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Cognitive reserve in Older Adults with Bipolar Disorder and its relationship with cognitive performance and psychosocial functioning
- L. Montejo, C. Torrent, S. Martín, A. Ruiz, M. Bort, G. Fico, V. Oliva, M. De Prisco, J. Sanchez-Moreno, E. Jimenez, A. Martinez-Aran, E. Vieta, B. Sole
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S324-S325
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Introduction
Cognitive reserve (CR) refers to the ability of the brain to cope with damage or pathology. In bipolar disorder (BD), it has been seen that the effects of the disease may potentially reduce CR, thus compromising cognitive outcomes. This concept takes on special relevance in late life in BD, due to the increased risk of cognitive decline because of the accumulative effects of the disease and the potential effects of aging. Therefore, we believe that CR may be a protective factor against cognitive decline in older adults with bipolar disorder (OABD).
ObjectivesThe aim of this study was to study the CR in OABD compared with healthy controls (HC) and to analyze its association with psychosocial functioning and cognitive performance.
MethodsA sample of euthymic OABD, defined as patients over 50 years old, and HC were included. CR was assessed using the CRASH scale. Differences in demographic, clinical, and cognitive variables between patients and HC were analyzed by t-test or X2 as appropriated. Lineal simple and multiple regressions analyses were used to study the association of CR and several clinical variables with functional and cognitive performance.
ResultsA total of 83 participants (42 OABD and 41 HC) were included. Compared to HC, OABD exhibited poorer cognitive performance (p<0.001), psychosocial functioning (p<0.001) and lower CR (p<0.001). Within the patient’s group, the linear simple regression analysis revealed that CR was associated with psychosocial functioning (β=-2.16; p=0.037), attention (β= 3.03; p=0.005) and working memory (β = 2.98; p=0.005) while no clinical factors were associated. Age and CR were associated with processing speed and verbal memory, but after applying multiple regression model, only the effect of age remained significant (β =-2.26; p= 0.030, and β =-2.23; p= 0.032 respectively). CR, age, and number of episodes were related to visual memory, but the multiple regression showed that only age (β = -2.37; p= 0.023) and CR (β = 3.99; p<0.001) were associated. Regarding executive functions only the number of manic episodes were significant. CR and age at onset were associated with visuospatial ability, but multiple regression only showed association of CR (β =2.23; p=0.032). Other clinical factors such as number of depressive or hypomanic episodes, illness duration, admissions, type of BD, and psychotic symptoms were not associated.
ConclusionsTo the best of our knowledge, this is the first report that studies the CR in a sample of OABD. We demonstrated that OABD had lower CR than HC. Importantly, we observed that CR was associated with cognitive and psychosocial functioning in OABD, even more than disease-related factors. These results suggest the potential protector effect of CR against cognitive impairment, supporting that improving modifiable factors associated with the enhancement of CR can prevent cognitive decline.
Disclosure of InterestL. Montejo: None Declared, C. Torrent Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00344) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER), S. Martín: None Declared, A. Ruiz: None Declared, M. Bort: None Declared, G. Fico Grant / Research support from: Fellowship from “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), V. Oliva: None Declared, M. De Prisco: None Declared, J. Sanchez-Moreno Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER),, E. Jimenez Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060)integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER),, A. Martinez-Aran: None Declared, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/ 00805, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIIISubdireccio ́n General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357; the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151)., B. Sole: None Declared
Sex differences in neurocognitive performance in older adults with bipolar disorder
- S. Martín-Parra, C. Torrent, A. Ruiz, M. Bort, G. Fico, V. Oliva, M. D. Prisco, J. Sanchez-Moreno, E. Jimenez, A. Martinez-Aran, E. Vieta, B. Sole, L. Montejo
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S440
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Introduction
In recent years, research has focused on the older adults with bipolar disorder (OABD), aged 50 years and over, a constantly growing population due to the increased of life expectancy. Actually, some authors suggest that these individuals constitute a distinct subtype with a specific and different needs such as seen in epidemiologic, clinical and cognitive features. Further research has revealed significant differences between females and males with BD in clinical and cognitive variables in middle-aged and young patients, but this topic among OABD population remains unclear.
ObjectivesThe aim of this study is to identify the distinctive profile in clinical, functional and neurocognitive variables between females and males in OABD.
MethodsA sample of OABD and Healthy Controls (HC) were included. Euthymic patients or in partial remission were included. Neurocognition was measured with a battery of tests that included premorbid intelligence quotient, working memory, verbal and visual memory, processing speed, language and executive functions. Independent t-test and Chi-squared test analysis were performed as appropriated.
ResultsAccording to the analysis, statistically significant differences were seen between females and males. A more impaired cognitive profile is observed in women. They performed worse in the subscales of Arithmetic (F= 6.728, p = <0.001), forward digits (F= 0.936, p= 0.019) and Total Digits (F= 1.208, p= 0.019) of the WAIS-III, in the Stroop Color Word Test, color reading (F= 0.130, p= < 0.001), in the Continuous Performance Test, block change measure (F= 2.059, p= 0.037), in the Rey-Osterrieth Complex Figure-copy (F= 0.005, p= 0.029) and in the Boston Naming Test (F= 0.011, p= 0.024). Nor significant differences were found in clinical neither in psychosocial functioning variables.
ConclusionsIn view of the following results, and since no differences were observed between women and men in terms of clinical and functional outcomes, it could be said that the differences observed in cognition cannot be explained by disease-related factors. Furthermore, these results highlight the need to develop a gender-specific cognitive interventions in OABD population. In this way, we could have an impact on the course of the illness to reach a better quality of life.
Disclosure of InterestS. Martín-Parra: None Declared, C. Torrent Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00344) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIIISubdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), A. Ruiz: None Declared, M. Bort: None Declared, G. Fico Grant / Research support from: Fellowship from “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), V. Oliva: None Declared, M. Prisco: None Declared, J. Sanchez-Moreno Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), E. Jimenez Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), A. Martinez-Aran: None Declared, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/ 00805, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357; the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151), B. Sole: None Declared, L. Montejo: None Declared
Relation of Infrared, Crystallochemical, and Morphological Properties of Al-Substituted Hematites
- V. Barron, J. L. Rendon, J. Torrent, C. J. Serna
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- Clays and Clay Minerals / Volume 32 / Issue 6 / December 1984
- Published online by Cambridge University Press:
- 02 April 2024, pp. 475-479
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Synthetic Al-hematites prepared from ferrihydrites, at low (∼ 100°C) and high (400° and 800°C) temperatures were studied for their morphological, crystallochemical, and infrared (IR) characteristics. Low-temperature Al-hematites had a platy morphology (the plate thickness was inversely related to amount of Al substitution), and the high temperature Al-hematites showed a poorly defined morphology due to interparticle sintering. In the low-temperature Al-hematites shifts in the IR mode frequencies were noted and could be partly explained by a shape factor that was deduced from particle morphology. The intrinsic effect of Al substitution, however, was to produce shifts of as much as 10–15 cm−1 for the highest Al substitution (∼ 16%). Similar shifts were observed for the high-temperature hematites in which morphology was not appreciably affected by Al substitution.
Use and Limitations of Second-Derivative Diffuse Reflectance Spectroscopy in the Visible to Near-Infrared Range to Identify and Quantify Fe Oxide Minerals in Soils
- A. C. Scheinost, A. Chavernas, V. Barrón, J. Torrent
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- Clays and Clay Minerals / Volume 46 / Issue 5 / October 1998
- Published online by Cambridge University Press:
- 28 February 2024, pp. 528-536
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We measured the visible to near-infrared (IR) spectra of 176 synthetic and natural samples of Fe oxides, oxyhydroxides and an oxyhydroxysulfate (here collectively called “Fe oxides”), and of 56 soil samples ranging widely in goethite/hematite and goethite/lepidocrocite ratios. The positions of the second-derivative minima, corresponding to crystal-field bands, varied substantially within each group of the Fe oxide minerals. Because of overlapping band positions, goethite, maghemite and schwertmannite could not be discriminated. Using the positions of the 4T1←6A1, 4T2←6A1, (4E;4A1)←6A1 and the electron pair transition (4T1+4T1)←(6A1+6A1), at least 80% of the pure akaganeite, feroxyhite, ferrihydrite, hematite and lepidocrocite samples could be correctly classified by discriminant functions. In soils containing mixtures of Fe oxides, however, only hematite and magnetite could be unequivocally discriminated from other Fe oxides. The characteristic features of hematite are the lower wavelengths of the 4T1 transition (848–906 nm) and the higher wavelengths of the electron pair transition (521–565 nm) as compared to the other Fe oxides (909–1022 nm and 479–499 nm, resp.). Magnetite could be identified by a unique band at 1500 nm due to Fe(II) to Fe(III) intervalence charge transfer. As the bands of goethite and hematite are well separated, the goethite/hematite ratio of soils not containing other Fe oxides could be reasonably predicted from the amplitude of the second-derivative bands. The detection limit of these 2 minerals in soils was below 5 g kg−1, which is about 1 order of magnitude lower than the detection limit for routine X-ray diffraction (XRD) analysis. This low detection limit, and the little time and effort involved in the measurements, make second-derivative diffuse reflectance spectroscopy a practical means of routinely determining goethite and hematite contents in soils. The identification of other accessory Fe oxide minerals in soils is, however, very restricted.
Magnetic enhancement during the crystallization of ferrihydrite at 25 and 50°C
- E. Cabello, M. P. Morales, C. J. Serna, V. Barrón, J. Torrent
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- Clays and Clay Minerals / Volume 57 / Issue 1 / February 2009
- Published online by Cambridge University Press:
- 01 January 2024, pp. 46-53
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Soil formation usually results in an increase in magnetic susceptibility. The magnetic properties of the products of transformation of ferrihydrite, a typical precursor of other soil Fe oxides, were examined in the present work. Synthetic 2-line ferrihydrite was aged at two temperatures (25 and 50°C) and two different relative humidities (80 and 100%) in the presence of silicate, phosphate, citrate, and tartrate as adsorbed ligands (molar anion/Fe ratio = 1–3%). The ligands delayed or prevented the transformation of ferrihydrite to hematite. The magnetic susceptibility of the ferrihydrite transformation products increased with aging, the rate of increase depending on the type of ligand added and its concentration. The largest increase in magnetic susceptibility, sixfold, was obtained with ferrihydrite in a citrate/Fe ratio of 1%, after 1500 days. The resulting magnetic products exihibited superparamagnetic behavior at room temperature and high coercivity at 5 K. The formation of an intermediate ferrimagnetic phase in the ferrihydrite-to-hematite transformation might explain the magnetic enhancement observed in many aerobic soils lacking other sources of magnetic minerals.
PSYCHIATRIC COMORBIDITY IN A SAMPLE OF PATIENTS WITH COGNITIVE-BEHAVIORAL MINORITY DISEASE
- R. De la Mata, C. Manso-Bazús, S. Pujol, L. Torrent, L. Urraca, D. Vázquez-Tarrio, M. Esteve, E. Fernández, M. Pàmias
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S743
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Introduction
About the term cognitive-behavioral minority disease or rare disease are a group of diseases that affect between 6-8% of the populatio. It is estimated that there are more than 7000 in the world, the majority with a genetic basis and affect various organs and systems, they also present psychiactric comorbidities and cause a physical or mental disability. Given its definition, it is difficult to see a large number of these patients in our usual clinical activity, so their management can be complicated.
ObjectivesTo evaluate the prevalence of psychiatric comorbidity and the prevalence of psyhcopharmacological treatment in children and adolescents whe present a minority disease.
MethodsThis is a descriptive, controlled, retrospective cross-sectional study of a sample obtained by non-probabilistic sampling, which is representative of the study population.
The statistical analysis was made using the statistical program SPSS V22 (2013).
ResultsWith a sample of 114 patients, of which 26,6% presented fragile X syndrome, secondly 25,3% presented Prader-Willi Syndrome and 48,1% other chromosomal abnormalities.
By subgroups (male:female): in Prader-Willi syndrome 6:14 (30%:70%), in Fragile X syndrome 12:9 (57,14%: 42,86%) and in other diseases 25:13 (75,69%: 34,21%).
ConclusionsThe creation of clinical expert units makes the possibility to increase knowledge of diseases whose prevalence in the population, thanks to technological advances, is increasing and where scientific knowledge is still limited.
These units are also important, in order to be able to offer personalized intensive treatments in order to reduce polypharmacy. There is not a great difference between the minority diagnosis and polypharmacy, although there is less polypharmacy than expected, which may be the result of the success of the most intensive and personal psychotherapeutic intervention in the unit.
Disclosure of InterestNone Declared
High genetic diagnostic yield in children and adolescents with psychiatric disorders
- C. Manso-Bazús, N. Spataro, L. Torrent, L. Plans, M. Casadesús, M. Tomás, N. Baena, J. P. Trujillo, N. Capdevila, A. Brunet, V. Martínez-Glez, M. Pàmias, A. Ruiz Nel·lo
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S104
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Introduction
Psychiatric disorders are more prevalent in children with mild (MID) to borderline intellectual functioning (BIF). Rare pathogenic variants in neurodevelopmental genes increase the risk for psychiatric disorders and may explain the comorbidity. Despite these patients represent up to 35% of those attended at mental health services, genetic diagnosis is usually not offered. The identification of mentioned variants could lead to improved clinical care.
ObjectivesTo identify pathogenic variants responsible of the psychiatric disorders in mild and borderline intellectual functioning.
To correlate phenotypic and genetic profiles to personalize diagnostic, clinical care and support to clinicians and families.
MethodsWhole exome sequencing (WES) was performed on 99 enrolled children/adolescent (6-18 yo) affected by a psychiatric condition diagnosed following DSM-5 criteria, and either MID (IQ 55-69) or BIF (IQ 70-85). Severity and interference of IQ and psychiatric comorbidity was evaluated using several psychometric tests (Conners, CDI, STAIC, CAARMS, CBCL and hONOSCA). Inheritance pattern was assessed through Sanger sequencing. ACMG/AMP guidelines were used for variant classification.
ResultsIn our cohort, 64% patients presented BIF and 36% MID. 45% of the patients had 2 or more psychiatric diagnoses, the most prevalent (87%) being attention deficit hyperactivity disorder and, in second place, autism spectrum disorder (51%).
WES identified pathogenic/likely pathogenic variants in 30% of analyzed patients (30/99), 80% of the variants were de novo. There is no significant difference in patient severity between those with a genetic diagnosis and those without.
ConclusionsRare deleterious and de novo variants in neurodevelopmental genes are responsible for the comorbidity that exists between psychiatric disorders and mild/borderline intellectual disability.
The high diagnostic yield obtained from our exome sequencing approach demonstrates the need to offer genetic testing in children with psychiatric disorders and comorbid mild to borderline intellectual functioning.
Finally, patients being identified with a genetic diagnosis are subsequently attended in a specialised unit for rare disorders to receive personalised clinical management.
Disclosure of InterestNone Declared
Long-term outcome predictors after functional remediation in patients with bipolar disorder – CORRIGENDUM
- B. Solé, C. M. Bonnín, J. Radua, L. Montejo, B. Hogg, E. Jimenez, M. Reinares, E. Valls, C. Varo, I. Pacchiarotti, M. Valentí, M. Garriga, I. Torres, A. Martínez-Arán, E. Vieta, C. Torrent
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- Psychological Medicine / Volume 53 / Issue 12 / September 2023
- Published online by Cambridge University Press:
- 06 June 2023, p. 5886
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Efficacy of an integrative approach for bipolar disorder: preliminary results from a randomized controlled trial
- Èlia Valls, C. Mar Bonnín, Imma Torres, Mercè Brat, Mireia Prime-Tous, Ivette Morilla, Xavier Segú, Brisa Solé, Carla Torrent, Eduard Vieta, Anabel Martínez-Arán, María Reinares, José Sánchez-Moreno
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- Psychological Medicine / Volume 52 / Issue 16 / December 2022
- Published online by Cambridge University Press:
- 16 April 2021, pp. 4094-4105
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Background
Bipolar disorder (BD) represents one of the most therapeutically complex psychiatric disorders. The development of a feasible comprehensive psychological approach to complement pharmacotherapy to improve its clinical management is required. The main objective of the present randomized controlled trial (RCT) was to test the efficacy of a novel adjunctive treatment entitled integrative approach in patients with BD, including: psychoeducation, mindfulness training, and functional remediation.
MethodsThis is a parallel two-armed, rater-blind RCT of an integrative approach plus treatment as usual (TAU), v. TAU alone. Participants were recruited at the Hospital Clinic of Barcelona and randomized to one of the two conditions. They were assessed at baseline and after finishing the intervention. The main outcome variable included changes in psychosocial functioning assessed through the Functioning Assessment Short Test (FAST).
ResultsAfter finishing the treatment, the repeated-measures analyses revealed a significant group × time interaction in favor of the patients who received the integrative approach (n = 28) compared to the TAU group (n = 37) (Pillai's trace = 0.10; F(1,57) = 6.9; p = 0.01), improving the functional outcome. Significant effects were also found in two out of the six domains of the FAST, including the cognitive domain (Pillai's trace = 0.25; F(1,57) = 19.1; p < 0.001) and leisure time (Pillai's trace = 0.11; F(1,57) = 7.15; p = 0.01). Regarding the secondary outcomes, a significant group × time interaction in Hamilton Depression Rating Scale changes was detected (Pillai's trace = 0.08; F(1,62) = 5.6; p = 0.02).
ConclusionThis preliminary study suggests that the integrative approach represents a promising cost-effective therapy to improve psychosocial functioning and residual depressive symptoms in patients suffering from BD.
Identifying social cognition subgroups in euthymic patients with bipolar disorder: a cluster analytical approach
- C. Varo, B. Solé, E. Jiménez, C. M. Bonnín, C. Torrent, E. Valls, G. Lahera, A. Martínez-Arán, A. F. Carvalho, K. W. Miskowiak, E. Vieta, M. Reinares
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- Psychological Medicine / Volume 52 / Issue 1 / January 2022
- Published online by Cambridge University Press:
- 17 June 2020, pp. 159-168
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Background
Bipolar disorder (BD) is associated with social cognition (SC) impairments even during remission periods although a large heterogeneity has been described. Our aim was to explore the existence of different profiles on SC in euthymic patients with BD, and further explore the potential impact of distinct variables on SC.
MethodsHierarchical cluster analysis was conducted using three SC domains [Theory of Mind (ToM), Emotional Intelligence (EI) and Attributional Bias (AB)]. The sample comprised of 131 individuals, 71 patients with BD and 60 healthy control subjects who were compared in terms of SC performance, demographic, clinical, and neurocognitive variables. A logistic regression model was used to estimate the effect of SC-associated risk factors.
ResultsA two-cluster solution was identified with an adjusted-performance group (N = 48, 67.6%) and a low-performance group (N = 23, 32.4%) with mild deficits in ToM and AB domains and with moderate difficulties in EI. Patients with low SC performance were mostly males, showed lower estimated IQ, higher subthreshold depressive symptoms, longer illness duration, and poorer visual memory and attention. Low estimated IQ (OR 0.920, 95% CI 0.863–0.981), male gender (OR 5.661, 95% CI 1.473–21.762), and longer illness duration (OR 1.085, 95% CI 1.006–1.171) contributed the most to the patients clustering. The model explained up to 35% of the variance in SC performance.
ConclusionsOur results confirmed the existence of two discrete profiles of SC among BD. Nearly two-thirds of patients exhibited adjusted social cognitive abilities. Longer illness duration, male gender, and lower estimated IQ were associated with low SC performance.
Long-term outcome predictors after functional remediation in patients with bipolar disorder
- B. Solé, C. M. Bonnín, J. Radua, L. Montejo, B. Hogg, E. Jimenez, M. Reinares, E. Valls, C. Varo, I. Pacchiarotti, M. Valentí, M. Garriga, I. Torres, A. Martínez-Arán, E. Vieta, C. Torrent
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- Psychological Medicine / Volume 52 / Issue 2 / January 2022
- Published online by Cambridge University Press:
- 16 June 2020, pp. 314-322
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Background
Improving functioning in patients with bipolar disorder (BD) is one of the main objectives in clinical practice. Of the few psychosocial interventions that have been specifically developed to enhance the psychosocial outcome in BD, functional remediation (FR) is one which has demonstrated efficacy. The aim of this study was to examine which variables could predict improved functional outcome following the FR intervention in a sample of euthymic or subsyndromal patients with BD.
MethodsA total of 92 euthymic outpatients were included in this longitudinal study, with 62 completers. Partial correlations controlling for the functional outcome at baseline were calculated between demographic, clinical and neurocognitive variables, and functional outcome at endpoint was assessed by means of the Functioning Assessment Short Test scale. Next, a multiple regression analysis was run in order to identify potential predictors of functional outcome at 2-year follow-up, using the variables found to be statistically significant in the correlation analysis and other variables related to functioning as identified in the previous scientific literature.
ResultsThe regression model revealed that only two independent variables significantly contributed to the model (F(6,53): 4.003; p = 0.002), namely verbal memory and inhibitory control. The model accounted for 31.2% of the variance. No other demographic or clinical variable contributed to the model.
ConclusionsResults suggest that patients with better cognitive performance at baseline, especially in terms of verbal memory and executive functions, may present better functional outcomes at long term follow-up after receiving functional remediation.
P01-262 - Abnormal temperament in patients with morbid obesity seeking surgical treatment
- B. Amann, R. Mergl, G. Perugi, N. El-Gjamal, F. Padberg, C. Torrent, G. Laakmann
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- European Psychiatry / Volume 25 / Issue S1 / 2010
- Published online by Cambridge University Press:
- 17 April 2020, 25-E470
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Objectives
Obesity and its related disorders are growing epidemic across the world. As some forms of abnormal temperament are considered as subtype of the soft bipolar spectrum, we aimed to evaluate abnormal temperaments in morbid obese patients.
MethodsUsing a short version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego, we investigated abnormal depressive, cyclothymic, hyperthymic, irritable or anxious temperament in 213 patients with morbid obesity compared to a control group of 90 patients admitted prior to transplantation. Additionally, the Beck-Depression Inventory (BDI) and the Self-Report Manic Inventory (SRMI) were applied to assess the current mood states.
ResultsThe obese group showed statistically significant more psychiatric comorbidities compared to the control group. Abnormal temperaments were significantly more often observed in patients with morbid obesity rather than in controls. Cyclothymic, irritable and anxious temperaments showed specificity to obesity. Obese patients had significantly higher scores in BDI, while no difference for SRMI scores was registered among the whole groups. All temperaments were positively correlated with BDI and SRMI in the obese group.
ConclusionsOur results need replication but indicate an affective overlap in form of abnormal temperament and depressive symptoms in obese patients, whereas mood swings should be evaluated and early mood stabilization considered for patients with significant weight gain to prevent obesity or to reduce already existing overweight. Studies of mood stabilizers and prospective observations would shed further insight on this complex interface of a major clinical and public health issue.
Clinical Factors as Predictors on Functional Impairment in Bipolar Disorder
- A. Rosa, M. Reinares, C. Franco, M. Comes, C. Torrent, J. Sanchez-Moreno, A. Martinez-Aran, F. Kapczinski, E. Vieta
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- European Psychiatry / Volume 24 / Issue S1 / January 2009
- Published online by Cambridge University Press:
- 16 April 2020, 24-E603
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Introduction:
Recent studies have suggested that functional impairment in bipolar disorder may be strongly associated with residual depressive symptoms. However, there is a notable disparity between functional recovery and symptomatic recovery. This study was carried out to investigate clinical factors as potential predictors on functional impairment in a well defined euthymic bipolar sample.
Methods:Seventy-one patients were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. A Structured Clinical Interview for DSM-IV-TR, HAM-D and YMRS were used to diagnostic assessment and euthymia criteria. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment. The FAST is a reliable and valid, interview-administered scale, rapid and easy to apply (3-6 min). It consists of 24 items which allow to assess six specific areas of functioning such as autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time.
Results:The sample comprised 36 (51%) men, aged 48±13.56 years. Several clinical variables were associated with poor functioning on a linear regression model, such as age, depressive symptoms, number of previous mixed episodes and number of previous hospitalizations. This model explained 44% of the variance (F=12.54, df=58, p< 0.001).
Discussion:In this study, specific clinical and socio-demographic characteristics were identified as predictors of functional impairment in remitted bipolar patients. Poor functioning was identified in patients with older age and more severe illness course.
P0355 - Associated factors with psychiatric symptoms in a Spanish community-residing elderly
- F.J. Olivera Pueyo, S. Benabarre Ciria, T. Lorente Aznar, M. Rodriguez Torrente, C. Pelegrín Valero, A. Castillón Fantova, S. Lausín Marín
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- European Psychiatry / Volume 23 / Issue S2 / April 2008
- Published online by Cambridge University Press:
- 16 April 2020, pp. S296-S297
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Background:
There are various physical, functional, psychological and social factors associated with the appearance of mental symptoms in the elderly. Our objective was to determine the relationship and influence of these different variables in the psychiatric symptomatology of the elderly who reside in the community.
Methods:Cross-sectional study of a sample of 324 patients over 65 years, representative of the elderly who reside in the community in the province of Huesca (Spain). Symptoms of depression (Yesavage GDS), cognitive impairment (MMSE), anxiety (GADS), psychotic symptoms, obsessive symptoms and hypochondriacal ideas (GMS) were measured. Social-demographic, physical and somatic, functional and social data were evaluated. Analysis was carried out in 3 phases: univariate, bivariate and multivariate with logistic regression.
Results:At the time of the study, 46.1% of the elderly studied suffered from some psychiatric symptom. 16.4% had cognitive impairment, 15.7% anxiety, 14.3% depression, 6.1% hallucinations and delusions, 7.2% hypochondriacal ideas and 4.4% obsessive symptoms. Female gender was significantly associated with depression (PR: 3.3) and anxiety (PR: 3.9). Age was a factor associated with cognitive impairment (PR: 4.4). Depression was significantly related to severity of the physical illness (PR: 61.7 in extremely severe impairment). Solitude (PR: 16.3) and being single (PR: 13.4) were factors which were strongly associated with anxiety; living in residences was associated with psychotic symptoms (PR: 7.6).
Conclusions:Severity of physical illness, solitude, living in residences and female gender, among others, are related with psychiatric symptoms in community-residing elderly persons.
1954 – Intervention Group In Patients With Chronic Low Back Pain: a Multidisciplinary Approach
- P. Lusilla, C. Castellano-Tejedor, E. Barnola-Serra, C. Ramos Rodon, T. Biedermann-Villagra, M.L. Torrent-Bertran, G. Costa-Requena, L. Camprubí-Roca, A. Palacios-González, A. Cuxart-Fina, A. Ginés-Puertas, A. Bosch-Graupera
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- Journal:
- European Psychiatry / Volume 28 / Issue S1 / 2013
- Published online by Cambridge University Press:
- 15 April 2020, 28-E1182
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Introduction
Non-specific chronic low back pain is one of common causes of disability and a recurrent medical complaint with high costs. From rehabilitative medicine, physiotherapy programs and general postural recommendations are offered. Although this treatment is aimed to reduce disability, severity of pain and anxiety-depressive symptoms, many patients report partial improvements and recurrence of pain. Therefore, a new approach to treat this pathology with a broaden focus on psychososocial issues that might modulate pain and its evolution is required.
Aims and hypothesisTo assess the effectiveness of two complementary interventions to physiotherapy, such as relaxation techniques (specifically, sophrology) and cognitive behavioral intervention. It is hypothesized that intervention groups will significantly improve their adherence to physiotherapy and will gain control over their pain. Ultimately, this will foster better quality of life.
MethodsLongitudinal design with pre-post intervention measures and follow-up appointments (at 6 and 12 months) carried out in a sample of 66 participants. The sample will be divided into three groups: control (physiotherapy), intervention group 1 (physiotherapy & sophrology) and intervention group 2 (physiotherapy & cognitive behavioral intervention). In all groups biomedical aspects regarding type, evolution and characterization of pain as well as several psychosocial factors will be assessed.
ResultsPreliminary results are expected by December 2013.
ImplicationsIf hypotheses are confirmed, we will be able to provide empirical evidences to justify a multidisciplinary care model for chronic low back pain, which will favor a significant cost reduction in terms of health care and human suffering.
Influence of birth cohort on age of onset cluster analysis in bipolar I disorder
- M. Bauer, T. Glenn, M. Alda, O.A. Andreassen, E. Angelopoulos, R. Ardau, C. Baethge, R. Bauer, F. Bellivier, R.H. Belmaker, M. Berk, T.D. Bjella, L. Bossini, Y. Bersudsky, E.Y.W. Cheung, J. Conell, M. Del Zompo, S. Dodd, B. Etain, A. Fagiolini, M.A. Frye, K.N. Fountoulakis, J. Garneau-Fournier, A. Gonzalez-Pinto, H. Harima, S. Hassel, C. Henry, A. Iacovides, E.T. Isometsä, F. Kapczinski, S. Kliwicki, B. König, R. Krogh, M. Kunz, B. Lafer, E.R. Larsen, U. Lewitzka, C. Lopez-Jaramillo, G. MacQueen, M. Manchia, W. Marsh, M. Martinez-Cengotitabengoa, I. Melle, S. Monteith, G. Morken, R. Munoz, F.G. Nery, C. O’Donovan, Y. Osher, A. Pfennig, D. Quiroz, R. Ramesar, N. Rasgon, A. Reif, P. Ritter, J.K. Rybakowski, K. Sagduyu, A.M. Scippa, E. Severus, C. Simhandl, D.J. Stein, S. Strejilevich, A. Hatim Sulaiman, K. Suominen, H. Tagata, Y. Tatebayashi, C. Torrent, E. Vieta, B. Viswanath, M.J. Wanchoo, M. Zetin, P.C. Whybrow
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- Journal:
- European Psychiatry / Volume 30 / Issue 1 / January 2015
- Published online by Cambridge University Press:
- 15 April 2020, pp. 99-105
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Purpose:
Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.
Methods:The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.
Results:There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.
Conclusion:These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.
Euthymia is not always euthymia: Clinical status of bipolar patients after 6 months of clinical remission
- L. Samalin, I. De chazeron, M. Reinares, C. Torrent, C.D.M. Bonnin, D. Hidalgo, A. Murru, I. Pacchiarotti, F. Bellivier, P.M. Llorca, E. Vieta
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- Journal:
- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S125
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Introduction
Most studies selected euthymic patients with bipolar disorder in inter-episodic phase according to clinical remission criteria at least between 1 and 6 months. However, possible differences can exist in the course of clinical symptoms in bipolar patients related to the duration of clinical remission.
ObjectivesThe main aim of this study was to evaluate the clinical status of bipolar patients after 6 months of clinical remission.
MethodsWe performed a cross-sectional study of bipolar outpatients in clinical remission for at least 6 months. Bipolar Depression Rating Scale (BDRS), Young Mania Rating scale, Pittsburgh Sleep Quality Index (PSQI) scale, Visual Analogic Scales (VAS) evaluated cognitive impairment were used to assess residual symptomatology of patients. Multivariate analysis (MANCOVA) was conducted for analysing possible differences between 3 groups of patients according to their duration of clinical remission (< 6 months–1 year, < 1 year–3 years, < 3 years–5 years).
ResultsA total of 525 patients were included into the study. The multivariate analysis indicated a significant effect of the duration of clinical remission on the different residual symptoms (Pillai's trace: F 4.48, P < 0.001). The duration of clinical remission was associated with the significant improvement of the BDRS total score (P = 0.013), the PSQI total score (P < 0.001) and the cognitive VAS total score (P < 0.001)
ConclusionThese results support a possible improvement of residual symptoms according to the duration of clinical remission in bipolar patients. Any definition of euthymia should specify the duration criteria.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
High Cognitive Reserve in Bipolar Disorders as a Moderator of Neurocognitive Impairment
- I. Grande, J. Sanchez-Moreno, B. Solé, E. Jimenez, C. Torrent, C.D.M. Bonnin, C. Varo, R. Tabarés-Seisdedos, V. Balanza-Martínez, E. Valls, I. Morilla, A.F. Carvalho, J.L. Ayuso-Mateos, E. Vieta, A. Martinez-Aran
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S116
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Background
Cognitive reserve (CR) reflects the capacity of the brain to endure neuropathology, minimize clinical manifestations and successfully complete cognitive tasks. The present study aims to determine whether high CR may constitute a moderator of cognitive functioning in bipolar disorder (BD).
MethodsOne hundred and two patients with BD and 32 healthy controls were enrolled. All patients met DSM-IV criteria for I or II BD and were euthymic (YMRS ≤ 6 and HDRS ≤ 8) during a 6-month period. All participants were tested with a comprehensive neuropsychological battery, and a Cerebral Reserve Score (CRS) was estimated. Subjects with a CRS below the group median were classified as having low CR, whereas participants with a CRS above the median value were considered to have high CR.
ResultsParticipants with BD with high CR displayed a better performance in measures of attention (digits forward: F = 4.554, P = 0.039); phonemic and semantic verbal fluency (FAS: F = 9.328, P = 0.004; and Animal Naming: F = 8.532, P = 0.006); and verbal memory (short cued recall of California Verbal Learning Test: F = 4.236, P = 0.046), after multivariable adjustment for potential confounders, including number of admissions and prior psychotic symptoms.
ConclusionsHigh cognitive reserve may therefore be a valuable construct to explore for predicting neurocognitive performance in patients with BD regarding premorbid status.
Disclosure of interestDr. I. Grande has received a Juan Rodés Contract (JR15/00012), Instituto de Salud Carlos III, Spanish Ministry of Economy and Competiveness, Barcelona, Spain and has served as a consultant for Ferrer and as a speaker for AstraZeneca, Ferrer and Janssen-Cilag.
Disclosure of interestDr. I. Grande has received a Juan Rodés Contract (JR15/00012), Instituto de Salud Carlos III, Spanish Ministry of Economy and Competiveness, Barcelona, Spain and has served as a consultant for Ferrer and as a speaker for AstraZeneca, Ferrer and Janssen-Cilag.
European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe
- Part of
- A. Jobst, E.-L. Brakemeier, A. Buchheim, F. Caspar, P. Cuijpers, K.P. Ebmeier, P. Falkai, Gaag R. Jan van der, W. Gaebel, S. Herpertz, T. Kurimay, L. Sabaß, K. Schnell, E. Schramm, C. Torrent, D. Wasserman, J. Wiersma, F. Padberg
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- European Psychiatry / Volume 33 / Issue 1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, pp. 18-36
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Purpose
Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given.
MethodsWe performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders.
ResultsWe developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences.
DiscussionThe DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD.
ConclusionPatients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
Depression, physical illness and mortality in a Spanish community-dwelling elderly people
- J. Olivera-Pueyo, S. Benabarre-Ciria, T. Lorente-Aznar, M. Rodríguez-Torrente, C. Pelegrín-Valero, A. Acín-Sampietro, J. Aguaviva-Bascuñana, C. Alastrué-Pinilla, J. Alcubierre-Cura
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- Journal:
- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S189
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Objectives
The aim of this study is to investigate the association between depression, physical factors and mortality in elderly people living in the community.
MethodsProspective longitudinal multicenter study for 5 years. Cohort of 293 people aged 65 years and older living in the province of Huesca (Spain). Individual face-to-face interviews and with appropriate caregiver. The following information was collected:
– demographic data;
– psychosocial factors: sex, age, education, marital status, live-in family members, social relationships, life events;
– physical factors: severity of physical illness, comorbidity (Cumlative Illness Rating Scale);
– psychiatric factors: cognitive function (Spanish version of Mini-Mental State Examination), depression (Geriatric Depression Scale), diagnostic criteria according DSM-IV-TR.
Statistical analyses:
– a bivariate analysis;
– a multivariate analysis. Cox regression model (explanatory variables).
ResultsTwo hundred ninety-three participants, simple representative of people aged 65 years old or more in province of Huesca (Spain). Monitored 5 years follow-up study. Sixty-four people died (21.8%), annual mortality rate: 5.3%. Depression: 66 people (22.5%), (32.2% women, 13.3% men). Cognitive impairment: 51 people (17.4%). Bivariate: factors associated (P < 0.005) with mortality: functional impairment, living in nursing home, sensorial impairment, polypharmacy, severe physical illness and psychiatric comorbidity: depression (34.8 vs 18.1%), cognitive impairment (49.1 vs 15.8%). Association between some factors and mortality was nullified after multivariate statistical model; the case for depression (Hazard Ratio: 1.1), cognitive impairment (HR: 1.2) or functional impairment (HR: 1.3).
ConclusionsDepression and cognitive impairment are associated with mortality in elderly community living people in bivariate analysis, therefore, this association disappears after multivariate analysis. Severity physical illness seems to nullify the effect of other variables, such as depressive symptomatology.
Disclosure of interestThe authors have not supplied their declaration of competing interest.