- Email: [email protected]
S14-04 Disentangling Dysthymic Disorder from Major Depressive Disorder in Children And Adolescents: Recent Cognitive Neuroscience Insights
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Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
inflammation may contribute to the dysfunction of the HPA axis and neurotrophic system in depression.
S14-02 Developmental Neurobiology of Early Trauma – Early Parenting Disturbances and the Brain
Symposium
L. Newman. Monash University, Victoria, VIC, Australia
S13. Suicide: Biology, Culture and Media
Early brain development occurs in a relational context. The infant brain is establishing crucial neural pathways and organisation for the development of affective regulation, self-other awareness, and attachment functioning. Infant research points to the importance of potential responsibility to infant affective communication and mirroring processes in early life. Relationships on which the infant’s overall level of arousal is optimised by the consequences and where there is emotional resonance and regulation through interaction, optimise brain organisation. Parents with a range of emotional difficulties and mental health problems may have significant difficulties in interpretation of, and response to infant affective communication, contributing to misattuned interactions and infant stress. Parents with backgrounds of early trauma and abuse may also have difficulties in reflective capacity or the capacity to interpret and understand the infant and psychological terms. These issues have been examined specifically in parents with a diagnosis of Borderline Personality Disorder. The long-term implications of early relational trauma includes ongoing attachment disorganisation and affect and stress dysregulation suggesting that early trauma may be a risk factor for a range of mental disorders and functional difficulties.
S13-02 Suicide and Media: Current Perspectives and Applications to Asia N. Gill1,2 . 1 Rural Clinical School, University of Queensland, 2 Toowoomba-Darling Downs Mental Health Service, Queensland Health, Toowoomba, QLD, Australia More than hundred studies worldwide on imitative (copy-cat) suicides have consistently found that media reporting of suicides can lead to imitative suicidal behaviours, particularly if the coverage is extensive, prominent, sensationalist or normalises/rationalises suicide and explicitly describes the method and/or venue of suicide. However, responsible reporting may serve to educate the public about suicide/mental illness, and may encourage those at risk of suicide to seek help. Suicide is among the leading causes of death in Asia. However, suicide prevention efforts in Asia have been limited. In India, the official figures of suicide rate are around 10.5 per 100,000 per annum, however, recent verbal autopsy studies have found annual suicide rates in certain parts of India to be as high as 95 per 100,000. WHO (2008) issued guidelines to media professionals about suicide reporting, based on the evidence base and advised that every country should adapt the guidelines according to their local circumstances. However, most Asian countries do not have such guidelines for media professionals and suicide reporting continues to be poor in most Asian countries. Mental health professionals have an important role to play in supporting appropriate media coverage of suicide, mental health and mental illness. This is an overview of epidemiology of suicide in Asia, with particular reference to India, evidence base for impact of media reporting of suicide on actual suicides, and suggested guidelines on responsible reporting of suicide. Symposium S14. Neuro developmental Trajectory in Child Psychiatric Disorders S14-01 Understanding Developmental Trajectory: Implications for Early Intervention V. Eapen1,2 . 1 Infant, Child and Adolescent Psychiatry, University of New South Wales, 2 Academic Unit of Child Psychiatry South West Sydney (AUCS), Liverpool, Sydney, NSW, Australia Childhood psychiatric disorders are usually dynamic and change over time as the development progresses. This symposium will present insights gained through longitudinal studies into the nature of the developmental processes including delay, disruptions, or deviations from the trajectory of typical development in early trauma, childhood depression and language development. The longitudinal framework also allows the understanding of the neural bases of differential clinical outcomes. In this regard, presentations will focus on the neurocognitive insights in childhood dysthymic disorder and depression, the impact of early parenting disturbance on developing brain, long term outcomes of childhood depression as well as the relationship between language acquisition and behavioural adjustment.
S14-03 Long Term Outcomes of Childhood Depression U. Rao. Center for Molecular and Behavioral Neuroscience, Meharry Medical College, Nashville, TN, USA Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, a better understanding of the long-term outcomes of the disorder during this developmental stage and factors associated with differential clinical course is critical for developing early and effective intervention strategies. This presentation summarizes current knowledge on the natural course and consequences of unipolar depression in children and adolescents. Predictors of differential clinical course, specifically focusing on the interaction between neurobiological and psychosocial processes, will be discussed. Finally, research and clinical implications of these findings will be discussed. S14-04 Disentangling Dysthymic Disorder from Major Depressive Disorder in Children And Adolescents: Recent Cognitive Neuroscience Insights A. Vance. University of Melbourne, Melbourne, VIC, Australia Early onset depressive disorders, such as dysthymic disorder and major depressive disorder, are common conditions affecting children and adolescents. Indeed, they are a major driver for the referral of young people to public mental health services. Both conditions are important to recognise early and treat effectively because both are associated with significant impairments in functioning in academic, social and family domains. Further, dysthymic disorder is a major risk factor for the onset of a first major depressive episode and when both conditions occur together (termed a ‘double depressive disorder’), morbidity, psychological and/or medication treatment non-responsiveness and prognosis are known to be worse. Recently, manifest inattention and associated spatial working memory and spatial memory abilities have begun to be systematically investigated in children and adolescents with dysthymic disorder and/or major depressive disorder. Fortunately, attentional abilities and spatial working memory performance are known to be subserved by overlapping neural substrates, including predominantly inferior and superior parietal regions together with
Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
lateral prefrontal brain regions. Recent fMRI studies also suggest that spatial working memory, as opposed to verbal working memory, relies on cognitive processes associated with spatial attention, rather than involving memory per se, and thereby relies on the predominantly right-hemisphere frontal-parietal attentional system. This presentation will present findings from these studies that have involved these three groups of patients being compared to age-, gender- and IQ-matched healthy control participants. Further, the association of their working memory performance with inattention symptoms, depressive symptoms, anxious symptoms and suicidal ideation will be explored. Clinical applications and future directions will also be discussed. S14-05 Developmental Relationships between Language Acquisition and Behavioural Adjustment: A Longitudinal Study from 8 Months to 4 Years L. Bretherton, M. Prior, O. Okoumunne, E. Cini. University of Melbourne, Melbourne, VIC, Australia The research literature on child development clearly describes important links between language impairment and social, behavioural and emotional problems in young children. For example boys are more susceptible to both language impairment and behaviour problems than girls. However, detailed information is lacking on the specific nature of the relationships between language and behaviour and how child, maternal, and environmental factors influence these relationships, especially in early childhood. This study provided a unique opportunity to concurrently examine the contributions of various risk and protective factors for language impairment and behaviour problems in a large community sample of preschool children followed longitudinally. We examined the developmental relationships between language acquisition and behavioural adjustment in the children at age two and four years of age. Four year old boys scored higher on the Conduct Problems, Hyperactivity and Peer Problems, and lower on Emotional Symptoms and Prosocial behaviour than girls on the Strengths and Difficulties Questionnaire. There were however, no gender differences with regard to the impact of language on behaviour, and although this was surprising given the higher rates of behavioural problems and language impairment seen in boys, this finding is consistent with several other reports. Preschool children with language impairment were rated as having significantly more hyperactivity and significantly greater difficulty with peer relationships than children with typically developing language, consistent with findings from previous studies (e.g. Baker and Cantwell, 1987; Beitchman et al., 1996; Lindsay et al., 2008). Children with language impairment were also at a higher risk for clinical diagnosis of emotional or behavioural problems than typically developing children on the basis of a categorical analysis of SDQ status even at this early stage of development.
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S16-02 Medication Adherence: Patient Beliefs, Attitudes And Preference C. Ng. University of Melbourne, Melbourne, VIC, Australia Medication non-adherence is a common obstacle to the effective pharmacotherapy of major mental disorders. Beliefs and attitudes is a result of implicit analysis of the relative cost/ benefits of treatment. They represent a significant aspect among other important biopsychosocial factors influencing medication adherence. Although negative medication attitudes and beliefs are common among patients with serious mental disorders, it is uncertain if attitudes and beliefs are different across different clinical groups. Some of the relevant research findings are examined between patients of different diagnoses. Strategies including taking into consideration of patient’s attitudes and preference, need to be tailored to the individual patient and the right clinical setting. S16-03 Novel Antipsychotic Long-acting Injections in Clinical Practice J. Lee1,2 . 1 Graylands Hospital, Graylands Hospital, 2 School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia Poor adherence to medication is common in patients with schizophrenia and is associated with poor treatment outcomes – poor symptom control, decreased functioning, increased suicidality, and increased risk of relapse and re-hospitalization. Long-acting injections of antipsychotics (LAIs) were developed in the 60s in an attempt to promote medication adherence and improve treatment outcomes. LAIs have distinctive pharmacokinetic properties conferring advantages over their oral counterparts. Research has shown that LAIs improved global treatment outcome and reduced risk of hospitalization. However, LAIs remain underutilized in many countries and many clinicians perceive LAIs as old fashioned reserved for the most chronic and disabled patients. The introduction of novel antipsychotic LAIs – Risperidone LAI, Olanzapine Pamoate and Paliperidone Palmitate – allows the use of LAIs with advantages of the novel antipsychotics and stimulates a resurgence of interest in LAIs. Although clinical guidelines emphases the use of LAIs after non-compliance has been demonstrated and linked to repeated relapses, recent evidence underscores the potential benefits of novel LAIs in first episode patients and supports the use of novel LAIs earlier in the course of schizophrenia in patients at risk of non-adherence. This presentation will review the efficacy of LAIs comparing to oral antipsychotics, compare different LAIs – conventional and novel, and examine the pharmacokinetic and practical issues for the optimal use of LAIs. Case vignettes will be used to discuss the use of novel LAIs such as olanzapine pamoate in various clinical settings. Symposium
Symposium S16. Adherence in Schizophrenia and Role of Novel LAIs: Special Emphasis on Olanzapine Pamoate S16-01 Adherence issues in Schizophrenia R. Lakshmana1,2 . 1 Psychiatry, University of Melbourne, Heidelberg, 2 Psychiatry, Goulburn Valley Health, Shepparton, VIC, Australia Medication non-adherence is a common obstacle to the effective pharmacotherapy of major mental disorders such as Schizophrenia. There are multiple biopsychosocial factors that contribute toward poor adherence, patient’s beliefs and attitudes represent a significant aspect influencing medication adherence. A review of literature in Australasian context is presented.
S17. Psychosocial Support Program for Young Population with Mental Disorders S17-01 Student Mental Health: Psychological Problems and Psychosocial Support M. Kulygina. Moscow State Institute of International Relations, Moscow, Russia Research shows that a significant number of students experience mental health difficulties and need support during their education. It is associated with the age and psychosocial specifics of this population group. Emotional and psychological problems concerning education, interpersonal relations, and identity formation can seriously affect academic performance, as well as the mental state, physical health and quality of life of students.
Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
inflammation may contribute to the dysfunction of the HPA axis and neurotrophic system in depression.
S14-02 Developmental Neurobiology of Early Trauma – Early Parenting Disturbances and the Brain
Symposium
L. Newman. Monash University, Victoria, VIC, Australia
S13. Suicide: Biology, Culture and Media
Early brain development occurs in a relational context. The infant brain is establishing crucial neural pathways and organisation for the development of affective regulation, self-other awareness, and attachment functioning. Infant research points to the importance of potential responsibility to infant affective communication and mirroring processes in early life. Relationships on which the infant’s overall level of arousal is optimised by the consequences and where there is emotional resonance and regulation through interaction, optimise brain organisation. Parents with a range of emotional difficulties and mental health problems may have significant difficulties in interpretation of, and response to infant affective communication, contributing to misattuned interactions and infant stress. Parents with backgrounds of early trauma and abuse may also have difficulties in reflective capacity or the capacity to interpret and understand the infant and psychological terms. These issues have been examined specifically in parents with a diagnosis of Borderline Personality Disorder. The long-term implications of early relational trauma includes ongoing attachment disorganisation and affect and stress dysregulation suggesting that early trauma may be a risk factor for a range of mental disorders and functional difficulties.
S13-02 Suicide and Media: Current Perspectives and Applications to Asia N. Gill1,2 . 1 Rural Clinical School, University of Queensland, 2 Toowoomba-Darling Downs Mental Health Service, Queensland Health, Toowoomba, QLD, Australia More than hundred studies worldwide on imitative (copy-cat) suicides have consistently found that media reporting of suicides can lead to imitative suicidal behaviours, particularly if the coverage is extensive, prominent, sensationalist or normalises/rationalises suicide and explicitly describes the method and/or venue of suicide. However, responsible reporting may serve to educate the public about suicide/mental illness, and may encourage those at risk of suicide to seek help. Suicide is among the leading causes of death in Asia. However, suicide prevention efforts in Asia have been limited. In India, the official figures of suicide rate are around 10.5 per 100,000 per annum, however, recent verbal autopsy studies have found annual suicide rates in certain parts of India to be as high as 95 per 100,000. WHO (2008) issued guidelines to media professionals about suicide reporting, based on the evidence base and advised that every country should adapt the guidelines according to their local circumstances. However, most Asian countries do not have such guidelines for media professionals and suicide reporting continues to be poor in most Asian countries. Mental health professionals have an important role to play in supporting appropriate media coverage of suicide, mental health and mental illness. This is an overview of epidemiology of suicide in Asia, with particular reference to India, evidence base for impact of media reporting of suicide on actual suicides, and suggested guidelines on responsible reporting of suicide. Symposium S14. Neuro developmental Trajectory in Child Psychiatric Disorders S14-01 Understanding Developmental Trajectory: Implications for Early Intervention V. Eapen1,2 . 1 Infant, Child and Adolescent Psychiatry, University of New South Wales, 2 Academic Unit of Child Psychiatry South West Sydney (AUCS), Liverpool, Sydney, NSW, Australia Childhood psychiatric disorders are usually dynamic and change over time as the development progresses. This symposium will present insights gained through longitudinal studies into the nature of the developmental processes including delay, disruptions, or deviations from the trajectory of typical development in early trauma, childhood depression and language development. The longitudinal framework also allows the understanding of the neural bases of differential clinical outcomes. In this regard, presentations will focus on the neurocognitive insights in childhood dysthymic disorder and depression, the impact of early parenting disturbance on developing brain, long term outcomes of childhood depression as well as the relationship between language acquisition and behavioural adjustment.
S14-03 Long Term Outcomes of Childhood Depression U. Rao. Center for Molecular and Behavioral Neuroscience, Meharry Medical College, Nashville, TN, USA Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, a better understanding of the long-term outcomes of the disorder during this developmental stage and factors associated with differential clinical course is critical for developing early and effective intervention strategies. This presentation summarizes current knowledge on the natural course and consequences of unipolar depression in children and adolescents. Predictors of differential clinical course, specifically focusing on the interaction between neurobiological and psychosocial processes, will be discussed. Finally, research and clinical implications of these findings will be discussed. S14-04 Disentangling Dysthymic Disorder from Major Depressive Disorder in Children And Adolescents: Recent Cognitive Neuroscience Insights A. Vance. University of Melbourne, Melbourne, VIC, Australia Early onset depressive disorders, such as dysthymic disorder and major depressive disorder, are common conditions affecting children and adolescents. Indeed, they are a major driver for the referral of young people to public mental health services. Both conditions are important to recognise early and treat effectively because both are associated with significant impairments in functioning in academic, social and family domains. Further, dysthymic disorder is a major risk factor for the onset of a first major depressive episode and when both conditions occur together (termed a ‘double depressive disorder’), morbidity, psychological and/or medication treatment non-responsiveness and prognosis are known to be worse. Recently, manifest inattention and associated spatial working memory and spatial memory abilities have begun to be systematically investigated in children and adolescents with dysthymic disorder and/or major depressive disorder. Fortunately, attentional abilities and spatial working memory performance are known to be subserved by overlapping neural substrates, including predominantly inferior and superior parietal regions together with
Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
lateral prefrontal brain regions. Recent fMRI studies also suggest that spatial working memory, as opposed to verbal working memory, relies on cognitive processes associated with spatial attention, rather than involving memory per se, and thereby relies on the predominantly right-hemisphere frontal-parietal attentional system. This presentation will present findings from these studies that have involved these three groups of patients being compared to age-, gender- and IQ-matched healthy control participants. Further, the association of their working memory performance with inattention symptoms, depressive symptoms, anxious symptoms and suicidal ideation will be explored. Clinical applications and future directions will also be discussed. S14-05 Developmental Relationships between Language Acquisition and Behavioural Adjustment: A Longitudinal Study from 8 Months to 4 Years L. Bretherton, M. Prior, O. Okoumunne, E. Cini. University of Melbourne, Melbourne, VIC, Australia The research literature on child development clearly describes important links between language impairment and social, behavioural and emotional problems in young children. For example boys are more susceptible to both language impairment and behaviour problems than girls. However, detailed information is lacking on the specific nature of the relationships between language and behaviour and how child, maternal, and environmental factors influence these relationships, especially in early childhood. This study provided a unique opportunity to concurrently examine the contributions of various risk and protective factors for language impairment and behaviour problems in a large community sample of preschool children followed longitudinally. We examined the developmental relationships between language acquisition and behavioural adjustment in the children at age two and four years of age. Four year old boys scored higher on the Conduct Problems, Hyperactivity and Peer Problems, and lower on Emotional Symptoms and Prosocial behaviour than girls on the Strengths and Difficulties Questionnaire. There were however, no gender differences with regard to the impact of language on behaviour, and although this was surprising given the higher rates of behavioural problems and language impairment seen in boys, this finding is consistent with several other reports. Preschool children with language impairment were rated as having significantly more hyperactivity and significantly greater difficulty with peer relationships than children with typically developing language, consistent with findings from previous studies (e.g. Baker and Cantwell, 1987; Beitchman et al., 1996; Lindsay et al., 2008). Children with language impairment were also at a higher risk for clinical diagnosis of emotional or behavioural problems than typically developing children on the basis of a categorical analysis of SDQ status even at this early stage of development.
S17
S16-02 Medication Adherence: Patient Beliefs, Attitudes And Preference C. Ng. University of Melbourne, Melbourne, VIC, Australia Medication non-adherence is a common obstacle to the effective pharmacotherapy of major mental disorders. Beliefs and attitudes is a result of implicit analysis of the relative cost/ benefits of treatment. They represent a significant aspect among other important biopsychosocial factors influencing medication adherence. Although negative medication attitudes and beliefs are common among patients with serious mental disorders, it is uncertain if attitudes and beliefs are different across different clinical groups. Some of the relevant research findings are examined between patients of different diagnoses. Strategies including taking into consideration of patient’s attitudes and preference, need to be tailored to the individual patient and the right clinical setting. S16-03 Novel Antipsychotic Long-acting Injections in Clinical Practice J. Lee1,2 . 1 Graylands Hospital, Graylands Hospital, 2 School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia Poor adherence to medication is common in patients with schizophrenia and is associated with poor treatment outcomes – poor symptom control, decreased functioning, increased suicidality, and increased risk of relapse and re-hospitalization. Long-acting injections of antipsychotics (LAIs) were developed in the 60s in an attempt to promote medication adherence and improve treatment outcomes. LAIs have distinctive pharmacokinetic properties conferring advantages over their oral counterparts. Research has shown that LAIs improved global treatment outcome and reduced risk of hospitalization. However, LAIs remain underutilized in many countries and many clinicians perceive LAIs as old fashioned reserved for the most chronic and disabled patients. The introduction of novel antipsychotic LAIs – Risperidone LAI, Olanzapine Pamoate and Paliperidone Palmitate – allows the use of LAIs with advantages of the novel antipsychotics and stimulates a resurgence of interest in LAIs. Although clinical guidelines emphases the use of LAIs after non-compliance has been demonstrated and linked to repeated relapses, recent evidence underscores the potential benefits of novel LAIs in first episode patients and supports the use of novel LAIs earlier in the course of schizophrenia in patients at risk of non-adherence. This presentation will review the efficacy of LAIs comparing to oral antipsychotics, compare different LAIs – conventional and novel, and examine the pharmacokinetic and practical issues for the optimal use of LAIs. Case vignettes will be used to discuss the use of novel LAIs such as olanzapine pamoate in various clinical settings. Symposium
Symposium S16. Adherence in Schizophrenia and Role of Novel LAIs: Special Emphasis on Olanzapine Pamoate S16-01 Adherence issues in Schizophrenia R. Lakshmana1,2 . 1 Psychiatry, University of Melbourne, Heidelberg, 2 Psychiatry, Goulburn Valley Health, Shepparton, VIC, Australia Medication non-adherence is a common obstacle to the effective pharmacotherapy of major mental disorders such as Schizophrenia. There are multiple biopsychosocial factors that contribute toward poor adherence, patient’s beliefs and attitudes represent a significant aspect influencing medication adherence. A review of literature in Australasian context is presented.
S17. Psychosocial Support Program for Young Population with Mental Disorders S17-01 Student Mental Health: Psychological Problems and Psychosocial Support M. Kulygina. Moscow State Institute of International Relations, Moscow, Russia Research shows that a significant number of students experience mental health difficulties and need support during their education. It is associated with the age and psychosocial specifics of this population group. Emotional and psychological problems concerning education, interpersonal relations, and identity formation can seriously affect academic performance, as well as the mental state, physical health and quality of life of students.