27th Nordic Psychiatric Congress

S - Symposia Sessions I-IX

S - I / 1 Thursday 14/8, 11:00-12:30
The dexamethasone suppression test and CSF-5-HIAA in relation to suicidality and depression in suicide attempters


Åsa Westrin, MD, PhD, Anders Niméus MD, PhD, Dept. of Clinical Neuroscience, Division of Psychiatry, Lund University, Lund, Sweden

anders.nimeus@psykiatr.lu.se

This study tested suicidality in relation to cerebrospinal fluid (CSF), 5-hydroxyindoleacetic acid (5-HIAA), and the dexamethasone suppression test. Patients with nonsuppression of cortisol had the highest scores of the Suicide Assessment Scale (SUAS) and the Montgomery Asberg Depression Rating Scale, respectively (p<0.05;p<0.01). The results persisted when analysed for covariance with CSF-5-HIAA. We have previously noted an elevated suicide risk in suicide attempters with high SUAS scores, why a large part of nonsuppressors may be at high risk for future suicide.



S - I / 2 Thursday 14/8, 11:00-12:30
Whole brain serotonin- and dopaminetransporters in suicide attempters and controls

L Träskman-Bendz, Professor, Division of Psychiatry, Dept. of Clinical Neuroscience, University Hospital, SE-221 85 Lund, Sweden. M. Lindström, E.Ryding, P Bosson, J-A Ahnlide, I Rosén.

lil.traskman_bendz@psykiatr.lu.se

Background: Serious (violent) suicidal behaviour has repeatedly been associated with Dysregulation of serotonin and/or dopamine.

Aim: We wanted to further examine the role of these monoamines by studying the transporters of serotonin (5HTT) and dopamine (DAT) in vivo.

Material and methods: Twelve drug-free suicide attempters with high suicidal intent were compared with matched healthy controls. The cocaine analogue 127 I ß-CIT was used as ligand for SPECT-recordings and was combined with administration of citalopram. Several regions of interest (ROI:s) were examined. We report on findings from whole brain. The patients filled in the Marke Myman Temperament (MNT).

Results: Among patients there was a significant correlation between DAT and 5HTT. We found no significant differences between patients and controls. There were trends of lower 5HTT in depressed individuals. The most remarkable finding was a significant correlation between 5HTT and impulsivity (solidity) in suicide attempters, but not controls.

Conclusions: Our findings on impulsivity are intriguing. Whole brain 5HTT or DAT seem to be of little importance explaining suicidal behaviour. Studies on well defined ROI:s are pending.



S - I / 3 Thursday 14/8, 11:00-12.30
Familiality of suicides in Iceland

Högni Óskarsson, Psychiatrist, Therapeia, Suðurgötu 12, 101 Reykjavík, Iceland. Lilja Sigrún Jónsdóttir, Sverrir Þorvaldsson, Sigurður Páll Pálsson, Kári Stefánsson

Aims: To assess familial transmission of suicides in Iceland.

Methods: All death certificates of persons known to have committed suicide in Iceland between 1911 and 2000 were reviewed. In addition to cause of and age at death, suicide method was documented and demographic factors. Following a one-way encryption process this information was analysed for family-relatedness in the deCODE Genealogy Database which is based on the genealogical records for nearly 700,000 Icelanders, i.e. most of the 287,000 living Icelanders and their ancestors. The analysis is performed by applying recursive algorithms to find all common ancestors in the database related to any other family member with suicide as the cause of death.

Results: There were 1,242 men and 379 females on the list. Enough information was found for 1.558 for the genealogy analysis. Risk ratio (RR) was calculated; for 1st degree relatives the RR was 2.8, higher for parents and children than for siblings, but similar for both sexes. The RR decreased for 2nd degree relatives to 1.6. These results are highly significant and extend to 3rd and 4th degree relatives. Kinship coefficient calculation yielded similar results. The risk was not related to age at death. There was significant family segregation with both violent and non-violent methods.

Conclusion: These preliminary results suggest a genetic component to suicides, but our data do not allow differentiation between other possible contributing genetic causes such as depression and alcoholism.



S - I / 4 Thursday 14/8, 11:00-12:30
Association study of TPH gene polymorphisms and completed suicide in Slovenia


Andrej Marusic1, PhD, MD, MRCPsych, MSc, BSc, Institute of Public Health of the Republic of Slovenia, Trubarjeva 2, 1000 Ljubljana, Slovenia, J Balacic2, K Sugden3, S Roskar1, A Farmer3, P McGuffin3, I Craig3

1Institute of Public Health of Republic of Slovenia, Ljubljana, Slovenia, 2Institute of Forensic Medicine, Medical Faculty, Ljubljana, Slovenia, 3Institute of Psychiatry, London, UK

andrej.marusic@ivz-rs.si

Objectives: We investigated two polymorphisms across the TPH gene region, one SNP in intron 7 and the 5' microsatellite, in a study sample of suicide completers and controls.

Methods: Brain tissue was obtained from 75 successive suicide completers from Ljubljana, Slovenia. Controls were obtained from brain tissue of 47 successive deaths from natural causes. We assessed the pattern of linkage disequilibrium between the two polymorphisms within this sample, and to investigate association between TPH gene variants and suicidal behaviour.

Results: The male-female ratio was 3:1, mean age was 43.8 for cases and 55.2 for controls. Suicide was committed by hanging in 47.3% of cases. There was an overall association between both allele 'A' of the TPH intron 7 polymorphism and allele '2' of the 3' microsatellite with suicide. Controls have a significantly fewer number of allele '2' of the 3' microsatellite when compared to female cases, those under 48 years and those who used hanging as a suicide method. Female controls have a significantly fewer number of 'A' alleles at the TPH intron 7 than female suicides. Controls have a significantly greater number of 'CC' homozygotes at the TPH intron 7 than hanging suicides.

Conclusions: We confirmed association between both allele 'A' of the TPH intron 7 polymorphism and allele '2' of the 3' microsatellite with suicide completion in a very specific national sample. Both associations are consistent with some previous studies, which have shown associations between suicide and/or suicide attempts and these alleles.



S - I / 5 Thursday 14/8, 11:00-12:30
Suicide and suicide attempts in adolescent onset psychotic disorders

Håkan Jarbin, MD, Anne-Liis von Knorring, MD, Professor, Dept. of Child and Adolescent Psychiatry, County Hospital, SE-301 85 Halmstad, Sweden

hakan.jarbin@bup.lu.se

Background: High suicide rates of 13-16% have been reported in follow-ups of early onset schizophrenia while reports in affective psychotic disorder and on attempted suicide are scarce.

Aims: To assess the risk of suicide and suicide attempts, to describe individuals who attempt suicide and to analyse predictive factors.

Method: Eighty-eight subjects with adolescent onset psychotic disorders (mean age 15.7, sd 1.5 years), mainly schizophrenia and affective disorders, were followed up 10.6 (sd 3.6) years later, re-diagnosed (DSM-IV) and assessed with the Positive and Negative Symptom Scale, abuse of drugs including nicotine, the Lancashire Quality of Life Profile, the Strauss-Carpenter Scale and the occurrence of suicide or suicide attempts.

Results: Four males (4.5% of subjects) had died from suicide while another 25% of the subjects had attempted suicide. Subjects with schizophrenia and attempted suicide were older at onset, had more social relations and more symptoms of anxiety-depression at follow-up while subjects with mood disorder and suicide attempts showed trends to increased severity of dysfunction. Suicide attempts were predicted by more depressive symptoms but less negative symptoms at first episode, to re-admissions, and to dependence on nicotine.

Conclusions: Suicidal behaviour is a major concern in early onset psychotic disorders.



S - I / 6 Thursday 14/8, 11:00-12:30
Prescription drugs and late-life suicide: A case-control study


Waern M, MD, PhD, NAPE, Section for Psychiatry, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden. Carlsten A.

margda.waern@neuroscience.gu.se

Background: Depression has been shown a strong predictor of late-life suicide. An association between pain and suicide has been suggested.

Aims: To compare psychotropic and analgesic prescriptions in elderly persons who commit suicide and in population controls.

Methods: Eighty-five cases of suicide among elderly persons (65+) were investigated using the psychological autopsy method, 153 living controls were randomly selected from the tax register and interviewed using the same questionnaire.

Results: Thirty-nine percent of the suicide group had an antidepressant prescription at the time of the suicide. Only 6% of the individuals in the control group were on such medication (OR=10.2, 95%CI 4.6-22.7). Four of the suicide cases and none of the controls were on lithium. Almost one fifth of the suicides (n=16) had a current prescription for a neuroleptic. Such drugs were prescribed in only 3% of the control group (OR=8.6, 95%CI 2.8-26.8). Over a third of the suicides (n=31) had a prescription for a daytime sedative. This can be compared with 4% of those in the control group (OR= 14.1, 95%CI 5.6-35.6). Nineteen percent of the suicides and 11% of the controls used narcotic analgesics (OR= 1.9, 95%CI 0.9-3.9).

Conclusions: Psychotropic prescriptions were associated with suicide. Concerning narcotic analgesics, an association could not be shown.



S - II / 1 Thursday 14/8, 11:00
An examination of the need for psychological service in primary health care in Iceland

Agnes Agnarsdóttir, Psychologist, Landspítali University Hospital, Hringbraut, 101 Reykjavík

agnesa@landspitali.is

Background: Specialised psychological or psychiatric services are not yet an integrated part of primary health care settings in Iceland

Aims: To examine the need for psychological services in primary health, an attempt was made to reveal factors that influence doctors' decisions about referrals.

Method: A questionnaire was used to examine the frequency of psychological morbidity amongst general practice attendees, as identified by GPs, in 3 primary care health centres in Iceland for 3 consecutive days. The 30-item version of the GHQ was used as a pre-consultant questionnaire for patients waiting to see their GP. A questionnaire was designed for the doctors to investigate their attitude to psychological services.

Results: Out of 499 consultations, 23 GPs identified psychological problems in 176 patients. The GHQ identified 227 patients with such problems. A significant association was found between age of patient and identification of psychological problems by the GPs, indicating that the GPs were more uncertain in detection of such problem amongst younger patients consulting them. The GPs were found to be managing the majority of the patients - only 22 patients were referred to mental health professionals.

Conclusions: The frequency and management of psychological problems in the 3 primary health care settings support the case for psychological services within primary health care settings.



S - II / 2 Thursday 14/8, 11:00-12:30
Mental disorders among elderly in primary care, Linköping study


María Ólafsdóttir, MD, PhD, General Practitioner, Ass. Professor, University of Iceland, The Primary Care, Reykjavík, Mávahrauni 1, 220 Hafnarfjörður, Iceland. Skoog I, Marcusson J.

maria.olafsdottir@simnet.is

Aims: To describe the prevalence of mental disorders among elderly patients in primary care and to compare diagnoses from psychiatric interview with information in medical records.

Method: Randomized patients aged 70 years and above attending a primary care centre (N=350) were studied with a psychiatric examination and their medical records studied.

Results: The prevalence of mental disorder according to the psychiatric interview was 33% (16% dementia, 17% other mental disorders). Only 49% of these had any psychiatric diagnoses in case records and 17-38% received specific treatments. The frequency of psychiatric symptoms among those with no mental disorder was between 1-66%. Patients with mental disorders were more often females, had more visits to a doctor, and more diagnoses in medical records.

Conclusions: Mental disorders and symptoms are common among the elderly in primary care. More effort should be made to increase the recognition rate.



S - II / 3 Thursday 14/8, 11:00-12:30
Specialist consultations: Are they a useful service for the patients and their general practictioners?


Ingrid Østby-Deglum, MD, Innlandet Hospital Health Authority, Sanderud, Pb 68, 2312 Ottestad, Norway

Background: A central task for the specialist service in psychiatry is to make consultations of patients referred from the general practitioners (GP). Such consultations usually take place at the psychiatric outpatient department, and they are regularly followed by a written feedback with diagnostic considerations and treatment recommendations. The Collaborative Working Group on Shared Mental Health Care in Canada have summarised three opportunities for better collaboration as seen from GPs' point of view (1) The aim of this study is describing patients' and GPs' experience in this service and mapping change in mental symptom load and predictive factors for being satisfied.

Methods: In a rural area of 80.000 inhabitants in Norway all patients referred from GPs during 1997-1999 who received four or less sessions (N=160) were eligible. Ninety-one (57%) patients returned a completed questionnaire and a SCL-90-R form. Thirty-eight (79%) GPs gave their opinions on 128 (80%) written feedbacks from consultations. Analyses were performed by means of paired t-test (changes in SCL-90-R from consultation to follow-up) and logistic regression (predictive factors for being satisfied)

Results: Global Symptom Index (GSI) was reduced from mean 1.6 at consultation to 1.1 at follow-up (Mean difference 0.5, SD 0.7, 95% CI: 0.3-0.7, p<0.001) Patients' work/sick leave status was found to be predictive factor for the patients experience of the consultations to be "of great/very great use" (OR 4.5, 95% CI: 1.6-12.1, p=0.003). No predictive factors for GPs' satisfaction were found.

Conclusion: When treatment capacity is limited, patients going to work may benefit most from time-limited consultations by the specialist services.


References

  • Can J Psychiat 2002; 47: Suppl 1: Shared Mental Health Care: A Bibliography and Overview. April 2002.

Funding Source Supported by funding from Sanderud Hospital, grants from Josef and Haldis Adresen's Legacy, Solveig and Johan P. Sommer's Legacy and Dr. Dedichens Institute for Psychiatric Research. Travel expences funded by Pfizer



S - III / 1 Thursday 14/8, 11:00-12:30
Psychodynamic investigation: From clinical case study to neurobiology


Halldóra Ólafsdóttir, Psychiatrist, Landspítali University Hospital, Reykjavík, Iceland. Hulda Guðmundsdóttir, Group Analyst, Landspitali, University Hospital, Reykjavik

halldola@landspitali.is

Objectives: To give a brief overview over the development of a psychodynamic investigation and the methodological difficulties the field has been facing within psychiatry. Are there novel research possibilities in the field?

Description: Psychodynamic investigation is increasingly being disregarded both within psychiatry and psychology as "unscientific" and being replaced with somatic therapies and/or cognitive and/or behavioral therapies, that claim better scientific data for their results. Unlike pharmacological trials for depression and CBT/IPT for depression, that rely on very selected patients in short-term trials, psychodynamic treatments are by nature long-term and often set up for complicated psychological problems that are difficult to prove with the "golden standard" RCT methodology.

The clinical practitioner is being put in a "double-bind situation". In spite of the "lack of evidence" he may still rely heavily on psychodynamic theory and treatment methods in his clinical work, especially in complicated and treatment resistant cases. To illustrate the point there will be a short presentation of a case of treatment resistant depression that after 6 years of different somatic, supportive, and cognitive approaches responded excellently to psychodynamic group treatment that lasted only 9 months and in full remission at 1 year follow up. Hulda Gudmundsdottir, group analyst, will descripe her understanding of the "blind spots and double binds" of the more biological/cognitive approach to this particular case.

Innovative approaches by using neuroimaging and other "hard biological data" to prove scientifically the results of psychodynamic treatments are currently being tested and some will be presented in this symposium.

Conclusion: Unless psychodynamically oriented clinicians are able to prove the results of their treatment approaches and their theories in a more modern scientific way the field is in danger of being replaced prematurely by other methods. That would be at a cost to those patients who could benefit from psychodynamic treatment where other approaches fail.



S - III / 2 Thursday 14/8, 11:00-12:30
The scope of brain imaging in the research of the outcome of psychotherapy


Lehtonen J, Professor, Department of Psychiatry, Department of Clinical Physiology, Department of Forensic Psychiatry, University of Kuopio and Niuvanniemi Hospital, PO Box 1777 FIN-70211, Kuopio, Finland. Saarinen P, Kuikka J, Joensuu M, Tolmunen T, Ahola P, Tiihonen J.

Johannes.lehtonen@kuh.fi
Only a couple of years ago knowledge of connections between brain function and psychotherapy was non-existent. New imaging methods have rapidly changed the situation and there are already several reports showing changes in blood flow, transporter or receptor function that relate to psychotherapy outcome. Assessment of valid connections between the effects of psychotherapy and brain function requires careful exclusion of numerous confounding factors. We describe a protocol for studying the effects of dynamic psychotherapy in depression using a randomised patient- waiting list control paradigm. Only drug-naïve patients are recruited. A model for assessing the therapy process that typically arises with patients with depression is also described. Preliminary results are presented.



S - III / 3 Thursday 14/8, 11:00-12:30
PET studies of outcome of dynamic psychotherapy

Karlsson H, Professor, University of Turku, FIN-20014, Finland. Hietala J, Salminen J, Kajander J.

Hasse.Karlsson@utu.fi

During recent years a few studies looking at brain correlates of successful psychotherapy have been performed. These studies have, however, utilised other forms of psychotherapy than psychodynamic psychotherapy. In these studies the outcome variable has been cerebral metabolism. No studies looking at changes in receptor densities after psychotherapy have been published so far.

In this paper I present a study performed in Turku, Finland. We recruited patients suffering from major depression from the occupational health services, randomised them in two groups, one receiving fluoxetine medication, and the other brief psychodynamic psychotherapy. Among the many outcome measures was change in 5HT1A- and D2-receptor densities measured using positron emission tomography (PET). These measurements were performed before the treatment, at 4 months, and one year. The results are currently being analysed and will be presented at the congress.



S - III / 4 Thursday 14/8, 11:00-12:30
Outcome of psychodynamic psychotherapy measured by [123I]nor-b-CIT SPET-imaging


Joensuu M, MD, Departments of Psychiatry, Clinical Physiology, University Hospital of Kuopio, Department of Forensic Psychiatry, University of Kuopio (Niuvanniemi Hospital), PO Box 1777 FIN-70211, Kuopio, Finland. Saarinen PI, Tolmunen T, Kuikka J, Tiihonen J, Ahola P, Lehtonen J.

mikko.joensuu@kuh.fi

Background: Psychodynamic psychotherapy is a widely practised form of psychotherapy in the treatment of depression. There is evidence that SERT and DAT densities are altered in depression. Preliminary observations have suggested that SERT function may recover in connection of dynamic psychotherapy. In our study [123I]nor-b-CIT SPET is used in imaging of serotonin and dopamine transporter function.

Aims: The objective is to find out if there are changes in the densities of serotonin and/or dopamine transporters related to clinical recovery during psychodynamic psychotherapy.

Method: Twenty five drug-naïve currently depressed (moderate/ severe) patients with no previous treatment will be recruited for this study. The patients are randomised to psychotherapy and waiting-list control groups. For controls, psychotherapy is started after a 6-months waiting-time. SPET-imaging is performed at baseline and after 12-months of psychotherapy. For the controls additional imaging is performed after 6-months waiting-time.

Results: Preliminary results of patients studied so far will be presented in form of case reports.

Conclusions: SERT densities in n.raphe may correlate to the symptomatic recovery of depression during psychodynamic psychotherapy.



S - III / 5 Thursday 14/8, 11:00-12:30
Character, symptoms and relationship patterns before and after dynamic psychotherapy


Alexander Wilczek, MD, PhD, Dept. of Clinical Neuroscience, Karolinska Institutet. Björngårdsgatan 25, SE 118 52 Stockholm, Sweden. Robert M Weinryb, Jacques P Barber, J Petter Gustavsson, Marie Åsberg.

alexander.wilczek@pi.ki.se

Background: In psychoanalytic theory, character is conceived as a regulating structure intended for life-long adaptation between inner needs and outer reality. If this adaptation fails, symptoms and dysfunctional relationship patterns might emerge, implying a close association between symptoms, relationship patterns, and underlying character. Furthermore, improvements regarding symptoms and relationships are regarded as consequences of change in character structure.

Aims: To study 1) the psychiatric and demographic characteristics of patients selected for long-term dynamic psychotherapy in a naturalistic clinical setting; 2) the relationship between character, symptoms and relationship patterns in these patients; 3) the change in character, symptoms, and relationship patterns following psychotherapy; 4) whether change in one of these three aspects was interrelated with change in any other aspect; 5) the relationship between change and duration of treatment or frequency of sessions.

Method: The sample comprised 55 patients. Character was assessed with the Karolinska Psychodynamic Profile, and relationship patterns with the Core Conflictual Relationship Theme. The DSM-III-R, self-report questionnaires assessing symptoms and personality were used. Thirty-six patients who engaged in psychotherapy completed follow-up assessments 6 months after treatment termination, and 10 patients, who did not enter treatment, completed follow-up assessments 3 years after intake. The psychotherapists involved were all well trained and had long professional experience.

Results: After long-term psychotherapy, patients reported a decreased level of character pathology and symptomatic suffering, as well as improved relationship patterns. There were, however, very few significant associations between change in character and change in symptoms or maladaptive relationships. Duration of treatment and frequency of sessions were not related to change.

Conclusions: The patients benefited from treatment, but neither the psychoanalytic theory regarding a close association between character, symptoms and relationship patterns, nor the psychoanalytic theory of structural change received support from our results.



S - IV / 1 Thursday 14/8, 11:00-12:30
Psychodynamic personality profile in early severe mental disorders


Jyrki Heikkilä MD, Psychiatric Services, City of Turku and Department of Psychiatry, University of Turku, Turku, Kunnallissairaalantie 20, rak. 4, FIN-20700 Turku, Finland. Hasse Karlsson, Hilkka Virtanen, Raimo K.R. Salokangas

jyrki.heikkila@turku.fi

Objective: Personality may alter liability/vulnerability, manifestation, and course of a disorder. The aim of this study was to investigate how enduring psychodynamic personality traits are associated with psychopathology in early severe mental disorders.

Methods: The study included 61 successive patients suffering from their first episode of schizophrenia, bipolar disorder or severe major depression. Personality was assessed with the Karolinska Psychodynamic Profile (KAPP) -interview, including 18 items.

Results: Personality profile differed only weakly a) in the three diagnostic groups, b) in patients with and without schizophrenia, and c) in patients with and without psychosis. However, in a logistic regression adjusting for age, sex, and diagnosis, several KAPP items were strongly associated with symptoms clusters derived from the BPRS. The cluster including emotional withdrawal, psychomotor retardation, and blunted affect had the most frequent associations with the KAPP items.

Conclusions: We found no significant evidence of a diagnosis-specific psychodynamic personality profile in severe mental disorders. Certain personality traits may predict negative emotional symptoms in a manifest disorder. A comparison with a non-psychiatric control group from another study suggests that there may be significant dysfunctional personality traits which are common to all severe mental disorder groups in our study.



S - IV / 2 Thursday 14/8, 11:00-12:30
Screening for prodromal symptoms of psychosis


Heinimaa M, Research Psychiatrist, University of Turku, Department of Psychiatry, Kunnallissairaalantie 20, SF-20700 Turku, Finland. Salokangas RKR, Huttunen J, Rekola J, Heinisuo AM, Ristkari T, McGlashan TH.

markus.heinimaa@utu.fi

Background: In connection with the DEEP-study we developed the PROD-screen, an instrument for screening for prodromal symptomatology, both for self-rating and telephone interviews. According to the data from this study PROD-screen functions well with mixed samples and with first degree relatives of schizophrenic patients, being able to distinguish prodromal cases (as defined by SIPS instrument, McGlashan) from noncases. However, when used in clinically highly relevant population of new psychiatric outpatients, PROD-screen scores do not differentiate between SIPS positive and SIPS negative cases, presumably due to high levels of symptoms reported in this sample in general. This is a major drawback as clinical samples probably contain a higher base rate of true prodromal cases, only effective screening is achieved.

Aims: We developed this screening procedure to more qualitative direction by also including reports of verbal responses to symptom queries presented in the screen, and using these verbal responses as the basis for deciding screen positivity.

Method: On all symptom questions responded with "Yes" the subject was asked to give a detailed description of what kind of symptom prompted him/her to respond positively. The evaluation of these symptom descriptions was made independently by two experienced psychiatrists, who made a consensus decision on which subjects were asked for more extensive research interview.

Results: We have screened new attenders to psychiatric open care systematically and as for now 406 screens have been evaluated. Positive predictive value of positive screening result for prodromal state according to SIPS has been 61%.

Conclusion: Adding evaluation of qualitative data to PROD-screen makes it a powerful tool for detecting prodromal syndromes.



S - IV / 3 Thursday 14/8, 11:00-12:30
General health and vulnerability to psychosis

Korkeila JA, Clinical Lecturer, Psychiatric Clinic, Univeristy of Turku, Kunnallissairaalantie 20, 20700 Turku, Finland. Suomela T, Heinimaa M, Huttunen J, Ristkari T, Plathin M, Salokangas RKR.

jyrki.korkeila@postikaista.net

The sample comprises 157 subjects from the Detection of Early Psychosis project. The SIPS was used as a gold standard to determine the presence of vulnerability to psychosis. The psychiatric diagnoses were made according to SCID. General health and related symptoms were also probed. There were significant differences between those without psychiatric symptoms (58%) and those with mild psychiatric symptoms (9%), those vulnerable to psychosis (1 %) or psychotic (16%) in respect to reporting excellent general health (p<0.01). There were no significant differences between the groups pertaining to diagnosed CNS illnesses. The level of general health did not correlate with sex or age groups. There was a significant but weak negative correlation (r = -0.18, p = 0.04) between poor general health and level of functioning according to GAF. Poor general health did not correlate significantly with quality of life, study setting or level of psychological distress according to the SCL-111.



S - IV / 4 Thursday 14/8, 14:00-15:00
Sense of coherence among Finnish young men - a cross-sectional study at military call-up


Ristkari Terja1, MNSc, University of Turku, Dept. of Psychiatry, Kunnallissairaalantie 20, rak. 9, 20500 Turku, Finland. Sourander Andre2, Parkkola Kai3, Salanterä Sanna4, Nikolakaros Georgios2, Helenius Hans5.

1University of Turku, Dept. of Psychiatry, 2University of Turku, Dept. of Child Psychiatry, 3The Finnish Defence Forces, 4University of Turku, Dept. of Nursing Science, 5University of Turku, Dept. of Biostatistics.

terja.ristkari@utu.fi

Background: In recent years many studies have shown connections between life control and health. Several studies are based on Antonovsky´s theory about the sense of coherence (SOC). The sense of coherence based on salutogenic model which stresses positive aspects and resources of health rather than symptoms and diseases.

Aims: The aim of this study was to describe life control and its level among Finnish young men measured as sense of coherence. Furthermore, associations between sense of coherence and mental health problems, the use of mental health services, risk behaviour, predisposition to suicide, and possible psychiatric diagnosis was studied.

Methods: The study was carried out as a questionnaire (SOC-13) at the call up site. The study included 2348 18-19-year-old young men who attended military call-up in the fall of 1999.

Results: Suicidality, perceived mental health problems, psychiatric diagnosis at military call-up, use of mental health services, excessive alcohol consumption, and use of illicit drugs were identified as independent factors contributing to sense of coherence.

Conclusions: Sense of coherence is a valuable construction in psychiatric evaluation of adolescents. SOC-13 can be used both in clinical practice and epidemiological research to evaluate adolescents' life control and health resources. Future research on its applications in clinical practice is warranted.



S - IV / 5 Thursday 14/8, 11:00-12:300
Functioning ability, quality of life and subtreshold psychotic symptoms

Suomela T1, MD, University of Turku, Dept. of Psychiatry, Kunnallissairaalantie 20 rak 9 II krs. 20810, Turku, Finland. Heinimaa M1, Ilonen T1, Korkeila J1, Huttunen J1, Ristkari T1, Hietala J2, Syvälahti E2, McGlashan T3, Salokangas RKR1

1University of Turku, Department of Psychiatry, 2University of Turku, Department of Pharmacology, 3Yale University, Department of Psychiatry

tapasu@utu.fi

Objectives: It has been repeatedly reported that subjects experiencing subtreshold psychotic symptoms have relatively low functioning ability and low quality of life (QoL). We examined which individual symptoms explain the decrease (score below median) in functioning ability and QoL the best.

Methods: 150 help seeking patients or first-degree relatives of psychotic patients were assessed with Structured Interview for Prodromal Symptoms (SIPS/SOPS), Global Assessment of Functioning Ability (GAF-M) and Quality of Life Scale (QLS).

Results: The mean GAF scores and QLS scores decreased linearly and statistically significantly as symptoms measured with SIPS/ SOPS approached more psychotic like phenomena. When all symptoms of the SIPS/SOPS were put in the same stepwise logistic regression model only perceptual abnormalities (GAF: OR 4,434, 95% C.I. 1,114-17,648, p<0,035) and certain negative symptoms like social isolation and withdrawal (GAF OR 18,655, 95 % C.I. 2,158-161,274, p<0,008; QLS OR 3,438, 95 % C.I. 1,257-9,403, p<0,016) and decreased experience of emotions and self (QLS OR 79,556, 95 % C.I. 4,305-1470,332, p<0,003) remained statistically significant. After taking sex, age, marital status, duration of education, study sample, and disturbances in motor development, language development, and social development into account, within SIPS symptom categories positive, negative and disorganization symptom categories (OR 1,9, 95 % C.I. 1,098-3,288, p<0,022; OR 2,243, 95 % C.I. 1,285-3,914, p<0,004; OR 0,419, 95 % C.I. 0,206-0,849, p< 0,016, respectively) remained statistically significant explaining low functioning ability. In a similar analysis regarding low QoL only SIPS negative symptom category remained statistically significant (OR 2,044, 95 % C.I. 1,212-3,450, p<0,007).

Conclusion: Negative symptoms commonly influence the functioning ability and QoL of subjects with subtreshold psychotic symptoms.



S - V / 1 Thursday 14/8, 11:00-12:30
Mental health in children, adolescents and caretakers


Bruno Hägglöf, Professor, Department of Child and Adolescent Psychiatry, 901 85 Umeå University, Sweden, R Adolfsson, M Sandlund, M Jonasson, E Salander-Renberg, M Nilsson, AM Sandeberg.

Bruno.Hagglof@psychiat.umu.se

Indicators of mental health and psychological well-being were examined in a random sample (n=5 000) of the population in the county of Västerbotten. Valid self-rating scales were used for each of 3 age groups: 4-12 y (n=1000) and their caretakers (n=1000), 13-17 y (n=1 000) and 18-74 y (n=2000). The response rate was 69,2% (n=3 461); 4-12 y (n=685), care takers (n=670), 13-17 y (n=735), 18-74 y (n=1 371). In consideration of the limited space only some results are presented for the younger cohorts.

12% in the 4-12 y group had psychic problem (measured by CBCL 4-16; Achenbach 1991a) during the last year. Depressive symptoms increased with increasing age and 5,7 % in the 10-12 y group reported these symptoms sometimes/frequent. About 5% reported psychic symptoms equivalent to what child psychiatric patients with defined diagnosis have reported.

In the age group 13-17 y (Youth Self Report; Achenbach 1991b) 28% reported depressive symptoms, 38%. Thoughts of harming or killing themselves was reported by 7,7%, and 3,7% had made vague or serious suicide attempts. About 10% reported psychic symptoms equivalent to what child psychiatric patients with defined diagnosis have reported. Several psychosocial factors were associated with poor psychic health in all age groups. Suggestions for primary and secondary prevention will be presented.



S - V / 2 Thursday 14/8, 11:00-12:30
Preventive strategies in children and adolescent psychiatry

Anna Lindström, Head of Clinic, Sen. Med. Dr., Child and Adolescent Psychiatry, Umeå, Sweden

Background: A major increase during recent years of children and adolescents in need of child and adolescent psychiatric (CAP) service has highlighted the need for prevention and early intervention programmes.

A project was launched with the aim to give CAP education, consultations, and network methods to the primary health care service for children, adult psychiatry, schools, and social service. Before the programme all partners were asked about their needs in terms of CAP methods and knowledge. The experts of CAP were recruited from the different CAP clinics in the county. The research and developmental unit of the county council made evaluations of the projects by questionnaires and interviews to see if the aims and goals of the projects were fulfilled.

Results: A total of 31 projects were developed, each with specific goals. The activities reached 1100 different professionals as primary care doctors, nurses and psychologists, school nurses, social workers in the schools and social service, and staff from adult psychiatry.

There were high scores on the satisfaction of the programme from different partners. The participants reported a substantial increase of the knowledge in CAP. There were lot of suggestions of further cooperation and the development of preventive and early intervention methods in the mental health care of children and adolescents in county of Västerbotten.

Conclusion: An increase of the knowledge in CAP in primary health care settings, adult psychiatry, school and social service can be of importance in the development of mental heath care programmes for children and adolescents.



S - V / 3 Thursday 14/8, 11:00-12:30
Community-based psychiatry in sparsely populated areas


Karin Häggqvist, Psychologist, Västerbottens läns landsting, Psykiatriska öppenvården, Volgsjövägen 48, SE- 912 32 Vilhelmina, Sweden

karin.haggqvist.sls@vll.se

During the 70s the psychiatric care in Sweden as well as in other western countries went through dramatic changes. The big mental institutions were closed down and other forms of psychiatric care were built up. In the health care district of southern Lapland, situated in the Northern inland of Sweden, the psychiatry started building up a modern organisation with no own history of big institutions. Southern Lapland Health Care District has a small population with approximately 40 000 inhabitants but covers a vast land area with 7 separate municipalities. The challenge has been to build a psychiatric care that is based on as little in patient care as possible and with the ambition to work closely together with other health resources and the network around the patients. Today we have three open care units spread in the district and buy inpatient care from the coast district. Our inpatient care is extremely low and we work in close contact with the primary care and other caregivers. Working with the network and in the patients own environment are guiding stars. New technology such as videoconferences is frequently used as an important tool both in patient work, supervision and conferences.



S - V / 4 Thursday 14/8, 11:00-12:30
Psychiatric care and development at the non-university level

Carl-Gustaf Olofsson and Göran Nyberg, Chief Psychiatrists, Clinic of Psychiatry, Skellefteå lasarett, S-931 86 Skellefteå, Sweden

carlgustaf.olofsson@vll.se

We want to share clinical experiences in psychiatric care from a non-university clinic in the north of Sweden. We have full responsibility for psychiatric service in our catchment area of about 80000 inhabitants and hospital beds for an additional catchment area of 40000.

Our approach is family-oriented; the on-call system is team-based and mobile. We use modern techniques in both care and cooperation (using telemedicine). We have a special outpatient service for youth up to 25.

A short overview is given of our clinical tradition including compulsory care and forensic psychiatry. We give some comments on good co-operation with social services; the user and family members' associations and primary care, and share some visions from the reforms, which are going on in the county council, where psychiatry is in a "family" called "närsjukvård" ("health service close to population").



S - V / 5 Thursday 14/8, 11:00-12:30
Health care, research and education in symbiosis at the university clinic

Tonny Andersen, Dept. of Clinical Sciences, Umeå University, S-90185, Umeå, Sweden

tonny.andersen.us@vll.se

The University of Umeå is a rather young university - established in the mid sixties starting with the medical sciences. Prior to this, the hospital of Umeå was a general hospital for the local area. Within the field of psychiatry Umeå hosted a large psychiatric state hospital with nearly 1000 beds serving most of Northern Sweden. From these starting points the task during the decades has been to build a viable environment for medical research and education in general and in psychiatry and, of course, to develop and practice good quality everyday psychiatric care. A cornerstone for this - also necessitated by low governmental funding for research and education - has been a close integration between clinical and academic activities. Clinical research has been - and still is - at the heart of the University Psychiatric Clinic-work being done e.g. within the areas of social psychiatric research, epidemiology, suicide prevention, psychopathology, and psychiatric genetics. Pre- and postgraduation education in psychiatry is well integrated into the clinical activities - with many senior staff members serving as teachers or supervisors.



S - V / 6 Thursday 14/8, 11:00-12:30
A joint effort in research and development between patients, local authorities, health service providers and the university


Mikael Sandlund, Assoc. Professor/Head, Socialpsykiatriskt kunskapscentrum i Västerbotten, Psyk klin, NUS, SE-901 85 Umeå, Sweden. Urban Markström.

mikael.sandlund@vll.se

The responsibility to provide service for persons suffering from functional impairments due to long-term mental disorders is divided between several authorities in Sweden. Local authorities (the communes) are supposed to support an independent living and offer daily activities, the health care providers (county councils) should give primary care services as well as specialised psychiatric services. The regional social insurance offices have the responsibility to co-ordinate vocational rehabilitation, in co-operation with the employment offices. The users and family members' organisations have gradually taken a more active part, both as "pressure groups" and as suppliers of supporting services. "Socialpsykiatriskt kunskapscentrum" is a joint effort to improve the services to persons with functional impairments due to mental disorders living in the community. The means are to promote research and development in this area, with a high degree of involvement from users, relatives and professionals. All local authorities in the county as well as the users' organisations, the psychiatric services and Umeå University's own "Socialpsykiatriskt kunskapscentrum." The presentation will give some examples of projects which have been in focus for our efforts during the last 3 years of operation.



S - VI / 1 Thursaday 14/8, 11:00-12:30
General introduction


Jan H. Rosenvinge, prof. dr. psychol., Department of Psychology, University of Tromsø and Modum Bad, Nor

The introduction to the symposium aims to cover the following aspects:

  •  an overview of hospital treatment programmes,
  • criteria for hospital admission,
  • models for coordinating inpatient and outpatient treatment,
  • empirical evidence for the effect of hospital treatment.



S - VI / 2 Thursday 14/8, 11:00-12:30
Hospital treatment of adults with eating disorders: The treatment program at Modum Bad, Norway

Astrid Mortensen, occupational therapist

Modum Bad is the only hospital in Norway receiving adult patients with long-lasting eating disorders from the whole country. The hospital has over 10 years experience of treating chronic eating disorder patients in a specialised inpatient treatment program. During this period the number of patients treated each year has increased and is now about 40 patients.

The treatment is a multicomponent inpatient programme. Patients are treated in groups, one slow open group for patients with anorexia nervosa and one closed group for bulimia nervosa. The length of the hospital stay for anorexia nervosa is varying from one to nine months and for bulimia nervosa about 12-14 weeks. The program is based on group, cognitive behavioural and interpersonal therapy.

The presentation will describe the inpatient treatment program.



S - VI / 3 Thursday 14/8, 11:00-12:30
Two year follow-up of adults with chronic eating disorders after inpatient treatment at Modum Bad, Norway

Øyvind Rø, MD

Background: There are few follow-up studies of patients with treatment resistant eating disorders with comorbid personality disorders, and there is little knowledge about what kind of treatment they will benefit from.

Aims: The aims of this prospective study were to report on the two-year outcome of adults with chronic eating disorders, to investigate whether a specialised inpatient treatment might influence the course of the illness, and to search for prognostic factors.

Method: Seventy-two patients received inpatient treatment. Sixty-five patients (90 %) with mean age 30 years were available for the follow-up assessment.

Results: Forty-six (71 %) had improved at two-year follow-up, and of these had 12 (18 %) had recovered. Reductions in symptoms per time unit were statistically significant larger during the inpatient period than in waiting list and follow-up periods. No predictors of outcome were identified. Patients with an avoidant personality disorder had a higher level of distress at all points of time but improved at the same rate as the other patients.

Conclusion: At two-year follow-up there were substantially reductions in eating disorder symptoms and general psychiatric symptoms. Most of the improvement occurred during inpatient treatment. This might be a treatment option for patients with chronic eating disorders.



S - VI / 4 Thursday 14/8, 11:00-12:30
The course of personality disorders in chronic eating disorders

Øyvind Rø, MD

Background: Several studies have shown high rates of personality disorder among patients with eating disorders. They range from 30% to 80% depending on what patient group that has been investigated.

Aim: The aim of this prospective study was to report on the frequency of personality disorder over time for chronic eating disorder patients after inpatient treatment at Modum Bad.

Method: Seventy-two patients received inpatient treatment. Sixty-five patients (90 %) with mean age 30 years were available for the follow-up assessments at one and two years after treatment start and 61 (85 %) had been assessed with Structured Clinical Interview for DSM-IV axis II diagnoses (SCID-II) at the last part of inpatient treatment and at follow-ups to assess personality disorders.

Results: Forty-six (75%) patients had one or more personality disorders during inpatient treatment. The most frequent personality disorder was avoidant (51%) and borderline (21%) personality disorder. At follow-up the number of patients with one or more personality disorders was reduced to 38 (62%) at one year and 35 (57%) at two-year follow-up. There were significant reductions of dimensional scores of personality disorders from treatment to one-year as well as to two years follow-up (p<0,01 for both).

Conclusion: In chronic eating disorders comorbid personality disorders are common. Following inpatient treatment the frequency decrease over time.



S - VI / 5 Thursday 14/8, 11:00-12:30
More boys than girls required intensive care due to anorexia nervosa


Per H. Jonsson, Senior Consultant, Dept. of Child and Youth Psychiatry, Hälsinglands Sjukhus, 80381, Hudiksvall, Sweden

per.p.jonsson@lg.se

Background: Anorexia nervosa was until the beginning of the 70s, known as a disease in females. Around that time British doctors (Beaumont et al.) published clinical findings and concluded that AN is a disease in both sexes. A number of studies have reported a rather poor outcome for men. In a Danish study infertility was noted in affected men. In the county of Gävleborg a study of 46 inpatients, 12 boys and 34 girls, was performed, 12-15 years in mean, after falling ill. The children and adolescents were treated at the Child and Youth Psychiatric Clinic between 1971-1990.

Aim: The aim of the study was to describe typical arrays of clinical data in order to assess attitudes and values concerning the effect of treatment on 28 adults out of the total group. A sociometric questionnaire was used to assess the former patients' knowledge of their disease, their opinions concerning the competence of the staff, their feelings concerning treatment, including parenteral involvement and medication used, as well as their opinions on the results of treatment.

Reults and conclusions: An unexpected finding was that boys were referred to intensive care about three times more often than the girls. The boys were much more reluctant to accept inpatient care than were the girls, who seem to show a greater autonomy. Perticipants' final appraisal of treatment is slightly positive, whereas in the hypothetical situation that a friend might fall ill with eating disorder, a sizeable majority would recommend contact with child psychiatry.



S - VII / 1 Thursday 14/8, 11:00-12:30
Analysis of the psychopathology among first-episode psychosis patients with or without a criminal history


Runa Munkner, MD, Psychiatric Centre Glostrup, Glostrup University Hospital, Ndr. Ringvej 29 67, DK-2600 Glostrup, Copenhagen, Denmark

runa.munkner@dadlnet.dk

Background: Since many schizophrenia patients have committed crimes prior to their first contact with the psychiatric hospital system, a possibility is offered for early detection in the judicial system.

The aim of the study: To analyse

  • The temporal relationship between the first psychotic symptoms and first contact to the judicial system and the psychiatric hospital system respectively among individuals with a disorder in the schizophrenia spectrum.
  • Which psychopathological features characterise the patients who begin a criminal or a violently criminal career before their admission with first-episode-psychosis and which psychopathological features separate them from the schizophrenia patients who have not committed any registered crime previously.
Population: In Denmark the opportunities for register-based studies are as good as can be, due to thorough, comprehensive and accurate registers and the fact that all Danes have a civil registration number, making linkage across time and registers very accurate. Data concerning psychiatric hospital admittance and criminality were linked to data from the Danish National Schizophrenia Project, in which psychopathology, duration of untreated psychosis (DUP) and premorbid function was rated at admission for first-episode psychosis.

Results: The differences in psychopathology associated with prior criminal behaviour among first-episode will be presented and discussed.



S - VII / 2 Thursday 14/8, 11:00-12:30
Novelty seeking correlates negatively to prefrontal monoaminergic activity among alcoholics

Laine TPJ, Assistant Senior Physician, Oulu University Hospital, Pb 26 FIN 90029 OYS, Finland. Ahonen A, Räsänen P, Tiihonen J.

pekka.laine@oulu.fi

Novelty seeking asocial personality and prefrontal serotonin transporter among alcoholics

Several studies have shown that impulsive violent behaviour is associated with a central serotonin deficit (Damasio et al 1994, Mantere et al 2002). We studied prefrontal monoaminergic activity of 29 alcoholics using iodine-123-labelled 2beta-carbomethoxy-3beta(4-iodophenyl)tropane ([123I]beta-CIT) as the tracer with SPET (Single-photon emission tomography) immediately after detoxification. Beta-CIT binds mostly in dopamine transporters (DAT) but also in serotonin transporters (SERT) available in this area. Patients filled TPQ-questionnaire for measuring their temperament and their personality disorders were studied with SCID-II semi-structured questionnaire.

We found statistically significant negative correlation between prefrontal SERT availability and Novelty Seeking (r=-0.480, p=0.008, N=29, Pearsons 2-tailed correlation) and positive scores of asocial personality disorder (r=-0.484, p=0.009, N=28). The results imply that asocial and novelty seeking behaviour in man is associated with a decrease in the prefrontal 5-HT transporter density

References
  • Mantere T, Tupala E, et al. Serotonin transporter distribution and density in the cerebral cortex of alcoholic and nonalcoholic comparison subjects: a whole-hemisphere autoradiography study. Am J Psychiatry 2002: 599-606.
  • Damasio H, Grabowski T, et al. The return of Phineas Gage: Clues about the brain from the skull of a famous patient. Science 1994: 1102-5.



S - VII / 3 Thursday 14/8, 11:00-12:30
The relationship of alcohol withdrawal symptoms to suggestibility and compliance

Gísli H. Guðjónsson1, Kristín Hannesdóttir, Tómas Þór Ágústsson, Jón F. Sigurðsson, Ása Guðmundsdóttir, Þuríður Þórðardóttir, Þórarinn Tyrfingsson, Hannes Pétursson.

spjtghg@iop.kcl.ac.uk

1Department of Psychology, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, England

People who are experiencing alcohol withdrawal are disadvantaged in terms of their ability to cope with leading questions and interrogative pressure (i.e. interrogative suggestibility). What had not been studied previously was the relationship of the severity of alcohol withdrawal symptoms with suggestibility and compliance. Suggestibility and compliance scores, obtained during the first week of hospital admission, were correlated with the severity of alcohol symptoms measured on a daily basis over a seven-day period in a group of 393 patients attending treatment for alcohol abuse problems. Separate analyses were performed for the male and female patients. Significant gender differences emerged. Among males, alcohol withdrawal symptoms correlated positively with suggestibility and compliance across days. In contrast, among the females alcohol withdrawal symptoms were not significantly correlated with suggestibility and compliance, but were positively related with fabrications in memory recall. The findings suggest that in relation to psychological vulnerabilities during questioning, alcohol withdrawal symptoms are associated with different psychological factors in males and females.

Reference
Gísli H. Guðjónsson1, Kristín Hannesdottir, Tómas Þór Ágústsson, Jón F. Sigurðsson, Ása Guðmundsdóttir, Þuríður Þórðardóttir, Þórarinn Tyrfingsson, Hannes Pétursson. (in press). The relationship of alcohol withdrawal symptoms to suggestibility and compliance. Psychology, Crime & Law.



S - VII / 4 Thursday 14/8, 11:00-12:30
Motivation for offending and personality


Gísli H. Guðjónsson, Department of Psychology, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, England. Jón Friðrik Sigurðsson, Department of Psychiatry, University Hospital, Hringbraut, IS-101 Reykjavík, Iceland

spjtghg@iop.kcl.ac.uk; jonfsig@landspitali.is

Purpose: The study examined the relationship between motivation for offending and personality.

Method: A specially constructed Offending Motivation Questionnaire (OMQ) was developed along the lines of Farmington's (1986) theoretical framework of criminal offending. The OMQ, the Self-reported Delinquency Scale, the Gudjonsson Compliance Scale (GCS), the Gough Socialisation Scale, Rosenberg Self-Esteem Scale, and the Gudjonsson Blame Attribution Inventory (GBI) were administered to two groups of students: College students and University students.

Results: Factor analysis of the OMQ revealed four motivational factors for offending (Compliance, Provocation, Financial, Excitement) and one further factor associated with the failure to appreciate the consequences of the criminal act. As predicted, the GCS correlated significantly with a compliance motive (i.e. being coerced, manipulated, or tricked into crime by a peer, or eagerness to please a peer), whereas the remaining four factors were associated with a low score on the Gough Socialisation Scale. External and Mental Element attributions were mainly found to be associated with provocation and consequences factors.

Conclusions: The findings support the view that there is a relationship between the motivation for offending, failure to appreciate the consequences of one's actions, and personality. Further research should focus on studying this relationship among criminal populations.

Reference
Guðjónsson GH, Sigurdsson JF (in press). Motivation for offending and personality. Legal and Criminological Psychology.




S - VII / 5 Thursday 14/8, 11:00-12:30
Forensic psychiatric patients in Copenhagen - diagnoses, substance abuse and criminality

Peter Kramp, Head of Clinic of Forensic Psychiatry, Ministry of Justice, Clinic of Forensic Psychiatry, Blegdamsvej 6B, DK-2200 Copenhagen, Denmark. Gorm Gabrielsen.

pk@retspsykiatriskklinik.dk

A connection between schizophrenia and violence has been established in many studies. The purpose of the study is to map out criminality and diagnoses among Danish forensic psychiatric patients. A cross-sectional study recorded data including criminality, substance abuse and psychiatric diagnoses among 330 forensic patients treated in Copenhagen Hospital Corporation. The materials are analysed using logistic regressions. Forensic patients are older than other criminals are, and there are relatively more women. 73% are schizophrenics, 84% have an F20-spectrum disorder. 10% of all schizophrenic men aged 20 to 44 years in Copenhagen are forensic patients. There is no difference between the forensic patients and other criminals concerning substance abuse or relations between type of crime and type of abuse. Schizophrenics have mainly committed violence and especially fire setting. A growing number of schizophrenic patients commit criminal acts dangerous to others. The number of schizophrenic patients, who commit violence and fire setting, is so high, that a substantial reduction could be observed in the Danish crime statistic. It is concluded that lack of treatment of the schizophrenic patients is causing suffering for the victims, cost resources for the society and stigmatizes the patients.



S - VIII / 1 Thursday 14/8, 11:00-12:30
Acute admissions in adolescent psychiatry - I: Epidemiological data, discussion and future directions


Bertrand Lauth, Sigurður Rafn A. Levy, National University Hospital, Department of Child and Adolescent Psychiatry, Dalbraut 12, 105 Reykjavík, Iceland. Guðlaug M. Júlíusdóttir.

sigrafn@landspitali.is

Background: Emergency requests for acute admission in adolescent psychiatry have recently dramatically increased in Iceland, as in many other countries. The adolescent psychiatric unit of the National University Hospital is the only one of that kind in Iceland, which makes the population admitted quite representative. More than 140 patients have been admitted over 2001 and 2002, and epidemiological data have been collected by the clinical team.

Aims: To describe the population admitted: age, sex, circumstances of admission, diagnostics, family, social and school factors, adverse events, length of stay in the unit, treatment plans after discharge.

Method: Three members of the multidisciplinary team of the unit gathered information from hospital files. The sheet used for information gathering is kept in the individual hospital file. Information was coded before statistical analysis so results could not be traced back to individuals.

Results and conclusions: The results are compared with another similar study published in 1994 and differences are discussed. Comparisons are also made with available data from other countries. Retrospective questions about acute admissions in adolescent psychiatry are raised, and future directions are discussed.



S - VIII / 2 Thursday 14/8, 11:00-12:30
Acute admissions in adolescent psychiatry - II. family, school and social factors - discussion and future directions


Guðlaug M Júlíusdóttir, Social Worker, National University Hospital, Department of Child and Adolescent Psychiatry, Dalbraut 12, 105 Reykjavík, Iceland. Bertrand Lauth, Sigurður Rafn A. Levy.

gudljul@landspitali.is

Background: Family, school and social factors are known to play an important role in the activation of crisis that often lead to emergency request for acute admission in an adolescent psychiatric unit.

Aims: This study focuses on the family, school and social factors that have been identified in the whole population of adolescents admitted in the only adolescent psychiatric unit in Iceland over 2 years time period.

Method: This study is a part of a broader epidemiological study of all admissions in 2001 and 2002. Three members of the multidisciplinary team of the unit gathered information from hospital files. The information was coded so it could not be traced back to the individual and the sheet used in the information gathering is kept in the individual hospital file.

Results and conclusions: The presentation will try to determine what kind of service patients get and what kind of institutions are requested after discharge. Hypothesis will also be developed regarding the influence of social factors.

One of the main hypothesis is that family, school and social factors contribute to the psychological state of the patient. Another hypothesis is that those factors play a role in the process of emergency request for acute admissions.



S - VIII / 3 Thursday 14/8, 11:00-12:30
Acute Admissions in Adolescent Psychiatry III: Abuse and Neglect as Risk Factors

Sigurður Rafn A. Levy, Guðlaug M. Júlíusdóttir, Bertrand Lauth. National University Hospital, Department of Child and Adolescent Psychiatry, Dalbraut 12, 105 Reykjavík, Iceland.

sigrafn@landspitali.is

Background: Child abuse and neglect are considered as very serious social problem and harmful for children and their development, and goes against their legal rights. It is perceived common that children admitted to the only adolescent psychiatry ward in Iceland had been mistreated, but the rate has not been studied before.

Aim: Statistical mapping of the group admitted to the ward, and in this part of the study to estimate abuse and neglect as risk factors.

Method: This study is a part of a broader epidemiological study of all admittances in 2001 and 2002. Three members of the multidisciplinary team of the unit gathered information from hospital files. The sheet used for information gathering is kept in the individual hospital file, information was coded before statistical analysis so results could not be traced back to individuals.

Results and conclusions: Neglect and abuse is much more common among patients admitted to adolescent psychiatric wards, than in the general population. Nearly half of the whole group has been neglected in one way or another and nearly half of the girls have been sexually abused. These factors seem to be crucial in mental welfare of adolescents. These results underline that collaboration between the social system and the hospital should be strong and structured, and the whole community should be more aware about this risk.



S - IX / 1 Thursday 14/8, 11:00-12:30
Organisational aspects

Óttar Gudmundsson MD, Psychiatrist, Landspítali University Hospital

ottarg@landspitali.is

The availability of in-patient alcohol treatment is greater in Iceland than most other western countries. Laymen-organizations and religious groups have built hospitals and treatment centers that treat thousands of alcoholics each year. Most of these treatment-units use the 12-step program and the AA-movement has grown enormously in Iceland in recent years. Alcohol-treatment is free of charge in Iceland for the patient and there is no limit how many times a patient can be hospitalised for his/her problems.

The alcohol and drug addiction unit at the Landspitali University Hospital has put forward a different approach with main emphasis on out-patient treatment where a modified 12-step program is combined with traditional methods of psychiatry and psychology. Most of our patients suffer from other comorbidity beside their addiction. We have tried to select those patient with psychiatric diseases like depression, anxiety, obsessive-compulsive disorders, and personality disorders and offered them treatment like CBT-groups or medication that is specially focused on their particular problems. We have put great emphasis on family treatment and individual counselling.

In this way we have extended our treatment in order to treat simultaneously the alcohol or drug addiction along with the other psychiatric problems that can usually be found in these patient groups.



S - IX / 2 Thursday 14/8, 11:00-12:30
Psychiatric comorbidity. Clinical aspects

Kristinn Tómasson, MD, Dr. Med., Dept. of Research & Occupational Health, Administration for Occupational Health & Safety, Bíldshöfða 16, 110 Reykjavík, Iceland

kristinn@ver.is

Introduction: Psychiatric comorbidiy among alcoholics and other substance abusers is an important phenomenon that needs to be acknowledged by those taking care of them.

Methods: The present paper, reviews different definitions of comorbidity, gives a review of several studies on the prevalence of psychiatric comorbidity, both among the general population of substance abusers, and those who are treatment seeking

Results: Definition of comorbidity greatly affects the prevalence. However, using a definition without exclusion criteria the prevalence in the community varies between 20% and 60% depending on method of diagnosis, while among treatment seeking population the prevalence varies between 50% and 95% depending on method use for diagnosing and population surveyed. Even this wide definition has prognostic implication in terms of course of the substance use disorder, social consequences of substance use and mental health in general

Conclusion: For proper treatment of substance use disorders a thorough assessment is needed, without using or applying exclusion criteria while diagnosing psychiatric comorbidity.



S - IX / 3 Thursday 14/8, 11:00
Psychosocial treatment, especially for patients with comorbidity

Agneta Öjehagen, Associate Professor, Dept. of Clin. Neuroscience, Div. of Psychiatry, S-221 85 Lund, Sweden

agneta.ojehagen@psykiatr.lu.se

Background: In order to determine the effectiveness of psychosocial treatment for alcohol dependence, a systematic review of all randomized controlled trials (RCT) addressing this issue was performed by the SBU. Among questions addressed were: Are some treatment methods better than others? Does matching patients to treatment improve outcome? Is special treatment needed for substance abusers with mental illness?

Methods: With the search terms "alcoholism" and "randomized controlled trials" the literature was searched, and the latest update was performed April 2002. A total of 164 published RCTs were found reporting on outcomes of psychosocial treatment.

Results: Specific methods, i.e. theory based, well described and often manual based (motivational enhancement, cognitive behaviour therapy, interactional, well structured psychodynamic, 12 step programme) were better than general support. When comparing different specific treatment, no significant differences were found. There is little support for matching treatment to patient characteristics. Fifteen studies concerned subjects with comorbid psychiatric disorders, and there were no differences between the specific methods used. The psychosocial treatment for the substance use disorder should be coordinated with the treatment for the psychiatric disorder.

Conclusions: Specific methods targeting the substance abuse should be coordinated with treatment for the psychiatric disorder.



S - IX / 4 Thursday 14/8, 11:00-12:30
Psychopharmacological treatment, especially for patients with comorbidity

Mats Berglund, Professor, MD, Department of Clinical Alcohol Research, Malmö University Hospital, S-205 02 Malmö, Sweden

mats.berglund@alk.mas.lu.se

Background: Evidence-based treatment for alcohol dependence with medication has improved considerably during the last decade.

Methods: Systematic review of literature as a part of the Swedish SBU-report.

Results: In total, 104 published and 16 unpublished randomized controlled trials assessed the effects of medication on alcohol dependence. The agents acamprosate and naltrexone, have well-documented effects. Acamprosate significantly increases the rate of complete recovery while naltrexone significantly reduces alcohol abuse when the drug is combined with effective psychosocial interventions such as cognitive behavioral therapy. Antabus (disulfiram) is also documented as an effective method to reduce alcohol intake, but only when used under supervision. Drugs (antidepressants/buspirone) are effective in treating depression or anxiety in alcoholics. However, they have no confirmed effects on alcohol dependence.

Conclusion: Effective pharmacological treatment methods are available both for alcohol dependence and concomitant psychiatric comorbidity.



S - IX / 5 Thursday 14/8, 11:00-12:30
Educational assets. Addiction medicine

Marianne Månsson, Senior Physician, Addiction Centre, Malmö University Hospital, S-205 02 Malmö, Sweden

marianne.mansson@alk.mas.lu.se

Background: In 1992 a new clinical curriculum was introduced in the Medical School at Malmoe General Hospital, University of Lund. A 2-week problem based course in addiction medicine was created and integrated with the internal medicine/surgery courses during the fourth year. Three modules of the course were defined according to three different major goal sections; theoretical learning, attitude analysis, practical skills, and knowledge in specific clinical areas.

Methods: Theoretical learning: A specific textbook has been written defining the learning goals for medical schools. Attitudes: The students' attitudes towards alcohol drinking/drinkers are discussed in small groups. The objective of this exercise is to increase the students' awareness of different existing attitudes, including gender differences, and their impact on the clinician's readiness of obtaining adequate alcohol history when interviewing patients.

Practical skills: The identification of heavy drinking by clinical interview and subsequent intervention; assessment of alcohol/drug intoxication/withdrawal symptoms; ethics (case discussions in small groups relating to individual freedom versus community regulations of actions towards people with alcohol/drug dependence); prevention strategies; and spouse treatment.

Examination: One course-specific practical examination (i.e. alcohol interview/examination of professional patient) and one theoretical test (MEQ) as well as a test of clinical skills as a part of the total exam in internal medicine and surgery.
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