To compare eGFR values of patients on long term lithium compared to controls matched for age, sex and confounding comorbidities

Patients with bipolar affective disorder, who are on lithium (for at least a year), were compared against controls matched (1:1) for age, gender and presence or absence of diabetes and hypertension. The eGFR was calculated according to the modification of diet in renal disease study formula. A meta-analysis was performed to compare our findings with similar studies in literature.

Forty seven patients met the inclusion criteria. They were matched with 47 controls. The eGFR values of lithium users were significantly low (p = 0.04) compared to controls and the mean decline in eGFR was -2.7 ml/min/1.73m2(SD ± 9.8) per year. The significant difference in eGFR persisted between the subgroup without comorbidities (diabetes and hypertension) and their controls but disappeared for subgroup with comorbidities and their controls. Nevertheless, lithium users had a lower eGFR in both subgroups. A meta-analysis of 9 studies showed a significant lowering in the glomerular filtration rate in lithium users compared to controls [mean difference -10.3 ml/min (95% confidence interval: -15.13 to -5.55, p < 0.0001).

Lithium causes a subtle decline in glomerular filtration rate and renal functions need to be monitored in lithium using patients.

Bipolar disorder impacts negatively on the patient, the family as well as the society. It taxes the health care services due to a combination of the illness and associated medical as well as psychiatric comorbidities. Unfortunately, in Africa knowledge of the epidemiology and burden of bipolar disorders is based mainly on data from the United States and Europe.

To highlight the epidemiological, clinical, and economic burden of bipolar disorder in Africa.

A systematic review of publications from Africa relating to the burden of bipolar disorder was conducted, including studies on epidemiology, patient-related issues and costs.

Data from community surveys conducted in Nigeria and Ethiopia indicated a lifetime prevalence of 0.1% to 0.6% for bipolar disorder. A study from Egypt showed a misdiagnosis rate of up to 36.2%. In one study, 8.1% of the males and 5.4% of the females reported a previous suicide attempt, while another study showed that up to 60% of patients with bipolar disorder had at least one comorbidity. There were no reports on mortality and cost of illness.

Despite the heterogeneous methodologies, samples and dearth of adequate representative evidence from Africa, we have identified bipolar disorder as a major mental health issue. There still exists a dearth of evidence regarding the epidemiological, clinical, social, and economic burden of the disorder in Africa.

To describe the prevelance of life events as precipitants of manic episodes in patients with bipolar affective disorder.

A descriptive cross sectional study. Fifty three inward patients with mania were selected by simple random sampling method during the study period of one month. The data was obtained through an interviewer administered questionnaire and Holmes and Rahe Stress scale.

Thirty two (60.3%) of the study subjects were females and the mean age was 35.8 years (range 18-62). Bipolar affective disorder current episode mania with psychotic symptoms was the diagnosis in 52.8% (n=28). Thirty one patients (58.5%) had experienced life events in the month preceding the onset of manic episode. Eight (25.8%) of the life events were above 50 life change units of Holmes and Rahe Stress Scale. The most commonly occurring life events were marital separation (n=5, 16.1%), trouble with in laws (n=5, 16.1%) and change in living conditions (n=4, 12.9%). The other precipitant identified was defaulted treatment which was present in 43.3% (n=23), while 3.7% (n=2) share the combination of treatment default and life events.

This study reveals that life events have played an important role in precipitating manic episodes in patients with Bipolar Affective disorder.

Depersonalization (DP) and derealization (DR) may be detected both in healthy and pathological conditions, but the prevalence and clinical correlates of dissociative symptoms in bipolar disorder have received limited attention in literature (1). The aim of this study is to discuss new treatment possibilities of derealization and depersonalization in bipolar disorder.

We describe three different case reports of bipolar disorder patients with depersonalization and derealization. Case 1: M.P., 26 years old, lamotrigine (100 mg) augmentation with ziprasidone (40 mg); Case 2: C.A., 32 years old, lamotrigine (100 mg) augmentation with quetiapine ER (150 mg); Case 3: M.M., 38 years old, lamotrigine (100 mg) augmentation with aripiprazole (5 mg).

The addition of aripiprazole, quetiapine and ziprasidone in RP lamotrigine lead to a resolution of dissociative symptoms, most likely due to stimulation of serotonin. It is possible that partial agonism at the 5-HT1A receptor has been postulated as a potential therapeutic mechanism in the alleviation of depression, anxiety, negative symptoms, and extrapyramidal side effects [3] and the blockade of postsynaptic 5-HT1Areceptors may impart complementary anxiolytic properties, facilitate cortical and hippocampal glutamatergic [3,4]. Further research is warranted to replicate our clinical observations and, in general terms, controlled studies are needed to confirm the efficacy of this treatment.

It is necessary to explore the possibilities of brief intervention of smoking cessation in bipolar disorder (BD) that may act on the level of motivation for change.

Assess the effectiveness of the 3 A's intervention (Ask, Advise and Assess) in a sample of euthymic BD patients.

260 patients diagnosed with BD that were in the euthymic phase and attended the Community care centers of Spain that have been evaluated for their history of smoking habits and current use.

Patients who consumed in the last month qualified for the level of motivation for change (measured by URICA scale); before and after conducting a brief intervention of no more than 30 minutes in total, divided in three contacts during a month, two face to face and one phone contact.

The 49% of the evaluated patients showed an actual use of cigarettes with an average of 28.73 (SD 11.82) years of consumption, with a mean consumption of 21.00 (SD 10.40) cigarettes per day and a level of nicotine dependency of 5.72 (SD 3.03). The 67% of patients were in the Contemplation stage of change, after the intervention 18% progressed to the stage of motivation and 14% ended up in the Stage of Ready for Change. In the third appointment the 21.4% of the smokers reported a reduction of the consumption.

The results seem to confirm its effectiveness, although it should be considered the possibility of carrying out specific tools of brief intervention for this sort of patients.

Health practitioners are familiar with the challenge of linking academic knowledge to naturalistic treatment settings. For years unexplained and unacceptable variations of practice have plagued service delivery. The National Institute for Health and Care Excellence (NICE) set to address this situation by providing guidance on effective interventions. However the actual uptake of NICE standards remains poor (Variations in Health Care The good, the bad and the inexplicable, the King's Fund 2011).

Cheshire and Wirral Partnership NHS Foundation Trust (CWP) resolved on the use of clinical pathways integrated to the patient electronic system to promote and measure evidence based practice. NICE standards on Bipolar Disorder (www.nice.org.uk/cg038) were integrated to this assistive technology. The differential concordance to the NICE audit criteria was measured between two similar community teams, one using the Bipolar electronic Integrated Care Pathway (eICP) and the other providing treatment as usual (TAU). Outcome measures were taken in 2010 and repeated in 2014.

The average concordance with NICE standards is markedly higher for the team using the eICP, as measured in the baseline audit in 2010 and replicated in the re-audit in 2014.

The Bipolar eICP delivers reliable concordance to evidence based standards of good practice and facilitates the audit process. The outcomes have been consistent over time. It has proven to be flexible as used by various practitioners as well as being a vector of education. The Bipolar eICP stands as a low cost alternative to specialist teams in the effective management of Bipolar Disorder.

In the last years, there has been increased concerning about cardiometabolic morbidity and mortality in bipolar patients.

To review the literature about prevalence, risk factors and treatment of cardiometabolic diseases in patients with bipolar disorder.

Searches were undertaken in PubMed and other databases, from 2009 to 2014, using keywords ‘bipolar disorder', ‘cardiometabolic', ‘riskfactors', ‘treatment'.

Several studies have shown that diabetes, obesity, dyslipidemia and hypertension are more prevalent among patients with bipolar disorder than in the general population, and that they are under-diagnosed andunder-treated in these patients. Their higher risk is related to several factors, including medications (e.g. second generation of antipsychotics) and changes in hypothalamic-pituitary-adrenal axis and inflammatory pathways. The mechanisms underlying these alterations are the focus for new treatments. Recent interventions in these population integrates psychiatric and medical care.

Availabe data support the high prevalence of cardiometabolic diseases in bipolar patients. New and future interventions to reduce cardiovascular risks are very important concerns of psychiatric and medical approaches.

Food craving (FC) has been linked todepressive mood before. However, no study exists evaluating FC in a sample of bipolar disorder (BD).

This study aimed to determine the prevalence of FC in individuals with BD during euthymia.

Fifty individuals with a BD diagnosis according to the DSM-IV guidelines were drawn from the dedicated outpatient center of the University Clinic of Psychiatry Graz. Data were compared with data from a healthy control sample (HC, n=50). All probands took part in the BIPFAT study exploring shared pathophysiological pathways of obesity and brain function in BD. Participants completed a comprehensive diagnostic battery (including the Food Craving Questionnaire by White et al. 2002) measuring anamnestic, anthropometric, and clinical data. We performed a MANCOVA controlling for key covariates including gender, age, body mass index, smoking, mood stabilizing medication, and lipid levels.

BD patients exhibited significantly more total food craving (F=6.10, p=.016) and more sweets craving than controls (F=6.38, p=.014). Additionally, levels of fat craving were higher by trend in the male patient group than in the male control group (F=3.15, p=.087).

A higher prevalence of FC in BD patients than in controls suggests that FC may be of clinical importance in BD. Potentially, FC plays a role in the development of obesity, a well-known risk factor for unfavorable course of illness in BD. Furthermore, the impact of dysfunctions in the serotonergic system and/or an altered activation of the hypothalamic-pituitary-adrenal axis in relationship to increased FC are critically discussed.

Psychoeducational family intervention (PFI) has been proposed to supplement pharmacotherapy in order to improve the clinical outcome of people with bipolar I disorder. Only a few studies have been carried out on the efficacy of PFI on patients' social functioning and on relatives' burden.

to improve patients' social functioning and to reduce the level of family burden in relatives of people with bipolar I disorder.

to improve clinical outcome and social functioning of patients with bipolar I disorder, and to reduce family burden, in those receiving the experimental intervention compared with treatment as usual (TAU) group.

A multicentre, real-world, randomized, controlled, outpatient trial was carried out in 11 Italian mental health centres. Enrolled patients and key-relatives were consecutively allocated either to receive PFI and TAU or to a waiting list receiving TAU alone.

70 families were allocated to the experimental group and 67 to the control group. At the end of the intervention, a significant improvement in patients' clinical status and social functioning was found in the experimental group compared to TAU, as well as a significant reduction in the levels of relatives' subjective and objective burden. The effect of the intervention remained significant also after controlling for several confounding patient's socio-demographic and clinical factors.

PFI is effective in improving the clinical and social outcomes of patients with bipolar I disorder and of their relatives.

Bipolar disorder affects many psychosocial and functional aspects, leading to real social handicap and an alteration in quality of life.

Our purpose was to evaluate the bipolar patient's quality of life.

It is a cross-sectional study which lasted for four months. It included 104 patients with bipolar I disorder according to the DSM-IV-TR criteria and followed at the psychiatry consultation of the university hospital in Mahdia. Quality of life was measured using the SF-36 (Short form) generic scale. A global average score was calculated and we considered that quality of life was altered if the score was less than 66.7, according to the threshold value of Léan.

The assessment of quality of life revealed a global average score of 52.2 and an alteration in 78,8% of patients. The study of the dimensional average scores revealed that all dimensions were affected excepting the one exploring the physical activity (D1) with a score of 75,6. The standardization also revealed deterioration in all the dimensions, with the mental component particularly more affected than the physical component with respectively estimated scores of 31.7 and 40.5.

This clinimetric approach permitted us to consider the whole life of each patient suffering from bipolar disorder, rather than just the angle of their illness

Cerebral white matter lesions (WML) have been found in normal aging, vascular disease and several neuropsychiatric conditions. Correlations of volumetric measured WML with clinical parameters in men with Bipolar Disorder (BD) have been described in a currently submitted work of our study group. As we try to elucidate common pathways between obesity/metabolic syndrome and BD we reinvestgated our data in the context of obesity.

In a cross-sectional study 100 euthymic individuals (52 male, 48 female) with BD were enrolled to undergo brain magnetic resonance imaging using 3T including a FLAIR sequence for volumetric assessment of WML-load using FSL-software. Additionally, clinical characteristics and psychometric measures including Structured Clinical Interview according to DSM-IV were evaluated. Partial correlation analysis (WML-load with lifetime number of manic/depressive episodes) were performed in 4 different groups (male normalweight, male overweight/obese, female normalweight, female overweight/obese)

In overweight/obese men only (n=41), the number of manic/hypomanic episodes (r=0.85; p<0.001) as well as depressive episodes (r=0.55; p<0.001) correlated positively with WML-load.

WML-load strongly correlated with the number of manic episodes in overweight male BD patients, suggesting that overweight men might be more vulnerable to mania in the context of cerebral white matter changes.

Bipolar Disorder is a devastating disease with a genetic heritability. An orchestra of around 500 gene variants is leading to vulnerability.

One interesting candidate gene group are the socalled CLOCK GENES. The molecular 24h clock has several CLOCK GENES and the last gene ARNTL encodes for an activator of MAOA transcription and leads therefore to changes in neurotransmitter levels.

Genotyping of 150 paricipants with Bipolar Disorder and 78 healthy controls with the Illumina GWAS chip Omniexpress 1.1. Hypothesis driven extraction of ARNTL SNPs with the software PLINK. Statistical analysis with Chi square test with SPSS.

Patients with Bipolar Disorder differ significantly in ARNTL genotypes compared to healthy controls. Details are presented during the poster session.

Circadian rhythms seem to play an important pathogenetic mechanism in Bipolar Disorder.

Bipolar disorder is characterized by depressive and manic episodes, each with its own specific outcomes. To guarantee the best therapy it is important and necessary to assess the episodes of the disease and its exact degree of severity at an early stage.

During a time period of 12 weeks, 9 patients suffering from bipolar disorder were provided with a commercially available smartphone in order to collect behavioral patterns by the phone's internal sensors. These sensors included acceleration, GPS-traces, phone-call behavior and sound. During the trial the patients were also asked to fill out a daily self-assessment questionnaire that included a self-rating. Additionally, to gain ground truth psychological state examinations were performed every three weeks.

The sensor traces are very similar to the diagnosed scores and thus clearly provide an accurate representation of the patient's state. Further, our data suggest a strong empirical evidence that the sensor based data are, on average, a more reliable and objective way of monitoring the mental state and mood than the patient's self-assessment.

The MONARCA system introduces new opportunities for the treatment of patients with bipolar disorder. The acquired data allow for identifying changes in the patient's condition at an early stage and therefore support the timely intervention by psychiatrists.

Treatment adherence is important to enable the effectiveness of maintenance treatment for bipolar disease, which is an episodic disorder.

To determine clinical and sociodemographic factors related to the treatment adherence.

Firstly, 117 patients and their relatives were interviewed via telephone. Morisky Medication Adherence Scale-4 and McEvoy Treatment Observation Form were applied after 12 months from the discharge. Secondly, a face to face interview was conducted with 86 of 117 patients and Medication Adherence Rating Scale (MARS), Mood Stabilizer Compliance Questionnaire (MSCQ), Drug Attitude Inventory-10 (DAI-10), Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Beliefs Toward Mental Illness Scale (BMI), The Schedule for the Assessment of Insight (SAI), Bipolar Disorder Functioning Questionnare (BDFQ) and UKU Side Effect Rating Scale (UKU) were applied. Patients were divided into low, medium, and high compliant groups.

In the group with low adherence, it was found that BDFQ, SAI and DAI-10 scores were lower and existence of psychiatric comorbidity, living alone, preserved autonomy in dosing of mood stabilizers dimension of MSCQ, YMRS score, galactorrhea and ejaculatory dysfunction, number of hospitalization, longer duration of illness were higher. Female gender, lower scores at incurability subscale of BMI, cognitive dimension of BDFQ and SAI score, existence of psychiatric comorbidity, higher scores at preserved autonomy in dosing of mood stabilizers dimension of MSCQ’s, were found as risk factors in prediction model of non-adherence performed with regression analysis.

Treatment adherence is associated with many factors that should be considered carefully during a treatment management.

The Bipolar Disorder (BD) is underdiagnosed condition worldwide. In Russia BD-II is mostly diagnosed as recurrent depressive disorder (RDD), and most cases of mania or depression with psychotic symptoms (so-called affective-delusional states) have diagnosis of schizophrenia.

To evaluate BD symptoms within the cohorts of inpatients with primary diagnoses of schizophrenia or RDD.

Patients with primary diagnosis of schizophrenia, schizoaffective disorder RDD were included. Bipolarity Index (BI) was the primary variable. Mini International Neuropsychiatric Interview (MINI) was used as a diagnostic tool. Personal and Social Performance Scale (PSP), Hypomania Checklist (HCL-32), Angst criteria for bipolarity were used for evaluation. Medical history, demographic and clinical data were analyzed.

From 741 patients included in the study, only 12% of them reached diagnostic validity for BD using only BI (score ≥60). Using MINI and clinical data the diagnosis was revised to BD in 286 patients (38.6%). BD-I was diagnosed mostly in patients with former diagnosis of acute schizophrenia, BD-II was diagnosed exclusively in patients with former diagnosis of RDD. Mean PSP score in patients with BD was significantly higher (61.5±17.4 score) than in patients with the diagnosis of psychotic syndrome (39.3±16.2) and closer to that one in patients with RDD (63.0±16.8).

In our study BI has not shown to be proper screening instrument for bipolar spectrum disorders. BD is underdiagnosed in Russia.

ClinicalTrials.gov Identifier: NCT01028196.

Supported by funding from AstraZeneca Pharmaceuticals.

Resilience enables people to develop and regain mental health in the face of adversity, and is related to recovery. There are no current measures of resilience for Bipolar Disorder (BD).

To develop and validate a BD specific resilience measure, and examine relationships between resilience and recovery-related variables.

(1) Describe the development and psychometric evaluation of the Spanish 23-item Resilience to Bipolar Disorder (RBD) questionnaire. (2) Test relationships between RBD scores and recovery-related variables in BD.

The 41-item RBD questionnaire (developed based on prior qualitative research) was completed by 113 participants with BD, along with measures related to quality of life, functioning and recovery. Exploratory Factor Analysis (EFA) using Principal Axis Factoring with promax rotation was conducted to identify redundant items and underlying factors. Reliability and Confirmatory Factor Analysis (CFA) for the resulting factorial structure were assessed.

EFA identified 23RBD items suitable for retention, structured within five factors. Cronbach αs were all satisfactory (all αs ≥ .76) at both subscale and total score level. Convergent validity was supported through positive correlations between RBDand the Resilience Scale-25. Additionally, the RBD correlated significantlywith quality of life, well-being, personal recovery, functional impairment and symptoms. CFA fit indexes supported the five factor structure of the RBD scale.

TheRBD is a reliable and valid measure of resilience in BD, being associated with measures related to quality of life, functioning and recovery, which is consistent with previous research in resilience and mental health in other psychiatric populations.

Stigma is a serious concern for people with bipolar disorder (PBD). It may have critical yet insidious repercussions on the course of the illness and may represent a barrier to recovery.

To determine the influence of social stigma and internalized stigma on residual affective symptoms, treatment adherence, global functioning and metacognitive functioning in a population of euthymic PBD.

A Cross-sectional study was conducted on 32 outpatients with bipolar disorder I (BDI). Residual affective symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HRSD). Social stigma and internalized stigma were evaluated using the Discrimination and Stigma Scale (DISC). The Medication Adherence Rating Scale (MARS), the Global Assessment of Functioning (GAF) and the Metacognition Assessment Interview (MAI) were also used.

Higher rates of social stigma were correlated with poorer global functioning (p=0.029) and poorer adherence to medication (p=0.022). However, higher social stigma correlated with better metacognitive capacities (p=0.0001, r=-0.61); good metacognition may lead to a better perception of social stigma. Self stigma was significantly correlated to residual depressive symptoms (p=0.0001) and to poorer global functioning (p=0.018) and poorer adherence to treatment (p=0.002). Better metacognitive capacities were also correlated with the ability to overcome stigma.

Social stigma and self stigma may have negative impact on several aspects of the BD that are essential to the outcome such as medical adherence, functioning and residual symptoms. Targeting stigma may help PBD achieve recovery.

The belief that specific stages of the lunar cycle are related to human biology or behaviour has been present in popular culture since antiquity. Based on folklore or on clinical experience, several studies investigating possible links between the lunar cycle and mental illness were performed, with controversial results. To date, according to our knowledge, no study has yet considered a possible variability of the relationship with the seasons.

Our study aims to explore the relationship between the lunar cycle and acute manic states in bipolar patients, including a differentiation by seasons.

We designed an exploratory study, retrospectively analysing admissions of manic episodes over the period 2007/2013. Admission dates and dates of last symptomatic worsening were separated into seasons and then distributed into one of four quarters of the moon's synodic cycle. The last symptomatic worsening dates were obtained using information from admission notes, being considered whenever mentioned accurately and within no more than one week of admission.

Concerning the Autumn/Winter (n=221), we found a statistically significant disparity in the distribution of cases by lunar quarters in the admission dates of manic episodes (p=0.038), especially in episodes with psychotic symptoms (n=196; p=0.018), and in the last symptomatic worsening of manic episodes (n=60; p<0.001). No statistical significance was found during the Spring/Summer.

The lunar cycle appears to be strongly associated with acute manic states in bipolar patients, but the association seems determined by the season. Further studies are needed to corroborate or refute these results.