- Email: [email protected]
P.1.142 Obsessive-compulsive symptoms in mania
PI.
S234
m PI
141
Physical depressive
activity as symptoms
a protection in early
Affective
disorders
against adolescence
G. Morkeu’ , A.M. Swd2. ‘Ostmarka Hospital, 2Faculty Medicine, NiY’Vu Neuroscience, Trondheim, Norway
of
In au epidemiological study of adolescents: Does physical activity protect against depressive symptoms? Methods: A representative sample of 2465 12-14 year-old adolesceuts were assessed in two subsequent years. The adolescents were recruited in the middle part of Norway aud consisted of 50.8% girls aud 49.2% boys, with a meau age of 13.7 years. The participation rate was 88.3%. Depressive symptoms were measured by the Mood aud Feelings Questiomlaire &lFQ). Levels of physical activity aud of sedentary activity were measured. Results: Girls scored higher ou depressive symptoms thau boys, uo iucrease in symptom level was seeu at follow-up. At first assessment (Tl) the results of multiple regressiou analyses yielded the followiug significant predictors of depressive symptoms (meau total MFQ scores) in order of importance: Stressful life eve&, sex, vigorous exercise, ethnic group aud for girls; BMI (Body Mass Index) >22.5 kg/m2 aud pubertal development. A twoway iuteractiou was found betweeu level of exercise aud munber of stressful eveuts aud a three-way iuteractiou betweeu level of exercise, sex aud BMI> 22.5 kgim2. Further, the result of logistic regression analysis yielded the followiug significant predictors of being a high scorer ou the MFQ (JvIFQ >25) at the oueyear follow-up: MFQ at Tl (OR= 8.57;CI: 5X2-12.64), ethnic background (OR= 3.66;CI: 1X&7.42), Sex (OR= 2.42;CI: 1.703.44), high levels of sedentary activities (boys only: OR= 1.53;CI: 1.1552.03), low levels of vigorous exercise (OR= 1.23;CI: l.Oll 1.49) aud sum of stressful eveuts at Tl (OR=l.09: OR= 1.055 1.14). Conclusions: Young adolescents’ reports of low levels of vigorous exercise aud high levels of sedentary activities (boys only) constitute risk factors for developiug depressive symptoms in a one-year perspective.
and antidepressants Methods: Longitudinal observatiou of 7 cases with obsessivecompulsive-bipolar comorbidity. Results: The followiug characteristics (uucommou in typical OCD but frequent in BD) seemed common to these patients: psychotic symptoms, clear-cut ouset of symptoms, high prevalence of mood disorders in relatives, hostility, agitation, suicidal risk, ueed of hospitalization, aud improving OCD with mood stabilizers aud atypical autipsychotics. Response to SRI was observed during the first episode of ilhless in ouly 2 cases, with subsequent worseuiug of the course of illness. In all patients, the course of illness, (hypo)mauic episodes, cycling, or worseuiug of symptoms induced by autidepressauts, aud clear response to mood stabilizers or 2ud geueratiou autipsychotics shed light to the correct diagnosis. Conclusions: At least as far as therapy is concerned, these cases represent clinical entity separate from typical OCD. From a therapeutic point of view, the clinical course of the presented cases suggests hierarchical priority of a bipolar diagnosis eveu wheu bipolar symptoms are subthreshold. Whatever the iuteusity of OCD symptoms, curreut or past presence of symptoms cousisteut with BD, or a familiar load for BD, should suggest caution in prescribing SRI treatment. Probably, a safer first liue choice is treatment with mood stabilizers (including ECT) or 2ud geueratiou autipsychotics. Mood stabilization should be achieved as first objective. In uureuspousive patieuts, addition of low doses of SRI could be considered, looking for a reasouable compromise betweeu poteutial auti-OCD effectiveness aud detrimental effect 011 BD. References [l]
VI
m PI
mP 1 142
Obsessive-compulsive
M. Raja, A. Azzoui. Ospedale Salute Mentale, Rome, Italy
symptoms Santo
Spirito,
Cassano GB. Pini S. Saettoni M. Dell’ Osso L. Multiule anxietv disorder comorbidity’iu patients with mood spectrum disorders with psychotic disorders. Am J Psychiatry 1999;156:474-476. McElroy SL, Altshuler LL, Suppes T, Keck Pe Jr, Frye MA, Denicoff KD, Nolen WA, Kupka RW, Leverich GS, Rochussen JR, Rush AJ, Post RM. Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. Am J Psychiatry 2001;158:42&426.
143
Simplified potentional
citalopram depression
challenge marker
test
as a
in mania Dipartimento
di
Introduction: DSM-IV-TR does uot meutiou Bipolar Disorder (BD) among the disorders typically associated with Obsessive Compulsive Disorder (OCD). Reported rates of OCD in BD varied from 7 to 39% @IcElroy eta1,2001; Cassauo etal, 1999). While comorbidity of OCD with uuipolar depression, or anxiety disorders has little impact ou the psychopharmacological strategy since serotouiu reuptake iuhibitors (SRI) are first liue treatment for both conditions, comorbidity of OCD with BD is a therapeutic challenge for the risk of promoting a switch iuto mama, iuduciug rapid cycling, or precipitating suicidal behavior. Little is knowu about whether in these cases there are clinical characteristics differiug from typical OCD that might be helpful in raising the possibility of au alteruative diagnosis of BD. Objective: To assess the clinical characteristics aud the optimal treatment of OCD symptoms in patients with familial background, symptoms cousisteut with a bipolar spectrum diagnosis, we present lougitudiual observatiou of 7 cases with obsessivecompulsive-bipolar comorbidity.
J. Svarc. Prague Czech Republic
Psychiatric
Centel;
Psychiatric
Clinic,
Prague,
The citalopram challenge test is a uew ueuroeudocriuological test, which shows serotouergic activity via prolactiue (cortisol) plasma levels. The test has mauy advautages in comparsiou to the currently used challenge tests: pareuteral application (which preveuts distortion of results due to differeut iuteriudividual euteral absorptiou of the drug), selectivity, safety. Purpose of the study: to check the hypothesis about flatteuiug of the hormonal peak in the group of depressive patients compared to healthy volunteers; aud to propose a simple design for practical use. Methods: withiu 2 days, betweeu 7.30 a.m. aud 9.30 a.m., 6 blood samples (for prolactiue aud cortisol) were taken The 1st day the baseline level was estimated, the 2ud day the chauges after the stimulation were observed. Challeuge=rapid (15 minutes) iutravenous application of 20mg of citalopram. Standard conditions: hospitalization, uo food uor smoking prior to the test, women betweeu the 3rd aud 10th day of the meustruatiou cycle; depressed patients, didu’ t go through wash-out period after autidepressauts aud hadu’ t ECT.
S234
m PI
141
Physical depressive
activity as symptoms
a protection in early
Affective
disorders
against adolescence
G. Morkeu’ , A.M. Swd2. ‘Ostmarka Hospital, 2Faculty Medicine, NiY’Vu Neuroscience, Trondheim, Norway
of
In au epidemiological study of adolescents: Does physical activity protect against depressive symptoms? Methods: A representative sample of 2465 12-14 year-old adolesceuts were assessed in two subsequent years. The adolescents were recruited in the middle part of Norway aud consisted of 50.8% girls aud 49.2% boys, with a meau age of 13.7 years. The participation rate was 88.3%. Depressive symptoms were measured by the Mood aud Feelings Questiomlaire &lFQ). Levels of physical activity aud of sedentary activity were measured. Results: Girls scored higher ou depressive symptoms thau boys, uo iucrease in symptom level was seeu at follow-up. At first assessment (Tl) the results of multiple regressiou analyses yielded the followiug significant predictors of depressive symptoms (meau total MFQ scores) in order of importance: Stressful life eve&, sex, vigorous exercise, ethnic group aud for girls; BMI (Body Mass Index) >22.5 kg/m2 aud pubertal development. A twoway iuteractiou was found betweeu level of exercise aud munber of stressful eveuts aud a three-way iuteractiou betweeu level of exercise, sex aud BMI> 22.5 kgim2. Further, the result of logistic regression analysis yielded the followiug significant predictors of being a high scorer ou the MFQ (JvIFQ >25) at the oueyear follow-up: MFQ at Tl (OR= 8.57;CI: 5X2-12.64), ethnic background (OR= 3.66;CI: 1X&7.42), Sex (OR= 2.42;CI: 1.703.44), high levels of sedentary activities (boys only: OR= 1.53;CI: 1.1552.03), low levels of vigorous exercise (OR= 1.23;CI: l.Oll 1.49) aud sum of stressful eveuts at Tl (OR=l.09: OR= 1.055 1.14). Conclusions: Young adolescents’ reports of low levels of vigorous exercise aud high levels of sedentary activities (boys only) constitute risk factors for developiug depressive symptoms in a one-year perspective.
and antidepressants Methods: Longitudinal observatiou of 7 cases with obsessivecompulsive-bipolar comorbidity. Results: The followiug characteristics (uucommou in typical OCD but frequent in BD) seemed common to these patients: psychotic symptoms, clear-cut ouset of symptoms, high prevalence of mood disorders in relatives, hostility, agitation, suicidal risk, ueed of hospitalization, aud improving OCD with mood stabilizers aud atypical autipsychotics. Response to SRI was observed during the first episode of ilhless in ouly 2 cases, with subsequent worseuiug of the course of illness. In all patients, the course of illness, (hypo)mauic episodes, cycling, or worseuiug of symptoms induced by autidepressauts, aud clear response to mood stabilizers or 2ud geueratiou autipsychotics shed light to the correct diagnosis. Conclusions: At least as far as therapy is concerned, these cases represent clinical entity separate from typical OCD. From a therapeutic point of view, the clinical course of the presented cases suggests hierarchical priority of a bipolar diagnosis eveu wheu bipolar symptoms are subthreshold. Whatever the iuteusity of OCD symptoms, curreut or past presence of symptoms cousisteut with BD, or a familiar load for BD, should suggest caution in prescribing SRI treatment. Probably, a safer first liue choice is treatment with mood stabilizers (including ECT) or 2ud geueratiou autipsychotics. Mood stabilization should be achieved as first objective. In uureuspousive patieuts, addition of low doses of SRI could be considered, looking for a reasouable compromise betweeu poteutial auti-OCD effectiveness aud detrimental effect 011 BD. References [l]
VI
m PI
mP 1 142
Obsessive-compulsive
M. Raja, A. Azzoui. Ospedale Salute Mentale, Rome, Italy
symptoms Santo
Spirito,
Cassano GB. Pini S. Saettoni M. Dell’ Osso L. Multiule anxietv disorder comorbidity’iu patients with mood spectrum disorders with psychotic disorders. Am J Psychiatry 1999;156:474-476. McElroy SL, Altshuler LL, Suppes T, Keck Pe Jr, Frye MA, Denicoff KD, Nolen WA, Kupka RW, Leverich GS, Rochussen JR, Rush AJ, Post RM. Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. Am J Psychiatry 2001;158:42&426.
143
Simplified potentional
citalopram depression
challenge marker
test
as a
in mania Dipartimento
di
Introduction: DSM-IV-TR does uot meutiou Bipolar Disorder (BD) among the disorders typically associated with Obsessive Compulsive Disorder (OCD). Reported rates of OCD in BD varied from 7 to 39% @IcElroy eta1,2001; Cassauo etal, 1999). While comorbidity of OCD with uuipolar depression, or anxiety disorders has little impact ou the psychopharmacological strategy since serotouiu reuptake iuhibitors (SRI) are first liue treatment for both conditions, comorbidity of OCD with BD is a therapeutic challenge for the risk of promoting a switch iuto mama, iuduciug rapid cycling, or precipitating suicidal behavior. Little is knowu about whether in these cases there are clinical characteristics differiug from typical OCD that might be helpful in raising the possibility of au alteruative diagnosis of BD. Objective: To assess the clinical characteristics aud the optimal treatment of OCD symptoms in patients with familial background, symptoms cousisteut with a bipolar spectrum diagnosis, we present lougitudiual observatiou of 7 cases with obsessivecompulsive-bipolar comorbidity.
J. Svarc. Prague Czech Republic
Psychiatric
Centel;
Psychiatric
Clinic,
Prague,
The citalopram challenge test is a uew ueuroeudocriuological test, which shows serotouergic activity via prolactiue (cortisol) plasma levels. The test has mauy advautages in comparsiou to the currently used challenge tests: pareuteral application (which preveuts distortion of results due to differeut iuteriudividual euteral absorptiou of the drug), selectivity, safety. Purpose of the study: to check the hypothesis about flatteuiug of the hormonal peak in the group of depressive patients compared to healthy volunteers; aud to propose a simple design for practical use. Methods: withiu 2 days, betweeu 7.30 a.m. aud 9.30 a.m., 6 blood samples (for prolactiue aud cortisol) were taken The 1st day the baseline level was estimated, the 2ud day the chauges after the stimulation were observed. Challeuge=rapid (15 minutes) iutravenous application of 20mg of citalopram. Standard conditions: hospitalization, uo food uor smoking prior to the test, women betweeu the 3rd aud 10th day of the meustruatiou cycle; depressed patients, didu’ t go through wash-out period after autidepressauts aud hadu’ t ECT.