Ivona Šimunović Filipčić

EFFICACY AND SAFETY OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION USING AN H1-COIL OR FIGURE-8-COIL IN THE TREATMENT OF UNIPOLAR MAJOR DEPRESSIVE DISORDER: A STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique with few side effects that has been reported to be effective in the treatment of major depressive disorder (MDD). At present, no randomized controlled trials (RCT) have compared the efficacy and safety of rTMS delivered by the figure-8-coil and the H1-coil. We describe an industry-independent, randomized, controlled, single-blinded, single-center study protocol assessing the differences in efficacy and safety of rTMS for patients diagnosed with MDD with the H1-coil and figure-8-coil as an add-on to stable pharmacotherapy or pharmacotherapy alone. Stimulation protocols follow those that led to the FDA clearance of these treatments for MDD. The sample of 76 patents in each of the three groups will be enrolled and assessed with clinical and neuropsychological tests. The primary outcome is remission rate defined as Hamilton depression rating scale (HAM-D17) score ≤7 at the end of week-4. This clinical trial will address the efficacy and safety of rTMS modalities for MDD. The evaluation of biological markers will also help to elucidate the pathophysiology of MDD and the mechanisms of action of rTMS.

F96. AGE AND GENDER DETERMINED DIFFERENCES IN THE ONSET OF CHRONIC PHYSICAL MULTIMORBIDITIES AMONG PATIENTS WITH SCHIZOPHRENIA OR DEPRESSION AND THE GENERAL POPULATION

Abstract Background The links between schizophrenia (SCH) or major depressive disorder (MDD) and chronic physical multimorbidities (CPM) are well established. Patients diagnosed with these disorders have a higher prevalence of CPM than the general population (GEP). However, our knowledge of age and gender determined differences in the development of CPM between SCH, MDD, and GEP remains fragmented and inconsistent. This exploratory study intended to compare the onset of CPM in female and male SCH and MDD patients, and the general population (GEP). Methods This nested, single-centered, cross-sectional study was performed during 2016 at Psychiatric hospital Sveti Ivan, Zagreb-Croatia. Data were collected for a consecutive sample of 136 patients diagnosed with SCH, 290 diagnosed with MDD, and 861 participants from the general population of the city of Zagreb and Zagreb County. The primary outcome was the prevalence of CPM. The secondary outcome was the prevalence of CPM in the youngest age group ≤35 years. Results After adjustment for gender and education, the prevalence of CPM was significantly different between patients with SCH or MDD and GEP (p<0.001). In the oldest age group (≥65 years) the difference was not significant anymore. In the youngest age group, the prevalence was highest in SCH patients (33%) followed by MDD (26%) and GEP (15%) indicating the early onset of CPM in severe mental illness. In the male participants <35 years old, there were no significant differences in the prevalence of CPM between SCH (25%), MDD (23%) and GEP (15%) (p=0.411). However, in the female participants <35 years old the difference was significant and clinically relevant (p=0.006). Prevalence of CPM in female participants was 50% in SCH, 33% in MDD and 14% in GEP. Discussion This study finding indicated the earlier onset of CPM in SCH and MDD patients than in GEP. This difference is primarily caused by the high prevalence of CPM in young female patients diagnosed with SCH. More prevalent physical morbidity points to a substantial disadvantage of female SCH patients early in the course of the illness. Understanding the nature and biological basis regarding the risk and outcome of CPM might help to identify new therapeutic targets, allow more individualized treatment, and facilitate better risk prediction and application of healthcare resources.

F97. CHRONIC PHYSICAL MULTIMORBIDITIES, GENDER DISPARITIES AND TREATMENT OUTCOME IN SCHIZOPHRENIA

Abstract Background Increased physical morbidity in patients with schizophrenia (SCH) is well established. However, our knowledge on the role of gender in chronic physical multimorbidities (CPM) remains limited, and the evidence about the effect of CPM on SCH treatment outcome is sparse. The present study explored the gender-dependent differences in the prevalence, and age of onset of CPM between SCH and the general population (GEP), as well as the effect of CPM on hospital readmission in patients with SCH. Methods This cross-sectional study was nested within the larger frame of a prospective cohort study conducted at Psychiatric Hospital ‘‘Sveti Ivan’’, Croatia. Data were collected for a consecutive sample of 136 (49 female and 87 male) patients diagnosed with SCH (ICD-10) and 861 (467 female and 394 male) participants from the general population. The primary outcome was the prevalence of CPM. A secondary outcome was the number of psychiatric readmissions since diagnosis. Results In the total sample we observed the significant difference in CPM prevalence between SCH and GEP in the youngest age group, <35 years old (p=0.006). Among the male participants <35 years old, there were no significant differences in the prevalence of CPM between SCH (25%) and GEP (15%) (p=0.216). However, among the female participants <35 years old, the difference was significant and clinically relevant (p=0.002). Prevalence of CPM was 50% in SCH patients, and 14% in GEP. After the adjustment for age, sex, a number of psychiatric comorbidities and duration of SCH, the number of physical illness comorbidities was significantly associated with the number of previous psychiatric hospital readmission. (multivariate, robust regression; B=0.98; β=0.24; p=0.022). Approximately, the number of rehospitalizations increases for one with each chronic physical illness. Discussion This study identified gender differences in the prevalence of CPM in SCH patients, and the significant association of CPM with psychiatric hospital readmission. Higher physical morbidity points to a substantial disadvantage of female patients early in the course of illness. Understanding the nature and biological basis of gender-determined differences in risk and outcome of CPM might help to identify new therapeutic targets, allow more individualized treatment, and facilitate better risk prediction and application of healthcare resources.

Patterns of chronic physical multimorbidity in psychiatric and general population

OBJECTIVEnA growing body of evidence has demonstrated the high prevalence and complexity of chronic physical multimorbidity defined as ≥2 chronic physical illness in people with psychiatric disorders. The present study aimed to assess differences in the prevalence and patterns of self-reported chronic physical illness and multimorbidity in the general and psychiatric populations.nnnMETHODSnWe performed a latent class analysis of 15 self-reported chronic physical illnesses on a sample of 1060 psychiatric patients and 837 participants from the general population.nnnRESULTSnSelf-reported chronic physical illness and multimorbidity were significantly more prevalent in the population of psychiatric patients than in the general population (Pu202f<u202f.001). Psychiatric patients had 27% (CI95% 24% - 30%) higher age-standardized relative risk for chronic physical illness and a 31% (CI95% 28% - 34%) higher for multimorbidity (Pu202f<u202f.001). The number of chronic physical illnesses combinations was 52% higher in the psychiatric than in general population (255 vs 161 combinations respectively; Pu202f<u202f.001). We identified four distinct latent classes: Relatively healthy, Musculoskeletal, Hypertension and obesity, and Complex multimorbidity with no significant differences in the nature of multimorbidity latent classes patterns. The class Relatively healthy was significantly less (ARIu202f=u202f-25% (CI95% -30% -21%), and the class Hypertension and obesity was significantly more prevalent in the population of psychiatric patients (ARIu202f=u202f20% (CI95% 17% - 23%).nnnCONCLUSIONSnThese findings indicate that mental disorders are associated with an increased risk of a wide range of chronic physical illnesses and multimorbidity. There is an urgent need for the development of the guidelines regarding the physical healthcare of all individuals with mental disorders with multimorbidity in focus.

GERD is associated with the outcome of MDD treatment

Introduction Gastroesophageal reflux disease (GERD) is more prevalent among patients with major depressive disorder (MDD) than in general population, and vice versa. Bidirectional association of GERD and MDD is well documented. Although protective effect for gastric symptoms has been indicated for several antidepressants like trazodone, citalopram, fluoxetine, mirtazapine or fluvoxamine, these findings are sometimes contradictory. Similar may be claimed for antidepressive effect of some proton pump inhibitors. We decided to examine the association of GERD with the long-term efficacy of MDD treatment. Objective To examine the association of GERD and efficacy of MDD treatment. Methods This nested cross-sectional study was done during 2016 at Psychiatric hospital Sveti Ivan, Zagreb, Croatia on the sample of 1008 psychiatric patients. Key outcome was the number of psychiatric rehospitalizations since the first diagnosis of MDD. Predictor was patient-self-declared diagnosis of GERD. Covariates controlled by multivariate analysis of covariance were sex, age, duration of MDD in years, education, marital status, number of household members, work status, clinical global impression scale–severity of MDD at diagnosis, treatment with tricyclic antidepressants (TCA), selective serotonin reuptake inhbitors (SSRI), serotonin-norephinephrine reuptake inhibitors (SNRI), noradrenergic and specific serotonergic (NaSSA) and antipsychotics. Results MDD patients with GERD had significantly larger number of psychiatric rehospitalizations (meanxa0=xa05.4 (SD 6.82)) than MDD patients with no GERD (meanxa0=xa03.1 (SD 4.45)). After adjustment for all covariates, GERD significantly moderated the efficacy of treatment of MDD (Pxa0=xa00.048; η2xa0=xa00.05) ( Figure 1 ). Conclusion To treat MDD effectively we should treat GERD as well.