Bipolar Schizoaffective Disorder Research Articles

Bariatric surgery outcomes in patients with bipolar or schizoaffective disorders.

Obesity is associated with many co-morbidities and can cause harm to physical and mental well-being. While much has been studied in the general population about the outcomes of bariatric surgery, its implications in patients with bipolar/schizoaffective disorder (BSD) are less well understood. We aimed to describe outcomes of bariatric surgery in patients with BSD. Referral center for bariatric surgery. We conducted a retrospective chart review analysis of bariatric surgical procedures in patients with BSD between 2008 and 2021 at Mayo Clinic. Patients with BSD (cases) were matched via propensity score matching (1:2) with non-BSD controls based on surgical procedure, age, sex, body mass index, and type 2 diabetes. Hierarchical logistic regression model was performed using SAS software. We matched 71 patients with BSD with 142 controls in a 1:2 ratio. After adjusting for baseline preoperative weight, patients with BSD had a 3.4% greater total weight loss compared with controls over 24 months (P = .02 [95% CI, .65-6.08]). Remission in obesity-related diseases, such as diabetes, hypertension, dyslipidemia, and sleep apnea, was similar in both groups. Perioperative complication rates were similar other than deep venous thrombosis, which showed a higher rate in patients with BSD (P = .04). Patients with long-term BSD were at increased risk of alcohol use compared with controls. When compared with the general bariatric population, weight loss was similar to slightly improved, with a comparable risk and complication profile. Patients with BSD have increased alcohol use after bariatric surgery, highlighting the need for psychological care before and after surgery in this population.

Advancing the Science of Recovery: The Utility of the Recovery Assessment Scale in the Prediction of Self-Directed Health and Wellness Outcomes in Adults with a Diagnosis of a Serious Mental Illness.

Adults with serious mental illness commonly experience comorbid chronic physical conditions and experience a reduced life expectancy of 10-25 years compared to the general population (Saha et al. in Arch Gen Psychiatry 64(10):1123-31.2007; Hayes et al. inActa Psychiatr Scand 131(6):417-25.2015; Walker et al. in JAMA Psychiatry 72(4):334-41.2015). Dimensions of personal recovery may have real-world implications that extend beyond functional and mental health outcomes to impact the self-directed health and wellness of adults with serious mental illness. This study examined the predictive utility of the Recovery Assessment Scale with respect to medical self-efficacy, self-management, psychiatric symptoms, and community functioning for adults with serious mental illness. Data were derived from a secondary analysis of baseline and 10-month data collected from a randomized control trial with adults aged 18 years and older with a diagnosis of bipolar disorder, schizoaffective disorder, schizophrenia, or major depressive disorder (N=56). A linear regression was conducted to examine the predictive value of total baseline RAS scores on self-efficacy at 10 months while controlling for study group. This model significantly predicted self-efficacy (F (2, 53) = 13.28, p < .001) and accounted for 36.1% of the variance. Total baseline RAS scores significantly predicted self-efficacy (β = 059, p < .001); specifically, higher baseline RAS scores were associated with greater self-efficacy. A greater degree of recovery may facilitate greater medical self-efficacy in managing chronic disease in people diagnosed with a serious mental illness. Future intervention approaches may consider recovery-focused therapeutic targets such as peer support to promote self-efficacy to manage chronic diseases in people with serious mental illness.

THROUGH THE LENS OF A WOMAN WITH SCHIZOAFFECTIVE DISORDER: A CASE STUDY

Motivation/Background: Historically speaking, the distinction between manic-depressive disorders and schizophrenia finds itself in an unclear and vast spectrum bordered by the two illnesses. In this paper, we will present a case study that raises a question of diagnosis: bipolar disorder or schizoaffective disorder? Following the description of the symptoms and diagnosis criteria of each of the disorders, along with the personal data of the patient (the ones that are available to us), we will attempt analyzing the case as thoroughly as possible. The paper introduces the case of a 40-year-old woman who presents affective/mood related symptoms.&#x0D; Method: psychiatric evaluation, psychiatric interview, psychodynamic interview and psychodynamic interpretation.&#x0D; Results: The subject has a pathology of attachment developed over a structure with homosexual attachment choices. The multiple psychotraumas of childhood and the busy life history overlap with a vulnerability for emotional manifestations. She develops as axis I pathology a bipolar affective disorder, which at the moment takes the form of a mixed dispositional episode with psychotic phenomena. The artistic side makes it work markedly on delirious interpretativity, as it is to be appreciated the patient's effort not to completely detach from reality.&#x0D; Conclusions: Late detection of these habits by the relatives, as well as other signs of psychiatric conditions, has contributed to an alteration of the identity of the patient and an inability to develop proper social behavior. After an overview of the patient's life experience, we can presume that the psychiatric condition is present and that it is evolving. The aim of the paper is to provide a theoretical viewpoint on this specific pathology, with particular features for this case study

M64 - POLYGENIC RISK FOR ANXIETY SHAPES PATTERNS OF COMORBIDITY IN BIPOLAR DISORDER

Background Anxiety disorders are one of the most common comorbid conditions in people with bipolar disorder and are associated with unfavorable outcomes, including increased recurrence, higher rates of alcohol and substance abuse, and more frequent suicide attempts. However, the causal direction has remained unclear: Does poorer outcome lead to anxiety, or does comorbid anxiety result in poorer outcomes? Methods Here we used a Polygenic Risk Score (PGS) for anxiety to approach this question in a sample of 1754 adults with bipolar I or schizoaffective bipolar disorder previously characterized by the Diagnostic Interview for Genetic Studies (DIGS) and genotyped on Affymetrix 6.0 arrays. Anxiety PGS was calculated on the basis of results from the largest published GWAS meta-analysis of anxiety disorders (Otowa et al., 2016). Markers were LD clumped and the p-value threshold was set at 1. First we examined anxiety disorder comorbidity by creating a categorical ‘anxiety disorders’ variable comprising any DSM anxiety disorder diagnosis. Results Anxiety PGS was significantly associated with anxiety comorbidity (X2=7.756, df=1, p Discussion Taken together, these findings indicate that genetic risk for anxiety contributes to patterns of comorbidity in bipolar disorder, increasing risk for some anxiety disorders and for anorexia. Other common comorbidities and clinical features appear unrelated to genetic risk for anxiety, suggesting distinct etiologies.

Psychological Support for Personality (PSP) versus treatment as usual: study protocol for a feasibility randomized controlled trial of a low intensity intervention for people with personality disorder

BackgroundPrevious research has demonstrated the clinical effectiveness of long-term psychological treatment for people with some types of personality disorder. However, the high intensity and cost of these interventions limit their availability. Lower-intensity interventions are increasingly being offered to people with personality disorder, but their clinical and cost effectiveness have not been properly tested in experimental studies. We therefore set out to develop a low intensity intervention for people with personality disorder and to test the feasibility of conducting a randomized controlled trial to compare the clinical effectiveness of this intervention with that of treatment as usual (TAU).MethodsA two-arm, parallel-group, single-blind, randomized controlled trial of Psychological Support for Personality (PSP) versus TAU for people aged over 18 years, who are using secondary care mental health services and have personality disorder. We will exclude people with co-existing organic or psychotic mental disorders (dementia, bipolar affective disorder, delusional disorder, schizophrenia, schizoaffective disorder, or schizotypal disorder), those with cognitive or language difficulties that would preclude them from providing informed consent or compromise participation in study procedures, and those who are already receiving psychological treatment for personality disorder. Participants will be randomized via a remote system in a ratio of PSP to TAU of 1:1. Randomization will be stratified according to the referring team and gender of the participant.A single follow-up assessment will be conducted by masked researchers 24 weeks after randomization to assess mental health (using the Warwick and Edinburgh Well-Being Schedule), social functioning (using the Work and Social Adjustment Scale), health-related quality of life (EQ-5D-5 L), incidence of suicidal behavior, satisfaction with care (Client Satisfaction Questionnaire), and resource use and costs using a modified version of the Adult Service Use Schedule. In addition to this, each participant will be asked to complete the patient version of the Clinical Global Impression Scale.Feasibility and acceptability will primarily be judged by study recruitment rate and engagement and retention in treatment. The analysis will focus principally on descriptive data on the rate of recruitment, characteristics of participants, attrition, adherence to therapy, and follow-up. We will explore the distribution of study outcomes to investigate assumptions of normality in order to plan the analysis and sample size of a future definitive trial.DiscussionMost people with personality disorder do not currently receive evidence-based interventions. While a number of high intensity psychological treatments have been shown to be effective, there is an urgent need to develop effective low intensity approaches to help people unable to use existing treatments. PSP is a low intensity intervention for individuals, which was developed following extensive consultation with users and providers of services for people with personality disorder. This study aims to examine the feasibility of a randomized trial of PSP compared to TAU for people with personality disorder.Trial registrationISRCTN Registry, ISRCTN14994755. Registered on 18 July 2017.

Metabolic syndrome and features in children and adolescents diagnosed with mood disorders and psychotic disorders

Objective: Metabolic syndrome (METS) is described as cluster of risk factors including central obesity, hyperten-sion, low high-density lipoprotein (HDL), hypertriglyceridemia and hyperglycemia. The prevalence of METs has been associated with increased symptom severity and antidepressants utilization in many psychopathologies among adult population. We aimed to evaluate the effect of psychopathologies and antipsychotics in METs devel- opment, additionally to determine METs characteristics in children and adolescents diagnosed with bipolar and psychotic disorders. Methods: Thirty children and adolescents aged between 13-20 years old of whom were diag-nosed with bipolar mood disorders, schizophrenia, schizoaffective disorder and schizophreniform according to Diag-nostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) criteria were compared with a 30 healthy children and adolescents in present study. The anthropometric measurements including body weight, height, body mass index (BMI), waist circumference (WC) as well as blood pressure measurements were documented. In addition, total cholesterol, triglyceride (TG), HDL, low-density lipoprotein (LDL) and fasting blood glucose (FBG) levels were measured and METs assessed according to the IDF (International Diabetes Foundation) criteria in participants. Results: Overall the prevalence of METs was 20% (n=12) in our study. Among the METs patients, nine were (27%) in the case group, three were (10%) were in control group. The mean BMI, body weight, WC, serum TG and FBG values of the METs group were found to be statistically higher than the healthy control group. Moreover it was also found that utilization of mood-stabilizing drugs has a statistically significant effect on the development of METs. Conclusion: Psychopathologies and antipsychotic utilization have associated with an increased risk for the development of metabolic disorders and METs in the children and adolescents population. In this respect our findings may provide a new approach with the management of treatment strategies particularly in children and adolescents with high risk of METs.

Association Between Schizophrenia-Related Polygenic Liability and the Occurrence and Level of Mood-Incongruent Psychotic Symptoms in Bipolar Disorder

Bipolar disorder (BD) overlaps schizophrenia in its clinical presentation and genetic liability. Alternative approaches to patient stratification beyond current diagnostic categories are needed to understand the underlying disease processes and mechanisms. To investigate the association between common-variant liability for schizophrenia, indexed by polygenic risk scores (PRSs), and psychotic presentations of BD. This case-control study in the United Kingdom used multinomial logistic regression to estimate differential PRS associations across categories of cases and controls. Participants included in the final analyses were 4436 cases of BD from the Bipolar Disorder Research Network. These cases were compared with the genotypic data for 4976 cases of schizophrenia and 9012 controls from the Type 1 Diabetes Genetics Consortium study and the Generation Scotland study. Data were collected between January 1, 2000, and December 31, 2013. Data analysis was conducted from March 1, 2016, to February 28, 2017. Standardized PRSs, calculated using alleles with an association threshold of P < .05 in the second Psychiatric Genomics Consortium genome-wide association study of schizophrenia, were adjusted for the first 10 population principal components and genotyping platforms. Multinomial logit models estimated PRS associations with BD stratified by Research Diagnostic Criteria subtypes of BD, by lifetime occurrence of psychosis, and by lifetime mood-incongruent psychotic features. Ordinal logistic regression examined PRS associations across levels of mood incongruence. Ratings were derived from the Schedules for Clinical Assessment in Neuropsychiatry interview and the Bipolar Affective Disorder Dimension Scale. Of the 4436 cases of BD, 2966 (67%) were female patients, and the mean (SD) age at interview was 46 [12] years. Across clinical phenotypes, there was an exposure-response gradient, with the strongest PRS association for schizophrenia (risk ratio [RR] = 1.94; 95% CI, 1.86-2.01), followed by schizoaffective BD (RR = 1.37; 95% CI, 1.22-1.54), bipolar I disorder subtype (RR = 1.30; 95% CI, 1.24-1.36), and bipolar II disorder subtype (RR = 1.04; 95% CI, 0.97-1.11). Within BD cases, there was an effect gradient, indexed by the nature of psychosis. Prominent mood-incongruent psychotic features had the strongest association (RR = 1.46; 95% CI, 1.36-1.57), followed by mood-congruent psychosis (RR = 1.24; 95% CI, 1.17-1.33) and BD with no history of psychosis (RR = 1.09; 95% CI, 1.04-1.15). For the first time to date, a study shows a polygenic-risk gradient across schizophrenia and BD, indexed by the occurrence and level of mood-incongruent psychotic symptoms.

Bipolar disorders diagnostics in ambulatory medico-psychological service

IntroductionThe difficulties of diagnosis and clinical differentiation of bipolar disorders, schizophrenia and schizoaffective disorder have been repeatedly noted both foreign and Russian authors.ObjectivesFull medico-psychological service clinical documentation research, including bipolar disorder patient records.AimsDetermination of bipolar disorders in accordance with the DSM-5 criteria among psychiatric outpatients.MethodsA group of 142 patients with established according to ICD-10 diagnoses: schizophrenia, schizoaffective disorder 137 (96.5%); the average patient's age 50 ± 13 and bipolar disorder and mania episode 5 (3.5%) – 55.4 ± 14.4 has been investigated.ResultsIt was found that 18 (12.7%) of all patients meet the DSM-5 bipolar disorder criteria compared with the primary diagnosis (3.5%). Structure of the diagnosis of bipolar disorder was represented as follows: bipolar disorder type I – 11 (61.2%), bipolar disorder type II – 7 (38.8%). Consequently, due to formal application DSM-5 bipolar disorder criteria BD determination 3.5 times more.ConclusionTraditionally, the diagnosis of schizophrenia is preferred over bipolar disorder. Manic episode in bipolar disorder can be evidently regarded as an acute schizophrenia manifestation. The diagnostic criteria for DSM-5 are convenient in diagnostics of manic and depressive episodes in case of their combination in I type bipolar disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychological resilience and quality of life amongst people with psychotic illnesses

IntroductionPsychological resilience is defined as an individual's ability to adapt to stress and adversity. People with psychotic illness often experience high levels of distress and difficulties adapting.AimsTo assess the relationship between the resilience of people with psychotic illnesses and their quality of life.MethodologyOutpatients from multiple settings attending Sligo-Leitrim Mental Health Services, aged 18+ years old with a diagnosis of either schizophrenia, bipolar affective disorder or schizoaffective disorder were approached by their treating teams and invited to participate. Other inclusion criteria were having a family member. Drug induced psychoses or no family member were exclusion criteria. The scales used were the Resilience Appraisal Scale and the schizophrenia Quality of Life Scale. This study is part of a larger study looking at family factors and psychosis.ResultsThe study sample was 58 enrolled but only 49 participants completed the 2 assessments, of these 33 were males (67.3%). Data was analysed using SPSS 21. Pearson's correlation coefficient for resilience and quality of life was 0.503, P &lt; 0.001. This shows that higher resilience is associated with better quality of life amongst people with psychotic illnesses. These results could have useful clinical implications. If we can intervene to therapeutically increase resilience, we can eventually improve the quality of life of people with psychoses.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR+): study protocol for a randomised controlled trial

BackgroundSmoking is highly prevalent among people who have experience of severe mental ill health, contributing to their poor physical health. Despite the ‘culture’ of smoking in mental health services, people with severe mental ill health often express a desire to quit smoking; however, the services currently available to aid quitting are those which are widely available to the general population and may not be suitable or effective for people with severe mental ill health. The aim of this study is to explore the effectiveness and cost-effectiveness of a bespoke smoking-cessation intervention specifically targeted at people with severe mental ill health.Methods/designSCIMITAR+ is a multicentre, pragmatic, two-arm, parallel-group, individually randomised controlled trial.We aim to recruit 400 participants aged 18 years and above with a documented diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder who smoke. Potentially eligible participants identified in primary or secondary care will be screened, and baseline data collected. Eligible, consenting participants will be randomly allocated to one of two groups. In the intervention arm, the participant will be assigned a mental health professional trained to deliver smoking-cessation interventions who will work with the participant and participant’s GP or mental health specialist to provide an individually tailored smoking-cessation service. The comparator arm will be usual care – following current NICE guidelines for smoking cessation, in line with general guidance that is offered to all smokers, with no specific adaptation or enhancement in relation to severe mental ill health.The primary outcome will be self-reported smoking cessation at 12 months verified by expired carbon monoxide (CO) measurement. Secondary outcome measures include Body Mass Index at 12 months, the Fagerström Test for Nicotine Dependence, Motivation to Quit questionnaire, SF-12, PHQ-9, GAD-7, EQ-5D-5 L, and health service utilisation at 6 and 12 months. The economic evaluation at 12 months will be conducted in the form of an incremental cost-effectiveness analysis.DiscussionSCIMITAR+ trial is the largest trial to our knowledge to investigate the effectiveness of a bespoke smoking-cessation service for people with severe mental ill health.Trial registrationInternational Standard Randomised Controlled Trials Number, ISRCTN72955454. Registered on 16 January 2015.

Symptom profiles and illness course among Anabaptist and Non-Anabaptist adults with major mood disorders.

BackgroundAnabaptists comprise large and growing Amish and Mennonite populations with a unique genetic heritage and cultural background. Little is known about the symptoms and course of major mood disorders in Anabaptists. Even less is known about the impact of potential moderators on symptom severity and course.MethodsA sample of Amish and Mennonite participants with bipolar, recurrent unipolar, or schizoaffective bipolar disorder (n = 155) were systematically evaluated with a well-validated instrument. Cases were compared with non-Anabaptist participants (n = 155) matched for age, sex, and psychiatric diagnosis and evaluated by the same methods.ResultsDespite substantial cultural differences, the profile of manic and depressive symptoms during illness episodes did not significantly differ between the two groups. Alcohol use disorder (AUD) was significantly less frequent among Anabaptists, and was associated with more major depressive episodes and more hospitalizations for major depression in Anabaptist, but not non-Anabaptist participants. Lifetime history of head injury showed a trend toward association with more episodes of major depression in both Anabaptist and non-Anabaptist groups that did not withstand multiple test correction.ConclusionsThe presentation of a highly heritable psychiatric illness such as bipolar disorder does not differ in cases drawn from genetically unique Anabaptist populations. However, alcohol comorbidity, head injury, and their effects on illness course suggest some differences that deserve further investigation.

The Effects of Cannabis on Inpatient Agitation, Aggression, and Length of Stay

ABSTRACTObjective: This study examines the association between cannabis use and the hospital course of patients admitted to the psychiatric inpatient unit with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder. Many confounding variables potentially contribute to the clinical presentation of hospitalized patients in the psychiatric unit. Illicit drug use, in particular, has been associated with acute agitation, and questions can be raised as to what lasting effects drug use prior to admission may have throughout a patient's hospital stay. Methods: Subjects with a discharge diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder, or psychosis not otherwise specified (N = 201) were retrospectively identified, and those with positive results of urine drug screen for cannabis on admission were compared to negative counterparts. Agitation and aggression were measured using an adaptation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC). These markers were also quantified by comparing charted episodes of restraint and seclusion and administration of as needed medications, such as benzodiazepines and antipsychotics. Results: Positive urine drug screen results for cannabis was correlated with young (p = .001) males (p = .003) with bipolar disorder (p = .009) exhibiting active manic symptoms (p = .003) at the time of admission. Cannabis use was further associated with a shorter length of stay (p = .008), agitation triggering adapted PANSS-EC nursing assessments (p = .029), and oral medications as needed (p = .002) for agitation. Conclusions: Cannabis use, as defined by positive urine drug screen results, was more common in patients with bipolar disorder and was accompanied by a higher incidence of inpatient agitation. Although these patients also had short hospital lengths of stay, there was no clear relationship between level of agitation and length of stay across all patient groups. One possible explanation for patients with bipolar disorder experiencing short lengths of stay is that their source of agitation may be more closely related to a complex effect of cannabis use rather than a sole etiology of mental illness. Inpatient clinicians should be aware of patient cannabis use proximate to admission.

Conceptualizing psychotic disorders: don't throw the baby out with the bathwater

Conceptualizing psychotic disorders: don't throw the baby out with the bathwater

Right to decide: Preferences and satisfaction with treatment in women and men patients with agitation and bipolar or schizoaffective disorder

Introduction Current recommendations on agitation management advocate for involving patients in deciding the therapeutic plan. Verbal de-escalation is directed to calming the patient while clinical evaluation is performed, and allows agreeing treatment. However, research on patients preferences and satisfaction is scarce. Objectives To assess patients preferences and satisfaction related to treatment of agitation. Methods Prospective observational study among patients that were agitated during hospitalization in 2014. Patients with bipolar disorder, schizoaffective disorder or schizophrenia were offered to choose between inhaled loxapine or usual treatment (intramuscular antipsychotic). Satisfaction with treatment was measured at 7 and 14 days and satisfaction with hospitalization was measured at discharge. Results A total of 180 patients were agitated during 2014, but the majority of agitations were attended in the emergency room. Eighty patients presented agitation during hospitalization. Sixty of them had bipolar disorder, schizophrenia or schizoaffective disorder, and 90% had comorbidity with substance abuse, alcohol abuse or personality disorder. Forty patients were not able to deem their preferences and were treated with intramuscular antipsychotics. Twelve patients chose inhaled loxapine. Eight refused any treatment and received IM antipsychotics. Satisfaction with treatment was higher in patients receiving loxapine. More women than men received loxapine. Satisfaction with hospitalization was higher in women. Conclusions It is important to consider patient opinion in order to increase satisfaction with treatment and patient collaboration. Inhaled loxapine is a new therapeutic option that facilitates this approach.

Cognitive impairment in manic schizoaffective and bipolar patients: A Romanian sample

Introduction Cognitive functions are known to be impaired both in schizoaffective and bipolar patients during the acute manic episode, but also in euthymia. Objectives The purpose of the study was to identify differences in neurocognitive functioning of schizoaffective and bipolar patients. Methods The study was conducted between 2012 and 2015. It included inpatients from the Timisoara Psychiatric Clinic, diagnosed with either bipolar disorder ( n =45) or schizoaffective disorder ( n =43), according to ICD-10 criteria, and a healthy control group ( n =85). The Rey verbal memory test and the d2 Test of Attention were used to assess cognitive functions. Results Statistically significant differences ( P Conclusions The severity of cognitive deficits is similar in both bipolar and schizoaffective disorder during the acute manic episode. During euthymic periods, schizoaffective patients have a poorer neurocognitive functioning than bipolar patients.

Tolerability and side effects of an extended-release injectable suspension of aripripazole in a series of inpatients in a dual diagnosis unit

IntroductionThe integrated care in dual diagnosis units involves selecting pharmacological treatment strategies for both substance use disorder and the non-addictive psychiatric disorder. It is recommended to choose drugs with a favorable balance between efficacy/tolerability, an adequate side effects profile and the minimal drug interactions.Objectives and aimsTo evaluate the tolerability and side effects after first administration-first dose of an extended-release injectable suspension of aripiprazole in a group of patients admitted to an acute dual diagnosis unit.MethodsThe study included a series of patients admitted in our unit from May to August 2015 that received the first dose of the aripiprazole preparation (400 mg). Evaluations included different scales for side effects (SAS, ESRS, UKU) and the clinical global impression scale (CGI).ResultsA total of 9 patients were included and evaluated (all men, mean age: 39-years-old). Diagnoses were: bipolar disorder (5/9), schizophrenia (2/9), schizoaffective disorder (1/9) and delusional disorder (1/9) with concomitant substance use disorder (6 cannabis, 2 alcohol, 1 cocaine). All of them without outpatient control and treatment at admission. The results of the clinical scales conclude that none of them had significant side effects, including extrapyramidal, with an improvement in the ICG scale.ConclusionTolerability of extended-release injectable suspension of aripiprazole was good in all cases. In the future, new cases should be included to extend the sample and to evaluate other aspects such as the craving for substances.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Empathic response in manic bipolar and schizoaffective patients: A Romanian sample

Introduction Empathy is described as the ability to infer or share the feeling state of another person. Despite knowledge of impairments in cognitive and social functioning, to date, little work has been conducted concerning empathic response in bipolar and schizoaffective patients. Objectives Finding potential differences regarding the empathic response of manic bipolar and schizoaffective patients. Methods Inpatients from the Timisoara Psychiatric Clinic, diagnosed with either bipolar disorder ( n =50) or schizoaffective disorder ( n =45), according to ICD-10 criteria, and a healthy control group ( n =80) were included in the study. The study was conducted between 2011 and 2015. To assess the empathic response we used Empathy Quotient (EQ). Results We found statistically significant differences ( P P =0.03). Conclusions Bipolar and schizoaffective patients seem to have similar lower levels of empathy during the acute manic episode, but schizoaffective patients have a poorer empathic response than bipolar patients during euthymic periods.

Increased visual gamma power in schizoaffective bipolar disorder.

Electroencephalography and magnetoencephalography (MEG) studies have identified alterations in gamma-band (30-80 Hz) cortical activity in schizophrenia and mood disorders, consistent with neural models of disturbed glutamate (and GABA) neuron influence over cortical pyramidal cells. Genetic evidence suggests specific deficits in GABA-A receptor function in schizoaffective bipolar disorder (SABP), a clinical syndrome with features of both bipolar disorder and schizophrenia. This study investigated gamma oscillations in this under-researched disorder. MEG was used to measure induced gamma and evoked responses to a visual grating stimulus, known to be a potent inducer of primary visual gamma oscillations, in 15 individuals with remitted SABP, defined using Research Diagnostic Criteria, and 22 age- and sex-matched healthy controls. Individuals with SABP demonstrated increased sustained visual cortical power in the gamma band (t 35 = -2.56, p = 0.015) compared to controls. There were no group differences in baseline gamma power, transient or sustained gamma frequency, alpha band responses or pattern onset visual-evoked responses. Gamma power is increased in remitted SABP, which reflects an abnormality in the cortical inhibitory-excitatory balance. Although an interaction between gamma power and medication can not be ruled out, there were no group differences in evoked responses or baseline measures. Further work is needed in other clinical populations and at-risk relatives. Pharmaco-magnetoencephalography studies will help to elucidate the specific GABA and glutamate pathways affected.

EPA-0322 – Adherence and reduction of admissions in patients treated with paliperidone palmitate

Introduction Antipsychotic long-acting injections have been a great progress in the management of mental disorders and have improved the adherence to treatment. Paliperidone palmitate permits once a month administration, has a good antipsychotic power, is well tolerated and has a few adverse affects. Objective We want to study wether there is a reduction in the drop out and admissions in hospital rates. Methods We take all patients in treatment with paliperidone palmitate from commercialization of the product two years ago (n=70), at two community mental health center in Malaga, Spain. We are going to measure the following variables: age, gender, average dosage, presence or not of politherapy with other antipsychotcs, time in treatment, diagnosis, attitude towards medication (using Drug Attitudes Inventory –DAI-), drop out and its cause and number of admissions before and after treatment with paliperidone palmitate. Results We are analysing data. Up to date we have the following results: n=70; 65% male, 35% female; average 38,2 years, most of them in politherapy; average 339 days in treatment: the majority of patients has received the diagnosis of schizophrenia, although there are other diagnosis like bipolar disorder, schizoaffective disorder, personality disorder and substance abuse disorder. We have observed a reduction of medication drop out and number of admissions, but it has not been measured yet. Conclusion Our group consider (with the preliminary results) that paliperidone palmitate involves an advance in the treatment of schizophrenia and other mental disorders, a reduction of number of admissions and an improvement of adherence.

Deletion at the SLC1A1 glutamate transporter gene co‐segregates with schizophrenia and bipolar schizoaffective disorder in a 5‐generation family

Growing evidence for genetic overlap between schizophrenia (SCZ) and bipolar disorder (BPD) suggests that causal variants of large effect on disease risk may cross traditional diagnostic boundaries. Extended multigenerational families with both SCZ and BPD cases can be a valuable resource for discovery of shared biological pathways because they can reveal the natural evolution of the underlying genetic disruptions and their phenotypic expression. We investigated a deletion at the SLC1A1 glutamate transporter gene originally identified as a copy number variant exclusively carried by members of a 5-generation Palauan family. Using an expanded sample of 21 family members, quantitative PCR confirmed the deletion in all seven individuals with psychosis, three "obligate-carrier" parents and one unaffected sibling, while four marry-in parents were non-carriers. Linkage analysis under an autosomal dominant model generated a LOD-score of 3.64, confirming co-segregation of the deletion with psychosis. For more precise localization, we determined the approximate deletion end points using alignment of next-generation sequencing data for one affected deletion-carrier and then designed PCR amplicons to span the entire deletion locus. These probes established that the deletion spans 84,298 bp, thus eliminating the entire promoter, the transcription start site, and the first 59 amino acids of the protein, including the first transmembrane Na(2+)/dicarboxylate symporter domain, one of the domains that perform the glutamate transport action. Discovery of this functionally relevant SLC1A1 mutation and its co-segregation with psychosis in an extended multigenerational pedigree provides further support for the important role played by glutamatergic transmission in the pathophysiology of psychotic disorders.