27th Nordic Psychiatric Congress

P - Posters 65-96

P - 65 Friday 15/8, 14:00-15:00
Functional imaging (SPECT) of cortico-subcortical circuitry in depressive disorder

Van den Eynde F, MD, Department of Psychiatry, Ghent University, 9000 Ghent, Belgium. Audenaert K, De Saedeleer S, Naudts KH, Vervaet M, Dierckx R, Van Heeringen C.

Frederique.Vandeneynde@UGent.be

Background: Growing evidence of the involvement of cortico-subcortical circuits in depressive-like behavioural pathology in non-human animals is available.

Aims: This study will further explore the perfusion patterns related to potential functional disturbances in the cortico-subcortical circuit in patients with depressive disorder.

Methods: A 99m-Tc-ethyl cysteine dimer (ECD) brain SPECT was acquired in 63 inpatients (39F, 24M, mean age 43.0 years) within the acute phase of a major depressive disorder (MDD, DSM-IV). Sixty-three healthy volunteers (39F, 24 M, mean age 43.4 years) were used as a control group. All subjects showed a normal CT scan of the brain. The group of patients with MDD was compared with the group of healthy volunteers, using volume-of-interest (VOI) analysis.

Results: Compared to the group of healthy volunteers, the group of patients with MDD showed significant (p<0.001) hypoperfusion in the bilateral prefrontal regions and the head of the right caudate; and a significant (p<0.001) hyperperfusion in the left medial temporal lobe, the left thalamus and, bilaterally, in the cerebellar regions.

Conclusion: Our results indicate cortical and subcortical involvement in MDD. The increased perfusion in limbic system related structures together with the hypoperfusion in frontal and subcortical structures provides further support for cortico-subcortical circuit involvement in MDD.



P - 66 Friday 15/8, 14:00-15:00
Reduced serum prolactin levels following treatment with long-acting risperidone

C Canuso, C Bossie, G Gharabawi, R Lasser, CNS Medical Affairs, Janssen Pharmaceutica Products, Trenton-Harbourton Road, 08560 Titusville, NJ, USA.

sdbuyssc@psmbe.jnj.com

Background and Aims: Prolactin elevation observed with antipsychotic medication use results from pituitary dopamine D2 receptor antagonism. The magnitude and duration of such elevations may vary due to dosing regimens, patient characteristics, and collection bias. Moreover, the relationship and relevance of prolactin levels to presumed clinical sequelae is being increasingly challenged, with less robust relationships being reported than previously believed. Long-acting risperidone, with its reduced peak-trough fluctuations of active drug, may offer insight into some factors contributing to the reported variance of prolactin levels.
Method: Data were derived from a randomized double-blind study of patients with schizophrenia receiving long-acting or oral daily risperidone, examined prolactin levels over the course of 12 weeks.

Results: Prolactin levels reflecting oral risperidone treatment at baseline (n=276; 38.0 ng/ml, 2-6 mg/day) decreased at endpoint (-0.90 ng/ml; -2.3%). By both mean values and percent mean change, pharmacokinetically matched dosing for long-acting risperidone was associated with greater significant reductions in prolactin levels at endpoint (n=257; -4.83 ng/ml, P<0.001 versus baseline; -12.9%).

Conclusions: In this analysis, long-acting risperidone, with its reduced peak-trough fluctuations of active drug, was associated with significantly decreased prolactin levels.



P - 67 Friday 15/8, 14:00-15:00
Core symptom remission in patients with schizophrenia receiving long-acting risperidone

R Lasser, CNS Medical Affairs, Janssen Pharmaceutica Products, Trenton-Harbourton Road, 08560 Titusville, NJ, USA. Rodriguez, C Bossie, G Gharabawi, J Kane.

sdbuyssc@psmbe.jnj.com

Background and Aims: DSM-IV defines the essential features of schizophrenia as the presence and persistence of characteristic signs and symptoms. These include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. The objective of this analysis was to assess the effect long-acting risperidone on these core disease features, exploring the concept of disease remission.

Method: Expert-defined essential disease features (via Positive and Negative Syndrome Scale) defined remission: delusions (P1), conceptual disorganization (P2), hallucinations (P3), suspiciousness (P6), blunted affect (N1), emotional withdrawal (N2), and conceptual disorganization (G9). Remission was defined as a score of 3 (mild or less) on each item for 2 consecutive visits. Data were derived from an open-label 50-week study of long-acting risperidone in stable patients with schizophrenia or schizoaffective disorder.

Results: Although patients were clinically stable at study entry, 397 did not meet remission criteria at baseline (3, each item). PANSS total scores decreased significantly for these patients (baseline 74.7, endpoint 64.1; p<0.0001). Of these patients, 144 (36.3%) met remission criteria during the study.

Conclusions: A substantial number of patients treated with long-acting risperidone reached the defined level of remission, supporting the need for further attention to the symptomatic and functional definition of remission in schizophrenia.



P - 68 Friday 15/8, 14:00-15:00
Tic reduction with olanzapine in Tourette's disorder (TD)

Naudts KH, MD, Department of Psychiatry, Ghent University, 9000 Ghent, Belgium. Van den Eynde F, Sieben A, Dhondt K, Audenaert K, Van Heeringen C.

kris.naudts@hotmail.com

Background: Until recently, only haloperidol and pimozide were approved by the FDA for treatment of TD. To our knowledge there are no double-blind, placebo controlled trials on the use of atypical neuroleptics in TD.

Aims: To report on a case of TD, treated with Olanzapine.

Methods: We report on the use of Olanzapine in a 25-year-old male patient, diagnosed with TD since 13 years of age and unsuccessfully treated with pipamperon, haloperidol, pimozide, and risperidone

Results: On admission, the patient scored 90 on the Yale Global Tic Severity Scale YGTSS (max 100) and 22 on the Yale-Brown Obsessive Compulsive Scale Y-BOCS (max. 40). One week later, Olanzapine (ZyprexaR Velotabs) 10 mg daily was started. Another week later, we increased the dose to 20 mg daily. After 2 weeks on this dose, we noted a serious improvement in number of tics, frequency, and intensity. After 4 weeks, he obtained a score of 19 on the YGTSS and of 14 on the Y-BOCS.

Conclusions: Olanzapine 20 mg during 4 weeks yielded a spectacular and fast improvement of tics in this patient. This case report suggests that Olanzapine should be further explored as a potential alternative to conventional neuroleptic medication for treatment of tics in TD.

Note:



P - 69 Friday 15/8, 14:00-15:00
Quetiapine monotherapy for the treatment of mania

M Brecher, AstraZeneca, Wilmington, Delaware, USA. K Huizar, AstraZeneca, Södertälje, Sweden

martin.brecher@astrazeneca.com

Background: First-line therapy options for the treatment of mania include monotherapy with a mood stabilizer or atypical antipsychotic.

Aims: To evaluate quetiapine as monotherapy for mania.

Method: Patients (bipolar I disorder, manic episode) were randomized to 12 weeks double-blind treatment with quetiapine (QTP) (up to 800 mg/d), placebo (PBO), or an internal standard (haloperidol [HAL]). The primary endpoint was change from baseline YMRS score at Day 21 (QTP vs PBO).

Results: 53.9% (55/102) of QTP- vs 41.6% (42/101) of PBO-treated patients completed. Quetiapine-treated patients had a significant improvement in YMRS score vs PBO at Day 21 (-12.29 vs -8.32; P=0.0096), that increased by Day 84 (P<0.0001). Significantly more QTP patients achieved a YMRS response (50% decrease) at Day 84 (QTP 61.4%; PBO 39.0%; P=0.0015). Significant improvements in YMRS score at Days 21 and 84 for HAL were also observed. EPS were consistently higher in the HAL group (any EPS event: HAL 59.6%; QTP 12.7%; PBO 15.8%), as were discontinuations due to adverse events (HAL 10.1%; QTP 4.9%; PBO 5.9%). Mean last-week QTP dose in responders at Day 21 was 559 mg/d.

Conclusions: Quetiapine monotherapy is well tolerated and significantly more effective than placebo in the treatment of mania.



P - 70 Friday 15/8, 14:00-15:00
Randomized, double-blind, controlled data on the treatment of mania with Quetiapine


Martin Jones, Director, Biostatistics, Astra Zeneca, 1800 Concord Pike, P.O. Box 15437, Wilmington, DE 15437, USA. Karin Huizar.

martin.jones@astrazeneca.com

Background: Treatment guidelines for acute mania include monotherapy with lithium or an antipsychotic.

Aims: Evaluate the atypical antipsychotic quetiapine for the treatment of mania.

Method: Patients (N=604) with bipolar mania were treated with quetiapine (up to 800 mg/d), placebo, or an internal control (lithium or haloperidol) for 84 days. Outcomes were compared on several efficacy and safety endpoints.

Results: 60.8% (127/209) of quetiapine-treated vs 38.9% (77/198) of placebo-treated patients completed. The mean last-week quetiapine dose in responders at Day 21 was 575.5 mg/d. A significant improvement on the YMRS was observed with quetiapine by as early as Day 4 (P=0.021) that remained significant to Day 84 (P<0.001). At the primary endpoint (Day 21) improvement on the YMRS was -13.58 for quetiapine vs -7.76 for placebo (P<0.0001). Patients improved significantly in the lithium and haloperidol groups. Common adverse events (10%) in the quetiapine group were somnolence, dry mouth, and insomnia (insomnia was reported at a similar rate in all groups). Tremor was common in the haloperidol and lithium groups. Akathisia and extrapyramidal syndrome were common in the haloperidol group.

Conclusion: Quetiapine monotherapy is effective, fast-acting, and well tolerated when used for the treatment of mania associated with bipolar disorder.



P - 71 Friday 15/8, 14:00-15:00
Escitalopram and paroxetine in fixed doses for the treatment of social anxiety disorder (SAD)

EH Reines1, Section Head, H. Lundbeck A/S, Ottiliavej 9, 2500 Valby-Copenhagen, Denmark. SA Montgomery2, M Lader3, R Nil4.

ER@lundbeck.com

1H. Lundbeck A/S, Copenhagen, Denmark; 2Imperial College School of Medicine, London, United Kingdom; 3Institute of Psychiatry, University of London, London, UK; 4Lundbeck (Switzerland) Ltd., Glattbrugg, Switzerland
Social anxiety disorder (SAD) is one of the most common psychiatric disorders, but it remains under-treated because patients feel unable to seek help. However, SAD can be treated and failure to commence treatment has serious social and medical consequences.
A randomised, double-blind study in patients with SAD was conducted. After a 1-week, single-blind, placebo run-in period, patients were randomised to 24 weeks of double-blind treatment with fixed doses of escitalopram [5mg/day (n=167), 10mg/day (n=168), or 20mg/day (n=170)], paroxetine [20mg/day (n=169)], or placebo (n=166). Patients who completed double-blind treatment entered a 2-week, single-blind, placebo run-out period.

Escitalopram demonstrated significant efficacy relative to placebo for the primary endpoint (change from baseline to Week 12 (LOCF) in LSAS total score) for 5 and 20mg (p0.001) and a clear trend for 10mg (p=0.059). A further improvement in change from baseline in LSAS total score was seen for all doses at Week 24 (OC), with significant superiority over placebo for 5 (-8.1; p=0.006), 10 (-7.5; p=0.013), and 20mg (-17.35; p<0.001) escitalopram and for paroxetine, (-9.6; p=0.001). On the basis of this analysis, 20mg escitalopram was also significantly superior to the other escitalopram doses and 20mg paroxetine (-7.7; p=0.008;OC). Escitalopram was well tolerated. The proportion of withdrawals due to AEs was low and was higher in the paroxetine group than in the escitalopram or placebo groups. Significantly fewer discontinuation effects were seen for all escitalopram doses on the DESS than for paroxetine.



P - 72 Friday 15/8, 14:00-15:00
Abstract withdcrawn


P - 73 Friday 15/8, 14:00-15:00
The effects of influenza on risk of developing schizophrenia

Haukur Freyr Gylfason MA, Faculty of Social Science, University of Iceland, 101 Reykjavík, Iceland. Stefánsson B, Smári J, Tómasson H.

haukurgy@hi.is

Background: The first opportunity to study the effects of influenza on schizophrenia was after the influenza epidemic in 1918. That is because it was not until the late 18th century that Kraepelin described the symptoms of schizophrenia. In 1926 Menninger discovered that schizophrenia was the most frequent mental illness that followed the influenza epidemic eight years earlier, and by doing so started a debate that is yet to be decided.

Method: Data from the Icelandic State Social Security Institute was used to test the hypothesis that exposure to influenza during the second trimester of pregnancy would increase the risk for adult schizophrenia. Participants in this study were almost the total population of Iceland, and all those who had been diagnosed with schizophrenia and received disabilities for the last half a century. Analysis of transition data was used to record the sequence of states that were occupied and the times at which movements between them occurred (not diagnosed with schizophrenia - diagnosed with schizophrenia).

Results: The main results were that if there was an increased likelihood for maternal influenza infection in the second trimester then the child was at more risk of being diagnosed with schizophrenia later in life.

Conclusion: The research supports the hypothesis that maternal influenza during pregnancy is a risk factor for schizophrenia.



P - 74 Friday 15/8, 14:00-15:00
Parental age and risk for schizophrenia: A nested case-control study


Majella Byrne1, MSc, PhD, Esben Agerbo1, MSc, Henrik Ewald2, DMSc, William W. Eaton3, PhD, Preben Bo Mortensen1, MD, DMSc.

1National Centre for Register-Based Research, Aarhus University, Taasingegade 1, DK-8000 Aarhus C, Denmark, 2Institute for Basic Psychiatric Research, Psychiatric Hospital in Aarhus, Skovagervej 2, DK-8240 Risskov, Denmark, 3Department of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
We investigated the reported association between advanced paternal age and risk for schizophrenia. Unlike previous studies we investigated whether this association could be explained by social factors or family history of psychiatric illness.
A national population-based nested case-control study based on Danish longitudinal register data was conducted. The sample included 7704 first admissions to or contacts with Danish psychiatric services between 1981 and 1998 with an ICD-8 (until end of December 1993) or ICD-10 (from January 1994) diagnosis of schizophrenia, and 192590 individually time-, age-, and sex- matched population controls, their parents and siblings.

Paternal age was categorised into the following age groups: <20 years, 20-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years, 45-49 years, 50-54 years, and >= 55 years. Maternal age was defined as: <20 years, 20-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years, and >= 45 years. The risk for schizophrenia associated with parental age was investigated by conditional logistic regression.

Adjusting for socioeconomic and demographic factors and family psychiatric history, increased risk for schizophrenia was identified in those with paternal age >= 55 (Incidence Rate Ratio (IRR) 2.27; 95% CI 1.57-3.29). Significant sex interactions were observed. Sex specific analyses suggested that females were at higher risk from raised paternal age than males who were also at risk.

Increased risk for schizophrenia was associated with advanced paternal age. The interactions between sex and age of the parent of origin suggests that de novo genetic mutations occurring on the X chromosome might be involved in the aetiology of schizophrenia in males and females of older parents.

The study was funded by the Theodore and Vada Stanley Foundation and by NIMH Grant #MH53188. NCRR is funded by the Danish National Research Foundation.



P - 75 Friday 15/8, 14:00-15:00
Mortality in schizophrenia over the last 60 years in the township of Malmö


Lise-Lotte Nilsson, PhD, BSc in Social Work, Department of Psychiatry, University Hospital of Malmö, Lund University, Sege Park 8 A, 205 02 Malmö, Sweden. Bengt Lögdberg.

lise-lotte.nilsson@swipnet.se
The mortality and the standardized mortality ratio (SMR) for patients with the diagnosis of schizophrenia, and between 25-64 years of age, in the township of Malmö (population about 250 000) in Southern Sweden were studied from about 1935 until 2003, by analyses of patients' records. Data will be presented from the time period 1940-2000.
From about 1940-1960 most of the patients diagnosed with schizophrenia were living at mental hospital, and the mortality was similar to the general population, i.e. the standardized mortality ratio was about 1. Over the ensuing decades, the standardized mortality ratio increased about from 2 to 3 between 1960-1980, remained unchanged around 2 between 1980-1990, but then increased again from about 3 to 5 between 1990-2000, concomitant with the full sectorization and the final closure of the mental hospital.

Analyses of relationships between trends in standardized mortality ratio and organizational changes in psychiatry as well as societal changes will be presented and discussed.



P - 76 Friday 15/8, 14:00-15:00
Schizoaffective disorders in Denmark 1970-2000

Thomas Munk Laursen, Researcher, MSc, National Centre for Register-based Research, Taasingegade 1, 8000 Aarhus C, Denmark. Rodrigo Labouriau, Aksel Bertelsen, Rasmus Licht, Preben Bo Mortensen.

tml@ncrr.dk

Background: Schizoaffective disorder is related to both schizophrenia and to affective disorders. To our knowledge, however, no population-based study has investigated the association between the risk of schizoaffective disorders and familial aggregation of schizophrenia and affective disorders.
Aims: To determine how psychiatric histories of schizoaffective, bipolar and schizophrenia admissions among parents and siblings affect the risk of being admitted with a schizoaffective diagnosis.

Method: We established a register-based cohort study of 2.4 million persons born in Denmark. A total of 2203 persons were admitted with a schizoaffective disorder in approximately 43 million person years. Relative risks were estimated by Poisson regression.

Results: The relative risk of getting admitted with a schizoaffective disorder was 2.28 (95% CI 2.01-2.58) if the mother had been admitted to a psychiatric hospital. There was an additional risk of 1.96 (1.37-2.79) and 2.32 (1.68-3.19) if the mother had been admitted with schizophrenia or a bipolar disorder, respectively. The risk was 10.37 (~2.28*1.96*2.32) if the mother presented both disorders. Similarly for fathers and siblings.

Conclusion: There was an equal familial aggregation of bipolar and schizophrenia admissions in relatives of schizoaffective patients. The study suggests that the schizoaffective disorder is not simply a subgroup of either bipolar disorder or schizophrenia but may be genetically linked to both.



P - 77 Friday 15/8, 14:00-15:00
Offspring´s death and primary insomnia

Eva Edin, MD, Dept. of Psychiatry Sahlgrenska University Hospital, SE-41345 Göteborg, Sweden. Bertil Steen, Ingmar Skoog.

eva.edin@neuro.gu.se

Background: Insomnia is a common and important health issue in old age. The H-70 Population study in Göteborg, Sweden, is a longitudinal study of elderly people from Göteborg, Sweden, and has bee ongoing since 1971.

Aims: To explore whether the Primary Insomnia (PI), as defined by DSM-III-R, can be associated with other non-health related factors during the lifespan of participants.

Method: A representative sample of 347 non-demented 85-year olds were examined and interviewed regarding their mental and somatic health. Comprehensive neuropsychiatric examinations were performed by a psychiatrist.

Results: Multivariate regression analyses were performed. The multivariate model included gender, major health factors like coronary health, stroke, cancer, diabetes, blood pressure, and lipids. Socioeconomic factors such as disease and deaths of close relatives were included. In contrast to other insomnia types, only the PI revealed offspring's death as a significant factor. Of the 46 subjects with PI there were 16 subjects with previous experience of offspring's deaths. The corresponding figures for subjects without PI were 50 out of 300, p=0.0047, gender being the only confounding factor (p=0.006 in the entire multivariate model, OR=4,1 CI 1.5-11.1). There was no effect modification by gender.

Conclusions: There might be relevant risk factors associated with the sleep disorder entity classified as Primary insomnia. The death of offspring may be one of these.



P - 78 Friday 15/8, 14:00-15:00
Low blood pressure is related to anxiety and depression in older people


Bjørn Hildrum, MD, Department of Psychiatry, Helse Nord-Trøndelag HS, Hospital Namsos, N-7800 Namsos, Norway. Arnstein Mykletun, Eystein Stordal, Jostein Holmen, Alv A. Dahl.

bjorn.hildrum@hnt.no

Background: A few epidemiological studies the last years have indicated a relationship between low blood pressure and anxiety and depression in the elderly. This has begun to question the dominant paradigma that chronic hypotension is without clinical importance.

Aims: To examine further (i) Is the prevalence of anxiety, depression and comordbid anxiety depression higher among individuals with low blood pressure? (ii) Is the association equal in men and women, and in younger and older elderly? (iii) Can the association be explained by other variables?

Method: 73.5% (n=15.748) of the population 65-89 years old in Nord-Trøndelag County of Norway, participated in the HUNT 2 study 1995-97. Of these 12.749 (59.5%) filled in valid ratings of Hospital Anxiety and Depression Scale (HADS). Blood pressure and other somatic variables were obtained from the participants. Logistic regression analyses was used to examine the relation between blood pressure and anxiety and depression.

Results: Elderly with systolic and diastolic blood pressure in the lowest 10-percentile group had significant higher incidence of anxiety and depression, compared with the 26-75 percentile blood pressure group. The association seems stronger with comorbid anxiety depression. Control for other variables did not reduce the results essentially.

Conclusions: Low systolic and diastolic blood pressure is related to anxiety, depression and comorbid anxiety depression in the elderly.



P - 79 Friday 15/8, 14:00-15:00
Epilepsy and schizophrenia or schizophrenia-like psychosis: A population-based follow-up study

Ping Qin, Assistant Professor, MD, PhD, National Center for Register-based Research, Aarhus University, Taasingegade 1, DK-8000, Aarhus C, Denmark. Huilan Xu, Thomas Munk Laursen, Preben Bo Mortensen.

pq@ncrr.dk

Aims: To investigate epilepsy on the risk of schizophrenia or schizophrenia-like psychosis and to what extent family history of mental illness and/or epilepsy and age onset of epilepsy in cases contribute to the risk.

Methods: Using data from Danish longitudinal registers, we established a population-based cohort of 2.12 million persons born in 1950-2000 in which 25,736 persons had a history of epilepsy. We followed this cohort from their 15th years and identified 250 cases of schizophrenia and 463 cases of schizophrenia-like psychosis. We analyzed data with Log-liner Poisson regression.

Results: We found that the risks of schizophrenia and/or schizophrenia-like psychosis were highly associated with a history of epilepsy. This was the case when controlling for family histories of psychiatric illness and epilepsy as well as many other factors. Moreover, both a family psychiatric history and a family epileptic history increased significantly the risk of schizophrenia or schizophrenia-like psychosis, regardless of cases own history of epilepsy. In addition, the relative risks were significantly higher for people who were diagnosed with epilepsy at a higher age. All these findings hold true for the analyses when excluding subjects with alcohol abuse.

Conclusions: The risk of schizophrenia or schizophrenia-like psychosis associated with epilepsy is not confined to people's family history of schizophrenia or other mental disorders. The results suggest that schizophrenia-like psychosis and epilepsy may share common genetic and/or environmental factors.



P - 80 Friday 15/8, 14:00-15:00
Gender differences in motivation for seeking substance abuse treatment and in emotional and physical symptoms when entering treatment


Gísli H. Guðjónsson1, Kristín Hannesdottir2, Tómas Ágústsson2, Ása Guðmundsdóttir2, Jón F. Sigurðsson2, Þuríður Þórðardóttir2, Þórarinn Tyrfingsson3, Hannes Pétursson2

asagudmu@landspitali.is

1Institute of Psychiatry, De Cresigny Park, Denmark Hill, London SE5 8AF, 2Division of Psychiatry, Landspitali, University Hospital, IS-101 Reykjavik, Iceland, 3Vogur Hospital, IS-112 Reykjavik, Iceland

Background: Much concern is currently focused on motivation as an essential condition for successful substance abuse treatment. Research has shown controversial results.
Objective: To examine gender differences in motivation for seeking treatment and emotional and physical symptoms when entering treatment.

Subjects: 516 substance abusers, first week in treatment, age 16-81 years, mean age 36 years, 368 men and 148 women.

Methods: All patients who entered treatment in two treatment institutions in Reykjavik were asked to participate. Tests and self-administered questionnaires were completed during the first week of treatment.

Results: Women report more withdrawal symptoms than men and more symptoms of alcohol dependence. Factor analysis of the TMQ Treatment Motivation Questionnaire revealed five different factors; help seeking, internal motivation, external motivation, confidence in treatment, and internal pressure. There were no significant gender differences in motivation, except that women experience inner pressure to a greater extend than men. Both men and women in treatment rate higher on compliance than the general population, but they also show more antisocial behaviour. Women in treatment are more compliant than men and higher on state and trait anxiety and the Eysenck Neuroticism scale. The women have a tendency to give a better picture of themselves than men. These results underline the need for individual tailoring of treatment and the importance of assessing motivation on admission to treatment.



P - 81 Friday 15/8, 14:00-15:00
A 3-year follow-up of patients admitted with cannabis psychosis

Mikkel Arendt, Department of Psychiatric Demography Institute for Basic Psychiatric Research, Psychiatric Hospital in Aarhus, University Hospital, 8240 Risskov, Denmark. Povl Munk-Jørgensen.

mca@psykiatri.aaa.dk

Background: The existence of "cannabis psychosis" as a distinct diagnostic entity is controversial. It is not clear whether psychotic states induced by cannabis can be taken as evidence for vulnerability to develop long-term psychotic illness.

Aim: To evaluate whether the diagnosis of "cannabis psychosis", is a risk factor for the development of long-term psychotic conditions.

Method: Using The Danish Psychiatric Central Register patients admitted with cannabis psychosis were identified, and all prior and subsequent diagnoses from the following three years were analysed.

Results: Will be reported at the conference.

Conclusion: Will be reported at the conference.



P - 82 Friday 15/8, 14:00-15:00
Adolescents' involuntary psychiatric treatment

Virtanen C, PsM, University of Turku, Unit of Adolescent Psychiatry, Turku University Hospital, Kunnallissairaalantie 20, FIN-20700 Turku, Finland. Erkolahti R, Ilonen T, Saarijärvi S.

carita.virtanen@tyks.fi

Background: Ethical questions in involuntary psychiatric treatment are related to human rights. The latest reform of the Finnish Mental Health Act emphasises limiting the autonomy of a patient only when it is necessary for the treatment of an illness or for the patient's or others' safety.

Aim: Aim is to investigate characteristics of adolescents sent to involuntary psychiatric treatment and adolescents' involuntary psychiatric hospitalisation by comparing those who were committed to those who were released in the light of conditions stated for involuntary treatment in Finnish mental health legislation.

Method: Medical records of 106 adolescent inpatients sent to involuntary treatment in 1994-2002 were evaluated by a retrospective chart review.

Results: The main characteristics of adolescents sent to involuntary treatment were suicidal behaviour (72%), assaultive behaviour (44%), and psychotic symptoms (27%). Patients committed to involuntary treatment had significantly more often psychotic symptoms than those released (P = 0.016).

Conclusions: Psychotic symptoms and suicidal and assaultive behaviour are common among these adolescents. The autonomy of these patients should be limited to protect them and others from their own sudden aggressive impulses. Limiting the autonomy of an adolescent patient when needed should be equally emphasised with limiting the autonomy only when necessary.


P - 83 Friday 15/8, 14:00-15:00
Abstract withdrawn

P - 84 Friday 15/8, 14:00-15:00
Transferred to an oral presentation



P - 85 Friday 15/8, 14:00-15:00
A long-term follow-up study of child and adolescent psychiatric inpatients: Predictors of outcome

Ritva Erkolahti, MD, PhD, Child Psychiatric Clinic, Satakunta Hospital District, Sairaalantie 3, 28500 PORI, Finland. Elina Lahtinen.

ritva.erkolahti@satshp.fi

Background: Inpatient admission is an expensive psychiatric treatment. Follow-up studies of the prognosis of the patients are important.

Aims: This is a register-based study. Child psychiatric inpatients were followed up 13-16 years after hospitalization. We wanted to find out the predictors of outcome.

Method: The study population consisted of all 43 patients (mean age 9 years, range 3-16 years) consecutively admitted to the child psychiatric unit at the Satakunta Central Hospital, in Pori, Finland, during the years 1982-1985. At the time of the follow-up in 1998, the mean age of the former patients was 27 years (range 19-32 years).

Results: A total of 9 patients (21%) had obtained full disability benefits, a total of 8 patients (19%) had committed criminal offences and a total of 11 patients (26%) had been admitted to an adult psychiatric department. One patient had died (2%). A total of 24, 57% of the former child psychiatric inpatients had a non-negative outcome, here defined as not having entered the register of delinquency, disability, and death, and not having been admitted to the adult psychiatric department.

Conclusions: Follow-up prognosis was related to the severity of initial dysfunction, the age when seeking psychiatric help for the first time, and organic and developmental problems of the child. In addition, parental psychopathology and chronic diseases were statistically significant predictors of outcome.



P - 86 Friday 15/8, 14:00-15:00
To diagnose Asperger syndrome in adult patients

Birgitta Alexius MD, Department of Clinical Neuroscience, St Göran's Hospital, Karolinska Institute, SE 112 81 Stockholm, Sweden

birgitta.alexius@spo.sll.se

Aims: To describe symptoms supporting a diagnosis of Asperger syndrome in adult patients.

Method: Ten of 27 patients, half women, half men, diagnosed at a psychiatric department constituted the study group. The sample was not randomised and is not representative. Data on gender; age/ symptoms at first contact; age/symptoms when diagnosed; symptoms that precipitated neuropsychiatric examination was assembled from patients' charts.

Results: At first contact mean age was 17.8 years for women and 34.0 years for men. One woman and four men had stereotypidy; two women and one man social phobia; one woman maladaptive stress disorder; one woman eating disorder. At time of diagnosis mean age was 29.2 years for women; 38.6 years for men. Three women and all men were diagnosed during treatment for conflicts with colleagues, neighbours or relatives; two women were suicidal. Two women and four men were referred for neuropsychiatric examination because of communication problems; two women and one man were tested routinely; one woman had demanded testing.



P - 87 Friday 15/8, 14:00-15:00
Results of individual psychotherapy - a 3-years prospective follow-up study of patients who have a history of psychosis in psychiatric ambulatory care

Martti Kuokkanen, Helsinki City, Central Mental Health Unit, Helsinki, Finland

martti.kuokkanen@hel.fi

We provided intensive individual psychotherapy for young adults with psychotic disorders in an outpatient setting in one of the health districts of Helsinki. Initially 18 cases and controls (matched with age, sex, diagnose, marital status, employment status, past health history, and treatment history) were followed over 3 years (1997-2000). Outcome criteria were hospital days and disability days in previous year, i.e. annual GAFF- and SOFAS-results. Psychotherapy was psychoanalytic oriented therapy 1-3 times in a week. There were two qualified therapists and a doctor for cases. Controls received ordinary psychiatric care with contacts 3-20 times in a year. Both cases and controls received treatment in the form of psychotropics as indicated (neuroleptics, antidepressive medicines). Preliminary results indicate that the outcome was better for cases than controls.



P - 88 Friday 15/8, 14:00-15:00
Transferred to an oral presentation


P - 89 Friday 15/8, 14:00-15:00
Adult psychiatric patients bullied in childhood: Marital status, level of education, and occupation


Gunilla Klensmeden Fosse MD, Department of Neuroscience, Faculty of Medicine, Medisinsk teknisk forskningssenter, N-7489 Trondheim, Norway. Are Holen.

gunilla.fosse@medisin.ntnu.no

Background: Few studies have investigated social-demographic condition of adult psychiatric patients that were bullied in childhood.

Aims: To compare adult psychiatric outpatients who had been bullied in childhood with outpatients without such experiences with regard to social-demographic variables.

Methods: One hundred and sixty consecutive adult patients from a psychiatric outpatient clinic in Norway completed self-administered questionnaires about marital status, level of education, work status, and occupation. Bullying was measured by an inventory often used in schools.

Results: As adults, outpatients bullied in childhood were more often single and less often married or cohabiting. Bullied outpatients also had significantly lower levels of education and were more often out of work, and they worked significantly more frequently as shop assistants than as schoolteachers and engineers.

Conclusion: The findings suggest negative associations between bullying in childhood and social and occupational function in adult life.



P - 90 Friday 15/8, 14:00-15:00
Mourning multiple losses in childhood: Prospective case analysis

Kenneth R. Kaufman, MD, MRCPsych., Professor of Psychiatry and Neurology, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite #2200, New Brunswick, New Jersey 08901, USA. Nathaniel D. Kaufman, Diane L. Kaufman.

kaufmakr@umdnj.edu

Background: Multiple losses within short periods of time make one question life and can exponentially influence one's coping skills. But what are the effects on a child and what should be done when the next loss occurs? This unusual case addresses the multiple losses suffered by a 7-year-old boy over an eighteen month time period.

Aims: To assess coping skills of the child and the coping strategies of the parents with the goal of continuing this case study while the child grows into adolescence.

Method: Prospective case analysis with literature review.

Results: A 7-year-old boy experienced the deaths of three grandparents within 18 months (paternal grandmother 11/13/01; maternal grandmother 7/31/03; and paternal grandfather 5/21/03). He was the only grandchild who was actively involved in the eulogies of the paternal grandparents. On the morning following his paternal grandfather's funeral, he was informed that that his maternal uncle had died from an "insulin reaction." As such, this child has had to cope with the loss of four significant relatives within 18 months in the context of being born to older parents. At his maternal grandmother's unveiling he commented that "Bubby Becky will never die ... there is a piece of her in my heart forever." At the eulogy to the paternal grandfather he summarized emotions well beyond his years - "Too many petals and thorns have fallen from the family rose."

Conclusions: This case report analyzes the deaths, the responses, the parental input to assist the child through the grieving process, and suggests steps to be taken for children faced with coping with multiple losses.



P - 91 Friday 15/8, 14:00-15:00
Psychosocial functioning and psychiatric comorbidity among substance-abusing Icelandic adolescents


Helga Hannesdóttir, Psychiatrist, Landspítalinn University Hospital, Reykjavik, Iceland. Þórarinn Tyrfingsson, Jorma Piha.

helgah@centrum.is

Our objectives were to compare behaviour problem scores (BPS) for Icelandic adolescents admitted for detoxification treatment for alcohol and narcotic abuse as compared with the general population, in accordance with the Youth Self Report (YSR), and to describe psychosocial functioning and psychiatric comorbidity for the treated adolescents. The case series consisted of 103 adolescents, ages 12-18 years, who completed the YSR at the end of a 10-day stay at the national Hospital of Addiction Medicine. The total BPS tallied from the YSR items was compared with scores for the general population. The psychiatric comorbidity and psychosocial functioning of the case series were assessed through diagnostic interviews in accordance with DSM-IV and ICD-10 criteria. The BPS for the 36 treated girls was significantly higher than for the general population (104 versus 36) and higher than for the 56 treated boys (82 versus 56) with 2 standard deviations above the norm for the population. Three-quarters of the adolescents had psychiatric comorbidity: conduct disorder (44%), depression (28%), or posttraumatic stress disorder (11%). The findings support the discriminative validity of the YSR as part of a structured global assessment of substance-abusing adolescents, in particular to identify the frequently present psychiatric comorbidities.

* Adolescents, Clinical epidemiology, Comorbidity, Substance abuse, Youth Self Report.




P - 92 Friday 15/8, 14:00-15:00
Different levels of oxidative stress with typical and atypical neuroleptics


Stefan Kropp PD Dr., Klinische Psychiatrie und Psychotherapie, Medizinische Hochschule Hannover, OE 7117, 30623 Hannover, Germany. Kern V, Degner D, Schneider U, Bleich S.

kropp.stefan@mh-hannover.de

Background: Toxicity of neuroleptics and potential side effects might be mediated by lipid peroxidation.
Aims: To examine potential neurotoxic effects, a comparative study of the potential of haloperidol and flupentixole to induce oxidative stress in contrast to atypical neuroleptics (amisulpride, clozapine, olanzapine, quetiapine and risperidone) was designed.

Methods: Malondialdehyde (MDA) was chosen as a marker for lipid peroxidation. Blood samples from patients taking neuroleptic drugs were analysed for MDA by HPLC. 92 of initially 115 enrolled patients were completers (80%). 22 patients were in the typical, 70 in the atypical group. Mean values of MDA in patients taking atypical vs. typical antipsychotics were calculated. Variables such as smoking status, gender, severity of illness (BPRS) and extrapyramidal movements (AIMS) were documented.

Results: Most MDA levels were within normal ranges (<1,0 µmol/l). Nevertheless, MDA concentrations in patients receiving clozapine (p=0.001), quetiapine (p=0.001), amisulpride (p=0.02) and risperidone (p=0.01) were significantly lower than within the typical group.

Conclusions: Significant differences between MDA levels in patients taking typical and atypical neuroleptics were found with clozapine, quetiapine, amisulpride and risperidone. The results indicate that lipid peroxidation is significantly lower in most patients with atypical neuroleptics and higher in patients receiving flupentixole and haloperidol.



P - 93 Friday 15/8, 14:00-15:00
The influence of phototherapy and fluvoxamine on phospholipase D activity in blood platelets in anorexia nervosa


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, Henryk I. Trzeciak, Jan Szymszal.

malgorzata.janas-kozik@psychiatria.pl

Membrane phospholipase D (PLD) is one of crucial enzymes playing an important role in cell second messengering. Anorexia nervosa (AN) is a disorder characterized by aberrant eating behavior, a desire to lose weight and fear of becoming obese. A relation between AN and disturbances in PLD system has never been explored before. Changes of PLD activity after phototherapy are also an original idea worth exploring.
The study aimed at characterization of PLD activity in blood platelets in female AN patients treated with fluvoxamine (100 mg/d) or phototherapy with a group without a treatment.

The examined group consisted of 7 patients on fluvoxamine and 9 receiving phototherapy. The control group was 25 healthy girls. PLD activity was assessed according to Strosznajder and Zhou et al. before the treatment and after 6 weeks [1,2].

The activity of PLD in AN patients before and after the treatment was 1.353 and 1.358 nmol/mg/min in fluvoxamine group, and 1.471 and 1.438 nmol/mg/min in phototherapy group. The activity measured in the controls was 1.367 nmol/mg/min. There were no statistically significant differences between the examined groups.

Both phototherapy and fluvoxamine do not seem to change PLD activity in blood platelets in AN patients after 6 weeks of treatment.

References
1. Strosznajder J, Strosznajder RP. Guanine nucleotides and fluoride enhance carbachol-mediated arachidonic acid release from phosphatidylinositol. Evidence for infolvement of GTP-binding protein on phospholipase A2 activation. J Lipid Mediat 1989; 1: 217-29.

2. Zhou M, Diwu Z, Panchuk-Voloshina N, Haugland RP: Developmental changes in phospholipase D activity and mRNA levels in rat brain. Anal Biochem 1997; 253: 162-8.



P - 94 Friday 15/8, 14:00-15:00
Parkinson's disease and clozapine-induced aplastic anaemia

Marc Ziegenbein, MD, Social Psychiatry and Psychotherapy, Medical School Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany. Anja Steinbrecher, MD, Neurology and Clinical Neurophysiology, Medical School Hannover, Germany, Petra Garlipp, MD, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany.

mziege999@yahoo.com

Psychosis is a common complication of the drug treatment of Parkinson's disease. All patients suffering from idiopathic Parkinson's disease are at risk of developing delusions or hallucinations. The most prominent psychotogenic factors are dopaminomimetic agents, which may induce dopamine hypersensitivity in the frontal and limbic dopamine projection regions, and consequently, either directly or indirectly, elicit psychotic signs and symptoms. A Parkinson's disease-related cholinergic deficit in combination with an age-related further loss of cholinergic integrity also plays a prominent role. Treatment of this complication is difficult, as most typical antipsychotic drugs, because of their selective dopamine receptor antagonistic effects, worsen motor symptoms of Parkinson's disease. As a consequence of a non-selective antagonism at both serotonergic and dopaminergic receptors, atypical antipsychotics such as clozapine, are associated with fewer extrapyramidal side-effects. Clozapine treatment is associated with wide side-effects such as blood-cell dyscrasias, including transient granulocytosis, benign granulocytopenia, and a considerable risk of agranulocytosis as high as 0.5-1%, transient fever, sedation, and considerable body weight gain. The mechanisms underlying these side effects are still unknown, but recent data suggest that the metabolism of clozapine and its immunmodulatory effects might play a role. Aplastic anaemia, comprising all its features, during clozapine therapy has not been documented in the literature. Herein we present a case of clozapine-induced aplastic anaemia.


P - 95 Friday 15/8, 14:00-15:00
Transferred to an oral presentation


P - 96 Friday 15/8, 14:00-15:00
Patterns of bipolar swings - the usefulness of "life-charting"

Lena Backlund, Karolinska Institutet, Neurotec Department, Division of Psychiatry, Huddinge University Hospital, 141 86 Stockholm, Sweden. Göran Isacsson, Hans Ågren.

lena.backlund@slpo.sll.se
For the study of factors predicting the long-time course of bipolar disorder, we used a life-charting methodology to study a random sample of 60 patients diagnosed with bipolar disorder (26 men, 34 women; 48 Bipolar I, 12 Bipolar II).
A descriptive analysis showed 16 subjects with a first illness episode under age 18 (27%); 37 had been psychotic (62%). Since onset of illness subjects had spent more than one fifth of their lives acutely ill. The time span between onset of illness and receiving psychiatric care was at average 3 years, and until receiving mood-stabilizers nearly 13 years. On mood-stabilizers, the frequency of episodes decreased substantially, particularly in subjects whose first episode was manic. Fifty-one subjects had heredity for affective disorder (85%). In the 16 with affective siblings, functioning was less affected by the illness and the time spent in mania was shorter. Maybe individuals with affected siblings are better informed, seeking psychiatric treatment earlier and thus achieving a better prognosis.

These preliminary results support the concern that bipolar disorder is an illness with a largely juvenile onset, having a major impact on the affected person's course of life, and with a prognosis that it is possible to influence with mood-stabilizers.

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