418s Schizophrenia, antipsychotics and neuroimaging

The studypresentedhere investigates whetherwomenwithseveremental health problems (e.g. schizophrenia) differ from men con­cerningtheir needsfor care and utilization of as well as benefit frommentalhealthcare services.

Study design: For one year, 66 vulnerable schizophrenic patients(26 women and40 men)werefollowed afterdischarge frominpatientcare throughout the following twelvemonths in thehighlyfragmentedmental healthcaredelivery systemin Mannheim area.Theclinicaldi­agnosisof schizophrenia (according to ICO-IO) wasconfirmed by aSCAN-interview. including PSE 10, which was repeated at the endof the follow-up. For assessing the patients needs for therapeuticalinterventions and rehabilitation, we appliedthe "Needs for Care As­sessment"everythreemonths. Torecordthepatientspassage throughthe network of mental healthcare services in the community we ap­plied the Mannheim Service Recording Sheet. It not only recordseach contact of patients with the services in a defined time interval(weekly) butalsoeach treatment or care-intervention provided by thecontacted services. Information wasobtained continuously through­out the follow-up period.

Results: There were no sex-related differences in sociodemo­graphic variables in the sample. neither did women and men differsignificantly in variables concerning their illness history. such as du­ration,numberofhospitalstays.etc.Theirneedforcarewascompara­ble to thoseof themen.sameas the psychopathology at the beginningandend of thefollow-up. Nevertheless womenshoweda significantlyhigher utilization rate of mental healthcare services. They not onlyhada highernumberofcontacts.butalsomoreinterventions provided.

Discussion: We could not confirm that chronically mentally illwomen were not adequately served. In contrast. we found an in­creased utilization rate of outpatientservices not due to differencesin the course of the disease respectively different need statusor psy­chopathology. Possibleexplanations could be a lower threshold forthe utilization of servicesor a lower threshold for the perception ofpsychotic symptomsand the needof therapeutic interventions.

FORMAL CHARACTERISTICS OF DELUSIONS

P.Oulis,V.Mavreas,J. Mamounas, C. Stefanis. Department ofPsychiatry, AthensUniversity MedicalSchool, Eginition Hospital.72-74 Vas. SophiasAve.,11528 Athens,Greece

Westudied 13 formal clinicalcharacteristics of delusions by meansof observer-rated ordinal scales in a sample of 74 psychiatric inpa­tients with mainlyschizophrenic or schizophreniform disorders. Theinterrater reliability of the scaleswasfoundtobe satisfactory withthesoleexceptionof the item-scale of congruence withtheaffective state.Highlevelsofconviction abouttheirtruthandto a lesserextentlackofdismissibility andlackof resistance againstthemwerefoundto bethehallmarks ofdelusional beliefs.The latterfinding underscores thefactthat contrary to obsessions. delusions are typically "ego-syntonic"subjective experiences although frequently unpleasant ones. In al­most one third of the cases, delusional beliefs resulted in aggressiveor violent behavior against self or others. The lack of strong inter­correlations among the scales items support the hypothesis that theconceptof delusionsrepresents variousaspectsof patientsdelusionalexperiences whichare relatively independent of one another.

COGNITIVE FUNCTIONING IN SCHIZOPHRENICSUBJECTS ANDTHEIR FIRST DEGREE RELATIVES

O.M.Mockler,RM. Murray,T.Sharma. Institute ofPsychiatry,DepartmentofPsychological Medicine, De Crespigny Park,DenmarkHill. London, UK

The study investigated memory and intellectual functioning in bothschizophrenics (N = 35) and their first degree relatives (N = 77).

The two subjectgroups were comparedto a healthy control sample(N = 48). Memory and intellectual functioning was estimatedusingthe Rivermead Behavioural Memory Test (RBMT) and the Wech­sler AdultIntelligence Scale-Revised (WAIS-R) respectively. Signif­icantly impaired memoryfunctioning was evident when comparingboth schizophrenic subjects and their relatives to healthy controls.Schizophrenic subjects weremore impaired on testsof memoryfunc­tioning in comparison to their relatives. The first degree relativeswere comparable to healthy controls on tests of intelIectual ability.Theschizophrenic subjects weresignificantly more intellectually im­paired than both their relatives and healthy controls. The findingsindicate some evidence of a similar neuropsychological deficit inmemory functioning in schizophrenics andtheirfirstdegreerelatives.

COGNITIVE DECLINE IN SCHIZOPHRENIA

O.M.Mockler, T.Sharma. InstituteofPsychiatry, DepartmentofPsychological Medicine, De Crespigny Park, DenmarkHill.London,UK

The prevalence and course of cognitive impairment schizophreniaremains a point of debate. Is cognitive impairment in schizophreniaa dementing process. markedly declining with age or does cogni­tive impairment occur in the early stages of development, possiblypre onset of schizophrenia with no further marked decline with ad­vancing age?The study investigates memoryand intellectual declinein schizophrenic (n = 83) subjects comparedto healthy controls (N=47) using the Wechsler Adult Intelligence Scale-Revised (WAIS­R). Rivermead Behavioural Memory Test (RBMT)and the NationalAdultReading Test(NART) in a cross-sectional study using5 age re­latedcohorts(18-29, 30-39, 40-49, 50-59 and 60-69 yearsof age).Nosignificant variation inmemory functioning wasfoundacrossthe5cohortsfor theschizophrenic subjects. However, memoryfunctioningin the controlsubjectswassignificantly disparatewith impairedper­formance with increasing age.This foundto be relatedto age effects.Theschizophrenic subjectsshowedimpaired intellectual and memoryfunctioning compared to the control cohorts, Memory functioningwas not significantly variable when comparing the 60-69 year oldschizophrenic/control cohorts,A significant reduction in intellectualability was evident across the 5 schizophrenic cohorts,The findingsindicatethat memory functioning does not decline significantly withage in schizophrenia. The healthy subjects memory functioning be­comescomparable to schizophrenic subjectsbetweenthe age of 60­69 years. It is possiblethat impaired memoryfunctioning in schizo­phreniareaches a base level in the earlyyears/orpre-illnessand doesnotdeteriorate significantly beyondthis level with increasing age andyearsof illness.

AMISULPRIDE IN THE TREATMENT OF SUBCHRONICOR CHRONIC SCHIZOPHRENIA WITH ACUTEEXACERBATION:A DOUBLE·BLIND COMPARISONWITH HALOPERIDOL

RI. MoHer I, S. Turjanski 3, S. Turjanski 3, O. F1eurot 3, and theAmisulpride StudyGroup. I Psychiatric DepartmentUniversity,Munich, Germany: 2 InsermU302, Pitie-Salpetriere, 75013Paris:3 Synthelabo, 92350Le Plessis-Robinson, France

Amisulpride is a substituted benzamide selective for dopamine 02and 03 receptors withoutactivity on other receptors, In animal stud­ies it binds preferentially to limbic receptors, indicating a poten­tiallylowpropensity to induceextrapyramidal symptoms. In previousstudies amisulpride was effective in productive and deficit schizo­phrenia. The purposeof this rnulticentre, international. randomized,haloperidol-controlled, double-blind study was to compare the effi­cacy of amisulpride (AMI) versus haloperidol (H) in the treatment