27th Nordic Psychiatric Congress
S - Symposia Sessions X-XIX
S - X / 1 Thursday 14/8, 11:00-12:30
Medical students, environmental stress and mental health
Marie Dahlin, Nils Joneborg, Bo Runeson, Karolinska Institute, Department of Clinical Neuroscience, Section for Psychiatry, St Gorans Hospital, Stockholmnils.joneborg@spo.sll.se
Background: Medical school is conceived as a stressful university education. Several studies have confirmed that medical students often suffer from considerable stress, sometimes due to the load of medical information to be studied, sometimes due to the responsibility connected to their clinical practice. This is a study examining environmental stress and mental health among medical students and the variation over time during the eleven-semester long programme.
Method: A questionnaire was sent by mail to medical students at the Karolinska Institute, in the fall of 2001 in their 1st semester and during the fall 2002, in their 6th and 11th semesters. Response rates were 89%, 97% and 86% respectively. The questionnaire included perceived stress during studies and in other areas of life. Somatic and mental health and personality features prognostic of future ill health were focused as well as misuse/dependence of substances. Comparisons are made possible by questionnaires sent to medical students in the same stages at the Lund University. Comparisons are also made by questionnaires sent to other university students, namely to the education of social workers at the Stockholm University.
Interviews were performed with students on the 1st semester at the Karolinska Institute. We will follow these groups longitudinally.
Conclusion: 62% of first year students rated their studies as stressful. Last year students rated studies stressful in only 14%. There seemed to be several areas contributing to the experience of stress among medical students and these varied over time during the studies. A larger share of female students had applied for professional help. The occurrence of depression, anxiety and substance misuse will be reported as well as comparisons with other university education.
S - X / 2 Thursday 14/8, 11:00-12:30
Subjective weel-being among young Norwegian doctors: A comparative and analytical longitudinal study
Reidar Tyssen, Senior Researcher, Department of Behavioral Sciences in Medicine, University of Oslo, Postbox 1111- Blindern. N-0317 Oslo, Norway reidar.tyssen@basalmed.uio.no
Subjective well being among young Norwegian doctors: a comparative and analytical longitudinal study.
This prospective study aimed to identify: 1) if the level of life-satisfaction among young doctors differ from that in the general population 2) predictors that promote subjective well being among young physicians.
We carried out a longitudinal study of all Norwegian medical students (N=631), which graduated in 1993-94 (T1), response rate 83%, and approached them again in postgraduate year-one (T2), and postgraduate year-four (T3), response rate 63%. The main outcome was an index of subjective well being at T3. Several possible predictor variables were included in the study. When compared with a sample of the general population in the same age and the similar socioeconomic group, the level of life satisfaction was significantly lower among the young doctors, and this applied to both genders. The predictors of subjective well being among the young doctors will be presented at the conference. We will also examine the relative and sequential importance of the predictors in a block-wise multivariate regression model.
S - X / 3 Thursday 14/8, 11:00-12:30
Sex differences in performance and stress among medical students and young doctors
Jan Ole Røvik, Research Fellow, Department of Behavioral Sciences in Medicine, University of Oslo Postbox 1111 - Blindern, N-0317 Oslo, Norway. Tore Gude.j.o.rovik@basalmed.uio.no
Aims: To investigate sex differences in the predictors of performance and medical school/work stress among medical students and young physicians in a longitudinal study.
Methods: We present a prospective study of nationwide cohorts. The first cohort comprises medical students throughout their curriculum, assessed at three time points during medical school (at start, in the middle, and at the end). The other cohort comprised Norwegian physicians that graduated in 1993/1994, they were assessed in the last year of medical school, and at the end of the first postgraduate year, and at their fourth postgraduate year. The main outcome variables were performance and medical school/job stress as medical student/house officer. Predictor variables were age, gender, personality factors, interpersonal problems, coping, expectations of becoming a physician, presumed supportive and stressing conditions at work and life events.
Preliminary results: Female students have higher scores on personality factors like vulnerability, negative coping and perceived medical school stress (although not at the end of the curriculum) and lower scores on problem focused coping and performance (at the end) than male students.
Female physicians tend to be more stressed at work than male physicians as they reach their forth postgraduate year.
S - X / 4 Thursday 14/8, 11:00-12:30
Well-being and work satisfaction among Icelandic hospital doctors
Kristinn Tómasson, MD, Dr. Med., Dept. of Research & Occupational Health, Administration for Occupational Health & Safety, Bíldshöfða 16, 110 Reykjavík, Iceland. Haukur Hjaltason, Ólöf Sigurðardóttir, Þorsteinn Blöndal, Hörður Alfreðsson, Jón Högnason.
kristinn@ver.is
Objective: To study the work environment of medical doctors working at the National University Hospital in Reykjavík with special emphasis on the psychosocial work environment and differences related to positions.
Methods: In collaboration with the medical council of the hospital and the Administration for Occupational Health and Safety a questionnaire was created that was subsequently sent out to 581 physicians working at the hospital. The questionnaire was returned by 78% of the administrating (AP), 58% of regular staff (RSP) and 47% of resident physicians (R).
Results: Too much work pressure was perceived equally by the 3 different groups or about 14%, while 69% of the AP compared with 29% of the RSP, and only 11% of the R. took their work with them home more than 2 a week. Similar percentage in each group perceived that they were receiving support from their supervisors, but the R, and RSP complaint significantly more often about poor flow of information, poor work moral, lack of possibilities to influence the work, and dissatisfaction with the hospital management in general. Satisfaction with work and mental well-being was significantly better among the AP than among the other two groups.
Conclusions: Special effort is needed to improve psychosocial work environment for all physicians, but in particular for regular staff and resident physician.
S - XI / 1 Friday 15/8, 11:00-12:30
Antidepressants and public health
Tómas Zoega, Chief Psychiatrist, National University Hospital of Iceland, Department of Psychiatry, 101 Reykjavík, Iceland. Helgi Tómasson, Tómas Helgason.
tomasz@landspitali.is
Background: Major depressive disorder is the second leading cause of disability adjusted life years in developed regions of the world and antidepressants are the third ranked therapy class worldwide. Antidepressants are also used for anxiety disorders.
Aim: To test the public health impact of the escalating sales of antidepressants.
Methods: Nation-wide data from Iceland are used as an example to study the effect of sales of antidepressants on suicides, disability, hospital admissions and outpatient visits.
Results: Sales of antidepressants increased from 8.4 Daily Defined Doses /1000/day in 1975 to 72.7 in 2000, a user prevalence of 8.7 % for the adult population. Suicide rates fluctuated during 1950-2000, but did not show any definite trend. Rates for outpatient visits increased slightly over the period 1989-2000, admission rates increased even more. Prevalence of disability due to depressive and anxious disorders has not decreased over the last 25 years.
Conclusions: The dramatic increase in the sales of antidepressants has not had any marked impact on the selected public health measures. Obviously, better treatment for depressive disorders is still needed in order to reduce the burden caused by them.
S - XI / 2 Friday 15/8, 11:00-12:30
Epidemiology of antidepressant use in Iceland
Kristinn Tómasson, MD, Dr. Med, Dept. of Research & Occupational Health, Administration for Occupational Health & Safety, Bíldshöfða 16, 110 Reykjavík, Iceland. Tómas Zoëga, Eggert Sigfússon,Tómas Helgason.kristinn@ver.is
Background: Sales of antidepressants have increased almost six fold in Iceland during the last 15 years.
Aim: To study the prevalence of antidepressants' usage, and to compare it with national prescription data.
Material and methods: Data was collected in 2001 by a postal and telephone survey of a random sample of the population aged 18-75 years, 4000 individuals. Anonymous prescription data was obtained from the State Social Security Institute.
Results: The response rate in the survey was 63.6%. The one-year prevalence of antidepressant use was 8.3%, slightly higher for women than men, similar in all age groups. One half of the youngest age group used antidepressants for less than three months. Smokers and people with limited education and low income were most likely to have used antidepressants. People aged 18-75 years filled prescriptions for 95.2 DDD/1000/Day increasing from 45 among the 18-24 year old to 134 among those 65-75 years old. The quantity filled for women was almost twice as much as for men.
Conclusions: Sex difference was smaller in the community survey than according to the prescription data. Prescriptions filled and long-term use increased with age. As expected the use was most common among the socio-economically disadvantaged.
S - XI / 3 Friday 15/8, 11:00-12:30
The antidepressant debate: How to identify patients benefiting from antidepressants is the key question
Ulrik Fredrik Malt, Dept. of Psychosomatic and Neurobehavioural Medicine, Rikshospitalet, University of Oslo, NO-0027 Oslo, Norwayu.f.malt@psykiatri.uio.no
Studies of the efficacy of antidepressants compared to psychotherapy among outpatients often suggest equal effects. However, not all studies support this view. In the largest primary care randomised controlled study until to day NOT applying placebo responder exclusion prior to the study, 372 patients were treated for 24 weeks. All patients received a combination of a simple problem solving and supportive therapy (PSST). In addition, the patients received placebo or active medication (mianserin, sertraline). The overall results favoured the PSST+active drug combination. Interestingly, the difference in effect size between the PSST-active drug combination compared to PSST-placebo combination was largest among MADRS-items reflecting core depressive symptoms, thus supporting a true effect of adding active drug.
However, secondary analyses showed that the severity of the depressive episode and the presence of previous depressive episodes explained the overall results. In patients not having those clinical features, the effect size of PSST the treatment corresponded to the PSST-active drug combination. Furthermore, the effect of PSST and placebo corresponded to the results reported in other studies of cognitive behavioural therapy for depression conducted by clinical psychiatrists or psychologists.
These results strongly indicate that the current debate of the efficacy of antidepressant per se is ridiculous. The key questions is to identify those needing drugs in addition to psychological intervention.
S - XI / 4 Friday 15/8, 11:00-12:30
Are psychotropic medications over-prescribed in children and adolescents? Discussion of recent data
Bertrand Lauth, Child and Adolescent Psychiatrist, National University Hospital, Dept. of Child and Adolescent Psychiatry, Dalbraut 12, 105 Reykjavík, Icelandbertrand@landspitali.is
Background: The growing use of psychotropic drugs in children and adolescents and increasing knowledge in that field represent major progress in child psychiatry, both in the areas of treatment and prevention, especially if medications are used in combination with other treatment methods. But today, in many cases, the clinical use of psychotropic treatments of child and adolescent psychiatric disorders outstrips its demonstrated scientific validity.
Aims: To study prescribing practices and prescription rates in different countries. To raise questions and discuss important practical and theoretical issues in that field.
Method: Use of national statistics, central guidelines and medical articles searched on Medline.
Results: Prescribing practices are very different from one European country to another, from one "school" to another, and from one physician to another. However, today there is a growing consensus that the benefit/ risk ratio of drugs use for non-FDA-approved indications is often preferable to that of currently approved older medications. Moreover, dramatic changes in child psychiatric clinical everyday practices have substantially modified both identity and role of child psychiatrists inside multidisciplinary teams.
Conclusions: Beyond many important practical issues regarding indications and rules of prescription at that age, clinicians have now to think about the role and redefine the part that psychopharmacologic approaches should play among all other treatment methods used for children and adolescents.
S - XII / 1 Friday 15/8, 11:00-12:30
Haplotypes are not found in excess within dysbindin, G72 or DAAO among schizophrenic patients in Iceland
Hreinn Stefánsson1, Engilbert Sigurðsson2, Valgerdur Steinþórsdóttir1, Þórdur Sigmundsson2, Jón Brynjólfsson2, Steinunn Gunnarsdóttir1, Ómar Ívarsson2, Ómar Hjaltason2, Helgi Jónsson2, Vala G. Guðnadóttir1, Andrés Ingason1, Hrönn Harðardóttir2, Jeffrey R. Gulcher1, Einar Guðfinnsson, Hannes Pétursson2, Kári Stefánsson1 hreinn@decode.is
1DeCODE Genetics, Sturlugötu 8, 101 Reykjavík, Iceland. 2Division of Psychiatry, Landspítali University Hospital, Reykjavík, Iceland
Although many genes have been investigated using the candidate gene approach, only a few schizophrenia susceptibility genes have been identified by positional cloning. This involves a genome-wide scan for linkage followed by the fine mapping of a susceptibility locus and subsequent haplotype analysis. Last year three schizophrenia candidate genes were identified with this approach, NRG1, G72 and dysbindin. Interestingly, all three genes are involved in the glutamatergic system. Application of the yeast two-hybrid system has also lead to the identification of molecular partners for some of these genes. This will aid in the search for epistatic interactions to get clearer picture of how each gene might contribute to the disease etiology. In this manner the D-amino acid oxidase (DAAO) was found to interact with G72, and haplotype analysis in both genes suggested a possible epistatic interaction. It is thus possible that variants of both genes confer increased risk of schizophrenia through the same pathway.
Replication studies are underway for all four genes, i.e. NRG1, dysbindin, G72 and DAAO. The NRG1 at-risk haplotype, seven markers, found in excess in Icelandic schizophrenia patients was also found in excess in a large Scottish sample of patients and controls. For the dysbindin gene the initial haplotype described has not been found in significant excess in other schizophrenia cohorts. The follow-up studies have either identified other at-risk haplotypes within the same gene or find no significant association. We have estimated haplotype frequencies within boundaries of dysbindin, G72 and DAAO in Icelandic schizophrenia patients and controls but failed to find significant association.
S - XII / 2 Friday 15/8, 11:00-12:30
Genetics of bipolar disorder: The role of the G72 gene in Iceland
Þorgeir E. Þorgeirsson, Engilbert Sigurðsson2, Andrés Ingason1, Þórdur Sigmundsson2, Jón Brynjólfsson2, Ómar Ívarsson2, Ómar Hjaltason2, Helgi Jónsson2, Vala G. Guðnadóttir1, Hrönn Harðardóttir2, Jeffrey R. Gulcher1, Einar Guðfinnsson, Hreinn Stefánsson1, Hannes Pétursson2, Kári Stefánsson1
1DeCODE Genetics, Sturlugata 8, 101 Reykjavík, Iceland. 2Division of Psychiatry, Landspitali University Hospital, Reykjavík Iceland.
Last year, three schizophrenia candidate genes were identified based on positional cloning, or NRG1, G72, and dysbindin (1-3). D-amino acid oxidase (DAAO) has been found to interact with G72, and genetic analysis suggests epistatic interaction (3). Bipolar disorder (BPD) links to 13q32-33, the region containing the G72 gene (4), and association to BPD has been suggested in or near the G72 gene (5). These findings are independent of the association found for schizophrenia as the results are based on a positional cloning approach, i.e. linkage analysis followed by fine mapping, TDT and haplotype analysis. The reported associations to variants of the same gene for both disorders in independent studies constitute genetic evidence for the widely held belief that schizophrenia and bipolar disorder share a common genetic basis. Although the associated haplotypes are in both cases within the G72 gene, they are not identical for the two disorders. Thus it is possible that the increased susceptibilities to bipolar disorder and schizophrenia are due to different variants of the G72 gene.
As part of our ongoing study of the genetics of bipolar disorder we have estimated haplotype frequencies within boundaries of the G72 gene in Icelandic bipolar patients and controls, and the results of these studies will be reported.
References
-
Stefánsson et al. Am J Hum Genet 2002; 71: 877-92.
-
Straub et al. Am J Hum Genet 2002; 71: 337-48.
-
Chumakov et al. Proc Natl Acad Sci USA 1999; 96: 13675-80.
-
Detera-Wadleigh et al Proc Natl Acad Sci USA 1999; 96: 5604-9.
- Hattori et al. Am J Hum Genet 2003; 72: 1131-40.
S - XII / 3 Friday 15/8, 11:00-12:30
Conditional analyses in a genome-wide scan of bipolar disorder: Evidence for gene-gene interaction
McInnis MG, Associate Professor of Psychiatry, Johns Hopkins University, 600 N Wolfe Street, Baltimore MD, 21287-7381, USA. DePaulo, JR, Nurnberger J, Reich T, Foroud T.mmcinnis@jhmi.edu
In 1989 the NIMH began an extensive collaborative effort to identify susceptibility genes for bipolar (BP) disorder. This collaboration has identified several hundred multiplex BP disorder families and we now describe results of genetic analyses performed in the combined sample of 153 pedigrees. Three hierarchical affection status models were employed in analyses performed with 513 highly polymorphic simple sequence repeat markers distributed throughout the genome. Under the broadest affection status model there were 641 affected subjects creating 909 affected relative pairs. Both parametric and nonparametric genetic analyses were performed. We identified 15 chromosomal regions with nominally significant linkage findings (p<0.05), 11 of which have been previously implicated in independent studies of either bipolar disorder or schizophrenia. The most significant linkage results were on chromosomes 16p13, 20p12, 6q24, 10p12, and 11p15. We performed conditional analyses based on epistasis or heterogeneity for these five loci. There was a significant increase for evidence of linkage at four chromosomal regions under the epistasis model and three under the heterogeneity model of interaction. Conditional on non-linkage to 10p12 there was a significant increase in the linkage on 1p22 and 4q35, a region on 19q13 was identified based on heterogeneity with 11p15. Families linked to 6q24 showed a significant increase in NPLs at 5q11 and 7q21. Epistasis was observed between 20p12 and 13q21, and between 16p13 and 9q21. Application of conditional analyses is potentially useful in larger sample collections to identify susceptibility genes of modest influence that may not be identified in a genome-wide scan aimed to identify single gene effects.
S - XII / 4 Friday 15/8, 11:00-12:30
The brain structural phenotypes of schizophrenia and bipolar disorder
Colm McDonald1, Div. of Psychological Medicine, Box No 63, Institute of Psychiatry, de Crespigny Park, Camberwell, London Se5 8 AF. Ed Bullmore2, Pak Sham1, Xavier Chitnis1, Robin Murray1.
1Division of Psychological Medicine, Institute of Psychiatry, de Crespigny Park, London SE5 8AF, U.K, 2Brain Mapping Unit, University of Cambridge, Department of Psychiatry, Addenbrookes Hospital, Cambridge CB2 2QQ, UK
sphacdm@iop.kcl.ac.uk
There is considerable uncertainty about whether the same genetic aetiology and pathophysiology underlies the major functional psychotic disorders of schizophrenia and bipolar disorder. We explored the structural MRI phenotype of these illnesses using computational morphometry to detect regional grey and white matter volume changes in multiply affected families. MRI scans were obtained from 25 patients with schizophrenia, 36 of their unaffected first-degree relatives, 37 patients with psychotic bipolar 1 disorder and 50 of their unaffected first-degree relatives. A measure of 'genetic loading' was calculated for each subject based on the density of illness within their family and this score was used to predict regional tissue volume in each set of families.
Genetic risk for schizophrenia was associated with distributed grey matter volume deficit in frontal-subcortical and left lateral temporal regions (p=0.004), but for bipolar disorder with deficit only in the right medial frontal lobe and ventral striatum (p=0.004). Increasing genetic liabilities for schizophrenia (p=0.010) and bipolar disorder (p=0.011) were associated with white matter volume deficit, which included overlapping left fronto-temporal regions. Our data indicates that distributed grey matter volume deficit represents a distinctive morphometric phenotype of schizophrenia and that the overlapping impact of susceptibility genes for the major psychoses upon brain structure is expressed as anatomical dysconnectivity in frontal and temporal lobes.
S - XIII / 1 Friday 15/8, 11:00-12:30
DSM-IV disorders, comorbidity and completed suicide after discharge from inpatient psychiatric care
Walby FA, Research Fellow, Suicide Research and Prevention Unit, University of Oslo, Sognsvannsveien 21, building 20, Norway. Ødegaard E, Mehlum L.fredrik.walby@psykiatri.uio.no
Background: Psychiatric disorders are well known risk factors for suicide and the time following discharge from psychiatric inpatient care is an extreme high-risk period. Few, if any, studies have looked at the impact of different disorders and comorbidity in this population using structured diagnostic procedures.
Aims: To investigate whether some psychiatric disorders imply increased risk over others, and whether comorbidity predicts suicide in a sample of discharged inpatients.
Method: A total of 1O8 suicides were compared to matched controls (1:1). Raters were blind to outcome and clinical diagnoses. DSM-IV Axis-I diagnoses were made on the basis of case notes by using the SCID-CV and divided into 6 groups. Axis-II diagnoses were rated as present/absent using the general criteria in DSM-IV. Data were analyzed using conditional logistic regression.
Results: Independent of previous suicidal behaviour, depressive disorders implied increased risk whereas schizophrenia implied reduced risk for suicide after discharge. Neither Axis-I nor Axis-II comorbidity was significant when adjusted for main diagnoses and other factors.
Conclusions: A psychiatric diagnosis of depression or schizophrenia was related to completed suicide in a sample of consecutive discharged patients whereas comorbidity was not.
S - XIII / 2 Friday 15/8, 11:00-12:30
Suicide trends during the period 1981-1997 in patients with affective disorders
Eyd H. Høyer, MD, PhD, National Centre of Register-based Research, University of Aarhus, Tåsingegagde 1, 8000 Aarhus, Denmark. Thomas Larsen, Esben Agerbo, Ping Qin, Merete Nordentoft, Preben B. Mortensen.
ehh@ncrr.dk
Introduction: In the general population in Denmark the risk of suicide has been decreasing since 1980. Patients who have been admitted to a psychiatric hospital or department constitute more than 40% of all suicides in Denmark and the largest single diagnostic group is affective disorder.
Aims: To study if the risk of suicide decreased during the period 1980-1997 among patients with affective disorders.
Method: A nested case-control design was used. Included were all suicides in Denmark during the study period 1981-1997, and all patients with affective disorder who had been admitted to a psychiatric hospital. Each case was matched with 20 controls.
Results: The risk of suicide in patients hospitalised because of affective disorder decreased significantly during the time period from 212 in 1981 to 85 in 1997. The suicide risk declined at higher rate than the suicide risk in persons who had never had contact with the mental health system.
Conclusion: The reduction in the number of suicides in affective disorders could be because of better treatment of depression and of more attention on depression as a treatable disease, and also because of factors shared with the general population such as less access to lethal suicidal means.
S - XIII / 3 Friday 15/8, 11:00-12:30
Relationship between suicidality and comorbid psychiatric disorders
Högni Óskarsson, Psychiatrist, Therapeia, Suðurgata 12, 101 Reykjavík, Iceland. H Kolbeinsson, E Líndal, Þ Þorgeirsson, Gulcher J, K Stefánsson, JG Stefánsson.Aims: To clarify the interrelationship between symptoms of suicidality and comorbid lifetime psychiatric illness.
Method: The original sample was based on a population-wide screening for anxiety and depression in Iceland, followed by diagnostics with the Composite International Diagnostic Interview (CIDI). The four suicide-related items in the CIDI were given a severity rating (Thoughts of Death=1, Wish to Die=2; Suicidal Thoughts=5, Suicide Attempt=10; the first three with a time frame of at least two weeks). Four groups were created, with accumulated suicidal severity of 0 (I), 1-4 (II), 5-9 (III) and 9-18 (IV). The anxiety mean was based on eight lifetime disorders, depression on two, and alcohol/substance abuse/dependence on two disorders.
Results: 2.236 individuals underwent the CIDI; 1.274 with an anxiety disorder, 1.053 with depression, with much overlap. 1.260 scored 1-18 on the suicidality item score; f/m ratio = 2.2:1; 976 scored zero, f/m ratio 1.7:1. There were 976 in group I, 567 in group II, 518 in group III and 166 in group IV. The mean rate of anxiety disorders increased according to suicidal severity from 0.8 to 2.2; that of depressive disorders from 0.3 to 1.1; and that of alcohol/ substance abuse from 0.2 to 0.6. These increases are highly significant (P<0.001) across categories and disorders.
Conclusion: These results show a significant linear relationship between the severity of lifetime morbidity of anxiety, depressive disorders and substance abuse/dependence, and suicide risk.
S - XIII / 4 Friday 15/8, 11:00-12:30
Can suicide rates be reduced by antidepressants?
Göran Isacsson, Associate Professor, Karolinska Institute, Neurotec, Division of Psychiatry, Huddinge University Hospital, S-141 86 Stockholm, SwedenGoran.Isacsson@neurotec.ki.se
Method: Review of evidence and new toxicological data.
Result: Several reports give evidence for that lithium prevents suicide in bipolar patients (1). A long-term study of a cohort in Zurich found that the amount of received antidepressants was the best predictor for not having committed suicide at follow-up (2). It has been shown that only a minority of individuals committing suicide have received adequate antidepressant treatment. Based on epidemiological studies until 1991, it was estimated that treatment with antidepressants reduced suicide rates by 50% in depressed individuals. Less than 1-in-5 of depressed individuals was treated, however, leading to a very subtle reduction of suicide - in Sweden 5% during 1978-1991. It was therefore predicted that a 5-fold increase in the use of antidepressants would lower suicide rates by 25%. Ten years later, the use of antidepressants in Sweden was five times higher than in 1990 and the suicide rate was 31% lower (3). The proportion of suicides found positive for antidepressants in forensic toxicology had increased from 16% to 23%.Conclusion. Although definitive conclusions cannot be drawn, the increased use of antidepressants is the most probable cause of the decrease in suicide.
References
- Tondo L, Isacsson G, Baldessarini RJ. Suicidal behaviour in bipolar disorder. Risk and prevention. CNS Drugs 2003; in press.
- Angst
F, Stassen HH, Clayton P, Angst J. Mortality of patients with mood
disorders: follow-up over 34-38 years. J Affect Disord 2002; 68: 167-81.
- Isacsson G. Suicide prevention--a medical breakthrough? Acta Psychiatr Scand 2000; 102: 113-7.
S - XIII / 5 Friday 15/8, 11:00-12:30
Rational elder suicide - when the clock cannot be turned back
Mira J. Sheerin, 1050 George Street, apt. 8N - New Brunswick, NJ 08901, USA
sheerinmj@aol.com
Background: There is an increasing awareness of elder suicide. Since I am approaching the stage in life when irreversible mental and physical decline cannot be stopped, the thought of achieving a dignified death is increasingly with me.
Aims: Written by a nonprofessional, the paper examines reasons for rational suicide and the importance of physician assistance.
Method: Discussions with peers, reading of studies by physicians and social workers, and, most importantly, personal feelings, are the basis of this paper. Consideration is given to causes of suicide, advance preparations, and the presence of depression which can be treated medically.
Results: Someone aged 65 completes suicide every 90 minutes in the United States and this rate will increase once today's "baby- boomers" reach that age. Although taking one's life is a unique human trait its ethics continue to be debated and physician assistance remains illegal except in The State of Oregon and The Netherlands. Presently the University of Pennsylvania's Center of Bioethics is sponsoring research to find common grounds of understanding.
Conclusions: If the right to life can be advocated for the unborn fetus why not recognize the human right to a "good death" once the end of life's spectrum is reached?
S - XIV / 1 Friday 15/8, 11:00-12:30
What gives hope to schizoprenia sufferers and their relatives?
Opening remarks by Professor Matti Isohanni
S - XIV / 2 Friday 15/8, 11:00-12:30
Outcome in schizophrenia
Raimo KR Salokangas, Professor of Psychiatry, University of Turku, Dept. of Psychiatry, Kiinamyllynkatu 4-8, 20520, Turku, Finland
raimo.k.r.salonkangas@tyks.fi
Results concerning the outcome of schizophrenia depend on several methodological and patient-related factors such as definition of schizophrenia, sampling procedure, instruments used in assessment, patient's treatment compliance, and the natural course of the illness. The outcome of patients with a broad definition of schizophrenia is better than that of the patients with a narrow definition. During the 1900s, the outcome of schizophrenia improved, possibly because of development of treatment methods and decreased stigma. Towards the end of the last century, this favourable development seems to have halted, possibly because of changes in classification of mental disorders and changes in society. It has been suggested that the outcome of schizophrenia is poorer in developed than in developing countries, where emotional support from families is stronger and opportunities to work, despite having disturbances in cognitive performance, is better than in developed countries. Acute onset and affect-loaded symptoms are predictors of a good outcome, while negative symptoms and disturbances in neurocognitive performance predict a poor outcome. Female and married patients usually have a better outcome than male and unmarried patients. Single men generally have an extensively poor outcome.
S - XIV / 3 Friday 15/8, 11:00-12:30
Outcome and its predictors in schizophrenia before 35 years of age within the northern Finland 1966 birth cohort
E Lauronen, Medical Student (Bachelor of Medicine), Dept. of Psychiatry, University of Oulu, PO BOX 5000, FIN-90014, Finland. J Koskinen, J Veijola, J Miettunen, PB Jones, WS Fenton, M Karhu, A Ala-Räisänen, M-R Järvelin, M Isohanni.llaurone@paju.oulu.fi
Background: Although many follow-up studies of schizophrenia have been reported, very few population-based studies have evaluated the outcome of schizophrenia. Only follow-up of an epidemiological population-based cohort can establish the natural history and prognosis of schizophrenia.
Aims: We wished to investigate outcomes of schizophrenia before age 35 years in a longitudinal, population based birth cohort, and to test prognostic value of some historical variables including perinatal risk, gender, age of onset of illness, age of first hospital admission, educational performance, and genetic risk for mental disorder.
Method: We explored 59 DSM-III-R schizophrenia cases in the Northern Finland 1966 Birth Cohort by using registers and interviews with several measures of outcome: social and occupational functioning, positive and negative symptoms, occupational status, psychiatric hospitalizations, and use of neuroleptic medication. Three categories of outcome were used: good, moderate and poor.
Results: Nine (15%) patients had good outcome, 16 (27%) moderate, and 34 (58%) had poor outcome. When compared to good outcome, cases having poor outcome had e.g. earlier age of first psychiatric hospitalization and more often genetic risk.
Conclusions: Too few patients have favourable outcome of schizophrenia in this relatively early onset group. Some predictors for good and poor outcome can be found.
S - XIV / 4 Friday 15/8, 11:00-12:30
Excess comorbidity, somatic morbidity and mortality in psychoses - What can be done in clinical practice?
Koponen HJ, Professor, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014 Oulun yliopisto, Finland. Saari K, Lindeman S, Savolainen MJ, Isohanni M.
hannu.koponen@reimari.net
For some schizophrenia patients the weight gain and disturbances in blood lipid levels and glucose balance are significant disadvantages, and pose health risks that may affect prognosis. Long-term weight gain is the most important risk factor for adult onset diabetes. The metabolic syndrome associated with obesity also involves other significant risk factors for cardiovascular disease. Consequently, weight gain can have a negative effect on the prognosis in a patient on antipsychotic medication. The prognosis is often further adversely affected by other factors prejudicial to health, such as smoking and poor dietary habits. For instance, in patients with schizophrenia, significant excess mortality from cardiovascular disease has been observed. Metabolic changes can also increase risks of neurological adverse effects, because diabetes has been found to be a risk factor for abnormal movements and tardive dyskinesia.
A substantial body of evidence suggest that weight gain it is at least partly related to the blocking effects of antipsychotic medication on serotonin- and histamine-mediated neurotransmission. The disadvantages associated with weight gain can be reduced by an appropriate choice of antipsychotic and avoidance of polypharmacy, by regular monitoring of the patient´s weight, glucose and lipid levels, and, if necessary, by the patient's participation in a dieting programme.
Reference
- Koponen H, Saari K, Savolainen M, Isohanni M. Weight gain and glucose and lipid metabolism disturbances during antipsychotic medication. A review. Eur Arch Psychiatry Clin Neurosci 2002; 252: 294-8.
S - XIV / 5 Friday 15/8, 11:00-12:30
Excess mortality in bipolar and unipolar disorder in Sweden
Urban Ösby, MD, PhD, Senior Consultant, Karolinska Institutet, Berzelius väg 8, SE-171 77 Stockholm, Sweden. Lena Brandt, Nestor Correia, Anders Ekbom, Pär Sparén.
urban.osby@cns.ki.se
Background and Aim: This is the first population-based study of mortality for patients with bipolar and unipolar disorder followed-up from the onset of illness.
Method: All patients with a hospital diagnosis of bipolar (N=15,386) or unipolar (N=39,182) disorder in Sweden from 1973 to 1995 were linked with the cause-of-death register to determine date and cause of death. Standardized mortality ratios (SMRs) and numbers of excess deaths were calculated by 5-year age and calendar time periods.
Results: SMR for suicide was 15.0 for men and 22.4 for women in bipolar disorder, and correspondingly 20.9 and 27.0 in unipolar disorder. For all natural causes of death, SMR was 1.9 for men and 2.1 for women in bipolar disorder, and 1.5 and 1.6 in unipolar disorder. In bipolar disorder, most excess deaths were from natural causes, whereas in unipolar disorder, most excess deaths were from unnatural causes. SMR for suicide was especially high for the younger patients during the first years after the first diagnosis. Increasing SMR for suicide was found for females in unipolar disorder.
Conclusions: Suicide risk was highly increased in both bipolar and unipolar disorder. Still, natural causes of death caused half the excess deaths in bipolar disorder.
S - XV / 1 Friday 15/8, 11:00-12:30
Gender, work, stress and depression
No abstract received
S - XV / 2 Friday 15/8, 11:00-12:30
Gender and PTSD
Marianne Kastrup, Consultant, Centre Transcultural Psychiatry, Rigshospitalet 2100 Copenhagen, Denmarkmarianne.kastrup@rh.dk
Background: There is no indication that men and women have different lifetime prevalence of exposure to traumatic events. But women have a PTSD lifetime prevalence that is twice as high as men and exposed to a given trauma women are four times as likely to develop PTSD and the course of disorder tends to become more chronic.
Results: Findings of gender differences in PTSD among persons exposed to political violence are inconsistent and surprisingly little attention has been paid to gender and refugee status.
Treatment of traumatized women includes consideration of the complexity of the social context in which they live. Women are providers of emotional support, and exposure to disaster may overload the woman's capacity to cope.
Refugee women in a mental health setting often share common traits and may experience dis-empowerment, fear for safety of themselves and their children, and continuous harassment.
In order to empower refugee women the therapist and the patient have to look for common ground and agree on goals for treatment in recognition of cultural incongruities.
Conclusion: The paper will outline ways to optimize the fulfillment of refugee women's need for treatment with a particular focus on the rights of these women.
S - XV / 3 Friday 15/8, 11:00-12:30
The psychiatrist's role in a profession with an increasing number of female psychiatrists
Karin Garde, Psychiatrist, Boserupvej 2, 4000 Roskilde, Denmark karin.garde@shh.hosp.dkBackground: During the last decades an increase in the female proportion of medical students has resulted in a growing proportion of female psychiatrists (35% of specialists in psychiatry in Denmark are female).
Aims: In which ways does this change influence the working conditions, the clinical performance and decision-making, the choice of subspecialty and the prestige of the profession?
Method: Study of the (scarce) available literature.
Results: Male and female doctors and psychiatrists differ in a number of ways, for instance the working conditions for female psychiatrists being stressed by double responsibility (family/profession) and differing expectations from staff. Research areas differ, male psychiatrists being more involved in biological research, female psychiatrists in psychosocial research. The prestige of the psychiatric profession is traditionally linked to the biological research areas, much less to the psychosocial areas.
Conclusions: There are remarkable gender differences among male and female psychiatrists concerning their working conditions, clinical performance, and choice of areas of interest. The prestige of the profession is traditionally linked to the choice of special areas of interests.
S - XV / 4 Friday 15/8, 11:00-12:30
Social and psychopathological aspects of gender differences in first episode psychotic patients
Anne Thorup, MD, PhD Student, OPUS-projektet, Bispebjerg Hospital, C F Richs Vej 23, 2000 Frederiksberg, Denmark. Lone Petersen, Johan Øhlenschlæger, Merete Nordentoft, Pia Jeppesen, Per Jørgensen, Maj-Britt Abel.atv@dadlnet.dk
Objective: A two-site randomised controlled trial of intensive psychosocial treatment with first episode psychotic patients, 18-45 years old with diagnoses of schizophrenia, delusional disorder, and other paranoiac states, is conducted in Copenhagen and Aarhus, Denmark.
Method: The treatment consists of assertive community treatment, psycho-educational treatment in McFarlanes multifamily groups and social skills training. Inclusion was from 1st of February 1998 to 31st of December 2000, 547 patients were included. Patients were assessed comprehensively at baseline and at 12-month follow-up with SCAN interview, SAPS, SANS and other validated instruments.
Results and conclusion: Results show that women at baseline have fewer or less severe negative symptoms than men but more positive symptoms. Age of onset is surprisingly the same for both male and female, as the DUP (Duration of Untreated Psychosis) was. Male patients have more social problems than female patients concerning having a job, getting an education or a partner. A larger proportion of the men have some kind of harm- and dependency diagnosis. Since gender differences are marked in first episode psychotic patients more focus may lead to better understanding of the schizophrenic syndrome.
S - XVI / 1 Friday 15/8, 11:00-12:30
Cognitive decline is associated with reduced white matter in schizophrenia
MacCabe JH, BSc, MB, BS, MRCPsych, Clinical Researcher, Division of Psychological Medicine, Institute of Psychiatry, PO63, Institute of Psychiatry, de Crespigny Park, London, SE5 8AF. Rossell SL, Chitnis XA, David AS, Murray RM.
j.maccabe@iop.kcl.ac.uk
Background: There is growing evidence that some schizophrenia patients decline in IQ over time. We hypothesised that such decline may have a neural substrate, and consequent neuroanatomical correlates.
Aims: To use voxel-based morphometry (VBM) of MR images to investigate neuroanatomical correlates of current IQ and IQ decline in schizophrenia.
Methods: 72 patients with DSM-IV schizophrenia and 32 age, gender, handedness and IQ matched healthy controls underwent neuropsychological testing (National Adult Reading Test (NART), 4 subtests of Weschler Adult Intelligence Scale, Revised (WAIS-R)) and VBM using S-BAMM. IQ decline was estimated by subtracting NART IQ from WAIS-R full-scale IQ.
Results: Patients had significantly greater IQ decline than controls (18.7 vs. 6.0, p<0.00005), smaller total brain volume (1235 vs 1300cc, p<0.005) and smaller total white matter volume (506 vs. 544 cc, p<0.05). There was no difference in grey matter and CSF volumes. IQ decline was not related to age, chronicity, age at onset, education or length of unemployment, but it was related to symptom scores.
In patients, there was a negative correlation between IQ decline and total white matter volume (patients: r =-0.26, p<0.05; controls: r=0.00, p=N.S.). Voxel-based analysis demonstrated that this correlation was marked in three clusters: one in the left frontal and parietal lobe, a second in the left temporal lobe, and a smaller cluster in the right temporal lobe.
Conclusions: Cognitive decline in schizophrenia may be mediated by reduced white matter in left frontal and bilateral temporal lobes.
S - XVI / 2 Friday 15/8, 11:00-12:30
The neuropsychology of anosognosia for memory impairment in Alzheimer's disease
Kristín Hannesdóttir, PhD Student, Neuropsychology, Institute of Psychiatry, King's College, University of London, Kjarrvegi 2, 108 Reykjavík, Iceland. Morris RG.
Anosognosia or 'lack of insight' is a phenomenon frequently noticed in Alzheimer's disease (AD). Although documented in early clinical observations and often considered a hallmark for the illness, research remains scare and the condition poorly understood. There are both theoretical and clinical importance of studying insight. Theoretically, it makes us wonder about the mechanism that normally allows people to be aware of their own cognitive functioning. Clinically speaking, impaired insight may form an obstacle for rehabilitation, whereas patients may refuse to participate in 'any remedial interventions'. It can 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. The age of subjects ranges from 65 - 85 years. The research is conducted from a neuropsychological profile approach and by using a thorough neuropsychological test battery, provides information about memory, executive functioning, anosognosia, language, and visuospatial perception. 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. It is hypothesised that the level of insight correlates with executive and visuospatial functioning but is relatively independent of degree of memory impairment. Insight levels are compared between AD patients and controls as well as correlated with each neuropsychological test. The results revealed a highly significant difference between the AD patients and controls on all measures of insight. Moreover, the results indicate an association between the Rey Complex Figure Copy, the Organizational aspect of the Rey Figure Complex copy, the DEX questionnaire, Fluency Letter and insight.
S - XVI / 3 Friday 15/8, 11:00-12:30
The prevalence of frontal variant frontotemporal dementia and the frontal lobe syndrome in a population-based sample of 85-year-olds
Þorsteinn B. Gíslason, MD, Psychiatrist, Psychiatric Department, University Hospital of Iceland, 101 Reykjavík, Iceland. Magnus Sjögren, MD, PhD, Lena Larsson, MD, Ingmar Skoog, MD, PhD.thorstgi@landspitali.is
Objectives: To investigate the prevalence of the frontal lobe syndrome (FLS) and the frontal variant of frontotemporal dementia (fvFTD) in a population-based sample of 85-year-olds.
Methods: A representative sample of 451 85-year-olds in Gothenburg, Sweden was examined with a neuropsychiatric examination and a key informant interview performed by an experienced psychiatrist. A subsample underwent a computerised tomography (CT) of the head. The Lund-Manchester research criteria were used as a basis for a symptom algorithm to identify individuals with FLS and fvFTD. These were diagnosed blindly to the diagnosis of dementia according to DSM-III-R.
Results: We found that 86 individuals (19%) fulfilled the criteria for FLS, and 14 of them (3% of the population) fulfilled criteria for fvFTD. There were no differences between men and women. Among those with FLS, 75 (87%) fulfilled DSM-III-R criteria for other types of dementia, mainly Alzheimer's disease and vascular dementia. Among the 14 fvFTD cases, only 5 were demented according to DSM-III-R. Moderate-severe frontal atrophy was found in 93% of those with FLS (and in all cases with fvFTD), but also in 49% of those without FLS. FLS was found in 35% of those with moderate-severe frontal atrophy, and in 3% of those without these changes.
Conclusions: The prevalence of fvFTD was 3% in 85-year-olds, which is higher than previously expected in this age group. Only a minority of those with fvFTD were detected by the DSM-III-R criteria for dementia. FLS was even more common, especially in those diagnosed with a dementia disorder.
S - XVI / 4 Friday 15/8, 11:00-12:30
Update on clinical characteristics and neurochemistry of frontotemporal dementia
Sjögren M, Associate Professor, Institute of Clinical Neuroscience, SE413 45 Göteborg, Swedenmagnus.sjogren@medfak.gu.se
Background: Research on frontotemporal dementia (FTD) is in an active and developing stage. During the last few years, several disorders have been recognised as being part of the FTD-spectrum. For example, semantic dementia and progressive non-fluent aphasia as well as corticobasal degeneration and progressive supranuclear palsy, are now recognised as FTD-disorders. The characteristics of FTD, e.g. personality change and loss of empathy, are in focus of modern neurobiological as well as neuropsychological research. For example, loss of empathy has been explored in the realms of theory of mind. Several studies have shown that FTD-disorders are difficult to identify early in the course of the disease. In this respect diagnostic markers are needed and some have been suggested, e.g. cerebrospinal fluid markers such as tau, phosphotau and neurofilament protein that improves the accuracy of the clinical diagnosis of FTD. Furthermore, much research on the pathophysiology of these disorders have recently been published, the most reckoned is the identification of tau-gene mutations in hereditary FTD (FTDP-17). The presentation will focus on nosology, some recent clinical and neurochemical findings, and relate these to putative pathophysiological mechanisms of FTD.
S - XVI / 5 Friday 15/8, 11:00-12:30
Cognitive function in restless legs syndrome
Hjördís B. Tryggvadóttir, Sleep Laboratory, Dept. of Psychiatry, Landspítali-University Hospital, Hringbraut, 101 Reykjavík, MK Jónsdóttir, K Kristjánsson, D Rye, T Sigmundsson. Background: Restless Legs Syndrome (RLS) is a common and clinically significant sensorymotor disorder which is often either misdiagnosed or underdiagnosed. Its pathophysiology remains unknown but is believed to involve central dopaminergic dysfunction. Patients with other motor syndromes linked to dopamine dysregulation including Parkinson´s disease, Tourette syndrome and attention deficit hyperactivity disorder (ADHD) show deficits on tests of attention and executive functioning.
We compared RLS patients to healthy volunteers on tests assessing these areas of cognitive functions. To our knowledge this is the first neuropsychological study of RLS.
Method: Nineteen patients (16 drug naïve) and 18 controls matched on age, sex and occupation underwent neuropsychological testing which focused on planning, selective and sustained attention, flexibility of attention, spatial working memory, verbal fluency, and reaction time. In addition, matrix reasoning and similarities from the WAIS-III were administered.
Results and discussion: The RLS patients performed significantly worse than the healthy controls on tests of verbal fluency, reaction time and sustained and selective attention. There was also a trend towards worse performance on other tests of executive functioning. These results are consistent with the hypothesis that the pathophysiology of RLS involves the dopamine system. This study awaits replication with a larger sample of patients.
S - XVII / 1 Friday 15/8, 11:00-12:30
Prevalence of autism spectrum disorders in Iceland
Páll Magnússon, Dept. of Child and Adolescent Psychiatry, National University Hospital, Reykjavík, Iceland. Evald Sæmundsen, State Diagnostic and Counselling Center Kópavogur, Iceland
pama@landspitali.is
Background: Previous knowledge of the prevalence of autism in Iceland stems from two studies evaluating the rate of autism in three birth cohorts; individuals born in the periods 1964-1973, 1974-1983, and 1984-1993. The results showed an increased rate of autism in the youngest cohort.
Aims: The objective of the present study is to evaluate the prevalence of autism spectrum disorders in a new cohort, i.e., children born in the five-year period 1994-1998.
Method: The data were collected from the records of the State Diagnostic and Counselling Center, a tertiary service charged with the surveillance of serious neuro-developmental disorders in the whole country. Diagnosis was based on the results of the Autism Diagnostic Interview-Revised, the Autism Diagnostic Observation Schedule, and/or the Childhood Autism Rating Scale, and a consensus of an interdisciplinary team of clinicians. All the children were tested for cognitive development.
Results: The results are presented in terms of ICD-10 diagnoses, as well as age, gender, and cognitive level.
Conclusion: The rates found in the age groups studied parallel recent findings in population-based studies.
S - XVII / 2 Friday 15/8, 11:00-12:30
The Autism Diagnostic Interview-Revised and the Childhood Autism Rating Scale: Convergence and discrepancy in Diagnosing Autism
Evald Sæmundsen, Psychologist, State Diagnostic and Counseling Center, Digranesvegur 5, 200 Kópavogur, Iceland. P Magnússon, J Smári, S Sigurðardóttir evald@greining.is
The agreement between the Autism Diagnostic Interview-Revised (ADI-R) and the Childhood Autism Rating Scale (CARS) was investigated in the diagnostic assessment of 54 children referred for possible autism. The sources of information for the ADI-R and the CARS were totally separate and raters using the instruments were blind to each other's results. Significant correlations were found between the total score on the CARS and the three ADI-R domain scores, supporting concurrent validity of the two instruments. Observed agreement between the two systems was 66.7% (kappa = .40) when the ADI-R definition for autism was applied (i.e., scores reaching cutoff in three domains on the ADI-R) but increased considerably (83.3%; kappa = .66) with less stringent criteria (scores reaching cutoff in two domains on the ADI-R). Almost perfect agreement (kappa = .87) was found when criteria were still less stringent (scores reaching cut-off in one domain on the ADI-R). Children classified as autistic according to both instruments had significantly lower IQ/DQ and more severe autistic symptomatology than those classified with the CARS only. The results of this study indicate that the CARS represents a broader diagnostic concept of autism than the ADI-R.
S - XVII / 3 Friday 15/8, 11:00-12:30
Follow-up of children diagnosed with pervasive developmental disorders according to ICD-10: Stability and change during the preschool years
Sigríður Lóa Jónsdóttir, Psychologist, The State Diagnostic and Counseling Center, Digranesvegur 5, Kópavogur, Iceland. Sæmundsen E, Hjartardóttir S, Ásgeirsdóttir BB, Smáradóttir HH, Sigurðardóttir S.
sigridurloa@greining.is
There are two important interacting variables present in all outcome studies on autism that hinder any firm conclusions when comparing results over time. First, is the constant development of services that strive to improve the likelihood that individuals with autism become integrated into the mainstream society. Second, is the increased knowledge in the field of autism that is partly reflected in revisions of definitions of autism, classification schemes, and changing epidemiology of autism, which is no longer considered a rare disorder. Hence, it is of importance to gather consistently new data on outcome in autism. The present study purports to address this issue in assessing the stability and change in children with autism and related disorders during the preschool years. Participants were Icelandic children in four age cohorts, who were diagnosed with pervasive developmental disorders according to ICD-10 during the preschool period (Time 1) and evaluated again before school start around 6 years of age (Time 2). Forty-eight children met intake criteria. Preliminary outcome data will be presented on behavioural characteristics of autism, classification, adaptive behaviour, cognitive and language development, as well as associated medical conditions.
S - XVII / 4 Friday 15/8, 11:00-12:30
Prevalence of autistic symptoms among children diagnosed with ADHD: A comparison between five clinical groups
Urður Njarðvík, PhD, Dept. of Child and Adolescent Psychiatry, Landspítali University Hospital, Dalbraut 12, 105 Reykjavík, Iceland. Guðmundur Arnkelsson, Páll Magnússon, María Guðsteinsdóttir.urdurnja@landspitali.is
Background: Recent studies suggest an overlap in symptoms between ADHD and pervasive developmental disorders (Gillberg, 1991; Clarke et al. 1999) but do not include other clinical groups for comparison.
Aims: The aim of the study was to explore the relationship between ADHD and pervasive developmental disorders by comparing the prevalence of autistic symptoms in ADHD and mood/anxiety disorders.
Method: Parents of 84 children filled out the Autism Spectrum Screening Questionnaire (ASSQ) and the Strengths and Difficulties Questionnaire (SDQ). Of the 84 children, 37 were diagnosed with ADHD, 14 with Autistic Disorder, 14 with PDD-NOS, 7 with Asperger's Syndrome, and 12 with mood and/or anxiety disorders.
Results: Children diagnosed with ADHD showed higher frequency of autistic symptoms, as measured on the ASSQ, than children diagnosed with mood and anxiety disorders. ADHD and Autistic Disorder could not be differentiated by the ASSQ, but appeared as a distinct group when SDQ was added to the equation.
Conclusion: The results indicate a high frequency of severe social skills deficits in ADHD and a considerable overlap in symptoms with pervasive developmental disorders. With these two distinct but related diagnostic categories, a routine screening for autistic symptoms among children being evaluated for ADHD should be considered.
S - XVII / 5 Friday 15/8, 11:00-12:30
"What is it like": The experience of mothers of children with autism
Sólveig Guðlaugsdóttir, psychiatric nurse and family therapist, Dept. of Child and Adolescent Psychiatry, Dalbraut 12, 104 Reykjavík, Icelandsolveigg@landspitali.is
The purpose of this study was to explore the experience of mothers of autistic children and gain new perspective of how parents and professionals work together.
The methodology used was hermeneutic phenomenology.
Data consisted of transcripts from in-dept interviews with ten Icelandic mothers of children with autism. Themes of the transcribed interviews were grouped into five categories.
The findings revealed that the participants experienced themselves as being alone in the period of the discovery of the child's handicap. Even though the participants saw their role as caretakers for their child as a never-ending responsibility they all saw the importance of taking care of themselves as well. The participant´s experience of cronic sorrow, anger and empowerment is consistent with research literature. Outstanding in this study was the participants' descriptions of how their love for their child was rewarded in the way they learned and grew through the experience of having a special child. The participants use of humour became evident and was an important and spontaneous part in the dialogues with the researcher. The participants experienced a difference in how themselves and the fathers' felt and responded towards their autistic children. Based on the findings it was concluded that professionals working in the autism sector need to be more caring and respectful toward parents.
S - XVIII / 1 Friday 15/8, 11:00-12:30
Language impairment (LI) in children with attention-deficit/hyperactivity disorder (ADHD)
soljonsd@landspitali.is
Background: A high percentage of children referred to child psychiatry clinics reach critera for language impairment (LI). The most frequent psychiatric diagnosis among children with LI is ADHD. Children with psychiatric problems are seldom routinely screened for LI even though most therapies are language based. This study examined the ability of the Kaufman Assessment Battery for Children (K-ABC) to differentiate between Icelandic ADHD children with and without LI.
Methods: Out of a sample of 127 children aged 6 to 12 years old who had been referred for neuropsychological assessment, children diagnosed with ADHD were selected. Those children who scored 1 _ standard deviation below the mean on a measure of language development standardized on Icelandic children were compared to children with normally developed language on the K-ABC.
Results: ADHD children with LI have similar nonverbal intelligence and similar simultaneous processing ability as ADHD children without LI. ADHD children with LI score significantly lower on sequential processing skills and on subtests measuring verbal working memory.
Conclusion: Even though the K-ABC has not been standardized on Icelandic children, those with LI show up with distinctive neuropsychological deficits on it. It is concluded that the K-ABC can be confidently used to screen for language disorders in Icelandic ADHD children referred for psychiatric services.
S - XVIII / 2 Friday 15/8, 11.00-12:30
Effects of transcutaneous electrical nerve stimulation (TENS) on the rest-activity rhythm in children with attention-deficit hyperactivity disorder
Sólveig Jónsdóttir, Clinical Child Psychologist, Landspítali-háskólasjúkrahús, Dept. of Child and Adolescent Psychiatry, Dalbraut 12, 105 Reykjavík, Iceland. Erik JA. Scherder, Anke Bouma, Joseph A. Sergeant.soljonsd@landspitali.is
Background: Attention-deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder of childhood. It is characterized by inattention, impulsiveness, and excessive motor activity. Sleep disorders are a common comorbidity and research has shown that children with ADHD are more motorically active in their sleep than other children and that their sleep-wake schedule is more unstable. Previous studies have shown that transcutaneous electrical nerve stimulation (TENS) has a beneficial effect on the rest-activity rhythm in patients with Alzheimer's disease.
Aims: The main objective of this pilot study was to examine whether TENS treatment could improve the rest-activity rhythm in children with ADHD.
Method: Fourteen boys with ADHD, aged 7 to 14 received TENS treatment for 30 minutes, two times daily, for 6 weeks. Burst-TENS stimulus was applied through two electrodes placed at the back of the neck. Motor activity was measured before and after treatment with actigraphy.
Results: Nightly restlessness decreased significantly (Z=2.06, p<0.02) Motor activity during the day did not decrease.
Conclusions: TENS treatment of boys with ADHD had a similar effect on nightly restlessness as previously shown in studies on Alzheimer's disease. It is hypothesized that TENS treatment might be having a regulatory effect on the suprachiasmatic nucleus through direct spino-hypothalamic pathways. Results warrant more rigorous studies.
S - XVIII / 3 Friday 15/8, 11:00-12:30
Children with ADHD: How parents experience the support they get from different institution
Oktavia Guðmundsdóttir, Social Worker, Landspítali University Hospital, Dalbraut 12, 105 Reykjavík, Iceland
oktavia@landspitali.is
Background: The subjects in the study were 12 parents in Sweden with ADHD-diagnosed children. The study is a part of the requirements for a master's degree in social work. The purpose was to improve knowledge of the problem and to gain understanding of the parents' view.
Aim: The aim of the study was to examine how parents of children with ADHD experience the treatment and support that the child and its family get from society, for example from child psychiatrists, social health care services, schools etc.
Method: The study is qualitative and was based on in-depth interviews with parents of ten children who have ADHD. A tape recorder was used and all answers written out in full. Each interview was an hour long.
Result: The results showed that specially trained teachers and small classes are very important. In this environment the interaction with the child and the parents seems to be significantly improved. Medical treatment as well as assistance for parents from specialists is also very important.
Conclusion: My conclusion was that early diagnosis, medical treatment, and an informed social response to the special needs of these children are central to the development of an ADHD child.
S - XVIII / 4 Friday 15/8, 11:00-12:30
Possible aetiological factors in pregnancy, delivery, and the perinatal period for Icelandic children with ADHD
Margrét Valdimarsdóttir, Physician, Landspítali University Hospital, Dept. of Child and Adolescent Psychiatry, Meðalholti 4, 105 Reykjavík. Agnes Huld Hrafnsdóttir, Ólafur Ó. Guðmundsson, Páll Magnússon.
margval@lsh.is
Background: ADHD is a well known psychiatric disorder that begins in childhood and can extend into adulthood. In the last decade numerous studies have shown the importance of genetic factors in the etiology in ADHD. However, other etiological factors seem to be involved, and ADHD my in fact be a cluster of different disorders rather than one homogenous entity.
Aims: To examine the frequency of some possible etiological factors for ADHD in Icelandic children with ADHD.
Method: The participants were 225 children referred to the outpatient unit of the Dept. of Child and Adolescent Psychiatry of the Landspitali University Hospital during a 2 year period. Information that the parents had provided in a questionnaire concerning pregnancy and the perinatal period was retrospectically analysed.
Results: Preliminary results show an increase in several factors such as low birthweight, young age of the mother at time of birth of child, and smoking during pregnancy for the ADHD children compared to estimated mean values in the community.
Conclusions: This study shows, as research from other countries has suggested, that there is an association between a number of factors in pregnancy, delivery, perinatal period, and ADHD, even though there still is not enough evidence to confirm definite etiological factors.
S - XIX / 1 Friday 15/8, 11:00-12:30
Why this topic?
Opening remarks by Tytti SolantausS - XIX / 2 Friday 15/8, 11:00-12:30
Preventive intervention aimed at mentally ill mothers and their children with focus on early childhood
Lene Lier, Child & Adolescent Psychiatrist, Cognitive Research Unit, Hvidovre Hospital, Psychiatric Department, Copenhagen, DenmarkLittle is known concerning the epidemiology of mentally ill parents. How many are they? How old are their children at the debute of parental mental illness? Which are the risks during the child's development? Knowledge of these and many other issues would be helpful when planning preventive intervention towards this well-known high-risk population.
During the last 20 years I have been involved in four projects concerning mentally ill mothers and their children. 1) An epidemiological study on admissions to psychiatric institutions +/- two years from childbirth and perinatal outcome for mother and child 2) A preventive intervention program aimed at mentally ill mothers and their 0-3 year old infants 3) A qualitative investigation on problems and needs experienced by parents with major psychiatric illness and their children and 4) The Copenhagen Infant Follow-up Study (CIFS): an ongoing follow-up study of mothers and children (now 13-15 years old) from project 2.
The paper will discuss: Which are the possibilities of preventive intervention? Is it possible in infancy to identify early developmental trajectories related to/predictive of later difficulties?
S - XIX / 3 Friday 15/8, 11:00-12:30
Children of mentally ill immigrants
Marianne Kastrup, Consultant, Centre Transcultural Psychiatry, Rigshospitalet, 2100 Copenhagen, Denmark
marianne.kastrup@rh.dk
Background: Immigrant families compared to Danish comprise more children. This is also the case among families with a mentally ill parent. Children from ethnic minorities growing up with a psychiatric ill parent have received less attention and support compared to Danish children.
Mentally ill immigrant parents may have a different threshold to seek professional help due to different concept of mental illness, stigma and taboo related to mental illness, and lack of knowledge about available services.
Results: Refugee families may be particularly traumatized with a risk that the traumatized individual may suffer from PTSD. This implies that the person may e.g. exhibit mistrust and have a lowered threshold with respect to irritability and outburst of aggressive behaviour. Such behaviour may be directed towards the children and traumatized families may be reluctant to seek help and support, fearing that any focus upon the family may lead to social interventions and in the worst case removal of the child.
There is a tendency that health and other services see a preponderance of refugee males but less attention is paid to females who may tend to become invisible and isolated.
Children from such families show many symptoms reflecting their dysfunction. They may act as small adults in the home, be socially isolated, lack stimulation, and be told to remain silent regarding the severity of the family problems.
Conclusion: The paper will focus upon ways to strengthen the preventive aspects and interventions towards these children.
S - XIX / 4 Friday 15/8, 11:00-12:30
Helping preschool and school aged children: The Beardslee Family Intervention
Tytti Solantaus, Doctor, The Research and Development Centre for Welfare and Health, POB 220, 00531 Helsinki, FinlandTytti.Solantaus@stakes.fi
An initiative has been taken on a national level in Finland (the Ministry of Social Affairs and Health and STAKES) to ensure that the needs of the children of the mentally ill will be met. A special project (the Efficient Family) was set up to develop means to work with these families as part of their psychiatric services. The core of the work is the prevention of children's disorders and it includes implementing the Beardslee Preventive Family Intervention.
Although parental mental illness is a risk for children, not all children succumb to psychopathology. These resilient children are known to have an understanding of their parents' problems and to have abilities to keep up with their own social relationships and activities outside the family. The Preventive Family Intervention developed by Prof. Beardslee in the US is designed to foster these protective qualities in children and in their families. The intervention includes separate sessions with parents and children and a joint family meeting (approximately 6-8 sessions). The Family Intervention has been studied in a randomized design with good results in American families.