27th Nordic Psychiatric Congress

P - Posters 33-64

P - 33 Thursday 14/8, 14:00-15:00
Mental disorders in a danish working population

Anelia Larsen, Research Fellow, Cand Psych, Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Mölleparkvej 10, 9000 Aalborg, Denmark. Henrik Böggild, Jens T. Mortensen, Povl Munk-Jørgensen.

Background: Studies have shown that 20-35% of the working population experience stress and approx. 10% minor, usually mixed, anxiety and depression. Screening for psychiatric morbidity often shows methodological weakness. Therefore, there is a deficit in knowledge of prevalence of mental problems in working populations.
Aims: To estimate the prevalence of psychiatric morbidity within the working population in Denmark.

Method: A cross-sectional multicentre study utilizing a two-phase design was carried out in two counties in Denmark in February 2002-March 2003. Six enterprises within private and public sectors were included. At step one questionnaire was administered to 925 employees aged 18+. At step two a PSE interview was conducted with selected respondents according to their scores on SCL-90-R and CAGE. Two psychiatrists gave consensus diagnoses after an independent assessment of the PSE ratings.

Results: 598 (65%) employees responded. SCL-90-R and CAGE screening: 148 (25%) scored above GSI cut-off 1, 00 and/or subscale cut-off 1, 25 and/or above threshold on GAGE. 54 (37%) accepted PSE interview; so did 54 low score controls. Further results from PSE scores correlated to SCL-90-R will be presented.

Conclusions: The poster will comment on prevalence and methodology of study.

P - 34 Thursday 14/8, 14:00-15:00
Psychosocial risk factors for musculoskeletal symptoms among women working in geriatric care

Hólmfríður K. Gunnarsdóttir, Guðbjörg L. Rafnsdóttir, Berglind Helgadóttir, Kristinn Tómasson, MD, Dr. Med., Dept. of Research and Occupational Health, Administration for Occupational Health and Safety, Bíldshöfða 16, 110 Reykjavík, Iceland

Background: The aim was to explore the extent of the association between psychosocial work characteristics and musculoskeletal symptoms among women working in geriatric care.

Methods: The participants were female employees of all geriatric nursing homes and geriatric hospital wards in Iceland having a staff of 10 or more. A total of 1886 questionnaires were distributed. The response rate was 80%.

Results: Finding the job mentally difficult, mental exhaustion after one's shift, dissatisfaction with supervisors or the flow of information, insufficient influence at work, dissatisfaction with the hierarchy, intense time pressure, lack of solidarity, dissatisfaction with the job, harassment, violence or threats at work; all of the aforementioned gave crude odds ratios (OR) 2 or above for one or more musculoskeltal symptoms. Mental exhaustion and harassment, violence, and threats were the factors connected with symptoms from all the body regions studied.

Conclusions: The extent of the association of work-related psychosocial factors and musculoskeletal symptoms among the geriatric female nursing staff is substantial and needs to be taken into account by occupational health services and others involved in preventive work.

P - 35 Thursday 14/8, 14:00-15:00
Predictors of receiving first ECT treatment: A nested case-control study

T Munk-Olsen, Researcher, MSc, National Centre for Register-based Research, Taasingegade 1, Aarhus Universitet, 8000 Aarhus C, Denmark. P Videbech, R Rosenberg, PB Mortensen.


Background: Electroconvulsive therapy (ECT) is an established treatment, which is most commonly used in the treatment of major depression.
Aim: The aim was describe the characteristics of ECT treatments and to identify predictors for receiving ECT for the first time.

Method: The study was a register-based nested case control study. The sample included 2,010 cases admitted and treated with ECT at a large regional psychiatric hospital in Aarhus, Denmark between 1976 and 2000 and 148,284 individually time-matched controls.

Results: The use of ECT declined between 1976 and 2000. For all patients admitted during the study period 5.53% received ECT, and 18.86% of all patients with affective disorders were ECT recipients.

Preliminary results show that after adjusting for demographic variables, strong predictors for receiving first ECT treatment were having a diagnosis within the diagnostic group: affective disorders (including major depression, not including bipolar disorders), IRR: 18.75 (95% CI 15.83-22.21), an index admission lasting 181 days or more, IRR: 15.50 (95% CI 12.91-18.60), and having no history of previous admissions, IRR: 2.00 (95% CI 1.69-2.36).

Conclusion: Patients with affective disorders, patients with a long duration of admissions and patients with no history of previous admissions had an increased risk of receiving their first ECT treatment.

P - 36 Thursday 14/8, 14:00-15:00
Problem gambling among 16 to 18 year old college students in Iceland

Daníel Þór Ólason Dr., Department of Psychology, University of Iceland, Odda, Sturlugötu, 101 Reykjavík, Iceland. Karen Júlía Sigurðardóttir, Jakob Smári.

Background: Research findings in the United States, Canada, England, and Australia suggest that the prevalence of problem gambling among adolescents is considerably higher (4,4%-7,4%) than typically seen for adult populations (1%-2%).

Aims: This paper presents a first study on the rate of adolescent gambling in Iceland using two different screening measures specifically developed for adolescents; the SOGS-RA (Winters, Stinchfield & Fulkerson, 1993) and the DSM-IV-MR-J (Fisher, 2000).

Method: Students from 12 colleges in Iceland were surveyed concerning their gambling behaviour. The final sample consisted of 750 students, 379 males and 371 females.

Results: About 96% of the students had gambled at least once during their lifetime and 79% had gambled within the past 12 months. Gambling was more common among males (89%) than females (71%) and the most popular gambling activities were scratch-tickets, slot machines, and lotto. The DSM-IV-MR-J was found to be a more conservative measure identifying 2% of the students as problem/pathological gamblers while the SOGS-RA identified 2.7% of the students as having serious gambling problems. Risk and problem gambler groups scored higher on an index measuring gambling related cognitive distortions than those who gamble without problems.

Conclusions: These findings suggest that problem gambling rates among adolescents are lower in Iceland than reported internationally. The implications of these findings and the possible role of cognitive distortions in the development and maintenance of problem gambling behaviour are discussed.

P - 37 Thursday 14/8, 14:00-15:00
Am I my brother's keeper: Responsibility attitudes and obsessive compulsive symptoms in childhood

Jakob Smári, Professor, Faculty of Social Science, University of Iceland, 101 Reykjavík, Iceland. Þóra Magnúsdóttir, Anika Böðvarsdóttir.
Background: Responsibility attitudes and appraisals have in cognitive models been suggested as important determinants of obsessive-compulsive symptoms. Support for this has mostly been obtained in studies of adults. It seems thus important to investigate whether the model is applicable to children and adolescents.

Aims: To investigate whether responsibility attitudes are related to self-reported obsessive-compulsive symptoms over and above depression and anxiety. Furthe the relationships between responsibility attitudes and different types of obsessive-compulsive symptoms are elucidated.

Method: The Responsibility Attitudes Scale Child-Version (RAS-CV), the Obsessive-Compulsive Inventory-Child-Version (OCI-CV), the Children's Depression Inventory (CDI) and the Multidimensional Anxiety Scale for Children (MASC-10) were administered to 407 Icelandic schoolchildren aged 13-15 yrs.

Results: Responsibility attitudes had higher correlations with OCI-CV than with CDI or MASC and the correlation between OCI-CV and responsibility attitudes was significant when CDI and MASC were partialized out. Furthermore, in a hierarchical multiple regression, responsibility attitudes added significantly to the prediction of OCI-CV scores over and above age, gender, CDI score and MASC scores. Among the OCI-CV scales responsibility attitudes were most strongly related to obsessing.

Conclusions: Responsibility attitudes seem to be specifically related to obsessive-compulsive symptoms in late childhood, over and above symptoms of anxiety and depression.

P - 38 Thursday 14/8, 14:00-15:00
Brain function and structure in paedophilia

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


Background: Paedophilia is recognised as a mental disorder in International and American classification manuals, but clinicians on both sides of the Atlantic are, at best, ambivalent about any case for treatment. Recognition is in operational terms only; there is indication neither of aetiology nor prognosis.
Aims: To review the literature on brain imaging in this condition; to evaluate the evidence for an organic brain contribution to its aetiology and develop testable hypotheses.

Methods: Medline search for the period 1.1.1960 through 2002 and a PsycINFO search from 1995 until July 2002 and a manual search of selected high impact journals from the general/forensic psychiatric field; from the neuro-imaging/sexuality literature. We included only articles which fulfilled our operational criteria for paedophilia.

Results: From neuropsychological tests, EEG, CT-, SPECT, MRI and PET-scans possible involved brain regions in paedophilia appear the frontal and temporal lobes; the septal and hypothalamic nuclei; the limbic system. There are also indications for hemispheric dysfunction.

Conclusions: PET and (f)MRI in a large, homogenous sample of fixated paedophiles- compared to other subgroups of paedophiles or sex offenders and normals could yield a further insight into the aetiology of paedophilia and sex-offending.

P - 39 Thursday 14/8, 14:00-15:00
Child sexual abuse in Iceland

Hrefna Ólafsdóttir, Social Worker MSW, Landspítalinn, The University Hospital, Department of Child and Adolescent Psychiatry, Dalbraut 12, 105 Reykjavík, Iceland


Background: I had been working on a questionnaire for this research with researchers in this field in Schandinavia since the year 1995. In the year 2000 this first probability research was made on Child Sexual Abuse in Iceland. I worked with The University of Iceland - Social Science Research Institute. In the year 2001 the first step of data analyses was made.
Aims: The aim is to determine the prevalence and the nature of the abuse in accordance with relations and social and psychological situation. Also to try to determine the epidemological impact of CSA, especially for the survivors.

Method: It is a Questionnaire Survey Research. We sent a questionnaire out to a random sample of 1500 people in the age from 18 to 60 years. The random sample was made from the whole population of Iceland.

Results: The group of survivors is determined to be 16.7% of all children/adolescents within the age of 18 years have at least once been sexually abused. This group is a little bigger than in the other Schandinavian countries. The survivor is a girl at the age 7-10 years, she is sexually abused by some man within the family who is either under 20 or older than 50 years. The abuse happens more than once and spreads over more than one year and is coarse or very coarse in over 60% of the cases.

Conclusions: Survivors of CSA is a big group. The biggest part of the group are young girls within the age of 10 years that are mostly abused within the shelter of their home environment. It seems to have a major negative impact on their future life, both socially and psychologically.

P - 40 Thursday 14/8, 14:00-15:00

Behaviour and emotional disorders among icelandic children and adolescents

Helga Hannesdóttir, Psychiatrist, Landspítalinn University Hospital, Reykjavík, Iceland. Lilja Sólnes, Jorma Piha.


Objectives: 1) Compare behaviour problem scores (BPS) between Icelandic child/adolescent psychiatric patients and a population sample utilising the Child Behaviour Checklist (CBCL). 2) Indicate the diagnostic/treatment modalities in use in Iceland at the time.
Methods: Subjects were 329 outpatients ages 4-16 evaluated at the Landspitali University Hospital, Child Psychiatric Clinic. Each patient/parent completed a CBCL 4-16, which was used to tally a total BPS. Patient scores were compared to those of a randomly selected group from the general population. The therapists completed an Applied Treatment Form for each subject at the end of treatment or at the end of the study in 1995.

Results: Patient BPSs were three times higher for boys and for girls in each age group than for the general population. The most frequent treatment approaches used were parental advice and support (87%) and family therapy (67%). Physical examination was a part of only 44% of evaluations.

Conclusion: With a mere 1-5% overlap in patient and general population scores, the CBCL is clearly a valuable diagnostic indicator of child/adolescent behaviour problems and should be a component of global assessment.
Key words: Child/Adolescent Psychiatry, Child Behaviour Checklist, Diagnostic Tests, Applied Treatments, Clinical Epidemiology.

P - 41 Thursday 14/8, 14:00-15:00
Is there a link between creativity and mental disorder?

E Lauronen, Medical Student (Bachelor of Medicine), Dept. of Psychiatry, University of Oulu, PO BOX 5000, FIN-90014, Finland. J Veijola, I Isohanni, PB Jones, P Nieminen, M Isohanni.


Background: A link between decreased ability and mental disorder is commonly assumed, however, evidence to the contrary also exists.
Aims: Our aim is to update the literature concerning associations between creativity and mental disorder as well as to include an epidemiological and theoretical discussion of the topic.

Methods: As literature retrieval we used Medline, PsycINFO and manual literature searches.

Results: There are numerous, largely empirical studies - mostly with methodological difficulties and variation - that provide no clear consensus. However, some trends are apparent. We found 13 essential major case series (over 100 cases), case-control studies or population-based studies, with valid measures of mental disorders. All but one of these studies supported the association, at least when concerning some group of mental disorder, and in two studies the findings were somewhat unclear. Most of the rest studies explored (N=8) also show delicate association between creativity and mental disorder, but the link is not apparent for all groups of mental disorders or for all forms of creativity.

Conclusions: Some evidence exists to support association between creativity and mental disorder. Creative people may have more psychopathology, especially affective disorders, than does the general population.

P - 42 Thursday 14/8, 14:00-15:00
Alexithymia after traumatic brain injury

Koponen Salla, MD, Dept. of Psychiatry, Turku University Hospital, PL 52, FIN-2052, Turku, Finland. Taiminen Tero, Portin Raija, Isoniemi Heli, Tenovuo Olli.


Background: The inability to identify and describe feelings is known as alexithymia. Patients with traumatic brain injury often fail to identify and understand emotions. We hypothesized that brain injury may impair processing of emotional information and thus result in alexithymia.
Aims: To evaluate the prevalence of alexithymia after traumatic brain injury.

Method: Fifty-eight subjects (mean age 61 years, 18 female) had received traumatic brain injuries on average 30 years ago. The Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia. Current axis I psychiatric disorders were diagnosed with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1 and axis II disorders with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II).

Results: The mean score of TAS-20 was 53.6 points (56.3 in men, 47.4 in women). Alexithymia was found in 31.0% of the subjects (35.0% of men, 22.2% of women). Its presence was not associated with the severity of traumatic brain injury. The only current psychiatric diagnoses that were associated with alexithymia were organic personality syndrome and SCID-II personality disorders.

Conclusions: The possibility of alexithymia after traumatic brain injury should be kept in mind, as alexithymia affects the way emotional distress is communicated. These patients may be prone to somatization.

P - 43 Thursday 14/8, 14:00-15:00
Life events and onset of a new phase in bipolar affective disorder

Ellen Margrethe Christensen, Chief Psychiatrist, Psychiatric Hospital, Hillerod, Dyrehavevej 48, DK-3400 Hillerod, Denmark. Jens Knud Larsen, Annette Gjerris.


Background: There is an increasing focus on the impact of psychosocial factors on the course of bipolar affective disorder but the research results are conflicting.
Aims: In a prospective study to examine the relationship between life events and affective phases in a group of bipolar patients with a long duration of the disease.

Method: A group of bipolar patients was followed every three months for up to three years. At each examination an evaluation was made according to the Hamilton Depression Scale, the Bech Rafaelsen Mania Rating Scale and the Paykel Life Events Scale.

Results: Fifty-six patients were included. In male examinations the distribution between manic and depressive phases was 13%/5%, in female it was 5%/15%. Women experienced more life events than men. In 21% of women a new phase was preceded by life events against 8% in men. Half of the women depressive phases were preceded by life events, but none of the depressive phases of men. The life events categories presented were mostly somatic ill health and conflicts in the family.

Conclusion: Women had a significantly higher number of depressive episodes than men and men had a higher number of manic episodes than women. A significant number of depressive episodes in women were preceded by negative life events.

P - 44 Thursday 14/8, 14:00-15:00
Finnish normative data and international comparison of Cloninger's temperament dimensions

Jouko Miettunen, NAPE, Researcher, MSc, Dept. of Psychiatry, University of Oulu, PO Box 5000, FIN-90401, Oulu, Finland. Liisa Kantojärvi, Juha Veijola, Marjo-Riitta, Järvelin, Matti Joukamaa.


Background: Cloninger's Tridimensional Personality Questionnaire (TPQ) and Temperament and Character Inventory (TCI) were developed to measure temperament dimensions: novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (P).
Aims: Our aim is to present the first Finnish normative data of Cloninger's temperament dimensions of TCI. We also compare previously presented normative scores and our scores with each other.

Method: As part of the 31-year follow-up survey of the prospective Northern Finland 1966 Birth Cohort Project the TPQ and TCI were filled in by 4349 subjects (1974 males and 2375 females). We combine previous TPQ and TCI studies and compare the temperament dimension scores between 10 countries.

Results: The mean TCI scores for the Finnish sample were 20.3 (NS), 14.1 (HA), 14.7 (RD) and 4.3 (P). The NS scores of the 10 countries were between 16.2 and 20.0 and in HA between 12.6 and 16.7. By far the lowest mean score of the RD was in Japan (8.9); other mean scores were between 13.5 and 16.2. In persistence scores were between 3.7 and 5.6.

Conclusions: Variations in temperament were found between different countries. The Finnish population does not have extreme values in any of the four temperament scales.

P - 45 Thursday 14/8, 14:00-15:00
Rapid increase of intravenous buprenorphine abuse in opiate naïve area

Pekka Laine, Assistant Senior Physician, Oulu University Hospital, Pb 26 FIN 90029 OYS, Finland. Juha Oksanen, Minna Virta.


Oulu district is about 200 000 peoples area in northern Finland. Use of illegal drugs has been similar as in Iceland (Ottar Gudmundsson, personal communication): mostly alcohol abuse, some cannabis and amphetamines, but not marked abuse of opiates. Since France liberated their policy of buprenorphine maintenance therapy during late 90's, many Finnish opiate abusers have carried buprenorphine from France to Finland; both for own use and for sale (Tacke 2002).
We compared clients of open ward clinic for young narcotic abusers in Oulu during 1.1.2001-1.3.2001 (67 patients) with 1.4. 2002-31.5.2002 (124 patients). We found buprenorphine as the most important drug for 4.5% of patients during the first period and for 19.4% (p<0.001, Khi square test) during the second period. Lifetime intravenous abuse increased from 22.7% to 43.8% (p=0.004). HIV was not found among our patients, however, only a minority had been tested (30.3% and 46%). Incidence of hepatitis C increased from 9.1 % to 21.8 % (p<0.001, Khi square test).

Buprenorphine seems to be a drug of high potential for intravenous abuse with all its consequences which may be the reason of its rescheduling by DEA (2002).


P - 46 Thursday 15/8, 14:00-15:00

Effective ECT Practice

Dag Norum, Ridehusgt.20, N-1606 Fredrikstad, Norge

For a long time ECT (Electro-Convulsive Therapy) has for been among the most effective therapies in severe depression. Since the introduction of the modern antidepressants patients who are referred to hospitalisation, may have undergone several adequate antidepressant cures before hospitalisation. A new failing psychopharmacological cure should then prolong their suffering, whereas ECT should shorten their way to recovery.
In order to shorten the course of suffering for the most severe depressed patients, a naturalistic study was carried out between Dec 1st 2002 and April 30th 2003.

All patients meeting the clinic's criteria for introducing ECT, i.e. DSM IV criteria for MDD, or a former well-known positive response to ECT, were scored by MADRS within the first week in hospital. All patients with a MADRS-score of 30 or more were offered ECT within the first week of their stay.

The mean length of hospitalisation was 42 days prior to this programme. Our aim was to shorten the stay by 20%. The mean length of stay was shortened by about 30%. Statistic Process Control was used in the statistical judgement of the results. The programme will continue as a new practice for ECT in our clinic.

P - 47 Friday 15/8, 14:00-15:00

Suicidal behaviour: Interplay of genes and environment

Andrej Marusis, PhD, MD, MRCPsych, MSc, BSc, Institute of Public Health of Republic of Slovenia, Trubarjeva 2, 1000 Ljubljana, Slovenia

Evidence regarding a role for genetic risk factors for suicide comes from epidemiological and populational genetic observations (the so called J-shaped curve from Finland to Slovenia); family, twin and adoption studies; and molecular genetic investigations. The proportion of variance that is attributable to heritability is 43%.
Evidence indeed suggests an important role for the heritability of suicidal behaviour, but how can genetic risk factors increase the probability of suicide behaviour in an individual? As with other complex traits it is reasonable to argue that the liability to commit suicide is contributed to by multiple genetic and environmental factors and only those whose liability at some point exceeds a certain threshold actually manifest as completed suicide. Interactions between these factors occur at several stages in the development of suicide behaviour. Some genetic factors in suicide should be related to impulsivity and aggressiveness, which have their effects independently of, or additively to, a mental disorder.

The proposal that there is a genetic aetiological component to suicidal behaviour does not mean that environmental factors are not also important. If anything, it would make it even more necessary to control these risk factors in populations of high genetic risk. Unless both risk factors are taken into account simultaneously, it is unlikely that any suicide reduction intervention will be effective.

P - 48 Friday 15/8, 14:00-15:00

Transferred to an oral presentation

P - 49 Friday 15/8, 14:00-15:00
Suicidal behaviour in northern Iceland

Brynjólfur Ingvarsson, Psychiatrist, FSA University Hospital, 600 Akureyri


Background: Clinicians at the Akureyri Regional Hospital in Northern Iceland (FSA University Hospital, Akureyri) have noted an increase in suicidal attempts in the region over the last decade.
Aims: To try to get a clear picture of the development of deliberate self-harm in the community during the years 1985-2002 incl. as confirmed in the emergency and intensive care units to plan service needs for the next years if this increase is confirmed and continuing.

Method: Having got the necessary permissions, the Hospital Data Base was asked to deliver all information about registered suicide attempts, self-inflicted injury, and parasuicides according to ICD-9 (1985-1996) and ICD-10 (1997-2002).

Results: There was a more or less annual rise of the total number all the time from 11 (1985) to 66 (2002) in spite of a stable population denominator. Women outnumbered men all the last decade without exceptions. The most frequently used method of self-harm was intoxication with prescription drugs. The most frequently used pharmacological categories were analgetics and psychotropic drugs, X60, X61 and X62 in ICD-10.

Conclusions: Our findings correspond with research in other Nordic countries. The primary aim of this research is to get a clear picture of the development of deliberate self-harm in the community last 18 years is in sight, but the secondary aim, to highlight the most important expected changes in the future remains further away.

P - 50 Friday 15/8, 14:00-15:00
Transferred to an oral presentation

P - 51 Friday 15/8, 14:00-15:00
Suicidal feelings in a population sample of non-demented 70- and 74-year old women in Gothenburg. The Women's Health Study

Sigurður Páll Pálsson, Psychiatrist, Institute of Clinical Neuroscience, Psychiatry Section, Sahlgrenska University Hospital, Göteborg Un, Department of Psychiatry, Sahlgrenska Hospital, S41345 Göteborg, Sweden. Margda Waern, Lena Larsson, Elisabet Tengelin, Sverker Samuelsson , Tore Hällström, Ingmar Skoog.

siggipp@centrum.is; sigpp@landspitali.is

Aim: To study the one-month frequency of suicidal feelings in 70- and 74-year-old women and lifetime self-reported suicidal feelings.

Method: A representative sample of 70- and 74-year-old women (N=483) was examined in 1992. Suicidal feelings were rated according to Paykel and the CPRS. Lifetime suicidality was calculated using information from previous examinations (1981, 1974, and 1968).

Results: The one-month prevalence of any suicidal feeling according to the CPRS (life weariness, death wishes, and suicidality) was 9.3%. Any suicidal feeling, according to Paykel, during the last month was reported by 5.6%. Among mentally healthy women (n=370), the one-month frequency of thoughts that life was not worth living was 1.7%, of death wishes 0.8% and of thoughts of taking life 0.5%. Among subjects with mental disorders (n=113) 15.9% had thoughts that life was not worth living, 4.4% had death wishes, and 1.8% had thoughts of taking life.

Longitudinal analysis: Self-reported total (lifetime) prevalence of any suicidal feeling or behaviour according to the investigations in 1968, 1974, 1981, and 1992 was 34.6 % CI 95 (30.3-39.0). Lifetime prevalence of suicidal thoughts was 14.1 % CI 95 (11.1-17.5). Lifetime prevalence of suicide attempts was 3.3 % CI 95 (1.9-5.3).

Conclusions: Mild suicidal feelings are common in 70- and 74-year-old women with mental disorders but infrequent in the mentally healthy. However, in a lifetime perspective any suicidal tendencies are highly prevalent.

P - 52 Friday 15/8, 14:00-15:00

Anosognosia for memory impairment in Alzheimer's disease and caregiver burden

Kristín Hannesdóttir, PhD, Student, Neuropsychology, Institute of Psychiatry, King's College, University of London, Kjarrvegi 2, 108 Reykjavík, Iceland. Morris RG.
Babinski was the first to describe and give the term of anosognosia to the phenomenon of not being aware of the presence of a neurological impairment. Anosognosia (unawareness) can form an obstacle for rehabilitation, whereas patients may refuse to participate in 'any remedial interventions'. It may also result in poor interaction between patient and caregiver, thus perhaps increasing caregiver burden. Ninety-two Icelandic AD patients are compared with 92 normal controls for this study. Furthermore, 92 informants (caregivers) for the AD patients and 92 informants for the controls take part in this study. Caregiver burden is assessed using two scales, the Greene Scale and the General Health Questionnaire. Three quantitative measures are used to investigate anosognosia: 1) experimenter rating, 2) objective judgement discrepancy between actual and estimated performances, and 3) subjective-rating discrepancy between subject and informant judgements. Caregiver burden is compared between AD caregivers and informants of controls as well as within AD subgroups. Caregiver burden is then correlated with neuropsychological functioning of patients as well as level of insight. Here it is hypothesised that the caregiver burden will correlate with patients' lack of insight as well as lack of judgement regarding driving, but will remain relatively independent of the patient's overall cognitive performance. The results revealed a highly significant difference between the AD caregivers and informants of controls on both measures of burden. The results suggest that anosognosia may play the key role in caregiver burden and patients who lack awareness are found to be more likely to drive a car and consider themselves competent drivers than those patients with good awareness.

P - 53 Friday 15/8, 14:00-15:00
Transferred to an oral presentation

P - 54 Friday 15/8, 14:00-15:00
Transferred to an oral presentation

P - 55 Friday 15/8, 14:00-15:00

Integration of migrants in Danish psychiatric services

Marianne Kastrup, Consulant, Centre Transcultural Psychiatry, Rigshospitalet, 2100 Copenhagen, Denmark


Background: Denmark has had little focus directed towards investigating special needs and demands of psychiatric ill immigrants. Approx. 10% of patients treated in Danish psychiatric institutions have a non-Danish background with large geographical variation. No mental health policy is directed towards immigrants and no special public services provided. Asylum seekers have only access to acute psychiatric care.
Methods: A questionnaire was sent to all Danish psychiatric institutions to assemble information about local services/projects involving immigrants. Based upon this, four regional focus group interviews were carried out with the local liaison officers.

Results: The paper will concentrate on issues of concern related to:
  • Delineation of the population treated at psychiatric institutions
  • Available psychiatric services
  • Staff competence
  • Treatment.
Conclusions: Recommendations for strategies to enhance the cultural competence of psychiatric staff will be outlined.

P - 56 Friday 15/8, 14:00-15:00
Automatic collection and exchange of clinical data: Security issues and a quality assurance application

Roberto Viviani Dr., Department of Psychiatry III, University of Ulm, Leimgrubenweg 12, Germany. Susanne Hammel, Manfred Spitzer.


Background and aims: The electronic collection of medical data has been in the centre of attention after proposals for a nation-wide medical database in Iceland. Exchange of sensitive data via Internet poses even more challenging security problems. It is more important than ever to develop security models that properly address the privacy issues of patients, while reaping the benefits these technologies have to offer.
Method: We report here on a security protocol for the exchange of psychiatric data via Internet, based on the notion of data types. We will argue that this notion is apt to capture the constraints contained in ethical and legislative regulations (for example, the relevant EU Directives). Access rights are set for each data type at two levels: institutions, and individual users (or user groups) within each institution.

Results and conclusions: We present an application for the automated collection of satisfaction with treatment data from psychiatric wards that pool the data in real time in a central research site. We will present our experience on the positive impact of Internet-based information technologies on the way quality assurance may be implemented.

P - 57 Friday 15/8, 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.


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 - 58 Friday 15/8, 14:00-15:00
A study of sheltered care residence for the mentally ill in Reykjavík, Iceland

Kristín G. Jónsdóttir, Chief Social Worker, Landspítali University Hospital, Department of Psychiatry, Hringbraut, 101 Reykjavík, Iceland. Sigurrós Sigurðardóttir, former Chief Social Worker, Bergstaðastræti 48a, 101 Reykjavík, Iceland. Hrafnhildur Reynisdóttir, BA Psychology, Landspítali University Hospital, Department of Psychiatry, Hringbraut, 101 Reykjavík, Iceland

Sheltered residency for the mentally ill has been the focus of significant attention in deinstitutionalisation discussions. Very limited information on the experience is available on sheltered residency in Reykjavík, Iceland, has been available and this report is intended to remedy that lack. The purpose of this study was to collect data on the operation of all 19 sheltered care residences for the mentally ill in Reykjavík. Three homes declined to take part. Residents (N=55) of the homes (N=16) were studied. Data was collected from residents, social workers, and home staff on each resident's functioning, treatment, duration of residence, and frequency of rehospitalization, and on each home's service and environment. The findings were evaluated in terms of adequacy and appropriateness of care provided using accepted guidelines. The results indicate that the homes have a personal and homelike atmosphere that the staff provides emotional support, and that skill-development are provided. The staff has almost exclusive responsibility for formal decisions and in this respect the homes show some characteristics of institutions. Residents expressed a high level of satisfaction and they view the homes as a positive solution, compared to hospitalisation. Residents are much less likely to be admitted to a psychiatric hospital in the three years after moving to a sheltered residence than in the year prior.

P - 59 Friday 15/8, 14:00-15:00

Standardisation of the Resident Assessment Instrument-Mental Health (RAI-MH) in Iceland.

Halldór Kolbeinsson
, MD, Psychiatrist, Landspítali University Hospital, Reykjavík, Dept. of Psychiatry at Kleppur, Iceland. GA Arnþórsdóttir, G Guðmundsdóttir, RÞ Þórsdóttir.


Background: The RAI-MH was created to be a broad screening instrument, which includes series of items covering a range of common problems in mental health.
Aim: The purpose of this research was to translate, validate, and assess the utility of the RAI-MH at psychiatric inpatient wards in Iceland.

Methods: The RAI-MH project began in 1999 with the translation of the assessment instrument. The data was collected after obtaining informed consent at nine psychiatric rehabilitation wards at Landspitali University Hospital. Trained psychiatric nurses performed the assessment. Individuals' items were assessed for inter-rater reliability and the analysis of the reliability was based on weighted kappa coefficients and percentage agreement. All data was analysed with the Statistical Package of the Social Sciences (SPSS)

Results: The study group comprised of 102 patients, 39% females and 61% males. The majority of patients (60%) were over 45 years of age. The main length of stay was over five years, with range of days 7-20 thousand. The main reasons for admission were specific psychiatric symptoms. The most important psychiatric diagnosis according to DSM-IV was schizophrenia, about 50%, affective disorders 22%, and cognitive disorders 17%. Further results will be revealed.

Conclusion: The RAI-MH is a comprehensive standardised instrument for evaluation of psychiatric inpatients. The RAI-MH instrument records important issues related to psychiatric, social, environmental, and medical issues emphasising patients' functioning.

P - 60 Friday 15/8, 14:00-15:00
Occupational therapy in mental health - does it work and for whom?

Sylviane Pétursson, Hallgerður Ásta Guðjónsdóttir, Occupational Therapists, University Hospital, Psychiatry, Psychiatric Unit, Occupational Therapy Department, Reykjavík, Iceland

No systematic studies in mental health have been performed in Iceland that address which clients benefit from occupational therapy. This pilot study was an attempt to explore what clients benefit from occupational therapy and what impact therapy has on the occupational performance of clients that completed therapy. Statistic charts from 2000-2002 were explored and occupational therapy clients categorized. Clients who met minimum attendance standards were contacted and interviewed concerning current occupational performance. Only clients who stated initially that they were motivated to attend OT completed their program. Of those clients who were interviewed the majority had met their personal goals. These clients' vicious circle of admission-discharge-readmission had been broken. Good teamwork is needed to ensure that clients are motivated to attend OT. Neither OTs nor other staff decides if people are ready to take responsibility for their rehabilitation. Clients that completed their program had learned to take more control over their lives. Clients reported increased satisfaction with their daily occupations and satisfaction with life in general. Social services need to offer more diversity and flexibility in their services in order to meet individual needs, as there are great personal differences in the process of recovery.

P - 61 Friday 15/8, 14:00-15:00
Patients' experience and views: Research on social rehabilitation

Sveinbjörg Júlía Svavarsdóttir, Head of Social Work, Department of Psychiatry, Landspítali University Hospital, Hringbraut, 101 Reykjavík, Iceland


Background: Attitudes and expectations of patients to rehabilitation had not been examined recently in psychiatric wards of Landspitali University Hospital in Reykjavik and these may vary from one decade to another as social and health systems continue to change.
Aims: To investigate whether rehabilitation helped to increase patients' possibilities to lead independent lives, with regard to their employment, education, residence, and social relations.

Method: A qualitative interview approach was used in the study.

Results: Patients' expectations of rehabilitation did not accord with the reality of their lives. Many people expected to boost their self-confidence and receive help in expressing their emotions and doing something useful. They wished to increase their education and acquire a home of their own. Due to their anxiety and persistent lack of self-respect and self-confidence, they often had not taken necessary steps towards full independence on their own.

Conclusion: Further work is required to examine why many psychiatric patients have difficulty in regaining their independence in society following their stay in hospital and what can be done to simplify their process of adaptation to life following discharge.

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Social deprivation, ethnicity and incidence of schizophrenia in Nottingham 1997-1999

Jouko Miettunen, Researcher, MSc, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90401 Oulu, Finland. Tim Croudace, Hazel Hayhurst, Peter Jones and the Æsop Study Team.


Background: African-Caribbean people in the United Kingdom have more schizophrenia and other psychoses than the white population. Social deprivation has been associated with an increased risk for psychosis.
Aims: To investigate the roles of social deprivation and proportion of ethnic minorities in neighbourhood in incidence rates of psychoses.

Method: The ÆSOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study collected all incidence cases of psychosis in Nottingham between 1997-99. The population data of electoral wards by ethnicity was collected from the 1991 census. The Multiple Deprivation Index for year 2000 was used as a measurement of deprivation.

Results: Preliminary results showed that annual incidence of psychoses was highest in the most deprived quartile of wards (34 cases per 100000) compared with other areas (22 cases per 100000). No African-Caribbean incidence cases occurred in the least deprived areas. The incidence rate of psychoses among ethnic groups was lowest in areas with more people from those same ethnic groups.

Conclusions: The incidence of schizophrenia and other psychoses is higher in more deprived areas. The proportion of different ethnic groups in an area also has an effect on incidence rates. The interaction of these phenomena will be explored further.

P - 63 Friday 15/8, 14:00-15:00
Measuring patients' experiences of and expectations from mental health services: ARVO-questionnaire

Kaltiala-Heino R, Docent, Chief Psychiatrist, Tampere School of Public Health, 33014 University of Tampere, Finland. Fröjd S, Laurila AM, Kilkku N. Tampere University Hospital, Psychiatric Treatment and Research Unit for Adolescent Intensive Care, and Pirkanmaa Mental Health Project.


Background: CUES-U measures psychiatric patients' experiences of their material, social and service-related well-being and needs in these domains. It comprises 16 descriptions giving a standard of acceptable situation in the selected domains, followed by questions of how the patient's personal circumstances are compared to the description, and is she/he satisfied with her/his own situation. CUES-U can be used either as an aid in a given patient's treatment planning, or to receive a view of the needs of the clients in a given service.
Aims: To test a Finnish version of CUES-U (called ARVO = "value").

Method: 220 psychiatric and substance use clinic patients filled in the ARVO. The patients aged 19-68 years. 35% had a diagnosis of schizophrenia. 38% had received treatment for more than 10 years. 58% were female. Psychometric properties of the scale were calculated.

Results: Patients were well able and motivated to fill in ARVO-questionnaire. The better the patients' situation fitted the normative description in each domain, the more satisfied they were with their own circumstances. Principal component analysis revealed a similar factor structure for the Finnish measure as had previously been found in the English one. Reliability analyses showed a good internal consistency of the scale.

Conclusion: ARVO works as well as the English original version. An advantage compared to traditional satisfaction with services-enquiries is that CUES-U/ARVO gives concrete information on what exactly the patients are (dis)satisfied with.

P - 64 Friday 15/8, 14:00-15:00
Are symptoms of anxiety and depression more prevalent in patients with implantable defibrillators than in those with pacemakers?

Margrét Leósdóttir
1, Sigurðsson E1, Reimarsdóttir G1, Gottskálksson G1, Vigfúsdóttir M1, Torfason B1, Eggertsson S2, Arnar DO1

1Landspítali-University Hospital, Reykjavík, Iceland, 2Department of Anthropology, University of Iceland, Reykjavík, Iceland

Introduction: Indications for Implantable Cardioverter Defibrillators (ICD) have been expanding in recent years but questions remain regarding the mental well-being of these patients. Some studies indicate a poorer quality of life for ICD patients than the general population. However, studies comparing self-rated anxiety and depressive symptoms of ICD patients with that of patients with other implantable cardiac devices are lacking.
Aims: To test the hypothesis that ICD patients are more prone to anxiety and depression than pacemaker patients and are more likely to meet criteria for psychiatric caseness.

Methods: The Beck Anxiety Inventory (BAI),the Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ) were submitted to 41 ICD patients (mean age 62 years) and a comparison group of 61 patients with pacemakers (mean age 64 years).

Results: No difference was found between the ICD and pacemaker groups on BAI, BDI and GHQ scores.

Conclusion: Contrary to our predictions, among ICD patients the propensity to anxiety and depression and their probability of meeting criteria for psychiatric caseness was similar to that of pacemaker recipients.

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