27th Nordic Psychiatric Congress
P - Posters 1-32
P - 1 Thursday 14/8, 14:00-15:00
Suicide in Iceland, 1911-2000. A demographic survey
Sigurður Páll Pálsson, Psychiatrist,
Landspítalinn University Hospital, Reykjavík, Iceland. Lilja Sigrún
Jónsdóttir, Óttar Guðmundsson, Sigurður Guðmundsson, Högni Óskarsson.
siggipp@centrum.is; sigpp@landspitali.is
Aims: To study the incidence and demographic factors of suicides in Iceland from 1911 to 2000.Method: All death certificates of persons known to have committed suicide in Iceland between 1911 and 2000 were reviewed. In addition to cause of and age at death, suicide method was documented and demographic factors.
Results: Certain suicides were 1631, increasing over the period but only for males. Young males aged 15-24 showed a marked increase in suicide rates. From 1911-1950, calculated 5-year periods range 3.3-14.1 /100000. From 1951-1980, calculated 5-year periods range 9.4-19.8 /100000. From 1981-2000 calculated 5-year periods range 28.5-31.4 /100000). The mean age of suicides decreased for males (47.7 vs. 39.3, P=0.000) in the compared periods 1911-1940 and 1971-2000 but increased for females (40.7 vs. 48.1, P=0.001). Despite this the mean age of all suicides decreased (45.7 vs. 41.2, P< 0.001). Suicide rates in the elderly were low compared to other European nations. The range of the male/female ratio was 3-4, lowest in the beginning of the century.
Males used more violent methods than females. Psychiatric disorders were described in almost 50% of the suicide cases, this suffered from lack of documentation.
Conclusions: Suicides by young males increased steadily over the last century.
P - 2 Thursday 14/8, 14:00-15:00
Medical quality audit in Sweden - the case for psychiatry
jerker.hanson@telia.com
Background: In 1996 a programme for senior Swedish psychiatrists in Medical Quality Audits (MQA) started. This is a method for development of medical quality in health care organisations. MQA is also useful for follow up of agreements between purchasers and providers.
Aims: The educational programme and the results of the first 15 MQAs will be described.
Method: The educational programme contains two days lecturing and a MQA under supervision. The process of MQA have some crucial steps, e.g. stating in writing who orders/pays the audit and is to be reported to and foci of the audit. Before the audit the clinic to be inspected has to fill in a standardised protocol, produce care programmes, analyse and revise processes. Minor faulty procedures will be attended to immediately. Improvement is the ultimate goal of MQA. For feedback to the clinic the auditors usually explain their findings in a major staff meeting. A specified written report is mandatory. All 15 reports were examined in this study.
Results: Most frequent audit-foci were: Cooperation with other units, priorities, management and staff competence. Other findings reported often concerned: Care programs, IT-support, user cooperation and support, documentation.
Conclusions: MQA is a useful tool for improvement of and reporting about psychiatric services quality.
P - 3 Thursday 14/8, 14:00-15:00
Hand-held computers in monitoring bipolar patients
Lena Backlund, Senior Psychiatrist, Karolinska Institutet, Neurotec Department, Division of Psychiatry, Huddinge University Hospital, Stockholm, Swede Göran Isacsson.
lena.backlund@slpo.sll.se
Background and aims: Hand-held computers (PDA) have been used with good results in investigations of some chronic diseases. We investigated PDA's usefulness for daily monitoring of symptoms in patients with bipolar disorder and their acceptance in a 12-week pilot study.
Method: Twenty-four bipolar patients with varying severity of illness were equipped with a PDA programmed to ask questions about symptoms, sleep and life events twice a day. They were asked weekly about psychosocial function (SDS) and quality of life (PGWB). The data were transmitted wireless to a server. This is an evaluation after six weeks.
Results: All 24 participants completed with a high compliance. Twenty-three found the PDA easy to use. Twenty-one were positive but they experienced some shortcomings with the program configuration. Several reported that the PDA helped them to be more aware of their sleep and signs of illness. Some reported being helped to remember taking their lithium. Only one reported a sense of being controlled and two expressed some worry about the secrecy.
Conclusions: These patients with bipolar disorder were positive, motivated and capable to use PDAs. PDAs appear to be effective in monitoring symptoms, detecting early signs and reminding of medication.
P - 4 Thursday 14/8, 14:00-15:00
The Red Cross House for runaway, throwaway and homeless adolescents in Iceland
Eiríkur Örn Arnarson, Head of Psychological Health Services, Landspítali University Hospital, 101 Reykjavík, Iceland. Haukur Hauksson.eirikur@landspitali.is
Objective: To explore the relationship between running away from home with doing poorly at school, the use of alcohol and drugs, family structure etc.
Material and methods: Analysis of data collected among adolescents (runaways, throwaways, and homeless adolescents) who sought help at the RCH during 1996-2000. Admission records were used for collecting data for subsequent analysis. Runaways came off the street or left home on their own accord, throwaways had been asked to leave home, the homeless had nowhere to stay.
Results: Compared with the operation during 1985-1995, there was about 32% increase of registered visits, mostly runaway boys and throwaways of both sexes. Fewer adolescents were homeless than in 1985-1995. About a third of runaways/throwaways and more than 70% of homeless were neither working nor at school when presenting at the RCH. Use of tobacco, alcohol/drugs was common among guests. The most frequent reasons for the homeless seeking assistance were alcohol/drug abuse but for runaways/throwaways having nowhere to stay and conflicts within their family. Runaway/throwaway boys were more likely than girls to be school dropouts, abuse alcohol/drugs and be out of work. Frequent visitors were worse off than first time visitors.
Conclusions: The plight of homeless adolescents seemed more serious than that of runaways/throwaways. The RCH aims to keep adolescents off the streets and to prevent runaways/throwaways to become homeless who are more likely to be out of work, commit crimes and abuse alcohol/drugs. The increase of visits by adolescents registered as runaways or throwaways to the RCH, and the decrease of visits by those registered as homeless suggest the frequency of severe relational problems between parents and their child is on the increase in Icelandic homes.
P - 5 Thursday 14/8, 14:00-15:00
Duration of treatment in Danish office-based psychiatry
Bodil Andersen, Psychiatrist, Private Psychiatric Practice, Algade 65 A, DK-4000 Roskilde, Denmark. Kirsten Gormsen, Eskil Hohwy, Frands Jacobsen, Jens Thimmer, Povl Munk-Jørgensen.
b.andersen.rosk@dadlnet.dk
Background: In 1996 a group of private practicing psychiatrists (ppp) organized a quality assurance database registering the activities in private psychiatric practice (QAD3P). The group represents approximately 20% of the ppp's in Denmark.
Aims: To investigate the duration of treatment in courses with planned termination.
Method: Analysis of data from the QAD3P database for patients that began treatment in the years 1997 and 1998 and terminated before the beginning of 2002.
Results: A total 3576 courses were begun in 1997 and 1998 and terminated before the beginning of 2002. The most frequent diagnoses were: Anxiety and stress disorders (n=1076), affective disorders (n=976) and personality disorders (n=906). Among these more than 50% of the patients had terminated their treatment within 6 months, and approximately 60% of the patients got maximum 6 consultations. Among patients who were treated more than 24 months, patients with schizophrenia, acute psychotic disorders and affective disorders had higher frequency than in the original sample.
Conclusion: In private psychiatric practice in Denmark, the majority of the patients are treated for a short period and with few consultations.
P - 6 Thursday 14/8, 14:00-15:00
Anxiety disorders. Quality assurance in private psychiatric practice
Eva Jensen1, Practicing Psychiatrist, QAD3P-group (Quality Assurance In Danish Private Psychiatric Practice), Helsehuset, Hold-an Vej 5, DK-2750 Ballerup, Denmark. Bodil Andersen1, Eskil Hohwy1, Frands Jacobsen1, Jens Timmer1 and Povl Munk-Jørgensen2.
1QAD3P-group (Quality Assurance In Danish Private Psychiatric Practice), Helsehuset, Hold-an Vej 5, DK-2750 Ballerup, Denmark. 2Department of Psychiatric Demography, Institute for Basic Psychiatric Research, Psychiatric Hospital in Aarhus, Skovagervej 2, DK-8240 Risskov, Denmark.
de@psykiatri.aaa.dk
Background: In 1996 a group of private practicing psychiatrists (ppp) organized a quality assurance database registering the activities in private psychiatric practice. The group represents a little more than 20% of the ppp's in Denmark. Approximately 30% of the patients treated in ppp are diagnosed with anxiety or stress related disorders.
Aims: To describe the diagnostic distribution of anxiety states in ppp. Furthermore, to investigate the treatment profile and the duration of treatment.
Method: Analysis of data from the QAD3P database for the period 1996-200.
Results: The proportion of patients in ppp diagnosed ICD-10 F40-41 decreased from 3.9% to 2.5% over the period. Approximately 1/3 were diagnosed with panic disorder, 1/3 as mixed anxiety - depressive state. 95% of the patients were treated for periods not longer than six months. Two thirds of the patients were treated psychopharmacologically exclusively, or as part of a broader treatment method; among patients suffering from phobia, the proportion was only 50% in psychopharmacological treatment.
Conclusions: Private practice is a highly effective part of mental health service. Exemplified by anxiety disorders, it is documented that patients are treated within six months with a broad spectrum of psychopharmacological and psychotherapeutic methods.
P - 7 Thursday 14/8, 14:00-15:00
Utilization of specialist outpatient services in Iceland
Ólafur Hergill Oddsson, MD, M.Cl.Sc., Resident Physician, Psychiatric Department, Regional Hospital, Akureyri, Iceland
olafur@fsa.is
Background: The accessibility of specialist outpatient services differs among geographical areas within countries. The aim of this study was to explore differences in the utilization of such services between geographical areas within Iceland, an island with a population of 280.000 inhabitants. Over 90% of the country's specialist doctors live in the capital, Reykjavík, and in Akureyri, the main town in northern Iceland.
Methods: The National Health Insurance Patient Data Base for the years 1993-1996 was explored in a retrospective manner. Information regarding the 1.4 million specialist consultations for those four years was analyzed. This was quantitative data and neither patients nor the specialists were identifiable.
Results: Icelanders visit specialists 1.3 times per year on average. The use of these services is highest in the capital area, 1.7 visits per year. In the northwestern part of Iceland people only visited specialists 0.6 times per year. The utilization of specialist services was much higher in the capital area than elsewhere in the country with two exceptions. In ophthalmology and otolaryngology there were small regional differences in the use of the services. The most probable explanation for this is that there is a long tradition for planned visits by these specialists, especially the ophthalmologists, to the sparsely populated areas at least once a year. The greatest regional difference was found in the use of psychiatric services. The people in Reykjavík went 15 times as often to see a psychiatrist as the people of Vopnafjörður, Fáskrúðsfjörður (both in eastern Iceland) and Vík (in southern Iceland).
Conclusions: This investigation documents huge differences in the utilization of outpatient specialist services in Iceland. To ensure equity the service of the specialist doctors should be planned and brought near the people in the sparsely populated areas. The small differences in the utilization of ophthalmology and otolaryngology services shows what can be achieved with good planning.
P - 8 Thursday 14/8, 14:00-15:00
Characterization of fMRI haemodynamic responses in schizophrenic patients
Roberto Viviani Dr., Department of Psychiatry III, University of Ulm, Leimgrubenweg 12, Germany. Henrik Walter, Georg Grön, Manfred Spitzer.
roberto.viviani@medizin.uni-ulm.de
Background and aims: The statistical models currently used to draw inferences on cortical activation areas in fMRI studies rely on the assumption of a predefined haemodynamic response function (HRF) representing the BOLD response in the affected vessels. If this assumption is not justified, as it may be the case in patient populations, no conclusion may be drawn from the failure of the model to provide evidence of significant activation areas. Of particular interest is the study of schizophrenic patients, where a systematic abnormality of the HRF may provide a clue to a clinical subgroup.
Methods: We applied equivalents of multivariate procedures operating on functions rather than vectors of observations to a simple block design on a working memory paradigm comparing schizophrenic, depressive patients and controls.
Results: The HRFs in the schizophrenic group do not form a homogeneous group, unlike normal controls.
Conclusions: Anomalous HRFs in schizophrenics awaits clinical characterization. Possible causes are medication, a side-effect of a biochemical abnormality, a sub-clinical infectious process.
P - 9 Thursday 14/8, 14:00-15:00
Persistent somatoform pain - a bridge between anxiety and depression
Högni Óskarsson, Psychiatrist, Therapeia, 12 Sudurgata, 101 Reykjavík, Iceland. H. Kolbeinsson, Þ Þorgeirsson, J Gulcher, K Stefánsson, E Líndal, JG Stefánsson.
Introduction: This study explores the relationship between somatoform pain disorder (SPD), anxiety, and depression.
Method: The sample is based on a population screening for anxiety and depression followed by a Composite International Diagnostic Interview (CIDI). SPD was an incidental finding as comorbid with the above disorders. Interrelationship between Age of Onset and comorbidity of these disorders as well as shared symptoms were analysed.
Results: 1903 individuals underwent the CIDI, 441 have chronic somatoform pain, m/f ratio = 1:3. Comorbid anxiety and depression are found in 83% of those with SPD. The comorbidity of anxiety is significantly higher in SPD than in those affected with anxiety and depression but without SPD. Depression comorbidity is the same in those with and without SPD. The presence of SPD lowers the Age of Onset (AGO) of most anxiety disorders and depression. The presence of anxiety and/or depression in SPD is related to a significantly higher number of pain symptoms, and this also has an impact on the sex ratio and location of some pain symptoms.
Conclusion: The results described underline some interactive processes between SPD, anxiety and depression and give an indication of possible shared etiological factors.
P - 10 Thursday 14/8, 14:00-15:00
Brain perfusion in anorexia nervosa (AN): Indicative of cortico-subcortical dysfunctions
Van den Eynde F, MD, Department of Psychiatry, Ghent University, 9000 Ghent, Belgium. Vervaet M, Audenaert K, De Saedeleer S, Naudts KH, Dierckx R, Van Heeringen C.
Frederique.Vandeneynde@UGent.be
Background: The aetiology of AN remains elusive. However, there is growing evidence for the involvement of brain circuitry dysfunction. Neuropsychological studies point at frontal and parietal cortical dysfunctions.
Aims: This study aimed to assess regional cerebral blood flow in AN patients. In addition, we evaluated whether there were differences in this respect between the AN-Restricting type (AN-R) and the AN-Binging/Purging type (AN-BP).
Methods: A 99m-Tc-ethyl cysteine dimer (ECD) SPECT was acquired in 22 inpatients with AN (21F, 1M, mean age 22, mean BMI 15.1). Twelve patients (11F, 1M, mean age 19, BMI 14.8) met the diagnostic criteria (DSM-IV) of AN-R, ten patients (10F, mean age 26, BMI 15.4) those of AN-BP. Fifteen healthy volunteers (14F, 1M, mean age 24 y) were used as a control group. All subjects showed a normal CT-scan of the brain. Group comparisons were performed using SPM 99.
Results: When compared to the control group, the AN patient group showed significant hypoperfusions in the bilateral superior frontal gyri, and, to a lesser extent, in the left superior temporal gyrus and the left parietal lobule. Significant hyperperfusions were found bilaterally in the basal ganglia, the thalamic structures and occipital cortices. No differences were found between the AN-R and AN-BP.
Conclusion: The results are indicative for dysfunctional cortico-subcortical pathways to be involved in AN-P. This study could not demonstrate a difference between the AN subtypes.
P - 11 Thursday 15/8, 14:00-15:00
Functional brain imaging in bulimia nervosa: Preliminary data
Van den Eynde F, MD, Department of Psychiatry, Ghent University, 9000 Ghent, Belgium. Naudts KH, De Saedeleer S, Vervaet M, Audenaert K, Maenhout A, Dierckx R, Ven Heeri.
Frederique.Vandeneynde@UGent.be
Background: Previous research has provided substantial support of involvement of dysfunction of brain circuitry in both pathogenesis and pathophysiology of BN.
BN-P (purging) and BN-NP (non-purging) are 2 subtypes of BN.
Aims: In this study we aimed at further exploring the brain perfusion patterns related to potential functional disturbances in the brain circuits in patients with BN-P.
Methods: A 99m-Tc-ethyl cysteine dimer (ECD) SPECT was acquired in 7 female BN-P inpatients (mean age 23.8 y, mean BMI 20,3). Seven healthy female volunteers (mean age 25.4 y) were used as a control group. All subjects showed a normal CT-scan of the brain. Group comparisons were performed using SPM 99.
Results: Compared to the group of healthy volunteers, the BN-P patients showed significant hyperperfusion in the right parieto-occipital lobe, the right frontal lobe, the anterior and posterior cingulate (limbic) cortex and to a lesser extent the left temporal lobe. No significant brain hypoperfusions were found within this group comparison.
Conclusion: These preliminary data in BN-P inpatients demonstrated hyperfusions in both cortical and limbic structures. The increased perfusion in both limbic and cortical lobes suggest an important role of dysfunctional pathways in brain circuitry comprising limbic, cortical and subcortical structures, in BN-P.
P - 12 Thursday 14/8, 14:00-15:00
Eating disorders at Landspítali University Hospital, Reykjavik, 1983-2001
Guðlaug Þorsteinsdóttir, Psychiatrist, Department of Psychiatry, Landspítali University Hospital, Reykjavík, Iceland
gudlthor@landspitali.is
Objective: To investigate the number, demographics, and survival of patients in first admission to psychiatric inpatient treatment at Landspitalinn University Hospital, Reykjavik, with a diagnosis of an eating disorder. The study includes admissions to the child and adolescent unit and about 90% of all emergency psychiatric hospital beds in Iceland.
Method: Medical records of hospitalised patients with a discharge diagnosis of an eating disorder according to ICD-9 and ICD-10 in the period of 1.1.1983- 31.12.2001, were viewed. Survival of the patients was investigated at the end of the study period.
Results: A total of l10 patients received a diagnosis, 103 women and 7 men. Mean age of the women was 23,5 years (8-50 years). Fifty-two (51.5%) women had anorexia nervosa, 40 (38.8%) had bulimia nervosa, 2 had atypical bulimia nervosa and 9 (8,7%) had EDNOS diagnosis. Of the men, 2 had anorexia, 2 atypical anorexia and 3 bulimia nervosa. Mean age was 27,5 years, (13-62 years). Forty-five (43.7%) women were diagnosed in the last 5 years (1997-2001) of the study period and 6 (86%) men. At the end of study period, 2 women had died, 98% of patients were alive.
Conclusions: Number of diagnoses dramatically increased over time. This may be due to either increased incidence of eating disorders or to a better diagnosis. 6,4% of the sample were men, which is as expected. Low mortality rate may be explained by the fact that the majority of patients were diagnosed in the latter half of the period.
P - 13 Thursday 14/8, 14:00-15:00
Treatment of bulimia nervosa with sertraline: A randomized controlled trial
Capasso Anna, PhD, University of Salerno, Via Ponte don Melillo-Fischiano-Salerno, Italia. - Sabatino C, Milano W, Petrella C.
annacap@unisa.it
Bulimia Nervosa (BN) is one of the most frequent eating disorders in industrialized societies. Reduced serotonin activity has been suggested to trigger some of the cognitive and mood disturbances associated with BN. Therefore, pharmacological treatment of BN is mainly based on the use of selective serotonin reuptake inhibitors, that have proved effective. At the present, the biological bases of this disorder are not yet completely clear.
The aim of this randomized, controlled trial was to verify the efficacy of sertraline, a selective serotonin reuptake inhibitor, in a group of patients with a diagnosis of BN. Twenty female outpatients, with an age range of 24-36 years and diagnosis of BN-binge purging, as defined by the DSM IV, were assigned randomly to two treatment groups: the first group received 100 mg/day sertraline for 12 weeks, the second group received placebo. The study was conducted for 12 weeks with weekly clinical assessments.
At the end of the observation period, in the group treated with sertraline there was a statistical significant reduction in the number of binge eating crisis and purging with respect to the group who received placebo treatment. In no case was treatment interrupted for emergency effects.
This study confirms that sertraline is well tolerated and effective in reducing binge-eating crises and purging in patients with bulimia nervosa.
P - 14 Thursday 14/8, 14:00-15:00
Treatment of monosymptomatic sleep disturbances during premenstrual period with zolpidem
Judit Radics, MD, Dr., Senior
Psychiatrist, 2nd Department of Psychiatry, Aladar Petz Teaching
Hospital, Gyor, Hungary. Gyorgy Ostorharics-Horvath, MD, PhD.radicsjudit@freemail.hu
Cyclic changes of gonadal steroid hormones play a role in the regulation of mood and affect. Progesterone has been shown to have major influence on thermoregulation and sleep. High levels of progesterone during the luteal phase have been associated with sleep disturbances during the premenstrual period. It has been described that premenstrual syndrome may only appear in the form of sleep disturbances without other significant complaints (recurrent luteal phase insomnia) in 31% of reproductive age females.
Our aim was to determine the effect of zolpidem in a group of women diagnosed with monosymptomatic sleep disturbances during the premenstrual period.
We studied 26 women (age 28-43 years, mean age: 35.6 years) who showed insomnia throughout 3 menstrual cycles (between 10 days before and 1-2 days after the start of the menses). During this period the patients received zolpidem in 5 or 10 mg dose for an average of 8.4 days. Seven patients (27%) and 19 patients (73%) responded to 5 and 10 mg daily dose of zolpidem, respectively. Adverse side effects have not been reported. All patients reported significantly improved subjective sleep status.
We conclude that daily zolpidem treatment during the mid and late luteal phase effectively normalizes sleep disturbances in recurrent luteal phase insomnia.
P - 15 Thursday 14/8, 14:00-15:00
Maintenance clozapine therapy of schizophrenia
Peter Gaszner, Professor of Psychiatry, National Institute of Psychiatry and Neurology, H-1021 Budapest, Hüvösvölgyi u. 116, Hungary. Zoltán Makkos.
h12890gas@ella.hu
During the last seventeen years at the Department of Clinical Psycho-pharmacology, National Institute of Psychiatry and Neurology (Budapest) 1071 inpatients were treated with clozapine and in this material 778 were schizophrenic. The diagnosis was made by the DSM-IV criteria (with the modification of the time). The efficacy of clozapine was 76%; 23% of the schizophrenic inpatients become symptom-free. The maintenance therapy of these 175 inpatients was examined: because the compliance of the patients, 144 continued clozapine treatment after one year, (31 schizophrenics discontinued treatment). Some of the patients continued clozapine treatment during seventeen years and they were also symptoms-free. From the 31 patients, who discontinued the treatment, 29 had symptoms of schizophrenia after one month; most of them had the previous serious problems. In these two groups, 79 inpatients had clozapine as first antipsychotic, 96 were nonresponders to the classical (or atypical) antipsychotics. The patients had no serious side effects with clozapine.
In the control group, 152 schizophrenic inpatients received haloperidol treatment during more than one year and were symptom-free. Only 48 inpatients had good compliance and were symptoms-free, after one year 104 discontinued haloperidol treatment and 101 had previous symptoms after one month, only 3 were symptom-free after six months.
Two patients (58 and 49 years old males) are selected for case report. They received clozapine during 25 years and are symptom-free.
During the antipsychotic treatment most of the schizophrenics become symptom-free. The compliance of clozapine is much better than at the classical antipsychotics. If the responders are taking the clozapine most of them are symptom-free after several years.
References
- Gaszner P, Makkos Z. Clozapine in the treatment of schizophrenia. Neuropsychopharmac Hung 1999; 1: 28-30.
- Meltzer HY. Treatment-resistant schizophrenia - the role of clozapine. Curr Med Res Clin 1997; 14: 1-20.
P - 16 Thursday 14/8, 14:00-15:00
Suboptimal pharmacotherapy and partial compliance: Barriers to continued improvement
Robert Lasser, MD1, CNS Medical Affairs, Janssen Pharmaceutica Products, Trenton-Harbourton Road, 08560 Titusville, NJ, USA. Cyndi Bossie, PhD1, Young Zhu, PhD1, Georges Gharabawi, MD1.
1Janssen Pharmaceutica Products, Titusville, NJ, USA.
sdbuyssc@psmbe.jnj.com
Background and Aims: Stepwise improvements in schizophrenia management were realized with the introduction of oral conventional antipsychotics, followed by long-acting conventionals, and more recently, oral atypicals. A long-acting atypical agent, offering more stable blood levels and assured medication delivery - the foundation of symptom improvement, remission, and functional gains - could provide further benefits. This analysis examined the effect of long-acting risperidone, the first long-acting atypical, in stable patients.
Method: Data were derived from an open-label 50-week study of long-acting risperidone (25, 50, or 75 mg every 2 weeks) in 725 stable patients with schizophrenia or schizoaffective disorder. The effect of treatment was examined in clinically stable patients at study entry on oral risperidone, conventional depot antipsychotics, or conventional oral antipsychotics.
Results: At study entry, 336 patients were receiving oral risperidone, 188 conventional depots, and 46 conventional oral antipsychotics. After receiving long-acting risperidone, mean PANSS total scores improved significantly throughout the 50 weeks and at end point in all groups (p<0.001). The greatest numeric improvement was observed in the latter group.
Conclusions: Results show significant symptom improvement with long-acting risperidone in stable patients with schizophrenia. They support the concept that improved pharmacotherapy and more assured delivery contribute to the benefits of a long-acting atypical.
P - 17 Thursday 14/8, 14:00-15:00
Clinical improvement with long-acting risperidone in patients previously receiving oral olanzapine
P Jones, C Bossie, R Lasser, CNS Medical Affairs, Janssen Pharmaceutica Products, Trenton-Harbourton Road, 08560 Titusville, NJ, USA.sdbuyssc@psmbe.jnj.com
Background and Aims: Although atypical antipsychotics have advanced the management of schizophrenia, currently available agents require daily dosing - commonly associated with limitations on adherence, response, and functional outcomes. This analysis examined long-acting risperidone for symptom control and quality of life in patients previously receiving the oral atypical, olanzapine.
Method: A 12-week, placebo-controlled, multicenter, double-blind study assessed patients receiving long-acting risperidone (25, 50, or 75 mg) every 2 weeks (n=370). Patients receiving prior therapy with oral olanzapine were analyzed (n=16, placebo; n=42 long-acting risperidone).
Results: Baseline PANSS-Total scores and mean prior olanzapine doses were comparable between placebo and long-acting risperidone groups (83.3±9.7, 83.1± 2.4; 15.3±1.9 mg/d, 16.0±0.83 mg/day, respectively). At endpoint, PANSS-Total scores worsened in placebo group, while improving significantly from prior olanzapine treatment (p=0.027) in the long-acting risperidone group (+4.4 and -6.9, respectively; p=0.05 between groups). Significant improvement (p<0.05) from prior olanzapine treatment was present in the long-acting risperidone group across Positive, Negative and Mood/ Anxiety domains. Improvement from prior olanzapine treatment was present in the SF-36 domain social functioning (p=0.053) and the mental health index (p=0.041) following treatment with long-acting risperidone.
Conclusions: These data support potential improvements in symptoms and quality of life with long-acting risperidone in patients previously receiving oral olanzapine.
P - 18 Thursday 15/8, 14:00-15:00
Effect of a novel long-acting antipsychotic in stable patients with schizoaffective disorder
Vieta Eduard1 Gharabawi Georges2, Bossie Cynthia A2, Zhu Young2, Lasser Robert A2.1Hospital Clinic, University of Barcelona, Barcelona Spain; 2CNS Medical Affairs, Janssen Pharmaceutica Products, LP, Titusville, NJ, USA.
sdbuyssc@psmbe.jnj.com
Background and Aims: Evaluate efficacy and safety of long-acting injectable risperidone in stable patients with schizoaffective disorder.
Methods: After a 2-week run-in period during which patients received flexible doses of oral risperidone 1-6 mg, patients received intramuscular injections of 25, 50, or 75 mg of long-acting risperidone every 2 weeks for 50 weeks. Efficacy and safety measures included the Positive and Negative Syndrome Scale (PANSS) and Extrapyramidal Symptom Rating Scale (ESRS).
Results: Of the 725 patients receiving treatment in the study (RIS-INT-57), 110 had schizoaffective disorder: the latter are the subjects of this analysis. Mean age was 43.5 years; 52.7% were women; 67.3% completed the trial. The baseline mean (SE) PANSS total score was 62.3 (1.73). Mean PANSS total scores improved significantly (P < .001) from baseline at weeks 12 (-7.4), 24 (-10.0), 36 (-8.4), 50 (-10.2), and endpoint (-7.9). Significant reductions were observed at endpoint in mean PANSS scores for positive symptoms (-1.7, P < .01), negative symptoms (-2.9, P < .001), anxiety/depression (-1.2, P < .01), and disorganized thoughts (-1.5, P < .001). A 20% reduction in PANSS total scores was seen in 56.2% of patients at endpoint. According to Clinical Global Impressions scores, the proportion of patients rated not ill or with very mild or mild symptoms increased from 54.6% at baseline to 76.6% at endpoint. Significant improvements (P<0.001) from baseline ESRS scores were noted on the overall subjective rating and the Parkinsonism exam. The most common adverse events were insomnia in 36.4%, anxiety in 30.0%, depression in 25.5%, and psychosis in 24.6%. The incidence of adverse events was reduced substantially from months 1-3 to months 10-12.
Conclusions: Stable patients with schizoaffective disorder can safely and effectively be switched from current treatment to long-acting risperidone.
P - 19 Thursday 14/8, 14:00-15:00
Management options of treatment-resistant panic disorder
Marc Ziegenbein, MD, Social Psychiatry and Psychotherapy, Medical School Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany. Petra Garlipp, MD.
mziege999@yahoo.com
Treatment resistance is a common problem in severe panic disorder. First line agents are selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). Well known factors contributing to medication treatment resistance include inadequate dosage, non-compliance, poor tolerability and psychiatric or medical comorbidity. Combination treatment with a benzodiazepine or tricyclic antidepressant (TCA) is a possible option for those patients who have not responded to one or more adequate trials of SSRIs. Augmentation with the presynaptic 5-HT1A-antagonist pindolol or switching to to a different class of medication is beneficial for the refractory patients as well. The newer antidepressants like reboxetine might be useful for patients with a comorbid mood disorder. For patients with hypomania, irritability and insomnia Carbamazepine and olanzapine might be particularly beneficial. Fortunately a number of promising pharmacological approaches have been introduced during the last years, but so far there is no clinical data on the usefulness and safety of such drugs. Ongoing research is needed to further elucidate the role of corticotrophin releasing factor, glutamate systems and GABA systems in refractory panic disorder.
P - 20 Thursday 14/8, 14:00-15:00
Reboxetine versus citalopram in major depressive disorder: Antidepressive effect and sexual side-effects
Owe Bodlund, MD, PhD, Dept of Clinical Science, Division of Psychiatry. Umeå University, S-901 85 Umeå, Sweden. Torbjörn Ohrt, Hans Ågren.owe.bodlund@psychiat.umu.se
Aims and methods: The objective of the study was to compare the efficacy and tolerability of reboxetine (selective NRI) with the SSRI citalopram, in treatment of MDD. In total, 357 outpatients with MDD were randomized to treatment with reboxetine 8 -10 mg or citalopram 20-40 mg per day during 24 weeks. Primary end-point was change from baseline in the Hamilton Depression Rating Scale (HAMD, 21 items). Sexual function/dysfunction was measured by the Sexual Function scale.
Results: Observed case analysis showed that both treatments yielded a gradual reduction of HAMD scores: reboxetine with -21.4 and citalopram with -22.1 points (NS). The response rate was 90.3% for reboxetine and 92.7% for citalopram (NS).
The most common side-effect in the reboxetine group was dry mouth, and in the citalopram group sexual dysfunction. At week 24, anorgasmia was reported by 5.9% of the sexually active women in the reboxetine group vs 39% in the citalopram group (p<0.001). In sexually active men, delayed ejaculation was reported by 11.8% in the reboxetine group vs 44.8% in the citalopram group (p<0.05). The dropout number was 91 in the reboxetine group, and 54 in the citalopram group.
Conclusions: To summarize, both treatments yielded a satisfactory antidepressant effect. The side-effect profile differed between the groups. The fairly high number of early dropouts in the reboxetine group is considered as a result of the non-titration starting dose of 8 mg reboxetine per day and this fact, however, weakens the validity of the study.
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Escitalopram versus citalopram: Well tolerated and more efficacious in long-term treatment of moderately depressed patients
EH Reines1, Section Head, H. Lundbeck A/S, Ottiliav ej 9, DK-2500 Copenhagen-Valby, Denmark. HF Andersen1, L Colonna2.1H. Lundbeck A/S, International Clinical Research, Copenhagen, Denmark, and 2University Hospital, Rouen Cedex, France
ER@lundbeck.com
Patients with Major Depressive Disorder were randomised into a 24-week, double-blind period, where they received 10mg/day escitalopram or 20mg/day citalopram. The effect of treatment with fixed doses of escitalopram versus citalopram is examined in the sub-population of moderately depressed patients.
The mean change from baseline in MADRS total score showed that escitalopram (n=85) was better at all time points compared to citalopram (n=85) and demonstrated a statistically significantly superior therapeutic effect at many visits, including Week 8 (p=0.02) and Week 24 (p=0.04). At Week 8, compared with citalopram, escitalopram showed a significantly higher response rate (50% reduction in MADRS) (75% with escitalopram versus 58% with citalopram, p=0.002) as well as a significantly better remission rate (MADRS 12) (75% with escitalopram versus 53% with citalopram, p<0.001).
Both escitalopram and citalopram were safe and well tolerated. Statistically significantly more patients in the citalopram group than in the escitalopram group withdrew from the study (31% with citalopram and 12% with escitalopram, p<0.01). The overall adverse event profile for escitalopram was similar to that for citalopram. However, the higher withdrawal rate in the citalopram group was especially pronounced from Week 8 to Week 24 (19% with citalopram and 4% with escitalopram p=0.004), suggesting better long-term tolerability for escitalopram.
This study demonstrates that 10 mg/day escitalopram shows significant clinical superiority to 20 mg/day citalopram in the treatment of moderately depressed patients.
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Escitalopram: Effective and better tolerated than venlafaxine XR in the treatment of depression
J Bothmer1, PhD, Lundbeck GmbH & Co, Karnapp 25, D-21079 Hamburg, Germany. SA Montgomery2, AKT Huusom3, EH Reines3.1Lundbeck GmbH & Co. Germany; 2Imperial College School of Medicine, London, United Kingdom; 3H. Lundbeck A/S, International Clinical Research, Copenhagen, Denmark.
PLJB@lundbeck.com
The efficacy of escitalopram relative to venlafaxine (an SNRI) in the treatment of Major Depressive Disorder (MDD) was assessed in a randomised, double-blind, non-inferiority study of standard dosages of venlafaxine XR and escitalopram. Patients in primary care with a MADRS total score 18 at baseline were included. Patients were randomised to 8 weeks of double-blind treatment with either escitalopram (n=148) or venlafaxine (n=145). Patients started with 10mg/day escitalopram or 75mg/day venlafaxine; if needed, the dose could be doubled after 2 or 4 weeks of treatment. Patients completing treatment entered a single-blind washout period to evaluate discontinuation symptoms.
The primary efficacy variable showed that escitalopram was at least as effective as venlafaxine. Patients in both treatment groups had mean baseline MADRS total scores of ª29, which decreased to <9 by Week 8. The response rate (50% reduction in MADRS) for escitalopram versus venlafaxine was numerically superior at all time points after Week 1. In the survival analysis of sustained response and sustained remission, there was a significant superiority of escitalopram relative to venlafaxine (p<0.05).
More patients treated with venlafaxine withdrew due to adverse events (11%) than did those treated with escitalopram (8%). Nausea was the most common adverse event, with a statistically significantly higher incidence for venlafaxine-treated patients (27% for venlafaxine and 17% for escitalopram, p=0.02). At the end of the washout period, significantly more venlafaxine-treated patients had an increase 4 in discontinuation-emergent signs and symptoms score (p<0.01).
In conclusion, escitalopram is a highly efficacious treatment for MDD, with superiority on sustained remission and sustained response rates when compared with venlafaxine XR, and with significantly better tolerability.
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Escitalopram is efficacious and well tolerated in the treatment of depression in primary care
U Lepola1, PhD, Kuopion Psykiatripalvelu OY, Psychiatric Research, Clinic of Kuopio, Kuopio, Finland. H Loft2, EH Reines2.1Psychiatric Research Clinic of Kuopio, Helsinki, and Oulu University, Department of Psychiatry, Finland; 2H. Lundbeck A/S, Copenhagen, Denmark.
Ulla.lepola@iwn.fi
This multinational, parallel-group study compared the efficacy and safety of escitalopram and citalopram, the active reference, to placebo in patients with Major Depressive Disorder. The mean MADRS total score at baseline was 29, indicating that the patients were moderately to severely depressed. After a 1-week, single-blind placebo period, patients were randomised into an 8-week, double-blind period where they received 10mg/day escitalopram (n=155), 20mg/day citalopram (n=160), or placebo (n=154), with the option of doubling the dosage after 4 or 6 weeks of treatment.
The efficacy analysis of mean change in MADRS total score from baseline showed a statistically significantly superior therapeutic effect for escitalopram versus placebo with a treatment difference of 2.9 points (p=0.002) at Week 8 (LOCF). Further by-visit analysis of the change in MADRS total score at each week showed escitalopram to be statistically significantly superior to placebo from Week 1 onwards (OC). The proportion of escitalopram responders (50% reduction in MADRS) and remitters (MADRS 12) at Week 8 (OC) was 64% and 52%, respectively; escitalopram was superior to both citalopram and placebo with respect to these parameters. Secondary efficacy analyses using the CGI-S and CGI-I scales showed a significant superior effect (p0.05) for escitalopram versus placebo as early as Week 1 on each scale. This effect was sustained through to Week 8.
Escitalopram was very well tolerated, with an adverse event profile that was as favourable as that for citalopram. The withdrawal rate was 10% for the placebo group, 6% for the escitalopram group, and 5% for the citalopram group. The withdrawal rate due to adverse events for the escitalopram group (2.6%) was identical to the placebo group.
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Thought suppression in smoking dependency
Jón T. Ingjaldsson Dr., Researcher,
Psychologist, Norwegian Department of Defensive Leadership, Akershus
Festning, 0015 Oslo Mil, Norway. Smári J, Laberg JC, Thayer JF.Jon.Ingjaldsson@psych.uib.no
Purpose: The aim of the current study was to investigate the effect of thought suppression on the frequency of smoking related thoughts in smokers.
Method: A total of 407 individuals labelled as active smokers, quitters and non smokers were either instructed to suppress or not to suppress their thoughts of smoking after exposure to smoking related or non-smoking related videotape in a controlled experiment. Self-reported frequency of thoughts of smoking was registered on baseline, after manipulation (exposure and instruction) and at follow up.
Results: Active smokers reported in general more frequent smoking related thoughts and slower habituation of such thoughts compared to non-smokers and quitters. Importantly, active smokers had problems with effectively suppressing smoking related thoughts after exposure to smoking related videotape, while suppression reduced thoughts on smoking in other active smokers exposed to neutral cues. Frequency of thoughts of smoking in active smokers was positively related to urge to smoke, worry and negative affect.
Implication: Instructed thought suppression is useful method for investigating involuntary cognition in addiction. To successfully cope with high risk situations more flexible mental strategies are advised.
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Quetiapine for the treatment of mania in bipolar disorder: A randomized controlled trial
Björn Paulsson, MD, Associate
Director, Dept. of Biostatistics, Astra Zeneca, Clinical R&D
Södertälje (B238) S-151 85, Södertälje. Huizar K.bjorn.paulsson@astrazeneca.com
Background: Monotherapy with lithium or an atypical antipsychotic is recommended therapy for treatment of mania.
Aims: Evaluate quetiapine as monotherapy for mania.
Methods: 302 patients (bipolar I disorder, manic episode) were randomized to 12 weeks double-blind treatment with quetiapine (QTP) (flexibly dosed up to 800 mg/d), placebo (PBO), or lithium (0.6-1.4 mEq/L).
Results: 67.3% (72/107) of QTP-, 36.1% (35/97) PBO-, and 68.4% (67/98) lithium-treated patients completed the trial. Quetiapine-treated patients had a significantly greater reduction in mean YMRS scores vs PBO at Day 21 (-14.62 vs -6.71; P<0.0001) and Day 84 (P<0.0001). Significantly more QTP patients achieved a response (50% decrease from baseline YMRS score) at Day 21 (QTP 53.3%; PBO 27.4%; P=0.0002), and Day 84 (QTP 72%; PBO 41.1%; P<0.0001). Quetiapine and lithium were similar in all efficacy measures vs PBO. Most common adverse events (10%) in QTP-treated patients included dry mouth and somnolence. Lithium was associated with tremor. Mean last-week QTP dose in responders at Day 21 was 586 mg/d.
Conclusions: In acute mania, quetiapine monotherapy is well tolerated and significantly more effective than placebo.
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Quetiapine adjunctive therapy for acute mania associated with bipolar disorder
Jamie Mullen, MD, Director, Clinical
Research, AstraZeneca, 1800 Concord Pike, FOC-2, P.O. Box 15437
Wilmington, DE 19850, USA. Nancy Devine, MS, Dennis Sweitzer, PhD.jamie.mullen@astrazeneca.com
Background: The addition of an atypical antipsychotic to lithium or divalproex is a first-line option for the treatment of more severe and psychotic forms of mania, although few clinical studies have been undertaken to support this approach.
Aims: Evaluate quetiapine (QTP) in combination with lithium (Li) or divalproex (DVP) for the treatment of mania.
Methods: Subjects with bipolar I mania were randomized to 21 days double-blind treatment with: QTP (flexibly dosed up to 800 mg/d) plus Li or DVP (target trough serum concentrations 0.7-1.0 mEq/L and 50-100 µg/mL, respectively); or placebo (PBO) plus Li/DVP.
Results: 56/91 (61.5%) QTP+Li/DVP-treated patients completed, compared to 49/100 (49.0%) in the PBO+Li/DVP group. By Day 21 QTP+Li/DVP-treated patients had a significantly greater reduction in YMRS compared with the PBO+Li/DVP group (-211;13.76 vs -;9.93; P=0.021). Significantly more quetiapine-treated patients (54.3%) achieved a YMRS response at Day 21 than Li/DVP-treated patients (32.6%) (P=0.005). Mean last-week quetiapine dose in responders was 580 mg/d. Common adverse events (;10%) included somnolence, dry mouth, asthenia, and postural hypotension. Discontinuation due to adverse events was similar in both groups.
Conclusions: Quetiapine in combination with lithium or divalproex is well tolerated and has superior efficacy in acute mania compared to Li/DVP alone.
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Possible mechanisms of antipsychotic-induced long-term weight gain
Marc Ziegenbein, MD, Social
Psychiatry and Psychotherapy, Medical School Hannover, Germany, Hannover
Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany. Stefan
Kropp, MD, Clinical Psychiatry and Psychotherapy, Medical School
Hannover, Germany.mziege999@yahoo.com
Weight gain occurs during treatment with drugs of different chemical structures and is an important problem when patients are treated with antipsychotics. The clinical relevance of drug-induced weight changes is due to increased rates of morbidity and reduced treatment compliance. Regarding the underlying causes, the important role of neurotransmitter systems has been discussed since decades. Understanding of the regulation of appetite and weight has made major progress, particularly in the last decade. In this context, the discovery of leptin was crucial. In addition to the neuroendocrine systems, weight gain induced by psychotropic agents might also involve immune modulators. The majority of studies dealing with antipsychotic-induced weight gain hypothesize that there is a limited period of weight gain. In contrast we suggest that psychotropic drugs, especially novel antipsychotics, appear to cause long-term weight gain. Risperidone 4mg/daily caused 42 kg weight gain over a period of four years in a patient with schizophrenia. The present poster discusses the possible mechanisms of long term weight gain and shows strategies to minimize or to counteract weight gain induced by novel antipsychotics. Although numerous psychotherapeutic approaches are available, they are only of limited usefulness in severely ill psychiatric patients. Fortunately, a number of promising pharmacological approaches have been introduced during the last years, but so far there is no clinical data on the usefulness and safety of such drugs.
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Is phototherapy useful in treatment of anorexia patients?
Janas-Kozik Malgorzata, MD, PhD,
Department and Clinic of Psychiatry and Psychotherapy, Silesian Medical
University, Ziolowa 45/47, PL 40-635 Katowice, Poland. Irena
Krupka-Matuszczyk, Marek Krzystanek, Jan Szymszal, Ewa Augustyniak.malgorzata.janas-kozik@psychiatria.pl
Phototherapy was introduced by N. Rosenthal as a treatment of seasonal affective disorder. Phototherapy synchronizes biological rhythms of humans and increases serotoninergic transmission in a brain [1]. Anorexia nervosa (AN) is a disorder with a putative increase of serotoninergic activity. Characteristic symptoms of AN are aberrant eating behavior, a desire to lose weight and fear of becoming obese. The theoretical assumption that phototherapy may improve symptoms of AN has never been explored before.
The aim of the study was to assess an influence of phototherapy on body mass changes in AN patients during a 6 weeks of treatment.
Twenty-six female AN patients aged from 12-22 years were the examined group. Nine patients were treated with phototherapy and 17 were a control group. Every subsequent week of treatment the body mass index (BMI) and BMI changes were calculated and depressive symptoms assessed using Hamilton rating scale.
BMI increases in each of the examined groups were observed (p<0,001). There were no statistically significant differences between BMI increases in the examined groups. AN patients with depressive symptoms showed improvement after 6 weeks (p=0.028). Phototherapy may be considered effective in treatment of depressive symptoms in AN.
References
1. Metzger JY, Berthou V, Perrin P, Sichel JP. Phototherapy: clinical
and therapeutic evaluation of a 2-year experience. Encephale 1998; 24:
480-5.
2. Ericsson M., Poston II WSC, Foreyt JP. Common biological pathways in
eating disorders and obesity. Addict Behav 1996; 21: 733-43.
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Neuroleptic malignant syndrome and serotonin syndrome in critical care
Kenneth R. Kaufman, MD, MRCPsych,
Professor of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 125
Paterson Street, Suite #2200, New Brunswick, New Jersey 08901, USA.
Michael J Levitt, Jagadeeshan Sunderram.kaufmakr@umdnj.edu
Background: Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are two medical emergencies associated with psychotropics. Differentiation and treatment are complex, especially when features of both are present and the patient has taken both serotonergic and neuroleptic agents.
Aims: Create an algorithm for complex cases with mixed features in the critical care setting.
Methods: Retrospective case analysis with literature review.
Results: 23-year-old white female was admitted following a polydrug overdose of venlafaxine, topiramate, divalproex sodium, risperidone, and carbamazepine. Upon presentation, the patient was afebrile, normotensive but tachycardic with WBC 12000, CPK 523, valproic acid level 122, carbamazepine level 39, and ammonia 113. She was intubated for airway protection, initiated on L-carnitine 250mg IV q8h, and managed with supportive care. On the third day of admission temperature rose to 103.7 and physical examination revealed 4+ reflexes with sustained clonus and increased upper and lower extremity rigidity. Cyproheptadine and dantrolene were initiated for presumptive SS and concomitant NMS. With persisting symptoms and rising CPK levels to 1033, the diagnosis of NMS was more evident. Bromocriptine was initiated and cyproheptadine was discontinued. Clinical improvement was noted with normalizing CPK. She was extubated on day 10 and confirmed a polydrug overdose, depression and agreed to inpatient psychiatric transfer.
Conclusions: Initial management should include intubation for airway protection, IV hydration, benzodiazepines, and monitoring for vital signs and laboratory values. Aggressive intervention for NMS and SS is indicated with a combination of cyproheptadine and dantrolene. If clinical features persist with CPK levels greater than 1000, bromocriptine should be included.
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Placebo controlled crossover trial with repetitive transcranial magnetic stimulation in major depressive illness: Double-blind crossover study
Anna L Þórisdóttir1, Ómar Hjaltason2, Ómar Ívarsson2, Sigurjón B. Stefánsson11Department of Neurology and 2Department of Psychiatry, Landspitali University Hospital, Iceland
annaltho@landspitali.is
Background: Several studies indicate that repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) has a beneficial effect on depressive symptoms.
Aims: To test antidepressant effects of left DLPFC activation by rTMS.
Method: Ten adults with major depression received two rTMS treatment periods of 5 days each. During one treatment period the patients received rTMS over the left DLPFC and in the other treatment period a placebo stimulation. The order of treatment periods was randomly allocated. Four weeks washout time elapsed between treatment periods. The patients were evaluated with Hamilton Depression Rating Scale (HDRS) before and after each treatment period by two psychiatrists blind to the nature of the treatment. Event-Related-Potentials (ERP) using oddball paradigm were recorded before and after each treatment period.
Results: Changes in depressive symptoms following left DLPFC stimulation did not show significant difference compared with placebo stimulation. There was an increase in P300 amplitude following left DLPFC stimulation compared with placebo (p = .044).
Conclusions: Our findings do not support findings that rTMS over the left DLPFC has antidepressant effects in depressive illness as evaluated by HDRS.
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Paired pulse transcranial magnetic stimulation shows increased cortical inhibition in major depression
Anna L Þórisdóttir1, Ómar Hjaltason2, Ómar Ívarsson2, Sigurjón B. Stefánsson1.
1Department of Neurology and 2Department of Psychiatry, Landspitali University Hospital, Iceland
annaltho@landspitali.is
Background: It is possible to use Transcranial Magnetic Stimulation (TMS) to probe different cortical inhibitory mechanisms. Prolonged cortical silent period (CSP) has been reported in patients with depressive illness following single pulse stimulation suggesting increased cortical inhibition.
Aims: To test cortical inhibition in depression by single and paired pulse TMS.
Method: Ten patients with major depression and 7 control subjects were stimulated with a single pulse. All controls and 3 patients had paired pulse stimulation of equal intensity with 100 ms inter stimulus interval. Motor evoked potentials (MEP) from voluntary activated abductor pollicis brevis muscle were recorded. The first pulse evoked a conditioned MEP and the second pulse evoked a test MEP.
Results: The duration of CSP was similar in both groups (p = .36). Mean amplitude of the test MEP was 63 % of the conditioned MEP for controls but 18 % for the 3 patients tested. The latency of the test MEP was increased both in controls and patients.
Conclusions: Reduced MEP following the test stimulus suggests an increased cortical inhibition in depressed patient, but this did not affect the duration of the CSP.
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Backward visual masking and TMS-induced visual suppression
H. Magnús Haraldsson, MD, Department
of Psychiatry, University of Wisconsin, Madison, WI 53719. Fabio
Ferrarelli MD, Ned H. Kalin MD, Giulio Tononi MD, PhD.hm.haraldsson@hosp.wisc.edu
Background: In backward visual masking (BVM), the perception of a visual stimulus is reduced by a subsequently presented mask. Abnormalities in BVM are well established in schizophrenia. Visual perception can also be suppressed by Transcranial Magnetic Stimulation (TMS) of visual cortex, possibly through similar mechanisms.
Aims: In preparation for a study of TMS-induced visual suppression in schizophrenics, we examined BVM and TMS-induced suppression in healthy subjects.
Methods: Sixteen subjects were presented with visual stimuli (letters) at one of 4 screen locations. The stimuli were followed, at different inter-stimulus intervals (ISIs), either by a second visual stimulus (mask), or by a single TMS pulses over right occipital cortex.
Results: As expected, BVM was strong at ISIs < 40 milliseconds (ms) but performance returned to over 90% of normal at ISI = 100ms. TMS-induced visual suppression was strongest at ISIs between 65 and 95 ms. At those ISIs, error rate was 42-52% for stimuli presented in the left visual field vs. 10-18% in the right visual field.
Conclusions: In normal subjects, right occipital TMS induces left visual field suppression with a well-defined peak at 65-95ms. Further studies will investigate whether schizophrenic subjects are abnormally sensitive to TMS-suppression as they are to BVM.
Educational Objectives: At the conclusion of this presentation, the participant should be able to recognize backward visual masking and visual cortex transcranial magnetic stimulation (TMS) as tools for investigating visual processing. We introduce the application of TMS induced visual suppression for studying populations with impaired early visual processing, such as schizophrenia patients
References
1. Amassian VE, Cracco RQ, et al. Transcranial magnetic stimulation in study of the visual pathway. J Clin Neurophysiol 1998; 15: 288-304.
2. McClure RK. The visual backward masking deficit in schizophrenia. Prog Neuro-Psychopharmacol & Biol Psychiat 2001; 25: 301-11.