Onset Of Episode Research Articles

Lactoferrin and Human Neutrophil Protein (HNP) 1-3 Levels During the Neonatal Period in Preterm Infants.

Antimicrobial polypeptides (APPs) are part of the innate immune system, but their specific role in the context of preterm birth is not yet understood. The aim of this investigation was to determine the systemic expression of APPs, i.e., lactoferrin (LF) and human neutrophil protein (HNP) 1–3 in preterm infants in the period of highest vulnerability for infection and to correlate these biomarkers with short-term outcome. We therefore conducted a prospective two-center study including plasma samples of 278 preterm infants and 78 corresponding mothers. APP levels were analyzed on day 1, 3, 7, and 21 of life via enzyme-linked immunosorbent assay (ELISA). The levels of LF and HNP1–3 remained stable during the first 21 days of life and were not influenced by maternal levels. Elevated APP levels were found at day 1 in infants born to mothers with amniotic infection syndrome (AIS vs. no AIS, mean ± SD in ng/ml: LF 199.8 ± 300 vs. 124.1 ± 216.8, HNP 1–3 16,819 ± 36,124 vs. 8,701 ± 11,840; p = 0.021, n = 179). We found no elevated levels of APPs before the onset of sepsis episodes or in association with other short-term outcomes that are in part mediated by inflammation such as necrotizing enterocolitis (NEC) or retinopathy of prematurity (ROP). Interestingly, infants developing bronchopulmonary dysplasia (BPD) showed higher levels of HNP1–3 on day 21 than infants without BPD (13,473 ± 16,135 vs. 8,388 ± 15,938, n = 111, p = 0.008). In infants born without amniotic infection, levels of the measured APPs correlated with gestational age and birth weight. In our longitudinal study, systemic levels of LF and HNP 1–3 were not associated with postnatal infection and adverse short-term outcomes in preterm infants.

Comorbidity of adult ADHD and substance use disorder in a sample of inpatients bipolar disorder in Iran

BackgroundsThe study of the relationship between adult Attention deficit hyperactivity disorder (ADHD) and bipolar disorder has received more attention in recent years and there is limited information in this area. On the other hand, there is a significant comorbidity between ADHD and bipolar disorder with substance use disorder. In this study, we investigated the prevalence of comorbidity of adult ADHD and substance use disorder among a group of bipolar patients admitted to a psychiatric hospital.MethodsOne hundred fifty patients from a total of 200 consecutive patients who were referred to the emergency department of Roozbeh Psychiatric Hospital in Tehran, diagnosed with bipolar disorder based on the initial psychiatric interview and needed hospitalization, were evaluated again by an experienced faculty member psychiatrist by using a subsequent interview based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5).They were evaluated using the Structured Clinical Interview for DSM-5 (SCID-5) questionnaire to confirm the diagnosis of bipolar disorder and the comorbidity of adult ADHD and substance use disorder.ResultsFrom 150 patients diagnosed with bipolar disorder, 106 patients (70.7%) had adult ADHD. 89 patients (59.3%) had substance use disorder and 58 patients (38.7%) had both of these comorbidities with bipolar disorder. Comorbidity of adult ADHD was associated with the earlier onset of the first mood episode in bipolar disorder (p value = 0.025). There was no statistically significant relationship between substance use disorder and age of onset of the first episode. (P value = 0.57).ConclusionsDue to the limitations of studies on adult ADHD comorbidity with bipolar disorder, especially in hospital settings, as well as the increased risk of association with substance use disorder, further multicenter studies in this area with larger sample sizes can increase awareness in this regard.

Analysis of P-wave Changes for Prediction of Atrial Fibrillation Episodes

Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice. It usually initiates as a paroxysmal activity (PxAF), with the subject having sinus rhythm, with interleaved AF episodes.
 The objective of the study is to evaluate the observations made by Pyotr Platonov, who hypothesized that slower conduction in the atria and the presence of fibrosis in the atrial myocardium, both associated to AF, lead to P waves widened, more complex and with increased rugosity.
 The study shows that P wave morphology significantly changes prior to the onset of AF episodes in PxAF, increasing the variability, making more complex P-wave loop, and enlarging the duration, which can be attributed to the de-structuring of the atrial wavefront.

COVID-19 vaccination-triggered cluster headache episodes with frequent attacks.

The pathophysiology of cluster headache and how cluster episodes are triggered, are still poorly understood. Recurrent inflammation of the trigeminovascular system has been hypothesized. It was noted that some long-term attack-free cluster headache patients suddenly developed a new cluster episode shortly after COVID-19 vaccination. Cases are described from patients with cluster headache who reported a new cluster episode within days after COVID-19 vaccination. All cases were seen in a tertiary university referral center and a general hospital in the Netherlands between March 2021 and December 2021, when the first COVID-19 vaccinations were carried out in The Netherlands. Clinical characteristics of the previous and new cluster episodes, and time between the onset of a new cluster episode and a previous COVID-19 vaccination were reported. We report seven patients with cluster headache, who had been attack-free for a long time, in whom a new cluster episode occurred within a few days after a COVID-19 vaccination. COVID-19 vaccinations may trigger new cluster episodes in patients with cluster headache, possibly by activating a pro-inflammatory state of the trigeminocervical complex. COVID-19 vaccinations may also exacerbate other neuroinflammatory conditions. .

Role of Omics in Migraine Research and Management: A Narrative Review.

Migraine is a neurological disorder defined by episodic attacks of chronic pain associated with nausea, photophobia, and phonophobia. It is known to be a complex disease with several environmental and genetic factors contributing to its susceptibility. Risk factors for migraine include head or neck injury (Arnold, Cephalalgia 38(1):1-211, 2018). Stress and high temperature are known to trigger migraine, while sleep disorders and anxiety are considered to be the comorbid conditions with migraine. Studies have reported various biomarkers, including genetic variants, proteins, and metabolites implicated in migraine's pathophysiology. Using the "omics" approach, which deals with genetics, transcriptomics, proteomics, and metabolomics, more specific biomarkers for various migraine can be identified. On account of its multifactorial nature, migraine is an ideal study model focusing on integrated omics approaches, including genomics, transcriptomics, proteomics, and metabolomics. The current review has been compiled with an aim to focus on the genomic alterations especially involved in the regulation of glutamatergic neurotransmission, cortical excitability, ion channels, solute carrier proteins, or receptors; their expression in migraine patients and also specific proteins and metabolites, including some inflammatory biomarkers that might represent the migraine phenotype at the molecular level. The systems biology approach holds the promise to understand the pathophysiology of the disease at length and also to identify the specific therapeutic targets for novel interventions.

Effects of Satureja Bachtiarica Essential Oil in Preventing Seizure in Pentylenetetrazol-Kindled Mice.

Epilepsy is a group of chronic neurological disorders characterized by seizures. The present study aimed to investigate the effects of Satureja bachtiarica essential oil in preventing epilepsy. In this experimental study, 50 mice were randomly assigned to five groups of 10 each. The control group received normal saline plus tween-80 and after 30 min pentylenetetrazol (PTZ). Groups 2 and 3 were treated first with S. bachtiarica essential oil at 50 and 100 mg/kg, respectively and then after 30 min received PTZ. Group 4 received diazepam and 30 min later PTZ. Group 5 received flumazenil and 30 min later PTZ. After the last injection of PTZ, the time of seizure onset, seizure severity and score, the completion time of each seizure (attack episode), and mortality rate in different groups were recorded and compared. The administration of S. bachtiarica essential oil at 50 and 100 mg/kg to PTZ-treated mice caused a significant increase in latency to the first seizure and survival of mice, as well as a significant decrease in the frequency of the head and upper limbs seizure, total body seizures, tonic seizures, and jumping. S. bachtiarica essential oil at 100 mg/kg caused a significant decrease in the head tic frequency. The administration of flumazenil significantly inhibited S. bachtiarica essential oil-induced effects and increased the head and upper limbs seizures, tonic seizures, and jumping. The present study demonstrated that S. bachtiarica essential oil could prevent PTZ-induced seizure and these findings authenticate the traditional claims about the use of S. bachtiarica in treating epilepsy. The administration of S. bachtiarica essential oil at 50 and 100 mg/kg to pentylenetetrazol PTZ-treated mice caused a significant increase in latency to the first seizure.• The administration of S. bachtiarica essential oil at 50 and 100 mg/kg to PTZ-treated mice caused a significant decrease in the frequency of the head and upper limbs seizures, total body seizures, tonic seizures, and spin and jump.• The administration of flumazenil significantly inhibited S. bachtiarica essential oil-induced effects and increased the head and upper limbs seizures, tonic seizures, and jumping. Epilepsy is one of the most common disorders of the central nervous system, so that one in every 100 people is suffering from epilepsy globally. Despite the development of antiepileptic drugs, novel strategies are sought out because of drug resistance and the side effects resulting from these drugs at high concentrations. Researchers have focused on plants for certain reasons such as availability, the history of long-term use, being nature-based, and relative safety. In the current study, the effect of the pretreatment with S. bachtiarica essential oil in preventing seizure was studied in the pentylenetetrazol-kindled mice. The injection of 50 and 100 mg/kg of S. bachtiarica essential oil caused a significant increase in latency to the first seizure and survival duration, and a significant decrease in the frequency of the head and upper limbs seizures, tonic seizures, and spin and jump in the pentylenetetrazol-receiving mice.

Effects of social hierarchy on innate fear‑induced panic responses.

Studies have previously demonstrated a relationship between social status and anxiety disorders such as panic disorder. Repeated episodes of panic attacks do not occur in combination with an actual fear stimulus or stressor. However, social ranking modulates the perception of the social signals of a threat or stressor. The hypothalamic nuclei are well‑known for their role in the elaboration of fear‑induced reactions. The dorsomedial hypothalamus (DMH) and the ventromedial hypothalamic (VMH) nuclei are hypothalamic subnuclei involved in the processing of threatening stimuli‑evoked aversive response and innate fear development. These structures are also located in the medial amygdala‑hypothalamus‑brainstem circuit that modulates innate fear‑induced defensive behaviors. This work aimed to investigate the relationship between social hierarchy and innate fear‑induced panic‑like responses in male rats. In our study, the dominance tube test was used to determine the social hierarchy. Then, DMH/VMH nuclei were unilaterally implanted with a guide cannula. After intra‑DMH/VMH injection of bicuculline (GABAA receptor antagonist), both innate fear induction and differences in dominant/subordinate rats were evaluated by the open field test. Intra‑DMH/VMH bicuculline increased the frequency of defensive immobility, forward escape movements, and crossing behaviors, as well as the duration of defensive immobility and forward escape movements in dominant rats. Subordinate rats showed a higher frequency of defensive attention, defensive immobility, and crossing than dominant rats. Additionally, dominant rats demonstrated a lower duration of defensive attention and defensive immobility than subordinate rats. Dominant rats seemed to adopt a form of innate‑fear characterized by increased proactivity with the environment. In contrast, subordinate rats exhibited a reactive form of innate‑fear characterized by passivity and freezing.

A study to investigate the prevalence of headache disorders and migraine among people registered in a health insurance association in Japan

BackgroundMigraine is a chronic disease characterized by episodic headache attacks. No recent studies have, however been conducted on the epidemiology of migraine or the treatment landscape in Japan. This study was conducted as a fact-finding survey using medical claims data and an online survey on migraine and headaches, conducted among members of health insurance associations with the objective of gaining an understanding of migraine prevalence and the treatment status in Japan.MethodsThe study methodology utilized a unique approach of combined data sources. The data sources used in this study are medical claims data and linked online survey data provided by DeSC Healthcare Inc (DeSC). The primary outcomes (from survey responses) were: the overall number and proportion of migraine patients; and the overall prevalence of migraine, stratified by age and sex. The secondary outcomes (from survey responses) were use of medical care; and clinical features/headache symptoms. The analysis population included all individuals who had response data for surveys conducted by DeSC. The online survey data and medical claims data were summarized.ResultsThe data population comprised 21,480 individuals. On the basis of the survey results, including probable cases, the overall prevalence of migraine was 3.2%. The highest prevalence of migraine was observed in patients aged 30–39 years. The prevalence of migraine in women was 4.4 times higher than in men. The percentage of migraine patients who had not been seen by a doctor was 81.0%. More than 80% of patients were taking over-the-counter drugs and 6.1% took prescription medicines only. Approximately 52.9% of patients considered that the intensity of pain symptoms was severe. Moreover, the majority of patients (72.9%) considered that the impairment of daily life activities was of moderate or severe degree.ConclusionsIn Japan, the percentage of people with migraine who did not receive medical attention is as high as 80%. Additionally, the majority of patients tend to endure symptoms and continue with everyday activities. With innovative treatment approaches becoming available it is necessary to disseminate information that migraine is not a simple headache but an illness that requires medical treatment and consultation.

External Concurrent Occipital and Trigeminal Neurostimulation Relieves Migraine Headache: A Prospective, Randomized, Double-Blind, Sham-Controlled Trial.

IntroductionCurrent external peripheral nerve stimulation devices stimulate only one nerve. This prospective, randomized, double-blind, sham-controlled trial assessed efficacy, safety, and tolerability of a novel external combined occipital and trigeminal neurostimulation (eCOT-NS) device as a self-administered home treatment for migraine (Relivion®MG, Neurolief Ltd; Netanya, Israel).MethodsEpisodic and chronic migraine subjects (N = 55) were randomized to receive active (n = 27) or sham (n = 28) treatment. Subjects received eCOT-NS devices and performed 60 ± 20-min home treatments within 45 min of migraine episode onset. The primary endpoint was relative (percent) change in mean baseline VAS pain scores 1 h after treatment initiation. Treatment outcomes assessed at 1-, 2-, and 24-h post-treatment initiation were pain reduction and proportion of pain-free subjects and treatment responders, defined as ≥ 50% pain reduction. Categorical pain ratings (none, mild, moderate, and severe pain) were also analyzed.ResultsActive stimulation was significantly more effective than sham stimulation for decreasing pain intensity at 1 h (53% vs. 10%), 2 h (52% vs. 17%), and 24 h (71% vs. 34%). Pain-free ratings were greater for the active treatment arm at 1 h (29.2% vs. 16%), 2 h (41.7% vs. 20%), and 24 h (65.2% vs. 40%). The number of subjects with baseline moderate or severe migraine pain who were pain-free at 2 h was significantly greater among active treatment subjects (43% vs. 10.5%). The responder rate was significantly higher among the active treatment group at 1 h (67% vs. 20%), 2 h (66.7% vs. 32%,), and 24 h (78.3% vs. 48%). Overall headache relief was significantly higher in the active treatment group at 1 h (67% vs. 26%) and 2 h (76% vs. 31.6%). Mild adverse events, reported by a minority of subjects, resolved spontaneously.ConclusionseCOT-NS provides superior clinically meaningful relief and freedom from migraine pain, offering an effective and safe therapy for acute treatment of migraine.Trial registrationClinicalTrials.gov Identifier NCT03398668.

Incidence and time course of atrial fibrillation following patent foramen ovale closure.

Determine the true incidence and time course of atrial fibrillation (AF) after patent foramen ovale closure (PFOc) using implantable loop recorders (ILR) placed during cryptogenic stroke evaluation. Published trials report a 2%-6.6% incidence of postimplant atrial fibrillation (PIAF) after PFOc, which is probably a gross underestimation, as only patients presenting in AF were captured. Episodes of paroxysmal and silent AF would have been missed. Of 761 patients who underwent PFOc at a single center between January 2016 and December 2020, 35 patients had an ILR implanted before PFOc, without documentation of AF, and had ≥1 month of monitoring post-PFOc. The incidence, onset, and conclusion of AF episodes were determined from a review of patient records. The mean duration of ILR monitoring was 54.6 ± 39.4 weeks after PFOc. AF occurred in 13/35 (37%) patients. PFOc patients who developed PIAF were older than those who did not (62 ± 11 vs. 52 ± 14 years, p = 0.03). In 12/13, the initial PIAF event occurred within 4 weeks of PFOc, with the greatest frequency around 2 weeks and conclusion by 12 weeks in all. No recurrent strokes occurred during ILR monitoring. The actual incidence of PIAF was far greater than previously reported and was significantly associated with older age at PFOc. The timing of PIAF onset and termination were consistent with a postimplant inflammatory mechanism. The higher actual PIAF incidence underscores its low stroke potential in this population. A larger prospective trial is required to validate these preliminary results.

A study on the correlation between pain frequency and severity and vitamin B12 levels in episodic and chronic migraine.

It is believed that vitamin B12 deficiency and hyperhomocysteinemia cause endothelial cell damage by increasing the levels of free oxygen radicals, which may, in turn, be related to the onset of migraine episodes. The objective of our study was to ascertain a correlation between vitamin B12 levels and migraine attack frequency and pain severity. 127 patients with migraine and 45 healthy controls who presented to Okmeydanı Training and Research Hospital were included in the study. The migraine attack frequency and the duration and severity of pain in migraineurs were recorded. Pain severity was evaluated using a visual analogue scale (VAS). Vitamin B12 levels below 300 ng/L were considered low. The vitamin B12 levels in migraineurs were found to be significantly lower than those in the control group (227.30 ± 104.72 ng/L vs 278.44 ± 149.83 ng/L; p = 0.047). The vitamin B12 levels of patients with chronic migraine (CM) were found to be lower than those in patients with less frequent migraine attacks (197.50 ± 69.16 ng/L vs 278.56 ± 147.91 ng/L; p = 0.019). The ratio of vitamin B12 levels of 300 ng/L and above in patients with CM was lower than that of patients with episodic migraine (p < 0.05). Along with attack frequency and pain severity assessment, it is important that migraine follow-ups should include regular measurement of vitamin B12 levels. We found lower vitamin B12 values in the CM group.

Post-stroke mania

IntroductionApproximately one-third of stroke survivors develop poststroke depression. Post-stroke mania is relatively rare, with a prevalence of less than 2%. One review of case reports of late-onset mania in 2015 demonstrated that 51% of the patients had established vascular risk factors. In 28% of cases, the treatment of underlying organic cause contributed to successful remission of the manic episode.ObjectivesFor this review, we aimed to compile published case reports from the past 20 years to review late-onset mania as one of the neuropsychiatric outcomes of stroke and its management.Methodsliterature search on Pubmed, PsychInfo, and Embase utilizing keywords combinations: Bipolar, Manic, Mania, Secondary, Stroke, Poststroke, Post-stroke, Elderly, Old, Late onset, Late-onset, Lateonset, Hemisphere, Brain, Vascular, Infarction.ResultsAmong the 17 case reports, the age of onset of manic episode ranged from 47 to 86 with a mean of 67 years. Of the 17 cases, the right hemisphere was the most frequently affected (14/17, 82%), with cerebrovascular lesion involving the left hemisphere in 3 cases (17.6%).ConclusionsClinicians should consider mania secondary to an organic cause in patients presenting with focal or soft neurological signs or symptoms, manic episode with atypical symptoms such as visual or olfactory hallucinations, altered mental status, disorientation, impairment in memory or cognition, unusual age of onset for bipolar disorder, or unusual illness course such as single episode of mania or poor response to psychopharmacologic treatment. Some reviews suggest combination of mood stabilizers and second-generation antipsychotics. Benzodiazepines recommended as an adjunctive drug for acute management such as agitation, aggressive behavior or disinhibition.DisclosureNo significant relationships.

Is Maternity Blues a risk factor for the onset of post-partum depression? A longitudinal Study

IntroductionThe period after delivery is characterised by physical, hormonal and psychological changes. Up to 20% of women can present depressive and anxiety symptoms and difficulties in the interaction with the newborn, emotional lability. This condition is also called “Maternity Blues (MB)”.ObjectivesTo: 1) assess the frequency of MB presentation of depressive symptoms immediately after the delivery; 2) identify those characteristics more frequently associated to the onset of depressive symptoms after the delivery; and 3) verify the hypothesis that the presence of maternity blues is a risk factor for the onset of a depressive episode in the 12 months after the delivery.MethodsFrom December 2019 to February 2021 all women who gave birth at the University of Campania “Vanvitelli” were enrolled. Upon acceptance, they filled in the EPDS Scale. Sociodemographic, gynaecological, peripartum and psychiatric anamnesis was collected at baseline. Women have been reassessed after 1, 3, 6 and 12 months.Results359 women were recruited, with a mean EPDS score of 5.51. Among these, 83 reported the presence of MB (EPDS score≥10; 23.12%). Anxiety disorders with onset prior to pregnancy (p&lt;.000), preeclampsia (p&lt;.01), increased foetal health rate (p&lt;.01), conflicts with relatives (p&lt;.001) and anxiety disorders the partner (p&lt;.01) emerged as predictors of Mb. The presence of MB increase 7 time the risk to have higher EPDS score at follow-up assessments (p&lt;.000).ConclusionsThe presence of MB should always be assessed in the immediate post-partum and psychosocial interventions should be provided to women with MB to reduce its potential negative effect on mental health.DisclosureNo significant relationships.

Psychotic episode with onset in childhood and adolescence – Factors which may influence the outcome

IntroductionA psychotic episode might stem from various psychiatric disorders, such as Major Depressive Disorder, Mania, Autism Spectrum Disorder, it might lead to Schizophrenia, or it might be a single event.Objectives The study aimed to assess the main comorbidities encountered in the onset of psychotic episodes in children and adolescents, who were hospitalized in a pediatric psychiatry department for at least one night. Furthermore, another objective was to establish whether a family history of mental illness or a poor socio-economic status have bigger impact on the evolution of these patients.MethodsTo analyze the objectives, it was used an observational study, based on patients with the onset of a psychotic episode and associated diagnosis according to ICD-10, evaluated in Child and Adolescent Psychiatric Department of “Prof. Dr. Al. Obregia” Hospital, between 2015-2019. Patients with psychotic episodes with onset related to Major Depressive Disorder and Mania or a personal history of Schizophrenia were excluded.ResultsThe most frequent associated comorbidity was Autism Spectrum Disorder. In terms of long-term evolution, patients with comorbidities have poorer outcomes, more relapses and hospitalizations. Family history of mental illness, low socio-economic status, the age of onset were found to be prognostic factors and have an important impact on the outcome.ConclusionsThis study compared patients with psychotic episodes with and without comorbid conditions associated, considering the length of hospitalization period, the evolution and the number of relapses. The presence and the type of comorbidities are important factors of evolution and prognostic for these patients.DisclosureNo significant relationships.

The importance of blood count and oxidative stress in the drug-naïve first episode schizophrenia

IntroductionSchizophrenia (SZ) is associated with changes in haematological parameters related to low-grade inflammation state and could be amplified via oxidative stress (OS) related mechanisms. Although studies confirm this relationship, the results could be cofounded by patients’ treatment.ObjectivesThe study aimed to assess the connection between venous blood count and OS in drug-naïve first-episode SZ patients.MethodsThe study consisted of 24 SZ drug-naïve patients during first episode of psychosis (median age: 22 years), and 31 healthy individuals (HC) as a control group (median age: 28 years). The examination included clinical data, OS parameters (enzymatic and non-enzymatic antioxidants), peripheral blood counts.ResultsWe did not find differences between SZ and HC in blood count parameters (p&gt;0.05). In patients group, white blood cells (WBC), neutrophils and neutrophils-to-lymphocyte ratio (NLR) were positively related with the severity of positive symptoms (R=0.59, R=0.53, R=0.50; p&lt;0.05, respectively). WBC was related to superoxide dismutase (SOD-1) levels (HC: R=-0.36, SZ: R=0.70; p&lt;0.05). Neutrophils were positively related to catalase (CAT) (R=0.52; p&lt;0.05) and ferric reducing antioxidant power (FRAP) (R=0.61; p&lt;0.05), but only in the patients’ group. There was a positive relationship between NLR and CAT (R=0.45; p&lt;0.05) in the SZ group.ConclusionsThe results indicate potential connection and interplay between OS and blood count parameters in the onset of psychotic episode. Further studies on a larger group of patients are needed.DisclosureNo significant relationships.

A review: Circadian Rhythm Dysfunction and Bipolar Disorder

IntroductionCircadian rhythm (CR) dysfunction is a prominent feature in bipolar disorder (BD) and sleep disturbances are characteristic, although not essential to the diagnosis.ObjectivesTo review the literature regarding the CR dysfunction and its impact on the onset and clinical course of BD.MethodsWe conducted a MEDLINE search using bipolar disorder, circadian rhythm and sleep as keywords, selecting studies written in English.ResultsCR dysfunction is a trait marker of BD. It’s known that during depressive episodes insomnia is present, with difficulty falling asleep/ maintaining sleep and early awakening. Regarding mania, decreased need for sleep is a critical marker. During the euthymic period significant alterations in sleep pattern have been described. It’s also known that changes in the sleep pattern occur prior to those in mood patterns, indicating that sleep dysregulation may trigger the onset of mood episodes or relapses. Therefore, CR disruption may be associated with the pathophysiology of BD and some factors have already been identified: irregularity of the sleep-wake rhythm, eveningness chronotype, abnormality of melatonin secretion, vulnerability of clock genes and the irregularity of social zeitgeber.ConclusionsDisturbances of sleep are pervasive, and an essential feature of BD, worse during mood episodes, but still present during euthymic periods. It remains to determine whether circadian rhythm dysfunction is a trait marker or mood state dependent. Further studies are warranted to clarify this association.DisclosureNo significant relationships.

Role of migration in the development of a first episode of psychosis

Introduction Currently, there is scientific evidence supporting the relationship between socio-environmental factors and the onset of a first episode of psychosis (FEP). In this context, the phenomenon of migration, seen as a negative life experience, may become an important risk factor in developing a psychotic disorder (PD). In Europe, the impact of this phenomenon is growing and, therefore, it’s necessary to provide a proper answer to these individual’s mental health problems.ObjectivesIdentify which phases of this migration process are most important in the development of a FEP and what are the more significant socio-environmental factors in each phase.MethodsBibliographic research in Pubmed database using the terms “Migration” and “First Episode Psychosis”.Results Research confirms that migrants have a 2 to 3-fold increased risk of developing a PD. This risk will be even higher in the refugee population. Pre- and post-migration factors demonstrated to be more important than factors related with the migration process itself. In the pre-migration phase highlight factors like the lower parental social class and a previous trauma. In the post-migration phase highlight factors like discrimination, social disadvantage and a mismatch between expectations and reality.Conclusions Literature is unanimous in considering migrant status as an independent risk factor for the development of FEP, possibly due to the outsider’s role in society. Thus, despite the growing interest in Biological Psychiatry, this work demonstrates that socio-environmental factors are very preponderant in the development of these disorders and because of that further investigation is still necessary.DisclosureNo significant relationships.

Clinical characteristics of treatment-resistant depression in adults in Hungary: Real-world evidence from a 7-year-longz retrospective data analysis

Treatment-resistant depression (TRD) is associated with poor quality of life, elevated morbidity and mortality and high economic burden.Our observational retrospective epidemiological study have estimated the rate of patients with TRD within a cohort of major depressive disorder (MDD) patients in Hungary and examine the comorbidities and mortality of patients with and without TRD.Our study included patients with MDD who experienced new onset of depressive episode and received antidepressant prescription between 01 January 2009 and 31 August 2015, using data from nationwide, longitudinal database. A patient was considered to have TRD if two different antidepressant treatments had failed during a given pharmacologically treated periode.Overall, 99,531 MDD patients were included, of which 8,268 (8,3%) met the criteria of TRD. Patients with TRD had significantly higher rate of having “Neurotic, stress-related and somatoform disorders”, autoimmune disorders, cardio-or cerebrovascular diseases, thyroid disorders and suicide attempts than non-TRD patients (for all comparisons, p &lt; 0,005).Ths first study to assess the frequency of TRD in Hungary have found that the proportion of TRD is in the same range as in studies with similar methodology reported form other countries. The majority of our other main findings are also in line with previous studies from other countries.DisclosureThis study was founded by Janssen Pharmaceutical Companies of Johnsson and Johnsson. I, as scientific advisor/consultant have received honoraria as I have participated in conceptualization, investigation, validation and writing this lecture.

The age of onset and cognitive impairment at the early stage of schizophrenia.

In schizophrenia, the age of first episode onset can reflect genetic loading and predict prognosis. Little is known about the association between the age of onset and cognition among individuals with early-stage schizophrenia. We aimed to compare the pre-treatment neurocognition profile between individuals with early-onset schizophrenia (EOS, the age of onset < 18years), typical-onset schizophrenia (TOS, the age of onset between 18 and 39years), and late-onset schizophrenia (LOS, the age of onset between 40 and 59years). We included individuals with a current diagnosis of schizophrenia within 3 years and medication naive or less than 2weeks of cumulative antipsychotic exposure and current daily antipsychotic dosage equivalent to ≤ 15mg of olanzapine. Assessments included the MATRICS Consensus Cognitive Battery (MCCB) and the Positive and Negative Syndrome Scale (PANSS). We used linear regression to compare the difference between age-of-onset groups. We included 356 participants (67 EOS, 195 TOS, and 94 LOS). Compared with LOS, TOS was associated with lower scores in the verbal learning scores of the MCCB after adjusting for education years and the subscale scores of the PANSS (45.5 ± 12.9 vs. 40.5 ± 14.1, adjusted B = - 5.79, p = 0.001). The three groups had no difference in other cognitive domain scores. The association between the age of onset and MCCB verbal memory was U-shape (square of the age of onset, adjusted B = 0.02, p = 0.003). Patients with LOS had a better verbal learning function compared with individuals with TOS. These findings suggest that involvement of cognition assessment and rehabilitation training is necessary for patients with TOS.

Visual function during and after an acute central serous chorioretinopathy episode.

To evaluate visual function parameters during and after an acute central serous chorioretinopathy (CSC) episode. A prospective study included 19 fovea involving acute CSC patients with episode resolution within 3months from the episode onset. Optical coherence tomography, best corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG) were performed at baseline, 3 and 6months from the episode onset. In a sub analysis, patients were divided into groups with greater (gMV, N = 9) and lower (lMV, N = 10) macular volume at presentation, and functional outcomes were observed. BCVA (p < 0.001), average CS (CS-A) (p < 0.001), average retinal sensitivity (MP-A) (p < 0.001), mfERG amplitude densities in the first and second ring (mfERG-A1, p < 0.001; mfERG-A2, p = 0.017), and implicit times in the first, second, and third ring (mfERG-IT1, p = 0.024; mfERG-IT2, p = 0.002; mfERG-IT3, p = 0.018) improved with episode resolution 3months after the episode onset. From 3 to 6months after the episode onset, only CS-A (p = 0.045) continued to improve. Patients in thegMV group had lower mfERG-A1 (p = 0.017) and central retinal sensitivity (MP-C, p = 0.05) 6months from the episode onset. Although all functional parameters mostly improve with CSC episode resolution, only CS continues to improve thereafter. Patients with greater MV at presentation have worse functional outcomes. Visual function impairment in acute CSC patients is confined to the topographical area of subretinal fluid detachment.