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IntroductionBipolar disorders (BD) are chronic and recurrent psychopathological conditions characterized by therapeutic failures (TFs), regardless of the initial choice of psychiatric medication with a high prevalence of adverse drug reactions (ADRs). Cytochrome P450(CYP)2D6 genetics has been recently suggested to have a role in the response to treatment and extra-pyramidal symptoms (EPS) across several psychiatric conditions.ObjectivesTo evaluate interindividual differences in CYP2D6 enzyme activities, TFs and ADRs rates in BDs patients.AimsTo tailor psychiatric medication choice and dose based on pharmacogenetic test.MethodsWe analyzed 16 clinical relevant polymorphisms CYP2D6 genotype in Psychiatric Unit of Foggia using the InfinitiTM Analyzer; the Simpson Angus Scale (SAS) was used to measure drug-induced EPS and Brief Psychiatric Rating Scale-24 (BPRS-24) response to treatment.ResultsTen drug-resistant patients were consecutively enrolled, and six of these experience major ADR during therapy with worsening of symptoms before screening for CYP polymorphism: BM (*2A/*5 genotype, BPRS-24 T0: 63, T14: 51), SR (*2A/*4, BPRS-24 T0: 66, T14: 59), LT (*4/*17 BPRS-24 T0: 72, T14: 64), DC (*2A/*4A BPRS-24 T0: 69, T14: 54), AL (*2A/*2A, BPRS-24 T0: 72, T14: 64), PA (*2A/*2A BPRS-24 T0: 52, T14: 46).ConclusionsAccording to the specific CYP2D6 polymorphism, we personalized patients’ treatment considering that poor and extensive metabolizers have different rates of ADR and responses to treatment. CYP2D6 genotype's knowledge is useful for the reduction of therapeutic attempt during patient clinical history, thus reducing admission time and costs, and to guide clinicians toward a better patient management.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe validity of the 30-item Geriatric Depression Scale (GDS-30) in detecting late-life depression (LLD) requires a certain level of cognitive functioning. Further research is needed in population-based setting on other socio-demographic and cognitive variables that could potentially influence the accuracy of clinician rated depression.ObjectiveTo compare the diagnostic accuracy of two instruments used to assess depressive disorders [(GDS-30) and the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID)] among three groups with different levels of cognitive functioning (normal, Mild Cognitive Impairment – MCI, Subjective Memory Complain – SMC) in a random sampling of the general population 65+ years.MethodsThe sample, collected in a population-based study (GreatAGE Study) among the older residents of Castellana Grotte, South-East Italy, included 844 subjects (54.50% males). A standardized neuropsychological battery was used to assess MCI, SMC and depressive symptoms (GDS-30). Depressive syndromes were diagnosed through the SCID IV-TR. Socio-demographic and cognitive variables were taken into account in influencing SCID performance.ResultsAccording to the SCID, the rate of depressive disorders was 12.56%. At the optimal cut-off score (≥ 4), GDS-30 had 65.1% sensitivity and 68.4% specificity in diagnosing depressive symptoms. Using a more conservative cut-off (≥ 10), the GDS-30 specificity reached 91.1% while sensitivity dropped to 37,7%. The three cognitive subgroups did not differ in the rate of depression diagnosis. Educational level is the only variable associated to the SCID diagnostic performance (P = 0.015).ConclusionsAt the optimal cut-off, GDS-30 identified lower levels of screening accuracy for subjects with normal cognition rather than for SMC (AUC 0.792 vs. 0.692); educational attainment possibly may modulate diagnostic clinician performance.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionSeveral studies have reported controversial links between swallowing disturbances (SD) and psychiatric disorders in older age. The available data on the epidemiology of SD in the general population are scarce and often conflicting, because of numerous methodological factors source of possible counfounders.ObjectivesWe aimed to screen the presence of psychiatric and cognitive disorders associated with SD in a random sampling of the general population ≥ 65.MethodsA sample of 1127 elderly individuals collected in a population-based study (GreatAGE) in Castellana Grotte (53,50% males, mean age 74.1 ± 6.3 years), South-East Italy, were mailed a validated self-report questionnaire to assess SD (Eating Assessment Tool-EAT10). Psychiatric disorders and symptoms [assessed with Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders, Geriatric Depression Scale-30 (GDS-30) and Symptom Checklist Revised-90 (SCL-90R)], cognitive functions were assessed with a comprehensive neuropsychological battery, neurological exam, and demographics were compared in participants with and without SD using t-tests and Mann–Whitney U-test.ResultsThe prevalence rates of SD amounted at 5.97%. Psychiatric diagnosis (24.22% of the sample) was statistically significant associated with SD (EAT ≥ 3, P = 0.038), and a trend was found for major depressive disorder and generalized anxiety disorder. Among SCL-90R domains, only anxiety showed a significant association with EAT ≥ 3 (P = 0.006). GDS-30 score was found to be higher in subjects with SD (P = 0.008). Cognitive functions did not differ between the two groups except for an increasing trend for Clinical Dementia Rating Scale in EAT ≥ 3 (P = 0.058).ConclusionsThese preliminary results showed an association between SD in older age and late-life major depression and anxiety disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionCognitive dysfunctions concerning working memory, attention, psychomotor speed, and verbal memory are a disabling feature of the bipolar disorder (BD). According to scientific literature, cognitive disturbances are present not only in depressive and manic phases of BD, but also during the euthymic period, without regard to whether or not drugs are assumed.ObjectiveTo determine the presence of one or more dysfunctions in cognitive domains in a sample of subjects suffering from BD, in euthymic phase, compared with healthy controls.AimsEvaluation of the following cognitive performances in subjects affected by BD: speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition.MethodsForty-six patients affected by BD in the euthymic phase (mean age: 43.17 years old; 39.13% male), and 58 healthy controls (mean age: 39.21 years old; 51.72% male) were enrolled in the psychiatric unit of Azienda Sanitaria Locale, Foggia. The neuropsychological battery MATRICS Consensus Cognitive Battery (MCCB) was administered by trained psychiatrists.ResultsWe found the presence of cognitive impairment, affecting six out of seven of cognitive functions assessed (P < 0.001): speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving.ConclusionsThese preliminary results from our case-control study show that cognitive deficits are clearly present also during the euthymic phases of subjects with bipolar disorder (mainly pertaining attention/vigilance domain). These cognitive abnormalities may represent a biomarker of bipolar disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionAccording to scientific literature, cognitive impairment is a disabling feature of the bipolar disorder (BD), present in all the phases of the disease. Obesity and metabolic disorders represent another risk factor for cognitive dysfunctions in BD, since the excess of weight could adversely influence several cognitive domains.ObjectiveTo highlight the presence of impairment of cognitive functions in a sample of subjects suffering from BD and obesity.AimsEvaluation of the cognitive performance in a sample of BD patients, considering their anthropometric measures (height and weight) and body mass index (BMI).MethodsThe neuropsychological battery MATRICS Consensus Cognitive Battery (MCCB) was administered by trained physicians for the evaluation of seven different cognitive domains in 46 patients (mean age: 43.17 years old; 39.13% male), affected by BD enrolled in the psychiatric unit of Azienda Sanitaria Locale and University of Foggia. In particular, cognitive functions assessed were speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition. BMI was calculated, and patients were divided into a group of normal weight and another one of overweight or obese, on the base of BMI value (BMI cut-off = 25).ResultsThe obese patients amounted at 56.52%. We have found the presence of cognitive deficits in two of the seven domains assessed, that are speed of processing (P < 0.01) and reasoning and problem solving (P < 0.05) in the sample of overweight patients.ConclusionsCognitive deficits are clearly revealed in BD patients during the euthymic phase of the disorder. The obesity in BD could contribute to increase dysfunctions in cognitive domains.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionDepression is a common disorder in late-life. Structured clinical interviews may be less efficient compared to self-administered questionnaires, but provide more accurate findings in terms of diagnosis. No population-based studies with both these depression assessment instruments have been ever performed.ObjectivesTo estimate the GDS-30 accuracy for depression assessment against the gold standard [Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID)] in subjects 65+ years in a random sampling of the general population.MethodsThe sample was collected in a population-based study (GreatAGE) conducted among elderly residents in Castellana, Southeast Italy. It includes 597 participants (57.62% males, mean age 73 years). Depression was assessed through the GDS-30 and the SCID, both double-blinded administered respectively by a trained neuropsychologist and psychiatrist. The GDS-30 screening performances were analyzed using ROC curves.ResultsAccording to the gold standard SCID, the rate of depressive disorder was 10.22% (15.81% of women; 6.1% of men) while with GDS-30 instrument 12.06% of the residents met the depression cutoff. Only 36.1% of GDS cases were true positive. At the optimal cutoff score (> 5), GDS had 62% sensitivity and 81% specificity. Using a more conservative cutoff (> 9), the GDS-30 specificity reached 91% while sensitivity dropped to 43%.ConclusionsThese preliminary results from the first population-based study that compares GDS-30 and SCID showed that the GDS-30 identified adequate levels of screening accuracy (AUC 0.76) compatible with scores established in community settings.FundingPRIN2009E4RM4Z.Disclosure of interestThe authors have not supplied their declaration of competing interest.