Bipolar disorder (BP) and schizophrenia (SCZ) are severe, heritable psychiatric disorders. Genome-wide research suggests that the molecular basis of BP and SCZ overlap (Cross Disorder PGC Group, Lancet, 2013).

of our work was to investigate whether poligenic scores based on SCZ-associated SNPs in the PGC sample (www.med.unc.edu/pgc/) might predict the age of onset (AO) in BP-I. We hypothesized that the SCZ associated SNPs might predict the late AO of BP-I due to the common character of the SCZ-associated variants.

We selected 10,681 non-ambigous SNPs among the 102,637 SNPs present in the PGC SCZ-sample. Using these SNPs we derived poligenic scores in a Romanian sample of 243 BP-I patients with genome-wide data (604,064 SNPs) to predict the patient AO as dichotomous variable (early onset: AO≤24 years; late onset: AO>24 years). The genotyping of the Romanian patients was performed at the Institute of Human Genetics of Bonn. PLINK 1.07 (Purcell, 2009) was used for computing polygenic scores, means of which were compared by t-test between the early- and the late-AO patient groups.

2114 out of 10, 681 SCZ-SNPs were informative in our sample contributing to polygenic scores in BP-I patients. There was no significant difference in mean polygenic scores between the early- and the late-onset group of BP-I patients (t=1.14, P=0.25).

The polygenic scores based on 2114 SCZ-associated common variants did not predict the onset group in our BP-I patients under the AO-cutoff 24 years. Other AO-cutoffs and phenotypic traits (e.g. incongruent psychosis) might be tested.

(Hypo)mania is a known consequence of antidepressants in type I, type II and type III bipolar disorder. This conceptualization often induces the generalized belief that only the introduction of the antidepressant induces the mood switch.

Report the occurence of an understudied therapeutic event with unknown mechanism and associations. Promote clinical attention and further investigation.

Case report of a patient who developed a hypomanic switch upon venlafaxine discontinuation; bibliographic search using PubMed/MedLine database with the following keywords: bipolar; mania; hypomania; venlafaxine; antidepressant; discontinuation.

We report and discuss the case of a 48-year-old woman with previous history of a recurrent depression. The patient was successfully treated with Venlafaxine (300mg/day), Pregabalin (300mg/day) and Clonazepam (0.5mg/day) completing the acute and continuation phases of the treatment. She was then discharged with the indication to maintain treatment for her maintenance phase. After a couple of months the patient initiated slow Venlafaxine discontinuation after which she developed a clinical picture characterized by talkativeness, persistently elevated mood, increased goal-directed activity and unreasonable expenses lasting for an unspecified number of weeks and subsequent severe depressive episode without psychotic symptoms. The patient was again referred to our consultation and medicated with Venlafaxine (300mg/day) and Valproic acid (1000mg/day) remaining depressed and treatment resistant to this day.

Studies show that antidepressant-withdrawal (hypo)mania is a known but rarely reported leading to its unawareness an consequent unknown true incidence. Two hypothetical models may explain this clinical entity: Withdrawal-induced cholinergic overdrive; and Noradrenergic hyperactivity.

Asenapine is a second-generation antipsychotic approved in Europe for the treatment of moderate to severe manic episodes in adults affected by Bipolar Disorder I (BD I).

We aimed to assess the efficacy of asenapine in controlling manic, mixed and/or depressive symptoms in an inpatient psychiatric population.

A total of 119 voluntarily hospitalised patients with DSM-IV-TR BD I diagnosis received flexible asenapine doses ranging 5 to 20 mg/day. Patients were assessed with clinician-rated questionnaires, i.e., Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Global Assessment of Functioning (GAF). Assessment was carried-out at baseline (T0, prior to treatment), and three (T1), seven (T2), 15 (T3), and 30 days (T4) after starting treatment for all clinical scales and at T0 and T4 for the GAF.

Patients improved on all scales (p<.001) across time-points, as shown both by paired-sample comparisons and by applying a repeated-measures, generalized linear model (GLM). Substance abuse was associated with greater reductions in anxious-depressive scores. Side effects were few and not severe.

Asenapine showed effectiveness and safety in a hospitalised bipolar I population. Its effect was greater in the presence of substance abuse.

Cognitive emotion regulation refers to the way the individual responds to emotionally arousing information.

Identifying differences in cognitive emotion regulation of remitted bipolar (after a depressive episode), remitted unipolar patients and a healthy control group.

This study was conducted in Timisoara, Romania, between 2009 and 2013 and consists of outpatients from the Timisoara Psychiatric Clinic and the Timisoara Mental Health Center, diagnosed with either bipolar disorder (n=27) or recurrent depressive disorder (n=32), according to ICD-10 criteria and a healthy control group (n=70). For assessing cognitive emotional regulation we used the Cognitive Emotional Regulation Questionnaire (CERQ), which comprises of five positive and four negative emotional response strategies (subscales).

Statistically significant differences (p<0.001) between the patient groups and the control group were found in the following subscales: 'self-blame”, 'rumination”, 'catastrophizing”, 'blaming others” (negative emotional response strategies – higher mean scores than the control group), 'positive refocusing” and 'putting into perspective” (positive emotional response strategies – lower mean scores than the control group). When comparing the two patient groups, we found statistically significant differences in the following subscales: 'self-blame” (higher mean scores for unipolar subjects), 'blaming others” (higher mean scores for bipolar subjects), 'positive refocusing” (higher mean scores for unipolar subjects) and 'putting into perspective” (higher mean scores for bipolar subjects).

Cognitive emotional regulation strategies used by unipolar and bipolar patients seem to differ significantly and may be an insight to the medium and long-term outcome, thus potentially guiding therapeutic strategies.

Dysfunction of the hypothalamus-pituitary-thyroid axis has been shown to play a role in the pathophysiology of bipolar disorder. Autoimmune thyroiditis is the most common cause of thyroid function alteration. Thus, auto-immune thyroiditis is likely associated with bipolar disorder. It might influence its course, prognosis and/or management.

To study the prevalence of positive anti-thyroid antibodies in patients with bipolar disorder and to examine the prognostic and the therapeutic implications of their presence.

Literature was reviewed using the Medline database and the following keywords: ‘bipolar disorder” ‘antithyroid antibodies” ‘thyroiditis”.

PubMed research returned 12 results. After manual inspection, 10 articles were retained and examined.

The prevalence of positive antithyroperoxydase antibodies (anti-TPO Abs) is higher in bipolar patients than in healthy controls, reaching 27%. The presence of positive anti-TPO Abs has been associated with rapid-cycling, with a higher risk of lithium-induced hypothyroidism as well as with poor prognosis.

Auto-immune thyroiditis appears to be related not only to bipolar disorder itself but also to the genetic vulnerability to develop the disorder.

The presence of anti-TPO Abs is a possible endophenotype for bipolar disorder. Anti-TPO Abs should be obtained in many patients with bipolar disorder, especially in those on lithium.

Thisstudy was to assess the prevalence and its correlates of restless legs syndrome(RLS) in outpatients with bipolar disorder.

A total of 100clinical stabilized bipolar outpatients were examined. The presence of RLS andits severity were assessed using the International Restless Legs Sydrome StudyGroup (IRLSSG) diagnostic criteria. Beck's Depression Inventory (BDI), Spielberg's StateAnxiety Inventory (STAI-X-1), Pittsburgh Sleep Quality Index (PSQI), Koreanversion Drug Attitude Inventory (KDAI-10), Subjective Well-Beings under NeurolepticTreatment Scale-Short Form(SWN-K) and Barnes Akathisia Rating Scale (BARS) wereused to evaluate the depressive symptomatology, level of anxiety, subjectivequality of sleep, subjective feeling of well-being, drug attitude, presence ofakathisia, respectively.

Of the 100 bipolar outpatients,7 (7%) were met to full criteria of IRLSSG and 36 (36%) have at least one ofthe 4 IRLSSG criterion. Because of relatively small sample size, non-parametricanalysis were done to compare the characteristics among 3 groups (full-RLS, 1≥positiveRLS-symptom and Non-RLS). There were no significant differences in sex, age, and other sociodemographic and clinical data among 3 groups. BDI, STAI-X-1 andPSQI are tended to be impaired in RLS and 1≥positive RLS-symptomgroups.

This is the first preliminarystudy for studying the prevalence and its correlates of RLS in bipolardisorder. The results shows that RLS was relatively smaller presentin bipolar disorder than schizophrenia. Sametendencies shown in schizophrenic patients were found that bipolar patientswith RLS had more depressive symptoms, state anxiety and poor subjective sleepquality.

Presentation of a case report.

This case is about a 32-year-old woman with a history of type 1 diabetes, coeliac disease, and hypothyroidism, followed since the age of 22 for a type 1 bipolar disorder. She was admitted in psychiatric care for psychomotor instability, irritability, logorrhea, aggressiveness, subtotal insomnia, and delirious ideas of greatness, all treatment having been stopped for about twenty days, with besides a diabetic ketoses and non-adherence to a gluten-free diet. We have retained the diagnosis of mania with mood-congruent psychotic features within a type 1 bipolar disorder. Psychiatric treatment was instituted, based on mood stabilizers and atypical antipsychotics, with an equilibration of diabetes, reinstitution of a gluten-free diet, and adjustment of the thyroid hormones therapy. This was followed, within 15 days, by a good stabilization of her condition, both psychiatrically and somatically.

It is well established that psychiatric disorders can exist in some autoimmune diseases. The imputability of the bipolar disorder to the autoimmune polyendocrinopathy remains possible. Further studies are necessary to elucidate the aetiopathological mechanisms.

There have been many changes in the treatment of bipolar disorder.

It is necessary to develop guidelines that can more aptly respond to cultural issues and specifics in different countries.

The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) was firstly published in 2002, with updates in 2006 and 2010. This third update reviewed the experts' consensus of opinion on the pharmacological treatments of bipolar disorder.

The newly revised questionnaire composed of 55 key questions about clinical situations including 223 sub-items was sent to the experts.

Combination of mood stabilizer (MS) and atypical antipsychotic (AAP) was the first-line treatment option in acute mania. For the management of severe psychotic bipolar depression, combination of MS and AAP, combination of AAP and LTG, combination of MS, AAP and AD or LTG, combination of AAP and AD, and combination of AAP, AD and LTG was the first-line treatments. Combination of MS and AAP was the treatment of choice for management of mixed features. Combination of MS and AAP, MS or AAP monotherapy was the first-line options for management of maintenance phase after manic episode. For maintenance treatment after bipolar I depression, combination of MS and AAP, combination of MS and LTG, combination of AAP and LTG, MS or LTG monotherapy, and combination of MS, AAP and LTG were the first-line options.

Despite the limitations of expert consensus guideline, KMAP-BP 2014 may reflect the current patterns of clinical practice and recent researches.

The aim of this study was to monitor changes of prescription trends for bipolar disorder in inpatient settings in one university hospital.

A retrospective chart review was performed and data of 188 cases (2009–2012) and 118 cases (1998–2001) with a diagnosis of bipolar disorder were collected. Data on demographic variables, duration of hospitalization, kinds of psychotropic medications and the patterns of prescription over each four-year period were analyzed.

The proportion of patients with manic episode was decreased, whereas those of mixed and depressive episodes were increased. The use of lithium was decreased with the increased use of valproate. Increased use of lamotrigine in depressive episode was prominent. The use of combination treatment with mood stabilizers and antipsychotics was almost same level in both periods. The use of typical antipsychotics was significantly decreased and that of atypical antipsychotics was increased. Especially, the use of quetiapine showed great increase. In bipolar depression, the use of antidepressant was increased.

Data showed that quetiapine monotherapy had favorable effect on acute manic symptoms and well tolerated. Also this result suggests that quetiapine monotherapy may improve the self-perceived quality of sleep without any daytime impairment following sleep in acute manic patients.

The chronic dysphoric irritable state is a common consequence, but not very known, of the long-term antidepressants prescription for bipolar patients.

of our study was to illustrate this clinical entity, through the study of a clinical case.

Our study focused on the case of Mrs LA, 36 years old and with a history of a major depressive episode treated with tricyclic antidepressant. The evolution when taking antidepressant, was marked by a persistent irritability, dysphoric mood and sleep disorders.

These symptoms have been attributed to a personality disorder after eliminating organic causes. Increasing antidepressant doses induced to an exacerbation of the characterological symptomatology. A mood stabilizer was added in combination with low doses of antidepressants, but without finding premorbid functioning. After stopping a treatment of five months, Mrs. LA, showed an acute manic episode requiring hospitalization. Thus the diagnosis was of bipolar disorder type I. The long-term evolution when taking mood stabilizer alone was marked by the disappearance of characterological disorder and return to premorbid functioning.

Taking antidepressants in the case of bipolar individuals may induce a turning to mania, mixed episodes, rapid cycling or a the chronic dysphoric irritable state, recently described in the literature.

One year affective symptom status rating with BP-II for 40 patients were based on interviews conducted at one month interval in prospective follow up. The clinical pictures, the number of shifts and the polarity were examined.

In these 1 years follow up the patients with BP-II were szmptomatic 56.1 % of months: depressive 61.2 % of months, manic 9.5 % of months and mixed 6.3 %. Subsyndromal (minor) depressive states and hzpomanic syndromes were evaluated in 33 % of months.

According to this results, our older results and many other clinical observations in literature, it is obligatory to introduce the new clinical/nosological category in current clinical praxis and in new classifications with name TRIPOLAR AFFECTIVE DISORDERS.

We evaluated, in patients admitted to our day-hospitalpsychodinamically-oriented treatment program, the impact of mixed featurestreatment on compliance and on clinicaloutcome.

We have included a small sample of patients withbipolar disorder based on DSM V, aged between 18 and 65. Patients are assessedby BPRS and M.I.N.I. in to analyze theimpact of different antipsychotics on specific symptomatology cluster, focusingon mixed features, and CGI and VGF toevaluate working and social functioning. Changes from baseline to 12-weeks intotal score and in partial score for symptomatology clusters was considered.

Asenapine improved mixed features (ANOVA, p<0,05). Moreover is associated with a lower rate of metabolic syndrome compared toother antipsychotics. The improvement of mixed symptoms and the decrease ofmetabolic syndrome incidence enhance treatment adherence.

Our treatment model, where converge psychiatrics, psychologists, physicians andrehabilitation operators, allows a drugchoice focused on symptoms assisting psychotherapeutic play and an early noticeof side effects, advancing towards recovery. Asenapine, in the treatment ofmixed features, enhances the efficacy of the program in bipolar patients.

Mixed states have had growing importance since Kraeplin. They have long contributed to the concept of bipolar disorder. They are frequent, occurring in 1/3 of all bipolar episodes. Many severe psychotic mixed states are still misdiagnosed and mistreated as schizophrenia. Because they have such complex presentations, they represent a challenge to diagnosis and treatment.

The authors' aims are to report a mixed episode; to describe its fast improvement only when lithium was introduced and to compare this result with the evidence in current guidelines.

A patient clinical file was analyzed. Literature research was performed. Relevant chosen papers were selected.

Women. 33. Actress. Gradual depressive simptoms, after broke up with her boyfriend the month before. She became suspicious, showing persecutory ideias. She was thin, unable to sleep, her house was disorganized. On admisson she was agitated, her eyes sad, her face almost inexpressive, her speech disconected. She showed great instability: she seemed depressive, then loughed inexpectedly, suddendly became coprolalic. She was diagnosed borderline personality before. She has positive psychiatric family history (mother, psychotic depression). After valproate, bupropion and olanzapine her humor and judgment improved but she kept an unstable behaviour. Lithium´s introdution enabled a fast, sharp recovery and organized behaviour.

Despite the prevalence of mixed states, research into the eficacy of treatments is limited. Current guidelines lack specific treatment recommendations and are sometimes inaccurate. Further studies are needed to complete our knowledge´s gap in the treatment of mixed states.

With about 12 million people, Roma constitute the largest ethnic minority group in the EU. Children from Roma communities are much more likely to be out of school than their peers from majority communities, with a strong impact in global mental health status.

This paper reports the findings of an integrative review conducted to analyze recent empirical and theoretical literature on the factors of school absenteeism in Roma Children.

A comprehensive multi-step search (published 2004–2014) using databases such as SciELOand search engine such as B-on and EBSCO-host was performed. A sample of 8 final research reports met the inclusion criteria and was included in the review. A systematic and interactive approach was used to extract and reduce the data to draw conclusions.

The integrative literature review shows that there are three major groups of factors related to school absenteeism in Roma children – factors related to the children, factors related 8 to the school organization and factors related to the Roma families. These factors exist at the individual, community and institutional levels and are largely consistent with conceptual and empirical framework on mental health vulnerabilities factor’s

A pediatric-psychiatric liaison programs have evolved to enable the staff pediatricians to assume adequate training to assess emotional, behavioral, and family problems that may be an integral part of the patient's symptoms.

The aim of the current study is to assess prevalence of psychiatric symptoms among physically ill children aging from six to eighteen attending pediatric out-patient clinic in Beni Suef University Hospital.

A random sample of 300 Egyptian diseased children with acute and chronic illness aged between 6 and 18 years, fulfilling inclusion and exclusion criteria participated in this study along eight months duration starting from May 2011 to December 2011. All subjects of the study were subjected to screening test for the patients or their informants using 'The Child Behavior Checklist (CBCL) for ages 6–18” and IQ was assessed for all sharing patients using &Stanford-Binet Intelligence Scale.”

170 (%56.7) of the 300 selected patients were females and 130 (%43.3) were males, 260 of them attended regular schools. Out of the total number of patients 155 (51.67%) presented with acute illness, while 145 (48.33%) had chronic illnesses. Mean IQ score was (79.8± 15.2) and only 67 (22.3%) of the sample had an 'average” IQ. Gender based comparison of IQ results revealed that female patients had significantly higher IQ scores (82.2±13.6 with p=0.035).

The current status of psychiatric problems in pediatric physically ill patients assures the mandatory cooperation in pediatric consultation-liaison (C-L) services in Beni Suef Governorate.