O-03-01

Experiences from the first Assertive Community Treatment (ACT) programme in Denmark

J. Aagaard, C. Müller-Nielsen. Psychiatric Hospital in Aarhus Dept. of Psychiatric Demograp., Risskov, Denmark

Objective: Several studies, mostly in US, have shown that patients attached to an ACT programme have better outcome, these results have not to the same degree been replicated in European studies. On May 1, 2001, we started in the T0nder region (45,000 inhabitants), S0nderjyllands county, aiming an evaluation of the ACT model. The treatment included intensive case management, psycho education, social skill training, crisis homes and vocational rehabilitation.

Methods: The principle of evaluation is within a quasi experimental design (intervention-/control region) to obtain register data and clinical data.

Results: During the first two years 90 patients started in the ACT programme in Tonder. A corresponding number of ACT target group patients were identified in the control region (Aabenraa). The Tender and the Aabenraa regions had prior to the start of the ACT programme the same pattern of use of psychiatric services. Compares to control more patients were treated as outpatients and more were adherent. A significant reduction in use and costs of hospital benefits were found, as improvements in psychopathology and social functions. Patients and relatives were rather satisfied with the treatment and service.

Conclusion: The results are encouraging. Similar projects are in progress at two other places in Denmark, thus meta analyses might be a possibility, before a more general implementation of some of the ACT principles in Denmark.

O-03-02

Nonparticipants have more commonly mental disorders than participants

J. Veijola, M. Haapea, M. Joukamaa, K. Läksy, J. Miettunen. University of Oulu Psychiatry, Oulu, Finland

Objective: There exist only a few studies estimating psychiatric morbidity among nonparticipants. We were able to compare the psychiatric morbidity between nonparticipants and participants in a field survey.

Methods: The material consists of 8 411 subjects in the Northern Finland 1966 Birth Cohort. All subjects were invited to participate in a field survey during the year 1997. Of the subjects 5988 participated in the field survey and 2 423 did not. The psychiatric morbidity of participants and nonparticipants in this general population birth cohort was followed up 31 years using the Finnish National Hospital Discharge Register.

Results: Of the participants 2.6 % and of the non-participants 5.3 % (p<0.001) had been treated at least once in hospital due to psychiatric disorders. The prevalence of schizophrenia was 0.5 % in participants and 1.5 % (p<0.001) in non-participants.

Conclusion: Non-participants were more commonly treated in hospital due to mental health problems than participants. Especially schizophrenia tended to cumulate in the group of non-participants. The true prevalences of severe mental disorders may be higher than the prevalences drawn from epidemiological field studies.

O-03-03

Group treatment of depression: Psycho-education vs. behavior therapy

F. Caspar, W. Greil, T. Doppmann, T. Berger. Universität Freiburg Klinik Psychologie, Freiburg, Germany

Objective: “Psychoeducation” is an important contribution to the treatment of depression, be it as a stand-alone therapy, be it as a part of more comprehensive psychotherapeutic approaches. In this study, the effectiveness of two forms of group therapy have been compared: Traditional behavioral group therapy with a flexible approach to the needs and wishes of every individual patient vs. psychoeducation. Differences between these conditions have not been artificially increased; the study has been conducted under practice conditions.

Methods: In each group, 41 patients with an ICD diagnosis in the spectrum of depressive disorders have been attributed to one of the groups. At pre, post and follow up, SCL-90, BDI, IIP-64, UQuestionnaire, EMI-B, VEV, and Goal Attainment Scaling have been assessed. A knowledge test has been filled in by the patients to assess whether they had learned the information provided in psychoeducation in a reproducable way. A special randomization procedure, which is particularly suitable for experimental studies in practice, has been used in which entire groups instead of patients are randomly assigned to a condition.

Results: Patients in both conditions showed changes with effects sizes around .80 with no significant differences between the two conditions. In a knowledge test, there we no significant differences between the two groups. Strong interactions with interpersonal patient properties were found: Very submissive patients profited more from traditional group therapy.

Conclusion: In a psychiatric hospital which emphasized the information of patients, they seem to learn much even outside a special psychoeducative group. The absence of overall differences between the conditions allows to decide about the form of therapy depending on other criteria, such as availability of therapists for one or the other. If both forms are available, very submissive patients should be sent to regular behavior therapy, and vice versa.

O-03-04

Measuring social capital in mental health research: A new approach

M. Webber. Institute of Psychiatry P032, Health Services Research, London, United Kingdom

Objective: There are a number of ways in which social networks can have an influence on mental health. Some are well researched, such as the ‘stress-buffering’ model or the ‘main effect’ model. However, little is known about the effect of access to resources embedded in social networks, the ‘social capital’ model. This is largely due to the lack of standardised instruments to measure individual social capital. This study aims to develop and validate a self-complete measure, the Resource Generator-UK, from a similar version used in a Dutch social survey. Through a series of pilots, it aims to test the reliability and validity of the measure and whether or not common mental disorder is associated with low social capital.

Methods: Focus group discussions and an expert panel were used to generate items for the Resource Generator-UK and establish its face validity. Cognitive appraisals were also used to minimise potential response error. Data from the first crosssectional pilot study (n=295) was used for item reduction and scaling. The second pilot tested convergent-divergent validity and, using the GHQ-12, measured common mental disorder. Two further pilots established its test-retest reliability and ‘known group’ validity.

Results: The Resource Generator-UK is a 27-item measure of individual social capital. Early results from the study indicate that it is both valid and reliable.

Conclusion: This brief instrument can help researchers to investigate the effect of social capital on mental health. Two examples of its use will be briefly presented.

O-03-05

Having mentally ill parents: Impact on spare time activity, school performance and familial relationship

S. Rothen, F. Ferrero, O. Chouchena, M. Preisig. UREP, Prilly, Switzerland

Objective: 1) Is there an association between psychopathology in probands and spouses and social variables in their children, such as school performance, spare time activity and familial relations? 2) Are children of psychiatric patients at a higher risk of psychiatric disorders? 3) Do these psychiatric disorders in children impact social variables?

Methods: Extensive clinical information was collected on patients with bipolar or unipolar mood disorder, alcohol or heroin dependence and medical controls, with their 336 7 to 17-year-old children. Diagnostic assignment of parents and children was based on a best-estimate procedure using semi-structured interviews, medical records and family history information. Data on social variables in children were gathered within the interview.

Results: 1) The offspring of probands suffering from psychiatric disorders revealed more problems with spare time activity, familial relations and school performances, whereas, psychopathology of spouses was not associated with social variables in children. 2) The offspring of probands suffering from psychiatric disorders were at an increased risk for psychiatric disorders, such as MDD, anxiety disorders and ADHD. 3) The presence of psychiatric disorders in offspring was associated with all three social variables in children. Using logistic regression models including all variables, only mood disorders in probands predicted lower levels of school achievement, whereas child's psychopathology remained associated with all social variables.

Conclusion: Our data confirmed the impact of proband but not spouse psychopathology on school performance, social activity and familial relations of children. The effect of proband psychopathology is generally mediated by the presence of psychopathology in offspring.

O-03-06

New perspectives on reducing stigma: Fighting burnout to enhance provider attitudes of recovery

B. Schulze. Psychiatric Univ. Hosp. Zurich Public Mental Health Research, Zürich, Switzerland

Objective: Psychiatry itself has been described as contributing to mental health-related stigma. Interventions in this field have repeatedly been called for. Professional attitudes, however, can hardly be improved by training interventions with a moral imperative alone. All providers share the aim of offering effective treatment - which may be hampered by excessive job strain and burnout. A new training programme against stigma is being developed for mental health professionals, integrating burnout prevention and training in empowerment competencies.

Methods: Interventions will consist of three modules: (1) staff support in stress management and burnout prevention; (2) developing recovery skills and (3) facilitating client empowerment. Contact with service users in competent roles will be a central part of the programme, aiming to challenge common stereotypes. Courses will be evaluated in a pre/post experimental design.

Results: Course content concerning staff support is based on the results of a needs assessment carried out among Swiss mental health professionals (n=100). Central training needs concerned stress awareness and stress management, effective client-provider communication, time management, as well as relaxation techniques.

Conclusion: Improving providers' work-related quality of life and stress management skills is expected to contribute to facilitating effective client-provider relationships and more positive treatment outcomes - which, in turn, are likely to enhance provider attitudes of recovery.

O-03-07

Study on mental health status in hemodialysis patient

A. Navidian. Iran

Objectivea: hemodialysis as a resulotion in treatment of chronic renal failure which it is a stressful process and has several psychocognitive and social complication.This investigation was done to determaine the mental health status in hemodialysis patient.

Methods: This descriptive-analytic research was carried out on 80 persons (40dialysis patient, 40 healty persons) that matched as group, data were gathered by GHQ - 28 questionnaire and through interview then compared two group together. Results: finding showed that dialysis patient (mean=l 1/65) has lower mental health state than control or healty group (mean = 6/20) the result of T test show a significant relation betweenthese two group (p<0/001). Also there are statistical significant relation between mental health status of dialysis patient and dialysis times in week (p<0/009) and sex (p<0/03).

Conclusions: considering lowering mental health status of dialysis patient and its effect on disease process and patient health / well being, the psycholoNcal team has a pibotal role in assessment before dialysis and during dialysis period which they are effective in patient adjustment and coping.

O-03-08

When is the most appropriate moment for psychotherapeutic intervention following autologous peripheral blood stem cell transplantation?

E. Frick, M. Tyroller, N. Fischer, R. Busch, B. Emmerich, I. Bumeder. Psychiatric Clinic Psychotherapy & Psychosomatics, Miinchen, Germany

Objective: To compare the impact of (A) an earlier (months 1 to 6 after PBSCT) vs. (B) a later (months 6 to 12) individualised psychodynamic short-time psychotherapy on health related quality of life.

Methods: Psychotherapy focused on coping and relevant elements of the patient's history. It used guided imagery. One hundred and seventy-nine of 194 eligible patients were randomly assigned to the arms A (n = 88) and B (n = 91). Fifteen patients participated in data survey only. All patients filled in the EORTC Questionnaire Core 30 and the Profile of Mood States (POMS).

Results: Sixty-one patients (36 A; 25 B) completed psychotherapy. In comparison with B-completers, A-completers showed significantly higher pre/post psychotherapy improvements in the following EORTC QLQ-C30 subscales: Global Health Score (empirical effect size d=.97; p=.001), Role Function (d=.84; p = .004); Fatigue (d = .74; p = .01). Furthermore, A-completers scored better than B-completers in Emotional and Social Function and in POMS-Vigour (p = .32). We statistically controlled for Karnofsky performance status and illness stage. Additionally, we carried out an analysis of dropouts and an intention-to-treat analysis implementing different strategies to deal with missing data.

Conclusion: Psychotherapy can more efficiently enhance HRQoL during the early phase following PBSCT, rather than later in the survivor's time trajectory.

O-03-09

Religious coping with a life-threatening disease

O. Seidl, E. Frick. Psychiatric Clinic Psychotherapy & Psychosomatics, Muenchen, Germany

Objective: The effect of religious coping (RC) with severe diseases is considered to be important. There are, however few empirical studies.

Methods: We interviewed 105 HIV-infected homosexuals, haemophiliacs, and iv-drug addicts during a period before antiretroviral medical therapy. Coping was assessed with the Bemer Bewaeltigungsformen (Helm et al. 1990). The outcome of coping was assessed with the Beeintraechtigungsschwerescore (Schepank 1995).

Results: Twenty-five percent of the patients reported RC. This group of respondents consisted almost exclusively of homosexuals. RC was not more effective than other coping strategies. There was no change RC patterns during the disease time-trajectory. RC was not influenced by the severeness of the illness nor by the subjective beliefs about aetiology of the illness. Patients with RC showed more optimism and help-seeking behaviour than other patients. RC was associated with internal locus of control.

Conclusion: RC seems to be a stable trait factor of copingbehaviour. Patients who report PC do not adjust more efficiently than other patients.

O-03-10

Ethics in psychiatry: From hippocrates to the WPA Declaration on Ethics

G. Christodoulou. Hellenic Psychiatric Associa., Athens, Greece

Objective: The contribution of Hippocrates to the establishment of ethical rules in Psychiatry is discussed and the conclusion is reached that Hippocrates managed to harmonize the theocratic and the rational approaches in Medicine and Psychiatry, thus avoiding one-sided approaches and polarization. The common elements in the ethics declarations and rules that followed Hippocrates are outlined and it is pointed out that practically all of them identify the rights of the patient as the most important priority. Controversial issues like exposure of incompetent colleagues will be discussed.