I?2 Psychotic disorders and antipsychotics S271 [ml Schizophrenia and seasonality of birth: clinical features and biological patterns A.C. Altamura, S. Bignotti’, C+.B. Tura’, B. Brambilla’, P Mannu, M. Maes2. V Chair of Psychiatry, University of Milan, Istituto Scienze Biomediche-Ospedale ‘L. Sacco”, Milan; ‘IRCCS “Centm S. Giooanni di Dio” Fatebenefmtelli, Brescia, Italy ‘CRC-MH, Antwerp, Belgium Concerning clinical symptoms, depressive episodes were significantly more present regardless of the diagnosis in the subjects who attempted suicide. There is a body fo evidence indicating as in schizophrenia infectious agents may play some role in the etiology of the disorder. The hypothesis that schizophrenia could be due to infectious agents was first formulated in the 19* century, and supported by consequences of epidemic influenza in this century. The vital hypothesis is supported, for example by geographic differences in the pathology distribution, specific season division of births (tipically inverted in the two emispheres) and the relationship with the exposure to virus epidemies before the birth. The immunitary hypothesis of the schizophrenia is suggested by the presence of a “pool” of alterations of the cellular- and humoral-mediated immunitary system, and by an important functional activation of the cytokine system, probably started an infective event. Reported motivations for the suicide attempts were the following: depression in 5 cases (22.7%), command hallucinations in 4 cases (18.2%), severe anxiety in 1 case (4.5%). When the suicide attempt occurred only 2 patients (10%) were having clozapine treatment. This confirm the possibility of clozapine to play a role in reducing suicidal ideation. The AA. discuss the importance of a careful investigation on suicide attempts in schizophrenia for prevention and therapeutic management. [p.2.0551 Longitudinal changes of plasma HVA and IHIAA levels in schizophrenic patients resistant to neuroleptics In a study on 54 schizophrenic patients, treated with different neu- roleptics, plasma levels of interleukin 6 (IL-6) and interleukin 6 receptor (sIL-6R) were higher than in normal people, and Clara cell 16 KD plasma levels (CC16) were significantly lower (Linet al, 1998). In the same patient sample, the specific role of infective and immunoinflammatory factors have been evaluated. Three groups of schizophrenic patients in relation to their birth-date (January-April 20 patients, May-August 23 patients, Septembre-December 11 patients) were considered and relative plasma levels of IL6, sIL-6R, CC16, and gp 130 were evaluated. The data analysis didn’t show significant differences in the three groups for sIL-6R, gp 130 and CC16. On the other hand, IL-6 plasma levels were higher in schizophrenic patients born in the first four months of the year than in the two other four-month periods. The high levels of IL6 schizophrenic patients born in the first four-month period might be due to an activation of the immunoinflammatory system, possibly secondary to infective events during winter and spring-time (such as flu and paraflu syndromes, herpetic infections and citomegalovirus pathologies). On the other hand, atypical neuroleptics appear to have complex “in vivo” immunomodulatory effects pointing to interactions with activated T cells and proinflammatory as well as immunosuppressive activities. L. Bocchio Chiavetto’, S. Bignotti’, G.B. Tura’, M. Maes2, R. Pioli’, C.A. Altamura3, G. Racagm . ‘4 ‘IRCCS Centm S. Giovanni di Dio, Fatebenefmtelli, Brescia; 3Department of Psychiatry, University of Mi- lan, Ospedale Sacco, Milano; 41nstitute of Pharmacological Sciences, Center of Neuropharmacology, Universiiy of Milan, Italy 2Department of Psychiatry, CRC-MH, University of Antwerp, Belgium The measure of the main neurotrasmitter metabolites in biological fluids has been proven to be an interesting strategy to understand functional activity of biogenic amines in psychiatric disorders. In the last years, methods for the estimation of the metabolite levels in plasma have been developed with adequate accuracy and sensitivity. Data collected from such measurements indicate that plasma concentration may reflect modifications in central monoamine turnover. A number of studies have demonstrated the efficacy of pHVA levels for the study of schizophrenia, including prediction of the outcome of neuroleptic treatment and the observation of longitudinal changes in symptoms in chronic states. References [I] Lin A, Kenis G, Bignotti S, Tura GB, De Jong R, Bosmans E, Pioli R, Altamura AC, Scharpk S, Maes M: The inflammatory response system in treatment- resistant schizophrenia: increased serum interleukind. Schizophrenia Res. 32: 9-15, 1998. Atypical antipsychotics affect different neurotransmitters systems in CNS of potential relevance to the pathophysiology of schizophrenia and have shown to be active in the treatment of drug resistant patients. The aims of our study is the identification of possible correlations between plasma levels of HVA, DOPAC, 5-HIAA and 5-HT and clinical outcome in chronic drug resistant schizophrenics treated with atypical antipsychotics (Clozapine and Risperidone). We enrolled 17 inpatients who met the Kane’s criteria for drug resis- tance. We recruited even 14 patients with a diagnosis of schizophrenia good responder to neuroleptics and 7 healthy volunteers as control groups. (p.2.0541 Suicidal behaviour in schizophrenia: a retrospective study AC. Altamura’, S. Bignotti2 l , R. PioIi2, G. Rossi2, G.B. Tura2, P Mannu, A. Soddu, L. la Croce. ‘Istituto Scienze Biomediche, Uniuersita di Milano, Ospedale “L. Sacco “; 21RCCS “Centro S. Giovanni di Dio” Fatebenefmtelli, Brescia, Italy The samples for analysis of HVA, DOPAC, 5-HT and SHIAA were collected before initiation of the treatments (TO) (after a minimum of 15 days of wash-out), after 2 months (Tl) and after 4 months (T2) of therapy with atypical antipsychotic drugs; Brief Psychiatric Rating Scale scores (BPRS) 24-items version was used for clinical observations. For the responders to typical neuroleptics in the control group, BPRS was administered only once during the study (at the time of samples collection). Suicide is the leading cause of death among patients with schizophrenia. The lifetime incidence of completed suicide among schizophrenic pa- tients is 10% to 13% and an estimated 18% to 55% of patients with schizophrenia make suicide attempts. For the determination of biogenic amines in plasma High Performance Liquid Chromatography with electrochemical detection has been used. After 4 months of treatment with atypical neuroleptics, 11 patients responded to pharmacological therapy with a decrease in the BPRS score greater than 13% while for 6 patients the symptomatology didn’t change significantly. This retrospective study included a population of chronic schizo- The preliminary results indicated a correlation between the decrease phrenic and schizo-affective patients diagnosed according to DSM-III-R. of 5-HIAA and the response to treatment. In responder patients HVA Clinical records dated back from 1992 to 1997 and all the patients with plasma levels showed a substantial stabilisation toward higher values the above mentioned diagnoses were investigated. The sample included similar to healthy controls in responder patients. 103 subjects (68 men and 35 women): 92 (89.3%) and 11 (10.7%) were DOPAC had a modulation similar to HVA and for serotonin we didn’t affected respectively by schizophrenia or schizoaffective disorder. find correlations with therapeutic response. In 22 cases (2 1.4%) has been recorded at least one suicide attempt in The reduction of SHIAA in plasma could indicate a slowing down of the period of observation. There were no differences for age, onset and the serotonin degradation turnover acted by atypical antipsychotics that duration of illness and family history between patients with and without suicide attempts.