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566 High Salivary Alpha-Amylase Levels in Patients with Schizophrenia: A Pilot Study
Poster presentations / Asian Journal of Psychiatry 4S1 (2011) S41–S90
Results and Conclusion: The findings will be presented as to the inter-relationship between parent self efficacy, parent satisfaction, socio-economic status, child developmental levels and autism severity. Our findings indicate a low rate of depression, stress and anxiety in participating families with a trend towards higher parent competence among parents of those with milder severity of autism. Potential explanations for this finding and implications for service delivery will be discussed. KU Marcia Burgess Autism Specific Early Learning Childcare Centre, Liverpool, was established by KU Children Services with UNSW as Research partner through funding from the Government of Australia 216 Reductions in Unwanted Behaviours in Children with Autism Spectrum Disorders Treated with ESDM in a Community Child Care Setting E.C. Fulton1 , V. Eapen2 , R. Crncec2 . 1 KU Marcia Burgess Autism Specific Early Learning Childcare Centre, Liverpool, 2 Academic Unit of Child Psychiatry South West Sydney (AUCS), SWSLHN, Liverpool, University of New South Wales, Sydney, Australia Introduction: Unwanted behaviours – those that are disruptive, destructive, aggressive or significantly repetitive – are quite prevalent in young children with Autistic Disorder and can lead to social consequences that impede their learning and development. In a group setting such as a Community Child Care Centre, they can also be destructive to the learning program and harmful to themselves, their peers and their staff. For these reasons, it is important that they are prevented, reduced and replaced over time with more conventional behaviours. The Early Start Denver Model (ESDM) is a comprehensive early intervention approach that is defined by a specific developmental curriculum combined with a specific set of teaching procedures used to deliver the curriculum. The ESDM combines several complimentary foundations including developmental psychology, relationship based intervention and pivotal response training. Aim: To explore whether the ESDM treatment approach reduces unwanted behaviours in children with Autistic Disorders in Community Child care settings. Methods: The Behaviour Records of 30 children attending the KU Marcia Burgess Autism Specific Early Learning Childcare Centre (ASELCC) (established through funding from the Government of Australia), were examined over six months. The behaviour of each child was coded, on entry to the program and again at the end of the six month period, using the ESDM Daily Behaviour Coding System of 1–6 (1 representing significant level of unwanted behaviour and 6 representing no unwanted behaviours). Results: Data for all 30 children showed significant reductions in unwanted behaviours. Conclusions: ESDM treatment has a significant impact on reducing unwanted behaviour in children with ASD. 565 Expressive Communication of Children with Autism: Differences between Home and School Environments H.-M. Chiang. Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA Expressive communication deficits constitute one of the defining characteristics of autistic disorder (American Psychiatric Association, 2000). The aim of this study was to investigate and compare the characteristics of expressive communication (i.e., total amount, form, function, spontaneity) in children with autism who have severe spoken language impairments across school and home settings. Eight children with autism were observed during a 30min free play period at school and home in Taiwan. The Wilcoxon signed-ranks tests were used to determine the differences in the total expressive communicative acts, communicative forms, communicative functions, and communicative spontaneity. Total
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expressive communicative acts and communicative spontaneity varied across school and home settings but not communicative forms or functions. The findings from the current study may have important implications for clinicians and educators. Poster session P12. Biological Markers 22 Serum Free Testosterone Levels Emerging as a Biomarker of Sexual Dysfunction Secondary to SSRI’s and SDA’s in Both Genders P. Khairkar1 , A. Basak2 , G. Bang3 , P. Tiple3 , V. Jain3 , P. Patil3 . 1 Department of Psychiatry and Neurology, 2 Department of Biochemistry, 3 Department of Psychiatry, JNMC, DMIMS, Wardha, India Background: Increasing number of studies reflects a growing awareness of the impact of psychotropic medications on sexual functioning but mechanisms are poorly understood. None of the empirical studies have as yet clearly demonstrated a biomarker for this epiphenomenon. Aims and Objectives: To ascertain the possible underlying biological mechanisms related to sexual dysfunction secondary to psychotropic (SSRI’s and SDA’s) medications. Methodology: A total of 30 drug naïve patients with first episode (time presentation) of psychiatric problems, who were not having sexual dysfunction at the time of presentation but have volunteered to screen if developed so after medications were recruited in the study. They were screened at the baseline and evaluated after every 4 weeks using Arizona Sexual Effects Change Scale (ASECS) for assessing sexual dysfunction and for serial levels of CBC, serum prolactin, serum TSH, serum total testosterone and serum free testosterone levels till 12 weeks. Results: Sexual dysfunction is seen in 56% (17 out of 30) of the patients. 94% of them have showed subnormal serum free testosterone levels in both genders. The mean serum free testosterone levels were 13.5 (pg/ml) and (0.8 pg/ml) in male and female patients respectively. Conclusions: Serum free testosterone levels clearly seems to be an emerging biomarker in sexual dysfunction secondary to psychotropic medications. It is hoped that the findings of this study shall be succeeded by the specification of proximal outcomes that are directly implicated by changes in the variables that are targeted for change in the prophylactic intervention. 566 High Salivary Alpha-Amylase Levels in Patients with Schizophrenia: A Pilot Study M. Ieda1 , T. Inagaki2 , T. Miyaoka3 , S. Okazaki3 , H. Yasuda3 , T. Kawamukai4 , E. Utani4 , R. Wake3 , M. Hayashida3 , J. Horiguchi3 , S. Tsuji5 . 1 Psychiatry, Shimane University Faculty of Medicine, Izumo-city, 2 Shimane University, Matsue-city, 3 Shimane University Faculty of Medicine, Izumo-city, 4 Sekitoh Hospital, Ohda-city, 5 Tsuji Mental Clinic, Hiroshima-city, Japan Objective: Previous studies have demonstrated the autonomic dysregulation in patients with schizophrenia using electrophysiological methods, such as electrodermal measures and heart rate analysis. Several theories have been proposed to explain the underlying mechanisms of schizophrenia and its autonomic function. Recently, the measurement of salivary alpha-amylase has been considered to be a useful tool for evaluating the sympatheticadrenal-medullary (SAM) system. Psychosocial stress increases the release of salivary alpha-amylase. Although some studies have evaluated salivary alpha-amylase under psychosocial stress, no studies have demonstrated the change in the salivary alpha-amylase (sAA) activity level in schizophrenic patients.
S48
Poster presentations / Asian Journal of Psychiatry 4S1 (2011) S41–S90
Methods: A total of 54 patients with schizophrenia (n = 54) and the control subjects (n = 55) were enrolled. sAA was measured using a portable and rapid hand-held monitor (NIPRO, Osaka, Japan). Also, Schizophrenic symptoms of all patients were assessed using the Brief Psychiatric Rating Scale (BPRS). Results: The sAA activity in the patients was significantly higher than that in the control subjects (p < 0.01). The correlation between amylase level and psychiatric symptoms was highly significant (r=0.37, p < 0.01). Conclusion: The present data imply a predominant role of the sympathetic nervous system in the secretion of sAA, together with parasympathetic withdrawal, under psychosocial stress. Poster session P13. Bipolar Disorders 10 Experiences of Family Member Caregiver of Patients with Bipolar Disorder F. Shamsaei1 , S. Mohamad Khan Kermanshahi1 , Z. Vanaki1 , M.R. Hayatbakhsh2 . 1 Tarbiat Modares University, Tehran, Iran; 2 The University of Queensland, Queensland, QLD, Australia Background: Attention to caregiving consequences has been mainly restricted to bipolar disorder, although studies suggest that relatives of bipolar patients also experience considerable distress. Aim: The purpose of this study was to explore the lived experiences from family member caregiver with bipolar disorder patient. Methods: In a qualitative research of phenomenological methodology, the family member’s caregivers of bipolar disorder in fsrshchian psychiatric hospital in Hamedan (Iran) were selected by purposive sampling in the year 2010. By reaching data saturation the number of participant was 12. Data were gathered through in-depth interviews and analyzed by “Van manen” method. Results: Analysis of the interviews revealed six major themes: fears and anxiety for the future, psychosomatic impact, feeling Isolated and loneliness, financial Impact, change in life style and family functioning and lack of support and knowledge. Conclusions: The findings highlight the need for family-oriented mental health services to be developed and for further research to identify the specific nursing interventions that are effective in helping to sustain family caregiving. 11 Survey of Family Caregiver Needs of Patients with Bipolar Disorder F. Cheraghi, F. Shamsaei. Hamadan University of Medical Sciences, Hamadan, Iran Introduction: Currently families of individuals with bipolar disorders are actively participating in the care of their relatives. Successful management of bipolar disorder in the community relies significantly on family caregivers. The need and experiences of such caregivers have been little studied with respect to bipolar disorder. Objective: The aim of the study was to identify family caregivers needs of patients with bipolar disorder. Methods: This study is a qualitative research of phenomenological methodology; the family member caregivers of bipolar disorder in farshchian psychiatric hospital in Hamedan were selected by purposive sampling. By reaching data saturation the number of participant was 12. Data were gathered through semi-unstructured interviews and analyzed by “Colaizzi” method. Results: Five groups were identified in this study analysis: illness management, consoling, economic needs, persistent care and social attention & perception. Conclusion: We identified the need of family member caregiver of bipolar disorder patients to be helped and to identify the specific caring interventions that are effective in helping to sustain family caregiving.
87 Creativity and Intelligence Quotient in Bipolar Disorder Patient and their Offsprings: A Controlled Study F. Sheikhmoonesi, M. Shahsavari, A. Jaafarzadeh, M. Khademloo. Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran Objective: Several studies and theories propose a connection between psychopathology and creativity, however to date, there have been no studies specifically examining creativity and intelligence quotient in offspring of bipolar patients. Methods: Twenty patients with bipolar disorder and twenty of their offspring (all euthymic) were matched with twenty normal control subjects and twenty of their offspring. All of participants completed creativity randsyp questionnaire (an objective measure of creativity) and Wechsler adult intelligence scale. Mean scores on these instruments were compared across group. Results: Bipolar parents compared to healthy control parents had significantly lower scores on Wechsler adult intelligence scale.(p < 0.001) but when we compared total intelligence quotient scores of bipolar off springs and healthy control off springs, there was no significant difference. For other comparisons, creativity scores did not differ significantly between groups. We used Pearson correlation test to assess relationship between intelligence quotient scores and creativity scores and no significant association was found. Conclusion: We found that bipolar disorder patients and healthy control subjects had similar scores on the creativity randsyp questionnaire and we did not find high creativity in bipolar offsprings. An important limitation of our study was that both cases and controls had low socioeconomic status and low education which may have contributed to these results. Intelligence quotient scores were lower in bipolar parents than healthy control subjects. Bipolar disorder may be associated with significant and persistent cognitive impairment. Intelligence quotient maybe also affected at least in some recovered bipolar patients. 245 Predominance of Manic Episodes in the Course of Bipolar Diorder G. Rakesh, S. Hatti, J. Thirthahalli, Y.C. Janardhan Reddy. Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India Background: Manic and depressive episodes have been described to be equally frequent in the course of bipolar disorder. Literature from India on the course of bipolar disorder is sparse. Evidence from Indian follow up studies of bipolar disorder in children suggest predominant manic course. In this study we examined the course of bipolar disorder in 315 adult inpatients. Method: The hospital records of 315 consecutively admitted patients were reviewed at the National Institute of Mental Health & Neurosciences Bangalore. The number and nature of past episodes, nature of first episode, age at onset of first episode and duration of illness were noted. Results: The current episode was mania, depression and mixed in 78.3%, 7.3% and 5.7% patients respectively. Mean age (SD) at onset of illness was 25.4 (9.8) years; mean (SD) duration since onset was 11.0 (9.2) years. The first episode was mania in 83.1%. The patients had experienced significantly higher number of manic, than depressive episodes in their lifetime [mean (SD) number of manic and depressive episodes were respectively 4.2 (4.7) and 1.1 (2.8); t = 10.9; p < 0.001)]. Half of the patients (n = 148; 47%) had experienced only manic episodes. Conclusion: Manic episodes were significantly more frequent among inpatients with bipolar disorder in this sample, with a substantial proportion experiencing “unipolar mania”. This is in stark contrast to the literature from high-income countries. Limitations of retrospective nature of this study notwithstanding,
Results and Conclusion: The findings will be presented as to the inter-relationship between parent self efficacy, parent satisfaction, socio-economic status, child developmental levels and autism severity. Our findings indicate a low rate of depression, stress and anxiety in participating families with a trend towards higher parent competence among parents of those with milder severity of autism. Potential explanations for this finding and implications for service delivery will be discussed. KU Marcia Burgess Autism Specific Early Learning Childcare Centre, Liverpool, was established by KU Children Services with UNSW as Research partner through funding from the Government of Australia 216 Reductions in Unwanted Behaviours in Children with Autism Spectrum Disorders Treated with ESDM in a Community Child Care Setting E.C. Fulton1 , V. Eapen2 , R. Crncec2 . 1 KU Marcia Burgess Autism Specific Early Learning Childcare Centre, Liverpool, 2 Academic Unit of Child Psychiatry South West Sydney (AUCS), SWSLHN, Liverpool, University of New South Wales, Sydney, Australia Introduction: Unwanted behaviours – those that are disruptive, destructive, aggressive or significantly repetitive – are quite prevalent in young children with Autistic Disorder and can lead to social consequences that impede their learning and development. In a group setting such as a Community Child Care Centre, they can also be destructive to the learning program and harmful to themselves, their peers and their staff. For these reasons, it is important that they are prevented, reduced and replaced over time with more conventional behaviours. The Early Start Denver Model (ESDM) is a comprehensive early intervention approach that is defined by a specific developmental curriculum combined with a specific set of teaching procedures used to deliver the curriculum. The ESDM combines several complimentary foundations including developmental psychology, relationship based intervention and pivotal response training. Aim: To explore whether the ESDM treatment approach reduces unwanted behaviours in children with Autistic Disorders in Community Child care settings. Methods: The Behaviour Records of 30 children attending the KU Marcia Burgess Autism Specific Early Learning Childcare Centre (ASELCC) (established through funding from the Government of Australia), were examined over six months. The behaviour of each child was coded, on entry to the program and again at the end of the six month period, using the ESDM Daily Behaviour Coding System of 1–6 (1 representing significant level of unwanted behaviour and 6 representing no unwanted behaviours). Results: Data for all 30 children showed significant reductions in unwanted behaviours. Conclusions: ESDM treatment has a significant impact on reducing unwanted behaviour in children with ASD. 565 Expressive Communication of Children with Autism: Differences between Home and School Environments H.-M. Chiang. Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA Expressive communication deficits constitute one of the defining characteristics of autistic disorder (American Psychiatric Association, 2000). The aim of this study was to investigate and compare the characteristics of expressive communication (i.e., total amount, form, function, spontaneity) in children with autism who have severe spoken language impairments across school and home settings. Eight children with autism were observed during a 30min free play period at school and home in Taiwan. The Wilcoxon signed-ranks tests were used to determine the differences in the total expressive communicative acts, communicative forms, communicative functions, and communicative spontaneity. Total
S47
expressive communicative acts and communicative spontaneity varied across school and home settings but not communicative forms or functions. The findings from the current study may have important implications for clinicians and educators. Poster session P12. Biological Markers 22 Serum Free Testosterone Levels Emerging as a Biomarker of Sexual Dysfunction Secondary to SSRI’s and SDA’s in Both Genders P. Khairkar1 , A. Basak2 , G. Bang3 , P. Tiple3 , V. Jain3 , P. Patil3 . 1 Department of Psychiatry and Neurology, 2 Department of Biochemistry, 3 Department of Psychiatry, JNMC, DMIMS, Wardha, India Background: Increasing number of studies reflects a growing awareness of the impact of psychotropic medications on sexual functioning but mechanisms are poorly understood. None of the empirical studies have as yet clearly demonstrated a biomarker for this epiphenomenon. Aims and Objectives: To ascertain the possible underlying biological mechanisms related to sexual dysfunction secondary to psychotropic (SSRI’s and SDA’s) medications. Methodology: A total of 30 drug naïve patients with first episode (time presentation) of psychiatric problems, who were not having sexual dysfunction at the time of presentation but have volunteered to screen if developed so after medications were recruited in the study. They were screened at the baseline and evaluated after every 4 weeks using Arizona Sexual Effects Change Scale (ASECS) for assessing sexual dysfunction and for serial levels of CBC, serum prolactin, serum TSH, serum total testosterone and serum free testosterone levels till 12 weeks. Results: Sexual dysfunction is seen in 56% (17 out of 30) of the patients. 94% of them have showed subnormal serum free testosterone levels in both genders. The mean serum free testosterone levels were 13.5 (pg/ml) and (0.8 pg/ml) in male and female patients respectively. Conclusions: Serum free testosterone levels clearly seems to be an emerging biomarker in sexual dysfunction secondary to psychotropic medications. It is hoped that the findings of this study shall be succeeded by the specification of proximal outcomes that are directly implicated by changes in the variables that are targeted for change in the prophylactic intervention. 566 High Salivary Alpha-Amylase Levels in Patients with Schizophrenia: A Pilot Study M. Ieda1 , T. Inagaki2 , T. Miyaoka3 , S. Okazaki3 , H. Yasuda3 , T. Kawamukai4 , E. Utani4 , R. Wake3 , M. Hayashida3 , J. Horiguchi3 , S. Tsuji5 . 1 Psychiatry, Shimane University Faculty of Medicine, Izumo-city, 2 Shimane University, Matsue-city, 3 Shimane University Faculty of Medicine, Izumo-city, 4 Sekitoh Hospital, Ohda-city, 5 Tsuji Mental Clinic, Hiroshima-city, Japan Objective: Previous studies have demonstrated the autonomic dysregulation in patients with schizophrenia using electrophysiological methods, such as electrodermal measures and heart rate analysis. Several theories have been proposed to explain the underlying mechanisms of schizophrenia and its autonomic function. Recently, the measurement of salivary alpha-amylase has been considered to be a useful tool for evaluating the sympatheticadrenal-medullary (SAM) system. Psychosocial stress increases the release of salivary alpha-amylase. Although some studies have evaluated salivary alpha-amylase under psychosocial stress, no studies have demonstrated the change in the salivary alpha-amylase (sAA) activity level in schizophrenic patients.
S48
Poster presentations / Asian Journal of Psychiatry 4S1 (2011) S41–S90
Methods: A total of 54 patients with schizophrenia (n = 54) and the control subjects (n = 55) were enrolled. sAA was measured using a portable and rapid hand-held monitor (NIPRO, Osaka, Japan). Also, Schizophrenic symptoms of all patients were assessed using the Brief Psychiatric Rating Scale (BPRS). Results: The sAA activity in the patients was significantly higher than that in the control subjects (p < 0.01). The correlation between amylase level and psychiatric symptoms was highly significant (r=0.37, p < 0.01). Conclusion: The present data imply a predominant role of the sympathetic nervous system in the secretion of sAA, together with parasympathetic withdrawal, under psychosocial stress. Poster session P13. Bipolar Disorders 10 Experiences of Family Member Caregiver of Patients with Bipolar Disorder F. Shamsaei1 , S. Mohamad Khan Kermanshahi1 , Z. Vanaki1 , M.R. Hayatbakhsh2 . 1 Tarbiat Modares University, Tehran, Iran; 2 The University of Queensland, Queensland, QLD, Australia Background: Attention to caregiving consequences has been mainly restricted to bipolar disorder, although studies suggest that relatives of bipolar patients also experience considerable distress. Aim: The purpose of this study was to explore the lived experiences from family member caregiver with bipolar disorder patient. Methods: In a qualitative research of phenomenological methodology, the family member’s caregivers of bipolar disorder in fsrshchian psychiatric hospital in Hamedan (Iran) were selected by purposive sampling in the year 2010. By reaching data saturation the number of participant was 12. Data were gathered through in-depth interviews and analyzed by “Van manen” method. Results: Analysis of the interviews revealed six major themes: fears and anxiety for the future, psychosomatic impact, feeling Isolated and loneliness, financial Impact, change in life style and family functioning and lack of support and knowledge. Conclusions: The findings highlight the need for family-oriented mental health services to be developed and for further research to identify the specific nursing interventions that are effective in helping to sustain family caregiving. 11 Survey of Family Caregiver Needs of Patients with Bipolar Disorder F. Cheraghi, F. Shamsaei. Hamadan University of Medical Sciences, Hamadan, Iran Introduction: Currently families of individuals with bipolar disorders are actively participating in the care of their relatives. Successful management of bipolar disorder in the community relies significantly on family caregivers. The need and experiences of such caregivers have been little studied with respect to bipolar disorder. Objective: The aim of the study was to identify family caregivers needs of patients with bipolar disorder. Methods: This study is a qualitative research of phenomenological methodology; the family member caregivers of bipolar disorder in farshchian psychiatric hospital in Hamedan were selected by purposive sampling. By reaching data saturation the number of participant was 12. Data were gathered through semi-unstructured interviews and analyzed by “Colaizzi” method. Results: Five groups were identified in this study analysis: illness management, consoling, economic needs, persistent care and social attention & perception. Conclusion: We identified the need of family member caregiver of bipolar disorder patients to be helped and to identify the specific caring interventions that are effective in helping to sustain family caregiving.
87 Creativity and Intelligence Quotient in Bipolar Disorder Patient and their Offsprings: A Controlled Study F. Sheikhmoonesi, M. Shahsavari, A. Jaafarzadeh, M. Khademloo. Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran Objective: Several studies and theories propose a connection between psychopathology and creativity, however to date, there have been no studies specifically examining creativity and intelligence quotient in offspring of bipolar patients. Methods: Twenty patients with bipolar disorder and twenty of their offspring (all euthymic) were matched with twenty normal control subjects and twenty of their offspring. All of participants completed creativity randsyp questionnaire (an objective measure of creativity) and Wechsler adult intelligence scale. Mean scores on these instruments were compared across group. Results: Bipolar parents compared to healthy control parents had significantly lower scores on Wechsler adult intelligence scale.(p < 0.001) but when we compared total intelligence quotient scores of bipolar off springs and healthy control off springs, there was no significant difference. For other comparisons, creativity scores did not differ significantly between groups. We used Pearson correlation test to assess relationship between intelligence quotient scores and creativity scores and no significant association was found. Conclusion: We found that bipolar disorder patients and healthy control subjects had similar scores on the creativity randsyp questionnaire and we did not find high creativity in bipolar offsprings. An important limitation of our study was that both cases and controls had low socioeconomic status and low education which may have contributed to these results. Intelligence quotient scores were lower in bipolar parents than healthy control subjects. Bipolar disorder may be associated with significant and persistent cognitive impairment. Intelligence quotient maybe also affected at least in some recovered bipolar patients. 245 Predominance of Manic Episodes in the Course of Bipolar Diorder G. Rakesh, S. Hatti, J. Thirthahalli, Y.C. Janardhan Reddy. Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India Background: Manic and depressive episodes have been described to be equally frequent in the course of bipolar disorder. Literature from India on the course of bipolar disorder is sparse. Evidence from Indian follow up studies of bipolar disorder in children suggest predominant manic course. In this study we examined the course of bipolar disorder in 315 adult inpatients. Method: The hospital records of 315 consecutively admitted patients were reviewed at the National Institute of Mental Health & Neurosciences Bangalore. The number and nature of past episodes, nature of first episode, age at onset of first episode and duration of illness were noted. Results: The current episode was mania, depression and mixed in 78.3%, 7.3% and 5.7% patients respectively. Mean age (SD) at onset of illness was 25.4 (9.8) years; mean (SD) duration since onset was 11.0 (9.2) years. The first episode was mania in 83.1%. The patients had experienced significantly higher number of manic, than depressive episodes in their lifetime [mean (SD) number of manic and depressive episodes were respectively 4.2 (4.7) and 1.1 (2.8); t = 10.9; p < 0.001)]. Half of the patients (n = 148; 47%) had experienced only manic episodes. Conclusion: Manic episodes were significantly more frequent among inpatients with bipolar disorder in this sample, with a substantial proportion experiencing “unipolar mania”. This is in stark contrast to the literature from high-income countries. Limitations of retrospective nature of this study notwithstanding,