- Email: [email protected]
P.2.e.005 Mood stabilisers and atypical antipsychotics in the long-term treatment of bipolar disorder
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P.2.e. Affective disorders and antidepressants − Bipolar disorders (clinical)
P.2.e.004 Neuropsychological and psychosocial impairment in euthymic bipolar patients E. Mora1 ° , I. Forcada1 , M. Mur1 , M.J. Portella2 , N. Vidal3 , 1 Santa Maria Hospital, Psychiatry, J. Pifarre3 , E. Vieta4 . 2 Lerida, Spain; Santa Creu i Sant Pau Hospital, Psychiatry, Barcelona, Spain; 3 Santa Maria Hospital, Psychiatry, Lleida, Spain; 4 Neurosciences Hospital Clinic IDIBAPS, Psychiatry, Barcelona, Spain Unlike the classic authors, current studies find that 30−60% of patients with bipolar disorder have poor psychosocial functioning even during periods of clinical remission[1,2]. Purpose of the study: The main purpose of this study is to investigate the clinical, neuropsychological and pharmacological factors involved in the poor prognosis of psychosocial functioning in bipolar disorder patients. Methods: Twenty-eight stable outpatients, fulfilling criteria of bipolar disorder (DSM-IV) were recruited from a Lithium Clinic Program at Santa Maria Hospital (Lleida, Spain). • Inclusion criteria required that outpatients, aged between 18 and 75 years, were euthymic for at least three months (Hamilton Depression Rating Scale (HAM-D) score < 8 and Young Mania Rating Scale (YMRS) score < 6). • Exclusion criteria were significant physical or neurological illness; substance abuse or dependence in the last 12 months; and electroconvulsive therapy in the preceding year Demographic, clinical, psychometric and pharmacological variables were analyzed. Cognitive assessment was performed by means of neuropsychological test battery taping into the main cognitive domains (cognitive function, attention, processing speed, verbal memory and visual memory). We quantify psychosocial functionality using the cognitive area and the overall score of the functioning assessment short test (FAST). Data analyses were carried out with statistical package SPSS 15.0 for Windows. Correlation and linear regression analyses were required to identify those variables that would be a good predictor of functional outcome. Analyses of variance (MANOVA and ANOVA) were used to examine the impact of medication in psychosocial and cognitive functioning; defining pharmacological treatment as a factor (Lithium monotherapy and other treatment combinations). Results: Pearson and Spearman correlations were used in order to establish which subclinical (HDRS, MADRS and GAF) and neuropsychological variables (TMT-B, visual memory immediate recall and Stroop inhibition) correlated with the cognitive area of FAST. These variables were included in a linear regression model. The variance explained from the model is R2 =0.66, ANOVA F = 6.18, p = 0.001. The same statistic analysis was used to predict the total score of FAST with subclinical (HDRS, MADRS and GAF) and neuropsychological variables (TMT-A, TMT-B, visual memory immediate recall, Stroop inhibition and number of categories of WCST) and these variables were included in a linear regression model. The variance explained from the model is R2 =0.72, ANOVA F = 5.47, p = 0.002. Analyses of variance were used to determine the effect of psychopharmacological treatment in psychosocial functioning. Multivariate analyses did not reach significant differences between the two groups (lithium monotherapy/other treatment combinations) in any of the neuropsychological variables. But, a significant group effect was observed in the cognitive area
of FAST [F = 4.65, p = 0.04] and in the total score [F = 4.34, p = 0.04]. Conclusions: • Cognitive impairment remains in bipolar euthymic patients and it has shown an association to a poor functional recovery • Executive dysfunction may be a good predictor of functional outcome in bipolar euthymic patients • Current psychopharmacological treatments can achieve clinical stabilization but have limitations regarding functional recovery • More studies are required to study the poor functional outcome in bipolar disorder in order to decrease the gap between functional and clinical recovery References [1] Goodwin FK, Jamison KR: Manic-depressive illness: Bipolar disorders and recurrent depression. Second edition New York. Oxford University Press: 2007. [2] MacQueen GM, Young LT, Robb JC, Cooke RG, Joffe RT: Levels of functioning and well-being in recovered psychotic versus nonpsychotic mania. J Affect Disord. 1997 Oct; 46(1): 69−72.
P.2.e.005 Mood stabilisers and atypical antipsychotics in the long-term treatment of bipolar disorder A.C. Altamura1 , M. Buoli1 ° , R.A. Paoli1 , D. Primavera2 . 1 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Psychiatry, Milan, Italy; 2 University of Cagliari, Psychiatry, Cagliari, Italy Purpose of the study: The treatment of Bipolar Disorder (BD) includes not only the remission of the acute major episode, but also the prevention of recurrences [1,2]. The treatment of the acute episode should be followed by a stabilization and a maintenance phase [1]. Previous studies showed as combination therapies with a Mood Stabilizer and an Atypical Antipsychotic are particularly effective in the maintenance treatment of BD [1,3]. Purpose of this trial is to evaluate the effectiveness of Mood Stabilizers and Atypical Antipsychotics in long-term treatment of BD. Methods: 67 bipolar patients, selected from those treated and followed up at Community Services afferent to our Department, were followed retrospectively for a period of 48 months and divided into 6 groups according to the prescribed pharmacological treatment: Lithium monotherapy (N = 21), Valproate monotherapy (N = 14), Atypical Antipsychotic monotherapy (N = 15), Lithium plus Atypical Antipsychotic (N = 7), Valproate plus Atypical Antipsychotic (N = 4), other treatments (N = 6). Patients with complete clinical chart for the 48 months follow-up period were included in the study, after giving their informed written consent for participating in the study and for having reviewed the clinical information included in their charts. Diagnoses were assessed by the administration of a semi-structured interview based on DSMIV criteria (SCID-I). A survival analysis (Kaplan-Meier) of the follow-up period (48 months) was performed considering as death events: a change of treatment due to side effects, a major affective episode or a hospitalization. Results: The six groups were not different regarding age (F = 1.43, p = 0.23), duration of illness (F= 0.33, p = 0.89), duration of untreated illness (DUI) (F = 0.92, p = 0.48) and family history (c2 =5.54, df=5, p = 0.38). No differences were found between monotherapies. Lithium association with an Atypical Antipsychotic resulted more effective in terms of recurrence prevention compared to Lithium monotherapy (Log Rank: c2 =7.01, p = 0.008; Breslow: c2 =8.59, p = 0.003), Valproate monotherapy
P.2.e. Affective disorders and antidepressants − Bipolar disorders (clinical) (Log Rank: c2 =18.00, p < 0.001; Breslow: c2 =13.93, p < 0.001) or Atypical Antipsychotic monotherapy (Log Rank: c2 =8.61, p = 0.003; Breslow: c2 =8.35, p = 0.004). Valproate association with an Atypical Antipsychotic was superior in terms of relapse prevention to Valproate monotherapy (Log Rank: c2 =8.55, p = 0.003; Breslow: c2 =7.22, p = 0.007), but not to Lithium (Log Rank: c2 =0.35, p = 0.55; Breslow: c2 =2.36, p = 0.12) and Atypical Antipsychotic (Log Rank: c2 =1.25, p = 0.26; Breslow: c2 =2.42, p = 0.12) monotherapies. All treatments were well tolerated by patients and in particular just 4 patients showed extrapyramidal symptoms (EPS) and 2 metabolic alterations. However, the treatment groups were not different in terms of side effects presentation (c2 =7.28, df=10, p = 0.38). Conclusions: These preliminary data seem to confirm results of a previous study from our group [1]. The combination therapy with a Mood Stabilizer and an Atypical Antipsychotic would be more effective in preventing major affective recurrences in bipolar patients. In particular, Lithium association with an Atypical Antipsychotic would be result particularly effective in long termtreatment of BD. References [1] Altamura, A.C., Mundo, E., Dell’Osso, B., Tacchini, G., Buoli M., Calabrese, J.R., 2008. Quetiapine and classical mood stabilizers in the long-term treatment of Bipolar Disorder: a 4-year follow-up naturalistic study. J Affect Disord 110, 135–141. [2] Fountoulakis, K.N., Vieta E., 2008. Treatment of bipolar disorder: a systematic review of available data and clinical perspectives. Int J Neuropsychopharmacol 11, 999–1029. [3] Vieta, E., Suppes, T., Eggens I., Persson, I., Paulsson, B., Brecher, M., 2008. Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar I disorder (international trial 126). J Affect Disord 109, 251−63.
P.2.e.006 Can we distinguish bipolar from unipolar depression: preliminary results Hranov1 ° ,
Simov2 ,
Hranov3 .
1 University
V. G. Hospital L.G. “St. Naum”, 2nd Psychiatric Clinic, Sofia, Bulgaria; 2 University General Hospital “Aleksandrovska”, Psychiatric Clinic, Sofia, Bulgaria; 3 University Hospital “St. Naum”, 1st Psychiatric Clinic, Sofia, Bulgaria Introduction: Bipolar disorder presents initially with a depressive episode in 35% to 60% of patients making accurate early diagnosis really difficult. There are currently no accepted diagnostic criteria for bipolar depression for either research or clinical purposes. Switch rates among initially depressed patients are as high as nearly 40% in long-term follow-ups [1]. The delay in proper diagnosis can have a grave impact on treatment outcome and on long-term prognosis. Yet, there is an evolving notion that there are clinically relevant differences in patient characteristics, clinical course, diagnostic features, and response to antidepressants between the two mood disorders [2]. The purpose of this study was to search for clinical/historic identifiers of the bipolar nature of a presenting major depressive episode. Methods: 60 consecutive inpatients with at least 3 previous affective episodes: 14 males and 16 females with bipolar (BPD), and as many with unipolar depression (UPD) diagnosed by the MINI were studied. Demographic indices, onset and course of illness parameters, family history, psychosocial development, relevant life events and stressors, etc. were systematically explored. Results: Mean age was 40.8 years for BPD versus 44.8 years for UPD. 46.7% UPD and 16.7% BPD patients were university
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graduates (p < 0.01). 63.3% of the UPD group and 50% of the BPD group were married (n.s.), and 16.7% of the BPD patients versus 6.7% of the UPD patients were divorced (n.s.). 40.0% of BPD and 46.6% of UPD patients were unemployed or on social security pension (n.s.). Relatives with BAD I, BAD II, cyclothymic disorder, hyperthymic disorder; eccentrics; artistically gifted persons were found in the families of 86.7% BPD versus those of 16.7% UPD patients (p < 0.001). Mean age at onset was 23.8 years in bipolars versus 29.0 years in unipolars. 5 bipolars and 4 unipolars (n.s.) had committed suicidal attempts prior to study. 83.3% of BPD versus 16.7% of UPD patients experienced evening brightening and invigoration (p < 0.001). Inter-episode symptoms (emotional instability; high anxiety; suicidal thoughts; disturbed appetite, sleep, sexuality and/or disturbed psychomotor performance) were registered during the preceding 2 year-period in 56.6% of BPD versus 30.0% of UPD patients (p < 0.05). Conclusions: Compared to patients with UPD, patients with BPD had much higher familial loading with bipolar spectrum disorders. Early onset of the first affective episode, incomplete remissions, and mood lability during depression provide some potential diagnostic information for distinguishing bipolar from unipolar depression. Suicidality, vocational difficulties, reliance on social support were highly prevalent in both groups, yet not as significantly differing as to be used for distinguishing between the two groups. Bipolar disorder was more deleterious to educational achievement than recurrent unipolar depression. True distinguishing clinical features should be sought in energy level and in behavioural indices [also 2,3]. There were much more marked diurnal variations of activity and energy in BPD. References [1] Akiskal, H.S., Maser, J.D., Zeller, P.J., et al., 1995. Switching from “unipolar” to “bipolar II”: an 11-year prospective study of clinical and temperamental predictors in 559 patients. Arch Gen Psychiatry 52, 114–123. [2] Bowden, C.L., 2005. A different depression: clinical distinctions between bipolar and unipolar depression. J Affect Disord 84, 117–125. [3] Mansell, W., Colom, F., Scott, F., 2005. The nature and treatment of depression in bipolar disorder: a review and implications for future psychological investigation. Clin Psychol Rev 25, 1076–1100.
P.2.e.007 Outcome of bipolar illness and comorbid personality disorder O. Garcia L´opez1 ° , P. Fernandez-Arg¨uelles1 , N. Casas1 , M. Camacho1 , J.M. Garcia1 . 1 Hospital Universitario ‘V. Macarena’, Psiquiatria, Sevilla, Spain Introduction: The purpose of this study was to investigate whether the presence of comorbid personality disorder influences the course of bipolar illness. Subjects with co-occurring bipolar disorder and axis II personality disorders differ from bipolar patients without personality disorders in the clinical correlates [1]. Methods: We examined 40 Bipolar disorder patients (DSMIV criteria) recluted in University Hospital of Seville. Bipolar patients with a diagnosis of comorbid personality disorder (n = 30) were compared with ‘pure’ bipolar patients (n = 10) with regard to demographic, clinical, course of illness variables, age at onset of the first episode, number and type of affective episodes, duration of bipolar disorder, and number of hospitalizations. There were
P.2.e. Affective disorders and antidepressants − Bipolar disorders (clinical)
P.2.e.004 Neuropsychological and psychosocial impairment in euthymic bipolar patients E. Mora1 ° , I. Forcada1 , M. Mur1 , M.J. Portella2 , N. Vidal3 , 1 Santa Maria Hospital, Psychiatry, J. Pifarre3 , E. Vieta4 . 2 Lerida, Spain; Santa Creu i Sant Pau Hospital, Psychiatry, Barcelona, Spain; 3 Santa Maria Hospital, Psychiatry, Lleida, Spain; 4 Neurosciences Hospital Clinic IDIBAPS, Psychiatry, Barcelona, Spain Unlike the classic authors, current studies find that 30−60% of patients with bipolar disorder have poor psychosocial functioning even during periods of clinical remission[1,2]. Purpose of the study: The main purpose of this study is to investigate the clinical, neuropsychological and pharmacological factors involved in the poor prognosis of psychosocial functioning in bipolar disorder patients. Methods: Twenty-eight stable outpatients, fulfilling criteria of bipolar disorder (DSM-IV) were recruited from a Lithium Clinic Program at Santa Maria Hospital (Lleida, Spain). • Inclusion criteria required that outpatients, aged between 18 and 75 years, were euthymic for at least three months (Hamilton Depression Rating Scale (HAM-D) score < 8 and Young Mania Rating Scale (YMRS) score < 6). • Exclusion criteria were significant physical or neurological illness; substance abuse or dependence in the last 12 months; and electroconvulsive therapy in the preceding year Demographic, clinical, psychometric and pharmacological variables were analyzed. Cognitive assessment was performed by means of neuropsychological test battery taping into the main cognitive domains (cognitive function, attention, processing speed, verbal memory and visual memory). We quantify psychosocial functionality using the cognitive area and the overall score of the functioning assessment short test (FAST). Data analyses were carried out with statistical package SPSS 15.0 for Windows. Correlation and linear regression analyses were required to identify those variables that would be a good predictor of functional outcome. Analyses of variance (MANOVA and ANOVA) were used to examine the impact of medication in psychosocial and cognitive functioning; defining pharmacological treatment as a factor (Lithium monotherapy and other treatment combinations). Results: Pearson and Spearman correlations were used in order to establish which subclinical (HDRS, MADRS and GAF) and neuropsychological variables (TMT-B, visual memory immediate recall and Stroop inhibition) correlated with the cognitive area of FAST. These variables were included in a linear regression model. The variance explained from the model is R2 =0.66, ANOVA F = 6.18, p = 0.001. The same statistic analysis was used to predict the total score of FAST with subclinical (HDRS, MADRS and GAF) and neuropsychological variables (TMT-A, TMT-B, visual memory immediate recall, Stroop inhibition and number of categories of WCST) and these variables were included in a linear regression model. The variance explained from the model is R2 =0.72, ANOVA F = 5.47, p = 0.002. Analyses of variance were used to determine the effect of psychopharmacological treatment in psychosocial functioning. Multivariate analyses did not reach significant differences between the two groups (lithium monotherapy/other treatment combinations) in any of the neuropsychological variables. But, a significant group effect was observed in the cognitive area
of FAST [F = 4.65, p = 0.04] and in the total score [F = 4.34, p = 0.04]. Conclusions: • Cognitive impairment remains in bipolar euthymic patients and it has shown an association to a poor functional recovery • Executive dysfunction may be a good predictor of functional outcome in bipolar euthymic patients • Current psychopharmacological treatments can achieve clinical stabilization but have limitations regarding functional recovery • More studies are required to study the poor functional outcome in bipolar disorder in order to decrease the gap between functional and clinical recovery References [1] Goodwin FK, Jamison KR: Manic-depressive illness: Bipolar disorders and recurrent depression. Second edition New York. Oxford University Press: 2007. [2] MacQueen GM, Young LT, Robb JC, Cooke RG, Joffe RT: Levels of functioning and well-being in recovered psychotic versus nonpsychotic mania. J Affect Disord. 1997 Oct; 46(1): 69−72.
P.2.e.005 Mood stabilisers and atypical antipsychotics in the long-term treatment of bipolar disorder A.C. Altamura1 , M. Buoli1 ° , R.A. Paoli1 , D. Primavera2 . 1 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Psychiatry, Milan, Italy; 2 University of Cagliari, Psychiatry, Cagliari, Italy Purpose of the study: The treatment of Bipolar Disorder (BD) includes not only the remission of the acute major episode, but also the prevention of recurrences [1,2]. The treatment of the acute episode should be followed by a stabilization and a maintenance phase [1]. Previous studies showed as combination therapies with a Mood Stabilizer and an Atypical Antipsychotic are particularly effective in the maintenance treatment of BD [1,3]. Purpose of this trial is to evaluate the effectiveness of Mood Stabilizers and Atypical Antipsychotics in long-term treatment of BD. Methods: 67 bipolar patients, selected from those treated and followed up at Community Services afferent to our Department, were followed retrospectively for a period of 48 months and divided into 6 groups according to the prescribed pharmacological treatment: Lithium monotherapy (N = 21), Valproate monotherapy (N = 14), Atypical Antipsychotic monotherapy (N = 15), Lithium plus Atypical Antipsychotic (N = 7), Valproate plus Atypical Antipsychotic (N = 4), other treatments (N = 6). Patients with complete clinical chart for the 48 months follow-up period were included in the study, after giving their informed written consent for participating in the study and for having reviewed the clinical information included in their charts. Diagnoses were assessed by the administration of a semi-structured interview based on DSMIV criteria (SCID-I). A survival analysis (Kaplan-Meier) of the follow-up period (48 months) was performed considering as death events: a change of treatment due to side effects, a major affective episode or a hospitalization. Results: The six groups were not different regarding age (F = 1.43, p = 0.23), duration of illness (F= 0.33, p = 0.89), duration of untreated illness (DUI) (F = 0.92, p = 0.48) and family history (c2 =5.54, df=5, p = 0.38). No differences were found between monotherapies. Lithium association with an Atypical Antipsychotic resulted more effective in terms of recurrence prevention compared to Lithium monotherapy (Log Rank: c2 =7.01, p = 0.008; Breslow: c2 =8.59, p = 0.003), Valproate monotherapy
P.2.e. Affective disorders and antidepressants − Bipolar disorders (clinical) (Log Rank: c2 =18.00, p < 0.001; Breslow: c2 =13.93, p < 0.001) or Atypical Antipsychotic monotherapy (Log Rank: c2 =8.61, p = 0.003; Breslow: c2 =8.35, p = 0.004). Valproate association with an Atypical Antipsychotic was superior in terms of relapse prevention to Valproate monotherapy (Log Rank: c2 =8.55, p = 0.003; Breslow: c2 =7.22, p = 0.007), but not to Lithium (Log Rank: c2 =0.35, p = 0.55; Breslow: c2 =2.36, p = 0.12) and Atypical Antipsychotic (Log Rank: c2 =1.25, p = 0.26; Breslow: c2 =2.42, p = 0.12) monotherapies. All treatments were well tolerated by patients and in particular just 4 patients showed extrapyramidal symptoms (EPS) and 2 metabolic alterations. However, the treatment groups were not different in terms of side effects presentation (c2 =7.28, df=10, p = 0.38). Conclusions: These preliminary data seem to confirm results of a previous study from our group [1]. The combination therapy with a Mood Stabilizer and an Atypical Antipsychotic would be more effective in preventing major affective recurrences in bipolar patients. In particular, Lithium association with an Atypical Antipsychotic would be result particularly effective in long termtreatment of BD. References [1] Altamura, A.C., Mundo, E., Dell’Osso, B., Tacchini, G., Buoli M., Calabrese, J.R., 2008. Quetiapine and classical mood stabilizers in the long-term treatment of Bipolar Disorder: a 4-year follow-up naturalistic study. J Affect Disord 110, 135–141. [2] Fountoulakis, K.N., Vieta E., 2008. Treatment of bipolar disorder: a systematic review of available data and clinical perspectives. Int J Neuropsychopharmacol 11, 999–1029. [3] Vieta, E., Suppes, T., Eggens I., Persson, I., Paulsson, B., Brecher, M., 2008. Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar I disorder (international trial 126). J Affect Disord 109, 251−63.
P.2.e.006 Can we distinguish bipolar from unipolar depression: preliminary results Hranov1 ° ,
Simov2 ,
Hranov3 .
1 University
V. G. Hospital L.G. “St. Naum”, 2nd Psychiatric Clinic, Sofia, Bulgaria; 2 University General Hospital “Aleksandrovska”, Psychiatric Clinic, Sofia, Bulgaria; 3 University Hospital “St. Naum”, 1st Psychiatric Clinic, Sofia, Bulgaria Introduction: Bipolar disorder presents initially with a depressive episode in 35% to 60% of patients making accurate early diagnosis really difficult. There are currently no accepted diagnostic criteria for bipolar depression for either research or clinical purposes. Switch rates among initially depressed patients are as high as nearly 40% in long-term follow-ups [1]. The delay in proper diagnosis can have a grave impact on treatment outcome and on long-term prognosis. Yet, there is an evolving notion that there are clinically relevant differences in patient characteristics, clinical course, diagnostic features, and response to antidepressants between the two mood disorders [2]. The purpose of this study was to search for clinical/historic identifiers of the bipolar nature of a presenting major depressive episode. Methods: 60 consecutive inpatients with at least 3 previous affective episodes: 14 males and 16 females with bipolar (BPD), and as many with unipolar depression (UPD) diagnosed by the MINI were studied. Demographic indices, onset and course of illness parameters, family history, psychosocial development, relevant life events and stressors, etc. were systematically explored. Results: Mean age was 40.8 years for BPD versus 44.8 years for UPD. 46.7% UPD and 16.7% BPD patients were university
S405
graduates (p < 0.01). 63.3% of the UPD group and 50% of the BPD group were married (n.s.), and 16.7% of the BPD patients versus 6.7% of the UPD patients were divorced (n.s.). 40.0% of BPD and 46.6% of UPD patients were unemployed or on social security pension (n.s.). Relatives with BAD I, BAD II, cyclothymic disorder, hyperthymic disorder; eccentrics; artistically gifted persons were found in the families of 86.7% BPD versus those of 16.7% UPD patients (p < 0.001). Mean age at onset was 23.8 years in bipolars versus 29.0 years in unipolars. 5 bipolars and 4 unipolars (n.s.) had committed suicidal attempts prior to study. 83.3% of BPD versus 16.7% of UPD patients experienced evening brightening and invigoration (p < 0.001). Inter-episode symptoms (emotional instability; high anxiety; suicidal thoughts; disturbed appetite, sleep, sexuality and/or disturbed psychomotor performance) were registered during the preceding 2 year-period in 56.6% of BPD versus 30.0% of UPD patients (p < 0.05). Conclusions: Compared to patients with UPD, patients with BPD had much higher familial loading with bipolar spectrum disorders. Early onset of the first affective episode, incomplete remissions, and mood lability during depression provide some potential diagnostic information for distinguishing bipolar from unipolar depression. Suicidality, vocational difficulties, reliance on social support were highly prevalent in both groups, yet not as significantly differing as to be used for distinguishing between the two groups. Bipolar disorder was more deleterious to educational achievement than recurrent unipolar depression. True distinguishing clinical features should be sought in energy level and in behavioural indices [also 2,3]. There were much more marked diurnal variations of activity and energy in BPD. References [1] Akiskal, H.S., Maser, J.D., Zeller, P.J., et al., 1995. Switching from “unipolar” to “bipolar II”: an 11-year prospective study of clinical and temperamental predictors in 559 patients. Arch Gen Psychiatry 52, 114–123. [2] Bowden, C.L., 2005. A different depression: clinical distinctions between bipolar and unipolar depression. J Affect Disord 84, 117–125. [3] Mansell, W., Colom, F., Scott, F., 2005. The nature and treatment of depression in bipolar disorder: a review and implications for future psychological investigation. Clin Psychol Rev 25, 1076–1100.
P.2.e.007 Outcome of bipolar illness and comorbid personality disorder O. Garcia L´opez1 ° , P. Fernandez-Arg¨uelles1 , N. Casas1 , M. Camacho1 , J.M. Garcia1 . 1 Hospital Universitario ‘V. Macarena’, Psiquiatria, Sevilla, Spain Introduction: The purpose of this study was to investigate whether the presence of comorbid personality disorder influences the course of bipolar illness. Subjects with co-occurring bipolar disorder and axis II personality disorders differ from bipolar patients without personality disorders in the clinical correlates [1]. Methods: We examined 40 Bipolar disorder patients (DSMIV criteria) recluted in University Hospital of Seville. Bipolar patients with a diagnosis of comorbid personality disorder (n = 30) were compared with ‘pure’ bipolar patients (n = 10) with regard to demographic, clinical, course of illness variables, age at onset of the first episode, number and type of affective episodes, duration of bipolar disorder, and number of hospitalizations. There were