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


Disclosure of interest

AM received honoraria or advisory

board/consulting fees from the following companies: Janssen

Pharmaceuticals, Otsuka, Pfizer and Pierre Fabre.

SG received honoraria or advisory board/consulting fees from

the following companies: Lundbeck, Janssen Pharmaceuticals,

Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and



Progressive brain changes associated

with persistent negative symptoms

following a first episode of psychosis

M. Lepage

1 ,

, M. Carolina


, B. Michael


, C. Mallar


, J. Ridha



M. Ashok



McGill University, Psychiatry, Montreal, Canada


McGill University, integrated program in Neuroscience, Montreal,


Corresponding author.

Early persistent negative symptoms (ePNS) refer to the presence

of potentially idiopathic or primary negative symptoms and have

been observed following a first episode of psychosis (FEP). There is

evidence for cortical changes associated with ePNS and given that

a FEP often occurs during a period of ongoing brain development

and maturation, neuroanatomical changes may have a specific age

related component. The current study examined cortical thickness

(CT), hippocampal/amygdala volume and shape as a function of

clinical trajectories and age using longitudinal structural imaging

in FEP. T1-MRI scans were acquired for early (


= 21), secondary



= 30), non-(


= 44) PNS patients with a FEP, and controls (


= 44).

Cortical thickness and amygdalar–hippocampal volumes and sur-

face area (SA) metrics were extracted from three time points over

a two-year period. Linear mixed models were applied to test for

a main effect of group, and age group interactions. Relative to the

other groups


ePNS patients showed cortical thinning over time in

temporal regions and a thickening with age primarily in prefrontal

areas. They also exhibited reduced left amygdalar and right hip-

pocampal volumes. Morphometry revealed decreased surface area

in ePNS compared to other groups in left central amygdala. The

current study demonstrates that FEP patients with ePNS show sig-

nificantly different CT trajectories with age. Increased CT may be

indicative of disruptions in cortical maturation processes within

higher-order brain regions. Amygdalar-hippocampal changes with

age are also linked to ePNS with converging results from volumet-

ric and morphometric analyses. Taken together, these results could

represent dynamic endophenotypes setting these ePNS patients

apart from their non-symptomatic peers.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

Symposium: New avenues in the management of

bipolar disorder


Mania and depression: What’s new?

A. Fagiolini

1 ,

, G. Amodeo



University of Siena, School of Medicine, Siena, Italy


University of Siena, Molecular Medicine, Siena, Italy

Corresponding author.

Despite the high burden of bipolar disorder and the noticeable

progress in its treatment, the disorder still goes frequently mis-

diagnosed, unrecognized, or not optimally treated. To date, no

medication has been specifically developed on the basis of a precise

understanding of the pathophysiology of the disorder, or based on

the unique characteristics of several subtypes of bipolar disorder or

on the medication mechanism of action. Lithium remains on of the

gold standard treatments for bipolar disorder. Its mood-stabilizing

properties are thought to occur via specific cellular signaling path-

ways, such as inhibition of glycogen synthase kinase 3, which

is considered to regulate cellular apoptosis. Divalproex, carba-

mazepine and several atypical antipsychotics are also approved for

bipolar disease Evidence also suggests that antipsychotics show the

ability to treat and prevent mania and/or depression but are often

burdened by side effects such as sedation, hortostatic hypotension

and weight gain. Hence, while it is clear that there still are sev-

eral unmet needs especially for what pertains tolerability, efficacy

for specific subtypes, and predictability. Novel and more effective

treatments are needed and researchers are currently engaging in

targeted drug development for bipolar illness, aimed at improv-

ing pharmacological strategies with marked and sustained effects.

A variety of newer medications are being tested. Some of these

drugs target pathways that are similar to those targeted by lithium,

while others focus on newer targets, such as opiate receptor and


-methyl-D-aspartate (NMDA) receptors. Newer and older treat-

ment strategies for bipolar disorder will be presented and critically


Disclosure of interest

Andrea Fagiolini is/has been a consultant

and/or a speaker and/or has received research grants fromAllergan,

Angelini, Astra Zeneca, Boehringer Ingelheim, Pfizer, Eli Lilly, Ferrer,

Janssen, Lundbeck, Novartis, Otsuka, Roche.


The role of long acting antipsychotics

in bipolar disorder

E. Vieta

Hospital Clinic de Barcelona, Psychiatry Bipolar Disorders Program,

Barcelona, Spain

Antipsychotics are widely used for the short and long-term

treatment of bipolar disorder. Depot and long-acting injectable for-

mulations (LAIs) can be particularly useful for certain subgroups

of patients. This lecture will discuss the available data from ran-

domized controlled trials of LAIs in bipolar disorder. A recently

published meta-analysis and individual studies assessing depot

medications, as well as modern LAIs such as risperidone, paliperi-

done and aripiprazole, will be reviewed, looking carefully into the

prevention of either pole of illness and tolerability. Potential indi-

cations and patient profile, based on data and clinical experience,

will be discussed.

Disclosure of interest

The author has not supplied his declaration

of competing interest.


Managing cognitive dysfunction in

bipolar disorder

K. Miskowiak

University Hospital of Copenhagen, Psychiatric Centre, Copenhagen,


Cognitive dysfunction, including memory and concentration diffi-

culty, is an emerging treatment target in bipolar disorder. However,

a key challenge in the management of these cognitive deficits

is the lack of treatments with robust effects on cognition. Fur-

ther, it is unclear how cognitive dysfunction should be assessed

and addressed in the clinical treatment of the disorder. This talk

will review the evidence for cognitive impairment in bipolar dis-

order, including its severity, persistence and impact on patients’