1 CLINICAL ASSOCIATIONS BETWEEN ANOREXIA NERVOSA AND AFFECTIVE SPECTRUM DISORDERS IN COLOMBIAN FEMALE ADOLESCENTS: PRELIMINARY RESULTS OF A CASE SERIES Casas G., Auli J., Achury D., Ospina L., Reyes P., Gálvez JF.. Department of Psychiatry, Javeriana Univesity School of Medicine. Child & Adolescent Psychiatry/Affective Disorders Research Programs. Bogotá, Colombia. INTRODUCTION Eating & Affective Spectrum Disorders (ASD) are considered among the most common & prevalent early - onset psychiatric disorders. Eating Disorders (ED) are frequently associated with the emergence of depressive symptoms during early and late adolescence. Anorexia Nervosa (with a lifetime mortality around 10-20%) & Bipolar Disorders (with a lifetime suicide rate of about 10%) are potentially disabling and life-threatening, but also highly treatable Colombia has the highest prevalence in depressive disorders in Latin America. Children and adolescents have been identified as a risk population for MDD and BD. It is not known if the presence of co-morbid Major Depressive Episodes (MDE) in the course of established Early-Onset Anorexia Nervosa is associated with Mayor Depressive Disorder (MDD) or belongs to the Bipolar Spectrum Disorders (BSD). Several predicting and predisposing factors for BDS are documented in the literature such as female gender, late onset anorexia nervosa in adolescence, early onset anxiety disorders, recurrent affective episodes previous to ED diagnosis, chronicity, subclinical hypothyroidism & recent exposure to mood elevating agents. OBJECTIVE & METHODS Describe some clinical associations between early-onset Anorexia Nervosa (AN), comorbid Major Depressive Episodes (MDE) and Bipolar Spectrum Disorders in a Colombian sample of female adolescents. A retrospective case series of twenty-one (n=21) adolescents with documented DSM IV –TR Anorexia Nervosa (AN) and Major Depressive Episode (MDE) diagnosis. This sample of patients was treated in the Child & Adolescent Psychiatric Unit at San Ignacio Hospital in Bogota, Colombia as inpatients between January All patients who full filled the inclusion criteria accepted to participate in this case series. Attending Child & Adolescent Psychiatrist interviewed all 21 patients during outpatient controls, applying 5 psychometric instruments during their last visit in February Screening of depressive (CDI), eating (KEDS), bipolarity (BEDS), obsessive-compulsive (CY-BOCS), and global impairment (CGI-S) symptoms were recollected using instruments adequately validated in Spanish versions for Latin-American children & adolescents. Parents and patients were well informed and signed legal and ethical considerations to participate in the study. PRECLINICAL RESULTS 100% female cases & early-onset anorexia in adolescence 29% had an active Anorexia Nervosa (AN) 29% Bipolar Eating Disorder Scale (BEDS) > 13 66-81% clinically significant depressive symptoms 62% early onset anxiety (OCD) symptoms 57% reported at least to feel marked impairment 30% exposure to mood elevating agents 15% had subclinical hypothyroidism Global Statistical Descriptive Correlations KEDS BEDS CY-BOCS ICG -S CDI Correlation Coefficient 1.000 .339 .455* .168 .602** Sig. (2-tailed) . .133 .038 .468 .004 N 21 .146 .900** .361 .529 .000 .108 Y-BOCS -.014 .259 .953 .256 CGI-S .190 .410 * Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level (2-tailed). PRELIMINARY CONCLUSIONS Depressed AN patients with marked/severe impairment in ICG-S scores might have a higher probability of suffering from a Bipolar Spectrum Disorder (BSD). Probable associations between early-onset mild > moderate OCD symptoms and BSD using a lower cut-off point in the BEDS BEDS adaptation should include a lower cut off point around 9-11 instead of 13 to improve sensibility for BSD. A significant association between early-onset AN and BSD might be reflected in this sample. Tabl e– 1 Basic Statistics for the Sample Age BEDS Y-BOCS CGI -S KEDS CDI N 21 Mean 16.71 10.95 9.19 3.57 16.10 21.76 Median 17.00 11.00 8.00 4.00 18.00 24.00 Mode 16 7a 14 4 18 31 Std. Deviation 1.765 4.863 5.776 .811 5.629 9.316 Variance 3.114 23.648 33.362 .657 31.690 86.790 Minimum 2 Maximum 20 5 23 35 a. Multiple modes exist. The smallest value is shown DISCUSSION Overlapping clinical features of early-onset AN and BSD is an interesting but underexplored area of clinical research. Cyclic features, rapid changes in energy levels, predominance of comorbid depressive symptomatology, high recurrence, chronicity, metabolic and biological changes are shared commonly in ED and BSD. Depressive episodes improves acute treatment and early prognosis in AN, probably due to the limited nature of depressive episodes in Bipolar Spectrum Disorders (BDS). Anorexia Nervosa (AN) paradoxically seems to reduced the possibility of long-term stabilization of comorbid affective disorders. Screening of Bipolar Spectrum Disorders (BSD) in Eating Disorders (ED) inpatient treatment might be associated with better long-term outcomes in a subgroup of Colombian adolescent females with subthreshold or atypical Bipolar Disorder with ED predominant clinical picture. Taking into account the high morbidity & mortality associated with both disorders, more attention and funding should be focus on this particular subject. Table – 2 CDI > 12 Cut Off-Point Frequency Percent CDI < 12 4 19.0 CDI > 12 17 81.0 Total 21 100.0 Table – 3 CDI > 19 Cut Off-Point Frequency Percent CDI < 19 7 33.3 CDI > 19 14 66.7 Total 21 100.0 LIMITATIONS Pilot study with small sample size, limiting the power of this preliminary results Retrospective analyses has limitations to explain causality or make clinical recommendations Prospective clinical trials should be done REFERENCES Andriazen C., Pacheco Z., Vivar R.,et al. Validity and reliability of Yale Brown’s Scale version children and teenagers (cy-bocs) in Peru. Rev Peru Pediatr. 2008; 61 (1):68-75. Gálvez JF., Thommi S., Ghaemi SN. Positive aspects of mental illness: A review in bipolar disorderJournal of Affective Disorders 128 (2011) 185–190. Lunde AV, Fasmer OB, Akiskal KK, Akiskal HS, Oedegaard KJ. The relationship of bulimia and anorexia nervosa with bipolar disorder and its temperamental foundations. J Affect Disord Jun;115(3): Epub 2008 Nov 12 Moya T, Cordás TA, Lafer B. Comorbidity of anorexia nervosa and bipolar disorder in early adolescence. Bipolar Disord Oct;6(5):442-3. Segura S., Posada S., Ospina ML., et al. Inventory Standardization of Children Depression scale for adolescents aged 12 and 17 years of age the Municipality of Sabaneta, Department Antioquia, Colombia. International Journal of Psychological Research, Vo.3. No. 2. pgs Torrent C., Vieta E., Crespo JA., et al. [Barcelona Bipolar Eating Disorder Scale (BEDS): a self-administered scale for eating disturbances in bipolar patients]. Actas Esp Psiquiatr May-Jun;32(3): Zuniga O., Padron E. Translation and psychometric properties of the kid´s eating disorders survey (KEDS)-Spanish version. Actas Españolas de Psiquiatría Dic;37(6): DISCLOSURES Funding: None In the last 12 months, Dr. Juan Francisco Gálvez has been a lecturer for the speaker's bureau at GlaxoSmithKline, Eli Lilly Interamerica, & Pfizer. He has also been a consultant for both Pfizer. Member of the ISBD Board Colombian Chapter. Dr. German Casas, Dr. Javiier Auli, Dr. Doriam Achury, Dr. Laura Ospina, Dr. Adriana Bohorquez & Dr. Pablo Reyes have no disclosures.