O-10-01

A retrospective and prospective study of delayed sleep-phase shift in patients with severe, chronic obsessive-compulsive disorder (OCD)

L. Drummond, N. A. Fineberg, S. Mukhopadhyay, J. Turner, H. Ghodse. St Georges Hospital Medical School Mental Health, London, United Kingdom

Objective: Bobdey et al (2001) described a group of nondepressed OCD patients who subjectively reported phase shifted sleep patterns. We performed a retrospective case note and a prospective study of sleep patterns of all OCD patients admitted to a specialist Unit.

Methods: Retrospective Study Case notes of consecutive admissions for 5 years were examined. The nurses' record of sleep was examined. Age, gender, duration, severity of illness, history of substance misuse and prescribed medication were noted. Prospective Study Consecutive admissions to an IP unit with OCD were asked to participate. Patients' sleep patterns were recorded by nurses for 5 nights. Measures of OCD, depression, sleep and demographic data were recorded

Results: Retrospective 123 files were evaluated and nursing sleep reports were found in all (100%). 21 patients (17.1%) demonstrated delayed sleep-phase shift, 28 (22.8%) other sleep disturbance and 51 (41.4%) no abnormalities of sleep. Patients with delayed sleep were younger and more likely to be male Prospective 20 of 23 consecutive admissions consented. Half of these showed delayed sleep. 8 of the 10 patients with delayed sleep were male (equal sex ratio for others). Patients with delayed sleep had significantly more severe OCD symptomatology.

Conclusion: In a specialist OCD inpatient unit, a retrospective study identified 17.1% and the prospective study, 50% of patients having delayed sleep. This is much higher than in the general population (0.17%-0. 72%; Schrader et al., 1993). The affected patients were likely to be male, younger, earlier onset and more severe OCD symptoms. We suggest these patients form a small but clinically important sub-group of OCD. Further studies may yield insight into aetiology.

O-10-02

Typical and atypical neuroleptics in the treatment of obsessivecompulsive symptoms in schizophrenia patients

I. Reznik, M. Reznik, A. Weizman. Bat-Yam, Israel

Objective: Current therapeutic approaches to obsessivecompulsive (OC) symptoms in schizophrenia patients are based on usage of neuroleptics (classical and atypical), as a sole agents or in combination with serotonin reuptake inhibitors (SRI's - selective and non-selective). There is obvious lack of systematic studies, providing therapeutic guidelines to OC symptoms in schizophrenia. In this paper we present newly elaborated clinical typology and classification of OC symptoms in schizophrenic patients that will clarify some diagnostic unclearness of this disorder and could predict the response of OC and psychotic symptoms on typical and atypical antipsychotic agents.

Methods: Based on our model of the clinical typology, as well as on contemporary literature on this topic and our wide experience with atypical antipsychotic agents (clozapine, risperidone, olanzapine and ziprazidone) and classical ones (perphenazine and haloperidol) as sole agents and in combination with SRI's, we tried to figure out the predictors of response of OC and schizophrenia symptoms on neuroleptic medications.

Results: We found some clinical and pathophysiological factors that could serve as such predictors.

Conclusion: Further investigations are needed to substantiate our observations and to elaborate the most effective and safe therapeutic approaches to these difficult-to-treat group.

O-10-03

Overnight metyrapone tests in patients with panic disorder

M. Kellner, M. Schick, A. Yassouridis, T. Struttmann, K. Wiedemann, B. Alto. UKE Hamburg Psychiatrie und Psychotherapie, Hamburg, Germany

Objective: Data about the hypothalamic secretion of corticotropin-releasing hormone (CRH) in panic disorder patients in the non-panic state (using CRH tests) are contradictory. So far, no study about the response of the hypothalamic-pituitaryadrenocortical (HPA) axis to metyrapone (as an indirect measure of hypothalamic CRH release) has been published in panic patients.

Methods: In 14 patients with panic disorder (DSM-IV) and in 14 healthy matched control subjects a standard overnight metyrapone test (2,000-3,000 mg at 24:00) and in addition a combined metyrapone-low dose dexamethasone test (0.5 mg at 23:00) was performed in a single-blind design in fixed order. Plasma concentrations of adrenocorticotropic hormone (ACHT), cortisol and 11-deoxycortisol were measured repeatedly on the following mornings from 08:00 to 08:30. Statistical analyses were performed using MANOVA.

Results: Significant treatment effects of metyrapone and of combined metyrapone/dexamethasone on ACTH, cortisol and 11- deoxycortisol concentrations were found. However, no group effects between panic patients and controls emerged. Considering depression, anxiety, tension and restlessness as covariates, no group effects were deteted either.

Conclusion: Our data do not support a hypersecretion of hypothalamic CRH in panic patients in the non-panic state. In addition, no altered glucococorticoid negative feedback activity was found. Studies with metyrapone using different time frames are needed.

Figure 1.

Scattergrams of Individual Bmax Values of [³H] PK 11195 Binding to Platelet Membranes from Controls and Panic Disorder (PD) Patients with or without Separation Anxiety (SA).

Each point represents an individua subject Bmax values from controls (▀), PD patients with Separation Anxiety (PD + AS) (•) or without Separation Anxiety (PD - AS) (▴) were obtained by Scatchard analysis of saturation isotherm.

O-10-04

Peripheral-type benzodiazepine receptor binding sites in platelets of patients with panic disorder associated to separation anxiety symptoms

S. Pini, C. Martini, M. Abelli, M. Muti, M. Preve, M. Montali, B. Chelli, A. Lucacchini, G. B. Cassano. University of Pisa Department of Psychiatry, Pisa, Italy

Objective: Rationale: Although it is still a matter of debate whether panic disorder (PD) and separation anxiety (SA) are associated or causally linked disorders, this latter domain has been included in the panicagoraphobic spectrum as a dimension that could better characterize a more specific PD subtype. A decrease of peripheral-type benzodiazepine receptor (PBR) has been demonstrated in several psychiatric disorders including PD.

Objectives: the aim of the present study was to evaluate the kinetic binding parameters of the specific PBR ligand, PK 11195, in platelets from patients with PD in relation to the presence and severity of adulthood SA.

Methods: Using the specific radioligand, [3H] PK 11195, the kinetic binding parameters of PBR were determined on platelet membranes of twenty seven adult outpatients with a DSM-IV diagnosis of PD, assessed with the SCID-I, the Panic Disorder Severity Scale, the Structured Clinical Interview for Separation Anxiety Symptoms and the Adult Separation Anxiety Checklist and of eighteen healthy volunteers, recruited as controls.

Results: A significant decrease in PBR density was observed in PD patients as compared to controls. However, only the group of PD patients who also fulfilled the DSM-IV criteria for adult SA disorder showed a significant reduction of PBR. Significant and negative correlations between PBR density and each of the two SA scales total scores were also found.

Conclusion: The decrease of PBR density in platelets of patients with PD is significantly associated with the presence of SA symptoms, therefore PBR expression might become an useful biological marker of this dimension.

O-10-05

Aripiprazol as main treatment of the obsessive-compulsive symptoms

J. R. Lippi. CIOPE Mental Health, Belo Horizonte, Brazil

Objective: To test a new drug in the obsessive-compulsive symptoms.

Methods: The compulsive obsessive Syndrome is known there is more than 300 years. We gathered a group of patients for clinical observation and therapeutic answer. The obsessive symptoms (thoughts, pulses, ideas and images) compulsive (repetitive behaviors) they are some of the ones that they offer the largest difficulty for the treatment in psychiatry. So much in the main Syndrome, as in the co-morbidities, these symptoms offer unpleasant consequences. So much of the physical, psychic, as relational point of view, the compromising is serious and uncomfortable. Like this, repetitive acts that are tiresome, physics, mental and relationship, offer, equally, vexatious situations when done in the presence of third and people, sometimes, strangers.

Results: To find effective treatments is being one of the great needs of the psychiatry. We know about the value of Clorimipramine and ISSR. We believed that the antipsychotics of third generation can help us in the treatment interdisciplinary. We treated 15 patients with pathologies several such as Syndromes of Leopard and Gilles of La Tourette, Schizophrenia, among others, but where they were the symptoms common of obsessioncompulsion. The results were surprisingly good, with the Aripiprazol, in a medium time of 06 months, with the medium dosage of 15mgs/dia.

Conclusion: The results of experiment gotten through the psychopharmacoterapy, with the use of Aripiprazol in the medium dose of 15mg/day revealed effectiveness and allies to the psychotherapy and /or therapy cognitive-behavioral, they are encouraging.

O-10-06

Social phobia symtoms and comorbidity with specific phobia: a study of 850 Israeli young soldiers

I. Iancu. Beer Yaakov Hospital Psychiatry B, Beer Yaakov, Israel

Objective: Social Phobia (SP) and Specific Phobia are highly prevalent disorders and there is a high comorbidity rate. The aims of this study were to assess the prevalence of SP and Specific Phobia symptomatology in a non-clinical sample of Israeli young adults.

Methods: 850 young soldiers from the Israel Defense Forces (IDF) participated in our study. Measures included the Liebowitz Social Anxiety Scale (LSAS; self-report version), a self-report questionnaire on specific phobias and a socio-demographic questionnaire. Data on Specific Fears representing DSM-IV-TR Specific Phobias were analyzed to evaluate their prevalence, the comorbidity rate with SP symptomatology and to characterize socio-demographic correlates.

Results: SP symptomatology was reported by a great percentage of the subjects, as displayed by the rather high mean LSAS scores in this non-clinical sample (=29). Overall, 4.5% of the sample scored as SP positive according to our cutoff score(LSAS score > 79). The prevalence of fears and phobias in our sample was 49.1% and 8.7% respectively. The most frequent fears and phobias were from animals, heights, injury and closed places. Also, we found a significant positive correlation between the number of phobias and the LSAS score. Those with positive SP (LSAS >79) had a 50% chance of having also a specific phobia. The following variables were accompanied by a higher number of phobias: male gender, role of soldier (mechanic), no matriculation exams, not being presently involved in a romantic relationship, not having at least two good friends, mental treatment before enlistment, mental treatment during the military service and receiving psychotropic medications in the past.

Conclusion: Our findings corroborate findings from other studies in the Western world, regarding both the high prevalence of SP symptoms and specific phobias as well as the high comorbidity rate among the two disorders.

O-10-07

Leptin and leptin-receptor of inpatients with anorexia nervosa in progression of treatment

G. Ristow, A. Maras, C. Goepel, M. H. Schmidt, C. Goepel. Zentr. Instiut f. See. Gesundh Kinder- und Jugendpsychiatrie, Mannheim, Germany

Objective: Leptin (lep) and soluble leptin-receptor (slep-rec) are metabolites of energy and adipose metabolism excreted by adipocytes. There is a discussion about the influence of these metabolites on development and progress of eating disorders. A positive correlation between leptin and BMI is described for patients with anorexia nervosa (AN). There are rare data for sleprec of adolescent AN-patients. Target of our investigation is the influence of lep and slep-rec on course of treatment by patients with AN.

Methods: The study includes 15 patients (mean-age 14,7 y., mean-BMI at start 14,8). Lep and slep-rec are investigated at start of inpatient treatment (tO), at second day of 50% weight gain (tl) and at destination weight (t2). In addition we explored psychopathology by using an eating disorder inventory (edi-2). Coherence of variables BMI, time of treatment and edi-2 are calculated. A control group of 11 healthy girls was also investigated. In a one year follow-up investigation we looked for relapse of patients.

Results: Under progression of treatment we found a significant elevation of lep from tO over tl to t2. A significant decrease of leprec from tO to t2 was found as well. Another result was correlation between lep and bmi and between and lep-rec and bmi. Nonetheless only few coherences between biological parameters and psychopathology could be assessed. In comparison with healthy controls there was a discrete but non significant elevation of lep at t2. There was a relapse-rate of 50% and a significant correlation to lep-rec at tl.

Conclusion: Level of lep and lep-rec are modifying under weight gain. For lep we find negative coherences to subscales of edi-2, which can be interpreted as a hint for severity code of illness. Level of lep at t2 allows no conclusion for relapse of patients while lepfin-receptor at tl shows correlations to relapse.

O-10-08

Brief hospitalization plus outpatient group therapy in bulimia nervosa: Analysis of the effectiveness of a combined therapy

F. Fernandez-Aranda, A. Badia, R. Solano, J. Vallejo Ruiloba. University Hospital of Bellvit, Barcelona, Spain

Objective: The purpose of the current study was to determine the efficacy of a combined treatment (brief inpatient treatment - BIT- plus a short outpatient therapy -CBT-) in Bulimia nervosa (BN).

Methods: 100 treated BN patients, diagnosed according to the DSM-IV criteria, participated in this study. All were female. The whole patients were consecutively assigned to two different therapy conditions: (1) Combined therapy (brief inpatient (BIT) + shorter outpatient CBT) or (2) standardized outpatient CBT. Both groups were compared to 50 BN patients on the waiting list (WL). Prior, after the treatment and at 6 to 12 months follow-up several clinical and psychometrical measures were used for the assessment.

Results: ANOVA was computed to examine therapy effectiveness. Significant reductions in bingeing and vomiting frequency as well as in psychopathological traits, were found at the end of both therapy conditions (BIT+ shorter CBT group or standardized CBT group), however no improvements were found in the WL. After both therapy options, an abstinence rate on bingeing-vomiting episodes between 64' 8% and 73,5% were found (p<.001). However, there was no significant main effect according to the type of treatment (p>.05).

Conclusion: Our findings suggest that such a combined therapy is effective for treating BN when compared to a longer outpatient CBT. Due to time-economical reasons this approach should be considered in further therapy programs with this type of patients. Supported by FIS (G03-184)

O-10-09

The effect appraisal of profilactics of nutrition disturbances project

K. Bargiel-Matusiewicz, K. Kucia. Medical University of Silesia Dept. of Psychology, Katowice, Poland

Objective: Over half of girls and women see themselves as obese. It is connected with the ideal of slimness, predominating in our culture. The consequences of this growing cult of slimness involve more and more frequent disturbances of nutrition. The problems being the basis for obesity, anorexia and bulimia cannot be reduced merely to nutrition, weight and body size issues. The aim of the project is profilactic action concerning nutrition disturbances.

Methods: The project is addressed to the girls aged around fourteen. The programme comprises eight meetings devoted to the issues that according to current knowledge constitute a significant element of the process of building positive image of self, creating a feeling of one's individuality and developing ability of giving independent opinions. The aim of the classes is also paying attention at the healh aspect of our nutrition. The concentration upon health helps maintaining optimum weight. The Questionnaire of Self Esteem and the Questionnaire of Appraisal of Prohealth Approach have been used in the research.

Results: Average results obtained in the above mentioned questionnaires have been compared, before starting the profilactic programme and after its completion. The test for two averages has been applied with this purpose (Level of statistical significance 0.001). Increase of the level of self esteem as well as of prohealth attitude has been confirmed.

Conclusion: The presented Profilactics of Nutrition Disturbances Project contributes to improvement of self estrem and to strenghtening of pro-health attitude. The girls taking part in profilactics classes are becoming more and more conscious of their strong sides.

O-10-10

Body image and suicidality among youth

M. Pompili, P. Girardi, A. Ruberto, R. Tatarelli. University of Rome Psychiatry - Santi Andrea Hosp, Rome, Italy

Objective: Attitudes and feelings toward the body may be a source of pleasure and well-being; on the other hand bodily dissatisfaction may lead to suffering, depression and even to suicide.

Methods: The study population consisted of 500 university students (190 males, 310 females); mean age of participants was 21.62 (SD=2.70). Participants were assessed by means of the Body Uneasiness Test (BUT), the Reason for Living Inventory (RFL), Zung Self Depression Scale (SDS).

Results: Data underline a linear relationship between uneasiness linked to body image and suicide risk. Such evidence suggests that only a serious disorder of the body image may be linked to an increased suicide risk. In our sample the increased suicide risk was due to primary depressive disorders or depression caused by the body uneasiness, which in turn is worsened by depression. Our results show significant gender differences for the body image and a moderate relationship between body uneasiness and depression.

Conclusion: Body uneasiness is a source of great distress among non-clinical young individuals, causing depression and even increase of suicide risk.