- Email: [email protected]
“One flew over psychiatry's nest” – The theory and practice of psychiatry in the cinema
ABSTRACTS / Schizophrenia Research 98 (2008) 3–199
Presenting Author details: [email protected] P.O. Box 5000, 90014 Oulu, Finland, Tel.: +358 40 7232128; fax: +358 8 333167. Background: Duration of untreated psychosis (DUP) is associated with poor outcome in schizophrenia and possibly with changes in brain structures. Our aim was to define differences in volumes of gray and white matter, intracranial cerebrospinal fluid (CSF), amygdala, thalamus and hippocampus between schizophrenia subjects with long and short DUP. Methods: Subjects with psychosis from the population-based Northern Finland 1966 Birth Cohort were invited to MRI scan of the brain conducted in 1999–2001. DUP was assessed from medical records and divided into three subgroups; short (b1 month), medium (1–6 months) and long (N6 months). MRI-data and DUP information was available for 44 subjects with DSM-III-R schizophrenia. The results are presented separately for men (n = 24) and women (n = 20) and intracranial volume is used as a covariate. Results: Cases with long DUP had decreased volume of hippocampus, especially right hippocampus in men (means for short/medium/long DUP: 3.76/3.84/3.37; p = 0.039). Other differences did not reach statistical significance, although there was also some increased volumes with longer DUP; among women in white matter (535.0/ 536.7/553.1; p = 0.07) and among males in left amygdala (1.17/1.28/ 1.27; p = 0.08). Among women the volumes of right hippocampus were also somewhat decreased (4.18/3.93/3.73; p = 0.11). Conclusions: At least some brain abnormalities were associated with long DUP in schizophrenia. This indicates that psychosis may have toxic effect on brain and deteriorate cognitive functions in hippocampus. doi:10.1016/j.schres.2007.12.018
Forum: The Celluloid Face of Psychiatry “ONE FLEW OVER PSYCHIATRY'S NEST” – THE THEORY AND PRACTICE OF PSYCHIATRY IN THE CINEMA L. Mountany 1. 1
Life Riverfield Lodge Clinic, Johannesburg, South Africa
Presenting Author details: [email protected] P.O. Box 127, 2055 Fourways, South Africa, Tel.: +27 82 4528572; fax: +27 11 4601343. This session aims to make use of film clips to illustrate the portrayal of psychiatric illness in the cinema. Psychiatry and the cinema have grown up together and have had a love hate relationship over many decades. The cinema is a medium that has access to the masses and can be a powerful propaganda tool. To be able to discuss various films and their use in teaching about mental health and destigmatizing mental illness would make this an interactive workshop. Attendants will be encouraged to continue a discussion forum in their own communities and train others to be able to continue the process on all educational levels. doi:10.1016/j.schres.2007.12.019
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Symposium 6: What are the Scope and Limits of Medication in the First Episode? A DOUBLE-BLIND RANDOMIZED PLACEBO-CONTROLLED STUDY OF RELAPSE PREVENTION IN REMITTED FIRST-EPISODE PSYCHOSIS PATIENTS FOLLOWING ONE YEAR OF MAINTENANCE THERAPY E.Y.H. Chen 1, C.L.M. Hui 1, M. Lam 3, C.W. Law 2, C.P.Y. Chiu 2, D.W.S. Chung 3, S. Tso 5, E.P.F. Pang 3, K.T. Chan 5, Y.C. Wong 3, F. Mo 3, K.P.M. Chan 4, S.F. Hung 4, W.G. Honer 6. 1
Department of Psychiatry, Department of Psychiatry, 3 Department of Psychiatry, 4 Department of Psychiatry, 5 Department of Psychiatry, 6 Department of Psychiatry, Vancouver, Canada 2
University of Hong Kong, Hong Kong Queen Mary Hospital, Hong Kong Tai Po Hospital, Hong Kong Kwai Chung Hospital, Hong Kong Castle Peak Hospital, Hong Kong University of British Columbia,
Presenting Author details: [email protected] Department of Psychiatry, Queen Mary Hospital, HK Pokfulam Road, Hong Kong, Hong Kong, Tel.: +852 28 554488; fax: +852 28 551345. Background: Currently, there is no consensus regarding how long antipsychotics medication should be continued following a first/single psychotic episode. Long-term maintenance therapy carries side-effects and may not be necessary for some patients. Clinically, patients often request discontinuation after a period of remission. This is one of the first double-blind randomized-controlled studies designed to address the issue. Methods: Patients with DSM-IV schizophrenia and related psychoses (excluding substance induced psychosis) who remitted well following a first/single-episode and had remained well on maintenance medication for 1 year were randomized to receive either maintenance therapy with quetiapine (400 mg/day), or placebo for 12 months. Relapse was defined by the presence of (i) an increase in at least one of the following Positive and Negative Syndrome Scale (PANSS) psychotic symptom items to a threshold score (delusion, hallucinatory behaviour, conceptual disorganization, unusual thought content, suspiciousness); (ii) Clinical Global Impression (CGI) Severity of Illness 3 or above and (iii) CGI Improvement 5 or above. Results: 178 patients were randomized. 144 patients completed the study (80.9%). The relapse rate was 35% (31/89) for the maintenance group and 66% (59/89) for the placebo group (logrank test, χ2 = 15.858, p b 0.001). Relapse was not related to age or gender. Other significant predictors of relapse include medication status, pre-morbid schizotypal traits, verbal memory and soft neurological signs. Conclusions: This study provides new data for relapse risks in remitted first-episode psychosis patients following 1 year of maintenance therapy. There is a substantial risk of relapse if medication is discontinued. Maintenance medication halves relapse rate. On the other hand, 34% of patients discontinued medication and remained well. Explorations of potential predictors of relapse may help further to estimate risks so that an informed decision about medication discontinuation can be made.
Presenting Author details: [email protected] P.O. Box 5000, 90014 Oulu, Finland, Tel.: +358 40 7232128; fax: +358 8 333167. Background: Duration of untreated psychosis (DUP) is associated with poor outcome in schizophrenia and possibly with changes in brain structures. Our aim was to define differences in volumes of gray and white matter, intracranial cerebrospinal fluid (CSF), amygdala, thalamus and hippocampus between schizophrenia subjects with long and short DUP. Methods: Subjects with psychosis from the population-based Northern Finland 1966 Birth Cohort were invited to MRI scan of the brain conducted in 1999–2001. DUP was assessed from medical records and divided into three subgroups; short (b1 month), medium (1–6 months) and long (N6 months). MRI-data and DUP information was available for 44 subjects with DSM-III-R schizophrenia. The results are presented separately for men (n = 24) and women (n = 20) and intracranial volume is used as a covariate. Results: Cases with long DUP had decreased volume of hippocampus, especially right hippocampus in men (means for short/medium/long DUP: 3.76/3.84/3.37; p = 0.039). Other differences did not reach statistical significance, although there was also some increased volumes with longer DUP; among women in white matter (535.0/ 536.7/553.1; p = 0.07) and among males in left amygdala (1.17/1.28/ 1.27; p = 0.08). Among women the volumes of right hippocampus were also somewhat decreased (4.18/3.93/3.73; p = 0.11). Conclusions: At least some brain abnormalities were associated with long DUP in schizophrenia. This indicates that psychosis may have toxic effect on brain and deteriorate cognitive functions in hippocampus. doi:10.1016/j.schres.2007.12.018
Forum: The Celluloid Face of Psychiatry “ONE FLEW OVER PSYCHIATRY'S NEST” – THE THEORY AND PRACTICE OF PSYCHIATRY IN THE CINEMA L. Mountany 1. 1
Life Riverfield Lodge Clinic, Johannesburg, South Africa
Presenting Author details: [email protected] P.O. Box 127, 2055 Fourways, South Africa, Tel.: +27 82 4528572; fax: +27 11 4601343. This session aims to make use of film clips to illustrate the portrayal of psychiatric illness in the cinema. Psychiatry and the cinema have grown up together and have had a love hate relationship over many decades. The cinema is a medium that has access to the masses and can be a powerful propaganda tool. To be able to discuss various films and their use in teaching about mental health and destigmatizing mental illness would make this an interactive workshop. Attendants will be encouraged to continue a discussion forum in their own communities and train others to be able to continue the process on all educational levels. doi:10.1016/j.schres.2007.12.019
11
Symposium 6: What are the Scope and Limits of Medication in the First Episode? A DOUBLE-BLIND RANDOMIZED PLACEBO-CONTROLLED STUDY OF RELAPSE PREVENTION IN REMITTED FIRST-EPISODE PSYCHOSIS PATIENTS FOLLOWING ONE YEAR OF MAINTENANCE THERAPY E.Y.H. Chen 1, C.L.M. Hui 1, M. Lam 3, C.W. Law 2, C.P.Y. Chiu 2, D.W.S. Chung 3, S. Tso 5, E.P.F. Pang 3, K.T. Chan 5, Y.C. Wong 3, F. Mo 3, K.P.M. Chan 4, S.F. Hung 4, W.G. Honer 6. 1
Department of Psychiatry, Department of Psychiatry, 3 Department of Psychiatry, 4 Department of Psychiatry, 5 Department of Psychiatry, 6 Department of Psychiatry, Vancouver, Canada 2
University of Hong Kong, Hong Kong Queen Mary Hospital, Hong Kong Tai Po Hospital, Hong Kong Kwai Chung Hospital, Hong Kong Castle Peak Hospital, Hong Kong University of British Columbia,
Presenting Author details: [email protected] Department of Psychiatry, Queen Mary Hospital, HK Pokfulam Road, Hong Kong, Hong Kong, Tel.: +852 28 554488; fax: +852 28 551345. Background: Currently, there is no consensus regarding how long antipsychotics medication should be continued following a first/single psychotic episode. Long-term maintenance therapy carries side-effects and may not be necessary for some patients. Clinically, patients often request discontinuation after a period of remission. This is one of the first double-blind randomized-controlled studies designed to address the issue. Methods: Patients with DSM-IV schizophrenia and related psychoses (excluding substance induced psychosis) who remitted well following a first/single-episode and had remained well on maintenance medication for 1 year were randomized to receive either maintenance therapy with quetiapine (400 mg/day), or placebo for 12 months. Relapse was defined by the presence of (i) an increase in at least one of the following Positive and Negative Syndrome Scale (PANSS) psychotic symptom items to a threshold score (delusion, hallucinatory behaviour, conceptual disorganization, unusual thought content, suspiciousness); (ii) Clinical Global Impression (CGI) Severity of Illness 3 or above and (iii) CGI Improvement 5 or above. Results: 178 patients were randomized. 144 patients completed the study (80.9%). The relapse rate was 35% (31/89) for the maintenance group and 66% (59/89) for the placebo group (logrank test, χ2 = 15.858, p b 0.001). Relapse was not related to age or gender. Other significant predictors of relapse include medication status, pre-morbid schizotypal traits, verbal memory and soft neurological signs. Conclusions: This study provides new data for relapse risks in remitted first-episode psychosis patients following 1 year of maintenance therapy. There is a substantial risk of relapse if medication is discontinued. Maintenance medication halves relapse rate. On the other hand, 34% of patients discontinued medication and remained well. Explorations of potential predictors of relapse may help further to estimate risks so that an informed decision about medication discontinuation can be made.