bluuebunny/crossref_metadata_2025 huggingface dataset:
P02-378 - Prevalence Of Premenstrual Syndrome And Premenstrual Dysphoric Disorder In Greek Nursery Students
Authors: Karaoulanis S.E. , Mouzas O.D. , Rizoulis A.A. , Angelopoulos N.V.
Published: June 2010

Objectives

This study was designed to provide information on prevalence of premenstrual syndrome and premenstrual dysphoric disorder in Greek nursery students.

Methods

Premenstrual symptoms of 125 students (18-22 years old) were assessed by the Premenstrual Symptoms Screening Tool (PSST). The PSST reflects and translates categorical DSM-IV criteria into a rating scale with degrees of severity. The premenstrual symptoms were examined over the course of one menstrual cycle.

Results

The diagnosis of premenstrual syndrome was confirmed in 26 of 101 women (25.7%) who completed the questionnaire. Nine subjects (8.9%) met criteria for premenstrual dysphoric disorder.

Conclusions

This study indicates a significant prevalence of premenstrual syndrome and premenstrual dysphoric disorder in Greek nursery students. Given the associated impairment in social and occupational functioning seen in premenstrual disorders, these prevalence data provide a strong rationale for enhanced recognition and treatment of the disorders.
P02-388 - Positive Effect Of Escitalopram On Disease Activity In Women With Relapsing-Remitting Multiple Sclerosis
Authors: Mitsonis C. , Zervas I. , Potagas C. , Dimopoulos N. , Psara V. , Gkeka A.E. , Papadimitriou G.
Published: June 2010

Objectives

Preliminary studies providing evidence of the neuroprotective effect of SSRIs in patients with Multiple Sclerosis (MS) by improving the metabolic function of axons. The aim of this, open label, randomized, controlled, one year follow-up prospective study was to investigate the effect of escitalopram in the prevention of relapses in women with MS.

Methods

Forty eight ambulating women with relapsing-remitting MS were randomly assigned to receive 10 mg of escitalopram per day (e-group, N=24) or to continued the study without medication as a control group (c-group, N=24). Neurological examination was performed, by the same neurologist, at baseline and at every regular (4 weeks) and additional visit after a suspect exacerbation.

Results

During the study period 55 exacerbations occurred in 33/48 (68.7%) of the patients, and these were confirmed by the study neurologist. E- group patients’ present a mean of 0.8 (SD=0.8) and c-group patients’ a mean of 1.4 (SD=1.0) exacerbations per year. Patients treated with escitalopram present a statistically significant reduction in the mean number of MS relapses respect to the previous year (paired t-test, df=23, t=4.9, p< .001). There was no significant difference between the mean number of MS relapses during the year of the study and the previous year in c-group (paired t-test, df=23, t=-0.68, NS). The cumulative risk for relapse was 2.9 times higher for the controls than for escitalopram-treated patients (95% CI= 1.7- 5.1, p< .001).

Discussion

This study provides evidence that escitalopram tends to decrease MS disease activity in women with MS.
P02-393 - Genders Differences In Opiate-Dependent Patients Undergoing A Replacement Therapy Program In Spain: The Proteus Study
Authors: Roncero C. , Box B. , Miquel L. , Fuste G. , Llaudó J. , Martínez N. , Rodríguez-Cintas L. , Casas M. ,   PROTEUS Group
Published: June 2010

Introduction

There are 80.000 patients undergoing replacement opiate programs in Spain, mainly methadone. Gender differences and the ratio of dual diagnosis in this population are unknown.

Objectives

To describe gender differences in the current therapeutic management of opiate-dependent patients undergoing a replacement therapy program in Spain.

Methods

624 patients from 74 centers in Spain were included between September 2008 and February 2009 in an observational, cross-sectional, multicenter study. Patients were ≥ 18 years, had a diagnosis of opiate dependence according to DSM-IV-TR criteria, were currently scheduled in a replacement therapy program in Spain and were given written informed consent.

Results

Only 16% of patients were female. Methadone average doses were significantly higher in man (57,59mg ± (SD 46,77) vs 52,81mg ± (SD 50,81) (p< 0.05)). Most women were caretaken by their partner (56.8% vs 34,2%) and man by their parents (61,6% vs 37,8) p< 0,05.Women were found to have significantly more sexual disorders than men (6% versus 2%; p=0.0316); but less delirium, dementia, amnesic and other cognitive disorders (none versus 6%; p=0.0486); schizophrenia and other psychotic disorders (3% versus 13%; p=0.0226); and adaptive disorders (2% versus 9%; 0.0427). No significant differences were found between sexes for other psychiatric comorbidities.

Conclusion

The ratio between men and women was close to 5/1, being bigger than that in the general opiate dependent Spanish population. Dual diagnosis rates vary by gender, but not in the number of diagnosis in Axis I or II. Gender differences must be considered when planning dependence services as women.
P02-394 - Psychological Stress And Mental Health Among South Asian Women Brought Up In The Uk
Authors: Rout U. , Rout J.
Published: June 2010

Introduction

Much of the research concerning psycho-social stress and mental health within the South Asian community in Britain has centred around new communities settling in England and the associated issues of accommodation, assimilation and integration into the dominant British society. There is a paucity of empirical research concerning the outcomes of psycho-social stress and mental health of British South Asian women in England.

Objective

To explore the manifestations of psycho-social stress and mental health in the lives of British South Asian women.

Methods

A qualitative research design was employed. A total of 34 British South Asian young women, aged 16-29 years, in formal education and living in the North-West of England, were interviewed. Purposive sampling ensured the demographic characteristics of the sample were broadly representative of young British South Asian women living in the North West. Semi-structured, in-depth interviews were undertaken and analysed using a process of thematic analysis.

Results

The emerging themes suggest that the outcomes of psycho-social stress in young British South Asian women manifest themselves in three folds: in psychological and physical ways and through negative behavioural practices. Depression and self-harm were the most occurring themes in the sample.

Conclusions

These findings have some fundamental implications for the practice and provision of counselling and support groups for British South Asian young women to help them to manage the psycho-social stress in their lives and improve their mental health. Positive action is required for the development of culturally appropriate services to encourage this group to seek help.
P02-395 - Mental Outcomes Of Tubal Sterilized Contraceptive Methods At Semnanian Women
Authors: Shahbazi Noodeh A. , Ghorbani R. , Behnam B.
Published: June 2010

Introduction

Contraceptive pregnancy methods can cause physical and mental disorders. This study was done to show the mental outcomes of tubal sterilized contraceptive methods (both of tubectomy and vasectomy's husbands) on Semnanian women.

Material and methods

In this study 69 married women with tubectomy or vasectomy husbands’ have been surveyed at three stages: before, six months and a year after that. Subjects have been interviewed by Scle-90-R.

Findings

The most common mental disorders that should be cured:

First stage

depression (5.8%), psychosis (2.7%), and paranoid thoughts, phobia, somatic complaints and aggression (each of them 1.4%);

Second stage

depression (8.8%), paranoid thoughts, and phobia (each of them 1.7%); and

Final stage

depression (5.3%), psychosis (1.8%), interpersonal sensitivity (1.7%), and aggression (1.4%). the most common disorders that need some consultation: first stage: paranoid thoughts and phobia (each of them 28.4%), somatic complaints (28.2%), interpersonal sensitivity (23%), obsession (20.8%), depression (20.3%), anxiety (19.7%), aggression (18.9%), psychosis (4.1%); second stage: somatic complaints (42.1%), obsession (25.5%), aggression (24.1%), anxiety (22.4%), interpersonal sensitivity (19%), paranoid thoughts and phobia (each of them 17.2%), depression (12.3%) and psychosis (11.9%); and final stage: paranoid thoughts and phobia (each of them 30%), somatic complains (28.1%), obsession (25.9%), depression and anxiety (each of them 21.1%), interpersonal sensitivity (15.3%) and psychosis (7%).

Conclusion

Although mental disorders tubal sterilized contraceptive methods users has not changed more, the high prevalence of them that need consultation confirms the need and necessity to form psychiatric and psychological sections for women at the health centers.
P02-397 - Personality Profile Or Postraumatic Stress Disorder? Personality Characteristics In Women Victim Of Chronic Intimate Partner Violence
Authors: Torres A. , Garcia-Esteve L. , Navarro P. , Tarragona M.J. , Imaz M.L. , Gutiérrez F. , Santos C. , Ascaso C. , Martin-Santos R. , Subirà S.
Published: June 2010

Objective

To study whether there are personality characteristics that discriminate between IPV women and non-abused control women, taking into account the effect of emotional state (depressive symptoms).

Method

A total of 176 women victim of IPV and 193 non-abused control women were assessed with the Dimensional Assessment of Personality Pathology (DAPP-BQ; Livesley, 1990), the Beck Depression Inventory -II (BDI-II; Beck, 1996), and the Index of Spouse Abuse (ISA; Hudson & McIntosh, 1981). Women victim of IPV were recruited from Domestic Violence Centers, and non-abused control women were recruited from Primary Care Centers and Mental Health Services. A two way analysis of variance (IPV * Depression) were used for detecting differences in personality traits taking into account the effect of depression (BDI ≥ 17).

Results

After controlling for depression, IPV victims scored higher than control women in submissiveness (F=6.41; p=0.01), cognitive distortion (F=4.35; p=0.04), intimacy problems (F=27.02; p< 0.001), suspiciousness (F=5.02; p=0.03) and self-harm (F=4.93; p=0.03), and lower in rejection (F=14.66; p< 0.001).

Conclusions

IPV victims showed high submission, low hostility, intimacy problems, suspiciousness, tendency to depersonalization or derealization, and suicidal ideation and attempts, as a result of chronic abuse. Some of these aspects could be explained by the presence of PTSD, more than by pre-existing personality characteristics. Traumatic and chronic stress can alter functional aspects of the brain and lead to the development of dysfunctional cognitive and behavioral characteristics that may be considered in the psychotherapeutic approach.
P02-399 - Success of Functioning of Family with Childwith Time-lagged Psychical Development, on Mental Condition of Children and Mothers
Authors: Vyetrila T.
Published: June 2010

Objectives

With purpose of establishment of influence of success of functioning of family where child with time-lagged psychical development is educated, on psychical health of its members, 200 families where child grows with violation of psychical development are investigated. On criterion of success of functioning the inspected families were parted on two groups: basic (164 families) - disfunctional and comparisons (36 families) - functional.

Methods

Assessment tools: surveillance, clinical and diagnostic interview, objective psychometric scales and test methods to identify the studied trait. Data were subjected to quantitative analysis with subsequent qualitative interpretation and meaningful generalization.

Results

For all of women from disfunctional families neurotic and highly emotional disorders are diagnosed depressed, anxiously-depressed and fobial spectrum. For children, educated in disfunctional families, negative psycho-emotional state is set with predominance of alarm, depression, nervousness and depression, sense of unscreenedness, outcast and lonelyness.

Women from successful families demonstrated absence of psychical violations, and children time-lagged psychical development from families with favourable psychological atmosphere is differed an optimistic emotional background and predominance of sense of protected.

Conclusions

There is necessity of development and introduction in practice, of complex system of medical-psychological rehabilitation of families, educative child with violation of psychical development, including measures, directed on strengthening of health of family and increase of success of domestic functioning. Such complex approach will be given by possibility both to heave up efficiency of rehabilitation of children and promote quality of life of parents of children with violation of psychical development.
P03-387 - Epileptic Seizures Vs Psychogenic Non Epileptic Seizures: Literature Review
Authors: Tzikos A. , Kentigeleni K. , Keskeridou F.G. , Christoudis K. , Samakouri M. , Livaditis M.
Published: June 2010

Objectives

This paper aims

a)

to explore the difficulties in differential diagnosis between epileptic crises and psychogenic non epileptic seizures (pseudoseizures),

b)

to suggest therapeutic guidelines for psychogenic non epileptic seizures. Our purpose is to present a literature review on this subject and to discuss the problems involved.

Method

Typical systematic review of recent articles regarding this topic at the internet search engines of PubMed and Scopus. We used the following keywords: psychogenic seizures, psychogenic non epileptic seizures (PNES), pseudoseizures, conversion disorder, dissociative disorder.

Results

A large percentage of the seizures are found to be psychogenic non epileptic. Most of the patients are firstly treated by neurologists and only a percentage of close to 1/3 of these are referred to psychiatrists for further therapy. The differential diagnosis is difficult because most of the patients actually suffer from both epileptic and non epileptic seizures and usually come to the emergency clinics with either. Video EEG and therapeutic hypnosis are considered to be helpful techniques.

Conclusions

In order to treat patients suffering from psychogenic non epileptic seizures there must be a close collaboration between the neurologists, the psychiatrists and the emergency physicians considering both the medication prescribed and the therapeutic guidelines followed.
PW01-02 - Reduced Left Subgenual Anterior Cingulate Cortical Activity During Withdrawal-Related Emotions In Unipolar Depressed Female Patients
Authors: Baeken C. , De Raedt R. , Van Schuerbeek P. , De Mey J. , Vanderhasselt M.A. , Luypaert R.
Published: June 2010

Background

Although the subgenual anterior cingulate cortex (Cg25: Brodmann area 25) is an important target area in the treatment of affective disorders, its involvement in the evaluation of emotional salience of visual stimuli during depressed episodes is not quite understood. Research regarding the neurocircuitry in mood disorders suggests an important role of this anatomical region for affective information processing.

Objective

In this study, we focused on Cg25 neuronal responses in depressed females using a paradigm in which emotions are elicited without explicit cognitive control, relying on the salient nature of the mood inducing stimuli eliciting approach-related emotions (like happiness) or withdrawal-related emotions (like disgust).

Methods

Twelve treatment-resistant melancholic depressed women and 12 age-matched healthy female control subjects were asked to passively view blocks of baby faces when undergoing functional magnetic resonance imaging (fMRI).

Results

Compared to the healthy females, the depressed patients displayed significantly higher bilateral Cg25 neuronal activities in both emotional experiences. Whereas in melancholically depressed women, right-sided Cg25 activity was comparable for both emotional experiences, we found significantly less leftsided Cg25 neuronal activity during the withdrawal-related emotional experience.

Conclusions

Our results could indicate that in depressed women the left Cg25 modulates intense visceral emotional responses to aversive visual stimuli. Our observations could help to explain why in unipolar melancholic depression the left Cg25 provides a valid target region for antidepressant treatment strategies, such as deep brain stimulation and anterior cingulotomy and nervus vagus stimulation therapy, which all seem to correlate with decreases in left Cg25 activity.
PW01-06 - Bipolar Mood Disorder - Diagnostic Stability and Evolution: a Retrospective Study of Twenty Years
Authors: Cerullo G. , Saraiva C. , Garrido P.
Published: June 2010

Aim

The purpose of this study is to identify factors associated with diagnostic stability of Bipolar Mood Disorder (BMD) with statistical and clinical interest.

Methods

Retrospective cohort study, in which the medical records of 916 individuals admitted to Coimbra University Hospital, between 1989 and 2008 with first diagnostic of BMD, were analysed for the following characteristics: age, gender, occupation, educational level, age at first diagnostic, number and types of hospital admissions, presence of suicide attempts, pharmacological treatments, time between first diagnostic and the new one (Schizophrenia, Delusional Disorder or Dementia), type of cognitive impairment, assessment examinations (TC-CE and EEG) and presence of co-morbidities.

The analysed sample was divided in two groups: one that kept the first diagnostic (BMD) and another that later received a different diagnostic.

Diagnostic criteria according to International Classification of Diseases- 10th edition.

Results

4,7% of the total sample received a different diagnostic in a posterior assessment: 41,9% Schizophrenia, 4,7% Delusional Disorder and 53,5% Dementia. The factors were analyzed with traditional statistical methods and Mann-Whitney's test. The authors found five main factors with statistical significance between the two groups, namely, age, age at first diagnostic, total number of admissions and number of admissions for maniac episodes, and educational level.

Conclusions

The aim of the study was achieved. In clinical practice the reported characteristics must receive a special attention in patient's assessment, in order to verify the diagnostic stability and eventual evolution to another diagnostic.
PW01-10 - Columbia University Lithium Archives Project: Bridging the Gap From Laboratory Evidence to Clinical Findings
Authors: Fieve R.R. , Saxena S. , Gilbert M.L. , Orlowski B.
Published: June 2010

Objective

Lithium has been used in the successful treatment of bipolar disorders since the 1950's. Advancements in neuroscience show that it has neuroprotective properties suggesting a possible efficacy in stroke, Alzheimer's and dementia. There is also evidence showing lithium protection of neurologic injury by changing GSK-3 inhibition in animals.

Methods

The Lithium Archives Project research design is a retrospective, random paper based chart review of patients with mood disorders. The charts are examined for over 100 variables including demographic, symptom, mood, biochemical, neurologic, and medical items. The current sample of over 700 charts was analyzed by a skilled statistician using standard SPSS statistical software. Mean, standard deviation and significance of cerebrovascular disease, myocardial infarction, brain tumors, stroke, seizures, and eye diseases of patients treated with lithium and patients treated without lithium were compared and analyzed. Multivariate analysis was performed to analyze group (lithium/no lithium) and incidence of disease. The means of disease incidence in the lithium versus non-lithium groups were then charted.

Results

The Multivariate Analysis of Variance of the current data shows that group is a significant variable in the incidence of diseases analyzed (Pillai's Trace F = 2.926, df = 11,416, p=.004). The patients treated with lithium show less incidence of cerebrovascular disease (p=.053), myocardial infarction (p=.012), seizures (p=.091), eye diseases (p=.011), stroke (p=.014) and brain tumors (p=.072).

Discussion

The current analysis is very promising and indicates that in this patient population, lithium may have played a role in protection from these diseases.
PW01-13 - Neurocognitive Mechanisms of Emotion Regulation in Depression
Authors: Hyett M. , Green M. , Parker G.
Published: June 2010

Objectives

Neurocognitive impairments in depression have traditionally been regarded as epiphenomena of the illness. Increasing evidence for the stability of neurocognitive deficits outside of depressive episodes implicates their potential role as mechanisms for emotion dysregulation associated with depressive states. This study thus examined associations between neurocognition and emotion regulation in currently depressed patients.

Methods

Participants were thirty patients presenting with current DSM-IV major depression. Participants completed neurocognitive tasks assessing executive function, attention, working memory, and response control to emotional stimuli. The capacity to implement functional emotion regulation strategies was assessed using additive sub-scales from the ‘Cognitive Emotion Regulation Questionnaire’ (CERQ), while emotion regulation difficulties were assessed using the ‘Difficulties in Emotion Regulation Scale’ (DERS).

Results

Neurocognitive performance was compared between sub-groups of patients identified via median split on combined CERQ and DERS items. Patients reporting greater difficulties in emotion regulation demonstrated impaired sustained attention and response control, and increased reaction time to negative stimuli, in comparison to those reporting fewer difficulties. In addition, patients with better access to functional strategies demonstrated better attentional performance and fewer errors of omission to positive stimuli on the response control task.

Conclusions

Neuropsychological impairments in attention and response inhibition may contribute to emotion dysregulation in depressive episodes. By implication, remediation of particular neurocognitive deficits may improve the capacity to implement context-appropriate emotion regulation strategies in affective disorders. Examination of associations between neurocognitive impairment and emotion dysregulation outside of acute illness episodes is necessary to determine the relevance of these associations for illness development.
PW01-14 - Lithium Placental Passage and Perinatal Outcome: Clinical Management During Late Pregnancy
Authors: Imaz M.L. , Torra M. , Santos-Lozano C.C. , Torres A. , Marqueta C. , Hernández J.M. , Pérez J.M. , Teixido I. , Martín-Santos R. , García-Esteve L.
Published: June 2010

Introduction

Despite lithium has been used for the last 50 years as a maintenance treatment for bipolar disorder during pregnancy, there is limited information about perinatal clinical outcomes from fetal exposure to lithium.

Objectives

1.

To quantify the rate of lithium placental passage

2.

To assess any association between plasma concentration of lithium at delivery and perinatal outcome.

Methods

Observational and prospective study. Subjects: Women in maintenance treatment with lithium, being attended during pregnancy at the Perinatal Psychiatry Programme of Hospital Clínic (Barcelona, Spain) between 2007 and 2009. Procedure: We assessed sociodemographical data; dose/day of lithium carbonate; other drugs doses; plasmatic concentration of lithium carbonate in maternal blood intrapartum and in the umbilical cord; obstetrical maternal complications; gestational age at delivery; weight at delivery; Apgar scores; congenital malformations; hospital stays, infant serum concetrations of thyroid-stimulating hormone.

Results

Eight mother-child diads. Mean age of the mother (SD): 32.1 (4,7); 100% caucasian and married. Mean dose of maternal lithium (SD): 675mg (237,5mg). Premature rupture of membranes (%):25. Gestational mean age (in weeks) (SD): 39,9 (1). Birth weight (SD) : 3625gr (451,2gr); Mean Apgar1min (SD): 8,38 (1,1); Mean Apgar5min (SD): 9,75 (0,4). Loss of fetal intrapartum wellness (%): 12,5. Days of hospitalization (mean) (SD):9,5(16,6). Lithium plasmatic concentration (mEq/L), mean (SD): maternal 0,45(0,1), umbilical cord 0,33(0,1), lithium ratio uc/m 0,93 (0,3); infant TSH μU/mL mean (SD): 4,9(4,6).

Conclusions

Lithium placental passsage was 0,93 (0,63-1,07). ≤At umbilical cord lithium levels ≤ 0.60 mEq/L, we didn't have any preterm deliveries, low birth weight newborns, nor neonatal complications.
PW01-19 - Rumination is Influenced by a Genetic Interaction Between GIRK2 Receptor and CREB in Two Independent European Samples
Authors: Lazary J. , Juhasz G. , Anderson I. , Deakin J.F. , Bagdy G.
Published: June 2010

Objectives

Rumination is a significant cognitive symptom of depression. As rumination is strongly related to altered memory function we selected two genes previously described as important candidates for both depression and memory processing to assess their contribution to rumination. Based on a possible functional role for cAMP-dependent protein kinase in the mechanism of action antidepressants, we studied the association between G protein-activated K+ channel 2 (GIRK2) and cAMP-response element binding (CREB) protein genes and rumination in two independent European samples.

Methods

We genotyped an exonic SNP (rs2070995) in GIRK2 gene and a promoter SNP (rs2253206) in CREB gene of 611 individuals from Budapest and 1174 individuals from Manchester. Rumination was measured by Ruminative Response Scale (RRS) of Response Style Questionnaire. Generalized linear models (GLMs) were performed for single marker associations. Likelihood ratio tests were used for interactions between genetic markers on RRS.

Results

Single marker associations did not provide any significant individual effect of the two SNPs on rumination. However, interaction analyses revealed a strongly significant interaction between the rs2070995 and rs2253206 on RRS in both European samples (pBudapest=0.00099; pManchester=0.0027). Homozygous TT individuals for rs2070995 in interaction with homozygous GG for rs2253206 scored significantly higher on RRS compared with other genotypes.

Conclusion

Our results suggest that two key post-receptor signalling proteins, GIRK2 and CREB, interact with each other in regulating the process of rumination which may have relevance for depression and its treatment.

These studies were supported by the Sixth Framework Programme of the EU, LSHM-CT-2004-503474, HRF T03298/2000.
PW01-24 - Evaluation of the Effects of Quetiapine XR Monotherapy According to MDD Severity: Pooled Data From 4 Placebo-controlled Trials
Authors: Montgomery S. , Thase M. , Papakostas G. , Bauer M. , Trivedi M. , Svedsäter H. , Udd M. , Gustafsson U. , Eriksson H.
Published: June 2010

Objectives

Evaluate the effects of once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy in patients with major depressive disorder (MDD) according to disease severity.

Methods

Pooled data (quetiapine XR 50, 150 and 300mg/day doses combined) from four 6- or 8-week placebo-controlled quetiapine XR monotherapy studies (D1448C00001, D1448C00002, D1448C00003, D1448C00004) were analysed. Key inclusion criterion for all 4 studies: HAM-D total score ≥22. Primary endpoint: change from randomisation in Montgomery-Åsberg Depression Rating Scale (MADRS) total score. A post-hoc analysis assessed change from randomisation in MADRS total score and MADRS response (≥ 50% reduction in MADRS total score) at endpoint (Week 6 or Week 8) in 6 severity cohorts (defined by a MADRS total score at randomisation ≥24, ≥26, ≥28, ≥30, ≥32 or ≥34).

Results

1752 patients (comprising the l’ all patients’ group) were evaluated (MADRS score ≥24 at randomisation, n=1601; ≥26, n=1467; ≥28, n=1269; ≥30, n=1038; ≥32, n=745; ≥34, n=500). Quetiapine XR significantly reduced mean MADRS total score at endpoint in lrsquo;all patients’ (p< 0.001 vs placebo) and in all 6 severity cohorts (≥24, ≥26, ≥28, ≥30 and ≥32, p< 0.001 vs placebo; ≥34, p< 0.01 vs placebo). MADRS response rates were significantly higher in the quetiapine XR group vs placebo in the ‘all patients’ group (p< 0.001 vs placebo) and in all 6 severity cohorts (≥24, ≥26, ≥28, ≥30 and ≥32, p< 0.001 vs placebo; ≥34, p=0.001 vs placebo).

Conclusions

Quetiapine XR monotherapy significantly improved depressive symptoms in patients with MDD irrespective of disease severity, including the most severe levels of depression.

AstraZeneca funded
PW01-25 - Extended Release Quetiapine Fumarate (quetiapine XR) In Patients With MDD: Results From 8 Placebo-controlled Studies
Authors: Montgomery S. , Kalali A. , Earley W. , Szamosi J. , Eriksson H.
Published: June 2010

Objectives

To evaluate once-daily extended release quetiapine fumarate (quetiapine XR) as monotherapy (50, 150 and 300mg/day) (acute and maintenance treatment) or adjunct treatment (150 and 300mg/day) in patients with MDD.

Methods

Eight (7 acute, 1 maintenance) placebo-controlled studies were analysed. Primary endpoints: change from randomisation in Montgomery-Åsberg Depression Rating Scale (MADRS) scores (acute); time from randomisation to depressed event (maintenance). Statistical analyses: ANCOVA for difference between quetiapine XR and placebo in LSM change in MADRS total score from randomisation to study end (LOCF; acute); hazard ratio (HR) for time to recurrence of a depressed event (maintenance).

Results

Figure 1 shows treatment differences (95% CIs) for primary efficacy variable for the seven acute studies. Four monotherapy studies (D1448C00001, D1448C00002, D1448C00003, D1448C00014) were significant in favour of quetiapine XR; Study D1448C00004 (monotherapy) was not. Studies D1448C00006 and D1448C00007 were significant in favour of adjunct quetiapine XR. Time from randomisation to depressed event (Study D1448C00005) significantly increased with quetiapine XR; HR (95% CI): 0.34(0.25, 0.46); p< 0.001; number of depressed events: 55, quetiapine XR; 132, placebo. Safety findings were consistent with the known tolerability profile of quetiapine.

Conclusions

Quetiapine XR consistently demonstrated antidepressant efficacy, with 6/7 acute studies positive in favour of quetiapine XR (monotherapy or adjunct). Quetiapine XR maintenance therapy significantly reduced risk of a depressed event, demonstrating relapse prevention. AstraZeneca funded
PW01-28 - Asenapine as Adjunctive Treatment For Bipolar Mania: A Placebo-controlled 12-week Study and 40-week Extension
Authors: Calabrese J. , Stet L. , Kotari H. , Zhao J. , Kouassi A. , Szegedi A. , Panagides J.
Published: June 2010

Objectives

Asenapine is indicated in adults for acute treatment of schizophrenia and bipolar I disorder. We describe the efficacy and tolerability of adjunctive asenapine in bipolar patients showing incomplete response to lithium or valproate monotherapy.

Methods

In a 12-week core study, patients were randomized to flexible-dose asenapine (5 or 10 mg BID) or placebo as an adjunct to continued mood stabilizer therapy. Patients completing the core study without protocol violations could enter a 40-week extension. Changes from core study baseline on the Young Mania Rating Scale (YMRS) and Montgomery-Asberg Depression Rating Scale (MADRS) total scores were assessed at week 3 of the core study and at week 52 in the extension. Efficacy in the core study was assessed using ANCOVA with LOCF to impute missing data. The extension was not powered for statistical comparisons; descriptive statistics were employed.

Results

The intent-to-treat population comprised 318 patients (asenapine, 155; placebo, 163) in the core study and 71 (38; 33) in the extension. Mean±SD changes at week 3 with asenapine and placebo, respectively, were -9.7±10.1 versus -7.7±9.6 (P=0.0257) on YMRS and -2.8±7.2 versus -2.2±6.8 (P=0.3684) on MADRS. Mean±SD changes at week 52 with asenapine and placebo were -17.2±13.7 versus -19.7±11.8 on YMRS and -3.3±9.8 versus -3.9±7.7 on MADRS. The incidence of treatment-emergent AEs with asenapine and placebo was 73% and 69% in the core study, 78% and 69% in the extension.

Conclusions

Asenapine was effective as an adjunct to mood stabilizer in bipolar I disorder and was well tolerated.
PW01-35 - A Prospective Study of Mixed Bipolar Patients: Ten Years of Follow Up
Authors: Ugarte A. , García J. , Ruiz de Azúa S. , González I. , Sáenz M. , Gutierrez M. , Valcarcel C. , Zuhaitz E. , de la Rosa I. , Alonso R. , González-Pinto A.
Published: June 2010

Introduction

Mixed Bipolar patients are those who have co-existing depressive symptoms during mania. These patients are supposed to have a worse evolution.

Objective

The objective of this study was to compare the long-term outcomes of patients who had at least one mixed episode with those who experienced only pure manic episodes.

Methods

169 outpatients diagnosed of Bipolar I disorder and treated at least during two years were included. 120 patients (71%) complited the follow-up over 10 years. Baseline demographic and clinical variables were included.

Results

The patients with mixed episodes (37%) had a significantly younger mean age at onset comparing with those with manic episodes (25.3 years vs. 30.8 years; p=0.025) they also had more previous mood- incongruent psychotic symptoms χ2= 6.77, p=0.034), more number of hospitalizations (OR= 1.36, 95% CI = 1.14; -1.63; p< 0.001), and more number of episodes (OR= 1.21, 95% CI = 1.10-1.31; p< 0.001). There were no significant differences relating to depressive episodes, alcohol use, drug abuse, suicidal behaviour and suicide attempts.

Discussion

Age at onset differed significantly between the mixed episode and pure mania groups, with mixed episode patients having a younger age of onset. This is interesting as one of the major results of the study we have found that age at onset mediates some of the factors classically related to outcome in mixed episodes like alcohol abuse and suicide attempts. However, independently of age at onset, these patients represent a especially severe type of bipolar disorder.
PW01-36 - The Long-term Safety, Tolerability And Effectiveness Of Adjunctive Aripiprazole To Lithium/valproate In Bipolar i Patients Partially Non-responsive To Mood Stabilisers
Authors: Vieta E. , Owen R. , Baudelet C. , McQuade R. , Sanchez R. , Fyans P. , Loze J.-Y. , Marcus R.
Published: June 2010

Objective

To evaluate the long-term tolerability and effectiveness of aripiprazole adjunctive to lithium or valproate in bipolar mania.

Methods

Completers of a 6-week double-blind comparison of adjunctive aripiprazole versus placebo in bipolar mania partially responsive to monotherapy were followed up over 46-weeks on open-label aripiprazole plus lithium (ARI+LI) or valproate (ARI+VAL).

Results

283 (ARI+LI n=108; ARI+VAL n=175) patients entered and 146 (ARI+LI n=55; ARI+VAL n=91) completed the 46-week extension. Safety results for both combinations were consistent with the known tolerability profile of aripiprazole, lithium and valproate. No clinically significant changes in lipids or glucose were observed with either ARI+LI or ARI+VAL. Mean (SE) weight change from double-blind endpoint to Week 46 (LOCF) was 2.3 (0.6) kg with ARI+LI and 2.0 (0.4) kg with ARI+VAL. Temporal analysis of the time of first onset of adverse events showed that akathisia and insomnia tended to occur early in treatment, with few new cases in patients previously treated with aripiprazole during the 6-week study.

Significant improvements from baseline in YMRS total score and MADRS total score were sustained over the 52 weeks with both ARI+LI and ARI+VAL treatment.

Mean reduction from baseline at Week 52 LOCF[95%CI], p value vs baselineARI+LIARI+VALYMRS total score-16.5 [-18.1; -14.8], p<0.001-17.6 [-18.9; -16.3] p<0.001MADRS total score-1.7 [-3.3; -0.1] p<0.05-2.7 [-4.0; -1.4] p<0.001

Conclusions

Long-term aripiprazole adjunctive to lithium/valproate in bipolar mania was safe and well-tolerated. Improvements in manic and depressive symptoms observed during the first 6 weeks of treatment were maintained.
PW01-39 - Characteristics of Patients With Hypomanic Symptoms Presenting a Current Major Depressive Episode Identified With The Hcl-32 Patient Questionnaire
Authors: Vieta E. , Angst J. , Azorin J.-M. , Bowden C.L. , Perugi G. , Young A.H. ,   for the BRIDGE Study Group
Published: June 2010

Objectives

To evaluate the extent of hypomanic symptoms in patients presenting with a current major depressive episode (MDE) and to identify characteristics differentiating patients with hypomanic symptoms from those with pure unipolar depression, using the HCL-32 self-assessment tool.

Methods

This cross-sectional diagnostic study was performed in eighteen countries. Community- and hospital- based psychiatrists included consecutively all consulting adult patients with a diagnosis of MDE and completed a questionnaire on sociodemographic variables, diagnosis, medical history, treatment and comorbid psychiatric disorders. Each patient completed the Hypomania Self-Rating Scale (HCL-32 R2), and those scoring ≥14 were assigned a diagnosis of bipolar disorder. The frequency of study variables in the bipolar disorder (BD) and unipolar depression subgroups were compared.

Results

A total of 5635 patients were included. Overall, 1645(39%) had received a diagnosis of BD, 703(16%) fulfilled DSM-IV-TR criteria for BD and 2942(54%) scored ≥14 on the HCL-32. Patients scoring ≥14 on the HCL-32 were significantly more likely to have experienced a mood switch in response to antidepressants (OR:3.4), a family history of bipolarity (OR:2.4), comorbid substance abuse (OR:2.1) or borderline personality disorder (OR:1.7) and current mixed-state symptoms (OR:1.5).

Conclusions

In patients with DSM-IV MDE self-assessed, hypomanic symptoms were present in 54% of patients, whereas only 16% fulfilled DSM-IV criteria for bipolar disorder. However, these patients presented features recognised to be associated with bipolar disorder. The presence of bipolarity in patients presenting with a major depressive disorder may be frequent and use of this questionnaire would contribute to improve awareness and prompt better diagnosis.
PW01-40 - Reward Learning and Processing In Euthymic Bipolar Patients: Insights From Behavioural and Neuroimaging Studies
Authors: Wessa M. , King A.V. , Bongers A. , Hennerici M.G. , Gass A. , Linke J.
Published: June 2010

Introduction

Dysregulation of motivation and altered processing of reward represent important diagnostic criteria of bipolar disorder and have been proposed as a trait marker of the disorder. Until now, only few studies investigated the processing of reward and learning through reward and punishment in euthymic bipolar patients (BP).

Objectives/aims

Two studies were conducted to investigate mechanisms of reward learning and processing in euthymic BP and healthy individuals (HC).

Methods

In the first study, 23 euthymic BP, 15 remitted patients with Major depression (MD) and 16 HC participated in an associative learning task, assessing the efficiency of contingency learning as well as the preference to learn through positive or negative feedback. In the second study, a probabilistic reversal learning task was conducted during functional magnetic resonance imaging. Here, the neural correlates of reward and punishment were assessed in 22 euthymic BP and 21 HC.

Results

We observed no group differences for the efficiency of contingency learning. However, euthymic BP with a manic episode prior to remission learned better from positive feedback whereas euthymic BP with a depressed episode prior to remission and remitted MD patients learned better from negative feedback. HC did not show such preferences in learning. In addition, bipolar patients exhibited increased orbitofrontal and parahippocampal activity in response to reward but no differences in response to punishment.

Conclusions

Interestingly, the last episode seems to differentially affect emotional and learning processes during euthymia. On a neural level, euthymic BP seem to be more sensitive to reward than healthy individuals.
PW01-41 - Mania Induced By Mefloquine Prophylaxis: Case Description And Literature Review
Authors: Yelmo S. , Morera A. , Henry M. , Renshaw A. , Gracia R.
Published: June 2010

Objectives

Mefloquine is being used as malaria prevention by Plasmodium Falciparum in chloroquine-resistant zones. We describe a woman who developed a manic episode with psychotic symptoms during mefloquine treatment.

Methods and results

The case describes a 26-year-old Spanish woman who had been working in Mali for the last six months and had started antimalarial prevention with mefloquine. In Mali, the clinical picture had a sudden debut and she related: excessive happiness, incapacity to sleep, and megalomania (she believed to have special powers and to be the mother of all the children). She was admitted in a hospital in Mali for seven days and received treatment with haloperidol and chlorpromazine. Then, she was repatriated to Spain without treatment and she continued suffering the same symptoms. After 15 days, she went to our hospital and she was admitted. Treatment started with risperidone (up to 6 mg/day) and clonazepam (up to 1.5 mg/day). At admission Young Mania Rating Scale (YMRS) was 25 points. Physical examination and complementary tests were normal, and was orientated as a manic episode with psychotic symptoms secondary to mefloquine. She had a quick symptomatic improvement (after 7 days of treatment YMRS was 5 points) and was discharged after 15 days.

Conclusion

Mefloquine more frequent adverse neuropsychiatric effects are: dizziness, vivid dreams and insomnia. Others are confusion, and auditory hallucinations. Side effects are dose dependent. Psychotic symptoms are frequently auto-limited when mefloquine is suppressed but treatment with atypical antipsychotics is often needed. MDR1/ABCB1 polymorphisms may play a role in neuropsychiatric side effects.
PW01-43 - White Matter Integrity In Social Anxiety Disorder - a Diffusion Tensor Imaging Study
Authors: Baur V. , Hänggi J. , Rufer M. , Jäncke L. , Herwig U. , Brühl A.
Published: June 2010

Objectives

Social anxiety disorder (SAD) is characterized by anxiety in situations in which one may be evaluated or be in focus of attention by others. Functional neuroimaging studies revealed hyperactivity of the amygdala in response to social cues like faces in patients with SAD. To date, little is known about the neuroarchitecture of SAD. We hypothesized structural alterations in white matter regions projecting to or from the amygdala such as the uncinate fasciculus.

Methods

Diffusion tensor imaging (DTI) was applied in 26 patients with SAD and 24 healthy controls (HC). White matter integrity was assessed by fractional anisotropy (FA), a measure of fiber coherence and integrity. In addition, individual scores of trait anxiety were correlated voxel-wise with FA values.

Results

Patients with SAD showed reduced global mean FA across the whole brain and locally in regions near the left amygdala, thalamus, cerebellum, cingulate cortex/corpus callosum, and in the corticospinal tract. Furthermore, trait anxiety correlated negatively with FA in a similar region as in the group comparison near the left amygdala, probably representing the left uncinate fasciculus.

Conclusions

Reduced white matter integrity in patients with SAD was found globally as well as locally in different brain regions. The region near the left amygdala/uncinate fasciculus was the only one yielding significance in both the FA group comparison and voxel-wise correlation with trait anxiety. This points to a functional role of this fiber tract in anxiety and emotion regulation, for instance in top-down inhibition of the amygdala by the frontal cortex.
PW01-44 - Impact of Glyoxalase-1 Mrna Expression On Cck-4 Induced Anxiety
Authors: Eser D. , Leicht G. , Laenger A. , Schuele C. , Baghai T. , Mulert C. , Uhr M. , Rupprecht R.
Published: June 2010

Objectives

There is evidence that the antioxidant enzyme glyoxalase-1 (Glx-1) may play a role in anxiety-related behaviour. However, discordant findings between Glx-1 expression and anxiety-related behaviour have been observed in animal models. Because no data are available on the relation between Glx-1 mRNA expression and human anxiety so far, we investigated the expression of Glx-1 mRNA in peripheral red blood cells in relation to cholecystokinin-tetrapeptide (CCK-4) induced anxiety in healthy subjects.

Methods

Twenty-three healthy subjects underwent challenge with CCK-4. Glx-1 mRNA expression was assessed by quantitative real-time polymerase chain reaction prior to CCK-4 injection. Baseline anxiety was assessed with the State-Trait-Anxiety-Inventory (STAI) and panic response was measured with the Panic Symptom Scale (PSS).

Results

CCK-4 elicited a marked anxiety response accompanied by a significant increase in heart rate. Glx-1 mRNA expression correlated significantly with severity of CCK-4 induced anxiety. In contrast, Glx-1 activity did not correlate with state or trait anxiety.

Conclusions

The positive correlation between Glx-1 mRNA expression and CCK-4 induced panic severity suggests that Glx-1 is involved into the acute anxiety response to CCK-4. Our preliminary findings support preclinical findings and point towards a role of Glx-1 for human anxiety.
PW01-50 - Broadening Of Generalized Anxiety Disorders Definition Does Not Affect The Response To Therapy: Findings From The Adan Study
Authors: Álvarez E. , Carrasco J.L. , Olivares J.M. , Perez M. , Pérez-Gómez V. , Vilardaga I. , Rejas J.
Published: June 2010

Purpose

To elucidate the consequences of broadening DSM-IV criteria for generalized anxiety disorder (GAD), we examined the evolution of GAD symptoms in two groups of newly diagnosed patients; one group according to DSM-IV criteria and the other, according to broader criteria.

Methods

Multicentre, prospective and observational study conducted in outpatient psychiatric clinics. Patients with GAD according to DSM-IV criteria and subjects with anxiety symptoms fulfilling broader criteria were compared. Broadening criteria was considered 1-month of excessive or non-excessive worry and only 2 associated symptoms listed on DSM-IV for GAD. Socio-demographic data, medical history and functional outcome measures were collected three times during a 6-month period.

Results

3,549 patients were systematically recruited; 12.8% excluded because not fulfilling inclusion criteria, 1,815 patients in DSM-IV group (DG) and 1,264 in broad group (BG). Both groups were similar on their sociodemographic characteristics at baseline and most patients (about 80%), even newly diagnosed were exposed previously to pharmacological therapies (mainly benzodiazepines) of their anxiety symptoms. As a result of treatment at psychiatric clinics, the percentage of patients without symptoms of anxiety as per HAM-A scale were 49.0% and 58.0%, respectively at the 6 month visit (p=0.261). Similarly, responder rate (≥ 50% reduction of baseline scoring) were, respectively, 59.7% and 67.7% (p=0.103). Improvement in MADRS scores were observed in both group to a similar extent; 12.1 and 12.5 points average reduction respectively (p=0.264).

Conclusion

Broadening of GAD criteria could lead to earlier diagnosis that will benefit patients by starting appropriate treatment sooner.