Bipolar insights

The first presentation, by Dr José Oliveira from the Université Paris-Est Créteil Val de Marne, looked at the combined effect of Toll-like receptors 2 (TLR2), gene polymorphism and early life stress on the age of onset of bipolar disorders.

Dr Oliveira described bipolar disorder (BD) as a progressive chronic illness whose clinical manifestations can be underpinned by biological and environmental factors interacting in a complex manner, particularly in early-onset disease.

Environment + biology = early onset

Dr Oliveira et al¹ investigated the potential interaction between genetic variants of TLR2 and TLR4, major innate immune response molecules to pathogens, and the childhood trauma questionnaire (CTQ) in age of onset of BD.

His results showed a significant (p=0.02) combined effect of TLR2 rs3804099TT genotype and reported sexual abuse in determining an earlier age of onset of BD. Regression analysis was non-significant for the combined effect of TLR2-CTQ and sexual abuse.

Immuno-genetic susceptibility

“The pathological effect of childhood adversity may be of greater importance in patients with an immuno-genetic susceptibility background,” said Dr Oliveira, “and further exploration of clinical characteristics of severity and immune phenotypes in BD may allow the development of innovative therapeutic interventions.”

Country differences

Delegates also heard about national differences in the prevalence of depressive symptoms in mania. Professor Andrea Fagiolini, from the University of Siena, started by acknowledging that manic episodes with depressive symptoms are generally more severe than pure manic episodes but are not easily identified.

Using the DSM-5 mixed features specifier and the accompanying patient-rated M.I.N.I International Neuropsychiatric Interview module, Prof Fagiolini examined bipolar I (BPI) patients across countries. His results showed that patients with BPI with mixed features suffer from a greater burden of disease than patients with pure mania, and that there is variation between countries. For example, the proportion of patients experiencing ‘prominent dysphoria or depressed mood’ was highest in Italy (64.2%). Recurrent suicidal ideation ranged from 8% (Germany) to 25.7% (Spain); lifetime rate of attempted suicide was highest in Canada (64.7%).

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