P.6.071 Structural brain abnormalities in obsessive-compulsive disorder (OCD)

S456

P6.

Other

Conclusions: Data presented here provide evidence of the efficacy of atomoxetiue in maiiitaiiiiiig treatmeiit respoiises for up to 9 mouths followiug au initial 3-mouth treatment period. This fiudiug supports the usual clinical practice of maiutaiuiug treatment for extended periods in patients whose symptoms respond to au initial treatment trial. This study also provides evidence that treatmeutassociated improvements in psychosocial fuuctiouiug observed in acute trials, as assessed by the CHQ, are maiutaiued during lougerterm treatmeiit. References

[l]

mP6

Gillberg, C., Melander, H., van Knorring, A.L., Jan&, L.O., Thernlurid, G., Hagglof, B., Eidevall-Wallin, L., Gustafsson, P, and Kopp, S. (1997) Long-term stimulant treatment of children with attentiondeficit hyperactivity disorder symptoms. A randomized, double-blind, placebo-controlled trial. Arch. Gen. Psychiatry 54(g), 8577864.

071

Structural compulsive

brain abnormalities disorder (OCD)

in obsessive-

T. Sobauski’ , G. Wagne?, U. Gruhu2, A. Herwig2, G. Peikert2, H. Saue?. ’ Thueringen-Klinik Saalfld, and Psychotherapy, Saalfeld, Germany; 2 University Department of Psychiatry, Jena, Germany; 3Klinik Kreischa, Department of Psychosomatic Medicine, Germany

R. Tauber3, Psychiatry of Jena, Bavaria Kreischa,

Introduction: Several CT aud MRI studies have revealed structural braiu abnormalities in obsessive-compulsive disorder (OCD) although particular fiudiugs are uot consistent. The followiug results have beeu reported: decrease of the caudate nucleus aud striatal volume, iucrease of the ventricle-to-brain ratio @‘BR), iucrease of the total cortex volume, aud reduction of the total white matter. Methods: Fourteeu OCD patients aud 14 control subjects matched for age aud gender participated in the study. MRI scam were performed aud analyzed by a semiautomated segmeutatiou approach to determine the volumes of the followiug structures: whole braiu volume, froutal lobe, temporal lobe, amygdalahippocampus complex (AHC), caudate nucleus, putameu, aud braiu ventricles. All measurements were made by two traiued aud reliable raters who were unaware of ideutifyiug subject iufonnatioii. Results: Patients with OCD had significantly larger AHC aud whole braiu volumes thau controls, but did uot differ in froutal or temporal lobe, ventricle or basal ganglia measures. Conclusions: Our fiudiugs provide uew evidence for abuonnalities of the amygdala-hippocampus complex in OCD. The fiudiug of au iucreased whole braiu volume is in liue with fonner results of au iucreased grey matter volume, possibly iudicatiug au alteratiou of the programmed ueuroual death which uonnally occurs during braiu developmeut in patients with OCD.

topics

m P6

072

Placebo-controlled atomoxetine

in the

study school

of once-daily setting

M. Weiss’, R. Tamrock2, C. Kratochvi13, D. Dumr4, .I. VelezBorra8, C. Thomason’, L. Lambrecht’, R. Tamura’, D. Kelsey’, A.J. Alleu6. ‘University of British Columbia, Children’ s & Women’s Health Center of B.C., Vancouver, Canada;2The Hospital for Sick Children, Department of Psychiatry Research, Toronto, Canada; 3University of Nebraska Medical Centel; Psychopharmacology and Psychiatric Research Centel; Omaha, US.A.; 41ndiana University, Departments of Psychiatry and Neurology, Indianapolis, US.A.; 5 University District Hospital, RCMI - Clinical Research Centel; San Juan, Puerto Rico; 6Eli Lilly and Company, Lilly Research Laboratories, Indianapolis, US.A. Objective: Atomoxetiue is a non-stimulant approved in the United States for the treatment of ADHD. Several studies have demou&rated the efficacy of atomoxetiue compared to placebo in reduciug ADHD symptoms based ou pareut reports. In moue of these trials were teacher reports of ADHD symptoms the primary efficacy measure. The study presented here is the sixth double-blind, placebo-controlled trial of atomoxetiue for ADHD in children, aud the first designed to assess the effectiveness of atomoxetiue primarily in the school set&g based ou teacher reports. Methods: Children aged 8 to 12 years with DSM-IV defined ADHD coufinned by structured iuterview as well as through iufonnatiou gathered from the patieut’ s primary classroom teacher were eligible to participate. Symptom severity had to be at least 1 .O standard deviatiou above age aud gender uonns ou the AtteutiouDeficimyperactivity Disorder Rating Scale-IV-School Version (ADHD RS) aud at least 1.5 standard deviatious above age aud gender uonns ou the Comlers’ Pareut Rating Scale (CPRS-R:S). Eligible patients were randomized (11~153) to receive either oucedaily atomoxetiue (up to 1.8 “g/kg/day, based ou weight) or placebo in a 2:l ratio for a 7-week period. ADHD symptoms were primarily assessed by chauge in the ADHD RS, rated by cliuiciaus based upon a telephoue iuterview with the child’ s primary teacher. Secondary measures included the Academic Perfonnauce Rating Scale (APRS), the Browu ADD Scales: Teacher version, the Social Skills Rating System-Teacher (SSRS-T), the Comrers’ Global Index-Teacher (each collected by fax from the teacher), the Behavioral Grade Measure, Clinical Global Impressions scales (CGI) for severity aud improvement of ADHD symptoms, aud the CPRS-R:S. Results: Participants in the atomoxetiue group had greater reduction in ADHD symptoms compared with the placebo group as assessed by the total score aud each subscale (iuatteutiou aud hyperactivityiimpulsivity) of the ADHD RS. A statistically significaut difference betweeu treatments was seeu at each visit postraudomizatiou ou the ADHD RS total score. Data do uot suggest a differential efficacy treatment effect by age, gender, ADHD subtype, presence of oppositional defiant disorder or learuiug disorders, severity at baseline, or prior stimulant use, as treatmeutby-subgroup iuteractious were uot statistically significant. Statistically siguificaut chauge favoring atomoxetiue was also observed for the iuatteutive (p=.O16) aud hyperactive/impulsive (pi.001) subscales, Clinical Global Impressions-Improvement (p