The authors have not supplied their declaration of competing interest.

Bipolar disorder (BD) is often associated with various comorbidities. It is substance use disorders (SUD) one of the most frequent comorbidities.

The ECA study (Epidemiologic Catchment Area) observed a prevalence over the life of the 56, 1% for any TUS in the total sample of patients with bipolar disorder. In subjects with bipolar I disorder prevalence was 60.7%, and those of type II 48.1.

In the OMS study conducted in America, Europe and Asia, the results confirm the high rates of disorders in patients diagnosed with bipolar disorder regardless of the country of study.

This is a male, 32, who came first to the Provincial Drug Addiction Service of Huelva in 2009 for cocaine, cannabis and alcohol.

In his personal history, he relates a convulsive episode at 14 years and one manic episode associated with consumption of cocaine in 2002 which began to be treated by a team of Mental Health and Provincial Center for Addictions.

He entered twice in a therapeutic community in 2009 for treatment for their disorder dependence on cocaine, alcohol and cannabis.

It has required admission to the Unit Hospitalization twice in 2012, with the discharge diagnosis of manic episode secondary to drug consumption.

Most epidemiological studies in recent decades note the high prevalence of comorbidity BD + SUD.

BD-SUD comorbidity is particularly complex because each disorder affects the evolution of the other and they are frequently multiple comorbidities. In addition, it implies a worse clinical and functional outcome as well as poorer therapeutic response.

The authors have not supplied their declaration of competing interest.

Analysis of the treatment alternatives for patients diagnosed with a bipolar disorder of torpid evolution. Revision of the possible adverse effects of lithium and its impact on the adherence to treatment.

We revise the clinical evolution of a patient diagnosed with Bipolar disorder type I, with the following characteristics: at least two maniac episodes per year, consumption of toxic substances and high sensibility to antipsychotics and euthymics.

We will describe the case of a 23-years-old patient diagnosed with bipolar disorder type I. During the course of the illness, benign intracranial hypertension is diagnosed and the treatment with lithium must be stopped. We replace lithium treatment by Asenapine monotherapy. The evolution of the patient was very positive. Taking account of the adverse effects of lithium and reducing them can facilitate the adherence to treatment and also benefit early remission and less deterioration in each episode.

It is fundamental to promote a comprehensive approach to each patient, including psychotherapy, psychoeducation as well as appropriate medication. The knowledge of the described effects helps us to determinate the appropriate medication for each patient.

The authors have not supplied their declaration of competing interest.

Behavioral disturbances are common in psychiatric patients. This symptom may be caused by several disorders and clinical status.

We report the case of a 40 year-old male who was diagnosed of nonspecific psychotic disorder, alcohol dependence, cannabis abuse and intellectual disability. The patient was admitted into a long-stay psychiatric unit because of behavioral disturbances consisted in aggressive in the context of a chronic psychosis consisted in delusions of reference and auditory pseudohallucinations. During his admission the patient received the diagnosis of bipolar disorder type 1, presenting more severe behavioral disturbances during these mood episodes. It was necessary to make diverse pharmacological changes to stabilize the mood of the patient. Finally, the treatment was modified and it was prescribed clozapine (25 mg/24 h), clotiapine (40 mg/8 h), levomepromazine (200 mg/24 h), topiramate (125 mg/12 h), clomipramine (150 mg/24 h) and clorazepate dipotassium (50 mg/24 h). With this treatment, the patient showed a considerable improvement of symptoms, presenting euthymic and without behavioral disturbances.

In this case report, we present a patient with severe behavioral disturbances. The inclusion of bipolar disorder in the diagnosis of the patient was very important for the correct treatment and management, because of depressive and manic mood episodes the behavioral disturbances were exacerbated.

Patients with behavioral disturbances could present psychotic and affective symptoms as cause of them. It is necessary to explore these symptoms and try different treatments to improve them.

The authors have not supplied their declaration of competing interest.

Bipolar depression is difficult to manage, and causes considerable disability and distress for patients and their surroundings. Electroconvulsive therapy (ECT) is an effective treatment, but there are concerns regarding long-term neurocognitive impairment, and in particular autobiographical memory.

To compare the long-term effects of algorithm-based pharmacologic treatment (APT) and ECT in treatment-resistant bipolar depression as measured with standard neurocognitive tests and autobiographical memory interview.

To examine the long-term neurocognitive effects of ECT.

In this multicenter randomized controlled trial 73 in-patients with treatment resistant bipolar depression were randomized to either APT or unilateral ECT. Patients were assessed at baseline and at 6 months. Neurocognitive functions were assessed with the MATRICS Consensus Cognitive Battery (MCCB), Wechsler Abbreviated Scale of Intelligence (WASI) and the Autobiographical Memory Inventory - Short form (AMI-SF). At 6 months, neurocognitive data were available for 26 patients (APT n = 11, ECT n = 15).

There were no group-differences at baseline.

At 6 months, there was no group-difference in MCCB-score (APT 44.9 vs. ECT 46.0, P-value: 0.707), or WASI total IQ-score (APT 103.9 vs. ECT 107.2, P-value: 0.535). There were indications of (P-value: 0.109) poorer AMI-SF consistency score in the ECT group (APT 72.3% vs. ECT 64.3%).

This study does not find that ECT causes long-term impairment in neurocognitive function as measured with standard neuropsychological tests. We find a trend towards poorer autobiographical memory in the ECT-group, and there needs to be further research regarding this.

The authors have not supplied their declaration of competing interest.

Independently of the drug choice, antimaniac treatment has to be continued at least until full remission. Most guidelines recommend continuation therapy for 6–12 months but controlled studies are lacking.

A six months follow-up study on a sample of 57 inpatients affected by mania at Mood Disorder Unit.

To evaluate a timeframe for the discontinuation of the antipsychotic therapy.

Fifty-seven bipolar inpatients affected by a manic episode according to DSM-5 criteria. Patients treated according to our pharmacological protocol with a mood stabilizer (lithium or valproate) and an antipsychotic (haloperidol or risperidone). Course of illness assessed with Young Mania Rating Scale (YMRS) scored at week 0, 1, 2, 4, 8, 24. Remission defined as YMRS < 12.

Twenty men (35.09%) and 37 women (64.91%); mean age 43.18 ± 12.71 years. Mean YMRS basal score 38.55 ± 8.08. At 4th week, remission rate was 54.39% (31 patients); at 8th week was 80.70% (46 patients). At 8th week, 39/57 patients (68.42%) discontinued the antipsychotic. Relapse rate after 6 months was 26.32% (12 depressed, 3 manic). Multiple regression, t-test and Chi2 analysis were performed: older patients (P = 0.01) and with higher number of episodes (P = 0.04) tend to relapse earlier. Neither severity of the episode (P = 0.3), nor delusional symptoms (P = 0.6) nor discontinuation of the antipsychotic (P = 0.3) correlate with relapse time.

Our experience suggests that an early discontinuation of antipsychotics, usually 4–8 weeks after remission, does not worsen the short-term course of illness. This approach could minimize the risk of side effects. Evidence is lacking about the duration of this therapy, long-term studies are still necessary.

The authors have not supplied their declaration of competing interest.

Insight is an important factor associated with non-compliance and poor outcome. Poor level of insight has been described as a characteristic in patients with acute bipolar disorder with more unawareness in social consequences. In contrast, awareness of having a mental disorder, of its symptoms, of its consequences, and/or of the need for treatment is associated with a number of positive prognostic indicators. Insight is also linked, however, to depression and suicidal ideation in bipolar disorder.

(1) Assess the illness perception. (2) Assess the impact of insight in suicidal tendencies.

Contribute to development measures to improve the insight in bipolar disorders.

In this cross sectional study we use a convenience sample of patients with bipolar disorder attending in the mental health departments of three general hospitals in Lisbon great area. We have applied clinical and socio-demographic questionnaire and additional measures to assess symptom severity, treatment adherence and illness perception.

A samples was composed by 64 patients with bipolar disorder (mean age = 38.7; SD ± 10.1). A total of 48.4% patients (n = 31) had made a suicide attempted and 23.4% (n = 15) of this patient done 5 or more attempted suicide. We found a significant correlation with symptoms and insight (rs = 0.56; P < 0.01).

Mental health professionals often utilize insight as an indicator of prognosis, because of its association with treatment adherence. The findings of the current study suggest that having intact or good insight may be an indicator for suicidal ideation among patients with bipolar disorders. A brief psychoeducational approach could potentially be effective. We recommend a combined approach to Improve clinical insight in bipolar disorder.

The authors have not supplied their declaration of competing interest.

Emotional intelligence is defined as the ability to process, understand and manage emotions. In bipolar disorder seem to be more conserved, with less functional impairment than other severe mental disorders as schizophrenia. So far, there are few studies analyzing emotional intelligence in bipolar disorder.

The objective of this research is to better understand the different characteristics and the factors affecting these social-cognitive dysfunctions in bipolar disorder.

To explore possible factors related to emotional intelligence in these severe mental disorders: symptoms, cognitive functioning, quality of life and psychosocial function.

Twenty-six adults bipolar type I patients were examined using MSCEIT (the most validated test for emotional intelligence), BPRS, YMRS, HDRS, WAIS-IV, TMT and Rey Figure in order to determine the level of emotional intelligence and factors relate.

Bipolar patients show lack of emotional intelligence when compared with general population. Cognitive impairment and age are the principal factors related.

Results are discussed and compared with recent literature.

The authors have not supplied their declaration of competing interest.

Severe mental disorders have deficits in different aspects of social cognition, which seem to be more pronounced in patients with schizophrenia compared to those with bipolar disorder. Emotional intelligence, defined as the ability to process, understand and manage emotions, is one of the main components of the sociocognition. Both in schizophrenia and bipolar disorder have been described changes in emotional intelligence, but only few studies compare both disorders.

The objective of this research is to increase knowledge about the differences between schizophrenia and bipolar disorder.

To compare emotional intelligence in patients with schizophrenia versus bipolar patients.

Seventy-five adult patients with schizophrenia and bipolar disorder were evaluate.

The assessment protocol consisted of a questionnaire on socio-demographic and clinical-care data, and a battery of assessment scales (BPRS, PANSS, SCID-I-RV, YMRS, HDRS, CGI-S, EEAG, MSCEIT). Among the assessment tools of emotional intelligence, we select MSCEIT as the most validated.

Statistical analysis was performed using SPSS 23 version. After the descriptive analysis of the data, we compare the results of the scales.

Both disorders show a deterioration of emotional intelligence compared to the general population. There were no statistically significant differences in the comparison of emotional intelligence between schizophrenia and bipolar disorder.

Schizophrenia and bipolar disorder have deficits in emotional intelligence, while it is difficult to show differences between them. These changes in emotional intelligence are part of a set of cognitive, social and non-social skills, which are altered in these severe mental disorders.

The authors have not supplied their declaration of competing interest.

The bipolar disorder (BD) has an important effect over the lives of patients and families. The attitude of the family is a modifiable factor through specific interventions and it has been related with BD prognosis.

Study a sample of families and patients with BD.

Compare between two groups its course of burden of caring for family members with BD. Also, we will see the course of the functionality in patients.

Sample of 148 individuals who caring a familiar with BD. Seventy-six of these followed psychoeducation session are going to be experimental group (EG), and the others 72 did not followed any session are going to be control group (CG). There is a follow-up at 6 months and one year. To see the course of the burden and the functionality it will be used mixed models.

At baseline, there were not significant differences between CG and EG in objective and subjective burden and functionality. But over time there were significant results in the three cases. For objective burden (b = −0.016; P = 0.0001) EG presented a drop (b = −0.014; P = 0.0062), while CG did not show changes (b = 0.002; P = 0.4691). For subjective burden (b = −0.014; P = 0.0058) without significant results for CG (b = −0.352; P = 0.3203) and a significant decrease in EG (b = −0.017; P = 0.003). For the functionality (b = 1.474; P = 0.000) there was a significant increase in EG (b = 1.349; P = 0.000) but not for CG (b = −0.125; P = 0.3828).

Two groups did not differ at baseline however after the psychoeducation sessions appear clear differences, decreasing the burden for EG group and the functionality also improved for EG.

The authors have not supplied their declaration of competing interest.

Recent studies have focused on the imbalance in inflammatory and antioxidant pathways as possible causes of the underlying neurodegenerative processes in bipolar disorder. Thus, the study of these pathways in first episodes of mania (FEM) can increase knowledge about this issue.

To compare plasma concentrations of pro-inflammatory (MCP-1, PGE2, TNFα) and oxidative parameters (TAS, NO2 and TBARS) between controls and FEM patients and to analyze the evolution of these parameters in patients from baseline to 6 months assessment time.

This study included 44 FEM patients and 79 healthy controls, aged 18 to 40. Blood samples were available for controls at baseline and for patients at baseline and 6 months after. TAS and TBARS were measured using non-EIA assay kits, N02 was measured with Griess method and PGE2, MCP-1 and TNFα with ELISA kits.

At baseline, TAS was significantly lower in patients than in controls and TBARS, MCP-1 and TNFα were significantly higher in patients. Among patients, TAS and MCP1 were lower at 6 months than at the illness onset and PGE2 and NO2 were significantly higher than at baseline.

Patients presented an increased oxidative damage and also a higher activation of pro-inflammatory pathways than healthy controls at baseline. After 6 months their level of oxidative stress continue increased. Pro-inflammatory parameters decreased overtime (MCP-1 and TNF α) but PGE2, increased surprisingly. This can be due to the fact that antipsychotics are not able to completely reverse baseline inflammation.

The authors have not supplied their declaration of competing interest.

Agitation is the most evident symptom in an acute manic episode. It can be defined as excessive motor or verbal activity that can degenerate into aggressive behaviour. Both aripiprazole and asenapine are indicated for the treatment of agitation in patients with manic episode.

To retrospectively evaluate the acute effects of drug therapy on psychomotor agitation rated with the PANSS-EC, the change in manic symptoms through the YMRS, the QoL with the SF-36v2 and the cardiometabolic effects of the new oral APS.

We administered the following tests to 13 patients with DBI at T0 (baseline), T1 (after 1 week), T2 (after 4 weeks), T3 (after 12 weeks) and T4 (after 24 weeks): PANSS-EC, YMRS, SF-36v2, CGI-BD, CGI-S, HAM-D, BPRS. We also considered weight, height, BMI, ECG and complete blood count.

Patients recruitment and statistical analyses are still in progress. Our preliminary results suggest that there is not a marked difference between the two drugs. We highlighted that there has been a noticeable decrease in results at PANSS as well as at YMRS from T0 to T4 and patients showed an improvement in QoL. Only one patient treated with asenapine showed an increase in the results of HAM-D.

Results suggest the efficacy of the two new APS but further recruitment and data collection are needed to better understand their impact on agitation and QoL, including the metabolic profile, with the aim to help clinicians to make a more accurate choice of drug for each specific patient.

The authors have not supplied their declaration of competing interest.

Recently, depot aripiprazole was approved as a maintenance treatment for schizophrenia. However, long-acting antipsychotics has not been established efficacy in manic episode or maintenance treatment of bipolar disorder.

Describe a clinical case of multiresistant bipolar disorder.

Thirty-nine years old male, diagnosed since 8 years ago with bipolar disorder, current episode manic with psychotic symptoms, admitted to Acute Psychiatrist Unit. It was his seventh internment. He was dysphoric, had insomnia, and showed many psychotic symptoms like grandiose delusions and delusions of reference. He thought he was a famous painter from nineteenth century.

His disorder was refractory to mood stabilizers monotherapy and to many neuroleptic and, like olanzapine 30 mg/day, depot risperidone, zuclopenthixol, haloperidol, palmitate paliperidone, He was on treatment with lithium 1200 mg/day (lithemia 0.62 prior to admission) and oral aripiprazole 15 mg/day that he was not taking regularly. Poor compliance to oral treatment. No awareness of illness.

during the patient admission, we started long-acting aripiprazole 400 mg per 28–30 days. First 3 days he persisted dysphoric, hostile, and showing delusions of mind being read. From the fourth day, delusions disappeared and later he was calmer and more friendly, He was discharged 9 days later fully euthymic.

For 6 months follow-up, the patient came once a month to community center for aripiprazole injection and he was taking lithium regularly. Last lithemia 0.65 mEQ/L.

Long-acting antipsychotics, like depot aripiprazole could be a useful alternative to oral medication, specially when there is no awareness of illness and there is low adherence to oral treatment.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Women with bipolar disorder warrant special consideration with regard to sexual health. The impairment in sexual function would be frequent but underestimated and contributes to non-compliance with treatments.

(1) Evaluate sexuality among a population of women affected by bipolar disorder.

(2) Determine the factors associated with impaired sexual function.

This is a cross-sectional and descriptive study during the period ranging from 1st September to 15 October 2015.

It was conducted in 40 women suffering from bipolar disorder.

The exclusion criteria were: relapse period in sick, age over 60 years or severe somatic comorbidity.

The evaluation of sexual function was made using the “Sexual Behavior Questionnaire” (SBQ).

The mean age was 30 years. Bipolar disorder type I accounted for 72.5%.

According to the SBQ, 37.5% of patients had a desire disorder, 57.5% had a frequency less than 3 times per week sexual intercourse, 45% had a drop in excitation and 42.5% were not satisfied with their sex life.

Sexual problems are positively correlated at an early age of onset of bipolar disorder (P = 0.001).

The lack of desire, the sexual excitation disorder and the decrease in the frequency of sexual intercourse are positively correlated with the depressive phase of bipolar disorder.

A better understanding of sexual behavior in women with bipolar disorder and the early screening of the sexual disorders must be integrated into the management of the disease. It can improve their quality of life and adherence to therapy.

The authors have not supplied their declaration of competing interest.

Growing body of evidence have showed that euthymic bipolar patients have poor psychosocial functioning. Most of the studies have focused on the psychosocial functioning in euthymic bipolar disorder (BD)-I patients. On the contrary, there have been limited researches investigating psychosocial functioning in euthymic BD-II patients. Moreover, the factors associated with psychosocial functioning in euthymic patients with BD II have been also understudied.

Aim of our study was to investigate the association between clinical variables and poor psychosocial functioning in euthymic BD-II patients. Hypothesis of this study was that euthymic BD-II patients would have low level of psychosocial functioning compared with healthy individuals.

BD-II (n = 37) and healthy subjects (n = 35) were compared in terms of their psychosocial functioning which were assessed by Functional Assessment Short Test (FAST). The euthymic state was confirmed by low scores both on the Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). Anxiety symptoms were also assessed by Hamilton Anxiety Rating Scale (HARS) in both groups. Clinical variables were taken as independent variables and FAST scores were taken as dependent variable in order to run correlation analysis in BD-II group.

No socio-demographic differences were found between two groups. Euthymic BD-II patients had significantly higher FAST, HARS, HDRS YMRS scores compared with healthy individuals. Only HDRS scores correlated with FAST scores of BD-II patients.

This study indicated that euthymic BD-II patients had poorer psychosocial functioning. And subclinical depressive symptoms were associated with poor psychosocial functioning.

The authors have not supplied their declaration of competing interest.

Insight is a well-documented phenomenon for psychotic disorders. It has been studied extensively in schizophrenia and its association with clinical outcomes has drawn increased attention. Although less is known for affective disorders, recent studies point out that impaired insight in bipolar disorder may take part in patients’ overall well-being.

Exploring the main components of insight in psychiatry, particularly in bipolar disorder.

With this study, we wanted to examine how clinical and cognitive insights change in patients with bipolar disorder through their hospitalization period and how they correlate with symptom severity and neuropsychological functioning.

In this prospective study, inpatients with bipolar I disorder who were presented by manic episode with psychotic features were included. The patients were assessed with Young Mania Rating Scale, Beck Cognitive Insight Scale, Schedule for the Assessment of Insight-Expanded Version (SAI-E) and a neuropsychological test battery both at the time of admission and discharge.

As of October 2015, a total number of 20 patients with bipolar I disorder participated in the study. Preliminary results revealed a significant improvement in the total score of clinical insight, which was measured with SAI-E by the time of discharge (P = 0.001). This transition was strongly correlated with the decrease in symptom severity (P = 0.006, r = −0.61). Improved clinical insight exhibited significant correlation with the increase in patients’ memory span (P = 0.007, r = −0.596).

The preliminary results suggest that changes in symptom severity and working memory might be the determinants of improvement in clinical insight of inpatients with bipolar disorder through manic episode.

The authors have not supplied their declaration of competing interest.

Hyperprolactinemia can produce clinical symptoms affecting the patient's quality of life and therefore limiting therapeutic approaches to bipolar disorder.

We report a case of a 46-year-old woman, with a 10 year history of type I bipolar disorder and a microprolactinoma, who was admitted to a psychiatry inpatient unit due to a maniac episode. Current symptoms at the moment of admission included hyperthymia, verbiage, flight of ideas and insomnia. Menstrual changes and galactorrea had been present previously. Aripiprazole was introduced, reaching a dose of 30 mg/day, in addition to her usual treatment with lithium and gabapentin. Response to treatment was good and euthymia was reached within 10 days. Moreover, gabapentin was substituted by Valproic acid, and the patient was discharged once therapeutic levels were attained. Prolactin levels were measured at the moment of admission (128.75 ng/mL) and after 11 days of treatment (92.93 ng/mL).

Choosing an adequate antipsychotic agent can reduce the risk of iatrogenesis and thus enhance adherence to treatment and quality of life. Aripiprazole had previously shown a high potential at decreasing levels of prolactine. In this case, clinical practice supports scientific evidence.

Aripiprazole is an effective treatment for type I bipolar disorder. Especially, it can be a treatment of choice in patients suffering from symptoms related to high levels of prolactine, even using a high dosage.

The authors have not supplied their declaration of competing interest.

The bipolar disorder (BD) is a chronic and severe disease which diagnosis and treatment are still raising the issues.

To show a potential clinical and socio-demographic profile in BD patients.

We hypothesized that BD patients have a particular clinical and socio-demographic characteristics.

This was a descriptive and retrospective study which assesses 49 BD's outpatients. The diagnosis was accorded to DSM-IV criteria. The enrollment was conducted from January 2010 to August 2015. The socio-demographic and clinical data were collected by a preestablished railing.

The mean age was 39.7 years with a sex ratio of 1.33. Six patients (12.2%) lived in urban zones and 61% (n = 30) patients have a lowly socioeconomic conditions. Celibacy was the prevailing civil status in 57.1% (n = 28) among which 17 lived in family home. Thirty-four (69.4%) patients were unemployed.

A primary school level was found in 34.7% of the cases (n = 17). Nineteen patients (38.8%) were schooled until the secondary level and 9 patients (18.4%) followed a university program.

Addiction to smoking was found at 26 patients (53%) whose half of them had moreover an alcoholic poisoning. The mean age at the diagnosis was 35.6 years with an inaugural manic episode in 63.4% (n = 31) of the cases. The average number of relapse was 1.23 and the mean duration of follow-up was 3.2 years.

The knowledge of the profile of the consultants, their socio-demographic and clinical characteristics would allow to adapt the offer of care to the request.

The authors have not supplied their declaration of competing interest.

It has been suggested that the features of childhood ADHD are significantly associated with adult mood disorders. Some genetic factors may be common to both ADHD and mood disorders underlie the association between these two phenotypes. The present study aimed to determine whether a genetic role may be played by the serotonin transporter-linked polymorphic region (5-HTTLPR) in the childhood ADHD features of adult patients with mood disorders.

The present study included 232 patients with MDD, 154 patients with BPD, and 1288 normal controls. Childhood ADHD features were assessed with the Korean version of the Wender Utah Rating Scale. The total score and the scores of three factors (impulsivity, inattention, mood instability) from the WURS-K were analyzed to determine whether they were associated with the 5-HTTLPR genotype.

In the BPD II group, the 5-HTTLPR genotype was significantly associated with the total score (P = 0.029) and the impulsivity factor (P = 0.004) on the WURS-K. However, the inattention and mood instability factors were not associated with the 5-HTTLPR genotype, and the MDD and normal control groups did not exhibit any significant associations between the WURS-K scores and the 5-HTTLPR genotype.

The present findings suggest that the 5-HTTLPR genotype may play a role in the impulsivity component of childhood ADHD in patients with BPD II. Because of a small sample size and a single candidate gene, further studies investigating other candidate genes using a larger sample are warranted to more conclusively determine any common genetic links.

The author has not supplied his declaration of competing interest.