ABSTRACTS - World Psychiatric Association

oader lessons for psychiatric research and treatment, particularly in
the field of mood and substance use disorders. Furthermore, the crucial
developmental needs of this age group are poorly met by existing
service models and approaches. Young people need a different style
and range of service provision in order to engage with and benefit
from interventions. The need for structural reform and a long term
research agenda is clear.
UL7.
IMPROVING COGNITIVE PERFORMANCE
AND REAL-WORLD FUNCTIONING IN PEOPLE
WITH SCHIZOPHRENIA
M.F. Green
Semel Institute for Neuroscience and Human Behavior, UCLA,
Los Angeles, CA, USA
Considerable efforts are underway to find new treatments for cognitive
impairment in schizophrenia. These efforts have been stimulated by
activities from the US National Institute of Mental Health (e.g.,
MATRICS and TURNS Initiatives) that have provided a pathway for
approval of cognition-enhancing drugs. We present data on new pharmacological
and behavioral interventions that are designed to enhance
cognition and improve daily functioning. For pharmacological interventions,
the cognitive effects of second-generation antipsychotic
medications and anti-dementia drugs in schizophrenia have been
inconsistent and relatively disappointing. This situation has led to
careful consideration of newer types of drugs. Proof of concept trials of
drugs that act on novel mechanisms (e.g., alpha 7 nicotinic receptor,
AMPA receptor, neural protective agents, glycinergic agents) are starting
to emerge and are showing mixed results as cognitive enhancers.
Several behavioral training interventions have been implemented,
including cognitive remediation and errorless learning. These are
showing success in improving outcomes when combined with vocational
rehabilitation. Social cognitive deficits in schizophrenia have
become a relatively new target for intervention. Recently developed
training programs for social cognition are showing promise. Overall,
this is a time of considerable innovation in both the pharmacological
and behavioral treatments for schizophrenia.
UL8.
EVIDENCE-BASED COMPREHENSIVE
MANAGEMENT OF BIPOLAR DISORDER
E. Vieta
Bipolar Disorder Program, University of Barcelona, Spain
The successful treatment of bipolar disorder heavily depends on having
a medical model of the disease in mind. The cornerstones of such
treatment are evidence-based psychopharmacology and psychoeducation.
The treatment of mania can be addressed with antipsychotics,
as all of them have antimanic properties and may have a faster onset
of action than lithium or anticonvulsants such as valproate or carbamazepine.
The choice of the antipsychotic should rather rely on the
safety/tolerability profile and on the availability of long-term data for
that specific compound. As far as possible, compounds with low
extrapyramidal and metabolic side effects liability should be preferred.
The treatment of bipolar depression may be addressed with a
more heterogeneous range of medications, including quetiapine, lamotrigine,
the combination of olanzapine and fluoxetine, and other
combinations of drugs. The long-term treatment of bipolar disorder is
crucial for a good clinical outcome and to prevent cognitive and functional
impairment, and may involve lithium, lamotrigine, valproate,
carbamazepine, quetiapine, aripiprazole, olanzapine, and combinations
of these and other agents. Long-acting risperidone may be used
in highly relapsing patients, and electroconvulsive therapy or clozapine
may be a good choice in treatment-resistant cases. Education on
the disease aimed at the patient and also at the family, caregivers, and
significant others is also essential for a good outcome. Enhancing illness
awareness improves treatment adherence and helps to cope with
stigma; teaching patients on the recognition of early warning signs of
relapse and on effective seek for help may be particularly effective to
prevent relapse into mania; helping patients to understand the potential
impact of legal and illegal drugs on the course of their condition,
promoting healthy sleep and eating habits, and reinforcing resilience
may be very useful to decrease their vulnerability to stressors and to
keep them well.
UL9.
MANAGEMENT OF PATIENTS
WITH CO-OCCURRING SUBSTANCE ABUSE
AND SEVERE MENTAL DISORDER
R.E. Drake
Dartmouth Psychiatric Research Center, Dartmouth Medical
School, Lebanon, NH, USA
This paper discusses the clinical implications of past and current
research on co-occurring substance abuse and severe mental disorder.
Past research findings include: a) co-occurring disorders are modal;
b) co-occurring disorders are costly; c) parallel treatments are ineffective;
d) integrated treatment are more effective; e) integrated dual
diagnosis treatment fidelity is important. These findings suggest that
all mental health clinicians need to be skilled in assessing and treating
co-occurring disorders and that all mental health programs need
to be co-occurring disorders programs. Recent research points to several
new findings: a) recovery is multi-dimensional; b) types of interventions
have specific effects; c) group interventions and residential
programs are the most effective modalities for addressing co-occurring
substance abuse; d) relapse prevention is correlated with safe
housing, employment, relationships, and maintenance treatment; e)
supported employment effectively provides a critical recovery component:
structured and meaningful activity; f) subtypes of co-occurring
disorders patients have different treatment needs and different trajectories
of recovery. These findings support using client preferences for
a variety of interventions; long-term programs; emphasizing groups,
residential services, and supported employment; and developing person-centered
algorithms for interventions. Several other research
findings, related to families, trauma treatments, and other aspects of
co-occurring disorders, are less clear.
UL10.
COMPREHENSIVE MANAGEMENT OF BORDERLINE
PERSONALITY DISORDER IN ORDINARY CLINICAL
PRACTICE
M.H. Stone
Department of Clinical Psychiatry, Columbia College
of Physicians and Surgeons, New York, NY, USA
Within the past decade, manuals containing treatment guidelines
have been developed for a number of the different, and currently popular,
approaches to the therapy of borderline personality disorder
(BPD). Among these are manuals of transference-focused psy-
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