life has been shown to alter a variety of behaviours of the adult animal and the responsitivity to psychotropic drugs. In the present experiments, we compared isolation and socially reared rats in three complementary paradigms for assessing responding to the forced swimming test. Both isolation and socially reared rats were exposed to the swimming test: 1) without drug pretreatment; 2) following acute systemic administration of a 5-HT1A partial agonist, busipirone (0.5; 1 and 5 mg/kg i.p.) or saline; 3) following chronic injected with buspirone (0.5 mg/kg i.p.) or saline. Male Wistar rats were raised from weaning either alone (isolation rearing) or in groups of six rats/cage (social rearing). Four weeks later, these rats were tested for their sensitivity to buspirone using the forced swimming test. The results demonstrate that the isolation reared rats showed significantly less immobility time and more struggling than the socially reared rats. Buspirone (0.5 mg/kg i.p.) caused antidepressant-like effect (a marked decrease in immobility time and increase in struggling) compared to the saline treated group. These effects were significantly greater in the isolation reared rats than the socially reared rats. In chronic experiments, in which all rats were repeatedly injected for 7, 14, 21 and 28 days, the buspirone treated rats (both isolation and socially reared rats) still showed significantly less immobility time and more struggling than the saline treated groups. These responses were greater in isolation compared to socially reared rats. The results suggest that rearing in isolation may produce some of its behavioral effects through central serotonergic mechanisms, and that 5-HT1A receptor may be involved in behavioral despair.
501
USING TRANSCRANIAL MAGNETIC STIMULATION TO INVESTIGATE THE CORTICAL ORIGINS OF MOTOR OVERFLOW IN SCHIZOPHRENIA
Kate E Hoy
The Alfred Hospital, Alfred Psychiatry Research Centre, The Alfred and Monash University, Department of Psychological Medicine and Experimental Neuropsychology Research Unit, School of Psychology, Psychiatry and Psychological Medicine, Monash University, Australia
Paul B Fitzgerald
The Alfred Hospital, Alfred Psychiatry Research Centre, The Alfred and Monash University, Department of Psychological Medicine, Australia
Nellie Georgiou-Karistianis
Experimental Neuropsychology Research Unit, School of Psychology, Psychiatry and Psychological Medicine, Monash University, Australia
Background: Previous research has strongly suggested the presence of exacerbated motor overflow in schizophrenia. There are essentially two theories regarding the cortical origins of motor overflow. Recent research suggests that both may be correct, and that the cortical origin of overflow is highly dependent upon the specific population in which it presents. Motor overflow, due to an abnormally active ipsilateral corticospinal tract, may indicate a potentially severe congenital brain abnormality. Bilaterally-active contralateral corticospinal tracts may also account for overflow possibly indicating either a developmental lag or simply a naturally-occurring response during fatiguing contractions. The current study aimed to investigate which of these theories is responsible for the presence of exacerbated motor overflow in schizophrenia.
Method: Data from 10 patients with schizophrenia and 10 age-matched controls are presented. Through the use of a number of TMS protocols the origins of motor overflow in both the patient group and the control group were investigated under effort induced conditions. Clinical symptoms were also assessed.
Results: Results indicate that the cortical origins of motor overflow in schizophrenia are the same as those observed in normals; that is, motor overflow seems to be due to the presence of bilaterally active contralateral corticospinal tracts.
Conclusions: The study indicates that the observed motor overflow occurrence in both groups under effort induced conditions is essentially the result of bilaterally-active contralateral corticospinal tracts. The presence of exacerbated overflow in schizophrenia is likely to be due to increased cortical excitability.
Keywords: Biological Psychiatry, Neuropsychiatry
502
IMPACT OF SUBSTANCE USE ON ATTRITION AND MEDICATION SWITCHING IN AN EFFECTIVENESS TRIAL FOR INDIVIDUALS WITH SCHIZOPHRENIA
David Smelson
UMDNJ-Robert Wood Johnson Medical School, United States
Allen W Nyhuis
Eli Lilly and Company, United States
Douglas E Faries
Eli Lilly and Company, United States
Sandra L Tunis
Eli Lilly and Company, United States
Haya Ascher-Svanum
Eli Lilly and Company, United States
William S Montgomery
Eli Lilly Australia Pty Ltd, Australia
Background: Clinical trials involving individuals with schizophrenia often exclude those with co-occurring substance abuse. This is unfortunate given that between 50–70% of individuals with schizophrenia abuse substances, which results in a more severe illness course and increased service utilization compared to those who do not use. This study compared the rates of trial discontinuation and medication switching among individuals with schizophrenia, with and without co-occurring substance use.
Methods: In a randomized open-label, 1-year effectiveness trial comparing olanzapine, risperidone and conventional antipsychotics, 236 individuals reported using substances at baseline, while 394 did not. Patients were further subgrouped by substance of abuse, and compared on time to trial discontinuation and medication switching using survival analyses adjusted for baseline characteristics.
Results: Substance users were more often male, younger, with shorter psychiatric history than non-substance users. Substance users had significantly shorter times to study discontinuation across all abused substances (p <.001) and across all three treatment groups (p <.006 within each treatment group). Individuals using cocaine had the highest 6-month discontinuation rates, whereas cannabis had the highest 1-year rates. Among all substance users, time to all-cause discontinuation of the randomized medication (study discontinuing or switching antipsychotics) was significantly longer for those randomized to olanzapine compared to conventional antipsychotics (p ≤.001) or risperidone (p =.034).
Conclusions: Individuals with co-occurring substance use are prone to significantly greater treatment discontinuation than non-substance users. Interestingly, among the substance users, treatments with particular antipsychotics appear to be associated with longer time to all-cause medication discontinuation.
Keywords: Biological Psychiatry, Neuropsychiatry
503
FUNCTIONAL BRAIN IMAGING OF AUDITORY PREPULSE INHIBITION
Timothy W Budd
School of Behavioural Sciences, University of Newcastle, Australia
Linda E Campbell
Centre for Mental Health Studies, University of Newcastle, Australia
Patrick J Johnston
Centre for Mental Health Studies, University of Newcastle, Australia
Mary-Claire Hanlon
Centre for Mental Health Studies, University of Newcastle, Australia
Frini Karayanidis
School of Behavioural Sciences, University of Newcastle, Australia
Ulrich Schall
Centre for Mental Health Studies, University of Newcastle, Australia
Background: Inhibition deficits have been consistently demonstrated in a broad spectrum of neuropsychiatric conditions where altered dopamine neurotransmission has been implicated. This is thought to result in impaired ‘sensory motor gating’, a physiological measure of inhibitory brain processes. Previous and current studies by our group suggest attention modulation of sensory motor gating and its impairment in schizophrenia (Bender et al., 1999), obsessive-compulsive disorders (Schall et al., 1996), and pathological gambling (Stojanov et al., 2003). Study Rational: Traditionally, sensory motor gating is measured using prepulse inhibition of the acoustic startle eye-blink response. However, this measure is limited in terms of assessing individual elements of the neural networks underlying sensory motor gating. Functional brain imaging, on the other hand, offers the potential to address these limitations. Methods and Results: Our pilot Positron Emission Tomography data indicate increased prefrontal regional cerebral blood flow (rCBF) in association with a prepulse presented at short lead intervals (i.e. 120 ms) when compared to a no-prepulse baseline and a 480 ms prepulse condition, respectively. By contrast, rCBF in the primary auditory cortex followed the opposite pattern, thus resembling the responses assessed by the auditory startle eye-blink reflex. This pattern of activation was partially confirmed when adapting the procedure to the magnet resonance-imaging environment. Conclusion: Our findings suggest a fronto-temporal mechanism of cortical prepulse inhibition, which may help to explain attention modulation effects and its impairment in various neuropsychiatric conditions. (Supported by NH & MRC project grant 351129, University of Newcastle project grant and infrastructure support of NSW Health through the Hunter Medical Research Institute and the Neuroscience Institute of Schizophrenia and Allied Disorders).
Keywords: Biological Psychiatry, Neuropsychiatry
504
THE REPEATABLE BATTERY FOR THE ASSESSMENT OF NEUROPSYCHOLOGICAL STATUS (RBANS): NORMATIVE DATA FOR AUSTRALIAN ADULTS
Alisa Green
Department of Pathology, University of Sydney, Australia
Therese Garrick
The University of Sydney, Australia
Donna Sheedy
Australia
Helen Blake
University of Sydney, Australia
Clive Harper
Royal Prince Alfred Hospital, Australia
Purpose: To provide preliminary normative data for the RBANS in an Australian sample for use with psychiatric populations.
Background: Studies of individuals with psychiatric illness indicate that cognitive impairment is often a prominent feature of the illness. Unfortunately, traditional neuropsychological batteries are often quite extensive, limiting their use with psychiatric populations, and brief screening tools are often insensitive to milder degrees of impairment. The RBANS is a new screening instrument that attempts to overcome these limitations. The RBANS assesses the cognitive domains of memory, attention, processing speed, visuospatial skills and language abilities. Preliminary studies indicate that the RBANS has good convergent validity, test-retest stability, sensitivity and specificity. As yet there is no normative data for the RBANS in an Australian context. This is despite several recent studies showing that Australian samples may differ from other English speaking populations on traditional neuropsychological measures.
Method: Healthy control subjects (N = 241) completed the RBANS (Part B) as part of joining the “Using our Brains” tissue donor program. This program invites members of the general community to donate their brain to medical research in life. Means and standard deviations were calculated across six age bands.
Results: Analysis of the results of the Australian normative study revealed higher performance across a number of RBANS measures relative to that of the standardization sample from the United States of America, with differences as large as 11 points on language tasks.
Conclusion: This study highlights the need to take into consideration cultural differences even amongst other English speaking populations when interpreting RBANS test results. Clinical implications of these findings will be discussed.
Keywords: Epidemiology, Aetiology, Other
505
BLOOD UREA NITROGEN VALUES IN THE PATIENTS WITH SCHIZOPHRENIA
Masatomo Suetsugi
Department of Neuroscience, Yamaguchi University School of Medicine, Japan
Yasushi Mizuki
Yamaguchi Mental Health Medical Center, Japan
Takeya Aoki
Yamaguchi Mental Health Medical Center, Japan
Kumiko Hara
Division of Neuropsychiatry, Yamaguchi University School of Medicine, Japan
Yoshifumi Watanabe
Department of Neuroscience, Yamaguchi University School of Medicine, Japan
In some patients with schizophrenia, the antipsychotics prescribed induce the depletion of blood urea nitrogen (BUN). However, the mechanism of that phenomenon is not clear. In this study, we examined BUN values, performed quantitative EEG analysis, and carried out PANSS evaluations for schizophrenic patients. Patients were hospitalized during 2004 and 2005 at the Shimonoseki Hospital. Schizophrenia was diagnosed by two independent psychiatrists according to DSM-IV criteria. Subjects with any type of physical disorder were excluded. Informed consent was obtained from all subjects. The study groups consisted of 8 subjects who exhibited depletion of BUN values (BUN depletion group), 8 subjects in whom the antipsychotic did not reduce the BUN values (BUN non-depletion group), and 8 age matched healthy control subjects. Each patient was treated with antipsychotic drugs for a year or more prior to having blood drawn. EEG recording was performed in the morning (between 9:00 and 11:00 h). A 60-s period (free artefact) was selected from the recording for the fast Fourier transformation (FFT) procedure. Data were analyzed using the RHYTHM program. The 2 and 30 Hz frequency range was split up into six frequency bands (delta 2–4 Hz, theta 4–8 Hz, alpha 1 8–10 Hz, alpha 2 10–13 Hz, beta 1 13– 20 Hz, beta 2 20–30 Hz). The international 10/20 electrode system was used to position 16 electrodes (Fp1, Fp2, F3, F4, C3, C4, P3, P4, O1, O2, F7, F8, T3, T4, Fz, Pz). There were no differences in the duration of illness and the amount of antipsychotics administration between the BUN depletion group and the BUN non-depletion group. The BUN non-depletion group showed higher positive and negative symptoms, and higher delta and theta power in the frontal regions than the BUN depletion group and control group. The present study showed that the depletion of BUN values after antipsychotic medication could be used as a favorable biomarker in schizophrenics.
Keywords: Biological Psychiatry, Neuropsychiatry
506
CHRONIC CATATONIA, NEGATIVE SYMPTOMS AND RESPONSE TO SELEGILINE AND AMANTADINE
Joseph W Y Lee
Graylands Hospital and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia
Purpose: There is significant overlap between catatonic stupor and schizophrenic negative symptoms in symptomatology, treatment response and putative pathophysiology. This study examines in a case series of chronic catatonic schizophrenia the co-occurrence of catatonic and negative symptoms and their responses to Selegiline (an MAOB inhibitor) and Amantadine (an NMDA antagonist), and explores the relationship between catatonic stupor and schizophrenic negative symptoms.
Methods: Seven patients (9 episodes) with schizophrenia (DSM IV) presented in a chronic stuporous (retarded) catatonic state associated with prominent negative symptoms. In all of them negative symptoms progressed insidiously over months or years into catatonic stupor. Their catatonic and negative symptoms showed minimal responses to lorazepam and various antipsychotics. They were treated with either amantadine (5 episodes) or selegiline (4 episodes). Their responses were monitored by using the Bush-Francis Catatonia Rating Scale, Negative Syndrome Scale of the Positive and Negative Syndrome Scale, Simpson Angus Scale, and Clinical Global Impression.
Results: 7 episodes (4 selegiline, 3 amantadine) showed prompt resolution of catatonic symptoms and substantial improvement in negative symptoms within 1 to 2 weeks. In 1 episode, catatonic symptoms responded to amantadine but negative symptoms remained unchanged. Two episodes in 1 patient resulted in exacerbation of psychotic symptoms with either selegiline or amantadine.
Conclusions: Catatonic stupor was associated with prominent negative symptoms in this case series. Both catatonic and negative symptoms responded to selegiline or amantadine, supportive of the hypothesized pathophysiology of D2 hypoactivity and glutamate dysregulation for catatonic and negative symptoms in schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
507
NEUROLEPTIC-INDUCED CATATONIA: CLINICAL PRESENTATION AND TREATMENT RESPONSE
Joseph W Y Lee
Graylands Hospital and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia
Purpose: Neuroleptic-induced catatonia (NIC) is a rare reaction to antipsychotic medications sparsely reported in the literature. This study examines the clinical presentation and treatment response in 18 episodes of NIC, and explores the relationship between NIC and neuroleptic malignant syndrome (NMS).
Methods: 18 episodes of NIC were prospectively identified. The catatonia episodes associated with prominent extrapyramidal symptoms developed following exposure to antipsychotics. Catatonia was diagnosed based on research criteria. All were treated with benzodiazepines. The NIC episodes were analysed noting their catatonic, extrapyramidal, and associated symptoms, laboratory findings, and responses to benzodiazepines and other treatments.
Results: The catatonic syndrome, predominantly in the retarded (stuporous) form (78%), was associated with parkinsonism in 15, both parkinsonism and dystonia in 2, and recurrent dystonia in 1. The duration of antipsychotic treatment at the onset of symptoms was 1–21 days (mean = 7.9,S.D = 5.85). High potency antipsychotics were involved in 15 (4 depot); risperidone was implicated in 3. Delirium (56%), autonomic abnormality (44%), urinary incontinence (28%), ataxia (44%), dyarthria (50%), dysphagia (28%), elevated serum creatine phosphokinase (75%), low serum iron (50%), and leukocytosis (28%) were all common. NMS was diagnosed in 3 episodes (17%). 14 (78%) showed full responses to benzodiazepines. 3 with partial responses responded promptly to amantadine.
Conclusions: NIC manifests predominantly in a stuporous parkinsonian-catatonic syndrome. Benzodiazepines and amantadine are effective in the treatment of NIC. NIC and NMS show considerable overlap in presentation, laboratory findings and treatments, supporting the hypothesis that they are disorders on the same spectrum.
Keywords: Biological Psychiatry, Neuropsychiatry
508
THE ESTROGEN 100
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Suzette Sheppard
Alfred Psychiatry Research Centre, Australia
Simone White
Alfred Psychiatry Research Centre, Australia
Cali Bartholomeusz
Alfred Psychiatry Research Centre, Australia
Kathryn Garland
Alfred Psychiatry Research Centre, Australia
Anthony de Castella
Alfred Psychiatry Research Centre, Australia
Paul Fitzgerald
Alfred Psychiatry Research Centre, Deputy Director, Australia
Aim: To compare the efficacy of adjunctive 100 mcg transdermal estradiol with adjunctive placebo in the treatment of acute psychotic symptoms in 100 women with schizophrenia.
Background: Estrogen has been shown in animal studies to have dopamine down-regulation effects and has also been shown to impact the serotonergic system. Additionally, there are clinical case reports of women whose schizophrenic symptomatology is exacerbated at low estrogen phases of the menstrual cycle. Similarly, there are clinical case reports of women with chronic schizophrenia improving during pregnancy when estrogen levels are extremely high.
Methods: A double blind 28-day placebo controlled adjunctive study was conducted comprising two groups of women of child-bearing age. While one group of women received 100 mcg transdermal estradiol the other group received transdermal placebo. The differences in psychopathology between the two groups were subsequently compared. Hormone, psychopathology, and cognitive assessments were performed routinely throughout the four week trial period.
Results: Using the PANSS rating scale it was noted that women receiving 100 mcg estradiol improved significantly more in terms of their psychotic symptoms compared to women receiving placebo. Women on estradiol also improved significantly in verbal memory however their visual memory significantly declined.
Conclusion: Estradiol appears to be a useful treatment for women with schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
509
REDUCED TEMPORAL LOBE ACTIVATION IN SCHIZOPHRENIA PATIENTS PERFORMING AN IMPLICIT MEMORY TASK
Patrick J Johnston
Centre for Mental Health Studies, University of Newcastle, Australia
Ulrich A Schall
Centre for Mental Health Studies, University of Newcastle, Australia
Eric Halgren
Department of Radiology, Massachussetts General Hospital, United States
Patients with schizophrenia (SZ) show problems in short term memory that may be associated with dysfunction of medial temporal lobe structures, particularly the hippocampal formation. In this study, BOLD fMRI activation to an implicit memory task was assessed in 10 SZ patients and 10 controls. Subjects were visually presented with a series of word stimuli representing animals (i.e. “cat”) or objects (i.e. “table”). Explicitly, the task was to make a size judgement, pressing a button if they evaluated the animal/object as exceeding 30cm in any dimension. Before the experiment subjects had a practice session during which they were pre-exposed to a subset of stimuli, which were repeated a number of times throughout the experiment. Other stimuli were presented only once during the experiment. The manipulation of interest was whether brain activation to repeated words differed from brain activation to novel words. Each subject performed 4 runs of the task, during which a total of 320EPI brain volumes were acquired. Statistical contrasts were performed comparing brain activation to words versus fixation, and comparing novel to repeated words across groups. Analysis of a subset of 5 controls and 5 SZ patients showed activation to words in the occipito-temporal junction, middle occipital gyrus, inferior frontal gyrus, anterior cingulate and precuneus. Healthy subjects showed greater activation to novel words versus repeated words in the occipito-temporal junction, inferior frontal gyrus, and bilaterally in the region of hippocampal formation. Repeated words elicited greater activation in the inferior temporal gyrus and posterior cingulate. For novel words, SZ patients showed a pattern of highly similar to controls. However, patients showed no increased activation to novel words in the occipito-temporal junction, inferior frontal gyrus or hippocampal region. Patients also showed greater activation to repeated words in regions of the temporal, parietal and frontal cortices. It is suggested that these differences suggest a reduced ability to distinguish between novel and repeated stimuli in SZ patients, possibly reflecting problems in implicit memory encoding or retrieval processes.
Keywords: Biological Psychiatry, Neuropsychiatry
510
PREDICTORS OF OUTCOME 2–3 YEARS AFTER DIAGNOSIS OF FIRST EPISODE PSYCHOSIS
Sara K Lucas
Department of Medical Psychology, Westmead Hospital and Macquarie University, Australia
M A Redoblado-Hodge
Department of Child and Adolescent Psychiatry, Westmead Hospital, Australia
Dianne Fitzgerald
Department of Child and Adolescent Psychiatry, Westmead Hospital, Australia
John Brennan
Department of Child and Adolescent Psychiatry, Westmead Hospital, Australia
Anthony Harris
Department of Psychiatry, Westmead Hospital & University of Sydney, Australia
Examination of the course of the illness in first episode psychosis (FEP) has been an area of burgeoning research over the past 10 to 15 years. The hope is that by increasing our understanding of the early stages of psychosis, we can improve longer-term outcomes. Identifying the indicators of prognostic outcome in FEP is also likely to be very helpful when providing the families of these young people with information about the potential for recovery, as well as in identifying targets for rehabilitation. The Western Sydney First Episode Psychosis Group began collecting data in young people (aged 13 to 25) presenting with newly diagnosed psychosis in 1999. Ninety-four participants were tested at baseline, and 54 returned for 2–3 year follow up. This study aimed to determine which of demographic, psychiatric or neuropsychological factors best predict functional outcome at 2 to 3 years after a first episode of psychotic illness. Outcome was measured using two measures: the Social and Occupational Functioning Assessment Scale (SOFAS) from DSM-IV and the Clinical Global Impression Scale – severity of illness measure (CGI). Multiple regression analyses were performed to identify the main baseline predictors of outcome. Premorbid Adjustment Scale in Adolescence and Verbal Comprehension Index were found to be the two most significant predictors of outcome. Results are discussed with regards to the implications for rehabilitation and determination of prognosis.
Keywords: Epidemiology, Aetiology, Other
511
A CASE OF HIGH SCHOOL BOY WITH THE FIRST PSYCHOTIC EPISODE: TREATMENT IN JAPAN
Izuru Matsumoto
University of Sydney, Australia
Takeshi Iwazaki
Department of Pathology, University of Sydney, Australia
Haruka Matsuda
Department of Pathology, University of Sydney, Australia
Therese Garrick
Tissue Resource Center, The University of Sydney, Australia
Natalie Cutler
St. George Hospital Mental Health Service, Australia
Recently in Japan there has been a trend towards community-based psychiatric medicine. However, many problems still exist with the medical system of care and the integration of community resources.
We aim to compare the New South Wales and Japanese treatment processes in the management of a person presenting with a first psychotic episode.
An 18-year-old male high school student, presented to see a psychiatrist at a psychiatric hospital in Japan (day X). He was found to have a lack of insight, psychomotor excitement, catatonic excitement, disorganized speech and behaviors, hallucinations and delusions. Treatment including hospital admission was determined to be necessary, however patient refusal due to lack of insight necessitated a compulsory admission. He was unable to look after himself independently, and was isolated and restrained to a bed. He was given haloperidol (HP) IV per day for one week. On day X+7 the patient’s mood was relatively stable and restraint was ceased. HP IV was ceased and he changed to oral medications, which were typical antipsychotic. On day X+14 the psychiatrist decided to stop restriction and he was transferred to the ward. On day X+28 weekend leave became possible and repeated every weekend. On day X+112, he was discharged. The patient came to see the psychiatrist once or twice over a two-week period. Three months after discharge daycare started once a week, and increased to twice a week and social skills training was added to the program. HP was replaced with atypical antipsychotic drugs. On day X+365, the patient was managing at home, and considering going to a workshop. He has not been to school for one year.
When comparing the Japanese treatment processes described above with that in NSW, the main differences are: the use of medications, behavioral restriction, medical team, education for co-medical staff, resources in the community and ways of hospitalization. It may be possible to introduce and establish more community-based medicine in Japan when these issues are carefully addressed and adjusted to Japanese culture and medical systems.
Keywords: Epidemiology, Aetiology, Other
512
REDUCED HOSPITALISATION IN AUSTRALIAN SCHIZOPHRENIA OUTPATIENTS INITIATED ON LONG-ACTING, INJECTABLE RISPERIDONE: THREE-MONTH FOLLOW-UP FROM THE E-STAR DATABASE
Tim Lambert
University of Melbourne, Australia
Brett Emmerson
Royal Brisbane and Women’s Hospital, Australia
Harry Hustig
Royal Adelaide Hospital, Australia
Michael Povey
SGS Biopharma, Belgium
An Jacobs
Janssen Pharmaceutica, Belgium
Claire Methven
Janssen-Cilag, Australia
Purpose: To examine hospitalisation rates and functioning in patients with schizophrenia three months after initiation on long-acting risperidone.
Methods: Data on 358 Australian patients initiated on long-acting risperidone were extracted from the electronic-Schizophrenia Treatment Adherence Registry (e-STAR). Data were available for the first three months after treatment initiation.
Results: At baseline, the mean age was 38.1 ± 11.9 (SD) years, 70.1% were male and 98.3% had a diagnosis of schizophrenia or schizoaffective disorder. Patients hospitalised at baseline (48%) were defined as inpatients. Most patients (94%) started on a dose of 25 mg of long-acting risperidone and 64% of patients remained on their initiation dose. In the outpatient group, 30% of patients were hospitalised in the three months prior to initiation compared with 17% in the three months following initiation (p < 0.001). The number of days hospitalised per patient also decreased from 6.3 ± 13.8 to 2.8 ± 8.8 in the outpatient group (p < 0.001). No change in hospitalisation was seen in the inpatient group. The Clinical Global Impression-severity (CGI-S) score was 4.2 ± 1.1 three months after initiation compared with 4.6 ± 1.1 at baseline (p < 0.001). The Global Assessment of Functioning (GAF) score was 50.1 ± 15.6 after three months compared with 43.2 ± 15.0 at baseline (p < 0.001). Adherence data was available for 267 patients. Of these, 228 patients were 81–100% adherent to long-acting risperidone. Patients discontinued treatment due to patient/family choice (n = 12), insufficient response (n = 13), loss to follow up (n = 3), adverse events (n = 8) and other reasons (n = 11).
Conclusions: From this preliminary analysis, there was a decrease in hospitalisation in outpatients initiated on long-acting risperidone. In the total patient sample, there were improvements in CGI-S and GAF scores and high levels of adherence. Long-term evaluation of these patients is being conducted to confirm whether these benefits are sustained.
Keywords: Biological Psychiatry, Neuropsychiatry
513
BEHAVIOURAL PROFILE OF TYPICAL AND ATYPICAL ANTIPSYCHOTICS AFTER CHRONIC TREATMENT
Liesl Duffy
Neuroscience Institute of Schizophrenia and Allied Disorders, Garvan Institute of Medical Research, Australia
Elizabeth O’Brien
Department of Pathology, Sydney University, Australia
Irina Dedova
Department of Pathology, Sydney University, Australia
Izuru Matsumoto
Sydney University, Australia
Tim Karl
NISAD, Garvan Institute of Medical Research, Australia
Proposal: Typical antipsychotic drugs (APDs) such as haloperidol reverse positive symptoms of schizophrenia but do not alleviate negative symptoms or cognitive dysfunction. Positive symptoms arise from hyperdopaminergic activity, particularly at D2 receptors, which are blocked by typical APDs. This is accompanied by side effects such as extrapyramidal symptoms (EPS). In addition to D2 receptors, atypical APDs such as risperidone also target other neurotransmitter receptors. These drugs are more effective in treating both positive and negative symptoms and have a lower risk of EPS than typical APDs. In the past animal models have been used to characterise side effects of APDs. However to date there is a lack of comprehensive strategies in behavioural profiling of APDs.
Methods: In order to examine effects of chronic APD treatment on a range of behavioural domains (motor activity, exploration, anxiety, and EPS), male Sprague Dawley rats were treated either with haloperidol (0.5 mg/kg), risperidone (2.5 mg/kg), or vehicle for four weeks. Drugs were administered using s.c. implanted osmotic minipumps. Untreated rats served as controls. Animals were tested in open field, cross maze, elevated plus maze, hole board, and in several motor function-related tests. The incidence of EPS was examined twice.
Results: APD treatment in general had a significant sedative-like effect on motor activity. Furthermore, drug-treated animals exhibit an anxiouslike phenotype and a loss of fine motor movements. The first detected increase in EPS in APD-treated animals disappeared over time. Risperidone had a more stimulating effect on grooming behaviour whereas haloperidol had a stronger sedative-like effect.
Conclusions: We have shown that the effects of APDs are not limited to EPS. Domains such as anxiety and motor activity are affected as well. Differences in the behavioural profile of typical and atypical APDs are not restricted to EPS. This study demonstrates the importance of using a comprehensive behavioural phenotyping strategy.
Keywords: Biological Psychiatry, Neuropsychiatry
514
THE INCIDENCE AND PREVALENCE OF SCHIZOPHRENIA VARIES WITH LATITUDE
Sukanta Saha
Queensland Centre for Mental Health Research (QCMHR), Australia
David Chant
Queensland Centre for Mental Health Research (QCMHR), Australia
Joy Welham
Queensland Centre for Mental Health Research (QCMHR), Australia
John J McGrath
University of Queensland and Queensland Centre for Mental Health Research (QCMHR), Australia
Purpose: The aim of this study was to examine the association between latitude and the incidence and prevalence of schizophrenia based on two recently-published systematic reviews.
Methods: Studies with original data related to the incidence and prevalence of schizophrenia (published 1965–2002) were identified by searching electronic databases, reviewing citations and writing to authors. Exact latitude values were used for cities, and geocentral values for other sites. The analyses were based on 353 incidence rates (from 68 studies) and 258 prevalence estimates (from 94 studies). Based on three equal latitude bands, we compared the frequency measures of schizophrenia for persons, males and females when adjusted for withinstudy variation.
Results: Prevalence estimates from sites in the high latitude band were significantly higher compared to lower bands (low and medium) for persons (p < 0.005), males (p < 0.02) and females (p < 0.003). Incidence rates were positively associated with absolute latitude for males (p < 0.04), but neither for females (p = 0.06) nor persons (p = 0.69).
Conclusions: The interpretation of ecological studies requires caution, however the results of this study suggest that risk factors that have latitude gradients warrant closer inspection in schizophrenia epidemiology.
Keywords: Epidemiology, Aetiology, Other
515
REMEDIATION OF VISUAL SCANPATH DEFICITS IN SCHIZOPHRENIA
Kathryn L McCabe
Neuroscience Institute for Schizophrenia and Allied Disorders, Centre for Mental Health Studies, University of Newcastle, Australia
Carmel M Loughland
Neuroscience Institute for Schizophrenia and Allied Disorders, Centre for Mental Health Studies, University of Newcastle, Australia
Martin Cohen
Hunter and New England Health Service, Australia
Patrick J Johnston
Centre for Mental Health Studies, University of Newcastle, Australia
Mick Hunter
School of Behavioural Sciences, University of Newcastle, Australia
Terry Lewin
Hunter and New England Health Service, Australia
Vaughan Carr
Neuroscience Institute for Schizophrenia and Allied Disorders, Centre for Mental Health Studies, University of Newcastle, Australia
Recent research has explored the potential clinical utility of cognitive remediation strategies to improve facial emotion recognition in patients with schizophrenia. Observed facial identity and facial emotion recognition deficits are commonly interpreted as a dysfunction in the neurocognitive mechanisms that underlie face processing. The role of extraocular muscle (EOM) proprioception is largely neglected in these accounts. This study uses an EOM training task to determine whether proprioceptive retraining of eye movements delivered using visual scanpath technology improves emotion perception by assisting schizophrenia patients to develop more adaptive face viewing strategies. Subjects will be randomly assigned to one of three remediation groups (proprioception retraining group, face perception retraining group and control group [computerised information only]) for six, weekly 30 minute sessions and will complete follow-ups at 1 and 6 months post treatment in order to explore the potential sustainability of gains made as a consequence of remediation training. It is predicted that EOM proprioceptive retraining will produce greater improvements in affect recognition accuracy and visual scanpath strategies to face stimuli, and that these gains will be more stable over time, than either face perception retraining or information provision alone. The theoretical underpinnings of this unique line of enquiry will be described, as will the novel methodology and stimulus proposed for this research. Potential clinical significance and expected outcomes will also be discussed.
Keywords: Epidemiology, Aetiology, Other
516
BRAIN GLUTATHIONE DEPLETION AS AN ANIMAL MODEL WITH RELEVANCE TO SCHIZOPHRENIA: 2-CYCLOHEXENE-1-ONE (CHX) DOSE-RESPONSE STUDIES
Olivia M Dean
University of Melbourne, Mental Health Research Institute, Australia
David L Copolov
Mental Health Research Institute of Victoria, Australia
Michael Berk
Barwon Health and Geelong Clinic and the University of Melbourne, Australia
Ashley Bush
Mental Health Research Institute, Australia
Maarten van den Buuse
Mental Health Research Institute, Australia
Oxidative stress has recently been implicated in many psychiatric illnesses including schizophrenia. This oxidative stress, in particular depletion of glutathione (GSH), the primary endogenous antioxidant in the brain, may be related to altered dopaminergic transmission. In schizophrenia, recent studies have demonstrated 52% lower levels of GSH levels cerebrospinal fluid and imaging studies have confirmed prefrontal cortical deficits of this peptide. In order to investigate the behavioural consequences of GSH modulation, a suitable animal model is required. 2-cyclohexene-1-one (CHX) has been used previously to deplete glutathione in various animal models. The current study aimed to produce a dose-response curve investigating the biochemical response to CHX dosing in parallel with locomotor behaviour testing. The object of the study was to induce a similar degree of brain glutathione depletion in mice to that in schizophrenia, but still maintain a normal behavioural response.
Method: Doses ranging from 0 to 150 mg/kg of CHX were administered to a total of 81 male C57BL/6 mice (average weight 25.9 g). Total glutathione levels were assessed using an enzymatic-recycling assay. Spontaneous locomotor activity was assessed using video-tracking with Ethovision (Noldus).
Results: GSH levels were highest in striatum, followed by liver and lowest in cortex samples. CHX treatment caused significant depletion of GSH levels in striatum at 90 (33% decrease), 120 (38% decrease) and 150 mg/kg (65% decrease). The effect of CHX was significant in frontal cortex at 60 mg/kg and higher doses (27–59% depletion). In contrast, there was no effect of CHX in the liver. In addition, there were no major effects on spontaneous locomotor activity.
Conclusion: CHX causes regionally specific GSH depletion in mouse brain without a peripheral effect or behavioural side-effects. This makes it a useful model for use in brain and behavioural studies, including the role of GSH in schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
517
OESTROGEN PREVENTS BUSPIRONE-INDUCED DISRUPTIONS OF PREPULSE INHIBITION IN HEALTHY WOMEN
Andrea Gogos
Behavioural Neuroscience Laboratory, Mental Health Research Institute, Australia
Valerie Guille
Brain Sciences Institute, Swinburne University of Technology, Australia
Rodney J Croft
Centre for Neuropsychology, Swinburne University of Technology, Australia
Pradeep J Nathan
Department of Physiology, Monash University, Australia
Maarten van den Buuse
Behavioural Neuroscience Laboratory, Mental Health Research Institute, Australia
The sex steroid hormone, estrogen, has been proposed to be protective against schizophrenia. This study examined the effects of estrogen treatment on modulation of prepulse inhibition (PPI) by the serotonin-1A (5-HT1A) receptor partial agonist, buspirone. PPI is a model of sensorimotor gating, which is deficient in schizophrenia and other mental illnesses. Eleven healthy women were tested following four acute treatment conditions: placebo, buspirone (Buspar; 5 mg), estradiol (Estrofem; 2 mg), and combined buspirone and estradiol. Electromyogram activity was measured across three inter-stimulus intervals: 30, 60 and 120 msec. There was no significant effect of either drug treatment on startle amplitude or habituation. At the 120 msec inter-stimulus interval, buspirone caused a significant disruption of PPI, whereas there was no significant disruption of PPI with combined estrogen and buspirone treatment. In conclusion, estrogen treatment, administered in the appropriate experimental conditions, prevented PPI deficits induced by 5-HT1A receptor activation and may therefore also play a protective role in sensorimotor gating deficits in schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
518
PATIENTS WITH SCHIZOPHRENIA/SCHIZOAFFECTIVE DISORDER: IS THERE IS A DIFFERENCE IN HOSPITALISATIONS AFTER TREATMENT WITH LONG-ACTING RISPERIDONE?
Brett Emmerson
Royal Brisbane and Women’s Hospital, Australia
Dieter Naber
Universitätsklinikum Hamburg-Eppendorf, Germany
Michael Povey
SGS Biopharma, Belgium
Sue Caleo
Janssen Pharmaceutica N.V., Health Economics, Belgium
An Jacobs
Janssen Pharmaceutica N.V., Health Economics, Belgium
Purpose: To compare hospitalisations in patients with schizophre-nia/schizoaffective disorder three months before and after commencing treatment with long-acting risperidone.
Methods: Data on 1,728 German and Australian patients initiated on long-acting risperidone were extracted from the electronic-Schizophrenia Treatment Adherence Registry (e-STAR), a secure web-based, international observational study of patients with schizophrenia. Retrospective and prospective data collection includes patient demographics, disease characteristics and hospitalisations. Data were available for the first three months after treatment initiation.
Results: Mean age was 41.8 (SD 13.5) years, 58.6% were male, and mean duration of illness upon commencing treatment with long-acting risperidone was 10.4 (SD 9.5) years. The majority of patients had a diagnosis of schizophrenia (78.4%) or schizoaffective (18.1%) disorder. Three months before treatment with long-acting risperidone, the average number of days hospitalised was 13.3 (SD 23.5). This fell to an average of 8.5 (SD 21.2) days after treatment (p < 0.001). The total number of days hospitalised declined from 22,962 to 14,689 (p < 0.001), a decrease of 8,273 days over the 3 month period. The proportion of patients hospitalised also declined from 36.5% to 24.3% (p < 0.001). The re-hospitalisation rate was 10.4% (95%CI: 8.9; 11.8) during the 3 months and the time to first re-hospitalisation was 89.4 (SD 72.3) days. There were 124 patients (7.2%) who discontinued treatment with longacting risperidone, but unless lost to follow-up (3.8%), will continue to be followed in the study.
Conclusion: Patients commencing treatment with long-acting risperidone seem less likely to be hospitalised during the first 3 months of treatment. This potentially can reduce the costs associated with treating patients with schizophrenia. More data are being accrued to determine whether these results pertain to other countries and over the long-term.
Keywords: Biological Psychiatry, Neuropsychiatry
519
OLFACTORY HALLUCINATIONS IN SCHIZOPHRENIA: PREVALENCE AND CLINICAL CORRELATES
Robyn Langdon
Macquarie Centre for Cognitive Science, Macquarie University, Australia
Richard Stevenson
Psychology Department, Macquarie University, Australia
Stanley V Catts
Department of Psychiatry, University of Queensland, Australia
Two pre-existing research datasets were examined to investigate the prevalence and clinical correlates of olfactory hallucinations (OHs) in schizophrenia. Dataset 1 contained Present State Examination, 9th Edition (PSE-9), categorical codes from an original cohort of 1379 patients interviewed for the World Health Organization Study on Determinants of Outcome of Severe Mental Disorders (WHO 10-Country Study: Jablensky et al., 1992). There were 962 cases (531 males, 431 females) with valid ratings for either the PSE-9 item 68 (OHs excluding self smell) or item 69 (self smell). Dataset 2 contained 266 cases (105 males, 52 females) with numeric ratings on the Scales for Assessment of Positive and Negative Symptoms of Schizophrenia (SAPS and SANS) drawn from individual datasets collected for research purposes by SVC or RL. OHs were present in 13.1% of the PSE-9 dataset and in 17.5% of the SAPS/SANS dataset. In the PSE-9 dataset, there was a tendency for OHs to be more frequent in females (15.3%) than in males (11.3%). Furthermore, women reporting OHs at intake had a poorer course of illness than those without OHs. Amongst patients reporting OHs in the SAPS/SANS dataset, OHs were more severe in patients with a younger age-at-onset. Principal components analysis (PCA) was used to examine the factor structure of the SAPS/SANS items from dataset 1, excluding low prevalence items, including OHs. Logistic and linear regression techniques were then used to identify predictors of the presence and the severity of OHs. Visual/verbal hallucinations, a factor comprising persecutory and loss of boundary delusions and a somatic factor combined as significant independent predictors of both the presence and the severity of OHs. Logistic regression analyses conducted on the categorical PSE-9 codes from dataset 2 yielded a similar pattern of results. Discussion focuses on the role of top-down and bottom-up processes in the genesis of OHs in schizophrenia.
Keywords: Epidemiology, Aetiology, Other
520
THE EFFECTS OF PREFRONTAL 1 Hz rTMS ON THE EEG DURING AN AUDITORY ODD-BALL TASK: A PILOT STUDY OF CORTICAL PLASTICITY IN SCHIZOPHRENIA
Daniel J Upton
Alfred Psychiatry Research Centre, Department of Psychological Medicine, Monash University, Australia
Nicholas Cooper
Alfred Psychiatry Research Centre, Department of Psychological Medicine, Monash University, Australia
Rebecca Segrave
Alfred Psychiatry Research Centre, Department of Psychological Medicine, Monash University, Australia
Robin Laycock
Alfred Psychiatry Research Centre, Department of Psychological Medicine, Monash University, Australia
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Rodney Croft
Brain Sciences Institute, Swinburne University of Technology, Melbourne, Australia
Paul B Fitzgerald
Alfred Psychiatry Research Centre, Monash University, Australia
A growing body of evidence suggests that abnormal plasticity is a feature of schizophrenia; however invivo findings to support this hypothesis are limited. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive means of investigating dynamic brain processes. Its capacity to modulate neuropsychological and psychophysiological phenomena such as event-related potentials (ERP) provides an investigative tool to compare normal and abnormal brain dynamics. The P300 is well established as a cognitive component of the ERP, and has been reported in a number of studies to be deviant in schizophrenia. Thus, it provides an opportunity to explore whether rTMS can modulate an anomaly consistently identified in this disorder. The purpose of our Initial investigation was to determine the effects of 1 Hz rTMS of the dorsolateral prefrontal cortex on P300 parameters in normal subjects.
On two separate occasions, 18 normal participants received 15 minutes of 1 Hz rTMS at 110% of the resting motor threshold. On one occasion, the right DLPFC was stimulated, and on another, the left. The P300 ERP component was elicited using an auditory odd-ball task and assessed using measures of amplitude and latency. Results demonstrate that 1 Hz rTMS of the DLPFC has a lateralised effect on P300 parameters in control subjects. These results will be discussed in terms of plasticity and its relationship to schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
521
EARLY PSYCHOSIS SERVICES FOR RURAL AND REMOTE COMMUNITIES: WHERE ARE THEY?
Helen J Stain
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Gina Sartore
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Susan Blinkhorn
Child and Adolescent Mental Health Statewide Network, Australia
Brian Kelly
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Doug Andrews
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Aim: To investigate access to care and service delivery for rural and remote residents experiencing early psychosis.
Background: An effective means of reducing disability from psychotic disorders is the provision of early detection and intervention targeted at the prodromal phase. Research has led to the reliable identification of individuals at risk of developing a psychotic disorder (Yung et al., 1998) and assisted in the development of preventative interventions in clinical settings (French & Morrison, 2004). However while intervention programs have been trialled for early psychosis (EP), there has been a lack of research directed towards EP service delivery for rural and remote communities (RARC).
Method: This paper presents an analysis of routine clinical mental health service data for 10–25 year old patients across three rural regions in New South Wales. A large data set (N = 1562) for the Central West region was compared to smaller data sets for a remote region and a coastal region. Demographic, clinical and service features were analysed against characteristics specific to RARC. Clinical measures included the HoNOSCA, HoNOS and SDQ.
Results: EP patients in the Central West represented 10.44% of patients accessing mental health services, but utilised services twice as often as non EP patients and absorbed 37.60% of inpatient service encounters. Although 42.94% of EP patients were under 18 years of age, only 11.98% of EP clinical encounters were seen by child and adolescent services. The median distance to access services was 88 km (range 0– 895 km). These results were compared to findings for EP patients from the remote and coastal regions.
Conclusion: The results raise a number of implications for delivery of intervention services for early psychosis in RARC, including access to age appropriate services with limited disruption to family.
Keywords: Work and Voc Rehab, Social Psychiatry
522
THE HUNTER DNA BANK FOR SCHIZOPHRENIA AND ALLIED DISORDERS: A UNIQUE AUSTRALIAN RESOURCE FACILITATING GENETIC RESEARCH INTO MENTAL ILLNESS
Sarah G Russell
Neuroscience Institute for Schizophrenia and Allied Disorders (NISAD), Centre for Mental Health Studies, Australia
Carmel L Loughland
Neuroscience Institute for Schizophrenia and Allied Disorders (NISAD), Centre for Mental Health Studies, Australia
Paul A Tooney
Neuroscience Institute for Schizophrenia and Allied Disorders (NISAD), Biomedical Science, University of Newcastle, Australia
Rodney J Scott
Biomedical Science, University of Newcastle, Hunter and New England Health, Australia
Terry J Lewin
Neuroscience Institute for Schizophrenia and Allied Disorders (NISAD), Centre for Mental Health Studies, Australia
Vaughan Carr
Neuroscience Institute for Schizophrenia and Allied Disorders (NISAD), Centre for Mental Health Studies, Australia
A genetic contribution to the development of schizophrenia has been clearly demonstrated in family, twin and adoption studies showing that people who have a close relative with schizophrenia are more likely to develop the disorder than those who have no relatives with the illness. Currently, a major limiting factor for genetic studies that include patients with mental illness and their relatives is obtaining the genetic material from large enough samples to be able to perform complex and meaningful analyses. The Hunter DNA Bank for Schizophrenia and Allied Disorders was established in 2002 to facilitate genetic research into schizophrenia and affective disorder by providing researchers with access to well characterized genetic material. The Hunter DNA Bank for Schizophrenia and Allied Disorders collects and stores genetic material including DNA, RNA and lymphocytes, cross-referenced with clinical and neuropsychological data from people with schizophrenia and affective disorder, their biological first-degree relatives and healthy non-psychiatric controls. The aim of the Hunter DNA Bank is to make this material available to approved researchers and clinicians undertaking genetic research once sufficient samples have been collected. This paper discusses the establishment of the Hunter DNA Bank for Schizophrenia and Allied Disorders and describes the clinical and neuropsychological profiles of the first 100 participants. Future directions will also be discussed, including the expansion of the DNA Bank beyond the Hunter Region and to other mental illnesses, as well as expected outcomes.
523
BIASED PERCEPTION TOWARDS FEARFUL WORDS IN DELUSIONS
Alison M McPhee
Mental Health Research Institute of Victoria, Australia
Nicole R Joshua
Mental Health Research Institute of Victoria, Australia
Susan L Rossell
Mental Health Research Institute of Victoria, Australia
This study sought to extend the growing literature on emotion processing deficits in psychosis-prone individuals. Three matched participant groups were tested: patients with schizophrenia, patients with bipolar disorder, and healthy controls. They completed two emotional Stroop paradigms, one that included happy, sad and fearful word stimuli, and a second that utilised three types of threat or fear-related words, internal threat, external threat and physical threat. In each Stroop version participants were asked to name the colour of each word; the reaction times of emotional words were compared to neutral words to give an interference effect, i.e. an indication of how much longer it takes to read emotional words compared to neutral words. For task one, fearful words had a greater interference effect than both happy and sad words, with schizophrenia patients showing the greatest interference effect for fear words. Schizophrenia and bipolar patients also displayed a reverse interference effect for sad words, where they responded faster to sad words than neutral words. For task two, the threat-related data showed that external-threat words had a greater interference effect than both internal-threat and physical-threat. Unfortunately, however there were no group differences on this task version. For both patient groups there was a correlation between the fear interference effect and severity of current delusions. These findings support previous research that asserts that affective stimuli do affect the way in which one attends to information. It also further demonstrates differences between psychosis-prone individuals and normal controls. Patients with delusions appear to be particularly prone to attending to fearful words. Such a bias may help to explain why delusions are typically of a persecutory nature.
Keywords: Biological Psychiatry, Neuropsychiatry
524
DOSE DETERMINATION OF HALOPERIDOL, RISPERIDONE AND OLANZAPINE USING AN IN VIVO DOPAMINE D2-RECEPTOR OCCUPANCY METHOD IN THE RAT
Dineshree (Dini) V Naiker
The University of Queensland, Australia
Purpose: What is the appropriate dose of an antipsychotic in an animal model? The literature suggests that there is no standard rationale across studies. This study was designed to use dopamine D2-receptor occupancy as a marker for determining doses that are clinically comparable for animal models.
Methods: Adult male Wistar rats of two different ages (11 and 24 week old) were treated with haloperidol (0.25 and 0.5 mg/kg/day), risperidone (3, 5 and 6 mg/kg/day) and olanzapine (5 and 10 mg/kg/day) for seven days. Drugs were delivered by continuous infusion via osmotic minipumps. After treatment animals were injected with [3H]-raclopride and sacrificed 30 minutes later. Striatal and cerebral tissue were collected and in vivo dopamine D2–receptor occupancies were determined.
Results: Haloperidol 0.25 mg/kg/day, risperidone 5 mg/kg/day and olanzapine 10 mg/kg/day induced clinically comparable dopamine D2receptor occupancies in both 11 and 24 week old animals. Statistical tests proved that these doses were within the clinical therapeutic range (65% to 80%). There were also no significant differences in the dopamine D2-receptor occupancy values for the three different drugs.
Conclusions: This study provides a rationale and guide for investigators to choose antipsychotic doses that are comparable to those used in clinically in humans.
Keywords: Biological Psychiatry, Neuropsychiatry
525
SELECTIVE IMPAIRMENT TO TEMPORAL CUES TO SOUND LATERALISATION IN SCHIZOPHRENIA
Natasha L Matthews
School of Behavioural Sciences, University of Newcastle, NISAD, Australia
Juanita Todd
School of Behavioural Sciences, University of Newcastle, NISAD, Australia
Patricia T Michie
School of Behavioural Sciences, University of Newcastle, NISAD, Australia
Gavin Cooper
Neuroscience Institute of Schizophrenia and Allied Disorders, Australia
The ability to locate the position of a sound in space is crucially important to a range of cognitive abilities including, selective attention, perceptual grouping of auditory information, and integrating information between different modalities. Yet despite the obvious importance of spatial perception to effective auditory information processing, little research has investigated this ability in schizophrenia. There are three primary cues used by the auditory system to locate the position of a sound in space; interaural (between ear) differences in the arrival time of the sound at the two ears (ITD), the intensity of the sound at the two ears (ILD) and the phase of the sound at the two ears (IPD). Both ITD and IPD cues are temporal cues, since they rely on precise neural encoding of brief differences in arrival time or phase of the sound at the two ears. The integrity of neural representations as well as behavioural discrimination ability for each cue was investigated in individuals with schizophrenia and controls. The integrity of cortical representations of each of the cues was investigated using the mismatch negativity (MMN) component of the auditory-event-related-potential. Participants were presented with a series of tones: 90% standards (complex tones with two tonal components 3000 Hz and 600 Hz, 80 dB SPL, 50 ms, SOA of 550 ms), and 10% deviants experienced as 90? to the right or left of standards. Deviants were created in separate blocks by employing ITD, ILD, or IPD cues. Behavioural tasks assessed discrimination ability for each cue. Behavioural tasks employed the same tone sequence as for the MMN, except participants were required to make a button press to each detected deviant. Results from both the MMN and behavioural task revealed a selective impairment in the use of temporal cues to sound lateralization in individuals with schizophrenia. Results will be discussed with references to theories of temporal processing deficits in schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
526
NISAD SCHIZOPHRENIA RESEARCH REGISTER: CHARACTERIZING THE FIRST-DEGREE RELATIVE VOLUNTEERS
Gali E Lawrence
Neuroscience Institute of Schizophrenia and Allied Disorders (NISAD), Centre for Mental Health Studies, Australia
Carmel L Loughland
Neuroscience Institute of Schizophrenia and Allied Disorders (NISAD), Centre for Mental Health Studies, Australia
Terry J Lewin
Neuroscience Institute of Schizophrenia and Allied Disorders (NISAD), Centre for Mental Health Studies, Australia
Vaughan J Carr
Neuroscience Institute of Schizophrenia and Allied Disorders (NISAD), Centre for Mental Health Studies, Australia
The NISAD Schizophrenia Research Register is a volunteer research database of people with schizophrenia and their first-degree relatives. Information about the characteristics of schizophrenia volunteers registered with the database has been published previously (Loughland et al., 2001, 2004). However, little is known about their first-degree relatives registered with the database including their socio-demographics, personality characteristics or neuropsychological profiles. A total of 340 first-degree relatives of people with a diagnosis of schizophrenia are registered with the database. Relatives are screened for a previous history of depression, mania and psychotic experiences using the Diagnostic Interview for Psychosis (DIP: Jablensky et al., 2000). General and social functioning is assessed using the Global Assessment of Functioning (GAF) and SOFAS (American Psychiatric Association). Psychosis proneness is assessed using the Schizotypal Personality Questionnaire (Raine et al., 1991), and personality disorder assessed using the International Personality Disorder Examination (IPDE-Loranger, 1999). Neuropsychological performance is assessed using the National Adult Reading Test (NART-Nelson, 1982) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS-Randolph, 1998). Of the total relatives registered on the database, 249 (73.2%) are female and 91 (26.8%) male. The mean age of relatives is 47.4 years (SD = 14.2, range 20–84 years). The majority of relatives were recruited via a television advertising campaign and are located primarily in the Sydney metropolitan (35.6%) and Hunter regions (14.7%) of NSW, Australia. Another 33.5% are from regional NSW, while 16.2% are from other States. Analyses from a subset of first-degree relatives will be reported describing rates of depression, personality characteristics and neuropsychological profiles.
Keywords: Biological Psychiatry, Neuropsychiatry
527
SUBGROUPS IN AGE-AT-FIRST-ADMISSION FOR VARIOUS PSYCHOTIC DISORDERS
Joy L Welham
Queensland Centre for Mental Health Research (QCMHR), Australia
Kai Wang
Centre of Excellence for Mathematics and Statistics of Complex Systems, University of Queensland, Australia
John J McGrath
Queensland Centre for Mental Health Research and University of Queensland (QCMHR), Australia
Sukanta Saha
Queensland Centre for Mental Health Research (QCMHR), Australia
Geoff McLachlan
Department of Mathematics, University of Queensland, Australia
Introduction: A number of studies have identified subgroups of schizophrenia by decomposing age-at-onset (AAO) distributions using mixture models such as latent class analysis or Gaussian mixtures. To date, these analyses (a) have not been used to examine AAO subgroups in other psychotic disorders, and (b) have not included covariates such as season-of-birth (sob) or levels of perinatal sunshine (sun). The aim of this study is to identify subgroups for various psychoses based on age-at-onset (approximated by age-at-first-admission), using mixtures of Gaussian regressors with covariates (sob and sun).
Methods: Using the Queensland Mental Health Statistics System, we extracted age-at-first-admission data for schizophrenia (ICD8/9 295) to represent ‘narrow’ schizophrenia, we then added paraphrenia (297) and other non-organic psychoses (298) for a ‘broad’ definition. We also extracted data for Affective psychosis (296) and differentiated bipolar disorder (296.1-3). Mean monthly sunshine data for south east Queensland was gained from the Australian Bureau of Meteorology. Gaussian mixture regression models with sob and sun as covariates were defined and fitted to the psychoses distributions for males and females separately.
Results: For both males and females, a 3-component model best fitted the narrow-schizophrenia definition, while a 4-component model best fitted the broad-definition. For both definitions, the same number of subgroups characterised by similar mean ages were identified for both males and females: however male:female ratios changed from a male excess in early-onset groups to a female excess in later-onset groups. While similar results regarding subgroups were found for both definitions of Affective psychoses, there were dissimilarities, such as in the male:female ratios across sub-groups.
Conclusion: Mixture modelling can consistently detect subgroups based on age-at-first-admission and identify important sex differences. For the first time, covariates, such as season-of-birth and perinatal sunshine, were fitted.
Keywords: Epidemiology, Aetiology, Other
528
GAMMA BAND CHANGES IN A PROSPECTIVELY FOLLOWED COHORT OF YOUNG PEOPLE WITH THEIR FIRST EPISODE OF SCHIZOPHRENIA
Anthony WF Harris
Discipline of Psychological Medicine, The University of Sydney, Australia
Leanne Williams
Brain Dynamics Centre, Westmead Hospital, Australia
Kerri Brown
The Brain Dynamics Centre, Australia
John Brennan
Redbank House, Westmead Hospital, Australia
Recent conceptualisations of schizophrenia as a disorder of connectivity have highlighted the temporal integration of these cortical networks across dispersed regions of the brain. A possible mechanism of this temporal integration is gamma band activity which has been identified during both cognitive and perceptual tasks. This study reports changes in gamma band activity in a group of 25 subjects with schizophrenia initially identified within 3 months of their first presentation to clinical services with a psychotic illness and then followed up over a two year period.
Keywords: Biological Psychiatry, Neuropsychiatry
529
THE ANTECEDENTS OF SCHIZOPHRENIA: A REVIEW OF FINDINGS FROM POPULATION-BASED COHORT STUDIES
Joy L Welham
Queensland Centre for Mental Health Research (QCMHR), Australia
John J McGrath
Queensland Centre for Mental Health Research and Department of Psychiatry, University of Queensland (QCMHR), Australia
Sukanta Saha
Queensland Centre for Mental Health Research (QCMHR), Australia
Purpose: The developmental model of the etiology of schizophrenia is based on findings that delays and deviations in childhood functioning precede the onset of schizophrenia in adulthood. Our aim is to review publications from population-based cohort studies which have reported on these antecedents.
Methods: We used the search terms “cohort” and (“antecedents” or “precursors”) and (“schizo*” or “psych*”) to search the Medline and PsychInfo databases. We identified three main types of cohort studies reporting on the antecedents of schizophrenia; cohorts of conscripts, cohorts of high-risk populations (offspring of mothers with schizophrenia), and birth cohorts from the general population. Apart from one cohort from New Zealand and one conscript cohort from Israel, all came from Scandinavia, the UK and the USA.
Results: Population-based cohort studies have identified childhood developmental delays and deviations in various growth and developmental domains which reflect liability to schizophrenia. From infancy onwards, studies consistently identified delays in physical growth and developmental milestones (such as walking, talking and potty training), impaired speech and language, poor motor coordination, impaired cognitive functioning and educational achievement, together with behavioural and interpersonal difficulties. Associated putative risk factors, such as socio-economic status and substance use, were also assessed. Some continuity was found, such as psychosis-like thoughts together with solitariness during childhood being strongly predictive of schizophrenia in adulthood.
Conclusion: Population-based cohort studies are providing rich and coherent information on the antecedents of schizophrenia. They show that schizophrenia does not develop de novo in adulthood but is preceded by delays and deviations in many inter-related domains. Cohort studies can both describe developmental pathways and, through their repeated assessment, allow tests of causality. The importance of this has been recently demonstrated in cohort findings that cannabis use constitutes a substantial risk for schizophrenia (rather than being a co-occurring factor); this is influencing preventative clinical strategies.
Keywords: Epidemiology, Aetiology, Other
530
MODULATION OF MMN AMPLITUDE IN RESPONSE TO DECREASING DEVIANT PROBABILITY IN PATIENTS WITH SCHIZOPHRENIA
Lea Meyer
University of New South Wales, Australia
Emily B Stone
University of New South Wales, Australia
Philip B Ward
University of New South Wales, Sydney South West Area Health Service, Australia
Ulrich Schall
Centre for Mental Health Studies, University of Newcastle, Australia
Patricia T Michie
School of Behavioural Sciences, University of Newcastle, Australia
Juanita Todd
School of Behavioural Sciences, University of Newcastle, Australia
People diagnosed with schizophrenia demonstrate abnormalities in mismatch negativity (MMN), an ERP index of auditory sensory memory. Previous research studies have suggested a modulation of the MMN amplitude in response to decreasing deviant probability in healthy subjects. The present study aims to determine whether the similiar pattern of modulation of MMN amplitude is present in patients with schizophrenia. We tested patients meeting DSM-IV criteria for schizophrenia with a duration of illness (DOI) greater than five years as part of a larger study assessing early auditory brain dysfunction and cortical grey matter volume loss in two groups of patients with different DOI’s. The assessment of executive function consisted of the Haylings Sentence Completion and Brixton Spatial Anticipation tests. MMN amplitude was assessed by presenting subjects with "miniblocks" of either 4, 8 or 16 standard duration (50 ms) tones, followed by either a single duration deviant (100 ms) or a single standard tone. In preliminary analyses we did not find any modulation of MMN amplitude in response to the different miniblock conditions in patients with schizophrenia. Correlations between reduced MMN responding and the extent of executive dysfunction as well as severity of negative and positive symptoms resemble those results from standard MMN tasks.
Keywords: Biological Psychiatry, Neuropsychiatry
531
INVESTIGATING MYOCARDITIS AND CARDIOMYOPATHY IN TREATMENT-RESISTANT SCHIZOPHRENIC PATIENTS TREATED WITH CLOZAPINE
Joanna K Fitzsimons
The University of Melbourne, Australia
Michael Berk
The University of Melbourne, Australia
Seetal Dodd
Department of Clinical and Biomedical Sciences, The University of Melbourne, Australia
Tim Lambert
University of Melbourne, Australia
Myocarditis and cardiomyopathy are recognised serious and potentially fatal adverse effects of clozapine treatment, and are significantly more often related to clozapine treatment than with other first and secondgeneration antipsychotics.
The current study aims to examine echocardiographic recordings from 40 schizophrenia patients treated with clozapine for evidence of cardiac related adverse effects.
Echocardiographic recordings were conducted on all subjects prior to commencing clozapine treatment and were then repeated following an average of 12.3 months of treatment (SD: 9.9, Range: 0.6–42.8 months). Reports were examined for left ventricular dysfunction. White blood cell counts, co medications, creatine kinase levels and serum troponin I levels were also investigated.
Differences between pre and post clozapine treatment echocardiograph reports are reported for the clozapine treated cohort.
Keywords: Biological Psychiatry, Neuropsychiatry
532
ARE PROTEIN ALTERATIONS IN SCHIZOPHRENIA DUE TO EARLY ENVIRONMENTAL INSULT?
Carmit Nadri
Stanley Research Center, Faculty of Health Science, Ben-Gurion University of the Negev and Mental Health Center, Israel
Barbara K Lipska
Clinical Brain Disorders Branch, NIMH, United States
Galila Agam
Stanley Research Center, Faculty of Health Science, Ben-Gurion University of the Negev, and Mental Health Center, Israel
R H Belmaker
Stanley Research Center, Faculty of Health Science, Ben-Gurion University of the Negev and Mental Health Center, Israel
Purpose: Genetic inheritance and perinatal environmental insults contribute to schizophrenia manifestation. Little is known concerning the biological and physiological processes that mediate the environmental contribution. The neurodevelopmental-etiological hypothesis of schizophrenia proposes that orderly brain development is disturbed by an-as-yet unidentified event or insult occurring during perinatal period. Non-genetic risk factors include viral infection, stress, premature birth and perinatal hypoxia.
Method: We chose to address the search for etiological factors of schizophrenia by looking at two neurodevelopmental perturbations in rats: ventral hippocampal (VH) lesion at a neonatal age (Lipska and Weinberger, [Citation2000]), and exposure of neonates to hypoxia or anoxia conditions (Boksa, [Citation2004]). Studies in postmortem (PM) brain of schizophrenia patients found aberrant expression of synaptic and signal transduction proteins such as synaptophysin, neuregulin, calcineurin, GSK3beta and AKT/PKB. We studied the levels of these proteins in the frontal cortex (FC) of rats with perinatal insult.
Results: In the FC of VH-lesioned rats we found, in parallel with the PM findings, reduced GSK-3beta and elevated PKCepsilon protein levels compared to sham animals at a pre-pubertal age, but no change in calcineurin and neuregulin levels; in contrast with PM findings synaptophysin levels were found elevated. Preliminary results in the hypoxia-exposed neonates at adulthood show reduction in GSK3beta and PKB/AKT protein levels.
Conclusions: The results suggest that the proteins that show similar deviation from controls in the animal models and in the schizophrenia patients PM brain may reflect the environmental insult component of schizophrenia whereas other protein changes may be genetically inherited aberrations.
Keywords: Biological Psychiatry, Neuropsychiatry
533
CHOICE OF SUBSCALES FOR THE BRIEF PSYCHIATRIC RATING SCALE (BPRS-24)
Terry J Lewin
Centre for Mental Health Studies, University of Newcastle, Hunter New England Mental Health, and NISAD, Australia
Vaughan J Carr
Centre for Mental Health Studies, University of Newcastle, Hunter New England Mental Health and NISAD, Australia
Amanda L Baker
Centre for Mental Health Studies, University of Newcastle, Hunter New England Mental Health, & NISAD, Australia
Purpose: The 24-item version of the Brief Psychiatric Rating Scale (BPRS-24) is a widely used, clinician rated, semi-structured measure of adult psychopathology. However, while it has a well developed item set, there is little consensus about how to form subscales. We sought to construct a parsimonious set of subscales, which could facilitate cross-sectional and longitudinal comparisons.
Methods: A relatively large data set was available, collected from community-recruited samples of people with co-existing psychosis and substance use disorders, who were participating in treatment studies primarily targeting their current substance use. The 1,531 sets of BPRS ratings from these studies were factor analysed, comprising 427 participants assessed at baseline and on up to three follow-up occasions.
Results: The solution that was extracted, based on a principal components analysis with an oblique rotation, resulted in the assignment of five items to each of four factors: 1) mania (motor hyperactivity, excitement, tension, distractibility, elevated mood); 2) dysphoria (depression, guilt, anxiety, suicidality, somatic concern); 3) negative symptoms (blunted affect, emotional withdrawal, motor retardation, disorientation, self-neglect); and 4) positive symptoms (unusual thought content, grandiosity, hallucinations, bizarre behaviour, suspiciousness). These factors are generally consistent with those reported previously and have acceptable reliabilities: 0.73, 0.75, 0.70, and 0.70, respectively; with an overall reliability estimate of 0.82 for the BPRS-24 total score.
Conclusions: Whether or not the particular ‘solution’ that we propose has a more universal application is of less concern than our desire to illustrate some of the issues involved in attempting to formulate a consensus set of BPRS-24 subscales. Our interest in sharing these findings is heightened by the fact that most of the previously published BPRS-24 factor analyses have been based on inpatient samples.
Keywords: Epidemiology, Aetiology, Other
534
HYPERPROLACTINEMIA AND COGNITIVE FUNCTIONING
Marjorie L Shuer
Queensland Health, Australia
Elissa Waterson
Queensland Health, Australia
Steven Hay
United Kingdom
The treatment of psychotic illness with the requisite antipsychotic medications is not without side effect risk. The hyperprolactinaemia that accompanies the administration of certain atypical antipsychotic medications has been documented to result in osteopenia, hypogonadism, galactorrhea, amenorrhea and weight gain. What has not been investigated is the secondary impact of the disrupted hypothalamic-pituitary-gonadal axis (HPG) on cognition in reproductive aged women. What follows is a case study investigating the effect of antipsychotic induced hyperprolactinaemia on neuropsychiatric testing as well as endocrine hormonal levels. Preliminary neuropsychiatric testing was compared with testing undertaken after titration to an alternative antipsychotic (non prolactin inducing) and normalisation of menses. A discussion of the results will follow.
535
THE PATERNAL AGE HYPOTHESIS AND THE BRAHMIN OF TAMIL NADU
David C Chant
Queensland Centre for Mental Health Research (QCMHR), Australia
Bryan J Mowry
Queensland Centre for Mental Health Research (QCMHR), Australia
R Thara
Schizophrenia Research Foundation, India
TN Srinivasan
Schizophrenia Research Foundation, India
A number of studies have put forward the hypothesis that advanced paternal age with concomitant mutations in the male germ line is associated with sporadic schizophrenia in offspring. Other results, however, indicate a lack of support for the finding that sporadic probands tend to have older fathers at birth than familial probands; this failure to support the ‘paternal age hypothesis’ may, however, be a function of heterogeneous samples.
This paper will present results from a study of data arising from a schizophrenia study among the Brahmin of Tamil Nadu, India that lend tentative, if neither strong nor not particularly robust, support to the paternal age hypothesis. This statistical support will, however, be shown to be stronger for an association of birth-order of the offspring with the risk of schizophrenia rather than for paternal age. Furthermore a purely within-family component of paternal age, viz the years since the birth of the first offspring, associates marginally better than paternal age itself. The methodology will be based on regressive, repeated-measures (i.e., within-family), logistic models.
Keywords: Epidemiology, Aetiology, Other
536
REDUCTION IN HOMOCYSTEINE IMPROVES COGNITIVE FUNCTIONING IN FIRST EPISODE PSYCHOSIS
Alicia Papas
ORYGEN Research Centre, Australia
Colin O’Donnell
ORYGEN Research Centre, Australia
Michaela K O’Regan
ORYGEN Research Centre, Australia
Tina Marie Proffitt
ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia
Paul Maruff
CogState Ltd, Australia
Gregor Berger
ORYGEN Research Centre, Australia
Timothy Stephens
University of Melbourne, Australia
Pat D McGorry
ORYGEN Research Centre, Australia
Purpose: Cognitive decline in patients with schizophrenia has been well documented in the literature. Furthermore, high levels of homocysteine have recently been implicated in the biochemistry of schizophrenia. The aim of the current study was to investigate: i) homocysteine levels of 15–25 year olds who have experienced first-episode-psychosis (FEP), ii) the relationship between baseline homocysteine levels and cognition in this cohort, and iii) the effect of changes in homocysteine levels on cognitive performance.
Method: FEP patients of ORYGEN Youth Health consented to a randomised controlled trial investigating the homocysteine-lowering effects of a B-complex vitamin and its impact on cognition. Blood was drawn at baseline and following a 3-month trial period to determine homocysteine levels. A battery of neuropsychological tests was administered to ascertain levels of cognitive functioning at three time-points (baseline, week six and week 12). To date, 25 patients have completed both baseline and 3-month follow up neuropsychology assessments. Healthy controls were also recruited for the purpose of comparing baseline homocysteine levels.
Results: Analysis of baseline homocysteine indicated the FEP group had significantly higher levels than controls (p <.02). Regarding the FEP group, a significant relationship was found between elevated baseline homocysteine levels and impairments in visuomotor speed and visuospatial ability. Patients whose homocysteine decreased by the end of the study period displayed significant improvements in these domains, as well as in reasoning and problem solving ability. This group of patients also demonstrated some improvement in verbal learning and memory, with a high effect size (Cohen’s d <.86).
Conclusion: Preliminary data suggest elevated homocysteine may be a feature in early psychosis. Impairments in cognition were found in patients with higher baseline levels of homocysteine, consistent with literature on schizophrenia. Furthermore, decreased homocysteine levels over time seem to be related to improvements in cognitive functioning. More conclusive evidence will be available once the anticipated 120 participants have completed the trial.
Keywords: Biological Psychiatry, Neuropsychiatry
537
PREDICTORS OF SUICIDE ATTEMPT IN TREATMENT IN FIRST EPISODE PSYCHOSIS
Sue M Cotton
ORYGEN Research Centre, University of Melbourne, Australia
Jo Robinson
ORYGEN Research Centre, University of Melbourne, Australia
Philippe Conus
Departement Universitaire de Psychiatrie Adulte, Clinique de Cery, Switzerland
Martin Lambert
University Hosptial Hamburg-Eppendorf, Germany
Patrick McGorry
ORYGEN Research Centre, University of Melbourne, Australia
Little is known about the factors associated with suicidal behaviour in treatment amongst young people experiencing first episode psychosis (FEP). The aim of this paper is to describe the demographic, diagnostic, premorbid, and entry characteristics, of FEP patients who attempt suicide during the course of treatment at a specialist first-episode psychosis service. Data were collected via extensive file audit. The sample comprises 668 young people who received a specialist first-episode psychosis service from EPPIC between 1998 and 2000. Patients who attempted suicide during treatment were significantly younger, had fewer years of education, were more likely to have a diagnosis of major depressive disorder with psychotic features, or a substance use disorder. Premorbid factors associated with suicide attempt in treatment included poorer functioning, a longer duration of untreated psychosis, an earlier age of onset of psychosis, exposure to a traumatic event, and having a past psychiatric diagnosis. At entry to service, patients who attempted suicide demonstrated greater severity of symptoms and poorer functioning than those who did not attempt suicide while in treatment. The clinical implications of these findings will be discussed with particular attention being given to the role of early intervention services in devising treatment strategies and reducing risk of suicide attempts in treatment.
Keywords: Epidemiology, Aetiology, Other
538
73% MEDICATION COMPLIANCE NEEDED TO ACHIEVE THERAPEUTIC BENEFIT IN FIRST EPISODE PSYCHOSIS (FEP)
Michaela K O’Regan
ORYGEN Research Centre, Australia
Colin O’Donnell
ORYGEN Research Centre, Australia
Alicia Papas
ORYGEN Research Centre, Australia
Margaret Dell’Olio
ORYGEN Research Centre, Australia
Rosemary Purcell
ORYGEN Research Centre, Australia
Pat D McGorry
ORYGEN Research Centre, Australia
Purpose: To objectively investigate medication compliance in a FEP cohort utilising electronic pill cap monitoring and to explore the level of compliance needed to achieve therapeutic benefit.
Method: Forty patients from the EPPIC outpatient clinic took part in a randomised controlled trial investigating the homocysteine lowering effects of a B-complex vitamin. Electronic pill cap monitoring (MEMS, Aardex Ltd.) was used to assess oral antipsychotic and trial medication compliance. Psychopathology was assessed using the BPRS, PANSS and GAF at the beginning and end of the monitored period. Eleven patients on depot antipsychotic were also monitored. Powerview software (Aardex, Ltd.) was used to calculate three measures of compliance; Taking Compliance (percentage of prescribed medication doses taken), Correct Dosing (percentage of days on which the correct number of doses were taken), and Therapeutic Coverage (percentage of time for which the patient was covered by the medication).
Results: Patients whose symptoms improved (i.e. by more than 15 points on the PANSS) were compared to those who did not meet this criterion. The average taking compliance (73%) of the ‘improved’ group was used to segregate the patients into ‘compliant’ and ‘noncompliant’. Those in the compliant group significantly improved during the monitored period as measured by the GAF, PANSS and the BPRS (p <.046, p <.034. p <.002, respectively). The depot group was more compliant than the oral group across Taking Compliance (p <.012) and Correct Dosing (p <.045). Compliance to antipsychotic medication and vitamin/placebo did not differ across the three compliance variables. Patients living with a family member had higher rates of Correct Dosing (p <.028) and Therapeutic Coverage (p <.034).
Conclusion: Pharmacological exposure to antipsychotic medication was significantly related to improved symptoms; those who took 73% or more prescribed medication showed improvement across several domains. Despite a perceived favourability for vitamins there was no difference between their compliance and antipsychotic compliance. Also, caregivers may play an important role in compliance.
Keywords: Work and Voc Rehab, Social Psychiatry
539
EARLY PSYCHOSIS IN THE NORTH COAST AREA HEALTH SERVICE (NCAHS)
Doug Andrews
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Yvette Greenhalgh
North Coast Area Health Service (NCAHS), Australia
Helen J Stain
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Brian J Kelly
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Aim: To describe a population with first episode psychosis (FEP) and to assess the effectiveness of a generic model of care in a rural/regional setting.
Background: Early psychosis (EP) programs have proven efficacy in specialised centres but the effectiveness of generic programs especially rural/regional ones is uncertain. The NCAHS utilises a ‘key person’ – a clinical coordinator – in a generic case management model.
Method: A 12 month cohort of FEP clients was compared with an historical control group. They are described demographically and clinically, allowing comparison with published urban samples. Key process indicators were identified from local guidelines (adapted from the Australian Clinical Guidelines for Early Psychosis).
Results: Our FEP population is ethnically homogenous and fewer than 10% are indigenous. Education levels are low with most not proceeding past year 10. Families remain involved with many of our clients still living at home. Substance abuse is ubiquitous. Families and police figure prominently in pathways to care but general practitioners were relatively uninvolved. Average duration of untreated psychosis was about 23 weeks. Our model achieved improvements in a number of process variables including speed of case management referral, formal family meetings, client psychoeducation and the use of formal relapse prevention plans. Others, such as GP notification, did not improve.
Conclusion: Our study population shows some similarities to urban samples but differs in important ways that may reflect its rural/regional character. The described model of care demonstrated improvements in process but outcome measures are needed to establish effectiveness.
540
INFLUENCE OF EARLY LIFE STRESS ON THE OPEN FIELD BEHAVIOR OF FEMALE ADULT RATS
Noppamars Wongwitdecha
Department of Pharmacology, Faculty of Science & Institute of Science & Technology for Research & Development, Mahidol University, Thailand
Nattaporn Yoopan
Department of Pharmacology, Faculty of Science & Institute of Science & Technology for Research & Development, Mahidol University, Thailand
Early maternal deprivation is considered an animal model of early life stress that causes long-term alteration in later life behaviors.
Objective: The aim of this study was to explore the long-term effect of early life stress on locomotion and exploration activity in female adult rats.
Methods: Female Wistra rats and their female pups were reared under 3 conditions: 1) 360 min daily maternal separation (MS), 2) handling by man for 5 min daily (H) both conditions were done on the first 10 days after birth and 3) no handling or separation (NH). At 21 days of age rats, were housed in each group for 4 weeks. Subsequently, rats were tested individually for 5 min in a circular open field arena.
Results: The results showed that both stress conditions, handling and maternal separation, produced hyperlocomotion (increased total zone transition) and exploration activity (increased number of rears). Both effects were significantly increased in H group when compared with NH as control.
Conclusion: These finding suggested that early life stress condition alters long-term effect on locomotion and exploration behaviors of female adult rats.
541
VISUO-COGNITIVE DEFICITS IN SCHIZOPHRENIA AND FIRST-DEGREE RELATIVES
Carmel M Loughland
Neuroscience Institute for Schizophrenia and Allied Disorders, Centre for Mental Health Studies, University of Newcastle, Australia
Kathryn L McCabe
Neuroscience Institute for Schizophrenia and Allied Disorders, Centre for Mental Health Studies, University of Newcastle, Australia
Patrick J Johnston
Centre for Mental Health Studies, University of Newcastle, Australia
Terry Lewin
Hunter and New England Health Service, Australia
Vaughan Carr
Neuroscience Institute for Schizophrenia and Allied Disorders, Centre for Mental Health Studies, University of Newcastle, Australia
It is well documented that patients with schizophrenia display face and facial affect information processing deficits that likely contribute to their social dysfunction. Previous research demonstrates that patients exhibit abnormally ‘restricted’ visual scanpaths to face and facial expression stimuli which appear to be diagnostically specific to schizophrenia. This study explored whether the observed scanpath deficits to faces in schizophrenia are associated with 1) dysfunction in information sequencing or information retention/integration of facial information, and 2) whether attenuated forms of these disturbances are observable in the first-degree relatives of schizophrenia probands, suggesting a familial transmission. The visual scanpaths of 20 schizophrenia subjects, 20 first-degree relatives and 20 non-related ‘healthy’ control subjects were recorded while viewing seven facial expressions. Affect recognition accuracy was recorded concurrently. The information sequencing and information retention/integration tasks consisted of facial images masked by a five by five matrix of tiles covering the main facial features. Participants were asked to determine the facial emotion of the stimuli (forced choice between seven emotional categories) by removing as few of the tiles as necessary. Preliminary data analysis will be presented and the clinical significance of these findings discussed.
Keywords: Epidemiology, Aetiology, Other
543
CORTICAL THICKNESS ESTIMATION – A NEW METHOD FOR DETERMINING CORTICAL THICKNESS
Anthony WF Harris
The University of Sydney, Australia
Sebastien Ourselin
Australia
Raphael Moreno
Australia
Mark Holden
Australia
Lavier Gomes
Australia
Tom Whitford
Australia
The study describes a new automated tool for the quantitative measurement of cortical thickness from magnetic resonance images. The estimation of cortical thickness is of interest in disorders such as schizophrenia or Alzheimer’s disease where cortical thinning is noted to be a part of the pathological process. Manual estimation of cortical thickness is fraught with difficulties surrounding definition of cortical boundaries and plane of measurement and is usually very time intensive. This new methodology segments the MRI into gray matter, white matter and CSF using a Gaussian mixture model and a priori probability maps. It then uses Laplace’s equation to compute streamlines through the cortex that enable accurate reproducible measures of thickness. The method is rapid enabling thickness estimation to be completed within 15–20 minutes. This is tested using images derived from 25 young people with schizophrenia who were followed up over a two-three year period.
Keywords: Biological Psychiatry, Neuropsychiatry
544
FACTORS ASSOCIATED WITH MENTAL STATE CHANGE DURING ACUTE PSYCHIATRIC HOSPITALISATION
Ketrina A Sly
Centre for Mental Health Studies (CMHS), Australia
Terry J Lewin
Centre for Mental Health Studies (CMHS), Australia
Vaughan J Carr
Centre for Mental Health Studies (CMHS), Australia
Agatha Conrad
Centre for Mental Health Studies (CMHS), Australia
Philip B Ward
University of New South Wales, Sydney South West Area Health Service, Australia
Purpose: The Acute Services Project examined pathways to care among adult psychiatric admissions to 11 acute inpatient units in NSW. One of the aims was to document current mental state profiles and associated factors.
Methods: A series of clinical modules and logs was developed, including the Patient Daily Log (PDL), which was completed by nursing staff for each patient on each shift. The PDL recorded a range of clinical management and patient-related factors, together with a brief observational instrument requiring five mental state ratings: emotional distress; withdrawal; disinhibition; psychosis and cognitive impairment.
Results: Day and afternoon shift mental state ratings (54,285 PDLs) were utilized in the analyses. Based on admission records 36% of patients had a diagnosis of schizophrenia, 17% depression, 15% bipolar disorder, and 31% another disorder. A consistent improvement in mental state was observed from admission to discharge. Emotional distress levels were similar regardless of diagnosis, withdrawal was lowest among the bipolar disorder group who also exhibited the highest level of disinhibition, while psychosis and cognitive impairment rated highest among the schizophrenia and bipolar group. Overall ‘active psychopathology’ was higher among the schizophrenia and bipolar disorder groups, who exhibited the largest improvement. Aggressive incidents and PRN medication were associated with higher levels of ‘active psychopathology, whilst attendance at structured therapy was associated with improved mental state.
Conclusions: Patients exhibiting higher levels of ‘active psychopathology’ on admission required longer periods of hospitalisation, while patterns of change in mental state were related to diagnosis. Additionally, patients involved in serious aggressive incidents were rated by nursing staff as having higher levels of ‘active psychopathology’ both on admission and throughout the period of hospitalisation.
Keywords: Epidemiology, Aetiology, Other
545
DIFFERENTIAL REGULATION OF THE MAPK SIGNAL TRANSDUCTION PATHWAY BY CLOZAPINE AND HALOPERIDOL IN CORTICAL NEURONS
Avril M Pereira
Mental Health Research Institute of Victoria, Australia
George Fink
Mental Health Research Institute of Victoria, Australia
Suresh Sundram
Mental Health Research Institute of Victoria, Australia
Delineating the mechanisms of action of typical versus atypical antipsychotic drugs may provide insight into their different clinical and side effect profiles. How repeated short term interaction of these agents with receptors can be translated into long term cellular adaptive changes resulting in delayed onset in antipsychotic efficacy is unknown, but may involve intraneuronal signaling pathways. A likely candidate is the mitogen activated protein kinase-extracellular signal regulated kinase (MAPK-ERK) cascade. For instance, the atypical antipsychotic clozapine reduced, whereas the typical drug, haloperidol, increased phosphorylation of the MAPK isoforms ERK1/2 in mouse dorsal striatum implicating this pathway in extrapyramidal side effects seen with haloperidol but absent with clozapine1. Here we investigated whether these two drugs elicit similar effects in primary cortical neurons. Activation of ERK1/2 upon exposure to drug over a 60 min period was measured utilizing phospho-specific antibodies by Western immunoblotting and results normalized against non-drug and total ERK1/2 levels. Both clozapine (48 ± 10%; p < 0.01) and haloperidol (55 ± 12%; p < 0.05) significantly decreased pERK1 but not pERK2 at 10 min. However, clozapine but not haloperidol markedly increased levels of both isoforms at 60 min (pERK1: 220 ± 41%, p < 0.05; pERK2: 301 ± 50%, p < 0.01). Raclopride had no effect across the time course. Clozapine phosphorylation of ERK at 60 min was attenuated with PD 98059 but not H-89 or agonists DOI, 8-OH-DPAT and carbachol. The actions of clozapine appear to be mediated by non D2R activation of ERK, however, through which G-protein the drug couples or whether growth factor receptor trans-activation is necessary for stimulation remains to be defined. Importantly, the effects of clozapine in contrast to haloperidol in cortical neurons may link this pathway to the ability of clozapine to improve cognition in schizophrenia.
Keywords: Biological Psychiatry, Neuropsychiatry
601
A PILOT STUDY OF BOREDOM IN A COMMUNITY SAMPLE OF ADOLESCENTS AND A CLINICAL SAMPLE OF ADOLESCENTS
Campbell Thorpe
Alfred Child and Adolescent Mental Health Service, Australia
Nadya M Kouzma
Alfred Psychiatry Research Centre, Australia
Anthony de Castella
Alfred Psychiatry Research Centre, Australia
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Boredom has been associated with a wide variety of problems in various contexts including school (low academic achievement and high school dropout rates), workplace (diminished work performance, increased accident rates, and job dissatisfaction), and personal life (negative affective states, including depressive symptoms, anxiety, hopelessness, loneliness, and dysfunctional behaviours such as hostility, property damage, substance abuse, pathological gambling, drink driving, and eating disorders). Despite these associations, limited research has focused on this construct and boredom continues to be ignored by most clinicians. This oversight is especially evident in the research and practices associated with the care of people with mental illness. Research into boredom in adolescents is especially lacking in the psychological literature, which is surprising given that adolescence is a time marked by change, stress, and identity issues. The aim of this pilot study is to examine and compare levels of boredom in a clinical and community sample of adolescents. Participants are asked to complete a survey, the Boredom Proneness Scale, and a demographic/ background form. The community sample of adolescents is recruited from secondary schools in Victoria, and the clinical sample of adolescents is recruited from the Alfred Child and Adolescent Mental Health Service. The results of this study are important in order to examine differences among adolescents with mental illnesses such as depression, anxiety, and ADHD and healthy adolescents. This has implications for both prevention and intervention strategies and programs, such as the assessment and treatment of adolescents with mental illness. This study is currently in progress and preliminary data will be presented.
602
PSYCHOLOGICAL ASSESSMENT OF PRE-BONE MARROW TRANSPLANT PATIENTS
Lynda Katona
The Alfred, Australia
Nadya M Kouzma
Alfred Psychiatry Research Centre, Australia
We presented data at last year’s ASPR Conference on a study which looks at the psychological assessment of patients undergoing an Allogeneic Bone Marrow Transplant (BMT) at The Alfred Hospital. This was in recognition of the growing research evidence that depression is a risk factor for mortality, morbidity, and reduced psychosocial functioning in BMT patients, and that about 20–30% of BMT patients report significant anxiety and depression pre-transplant. Internationally there is a strong move to screen BMT patients for depression and distress prior to transplant to identify those at risk and to provide appropriate interventions. Hence, an assessment process was implemented at The Alfred Hospital to help identify patients and their carers who would benefit from formal psychological intervention and support. Patients are asked to attend an assessment interview with their carer. The patient is interviewed first, then their carer, followed by a joint interview. Patients are asked to complete the Hospital Anxiety and Depression Scale, Mental Adjustment to Cancer Scale, and Brief Symptom Inventory. The aims of the assessment are to: 1. assess patient’s and their carer’s understanding and expectations regarding the transplant and recovery process; 2. assess for depression, anxiety, distress, and other psychiatric symptoms/disorder in the patient and their carer; 3. identify patient’s and their carer’s coping style; and 4. identify aspects of the transplant process which the patient anticipates will be most difficult. As data collection for this study is ongoing, updated results on the psychological assessment of pre-BMT patients will be presented.
Keywords: Epidemiology, Aetiology, Other
603
‘USING OUR BRAINS’ – WHO DONATES TO RESEARCH AND WHY?
Therese M Garrick
University of Sydney, Department of Pathology, Australia
Simon Howell
University of Sydney, Department of Pathology, Australia
Peter Terwee
Rhumbline Group, Australia
Joanna Redenbach
University of Sydney, Department of Nursing and Midwifery, Australia
Helen Blake
University of Sydney, Australia
Clive Harper
Royal Prince Alfred Hospital, Australia
Purpose: The need for human autopsy brain tissue is critical for the future of psychiatric research. Donor programs are becoming the primary source of this material and understanding who is interested in donation and what influences them is imperative. Most of our knowledge about motivation for donation comes from the transplantation literature and little is known about donation of organs for research. Are people influenced by the same factors regardless of whether they are donors for transplantation or research? Four brain donor programs are co-ordinated through the University of Sydney. The ‘Using our Brains’ (UoB) program encourages people without illness to donate their brain during life, for use as controls in research (after death). The aim of this study was to define the demographics of the UoB donors and to explore the factors that influenced them to donate their brains for research.
Method: People involved in the Using our Brains program were asked to complete a specifically designed questionnaire using web-based technology.
Results: The response rate was 82%. Most of the UoB donors are young, female, and were born in Australia. Motivating factors included the desire to help science, medicine and the community. Seventy-eight percent of participants are also involved in transplant donation programs. Most thought that the ‘brain’ was on the transplant donation selection list and that research was included in the donation. Most donors indicated that they were not concerned how their tissues or organs were used, provided all activities surrounding the donation were carried out with respect and dignity.
Conclusions: The majority of people involved in the ‘UoB’ program are also donors for transplantation purposes. People don’t seem to discriminate between research or transplant use when deciding to become a donor. An improvement in the overall donation rate might be possible if the systems between the research and transplant organizations were combined.
Keywords: Biological Psychiatry, Neuropsychiatry
604
BRAIN DONATION FOR PSYCHIATRIC RESEARCH: HOW DO NEXT-OF-KIN RESPOND?
Amanda K North
The Neuroscience Institute of Schizophrenia and Allied Disorders, University of Sydney, Australia
Therese Garrick
The University of Sydney, Australia
Lisa Azizi
The Neuroscience Institute of Schizophrenia and Allied Disorders, Australia
Clive Harper
The University of Sydney, Australia
Purpose: To investigate responses of the next-of-kin (NOK) of deceased persons to the question of brain donation for research, and to examine response pattern consistency over three years. Further, to elucidate what factors influence NOK decision-making under the necessary time pressure.
Background: Post-mortem brain tissue is becoming increasingly valuable to psychiatric research, enabling progress in understanding and treatment. Australian rates of organ and tissue donation are low, and in an attempt to identify the reasons for this, studies have examined prospective motivation to donate. The post-mortem situation is different. NOK must make a decision under emotive circumstances and within a restricted time-frame. There is considerable confusion about the distinction between donation for research and donation for transplantation. Further, there exists a perception that people are less happy to donate for research. A previous study at our centre examined NOK responses to brain donation for research over one year. The present study extends this to encompass three-year data.
Methods: Standard NSW Tissue Resource Centre (NSWTRC) processes for brain donation were carried out. On the day of autopsy a phone call was made to the deceased’s family. The senior available NOK was asked to consider donating the deceased’s brain tissue to research. Responses were tabulated over three years for analysis.
Results and Conclusions: Our results contradict public assumptions about brain donation. Donation ratios were high (60%) and remained constant across the three-year data. The presence or absence of a psychiatric illness in the deceased did not affect the response. In fact, results showed that most families who decided to donate did so because the donation allowed an ‘altruistic’ outcome to the death. The organ donation literature indicates that people who discuss the donation question with family members are much more comfortable with their ultimate decision than those who decide alone. It is encouraging that in our study, consultation with family members more often led to a “yes” response than did a lone decision. This suggests that the positive response was a considered one, and likely to be a comfortable one.
Keywords: Biological Psychiatry, Neuropsychiatry
605
EFFECTIVENESS OF DISTAL INTERVENTIONS FOR ENCOURAGING PHYSICAL ACTIVITY: A SYSTEMATIC REVIEW
Affrica Jenkins
Centre for Mental Health Research, The Australian National University, Australia
Helen Christensen
Centre for Mental Health Research, The Australian National University, Australia
Keith Dear
National Centre for Epidemiology and Population Health, The Australian National University, Australia
Janine G Walker
Centre for Mental Health Research, The Australian National University, Australia
Purpose: Physical activity has been shown to be effective in treating depression across age groups. For universal, population wide dissemination, as well as for targeting people at high risk of depression, non-face-to-face, or "distal", physical activity interventions have advantages over face-to-face interventions. These include reach, accessibility and potential cost effectiveness. A literature review was conducted of the effectiveness of distal interventions for encouraging physical activity and to determine which intervention features are keys for success.
Methods: Computerized searches for distal physical activity intervention trials together with visual scans of reference lists of related articles were performed in 2004. Studies were included if: (1) they employed a randomized controlled design; (2) the intervention aimed to promote physical activity; and (3) there was no face-to-face contact with participants.
Results: Fifteen studies meeting the stated criteria were identified, and effect sizes were calculated for most studies. Distal interventions had a small positive effect on physical activity in the short term. Efficacy of intervention features can be summarized as follows: print plus telephone was the most effective delivery mode; the number of sessions did not affect intervention outcome; and, stages-of-change, in-depth individual tailoring and social cognitive theory were useful theoretical models for physical activity interventions with the most evidence being in favor of targeting for stages-of-change.
Conclusions: Distal exercise interventions appear to be effective in encouraging physical activity, at least in the short term and for some population groups, but further research is needed to consolidate and extend these findings.
Keywords: Epidemiology, Aetiology, Other
606
CHANGES IN PRIVATE SECTOR ELECTROCONVULSIVE TREATMENT IN AUSTRALIA
Darrel P Doessel
Queensland Centre for Mental Health Research (QCMHR), School of Population Health, University of Queensland, Australia
Roman W Scheurer
Queensland Centre for Mental Health Research (QCMHR), Australia
David C Chant
Queensland Centre for Mental Health Research (QCMHR), Australia
Harvey Whiteford
Queensland Centre for Mental Health Research (QCMHR), University of Queensland, Australia
Purpose: This paper reports on changes, over time and between states, in the use of electroconvulsive therapy (ECT) in the private psychiatric sector in Australia between 1984 and 2004.
Method: Data for ECT services, and all specialist psychiatry services provided under the Medicare system, have been analysed in absolute numbers and as utilisation rates.
Results: Changes in the use of ECT over time are different from other services provided by private psychiatrists. As in other countries the use of ECT initially declined in period studied but has increased in recent years. In addition there is a clear pattern of differential use of ECT between the states and territories.
Conclusions: This descriptive study cannot ‘explain’ the results obtained: other data, incorporated into an explanatory model using regression analysis, are needed to determine the factors underlying the utilisation patterns obtained in this study. Thus, further work is needed. Furthermore it is important to analyse data at a lower level of geographical aggregation than that of the state/territory: this (state/territory) aggregation conceals differences in utilisation between metropolitan, minor city, rural, and remote regions of the country.
Keywords: Work and Voc Rehab, Social Psychiatry
607
DOES HORMONE REPLACEMENT THERAPY AFFECT COGNITION? A REVIEW BY COGNITIVE DOMAIN
Lee-Fay Low
Australian National University, Australia
Kaarin J Anstey
Australian National University, Australia
Background: Laboratory, animal and neuroimaging evidence suggest that hormone replacement therapy (HRT) may be beneficial to human cognition.
Aim: To systematically review the association between HRT and cognition and risk of dementia. It was hypothesised that HRT would have a positive association with cognitive speed and verbal memory and possibly visual memory but not with executive functioning, and would be associated with a decreased risk of dementia.
Methods: Search of MEDLINE and PsycINFO databases and reference lists of previous reviews. Articles were included if they reported original data on the relationship between estrogen replacement and cognition or dementia, involved postmenopausal females, had a sample size greater than 50, objectively measured cognition or a diagnosis of dementia, and were in English.
Results: Twenty-six studies on the association between HRT and cognition and 17 studies on HRT and risk of dementia were included. There was significant statistical and clinical heterogeneity among studies precluding meta-analysis. Forest plots showed no consistent relationship between HRT and performance in any cognitive domain. Cross-sectional studies tended to report more positive results than longitudinal studies and randomised controlled trials, particularly in the areas of verbal memory and executive functioning. HRT was associated with decreased risk of dementia in observational studies, but with increased risk in one randomised controlled trial.
Conclusions: Cognitive improvement or maintenance are not secondary benefits of HRT. HRT may have a beneficial effect under certain circumstances, which need to be identified through further research.
Keywords: Biological Psychiatry, Neuropsychiatry
608
ISSUES RELATING TO THE INTERFACE BETWEEN CRISIS ASSESSMENT TEAMS AND EMERGENCY SERVICES WHEN DEALING WITH THE MENTALLY ILL
Yitzchak Hollander
Department of Psychiatry, Alfred Hospital, Australia
Steven Tahtalian
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
David Young
Victoria Police, Australia
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Collaboration between mental health and crisis services is required to improve the care and management of people with a mental illness, particularly in times of crisis. Often, the interactions between these services can become problematic as issues regarding intervention, management and law enforcement of mentally ill people often arise. The systematic study of the complexities of service collaboration is required to develop a more effective service system for the management of people with mental illness. The identification and definition of key issues and concerns regarding the interface between mental health services and the police is vital for this to occur.
The aim of the project was to identify key issues associated with the interactions between Crisis Assessment & Treatment Teams (CATT) and the police of the Alfred Hospital catchment area. The objective was to collect information regarding key issues and concerns of staff from the relevant services. Information was collected through questionnaires distributed to staff who have had contact with these services whilst dealing with the mentally ill.
Preliminary results indicate that police are spending a great deal of time in emergency departments waiting for patient assessments. Police also reported a lack of information regarding the mentally ill prior to attending the scene, problems with obtaining information from treating professionals, and difficulty receiving feedback regarding outcomes of individuals. CATT identified concerns about response from emergency services, indicating that response times can be lengthy and that the getting a coordinated response is sometimes difficult.
In order to further delineate these issues, focus group interviews will be conducted with key staff from these services. An action research methodology will then be adopted whereby possible strategies and solutions to problems faced will be identified and tested. The efficacy of these strategies will then be evaluated. This process will be repeated until an optimal consensus about their effectiveness is achieved between services. This approach will allow for improved collaboration between services and better outcomes for people suffering from mental illness.
Keywords: Work and Voc Rehab, Social Psychiatry
609
HOMELESSNESS AND THE IMPACT ON LENGTH OF HOSPITAL STAY AND RELAPSE
Yitzchak Hollander
Department of Psychiatry, Alfred Hospital, Australia
Steven Tahtalian
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Adiel Bonett
Alfred Hospital, Department of Psychiatry, Australia
Brent Hayward
Department of Psychiatry, Alfred Hospital, Australia
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Accommodation is a fundamental need for people with a mental illness as for the rest of the community. The availability of suitable housing for this group of people is vital to providing community mental health support in the least restrictive way (Barling 1997; Newton & Rosen, 1997; Moxham & Pegg 2000). In Australia, institutions have long recognised the importance of suitable housing for people with a mental illness though over the past 10 years there has been a steady decrease in appropriate accommodation options for this group of people (Kliger et al., 2003). Private rooming houses, crisis shelters and supported accommodation are rapidly disappearing in the Inner-South-East area of Melbourne (Jope, 2000; Kliger et al., 2003), which will inevitably place greater strain on mental health services. Anecdotal evidence suggests that patients are now experiencing longer hospital stays as a result of insufficient accommodation options to which patients can be discharged. If this is the case, expensive hospital resources are being unduly utilized and bed availability subsequently reduced. This is further compounded by research which indicates that the appropriateness and quality of accommodation can have a critical effect on relapse (Baker & Douglas, 1990; Bergin et al., 1997).
The current study aims to investigate whether patients who are considered to be in unstable accommodation are experiencing longer hospital stays as compared to those in stable housing. Inpatient social workers will collect information from consecutive admissions for a 3 month period regarding patient’s accommodation situation at time of admission, accommodation options for discharge, time taken to secure accommodation, time spent in hospital after medical clearance for discharge and length of hospitalisation. Demographic information will also be collected and analysed with these factors. An additional 6 months will be spent obtaining the same information from patients who have relapsed and readmitted into hospital during this time period. The results will provide insight into the dynamic nature of accommodation availability and the impact on length of hospital stay and relapse.
Keywords: Work and Voc Rehab, Social Psychiatry
610
A 7-YEAR FOLLOW-UP STUDY OF FORMER LONG-STAY PATIENTS IN MELBOURNE
Prem K Chopra
The University of Melbourne, Australia
Helen Herrman
The University of Melbourne, Australia
In the wake of deinstitutionalisation the development of Community Care Units (CCUs) has provided a setting for residential rehabilitation in Victoria. The long-term impact and the applicability of residential rehabilitation services need to be assessed, particularly considering the changing roles of CCUs.
Objectives: To study the outcomes of the initial cohort of 17 patients admitted to the CCU using an integrated approach with clinician and self-report measures. To examine the feasibility of the Continuity of Life Instrument (COLI) in the qualitative assessment of long-term outcomes.
Methods: The study was performed at the CCU attached to St. Vincent’s Mental Health Service Melbourne. A retrospective/prospective study design was adopted to assess the outcomes of the initial cohort of patients admitted in 1995. A file audit form was designed to document the application of a range of rehabilitation interventions. Objective assessment of illness and functioning was made using the WHO Life Chart Schedule (LCS) based on recorded information. The Continuity of Life instrument (COLI) was used as a qualitative assessment of the impact of illness.
Results: The outcomes of this cohort varied with respect to level of functioning, symptoms and pattern of hospitalisations. The focus of rehabilitation comprised of medication compliance monitoring, living skills training and involvement with community services for individual and group activities. The majority of patients required some form of residential care following discharge. The COLI provided a feasible means of assessing patients’ insights. Using this interview, patients reported the negative impact of psychotic illness on a range of domains. These perspectives ought to be acknowledged as a valid means of assessing outcome.
Conclusions: A multifaceted approach is required to assess the longterm outcomes of former long-stay patients. Whilst there was significant variation in outcomes, the need for adequate supported residential care was highlighted. The ongoing needs of this group and other patients of a similar profile must be considered in view of the pressure on residential rehabilitation services.
Keywords: Work and Voc Rehab, Social Psychiatry
611
MENTAL HEALTH FIRST AID STORIES
Betty A Kitchener
ORYGEN Research Centre, University of Melbourne, Australia
Purpose: Given the high prevalence of mental disorders and the comparatively low rate of professional help-seeking, it is useful for members of the public to have some skills in how to assist people developing mental disorders. In 2001, a Mental Health First Aid training course was developed to provide these skills. This poster will present the findings from a qualitative study gathering stories from course participants about their subsequent experiences in providing mental health first aid.
Methods: The stories are from a sample of course participants of a previous cluster randomized trial of the course. They were sent a questionnaire either by post or via the internet 19–21 months posttraining. Responses were received from 94 out of 131 participants who were contacted. The questionnaire asked about whether the participant had experienced a post-training situation where someone appeared to have a mental health problem and, if so, asked questions about that experience.
Results: Post-training experiences were reported by 78% of respondents. Five key points emerged: (1) the majority of respondents had had some direct experience of a situation where mental health issues were salient and the course enabled them to take steps that led to better effects; (2) positive effects were experienced with increased empathy and confidence, as well as being able to better handle crises; (3) the positive effects were experienced by a wide range of people with varied expectations and needs; (4) there was no evidence of people over-reaching themselves because of over-confidence and (5) those who attended were able to identify quite specific benefits and many thought the course not only very useful but were keen to see it repeated and extended.
Conclusions: The qualitative data confirm that most participants of the Mental Health First Aid training subsequently provide support to people with mental health problems and that this support has positive effects.
Keywords: Work and Voc Rehab, Social Psychiatry
612
A RECOVERY BASED OUTREACH PROGRAM IN RURAL VICTORIA
Vaman R Prabhu
Latrobe Regional Hospital Mental Health Services, Australia
Yvonne Pywell
Latrobe Regional Hospital Mental Health Services, Australia
Mark A Oakley Browne
Latrobe Regional Hospital Mental Health Services, Monash University, Australia
The paper discusses the implementation of the Stepping Stones Recovery Program (SSRP), a recovery based outreach program in Gippsland, Victoria. The SSRP was instituted in 2002 within Latrobe Regional Hospital Mental Health Services. The program focuses on working with people with chronic and recurring mental illness who have significant difficulties in independent living, social and occupational functioning and poor quality of life. Between 2002 and 2005, 100 people were referred to the program. A demographic and clinical summary of the referrals will be presented along with an outcome evaluation of a sample of 20 clients who completed the program. The clinical framework used by the SSRP is the Collaborative Recovery Model (CRM) that has been developed by the University of Wollongong. The philosophy of the CRM is to enhance collaboration between clients and clinicians within a framework that covers 4 components: assessing readiness to change, identification of needs, goal setting and task setting and monitoring. The paper will focus on the benefits of active collaboration between consumers and clinicians and the need for specialised recovery programs within mental health services.
Keywords: Work and Voc Rehab, Social Psychiatry
613
HANDS OFF! CARE OF THE PREGNANT WOMAN IN THE ACUTE INPATIENT UNIT
Jayashri Kulkarni
Alfred Psychiatry Research Centre, The Alfred and Monash University, Australia
Kay M McCauley
Monash University, Australia
Glenice Ives
Monash University, Australia
Purpose: To identify the management issues of women who have psychosis and are pregnant in acute adult inpatient psychiatric settings.
Method: A purposive sample of mental health nurses, case manager and medical officers were invited to participate in individual face to face interviews. These mental health clinicians were from two key mental health services in Victoria, one metropolitan and one rural hospital.
Results: From the transcriptions of the interviews key themes were identified. These included: difficulties with the use of medications; fear of harm by the woman to the baby and staff, harm to the woman and baby by other inpatients or by staff in situations requiring chemical and/or physical restraint or seclusion for example. The difficulties in providing a safe environment for women who are psychotic and pregnant were identified and this has led to the implementation of practices which segregate the women from others and place staff in a dilemma as to the correct management. The use of appropriate antipsychotic medication to prevent relapse and the requirement for admission to the acute psychiatric setting is seen as critical to the wellbeing and safety of mother and baby.
Conclusions: There is clearly a need to identify the safety of medication use in women who are psychotic and pregnant. The "National Register for the use of Antipsychotic Medication in Pregnancy" provides the opportunity for this group of women to be monitored and to enable the development of guidelines for recommended management which will ensure the safety and wellbeing of mother and baby. Ethical approval for this important register also encourages a ‘hands off’ approach which raises difficulties in researching this vulnerable population of women.
Keywords: Work and Voc Rehab, Social Psychiatry
614
THE ROLE OF PSYCHOLOGICAL SKILLS TRAINING IN CESSATION OF LONG-TERM BENZODIAZEPINE USE
Jan M Parr
Queensland Health, University of Queensland, Australia
David J Kavanagh
University of Queensland, Australia
Ross McD Young
Queensland University of Technology, Australia
Purpose: An analysis of current benzodiazepine withdrawal management approaches was undertaken to determine the most effective approach to assist individuals to cease long term benzodiazepine use. A meta-analysis found that providing augmented treatment in the form of substitute medication or cognitive behavioural therapy did not overall result in a better outcome than that achieved by gradual benzodiazepine dose reduction alone. Gradual dose reduction on resulted in approximately. To progress the development of a more comprehensive treatment approach, a qualitative study was undertaken with general practitioners and benzodiazepine users.
Method: Semi structured interviews were conducted with 28 General Practitioners (GPs) and 23 Benzodiazepine Users (BUs). A Consensual Qualitative Research (CQR) approach was selected, because it acknowledged that interviewees were the experts in relation to their inner experience (Hill, Thompson, & Williams, 1997).
Results: GPs identified that they provided a supportive environment for individuals wishing to cease use and developed individual dose reduction programs. Some GPs also identified that they used written contracts and provided written instructions to facilitate a positive outcome. BUs identified that in addition to the support they received from their GP, they utilised a number of psychological strategies that assisted them to initially cease use and maintain abstinence.
Conclusions: Information gained from the review of the treatment literature and the qualitative studies was developed into a correspondencebased psychological skills training program. The program is designed to provide additional structured support in addition to that provided by the individual’s GP. A randomised control trial is being conducted to establish whether a comprehensive psychological skills program will increase the cessation rate following long-term use of benzodiazepines.
Keywords: Epidemiology, Aetiology, Other
615
DOES EXECUTIVE FUNCTION PREDICT AGGRESSION IN YOUNG PEOPLE ADMITTED TO AN INPATIENT MENTAL HEALTH FACILITY?
Emma Newberry
School of Psychology, University of Queensland, Australia
Angela J Dean
Kids in Mind Research, Mater Child & Youth Mental Health Service, Australia
Suzanne Duke
Mater Child & Youth Mental Health Service, Australia
James Scott
Mater Child & Youth Mental Health Service, Australia
Valerie Stone
School of Psychology, University of Queensland, Australia
Background: Aggression is a common clinical issues arising during treatment of young people with mental health problems. A growing body of research reports an association between aggression and conduct disturbances with impaired frontal lobe and executive functions. This study examines whether executive function can predict incidents of violence or aggression in young people admitted to a psychiatric inpatient facility.
Methods: Patients admitted to Mater Child & Youth Mental Health Service Inpatient Unit were recruited for this study. Executive function was assessed using the following measures from the Delis-Kaplan Executive Function System: Colour-Word Interference Test, Verbal Fluency, and Trail Making Test. Patients were categorised as aggressive or non-aggressive based on prospectively collected data documenting aggressive incidents within the unit.
Results: Preliminary results are available for 10 participants (6 females, mean age 13.0 years). Young people with aggressive behaviour problems exhibited poorer performance on a range of executive function measures, although the small sample available for preliminary analysis does not yet permit adequately powered statistical testing. Aggressive patients demonstrated impaired cognitive flexibility as measured by the trail-making task with poorer contrast scores for number-letter switching contrast with motor speed (t = 3.41; p < 0.01) and number-letter switching contrast with letter sequencing (t = 2.00; p = 0.08). Poor performance on the inhibition component of the colour word test was also associated with aggressive behaviour. Patients with aggressive behaviour exhibited poorer verbal fluency scores on a range of letter fluency, category fluency and category switching items, although these differences were not always maintained after controlling for age.
Conclusions: Children and adolescents with aggressive behaviour may have deficits in certain executive functions. Executive function assessments may assist in the identification of at risk young people.
Keywords: Biological Psychiatry, Neuropsychiatry
616
MANAGEMENT OF AGGRESSION ON A CHILD AND ADOLESCENT INPATIENT UNIT
Angela J Dean
Kids in Mind Research, Mater Child & Youth Mental Health Service, Australia
James Scott
Mater Child & Youth Mental Health Service, Australia
Michelle George
Mater Child & Youth Mental Health Service, Australia
Suzanne Duke
Mater Child & Youth Mental Health Service, Australia
Background: Aggression is a common clinical issues arising during treatment of young people with mental health problems. Poorly managed aggressive behaviours can compromise the therapeutic environment and pose a safety risk to patients and staff. Pre-existing management techniques included distraction, quiet time, open time out, sedative medication, therapeutic holding and physical restraint by staff. In extreme cases, children may be placed under the mental health act and put under seclusion. This study examined whether introduction of a new management strategy for aggressive behaviours had an impact on rates of seclusion, pharmacological interventions for aggression and number of assaults on staff.
Method: In early 2004, Mater Child & Youth Mental Health Service Inpatient Unit introduced a new behavioural management policy (The Management of Challenging Behaviours) based on the Positive Parenting Programme. The policy required that children had an individual management plan with logical and predictable consequences for challenging behaviours. Part of this plan introduced the use of a new management strategy of ‘closed time out’, in combination with staff training in behavioural management.
Results: In the six months following introduction of ‘closed time out’, there was a substantial reduction in the number of aggressive episodes requiring seclusion or sedative medication. The number of physical assaults on staff initially decreased and then remained stable. This occurred despite in an increase in numbers of admissions over the same period.
Conclusions: Introduction of ‘closed time out’ and staff training resulted in a marked reduction in the number of episodes of seclusion. This occurred without reducing the number of children admitted to the inpatient unit, suggesting that reduction in admissions is not necessary to reduce the need for restrictive behavioural interventions. Consistent and individualised behavioural management can result in a safer work environment for staff and a more therapeutic ward in which to provide patient care
Keywords: Epidemiology, Aetiology, Other
617
PHARMACOLOGICAL TREATMENTS IN CHILD AND ADOLESCENT PSYCHIATRY – REVIEW AND CLINICAL IMPLICATIONS
Angela J Dean
Kids in Mind Research, Mater Child & Youth Mental Health Service, Australia
Brett M McDermott
Mater Child & Youth Mental Health Service, Australia
Robert T Marshall
Mater Pharmacy Services, Australia
Background: This study aimed to identify rates and correlates of psychotropic drug utilisation in children and adolescents in both inpatient and outpatient settings, and to identify areas for future research.
Methods: A retrospective chart review examined 122 charts from inpatient (IP) and 126 outpatient (OP) charts from a child and youth mental health service (admissions occurring from April 2002 to September 2003). Demographics, diagnoses and medication details were obtained.
Results: Average age was 12.8 years (IP) and 11.2 years (OP). Most prevalent disorders were mood disorders and anxiety disorders for IP (38.5% & 35.2%); parent-child relational problems and adjustment disorders were the most common for OP (18.3%, 17.5%). 71% of IP received psychotropic medication compared to 25% of OP (p < 0.001). Patients receiving medication were more likely to be older (p < 0.001), have a longer admission (p < 0.001), and have a more complex clinical presentation including greater number of diagnoses (p < 0.001), history of abuse or neglect (p < 0.01), and history of suicide attempts (p < 0.01). SSRIs were the most frequently used class of drug, used by 44.3% of IP and 13.5% of OP. Most frequent indications included mood disorders (22/72); comorbid mood and anxiety disorders (14/72); and anxiety disorders (13/72). SSRIs were used more frequently in inpatients with a high suicide risk (recent suicide attempt or current suicide ideation)(p < 0.01), as were newer antidepressants such as venlafax-ine(p < 0.01). Atypical antipsychotics were the next most frequently used drug, used by 23% of IP and 3.2% OP, primarily for behavioural disturbances. Other drugs used included stimulants (14% & 8%), mood stabilisers (3% IP only), and sedatives (15%; 4%). 51% of those receiving psychotropic medication received more than one drug concurrently. Rates of polypharmacy were highest among patients receiving antipsychotics. Use of poly pharmacy was related to a diagnoses of ADHD (p < 0.01) and mental retardation (p < 0.01).
Conclusion: Use of psychotropic medication is frequent in children and adolescents. Key areas for future research include treatments for depression, use of atypical antipsychotics for behavioural disturbances & polypharmacy.
Keywords: Epidemiology, Aetiology, Other
618
MEASURING THE MENTAL HEALTH OF RURAL COMMUNITIES: HOW CAN WE DO IT BETTER?
Brian J Kelly
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Helen J Stain
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Vaughan J Carr
Centre for Mental Health Studies, University of Newcastle, Australia
John R Beard
Department of Rural Health, Northern Rivers, University of Sydney, Australia
Lyn Fragar
Australian Centre for Agricultural Health and Safety, University of Sydney, Australia
Terry J Lewin
Centre for Mental Health Studies, University of Newcastle, Australia
David Lyle
Department of Rural Health, Broken Hill, University of Sydney, Australia
Fleur Hourihan
Centre for Rural & Remote Mental Health, University of Newcastle, Australia
Purpose: Existing methods of categorising rural & remote communities have limited the understanding of mental health needs of rural areas. We describe the limitations of the current level of evidence regarding mental health in rural areas, and propose a model for incorporating the multi-level influences on mental health outcomes in rural and remote regions.
Method: A framework for investigating individual, family and community factors associated with the mental health of rural communities will be presented, with specific reference to a proposed large scale rural health survey of randomly selected households from a stratified sample across regions in rural and remote locations across NSW (with Orange, Broken Hill, Moree and Lismore, representing the bases of the 4 collaborating rural research units). The survey aims to provide the basis for a longitudinal study of the determinants and outcomes of mental health in rural areas, with a unique focus on multilevel influences on mental health (ie individual, family/household & community) and factors influencing health service utilisation.
Conclusions: A research framework is presented that aims to i) address deficiencies of previous studies through investigation of the interaction of specific rural community characteristics on mental health e.g. social & economic factors, severity of rural environmental stress (e.g. drought), family and household characteristics & the levels of access to health & other services; ii) develop a collaborative network of mental health and public health expertise across rural research centres and regions, facilitated through links with the Australian Rural Health Research Collaboration and incorporate a collaboration between research groups, mental health services and rural communities; iii) form the baseline for a longitudinal study examining determinants and consequences of mental health in rural Australians.
Keywords: Work and Voc Rehab, Social Psychiatry
619
PROTECTIVE FACTORS IN OVERCOMING ADVERSITY: A STUDY OF RESILIENCE IN ADULTHOOD
Lucinda Wedgwood
Black Dog Institute, Australia
Kay Wilhelm
Black Dog Institute, Australia
Dusan Hadzi-Pavlovic
Department of Human Behaviour, School of Psychiatry, The University of New South Wales, Australia
Gordon Parker
School of Psychiatry, University of New South Wales and Black Dog Institute, Australia
Purpose: Current literature frequently focuses on what makes individuals vulnerable to depression. This research takes a different perspective and examines the protective capacities of a range of intra-and interindividual resources in a cohort of adults.
Method: 148 adults were assessed at 5-yearly intervals over a 20year period (1978–1998). Data was collected for both personal and inter-personal characteristics, including life events, neuroticism, selfesteem, social support, parental bonding, coping, and optimism, as well as participants’ ‘caseness’ (defined as lifetime history of major depression, agoraphobia, GAD, Panic, substance abuse or anorexia nervosa using DSM criteria). Participants were divided into four groups based on their experience of adverse life events and their ‘caseness’ history.
Results: When comparing the groups that had been exposed to adverse life events, those who did not become ‘cases’ (labelled resilient) were less likely to view a failure to attain their goals as a potential stressor at baseline. By 2002, the resilient group reported significantly higher optimism scores than their ‘caseness’ counterparts, and more positive life events than any other experimental group. There were no significant changes in self-esteem and neuroticism over time, although there was a strong interaction trend; with neuroticism increasing in the ‘caseness’ groups and decreasing in the ‘non-case’ groups, regardless of having experienced an adverse life event.
Conclusion: Certain characteristics (including optimism and self-set goals) appear ameliorate the effects of adverse life events on psychological wellbeing. Identifying these factors has the potential to guide the development of intervention strategies which could serve to improve the characteristics that predict future resilience.
Keywords: Epidemiology, Aetiology, Other
620
ATYPICAL ANTIPSYCHOTICS IN AMPHETAMINE DEPENDENCE
Harry H Hustig
Glenside Campus Royal Adelaide Hospital, Australia
The use of atypical antipsychotics has largely focused on the role of these drugs in reducing drug related psychosis, but the mood stabilizing properties, anti aggressive effects and effect on reducing dysphoria have a major benefit in reducing other negative psychological symptoms associated with amphetamines. These include in vignette 1 acute paranoid driven violence during intoxication with iv amphetamine, vignette 2 the intense anxiety and dysphoria associated with withdrawal and assisting in establishing abstinence and in vignette 3 the effectiveness of reducing the mood lability associated with chronic amphetamine use.
The evidence based literature for use of antipsychotics is quite scant and traditional neuroleptics are generally found to be poorly tolerated in this group as demonstrated in the case vignettes. Use of atypical antipsychotics like quetiapine and olanzapine for treatment of amphetamine dependence and abuse highlight the benefit of these agents in reducing symptoms across the various states of intoxication withdrawal and long term sequelae which leads to a facilitation of harm minimization principles in the management of amphetamine related symptoms.
Keywords: Biological Psychiatry, Neuropsychiatry
621
PSYCHOTIC-LIKE EXPERIENCES IN THE GENERAL COMMUNITY: THE CORRELATES OF CIDI PSYCHOSIS SCREEN ITEMS IN AN AUSTRALIAN SAMPLE
James G Scott
Mater Child & Youth Mental Health Service, Australia
David Chant
Queensland Centre for Mental Health Research (QCMHR), Australia
Gavin Andrews
Clinical Research Unit for Anxiety and Depression (CRUfAD), Australia
John McGrath
Queensland Centre for Mental Health Research (QCMHR), Australia
Background: Apart from individuals with clinical psychosis, community surveys have shown that many otherwise well individuals endorse items designed to identify psychosis. The aim of this study was to characterize the demographic correlates of individuals who endorse psychosis screening items in a large general community sample.
Methods: The National Survey of Mental Health and Wellbeing interviewed 10,641 individuals living in private dwellings in Australia. As part of a diagnostic interview (the CIDI), respondents were asked between three and six items originally designed to screen for potential psychosis. We examined the impact of selected demographic variables on endorsement of these items including sex, age, marital status, migrant status, urban/rural status, employment, education, and socio-economic status.
Results: An estimated 11.7% of the Australian population endorsed at least one psychosis-screening item. Significantly higher endorsement was associated with younger age, migrants from non-English speaking backgrounds, those that had never married or who were divorced/separated, unemployed, those living in urban regions and those from the lowest socioeconomic levels.
Conclusions: Many of the correlates of endorsement of psychosisscreen items are also associated with psychosis. Unravelling the factors that contribute to this broader nonclinical phenotype will aid our understanding of psychosis.
Keywords: Epidemiology, Aetiology, Other
622
LAST OBSERVATION CARRIED FORWARD IN PSYCHIATRIC RESEARCH – A FLAWED GOLD STANDARD?
Sue M Cotton
ORYGEN Research Centre, University of Melbourne, Australia
Hok Pan Yuen
ORYGEN Research Centre, University of Melbourne, Australia
Gregor Berger
ORYGEN Research Centre, University of Melbourne, Australia
Patrick McGorry
ORYGEN Research Centre, University of Melbourne, Australia
Missing data is an unfortunate but foreseeable element of longitudinal psychiatric research. Data may be missing due to numerous factors that may be either exogenous and/or endogenous to the patient. One of the most prevalent techniques for dealing with missing data is last observation carried forward (LOCF). Although LOCF is straightforward and easy to implement, recent research has indicated that this technique has serious potential flaws. The aim of this paper will be to explain the problems that can occur when using LOCF for research on first episode psychosis. Of particular interest is the effect that LOCF can have on study parameters such as mean change scores, standard error of the mean change scores, and type I error rates. Data from a double blind randomized control trial investigating the effectiveness of Ethyl-Eicosapentaenoic acid (E-EPA) as an add on treatment in first episode psychosis (Berger et al., in submission) was used as a benchmark for a series of simulations that differed in terms of patterns of ‘missingness’ (missing completely at random, missing at random, and missing not at random) and the percentage of data missing (10%, 25%, 40%). It will be demonstrated that LOCF can lead to deleterious outcomes including overestimating and underestimating treatment effects, distorting the standard error of the estimate, and inflating type I error. Caution is warranted with the use of LOCF in psychiatric research.
Keywords: Work and Voc Rehab, Social Psychiatry
623
SEASON OF BIRTH IS ASSOCIATED WITH ANTHROPOMETRIC AND NEUROCOGNITIVE OUTCOMES DURING INFANCY AND CHILDHOOD
Sukanta Saha
Queensland Centre for Mental Health Research (QCMHR), Australia
Daniel E Lieberman
Department of Anthropology, Harvard University, United States
Stephen Buka
Departments of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, United States
John J McGrath
University of Queensland and Queensland Centre for Mental Health Research (QCMHR), Australia
Purpose: Infants born in winter and spring tend to be heavier than those born in summer and autumn. In addition, summer born children tend to have lower educational outcomes. The aim of this study was to explore the impact of season of birth on various anthropometric and neurocognitive variables from birth to age seven.
Methods: A sample of white singleton infants born after 37 weeks gestation (n = 22,123) was drawn from the US Collaborative Perinatal Project. The main outcome measures for anthropometric variables were weight, head circumference, and length/height, and measures of neurocognitive development were Bayley assessments, Stanford Binet IQ, Graham-Ernhart test, Wechsler Intelligence Scale for Children and the Bender-Gestalt test. Results: Compared to summer/autumn born infants, winter/spring born infants were significantly longer (0.07 cm) but not heavier at birth, and at age seven were significantly heavier (0.21 kg), taller (0.19 cm) and had larger head circumference (0.12 cm). Compared to summer/autumn born infants, winter/spring born infants were achieving significantly higher scores on the Bayley motor score at 8 months, the Graham-Ernhart block test at age 4, the Wechsler Intelligence Performance and Full Scale scores (full scale difference = 1.58 points) at age 7, but had significantly lower scores on the Bender-Gestalt test at age 7 years. Within the sibships significant season of birth differences persisted for the Bayley motor score, Graham-Ernhart test, head circumference and the Wechsler Intelligence Performance and Full Scale scores. Many of these variables had clear twelve month periodicity and sine-wave like within-year fluctuations consistent with seasonality. Conclusions: Season of birth influences both physical and neurocognitive development over the first seven years of life. While the seasonal differences are small, unravelling the environmental factors associated with these changes may have important public health implications.
Keywords: Epidemiology, Aetiology, Other
624
COMMUNITY FOCUS GROUPS AND PARTNERSHIPS: AIMHi PROJECT
Merrill J Turpin
The University of Queensland, Australia
Cindy Gallois
The University of Queensland, Australia
The rural stream of the Aim High project aims to evaluate the effectiveness of providing community intervention to support people with a Chronic or Recurring Mental Disorders (CRMD) in eight rural towns in Queensland. This community intervention includes providing training for general practitioners (GPs), encouragement to communitybased agencies and strategies for raising community awareness. As part of establishing an understanding of the current situation in each town, focus groups with key informants in the community were undertaken. These focus groups consisted of representatives from various community groups that are involved in the support of people with CRMD, mental health staff and GPs as well as some adults with CRMD and carers. Focus groups were audio taped and transcribed verbatim and additional field notes were used to record some of the main issues raised. A thematic analysis of data was conducted to identify issues that were important to informants. This presentation aims to provide an overview of the main themes raised by informants in the focus groups. It also discusses some of the strategies used in two towns to facilitate community partnerships in response to these results.
Keywords: Work and Voc Rehab, Social Psychiatry
625
DROUGHT, THE ENVIRONMENT, AND MENTAL HEALTH IN A RURAL NSW COMMUNITY
Gina M Sartore
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Helen J Stain
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Brian Kelly
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Nick Higginbotham
Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Australia
Glenn Albrecht
School of Environmental and Life Science, University of Newcastle, Australia
Anne Tonna
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Aim: Drought is a chronic, recurring natural disaster. Such disasters have effects through entire communities. The impact of drought and other environmental changes on mental health are not clearly known, nor are the most effective ways of ameliorating those impacts. This study is the first phase of an in-depth, community-based research project into the effects of drought on rural Australian communities, and the development of strategies to improve the access to improve mental health facilities.
Method: Participants in this investigation were drawn from five groups in a town in the central west of NSW: farmers (male and female), individuals from non-farm businesses, agriculture support workers, local health-and mental healthcare providers serving this population. Focus groups and individual interviews explored the mental health impact and community response to the drought within the following domains: impact of drought; availability and use of health services; psychological distress; impact on the expectations of the future of the community; individual, family and community mental health needs.
Results: Qualitative data analysis highlights the impact of uncertainty, farming bureaucracy, perceived restriction of lifestyle and future options, and distress caused by loss associated with prolonged drought. Analysis also identified important differences across groups in the impact, perceived mental health needs and patterns of help-seeking.
Conclusions: The mental health response to drought should be carried out in conjunction with other service providers, especially front-line agricultural support workers. To enhance the mental health service capacity of rural communities and focus on improving farmers’ access to care, the Centre for Rural and Remote Mental Health is conducting a research program evaluating training and primary care service development in collaboration with rural organisations and health services across NSW.
Keywords: Epidemiology, Aetiology, Other
626
THE FEASIBILITY OF ROUTINE EFFECTIVENESS EVALUATION IN PUBLIC MENTAL HEALTH SERVICES: WHAT DOES IT TAKE?
Stanley V Catts
University of Queensland, Royal Brisbane and Women’s Hospital, Australia
Brian O’Toole
Concord Hospital, Australia
Vaughan Carr
Newcastle University, Australia
Terry Lewin
Hunter New England Mental Health Service, Australia
Amanda Neil
Newcastle University, Australia
Meredith Harris
ORYGEN Youth Health Service, Australia
Purpose: To evaluate the effectiveness of early psychosis teams in the management of young persons suffering from first episode psychosis and determine whether adherence to clinical practice guidelines improves the effectiveness of such teams.
Methods: Processes were designed to carry out effectiveness evaluation routinely as a quality assurance activity in relation to early psychosis patients. Public mental health services were invited to participate in a prospective observational evaluation of the initial six months of care for after patients presenting for the first time with early psychosis. Measurement of routinely recorded service descriptors, baseline patient characteristics, and clinical intervention was built directly upon the National Outcomes and Casemix Collection (NOCC) and the New South Wales Early Psychosis Clinical Indicators. Consumer, carer, and case manager feedback was obtained by questionnaire. Across-service data aggregation, measurement, and guideline-adherence coding was achieved by transfer of copied de-identified information to the project for a comprehensive and systematic file audit.
Results: All approached ethics committees determined the project was quality assurance and that the consent of patients, carers, and staff was not necessary. Nine mental health services participated: more than 450 episodes of care were captured within the prospective evaluation over an 18-month period. Training resulted in excellent levels of clinician agreement for the clinical indicators. Adherence with procedures, including rating the HoNOS and LSP, was adequate at around 70%. Copying de-identified files was expensive and tedious. File auditing was very time-consuming.
Conclusions: The project’s processes were successfully implemented, highly appropriate, sensitive to change, but not sustainable. No service can expect to evaluate effectiveness routinely without fully electronic clinical record keeping and indicator coding. The project has developed a well-defined framework in which this work could be advanced, and the methodology could be readily applied to all mental health delivery regardless of diagnosis.
Keywords: Work and Voc Rehab, Social Psychiatry
627
FIRST SMALL STEPS – COLLECTION AND ANALYSIS OF DATA TO SUPPORT RESEARCH INTO MENTAL HEALTH OUTCOMES IN RURAL AND REMOTE AREAS
Philip Lane
Centre for Rural and Remote Mental Health, Australia
Helen Stain
Centre for Rural and Remote Mental Health, University of Newcastle, Australia
Brian Kelly
Centre for Rural and Remote Mental Health, Australia
Terry Lewin
Centre for Mental Health Studies, Australia
Aim: To investigate the geographic distribution of social determinants of mental health, and links with existing models of rurality.
Background: The geography of mental health is of primary concern in rural areas. The development of epidemiologic mapping of mental health across rural and remote areas can provide improved methods for investigating the links between remoteness, other community characteristics and mental health indicators.
Method: A database was developed by compiling information on the following factors: Housing, Health, Demographics, Family and Social Characteristics, Education, Income, Service Utilisation, Crime and Transport, chiefly from the Australian Bureau of Statistics at a Local Government Area level. 168 variables were selected across the 172 Local Government Areas of NSW.
Results: Principal Components Analysis yielded 33 factors with an Eigenvalue greater than 1. The top six factors were selected on the basis of the scree plot and accounted for over half (52%) of the total variance. The six factors were labelled as Disadvantage, Non-Responders, Family and Language, Family and Changes, Elderly and Remote, and finally Family and the Elderly.
Conclusions: The results identify variables that may be useful in describing the characteristics of rural areas, with reference to mental health determinants. The establishment of a database to support investigation of mental health outcomes in rural areas is an important step to identifying and rectifying inequalities. Further analysis will be possible when direct measures of mental health outcomes are included in the database in the near future.
Keywords: Work and Voc Rehab, Social Psychiatry
628
“WITHDRAWN”
629
A FIRST PSYCHOMETRIC ANALYSIS OF RISK ASSESSMENTS AMONG PARTICIPANTS IN THE WORC PROJECT
Alice Morgan
Queensland Centre for Mental Health Research (QCMHR), Australia
David C Chant
Queensland Centre for Mental Health Research (QCMHR), Australia
Judith Sheridan
Queensland Centre for Mental Health Research (QCMHR), Australia
Michael F Hilton
Queensland Centre for Mental Health Research (QCMHR), Australia
Harvey Whiteford
Queensland Centre for Mental Health Research (QCMHR), University of Queensland, Australia
Introduction: The Work Outcomes Research Cost-Benefit (WORC) Project is a prospective Australia wide study evaluating the cost effectiveness of facilitating an increase in help seeking behaviour among employed people reporting depressive symptoms. Within this cohort a significant proportion of individuals have reported suicidal ideation within seven days of contact. This group is examined in regards to level of depression in comparison to individuals reporting depressive symptoms without suicidal ideation.
Method: The WORC Project has invited 342,000 employees to answer a General Health Questionnaire (GHQ), the Kessler 6 (K6) and the World Health Organisation Work Performance Questions (HPQ). Employees who screen positive for symptoms of depression on the K6 are further screened using the Quick Inventory of Depressive Symptoms (QIDS). People who screened positive on the K6 and the QIDS, are not currently in treatment, and reported thoughts of suicide within the prior seven days, are transferred to a psychologist for risk assessment. The QIDS is readministered at 6 weeks from this call.
Results: Individuals classified as at risk of suicide reported a greater degree of depressive symptoms than those not at risk. This group also exhibited greater resistance to intervention at follow up. Across all depressed participants a reduction in reported symptoms was demonstrated, however within the Risk Assessment group intervention increased depressive symptoms. Further differences between these groups will be discussed.
Conclusion: Suicidal ideation indicates a greater severity of depression than depression without ideation. Brief intervention results in a greater awareness of symptoms and a higher self-report of depressive symptoms. The presence of suicidal ideation suggests a distinct behavioural response to intervention separate from that of depressed individuals without suicidal ideation
Keywords: Work and Voc Rehab, Social Psychiatry
630
VOCATIONAL REHABILITATION IN PSYCHIATRY; WHAT WORKS BEST
Philip LP Morris
Mirikai Drug Rehabilitation Centre, Australia
Chris Lloyd
University of Queensland, Australia
Objective: To highlight the vocational gap in the provision of psychiatric rehabilitation, to outline the goals and conceptual framework of psychiatric vocational rehabilitation, and to rate vocational rehabilitation interventions with specific reference to the evidence base for supported employment in comparison to other approaches.
Method: Search of the relevant literature databases for information on vocational rehabilitation in psychiatry, and the characteristics, merits and success of different approaches to vocational rehabilitation.
Results, Conclusions and Service Implications: Vocational psychiatric rehabilitation has been a neglected area of practice in Australian psychiatry. Psychiatric treatment and recovery services need to adopt a more balanced approach in the provision of a range of services, including vocational rehabilitation, in order to improve long term outcomes for people with psychiatric disability. A vocational focus should be included in psychiatric rehabilitation and better integration between mental health services and vocational services needs to take place. Supported employment is an evidence-based practice that is designed to help people with psychiatric disabilities participate as much as possible in the competitive job market. Evidence supports this method of vocational rehabilitation being the most effective way of assisting patients with chronic psychiatric illnesses back to work. Certain program qualities of supported employment programs are linked with greater employment success. The challenge for vocational rehabilitation in psychiatry is to adapt the successful methods used in supported employment programs for chronically ill populations to the management of workers suffering from mental disorders in the general workforce. Principles of management and practical examples are provided.
Keywords: Work and Voc Rehab, Social Psychiatry
631
EMOTIONAL BRAIN DYSFUNCTIONS IN ANTISOCIAL BEHAVIOUR: AN ERP AND fMRI STUDY
Donna Palmer
The Brain Dynamics Centre, Westmead Hospital and University of Sydney, Australia
Mark Dadds
University of New South Wales, Australia
Evian Gordon
The Brain Resource Company & Brain Resource International Database & The Brain Dynamics Centre, Westmead Hospital, Australia
Leanne Williams
Brain Dynamics Centre, Westmead Hospital, Australia
This project seeks to investigate the neurological mechanisms underlying deficits in processing emotional information in children with conduct disorder (CD). To date, research has focused on adult antisocial behaviour and the generalisability of findings to children is not known. In children, ‘callous-unemotional’ (CU) traits (broadly analogous to adult psychopathic personality traits) have been associated with a particularly poor response to treatment interventions. In adults, these traits have been associated with an inability to decode emotion (such as facial expressions), and at the neural level a loss of autonomic orienting (phasic arousal) to fear and novelty stimuli, and a reduction in activity in amygdala-medial prefrontal systems. However, direct neural activity (using neurophysiology) has not been examined.
In this project children with CD (varying in CU traits) will be assessed using behavioural measures of emotion perception, coupled with measures of neurophysiology (Event-related potentials, ERPs) as well functional MRI and arousal.
Methodology: Subjects will be children and young adolescents with CD and matched healthy controls, recruited in collaboration with the Brain Resource International Database (www.brainresource.com). Given the high comorbidity of CD with ADHD, comorbid ADHD will be included. ERPs and functional MRI, with concurrent measures of autonomic arousal (skin conductance, heart rate), will be recorded in response to both emotion relevant and non-emotion relevant stimuli. Emotion stimuli will consist of facial expressions of happy, fear, anger, sad and disgust, as well as emotionally neutral faces, providing biologically-relevant signals of emotion. These stimuli will be presented at both nonconscious and conscious detection thresholds, in order to assess the role of level of awareness. Concurrent measures of autonomic activity will provide a measure of arousal response to emotional stimuli of differing valence, and responses to non-emotional stimuli (auditory oddball task), will index generalisability of arousal deficits to other salient stimuli.
Conclusions: The results will provide a platform for developing an affective neuroscience model of antisocial behaviour in children and adolescents. Given that treatment for antisocial behavioural problems becomes less effective with age, identifying the nature of these deficits in childhood and the causal mechanisms underlying them has important implications for improving treatment efficacy.
632
A SURVEY OF THE PREVALENCE AND PATTERN OF USE OF ANTIPSYCHOTIC MEDICATION IN AGED CARE FACILITIES
Peter M Herriot
Noarlunga Health Services, Australia
Julie Chiang
Hospital Pharmacy Services, Australia
Aim: The aim of this survey was to determine the prevalence and pattern of antipsychotic prescribing amongst aged care residents.
Methods: Data for this cross-sectional study were collected over a three-month period from February to April 2003. Subjects taking antipsychotic medication (either on a regular or as required basis) were identified and extracted from computerised pharmacy dispensing records. Diagnostic indications for the prescription of antipsychotic medication were obtained from medical case notes or medication charts. Details of antipsychotic medication and total daily dose were recorded from individual medication charts.
Results: A total of 54 aged care facilities (51 in SA and 3 in VIC) with 2829 residents participated. 692 (24%) of residents were receiving antipsychotic medication. Of these 692 residents, 454 (66%) were females and 238 (34%) were males. The mean age was 83 years (range 37–105 years). 652 (94%) of residents were receiving antipsychotic medication on a regular basis and the remaining 40 (6%) on an "as required" basis. 66% has a diagnosis of dementia, 6% schizophrenia and in 8% there was no diagnosis recorded. Other diagnoses accounted for the remaining 20%. The commonest prescribed antipsychotic was pericyazine (39%). Atypical antipsychotics accounted for 42% of antipsychotic prescriptions.
Discussions: The prevalence of antipsychotic use found in the current survey is consistent with figures reported in previous surveys. Of particular interest is the finding that atypical antipsychotic medications accounted for 42% of regular antipsychotic prescriptions. Although a lower incidence of extra-pyramidal side-effects has generally made atypical antipsychotics the preferred choice of antipsychotic, this should be balanced against other factors and evidence for their use in the elderly population.
633
EMOTIONAL PROSODIC PROCESSING AND SOURCE MONITORING IN AUDITORY HALLUCINATIONS
Tracey Shea
Mental Health Research Institute of Victoria, Australia
Alex A Sergejew
Maroondah Hospital, Mental Health Research Institute of Victoria and Centre for Neuroscience, University of Melbourne, Australia
Gary F Egan
Mental Health Research Institute of Victoria and Howard Florey Institute, University of Melbourne, Australia
Denis Burnham
MARCS Auditory Laboratories, University of Western Sydney, Australia
David L Copolov
Mental Health Research Institute of Victoria, Australia
The aim of the present study was investigate the relationship between emotional prosodic processing and source monitoring deficits in hallucinating and non-hallucinating patients with schizophrenia. The most influential contemporary theory of the origin of hallucinatory hallucinations (AHs) in psychosis, the misattribution theory, proposes that AHs arise because patients misattribute internal cognitive events to an external source. Specific mechanisms of misattribution have yet to be elucidated, but Cutting (1990) speculated that deficits of emotional prosodic processing may lead patients to be unable to recognise AHs as belonging to the self. The purpose of this study was to test this putative association between deficits in prosodic processing and source monitoring in patients with auditory hallucinations. After Cutting, it was hypothesised that hallucinators would demonstrate greater deficits in both source monitoring and emotional prosodic processing than non-hallucinators, who in turn would show deficits compared to normal controls. Participants completed both a source monitoring task and an emotional prosodic processing task. The source monitoring task comprised of two word association lists, with the participant and the experimenter each generating (speaking) 24 words for both lists. Participants were tested on their ability to monitor the origin of the items in these lists. Participants also listened to a series of neutral sentences that were expressed in happy, sad and neutral voices, and rated them on a 7-point Likert scale from sad (−3) through neutral (0) to happy (+3). Preliminary results for both tasks indicate deficits for hallucinating compared to non-hallucinating patients and normal controls, with trends observed for hallucinators to perform more poorly in both tasks than non-hallucinators and normal controls. These results lend support for the first time to Cutting’s hypothesis, indicating that emotional prosodic processing might play a role in the misattribution of auditory hallucinations.
634
A COMMUNITY EDUCATION PROGRAMME OF THE PARTNERSHIPS IN HEALTH PROMOTION CONSORTIUM – THE DEPRESSION, STRESS AND ANXIETY PROJECT
Robb Stanley
Department of Psychiatry, University of Melbourne (Austin Health) Melbourne, Australia
Graham Burrows
Department of Psychiatry, University of Melbourne (Austin Health) Melbourne, Australia
Megan McQueenie
Partnerships In Health Promotion and Mental Health Foundation of Australia, Australia
Catherine Mather
Partnerships in Health Promotion Consortium and Mental Health Foundation of Australia, Australia
Janet Haynes
Partnerships in Health Promotion Consortium and Mental Health Foundation of Australia, Australia
Marion Wilde
Partnerships in Health Promotion Consortium and Mental Health Foundation of Australia, Australia
Throughout 2002–2004 the Partnerships in Health Promotion Consortium, (comprising 8 non-government community organizations: Australian Red Cross; The Smith Family; Mental Health Foundation; National Stroke Foundation; International Diabetes Institute; St Vincent de Paul Society; Alzheimer’s Australia; Victorian Relief Committee) conducted a health education programme for their workers (64.1%) and volunteers (35.9%) to inform them of contemporary perspectives on the causes and management of depression, stress and anxiety (DSA). A total of 91 one-day education workshops were conducted for approximately 1153 participants across Australia, including all states and territories, and in rural settings, country towns and major cities. Seventy-two percent of participants had no formal mental health training. Attitudes to and knowledge of mental health issues as well as their perceptions of the significance of the mental health issues were evaluated before and after training and at follow-up. The results of the evaluation are reported here.
635
EDUCATING THE COMMUNITY TO LESSEN THE BURDEN OF DISEASE RELATED TO LINKS BETWEEN UNTREATED DEPRESSION AND DEMENTIA
Graham Burrows
Department of Psychiatry, University of Melbourne (Austin Health) Melbourne, Australia
Megan McQueenie
Partnerships In Health Promotion and Mental Health Foundation of Australia, Australia
Robb Stanley
Partnerships In Health Promotion and Mental Health Foundation of Australia, Australia
The public is beginning to be aware of the link between untreated depression and dementia. The Weekend Australian ran a headline in February 2004 "Depression A Key Suspect In Dementia Cases". This paper will address the links between depression as a neurodegenerative disorder and dementias. Current predictions indicate that dementia will cost the community in the region of $7billion by the year 2010; by 2040 dementia will affect 2.3% of the population. Currently we know that dementia costs about 1% of GDP which will have rise by the year 2050 to 3.3% of GDP. Dementia is the second largest cause of disability burden in Australia after depression. Disability caused by the illness is severe, 98.5% of people with dementia are disabled. We know that the prevalence rates for major depression is 11–17% in patients with Alzheimer’s disease and 25–50% in studies of dementia. It will explore how we distinguish between depression and dementia; the essentials of management for patient education; and, how we might address the stigma associated with mental illness which acts as a barrier to people with undiagnosed depression receiving treatment. Preventing illness will prevents costs to the community and will improve health status of community.
636
A PREVENTIVE PROGRAM IN RESILIENCY AND WELLBEING TRAINING FOR YOUNG AUSTRALIANS
Graham Burrows
Department of Psychiatry, University of Melbourne (Austin Health) Melbourne, Australia
Megan McQueenie
Embrace the Future Project, Mental Health Foundation of Australia, Australia
Pierz Newton-John
Embrace the Future Project, Mental Health Foundation of Australia, Australia
The Embrace the Future Young Australians Mental Health and Wellbeing Project was initiated by the Mental Health Foundation of Australia in 2003 in recognition of the mental health needs of children and youth in Australia. An Australian Bureau of Statistics survey in 1999 found that 27% of Australians aged 18–24 suffer from some form of mental disorder, compared with only 6% of those aged over 65. The epidemic of youth suicide and depression is well-known. There are clear indicators that not enough is being done promote the mental health and wellbeing of Australia’s young people. Embrace the Future is a national program to develop and support programs which foster resiliency and wellbeing in young people aged 0–24 years. During 2004, Embrace the Future initiated a number of projects targeting young people, including projects to promote self-esteem, an adolescent mental health website, and a major project to map youth mental health promotion programs nation-wide. Currently, the project has identified a particular need for services aimed at children between the ages of 8–13, who currently fall in the gap between early childhood intervention programs and projects which target adolescents. Embrace the Future is currently developing an Online Resiliency Resource Centre for teachers and parents of primary age children. The website offers a range of resiliency related resources to assist teachers and schools to develop policies which foster resiliency, and is based on an extensive review of the international research. This online resource will support a broader push to raise awareness of resiliency and mental health issues in primary schools through a two year project providing professional development, consultancy and support. Although this project ultimately has national application, the initial pilot will target Victorian schools within areas of high need. A future priority for the project is a national campaign to raise community awareness of youth mental health issues.
637
RESILIENCY TRAINING FOR YOUNG PEOPLE AS PREVENTION OF PSYCHIATRIC DISORDERS AND SUBSTANCE ABUSE
Graham Burrows
Department of Psychiatry, University of Melbourne (Austin Health) Melbourne, Australia
Megan McQueenie
Embrace the Future Project, Mental Health Foundation of Australia, Australia
Pierz Newton-John
Embrace the Future Project, Mental Health Foundation of Australia, Australia
Increasingly, researchers in the field of youth mental health and substance abuse prevention are focusing on the concept of resiliency as a touchstone for intervention. Rather than focusing solely on risk and pathology, the resiliency approach orients itself towards strengths and resources, acknowledging and building upon the innate human capacity to adapt to stress and adversity. Youth substance abuse can frequently be viewed as a maladaptive coping response to enduring life stressors. Resiliency research indicates that the best prevention for substance abuse, and indeed other psychological disorders, lies in strengthening young people’s natural adaptational mechanisms, including the availability of environmental sources of support. Appropriate resiliency strengthening programs may intervene at the cognitive, interpersonal, or broader community level. Cognitive programs include those that teach optimism, problem-solving skills, self-esteem, and other building blocks of resilient thinking. Interpersonally-oriented programs may provide mentoring or support families to improve communication and parenting skills. Community-oriented programs may assist schools to create resiliency and health-promoting school environments, or to make local neighbourhoods safer and more friendly for young people. One example of a community-oriented resiliency program is the Mental Health Foundation’s Embrace the Future program, which promotes resiliency and wellbeing for young people aged 0–24, with a current focus on children 8–13. By supporting children during the transitional period from primary to secondary school, the project aims to develop the adaptational systems that underpin resiliency before children encounter the demands and stresses of adolescence.
638
DEMENTIA AND DEPRESSION: POSSIBLE RELATIONSHIPS?
Graham Burrows
Department of Psychiatry, University of Melbourne (Austin Health) Melbourne, Australia
Peter Bosanac
Department of Psychiatry, University of Melbourne, Austin Hospital, Australia
James Olver
Department of Psychiatry, University of Melbourne, Austin Hospital, Australia
Trevor Norman
Department of Psychiatry, University of Melbourne, Austin Hospital, Australia
This paper considers Dementia of the Alzheimer’s type and relationship with Depression. Community education programs recently have been concentrating on the concept that Depression and Dementia may be prevented in some people. Life style of exercise, diet, healthy living, mental activities and weight control are important. Dementia is now considered a disease of the young ie preventable in many. Recent scanning data has shown abnormalities in those with Dementia some of which were depressed people. Hippocampus is an important focus of neurobiological investigations. Hippocampal neuronal loss can be reversed in some with appropriate treatments. Is Depression a risk factor for Dementia in later life? The role of treatment of Depression and its relationship to Dementia will be considered in this paper.