-Anxious Distress Specifier is one of the newly added specifier in diagnosis and managment of bipolar disorder.This unique item may paly a role in not only the symptoms severity but also the degree of adherence to the psychotropics. -DSM5 Anxious distress specifier is not well studied in the 1st manic episode of bipolar disorder.

1-To study the role of DSM5 Anxious Distress Specifier in the symptoms severity of 1st diagnosed manic episode 2-To investigate its role in medication adherence in thses patients

1-DSM 5 Anxious distress specifier interview which includes 5 items : a- Keyed up or tense b-Restlessness c-Impaired concentration. d-Sense of foreboding e-Loss of control 2-The Young Mania Rating Scale (YMRS) is one of the most frequently utilized rating scales to assess manic symptoms. The scale has 11 items and is based on the patient’s subjective report of his or her clinical condition 3-Drug Attitude Inventory:consists of a questionnaire that is completed by the patient, pertaining to various aspects of the patient’s perceptions and experiences of treatment.

1-There is a positive correlation between the mean score of Young mania Rating scale in 1st episode manic patients and the mean score of DSM5 Anxious Distress specifier Interview 2-The presence of high score of DSM5 Anxious Distress Specifier Interview is positively correlated to the mean score of Drug Attitude Inventory during the follow up visits after controlling the 1st episode mania

The presence of high levels of Anxious Distress in the 1st episde mania affected the symptoms severity and medication adherence

No significant relationships.

In vivo and in vitro studies suggest that inflammation and oxidative damage may contribute to the pathogenesis of major depressive disorder (MDD) and bipolar disorder (BD). Imbalance between DNA damage and repair is an emerging research area examining pathophysiological mechanisms of these major mood disorders.

This systematic review sought to examine current evidence on the association between mood disorders and deficits in base excision repair (BER), the primary repair mechanism for repair of oxidation-induced DNA lesions.

We conducted a comprehensive literature search of Ovid MEDLINE® Epub Ahead of Print, Ovid MEDLINE® In-Process & Other Non-Indexed Citations, Ovid MEDLINE® Daily, EMBASE (1947), and PsycINFO for studies investigating the alterations in base excision repair in patients with MDD or BD.

A total of 1,364 records were identified. 1,352 records remained after duplicates were removed. 24 records were selected for full-text screening and a remaining 12 articles were included in the qualitative synthesis. SNPs (Single Nucleotide Polymorphisms) of several BER genes have been shown to be associated with MDD and BD. However, it was difficult to draw conclusions from BER gene expression studies due to conflicting findings and the small number of studies.

Future studies comparing DNA repair during the manic or depressive episode to remission will give us a better insight regarding the role of DNA repair in mood disorders. These alterations might be utilized as diagnostic and prognostic biomarkers as well as measuring treatment response.

No significant relationships.

Lithium is used as a first-line treatment for bipolar disorder during perinatal period. Dosing of lithium can be challenging as a result of pharmacokinetic changes in renal physiology. Frequent monitoring of lithium blood levels during pregnancy is recommended in order remain within the therapeutic window (0.5 to 1.2 mEq/L). Lower neonatal lithium blood level (<0.64 mEq/L) at time of delivery reduces the risk of lithium side effects in the neonate.

The aim of the present study was to quantify the rate of lithium placental passage in real word.

We included a total of 68 mother-infant pairs for which a lithium measurement was performed intrapartum. Lithium serum concentrations were determined by means of an AVL 9180 electrolyte analyzer. The limit of quantification (LoQ) was 0.20 mEq/L and detection limit was 0.10 mEq/L. Pearson analyse was performer to assess the correlation between mother and umbilical cord lithium serum concentrations.

The mean of umbilical cord serum concentration at delivery was 0.57 mEq/L (SD=0.26, range 0,20-1,42). The mean infant-mother lithium ratio at delivery for the 68 pairs was 1.12 (SD=0.24) across a wide range of maternal concentrations (range 0.14-1,40 mEq/L). There was a strong positive correlation between maternal and umbilical cord lithium blood levels (Peearson correlation coefficient 0.948, p<0.001).

Lithium demostrates complete placental passage. This finding is consistent with the results of others studies (Newport 2005; Molenaar 2021).

No significant relationships.

Atherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder.

We attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease.

The euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records.

Forty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT.

Lithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis.

No significant relationships.

Patients with bipolar disorder (BD) have an increased risk for cardiovascular morbimortality. Clinical risk factors, specifically for arrhythmias and sudden cardiac death remain understudied.

This study was conducted to assess differences in cardiac conduction among BD patients.

We included patients with BD in a cross-sectional design, confirmed by structured interview, age 18 through 80. Clinical characteristics were obtained using a structured questionnaire or medical records review. ECG intervals duration and morphology were manually assessed by cardiologists and compared among clinical subgroups using Chi-square, Mann-Whitney, and Kruskall-Wallis tests. Exploratory multivariable linear and logistic regression models were fitted to adjust for potential confounders.

We included 117 patients (60.7% women, 76.9% bipolar I, 50% history of psychosis, 22.6% suicide attempts). We found a significantly longer QTc interval in BD patients with hypertension (difference: 9.5 ms, p=0.006), obesity (difference: 25 ms, p=0.001), and metabolic syndrome (difference: 13 ms, p=0.007). Hypertension remained a significant predictor of longer QTc after adjusting for age, gender, and antipsychotic use (estimate 17.718, p=0.018). We observed a significantly shorter PR interval in women (difference: 6 ms, p=0.029), early age of onset (difference 6 ms, p=0.025), non-users of lithium (difference 4 ms, p=0.002), and early trauma (difference 4 ms, p=0.038). Finally, we identified significant correlations between symptom severity, blood glucose and PR interval (r=0.298, p=0.001; r=0.278, p=0.003; respectively).

Patients with BD and hypertension may have an increased risk for QTc prolongation. Careful cardiovascular monitoring may be warranted.

No significant relationships.

A history of childhood trauma and Comorbid anxiety disorders have each been identified as potential predictors of unfavorable outcomes in patients with bipolar disorder. Nevertheless, the relationship between these two prognostic features has been little studied.

In the present study, we aim to explore the relationship between childhood trauma and comorbid anxiety disorders in bipolar patients.

We conducted a cross-sectional, descriptive, and analytical study. Sixty-one euthymic patients with bipolar disorder were recruited in the department of psychiatry B of Razi Hospital, during their follow-up. We assessed history of childhood traumatic experiences with the Childhood Trauma Questionnaire (CTQ) and current diagnosis of anxiety disorders with the M.I.N.I. International Neuropsychiatric Interview.

The mean age of patients was 43.4. The sex ratio was 2.4. Almost two-thirds of patients (64%) had experienced at least one type of childhood trauma. Twenty-one percent of participants had one anxiety disorder and 12% participants had two or more current anxiety disorders. Of the anxiety disorders, social anxiety disorder was significantly associated with emotional abuse subscale (p=0.002). Generalized anxiety disorder was significantly associated with the physical abuse subscale (p=0.025) and the number of severe childhood trauma per patient (p=). A statistically significant association was found between the number of current anxiety disorders and the emotional abuse sub score (p=0.021).

Exposure to childhood traumatic experiences is associated with more common comorbid anxiety disorders among bipolar patients. These prognostic features should systematically be a part of clinical assessment and taken into account in the management of these patients.

No significant relationships.

NATSUKASHII: Japanese word that means happy nostalgia, it is the moment in which memory transports you to a beautiful memory that fills you with sweetness. NOSTALGY: (from the classical Greek [nóstos], “return”, and [algos], “pain”) feeling of sadness, suffering of thinking about something that has been had or lived in a stage and now not. In bipolar disorder, patients are more likely to complain of dysphoria than euphoria. Hypomanic periods often provide pleasant relief from depression. Patients experience this situation as pleasant, positive and longing once it has remitted, since they feel more creative, active and sociable.

We intend to draw attention to the blurred limits of the state of euthymia, even when stable there is a sustained emotional hypersensitivity, which must be learned to identify and coexist. Behind the desire to be euthymic, in certain patients there is a desire to remain hypomanic and / or manic due to the fact that they have tasted absolute happiness.

After several interviews with stable patients, we have realized that a great majority want to re-experience the sensations of a hypomanic episode.

After a bibliographic search we have realized that in the West there is no term in psychopathology that describes that longing that they verbalize as “maniac lives happier”

Special attention must be paid to these patients since they have less adherence to treatment and risk of abandoning it.

No significant relationships.

Self-stigma is widespread in patients with bipolar disorder, with many consequences for family, social and occupational functioning, as well as treatment adherence.

The aim of this study was to evaluate self-stigma in remitted patients with bipolar disorder and to investigate its impact upon functioning.

We conducted a cross-sectional, descriptive, and analytical study of 61 patients with bipolar disorder. Euthymia was verified using the Hamilton scale for depression and the Young scale for mania. We used the Internalized Stigma of Mental Illness (ISMI) to evaluate self-stigma, the Functioning Assessment Short Test (FAST) to assess functioning.

The mean age of patients was 43.4 years. The sex ratio was 2.4. The mean score on the ISMI was 2.36. More than half of our patients (59%) were self-stigmatized. Regarding functioning, a global impairment was noted in more than two thirds of the patients (71%). Occupational functioning was the most affected area (82%). Patients with higher self-stigma scores had significantly more impaired functioning (p<10-3). To decompose the relationship between stigma and functioning into more specific spheres, we found that all scores on the different domains of functioning were associated with a significantly higher mean self-stigma score.

The relationship between self-stigma and functioning seems to be bidirectional. Therefore, improved social functioning could reduce self-stigma and improve self-esteem.

No significant relationships.

The COVID-19 pandemic has led to an increased psychological strain on public mental health and may impact behavioural, mental, and physical health, presumably with effects on patients with severe mental disorders.

This study examines pandemic-related physical and mental health and (compensatory) behavioural changes, in patients with BD as compared to healthy control individuals.

Physical and mental health and self-reported changes in daily structure and behaviour due to pandemic were assessed using a self-constructed questionnaire and the brief symptom inventory (BSI) from outpatient clinics in Germany, Austria, and Denmark in individuals with BD and a healthy control group.

The present study included 118 individuals with BD and 215 healthy controls. Individuals with BD reported statistically significant higher physical risk burden, increased weight gain, more physical comorbidities, and a decrease in physical activity and they further reported higher rate of COVID-19 testing, had more worries concerning health and experienced more anxiety but less social distancing.

The COVID-19 pandemic seems to have a greater impact on physical health in individuals with BD than in healthy controls. Individuals with BD appear to be having more difficulties compensating their behaviour due to the pandemic which could amplify the effect of risk factors associated with poorer physical health. This highlights the necessity for optimising and targeting the overall treatment of both mental and physical health in patients with BD during periods with far-reaching changes such as COVID-19 pandemic.

No significant relationships.

Lurasidone is an atypical antipsychotic agent with potential antidepressant effects through its antagonist activity at the 5-HT7 receptor. Although treatment-emergent affective switch (TEAS) induced by second-generation antipsychotics are not frequent, several cases have been reported. To our knowledge, there is no evidence of lurasidone-induced TEAS.

To describe a case of lurasidone-induced mania.

We describe a clinical case of a patient admitted to our psychiatric outpatient unit who developed a manic episode, presumably induced by the introduction of lurasidone. We also conduct a review of the literature on this subject.

A 37-year-old man diagnosed with obsessive-compulsive disorder (OCD) and an alcohol use disorder was hospitalized due to OCD decompensation with depressive symptomatology and suicidal thoughts, and for alcohol detoxification process. Since he had a previous history of clomipramine-induced TEAS, he was started on lurasidone up to 111mg to avoid the use of antidepressants, showing a progressive improvement of depressive symptoms. Thus, the patient was discharged when alcohol detoxification process was completed. Eight days after discharge, the patient began to show manic symptoms, so he had to be readmitted. Lurasidone was discontinued and valproic acid up to 1000mg/day as mood stabilizer was added, presenting a positive remission of manic symptoms.

According to our experience, lurasidone may have induced an affective switch in this patient. Based on our findings, patients and psychiatrists should monitor possible lurasidone-induced mood switching. However, further research is needed in order to back-up this one case report findings.

No significant relationships.

Medication adherence by persons with bipolar disorder (BD) is inconsistent. This is disconcerting, as BD is treatment responsive, side-effects are few, and the impact of both hypo/manic and depressive mood episodes can be considerable (e.g., self-harm).

For this study, we computed a path model to identify both direct and indirect predictors of medication adherence. This included both clinical and psychosocial independent variables (e.g., BD symptoms, psychological well-being, alcohol misuse).

From the BADAS (Bipolar Affective Disorder and older Adults) Study, we identified a global sample of adults with the BD. Participants were recruited using microtargeted, Facebook advertising. This sample included persons living in Canada, U.S., U.K., Ireland, Australia and New Zealand (M = 55.35 years, SD = 9.65).

Direct predictors included perceived cognitive failures and alcohol misuse. Of note, medication adherence is inversely associated with number of prescribed antipsychotic medications. Neither symptoms of depression nor hypo/mania emerged as direct predictors of medication adherence. Similarly, psychological well-being appears indirectly associated with adherence (via BD symptoms).

Despite the wide age range of participants (22 – 73 years), age did not emerge as a predictor of adherence. Nor do cognitive failures appear significantly associated with age suggesting that both young and older adults with BD perceived cognitive loss.

No significant relationships.

Maintaining remission, preventing from future episodes, better treatment adherence and improving the quality of life are main aims of long-term treatment in bipolar disorders (BD). In recent years, new generation long-acting injectable (LAI) antipsychotics have been frequently used in maintenance treatment for bipolar disorders.

We aimed to review socio-demographic and clinical characteristics of bipolar patients taking LAI treatment for maintenance treatment.

Clinical records of 44 bipolar patients who are on LAI treatment and followed in Mazhar Osman Mood Clinic (MOMC) of Selcuk University Medical Faculty were evaluated.

Nearly half of the patients were male (n:24, 54%). 43,2% of the patients were married. The mean age was 36.6±11.9 years and the mean duration of education was 11.5±3.9 years. All of the patients were diagnosed with bipolar 1 disorder. Most of the patients (65.9%) was on aripiprazole LAI while remaining was receiving paliperidone LAI for maintenance treatment. Ten of the patients discontinued the treatment due to the side effects and extrapyramidal side effects was the most common side effect. Relapse was observed in 25% of the patients and there was no difference between aripiprazole and paliperidone in terms of relapse rate.

LAI new generation antipsychotics are taking place in long-term treatment of bipolar disorder via improving treatment adherence. Side effect profile of aripiprazole and paliperidone are different. However, we could not find any difference between two drugs in terms of side effects and relapse rates. Small sample size and shorter duration of follow-up should be considered as limitations.

No significant relationships.

Bipolar disorder (BD) is characterized by episodic changes in affect, motivation, cognition and behavior. This severe mental disorder has a prevalence of at least 1% and a high heritability of 60%-80%. The pathophysiology is still poorly understood but evidence indicate that the disorder relates to disturbances in front-limbic networks relevant for emotion processing and regulation. New techniques have been used to study BD and showed aberrante white matter (WM) microstructure in the corpus callosum and from-limbic pathways. However, lithium, a mood stabilizier, it looks like has celular and neuromodulatory effects.

The authors elaborate a narrative literature review to identify the existing clinical evidence of lithium’s effect on the WM from BD patients.

Pubmed databased searched using the therms “bipolar disorder”, “white matter” and “lithium”.

Lithium is a bipolar medication that confers treatment and long-term prophylaxis and been reported as having neuroprotective effects.

Studies that used new techniques such diffusion tensor imaging measures to assess white matter integrity reported a positive effect of lithium on the integrity of WM of BD patients and suggest that response to lithium treatment in BD patients is associated with normalization of WM microstructure in regions associated with emotion processing.

Lithium appears to positively influence the evolution of the white matter abnormalities described in BD patients however further investigation is required to strongly reinforce this potential and safety.

No significant relationships.

Knowledge of the main markers of bipolarity, clinical features and the course of depression within BPAD in men and women will contribute to the correct diagnosis, prog- nostic assessment of the disease course and administration of an adequate therapy.

The aim of the investigation was to study the clinical features of depression in men and women with BPAD in order to identify markers of bipolarity, facilitate a diagnostic search and determine therapeutic tactics.

The study was conducted from 2018 to 2020 in outpatient and inpatient conditions of the S. S. Korsakov Psychiatric Clinic of Sechenov University. 100 patients (50 women and 50 men) with a diagnosis of F31.3-F31.5 according to ICD-10 were examined by the clinical method.

In the structure of the depressive phase in men, the following were more common: pronounced seasonality (with deterioration in autumn-winter) and daily fluctuations in the state (with improvement in the evening), anesthesia of the senses, depersonalization-derealization syndrome, decreased libido, difficulty falling asleep and increased appetite and / or body weight, comorbid depression, panic attacks and alcohol and surfactant abuse. Depression within the BPAD in women was characterized by a more frequent presence of apathy, tearfulness, self-harm, dysmorphophobic inclusions, decreased appetite.

The revealed features of psychopathological symptoms and correlations between some characteristics and factors, taking into account gender differences, can be used as markers of bipolarity, which will allow for an earlier and more accurate diagnosis of BPAD and adequate therapy.

No significant relationships.

Type I bipolar disorder (BDI) is characterized by a chronic evolution, with recurrent mood episodes that severely disrupt the overall functionality and quality of patients’ life. An adequate maintenance treatment is necessary to prevent relapses and to improve the functional prognosis of these patients.

To find data regarding the most evidence-based therapeutic strategies in the maintenance phase of BDI.

A literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE) using the search paradigm “type I bipolar disorder” AND “mood stabilizers” AND “antipsychotics” AND “anticonvulsants”. All papers published between January 2000 and August 2021 were included.

The main recommendation is to continue in the maintenance phase the same medication that has proven its efficacy and tolerability in the acute phase. In BDI the most evidence-supported pharmacological approaches for the maintenance phase were lithium, valproate, lamotrigine, and carbamazepine as anticonvulsants/mood stabilizers, as well as olanzapine, quetiapine, and aripiprazole as antipsychotics. Lithium and valproate have been associated with positive influence over neuroplasticity, while antipsychotics have considerably higher metabolic adverse events. Monotherapy is recommended, but drugs associations are frequently met in clinical practice. There are no consistent data about the superiority of one class over the other, but lithium has a proven effect of decreasing the suicide rate in this population.

Both anticonvulsants and antipsychotics are used in the maintenance phase of the BDI, without significant differences in the efficacy rates. However, benefits and risks should be weighted for each class and each individual agent recommended.

No significant relationships.

The lifetime prevalence of comorbid posttraumatic stress disorder (PTSD) in patients with bipolar disorder (BD) is approximately 20%. Guidelines for BD give adequate pharmacological treatment options when there is a ‘pure’ bipolar disorder but lack of treatment options when there is a comorbid disorder present.

The present study aimed to review the pharmacological treatment options for comorbid PTSD in patients with BD.

Literature research was conducted via PubMed, Embase and the Cochrane Library. Search terms included ‘bipolar disorder’, ‘posttraumatic stress disorder’, ‘PTSD’, ‘pharmacotherapy’ and ‘treatment’. Relevant studies were reviewed.

No randomized controlled trials have been conducted in patients with bipolar disorder and comorbid PTSD. Most studies included open-label studies and case-reports. No convincing scientific evidence for pharmacological treatment of comorbid PTSD in patients with BD was found. Selective serotonin reuptake inhibitors (SSRIs) are effective in the treatment of PTSD. However, SSRIs or other antidepressants are complicated due to potential induction of a manic episode or promote rapid cycling. Nevertheless, it is important to treat the bipolar patient with a mood stabilizer first before antidepressants are prescribed.

The findings of this study show that there is no convincing scientific evidence for the pharmacological treatment of comorbid PTSD in patients with bipolar disorder. Therefore, psychotherapy is preferable. When psychotherapy is not effective, pharmacotherapy can be considered. However, randomized controlled trials are needed to obtain scientific evidence for pharmacological treatment options.

No significant relationships.

Suicide risk is 20-30 fold higher in bipolar disorder(BD) than general population. A positive family history of suicide, early-onset bipolar disorder, rapid cycling, and drug/alcohol addiction have been identified as risk factors for non-fatal suicidal behavior. Lithium is the only mood stabilizer known to have a suicide-reducing effect in patients with BD. Less than half of the bipolar patients respond lithium well. Even though mechanism of action on suicide behavior is not clearly known, it is thought that lithium significantly reduces “impulsive-aggressive” behavior via serotonergic system which might also be related with treatment response in BD.

The aim of this study is to evaluate the relationship between lithium response and history of suicide.

Those who scored 7 points or more from the Alda total score were considered good responders. Patients were divided into those who responded well to lithium treatment and those who did not. History of suicide attemptbetween these two groups was compared.

65.3% of the patients were female (n:49). The mean age of the patients was 36.82±13.35 years. 25 patients responded well to lithium treatment. Among the good responders, 32% of the patients and 25% of the non-responders had a history of suicide attempts. This difference was not statistically significant. (p=0.46 x²=0.13)

The insufficient number of data in the study was considered as a limitation of this study. In addition, there is a need for more studies as there are many factors that cause suicide attempts.

No significant relationships.

Use of Monoamine Oxidase Inhibitors (MAOIs) has experimented an important reduction in recent years, being replaced by other antidepressant drugs (ADs) associated with a better safety profile. Its use has been restricted to instructed professionals treating resistant and atypical depression. Thus, treatment-emergent affective switch (TEAS) induced by MAOIs is a rare event nowadays.

To describe a manic episode associated to a one-year-long treatment with phenelzine, a MAOI agent.

We present the case of a 47-year-old man hospitalized in our acute psychiatric unit after presenting compatible clinical symptoms with a manic episode. He showed severe irritability, decreased need for sleep, pressured speech, increased energy and goal-directed activities. The patient had started phenelzine a year ago for the treatment of major depressive episode resistant to previous pharmacological essayed treatments. No previous history of TEAS was reported, although he had already taken other ADs and mood-stabilizer treatments in the past.

Several studies reported the effectiveness of MAOIs for the treatment of monopolar depressive episodes resistant to other ADs, especially when atypical symptoms were observed. Data on the use of MAOIs for the treatment of drug-resistant bipolar depressive episodes is scarce. Few studies have described a good response without showing and increased risk of TEAS.

As MAOIs have fallen out of favour with modern psychiatry, there is scarce evidence on the prevalence of TEAS in patients undergoing treatment with these drugs. Further research is needed in order to accurately define these complex relationships.

No significant relationships.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in bipolar disorders(BD). The heart age of patients with BD was found to be 8.5 years higher than gender-age matched health controls. Metabolic side effects of antipsychotics, poor diet, insufficient physical activity, smoking and sedentary life style increase the risk of cardiovascular disease in bipolar patients. QRISK-3 is an approved risk classification that calculates the 10-year risk of developing a heart attack or stroke.

This study aims to determine whether there is a difference between cardiovascular disease risk scores and clinical stages of bipolar disorder

35 outpatients that were followed up in Selcuk University Medical Faculty were evaluated. The clinical stages and qrisk3 scores were calculated.

68.6% (n:24) of the patients were female. 42.9% of patients were in stage 3b (recurrent relapses, complete remission between episodes). The mean age was 36.94 ±10.46 years. The mean heart age was 50.54±17.35. The mean Q risk3 score was 5.59±8.18. There was no difference between bipolar patients at stage 2 and stage 3 in terms of age(p=0.36 and gender(p=0.73). When we compared the qrisk3 total socres and heart age of the patients in stage 2 and 3, we could not find any difference between groups (p=0.74, p=0.57 respectively).

Even though we could not find any difference of qrisk scores at different clinical stages of patients with BD, the CVD risk increases with the age. Prospective longitudinal follow-up studies are required to evaluate dual interaction of clinical stages and CVD risk in BD.

No significant relationships.

Age at onset of pediatric bipolar spectrum disorder (BSD) is an important marker of a more severe form and a highly heritable mood/mental disorder.

Here, we report a familial Tunisian BSD follow-up study showing a very early onset of the BSD at the neonatal period.

A 28-year-old female and her 30-year old sister were referred for genetic and psychological assessments due to recurrent depressive episodes.

Psychological assessment revealed a BSD type II with episodes of hypomania for both patients. The 30-year old sister presented a mixed form of BSD coupled with autistic traits, hyposomnia and obsessive-compulsive behaviors. Intellectual and cognitive abilities were without concerns. Familial history revealed BDS among paternal relatives including the brothers’ and sisters’ father as well as all their uncles offspring’s, and their grandparents, who were consanguineous. The depressive mood was a common sign in the three generations. Personal history revealed significant signs of a very early onset of the disorder since the neonatal period for the two sisters as well as for their four paternal cousins who also presented BSD features. Familial risk of BSD in this family correlates with a variably higher personal risk of other psychiatric disorders such as anxiety, drug abuse, personality disorders, and autism spectrum disorder.

Environmental conditions, familial care and educational level have a strong correlation with the severity and the efficiency of cognitive management of BSD and its psychiatric comorbidities. BSD is highly heterogeneous and polygenic and personalized management has considerable clinical repercussions benefits.

No significant relationships.