analyse GAD impact on clinical and self-perceived health status in outpatients followed in Psychiatric clinics.

Multicentre, cross-sectional study enrolling subjects above 18 years-old with GAD according with ICD-10. Participants were chosen at ramdon by quotes and weighted geographically, but patients were enrolled consecutively. HAM-A and CGI-S were administered to determine clinical status and SF-36 and Sheehan disability scales for health status assessment.

A total of 792 patients; 15.7% naives (GADn), 68.9% women, mean (SD) age of 40.0 (12.9) years were included. Time to effective diagnosis and start up of treatment were, respectively, 2.3 (4.9) and 2.6 (4.7) years. Severe symtoms of anxiety (HAM-A > 24) were presented in 45.2%; 56.9% in GADn vs 43.0% on-treatment (GADt), p<0.001. CGI-S was 3.7 (1.1) in GADn vs. 4.2 (0.8) in GADt, p<0.001. The 77,7% of GADt were receiving 2 or more drugs: 94.1% ansiolytics and/or antidepressants. The 39.3% of subjects showed high/extreme disability for work; 44.4% GADn vs 38.5% GADt, p=0.33, 34.5% for daily-living domestic activities; 39.7% vs 33.7% respectively, p=0.082, and 41.8% for social life; 43.1% vs 41.7% respectively, p=0,145. Mental composite summary of SF-36 was below normal; 30,0 (11,4), much lower in GADn: 25,4 (8,5) vs. 30,8 (11,7), p<0.001. No gender differences were found.

This study showed that a considerable proportion of GAD patients still need for additional medical remedies which should improve the level of disability caused by the diasease and counteract the deteriorated mental health observed in such patients.

Tobacco consumption has been related to the onset of panic attacks (PA), panic disorder (PD) and agoraphobia, to panic symptoms and to features related to PD. The relationship that links tobacco and panic is not clear, and some models have been proposed to explain it (causal, neuroticism as a vulnerability factor).

Our aim was to study the relationship that tobacco consumption before the onset of PD has with some features of the disorder and to clarify the relationship that links tobacco and panic.

A sample of 82 naïve PD patients was included. Patients were extensively evaluated (Mini Neuropsychiatric Interview–MINI-, Panic Disorder Severity Scale–PDSS-, State-Trait Anxiety Inventory–STAI-, Beck Depression Index–BDI-; Anxiety Sensitivity Index–ASI-, Mobility Inventory of Agoraphobia–MIA-, Clinical Global Impression-CGI-, NEO-Five Factor Inventory–NEO-FFI). Tobacco consumption was retrospectively assessed by asking the patients the consumption they had the week before suffering the first panic attack.

The condition of smoker before the onset of PA showed significant relationships with earlier age of onset of PD (p=0.04), less frequency of PA (p=0.04), and higher scores in BDI (p=0.04) and NEO-FFI neuroticism (p=0.02). After analysis with multiple logistic regression, neuroticism did not show considerably influence on any of these associations.

Being a smoker before the onset of PA is related, in the early phases of PD, to higher neuroticism and depressive symptoms, less frequency of PA and PD onset at a younger age.

Although proposed as a common vulnerability factor, neuroticism does not influence the observed associations.

The association between Mitral Valve Prolapse (MVP) and anxiety disorders, particularly Panic disorder (PD) and Social Anxiety disorder (SAD), attracted considerable interest in the 1980 and 1990 decades but the published results were not sufficient to definitely establish or to exclude an association between MVP and PD or SAD, with prevalences ranging from 0 to 57%.

According to a recent literature review on this topic, there are no studies about this possible association using current MVP criteria.

The study consisted of echocardiographic evaluation of 232 volunteers previously diagnosed with SAD (N=126), PD (N=41) or Control (N=65). The exams were performed by two cardiologists specialized in echocardiography who were blind to the psychiatric diagnosis of the participants.

There were no statistical differences between groups in MVP prevalence (SAD=4.0%, PD=2.4% and Control=0.0%), with values similar to the prevalence currently estimated for the normal population (2-4%). When the data were evaluated using the M-mode, the method used in most of the previous studies but currently considered of questionable validity, the prevalence was higher in the SAD group (8.7%) compared to control (0.0%).

Regarding the other morphological characteristics of the mitral valve, no significant differences were detected between groups in terms of the presence of mitral insufficiency, mean valve thickness and mean valvar dislocation in any two-dimensional echocardiographic view.

If any relationship does actually exist among SAD, PD and MVP, it could be said that it is infrequent and that it mainly occurs in subjects with minor variants of MVP.

The Social Anxiety Disorder (SAD) is a highly incapacitating condition that can cause considerable subjective suffering, with a negative impact on psychosocial functioning. However, few data are available in the literature about the influence of SAD severity and of SAD subtypes or the presence of comorbidities on psychosocial functioning, and the possible extent of this impairment in individuals with subclinical signs and symptoms.

The study consisted of the evaluation of psychosocial functioning using the Disability Profile (DP) in 355 volunteers, all of them college students who had been diagnosed in a previous study as SAD (N=141), Controls (N=92) or Subclinical (N=122), the last ones being defined as having unreasonable fear of a social situation but not fulfilling the criteria of avoidance or functional/occupational impairment due to this fear.

The groups were balanced regarding age, sex and socioeconomic level.

The SAD group had higher scores than the other two groups in all domains of DP, both on a lifetime basis and during the last two weeks. Subjects with subclinical SAD presented intermediate values.

The impairment of psychosocial functioning was also significantly related to the severity of the disorder. Regarding subtype, generalized SAD causes more harm, and the presence of comorbidities is associated with greater impairment of psychosocial functioning in each group.

The impairment of psychosocial functioning progressively increases along the spectrum of social anxiety. Further studies are needed to evaluate the consequences of this association.

Most patients with Social Anxiety Disorder (SAD) present other psychiatric disorders. The lifetime prevalence of comorbidities has been reported to range from 52% to 92% in epidemiological studies. There is some evidence showing that the frequency of comorbidities varies according to subtype and severity of SAD and those subjects with subclinical SAD present intermediate values.

The study consisted of the evaluation of psychiatric comorbidities in 355 volunteers, all of them college students who had been diagnosed as SAD (N=141), Controls (N=92) or Subclinical (N=122) in a previous study. The groups were balanced regarding age, sex and socioeconomic level. Three interviewing psychiatrists, blind to the group to which the volunteers belonged, applied the SCID for the DSM-IV.

The rate of comorbidity with other psychiatric disorders was 71.6% in the SAD group and 50% in subjects with Subclinical SAD and differed significantly from the Controls (28.7%). These results confirm in a Brazilian sample of college students the results of other epidemiological and clinical studies on the existence of high levels of lifetime comorbidity in SAD.

The presence of comorbidities increased progressively according to SAD subtype and severity, with the rates for subclinical subjects being intermediate, with lower values than subjects with circumscribed SAD or with mild cases of SAD, but significantly higher than control.

The rates of psychiatric comorbidity increase progressively along the spectrum of social anxiety. Further studies are needed to determine the consequences of this association.

Most of the previous systematic reviews are methodologically problematic or limited in their analysis. The aim was to systematically review all RCTs of SSRIs versus placebo in OCD in adults using continuous and dichotomous efficacy data and adverse effects data.

All published RCTs were identified using Cochrane Collaboration's Depression, Anxiety and Neurosis Groups' Controlled Register, which includes all RCTs from other databases and other sources. Study selection and data extraction was carried out by two co-reviewers. The RCTs were quality assessed. Analysis included investigating publication bias, summary measures, sensitivity analysis, heterogeneity exploration and subgroup analysis.

Random effects model was used in view of clinical and some statistical heterogeneity. Overall pooled WMD for YBOCS (Yale Brown Obsessive Compulsive Scale) for all the studies of SSRIs was -3.21 (95% CI -3.84 to -2.57, number of RCTs 17, number of patients 3097). Pooled WMD for YBOCS of individual drugs were similar and not statistically different. Overall pooled RR for response across all the studies of all the 5 SSRIs was 1.84 (95% CI 1.56 to 2.17, number of RCTs 13, number of patients 2697). (Thus NNTs for patients with baseline risk of response rate of 10% would be 12 and of 20% would be 6). Pooled RR of individual drugs were similar and not statistically different.

SSRIs are effective in reducing symptoms in OCD in comparison to placebo. Potential benefits of SSRIs should be weighed against their adverse effects before prescribing these drugs.

To compare female and male patients with panic disorder with agoraphobia (PDA) in terms of the co-occurring Axis I and Axis II (personality) disorders.

The Structured Clinical Interview for DSM-IV Axis I Disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders were administered to 157 consecutive outpatients (112 females and 45 males) with PDA, who attended two anxiety disorders clinics. Women and men with PDA were compared with regards to the type and frequency of the co-occurring Axis I and Axis II disorders.

Women with PDA had a statistically greater tendency to receive co-occurring Axis I diagnoses and a greater number of Axis I diagnoses than men. Such a difference was not found for Axis II disorders. There was no gender difference in terms of the mean number of co-occurring Axis I and Axis II diagnoses per patient. There were significantly more women with at least one co-occurring anxiety disorder. Women had a significantly higher frequency of specific phobia, while men were significantly more frequently diagnosed with hypochondriasis and past alcohol abuse/dependence. With regards to Axis II disorders, only dependent personality disorder was significantly more frequent among women.

There are more similarities than differences between genders in terms of the co-occurring Axis I and Axis II disorders. Still, the relatively specific relationships between PDA and excessive alcohol use in men and between PDA and dependent personality traits and personality disorder in women seem important and have implications for clinical practice and treatment.

To evaluate the clinical characteristics of GAD patients with prominent GI symptoms (GI-high) and their response to pregabalin (PGB) treatment.

Data were pooled from 6 double-blind, placebo-controlled, 4-6 week trials of outpatients who met DSM-IV criteria for GAD with a minimum HAM-A total score ≥18. Treatment response was evaluated for 3 PGB fixed-dosage groups: 150 mg/d, 300-450 mg/d, and 600 mg/d. A GI-high subgroup (high GI symptomatology) was defined by a baseline HAM-A item-11 (GI) score ≥3 (severe/very severe).

At baseline, 261 patients (17%) met criteria for the GI-high subgroup, while 1294 patients (83%) were in the GI-low subgroup. Baseline characteristics were similar for the 4 study treatments in the GI-high subgroup. For the GI-high subgroup, LOCF-endpoint reduction in HAM-A was significantly higher on PGB-150, -13.8±1.7; PGB-300/450 -13.5±1.2; PGB-600, -14.8±1.1; vs PBO, -10.6±1.0 (P<0.0001 for all comparisons). In the GI-high subgroup, the proportion of patients showing a response in GI symptoms (HAM-A item 11 improving from severe/very severe to mild-to-none) was significantly higher on PGB-150 (62%), PGB-300/450 (73%), PGB-600 (68%) vs PBO (56%; P<0.0001 for all comparisons). The incidence of adverse events referable to the GI system was the same on PGB-150 and PBO, 8% higher on PGB-200/450 vs PBO, and 5% higher on PGB-600 vs PBO.

PGB was effective and well-tolerated in the subgroup of GAD patients presenting with severe GI symptoms. Treatment with PGB improved both overall levels of anxiety, as well as specifically improving GI symptoms.

Funded by Pfizer Inc

To assess gender differences in the clinical presentation of GAD and response to pregabalin (PGB) treatment.

Data were pooled from 6 randomized, double-blind, placebo-controlled, 4- to 6-week trials of outpatients who met DSM-IV criteria for GAD with a minimum HAM-A total score >18. Response was evaluated for 3 fixed-dosage groups: 150 mg/d, 300-450 mg/d, and 600 mg/d.

Baseline presentation of GAD was similar for women and men, respectively, for mean (±SD) age (38.6±12.3 vs 39.4±11.5 y) and severity of concurrent depressive symptoms (HAM-D score, 13.7±4.4 vs 13.4±4.3). However, women had a modest but significantly higher mean HAM-A somatic factor score (11.5±3.2 vs 10.8±3.1; P<0.01). For both sexes, treatment with PGB resulted in significantly higher LOCF-endpoint improvement in HAM-A total score: Women: PGB-150 mg, -10.7±0.82; PGB-300/450 mg, -11.8±0.68; PGB-600 mg, -12.4±0.59 vs. placebo, -9.5±0.51; P<0.0001 for all comparisons; Men: PGB-150 mg, -10.8±0.81; PGB-300/450 mg, -12.6±0.59; PGB-600 mg, -11.6±0.51 vs placebo, -8.7±0.47; P<0.0001 for all comparisons. CGI-I responder rates were significantly higher (P<0.001) on PGB (combined doses) vs. placebo for both women (50% vs 35%) and men (53% vs 38%). There were no gender differences in attrition due to adverse events, or in proportion of severe adverse events.

Women and men with GAD showed similar clinical presentations, with women reporting somewhat more somatic symptoms. Pregabalin was an effective and well-tolerated treatment for GAD for both sexes.

Funded by Pfizer Inc

Full research in investigation the neurotic disorders in patients with virgogamia and construction the strategy in treatment actions.

In ambulance conditions 206 patients with neurotic disorders (99-48,1% males and 107- 51,9% females) in virgogamia were investigated, from 1998 to 2004.

During the research for the first time the imaginations about clinic-pathogenesis virgogamia were widened. For the first time the complex investigation of clinic-psychopathologic, psychological, social, hormonal and of vegetative level of patients with virgogamia was made. The psycho traumatic factors, which are components of neurotic disorders and proximate reasons of couples disharmony were marked and this brings то neurotic misbalance; the specification of sexual disorders in patients with virgogamia was investigated, the psychological behavior and psycho vegetative dysfunctions were studied in patients with virgogamia; diagnostic meaning of neurotic disorders were investigated and several clinical syndromes which effects on virgogamia were chosen; the personal-specialties of patients with virgogamia were investigated. The principle of psychotherapy of neurotic disorders were offered and the recommendations of their corrections were made.

The research helps us show the diagnostic level of neurotic disorders of psychic in virgogamia. The recommendations on deferential psychotherapy effects on effect of treatment of virgogamia. The modern investigation and treatment of virgogamia can serve as a prophylactic of nervous and nervous conditions among the population of our republic. Vegetative vasomotor reactions effects badly on sexual nervous. The high efficiency of psychotherapeutics care is shown at neurotic disorders in couples with virgogamia.

Iraq-Iran war lasted 8 years and ended approximately 20 years ago. It left many mentally injured veterans suffering from chronic post-traumatic stress disorder (PTSD). In this research we tried to evaluate the most frequent dream contents.

Fifty patients with chronic PTSD and fifty matched healthy individuals were included in the study. Patient's demographic data, status of depression and anxiety and severity of PTSD were valuated. Frequent dreams in the past 6 months were recorded, using a checklist which was designed based on Hall/Van de Castle test.

The mean±SD of age was 38.08 years four most frequent dreams were threatening situations (rather then war events), natural disasters, death and falling down. There was no relation between the level of depression and anxiety and contents of dreams. Patients with more sever PTSD had more dreams including theme of death (P<0.0001).

Frequent dreams in patients with chronic PTSD were not related to war experiences .We suggested dissociation as a defense mechanism is a more important factor shaping dreams than war experiences per se.

The World Health Organization recognizes acupuncture as a viable form of treatment for many medical conditions, although western physicians are still cautious to recommend it due in part to the sparse scientific empirical evidence validating its benefits. The present study evaluated the benefits of adding acupuncture (three mornings per week for four weeks, for 45 minutes per session) to a 21-day outpatient structured psychoeducational treatment program (treatment as usual -TAU) in a sample of 305 women with concurrent substance use problems, anxiety, and depression.

Women were assigned to either the TAU or the TAU plus acupuncture -TAUAC condition. Participants completed the Beck Depression Inventory, Beck Anxiety Inventory, Drug-Taking Confidence Questionnaire, and Reflective Activity Scale at pre- and post-treatment and at one- and three-months follow-up.

At post treatment and follow-up, women in the TAUAC condition reported greater reduced physiological cravings for substances, reduced depression, anxiety, and better ability to reflect on and resolve difficulties than women in the TAU comparison group. Results also suggested that women were more receptive to receiving acupuncture as an adjunct treatment for substance use than previously realized by some physicians. Reported side-effects from acupuncture were minimal and overall patient satisfaction was high.

Auricular acupuncture, as an adjunct therapy to a comprehensive psychoeducational treatment program for women with addictions can be an effective method to reduce cravings, improve overall health and general functioning, and be a potentially safer, more viable treatment alternative to anxiolytics. Suggestions for future research will be presented.

Ginkgo biloba extract (EGb761) has been used for many years to treat age-related cognitive disorders. Recent studies also indicate a therapeutic potential of EGb761 in Alzheimer disease (AD). Bolstered evidence indicates that mitochondrial abnormalities might be part of the spectrum of chronic oxidative stress occurring in aging and AD finally contributing to synaptic failure and neuronal degeneration.

We investigated the protective effects of EGb761 on mitochondrial function and ATP production.

As cellular models, PC12 cells and acutely dissociated brain cells from young and aged mice were investigated under a variety of conditions, e.g. oxidative and nitrosative stress, associated with impaired mitochondrial function and decreased membrane potential.

EGb761 alleviated mitochondrial functions in vitro at concentrations as low as 0.01mg/ml. The effect of EGb761 was specific, since protective effects were mainly seen after specifically impairing respiratory chain complexes II, IV, and V. Comparable findings were made with dissociated brain cells from young and aged mice where usually aged brain cells were more sensitive for the protective effects of EGb761. In addition, PC12 cells bearing an AD-related mutation in the amyloid precursor protein, that leads to enhanced beta-amyloid production, showed a greater benefit from treatment with EGb761 than control cells.

Taking together, our finding clearly show stabilization and protection of mitochondrial function as a specific and very sensitive property of EGb761 at rather low concentrations. This mechanism can explain many of the until now rather unrelated observations of EGb761 in brain aging and neurodegeneration.

To test the association between the use of sedative/hypnotic medication and in-patient episodes of psychiatric disorders caused by sedatives/hypnotics.

Annual sales statistics of sedatives/hypnotics in Sweden between 1998 – 2004 were retrieved from the Swedish Corporation of Pharmacies and information about misuse defined as episodes of in-patient treatment of psychiatric disorders caused by sedatives/hypnotics was retrieved from the Swedish Hospital Discharge Register.

The use of sedatives/hypnotics increased by 31 %. Of the sedatives/hypnotics, benzodiazepines decreased by 49% and benzodiazepine-like hypnotics increased by 100%. These changes were each significantly (p<0.01) associated with a decrease (33%) of episodes for in-patient treatment of psychiatric disorders caused by sedatives/hypnotics. There was no significant association between the increased use of sedatives/hypnotics and the decrease (2.8 %) of episodes of psychiatric care caused by other psychiatric disorders.

The benzodiazepine-like hypnotics successively replaced the benzodiazepines for hypnotic use. The associated reduction of psychiatric treatment episodes for misuse provides support for the benzodiazepine-like hypnotics to be less liable to misuse than the benzodiazepines.

On model of neurotic states properties of tranquilizers with benzodiazepine structure: alprozalam, lexilium, tranxen were studied.

Rating of anxiety (HARS), state of cellular immunity, pharmacokinetic (antipirine test).

At baseline total level of anxiety according to HARS constituted 17,3 ± 0,8 scores with anxious disorders assessed as 12,06 ± 0,6 scores, somatic manifestations – 4,41 ± 0,8 and neurovegetative reactions – 3,4 ± 0,35. During therapy with alprozalam, positive reverse dynamic of clinical symptoms was registered, leveling of neurovegetative manifestations. Peculiarity of lexilium is activation of factors of non-specific resistance, increase of percent of phagocyting neutrophiles both as compared with control and with indices at admission. Pharmacological action of tranxen was associated with normothymic, sedative action, presence of vegetostabilizing effect. Immunological dynamic during therapy with tranxen manifested itself in insignificant trend to normalization of cellular immunity. Pharmacokinetic of these preparations is as follows: constant of elimination of cassadan and tranxen has similar values (0,13 ± 0,031 min-1 и 0,12 ± 0,061 min-1), for lexilium this characteristic has lower values 0,075 ± 0,017 min-1 (P<0,05). Basic characteristics were permanent for all preparations and did not change in the course of the therapy.

Of most efficacy in mental anxiety is alprozalam; action of tranxen is more delicate. Somatic anxiety is better removed by lexilium. Alprozalam and tranxen are preparations of quick elimination; lexilium has a lower tempo of elimination. Alprozalam possesses an immunomodulating property, especially on indices of cellular immunity, lexilium activates phagocytosis, and tranxen is intact regarding immunity.

Paraneoplastic cerebellar degeneration (PCD) is a rare disorder, presenting with severe cerebellar dysfunction. In addition to motor deficits, cognitive and behavioural changes can be associated with cerebellar damage. The cerebellar cognitive affective syndrome (CCAS) describes affective disturbances and impairments in executive function, spatial cognition and language.

We describe, using a timeline, a patient who developed a psychiatric disorder following PCD.

A 19-year-old female presented with subacute ataxia, dysarthria and nystagmus. She was diagnosed with Hodgkin's lymphoma and achieved complete remission following chemotherapy. Over the next seven years she experienced recurrent episodes of altered mood. Her depressive symptoms included low mood, crying spells, irritability, apathy, lack of energy and early waking. There were periods when she felt “high”, harboured unrealistic optimism, had reduced attention, increased her alcohol intake and was described as being “reckless” by her family. She was diagnosed with bipolar affective disorder and eventually stabilised on imipramine and lithium.

This presentation appears to describe a case of CCAS, in which the affective component is bipolar affective disorder, type II. The psychiatric findings are a direct result of the neuropathology, emphasizing the role of the cerebellum in affective illness. While depression, mood instability and psychosis are the possible psychiatric consequences of CCAS, bipolar disorder appears to be a more unusual variant.

This presentation adds to the existing literature suggesting a cerebellar role in the modulation of emotion, and emphasizes the importance of addressing psychiatric sequelae in the treatment and rehabilitation of patients with paraneoplastic cerebellar degeneration.

Bipolar disorder is frequently misdiagnosed or diagnosed late.

We aimed to improve the diagnosis of bipolar disorder in our team.

Using an excel database, an audit of the diagnoses of all patients in a CMHT in Bedford was carried out.

It was noted that few patients were diagnosed as having bipolar II disorder, while there was a large number of Bipolar I patients, and a larger number of patients with recurrent depressive disorder, mixed anxiety and depression, unipolar depression, and psychotic depression.

All patients with recurrent depressive disorder, anxiety and depression, unipolar depression and psychotic depression are being reassessed in the outpatient clinic, using a longitudinal history, a family history, and, when these tests are positive, the ‘mood disorder questionnaire’.

The new diagnoses are recorded in the Database.

This poster represents work in progress. Increased awareness of bipolar disorder is leading to a more frequent diagnosis or re-diagnosis of Bipolar II disorder, as well as a consequent change in the proportions of each diagnosis in the sample.

The frequent misdiagnosis of Bipolar II disorder frequently leads to the treatment of these patients with anti-depressants only.

This leads to the possibility of patients becoming elated, or going into mixed states, with increased suicidality.

Appropriate diagnosis of bipolar II disorder requires skills at present found in secondary care. Such patients should therefore be referred to secondary care. Both Primary and Secondary care should be more aware of this diagnosis and its consequences.

Ziprasidone is effective and well tolerated in patients with bipolar mania, as demonstrated by 2 pivotal, placebo-controlled trials.

We evaluated pooled data for subjects with baseline Mania Rating Scale (MRS) scores in the highest 10% of the severity distribution at study baseline. All subjects in this post hoc analysis had an MRS score ≥ 36, indicating marked severity of mania. Changes in MRS scores from baseline to days 2, 4, 7, 14, and 21 were analyzed using a Cochran-Mantel-Haenszel test to determine response, defined as a decrease in MRS score of ≥ 50% from baseline, and remission, defined as an MRS score ≤ 10.

The proportion of subjects achieving response was significantly greater for subjects receiving ziprasidone compared with placebo from day 7 (p = 0.03) through to study end point (p < 0.001). The proportion of subjects achieving remission was significantly greater than placebo (p = 0.01) at study end point. Few subjects who received placebo achieved response, and none achieved remission at any timepoint during the study.

Ziprasidone is effective in the treatment of patients with severe manic symptoms. This conclusion is underscored by the relatively large drug-placebo differences observed in this patient subsample.

The corpus callosum plays a pivotal role in inter-hemispheric transfer and integration of information and is a relatively understudied structure in bipolar disorder. Magnetic resonance studies have reported callosal abnormalities in this condition but findings have been inconsistent. Structural changes affecting the CC may underlie functional abnormalities in bipolar disorder and could contribute to, or explain the pathophysiology of the condition.

A systematic review was carried out to identify, appraise and summarise magnetic resonance studies which compared callosal areas in bipolar disorder with an unrelated control group. The findings were then synthesised using random effects meta-analysis. Consideration was given to a number of variables to explain heterogeneity.

Five case-control studies were identified. Bipolar patients showed reduced callosal areas and the effect size revealed a statistically significant effect: (- 0.52, 95% CI = -0.82, - 0.21). Bipolar patients showed reduced callosal areas in comparison to healthy volunteers. There was no statistically significant heterogeneity in the studies included (I2 = 0.15, P = 0.3) and no evidence of publication bias was detected (Egger test P value = 0.5). No significant effects were noted in meta-regression analysis with reference to age (P = 0.9), gender expressed as percentage of male subjects (P = 0.6), and year of publication (P = 0.4).

Findings from this study indicate that callosal areas are reduced in bipolar disorder and suggest that a failure to integrate information across the hemispheres may contribute to the pathophysiology of the disorder.