Depressive episodes in bipolar type I, II and unipolar disorder have many common traits, but also differences. Failing to diagnose bipolar disorder in patients who are in a severe depressive episode can lead to unfortunate treatment options and a poor outcome.

Identifying differences in clinical features of bipolar and unipolar depression.

Identifying clinical features that distinguish bipolar from unipolar depression will allow better treatment options, improve the outcome and the quality of life of the patients.

The preliminary study is being conducted in Timisoara, Romania and consists of 76 in- and outpatients from the Timisoara Psychiatric Clinic and the Timisoara Mental Health Center, diagnosed with either bipolar type I, II or recurrent depressive disorder, according to ICD-10 criteria. 5 separate assessments will be made over a period of 20 months, comprising of a battery of assessment scales and tests, including neurocognitive assessments.

The preliminary results show an association between the age of onset (earlier in bipolar depression), atypical depressive symptoms (more frequent in the bipolar group), number of depressive episodes (a higher number in the bipolar group), somatic symptoms (more frequent in the unipolar group) and cognitive functioning (less impared in the unipolar group).

Initial results show that there are subtle differences in presentation between bipolar and unipolar depression and that these differences may help guide the initial diagnosis.

Several studies demonstrate that patients with Bipolar Disorder (BD) have worse physical health in comparison with the general population, reporting higher frequency of cardiovascular disease, diabetes, hepatitis, and respiratory disease (Kilbourne et al., 2004; Casey, 2005; Perron et al., 2009). However, no studies have reported whether medical comorbidities correlate with clinical characteristics such as diagnosis, comorbidity, or other clinical variables.

We evaluated patients with BD diagnosed by SCID-I. Medical conditions were classified by ICD-10 and grouped according to the Cumulative Illness Rating Scales in: cardiac, vascular, hematopoietic, respiratory, ear/nose/throat, upper and lower gastrointestinal, hepatic, renal, genitourinary, musculoskeletal, neurologic, endocrine/metabolic.

The following variables were also collected: psychiatric comorbidity, age at onset, duration of illness, duration of untreated illness (DUI), lifetime suicide attempts.

309 patients with BD were recruited; the 68% had type II disorder. 195 (63%) were females. Age at onset was 50.7 years. 170 patients (55%) had at least one medical condition; the most frequent were endocrine/metabolic (23%), vascular (21%), musculoskeletal (11%). Medical comorbidity was related with age and DUI. Hepatic conditions were associated with Axis-II comorbidity.

within medical conditions, endocrine/metabolic disease is the most frequently represented in patients with BD. DUI, which has been associated with worse outcome of BD (Suominen et al., 2007; Morken et al., 2009; Dell’Osso et al., 2010), is also associated with a higher medical burden also after controlling for age. This association might be mediated by the worse lifestyles and low levels of access to care in under-recognized patients.

Residual symptoms (RS) are common in bipolar disorder. There is no clear consensus on how RS are defined, and individual clinicians may have their own perceptions of this clinical problem.

The aim of this study is to define RS and to describe their management using a qualitative analysis.

A qualitative study was conducted. Data were collected from five focus groups including 41 psychiatrists all over France. An interview guide was used, including questions about definition of RS, their assessment and influence on the management of bipolar patients. Content analysis was used to identify themes emerging from the focus groups.

There was no consensus among participants regarding an explicit definition of RS. The definition appears to be multifactorial, interactive and scalable. It is based both on the psychiatrist's therapeutic objectives and patient's complaints. Eight major RS was identified: suicidal risk, emotional dysregulation, compliance, cognitive impairment, sleep disorder, functional disability, complaints from the patients and the development of comorbidities.

Content analysis underlines the fact that: standardized tools are not used in clinical practice; RS are a constant preoccupation; they justify optimisation of medication and adjustment of visit frequency.

Qualitative study is helpful to define and describe RS. Identifying RS is an important way of achieving implementation strategies and improve management of bipolar patients.

Suicide rates are elevated among people with Bipolar Disorder (BD), yet there is limited research on the nature of suicide in this population. Intentional overdose (OD) is a common method of suicide, and the objective of this study was to characterize the specifics of OD suicides in a BD cohort, and compare with non-BD suicides.

Coroner records for all cases of OD suicide in Toronto, Canada over a 10-year period (1998-2007) were examined. Data collected included demographics, psychiatric diagnosis and all substances present at lethal levels determined by the coroner to have caused death. Data analysis focused on comparisons between the BD cohort and non-BD suicides.

Suicide by overdose was recorded in 34 people with BD (61.8% female) and 343 people without BD (46.9% female). There were numerous differences between the BD and non-BD suicide cohorts. The BD suicide group was younger, more likely to have made a prior suicide attempt, less likely to have a comorbid medical condition, and more likely to overdose on mood stabilizers or antipsychotics. Carbamazepine was the most frequently identified lethal substance among BD suicides (20.6%), with next most common being diphenhydramine (14.7%) and codeine (14.7%). Lithium was found at lethal levels in only one BD suicide (2.9%) and 3 non-BD suicides (0.9%).

Key differences exist between BD and non-BD groups who suicide by OD, including the types of ingested medications. Improving our understanding of suicide in people with BD will ultimately aid in development of effective, targeted prevention strategies.

In the light of several recent reports on long-term effectiveness of psychoeducation the Dutch Foundation for Bipolar Disorders (DFBD) decided to update the psychoeducation program. Most systematic reviews on psychoeducation in bipolar disorder date from 2008 or before and even newer ones do not include all relevant studies.

The aims of this review are;

1. 1) to determine the long-term effectiveness of addition of psychoeducation to treatment as usual in terms of symptoms, relapse, suicide, quality of life and other secondary outcomes (see below) in bipolar patients;

2. 2) to review the acceptability of psychoeducation to patients and key-persons, measured by numbers of withdrawal from this intervention;

3. 3) to determine long-term beneficial effects on key-persons if involved in psychoeducation.

A protocol-based systematic literature search and review.

We found three randomized controlled trials (RCTs) of group psychoeducation, one trial of individual psychoeducation, one trial of multifamily psychoeducation and three trials of caregiver grouppsychoeducation showing efficacy of psychoeducation in mood stability of the patient and/or better coping and less burden in caregivers. The trials show similarities but also differences in content and delivery of psychoeducation.

Psychoeducation is efficacious in bipolar disorder. Based on the extensive experience in bipolar psychoeducation in the Netherlands and in the light of the results of the RCTs we suggest a prototype of psychoeducation in a multifamily format with 12 sessions and additional booster sessions.

Today's, families of individuals with bipolar disorders are actively participating in the care of their relative. Successful management of bipolar disorder in the community relies significantly on family caregivers. The need and experiences of such caregivers have been little studies with respect to bipolar disorder.

The aim of the study was to identify of family caregivers needs of patients with bipolar disorder.

This study is a qualitative research of phenomenological methodology; the family member's caregivers of bipolar disorder in farshchian psychiatric hospital in Hamedan were selected by purposive sampling. By reaching data saturation the number of participant was 12. Data were gathered through in-semi unstructured interviews and analyzed by “Colaizzi” method.

Five groups were identified in this study analysis: illness management, consoling, economical needs, persistent care and social attention & perception.

Identified the need of family member caregiver with bipolar disorder patient for mental health services to be helped and to identify the specific caring interventions that are effective in helping to sustain family caregiving.

High level of perceived concerns surrounding unethical use of genetic data could hinder participation in psychiatric genetic studies. We investigated the quality of Questionnaire about Genetic Research (QGR) for measuring the extent of perceived concern in a population with Bipolar disorder, and examined the robustness of the response items to differential bias by ethnic status.

Six questions measured the degree of concerns about negative consequences from psychiatric genetic studies in the QGR. Each question has 5 response categories corresponding to increasing degree of concern, ranging from “not at all” concerned to “very concerned” We coded responses from 0 to 4, with larger scores indicating greater concerns. We used polytomous item response models (IRM) with latent constructs for analysis of complete responses by respondents.

Most items of the QGR provided reliable measure of the extent of concerns. the instrument also validated the findings of greater concern about genetic studies among American Blacks compared to Whites. Item bias was observed for concerns about racism, procreation and privacy, but adjusting for these latter 3 items in a sensitivity analysis did not substantially change the association between Blacks and level of concern.

For the most part, the QGR is a reliable measure of the extent of perceived concern, based on response patterns to its six items. However, cautious interpretations of some items are warranted when the ethnicity of the study sample is diverse, due to vulnerability to response bias.

To investigate factors that may influence treatment choice for Bipolar I/II Disorder (BDI/BDII) patients experiencing a major depressive episode.

The HARMONY study (NCT00888264) was a multi-centre, prospective, non-interventional Belgian study that enrolled BDI or BDII patients experiencing a major depressive episode. the study involved four visits (V): V1 (Baseline), V2 (after 6-weeks), V3 (3-months) and V4 (6-months). Data collection included psychiatric hospitalizations, effect of substance abuse or work/school situation on treatment. Safety and tolerability were not assessed.

152 patients aged 19–75 years (mean ± SD: 46.5 ± 11.0; 62.3% female) were recruited: 95 patients (63.3%) with BDI and 55 (36.7%) with BDII, diagnosis was missing for 2 patients. At enrolment, 138 patients were treated by atypical antipsychotics (AAPs) combined with other antipsychotic medications, 14 by AAP monotherapy. Depressive symptoms were treated with quetiapine (42.7%, 64/150), at least one other AAP (40.0%, 60/150; olanzapine, aripiprazole, risperidone or paliperidone), amisulpride (2%, 3/150) and the benzodiazepine chlordiazepoxide (0.67%, 1/150). Patients who first developed symptoms at ≤ 30-years-old were prescribed quetiapine less than patients who developed symptoms when older (34.2%, 27/79 vs. 53.6%, 37/69, p = 0.017). Males were prescribed quetiapine for depressive symptoms more than females (52.6% vs. 36.2%; p = 0.047), more females were prescribed other antipsychotics (42.6% vs. 35.1%). 56.7% (85/150) of patients were hospitalized ≥once for psychiatric symptoms (last 5-years): BDI-63.2% (60/95), BDII-45.5% (25/55). Current treatment choice was not influenced by prior AAP treatment or substance abuse.

Age and gender were the main factors influencing treatment choice for BD patients experiencing a depressive episode.

To determine whether early manic symptom improvement predicts outcome in bipolar I disorder patients experiencing manic or mixed episodes.

Pooled data from two 3-week trials; asenapine (5 or 10 mg BID; n = 372), olanzapine (5-20 mg QD; n = 391), or placebo (n = 197). Early improvement (YMRS total score changes from baseline ≥15%, ≥20%, and ≥25%) was assessed at days 2, 4, and 7. Associations between early improvement and week 3 outcomes (YMRS response [≥50% total score reduction] and remission [total score ≤12]) were calculated using Fisher's exact tests; odds ratios classified their relative strength. Sensitivity (SN), specificity (SP), and positive (PPV) and negative (NPV) predictive values were calculated as previously described (J_Clin_Psychiatry_2009;70:344–353).

Early improvement was strongly associated with positive outcomes. the earliest positive associations across all cutoffs occurred with asenapine at day 2 (response, all P < 0.04; remission, all P < 0.007), olanzapine at day 4 for response (all P < 0.02) and day 2 for remission (all P < 0.002), and placebo on day 7 (response, all P < 0.003; remission, all P ≤ 0.0005). Odds ratios were higher for asenapine (1.8–9.1) than olanzapine (1.4–3.5) and placebo (1.3–8.0). Respective day 4 remission values for SN, SP, PPV, and NPV at the ≥ 15% cut-off were 80%, 58%, 48%, and 85% for asenapine; 76%, 43%, 49%, and 71% for olanzapine; and 50%, 67%, 31%, and 82% for placebo.

Early improvement was strongly associated with week 3 response and remission; high NPVs indicated little chance of stable remission in the absence of early improvement.

Assess the incidence and time-course of somnolence in placebo- and active-controlled asenapine schizophrenia and bipolar I disorder (BD) trials.

Data were from schizophrenia (4 short-term [6wk]; 3 long-term [26-52wk]) and BD (2 short-term [3wk]; one 12-wk adjunct therapy to mood stabilizers) trials. Data were pooled across asenapine doses (5or10 mg BID); active controls were risperidone 3 mg BID, olanzapine 5-20 mg QD, and haloperidol 4 mg BID.

For schizophrenia, incidence of somnolence was higher with active treatment than placebo in short-term trials; (asenapine,13.1%; placebo, 6.9%; active controls, 5–20%); and comparable for asenapine and olanzapine in long-term trials; (asenapine,18.4–18.5%; olanzapine, 19.6–21.1%); severe somnolence was infrequent (0–8%). Somnolence onset (median [days]) occurred early in short-term (asenapine, 2.0; placebo, 7.0; active controls, 2–6) and long-term (asenapine, 9.0; olanzapine, 7.5–9.0) trials; median somnolence duration (days) was relatively brief in short-term (asenapine,15.0; placebo, 4.5; active controls; 3.0–22.5) and long-term (asenapine, 22.0–25.0; olanzapine, 21.0–25.0) trials. For BD, incidence of somnolence was higher with active treatment than placebo in short-term (asenapine, 23.8%; placebo, 6.4%; olanzapine, 26.4%) and adjunctive therapy (asenapine, 24.1%; placebo, 10.2%) trials; severe somnolence was infrequent (0–3%). Somnolence onset (median [days]) occurred early in short-term (asenapine, 1.0; placebo, 2.0; olanzapine, 1.0) and adjunctive therapy (asenapine,1.5; placebo,2.0) trials; median somnolence duration (days) was brief in short-term (asenapine, 7.0; placebo, 5.0; olanzapine, 8.5) and adjunctive therapy (asenapine,12.5; placebo, 7.0) trials.

The analyses show, on average, an early onset and a limited duration of treatment-emergent somnolence with asenapine, which may be clinically useful in certain clinical situations.

Each episode of mania has adverse effects on mental status of patients and their families, so finding effective treatments are needed.

The objective was to compare the efficacy of oxcarbazepine and sodium valproate in the treatment of acute mania in Iranian population.

Oxcarbazepine is not routinely used in Iran for the treatment of mania so we decided to introduce it and compare its effects with the standard drugs for mania.

The sample included 18 to 60 years old bipolar manic patients who admitted in Ibn-e-Sina hospital in Mashhad city (north-eastern part of Iran) during 2008 to 2010. the diagnosis confirmed by Structured Clinical Interview for DSM-IV by two psychiatrists. Patients were randomly allocated in two groups taking oxcarbazepine (900–2400 mg/day) and sodium valproate (20–30 mg/kg/day) and trial consisted 2 weeks for titration and 4 weeks for maintenance dose. Assessments were done by a blind psychologist using Mini-Mental Status Examination, Young Mania Rating Scale, and Clinical Global Impression Scale, and adverse effects forms at baseline and after 3 and 6 weeks.

Symptoms of mania based on mean scores of YMRS and CGI-S decreased significantly from baseline to endpoint in both groups (P < 0.05), but there was not any significant difference between two groups in terms of reduction of symptoms at weeks 3 and 6 (P = 0.872 and P = 0.594, respectively) and adverse events of drugs.

The result of this study showed that oxcarbazepine efficacy is almost equal to sodium valproate in treatment of acute manic patients.

To determine the nature of poor impulse control and suicidal behaviour.

To understand the relationship between poor impulse control,co-morbid diagnosis and suicidal behaviour in patients with bipolar disorder.

A cross sectional study was carried out in 40 patients with bipolar disorder. Clinical parameters were established using semi-structured interview, co-morbid diagnosis and impulse control disorders using SCID. All completed impulsivity questionnaire (UPPS) and Suicidal behaviour questionnaire (SBQ). ANOVA and Pearsons correlation was performed.

There was high degree of co-morbidity (55% anxiety, 30% substance use, 13% personality disorder and 47% impulse control disorder). 45% did not have a past history of self harm, 40% had history of less severe self harm and 15%had near fatal self harm history.The sample mean showed significant difference compared to population mean (P < 0.05) with marked difference noted for near fatal self harm group (P < 0.01) indicating that patients with bipolar disorder might have a high degree of trait impulsivity.The three items on impulsivity scale-lack of premeditation, urgency and lack of perseverance correlated significantly (P < 0.01) with the future likelihood of dying.

This study supports the view that there is a high degree of suicidal behaviour in bipolar disorder.15% of the sample had past history of near-fatal self harm.High scores of trait impulsivity in sample are akin to scores for patients with borderline personality and addiction. There is a clear correlation between impulsivity scores and future risk of completed suicide.

The dopaminergic, noradrenergic, serotoninergic and GABA-ergic imbalances as well as the kindling phenomena lead to a particular therapeutic approach for the bipolar affective disorder.

The therapeutic management aims both at prolonged remissions, and at the prevention of mood veering.

Evaluating the efficacy of using atypical antipsychotic substances with and without the association of mood-stabilizing substances in the favourable evolution of the disorder.

The study included two groups of patients with bipolar affective disorder (according to DSM-IV criteria) in the period 2009–2011.

Group A (n = 28) was treated with quetiapinum 600 mg /day, while group B (n = 30) with quetiapinum 600 mg/day together with valproat 1500 mg/day, during the study period, with evalution through MADRAS, CGI, YMRS scales.

Remission was obtained in both groups, within sensibly equal time.

In group A(quetiapinum), 7,15% of patients presented mood veering (from anger to depression), 42,7% relapsed within the first 12 months, and 7,15% had at least 4 depressive episodes in 12 months. Remission was not maintained in any of the patients during the study period.

In group B (quetipinum+valproat) remission had longer duration for 80% (over 18 months), 20% didn’t have any decompensation, and no mood veering was recorded.

The association of mood-stabilizers in the treatment with atypical antipsychotic substances led to remissions with long duration.

The use of mood-stabilizers in the treatment of bipolar affective disorder prevents mood veering and avoids the disorder evolution towards a rapid cycling form.

This project approaches reasons reported on adherence to treatment for patients with bipolar affective disorder (BAD), through qualitative study of bipolar individuals out of crisis.

To discuss psychological meanings of the stable adherence such as brought in qualitative interviews with bipolar patients considered in complete adherence at psychiatric outpatient service of General Hospital of the State University of Campinas.

Research methodology from the Humanities employed to health settings, using clinical-qualitative method particularly, employing the technique of semi-directed interview with open-ended questions. the sample was closed by the criterion of theoretical saturation of information. Data were treated through the qualitative content analysis, with free-floating readings of the corpus - the set of the transcribed interviews - in order to categorize in core's discussion.

Several aspects were reported by patients as essential to maintain the adherence to their treatment over time. for this presentation, two categories were chosen: subjects expressed feelings of fear of the disease, because of its evolution with relapse, although the phases in which they feel almost normal people; and the meaningful emotional connections with their family, the protective health institution and religion - all perceived as supportive of adherence phenomenon.

To listen to what compliant patients experience in this context can help in practical understanding of integrated health and context, thus promoting greater understanding of the factors of adherence in the treatment of BAD.

WAVE-bd addresses limitations of previous longitudinal bipolar disorder (BD) studies (mainly single disease phase- or treatment-focused).

To provide real-world data on BD treatment practices across countries.

To report descriptive analyses of patients’ profiles and use of quetiapine extended and immediate release (XR and IR).

Multicentre, non-interventional, longitudinal study of BD-I/II patients, with ≥1 mood episode in the preceding year (minimum 9 months’ follow-up). Sample was representative of BD populations from Austria, Belgium, Brazil, France, Germany, Portugal, Romania, Turkey, Ukraine and Venezuela.

During the index episode, 662/2896 (22.9%) patients took quetiapine (326 XR, 336 IR); baseline analysis of this population revealed higher incidence rates of previous hospitalisations (hospitalisations/person-year; diagnosis to study-start) in patients taking XR at index event (0.29) vs those taking IR (0.22) (p < 0.0001). Analysis of all episodes occurring during WAVE-bd in quetiapine patients revealed more frequent prescription of XR vs IR in manic (56.2% vs 43.8%) and depressive (60.5% vs 39.5%) episodes. XR prescriptions also exceeded IR prescriptions during euthymia (62.0% vs 38.0%). XR was more frequently started before, and continued after, episodes (mania: 46.5% [XR] vs 23.4% [IR], p < 0.0001; and depression: 48.1% [XR] vs 34.0% [IR], p = 0.0002). Average dose (mg/day) was higher for XR vs IR (mania: 493.7 vs 423.4 [p = 0.0194]; depression: 371.0 vs 269.0 [p < 0.0001]).

Quetiapine XR and IR use differs in BD. the XR formulation appears to be prescribed more than IR, both for patients previously hospitalised more frequently, and irrespective of disease phase. AstraZeneca-funded study; Clinical Trials Registry: NCT01062607.

Bioinformatic investigations indicate that has-mir-206 (microRNA-206, miRNA-206) could regulate BDNF protein synthesis by interfering with BDNF mRNA translation, which is disrupted in bipolar disorder (BPD).

This study is to investigate whether miRNA-206 gene variants were associated with BPD susceptibility in a Han Chinese population.

342 patients who met DSM-IV criteria for bipolar disorder type I (BPD-I) or type II (BPD-II) and 386 matched health controls were enrolled into this study. the miRNA-206 gene and +/-500bp were selected for gene sequencing. for the case-control genetic comparisons, differences in the genotype and allele distributions between patients and controls were examined using Pearson's χ2 test.

Gene sequencing showed that there are two polymorphisms rs16882131(C/T) and rs62408583 (A/C) located at the upstream of miRNA-206 gene, which are complete linkage disequilibrium. the association analysis showed that there was no significant difference for genotype frequencies (χ2 = 2.075, df = 2, P = 0.354) or for allele frequencies (χ2 = 0.041, df = 1, P = 0.839) between BPD patients and controls. Similarly, no significant difference was found between BPD-I patients and controls (genotype χ2 = 1.411, df = 2, P = 0.494; allele χ2 = 0.380, df = 1, P = 0.538). However, there was significant difference between BPD-II patients and controls (genotype χ2 = 7.933, df = 2, P = 0.019; allele χ2 = 5.403, df = 1, P = 0.020).

Our findings do not support that BPD susceptibility was associated with miRNA-206 gene polymorphisms in the studied Han Chinese population. the association between miRNA-206 gene polymorphisms and bipolar disorder type II is needed to be carefully interpreted. Further studies are necessary to elucidate the involvement miRNA-206 in the pathophysiology of BPD.

Increasing evidence supports that 5HTTLPR polymorphism of the serotonin transporter gene(5HTTLPR) might associate to bipolar disorder and affective temperaments as measured by TEMPS-A. But the results are discrepant, furthermore, there are no data from Chinese population.

The present study was designed to investigate association between 5HTTLPR and bipolar disorder and affective temperaments of patients with bipolar disorder in the specific Chinese population and add new evidence to the field.

There hundred and five patients with bipolar disorder and 272 normal controls were included in the present case-control study⌧Temperament Evaluation of Memphis, Pisa, Paris and San Diego -autoquestionnaire version (TEMPS-A) in Chinese was used to assess affective temperament. Chi-square test, T test, Nonparametric test and ANOVA were employed to explore association between 5HTTLPR polymorphism and bipolar disorder and affective temperament of patients with bipolar disorder.

5-HTTLPR L/S polymorphism was associated with bipolar disorder in female (genotype χ2 = 6.769⌧P = 0.034⌧allele χ2 = 6.028⌧P = 0.014) and the S allele was associated with anxious temperament (t = 8.248⌧P = 0.005) in patients with bipolar disorder. the LA allele of 5-HTTLPR rs25531 A/G polymorphism was associated with hyperthymic temperament in patients with bipolar disorder (Z = −2.205⌧P = 0.027).

5-HTTLPR might have an effect on the prevalence of bipolar disorder in female and regulate affective temperaments of patients with bipolar disorder in some degree in Chinese population.

The psychological benefits of regular physical activity is well known, neverthless only recently the impact on physical and mental health in patients with severe mental disorders has begun to be analyzed. the low incidence rates of depression and some anxiety disorders in subjects performing physical activity raises the question about the use of exercise in the prevention of some mental disorders.

Our study aims to assess preferences, degree of physical effort, level of motivation and perceived barriers that prevent the development of more regular physical activity in patients with psychiatric illness.

We collect data and clinical records of 131 randomized patients. We therefore designed a 15 questions questionnaire associated with a useful section with personal and clinical data of patients.

The 52.7% of the sample (n = 69) has a body mass index above 25, thus confirming the trend of overweight and obesity that are secondary both to psychiatric therapies practiced and to a general lack of physical effort, which is due to poor level of motivation, although most of the patients agree that exercise is crucial for their physical and mental health.

Any psychoeducational interventions aiming to implement healthy lifestyles including physical care activities are therefore appropriate. the very nature of the disorder and treatment practiced explains the main barriers perceived by patients to perform physical activity; thus in the therapeutic area is important to ensure euthymic condition and limit the use of drugs that give fatigue and sedation.