P.2.d. Mood disorders and treatment − Bipolar disorders (clinical)
treatment (p < 0.001 for both parameters). Also there was a signiﬁcant difference between admission and discharge in terms of TC (p < 0.001) and LDLc (p < 0.001). HDLc levels showed no difference before and after treatment. Conclusion: In our study we showed an increase in cardiovascular risk with short term treatment via new parameters of CRI-I and II. Early literature conﬁrms that Bipolar patients have higher risk of hyperlipidemia when compared to healthy controls . In a study comparing the effects of atypical (olanzapine and quetiapine) and typical (haloperidol) antipsychotics (AP) on the lipid proﬁle; atypical APs were reported to cause more dysregulation on lipid proﬁle. It was shown that both typical and atypical APs increase the TC and LDLc levels . According to our results; even in short term of treatment, antipsychotics have an important role in developing dyslipidemia and increasing cardiovascular risk. References  Bhardwaj, S., Bhattacharjee, J., Bhatnagar, M.K., Tyagi, S., 2013. Atherogenic index of plasma, castelli risk index and atherogenic coefﬁcient-new parameters in assessing cardiovascular risk. Int J Pharm Biol Sci 3, 359–364.  Hsu, J.H., Chien, I.C., Lin, C.H., 2015. Increased risk of hyperlipidemia in patients with bipolar disorder: a population-based study. General Hospital Psychiatry 37, 294–298.  Duncan, E.J., Woolson, S.L., Hamer, R.M., Dunlop, B.W., 2009. Risk of lipid abnormality with haloperidol, olanzapine, quetiapine, and risperidone in a Veterans Affairs population. International Clinical Psychopharmacology, 24, 204–213.
P.2.d.013 Association between inﬂammation, oxidative stress and clinical features of bipolar disorder manic episode Karamustafalioglu1 ° ,
N. A. M. T. E. Genc1 , M. Emul2 1 Bakirkoy Mazhar Osman Ruh Ve Sinir Hastaliklari, Psychiatry, Istanbul, Turkey; 2 Medical School of Cerrahpasa, Psychiatry, Istanbul, Turkey
Introduction: Recent years researchers show a growing interest about the role of inﬂammation and oxidative stress on etiology of Bipolar disorder. In this study, inﬂammation was assessed by Neutrophil to lymphocyte ratio (NLR) which is a simple systemic peripheral inﬂammation marker . Oxidative stress was measured by Oxidative stress index (OSI) which is calculated as Total oxidative status (TOS)/Total anti-oxidative status (TAS) . In this study we aimed to evaluate the relationship between clinical features of manic episode and inﬂammation, oxidative stress. Our hypothesis may be summarized as; we expect a positive correlation between inﬂammation, oxidative stress and clinical features. Methods: A total of 68 male patients with the diagnosis of Bipolar Disorder manic episode were included in the study. Young Mania Rating Scale (YMRS) scores of the patients at admission were recorded. Serum TAS, TOS levels and total blood count were assessed in patient group. OSI was calculated as TOS / TAS and NLR was calculated as Neutrophil / Lymphocyte counts. Linear associations between inﬂammation, oxidative stress markers and YMRS sub-scores were evaluated with Pearson’s correlation test. p < 0.05 was accepted as being statistically signiﬁcant. Results: The average age of patients was 34.76±10.63 years. The mean YMRS score of patients was 45.1±6.7 points and the mean duration of disease was 9.9±8.7 years. For TAS, TOS, OSI and NLR; the mean value of patients was 14.56±11.75, 2.69±0.91, 0.24±0.14 and 2.93±1.86 respectively.
The NLR and Elevated mood (1st item of YMRS) were signiﬁcantly (p < 0.001) correlated with a correlation coefﬁcient of 0.399. NLR was also positively correlated with duration of illness (p = 0.037, R = 0.254) and number of depressive episodes (p = 0.022, R = 0.277). Both TOS (p = 0.005, R = −0.335) and OSI (p = 0.006, R = −0.328) were signiﬁcantly correlated with Irritability (5th item of YMRS). TAS was negatively correlated with presence of lifetime psychotic features (p = 0.005, R = −0.335) and signiﬁcantly correlated with presence of previously attempting to suicide (p = 0.003, R = 0.356). Conclusion: According to our results there is a positive association between increased inﬂammation and Elevated mood which is the core symptom of mania. Also we found weak but signiﬁcant correlation between increment of inﬂammation and the age of illness. Number of depressive episodes is also found in relation with increased inﬂammation. Inconsistent with our hypothesis, we found a negative correlation between oxidative stress and Irritability. Another important result of our study is that, presence of lifetime psychotic feature is negatively correlated with serum antioxidant levels. There was no signiﬁcant correlation between inﬂammation and oxidative stress. References  Zahorec, R., 2000. Ratio of neutrophil to lymphocyte counts − rapid and simple parameter of systemic inﬂammation and stress in critically ill. Bratislavsk´e lek´arske listy 102, 5−14.  Kalelioglu, T., Genc, A., Karamustafalioglu, N., Tasdemir, A., Gungor, F.C., Cansiz, A., Emul, M. 2014. Initial and post-treatment total oxidant–antioxidant status and oxidative stress index in male patients with manic episode. Psychiatry research 218, 249–251.
P.2.d.014 The possible resilience role of cognitive reserve in bipolar disorder I. Grande1 ° , J. Sanchez-Moreno1 , C. Torrent1 , C. Bonnin1 , B. Sole1 , E. Jimenez1 , C. Varo1 , R. Tabares-Seisdedos2 , V. Balanza-Martinez2 , E. Valls1 , J. Ayuso-Mateos3 , E. Vieta1 , A. Martinez-Aran1 1 Bipolar Disorders Unit- Clinical Institute of Neurosciences, Hospital Clinic- University of BarcelonaIDIBAPS- CIBERSAM, Barcelona, Spain; 2 Department of Medicine, University of Valencia- CIBERSAM- INCLIVA, Valencia, Spain; 3 Department of Psychiatry, Autonomous University of Madrid- Research Institute of the Hospital de la Princesa- CIBERSAM, Madrid, Spain Introduction: The concept of cognitive reserve (CR) provides a possible explanation for the recurrent discrepancy in clinical practise between brain damage and the absence of clinical evidence. It reﬂects the capacity of the brain to endure neuropathology minimizing clinical manifestations and to successfully complete cognitive tasks through an active process by which injury is buffered by pre-existing cognitive processes or by the development of alternative processes . The purpose of the present study was to assess the possible impact of CR in bipolar patients, an incipient ﬁeld of research in psychiatric disorders, and in particular, in bipolar disorder since no agreement has barely been reached about the methodology of how to assess cognitive reserve. Methods: 120 patients were enrolled from the Bipolar Disorders Program (Barcelona). All patients met DSM-IV-TR criteria for bipolar I and II disorder (SCID) and were euthymic (YMRS 6, HDRS 8) for at least 6 months. Clinical and functional variables were collected. A comprehensive neuropsychological assessment was performed including estimated premorbid
P.2.d. Mood disorders and treatment − Bipolar disorders (clinical) IQ, frontal executive functions and verbal learning and memory. Cognitive Reserve Score (CRS) was estimated from educational level, occupational achievement and estimated IQ according to the Vocabulary subtest of the Wechsler Scale. Although leisuresocial activities is an item used in the ﬁeld of CR to replace the occupational attainment item , this item was disregarded in our sample as most of the bipolar patients are active workers at the onset of the disorder. Subjects with CRS below the median were assumed to have low CR, and subjects above the median were considered to have high CR. Comparison of clinical and sociodemographic characteristics across groups (bipolar patients with high CR, bipolar patients with poor CR and healthy controls) was carried out using ANOVA and chi-square tests. An ANOVA was performed to study the potential impact of clinical variables on the cognitive performance, and after that, we controlled for the effect of all these potential confounders on cognition using MANOVA. Results: 56 patients were classiﬁed with high CR and 46, with low CR. Patients with high CR had a higher number of depressive and hypomanic episodes (p = 0.037, p = 0.009, respectively) whereas the low CR group had a higher number of hospitalizations, prior psychotic symptoms and were more commonly treated with lithium (p = 0.009, p = 0.026, p = 0.010, respectively). After controlling for clinical variables, neurocognitive performance in subjects with low CR was signiﬁcantly poorer in attention (digits forward of Wechsler Adult Intelligence Scale, p = 0.013; Trail Making Test -A, p = 0.041) as well as in verbal ﬂuency (Controlled Oral Word Association Test FAS, p=<0.001, and Animal naming, p=<0.001). Conclusions: There is evidence to suggest that CR may be a resilience factor in bipolar disorder. Thus speciﬁc programs addressed to improve cognition and functioning, such as functional remediation and psychoeducation, may be crucial in this disorder. References  Forcada, I., Mur, M., Mora, E., Vieta, E., Bartr´es-Faz, D., Portella, M.J. 2015. The inﬂuence of cognitive reserve on psychosocial and neuropsychological functioning in bipolar disorder. Eur Neuropsychopharmacol 25, 214−22. doi:10.1016/j.euroneuro.2014.07.018.  Stern, Y. 2012. Cognitive reserve in ageing and Alzheimer’s disease. Lancet Neurol. 11, 1006−12. doi:10.1016/S1474–4422(12)70191−6. Disclosure statement: Dr. I. Grande has received a research grant Juan Rod´es Contract (JR15/00012), Instituto de Salud Carlos III, Spanish Ministry of Economy and Competiveness, Barcelona, Spain.
P.2.d.015 Age at onset of bipolar disorders: clinical implication and prognosis of early and late onset A. Ben Haouala1 ° , B. Amamou1 , M. All`egue2 , F. Zaafrane2 , F. Gaha2 1 Hospital of Monastir, psychiatric department of Monastir, Monastir, Tunisian Republic; 2 Hospital of Monastir, psychiatric department, Monastir, Tunisian Republic Background: Bipolar disorder, also known as manic depressive illness, is a mental illness marked by extreme shifts in mood ranging from a manic to a depressive state, it is characterized by depression and at least 1 manic or hypomanic episode during the lifetime of the illness. Age at onset of bipolar disorders may be a key indicator for identifying more homogeneous clinical subtypes. The impact that age at onset has on the overall clinical picture of an individual’s illness has proven to have clinical, familial, and
possible biological implications for those suffering from Bipolar Disorder. Objective and Methodology: The primary aim of our study was to test whether early onset and late onset bipolar illness represent two different forms of bipolar illness in terms of clinical features, individual and familiar antecedents . It was a retrospective study which involved 173 patients treated at psychiatric department of Monastir for bipolar disorder. We compared early onset (group 1 with n = 41) and late onset (group 2 with n = 23) bipolar patients; the cut-off points were age at onset before 18 years and after 35 years for the two subgroups. The subgroups were compared by independent t tests and a contingency table by raw chi-square test. We used « diagnostic age » as deﬁnition of age at onset (AAO) (i.e. the age at which the patient ﬁrst met DSM IV criteria for a major depressive episode, mania or hypomania according to medical case notes and interviews). Results: In the whole sample of 173 bipolar patients, we observed two patterns of age at onset: in group 1 we had 24 male vs 17 female patients and in group 2 there were 15 male vs 8 female subjects. Clinical comparison of early and late onset bipolar patients showed no signiﬁcant difference in sex ratio. Bipolar patients with early onset (group 1) had more familiar psychiatric antecedents and more episodes with psychotic features than group 2 patients (50% vs 38% together with p = 0.04). Moreover, they have manic predominant polarity in their relapses (63.4% manic relapses in group 1 vs 34.7% manic episodes in group 2 together with p = 0.029). We found that late onset bipolar patients (group 2) had duration of the ﬁrst mood disorder’s episode more extended than the subject with early onset age (10.8 months vs 6.5 months together with p = 0.02). Furthermore, group 2‘s patients had a faster ﬁrst relapse of their bipolar disorder (33.4 months vs 62.12 months together with p = 0.035). Despite that, there was no signiﬁcant difference between the numbers of hospitalizations between this two groups. Conclusion: Results from our study suggest that early and late onset bipolar disorders differ in clinical expression. This ﬁnding, which requires further replication in independent samples, may have important clinical implications, and warrants a different therapeutic care with those two subgroups. References  Sch¨urhoff, F., Bellivier, F., Jouvent, R., Mouren-Sim´eoni, M.C., Bouvard, M., Allilaire, J.F., Leboyer, M., 2000. Early and late onset bipolar disorders: two different forms of manic-depressive illness?J Affect Disord. 2000 Jun 58(3), 215−21.
P.2.d.016 Hypomania detection in psychiatric primary care programmes M. Brat1 ° , E. Sole1 , M. Garriga1 , M. Bifano1 , M. Bonnin1 , I. Pacchiarotti1 , J. Sanchez-Moreno1 , E. Vieta1 1 Bipolar disorders program Institute of neuroscience. Hospital cl´ınic, Bipolar Disorder, Barcelona, Spain Background: Bipolar disorder (BD) is a serious, recurring psychiatric condition, in some cases with symptoms persisting for long periods . Evidences also indicate that BD is prevalent and frequently under-recognized in primary care . The detection and diagnosis of present or past hypomanic episodes is of key importance for the differential diagnosis between unipolar depressive disorders and type II BD . Hypomanic symptoms