- Email: [email protected]
P.4.a.001 Clinical and sociodemographic features of patients with obsessive-compulsive disorder
P.4.a Anxiety disorders and anxiolytics - Anxiety disorders (clinical)
Ip.3.f.0071 Microglia is widespread activated in recent onset schizophrenia: evidence from PET and post mortem studies B. van Berckell " M. Yaqub 1, M. Bossong/, R. Boellaard'[, A Schuitemaker'', AA Lammertsma'', AD. Windhorsr", 1 VU University A Rozemuller", W. Cahn'', R.S. Kahn5 . Medical Center, Dept. of Nuclear Medicine & PET Research, Amsterdam, The Netherlands; 2 University Medical Center Utrecht, Dept. of Psychiatry, Utrecht, The Netherlands; 3 VU University Medical Center, Dept. of Nuclear Medicine & PET research, Amsterdam, The Netherlands; 4 VU University Medical Center, Dept. of Pathology, Amsterdam, The Netherlands; 5 University Medical Centre Utrecht, Dept. ofPsychiatry, Utrecht, The Netherlands Purpose: Schizophrenia is a brain disease involving progressive loss of grey matter of unknown cause. Most likely, this loss reflects neuronal damage, which should in turn be accompanied by microglia activation. The purpose of this study was to assess regional microglia activation using (R)-[11C]PKl1195 PET and to measure activated microglia in post-mortem brains of patients with schizophrenia. Methods: For the PET study, ten patients with schizophrenia (age: 24±2 years, M=9/F = 1) within the first five years after disease onset and ten healthy controls (23±4 years, M=7/F=3) were included. All PET scans were performed using an ECAT EXACT HR+ scanner. A dynamic (R)-[11C]PKl1195 emission scan in 3D acquisition mode with a total duration of 60 minutes was performed in all subjects. Arterial blood was withdrawn continuously using an on-line detection system. At set times, discrete blood samples were taken to measure both whole blood and plasma concentrations and to determine parent (R)-[11C]PKll195 fractions. All sinograms were corrected for dead time, tissue attenuation, decay, scatter and randoms, and reconstructed using a standard filtered back projection algorithm and a Hanning filter with a cut-off at 0.5 times the Nyquist frequency. MRl images were aligned to corresponding PET images and were used to delineate total grey matter using an automatic procedure. (R)-[11C]PKl1195 PET scans were data were analyzed using a supervised cluster imaging method. This method was recently validated for analysis of (R)-[l1C]PK11 195 scan PET studies yielding BPND as outcome measurement. An increased binding was observed in frontal regions, hippocampus and thalamus but not in parietal cortex, occipital cortex and striatum. In addition to the PET study, a post-mortem study was performed to asses activated microglia. Ten patients with schizophrenia and without other neurological diseases were autopsied (aged 18 and 72 y. mean 59.1 y). Disease duration was much longer than 5 years. Brain tissue of frontal cortex was used for immunohistochemical evaluation of microglia and astrocytes (using HLADR and GFAP respectively). In the post-mortem study, an increase in the number of activated microglia cells an increase of reactive astrocytes was seen in only 5 subjects. No relation with age was found. The symptoms before death have to be evaluated yet. Conclusions and Discussion: This study indcates that microglia is widespread activated in recent onset schizophrenia. The function of microglia in the brain is twofold: in normal brain tissue they survey the brain environment (surveying microglia) and when functional or structural integrity of the brain is threatened, they become activated (activated microglia). When activated, microglia can have either a neuroprotective or a neurotoxic role. Thus,
S585
activated microglia may be the result, but also the cause of neuronal damage. Possibly, microglia activation in schizophrenia is triggered by neuronal damage induced by psychosis. It remains unclear, however, whether psychosis induces neuronal damage leading to microglia activation or vice versa. Interestingly, (atypical) antipsychotic agents may prevent microglia activation directly, in addition to affecting psychosis. This could explain postulated "neuroprotective" effects of (certain) antipsychotics. In order to unravel the different factors that may be involved in microglia activation in schizophrenia, in vivo assessment is essential. (R)-[ 11C]PKl1195 is not an optimal tracer, given its high non-specific binding. Measurement of the non-specific component of (R)-[11C]PKl1195 binding by applying a reference tissue analysis like the supervised cluster imaging method greatly increases its applicability. References [I] Boellaard et al.; Performance of a modified supervised cluster algorithm for extracting reference region input functions from [IIC](R)-PK11195 Brain PET Studies. Conference Record, IEEE Medical Imaging Conference, Dresden, 2008.
P.4.a Anxiety disorders and anxiolytics Anxiety disorders (clinical) 1P.4.a.0011 Clinical and sociodemographic features of patients with obsessive-compulsive disorder E.A Yildirim1 , M. Kasar 1 " E. Ozcan1, E. Albayrak1, R.p. Gokalp/, S. Ozer1 . 1 Bakirkoy Research and Training Hospital for Psychiatry Neurology and Neurosurgery, Psychiatry, Istanbul, Turkey; 2Maltepe University Faculty of Medicine, Psychiatry, Istanbul, Turkey Purpose: Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder which interfere with many aspects of functioning. Regular follow-up and appropriate treatment is crucial for a better outcome. OCD symptoms usually have an insidious onset, however symptom severity and content might show alterations. Obsessions of contaminations and cleaning compulsions are most frequently encountered [1]. Here we present sociodemographic and clinical features of OCD patients that are followed-up in OCD outpatient unit in our hospital. Methods: Patients that applied primary outpatient clinic and diagnosed with OCD according to DSM-IV-TR criteria were referred to anxiety disorders outpatient clinic. After application of clinical interview forms the patients were enrolled in OCD unit and we began follow-up according to guidelines. We evaluated clinical interview forms including sociodemographic and clinical features particularly questioning various obsessions and compulsions of 240 OCD patients retrospectively. Results: Our sample included 162 female (67.1%) and 78 male (32.9%) patients. 154 patients (64.2%) were married, 72 patients (30.2%) were single, 14 patients (5.6%) were divorced. 1.9% (n=5) had no education, 41% (n=98) had primary education, 39.2% (n = 94) had secondary education or high school and 17.2% (n = 43) had university education. Family history was positive for 85.8% (n=206) of patients. 15 patients (6.2%) had a first degree relative suffering from OCD. 84 patients (35%) had no comorbid psychiatric disorder, while 44% (n = 106) had co-existing depression, 21% (n = 51) had another comorbid anxiety disorder, 5.4% (n = 13) had bipolar disorder and
S586
P.4.a Anxiety disorders and anxiolytics - Anxiety disorders (clinical)
10.8% (n=26) had other psychiatric disorders. The number of patients with insight were remarkably higher (90.3%) than the ones without insight (9.7%). We present the findings of various obsessions and compulsions and their relation to gender in Table 1. We also evaluated OCD symptoms within the multidimensional model [2]. Doing so, 162 patients (67.5%) had symptom dimension in contamination/cleaning factor; 172 patients (71.6%) had symptom dimension in thinking obsessions (agressive, religious, sexual etc.)/checking factor, 72 patients (30%) had symptom dimension in symmetry/ordering factor and only two patients (0.8%) had symptom dimension in hoarding factor. Conclusions: Our sample included more women than men (female/male ratio was almost 2/1). In general, contamination obsessions were the most common obsessions, but among males fear of saying/doing the right thing was more common. Furthermore, symptom dimension including thinking obsessions/checking compulsions was most frequently encountered. Comorbidity rates for depression were consistent with pre-existing data [1], but another comorbid anxiety disorder was relatively low as our evaluation reflected a cross-sectional clinical status. Patients with hoarding dimension were rarely found in our sample which might be associated with relatively high rate of insight [3]. Table I. Distribution of obsessions and compulsions according to frequency and gender
Obsessions Contamination Fear of not saying/doing the right thing Religious Sexual Symmetry Aggressive Somatic Compulsions Cleaning Checking Repeating Counting Ordering/Arranging Hoarding
Rate
Female
Male
56.1% 27.5% 15.4% 15% 11.7% 9.2% 6.3%
67.1% 22.4% 12.4% 11.2% 12.4% 9.3% 5.6%
33.3% 38.0% 21.5% 21.5% 10.1% 8.9% 7.6%
63.9% 42.9% 15% 12.9% 5.8% 0.8%
74.5% 42.2% 14.9% 11.8% 7.5% 0.6%
41.8% 44.3% 15.2% 15.2% 2.5% 1.3%
References
[I] Tiikel R, Polat A, Ozdemir 0, Aksiit D, Tiirksoy N.Comorbid conditions in obsessive-compulsive disorder. Compr Psychiatry. 2002 MayJun;43(3):204-9 [2] Mataix-Cols D, Campos MC, Leckman IF. A multidimensional model of obsessive-compulsive disorder. Am J Psychiatry 2005; 162:228-238 [3] Tiirksoy N, Tiikel R, Ozdemir 0, Karali A.Comparison of clinical characteristics in good and poor insight obsessive-compulsive disorder. J Anxiety Disord. 2002;16(4):413-23.
Ip.4.a.0021 Prevalence of PTSD in a sample of victims of Gwangju democratic uprising S.h. Kim 1 ., H.r. Kim 1, S.h. Park1, M.i. Lee1 . 1 Chosun University Medical College, Psychiatry, Gwangju, South-Korea Background & Purpose: In May 1980, the most tragic and disgraceful incident in modem Korean history took place in
Gwangju. A group of politically minded soldiers undertook Operation Chungjung(Operation True Heart) to quell the uprising in Gwangju. During the uprising many citizens of Gwangju were killed by soldiers. The victims of the martial law force's brutality numbered 4,369 all told: 154 killed, 74 missing, 4,141 wounded. Victims of violent assault may have multiple, simultaneous emotional problems. Post-traumatic stress disorder(PTSD) is a common emotional problem, and other emotional consequences may be secondary to PTSD. The risk of post-traumatic emotional problems has been found to be highest in persons who were actually injured and/or who reported that they feared they might be seriously injured or die during the assault. For the study of being investigated about victims to keep away from the political pressure like the devastation of human right or torture and so on, 50% of them had distinguishable symptoms about PTSD. And 70% of the total racked victims exhibited PTSD symptoms in the study to examine symptoms about PTSD for racked victims. This study is designed to find out how the present victims show the PTSD symptoms since nearly 30 years have passed from Gwangju Democratic Uprising. Methods: We selected the randomized objects among about 10% of 3004 persons of making on entry to Ministry of Patriots & VeteransAffairs using telephone contact. Total 260 persons(194 wounded, 66 arrested) were participated in this study except candidate without content to intend or contract address and invalid responders. For collect data, we trained college students of 3rd or 4th grade, graduate students in clinical psychology and then carried into individual interview and survey. We measured the symptoms using instruments like post-traumatic stress disorder symptom scale - interview (PSS-I), life stress questionnaire, ways of coping checklist, UCLA social support inventory(UCLA SSI), general health questionnaire. Results: The results showed that 45.4%(118/260) of victims were diagnosed as PTSD(scored 15-19 in PSS-I). If more rigid criteria(above 20 in PSS-I) were applied, 30.8%(80/260) of respondents were diagnosed as PTSD. The symptoms of PTSD more prevalent in the wounded group than arrested group(34.5%:19.7%). Particularly, the wounded group showed the worst mental health, that is, they showed high scores in all symptoms including anxiety, depression, and somatization. In the case of current life stress, victims more suffered from economic difficulty, job problem, and disease of self and families than other life stress. And they coped with stressful situation on passive styles such as forgetting, worrying, or imaginating unreally. Also, they received insufficient social support like informational, material, emotional support. Conclusion: Our results showed that experience of violent assault may cause serious chronic emotional problems, and therefore it is important to be aware of early symptoms indicating needs for special follow-up. References
[I] Breslau N. 2001. The epidemiology of post-traumatic stress disorder; What is the extent of the problem? J Clin Psychiatry 17(62 suppl), 16-22. [2] Kilpatrick DG, Acierno R. 2003. Mental health needs of crime victims; epidemiology and outcome. J Trauma Stress 16, 119-132. [3] Johansen VA, Wahl AK, Eilertsen DE, Weisaeth L. 2007. Prevalence and predictors of post-traumatic stress disorder(pTSD) in physically injured victims of non-domestic violence. Soc Psychiatry Psychiatr Epidemiol 42, 583-593.
Ip.3.f.0071 Microglia is widespread activated in recent onset schizophrenia: evidence from PET and post mortem studies B. van Berckell " M. Yaqub 1, M. Bossong/, R. Boellaard'[, A Schuitemaker'', AA Lammertsma'', AD. Windhorsr", 1 VU University A Rozemuller", W. Cahn'', R.S. Kahn5 . Medical Center, Dept. of Nuclear Medicine & PET Research, Amsterdam, The Netherlands; 2 University Medical Center Utrecht, Dept. of Psychiatry, Utrecht, The Netherlands; 3 VU University Medical Center, Dept. of Nuclear Medicine & PET research, Amsterdam, The Netherlands; 4 VU University Medical Center, Dept. of Pathology, Amsterdam, The Netherlands; 5 University Medical Centre Utrecht, Dept. ofPsychiatry, Utrecht, The Netherlands Purpose: Schizophrenia is a brain disease involving progressive loss of grey matter of unknown cause. Most likely, this loss reflects neuronal damage, which should in turn be accompanied by microglia activation. The purpose of this study was to assess regional microglia activation using (R)-[11C]PKl1195 PET and to measure activated microglia in post-mortem brains of patients with schizophrenia. Methods: For the PET study, ten patients with schizophrenia (age: 24±2 years, M=9/F = 1) within the first five years after disease onset and ten healthy controls (23±4 years, M=7/F=3) were included. All PET scans were performed using an ECAT EXACT HR+ scanner. A dynamic (R)-[11C]PKl1195 emission scan in 3D acquisition mode with a total duration of 60 minutes was performed in all subjects. Arterial blood was withdrawn continuously using an on-line detection system. At set times, discrete blood samples were taken to measure both whole blood and plasma concentrations and to determine parent (R)-[11C]PKll195 fractions. All sinograms were corrected for dead time, tissue attenuation, decay, scatter and randoms, and reconstructed using a standard filtered back projection algorithm and a Hanning filter with a cut-off at 0.5 times the Nyquist frequency. MRl images were aligned to corresponding PET images and were used to delineate total grey matter using an automatic procedure. (R)-[11C]PKl1195 PET scans were data were analyzed using a supervised cluster imaging method. This method was recently validated for analysis of (R)-[l1C]PK11 195 scan PET studies yielding BPND as outcome measurement. An increased binding was observed in frontal regions, hippocampus and thalamus but not in parietal cortex, occipital cortex and striatum. In addition to the PET study, a post-mortem study was performed to asses activated microglia. Ten patients with schizophrenia and without other neurological diseases were autopsied (aged 18 and 72 y. mean 59.1 y). Disease duration was much longer than 5 years. Brain tissue of frontal cortex was used for immunohistochemical evaluation of microglia and astrocytes (using HLADR and GFAP respectively). In the post-mortem study, an increase in the number of activated microglia cells an increase of reactive astrocytes was seen in only 5 subjects. No relation with age was found. The symptoms before death have to be evaluated yet. Conclusions and Discussion: This study indcates that microglia is widespread activated in recent onset schizophrenia. The function of microglia in the brain is twofold: in normal brain tissue they survey the brain environment (surveying microglia) and when functional or structural integrity of the brain is threatened, they become activated (activated microglia). When activated, microglia can have either a neuroprotective or a neurotoxic role. Thus,
S585
activated microglia may be the result, but also the cause of neuronal damage. Possibly, microglia activation in schizophrenia is triggered by neuronal damage induced by psychosis. It remains unclear, however, whether psychosis induces neuronal damage leading to microglia activation or vice versa. Interestingly, (atypical) antipsychotic agents may prevent microglia activation directly, in addition to affecting psychosis. This could explain postulated "neuroprotective" effects of (certain) antipsychotics. In order to unravel the different factors that may be involved in microglia activation in schizophrenia, in vivo assessment is essential. (R)-[ 11C]PKl1195 is not an optimal tracer, given its high non-specific binding. Measurement of the non-specific component of (R)-[11C]PKl1195 binding by applying a reference tissue analysis like the supervised cluster imaging method greatly increases its applicability. References [I] Boellaard et al.; Performance of a modified supervised cluster algorithm for extracting reference region input functions from [IIC](R)-PK11195 Brain PET Studies. Conference Record, IEEE Medical Imaging Conference, Dresden, 2008.
P.4.a Anxiety disorders and anxiolytics Anxiety disorders (clinical) 1P.4.a.0011 Clinical and sociodemographic features of patients with obsessive-compulsive disorder E.A Yildirim1 , M. Kasar 1 " E. Ozcan1, E. Albayrak1, R.p. Gokalp/, S. Ozer1 . 1 Bakirkoy Research and Training Hospital for Psychiatry Neurology and Neurosurgery, Psychiatry, Istanbul, Turkey; 2Maltepe University Faculty of Medicine, Psychiatry, Istanbul, Turkey Purpose: Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder which interfere with many aspects of functioning. Regular follow-up and appropriate treatment is crucial for a better outcome. OCD symptoms usually have an insidious onset, however symptom severity and content might show alterations. Obsessions of contaminations and cleaning compulsions are most frequently encountered [1]. Here we present sociodemographic and clinical features of OCD patients that are followed-up in OCD outpatient unit in our hospital. Methods: Patients that applied primary outpatient clinic and diagnosed with OCD according to DSM-IV-TR criteria were referred to anxiety disorders outpatient clinic. After application of clinical interview forms the patients were enrolled in OCD unit and we began follow-up according to guidelines. We evaluated clinical interview forms including sociodemographic and clinical features particularly questioning various obsessions and compulsions of 240 OCD patients retrospectively. Results: Our sample included 162 female (67.1%) and 78 male (32.9%) patients. 154 patients (64.2%) were married, 72 patients (30.2%) were single, 14 patients (5.6%) were divorced. 1.9% (n=5) had no education, 41% (n=98) had primary education, 39.2% (n = 94) had secondary education or high school and 17.2% (n = 43) had university education. Family history was positive for 85.8% (n=206) of patients. 15 patients (6.2%) had a first degree relative suffering from OCD. 84 patients (35%) had no comorbid psychiatric disorder, while 44% (n = 106) had co-existing depression, 21% (n = 51) had another comorbid anxiety disorder, 5.4% (n = 13) had bipolar disorder and
S586
P.4.a Anxiety disorders and anxiolytics - Anxiety disorders (clinical)
10.8% (n=26) had other psychiatric disorders. The number of patients with insight were remarkably higher (90.3%) than the ones without insight (9.7%). We present the findings of various obsessions and compulsions and their relation to gender in Table 1. We also evaluated OCD symptoms within the multidimensional model [2]. Doing so, 162 patients (67.5%) had symptom dimension in contamination/cleaning factor; 172 patients (71.6%) had symptom dimension in thinking obsessions (agressive, religious, sexual etc.)/checking factor, 72 patients (30%) had symptom dimension in symmetry/ordering factor and only two patients (0.8%) had symptom dimension in hoarding factor. Conclusions: Our sample included more women than men (female/male ratio was almost 2/1). In general, contamination obsessions were the most common obsessions, but among males fear of saying/doing the right thing was more common. Furthermore, symptom dimension including thinking obsessions/checking compulsions was most frequently encountered. Comorbidity rates for depression were consistent with pre-existing data [1], but another comorbid anxiety disorder was relatively low as our evaluation reflected a cross-sectional clinical status. Patients with hoarding dimension were rarely found in our sample which might be associated with relatively high rate of insight [3]. Table I. Distribution of obsessions and compulsions according to frequency and gender
Obsessions Contamination Fear of not saying/doing the right thing Religious Sexual Symmetry Aggressive Somatic Compulsions Cleaning Checking Repeating Counting Ordering/Arranging Hoarding
Rate
Female
Male
56.1% 27.5% 15.4% 15% 11.7% 9.2% 6.3%
67.1% 22.4% 12.4% 11.2% 12.4% 9.3% 5.6%
33.3% 38.0% 21.5% 21.5% 10.1% 8.9% 7.6%
63.9% 42.9% 15% 12.9% 5.8% 0.8%
74.5% 42.2% 14.9% 11.8% 7.5% 0.6%
41.8% 44.3% 15.2% 15.2% 2.5% 1.3%
References
[I] Tiikel R, Polat A, Ozdemir 0, Aksiit D, Tiirksoy N.Comorbid conditions in obsessive-compulsive disorder. Compr Psychiatry. 2002 MayJun;43(3):204-9 [2] Mataix-Cols D, Campos MC, Leckman IF. A multidimensional model of obsessive-compulsive disorder. Am J Psychiatry 2005; 162:228-238 [3] Tiirksoy N, Tiikel R, Ozdemir 0, Karali A.Comparison of clinical characteristics in good and poor insight obsessive-compulsive disorder. J Anxiety Disord. 2002;16(4):413-23.
Ip.4.a.0021 Prevalence of PTSD in a sample of victims of Gwangju democratic uprising S.h. Kim 1 ., H.r. Kim 1, S.h. Park1, M.i. Lee1 . 1 Chosun University Medical College, Psychiatry, Gwangju, South-Korea Background & Purpose: In May 1980, the most tragic and disgraceful incident in modem Korean history took place in
Gwangju. A group of politically minded soldiers undertook Operation Chungjung(Operation True Heart) to quell the uprising in Gwangju. During the uprising many citizens of Gwangju were killed by soldiers. The victims of the martial law force's brutality numbered 4,369 all told: 154 killed, 74 missing, 4,141 wounded. Victims of violent assault may have multiple, simultaneous emotional problems. Post-traumatic stress disorder(PTSD) is a common emotional problem, and other emotional consequences may be secondary to PTSD. The risk of post-traumatic emotional problems has been found to be highest in persons who were actually injured and/or who reported that they feared they might be seriously injured or die during the assault. For the study of being investigated about victims to keep away from the political pressure like the devastation of human right or torture and so on, 50% of them had distinguishable symptoms about PTSD. And 70% of the total racked victims exhibited PTSD symptoms in the study to examine symptoms about PTSD for racked victims. This study is designed to find out how the present victims show the PTSD symptoms since nearly 30 years have passed from Gwangju Democratic Uprising. Methods: We selected the randomized objects among about 10% of 3004 persons of making on entry to Ministry of Patriots & VeteransAffairs using telephone contact. Total 260 persons(194 wounded, 66 arrested) were participated in this study except candidate without content to intend or contract address and invalid responders. For collect data, we trained college students of 3rd or 4th grade, graduate students in clinical psychology and then carried into individual interview and survey. We measured the symptoms using instruments like post-traumatic stress disorder symptom scale - interview (PSS-I), life stress questionnaire, ways of coping checklist, UCLA social support inventory(UCLA SSI), general health questionnaire. Results: The results showed that 45.4%(118/260) of victims were diagnosed as PTSD(scored 15-19 in PSS-I). If more rigid criteria(above 20 in PSS-I) were applied, 30.8%(80/260) of respondents were diagnosed as PTSD. The symptoms of PTSD more prevalent in the wounded group than arrested group(34.5%:19.7%). Particularly, the wounded group showed the worst mental health, that is, they showed high scores in all symptoms including anxiety, depression, and somatization. In the case of current life stress, victims more suffered from economic difficulty, job problem, and disease of self and families than other life stress. And they coped with stressful situation on passive styles such as forgetting, worrying, or imaginating unreally. Also, they received insufficient social support like informational, material, emotional support. Conclusion: Our results showed that experience of violent assault may cause serious chronic emotional problems, and therefore it is important to be aware of early symptoms indicating needs for special follow-up. References
[I] Breslau N. 2001. The epidemiology of post-traumatic stress disorder; What is the extent of the problem? J Clin Psychiatry 17(62 suppl), 16-22. [2] Kilpatrick DG, Acierno R. 2003. Mental health needs of crime victims; epidemiology and outcome. J Trauma Stress 16, 119-132. [3] Johansen VA, Wahl AK, Eilertsen DE, Weisaeth L. 2007. Prevalence and predictors of post-traumatic stress disorder(pTSD) in physically injured victims of non-domestic violence. Soc Psychiatry Psychiatr Epidemiol 42, 583-593.