S. Yelmo-Cruz

Psychopathology and Serum Bdnf in First-episode Psychosis

Introduction The brain-derived neurotrophic factor (BDNF) is a neurotrophin related to the differentiation and survival of neurons as well as synaptic plasticity during brain development. It has been found reduced levels of BDNF in first-episode psychosis (FEP). There are contradictory results regarding its relation to psychopathology. Objectives Establishing the relationship between serum BDNF levels in a group of 28 inpatients with FEP and psychopathology measured with the Positive and Negative Syndrome Scale (PANSS). Methods BDNF serum levels at admission, discharge, three, six, nine and twelve months were related with psychopathology measured with the PANSS (positive, negative and general psychopathology subscales). Data are present as mean. Results At admission PANSS scores were high, decreasing progressively in the following determinations due to psychopathological improvement, although over the time remained higher scores on the negative than in the positive subscale. At admission: PANSS-positive 22.78; PANSS-negative 17.85; PANSS-general psychopathology 39.67; at discharge: PANSS-positive 8.51; PANSS-negative 11.07; PANSS-general psychopathology 20.11; at six months: PANSS-positive 8.04; PANSS-negative 10.91; PANSS-general psychopathology 19.56; at twelve months: PANSS-positive 7.80; PANSS-negative 10.95; PANSS-general psychopathology 19.75. There is a negative correlation between BDNF levels and PANSS negative scores at admission (r=-0.337), with a trend towards significance (P=0.079). This correlation disappears at discharge because of psychopathology improvement and is not maintained in the following determinations. Conclusions Lower serum BDNF levels may be associated with worse clinical symptoms, especially negative symptoms. Further studies with a larger sample are needed to replicate our results.

Serum BDNF in First-episode Psychosis and Controls

Introduction The brain-derived neurotrophic factor (BDNF) is a neurotrophin fundamentally involved in the differentiation and growth during brain development. BDNF has pathogenically been linked to the schizophrenia neurodevelopmental hypothesis. Several studies have found lower BDNF blood levels in chronic schizophrenia than controls. Few studies suggest that BDNF levels in first-episode psychosis (FEP) are lower than in healthy controls (HC). Objective Comparing serum BDNF levels in a group of antipsychotic-naive FEP with HC and determining the serum BDNF pattern during the first year illness evolution. Methods Serum BDNF levels at admission of 28 inpatients with FEP were compared with 28 age/gender matched HC. BDNF was also measured at discharge, three, six, nine and twelve months. After discharge, antipsychotics were gradually decreased. Results are presented as mean±sd. and BDNF levels in ng./ml. Results At admission, patients BDNF levels were significantly lower than controls (18.06±4.06 vs 26.55±3.22, p>0.001). At discharge FEP levels increase until HC levels without significant differences between gropus (25.95±3.93 vs 26.55±3.22, p=0.539). Upon the following determinations, BDNF FEP levels progressively decreased, reaching the admission values, and being significantly lower than the controls and that levels at discharge (patients: three months: 19.68±3.88; six months: 19.02±4.13; nine months: 17.64±5.24; twelve months: 17.51±3.45 vs controls: 26.55±3.22, all p>0.001). Conclusions Our results confirm the studies that found lower BDNF levels in chronic schizophrenia. Serum BDNF levels could be considered as a biological marker of treatment and evolution of FEP. Further studies with FEP patients with and without treatment are warranted.

Secondary Mania and Tapentadol

Introduction Tapentadol is a centrally-acting synthetic analgesic which acts as a mu-opioid receptor agonist as well as a norepinephrine re-uptake inhibitor. It is use to treat cronic pain. Most prevalence adverse effects are gastrointestinal and nervous symptoms. Furthermore, it has objectified, with less frequency, psychiatric disturbances. Objetives To analyse the relationship between a maniac episode and tapentadol. Methods Forty-nine-year-old female, with personal history of dyslipidemia and lumbar herniated discs in L4-L5, L5-S1, in treatment with tapentadol 200 mg/day for 20 days and no past psychiatric history. She was admitted to the Psychiatry Department due to a maniac episode, with desinhibition, pressure and loud speech, euphoria, megalomaniac delusion and sleep disturbance for the last 10 days. Young Mania Rating Scale (YMRS) was 36 points. Olanzapina 15 mg/day was introduced and tapentadol was removed. Symptoms remitted quickly and 6 days later, at discharge, YMRS was 4 points. One year later, the patient continued to be asymptomatic. Results Opioids can produce psychiatric disorders like hallucination, sleep disorders, depressed mood, disorientation, agitation, nervousness, restlessness, euphoric mood. Secondary mania to tapentadol mechanism is unknown, but having opiate cases described, it is possible to attribute this episode to tapentadol. Conclusions – Secondary mania is associated with various medical conditions, including vitamin B12 deficiency, brain injury, HIV infection and drugs such as alcohol, caffeine, sympathomimetics, steroids, bupropion, isoniazid, clarithromycin and opioids. – Further research is required to determine if the maniac episode was only isolated by the tapentadol or it is the beginning of a bipolar disorder.

EPA-0356 – Tuberous esclerosis complex and psychiatric comorbidity: two case reports

Introduction Tuberous Sclerosis Complex (TSC) is a genetic inherited disease characterized by hamartomatous growths in several organs as brain, skin, kidneys, hearth and eyes. The estimated incidence is approximately 1:6000 live births. The diagnosis is made clinically. Seizures are present in 87% of patients. Psychiatric comorbidity has been reported. Objectives We report the clinical course of two patients with previous diagnosis of TSC. Psychiatric symptoms start in the adulthood without seizures history and absence of Subependimal Giant Cells Tumor (SGCT). The evolution and clinical features are described. Methods Patient 1 Married 33-years-old woman with two children affected with TSC. She was diagnosed after headache presentation in 2011. Initial MRI showed periventricular glioneuronal hamartomas. In January 2013 start with self-injurious (swallowing of objects) and autistic behaviours as well as several hospital urgency room visits. In addition, the patient presented with dull mood, emotional indifference and intellectual impairment, with no response to medication. Patient 2 Married 43-years-old woman with a daughter affected with TSC. Diagnosis was made in 1999 and psychotic symptoms (delusional beliefs and auditory hallucinations) started in 2011 without previous psychiatric history. The MRI in 2013 shown subependymal nodules. Treatment with risperidone was effective. Results Psychiatric symptoms are very often associated to the physical findings on TSC, even in adulthood diagnoses. Conclusions Psychiatric comorbidities are well described in literature. About 10-20% adult patients with TSC present clinically significant behavioral problems as self-injuries, frequently associated with SGCT. The European Expert Panel recommended regular assessment of cognitive development and behaviour and symptomatic treatment.

EPA-0325 – Serum s100b protein levels in first-episode psychosis

Introduction S100B is a calcium-binding protein produced by the astrocytes that has been used as a biomarker of brain inflammation. S100B has been involved in the schizophrenia pathophysiology, being considered a marker of state and prognosis. Objectives Studying the relationship between serum S100B levels and psychopathology in first-episode psychosis (FEP). Methods At admission and discharge, serum S100B levels were measured in 20 never-medicated FEP in-patients and 20 healthy controls. Psychopathology was assessed with the PANSS (Positive and Negative Syndrome Scale). The total, positive, negative and general psychopathology scores were assessed. Results are presented as mean±sd. and S100B levels in pg./ml. Results At admission, patients had significantly higher serum S100B concentrations than healthy subjects (39.2±6.4 vs. 33.3±0.98, p Conclusions FEP in-patients have significantly increased serum levels of S100B proteins, suggesting an activation of glial cells that may be associated with a neurodegenerative/inflammatory process. Apart from the study of total scale scores, the analysis of individual item is also recommended. The long-term treatment effect (one year or more) may be relevant to see their relationship to S100B levels.

EPA-0289 – Psychopathology sex differences in asthmatics

Introduction Although asthma has been one of the most investigated topics in psychosomatics, studies and papers on psychopathology in asthma are fairly scarce and of diverse meaning. Furthermore, psychopathology acoording to sex in asthma is not a common research topic. Aim This study aims at analyzing psychopathology sex differences in asthmatics. Methods The psychopathology profile in a sample of 84 adult asthmatics in a hospital outpatient facility, mean age 34.62 (s.d.12.78), 36 male / 48 female, is studied. The Symptom Checklist-90-R (SCL-90-R) Self-Report Questionnaire was administered. Results The symptomatic profile is characterized by higher scores in women, with a main elevation in the dimensions of Somatization (1.92), Depression (1.66), Obsession-Compulsion (1.62) and Anxiety (1.44) whereas lower scores are recorded in men, with a profile dominated by Hostility (1.70), Anxiety (1.68), Interpersonal Sensitivity (1.58) and Depression (1.44). These scores mainly contribute to the psychopathology pattern according to sex. Conclusions The possible clinical implications of the observed psychopathology sex differences should be taken into account in the management of these patients.