The Australasian Society for Bipolar Disorders (ASBD) Conference 2007

The 2nd ASBD conference was recently held in Sydney. The Australasian Society for Bipolar Disorders was started in 2004 and is associated with the International Society for Bipolar Disorders. Over the two days of the conference, those attending where presented with a wide range of topics regarding bipolar affective disorder (BPAD). The focus was on the latest research findings, including career issues and psychotherapy. Numerous guest speakers and a variety of international experts presented their new research, skills and ideas. The conference was open to psychiatrics, psychologists, researchers, social workers, trainees and students.

The Australian Society for Bipolar Disorders conference was held from the 20th to 22nd of September at the Sydney Convention Center.

The conference consisted of plenary lectures, research presentations, workshops and poster sessions. A highlight was a full day workshop dealing with family-focused treatment for bipolar disorders, given by Professor David Miklowitz form the University of Colorado. Other esteemed guests included, among many others, Professor Mauricio Tohen and Professor Lakshmi Yatham.¹ There where four keynote presentations, outlined below.

Neurobiology of bipolar disorder: approaches to solving the mystery²

Presented by Professor Lakshmi Yatham, this dealt with new research about the genetics involved in BPAD. Although research is ongoing, precise genes that predispose for BPAD are still unknown. It seems that these genes are turned on at some time during adolescence, triggering the symptoms of BPAD. However, it is still unclear exactly what causes these genes to be activated in some individuals. Theories include changes in neurotransmitter pathways, second messenger signals and oxidative stress.

Clinical and neurobiological implications of delayed and inconsistent treatment of bipolar disorder³

Presented by Robert Post, this presentation dealt with new research about the need for early diagnosis and treatment of BPAD. BPAD often starts early in life but is not diagnosed or treated for years with poor long term outcomes. Each untreated episode of depression or mania is associated with decreases in Brain Derived Neurotrophic Factor (BDNF) and cellular oxidative stress. This has serious effects on the brain and increases the risks of neuronal and support cell atrophy. The progressive result is cognitive decline and a worsening of symptoms. Effective treatment, started as early as possible, is therefore essential to slow brain changes, which will in the long term result in fewer symptoms and better functioning.

Family-focused treatment for bipolar disorder in adults and youth⁴

Presented by David Miklowitz, this dealt with the importance of family support to a patient with BPAD. A person whose family environment is high in criticism, hostility or emotional tension is far more likely to have recurrent episodes of mania or depression with more severe symptoms than individuals who have supportive families. The therapy should consist of 21 sessions over 9 months and focus on education about BPAD, conflict resolution skills and communication skills.

Predictors of syndromal and functional recovery in patients with a first-episode of mania⁵

Presented by Professor Mauricio Tohen, this dealt with new research regarding what features can predict how quickly patients will recovery from their first episode of mania. The study was a prospective cohort design with 173 participants. Features associated with a quick recovery included being married, having a shorter hospital stay and being female. The features associated with longer recovery or relapse included psychotic features, a mixed episode, other co-morbidity and being aged over 30.

There were numerous other interesting presentations that covered a wide variety of topics. The other topics covered during the conference included:¹

• Novel treatments and mechanisms in BPAD
• Diagnostic issues including neuroimaging
• Therapeutic issues including psychosocial treatments
• Early onset BPAD
• The pathophysiology of BPAD
• The correlation between mixed states and suicide
• Consumer and carer issues
• A wide range of poster presentations

One interesting presentation was ‘Suicide and self harm: mixed mood or personality in bipolar disorder’ by Sue Luty. This research was conducted in Christchurch, New Zealand and investigated whether suicide in mixed states was due to the BPAD or a co-morbid borderline personality disorder. Of the patients in the study, 50% had a history of self harm and 60% had made one or more suicide attempt. However, less then 20% of these patients had a co-morbid borderline personality disorder. The study concluded that suicide and self harm are often associated with BPAD itself regardless of a co-morbid borderline personality disorder.⁶

Another interesting presentation was ‘Paediatric bipolar disorder – cross cultural comparisons’ by Rajeev Jairam, Gin Malhi and Shoba Srinath. This study looked at BPAD in adolescents, specifically comparing features and short term outcomes between children in Australia and India. The study had 12 patients in the Australian group and 25 in the Indian group. The differences between groups included that the Indian group was on average 3 years younger at diagnosis, had more males, had fewer psychotic symptoms and fewer substance abuse issues. However, the two groups did not differ greatly in terms of symptoms, functioning and short term outcomes.⁷

There were many other interesting presentations that will doubtless have practical impacts in the diagnosis and management of BPAD. The keynote presentations will effect management of BPAD patients in a number of ways. The importance of family therapy has again been highlighted, as has the need for early diagnosis and treatment. New advances in genetic theory were also presented. Of the other presentations, new areas have been explored about cross cultural comparison of BPAD, the use of neuroimaging in BPAD and BPAD relapse during pregnancy and childbirth. Overall, this was a very successful and informative conference that dealt with a wide range of important issues regarding BPAD.

For further information and highlights of the 2007 conference, please refer to the following website: http://www.asbd.com

(Author: Simon Parys, October 2007)

References:

1. ASBD, Australasian Sociey for Bipolar Disorder Conference 2007. Bipolar Disorder 2007; 9(S2): 3-20.
2. Yatham LN. Neurobiology of bipolar disorder: approaches to solving the mystery (Keynote 58), ASBD Conference 2007. Sydney, Australia 2007.
3. Post RM. Clinical and neurobiological implications of delayed and inconsistent treatment of bipolar disorder (Keynote 01). ASBD Conference 2007. Sydney, Australia 2007.
4. Miklowitz DJ. Family-focused treatment for bipolar disorder in adults and youth (Keynote 57). ASBD Conference 2007. Sydney, Australia 2007.
5. Tohen M. Predictors of syndromal and functional recovery in patients with a first-episode of mania (Keynote 56). ASBD Conference 2007. Sydney, Australia 2007.
6. Luty S. Suicide and self harm: mixed mood or personality in bipolar disorder (Presentation 08). ASBD Conference 2007. Sydney, Australia 2007.
7. Jairam R, Malhi GS, Srinath S. Paediatric bipolar disorder – cross cultural comparisons (Presentation 48). ASBD Conference 2007. Sydney, Australia 2007.