Abstracts / Schizophrenia Research 102/1–3, Supplement 2 (2008) 1–279 259 604 – PHARMACOGENETICS OF NEGATIVE SYMPTOM RESPONSE TO ANTIPSYCHOTIC DRUGS - THE ROLE OF 5-HT SYSTEMS Gavin Reynolds , James Armstrong, Suzanne Barrett, Ciaran Mulholland, Richard Anderson, Rosalind McCaul, Teresa Rushe, Stephen Cooper Queen’s University Belfast, Belfast, Ireland g.reynolds@qub.ac.uk Introduction: Negative symptom response to antipsychotic drugs is generally poor and subject to substantial individual variation. The few studies that have investigated pharmacogenetic associations with negative symptom response to treatment have implicated 5HT systems (1, 2). Methods: We have determined the association of two functional polymorphisms in genes associated with synaptic 5HT activity, those for the 5-HT transporter (5HTT) and the 5HT1A receptor, with negative symptom response to treatment. The sample comprised 95 first-episode psychosis patients receiving antipsychotic treatment ac- cording to standard practice. Symptom severity was determined by PANSS at baseline and after one year. Results: A significant association of the 5HTT short/long (s/l) pro- moter polymorphism with negative symptom response to treatment was found, in which the l/l genotype demonstrated greater improve- ment in negative symptoms than those patients with an sallele. There was also an effect of genotype on negative symptom score at base- line; including baseline score as a covariate, the effect on symptom response remained significant. No association with changes in positive or general psychopathology scores or with baseline scores were seen. We found no association of the 5HT1A -1019C/G polymorphism with any change or baseline negative symptoms or other subscores. Conclusions: While these results fail to confirm the previously re- ported association of the 5HT1A polymorphism on negative symptom response in drug-naive patients (1), they indicate that another poly- morphism influencing 5HT activity is implicated, underlining the evidence that 5HT systems contribute to determining severity of negative symptoms and their response to antipsychotic drug treatment. References [1] Reynolds GP, Arranz B, Templeman LA, Fertuzinhos S, San L (2006) Effect of a 5-HT1A receptor gene polymorphism on nega- tive and depressive symptom response to antipsychotic treatment of drug-naïve psychotic patients. Am J Psychiat 163, 1826-1829. [2] Reynolds GP (2007) The impact of pharmacogenetics on the de- velopment and use of antipsychotic drugs. Drug Discovery Today 12, 953-959. 605 – COMPILATION OF AN INTERDISCIPLINARY LONGITUDINAL TREATMENT HISTORY FOR COMPLEX PATIENTS WITH PSYCHOSIS Christian Schenk , J. Dumontet, W.G. Honer, S. Flynn University of British Columbia, Coquitlam, BC, Canada christianschenk@hotmail.com Introduction: Complex patients with schizophrenia or similar psy- choses often present for clinical care or for research studies with an extensive history of medical and psychiatric treatments. Rational treatment planning and patient counseling hinge on ascertaining this information as completely as possible in a user-friendly manner. Legis- lation constraining release of information and the protection of privacy varies between jurisdictions, and can threaten the completeness of the task. Past treatments may be inclusion or more commonly exclusion criteria for research studies, so a diligent history is a requirement as part of the management of information flow around a human subject. Methods: The methodology our group pursues is shown in a flowchart, covering the patient’s admission process, the use of the two weeks prior to a formal diagnostic and treatment planning interdisciplinary meeting, then the integration of the information in following treat- ments used and the response to it, culminating in the discharge summary at the end of the inpatient care episode. Acknowledgements: The legal and human resources framework is discussed, as the process works well with the contributions of Psy- chiatry, Pharmacy, Nursing, Social Work, and the efforts of Health Information Services (Health Records) staff. References [1] Compton, Michael T. et al., Defining, Operationalizing and Mea- suring the Duration of Untreated Psychosis: advances, limitations and future directions: Early Intervention in Psychiatry, Volume 1, Number 3, August 2007, pp. 236-250(15) [2] Marengo, J T, Harrow, M, Longitudinal Courses of Thought Disor- der in Schizophrenia and Schizoaffective Disorder, Schizophrenia Bulletin, 1997; 23(2): 273-85 606 – RANDOMIZED CONTROLLED TRIAL OF YOGA AS AN ADD-ON TREATMENT IN SCHIZOPHRENIA – ETHICAL AND METHODOLOGICAL CONSIDERATIONS S. Varambally 1 , A. Jagannathan 5 , J. Thirthalli 1 , S. Baspure 1 , B.R. Gunthati 1 , H. Nagendra 2 , G. Venkatasubramanian 1 , K.T. Shetty 3 , D.K. Subbakrishna 4 , D. Muralidhar 5 , B.N. Gangadhar 1 1 Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore; 2 Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bangalore; 3 Dept. of Neurochemistry, NIMHANS, Bangalore; 4 Dept. of Biostatistics, NIMHANS, Bangalore; 5 Dept. of Psychiatric Social Work, NIMHANS, Bangalore, India drvarambally@gmail.com Introduction: Demonstration of the efficacy of novel treatment meth- ods in psychiatry necessitates the use of double-blind, placebo-con- trolled trials. This paper discusses the ethical and feasibility issues in conducting such trials in yoga therapy for patients with schizophrenia. Methods: A study currently underway at NIMHANS, Bangalore, India, has adopted a single-blind randomized controlled study de- sign. Consenting patients with schizophrenia attending NIMHANS are recruited and randomized into one of three groups: yoga, physical exercises and waitlist. Outcome is rated by a trained psychiatric social worker that is blind to the group status at the start of study, and at 1, 2 and 4 months. After four months, the subjects in the exercise/waitlisted group are offered option of yoga therapy. Results: Development and use of a placebo-yoga treatment is not only impractical in countries like India where general public is aware of yoga techniques, but also poses serious ethical challenges. Choice of a physical exercise group would control for several treatment-related factors and a waitlist group would control for illness related factors, including regression to mean. Moreover, it is not possible to have a double-blind design, as patients would be aware of the group they are randomized into. Even in the single-blind alternative, rater blinding can be broken as some subjects might inadvertently reveal their group status to the rater. Conclusions: We have devised ways of overcoming some of the methodological and ethical problems of conducting such trials: (a) video-recorded interviews rated by independent raters blind to the group status; (b) outcome assessment across several domains using different raters: subjects as self-raters, family members as proxy-raters, in addition to trained raters. References [1] Duraiswamy G, Thirthalli J, Nagendra HR, Gangadhar BN. Yoga therapy as an add-on treatment in the management of patients with schizophrenia – a randomized controlled trial. Acta Psychiatr Scand. 2007 Sep;116(3):226-32.