Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.

To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.

Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.

Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.

AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.

It is not known with certainty how different phenotypes are transmitted in groups of families divided into three generations.

Having meticulously searched for terms of psychopathogic lexicon that best translated the sterile categorical diagnosis, we obtained three dimensional groups for all six families in the three generations.

We calculated the frequencies and percentages of the three dimensional groups for the three generations of families based on sex.

The chi-square TEST attests a p-value = 0.049, statistically significant for the dimensional group “A”. (Tab. 3)

The genetics, and above all the epigenetics, of the phenotypes are periodically transmitted in group “A” and group “C” in the female and male sex. (Graphs 2.1.1 and 2.3.1) Different phenotypes indicate that the complexity of the interactions of the regulatory mechanisms of genes with the environment is extremely significant for the group with the most severe psychiatric pathology.

Severe mental disorders (SMD) are associated with higher morbidity rates and poorer health outcomes compared to the general population. They are more likely to be overweight, to be affected by cardiovascular diseases, and to have higher risk factors for chronic diseases.

To assess physical health in a sample of patients with SMD and to investigate which mental health-related factors and other psychosocial outcomes could be considered predictors of poor physical health.

Patients referring to the psychiatric outpatients unit of the University of Campania “L. Vanvitelli” were recruited, and were assessed through validated assessment instruments exploring psychopathological status, global functioning and stigma. Physical health was assessed with an ad-hoc anthropometric schedule. A blood sample has been collected to assess levels of cholesterol, blood glucose, triglycerides, and blood insulin.

75 patients have been recruited, with a mean age of 45.63±11.84 years. 30% of the sample had a diagnosis of psychosis, 27% of depression and 43% of bipolar disorder. A higher BMI is predicted by higher number of hospitalizations, a reduced score at MANSA (p<.000), and PSP (p<.05), and higher score at ISMI and BPRS (p<.05). A higher cardiovascular risk is predicted by a reduced MANSA score (p<.000), a higher ISMI score and a poorer adherence to pharmacological treatments (p<.05). Higher ISMI score (p<.0001) and number of hospitalizations (p<.05) are predictors of insulin-resistance.

Our study shows that psychosocial domains negatively influence physical health outcome. It is necessary to disseminate an integrated psychosocial intervention in order to improve patients’ physical health.

No significant relationships.

Antidepressants in older people have experienced their increase in medical prescriptions in recent decades whit comorbidity with other pathologies and drug polytherapies. With the use of antidepressants, can be observed side and unwanted effects (e.g. emotional blunting). Vortioxetine is a new antidepressant agent which promises fewer side effects.

To evaluate the clinical efficacy, safety, side effects (e.g emotional blunting) and cognitive profile

45 elderly patients affected by MDD (DSM-5) were recruited in our observational study. All patients were treated with vortioxetine for 12 months. Physiological and pathological parameters were collected at baseline (T0), after 3 months (T1), 6 months (T2); 12 months (T3). All patients were administered the following scales: GDS; MMSE; QLi; ODQ. The statistical data were processed with EZAnalyze.

33.33% of patients had a score in the “unlikely depression” GDS group. The ANOVA ODQ “Total” results indicate that at least two of the repeated measures differ significantly. Data of the “antidepressant as cause” dimension are interesting [T0 vs T3 (P-Unadjusted .000; P-Bonferroni .000; T-value 5.687. MMSE scores are indicative of one small but not significant difference. Mean QLIndex scores did not show statistically significant changes, but are indicative of positive changes from the baseline score

Vortioxetine resulted in partial reduction of depression. There was a moderate non-statistically significant increase in body weight, glycidic and lipid profiles. Overall data highlight the importance and role that vortioxetine can have in the management of depressive symptoms in elderly subjects. The handling, effectiveness and reduced side effects of the molecule are emphasized.

Panic disorder is among the most prevalent anxiety diseases. Although psychotherapy is recommended as first-line treatment for panic disorder, little is known about the relative efficacy of different types of psychotherapies.

To evaluate the effectiveness and acceptability of different types of psychotherapies for adults suffering from panic disorder, with or without agoraphobia.

We are conducting a systematic network meta-analysis of randomized controlled trials examining panic disorder. A comprehensive search was performed to identify relevant studies. The primary efficacy outcome is anxiety symptoms at study endpoint. The primary acceptability outcome is all-cause trial discontinuation at endpoint. Pairwise and network meta-analysis will be conducted. We are considering any kind of psychotherapy delivered by any therapist, as long as they were trained to deliver the therapy, or as self-help.

To date we have identified 126 panic disorder and agoraphobia trials. The publication time span ranges from 1968 to 2020. We are now extracting data to provide an overview of the included study characteristics. The statistical analysis will be conducted between December 2020 and January 2021, and its results presented for the first time at the forthcoming 2021 EPA congress.

126 trials on psychotherapy for panic disorders in adults are available. Because of this huge body of knowledge, it is important that the results of these studies are summarized using network meta-analytic techniques. The findings of this study will guide future research as knowledge gaps will be easily identified. Moreover, policymakers will have the opportunity to use this summarized knowledge to inform evidence-based decision making.

No significant relationships.

Eating Disorders are a frequent pathology, particularly among teenagers, a group characterized by its vulnerability and body dissatisfaction. Social networks (SN) can be a gateway to ED, mainly with Pro-Ana and Pro-Mia resources. Despite the aforementioned, SN can also be helpful for professionals, either as a tool of approach to vulnerable groups or as a way of interaction in patients already diagnosed.

To study the relationship between ED and SN, using the open access evidence available in Pubmed over the last 5 years.

A single-phase computerised search was carried out in Pubmed. The search terms were: (“Anorexia Nervosa”[Mesh] OR “Bulimia Nervosa”[Mesh] OR “Feeding and Eating Disorders”[Mesh] OR “Eating Disorders”[Tiab] OR “Eating Disorder”[Tiab] OR “Disorder, Eating”[Tiab] OR “Disorders, Eating”[Tiab] OR “Anorexia”[Tiab] OR “Bulimia”[Tiab]) AND (“blogging”[Mesh] OR “social media”[Mesh]). The filters applied were: “free Full Text” and publications for the last 5 years.

36.84% studied SN as a positive tool for ED. 47.37% revealed negative influence, only 44.44% focused on Pro-Ana and Pro-Mia. 15.79% provided both positive and negative arguments. The most studied SN were Twitter and Facebook.

Despite the known negative effect that SN can have on ED, they can also be used as a supportive recovery framework. They can be used to identify dangerous behaviours and intervene or as a prevention tool.

No significant relationships.

Bipolar disorder (BD) is one of the most burdensome psychiatric illnesses, being associated with a negative long-term outcome and high suicide rate. Although affective temperaments are considered possible mediators of outcome, their role on the course and outcome of BD remains poorly studied.

The aims of the present study are to describe the clinical characteristics of patients with BD more frequently associated with the different affective temperaments and to verify which affective temperaments are associated with a more severe clinical picture in a sample of patients with BD.

All patients with BD referring to the outpatient units of two Italian university sites have been recruited. Patients’ psychiatric symptoms, affective temperaments, and quality of life were investigated through validated assessment instruments.

199 patients were recruited. 54.8% of patients had a diagnosis of bipolar I disorder. 56.8% of the sample reported at least one episode of aggressive behaviours and 30.2% of suicidal attempt. Predominant cyclothymic and irritable temperaments predicted more frequent relapses, a poorer quality of life (p<;0.05), more aggressive behaviours and suicide attempts (p<;0.01). The predominant hyperthymic disposition was a protective factor for several outcome measures, including relapses and suicidality (p<;0.01), and was correlated with a less severity of psychiatric symptoms and later age at onset (p<;0.05).

Early identification of affective temperaments in BD patients can help clinicians to identify those who could show a worse prognosis. A screening of affective temperaments can be useful to develop early targeted integrated pharmacological and psychosocial interventions.

No significant relationships.

Suicide is one of the major public health concerns worldwide, currently listed as the 15th most common cause of death. Mental illness stigma may contribute to suicidality and is associated with social isolation and low self-esteem among people with affective disorders.

The aim of the present study is to assess, in a sample of people with affective disorders, whether high levels of internalized stigma are associated to suicidal thoughts and behaviours.

60 outpatients diagnosed with depression or bipolar disorder according to DSM-5 have been recruited. Suicidal behaviours and ideation were assessed through the Columbia Suicide Severity Rating Scale (C-SSRS); internalized stigma through the Internalized Stigma of Mental Illness (ISMI) scale. Socio-demographic characteristics have been collected through an ad hoc schedule.

62.9% of the sample was female, with a mean age of 45.7 (±14) years. About half of the sample had a diagnosis of major depression (54.8%). Patients with suicidal ideation reported higher score at ISMI “alienation” subscale (p<0,05), compared to those without suicidal ideation. Patients with a previous history suicide attempts reported higher score at “alienation” and “social withdrawal” ISMI subscales (p<0,05). Moreover, “alienation” ISMI subscale significantly correlated with suicidal ideation and behaviours (p<0,01).

These results are in line with the available literature, highlighting that stigma and suicidality are strongly correlated. This underline the importance of interventions at addressing internalizing stigma, in particular to those with previous suicidal attempts and with an active suicidal ideation.

No significant relationships.

INTRODUCTION TikTok is a social network (SN) that allows users to share short videos about different issues. Since the COVID-19 lockdown, there has been an increase in Pro-Ana and Pro-Mia videos in this specific SN.

OBJECTIVES To know the main characteristics about Pro-Ana and Pro-Mia contents among TikTok users.

METHODS A search was carried out using uncontrolled language with the term “TCA” (ED in English). The study included only Pro-Ana and Pro-Mia resources in Spanish. Resources under the category “recovery” were excluded. A random sample of 16 TikTok was used, since it is enough to estimate, with a confidence of 95% and an accuracy of +/- 20 percentage units, a population percentage that is expected to be around 20%. The studied variables were images, type of resources, “challenges” and misspelled words.

RESULTS In the sample, 68.75% of the profiles were created upon confinement, 56.25% had more than 500 followers and 68.75% had more than 3000 “likes”. 43.75% included more than 30% of ED advocacy content, 18.75% promoted challenges and 37.5% used misspelled words to avoid SN censorship.

CONCLUSIONS There has been a remarkable increase in ED-related content as a result of lockdown. In turn, the increasing number of users who are part of TikTok reveals that this is a SN that can be associated with ED advocacy.

No significant relationships.

This study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention.

A multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group—studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)—or to the active control group, who followed the 5 A’s intervention.

The study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group.

In this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A’s intervention.

To investigate the prevalence of suicidal thoughts and behaviours (STB; i.e. suicidal ideation, plans or attempts) in the Spanish adult general population during the first wave of the Spain coronavirus disease 2019 (COVID-19) pandemic (March−July, 2020), and to investigate the individual- and population-level impact of relevant distal and proximal STB risk factor domains.

Cross-sectional study design using data from the baseline assessment of an observational cohort study (MIND/COVID project). A nationally representative sample of 3500 non-institutionalised Spanish adults (51.5% female; mean age = 49.6 [s.d. = 17.0]) was taken using dual-frame random digit dialing, stratified for age, sex and geographical area. Professional interviewers carried out computer-assisted telephone interviews (1–30 June 2020). Thirty-day STB was assessed using modified items from the Columbia Suicide Severity Rating Scale. Distal (i.e. pre-pandemic) risk factors included sociodemographic variables, number of physical health conditions and pre-pandemic lifetime mental disorders; proximal (i.e. pandemic) risk factors included current mental disorders and a range of adverse events-experiences related to the pandemic. Logistic regression was used to investigate individual-level associations (odds ratios [OR]) and population-level associations (population attributable risk proportions [PARP]) between risk factors and 30-day STB. All data were weighted using post-stratification survey weights.

Estimated prevalence of 30-day STB was 4.5% (1.8% active suicidal ideation; n = 5 [0.1%] suicide attempts). STB was 9.7% among the 34.3% of respondents with pre-pandemic lifetime mental disorders, and 1.8% among the 65.7% without any pre-pandemic lifetime mental disorder. Factors significantly associated with STB were pre-pandemic lifetime mental disorders (total PARP = 49.1%) and current mental disorders (total PARP = 58.4%), i.e. major depressive disorder (OR = 6.0; PARP = 39.2%), generalised anxiety disorder (OR = 5.6; PARP = 36.3%), post-traumatic stress disorder (OR = 4.6; PARP = 26.6%), panic attacks (OR = 6.7; PARP = 36.6%) and alcohol/substance use disorder (OR = 3.3; PARP = 5.9%). Pandemic-related adverse events-experiences associated with STB were lack of social support, interpersonal stress, stress about personal health and about the health of loved ones (PARPs 32.7–42.6%%), and having loved ones infected with COVID-19 (OR = 1.7; PARP = 18.8%). Up to 74.1% of STB is potentially attributable to the joint effects of mental disorders and adverse events−experiences related to the pandemic.

STB at the end of the first wave of the Spain COVID-19 pandemic was high, and large proportions of STB are potentially attributable to mental disorders and adverse events−experiences related to the pandemic, including health-related stress, lack of social support and interpersonal stress. There is an urgent need to allocate resources to increase access to adequate mental healthcare, even in times of healthcare system overload.

NCT04556565

Eating Disorders concern a growing number of people. Several instruments were created to assess symptomatology of Anorexia Nervosa and Bulimia Nervosa. Our aim is to create and validate a short questionnaire about all the eating symptoms of Eating Disorders, including Binge Eating Disorder.

The Questionnaire of Eating Behaviours (Scheda dei Comportamenti Alimentari, SCA) is a self-administered questionnaire composed of 13 items regarding all the eating symptoms of Eating Disorders. Items are divided into 3 scales: Restrictive Eating, Weight Control Practices and Binge Eating. The SCA was given to 200 female outpatients with Eating Disorders and to 218 non-clinical adult women. Student's t test was performed to compare clinical and non-clinical subjects, one-way ANOVA was performed to compare three diagnostic subtypes (Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder). Cronbach's Alpha and factor analysis were used to validate the questionnaire.

Clinical and non-clinical subjects get significantly different scores in all the three subscales. Besides, the three diagnostic subtypes scores significantly differ on each scale. Cronbach's Alpha values show a significant inner consistency in the subscales of Restrictive Eating and Binge Eating, while the Weight Control Practices one is not very homogeneous, as expected. The factor analysis has shown the presence of three factors, corresponding to the 3 scales.

The SCA has shown to be effective in distinguishing people with Eating Disorders from non-clinical subjects. For its characteristics of being short, easy to fill in and to interpret, the SCA seems to be an instrument suitable for screening purposes.

The brain-derived neurotrophic factor (BDNF) seems to be implicated in the neurobiology of depression. The aim of the study was to assess the relationship between the improvement of depressive symptoms during a one-year antidepressant treatment and serum and plasma BDNF levels.

Plasma and serum BDNF levels were assayed using the ELISA method, in 15 drug-free patients with major depression and in 15 healthy control subjects. Blood samples were collected at the baseline and the 2nd week, 1st, 3rd, 6th and 12th month of antidepressant treatment. Patients were naturalistically treated with selective serotonin reuptake inhibitors and tricyclic antidepressants at variable dosage.

At baseline, the mean serum and plasma BDNF levels were significantly lower (p<.05) than those found in the control subjects. However, from the 1st month of treatment, patient plasma BDNF levels did not differ significantly from the values reported in healthy control subjects (p=.079). On the contrary, at each evaluation time, serum BDNF levels in patients were significantly lower than those of the control subjects.

Untreated depressed patients showed reduced baseline serum and plasma BDNF levels, as compared with control subjects. The normalization of plasma BDNF up to the values found in control subjects occurred after 1 month of antidepressant treatment. On the contrary, at every time assessment, patient's serum BDNF levels were lower than those of control subjects suggesting that serum BDNF might represent a non-specific trait marker of depression.