European Psychiatry - Volume 33 - March 2016

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S52 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S18–S55
Aim To explore if emotional instability is a useful construct in
adults with autism spectrum disorder (ASD) and intellectual dis-
ability (ID).
Method/approach The current diagnostic criteria for ASD and ID
will be outlined and related to any relevant literature on emotional
instability in those with ASD or ID. Recent cross-sectional studies in
a clinic and a prison of adultswith ASD and/or IDusing standardised
screening and diagnostic tools will be described.
Findings Current literature indicates there is little research on
emotional instability in adultswithASD and ID. Studies across clinic
and forensic settings indicate high levels of comorbidity such as
attention-deficit hyperactive disorder (ADHD) and mood disorders
in adults with ASD and ID.
Conclusion At present emotional instability as a construct may
not have validity for adults with ASD and ID but may do in the
context of other comorbid conditions such as ADHD.
Disclosure of interest The author has not supplied his declaration
of competing interest.
Thought and language disorders: Phenomenology
and neural pathophysiology
S107
How increasing the effect of rTMS in
the treatment of auditory
hallucinations in schizophrenia?
S. Dollfus ∗, C. Nathou , E. Olivier
1 CHU de Caen, Department of psychiatry, Caen, France
2 CHU Caen, Department of psychiatry, Caen, France
3 CHU de Caen, Department of neurophysiology, Caen, France
∗ Corresponding author.
Repetitive transcranial magnetic stimulation (rTMS) shows a high
inter-subjects variability in the efficacy of treatment of auditory
verbal hallucinations (AVH) in schizophrenia. The aim of this pre-
sentation is to demonstrate the involvement of several factors in the
efficacy of rTMS such as the frequency of stimulation, the placebo
effect and the brain morphology underlying the target of stimula-
tion.
Methods A meta-analysis was conducted to determine the effect
sizes of placebo effect in 21 controlled studies on rTMS in the treat-
ment of AVH in schizophrenia. MRI was also acquired in patients
treated by rTMS to evaluate the scalp to cortex distances (SDCs)
and the gray matter densities (GMDs) at the target of stimula-
tion. Finally, we evaluated the efficacy of high (20Hz) frequency
stimulation in a controlled placebo study.
Results Weak or no placebo effect in the control groups led to
reveal a superiority of active rTMS over sham rTMS in the treatment
of AVH. Clinical efficacy of rTMS was also correlated with the SCD
or the GMD at the region of the target stimulation. Finally, we also
demonstrated that more responders were observed after 2 weeks
in the active group treated by 20Hz than in the placebo group.
Conclusion We clearly demonstrated that several factors such as
high frequency, the placebo effect, anatomical cortical variations
can impact on the efficacy of rTMS. These results fundamentally
inform the design and the method of further controlled studies,
particularly with respect to studies of rTMS in the treatment of
AVH.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
S108
Phenomenology and neural correlates
of formal thought disorder
T. Kircher
Philipps-University, Psychiatry and Psychotherapy, Marburg,
Germany
Speech and language disorders, such as concretism and formal
thought disorder (FTD) are core symptoms of Schizophrenia, but
do occur to a similar extent in other diagnoses such as bipolar dis-
order and major depression. We will review clinical rating scales
of FTD and introduce a new, validated scale, the TALD. Further,
structural and functional brain imaging data will be reviewed and
own novel findings presented, relating speech and language dys-
functions to neural networks, within schizophrenia and across the
“functional psychoses”. The impact of genetic variance and NNDA
receptor blockage on brain functionwill be addressedwith a partic-
ular focus on speech and language (dys-) demonstrate,
from the genetic to the brain structural and functional level, that
particular aspects of the neural language system are disrupted in
patients with FTD across traditional diagnoses.
Disclosure of interest The author has not supplied his declaration
of competing interest.
Further reading
Kircher T, Krug A, Stratmann M, Ghazi S, Schales C, Frauenheim
M, et al. A rating scale for the assessment of objective and subjec-
tive formal Thought and Language Disorder (TALD). Schizophr Res
2014;160(1–3):216–21.
S109
Language, psychosis and the brain:
Novel insights from a dimensional
approach
W. Strik
University of Bern, Psychiatry, Bern, Switzerland
The brain mechanisms related to formal thought disorders (FTD)
and auditory verbal hallucinations (AVH) appear to be closely
linked to structural and functional abnormalities of the language
system.
In particular, functional imaging data indicate that several com-
ponents of the language system are involved in the generation of
both, FTD and AVH. Co-activation of the primary auditory cortex
(Heschl’s gyrus) during verbal thoughts appears to be crucial for
the subjective perception of an externally generated voice, and
DTI studies indicated that the intrahemispheric fronto-temporal
connectivity of the language system is specifically increased in
hallucinating patients. On the other hand, FTD are significantly
correlated to a gray matter reduction in Wernicke’s region along
with a hyperactivation of frontal and temporal components of the
language system.
AVH are intimately related to a dysfunction of the left hemi-
spheric language system, including the primary auditory cortex
and the fronto-temporal fibre tracts connecting Broca’s and Wer-
nicke’s regions. Co-activation of the primary auditory cortex during
verbal thoughts appears to be the basis of the pathological net-
work dynamics during AVH, while FTD are linked to a pathological
hyperactivity of central components of the language system. Both
phenomena are related to functional imbalances of the language
system, and phenomenological differences may depend on the dif-
ferent contributions of the system components.
Disclosure of interest The author has not supplied his declaration
of competing interest.