In recent years, the increasing use tendency of NPS has motivated both awareness and concern about their identification and potential harmfulness. Synthetic cathinones represent a significant proportion of the NPS available and methylone is one of the most frequently found in Europe.

The aim of the present study is to determine methylone presence and characteristics from the samples analyzed by Energy Control between the years 2009 and 2015 in Spain.

From all 21,198 samples analyzed from august 2009 to august 2015, only those in which methylone was found are studied (n = 140). The samples have been analyzed by Energy Control, a spanish harm-reduction NGO that offers to users the possibility of analyzing the substances they intend to consume. The analysis is done by gas chromatography–mass spectrometry.

From the 140 samples containing methylone, 87 were handled as methylone, 20 as MDMA, 8 as other synthetic cathinones and 25 as other substances. The peak of consume was registered in 2011 with 41 samples then the number decreased until 10 samples in 2015.

Results suggest that methylone is most frequently handled as methylone or as MDMA and that its consumption could be decreasing. Further pharmacokinetic, pharmacodynamic, clinical and epidemiological studies should be conducted to enhance the knowledge not only about methylone consumption, but also about synthetic cathinones in general in order to assess their potential risk and study the complications and its management.

The authors have not supplied their declaration of competing interest.

New psychoactive substances (NPS) are substances that have recently appeared on the market and are not under international control. NPS use is experiencing an unprecedented increase. DiPT, 4-HO-DiPT and 4-AcO-DiPT are new psychoactive tryptamines and their effects may differ from those of other psychoactive tryptamines.

To explore the presence of DiPT, 4-HO-DiPT and 4-AcO-DiPT from samples delivered to and analyzed by Spanish harm reduction service Energy Control.

All samples analyzed from 2009 to 2014 delivered as DiPT, 4-HO-DiPT and 4-AcO-DPT or containing these substances. Analysis was performed by gas chromatography–mass spectrometry.

From 17,432 samples, 4-HO-DiPT was found in 16, delivered as 4-HO-DiPT (6); 4-AcO-DiPT (7); DiPT (1); 4-AcO-DMT (1) and cocaine (1). 4-AcO-DiPT was found in 16, delivered as 4-AcO-DiPT (12); 5-MeO-DMT (1); 5-MeO-DiPT (1); 4-AcO-DMT (1) and cocaine (1). Only 4 samples contained DiPT, all presented as DiPT. Nine samples contained both 4-AcO-DiPT and 4-HO-DiPT. During the years of study, 4-HO-DiPT deliverance was increasing (4 samples in 2014) while deliverance of 4-AcO-DiPT and DiPT was decreasing (1 sample in 2014).

Increasing 4-HO-DiPT presence could translate a progressive replacement of 4-AcO-DiPT and DiPT recreational use. Clinical relevance comes from its growing use and the absence of scientific evidence on humans, therefore relying on users subjective experience to predict the effects.

The authors declare that they have no competing interest.

The recommendations of duration of treatment for alcohol use disorders (AUD) in clinical guidelines are based on consensus decisions. There is a risk that patients will receive too little or too much therapy. We hypothesize that there is an association between duration and effect up until a point where the effects of treatment diminish.

A systematic review and meta-analysis of randomized controlled trials of psychosocial interventions in the alcohol outpatient treatment centers. Population: adults (> 17 years) suffering from AUD treated with at least two sessions of therapy.

Multiple linear regression analysis with outcome measured in percentage of days abstinent (PDA), percentage of heavy days drinking (PHD), drinks per drinking day (DDD) and/or proportion of participants abstinent (ABS) as a function of duration of treatment.

Forty-four studies with 8485 participants were included. Mean duration: 18 (8–82) weeks and 15 (2–36) sessions. Mean follow-up time: 43 (8–104) weeks with a mean of 5 (2–18) research assessments. Only ABS was significantly associated with duration of treatment; ABS increased with 1.6%-point (P < 0.01) with each additional week in treatment. Surprisingly the analysis showed that each research assessment increased PDA with 11%-point (P < 0.001), decreased PHD with 4%-point (P < 0.05) and decreased DDD with 8%-point (P < 0.001).

Duration of treatment was associated positively with proportion of participants abstinent but not percentage of days abstinent drinks per drinking day or percentage of heavy drinking days. The three latter outcomes were affected positively by number of research assessments.

The authors have not supplied their declaration of competing interest.

Longitudinal studies on how temperament is related to alcohol use in general population are scarce.

Finding relations with temperament and problematic alcohol use using prospective birth cohort data.

To investigate trends in self-reported alcohol consumption in adulthood.

In the Northern Finland Birth Cohort 1966 (n = 5247), alcohol use was studied with questionnaires at ages 31 and 46. Participants were classified into abstainers, bingers, heavy drinkers, steady drinkers, increasers or reducers based on the change in consumption (g/day). Cloninger's TCI-scores were calculated for each group. Multinomial regression analysis was conducted with TCI-scores as factors influencing the change in alcohol consumption.

High novelty seeking was associated with increased consumption, binging and heavy drinking among both sexes at both time points (P < 0.01). Lower persistence was associated with increased consumption at both time points among men and among women at age 46. Baseline novelty seeking predicted both increasing (OR 1.1; 95% CI: 1.0–1.1) and reducing (1.1; 1.0–1.1) for men and for women also increasing (1.1; 1.0–1.1) and reducing (1.1; 1.0–1.1), but when adjusted with baseline alcohol use novelty seeking only predicted increasing for men (1.0; 1.0–1.1).

High novelty seeking and low persistence are associated with problematic alcohol use among middle-aged Northern Finns. Gender differences in predictors existed: novelty seeking predicted increase only for men in the adjusted model. Temperament scores do not seem to affect strongly changes in alcohol use.

The authors have not supplied their declaration of competing interest.

The objective of current study was to investigate whether associaction exist between depression and low BMD during menopausal and post-menopausal period.

A cross-sectional descriptive study and 1650 women aged 45–65 years were included during 1182 women agreed to participate (71.6%). Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory (BDI) was administered for depression purposes.

A total of 1182 women agreed to participate and responded to the study. The mean age and SD of the menopausal age were 48.71 ± 2.96 with depressed and 50.20 ± 3.22 without depressed (P < 0.001). Also, the mean and SD of postmenopausal age were 58.55 ± 3.27 depressed and 57.78 ± 3.20 without depressed (P < 0.001). There were statistically significance differences between menopausal stages with regards to number of parity, and place of living. There were statistically significance differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, vitamin D deficiency, calcium deficiency and sheesha smoking habits. Overall, osteopenia and osteoporosis and bone loss were significantly lower in post-menopausal women than in menopausal women (P < 0.001). Similarly, T-score and z-score were lower with depressed menopause and postmenopausal women (P < 0.001).

The multivariate logistic regression analyses revealed that the depression, the mean serum vitamin D deficiency, calcium level deficiency, less physical activity, co-morbidity, number of parity, systolic and diastolic blood pressure and sheesha smoking habits were considered as the main risk factors associated with bone mineral loss after adjusting for age, BMI and other variables.

The author has not supplied his/her declaration of competing interest.

To determine correlation between depression, anxiety and stress in menopausal and post-menopausal women and shedding more light on a complex relationship.

A cross-sectional descriptive study was used and 1468 women aged 45–65 years were included and 1101 women agreed to participate (75.0%). Depression, anxiety and stress were measured using the Depression Anxiety Stress Scales (DASS-21). Data on body mass index (BMI), clinical and other parameters was used.

A total of 1101 women agreed to participate after informed consent was obtained. The mean age and SD of the menopausal age was 49.55 ± 3.12, the mean and SD of postmenopausal age was 58.08 ± 3.26 (P < 0.001). There were statistically significant differences between menopausal stages with regards to age, ethnicity, educational status, occupation status, and place of living. Also, there were statistically significant differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, vitamin D deficiency, and diseases. Depression and anxiety were more common among post-menopause women. Also, there were no differences between the groups regarding the frequency of certain levels of stress among menopause and post-menopause. Multivariate regression analyses revealed that age in years, diastolic BP, consanguinity, regular exercise were predictor for depression. Meanwhile, diastolic BP, occupation and physical activity considered the main risk factors for anxiety. Furthermore, age in years, occupation and sheesha smoking habits were considered as the main risk factors associated with stress.

A large number of factors were associated with experiencing menopausal and psychosocial problems which had negative effects on the quality of life among Arabian women.

The author has not supplied his/her declaration of competing interest.

Obsessive compulsive disorder (OCD) is one of the most common psychiatric chronic disorders (prevalence 2–3%) and has been associated with various neurocognitive impairment, including visual memory function. Although the relapse rate of OCD is highly considerable, little is known regarding the relationship between neurocognitive dysfunction and the chronicity of the illness, mainly because there are confounding factors as the medication effect. Therefore, we compared the difference of neurocognitive functions of the first-episode, medication-naive OCD patents to chronic, medication-naïve OCD patients.

We defined the first-episode (FEOCD) if the illness duration was less than 3-year by DSM-IV criteria. Twenty-one FEOCD and 28 chronic OCD patients performed Korean version of the Wechsler Adult Intelligence Scale (K-WAIS), the Trail Making Test (TMT). All the participants were medication-naïve.

There was no differences in the severity of illness (YBOCS), depressive symptoms (Hamilton depression rating scale), general anxiety symptoms (Hamilton anxiety rating scale). FEOCD group showed significant impairment on the block design subtest of the K-WAIS (P = 0.04, t = 1.294).

These results suggest that visual spatial cognitive dysfunction in patients with OCD may deteriorate as the untreated duration of illness get longer.

The authors have not supplied their declaration of competing interest.

Pharmacodynamics of serotonergic antidepressants differently influencing on serotonin reuptake receptors is poorly investigated.

To compare biochemical profiles at patients with anxious depression under treatment with tianeptine–serotonin reuptake enhancer and sertraline–selective serotonin reuptake inhibitor.

Platelet monoamine oxidase (MAO) and serum amine oxidase (AO) activities, level of middle mass endotoxic molecules (MMEM) and serum albumin functional properties – effective albumin concentration (EAC) and reserve of albumin binding (RAB) were investigated at 43 patients with anxious depression (F 32.1 and F 33.1). Clinical severity of illness was assessed using Hamilton Depression (21 items) and Hamilton Anxiety Scales. All patients were divided in two groups: group I (21 person) received tianeptine (37, 5 mg/day), group II – sertraline (50 mg/day).

It was established that patients with anxious depression were characterized by significant increase in MAO activity (by 95%) and the level of MMEM (by 86%) and significant decrease in AO activity (by 28%) and EAC and RAB parameters by 43 and 38%, respectively, in comparison with healthy volunteers. Under tianeptine and sertraline treatment, there were revealed contrary directed changes of all investigated parameters.

Results of study show that both tianeptine and sertraline are equally effective in treatment of anxious depression. Present biochemical investigation, however, suggest that underlying biochemical changes are more complete following tianeptine treatment.

The authors have not supplied their declaration of competing interest.

The aim of this study was to determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder by means of retrospective reviews of medical records.

The medical records of 250 patients with a diagnosis of major depressive disorder for at least 5 years were retrospectively reviewed for this study. We reviewed DSM-IV diagnosis and detailed clinical information at the index admission with assessments made every year after discharge to determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder.

Receiver operating characteristic curve analysis indicated cut-off scores for recurrent depressive episode of more than three times (area under curve = 0.647, sensitivity = 0.435, specificity = 0.819, positive predictive value = 0.351, negative predictive value = 0.865).

These findings suggest that it could predict the best diagnostic conversion from unipolar depression to bipolar disorder when depressive episodes are recurrent more than three times. Based on these findings, it will be able to promote the accuracy of diagnosis and the efficiency of treatment.

The authors have not supplied their declaration of competing interest.

To determine the frequency of first rank symptoms in manic patients.

The cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. One hundred and twenty manic patients were recruited from November 2014 to May 2015.FRS was assessed by administration of validated Urdu version of Present State Examination (PSE) tool.

The mean age of the patients was 37.62 + 12.51. The mean number of previous manic episode was 2.17 + 2.23. In total, 11.2% males and 30.6% females had FRS. This association of first rank symptoms with gender in patients of mania was found to be significant with a P value of 0.008. All-inclusive, 19.2% exhibited FRS in their course of illness, 43.5% had thought broadcasting, made feeling, impulses, action and somatic passivity, 39.1% had thought insertion, 30.4% had auditory perceptual distortion, and 17.4% had thought withdrawal. However, none displayed delusional perception.

The study confirms the presence of FRS in mania in both male and female, irrespective of the duration of current manic illness or previous number of manic episodes. A substantial difference was established between both the genders.

The authors have not supplied their declaration of competing interest.

Patients affected by severe manic episode, often with delusional symptoms, are commonly treated with a combination of mood stabilizers, antipsychotics and other sedatives. The choice of a specific drug, dose and term is still debated.

A naturalistic study on a sample of 84 inpatients affected by acute severe mania treated with a combination therapy.

To compare efficacy and tolerability of haloperidol/risperidone/quetiapine in association with lithium and/or valproate.

Eighty-four bipolar inpatients affected by a manic episode according to DSM-5 criteria. Drugs administered according to our best practice. Clinical course weekly monitored with Young Mania Rating Scale (YMRS) for 4weeks. Extrapiramidal side effects (EPSE) monitored with Saint Hans Rating Scale (SHRS).

Twenty-five men (29.76%) and 59 women (70.24%); mean age 43.37 ± 13.58 years. Mean YMRS score T0 40.27 ± 9.04. Forty-one patients (48.81%) treated with haloperidol (3.4 mg/die); 16 (19.05%) with risperidone (4.3 mg/die); 27 (32.14%) with quetiapine (438 mg/die). The 3 groups showed no difference regarding clinical characteristics and YMRS basal scores. Chi2 analysis confirmed an higher response rate (50% of reduction of YMRS final score compared to T0) with haloperidol (χ2 = 14.88; P = 0.00). The repeated-measures model analysis showed a significant decrease (P < 0.05) in YMRS scores in haloperidol vs. risperidone vs. quetiapine patients for all time points from second week. No statistical difference for EPSE was found.

We suggest that haloperidol could be advisable in the treatment of severe mania, with rapid efficacy, even with low doses. Occurrence of EPSE was not considerable during the acute treatment. Studies with a larger sample size, randomization, fixed doses, double blind design are needed.

The authors have not supplied their declaration of competing interest.

Geriatric-onset of a first-episode mania is a rare psychiatric condition, which may be caused by a heterogeneous group of non-psychiatric conditions. To confirm late-onset bipolar disorder (LOBD) diagnosis, secondary-mania causes should be ruled out.

To provide a comprehensive review reporting prevalence, features, differential diagnosis, comorbidity and treatment of LOBD.

The literature was systematically reviewed by online searching using PubMed®. The authors selected review papers with the words “Late-onset mania” and/or “Late-onset bipolar” in the title and/or abstract published in the last 10 years.

With population ageing, LOBD is becoming a more prevalent disorder. Clinical presentation may be atypical and confounding, making the diagnosis not always obvious. Several non-psychiatric conditions must be considered in an elderly patient presenting with new-onset mania, namely stroke, dementia, hyperthyroidism or infection causing delirium. Only then LOBD diagnosis may be done, making that an exclusion diagnosis. Comorbidities, such as hypertension or renal insufficiency are often present in the elderly and must be taken into account when choosing a mood stabilizer.

LOBD remains a complex and relatively understudied disorder with important diagnostic and therapeutic implications. This diagnosis must be kept in mind for every elderly patient presenting with new-onset mania. Further investigations could contribute to a better understanding of LOBD etiopathogenesis and to set out better treatment guidelines.

The authors have not supplied their declaration of competing interest.

To assess the efficacy of an innovate telemedicine psyeducational treatment (TPT) based on a psychoeducational intervention (21 sessions) with an additional support through telemedicine which has 12 videos versus treatment as usual (TAU) based on psychiatry reviews. Specifically, the objective was to evaluate patients’ efficacy of psyeducational treatment with telemedicine (TPT) in the fuctionalitity, depressive symptoms and manic symptoms.

Thirty-eight patients with bipolar disorder were included in the study and randomly distributed in the two groups. The telemedine treatment is performed through a www.puedoser.es web platform provided by Astra Zeneca. In the web platform is available forums, emails and digital-course with the sessions worked as a reminder. In order to assess the effectiveness of treatments, FAST scale was administered at baseline and 6 months after the intervention. To obtain the results we used coparative data analysis.

In patients, we found a low daily functionality. The main issues were: interpersonal cognitive area (t = –2.611; P = 0.014) and interpersonal-area (t = –2.617; P = 0.014). We found, at baseline, that TPT group had worse overall results in daily functionality (t = –2.876; P = 0.008). After intervention, there is an improvement in the daily functionality of the TPT group. This improvement occurred in cognitive area (z = –3.24; P < 0.001), leisure area (z = –1.85; P = 0.065) and interpersonal area (z = –1.72; P = 0.086).

The psychoeducational program combined with telemedicine shows to be more effective than TAU in the improvement of general patient functioning in bipolar disorder patients.

The authors have not supplied their declaration of competing interest.

The SIMPLe project was designed with the aim of developing a smartphone application (i.e. app) to monitor and psychoeducate subjects with bipolar disorder through highly personalized messages from both passive and active data. The project was based on a face-to-face group program, which has an increasing scientific evidence of its efficacy and cost-effectiveness reducing bipolar disorder relapses.

An initial feasibility study was conducted to evaluate the usability and satisfaction of an Android version of the SIMPLe app 1.0.

The SIMPLe feasibility study was conducted from March 2015 to June 2015. The participation in the study was offered to a consecutive sample of adult patients diagnosed of bipolar disorder I, II or NOS (not otherwise specified) attending the outpatient mental health clinic of the Hospital Clinic of Barcelona, Spain.

The participation in the study was offered to 72 stable bipolar patients. Forty-three subjects were enrolled in the study. Since the day the patients were enrolled in the study, the rate of completed tests was 0.74 per day and 1.13 per week. Nine emergency alerts were received through the application and notified to the reference patients’ psychiatrists. Ninety-five percent of the initial participants remained actively using the app and no relapses were identified during the 3 months of the study.

These preliminary results suggest a high feasibility of the SIMPLE app based on the rates of tasks completed and retention.

The authors have not supplied their declaration of competing interest.

Most of the studies have indicated that there have been neurocognitive impairments especially in the domains of executive functions, attention, verbal and working memory among euthymic patients with bipolar disorder type I (BD-I). However, there has been limited research investigating neurocognitive functioning in euthymic patients with BD- II.

Aim of this study was to investigate neurocognitive functions in euthymic BD-II patients. Our hypothesis was that euthymic BD-II patients would have neurocognitive impairments in the domains of executive functions, attention, verbal and working memory.

Euthymic BD-II patients (n = 37) and healthy controls (HC) (n = 35) were compared in terms of their neurocognitive functioning in the domains of executive functions assesed by the number of perseverative errors, non-perseverative errors and category completed on the Wisconsin Cart Sorting Test (WCST); working memory assessed by Auditory Consonant Trigrams (ACT); immediate verbal memory assessed by the Logical Memory subscale of the Wechsler Memory Scale I (WMS I) and attention assesed by Stroop Colour-Word Interference Test (SCWIT). Euthymic state was confirmed by the low scores both on Hamilton Depression Rating Scale, Young Mania Rating Scale.

Significant differences were found between two groups in terms of WCST non-perseverative errors (Z = 3.8, P < 0.01) and category completed subtests (Z = 3.8, P < 0.01), ACT (t = 2.97, P < 0.01) WMSI (Z = 2.4, P = 0.01), SCWIT (t = 3.52, P < 0.01) performances.

Our study indicated that euthymic BD-II patients had poorer performance on the domains of executive functions, attention, working memory and verbal memory than the HC group. But future studies with large samples are needed to support our results.

The authors have not supplied their declaration of competing interest.

Several studies have analyzed the influence of bipolar disorder (BD) related to many kinds of functioning. Even if it is obvious that patients in relapse have poor quality of live (QoL), what's about it in interictal phases with subthreshold symptoms?

To study the potential relationship between QoL and subthreshold symptoms in bipolar I patients in remission.

To evaluate the above relationship, we hypothesized that subsyndromic BD phases can be related to worse subjectively QoL.

This was a cross-sectional study. Forty-four BD patients were enrolled. The subthreshold symptoms were evaluated by Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Patients with HDRS lower than 7 and YMSR lower than 6 were the successful applicants. Then, we run the Tunisian version of SF-36 to measure the QoL.

Twenty-seven men and seventeen women with an average age of 39.3 years were selected. Age of beginning of BD was 31.5 years and patients were in relapse since 1.56 years. The HDRS's average score was 2.73. Twenty patients (45.5%) have an HDRS upper than 4. The YMRS's average score was 2.25 and twenty-nine BD's patients have a score between 1 and 6. The overall average score at SF-36 scale were 64.2 and 25% of BD patient with subthreshold symptoms had a poor QoL.

Subsyndromic interictal phases affect the QoL of BD patients and it's necessary to introduce therapy adapted according to troubles in order to improve patient's quality of life and functioning.

The authors have not supplied their declaration of competing interest.

It is important to make an early and effective intervention from the first bipolar episode. The presence of depressive symptoms in the course of a manic episode could influence negatively the evolution and the prognosis of the patient. Inflammation and oxidative stress are also related with functionality.

To explore the relationship between depressive symptoms during a first episode of mania, inflammatory parameters and patient functionality during the follow-up.

We included in the study 92 are patients with a first manic episode and 92 matched healthy controls. We compared 13 inflammatory/oxidative stress parameters measured at baseline (TFNα, IL6, PGE2, MCP1, TBARS, NO2, SOD, CAT, GSHTOT, GSSG, GSHfree, GPx, TAS) between both groups. Between patients, 46 presented pure mania (PM) (no depressive symptoms) and 46 mixed mania (MM) (with depressive symptoms). We explored the influence of inflammatory factors in functionality, exploring differences between PM and MM. To measure patients’ general functioning one year after illness onset, we used the Functional Assessment Short Test (FAST).

We found significant differences in TFNα, MCP1 and TBARS (higher in patients) and in SOD, GSHtot, GSSG, GSHfree, GPx and TAS levels (lower in patients). Only In MM group, there was a significant influence of SOD and GSHfree in FAST scores suggesting that a higher antioxidant levels at baseline the patient functionality improves one year after.

Some parameters of oxidative stress at baseline are related with patient's functionality one year after the first episode of mania, but only when mania debuts with depressive symptons simultaneously.

The authors have not supplied their declaration of competing interest.

In spite of more studies dedicated to the topic of sexual disorders among schizophrenic patients or to the sexual effects of antipsychotics and antidepressants, few studies entangle broadly the issue of sexual attitudes and behaviors of bipolar patients, due partly to the heterogeneity of the disorder and the variety of episodes, and treatments.

To establish if special sexual patterns are specific to depressive or manic episodes and if the sexual disorders are related to the severity of the mood episodes.

To compare depressive, manic, and matched controls regarding their sexuality.

The current study is an observational cross sectional study, carried out on 173 women, among them 112 bipolar, diagnosed according to ICD-10 criteria (81 depressive, and 31 manic), and 61 controls. All subjects fulfilled the Sexual Disorders Interview (SDI), Female Sexual Function Index (FSFI) and to bipolar patients BDI, YMRS have been administered.

Female bipolar patients were significant less sexual active than controls, depressive women being less interested in sexuality than manic patients; there were not significant differences between the two patients’ samples regarding the frequency of sexual intercourse, degree of psychopathology. Sexual problems on FSFI were detected in 75% of bipolar patients, both bipolar groups emphasizing difficulties in arousal, lubrication and sexual satisfaction.

The issue of sexual problems in bipolar female patients is delicate to investigate and often neglected, being difficult to ascertain to the mood disorder itself or to different treatments the patients have been exposed to, or to stigma.

The authors have not supplied their declaration of competing interest.

Management of bipolar disorder is limited by absence of laboratory test. While alterations related to multiple biological pathways have been found in bipolar disorder, findings have not translated into clinically applicable biomarkers. We previously found promise for a combined gene expression biomarker. The combination of gene expression and proteomic biomarkers could have potential as a meaningful clinical test.

To identify a composite biomarker based on multiple potential peripheral biomarkers related to neuroplasticity, inflammation and oxidative stress, both on a proteomic and gene expression level.

To test the ability of a composite biomarker to discriminate between bipolar disorder patients and healthy control subjects and between affective states in bipolar disorder patients.

mRNA expression of a set of 19 candidate genes and protein levels of immune markers and neurotrophic factors were measured in peripheral blood mononuclear cells and combined with urinary levels of oxidized nucleosides of 37 rapid cycling bipolar disorder patients in different affective states (depression, mania and euthymia) during a 6–12-month period and in 40 age- and gender-matched healthy control subjects. A composite measure was constructed in the first half of the sample and independently validated in the second half of the sample. The composite measure was evaluated using ROC curves and by calculating sensitivity and specificity.

Statistical analysis is ongoing. Results will be presented at the congress.

A peripheral composite biomarker based on multiple biological pathways on both proteomic and gene expression levels may have potential as a clinically applicable biomarker.

The authors have not supplied their declaration of competing interest.

Guidelines for the maintenance treatment of bipolar disorder discourage the use of antidepressants chiefly on grounds of unproven efficacy and risk if mania for bipolar I. However, for patients stabilised on an antidepressant, naturalistic data support its continued use.

The aim is to describe use of antidepressants in patients with bipolar disorder in remission seen at an outpatient clinic in Singapore.

The case notes of patients with bipolar disorder in remission, seen by psychiatrist in an outpatient psychiatric clinic in a general hospital unit from December 2014 to March 2015 were studied. Data describing the age, sex, type of bipolar disorder and psychotropic medications prescribed, was obtained.

Forty-two patients were included, of which 13 (31%) were male and 29 (69%) were female. The age ranged from 23 to 82, with mean age of 47 years. Of these 17 (40%) had bipolar I and 25 (60%) had bipolar II. Antidepressant use for maintenance treatment was present in 19 out of 42 (45%) of these patients; of these 7 out of 17 (41%) were bipolar 1 and 12 out of 25 (48%) were bipolar II. Eighteen out of the 19 (95%) patients who were prescribed antidepressants were on combination treatment with mood stabilizers. Antidepressant type included SSRI (37%), NDRI (37%), SNRI (10.5%), TCA (10.5%), NASSA (5%).

Almost half of patients with bipolar disorder managed in an individual practice were on antidepressants together with mood stabilisers. They remained in remission with combination treatment, which did not seem to jeopardise their condition.

The authors have not supplied their declaration of competing interest.