Self-Report, Young Adult Self-Report and Teacher’s Report
`Form) and Kiddie-SADS-Lifetime Version (K-SADS-PL) were
`used to assess 132 13–23-year-old-offspring of bipolar parents.
`Results: Rating scale scores for bipolar offspring showed few
`differences with problem scores for normative adolescents. Forty-
`nine percent of the sample had a lifetime psychiatric disorder, most
`commonly (33%) a mood disorder.
`level of psychopathology of bipolar
`Conclusions: The overall
`offspring was not highly elevated compared to that found for the
`general population. However, whenever bipolar offspring were
`more deviant, it was especially in the domain of mood disorders
`that they showed problems.
`Acknowledgements: This study was financially supported by NWO
`(Dutch Organization for Scientific Research) and by the Stanley
`Medical Research Institute.
`Key words: adolescents, bipolar disorder, psychopathology
`
`59
`Effects of family psychoeducation on relatives of
`bipolar patients
`M. Reinares*, E. Vieta, F. Colom, A. Martínez-Arµn, C. Torrent,
`M. Comes, A. Benabarre, J. M. Goikolea and J. Sµnchez-Moreno
`Bipolar Disorders Program, Hospital Clínic de Barcelona, Stanley
`Foundation Research Center, Spain
`
`Background: Several studies support that family intervention as
`adjunctive therapy to pharmacological treatment may improve the
`outcome of bipolar patients and the family functioning. Some
`findings show that family beliefs about the illness might predict
`family burden, and this burden could condition the outcome of
`bipolar disorder.
`Methods: Relatives of 45 bipolar outpatients were divided into an
`experimental (n ¼ 30) and a control group (n ¼ 15). Patients were
`in remission for at least 3 months. All the patients received
`standard pharmacotherapy. Relatives of the experimental group
`received 12 psychoeducational 90 min-sessions about bipolar
`disorder. The bipolar disorder knowledge, the relationship sub-
`scales of the Family Environment Scale (FES), and the family
`burden subscales of the Social Behaviour Assessment Scale (SBAS)
`were assessed for both groups before and after the intervention.
`Results: After the intervention, relatives of experimental group
`significantly improved in bipolar disorder knowdlege, and reduced
`both the subjective family burden and their view on the role of the
`patient in the objective family burden. There were no statistical
`differences neither in the objective burden nor in the family
`environment subscales.
`Conclusions: Family psychoeducation improves bipolar disorder
`knowledge, reduces the stress of the relatives and decreases their
`view on the role of the patient in the objective family burden.
`Acknowledgements: This work was supported in part by the
`Theodore and Vada Stanley Research Foundation (Bethesda,
`USA) and by a grant from the Fondo de Investigaciones Sanitarias
`(FIS 01 ⁄ 1489).
`
`60
`Do personality disorders contribute to a 'false positive'
`diagnosis bipolar disorder?
`M. L. Rosso1,*, E. J. Regeer1, M. ten Have2, W. Vollebergh2,
`A. Forsthoff3 and W. A. Nolen1,3
`1Altrecht Institute for Mental Health Care, Utrecht, 2Trimbos Institute,
`Utrecht, 3University Medical Center Utrecht, Utrecht, The Netherlands
`
`Purpose of the study: According to the Dutch epidemiological
`population study into the prevalence of mental disorders in the
`general population (NEMESIS) (1) in which the CIDI was used,
`2.4% of the population suffers from a bipolar disorder. Recently a
`
`Abstracts
`
`reappraisal study using DMS-IV criteria found that of the 80
`persons diagnosed with a bipolar disorder based on the CIDI, only
`33 were diagnosed as such based on the SCID. The high false
`positive rate when using the CIDI may be explained by personality
`disorders interfering with the Axis I disorders. Personality charac-
`teristics of the group of false positives (subjects diagnosed as
`bipolar with the CIDI and not with the SCID) will be compared to
`personality characteristics of the subjects diagnosed with a bipolar
`disorder using both CIDI and SCID and SCID alone.
`Methods: All patients who participated in the study also completed
`the self-report Personality Disorders Questionnaire for DSM-IV
`(PDQ-4+).
`Results: Results are currently being analysed.
`Acknowledgements: This study was supported by an unrestricted
`grant from Eli Lilly.
`Key words: bipolar disorder, personality disorders
`Reference
`1. Ten Have M, Vollebergh W, Bijl R, Nolen WA. Bipolar disorder in the
`general population. Prevalence, consequences and care utilization.
`Results from the Netherlands Mental Health Survey and Incidence
`Study (NEMESIS). J Affective Disorders 2002; 68: 203–213.
`
`61
`Quetiapine versus placebo as adjunct to mood
`stabilizer for the treatment of acute mania
`G. Sachs1,* , J. A. Mullen2, N. A. Devine2 and D. E. Sweitzer2
`1Harvard Bipolar Research Program, Boston, MA, USA,
`2AstraZeneca, Wilmington, DE, USA
`
`Objective: To evaluate the efficacy, tolerability and safety of que-
`tiapine as adjunct therapy to lithium (Li) or divalproex (DVP) in
`the treatment of acute mania in patients with bipolar disorder.
`Methods: Adult inpatients meeting DSM IV criteria for Bipolar I
`Disorder, manic episode, were randomly assigned to 21 days of
`treatment with a mood stabilizer and placebo (PBO ⁄ MS) or
`quetiapine (QTP ⁄ MS) under double blind conditions. Prior to
`randomization, the study clinician assigned all patients to treatment
`with Li or DVP and tapered nonstudy medications. Mood stabilizer
`was titrated to therapeutic levels (Li 0.7–1.0 mEq ⁄ L; DVP 50–
`100 lg ⁄ mL), and dosing guidelines instructed clinicians to titrate
`study drug to maximize efficacy and tolerability within the range of
`200–800 mg. Psychiatric assessments and vital sign measurements
`were performed at baseline and days 4, 7, 10, 14, and 21. The a priori
`primary outcome measure was change in Young Mania Rating
`Scale (YMRS) score from baseline to final assessment (LOCF);
`results were analyzed using ancova. Additional assessments included
`CGI-BP, MADRS, PANSS, and GAS scores. Safety and tolerab-
`ility assessments included adverse events, the modified Simpson-
`Angus Scale, and the Barnes Akathisia Rating Scale.
`Results: 56 of 90 patients (62.2%) receiving QTP ⁄ MS completed
`the study, while 49 of 100 (49.0%) patients receiving PBO ⁄ MS
`completed. The mean of the median quetiapine dose during the last
`week of treatment was 500 mg. QTP ⁄ MS treated patients had a
`significantly greater change in YMRS compared to PBO ⁄ MS (LS
`Mean changes of )13.76 and )9.93, respectively; P ¼ 0.021).
`Significantly more quetiapine-treated patients achieved a 50%
`reduction in YMRS scores (QTP ⁄ MS, 54.3%; PBO ⁄ MS, 32.6%;
`P ¼ 0.005). Change in CGI-BP severity score was significantly
`greater for the quetiapine group (LS Mean changes of )1.38 and
`)0.78, respectively; P ¼ 0.001). The most common adverse events
`noted in QTP ⁄ MS patients (310% and twice the rate of PBO ⁄ MS)
`were somnolence, dry mouth, asthenia, and orthostatic hypoten-
`sion. Discontinuation due to adverse events was similar (QTP ⁄ MS,
`5.6%; PBO ⁄ MS, 6.0%).
`Conclusions: These results demonstrate the superior efficacy of
`quetiapine over placebo as adjuncts to treatment with mood
`stabilizers for acute mania. Quetiapine was safe and well tolerated.
`
`133
`
`1 of 2
`
`Alkermes, Ex. 1014
`
`

`
`Abstracts
`
`This is the first double-blind placebo-controlled trial to examine the
`efficacy, tolerability, and safety of quetiapine as adjunct treatment
`in adults with acute mania.
`Acknowledgements: This study was funded by AstraZeneca.
`Key words: antipsychotics, bipolar disorder, mood stabilizers
`
`62
`Neuropsychological performance in depressed and
`euthymic bipolar patients
`J. Sµnchez-Moreno*, A. Martínez-Arµn, E. Vieta, F. Colom, M. Reinares,
`A. Benabarre, C. Torrent, M. Comes and M. Salamero
`Bipolar Disorders Program, Hospital Clínic i Provincial de Barcelona,
`Stanley Foundation Research Center, Spain
`
`studies have suggested the presence of
`Introduction: Recent
`enduring cognitive dysfunctions
`in bipolar patients even in
`remission states. Most studies dealing with cognitive disturbances
`in affective disorders have focused on alterations during depressive
`episodes, often without differentiating unipolar and bipolar
`patients. Other methodological pitfalls are unclear remission
`criteria and small sample size.
`Methods: Several domains of cognitive function were examined in
`30 depressed bipolar patients (DSM-IV criteria for major depres-
`sion, HDRS ‡ 17) and 30 euthymic bipolar patients (at least
`6 months of remission, HDRS £ 8 and YMRS £ 6).
`Results: The two groups showed a similar pattern of neuropsy-
`chological performance. However, the depressed group was signi-
`ficantly more impaired on verbal fluency tasks compared to the
`euthymic group.
`Conclusions: Neuropsychological impairment in bipolar patients
`may be enduring, even between episodes. Further research inclu-
`ding longitudinal designs will be required to evaluate changes on
`cognition in these patients.
`Acknowledgements: This study was supported by a grant from the
`Stanley Research Foundation, Bethesda, MD, USA.
`
`63
`sICAM-1 and depressive symptoms during interferon-a
`treatment
`M. Schaefer1,*, M. Horn2, F. Schmidt2, M. Schmid-Wendtner3,
`M. Ackenheil2, M. Volkenandt3 and M. Schwarz2
`1Department of Psychiatry, CharitØ, Humboldt-University, Schumannstr.
`20 ⁄ 21, D-10117 Berlin, 2Department of Psychiatry, Ludwig-Maximilians-
`University, Nußbaumstr. 7, D-80336 Munich, 3Department of
`Dermatology, Ludwig-Maximilians-University, D-80337 Munich, Germany
`Interferon-a (IFN-a)
`is frequently associated with
`treatment
`psychiatric side-effects, such as depression with suicidal thoughts,
`irritability and manic episodes. Thus, IFN-a induced psychiatric
`side-effects can be used as a clinical model for studying immuno-
`logical changes during IFN-a induced mood changes. However,
`mechanisms by which peripheral administrated IFN-a modulates
`central nervous system remain unknown. Cell adhesion molecules
`as ICAM-1 are possibly involved in an increased permeability of
`the blood brain barrier (BBB) and known as useful markers for the
`activity of immune response in animal models of MS. Recently
`ICAM-1 expression on cerebral endothelial cells has also been
`associated to late life depression. Therefore we hypothesized, that
`soluble ICAM-1 is induced by IFN-a treatment, may affect the
`BBB and is possibly associated with IFN-a induced depression. In
`a prospective study, serum levels of soluble ICAM-1 and depressive
`symptoms were measured using the Zung self-rating scale (SDS) in
`patients with malignant melanoma during adjuvant IFN-a treat-
`ment. Scores for SDS and the serum levels of sICAM-1 increased
`highly significant between baseline and the third month of
`
`134
`
`treatment (p < 0.001). The increase of sICAM-1 was positively
`correlated to SDS-values after three treatment months. Our data
`indicate a correlation between IFN-a induced depression and
`serum sICAM-1 levels and support the hypothesis of a causal
`relationship between sICAM-1 levels and depressive symptoms,
`possibly by modulating the BBB permeability. This model could
`help to understand dynamic immunological processes during
`(bipolar) affective disorders.
`
`64
`Introduction of an electronic life-chart for bipolar
`patients
`L. O. Schärer1,*, V. Hartweg1, M. Graf1, G. Valerius1, M. Hoern1,
`C. Biedermann1, S. Walser1, A. Boensch1, S. Dittmann2, A. Forsthoff2, B.
`Hummel2, H. Grunze2 and J. Walden2
`1Christophsbad Hospital Goeppingen, 2Department of Psychiatry of the
`Universities Freiburg and Munich, Germany
`
`Introduction: A combination of different drugs is more the rule
`than the exception in the treatment of bipolar disorder. As
`scientific data on combination therapy is sparse, drugs are chosen
`symptom-orientated and intuitive. Due to longitudinal intrasubject
`variability of symptoms, it can be very difficult to make clinical
`decisions about the success of individual drug for a patient. The
`NIMH Life-Chart Method (LCM), a sophisticated long-term
`monitoring method can be extremely helpful
`in this situation.
`However, due to the efforts needed to obtain continuous graphical
`summaries, which become necessary after some months, the LCM
`is restricted to special projects. Automation of data-entry and
`graphical processing can make this method available for every days
`clinical use.
`Methods: The NIMH Life-Chart Method (LCM) was adopted for
`a common palmtop computer (Palmpilot M100). Fifty Patients
`that have demonstrated their understanding of the LCM for at
`least 2 month are now using the electronic Palm Life-Charts
`(PLC). Like with the paper based LCM, Mood, Impairment of
`Function, Drugs, Side-Effects, Life-Events, etc. are recorded each
`day. Using a modified modem a single button action synchronizes
`the PLC with a server, which automatically sends a printed life-
`chart to the patient. PLC is evaluated versus LCM.
`Results: Feedback from patients is mostly positive. On average
`learning the method is perceived as easy – even without computer
`experience. Average time consumption is 1–2 min ⁄ day. Patient
`satisfaction is high. Total cost of ownership is very much lower
`than for the LCM.
`Conclusion: This feasibility study shows that the electronic PLC is
`a viable alternative to the paper based LCM.
`Acknowledgements: We gratefully acknowledge the support of
`the German Society for Bipolar Disorder (DGBS e.V) and the
`Theodore and Vada Stanley Foundation.
`Key words: bipolar, life-chart, palm
`
`65
`Serum cytokines and soluble ICAM-1 during depressive
`and manic episodes in patients with bipolar disorders
`M. Schaefer1, R. Neumer1, F. Schmidt2,*, A. Forsthoff2, B. Amann2,
`B. Hummel2, H. Grunze2, M. Ackenheil2 and M. Schwarz2
`1Department of Psychiatry, CharitØ, Humboldt-University, Berlin,
`2Department of Psychiatry, Ludwig-Maximilians-University, Munich,
`Germany
`
`Over the past decade immunological changes are freqently reported
`in animal models of depression or patients with affective or
`psychotic disorders. Proinflammatory cytokines might directly or
`indirectly trigger immune response and some cytokines such as
`
`2 of 2
`
`Alkermes, Ex. 1014