Abstract Book ASCP Annual Meeting FAIRMONT SCOTTSDALE PRINCESS MAY 30-JUNE 3, 2016 www.ASCPP.org Monday, May 30, 2016 12:00 p.m. - 2:00 p.m. Latin America Satellite Symposia: An Update on Biomarkers and Clinical Outcomes in Psychiatry AN UPDATE ON BIOMARKERS AND CLINICAL OUTCOMES IN PSYCHIATRY Mauricio Tohen, University of New Mexico Overall Abstract: This symposium will focus on an Update on Biomarkers and Clinical Outcomes in Psychiatry. Mauricio Tohen MD, will discuss Outcome in First Episode Non- Affective Psychosis. The goals of the study are to determine predictors of diagnostic stability in first episode psychosis and to determine time to recovery across non-affective psychoses Antonio Teixeira will describe the complex interactions among temporal lobe epilepsy, depression and low-grade peripheral inflammation, and to evaluate this interaction network as a model for understanding psychiatric disorder. Jair Soares will summarize recent studies that have examined brain mechanisms in bipolar disorder (BD) in children and adolescents. Gustavo Turecki will focus on small non-coding RNAs. He will review data suggesting that microRNAs may be good biomarkers of antidepressant response. Nancy DiazGranados will introduce the behavioral and biological processes involved in the development of alcohol addiction. She will review some recent neuroimaging and genetic findings. The goal is to distinguish some of the genetic variables that contribute to use of alcohol and to the transition from use to abuse and dependence. Carlos Zarate will be the discussant. SMALL NON-CODING RNA AS PREDICTORS AND MEDIATORS OF ANTIDEPRESSANT RESPONSE Gustavo Turecki, McGill University Individual Abstract: Genes can be regulated through the activity of several non-coding RNA (ncRNA) transcripts that act as fine-tuners and on-off switches of gene expression patterns. Among the ncRNAs, microRNAs (miRNAs) are particularly interesting, as they circulate peripherally in exosomes and may act at a distant target. There is increasing evidence suggesting a key role for miRNAs in the regulation of essential processes of brain function, including in psychiatric disorders and their treatments (1). We have recently reported that miR-1202, a primate-specific and brain-enriched miRNA, is down-regulated in the prefrontal cortex of depressed individuals and regulates the expression of the metabotropic glutamate receptor (GRM4) (2). Interestingly, peripheral levels of this miRNA change as a function of antidepressant response. This presentation will discuss the use of microRNAs as potential biomarkers of antidepressant response, discuss most promising findings to date and future avenues. Learning Objectives: Learn about small non-coding RNAs Review data suggesting that microRNAs may be good biomarkers of antidepressant response. Literature References: *of special interest to clinicians Issler O, Chen A. Determining the role of microRNAs in psychiatric disorders. Nat Rev Neurosci. 2015;16:201-212. Lopez JP, Lim R, Cruceanu C, Crapper L, Fasano C, Labonte B, Maussion G, Yang JP, Yerko V, Vigneault E, El Mestikawy S, Mechawar N, Pavlidis P, Turecki G. miR- 1202 is a primate-specific and brain-enriched microRNA involved in major depression and antidepressant treatment. Nature medicine. 2014;20:764-768. OUTCOME IN FIRST EPISODE AFFECTIVE AND NON-AFFECTIVE PSYCHOSIS Mauricio Tohen, University of New Mexico Individual Abstract: Background: Early course in contemporary, clinically treated, non- affective psychotic disorders remains incompletely defined. Methods: We prospectively, repeatedly, and systematically assessed 114 patients hospitalized for a first episode of DSM-IV-TR nonaffective psychotic illness for ≥2 years (1989 1996) using structured (SCID-P, CGI, SANS, SAPS, BPRS-E) and unstructured (best-estimate procedure, life-charting) naturalistic follow-up procedures and survival analysis. Results: Duration of untreated psychosis (DUP; 22±38 months) was longest with schizophrenia. Within two years, syndromal remission sustained for ≥8 weeks (recovery) was attained by 75 (65.8%) subjects; median latency to syndromal recovery was 9.4 [CI: 5.7– 13.3] weeks, and was shorter with cycloid features, initial brief psychosis or schizophreniform disorder, and shorter initial hospitalization. Functional recovery within 2 years was achieved by 28/68 (41.2%), more often without initial mood-psychomotor instability or homicidal ideation. New episodes occurred in 52/114 (45.6%), and were more likely with less affective flattening, younger age, and Caucasian race. Median time to new episodes (43.7 [27.9–70.6] weeks) was earlier with initial first-rank auditory hallucinations, substance abuse, and functional nonrecovery. Diagnosis changed to other nonaffective, schizoaffective, or affective disorders within two-years in 62/108 (57.4%) of cases. Conclusions: Three-quarters of patients presenting in first-lifetime, nonaffective psychotic episodes achieved recovery within 2 years, but only 41% returned to baseline functioning, and nearly half experienced new episodes. Patients with schizophrenia had the longest duration of untreated psychosis. A majority changed diagnosis, indicating instability of some DSM psychotic-disorder diagnoses Learning Objectives: To determine predictors of diagnostic stability in first episode psychosis. To determine time to recovery across non-affective psychoses. Literature References: Tohen M, Khalsa H, Salvatore P, Vieta E, Ravichandran C, Baldessarini R. Two-year Outcomes in First-Episode Psychotic Depression: The McLean-Harvard First- Episode Project Journal of Affective Disorders 2012 Jan;136(1-2):1-8. Tohen M, Strakowski SM, Zarate C, Hennen J, Stoll AL, Suppes T, Faedda GL, Cohen BM, Gebre-Medhin P, Baldessarini RJ. The McLean-Harvard first-episode project: 6-month symptomatic and functional outcome in affective and nonaffective psychosis. Biol Psychiatry 2000 Sep;48(6):467-476. OUTCOME IN FIRST EPISODE NON-AFFECTIVE PSYCHOSIS *of special interest to clinicians Antonio Teixeira, University of Texas Health Science Center at Houston Individual Abstract: Patients with temporal lobe epilepsy (TLE) are at an increased risk of mood disorders. Around 30% of patients with TLE followed at referral centers present major depression [1]. Recent studies have proposed a role for inflammatory/immune mechanisms in epilepsy [2]. Immune cells of patients with TLE show an activation profile, mainly in effector T cells, in line with the low-grade peripheral inflammation. For instance, frequency of HLA- DR in CD19+ B cells and regulatory T cells CD4+CD25+Foxp3+ producing IL-10 was higher in TLE when compared with controls [3]. Inflammation also seems to be relevant in the physiopathology of psychiatric disorders, including major depression. We evaluated the peripheral levels of IL-1β, a prototypic pro-inflammatory cytokine, in patients with TLE with depression, patients with TLE without depression and in healthy controls [4]. Levels of IL-1β were significantly higher in patients with TLE with depression than in controls or patients with TLE without depression. IL-1β levels positively correlated with Hamilton Rating Scale for Depression scores. Our current results suggest that at least part of the peripheral immune changes observed in TLE is associated with depression. This finding corroborates the view of systemic impact of major psychiatric disorders, i.e. the presence of low-grade inflammation in patients with major depression. It remains to be determined the influence of treatment on the interaction among TLE, depression and inflammation. Learning Objectives: To describe the complex interactions among temporal lobe epilepsy, depression and low-grade peripheral inflammation. To evaluate this interaction network as a model for understanding psychiatric disorder. Literature References: Oliveira GN, Kummer A, Salgado JV, Portela EJ, Sousa-Pereira SR, David AS, Teixeira AL. Psychiatric disorders in temporal lobe epilepsy: an overview from a tertiary service in Brazil. Seizure. 2010 Oct;19(8):479-84. Silveira G, de Oliveira AC, Teixeira AL. Insights into inflammation and epilepsy from the basic and clinical sciences. J Clin Neurosci. 2012 Aug;19(8):1071-5. Vieira EL, de Oliveira GN, Lessa JM, Gonçalves AP, Oliveira AC, Bauer ME, Sander JW, Cendes F, Teixeira AL. Peripheral leukocyte profile in people with temporal lobe epilepsy reflects the associated proinflammatory state. Brain Behav Immun. 2015 Nov 27. pii: S0889-1591(15)30061-1. doi: 10.1016/j.bbi.2015.11.016. Vieira EL, de Oliveira GN, Lessa JM, Gonçalves AP, Sander JW, Cendes F, Teixeira AL. Interleukin-1β plasma levels are associated with depression in temporal lobe epilepsy. Epilepsy Behav. 2015 Dec;53:131-4. NEUROBIOLOGY OF ALCOHOL USE DISORDERS Nancy DiazGranados, National Institute on Alcohol Abuse and Alcoholism (NIAAA) Individual Abstract: The talk will introduce the behavioral and biological processes involved in the development of alcohol addiction. I will review some recent neuroimaging and genetic findings. Learning Objectives: Distinguish some of the genetic variables that contribute to use of alcohol and to the transition from use to abuse and dependence. *of special interest to clinicians Compare some of the current neuroimaging tasks developed to assess alcohol addiction and discuss their findings. Literature References: Kwako LE, Momenan R, Litten RZ, Koob GF, Goldman D: Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders. Biol Psychiatry 2015;