S-61-01

Overlapping of schizophrenic and affective spectra: The clinical argument

A. Marneros. Martin-Luther University Halle Psychiatry and Psychotherapy, Halle, Germany

Objective: Since the Kraepelinean dichotomy of the so-called endogenous psychoses into schizophrenic and affective disorders it has been observed that some disorders could not be allocated neither to schizophrenia nor to affective disorders. We present clinical, paraclinical and prognostic features of cases-in-between.

Methods: Two studies were carried out aiming at answering the above questions: a. Schizophrenic, affective and schizoaffective patients were longitudinally compared using international standardized instruments, b. Patients with ICD-10: F 23 (Acute and transient psychotic disorders - ATPD)were compared to schizophrenic, bipolar schizoaffective and mentally healthy groups, also longitudinally and also using international and standardized instruments.

Results: Both groups - schizoaffective and acute and transient psychotic disorders - occupy a position between schizophrenic and affective disorders, presenting an overlap of schizophrenic and affective spectra. It seems that SA and ATPD are closer to affective than to schizophrenic disorders. But nevertheless they are positioned in-between which gives them special clinical, paraclinical and prognostic features.

Conclusion: There is an overlap of schizophrenic and affective spectra which may be genetically determinated. It seems that neither acute and transient psychotic disorders nor schizoaffective disorders are independent entities (the ,,3rd or 4th psychosis"), but nevertheless they have some very special features.

S-61-02

Cognitive deficits in schizophrenia and bipolar disorder

E. Vieta, C. Daban, A. Martinez-Aran. University of Barcelona Hospital Clinic, Barcelona, Spain

Objective: More and more epidemiologic, genetic and neuroimaging studies show similarities between bipolar disorder (BD) and schizophrenia (SZ). The purpose of this lecture is to compare the cognitive deficits in bipolar disorder (BD) and schizophrenia (SZ).

Methods: A systematic review of the literature of neuropsychological studies comparing BD and SZ was made, beginning in the year 1990 and ending in April 2004. Thirty studies have been selected for this review.

Results: BD exhibit a widespread of cognitive abnormalities with a pattern of deficits ranging from poor social functioning to executive dysfunctions, but seem to have preserved premorbid intellectual functioning. With regards to schizophrenia, BD show a lesser degree of deficits, even in periods of remission. In general, BD has a similar pattern of alterations, except for premorbid intelligence and verbal memory, which are almost always in the normal range.

Conclusion: In general, cognitive deficits are not specific of one or the other disease. However, the differences seen in premorbid intellectual functioning and verbal memory could be due to the presence of psychotic features, and to environmental factors (stressful events, duration of the disease and number of hospitalisation) and could also be due, at another level, to differences during the neurodevelopmental phase.

S-61-03

Diagnosis-specific or unspecific disposition genes for schizophrenia and affective disorders?

W. Maier. Department of Psychiatry, Univ, Bonn, Germany

Schizophrenia and affective disorder have been considered to be nosologically and etiologically distinct disorders. This postulate is challenged by progress in new biological research. Both disorders are strongly influenced by genetic factors; thus genetic research is a main contributor to this discussion. We review current evidence of the genetic relationship between schizophrenia and affective disorders, mainly bipolar disorder (the various genetic research methods have been particularly applied to bipolar disorder). Recent family and twin studies reveal a growing consistency in demonstrating cosegregation between both disorders which is difficult to detect with certainty given the low base rates. Systematic molecular genetic search for specific genes impacting on either disorder has now identified one gene which is apparently involved in both disorders (G72/G30); other candidate genes reveal some evidence to present as susceptibility genes with modest effects for each of both disorders: particularly COMT and BDNF, but less consistently so. There is room for speculations of other common susceptibility genes, given the overlap between candidate regions for schizophrenia and those for bipolar disorder emerging from linkage studies.

S-61-04

Depression in schizophrenia and affective disorder - cluces to affective-emotional dysfunction from the viewpoint of functional psychopathology

W. Gaebel. Heinrich-Heine University Dues, Duesseldorf Germany

Objective: Successful aetiopathogenetic research in psychiatry depends on the valid characterization and diagnosis of mental disorders. Usually this is accomplished by use of contemporary diagnostic systems such as DSM-IV or ICD-10. It has been questioned, however, whether this operationalized descriptive approach generates phenotypes homogeneous and valid enough to be the starting point for the sophisticated questions and research methods of neuroscience and molecular biology. The emergent neurobiological discoveries of brain function will have distinctly less clinical relevance and meaning if there is no parallel development of the capacity to delineate and quantify specific behavioral phenomena.

Methods: Against this background, depressive syndromes in schizophrenia and affeetive disorder will be assessed for their phenotypal homogeneity, their neuropsychological and neurobiological correlates, and their genetic profile. The aim is to draw conclusions whether both syndromes refer to dysfunctions of the same affective-emotional circuits, though at different neural components and of different origin.

Conclusion: Diagnosis in biological psychiatry should take a more syndrome- or even symptom-oriented approach. Moreover, the traditional descriptive psychopathological orientation should be modified towards a more experimental and functionally oriented approach including the concept of endophenotypes.