ABSTRACTS - World Psychiatric Association

the actual effects of mass disasters. We propose basic principles to
guide the integration of mental health professionals with other social
agents active in the community, and underscore the importance of
empowering mediators in the process of community recovery after
disaster. Finally, we describe a teacher-mediated model of post-disaster
clinical intervention in schools, which focused on the psychological
reactivation of students and teachers.
RS11.3.
PROTECTIVE FACTORS IN LONG-TERM OUTCOME
FOLLOWING A DISASTER IN CHILDHOOD
A.C. McFarlane
University of Adelaide Node, Centre of Military and Veterans
Health, Adelaide, Australia
In a longitudinal study of 1,014 individuals who were exposed to a
major bushfire disaster in childhood, the role of protective factors in
adult mental health outcomes was explored. Within this cohort and
the comparison group, there were large numbers of individuals
exposed to traumatic events other than the disaster. By comparing
individuals who had high levels of trauma exposure who did and did
not develop post-traumatic stress disorder, a series of indices of
resilience were identified, including patterns of childhood behaviour
and attachment behaviours in the family environment.
RS11.4.
RISK AND PROTECTIVE FACTORS
IN DEVELOPMENT OF POST-TRAUMATIC STRESS
DISORDER
Y. Yazgan
Marmara University, Istanbul, Turkey; Yale Child Study Center,
New Haven, CT, USA
Environmental (e.g., degree of exposure, mother’s responses) and personal
(e.g., past trauma, previous functioning) factors may influence
the child’s long-term response to a trauma, either “man-made” or
“natural”. For example, more severe symptoms following exposure to
a missile attack were associated with physical displacement, living in
a family with inadequate cohesion, and having a mother with poor
psychological functioning. Family factors have received a well
deserved attention in data based and observational studies of Turkish
earthquakes. Parental somatization was identified as a predictor of
acute child distress, accounting for 11.2% of the total variance. A significant
relation was demonstrated between the diagnosis of posttraumatic
stress disorder (PTSD) and the loss of family members and
neighbors in another study of the Marmara earthquake. In the face of
a great number of deaths following the Marmara earthquake, the traditionally
well-established pattern of coming together and dealing
with loss, and increased social cohesion in response to the collective
loss, have been suggested as a “protective” factor, while empirical
support is not yet available. In a longitudinal study conducted during
the 4 year period following the Marmara earthquake, a composite
index of potential risk factors such as stressful/traumatic episodes
before and after the earthquake and degree of exposure to the earthquake,
as well as frequently associated factors such as age and gender,
were not related to symptom decrease. However, when daily functioning
in academic, behavioral and social domains was taken as the
outcome measure, higher levels of functioning before the earthquake,
participating in the school reactivation program and having fewer
post-traumatic symptoms at three years post-disaster were associated
with better daily functioning three and a half years after the earthquake.
Measures of daily functioning, beyond symptomatology,
should be further utilized for understanding the role of risk and protective
factors in development of or resilience against PTSD.
RS12.
DELAY IN TREATMENT OF FIRST EPISODE
OF PSYCHOSIS: PATHWAYS TO CARE
AND IMPACT OF INTERVENTIONS
RS12.1.
THE POTENTIAL SIGNIFICANCE OF TREATMENT
DELAY IN PSYCHOTIC DISORDERS
R. Norman
Departments of Psychiatry and Epidemiology and Biostatistics,
University of Western Ontario, London, Ontario, Canada
Recent interest in early intervention for psychotic disorders has been
partially predicated on the possible significance of treatment delay,
particularly duration of untreated psychosis, as an influence on clinical
and functional outcomes once treatment is initiated. This paper
provides an overview of research on treatment delay and outcomes
and a critical examination of the extent to which the current evidence
supports the hypothesis that a longer period of treatment delay compromises
the potential for recovery. At this point, there is substantial,
although not consistent, evidence that greater delay between the
onset of psychotic symptoms and obtaining treatment is associated
with poorer clinical outcomes. This relationship does not appear to
result entirely from confounding with other prognostic indicators.
The mechanism by which treatment delay influences outcomes is
uncertain. Given the potential importance of treatment delay, it is
essential that the field address challenges in reliably assessing components
of duration of untreated psychosis and pathways to care.
RS12.2.
THE PATHWAYS TO MENTAL HEALTH CARE
OF FIRST-EPISODE PSYCHOSIS PATIENTS:
A SYSTEMATIC REVIEW
K. Anderson, R. Fuhrer, A. Malla
Department of Epidemiology and Biostatistics, McGill University,
Montreal, Canada
The pathways to care of patients suffering from a first psychotic
episode are complex, and involve such diverse contacts as general
practitioners, psychiatrists, emergency services, educational counselors,
social services and the criminal justice system. We conducted
a systematic review of the literature on the nature and determinants of
the pathways to care of patients experiencing a first episode of psychosis.
Four databases (MEDLINE, Healthstar, EMBASE, PsycIN-
FO) were searched to identify articles published between 1985 and
2008. We also conducted a manual search of reference lists, relevant
journals, and the ISI Web of Knowledge. Studies were included in the
review if they used an observational design and assessed the pathways
to care taken by patients with a first episode of psychosis. The
included studies (n=23) explored the first contact in the pathway to
care and/or the final referral source that led to successful treatment.
In ten of the fifteen studies that provided data on the first contact in
the pathway, the point of contact for the majority of patients was a
physician. However, in seven of the fifteen studies that used the referral
source as a measure of care pathways, the majority of patients used
emergency services as the source of referral. Very few studies (n=8)
explored the sex, socioeconomic, ethnic or geographic determinants
of the pathway. Further research is needed to understand the
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