New Research Session One: Highlights from the Poster Presentations

Article

Ten of the latest investigations into schizophrenia and bipolar disorder.

Of the 73 posters presented during the first New Research session from 9:00-10:30AM on Monday, May 24, the following stood out from the rest.

A Clinical Comparison Between Early (<15 Years) and Late-onset Bipolar Patients

Poster Number: NR1-39

Researchers: Farah S. Hassan, MD, Elizabeth C. Penick, PhD, Ekkehart

Othmer, MD, PhD, Elizabeth J. Nickel, MA, Cheryln DeSouza, MD, E. N. Hunter, PhD, William F. Gabrielli, MD, PhD

Purpose:“To contrast the clinical histories of early onset (15 and below) and late onset (16 and above) bipolar patients attending a University- sponsored psychiatric clinic.”

Results:With early-onset patients reporting more mania and phobia among biological relatives; meeting criteria for more lifetime psychiatric syndromes for themselves; experiencing a higher prevalence of alcohol dependence, ASPD, somatiziation disorder, OCD, and phobia; reporting greater unhappiness and more problems in childhood; and indicating greater symptomatic distress when first seen when compared to late-onset patients—despite not treatment differences between the groups&mdash;the researchers concluded that early-onset “bipolar patients represent aparticular challenge to the practitioner because their clinicalhistories suggest a more severe and virulent form of theillness.”

A Comparison of Medical Comorbidities in Elderly Versus Younger Bipolar Patients

Poster Number: NR1-41

Researchers: Ilyse Rosenberg, DO, BS, J. Prosser MD, K. Shah,MD, I. Galynker, MD, L. Cohen, PhD, M. Lantz, MD

Purpose: To review “133 patient charts with the diagnosis of bipolar disorder in an urban outpatient clinic setting from June 2006 to September 2007”—67 patients 55 and older, and 66 patients younger than 55&mdash;and compare “the groups based on age, demographic variables, and frequency of co-morbid medical disease.”

Results: Rosenberg, et al found that the “prevalence of geriatric bipolar patients was 4.3% compared to 9.1% for the younger subset. Statistical significance was noted for the elderly group for cardiac (37.3%), dementiarelated illness (6%), GU disease (6%), and musculoskeletal illness (16.4%).” Thus, he explained, the team concluded that geriatric “bipolar patients have more co-morbid medical illness, which can lead to higher rates of medical hospitalization and functional impairment. The management of bipolar disorder is complex and reflects the multiple co-morbid conditions associated with an aging population.”

Seasonal Variation of Mood and Behavior in Bipolar I and Bipolar II Disorders

Poster Number: NR1-43

Researchers: Jungmi Choi, MD, Jihae Noh, MA, Ji Hyun Baek, MD, JiSun Kim, MD, Ji Sun Choi, RN-BSN, Hee Jung Nam, MD,Dongsoo Lee, MD, PhD, Kyung Sue Hong, MD, PhD

Purpose: “To compare seasonal variations of mood and behavior among bipolar I, bipolar II patients and unaffected controls,” as seasonal changes in mood and behavior—described in mood disorders&mdash;“might also be observed in healthy individuals without any mood disorder.”

Results: Choi and colleagues concluded that “patients with bipolar disorder more frequently experience seasonal changes in mood and behavior compared to the healthy control. The difference of global severity of seasonality by bipolar subtype, gender, and age was not significantly observed.”

Beyond Smoking Cessation: Varenicline in Schizophrenia?

Poster Number: NR1-61

Researchers: Durga Bestha, MBBS, Psychiatry, VishalMadaan, MD, Namita Dhiman, MBBS

Purpose: Although it has been hypothesized that varenicline, approved in 2006 for smoking cessation, could help enhance cognitive function in schizophrenia, patients with schizophrenia were excluded from premarketing analysis and recent warnings of aggression, anxiety, suicidal ideation, and emergence of manic and psychotic symptoms have impeded use of the agent in patients with schizophrenia. Thus, Bestha and colleagues sought to review the literature on this topic in an evidence-based manner to discuss these conflicting reports.

Results:Because only a few articles, mostly case reports, were found searching “varenicline, psychosis, schizophrenia,” on Pubmed, Bestha feels the topic “deserves a well-designed study toelicit any benefits on the cognitive and negative symptomdomains which are not really addressed by the availableantipsychotics.”

Facial Emotion Recognition in Chinese with First-episode Schizophrenia: Emotion Specific Deficit and Error Pattern

Poster Number: NR1-62

Researcher: Joey Shuk Yan Leung, MBBS

Purpose: “This study was designed to 1)examine the performance of facial emotion recognition inlocal Chinese with first-episode schizophrenia, 2) investigatethe pattern of identification in specific facial emotions, and3) explore pattern of error in misidentified emotions.”

Results: Yan Leung said he found that impaired “facial emotion recognition was demonstrated in Chinese with first-episode schizophrenia, supporting it as a trait deficit of the illness. The emotion-specific deficit and error may have implications for understanding the behavior and difficulties in schizophrenia.”

Antipsychotics and Long-term Outcome in Schizophrenia: Milan-Stanford Collaborative Project

Poster Number: NR1-64

Researchers: Massimiliano Buoli, MD, FilippoDragogna, MD, Massimo Carlo Mauri, MD, Giobbio GianMarco, MD, Bernardo Dell'Osso, MD, Carlo Altamura, MD,Ira D. Glick, MD

Purpose:To “evaluate the effectiveness in prevention of

recurrences and the tolerability of haloperidol versus atypical

antipsychotics (risperidone, olanzapine, clozapine and

aripiprazole) in patients with schizophrenia.”

Results: Buoli’s team feel their preliminary data—while needing to be confirmed by studies with larger samples and a prospective design&mdash;seem to show “differences in terms of reduced recurrences between haloperidol and atypical antipsychotics, indicating, moreover, for the former, the presence of more frequent side effects, in particular extrapyramidal ones.”

Delusions, Delusional Conviction and Metacognitive Impairments in Patients with Schizophrenia

Poster Number: NR1-66

Researchers: Nicolas Bruno, MD, Nadia Sachs, PhD, Nicolas Franck, MD, PhD, Elisabeth Pacherie, PhD

Purpose:Bruno explains that his research team aimed to test the hypothesis that “metacognitive deficits may play an importantrole in accounting for the persistence of delusional beliefsand thus constitute plausible candidates for the putativefactors.” They also sought to test the hypothesis that “emotionally salient material or content” may be a factor that triggers or exacerbates “metacognitive dysfunction, yielding extreme metacognitive responses.”

Results: Although “all schizophrenic patients present with metacognitive impairments, patients with delusions are more seriously impaired, in particular, on the control dimension of metacognition,” explains Bruno. “However,” he says, “It remains unclear whether emotions favor this metacognitive disruption and need to be tested further. Ultimately, this study supports the fundamental idea that metacognitive remediation could be a first-rate candidate among the psychotherapeutic resources available to relieve schizophrenic patients from their delusional symptoms.”

Predictors of Functional Disability and Number of Hospitalizations in Schizophrenia: Relations with Neurocognition, Symptoms and Premorbid Adjustment

Poster Number: NR1-67

Researchers: Javier Peña, PhD, Pedro Manuel Sánchez, MD,Natalia Ojeda, PhD, Edorta Elizagarate, MD, Jesus Ezcurra,MD, Miguel Gutiérrez, MD

Purpose: Because it is “unclear whether neurocognitivedeficits have a direct effect on functional outcome andclinical improvement or whether that relationship ismediated by additional variables in the illness,” the researchers aimed to analyze “the specific contribution of each variable to theresulting level of functional disability and number ofhospitalizations.”

Results: Peña read his teams’ results, saying that although “negative symptoms were found to be significantly related to functional disability (p< 0.01), positive symptoms were not. Cognitive deficits were significantly related to functional disability (p< 0.01), illness duration (p< 0.01) and number of hospitalizations (p< 0.01). However, these correlations were mediated by processing speed, so that once the effect of processing speed is controlled, the magnitude of the relationship among other cognitive variables and outcome significantly decreases. Additionally, after controlling processing speed, negative symptoms and premorbid adjustment maintain a significant level of prediction on functional disability.”

Comparative Analysis of Involuntary Admission and Voluntary Admission in Schizophrenia: A Three-year Follow Up

Poster Number: NR1-68

Researchers: Seung-Ho Jung, MD, Young-Su Lee, MD, Chul-Eung Kim,PhD

Purpose: “To investigatedifferences between the involuntary hospitalized patientsand voluntary hospitalized patients in schizophrenia.”

Results:Patients who were hospitalized on an involuntary basis were more likely to have lower rates of follow-up retention. Thus, Jung’s team concluded that involuntary “hospitalization may be an important variable as a predictorfor treatment maintenance in patients with schizophrenia.”

Perceive Stress and Psychopathology in Schizophrenia

Poster Number: NR1-73

Researchers: Anders Jørgensen, MD, Anders Fink-Jensen, MD,DMSci, Henrik Enghusen Poulsen, MD, DMSci, MartinBalslev Jørgensen, MD, DMSci

Purpose:To validate the use of the Percevied Stress Scale (PSS) in a schizophrenia population, as prolonged “psychological stress is a precipitatingfactor for the development of psychosis and hasneurobiological effects of relevance to the pathophysiologyof schizophrenia.”

Results: The PSS is applicable and valid in measuring subjective stress in patients with schizophrenia who are able to provide informed consent. Jørgensen adds that the “elevated subjective stress either does not result in an elevated plasma cortisol concentration, or, more likely, a single AM plasma cortisol measurement is not a good estimate of the glucocorticoid reaction to stress.”

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