Amra Memic

CORRELATION BETWEEN MOCA AND MMSE FOR THE ASSESSMENT OF COGNITION IN SCHIZOPHRENIA

Introduction: Schizophrenia (Sch) is a complex neurodevelopmental disorder associated with impairment of cognitive function as a central feature, which is confirmed by a number of studies performed on patients suffering from Sch, where clinical symptoms and social functioning of patients are consequences of neurocognitive deficits. Goal: The goal of this study was to assess the clinical usability of the Montreal Cognitive Assessment (MoCA) as a screening instrument for cognitive impairment in schizophrenic patients, alone and in correlation with the Mini-Mental State Examination (MMSE). Material and methods: This clinical prospective study included 30 patients diagnosed with schizophrenia. Patients were selected from Psychiatric Clinic, Clinical Center University of Sarajevo (CCUS) during 2010. For assessment of cognitive impairment we used Montreal Cognitive Assessment Scale (MoCA) and Mini-Mental State Examination (MMSE). Results: From the total number of respondents (n=30), 15/30 (50 %) were males and 15/30 (50 %) were females; age of onset were 23.5±6.69; duration of illness before hospitalization (mean±SD) 32.5±12.9. If we make a comparison of MoCA scale and MMSE under the limit values, then we get that there was 10 true positive, 4 true negative, 14 false positive and 2 false negative. This all leads to sensitivity of MoCA scale again in comparison with the MMSE of 41.7%, specificity 66.7%, positive predictive value of 83.3% and negative predictive value of 22.2%. Conclusions: Our findings provide preliminary evidence that MoCA scale performs well in detecting true positive but it is imprecise in the detection of true negative findings.

Perceived stress and hair cortisol: Differences in bipolar disorder and schizophrenia

INTRODUCTION Bipolar disorder (BD) and schizophrenia (SCZ) are psychiatric disorders with shared and distinct clinical and genetic features. In both disorders, stress increases the risk for onset or relapse and dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis has been reported. The latter is frequently investigated by measuring changes in the hormonal end product of the HPA axis, i.e., the glucocorticoid cortisol, whose concentration exhibits diurnal variation. The analysis of hair cortisol concentration (HCC) is a new method, which allows assessment of cumulative cortisol secretion over the preceding three months. AIMS To explore whether perceived stress and HCC: (i) differ between BD patients, SCZ patients, and controls; (ii) change over disease course; and iii) are associated with an increased genetic risk for BD or SCZ. METHODS 159 SCZ patients, 61 BD patients and 82 controls were included. Assessment included psychopathology, perceived stress, and HCC. Inpatients with an acute episode (38 BD and 77 SCZ) were assessed shortly after admission to hospital and at 3 and 6 months follow-up. Outpatients in remission and controls were assessed at one time point only. Polygenic risk scores for BD and SCZ were calculated based on results of the Psychiatric Genomic Consortium. RESULTS (i) Perceived stress was higher in BD and SCZ patients compared to controls (p<0.02), and was lower in outpatients in remission compared to inpatients on admission. HCC was higher in BD patients compared to SCZ patients and controls (p<0.02), and higher in inpatients on admission than in outpatients in remission (p=0.0012). In BD patients (r=0.29; p=0.033) and SCZ patients (r=0.20; p=0.024) manic symptoms were correlated with HCC. (ii) In both BD and SCZ inpatients, perceived stress decreased over the 6 month study period (p=0.048), while HCC did not change significantly over the 6 month study period. (iii) In controls, but not in the patient groups, the genetic risk score for BD was associated with HCC (r=0.28, p=0.023). CONCLUSIONS While our results are consistent with previous reports of increased perceived stress in BD and SCZ, they suggest differential involvement of the HPA axis in the two disorders. The genetic study supports this latter finding, and suggests that this effect is present below the threshold of manifest disorder.

Neurocognitive Endophenotypes of Schizophrenia and Bipolar Disorder and Possible Associations with FKBP Variant rs3800373

Introduction: Schizophrenia(SCZ) and Bipolar disorder (BD) are frequently occurring and impairing disorders that affect around 1% of the population. Important endophenotypes in the genetic research of SCZ and BD are cognitive functions. Core symptoms for SCZ and BD are impairments in working memory, declarative memory and attention, all of which fulfill the criteria for an endophenotype. The FK506 Binding Protein 5 (FKBP5) gene codes for a co-chaperone of the glucocorticoid receptor and has been reported to be associated with cognition. Aim: The aims of our research were to determine the degree of cognitive impairment in patients suffering from SCZ and BD and to explore the association of the FKBP5 variant rs3800373 genotype with the cognitive endophenotypes. Material and Methods: Patients and healthy controls were recruited over a period of two years from the Psychiatric Clinic, Clinical Center University of Sarajevo. Genotyping and neuropsychological assessments were performed for 263 subjects (129 SCZ, 53 BD, and 81 healthy controls [HC]). Neuropsychological assessments were performed for all patients with the Trail Making Test-A&B (TMT-A&B) and Digit-span forward&backwards tasks. The single nucleotide polymorphism (SNP) rs3800373 in the FKBP5 gene was genotyped using Infinium PsychArray Bead Chips. Results and Conclusion: SCZ and BD patients performed lower than HC in the TMT-A&B and in the Digit-span backwards task, while no differences were observed between SCZ and BD patients. While SCZ patients performed lower than HC in the Digit-span forwards task, there were no differences between BD and HC or between BD and SCZ. Rs 3800373 was not associated with performance in the TMT-A&B or Digit-span forwards&backwards tasks. SCZ and BD share largely overlapping neurocognitive characteristics. Rs3800373 was not associated with performance in the neuropsychological tests. However, given the limited sample size, the results do not exclude an association with the rs3800373 variant in a larger sample. Furthermore, as the analysis was limited to one SNP, the results cannot be generalized to other genetic variants in FKBP5.

P03-74 - Individual genetic variation and response to antipsychotic medications

Schizophrenia is a severe mental disorder with relatively high occurrence in general population (around 1%). Classical genetic studies (Family, twin and adoption) undoubtedly prove its genetic etiology. On the other hand genetics studies are important in exploration of innate mechanisms responsible for specific response to antipsychotic medications. Significant differences in therapeutic responses to antipsychotic agents in patients suffering from schizophrenia were observed and therefore pharmacogenetics of antipsychotics represents main focus in current psychiatric genetics studies. This is particularly observed at polymorphisms in dopamine and serotonin receptor genes, but also some other biomolecules involved in signal transduction mechanism such are regulators of G-protein signalling in brain (RGS4). In order to test this hypothesis, association between certain variants of RGS4 linked polymorhic marker and responsiveness status towards antypsychotics was evaluated within the group of 52 psychiatric patients under antipsychotics treatment. No association between specific allele or genotype for RGS4 linked loci and therapeutical response using Fisheŕs Exact Test was found (P>0.05).

PW01-189 - Correlation between serum levels of nitric oxide and bilirubin in patients with schizophrenia: preliminary results

Objectives There is a growing evidence that oxidative injury contributes to the patophysiology of schizophrenia (Sch), where higher concentrations of nitric oxide (NO) found to be neurotoxic. Data also suggest that bilirubin (BR) can serve as an endogenous scavenger of NO. The aim of this pilot study was to compare the serum levels of BR and NO among patients suffering from Sch, as well as to estimate whether NO serum levels differ between patients and healthy controls. Methods The study population were consisted of inpatients (n=20) who met DSM-IV diagnostic criteria for Sch confirmed by Structured Clinical Interview (SCID 1) and healthy controls (n=20). In order to exclude psychiatric morbidity in control subjects the same diagnostic procedure was applied. Serum BR levels were measured by the method of Ehrlich. NO concentration in serum was determined by classic colorimetric Griess reaction Results In patients with schizophrenia BR serum level were 9.85±1.182 mmol/L ; X±SEM. Serum NO level was significantly higher in patients with Sch (23, 26 ± 1, 76 μmol/L; X±SEM) than in control subjects (14, 36±1, 42 μmol/L; X±SEM, p=0.001). Correlation between serum nitric oxide and BR values were 0.1518. Conclusions Results of this study reveal that BR plays possible protective role in NO cell toxic activity. Our finding of increased serum NO levels in patients with Sch indicates its potential role in pathophysiology of this severe psychiatric disorder. However, those results are preliminary and have to be confirmed in sample of larger size.