Mood Disorders in the Elderly

Poster Session I – Advocacy/Patient Organisations P-001 A way to recruiting and study participants to a clinical trial (NACOS-study) PK Ellegaarda, RW Lichtb, HE Poulsenc, CT Nielsend a Mental Health Service, Research Unit, Esbjerg, Denmark, b Aalborg University Hospital, Unit for Psychiatric Research Psychiatry, Aalborg, Denmark, cDepartment of Clinical Pharmacology Q, Rigshospitalet - University Hospital, Copenhagen, Denmark, dMental Health Service, Head of Department, VejleKolding, Denmark Background and Aims: NACOS-study –a 24-week clinical trial includes people suffering from bipolar disorder, and investigates whether adjunctive treatment of N-acetylcysteine reduces symptoms of depression and oxidativ stress. To include 80 participants over a 1½-year period, there were a strong need for creative methods to reaching out to potential participants. Methods: The study participants are out- and inpatients, and are informed by the health care professionals and the trial staff. Besides the oral information and the letter, a flyer and written information is provided. Since the patients are in a depressive mood-episode prior to recruitment and might be cognitive impaired, the ability to read and recall the information is limited. Consequently, a short video for the patients were made with needed information. It is accessible via URL-link and QR-code on the flyers. When the patients consent to attend in the trial, it is their decision whether the study activities should be conducted in outpatient settings or at home. Results: In accordance to our timeframe, so far it has been possible to recruit the required number of participants. If this trend continues, the inclusion period will be completed ahead of schedule. The possibility of organizing the study activities individually possibly contributes to faster recruitment of patients. Patients suffering from anxiety disorders, or patients who lives far away from the study centers, also have the opportunity to take part in the trial. Conclusions: Creative methods and tailored recruiting material are necessary for recruiting sufficient participants. Video l might be one way to reach out to potential participants.

P-002 Comparison of experienced burden and distress among families of patients with schizophrenia and bipolar disorder SM Samimi Ardestania, M Radmaneshb, Y Mottaghipourc, N Abbasvandid a Imam Hossein HP - Shahid Beheshti University of Medical Sciences, Tehran, Iran, bUrmia University Of Medical Science, Psychiatry, Urmia, Iran, cTaleghani HP - Shahid Beheshti University of Medical Sciences, Psychiatry, Tehran, Iran, dPrivate Practice General Practitioner, Private Office, Tehean, Iran Background and Aims: The burden of severe psychiatric disorders like bipolar disorder and schizophrenia on families of these patients are well known. With closing down and limiting the residential homes and long stay psychiatric wards, this burden is becoming

70

more and more devastating for families and caregivers of these long enduring disorders. There is limited data available about the comparison of the burden of bipolar disorder and schizophrenia, due to the rapidly evolving face of the bipolar disorder Methods: This study was conducted at the psychiatric outpatient clinic of Imam Hossein Hospital,Tehran, Iran. The sample size was 70 caregivers of bipolar (n = 35) and schizophrenia(n = 35) patients. The participants then were asked to fill out Family Experience Inventory Schedule (FEIS) and the 21 item form of Depression, Anxiety and Stress Scale (DASS21) Results: The mean score and standard deviation of FEIS in caregivers of bipolar and schizophrenia patients were 126.9 19.6 and 113.5 20.2 (p = 0.004).The mean scoreand standard deviation of DASS21in caregivers of bipolar and schizophrenia patientswere 33.7 10 and 21.3 10.6 respectively (p < 0.001). The rate of moderate or higher depression, anxiety and stress in the caregivers of bipolar patients were 91.4%, 71.5% and 80%, and in the caregivers of schizophrenia patients were 82.9%, 34.3% and 25.8% respectively Conclusions: The experienced burden and the severity of depression, anxiety and stress were higherin the caregivers of bipolar patients in the clinical settings. Further investigations are required to accurately discover and define the effective factors causing high burden on caregivers of bipolar disorder

P-003 Moodnetwork: a platform for patient-centered, comparative effectiveness research L Sylvia, C Hearing, A Gold, T Deckersbach, A Nierenberg Massachusetts General Hospital, Psychiatry, Boston, USA Background and Aims: MoodNetwork is a patient-centered, online infrastructure to conduct comparative effectiveness research for mood disorders on an unprecedented scale. MoodNetwork also serves as a resource where patients can track their symptoms, engage in forums, ask study clinicians questions about mood disorders, and prioritize areas of research. Methods: Participants complete a waiver of consent, a self-report demographic survey, as well as an optional survey on preferred research topics. Participants also have the option of completing the Quick Inventory of Depressive Symptomatology, Depression and Bipolar Support Alliance Wellness Tracker, Who-Five Well-Being Index, Experience of Care and Health Outcomes Survey, Altman Self-Rated Mania Scale, and Mini International Neuropsychiatric Interview. Results: As of February 2016, MoodNetwork has enrolled 2311 participants with mood disorders. 96% report experiencing depression and 80% endorse experiencing mania or hypomania. The mean age of participants is 43.84. 77% of participants are female, 83% are Caucasian, 37% are married, 49% are employed, and 26% are disabled. Participants who have voted (N = 1514) identified reducing stigma (12%), alleviating symptoms (11%), and reducing barriers to care (10%) as the top three research priorities for individuals with mood disorders. Data on the optional assessments will also be presented

© 2016 The Authors Bipolar Disorders © 2016 John Wiley & Sons A/S, Bipolar Disorders, 18 (Suppl. S1) 70–194

13-16 July, Amsterdam, the Netherlands Conclusions: MoodNetwork is a unique collaboration between researchers, clinicians, patients, their family members, and other stakeholders to improve the care of mood disorders by conducting patient-centered research studies. This Network has the

opportunity to conduct some of the largest trials to date to improve the care of the condition, raise awareness and disseminate findings through our members and advocacy partners.

Poster Session IIBrain Structure and Brain Function: Part I P-004 Investigating alteration of brain regional homogeneity in bipolar disorder type I using resting state fMRI R Achaliaa, N Raob, G Venkatasubramanianb a Department of Psychiatry, Achalia Neuropsychiatry Hospital, Aurangabad, India, bDepartment of Psychiatry, NIMHANS, Bangalore, India Background and Aims: Background: Although decades of efforts have been spent studying the pathogenesis of bipolar disorder type I (BD), there are still no objective biological markers that could be reliably used to identify individuals with BD. Hence, we used resting state functional magnetic resonance (RS-fMRI) imaging to detect spontaneous brain activity in patients with BD. Aim: We used regional homogeneity (ReHo) approach using RSfMRI to investigate patients with bipolar disorder type I (BD) compared to age and gender matched healthy control. Methods: 20 patients with BD and 20 age , gender and education matched healthy controls participated in the study. The fMRI data was obtained using 1.5 T scanner. RS-fMRI abnormalities were analysed using ReHo method. Results: Compared to healthy adults significantly increased ReHo in the BD group was found in the right precuneus , right insula , right suprmarginal gyrus , left superior frontal gyrus , right inferior frontal gyrus , right precentral gyrus , and right paracentral lobule . No region had significantly lower ReHo values in BD patients compared to controls. Conclusions: These results suggested that abnormal local synchronization of spontaneous brain activity is present in fronto-parietoinsular region which may be related to the pathophysiology of BD.

P-005 Soft neurological signs in euthymic bipolar patients: a comparative study with healthy controls S Aloui, A Larnaout, A Aissa, S Ben Mustpha, H Ben Ammar, E Khelifa, Z El Hechmi Department F, Razi Hospital, Mannouba, Tunisia Background and Aims: Soft neurological signs (SNS) reflect a dysfunction of the central nervous system. They have been well studied in schizophrenia and in bipolar disorder during the dysregulation mood periods. However, few studies have been interested in SNS during the euthymic phase of the disease. The aims of this study were to determinate the scores of SNS in euthymic bipolar patients and to explore the possible correlations with their socio-demographic and clinical features. Methods: Fifty-six patients, who fulfilled the DSM 5 criteria for bipolar disorder I or II, were compared to 30 healthy controls. Healthy subjects were matched individually for age, gender, education level and dominant cerebral hemisphere. The euthymic phase was verified using the Hamilton Rating Scale for depression

(HAMD score ≤8) and the Young Mania Rating Scale (YMRS ≤6). The assessment of functioning level was made using the Global Assessment of Functioning (GAF) scale. The SNS were assessed using the Neurological Examination Scale (NES) which included 26 signs with three rating levels of 0 to 2 and three main subscales. Results: The total score of the NES was significantly higher in the bipolar group compared to the control group (p < 0.05). Bipolar euthymic patients had also, higher sub-scores in sensory integration and motor sequencing. No correlation was found between the total score of the NSE and, clinical and socio-demographic features of patients except, a negative correlation with the GAF score. Conclusions: This study confirms that bipolar disorder is accompanied with neurological deficit and suggests that SNS constitute markers of vulnerability in this disease.

P-006 White matter abnormalities in the corpus callosum, cingulum and fornix revealed in euthymic bipolar disorder subjects: an exploratory analysis with dti deterministic tractography G Sousa Alvesa, C Knoechelb, C Schmiedb, A Reifb, D Lindenc, A Carvalhoa, V Oertel-Knoechelb a Universidade Federal do Cear a, Medicina Clınica, Fortaleza, Brazil, bGoethe University Frankfurt am Main, Laboratory for Neuroimaging- Dept. of Psychiatry- Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany, cSchool of Medicine Cardiff University, MRC Centre for Neuropsychiatric Genetics & Genomics- Institute of Psychological Medicine and Clinical Neurosciences- School of Medicine, London, United Kingdom Background and Aims: Background: In bipolar disorder (BD), white matter microstructural changes have been detected previously; however, findings are heterogeneous. In this study, we employed deterministic tractography to reconstruct white matter bundles in BD patients. Methods: Diffusion tensor imaging (DTI) data was carried out with n = 32 euthymic BD type I patients and 30 matched healthy controls. Deterministic tractography using multiple indices of diffusion (fractional anisotropy (FA), tract volume (Vol), tract length (Le) and number of tracts (NofT)) were obtained from the fornix, the cingulum, the anterior thalamic radiation, and the corpus callosum bilaterally. Results: We showed lower FA and Le in the left and right fornices in patients with BD compared to controls. Lower corpus callosum volumes and higher Le as well as higher NofT of the left cingulum in patients with BD compared to controls were observed. Crystallized intelligence was positively correlated with Vol of the corpus callosum. Both age and age at disease onset were associated with right fornix Le in the BD patient group. Conclusions: Limitations: Although the influence of psychopharmacological drugs as biasing variables on morphological alterations


71

18th Annual ISBD & 8th Biennial ISAD has been discussed for schizophrenia and BD, we did not observe a clear influence of drug exposure on our findings. Conclusions: Our results indicate abnormal WM microstructural integrity of fornix, corpus callosum and left cingulum crossing fibers in euthymic BD patients. These findings support current pathophysiological models of BD, indicating abnormal fronto-limbic connections.

P-007 Cortical thickness abnormalities in bipolar disorder: impact of psychotic symptoms V Bandalli Rajua, R Achaliab, A Jacobc, N P Raod a Bangalore Medical College and Research Institute, M. B. B. S. Student, Bangalore, India, bDepartment of Psychiatry, Achalia Neuropsychiatry Hospital- Aurangabad, Aurangabad, India, c Department of Psychiatry, National Institute of Mental Health and Neurosciences NIMHANS, Bangalore, India, dDepartment of Psychiatry, National institute of mental health and neurosciences NIMHANS-Bangalore-India, Bangalore, India Background and Aims: Despite considerable efforts in the last few decades,pathogenesis of Bipolar disorder remains elusive.Previous studies have examined cortical thickness abnormalities using structural MRI with inconsistent results. However,very few studies have examined differences between bipolar disorder patients with psychosis and those without psychosis. Hence in this study we examined the cortical thickness abnormalities between patients with bipolar disorder and Healthy controls.We also examined the differences between those with psychotic-symptoms and those without psychotic-symptoms. Methods: We acquired brain magnetic resonance images(MRI)of 30 patients with bipolar disorder(Mean-age = 25 6.64) and 30 age&sex matched Healthy controls(Mean-age = 25 6.88)using 1.5T scanner. We calculated cortical thickness of these subjects using surface-based processing stream of Freesurfer.The impact of psychotic symptoms on cortical thickness was examined within a subgroup of patients. We conducted statistical analysis with qdec module of FreeSurfer. We corrected for multiple comparison using Monte-Carlo cluster-wise simulation approach(threshold = 1.3 absolute,corresponding to p = 0.05) Results: Bipolar disorder patients,compared to healthy controls, had significantly reduced cortical thickness in left fusiform gyrus (p = 0.0001) and right lateral-occipital gyrus(p = 0.0094).Those with psychotic symptoms had lower cortical thickness in bilateral lateral-occipital gyrus (p = 0.001),lateral-occipital(p = 0.0001)and left frontal-pole(p = 0.0055). However,we did not observe significant differences between patients with bipolar disorder without psychotic symptoms and healthy controls. Similarly,we did not observe significant differences between those with psychotic symptoms and those without psychotic symptoms. Conclusions: Results of this study suggests cortical thickness abnormalities in bipolar disorder.Cortical thinning in brain regions involved in emotional processing and metacognition suggests their potential role in pathogenesis. These differences were predominantly due to those with psychotic symptoms.Future studies need to examine whether bipolar disorder with psychotic symptoms is be a sub-type of bipolar disorder.

P-008 Multimodality neuroimaging investigation of frontotemporal neural system trajectories in adolescents and young adults with bipolar disorder who attempt suicide H Blumberg, J Johnston, L Spencer, K Purves, E Lippard, F Wang Yale School of Medicine, Psychiatry, New Haven CT, USA

72

Background and Aims: Bipolar Disorder (BD) is associated with a high risk of suicide. Suicide behavior often commences during adolescence and young adulthood. Converging evidence from our and other research groups supports alterations in trajectories of frontotemporal neural system, that subserve emotion regulation, during adolescence/young adulthood in BD. The aim of this research is to use multimodality magnetic resonance imaging (MRI) to investigate alterations in frontotemporal neural system development associated with suicide behavior in adolescents/young adults with BD. Methods: Adolescents/young adults with BD, with and without history of suicide attempts, and a healthy comparison (HC) group, participated in clinical and behavioral assessments, including multidimensional assessments of suicide ideation and behavior, and multimodality MRI scanning (structural MRI, diffusion tensor imaging, functional MRI). A subset of participants with BD were followed longitudinally, and reassessed on average approximately 3 years later, to explore predictors of future suicide attempts and associated brain trajectories. Results: Cross-sectional findings in adolescents/young adults support frontotemporal system gray and white matter structural and functional differences, in those with BD with a history of suicide attempts, compared to those without history of attempts and HCs. Preliminary longitudinal data analyses suggest the magnitude of differences in components of this system at baseline, and of differences in their developmental trajectories, are associated with future attempts. Conclusions: The findings suggest differences in frontotemporal developmental trajectories associated with risk of suicide attempts in adolescents and young adults with BD that may serve as targets in strategies to identify individuals at risk and to prevent future attempts.

P-009 Evidence for a bidirectional relationship between hippocampal volume/neurochemistry and weight gain in early-stage bipolar disorder: a 12-month longitudinal study D Bonda, L Silveirab, E MacMillanc, I Torresd, R Lamd, L Yathamd a University of Minnesota, Psychiatry, Minneapolis, USA, b Universidade Federal do Rio Grande do Sul, Laboratory of Molecular Psychiatry, Porto Alegre, Brazil, cUniversity of British Columbia, Medicine Neurology, Vancouver, Canada, dUniversity of British Columbia, Psychiatry, Vancouver, Canada Background and Aims: We and others have found that elevated BMI is associated with structural and chemical alterations in limbic brain areas in early-stage bipolar disorder (BD). However, BD is a lifelong illness and whether, and how, BMI-related brain changes progress over time is unknown. Moreover, since all studies to date have been cross-sectional, it is unclear whether increased BMI causes brain changes, or brain changes cause increasing BMI. Methods: We used MRI and proton MR spectroscopy to measure hippocampal volume and two hippocampal metabolites - glutamate (Glu) and N-acetylaspartate (NAA) – at baseline and 12 months in 41 BD patients and 26 healthy subjects (HS). We investigated (1) whether baseline body mass index (BMI) and 12month BMI change predicted changes in hippocampal volume/ chemistry, and (2) whether hippocampal volume/chemistry predicted BMI change. Results: Increasing 12-month BMI predicted decreasing bilateral NAA in patients, and predicted decreasing bilateral Glu in HS. Baseline neurochemistry and 12-month neurochemical changes did not predict BMI change in either group. Smaller baseline right hippocampal volume and smaller right CA1, CA2/3, and CA4/dentate gyrus subfields predicted increasing 12-month BMI in HS. Baseline


13-16 July, Amsterdam, the Netherlands BMI and BMI change did not predict 12-month hippocampal volume change. Conclusions: These results suggest a bidirectional relationship between weight gain and hippocampal volume/chemistry. Specific findings differed between patients and HS, suggesting that BD diagnosis and BMI interact to influence hippocampal structure/ function. Increasing BMI predicted hippocampal chemical changes, while volume changes predicted increasing BMI, consistent with (though not sufficient to prove) causal relationships.

P-010 The impact of childhood trauma on executive functioning in affective disorders: a fMRI study L Cassiersa, T Pattyna, L Schmaalb, F Van Den Eedec, B Penninxb, D Veltmanb, B Sabbea a University of Antwerp, Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium, bVU Medical Center, Dept. of Psychiatry, Amsterdam, the Netherlands, cAntwerp University Hospital, Dept. of Psychiatry, Antwerp, Belgium Background and Aims: Affective disorders as well as childhood trauma are associated with impaired executive functioning (EF) and prefrontal brain dysfunction. This study aims to clarify the impact of childhood trauma on EF-related brain activity in affective disorders. Methods: A fMRI paradigm with the Tower of London task was conducted in 235 participants with depression and/or anxiety and healthy subjects from the Netherlands Study of Depression and Anxiety. Contrasts were computed for task load and easy and difficult trials versus baseline and entered into second level between-groups (traumatized versus non-traumatized) analyses with diagnosis as (1) covariate and (2) additional factor in two-way ANOVA. The dorsolateral prefrontal cortex (dlPFC), insula, anterior cingulate cortex and superior parietal cortex were selected as regions-of-interest. Results: Traumatized and non-traumatized groups differed on diagnostic state, but not on demographic variables or task performance. Taking diagnosis into account, task performance did differ between trauma groups, but only in individuals with affective disorders. Increased insular activation was observed in the traumatized group for difficult trials versus baseline. For task load two-way ANOVA revealed a trauma x diagnosis interaction in the left dlPFC, with stronger dlPFC activation in traumatized healthy controls versus their non-traumatized counterparts. Conclusions: Traumatized individuals show normal task performance but higher insular activation during difficult planning tasks, suggesting compensatory activation of the insula (implicated in visuospatial processing). The effect of trauma on dlPFC activation with increasing task load was only present in healthy controls, suggesting compensatory activation in traumatized healthy individuals not maintained by individuals with affective disorders.

P-011 Necker cube and the phenomenology of racing thoughts in bipolar disorder JB Causin, L Weiner, G Bertschy, G Anne INSERM, 1114, Strasbourg, France Background and Aims: The Necker cube (NC) is a bistable image, i.e., there are two possible perceptions which alternate spontaneously, related to the time needed to experience an event. A slowing of the alternation rate of the NC has been reported in bipolar patients whereas a study on patients with mania reported the reverse. We explored whether alternation rates vary as a function

of attention conditions and of the patients’ clinical state, i.e. ‘tachypsychia’ (racing thoughts). Methods: We compared the spontaneous median duration of perception of the two possible presentations of the NCin a sample of 50 bipolar patients and 28 controls. Subjects additionally performed this task in two controlled conditions: focus, during which they had to focus on one of the perceptions, and switch, during which patients were asked to switch between the two perceptions of the Necker cube. Patients filled out the Racing and Crowded Thoughts Questionnaire (RCTQ). Results: RCTQ scores were negatively correlated to the duration of perceptions in the focus condition (p < 0.05). Groups (controls vs. patients with tachypsychia vs. patients without) differed on the effect of attention. Controls and patients without tachypsychia were able to increase the time spent on one NC perception in the focus condition. In contrast, patients with tachypsychia were impaired at doing so. Conclusions: Patients with racing thoughts have difficulties to increase the time spent on one perception in the focus condition. This difficulty to stabilize perceptions might represent a possible mechanism involved in racing thoughts.

P-012 Attenuated connectivity between the default mode network and hippocampus after sad autobiographical recall in remitted major depressive disorder C Figueroa Acadamic Medical Centre, Psychiarty, Amsterdam, the Netherlands Background and Aims: Major depressive disorder (MDD) is highly recurrent in about one third of patients. Persisting rumination and cognitive reactivity to sad mood are risk-factors for MDD-recurrence. Relating these processes to neurobiological vulnerabilityfactors improves our understanding of recurrent-MDD. Cognitive reactivity and rumination have been linked to increased functionalconnectivity within the Default-Mode Network (DMN). We investigated whether increased DMN-connectivity persists during MDD-remission, and whether sad mood-induction differentially affects DMN-connectivity in remitted-MDD patients versus controls. To avoid confounding by antidepressant use, we investigated antidepressant-free patients. Methods: Sixty-two antidepressant-free MDD-patients, remitted from ≥2 previous episodes and 41 controls, participated in two 5minute sessions of neutral and sad mood-induction by autobiographical-recall and neutral/sad music, each followed by 8 min resting-state fMRI scanning. We identified DMN-components using Independent Component Analysis and entered subject- and sessions-specific components into a repeated measures analysis of variance. Connectivity-differences were extracted and correlated with baseline cognitive reactivity and rumination. Results: After sad vs. neutral mood-induction, remitted-MDD showed attenuated posterior-DMN-hippocampal connectivity. Sad mood-induction increased connectivity between the posteriorDMN and the hippocampus in controls but not in remitted-MDD (p = 0.006). Higher posterior-DMN-hippocampal connectivity was associated with lower cognitive reactivity (r = 0.21, p = 0.046) and rumination (r = 0.27, p = 0.017). At the conference we will be able to present (preliminary) associations with recurrence-rates from prospective follow-up. Conclusions: After recalling sad autobiographical-memories, attenuated posterior-DMN-hippocampal connectivity in remittedMDD, at high risk for recurrence, represents a neural MDDvulnerability marker, associated with cognitive reactivity and rumination. During remission of MDD, the DMN remains


73

18th Annual ISBD & 8th Biennial ISAD persistently dysfunctional, which becomes apparent only in the presence of stressful triggers.

P-013 Resting state prefrontal cortical connectivity in women with bipolar disorder during euthymia: a seed-based analysis SK Syana, L Minuzzib, M Smithb, O Allegaa, GBC Hallc, BN Freyb a McMaster University, MiNDS Neuroscience Graduate Program, Hamilton, Canada, bMcMaster University, Psychiatry & Behavioural Neurosciences, Hamilton, Canada, cMcMaster University, Psychology- Neuroscience & Behaviour, Hamilton, Canada Background and Aims: Cognitive impairment and emotional lability have been reported not only in episodic but also during remitted phases of bipolar disorder (BD). Previous studies have reported abnormal patterns of functional connectivity in specific prefrontal regions implicated in cognitive and emotional control. Here we aim to examine the resting state functional connectivity (Rs-FC) of four prefrontal cortical areas during euthymia in a well-characterized sample of women using Rs-FC seed-based analyses. Methods: Thirty-two women with BD, euthymic for at least 2 months, and 36 matched controls between 18–45 years of age were studied. Participants were right-handed and were not on hormonal treatment. Rs-FC was measured using a 3T MRI during the mid-follicular phase (days 5–10). The right and left dorsolateral prefrontal cortex (dlPFC; BA 9), orbitofrontal cortex (OFC; BA 11), inferior prefrontal gyrus (IFG; BA 47) and medial prefrontal cortex (mPFC) were used as seed points. Results: In BD, compared to controls, we found increased coupling between the right IFG (BA 47) and two regions of the right primary somatosensory cortex (BA 2: FDR-corrected, p = 0.02; BA 3: FDR-corrected, p = 0.04). No differences in Rs-FC were found using the mPFC, dlPFC(BA 9) and OFC (BA 11) as seed points. Conclusions: The IFG and somatosensory cortex both play important roles in emotional processing: the IFG through mood regulation and the formation of emotional memories, and somatosensory cortex by facilitating emotional empathy. Heightened functional coupling between these regions may reflect an adaptive, compensatory neural effort to maintain emotional stability during periods of clinical remission.

P-014 Intracortical myelin content in the DLPFC predicts verbal memory, and self-reported cognitive and psychosocial functioning in bipolar disorder M Sehmbia, CD Rowleya, P Rajasekerab, L. Minuzzic, NA Bockd, BN Freyc a McMaster University, MiNDS Neuroscience Graduate Program, Hamilton, Canada, bSt. Joseph’s Healthcare Hamilton, Women’s Health Concerns Clinic, Hamilton, Canada, cMcMaster University, Psychiatry & Behavioural Neurosciences, Hamilton, Canada, d McMaster University, Psychology- Neuroscience & Behaviour, Hamilton, Canada Background and Aims: Although poor cognitive function has been reported during both affective and euthymic states in bipolar disorder (BD), its neurobiological correlates remain poorly understood. Here we investigated whether intracortical myelin content is associated with subjective and/or objective measures of cognition, and psychosocial functioning in BD. Methods: Thirty-one BD subjects (19F, 12M) and 57 healthy controls (HC - 30F, 27M), aged 17–45 yo, completed a novel anatomical MRI protocol to measure intracortical myelin content. Right

74

and left dorsolateral prefrontal cortices (DLPFC) were used as regions-of-interest. Verbal memory was assessed using a standardized computerized test, the CNS-Vital Signs. Self-reported cognitive and psychosocial functioning were assessed with the Cognitive Failures Questionnaire (CFQ) and Functioning Assessment Short Test (FAST), respectively. IQ was assessed using the WASI-2 subtest IQ. Results: Backward stepwise linear regressions followed by ANOVAs revealed that: Intracortical myelin content in the right DLPFC predicted (1) verbal memory performance in BD [F3,27 = 5.6; p = 0.004; R2 = 0.31], but not in HC; (2) CFQ scores in BD [F3,26 = 4.4; p = 0.01; R2 = 0.27], but not in HC; and (3) FAST scores in BD [F5,24 = 4.4; p =0 .006; R2 = 0.37], but not in HC. Similar results were seen in the left DLPFC (data not shown). Conclusions: Our results show that intracortical myelin content in the DLPFC predicted both objective and subjective measures of cognition - verbal memory and CFQ scores - and psychosocial functioning in BD.

P-015 Neuroanatomical correlates of childhood trauma exposure in psychotic and mood disorders

M Greena, Y Quidea, N O’Reillya, V Carra, B Elzingab a University of New South Wales, Psychiatry, Sydney, Australia, b University of Leiden, Leiden Institute for Brain and Cognition, Leiden, the Netherlands

Background and Aims: Childhood trauma is a significant risk factor for schizophrenia (SZ), schizoaffective (SZA) disorder, and (psychotic) bipolar-I disorder (BD), and may contribute to alterations of grey matter concentrations (GMC) associated with these disorders. We set out to identify childhood trauma-related GMC alterations in a combined sample of cases with these disorders, using both univariate (voxel-based morphometry; VBM) and multivariate (source-based morphometry; SBM) analytic approaches. Methods: Participants included 37 SZ, 21 SZA, 54 BD cases, and 57 healthy controls (HC). Of these, 69 cases (SZ = 21; SZA = 15; BD = 33) and 24 HC reported clinically significant levels of exposure to childhood trauma, while 43 clinical cases (SZ = 16, SZA = 6; BD = 21) and 33 HC did not. The effects of childhood trauma exposure on GMC integrity were investigated (i) at the whole-brain level (using VBM), and; (ii) on sets of brain regions with highly covarying GMC (using SBM) in the full sample of clinical patients (regardless of disorder), relative to non-exposed clinical cases and exposed/non-exposed HC. Results: Only the SBM analyses revealed evidence of traumarelated GMC alterations in a set of regions including the sensorimotor and somatosensory systems (decreased GMC) and in bilateral temporo-parieto-occipital regions (increased GMC). Regardless of trauma, psychotic patients showed decreased hippocampal GMC (using VBM) and diffuse frontal, temporal, occipital and cerebellar GMC reductions (using SBM). Conclusions: Effects of childhood trauma exposure on diffuse grey matter alterations across the brain in psychotic patients may contribute to issues with self/other representation and/or social cognition deficits. We did not replicate previously reported associations between trauma-exposure and hippocampal abnormalities in psychosis.

P-016 Neurodevelopmentalanomalies in bipolar disorder and schizophrenia S Hiwale, N. Rao, V Ganesan, S Varambally National Institute of Mental Health & Neurosciences, Psychiatry Psychiatry, Bangalore, India


13-16 July, Amsterdam, the Netherlands Background and Aims: Neurodevelopmental hypothesis has been proposed for Bipolar disorder and Schizophrenia, and anomalous cerebral asymmetry could underlie the pathophysiology of these disorders. Neurological soft signs and line bisection tool(LBT), a valid test to measure cerebral asymmetry could be markers of such aberrations. Based on our previous work, we hypothesised that Bipolar and Schizophrenia have antithetical origins, and could be differentiated based on indices of cerebral asymmetry and neurological soft signs scores. This study was an attempt to combine markers of aberrant neurological development to differentiate these disorders using simple bedside tests. Methods: Outpatients with schizophrenia and bipolar disorder, (CGI severity ≤3) were recruited. A two-hand line bisection test was administered, with the Neurological Evaluation Scale (NES). A control group of healthy individuals was recruited. All participants were right- handed. Results: 34 patients with Bipolar disorder, 31 with Schizophrenia and 28 controls were recruited. Significant differences were found on the performance on LBT. Using their right hands, patients with schizophrenia erred more towards the right of the true centre, while those with bipolar disorder tended to err to the left (p = 0.002) There were no significant differences between the groups in scores on the NES (p = 0.218). Conclusions: Study findings suggest that schizophrenia and bipolar patients have antithetical asymmetry in line bisection; while patients with bipolar disorder had accentuated pseudoneglect, an exaggerated tendency to neglect the right visual field compared to schizophrenia patients. Future studies need to examine whether line bisection test, as a clinical tool,will help differentiate these disorders.

P-017 Ketamine’s rapid antidepressant action correlates with recovery of functional connectivity in the network including amygdala and ACC N Horikawa, M. Tomita, K Uematsu, T Nakamura, H Fukuyama, N Uchimura Department of Neuropsychiatry, Kurume University School Of Medicine, Kurume city, Japan Background and Aims: Ketamine is a novel antidepressant, effective to 50–70% of treatment resistant unipolar depression (TRD). However, the mechanisms of its rapid antidepressant action in the brain network level are largely unknown. To investigate neural substrate of the effect of ketamine, we conducted a resting-state fMRI study. The present study was conducted as part of the study UMINCTR No. UMIN000017529. The ethical committee of Kurume University School of medicine approved the present study. Methods: We treated TRD patients (n = 7, age 44 15, one male, all right handed, HAM-D>18, acquired a written informed consent) with repeated intravenous ketamine infusion (bolus, 0.5 mg/ kg/40 min, four times in 2 weeks) following discontinuation of previous antidepressant medication. Resting-state fMRI scans were conducted repeatedly before and after the treatment. Whole brain echo-planner images (TE = 25 ms, TR = 3s, a total of 200 scans) and a SPGR T1-weighted structural image were acquired on a GE discovery 3T scanner. Data were analyzed using via FSL version 5.0.6, and were compared between before and after the treatment simultaneously clinical symptoms ratings. Results: Seed-based analysis using a priori bilateral amygdala seed demonstrated increased functional connectivity to anterior cingulate cortex after the ketamine administration, and the change in the connectivity was significantly correlated to the MADRS decreases after the treatment (p = 0.023, Spearman’s rank correlation

coefficient). Hippocampus-seed analysis or posterior cingulate-seed analysis revealed no significant network correlated to clinical responses to ketamine. Conclusions: Our preliminary data suggested that intravenous ketamine shows antidepressant effect via recovery of functional connectivity in the network including amygdala and anterior cingulate in TRD.

P-018 Bipolar disorder and white matter microstructure: ENIGMA bipolar disorder DTI results M Paulinga, S. Sarrazina, N Jahanshadb, D Hibarb, C Henrya, P Thompsonb, O Andreassenc, J Houenoua, D.T.I. ENIGMA Bipolar Disorder Collaborationa a Psychiatry Department, CHU Mondor, Cr eteil, France, bUniversity of Southern California, Imaging Genetics Center, Marina del Rey, USA, cDepartment of Neurology, Oslo University Hospital – Rikshospitalet, Oslo, Norway Background and Aims: Models of bipolar disorder (BD) assume that an altered fronto-limbic connectivity underlies the emotional dysregulation. However, the heterogeneous results of diffusion tensor imaging studies (DTI) suggest the involvement of additional networks. Sources of heterogeneity include insufficient power and clinical heterogeneity. The ENIGMA BD DTI collaboration aimed to compare the DTI measures of a greater number of patients with BD and controls. Methods: We analyzed a 6 sites dataset of the ENIGMA BD DTI consortium gathering 264 patients and 315 controls. DTI data was processed according to the ENIGMA DTI pipeline (http://enigma.ini.usc.edu/protocols/dti-protocols/) using the TBSS/FSL software. Using a linear regression model, we then compared FA values across 25 regions of interest between patients and controls with age, sex and scanning site as covariates of no interest. Results: Mean age of the sample was 29.25 (SD 11.9). We identified statistically decreased FA in patients compared to controls within the uncinate (bilaterally t = 2.944 p = 0.003), but also in the corpus callosum (all segments: body t = 3.4, p = 0.001; genu t = 2.9, p = 0.004; splenium t = 3.320 p = 0.001), the cingulum (bilaterally t = 3.155 p = 0.002), the fornix (t = 1.971 p = 0.049), the posterior thalamic radiations (t = 2.385 p = 0.017) and the superior corona radiata (t = 2.222 p = 0.027). We did not find any statistically significant increase in FA. Conclusions: Our results highlight the importance of fronto-limbic dysconnectivity but also the implication of other networks (especially interhemispheric). Our future analyses will focus on mean, axial and radial diffusivity and address the issue of heterogeneity by comparing subgroups of patients with BD between them.

P-019 Investigating functional neural network vulnerability in bipolar disorder patients and high-risk offspring C Pigueta,b, A Dayera,b, P Corderaa, K Apazogloub, M Preisigc, P Vuilleumierb, J-M Aubrya a Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland, b Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland, cDepartment of Psychiatry, University Hospital of Lausanne, Switzerland The offspring of bipolar patients (BP) have an increased risk to develop mood and anxiety disorders, particularly during adolescence or early adulthood. Many lines of evidence in animal and human studies indicate an interaction between genetic risk and


75

18th Annual ISBD & 8th Biennial ISAD early-life stress, resulting in stress-reactivity as a core feature and potential vulnerability marker of bipolar disorder. We are currently probing stress-related functional neural networks using fMRI and concomitantly assessing the level of early-life stress and various emotion regulation traits in remitted BP, high-risk BP offspring and controls, all between 15 and 25 years old. The dynamics of fronto-limbic circuit recovery after a social laboratory stressor is investigated using an fMRI task based on an adapted version of the Montreal Imaging Stress task. Participants receive positive or

negative feedback with a social component after mental calculations done in a given time frame. Small resting periods are interleaved with stress periods. We also register psychophysiological data such as eye-tracking, heart and respiratory rate, and salivary cortisol. The aim is to probe the functional reactivity of limbic structures (subgenual and posterior cingulate, parahippocampal gyrus, amygdala) that are part of emotion processing network after stress, and to correlate this with clinical measures of early-life stress and cognitive emotion regulation strategies.

Poster Session IIIComorbidity Between Mood Disorder and the Other Psychiatric Disorders, e.g. Psychotic Disorders, Anxiety Disorders, Substance Use Disorders or Personality Disorders: Part I P-020 Bipolar disorder and co-occurring cannabis use disorders S Ben Mustapha, W Homri, S Aloui, M Mezghanni, R Labbane Razi Hospital, service de psychiatrie C, Mannouba, Tunisia Background and Aims: It has been established that cannabis use is involved in the emergence and evolution of psychotic disorders. Although cannabis use is very frequent in mood disorders, there has been a considerable debate about the association observed between these two disorders. The aim of our study was to evaluate the prevalence of cannabis use disorders (CUD) in patients with bipolar disorder (BD) and the impact of this co-morbidity on prognosis and evolution of BD. Methods: Case-control study during a period of 6 months from July 2015 to December 2015. 100 euthymic patients with BD (type I, II or unspecified) were recruited in the department of psychiatry C Razi Hospital, during their follow-up. 2 groups were individualized by the presence or not of CUD co-morbidity Results: The prevalence of CUD was 27.53% in our sample. A statistically significant association was found between CUD and variables: gender, employment status, living abroad, psychiatric family history, criminal record, history of violence, lack of family cohesion, personality disorder co-morbidity, family and professional integration, mixed features during mood episodes, psychotic features during mood episodes, the presence of a trigger, need for long-term antipsychotic treatment, adherence, quality of open intervals, response to treatment, duration of the last thymic episode and total duration in days of hospitalization. Conclusions: The frequency of CUD in BD is higher than the prevalence in the general population and CUD is a factor in the evolution and prognosis of bipolar disorder and promotes the development of mood disorders in predisposed patients.

P-021 The duration of undiagnosed bipolar disorder: impact of substance use disorders co-morbidity S Ben Mustapha, W Homri, S Aloui, H Belhadj, R Labbane Razi Hospital, service de psychiatrie C, Mannouba, Tunisia

76

Background and Aims: There are commonly long delays between the onset of bipolar disorder (BD), seeking of treatment and acquiring a bipolar disorder diagnosis. The aim of our study was to study the impact of substance use disorders (SUD) comorbidity on the duration of undiagnosed bipolar disorder (DUBP). Methods: Case-control study during a period of 6 months from July 2015 to December 2015. 100 euthymic patients with BD (type I, II or unspecified) were recruited in the department of psychiatry C Razi Hospital, during their follow-up. 2 groups were individualized by the presence or not of a SUD co-morbidity. In our study DUBP was defined as the period between the first symptoms and the beginning of treatment by a mood stabilizer. Results: The all patients’ mean DUBP was 4.80 years with a standard deviation of 8.04 and extremes ranging from 0.08 to 37.5.The mean DUBP in patients without SUD was 5.91 years with a standard deviation of 8.16 and extremes ranging from 0.08 to 35, that of patients without SUD was 3.68 years with a standard deviation of 7.84 and extremes ranging from 0.08 to 37.5. Conclusions: According to studies over two thirds of patients with bipolar disorder received misdiagnoses before diagnosis of BD, and among the factors involved can report the presence of SUD co-morbidity. Hence, we should detect BD among patients with SUD.

P-022 Comparison of insight in bipolar disorder with and without co-morbid substance use disorders S Ben Mustapha, W Homri, S Aloui, J Jendoubi, R Labbane Razi Hospital, Service de Psychiatrie C, Mannouba, Tunisia Background and Aims: Research over the past few decades has found that lack of insight may compromise treatment compliance and clinical outcome for patients with mental disorders. The aim of our study was to compare the level of insight in bipolar disorder (BD) with and without substance use disorders (SUD). Methods: Case-control study during a period of 6 months from July 2015 to December 2015. 100 euthymic patients with BD (type I, II or unspecified) were recruited in the department of psychiatry C Razi Hospital, during their follow-up. 2 groups were individualized by the presence or not of a SUD co-morbidity. We evaluated


13-16 July, Amsterdam, the Netherlands and compared insight with Birchwood IS scale (with its three subscales). Results: There is no statistically significant difference between bipolar and non-addictive behavior in terms of quality of insight.Regarding the subscales, bipolar patients with co-morbid addictive had a lower awareness of symptoms, whereas there was no significant difference regarding the awareness of the disease and the need of treatment between the two populations. Conclusions: Co-morbid SUD can affect the quality of insight in individuals with BD. Individuals with this co-morbidity should be targeted for intensive psycho-educational measures and psychotherapeutic interventions focused on the improvement of insight.

P-023 Attempted suicide in people with co-occurring bipolar and substance use disorders S Ben Mustapha, W Homri, S Aloui, A Larnaout, R Labbane Razi Hospital, service de psychiatrie C, Mannouba, Tunisia Background and Aims: Both individuals with bipolar (BD) and those with substance use disorders (SUD) are likely to attempt suicide. Co-morbidity of BD and SUD may increase the likelihood of suicide attempts. The aim of our study was to study the impact of SUD co-morbidity on suicide risk in patients with BD. Methods: Case-control study during a period of 6 months from July 2015 to December 2015. 100 euthymic patients with BD (type I, II or unspecified) were recruited in the department of psychiatry C Razi Hospital, during their follow-up. 2 groups were individualized by the presence or not of a SUD co-morbidity Results: 26% of patients with SUD co-morbidity had a history of suicide attempts.14% of patients without SUD co-morbidity had a history of suicide attempts. The average of suicide attempts was 3.08 (2.95) for patients with SUD co-morbidity and 2.00 (1.29) for patients without SUD co-morbidity. The methods used in suicide attempts were in 12% of cases by drugs, 3% of cases by phlebotomy, 3% of cases by hanging, 3% of cases by immolation, 2% of cases of by organophosphate ingestion, 3% of cases by defenestration, 3% of cases by a car accident and 1% of cases by drowning. Conclusions: Co-morbid SUD in individuals with BD is significantly associated with suicide attempts. Individuals with this co-morbidity should be targeted for intensive suicide prevention efforts.

P-024 Bipolar disordes triggered by ayahuasca: a case report C Castroa, LM Sarinb, AF Castro Ferreira Martinsb, JA Del Portob a S~ ao paulo, Brazil, bUNIFESP, Psychiatry, S~ ao Paulo, Brazil Background and Aims: The use of Ayahuasca, traditionally related to religious rituals has grown and spread to recreational purposes. Studies suggests it has antidepressant properties, but the psychopathology in mental illness induced by Ayahuasca is poorly understood. Manic-induced symptoms and first manic episodes are frequently related to antidepressants use, but no clear connection has been made with Ayahuasca so far. Methods: Case Report Results: Case Report: A 24-year-old woman had a first psychotic episode after an ayahuasca consumption ritual. Persecutory symptoms, insomnia, dysphoric humor, emotional lability and hyperactivity begun after the drug use and persisted for over 2 months before first medical assistance. She had no past history of manic or depressive episodes. After first episode she had another manic episode with psychotic symptoms and 6 months later a new mixed

state episode. She was treated with atypical antipsychotic and valproic acid achieving remission. Conclusions: Probably Ayahuasca antidepressant properties triggered this patient’s symptoms of Bipolar Disorder. The study of Ayahuasca’s pharmacological properties may lead to better understanding of drug –induced mental disorders mechanisms.

P-025 Screening for pseudobulbar affect in an outpatient mental health clinic R Bera University Of California- Irvine, Psychiatry and Human Behavior Psychiatry, Irvine, USA Background and Aims: Pseudobulbar affect (PBA) occurs secondary to neurologic conditions affecting the brain and is characterized by frequent, uncontrollable laughing/crying episodes that are unrelated to mood or social context. Episodes are often disruptive, embarrassing, and lead to social isolation and impaired quality of life. Mood disorder symptoms often overlap with PBA and therefore PBA may often be misdiagnosed as Bipolar Disorder. Our main objective in this study was to utilize the Center for Neurologic Study-Liability Scale (CNS-LS), the primary tool currently utilized for screening for PBA, in a population of patients with Bipolar Disorder in a psychiatric outpatient clinic. Methods: A total of 83 patients with Bipolar Disorder were administered the CNS-LS Scale. A score of 13 or higher is felt to correlate with a high likelihood that PBA may exists and warrants further evaluation if an underlying neurologic condition may exist. Results: The average score on the CNS-LS Scale for the 83 patients with Bipolar Disorder was 15.21. 58.39% of the patients had a score greater than or equal to 13. Conclusions: To our knowledge our study is the first screening for PBA utilizing the CNS-LS Scale in a general outpatient psychiatric clinic. The high prevalence of positive screening in this population with Bipolar Disorder suggests that more regular evaluation for PBA would be a benefit to patients. With new pharmacologic treatments now available for treating PBA, more regular assessments may result in improved outcomes for patients with Bipolar Disorder.

P-026 Special features of the affective episodes of bipolar affective disorder in patients with cannabis abuse Z Bereza Sain-Peterburg, Russia Background and Aims: The use of cannabis often leads to the development of affective maniacal episodes, anxiety, depressive and apathetic syndromes or patterns that may be associated with periods of intoxication or withdrawal of this group of psychoactive substances.Identification of peculiarities of affective episodes in patients with bipolar affective disorder associated with cannabis addiction. Methods: The inclusion criteria were: age above 18 years, F 31 ICD-10.1 st group: 52 patients (29 men and 23 women) with bipolar disorder and cannabis addiction (F12). Age of patients 33.32 (SD = 4,35), experience of substance abuse of 6.7 (SD = 5,46), disease duration BAR of 7.2 (SD = 6,82).2 d group: 44 patients (26 men and 18 women) with bipolar affective disorder, and not addicted to cannabis or other substances. Age of patients are 37,2 (SD = 6.85), Experience of BAD is 10.4 (SD = 5,6).Clinical-anamnestic method, clinical-psychopathological method (criteria ICD10 and clinical diagnostic scales: M. I. N. I, HADS, HCL-32, YMPS).


77

18th Annual ISBD & 8th Biennial ISAD Results: The use of cannabis in patients with BAR is a significant factor of more frequent relapses, Cannabis users were significantly more revealed episodes of severe mania with psychotic symptoms.In the structure of maniacal episodes in patients who use cannabinoids psychotic symptoms incongruent of affect are significantly more frequent. Conclusions: In the structure of depressive episodes patients with BAR using cannabis presented apatho-abulic syndrome, anxietyphobic syndrome and severe insomnia more often. Depressive episodes in cannabis users with BAR are more prolonged and resistant to medical therapy than in patients who are not using cannabinoids

P-027 The mediating role of cognitive emotion regulation strategies on the relationship between childhood trauma and adulthood depression and anxiety JH Chae, H Hyujung Seoul St. Mary’s Hospital - The Catholic University of Korea, Psychiatry, Seoul, Korea Background and Aims: The purpose of the present study is to evaluate a hypothesized model describing the possible pathway of childhood trauma and its influence on depression and anxiety. We hypothesized that childhood trauma would be positively associated with current symptoms of depression and anxiety, which is mediated by cognitive emotional regulation strategy. Methods: Patients with depression and/or anxiety disorder (n = 585, 266 men and 316 women) completed the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Childhood Trauma Questionnaire (CTQ) and Cognitive Emotion Regulation Questionnaire (CERQ). We divided cognitive emotion regulation strategies into positive and negative emotion regulation strategies using the sub-score of CERQ. Results were analyzed with correlation analysis and structural equation modeling (SEM), by suing SPSS AMOS 21.0 Results: Childhood traumatic experience was significantly related with the severity of depressive and anxiety symptoms, which was fully mediated by negative emotion regulation strategies in depression and/or anxiety disorder. On the other hands, positive emotion regulation strategies were related with decline of the severity of depression and anxiety, but not with childhood traumatic experience. Conclusions: Together these findings, a model in which childhood trauma and adulthood mental health outcomes such as depressive and anxiety symptoms in clinical samples may be related with negative emotion regulation strategies. Our results suggest that emotion dysregulation is a viable therapeutic target for depression and/ or anxiety disorder in patients with childhood trauma. SEM is a method used for hypothesis modeling and not for causal modeling. Therefore, the possibility of developing more suitable models including other variables cannot be excluded.

P-028 Obsessive compulsive symptoms in bipolar disorder: a clinical study M ElHadidya, A Khaterb Mansoura Faculty of Medicine, Psychiatry, Mansoura, Egypt, b Mansoura University- Medical Administration, Psychiatry, Mansoura, Egypt a

obsessive-compulsive symptoms (OCS) in bipolar disorder and to recognize the clinical difference between the bipolar disorder with or without OCS. Also, to find the prognostic impact of the presence of OCS on bipolar disorder. Methods: A survey for all patients first diagnosed with bipolar disorder came to (for 1 year duration) Mansoura university hospital for treatment were chosen to participate in this study (985 patients). All patients must fulfill the DSM-5 criteria for bipolar disorder. All patients were then examined using Yale-Brown Obsessive compulsive Scale, Young Mania Rating Scale, Arabic Beck Depression Inventory, Positive and Negative Syndrome Scale (PANS), Personality assessment form, Global Assessment of functioning, and WHO (five) well being index. Results: OCS was found to be present in 18.9% (52 patients) of patients with bipolar disorder. Patients with OCS showed, higher scores in PANS than without OCS. Obsessive (p = 0.04) and depressive personalities (p = 0.3) were found to be more prevalent in patients with OCS than without. Poorer quality of life were found in patients with OCS than without (p = 0.02). Conclusions: OCS present in nearly one fifth of bipolar disorder patient. These patients showing different psychopathology and poorer health well being.

P-029 The relationship between chronotype, course of illness characteristics, and comorbid axis i disorders in bipolar type I disorder A Forero, R Gonzalez Texas Tech University Health Sciences Center, Psychiatry, El Paso, USA Background and Aims: Chronotype, or the preference time for daily activities, may be associated with bipolar disorder (BD). We designed a proof-of-concept study to explore the relationship of chronotype, course of illness and co-morbid axis I disorders in subjects diagnosed with bipolar type I disorder (BDI). Methods: 126 subjects with BDI were included in the study. The Mini International Neuropsychiatric Interview (MINI) was used to confirm BDI diagnosis according to DSM-IV-TR and to establish lifetime diagnosis of co-morbid psychiatric conditions. Chronotype was assessed with the 13-item Composite Scale for Morningness (CS). Course of illness characteristics included the degree of interepisode recovery, history of hospitalizations, rapid cycling phenotype, and the ages at onset of psychiatric symptoms, depression, mania, and psychosis. Univariate analyses were conducted to assess the correlations between chronotype (morning, intermediate, and evening type) course of illness characteristics and psychiatric co-morbidities. Results: A stepwise pattern was noted with evening chronotypes having an earlier age at onset of depression and psychosis (p = 0.05 and p = 0.02, respectively). A similar stepwise pattern was noted with relation to age at first recognized psychiatric symptoms (p = 0.08). Results were also significant for a relationship between morning chronotype and a lifetime history of non-alcoholic substance dependence (p < 0.01). Conclusions: Results from this study suggest that chronotype may be related to course of illness characteristics and co-morbid conditions in BD. Future studies are required to better characterize these relationships.

Background and Aims: Many studies found that at least 50% of bipolar disorder (BD) patients have an additional diagnosis, one of the most difficult to manage being obsessive-compulsive disorder (OCD). Aim of this study is to detect the frequency of co-morbid

78


13-16 July, Amsterdam, the Netherlands P-030 Self-reported psychotic-like experiences among patients with mood disorders E Isometsaa, I Baryshnikovb, J Suvisaaric, K Aaltonenb, M Koivistob, P N€ a€ at€ anenb, B Karpovb, T Melartinb, J Oksanenb, K Suominend, T Pauniob, G Joffee a University of Helsinki, Departement of Psychiatry, Helsinki, Finland, bDepartment of Psychiatry, University of Helsinki and Helsinki University Hospital,Helsinki, Finland, cNational Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland, d Department of Psychiatry, City of Helsinki- Social Services and Healthcare- Aurora Hospital, Helsinki, Finland, eDepartment of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinkifin, Finland Background and Aims: Self-reported psychotic-like experiences (PE) may be common in patients with mood disorders, but their clinical correlates are not well known. We investigated their prevalence and relationships with self-reported symptoms of depression, mania or hypomania, anxiety, borderline (BPD and schizotypal (SPD) personality disorders among psychiatric patients with mood disorders. Methods: The Community Assessment of Psychic Experiences (CAPE-42), Mood Disorder Questionnaire (MDQ), McLean Screening Instrument (MSI), The Beck Depressive Inventory (BDI), Overall Anxiety Severity and Impairment Scale (OASIS) and Schizotypal Personality Questionnaire-Brief form (SPQ-B) were filled in by patients with mood disorders (n = 282) from specialized psychiatric care. Correlation coefficients between total scores and individual items of CAPE-42 and BDI, SPQ-B, MSI and MDQ were estimated. Hierarchical multivariate regression analysis (HMRA) was conducted to examine factors influencing the frequency of self-reported PE. Results: The “frequency of positive symptoms” score of CAPE-42 correlated strongly with total score of SPQ-B (rho = 0.63; p < 0.001) and moderately with total scores of BDI, MDQ, OASIS and MSI (rho varied between 0.37 and 0.56; p < 0.001). Individual items of CAPE-42 correlated moderately with specific items of BDI, MDQ, SPQ-B and MSI (rφ varied from 0.2 to 0.5; p < 0.001). In HMRA, symptoms of anxiety, mania or hypomania and BPD were significant predictors of the “frequency of positive symptoms” score of CAPE-42. Conclusions: Several, both state- and trait-related factors may underlie self-reported psychotic-like experiences among mood disorder patients. These include cognitive-perceptual distortions of SPD; distrustfulness, identity disturbance, dissociative and affective symptoms of BPD, and cognitive biases related to depressive or manic symptoms.

P-031 The influence of borderline personality traits on the course of bipolar disorder T Jonesa, K Gordon-Smithb, L Fortyc, N Craddockc, I Jonesc, KE Saundersd, L Jonesb a University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom, bDepartment of Psychological Medicine, University of Worcester,Worcester, United Kingdom, c Cardiff University, Institute of Psychological Medicine and Clinical Neurosciences- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, United Kingdom, dDepartment of PsychiatryWarneford Hospital, University of Oxford, Oxford, United Kingdom Background and Aims: Bipolar disorder and borderline personality disorder are commonly comorbid. Borderline personality disorder is diagnosed categorically, but personality pathology may be better characterised dimensionally. The impact of borderline personality

traits (not diagnosis) on the course of bipolar disorder is unknown. We examined the presence and severity of borderline personality traits in a large UK sample of bipolar disorder, and the impact of these traits on illness course. Methods: Borderline Evaluation of Severity over Time (BEST) was used to measure presence and severity of borderline traits in 1447 individuals with DSM-IV bipolar I disorder (n = 1008) and bipolar II disorder (n = 439) recruited into the Bipolar Disorder Research Network (www.bdrn.org). Clinical course was measured via semistructured interview (Schedules for Clinical Assessment in Neuropsychiatry) and case-notes. Results: BEST score was higher in bipolar II than bipolar I (36 v 27, p < 0.001) and 9/12 individual BEST traits were significantly more common in bipolar II than bipolar I. Within both bipolar I and bipolar II higher BEST score was associated with younger age of bipolar onset (p < 0.001), history of alcohol misuse (p < 0.010), and history of suicide attempt (p < 0.001). Conclusions: Borderline personality traits are common in bipolar disorder, and more severe in bipolar II than bipolar I disorder. Borderline trait severity was associated with more severe bipolar illness course; younger age of onset, alcohol misuse and suicidal behaviour. Clinicians should be vigilant for borderline personality traits irrespective of whether criteria for diagnosis are met, particularly in those with bipolar II disorder and younger age of bipolar onset.

P-032 Relations of anhedonia and impulsivity is different in bipolar patients with nicotine dependence vs without S Kesebira, M Altıntasßb, A Ulupınarc a€ Usk€ udar University, Psychiatry, Istanbul, Turkey, bErenk€ oy Mental and Neurological Disease Training and Research Hospital, € udar University, Psychology, Psychiatry, Istanbul, Turkey, cUsk€ Istanbul, Turkey Background and Aims: The aim of the present study was to investigate whether relations of anhedonia and impulsivity differentiate between bipolar patients with nicotine dependence (ND) vs without. Methods: For this purpose 174 bipolar patients with ND were compared 100 bipolar patients without ND. The instruments were a Fagerstr€ om Test for Nicotine Dependence, Snaith-Hamilton Pleasure Scale (SHAPS) and Barratt Impulsiveness Scale (BIS). Subjects with current other substance or alcohol abuse, with medical comorbidities were excluded. Results: SHAPS scores were similar between bipolar patients with ND and without when BIS scores were higher in bipolar patints with ND (p = 0.045). There was a strong inverse correlation between SHAPS and BIS scores in bipolar patients with ND (r = 0.489, p < 0.001). There was not found any relation between SHAPS and BIS scores in bipolar patients without ND. BIS scores were correlated with both number of cigarette/day and duration of nicotine dependence (year), (r = 0.345, p = 0.003 and r = 0.304, p = 0.008). There was a inverse correlation between SHAPS scores and number of cigarette/day (r = -0.237, p = 0.042), without duration of nicotine dependence. Conclusions: A better understanding of the brain pathophysiology of ND may help us to better understand the brain pathophysiology of ND the brain pathophysiology of BD.

P-033 ASO and CRP levels in BD vs OCD vs BD comorbid OCD € S Kesebir, G Eryılmaz, E Ozten € udar University, Psychiatry, Istanbul, Turkey Usk€


79

18th Annual ISBD & 8th Biennial ISAD Background and Aims: The present study will investigate antistreptolysin-O (ASO) and C-reactive protein (CRP) levels in bipolar disorder (BD), obsessive compulsive disorder (OCD) and BD comorbid OCD. Methods: This study employed 38 BD, 38 OCD and 30 BD comorbid OCD diagnosed patients according to DSM-IV. Three groups have been compared in terms of ASO and CRP levels. Results: Maudsley Obsessive Compulsive Inventory scores were OCD> BD+OCD> BD (p = 0.014, 0.001), ASO levels were BD+OCD> OCD = BD (p = 0.042, 0.071), CRP levels were BD> BD+OCD> OCD (p = 0.025, 0.031). There was not any correlation between ASO-CRP levels and Maudsley Obsessive Compulsive Inventory scores. Conclusions: Higher level of ASO in bipolar patients had not obtain before. The correlation between frequency of revelation of high serum titers of antibodies to myelins glycolipids galactocerebrosides and multipl sclerose stage was observed. The corelation between level of high serum titers of antibodies to myelins glycolipids galactocerebrosides and blood immune complexes concentrations (complement and ASO) was established too. High serum titers of antibodies to myelins may be related both to BD and OCD.

P-034 Vitamin D deficiency and hyperparathyroidism: a comparison between BD with comorbid ADHD and without S Kesebira, E Tatlıdil Yaylacıb, F Akdenizc a€ Usk€ udar University, Psychiatry, Istanbul, Turkey, bErenk€ oy Mental and Neurological Disease Training and Research Hospital, Psychiatry, Istanbul, Turkey, cEge Universty, Psychiatry, Izmir, Turkey Background and Aims: The aim of the present study was to investigate whether levels of 25(OH) vitamin D, calcium, phosphate and parathormone (PTH) differentiate between bipolar patients and bipolar patients with comorbid Attention Deficit Hyperactivity Disorder (ADHD). Methods: For this purpose 100 bipolar patients evaluated cross-sectional. Lithium use, current substance or alcohol use and medical comorbidities that can cause secondary hyperparathyroidism such as renal impairment and diabetes were exluded. 24 bipolar patients with comorbid ADHD were compared the others in terms of serum 25(OH) vitamin D, calcium, phosphate and PTH levels. Results: 25(OH) vitamin D levels were lower and calcium and PTH levels were higher in ADHD comorbid bipolar patients (p = 0.040, 0.035, 0.011). Conclusions: 25(OH) vitamin D status related to behavioral and affective disorders but pathophysiological mechanisms may be different in two disorder. It would be better if not only 25(OH) vitamin D levels, but also serum PTH levels were examed in ADHD comorbid bipolar patient except of lithium use.

P-035 Characteristics of comorbid substance use disorders in hospitalized patients with bipolar disorder

J Martı-Bonany, R Sanchez Gonzalez, R Martınez Riera, MG Hurtado Ruiz, A Farre Martınez, JL Perez de Heredia, L Galindo, M Campillo Sanz, F Lana Moliner, G Mateu Codina, M Torrens M elich Neuropsychiatry and Addictions Institute INAD- Parc de salut Mar, Psychiatry, Barcelona, Spain Background and Aims: Concurrent Bipolar disorder (BD) and substance use disorder (SUD) is common in clinical practice. Cannabis is the most common illicit drug used. Published data suggest that

80

cannabis use is associated with several negative consequences among individuals with BD. Main objective is describe the characteristics of patients with concurrent BD/SUD admitted in a Dual Diagnosis Unit. Methods: All the subjects diagnosed of BD according to DSM-IVTR criteria, consecutively admitted to a Dual Diagnosis Unit where included in the study. Statistical analysis was performed by using SPSS program. Results: A total of 66 subjects were included, mainly men (84.8%) with a mean age of 37.7 years (SD = 11.7). The main reason for admission was behavior disorder (37.8%), mania (25.8%), hallucinations/delusions (15.2%), depression (12.1%) and suicide attempt (9.1%). GAF was 39.8 (SD = 10’3) at admission and 60.6 (SD = 10’0) at discharge (p < 0.001). Mean length of admission was 24.9 days (SD = 17.9). Aggressive behavior, suicide attempts, criminal record and incarceration history was 34.8%, 27.3%, 36.4% and 10.4% respectively. 77.3% didn’t follow regular treatment in the last 6 months and 37.9% had previous admissions. Main drug at admission was cannabis (34.8%), cocaine (33.3%) and alcohol (24.2%). Results of polidrug abuse and age of onset of initial consumption and SUD are shown in tables 1 and 2. Conclusions: Patients with BD and comorbid SUD appear to be a complex population with need for enhanced clinical monitoring. The alarmingly early age of onset for alcohol and cannabis use should encourage preventive efforts, especially in the adolescent population.

P-036 Clinical differences of bipolar disorder in a dual pathology facility in Barcelona

J Martı-Bonany, L Galindo Guarin, R Sanchez Gonzalez, G Mateu Codina, R Martınez Riera, MG Hurtado Ruiz, A Farre Martınez, JL Perez de Heredia Flores, M Campillo Sanz, C Castillo Buenaventura, M Torrens Melich Neuropsychiatry and Addictions Institute INAD- Parc de salut Mar, Psychiatry, Barcelona, Spain Background and Aims: Several studies have suggested variations the differences of prognosis and functionality between the bipolar disorder and the others mental disorders. Especially the differences of adherence of treatment and substance use disorders. The aim of this study is to explore the differences in the adherence to the pharmacological treatment and the psychiatrist visits between patients and the specific substance use disorder in patients with bipolar disorder in a Dual Pathology Facility in Barcelona. Methods: A retrospective review of all psychiatric discharges in a Dual Pathology Facility between 2007 and 2013. Chi Square analysis was used to calculate the differences of between adherence to the pharmacological treatment and adherence the psychiatrist follow up and the diagnosis. In addition, a comparison of the frequencies of the specific substances use disorder was performed. Results: 975 patients were included, 72% females with a mean age of 39.2 years (SD 9.93). There is no significant differences in the adherence to the pharmacology treatment or in the adherence the psychiatrist follow up between patients with bipolar disorder and others mental disorders. Patients with bipolar affective disorder made more voluntary admissions.There are significant differences of the frequency of the amphetamine, cannabis and inhalants use disorder. Conclusions: In patients with dual pathology, its more frequent the substance of disorders of amphetamine, cannabis and inhalants in patients with bipolar disorder. In comparison with other mental illness, the patients with bipolar and substance use disorder don’t showed differences in the adherence to treatment. Acknowledgments: L.Galindo is a Rio Hortega fellowship (ISC-III; CM14/00111). Supported-by-Instituto-de-Salud Carlos-IIIFEDER-(RTA RD12/0028/0009)


13-16 July, Amsterdam, the Netherlands P-037 A genome-wide association study of binge eating behavior in patients with bipolar disorder implicates PRR5 a,b

c

c

d

e

S McElroy , S Winham , C Colby , A Cuellar-Barboza , M Frye , J Biernackac a Lindner Center of HOPE, Psychiatry, Mason, USA, bDepartment of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati- OH, USA, cDepartment of Health Sciences Research, Mayo Clinic, Rochester- MN, USA, d Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico, eDepartment of Psychiatry & Psychology, Mayo Clinic, Rochester- MN, USA Background and Aims: Patients with bipolar disorder (BD) have higher rates of binge eating (BE) than the general population. We performed a genome-wide association study (GWAS) to explore the role of genetics contributing to comorbid BD and BE. Methods: We conducted GWAS of BE using data from the Mayo Clinic Bipolar Disorder Biobank (N = 700). BE was defined in two ways: (1) a current DSM-V diagnosis of binge eating disorder (BED) based on the Eating Disorder Diagnostic Scale (EDDS), and (2) current binge eating behavior (BEB) based on the EDDS. For both definitions, we conducted GWAS using logistic regression analyses comparing BD patients with and without BE, adjusted for 4 principal components. Top variants were assessed for replication in the Genetic Association Information Network (GAIN) BD data (N = 1001). Results: No variants reached genome-wide significance, and top association signals were not replicated in the GAIN sample. However, association of BE with rs6006893 in PRR5, previously associated with BD with BEB in GAIN, was replicated with both BE definitions; in particular, the minor allele was associated with increased risk of BED (OR = 1.65, p = 0.004) and BEB (OR = 1.61, p = 0.005). A meta-analysis of BEB association with this SNP using the Mayo and GAIN data provided genome-wide significant evidence of association (OR = 1.92, p = 3.4E-08). PRR5 encodes a subunit of the mammalian target of rapamycin (mTOR) complex 2, a serine/threonine kinase expressed in brain that participates in food intake regulation. Conclusions: The demonstrated association of BE among BD patients with a variant in PRR5 warrants further investigation.

P-038 Stanley foundation bipolar network: predictors of psychosocial outcome

F Bennetta, H Grunzeb, A Closec, L Sch€aererd, T Suppese, J Mintzf, G Hellemanng, M Fryeh, S McElroyi, W Nolenj, R Kupkak, G Leverichl, L Altshulerm, S Millern, P Kecko, R Postl, A Sharmaa a Newcastle University, Institute of Neuroscience, Newcastle-uponTyne, United Kingdom, bLMU Munich, Psychiatry, Munich, Germany, cNewcastle University, School of Biology, Newcastleupon-Tyne, United Kingdom, dDepartment of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany, eStanford University, VA Palo Alto Health Care System, Stanford, USA, fUniversity of Texas Health Sciences Center, San Antonio Psychiatry, San Antonio, USA, gUCLA, Neuropsychiatric Institute, Los Angeles, USA, hDepartment of Psychiatry, Mayo Clinic, Minnesota, USA, iUniversity of Cincinnati, Psychiatry, Cincinnati, USA, jUniversity Medical Center Groningen, Psychiatry, Groningen, the Netherlands, kAltrecht Institute for Mental Health Care, Bipolar Disorders Clinic, Altrecht, the Netherlands s, lGeorge Washington University School of Medicine, Bipolar Collaborative Network, Washington, USA, mUniversity of California, Psychiatry and Biobehavioral Sciences, Berkeley, USA, nStanford University, Psychiatry and Behavioral Sciences, Stanford, USA, oUniversity of Cincinnati College of Medicine, Psychiatry, Cincinnati, USA Background and Aims: Impairments in psychosocial functioning have been demonstrated in 30–60% of adults with Bipolar Disorder (BD). The aim of this project was to investigate the impact of the following factors on longitudinal psychosocial outcome in participants with BD: comorbid mental health disorders, age at onset and duration of untreated BD. Methods: Baseline factors (random effects) were entered into a Mixed Effects Model with Global Assessment of Functioning (GAF) score as the longitudinal outcome measure. Relative (Akaike’s Information Criterion) and absolute (R²) model fit were calculated. Results: Complete data was available for 469 participants. Presence of any lifetime anxiety disorder (t = -2.27, p = 0.02), but not substance use disorders (t = 0.04, p = 0.97) or attention deficit hyperactivity disorder (t = 0.44, p = 0.66), predicted poorer GAF scores. Longer duration of untreated BD (t = -2.41, p = 0.02) also predicted poorer GAF scores, with younger age at onset (t = 1.84, p = 0.07) showing a trend towards this result. The final model predicted just over half of the variance (R² = 0.545) in the sample. Conclusions: Studies have shown that the resolution of clinical symptoms is rarely followed by recovery of psychosocial functioning. The growing evidence base added to by this study suggests comorbid anxiety disorders are a significant factor hindering psychosocial recovery. This finding may have implications for screening tools and staging systems. Both have been incorporated extensively into many medical fields, and there is promising evidence of their utility in BD. The current results suggest an important role for anxiety disorders in the future development of these tools, while the mechanisms behind these findings deserve further exploration.


81

18th Annual ISBD & 8th Biennial ISAD

Poster Session IVComorbidity Between Mood Disorders and Somatic Disorders: Part I P-039 Bipolar disorder and epilepsy F Ghali, E Khelifa, M Zghal, G Jmii, S Aloui, R Beji, S Ben Mustapha, Z El Hechmi Razi Hospital, psychiatry, Mannouba, Tunisia Background and Aims: Many studies have already demonstrated that affective disorders in epilepsy represented a common psychiatric comorbidity; however, most of the classic neuropsychiatric literature focuses on depression anda little is known about bipolar depression, and especially mania, in epilepsy. There are many similarities between bipolar disorder and epilepsy such as their episodic nature, their chronicity and the efficiency of some antiepileptic medications in the prophylaxis of both disorders. The aim of our study was to identify the clinical and therapeutic features of bipolar patients with a history of epilepsy Methods: A descriptive and retrospective study was conducted in the “F” department of psychiatry in Razi Hospital including all the patients with a diagnostic of a bipolar disorder according to the DSM-IV-TR between 2010 and 2015. Results: Eleven bipolar patients had a history of epilepsy. Among them, two had a family history of epilepsy.The first seizure happened at an average age of 15,7. For all patients, it was aa generalized epileptic seizure.The onset the bipolar disorder was at an average age of 27.5 years.Seven patients were taking anticonvulsant drugs when they had their first manic or depressive episode. Conclusions: An integrated clinical approach to both epilepsy and bipolar disorder is crucial to improvethe management and the outcome of these two severe disorders.

P-040 Psychosis and manic symptoms following tramadol withdrawal

A Ballesterosa, F Inchaustib, A Portillab, E Manriquec, B Cortesd, W Jaimese, V Martı a Osasunbidea, Psychiatry, Estella, Spain, bOsasunbidea, Psychiatry, Pamplona, Spain, cOsasunbidea, Psychiatry, Tafalla, Spain, d Outpatient Clinic Dr. B. Cortes, Psychiatry, Salmanca, Spain, e Osakidetza, Psychiatry, Donosti, Spain, Red de Salud Mental de Murcia, Psychiatry, Cartagena, Spain Background and Aims: Tramadol is an opioid pain medication used to treat moderate to moderately severe pain. Pharmacologically, not only binds to the mu opioid receptor, but also inhibits the reuptake of serotonin and norepinephrine. Aim: report a 28 years old patient treated with tramadol/acetaminophen analgesic combination that had a first episode of psychosis and manic symptoms after tramadol withdrawal. Methods: To study, whether tramadol withdrawal maybe associated to psychotic symptoms and affective psychopathology. Results: This article reports a 28 years old female treated with tramadol/acetaminophen analgesic combination that had a first episode of psychosis and manic symptoms after tramadol withdrawal. The patient received oral antipsychotic treatment after hospital admission (Olanzapine 20 mg per day) and workup tests (CT scan

82

and blood tests) revealed no significant results. After 15 days the patient was discharged after a full recovery with an acceptable functioning in the community. Conclusions: We report a case that presented atypical discontinuation symptoms of psychosis and manic features within days of stopping the medication. Atypical symptoms of withdrawal are usually seen during the withdrawal period just in one of eight cases (whereas typical symptoms occur in 7 out of 8 cases). Psychotic symptoms may be related to tramadol mechanism of action as a serotonin and epinephrine reuptake blocker. In this case, psychotic features were predominant to mood dimension. The differential diagnosis of substance withdrawal versus psychotic disorder was made according to the particular clinical features of psychosis in these cases as an antipsychotic free period of observation was not clinically beneficial to the patient.

P-041 Clinical case: manic episode (shizoaffective disorder, manic type) following tramadol treatment

A Ballesterosa, F Inchaustib, E Manriquec, B Cortesd, V Martıe, W Jaimesf, C Carrionb a Madrid, Spain, bOsasunbidea, Psychiatry, Pamplona, Spain, c Osasunbidea, Psychiatry, Tafalla, Spain, dClınica Privada Dr. B. Cort es, Psychiatry, Salamanca, Spain, eRed de Salud Mental de Murcia, Psychiatry, Cartagena, Spain, fOsakidetza, Psychiatry, Donosti, Spain Background and Aims: Tramadol hydrochloride (HCl) is a centrally acting synthetic opioid analgesic. Psychotic and manic symptoms are relatively rare in reported adverse events.Tramadol is an opioid pain medication used to treat moderate to moderately severe pain. Pharmacologically, not only binds to the mu opioid receptor, but also inhibits the reuptake of serotonin and norepinephrine. These effects on neurotransmitters may explain the clinical pattern of the following clinical case. Aim: a better understanding of underlying mechanisms of tramadol in psychopathology. Methods: To study, whether tramadol treatment maybe associated to psychotic symptoms and affective psychopathology. Results: Case: A 69-year-old female had underlying schizoaffective disorder (manic type). 1 month before the last outpatient clinic, she had been taking tramadol HCl/acetaminophen for thoracic pain. She had adherence to the treatment but she then developed persecutory delusion and disphoria. Previously, she received lithium, aripiprazole and risperidone treatment with stable affective/psychotic status (6 months of stability, 1 manic relapse with similar clinical pattern over the last 12 months). After adding clonazepam (low doses) in addition to the previous treatment, based on collateral information (her husband, the primary carer) there was a partial recovery (in terms of improving sleep pattern and mood). Conclusions: Tramadol HCl is commonly prescribed in clinical practice and manic or psychotic symptoms related to it are uncommon. However, there are several case reports showing psychotic and/or manic symptoms after starting/withdrawal tramadol. We


13-16 July, Amsterdam, the Netherlands should be careful about the rare but important adverse events while prescribing tramadol HCl.

P-042 Migraine in female patients with bipolar disorder H Belhadj, H Ben Ammar, M Mezghanni, A Larnaout, E Khlifa, Z Elhechmi Razi Hospital, F, Mannouba, Tunisia Background and Aims: The aim of this study was to compare the prevalence of migraine in female patient with DSM-IV bipolar disorder, and healthy female controls, to assess association between migraine and clinical features in subjects with bipolar disorder. Methods: A transversal comparative study was undertaken. We included Tunisian female patients with DSM-IV bipolar disorder (N = 24) with 6 months of discharge of psychiatric inpatients, and healthy female controls (N = 44). They were interviewed, after obtaining their consent, with the PALM questionnaire used in determining the prevalence of migraine.We used a form detailing social, demographic and clinical characteristics. Results: Migraine was more frequent in female with bipolar disorder (37.5%) than in healthy controls (11.4%).Migraine was more common in subjects with bipolar II disorder (50%) than in subjects with bipolar I disorder (33.3 %).Presence of migraine was associated with tobacco consumption, earlier age of first hospitalization and suicidal ideation. Conclusions: There is a need for screening migraine for its impact in mood outcome in patients with bipolar disorder.

P-043 Cognitive functioning in euthymic bipolar disorder and pre-surgical focal epilepsy arising from the temporal lobes E Bostocka, K Kirkbyb, M Garrya, B Taylorc a University of Tasmania, Psychology, Hobart, Australia, b University of Tasmania, Psychiatry, Hobart, Australia, cUniversity of Tasmania, Medicine, Hobart, Australia Background and Aims: This systematic review compares methodologies and neuropsychological test profiles in euthymic bipolar disorder type I (BD–I) and in pre-surgical focal seizures arising from the temporal lobes (FS). Bipolar disorder and FS overlap in domains including epidemiology, treatment response, shared neurotransmitter involvement and temporal lobe pathology. Methods: Following the PRISMA guidelines a search of PubMed, PsychINFO and Scopus was conducted. Results: Fifty-nine studies were included: 26 pertained to BD–I and 33 to pre-surgical FS. Consistent deficits in BD–I were executive function, attention span and verbal memory. In FS, deficits were in verbal memory in left temporal lobe (LTL) and less consistently visuo-spatial memory in right temporal lobe (RTL) epilepsy. The study had several limitations as the reviewed research in BD–I included the use of comprehensive test batteries in well defined euthymic patients compared to matched healthy control groups. By contrast FS studies used convenience samples in pre- to postsurgical comparisons, in addition to LTL and RTL subgroups. FS studies typically utilized a narrow range of known temporal lobe mediated neuropsychological functions, including tests of verbal and visuo-spatial memory. Conclusions: Comparison of cognitive function, in particular verbal memory, may assist in elucidating temporal lobe mediated processes in bipolar disorder.

P-044 The relationship between somatic pain and cognitive emotion regulation strategies in depression and anxiety disorder JH Chae, T Hyejin, H Hyujung Seoul St. Mary’s Hospital - The Catholic University of Korea, Psychiatry, Seoul, Korea Background and Aims: Affective state and emotion regulation strategies have been considered as an important factor which influence on the pattern and severity of somatic pain. The aim of this study is to investigate the relationship between somatic pain and cognitive emotional regulation strategies in depression and anxiety. Methods: A total of 140 outpatients diagnosed with depression and/or anxiety disorders according to DSM IV-TR, were evaluated with Beck Depression Inventory(BDI), State-Trait Anxiety Inventory(STAI), Cognitive Emotion Regulation Questionnaire (CERQ), Numerical rating scale(NRS) about somatic pain. Pearson correlation and independent t-test were performed to investigate the relationship between somatic pain, the severity of depression and/or anxiety and cognitive emotion regulation strategies. Results: The severity of pain was correlated with the severity of depressive symptoms (r = 0.229, p = 0.007), but not anxiety. Patients with somatic pain tend to use maladaptive cognitive emotion regulating strategies more frequently(t = 2.58, p = 0.01), especially rumination(t = 2.71, p = 0.008) and catastrophizing (t = 2.40, p = 0.018). Conclusions: These finding suggest that somatic pain is related with maladaptive cognitive emotional regulating strategies. Intervention modulating maladaptive cognitive emotion strategies especially rumination and catastrophizing would be newer approach of management to patients with depressive and/or anxiety disorders suffering from somatic pain.

P-045 Somatic comorbidity in a tertiary referral centre for bipolar disorders M Chrispijn, AW Stevens Dimence, Centre for Bipolar Disorders, Deventer, the Netherlands Background and Aims: Bipolar disorder is often accompanied by somatic comorbidity, which is mainly caused by the use of psychopharmacological agents (mood stabilizers, antidepressants and antipsychotics). Considering the large scope of side effects that is caused by these agents we wanted to evaluate the occurrence of somatic comorbidity in a cohort of patients with bipolar disorder in a tertiary referral centre. Methods: We collected data from patients that are under treatment in the tertiary referral centre ‘Centre for Bipolar Disorders’ (SCBS). We included patients with type I and type II bipolar disorder, cyclothymia, and schizoaffective disorder (bipolar type). Patients with no available data or with another diagnosis were excluded, as well as patients who were not under treatment of SCBS. We searched in electronic patient records and in electronic prescription software. Results: We included 97 patients (72% female). Some 71% uses lithium, 51% another mood stabilizer, 47% an antipsychotic, and 34% an antidepressant. In this group, 35% of patients suffers from thyroid disease and 25% uses thyroid drugs. Furthermore, 6% suffers from chronic kidney disease and 5% from nefrogenic diabetes insipidus. In the laboratory results we found that 27% of patients has hyperglycaemia and 8% (7/88) has hypercholesterolaemia. However, 74% (57/77) had elevated LDL cholesterol. Finally, 58% was overweight (BMI ≥ 25). The latter was associated with antidepressant use, but not with use of antipsychotics or lithium.


83

18th Annual ISBD & 8th Biennial ISAD Conclusions: This study shows that somatic comorbidity occurs in a high proportion of patients with bipolar disorder. A greater part of the cohort was overweight, this was associated with antidepressant use.

P-046 Neuroinflammation and genesis of affective symptoms in multiple sclerosis: integrating evidence from TSPO PET and resting state FMRI A Colasantia, Q Guob, P Giannettic, M Wallb, R Newbouldb, C Bishopb, M Onegab, R Nicholasd, O Ciccarellie, P Muraroc, O Malikd, D Owenc, A Younga, R Gunnb, P Piccinic, P Matthewsc, E Rabinerb a Institute of Psychiatry, Centre for Affective DisordersPsychological Medicine, London, United Kingdom, bImanova, Centre for Imaging Sciences, London, United Kingdom, cImperial College London, Brain Sciences, London, United Kingdom, d Imperial College London, Imperial College NHS Healthcare Trust, London, United Kingdom, eDepartment of Neuroinflammation, UCL Institute of Neurology, London, United Kingdom Background and Aims: PET with TSPO radioligands enables the characterisation of microglial activation in vivo in patients with neuroinflammatory conditions. To evaluate the mechanistic basis for an association between hippocampal neuroinflammation and depression in multiple sclerosis, we explored the relationships between depressive symptoms, hippocampal microglial activation measured with the second generation TSPO radioligand [18F]PBR111, and hippocampal functional connectivities defined by resting state fMRI. Methods: Eleven patients with multiple sclerosis and 22 healthy controls underwent [18F]-PBR111 PET and fMRI scanning on the same day. The Distribution Volume Ratio (DVR) of [18F]-PBR111 in the hippocampus was estimated as an index of activated microglia density. For the analysis of functional connectivity, the hippocampus was used as the seed region. Results: The hippocampal [18F]-PBR111 DVR in MS patients was higher relative to healthy controls and was correlated with the intensity of depressive symptoms. The strength of hippocampal functional connectivity to prefrontal regions, including the subgenual cingulate, and parietal regions, such as posterior cingulate and precuneus, correlated with both depressive symptoms and [18F]PBR111 DVR. Conclusions: The integration of TSPO PET and resting state fMRI allowed the exploration, in the living human brain, of the mechanisms underlying the association between hippocampal neuroinflammation and manifestation of affective symptoms in patients with multiple sclerosis. Our results indicate that hippocampal microglial activation in MS impairs the brain functional connectivities in regions contributing to maintenance of a normal affective state. The application of this experimental paradigm may have broader implications for characterizing the role of neuroinflammation in the genesis of affective disorders more generally.

P-047 Seasonal metabolic changes in Mexican outpatients with bipolar disorder

A Diaz-Anzalduaa, Y Ocampo-Mendozab, JO Hernandez-Lagunasb, C Becerra-Palarsc, C Berlanga-Cisnerosb, A Dıaz-Anzalduab a Instituto Nacional de Psiquiatrıa ”Ram on de la Fuente Mu~ niz”, Consulta Externa- Servicios Clınicos, Mexico City, Mexico, b Instituto Nacional de Psiquiatrıa ”Ram on de la Fuente Mu~ niz”, Subdivisi on de Investigaciones Clınicas, Mexico City, Mexico, c Instituto Nacional de Psiquiatrıa ”Ram on de la Fuente Mu~ niz”, Clınica de Trastornos del Afecto- Servicios Clınicos, Mexico City, Mexico

84

Background and Aims: Metabolic comorbidities are frequent in patients with bipolar disorder. Seasonal changes could influence metabolic parameters in these patients. Our aim was to compare metabolic risk in outpatients with bipolar disorder in summer and winter in Mexico City. Methods: We evaluated 84 individuals during summer (38 patients with bipolar disorder I or II and 46 first-degree relatives). Followup in winter included 49 individuals (25 patients with BD and 24 relatives). Informed consent was obtained and participants were evaluated with SCID-I. Body measurements were recorded and biochemical analyses were carried out. Results: In female patients, mean values of HDL, LDL, and triglycerides fell within the range of risk for metabolic syndrome. During winter, only LDL values fell within that range, but increased significantly with respect to summer (p = 0.05). For male patients, LDL and triglycerides were within the range of risk both in summer and winter. In winter, mean HDL values were also within that range. Leptin levels were high (≥19 ng/mL) in both seasons in women, and in winter in men. In relatives, mean values changed seasonally, but they did not fall within the range of metabolic risk. Conclusions: There were seasonal differences in mean values related with metabolic risk in outpatients with bipolar disorder. While there were changes in first-degree relatives, mean values did not represent a higher risk for metabolic syndrome.

P-048 Clinical correlates of general medical comorbidities in bipolar disorder F Gomesa, M Kunzb, P Magalhaesb, F Kapczinskib a Universidade de Brasilia, Hospital Universitario de Brasilia, Brasilia, Brazil, bUniversidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil Background and Aims: To evaluate clinical correlates of general medical comorbidities in outpatients with bipolar disorder (BD). Methods: We performed a cross-sectional study of 203 patients with DSM-IV BD, 18 years or older, consecutively recruited from the Bipolar Research Program (PROTAHBI) in Porto Alegre. Clinical, demographic and anthropometrical variables were systematically assessed and General medical comorbidity was measured by means of the Cummulative Illness Rating Scale (CIRS). Results: The prevalence of at least one medical comorbidity was 90.1% and the most common comorbidities were from endocrinemetabolic-breast, neurologic and vascular categories. The mean number of CIRS categories endorsed by BD patients (CIRS count) was 2.18 1.27 [0–6] and the mean CIRS total score of the sample was 4.02 2.54 [0–10]. A high burden of general medical comorbidities (CIRS total score ≥ 4) was related to increasing age and body mass index and longer duration of illness after controlling for confounding factors. Conclusions: BD is associated with a high burden of general medical conditions related to age, obesity and longer duration of illness. Medical comorbidity must be incorporated as a core feature in the development of effective treatment strategies for bipolar disorder.

P-049 The relationship between sleep and rhythm disturbances and inflammation in bipolar disorder R Gonzaleza, S Gonzalezb, A Foreroc a Texas Tech University Health Science Center, Psychiatry, El Paso, USA, bBiomedical Sciences, El Paso, USA, cUSA Background and Aims: Sleep and rhythm disturbances have been associated with bipolar disorder. Inflammation may play a


13-16 July, Amsterdam, the Netherlands significant role in the pathophysiology of the illness. We designed a study to explore the relationship between sleep and rhythm disorders as measured via actigraphy and plasma markers of inflammation. Methods: 40 subjects with a diagnosis of bipolar type I disorder (BDI) were included in the study. Young Mania Rating Scale and the 30-item Inventory of Depressive Symptomatology were used to determine mood state. Actigraphy was used to collect locomotor activity data for 7 days. Cosinor analysis was used to calculate amplitude and mesor with goodness-to-fit omega calculated as an estimate of how well the cosinor model fit the actigraph data. Total sleep time and percentage of the observational period scored as sleep was calculated. C-reactive protein was measured via ELISA. Cytokines were measured via fluorescent bead human cytokine immunoassay. Multivariate analysis was conducted to assess the relationships between sleep and rhythm variables and inflammatory biomarkers with mood state, medication status, and blood sampling draw time included in the modeling as possible cofactors. Results: After Bonferroni correction for multiple testing, amplitude was found to be significantly associated with IL-17 (regression coefficient = 3.12, p = 0.008) and IL-8 (regression coefficient = 2.95, p = 0.008). Other nominally significant associations were also noted. Conclusions: These results suggest that sleep and rhythm characteristics may be associated with inflammation in bipolar disorder. Longitudinal studies are required to fully characterize the relationships between sleep and rhythm disturbances and inflammation in BDI.

P-050 Comorbid migraine in major depressive disorder suggests a subgroup related to bipolar disorder K Gordon-Smitha, S Knotta, A Perrya, L Fortyb, N Craddockb, I Jonesb, L Jonesa a University of Worcester, Psychological Medicine, Worcester, United Kingdom, bCardiff University, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom Background and Aims: Previous small-scale studies suggest presence of migraine in major depressive disorder (MDD) is associated with specific clinical characteristics that may overlap with those of bipolar disorder. We aimed to compare a broad range of characteristics in participants who have MDD with and without migraine, and to explore possible similarities between those characteristics associated with the presence of migraine in MDD and those in bipolar disorder in a large UK sample. Methods: Lifetime and episodic clinical characteristics and affective temperaments in DSM-IV MDD with (n = 134) and without (n = 218) migraine were compared. Characteristics associated with the presence of migraine were then compared with a sample of participants with DSM-IV bipolar disorder (n = 407). All participants were recruited into the Bipolar Disorder Research Network (www.bdrn.org). Results: The presence of migraine in MDD was associated with female gender (76.9% vs 56.9%, p < 0.001), younger age of onset (23 vs 27 years, p = 0.002), history of attempted suicide (38.3% vs 22.7%, p = 0.002), and more panic/agoraphobia symptomatology (6 vs 4, p < 0.001). Female gender (OR = 2.44, p = 0.006) and younger age of onset (OR = 0.97, p = 0.013) remained significant in a multivariate model. These clinical characteristics were not significantly different to those of our participants with bipolar disorder. Conclusions: The presence of migraine in MDD delineates a subgroup of individuals with a more severe illness course. The clinical presentation of this subgroup more closely resembles that of

bipolar disorder than that of MDD without migraine. The presence of migraine in major depression may be a marker of a specific subgroup that could be useful in future research.

P-051 Adverse renal, endocrine, hepatic and metabolic events during maintenance mood stabilizer treatment for bipolar disorder: a population based cohort study J Hayesa, L Marstonb, K Waltersb, J Geddesc, M Kinga, D Osborna a University College London, Division of Psychiatry, London, United Kingdom, bDepartment of Primary Care and Population Health, University College London, London, United Kingdom, cDepartment of Psychiatry, University of Oxford, Oxford, United Kingdom Background and Aims: There is limited, poorly characterized, information about adverse events occurring during maintenance bipolar disorder treatment. We aimed to determine adverse event rates during treatment with lithium, valproate, olanzapine and quetiapine. Methods: A propensity score adjusted cohort study using nationally representative electronic health records. Included patients had diagnosed bipolar disorder and were prescribed lithium (N = 2,148), valproate (N = 1,670) olanzapine (N = 1,477) or quetiapine (N = 1,376) as maintenance mood stabilizer treatment. Averse outcomes were chronic kidney disease, thyroid disease, hypercalcaemia, weight gain, hypertension, diabetes mellitus, cardiovascular disease and hepatotoxicity. Results: Patients prescribed lithium had increased rates of ≥chronic kidney disease stage 3 (valproate HR 0.59; 95% CI: 0.47–0.72, olanzapine HR 0.54; 95% CI: 0.43–0.67, quetiapine HR 0.69; 95% CI: 0.53–0.88), hypothyroidism (valproate HR 0.70; 95% CI: 0.50– 0.99, olanzapine HR 0.52; 95% CI: 0.36–0.77, quetiapine HR 0.60; 95% CI: 0.39–0.92), hyperthyroidism (valproate HR 0.24; 95% CI: 0.09–0.61, olanzapine HR 0.31; 95% CI: 0.13–0.73) and hypercalcemia (valproate HR 0.25; 95% CI: 0.10–0.60, olanzapine HR 0.32; 95% CI: 0.14–0.76, quetiapine HR 0.23; 95% CI: 0.07–0.73). However, rates of greater than 15% weight gain on lithium were lower (valproate HR 1.55; 95% CI: 1.28–1.86, olanzapine HR 1.64; 95% CI: 1.35–2.00, quetiapine HR 1.48; 95% CI: 1.16–1.87), as were rates of hypertension compared to olanzapine (HR 1.41, 95% CI: 1.06–1.87). We found no difference in ≥chronic kidney disease stage 4, diabetes mellitus, cardiovascular disease or hepatotoxicity rates. Conclusions: Lithium is associated with more renal and endocrine adverse events, but less weight gain than commonly used alternatives. Risks need to be offset with the effectiveness and anti-suicidal benefits of lithium, and potential metabolic side effects of alternative treatment options.

P-052 Does unhealthy lifestyle predict course of major depressive disorder? S Hiles, F Lamers, Y Milaneschi, B Penninx VU University Medical Center, Psychiatry, Amsterdam, the Netherlands Background and Aims: People with psychopathology often exhibit unhealthy lifestyle behaviours, however longitudinal associations are less clear. The aim of the current study was to examine whether unhealthy lifestyle behaviours – physical inactivity, alcohol misuse and smoking – were associated with the course of major depressive disorder (MDD) over 6 years. Methods: Participants were drawn from the Netherlands Study of Depression and Anxiety (NESDA; 18–65 years; N = 2,114; at baseline: 50.6% current MDD, 19.7% remitted MDD, 29.7%


85

18th Annual ISBD & 8th Biennial ISAD healthy controls). At baseline, 2, 4, and 6 years, participants completed a diagnostic interview and self-report questionnaires assessing physical activity, alcohol use (none, moderate, high) and current smoking. Course among participants with MDD at baseline was defined as remitted (remained without MDD during follow-up assessments), chronic (MDD consistently present during follow-up assessments) or intermediate (all other participants). Results: Consistently across the four assessment waves, lower activity levels, current smoking and no use of alcohol compared to moderate use were associated with a current or lifetime MDD diagnosis (p < 0.01). Preliminary analyses indicate that among participants with MDD at baseline, an increasing number of unhealthy lifestyle behaviours defined according to health guidelines was associated with lower risk of chronic course (RR = 0.82, p = 0.02) and increased risk of intermediate course (RR = 1.17, p = 0.002) compared with a remitted course. Examining behaviours individually indicated that physical activity level was primarily driving the findings. Conclusions: The implications of findings that unhealthy lifestyle distinguishes longitudinal course of MDD for practice and public health will be discussed.

P-053 Metabolic syndrome in sad: winter vs summer

S Kesebira, Y K€ußc€uksubasßıb, E Tatlıdil Yaylacıb a€ Usk€ udar University, Psychatry, Istanbul, Turkey, bErenk€ oy Mental and Neurological Disease Training and Research Hospital, Psychiatry, Istanbul, Turkey Background and Aims: The aim of this study was to examine the differentiation of frequency of metabolic syndrome (MetS) between winter and summer type of seasonal affective disorder (SAD). Methods: 32 winter and 42 summer type, totally 74 patients with SAD according to DSM-IV were evaluated in this study with Seasonal Pattern Assessment Questionnaire (SPAQ). The presence of the following three or more characteristics were selected based upon NCEP ATP III’s operational definition of MetS: (1) abdominal obesity (waist circumference), (2) hypertriglyceridemia, low HDL or being on an antilipidemic agent, (3) high blood pressure

or being on an antihypertensive agent, and (4) fasting hyperglycemia or being on antiglycemic agent. Results: Fifty seven patients had a MetS (77%). MetS was found to be more frequent in winter type of SAD (p = 0.005). Conclusions: Winter and summer type of SAD differ each other in terms of frequency of MetS.

P-054 Lithium induced hyperparathyroidism in lithium monotherapy: comparison of clinical properties of BD between before and after lithium monotherapy S Kesebira, E Tatlıdil Yaylacıb, F Akdenizc a€ Usk€ udar University, Psychiatry, Istanbul, Turkey, bErenk€ oy Mental and Neurological Disease Training and Research Hospital, Psychiatry, Istanbul, Turkey, cEge University, Psychiatry, Izmir, Turkey Background and Aims: The aim of the present study was to comparing of clinical properties of BD between patients with lithium induced hyperparathyroidism in lithium monotherapy and before lithium monotherapy. Methods: For this purpose 96 patients with bipolar disorder (BD) who have been on lithium monotherapy for at least 2 years were evaluated cross-sectional in terms of clinical properties of BD. Clinical properties were compared between two groups: with lithium induced hyperparathyroidism and without. Clinical properties were evaluated for two situation: before and after lithium monotherapy. Results: Subtype of depressive episode (melancholic subtype), number of manic episode and seasonality were differantiated in lithium induced hyperparathyroidism before lithium use (p = 0.041, 0.037, 0.025). Conclusions: In lithium monotherapy with lithium induced hyperparathyroidism, clinical properties of BD differantiated before and after.

Poster Session VEpidemiology P-055 National epidemiological survey on bipolar disorders (RENDIBI): preliminary data AC Altamuraa, G Mainab, A Fagiolinic, BM Cesanad, U Albertb, G Tacchinia a Fondazione IRCCS Ca’ Granda- Ospedale Maggiore PoliclinicoUniversity of Milan, Department of Psychiatry, Milan, Italy, b University of Turin- S. Luigi Gonzaga Hospital, Department of Neuroscience- Psychiatric Unit, Turin, Italy, cUniversity of Siena Medical Center, Department of Mental Health and Department of Molecular Medicine, Siena, Italy, dUniversity of Brescia, Department of Molecular and Translational Medicine, Brescia, Italy Background and Aims: Bipolar disorder (BD) is related to high disability rates and significant social costs. The aim of the survey was to collect the main socio-demographic and clinical variables of bipolar patients referring to Italian public psychiatric services. The survey was conducted with the support of the Italian ISBD section. Methods: Each centre enrolled 20–50 bipolar subjects over a 3months-period, for three times between 2014 and 2015. Patients

86

underwent a diagnostic (MINI) and psychometric assessment (HAM-D, HAM-A, YMRS, Mood Insight Scale, CGI). Statistical descriptive analyses were performed. Results: Twenty-eight centres collected 1,674 patients (M = 714, F = 960, mean age 48.7 + 13.5 SD years). A positive psychiatric family history was found in 9.2%. The duration of illness was 17 + 12.6 SD years, whereas the age at first BD episode was 31.3 + 12 SD years, comparable to the age at first contact with a mental health service. The predominant polarity over the course of illness was depressive in 47.3% of cases, followed by manic polarity (26.2%). A similar pattern of frequency was reported for the first BD episode. First psychiatric diagnosis was formulated at 30.6 + 11.9 SD years, being more frequently Major Depressive Disorder (43.9%) and BD (32.7%). Patients received the first BD diagnosis and appropriate treatment around 37.4 + 13.4 SD years. Conclusions: BD is often related to a delayed diagnosis and, frequently, treatment is limited to acute phases rather than be aimed to long-term mood stabilization. Therefore, a raised awareness among psychiatric services is needed in order to detect and treat earlier the disorder.


13-16 July, Amsterdam, the Netherlands P-056 Rates and predictors of recurrence and conversion to bipolar disorder after the first lifetime episode of depression. A 5-year followup study J Bukha, P Andersenb, L Kessinga a Psychiatric Center Copenhagen, Department O, Copenhagen, Denmark, bUniversity of Copenhagen, Faculty of Health SciencesDept. Of Biostatistics, Copenhagen, Denmark Background and Aims: The long-term course of illness after first episode depression remains to be clarified. The present study aimed to determine the rates of recurrence of depression and conversion to bipolar disorder, respectively, in a 5 year period following the first lifetime depressive episode, and to assess clinical and demographic predictors of these outcomes. Methods: A total number of 301 in- and outpatients aged 18– 70 years with a validated diagnosis of a single depressive episode were systematically recruited from 2005 through 2007. Clinical characteristics of the first depressive episode, psychiatric co-morbidity, treatment history, and family history of psychiatric disorders were assessed by semi-structured interviews. A total of 264 study participants were reassessed at the five-year follow-up. The longitudinal course of illness was established by the Life Chart Method and diagnostic interviews. Results: A total of 31.3% of the patients with remission from first episode depression experienced recurrence of depression within 5 years, and 8.6% developed bipolar disorder within 5 years after discharge from in- or outpatient psychiatric hospital care.The rate of recurrence increased with severity and treatment resistance of the first depression, and a comorbid cluster C personality disorder. The rate of conversion to bipolar disorder increased with treatment resistance of the first depression, a family history of affective disorder, comorbid alcohol or drug abuse, and a higher level of extraversion. Conclusions: The identified clinical predictors of the course of illness following the first lifetime episode of depression should guide patients and clinicians for the long-term individualised treatment.

P-057 Evaluation of mortality causes among bipolar patients in a specialized mood clinic

A Cansiza, B _Incea, K Altinbasßb, E Kurta a Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry- Neurology and Neurosurgery, Department _ of Psychiatry, Istanbul, Turkey, bFaculty of Medicine- C ß anakkale Onsekiz Mart University, Department of Psychiatry, C ß anakkale, Turkey Background and Aims: It is a well-known fact that bipolar disorder is associated with premature mortality. Also investigations confirm that the patients with bipolar disorder have elevated all-cause mortality rates in the general population. Nonetheless, cardiovascular diseases and suicide are seemed to be the most common causes. We aimed to evaluate the death causes among bipolar patients in a specialized mood clinic in Turkey. Methods: Causes of deaths of 22 (1.5%) bipolar patients among 1,500 patients with mood disorders followed since 2003 in Rasßit Tahsin Mood Clinic in Turkey were presented. Results: The mean age of the 22 patients (14 female, 8 male) was 49.2 13 years (min: 27 max: 68) and the mean disease duration was 23.2 13.5 years. The mean onset age was 26 12.9 and juvenile onset (age ≤18 years) involved 36.3% of subjects (n = 8). 12 of the 22 the patients (54.5%) were died from circulatory and respiratory diseases while the causes were suicide (n = 5, 22.7%), lithium intoxication (n = 2, 9.1%), traffic accident (n = 1, 4.5%)

agranulocytosis-related infection (n = 1, 4.5%), and brain cancer (n = 1, 4.5%) for remaining Conclusions: Our findings are consistent with literature that two out of three were died from cardiovascular and respiratory disease and suicide. Preventive strategies such as early diagnosis of chronic medical conditions, monitoring the side- effects of the treatment agents, quitting smoking, regular diet, examining ideas about suicide and self-harm behaviors are useful to reduce excess mortality in bipolar patients.

P-058 A pro-inflammatory diet is associated with increased risk of de novo depression at 5-year follow up in Australian women S Dasha, S Nitinb, J Hebertb, A O’Neilc, S Quirkd, A Stuartd, L Williamsd, J Pascod, F Jackad a Australia, bUniversity of South Carolina, Cancer Prevention and Control Program, Columbia, USA, cThe University of Melbourne, Melbourne School of Population and Global Health, Melbourne, Australia, dDeakin University, IMPACT SRC, Geelong, Australia Background and Aims: Diet quality is positively associated with mental health, and systemic inflammation is posited as an explanatory factor. Evidence suggests that diets associated with systemic inflammation are also associated with the risk for depression. This study aimed to investigate the association between a dietary pattern characterised by inflammation, measured by “dietary inflammatory index (DII)”, and the risk for de novo depressive disorders (DD) in a randomly selected, population-based sample of women. Methods: The sample comprised 579 women from the Geelong Osteoporosis Study for whom the required dietary and psychiatric data were available, and who had no history of DD. Baseline DIIs were derived from validated food frequency questionnaires, and de novo DD 5 years later was assessed using gold-standard clinical interviews. Logistic regression was used to assess the odds for de novo DD at the five-year follow up as a function of DII scores at baseline, before and after controlling for age, physical activity, smoking, socioeconomic status, education and anti-inflammatory medication use. Results: Sixty-eight cases of de novo DD were identified at five-year follow up. Each one standard deviation increase in DII at baseline was associated with an approximate 40% increase in the likelihood of de novo DD at five-year follow up, before (OR: 1.43, 95% CIs: (1.08–1.90) and after adjustments (OR: 1.39, 95% CIs: (1.04, 1.86). Conclusions: A pro-inflammatory dietary pattern may be a risk factor for de novo DD in women. Immune dysfunction arising from unhealthy diet may, at least in part, be an explanation for the associations observed between diet quality and mental health.

P-059 Arterial stiffness but not carotid atherosclerosis is associated with depressive symptom dimensions R de Miranda Azevdoa, AM Roesta, N Groenewolda, B Penninxb, P de Jongea a University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotional Regulation, Groningen, the Netherlands, bVU Medical Center, Psychiatry, Amsterdam, the Netherlands Background and Aims: Arterial stiffness (AS) and carotid atherosclerosis (CA) are potential mechanisms explaining the association between depression and heart disease. However, the association may be bidirectional and recent evidence suggests that markers of CA are prospectively associated with depression in the elderly. Nonetheless, this association still needs to be prospectively


87

18th Annual ISBD & 8th Biennial ISAD investigated in younger participants. The objective of this study was to assess the association between markers of AS and CA with symptom dimensions of depression in adults. Methods: The sample included 649 depressed and non-depressed participants enrolled in the Netherlands Study of Depression and Anxiety (NESDA). CA was represented by carotid intima-media thickness and presence of plaque, AS was represented by augmentation index. Both were measured at the third time-point. Depressive symptoms were measured at the same time-point and 1 year and 2 years later with the Inventory of Depressive Symptoms SelfReport. Mood/cognition and anxiety/somatic symptom dimensions were used. Data was analyzed with linear mixed models. Interaction terms between predictors and time assessed significant prospective changes in depressive symptoms. Results: Augmentation index was positively associated with increased overall mood/cognition (+0.08; SE = 0.003; p = 0.005) and anxiety/somatic symptoms (+0.03; SE = 0.002; p = 0.003). The remaining predictors were not associated with depressive symptom dimensions. Interaction terms between predictors and time were not significant. Conclusions: AS, but not CA, was significantly associated with both symptom dimensions. This association was constant and did not change over time. Arterial stiffness and carotid atherosclerosis does not seem to have a short-term effect on the progression of depressive symptoms. Future studies should assess this association using a longer follow-up time.

P-060 Risk of mood and psychotic disorders in the UK according to month of birth L Forty Cardiff University School of Medicine, Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom Background and Aims: Although the literature on birth month and risk of schizophrenia is extensive, fewer studies have focused on affective disorder or taken account of diagnostic subtype or clinical features. The aim of the current study was to (i) compare birth month in large samples of patients with mood and psychotic disorders with the general population and (ii) examine clinical features of bipolar illness according to birth month. Methods: Participants (N = 5,307) were included if they met DSMIV criteria for bipolar I disorder (BDI N = 3,067), bipolar II disorder (BDII 986), schizophrenia (SCZ N = 516) or major depressive disorder recurrent (MMDR N = 738). Patients were compared to 38,261,966 general population births between 1938 and 1991 from the UK Office for National Statistics (http://www.ons.gov.uk/). Results: Patients in the SCZ and BPI groups were more likely to be born during the winter (SCZ; December, Odds Ratio [OR]: 1.45, p = 0.007: bipolar I; February OR: 1.58, p = 0.012). Patients in the BPII and MDDR groups were more likely to be born during the spring/summer (BPII; June OR: 1.30, p = 0.012: MDDR; May OR: 1.29, p = 0.030; July OR: 1.30, p = 0.028). Data exploring the relationship between birth month and clinical characteristics of BD will also be presented. Conclusions: These findings are in agreement with previous studies finding a winter excess of births in patients with schizophrenia. Our study found that patients with BPI similarly show a winter excess of births, but that patients with BPII show a summer excess of births that is more similar to that seen in MDDR patients.

88

P-061 The predictive effect of the DSM-5 anxious distress specifier on treatment outcomes in persons with major depressive disorder R Gaspersza, F Lamersa, J Kentb, A Beekmana, J Smita, A van Hemertc, R Schoeversd, B Penninxa a VUMC, Psychiatry, Amserdam, the Netherlands, bJanssen Research & Development, Janssen Research & Development, LLCTitusville- NJ, USA, cLeiden University Medical Center, Psychiatry, Leiden, the Netherlands, dUniversity Medical Center Groningen, Psychiatry, Groningen, the Netherlands Background and Aims: While the DSM-5 anxious distress specifier is capturing a clinically valid construct, no evidence exists for its predictive effect on treatment outcomes. We examined the predictive effect of the anxious distress specifier on remission, depression severity and frequency of antidepressant side effects over a 2-year period in persons with MDD on antidepressant treatment. Methods: Patients were from the Netherlands Study of Depression and Anxiety, an ongoing longitudinal cohort study. Baseline, 1year and 2-year follow-up data from 149 patients (18–65 years) with current MDD on adequately dosed antidepressant treatment were used. The DSM-5 anxious distress specifier was constructed by five matching self-report items. Subsequent treatment outcomes were remission, measured by diagnostic status after 2 years, depression severity after 1 year and 2 years, and side effects measured in the period from baseline to 2-year follow-up. For comparison, analyses were repeated for comorbid DSM-IV-based anxiety disorders as predictor. Results: The anxious distress specifier predicted lower remission rates (OR = 0.44, p = 0.05), higher severity (1 year: B = 3.23, p < 0.001; 2 years: B = 2.72, p = 0.001) and greater frequency of side-effects (≥4 vs. 0: OR = 2.74, p = 0.06). The specifier predicted treatment outcomes better than anxiety disorders as predictor. Conclusions: The anxious distress specifier is associated with poorer treatment outcomes as shown by lower remission rates, higher depression severity and greater frequency of antidepressant side effects in patients with MDD on adequate antidepressant treatment. Interestingly, this simple 5-item specifier performed better as a predictor than does extensively diagnosed DSM-IV-based anxiety disorders, making this specifier a quick assessment which is of great clinical usefulness.

P-062 A study on demographic and clinical profile of patients with unipolar versus bipolar depression P Khurana Guru Teg Bahadur Hospital, Psychiatry, Ludhiana, India Background and Aims: Background: Studies in the past have identified significant differences between bipolar (BP) and unipolar depression (UP). Failure to diagnose BP depression results in partial resolution of symptoms, manic switch, mixed state, or accelerated cycling. This study compares various demographic, longitudinal course, and psychopathology associated with BP and UP depression. Methods: Materials and Methods: 40 UP and 40 BP depression patients were compared using a semi-structured proforma, Diagnostic and Statistical Manual of Mental Disorder fifth edition, Hamilton Rating Scale for Depression-21, Hypomania/Mania Symptom Checklist (HCL-32), Brief psychiatric rating scale, and Kuppuswami’s socioeconomic status scale. Results: BP depression group comprised of mostly males, with earlier age of onset of illness, longer illness duration, frequent episodes, hospitalizations and psychotic symptoms. The total HAMD score and four HAM-D item scores–psychomotor retardation,


13-16 July, Amsterdam, the Netherlands insight, diurnal variation of symptoms and its severity, and paranoid symptoms were significantly higher in BP depression group. Statistical analysis identified the age of onset, the total duration of illness, frequency of affective episodes, and presence of psychotic symptoms as predictors of bipolarity. Conclusions: There is need to identify clinical markers of bipolarity from large scale prospective studies.

P-063 Predictive value of inflammatory markers on 2-year depression course and onset: an epidemiological approach F Lamersa, G van Grootheesta, G Wittenbergb, JH Smita, B Penninxa a VU University Medical Center, Psychiatry, Amsterdam, the Netherlands, bJanssen R&D LLC, Neuroscience, Titusville- NJ, USA Background and Aims: Major depressive disorder (MDD) a biologically heterogeneous illness. Patients with elevated cytokines have garnered interest as a putative MDD subtype for personalized therapy. Here, we explore whether levels of C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Tumor Necrosis Factor alpha (TNF-a) at baseline can predict 2-year patient outcomes in the Netherlands Study of Depression and Anxiety (NESDA). Methods: From NESDA, we selected 835 persons with a current MDD at baseline and 565 persons free of current disorders at baseline. IL-6, CRP and TNF-a were assessed at baseline. The 2-year follow-up (FU) included the CIDI diagnostic interview and the percentage of time between baseline and follow-up with depressive symptoms (Life chart method). Within current MDD subjects, models were fit to predict chronicity of depression (MDD at FU and percentage of FU time with symptoms). Within control subjects, models were fit to predict new MDD onset at FU. Models were adjusted for age, sex, education level, lifestyle factors, including BMI, and drug use. Results: Baseline IL-6 was a significant predictor of chronic depression, even after adjustment for covariates (OR 2-yr MDD = 1.16, 95% CI: 1.002–1.35, p = 0.048; B IL-6 for percentage of time with symptoms = 0.042, p = 0.006). None of the markers however, predicted onset of depression. Conclusions: This is one of the first studies evaluating the predictive effect of inflammatory markers on subsequent depression diagnoses. While we could not confirm longitudinal studies finding effects of CRP on subsequent depressive symptomatology, we found that IL-6 may hold promise as a predictor of disease trajectory in MDD patients.

P-064 Mood variability and reactivity in bipolar spectrum disorders: an ecological momentary assessment study F Lamersa, J Swendsenb, L Cuic, V Zipunnikovd, M Huskye, K Merikangasc a VU University Medical Center, Psychiatry, Amsterdam, the Netherlands, bUniversity of Bordeaux, PSL Research University, Bordeaux, France, cNIMH, Genetic Epidemiology Research Branch, Bethesda, USA, dJohns Hopkins Bloomberg School of Public Health, Biostatistics, Baltimore, USA, eUniversity of Bordeaux, Laboratoire de Psychologie, Bordeaux, France Background and Aims: Ecological Momentary Assessment (EMA) is an important tool in identifying mood fluctuations that may characterize specific types of mood disorder. We evaluated differences in mood disorder groups in emotional reactivity to daily events, and variability in the intensity and tonality of emotional states.

Methods: Participants with bipolar I disorder (BP-I; n = 33), bipolar II disorder (BP-II; n = 37), major depressive disorder (MDD; n = 116), anxiety disorders without comorbid mood disorders (n = 36) and unaffected controls (n = 65) completed 2 weeks of EMA measuring emotional status (sad & anxious mood) and daily event occurrence (positive-negative-neutral). All analyses were corrected for age and sex. Results: Individuals with BP-I disorder experienced a significantly greater decrease in sad and anxious mood following positive events than controls. By contrast, individuals with BP-II, MDD or anxiety disorders experienced greater increases in anxious mood than controls specifically following negative events. The BP-II group showed the greatest variability in mood states. Compared to controls, significantly increased variability was observed in BP-II, MDD and anxiety disorders for both sad and anxious moods, and in BP-I for anxious mood. Conclusions: The findings suggest that mood variability is a nonspecific characteristic of diverse forms of psychopathology. However, the finding that people with BP-I have greater reactivity to positive events, whereas those with BP-II, MDD and anxiety have greater reactivity to negative events provides further support for distinguishing these subtypes. Future research is needed to examine whether reactivity patterns comprise an endophenotype that indexes heterogeneity of bipolar spectrum disorders.

P-065 How well does the HCL-32 work in a population sample? findings from the ‘PsyCoLaus’ study

T Meyera, E Castelaoa, M Preisigb a University of Texas at Houston, Houston, USA, bLausanne University, Lausanne, Switzerland

The screening properties of the Hypomania Checklist-32 (HCL-32) for bipolar disorders (BD) has been evaluated in several studies showing that it does well in the setting for which it has been developed for, i.e. identifying potential bipolar disorders in depressed patients or mood disorder specialty clinics. The HCL-32 still did sufficiently well in detecting potential BD in the studies which had excluded patients with known BD (Meyer et al., 2014). However, it has not been tested if it could even been used in the general population to screen for BD. Using the sample of the PsyCoLaus study, a population-based survey on psychiatric disorders (Preisig et al., 2009), we will present results about how good the HCL-32 is suited to identify BD outside of mental health clinic settings.

P-066 Subthreshold bipolar symptomatology in MDD ~o Paulo megacity population-based in the Sa study D Morenoa, LH Andradeb a Mood Disorders Unit GRUDA Institute of Psychiatry, Faculty of Medicine- University of S~ ao Paulo, Brazil, bSection of Epidemiology Institute of Psychiatry, Faculty of Medicine- University of S~ ao Paulo, Sao Paulo, Brazil Background and Aims: Background: The presence of manic symptoms in Major Depressiver Disorder (MDD) may increase the morbimortality and point to the need of using mood stabilizing agents.Aims: estimate prevalence and characteristics of subthreshold manic syndrome (mSND) and manic symptoms (mSMP) in MDD subjects in a population-based sample, and to compare these groups with bipolar disorder subjects. Methods: Sample of DSM5-WHOCIDI-MDD subjects (N = 844) from the S~ao Paulo Megacity Mental Health Survey, part of the WHO World Mental Health Survey Initiative (≥18 years; N = 5,037) conducted in the metropolitan area of S~ao Paulo,


89

18th Annual ISBD & 8th Biennial ISAD Brazil. Two bipolar subthreshold groups were created and compared to MDD without any manic symptoms: mSND (presence of modified manic/hypomanic DSM5 criteria A defined as increased activity/energy and/or elated and/or irritable mood plus 3 or 4 of 7 criteria B symptoms, respectively) and mSMP (MDD with any manic symptoms). DSM5 Bipolar Disorder criteria were considered. Results: Prevalence of MDD without any manic symptoms (N = 619), mSMP (N = 161) and mSND (N = 104) was respectively 11.4% (SD = 0.6), 3.1% (SD = 0.3), and 2.4% (SD = 0.3) with a full manic syndrome. MDD with manic symptoms and MDD with a full manic syndrome cases were not detected by DSM5 criteria. Lifetime prevalence of DSM-5 bipolar-broad in our sample (98 cases) was 2.1% (SD = 0.2). Course of depression, age of onset, family history of mood, anxiety, substance use disorders, comorbidity, and suicide attempts in each will be presented. Conclusions: Similarly to findings in the Zurich Study cohort, a considerable proportion of bipolarity was not detected by current DSM criteria.

P-067 Age at onset, delayed diagnosis and suicide attempts among patients with bipolar disorder in Fortaleza, the fifth largest city of Brazil

J Nascimentoa, S Souza Juniorb, F Souzac a Christus University Center, Faculty Of Medicine, Fortaleza, Brazil, b University of Fortaleza, Faculty of Medicine, Fortaleza, Brazil, c Federal University of Ceara, Clinical Medicine Department, Fortaleza, Brazil Background and Aims: To study suicide attempts (SA), age at onset (AAO) and delayed diagnosis (DD) in Bipolar Disorder (BD). Methods: A structured questionnaire containing topics about sociodemographic data and suicide attempts was applied in 135 patients with BD (according to DSM-5), followed by a University Hospital in Fortaleza. SA were stratified in 3 groups: (a) no SA (n = 78); (b) 1 to 3 (n = 39); (c) 4 or above (n = 11). The AAO was divided into three groups: (1) up to 18 years (n = 46); (2) 19–30 (n = 49); (3) 31 or above (n = 33). DD was structured into 3 groups: (a) no DD (n = 32); (b) up to 10 years after the onset (n = 41); (c) 11 years or more (n = 27). SPSS was used. Results: A statistically significant relationship between the AAO of BD and the number of suicide attempts was found (v2 = 10.280; p = 0.036). While 63% (n = 7) of them with at least 4 suicide attempts have reported their onset before 18 years old, 31% (n = 24) of the patients without any suicide attempt have their onset later (after 31 years old). Delayed diagnosis and type of onset were also statistically significant (v2 = 9.031; p = 0.050). 36% (n = 21) of patients with depressive episode in the onset had a delay of at least 11 years their diagnosis, while only 15% (n = 4) of them with manic episode had the same delay. Conclusions: Older age is associated with last suicide attempts. Depressive episodes has a huge delay in diagnosis compared with manic episodes.

P-068 Psychiatric hospitalizations, presence of psychosis in the onset and delayed diagnosis among patients with bipolar disorder in Fortaleza, the fifth largest city of Brazil

Background and Aims: To study psychiatric hospitalizations (PH), presence of psychosis at illness onset and delayed diagnosis (DD) in Bipolar Disorder (BD). Methods: A structured questionnaire containing topics about sociodemographic data, DD, PH and characteristics about the onset of BD was applied in 135 patients with BD (according to DSM-5), followed by a University Hospital in Fortaleza. The number of PH was stratified in 3 groups: (a) no psychiatric hospitalization (n = 68); (b) 1–3 (n = 37); (c) 4 or above (n = 15). DD was structured into 3 groups: (a) no DD (n = 32); (b) up to 10 years after the onset (n = 41); (c) 11 years or more (n = 27). Psychosis in the onset was related by 51 patients. SPSS was used. Results: A statistically significant relationship between the number of PH and the presence of psychosis at the onset of BD was found. Sixty-five percent (n = 33) of them with psychosis at the onset related at least one PH compared to only 35% (n = 28) of patients without psychosis (v2 = 11.436; p = 0.001). In patients with 11 or more years of DD, 28% (n = 10) of them related at least 1 PH, compared to 45% (n = 17) did not relate PH (v2 = 5.851; p = 0.050). Conclusions: An important correlation between number of PH and presence of psychosis in the onset of BD was found. In this sample, DD is not associated with a higher number of PH. This fact may be related to the less severity of index episodes.

P-069 Relationships between first intercourse, use of condom, gender and school years in patients with bipolar affective disorder in the fifth largest city of Brazil J Nascimentoa, S Souza Juniorb, F Souzac a Christus University Center, Faculty Of Medicine, Fortaleza, Brazil, b University of Fortaleza, Faculty of Medicine, Fortaleza, Brazil, c Federal University of Ceara, Clinical Medicine Department Faculty of Medicine, Fortaleza, Brazil Background and Aims: To study the relationships between first intercourse (FI), use of condom, gender and number of years in school among patients with Bipolar Disorder (BD). Methods: A structured questionnaire containing these topics was applied in 123 patients (M = 40, F = 83) with BD (according to DSM-5), followed by a University Hospital in Fortaleza. The age of FI was stratified in 3 groups: (a) before 18 years (n = 81); (b) 19 to 30 (n = 39); (c) 31 or above (n = 3). Number of year in school was divided: (1) up 9 years–Elementary School (n = 30); (2) up to 12 years–High School (n = 53); (3) 13 years and above Higher Education (n = 30). SPSS was used. Results: A significant relationship between the age of FI and gender was found. Among men, 90% (n = 36) had their FI before 18 years, while only 54.2% of women did so (v2 = 15.50; p = 0.000). When use of condom in FI is compared to number of years in school, important data were found. In Elementary School group, the use of condom in FI is found in a proportion of 9.3:1 (no use = 28; use = 3), while in Higher Graduation group this proportion reduces to 5.6:1 (no use = 17; use = 3) (v2 = 8.784; p = 0.012). Conclusions: Male gender is associated with FI earlier than female. Use of condom in FI seems be correlated to number of years in school.

J Nascimentoa, S Souza Juniorb, F Souzac a Christus University Center, Faculty Of Medicine, Fortaleza, Brazil, b University of Fortaleza, Faculty of Medicine, Fortaleza, Brazil, c Federal University of Ceara, Clinical Medicine Department Faculty of Medicine, Fortaleza, Brazil

90


13-16 July, Amsterdam, the Netherlands P-070 Prevalence and risk factors of bipolar disorder in university students in Turkey A Omer, F Akdeniz, S Oztekin Celal Bayar University Faculty of Medicine, Psychiatry, Manisa, Turkey Background and Aims: Even though the prevalence of bipolar disorder is estimated as %1.0 invariably from cultures, the epidemiological and clinical features in the community are of interest. In this present study, the aim is to determine the prevalence and risk factors of bipolar disorder in Turkish university students. Methods: In this study out of 11,035 students from all faculties and schools of Celal Bayar University, 2,757 students were included and evaluated in the study. The participants were screened with HCL-32-R. All participants with a score of 14 or above in HCL32-R and 5% of participants with a score below 14 were invited to participate a SCID-CV interview according to DSM-IV-TR. A total of 1,688 (61.2%) participants had a score of above 14. Results: The mean age of the study group is 19 and 53% were male. Based on SCID-CV interview the prevalence of bipolar disorder was %1.4 (n = 36) in university students. Bipolar I disorder was diagnosed in 10 out of 36 patients, bipolar II disorder in 13 patients, and bipolar disorder NOS in 13 patients. The mean age of onset is 17. Eighteen out of 36 patients had depression as their first episode, 5 had mania and the remaining 13 had mixed features. In further analyses, substance abuse, medical drug use and female gender were risk factors.

Conclusions: The prevalence of bipolar disorder is the same with regard to previous studies and atypical forms are more prevalent. Drug use, both illicit and therapeutic is the main risk factor.

P-071 Use of the hypomania checklist to identify risk factors for hypomania within a prospective birth cohort DJ Smitha, JMD Andersonb, S Zammitb a University of Glasgow, Glasgow, UK, bUniversity of Bristol and Cardiff University, Cardiff, UK We have conducted a Rasch analysis of the 32-item HCL questionnaire to generate a dimensional measure of hypomania for use in epidemiological studies (Court et al, 2014). This talk will present the findings of work conducted to date within the landmark ‘Children of the Nineties’ birth cohort (also known as the Avon Longitudinal Study of Parents and Children, ALSPAC). Specifically, we will present findings on the relationship between childhood IQ measured at age eight and risk of hypomania in early adulthood (Smith et al, 2015); as well as data on both smoking during pregnancy and influenza infection during pregnancy as possible risk factors for the later development of bipolar disorder. We will also consider the implications of this work for future research on Research Domain Criteria (RDoC) for manic features and for genetic epidemiology research in bipolar disorder.

Poster Session VIOther: Part I P-072 Neurocognitive and peripheral cytokines changes in latent-, early-, and late- stage bipolar disorder

but significant increases in the concentrations of IL-10 and TNFa, but not in IL-6 or neurotrophins, were found during euthymia. IL-10 concentration was increased in early-stage whereas TNF- a was increased in late-stage patients. Total leukocytes, neutrophils and monocytes were significantly increased in late-stage patients compared to controls. Healthy siblings did not show significant changes in peripheral biomarkers. The clinical stages of BD would be associated with increasing levels of neurocognitive and social deterioration. The latter appears to be the result of the clinical phenotype. Changes in peripheral inflammation would differ depending on staging. The comparative analysis of peripheral inflammation, including leukocytes, and neurocognitive and social functioning across stages clearly deserves further studies.

Bipolar disorder (BD) may be associated with progressive neurocognitive and functional impairment, but few studies have focused on the latenr stage. In this cross-sectional study, 25 earlystage and 23 late-stage strictly euthymic BD-I patients, 23 healthy siblings of BD patients (latent-stage), and 21 healthy controls underwent a comprehensive neuropsychological battery and their social functioning was assessed with the FAST scale. Blood samples were extracted to analyze cytokines (IL-6, IL-10, TNF-a), leukocytes blood count, and neurotrophins concentration. Healthy siblings´ social functioning was similar to that of controls, and significantly better than both patient groups. Increasingly greater neurocognitive dysfunction was observed across stages. Siblings´ performance lied between controls and patients, with select deficits in psychomotor speed, executive attention, and verbal and visual memory. Overall, late-stage patients showed the most severe deficits, and was the only group with dysfunctional abstraction. Small

P-073 Self-reported empathic responding in euthymic patients with bipolar I disorder: a comparison with schizophrenia patients and healthy controls

A Tataya, O Caulib, P Correac, G Bristotd, R Tabares-Seisdedose a Psychiatry Service, University General Hospital, Valencia, Spain, b Department of Nursing, University of Valencia, Valencia, Spain, c Department of Evolutive Psychology, School of Psychology, University of Valencia, CIBERSAM, Valencia, Spain, dLaboratory of Molecular Psychiatry, Hospital de Clınicas de Porto Alegre, UFRGS, INCT-TM, Porto Alegre, Brazil, eDepartment of Medicine, Teaching Unit of Psychiatry, University of Valencia, CIBERSAM, INCLIVA, Valencia, Spain

HS Choa, L Byeongheeb, SH Kimc, R Vind a Yonsei University College of Medicine, Department of Psychiatry and Institute of Behavioral Science in Medicine, Seoul, Korea, b Yonsei University College of Medicine, Psychiatry, Seoul, Korea, c Hallym University College of Medicine, Psychiatry, Hwaseong, Korea, dSeoul National Hospital, Department of Psychiatry, Seoul, Korea Background and Aims: Empathy, an important element in social cognitive functioning, is multi-dimensional in nature involving


91

18th Annual ISBD & 8th Biennial ISAD both cognitive and affective components. Lack of empathy and its association with poor social functioning was clarified in schizophrenic patients.We investigated the self-reported empathic responding and the relationships between empathy and other clinical factors in euthymic patients with bipolar I disorder. Methods: Forty euthymic bipolar patients, 38 patients with schizophrenia, and 58 healthy subjects participated. We applied the Interpersonal Reactivity Index (IRI) and compared the four dimensions of the IRI. ‘Perspective Taking’ and ‘Fantasy’ represents cognitive empathy and ‘Empathic Concern’ and ‘Personal Distress’ represents affective empathy. The correlations between factors such as onset age, duration of illness, education years, intelligence and mood symptoms and IRI scores were investigated. Results: Analysis of variance showed significant difference in ‘Personal Distress’, but did not in other 3 dimensions, among the three groups (p = 0.007). In post-hoc comparison, bipolar patients showed significantly higher ‘Personal Distress’ compared to the healthy controls (p = 0.017). Schizophrenia patients showed significantly elevated ‘Personal Distress’ compared to the healthy controls (p = 0.042). There was no significant difference between the bipolar and schizophrenia groups. Positive correlations of ‘Personal Distress’ scores with education years (r = 0.388, p = 0.013) and depression scores (r = 0.366, p = 0.020) were observed within bipolar patients. Conclusions: These preliminary results suggest that stable bipolar I patients have difficulties in affective empathy, especially discomfort responses resulting from observing another’s negative experience, as much as patients with schizophrenia. Underlying depressive mood and previous education levels may be related to this empathy responding in bipolar disorder.

P-074 It’s not all about that BAS: trait bipolar disorder vulnerability weakly correlated with trait bas and not predictive of risky decision-making J Collett, C Perry, G Murray Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Australia Background and Aims: The behavioural activation system (BAS) theory of bipolar disorder proposes that abnormal BAS functioning is aetiologically linked to bipolar disorder. We investigated the extent to which an association between BAS and bipolar disorder was observable in a non-clinical sample, applying a vulnerability trait perspective. Methods: Trait bipolar disorder vulnerability was measured using the 7 Up 7 Down Inventory. BAS was examined as a three-factor personality trait measured using the BIS/BAS Scales, and was also assessed via three risky decision-making tasks, included as putative behavioural measures of BAS. A mood induction was also administered to investigate potential interactions between the influence of trait and mood state on risky decision-making. Results: The results showed only weak correlations between trait bipolar disorder vulnerability and trait BAS, and no association between trait bipolar disorder vulnerability and risky decisionmaking was found. Conclusions: Discussion of findings focused on (i) the continuity of trait bipolar disorder vulnerability; (ii) alternate perspectives of trait BAS; and (iii) difficulties in accounting for individual state and strategy use during risky decision-making tasks. It was concluded that BAS may not be elevated in individuals vulnerable to bipolar disorder until a categorical threshold of disorder has been exceeded, and that risky decision-making tasks may not be effective in eliciting BAS.

92

P-075 Unmet needs of parents with major mood disorders and their offspring: towards acceptable early interventions in families at risk J Cumbya, S Nevilleb, R Uhera,b a Nova Scotia Health Authority, Halifax, NS, Canada, bDepartment of Psychiatry, Dalhousie University, Halifax, NS, Canada Background: Mental illness adds additional stress to the challenges of parenting. Offspring of parents with mental illness are at increased risk of developing mental illness and may require early interventions. We map the needs of parents with mental illness and their offspring to design interventions that will be acceptable to the families. Method: We conducted focus groups, semi-structured interviews, and administered the Camberwell Assessment of Needs questionnaire with parent/family extension , to 20 parents with major mood disorders (bipolar disorder, schizoaffective disorder, major depressive disorder) and 20 adults who grew up as sons and daughters of parents with major mood disorders. Results: Parents living with severe mental illness reported unmet needs for practical help with child care and parenting, understanding of their illness, accessible health care for themselves (child care during parent appointments, clinicians able to address the needs of parents) and for their offspring (emotional coping skills, peer support, education on parent mental illness, monitoring of early symptoms, and safety net when parent is unwell). Offspring reported unmet needs for early diagnosis and treatment for their parents, education about their parent’s illness, emotional coping and safety. Lack of material resources and fear that clinicians will remove children from parents’ care were major barriers to accessing services. Conclusions: The overlap of unmet needs reported by parents and offspring suggests that early interventions in high risk families should contain accessible and non-threatening health care respectful of parental roles, and monitoring and emotional skills learning tools for offspring.

P-076 Executive functioning affects verbal learning strategies in patients with bipolar disorder and schizophrenia T Hellvina, T Uelanda, C Simonsena, JU Lystada, BC Haatveita, I Mellea, K Sundetb, OA Andreassena, A Vaskinnb a Oslo University Hospital, TOP NORMENT psychosis research unit, Oslo, Norway, bUniversity of Oslo, TOP NORMENT psychosis research unit, Oslo, Norway Background and Aims: Verbal learning and memory impairment is a well-recognized feature of bipolar disorder and schizophrenia. The underlying cognitive processes are however not well established. Here we investigated verbal learning strategies, focusing on semantic clustering, in patients with bipolar disorder and schizophrenia. We examined the relationship between executive functioning and the use of semantic clustering as a strategy for learning verbal material. Methods: The California Verbal Learning Test (CVLT-II), a list learning task consisting of sixteen words belonging to four different semantic categories, was used to assess learning and memory in participants with bipolar disorder (n = 78) and schizophrenia (n = 94) compared with 254 healthy control participants. The Color-Word interference test and Verbal Fluency test from the Delis-Kaplan Executive Function System (D-KEFS) battery were used to examine the relationship between executive functioning and verbal encoding strategies. Results: Patients with schizophrenia scored significantly below healthy controls on semantic clustering (p = 0.002), whereas


13-16 July, Amsterdam, the Netherlands patients with bipolar disorder obtained scores in between but not significantly different from either group. Semantic clustering was positively correlated with learning and remembering words from the list for all groups. There were significant correlations between CVLT-II semantic clustering and subtests from the Color-Word interference test and the Verbal fluency test in all groups. Conclusions: Patients with bipolar disorder use semantic clustering as a learning strategy to a larger extent than schizophrenia patients. Poorer executive functions were related to less use of semantic clustering. These findings suggest that executive dysfunction may affect memory through ineffective learning strategies in people with schizophrenia and bipolar disorder.

P-077 Impulsivity during depressive and manic episodes in bipolar I patients L Hranov, M Stoyanova University Hospital for Neurology and Psychiatry ”St. Naum”, Second Pssychiatric Clinic, Sofia, Bulgaria Background and Aims: The aim of the study was to find out (1) whether patients with bipolar disorder (BD) in depressive (BD-D) or manic (BD-M) episode differ from healthy controls (HC) by their level of impulsivity and (2) whether episode affective polarity correlates to impulsivity level. Methods: We report data on 30 demographically matched BD I depressed patients (80% females; mean age 51.33 10.80), 32 manic patients (81.2% females; mean age 42.72 13.03) and 37 HC (62.2% females; mean age 43.38 14.38). All patients were evaluated by the Hamilton Depression Rating Scale (HAM-D) and the Young Mania Rating Scale (YMRS). Impulsivity was measured by the Barratt Impulsiveness Scale (BIS-11). Results: In comparison to HC, BD-D patients had significantly higher BIS-total (p < 0.05) and BIS-attentional subscore (p < 0.0001) values whereas BD-M patients had significantly higher BIS-motor subscore (p < 0.05). Additionally, BIS-total score demonstrated a trend toward a significant difference between BD-M patients and HC (p = 0.08). BD-D and BD-M groups did not differ significantly from each other in respect to their BIS-total scores or BIS-subscores. Neither HAM-D score nor YMRS score did correlate with BIS-total score. Conclusions: Our data point that (1) BD patients have higher levels of impulsivity in comparison to HC irrespective of episode affective polarity; (2) the impulsivity level does not correlate with the actual severity of affective symptoms, and (3) different components of impulsivity are increased in manic and depressed episodes and this could possibly contribute differentially to proneness of impulsive behavior. Our results support the notion that impulsivity could be regarded as a stable trait characteristic of BD.

P-078 Basal autonomic activity, stress reactivity, and increases in metabolic syndrome components over time M Hua, F Lamersa, S Hilesa, B Penninxa, E De Geusb a VU University Medical Center, Psychiatry, Amsterdam, the Netherlands, bVU University, Biological Psychiatry, Amsterdam, the Netherlands Background and Aims: Basal autonomic nervous system (ANS) functioning has been linked to the metabolic syndrome (MetS), but the role of ANS reactivity in response to stress remains unclear. The aim of this study was to examine cross-sectionally and longitudinally to what extent ANS basal level and stress reactivity are related to MetS.

Methods: This study included cross-sectional data of 1,922 respondents and 4-year longitudinal data of 1,616 respondents from the Netherlands Study of Depression and Anxiety. Indicators of ANS functioning were heart rate (HR), respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP). ANS stress reactivity was measured during a cognitively challenging stressor and a personalemotional stressor. MetS components included triglycerides, highdensity lipoprotein cholesterol, blood pressure, glucose and waist circumference. Results: Cross-sectional analyses indicated that higher basal HR, lower basal RSA and PEP, and higher RSA reactivity during cognitive challenge were related to less favorable values of almost all individual MetS components. Longitudinal analyses showed that higher basal HR and lower basal PEP predicted 4-year increase in many MetS components. Higher RSA stress reactivity during cognitive challenge predicted 4-year increase in number of MetS components. Conclusions: Higher basal sympathetic, lower basal parasympathetic activity, and increased parasympathetic withdrawal during stress are associated with multiple MetS components, and higher basal sympathetic activity predicts an increase in metabolic abnormalities over time. These findings support a role for ANS dysregulation in the risk for MetS and, consequently, the development of cardiovascular disease.

P-079 Emotional abuse as an impact factor for suicidal ideation in bipolar patients MF Juruenaa,b, IC Menezesb, CVW Baesb a Centre for Affective Disorders - Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom, b Department of Neurosciences and Behavior, University of Sao Paulo, Sao Paulo, Brazil Background and Aims: Patients with bipolar disorder present higher suicide ideation than patients with other psychiatric disorders. Exposure to early life stress (ELS) may induce persistent changes in HPA axis response to stress, which can lead to a greater susceptibility of developing depression and other comorbities (CARR et al., 2013; JURUENA, 2014). ELS present some subtypes that must be considered – emotional, physical and sexual abuses, and emotional and physical neglect.Aim: To assess if ELS and its subtypes can influence the level of suicidal ideation in bipolar patients, when compared to unipolar depressive patients Methods: The sample was composed by two groups - unipolar depression (n = 31; with ELS = 17; without ELS = 14) and bipolar depression (n = 51–with ELS = 28; without ELS = 23). For diagnostic assessment, MINI International Neuropsychiatric Interview was used. To assess the intensity of depressive symptoms, GRIDHamilton Depression Rating Scale (GRID-HAM-D21), ELS, to assess Childhood Trauma Questionnaire and. Beck Scale for Suicide (BSI) to assess suicidal ideation were applied. Results: There was no difference in depressive symptoms between bipolar and unipolar groups, with or without ELS (p = 0.108). Subjects with ELS presented higher levels of suicidal ideation (p = 0.002), but there was no difference when considering unipolar or bipolar groups (p = 0.41). Although, when considering only emotional abuse, bipolar patients with ELS presented higher suicidal ideation than unipolar patients (p = 0.005). Conclusions: Emotional abuse is a subtype of ELS that may impact the suicidal ideation in subjects with bipolar depression.Carr CP et al. J Nerv Ment Dis. 2013;201,12:1007-20.Juruena MF. Epilepsy Behav. 2014,38:148-59.


93

18th Annual ISBD & 8th Biennial ISAD P-080 Early life stress in bipolar patients: HPA axis response to GR and MR challenges MF Juruenaa,b a Centre for Affective Disorders - Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom, b Department of Neurosciences and Behavior - University of Sao Paulo, Brazil Evidence indicates that early life stress (ELS) can induce persistent changes in the HPA axis in adults and that could trigger Bipolar Affective Disorders. These appear to be related to the impairment binding to glucocorticoid (GR) and mineralocorticoid receptors (MR). The aim of this study was to evaluate the impact of ELS in HPA axis response to challenges with GR and MR agonists in bipolar patients. Patients were recruited into two groups according to ELS history assessed by the Childhood Trauma Questionnaire (CTQ). The cortisol measures in the saliva were evaluated after placebo, fludrocortisone (MR agonist), or dexamethasone (GR agonist). Bipolar showed a lower salivary cortisol upon waking after placebo compared with controls. Moreover, cortisol awakening responses (CAR) after MR agonist were found to be lower in patients than in controls. CAR after placebo, GR agonist, MR agonist we found in a Linear Regression model that patients with ELS show differences between placebo vs. MR agonist but not after GR agonist; in patients, without ELS the data show differences between placebo vs. MR agonist; but now as well in placebo vs. GR agonist. Our findings indicate that MR activityis impaired in bipolar patients compared with controls. In patients with ELS, there was suppression by MR agonist, indicating that patients with ELS are sensitive to MR agonists. In contrast with bipolar patients without ELS, we found suppression after both MR and GR agonist. These data suggested that in ELS an imbalance exists between MR and GR with MR dysfunction.

P-081 Cortisol in response to pharmacological challenges of the mineralocorticoid receptor in patients with unipolar or bipolar depression MF Juruenaa,b, E. Umeokab, CVW Baesb, B Burgos, D. Macedob a Centre for Affective Disorders - Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom, b Department of Neurosciences and Behavior - University of Sao Paulo, Brazil Background and Aims: Favorable outcomes in treatment depend on differential diagnosis between unipolar and bipolar depression. Biomarkers, such as the mineralocorticoid receptor (MR) function, are considered a promising strategy for such differentiation, seeing that malfunctioning of the HPA axis is one of the most common findings in psychiatry patients. Therefore, the aim of this study was to evaluate the different role of MR on the regulation of cortisol release in unipolar and bipolar depression. Methods: Patients were diagnosed with bipolar depression (n = 18) or unipolar depressive disorder (n = 8) by mean of MINI-Plus, patients presenting scores ≥16 in HAM-D21 were included in this study. Placebo, fludrocortisone and spironolactone were administered at 22:00 and plasmatic cortisol assessment was performed at 09:00 next day. Each drug was administered with an interval of 72 h. Results: Bipolar patients show significant lower levels of cortisol than unipolar after placebo. After treatment with fludrocortisone, also,lower cortisol levels in bipolar compared to unipolar. There was no difference between bipolar and unipolar after spironolactone.Cortisol levels of bipolar patients after fludrocortisone treatment were not different from placebo-treated bipolar, however after spironolactone treatment it was higher. Therefore, cortisol

94

concentration of unipolar patients after fludrocortisone treatment was lower from placebo-treated unipolar and after spironolactone treatment it was not different. Conclusions: Our data indicate lower levels of cortisol in bipolar depressive patients. Furthermore, when compared to unipolar patients, bipolar patients show higher cortisol suppression after MR agonist treatment and higher cortisol release after MR antagonist treatment, which indicate an increase in MR activity in patients with bipolar depression.

P-082 ASO and CRP levels in first manic episode S Kesebir, G Eryılmaz € udar University, Psychiatry, Istanbul, Turkey Usk€ Background and Aims: Inflammatory effector systems are intersections pointing to pathophysiological relationships between bipolar disorder and general medical conditions that are susceptible to stress as metabolic syndrome The present study will investigate antistreptolysin-O (ASO) and C-reactive protein (CRP) levels in first manic episode (FME) and compare with healthy controls. Methods: This study employed 150 bipolar patients according to DSM-IV criteria who were experiencing their FME. The instruments were Maudsley Obsessive Compulsive Inventory and Young Mania Rating Scale (YMRS). Healthy controls (n = 150) were without any psychiatric admission or treatment history subjects. Results: ASO and CRP levels were higher in FME than healthy controls (p = 0.003, p < 0.001). There was not found to be any correlation between Maudsley Obsessive Compulsive Inventory scores and ASO and CRP levels. CRP levels were found to be correlated with YMRS scores. Conclusions: Higher level of ASO in bipolar patients had not obtain before. The correlation between frequency of revelation of high serum titers of antibodies to myelins glycolipids galactocerebrosides and multipl sclerose stage was observed. The corelation between level of high serum titers of antibodies to myelins glycolipids galactocerebrosides and blood immune complexes concentrations (complement and ASO)was established too. Meanwhile these were not bound in patients with cerebellospinal ataxias and with other similar neurological diseases. We discussed that this may be related with comorbid mood disorders.

P-083 Impact of affective temperament on the age of menopause S Kesebira, B Evkuranb a€ € udar Usk€ udar University, Psychiatry, Istanbul, Turkey, bUsk€ University, Psychology, Istanbul, Turkey Background and Aims: Menstrual cyclus is intersection pointing to pathophysiological relationships between bipolar disorder and hypotalamopituiter-gonadal axis that are susceptible to stress as early menarche or menopause. The present study will investigate whether or not the relation between affective temperament and the age of menopose. Methods: This study employed 550 healty subjects without any prior psychiatric admission or treatment history. Affective temperament for each subjects were evaluated with Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). Results: Early menopause was 23%. Cyclotymic temperament scores were higher in early menopause group (p < 0.001). There was a strong inverse correlation between the age of menopause and cyclothymic temperament scores (r = 0.510, p = 0.010). Conclusions: According to our results, links between age of menarge or menopause and affective disorders may also have related and validated for affective temperament.


13-16 July, Amsterdam, the Netherlands P-084 Is there a relation between affective temperament and metabolic syndrome ? S Kesebira, B Erdincßb, M Altıntasßc a€ € udar Usk€ udar University, Psychiatry, Istanbul, Turkey, bUsk€ University, Internal Medicine, Istanbul, Turkey, cErenk€ oy Mental and Neurological Disease Training and Research Hospital, Psychiatry, Istanbul, Turkey Background and Aims: The present study will investigate whether or not the relation between affective temperament and metabolic syndrome (MetS). Methods: This study employed 100 bipolar patients according to DSM-IV criteria who were their remission. The patients who had been in remission period for at least 8 weeks were evaluated with TEMPS-A. Remission was defined as HDRS score 0.05). Conclusions: The FN may represent a vulnerability marker for depression risk that is apparent in 9–13 yo youth even before they exhibit any clinically significant depression symptoms. Additional subjects are still being recruited.

P-306 Polyunsaturated fatty acid composition and childhood adversity: independent correlates of depressive symptom persistence a

b

a

c

d

W Coryell , A Norris , J Yao , L Dindo , C Calarge a University of Iowa, Psychiatry, Iowa City- IA, USA, bUniversity of Iowa, Pediatrics, Iowa City- IA, USA, cBaylor College of Medicine,

Psychiatry, Houston- TX, USA, dBaylor College of Medicine, Psychiatry and Pediatrics, Houston- TX, USA Background and Aims: Adverse experiences during childhood, personality, and polyunsaturated essential fatty acid (PUFA) composition have all been shown to affect the likelihood of depressive symptoms. Few studies have addressed interactions between these risk factors, however. The following analysis was designed to do so. Methods: Subjects, 15 to 20 years old, had either begun antidepressant treatment within the preceding month (n = 88), or had never taken psychiatric medications (n = 92). Baseline assessments included a structured diagnostic interview, the self-completed Multiphasic Personality Questionnaire, and plasma PUFA phospholipid composition determinations. Depressive symptom levels were assessed at baseline and again at 4, 8 and 12 months. Results: Omega-3 composition and the measure of general childhood trauma were unrelated to each other but both correlated, though in opposite directions, with negative emotionality. Low omega-3 composition and history of childhood trauma were associated with persistence of depressive symptoms during follow-up, largely through independent effects on negative emotionality. Conclusions: Negative emotionality appears to comprise a final common pathway to depressive disorder through which diverse risk factors are expressed.

P-307 Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose YA de Vriesa, P de Jongea, L Kalverdijkb, JHJ Bosc, CCM SchuilingVeningac, E Hakc a University of Groningen- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, the Netherlands, bUniversity Medical Center Groningen, Psychiatry, Groningen, the Netherlands, cUniversity of Groningen, Pharmacy, Groningen, the Netherlands Background and Aims: The Dutch guideline for the treatment of depression in young people recommends initiating antidepressant treatment with fluoxetine, as the evidence for its efficacy is strongest and the risk of suicidality may be lower than with other antidepressants. Furthermore, low starting doses are recommended. We


165

18th Annual ISBD & 8th Biennial ISAD aimed to determine whether antidepressant prescriptions are in accord with guidelines. Methods: A cohort of young people aged between 6 and 17 at the time of antidepressant initiation was selected from IABD, a Dutch pharmacy prescription database. The percentage of prescriptions for each antidepressant was determined. Starting and maintenance doses were determined and compared with recommendations for citalopram, fluoxetine, fluvoxamine, and sertraline. Results: During the study period, 2942 patients initiated antidepressant treatment. The proportion of young people prescribed fluoxetine increased from 10.1% in 1994 – 2003 to 19.7% in 2010 – 2014. However, the most commonly prescribed antidepressants were paroxetine in 1994 – 2003 and citalopram in 2004 – 2014. The median starting and maintenance doses were ≤0.5 defined daily doses (DDD)/day for tricyclic antidepressants and 0.5 – 1 DDD/ day for SSRIs and other antidepressants. Starting doses were guideline-concordant 58% of the time for children, 31% for preteens, and 16% for teens. Sixty percent of teens were prescribed an adult starting dose. Conclusions: Guideline adherence was poor. Physicians preferred citalopram over fluoxetine, in contrast to the recommendations. Furthermore, although children were prescribed a low starting dose relatively frequently, teens were often prescribed an adult starting dose. These results suggest that dedicated effort may be necessary to improve guideline adherence.

P-308 Mood and anxiety disorders, school and social functioning in children at risk for developing bipolar disorder M Escamilla Texas Tech University Health Sciences Center, Psychiatry, El Paso, USA Background and Aims: This study seeks to follow the course of children and adolescents who are at biological risk for developing bipolar disorder due to their having at least one biological parent with confirmed bipolar disorder. A goal of the study is to follow, chronologically, how bipolar disorder evolves in its earliest stages. Methods: We assessed 119 high risk children between age 6 and 20, each of whom had a parent diagnosed with bipolar type I disorder or schizoaffective bipolar disorder. 113 age matched controls from the same populations were also studied. Parents were diagnosed through direct interview by a psychiatrist or review of the Family Interview for Genetic Studies. Children were assessed with the MINI psychiatric interview for children. School, social, family, and behavioral functioning was scored using the UCLA Life Stress Interview. Results: Lifetime history of major depressive episodes, manic episodes and anxiety disorders were significantly more likely to have occurred in the at-risk children compared to the epidemiologic controls. Rates of lifetime history depression and mania rose steadily from the earliest (6–10) to the intermediate (11–15) and oldest age group (16–20). Behavioral, social, and family functioning were significantly decreased in the at-risk youth. Academic functioning was only significantly decreased for males in the oldest old group. Psychopathology and socio-behavioral functioning will be presented as it appears in males and females and across the age ranges from 6 to 20. Conclusions: Mood, anxiety, and socio-behavioral problems can be detected during childhood and adolescence in high risk children and highlight opportunities for early intervention.

166

P-309 Alexithymia in mothers of autistic children A Ghamarania, K Abazaria, M Shariatib, H Karimic, A Karimic a Department of Children with Special Needs, University of Isfahan, Isfahan, Iran, bUniversity of Ahvaz, Psychology, Ahvaz, Iran, c Isfahan University of Medical Sciences, Isfahan, Iran Background and Aims: Alexithymia is a cognitive set of features that include difficulty in identifying feelings, difficulty describing feelings in themselves and others, emotionally oriented thinking and limited imaginative capacity. This study compared alexithymia in autistic & typical children mothers. For this purpose, 50 autistic children mothers were selected in the 3 autism centers in Tehran (Iran) and for compare their score with typical children mother’s scores, 50 normal children’s mothers of pre-school children and schools randomly were determined in Tehran as control group. Finally Torento questionnaire was delivered them. Methods: 50 autistic children mothers were selected in the 3 autism centers in Tehran (Iran) and for compare their score with typical children mother’s scores, 50 normal children’s mothers of preschool children and schools randomly were determined in Tehran as control group. Finally Torento questionnaire was delivered them. Results: The results of this research that were obtained by multivariate analysis of variance (MANOVA), chi-square, correlation and regression, show there were no significant differences in alexithymia scores between Mothers of autistic & normal children. Also were not significant relationship between education and maternal age and alexithymia scores. Conclusions: Alextymia is a important variable in family of children with autism.:

P-310 The implementation of a personalised assessment system to characterise clinical and functional profiles in young people with affective disorders F Iorfino, I Hickie, T Davenport, D Hermens The University of Sydney, Brain and Mind Centre, Sydney, Australia Background and Aims: Affective disorders are leading causes of disability, due largely to their early onset and adverse impacts on educational/employment participation. Utilising internet-based technologies, we have developed a system of personalised assessment and feedback that aims to reduce such impacts by improving the effective characterisation of early and often less specific presentations of affective disorders. This study aims to determine the uptake of this system and its ability to effectively characterise the clinical and functional profiles of young people with affective disorders. Methods: Young people (aged 12–25) presenting to our early intervention service with a primary mood or anxiety disorders utilise this system by completing an online self-report questionnaire and clinician-rated assessment. These assessments focus on current and lifetime diagnosis/symptomatology, stage of illness, and functional profile (e.g. educational/employment participation). Data from these assessments are presented in a personalised feedback report for the young person and clinician to use in ongoing clinical care. Results: Preliminary findings on the first wave of subjects will be presented with a focus on the relationships between clinical and functional outcomes. Initial data around the uptake (e.g. service outcomes) and effectiveness (e.g. individual outcomes) of this system will be evaluated. Detailed examples of the feedback reports that communicate individual results to young people and clinicians will be presented.


13-16 July, Amsterdam, the Netherlands Conclusions: This novel online system introduces a more personcentered approach to mental health care that focuses on longitudinally tracking clinical outcomes as well as other key factors (e.g. physical health, substance use) that have significant impacts on levels of functioning in young people.

P-311 Is age of onset associated with severity, prognosis and clinical features in bipolar disorder? A meta-analytic review C Joslyna, D Hawesa, C Hunta, PB Mitchellb a The University of Sydney, Clinical Psychology, Sydney, Australia, b University of New South Wales, Psychiatry, Sydney, Australia Background and Aims: To identify clinical characteristics and adverse outcomes associated with an earlier age of onset of bipolar disorder. Methods: A comprehensive search yielded 15 empirical papers comparing clinical presentation and outcomes in individuals with bipolar disorder grouped according to age of onset (Total N: 7370). The following variables were examined to determine odds ratios (ORs) and 95% confidence intervals (CI): presence of axis 1 comorbidity, rapid cycling, psychotic symptoms, mixed episodes, lifetime suicide attempts, lifetime alcohol and substance abuse, symptom severity and treatment delay. Results: Early age of onset was found to be associated with longer delay to treatment (Hedges g = 0.39, p = 0.001), greater severity of depression (Hedges g = 0.42, p < 0.001), higher rates of suicide attempts (OR = 1.68, p < 0.001), and higher levels of comorbid anxiety (OR = 2.34, p < 0.001) and substance use (OR = 1.80, p < 0.001). Surprisingly, no association was found between early age of onset and clinical characteristics such as psychotic symptoms or mixed episodes. Conclusions: Earlier age of onset of BD is associated with factors that can negatively impact long term outcomes such as increased comorbidity and suicidality. However, no association was found between early onset and indicators of severity or treatment resistance such as psychotic symptoms and mixed episodes. Clinical features found to have the strongest relationship with early age of onset were those potentially amenable to pharmacological and psychological treatment. Results highlight the importance of early identification and provide potential areas of focus for the development of early intervention in BD.

P-312 Family environment and psychopathology in high-risk offspring of parents with bipolar disorder P Laua, D Hawesa, C Hunta, PB Mitchellb a University of Sydney, School of Psychology, Sydney, Australia, b University of New South Wales- Black Dog Institute, School of Psychiatry, Sydney, Australia Background and Aims: Few studies have investigated family functioning as a significant interpersonal stressor that is associated with the presence of psychopathology in high-risk offspring. The study explored differences in family environment between families with a parent with BD (high-risk families) and families where parents do not have psychiatric histories. It is one of few studies to investigate these associations based on child-report measures, gaining valuable insight into the perspective of high-risk offspring. Methods: High-risk offspring and control offspring groups were derived from a cross-section of baseline participants between the ages of 12 and 18 years old from an ongoing prospective study. High-risk offspring had at least one parent with a BD-I or BD-II diagnosis. Measures were sent online or posted to participants.

Results: Preliminary results indicate that high-risk and control offspring do not differ in their perception of their family environment (cohesion, adaptability, conflict and parental bonding) or their level of internalizing and externalizing difficulties. Interpersonal distress from paternal conflict and low maternal care significantly predicted self-reported internalizing problems in general, while maternal care negatively predicted externalizing problems. However, these factors were not predictive of parent reported offspring psychopathology. Conclusions: Early results suggest that offspring perception of parent-child relationship appears to be associated with self-reported internalizing and externalizing problems regardless of parent illness status. Offspring perceptions of family environment in general may play an important role in their level of psychopathology.

P-313 Cognitive behavioral therapy for depression in children and adolescents: practical guide for brief 30 min sessions in busy psychiatric/mental health clinics P Lusk College of Nursing, University of Arizona, Tucson, USA Background and Aims: Despite a U.S. prevalence of 9%, less than 25% of depressed adolescents receive treatment because of time constraints in clinical practice and lack of mental health providers available to deliver it.To assess the feasibility and effects of a brief manualized seven-session cognitive—behavioral skills building intervention entitled COPE (Creating Opportunities for Personal Empowerment) delivered to 15 depressed adolescents in routine 30-minute mental health medication management outpatient visits. Methods: A preexperimental one group pre- and posttest design was used. Results: The Beck Youth Inventories were given pre and post COPE CBT program. Adolescents reported significant decreases in depression, anxiety, anger, and destructive behavior as well as increases in self-concept and personal beliefs about managing negative emotions. Post treatment evaluations indicated that COPE was a positive experience for teens and parents re[ported that their adolescent was using the coping skills, and increased ability to regulate their own thoughts/ moods behaviors at home and at school after completing the 7 session COPE CBT program. Conclusions: COPE is a promising brief cognitive—behavior therapy—based intervention that can be delivered within 30-minute individual outpatient visits. With this intervention, advanced practice psychiatric nurses and other outpatient clinicians can work with busy outpatient practice time limitations and still provide evidence-based treatment for depressed teens.

P-314 Serotonin transporter gene promotor polymorphisms in adolescents presenting for depression treatment in a pharmacogenomic guided clinic J Vande Voort, S Orth, K Schak, T Johnson, J Leffler, J Huxsahl, M Frye, P Croarkin Mayo Clinic, Psychiatry and Psychology, Rochester, USA Background and Aims: We sought to present initial data from a pharmacogenomic guided clinic for adolescent depression. We hypothesized 5-HTTLPR genotypes would have associations with symptom severity and treatment response. Methods: Subjects (n = 59) were ages 13–18 with symptom severity of 40 or greater on Children’s Depression Rating Scale Revised (CDRS-R). The Schedule for Affective Disorders and


167

18th Annual ISBD & 8th Biennial ISAD Schizophrenia and Parent General Behavior Inventory-10 Item Mania Scale (PGBI-10M) were used. Potential associations between 5-HTTLPR genotypes (L/L, S/L, S/S) and symptoms severity (CDRS-R and PGBI-10M) were examined with linear regression and Spearman’s correlation coefficients. Clinical Global Impressions (CGI) scale was used to evaluate response. Results: Mean age was 15.5 years, 8.6% were male. Common comorbidities were: anxiety (46.6%), ADHD (22.4%), dysthymia (20.7%), substance use disorder (13.8%), PTSD (6.9%). There were no significant associations between 5-HTTLPR polymorphisms and CDRS-R Score (p = 0.83, b = 0.03, R2 = 0.001) or 5HTTLPR polymorphisms and PGBI-10M (p = 0.06, b = 0.25, R2 = 0.062). Furthermore, there were no significant correlations between 5-HTTLPR polymorphisms and CDRS-R (Spearman’s rho = 0.028, p = 0.837) or PGBI-10M (Spearman’s rho = 0.235, p = 0.081). There was no association between having the S/S genotype and response/nonresponse at 4 weeks (p = 0.746), 8 weeks (p = 0.354) or 6 months (p = 0.834). When comparing mean CGI severity scores to baseline, significant improvement was seen at 4 weeks (p < 0.001), 8 weeks (p < 0.001) and 6 months (p < 0.001). Conclusions: There was no association between 5-HTTLPR polymorphisms and symptom severity. There was significant improvement in CGI scores at 4 weeks, 8 weeks, and 6 months. Future systematic studies of pharmacogenomic guided treatment for adolescent depression may help optimize outcomes.

P-315 The need for accurate screening for depression in children in primary care M Willettsa, C Kitchenb, H Lyonc, H Robbd, P Tiffinb a Westlane Hospital, The Newberry Centre, Middlesbrough, United Kingdom, bDurham University, School for Medicine Pharmacy and

Health, Stockton, United Kingdom, cClinical Psychology Department, Teesside University, Teesside, United Kingdom, d Durham University, University Library, Stockton, United Kingdom Background and Aims: With an estimated prevalence of 10–15% depression is common in children seen in primary care but often goes undetected. Screening may improve the identification of depression in children thus increasing the opportunities for effective intervention at a developmentally sensitive time. Our project used a systematically informed reviewto summarize the evidence regarding the accuracy of brief screening tools to identify depression in children specifically in primary health care settings. Methods: Medline, Medline in process, EMBASE and PsycINFO databases were systematically searched and secondary sources followed up. A total of 1079 titles and abstracts were reviewed against pre-specified inclusion and exclusion criteria. This was followed by full text review of 85 articles. Relevant data were extracted from screening studies reporting the sensitivity and specificity of brief screening tools for detecting depression in primary health care patients aged 7 to 18 years. Results: Six studies met review criteria and eight different screening tools were used. No single study stood out as being of better quality than the others. Sensitivity and specificity values for the instruments ranged from 27–91% and 66–96% respectively, with Negative Predictive Values generally much higher than Positive Predictive Values. Conclusions: Evidence to support the role of any one specific screening tool for use in children attending primary care is lacking, with most reporting relatively high false positive rates in this population. Further research is needed to explore the accuracy of screening tools specifically in primary care settings, and to explore the utility of implementing such screening approaches.

Poster Session XXVIINovel Treatments P-316 The efficacy of adjunctive Garcinia mangostana Linn pericarp for bipolar depression: a 24-week double-blind, randomised, placebo controlled trial M Ashtona, M Berka,b,c,d, C Ngb, M Hopwoodb, B Harveye, O Deana,b,d a Deakin University, IMPACT SRC, Geelong, Australia, b Department of Psychiatry, University of Melbourne, Melbourne, Australia, cOrygen Youth Research Centre, Psychiatry, Melbourne, Australia, dThe Florey Institute of Neuroscience and Mental Health, Psychiatry, Melbourne, Australia, eNorth-West University, Centre of Excellence for Pharmaceutical Sciences, Potchefstroom, South Africa Background and Aims: Bipolar disorder (BD) is a highly debilitating illness often with suboptimal recovery, characterized by changes in oxidative stress and neuroinflammation, supporting the search for novel therapeutics. We propose to trial a natural adjunctive therapy that targets perturbed oxidative biology.The primary aim is to investigate the efficacy of adjunctive mangosteen 1000 mg/day for the treatment of bipolar depression using a 24-week randomised, placebo-controlled trial. Methods: Garcinia mangostana Linn, commonly known as mangosteen, is a tropical fruit within a husk known as pericarp, containing a multitude of bioactive components including xanthones and

168

alpha-mangostin which reduce oxidative stress and inflammation and improve neurogenesis, making mangosteen a highly suitable agent to explore as an adjunctive therapy. We have preclinical evidence to show mangosteen reduced depressive-like behaviour (forced swim test) in a model of depression (Flinder’s Sensitive Line rats). Results: The primary outcome measure will be the change in the severity of mood symptoms, measured using the Montgomery Asberg Depression Rating Scale (MADRS). Secondary outcomes include global psychopathology, substance use, functioning, quality of life and safety and tolerability data. A follow-up interview will be conducted 4 weeks post-treatment. Blood samples will be collected at baseline, week 24 and 28 to assess antioxidant defence, oxidative stress and inflammation. Conclusions: If positive, this trial has potential to significantly enhance treatment options for people with BD. The trial will also contribute to the understanding of the underlying pathophysiology of bipolar depression. The poster will overview the rationale, protocol and current recruitment update for the ongoing trial.


13-16 July, Amsterdam, the Netherlands P-317 A commercial extract of Garcinia mangostana Linn has antidepressant-like effects in a genetic animal model of depression

B Harveya, I Oberholzerb, M M€oller-Wolmaransb, O Deanc, M Berkc a North-West University, Center of Excellence for Pharmaceutical Sciences, Potchefstroom, South Africa, bNorth-West University, Pharmacology, Potchefstroom, South Africa, cDeakin University, IMPACT Strategic Research Centre, Geelong, Australia

Background and Aims: Novel treatments and new biological targets are urgently needed for the treatment of major depression (MD). With broad evidence for disorganized redox balance in MD, we investigated whether powdered Garcinia mangostana Linn pericarp (GMP), which has demonstrable antioxidant effects, has antidepressant-like effects in a genetic animal model of MD. Methods: The acute dose-dependent effects of GMP (50, 150 and 200 mg/kg), imipramine (IMI) (20 mg/kg) and vehicle were determined in the forced swim test (FST) in Flinders Sensitive Line (FSL) rats using a behavioral sampling technique, with locomotor testing conducted using the open field test (OFT). Based on these findings, behavioral testing in the FST and OFT following 14 days chronic treatment (viz. GM, 50 mg/kg/day; IMI, 20 mg/kg/day) were conducted vs. vehicle-treated Flinders Resistant Line (FRL) rats as control. Results: FSL rats showed significantly increased immobility (depressive-like) behaviour, with both acute and chronic IMI reversing these behaviours via an apparent bolstering of noradrenergic activity (increased climbing behaviour). Similarly, dose dependent antidepressant-like effects with increased climbing was observed following acute 50 mg/kg GMP. Although chronic GMP treatment showed a strong tendency towards reversing immobility, this narrowly missed significance although presented with a pronounced increase in serotonergic-mediated behaviours, i.e. swimming. Conclusions: GML presents with pronounced dose-dependent antidepressant-like effects following acute treatment in a genetic animal model of MD. Although chronic treatment shows a tendency towards antidepressant-like effects, further dose-ranging studies are needed to confirm these promising results. This work confirms GMP to be a potential antidepressant compound acting through novel pathways and worthy of further investigation.

P-318 Do new direct-acting antiviral treatments impact quality of life in chronic hepatitis C patients? Preliminary data

E Egmonda,b, G Orioloc, A Plad, C Bartresd, M Caveroa, Z Mari~nod, R Navin esa, X Fornsd, R Martin-Santosa,c a Hospital Clınic- IDIBAPS- CIBERSAM, Psychiatry and Psychology, Barcelona, Spain, bDepartment of Clinical and Health Psychology, Universitat Aut onoma de Barcelona, Bellaterra, Spain, c Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona, Barcelona, Spain, dHospital Clınic- CIBEREHDIDIBAPS, Liver Unit, Barcelona, Spain

Background and Aims: Chronic hepatitis C (CHC) is a public health problem with around 170 million people infected. Interferon-alpha treatment has been associated with depression and impaired life quality. Recently, new direct-acting antivirals (DAA) have been introduced, showing promising results. However, there is limited research assessing quality of life. The aim of this study was to assess life quality in CHC patients receiving DAA using EQ-5D questionnaire. Methods: Of 74 patients receiving DAA, socio-demographic and clinical details, and EQ-5D scores were obtained, before treatment, at 4 weeks, and end of treatment. EQ-5D has five subscales (pain,

anxiety/depression, mobility, self-care and daily activities), scoring 1-5 (no to severe problems), and a visual analog scale (EQ-VAS) (0-100) reflecting worst to best health state. Changes to baseline were assessed (p ≤ 0.05). Results: Fifty-three percent was male, with mean age of 60.7 (11.2). Ninety percent had CHC genotype 1a/1b, 58.8% had liver cirrhosis. At baseline, EQ-5D subscales were varied slightly, from “self-care” 1.12 (0.44), to “anxiety/depression” 1.6 (0.98) (p > 0.05), with EQ-VAS score of 67.1 (18.24). At 4 weeks of treatment, EQ-5D scores did not change significantly (p > 0.05). At end of treatment, an improvement was observed in EQ-VAS (73.3 20.6; p = 0.049). Conclusions: Preliminary data of CHC patients treated with DAA showed impaired quality of life before and during treatment, scoring lowest for “anxiety/depression”. At treatment cessation, a general improvement was observed. However, health states were significantly lower in these patients (67-73) compared to general population (77). It seems important to monitorize mental and physical health in these patients, in a multidisciplinary, individualized clinical setting.

P-319 The effects of brain-derived neurotrophic factor on treatment response in youth with mood disorders B Graciousa, A Bonnerb, A Seidenfeldc, A Youngd, LE Arnolde, M Fristade a Department of Psychiatry and Behavioral Health Fristad Child Mood Laboratory, Ohio State University, Columbus, USA, bOhio State University, College of Medicine, Columbus, USA, c Department of Psychological and Brain Sciences, University of Deleware, Deleware, USA, dJohns Hopkins University, Psychiatry and Behavioral Sciences, Baltimore, USA, eDepartment of Psychiatry and Behavioral Health, The Ohio State University, Columbus, USA Background and Aims: Lower brain-derived neurotrophic factor (BDNF) levels correlate with depressive traits (1); higher levels in adults predict better response to therapy (2) but associations in youth are unknown. Aim 1: Quantify association between serum BDNF and mood symptoms. Aim 2: Determine if n3 supplementation increases BDNF pre-post-treatment. Aim 3: Determine whether baseline BDNF moderates treatment trajectories. Methods: Relationships explored between brain-derived neurotrophic factor (BDNF), omega-3 fatty acids (n3), outcomes in a 2 9 2 12-week trial of n3 supplementation (vs placebo) and psychoeducational psychotherapy (PEP vs active monitoring) in children with depressive disorders and non-Type I or II bipolar disorders. Community youth aged 7-14 meeting criteria for COBY BP-NOS or DSM-IV cyclothymia (CYC); or major depressive disorder (MDD), dysthymic disorder (DD), or depressive disorder not-otherwise-specified (NOS), were enrolled, block-randomized, blinded to either (n3 + PEP), (n3 + active monitoring), (placebo + PEP), (placebo + active monitoring). Measures: KSADS-Depression, Mania Rating Scales (KDRS; K-MRS; Young Mania Rating Scale (YMRS). Fasted blood samples collected at weeks 0, 12; spun, serum frozen at -80C. BDNF quantified for 81/95 children at baseline; 60(63%) at end (Quantikine ELISA Human BDNF Immunoassay, R&D Systems, Inc.; Minneapolis, MN). Free fatty acids, Belury lab, The Ohio State University. Results: Repeated-measures ANOVA: baseline BDNF mediated treatment changes in serum n3 (greater serum n3 increases; F(1, 52) = 3.7, p = 0.058); those supplemented had higher baseline BDNF.Higher serum BDNF levels at baseline predicted better response in manic symptoms to PEP in youth with bipolar spectrum disorders.


169

18th Annual ISBD & 8th Biennial ISAD Conclusions: BDNF mediates psychoeducational psychotherapy effects on manic symptoms; may affect child psychotherapy response.

P-320 Blue-blocking glasses as additive treatment for mania: a single-blinded randomized placebocontrolled trial TEG Henriksena,b,c, S Skreded,e, OB Fasmerb,c,f, H Schøyenb,c,g, I Leskauskaiteb,h, J Bjørke-Bertheusseng, J Assmusi, B Hamrej, A Lundb,c a Division of Mental Health Care- Valen Hospital, Helse Fonna, Valen, Norway, bMoodnet Research Group- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway, cDepartment of Clinical Medicine- Section for Psychiatry- Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway, dDr. Einar Martens Research Group for Biological Psychiatry- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital/The Norwegian Centre for Mental Disorder Research Norment, Bergen, Norway, eThe KG Jebsen Centre for Psychosis Research- Department of Clinical Science, University of Bergen, Bergen, Norway, fThe KG Jebsen Centre for Research on Neuropsychiatric Disorders- Department of Clinical Science, University of Bergen, Bergen, Norway, gDivision of Psychiatry, Stavanger University Hospital, Stavanger, Norway, hDivision of Mental Health Care- Haugesund Hospital, Helse Fonna, Haugesund, Norway, iCentre for Clinical Research- Haukeland University Hospital, University of Bergen, Bergen, Norway, j Department of Physics and Technology, University of Bergen, Bergen, Norway Background and Aims: Blocking blue light by means of amber glasses, is a novel treatment option for bipolar disorder. Use of blue-blocking glasses (BB) builds on promising reports on dark therapy and the discovery of the blue-light sensitive retinal receptor responsible for the daylight-signal to the brain. We aimed to test the effectiveness of BB for hospitalized bipolar patients in a manic episode. Methods: In this single-blinded, randomized placebo-controlled trial, eligible patients (bipolar mania, age 18-70 years) were recruited from five clinics in the southwest of Norway. The patients were assigned to wear orange-tinted glasses or clear glasses (placebo), from 6 p.m. to 8 a.m. for 7 days, as add-on treatment. The main outcome was change in manic symptoms, rated daily by means of Young Mania Rating Scale (YMRS). Use of glasses for one evening and night qualified for inclusion in the intention-totreat analysis. The study is registered at ClinicalTrials.gov, number NTC0181862 (completed). Results: From 2012 to 2015, 32 patients were enrolled, whereof eight dropped out and one was excluded, resulting in 12 patients in the BB-group and 11 patients in the placebo-group. YMRS score was significantly lower in the BB-group after 3 days (p = 0.042) and continued to decline in the BB-group throughout the intervention (p = 0.001 after 7 days). In the BB-group one patient developed headache and two patients experienced rapidly reversible depressive symptoms. Conclusions: We found that blue-blocking glasses were effective and feasible as add-on treatment for bipolar mania.

170

P-321 Minocycline as an adjunct for the treatment of depressive symptoms: pilot randomised controlled trial MI Husaina,b, IB Chaudhryc, R Rahmand, M Hamiranie, I Qurashif, AB Khosog, N Husainc, AH Younga a King’s College London, Institute of Psychiatry- Psychology and Neuroscience, London, United Kingdom, bCamden and Islington NHS Foundation Trust, Complex Depression- Anxiety and Trauma, London, United Kingdom, cUniversity of Manchester, Psychiatry, Manchester, United Kingdom, dDow Institute of Health Sciences, Psychiatry, Karachi, Pakistan, eAbbasi Shaheed Hospital, Psychiatry, Karachi, Pakistan, fMersey Care NHS Trust, Ashworth Research Centre, Maghull, United Kingdom, gPakistan Institute of Learning and Living, Psychiatry, Karachi, Pakistan Background and Aims: Depression is one of the leading causes of disability worldwide. A high proportion of patients do not respond to standard drug treatments. Recent evidence has shown that antiinflammatory treatment may have beneficial effects in major depression. Minocycline is a tetracycline antibiotic with good CNS penetration that exerts effects on multiple interacting symptoms) implicated in the pathophysiology of mood disorders. Open label studies have suggested that minocycline is effective as an adjunct drug in improving depressive symptoms. Methods: This is a multi site, three-month, double blind placebo controlled, pilot trial of minocycline added to treatment as usual for patients suffering from DSM IV major depressive disorder. This will be a two-arm design with 20 participants in each arm, giving a total of 40 participants. There will be a screening, a randomisation and four follow-up visits. Clinical assessments using the Hamilton Depression Rating Scale (HAMD), Clinical Global Impression scale (CGI), Patient Health Questionnaire-9 (PHQ -9), and the Generalised Anxiety Disorder scale (GAD-7) will be carried out at every visit. Side effects checklists will also be undertaken at each visit. Minocycline will be started at 100 mgs once daily (OD), increased to 200 mgs at 2 weeks. Results: Thus far we have recruited and randomised 41 participants. 25 participants have completed the 3 month study period. Final results for all participants will be presented at the conference. Conclusions: Our pilot study aims to establish the degree of improvement in depressive symptoms with the addition of minocycline to treatment as usual.

P-322 Effects of a paleo diet on depressive symptoms in the normal population. Results from a pilot study E Nederhofa,b, E Bikkerc a Department of Psychiatry Interdisciplinary Center Psychopathology and Emotion regulation, University Medical Center Groningen, Groningen, the Netherlands, bVan Hall Larenstein University of Applied Sciences, Applied Research Center Food and Dairy, Leeuwarden, the Netherlands, cUniversity Medical Center Groningen, Faculty of Medicine, Groningen, the Netherlands Background and Aims: Consumption of vegetables, fruit and fish are consistently associated with less depressive symptoms, whereas consumption of processed foods is associated with more depression. Throughout human evolution, homo sapiens ate vegetables, fruit, fish, meat, eggs and nuts. Grains and dairy have been introduced around 10,000 years ago, and processed foods around 200 years ago. Our hypothesis is that a evolutionarily appropriate diet, such as the paleo diet, is more effective in reducing depressive symptoms compared to a diet that includes grains, dairy and processed food, such as the Dutch consensus diet. With this pilot


13-16 July, Amsterdam, the Netherlands study, we wanted to investigate feasibility of a web-based crossover diet intervention in the normal population. The effects on depressive symptoms were the secondary outcome. Methods: 36 Participants were recruited to follow both the paleo diet and the Dutch consensus diet during 4 weeks in randomized order. Results: Participants were representative for the Dutch population, except the higher percentage of females and higher educated participants. 75% Of recruited participants completed the study. Compliance to the diets was reasonable. Results on depressive symptoms suggest that a paleo diet might result in greater reduction in depressive symptoms compared to the Dutch consensus diet (Figure 1). Power calculations suggest that a study group of 50 is needed to show significant differences. Conclusions: A larger future study should confirm the effectiveness of the paleo diet in reducing depressive symptoms and investigate the mechanisms through which a paleo diet might reduce depressive symptoms.

P-323 Adjunctive nutraceuticals for treatment of unipolar and bipolar depression J Sarris, K Savage University of Melbourne, Psychiatry, Melbourne, Australia Background and Aims: The adjunctive use of nutraceuticals has potential to modulate several neurochemical pathways implicated in depression. This presentation covers the current evidence based on three leading systematic reviews and meta-analyses we have published in high impact journals. Methods: Systematic search of MEDLINE, CINAHL, PsycINFO was conducted of clinical trials using adjunctive nutrient-based nutraceuticals for unipolar and bipolar depression. A randomeffects meta-analytic model analyzed the standard mean difference between treatment and placebo from baseline and endpoint, combining the effect size (Hedge’s g) data. Results: In unipolar depression, primarily positive results were found for replicated studies testing S-adenosyl methionine, methylfolate, omega-3 (EPA/ethyl-EPA), and Vitamin D; with positive isolated studies for creatine and an amino acid combination. Mixed results were found for zinc, folic acid, Vitamin C, and tryptophan. A meta-analysis of adjunctive omega-3 versus placebo revealed a significant and moderate/strong effect size g of .61 (p = 0.009) in favor of omega-3. Conversely, a meta-analysis of folic acid revealed a non-significant difference over placebo (p = 0.23). Marked study heterogeneity was found in a Higgin’s test (I2 = 82%; 93%) for both omega-3 and folic acid studies, respectively. In bipolar depression, positive evidence with large effect sizes were found for N-acetyl cysteine, and a chelated mineral and vitamin formula. The meta-analytic findings of five pooled datasets (n = 291) on the outcome of bipolar depression revealed a significant effect in favor of omega-3 (p = 0.029), with a g of 0.34. Conclusions: A range of nutraceuticals provide encouraging evidence for adjunctive use in enhancing medication response in both unipolar and bipolar depression.

P-324 Emotion recognition modification for bipolar disorder

A Van Metera, M Munaf ob, I Penton-Voakc a Albert Einstein College of Medicine, Ferkauf Graduate School of Psychology, Bronx, USA, bBristol University, MRC Integrative Epidemiology Unit- UK Centre for Tobacco and Alcohol StudiesSchool of Experimental Psychology, Bristol, United Kingdom, c Bristol University, School of Experimental Psychology, Bristol, United Kingdom

Background and Aims: Bipolar disorder (BD) is associated with poor emotion recognition (Vederman et al., 2012), which may exacerbate or play a causal role in disordered mood, interfere with social functioning, and reduce treatment efficacy (Michalak et al., 2006; Harmer et al, 2009).Research has indicated that a cognitive bias modification intervention designed to modify emotion perception biases may positively influence mood and behavior (PentonVoak et al., 2012; 2013). Our goals are to determine whether this intervention can (1) shift emotion processing biases in people with BD, (2) have a positive impact on mood and social functioning. Methods: Young adults with BD were interviewed to assess eligibility, completed mood/social functioning self-reports, and were randomized to three sessions of intervention or sham. Two months later, emotion perception, mood, social functioning were evaluated to see whether changes were maintained. Results: Twenty-five euthymic participants (age 21.75, SD = 2.6) consented. There were no baseline differences between groups, except positive affect (slightly higher in the treatment group).Emotion perception shifted more in the treatment group (d = 1.03, p = 0.017), indicating the intervention was effective.At follow-up, the treatment group showed a decrease in negative affect (p = 0.027), higher positive affect (p = 0.066), and a slight decrease in perceived social support (p = 0.028). Though depression increased in the control and decreased in the treatment group, the difference was not significant. Conclusions: In preliminary results, the intervention shifted emotion perception, possibly contributing to decreased negative affect and higher positive affect, consistent with the “virtuous cycle” theory that seeing others’ emotions positively can lead to better interactions and improved mood. We expect more robust results with a full sample (N = 40).

P-325 The effects of a personalized lifestyle advice and tandem skydive on pleasure in anhedonic young adults E van Roekel, C Vrijen, VE Heininga, M Masselink, E Nederhof, AJ Oldehinkel University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, the Netherlands Background and Aims: Anhedonia (i.e. loss of pleasure) is a major public health concern and has proven particularly difficult to counteract. Anhedonia may be deterred by a healthy lifestyle, however, it is unlikely that a one-size-fits-all approach will be effective for everyone. The first aim of the present study was to examine the effects of a personalized lifestyle advice based on observed individual patterns. As lifestyle changes are in general hard to achieve, it is worth investigating whether a noninvasive ‘rebooting’ of the reward system can be accomplished. Hence, the second aim was to explore whether a tandem skydive following the lifestyle advice positively influenced anhedonic adults’ abilities to carry out the recommended lifestyle changes. Methods: Participants (N = 69) were selected through an online survey (N = 2940, 18-24 years). Main inclusion criteria were persistent anhedonia and willingness to perform a tandem skydive. Participants filled out 3 questionnaires per day on their smartphones for two consecutive months. After 1 month they were randomly assigned to one of three groups: no intervention (N = 22), lifestyle advice (N = 22), and lifestyle advice and tandem skydive (N = 25). Momentary levels of positive affect (PA), pleasure, and negative affect (NA) were compared between groups using interrupted time series analyses (ITSA). Results: Evidence was found for an average increase in momentary PA and pleasure in the intervention groups. The tandem skydive


171

18th Annual ISBD & 8th Biennial ISAD did not have additional effects above the effects of the lifestyle advice. Conclusions: In sum, our findings indicate that providing anhedonic young adults with a lifestyle advice slightly increases their PA and pleasure.

P-326 Adjunctive Hatha yoga vs. bibliotherapy for bipolar depression: a pilot randomized controlled trial LM Weinstocka,b, G Tremonta,c, K Tezanosa,b, MK Broughtona,b, T Gilletted, LA Uebelackera,b a Department of Psychiatry and Human Behavior, Brown University, Providence, USA, bButler Hospital, Psychosocial Research Program, Providence- RI, USA, cDepartment of Psychiatry, Rhode Island Hospital, Providence- RI, USA, dIndependent Experienced Registered Yoga Teacher E-RYT, -, Providence- RI, USA Background and Aims: Although yoga has frequently been recommended as a mood management strategy for bipolar disorder (BD), there have been no published studies on yoga for the treatment of BD symptoms. This study systematically developed and evaluated the feasibility, acceptability, and safety of adjunctive yoga for bipolar depression in a 10-week pilot randomized trial. Methods: Individuals with bipolar I/II depression were recruited and randomized to yoga (n = 10) or bibliotherapy in the form of a published BD self-help book (n = 8), both delivered as adjuncts to BD pharmacotherapy. Yoga participants were invited to attend at least one of two weekly yoga classes for 10 weeks, following a structured yoga manual. The primary outcome was depression severity, assessed post-treatment by a blind rater. Participants also completed functioning and treatment satisfaction measures at each time point. Results: Although between-group analyses yielded no significant difference in depression outcomes by condition, within-group analyses revealed statistically significant reductions in depression (Cohen’s d = 0.50) and improvements in quality of life (Cohen’s d = 0.89) among those assigned to yoga. Mania severity remained low throughout the program. Participants attended an average of only 5.23 (SD = 5.16) yoga classes, but reported practicing yoga an average of 2.19 (SD = 1.65) hours per week outside of class. Satisfaction with the yoga program was high (CSQ-8 = 27). Conclusions: Alongside expert recommendations for the use of yoga in BD treatment, our pilot data suggest that yoga carries promise for the adjunctive treatment of bipolar depression. Yet, there remain obstacles to class attendance outside the home for many, highlighting the need for alternative avenues of delivery.

P-327 The acceptability and feasibility of an online yoga intervention for individuals with mood disorders: a moodnetwork study LM Weinstocka,b, LA Uebelackera,b, C Hearingc,d, T Deckersbachc,d, AA Nierenbergc,d, LG Sylviac,d a Department of Psychiatry and Human Behavior, Brown University, Providence- RI, USA, bButler Hospital, Psychosocial Research Program, Providence- RI, USA, cMassachusetts General Hospital, Bipolar Clinic and Research Program, Boston- MA, USA, d Department of Psychiatry, Harvard Medical School, Boston- MA, USA Background and Aims: Preliminary data has established the efficacy of yoga for reducing depression, but further research is needed to

172

explore whether online delivery of yoga would be acceptable and beneficial for individuals with depression. In this pilot study, we examined the feasibility and acceptability of an online yoga program for individuals with mood disorders. Methods: Participants were recruited from MoodNetwork.org, an online community of individuals with mood disorders and an infrastructure to conduct comparative effectiveness studies. Participants completed the Positive and Negative Affect Scale (PANAS) before and after viewing a 30 min online Hatha yoga class. High PA is a state of high energy, full concentration, and pleasurable engagement. The NA scale measures subjective distress (i.e., anger, contempt, disgust, guilt, fear, and nervousness), with lower NA reflecting a state of calmness and serenity. Participants also gave feedback on their experience of participating with the online class. Results: On a 10-point scale rating how much participants liked the online yoga class (1 = did not like it to 10 = liked it very much), the mean score was 7.95 (SD = 1.12). Most participants (89%) reported that they would be “very likely” or “somewhat likely” to participate in an online yoga program. PA did not change from pre- to post-intervention (Cohen’s d = 0.08), but NA improved significantly (Cohen’s d = 0.64). Conclusions: An online yoga class demonstrated high acceptability and feasibility in individuals with a mood disorder as well as preliminary data for its efficacy in enhancing mood. Future treatment development efforts examining online yoga for mood disorders are indicated.

P-328 The safety of light therapy and its influences on melatonin secretion of volunteers S Zhoua, T Zhoub, W Danga a Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Beijing, China, b Department of Global Health & Social Medicine, Harvard Medical School, Boston, USA Background and Aims: To investigate the safety and the influences of melatonin secretion of light therapy on volunteers. Methods: The biological rhythm light system was developed by the Physics School of Peking University. 7 healthy volunteers were recruited and 2 women participated in the pre-test. The whole experimental procedure lasted for 5 days and the biological rhythm light system (150~300lux) was the only light source. The system was set to 12 h light and 12 h darkness in the experimental room. Measurement of melatonin rhythm: Blood samples were collected to measure melatonin levels every 2 h from 20:00 to 08:00. Subjects wore goggles to avoid additional light stimulation in the process of taking a blood sample. Vital signs, blood and urine test routines, blood chemistry, EEG and ECG changes were recorded before and after accepting biological rhythm light system. Subjective feelings and diaries were kept during this study. Results: (1) Laboratory tests did not change significantly before and after accepting biological rhythm light system; (2) Neuropsychological evaluation index did not change significantly before and after accepting biological rhythm light system; (3) The peak of melatonin secretion changed 2 h (02:00 to 04:00) after accepting this light system. Melatonin secretion ascended after accepting this light system (44.30 17.24, 69.59 53.22, p = 0.243); (4) Volunteers felt good and slept well in this light system. Conclusions: The biological rhythm light system has a high safety, adaptability and can effectively adjust the rhythm of melatonin secretion to about 2 h.


13-16 July, Amsterdam, the Netherlands

Poster Session XXVIIIOther: Part II P-329 Epilepsy in bipolar disorder: impact on clinical features, course and outcome S Knotta, L Fortyb, M Kerrb, K Gordon-Smitha, L Jonesa, N Craddockb, I Jonesb a University of Worcester, Institute of Health and Society Psychological Medicine, Worcester, United Kingdom, bCardiff University, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom Background and Aims: It is well recognized that mood disorders and epilepsy commonly co-occur. However, the relationship between epilepsy and the clinical features and course of illness in bipolar disorder (BD) is currently unknown. Here we explore the rate of epilepsy within a large sample of individuals with BD and examine bipolar illness characteristics according to the presence or absence of epilepsy. Methods: 1596 participants recruited to the Bipolar Disorder Research Network; a well-defined sample of UK subjects with a diagnosis of BD, completed a self-report questionnaire to assess lifetime history of epilepsy (Ottman et al., 2010). A subset of participants (n = 59) completed a telephone interview assessment to determine expert-confirmed epilepsy status. Lifetime clinical characteristics of illness were compared between BD subjects with and without a history of epilepsy. Results: 127 individuals (8%) screened positively for lifetime history of epilepsy. Bipolar subjects with epilepsy experienced higher rates of: suicide attempt (64.2% vs. 47.4%, p = 0.000367); panic disorder (29.6% vs. 16.1%, p = 0.001); phobias (13.6% vs. 5.7%, 0.004); alcohol abuse (18.6% vs. 10.6%, p = 0.017); and other substance abuse (10.2% vs. 4%, p = 0.009). History of suicide attempt (OR = 1.79, p = 0.013) remained significant within a multivariate model. Similar trends were observed within bipolar subjects with well-defined, expert-confirmed epilepsy (n = 29). Conclusions: Results demonstrate an increased rate of self-reported epilepsy in the BD sample, compared to the general population, and suggest differences in the clinical course of BD according to the presence of epilepsy. Comorbid epilepsy within BD may provide an attractive opportunity for subcategorising for future genetic studies, potentially identifying common underlying mechanisms.

P-330 Resilience in social anxiety disorder and posttraumatic stress disorder in the context of childhood trauma M Marxa, S Younga, J Harveyb, D Rosensteina, S Seedata a Stellenbosch University, Psychiatry, Cape Town, South Africa, b Stellenbosch University, Statistics and Actuarial Science- Faculty of Economics and Management Sciences, Cape Town, South Africa Background and Aims: Much of the research on anxiety disorders has focused on associated risk factors with less attention paid to factors such as resilience that may mitigate risk. The aim of this study was to compare resilience in individuals with posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) relative to individuals with no psychiatric disorder. Further we assessed the correlation of resilience scores with childhood trauma (CT).

Methods: The sample comprised of 93 participants, 40 with SAD with moderate/severe CT, 22 with PTSD with CT, and 31 with no psychiatric disorder. Participants were administered the MiniInternational Neuropsychiatric Interview (MINI), Liebowitz Social Anxiety Scale (LSAS), Clinician-Administered PTSD Scale (CAPS), CT Questionnaire - Short Form (CTQ-SF), and the Connor-Davidson Resilience Scale (CD-RISC). The mean age of participants was 34 years (SD = 11). Most participants were female and Caucasian. Analysis of variance was used to assess for significant group differences in resilience scores. Non-parametric correlation analyses were conducted for resilience with different types of CT. Results: There were significant differences in resilience between the SAD and PTSD groups with CT, and controls. Both disorder groups had significantly lower levels of resilience than healthy controls. In the SAD with CT and PTSD with CT groups combined, there was a significant positive correlation between resilience and physical neglect. Conclusions: Patients who have PTSD and SAD with CT appear to be significantly less resilient than those with no disorder. Assessing and addressing resilience in these disorders, particularly when CT is present, may facilitate long-term recovery and warrants further investigation.

P-331 Characteristics of cognitive and behavioral coping strategies between bipolar and depressive disorders and controls E Moon, Y Choi, JM Park, BD Lee, YM Lee, HJ Jeong, TU Kang Department of Psychiatry, Pusan National University Hospital, Busan, Korea Background and Aims: In mood disorder, the absence of adequate coping skills entails the likelihood of mood symptoms. Present study aims to compare cognitive and behavioral coping strategies between bipolar and depressive patients, and controls. Methods: The subjects were bipolar and depressive patients (N = 236) and healthy individuals (N = 236) who were age- and sexmatched using propensity scores. Cognitive and behavioral coping strategies were assessed using the Coping Inventory for Stressful Situations (CISS) and the Behavioral Checklist for Coping with Stress (BCCS). T-test and analysis of variance (ANOVA) were carried out to compare the groups while correlation analysis between two scales was conducted. Results: Mood patients showed lower task-coping (p < 0.001) and social/outgoing activity (p < 0.001) and higher emotion-coping (p < 0.001) than controls, yet bipolar patients presented higher social/ outgoing activity than depressive patients (p = 0.012). Bipolar patients and controls both showed higher avoidance-coping scores than depressive patients (p = 0.017, p = 0.000). As for correlation analysis, avoidance-coping was correlated with social/outgoing activities (p < 0.001), emotion-coping with compulsive/inner activity (p < 0.001) and task-coping with personal/inner activity (p < 0.001). Conclusions: These results suggest that patients with mood disorder in stressful situations are likely to adopt different approaches compared to healthy people. Moreover, there can be differences in cognitive and behavioral coping skills between bipolar and depressive disorder, implying that subtypes of mood disorder might have


173

18th Annual ISBD & 8th Biennial ISAD distinct effects on coping styles. Hence, different therapeutic strategies may be needed according to the coping patterns in patients with mood disorder.

P-332 Interindividual variability and related factors of Quinpirole induced locomotor activity as an animal model of bipolar mania E Moona, J Parka, JM Parka, BD Leea, YM Leea, HJ Jeonga, TU Kanga, Y Cheonb, Y Choia a Department of Psychiatry, Pusan National University Hospital, Busan, Korea, bDepartment of Psychiatry, Yangsan Hospital, Yangsan, Korea Background and Aims: One of the bipolar animal models is examining drug-induced locomotor activity. Quinpirole, which is used for bipolar animal model is a selective agonist for inhibitory dopamine D2 and excitatory dopamine D3 receptors. In this study, we aimed to investigate the activity changes of quinpirole injected mice. Methods: Forty eight ICR mice(8~12 week) were used in this study. Quinpirole induced locomotor activity was measured by the open field test. The apparatus was 50 X 50 X 50 cm space, and the arena was equally divided into 25 squares using black lines. Quinpirole was injected intraperitoneally 0.5 mg/kg. We counted the number of the lines crossed by the front leg of each mouse to measure the locomotor activity. The relationship between related factors and locomotor activity were examined by Spearman correlation. Results: Quinpirole-induced locomotor activity showed various ranges. It gradually decreased as time elapsed after the injection in most mice, but in some cases those activities were increased or fluctuated. Quinpirole-induced locomotor activities were correlated with weight(q = 0.343; p = 0.015), room temperature(q = 0.364; p = 0.014). Conclusions: This study demonstrated the interindividual variability of quinpirole-induced locomotor activities. The distinct patterns of locomotor activity after dopamine D2, D3 agonist injection may explain this vulnerability of mood and behavior fluctuation in mice. In the future, it is needed to evaluate interindividual variability of drug-induced locomotor activities are related to bipolarity in animal model.

P-333 The newly-cardinal ‘activity’ symptom of hypo/ mania: insights from actigraphy studies G Murray Swinburne University, Psychological Sciences, Hawthorn, Australia Background and Aims: Prompted by its inclusion as a cardinal symptom of manic and hypomanic episodes in DSM-5, there is resurgent interest in ‘activity’ as a central facet of the bipolar disorder (BD) phenotype. Activity can be conceptualised in a number of ways, but one paradigm with high face validity is motor activity measured using wrist-worn accelerometer (actigraphy). The aim of this presentation is to advance understanding of the activity construct by critically reviewing findings linking BD to three different actigraphy-derived variables. Methods: Three recently-published actigraphy studies investigating the bipolar spectrum are reviewed from the perspective of ‘activity’ as a cardinal symptom of bipolar disorder. Results: Our previous research has shown BD diagnosis and/or clinical state to associate with, (i) amplitude of the 24-hour activity rhythm, (ii) nonlinear dynamic features of activity, and (iii) the sleep/wake cycle. Integrative evaluation of these existing findings enables the generation of new hypotheses about the meaning and measurement of activity in BD: How do the various parameters of overt behaviour relate to recognised neurobiological (e.g., arousal),

174

psychological (e.g., grandiosity), and biobehavioural (e.g., rewardseeking) processes relevant to activity defined more broadly? Conclusions: Actigraphy is an early form of ‘wearable’ device with significant potential for generating clinically-useful biomarkers. Actigraphy generates continuous, non-intrusive high resolution (30–100 Hz) time series quantification of locomotor activity across multiple 24 h periods, and supports a range of analytic approaches. It is concluded that overt behaviour is pivotal to understanding the complex construct ‘activity’ in BD, and actigraphy provides one useful measure.

P-334 Plasma Interleukin-6 in remitted early bipolar I disorder and subjects at high-risk for bipolar disorder compared to healthy subjects N Sanjaya, S Venkatarama, M Subbannab, S Biradara, M Kesavana, V Ganesana a Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India, bNational Institute of Mental Health and Neuro Sciences, Research, Bangalore, India Background and Aims: Bipolar I disorder (BDI) is reportedly associated with abnormalities in proinflammatory markers, Interleukin 6 and 10 (IL-6 and IL-10) in particular. IL-6 levels are reportedly elevated in mania and depression in BD I. Elevated IL-6 has been reported in remitted early compared to longstanding BD I, though in the latter they remain higher than healthy subjects (HS). IL-6 elevation is also documented in adolescent onset BD. However, the role of IL-6 in the risk for BD I is unclear. Methods: Plasma IL-6 levels were assayed in 28 subjects with first manic episode, in remission for less than 6 months (early BD I), 21 first-degree relatives of patients with BD (HR) and 18 HS using a high-sensitivity ELISA kit. The difference in IL-6 levels between the three groups was assessed using univariate ANCOVA, controlling for gender, and post-hoc Tukey tests. Correlations between IL-6 and potential confounders were assessed by Pearson’s correlations Results: There was a statistically significant difference between the groups (F = 6.981, p < 0.05) on IL-6 levels. Post-hoc Tukey revealed significant differences between early BD I and HS (p < 0.05) and HR groups (p < 0.05) but not between HR and HS groups (p = 0.93). There was no correlations between plasma IL-6 with age, gender and illness variables in the BD I group (p > 0.15) Conclusions: Significant IL-6 elevations was noted in the BD I group relative to both HR and HS groups, but not between the HR and HS groups we conclude that IL-6 is a disease marker more than a risk marker, though this warrants further investigation

P-335 Between heaven and hell: interpretation of religious/spiritual experiences in clients with bipolar disorder E Ouwehanda,b, H Zockc, A Braamd,e, H Muthertf, H Boeijeg a Department of Theology and Religious Studies, University of Groningen, Groningen, the Netherlands, bDepartment of Spiritual Counseling, Altrecht Mental Health Care, Utrecht, the Netherlands, c University of Groningen, Faculty of Theology and Religious Studies, Groningen, the Netherlands, dDepartment of Globalization and Dialogue Studies, University of Humanistic Studies, Utrecht, the Netherlands, eDepartment of Emergency Psychiatry- Department of Specialist Training, Altrecht Mental Health Care, Utrecht, the Netherlands, fDepartment of Theology and Religious Studies, University of Groningen, Groningen, the Netherlands, gNetherlands Institute for Health Services Research, Program Director ’Health care expectations and Chronic Illness’, Utrecht, the Netherlands


13-16 July, Amsterdam, the Netherlands Background and Aims: Objective: To explore the interpretation of religious/spiritual experiences during mania, depression and recovery as perceived after recovery by persons diagnosed with a bipolar disorder and to inquire into their expectations of treatment . Methods: Design: Qualitative study, including 30 semi-structured interviews, conducted by a spiritual caregiver and a resident psychiatrist. Participants were outpatients of Altrecht Mental Healthcare, members of the Dutch patients’ association for bipolar disorder and persons who applied for the study via www.psychosenet.nl. Assessment of recovery was administered using the QIDSR, the ASRM and the CGI-BP. The interviews were analysed in NVivo, a program for qualitative data analysis. Results: The first, tentative coding yielded the following results. In many participants the phenomenology of religious/spiritual experiences was in essence similar as in persons without psychiatric diagnosis, although the context of the experiences was different. The question of their authenticity proved to be an important theme for many participants; a small group rejected them as mainly pathological.Other important themes were: the search for the meaning of the experiences, the desire for sharing them, spiritual growth, validation by others, maintaining balance of spirituality, the costs of manic episodes, the support of a religious outlook and spiritual practice, the desire for more attention to the topic during treatment. Conclusions: Religious and spiritual experiences in recovered persons diagnosed with a bipolar disorder were by and large interpreted as meaningful, sometimes, pathological, and raise questions about their authenticity and how to cope with them. Clinical exploration, also after recovery, seems to be warranted.

P-336 Peripheral immune abnormalities in two highrisk populations for bipolar disorder G Snijdersa, C Schiweckb, R Brouwera, E Mesmana, L Grossec, H De Witd, WA Nolene, HA Drexhaged, MHJ Hillegersa a Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands, bThe University Psychiatric Centre KU Leuven, Leuven, Belgium, c Department of Psychiatry, University of Munster, M€ unster, Germany, dErasmus Medical Center Rotterdam/Department of Immunology, Rotterdam, the Netherlands, eDepartment of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands Objective: Mounting data support the hypothesis for a role of the immune system in the pathophysiology of bipolar disorder. The aim of this study was to examine immune alterations in two unique familial high-risk cohorts for bipolar disorder. Methods: The study population comprised bipolar offspring, bipolar twins and controls from the Dutch Bipolar Offspring Study and the Dutch Bipolar Twins Study. T-cell percentages were measured by FACS analysis and serum levels of several hematopoietic/neuronal growth and differentiation factors were measured using a Luminex or Cytometric Bead Array kits. Results: In bipolar offspring, of who 13% developed a bipolar disorder and 54% a life time mood disorder, partial T cell defects are observed, i.e. lower numbers of circulating CD3+ and/or CD4+ T cells, from adolescence through adulthood. Inflammatory and regulatory T cells followed a dynamic course over time with reduced levels of natural T regulatory cells in adolescence and a reduced number of Th-1 and -17 cells in young adulthood in bipolar offspring. Bipolar twin studies show that the genetic background of the individual mainly determined these T cell defects. During adolescence lymphoid and myeloid growth factors (IL-7, IGFBP-2 and SCF) are increased, while general (neuronal) factors (EGF, BDNF, S100B) are decreased in serum of bipolar offspring. No significant

association between these immune abnormalities and bipolar disorder was found. Conclusion: These studies demonstrate a dysregulation of peripheral immune cells and factors in familial high-risk populations for bipolar disorder that may represent a vulnerability factor for the development of mood symptomatology.

P-337 Association between TEMPS-A and O-LIFE – gender influence A Tereszkoa, AA Chrobaka, A Arciszewskab, M Siwekb, D Dudekb a Jagiellonian University Medical College, Students’ Scientific Association of Affective Disorders, Krak ow, Poland, bDepartment of Affective Disorders, Jagiellonian University Medical College, Krak ow, Poland Background and Aims: Currently, in both psychiatry and psychology we strive to seek common points of many types of diseases and psychological constructs. Such common features were found i.a. in the case of bipolar disorder and schizophrenia. Recent researches have reported the association between schizotypy and affective temperaments, two construct related to above-mentioned disorders but focused on healthy population. However, there were no data on the gender differences in these associations. In our study, we want to focus on determining the gender differences in the relationship between schizotypy and affective temperaments. Methods: The study was conducted via an online survey which consisted of The Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE) that was used in order to assess schizotypal traits and Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPS-A) by which we evaluated affective temperaments. Statistical analysis included Pearson correlation and t test for estimating gender differences. Results: We found several differences among two gender groups. Women exhibit significantly stronger positive correlation between Cognitive Disorganization and both depressive and cyclothymic temperament. The latter temperament’s correlation with Unusual Experiences and Impulsive Nonconformity is also stronger in women. In case of irritable temperament, its correlation with Cognitive Disorganization and Impulsive Nonconformity is more pronounced in women, too. Lastly, Cognitive Disorganization also correlates with anxious temperament significantly higher in women. Conclusions: There are many schizotypal traits that coexist with certain affective temperaments, but what is important is that this co-existence is much more pronounced for women.

P-338 Measuring depression in clinical trials: a systematic review of the HAM-D original scale versus the embedded subscales as efficacy measures D Tsapekos, R Strawbridge, A Cleare, A Young Institute of Psychiatry- Psychology & Neuroscience- King’s College London, Psychological Medicine, London, United Kingdom Background and Aims: The 17-item Hamilton depression rating scale (HAM-D17) has been the “gold standard” outcome measure for assessing antidepressant treatment efficacy in clinical trials. Several HAM-D subscales have been developed to address criticisms of the HAM-D17 regarding multidimensionality and insensitivity. This study aimed to review the psychometric properties of these measures and their use as efficacy outcomes. Methods: A systematic review identified reports comparing the HAM-D17 with different subscales as efficacy endpoints in antidepressant treatment trials. Psychometric properties for all measures


175

18th Annual ISBD & 8th Biennial ISAD were derived from the original validation studies. The extent of use for each scale was assessed through total citations and times applied as an outcome measure. Results: Our search yielded 17 studies reporting 162 trials (N = 29,841) comparing HAM-D17 to unidimensional subscales. In total, eight subscales (containing 1–8 items) were identified. Effect sizes derived from HAM-D subscales demonstrated good correlations to HAM-D17, but also reduced variability. These effects were comparable among different subscales. Regarding sensitivity, HAM-D subscales showed consistently greater discriminative power in studies of newer antidepressants, but not in other trials. HAM-D17 remains the most frequently used outcome measure in clinical trials, while Bech’s HAM-D6 is the most extensively explored subscale. Conclusions: HAM-D17 poses significant measurement difficulties when used as an efficacy endpoint, potentially underestimating true treatment effects, requiring larger sample sizes, and increasing clinical trials cost. However, whether unidimensional subscales confer improved discriminative power over the parental scale remains unclear. Novel methodologies such as a visual analogue scale may further improve the accuracy and sensitivity of mood measurement in efficacy trials.

P-339 The link between mindful eating and depressive symptoms and the mediating role of psychological eating styles LHH Winkensa, T van Strienb, IA Brouwera, BWJH Penninxc, M Broman Toftd, M Vissera,e, L L€ahteenm€akid a Department of Health Sciences and the EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands, bDepartment of Clinical Psychology and the Institute for Gender Studies, Radboud University Nijmegen, Nijmegen, the Netherlands, cDepartment of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center / GGZ inGeest, Amsterdam, the Netherlands,

d MAPP Centre- Department of Management- Aarhus BSS, Aarhus University, Aarhus, Denmark, eDepartment of Internal MedicineNutrition and Dietetics, VU University Medical Center, Amsterdam, the Netherlands

Background and Aims: Earlier studies on mindfulness-based interventions focused on eating behaviour suggest that mindful eating (eating with awareness and attention, while not being distracted) may be related to depressive symptoms. We wanted to study the association between mindful eating and depressive symptoms and investigate two psychological eating styles, emotional and external eating as potential mediators. Methods: Depressive symptoms (CES-D-20), mindful eating (17 items on a 5-point Likert-scale) and psychological eating styles (DEBQ-20) were measured through an online survey in a random sample of Danish (N = 1421) and Spanish (N = 1424) men and women (age 18–87 years; BMI 18–40 kg/m2). Analyses were conducted using multiple linear regression analysis and bootstrapping and adjusted for socio-demographic characteristics and lifestyle factors. Results: Higher mindful eating scores were related to lower depressive symptoms in both Denmark (b = 0.52, 95% CI [0.59, 0.44], p < 0.001) and Spain (b = 0.61, 95% CI [0.68, 0.54], p < 0.001). Emotional eating was found to be a mediating factor in the mindful eating-depressive symptoms link in both Denmark (B = 0.15 (SE = 0.02), 95% CI [0.19, 0.11]) and Spain (B = 0.19 (SE = 0.02), 95% CI [0.24, 0.15]), as was external eating in both Denmark (B = 0.03 (SE = 0.01), 95% CI [0.05, 0.01]) and Spain (B = 0.03 (SE = 0.01), 95% CI [0.05, 0.001]). Higher mindful eating scores were related to lower emotional and external eating scores and lower emotional and external eating scores were related to lower depressive symptoms scores. Conclusions: This study shows that mindful eating and depressive symptoms are negatively associated and that the psychological eating styles emotional and external eating are mediating factors in the mindful eating-depressive symptoms link.

Poster Session XXIXPharmacological/Somatic Treatments: Part II P-340 Art therapy in the mood disorder unit SMG Magnaval MDU, Institute of Mental Health, Singapore The latest systematic studies of the benefits of Art therapy for mood disorders conclude that art therapy might have benefits in the alleviation of depressive and anxiety symptoms. There is a lack of studies however on the effect of art therapy in bipolar disorders, or the use of brief art therapy group in inpatients settings as part of a multidisciplinary mood disorders unit. The visual data gathered during a year running twice weekly brief art therapy inpatients open groups in the Mood Disorder Unit in the Institute of Mental Health (Singapore) will be presented to discuss the direct and indirect benefits of art therapy with an emphasis on the use of art therapy as an assessment tool for the definition of a comprehensive treatment plan. Descriptions of the difficulties encountered in the running of the programme, in particular with regard to anxiety disorders, as well as cultural aspects, will be discussed as limitations to the generalisation of the review.

176

P-341 Can lithium salts, in real life, prevent depressive-mixed episodes? Data from a long prospective follow-up A Gonzalez-Pintoa, C Bermudez-Ampudiab, M Martinez-cengotitabengoac, I Zorrillaa, S Lopezd, MP Lopez-Pe~naa a CIBESAM- University Hospital of Alava, UPV/EHU University of the Basque Country, Psychiatry, Vitoria, Spain, bCIBERSAMUniversity Hospital of Alava, Psychiatry, Vitoria, Spain, c CIBERSAM- University Hospital of Alava, UNED- National Distance Education University, Psychiatry, Vitoria, Spain, d University Hospital of Alava, Psychiatry, Vitoria, Spain Background and Aims: After decades of clinical use, lithium salts continue being the most important therapeutic treatment of bipolar disorder (BD). A major problem to achieve the effect of treatment in real life is to distinguish between those who follow the medical indications from those who not. The effect of lithium on manic and hipomanic episodes is well stablished but it0 s real life effect on depressive-mixed episodes has not been measured in long term studies. The objective of this study was to assess in a


13-16 July, Amsterdam, the Netherlands pragmatic way the effectiveness of lithium in preventing depressive symptoms (measured by depressive and mixed episodes), considering the adherence to treatment. Methods: Seventy-two patients initially treated with lithium carbonate were included in the study and followed-up during 10 years, assessing every 8 weeks their morbidity (episodes, hospitalizations) and alcohol/drugs consumption. Patients could receive other adjunctive treatment, being lithium their primary mood stabilizer. Adherence was rated as good when ≥ 90% bimonthly serum lithium assays remained ≥0.50 mEq/L and verified with the “Lithium Attitudes Questionaire”. Results: Fifty-six patients (77.8%) were considered adherent to lithium. Patients treated with lithium with good adherence had significantly lessepisodes with depressive symptoms (mixed and depressive episodes) than non adherent patients, and required less hospitalizations during treatment. Non adherent patients used alcohol more frequently (B = 1.946; p = 0.002; OR = 7.000). The differences in mixed-depressive episodes were significant also after controlling the results by alcohol abuse. Conclusions: In real life settings, lithium salts have also a preventive effect of depressive symptoms (mixed and depressive episodes), in the long-term.

P-342 Meta-analysis and meta-regression of Omega-3 polyunsaturated fatty acid supplementation for major depressive disorder

R Mockinga, I Harmsenb, J Assiesb, H Ruhec, M Koeterb, A Schened a Academic Medical Center, Psychiatry Mood Disorders, Amsterdam, the Netherlands, bAcademic Medical Center- University of Amsterdam, Psychiatry, Amsterdam, the Netherlands, cUniversity of Groningen- University Medical Center Groningen, Psychiatry, Groningen, the Netherlands, dRadboud University Medical Center/ Donders Institute for Brain- Cognition and Behavior- Radboud University, Psychiatry, Nijmegen, the Netherlands Background and Aims: Omega-3 poly-unsaturated fatty acid (PUFA)-supplementation has been proposed as (adjuvant) treatment for major depressive disorder (MDD). In the present metaanalysis we pooled randomized placebo-controlled trials assessing the effects of omega-3 PUFA-supplementation on depressive symptoms in MDD. Moreover, we performed meta-regression to test whether supplementation-effects depended on eicosapentaenoic acid (EPA)- or docosahexaenoic acid (DHA)-dose, their ratio, study duration, participants’ age, percentage antidepressant users, baseline MDD symptom-severity, publication year, and study quality. Methods: To limit heterogeneity, we only included studies in adult patients with MDD assessed using standardized clinical interviews, and excluded studies that specifically studied peri-natal/-menopausal or comorbid MDD. Our PubMED/EMBASE search resulted in 1955 articles, from which we included 13 studies providing 1233 participants. Results: After taking potential publication bias into account, metaanalysis showed an overall beneficial effect of omega-3 PUFAs on depressive symptoms in MDD [SMD = 0.398 (0.114–0.682), p = 0.006, random-effects model]. As an explanation for significant heterogeneity (I² = 73.36, p < 0.001), meta-regression showed that higher EPA-dose [b = 0.00037 (0.00009 – 0.00065), p = 0.009], higher percentage antidepressant users [b = 0.0058 (0.00017– 0.01144), p = 0.044] and earlier publication year [b = 0.0735 (0.143 – 0.004), p = 0.04] were significantly associated with better outcome for PUFA-supplementation. Additional sensitivity analyses were performed. Conclusions: In conclusion, present meta-analysis suggested a beneficial overall effect of omega-3 PUFA-supplementation in MDDpatients, especially for higher doses of EPA and in participants

taking antidepressants. Future precision medicine trials should establish whether possible interactions between EPA and antidepressants could provide targets to improve antidepressant response and its prediction. Furthermore, potential long-term biochemical side effects of high-dosed add-on EPA-supplementation should be carefully monitored.

P-343 Salivary levels of mood stabilizers across lifespan: implications for the clinical management of bipolar disorder A Murrua, C Varoa, M Torrab, S Romeroc, A Callarid, I Pacchiarottia, JM Goikoleaa, B Gonzalezb, E Vietaa, F Coloma a Hospital Clınic, Bipolar Disorders Unit- IDIBAPS CIBERSAM, Barcelona, Spain, bHospital Clınic, Toxicology Unit - IDIBAPS CIBERSAM, Barcelona, Spain, cDepartment of Child and Adolescent Psychiatry and Psychology- Institute of NeuroscienceIDIBAPS CIBERSAM, Hospital Clınic of Barcelona, Barcelona, Spain, dSection of Psychiatry, Department of Clinical and Experimental Medicine- Section of Psychiatry- University of Pisa, Pisa, Italy Background and Aims: To evaluate the bioequivalence of salivary and blood levels of Li and VPA in a sample of adult patients affected by Bipolar Disorder (BD). Secondarily, Li bioequivalence in saliva and serum was evaluated across different patients’ lifespans. Methods: Patients affected by BD, type I or II, with pre-scheduled, periodic blood analyses for either Li or VPA dosing were asked to participate and undergo contemporary salivary measurements. Blood levels of both Li and VPA were taken according to standard procedures. Salivary levels of Li were detected with a direct potentiometric method. Salivary levels of VPA were taken with an immune-assay method. Correlations were calculated with Pearson Product Moment Correlation (Pearson’s r) in an interim analysis. Age was controlled with partial correlation technique. Patients had to sign a written informed consent. Results: A total of 50 patients (38 Li-treated and 12 VPA-treated) were enrolled in the present cross-sectional study. VPA measures did not permit assessing a blood-saliva bioequivalence due to a high variability in salivary measures. Li measures resulted in a high correlation (r = 767, p < 0.001) in the present sample, no partial correlation with age (r = 0.147, p = 0.380). Conclusions: Patients affected by BD are at risk of poor treatment adherence, especially those with Manic Predominant Polarity, who are more likely to receive Li and/or VPA. alivary measures grant quick, non-invesive patient administration. Unexpected salivary controls may give clinicians a more reliable estimate of patients’ true adherence status, at all ages, as compared to the routinely scheduled lab tests.Salivary VPA concentrations did not show to be reliable.

P-344 Tolerability and efficacy of aripiprazole long acting injection (LAI) in bipolar disorder F Cartas Morenoa, M Valverde Bareab, ME Ortigosa Luqueb a Servicio Psiquiatria, USMC, Ubeda, Spain, bServicio Psiquiatria, USMC, Ja en, Spain Background and Aims: To assess the tolerability of aripiprazole depot administration in outpatient follow-up for 12 months, by UKU scale and evaluate the clinical effectiveness by assessing the number of entry and emergency room visits before and after the treatment administration. Methods: Observational study, 35 patients treated with aripiprazole (LAI) were followed in specialized mental health consultation


177

18th Annual ISBD & 8th Biennial ISAD for 1 year.Some variables are collected: sociodemographic data, number of emergency room visits, and numbers of entries before and after the treatment instauration and evaluation of adverse effects by UKU (Udvalg f€ ur Kliniske Undersogelser) scale. Results: We have observed that the numbers of admissions into mental health unit have decreased from 89% to 11% and the number of visits to the emergency room have decreased from 69% to 31%. Regarding the UKU scale, the adverse effect that patients most commonly presented with mild intensity is restlessness, in seven patients (during the period with oral aripiprazole’s suministration), followed by asthenia, in five patients. Conclusions: Treatment with aripiprazole long acting injection, has shown to have an adequate tolerability profile being their adverse effects in frequents and with mild intensity.

P-345 Physical health monitoring in adolescents with bipolar disorder: experience from the UK national adolescent bipolar service M Para, K McGurk, J Bamford, C Willis, A Sharma Northumberland Tyne and Wear NHS Foundation Trust, National Adolescent Bipolar Service, Newcastle upon Tyne, United Kingdom Background and Aims: Psychotropic medications are frequently used in the management of adolescent bipolar disorder (BD). These medications can impact on physical health including metabolic syndrome and cardiovascular complications. The UK National Adolescent Bipolar Service (ABS) is a second opinion tertiary affective disorders service for young people under the age of 18 years. The aim of this audit was to monitor performance of ABS against established standards for patients referred between 1 January 2014 and 1 November 2015. Methods: The audit was registered with the NHS trust (CA-150083). Audit standards and pro forma were developed. Electronic health records (RiO) were searched to gather data over the audit period. Results: The number of eligible participants for the audit were 31. Blood investigations (Full blood count, liver and renal function, blood sugar, lipid profile, serum prolactin and thyroid function) and ECG (to monitor QTc interval) were reported in 67.7% of patients. Monitoring of height, weight, pulse and blood pressure was documented in 74% of cases. Conclusions: These data demonstrate the need for ongoing careful monitoring of physical health for adolescents with BD especially in the context of physical health complications. The service needs to develop pathways to improve the existing monitoring further. This will require to be re-audited in 1–2 years.

P-346 Lurasidone adjunctive to lithium or valproate for prevention of recurrence in patients with bipolar I disorder A Pikalova, JR Calabreseb, J Cucchiaroc, C Streicherc, A Loebeld a Sunovion Pharmaceuticals - Inc., Fort Lee, USA, bDepartment of Psychiatry, University Hospitals Case Medical Center- Case Western Reserve University, Cleveland, USA, cSunovion Pharmaceuticals - Inc., Clinical Development, Fort Lee, USA, d Sunovion Pharmaceuticals - Inc., Medical Affairs, Fort Lee, USA Background and Aims: To evaluate the recurrence prevention efficacy of lurasidone in combination with lithium or valproate for the maintenance treatment of bipolar disorder. Methods: Patients with bipolar I disorder with ≥1 manic, mixed manic, or depressed episode in the past 2 years, and with a YMRS or MADRS score ≥14 (if on lithium [Li] or valproate [VPA]); or ≥18 (if not on Li or VPA) were stabilized during 12–20 weeks of

178

open-label treatment with lurasidone adjunctive with Li or VPA, and were then randomized, double-blind, to 28 weeks of lurasidone, 20–80 mg/d or placebo, adjunctive with Li or VPA. A Cox proportional hazards model was used to assess the hazard ratio of time to recurrence of any mood disorder; Kaplan-Meier (KM) estimates were also calculated. Results: 496 patients met stabilization criteria and were randomized to adjunctive lurasidone (N = 246) vs. placebo (N = 250). Fewer patients on lurasidone (vs. placebo) experienced a mood event compared (hazard ratio, 0.71; p = 0.078; Cox model), indicating a 29% reduction in recurrence risk. KM estimates of the probability of time to recurrence of any mood event were 20.9% for lurasidone and 51.5% for placebo (log-rank test, p = 0.055). In a sensitivity analysis based on symptom criteria (MADRS/YMRS ≥18 or CGI-BP-S ≥4) there was 47% reduction in recurrence risk for lurasidone (p = 0.025; Cox model). Conclusions: In this double-blind, 28-week study of patients with a bipolar I diagnosis, treatment with adjunctive lurasidone was associated with a trend-significant reduction in recurrence risk for any mood event compared with placebo plus lithium or valproate. Sponsored by Sunovion Pharmaceuticals Inc.

P-347 Efficacy of lurasidone in bipolar depression: pooled results of two adjunctive studies with lithium or valproate A Pikalova, M Tohenb, J Tsaic, A Loebelc a Sunovion Pharmaceuticals - Inc., Fort Lee, USA, bDepartment of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, USA, cSunovion Pharmaceuticals Inc., Medical Affairs, Fort Lee, USA Background and Aims: The aim of this pooled analysis was to evaluate the efficacy of lurasidone adjunctive with lithium (Li) or valproate (VPA) for the acute treatment of bipolar depression. Methods: Data were combined from two studies of patients with bipolar I depression who were randomized to 6 weeks of double-blind treatment with lurasidone 20–120 mg/d adjunctive with Li (N = 146) or VPA (N = 209), or placebo adjunctive with Li (N = 131) or VPA (N = 196). The primary endpoint was week 6 change in MADRS, analyzed using a mixed model for repeated measures analysis. Results: Treatment with lurasidone (vs. placebo) was associated with significant week 6 improvement in mean MADRS total scores (14.4 vs. 11.9; p = 0.003) for the pooled analysis sample. Week 6 responder rates (≥50% reduction in MADRS at LOCF-endpoint) were significantly higher for treatment with lurasidone vs. placebo (48.2% vs. 36.7%; p = 0.01). In a comparison of improvement based on which adjunctive therapy was utilized, lurasidone vs. placebo effect sizes were higher for the Li group (vs. VPA) for endpoint change in the MADRS (0.32 vs. 0.20). Treatment-emergent adverse events (≥5% for lurasidone vs. placebo) were nausea (13.9% vs. 10.2%), Parkinsonism (12.8% vs. 8.1%), somnolence (11.4% vs. 5.1%), and akathisia (10.8% vs. 4.8%). Rates of protocol-defined treatment-emergent mania were similar (0.8% vs. 1.5%) for lurasidone vs. placebo, respectively. Minimal changes in weight and metabolic parameters were observed. Conclusions: Pooled results from two similarly designed, short-term studies of patients with bipolar depression found that treatment with lurasidone adjunctive with lithium or valproate significantly improved depressive symptoms. Sponsored by Sunovion Pharmaceuticals Inc.


13-16 July, Amsterdam, the Netherlands P-348 Medication discrepancies in outpatients with mood and anxiety disorders. Risks and clinical relevance

M Simoonsa,b,c, H Muldera, E Ruhec, E van Roonb,d a Wilhelmina Hospital Assen, Clinical Pharmacy, Assen, the Netherlands, bUnit of Pharmacotherapy and Pharmaceutical CareDepartment of Pharmacy, University of Groningen, Groningen, the Netherlands, cDepartment of Psychiatry, University of GroningenUniversity Medical Centre Groningen- Interdisciplinary Center for Psychopathology and Emotion regulation, Groningen, the Netherlands, dDepartment of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands Background and Aims: To identify discrepancies between the medication overviews of outpatient departments for mood and anxiety disorders and the actual drug usage by their patients and to investigate the clinical relevance of those discrepancies. Methods: We conducted a cross-sectional study at four mood and anxiety disorder outpatient departments in the north of The Netherlands. We assessed discrepancies between the electronic medication list from the outpatient department and the actual medication use by outpatients over 18 years on the day of inclusion. Actual medication usage was determined by medication reconciliation with the patient. Primary outcome was number of discrepancies on the inclusion date. Secondary outcome was clinical relevance of the discrepancies, as assessed by an expert panel (a psychiatrist and a hospital pharmacist/clinical pharmacologist) who independently reviewed each discrepancy for its potential to cause patient discomfort or clinical deterioration. Results: At least one discrepancy in the medication overview was found in 348 of 367 patients (94.8%). The medication overview contained on average 3.92.8 discrepancies per patient. Most discrepancies were omitted drugs that were regularly used by the patient. 22.7% of all discrepancies, present in almost half of all patients (49.3%), had the potential to cause patient harm. Conclusions: To our knowledge, this is the first study on medication discrepancies and their clinical relevance in psychiatric outpatients. We found on average 3.9 discrepancies in the medication overviews of the psychiatry outpatient departments. Furthermore, a substantial part of these discrepancies were considered to be a clinically relevant risk to medication safety in outpatients with mood and anxiety disorders.

P-349 Ketamine in bipolar depression: neurobiological predictors and neurocognitive performance JK Rybakowskia, A Permoda-Osipa, J Kisielewskia, M Skibinskab, A Bartkowska-Sniatkowskac a Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland, bPsychiatric Genetics Unit, Poznan University of Medical Sciences, Poznan, Poland, cDepartment of Pediatric Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland In the last decade the evidence had showed that a sub-anaesthetic dose of ketamine produces rapid and robust antidepressant effect in patients with treatment-resistant major depressive disorder and bipolar depression. In our own studies, a single ketamine infusion, 0.5 mg/kg, was giving to patients with bipolar depression maintained on mood-stabilizing drugs of the first (lithium, valproate, carbamazepine) and/or second generation (clozapine, olanzapine, quetiapine, aripiprazole), in which antidepressant drugs were not effective. In such group of patients, more than a half showed a significant improvement defined as a reduction of intensity of

depression on the Hamilton Depression Rating Scale 50% or more on the 7th day after infusion, compared to baseline (responders). The assessment of neurotrophins in the subset of 25 patients showed a significant reduction of serum brain-derived neurotrophic factor (BDNF) in non-responders on the 7th day after infusion. Biochemical tests in the subset of 20 patients demonstrated that responders had higher concentration of vitamin B12 and receptor-1 Vascular Endothelial Growth factor before administration of ketamine. Neuropsychological studies in another subset of 20 patients showed that the performance on the Trail Making Test and the Stroop color-word interference test significantly improved on the 3rd day after ketamine infusion. Such an improvement correlated positively with baseline intensity of neuropsychological impairment and was not associated with baseline intensity of depression or reduction of depressive symptoms after 3 or 7 days.

P-350 Psychopharmacological treatment in a sample of inpatients with bipolar disorder

R Sanchez Gonzaleza, J Martı Bonanya, L Galindo Guarınb, MG Hurtado Ruiza, M Campillo Sanza, R Martınez Rieraa, A Farre Martıneza, G Mateu Codinaa a Department of Psychiatry, Institut de Neuropsiquiatria i AddicionsParc de Salut Mar, Barcelona, Spain, bDepartment of Psychiatry, IMIM Foundation. Institut de Neuropsiquiatria i Addicions- Parc de Salut Mar., Barcelona, Spain Background and Aims: Bipolar Disorder (BD) is a chronic illness and patients require longterm multi-disciplinary management. Psychopharmacological therapy remains the mainstay of this treatment. The main objective of this study is to describe the clinical characteristics and profile of psychopharmacological treatment of patients with BD admitted in an acute psychiatric unit during a 5 year period. Methods: A descriptive and retrospective analysis evaluating hospitalizations between 2009 and 2014 was performed. Results: Sample description: a total of 217 hospital admissions have been analyzed. A 65% were women. The mean age was 42.61 years (SD 11.94 years). An average of 27.83 days of hospitalization (SD 22.81 days) was observed. Diagnosis: 49.8% were diagnosed of BD-I with a manic episode; 17.1% BD-I with mixed features episode; 16.1% BD-I depressive episode; 8.8% BD-I single manic episode; 2.8% BD- II; and a 5.6% non-specific episode.Treatment with mood stabilizers at discharge: a 45.2% of the incomes received Valproic Acid as a main mood stabilizer, a 37.8% Lithium and a 12.9 other mood stabilizers. A 5.1% of the incomes not received treatment with mood stabilizers at discharge.Antipsychotic treatment at discharge: a 30% of incomes received Olanzapine, 27% Quetiapine, 10.6% Risperidone and a 21.8% other antipsychotics. A 10.6% of incomes not received antipsychotic treatment at discharge.Other: a 19.8% of hospitalizations received antidepressant treatment and 54.4% benzodiazepines at discharge. Conclusions: In this sample we found that the most commonly used antipsychotics are Olanzapine and Quetiapine, and the main mood stabilizers are Lithium and Valproic Acid.

P-351 Pharmacological treatment of paediatric bipolar disorder: 6 years of the national UK adolescent bipolar service MB Mohamed, K McGurk, E Smith, A Le Couteur, A Sharma The National UK Adolescent Bipolar Service ABS, Children and Adolesent Psychiatry, Newcastle Upon Tyne, United Kingdom


179

18th Annual ISBD & 8th Biennial ISAD Background and Aims: The National UK Adolescent Bipolar Service (ABS) is a specialist second opinion service which provides support to local teams with regards to diagnosis and advice on management of Paediatric Bipolar Disorder (PBD). Data are limited regarding patterns of prescribing to manage PBD. The aim of this project was to study patterns of prescribing (on and off label) for PBD. Methods: All patients referred to ABS over 6 years were searched for using electronic health records and the psychotropic medications used during treatment were recorded. Results: Antipsychotics were the most commonly used medication during treatment in the ABS service (88%). Quetiapine was the most commonly used antipsychotic (57.7%), followed by Aripiprazole (30.8%).Anticonvulsants: Lamotrigine (28.8%) was the most commonly used one followed by valproate (11.5%; only in males) Antidepressants were used for treatment in 36.5% of cases.Stimulants were prescribed for 9.7% cases where there was a dual diagnosis of BD and ADHD. Conclusions: These first data from the UK are keeping with most guidelines. Medications used by ABS were all prescribed onlicense, with the exception of Lamotrigine. Lamotrigine is known to be one of the most effective treatments of depression in adult BD however few trials have looked at its use in PBD. Longer term data is required on the safety and efficacy of psychotropic medications used in PBD.

P-352 Tamoxifen for the treatment of episodes of mania: meta-analysis M Taylora, J Palaciosb, A Yildizc, A Youngb a Department of Psychosis Studies, Institute of PsychiatryPsychology and Neuroscience- King’s College London, London, United Kingdom, bDepartment of Psychological Medicine, Institute of Psychiatry- Psychology and Neuroscience- King’s College London, London, United Kingdom, cDepartment of Psychiatry, _ Dokuz Eyl€ ul University, Izmir, Turkey Background and Aims: Tamoxifen is an oral medication that has been proposed as a potential acute treatment for episodes of mania. Tamoxifen acts to inhibit the intracellular action of Protein Kinase C, which is also an action of established anti-manic treatments such as lithium and valproate.Here we aimed to identify randomised controlled trials of tamoxifen in the treatment of mania and synthesise their results using meta-analysis. Methods: Randomised controlled trials were identified by searching of electronic databases and from discussion with experts in the field. Data were extracted, and meta-analyses were performed using the meta package in R. Random effects estimates are presented. Results: Five placebo-controlled randomised controlled trials of tamoxifen were identified. They were of between three and 6 weeks duration. Tamoxifen was studied either as monotherapy or as augmentation of lithium or valproate.Endpoint mania scale scores favoured tamoxifen over placebo: SMD 1.16 (95% CI 1.91 to 0.42; 4 trials). Response rates were also higher: RR 4.35 (1.99 to 9.50; 4 trials).Acceptability was similar to placebo: RR 1.03 (0.94 to 1.13; 5 trials). Conclusions: Tamoxifen appears to be a promising potential treatment for episodes of mania. Future studies could investigate its effects as an adjunct to antipsychotic medications, and establish its longer term effects on mood and relapse.

180

P-353 Lurasidone for major depressive disorder with mixed features: effect of irritability J Tsaia, A Swannb, Y Maoc, A Loebela a Sunovion Pharmaceuticals Inc, Medical Affairs, Marlborough, USA, bMenninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA, cSunovion Pharmaceuticals Inc, Medical Affairs, Fort Lee, USA Background and Aims: Major depressive disorder (MDD) with mixed features has recently been recognized as a diagnostic subtype in DSM-5. In this post-hoc analysis, we examine the prevalence of irritability, and its impact on response to lurasidone. Methods: Patients meeting DSM-IV-TR criteria for unipolar MDD, with a MADRS total score ≥26, who presented with 2 or 3 protocol-defined manic symptoms, were randomized to 6 weeks of double-blind treatment with either flexible doses of lurasidone 20– 60 mg/d (N = 109) or placebo (N = 100). Irritability was defined as a score ≥2 on both the Young Mania Rating Scale (YMRS) irritability item (#5) and the disruptive-aggressive item (#9). Change in MADRS and YMRS items 5 & 9 were analyzed using a mixed model for repeated measures analysis for subgroups with and without irritability. Results: Irritability was present at baseline in 20.7% of patients and was not associated with difference in MADRS total score. Lurasidone was associated with significant week 6 change vs. placebo in MADRS total score for both the irritability (22.63 vs. 9.47; p < 0.0001; effect size [ES], 1.41) and non-irritability (19.91 vs. 13.80; p < 0.0001; ES, 0.66) groups. In the irritability group, lurasidone was associated with significant week 6 change in both the YMRS irritability item (1.38 vs. 0.32; p = 0.0012; ES, 1.04), and the disruptive-aggressive item (0.99 vs. 0.32; p = 0.0002; ES, 1.19). Conclusions: In this post-hoc analysis, acute treatment with lurasidone significantly improved depressive symptoms in patients with MDD with mixed features who presented with irritability. Symptoms of irritability also showed significant improvement. Sponsored by Sunovion Pharmaceuticals Inc.

P-354 Continuous circular cycling in bipolar disorders as a predictor of poor response to short-term antidepressant treatment A Tundoa, JR Calabreseb, L Proiettic, R De Filippisc a Istituto di Psicopatologia, Clinical Psichiatry, Rome, Italy, b Department of Psychiatry, University Hospital Case Medical Center- Case Western Reserve University, Cleveland, USA, cIstituto di Psicopatologia, Section of Psychiatry, Rome, Italy Background and Aims: To compare effectiveness of short-term AD treatment between patients with continuous (CCC) and non-continuous (N-CCC) cycling bipolar disorders. Methods: We include consecutive patients seen from 2005 through 2009 meeting DSM-IV criteria for a current major depressive episode and for bipolar I (BP-I) or II (BP-II) disorder. Exclusion criteria and AD use were based upon ISBD recommendations 2013. Response was defined as a HDRS21 total score 2 categories. Results: The study includes 140 patients, 28% have a CCC pattern of course. Compared with N-CCC patients, CCC patients were more likely treated with divalproex and lamotrigine; no significant differences were found within respect to the other mood stabilizers and to the adjunctive use of antidepressants and/or antipsychotics between the two groups. The proportion of patients who had no recurrences during the follow-up was significantly lower in the CCC than in the N-CCC group (15.4% and 37.6%, p = 0.001). No significant differences between the two groups were found regarding the secondary outcomes. Conclusions: Our findings show that the absence of a free interval identifies a bipolar sub-population with poor response to maintenance treatment.

P-356 Does onset polarity predict the effectiveness of long-term treatment in bipolar disorders? A naturalistic study A Tundoa, L Musettib, A Benedettib, G Massimettib, L Dell’Ossob a Istituto di Psicopatologia, Clinical Psichiatry, Rome, Italy, b Department of Clinical and Experimental Medicine, Section of Psychiatry University of Pisa, Pisa, Italy Background and Aims: To test if the onset polarity has any long term treatment implication in patients with bipolar disorders followed in a naturalistic setting. Methods: We include consecutive patients meeting DSM IV criteria for bipolar I or II disorder treated for at least 8 months at two Italian centers specialized in mood disorders. Diagnosis of manic, hypomanic, and depressive episode in BP-I and II, and of mixed

episode in BP-I was formulated according to DSM-IV criteria. For diagnosing mixed episode in BP-II we adopted Koukopoulos criteria. Treatment was based upon international guidelines at the time of patient’s enrollment (2002–2006). Chi-square test or two-tailed Fisher’s exact test was used, as appropriate, to compare categorical variables. Paired T-test was also used. Cox’s regression adjusted for the length of follow-up were used to identify the predictors of relapses. Results: The study includes 266 patients, 57.5% with BP-I. During the follow-up (mean lenght 46.0 + 27.5 months) 35.7% had no relapses, 33.8% had 1 or 2 relapses, and 30.4% had >3 relapses. Compared with the number of episodes per year before study entering, the number of episodes after the study entry showed a significant reduction (1.6 vs. 0.6; t = 6.6; p < 0.000). Female gender predicts at least one relapse, the number of previous episodes predicts >3 relapses. Polarity at onset (including mixed depression) is not related to treatment response. Conclusions: Our findings do not support results of previous studies suggesting that onset polarity had implications on long term treatment response in patients with bipolar disorders.

P-357 The effect of mood-stabilizing drugs on cytokine levels in bipolar disorder S van den Ameelea,b, L van Diermena,b, W Staelsc,d, V Coppensa,b, G Dumonte, S Bernarda,b, M Morrensa,f a University of Antwerp, Collaborative Antwerp Psychiatric Research Institute CAPRI, Antwerp, Belgium, bVZW Emmaus, University Psychiatric Hospital Duffel, Duffel, Belgium, cGhent University, Pediatrics and Genetics, Ghent, Belgium, dVrije Universiteit Brussel, Diabetes Research Center, Brussel, Belgium, eDepartment of Pharmacology, University of Amsterdam- Academic Medical Center, Amsterdam, the Netherlands, fPsychiatric Hospital, Broeders Alexianen, Boechout, Belgium Background and Aims: Cytokine level alterations suggest a role for the immune system in the pathophysiology of bipolar disorder (BD). Pharmacological treatment is an important confounding factor in clinical research on cytokine levels. In this systematic review we collate the evidence on blood cytokine levels in medication-free BD and the effects of mood-stabilizing drugs on these levels. Methods: A systematic literature review was conducted according to the PRISMA statement. We searched the Pubmed and Embase database for clinical studies reporting either on cytokine levels in medication-free BD or on the effects of single mood-stabilizing drugs on cytokine levels in BD. Results: Of the 564 articles screened, 17 were included. Fourteen articles report on medication-free BD patients and indicate staterelated cytokine alterations. Six articles discuss the effect of lithium. Whereas no data on short-term effects of lithium were found, ≥2 months lithium use in euthymic populations is associated with normal cytokine levels. Two studies report no effect of valproate on cytokine levels. No studies were found on carbamazepine, lamotrigine and antipsychotics. Conclusions: A systematic review of the literature suggests the presence of state-related cytokine level alterations in medication-free BD with most evidence pointing to a proinflammatory cytokine response in mania. Euthymia and long-term lithium use are associated with normal cytokine levels. The available studies are characterized by methodological heterogeneity. Longitudinal studies with medication-free baseline measurements, standardized single-drug treatment protocols and close mood state monitoring are needed.


181

18th Annual ISBD & 8th Biennial ISAD P-358 Transdiagnostic group CBT for mood and anxiety disorders in a psychiatric hospital outpatient clinic in Singapore CSM Wong Psychology, Institute of Mental Health, Singapore Theory and evidence relating to etiology and latent structure suggest that commonalities across emotional disorders may outweigh the differences. Transdiagnostic treatment protocols that target common cognitive and behavioral maintaining factors in individuals with heterogeneous mood and anxiety disorders have been found to be effective. However, these conclusions are tempered by the small number of studies and methodological limitations. This study aimed to evaluate the effectiveness of a transdiagnostic group cognitive-behavioral therapy (CBT) program for mood and anxiety disorders at a psychiatric hospital outpatient clinic in Singapore. Development and delivery of the program will be presented alongside treatment outcomes.

P-359 Efficacy of cariprazine in bipolar depression: post hoc band-pass analyses of two randomized, double-blind, placebo-controlled trials L Yathama, E Vietab, S Durgamc, W Earleyc, K Luc, I Laszlovszkyd, G N emethd a University of BC, Psychiatry, Vancouver, Canada, bUniversity of Barcelona, Hospital Clinic, Barcelona, Spain, cForest Research Institute- an Allergan affiliate, Clinical Development, Jersey City, USA, dGedeon Richter Plc, Medical Division, Budapest, Hungary

Background and Aims: Cariprazine demonstrated efficacy in 1 of 2 Phase II studies in patients with bipolar depression (NCT01396447; NCT00852202). This post hoc analysis explored the efficacy of cariprazine versus placebo after excluding study centers with unusually high placebo responses. Methods: Band-pass filter analysis excluding study centers with placebo response (MADRS improvement ≥50%) in >50% of patients was applied to two 8-week, randomized, placebo-controlled studies. The protocol-defined primary efficacy parameter was mean MADRS total score change at Week 6 (RGH-MD-56) or Week 8 (RGH-MD-52). Patients were randomized to placebo, cariprazine 0.25–0.75, or 1.5–3.0 mg/d in RGH-MD-52 (N = 233) and to placebo or cariprazine 0.75, 1.5, or 3.0 mg/d in RGH-MD-56 (N = 584). Results: In RGH-MD-52, the least squares mean difference (LSMD) in MADRS score change for cariprazine versus placebo was not statistically significant at Week 6 or 8. After applying the band-pass filter, LSMDs were significant for both doses at Week 6 (0.25–0.75 mg/d: 5.0 [p = 0.0306]; 1.5–3.0 mg/d: 5.2 [p = 0.0295]) and for 0.25–0.75 mg/d at Week 8 (5.2; p = 0.0317). In RGH-MD-56, significant improvement versus placebo was observed for cariprazine 1.5 mg/d at Week 6 (p = 0.0030) and for 3.0 and 4.5 mg/d at Week 8 (both, p < 0.05). After bandpass filter, LSMDs for all cariprazine doses versus placebo were significant at Week 6 and 8 (range: 4.1 to 5.5, all p < 0.01). Conclusions: Cariprazine was effective in treating bipolar depression in RGH-MD-56, a large placebo-controlled clinical trial. High placebo response may explain the negative outcome in RGH-MD52, as cariprazine treatment effects were significant versus placebo after filtering sites with excessive placebo response rates.

Poster Session XXXPregnancy/Childbirth P-360 Depressive disorders during pregnancy F Ghali, E Khelifa, G Jmii, M Zghal, S Aloui, R Beji, A Ben amor, H Zalila Razi Hospital, Psychiatry, Mannouba, Tunisia Background and Aims: Nowadays, pregnant women have a systematized medical follow up but they rarely have the opportunity to express their worries and emotions. Despite regular contact with health professionals, all through pregnancy, depressive, anxious and psychosocial issues often remain unidentified.The aim of our study was to identify depressive symptoms within 100 women in their third trimester of pregnancy presenting for regular consultation at the outpatient « B » department of the maternity and neonatology centre of Tunis. Methods: We used a semi-structured questionnaire as well as the EPDS scale to screen for depressive symptoms. Results: According to the EPDS, the prevalence of depressive symptoms was 26% and suicidal ideation was 9%.The lack of a partner (p = 0.01), the poor household economy (p = 0.048, OR = 2.73) and the lack of social security (p = 0.03, OR = 3.03) were found to be associated with depression.Depression was also significantly associated with a lack of practical support, unwanted pregnancy and domestic violence. Conclusions: All those concerned with antenatal care need to pay attention to maternal suffering during pregnancy in order to

182

prevent considerable consequences on mothers, growing foetus and in mother- infant interactions.

P-361 Patterns of depression and treatment from pregnancy to five years postpartum

A Bowena, K Rahmanb, N Muhajarineb a University of Saskatchewan, Saskatoon, Canada, bUniversity of Saskatchewan, Community Health& Epidemiology, Saskatoon, Canada Background and Aims: Although ample studies describe antenatal and postpartum depression, there is very little evidence to demonstrate the patterns of depression and treatment over and beyond the perinatal period, specifically in the 5 years after birth. We sought to determine the patterns of depression status and the impact of treatment, medication and counseling, from mid pregnancy up to age five of the child. Methods: This longitudinal study was conducted with 646 pregnant women to 5 years postpartum in Saskatchewan, Canada. Women were interviewed five times with the Edinburgh Postpartum Depression Scale (EPDS) to measure maternal depression status. Due to the five-year time span, followup was an inherent challenge. To handle this, besides study design process, we took precaution to analyze this data using a growth curve model. In the


13-16 July, Amsterdam, the Netherlands analysis, missing data patterns were identified and accounted for measuring EPDS score and treatment status among the mothers. Results: Overall, women experienced improving depression from early pregnancy to the end of the study in both depressed and nondepressed women (b = 0.05; p < 0.05) controlling for age, ethnicity, income, depression history, relationship satisfaction, social support, exercise, and missing data pattern. While treatment (psychotropic medications and/or counselling) overall had a significant effect on depression status (b = -0.05; p < 0.001), further analysis showed counselling had a more significant impact over time on depression status. Conclusions: Depression status continued to improve from pregnancy until 5 years postpartum and counselling has most significant impact on their mood in the long term.

P-362 Perinatal use of clozapine: placental transfer, half-life in neonates and neonatal outcomes ML Imaza, G Oriolob, M Torrac, D Soyd, F Botete, R Martin-Santosf, L Garcia-Esteveg a Department os Psychiatry and Psychology, Institut Clınic of Neuroscience, Perinatal Psychiatry and Gender Research Program, Barcelona, Spain, bInstitut Clinic of Neuroscience, Hospital Clinic, Psychiatry and Psychology, Barcelona, Spain, cDepartment of Biochemistry and Molecular Genetics, Biomedical Diagnostic Centre CDB, Hospital Clinic, Barcelona, Spain, dPharmacy, Hospital Clinic, Barcelona, Spain, eGinaecology- Obstetric and Neonatology ICGON, Hospital Clınic, Neonatology, Barcelona, Spain, fInstitut Clinic of Neuroscience, Psychiatry and Psychology, Barcelona, Spain, gDepartment of Psychiatry and Psychology, Institut Clinic of Neuroscience, Hospital Clinic, Perinatal Psychiatry and Gender Research Program, Barcelona, Spain Background and Aims: Background: Clozapine is an atypical antipsychotic that is used to treat severe treatment-resistant schizophrenia. Given the known negative consequences of relapse of schizophrenia on outcomes for both mother and baby, the maintenance of clozapine during pregnancy is recommended1. It has been suggested that accumulation of clozapine in fetal serum is associated with increasing neonatal complications2. Aims: To determine the placental passage, half-life in neonates and neonatal outcomes after maternal treatment with clozapine through pregnancy. Methods: We report three cases of women with schizophrenia and related disorders attended al the Perinatal Psychiatry Program of Hospital Clinic (Barcelona, Spain), who become pregnant while being treated successfully with clozapine and continued treatment through pregnancy. Clozapine and norclozapine plama levels and white blood cell count were determined in mother-infant pairs at the day of delivery, 48 h pospartum and weekly after delivery. Neonatal outcomes were reviews of pediatric records. Results: Three deliveries were term. There were no neonatal seizures and the white blood cell count were normal. The mean umbilical cord/maternal serum clozapine and norclozapine ratios was 0.50 (SD = 0.10) and 0.32(SD = 0.04) respectively. The mean halflife of neonatal elimination of clozapine was 79.70 (SD = 2.58) hours. Conclusions: Clozapine and norclozapine crosses placental barrier partially.In neonates, clozapine is eliminated with a half-life value of 79 hIn our three cases, there were not positive pediatric records on seizure or agranulocytosis afther maternal use of clozapine.

P-363 Identifying risk factors for postpartum mood episodes in bipolar disorder–A UK prospective study A Perrya, K Gordon-Smitha, A Di-Floriob, L Fortyb, N Craddockb, L Jonesa, I Jonesb a Department of Psychological Medicine, University of Worcester, Worcester, United Kingdom, bCardiff University, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom Background and Aims: Women with bipolar disorder are vulnerable to episodes postpartum, but risk factors are poorly understood. We are exploring risk factors for postpartum mood episodes in women with bipolar disorder using a prospective longitudinal design. Methods: Pregnant women with lifetime DSM-IV bipolar disorder are being recruited into the Bipolar Disorder Research Network (www.BDRN.org). Baseline assessments during late pregnancy include lifetime psychopathology and potential risk factors for perinatal episodes such as medication use, sleep, obstetric factors, and psychosocial factors. Blood samples are taken for genetic analysis. Perinatal psychopathology is assessed via follow-up interview at 12-weeks postpartum. Interview data are supplemented by clinician questionnaires and case-note review. Potential risk factors will be compared between women who experience perinatal episodes and those who remain well. Results: 80 participants have been recruited to date. 32/61 (52%) women had a perinatal recurrence by follow-up. 16 (26%) had onset in pregnancy. 21 (34%) had postpartum onset, 19 (90%) within 6-weeks of delivery: 11 (18%) postpartum psychosis, 5 (8%) postpartum hypomania, 5 (8%) postpartum depression. Postpartum relapse was more frequent in women with bipolar-I than bipolar-II disorder (45% vs 17%). 62% women with postpartum relapse took prophylactic medication peripartum and almost all received care from secondary psychiatric services (95%). Conclusions: Rate of postpartum relapse is high, despite most women receiving specialist care and medication perinatally. A larger sample size will allow us to examine potential risk factors for postpartum episodes, which will assist in providing accurate and personalised advice to women with bipolar disorder who are considering pregnancy.

P-364 Postpartum psychosis in bipolar disorder: no association with personality, cognitive style and temperament I Webba, K Gordon-Smithb, A Perryb, C Fraserc, L Fortyc, N Craddockc, I Jonesc, L Jonesb a University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom, bDepartment of Psychological Medicine, University of Worcester, Worcester, United Kingdom, c Cardiff University, Institute of Psychological Medicine and Clinical Neurosciences MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, United Kingdom Background and Aims: Bipolar disorder has been associated with a number of personality traits, cognitive styles and affective temperaments. Women who have bipolar disorder are at increased risk of experiencing postpartum psychosis, however no previous research has investigated these traits in relationship to postpartum episodes. Our aim was to establish whether aspects of personality, cognitive style and affective temperament, that have been associated with bipolar disorder, confer vulnerability to postpartum psychosis over and above their known association with bipolar disorder. Methods: Participants were 552 parous women with DSM-IV bipolar I disorder recruited into the Bipolar Disorder Research


183

18th Annual ISBD & 8th Biennial ISAD Network (www.bdrn.org). Postpartum psychosis group: lifetime episode of postpartum psychosis within 6 weeks of delivery (N = 284). Non-postpartum psychosis group: no history of any perinatal mood episodes (N = 268). Bipolar disorder-associated personality traits (neuroticism, extraversion, schizotypy and impulsivity), cognitive styles (low self-esteem and dysfunctional attitudes) and affective temperaments were measured using well validated self-report questionnaire measures. Results: After controlling for key demographic, clinical and pregnancy-related variables, and measures of current mood state, there

were no statistically significant differences between the postpartum psychosis group and non-postpartum psychosis group on any of the personality, cognitive style or affective temperament measures. Conclusions: Personality traits, cognitive styles and affective temperaments associated with the bipolar disorder diathesis in general were not associated with the onset of postpartum psychosis specifically. We have found no evidence that these traits should play a key role when evaluating risk of postpartum psychosis in women with bipolar I disorder considering pregnancy.

Poster Session XXXIPsychoeducational/Self Management P-365 The development of self-help therapy for bipolar disorder

Ribeir~ ao Preto, Brazil, cFaculdade de Medicina de Ribeir~ ao PretoFMRP- USP- Brasil, Neuroci^ encias e Ci^ encias do Comportamento, Ribeir~ ao Preto, Brazil

YB Bae, S Choi Duksung Women’s University, Psychology, Seoul, Korea

Background and Aims: The Bipolar Affective Disorder (BD) is characterized by high rates of recurrence and low rate of treatment adherence. The combination of the pharmacological treatment and psychoeducational (PE) approach, is an effective treatment option for individuals with BD. The use of PE in group format has often been used in several studies with good applicability, however PE in home visits to our knowledge have not been evaluated in controlled trials yet. Our aim is to evaluate the efficacy of PE in home visits in Bipolar Affective Disorder patients in pharmacological treatment and their clinical course, medication adherence and functionality. Methods: This was a randomized controlled trial with 30 patients with bipolar I or II, according to the DSM-IV-TR criteria. The experimental group consisted of 15 patients received pharmacological treatment and home visits with structure PE intervention reduced version of the PE program created by the Group of Barcelona. The control group consisted of 15 patients received, in addition to pharmacological treatment, home visit without PE. Results: The experimental group, after received PE, showed a significant reduction in depression score in Hamilton Depression Rating Scale during the treatment phase (p < 0.01). Furthermore, compared to the control group, the PE group showed a significant improvement in medication adherence (p < 0.01). Conclusions: The method of PE with home visit provide to be effective as adjunctive treatment for patients with bipolar affective disorder, reducing the risk of symptomatic recurrence and significantly improving adherence to medication. Home visits with PE in medication can provide adherence improvement.

Background and Aims: Bipolar disorder is a chronic condition with high relapse rates. Many patients with bipolar disorder have prodromal or residual symptoms between episodes. Chronic course of bipolar disorder leads to decrease functioning and quality of life. Psychological interventions can enhance medication adherence, reducing symptoms, preventing relapse and improving quality of life. The high costs and the shortage of therapists are disadvantage although psychological interventions can provide treatment benefits. Therefore, the objective of this study is to overcome these limitations by developing the self-help therapy for bipolar disorder. Methods: Participants with Bipolar I or II disorder were randomized to receive self-help therapy or treatment as usual. Self-therapy group has conducted the program for 8 weeks (16 sessions), including mood chart, psychoeducation, life chart, identification of triggers, and medication management. Quality of Life in Bipolar Disorder Questionnaire, Attitudes toward seeking professional help Scale, Barratt Impulsivity Scale, Young Mania Rating Scale and Montgomery Asberg Depression Rating Scale were measured pre, post, and follow up. The efficacy of the self-help therapy was analyzed by using mixed ANOVAs. Results: There were significant between group results for mood symptoms. Participants who received self-help therapy reported reductions in mood symptoms and improvements in quality of life and treatment adherence. Conclusions: Implication of the result is that self-help based psychological treatment could be a good alternative in developing countries like South Korea where the number of experienced clinicians are limited.”This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HM15C1245).

P-366 Psychoeducation for bipolar: home visits approachpsychoeducation for bipolar: home visits approach T Batistaa, C Baesb, L Cardosoa, M Juruenac a Escola de Enfermagem de Ribeir~ ao Preto- EERP- USP- Brasil, Enfermagem Psiqui atrica, Ribeir~ ao Preto, Brazil, bFaculdade de Medicina de Ribeir~ ao Preto- FMRP- USP- Brasil, Sa ude Mental,

184

P-367 A 4-years follow-up study on effectiveness of psychoeducation for bipolar patients in routine mental health services C Buizzaa, V Candinib, G Albertoa, S Emilioa, FM Saviottic, C Turrinaa, G de Girolamod a Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, bDepartment of General Psychology, University of Padua, Padua, Italy, cDepartment of Mental Health, A.O. Desenzano del Garda, Desenzano BS, Italy, dIRCCS ”St. John of God” Fatebenefratelli, Psychiatric Epidemiology and Evaluation Unit, Brescia, Italy Background and Aims: To assess the effectiveness of psychoeducation in reducing the number of hospitalisations and days spent in hospital in people with Bipolar Disorder, at a 4-year follow up; to


13-16 July, Amsterdam, the Netherlands identify variables associated with a better outcome over time in people who attended group-psychoeducation, in order to understand who benefits from this intervention. Methods: This is a continuation research of a published study, which evaluated the effectiveness of psychoeducation in routine mental health services. This study involving two groups: an experimental group receiving standard pharmacological treatment and additional psychoeducation, and control subjects receiving only standard care. The 4-years follow-up started at the end of psychoeducation, and during this period all participants continued receiving standard pharmacological treatment. Results: One hundred and two euthymic out-patients were recruited: 57 in the experimental group and 45 in the control group. Two years after the programme’s conclusion, significant differences in the percentage of patients admitted to GHPUs were observed: 7 (12.3%) individuals in the treatment group had been hospitalised, versus 11 (34.4%) in the control group (Chisquare = 6.201; df = 1; p = 0.013). Moreover, during the 2-year follow up, patients who had received psychoeducation had statistically significantly fewer admissions, and days spent in hospital than control group. After 4-year, there were no statistical differences. Conclusions: To our knowledge, this is one of the few study assessing the longer-term efficacy of psychoeducation. Although the difference did not reach any statistical significance after 4-years of follow up, there was a strong trend toward fewer hospitalizations over time in the psychoeducation group.

P-368 An online psychoeducation forum for bipolar disorder in young people

omez S anchez-Lafuentea, R Reina Gonzalezb, I Tilves Santiagoa C G a Hospital Universitario Virgen de la Victoria, Psychiatry, M alaga, Spain, bHospital Regional Universitario, General Practitioner, M alaga, Spain Background and Aims: New generations often use social networking websites, blogs and online forums as a way to learn about their illness, in particular, about medication and adverse effects. Usually, erroneous information is spread through the web. Our objective is to investigate if patients collaborate on a new online forum and detect relevant issues about the illness for them. Methods: Our team tried to create a new online forum for Spanish users to talk about their concerns about bipolar disorder. 48 patients diagnosed by bipolar 1 disorder, younger than 30, created an account for the forum. 5 psychiatrists started topics, wrote answers and made a brief guide about pharmacotherapy. Forum posts were analyzed using qualitative content analysis and some aspects of discourse analysis. Results: 3 months after, 37 themes and over 200 messages were posted. The most discussed themes in the forum were: management of treatment, early symptoms of bipolar decompensation, coping strategies, stigma and loneliness. Nearly half of the posts included life experiences and personal strategies to handle the challenges of the illness. 7 patients showed symptoms for destabilization that later were confirmed in a psychiatric examination. 6 months later, 17 patients organized a face-to-face meeting to get to know each other. Conclusions: Internet can provide us an easy and inexpensive way to provide help, peer support and the opportunity for patients to share their thoughts and experiences and to explore issues related to their illness. This forum could have benefitted patients to get more open view of bipolar disorder and strategies to handle their illness.

P-369 Relationship between chronotype and coping strategies in patients with bipolar and depressive disorders TU Kanga, E Moona, JM Parka, BD Leea, YM Leea, HJ Jeonga, Y Choia, DK Leeb a Pusan National University Hospital, Psychiatry, Busan, Korea, b Yangsan Hospital, Psychiatry, Yangsan, Korea Background and Aims: The chronotype and coping styles can have influence on the course of mood disorder. There is little study of relationship between coping strategies and chronotype of patients with mood disorder. The purpose of this study is to investigate the relationship between coping strategies and chronotypes of patients who have bipolar and depressive disorders. Methods: Patients with bipolar disorder and depressive disorder (N = 183) who meet DSM-IV diagnostic criteria were included in this analysis. Chronotype was evaluated using the Korean version of the composite scale of morningness (CSM) and was divided into morning (N = 21), intermediated (N = 122), evening (N = 40) type by the total score of CS. Coping strategies were assessed using the Coping Inventory for Stressful Situations (CISS), Anger Coping Scale (ACS). Results: According to chronotype, there were significant differences in CISS emotion-focused coping (F = 6.957, p = 0.001), ACS behavioral aggression (F = 4.028, p = 0.019), ACS verbal aggression (F = 4.702, p = 0.010), ACS tension releasing (F = 3.510, p = 0.032). Eveningness subjects had higher scores of emotionfocused coping(p = 0.001), behavioral aggression(p = 0.010) and verbal aggression(p = 0.015) than morningness subjects and intermediation subjects (p = 0.012; p = 0.038; p = 0.008). Morningness subjects had higher score of tension releasing than eveningness. (p = 0.040). The total score of CSM were negatively correlated with emotional coping (r = 0.303, p < 0.001), verbal aggression (r = 0.171, p = 0.020), and positively correlated with tension releasing (r = 0.178, p = 0.015). Conclusions: The eveningness tend to have more emotional, impulsive coping styles than other chronotypes. These results suggest that the chronotype of patients with bipolar and depressive disorders might have different relations with coping strategies in stressful situations and influence the trajectory of mood symptoms.

P-370 Large-scale roll out of online prospective measurement of mood symptoms in affective disorders S Knotta, K Gordon-Smitha, L Fortyb, N Craddockb, C Hindsc, V Wadekarc, A Bilderbeckc, K Saundersc, P Harrisonc, G Goodwinc, J Geddesc, I Jonesb, L Jonesa a Department of Psychological Medicine, University of Worcester, Worcester, United Kingdom, bCardiff University, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom, cDepartment of Psychiatry, University of Oxford, Oxford, United Kingdom Background and Aims: True Colours is an online prospective mood-monitoring system developed at the University of Oxford to assist local patients and clinicians with monitoring course of illness in bipolar disorder. We report our initial experiences of using True Colours for research purposes in the Bipolar Disorder Research Network (BDRN; www.bdrn.org), a large research network of individuals with mood disorders spread throughout the UK. Methods: After initial piloting to ensure the practicality/acceptability of using True Colours within BDRN, we invited all BDRN participants (n = 7000) to participate in weekly True Colours ratings via three postal invitations sent over an 8-month period.


185

18th Annual ISBD & 8th Biennial ISAD Results: Following the three postal invitations, 915 individuals have so far expressed an interest in joining True Colours, and, of these, 662 (72.3%) have registered. 32 of those who registered for True Colours (5%) have so far asked to leave the system. Positive feedback from participants has focused around the ease of use and convenience of True Colours and potential clinical utility of the graphical representation of weekly mood scores. Conclusions: We have demonstrated that large-scale prospective mood monitoring for research purposes using a contemporary online approach is feasible. Challenges have included: (i) variation in participants’ technological ability; (ii) management of requests for clinical advice based on mood scores within a research setting; and, (iii) resources required to provide access and on-going support for participants using True Colours. We continue to expand recruitment to True Colours within BDRN, and plan to trial email invitations in the next phase of recruitment.

P-371 Expressed emotion in relatives of patients with bipolar disorder A Martinez-Estradaa, R Salin-Pascualb, JJ Aguilar-Gascac, E Barron-Velasquezd a hospital Angeles Lomas, Psychiatry Consultorio 560, M exico, Mexico, bDepartment of Psychiatry and Mental Health, UNAM, Mexico City, Mexico, chospital Angeles Lomas, Psychiatry Office 560, M exico, Mexico, dhospital Angeles Lomas, Psychiatry, M exico, Mexico Background and Aims: Background: Over the years patients with bipolar disorder (BPD) affect family dynamics presenting different levels of expressed emotion.Aim: To assess the difference in expressed emotion (EE) in relatives of patients diagnosed with BPD before and after receiving a psychoeducational ongoing. Methods: Type of study: Observational, prolective, prospective, longitudinal, quantitative.Methods: 56 subjects were evaluated relatives with bipolar disorder type I (BPD –I) and II (BPD –II), with Expressed Emotion Scale, who were older than 18 years old, live together with the patient over a year and finish the psychoeducational course. Results: We studied 31 female subjets (55.4%) and 25 male subjets (44.6%); we find a higher prevalence of relatives of subjects with 43 BPD-I vs 13 BPD-II, with an average age of 42.57 and coexistence 7.54 years; the mothers were the most prevalence of relatives in 53.6% followed by the wives and sisters 8.9% respectively. At baseline of EE was 78.58 (71.10–86.06) points and post psychoeducational course there was a reduction of 27 points with p < 0.001. Conclusions: When the family learn more about BPD improves the rating of EE, especially in subscales of hostility and overprotection.Key words: expressed, emotion, relatives, bipolar.

P-372 Effective self-management strategies for bipolar disorder: a community-engaged Delphi consensus consultation study E Michalaka, M Sutob, S Lapsleya, M Scotta, S Barnesc, G Murrayd, N Balram Elliotta, S Houe, L Berkf a University of British Columbia, Psychiatry, Vancouver, Canada, b University of British Columbia, Occupational Science & Occupational Therapy, Vancouver, Canada, cUniversity of British Columbia, Psychology, Vancouver, Canada, dSwinburne University of Technology, Psychological Sciences & Statistics, Melbourne, Australia, eUniversity of Guelph, Psychology, Guelp, Canada, f Deakin University, Medicine, Melbourne, Australia Background and Aims: Self-management represents an important complement to psychosocial treatments for bipolar disorder (BD),

186

but research is limited. Specifically, little is known about self-management approaches for elevated mood states; this study investigated self-management strategies for: (1) maintaining balance in mood, and (2) stopping progression into hypomania/mania. Methods: Delphi Consensus Consultation methods were used within a Community-Based Participatory Research (CBPR) framework across five study phases: (1) Qualitative dataset content analysis; (2) Academic and grey literature reviews; (3) Content analysis; (4) Two Delphi rounds, and; (5) Quantitative analysis and interpretation. Participants were people with BD and healthcare providers. Results: Phases 1 and 2 identified 262 and 3940 candidate strategies, respectively. Of these 4202 potential strategies, 3709 were discarded as duplicates/unintelligible. The remaining 493 were assessed via Delphi Consensus Consultation in Phase 4: 101 people with BD and 52 healthcare providers participated in Round 1; 83 of the BD panel (82%) and 43 of the healthcare provider panel (83%) participated in Round 2—exploratory factor analysis (EFA) was conducted on Round 2 results. Conclusions: High concordance was observed in ratings of strategy effectiveness between lived experience and healthcare provider participants. Future research could usefully investigate the provisional discovery here of underlying factors which link individual strategies. For example, ‘maintaining hope’ arose as a factor underpinning strategies for maintaining balance, and ‘decreasing use of stimulants’ as a factor for strategies to interrupt hypo/manic ascent. There is merit in combining CBPR and Delphi methods.

P-373 An investigation of self-management in young adults with bipolar disorder: oppertunities for smartphone support J Nicholasa, H Christensenb, K Boydella a Black Dog Institute - University of New South Wales, School of Psychiatry, Sydney, Australia, bBlack Dog Institute - University of New South Wales, Faculty of Medicine, Sydney, Australia Background and Aims: Early adoption of effective self-management strategies for bipolar disorder (BD) leads to better symptom and functional outcomes. Therefore, it is important to facilitate the development of these skills in young adults with BD. The pervasive use of smartphones among young adults represents an opportunity for resource dissemination to this critical but challenging population. This project explored how young adults with BD self-manage their health, their perceived challenges, and the potential utility of apps to support self-management. Methods: Young adults with BD completed an online survey about disorder management and its support with app use. Recruitment occurred online between 01/09/15 and 01/03/16 through the Black Dog Institute and other mental health organisations. Results were analysed using descriptive statistics and qualitative content analysis. Results: Fifty participants aged 18–30 (M = 23.8; SD = 3.9) who averaged 3 years since BD diagnosis completed the survey. Disorder psychoeducation, sleep-management, and adherence to treatment were the strategies rated as most helpful. The most common self-management challenges were uncertainty and difficulty surrounding episode recurrence, stigma, and suicidal ideation. One third reported using apps to support self-management. Strategies most endorsed by participants for app support were sleep-management, understanding triggers or early warning signs, and ‘stay-well’ plans. Conclusions: Survey results demonstrate the viability of app support for self-management among young adults with BD. Self-management challenges and strategies endorsed by participants for app support represent novel target areas for apps. This increased understanding of current self-management strategies of young adults, and their app needs, is an important step towards understanding the feasibility of mHealth for BD.


13-16 July, Amsterdam, the Netherlands P-374 The development of an mhealth application for the self-management of bipolar disorder: a service user`s perspective J Oldenburga, L Switsersb a University of Antwerp, Psychiatry Collaborative Antwerp Psychiatric Research Institute CAPRI, Antwerp, Belgium, b University of Brussels, Social Agogics, Brussels, Belgium Background and Aims: Medication alone is insufficient to prevent relapse in bipolar disorder. Additional interventions such as psychotherapy, cognitive training and psycho-education have proven beneficial to outcome. In addition, self-management is an effective tool in helping patients maintaining long term stability. Mobile (mHealth) devices seem a promising aid in managing one’s mental health. However, the self-management applications that are currently available lack evidence based methodology and are often not tuned to the needs of users. Methods: We organized two focus group sessions with participants (n = 16) diagnosed with bipolar disorder type 1 or type 2. We collected the outcome of various pen and paper exercises and video and audio data which were transcribed, labeled and analyzed. Results: Analysis revealed three core themes regarding functionality: rest and routine, insight and social feedback. Participants found it crucial that a single application should provide insight in illness characteristics as well as strategies to remain stable and prevent further episodes. Regarding design, the main finding was that the application should be highly customisable to cope with the individuality of users0 disease characteristics and personality. Also, simplicity, engaging visualisation, presence of a crisis button and level of invasiveness were important issues to participants. Conclusions: According to service users, providing rest and routine, insight and social feedback are crucial to the functionality of a selfmanagement application for bipolar disorder. Also, the application should be highly customisable. In sum, the current study sheds light on important issues in mHealth design from a service user’s perspective and crucial factors of mHealth self-management of bipolar disorder.

P-375 In sickness and in health: what is it like for couples when one person has bipolar disorder, and how do they manage? Y Oshera, L Granekb, D Dananc, Y Bersudskya a Beer Sheva Mental Health Center, Mood Disorders Clinic, Beer Sheva, Israel, bFaculty of Health Sciences- Ben-Gurion University of the Negev, Public Health, Beer Sheva, Israel, cFaculty of Health Sciences- Ben Gurion University of the Negev, Medical Student, Beer Sheva, Israel Background and Aims: Aims: Explore and better understand the experience of couples contending with the bipolar disorder of one member, and to investigate the coping mechanisms used. Methods: Eleven patients with bipolar disorder and 10 spouses (including 9 couples) were interviewed individually about the impact of bipolar disorder on their lives and on the marital relationship, and on how they coped. Data were analyzed using the grounded theory method. Results: Bipolar disorder impacted the affected and the nonaffected spouse in ways which overlapped to some extent, but not completely. Neither patients nor spouses seemed to accurately assess the impact of the disorder on the life of their partner. Bipolar disorder was seen to inject a very large degree of volatility into the relationship, and had a clear influence on family planning. It was felt that contending with the disorder both strengthened and weakened the relationship. Coping mechanisms included the

utilization of support from various sources, professional and social, and also support which was spiritual/religious in nature. Both patients and spouses used instrumental methods. Conclusions: Both patients and partners struggle with the tremendous impact of bipolar disorder on their lives and relationship. Coping methods are varied, numerous, and include reliance on outside sources of support. In this sample, drawn from one specific clinic, the importance of the treatment team (psychiatrist and psychologist) as sources of support was highlighted. Awareness of the stresses and adaptations used by couples dealing with bipolar disorder can be very useful in the planning and implementation of comprehensive treatment planning.

P-376 Self-management skills in euthymic outpatients with bipolar disorders: a comparison with outpatients with diabetes A Pozzaa, A Colucciab, F Ferrettib, A Fagiolinic a Sesto Fiorentino, Italy, bDepartment of Medical Science- Surgery and Neurosciences, University of Siena, Siena, Italy, cDepartment of Molecular Medicine, University of Siena, Siena, Italy Background and Aims: Self-management skills, such as warning signs recognition, already studied in medical chronic diseases may have a role in preventing (hypo)manic or depressive episodes during the euthymic phase in Bipolar Disorder (BD). Knowledge of which skills are impaired could suggest the introduction of modules targeting skills in psychosocial programs. The current study investigated differences on self-management skills between euthymic outpatients with BD and outpatients with Diabetes. Methods: Fourty-one euthymic outpatients with BD and 45 with Diabetes (total mean age = 53.93) completed Health Education Impact Questionnaire (heiQTM). ANOVAs were conducted to test for differences between the group with Diabetes and that with BD on heiQTM scales measuring self-management skills. Regression analysis was performed entering heiQTM Emotional Distress scores as outcomes and as predictors scores of heiQTM scales. Results: Compared to those with Diabetes, outpatients with BD reported lower scores on Health Directed Behaviours (F = 17.23, p < 0.001), Self-Monitoring and Insight (F = 31.26, p < 0.001), Active Engagement in Life (F = 27.77, p < 0.001), Constructive Attitudes (F = 32.84, p < 0.001), and Skills Acquisition (F = 25.62, p < 0.001). Outpatients with BD had higher Emotional Distress than those with Diabetes (F = 4.20, p < 0.05). In the BD group, lower levels of Active Engagement in Life (B = 0.43, p < 0.01) and Constructive Attitudes (B = 0.35, p < 0.05) were significant predictors of lower Emotional Distress. Conclusions: In euthymic BD, emotional distress might be associated to lower engagement in life and constructive attitudes. Psychosocial programs for BD should focus also on the development of engagement in daily living and constructive attitudes with the aim to prevent reoccurrence of critical episodes.

P-377 Participatory design methods to co-design and co-produce digital health technology with adolescents A Sharmaa, A Marshallb, D Flynnb, M Balaamb a Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, UK, bNewcastle University, Newcastle Upon Tyne, UK Aim: Young people are keen to interact with clinicians using digital health technologies. Further, active engagement of experts by experience (including adolescents with bipolar disorder) has many benefits. This project aimed to use participatory design methodology to


187

18th Annual ISBD & 8th Biennial ISAD co-develop and co-produce digital health technologies to improve outcomes for adolescent bipolar disorder. Method: Adolescents with Bipolar Disorder and their families attended 6 weekly workshops. Opinions elicited during each workshop were analysed qualitatively with HCI team to inform the agenda for the subsequent workshop. Results: The workshops were informed by the tenets of experiencecentred design meaning workshop activities were designed to reveal the felt life of adolescents with Bipolar Disorder. These workshops enabled the research team to focus on the following themes: what it is like to live with Bipolar Disorder, areas where the participants most felt support was needed, ways in which required support could be provided and potential issues that may impact acceptability of any digital health technology to support self-management of Bipolar Disorder. Conclusions: It is not only feasible to work with adolescents with bipolar disorder and their families but crucial in the successful uptake of digital health technologies co-designed and co-produced. The next steps will include developing prototypes of the technology and assess its usability.

P-378 An intervention for prevention of mood disorders and suicide in university students: internet-based programmes for stress reduction and suicide prevention in students (IP-3s)

M Tourniera, P Rocheb, J Arnaudb, C Roussillonc, T Kurthc, E Pereirac, C Polletc, B B egauda, S Lieged, C Batailled, K Palind, C Tzouriob, H Verdouxa a Universit e de Bordeaux, Inserm U1219 Team of pharmacoepidemiology, Bordeaux, France, bInserm, U1219, Bordeaux, France, cInserm, U1219 - i-Share, Bordeaux, France, d Inserm, U1219 - Eu2P, Bordeaux, France Background and Aims: We aimed to develop an intervention for prevention of mood disorders and suicide in university students. It consists of two programmes of stress reduction using web and mobile phone messaging applications; one on stress management based on cognitive and behavioural therapy and the other on health promotion. The present study encompassed (1) building both programmes and (2) assessing their acceptability in students. Methods: First, both programmes were designed. Then, each programme was proposed to 49 students of the i-Share cohort. In order to identify students most likely to benefit from each programme, each group of 49 students comprised half of persons with high level of stress and half of persons with low level. The primary endpoints are quantitative: the participation rate of students in programmes and the number of connections to the website. The secondary outcome measures are qualitative: satisfaction, reservations and recommendations. Anxiety and depressive symptoms, suicidal risk, quality of life are assessed before and after intervention. Results: To meet the needs of students, short videos of 2 to 6 min were created for the first part of programmes: 19 for stress management and 13 for health promotion. Comics were used to obtain colorful and dynamic illustrations. For the feasibility study, 330 students were e-mailed to obtain 98 participants. All met students agreed to participate. Their main motivations were interest in stress questions (55%), financial compensation (46%), attachment to iShare value (22%), contribution to research (16%) and for the other peoples (15%). Conclusions: This study reveals good initial acceptance of the programmes.

188

P-379 Group psychoeducation normalises cortisol awakening response in stabilised bipolar patients under pharmacological maintenance treatment R Delle Chiaiea, G Trabucchib, S Campib, N Girardia, I Marinia, R Pannesea, L Vergnania, M Careddaa, MP Zerellaa, A Minichinoa, F.R Patacchiolic, S Simeonic, M Biondia, P Girardib a Sapienza University of Rome, Neurology and Psychiatry, Rome, Italy, bSapienza University of Rome, NESMOS Dipartimento di Neuroscienze- Salute Mentale e Organi di Senso, Roma, Italy, c Sapienza University of Rome, Physiology and Pharmacology, Rome, Italy Background and Aims: Relapse rate is one of major concerns in treatment of Bipolar Disorder patients (BD). Psychoeducational program has evidence of efficacy in reducing relapses. BD present high levels of stress vulnerability which is an important relapse provoking factor. Our aim is verify if psychoeducation efficacy due to improving stress vulnerability, detectable assessing their functional status of HPA axis. Methods: 20 patients with stabilised BD entered this prospective, randomised, controlled study: 9 patients randomly assigned to a PsychoEducation group (PE) and 11 to continuation of Treatment As Usual (TAU). Patients were assessed at baseline and at end of PE program with psychometric scales. Cortisol Awakening Response (CAR) was assessed measuring saliva cortisol levels collected upon waking, 30 and 60 min thereafter. Results: No differences were found in YMRS, HDRS, ARMS scores. At BASELINE, no significant change was shown in cortisol concentration over time, neither between groups. At ENDPOINT a significant change in cortisol concentration was found within PE group between CAR values but not within TAU group. The CAR profile measured at the ENDPOINT within PE group is similar to physiological pattern if compared with that measured in the same group at baseline or in TAU group at all times. Conclusions: We found a normalisation of cortisol release with restoration of physiological CAR pattern in stabilised BD patients under pharmacological treatment who underwent a group PE program. Since this result was obtained without any difference in treatment adherence, it suggests that a reduction of stress vulnerability may be achieved in patients undergoing a PE program.

P-380 Inclusion of an expert patient as co-coordinator in psychoeducation workshops for family members of bipolar patients an innovative model: results and effectiveness

C Vinacoura, G Rodrıguez Mendezb, S Salvadorb, A Sacerdotic, C Cilleyd, C Rodriguezb, I Bernhardb, L Herbste a Fundacion Bipolares de Argentina FUBIPA, Board of directors on Bipolares de psychoeducation, Buenos Aires, Argentina, bFundaci Argentina, Psychoeducation, Buenos Aires, Argentina, cNational University from La Matanza UNLaM, Probability and Statistics, Buenos Aires, Argentina, dVOICES! Research and Consultancy, e T Borda Hospital, Mood Sociology, Buenos Aires, Argentina, eJos Disorder Department, Buenos Aires, Argentina Background and Aims: The so called “Caregiver burden” (CB) is a variable that measures the impact of a chronic disease on the people who are close to the patient. Reducing the burden on the relatives of patients with bipolar disorder helps to improve the patients’ symptoms. In this study, we evaluated the impact of a psychoeducational model for relatives co-coordinated by an “expert patient”, with the auxiliary of a psychiatrist and a psychologist


13-16 July, Amsterdam, the Netherlands Methods: We evaluated ninety-five relatives during the Workshops carried out between 2008 and 2013.In every Workshop, a demographic interview was conducted and the 22-item Zarit Scale was applied; a baseline was taken at the beginning of the workshop, another at the end, and the last telephone follow-up was performed after 3 months. The SPSS was established to perform the statistical analysis. Results: This sample showed that 82% of the familis had an overall decrease in levels of the Quantitative CB. At the beginning of the workshop, relatives with burden represented 75% of the studied

population; At the end of the workshop (10 weeks), the percentage of relatives with CB decreased to 68%, Greater persistence of the effectiveness of the workshop was proved in the evolution of severe Caregiver burden where the 54% of relatives at the beginning turned into 37% (3 months later). Conclusions: The workshop co-coordinated by a health-care team and an “expert patient” proved to be effective in reducing the burden of relatives, both quantitatively, and in terms of objective and subjective burden.

Poster Session XXXIIRehabilitation P-381 Rehabilitation assistance resources in a sample of patients diagnosed with bipolar disorder (type I and type II) treated on an outpatient basis

L Niell, RA Baena, J Rodrıguez, P Gomez Merino, O Grazier, A Carrillo Hospital Clınico San Carlos, Psychiatry, Madrid, Spain Background and Aims: Obtain and analyze information on the use of rehabilitation resources about patients diagnosed with Bipolar Disorder I and Bipolar Disorder II and treated at a mental health center in a district of Madrid (Spain) under the conditions of usual clinical practice. Methods: We performed a descriptive study of a sample of 100 patients diagnosed with bipolar disorder (type I and type II) at any stage of the disease who receive regular treatment in a mental health center in a district of Madrid. The information about sociodemographic and clinical data and the use of rehabilitation resources was collected retrospectively from the data obtained from the medical record. Results: 70% of patients are diagnosed with Bipolar Disorder I and 30% of Bipolar Disorder II. 65% male and 35% female. 80% are in euthymia situation. The average years of evolution is 22.8. Almost 100% of patients are taking any psychotropic mood stabilizer. 72% of patients are taking lithium for maintenance treatment versus 27% who are taking valproate. More than half of patients live with their own familyA third of the patients are working, 20% retired, another 20% is dedicated to their work and finally another 20% are inability to work (permanent or temporary). The rate of use of rehabilitation resources is only 8%. Conclusions: The rate of use of rehabilitation resources is very low, this can be explained by the fact that most patients are stable and also exhibit high average years of evolution. Furthermore, only a small percentage of all of them is inable to work.

P-382 Problem solving and cognitive flexibility intervention to improve functional outcomes in individuals with bipolar disorder

G Escartina, N Tousb, C Garcia Giberta, R.M Duen~asb, J Quilisa, E Curtoa, F Chiesaa, J Jokombob, A Farrenyc a Parc Sanitari Sant Joan de D eu, Servei de Rehabilitaci o Comunitaria., Barcelona, Spain, bParc Sanitari Sant Joan de D eu, Servei Polivalent Numancia, Barcelona, Spain, cQueen Mary University of London, Unit for Social and Community Psychiatry., London, United Kingdom Background and Aims: Cognitive impairments are thought to contribute to functional impairment seen in patients with bipolar disorder even in remission (Rosa 2012) and cognitive deficits were strongly associated with lower quality of life (Brissos et al., 2008).The present study aims to assess the efficacy of cognitive remediation (CR) treatment in patients with bipolar disorders using REPYFLEC_BIP (Farreny et al., 2012). Methods: This is a randomized trial with blind assessment. Fortyfour outpatients with Bipolar disorder who were euthymic but manifested cognitive complaints participated in 4 months of cognitive remediation treatment (REPYFLEC BIP, n = 25) or to treatment as usual (TAU, n = 19). Assessments were conducted at baseline and 16 weeks afterwards as post-treatment. Outcomes were improved psychosocial function, cognitive function, and quality of life and satisfaction with the treatment. Results: Repeated-measures analysis revealed a significant functional improvement. REPYFLEC_BIP showed superiority when compared with treatment as usual in: FAST Cognitive domain (F = 5.920, df = 1, p = 0.019) and the FAST Leisure domain (F = 4.528, df = 1, p = 0.039). Moreover, regarding quality of life, repeated-measures analysis revealed significant quality of live improvement in REPYFLEC_BIP group in two domains: SF-36 General Health (F = 6.737, df = 1, p = 0.013) and SF-36 Vitality (F = 5.312, df = 1, p = 0.026). The results showed no significant effect of treatment group on neurocognitive variables. Conclusions: These findings demonstrate that REPLYFEC_BIP program would be effective to improve functionality and quality of life in patients with BD, which is ultimately the main proposal of clinical practice. One of the main problems in therapy is the adherence to treatment, and our results show high attendance and great patient’s satisfaction.


189

18th Annual ISBD & 8th Biennial ISAD

Poster Session XXXIIISuicide P-383 Suicide in bipolar disorder F Ghali, R Beji, M Karoui, L Robbana, G Jmii, M Zghal, S Aloui Razi Hospital, Psychiatry, Mannouba, Tunisia Background and Aims: Bipolar disorders are common illnesses with elevated premature mortality. Suicide is the cause of death in up to 15% of patients and about half of them make at least one suicide attempt in their lifetime. Risk factors of suicide in bipolar disorder are likely to include additional ones compared in general population. The aim of our study was to identify risk factors of suicide among 45 patients with bipolar disorder, following in Razi’s mental institution in Tunis, who made at least one suicide attempt in their lifetime. Methods: We used a semi-structured questionnaire to explore socio demographic, clinical characteristics and also family history . Results: The majority of patients were male with an average age of 26.7 years. A quarter of these acts occurred within the first year of illness. A greater risk of suicide was associated with bipolar II disorder with more prominent depression than hypomania. The current clinical state of patients who made serious suicide attempt was depression in 77.5% and mixed state in 18% of cases. Attempted suicide was associated with comorbid anxiety disorder. It was also clearly linked to substance misuse especially alcohol abuse. It was also associated in 11% with a history of early physical abuse. Conclusions: Identifying risk factors of suicide among patients with bipolar disorder is important in order to assist clinicians in the detection of individuals at risk and institute preventative therapeutic interventions .

P-384 A 6-year longitudinal study of predictors for suicide attempts in major depressive disorder M Eikelenboom, ATF Beekman, BWJH Penninx, JH Smit Department of Psychiatry, EMGO Institute for Health and Care Research- VU University Medical Center Amsterdam / GGZ inGeest, Amsterdam, the Netherlands Background and Aims: Mental disorders, especially major depressive disorder (MDD), represent a major source of risk for suicidality. However, knowledge about risk factors for future suicide attempts within MDD is limited. The present longitudinal study examined a wide range of putative non-clinical risk factors (demographic, social, lifestyle, personality) and clinical risk factors (depressive and suicidal) for future suicide attempts among treated and untreated persons with MDD. In addition, we examined whether known general, non-clinical risk factors are independently associated with a future suicide attempt taking clinical characteristics of the MDD and clinical suicidality characteristics into account. Methods: Data are from 1713 persons with a lifetime MDD at baseline of the Netherlands Study of Depression and Anxiety who were subsequently followed up 2, 4 and 6 years. Cox proportional hazard regression analyses were used to examine a wide range of possible non-clinical and clinical predictors for future suicide attempts. Results: Over a period of 6 years, 3.4% of the respondents attempted suicide. Younger age, lower education, unemployment, insomnia, antidepressant use, a previous suicide attempt and

190

current suicidal thoughts predicted a future suicide attempt independently in a multivariate model. Conclusions: Of the non-clinical factors particularly socio-economic factors predicted a suicide attempt independently. Furthermore, preexisting suicidal ideation and insomnia appear to be important clinical risk factors that are open to preventative intervention.

P-385 Suicide attempts in a Chilean bipolar patients sample

G Gonzaleza, A Aedob, P Floresb, F Silvab, R Sanchezb a Pontificia Universidad Cat olica, Salud Publica, Santiago de Chile, olica, Unidad trastornos bipolares, Chile, bPontificia Universidad Cat Santiago de Chile, Chile Background and Aims: Bipolar disorder is one of the main risk factors for attempted suicide. The aim of this study is characterizing a Chilean bipolar outpatient clinical sample, emphasizing on the description of suicide attempts and depressive episodes. Methods: The clinical sample is 250 bipolar I and II patients receiving treatment at the Bipolar Disorder Unit of Universidad Cat olica de Chile, between 2007 and 2015. Clinical assessments were performed by psychiatrists using clinical patient interview, semi-structured interview SCID-I (Structure Clinical Interview for DSM-IV, First et al, 2007), family interview and review of the medical records of each patient. A logistic regression analysis were made to obtain odd ratio (OR) for total duration of depressive episodes and suicide attempts, adjusted for sex, gender and clinical characteristics. Results: For suicide attempts, we found a OR: 4.9 in patients with total duration of depressive episodes between 3 and 12 months; and OR 7.9 if these episodes were greater than 12 months, compared with those who had less than 3 months; OR: 2.2, in patients with mixed symptoms and OR: 2.2 in patients with family history of suicide attempts. Conclusions: There was no association between number of episodes and suicide attempts, however there is a significant association between the duration of depressive episodes and suicide attempts. Mixed symptoms and family history of suicide attempts are strong risk factors for suicide attempt in this population, according to international clinical findings in bipolar outpatient samples.

P-386 Emotional impact and therapeutic changes due to patient’s suicide E Guzzoa, F Taraganob, A Ragusac, S Heisecked, K Chimerac, H Krupitzkie a C atedra de Psiquiatrıa -IUC- Instituto Universitario CEMICBuenos Aires- Argentina Av. Galv an 4102- 1er. Piso C1431FWO Buenos Aires - Argentina TE: 54-11 5299-0247, Buenos Aires, Argentina, bInstituto de Investigaciones CEMIC -Instituto Universitario CEMIC- Buenos Aires- Argentina Valdenegro 4337 C1430EFA Buenos Aires - Argentina TE: 54-11 5299-0914/15, C atedra de Psiquiatrıa -IUC- Instituto Universitario CEMICBuenos Aires- Argentina Av. Galv an 4102- 1er. Piso C1431FWO Buenos Aires - Argentina TE: 54-11 5299-0247, Buenos Aires, Argentina, cC atedra de Psiquiatrıa -IUC- Instituto Universitario


13-16 July, Amsterdam, the Netherlands CEMIC- Buenos Aires- Argentina, Buenos Aires, Argentina, d Instituto de Investigaciones CEMIC -Instituto Universitario CEMIC- Buenos Aires- Argentina, C atedra de Psiquiatrıa -IUCInstituto Universitario CEMIC- Buenos Aires- Argentina Av. Galv an 4102- 1er. Piso C1431FWO Buenos Aires - Argentina TE: 54-11 5299-0247, Buenos Aires, Argentina, eInstituto de Investigaciones CEMIC -Instituto Universitario CEMIC- Buenos Aires- Argentina Valdenegro 4337 C1430EFA Buenos Aires Argentina TE: 54-11 5299-0914/15, Buenos Aires, Argentina Background and Aims: To explore the attitude of health professionals regarding emotional impact and therapeutic behavior changes because of the suicide of their patients. Methods: Since July to September 2014, a nationwide survey was conducted through the Survey Monkey tool. Health professionals registered in the CEMIC University Institute Department of Psychiatry data base were invited to respond by e-mail.The survey was anonymous and confidential. A total of 250 responses were obtained. Specialties distribution was: psychiatrists 42.9%, nonpsychiatry physicians 22.4%, psychologists 20.8%, others 13.9%. Results: From total professionals, 50.6% had patients under treatment who committed suicide; 62.5% of them were psychiatrists. The professional group who experienced patient’s suicide, was evaluated through the Impact of Event Horowitz Scale. The mean group score was 19.6 (Low Intensity), being higher for women (21.2) compared to men (18.1). Only a difference was found in the 20–29 years old group, where the score was moderate (29.0). 11.5% professionals said they had to make treatment due to the death of a patient by suicide, although 41.5% reported a negative impact on their physical or mental health as a result of the fact.A change in their clinical practice after a patient’s suicide was reported by 58.9% of professionals. Many health professionals (77.7%) stated they did not receive sufficient training about suicide. Conclusions: Prevalence of patient’s suicide among professionals answering our survey was similar as the reported in previous studies.Patient’s suicide has consequences that can be objectively measured by adequate instruments. Its impact was mild in our surveyed professionals, as measured by the Horowitz Scale.

P-387 The relationship between suicide attempt and personality characteristics in bipolar disorders JE Ryu, EJ Kim, J Lee, K Ha, D Park, T Chung, HJ Lee, TH Ha Seoul National University Bundang Hospital, Psychiatry, Seongnam si- Gyounggi-do, Korea Background and Aims: Suicide is a major burden of bipolar disorders. This study aimed to figure out the personality characteristics of patients with bipolar disorder who have attempted suicide in the past. Methods: 857 patients with bipolar disorders were included in this study. Personality characteristics were measured using the Munich Personality Test, Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire, Temperament Character Inventory, and SCID-II inventory, and were factor-analyzed. Multivariate logistic regression models were calculated adjusting for depression, anxiety, and various sociodemographic variables. Results: Three factors were found to be associated with suicide attempt. ‘Negative/Internalizing’ factor and ‘Emotional Instability’ factor were associated with increased suicidal attempt, while the ‘Frustration Tolerance’ factor was associated with lowered risk. Conclusions: The results highlight the role of personality dimensions as risk factors for suicidal attempt in bipolar disorder. With this study, a new applicable personality assessment scales could be developed to assess suicidal risk of bipolar patients.

P-388 The protective effect of hypomanic symptoms during depression on suicide attempt in patients with bipolar disorders J Lee, JE Ryu, EJ Kim, K Ha, HJ Lee, D Park, T Chung, TH Ha Seoul National University Bundang Hospital, Psychiatry, Seongnam si- Gyounggi-do, Korea Background and Aims: The aim of the current study was to find out which clinical factors were associated with suicide risk in patients with bipolar disorders. Methods: We collected 101 bipolar patients either in a major depressive episode or in a mixed episode and divided them into two groups according to the presence of a suicide attempt history. Demographic characteristics and clinical features were compared between the patients having a suicide attempt history and the patients without a suicide attempt history. Manic or hypomanic symptoms were factor analyzed to yield two factors. Clinical features that showed a group difference in univariate analyses and (hypo)manic symptoms factor scores were tested if they were related to suicide attempts by a logistic regression model. Results: A logistic regression model showed that smoking (OR = 4.59) and psychiatric comorbidity (OR = 3.03) increased the risk of suicide attempt. On the other hand, the sunny component of (hypo)manic symptoms in an acute depressive or mixed episode decreased the risk of suicide attempts (OR = 0.51). Conclusions: Our findings suggest that bipolar patients with a history of suicide attempts have a distinct clinical profile and each component of (hypo)manic symptoms may have a different role in suicide behaviors. Attention should be paid to those risk factors.

P-389 Self-harm, accidental injury and suicide in bipolar disorder during maintenance mood stabilizer treatment: a UK population-based electronic health records study J Hayesa, A Pitmana, L Marstonb, K Waltersb, J Geddesc, M Kinga, D Osborna a Division of Psychiatry, University College London, London, United Kingdom, bDepartment of Primary Care and Population Health, University College London, London, United Kingdom, cDepartment of Psychiatry, University of Oxford, Oxford, United Kingdom Background and Aims: Self-harm is a prominent cause of morbidity in patients with bipolar disorder (BPD), and is strongly associated with suicide. There is evidence that lithium may reduce, and anticonvulsants may increase, suicidal behavior. There is limited information about the effects of antipsychotics when used as mood stabilizer treatment. Rates of accidental injury are poorly defined in BPD. This study aims to compare rates of self-harm, accidental injury, and suicide in patients with BPD prescribed maintenance mood stabilizers. Methods: A propensity score adjusted and matched cohort study in nationally representative electronic health record data including all patients diagnosed with BPD prescribed lithium (N = 2148), valproate (N = 1670), olanzapine (N = 1477), or quetiapine (N = 1376). The primary outcome was any form of self-harm. Secondary outcomes were accidental injury and suicide. Results: Self-harm rates were lower in patients prescribed lithium (205 per 10,000PYAR; 95% CI: 175–241) compared with those prescribed valproate (392 per 10,000PYAR; 95% CI: 334–460), olanzapine (409 per 10,000PYAR; 95% CI: 345–483) or quetiapine (582 per 10,000PYAR; 95% CI: 489–692). This relationship was maintained after propensity score adjustment (valproate, olanzapine or quetiapine versus lithium; HR 1.40; 95% CI: 1.12–1.74) and matching (HR 1.51; 95% CI: 1.21–1.88). After propensity score


191

18th Annual ISBD & 8th Biennial ISAD adjustment, accidental injury rates were lower in lithium compared to valproate and quetiapine. The suicide rate in the cohort was 14 per 10,000 PYAR (95% CI: 9–21). Although this was lower in the lithium group, there were too few events to allow accurate estimates. Conclusions: Patients taking lithium had reduced self-harm and accidental injury rates. This finding augments limited trial and smaller observational study results.

P-390 Comparison of suicide related behavior between borderline personality disorder patients with and without bipolar disorder HC Huanga, CR Huanga, MR Sunga, SI Liub a Deapartment of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan, bDeapartment of Psychiatry, MacKay Memorial Hospital, New Taipei City, Taiwan Background and Aims: Suicidal behavior is common in both borderline personality disorder (BPD) and bipolar disorders (BD), and comorbidity affects suicide behavior related component. This study was to determine whether there were significantly differences in suicide related behavior between borderline personality disorder patients with and without bipolar disorder. Methods: Participants were 60 patients agreed to participate a randomized control trial for Dialectical behavior therapy. The SCAN (Schedules for Clinical Assessment in Neuropsychiatry) was undertaken to evaluate axis I co-morbidity. The suicide related behaviors and treatment history was assessed with the Suicide Attempt SelfInjury Interview (SASII) and Treatment History Interview (THI). Patients also completed the self-report questionnaires to investigate the severity of depressive symptom, suicidal ideation, hopelessness and quality of life. Results: The study group consisted of 60 BPD patients, 19 (31.7%) patients with BD and 41 (68.3%) without BD. Female subjects outnumbered male subjects (93.3% and 6.7% respectively). The mean age was 28.9 years (SD = 7.8) and mean years of formal education was 13.9 (SD = 2.8). Seventy-five per cent were single, 13.3% were divorced and 6.7% were married. A comparison of patients’ demographic characteristics within the two groups, it didn’t revealed statistically significant differences. Between BPD patients with and without BD significant differences were found in suicide intent, revealed suicide attempt and had been received individual psychotherapy. Conclusions: There are significant differences in suicide behavior related component between BPD patients with and without BD, the suicide prevention could evolve to some particular features of BPD.

P-391 Temperament, character and suicide attempts in unipolar and bipolar mood disorders

E Isometsaa, P Jylha€b, T Rosenstr€omc, O Mantereb, K Suominend, T Melartinb, M Vuorilehtob, M Holmae, K Riihim€akie, M Oquendof, L Keltikangas-J€arvinenc a Departement of Psychiatry, University of Helsinki, Helsinki, Finland, bDepartment of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, cUniversity of Helsinki, IBS- Unit of Personality- Work and Health Psychology, Helsinki, Finland, dDepartment of Psychiatry, City of HelsinkiHealth and Social Services, Helsinki, Finland, eNational Institute of Health and Welfare, Mental Health Unit, Helsinki, Finland, f Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, USA

Background and Aims: Personality features may indicate risk for both mood disorders and suicidal acts. However, how dimensions

192

of temperament and character predispose to suicide attempts remains unclear. Methods: Patients (n = 597) from three prospective cohort studies (Vantaa Depression Study [VDS], Jorvi Bipolar Study [JoBS], and Vantaa Primary Care Depression Study [PC-VDS]) were interviewed at baseline, at 18 months, and, in VDS and PC-VDS, at 5 years. Personality was measured with the Temperament and Character Inventory-Revised (TCI-R). Follow-up time spent in major depressive episodes (MDEs) as well as lifetime (total) and prospectively ascertained suicide attempts during the follow-up were documented. Results: Overall, 219 patients had 718 lifetime suicide attempts; 88 patients had 242 suicide attempts during the prospective follow-up. The numbers of both the total and prospective suicide attempts were associated with low self-directedness and high self-transcendence. Total suicide attempts were linked to high novelty seeking. Prospective, but not total, suicide attempts were associated with high harm avoidance and low reward dependence, cooperativeness, and novelty seeking. No association remained significant including only prospective suicide attempts during MDEs. After adjustment for time spent in MDEs, only high persistence predicted suicide attempts. Formal mediation analyses of harm avoidance and selfdirectedness on prospective suicide attempts indicated significant mediated effect through time at risk in MDEs, but no significant direct effect. Conclusions: Among mood disorder patients, suicide attempt risk is associated with temperament and character dimensions. However, their influence on predisposition to suicide attempts is likely to be mainly indirect, mediated by more time spent in depressive episodes.

P-392 Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders

E Isometsaa, K Aaltonenb, P Na€a€ta€nenb, M Heikkinenb, M Koivistob, I Baryshnikovb, B Karpovb, J Oksanenb, T Melartinb, K Suominenjc, G Joffeb, T Pauniob a Department of Psychiatry, University of Helsinki, Helsinki, Finland, bDepartment of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, cDepartment of Psychiatry, City of Helsinki- Health Care and Social Services, Helsinki, Finland Background and Aims: Substantial literature exists on risk factors for suicidal behavior. However, their comparative strength, independence and specificity for either suicidal ideation or suicide attempt(s) remain unclear. Methods: The Helsinki University Psychiatric Consortium (HUPC) Study surveyed 287 psychiatric care patients with ICD-10-DCR depressive or bipolar disorders about lifetime suicidal behavior, developmental history and attachment style, personality and psychological traits, current and lifetime symptom profiles, and life events. Psychiatric records were used to confirm diagnosis and complement information on suicide attempts. Multinomial regression models predicting lifetime suicidal ideation and single or repeated suicide attempts were generated. Results: Overall, 21.6% patients had no lifetime suicidal behavior, 33.8% had lifetime suicide ideation without attempts, and 17.1% had a single and 27.5% repeated suicide attempts. In univariate analyses, lifetime suicidal behavior was associated with numerous factors. In multivariate models, suicidal ideation was independently predicted by younger age, severe depressive disorder, bipolar disorder type II/nos, hopelessness, and childhood physical abuse. Repeated suicide attempts were independently predicted by younger age, female sex, severe depressive disorder with or without


13-16 July, Amsterdam, the Netherlands psychotic symptoms, bipolar disorder type II/nos, alcohol use disorder, borderline personality disorder traits, and childhood physical abuse. Conclusions: Risk factors for suicidal ideation and attempts may diverge both qualitatively and in terms of dose response. When effects of risk factors from multiple domains are concurrently examined, proximal clinical characteristics remain the most robust. All risk factors cluster into the group of repeated attempters.

P-393 Construct validity of the BDI and STAI for classifying depressed patients according to their suicidal behaviour W Kaschkaa, S Hodgkinsona, J Steyerb, M Jandlc a University of Ulm, Psychiatry I, Ravensburg, Germany, bZentrum f€ ur Psychiatrie ZfP S€ udw€ urttemberg, Psychosomatics, Ravensburg, Germany, cPsychiatric University Hospital Berne, General Psychiatry, Berne, Switzerland Background and Aims: Aims of the study were to test the construct validity of the Beck Depression Inventory (BDI) and the Spielberger Trait Anxiety Inventory (STAI) in the classification of patients with major depressive disorder according to category of assessed suicidal behaviour. Methods: Regression analysis (R statistical platform, linear modelling) was performed using BDI and STAI rating scores for 629 patients with major depressive disorder by suicidal category (nonsuicidal, death wish, suicidal ideation, non-violent suicide attempt, violent suicide attempt). Results: Statistically significant (p < 0.05) differences in the regression of BDI score by STAI score between non-suicidal depressed patients and other categories of suicidal behaviour were found. Conclusions: Given the strong correlation reported elsewhere between BDI and STAI scores for depressed patients (r~0.78) and in our sample (r = 0.83), differences in the association between these two rating scales in patients with varying severities of suicidal behaviour might prove to be a useful adjunct screening tool for at risk inpatients.

P-394 Predicting models for choosing the suicidal method M Maneaa, L Deheleanb, AM Draghicia a Eduard Pamfil Psychiatry Clinic of Timisoara, Psychiatry, Timisoara, Romania, b”Victor Babes” University of Medicine and Pharmacy, Psychiatry, Timisoara, Romania Background and Aims: To identify predictive factors for certain suicidal methods such as hanging, substance ingestion, drowning, and precipitation from higher places. Methods: All suicide cases autopsied at Timisoara Institute of Legal Medicine from 2005 to 2012 were analyzed for demographic data, methods of suicide, medical history and pathology findings, alcohol blood levels, previous suicide attempts, economic context. We applied logistic regression to demonstrate the influence of gender, age, alcohol consumption, known previous suicidal attempts, psychiatric history, somatic certified pathology, and economic crisis period (2008–2012) for choosing a specific suicidal method. Results: The study included 673 cases of committed suicide, among them 537 (79.8%) men and 136 (20.2%) women. The mean age was 50.76 years (SD = 17.35). The significant predictive factors for hanging were: absence of psychiatric history (OR = 4.31, p < 0.0001), male gender (OR = 3.75, p < 0.0001), minimal certified somatic pathology (OR = 0.646, p < 0.0001), and economic period crisis (OR = 1.52, p = 0.043). For substance ingestion, the significant predictor factors were: presence of psychiatric history (OR =

3.61, p = 0.007), low blood alcohol level (OR = 0.363, p = 0.015), severe certified somatic pathology (OR = 1.98, p = 0.001), and the absence of economic crisis (OR = 2.71, p = 0.017). The significant predictive factors for drowning were: female gender (OR = 5.13, p < 0.0001), presence of psychiatric history (OR = 2.67, p = 0.014), high blood alcohol level (OR = 1.68, p = 0.001), and the absence of economic crisis (OR = 2.09, p = 0.019). For precipitation, we found alcohol consumption regardless of the blood level, as predictive factor (OR = 2.85, p = 0.02). Conclusions: We identified models consisting in significant predictive factors, each model being capable to distinguish among subjects who have chosen a certain method of suicide.

P-395 Two hundred forty years from werther to Robin Williams: should suicide prevention in bipolar disorder include a focus on media reporting? A Schaffera, M Sinyora, A Cheunga, J Pirkisb a Sunnybrook Health Sciences Centre, Psychiatry, Toronto, Canada, b Melbourne School of Population and Global Health, Centre for Mental Health, Melbourne, Australia Background and Aims: To identify the extent of media reporting on suicide in bipolar disorder and the high profile celebrity death of Robin Williams, and to explore the potential risks and benefits of media exposure of suicide in bipolar disorder Methods: First, all media reports from July – Dec 2014 produced by the top 10 print and online news sources by circulation in Toronto, Canada were analyzed for suicide-related content by an external media research company. The proportion of reports that included information on the death of Robin Williams and / or bipolar disorder was determined. Second, we conducted a systematic review of the current evidence of potential harms and benefits of media reporting on suicide in general. Results: Nearly 10% of media reports on suicide included a focus on Robin Williams or bipolar disorder, often in combination. Information about effective treatments was frequently absent. Systematic review identified 85 studies, many indicating that media reporting, particularly when repetitive and/or relating to celebrities, results in increases in suicide rates both by specific methods and overall. There is highly replicated evidence that exposure to suicide-related media can have a significant impact particularly on youth and on those at high risk for suicide in general. Conclusions: Media coverage of suicide in bipolar disorder is quite extensive, especially in the context of a high-profile celebrity suicide death. Given the mounting evidence of predominantly negative effects of this type of media coverage, the research and clinical community is encouraged to promote and disseminate media reporting guidelines that encourage responsible reporting.

P-396 Structural correlates underlying suicidal ideation in major depressive disorder: a voxelbased morphometry study

L Zhanga, E Opmeera, H Ruheb, N Van der Weec, D Veltmand, M.J Van Tola, A Alemana a Department of Neuroscience- Neuroimaging Center, University of Groningen- University Medical Center Groningen, Groningen, the Netherlands, bMood and Anxiety Disorders- Department of Psychiatry, University of Groningen- University Medical Center Groningen, Groningen, the Netherlands, cDepartment of Psychiatry, Leiden University Medical Center LUMC, Leiden, the Netherlands, d Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands


193

18th Annual ISBD & 8th Biennial ISAD Background and Aims: Suicidal ideation is an important predictor for future suicide. Previous studies have investigated structural changes related to suicide attempts. However, structural characteristics related to suicidal ideation have not been investigated. Methods: Three groups of patients with major depressive disorder were included for voxel-based morphometry analysis: suicidal ideators with current suicidal ideation and with or without past suicide attempts (SI, n = 44); suicide attempters who had past suicide attempts but no current suicidal ideation (SA, n = 24); and patient controls (PC, n = 114). Fifty-one healthy controls (HC) were also included. A one-way ANOVA was performed to compare SI to PC/HC. SI were also compared to SA with a two-sample t-test, excluding SI with past suicide attempts. Both grey matter (GM) and white matter (WM) were tested. Because the suicidal ideation scale (for defining SI) was conducted a few weeks before fMRI

194

scanning, we also defined suicidal ideation severity according to the suicide item of the Montgomery-Asberg depression rating scale conducted on day of scanning. A regression analysis was conducted to investigate the relationship between current suicidal ideation severity and GM/WM volumes in all patients. Threshold was set to p < 0.05 family wise error corrected on cluster-level (with non-stationarity correction), with an initial threshold of p < 0.001. Results: Groups were comparable on demographics and the patient groups were comparable on depression/anxiety severity. SI did not differ from control groups on GM/WM volumes and there was no association between GM/WM volume and current suicidal ideation severity. Conclusions: Our results indicate that suicidal ideation is not associated with differences in GM/WM volumes.
