Assessment and management of bipolar disorder, and particularly manic episodes in adolescents means a challenge. The presence of comorbid disorders, and divergent interpretations of manic symptoms in the context of the adolescent natural inmaturity, can make diagnosis and treatment hard goals to achieve. The existence of juvenile specific criteria for bipolar disorder is a debate topic. This concept emerged from an attempt to solve diagnosis issues and involves a wide range of definitions for mania.

Literature review concerning bipolar disorder in young population: Main comorbidities, psychosocial problems, prognosis. Clinical presentation: Shared and specific features compared to adult population. Available treatment options. Issues related to safety and tolerability.

We present a case of a 16 year old woman diagnosed with bipolar II disorder, hospitalised in an inpatient adolescent unit in 2021. Review of the literature available (clinical guidelines, PubMed).

Patient initially oriented as a Bipolar II disorder, after depressive episodes followed by hypomanic symptoms in the past years. The following clinical course was conditioned by personality traits. Emotional disregulation and a complex family environment made affective symptoms difficult to evaluate, leading to a diagnostic hypothesis of personality-related disorder. After a period of outpatient treatment in a day hospital, she debuted with a clinical picture of manic symptoms, mixed features and rapid mood cycling.

After an initial trial, stabilization was achieved with aripiprazole and asenapine. Combination therapy might be necessary in longer-term treatment, according to existing evidence. Diagnosis and treatment concerns are interfered by the limited number of trials.

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Lurasidone is an atypical antipsychotic used in the treatment of schizophrenia and bipolar depression. Both indications are approved by the FDA nowadays, whereas in Europe it is only approved for schizophrenia. Lurasidone has been barely studied for the treatment of acute mania, nonetheless it is sometimes used off-label.

A case of a patient with a manic episode treated with lurasidone is presented, in order to provide further evidence on this topic.

The patient is a 43 year-old-woman with diagnosis of type I bipolar disorder, personality disorder and borderline intellectual functioning, resident in our Hospital’s long-stay psychiatric rehabilitation unit. She was previously under treatment with venlafaxine 75 mg/day, valproate 1500 mg/day and levomepromazine 25 mg on demand; remaining stable for months. The patient presented an episode consisting on agitation, irritability, verbiage, tachyphase, verbal aggressiveness and behavioral disturbances. Psysical restraint was needed for one day long and zuclopenthixol acetate 50 mg IM was administered twice within 5 days for the acute agitation. Venlafaxine was immediately withdrawn and lurasidone was progressively introduced up to 111 mg daily.

Approximately 3 weeks after the treatment adjustment, the patient reached the psychopatological stabilty.

Antidepressive withdrawal and introduction of Lurasidone were effective to treat the acute manic episode in this patient. It has been previosuly suggested that lurasidone caused improvement in emergent manic symptoms in patients with bipolar depression, and in subsyndromal hypomanic symptoms in patients with mixed features of depression. However, no studies have been made yet to evaluate the efficacy of lurasidone in acute mania.

I received financing from Angelini Pharma, Casen Recordati, Janssen, Exeltis and Otsuka.

In December 2019, infection with the novel coronavirus (SARS-CoV-2) was first reported in the city of Wuhan, China. Although generally recognized for its often fatal respiratory problems, other neuropsychiatric complications are receiving increasing attention.

We will try through a clinical case to explain the psychiatric disorders in the context of this infection, and to highlight the two main explanatory theories of psychiatric disorders, in relation with the SARS-Cov-2 infection.

We report here a case of SARS-CoV-2 infection in a 54-year-old female patient with no specific pathological history, including psychiatric, who presented a fever, anosmia, and asthenia in the absence of any respiratory signs. Her PCR came back positive and her chest CT scan was normal.The patient was treated with paracetamol with vitamin C,with good clinical improvement. She came 15 days later to the psychiatric emergency room with psychomotor excitement. The patient was motorically unstable, could not hold still, her mimicry was hypermobile, contact with her was familiar, she was logorrheic with flight of ideas,she verbalized multiple projects, her mood was euphoric and her sleep was disturbed. Her blood tests were unremarkable.

The diagnosis of manic episode was retained, and the patient was put on Olanzapine 10 mg, sodium Valproate 1g and Lorazepam 2.5 mg in degression with good clinical improvement.

Although the data in the literature remain scarce concerning the impact of this virus on mental health, we will try through this clinical case to explain the psychiatric disorders in the context of this viral epidemic, due to stress and inflammation.

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Few data exist to estimate the burden of manic episodes on healthcare systems or the therapeutic strategies used. This study was undertaken to identify treatment strategies chosen, and to assess the “real-world” direct medical cost of treating manic episodes necessitating hospitalisation.

Case record data were reviewed during the three months following hospitalisation for a manic episode in France. Healthcare resource utilisation was assessed, direct costs calculated, and treatment strategies analysed. A total of 137 patients files (51.8% female; mean age: 35 years) were reviewed and data on 185 hospitalisations collected.

The mean duration of hospitalisation was 47 days over the study period. The most common treatment strategy during hospitalisation was the combination of a mood stabiliser with a neuroleptic drug (64% of patients at day 30). Anticonvulsants including valproate (39%) and carbamazepine (20%) were more common than lithium (42%). Treatment received during hospitalisation was generally continued after discharge, with a trend away from neuroleptics and towards mood stabilisers. The mean direct costs incurred over the three-month study period was Euro 22 297, with 98.6% of those costs due to hospitalisation.

These results confirm that the costs of treating a manic episode are high, and overwhelmingly due to the cost of hospitalisation.

The relationship between depression and mania remains poorly understood and is responsible for much of the confusion about mixed states. The difficulty in conceptualizing opposite states such as euphoric and depressive moods during the same episode may account for the considerable differences in reported frequencies of mixed states, among acutely manic patients. It is possible that the fundamental mood characteristic of mania is not tonality of mood (e.g. euphoric, irritable or depressed mood), but rather the intensity of emotions.

We interviewed 30 patients hospitalized for a manic episode, asking about their symptoms during the episode, using the list of symptoms for manic and depressive episode of the DSM-IV criteria. Emotional hyper-reactivity, defined as an increase in the intensity of all emotions, was assessed using the Hardy Scale. Manic symptoms were also assessed by a clinician using the Beck–Rafaelsen Mania Scale.

This study showed that most of the manic episodes presented many dysphoric symptoms, more particularly depressive mood (33%), irritability (53%), anxiety (76%), and recurrent thoughts of death or suicidal ideation (33%). However, only 10% of our sample met the criteria for mixed state. The other symptoms reported by patients and included in the DSM-IV criteria for depressive mood are common between depressive and manic episodes. All patients (100%) reported that they felt all their emotions with an unusual intensity.

We suggest that the most appropriate way to define mood in manic states is as a function of intensity, and not as a function of tonality. This definition circumvents the arbitrary dichotomy between mania and mixed state. With this definition, manic episodes can be described as being more or less dysphoric, with the actual characteristics of dysphoria encompassing irritability, anxiety, or depressive affect. This point could be extremely helpful in discriminating mixed state or dysphoric mania from depression.

Leptomeningeal metastasis (LM) is a neurooncological complication of advanced cancer that has a poor prognosis. The incidence of LM is increasing due to advances in neuroimaging. At the same time, the development of new systemic treatments with poor central nervous system penetration has improved outcomes and survival. However, diagnosis of LM remains quite difficult due to clinical polymorphism, inconsistent imaging abnormalities, and the inconsistent presence of neoplastic cells in cerebrospinal fluid. Psychiatric manifestations can blur the neurological frame and confound management of this complication.

To illustrate these difficulties, we report the case of a patient with no past psychiatric history who presented with a manic episode that was attributed to a recurrence of leptomeningeal metastasis.

With this case report, we highlight the importance of referring the patient to a psychiatrist or a member of the psychooncology unit when new behavioral disorders present.

Leptomeningeal metastases can elicit psychiatric consequences. A hypothesis of this diagnosis should be considered for cancer patients who present with sudden or recent profound mental changes during the course of their disease. Oncologists and neurooncologists should be aware of this possibility. Collaboration with a psychooncologist is recommended to better manage this neuropsychiatric pathology.