TR Criteria Research Articles

Efficacy of Adjunctive Extra Virgin Coconut Oil Use in Moderate to Severe Alzheimer?s Disease

Background: Ketogenic compounds derived from medium chain triglyceride (MCT) oils have been claimed to have beneficial health effects in the Alzheimer’s disease (AD] mainly attributed to its medium chain triglycerides. AD is known to have been characterized by early and region specific decline in cerebral glucose metabolism. It is hypothesized that Alzheimer brain tends to preferentially utilize ketones generated from medium chain triglycerides in light of decreased glucose metabolism to improve cognition. Extra virgin coconut oil with predominance of MCT content was used in subjects with moderate to severe AD to examine its efficacy in improving cognitive performance. Methods: Daily oral administration of extra virgin coconut oil (20 gm) was evaluated in 31 subjects with predominantly moderate to severe AD diagnosed as per DSM IV TR criteria for AD in a 6 week trial using quasi experimental non randomized pre-post intervention design. Subjects were on a normal diet and continued taking approved AD medications. Primary cognitive end points were mean change from baseline in the AD Assessment Scale-Cognitive subscale [ADAS-Cog], and Clinicians Interview based Impression of Change Plus Caregivers input [CIBIC-Plus]. Active oil administration continued for 4 weeks from baseline with successive ratings on measures of cognitive change at 2, 4 and 6 weeks respectively. Results: There was a significant difference between the ADAS-Cog scores from baseline over repeated ratings at 2, 4 and 6 weeks (Mauchly’s Chi Square Χ2 = 61.1, e=0.4, F =14, p=0.00, η2=0.31). Post hoc comparisons of ADAS-Cog scores from baseline at 4 and 6 weeks were similar [At 4 weeks, Mean difference=4.1, P=0.00, C.I= (1.4-6.7); at 6 weeks, Mean difference=4.1, p=0.00, C.I= (1.0-7.2). The response rate of CIBIC-Plus defined as improved or no change was significantly improved over successive ratings from 2 weeks to 6 weeks (Cochran’s Q=22.5, df=2, P=.00). No statistically significant difference could be noted for the total cholesterol, Triglycerides and LDL fractions over the study trial except for the HDL fraction over repeated measures at 4 and 6 weeks over baseline (Mauchly’s Chi Square Χ2 (df=2)=6.5, e=0.8, F (df 1.6, 49.9)=6.4, p=0.005, η2=0.17). Conclusions: Addition of adjunctive coconut oil is likely to have beneficial effects in cognitive performance for those suffering from moderate to severe AD and the effects were sustained for at least 2 weeks after the oil administration stopped. No deleterious effects on the overall lipid profile could be elicited.

EPA-0275 – Legal problems in patients with comorbid adult attention-deficit hyperactivity disorder and substance use disorders

Attention-deficit hyperactivity disorder (ADHD) affects not only children but persists for up to 4.4% in the general population. Comorbidity is common among adults with ADHD, including substance abuse. Patients who have both ADHD and SUD have to cope with the interrelated consequences of both disorders. Substance-dependent subjects have greater health, economic, work, and legal problems The aim of this study was to estimate effect of co morbidity of adult ADHD with substance use disorders on being prone to legal problems. This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) and Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist were used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis. Past history of legal problems was assessed using hospital records and self report questionnaire. Data were fed to the computer using the Predictive Analytics Software (PASW Statistics 18). Significance of the obtained results was judged at the 5% level. Thirty sex patients fulfilled the DSM – IV TR criteria for adult ADHD. Fourteen patients of the ADHD group had history of legal problems (38.9%), while only 12 patients of the non ADHD group gave such history (18.2%) and the difference was statistical significant (c 2 = 5.259, p = 0.022). Presence of adult ADHD was associated with significant increased risk of legal problems.

Does resilience affect illness perception and well-being in the elderly?

Background: Increased life expectancy has increased many chronic illnesses in the elderly population, adding a phase of life affecting resilience, well-being, and perception of illness. Aims and Objectives: To assess resilience, well-being, and illness perception in the elderly and study the relation among them. Materials and Methods: A population of 90 (30 from the psycho-geriatric OPD, 30 from medical geriatric OPD and 30 normal elderly, accompanying patients in psycho geriatric OPD) patients age 60 years or more were taken, at a tertiary care center. Geriatric depression scale was applied and score <7 were selected for normal and rheumatoid arthritis. Patients with score >7 and fulfilling diagnostic and statistical manual-IV TR criteria were taken in depression group. Semi-structured proforma and scales (Connor Davidson resilience scale, Warwick Edinberg mental well-being scale, and brief illness perception scale) were applied, and statistical analysis was done using Statistical Package for the Social Sciences. Results: Results demonstrated resilience (P < 0.001) significantly differed in the three groups. Resilience was higher in normal (P < 0.001) than rheumatoid arthritis, which is higher (P < 0.02) than depression group. Well-being also significantly differ in all three group (P < 0.001), higher in normal elderly (P < 0.001) than affected elderly. We found strong positive correlation between resilience and well-being. Conclusion: Resilience is higher in those with a higher hardiness, optimism, purpose of life, and resourcefulness. Well-being gets significantly affected with mental and physical illness.

EPA-0421 – Stimulant abuse in patients with comorbid adult attention-deficit hyperactivity disorder “ADHD” and substance use disorders “SUD”

Comorbidity is common among adults with ADHD, including substance abuse. Researchers have undertaken studies on the role of self medication in symptom control in adults with ADHD. Individuals with ADHD may use specific drugs, such as cocaine, that act in a manner similar to prescribed ADHD medications to lessen symptoms. Assessment of rate of abuse of stimulants among patients with comorbid ADHD and other SUD. The aim of this study was to estimate prevalence rate of stimulant use among patients with comorbid ADHD and SUD and to compare it with patients diagnosed with SUD only. This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) for retrospective assessment of symptoms of childhood ADHD. Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis. Type of drug of abuse was determined using Urine screen and semi-structred questionnaire. Thirty six patients out of the 102 patients screened positive for Adult ADHD (35.3%). Four patients of the ADHD group were abusing cocaine (11.1%) while non of the non ADHD group used cocaine (FEp = 0.014). Patients with adult ADHD have significant higher rates of abuse of cocaine in comparison to patients with SUD only.

Can Improved Intra- and Inter-team Communication Reduce Missed Delirium?

To assess the prevalence and the team interaction in cases of missed delirium in acute care veterans coded as not having a diagnosis of delirium in admission or discharge notes. In this retrospective study, the records of 183 hospitalized veterans admitted to the emergency department (ED), medicine, surgery and psychiatry services and coded as not having a diagnosis of delirium were analyzed. Clinical notes of each case were examined using DSM IV TR criteria for delirium. Of the 52 cases assessed to have delirium, 5 cases had been miscoded as not having delirium. In the remaining 47 cases the diagnosis of delirium had been missed. The rates of undiagnosed delirium were ED 46/160, medicine 39/132, surgery 4/17, psychiatry 4/29 and consult liaison (CL) 0/9. Of the 5 cases of delirium identified by the CL service, 2 consult diagnoses were accepted and 3 were rejected. Nursing notes had words suggesting delirium in 70.2% of 47 cases compared to 41.3 and 43.6% of the clinician case notes for these patients admitted to ED and medicine respectively. No delirium or cognitive screening scales were utilized in the work up of the 52 cases involving delirium. The study results suggest that continuing education by the CL service of all hospital personnel involved in patient care may improve the diagnosis of delirium. Also, increased clinician-nursing intra-team communication, in addition to careful scrutiny of the nursing and clinician notes may contribute to the reduced incidence of missed delirium.

Repetitive transcranial magnetic stimulation enhances sleep quality of patients with comorbid major depressive disorder and insomnia

Insomnia impacts the course of major depressive disorder (MDD), obstructs response to treatment, and raises risk of depression relapse. This study approached how repetitive transcranial magnetic stimulation (rTMS) relieves depression and enhances sleep quality of patients with comorbid major depressive disorder and insomnia. A randomized, controlled, pilot study was conducted in our hospital. The study was approved by local Ethics Committee. All subjects signed informed consents. 30 patients, conforming to meet the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV–TR) criteria for MDD, and Montgomery–Asberg Depression Scale (MADRS) score between 12 and 29 were randomly chosen as the MDD group. Another 30 patients, meeting the DSM–IV–TR criteria for MDD and insomnia, MADRS score between 12 and 29, and Pitts-burgh Sleep Quality Index (PSQI) scores >7, were randomly selected as the MDD and insomnia group. Both groups received rTMS (10 Hz for 4 weeks) once per day. After treatment, patients’ depression was assessed with MADRS, and their sleep quality was evaluated by PSQI. Raters were masked to treatment assignment. There were 30 subjects in MDD group (60% female, mean age 38.56¡‘À12.13 s.d. mean course of disease 11.35¡‘À7.53 months). MDD and insomnia group consisted of 30 subjects (66.67% female, mean age 32.72¡‘À14.69 s.d. mean course of disease 9.23¡‘À4.81 months). Although the rate of depression remission in MDD and insomnia group (59.36%) was higher than MDD group (57.21%), this difference was not significant. After 4 weeks treatment, both MDD group (12.56¡‘À6.73) and MDD insomnia group (11.38¡‘À7.16 s.d.) were significantly improved in MADRS scores (P<0.05). MDD and insomnia group was significantly improved (P<0.05) in PSQI sleep quality (1.40¡‘À0.41), time for falling asleep (1.73¡‘À1.21), sleep time (1.90¡‘À1.28), sleep efficiency (0.90¡‘À1.52), Function during the daytime (1.87¡‘À0.84), total score (8.57 ¡‘À3.74). This pilot study offers the evidence that rTMS improves depression and sleep quality of patients with comorbid major depressive disorder and insomnia. This research was supported by Fund Projects of International Cooperation and Exchanges of Ministry of Science and Technology of China. Grant No. 2011DFA30960.

Laboratory profiles of treatment-seeking subjects with concurrent dependence on cannabis and other substances: a comparative study.

Background:Cannabis is one of the most widely used illicit drugs in India and worldwide. It is considered to have a minimal effect on physical health.Objectives:The aim of this study was to compare the laboratory profiles of treatment-seeking patients who were cannabis dependent, and drug users who concurrently use other substances, with non-users.Materials and Methods:Medical records of patients, whose urine was tested for the detection of cannabis within the last year, were considered for the study. The inclusion criteria for the study group were; co-morbid diagnosis of cannabis dependence according to DSM-IV TR criteria, positive urine drug screen for cannabis, and at least one biochemical or hematological examination report during the treatment period. The subjects who underwent all of the above mentioned tests, but who were negative for any psychoactive substance with no past or current history of substance use, were placed in the control group.Results:A total of 51 subjects fulfilled the inclusion criteria for the study group and 30 subjects were considered as controls. There was no significant difference found between the demographic profiles of the subject and control groups. The mean duration of cannabis use in the patients was 9.53 ± 8.06 years. Serum levels of; bilirubin, SGOT (serum glutamic oxaloacetic transaminase), SGPT (serum glutamic pyruvic transaminase), total protein, alkaline phosphatase, ESR, and eosinophil counts, were raised in; 13.7%, 15.6%, 33.3%, 17.6%, 37.2%, 75% and 5.8% of subjects, respectively. The relative monocyte count was lower than normal in 92% of cases. Physical complaints were reported in 98% of subjects. The two groups showed significant differences in serum alkaline phosphatase [t (79) = 6.5, P ≤ 0.01], TLC [t (79) = 2.36, P = 0.03] and hemoglobin levels [t (79) = 5.50, P ≤ 0.01].Conclusions:Abnormal laboratory parameters were observed in patients with cannabis dependence. The study emphasizes the need for regular physical examinations and laboratory investigations for cannabis users.

Neuroleptic malignant syndrome in an adolescent with CYP2D6 deficiency

We describe a patient with dystonia and psychotic symptoms treated with standard doses of antipsychotics, who developed neuroleptic malignant syndrome (NMS). A 16-year-old male with a history of misuse of dextromethorphan and pseudoephedrine for recreational purpose presented with dystonia and a psychotic episode. Following continuous treatment with olanzapine (10 mg/day), repeated injections of levomepromazine (37.5 mg/day), and a single injection of haloperidol (2.5 mg), the patient developed NMS. Muscular rigidity, fever (up to 41 °C), hypotension (100/70 mmHg), tachycardia (120 beats per minute), tachypnea (26 breaths per minute), elevated leukocyte count (up to 16.6 × 103/μL), and elevated serum creatinine phosphokinase (CPK) (up to 15,255 U/L) were observed. A diagnosis of NMS was made according to the DSM-IV TR criteria. Genotyping revealed that he was homozygous for a non-functional CYP2D6*4 allele. The case highlights the importance of therapeutic drug monitoring in identification and differentiation of drug-induced effects in psychiatric disorder to prevent NMS and its complications. In addition, genotyping of CYP2D6 might be considered in patients with symptoms suggestive of drug toxicity who are treated with neuroleptics metabolized via the CYP2D6 pathway, as carriage of one or more non-functional alleles may increase the risk for adverse reactions, such as NMS.

CODEX (COGNITIVE DISORDERS EXAMINATION) FOR THE DETECTION OF DEMENTIA AND MILD COGNITIVE IMPAIRMENT: DIAGNOSTIC UTILITY

ObjectiveTo report the diagnostic utility of Codex (cognitive disorders examination), a two–step decision tree (Belmin et al. 2007) using three–word recall and spatial orientation from the MMSE and a simplified...

HEAD TURNING SIGN FOR DIAGNOSIS OF DEMENTIA AND MILD COGNITIVE IMPAIRMENT: A REVALIDATION

ObjectiveTo examine the utility of the head turning sign in the diagnosis of dementia and mild cognitive impairment, and to compare results with a previous report from this clinic (J...

Safety and efficacy of ORM-12741 on cognitive and behavioral symptoms in patients with Alzheimer's disease: A randomized, double-blind, proof-of-concept study

Safety and efficacy of ORM-12741 on cognitive and behavioral symptoms in patients with Alzheimer's disease: A randomized, double-blind, proof-of-concept study

Somatosensory evoked potentials in children with autism

IntroductionAutism is a neurodevelopmental disorder in the category of pervasive developmental disorders (PDD), which is characterized by widespread abnormalities of social interactions, communication, and severely restricted interests and highly repetitive behavior. Children with autism show sensory and perceptual abnormalities. They have either hyposensitivity or hypersensitivity to sensory, auditory, and visual stimuli. ObjectivesThe aim of this work was to study somatosensory evoked potential (SSEPs) changes among children with autism, and their relation to somatosensory manifestations and severity of autism. SubjectsThirty children with autism aged 2–12years were included in the study, all of them fulfilling criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV–TR). MethodsAll cases were subjected to thorough history taking including autistic symptoms and sensory abnormalities, comprehensive medical examination, psychiatric assessment according to DSM–IV–TR criteria for diagnosing autism, assessment of severity of autism using Childhood Autism Rating Scale (CARS) and measurement of somatosensory evoked potentials elicited by median nerve stimulation at wrist. ResultsThe majority of the cases were males (86.7%), according to CARS 53.3% were classified as mild to moderate autism, while 46.7% were severe. Sensory abnormalities were present in 56.7% of cases. Somatosensory abnormalities were present in 36.76% of the cases. There was a statistically significant relationship between sensory symptoms with SSEP abnormalities (P=0.040). The presence of abnormal SSEPs was not statistically associated with higher score in CARS. ConclusionsChildren with autism have abnormal SSEP changes and were significantly related to the presence of sensory abnormalities, indicating central cortical dysfunction of somatosensory area. On the other hand, these abnormal SSEP changes were not related to the severity of autism.

Obsessive compulsive phenomenology in a sample of Egyptian adolescent population

Background and Objectives: Obsessive symptoms among children and adolescent age groups are increasing, an observation made by mental health professionals working with this age group. Our epidemiological study targeted secondary school students to estimate the prevalence of obsessive symptoms, obsessive compulsive disorder and their different obsessive compulsive contents. Methods: The study is cross sectional carried on 1299 secondary school students, the sample size was chosen based on an estimated Obsessive Compulsive Disorder (OCD) prevalence of 2% in literature. Equal samples were recruited from the 3 educative zones in Alexandria Governorate. Obsessive compulsive symptoms were assessed by the Arabic version of Lyeton obsessive inventory child version LOI-CV. Students scoring above 35 were subjected to the Mini International Neuropsychiatric Interview for children MINIKID Arabic. OCD patient students detected by MINI-KID were assessed by psychiatric interview to confirm fulfilling criteria of OCD according to DSM IV �TR criteria. Different obsessive compulsive symptoms were assessed by a standardized questionnaire. Results: Among the studied sample (n = 1299), 201 students scored > 35 on LOI-CV i.e. 15.5% of the total sample have OCS. The prevalence of OCD among studied sample was 2.2% as 29 students from the OCS students were fulfilling diagnostic criteria for OCD according to DSM-IV TR. Common obsessive symptoms were of excessive conscience 65.5%, blasphemous 55.2%, repeated words 51.7% and sexual obsessions 48.2%. Conclusions: The prevalence of obsessive compulsive symptoms is high among adolescent age group. Cultural impact should be considered to better understand obsessive phenomenology, raising the importance of OCD study from a transcultural perspective.

Does Systemic Inflammation Play a Role in Pediatric Psychosis?

Human and animal studies have suggested an underlying inflammatory mechanism for a variety of neuropsychiatric disorders, including schizophrenia. To date, most available reports focused on adult patients. We wished to test the hypothesis that the first psychotic episode in youth is associated with inflammation. We studied patients admitted to a pediatric inpatient psychiatric unit. Patients (n=80) had new-onset psychosis diagnosed using DSM-IV TR criteria for Psychosis NOS, Schizophreniform Disorder or Schizoaffective Disorder. Patients were matched for age, race and gender with inpatient controls without psychosis within the same unit (n=66). We also compared these values to normal pediatric hematologic values. To study the role of inflammation in youth with psychosis, we collected serum samples of 28 children presenting with first-episode psychosis and compared their serum cytokine and S100B levels to eight healthy controls. In this study, we measured serum markers of systemic inflammation. Leukocyte counts revealed a statistically significant increase in absolute monocytes compared to patients without psychosis (0.61 ± 0.282 k/ml vs. 0.496 ± 0.14 k/ml; p<0.01) and lymphocytes (2.51 ± 0.84 k/ml vs. 2.24 ± 0.72 k/ml; p<0.05) in patients with psychosis. All other hematologic values were similar between the groups. In addition, psychosis was characterized by increased serum levels of S100B, a peripheral marker of blood-brain barrier (BBB) damage. Several inflammatory mediators (e.g., TNF-α, IL-1β, IL-6, IL-5, IL-10, and IFN-γ) were elevated in children with psychosis. These results strongly support a link between systemic inflammation, blood-brain barrier disruption and first-episode psychosis in pediatric patients.

Psychoeducation in Binge Eating Disorder and EDNOS: a pilot study on the efficacy of a 10-week and a 1-year continuation treatment

The goals of the present study were (a) to analyse the efficacy of short-term (10weeks) psychoeducation group treatment in patients with binge eating disorder (BED) and eating disorders not otherwise specified (EDNOS), and (b) to analyse the determinants of the success of psychoeducation on single outcome measures. The sample included all patients seeking help for their binge behaviour at the Psychiatric Clinic of the Teaching Hospital of Udine. They all met the inclusion DSM-IV TR criteria for a diagnosis of EDNOS or BED. Eating attitudes were measured with the Eating Disorder Inventory (EDI-2), which includes three scales: bulimia (EDI-BU), body dissatisfaction (EDI-BD) and drive to thinness (EDI-DT). Other psychometric instruments were the Hospital Anxiety and Depression Scale and the Toronto Alexithymia Scale (TAS-20). Psychoeducation group treatment was carried out in an outpatient setting. It consisted in 10 weekly sessions of group therapy. At the end of this period, patients who maintained an eating disorder (ED) were asked to participate to an extension protocol, which included two fortnightly sessions followed by further monthly sessions for a period of 8months. 98 patients were originally included in the protocol. Of these, 54 met the criteria for BED and 44 for EDNOS. At the end of the treatment, 30 patients (30.6%) no longer suffered from an ED. All patients showed significant improvements on several other outcome measures (frequency of binges, BMI, bulimic traits, body dissatisfaction, anxiety, depression and alexithymia). The probability to recover from an ED was greater in subjects with higher scores of both BMI (p=0.009) and EDI-BU (p=0.002), together with lower TAS-20 scores at t0 (p=0.003); the probability to reduce the frequency of binges was greater in subjects with higher frequency of binges at t0 (p<0.0001); the improvement in the EDI-BD scores was negatively associated (p=0.005) with BMI at t0, and positively associated with scores at t0 of EDI-BD (p<0.0001); the improvement in the EDI-BU scores at t1 was associated with the EDI-BU scores at t0 (p<0.0001). 53 patients accepted to participate to the continuation phase; of these, 32 were assessed at the end of the period. About 41% of the latter obtained a recovery from an ED, with a further reduction of the episodes of binges and an improvement of BMI scores. This study may demonstrate the efficacy of psychoeducation group treatment for BED and EDNOS patients.

Untreated major depressive disorder with and without atypical features: A clinical comparative study

Aims and methodA comparative study of major depression with and without atypical features (as per DSM IV TR criteria) was planned to assess illness characteristics, resulting dysfunction and co-morbidities, which can have important implications in its management. Serially, 107 newly registered patients with depression not taking any treatment for at least a month were included. Patients with psychotic features in present or past, known bipolar disorder and likely organic aetiology were excluded. They were interviewed using SCID I (Structured clinical interview for DSM IV axis I disorders). Impulsiveness, suicidal ideation and functioning in various spheres was also assessed and compared between those with and without atypical features. ResultsAtypical features were seen in a significant number (55.14%) of patients especially from urban and semi-urban areas. Interpersonal sensitivity and leaden paralysis were the commonest atypical features apart from mood reactivity. Presence of hypersomnia and/or hyperphagia documented in 36 (33.65%) of 107 patients. Comparison of patients with and without atypical features revealed no significant difference in illness characteristics including suicidal ideation. However, they differed in level of impulsiveness and associated psychiatric co-morbidities. Also, deterioration of functioning with rising HDRS was more significant in patients without atypical features. Clinical implicationsPresence of atypical features is common in patients with major depressive disorder. These patients should be vigilantly assessed and managed in view of equal morbidity but different co-morbidities like anxiety and soft bipolar disorders than those without atypical features.

2628 – Prevalence and characteristics of adult attention-deficit hyperactivity disorder among substance use inpatients

Comorbidity is common among adults with ADHD, including substance abuse. To our knowledge relation between ADHD and SUD has not been studied in Arab countries. Assessment of scope of comorbidity between ADHD and SUD in Egyptian patients. Estimating prevalence rate of adult ADHD among substance use inpatients and to compare substance use inpatients with and without adult ADHD regarding onset, and severity of SUD. This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One Hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) for retrospective assessment of symptoms of childhood ADHD. Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis. 36 patients were diagnosed as having adult ADHD (35.3%) according to DSM-IV TR criteria. Presence of adult ADHD was associated with an earlier mean age of onset of SUD (15.58 vs. 13.22 years) and larger number of hospital admissions, (6.83 vs. 3.39 times). ADHD subjects achieved a shorter mean period of abstinence (124.53 vs. 209.82 days). Data were fed to the computer using the Predictive Analytics Software (PASW Statistics 18). Significance of the obtained results was judged at the 5% level. The results of this study confirm the high rates of adult ADHD among substance use patients mentioned in other studies. Presence of adult ADHD was associated with a more complicated course of SUD.

Efficacy of Abreactive Ego State Therapy for PTSD: Trauma Resolution, Depression, and Anxiety 1, 2

Using manualized abreactive Ego State Therapy (EST), 30 subjects meeting DSM–IV–TR and Clinician-Administered PTSD Scale (CAPS) criteria were exposed to either 5–6 hours of treatment or the Ochberg Counting Method (placebo) in a single session. EST emphasized repeated hypnotically activated abreactive “reliving” of the trauma and ego strengthening by the cotherapists. Posttreatment 1-month and 3-month follow-ups showed EST to be an effective treatment for PTSD. Using the Davidson Trauma Scale, Beck Depression II, and Beck Anxiety Scales, EST subjects showed significant positive effects from pretreatment levels at all posttreatment measurement periods in contrast to the placebo treatment. Most of the EST subjects responded and showed further improvement over time.

Efficacy of Single-Session Abreactive Ego State Therapy for Combat Stress Injury, PTSD, and ASD1

Using abreactive Ego State Therapy (EST), 36 patients meeting DSM–IV–TR and PTSD checklist (PCL) criteria were exposed to either 5–6 hours of manualized treatment or placebo in a single session. EST emphasizes repeated hypnotically activated abreactive “reliving” of the trauma experience combined with therapists' ego strength. Both the placebo and EST treatment groups showed significant reductions in PTSD checklist scores immediately posttreatment (placebo: mean 17.34 points; EST: mean 53.11 points) but only the EST patients maintained significant treatment effect at 4-week and 16- to 18-week follow-ups. Abreactive EST appears to be an effective and durable treatment for PTSD inclusive of combat stress injury and acute stress disorder.

1127 – Evolution of addictive comorbidities in a group of patients diagnosed with schizophrenia during atypical antipsychotic treatment

Drug-related disorders are observed in 30–50% of the patients diagnosed with schizophrenia and is therefore an important problem to be adressed in clinical practice. There are many reasons for the overlap between addictive disorders and schizophrenia: the tendency to alleviate antipsychotic-related side effects, the need to decrease anxiety or depression, to interfere with sensory gating defficits etc. To assess the effects of atypical antypsychotic treatment in decreasing the drug of abuse consumption in a population of schizophrenia diagnosed patients. A group of 23 patients, diagnosed with schizophrenia and a drug related disorder (dependence 52.1%, polisubstance dependence 17.4%, substance abuse 26%, other 4.5%), according to DSM IV TR criteria, were monitored for 6 months, while being treated with atypical antipsychotics (olanzapine 43.4%, risperidone 34.7%, aripiprazole 17.4%, amisulpride 4.5%), using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Clinical Global Impressions (CGI) and Inventory of Drug Taking Situations (IDTS) every 4 weeks. The evolution of IDTS scores were not parallel to the PANSS evaluations: while the psychotic symptoms decreased continuously during the 6 months of the study (-40.5% at week 12 and -67.5% at endpoint), the IDTS decreased initially (- 33.2% at week 12) but increased slightly to the end of the study (-31.2% at endpoint). The CGI-I score has a decrease of 50.4% at week 12 and of 55.6% at week 24. The evolution of drug related disorders during the atypical treatment of schizophrenia doesn’t correlate with the severity of psychosis and necessitates a specific management.