Neurosis- personality disordersand eatingdisorders; old age psychiatry 365s

of referrals for the elderly attempted suicide was 9.4% of the totalreferralsfor attemptedsuicide for all ages. Drugoverdoseaccountedforonly 27.3%of caseswhereasself-injuryaccounted for n .7%.Themost frequentway of self-injury was by swallowing corrosiveor de­tergent(25.5%) followed by jumping from height(12.7%),cut wrist(9.1%),hanging(7.3%)and drowning(5.5%).Nearlyhalf (49.1%)ofthe patients sufferedfrom a mooddisorder(27.3%majordepression,20%adjustmentdisorderwithdepressedmoodand 1.8% dysthymia).Fourpatientshaddelusional disorderand I schizophrenia. Only2 haddementia. However, 36.4% had no psychiatric illness. None of thegroup had an Axis II diagnosis. In our groupof patients, the numberof cases only dropped drastically after 85, suggestingthat the risk ofattemptedsuicideremainshighafter 75 inour localelderly.

Our study shows that attempted suicide in the elderly is a ma­jor health problem in Hong Kong and our findings will be funherdiscussedin the lightof differences with westernstudies.

QUALITY OF LIFE IN PATIENTS WITH EATINGDISORDERS

C. Danzl,E. Gottwald,B. Mangweth, G. Kemmler, W. Biebl.DepartmentofPsychosomatics, UniversityHospitalsoflnnsbruck;Anichstr: 35, A-6020 Innsbruck; Austria

In a catamnestic study we assessed the eating behaviour, the qual­ity of life, and changes in life style in female patients with eatingdisorders, discharged from our psychosomatic unit later than 1991but at least six months ago. Patients meetingcriteria for DSM-ill-Ranorexianervosaor bulimianervosaweresenta questionnaireinclud­ing demographicquestions and a modified version of the LancashireQualityof Life Profile(Oliveret al., 1991)coveringeating behaviour,family situation, partnership, sexuality, friendship, leisure, housingsituation, work or education, financial situation,health, self-esteem.Results showed that the majority of patients reported improved eat­ing behaviour. More than 50% reponed positivechanges in 'familysituation', 'job or education', 'housing situation', and 'leisure timeactivities' compared withthe time before their admission in our unit'Workand education' were the variables with the highestsatisfactionscore, social domains like family and friendshipscoredconsiderablylower. Our study suggests, that positive changes in occupation andfamily life favourably affect both general life satisfaction and eatingbehaviour.

RELATIONS BETWEEN EVENT-RELATED POTENTIALSAND SELF·REPORTING SCALES IN PANIC DISORDER

W. Dengler I, G. Wiedemann 1, P. Pauli2. I Department ofPsychiatryand Psychotherapy; Osianderstr: 24, D-72076 Tubingen.Germany: 2 Institute ofMedical Psychologyand BehavioralNeurobiology, UniversityofTiibingen; Osianderstr. 24, D-72076Tilbingen; Germany

A former study in 15 patients suffering from panic disorder hadshown panic patients to have enhanced perceptual performance andincreasedlatepositiveevent-relatedpotentialsforbody-relatedwords,compared to neutraland pain-related words.Stimuli had been tachis­toscopically presented [I]. The results of this study supported cogni­tive modelsof panic disorder suggestingpanic attacks to result fromcatastrophicmisinterpretation of bodilysymptoms.

Now a number of self-reporting scales (BAI, BDI, BSQ, ACQ,STAIXI and X2, CCL, SCL-90-R) were compared to event-relatedpotentials in the same 15 panic patients. Interestingly a significantcorrelationwasfoundbetweenthescore of the BodySensationQues­tionnaire(BSQ> and the positiveslow wavepotentialsat 700-800 msafter presentation of body-related words (r = 0.54; p = 0.04). Thisfinding is a further hint at the importanceof body-relatedstimuli in

information processing in panicdisorder. In generalthereWhere no oronlyweakcorrelations betweenscoresandsubscoresof self-reportingscalesand event-related potentials.

[II Pauli P, Dengler W, Wiedemann Getal.: Behavioral and Neurophysiolog­ical Evidence forAltered Processing of Anxiety-Related Words in PanicDisorder (submitted).

NEVROSE TRAUMATIQUE ET "LIEN SOCIAL"

P.Dubelle. Hopita!d'lnstruction des Armees Begin,ServicePsychiatrie, 69 Avenuede Paris,94160 Saint-Mande. France

Dans la nevrose traumatique la mort deviem le centre de la viepsychique du sujet; elle est la, logee en lui, totalement insolite,depuis Ie jour d'une rencontre fortuite ou iI s'est laisse surprendreet absorbepar elle. Presencetout-a-fait reelle, insistanteet repetitived'une mortfiguree dansles reviviscences etcauchemarstraumatiques,mais presenceimpensablecar depourvuede support aussi bien dansI'inconscientque dansIediscours.

La mort dont iI est question ici deroge a l'histoire du sujet autantqu'a I'ordre social; de son absence de representation depend lOUIefonne de vie, individuelle et collective. C'est pourquoi la rencontretraurnatique peut provoquer une rupture catastrophique du lien oils'inscritle sujet dans I'ordre individuel, familial et social (celui desgroupements sociaux- organisations et institutions - emanationdela civilisation).

Deux observations cliniques concernant des patients atteints denevrosetraumatique se proposentd'illustrer lanaturedes enjeuxpsy­chologiquesdes lorsque la mortintervient dans Ierapportque Iesujetentretient avec les groupernents sociaux;elles permettentegalementd'avancer l'hypothese d'une relation d'exclusion rnutuelle entre Iemaintiendu lien dans I'ordre social et la presenced'images trauma­tiques. D'ou la necessite, dans la prise en charge de ces "patientstraurnatises", d'une ecoute et d'un travail de liaison relatifs a la di­mensionsocialeet institutionnelle du sujet,

DIAGNOSIS AND TREATMENT OF DEPRESSION IN THEELDERLY PHYSICALLY ILL

MavisEvans,MaggieHammond,KC .M. Wilson,M. Lye,J.R.M. Copeland. Departmentof Psychiatry; Royal LiverpoolUniversityHospital, Liverpool L693BX, UK: DepartmentofGeriatricMedicine, Royal Liverpool University Hospital, LiverpoolL693BX, UK

A screening scale for identification of depression in the acutely illgeriatricmedicalpatient(ELDRS)wasdeveloped. During validationstudiesprevalence of depression wasfoundto be approximately 30%,and response to treatment in an open trial of fluoxetine was good.It was therefore felt appropriate to carry out a single centre doubleblindplacebocontrolledtrialof fluoxetine treatmentin the acutely illelderly depressedpatient Admissionsto the geriatric medical wardswere screenedwith ELDRS.Those reachingcut-offon the screeningscalewereinterviewed morefully usingthe GMS/AGECAT diagnos­tic system;case levelof depressionwas the entry criteria. 84 patientswererecruitedto thestudy,62 reachedthreeweeksand enteredthe ef­ficacy analysis,42 completedthe eight week trial period.Presenceofphysicalillness,oftensevereandlormultiple,did not reducetheeffec­tivenessof the medication whichwas well toleratedoverall.Physicalstatus was rated using Burvill's method, with serious illness definedas cardiac or respiratory disease rated moderateor severe,or knownneoplasm, on entry to the trial. Although the fluoxetine group had arecovery rate increasedabovethat of the placebogroup by a factor of1.8,numberswere not sufficient to reachsignificance. Those patientswithseriousphysicalillnesswhocompleted5 or more weeks(n = 37)showeda significant improvement in moodwithactivetreatment(p <

366s Neurosis - personality disorders and eating disorders; old age psychiatry

0.05),increasing response by a factorof2.7. Therewasa trendforan­tidepressant response in allgroupsto increase asdurationof treatmentlengthened, suggesting that the physically ill elderlymaytake longerto respondto antidepressants thanthe physically well.Thosepatientswithconcomitant cerebrovascular diseasealso showed a significantlygreaterresponse to activetreatment (p = 0.05), moremarked in thosewith serious physical illnessas well (p = 0.02). suggesting the needfor furtherresearch in thisarea.

GENERALISED ANXIETY DISORDERIN CHRONICFATIGUE SYNDROME (CFS) ANDFIBROMYALGIA (FM)

B.Fischler,R. Cluydts,V.DeGucht,L. Kaufman, K. De Meirleir.DepartmentofPsychiatry. AcademischZiekenhuis, VrijeUniversiteitBrussel,Laarbeeklaan 101.B-109O. Brussels, Belgium

Objectives: I) compare psychopathology between CFS and medicalcontrols

2) comparepsychopathology betweenCFSwithand without FMResults:A structuredpsychiatric interview (DSM-llI-R), partof a

globalpsychopathological approach. revealed higherprevalence ratesof current and lifetime psychiatric disorders and a higherdegree ofpsychiatric comorbidity in the chronicfatigue syndrome(CFS)com­pared to a medical controlgroup. Contrasting with previous studies.wasthefinding of a veryhighprevalence of generalised anxietydisor­der (GAD)in CFS. characterised by an earlyonsetand a highrateofpsychiatric comorbidity. A significantly higher prevalence was alsofound for the somatisation disorder(SO) in the CFS group.CFS pa­tients with SD have a longer illness duration and a higher rate ofpsychiatric comorbidity.

No differences in psychopathology were observed betweenCFSpatientswithor withoutFM.

Conclusions: GAOis veryprevalent in CFSand FM. It is hypoth­esised thatGAD represents a risk factorfor thedevelopment of CFS.FindingsaboutSO are in accordance withthe suggestion of Hickieetal to isolatechronicfatigued subjectswithSD fromCFS.

POSTTRAUMATIC STRESS DISORDERANDWORKABILITY

V.Folnegovic-Smalc. N. Mimica,Z. Folnegovic. UniversityDepartmentofPsychiatry. Psychiatric HospitalYrapce, Bolnickacesta 32.HR-l0090 Zagreb, Croatia

The aim of this study was to evaluate the work ability of personswith posttraumatic stress disorder (PTSD).The study comprised 64patients (diagnosed according to DSM-IV and ICD-IO), 44 malesand 20 females, age between 25 to 50 years. All 44 men were ac­tive before the illness occurred. namely 31 was employed. II werepeasantsand 2 of them were free-lances. Before the treatment free­lances were working in spite of havingsymptoms, all peasantswerepassive. and amongthe employeesonly twoof them were still work­ing actively. After the psychopharmacotherapy and two-months ofcognitive-behavioral therapy9 employees returnedto work,but notasingle peasant.Before developing PTSDall womenwere successfulhousewives (not a single one was employed), but during the illnessall of them became totally passive. This study demonstrates that thepersons with PTSD show significant work disability in highly per­centage. Also it was noticed that the persons in which the symptomsof the disorder had disappeared often remained passive, and didn'treturn back to their previousjob. It is concludedthat PTSDpresentsalso a significant socialproblem.

IMMIGRATION RELATED PSYCHOLOGICALDISTRESSSYNDROME ASSOCIATED WITH LONELINESS

S. Safro,A. Ponizovsky, Y. Ginath.M. Ritsner. Talbieh MentalHealthCenter, 18 DisraeliStr; 91044. Jerusalem, Israel

Levelsof perceived loneliness and psychological distresswere inves­tigated among 966 adult immigrants from the former Soviet Unionto Israel. Perceived Loneliness Indexand Brief SymptomInventory(BSI) were employed as measures of loneliness and psychologicaldistressconcerning preimmigration as well as postimmigration peri­ods. On average, the prevalence rate of the perceived loneliness wasdoubled through immigration: from 18% to 36%. The BSI dimen­sions' scores were much higher for the lonely group compared tothenonlonely in bothimmigration stages.Wedivided all respondentsinto four groups: permanently lonely - those who reponed lone­liness prior to as well as after immigration; recent lonely - thosereporting loneliness only after immigration; former lonely - thosereporting "loss" of loneliness after immigration. and never lonely- those who did not report loneliness neitherbeforeor after immi­gration. Never lonely immigrants were overrepresented (61%) andformerlonely - wereunderrepresented (3%)in our sample.Amongcurrent lonely immigrants 15% were permanently lonely and 21%wererecentlonely. Bothloneliness andpsychological distresssignifi­cantly increased after immigration but the relationship betweentheseparameters was different in the distinct groups. Multiple regressionand factoranalyses allowed to establishthe immigration relatedsyn­dromes: psychological distresssyndrome associated with loneliness.and general anxiety syndrome not relatedto loneliness and psycho­logical distress.

THE APPLICATION OF THE INTERNETTO SUPPORTCARERSOF DEMENTIA PATIENTS

RJ. Harvey. DementiaResearch Group. TheNationalHospitalforNeurology and Neurosurgery. QueenSquare. LAndon WC1N3BG

Introduction: The Intemet is a globalcommunications and data net­work which is expanding rapidly. By establishing an e-mail mail­ing list and World Wide Web (WWW)pages we have been able todemonstrate that this technology is applicable and accetable to carersof dementiapatients.

Methodology: To examine the potential of the Internet for sup­portingdementiacarersan e-mailmailinglist wasestablished. Addi­tionallyWWWpagesweredesignedto provide accessible and usefulinformation, with links to other sites on the network of interest todementiacarers.The mailinglist and the web pageswere advertisedwidely on the Internet via other mailing lists and search databases.Peoplejoiningthee-maillist wereaskedto completea questionnaire,andweb pagesaccesseswereautomatically counted.

Results: After 9 months of operation 166 people had joined themailinglist. Members weredrawnfromthe UK, Europe.USA, Aus­tralia and the Far East.One third were familycaregivers with the re­mainderbeingprofessionals, educators andstudents.A largevolumeof livelydiscussion developed with several messages per day beingdistributed. Our presentation will provideexamplesof the threadsofdiscussion that developed. More than 500 accesses per month wererecordedfor theWebpages,and we Will presentexamplesof our webpagesand of the typeof information available on the Internet.

Conclusions: We have demonstrated that the Internet is a placewheredementiacarerscan lookfor,and find.support.Oure-mail andwebpagesare popularandofferconsiderable opportunities for furtherresearch anddevelopment.