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June 3–6, 2015, Toronto, Canada

tion. This can damage the anatomical substrates that for example cial functioning. At the brain level, patients with baseline over-
modulate mood, further driving the cycle of illness. Many psycho- weight/obesity had extensive volume reductions compared to
tropic agents such as lithium, antidepressants and atypical antipsy- normal-weight patients in frontal, temporal, and subcortical limbic
chotics impact components of the neuroprogressive cascade. More brain areas, and increased hippocampal glutamate/glutamine.
interestingly, a series of repurposed and novel agents including Patients with 12-month CSWG had additional limbic brain volume
N-acetyl cysteine, statins and anti-inflammatory agents such as sta- loss compared to those without CSWG. Higher weight was
tins and aspirin have neuroprotective potential. strongly associated with greater serum inflammatory cytokines,
which in turn predicted depressive relapse.
Conclusions: Increased weight is a potentially modifiable cause of
clinical and neurobiological illness progression early in the course
Overweight and obesity as risk factors for of bipolar disorder. Weight-related changes in serum biomarkers
clinical and neurobiological illness progression may mediate the association between obesity and outcomes in
bipolar patients.
in early-stage bipolar disorder
D Bond
University of Minnesota, Laboratory for Neuropsychiatric Imaging,
Minneapolis, USA
Allostatic load and neuroprogression
Aims: Up to 75% of people with bipolar disorder (BD) are over- I Grande
weight or obese. Studies in patients with lengthy illnesses, typically Bipolar Disorders Unit, Hospital Clinic de Barcelona, Barcelona,
10–20 years in duration, show that obese patients have worse long- Spain
term outcomes than normal-weight patients, including more mood
Many psychiatric disorders, such as bipolar disorder (BD), follow
episodes, more frequent suicide attempts, lower medication
response rates, and greater disability. However, the association of a progressive path. Clinical, neuroimaging and neurocognitive
obesity with clinical outcomes early in the illness, when long-term studies support the progressive nature of BD. Lithium and psycho-
disease patterns are established, has received less attention. As well, therapy may be less effective if used later in the course of illness.
Moreover, structural brain changes are not consistently found at
the impact of weight on neurobiological illness progression has not
been explored. illness onset and may evolve along with chronicity. Similarly,
Methods: We investigated (1) the association of weight with mood patients with BD may have cognitive deficits that become more
apparent as long as the number of episodes increase. The allostatic
illness severity in a cohort of bipolar patients the 12 months after
their diagnosis of bipolar disorder; (2) determined the impact of load (AL) hypothesis contributes to the understanding of these
weight on neurobiological illness severity and progression, mea- modifications along the course of the illness. This concept provides
sured using MRI; and (3) examined serum inflammatory markers a theoretical explanation of the “wear and tear” that occur in
patients with chronic mental disorders regarding stressors, added
as potential mediating factors between obesity and illness progres-
sion. factors such as substance use and the illness itself. These factors
Results: At recovery from their first mania, patients’ mean BMI may induce modulations on the brain circuits that may lead to
was within the normal range, and only a quarter were overweight/ decreasing responsiveness to therapy, the observed structural
changes and the associated cognitive decline. This remodeling fur-
obese. However, during the first 12 months of maintenance treat-
ment, patients gained a mean of 4.9 kg, and 47% experienced clini- thermore increases the vulnerability to future illness episodes. In
cally significant weight gain (CSWG; ≥ 7% of baseline weight), this lecture, we will portray the concept of allostasis, allostatic load
(AL) and allostatic overload (AO) and their application to explain
resulting a 12-month overweight/obesity rate of over 50%. Patients
the dimensional impact and the neuroprogression of psychiatric ill-
with CSWG spent 23% more time with depression over 12 months
than those without CSWG, and had significantly poorer psychoso- nesses, such as BD.

Symposium VI
Creativity, Artistic Genius and Bipolar Disorder
Chair: Manuel Sanchez de Carmona
Vincent van Gogh, biography, family history and the women in his life, his medical and psychiatric history, his failed
artistic genius careers, and their apparent impact or lack of impact on his artistic
J Calabrese productivity.
Mood Disorders Program, Bipolar Disorders Research Center,
Cleveland, USA
Pyotr I Tchaikovsky, musical creativity and his
Objectives: Detail the interface between van Gogh’s psychiatric
cyclic illness
symptoms and his artistic genius. Describe the exponential increase
M Sanchez de Carmona
in artistic productivity observed during van Gogh’s most impaired
Psiquiatrıa, Centro M
edico Infinito, Mexico City, Mexico
disabling years of life. Carefully detail his Axis 1 disorders using
contemporary diagnostic methodology This presentation will Objectives: Review Tchaikovsky’s biography, artistic creativity and
review Vincent van Gogh’s family history, his relationships with it’s correlation with his history of mental illness, analyze the

© 2015 The Authors


Bipolar Disorders © 2015 John Wiley & Sons A/S, Bipolar Disorders, 17 (Suppl. 1) 11–44 15
17th Annual Conference of the International Society for Bipolar Disorders

relationship between his musical productivity and mood disorder The Bipolar Roadshow – a creative approach to
symptomatology, and describe his interaction with his social envi- educating the audience and fighting stigma
ronment, including the consequences and impairment due to his M Kolbe
disorder. Composer Pyotr Ilych Tchaikovsky is widely considered DGBS, Deutsche Gesellschaft f€
ur Bipolare St€
orungen, Zurich,
the most popular Russian composer in history. His works includes Switzerland
The Sleeping Beauty and The Nutcracker. He struggled with a
mood disorder and a complicated personal life. Tchaikovsky suf- A brief recall of my life as a bipolar composer and musician; retro-
fered from mood swings, anxiety and was hospitalized after he spective of the Bipolar Roadshow which travelled throughout
unsuccessfully attempted to commit suicide. His artistic productiv- Germany in May, 2014.
ity is clearly connected with his psychiatric symptoms and its
impact on his functionality and social interaction.

Symposium VII
Who Benefits from Psychotherapy for Bipolar
Disorder?
Chair: Andrew Nierenberg
Extreme attributions and affective instability The role of age at onset, course of illness and
predict response to psychotherapy for sleep in response to psychotherapy in bipolar
depression in STEP-BD disorder
DJ Miklowitza, JP Stangeb, LG Sylviac, PV da Silva Magalhaesd, E Franka, A Petersb, LG Sylviac, PV da Silva Magalhaesd,
MW Ottoe, E Frankf, NS Hanseng, DD Doughertyc, M Berkh, DJ Miklowitze, MW Ottof, NS Hanseng, DD Doughertyc, M Berkh,
AA Nierenbergc, T Deckersbachc AA Nierenbergc, T Deckersbachc
a
UCLA School of Medicine, Los Angeles, USA, bDepartment of a
University of Pittsburgh, Pittsburgh, USA, bUniversity of Illinois at
Psychology, Temple University, Philadelphia, USA, cMassachusetts Chicago, Chicago, USA, cMassachusetts General Hospital, Boston,
General Hospital, Harvard Medical School, Boston, USA, USA, dUniversidade Federal de Rio Grande de Sul, Porte Alegre,
d
Universidade Federal de Rio Grande de Sul, Porte Alegre, Brazil, Brazil, eUCLA School of Medicine, Los Angeles, USA, fBoston
e
Boston University, Boston, USA, fUniversity of Pittsburgh, University, Boston, USA, gUniversity of Colorado, Boulder,
Pittsburgh, USA, gUniversity of Colorado, Boulder, USA, hDeakin Boulder, USA, hDeakin University and University of Melbourne,
University and University of Melbourne, Melbourne, Australia Melbourne, Australia
Extreme pessimistic attributional style (e.g. “black and white think- Response to pharmacotherapy appears to diminish with greater ill-
ing”) predicts increases in depressive symptoms in bipolar disorder, ness chronicity. However, less is known about whether patients’
particularly when individuals experience life stressors. In STEP- prior course of illness is related to responses to psychotherapy. Dr.
BD, extreme attributions, assessed pre-treatment with the Attribu- Frank will focus on the role of previous mood episodes, age of ill-
tional Style Questionnaire (ASQ), predicted lower likelihood of ness onset, illness duration and sleep as predictors or moderators
recovery (p = 0.01) and longer time until recovery (p < 0.04), inde- of the likelihood of recovery and time until recovery with STEP-
pendent of the effects of manic or depressive symptom severity at BD intensive psychotherapy vs. collaborative care. Independently
baseline. Patients with high affective instability also are at risk for of treatment condition, participants with 1–9 prior depressive epi-
poorer outcomes of depression treatment. In STEP-BD, instability sodes were more likely to recover and had faster time to recovery
of symptoms of depression and mania both predicted a lower likeli- than those with 20 or more prior depressive episodes. Participants
hood of recovery and longer time until recovery, independent of with fewer than 20 prior manic episodes had faster time to recovery
the effects of symptom severity (for all comparisons, p < .05). than those with 20 or more manic episodes. Longer illness duration
predicted a longer time to recovery. Surprisingly, age of onset nei-
ther predicted the rate of or the time to recovery. Participants were
more likely to recover in intensive psychotherapy than collabora-
tive care if they had 10–20 prior episodes of depression (Number
Needed to Treat NNT = 2.0), but equally likely to respond to psy-
chotherapy and collaborative care if they had 1–9 (NNT = 32.0) or
> 20 (NNT = 9.0) depressive episodes. There was no difference in
recovery rates between intensive psychotherapy and collaborative
care for normal sleepers (NNT = 100), but short sleepers
(NNT = 4.6) and long sleepers (NNT = 5.3) were slightly more
likely to recover with intensive psychotherapy than with collabora-
tive care. Limitations of the findings and implications for treating
clinicians will be discussed.

© 2015 The Authors


16 Bipolar Disorders © 2015 John Wiley & Sons A/S, Bipolar Disorders, 17 (Suppl. 1) 11–44

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