Previous studies showed that perfectionism has an important role in the aetiology and maintenance of a variety of mental disorders. It seems the role of perfectionism in relation to bipolar and major depressive disorders is not clear.

In the present study we investigated the differences among major depression, bipolar disorder, and control subjects regarding negative and positive perfectionism.

40 normal subjects as well as 80 depressed and bipolar subjects from Quds hospital in Sanadaj were chosen. Each group consisted of 40 subjects. The control group was matched with the other two groups in regard to sex, age, marital status, employment, economic class and education level. The bipolar and depressed subjects were interviewed based on criteria of the DSM IV in order to confirm the diagnosis. The members of control group had to first fill in the General Health questionnaire (GHQ) and after confirming their health they should have filled in the Positive and Negative Perfectionism Scale (PANPS). In the groups of bipolar and depressed subjects GHQ and then PANPS were carried out.

Results show that there are significant differences among bipolar, depressed, and normal subjects regarding negative and positive perfectionism scores. Also the average score of negative perfectionism is higher among the depressed subjects in comparison to the bipolar disordered subjects.

According to the present study although both bipolar and depressed subjects showed more negative and less positive perfectionism than the control group, the depressed group showed more negative perfectionism than the other two groups.

Foreign accent syndrome (FAS) is a rare condition involving speech output that usually occurs subsequent to cerebrovascular injury. Articulatory distortions of the native language are perceived as foreign/dialectical by others of the region.

This report considers a case of FAS during two distinct periods of mania without evidence of cerebrovascular injury. The case provides a detailed explanation of the patient's history, course, speech and neuropsychological testing patterns.

To describe in the literature the first case of mania-induced FAS.

This case study was detailed retrospectively, providing a thorough psychiatric and medical history, formal neuropsychological testing, and speech analysis of baseline and exacerbation periods via voice recordings.

The patient displayed two distinct episodes of FAS only present during mania. Due to signs of limited effort, as well as potential effects of anxiety on performance, neuropsychological testing reflected inconsistent findings irreconcilable with any particular diagnostic pattern. Speech samples from both exacerbation and recovery periods parsed for comparison showed excess-equal stress, and consonant-vowel distortions when symptomatic. Elevated fundamental frequency, higher intensity, decreased speech intelligibility, and faster rate of speech were produced during exacerbation. No significant medical abnormalities were revealed by laboratory, CT scan or physical exam results.

As the patient had no history of cardiovascular or cerebrovascular disease, negative medical workup, negative brain imaging, and neuropsychological testing failing to demonstrate an etiology for the FAS exacerbation, we conclude the patient's FAS was a result of mania. Speech analysis also supported this theory.

According to recent findings, certain clinical symptoms of the patients suffering from affective and anxiety disorder can be related to dissociation. The aim of our study is to examine if the level of dissociation in bipolar affective disorder differ from the level of dissociation in healthy volunteers.

41 patients suffering from bipolar disorder (51.2% females) and 198 healthy controls (71.2% females) were included in the study. The patients with bipolar affective disorder in remission of the illness were recruited from the Outpatient psychiatric department of Psychiatry Clinic of University hospital Olomouc. Patients were psychiatrically assessed and the state of the disorder was evaluated by experienced psychiatrist. Only patients in remission of the disorder, evaluated as 1 or 2 points of clinical global impression - severity scale, were included into the study. All participants were assessed with the Dissociative Experiences Scale (DES).

The groups didn’t differ in demographic variables like age, gender and education. Patients had significantly higher mean score on the DES and pathological DES than healthy controls.

Our results suggest that the level of psychological dissociation in bipolar affective patients is higher than in healthy controls.

By grant IGA MZ ČR NT11047.

Autonomic nervous system (ANS) dysfunction and reduced heart rate variability (HRV) have been reported in a wide variety of psychiatric disorders, but have not been well characterized in bipolar patiens in remission. We recorded cardiac activity and assessed HRV in bipolar outpatients in remission.

Ascertain if ANS decrease with the age of the patient; ascertain relation between activity of ANS and level of dissociation, and other components (age of patients, and age of disorder, dosage of psychotropic medication).

Autonomic nervous system (ANS) has been evaluated during orthostatic change in three positions (1- lie down 5 minutes, 2 - stand up 5 minutes, 3 - lie down 5 minutes). The functioning of the ANS has been measured by the diagnostic systems that are using the power spectral analysis which quantifies the heart rate variability (HRV) was assessed using time domain, frequency domain, and nonlinear analyses in 23 bipolar patients in remission.

We found highly statistically significant negative correlations between level of dissociation measured by DES and most of parameters of ANS. We found negative correlations between the age of the patient and activity of ANS, and negative correlations between activity of ANS and duration and onset of disorder.

Autonomic dysregulation is associated with bipolar disorder in remission and has relation to level of dissociation and probably to age of patiens and age of onset and duration of disorder.

By grant IGA MZ ČR NT11047.

To explore the difference in the clinical features between bipolar disorder and unipolar depression from the clinical phenomenology.

Two hundred bipolar patients with their current depressive episode and five hundred and sixty three recurrent depression were involved in the study. Clinical features of these two groups were compared and stepwise Logistic regression was used to identify the relationship between clinical features and bipolar disorder.

Clinical features of depressive episode which was different between two groups and were associated with bipolar disorder were as follows: age at onset of bipolar was earlier than that of unipolar depression; Bipolar patients whose age at onset before 25 years were more than unipolar depression; Sexual appetites which was one of atypical depressive symptoms were more common in bipolar depression than in unipolar depression; with psychiatric symptoms, psychomotor retardation, mood instability and duration of every depressive episode < 3 months, were more common in bipolar depression group than in unipolar depression group; Cognitive impairment factor, one of factors of HAMD-17 score, was significantly higher in bipolar depression group than in unipolar depression group. The odd ratio were 1.54, 1.50, 3.25, 1.99, 1.89, 1.48, 1.63, 1.63, and 1.42 separately.

The founding suggested that unipolar depression and bipolar depression might be distinct disorder, and age at onset, age at onset < 25, sexual appetites, psychiatric symptoms, psychomotor retardation, mood instability and duration of every depressive episode < 3 months might be potential to be the predictors of bipolar disorder.

To explore the factors associated with occurrence of suicidal risk after treatment of SSRI in bipolar disorder with their first depressive episode.

One hundred and seventy seven bipolar patients were enrolled in this retrospective study. One hundred fifty four patients were included in non-occurrence of suicidal risk group, while twenty three were included in occurrence of suicidal risk group. To compare the demographic and clinic features between these two groups. Stepwise Logistic regression model was used to identify the associated factors. Concordance statistics (i.e. the area under the ROC curve) was used to compute the discrimination of the associated factors, and Hosmer-Lemeshow goodness-of-fit statistic was used to measure the goodness-of-fit.

Clinical features associated with occurrence of suicidal risk after treatment of SSRI in bipolar disorder were as follows: psychotic symptom and symptom of irritability. The odd ratio was 6.23 and 4.04 separately.

This study demonstrated indicated that psychotic symptom and symptom of irritability were associated with occurrence of suicidal risk after treatment of SSRI in bipolar disorder, and it suggested that these two symptoms might be potential to be the predictors of occurrence of suicidal risk after treatment of SSRI in bipolar disorder.

Methylmalonic acidemia (MMA) is a common organic acidemias, mainly due to metabolic deficiencies of the methyl-malonyl coenzyme A mutase or its coenzyme adenosyl cobalamin (vitamin B12). Methylmalonic acidemia can cause a range of clinical manifestations, especially neuropsychiatric symptoms and signs. In this article, we reported one case with bipolar disorder, then diagnosed with methylmalonic acidemia and hyperhomocysteinemia.

To investigate neuropsychiatric symptoms, treatment and efficacy of methylmalonic acidemia and homocysteinemia.

A case of late-onset methylmalonic acidemia and homocysteinemia with psychiatric symptoms was reported. According to the literature, we analyzed the age, sex, neuropsychiatric symptoms and signs, laboratory tests, treatment and efficacy.

There are 15 patients with methylmalonic acidemia and homocysteinemia (including 6 males and 9 females) reported. It was difficult to make diagnosis directly. Cell types were tested in abroad. The clear diagnosis is based on the elevated level of methylmalonic acid. The clinical manifestations of methylmalonic acidemia and homocysteinemia included neurological symptoms and psychiatric symptoms. hydroxocobalamin, cyanocobalamin, methylcobalamin and adenosyl cobalamin were the main treatment drugs.

If it is difficult to explain the neurological symptoms and signs of psychiatric patients, organic or physical disease, such as methylmalonic acidemia with or without homocysteinemia, should be taken into account.

This study sought to evaluate the presence of the metabolic syndrome in a group of 171 patients with bipolar disorder who were consecutively recruited in our hospital in a year.

Data were collected from participants in 2009-2010. The study focused on the presence of the metabolic syndrome, as defined by the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCEP ATP III).

Thirty percent of the sample met the NCEP ATP III criterion for the metabolic syndrome, 49% met the criterion for abdominal obesity, 41% met the criterion for hypertriglyceridemia, 48% met the criterion for hypertriglyceridemia or were on a cholesterol-lowering medication, 23% met the criterion for low high-density lipoprotein cholesterol, 39% met the criterion for hypertension and 8% met the criterion for high fasting glucose or antidiabetic medication use. Patients with the metabolic syndrome and patients endorsing the obesity criterion were more likely (p = 0.05 and p = 0.004, respectively).

The prevalence of the metabolic syndrome in patients with bipolar disorder is alarmingly high. We need interventions specifically designed for preventing and treating the metabolic syndrome and its components in patients with bipolar disorder.

We conducted a systematic review in order to identify the long term employment outcomes of people with Bipolar Disorder. Our aims were to identify the proportions working over time, the nature of employment status change over time and whether employment rates after a single episode are different to rates in recurrent Bipolar Disorder.

We searched Medline, PsychInfo and Web of Science databases and used a predetermined decision tree to select papers for full text usage.

Out of 1410 abstracts retrieved, a total of 119 papers were selected for full text retrieval and 19 papers identified which met the full criteria for inclusion and data extraction. An assessment framework to assess the quality of papers was used to aid the analysis. There were few high quality studies. Most studies with samples of people with established Bipolar Disorder suggest that over a period of 5–15 years of follow-up, approximately 40–60% of people were in employment. However Bipolar Disorder appears to lead to underperformance whilst in employment and 40–50% of people may suffer a slide of their occupational status over time. Those with a first episode of Bipolar Disorder had a higher rate of employment than those with multiple episodes.

Bipolar disorders damage employment prospects for sufferers in the short and longer term, but up to around 60% of people may be able to recover to the extent that they are in paid work. Maximal damage to employment functioning may occur in the early phases of Bipolar Disorder.

The main aims of long-term management for bipolar disorder (BD) are the prevention of new mood episodes and maintaining symptomatic and functional remission. Although several pharmacological and psychosocial interventions have shown effectiveness in maintenance treatment of BP, long-term recovery is achieved only in some patients. Little is known how these treatments are effective in routine clinical practice.

121 patients (76 women) with BD confirmed by the Schedule for Affective Disorders and Schizophrenia (SADS) interview, with mean age of 44.6 and mean duration of illness of 13.1 years who were at least one year on maintenance monotherapy with the mood stabilizers (lithium, carabamazepine, valproate, lamotrigine and olanzapine) were assessed using the Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder (TRS).

Total score ≥ 7 in TRS (“full responders”) reached 22 (18%) patients. For particular mood stabilizers, we found response rate from 5% (valproate) to 28% (lithium). Responders did not differ from non-responders in the length of illness, age of onset, the polarity of first episode, number of episodes, the occurrence of psychotic symptoms and suicide attempts, rapid cycling, positive family history, and the presence of comorbid disorders.

Although mood stabilizer monotherapies remain recommended and desirable strategies for maintenance treatment of BD, our results show that a satisfactory response is achieved only in a minority of patients. This research was supported by the project 1M0517 MSMT CR.

Bipolar mixed states were systematically described for the first time by Emil Kraepelin. Since then, their high prevalence has been repeatedly recognized, but they still remain poorly understood. These patients appear to be extremely difficult to treat, many being refractory to pharmacological approaches. Clinical experience supports the use of electroconvulsive therapy (ECT) in mixed states, but there is little information on its effectiveness in scientific literature.

Report our experience in using acute phase ECT (aECT) in mixed states.

The authors reviewed the clinical records of all patients submitted to aECT between June 2006 and June 2011. The inclusion criteria were: a) presence of a mixed state according to Akiskal's criteria (Akiskal et al,2005); b) completed treatment course with aECT. The following variables were collected: demographic characteristics, previous response to pharmacotherapy, presence of psychotic symptoms, number of aECT sessions, referral to continuation or maintenance ECT (c/mECT), number of readmissions. Relation between the diagnostics and the number of ECT sessions was validated with Eta-coefficient. Comparison between these two groups was carried out with One-Way-ANOVA.

Eighteen patients met inclusion criteria and were resistant to pharmacotherapy. Eight patients had psychotic features. All patients but one showed a positive clinical response, as documented on CGI. The average number of ECT sessions was five, while the mean of ECT treatments in manic and depressive patients was seven and six respectively. Thirteen patients were scheduled for c/mECT.

Our results confirm the effectiveness of ECT in medication nonresponsive patients experiencing a mixed state.

There is accumulating evidence for the efficacy and effectiveness of divalproex sodium (divalproex) and risperidone in the treatment of pediatric bipolar disorder (PBD).

Clinical neuroimaging studies using appropriate challenge paradigms are a promising strategy for investigating how these medications influence brain function to provide therapeutic benefit.

Given that affect regulation is influenced by cognitive operations and vice versa, the current study of pediatric mania adopted a mechanistic orientation in comparing the action of two types of medications on brain function while engaged in memory operations, executive function, and response inhibition.

This was a double-blind 6-week fMRI trial with 24 unmedicated manic patients randomized to risperidone or divalproex, and 14 healthy controls (HCs) (mean age: 13.1 ± 3.3years). Response inhibition, affective N back, and affective colormatching fMRI tasks were completed pre- and post-treatment.

Risperidone, a serotonin dopamine antagonist, impacted frontostriatal circuitry while divalproex, a mood stabilizer, worked on frontotemporal circuitry. This finding was replicated across paradigms. in conjunction, across medication types, increased VLPFC at baseline timepoint predicted better treatment outcome. Conversely, increased amygdala activity at baseline predicted poorer treatment outcome.

Our study demonstrated how the neural networks were engaged in PBD patients during both cognitive and affective paradigms and while under the influence of an SGA and an anti-epileptic. When risperidone and divalproex are directly compared, there was significantly greater engagement of the frontostriatal regions with risperidone and in the frontotemporal regions with divalproex across all tasks.

The aim of our study is to evaluate, in a sample of bipolar (BD) eutimic patients, the association between depersonalization symptoms, facial emotions expression recognition and affective temperament.

95 bipolar eutimic patients (YMRS< 6 and HDRS< 8), are assessed with: SCID-P, TEMPS, SCI-DER1 e POFA (test of recognitionof facial emotions expression by Ekman e Friesen).

Throught a regression analysis we underline that, independently to panic disorder, the ipertimic temperament is associated with: major recognition of happiness (p < 0.001; β = -4,483) and minor recognition of anger (p = 0.005; β = 3,202) in BD patients with high scores in autopsychic depersonalization domain; major recognition of sadness (p = 0.001; β = -3,944) and minor recognition of anger (p = 0.005; β = 3,181) in BD patients with high scores in affective depersonalization domain. Moreover, the cyclotimic temperament is associated with: major recognition of surprise (p = 0.004; β = -3,233) and happiness (p = 0.044; β = -2,124) in BD patients with high scores in Derealization (DER-TOT); major recognition of surprise (p = 0.001; β = -3,792) and happiness (p = 0.018; β = -2,532) in BD patients with high scores in somatopsychic depersonalization domain.

The presence of depersonalization and derealization symptoms is associated with a selective deficit in the recognition of several emotions. in bipolar patients this selective deficit is dependent of type of affective temperament. Further research is warranted to replicate our clinical observation.

Impulsivity is a core feature of bipolar disorder (BD). The best definition of impulsivity is the predisposition to have rapid and unplanned reactions to internal and external stimuli without regard to the negative consequences of these actions to the impulsive individual or others. Thus, the aim of our study is to investigate the relationship between impulsivity, panic disorder (PD) comorbidity and panic spectrum symptoms in patients with BD.

247 eutimic patients were assessed with SCID-P, MOOD-SR, PAS-SR. Impulsivity dimension was defined on the basis BIS Scale score (version 11).

A backward stepwise logistic regression in bipolar patients with PAS explained score statistically much higher for impulsivity (pas +6.09 vs pas - 3.88 p < 001) and the difference is statistically significant stratifing for BD. A stepwise linear regression, corrected by age and gender, displayed significantly statistical correlation with impulsivity score and PAS-SR by cut-off 35 (OR = 1.210).

In our sample BD eutimic patients explained score statistically much higher for impulsivity. This data confirm the presence of the trait impulsivity in BD eutimic patients. BD patients with a comorbid anxiety disorder seem to display significant higher levels of impulsivity when compared to patients without an anxiety disorder. Impulsivity was linked with atypical panic like symptoms more with PD diagnosis. Results suggest the presence of specific bipolar disorder endophenotipe. Further neurobiologies studies are needed to elucidate the implications and reasons of this association.

Prevalence and clinical correlates of dissociative symptoms in general, and depersonalization (DP) in particular, in patients with mood disorders have received limited attention in the literature1. Thus, the aim ofour study is to evaluate the association between depersonalization symptoms and mood dimensions in a sample of unipolar (UD) and bipolar (BD) patients.

185 patients (95 BD and 90 UD) in eutimic phase (evaluate with YMRS and HDRS) are assessed with: SCID-P for axis I diagnosis, HDRS, YMRS, MOOD-SR-lifetime version2 and SCI-DER.

through a regression analysis we underline in UD patients that the presence of depersonalization symptoms is significantly associated with the following mood dimensions: psychomotor retardation (p = 0.031; B = 2,197), mixed irritability (p = 0.035; B = 2,137) and social extroversion (p = 0.028; B = -2,229). We found no significat association in the group of BD patients.

In UD patiens, the presence of depersonalization symptoms must carefully consider. Further research are needed to identify specific clinical endophenotypes3.

Even at therapeutic doses, mood stabilizers do not completely address symptoms in bipolar depression. Some guidelines recommend add-on antidepressant therapy or quetiapine.

Early effectiveness of quetiapine extended release (quetiapine XR) vs. sertraline in adults with bipolar depression; treated with lithium or valproate at clinically therapeutic blood levels (change from baseline in the MADRS global score at week 2 (LOCF) endpoint). Others (secondary objectives) were measured at week 8.

Prospective, open label, randomized study of 8 weeks follow-up (D1443L00058).

27 patients were randomized to quetiapine XR (14) or sertraline (13). Mean age was 46.07 years. 17 patients (62.96%) were male. 20 (74.07%) were diagnosed with bipolar disorder type I. Mean number of previous events were 9.74. Mean baseline MADRS score was 28.23 (SD 5.86) and 29.50 (SD 5.00) for sertraline and quetiapine XR groups, respectively (p = 0.59).

Mean change in MADRS score (2 weeks from baseline) was: -6.62 (sertraline group) and -13.14 (quetiapine XR group) (p = 0.08). Final change from baseline was: -10.62 (sertraline) and -17.14 (quetiapine XR) (p = 0.1). Patients with at least one AE and one AE leading to study withdrawal were 12 and 3, respectively (quetiapine XR group); and 9 and 2, respectively (sertraline group). the most frequent AEs were somnolence, dry mouth (35.7%, 21.4%, respectively) (quetiapine XR group), and insomnia, diarrhea, dyspepsia (14.3% for each one) (sertraline group).

Numeric differences (though not significant) in favour of quetiapine XR exist for the early effectiveness of quetiapine XR in bipolar depression. Sponsorship by AstraZeneca.

The co-occurrence of mania and delirium, named “delirious mania”, is an under-recognized entity not listed in major diagnostic classifications. Literature about this syndrome is still scarce and lacking evidence. Usually, reports of affective syndromes with delirium tend to be subdued in the manic descriptor

We report the case of a 44 year old female patient with a simultaneous affective episode and delirium.

To demonstrate the co-occurrence of depressive/mixed symptoms and delirium

Review of clinical records and complementary exams.

The patient was admitted after a three week long depressive syndrome with psychomotor agitation, followed by a week-long fluctuating pattern of delirious and mixed affective features. Shortly after admission the patient exhibited a stuporous state, with nocturnal agitation. A fluctuating pattern of symptoms ensued, with disorientation, disorganized behavior, cognitive impairment, anxiety and depressive features. the patient was put on mood stabilizers, antipsychotics and benzodiazepines. She was discharged symptom-free two months later and re-admitted 4 weeks later due to recurrence of symptoms. Electroconvulsive treatment was applied,with quick remission of affective symptoms. Yet, it took another two months until discharge, due to persistent cognitive symptoms. Medical conditions were excluded.

This case shows the simultaneous occurrence of an affective syndrome alongside delirium. the strongest treatment response occurred with ECT. the presence of depressed mood highlights the fact that this syndrome can begin without clear-cut manic symptoms. We suggest that its name should be changed to Delirious Affective Disorder, which might help to avoid misdiagnosis. Persistent cognitive deficits raise some questions in this case.

What distinguishes bipolar disorder from unipolar depression is that the affected person experiences not only states of depression but also mania. The depression episodes in these two disorders are too similar to be distinguished.

This is a review of studies comparing unipolar and bipolar depression, with focus on neurobiology, genetics and psychosocial features: does the evidence support diagnosing bipolar and unipolar depressions as the same disorder or different?

Literature review with articles selected on Pubmed and medlink from 1990 to 2011 that had depression, unipolar depression, bipolar depression, affective disorder as keywords.

There are overlapping genes for Unipolar and Bipolar Depression.Brain imaging reveal an atrophy of the prefrontal cortex and basal ganglia and a decrease in blood flow and metabolism in both types of depression. The amygdale become more active in depressive states. in unipolar depression hippocampus shows atrophy but in bipolar disorder this result is controversial.Theres is evidence of decreased concentration of serotonin and norepinephrine in unipolar and bipolar depression. Patients with bipolar depression have a decreased function of dopamine D2 postsynaptic in pituitary and an enhanced function of 5-HT2A receptors.Psychosocial research found the same social triggers for both diseases. However, low social support is connected only with unipolar depression. After remission of depression, bipolar patients show higher self-esteem.

These data supports the hypothesis of an approximation of unipolar and bipolar depression as belonging to a spectrum of depressive illness. Hence, Mania could be a comorbid disorder. This hypothesis needs, however, more comparative studies.