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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S8–S52


More precisely, the mission of the EPA guidance is defined as ‘to

improve quality of mental health care in Europe by disseminat-

ing written information based on best evidence and psychiatric

practice, to facilitate countries learning from each other’.

In consonance with this need of a wider multinational perspective

of Europeanpsychiatry, EPAadopted in2012 through a deep change

of its statutes a new membership structure that allows National

Psychiatric Societies/Associations (NPAs) in Europe the possibil-

ity to become full members of EPA. Up to 40 NPAs corresponding

to 37 countries and representing over 80.000 psychiatrists have

responded positively to the offer and are now part of the Council of

National Psychiatric Societies, the body within EPA that integrates


The Council of NPAs has become, in this way, a forum for its mem-

bers to meet, discuss and work on issues concerning European

psychiatry. One of the major issues is about the implementation

of European guidance in mental health policy, teaching and learn-

ing psychiatry, best clinical practice in different areas, and quality

indicators. This presentation provides further details on how par-

ticipating societies could put these policies and recommendations

into practice.

Disclosure of interest

The author has not supplied his declaration

of competing interest.

Symposium: The natural history of bipolar

disorders: from the age of onset to the long-term



How long is the interval between the

onset and the initial management of

bipolar disorder? A meta-analysis

G. De Girolamo

1 ,

, G

. Signorini

2 , J. D


2 , F. F




Saint John of God Clinical Research Center, Psychiatric Epidemiology

and Evaluation Unit, Brescia, Italy


IRCCS St John of God Clinical Research Centre, UOPEV, Brescia, Italy


To evaluate the length of the interval between the onset

and the initial management of bipolar disorder (BD).


We conducted a meta-analysis using the preferred

reporting items for systematic reviews and meta-analyses guide-

lines. Systematic searches located studies reporting estimates

of the age of onset (AOO) and indicators of the age at initial

management of BD. We calculated a pooled estimate of the inter-

val between AOO and age at management. Factors influencing

between-study heterogeneity were investigated using sensitivity

analyses, meta-regression, and multiple meta–regression.


Twenty-seven studies, reporting 51 samples and a total

of 9415 patients, met the inclusion criteria. The pooled estimate

for the interval between the onset of BD and its management was

5–8 years (standardized difference, .53; 95% confidence interval, .45

to .62). There was very high between-sample heterogeneity (I2 ¼

92.6; Q ¼ 672). A longer interval was found in studies that defined

the onset according to the first episode (compared to onset of symp-

toms or illness) and definedmanagement as age at diagnosis (rather

than first treatment or first hospitalization). A longer interval was

reported among more recently published studies, among studies

that used a systematic method to establish the chronology of ill-

ness, among studies with a smaller proportion of bipolar I patients,

and among studies with an earlier mean AOO.


There is currently little consistency in the way

researchers report the AOO and initial management of BD.

However, the large interval between onset and management of BD

presents an opportunity for earlier intervention.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.


Cognitive impairment in bipolar:

Neurodevelopmental or


A. Young

Institute of Psychiatry, Psychology and Ne, London, United Kingdom


Bipolar Disorders (BD) are common and complex

diseases. Recent findings have provided evidence that impairments

in cognition are evident in the various sub-groups of Bipolar Disor-

der and persist after resolution of acute episodes.


An opinion paper based on a narrative review of the



Quantifiable cognitive deficits are clearly found in Bipolar

1 and Bipolar 2 Disorders. These persist after recovery from acute

episodes. The aetiopathogenesis of these phenomena is likely to

be multifactorial. It seems clear that these cognitive impairments

are not in general neurodevelopmental and for most are related

to repeated episodes of illness

[1] .

However, the issues of sub-

groupswith differential profiles of impairment and the trajectory of

cognitive change remain to be fully established. The effects of puta-

tive treatments (e.g., pharmacological, neurostimulation, cognitive

remediation) are at an early stage of evaluation.


Future efforts should focus on further integrating

the current and emerging research findings into a coherent model,

which generates testable hypotheses and allows treatment effects

to be tested.

Disclosure of interest

Employed by King’s College London Hon-

orary Consultant SLaM (NHS UK)

Paid lectures and advisory boards for all major pharmaceutical

companies with drugs used in affective and related disorders

No share holdings in pharmaceutical companies

Lead Investigator for Embolden Study (AZ), BCI Neuroplasticity

study and Aripiprazole Mania Study

Investigator initiated studies from AZ, Eli Lilly, Lundbeck, Wyeth

Grant funding (past and present): NIMH (USA) CIHR (Canada)

NARSAD (USA) Stanley Medical Research Institute (USA) MRC (UK)

Wellcome Trust (UK) Royal College of Physicians (Edin) BMA (UK)

UBC-VGH Foundation (Canada) WEDC (Canada) CCS Depression

Research Fund (Canada) MSFHR (Canada) NIHR (UK).


[1] Lewandowski KE, Cohen BM, Ongur D. Evolution of neuropsy-

chological dysfunction during the course of schizophrenia and

bipolar disorder. Psychol Med 2011;41(2):225–41.


Impact of age at onset on the

long-term course of bipolar disorder

R. Kupka

VU University Medical Center, psychiatry, Amsterdam, The



Bipolar disorder (BD) typically starts in adolescence

or young adulthood (early-onset; EO-BD), whichmay have different

backgrounds and consequences than late-onset (LO) BD. There are

controversies over pre-pubertal age of onset (AoO).


To give an overview of the various concepts of AoO in

BD, the impact of AoO on subsequent illness course, and findings of

the Stanley Foundation Bipolar Network (SFBN) with relationship

to AoO.