We detected significant differences in personality disorders evaluated by SCID II. Temperament and character items - as evaluated by NEO FFI and TCI -showed also significant differences in personality traits, such as novelty seeking and self transcendence as well as conscientiousness. These results may be relevant for prognosis of treatment seeking individuals.

Brain tumors may present with multiple psychiatric symptoms (> 50%) and in 80% of the cases tumors are located in the frontal or limbic regions. Neuropsychiatric symptoms may be the first clinical indication of a brain tumor in 18% of the patients.

Brain metastatic tumors may be associated with a greater incidence of mental symptoms and are probably due to the tumors being scattered throughout the brain substance.

The authors report a case of a patient where the severe psychiatric symptoms, secondary to a metastatic brain tumor, were the initial presentation of a primary lung tumor.

A comprehensive review of the literature was conducted for reports of brain tumors and psychiatric symptoms, through PubMed, between Jan 1970 and Out 2010.

We also reviewed the patient medical records and computed tomography (CT) scans in detail.

Neither tumor location nor type is associated with specific psychiatric symptoms.

Mood symptoms may be a harbinger to an evolving brain tumor.

There is a statistically significant correlation of anorexia, without disturbance of body image perception, with hypothalamic tumors.

We conclude that brain tumors can be neurologically silent and only present with psychiatric symptoms. The diagnosis and treatment in the early phase of the disease are determinant for the survival and quality of life of patients with brain tumors.

Neuroimaging (CT and MRI scan) should be considered in patients with new-onset psychosis, recurrence of previously well-controlled psychiatric symptoms, occurrence of atypical symptoms and in patient's refractory to psychiatric treatment.

Description of socio-demographic characteristics and symptoms of patients diagnosed with schizophrenia or other psychotic disorders, treated in Tirana CAP (Child and Adolescent Psychiatry).

Study included 38 patients 13-19 years old who had been hospitalized in child and adolescent psychiatry during 2009-2012 years and diagnosed with psychotic disorders and/or schizophrenia. P value was obtained at 0.01 critical value using SPSS 19 for Windows 2007.

52.6% of study group were females. 84.2% were presented with psychotic symptoms, 5.3% were suicidal attempts. More than 55.3% have had loss of interest in daily activities. Through the correlation coefficient of Kendal there is a statistically significant correlation between the time when the disorder started for the first time (in months) and loss of interest in daily activities (r = 0,347, p = 0.014).

We have a time lag of first receiving specialized service, especially when dominated with negative symptoms. Early treatment challenge is to identify patients with high risk for developing psychosis. Data from this study may represent a modest starting point for creating a successful albanian community network for early detection and interevention of early psychosis.

Aim of this study is to determine the prevalence of attention deficit and hyperactivity symptoms, and to compare social phobia patients with high and low level symptoms in terms of disability and quality of life.

The study included 16 (44.4%) female and 20 (55.6%) male patients with social phobia (SP). The control group consisted of 36 volunteers who did not have any psychiatric disorder. Study and control group were evaluated using Wender-Utah Rating Scale (WURS-25), Turgay Adult Attention-Deficit /Hyperactivity Disorder (ADD/ADHD) DSM-IV-Based Diagnostic Screening and Rating Scale, Beck's Depression Inventory (BDI), The Sheehan Disability Scale (SDS), and The Short Form 36 Quality of Life Instrument (SF-36).

No statistically significant difference was found between the social phobia and control groups, based on gender, education level and mean age. Medium and high levels of ADHD symptoms were determined in 50.0% (n=18) of the SP group. Mean scores of WURS-25 scale, total and sub-scales of the Turgay ADHD scale in the SP group were higher than those of the control group. In the group with high levels of ADHD symptoms, the mental health sub-scale scores of SF-36 scale was statistically significantly lower than the group with low levels of ADHD symptoms.

Our results showed that ADHD symptom levels in social phobia patients were higher than controls and this situation can be associated with the deterioration of their mental health.

Primary polydipsia is an eating disorder which is often sub-diagnosed particularly in psychotic patients. Through a clinical observation of a patient who was treated for schizophrenia since 28 years and has presented a primary polydipsia, we suggest discussing the diagnostic and the therapeutic difficulties of this disorder.

Mr D.R, 46 years old, followed up since the age of 18 for a schizophrenia and a mental retardation. Despite the important dose of classic neuroleptic treatment and different association of classic neuroleptics, we never noted an improvement of the psychotic symptoms. One year ago, he had been hospitalized in a reanimation department for a metabolic encephalopathy secondary to a severe hyponatremia due to a primary polydipsia.

The eating disorder associated with a psychotic illness doesn’t usually fill all the criteria of the DSM IV classification and is often classified as an eating disorder not otherwise specified. It's important to notice that the early beginning of schizophrenia is one of major risk factors of primary polydipsia. Besides, many other mechanisms are involved to explain primary polydipsia Psychotropic substances can lead polydipsia especially neuroleptics because of an inappropriate secretion of the ant diuretic hormone or by their anticholinergic effect by increasing oral drought. Clozapine remains the best indication because it permits the stabilization of psychotic signs and the decrease of primary polydipsia at the same time.

Primary polydipsia has to be diagnosed and treated at time in psychotic patients to avoid serious complications of hyponatremia which can be fatal.

Treatment Resistant-Depression (TRD), known as the failure to respond to at least two different adequate trials of antidepressant treatments (ADT) in the current episode, is a relatively frequent clinical condition, associated to a high number of relapses, hospitalizations, and an elevated use of multiple pharmacological treatments. To date, however, the association between clinical variables and non-response in TRD remains unclear.

To identify predictors of non-response in inpatients with Major Depressive Disorder (MDD) and TRD.

To investigate clinical variables as potential predictors of non-response in TRD.

Two hundred fifty-three inpatients with MDD and TRD were divided into two groups: responders and non-responders to drug therapies, according to a decrease of 50% or more of the severity of depression (measured with HAM-D 17 items) at the end of forth week of hospitalization. A general model of Cox regression (with backward stepwise method) was used to identify independent predictors of non-response to treatment.

One hundred fifty-four TRD inpatients were responders and 99 non-responders. Cox regression identified three independent clinical predictors independently associated with the group of non-responders: (1) the presence of 5 or more depressive episodes in the medical history (OR = 2.27); (2) a current comorbid anxiety disorder (OR = 1.85); (3) a history of early life adversities (ELAs) (OR = 1.60).

The findings of this study suggest that the phenomenon of non-pharmacological response in the TRD is associated with different clinical variables, which might act through separate mechanisms in determining the persistence of depressive symptomatology.

The oculomotor system is closely linked to the neural circuits of attention. Recent evidence shows a novel role for eye vergence in orienting visual attention.

Identify patterns of attention disruption through eye vergence.

We investigated whether modulation in attention related eye vergence is disrupted in ADHD.

We measured eye vergence in children previously diagnosed with ADHD while performing a cue/no-cue task and compared the results to agematched controls.

We observed a strong modulation in the angle of vergence in the control group but not in the ADHD group. In addition, in the control group the modulation in eye vergence was different between the cue and no-cue condition. This difference was absent in the ADHD group.

Our study supports the observation of deficient binocular vision in ADHD children. We argue that the observed disruption in eye vergence modulation in ADHD children is proof of a deficient cognitive processing of sensory information. Our work may provide new insights into attention disorders, like ADHD.

Physician-assisted suicide (PAS) is currently the subject of controversial discussion in many European countries, albeit only a few of them have legalized this end-of-life practice under certain conditions. For the main part, the people who ask for assistance in suicide suffer from incurable physical diseases. In rare cases, however, the suicide of patients who additionally or solely suffer from mental disorders is also assisted.

The aim of this contribution is to describe potential roles of the psychiatrists in the context of PAS and to formulate ethical arguments for or against the respective involvement of psychiatrists in PAS.

Some authors argue that psychiatrists, invoking the social responsibility for suicide prevention, should strictly reject any involvement in PAS and offer a psychiatric treatment to patients with suicide plans. Others see the role of the psychiatrists in assessing the patients’ competence, which constitutes a fundamental prerequisite for PAS from an ethical point of view. Moreover, others deem a medical prescription of a lethal drug and the assistance in suicide by psychiatrists for ethically acceptable under certain conditions.

We argue that psychiatrists are particularly well-suited to differentiate autonomous and non-autonomous suicide plans based on their expertise in the field of suicidology and in competence assessment. From an ethical point of view, the involvement of psychiatrists can thus contribute to quality assurance of a legalized practice of PAS, benefit the patient autonomy at the end of life and minimize risks of abuse.

Mood Diisorders (MD) is an independent risk factor for Endocrine-Metabolic (E-M) disorders and metabolic syndrome. Biological processes relating to the pathophysiology of MD and metabolic syndrome have common characteristics.

To study the frequency and types E-M disorders in patients with the MD.

Research included 27 patients with Bipolar Affectiv Disorder (BAD) and 65 patients with a Depressive Disorder (DD) (ICD-10 diagnostic criteria), hospitalized during one year.

Among patients with BAD there were 11 men (40.7%) and 16 (59.2%) women. Comorbidity was registered in 8 (72.7%) men, with an average age of 47 years, and 10 (62.5%) women, with an average age of 51.3 years. Patients with DD were 24 men (36.92%) and 41 women (63.07%). Somatic comorbidity was observed in 31 women (75.61%), average age 51.2 years, and 17 men (70.83%), average age 52.8 years. The relationship between age and gender and prevalence of somatic comorbidity was analysed (statistical analysis by x2 and t-test). Analysis of somatic illnesses showed that E-M disorder had the highest prevalence, 11 patients (40.7% with BAD) and 36 patients (55.38% with DD).

Dyslipidemia, DM and disorder of the Thyroid gland were the most frequent. There was no statistically significant discrepancy in the prevalence of E-M disorders and MD depending on gender (p=0,64 BAD), (p=0,29 DD) and age (p=0,18 BAD), (p=0,25 DD).

MD are accompanied by E-M disordersat a high rate (51%), but there is no statistically significant difference depending on gender and age.

Effective antipsychotic treatment of schizophrenia should, beyond symptom control, translate into meaningful functional improvements. This study explored functional outcomes in patients with schizophrenia switched from previous unsuccessful treatment with oral antipsychotics to flexible doses of paliperidone palmitate (PP).

Two groups of acute (N=212) and non-acute (N=593) patients from an international prospective open-label 6-month study. Outcomes were change in Positive and Negative Syndrome Scale (PANSS) total score, Personal and Psychosocial Performance scale (PSP) and Mini International Classification of Functionality, Disability and Health Rating for Activity and Participation Disorders in Psychological Illnesses (Mini-ICF-APP).

Both groups significantly improved from baseline to endpoint in mean PANSS total score from 98.5±20.1 to 67.4±24.0 (mean change -31.0±29.0) in acute and from 71.5±14.6 to 59.7±18.1 (mean change -11.7±15.9) in non-acute patients (all p<0.0001). Patient functioning in PSP total score increased from 43.9±15.0 at baseline to 62.9±17.1 at endpoint (mean change 19.0±18.7; 95% confidence interval [CI] 16.4;21.6) in the acute and from 58.1±13.4 at baseline to 66.1±15.7 at endpoint (mean change 8.0±14.0; 95%CI 6.8;9.1) in the non-acute group (both groups p<0.0001). Illness-related disabilities of activity and participation within groups improved significantly in Mini-ICF-APP global score decreasing from 26.8±8.5 to 18.5±9.8 (mean change -8.0±10.4; 95%CI -9.5;-6.5) in acute and from 19.8±7.9 to 15.9±8.8 (mean change: -4.0±7.5; 95%CI - 4.6;-3.3) from baseline to endpoint in non-acute patients (both groups p<0.0001).

Symptom reduction in acute and non-acute patients with schizophrenia treated with PP after previous unsuccessful treatment with oral antipsychotics was associated with clinically meaningful functional improvements.

To explore tolerability, safety and treatment response of flexibly dosed once-monthly paliperidone palmitate (PP) in adult nonacute patients with schizophrenia previously unsuccessfully treated with oral aripiprazole.

International prospective open-label 6-month study. Outcomes were change in Positive and Negative Syndrome Scale (PANSS), patient functioning (Personal and Social Performance Scale; PSP), disease severity (CGI-S and CGI-C), Extrapyramidal Symptom Rating Scale (ESRS) and treatment-emergent adverse events (TEAEs).

46 patients (73.9% male, mean age 34.4±9.4 years, 78.3% paranoid schizophrenia) were analyzed. The mean prior oral aripiprazole dose was 22.7±10.7 mg/day. 67.4% of patients completed the study. Mean PANSS total score decreased from 74.7±14.9 at baseline to 62.6±16.5 at LOCF endpoint (mean change -12.2±16.7; 95% confidence interval -17.1;-7.2; p<0.0001). 52.2% of patients showed a ≥20% improvement in PANSS total score, the percentage of patients rated mildly ill or less in CGI-S increased from 23.9% to 56.5% and 75.5% of patients were rated improved in CGI-C. Patient functioning in PSP improved from 58.9±13.4 to 62.9±15.2 (p=0.041). TEAEs reported in ≥5% were anxiety (n=6), injection site pain, bronchitis, insomnia and akathisia (n=4 each), and weight increase, depression and pain in extremities (n=3 each). Extrapyramidal symptoms measured by ESRS total scores improved significantly in completers from baseline to month 6 by -1.4±2.7 (p<0.007) and by -0.6±3.4 from baseline to LOCF endpoint (p=0.046).

Flexibly dosed paliperidone palmitate was well tolerated and associated with a clinically relevant symptomatic treatment response, improved functioning and less EPS in non-acute patients with schizophrenia previously unsuccessfully treated with oral aripiprazole.

To explore tolerability, safety and treatment response of flexibly dosed paliperidone palmitate (PP) in adult non-acute schizophrenia patients previously unsuccessfully treated with oral antipsychotic monotherapy of risperidone (RIS), paliperidone ER (Pali ER), olanzapine (OLA), quetiapine (QUE) or aripiprazole (ARI).

International, prospective 6-month open-label study. Outcomes were response (≥20% improvement in Positive and Negative Syndrome Scale (PANSS) total score at endpoint), patient functioning (Personal and Social Performance scale (PSP)), treatment-emergent adverse events (TEAEs) and Extrapyramidal Symptom Rating Scale (ESRS).

Intent-to-treat population: n=191 (RIS), n=104 (Pali ER), n=87 (OLA), n=46 (ARI), n=44 (QUE). Patients presented some differences in baseline demographics, e.g. in age, years since diagnosis and BMI. Baseline mean PANSS total scores ranged from 74.7±14.9 (ARI) to 70.8±13.1 (QUE) and 70.8±15.1 (RIS). Between 67.4% (ARI) and 83.2% (RIS) of patients completed the study. At endpoint, 74% (RIS), 58% (Pali ER), 61% (OLA), 66% (QUE) and 52% (ARI) of patients had improved ≥20% in PANSS total score. Mean PSP improvement at endpoint was: 10.4±13.8 (RIS), 7.0±13.8 (Pali ER), 4.5±15.9 (OLA), 7.9±12.4 (QUE) and 3.9±13.2 (ARI); all p<0.05. TEAEs reported at least once in all subgroups were injection site pain, insomnia and psychotic disorder. Mean change in ESRS from baseline to endpoint was -1.2±3.5 (RIS), - 0.7±4.1 (Pali ER), -1.3±4.4 (OLA), -0.3±3.2 (QUE) and -0.6±3.4 (ARI; p<0.05 for all except QUE).

PP was well tolerated and associated with clinically relevant treatment response in patients previously unsuccessfully treated with oral atypical antipsychotic monotherapy, regardless of the medication that was switched.

Recent metaanalyses have reported conflicting results on the efficacy of long-acting compared to oral antipsychotics in the prevention of relapse in patients with schizophrenia.

2-year international randomized active controlled, open-label, rater-blinded study evaluating time to relapse, relapse rates, psychotic symptoms (PANSS) and treatment-emergent adverse events (TEAEs) in recently diagnosed patients with schizophrenia (≥1-5 years) treated with a monotherapy of paliperidone palmitate (PP) compared to investigators’ choice of oral antipsychotics (oAPs), i.e. aripiprazole, olanzapine, quetiapine, paliperidone ER, risperidone or haloperidol.

715 patients (58.4% male, mean age 32.5±10.4 years, 86.2% paranoid schizophrenia, no significant differences in baseline characteristics) entered the 2-year study period (352 PP, 363 oAPs). Time to relapse was significantly longer with PP compared to oAPs (mean±SE: 616±10.9 vs 603±13.1 days, p=0.019). Relapse rates were significantly lower with PP vs oAPs (14.8% vs 20.9%; p=0.032), reflecting a relative risk reduction of 29.2%. Reduction of psychotic symptoms in PANSS was significantly superior with PP at treatment day 8 (p=0.021) and showed a trend in favor of PP at endpoint (p=0.074). TEAEs reported in ≥5% in any group (PP vs oAPs) were weight increase (15.9% vs 17.4%), headache (11.1% vs 8.5%), insomnia (9.7% vs 8.0%), schizophrenia (8.2% vs 9.6%), nasopharyngitis (7.1% vs 5.0%), injection site pain (6.8% vs 0%), anxiety (5.7% vs 4.4%), tremor (5.1% vs 2.2%) and suicidal ideation (4.5% vs 5.5%).

In this randomized active controlled 2-year study PP was significantly delaying time to relapse and reducing relapse rates compared to investigators’ choice of oral APs.

This study explores tolerability, safety and treatment response of flexible doses of the atypical long-acting antipsychotic paliperidone palmitate (PP) in adult patients with an acute exacerbation of schizophrenia previously unsuccessfully treated with oral antipsychotics.

International prospective open-label 6-month study. Outcome parameters were change in Positive and Negative Syndrome Scale (PANSS) total score, Clinical Global Impression-Severity Scale (CGI-S), treatment-emergent adverse events (TEAEs) and weight change.

212 acute patients, 59.0% male, mean age 36.4 ±12.1 years, 85.4% paranoid schizophrenia were enrolled. 70.3% of patients completed the study. Most frequent reasons for early discontinuation were subject choice (9.4%), or an adverse event (9.0%). Recommended initiation regimen of PP (150 mg eq on day 1 and 100 mg eq on day 8) was administered in 92.9% of subjects. Mean baseline PANSS total score decreased from 98.5±20.1 as of day 8 of treatment to 67.4±24.0 at endpoint (mean change -31.0±28.97; 95% confidence interval [CI]-35.0;-27.1; p<0.0001). 66.7% of patients improved ≥30% in PANSS total score and percentage of patients rated markedly ill or worse in CGI-S decreased from 75.1% at baseline to 20.5% at endpoint. TEAEs reported in ≥5% were injection site pain (13.7%), insomnia (10.8%), psychotic disorder (10.4%), headache (6.1%) and anxiety (6.1%). Mean weight change at endpoint was 2.6±5.6 kg (95%CI 1.8; 3.4).

These data support results from previous randomized controlled studies that flexibly dosed paliperidone palmitate is well tolerated and associated with an early and clinically relevant treatment response in acute schizophrenia patients previously unsuccessfully treated with oral antipsychotics.

Negative, disorganized and depressive symptoms are among the major unmet needs in the treatment of patients with schizophrenia. The objective of this analysis was to explore the impact of flexibly dosed paliperidone palmitate (PP) on negative and depressive symptoms, disorganized thoughts, subjective well-being and treatment satisfaction in adult non-acute but symptomatic patients with schizophrenia previously unsuccessfully treated with oral antipsychotics.

International, prospective 6-month open-label multicenter study. Outcomes analyzed were changes from baseline to endpoint in negative symptoms, disorganized thoughts and anxiety/depression Marder factors of the Positive and Negative Syndrome Scale (PANSS), patient well-being (Subjective Well-Being with Neuroleptics, short version), and patient treatment satisfaction.

593 patients (intent-to-treat population), 63.1% male, mean age 38.4±11.8 years, 78.6% paranoid schizophrenia, were analyzed. 74.5% of patients completed the study. Mean baseline PANSS negative subscale scores (20.2±5.4) improved significantly by -3.5±5.4 points from baseline to endpoint (95% confidence interval [CI] -3.9;-3.0), the PANSS negative symptoms Marder factor score improved from 19.6±5.6 to 16.1±5.7 (95%CI of change -3.9;-3.1), and the disorganized thoughts Marder factor score improved from 16.2±4.4 to 13.9±4.6 (95%CI -2.6;-1.9). Similarly, the anxiety/depression Marder factor score improved from 9.3±3.1 to 7.6±3.1 (95%CI -2.0;-1.5, all p<0.0001). Subjective well-being (SWN-S) increased from 80.1±17.2 at baseline to 85.5±17.3 at endpoint (95%CI 4.0;6.7), and treatment satisfaction improved significantly from 55.3±19.6 to 63.9±22.8 (95%CI 6.4;11.0, both p<0.0001).

Paliperidone palmitate treatment of non-acute but symptomatic patients with schizophrenia showed significant and clinically relevant improvements in negative and depressive symptoms, disorganized thoughts, subjective well-being and patient treatment satisfaction.

To explore tolerability, safety and treatment response of flexibly dosed paliperidone palmitate (PP) in adult non-acute but symptomatic patients with schizophrenia previously unsuccessfully treated with risperidone long-acting injectable treatment (RLAT).

International, prospective 6-month open-label study. Major outcomes were clinical response (percentage of patients with ≥20% improvement in Positive and Negative Syndrome Scale (PANSS) total score at endpoint), functioning (Personal and Social Performance scale (PSP)), Extrapyramidal Symptom Rating Scale (ESRS), sleep quality, daytime drowsiness and treatment-emergent adverse events (TEAEs).

The intent-to-treat population comprised 56 patients (64.3% male, mean age 39.9±11.0 years, 71.4% paranoid schizophrenia). 71.4% of patients completed the 6-month study. Withdrawal of consent (8.9%) and adverse events (10.7%) were the most frequent reasons for early discontinuation. Mean PANSS baseline total score was 67.5±20.7 and decreased by -9.2 points at endpoint (95% confidence interval -15.0;-3.5, p<0.0001). At endpoint, 61.1% of patients had improved by ≥20% in PANSS total score. Patient functioning in PSP increased by 5.2±15.3 points (p=0.0163). Sleep quality and daytime drowsiness improved significantly (both p<0.0292). Extrapyramidal symptoms in ESRS significantly improved from 3.7±7.2 at baseline to 2.4±6.4 at endpoint (p=0.0011). TEAEs reported in ≥5% were psychotic disorder (10.7%), injection site pain, headache, schizophrenia, anxiety (7.1% each), constipation and somnolence (5.4% each). Mean body weight decreased by 0.9±4.5 kg from baseline to endpoint.

These data suggest that paliperidone palmitate is associated with a meaningful clinical response and functional improvement and is well tolerated with less EPS in non-acute, symptomatic schizophrenia patients previously unsuccessfully treated with RLAT.

To explore tolerability, safety and treatment response of flexibly dosed paliperidone palmitate (PP) in adult non-acute patients with schizophrenia previously unsuccessfully treated with the decanoate of haloperidol (Hal), flupentixol (Fpt), fluphenazine (Flu) or zuclopenthixol (Zuc).

International, prospective 6-month open-label study. Outcomes were clinical response (≥20% improvement in Positive and Negative Syndrome Scale (PANSS) total score), Personal and Social Performance scale (PSP), Extrapyramidal Symptom Rating Scale (ESRS) and treatment-emergent adverse events (TEAEs).

The intent-to-treat population comprised n=53 Hal, n=35 Fpt, n=44 Flu and n=42 Zuc patients. Mean age ranged from 42.1±10.7 [Zuc] to 44.4±9.4 years [Hal]), male gender from 57.1% [Zuc] to 69.8% [Hal]), and BMI from 27.3±5.9 [Hal] to 30.8±8.5 kg/m2 [Zuc]). Between 70.5% [Flu] and 85.7% [Fpt] of patients completed the study. Mean baseline PANSS total scores ranged from 73.7±14.1 [Fpt] to 75.7±13.2 [Hal]) and decreased significantly by -7.5±19.4 [Flu] to -10.6±21.5 points [Zuc] at endpoint (p<0.003 all subgroups). At endpoint, between 53.7% [Zuc] to 61.8% [Fpt] of patients had improved ≥20% in PANSS total score. Patient functioning (PSP) improved by 5.2±13.0 [Hal] to 6.4±15.2 points [Zuc] (all p≤0.0071). TEAEs reported at least once in all and in ≥5% in any subgroup were insomnia (max 11.5%), psychotic disorder (max 9.5%) and injection site pain (max 9.1% of subjects). Extrapyramidal symptoms in ESRS significantly improved from baseline to endpoint (all subgroups p<0.01).

Paliperidone palmitate was associated with a clinically meaningful treatment response and well tolerated in non-acute schizophrenia patients previously unsuccessfully treated with conventional depot antipsychotics.

Neuroleptic malignant syndrome (NMS) is a serious side effect of the antipsychotic, potentially life-threatening. The NMS is characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia. Even the newer atypical antipsychotics (AA), which are not classified accurately as neuroleptics, can cause NMS.

We report the clinical course of a NMS in a 37-year-old male with bipolar disorder. The clinical onset and the evolution are described.

The patient was treated with different AA drugs (risperidone and olanzapine), and after a dosage increase of olanzapine extrapyramidal symptoms appeared (muscular rigidity, hyperthermia, dystonia, tachycardia and profuse diaphoresis) and laboratory abnormalities (CK-NAC 21000U/L).

The patient is examined and evaluated by a internal medicine physician and moved to the Intensive Care Unit (ICU) where he started hydration using intravenous fluids, antibiotics (meropenem), benzodiazepines (diazepan) and dopamine agonist (bromocriptine). His admission in ICU was 13 days.

The pathogenesis of NMD in BD is poorly understood. Current theories are limited in their ability to explain all clinical manifestations. Although there is no diagnostic test for NMS, testing has a crucial role in the evaluation of patients with potential NMS. Typical laboratory abnormalities help to confirm the clinical diagnosis.

According to the literature reviewed, all classes of antipsychotics have been associated with neuroleptic malignant syndrome, including lowpotency neuroleptics, high potency neuroleptics and the newer atypical antipsychotics, so we must monitor patients who start or increase dose of atypical or typical antipsychotics.