Bipolar disorder and substance use disorder have well documented genetic component. Among Axis I disorder bipolar subjects have highest comorbidity for alcohol and substance use disorder, ranging from 17 to 60%. Some Authors find a familial association between bipolar disorder and substance use disorder, suggesting the question if these disorders share a common genetic liability.

To investigate familial loading in bipolar disorder (with and without alcohol/substance use disorder) and in patients with substance use disorder.

Sampe (62 patients with bipolar disorder and alcohol/substance use disorder-DD, 23 patients with bipolar disorder-BD, 22 patients with substance use disorder without mood disorder-SUD) was recruited in Psichiatric clinic of Pisa and Dependance Department of Pisa and Bolzano. Instruments: SCID-IV-I/P for Axis I diagnosis and Family History Screen (Weissman, 2000).

Bipolar pts (DD and BD) have higher familial diathesis for manic and depresive episodes respect DUS probands (p≤0.001). Moreover DD show higher familial loading for alcohol/substance use respect BD (p=0.000). Abuser subjects (DD and SUD) show higher familiarity for conduct disorder respect BD (p=0.008)

DD pts show a double familial loading, both for mood disorder (respect SUD), and for alcohol/substance use disorder (respect BD). Probably the familial loading for substance use disorder and mood disorder are distinct and they are both present in dual diagnosis patients.

The complex interrelationship between personality disorders and bipolar disorders is still a controversial aspect with multiple diagnosis, therapeutic and ethiologic implications.

Comorbidity has been defined as the presence of more than one disorder in the same patient at the same time.

We made a literature review between 1995 and 2005 about comorbidity in bipolar and personality disorders.

There are different studies that agree the theory that personality disorders are previous forms of bipolar disorders.

Besides, it is important to consider the effect that bipolar disorders have over personality.

In the last years, different authors have suggested that co-morbid personality disorders predict a worse evolution in the course of the bipolar disorders, finding recurrent and resistant to treatment affective symptoms.

The co-occurrence studies of personality and affective disorders have ranged from 3 to 70%.

If we take the global n (428) of all the reviewed articles, we see that the percentage of comorbidity between personality disorders and bipolar disorders is almost the 48% of the studied patients. Looking at the most prevalent cluster, cluster A is the 13%, cluster B is near the 39% and cluster C the 35%.

Personality traits, dimensions and personality disorders seem to play an important role in the evolution of bipolar disorders.

The identification of these specific personality traits and the knowledge of the influence in the evolution of the illness are extremely important in the treatment and prevention of bipolar disorders.

Depression is highly recurrent in Bipolar patients, causes more disability than other manifestations of the illness and depressive symptoms predominate over manic and hypomanic symptoms. Our aim is to describe whether in our sample we can find some specific differences from the early course of the illness.

33 patients meeting DSM-IV criteria of Bipolar Disorder I and II whose illness onset was less than 5 years from the first Manic/ hyponamic episode or/and less than 10years from the index depressive episode. Recorded variables included socio-demographic, clinical, treatment characteristics and scales (HRSD, YMRS, BPRS, GAF).Analysis was performed using SPSS Version 12.0.

57.6% were male, 42.4% female, mean age 34.42 years. 2 Patients (6.2%) were depressed when inclusion and 8.8% had had a depressive episode before were included in our Program.

The mean number of depressive episodes was 1.88 (SD 3.58). Only 1 patient had had self-harm intent. 15.2% has first degree family history of Unipolar depressive disorder and 20% of Bipolar disorder. 6.2% were hospitalized because a depressive episode.

We found less rates of depressive episodes than we found in the literature with less sub-syndromal and syndromal depressive symptoms than in routine bipolar population that could be explained by the short course of the illness in our sample. More research should be done to study bipolar depression in early phases to find predictors that help us to decrease the high impact it has in the disorder.

The Bipolar Functional Status Questionnaire (BFSQ) is a novel patient-reported instrument designed to assess day-to-day functioning among patients with bipolar disorder. The development and psychometric evaluation of the BFSQ are described.

Constructs of the BFSQ were identified through literature review, expert consultation, and patient interviews. Iterative sets of interviews with additional patients were conducted to inform item reduction and revisions. 596 patients completed the BFSQ and a series of other patient- and clinician-reported health assessments during a multi-site validation study. Participants included three patient groups: 148 patients who were hypomanic or recently recovered from a manic episode within the last month, 215 patients who were currently depressed or recently recovered from a dysthymic episode within the last month, and 233 patients whose mood had been stable for a minimum of 2 months. Test-retest was assessed in 187 stable patients using data from a second administration. Additional analysis evaluated the factor structure, internal consistency, reliability, and validity.

Exploratory and confirmatory factor analyses indicated that a one-factor structure best fit the data, providing support for a total score. Item-level descriptive statistics, Cronbach's alphas, and validity correlations all met standard criteria. Furthermore, the BFSQ demonstrated superior ability to discriminate among the three subgroups.

The BFSQ is a psychometrically sound measure of functional status among bipolar patients. Efforts are underway to gather evidence for its responsiveness. The ultimate goal is for the BFSQ to facilitate the identification of treatments, which maximize functional status and ultimately improve patient adherence to treatment.

We want to study comorbidity between substance abuse and bipolar disorder in patients who have been examined in psychiatric department as outpatients.

We examined 48 patients with bipolar disorder for two years and we investigated how many of the patients had the diagnosis of substance abuse. The diagnosis was according to DSM IV-TR diagnostic criteria. We used BPRS scale, Mini scale, GAF and self - report scale SF-36 Health Survey. Our patients were between 18 and 65 years old. They had done blood and urine tests.

Men were more often substance abusers than women but it seems that it starts to change in the younger populations. 22% of our bipolar patients were in a lifetime period substance abusers, especially alcohol and cannabis and more seldom cocaine and heroin. The results of pharmacological treatment were better in patients who weren't substance abusers.

Our findings are limited in a small population group. There is need to conduct further studies in which the patient's sample will be larger and the design of the studies will include more agents.

A Survey of changes in prescription patterns for Bipolar Disorder in a clinical setting and of coherence to therapy guidelines..

We collected data about demographic variables, diagnosis and discharge medication of all patients diagnosed with bipolar disorder admitted to the University Clinic for Psychiatry I, Salzburg, between January 2002 and October 2007.

679 bipolar patients (373 female / 306 male) with a total number of 3217 admissions to our hospital during an observational period of almost 6 years were included in the survey.

Since 2002, a substantial change of prescription patterns in bipolar patients has taken place, with a trend towards valproate and atypical antipsychotics and against lithium and typical antipsychotics. Modern antidepressants are routinely used in the treatment of bipolar depression. Combination strategies of two or more compounds are common. In general, adherence to treatment guidelines was high with the possible exception of very frequent use of antidepressants in bipolar depression.

The purpose of the present study was to examine the relationship between depression and hostility among teacher.

Participants were 531 teachers of education organization of Golestan province in Iran. The mean age of the participants was 37.49 years (SD = 5.58) and ages ranged from 21 to 50 years old. There were 215 men and 316 women. Measures: All participants completed a questionnaire booklet containing one self- report measures: The Symptom Checklist-90-R (SCL-90-R).

The results of the present study demonstrate that: 1) Correlation between depression and teacher's hostility is meaningful and positive (r = 0.714, p<0.001).

The present study revealed that a more depression is associated with a high level of self-reported hostility.

There is limited published data from long-term pediatric bipolar clinical trials with which to guide appropriate treatment decisions. Long-term efficacy and safety of aripiprazole was investigated in this patient population.

296 youths, ages 10-17 year-old with a DSM-IV diagnosis of bipolar I disorder were randomized to receive either placebo or aripiprazole (10mg or 30mg) in a 4-week double-blind trial. Completers continued assigned treatments for an additional 26 weeks (double-blind). Efficacy endpoints included mean change from baseline to week 4 and week 30 on the Young Mania Rating Scale; Children's Global Assessment Scale, Clinical Global Impressions-Bipolar version severity scale, General Behavior Inventory, Attention Deficit Hyperactivity Disorders Rating Scale, and time to discontinuation. Tolerability/safety assessments included incidence and severity of AEs, blood chemistries and metabolic parameters.

Over the 30-week course of double-blind treatment, aripiprazole (10 mg and 30 mg) was superior to placebo as early as week 1 (p< 0.002) and at all scheduled visits from week 2 through week 30 on mean change from baseline in the Y-MRS total score (p<.0001; all visits). Significant improvements were observed on multiple endpoints including the CGAS, GBI, CGI-BP, ADHD-RS-IV total score, time to discontinuation, and response and remission rates. The 3 most common AEs were somnolence, extrapyramidal disorder, and fatigue. Mean change in body weight z-scores over 30 weeks was not clinically significant.

Over 30-weeks of treatment, both doses of aripiprazole were superior to placebo in the long term treatment of pediatric bipolar patients. Aripiprazole was generally well tolerated.

The underlying genetic heterogeneity in Bipolar Disorder (BD) has led to the search of potential markers associated with subtypes of the disorder; as such, age at onset (AAO) could be considered as a factor that defines more genetically homogeneous subgroups.

To analyze the modal distribution of a BD population according to the AAO of the disorder, as well as the clinical characteristics related to the distribution findings.

357 patients with a BD diagnosis were included in the study. AAO was defined as the age when the patient first met DSM-IV criteria for a major mood episode. Using an admixture analysis, patients were distributed among different parameters; and parametric analyses were conducted in order to compare the demographic and clinical characteristics between groups.

The model that best fit the observed distribution was a mixture of three Gaussian distributions (mean ± SD): 17±3.7 years, 26±8.8 years, and 35.5±12.54 years. Statistically significant differences were found with respect to social status, course of illness, suicidal behavior, rapid cycling, medical co-morbidities and lithium response (p<0.05).

Our results support the existence of a tri-modal distribution in BD defined by AAO, each one with different clinical characteristics; and suggest that early-onset and late-onset BD reflect an underlying genetic heterogeneity in bipolar disorder, being early-onset BD implicitly a more serious subtype of disorder.

To test the prognostic value of suicidal status in depressed patients for responses to antidepressant treatment.

We evaluated treatment response and covariates in depressed patients diagnosed with DSM-IV major depressive (n=50) or bipolar disorders (n=32) treated initially in a day-hospital for 2 weeks, followed by 4 weeks of outpatient treatment with antidepressants, with or without a mood-stabilizer. Being suicidal was based on an item-3 of the 17-item Hamilton Depression Rating Scale (HDRS17) scored at ≥3 and verified by baseline clinical assessment; morbidity and improvement were based on the total of the remaining 16 nonsuicidal items (HDRS16).

Suicidal (n=31) and nonsuicidal subjects (n=51) were similar in baseline ratings of depressive symptom-severity (HDRS16), but were depressed longer and less likely to be married. Suicidality ratings improved by 36% during 6 weeks of treatment among initially suicidal patients, but other depressive symptoms (HDRS16) improved (13%) only half as much as in nonsuicidal subjects (25%), independent of diagnosis and treatment. Fewer than half as many suicidal subjects showed ≥20% improvement in HDRS16 scores.

Findings, based on diagnostically complex and relatively treatment-resistant subjects, may not generalize.

Being suicidal may limit response to treatment in depressed major affective disorder patients, independent of diagnosis or overall symptomatic severity.

Within a decade, the Repetitive Transcranial Magnetic Stimulation (rTMS) was being used to treat depression and schizophrenia. Antidepressant response has been reported in open and double-blind, sham-controlled studies of depression. Less is known about rTMS efficacy in the obsessive compulsive disorder.

The aim of the randomized, double-blind, sham controlled study was to compare the 2 and 4 week efficacy of the 10 sessions rTMS with sham rTMS in serotonin reuptake inhibitor resistant OCD patient. Thirty seven right-handed patients were randomly assigned to either active rTMS or to sham. Active rTMS with the frequency of 1 Hz at 110% of motor threshold was administered over the left dorso-lateral prefrontal cortex. The same time schedule was used for sham administration. Thirty three patients finished the study, three patients’ dropped out at the beginning. Psychopathology was assessed by CGI, HAMA, Y-BOCS and BAI before the treatment, immediately after the experimental treatment, and 2 weeks after by an independent reviewer.

Both groups improved during the study period but the treatment effect did not differ between them in any of the instruments.

Low frequency rTMS administered over the left dorso-lateral prefrontal cortex during 10 daily sessions did not differ from sham rTMS in facilitating the effect of serotonin reuptake inhibitors in OCD patients.

Supported by the project n. MŠMT ČR 1M0517

Bipolar spectrum disorders often go unrecognised and undiagnosed. One of the underlying reasons is the poor recognition of bipolar disorder among patients presenting depressive episodes. Our goal was to estimate the MDQ rate of positive screens for bipolar disorder in a Spanish sample of outpatients with a current major depressive episode and compare it with their psychiatric diagnosis.

971 consecutively outpatients with a current DSM-IV TR diagnosis of major depressive episode were included. Study measures included socio-demographic and clinical data, Clinical Global Impressions–Severity of Illness Scale (CGI-S), Hamilton Depression Scale (HAMD) and MDQ.

905 patients fulfilled criteria to be included in the analysis. All suffered a current depressive episode. 74.3% (n= 671) of the patients had received previously a diagnosis of unipolar depression and 25.7% (n= 232) of bipolar disorder by a psychiatrist. Using a MDQ of 7-or-more-item threshold, the global positive screen rate for bipolar disorder was 41,3% (n=373). From the 671 patients with previous unipolar depression diagnosis, 161 (24%) screened positive for bipolar disorder with MDQ, whereas in 232 patients diagnosed of bipolar disorder, 212 (91.4%) screened positive.

MDQ showed a positive screen rate for bipolar disorder in 24% of patients with a previous diagnosis of unipolar disorder and a current depressive episode. Screening tools like MDQ could contribute to increased detection of bipolar disorder in patients with depression. Early diagnosis of bipolar disorder may have, therefore, important clinical and therapeutic implications in order to improve the illness course and the long-term functional prognosis.

The study aimed to evaluate if and how online self-help forums are used by patients with bipolar affective disorders, their relatives and by professionals.

2400 postings in two German language forums for patients with bipolar affective disorders, their relatives and professionals were qualitatively and quantitatively analysed. Interrater-reliability was 0,84 (Cohen's Kappa). Chi-squared tests with Bonferroni correction were performed and exploratory factor analyses were conducted.

94% of all postings were written by patients, 4% were written by relatives, and 2% by professionals. “Disclosure” (44% of all postings), “friendship” (23%), “online-group cohesion” (22%), “empathy and support” (18%), and “provision of information” (15%) were the main self-help mechanisms. The topics most discussed were the “social network” of the patients (27%), the “symptoms of the illness” (22%), “medication” (14%), “professionals” (12%), and “diagnoses” (11%). The item “provision of information” was significantly more often named by professionals (chi(2)=32,30; p<0,001), whereas the item “gratitude” was significantly more often named by relatives (chi(2)=34,91; p<0,001). Factor analysis revealed three factors according to self-help mechanisms: “group cohesion”, “emotional support”, and “exchange of information”. Also according to fields of interest factor analysis yielded three factors: “illness related aspects”, “social aspects”, and “financial and legal issues”.

We infer that the main interest in participating in online forums for patients with bipolar affective disorders and their relatives is to share emotions. Our study also reveals that the social network is very important for patients coping with bipolar affective disorders. Psychoeducative programmes should focus on those aspects.

Depakine crono presents an immediate, longer absorption, with maximum plasmatic concentrations less high than the classic one. It allows a minor number of doses and a better therapeutic fulfillment.

To identify the characteristics and the patients profile treated with depakine crono in a unit of hospitalization. Patients had the diagnosis of bipolar or schizoaffective disorder and they were followed out of the hospital. We stand out the clinical improvement, level of satisfaction, adherence, fulfilment and quality of life obtained.

Patients with a descompensation of their affective disorder admitted in a Acute Unite were studied (N=30). They all needed depakine crono for their stabilization.The information has been obtained by a interview, applying a specific protocol with demographic and clinical data, exploring the reasons and satisfaction with the medication. Four clinical scales were used: DAI, the Scale of Disability of the OMS, EEAG and ICG for the Bipolar Disorder.

The profile showed an 32-48-year-old, married woman, with primary studies who lived in family environment, with a maniac episode, with a development of the disease of more than 20 year. The age of the first episode was of 21 years, with somatic and personality disorders and abuse of substances.

The clinical impression in the admission is serious. The average dose needed of depakine crono was 1.000 mg/día, with a good efficiency in the most of patients. The personal and labour functionality improve from the beginning of the treatment. The level of therapeutic fulfillment is satisfactory.