The substance use is common among people with a diagnosis of bipolar disorder. In addition, alcoholism and bipolar disorder coexist with a high frequency. This association is higher in men than in women, and this consumption is the factor that most strongly influences the hospitalization.

To analyze the clinical, epidemiological, diagnostic approach and evolution of bipolar disorder and alcoholism.

Review of the subject on recent articles of alcoholism in bipolar disorder.

The stages of mania associated with alcohol consumption up to 40% of cases and are more common at this stage that in depressive. This association is greater than that which occurs between alcoholism and schizophrenia or depression. Patients with bipolar disorder who have mixed and irritative states and those with rapid cycling have a prevalence of alcohol consumption and substance use higher than those who do not use substances. It has also been observed that the consumption of alcohol and substance use can change the symptoms of mania and turn them into a mixed state symptoms. It also states that rapid cycles can be precipitated by increased alcohol consumption during rotation from mania to depression.

The association of bipolar disorder with addictive behaviors is a factor that worsens the prognosis and comorbid alcohol itself is associated with a poor prognosis. Close monitoring of bipolar patients and especially in those who consume alcohol is very important.

The authors have not supplied their declaration of competing interest.

Risky sexual behaviors are typically seen in patients with bipolar disorder, especially during the manic phases.

Disinhibition, impulsivity and risk taking expose these patients to unplanned pregnancies and sexually transmitted infections.

However, there is a lack of studies regarding these behaviors in stabilized bipolar patients during euthymia.

The objective of this study was to look for a risky sexual behavior by evaluating sexual knowledge and sexual behavior of patients with bipolar disorder in the euthymic phase.

We conducted a descriptive cross-sectional study including 30 patients diagnosed with bipolar disorder I or II (DSM-IV).

Data were obtained through a semi-structured interview evaluating the following: sexually transmitted infections, condom use, multiple sexual partners, sex under the influence of drugs or alcohol, and prostitution.

The Young Mania Scale and the Hamilton Depression Scale were used for clinical assessment.

The preliminary results suggest a lack of knowledge leading to a tendency to risky sexual behavior in both male and female, married and unmarried patients.

Patients with bipolar disorder are exposed to risky and unsafe sex because of the clinical features of their disease and associated comorbidities.

Prevention and awareness of sexual risks are unavoidable in the management of these patients.

The author has not supplied his declaration of competing interest.

Bipolar disorder (BD) is associated with high morbidity and mortality. Patients are symptomatic almost half of their lives and experience significant disability. One subtype of BD is associated with a more chronic course, refractoriness to treatment and poor outcome. Diabetes mellitus type 2 (T2D) and insulin resistance (IR) have been identified as risk factors for this more severe form of BD.

We investigated the rates of IR and T2D in patients with BD and whether this comorbidity is associated with specific clinical features of BD such as rapid cycling or treatment resistance.

IR and T2D were screened in patients with BD types I or II, who were on stable treatment with mood stabilizers. The response to treatment was assessed by means of the Alda scale.

In a preliminary sample, we made a new diagnosis of IR in 40% of patients. The 1% of this sample had a diagnosis of T2D. The treatment response was worse in BD patients with comorbid IR or T2D as compared to those without metabolic abnormalities.

These findings show that IR and T2D have high prevalence in BD patients and have negative impact on treatment response.

The authors have not supplied their declaration of competing interest.

Systemic lupus erythematosus (SLE) is a multisystem disease with a broad spectrum of clinical features and neuropsychiatric manifestations that occur in up to 60% of patients. Disease activity and treatment with corticosteroids may contribute to this higher risk. It is also known that 36% of patients with SLE and comorbid Bipolar Disorder (BD) have had their psychiatric onset after they had been diagnosed with SLE.

Single case report.

A 51-year-old woman received a diagnosis of SLE 24 months before the beginning of depressive symptoms. After her diagnosis of SLE, seven years ago, she had three suicide attempts, being diagnosed with major depressive disorder. From them on, she had crises characterized by well-defined periods of 7 to 10 days with sadness, reduced need for sleep, social isolation, irritability, anger outbursts, impulsivity, racing thoughts and suicidal ideation. After treatment with mood stabilizers (quetiapine 300 mg/day and lithium 600 mg/day), she had a substantial reduction of symptoms intensity and frequency.

The link between immune dysregulation, autoimmunity and bipolar disorder may be closer than previously thought. Even if the autoimmune disease is not directly etiologically related to the psychiatric presentation, its detection is important due to the high morbidity and mortality, considering the current understanding that Bipolar Disease is strongly related with inflammation in central nervous system.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The National Institute for Health and Care Excellence (NICE) sets standards of clinical practice in the UK. An extensive update on guidance regarding bipolar disorder was released in September 2014. Practitioners face the challenge of translating this guidance into practice. NICE suggests that interventions might be better delivered by bipolar specialist clinics. Updated NICE standards were integrated into a Bipolar Clinical Effective Practice Screen (BICEPS), allowing existing community psychiatric teams to deliver these revised clinical standards in bipolar care.

To assess the effectiveness of the BICEPS in delivering interventions aligned with NICE clinical standards.

Three psychiatric community teams were audited; two teams (1 and 2) used the BICEPS to support their interventions whilst a third team provided management as usual. Team 1 was previously familiarized with the concept.

Table 1.

The teams using BICEPS show better concordance to NICE standards. Superior outcomes by the team previously acquainted with the concept suggest longer-term benefits and adaptability. Using BICEPS may offer a cheaper alternative to developing specialist clinics.

The authors have not supplied their declaration of competing interest.

Children of patients with bipolar disorder are at increased risk of developing psychopathology and psychosocial difficulties.

To understand the emotional experiences of adult children of mothers with bipolar disorder.

Qualitative study, using in-depth semi-directed interviews with open-ended questions, sample closed by saturation information criteria, content analysis, discussion under psychodynamic concepts.

From interviewees’ reports, it can be seen that offspring's experiences emotional vulnerability, such as directions given by early exposure to self injurious behaviour, psychiatric hospitalizations, routine absences from home and consequent perception of helplessness, especially in periods of the mother's crisis. The findings suggest that for the children the insecurity to assume the precociously inverted responsibility regarding the need of care to mother seems to experience by them as an entrapment to the care of the mother, for the effort they make to keep them alive, with an emotional burden due to both impaired childhood and adolescent.

It was analyzed the assumption that the evolution of reactive psychological stages regarding the mother affected by a mental illness marked by bipolarity manifestations, alternating with phases of the normality of psychic manifestations, would follow the evolution of the oscillating psychological stages of his/her own mother, which minimizes often both the disease and the treatment during the phases of remission of manifestations.

The authors have not supplied their declaration of competing interest.

Fertility and fecundity are usually considered signs of social and emotional well-being. Bipolar disorder (BD) is a prevalent psychiatric disease that influences the individual's life style and behaviours. Some studies have addressed the issue of fecundity among women with bipolar disorder but few have focused on determining the differences between disease subtypes, which is expected, taking into account the studied differences in demographic measures.

To examine the fecundity of a population of women with bipolar disorder.

The aim of this study is to compare the fecundity among women diagnosed with subtypes I to IV of BD, according to Akiskal's bipolar spectrum disorder classification.

A total of 108 female outpatients were divided into four groups. We analyzed number of offspring and demographic features between patients with different subtypes of BD using multivariate analyses.

Our results showed a significantly higher average number of children for BD IV patients when compared with BD I patients. Although not reaching statistical significance, BD I patients had less offspring than BD II and BD III patients. BD I patients had lower marriage rates compared to the other groups.

Our results suggest that the subtype of bipolar disorder influences fecundity and behaviours, as is expressed by the lower number of marriages seen in BD I patients. We found that fecundity is significantly impaired among BD I patients, which may imply that female with more severe disorders are less likely to become parents. Fecundity is higher among BD IV patients, which makes a way to speculate about the adaptive role of hyperthimic temperamental traits.

The authors have not supplied their declaration of competing interest.

The symptoms and behavior of children with ADHD impose demands and difficulties on part of their caring parents, which may cause the latter group to suffer psychological stress.

The study of the suffering and symptomatic expression of psychological stress in parents of children with ADHD.

To study type and severity of symptoms in children with ADHD and the effect of that on the stress response of their parents.

Thirty-seven children with ADHD diagnosed clinically and with Conner's Test were studied using Child Behavior Chick List (CBCL). Available parents for each child were interviewed and studied with Symptom Chick List 90 Revised (SCL90R). Two control groups were used for both ADHD children and their parents.

The mean age of the children with ADHD was 7.1 ± 1.6, they were 22 males and 15 females. Parents of these children scored highly on total and subscales of SCL90R, they were significantly higher than their control group on total and some of these subscales including somatization, interpersonal, depression, paranoid ideation and hostility domains. Depression and paranoid ideation of ADHD children parents were positively and significantly correlated with most of the sub-items of Conner's test of their children. In addition, somatization, depression and hostility of parents were positively and significantly correlated with most of the sub-items of CBCL of their ADHD children.

The symptoms, behavior and severity of illness of children with ADHD have a great impact on their parents’ psychological state of suffering and stress.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Institutionalized children and adolescents who reside in foster centres are a subgroup of population that use mental health resources. This group of population has an increased risk of physical and psychopathology health problems. That translates into a greater number of emergency visits. This is the same perception presented by different professionals.

The aim of the study is to analyse visits to emergency child and adolescent psychiatry service from a pediatric hospital. Also ask for a point of view of the professionals about it.

We select all the patients attended the emergency psychiatry child and adolescent care that were institutionalized. The sample was collected for 4 months in a pediatric hospital.

n = 66 (51.5% male; mean age 14.09 ± 1.95 years old), 31.8% was the first time at the emergency room, 31.8% had consulted between 2–4 times and 36.4% over 4 times. The main reason for consultation was aggressiveness (66.7%). The three main discharge diagnoses were conduct disorder (50%), adjustment disorder (25.7%) and TDAH (7.5%) The 45.5% had a history of drug use and the 24.2% of self-harm. Asking professionals 80% responded perception of increased emergency consultations and the 90% think inadequate value between 50–70% of queries.

The boys institutionalized perform a high use of paediatric and psychiatric emergencies. There are a significant number of re-consultations. Professionals have the perception that their emergency visits are increasing. Since patients are at high risk of suffering mental disorders and high use of emergency would be interesting to develop specific protocols for emergency care for these groups.

The authors have not supplied their declaration of competing interest.

The quality of adult–infant attachment plays an essential role in influencing the children's well-being (Groh et al., 2012). Disruptive Behavior Disorders (DBD) has been found as particularly influenced by the presence of unavailability in the parental caregiving. It is widely attested that parents’ attachment states of mind predict the attachment patterns of their children. Nonetheless, the investigation of the attachment organization during the middle childhood shows inconsistent data. Moreover, a paucity of studies focused on the role of father's attachment in this period still remains.

This pilot study investigates the attachment patterns of children with DBD and those of their parents.

The aims are to verify the presence of: (1) an over-representation of Disorganized attachment in these children; (2) an over-representation of Irresolution with respect to abuse or loss in one or both their parents.

The sample consists of 33 subjects: n = 11 children with DBD and n = 22 parents. The children completed the Child Attachment Interview (Shmueli-Goetz et al., 2000) and the parents completed the Adult Attachment Interview (George et al., 1985).

Findings showed: (1) a significant presence of Disorganized attachment with respect to both parents in the children; (2) an over-representation of Insecure states of mind in their parents; (3) a more significant presence of Disorganization in the fathers than in the mothers.

This focus on the topic of intergenerational transmission of attachment in a specific clinical sample enriches the research, underlining the more pronounced role of fathers’ attachment configuration.

The authors have not supplied their declaration of competing interest.

Emotion regulation (ER) is defined as the processes through which emotional awareness and experience are monitored, evaluated, maintained, and modified (Thompson, 1994). Difficulties with these processes have been proposed to increase risk for psychopathology. Disruptive behavior disorders (DBD) and somatic symptoms disorders (SSD) are characterized by an inability to express and modulate emotional states. Research aims to understand how ER influences mental health.

We focus on two strategy of ER: Cognitive Reappraisal, involves changing the way one thinks about a situation in order to change its emotional impact; Expressive Suppression involves suppressing or hiding external expressions of emotion from others (John and Gross, 2004)

We assess ER in order to examine the relation with SSD and DBD in childhood and with their parents.

The sample consists of 188 subjects divided in four groups: n = 41 children with DBD (M = 10.78 years, SD = 2.11); n = 50 parents (36 mothers and 14 fathers) of children with DBD; n = 44 children with SSD (M = 11.98 years, SD = 2.04); n = 53 parents (40 mothers and 11 fathers) of children with SSD. Were administered the ERQ (Balzarotti et al., 2010) for parents and ERQ-CA (Gullone and Taffe, 2012) for children.

DBD children reported higher levels of Suppression than SSD subjects; high levels of Suppression were reported in mother SSD and in father DBD.

This study extended previous research in childhood, including both mothers and fathers. The findings contribute to a greater understanding of the development of ER, which has important implications for psychological wellbeing.

The authors have not supplied their declaration of competing interest.

Cognitive deficits (executive functions, verbal and spatial learning and memory, visual processing and attention) are a fundamental trait of schizophrenia.

The main objective of this study is to compare the cognitive functioning in psychotic adolescents at the psychosis onset and after one year, using psychological tests.

This is a longitudinal study, during a period of two years and a half. Twenty-eight patients with first psychotic episode agreed to participate to this study and were assessed during their hospitalization in a university clinic for child and adolescent psychiatry in Cluj-Napoca, Romania. The diagnosis was based on DSM-IV criteria. All the patients were initially assessed for intelligence level using Raven Test and those with mental retardation were excluded. After one year, sixteen adolescents from the initial group were reassessed. The cognitive functioning was assessed with Trail Making A and B, verbal fluency tasks, Wisconsin Card Sorting Test and Rey Auditory Verbal Learning Test. The results from patients group were compared with those from healthy controls.

The results show weaker global cognitive performance from adolescents with early onset psychosis, initially and at one-year evaluation, than the healthy adolescents from the control group.

This results are consistent with those of previous studies. The adolescents with early onset psychosis show multiple cognitive impairments initially and one year after the psychosis onset.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Attention-deficit-hyperactivity-disorder (ADHD) is the most frequent psychiatric disorder present in childhood, and sleep-problems are a prominent, pervasive and clinically important feature of ADHD. Our understanding of whether sleep-problems mimic or exacerbate daytime ADHD-symptom expression remains insufficient. Furthermore we lack knowledge about the connection between objective measuring and subjective observations in children with early symptoms of ADHD.

Future research that examines sleep-problems and daily activity in very young children with and without ADHD-like symptoms might help us identify early risk factors and achieve a better understanding of the importance of sleep in ADHD.

To investigate if sleep-problems and activity level during day time is associated with early signs of ADHD.

A sample of 50 preschool children ages 2–3 and their parents recruited in a birth cohort are invited to participate and divided into two groups of 25 cases and 25 controls based on ADHD-symptom score. An actigraph on the child's non-dominant wrist measures sleep and daily activity. Sleep-latency, total sleep time and awakenings are examined. Moderate-to-vigorous-activity (MVPA) is the measure for daily activity. Subjective observations from parents are provided through questionnaires. Furthermore we examine the stability of the sleep problem score from child behavior checklist, which parents fulfilled when their child was 27 months old and again at the age of 5.

The results will be presented at the EPA March 2016 in Madrid.

Results from this study together with other findings of risk factors in the cohort may lead to a preschool ADHD risk-index, which can guide future early intervention.

The authors have not supplied their declaration of competing interest.