- Email: [email protected]
P.1.b.012 High prevalence of human herpesvirus 8 in a tunisian sample of schizophrenic patients
P.1.b. Basic and clinical neuroscience − Neuroanatomy and neurophysiology procedure (p < 0.05). Compared with the patient group, control group reported not significant changes of EMG-PSD between the different periods, whereas in the schizophrenia group, music exposure after WN caused a nearly significant decrease in terms of EMG power in the schizophrenia group. In order to analyze the effect of symptom severity on EMG activity patients divided into two classes according to their total PANSS score (group A=44−61, group B=68−87). As the severity of symptoms increased, more EMG activity was observed in all the periods. Average SC levels during the each period were analyzed and we showed that there was an increase in the SC during auditory stimuli periods in both groups. We reported a much more increase in SC while listening to music in the controls. Also, a decrease in SC in both groups in the post-stimulation period was found. Table 1. EMG PSD and skin conductance values in each period in both groups Control group EMG PSD Mean SD Skin conductance Mean SD
R1 19 3.54 WN-R1 0.0247 0.001
WN 17.9 5.84 M-R1 0.0459 0.007
Schizophrenia group M 18.1 4.33 R2-R1 0.0076 0.003
R2 17.3 5.54 M-WN 0.0212 0.008
R1 51.4 12.9 WN-R1 0.0228 0.005
WN 72.8 15.5 M-R1 0.0304 0.006
M 50.2 12.4 R2-R1 0.0151 0.004
R2 57.1 14.3 M-WN 0.0075 0.002
EMG (mVolts); Skin conductance (mSiemens) Abbreviations: R1 (first resting state), WN (white noise), M (Classical Turkish Music), R2 (second resting state).
Conclusions: These findings suggest that autonomic arousal for auditory stimuli in schizophrenic subjects is remarkably different from healthy individuals and psychophysiological reactions are correlated with PANSS scores. Psychophysiological reactivity may have a contribution to evaluate the symptom severity of schizophrenia. References [1] Nuechterlein K. H., Dawson M. E., “A heuristic vulnerability/stress model of schizophrenic episodes” Schizophrenia Bulletin, vol. 10, pp. 300–312, 1984. [2] Sudheesh N. N. and Joseph K. P., “Investigation into the effects of music and meditation on galvanic skin response” ITBM-RBM, vol. 21, pp. 158–163, 2000. [3] Wolf K., Mass R., Kiefer F., Eckert K., Weinhold N., Wiedemann K., Naber D., The influence of olanzapine on facial expression of emotions in schizophrenia: An improved facial EMG study, German Journal of Psychiatry, vol. 7, pp. 14−19, 2004.
P.1.b.011 Thyroid hormones and exposure to violence in childhood in suicide attempters C. Sinai1 ° , A.L. Nordstrom1 , P. Nordstrom1 , J. Jokinen1 . 1 Karolinska Institute, Department of Clinical Neuroscience, Stockholm, Sweden Introduction: Recent research on young lawbreakers and controls indicated that among criminal boys there is a subgroup of boys with attention difficulties, who proceed to violent offending even in the absence of early manifestations of aggression. However, aggressive behaviour was independently related to violent offending and a combination of all three early behavioural problems (early criminality, attention difficulties and aggression) further increased the likelihood for violent offences. In addition to the early behavioural risk factors focused on, there is a growing knowledge about genetic and biological factors connected to the development of antisocial behaviour. One of the biochemical markers found to be of interest for this issue is tri-iodothyronine
S233
(T3) levels. Association between thyroid hormones and psychopathy and aggression-related personality traits has been reported in previous studies in forensic psychiatric male patients [1] and recently in male suicide attempters [2]. Both childhood trauma and violent behaviour are considered important risk factors for suicidal behaviour. It has been proposed that childhood trauma is a mediating factor between aggressive traits and attempted suicide. Interestingly there appears to be findings of altered T3/T4 levels or thyroid hormones in populations with PTSD or with childhood sexual abuse. This supports the hypothesis that trauma may be involved in long-lasting alteration of thyroid hormone levels. Purpose: The aim of the present study was to assess relationships between thyroid hormone measures and the The Karolinska Interpersonal Violence (KIV) [3] scales measuring both the exposure to and the expression of violence in childhood and during adult life in suicide attempters. Methods: 78 clinically euthyroid suicide attempters with mood disorder diagnoses were assessed with KIV scales. The KIV rating is a new instrument, containing four subscales with concrete examples of exposure to violence and expressed violent behaviour in childhood (between 6−14 years of age) and during adult life (15 years or older). The ratings are filled in during a structured inperson interview to elicit a comprehensive lifetime trauma and victimization history and history of lifetime expressed violent behaviour. Baseline thyroid function was evaluated by measuring plasma TSH and Total T3 levels by immunoassays. Results: Total T3 levels showed a significant positive correlation with exposure to violence as a child. Suicide attempters with exposure to violence as a child reported higher scores in expressed violent behaviour as an adult. Conclusions: Altered thyroid activity, especially elevated Total T3 levels was associated with exposure to violence in childhood in suicide attempters. Childhood trauma may contribute to permanently altered thyroid levels or children with inherent altered thyroid levels may be prone to exposure to violence as a child, and/or develop psychopatohogy associated with suicide-attempts coming to the notice of psychiatric care. Being exposed to violence as a child is associated with expressed violent behaviour as an adult suicide attempter. References [1] Stalenheim, E.G., von Knorring, L, Wide, L, 1998, Serum levels of thyroid hormones as biological markers in a Swedish forensic psychiatric population. Biological Psychiatry May 15;43(10):755−61. [2] Sinai, C, Hirvikoski, T, Vansvik, E.D., Nordstrom, AL, Linder, J, Nordstrom, P, Jokinen, J, 2009, Thyroid hormones and personality traits in attempted suicide. Psychoneuroendocrinology Nov;34(10):1526−32. [3] Jokinen, J, Forslund, K, Ahnemark, E, Gustavsson, P, Nordstrom P, Asberg, M, 2010, Karolinska Interpersonal Violence (KIV) scales predict suicide in suicide attempters. Journal of Clinical Psychiatry [accepted].
P.1.b.012 High prevalence of human herpesvirus 8 in a tunisian sample of schizophrenic patients Y. El Kissi1 ° , N. Hannachi2 , S. Samoud2 , S. Gaabout1 , M. Ayachi1 , J. Boukadida2 , B. Ben Hadj Ali1 . 1 Farhat Hached university hospital, Psychiatry, Sousse, Tunesian Republic; 2 Farhat Hached university hospital, Microbiology and Immunology, Sousse, Tunesian Republic Background: Due to their potential neurotropism, Herpes family viruses are considered as possible agents in many chronic central nervous system (CNS) disorders. Although a number of studies
S234
P.1.b. Basic and clinical neuroscience − Neuroanatomy and neurophysiology
have reported an association between this virus’s family and an increased risk of schizophrenia, the prevalence of Human Herpesvirus 8 (HHV8), the most recently discovered human herpes virus, has never been investigated in schizophrenic patients. Objective: This study aimed to assess the prevalence of HHV8 serum antibodies in schizophrenic patients and in healthy controls. Methods: During a twenty four months period, we consecutively enrolled one hundred and eight patients meeting DSMIV criteria of schizophrenia, in psychiatry department of Sousse Farhat Hached hospital (Tunisia). They were drug na¨ıve or drug free for at least three months. Assessment was performed during an acute phase of the disease as defined by a BPRS global score 40. We also enrolled one hundred and eight controls among consenting blood donors, in Farhat Hached Hospital during the same period. They were age and sex matched and free from any psychotic disorder as screened by MINI-Plus. Data about demographic characteristics and patients’ clinical features were collected. Information about parenteral risk factors of viral infection was also obtained Standardized psychopathology and disease severity were measured using PANSS, BPRS, SANS, SAPS and CGI. Sera samples were obtained from patients and controls and then analyzed for the presence of anti-HHV8 antibodies (antiHHV8) using a sensitive indirect immunofluorescence assay to latent and lytic HHV8 antigens. Statistical analysis was performed using SPSS version 11. Comparisons between were performed using the khi2 test and Student test. Significance was assigned to p values lower than 0.05. Results: The mean age of schizophrenic patients was 36.8 years and the sex ratio was 1.9. Significant differences in sociodemographic characteristics between schizophrenic patients and controls were found for marital status, educational level and professional activity (p < 0.05). History of surgery or dental procedures and number of sexual partners was higher in controls than in patients (p < 0.001). A significantly higher prevalence of anti-HHV8 in schizophrenic patients than in healthy controls was found (28.7% vs. 14.8%, p = 0.01). Marital status, educational level, professional activity, poverty, promiscuity, number of children, sexual behavior or presence of risk factors of blood transmission were not associated with HHV8 prevalence (p > 0.05). However, among schizophrenic patients, HHV8 prevalence was statically associated with positive symptoms (SAPS score) (p = 0.01) and the severity of illness (CGI score) (p = 0.02). Conclusion: To our knowledge, this would be the first report of high HHV8 prevalence in schizophrenic patients, which support the role of this virus in the pathogenesis of schizophrenia, as suggested in literature. Since sociodemographic, sexual and parenteral risk factors did not interfere with HHV8 prevalence; the hypothesis of a potential role of this virus in the pathogenesis of schizophrenia becomes plausible. Both direct and indirect pathways of neuropsychiatric disorders in HHV8 infection are possible: HHV-8 was associated with neurological infections like encephalitis and the virus can stimulate secretion of proinflammatory cytokines wich are implicated in schizophrenia. To go on further with this hypothesis, more investigations of HHV8 in schizophrenia are needed, especially in areas of intermediate to high endemicity for the virus.
P.1.b.013 Characteristics of the power spectrum alpha activity in relation to clinical expression of schizophrenia N. Manuseva1 ° , B. Stefanovski2 . 1 Psychiatric clinic Skopje, Psychophysiology, Skopje, Macedonia; 2 Psychiatric clinic Skopje, Department for psychoses, Skopje, Macedonia Purpose of the study: Possible reasons for inconsistency in the findings in power spectrum of alpha activity in patients with schizophrenia include: the influence of the medication drugs on the EEG activity, heterogeneity of the group of patients included in the studies, chronic state of the disease etc. In order to overcome these deficiencies and to find the influence of the clinical expression of the schizophrenic disorder we need to classify presented psychopathology. In our study we examined EEG activity (power spectrum) in alpha range in actually untreated (drug-free) acute cases of schizophrenia. The hypothesis was that power spectrum of alpha activity will be different between patients with schizophrenia and healthy subjects and in relation to the present psychopathology (positive or negative syndrome of schizophrenia). Method: We examined 30 inpatients with schizophrenia. Criterions for inclusion were: presence of schizophrenic symptomatology, which are actually without antipsychotic treatment. Criterions for exclusion were: neurologic disease, data for traumatic injury of the head, dependence on psychoactive substances, mental retardation, febrile convulsions, which criterions were valid for the controls as well. Control group consisted of 30 subjects which have never been ill from any kind of psychiatric disorder, gender and age matched in order to compare the groups. All of them used right hand dominantly. We analyzed alpha activity (and also alpha1=8−9HZ and alpha 2=10−12HZ) power spectrum. We used clinical scale PANSS (positive and negative symptom scale for schizophrenia). Statistical analysis was performed with ANOVA (analysis of variance for two independent samples) and LSD (low sum differences) test. Results: The study group consisted of 13 man and 17 woman, age 18−55 (mean = 34.63 SD = 8.97). Comparing the patients with schizophrenia with the healthy subjects differences were found over the parietal and occipital derivations on the right witch point out towards decreased power spectrum of the alpha activity opposed to healthy subjects. We did not find any difference in the lower alpha activity but there was a difference over the parietal and occipital derivations for higher alpha activity. Then we compared the group of healthy subjects and the groups of patients with schizophrenia with positive (18 patients) and negative syndrome (12). In patients with positive syndrome of schizophrenia there was decrease of the spectral power over all derivations but what differs them from the healthy subjects and is statistically relevant is decrease of the activity of the higher alpha2 activity over F3, F4, T3, C3, C4, P3, and P4. Healthy subjects were different from the patients with positive and negative syndrome of schizophrenia because of the decrease over the occipital regions. Positive syndrome of schizophrenia unlike negative syndrome is different because of the decrease of the spectral power over the central and parietal derivations. Conclusions:Significant differences were noted in the alpha activity and alpha2 power spectrum over occipital regions in patients with schizophrenia. In positive syndrome of schizophrenia we found reduction of power spectrum over occipital regions and negative schizophrenia syndrome differed from positive syndrome
R1 19 3.54 WN-R1 0.0247 0.001
WN 17.9 5.84 M-R1 0.0459 0.007
Schizophrenia group M 18.1 4.33 R2-R1 0.0076 0.003
R2 17.3 5.54 M-WN 0.0212 0.008
R1 51.4 12.9 WN-R1 0.0228 0.005
WN 72.8 15.5 M-R1 0.0304 0.006
M 50.2 12.4 R2-R1 0.0151 0.004
R2 57.1 14.3 M-WN 0.0075 0.002
EMG (mVolts); Skin conductance (mSiemens) Abbreviations: R1 (first resting state), WN (white noise), M (Classical Turkish Music), R2 (second resting state).
Conclusions: These findings suggest that autonomic arousal for auditory stimuli in schizophrenic subjects is remarkably different from healthy individuals and psychophysiological reactions are correlated with PANSS scores. Psychophysiological reactivity may have a contribution to evaluate the symptom severity of schizophrenia. References [1] Nuechterlein K. H., Dawson M. E., “A heuristic vulnerability/stress model of schizophrenic episodes” Schizophrenia Bulletin, vol. 10, pp. 300–312, 1984. [2] Sudheesh N. N. and Joseph K. P., “Investigation into the effects of music and meditation on galvanic skin response” ITBM-RBM, vol. 21, pp. 158–163, 2000. [3] Wolf K., Mass R., Kiefer F., Eckert K., Weinhold N., Wiedemann K., Naber D., The influence of olanzapine on facial expression of emotions in schizophrenia: An improved facial EMG study, German Journal of Psychiatry, vol. 7, pp. 14−19, 2004.
P.1.b.011 Thyroid hormones and exposure to violence in childhood in suicide attempters C. Sinai1 ° , A.L. Nordstrom1 , P. Nordstrom1 , J. Jokinen1 . 1 Karolinska Institute, Department of Clinical Neuroscience, Stockholm, Sweden Introduction: Recent research on young lawbreakers and controls indicated that among criminal boys there is a subgroup of boys with attention difficulties, who proceed to violent offending even in the absence of early manifestations of aggression. However, aggressive behaviour was independently related to violent offending and a combination of all three early behavioural problems (early criminality, attention difficulties and aggression) further increased the likelihood for violent offences. In addition to the early behavioural risk factors focused on, there is a growing knowledge about genetic and biological factors connected to the development of antisocial behaviour. One of the biochemical markers found to be of interest for this issue is tri-iodothyronine
S233
(T3) levels. Association between thyroid hormones and psychopathy and aggression-related personality traits has been reported in previous studies in forensic psychiatric male patients [1] and recently in male suicide attempters [2]. Both childhood trauma and violent behaviour are considered important risk factors for suicidal behaviour. It has been proposed that childhood trauma is a mediating factor between aggressive traits and attempted suicide. Interestingly there appears to be findings of altered T3/T4 levels or thyroid hormones in populations with PTSD or with childhood sexual abuse. This supports the hypothesis that trauma may be involved in long-lasting alteration of thyroid hormone levels. Purpose: The aim of the present study was to assess relationships between thyroid hormone measures and the The Karolinska Interpersonal Violence (KIV) [3] scales measuring both the exposure to and the expression of violence in childhood and during adult life in suicide attempters. Methods: 78 clinically euthyroid suicide attempters with mood disorder diagnoses were assessed with KIV scales. The KIV rating is a new instrument, containing four subscales with concrete examples of exposure to violence and expressed violent behaviour in childhood (between 6−14 years of age) and during adult life (15 years or older). The ratings are filled in during a structured inperson interview to elicit a comprehensive lifetime trauma and victimization history and history of lifetime expressed violent behaviour. Baseline thyroid function was evaluated by measuring plasma TSH and Total T3 levels by immunoassays. Results: Total T3 levels showed a significant positive correlation with exposure to violence as a child. Suicide attempters with exposure to violence as a child reported higher scores in expressed violent behaviour as an adult. Conclusions: Altered thyroid activity, especially elevated Total T3 levels was associated with exposure to violence in childhood in suicide attempters. Childhood trauma may contribute to permanently altered thyroid levels or children with inherent altered thyroid levels may be prone to exposure to violence as a child, and/or develop psychopatohogy associated with suicide-attempts coming to the notice of psychiatric care. Being exposed to violence as a child is associated with expressed violent behaviour as an adult suicide attempter. References [1] Stalenheim, E.G., von Knorring, L, Wide, L, 1998, Serum levels of thyroid hormones as biological markers in a Swedish forensic psychiatric population. Biological Psychiatry May 15;43(10):755−61. [2] Sinai, C, Hirvikoski, T, Vansvik, E.D., Nordstrom, AL, Linder, J, Nordstrom, P, Jokinen, J, 2009, Thyroid hormones and personality traits in attempted suicide. Psychoneuroendocrinology Nov;34(10):1526−32. [3] Jokinen, J, Forslund, K, Ahnemark, E, Gustavsson, P, Nordstrom P, Asberg, M, 2010, Karolinska Interpersonal Violence (KIV) scales predict suicide in suicide attempters. Journal of Clinical Psychiatry [accepted].
P.1.b.012 High prevalence of human herpesvirus 8 in a tunisian sample of schizophrenic patients Y. El Kissi1 ° , N. Hannachi2 , S. Samoud2 , S. Gaabout1 , M. Ayachi1 , J. Boukadida2 , B. Ben Hadj Ali1 . 1 Farhat Hached university hospital, Psychiatry, Sousse, Tunesian Republic; 2 Farhat Hached university hospital, Microbiology and Immunology, Sousse, Tunesian Republic Background: Due to their potential neurotropism, Herpes family viruses are considered as possible agents in many chronic central nervous system (CNS) disorders. Although a number of studies
S234
P.1.b. Basic and clinical neuroscience − Neuroanatomy and neurophysiology
have reported an association between this virus’s family and an increased risk of schizophrenia, the prevalence of Human Herpesvirus 8 (HHV8), the most recently discovered human herpes virus, has never been investigated in schizophrenic patients. Objective: This study aimed to assess the prevalence of HHV8 serum antibodies in schizophrenic patients and in healthy controls. Methods: During a twenty four months period, we consecutively enrolled one hundred and eight patients meeting DSMIV criteria of schizophrenia, in psychiatry department of Sousse Farhat Hached hospital (Tunisia). They were drug na¨ıve or drug free for at least three months. Assessment was performed during an acute phase of the disease as defined by a BPRS global score 40. We also enrolled one hundred and eight controls among consenting blood donors, in Farhat Hached Hospital during the same period. They were age and sex matched and free from any psychotic disorder as screened by MINI-Plus. Data about demographic characteristics and patients’ clinical features were collected. Information about parenteral risk factors of viral infection was also obtained Standardized psychopathology and disease severity were measured using PANSS, BPRS, SANS, SAPS and CGI. Sera samples were obtained from patients and controls and then analyzed for the presence of anti-HHV8 antibodies (antiHHV8) using a sensitive indirect immunofluorescence assay to latent and lytic HHV8 antigens. Statistical analysis was performed using SPSS version 11. Comparisons between were performed using the khi2 test and Student test. Significance was assigned to p values lower than 0.05. Results: The mean age of schizophrenic patients was 36.8 years and the sex ratio was 1.9. Significant differences in sociodemographic characteristics between schizophrenic patients and controls were found for marital status, educational level and professional activity (p < 0.05). History of surgery or dental procedures and number of sexual partners was higher in controls than in patients (p < 0.001). A significantly higher prevalence of anti-HHV8 in schizophrenic patients than in healthy controls was found (28.7% vs. 14.8%, p = 0.01). Marital status, educational level, professional activity, poverty, promiscuity, number of children, sexual behavior or presence of risk factors of blood transmission were not associated with HHV8 prevalence (p > 0.05). However, among schizophrenic patients, HHV8 prevalence was statically associated with positive symptoms (SAPS score) (p = 0.01) and the severity of illness (CGI score) (p = 0.02). Conclusion: To our knowledge, this would be the first report of high HHV8 prevalence in schizophrenic patients, which support the role of this virus in the pathogenesis of schizophrenia, as suggested in literature. Since sociodemographic, sexual and parenteral risk factors did not interfere with HHV8 prevalence; the hypothesis of a potential role of this virus in the pathogenesis of schizophrenia becomes plausible. Both direct and indirect pathways of neuropsychiatric disorders in HHV8 infection are possible: HHV-8 was associated with neurological infections like encephalitis and the virus can stimulate secretion of proinflammatory cytokines wich are implicated in schizophrenia. To go on further with this hypothesis, more investigations of HHV8 in schizophrenia are needed, especially in areas of intermediate to high endemicity for the virus.
P.1.b.013 Characteristics of the power spectrum alpha activity in relation to clinical expression of schizophrenia N. Manuseva1 ° , B. Stefanovski2 . 1 Psychiatric clinic Skopje, Psychophysiology, Skopje, Macedonia; 2 Psychiatric clinic Skopje, Department for psychoses, Skopje, Macedonia Purpose of the study: Possible reasons for inconsistency in the findings in power spectrum of alpha activity in patients with schizophrenia include: the influence of the medication drugs on the EEG activity, heterogeneity of the group of patients included in the studies, chronic state of the disease etc. In order to overcome these deficiencies and to find the influence of the clinical expression of the schizophrenic disorder we need to classify presented psychopathology. In our study we examined EEG activity (power spectrum) in alpha range in actually untreated (drug-free) acute cases of schizophrenia. The hypothesis was that power spectrum of alpha activity will be different between patients with schizophrenia and healthy subjects and in relation to the present psychopathology (positive or negative syndrome of schizophrenia). Method: We examined 30 inpatients with schizophrenia. Criterions for inclusion were: presence of schizophrenic symptomatology, which are actually without antipsychotic treatment. Criterions for exclusion were: neurologic disease, data for traumatic injury of the head, dependence on psychoactive substances, mental retardation, febrile convulsions, which criterions were valid for the controls as well. Control group consisted of 30 subjects which have never been ill from any kind of psychiatric disorder, gender and age matched in order to compare the groups. All of them used right hand dominantly. We analyzed alpha activity (and also alpha1=8−9HZ and alpha 2=10−12HZ) power spectrum. We used clinical scale PANSS (positive and negative symptom scale for schizophrenia). Statistical analysis was performed with ANOVA (analysis of variance for two independent samples) and LSD (low sum differences) test. Results: The study group consisted of 13 man and 17 woman, age 18−55 (mean = 34.63 SD = 8.97). Comparing the patients with schizophrenia with the healthy subjects differences were found over the parietal and occipital derivations on the right witch point out towards decreased power spectrum of the alpha activity opposed to healthy subjects. We did not find any difference in the lower alpha activity but there was a difference over the parietal and occipital derivations for higher alpha activity. Then we compared the group of healthy subjects and the groups of patients with schizophrenia with positive (18 patients) and negative syndrome (12). In patients with positive syndrome of schizophrenia there was decrease of the spectral power over all derivations but what differs them from the healthy subjects and is statistically relevant is decrease of the activity of the higher alpha2 activity over F3, F4, T3, C3, C4, P3, and P4. Healthy subjects were different from the patients with positive and negative syndrome of schizophrenia because of the decrease over the occipital regions. Positive syndrome of schizophrenia unlike negative syndrome is different because of the decrease of the spectral power over the central and parietal derivations. Conclusions:Significant differences were noted in the alpha activity and alpha2 power spectrum over occipital regions in patients with schizophrenia. In positive syndrome of schizophrenia we found reduction of power spectrum over occipital regions and negative schizophrenia syndrome differed from positive syndrome