bluuebunny/crossref_metadata_2025 huggingface dataset:
PW01-17 - Attention Deficit Hyperactivity Disorder (ADHD) Medication Utilization and Expenditures in the Texas Medicaid Program: Comparison by Medication Class
Authors: Lawson K. , Johnsrud M. , Crismon M.L. , Hodgkins P.
Published: June 2010

Objectives

To determine if utilization and expenditures differ between ADHD medication classes.

Methods

Prescription and medical claims for Texas Medicaid patients with an ADHD diagnosis newly initiated on an ADHD medication (no previous use for 180 days) between January 2006 and September 2007 were analyzed. Logistic and linear regression analyses were used to evaluate differences in adherence, persistence, switching, and expenditures during a 180-day post-initiation observation period across ADHD treatment classes [immediate-release methylphenidate (IR-M) and amphetamines (IR-A) and extended-release methylphenidate (ER-M) and amphetamines (ER-A)] with relevant demographic and pre-initiation period comorbidities, utilization, and expenditure variables as covariates. Because prior authorization was required, the non-stimulant medication atomoxetine was excluded.

Results

The sample consisted of 15,055 subjects with 71% aged 6 to 12 years; 64.7% were initiated on ER-M and 25.4% on ER-A. Compared to the ER-A group, the IR-M (OR=0.56, 95%CI=0.45-0.69) and IRA (OR=0.60, 95%CI=0.46-0.78) groups were less likely to be adherent, more likely to discontinue therapy (OR=2.03, 95%CI=1.67-2.47; and OR=1.77, 95%CI=1.38-2.27; respectively) and more likely to switch medications (OR=2.44, 95%CI=2.05-2.90; and OR=2.85, 95%CI=2.28-3.56; respectively) (all p< 0.001). The ER-A group had significantly higher ADHD medication expenditures compared to other groups (all p≤0.001), but no significant differences in medical expenditures.

Conclusions

Utilization patterns differed across the ADHD medication classes. Most subjects were initiated on ER medications which demonstrated advantages in adherence, persistence, and less switching while the ER-A group, which included more complex patients as indicated by comorbidities, had higher ADHD medication expenditures but no difference in overall medical expenditures.
PW01-18 - Utilization and Expenditures for Lisdexamfetamine Dimesylate Compared to Other Attention-Deficit/Hyperactivity Disorder (ADHD) Medications in the Texas Medicaid Program
Authors: Lawson K. , Johnsrud M. , Sasane R. , Hodgkins P. , Crismon M.L.
Published: June 2010

Objectives

To determine if utilization and expenditures differ between a newly-marketed (at time of study) ADHD medication (lisdexamfetamine dimesylate [LDX]) and existing medications.

Methods

Prescription and medical claims for Texas Medicaid patients diagnosed with ADHD newly initiated on an ADHD medication (no previous use for 180 days) during August and September 2007 were analyzed. Logistic and linear regressions were used to evaluate differences in adherence, persistence, switching, and expenditures during a 180-day post-initiation period between the LDX group and existing medications (immediate-release methylphenidate [IR-M] and amphetamines [IR-A] and extended-release methylphenidate [ER-M] and amphetamines [ER-A, excluding LDX]) with relevant demographic and preinitiation period comorbidities, utilization, and expenditure variables as covariates. Because prior authorization was required, the non-stimulant atomoxetine was excluded.

Results

The sample consisted of 1810 subjects with 69% aged 6 to 12 years; 58.0% were initiated on ER-M and 14.4% on LDX. Psychiatrists prescribed 60.5% of LDX prescriptions. A greater proportion of LDX patients had psychiatric-related comorbidities compared to the other medication groups. Logistic regression showed that compared to the LDX group, the IR-M group was more likely to discontinue therapy (OR=1.95, 95%CI=1.05-3.60, P=0.034), and the IR-A group was more likely to switch therapy (OR=2.39, 95%CI=1.22-4.69, P=0.012). ADHD medication expenditures were significantly lower for the LDX group than the ER groups (all P≤0.003). ADHD-related and total medical expenditures did not differ significantly.

Conclusions

Although used in more complex patients, LDX demonstrated advantages over IR-M on persistence, IR-A on therapy switching, and the ER groups on medication expenditures.
PW01-20 - Adjunctive Aripiprazole in Patients with Major Depressive Disorder: Pooled Safety and Tolerability Data from Three Short-Term Studies
Authors: Loze J.-Y. , Gismondi R. , McQuade R. , Carson W. , Berman R.
Published: June 2010

Objectives

The safety and tolerability of aripiprazole as adjunctive treatment was examined in patients with major depressive disorder (MDD) without psychotic features who had a major depressive episode and who did not respond adequately to standard antidepressant therapy (ADT).

Methods

Data from three identical short-term, double-blind, placebo-controlled studies (CN138139, CN138163, CN138165) were pooled. After a prospective phase with placebo plus ADT, patients without adequate response entered a 6-week, double-blind phase with placebo or aripiprazole plus ADT. Safety endpoints included death, serious adverse events (SAEs), treatment-emergent adverse events (AEs), Simpson-Angus Scale (SAS), Barnes Akathisia Global Clinical Assessment, Abnormal Involuntary Movement Scale (AIMS), clinical laboratory tests, vital signs and electrocardiograms.

Results

In total, 538 patients were randomized to adjunctive placebo and 547 to adjunctive aripiprazole. AEs with an incidence ≥5% and at least twice the rate of placebo were akathisia (adjunctive aripiprazole, 22.7%; adjunctive placebo, 4.1%), restlessness (12.4% vs 2.2%), fatigue (8.6% vs 4.3%), insomnia (8.2% vs 3.2%), vision blurred (6.2% vs 1.5%), somnolence (5.9% vs 2.6%), and constipation (4.9% vs 2.4%). AEs that had a treatment difference of ≥2% included akathisia, somnolence, sedation, dizziness, disturbance in attention, extrapyramidal disorder, restlessness, insomnia, constipation, dyspepsia, fatigue, feeling jittery, vision blurred, weight increased, and dyspnea. SAEs occurred in 0.7% of patients in each treatment group. There were no deaths during the studies.

Conclusions

In this pooled analysis of patients with MDD and an inadequate response to ADT, adjunctive aripiprazole showed consistently high study completion rates and low discontinuation rates resulting from adverse events.
PW01-23 - Agomelatine, The First Melatonergic Antidepressant: A Sustained Efficacy in Severely Depressed Patients
Authors: Montgomery S.A. , Hale A. , Goodwin G.M.
Published: June 2010

Agomelatine is a melatonergic agonist and 5-HT2C antagonist, efficacious in patients with major depressive disorder. The aim of the present analysis was to assess its short- and long-term antidepressant efficacy in the more severely depressed patient according to predefined cut-offs at baseline on HAM-D total score. The short-term treatment efficacy was assessed versus placebo in a pooled analysis from three 6-8 week trials using increasing and non-overlapping cut-offs of the HAM-D17 score at inclusion (n=591), and versus fluoxetine 20-40 mg in an 8-week study (HAM-D at inclusion ≥25 and CGI ≥4; n=515). Long-term efficacy was assessed in the severely depressed subpopulation (HAM-D ≥25; n=270) of a relapse prevention study. Agomelatine's doses were 25- 50 mg/d.

In the pooled analysis, the difference between agomelatine and placebo at endpoint increased with increasing severity of depression at baseline, from 2.06 (95% CI, 0.31-3.81; P=0.021) (HAMD 22-25) to 4.45 (95% CI, 0.57-8.33; P=0.025) (HAMD>30). Agomelatine was significantly superior to fluoxetine, with a difference in the HAM-D score of 1.49 (95% CI, 0.20-2.77; P=0.024). Agomelatine was also significantly superior to placebo in preventing relapse in severe depression, with a relapse rate of 21.9% in the agomelatine group versus 45.1% in the placebo group (p=0.0001). Tolerability was good in all the studies versus placebo and versus fluoxetine.

In conclusion, these results show that agomelatine is efficacious in severely depressed patients, with a superior efficacy to fluoxetine in the short term. This is in line with the superiority reported of agomelatine versus venlafaxine and sertraline.
PW01-31 - Early Increase of Peripheral BDNF In Major Depression During Antidepressant Treatment Predicts Late BDNF Increase With High Sensitivity and Specificity
Authors: Schlicht K.F. , Wagner S. , Peetz D. , Borysenko L. , Krannich D. , Bernius A. , Hiemke C. , Lieb K. , Tadić A.
Published: June 2010

Objective

In patients with major depression (MD), mean BDNF serum concentration increases during antidepressant treatment. This increase has been associated with symptom amelioration. In a previous analysis of the time course of BDNF serum concentration, we could show a high association between early and final changes of BDNF levels during antidepressant treatment. The aim of this study was to analyse the predictive value of early BDNF changes for BDNF changes after 4 to 6 weeks of antidepressant treatment in individual patients with MD.

Methods

Forty-six patients with MD according to DSM-IV were included in this study. All patients were treated as clinically indicated. Depression severity was assessed by HAMD-17 by trained raters from baseline to week 6 in weekly intervals. Serum at each visit (baseline, V1-V6) was obtained from whole blood after centrifugation with 1.000 × g for 10 minutes. Aliquots were frozen at -80°C until analysis. BDNF serum concentration was determined with ELISA (R&D Systems). We determined sensitivity and specificity of early changes (from baseline to weeks 1 and 2) of BDNF serum concentration to BDNF changes in the later course (from baseline to weeks 4 to 6) of treatment.

Results

BDNF increase from BL to week 2 predicted BDNF increase from baseline to week 5 with high sensitivity (81%) and specificity (73%). Further analyses revealed comparable results (data not shown).

Conclusions

These results suggest that early BDNF increase is predictive for final BDNF increase in individual patients with MD during antidepressant treatment.
PW01-42 - Escitalopram In Treatment of Disability In Major Depressive Patients
Authors: Zivkovic N. , Pavicevic D. , Djokic G.
Published: June 2010

Major depressive disorder (MDD) is a common, and often severe affective disorder which causes significant psychological distress, reduces quality of life and incised suicidal risk and mortality. Neurobiological basis of MDD involves at first serotoninergic and noradrenergic neuronal systems. Escitalopram is highly potent and highly selective serotonin re-uptake inhibitor.

Purpose of this study was to

Estimate efficacy of the escitalopram in treatment of disability and impairment in social, professional and family life in patients with MDD.

Methods

This prospective clinical study included 110 patients with MDD diagnosed by ICD-10 criteria for MDD, who are randomly divided into control (40 patients) and experimental group (70 patients). Antidepressants were tested, for 6 months in hospital and outpatients conditions, according to specially designed protocol, which included Hamilton Depression Rating Scale (HAMD) and Sheehan Disability Scale (SDS). Control group was treated with mianserine (30-90 mg/24h) and experimental group was treated with escitalopram (10-20 mg/24h).

Results

Escitalopram therapy influenced on HAMD score with high statistical significance vs. Mianserine, p=0.000. Escitalopram therapy improves all SDS scores after 6 months in comparison to Mianserine therapy with high statistical significance in Social life p=0.000, Family life/home responsibilities p=0.000, Days lost p=0.036 and Days unproductive p=0.003. Percentage of adverse effects is significantly lower in Escitalopram (10.76%) than in Mianserine (26.67%) group.

Conclusion

Escitalopram has significantly better efficacy in treatment of MDD and disability and impairment in MDD patients comparing to Mianserine, with significantly lower adverse effects rate.
PW01-47 - Increased DHEA And Dhea-s Concentrations In Plasma of Patients With Post-traumatic Stress Disorder and A History of Childhood Abuse
Authors: Kellner M. , Muhtz C. , Peter F. , Dunker S. , Yassouridis A. , Wiedemann K.
Published: June 2010

Introduction

Findings about dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulphate (DHEA-S) in patients with post-traumatic stress disorder (PTSD) have been inconsistent and confusing.

Objective

Although its impact on the regulation of the hypothalamic-pituitary-adrenocortical axis has been demonstrated, the potential effect of severe childhood adverse events has not been considered regarding DHEA and DHEA-S data in PTSD.

Aims

We investigated whether a history of severe childhood traumatisation affects these steroids in PTSD patients.

Methods

33 patients with chronic PTSD (15 with and 18 without sexual and/or severe physical abuse before age 12) were studied in a combined low dose dexamethasone/corticotropin-releasing hormone (CRH) test. Mean pre-CRH levels of both plasma DHEA and DHEA-S were significantly increased in the subgroup with childhood abuse, the respective ratios with plasma cortisol were significantly lower. In the entire population of PTSD patients significant amounts of the variation of these parameters could be explained by childhood trauma history.

Conclusions

Further studies are needed to clarify the potential role of DHEA and DHEA-S as biomarkers for severe early adverse events in patients suffering from PTSD and in other stress-related disorders.
PW01-48 - Clinical And Vulnerability Characteristics Of Social Fears And Social Phobia Subtypes Among Community Youth
Authors: Knappe S. , Beesdo-Baum K. , Fehm L. , Lieb R. , Wittchen H.-U. ,   Early Developmental Stages of Psychopathology
Published: June 2010

Introduction/objectives

The DSM-IV indicates severity of social phobia (SP) by the “generalized subtype”, when “most social situations” are feared. This specifier refers to the number of feared social situations, perhaps ignoring quantitative differences. We therefore compared specific and interaction-related vs. performance-related social fears according to clinical (age of onset, avoidance, impairment, comorbidities) and vulnerability characteristics (behavioural inhibition (BI), parental psychopathology and rearing).

Methods

Six social situations and SP along with their clinical characteristics were assessed using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI) in a population-based sample of N=3,021 14-24 year olds. BI and parental rearing were assessed using self-report questionnaires. Parental psychopathology was assessed directly in parents via DIA-X/M-CIDI, supplemented by offsprings’ family-history reports.

Results

Isolated social fears were rare, except for fear of taking tests and public speaking. The majority reported to fear two or more social situations. Compared to isolated fears of either interaction or performance situations, their co-occurrence was associated with lower age of onset, severe avoidance and impairment, more comorbid anxiety and depressive disorders. All social fears (in particular interaction-related fears) were associated with higher BI. Associations with parental psychopathology and unfavourable rearing were less consistent, albeit strongest for interaction-related fears.

Conclusions

Interaction-related fears may represent a more familial form of SP, while performance-related fears might be less impairing and originate from non-familial factors. The DSM-IV specifier of SP may overlook these differences when individuals with predominantly interaction-related fears are categorized as generalized SP-cases. Findings suggest considering alternative specifiers for SP in future diagnostic systems.
PW01-57 - Lisdexamfetamine Dimesylate As Treatment For Adhd In Children Previously Treated With Osmotic-Release Oral System Methylphenidate: Parental Impressions
Authors: Antonucci D. , Manos M. , Kerney D. , Lopez F.
Published: June 2010

Objectives

We assessed parents’ perceptions of and satisfaction with daily lisdexamfetamine dimesylate (LDX; Vyvanse®, US tradename, Shire US Inc.) treatment for their children with attention-deficit/hyperactivity disorder (ADHD) previously treated with osmotic-release oral system methylphenidate (OROS-MPH).

Methods

Parents of children with ADHD were surveyed via telephone or Internet about their child's experience before and approximately 6 weeks after initiating LDX treatment. Participants received a $25 coupon toward their child's next LDX prescription after survey completion. Post hoc analyses using the Wilcoxon signed rank test were performed.

Results

School time was the most frequently reported most bothersome time of day at baseline (41%), followed by homework time (23%). At follow-up, most parents reported improvement during their child's most bothersome time of day. Significantly less interference from ADHD symptoms with school activities, family interactions, homework, and social interactions was reported (all P< .01). LDX tolerability and convenience were rated, on average, 7.1 and 8.0, respectively (1=not at all well tolerated/convenient, 9=very well tolerated/convenient). Satisfaction with LDX was significantly higher than satisfaction with OROS-MPH treatment (6.9 and 5.0, respectively, P< .01 [1=not at all satisfied, 9=very satisfied]). Eighty-four percent of parents reported that they intend for their child to continue taking LDX.

Conclusions

Parents of children with ADHD who were previously treated with OROS-MPH and currently taking LDX reported less interference of ADHD symptoms with daily activities after LDX treatment and high satisfaction with LDX. LDX was also well tolerated and convenient to use.

Supported by funding from Shire Development Inc.
PW01-59 - Effects Of An Internet Based Assessment Of Child And Adolescent Psychopathology (Dawba) On Clinical Decision Making
Authors: Kuhn C. , Winkler Metzke C. , Aebi M. , Steinhausen H.-C.
Published: June 2010

Objectives

The main objective was to examine agreement between the internet based Development and Well-Being Assessment (DAWBA) generated diagnoses and clinical diagnoses. Second, we aimed to explore how disclosure of the DAWBA-diagnosis before clinical decision making influenced the clinicians diagnosis. Third, whether there were differences of influence for different categories of disorders. Last, we examined how the use of DAWBA information affected identification of co-morbidities.

Methods

315 patients from outpatient clinics were randomised into two groups. In 177 cases the clinician was informed about DAWBA diagnosis, in 155 cases the clinican was blind to DAWBA information. DAWBA is an internet based package of questionnaires and rating techniques designed to generate psychiatric ICD10 or DSM IV diagnoses for 5- 17 year old children and adolescents. Information from parents, teachers and self-reports are brought together by a computer programme that predicts likely diagnoses. An expert rater decides on the diagnosis by synopsis of these different inputs.

Results

DAWBA diagnoses and clinical diagnosis without information from DAWBA showed acceptable agreement with Cohens kappa 0,26 for emotional disorders, kappa of 0,29 for hyperactive disorders and kappa of 0.31 for disruptive disorders.

There was a significant effect on clinical diagnoses for emotional disorders for disclosure of DAWBA (kappa of 0.26 without DAWBA information versus kappa of 0,52 with information, Fishers z of p< 0,05)

There was no significant effect of information about DAWBA-diagnosis considering comorbidities.

Conclusions

DAWBA showed the most pronounced effect on clinical diagnoses for emotional disorders in children and adolescents.
PW01-61 - Behavioural Dependences In Adolescents And Young Adults: Results From An Observational Study
Authors: Martinotti G. , Villella C. , Di Nicola M. , Cassano M. , Petruccelli F. , Conte G. , Janiri L.
Published: June 2010

Introduction

Our study aims to assess the prevalence of behavioural addictions in an adolescent populations, evaluating the effects of gender and age, and to assess the correlations and associations between different behavioural addictions.

Methods

A population of 2853 students (1142 F and 1711 M, mean age 16.7± 1.9) was assessed in order to evaluate the prevalence of behavioural dependences such as Pathological Gambling (PG), Compulsive Buying (CB), Exercise Addiction (EA), Internet Addiction (IA), and Work Addiction (WA). The South Oaks Gambling Screen-Revised Adolescent, the Compulsive Buying Scale, the Exercise Addiction Inventory, the Internet Addiction Test, and the Work Addiction Risk Test, were compiled anonymously by the students.

Results

Overall prevalence was 7.0% for PG, 11.3% for CB, 1.2% for IA, 7.6% for WA, 8.5% for EA. PG, and EA were more common among boys, while gender had no effect on the other conditions. CB was more common among younger (< 18 years old) students. Each of these conditions showed a strong association with others, and the scores of all of these scales were correlated.

Discussion

In line with previous studies our results indicate that behavioural addictions are quite common among adolescents. The strong association between behavioural addictions stresses the concept that treatment for one of these conditions should involve assessment and treatment for the others.
PW01-69 - Post-Infarct Depression In A General Hospital: Diagnosis And Therapy
Authors: Istikoglou C. , Vlissides D. , Foutsitzis D. , Papouli F. , Polonifis N. , Kanellos P. , Kogeorgos J. , Salla T.
Published: June 2010

Objectives

Post-infarct Depression appears to 15-30% of the patients treated in the Infarction Units, according to the International Standards. It appears 24-72 hours following an Acute Infarction of the Myocardium.

Methods

We studied 300 patients treated in the Infraction Treatment Unit for a period of three months, within the framework of a Liaison Consultation Psychiatry program. 180 patients were men (60%) and 120 patients were women (40%). The average age of male patients was 52 years and the average age of female patients was 58 years. These patients were submitted to the Montgomery-Arnsberg Depression Rating Scale (MADRS) to evaluate Depression. According to the results of the Scale, these 120 patients presented depressive symptomatology, 45 patients presented mild symptomatology, 70 patients presented average symptomatology, and 5 patients presented heavy symptomatology.

Results

All the above patients were treated with SSRIs. In particular, they received Fluoxetin, Sitalopram, Esitalopram, Fluvoxamine, Sertraline. The MADRS Scale has been evaluated on 15 days, 1, 2, 3, and 6 months following the initiation of therapy. 110 patients (91%) presented a significant reduction of MADRS Scale, while 10 patients (9%) showed resistance to the treatment and had to switch their treatment scheme with SNRIS or NASSAS.

Conclusions

The SSRIs constitute the most advisable treatment for post-infraction depression, due to their low side-effect profile. The rate of positive outcome for post-infarction depression treatment was especially high (91%) during treatment with SSRIs at a level consistent with the international literature reference.
PW01-80 - The Effects On The Level Of Intestinal Endotoxemia In Alzheimer Disease Rats
Authors: Han D. , Wang F.
Published: June 2010

Aim

The objective of the study was to explore whether IETM participate in the development of Alzheimer disease's rats which were established by D-galactose and aluminum trichloride (AlCl3).

Methods

Adult Wistar rats were subjected to 90 days of intraperitoneal injection with D-galactose and AlCl3 to establish the Alzheimer disease's model. After the administration, the study and memory ability of the Alzheimer disease's rats were observed by Morris water maze; The level of Lipopolysaccharide (LPS) in the sera of Alzheimer disease's rats was determined by tachypleus amebocyte lysate method; The level of tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1) in the sera of Alzheimer disease's rats were determined by radioimmunity method; The express of amyloid β-protein precursor (APP), presenilin 1 (PS1) and β-site APP-cleaving enzyme (BACE) in hippocampus of Alzheimer disease's rats were detected by RT-PCR.

Results

Compared with the normal control, the level of LPS in the sera and the express of APP, PSI, BACE mRNA in the hippocampus of Alzheimer disease's rats were markedly increased (P< 0.01).

Conclusions

The model of Alzheimer disease's rats which were established by D-galactose and AlCl3 is accompanied IETM. This result suggests that IETM play an important role in the development of Alzheimer disease.
PW01-85 - Atrial Fibrillation And The Risk For Conversion From Mild Cognitive Impairment To Dementia In Subjects Aged Over 65
Authors: Podea D.M. , Chenderes R.M. , Nanu P.D. , Mila C.
Published: June 2010

Background

Mild cognitive impairment (MCI) may be considered a pre-dementia cognitive state. The turn fromMCI to dementia is not clearly understood.It appears to be determined by the vascular risk factors of each individual.

Purpose

To determine if atrial fibrillation (AF) is a risk factor for conversion from MCI to dementia in an elderly population subgroup with certifiedMCI (MMSEscore: 28-21).

Material and method

There were included 123 subjects with MCI, aged over 65. They were evaluated yearly for 2 years using the Mini Mental State Examination(MMSE), ECG, CT scan and medical history.

Results

The average age was 72.8+/4.3 yrs,with a sex ration male to female 1.27:1. Of the123 subjects17.07% (n=21) had AF at admission. The average MMSE difference was 2.3 points between the two cohorts in favor for the non-AF subjects(n=102). At1year, theAF cohort increased to 28 subjects and at two years to 33. The MMSE scores remain lower in AF cohort with an average of 7.4 points on the scale (p< 0.001,CI95%) at 2 years. In the AF cohort 75.75% (n=25) of the subjects had certified dementia by the end of the study, while in non-AF group only 12.2% (n=12)conversed to dementia with a clear statistical difference between the two groups (p< 0.001, CI95%). When other vascular risk factors were considered the strongest correlations were associated with cerebral stroke (p=0.002, CI95%), hypertension (p=0.012, CI95%) and dyslipidemia (p=0.023, CI95%). The longest the time-span from the MCI onset positively correlated to MCI-dementia conversion in both cohorts (p< 0.001, CI95%).

Discussions

MCI is regarded as a precursor of dementia, but not all patients with MCIactually develop dementia. Alzheimer and vascular dementia share several pathogenic mechanisms and the involvement of vascular risk factors is determinant in the clinical course.

Conclusion

Atrial fibrillation may predict the conversion from MCI to dementia,but other vascular risk factors may concur to it.The time-span from MCI onset is an independent risk factor for conversion to dementia in MCI elderly subjects with a direct relation.
PW01-88 - Visualization And Quantification Of App Intracellular Domain (Aicd) Mediated Nuclear Signaling By Bimolecular Fluorescence Complementation
Authors: Riese F. , Goodger Z. , Kallinna K. , Konietzko U.
Published: June 2010

Although several targets of APP intracellular domain (AICD) mediated transcriptional gene regulation have been published, the role of AICD in nuclear signaling in health and (Alzheimer's) disease remains under debate. We previously demonstrated that AICD forms nuclear complexes with two other proteins, Fe65 and Tip60, called AFT complexes. Functionally, these co-localization areas likely represent sites of transcription. However, it is currently unknown how the formation of these complexes is regulated.

Bimolecular fluorescence complementation (BiFC) is a recently developped technique to visualize protein/protein interaction. We established a detection system based on BIFC to study the intracellular interaction of AICD, Fe65 and Tip60 in cell culture. By means of confocal microscopy the subcellular localization of the proteins was studied. The influence of several genetic mutations for familial Alzheimer's disease as well as for caspase cleavage and phosphorylation sites was quantified by fluorescence assisted cell sorting (FACS).

Using our BiFC visualization system, we could verify known findings such as APP/APP dimerization in the membrane and the interaction of AICD, Fe65 and Tip60 in the nucleus. Our system furthermore revealed the regulatory effect of familial AD and caspase cleavage site mutations on AFT complex formation.

AFT complex formation can be effectively visualized and quantified by means of our novel BiFC constructs, thus opening new insights into the functions of the amyloid precursor protein APP.
PW01-89 - Symtoms Of Dementia With Lewy Bodies Cluster In Persons With Mild Dementia
Authors: Rongve A. , Brønnick K. , Ballard C. , Aarsland D.
Published: June 2010

Objectives

To explore the inter-relationship between the core and suggestive symptoms of Dementia with Lewy Bodies (DLB) and the cognitive profiles in persons with newly diagnosed mild dementia.

Method

139 persons with mild dementia were recruited from dementia clinics in Western Norway. Symptoms were rated using standardized instruments. A two-step cluster analysis was applied to classify persons into groups according to scores on scales for hallucinations, parkinsonism, fluctuations and REM sleep behavior disorder (RBD).

Results

Four distinct clusters were revealed: A “Lewy Body Dementia” (LBD) cluster with high scores for both hallucinations, parkinsonism and fluctuation, and a “non-LBD” cluster with low scores on all DLB symptom scales were identified. In addition, two clusters with high scores on either RBD or cognitive fluctuation scales emerged. Persons in the LBD cluster had lower scores for visuospatial cognitive abilities as compared to the non-LBD group.(p=.002)

Conclusion

With a cluster analysis we provide empirical support for the existence of a distinct subgroup in mild dementia with high scores on scales for hallucinations, parkinsonism and cognitive fluctuations and a distinct cognitive profile, i.e. supporting the clinical diagnosis DLB.
PW01-91 - Italian Elderly Admitted To An Acute Psychiatric Unit: A Case-Control Study
Authors: Tomassi S. , Bonafede R. , Moretti F. , Pedrini E. , De Ronchi D. , Atti A.R.
Published: June 2010

Objectives

Even if medical and psychiatric co-morbidity often overlap, specific combined medical-psychiatric units do not exist in Italy and elderly who need urgent psychiatric care are usually admitted in the Acute Psychiatry Unit of general hospitals despite many difficulties. The aim of this study is to describe this phenomenon.

Methods

55 cases (>65 years) and 120 randomly selected controls (30-60 years), were picked-up among all patients hospitalized between 1st January-31st December 2008. Socio-demographic and clinical information were collected through the retrospective consultation of the case histories of all participants.

Results

Cases were significantly different from controls in terms of psychiatric background, medical history and medical pharmacotherapy: mood disorders (38.2%) and positive medical histories (81.8%) prevailed among elderly as compared to adult controls (p< 0.001; p< 0.001 respectively). The use of drugs (other than psychotropic ones) was four-fold more frequent in the elderly (74.5% vs 16.6%; p< 0.001). Cases and controls used differently the service: elderly requiring more frequently medical pharmacotherapy (81.8% vs 27.5%; p< 0.001), specialist consults (38.2% vs 11.6%; p< 0.001), laboratory tests (76.4% vs 60%; p=0.04) and instrumental tests (chest radiography 9% vs 0.8%; p=0.01; brain neuroimaging 12.7% vs 2.5%; p=0.01).The multi-adjusted logistic regression analysis confirmed a different pattern of use of the acute psychiatric service for elderly as compared to adult controls.

Conclusions

Elderly have peculiar medical histories and distinguishing management needs, notably in the medical field. Our data suggested the need of a new clinical approach concerning combined psychiatric-medical inpatient acute units in Italy.
PW01-96 - False Diagnosis Of Mental Retardation: Wisc Iii Test'S Place In A Child Psychiatry Service
Authors: Pegoraro L.F.L. , Santos A. , Salán T.M. , Jacintho A.C.d.Á. , Celeri E.H.R.V. , Dalgalarrondo P. ,   Child and Adolescent Psychiatry Study Group
Published: June 2010

Objectives

To access the Intelligence Wechsler Scale for Children (WISC-III) as an auxiliary resource in the diagnosis of patients with suspected mental retardation.

Methods

Thirty patients were evaluated in a university psychiatric service for children and adolescents, consulted during 2008. Those patients underwent a psychiatric evaluation and, after, subsequently the WISC III scale was administered. Patients were classified, according to their intellectual coefficients, as with or without a mental retardation score, following ICD-10 criteria. The results were transferred to a SPSS (Statistical Package for Social Sciences) spreadsheet and then analyzed in its socio-demographic and clinic variables.

Results

Of the thirty patients, 18 (60%) were children and 12 (40%) adolescents; 22 (73,33%) were male and 8 (26,67%) female. Furthermore, the sample revealed that 20 (68,97%) patients had had an axis I diagnosis. For the participants, 7 (23,3%) had an IQ below the cutoff of 70, consistent with the mental retardation diagnosis, and agreeing with the psychiatric evaluation. The other 23 (76,7%) patients had an IQ within the normal range. From those considered intellectually deficient, 5 (71,43%) had a score for mild and 2 (28,57%) for moderate mental retardation.

Conclusions

This study showed that clinical diagnosis of mental retardation is difficult, especially for mild cases, when the characteristics are not very clear. The error probability is increased if an instrument such as WISC III is not administered. Therefore, WISC III is an important instrument in the diagnostic process for mental retardation, in many instances changing a first clinic impression.
PW01-101 - From Diagnosis To Treatment - An Analysis Of Access To Depression-Specific Outpatient Treatment For Patients With Depression
Authors: Bönisch S. , Mergl R. , Matschinger H. , Wimmer-Brunauer C. , Tauscher M. , Kramer D. , Hegerl U. , Bramesfeld A. , Kocalevent R.-D.
Published: June 2010

Background

Former studies show low treatment rates of outpatients with a diagnosis of depression. The aims of this study are to examine

(1)

the rate of diagnosed depression in outpatient care,

(2)

rates of treatment of depression according to individual and regional characteristics and

(3)

effects of individual and regional characteristics on getting depression-specific treatment in the federal state of Bavaria.

Methods

Prevalence of depression and outpatient treatment for depression as well as individual and regional characteristics of outpatients diagnosed with depression were analysed based on secondary data from the Association of Statutory Health Insurance Physicians Bavaria in 2006 (N=780,226). Descriptive analyses were followed by logistic regression analysis (STATA, PASW) to examine predictive effects of individual and regional characteristics on getting depression-specific treatment.

Results

Prevalence of diagnosed depression is 9.2% for persons who are statutory health insured and older than 17 years. 55% of diagnosed depressed patients do not get a depression-specific treatment within one year. Rates of a depression-specific treatment are higher for persons who are female, of middle age, with a moderate or severe depression, with a psychiatric comorbidity, without somatic comorbidity, who live in more rural areas.

Conclusions

The access to depression-specific treatment after a diagnosis of depression must be facilitated. Training for physicians, psychoeducation for patients and anti-stigma campaigns are necessary measures to reach this goal. The knowledge about influence of individual characteristics on getting a depression-specific treatment is important to reach the groups who get least depression-specific treatment.
PW01-104 - Factors Associated to Use of Ambulatory Public Mental Health Services A Patients With Schizophrenia in Spain. Case Register Study: Resma
Authors: Moreno-Küstner B. , Navas-Campaña D. , Mayoral F. , Angona P. , García-Herrera J.M. , Moreno-Peral P. , Pérez O.
Published: June 2010

Objective

To identify factors associated with visits by patients with schizophrenia and related disorders to community mental health services, under the Mental Health Department of Carlos Haya Hospital in Malaga, Spain.

Methods

We undertook a cross-sectional study. Data on demographic and clinical factors and service use were obtained from the public mental health services database and centralized in the “Malaga Schizophrenia Case Register (RESMA)”. The outcome measure, defined as the total number of outpatient consultations during one year, was analyzed by multilevel multivariate linear regression.

Results

The analysis included 1097 patients with diagnoses of schizophrenia and related disorders (F20-F29, ICD-10).The adjusted model explained 46.35% of the variance. Patients who contacted both types of professional (nurses and psychiatrists) had a higher number of visits compared to patients who only contacted a psychiatrist (p< 0.001), and the individual psychiatrist attending the patients was also associated with the number of visits (p< 0.001).Clinical variables, such as a higher global level of severity (p< 0.001), a diagnosis of a persistent delusion disorder and having an inpatient episode (p< 0.001), were also associated with a higher number of visits. Patients who were receiving welfare benefits or who had no formal education or were illiterate had a higher number of visits. Patients living alone, living outside the study area and living in more rural municipalities was associated with fewer ambulatory contacts.

Conclusion

Among all variables, the role of psychiatrists and nurses in organized outpatient settings present the strongest association with the number of visits by similar patients.
PW01-109 - Epidemiology And Characteristics Of Suicidal Behaviour In General Population In Slovenia
Authors: Roskar S. , Kamin T. , Jericek Klanscek H. , Zorko M. , Bajt M.
Published: June 2010

Objectives

To study and to evaluate the mental health of the general population of Slovenia with a special emphasis on suicidal behaviour.

Methods

The representative sample consisted of 846 randomly selected adult Slovene inhabitants, chosen from a pool of telephone subscribers (N = 2433). Data were gathered by the means of a telephone interview using standardised measures (RSES, Questionnaire of social support, Sense of Mastery) on specific variables related to mental health and suicidal behaviour, e.g. presence of mental illness, use of psychotropic substances, self esteem, sense of mastery of life, social support, etc.

Results

10% of participants have had suicidal ideation, 2% have had a plan for a suicide attempt (in both cases statistically significantly more women) whereas only 1% of the respondents actually attempted suicide. Greater risk for suicide was found among divorced and single persons and those living in rural areas. More than half of suicidal individuals didn’t seek help for their problems anywhere and those who did, mostly turned to relatives and friends. We observed statistically significant differences in help seeking among men and women (the later asking for help more). Suicidal individuals reported of statistically significant smaller social network, of smaller emotional support, lower self-esteem and lower feelings of having control over their own lives when compared to non-suicidal individuals.

Conclusion

Our results accord with specific theories of risk factors (sociological, psychological, etc.) and bear potential for directions to be taken when tailoring suicide prevention strategies, in particular when addressing the general population.
PW01-112 - Prevalence Of Adhd In School Children In Athens. Association Of Adhd Subtypes With Clinical Impairment
Authors: Skounti M. , Philalithis A. , Giannoukas S. , Dimitriou E. , Nikolopoulou S.
Published: June 2010

Objectives

The aim of this study was to explore the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) and social and academic impairment in 6-11 year-old children residents of Athens, Greece.

Methods

Following the DSM-IV diagnostic criteria, the study combined information from teachers for 603 elementary school children following grades first to sixth. A 2-stage screening process was employed including the standardized ADHD test and the Teacher Report Form (TRF).

Results

Among 603 children, 36 (6.0%) met the study criteria for ADHD. The estimated prevalence was 8% for boys and 3.8% for girls (p=0.028). The most prevalent subtype of ADHD was the Combined type (3.8%), followed by ADHD- Inattentive (1.7%) and Hyperactive-Impulsive type (0,5%). Gender differences were observed in the prevalence of ADHD-Combined subtypes (p=0.003). Statistical significant differences were observed between ADHD subtypes and gender (p=0.047). ADHD-Combined type was associated with greater impairment in both academic and social domains, where ADHD-Inattentive subtype showed a higher academic, but lower social impairment. The ADHD-Hyperactive-impulsive children were not significantly impaired in their academic functioning, while social functioning resulted moderately impaired.

Conclusions

The prevalence of ADHD among schoolchildren in Athens and the risk factors are comparable to those reported in several epidemiological studies worldwide. Impairment in social and academic functioning seems to be strongly associated with the subtype of ADHD. Further research into the association between ADHD symptoms and impairment is warrant.
PW01-97 - Prevalence Of Mental Disorders In General Population
Authors: Ahmadvand A. , Sepehrmanesh Z. , Ghoreishi F.
Published: June 2010

Objectives

Mental health is one of the most important public health issues, because of its major contribution in decrease of global burden of diseases. This study investigates the prevalence rate of mental disorders in General population aged 18 years and over in (kashan city, Iran 2005).

Methods

This was a descriptive cross sectional study that was conducted via classified- randomized sampling. At stage one, by using the general health Questionnaire (N= 1800) and stage two by using clinical interview based on checklist DSM- IV by two psychiatrists;546 ones among 606 questionable people participated and 60 ones did not participated. Data were analyzed using Spss v. 16 and OR, CI and Chi-square test.

Results

The overall prevalence of mental disorders was 29.2% (women 35/5% and men 21.2%). The most prevalent disorders were mood disorders and Anxiety disorders respectively (9.3%),(4.7%).In 505 subject with mental disorders, major depression (8.2%) and generalized anxiety disorder (7.2%) were the most prevalent and 7.8% of people had one mental disorder at least. The prevalence was higher than in adult aged 56-65 years (35.8%), widow (35.8%), illiterate (42.8%) and unemployed (38.8%) in this study. Significant difference was found between genders, education, marital status variables with mental disorder.

Conclusions

This results show that psychiatric disorder in kashan city is higher than previous research in this region (1995).Although this prevalence is less than cities like Qazvin & Shahrekord, but it is higher than other city. There fore prevention programs and treatment psychiatric disorder in this city is of great priority.
PW01-98 - No Predictive Value Of Anxiety- And Depression Symptoms For Sub- Or Infertility
Authors: Biringer E. , Kessler U. , Mykletun A.
Published: June 2010

Objective

Mental distress has been suggested as an etiological factor of fertility problems. The aim of the study was to investigate the predictive value of common mental symptoms for fertility problems in a population sample.

Methods

The predictive value of anxiety and depression symptoms for incident fertility problems over an 11 year span was investigated in a N=5,873 female sub-sample from the Nord-Trøndelag Health Studies (HUNT 1 and HUNT 2). Only women who had not experienced fertility problems at the time of HUNT 1 were included. Fertility problems were reported retrospectively at HUNT 2. Sub-/infertility was defined as having tried to get pregnant for more than one year without success. Symptoms of anxiety and depression at HUNT 1 were measured by the one-dimensional 12-item Anxiety Depression Index (ADI).

Results

Mean age at HUNT 2 was 42 years (S.D. 4.96, range 28-49). N=152 reported having tried to get pregnant for more than one year. No predictive value of anxiety and/or depression symptoms for sub-/infertility was found (crude OR=0.97 (95% CI=0.82; 1.15), p=0.736; analyses adjusted for age, level of education, civil status, somatic conditions, parity, and gynaecological surgery: OR=0.97 (95% CI=0.81; 1.15), p=0.687). Results were comparable in a sub-sample who had never been pregnant.

Conclusion

There is no prospective effect of common mental health symptoms on incident fertility problems in women. This zero-finding emerges from a large population-based data set with a long follow-up interval, and it provides evidence against the hypothesised causal relationship between mental distress and sub-/infertility.
PW01-115 - Genetics In Psychiatry: Towards A ‘Gen-Ethical’ Attitude
Authors: Versonnen F.
Published: June 2010

The fairly recent explosion of genetic research, suggesting a real quest for genes in psychiatric diseases, didn’t result in the discovery of a gene as an ultimate determinant of psychiatric illness. Up to date, convincing evidence for a monogenetic cause is lacking. There is no strong evidence from candidate gene research or genome-wide studies. Genetic research for determining genetic and environmental causes, include clinical, behavioural and molecular biological methods and assays. New techniques like transcriptomics and proteomics examine gene products, whose expression is influenced by both genetic and environmental factors, and can contribute to identification of both causes of disease.

However, the conclusion thus far is that all genetic factors only contribute with environmental factors to a multifactorial inheritance. This weak genetic power is illustrated by the liability threshold model that can be conceived as an epigenetic challenge.

This paper is all about practical consequences for caregiver and patient. As the interplay of genetics and environment can be considered as cause of psychiatric diseases, ultimately the ethical responsibility for individual and society seems inevitable. What is the dilemma, put forward by the’real’ genetic portfolio on the human subject? How man should act in dialogue with its genes? How human behaviour can influence genetic expression in a well-tuned manner? What is the relation between prenatal genetic design and postnatal ethic demands? This neodarwinistic reflection focuses also on the antero- and retrograde aspects in human development. Finally, how can practical wisdom help us in the quest for a well-tuned epigenetic attitude?