9 results
The impact of obesity and metabolic syndrome on clinical and cognitive parameters in bipolar disorder: Results from the BIPFAT/BIPLONG study
- N. Dalkner, A. Birner, S. Bengesser, S. Guggemos, F. Fellendorf, A. Häussl, M. Lenger, A. Maget, A. Painold, M. Platzer, R. Queissner, F. Schmiedhofer, E. Schönthaler, S. Smolle, T. Stross, A. Tmava-Berisha, E. Z. Reininghaus
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S576-S577
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Introduction
Patients with bipolar disorder have a hig risk of becoming overweight and obese, associated with an increased risk of somatic diseases and premature mortality. The Austrian BIPFAT/BIPLONG study aims at investigating lipid metabolism, psychosocial functioning, and cognitive parameters in bipolar disorder (BD).
ObjectivesThe aim was to investigate to what extent overweight, obesity and metabolic syndrome (MetS) are associated with clinical symptoms (e.g. suicidality, depressive symptoms) and cognitive factors (attention, memory, executive function) in BD.
MethodsIn addition to anamnestic interview and psychological tests, all participants were tested with a neuropsychological test battery including the Trail Making Test A/B, the Stroop Color and Word Interference Test, the d2 Test of Attention Revised, Digit Span, Digit-Symbol-Test, and the California Verbal Learning Test. Additionally, body mass index (BMI) and variables defining MetS including waist circumference, serum triglycerides, high-density lipoprotein, blood pressure, and fasting glucose levels have been collected in DSM-5 diagnosed patients with BD and healthy controls.
ResultsIn our Austrian bipolar cohort (n=290), the median BMI was 27.9 (SD=5.9), 30.5 % of the patients were overweight (BMI = 25.5-29.9) and 24.6% of the patients were obese (BMI ≥ 30.0). In the control group (n=183), the median BMI was 24.5 (SD=4.8), 15.2% were overweight and 8.0% were obese. A sub-analysis in 215 patients showed that compared to overweight patients, normal weight patients showed more suicidal ideation in psychiatric history (χ2(2)=7.97, p=.019). In addition, there was a significant association between suicidal ideation and glucose (r=.15, p=.043) and cholesterol (r=−.17, p=.028). In another sub-analysis with 148 euthymic bipolar patients, we found a high prevalence of MetS in patients with BD (30.4% versus 15.4% in healthy controls) associated with impaired executive function compared to patients without MetS or healthy controls with and without MetS (p=.020). Clinical variables (illness duration, suicidality, number of affective episodes, medication, age of onset, and history of psychosis) did not relate to MetS in BD (p > .05). A longitudinal analysis in 52 patients (35 without MetS and 17 with MetS) did not find an association of MetS on the one-year trajectory of cognitive decline in BD. In contrast, high baseline BMI predicted a decrease in the patient’s performance in working memory in the 12-months observation period.
ConclusionsThe BIPFAT/BIPLONG study demonstrated a high prevalence of overweight, obesity and MetS in bipolar patients with adverse effects on cognitive function. Clinical variables such as suicidality were not related to the presence of obesity or MetS. Clinical impact and further (unpublished) results will be presented.
Disclosure of InterestNone Declared
The use of new technology in prevention and treatment of psychiatric diseases - preliminary results
- A. Häussl, F. Fellendorf, E. Fleischmann, S. Guggemos, E. Schönthaler, T. Stross, I. Zwigl, D. Albert, J. Mosbacher, K. Stix, S. Draxler, G. Lodron, T. Orgel, M. Pszeida, S. Russegger, M. Schneeberger, M. Uray, W. Weiss, M. Fellner, T. Fruhmann, R. Hartmann, P. Hauptmann, R. Pfiszter, G. Pötz, U. Prattner, N. Saran, S. Spat, E. Zweytik, T. Lutz, S. Lindner-Rabl, R. Roller-Wirnsberger, S. Schüssler, J. Zuschnegg, K. Ceron, M. Danilov, C. Grossegger, M. Macher, O. Sokolov, S. Egger-Lampl, B. Roszipal, L. Paletta, M. Lenger, N. Dalkner, E. Reininghaus
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S853-S854
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Introduction
The COVID-19 outbreak is a serious global public health issue with wide-ranging negative effects on people’s lives, which is reflected in steadily rising mental health problems. In order to appropriately respond to the increased occurrence of psychiatric illness, protect mental health and strengthen resilience it is necessary to include new technologies, such as extended reality (XR) or socially assistive robots (SAR) in not only psychiatric treatment but also in the prevention of psychiatric diseases. In this context, the use of new technologies offers innovative ways to strengthen resilience, self-efficacy and stress coping skills and plays an important role in improving psychological wellbeing.
ObjectivesPreliminary results from studies at the Clinical Department of Psychiatry and Psychotherapeutic Medicine in Graz, Austria, dealing with new technologies in psychiatry, show new options for psychiatric settings.
MethodsProject AMIGA: The aim of this study is to test the effectiveness of a cognitive training session, conducted with the SAR named Pepper. In this randomized controlled trial, the effectiveness of SAR on depressive symptoms and correlates is evaluated in a sample of 60 individuals with major depression. While the intervention group will receive cognitive training with the SAR Pepper, the control group will receive “treatment-as-usual” therapy with a common PC software. Participants will receive 30 minutes of training 2 times per week over a period of 3 weeks.
Project XRes4HEALTH: The aim of this study is to develop an XR resilience training to increase resilience and stress coping mechanisms in healthcare workers. A total of 40 people will be included. To test the effectiveness of the resilience training, 3 XR training sessions of 15 minutes each will be held. A pre-post measurement will test the effectiveness of the training on wellbeing and stress levels as well as the acceptance and satisfaction with the training.
Project AI-REFIT: The overall goal of this study is to explore key information to increase resilience in healthy individuals who are at increased risk for mental health problems. Through a usability study, the artificial intelligence-based prototype app of the resilience training will be tested for acceptance, usability, functionality, and efficiency. During the resilience training, participants are wearing a smartwatch which measures psychophysiological parameters. Conclusions about the success of the therapy can be drawn based on digital data acquisition.
ResultsNew technologies including XR and SAR support classical psychiatric treatment in the topics of resilience and cognitive training as an add-on therapy in times of reduced availability of healthcare workers.
ConclusionsThe rapid development of new technologies holds a lot of potential in the treatment of psychiatric disorders, which is why it is important to scientifically evaluate those innovative tools.
Disclosure of InterestNone Declared
Robot assisted treatment in psychiatry - fiction or reality?
- E. Z. Reininghaus, A. Häussl, I. Zwigl, S. Guggemos, F. T. Fellendorf, N. Dalkner
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S856
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Introduction
The evolution of technologies like artificial intelligence and robotics has already begun to shape the future of health care delivery and will have an undeniable impact on patient experiences over the next decades. In times of shortened human resources, especially in the field of health care settings, we should also consider robots as assistance for existing treatment settings. The use of robotic assisted surgery has already found its way into clinical practice and allows doctors to perform many types of complex procedures with more precision, flexibility and control. Nevertheless, to date, the use of robotics in the field of psychiatry is sparse, at least in European countries.
Socially assistive robots (SARs) are robotic technology platforms with audio, visual, and movement capabilities that are being developed to interact with individuals while also assisting them with their management of their well-being. Robots could support classic psychiatric treatment by training cognition and motivation as well as educating patients.
ObjectivesThe robot “Pepper” has found its home at the Medical University of Graz, Department of Psychiatry & Psychotherapeutic Medicine in Austria in summer 2022. It is friendly and positive, around 1,30m tall, can make conversations, learn people’s tastes, preferences, and habits to help personalize responses and better address needs. He can also offer games, make music and dance.
MethodsIn our ongoing studies we use the robot “Pepper” in the context of psychoeducational settings on different mental diseases, training of cognitive functions as well as motivational aspects in inpatients with psychiatric disorders. It can also react and suggest a break during the sessions if he has the impression that participants are stressed or overstrained with content. We collect personal feedback of the patients and associated employees in the hospital through the ongoing usability study, as well as perform a randomized controlled trial to test effects of cognitive and motivational training aspects in comparison to standardized treatment settings.
ResultsIt is time to apply new technologies in healthcare, especially in times when the staff is decreasing. Better integrating and expanding on the mental health implications of social robots will complement the ongoing drive in the field of psychology and psychiatry to better assist clients with supportive exercises and education, cognitive training, and an asynchronous care option.
ConclusionsAlthough the use of SARs in mental health research is not yet widespread, new robots and programming are constantly changing, adapting and expanding. There is an abundance of opportunity for growth, expansion, and exploration to triangulate SARs usability and efficacy as the next step in advancing this field. We should not be afraid of this new and expanding technology but come to use it as soon as possible as a support in psychiatric treatment. Let‘s make fiction become reality!
Disclosure of InterestNone Declared
Tryptophan metabolism in bipolar disorder
- F. Fellendorf, M. Platzer, A. Birner, R. Queissner, S. Bengesser, M. Lenger, A. Maget, A. Tmava-Berisha, N. Dalkner, D. Fuchs, J. Gostner, E. Reininghaus
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S110
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Introduction
Immune mediated inflammatory processes are involved in the aetiopathogenesis of bipolar disorder (BD) and weight associated comorbidities. Tryptophan breakdown via indoleamine 2,3-dioxygenase-1 (IDO-1) along the kynurenine axis concomitant with a pro-inflammatory state was found more active in BD but also associated with overweight/obesity.
ObjectivesAims of our study were to investigate 1.) the tryptophan metabolism in BD compared to mentally healthy controls, 2.) differences in weight classes, 3.) in a longitudinal setting, dependent on the incidence of BD episodes and euthymia.
MethodsAt the Medical University Graz anthropometric and clinical data as well as peripheral tryptophan and kynurenine were assessed in serum samples of 226 individuals with BD and 142 controls. For 75 individuals with BD a longitudinal assessment with three samples was performed. Serum concentrations of tryptophan and kynurenine were determined by reverse-phase high-performance liquid chromatography. The kynurenine/tryptophan was used as a proxy for IDO-1 activity.
Resultsshowed a higher kynurenine/tryptophan ratio in BD compared to controls and in overweight compared to normal weight persons. Levels remained stable over time. In the longitudinal course, no differences were found between individuals who were constantly euthymic or not as well who had an illness episode or none.
ConclusionsFindings indicate that IDO-1 activity might constitute more a trait and not a state marker of BD. Accelerated tryptophan breakdown along the kynurenine axis may be further facilitated by overweight. This may increase the risk of accumulation of neurotoxic metabolites which impacts BD symptomatology, cognition, and somatic comorbidities.
DisclosureNo significant relationships.
Clinical Implications of White Matter Lesions in Overweight Male Individuals with Bipolar Disorder
- A. Birner, S. Seiler, N. Lackner, S. Bengesser, R. Queissner, M. Platzer, F. Fellendorf, L. Pirpamer, S. Ropele, C. Enzinger, H.P. Kapfhammer, B. Reininghaus, E. Reininghaus
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- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Cerebral white matter lesions (WML) have been found in normal aging, vascular disease and several neuropsychiatric conditions. Correlations of volumetric measured WML with clinical parameters in men with Bipolar Disorder (BD) have been described in a currently submitted work of our study group. As we try to elucidate common pathways between obesity/metabolic syndrome and BD we reinvestgated our data in the context of obesity.
MethodsIn a cross-sectional study 100 euthymic individuals (52 male, 48 female) with BD were enrolled to undergo brain magnetic resonance imaging using 3T including a FLAIR sequence for volumetric assessment of WML-load using FSL-software. Additionally, clinical characteristics and psychometric measures including Structured Clinical Interview according to DSM-IV were evaluated. Partial correlation analysis (WML-load with lifetime number of manic/depressive episodes) were performed in 4 different groups (male normalweight, male overweight/obese, female normalweight, female overweight/obese)
ResultsIn overweight/obese men only (n=41), the number of manic/hypomanic episodes (r=0.85; p<0.001) as well as depressive episodes (r=0.55; p<0.001) correlated positively with WML-load.
ConclusionsWML-load strongly correlated with the number of manic episodes in overweight male BD patients, suggesting that overweight men might be more vulnerable to mania in the context of cerebral white matter changes.
EPA-0431 – Weight Cycling and Substance Abuse in Bipolar Disorder
- F. Fellendorf, N. Lackner, S. Bengesser, A. Birner, M. Platzer, K. Filic, R. Queissner, S. Wallner-Liebmann, H.P. Kapfhammer, E.Z. Reininghaus
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- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction:
Overweight and weight cycling represent common problems in individuals with bipolar disorder. Furthermore, substance dependency including alcoholism has been found to be a frequent co-morbid disorder, which affects the course and prognosis of bipolar disorder. Recently, substance use disorders have been related to weight cycling in a non-bipolar sample (Whyshak, 2006).
Objectives:The study aimed to investigate the association between weight cycling (loosing and regaining weight in the last four years for at least three times) and substance abuse (drug and alcohol abuse) in patients with bipolar disorder.
Methods:The study took place at the Department of Psychiatry of the Medical University of Graz, Austria and 90 euthymic patients with bipolar disorder were included. Questionnaire data about weight and weight cycling were collected. A’SCID-I’ was conducted to evaluate bipolar symptomatology and co-morbid disorders.
Results:Findings showed that bipolar patients with a history of weight cycling are prone to demonstrate a comorbid alcohol use disorder compared to non-weight cyclers (F1,87=5,531; p < .05). However, we could not find a significant relation between weight cycling and other drug or polydrug abuse in our bipolar sample (F1,87=1,548; p > .05).
Conclusions:Although, a relation between weight cycling and the co-morbidity of alcohol dependency has been detected, we do not know which phenomenon causes the other. Further studies on this topic including investigation of the relationship between alcohol abuse, weight cycling, and therapy outcome would be important. To conclude, the therapy of bipolar disorder should aim for a stable weight.
Is the Molecular Clock Ticking Differently in Bipolar Disorder?
- S. Bengesser, N. Lackner, A. Birner, B. Reininghaus, U. Heilbronner, R. Fuchs, N. Allard, S. Wallner-Liebmann, A. Rieger, R. Queissner, K. Filic, F. Fellendorf, E. Petek, C. Windpassinger, C. Schörkhuber, C. Gigler, K. Gatkowsky, T. Macheiner, N. Kainzbauer, E. Reininghaus
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- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Bipolar Disorder is a devastating disease with a genetic heritability. An orchestra of around 500 gene variants is leading to vulnerability.
One interesting candidate gene group are the socalled CLOCK GENES. The molecular 24h clock has several CLOCK GENES and the last gene ARNTL encodes for an activator of MAOA transcription and leads therefore to changes in neurotransmitter levels.
MethodsGenotyping of 150 paricipants with Bipolar Disorder and 78 healthy controls with the Illumina GWAS chip Omniexpress 1.1. Hypothesis driven extraction of ARNTL SNPs with the software PLINK. Statistical analysis with Chi square test with SPSS.
ResultsPatients with Bipolar Disorder differ significantly in ARNTL genotypes compared to healthy controls. Details are presented during the poster session.
DiscussionCircadian rhythms seem to play an important pathogenetic mechanism in Bipolar Disorder.
EPA-0444 – The Role of Staging in Bipolar Disorder - Associations with Overweight and Obesity
- N. Lackner, S. Bengesser, A. Birner, F. Fellendorf, R. Unterweger, S. Wallner-Liebmann, H.P. Kapfhammer, E. Reininghaus
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- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction:
Overweight and obesity are highly prevalent in bipolar disorder (BD), and have been observed to worsen treatment response and outcome. Moreover, a relationship between overweight/obesity and cognitive impairment has been reported previously. Clinical staging includes clinical features, data of biomarkers and cognition, and is related to global functioning in BD. Earlier stages of illness may be associated with a better prognosis and a higher treatment response.
Objectives:The present study aims to evaluate the relationship between clinical staging and overweight/obesity in euthymic BD individuals. Clinical staging was hypothesized to be associated with overweight/obesity, especially with indicators of abdominal obesity.
Methods:A cohort of 100 euthymic BD patients was recruited and anthropometric variables (including body mass index and waist/hip circumference) were measured. Body composition was evaluated with lipometry measurement, an exact calculation of the subcutaneous adipose tissue thickness. Clinical staging was done according to the staging model by Kapzinsky et al. For statistical analyses, partial correlations controlled for age were used.
Results:Findings show a positive correlation between staging and hip circumference r=.265, p<.05, and a tendeny towards significance between staging and total body fat: r=.183, p=.08).
Conclusions:As clinical outcome parameter, staging enables to unterstand the mechanisms underlying progression of BD and assists in treatment planning and prognosis. Based on the results we might suggest, that abdominal obesity is associated with a higher progression of BD accompanied with negative outcome characteristics. The data provide an updated quantification of the growing public health burden in BD.
Association Between HbA1c and Number of Episodes in Individuals with Bipolar Disorder
- F. Fellendorf
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- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S115
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Introduction
Bipolar disorder (BD) is associated with an impaired glucose metabolism (IGM) leading to diabetes mellitus Type II (DM). DM influences the medical state of BD individuals and leads to increased mortality. However, there is evidence that IGM is associated with psychiatric symptoms, as well.
AimThe study aimed to investigate the association between IGM and number of episodes and their ratio in individuals with BD, separated for gender.
MethodsHbA1c levels from fasting blood were measured of 162 individuals (46% females) with BD. Furthermore, clinical parameters e.g. number of depressive and (hypo)manic episodes were gathered.
ResultsAfter adjustment for illness duration and BMI there was a positive correlation in male individuals between HbA1c and number of depressive (M = 13.86, SD = 14.67; r = .308, P < 0.05) as well as (hypo)manic episodes (M = 17.23, SD = 24.24; r = 0.263, P < 0.05). There was no association in females as well as between HbA1c levels and ratio of episodes.
ConclusionAssociations between HbA1c and number of episodes in male individuals with BD were found. As there are correlations between IGM and somatic comorbidities as well as the course of illness the treatment of glucose metabolism is important in BD. However, number of episodes might have an impact on the glucose metabolism due to inflammation processes, but further investigations have to focus on the direction of the found correlation. As gender differences are known in different pathways, they should be considered in research, diagnosis and therapy.
Disclosure of interestThe author has not supplied his/her declaration of competing interest.
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