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S.05.03 Switching antipsychotics in schizoaffective disorder: rules and cautions
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S.06. Neurobiology of ADHD across the lifespan
References [1] Murru, A., Pacchiarotti, I., Nivoli, A.M., Colom, F., Vieta, E., 2012. Is schizoaffective disorder still a neglected condition in the scientific literature? Psychother Psychosom 81(6): 389–390. [2] Murru, A., Pacchiarotti, I., Nivoli, A.M., Grande, I., Colom, F., Vieta, E., 2011. What we know and what we don’t know about the treatment of schizoaffective disorder. Eur Neuropsychopharmacol 21(9): 680–690. [3] Murru, A., Pacchiarotti, I., Amann, B.L., A.M.A.N., Vieta, E., Colom, F., 2013. Treatment adherence in bipolar I and schizoaffective disorder, bipolar type. J Affect Disord 151(3): 1003–1008.
S.05.03 Switching antipsychotics in schizoaffective disorder: rules and cautions A.M.A. Nivoli1 ° , A. Murru1 , I. Grande1 , E. Vieta1 1 Bipolar Disorder Unit, Cinical Institute of Neuroscience, Barcelona, Spain Schizoaffective disorder (SAD) is a chronic, severe and disabling illness consisting on the concurrent presentation of symptoms of schizophrenia and affective disorders (depression and/or mania) [1] and rates of non-adherence in schizoaffective disorder are high [2]. Patients with more prominent schizophrenia-like characteristics could be at higher risk for poor adherence and need to be closely followed and monitored. Evidence for the treatment of SAD mostly derives from studies based on mixed samples (i.e. schizophrenic and schizoaffective patients) or on extrapolations from studies on schizophrenia or bipolar disorder (BD), and few articles on antipsychotic switching been published [3]. Switching among and between antipsychotics and mood stabilizers has become more common in the treatment of both BD and SAD, in particular, since the introduction of the novel atypical antipsychotics with mood stabilizer properties. In general, antipsychotic switching, regardless of the route of drug administration, was well tolerated in patients and no interference was shown in antipsychotic effectiveness during the interchange of drugs. Metabolic improvement was perceived when the switch involved antipsychotics with a low metabolic risk profile. The evidencebase for antipsychotic switching in SAD and also in BD is scant, and little controlled data is available. Switch from quetiapine to lithium and from risperidone to olanzapine has proven successful. Switching to antipsychotics with low metabolic risk had some positive impact on several safety measures. In stabilized patients, the plateau cross-taper switch may be preferred. References [1] Murru A1, Pacchiarotti I, Nivoli AM, Grande I, Colom F, Vieta E.What we know and what we don’t know about the treatment of schizoaffective disorder. Eur Neuropsychopharmacol. 2011 Sep; 21(9): 680−90. [2] Murru A, Pacchiarotti I, Nivoli AM, Bonnin CM, Patrizi B, Amann B, Vieta E, Colom F.Rates and clinical correlates of treatment nonadherence in schizoaffective bipolar patients. Acta Psychiatr Scand. 2012 May; 125(5): 412−8. ´ [3] Grande I, Bernardo M, Bobes J, Saiz-Ruiz J, Alamo C, Vieta E. Antipsychotic switching in bipolar disorders: a systematic review. Int J Neuropsychopharmacol. 2014 Mar; 17(3): 497–507.
S.05.04 Differentiating schizoaffective and bipolar disorder: a dimensional approach H. Grunze1 ° 1 Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom Categorial definition of Schizoaffective disorder (SA) is inconsistent between ICD and DSM, and the validity of this diagnosis
as a category of its own has frequently been questioned. Neither genetic nor other biological markers as cognitive functioning can clearly differentiate between SA and BD. In bipolar disorder, psychotic symptoms are a common feature and considered rather as an indicator of severity than a illness dimension independent from the affective disorder. However, they may become severe and bizarre to a degree that, as Strakowski et al pointed out, “based on risk factor and clinical history considerations, bipolar disorder may be better classified with schizophrenia in a psychotic cluster than with unipolar depression in an emotional cluster” [1]. Lake and Hurwitz [2] postulated that a single disease, a mood disorder with a broad spectrum of severity, accounts for functional psychoses. Schneiderian first-rank symptoms (FRS) are not exclusive to schizophrenia; they also occur in some bipolar patients although they may be more frequent and more severe in patients with schizophrenia than bipolar disorder. This dimensional view is clearly contrary to recent trends with DSM V classifications where affect is described only as “restricted” and a major affective episode has to be ruled out to allow the diagnosis of schizophrenia. Thus, a dimensional approach to SA by unifying affective and psychotic disorders as suggested by van Os and Kapur [3] may be a possible way to overcome artificial, yet not evidence based boundaries of categorical classification. References [1] Strakowski SM, Fleck DE, Maj M., 2011. Broadening the diagnosis of bipolar disorder: benefits vs. risks. World Psychiatry, 10: 181–186. [2] Lake CR, Hurwitz N., 2006. Schizoaffective disorders are psychotic mood disorders; there are no schizoaffective disorders. Psychiatry Res, 143: 255–287. [3] van Os J, Kapur S., 2009. Schizophrenia. Lancet, 374: 635–645. Disclosure statement: I have received grants/research support, consulting fees, and honoraria within the last 3 years from AstraZeneca, BMS, Otsuka Pharmaceuticals, Cephalon, Desitin, Eli Lilly, Gedeon Richter, Hoffmann LaRoche, Janssen-Cilag, Lundbeck, Merck, Organon, Servier, and UBC.
S.06. Neurobiology of ADHD across the lifespan S.06.01 The genetics of ADHD across the lifespan: tales and reality of common and rare genetic variants B. Cormand1 ° , M. Ribas´es2 , C. S´anchez-Mora2 , I. Garc´ıaMart´ınez2 , R. Bosch3 , M. Bay´es4 , M. Casas3 , J.A. RamosQuiroga3 , International Multicenter Persistent ADHD Collaboration (IMpACT)5 1 University of Barcelona, Facultat de Biologia Departament de Gen`etica, Barcelona, Spain; 2 Hospital Universitari Vall d’Hebron, Psychiatric Genetics Unit, Barcelona, Spain; 3 Hospital Universitari Vall d’Hebron, Department of Psychiatry, Barcelona, Spain; 4 National Center for Genome Analysis (CNAG), Barcelona, Spain; 5 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Twin and family studies document a high heritability, around 75%, for ADHD. However, the precise definition of the molecular genetics landscape of the disorder is still far from being completed. Possibly, the underlying genetic risk factors are numerous and the individual contributions are in general modest, with significant environmental interactions. Genetic research on ADHD has focused so far mainly on common variation, both SNPs and CNVs, with the first GWAS
S.06. Neurobiology of ADHD across the lifespan
References [1] Murru, A., Pacchiarotti, I., Nivoli, A.M., Colom, F., Vieta, E., 2012. Is schizoaffective disorder still a neglected condition in the scientific literature? Psychother Psychosom 81(6): 389–390. [2] Murru, A., Pacchiarotti, I., Nivoli, A.M., Grande, I., Colom, F., Vieta, E., 2011. What we know and what we don’t know about the treatment of schizoaffective disorder. Eur Neuropsychopharmacol 21(9): 680–690. [3] Murru, A., Pacchiarotti, I., Amann, B.L., A.M.A.N., Vieta, E., Colom, F., 2013. Treatment adherence in bipolar I and schizoaffective disorder, bipolar type. J Affect Disord 151(3): 1003–1008.
S.05.03 Switching antipsychotics in schizoaffective disorder: rules and cautions A.M.A. Nivoli1 ° , A. Murru1 , I. Grande1 , E. Vieta1 1 Bipolar Disorder Unit, Cinical Institute of Neuroscience, Barcelona, Spain Schizoaffective disorder (SAD) is a chronic, severe and disabling illness consisting on the concurrent presentation of symptoms of schizophrenia and affective disorders (depression and/or mania) [1] and rates of non-adherence in schizoaffective disorder are high [2]. Patients with more prominent schizophrenia-like characteristics could be at higher risk for poor adherence and need to be closely followed and monitored. Evidence for the treatment of SAD mostly derives from studies based on mixed samples (i.e. schizophrenic and schizoaffective patients) or on extrapolations from studies on schizophrenia or bipolar disorder (BD), and few articles on antipsychotic switching been published [3]. Switching among and between antipsychotics and mood stabilizers has become more common in the treatment of both BD and SAD, in particular, since the introduction of the novel atypical antipsychotics with mood stabilizer properties. In general, antipsychotic switching, regardless of the route of drug administration, was well tolerated in patients and no interference was shown in antipsychotic effectiveness during the interchange of drugs. Metabolic improvement was perceived when the switch involved antipsychotics with a low metabolic risk profile. The evidencebase for antipsychotic switching in SAD and also in BD is scant, and little controlled data is available. Switch from quetiapine to lithium and from risperidone to olanzapine has proven successful. Switching to antipsychotics with low metabolic risk had some positive impact on several safety measures. In stabilized patients, the plateau cross-taper switch may be preferred. References [1] Murru A1, Pacchiarotti I, Nivoli AM, Grande I, Colom F, Vieta E.What we know and what we don’t know about the treatment of schizoaffective disorder. Eur Neuropsychopharmacol. 2011 Sep; 21(9): 680−90. [2] Murru A, Pacchiarotti I, Nivoli AM, Bonnin CM, Patrizi B, Amann B, Vieta E, Colom F.Rates and clinical correlates of treatment nonadherence in schizoaffective bipolar patients. Acta Psychiatr Scand. 2012 May; 125(5): 412−8. ´ [3] Grande I, Bernardo M, Bobes J, Saiz-Ruiz J, Alamo C, Vieta E. Antipsychotic switching in bipolar disorders: a systematic review. Int J Neuropsychopharmacol. 2014 Mar; 17(3): 497–507.
S.05.04 Differentiating schizoaffective and bipolar disorder: a dimensional approach H. Grunze1 ° 1 Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom Categorial definition of Schizoaffective disorder (SA) is inconsistent between ICD and DSM, and the validity of this diagnosis
as a category of its own has frequently been questioned. Neither genetic nor other biological markers as cognitive functioning can clearly differentiate between SA and BD. In bipolar disorder, psychotic symptoms are a common feature and considered rather as an indicator of severity than a illness dimension independent from the affective disorder. However, they may become severe and bizarre to a degree that, as Strakowski et al pointed out, “based on risk factor and clinical history considerations, bipolar disorder may be better classified with schizophrenia in a psychotic cluster than with unipolar depression in an emotional cluster” [1]. Lake and Hurwitz [2] postulated that a single disease, a mood disorder with a broad spectrum of severity, accounts for functional psychoses. Schneiderian first-rank symptoms (FRS) are not exclusive to schizophrenia; they also occur in some bipolar patients although they may be more frequent and more severe in patients with schizophrenia than bipolar disorder. This dimensional view is clearly contrary to recent trends with DSM V classifications where affect is described only as “restricted” and a major affective episode has to be ruled out to allow the diagnosis of schizophrenia. Thus, a dimensional approach to SA by unifying affective and psychotic disorders as suggested by van Os and Kapur [3] may be a possible way to overcome artificial, yet not evidence based boundaries of categorical classification. References [1] Strakowski SM, Fleck DE, Maj M., 2011. Broadening the diagnosis of bipolar disorder: benefits vs. risks. World Psychiatry, 10: 181–186. [2] Lake CR, Hurwitz N., 2006. Schizoaffective disorders are psychotic mood disorders; there are no schizoaffective disorders. Psychiatry Res, 143: 255–287. [3] van Os J, Kapur S., 2009. Schizophrenia. Lancet, 374: 635–645. Disclosure statement: I have received grants/research support, consulting fees, and honoraria within the last 3 years from AstraZeneca, BMS, Otsuka Pharmaceuticals, Cephalon, Desitin, Eli Lilly, Gedeon Richter, Hoffmann LaRoche, Janssen-Cilag, Lundbeck, Merck, Organon, Servier, and UBC.
S.06. Neurobiology of ADHD across the lifespan S.06.01 The genetics of ADHD across the lifespan: tales and reality of common and rare genetic variants B. Cormand1 ° , M. Ribas´es2 , C. S´anchez-Mora2 , I. Garc´ıaMart´ınez2 , R. Bosch3 , M. Bay´es4 , M. Casas3 , J.A. RamosQuiroga3 , International Multicenter Persistent ADHD Collaboration (IMpACT)5 1 University of Barcelona, Facultat de Biologia Departament de Gen`etica, Barcelona, Spain; 2 Hospital Universitari Vall d’Hebron, Psychiatric Genetics Unit, Barcelona, Spain; 3 Hospital Universitari Vall d’Hebron, Department of Psychiatry, Barcelona, Spain; 4 National Center for Genome Analysis (CNAG), Barcelona, Spain; 5 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Twin and family studies document a high heritability, around 75%, for ADHD. However, the precise definition of the molecular genetics landscape of the disorder is still far from being completed. Possibly, the underlying genetic risk factors are numerous and the individual contributions are in general modest, with significant environmental interactions. Genetic research on ADHD has focused so far mainly on common variation, both SNPs and CNVs, with the first GWAS