Læknablaðið : fylgirit - 01.08.2003, Page 61

POSTERS / 27TH NORDIC PSYCHIATRIC CONGRESS I
year. In the northwestern part of Iceland people only visited specia-
lists 0.6 times per year. The utilization of specialist services was
much higher in the capital area than elsewhere in the country with
two exceptions. In ophthalmology and otolaryngology there were
small regional differences in the use of the services. The most prob-
able explanation for this is that there is a long tradition for planned
visits by these specialists, especially the ophthalmologists, to the
sparsely populated areas at least once a year. The greatest regional
difference was found in the use of psychiatric services. The people
in Reykjavík went 15 times as often to see a psychiatrist as the
people of Vopnafjörður, Fáskrúðsfjörður (both in eastern Iceland)
and Vík (in southern Iceland).
Conclusions: This investigation documents huge differences in the
utilization of outpatient specialist services in Iceland. To ensure
equity the service of the specialist doctors should be planned and
brought near the people in the sparsely populated areas. The small
differences in the utilization of ophthalmology and otolaryngology
services shows what can be achieved with good planning.
P - 8 Thursday 14/8,14:00-15:00
Characterization of fMRI haemodynamic responses in
schizophrenic patients
Roberto Viviani Dr., Department of Psychiatry 111, University of Ulm, Leimgruben-
weg 12, Germany. Henrik Walter, Georg Grön, Manfred Spitzer.
roberto.viviani@medizin.uni-ulm.de
Background and aims: The statistical models currently used to draw
inferences on cortical activation areas in fMRI studies rely on the
assumption of a predefined haemodynamic response function (HRF)
representing the BOLD response in the affected vessels. If this as-
sumption is not justified, as it may be the case in patient popula-
tions, no conclusion may be drawn from the failure of the model to
provide evidence of significant activation areas. Of particular inte-
rest is the study of schizophrenic patients, where a systematic ab-
normality of the HRF may provide a clue to a clinical subgroup.
Methods: We applied equivalents of multivariate procedures ope-
rating on functions rather than vectors of observations to a simple
block design on a working memory paradigm comparing schizo-
phrenic, depressive patients and controls.
Results: The HRFs in the schizophrenic group do not form a homo-
geneous group, unlike normal controls.
Conclusions: Anomalous HRFs in schizophrenics awaits clinical
characterization. Possible causes are medication, a side-effect of a
biochemical abnormality, a sub-clinical infectious process.
P - 9 Thursday 14/8,14:00-15:00
Persistent somatoform pain - a bridge between anxiety
and depression
Hiigni Óskarsson. Psychiatrist, Therapeia, 12 Sudurgata, 101 Reykjavik, Iceland. H.
Kolbeinsson, Þ Þorgeirsson. J Gulcher, K Stefánsson, E Líndal, JG Stefánsson.
Introduction: This study explores the relationship between somato-
form pain disorder (SPD), anxiety, and depression.
Method: Tlie sample is based on a population screening for anxiety
and depression followed by a Composite International Diagnostic
Interview (CIDI). SPD was an incidental finding as comorbid with
the above disorders. Interrelationship between Age of Onset and
comorbidity of these disorders as well as shared symptoms were
analysed.
Results: 1903 individuals underwent the CIDI, 441 have chronic
somatoform pain, m/f ratio = 1:3. Comorbid anxiety and depression
are found in 83% of those with SPD. The comorbidity of anxiety is
significantly higher in SPD than in those affected with anxiety and
depression but without SPD. Depression comorbidity is the same in
those with and without SPD. The presence of SPD lowers the Age
of Onset (AGO) of most anxiety disorders and depression. The pre-
sence of anxiety and/or depression in SPD is related to a signifi-
cantly higher number of pain symptoms, and this also has an impact
on the sex ratio and location of some pain symptoms.
Conclusion: The results described underline some interactive pro-
cesses between SPD, anxiety and depression and give an indication
of possible shared etiological factors.
P - 10 Thursday 14/8,14:00-15:00
Brain perfusion in anorexia nervosa (AN): Indicative of
cortico-subcortical dysfunctions
Van den Eynde F, MD, Department of Psychiatry, Ghent University, 9000 Ghent,
Belgium. Vervaet M, Audenaert K, De Saedeleer S, Naudts KH, Dierckx R, Van
Heeringen C.
Frederique.Vandeneynde@UGent.be
Background: The aetiology of AN remains elusive. However, there
is growing evidence for the involvement of brain circuitry dysfunc-
tion. Neuropsychological studies point at frontal and parietal corti-
cal dysfunctions.
Aiins: This study aimed to assess regional cerebral blood flow in
AN patients. In addition, we evaluated whether there were diffe-
rences in this respect between the AN-Restricting type (AN-R) and
the AN-Binging/Purging type (AN-BP).
Methods: A 99m-Tc-ethyl cysteine dimer (ECD) SPECT was ac-
quired in 22 inpatients with AN (21F, 1M, mean age 22, mean BMI
15.1). Twelve patients (11F, 1M, mean age 19, BMI 14.8) met the
diagnostic criteria (DSM-IV) of AN-R, ten patients (10F, mean age
26, BMI 15.4) those of AN-BP. Fifteen healthy volunteers (14F, 1M,
mean age 24 y) were used as a control group. AIl subjects showed a
normal CT-scan of the brain. Group comparisons were performed
using SPM 99.
Results: When compared to the control group, the AN patient
group showed significant hypoperfusions in the bilateral superior
frontal gyri, and, to a lesser extent, in the left superior temporal
gyrus and the left parietal lobule. Significant hyperperfusions were
found bilaterally in the basal ganglia, the thalamic structures and
occipital cortices. No differences were found between the AN-R
and AN-BP.
Conclusion: The results are indicative for dysfunctional cortico-sub-
cortical pathways to be involved in AN-P. This study could not
demonstrate a difference between the AN subtypes.
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