27th Nordic Psychiatric Congress

F - Free Papers

F - 1 / 1 Thursday 14/8, 15:00-16:00
Modest excess of obstetric complications in the offspring of bipolar mothers

James H. MacCabe Dr., Clinical Researcher, Division of Psychological Medicine, Institute of Psychiatry, London, and Dept. of Medical Epidemiology, Karolinska Institute, Stockholm, PO 63, Institute of Psychiatry, de Crespigny Park, London SE5 8AF. Lennart Martinsson, Paul Lichtenstein, Emma Nilsson, Robin M. Murray, Christina M. Hultman.

j.maccabe@iop.kcl.ac.uk

Background: The role of pregnancy and birth complications (PBCs) in the aetiology of bipolar disorder is unclear, with most studies showing weak associations. The question of whether the offspring of bipolar mothers are at increased risk of experiencing obstetric complications has not been investigated.

Aim: To use Swedish national registers to investigate the prevalence of 5 PBCs (stillbirth, neonatal death, pre-term delivery, low birth weight and smallness for gestational age) in the offspring of mothers with bipolar affective disorder.

Method: The study sample comprised data on 5,618 births to mothers with bipolar affective disorder, and 1,552,453 births to mothers without this diagnosis.

Results: We found modest elevations in risk for low birth weight (unadjusted OR 1.36 (95%CI 1.21-1.55)) and pre-term delivery (OR 1.29 (1.15-1.45)). These associations were attenuated, but remained significant, after adjusting for maternal age, parity, smoking, cohabitation, education level, immigrant status, and pregnancy-induced hypertensive disease. An additional unadjusted association with smallness for gestational age (OR 1.31 (1.13-1.51) was accounted for mainly by an excess of smoking in the bipolar group.

Conclusions: It appears that bipolar mothers have a modest excess of low birth weight and pre-term delivery in their offspring, which are not accounted for by smoking, nor by a range of other potential confounders. Possible explanations for this include a small genetic effect, medication effects, or misdiagnosis of some schizophrenic mothers as bipolar.



F - 1 / 2 Thursday 14/8, 15:00-16:00
Early risk factors for infantile autism: data from the Swedish Medical Birth Registry


Hultman CM, Research Fellow, Associate Professor, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Cnattingius S, Sparén P.

Christina.Hultman@mep.ki.se

Background: Etiologic hypotheses in infantile autism suggest a strong genetic component as well as possible environmental risks linked to early fetal development. We evaluated the association of maternal, pregnancy, delivery, and infant characteristics with risks of infantile autism.

Methods: We conducted a case-control study nested within a population-based cohort (all Swedish children born 1974-93). We used prospectively recorded data from the Swedish Birth Register, which was individually linked to the Swedish Inpatient Register. Cases were 408 children (321 boys and 87 girls) discharged with a main diagnosis of infantile autism from any hospital in Sweden before 10 years of age 1987-1994 and 2,040 matched controls. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: The risk of autism was associated with daily smoking in early pregnancy (OR = 1.4; CI = 1.1-1.8), maternal birth outside Europe and North America (OR = 3.0; CI = 1.7-5.2), Cesarean delivery (OR = 1.6; CI = 1.1-2.3), small-for-gestational-age (OR = 2.1; CI = 1.1-3.9), an Apgar score below 7 at 5 minutes (OR = 3.2, CI = 1.2-8.2), and congenital malformations (OR = 1.8, CI = 1.1-3.1). No association was found between autism and head circumference, maternal diabetes, being a twin or season of birth.

Conclusions: Our findings suggest that intrauterine and neonatal factors related to deviant intrauterine growth or fetal distress are important in the pathogenesis of autism.



F - 1 / 3 Thursday 1/8, 15:00-16:00
Childhood motor skills and persistent anxiety in early adult life


Engilbert Sigurðsson, Consultant Psychiatrist, Landspitali University Hospital, Department of Psychiatry, 101 Hringbraut, Reykjavík, Iceland

engilbs@landspitali.is

Background: Childhood motor impairment have been shown to be strongly associated with maternally rated persistent anxiety in male adolescents while no such association has been reported for female adolescents.

Aims: To test the hypothesis that childhood motor skills are associated with persistent anxiety in early adulthood.

Method: A historic cohort study. Post hoc analysis of data from the UK National Child Development Study (n=17,000) to put the hypothesis to the test within the 1958 UK birth cohort using an internal comparison group. Odds ratios were used to examine the effect of motor impairment on persistent anxiety after adjusting for sex, social class, birth weight, depressive symptoms and, by proxy, early-onset psychoses.

Results: No association was found between childhood motor delay and persistent anxiety in early adult life in the cohort. No effect modification by sex was observed unlike the findings for the same cohort in adolescence.

Conclusions: While childhood motor delay may be associated with persistent anxiety in adolescent males, this association does not seem to extend into adult life in the 1958 UK birth cohort.



F - 1 / 4 Thursday 14/8, 15:00-16:00
Depression and the incidence of first-ever stroke in 85-year olds

Ingmar Skoog, Professor, Institute of Clinical Neurosciences, Göteborg, University, Dept. of Psychiatry, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden. Liebetrau M, Steen B.

ingmar.skoog@neuro.gu.se

Background: Depression is common after stroke, but only little is known whether depression increases the risk for stroke.

Aims: To examine whether the prevalence of depression in a representative sample of 494 85-year olds from Gothenburg Sweden increased the incidence of first-ever stroke between age 85 and 88.

Methods: Depression was defined according to the DSM-III-R, based on information from a psychiatric examination at age 85. Information of first ever stroke between age 85 and 88 was obtained from hospital linkage system, death certificates, self-reports and key-informants. 85-year-olds with stroke at baseline were excluded.

Results: The prevalence of depression at age 85 was 13.0%. The relative risk for stroke incidence in those with depression compared to those without was 2.0 (95%-CI 1.0-3.8). This was only true in women (RR 2.2, 95%-CI 1.0-4.4), but not in men (RR 1.0, 95%-CI 0.0-7.2).

Conclusions: Depression is a risk factor for stroke in very old women, suggesting that treatment of depression may be a factor in stroke prevention.



F - 2 / 1 Thursday 14/8, 15:00-16:00
Non-pharmacological manipulations of central serotonergic neuro-transmission in humans

Broocks A. Prof. Dr. Med., Arzt für Neurologie, Psychiatrie und Psychotherapie Leitender Oberarzt, Klinik für Psychiatrie und Psychotherapie der Medizinischen, Universität zu Lübeck, Ratzeburger Allee 160, 23538 Lübeck. Schweiger U, Kordon A, Sommer M, Ehrenthal D, Hohagen F.

broocks.a@psychiatry.mu-luebeck.de

Serotonergic neurotransmission is involved in a number of neuropsychiatric disorders. Pharmacological treatments with antidepressants and other agents are known to modulate central serotonergic functions. However, there is evidence that certain behavioral factors such as eating behavior, motor activity, exposition to light, sleep withdrawal and smoking also affect serotonergic neurotransmission. For instance, regular endurance training, which has been used in the treatment of anxiety disorders and depression, is associated with decreased responses to the non-selective 5-HT2C agonist, m-CPP. Neuroendocrine responses to the selective 5-HT1A agonist, ipsapirone, are markedly affected by smoking. Current research tries to elucidate whether psychotherapeutic interventions also modulate central serotonergic function.

In conclusion, non-pharmacological interventions of serotonergic neurotransmission might be increasingly important in the treatment of neuropsychiatric disorders.



F - 2 / 2 Thursday 14/8, 15:00-16:00
Efficacy of thyroid hormone (T3) addition to paroxetine in major depression

Bente C Appelhof, MD1 , Room F5-173, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Jantien P Brouwer, MD1, Richard van Dyck, MD, PhD2, Eric Fliers, MD, PhD1, Witte JG Hoogendijk, MD, PhD2, Jochanan Huyser, MD, PhD3, Aart H Schene, MD, PhD3, Jan PG Tijssen, MD, PhD4, Wilmar M Wiersinga, MD, PhD1

1Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam. 2Department of Psychiatry, VU University Medical Center, Amsterdam. 3Department of Psychiatry, Academic Medical Center, University of Amsterdam. 4Department of Cardiology, Academic Medical Center, University of Amsterdam.

b.c.appehof@amc.uva.nl

Background and Aim: Guidelines for the treatment of major depressive disorder propose the addition of triiodothyronine (T3) to antidepressants as an augmentation strategy. However, evidence derives from relatively small studies and the efficacy of T3 has not been investigated in combination with selective serotonine reuptake inhibitors. We investigated the efficacy of T3-addition to paroxetine in major depression.

Methods: 113 patients with major depressive disorder and a baseline 17-item Hamilton Rating Scale for Depression (HRSD) score 16 were randomly assigned to 8 weeks of double-blind outpatient treatment with low dose T3 (25 ug), high dose T3 (25 ug twice daily) or placebo in addition to paroxetine 30 mg daily.

Results: 106 patients started treatment and were included in the outcome analysis. Response rate after eight weeks, defined as a reduction of HRSD score 50%, was 46% in all three treatment arms (p=0.99). Remission rate, defined as a HRSD score £8 at endpoint, was 32% in both T3 groups and 36% in the placebo group (p=0.92). Patients on T3-addition reported significantly more side effects than patients on placebo-comedication.

Conclusion: These results do not support a role for T3-addition to SSRI in the treatment of major depressive disorder.



F - 2 / 3 Thursday 14/8, 15:00-16:00
The cardiac effects of antipsychotics


Koponen H1, Professor, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014 Oulun Yliopisto, Finland. Saari K1, Pelkonen O2, Raatikainen MJP3, Savolainen MJ3, Isohanni M1

hannu.koponen@reimari.net

1Department of Psychiatry, 2Department of Pharmacology and Toxicology, and Department of Internal Medicine, 3University of Oulu, Oulu, Finland.

Antipsychotic medications are a mainstay in the treatment of psychotic disorders. It has, however, been observed that some antipsychotics may also have negative cardiovascular effects. Patients with treated schizophrenia have had higher rates of cardiac arrest and ventricular arrhythmia than controls, the ratios ranging from 1.7 to 3.2. The risk of sudden death is estimated to be about 2.4-fold in patients taking antipsychotics compared to persons who do not use antipsychotic drugs.

The causes of sudden death associated with antipsychotics use are poorly understood. In addition to smoking, the metabolic disturbances predispose to cardiovascular diseases, which together with poor treatment compliance and a possibly delayed diagnosis of somatic illnesses increase the risk of cardiovascular morbidity and sudden death. At least in part of the cases, the cause of sudden death is torsades de pointes caused by the proarrhythmic effect of the antipsychotic drug, sometimes probably associated with metabolic interactions and pharmacogenetic deficiencies. In addition, the effect of antipsychotics on the autonomous nervous system as well as on lipid and glucose metabolism may also contribute. In addition, some antipsychotic drugs also have direct effects on the ion channels in the heart.

Although dangerous arrhythmia is only rarely caused by antipsychotics, their safe use calls for care in patient selection, drug dosage, awareness of interactions and patient monitoring discussed in the presentation. The significance of less dangerous but unpleasant cardiac side effects should also be considered when making decisions on drug treatment of psychotic patients.

References

  • Ray WA, Meredith S, Thapa PB, Meador KG, Hall K, Murray KT. Antipsychotics and the risk of sudden cardiac death. Arch Gen Psychiatry 2001; 58: 1161-7.
  • Witchel HJ, Hancox JC, Nutt DJ. Psychotropic drugs, cardiac arrhythmia, and sudden death. J Clin Psychopharmacol 2003; 23: 58-77.


F - 2 / 4 Thursday 14/8, 15:00-16:00
Schizophrenia, neuroleptic medication, and mortality


Matti Joukamaa, Professor of Social Psychiatry, University of Tampere, Finland, Kajaaninkatu 28 A 17, FIN-90100, Oulu, Finland. Markku Heliövaara, Paul Knekt, Arpo Aromaa, Raimo Raitasalo, Ville Lehtinen.

matti.joukamaa@uta.fi

In the Mini-Finland Health Study comprising a representative population sample of Finns aged 30 or more (N=7217), we analysed the mortality of schizophrenics (N=99). A comprehensive health examination was carried out at baseline. Mental disorders were determined using the 36-item version of the General Health Questionnaire and the Present State Examination. During the 17-year follow-up 39 of the 99 schizophrenics died. The number of neuroleptic drugs the schizophrenics used by the time of the baseline survey was directly proportional to their subsequent risk of dying. Adjusted for age and sex, the schizophrenics using one, two and three or more neuroleptics had a relative risk (95% confidence interval) of 2.7 (1.5-5.0), 3.3 (2.0-5.4) and 7.6 (3.8-15.3), respectively. After further adjustment for somatic diseases and other potential risk factors for dying (smoking, blood pressure, LDL and HDL cholesterol, body mass index, and physical activity), schizophrenia and the number of neuroleptic drugs the patients used still predicted premature mortality. There remains an urgent need to clarify whether the high mortality among schizophrenics is mainly attributable to the disorder per se or the antipsychotic medication.



F - 3 / 1 Thursday 14/8, 15:00-16:00
Severity of anxiety and risk of depression

Jón G. Stefánsson1, Psychiatrist, Landspítali University Hospital, Reykjavík, Iceland. H Óskarsson2, H Kolbeinsson1, Þ Þorgeirsson3, Nikolai Gagunashvili3, J Gulcher3, K Stefánsson3.

1Landspítali University Hospital, 2Therapeia Reykjavík, 3deCode Genetics, Reykjavík, Iceland.

jongst@landspitali.is

Objective: To investigate the frequency of depressive disorders (Major Depressive Disorder and/or Dysthymia) among persons with Anxiety Disorders.

Method: The study is based on the screening for anxiety in a population sample, followed by diagnostic work-up with the computerized version of the Composite International Diagnostic Interview (CIDI). ICs have to meet criteria for either an ICD-10 or a DSM 3-R anxiety diagnosis. The number of anxiety disorders for each IC was calculated and their Odds Ratio (OR) of receiving a diagnosis of depressive disorders.

Results: 1.136 cases were diagnosed with a lifetime diagnosis of anxiety disorders. The co-occurrence of other anxiety disorders is highest in Panic Disorder, with an average of 2.7 per IC, but lowest in Social Phobia, 1.7 per IC (P<0.001). The co-morbidity of anxiety with depressive disorder is also found to be high (66.9%); the highest OR is found in Generalized Anxiety Disorder (6.6) and Panic Disorder (4.5). With multiple anxiety disorders the risk of co-morbid depressive disorder is increased, the difference between those with one or five disorders being highly significant (P<0.001).

Conclusions: Co-morbidity between the anxiety disorders is high, a possible explanation being that the anxiety disorders have common origins, with PD being the most severe form of these disorders. The linear relationship between depression prevalence and number of anxiety co-morbid conditions points to common etiological factors in the genesis of these disorders.



F - 3 / 2 Thursday 14/8, 15:00-16:00
Panic disorder and anxiety comorbidity - parallels in the age of onse


Högni Óskarsson, Psychiatrist, Therapeia, Suðurgötu 12, 101 Reykjavík, Iceland. H. Kolbeinsson, E Líndal, Þ Þorgeirsson, J Gulcher, K Stefánsson, JG Stefánsson.

Aims: To clarify the interrelationship between comorbid anxiety disorders by analysing parallels in their age of onset, using Panic Disorder (PD) as a reference point.

Methods: Original sample based on a population screening for anxiety in Iceland, followed by diagnostic work-up based on the Composite International Diagnostic Interview. Our analysis was based on three Age of Onset (AGO) PD subgroups and AGO of the comorbid anxiety disorders.

Results: 1.134 individuals received a lifetime anxiety disorder diagnosis, 252 had PD. A third had developed PD before age 16, 79% by age 30, averaging 2.8 comorbid lifetime anxiety diagnoses. Within the age group range the rise in AGO of each comorbid anxiety disorder is statistically significant (P<0.001). The rise in AGO of Major Depression through the age groups is significant only when the two first age groups are combined and compared with the oldest group (P<0.001). There is no significant rise in AGO of dysthymia. Anxiety comorbidity is highest in those whose PD starts early (P<0.001).

Conclusion: Anxiety disorders comorbid with Panic Disorder, have their onset in close relation to the onset of Panic disorder. Through analysing AGO and comorbidity among anxiety disorders we conclude that there is a common trait diathesis to anxiety disorders.



F - 3 / 3 Thursday 14/8, 15:00-16:00
The prevalence of bipolar disorders in a group of persons with panic disorder

Jón G. Stefánsson1, Psychiatrist, Landspítali University Hospital, Reykjavík, Iceland. H Kolbeinsson1, Þ Þorgeirsson3, E Líndal1, J Gulcher3, K Stefánsson3, H Óskarsson2.

1Landspítali University Hospital, 2Therapeia Reykjavík, 3deCode Genetics, Reykjavík, Iceland.

jongst@landspitali.is

Aim: To study the prevalence of bipolar disorder (BPD) in a group of persons with panic and other anxiety disorders.

Method: Participants were recruited in two stages: 1) A population screening for anxiety and depressive disorders and by aggregation into extended families with the help of deCODE´s Genealogy Database; 2) Those fulfilling diagnostic and family aggregation criteria received a further diagnostic work-up based on the Composite International Diagnostic Interview (CIDI-AUTO). Screening for anxiety and depression in close relatives also identified additional cases. DSM III-R criteria for lifetime diagnosis of PD and BPD were used.

Results: The lifetime prevalence of anxiety disorders and BPD in an Icelandic population sample and in the present sample, so called genetic sample of 1923 persons, were compared. Diagnostics in both groups were based on the CIDI. 252 (13.1%) in the genetic sample were diagnosed with PD, and of those 11.1% had BPD. In the population group the prevalence of BPD was 3.9%. As is to be expected the prevalence of anxiety disorders is considerably higher in the pre-selected genetic cohort than the population sample.

Conclusions: The group studied is selected to include an increased number of persons with anxiety and depression. In general, the prevalence of these disorders is increased in this group compared to a general population group, most for panic disorder (13.1% v. 1.8%). The prevalence of BPD is increased in all the anxiety disorders but most in panic disorder and in OCD.



F - 3 / 4 Thursday 14/8, 15:00-16:00
Prevention of posttraumatic stress disorder after acute traumatisation

Broocks A. Prof. Dr. Med., Arzt für Neurologie, Psychiatrie und Psychotherapie Leitender Oberarzt, Klinik für Psychiatrie und Psychotherapie der Medizinischen Universität zu Lübeck, Ratzeburger Allee 160, 23538 Lübeck. Nitsche M, Rumpf HJ, Backhaus J, Hohagen F.

broocks.a@psychiatry.mu-luebeck.de

Posttraumatic Stress Disorder (PTSD) can develop as a consequence of different traumata. Acute adjustment disorder after the trauma and prior depressive or anxiety disorder are associated with a high risk of developing PTSD. During the last decade, different approaches have been tried in order to prevent the development of PTSD. Debriefing techniques, cognitive-behavioral programs and pharmacological approaches will be presented and discussed with respect to early recognition and prevention of PTSD.



F - 4 / 1 Thursday 14/8, 15:00-16:00
Psychiatric diagnosis and sense of coherence in suicide attempters

Sjöström N, SRN, PhD Student, Section of Psychiatry, Institution of Clinical Neuroscience, Sahlgrenska Academy, Blå Stråket 15, 413 45 Göteborg, Sweden. Hetta J, Sundin M, Ågren L-L, Waern M.

nils.sjostrom@neuro.gu.se

Background: A total of 1380 persons died following suicide in Sweden in 2000. This is the lowest figure reported since 1969. However, the trend is not as favourable for patients who have received psychiatric treatment. Poor ability to cope with stressful life events may be one explanation for this.

Aim: The aim of this descriptive study was to examine sense of coherence (SOC) in diagnostic subgroups of suicide attempters.

Methods: Ninety-five patients aged 18-61 who were admitted to medical units/psychiatric wards at Sahlgrenska University Hospital after a suicide attempt during the period 011001-020930 participated in the study. Specially trained nurses performed structured clinical interviews according to SCID-I within 72 hours of the suicide attempt. The patients completed the Sense of Coherence self-report instrument.

Results: Most of the patients (n=85) fulfilled the criteria for any axis-I syndrome. Major depression (n=32), alcohol misuse (n=19), adjustment disorder (n=16), generalized anxiety disorder (n=14), and depression NOS (n=13) were the most common diagnoses. SOC scores will be compared in the different diagnostic subgroups.

Conclusions: Suicide attempters represent a heterogeneous patient group. Psychosocial treatments aimed at improving the patient's sense of coherence may provide an important complement in the nursing plan for the suicidal patient.



F - 4 / 2 Thursday 14/8, 15:00-16:00
Psychosocial follow-up after parasuicide in Norwegian general hospitals


Mehlum L, MD, PhD, Professor of Psychiatry and Suicidology, Director Suicide Research and Prevention Unit, University of Oslo, Sognsvannsvn 21, Bygg 20, 0320 Oslo, Norway. Mork E, Ekeid G, Ystgaard M, Holte A.

lars.mehlum@psykiatri.uio.no

Background: Routines and standards of care for parasuicide patients in general hospitals in Norway were reviewed in relation to international and national recommendations.

Material and methods: Telephone interviews were conducted with personnel at all Norwegian general hospitals with emergency units. Fifty-five of a total of 58 hospitals participated (95%).

Results: Two thirds of the hospitals reported that most parasuicide patients were routinely psychiatrically evaluated and then referred to psychiatric or community aftercare. At almost half of the hospitals (46%) the staff had, however, not received any specific training in clinical management of parasuicide patients during the last three years. Structured collaboration, regarding parasuicide patients, with external aftercare providers was non-existent in 43% of the hospitals. Hospitals with specific projects aimed at psychosocial follow-up of parasuicide patients or hospitals with a specific team or a person responsible for the follow-up, scored, however, significantly higher on a wide range of supplementary measures for the quality of care for parasuicide patients than hospitals without projects or teams.

Interpretation: The study shows great variations between Norwegian general hospitals in their routines and standards of care for psychosocial follow-up of parasuicide patients. Increasing the staff's competence, developing written routines and establishing mutually binding co-operation between the hospital and external caregivers are important areas for further development. To establish a specific local team or key person dedicated to this type of work seems clearly to increase the quality of care for parasuicide patients.



F - 4 / 3 Thursday 14/8, 14:00-15:00
Suicide assessment - evaluation of SUAS, a scale assessing suicidality


Anders Niméus MD, PhD, Dept. of Psychiatry, Inst. of Clinical Neuroscience, Lund University, S-221 85 LUND, Sweden, Fredrik Hjalmarsson, Lil Träskman-Bendz

anders.nimeus@psykiatr.lu.se

The Suicide Assessment Scale (SUAS) was developed to be sensitive to change in suicidality. It was recently found to be predictive of suicide in a group of suicide attempters. Our aim in this study was to evaluate the reliability and validity of a new interview-version of SUAS with defined scores and also a new self-rating version. We used an already available material from 42 subjects, who had a ten-year history of inpatient care because of a suicide attempt. The subjects had been rated according to several different rating scales both ten years ago and recently, at follow-up. Interrater reliability was found to be high. Individuals with a principal axis I diagnosis scored significantly higher than those with no such diagnosis. We found the self-rated scale to correlate significantly with the interview-rated SUAS, thus exhibiting good concurrent validity. SUAS seems to be a valid, reliable and easily used suicide assessment instrument, both in research and in clinic. Hopefully, this scale could become a valuable tool in assessing suicidality in a general psychiatric population.



F - 4 / 4 Thursday 14/8, 15:00-16:00
Repetition of suicidal behaviour following deliberate self-poisoning with pesticides

Naudts KH, MD, Department of Psychiatry, Ghent University, 9000 Ghent, Belgium. Van den Eynde F, Portzky G, Audenaert K, Van Heeringen.

kris.naudts@hotmail.com

Background: A previous suicide attempt brings with it an increased risk of subsequent suicidal behaviour.

Aims: To find out to what extent deliberate self-poisoning with pesticides is associated with subsequent suicidal behaviour.

Methods: There were 3483 referrals (during 8 years) following a suicide attempt, including 2654 cases of self-poisoning (76 %). In 42 patients (2 %), there was involvement of pesticides. Four patients died. Of the remaining 38 patients, 22 were men (58 %), 16 were women (42 %). The mean age was 42 (17-79). Substances involved were organophosphates (94 %) and carbamates (6 %). Organophosphates were combined with alcohol (11 %) / drugs (3 %).

Results: Repetition of suicidal behaviour was assessed on average 74.3 (1-120) months after referral. Repetition of suicidal behaviour was found in 3 patients (8 %). One was re-admitted due to severe suicidal ideation. Repetition with non-fatal outcome was found in 2 patients. One patient committed suicide by means of self-poisoning 41 days after the index intoxication.

Conclusions: This retrospective cohort study showed that deliberate self-poisoning with pesticides is not associated with an increased risk of subsequent suicidal behaviour. The repetition rate was clearly lower than that found in our longitudinal study of a large sample with a shorter follow-up period.

Reference



F - 5 / 1 Friday 15/8, 15:00-16:00
Villa Sana, Modum Bad, the counselling and coursing centre for doctors in Norway

Karin Isaksson Rø, Medical Doctor, Modum Bad, Norway, 3370, Vikersund, Norway

karin.roe@modum-bad.no

Background: At Modum Bad, a psychiatric hospital with patients referred from all of Norway, health personnel in need of treatment have traditionally been given high priority. Over the years an impression was formed that doctors often seek treatment late in the course of disease. The Norwegian Medical Association, in co-operation with Modum Bad, has therefore initiated a project where doctors can come for counselling and coursing. The intention is to give a low-threshold offer to doctors, with an opportunity to reflect over their situation and a possibility for the counsellor to give advice.

Aim: The aim of the project is three-fold: to strengthen the identity as a doctor; to promote health and quality of life; to prevent burn-out. Since the start in 1998, more than 450 doctors have made use of this possibility. A short evaluation, filled out in connection with the counselling or the course, has clearly shown the participants satisfaction.

The presentation will describe the project in more detail, and present a planned, extended evaluation.



F - 5 / 2 Friday 15/8, 15:00-16:00
Efficacy of group psychotherapy combined with art- and body-awareness therapies

Ingvar Kristjánsson, Psychiatrist, Department of Psychiatry, The University Hospital, Reykjavík, Adr.: Dagdeild Geðdeildar LSH, Hvítabandi Skólavörðustíg 37, 101 Reykjavík, Iceland. Anna K. Kristjánsdóttir, Halldóra Halldórsdóttir, Ragnheiður Indriðadóttir, Anna Þóra Kristinsdóttir, Anna María Jónsdóttir.

ingvar@centrum.is

Background: Non-verbal and creative arts psychotherapy methods have been used in combination with conventional psychotherapies or as an alternative to them for patients with various difficult-to-treat psychiatric disorders. A program combining analytic group therapy with art therapy and body-awareness therapy was established at a Day Hospital in Reykjavik in 1979. Most of the patients treated there have had very traumatic early experiences, have personality disorders and are already a heavy burden on health and social services.

Aims: The aims of this study are to assess the results of this long-term combination therapy and define which patients make the best use of it.

Methods: On admission and at intervals during their stay at the Day Hospital the patients filled in the following self rating scales: Beck's Depression Inventory, Symptom Check List 90, Gough's Socialization Inventory, Eysenck's Personality Inventory and a form for assessment of body image. The number of patients studied is 87 and a great majority of them are female. More than half of the patients (47) filled in the questionnaires more than once but 40 patients scored only once, as they did not stay on in therapy.

Results: Analysis of this material is underway and will be presented at the conference.



F - 5 / 3 Friday 15/8, 15:00-16:00
Integrated psychosomatic medicine in a department of acute internal medicine as part of the psychosocial service provision of a metropolitan area


Steffen Haefner, Dr., Centre for Psychotherapy Research, Christian-Belser-Str. 79a, 70597 Stuttgart, Germany. Rainer Schaefert, Joachim Roehm, Hans Wedler.

haefner@psyres-stuttgart.de

Background/aims: The study evaluates the integration of a hospital for internal medicine in the psychosocial health care system of a South German metropolitan area (Stuttgart).

Method: During a nine-months study period, data of all patients admitted to the hospital were collected about the way of admission to the hospital, treatments prior to admission, days in hospital, somatic and psychosomatic diagnoses according to ICD-10, the treatment on the wards, and the treatment after discharge. At admission and for the catamnestic evaluation 6 months after discharge, patients were given the SCL-90-R-questionnaire.

Results: A total of 1.250 treatment episodes could be included in the study: 245 (19.%) were classified as psychosomatic patients, 232 (18.6%) as patients with addictive behaviour, 25 (2.0%) as psychiatric patients, and 748 (59.8%) as internal-somatic patients. 55.5% of psychosomatic patients have not had any kind of psychosocial treatment during the last 12 months prior to admission to hospital. 84.1% of the psychosomatic patients were recommended for further psychosocial treatment after discharge. GSI of SCL-90-R was reduced from 1.20+0.74 to 0.92+0.80.

Conclusion: The low rate of patients with psychosocial treatment before admission to the hospital emphasizes the important switch function of the department for further treatment.



F - 5 / 4 Friday 15/8, 15:00-16:00
Organization of old age psychiatry in Norway: Past, present and future

Ásgeir Bragason, MD, Psychiatrist. Chairman of the Working Group for Old Age Psychiatry, Norwegian Psychiatric Assoc., Diakonhjemmet Hospital, Oslo, PB 23 Vinderen, 0352 Oslo, Norway. Knut Engedal.

asgeir1@msn.com

Background: Old Age Psychiatry has existed in Norway for about 30 years. It has been developing rapidly since 1990. The Working Group for Old Age Psychiatry (Norwegian Psychiatric Association) has collected information regarding the field in Norway.

Aims: To describe the field of Old Age Psychiatry in Norway, past, present, and future.

Method: Results of queries answered by Norwegian Old Age Psychiatrists in 1990, 1995, and 2001.

Results: There was no specialized outpatient department in 1990, 14 in 2001. There were 15 consultant appointments in 1990, 39 in 2001, internships increased from 10 to 22 and psychologists from 10 to 31. The number of beds decreased while the number of admissions has increased. The length of admissions has decreased dramatically. The number of outpatient consultations increased from 4469(1451) in 1995 to 7152(2526) in 2001. The number of PhD's within the field increased from 1 to 5.

Conclusions: Old Age Psychiatry is rapidly expanding in Norway and is seeing more patients than ever. The length of admissions is steadily decreasing. More patients are being treated as outpatients. The academic activity is increasing but is still low, especially regarding depression and psychotic disorders. In our view the field of Old Age Psychiatry in Norway is now mature enough to become a subspecialty.



F - 6 / 1 Friday 15/8, 15:00-16:00
Quality of life in patients with implantable defibrillators compared to that of pacemaker recipients


Margrét Leósdóttir1, Sigurðsson E1, Reimarsdóttir G1, Gottskálksson G1, Vigfúsdóttir M1, Torfason B1, Eggertsson S2, Arnar DO1

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

Introduction: While indications for Implantable Cardioverter Defibrillators (ICD) continue to proliferate, questions remain regarding the quality of life of these patients. Some studies indicate a poorer quality of life for ICD patients than the general population. However, studies comparing the quality of life of ICD patients with that of patients with other implantable cardiac devices are lacking.

Aims: To test the hypothesis that ICD patients have a poorer quality of life than pacemaker patients.

Methods: The Icelandic Quality of Life Questionnaire (IQL) was submitted to 41 ICD patients (mean age 62 years) and a comparison group of 61 patients with pacemakers (mean age 64 years). Additionally, questions regarding topics, which might be of relevance to ICD patients, were administered.

Results: No difference was found between the ICD and pacemaker groups on IQL scores. However, ICD patients were slightly more fearful of death (p=0,07) and towards returning to work (p=0,07) than pacemaker patients but this fell just short of statistical significance in our relatively small sample.

Conclusion: Contrary to our predictions, the overall quality of life among ICD patients was similar to that of pacemaker recipients.



F - 6 / 2 Thursady 15/8, 15:00-16:00
Amyloid beta-peptide pathology in demented elderly patients with schizophrenia

Religa D1,2, MD, PhD Student, Neurotec, Karolinska Institutet, KFC, Novum, plan 4, 141 86 Stockholm, Sweden, Laudon H2, Styczynska M1, Winblad B2, Naslund J2, Haroutunian V3.

1CMDiK, PAN, Warsaw, Poland, 2Karolinska Institutet, Neurotec, Stockholm, Sweden, 3MSSM/BVAMC, Bronx, NY, USA

dorota.religa@neurotec.ki.se

Objective: Severe cognitive impairment is common in elderly patients with schizophrenia. Alzheimer's disease (AD) is the main cause of dementia among the elderly. Biochemical and genetic studies suggest that amyloid beta-peptide (Ab) is central in AD. We examined the possible involvement of Ab in cognitive impairment in schizophrenia.

Method: Specific antibodies against two major forms of Ab, Ab40 and Ab42, were used in ELISA assays to determine the levels of Ab in postmortem brains from AD patients (N=10), controls (N=11), and schizophrenia patients with (N=7) or without (N=26) AD.

Results: The levels of amyloid b-peptide were highest in the AD, followed by the patients with schizophrenia and controls. The mean Ab42 level in the schizophrenia patients without AD was similar to that in the controls, but the level in the schizophrenia patients with AD was significantly higher than in those without AD or controls. The Ab42 level in the schizophrenia patients with AD was significantly lower than the level in the AD.

Conclusions: In contrast to elderly schizophrenia patients with AD pathology, those without AD had Ab levels that were not significantly different from those of normal subjects; hence Ab does not account for the cognitive deficits in this group. These results suggest that the causes of cognitive impairment in "pure" schizophrenia are different from those in AD. The decrease of Ab in schizophrenia patients with AD as compared to patients only with AD may be due to the neuroleptic treatment or the heavy smoking, as haloperidol and nicotine decrease the Ab levels.



F - 6 / 3 Friday 15/8, 15:00-16:00
Simvastatin treatment lowers both alpha- and beta-cleaved app in Alzheimer's disease

Magnus Sjögren, Associate Professor, Institute of Clinical Neuroscience, SE413 45 Goteborg, Sweden. K Gustafsson, S Syversen, A Olsson, A Wallin, K Blennow.

magnus.sjogren@medfak.gu.se

We investigated the clinical and biological effects of cholesterol-lowering treatment with a statin in 19 patients with Alzheimer's disease. All patients received simvastatin 20 mg/day for 12 weeks in an open trial. Primary efficacy parameters were the changes after 12 weeks in the cerebrospinal fluid (CSF) levels of beta-amyloid42 (AB42), alpha-secretase-cleaved APP (alpha-sAPP), beta-secretase-cleaved APP (beta-sAPP), tau, phospho-tau and the plasma levels of beta-amyloid (AB). A secondary efficacy parameter was the change in ADAS-cog score. After 12 weeks, CSF alpha-sAPP and CSF beta-sAPP were significantly reduced (p<0.001), but the CSF levels of tau, phospho-tau, AB42 and the plasma levels of AB were unchanged. The ADAS-cog score was slightly increased (p<0.05). Furthermore, a decrease in total-cholesterol levels was found at 12 weeks although all patients had normal levels at baseline. The results suggest that simvastatin acts directly on the processing of APP by inhibiting both the alpha- and the beta-secretase pathways. Results of 12-month follow-up and comparison with the effects of statin treatment in vascular dementia will also be presented.



F - 6 / 4 Friday 15/8, 15:00-16:00
Co-occurrence of anxiety, depression and alcholism


Halldór Kolbeinsson, MD, Psychiatrist, Landspítali University Hospital, Reykjavík, Dept. Psychiatry at Kleppur, Iceland. H Óskarsson, JG Stefánsson, Þ Þorgeirsson, K Stefánsson.

halldork@landspitali.is

Aims: To investigate the co-occurrence of depressive disorders and alcoholism among subjects diagnosed with anxiety disorders.

Method: The study is based on the screening for anxiety and depression in a population sample, followed by diagnostic work-up with the computerized version of the Composite International Diagnostic Interview (CIDI). ICs have to meet criteria for either an ICD-10 or a DSM 3-R anxiety diagnosis.

Results: 1.136 cases were diagnosed with a lifetime diagnosis of anxiety disorders. Thereof 67% had a depressive disorder. Co-morbid alcoholism was found in 31.8% of those with anxiety; 19.8% of the females and in 48,5% of the males. The presence of depression with anxiety would increase the number of those with alcoholism. The mean Age of Onset (AGO) of alcoholism in this group is 24.8 years; the AGO of all the anxiety disorders, except Generalized Anxiety Disorder, have an earlier onset. AGO of depression is 25.3 years.

Conclusion: The prevalence of alcoholism is high in our cohort of individuals with anxiety disorders, much higher than expected when compared with prevalence studies of alcoholism in the Icelandic population. The co-morbidity of alcoholism was still higher when there was co-occurrence of depression and anxiety disorders. It is noteworthy from an etiological point of view that alcoholism rarely precedes the onset of most affective disorders.



F - 7 / 1 Friday 15/8, 15:00-16:00
Patterns of antipsychotic use and side-effects in a 1st episode psychosis service


Páll Matthíasson, Dr., Section of Early Psychosis, Institute Of Psychiatry, Institute Of Psychiatry, PO BOX 67, DeCresigny Park, London SE4 1AR, UK. P Power, P McGuire.

p.matthiasson@iop.kcl.ac.uk

Background: Lambeth, an inner city area in South London has a very high incidence of psychosis. Patients are managed by The Lambeth Early Onset (LEO) service, a specialised community team, those with severe symptoms are admitted to a 18-bed inpatient unit.

Aims: This audit looked at patterns of antipsychotic use in the LEO service.

Methods: We reviewed patterns to care, diagnoses, antipsychotic medication and side-effects in patients with 1st episode of psychosis presenting over a 12-month period. This was a retrospective case note review over the first 3-6 months of each individual's treatment.

Results: Fifty-two patients (28 males, 24 females) were enrolled, just over half of admissions. The majority presented with non-affective psychosis. The most commonly used antipsychotics were risperidone, olanzapine and quetiapine. The doses prescribed were low and there was a good clinical response in the majority of cases. Side-effects occurred in 39% of patients. In 13.5% they led to withdrawal of medication. One patient had repeated urinary retention, one developed diabetes mellitus.

Conclusions: The results indicate that in a first episode population, atypical antipsychotic medication is effective in low doses. However, side-effects can still occur, presumably reflecting increased sensitivity to both the therapeutic and adverse effects of antipsychotics.



F - 7 / 2 Friday 15/8, 15:00-16:00
Eighteen-month outcome of the early treatment and home-based outreach service (ETHOS)


Dr. Swaran P. Singh, Consultant Psychiatrist & Senior Lecturer, St. George's Hospital Medical School, Department of Mental Health, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. Helen L. Fisher.

ssingh@sghms.ac.uk

Aim: To evaluate the effectiveness of an early intervention service in improving the outcome of first-episode psychosis.

Background: ETHOS is a tertiary early intervention service providing a community-based comprehensive package of care to young people (aged 17-30) with a first ever presentation for psychosis living in the boroughs of Merton, Sutton and Wandsworth (total population 627,000; 1998 estimate) in Southwest London, UK.

Method: A case-notes review was conducted of all patients referred to ETHOS between 1st June 2001 and 31st December 2002. Data were collected on socio-demographic, clinical and service variables. Outcomes were assessed using each patient as their own historical control, comparing psychiatric care prior to ETHOS and that provided by ETHOS, standardising for time spent within the respective services.

Results: In its first 18 months, 41 patients were accepted into the service (73% male; mean age 22 years; 54% White; 61% unemployed; median duration of psychosis at referral to ETHOS of 163 days). As compared to their previous psychiatric care, patients experienced higher levels of contact with their care co-ordinators (Z = -4.2, p <.0005); a reduction in self-harm (Z = -3.0, p < .005) and harm to others (Z = -3.1, p < .005); less use of inpatient facilities (Z = -3.6, p < .0005); and had greater structure to their day (29.3% vs. 65.9%).

Conclusions: ETHOS has managed to improve patient outcomes, decrease hospitalisation and reduce risk behaviours with modest resources. Well-resourced early intervention services should improve outcomes even further.



F - 7 / 3 Friday 15/, 15:00-16:00
Neurocognitive function in 1st episode schizophrenia. A functional MRI study


Páll Matthíasson, Dr., Section of Neuroimaging, Institute Of Psychiatry, Institute of Psychiatry, PO BOX 67, DeCresigny Park, London SE4 1AR, UK. M. Picchioni, S. Williams, P. McGuire.

p.matthiasson@iop.kcl.ac.uk

Background/Aims: Little is known about brain activation patterns in 1st episode psychosis, we explored this.

Methods: An fMRI study in patients suffering a 1st episode of psychosis. They met DSM-IV criteria for schizophrenia/schizophreniform psychosis and had <28 days antipsychotic medication. fMRI was acquired using a 1.5T MRI scanner. Four on-line blocked design tasks were chosen and selected to engage cognitive processes impaired in schizophrenia. Off-line test batteries included WAIS, NART, WCST, Hopkins Verbal Memory Test and Stroop.

Results: We scanned 10 patients/12 controls, matched for sex, age, race, and IQ. Mean treatment duration was 8 days. 1) Motor task: Greater engagement of motor system in controls. Patients failed to show normal suppression of activity. 2) N-back task: Greater prefrontal and cingulate activation in patients, greater parietal and temporal activation in controls. 3) Verbal fluency: Attenuated engagement of dorsolateral prefrontal, anterior cingulate and cerebellar cortex in patients. 4) Object location task: Greater engagement of right insular and parietal cortex in patients and attenuated activation in hippocampal, cerebellar cortex etc, only shown when higher demands.

Conclusions: The activation pattern in 1st episode psychosis is complex and dependent on task difficulty. This can help in assessing subtle medication effects at the start of treatment.



F - 7 / 4 Friday 15/8, 15:00-16:00
Influence of co-morbid substance misuse on outcome in schizophrenia


Fiona Hynes Dr. Cambridge & Peterborough Partnership NHS, The Yews, Box 353, Fulbourn Hospital, Fulbourn, Cambridge, CB1 5EF UK. Blackwell C, Gervin M, Jones P, and the CUtLASS study team.

fhynes@doctors.org.uk

Background: Co-morbid substance abuse is recognised in schizophrenia and has been reported to have a number of adverse effects on outcome. Few studies have described longitudinal follow-up.

Aims: To determine the impact of co-morbid substance abuse on symptoms and functioning.

Method: An opportunistic study of co-morbid substance misuse was carried out during a single blind randomised prospective study of conventional vs atypical drug treatment. People with DSM-IV schizophrenia, schizophreniform, schizoafffective, and delusional disorder were followed up for one year. Substance misuse was assessed using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) at baseline. Functioning was assessed using the Quality of Life (QoL) interview and the GAF while the Positive and Negative Symptom Scale (PANSS) was used to assess symptom severity.

Results: 121 patients were recruited into the trial and 101 patients were followed up. Of these 75 were male (74.3%) and 26 (25.7%) female with a mean age of 42.3 years (s.d.11.13, range 18-65). No difference was found in outcome between those with a history of harmful use and dependence in terms of symptomatology and functioning.

Conclusions: Co-morbid substance may have a less marked effect on outcome than previously thought, however the sample group limits the findings in this study.

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