Læknablaðið : fylgirit - 01.08.2003, Blaðsíða 21

ABSTRACTS / 27TH NORDIC PSYCHIATRIC CONGRESS I
Conclusions: The results indicate that in a first episode population,
atypical antipsychotic medication is effective in low doses. How-
ever, side-effects can still occur, presumably reflecting increased
sensitivity to both the therapeutic and adverse effects of antipsy-
chotics.
f~7/2 Friday 15/8,15:00-16:00
Eighteen-month outcome of the early treatment and
home-based outreach service (ETHOS)
Dr. Snarun P. Singh, Consultant Psychiatrist & Senior Lecturer, St. George's Hospital
Medical School, Department of Mental Health, St. George's Hospital Medical School,
Cranmer Terrace, London SW17 ORE. UK. Helen L. Fisher.
ssingh @sghms. ac.uk
Aim: To evaluate the effectiveness of an early intervention service
>n improving the outcome of first-episode psychosis.
Background: ETHOS is a tertiary early intervention service pro-
viding a community-based comprehensive package of care to young
people (aged 17-30) with a first ever presentation for psychosis
living in the boroughs of Merton, Sutton and Wandsworth (total
population 627,000; 1998 estimate) in Southwest London, UK.
Metliod: A case-notes review was conducted of all patients referred
to F.THOS between lst June 2001 and 31 st December 2002. Data
were collected on socio-demographic, clinical and service variables.
Outcomes were assessed using each patient as their own historical
control, comparing psychiatric care prior to ETHOS and that pro-
vided by ETHOS, standardising for time spent within the respective
services.
Results: In its first 18 months, 41 patients were accepted into the
service (73% male; mean age 22 years; 54% White; 61% unem-
ployed; median duration of psychosis at referral to ETHOS of 163
days). As compared to their previous psychiatric care, patients ex-
perienced higher levels of contact with their care co-ordinators (Z =
-4.2, p <.0005); a reduction in self-harm (Z = -3.0, p < .005) and
harm to others (Z = -3.1, p < .005); less use of inpatient facilities (Z
= -3.6, p < .0005); and had greater structure to their day (29.3% vs.
65.9%).
Conclusions: ETHOS has managed to improve patient outcomes,
decrease hospitalisation and reduce risk behaviours with modest
resources. Well-resourced early intervention services should im-
prove outcomes even further.
f~7/3 Friday 15/, 15:00-16:00
Neurocognitive function in lst episode schizophrenia. A
functional MRl study
I áll Matfhíasson, Dr„ Section of Neuroimaging, Institute Of Psychiatry, Institute of
Psychiatry, PO BOX 67, DeCresigny Park. London SE4 ÍAR. UK. M. Picchioni, S.
Williams, R McGuire.
P">atthiasson@iop.kcl.ac.uk
Background/Aims: Little is known about brain activation patterns
in lst episode psychosis, we explored this.
Methods: An fMRI study in patients suffering a lst episode of
psychosis. They met DSM-IV criteria for schizophrenia/schizo-
phreniform psychosis and had <28 days antipsychotic medication.
fMRI was acquired usinga 1.5T MRI scanner. Four on-line blocked
design tasks were chosen and selected to engage cognitive pro-
cesses impaired in schizophrenia. Off-line test batteries included
WAIS, NART, WCST, Hopkins Verbal Memory Test and Stroop.
Rcsults: We scanned 10 patients/12 controls, matched for sex, age,
race, and IQ. Mean treatment duration was 8 days. 1) Motor task:
Greater engagement of motor system in controls. Patients failed to
show normal suppression of activity. 2) N-back task: Greater pre-
frontal and cingulate activation in patients, greater parietal and
temporal activation in controls. 3) Verbal fluency: Attenuated en-
gagement of dorsolateral prefrontal, anterior cingulate and cere-
bellar cortex in patients. 4) Object location task: Greater engage-
ment of right insular and parietal cortex in patients and attenuated
activation in hippocampal, cerebellar cortex etc, only shown when
higher demands.
Conclusions: The activation pattern in lst episode psychosis is com-
plex and dependent on task difficulty. This can help in assessing
subtle medication effects at the start of treatment.
F-7/4 Friday 15/8,15:00-16:00
Influence of co-morbid substance misuse on outcome in
schizophrenia
Fíona Hynes Dr. Cambridge & Peterborough Partnership NHS, The Yews, Box 353,
Fulbourn Hospital, Fulbourn, Cambridge, CBl 5EF UK. Blackwell C, Gervin M, Jones
P, and the CUtLASS study team.
fhynes@doctors. org. uk
Background: Co-morbid substance abuse is recognised in schizo-
phrenia and has been reported to have a number of adverse effects
on outcome. Few studies have described longitudinal follow-up.
Ainis: To determine the impact of co-morbid substance abuse on
symptoms and functioning.
Mcthod: An opportunistic study of co-morbid substance misuse
was carried out during a single blind randomised prospective study
of conventional vs atypical drug treatment. People with DSM-IV
schizophrenia, schizophreniform, schizoafffective, and delusional
disorder were followed up for one year. Substance misuse was as-
sessed using the Schedule for Clinical Assessment in Neuropsychi-
atry (SCAN) at baseline. Functioning was assessed using the Qua-
lity of Life (QoL) interview and the GAF while the Positive and
Negative Symptom Scale (PANSS) was used to assess symptom
severity.
Rcsults: 121 patients were recruited into the trial and 101 patients
were followed up. Of these 75 were male (74.3%) and 26 (25.7%)
female with a mean age of 42.3 years (s.d.11.13, range 18-65). No
difference was found in outcome between those with a history of
harmful use and dependence in terms of symptomatology and func-
tioning.
Conclusions: Co-morbid substance may have a less marked effect
on outcome than previously thought, however the sample group
limits the findings in this study.
LÆKNABLAÐIÐ / FYLGIRIT 48 2003/89 21