ABSTRACTS - World Psychiatric Association

psychosocial interventions in randomized controlled trials. Such
interventions include cognitive behavioral social skills training, functional
adaptation skills training, diabetes awareness and rehabilitation
training, work rehabilitation, and an intervention specifically
focused on Latino patients. The results show that psychosocial interventions
are efficacious, practical, and acceptable to older patients
with schizophrenia being treated with medications. Shared decision
making involving patients and caregivers is necessary for choosing
specific treatments for specific patients.
US25.
PREVENTION AND EARLY INTERVENTION
STRATEGIES IN COMMUNITY MENTAL HEALTH
SETTINGS
US25.1.
PREVENTION AND EARLY INTERVENTION
STRATEGIES FOR MENTAL DISORDERS:
THE PREVENTION GAP
S. Saxena
Department of Mental Health and Substance Abuse,
World Health Organization, Geneva, Switzerland
Prevention of mental and behavioral disorders is likely to be the most
effective strategy to reduce the growing burden of these disorders in
the long term. While scientific knowledge in this area has increased
substantially in the last decade, only a small fraction of it is being used
in practice, leading to a large prevention gap. This paper focuses on
two aspects of prevention: a) the practical applicability of knowledge
on social and macro-economic factors in causation of mental disorders
and b) feasible preventive interventions within primary and secondary
health care in low and middle income countries. Reference is
made to the recent publications of WHO Commission on Social
Determinants of Health and other sources relevant to prevention of
mental disorders at policy as well as health care levels. Attempts to
evaluate the effectiveness and feasibility of prevention strategies within
primary and secondary care and to integrate these within the WHO
essential package for mental, neurological and substance use disorders
are also described. Issues related to responsibilities for prevention
and funding of prevention programmes are enumerated. Conclusions
are drawn on the steps needed to narrow the prevention gap.
US25.2.
EARLY COMMUNITY INTERVENTION FOR YOUNG
PEOPLE WITH EMERGING MENTAL DISORDERS
P.D. McGorry
ORYGEN Youth Health Research Centre, University
of Melbourne, Australia
Preventively-oriented clinical care is a realistic and achievable goal in
developed countries and a potentially cost-effective strategy for lowand
middle-income countries and developing economies. The frontier
for mental health promotion, prevention and early intervention is
located at the community level, where an enhanced primary care
model can offer a low stigma gateway for multidisciplinary evidencebased
interventions. This is particularly relevant for young people
with emerging mental disorders where help-seeking and engagement
are especially dependent on the setting and the culture of care. The
headspace program developed with the support of the Australian government
has created 30 new “communities of youth services” or “onestop
shops” across the nation over the past 2 years and many thousands
of young people are gaining better access to multidisciplinary
mental health care as a result. Initial experiences and data are featured
and broader lessons for preventive community care drawn.
US25.3.
PORTLAND IDENTIFICATION AND EARLY
REFERRAL (PIER): CONVERSION AND INCIDENCE
OUTCOMES IN A CATCHMENT-AREA-WIDE
PSYCHOSIS PREVENTION PROGRAM, 1994-2008
W.R. McFarlane, W. Cook, D. Downing, A. Maloney
Maine Medical Center, Portland, Maine, USA
Portland Identification and Early Referral (PIER) is a population-based
system of early detection and treatment for the prodrome to psychosis
in people aged 12-35. The goal is to reduce the incidence of psychotic
disorders in Portland, Maine, USA (population 330,000). Treated cases
receive comprehensive evidence-based treatment and rehabilitation.
PIER has educated the community-at-large and trained over 5000
health, education and youth-related professionals to identify young
people at ultra-high-risk of psychosis. Eligibility for treatment is established
by Structured Interview of Prodromal Syndromes (SIPS)/Scale
of Prodromal Symptoms (SOPS) criteria. The treatment is a prodromespecific
combination of psychoeducational multifamily group, supported
education/employment, assertive community treatment and psychotropic
medication. Over seven years, there were 966 referrals, of
which 259 (37.0%) were assessed and 149 were admitted to study. Of
those with currently available one-year outcomes (n=93), 9 (9.7%)
experienced psychosis meeting SOPS criteria. The mean Global Assessment
of Functioning (GAF) score was 38.1 at baseline and 54.5 at 12
months (pre-post t (92)=8.02). First hospitalizations for a psychotic disorder
were compared between experimental and control geographic
areas and between control (1994-2000) and experimental (2001-2006)
time periods. The net pre-post difference between control and experimental
area was 29.7/100,000. The control area experienced a 2.4-fold
increase in incident cases during the test period (2001-2006), in contrast
to a stable rate in the experimental area. These data suggest that community-wide
early detection and treatment is feasible and achieves low
conversion rates. The relative difference in incidence between treatment
and control catchment areas is consistent with a community-wide
treatment effect, in the absence of confounding factors.
US26.
MANAGING COMORBIDITY OF MENTAL
AND PHYSICAL ILLNESS
US26.1.
COMORBIDITY OF MENTAL AND PHYSICAL
DISORDERS: A CENTRAL CHALLENGE
FOR MEDICINE OF THE 21ST CENTURY
N. Sartorius
Association for the Improvement of Mental Health Programmes,
Geneva, Switzerland
The recognition and treatment of the simultaneous presence of mental
and physical disorders has become a central challenge for health
care systems worldwide. The comorbidity of mental and physical disorders
is frequent and its consequences for the persons who have
both types of disorders are numerous – ranging from a worsening of
the prognosis of both disorders (and a more severe impairment and
consequent disability) to the exposure to risks of inappropriate or
insufficient treatment. The management of the comorbidity of mental
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