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.

Supported by grant IGA MZ ČR NT11047

Persons suffering from bipolar affective disorder have a wide range of cognitive deficits, but there have been limited understanding of prospective memory performance. Time-based prospective memory is remembering to perform an action at a specific time, whereas event-based prospective memory is remembering to perform an action when an external cue appears.

Assess the time-based and event-based prospective memory performance in Chinese persons diagnosed with bipolar affective disorder.

Identify factors associated with prospective memory performance.

A sample of 40 persons diagnosed with bipolar affective disorder were recruited from a psychiatric outpatient clinic. All participants completed the Cambridge Prospective Memory Test, Rivermead Behavioral Memory Test, Test of Nonverbal Intelligence - Third Edition, the Young Mania Rating Scale and Hamilton Rating Scale for Depression.

The mean total score of the Cambridge Prospective Memory Test of persons diagnosed with bipolar affective disorder was 24.4 ± 7.0. Time-based prospective memory performance was worse than event-based PM task. The Cambridge Prospective Memory Test total score was associated with the Hamilton Rating Scale for Depression score and Rivermead Behavioral Memory Test score. The performance of time-based prospective memory tasks was associated with the Hamilton Rating Scale for Depression score, and the performance of event-based prospective memory tasks was associated with the Rivermead Behavioral Memory Test total score.

Persons diagnosed with bipolar affective disorder are found to have worse time-based than event-based prospective memory performance. The importance for everyday functioning and independent living needs to be explored in future studies.

Preliminary data suggest that patients who suffer from both bipolar disorder (BD) and alcohol dependence (AD) may be more vulnerable to cognitive dysfunction than patients with a single diagnosis, especially during periods that are clinically unstable.

The purpose of this study was to examine the cognitive recovery of dually-diagnosed patients during remission from an acute mood disturbance.

The study aimed to replicate our previous comparison of cognitive functioning between BD patients with and without AD, while on the inpatient unit, and to extend this investigation in a longitudinal design post-discharge.

Fifty-five adult inpatients with bipolar I disorder completed a neuropsychological battery, mood measures and substance abuse measures upon discharge from the hospital and at a 3 month follow up. Analyses provided group comparisons on these measures between patients who presented with co-occurrence of AD (n = 21) in the year prior to hospital admission and patients without a Substance Use Disorder (SUD; n = 34).

Compared to patients without SUD, dually-diagnosed patients scored significantly more poorly on measures of visual memory, verbal memory and executive functioning both at hospital discharge and follow-up. They also exhibited more limited recovery of these functions over the course of this period. Mood symptoms decreased in both groups from discharge to follow up.

Patients with co-occurring BD and AD may suffer from more severe cognitive dysfunction and less favorable recovery of cognitive deficits than BD patients without SUD over the course of remission from a mood episode.

Studies show that bipolar disorder is often misdiagnosed. One reason for misdiagnosis may be that psychiatrists do not rely strictly on ICD or DSM criteria but consider some symptoms, e.g., „decreased need for sleep”, as more critical than others. Another reason could be that the diagnosis of bipolar disorder is associated with the total number of reported symptoms.

Firstly, we investigate if an individual is more likely to be diagnosed with bipolar disorder if he/she reports a „decreased need for sleep”. Secondly, we explore if a high number of reported relevant symptoms increases the likelihood of a bipolar diagnosis.

Five case vignettes that varied in respect to the relevant information were sent to 400 randomly selected Austrian psychiatrists. The vignettes contained all information that is required to diagnose a bipolar disorder according to ICD-10 or DSM-IV. The psychiatrists were asked to return a questionnaire that collected data on their diagnostic decision making.

Preliminary data will be reported and discussed.

The concept of unipolar mania has been raised, rejected and resurrected by a number of authors, and its true position within bipolar affective disorders is still a subject of debate.

A 52-year-old Caucasian woman was presented to the emergency room accompanied by family members because she had seven days without sleeping, exaggerated self-confidence and was engaged in multiple activities.

At the mental examination she presented irritability, agitation, elation of mood, verbiage, sexual disinhibition, delusional activity of persecutory content, absence of insight. She had three manic episodes earlier and she didn’t have therapeutic adherence. The patient maintained an optimal level of performance functioning between maniac episodes, and also had no earlier depressive episodes. She described herself as a very creative, original, friendly, outgoing, sociable, responsible person. She had no family history of bipolar disease or other psychiatric disorder. An hemogram, basic biochemical investigations, cerebral TC, ilicits drugs screen and EEG were preformed showing no relevant alterations. She was admitted at an acute care psychiatric unit for 16 days. She had a good response to risperidone 2 mg and 1000 mg of divalproex sodium and to cognitive behavioural treatment.

Due to her previous 3 and her current manic episodes, without history of depressive symptoms, we concluded by the diagnosis of unipolar mania. Although there are certain sociodemographic and clinical variables that overlap, there does seem to be recent evidence concerning clinical, psychopathological and treatment features indicating a nosological separation of unipolar mania from bipolar mania.

Aripiprazole has demonstrated efficacy for the treatment of paediatric patients (10–17 years) with a manic or mixed episode associated with bipolar I disorder in a clinical trial that utilised the Young Mania Rating Scale (YMRS) Total score as the primary outcome measure.

This analysis evaluated the profile of discrete symptom response using the YMRS and other measures.

Post-hoc analysis of individual items of the YMRS and the parent or subject version of the General Behaviour Inventory (GBI) Mania and Depression scales using data from a 4-week, double-blind, randomised trial that compared aripiprazole (10 or 30 mg/day, n = 197) with placebo (n = 99).

In total, 296 patients were randomised; 80% completed the study. Significant decreases at Week 4 (p < 0.05) were seen in eight YMRS items: elevated mood, increased motor activity/energy, need for sleep, irritability, speech (rate and amount), language/thought disorder, abnormal thought content and disruptive/aggressive behaviour. For the GBI, effect sizes for parent-reported mania items were medium to large (for example, 0.41 for ‘depressed but high energy’ to 0.78 for ‘rage combined with unusually happy’) but were consistently small on subject self-reported items of mania and depression and, for the overall scale, had the poorest agreement with clinician ratings.

Aripiprazole demonstrated improvements in some of the more troublesome symptoms of paediatric patients with bipolar I disorder experiencing an acute manic or mixed episode. Of note, irritability and aggression showed large treatment effects on both clinician and parent-reported measures, but less so for subject-reported measures.

Bipolar disorder is associated with high personal and social burden, impaired social functioning and high levels of disability. The psychoeducational family intervention, found to be effective in the treatment of schizophrenia, may be particularly useful for patients with bipolar disorder and their relatives.

This study, funded by the Italian Ministry of Health, coordinated by the Department of Psychiatry of the University of Naples SUN and carried out in 11 randomly selected mental health centres, included the following phases

1) development of informative materials;

2) training of 2 mental health workers per center;

3) random selection of 16 families of patients with bipolar disorder for each center: 8 being randomly allocated to the experimental group and 8 to the control group.

62 families have been recruited. Mental health workers reported several advantages in conducting the intervention, in particular in the relationship with patients and families. Significant improvements have been reported in professional skills and relationships with colleagues. The advantages tend to increase over time. The main reported difficulties are lack of time to run the intervention, identification of appropriate families, excessive workload and the need to integrate this intervention with other work commitments.

It is possible to provide psychoeducational family intervention for patients with bipolar I disorder and their families, after a relatively short period of training. In order to facilitate the dissemination of this intervention in routine conditions, a better planning of the activities of the mental health centers may be useful.

Behcet's Syndrome is a chronic inflammatory disorder of unknown etiology, characterized by aphthous lesions and recurrent ulceration of the mouth, genitals and uveitis.

The central nervous system is involved in about 20% of cases.

Only few reports deal with affective symptoms associated with Behcet's syndrome.

We report a case of a 43 year old male with Neuro-Behcet's Syndrome that presents with a psychotic manic attack. He developed Behcet's Syndrome at the age of 23, with recurrent uveitis and aphthous lesions in the mouth, painful ulcers in the genitalia and erythema nodosum. HLA-B 5 was positive.

He was treated with azothioprine 150 mg/day for 13 years and prednole 100 mg/day during uveitis attacts for a week. At the age of 37 a sudden occurrence of right hemiparesia due to cerebrovascular accidence salicylic acid 100mg/day, siclosporine 150 mg/day, piracetame 1600mg/day were administered. He presented to psychiatry clinic in manic episode with euphoric mood, psychomotor agitation, talkativeness, decreased need for sleep, excessive buying and he had an unrealistical thought that he was a player of a famous soccer team. He was diagnosed as bipolar I disorder, according to DSM-IV. This was the patient's first admission and the symptoms which were continuing for 6 years exaggerated during uveitis attacks.Psychiatric examination releaved that increaced psychomotor activity, hypomaniac affect, amount and affect speed of speech affect, increased associations, grandiose delusions.

There are a few reports dealing with bipolar disorder as an entity related to Behcet's syndrome.

Post-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible of emotional regulation.

The objective of this work is to study the links between these disorders through a clinical case.

It was a 43 year old patient who consulted for an emotional incontinence appeared after an ischemic stroke with lenticulocapsular and right semioval center lesions.

Treatment with antidepressant was marked by the appearance of hypomania.

The appearance of a pharmacologically induced hypomania in this patient could suggest a link between emotional incontinence and bipolar disorder.

Especially that periventricular areas and deep subcortical structures, involved in emotional regulation, are affected in these disorders.

More attentiveness against antidepressant treatment is required, because of the potential risk of a pharmacological hypomania.

The classic opinion of a favorable prognosis of bipolar disorders, compared to schizophrenia, is refuted by modern conceptions.

The aim of this study was to assess the quality of life (QOL) in bipolar patients compared to schizophrenic patients’, and to identify clinical and sociodemographic variables statistically associated to a poor QOL in bipolar disorder patients.

One hundred and twenty outpatients, 50 with bipolar disorder and 70 with schizophrenia, according to DSM-IV-TR criteria, were included in the study. The QOL has been assessed, in all patients, using the «36 item Short-Form Health Survey» (SF-36).

Thirty-six percent of the bipolar patients had a poor QOL, versus 37% among the schizophrenic patients. The bipolar patients had the score of the standardized vitality subscale significantly lower than schizophrenic patients’ (p = 0.036); the latter had the standardized general health subscale score significantly lower (p = 0.03). There were no other statistically significant differences. The multivariate analyses showed three variables significantly correlated to a poor QOL in bipolar patients: age at the time of the study ≥ 40 years (p = 0.01), professional irregularity or inactivity (p = 0.005), age at onset ≥ 25 years (p = 0.004).

Our survey of the QOL in bipolar patients showed that it did not differ globally from the schizophrenic patients’, with the SF-36 scale. Results reported in the literature are not in agreement. Further longitudinal studies on several months, with other assessments, would permit to verify the validity of our results.

The sample consisted in 118 bipolar patients and all patients were recruited during an acute phase: 56% had a major depressive episode, 26% a manic or hypomanic episode, and 18% a mixed state using the DSM-IV criteria. Patients were assessed four times with MATHYS during a three weeks follow-up period. It is an observational study and treatment was prescribed as usual. We applied the GBTM method and MATHYS total score to define trajectories of recovery.

This method allows identifying 4 trajectories of recovery. At Baseline, two of them started with a score of inhibition but with quite different evolutive profiles (stable inhibition versus improvement). The two others trajectories started with a score of activation (mild versus moderate) and showed a linear improvement of symptoms but with a more rapid recovery for the patients with the higher activation at baseline.

When considering the diagnosis of patients belonging in each trajectory, there model seems particular relevant to explore the high heterogeneity in response to treatment in bipolar patients during an acute depressive episode.

Cognitive dysfunction in unipolar depression (UD) and bipolar disorder (BD) may persist into periods of remission and affect psychosocial function. Attention and memory deficits may be more pronounced during remission in BD compared with UD. However, patients’ subjective experience of cognitive difficulties is poorly understood, and it is unclear whether this differs between BD and UD.

To examine self-reported cognitive function in remitted patients with BD and UD.

Patients with BD (n = 54) and UD (n = 45) were referred to the outpatient clinic at Department of Psychiatry, Copenhagen University Hospital, following hospital discharge.

Affective symptoms and patients’ experience of cognitive symptoms were assessed at their initial consultation at the clinic.

Patients in remission experienced mild to moderate impairment of cognitive function with greatest difficulties in motivation, energy, attention and memory. Subjective experience of cognitive function were similar for BD and UD and were predicted by affective symptoms rather than by diagnosis, age, gender or comorbid alcohol misuse.

The absence of differences between UD and BD in the subjective experience of cognitive difficulties contrasts with evidence of greater objective cognitive dysfunction in BD. This highlights a potential discord between subjective and objective measures of cognitive function. The impact of affective symptoms on the subjectively experienced cognitive difficulties suggests that they reflect mood symptoms rather than objective cognitive deficits. Further investigation of the relation between objective and subjective measures of cognitive function and the influence of affective symptoms is warranted.

Non adherence to treatment is especially common in patients with chronic relapsing disorders. Schizoaffective disorder is a chronic, severe and disabling illness consisting of the concurrent presentation of symptoms of schizophrenia and affective disorders. Its course and prognosis has been found to be intermediate to those two conditions.

To evaluate treatment adherence in a schizoaffective sample and to which demographical and clinical variables it may be associated.

Adherence to treatment and its clinical correlates were assessed in 69 patients meeting DSM-IV-TR diagnosis of schizoaffective disorder, bipolar type, by means of adherence-focused interviews, measurements of plasma concentrations of mood stabilizers.

Adherent and poorly adherent patients were compared with respect to several clinical and treatment variables.

Poorly adherent patients were 40% of the total sample. Demographic variables (i.e.: gender, marital status, cultural level, employment) were not associated to treatment adherence, nor were clinical variables (age at onset, polarity of the first episode, lifetime history of seasonal pattern, rapid cycling, atypical depression, melancholia, catatonia) or family history for generic psychiatric, affective disorders and suicide. No pharmacological treatment (atypical antipsychotic, mood stabilizer and antidepressant) was associated to adherence in our sample.

Clinical and demographical factors are not related to medication adherence in our sample. Coherently with the general severity of this condition, and since there does not seem to be any clinical predictor of poor adherence, in clinical practice all schizoaffective patients should be monitored and treated as potentially non-adherent.

Lithium is the agent that has shown more efficacy for the treatment of Bipolar Disorder (BD), anyway a single agent isn’t effective to control all aspects of the syndrome.

The mood-stabilizer frequently used, in combination with Lithium, is Valproate which presents different methabolism and side effects. Further both molecules are glycogen synthase kinase-3 (GSK-3b) inhibitors and have synergistic neuroprotective action.

We underline the need to better investigate Lithium and Valproate combination therapy in BD.

Observation of Lithium and Valproate combination therapy in a sample of patients with BD, considering doses and serum levels.

56 patients with BD (mean age 38 ± 0,02), followed at the day hospital of the Psychiatric Clinic, University of Pisa, were studied. Serum levels evaluated at the Section of Pharmacology, Department of Neuroscience, University of Pisa.

We identified 5 comparison groups depending on the dose intake of Lithium (11 subjects: 300 mg /die, 9: 450 mg/die, 19: 600 mg/die, 7: 750 mg/die, 10: 900 mg/die) with increased serum levels of the medication (0.27 mEq/l, 0.37 mEq/l, 0.50 mEq/l, 0.52 mEq/l, 0,70 mEq/l). There are not significant differences between groups related to both, the mean dose intake of Valproate (772 mg/die, 744.4 mg/die, 867.5 mg/die, 821.4 mg/die, 845 mg/die) and its serum levels (45.2 mg/L, 46.6 mg/L, 53.2 mg/L, 47.4 mg/L, 48.4 mg/L).

This study aims to identify the effective dose of Lithium in combination with Valproate able to determine the prevention of relapse in BD patients. The use of the lower dose of Lithium maintaining therapeutic effectivness, means reducing side effects, toxicity and the need for constant monitoring.

It was estimated that in general adult population represented in 2–3% co-occurring mental and substance use disorders.

In our case we represented the patient who is a long-time heroin addict with a dual diagnosis of bipolar disorder. Special attention was payed to influence of the primary psychiatric disorder to a course and treatment of substance abuse.

Patient is observed during the five years from March 2005 to March 2010. In the evaluation of the case we used History of illness, MINI, HAMD. and psychological tests battery (MMPI 202, Drawing Human Figure, EGO Perception and EGO Ideal Test).

During the observation we have noticed that the patient was started treatment in periods of depression decompensation, because of heroin relapse. In that moment HAMD score was between 20 and 24 points. After detoxification, the patient was experiencing a switch in hippomanic state, which resulted in drop-out in the first month of treatment. This course of disease was repeated five times during our observation. Because the patient retained in treatment, we were able to progress. Now, the patient has been in abstinence for eight months, and he is in acceptable affective stability.

Bipolar Disorder is increased risk for frequent heroin relapses and continuity in the therapeutic treatment. This influence may involve direct effects of drugs on the initiation of affective symptoms and indirect effects on treatment compliance. When symptoms are controlled through these psychiatric medications, patients will benefit from therapeutic treatment of their substance abuse.

Bipolar Disorder is a serious, common and disabling mental disorder which is associated to high morbidity and high suicide attempt rates.

To identify clinical and social-demographic variables associated to suicidal behaviour in Bipolar Disorder.

The samples comprises 124 patients (62.1% females) diagnosed with Bipolar Disorder (ICD-10 diagnosis following DIGS/OPCRIT). The variables selected to the analysis were extracted from DIGS and OPCRIT.

Suicidal behaviour occurs in 27.1% of the patients; the most used method was voluntary drug poisoning; it's more frequent in females, with males using more violent methods - remaining results still unavailable.

This study identifies several clinical and social-demographic variables that can help the clinician to delineate a suicidal profile among his Bipolar patients, hence improving his ability to develop an early intervention plan and suicide prevention strategies.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme deficiency worldwide. In this condition acute hemolysis is caused by exposure to an oxidative stressor in the form of an oxidative drug, an infection or aliments. G6PD deficiency can be associated to different psychiatric conditions, but little is known about the risk of acute hemolysis in G6PD deficient patients that are treated with antipsychotics and mood stabilizers.

A clinical description is presented in order to illustrate the possible risk of acute hemolysis with Lithium therapy in a G6PD patient.

A 33 years old male of hispanic origin and a G6PD enzyme deficiency was admitted presenting a first episode of mania. Lithium treatment was initiated.

The patient was clinically examined daily. Extensive laboratory evaluation was performed, including complete blood cell count, liver, renal and thyroid function tests, serum electrolytes and glucose levels, urinalysis, lithium blood dosage. Neuroimaging studies were also performed excluding secondary causes of mania.

At J7 of lithium therapy the patient presented with jaundice and a blood count revealed a drop in the number of red blood cell (from 3,42 T/L to 2,42 T/L) with an increase of bilirubin (87,2 umol/l) which revealed an episode of acute hemolysis. Lithium therapy was discontinued immediately. Red blood cell count continued to drop for another 7 days and returned to normal after 2 weeks of discontinuation of Lihium therapy.

Lithium might be a trigger of acute hemolysis in bipolar patients with G6PD deficiency associated.

Although history of childhood trauma is present in nearly 50% of bipolar patients, the effects of childhood trauma on the course of bipolar disorder are rarely investigated. Thus, we aimed to investigate the effects of childhood trauma on psychotic symptoms seen in patients with bipolar disorder.

One-hundred DSM-IV-TR diagnosed bipolar patients who were either manic or depressive were recruited from inpatient units of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. Patients were initially evaluated by Young Mania Rating Scale (YMRS), Montgomery-Asperg Depression Rating Scale (MADRS), Scales for Assessment of Positive Symptoms. Patients were also evaluated by Childhood Trauma Questionnaire (CTQ) and Dissociative Experiences Scale in euthymia which was defined by scores of < 7 in YMRS, < 4 in MADRAS

There were no differences between the patients with and without a history of psychotic episode in terms of age at onset, duration of illness and episode characteristics. Patients with a history of psychotic episode were hospitalized more. CTQ physical abuse scores were higher in male comparing to female. CTQ sexual abuse scores were higher in female comparing to male. CTQ emotional abuse, physical neglect, physical abuse and total scores were higher in patients who had at least one psychotic episode in lifetime than in patients without a history of psychotic episode.

The history of childhood trauma should be investigated and therapeutic interventions for childhood trauma should be added to the standard treatment plan of bipolar patients.

The two-pole disorder is one of the diagnoses more prevalent to the hospitable revenue of the patients in the UHSM-HUSC. Nowadays there is scanty the knowledge of the pat physiology of this disease. Therefore, in the last years an advance has taken place in the different pharmacological therapies used for this disorder, being variable the current available evidence.

To analyze the prescription to the hospitable discharge of lithium, anti-epileptic, antipsychotic atypical medicaments and antipsychotic typical in patients.

We realize a descriptive retrospective study of the prescribed treatments. The different alternatives of treatment analyzed are: antipsychotic atypical medicament, antipsychotic typical medicament, lithium and anti-epileptic in monotherapy or mixed. We use as sample all the patients’ income that have the criteria of two-pole Disorder, current maniacal episode con/without psychotic symptoms according to the CIE-10 that have taken place in the triennium in the UHSM-HUSC of Granada. The obtained information was submitted to statistical analysis(SPSS v.16.0)

The medicaments prescribed with more frequency are the lithium in monotherapy or partner to antipsychotic atypical being the trend the use of the acid valproico in monotherapy or from concomitant form to antipsychotic atypical. The medicaments fewer employees are the acid valproico and the antipsychotic atypical ones in monotherapy.

It was prescribed as treatment to the hospitable discharge in patients during the triennium principally lithium or acid valproico partners to antipsychotic atypical being the trend the use of acid valproico associated to antipsychotic atypical. The use of antipsychotic typical was more limited.