- Email: [email protected]
P.8.a.021 Comparative acute efficacy and tolerability of OROS and immediate release formulations of methylphenidate in the treatment of adults with ADHD
P.8.a Other topics – Clinical Conclusion: Cortisol secretion has an important seasonal fluctuation. It is strongly recommended to take into account this variability of cortisol secretion when researching in this filed. References [1] Kostoglou-Athanassiou I., Treacher D.F., Wheeler M.J. and Forsling M.L., 1998, Bright light exposure and pituitary hormone secretion, Clin. Endocrinol. (Oxf), 48, pp. 73−79.
P.8.a.020 Dopaminergic, noradrenergic, adrenal and thyroid abnormalities in schizoaffective disorder F. Duval ° , M.C. Mokrani, J.A. Monreal Ortiz, C. Champeval, N. Chokmani, J.P. Macher. Centre Hospitalier, Psychiatry, Rouffach, France Background: Schizoaffective disorder – which is characterized by a combination of symptoms of schizophrenia and an affective (mood) disorder – is, clinically and biologically, a heterogeneous illness. Since patients with schizoaffective disorder (especially those with the bipolar subtype) have a better prognosis than that of patients with schizophrenia, it appears essential to better understand the pathophysiology of this illness. The aim of this study was to attempt to find external validators for the classification of inpatients meeting proposed DSM-IV criteria for schizoaffective disorder. Therefore, using a multivariate neuroendocrine approach, we assessed hypothalamic–pituitary dopaminergic (DA), noradrenergic (NA), thyroid (HPT) and adrenal (HPA) activity in hospitalized schizoaffective patients. Method: Hormonal responses to 8 AM and 11 PM protirelin (TRH) tests, dexamethasone suppression test (DST), apomorphine test (APO; a DA receptor agonist) and clonidine test (CLO; an alpha 2-adrenoreceptor agonist) were measured in 13 untreated male inpatients with DSM-IV schizoaffective disorder (bipolar subtype; mean age[SEM]: 32.3[3.0] years) and 13 matched hospitalized healthy controls (mean age: 33.2[2.5] years). Results: Compared with controls, patients showed (1) lower responses to TRH: 11 PM maximum increment in plasma thyrotropin (TSH) level (P = 0.02) and the difference between 11 PM and 8 AM maximum increment in plasma TSH values (P = 0.0005); (2) higher post-dexamethasone cortisol values (P = 0.02); (3) lower APO-induced PRL suppression (P = 0.04); (4) and lower growth hormone (GH) response to CLO (P = 0.001). On the other hand, there was no significant difference in ACTH/cortisol and GH responses to APO between controls and patients. Discussion: From a pathophysiological view point, the mechanisms underlying these abnormalities are not fully understood. The blunted TRH-induced TSH stimulation might reflect a downregulation of the TRH receptors in the pituitary gland – for chronobiological reason this abnormality is more obvious in the evening – secondary to a prolonged increase in hypothalamic TRH stimulation. Nonsuppression of cortisol in the DST may reflect impaired negative feedback at the level of the pituitary corticotroph (i.e. decreased type II glucocorticoid receptor function) on endogenous hypothalamic–pituitary–adrenal axis hyperactivity. The blunted PRL suppression to APO might suggest a hyposensitivity of the pituitary D2 receptors linked to an erratic tuberoinfundibular DA activity (while at the hypothalamic level the activity of the D2 and D1 receptors appears normal). The blunted GH response to CLO suggests subsensitive or downregulated postsynaptic alpha 2-adrenoreceptors at the hypothalamic level, linked to an erratic release of NA.
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Conclusion: Our results suggest that decreased pituitary TRH and DA-D2 receptor function together with increased HPA axis activity and decreased alpha 2-noradrenergic function characterize untreated male schizoaffective patients. These abnormalities have also been reported in bipolar patients, while in schizophrenia such results have rarely been found. Therefore, our results suggest a link between bipolar disorder and schizoaffective disorder (bipolar subtype). This may be of great interest in devising appropriate therapeutic strategies. References [1] Duval F., Macher J.P., Mokrani M.C., 1990, Difference between evening and morning thyrotropin responses to protirelin in major depressive episode, Arch Gen Psychiatry, 47, 443–448. [2] Mokrani M.C., Duval F., Crocq M.A., Bailey P., Macher J.P., 1995, Multihormonal responses to apomorphine in mental illness, Psychoneurendocrinology, 20, 365–375. [3] Monr´eal J.A., Duval F., Mokrani M.C., Pinault G., Macher J.P., 2005, Exploration de la fonction dopaminergique dans les d´epressions bipolaires et unipolaires, Ann M´ed Psychol Paris, 163, 399–404.
P.8.a.021 Comparative acute efficacy and tolerability of OROS and immediate release formulations of methylphenidate in the treatment of adults with ADHD J. Biederman ° , T.J. Spencer, E. Mick. Massachusetts General Hospital, Pediatric Psychopharmaclogy, Boston, USA Objective: The main aim of this study was to compare the safety and efficacy of equipotent doses of IR MPH administered TID to those of once daily OROS MPH in adults with DSM-IV Attention Deficit Hyperactivity Disorder (ADHD). Methods: Data from two independently conducted 6-week placebo controlled, randomized clinical trials of IR-MPH (tid) and of OROS-MPH were pooled to create three study groups: Placebo (N = 116), IR-MPH(tid) (N = 102) and OROS-MPH (N = 67). Subjects were outpatient adults with ADHD between 19 and 60 years of age. To be included subjects had to satisfy full diagnostic criteria for DSM-IV ADHD based on clinical assessment and confirmed by structured diagnostic interview. Results: All three groups were in their mid thirties, on average. There were no differences in gender, ADHD onset, number of symptoms, or clinical impression of severity at baseline. There were no differences in dose at endpoint between IR-MPH (tid) and OROS-MPH, but both were statistically significantly lower than placebo. Total daily doses at endpoint were 80.9±31.9 mg, 74.8±26.2 mg, and 95.4±26.3 mg in the OROS-MPH, IR-MPH (tid), and placebo groups, respectively. Eight-five percent (N = 99) of placebo treated subjects, 77% (N = 79) of the IR-MPH (tid) treated subjects, and 82% (N = 55) of the OROS-MPH treated subjects completed the 6-week trial. The rate of improvement according to the psychiatrist rated clinical global impression (CGI-I) for ADHD was statistically significantly higher for both IR-MPH (tid) (x2(1) = 27.7, p < 0.001) and OROS-MPH (x2(1)) = 21.2, p < 0.001) groups compared with placebo, and there were no statically (x2(1)) = 0.008, p = 0.9) or clinically significant differences between the two formulations of MPH. Forty percent (N = 46), 80% (N = 80), and 69% (N = 46) of the placebo, IR-MPH (tid) and OROS-MPH groups, respectively attained a 30% reduction of baseline AISRS scores at endpoint. Both the IR-MPH (tid) and the OROS-MPH groups were statistically significantly more likely to have a 30% reduction in symptoms than placebo (p < 0.001) and were not different from one another (p = 0.1). At endpoint,
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66% (N = 44) of subjects receiving OROS-MPH and 70% (N = 71) of subjects receiving IR-MPH(tid) were considered responders compared with 31% (N = 36) on placebo (x2(2) = 38.1, p < 0.001), using our a priori definition of response of much or very much improved on the CGI plus more than a 30% reduction in symptoms on the AISRS. Both active medication groups were statistically significantly more likely to demonstrate this level of improvement compared with placebo (p < 0.001) but not when compared to one another (p = 0.6). Both the IR-MPH(tid) and the OROSMPH treated subjects were more likely to report dry mouth, decreased appetite, sleep difficulties and moodiness than were subjects treated with placebo. Conclusions: Comparison of data from two similarly designed, large, randomized, placebo-controlled, trials, showed that equipotent daily doses of once daily OROS MPH has similar efficacy and tolerability to that of TID administered IR MPH. References [1] Spencer TJ, Wilens T, Biederman J, Faraone AV, Ablon JS, Lapey K, 1995, A double-blind, crossover comparison of methylphenidate and placebo in adults with childhood-onset attention-deficit hyperactivity disorder, ArchGen Psychiatry, 52, 6, 434–443. [2] Biederman J, Mick E, Surman C, et al., 2006, A randomized placebo controlled trial of OROS-methylphenidate in adults with ADHD, Biological Psychiatry, in press.
P.8.a.022 Analysis of the hospitalized frustrated suicides, classified according to the violence of the method used
are not statistically significant). The most frequents diagnosis in both groups were: personality disorders (26%), affective psychotic disorders (19%), other depressions (18%), paranoid psychosis (9%) and drug abuse (9%). The frustrated suicides using the most violent methods are mostly men (48% vs. 36%, p = 0.031), they have less personal psychiatric precedents (82 vs. 90%, p = 0.333), they more frequently work in primary sectors – agriculture, cattle raising and fishing – (21% vs. 6%, p = 0.001), they are mostly admitted in surgery units (43% vs. 2%, p < 0.001), they more frequently live alone (15% vs. 10% p = 0.031), they have less sociofamiliar conflicts (11% vs. 34%, p < 0.001), they receive less psychotherapy (20% vs. 36%, p = 0.002), they receive more follow-up consultations from either the psychiatrist or the psychologist (3.01% vs. 1.86%, p 0.001), they are treated in a bigger proportion with psychoactive drugs (80% vs. 64%, p = 0.002), and they receive more antipsychotic drugs (37% vs. 21%, p = 0.002). Conclusions: As a whole, the admitted frustrated suicides present a similar psychopathology; but those who use more violent methods are more frequently men, they work more in primary sectors, they suffer a bigger isolation, and they are treated with less psychotherapy and with more psychoactive drugs, particularly antipsychotics. References [1] Gunnell D, Bennewith O, Hawton K, Simkin S, Kapur N, 2005, The epidemiology and prevention of suicide by hanging: A systematic review, Int J Epidemiol, 34, 2, 433–442.
P.8.a.023 Lifetime comorbidity in bipolar disorder: bipolar subtype and gender differences
C. Castro Dono ° , F. Iglesias Gil de Bernab´e, J. Garc´ıa Fern´andez, M. Filgueira Bouza, E. Fontela Vivanco, S. Segade Rodr´ıguez, S. Gonz´alez Bardanca, J. Alberdi Sudupe, L. Ferrer i Balsebre, M. Amboage Paz. Universitary Hospital ‘Juan Canalejo’, Psychiatric Service, A Coruna, Spain
B. Grabski, D. Dudek ° , W. Datka, G. Maczka, A. Zieba. Jagiellonian University, Department of Adult Psychiatry, Cracow, Poland
Objectives: The aim of this study is to go deep into the clinic, sociodemographic and therapeutical characteristics of inpatients who survived to severe self-injuring attempts. It is postulated that frustrated suicides that use the most violent methods (such as firearms, throwing themselves headlong or self-hanging) have a different profile than those who use an overdose of medicines [1]. Methods: The sample analyzed included 304 frustrated suicides (176 women and 128 men) with an average age of 42.8 years old (s.d. = 17.8), consecutively admitted to the University Hospital ‘Juan Canalejo’ of A Coruna-Spain, from 1997 to 2005 (nine years), who were assessed and treated by the Consultation & Liaison Psychiatric Unit. We have excluded the slight to moderate pharmacological overdoses, discharged from the Emergency Room, that haven’t required a posterior admission. The sample includes a subgroup of 155 patients that used severe pharmacological overdose and a second subgroup of 149 patients that used more violent methods (36 firearms, 8 self-hanging, 51 throwing headlong, 38 self-poisoning and 16 generalized self-burning). All these patients answered a standard sociodemographic and psychiatric questionnaire. Chi-square was the statistical method used to compare the proportions and T-Student the one to compare averages for independent data, with the statistical package SPSS 12.0 for windows. Results: The average age, civil status, educational level, employment situation, family precedents, syndromic psychiatric diagnosis and the treatments with antidepressants or anxiolitics are similar in both subgroups of frustrated suicides (the differences
Background: The studies on lifetime comorbidity in bipolar disorder (BP) show that it is a common phenomenon with possible negative clinical consequences. The data on bipolar subtype and gender differences in comorbidity in BP are confusing. Aims: The main objective of the presented study was to investigate gender and bipolar subtype differences in psychiatric comorbidity in BP, and the relationships between lifetime comorbidity in BP with demographic and clinical variables and level of current functioning. Methods: 73 consecutive outpatients, who fulfilled inclusion criteria, i.e. aged over 18, BP I or II DSM-IV diagnoses in remission, were included in the study. The measurement instruments employed were: HDRS, YMRS, CIDI, self-constructed catamnestic questionnaire, and GAF. The comorbid groups (anxiety (ANX), substance use disorders (SUD), ANX+SUD) were then compared with a non-comorbid group according to demographic and clinical variables. Results: Fifty patients (68.5%) fulfilled the criteria for BP I and 23 patients (31.5%) for BP II. The group consisted of 31 men (42.5%) and 42 women (57.5%). Lifetime psychiatric comorbidity (with the exclusion of nicotine use disorders) was 71.2%. The comorbid lifetime anxiety disorders were found in 63% of the sample, and substance use disorders in 37%. After the inclusion of nicotine abuse/dependence the SUDs comorbidity reached 67.1%. The most prevalent disorders were GAD (31.5%) and alcohol abuse/dependence (30.1%). The prevalence of nicotine abuse/ dependence was 58.9%. Although the general rate of comorbidity
P.8.a.020 Dopaminergic, noradrenergic, adrenal and thyroid abnormalities in schizoaffective disorder F. Duval ° , M.C. Mokrani, J.A. Monreal Ortiz, C. Champeval, N. Chokmani, J.P. Macher. Centre Hospitalier, Psychiatry, Rouffach, France Background: Schizoaffective disorder – which is characterized by a combination of symptoms of schizophrenia and an affective (mood) disorder – is, clinically and biologically, a heterogeneous illness. Since patients with schizoaffective disorder (especially those with the bipolar subtype) have a better prognosis than that of patients with schizophrenia, it appears essential to better understand the pathophysiology of this illness. The aim of this study was to attempt to find external validators for the classification of inpatients meeting proposed DSM-IV criteria for schizoaffective disorder. Therefore, using a multivariate neuroendocrine approach, we assessed hypothalamic–pituitary dopaminergic (DA), noradrenergic (NA), thyroid (HPT) and adrenal (HPA) activity in hospitalized schizoaffective patients. Method: Hormonal responses to 8 AM and 11 PM protirelin (TRH) tests, dexamethasone suppression test (DST), apomorphine test (APO; a DA receptor agonist) and clonidine test (CLO; an alpha 2-adrenoreceptor agonist) were measured in 13 untreated male inpatients with DSM-IV schizoaffective disorder (bipolar subtype; mean age[SEM]: 32.3[3.0] years) and 13 matched hospitalized healthy controls (mean age: 33.2[2.5] years). Results: Compared with controls, patients showed (1) lower responses to TRH: 11 PM maximum increment in plasma thyrotropin (TSH) level (P = 0.02) and the difference between 11 PM and 8 AM maximum increment in plasma TSH values (P = 0.0005); (2) higher post-dexamethasone cortisol values (P = 0.02); (3) lower APO-induced PRL suppression (P = 0.04); (4) and lower growth hormone (GH) response to CLO (P = 0.001). On the other hand, there was no significant difference in ACTH/cortisol and GH responses to APO between controls and patients. Discussion: From a pathophysiological view point, the mechanisms underlying these abnormalities are not fully understood. The blunted TRH-induced TSH stimulation might reflect a downregulation of the TRH receptors in the pituitary gland – for chronobiological reason this abnormality is more obvious in the evening – secondary to a prolonged increase in hypothalamic TRH stimulation. Nonsuppression of cortisol in the DST may reflect impaired negative feedback at the level of the pituitary corticotroph (i.e. decreased type II glucocorticoid receptor function) on endogenous hypothalamic–pituitary–adrenal axis hyperactivity. The blunted PRL suppression to APO might suggest a hyposensitivity of the pituitary D2 receptors linked to an erratic tuberoinfundibular DA activity (while at the hypothalamic level the activity of the D2 and D1 receptors appears normal). The blunted GH response to CLO suggests subsensitive or downregulated postsynaptic alpha 2-adrenoreceptors at the hypothalamic level, linked to an erratic release of NA.
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Conclusion: Our results suggest that decreased pituitary TRH and DA-D2 receptor function together with increased HPA axis activity and decreased alpha 2-noradrenergic function characterize untreated male schizoaffective patients. These abnormalities have also been reported in bipolar patients, while in schizophrenia such results have rarely been found. Therefore, our results suggest a link between bipolar disorder and schizoaffective disorder (bipolar subtype). This may be of great interest in devising appropriate therapeutic strategies. References [1] Duval F., Macher J.P., Mokrani M.C., 1990, Difference between evening and morning thyrotropin responses to protirelin in major depressive episode, Arch Gen Psychiatry, 47, 443–448. [2] Mokrani M.C., Duval F., Crocq M.A., Bailey P., Macher J.P., 1995, Multihormonal responses to apomorphine in mental illness, Psychoneurendocrinology, 20, 365–375. [3] Monr´eal J.A., Duval F., Mokrani M.C., Pinault G., Macher J.P., 2005, Exploration de la fonction dopaminergique dans les d´epressions bipolaires et unipolaires, Ann M´ed Psychol Paris, 163, 399–404.
P.8.a.021 Comparative acute efficacy and tolerability of OROS and immediate release formulations of methylphenidate in the treatment of adults with ADHD J. Biederman ° , T.J. Spencer, E. Mick. Massachusetts General Hospital, Pediatric Psychopharmaclogy, Boston, USA Objective: The main aim of this study was to compare the safety and efficacy of equipotent doses of IR MPH administered TID to those of once daily OROS MPH in adults with DSM-IV Attention Deficit Hyperactivity Disorder (ADHD). Methods: Data from two independently conducted 6-week placebo controlled, randomized clinical trials of IR-MPH (tid) and of OROS-MPH were pooled to create three study groups: Placebo (N = 116), IR-MPH(tid) (N = 102) and OROS-MPH (N = 67). Subjects were outpatient adults with ADHD between 19 and 60 years of age. To be included subjects had to satisfy full diagnostic criteria for DSM-IV ADHD based on clinical assessment and confirmed by structured diagnostic interview. Results: All three groups were in their mid thirties, on average. There were no differences in gender, ADHD onset, number of symptoms, or clinical impression of severity at baseline. There were no differences in dose at endpoint between IR-MPH (tid) and OROS-MPH, but both were statistically significantly lower than placebo. Total daily doses at endpoint were 80.9±31.9 mg, 74.8±26.2 mg, and 95.4±26.3 mg in the OROS-MPH, IR-MPH (tid), and placebo groups, respectively. Eight-five percent (N = 99) of placebo treated subjects, 77% (N = 79) of the IR-MPH (tid) treated subjects, and 82% (N = 55) of the OROS-MPH treated subjects completed the 6-week trial. The rate of improvement according to the psychiatrist rated clinical global impression (CGI-I) for ADHD was statistically significantly higher for both IR-MPH (tid) (x2(1) = 27.7, p < 0.001) and OROS-MPH (x2(1)) = 21.2, p < 0.001) groups compared with placebo, and there were no statically (x2(1)) = 0.008, p = 0.9) or clinically significant differences between the two formulations of MPH. Forty percent (N = 46), 80% (N = 80), and 69% (N = 46) of the placebo, IR-MPH (tid) and OROS-MPH groups, respectively attained a 30% reduction of baseline AISRS scores at endpoint. Both the IR-MPH (tid) and the OROS-MPH groups were statistically significantly more likely to have a 30% reduction in symptoms than placebo (p < 0.001) and were not different from one another (p = 0.1). At endpoint,
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66% (N = 44) of subjects receiving OROS-MPH and 70% (N = 71) of subjects receiving IR-MPH(tid) were considered responders compared with 31% (N = 36) on placebo (x2(2) = 38.1, p < 0.001), using our a priori definition of response of much or very much improved on the CGI plus more than a 30% reduction in symptoms on the AISRS. Both active medication groups were statistically significantly more likely to demonstrate this level of improvement compared with placebo (p < 0.001) but not when compared to one another (p = 0.6). Both the IR-MPH(tid) and the OROSMPH treated subjects were more likely to report dry mouth, decreased appetite, sleep difficulties and moodiness than were subjects treated with placebo. Conclusions: Comparison of data from two similarly designed, large, randomized, placebo-controlled, trials, showed that equipotent daily doses of once daily OROS MPH has similar efficacy and tolerability to that of TID administered IR MPH. References [1] Spencer TJ, Wilens T, Biederman J, Faraone AV, Ablon JS, Lapey K, 1995, A double-blind, crossover comparison of methylphenidate and placebo in adults with childhood-onset attention-deficit hyperactivity disorder, ArchGen Psychiatry, 52, 6, 434–443. [2] Biederman J, Mick E, Surman C, et al., 2006, A randomized placebo controlled trial of OROS-methylphenidate in adults with ADHD, Biological Psychiatry, in press.
P.8.a.022 Analysis of the hospitalized frustrated suicides, classified according to the violence of the method used
are not statistically significant). The most frequents diagnosis in both groups were: personality disorders (26%), affective psychotic disorders (19%), other depressions (18%), paranoid psychosis (9%) and drug abuse (9%). The frustrated suicides using the most violent methods are mostly men (48% vs. 36%, p = 0.031), they have less personal psychiatric precedents (82 vs. 90%, p = 0.333), they more frequently work in primary sectors – agriculture, cattle raising and fishing – (21% vs. 6%, p = 0.001), they are mostly admitted in surgery units (43% vs. 2%, p < 0.001), they more frequently live alone (15% vs. 10% p = 0.031), they have less sociofamiliar conflicts (11% vs. 34%, p < 0.001), they receive less psychotherapy (20% vs. 36%, p = 0.002), they receive more follow-up consultations from either the psychiatrist or the psychologist (3.01% vs. 1.86%, p 0.001), they are treated in a bigger proportion with psychoactive drugs (80% vs. 64%, p = 0.002), and they receive more antipsychotic drugs (37% vs. 21%, p = 0.002). Conclusions: As a whole, the admitted frustrated suicides present a similar psychopathology; but those who use more violent methods are more frequently men, they work more in primary sectors, they suffer a bigger isolation, and they are treated with less psychotherapy and with more psychoactive drugs, particularly antipsychotics. References [1] Gunnell D, Bennewith O, Hawton K, Simkin S, Kapur N, 2005, The epidemiology and prevention of suicide by hanging: A systematic review, Int J Epidemiol, 34, 2, 433–442.
P.8.a.023 Lifetime comorbidity in bipolar disorder: bipolar subtype and gender differences
C. Castro Dono ° , F. Iglesias Gil de Bernab´e, J. Garc´ıa Fern´andez, M. Filgueira Bouza, E. Fontela Vivanco, S. Segade Rodr´ıguez, S. Gonz´alez Bardanca, J. Alberdi Sudupe, L. Ferrer i Balsebre, M. Amboage Paz. Universitary Hospital ‘Juan Canalejo’, Psychiatric Service, A Coruna, Spain
B. Grabski, D. Dudek ° , W. Datka, G. Maczka, A. Zieba. Jagiellonian University, Department of Adult Psychiatry, Cracow, Poland
Objectives: The aim of this study is to go deep into the clinic, sociodemographic and therapeutical characteristics of inpatients who survived to severe self-injuring attempts. It is postulated that frustrated suicides that use the most violent methods (such as firearms, throwing themselves headlong or self-hanging) have a different profile than those who use an overdose of medicines [1]. Methods: The sample analyzed included 304 frustrated suicides (176 women and 128 men) with an average age of 42.8 years old (s.d. = 17.8), consecutively admitted to the University Hospital ‘Juan Canalejo’ of A Coruna-Spain, from 1997 to 2005 (nine years), who were assessed and treated by the Consultation & Liaison Psychiatric Unit. We have excluded the slight to moderate pharmacological overdoses, discharged from the Emergency Room, that haven’t required a posterior admission. The sample includes a subgroup of 155 patients that used severe pharmacological overdose and a second subgroup of 149 patients that used more violent methods (36 firearms, 8 self-hanging, 51 throwing headlong, 38 self-poisoning and 16 generalized self-burning). All these patients answered a standard sociodemographic and psychiatric questionnaire. Chi-square was the statistical method used to compare the proportions and T-Student the one to compare averages for independent data, with the statistical package SPSS 12.0 for windows. Results: The average age, civil status, educational level, employment situation, family precedents, syndromic psychiatric diagnosis and the treatments with antidepressants or anxiolitics are similar in both subgroups of frustrated suicides (the differences
Background: The studies on lifetime comorbidity in bipolar disorder (BP) show that it is a common phenomenon with possible negative clinical consequences. The data on bipolar subtype and gender differences in comorbidity in BP are confusing. Aims: The main objective of the presented study was to investigate gender and bipolar subtype differences in psychiatric comorbidity in BP, and the relationships between lifetime comorbidity in BP with demographic and clinical variables and level of current functioning. Methods: 73 consecutive outpatients, who fulfilled inclusion criteria, i.e. aged over 18, BP I or II DSM-IV diagnoses in remission, were included in the study. The measurement instruments employed were: HDRS, YMRS, CIDI, self-constructed catamnestic questionnaire, and GAF. The comorbid groups (anxiety (ANX), substance use disorders (SUD), ANX+SUD) were then compared with a non-comorbid group according to demographic and clinical variables. Results: Fifty patients (68.5%) fulfilled the criteria for BP I and 23 patients (31.5%) for BP II. The group consisted of 31 men (42.5%) and 42 women (57.5%). Lifetime psychiatric comorbidity (with the exclusion of nicotine use disorders) was 71.2%. The comorbid lifetime anxiety disorders were found in 63% of the sample, and substance use disorders in 37%. After the inclusion of nicotine abuse/dependence the SUDs comorbidity reached 67.1%. The most prevalent disorders were GAD (31.5%) and alcohol abuse/dependence (30.1%). The prevalence of nicotine abuse/ dependence was 58.9%. Although the general rate of comorbidity