The objective of this study is to assess the frequency of adult Attention Deficit Hyperactivity Disorder (ADHD) comorbidity and the effect of ADHD comorbidity on various demographic and clinical variables in patients diagnosed with bipolar disorder (BD).

103 patients with BD (51 female, 52 male) presenting at outpatient clinic of the BD Unit of the Department of Psychiatry of Çukurova University Faculty of Medicine were included in this study. All patients were evaluated for the presence of adult ADHD diagnosis and comorbidity using the entire SCID-I and the childhood ADHD sections of K-SADS-PL. Furthermore, the patients have also completed the Wender Utah Rating Scale (WURS-25) and Present Symptoms Scales.

13 of the 103 patients diagnosed with bipolar disorder (12.6%) were diagnosed with adult ADHD. BD patients with ADHD comorbidity had mood episodes at an earlier age and had higher numbers of previous total episodes, depressive and hypomanic episodes and higher numbers of hospital admittances than those without comorbidity. Overall, a larger portion of the patients with comorbidity had axis I comorbidities and panic disorder and alcohol abuse disorders were found at higher rates.

Adult ADHD is a common comorbidity in BD patients, which adversely affects the course of the disease and disrupts the social adjustment of the patients. Regular monitoring and scanning that keeps in mind the diagnosis of ADHD, will help prevent the problems and complications in the disease process, particularly in patients with early onset BD.

In an earlier study we have found that emotion regulation in childhood and adolescence had been associated with depression and different type of suicidal behaviors. None of the studies has examined, however, the features of emotion regulation in youth with different psychiatric disorders. We thus investigated in a clinical sample of youth (N=400; ages 10-17 years) with internalizing and externalizing disorders the features of emotion regulation.

Our subjects were recruited from the inpatient unit of our hospital; children completed a self-rated scale of emotion regulation, “Feelings and Me” Questionnaire. The functional and dysfunctional, and the cognitive, behavioral and social domains of emotion regulation were examined.

We found differences in the cognitive and behavioral emotion regulation strategies in youngsters with different diagnoses, that is children with internalizing disorder were more likely to exhibit cognitive than behavioral emotion regulation strategies, and youth with externalizing disorders could be characterized by more behavioral than cognitive emotion regulation strategies.

These results emphasize the importance of investigation of different emotion regulation strategies in internalizing and externalizing disorders, as a basic of cognitive-behavioral or contextual emotion regulation psychotherapy.

Automutilation behavior and Suicidal thinking are common in individuals with bipolar disorder. Few studies have investigated the prevalence of and risk factors for self-injury behavior and Suicidal ideation among adolescent patients.

Patients aged from 13 to 18 years old with bipolar I or II disorder (DSM-IV criteria) diagnosed with structured interviews were evaluated using demographic, parents rearing style and adolescent self-rating life events checklist questionnaires to assess incidence and correlates of automutilation behavior and Suicidal ideation. Demographic and psychosocial characteristics were compared for patients with and without a history of self-injury and suicidal ideation.

More boys attempted self-insult (P= .035)and more girls had suicidal thinking (P= .005). The 44% of patients with a history of automutilation behavior, compared with those without such a history, had more negative life events(P=.000);more paternal punish(P=.024),interfere(P=.004)rejecting and negation(P=.008)and maternal rejecting and negation(P=.020). The 67% of patients with suicidal thinking, compared with those without such a history, had more negative life events(P=.033);more maternal interfere and protection(P=.024).

Our retrospective findings indicate that a history of automutilation behavior and suicidal ideation is associated with a more negative life events and more negative parental rearing style. Greater attention to realizing those at high risks for self-injury behavior and suicidal thinking could have an impact on bipolar disorder among adolescents.

7 women; average age: 44 years old; onset of bipolar disorder at the age of 32.

Continous use of oxcarbazepine: 26.1 months and continuous use of the previous mood stabiliser: 20.6 months. The percentage of time spent in euthymia improved from an average of 48% with the previous mood stabiliser to 62% with oxcarbazepine. The percentage of time spent ill both of (hypo)mania and of depression decreased respectively from 24% to 18% and from 25% to 19% with the use of oxcarbazepine. Improvement occurred with 4 of the 7 patients.

These results are in accordance with the literature. Oxcarbazepine has the advantage of fewer (drug-to drug) interactions than carbamazepine.

Cognitive- behavioural therapy (CBT) is an augmentation strategy used in bipolar depression because it improves compliance to treatment, patient's insight into specific areas of daily behavior, allows patient to recognize early signs of disease and to cope with stressfull events.

To analyse the efficacy and action onset of augmentation cognitive- behavioural specific techniques in patients diagnosed with bipolar depression that receive an antidepressant and anticonvulsant combination therapy.

A group of 18 patients, 6 male and 12 female, mean age 32.9, admitted in our clinic with bipolar disorder type I, major depressive episode (DSM-IV-TR) were distributed in two equally groups, one of them received only antidepressant drug plus anticonvulsant, the other combined psychopharmacological treatment with CBT. All patients received carbamazepine (flexible dose 400-600 mg/day) and selective serotonin reuptake inhibitor (SSRI): 7 patients fluoxetine 20-40 mg/day, 6 patients paroxetine 20-40 mg/day and 5 sertraline 150-200 mg/day. Inclusion criteria: Hamilton Depression Rating Scale 17 items (HAMD-17) over 17, Young Mania Rating Scale (YMRS) under 10. Exclusion criteria: axis I or II comorbidity. We used weekly for 4 weeks and monthly for 5 months HAMD, YMRS, Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI).

There was a significant better improvement in patients receiving CBT treatment (-12%HAMD, -14%GAF, -16%CGI). YMRS was stable in both groups. The onset of antidepressant action was observed earlier in CBT group (10.5 days compared to 17.5).

CBT stands as an efficacious augmentation strategy for patients who are treated with antidepressant and anticonvulsant therapy.

Adolescents with bipolar disorder are much more than people once thought. Although there have been multiple reports published regarding the treatment of manic symptoms in children and adolescents, albeit mostly open studies, the efficacy of agents to treat bipolar depression in this population has not been adequately studied. Treating with antidepressants such as tricyclic antidepressants and SSRI(selective serotonin reuptake inhibitors) should face the risk of mood switching and suicide. Acanthopanax senticosus has shown some antidepressant effect since the ancient china, and preliminary studies also indicated it may be helpful to depression. Will it be helpful if treating the adolescent bipolar disorder?

76 patients were randomized into two groups, 37 treated with capsule Acanthopanax senticosus plus tablet lithium, 39 treated with capsule fluoxetine plus tablet lithium. Hamilton depression rating scale, 17 items (HAMD-17) was assessed during the trial.

After 6 weeks treatment, There was a main effect for duration of treatment for Hamilton depression scale scores (F=183.06, P<0.01), but there was no group main effect(F=0.99, P=0.323) or group-by-duration of treatment interaction(F=0.779, P=0.437). The response rate and remission rate between the two group were similar. 3 patients suffered mood switching in fluoxetine treated group while no patients in Acanthopanax senticosus treated group.

This preliminary study suggested that lithium adding Acanthopanax senticosus was as effective as lithium adding fluoxetine for treating adolescent bipolar depression, and Acanthopanax senticosus may be more safer and less risk to mood switching.

Numerous studies on the treatment of acute mania in bipolar patients have demonstrated the efficacy of atypical neuroleptics versus placebo or active comparator. However, there is a lack of direct comparative studies between atypicals. We present an overview on the efficacy (response and remission rates) of atypicals.

Using MEDLINE-analysis, all prospective double-blind studies of atypical neuroleptics in acute mania published until November 2006 were identified. Response was defined as 50% improvement and remission as an endpoint ? 12 in YMRS. The following parameters were calculated: response rates, remission rates, odds ratios, adjusted odds ratios.

Response rates in placebo controlled studies (duration 3-4 weeks) ranged from 18.9% to 42.9% (placebo) and from 39.8% (aripiprazol) to 72.9% (risperidone) for comparators. The adjusted odds ratios ranged from 1.946 (ziprasidone) to 2.727 (risperidone), all differences versus placebo were statistically significant in favor of the atypical. Remission rates ranged between 22.1% and 35.7% (placebo) and for comparators between 27.7% (quetiapine) and 61.1% (olanzapine). In comparator controlled studies (duration 3-12 weeks) response rates ranged between 42.3% and 74.2%. With odds ratios between 0.580 and 1.629, differences versus comparator were not statistically significant. Remission rates in these studies varied from 27,7% (quetiapine) to 49% (lithium). The observed trends for treatment effect differences between the atypicals are confounded by different study designs and patient characteristics. Thus, direct comparative studies between atypicals in acute mania are required to detect potential treatment effect differences, e.g. in special patient subgroups.

As bipolar disorder drastically afflicts the patient's family, social, and occupational life alongside with a high suicide rate, early initiation and maintenance of pharmacotherapy is crucial. However, bipolar relapse prevention including modern atypical antipsychotics still deserves research.

Targeting relapse prevention in a natural setting, this ongoing 18-months, prospective, multicenter, non-interventional study compares mood-stabilizing therapies in German outpatients with bipolar disorder.

The present analysis of baseline-data reveals that of 761 adults included, 26.1% are receiving olanzapine monotherapy (OM), 21.2% lithium monotherapy (LM), 30.1% anticonvulsant monotherapy (AM), 6.4% olanzapine/lithium combination therapy (OLC), 9.5% olanzapine/anticonvulsant combination therapy (OAC), 6.7% other combinations of mood stabilizers (OC) and 5.8% no mood stabilizers (NO). A higher rate of females receive AM (32.5%, males 22.9%) while males are rather treated with OM (26.6%, females 23.0%). At baseline, 36.4% of the patients had been hospitalized within the last 12 months due to psychiatric disorder, 26.8% had a history of suicide attempts, 10.7% were considered rapid cyclers.

Within the last 12 months 66.5% of the patients experienced manic episodes, 88.6% depressive episodes and 43.1% mixed episodes. The highest rates of prevalent diabetes mellitus (12.6%) and lipid disorders (17.5%) and second highest of cardiovascular disease (20.4%) was found in Patients receiving LM. Employment rate at baseline was highest in the AM-group (39.6%) and lowest with OC (29.2%).

The present data show that these patients in whom maintenance therapy was initiated, form an exceedingly heterogeneous population, suggesting a strong demand for individually customized therapies.

Treating bipolar disorder, patients with mixed episodes are considered the most problematic subgroup as they do not respond easily, which makes the choice and dosage of the respective pharmacotherapy difficult. One objective of this ongoing 18-months, prospective multicenter, non-interventional study on mood-stabilizing therapies is to find out what specific patient features are associated with mixed episodes.

Observational data from 761 outpatients are collected by 150 office or hospital based psychiatrists throughout Germany in the course of standard treatment for bipolar disorder. A baseline analysis was run and patients without mixed episodes (0-MX) were compared to those with one (1-MX) and more (>1-MX) mixed episodes.

30.9% patients experienced mixed episodes within the last 12 months, with a hospitalization rate of 33.2% for the 0-MX, 36.5% for the 1-MX and 43.4% for the >1-MX group. The 0-MX group had 5.6% rapid cyclers, while it was 11.0% for the 1-MX and 32.8% for the >1-MX group. Regarding treatment, 0-MX mostly receive anticonvulsive monotherapy (31.1%), 1-MX olanzapine monotherapy (31.8%) and >1-MX anticonvulsive monotherapy (35.3%). A higher psycho-education rate appeared with the 1-MX (19.0%) and >1-MX (28.8%) than with the 0-MX group (14.8%). Further psychotic diseases were associated with less mixed episodes (0-MX: 71.3%, 1-MX: 69.2%, >1-MX: 57.5%).

The high hospitalization rate suggests the need for a careful medical monitoring and optimized pharmacotherapy to prevent bipolar relapse in patients with mixed episodes. The present data reveal a want for more detailed analysis.

This study aims to compare ADHD and Bipolar Disorder(BPD) regarding comorbid axis I psychiatric disorders, personality disorders, existence of general psychopathology as measured on SCL-90-R and in areas of educational attainment and psychosocial adjustment.

38 patients who were diagnosed with ADHD in Marmara University Hospital, Psychiatry Department Adult ADHD Outpatient Clinic and 38 patients receiving treatment for Bipolar Disorder in Mood Disorders outpatient clinic during the same period, have been included in the study. The socio-demographic characterization was done using a semi-structured interview. To evaluate the presence of psychiatric comorbidity, structured clinical interviews (SCID-I and II) were conducted by two general psychiatrists experienced in ADHD and trained in SCID administration. All groups were given SCL-90-R for general psychopathology assessment and BDI for depression assessment.

The ADHD and BPD patients did not differ in terms of marital status, the number of suicide attempts and family psychiatric history. However, ADHD patients had significantly greater scores on SCL-90 general psychopathology scale (F(1,66)=27.303, p<.001) and higher scores on depressive symptomatology (F(1,63)= 10.988, p<.005). ADHD patients had comparable frequency of comorbid axis I disorder and significantly higher frequency of comorbid axis II personality disorders (F(1,64)= 24.438, p<.001). Besides, repeating educational years (F(1,66)=7.447, p<.005) were more likely to be seen in ADHD patients in contrast to BPD patients.

ADHD is a disorder that affects, no less significantly than BPD, educational achievement, and psychiatric comorbidity, especially in terms of increased presence of axis II disorders and psychiatric symptoms.

This study aimed to investigate the effect of quetiapine monotherapy on subjective feelings of sleep in patients with acute mania.

In a Korean multicenter, open-label, 6-week study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to treatment with quetiapine (flexibly dosed up to 800mg/day). Clinical Improvement was evaluated using Young Mania Rating Scale (YMRS). Side effects were measured by Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS). Modified version of Leeds Sleep Evaluation Questionnaire (LSEQ) was used to assess the subjective measures of sleep, which included the factors covering four areas: i) getting to sleep (GTS), ii) quality of sleep (QOS), iii) awakening from sleep (AFS), and iv) behavior following wakefulness (BFW). All assessments were done at baseline and days 7, 14, 21 and 42 after treatment with quetiapine.

Fifty-six of 79 patients were completed the all assessments. Mean changes of YMRS from baseline were significant at days 7, 14, 21 and 42. There were no significant differences in SARS and BARS at any assessment. While mean changes of GTS, QOS and AFS from baseline were significantly improved at days 7, 14, 21 and 42, BFW was not differed between baseline and post-treatment assessments.

Quetiapine monotherapy showed improvements of self-perceived sleep without any impairment following sleep in acute manic patients.

Missed seizure (motor seizure duration <15 seconds and/or EEG seizure duration <20 seconds) in ECT even with the maximum stimulus dose delivered by the machine is clinically challenging. The maximum deliverable dose in many countries is up to 576mC, although in UK and some parts of Europe this is nearly double.

This study examined the incidence of missed seizures at the standard dose of 500mC set on the ECT machine. The effect of using higher stimulus intensity in in-patient with missed seizure was evaluated.

All patients who were initiated a course of ECT over one year period formed the sample (n=70; F=52, M=18). The tool used in data collation included demographic, clinical and ECT parameters. The ECT parameters included stimulus laterality, dosage administered, motor and EEG seizure duration of the last ECT treatment.

Six (8.5%) patients had missed seizures at 500mC. Two of them had adequate seizures at a higher stimulus dose (706 and 760mC each).The remaining four failed to have adequate seizures even when the stimulus dose was set at 1000mC. Of the six patients four were females, five received bilateral ECT and three each were on mood stabilizers and benzodiazepines. The average age and number of ECT treatment were 63.3 years and 12 respectively. All had moderate to severe depression except one (bipolar depression).

In a proportion of patients with missed seizures higher stimulus (>576mC) produces adequate seizures. The effect of this on cognition need to be further studied.

Numerous studies have found that subjective memory improves shortly following ECT using standard self-evaluation questionnaires. These changes covary strongly with mood state while being not associated with objective memory tests or treatment parameters. This study compared patients' evaluations of the cognitive effects of ECT using a novel direct interview about subjective global impact and standard methods.

We conducted a prospective, randomized, double-masked trial of the effects of pulse width (0.3 vs. 1.5 ms) and electrode placement (right unilateral vs. bilateral) on patients' evaluations of cognitive outcomes. Subjective evaluations were obtained prior to starting and during the week following the randomized ECT course, using the Cognitive Failures Questionnaire (CFQ), Squire Memory Complaint Questionnaire (SMCQ), and the novel Global Self-Evaluation of Memory (GSE-My). An extensive neuropsychological battery was administered at the same time points.

CFQ and SMCQ scores improved at postECT relative to preECT. At both time points, these scores were strongly associated with HRSD scores and not with objective deficits or treatment parameters. In contrast, on the GSE-My patients reported a deleterious memory effect after ECT. GSE-My scores were also associated with objective memory loss and treatment technique.

Characterization of patients' experience of cognitive side effects following ECT differs markedly depending on the assessment method. Direct questioning about global impact revealed more negative views about ECT's impact. These results support the findings of a prospective, naturalistic, observational community study representing together the first reports of concordance between subjective and objective measures of ECT's effects on memory.

Deep Brain Stimulation (DBS) is a neuromodulation technique that involves the implantation of electrodes into specific parts of the brain. DBS is reversible, nondestructive, and can be modified by adjustment of the stimulator settings after implantation. Since 1998 we investigate DBS as a therapeutic option for severe, treatment-refractory obsessive-compulsive disorder (OCD). DBS in the anterior limbs of the internal capsules induced clinically significant therapeutic benefit in this patient group, not only in severity of OCD symptoms, but also on the patient's mood scores.

Despite advances in biological treatment and psychotherapy for major depression (MD), a substantial number of patients fail to improve.

Based on the results of DBS in OCD, this study investigates the effectiveness, safety, and tolerability of DBS in the same target for treatment-refractory MD.

Three patients with a longstanding history of MD, who failed to improve even after years of pharmacotherapy, psychotherapy, electroconvulsive therapy and even experimental interventions were selected. Bilateral DBS leads were implanted in the ventral part of anterior limb of the internal capsule. Participants underwent standardized and detailed psychiatric assessments on a regularly scheduled basis, both pre- and postsurgically.

After six months of chronic DBS, all three patients showed a clinically significant reduction in depression severity of 50 percent or greater on the Montgomery-Asberg Depression Rating Scale. Two of the three patients were in remission. Quality-of-life measures improved as well.

Further research is warranted, but patients with severe, longstanding, treatment-refractory MD may benefit from DBS.

Young adult woman was admitted to our department with symptoms of depression. The patient had a history of sexual abuse in her childhood. After her admission she received antidepressive treatment with a selective serotonin reuptake inhibitor (sertraline) as well as supportive therapy.

After a four months treatment the patient suddenly disappeared from her hometown. Some days later she was found by the police in a city hundreds of miles away. She had no memory of her previous life and identity and named herself with a new name. The patient was diagnosed as having dissociative fugue. For five months after the diagnosis was made the patient remained amnesic for her identity and autobiographical memory. No pharmaceutical medication was administered; only psychotherapy. The patient begun to have suicidal thoughts which led to her hospitalization.

A course of electroconvulsive therapy (ECT) as well as SSRI medication (venlafaxine, initially 75mg and then 150 mg) was administered. Following the fifth course of ECT the patient recalled all of her past memory.

The electroconvulsive therapy has not been shown to be an effective or appropriate treatment for dissociative disorders; some authors have indicated that it may be important in relieving an associated depression.

There are no reports on the use of ECT for dissociative fugue.

This patients paradoxal recall of memory following a course of ECT treatment forced us to this announcement.

Depressive disorders are common in the older patients. There is a high level of non-response in this population. While there are many treatments available, side effects to medication continues to be a major issue. Electro Convulsive Therapy (ECT) is commonly used, but is associated with a high incidence of cognitive side effects. We hypothesized that rTMS may be a useful treatment for depressed elderly.

Elderly (over 60 years) in or out patients with Major Depressive Episode within Major Depressive or Bipolar Disorders were treated open label with high frequency, left sided repetitive transcranial magnetic stimulation (rTMS) for ten sessions. They all had at least one adequate trial of antidepressants or mood stabilizers

Twenty nine patients, average age 69.3, range 60-89, 41% males, took part in this prospective study. Hamilton Depression Rating Scale score reduced from 24 at baseline to 17 at the end of treatment and to 16 two weeks after the treatment ended. Hamilton Anxiety Rating Scale also reduced from 20 to 14. There were no cognitive side effects as measured by MMSE. Only one patient dropped out of the study due to side effects

rTMS seems to be a safe and effective method for treatment of depressed elderly patients. There is a need of larger randomized controlled studies.

This study was a retprospective review on use of electroconvulsive therapy (ECT) in a Military Medical Academy, Belgrade, Serbia. Aim of the study was to determine demographic and clinical predictors of ECT outcome.

The study subjects were 120 patients (59 male and 61 female) treated with bilateral ECT over the period 2000-2004. Data extracted from clinical records included demographic variables (age, sex, education and heredity of psychiatric illness) and clinical characteristics (diagnosis, duration of illness, episode duration, comorbid psychiatric disorders, presence of psychosis, previous hospitalizations, and ECT variables). As outcome measure was used Clinical Global Impression (CGI) scale.

The significant sex difference was found concerning age and diagnosis. Female patients were much older (mean age=46.9 years, SD=14.3) compared to male patients (mean age=35.4 years, SD=14.1), with much longer duration of illness (mean=88.7 months, SD=95.8), compared to male patients (51.9 months, SD=58.1). After a clinical course of ECT, 52.5% of all patients were rated as "much", and 40% as "very much" improved on the CGI. Statistically significant predictors of remission were sex and the number of previous hospitalizations.

Significant improvement after use of electroconvulsive therapy was associated with sex and the number of previous hospitalizations, but not with age or duration of illness or presence of psychosis.

The previous studies have detected changes of brain electrical activity (current density) after cerebellar rTMS. We suppose that right cerebellar rTMS evokes changes in the left frontal cortex. The aim of our study was to determine if 1Hz and 10Hz cerebellar rTMS induces antagonistic effect in frontal electrical activity.

We used 10 minutes of 10 Hz and 10 minutes of 1 Hz rTMS (both with 600 impulses, application over the right cerebellar hemisphere) in two sessions. 31-channel EEG was recorded in 10 right-handed healthy volunteers before and after rTMS. The 3D distribution of the current density was revealed by a method of qEEG- Low Resolution Brain Electromagentic Tomography (LORETA, Pascual-Marqui et al. 1994; 1999).

After right cerebellar 1 Hz rTMS the current density decreased in the alfa2, beta1, beta2 and beta3 band over the frontal cortex including medial frontal cortex and anterior cingulate. After 10 Hz rTMS we found a decrease over the frontal cortex in the delta, theta and alfa1 band bilaterally, more on the left side (p<0.01).

Our results suggest the possibility to influence the frontal cortical activity by means of the cerebellar 1Hz and 10 Hz rTMS (antagonistic effect in the frontal cortex- decrease in slow frequencies after 1 Hz and in fast frequencies after 10 Hz rTMS).

MZ0PCP2005 (MZ ČR)