European Psychiatry - Volume 33 - March 2016

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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805 S413
Objectives A series of genes are up or down regulated in BMD.
Aims We present an algebraic model that incorporates multiple
genes in the pathogenesis.
Methods The suprachiasmatic circadian gene CLOCK/BMAL1 het-
erodimer is regarded as the master oscillator with a curve of y = a
sinx + b.
Light/darkness events (noise < 5%) changes it into a more broken
curve; hence y = (nex + b) + a sinx. Superimposition of oscillating
(but not non oscillating) functions can change the pattern of peri-
odicity or even abolish it. The master oscillator, just like the cardiac
pacemaker has suppressing effect on 3 slave oscillators.
Alternating reigning of the master and slave oscillators can cause
a dying curve in the form of Y = f(et) g(sin1/t) + (b) where t is
time and f and g are functions typical for master and slave oscilla-
tors and (b) the effect of light/darkness (not negligible anymore).
This causes the disease course unpredictable. Alternate reigning of
master and slave oscillators is due to:
– mutation in the master with longer periodicity or no suppressing
effect on slaves;
– mutation in the slave with shorter periodicity than the master or
less sensitivity to the suppressing effect of the master.
Combination of the above in the form of genetic polymorphism.
Results Incorporation of many genes can explain many items in
BMD with good predictions of its course.
Conclusions This model can predict the course of BMD disease
spectrum.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV199
General results of personality scores
of bipolar patients studied by
MCMI-III during inter-attack periods
and relevance to clinical course
K. Pirkalani ∗ alaeerad
1 Mehr Medical Group, Internal Medicine, Tehran, Iran
2 Mehr Medical Group, Gynecology, Tehran, Iran
∗ Corresponding author.
Introduction Physicians and patients’ relatives regard patients
with BMD during inter attack periods with suspicion.
Aims Evaluation of relevance of personality tests for BMD and
finding correlations in addition to risk factors
Methods Thirty-three patients were evaluated by way of the
MCMI-III during inter attack interval. They were apparently with-
out prominent signs and symptoms, slept well and were under
treatment with Lithium. They were compared with 45 examinees
that were evaluated for unrelated reasons.
Results (1) There were overall higher scores in schizotypal, bor-
derline, narcissistic, histrionic and self destructive personalities
among BMD patients compared to the control group. P < 0.03.
(2) With the BR score of 72, all patients fulfilled the diagnosis of at
least one of the personality disorders. P < 0.1.
(3) Borderline personality had the highest correlation with BMD
and after scheduled interview 22 of 33 patients fulfilled the criteria
for it. P < 0.1.
Presence of high scores in apparently contradicting personali-
ties such as obsessive compulsive and histrionic or narcissistic
and dependent or avoidant and histrionic were also encountered.
P < 0.2.
Conclusions Though apparently normal functioning during inter
attack intervals BMD patients fulfill the criteria of some personality
disorders. This is in concordance with our idea that BMD spectrum
has correlation with personality disorders in a subgroup that has
mutations in the downstream genes to CLOCK/BMAL1 [glycogen
synthase kinase3-b (GSK3-b), casein kinase I epsilon, NCAN, PER1,
2, 3 or CRY1, 2. . .]. They do not show full-blown symptoms but
remain aberrant with subclinical attack like fluctuations.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV200
The role of medical condition in
perplexity inside psychotic mixed
states in bipolar disorder: Case series
and literature review
M. Preve ∗, E. Bolla , M. Godio , N.E. Suardi , R. Traber ,
R.A. Colombo
Sociopsychiatric Organization, Psychiatric Clinic, Mendrisio,
Switzerland
∗ Corresponding author.
Introduction In literature Leonard introduce, after Wernike
(1900) and Kleist (1928), the concept of cycloid psychoses, and
he gives again a weight to the mixed forms in affective disorders
lot of different medical conditions cause pychiatric prob-
lems, like hyperammonemia, hyponatiremia, thyroid disfunction,
urinary infections and still others. The aim of our study is to eval-
uate the role of a medical condition in perplexity inside psychotic
mixed states in bipolar disorder (BD). We propouse three different
cases and literature review.
Method Three patients with perplexity in BDwere assessedwith:
the SCID-P for axis I diagnosis, HRSD, YMRS, internistical examina-
tion, blood test exams and urinanalysis, and first level brain imagin
(CT and/orMRI).We conducted a systematic reviewof the literature
(PubMed, Embase, PsychInfo), using the terms “bipolar disorder”,
“mixed states”, “perplexity” and “medical condition”.
Results All our patients present: hyperammonemia, reduction of
TSH and presence of infection at the urinanalysis, and a resolu-
tion of perplexity with the normalization of the blood test and
urinanalysis.
Discussion and conclusion To our knowledge there are not studies
that confirm the relationship between thyroid and epatic dysfunc-
tion, andurinary infectionwithperplexity inpsychoticmixed states
in BD, and the resolution with the normalization of blood and uri-
nary exams. Further research is warranted to replicate our clinical
observations and to confirm our results.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
References
[1] Perugi G, et al. 2014.
[2] Perugi G, et al. 1997.
[3] Perugi G, et al. 2014.
[4] Leboyer M, et al. 2012.
EV201
Psychotic mixed state in bipolar I
disorder due to neurosyphilis: Case
report and literature review
M. Preve ∗ Godio , N.E. Suardi , R. Traber , R.A. Colombo
Sociopsychiatric Organization, Psychiatric Clinic, Mendrisio,
Switzerland
∗ Corresponding author.
Introduction The presence of mixed features in bipolar disor-
der (BD) has been associated with a worse clinical course and
high rates of comorbidities including anxiety, personality, alcohol
and substance use disorders and head trauma or other neuro-
logical problems A recent study reports the connection of
neurosyphilis and mania he aim of our study is to evaluate an