S. Gerber

Cognitive functioning in euthymic bipolar I and bipolar II patients

OBJECTIVE There is growing evidence of cognitive impairment as a trait factor in bipolar disorder. The generalizability of this finding is limited because previous studies have either focussed exclusively on bipolar I disorder or have analysed mixed patient groups. Thus, it is still largely unknown whether bipolar II patients perform differently from bipolar I patients on measures of cognitive functioning. METHODOLOGY A total of 65 patients with bipolar I disorder, 38 with bipolar II disorder, and 62 healthy controls participated in the study. Patients had to be euthymic for at least one month. Clinical and demographic variables were collected in a clinical interview and with the Structured Clinical Interview for DSM-IV. Cognitive functioning was assessed using a neuropsychological battery. Univariate and multivariate analyses of variance were conducted for analyzing possible differences between the groups. RESULTS The multivariate analysis of covariance (MANCOVA) indicated overall differences in neuropsychological performance between the three groups (Pillai Spur: F 1.96, p = 0.003). Post hoc comparisons revealed that patients with bipolar I disorder showed significantly lower scores in psychomotor speed, working memory, verbal learning, delayed memory, and executive functions than healthy controls. Patients with bipolar II disorder showed significant deficits in psychomotor speed, working memory, visual/constructional abilities, and executive functions compared to controls, but not on verbal learning and delayed memory. The two patient groups did not differ significantly from each other on any domain tested. CONCLUSION These results support a similar pattern of cognitive deficits in both subtypes of bipolar disorder.

The Hypomania Checklist-32 and the Mood Disorder Questionnaire as screening tools — going beyond samples of purely mood-disordered patients

BACKGROUND Bipolar disorders are often not recognized. Several screening tools have been developed, e.g., the Hypomania Checklist-32 (HCL-32) and the Mood Disorder Questionnaire (MDQ) to improve this situation. Whereas the German HCL-32 has been used in non-clinical samples, neither the HCL-32 nor the MDQ has been validated in German samples of mood-disordered patients. Additionally, hardly any prior study has included patients with non-mood disorders or has considered potential effects of comorbid conditions. Therefore the goal of this study was to test the validity of both scales in a diverse patient sample while also taking into account psychiatric comorbidity. METHOD A multi-site study was conducted involving seven centers. Patients (n=488) completed the HCL-32 and MDQ and were independently interviewed with the Structured Clinical Interview for DSM (SCID). RESULTS Sensitivity for bipolar I was similar for HCL-32 and MDQ (.88 and .84) but slightly different for bipolar II (.90 and .83), specificity, however, was higher for MDQ. In general, a comorbid condition led to increased scores in both tools regardless of whether the primary diagnosis was bipolar or not. LIMITATIONS AND DISCUSSION: Although we included not just mood-disordered patients, detailed subgroup analyses for all diagnostic categories were not possible due to sample sizes. In summary, HCL-32 and MDQ seem fairly comparable in detecting bipolar disorders although their effectiveness depends on the goal of the screening, psychiatric comorbidity, and potentially the setting.

Impaired functioning in euthymic patients with bipolar disorder--HSV-1 as a predictor.

There is a possible association between infectious agents and psychiatric disorders. Previous studies in the US provided evidence for cognitive impairment correlated with Herpes simplex virus type 1 (HSV-1) infection. For a replication study in Europe we chosed individuals diagnosed with bipolar disorder to analyse the correlation with HSV-1 infection. Antibody prevalence was analyzed by using solid phase immunoassay techniques. Cognitive functioning was tested with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Form A, the Trail Making Test A&B, and two subtests from the WAIS III: the Letter Number Sequencing Task and the subtest on information. History and psychopathology was assessed using structured interviews and validated rating scales (SCID, HRSD-21, YMRS, PANSS). Additionally, we investigated social functioning and quality of life using self-assessment-scales (SAS, LQLP). Prevalence rates of antibodies against diverse infectious agents did not differ significantly between patients and controls. We found a significant correlation between cognitive impairment in patients with bipolar disorder and the prevalence of antibodies directed against HSV-1. Cognitive functions were significantly impaired including language, attention, and immediate memory. The results of this study confirm previous findings suggesting that HSV-1 affects cognitive functions in patients with bipolar disorder. This may also result in more impaired functioning, less quality of life and difficulties in social adjustment.

An observational study of inflammation in the central nervous system in patients with bipolar disorder

The potential influence of infections and immunological changes on the aetiology and pathogenesis of bipolar disorder (BD) has been discussed. Our aim was to detect intrathecal specific antibody synthesis against the neurotropic infectious agents that have previously been linked to BD.

P-1140 - A survey from the WPA early career Psychiatrists council: what about training and practice of psychotherapy across Europe?

There are some doubts as to whether psychotherapy will remain in the armamentarium of future psychiatrists. Few studies have explored early career psychiatrists’ views and their experience with psychotherapy training. The Early Career Psychiatrists’ Council of the WPA carried out an online survey on training and practice in psychotherapy in 13 European countries in order to assess: 1) main characteristics of psychotherapy training in the partecipating countries; 2) organizational and clinical differences of psychotherapy training; 3) trainees’ satisfaction and confidence in the use of psychotherapy. An online survey was conducted through the use of a questionnaire specifically developed for the purposes of this study.Responders were required to collect their opinions on the basis of their own experience. Different aspects of psychotherapy training, such as compulsoriness, payment and supervision, as well as satisfaction with received training and confidence in the use of psychotherapy have been investigated. Results show that training in psychotherapy is mandatory in all countries, except Belgium and France, but most of early career psychiatrists have to pay for it. European trainees are satisfied (70%) with received training, and feel confident to treat patients in psychotherapy settings. Psychodynamic and cognitive-behavioural techniques are more common than systemic, interpersonal, supportive and psychoeducational ones. In 3 countries out of 12 it is not compulsory to attend a psychotherapy training, and only psychodynamic and cognitive-behavioural approaches are widely spread in all countries.This survey is a starting point to improve training and practice of psychotherapy across Europe and to enhance early career psychiatrists’ psychotherapeutic skills and knowledge.

P02-184 - The European federation of psychiatric trainees’ psychiatric resident - industry relationship survey (EFPT-PRIRS)

There is no doubt that, in the modern era, psychiatry and the pharmaceutical industry have a relationship, though the nature of this is not universally well defined. Given that psychotropic medication is widely prescribed (ranking 3rd and 4th in US sales in 2007), and the role of the pharmaceutical industry in medical education has come under scrutiny, it is worth noting that the relationship between the industry and psychiatry trainees has not been studied in great depth. Our Pan-European research group, composed exclusively of psychiatry trainees from at least 18 different countries, as part of the European Federation of Psychiatric Trainees (EFPT) has sought to study this in a systematic fashion. I will present preliminary findings of our survey, PRIRS (Psychiatric Residents-Industry Relationship Survey) which is currently taking place. It is also hoped that this will facilitate a discussion amongst those attending the session, on the role of the pharmaceutical industry in psychiatric training, education and in general.

P03-343 - Treatment choice in psychiatry? How would European trainees treat psychosis for their patients and themselves, and what influences decision-making?

Objectives Recent evidence has questioned modern psychiatric clinical practice, specifically the prescribing of “atypical” antipsychotics. Our Pan-European Research Group wished to ascertain clinical practice amongst European trainees, which treatments trainees would desire for themselves, and factors influencing this. Methods A semi-structured survey was constructed from prior literature, piloted, and a homogenous sample size of at least 50 was agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, with questions on preference of antipsychotic for patients in given scenarios, and factors influencing choice. Physicians were asked for their preference should they develop psychosis. Results i) Treatment choice of antipsychotic for patients 93% (n=600) of respondents chose to prescribe “atypical” antipsychotics (excluding Clozapine), 6% (n=42) choosing “typical” antipsychotics, 1% (n=6) choosing Clozapine as first-line therapy. ii) Treatment choice if trainees developed psychosis 89% (n=530) of responders chose to prescribe “atypical” antipsychotics (excluding Clozapine), 7% (n=40) choosing “typical” antipsychotics, 4% (n=23) choosing Clozapine as first-line therapy. iii) Factors influencing choice These mapped onto three domains: cost, efficacy and side-effect profile (less than 5% other reasons). 79% (n=458) of those who responded felt efficacy most important, 46% (n=270) felt side-effect profile most important and 3% (n=16) considered cost of paramount importance. 38% (n=272) of those who responded to the survey stated that the CATIE trial had influenced their decision-making. Conclusions Psychiatry trainees’ choice of antipsychotic medication for both patients and themselves is based on perceived benefits, as opposed to evidence base and recent literature.

PW01-264 - How would European trainees treat bipolar disorder for their patients and themselves, and what influences decision-making?

Objectives Guidelines produced for management of Bipolar Disorder illustrate change in evidence-base for treatment of acute and maintenance phases of illness. Our Pan-European Research Group assessed clinical practice and desired treatments amongst amongst Psychiatry trainees. Methods A semi-structured survey was piloted, and homogenous sample size (at least 50) agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, questioning preference of mood stabiliser for patients, trainees themselves and factors influencing choice. Results Tables 1 summarise choices. Number (n) Percentage Drug(s) 263/224 40.8/34.8 Lithium 121/101 18.8/15.7 Semisodium Valproate 133/85 20.7/13.2 Sodium Valproate 21/50 3.3/7.8 Lamotrigine 27/18 4.2/2.8 Lithium and Sodium Valproate 10/15 1.6/2.3 Carbamezapine 24/12 3.7/1.9 2nd Generation Atypical antipsychotics 8/4 1.2/0.7 Various combinations 34/134 5.3/21 Left blank [Choice of mood stabiliser for patient/themselves] Factors influencing decision-making mapped onto cost, efficacy and side-effect profile (less than 4% other reasons). 66% (n=538) of respondents felt efficacy most important, 25% (n=202) felt side-effect profile most important and 3% (n=24) considered cost of most importance. Conclusions No clear difference exists in choice of mood stabiliser for European trainees and their patients, and decisions based on perceived efficacy are generally in keeping with established guidelines.

Treatment choice in psychiatry? Would trainees choose similar treatments to those prescribed, and what influences decision-making? A survey of the European Federation of Trainees' (EFPT) Research Group

Electroencephalography has probably represented the first modern and scientifically sound attempt to functionally explore the in vivo activity of the human brain and it has, since ever, attracted attention of psychiatrists, from both the clinical and the research viewpoint. Probably due to the limitations implied by their traditional low spatial resolution, the use of psychophysiological techniques in psychiatry has been not continuous over the last century; however, the availability of newer EEG-based brain imaging techniques has recently renovated some interest (1). Furthermore, recent theories proposed that psychopathology may result from the failure to integrate the activity of different areas involved in cognitive processes, rather than from the impairment of one or more brain areas (2); within this view, a reliable brain imaging tool should be able to explore the dynamics of complex interactions among brain regions, with high sensitivity to the subtle deviation in complex processes that last fractions of seconds; psychophysiological techniques, indeed, offer the possibility to explore the functional correlates of major psychiatric illnesses, as well as to understand of the effects of psychotropic drugs on the central nervous system, with incomparable time resolution. Finally, the recent technical possibility to combine different brain imaging approaches has further fostered a renovated enthusiasm to ward the use of EEG-based techniques in psychiatry. This contribution will provide an historical overview of the EEGbased brain imaging techniques and an update on some recent advances concerning the use of such techniques within the psychiatric field. Finally, some examples of psychophysiological and ’’multimodal’’ imaging investigations in subjects with different psychiatric conditions will be provided. References: 1. Boutros NN, Arfken C, Galderisi S, Warrick J, Pratt G, Iacono W. The status of spectral EEG abnormality as a diagnostic test for schizophrenia. Schizophr Res 2008;99:225–237.