Prevalence and Characteristics of Mental Disorders Among Hospitalized Breast Cancer Patients in the United States

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this study, we aimed to investigate real-life treatment and biologic effectiveness in CD, in Taiwan.  Methods: The 2009-2013 NHI Research Database medical claims and catastrophic-illness-certificate (CIC) dataset were used. Patients eligible for CIC were divided into early and late cohorts (January1 2010-July1 2011 and July2 2011-December31 2012, respectively). An adalimumab cohort was also identified in the study period January 1 2010 – December 31 2013. Medication use within 3/6/12 months since CIC eligibility in early and late cohorts and indicators of loss-ofresponse in the adalimumab cohort were described.  Results: There were 72 CD patients in the early and 137 in the late cohort. Average age was 41 years, with a male preponderance in both cohorts. Most patients used 5-ASA (81/86/88% in early cohort; 79/82/84% in late cohort). Thiopurine use was 14/18/26% (early cohort) and 26/29/35% (late cohort). Systemic steroid use was 54/57/68% (early cohort) and 55/60/64% (late cohort). Adalimumab use was 1/3/7% in early cohort and 10/16/22% in late cohort. N= 49 adalimumab users had follow-up of > 40 weeks; median treatment duration was 17.0 months. Of these, 10% (n= 5) received IBD-related surgery, while 47% (n= 23) had ER-visit due to IBD from initial dose to end of follow-up. And, 29% (n= 14) discontinued adalimumab treatment, of whom 14% (n= 2) had IBD-related surgery and 57% (n= 8) required IBD ER-visits from initial dose to end of follow-up.  Conclusions: Thiopurine and adalimumab use increased over time. Further study on the association between biologic persistence and treatment effectiveness is ongoing. PGI12 Policy Evaluation on“The Pay-For-Performance Program of Hepatitis B and C” in Taiwan Lu S, Tang C, Lin Y, Tsai C Taipei Medical University, Taipei, Taiwan

Objectives: Taiwan is a hyper endemic country with viral liver diseases. “The pay-for-performance (P4P) program of Hepatitis B and C” was launch in Taiwan in 2010 to provide incentives to hospitals to enhance their follow-up on patients with HBV/HCV. This study aims to evaluate the effectiveness of this policy.  Methods: All the chronic HBV/HCV patients who had sought care in hospitals were identified. Follow-up rates of abdominal ultrasound, alpha-fetoprotein, GOT and GPT were calculated for each hospital every 6-months during 2007-2012. Chi-squares tests and generalized linear model regression were performed to assess the differences in the 6-month follow-up rates in the 3 years prior (the pre-policy periods) and post (the post-policy periods) to P4P policy intervention were compared among the hospitals. All analysis were stratified by types of follow-up examination and HBV/HCV.  Results: A significant higher follow-up rates among hospitals in the post-policy periods on the abdominal ultrasound (0.18 vs. 0.15, p< 0.0001), alphafetoprotein (0.26 vs. 0.19, p< 0.0001), GOT (0.48 vs. 0.42, p< 0.0001, and GPT examinations (0.54 vs. 0.46, p< 0.0001) were found, in comparison with the pre-policy periods. Non-propriety hospitals had the largest increases in the follow-up rates compared with other types of hospitals.  Conclusions: The P4P policy intervention seems to be quite effective in raising the follow-up rates of the HBV/HCV patients seeking care. PGI13 The Role of Insulin-Like Growth Factor-1 on Steatohepatitis Bulur O, Dal K, Ertugrul dT, Aydoğan Y, Beyan E, Karadag I, Ünsal O keçiören research hospital ANKARA /TURKEY, Ankara, Turkey

Objectives: Recent experimental studies have revealed that growth hormone and its transcription factor STAT5 were related to hepatosteatosis in mice. Loss of signal transducer and activator of transcription factor-5 leads to hepatosteatosis and impaired liver regeneration. We aimed to investigate the role of IGF-1 in hepatosteatosis and steatohepatitis in humans.  Methods: We included 272 NAFLD patients and 110 age, sex and body mass index (BMI)-matched healthy controls. We measured routine blood biochemistry and complete blood count, as well as IGF-1, insulin, c-peptide, ferritin, hsCRP and ESR. We also calculated HOMA-IR to measure insulin resistance. We subdivided NAFLD patients into hepatosteatosis and steatohepatitis.  Results: Age, sex and BMI were similar between NAFLD and controls. IGF-1 levels were significantly lower in NAFLD patients (120,6±48,2) than controls (148,9±53,8), (p< 0,0001). IGF-1 levels were also lower in steatohepatitis subgroup (93,4±27,8) than hepatosteatosis subgroup (123,1±49,0), (p:0,032). Waist circumference, fasting blood glucose, HbA1c, uric acid, hsCRP, AST, ALT, GGT, WBC, hemoglobin, hematocrit, ferritin, insulin, c-peptid and HOMA-IR measurements were significantly higher in NAFLD patients than controls (for all values: p< 0,0001). Total cholesterol (p:0,026), triglycerides (p< 0,0001), ESR (p:0,006) were significantly higher in NAFLD patients than controls. HDL-chelesterol levels were significantly lower (p:0,002) in NAFLD patients than controls.  Conclusions: This study supported previous findings of experimental studies in that, IGF-1 levels were lower in hepatosteatosis and steatohepatitis. Growth hormone-IGF-1 system may be involved in the pathogenesis of NAFLD.

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This HRR was calculated for the first(HRR1) , and the second minutes of recovery phase(HRR2).  Results: According to basic clinical and demographic characteristics, groups were similar with regard to age and gender. No significant differences were observed in the initial systolic blood pressures or maximal systolic blood pressures or resting heart rates between three groups. All patients and control group participants had sinus rhythm and normal 12 lead ECG results at rest. The maximal heart rate and baseline heart rate during exercise stress test were similar in UC, CD and control groups . The first and the second minute HRR indices of patients with UC and CD were similar to those of the control group. Conclusions: The HRR index, which is calculated by an exercise stress test and associated with autonomic nervous system function, is not affected in UC and CD. PGI15 Knowledge, Attitude and Practice Towards Hepatitis B Among Medical College Students of Quetta, Pakistan ul Haq N1, Malik Z1, Nasim A1, Riaz S1, Mohammad G1, Azhar S2 of Balochistan, Quetta, Pakistan, 2Comsats Institute of Information Technology, Abbottabad, Pakistan

1University

Objectives: Present study was aimed to evaluate the knowledge, attitude and practice (KAP) towards hepatitis B among medical students of Quetta, Pakistan  Methods: A cross-sectional, questionnaire based descriptive study was conducted among the students of Bolan Medical College, Quetta from April to September 2015. A pre-validated questionnaire and respondents were asked and guided to fill questionnaire on spot. All statistical analysis was done using SPSS 20  Results: A total of 310 questionnaires were distributed, 287 were returned (response rate of 92.5%). Gender distribution was female dominant (n= 165, 57.5%) with majority (n= 128 (44.6%) were between age group of 20-23. Two hundred of twenty-two (77.3%) showed adequate knowledge (mean score of more than 10 from max= 20), 214 (74.26%) showed positive attitude (mean score of more than 4 from max= 7) and 267 (93.03%) showed good practice (mean score of more than 5 from max= 8). Statistically significant and positive linear correlation between knowledge – attitude (r =  0.536, p <  0.05), knowledge – practice (r =  0.022, p <  0.05) and attitude – practice (r =  0.026, p <  0.05) were observed.  Conclusions: The results of study demonstrated adequate knowledge, positive attitude and good practice regarding hepatitis B by medical students, this will be helpful to transfer the knowledge to patients and general people when these students come to practice.

Mental Health – Clinical Outcomes Studies PMH1 Clinical Outcomes of Bipolar Disorder on Long-Term Treatment with Lithium with or without Mood Stabilizers De Guzman GQ Virgen Milagrosa University Foundation, San Carlos City, Pangasinan, Philippines

Objectives: This study assesses the long-term treatment outcomes of 204 ambulatory patients diagnosed with bipolar disorder who are taking daily dose of lithium carbonate with or without mood stabilizers for a span of at least 2 years.  Methods: Semi-structured questionnaires were used by psychiatrists and primary care physicians to monitor treatment outcomes parameters of bipolar disorder as prescribed by the British Association for Psychopharmacology.  Results: Female patients aged 25 years and above were found to be at great risks for poor treatment outcomes. Supplementing lithium carbonate with quetiapine, lamotrigine or valproic acid significantly reduced the frequency of hospitalization, manic episodes and affective behaviors in more than 50% of the population but did not significantly reduced the risks for suicidal tendencies. No significant improvement was observed in patients supplemented with carbamazepine. Adverse drug reactions, age and economic class, with preference for female patients, appear to positively influence adherence to medications and mood stabilization. After 2 years of treatment, lithium monotherapy, based on GAS rating, gave a good outcome in only 31% of the population while treatment with lithium supplemented with valproic acid or quetiapine gave a good outcome in 72% of the cases. Smoking and alcohol abuse were found to be associated with poor outcomes.  Conclusions: The findings show that supplementation of lithium carbonate with quetiapine, valproic acid and lamotrigine improved treatment outcomes in majority of the patients. The large variance in the treatment outcomes between monotherapy and combination treatments suggests underlying differences in the pathophysiology of bipolar disorder. PMH2 Prevalence and Characteristics of Mental Disorders Among Hospitalized Breast Cancer Patients in the United States

PGI14 Heart Rate Recovery in Inflammatory Bowel Disease (Ibd)

Wang X, Xiao H University of Florida, Gainesville, FL, USA

Ünsal O, Karakaya S, Bulur O, Dal K, Uzman M, Eser M Aydogan Y,keçiören research hospital ANKARA /TURKEY, Ankara, Turkey

Objectives: To estimate prevalence of clinically diagnosed mental disorders among hospitalized breast cancer patients and demonstrate their demographic characteristics.  Methods: The Nationwide Inpatients Sample (NIS) in the US between 2007 and 2011 was used for this study. Breast cancer patients were identified as ICD-9-CM codes (174.0–174.9), metastatic stage of breast cancer patients were identified as the ICD-9-CM code (196.0), and non-metastatic stage of patients were identified as ICD-9 code (2330). Prevalence of mental disorder was calculated as the proportion of any diagnosis of depression, depressive disorder, anxiety disorder, acute reaction to stress, and posttraumatic stress disorder (PTSD) among hospitalized breast cancer patients.  Results: Among hospitalized breast cancer patients, prevalence of mental disorder was 6.1%(2007), 7.0%(2008), 7.4%(2009), 8.3%(2010), 9.3%(2011). Patients were more likely (78%) to be diagnosed mental disorders between 30 and 60 years old. Among patients with any mental disorders, Caucasians had a higher proportion (77.3%) compared with African Americans, Hispanics and other ethnical groups.

Objectives: Inflammatory bowel disease is a chronic idiopathic inflammatory disease which includes Ulcerative colitis(UC) and Crohn disease(CD) . Various types of dysfunctions associated with cardiovascular system were documented in these patients, including ischemic heart disease, emboli. It has been shown that heart rate recovery(HRR) after exercise was an estimate of impaired parasympathic tone and predictor of all cause and cardiovascular mortality. The aim of the study was to assess HRR in patients with inflammatory bowel disease.  Methods: 52 consecutive patients, admitted to our Hospital, with diagnosis of inflammatory bowel disease and 50 healthy subjects were included in the study. Basal electrocardiography and tredmill exercise testing were performed in all patients and control grup. Heart rate recovery index was defined as the decrease in the heart rate from peak exercise value to 1 min and 2 min after the termination of the exercise.

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Patients with mental disorders had a higher proportion of Medicare beneficiaries, following private insurance, Medicaid and self-pay.  Conclusions: Recognizing the increase of mental disorders among hospitalized breast cancer patients is important. Research is needed to ascertain how co-existing mental health disorders would affect the quality of care and/or treatment strategies for hospitalized breast cancer patients. PMH3 Cross-Validation of A 7-Item Clinical Decision Rule for Detecting Panic-Related Anxiety in Emergency Medicine Patients Sung SC1, Rush AJ1, Earnest A2, Lim LE3, Lim SH3, Ong ME3 1Duke-NUS Medical School, Singapore, Singapore, 2Monash University, Melbourne, Australia, 3Singapore General Hospital, Singapore, Singapore

Objectives: Patients with panic-related anxiety frequently seek care in the Emergency Department (ED), but panic-related anxiety is rarely diagnosed by ED physicians due to limited time and a focus on stabilizing life-threatening conditions. We have previously developed a brief clinical decision rule (CDR) to help physicians quickly identify patients with panic-related anxiety in the ED setting. This study was undertaken to cross-validate the original CDR with a larger group of patients.  Methods: English and Mandarin-speaking adult ED patients with a primary complaint of palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic-related anxiety (i.e., panic attacks or panic disorder) using the Structured Clinical Interview for DSM-IV. All 13 panic attack symptoms were entered into a multivariate model using stepwise selection with presence/absence of panic-related anxiety as the outcome variable. We compared receiver operating characteristics, sensitivity, and specificity for the original 7-item CDR created with our derivation sample (n= 200) versus an alternative 7-item CDR created with the validation sample (n= 321) using the same model selection procedure.  Results: 46.5% of participants in the derivation sample and 39.3% of participants in the validation sample met criteria for panic-related anxiety. The original CDR showed excellent separation between those with panic-related anxiety and those without (AUC= 0.90) in the derivation sample. A cutoff score of 3 or greater retained good sensitivity (81.7%) and specificity (87.9%) while correctly classifying 85.0% of participants. The original CDR did not perform as well in the validation sample (AUC= 0.84, sensitivity= 78.1%, specificity= 89.3%, classified correctly= 77.9%). The alternative model performed slightly better (AUC= 0.88, sensitivity= 78.4%, specificity= 85.7%, classified correctly= 82.8%) in the validation sample.  Conclusions: Panic-related anxiety is common and should be strongly considered in ED patients. A brief clinical decision rule may be useful for screening purposes. Which items to retain in the final CDR requires further investigation. PMH4 Somatic Symptoms in Patients with Undiagnosed Depression: Prevalence and Health Care Utilization In Japan Takahashi O, Ohde S St.Luke’s International University, Tokyo, Japan

Objectives: Depression is one of the most common mental disorders. However, depressed patients are underdiagnosed and undertreated in the general population. We aimed to evaluate the prevalence of undiagnosed depression in the general Japanese population, healthcare utilization and somatic symptoms among undiagnosed depressed patients.  Methods: In a cross-sectional study, a populationweighted random sample from a nationally representative panel of adults was used to estimate health care utilization based on a prospective health diary recorded over one month. A baseline, pre-diary questionnaire was used to capture demographic data and symptoms. Depression was defined as a score of > 9 on the Patient Health Questionnaire (PHQ-9) and undiagnosed depressive patients were defined as those with a score of > 9 on the PHQ-9 who did not report the treatment of depression in hospital.  Results: A total of 2,113 people were included in this study (mean age, 52 years (SD, 18); 1,236 (58.5%) women.) The prevalence of depression was 16.2% (n= 343), among whom 264 (12.5%) were undiagnosed. Incidence rate of any symptom over a one month period among non-depressive, undiagnosed depressive, and depressive patients was 3.29, 4.40, and 4.92, respectively (p= 0.1). The most common symptoms were headache (37.2%), followed by back pain (35.5%) and diarrhea (20.0%). Comparing the non-depressive, undiagnosed depressive, and depressive patient groups, the symptoms showing the largest difference in prevalence were nausea (3.7%, 6.8%, and 15.2%, respectively p< 0.01) and gastric pain (6.0%, 10.6%, and 12.7%, respectively p< 0.01). Healthcare utilization rates per month were 31.7%, 38.6%, and 31.6% (p= 0.08) for non-depressive, undiagnosed depressive, and depressive patients, respectively.  Conclusions: Depressive disorders are prevalent in Japan and about 80% was undiagnosed. Screening for depression might be useful for those presenting with many symptoms including those of the gastrointestinal system.

(SMD -0.33, 95% CI –0.57 ~ -0.08, I2= 74%). Respectively, teleconferencing and webconferencing showed significant improvements by subgroup analysis. Especially, improvement of depressive symptom was significantly higher for telepsychotherapy in studies where telepsychotherapy was performed more than twice a month (SMD -0.48, 95% CI –0.72 ~ -0.25, I2= 16%), and the follow up period was between 4-11 months (SMD -0.36, 95% CI –0.57 ~ -0.16, I2= 31%). 2 articles compared telepsychotherapy and face-to-face psychotherapy, but each study had a different target population and intervention modality. They showed controversial results in depressive symptom score (Respectively, SMD 0.39, 95% CI 0.15 ~ 0.63, SMD -0.33, 95% CI -0.68 ~ 0.01).  Conclusions: Telepsychotherapy may be effective than care as usual in depressive symptom improvement in patients with depressive disorder. However most of the articles were published before 2012 as telephone, so additional studies are needed to confirm the clinical effectiveness of telepsychotherapy, especially compare with face-to-face psychotherapy. PMH6 comparative Evaluation of Safety, Efficacy and Cognitive Profile of Amisulpride and Olanzapine in Schizophrenia Patients- A Prospective Study Ramesh S, Sivakumar P, Prashant C, Sivasankar M, Manikandhan C, Jai Ganesh KP Nehru College of Pharmacy, Thrissur District, India

Objectives: To determine and compare the efficacy, safety, and cognitive profile of Amisulpride and Olanzapine. To determine the types of symptoms experienced by schizophrenic patients. To determine and compare the weight of patients in 2 groups.  Methods: Prospective comparative study. Six months duration. Safety assessment included adverse event reporting and abnormal involuntary movement scale (AIMS). Primary efficacy variable was the change from baseline in BPRS (Brief Psychiatric Rating Scale) score. Cognitive assessment involved token test, digit vigilance test and animal names test.  Results: The total number of patients were also categorised on the basis of symptoms. Out of total 74 patients, 29 patients (39.19%) came with positive symptoms, 37 patients (50%) experience negative symptoms and 8 patients (10.81%) shows mixed symptoms During the study period, change observed in BPRS score in amisulpride group was 16.63±4.617 and in olanzapine group was 14.72 ±2.275 (Table 5). This improvement was similar in both groups and was statistically significant (P < 0.0001).Analysis was performed using Graph pad prism software version 6.07. To evaluate cognitive profile, three tests were used, namely, token test, digit vigilance test and animal names test. In all these test amisulpride perform significantly better than olanzapine and hence amisulpride gains an upper hand over olanzapine in improvement of cognitive function.  Conclusions: The study showed that amisulpride and olanzapine were equally effective in the treatment of acute exacerbation of schizophrenia as shown by BPRS scores. To conclude, amisulpride and olanzapine show equivalent efficacy in improving psychotic symptoms of schizophrenia. When compared to Olanzapine, Amisulpride gains an upper hand in preserving body weight and in improvement of cognitive functions. PMH7 prevalence of Anticholinergic Drug Use in Older Adults With Dementia Ong YS, Fong TY, Chen LL, Chiang YY, Lim KW, Koh L, Mamun K Singapore General Hospital, Singapore, Singapore

Objectives: Anticholinergic usage is controversial in patients diagnosed with dementia due to increased risk of cognitive impairment and psychosis in this population. Yet the extent of anticholinergic drug use in Singapore General Hospital’s patient population is unknown. This study aims to determine the prevalence of anticholinergic drug use in older patients with dementia and evaluate the association between its use with mortality and morbidity outcomes in these patients.  Methods: This is a retrospective cross-sectional analysis of patients aged 65 or older with dementia with at least one admission in 2013 (n =  460). Identified subjects were followed up prospectively for one year after first admission in 2013 for morbidity and mortality events. Data on exposure to anticholinergic drugs three months prior to admission were collected. Anticholinergic burden was determined using the Anticholinergic Drug Scale (ADS).  Results: Most of the patients were female, Chinese with a mean age of 80.8 ± 8.4. Overall prevalence of anticholinergic drug use was 55.9% (n =  257). ADS level 1 drugs were most commonly prescribed (n =  234, 50.9%). Following this, ADS level 3 drug use was more prevalent (n =  73, 15.9%) than ADS level 2 drugs (n =  1, 0.2%). No association between anticholinergic drug use and mortality was found. However, it was significantly with associated morbidity outcomes.  Conclusions: Anticholinergic drug use in patients with dementia is common. This may have contributed to increased morbidity for these patients. Prescribers and pharmacists should work together to monitor and optimize anticholinergic drug use in these patients.

PMH5 Clinical Effectiveness Telepsychotherapy for Depression Disorder: A Systematic Review Park JJ1, Kim S2, Park D2 Evidence-based Collaborating Agency, Seoul, South Korea, 2National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea 1National

Mental Health – Cost Studies

Objectives: To evaluate the clinical effectiveness of telepsychotherapy compared to care as usual or face-to-face psychotherapy for depressive disorder.  Methods: We searched 4 international electronic database including MEDLINE, Embase, CENTRAL, PsycINFO and 5 domestic electronic database from its inception to April 2015. Synchronous and interactive telepsychotherapy articles were included, and the study design was limited to RCT only. Two reviewers independently conducted the data extraction and quality assessment using the Cochrane Risk of Bias tool.  Results: A total 12 articles (10 trials) with 2,562 patients were included. From the 10 trials, 7 were comparing with care as usual, and 3 were comparing with face-to-face psychotherapy. In comparison with telepsychotherapy and care as usual, depressive symptom score was significantly lower in the telepsychotherapy

PMH8 Estimating the Economic Burden of Treatment Resistant Depression in Taiwan using the NHIRD Klug J1, Yu F2, Chang C3, Juang H4, Wang M5, Fife D6, Liu C4, Wang BC7 Pacific, Kowloon, Hong Kong, 2Janssen Asia Pacific, Beijing, China, 3Chang Gung University, TaoYuan, Taiwan, 4Chang Gung Memorial Hospital, Tao-Yun, Taiwan, 5Janssen Taiwan, Taipei, Taiwan, 6Janssen, pharmaceutical company of Johnson and Johnson, Titusville, NJ, USA, 7Elysia Group Ltd, Taipei, Taiwan

1Janssen Asia

Objectives: Major depressive disorder (MDD) is a disabling mental disorder, and treatment-resistant depression (TRD) results in a substantial clinical and economic burden. We studied the direct medical costs and the healthcare utilization associated