2 results
Comparison of prophylactic response to lithium and valproate in patients with Early Onset Bipolar Disorder
- M. Purkayastha MUKHERJEE, G. G, P. Kandasamy, S. S, D. pandian
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S706-S707
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Introduction
The clinical presentation and the course and outcome in Early-Onset Bipolar Disorder (EOBD) patients are found to be atypical compared to adult bipolar patients. Lithium and valproate are among the first-line maintenance treatments for bipolar disorder. Because of atypical features, in many patients, valproate is preferred over lithium. However, recent studies have shown that valproate results in more neurocognitive deficits than lithium. There have been very few Indian studies that assessed the prophylactic response to mood stabilizers in patients with early-onset bipolar disorder. BDNF has an important role in neurodevelopment, and it is shown that peripheral levels of BDNF are reduced in early-onset bipolar disorder.
ObjectivesTo compare the effectiveness of lithium and valproate in attenuating manic, depressive, and mixed episodes in early-onset bipolar disorder.
MethodsThis study was an observational (cross-sectional analytical) study conducted in the Affective Disorder clinic of a tertiary care hospital. We have recruited a total of 50 adult patients with a history of early-onset, i.e., onset at <18 years of age and in remission. Patients were divided into two groups based on the mood stabilizer drug they were receiving. There were 25 patients each in the lithium and valproate group. Montreal Cognitive Assessment (MoCA) scale was applied to assess cognitive functions.
ResultsThe overall functioning was found to be significantly better in the patients receiving lithium than valproate, which was found by higher scores on the Global Assessment of Functioning (GAF) scale.We have found a statistically significant negative correlation between the number of episodes before starting a mood stabilizer and the time to recurrence after starting a mood stabilizer. However, the former cannot predict the latter. The age, educational status of the patient, total duration of illness and number of episodes before starting mood stabilizer correlated significantly with the MoCA score. Of all, the educational status could also predict the patient’s performance on the MoCA scale.
ConclusionsThere were no significant differences between lithium and valproate in attenuating further episodes, the frequency of neurocognitive deficits and other adverse effects. Both drugs were equally effective and tolerable. The severity of illness was more in valproate-treated patients, and overall functioning was better in lithium-treated patients. BDNF levels did not correlate with neurocognitive deficits significantly. Future studies comprehensively assessing neurocognitive measures with a larger sample size in the early-onset bipolar disorder population would shed more light on the role of biomarkers in cognition in subjects with early-onset bipolar disorder.
Disclosure of InterestNone Declared
Developing and testing a Video assisted brief CBT intervention for children and adolescent with anxiety disorder
- M. Purkayastha MUKHERJEE, S. T. Spalzang, P. Kandasamy, M. T, D. Pandian
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S451
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Introduction
CBT for childhood anxiety is used as the gold treatment of choice for anxiety disorders in children. Video-assisted CBT can serve as a cost and time effective intervention method in a low-resource setting.
ObjectivesTo develop, validate video-assisted CBT for children and adolescents with Anxiety disorder with secondary objective to explore feasibility of brief video assisted CBT as an additional component to treatment as usual in improving symptom severity.
MethodsStudy was divided into 2 phases. In the 1st phase videos (1 common introductory video and 2 videos each for children and adolescents,in Tamil and English) based on a validated CBT workbook was made. A second phase involving exploration of feasibility of video-based interventions along with treatment-as-usual was carried out in OPD of tertiary care hospital. Of 13 children recruited with anxiety disorder,2 were lost to follow-up. In 2nd phase, intervention delivered on OPD computer and provided to family members to watch at home through phone. Assessment of symptoms were done using SCARED, CGAS, CGI-S, VAS (parent) at baseline & 8 weeks. Written narratives were taken from participant at baseline & 8 weeks. Parent semi structured proforma was used to assess perceived benefit by parent.
ResultsIn first phase validation was obtained from 3 experts. All experts agreed or strongly agreed for videos to be appropriate for use in children and adolescents with anxiety disorder. Most frequent diagnosis was social anxiety disorder.Family history of psychiatric illness was there in 61.54% of participants. Post intervention at 8 weeks when compared to baseline found statistically significant reduction in symptom severity on SCARED, CGAS and VAS (parent) scores. In parent semi structured proforma good improvement in understanding, perceived reduction of symptom severity reported.For qualitative data, manual content analysis done with clustering of themes and sub-themes.
In theme of Treatment impact on self, codes of decreased self-esteem and overthinking generated the maximum response. In theme of impact of illness in various contexts, codes of peer relationship and academic performance generated the maximum responses. At the end of 8 weeks participants reported Relaxation techniques as most used, followed by coping skills and challenging negative thoughts with help of tension diary respectively.
In aspects of videos liked by parents, brevity and simplicity generated most responses. In aspects requiring improvement most of parents reported no improvement needed in videos.
ConclusionsThis pilot study on video based CBT can serve as a time and cost-effective treatment strategy for anxiety disorders in children and adolescents especially in low resource settings. Similar studies involving development of similar videos can be made for various mental illnesses in various vernacular languages and tested in a larger population.
Disclosure of InterestNone Declared