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NR1 Monday, May 20, 9:00 Am-10:30 Am Mental Health of Detained NR1 Monday, May 20, 9:00 a.m.-10:30 a.m. spectrum subjects. In contrast, the BSDS was highly sensitive Mental Health of Detained Asylum Seekers and specific for bipolar spectrum illness. Allen S. Keller, M.D., NYU School of Medicine, 125 Montclair Avenue, Montclair, NJ 07042; Douglas Ford, J.D., Chris Meserve, M.D., Chau N. Trinh, Hawthorne Smith, Kathleen M. NR3 Monday, May 20, 9:00 a.m.-10:30 a.m. Allden, M.D., Barry Rosenfeld, Ph.D. Risperidone Versus Olanzapine in Bipolar Disorder: Summary: A 16-Month Outcome Background: Asylum seekers arriving in the United States with- Klara J. Rosenquist, B.S., Department of Psychiatry, out documentation are likely to be held in detention by the Immigra- Cambridge Hospital, 1493 Cambridge Street, Cambridge, MA tion and Naturalization Services for months or years pending adju- 02139; S. Nassir Ghaemi, M.D., Jacob J Katzow, M.D., dication of their asylum claims. Concerns have been raised that Frederick K. Goodwin, M.D. the experience of detention is further traumatizing these individu- Summary: als. No studies, however, have been conducted to formally evalu- Objective: To compare long-term effectiveness and safety of ate their mental health. risperidone versus olanzapine as adjunctive maintenance treat- Methods: A longitudinal study of 46 asylum seekers detained ments of bipolar disorder. in the New York City area was conducted. The Hopkins Symptoms Methods: Retrospective chart review of naturalistic treatment Checklist 25 and the Harvard Trauma Questionnaire were used in 30 outpatients with bipolar or schizoaffective disorder (Type I = to evaluate symptoms of anxiety, depression and PTSD. At follow- 16, Type II = 2, NOS = 5, and Schizoaffective bipolar subtype = up, 26 and 20 were detained and released, respectively. 7) who received risperidone (RIS) or olanzapine (OLN) for at least Results: 75% of participants reported a history of torture in 3 months, added to at least lithium or valproic acid for depression their native country. At baseline, 74% of detainees suffered from (n = 7), rapid cycling (n = 10), manic or mixed states (n = 8) and anxiety, 83% depression and 47% PTSD. At follow-up, detained other indications (n = 8). individuals were significantly more likely to suffer from higher psy- Results: Risperidone (2.0 mg/d) and olanzapine (8.8 mg/d) were chological morbidity than those who were released: anxiety (92% used for a mean of 1.25 years. Medication was continued longer vs. 35%), depression (96% vs. 35%), and PTSD (61% vs. 10%) with risperidone (1.7 years) than olanzapine (0.8 years, p = 0.07). (p< .001). Mild or better efficacy was similar in both groups (71% for RIS Conclusion: Detained asylum seekers have high levels of anxi- and 73% for OLN). Moderate/marked response trended toward ety, depression and PTSD. Distress levels decreased markedly significance with risperidone (4/15, 27% vs. 0/14 with OLN, p = among those who were released from custody but increased 0.10). Weight gain occurred more frequently with olanzapine among those who remained in custody. Detention appears to be (60%, mean 10.7 Ibs., vs. 13%, p = 0.02) and led to drop-outs. a contributing factor to this psychological distress. EPS was similar and tardive dyskinesia did not occur. Conclusions: Both agents produced similar mild or better effi- cacy, but risperidone produced greater moderate/marked benefit. NR2 Monday, May 20, 9:00 a.m.-10:30 a.m. Side effects were similar except for more weight gain with olanzap- ine. Risperidone-treated patients continued treatment longer. Utility of Mood Disorder Questionnaire and Bipolar Spectrum Diagnostic Scale Christopher J. Miller, Department of Psychiatry, Cambridge NR4 Monday, May 20, 9:00 a.m.-10:30 a.m. Hospital, 1492 Cambridge Street, Cambridge, MA 02139; S. Nassir Ghaemi, M.D., Jeffry Klugman, M.D., Douglas A. Berv, Antidepressant Wear Off and Outcomes in Bipolar M.D., Ronald W. Pies, M.D. Versus Unipolar Depression Summary: James Y. Ko, Department of Psychiatry, Cambridge Hospital, 1493 Cambridge Street, Cambridge, MA 02139; S. Nassir Objective: To assess the sensitivity and/or specificity of two Ghaemi, M.D., Nicholas J. Kontos, M.D., Claudia F. self-report questionnaires for bipolar disorder, the Mood Disorder Baldassano, M.D., Frederick K. Goodwin, M.D. Questionnaire (MDQ) and the Bipolar Spectrum Diagnostic Scale (BSDS), a newly designed scale. Summary: Methods: 1) The MDQ was administered to 37 consecutive Objective: To determine if patients with bipolar disorder and patients with bipolar illness, 16 also received the Scale to Assess unipolar major depressive disorder differed in frequency of antide- Unawareness of Mental Disorder (SUMD) to measure insight. pressant wear-off phenomenon, antidepressant-induced acute 2) The BSDS was administered to 73 consecutive patients with mania, depressive relapse after antidepressant discontinuation, bipolar illness and 20 consecutive patients with unipolar major and other clinical features. depressive disorder. Created by Ronald Pies, it consists of a Methods:We systematically assessed history of antidepressant description that captures subtle features of bipolar illness, to which outcomes in 40 patients with DSM-IV diagnoses of bipolar disorder patients may assent on a sentence-by-sentence basis. (I =26, II = 10, NOS = 4) and 38 unipolar major depressive disorder All scales were compared to clinicians' DSM-IV based diag- patients. noses. Results: Antidepressant wear-off was noted in 23/40 (58%) bi- Results: 1) Sensitivity of the MDQ was 58%, higher in bipolar I polar patients, compared with 7/38 (18%) unipolar patients (p < (69%) than bipolar II/NOS (30%, p = 0.06). 2 patients with impaired 0.0001). Fluoxetine was most associated, and paroxetine least insight had false negative screens. associated with wear-off among antidepressants; TCAs and 2) Sensitivity of the BSDS was 81%, equal in bipolar I and bipolar SSRIs as classes did not differ. Antidepressant-induced mania II subjects (77% each). The BSDS identified 85% of unipolar was present in 21/40 (53%) bipolar patients, and 0/38 unipolar depressed patients as not having bipolar spectrum illness (speci- patients (p < 0.00001). SSRIs and TCAs had similar acute switch ficity of bipolar versus unipolar illness was highly significant, p < rates (17-24%). Depressive relapse after antidepressant discon- 0.0001). tinuation was more frequent in unipolar (7/12, 58%) than in bipolar Conclusions: The MDQ was more sensitive for bipolar I than disorder (6/36,17%; p = 0.009). Treatment resistance to therapeu- bipolar spectrum illness and less sensitive in uninsightful bipolar tic trials was more common in bipolar (20/40, 50%) than unipolar 1 depression (12/38, 28%), but did not reach statistical significance attempts (n = 8), (OR 2.5). Passive religiosity was associated with (p = 0.11). an increased risk of having multiple SA (OR 2.6) when compared Conclusions: Patients with bipolar disorder were more likely to to active religiosity. experience antidepressant wear-off, and antidepressant-induced Conclusion: Sustained religious activity in non-psychotic, sui- mania, but less likely to experience relapse into depression after cidal patients was associated with decreased number of suicide antidepressant discontinuation than a comparison group of pa- attempts. Non-religious males are at increased risk to present tients with unipolar depression. Bipolar patients may be more with multiple suicide attempts. These new and preliminary data likely to have a history of antidepressant nonresponse. will be used in our ongoing research and suggest that an interdisci- plinary approach should be considered. NR5 Monday, May 20, 9:00 a.m.-10:30 a.m. Marital Rates, Gender, and Age of Onset Among NR7 Monday, May 20, 9:00 a.m.-10:30 a.m. Brazilian Patients with OCD Religious/Spiritual Coping and Outcome in Luana M. Miller, Department of Psychology, SUNY at Buffalo, Hospitalized Adolescents 266 Highland Parkway, #6, Buffalo, NY 14223; Joanne Davila, Francis F. Hayden II, M.D., Department of Psychiatry, NYU Ph.D., Michelle T. Pato, M.D., Euripedes C. Miguel, Ph.D. School of Medicine, 550 First Avenue, NB2156, New York, NY Summary: 10016; Raul R. Silva, M.D. Objective: Investigated associations between age of onset, gen- Summary: der, and marital status among Brazilian OCD patients to examine Objective: There are few studies that examine the relationship whether decreased marital rates are most evident among early between mental health and religiosity. This study was designed to onset males cross-culturally. explore the relationship between adolescent religious and spiritual Method: A naturalistic epidemiological study of the marital status beliefs and outcome. of 124 OCD patients seen in a Brazilian OCD specialty program. Method: 15 consecutive patients admitted to the adolescent Data included gender, OCD age of onset (when OC symptoms psychiatric inpatient unit were screened. Diagnoses were based started), and marital status. on DSM-IV. Measures: 1) Brief Multidimensional Measure of Reli- Results: Among participants who were 18 years or older at giousness/Spirituality 2) The Addressing of Spiritual Religious Is- intake (n = 106), 64% were never married, 32% were married/ sues scale 3) Relevance of SRI scale. Outcome measures: Length cohabiting, and 4% were divorced/separated. This is consistent of stay (LOS), the Children's Global Assessment Scale (CGAS). with results from US and European studies, which indicated that Statistical analyses proceeded from descriptive statistics to a se- between
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