European Psychiatry - Volume 33 - March 2016

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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805 S409
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV186
The late-onset bipolar disease: A case
report
A. Lopes ∗ ales
Hospital Garcia de Orta, Psychiatry, Almada, Portugal
∗ Corresponding author.
The prevalence of bipolar disorder after 65 years is 0.1 to 0.4%.
Mania represents 4.6% to 18.5% of all psychiatric admissions in
geriatrics in the USA. It has some specificity in terms of clinical
presentation, evolution, prognosis and treatment.
We report the case of a patient who presented a first manic episode
after 65 years. E.H, AP, 67 years old, single, without personal and
familial psychiatric history, addressed to psychiatric emergencies
for psychomotor agitation and euphoric mood. He presented two
months ago a manic access with almost total insomnia, eupho-
ria, psychomotor agitation and delusions of grandeur. The balance
sheet reveals no incorrections (blood count, thyroid balance, serol-
ogy: TPHA, VDRL, hepatitis B and C, HIV). The cerebral CT was
normal. The patient has been received a quetiapine 200mg/day,
olanxapine 10mg/day and valproate 1000mg/day. The evolution
after three weeks was favorable.
The late-onset bipolar disorder is characterized by: a less intense
euphoria, replaced by anger and irritability, a more elements of
persecution, disinhibiting and impulsivity. Respecting to that, this
case is an exception. The most common confounding symptoms
and behavioral disorders. A higher frequency of neurological dis-
eases is noted in elderly subjects with a bipolar disorder and, so,
a neuropsychiatric rigorous evaluation is fundamental to exclude
the possibility of an organic pathology for the manic access. The
prescription of psychotropic drugs in the elderly must be under
monitoring.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV187
Control of attention in bipolar
disorder: Effects of perceptual load in
processing task-irrelevant facial
expressions
J. Grave , S. Soares , N. Madeira ∗, P. Rodrigues , T. Santos ,
C. Roque , S. Morais , C. Pereira , V. Santos
1 University of Aveiro, Department of Education, Aveiro, Portugal
2 Center for Health Technology and Services Research CINTESIS-UA,
Department of Education, University of Aveiro, Aveiro, Portugal
3 Coimbra Hospital and University Centre, Department of Psychiatry,
Coimbra, Portugal
4 University of Beira Interior, Department of Psychology and
Education, Covilhã, Portugal
5 Baixo-Vouga Hospital Centre, Department of Psychiatry and Mental
Health, Aveiro, Portugal
6 Coimbra Hospital and University Centre, Psychiatry, Coimbra,
Portugal
∗ Corresponding author.
Bipolar disorder (BD), along with schizophrenia, is one of the most
severe psychiatric conditions and is correlated with attentional
deficits and emotion dysregulation. Bipolar patients appear to be
highly sensitive to the presence of emotional distractors. Yet, no
study has investigated whether perceptual load modulates the
interference of emotionally distracting information. Our main goal
was to test whether bipolar patients are more sensitive to task-
irrelevant emotional stimulus, even when the task demands a high
amount of attentional resources.
Fourteen participants with BD I or BD II and 14 controls, age-
and gender-matched, performed a target-letter discrimination task
with emotional task-irrelevant stimulus (angry, happy and neu-
tral facial expressions). Target-letters were presented among five
distractor-letters, which could be the same (low perceptual load)
or different (high perceptual load). Participants should discrimi-
nate the target-letter and ignore the facial expression. Response
time and accuracy rate were analyzed.
Results showed a greater interference of facial stimuli at high
load than low load, confirming the effectiveness of perceptual
load manipulation. More importantly, patients tarried significantly
longer at high load. This is consistent with deficits in control of
attention, showing that bipolar patients are more prone to dis-
traction by task-irrelevant stimulus only when the task is more
demanding. Moreover, for bipolar patients neutral and angry faces
resulted in a higher interference with the task (longer response
time), compared to controls, suggesting an attentional bias for
neutral and threating social cues. Nevertheless, a more detailed
investigation regarding the attentional impairments in social con-
text in BD is needed.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV188
Clinical overlap between behavioral
variant of frontotemporal dementia
and bipolar disorder: A case report
P. Oliveira , C. Roque , V. Santos , N. Madeira ∗
1 Coimbra Hospital and University Centre, Psychiatry, Coimbra,
Portugal
2 Faculty of Medicine, University of Coimbra, Psychological Medicine,
Coimbra, Portugal
∗ Corresponding author.
The behavioral variant of frontotemporal dementia (FTD) often
begins with psychiatric symptoms, including changes in personal
conduct and/or interpersonal behavior. Prior to developing cog-
nitive impairment, differentiating FTD from primary psychiatric
disorders might be challenging.
This work presents a case of a manic episode with psychotic fea-
tures in a 61-year-old man, whom personality changes and daily
life difficulties arouse and persist after optimal management of
the active manic and psychotic symptoms. Neuropsychological
assessment detailed severe deficits among visuospatial and plan-
ning performances. Structural neuroimaging (CT-scan) primary
revealed a global pattern of brain volume reduction. Severe per-
fusion deficits on frontal and both parietal lobes were shown
on 99mTc-HMPAO single-photon emission computed tomography
(SPECT). The hypothesis of probable FTD (behavioral variant) was
established.
The present case highlights how putative atypical and late-onset
forms of bipolar disorder (BD) might instead progress to FTD. Sev-
eral links are being advanced between the BD and FTD, for instance
the close involvement of theC9ORF72 gene in a group of BD patients
which progresses to dementia. These relations have actually been
on focus recently. The field is however still relatively unexplored.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.