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The Polish standard of treatment with racemic ketamine for patients with depressive disorders was developed by a Working Group appointed by the National Consultant in the field of psychiatry. Despite the wide range of available medications, as many as one-third of depressed patients do not respond to standard antidepressant treatment, raising the need for an ongoing search for new effective and safe therapies. In recent years, the possible role of overactivity of the glutamatergic system in the etiopathogenesis of depression has again attracted the attention of many experts. The possibility of using substances with a modulating effect on the glutamatergic system in the treatment of depressive disorders has been postulated, among others, the long-known anesthetic ketamine, which is a noncompetitive NMDA receptor antagonist. This paper summarizes the results of studies on the efficacy and safety of racemic ketamine (administered intravenously) in the treatment of patients with depressive symptoms in the course of both unipolar and bipolar affective disorder, and, meeting the expectations of many practicing psychiatrists wishing to broaden the range of therapies offered to their patients, presents recommendations on indications, contraindications, precautions and the treatment regimen itself with intravenous ketamine for patients with mood disorders. [ABSTRACT FROM AUTHOR]

Copyright of Family Upbringing / Wychowanie w Rodzinie is the property of Family Upbringing Editorial Board / Redakcja czasopisma Wychowanie w Rodzinie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

L-theanine is an amino-acid found in green tea (Camellia sinensis), a beverage consumed by people all around the world. Its chemical structure is similar to L-glutamic acid. L-theanine acts as an antagonist of AMPA and kainate receptors as well as partial co-agonist of the NMDA receptors. The application may be associated with several health benefits, such as improvements in cognition, reduction of stress and anxiety-like symptoms. Although the dosage of L-theanine in green tea, which is around 20 mg per tea, is not very likely to have meaningful impact on mental health, supplementation of doses 200-400 mg/day has shown some promising advantages. Despite some evidence towards beneficial impact of L-theanine on mental health, longer-term and larger cohort clinical studies are required in order to justify its application for patients suffering from such diseases as anxiety, depression, bipolar disorder, schizophrenia and sleep disorders. What is more, it is more possible to act as a therapy augmentation in particular cases, rather than conventional therapy replacement.

Introduction: Lithium is one of the longest used drugs in psychiatry and is currently a mainstay in the long-term prophylaxis of bipolar disorder, preventing recurrent manic and depressive episodes. It also remains an important drug in the treatment of acute episodes of mania and depression. Out of the normothymic drugs, lithium has the greatest effect in preventing suicidal behavior. It also exhibits antiviral activity and in recent years evidence has also accumulated of the drug's neuroprotective properties. Aim of the study: The aim was to collect and analyze publications on the use of lithium in affective disorders, dementia and viral diseases, as well as its effect on reducing suicidal tendencies. Materials and Methods: The literature available in the PubMed database was reviewed, using the key words: "lithium"; "bipolar disorder"; "mania", "depression"; "suicidal risk", "side effects". Results: Chronic use of lithium in patients with bipolar disorder has an effect on preventing recurrence of manic and depressive episodes and can successfully last for 40 years or longer. Studies support the theory that long-term lithium pharmacotherapy has a significant impact on preventing suicidal tendencies among patients with affective disorders. In recent years, the antiviral and neuroprotective properties of the drug have also become known. Despite the rather high risk of overdose, as well as the occurrence of numerous side effects, lithium is still very often used in the treatment of affective disorders due to its high efficacy. Conclusions: Lithium has been one of the mainstays of psychopharmacology for several decades and is a precursor to mood-stabilizing drugs. In recent years evidence has also been collected for its potential use in non-psychiatric conditions. Conducting further research on lithium will certainly allow for wider use of the drug and a more thorough understanding of its mechanism of action.

Lithium is a drug of choice as a mood-stabilizer for the maintenance treatment of bipolar disorder (BD). The prophylactic efficacy of lithium can be determined by genetic factors, partially related to a predisposition to bipolar disorder. In the field of psychiatric genetics, the first decade of the 21st century was dominated by the "candidate gene" research. In this paper, the studies on candidate genes associated with lithium prophylaxis performed at the Poznan University of Medical Sciences in 2005-2018 are presented. During this time, the polymorphisms of multiple genes have been investigated, many of which are also associated with a predisposition to bipolar disorder. The associations with lithium prophylactic efficacy were found for the polymorphisms in 5HTT, ACP1, ARNTL, BDNF, COMT, DRD1, FKBP5, FYN, GLCC, NR3C1, and TIM genes, but not those in 5HT2A, 5HT2C, DRD2, DRD3, DRD4, GRIN2B, GSK-3P, MMP-9, and NTRK2 genes. The polymorphism of the GSK-3P gene was found to be associated with the kidney side-effects occurring during lithium therapy. Possible roles for these genes in both the mechanism of lithium prophylactic efficacy and pathogenesis of bipolar disorder were discussed. [ABSTRACT FROM AUTHOR]

Introduction and objective: The purpose of this paper is to systematically review articles and new research in the context of bipolar geriatric patients. Materials and methods: PubMed searches were completed using the key terms bipolar disorder, bipolar elderly, bipolar depression, bipolar elderly treatment and review articles. In addition, references in these resources were searched. Search dates: 2010 to 2022. Description of the state of knowledge: Mental disorders in the context of the elderly concern all depressive disorders. A problem with other disorders such as bipolar disorder is also increasingly recognized. In the elderly, it is quite rare in the general cross-section of society, but it may have a higher percentage, e.g. in nursing homes and care institutions. This review article shows both the difference and the similarities in the course of this disease in older and younger patients. The most important and common aspect for both age groups is psychotherapy with parallel pharmacological treatment. The greatest difficulty in pharmacotherapy in the elderly is polypharmacy and numerous drug interactions, as well as different pharmacodynamics and pharmacokinetics of the drugs used compared to younger patients. Attention should also be paid to the differentiation of bipolar disorder from different types of dementia and other cognitive disorders. Therefore, one should strive to carefully assess the patient's need for a given treatment, establish appropriate periodic monitoring of treatment, and assess the risk of taking or not intervening. This article also aims to review new research and drugs that seem promising, while the individualized and interdisciplinary approach to a geriatric patient with BD is the most important finding of this review. Summary: Bipolar disorder in older people, compared to the younger population, should be treated pharmacologically in combination with psychotherapy. The elderly patient population requires a multidisciplinary approach due to the number of drugs used in a large number of diseases.

Modern standards of therapy for mental disorders, including bipolar disorder, provide important support in making therapeutic decisions. Bipolar disorder by its variability - mania, hypomania, depression — is a significant therapeutic challenge. At the same time, it is a disease that accompanies the patient for most of his or her adult life, forcing use of mood stabilizers, antimanic, antipsychotic and/or antidepressant drugs not only in the active phase of the disease, but above all during the period of euthymia, in order to prevent relapse of the disease. This article analyzes the standard of therapy of bipolar disorders presented by the Canadian Psychiatric Association in 2018 (CANMAT 2018). The reference drug is quetiapine, which is a drug that belongs to both group A of normothymic drugs (has an antimanic effect - A above), and to the group of normothymic drugs B (has an antidepressant effect - B below), and the comparator was aripiprazole, a frequently used second-generation antipsychotic drug, which finds its application as a normothymic drug. The authors of the CANMAT 2018 standard analyzed several hundred clinical papers covering different levels of effectiveness of drugs used in bipolar disorder. This allowed them to assess the level of effectiveness of broadly understood normothymic drugs. The most important conclusions from this study are: 1. With regard to the therapy of a manic episode, first-line drugs are mainly those antipsychotic drugs that can be administered to a muscular or inhaled form. In the group of drugs administered orally, the administration of quetiapine or risperidone is proposed here. 2. The therapy for a first-line depressive episode is precisely quetiapine or a combination of lurasidone with lithium or monotherapy. Of the strategies for the therapy of depressive episode listed here, only all the conditions of normothymic, and thus its effectiveness has been confirmed not only in relation to depression, but also in the therapy of a manic episode and maintenance treatment of both mania and depression meets only quetiapine. 3. The first-line therapy in maintenance treatment is considered to be: lithium, quetiapine, valproate, lamotrigine and a combination of quetiapine with valproate or lithium.4. The first-line therapy for bipolar disorder type II is considered to be quetiapine, lithium and lamotrigine. The CANMAT 2018 standard also provides possibilities but also limitations of bipolar disorder therapy in specific groups of patients, e.g. pregnant women, patients with bipolar disorder co-occurrence with other mental and somatic disorders. 5. Therapy of an episode of depression in patient with bipolar disorder in old age is based on quetiapine, maintenance treatment in geriatric patients is considered to be first-line lithium or valproate drugs. [ABSTRACT FROM AUTHOR]

Aim. Comparison of the frequency of childhood traumatic events between a group of patients with bipolar disorder (BD), borderline personality disorder (BPD) and healthy persons. Methods. The study included 35 patients (10 male, 25 female) with BD, hospitalized in the Department of Adult Psychiatry in Poznań, the Neuropsychiatric Hospital in Kościan and the Medical Centre in Milicz, as well as 35 patients (9 male, 26 female) with BPD under the care of the Józef Babinski Hospital in Kraków. Seventy-one healthy persons (22 male, 49 female) constituted a control group. The Polish version of the Childhood Trauma Questionnaire (CTQ) was used. Results. In both clinical groups, no gender differences as to the CTQ indexes were found. Patients from both groups had more frequent childhood trauma compared with control subjects. Patients with BPD showed significantly higher CTQ indexes than those with BD. Conclusions. The obtained results indicate significantly more frequent experience of traumatic events in childhood in patients with BPD compared with BD. This is discussed in the context of the pathogenesis and treatment of both conditions. It is probable that in BPD childhood trauma plays the biggest role among all psychiatric disturbances. [ABSTRACT FROM AUTHOR]

Introduction: Over the last few decades, the interest of microbiota- gut – brain axis has increased. It is thought to have an impact on the overall health of the host. Gut microbiota and central nervous system can communicate in different ways. The connection between them is especially interesting in case of neuropsychiatric diseasesThe aim of the study: The purpose of this systemic review was to collect and analyse current data of the association between gut microbiota and neuropsychitric disorders, specifically schizophrenia and bipolar disorderMaterial and method: Standard criteria were used to review the literature data. The search of articles in the PubMed and Google Scholar database was carried out using the following keywords: gut microbiota, dysbiosis, schizophrenia, bipolar disorderDescription of the state of knowledge: Dysregulation of microbiota is a potential factor in pathogenesis of brain disorders. Gut microbiome is thought to be an important part of not only normal brain development, but also modulation of host physiological systems. Studies show that the composition of microbiota in psychiatric diseases including schizophrenia and bipolar disorder differs from healthy individuals. Many environmental factors can change the composition of microbiota and therefore potentially contribute to the development of many disorders, including neuropsychiatric disorders.Summary: Microbiota is a potential factor contributing to the onset or modulating the course of many illnessis, including brain disorders The subject of imbalanced microbiota composition give hope for finding etiology or improving treatment of many disorders. However, it still requires more studies.

Objectives: The purpose of this study was to examine relationship between anhedonia, disruption of biological rhythms, functioning and depression severity in patients with bipolar disorder (BD)., Methods: The sample included 58 patients with bipolar depression aged 18-65 years. The participants were assessed using the following scales: Dimensional Anhedonia Rating Scale (DARS), Snaith-Hamilton Pleasure Scale (SHAPS), Quick Inventory of Depressive Symptomatology- self-report (QIDS-SR), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), Functioning Assessment Short Test (FAST). Correlations between the variables were calculated. We built linear regression models with FAST or QIDS-SR as a dependent variable. Mediation analysis was performed., Results: Statistically significant correlations were observed between the included variables. Biological rhythms dysregulation and anhedonia were independent predictors of the level of functioning or depression severity. Mediation analysis demonstrated statistically significant mediation of the relationship between anhedonia and depression severity/functioning by the BRIAN score., Conclusions: We demonstrated for the first time the interactions between anhedonia, dysregulation of biological rhythms and functioning/depression severity in patients with BD. Reward deficits by causing disruption of rhythm of daily activities and social contacts may result in more difficulties in functioning and higher intensity of depressive symptoms.

The Polish standard of treatment with racemic ketamine for patients with depressive disorders was developed by a Working Group appointed by the National Consultant in the field of psychiatry. Despite the wide range of available medications, as many as one-third of depressed patients do not respond to standard antidepressant treatment, raising the need for an ongoing search for new effective and safe therapies. In recent years, the possible role of overactivity of the glutamatergic system in the etiopathogenesis of depression has again attracted the attention of many experts. The possibility of using substances with a modulating effect on the glutamatergic system in the treatment of depressive disorders has been postulated, among others, the long-known anesthetic ketamine, which is a noncompetitive NMDA receptor antagonist. This paper summarizes the results of studies on the efficacy and safety of racemic ketamine (administered intravenously) in the treatment of patients with depressive symptoms in the course of both unipolar and bipolar affective disorder, and, meeting the expectations of many practicing psychiatrists wishing to broaden the range of therapies offered to their patients, presents recommendations on indications, contraindications, precautions and the treatment regimen itself with intravenous ketamine for patients with mood disorders.

Autism spectrum disorder (ASD) is a heterogeneous group of neurodevelopmental disorders that can affect up to 2.6% of the population. Most of these people will have at least one other psychiatric disorder, often diagnosed with a delay or not recognized at all. This study describes the epidemiology, diagnostic difficulties and potential treatment of patients with ASD and comorbid bipolar disorder (BD). The prevalence of bipolar disorder in ASD is estimated at 5-8%. The study with the most numerous group included 700,000 children out of which 9,062 fulfilled ASD criteria at 16 - BD was found to be 6 times more prevalent in this group compared to the control group. Many factors affect the diagnosis. Patients with ASD often have limited insight into understanding the complex emotional states and difficulty in expressing them due to their impairment. The symptoms of bipolar disorder are in their case unspecific and differ from those occurring in the general population, which makes it difficult to make proper diagnosis. Despite the lack of research on the group of patients with ASD, psychometric tools designed to evaluate the general population are used to examine patients. This work aims to show the current state of knowledge and highlight areas that require further investigation. [ABSTRACT FROM AUTHOR]

Introduction and aims of the study: The aim of this study is to present recent reports on the treatment and therapy of schizophrenia and bipolar disorder (ChAD). The current treatment of patients affected by these diseases is difficult and unsatisfactory, therefore it is necessary to find new therapeutic options that will improve the effectiveness of treatment For the purpose of this study, scientific papers were reviewed using the Google Scholar search engine covering studies from 2016 to 2021. A dozen papers covering the scope of the publication were selected. Results: In the treatment of schizophrenia, the use of cannabinoids is of greatest interest due to the action of the preparations on the endocannabinoid system. In the treatment of ChaD, promising reports have been published on the therapy with aripiprazole and the need to improve its use in the treatment of both akathisia and agitation. Furthermore, from the fact that abnormalities of calcium signalling are considered a possible pathophysiological process in ChAD, it has been suggested that calcium channel L antagonists may be potential therapeutic agents in bipolar affective disorder. One study also demonstrated the potential use of vortioxetine in the treatment of patients with a depressive episode. Conclusions: The results of recent studies on the treatment of schizophrenia and ChAD cited in this paper offer the prospect of creating treatment regimens that are more effective and targeted in the aforementioned diseases. However, further randomised trials are needed to confirm the effective use of the cited drugs in the treatment of these diseases.

Objectives: "Schizotypy" is a term describing personality traits reflected in emotional, perceptual and cognitive styles. Affective temperaments are trait-like features which were observed to be stable in time and predispose to mood disorders. The purpose of this study was to examine relationship between schizotypal features, affective temperaments and anhedonia in patients with bipolar depression., Methods: 54 patients with bipolar depression were included in the study. Participant were administered the following psychometric tools: Dimensional Anhedonia Rating Scale (DARS), Snaith-Hamilton Pleasure Scale (SHAPS), Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), and Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR). Correlations between the variables were calculated and linear regression models were built., Results: Only hyperthymia (affective temperament) and introvertive anhedonia (schizotypal domain) were statistically significantly correlated with anhedonia. In regression models, introvertive anhedonia predicted higher whereas hyperthymic features lower severity of anhedonia (measured by the SHAPS scale)., Conclusions: Hyperthymic features are protective and introvertive anhedonia is a risk factor for consummatory anhedonia.

Aim. To investigate bipolar traits and impulsiveness in pathological gamblers, compared to non-pathological gamblers and non-gambling general population. To investigate interaction between traits of affective temperament, impulsiveness and the severity of pathological gambling. Methods. 139 participants (63 women, 76 men; mean age: 30.32; SD = 10.69) were included in the study. The Barratt Impulsiveness Scale was used to evaluate impulsiveness and the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire was used to evaluate affective temperamental traits. The participants were also screened for bipolar affective disorder spectrum using the Mood Disorder Questionnaire and the Hypomania Checklist-32. The Canadian Problem Gambling Index (CPGI) was used to evaluate the severity of pathological gambling in the assessed population. Polish versions of the questionnaires were filled out anonymously via the internet. Results. Pathological gamblers (N = 36) scored higher on 'Motor impulsiveness', 'Cyclothymic' and 'Irritability' subscales versus non-pathological gamblers (N = 61) and non-gamblers (N = 42). Cyclothymic and motor impulsiveness significantly predicted CPGI scores. Motor impulsiveness was found to moderate the influence of cyclothymic affective temperamental traits on pathological gambling. Conclusions. Our data support prior reports of higher impulsivity traits and traits from the bipolar spectrum among pathological gamblers. The results indicate that the influence of affective temperamental traits on pathological gambling severity is moderated by impulsiveness. [ABSTRACT FROM AUTHOR]

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This theoretical and practical article discusses the results of studies on aripiprazole in terms of its anti-maniac, antipsychotic effectiveness, its efficacy in relapse and re-hospitalisation prevention, and its effects on cognition. Study results indicate that aripiprazole may not only be a valuable component of combination therapy, but also, and perhaps above all, is an effective drug when used in monotherapy. The use of aripiprazole in too low doses does not allow for its full clinical effect. The use of high doses of the drug, exceeding 20 mg/day, translates into a high degree of dopaminergic receptor involvement. When excess dopamine is present, aripiprazole competes with dopamine for receptor binding, thereby acting as a D2 receptor antagonist. Therefore, the use of too low doses of the drug often has the opposite effect to the intended one, with aripiprazole acting as a dopaminergic receptor agonist, which results in additional activation instead of anti-manic and antipsychotic effects. Understanding the mechanism of action of this drug is therefore the key to successful treatment with aripiprazole. Data from scientific studies are presented and discussed below, explaining why and in which situations the 30 mg/day dose has an advantage over the 15 mg/day dose. The article answers the most common questions and explains doubts expressed by doctors, along with scientific background and a reference to the literature. Presenting data from the literature, the author also presents their clinical implications and refers to practical experience with the use of aripiprazole both in the hospital and in outpatient practice. [ABSTRACT FROM AUTHOR]

Polypharmacy, meaning combining two or more antipsychotic agents, is frequently used not only in Poland, but across the world. It is estimated, that even 2/3 of patients receive polypharmacy. It may be justified in the acute phase of illness and/or in the treatment resistant patients, or during the switching period from one drug to another. However, it should not be treated as a routine practice because of the increased risk of the adverse events. The analysis of the long-term adverse events of polypharmacy is essential, since those events may increase over the time. Amongst them the weight increase, glucose intolerance, hyperlipidemia, extrapyramidal symptoms, hyperprolactinemia, QTc prolongation and sedation are observed. Aripiprazole is one of the atypical or II generation antipsychotics known for several years. Many clinical trials and everyday practice confirm its clinical efficacy in schizophrenia and bipolar disorder. It is frequently used in the combination with the other antipsychotics. This paper reviews data about aripiprazole application in monotherapy, which should become a routine practice in the mental diseases treatment. [ABSTRACT FROM AUTHOR]

Copyright of Przegląd Socjologii Jakościowej is the property of Redakcja Przegladu Socjologii Jakosciowej and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bipolar disorder (BD) is characterized by pathological changes in mood as well as recurring episodes of mania, hypomania, depression and mixed symptoms. In recent years, the number of BD diagnoses has risen considerably in children and adolescents. It is believed that an average rate of prevalence of bipolar spectrum disorder in the pediatric population is 1.8%, and BD type I -- 1.2%, and the prevalence of the disorder increases with the age of patients. Despite the same diagnostic criteria, there are premises that suggest that the symptoms of the disorder are present with a different frequency among children and adolescents than in adults. The most frequent manic symptom in persons with childhood-onset of the illness is thought to be irritability, and in adolescence -- hyperactivity. BD in children and adolescent population is accompanied by a high rate of comorbid psychiatric conditions. Attention deficit hyperactivity disorder and borderline personality disorder constitute particular diagnostic challenges. Early onset of BP is linked with a more severe course of the illness, worse prognosis, and a higher suicidal rate. Pharmacotherapy of BD in the pediatric population includes 1st and 2nd generation mood stabilizers, while their efficacy and safety profiles are different than in adults. The American Food and Drug Administration recommends treating manic episodes in young persons with lithium, aripiprazole, quetiapine, risperidone, olanzapine and depressive episodes with a combination therapy of olanzapine and fluoxetine. [ABSTRACT FROM AUTHOR]

Copyright of Polish Sexology / Seksuologia Polska is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Polish Sexology / Seksuologia Polska is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aripiprazole differs from other antipsychotics in its unique mechanism of action: as a partial D2 and 5-HT1A agonist and a 5-HT2A antagonist, it acts as a dopamine system stabiliser. The drug allows controlling positive, negative and cognitive symptoms of schizophrenia. The indications in the summary of product characteristics also include treatment of up to 12 weeks of mild-tosevere manic episodes in type 1 bipolar affective disorder in adults and adolescents aged =13 years as well as prevention of new manic episodes in adults who experienced predominantly manic episodes and responded to aripiprazole treatment. Clinical trials have shown that the drug is well-tolerated compared to other neuroleptics. Aripiprazole therapy involves a relatively low risk of extrapyramidal symptoms and does not increase the risk of metabolic syndrome. Case reports where combining aripiprazole with another neuroleptic reduced sedation, hypersomnia, drooling, weight gain, dyslipidaemia and sexual dysfunction may be found in literature. Since the drug is available in different forms, it may be also used in agitated, catatonic or persistently uncooperative patients as well as in patients with swallowing problems. [ABSTRACT FROM AUTHOR]

Bipolar affective disorder (BPAD) is a chronic mental disorder characterised by high recurrence. There are numerous manic or hypomanic episodes in the course of the disease. Making a correct diagnosis can be difficult as patients most often turn for help in the depression phase; they also tend to interpret the hypomania phase as a state of very good mood and increased creativity, not identifying it with the disease. A depressive episode in the course of BPAD is characterised by the frequent coexistence of psychotic symptoms, excessive sleepiness and increased appetite. The first episode of the disease most often occurs at a young age. Apart from the typical symptoms of the depressive syndrome, we often observe accompanying cognitive disorders, which represent a group of symptoms causing significant discomfort and suffering to the patient. They most often intensify with the development of the disease and the number of subsequent episodes. In particular, the effectiveness of attention processes, executive functions and memory is weakened. These deficits have a negative impact on the patients' day-to-day functioning at school, in the workplace and in society, and severely impair it. The case report presented herein shows the difficulties in diagnosing severe cognitive disorders during a depressive episode in the course of BPAD and the difficulties in differentiating between them and dementia, as well as presents the effects of electroconvulsive therapy. [ABSTRACT FROM AUTHOR]

The article was written with the intention of filling the gap in the Polish psychiatric literature, which has not yet found room for the analysis of the phenomenon of bipolar disorder (BD) in terms of consequences that it may have for identity of people diagnosed with it. In order to do that, taking into account absence of the research in Poland, an attempt was made to find all previous reports on this subject in English-language professional journals and monographs. As a result, a detailed description with commentaries was made on five thorough studies of essentially qualitative nature. Although the 'identity' was operationalized a little differently in each of them, it addressed each time the question: "Who am I?", both in phenomenological terms, most often manifested in the loss of a sense of continuity, and cognitive terms, associated with the key elements of self-image. The presented studies revealed a number of threats to identity, more or less specific for BD. The nature of these studies does not allow the generalization of their results, nor answer the question of a scale of the phenomenon. On the other hand, the relative similarity of these results reveals previously overlooked difficulties, potentially frequent and important to more holistic understanding and therapy of people with BD, for which the implications have been summarized in the final part of the text. [ABSTRACT FROM AUTHOR]

In the article, the recommendations of the Polish Psychiatric Association regarding pharmacological treatment of women with bipolar disorder during pregnancy and postpartum period were presented. The issue pertains to every twentieth woman wanting to get pregnant. Before planned pregnancy, it is advisable to obtain a several-month stabilization of psychiatric state, to establish treatment with one mood-stabilizing drug (except for valproate and carbamazepine) or gradual discontinuation of drugs in case of mild course of illness and lack of recurrences in recent two years. In the first trimester of pregnancy, the dose of the mood-stabilizing drug should be reduced (lithium carbonate to 500 mg/day). Depression during pregnancy can be treated with quetiapine or lamotrigine or with antidepressant drug added to a mood-stabilizing drug. Atypical antipsychotics drugs with mood-stabilizing properties can be used in case of (hypo) manic or mixed states. Following the delivery, it is advisable to introduce a moodstabilizing drug as soon as possible to prevent postpartum psychiatric disturbances. In the treatment of postpartum depression, quetiapine can be used or an antidepressant drug added to a mood-stabilizer. Considering breastfeeding, it should be remembered that the infant/maternal ratio of serum drug concentration is low for valproate, olanzapine, quetiapine, sertraline and paroxetine, and high for lithium and lamotrigine. In the case of postpartum psychosis, a hospitalization and antipsychotic treatment are needed. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the coexistence of obsessive-compulsive symptoms with bipolar disorder (during the manic phase, depressive phase and remission). Method: The subjects were 70 patients previously diagnosed with and treated for bipolar disorder. For the purposes of this study, three subgroups were created: patients in the manic phase, depressive phase and in remission. The Hamilton Depression Rating Scale, Young Mania Rating Scale and Yale-Brown Obsessive Compulsive Scale were diagnostic tools used for the evaluation of patients’ mental health. Results: The data indicate high likelihood of co-occurrence of obsessive-compulsive disorder (28.6%) and obsessive-compulsive syndromes (32.8%) with bipolar disorder. Obsessions and compulsions were observed irrespectively of the type of bipolar disorder (type 1 and 2) and phase of the illness (depression, mania, remission). The results in the three subgroups were similar. The severity of anankastic symptoms depended both on the severity of depression and mania. The subjects confirmed the presence of obsessive-compulsive symptoms in the interview, although they were usually undiagnosed and untreated. Conclusions: Obsessive-compulsive disorder symptoms often coexist with bipolar disorder, both in its two phases and in remission. The severity of obsessive-compulsive symptoms in the course of bipolar condition varies, ranging from mild to extremely severe forms. The obsessive-compulsive disorder presentation in the course of bipolar disorder increases with the severity of depressive and manic symptoms. Obsessive-compulsive disorder can be primary to bipolar disorder. Obsessive-compulsive disorder coexisting with bipolar disorder is not diagnosed or treated properly.

Aripiprazole belongs to atypical antipsychotic medication of the so-called third generation, with a mechanism of action different from most antipsychotic drugs available. Its receptor action profile contributes to relatively good tolerance and low risk of metabolic complications. The high level of safety of aripiprazole was described in multiple groups of patients - the elderly and patients suffering from diabetes as well as kidney, liver and heart diseases. Furthermore, an increasing number of studies show that the drug used in the population of pregnant women was not linked to a clinically significant risk of major birth defects. At present, aripiprazole is mainly used in the treatment of schizophrenia, bipolar disorder and recurrent treatment-resistant depression and occupies a significant position in the recommendations for the treatment regimens for these diseases. In persons with mental illness, somatic diseases frequently coexist (among them, the metabolic syndrome and diabetes) and the inclusion of aripiprazole therapy may result in an additional improvement in metabolic parameters. The literature data suggest that polytherapy with the use of aripiprazole (especially in combination with such atypical drugs as olanzapine, clozapine or risperidone) can bring tangible benefits for patients with schizophrenia. Its clinical utility is significant in the context of the difficulties encountered in the treatment of schizophrenia and bipolar disorder - the lack of cooperation on the part of the patients with respect to drug consumption and the coexistence of numerous somatic ailments in both diseases. [ABSTRACT FROM AUTHOR]

Aripiprazole is an atypical neuroleptic of proven effectiveness for the treatment of schizophrenia and bipolar I disorder. Despite its many years' availability on the market, it tends not to be as popular as it deserves among psychiatrists. Aripiprazole is often used as an adjunctive treatment, added in a small dose to another neuroleptic, not as the primary antipsychotic treatment or prevention of manic episodes. Hence, its full benefits and optimal clinical effect cannot be achieved. This is due to the lack of knowledge concerning the full medical potential associated with the pharmacological profile of this neuroleptic and lack of awareness regarding its efficiency. Aripiprazole is characterised by better tolerability than some other antipsychotics, e.g. in terms of inducing symptomatic hyperprolactinemia, QTc prolongation, impaired glucose tolerance or significant weight gain. It is also associated with a low risk of extrapyramidal symptoms. Its good safety profile facilitates its use in patients with somatic burden, older than 65 years old and obese patients. The article briefly presents the current state of knowledge concerning the effect of aripiprazole in bipolar affective disorder and schizophrenia, focusing on the practical aspects. The following questions have been addressed: • Who is most likely to benefit from aripiprazole treatment, and how to adjust the dosage to the patient's symptom profile? • When to consider a change of therapy to aripiprazole? • When is it appropriate to use aripiprazole as monotherapy and when as an element of combination therapy? Several case reports have been included in the study to best illustrate the drug's therapeutic potential. [ABSTRACT FROM AUTHOR]

Bipolar disorder (BD) belongs to the group of recurrent affective disorders. As biological factors play an important role in its aetiopathogenesis, pharmacology remains the main treatment, while psychotherapy can augment its effectiveness. Psychotherapeutic methods, contributing to BD treatment, such as psychoeducation and family-focused therapy (FFT) have already been used in the treatment of schizophrenia. Cognitive behavioural therapy (CBT) has proved efficacious in the treatment of unipolar affective disorders. Specifically for BD, interpersonal and social rhythm therapy (IPSRT) was developed. All of the aforementioned procedures have proven to be efficacious in augmenting pharmacological treatment. Cognitive behavioural therapy constitutes a group of well-proven psychosocial interventions for the treatment of anxiety, depressive, personality, and eating disorders as well as for addictions. The aim of this article is to review the literature on the effectiveness of cognitive behavioural therapy in the treatment of bipolar disorder. The majority of studies bring about promising results of the use of CBT in BD. A recent meta-analysis shows that, using CBT results in decreasing frequency of recurrences of the illness, a reduction of intensity of depressive and manic symptoms as well as improvement in psychosocial functioning were seen, although is some studies the results are not unequivocal. In many papers, the necessity of further studies on the use of cognitive-behavioural therapy in BD is emphasised, in order to elaborate definite standards and therapeutic indications as well as better methods to assess its efficacy. [ABSTRACT FROM AUTHOR]

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Aim. Some scientific reports indicate the changes in the concentration of serum copper in patients with bipolar disorder (BD), however the data are inconclusive. The aim of this study was to assess the concentration of copper in the blood serum of patients in various phases of BD compared to healthy volunteers, taking into consideration the specific clinical features, and the stage of illness. Methods. The study enrolled 133 patients with a diagnosis of BD (type I, II and NOS), including 61 people in depressive episode, 23 in mania or hypomania and 49 in remission. The control group consisted of 50 people. Atomic absorption spectrometry was used to measure the concentration of copper. Results. There were no statistically significant differences in the serum copper concentration between patients in various phases of BD (mania/hypomania, depression, remission), sub-types (Type I, Type II + NOS) or stages and healthy volunteers. However, serum copper concentrations in patients in stage 1 was significantly higher than in advanced stages (2+3+4), (β = 0.22; p = 0.02). Serum copper concentration was also the higher, the later the age of onset was (β = 0.33; p < 0.001), and the lower, the greater the number of illness episodes (β = - 0.23; p = 0.02) (multiple regression model, adj R2 = 0.19, p = 0.0001). Conclusions. The dependencies demonstrated above may reflect pathophysiological processes that occur in the course of BD (e.g., inflammatory response and oxidative stress) with a different intensity depending on its stage. [ABSTRACT FROM AUTHOR]

The purely academic division into antidepressants, antipsychotics and mood stabilisers is misleading. In clinical practice, certainly not all types of depression can be treated with antidepressants, while the activity of antipsychotics is not limited to the treatment of psychoses (understood as mental disorders with positive symptoms). The therapy of bipolar disorder is a very good example in this regard. Antidepressants are not recommended in bipolar I disorder (also in the periods of depression), while they are usually considered as "of limited use" in bipolar II disorder. Their use is associated with the risk of transition from depressive to hypomanic phase on one hand, and the risk of drug resistance, on the other. Therefore, a question should be asked about the place of atypical antipsychotics in the treatment of bipolar disorder. The paper presents the current research findings on the use of olanzapine, quetiapine and amisulpride in the treatment of depressive and manic episodes in bipolar disorder. The role of agents from the discussed class in preventative therapy (mood stabilising) is also mentioned. A number of methodologically adequate double blind and placebo-controlled trials have demonstrated the efficacy of olanzapine in the treatment of both depressive and manic episodes in bipolar disorder.Olanzapine can be also used as a mood stabiliser, although usually in combination therapy. High risk of metabolic syndrome is the primary problem associated with this medication. Quetiapine may also be used in the treatment of depressive and manic episodes, as confirmed by the available data. The authors of studies on quetiapine point out that its effects are dosedependent. Doses of up to 300 mg per day show mainly antidepressant activity. Higher doses are needed in the treatment of manic episodes - usually above 500 mg per day. Excessive sedation is the major problem associated with this medication. In the case of amisulpride, studies determining the usefulness of this agent in the therapy of bipolar disorder are insufficient. Case reports indicating possible preventive effects of amisulpride in patients with significant metabolic disorders are very interesting. [ABSTRACT FROM AUTHOR]

Introduction. The Hypomania Checklist (HCL) has become an important tool for the assessment of hypomanic symptoms in patients with mood disorders and in the general population. The HCL-33 scale, containing 33 symptom items, is a new instrument which, in addition to the self-administered questionnaire, has a version for external rating. Aim. The aim of this study is to evaluate the consistency between the self - and external assessments using the HCL-33 in Polish patients with bipolar disorder. Method. The data from 81 euthymic bipolar patients recruited in Poznan and Krakow centers were analyzed. All the patients filled out the HCL-33 questionnaire, and, for each patient, the HCL-33 questionnaire-external assessment was completed by his/her significant other. Results. Of the 33 symptom items, sufficient agreement (significance of kappa factor < 0.05) was found for 13 out of the 19 questions of the "active/elated" (factor 1) and for all 14 items of the "irritable/risk-taking" (factor 2). Insignificant consistency was found for 6 items of factor 1 and the question regarding the longest period of hypomania. The inter-rater agreement between patient and significant other was not affected by gender, living together or subtype of relationship with the patient. Conclusions. The results show significant consistency between self - and external assessments for 27 symptom items (82%) of the HCL-33. The future status of the items showing insufficient consistency should be discussed. Limitation of the study is a small number of subjects recruited from only two centers which may not be representative for the Polish population. [ABSTRACT FROM AUTHOR]

Morgagni-Stewart-Morel (MSM) syndrome is a disease with a genetic basis, whose clinical picture consists of the following features: hyperplasia of the inner surface of the frontal bone (hyperostosis frontalis interna - HFI), obesity, hormonal and metabolic changes, and various neuropsychiatric disorders. Although the syndrome was first described in the medical literature over 240 years ago, the etiology is not yet fully understood, mainly because of the diverse clinical picture, the range of reported symptoms, and because of variable and incomplete penetration of the gene (autosomal dominant inheritance of the disease has been demonstrated). This paper presents the case of a 39-year-old patient treated for bipolar affective disorder over many years and in whom, in 2012, a diagnosis of MSM syndrome was also made. This is the first case in the literature of coexistence of the two states of psychopathology. The discussion highlights the possibility of partially common pathogenic mechanisms. [ABSTRACT FROM AUTHOR]

The aim of this paper is to review the effects of negative childhood experiences on the development and course of bipolar disorder (BD) and to discuss the involved mechanisms. The negative childhood experiences that may play a role in BD are critical or traumatic events including all kinds of abuse, loss of a parent or parents resulting from death, suicide, separation, divorce or prolonged separation. Previous studies indicate that in BD patients negative childhood events are more frequent than in control group. In BD patients these events are associated with an earlier onset and more severe course of the illness, including more frequent relapses, suicidal behavior, substance abuse and somatic diseases. This paper presents the possibility of the specific impact of individual events on the clinical outcome of BD. Mechanisms explaining the impact of negative childhood events on the development and course of BD include the interaction between biological predisposition and stress factors, the concept of kindling and activation of negative cognitive schemas. Early negative experiences cause a modification of the expression of the mediators of stress and neurotransmitters in certain areas of the brain. The interaction of these mediators with the development of neural networks may lead to long-lasting structural and functional changes. Molecular genetic studies indicate the possibility of interactions between environmental factors (stress) and the polymorphisms of serotonin transporter, brain-derived neurotrophic factor (BDNF) and toll-like receptor (TLR2). It has also been hypothesized that childhood experiences affect DNA methylation, acting as a form of molecular memory and modifying brain activity over the next decade. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to determine neurochemical alterations in bipolar disorder using proton magnetic resonance spectroscopy (1H-MRS). Method. We investigated a group of 27 patients diagnosed with bipolar disorder (with manic and mixed episodes, depression and after remission of symptoms) and 10 healthy subjects. MR imaging and 1H-MRS were performed on a 1.5 T scanner. Voxels of 8 cm3 were positioned in the anterior cingulate, left frontal lobe and left temporal lobe. Spectral peaks of NAA (N-acetylaspartate), Glx (glutamate/glutamine/GABA complex), Cho (choline), Cr (creatine/phosphocreatine) and mI (myo-inositol) were analyzed and the ratios of these metabolites to creatine (Cr) and non-suppressed water signal were determined. Results. In the anterior cingulate cortex of patients with bipolar disorder a significantly higher Cho/H2O ratio (p = 0.029) and a trend toward higher Cho/Cr ratio values (p = 0.096) were observed as compared to healthy controls. Conclusions. The findings of our study prove that neurochemical changes occurring in the anterior cingulate cortex of bipolar patients are related to altered choline levels. [ABSTRACT FROM AUTHOR]

Aim. Assessment of atypical symptoms in various types of depressive disorders, using the author's questionnaire for symptoms of atypical depression. Methods. The study involved 70 patients with a diagnosis of depressive episode in the course of recurrent depression, 54 patients with a diagnosis of depressive episode in bipolar disorder (BD) and 58 patients with a diagnosis of dysthymia. To assess the severity of atypical symptoms, the special questionnaire has been elaborated. In each diagnostic group, half of patients had normal body weight, and half were overweight or obese (BMI > 25). Results. Patients with various types of depression did not differ significantly in terms of clinical and demographic factors. Symptoms of atypical depression such as increased appetite, weight gain and leaden paralysis were more common in women. Patients with bipolar depression had significantly increased symptoms such as hypersomnia (compared with dysthymia), and leaden paralysis (vs. recurrent depression and dysthymia). In overweight and obese patients, the severity of atypical symptoms correlated with body mass index and intensity of depression score on the 17-items Hamilton Depression Rating Scale. In this group, all symptoms of atypical depression were significantly more intense in patients with depression in the course of bipolar disorder. Conclusions. The results indicate higher prevalence of symptoms of atypical depression in bipolar disorder compared with recurrent depression and dysthymia. They also suggest the interdependency between the symptoms of atypical depression, bipolar disorder and obesity. [ABSTRACT FROM AUTHOR]

Aim of study: The negative childhood experiences that may play a role in psychiatric illness are traumatic events including all kinds of abuse, parental loss, divorce or prolonged separation. It has been found that patients with bipolar disorder (BD) more often experience negative events in childhood than healthy people. These events may lead to a more severe course of illness. The aim of this study is to compare the frequency of negative childhood experiences between BD patients and control groups matched for gender and age. Material and methods: Fifty-two BD patients were included, aged 47 ±12 years, hospitalized in the Department of Adult Psychiatry, Poznań University of Medical Sciences, Neuropsychiatric Hospital in Kościan and the psychiatric ward in Milicz. The control group consisted of 52 healthy individuals, aged 47 ±12 years. Polish version of the Childhood Trauma Questionnaire (CTQ) and own Childhood Negative Experiences Questionnaire were used in the study Results: Compared with the control group, BD patients showed higher level of indices measured by the CTQ (physical abuse, emotional abuse, sexual abuse, emotional neglect, physical neglect) and also experienced more frequently such negative childhood events as alcoholism, psychiatric illness and suicide in the family, parental abandonment, divorce, death and prolonged separation. Conclusions: The results obtained point to significantly more frequent occurrence of negative childhood experiences in BD patients compared with control group what may play a role in the pathogenesis of the illness. A proper interview for the negative childhood experiences may be helpful for planning therapeutic procedures. [ABSTRACT FROM AUTHOR]

Introduction. Wilson's disease (WD) is an inherited disorder of copper metabolism with wide spectrum of clinical symptoms, mainly hepatic or neurological. Psychiatric disorders occur less frequently and are not pathognomonic for WD. However, in almost 20% of cases they are in fact the first clinical manifestation of WD. Aim. The aim of this paper is to emphasise the importance of including WD in differential diagnosis of psychiatric disorders in young adults, as well as caution in initiating psychiatric treatment for patients with already established diagnosis of WD. Methods. Case report of a patient with primarily psychiatric manifestation of WD. Results. The authors present the case of a 26-year-old patient treated for 3 years due to depressive syndrome who was diagnosed as WD in the differential diagnosis shortly after extrapyramidal symptoms developed. During the further WD treatment the manic episode occurred. The patient was treated with atypical neuroleptics and anxiolytics, with good psychiatric effect, but with severe neurological deterioration. However, long term use of valproic acid and olanzapine combined with continuation of anti-copper treatment and rehabilitation resulted in good psychiatric and neurological outcome. Conclusions. WD should be always considered in differential diagnosis of psychiatric disorders in young patients, especially if they present additional extrapyramidal or hepatic symptoms. It is also extremely important to remain cautious when drugs with high affinity to dopamine D2 receptors need to be initiated in patients already diagnosed with WD, as they may result in severe and often irreversible neurological complications. [ABSTRACT FROM AUTHOR]

The article presents a case report of comorbidity between bipolar disorder and Asperger syndrome in a 23-year-old woman. In the patient since adolescence, abnormal behavior and social functioning were observed, further accompanied by symptoms meeting the criteria for a diagnosis of bipolar disorder type II. Once the final diagnosis was established and treatment consistent with reports from the literature was introduced, it resulted in significant improvements of the psychiatric status. One and a half years after the last affective episode, the patient is continuing her academic activity (study of law) at a university in a foreign country. [ABSTRACT FROM AUTHOR]

Defense mechanisms are unconscious, automatic processes that allow us to cope with tension and stress. They play a significant role in maintaining mental health, but the use of some of them, especially immature ones which strongly distort reality, can be associated with psychopathological symptoms. Multiple studies show a relationship between immature defensive styles and mood disorders. Individuals with depressive and bipolar affective disorders use more immature mechanisms compared to non-clinical control groups. At the same time, they rely less on mature, adaptive defense mechanisms. Immature defense mechanisms may negatively affect the course and effectiveness of treatment, while improvements toward the use of more mature defenses due to psychotherapy and other treatment interventions are observed. Estimation of the maturity level of defense mechanisms may prove useful in the diagnostic process, especially in differentiating depressive disorders from anxiety disorders, differentiating between subtypes of mood disorders and in assessing the risk of suicidal behavior. Enhancing mature defense mechanisms and reducing reliance on immature ones may improve the overall functioning of patients with mood disorders and contribute to reducing the severity of psychopathological symptoms.

Aim: To assess the level of caregiving burden and psychological distress among spouses of bipolar disorder - BD (type I and II) patients. Methods: 77 subjects (41 women and 36 men) were enrolled in the study - 44 spouses of bipolar I (BD I) patients and 33 spouses of bipolar II (BD II). The whole group was divided into 4 subgroups: (I) the wives of BD I patients: n=27, (II) the husbands of BD I patients: n=17, (III) the wives of BD II patients: n=14, (IV) the husbands of BD II patients: n=19. The research methods: Involvement Evaluation Questionnaire - IEQ and General Health Questionnaire - GHQ-12. Results: Manic phase of BD I is more burdensome than episodes of depressed mood (BD I) and hypomania (BD II). Depression in BD II results in a significantly greater burden than hypomania. Spouses of BD I patients experience a higher level of burden. Women are generally more burdened with the patient care regardless of the episode. Partners of bipolar patients (type I and II) experience the same high level of psychological distress. Conclusions: The specific types of bipolar disorder (I and II) have the different impact on partners, which affects their subjective and objective burden and relationship with patients, indicating a real need to offer them an adequate help, depending on subtype of patient's bipolar disorder, as well as the spouse sex. [ABSTRACT FROM AUTHOR]

Aim: Few scientific reports indicate changes in the concentration of magnesium in the blood of patients with bipolar disorder (BD). So far very little studies concerning these issues have been conducted. Therefore, the aim of this study was to evaluate the serum magnesium level in patients with bipolar disorder (in different phases of the disease) in comparison to healthy volunteers. Methodology: The study included 129 patients (58 subjects in depressive episode, 23 in manic episode and 48 patients in remission) with the diagnosis of bipolar disorder type I or II. The control group consisted of 50 healthy people. Magnesium concentration was measured using flame atomic absorption spectrometry (FAAS). Results: Patients with a current depressive or manic/hypomanic episode had statistically significantly elevated serum magnesium levels compared to healthy volunteers. Moreover, a positive correlation between the duration of the manic/hypomanic episode and the relapse frequency in the last year was observed. The concentration of magnesium in patients in remission was unchanged in relation to the control group. Conclusions: Presented findings suggest a role of serum magnesium level as a potential state marker, reflecting the pathophysiological changes associated with acute episodes of bipolar disorder. [ABSTRACT FROM AUTHOR]

The use of antidepressants in treatment of depression in course of bipolar disorders (BD) is controversial. In case of no improvement during monotherapy with mood stabilizer, the use of antidepressants is often necessary. The safety of this group (in context of phase change, mixed states and rapid cycling) is essential and is the subject of many research. In the paper, the authors review the literature concerning efficacy and safety of use of antidepressants in the treatment of affective disorders and long-term impact on the course of the disease. Selection of articles have been made by searching the Medline and Pubmed databases using keywords: antidepressant drugs, bipolar depression, bipolar disorder, efficacy, safety, mania, hypomania. The risk of mania is greater in bipolar disorder type I, than in type II or during treatment with Tricyclic antidepressants (TCAs) and treatment with venlafaxine. The use of SSRIs and bupropion is associated with a relatively small increase of phase change risk. There are different opinions concerning recommended duration of antidepressant treatment. Generally antidepressant use should end after 2-3 months of remission, the risk of recurrence of depression after discontinuation of antidepressants is, however, higher than in case of continuation. In BD type II or BD spectrum, antidepressant monotherapy is allowed in severe depression. In bipolar disorder type I and in case of phase change after antidepressants use in the past, use of antidepressants should be very cautious. Antidepressants are contraindicated in rapid cycling and in mixed episodes. Further work is needed to evaluate the efficacy and safety of antidepressants use. [ABSTRACT FROM AUTHOR]

Copyright of Psychiatria Polska is the property of Editorial Committee of Polish Psychiatric Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper looks at some recent developments in the official diagnostic definitions (DSM-5) and in the research domain. The spectrum concept of mood disorders consists of the components of depression and mania, alone or in combination, on a continuum. Its international operational classification changes regularly, being based on symptoms, their duration and consequences. Causation is as yet unknown. DSM-5 excludes unipolar mania and mania with mild depression as separate diagnoses (they come under bipolar I and bipolar II disorders) and introduces a new hierarchy of manic symptoms, placing energy/activity above mood (elated, irritable). This is shown to be problematic on the basis of recent data. The validity of the duration criteria for mania (1 week), hypomania (4 days) and depression (2 weeks) is also seriously questioned. Shorter episodes are clinically very relevant. The definition of mania/hypomania is a persistent problem, contributing to frequent underdiagnosis of bipolar disorder in depressed patients. Other contributory factors include that patients often do not feel ill or seek treatment for the consequences of their high mood, and that hypomania can be hidden by substance use disorders (SUD). Hidden hypomanic syndromes are important because associated with treatment resistance, high comorbidity with anxiety/panic and SUD, psychotic and cognitive symptoms, dementia and higher mortality. Anxiety, too, is doubtless a mood disorder but there is still no concept which integrates anxiety with bipolar disorder and depression. Classification involves the definition of artificial subgroups and is necessary for treatment and communication but clinicians, when in doubt, need to exercise their own diagnostic judgment especially on the basis of indicators of bipolarity in patients presenting with depression. [ABSTRACT FROM AUTHOR]

This article presents a summary of available data on the use of quetiapine extended release (QUE-XR). QUE-XR is an example of an atypical antipsychotic drug that can be used in a single dose, thereby simplifying the treatment regimen. From the therapeutic standpoint, this issue is of paramount importance, since approximately 50% of patients have adherence issues. Therefore, availability of the drug which is comfortable in administration can significantly improve treatment outcomes. Due to its antipsychotic, antidepressive, mood stabilizing and anxiolytic efficacy, QUE-XR seems to be a promising drug with potentially broad spectrum of indications (in patients with schizophrenia, bipolar disorder, major depression and some anxiety disorders - both in the acute phase of treatment, and the maintenance treatment). Notably, QUE-XR seems to ameliorate sleep disturbances, and it may also improve patients' quality of life (as suggested by some studies). Due to the simple dosing regimen of QUE-XR, conducting therapy with this drug may contribute to the improvement of compliance. Yet, the primary clinical criterion for selection of the type of formulation of quetiapine should be the individual preferences of the patient, and the knowledge and experience of the treating physician. [ABSTRACT FROM AUTHOR]

Aim. To assess the influence of group psychoeducation in bipolar disorder on selected aspects of cognitive representation of illness. Method. 51 patients with bipolar diagnosis were included in the study, and 24 were included in the final statistical analysis. The participants took part in 8 meetings of group psychoeducation. The assessment of selected aspects of cognitive representation of illness, i.e. acceptance of illness, health locus of control, generalized self-efficiency, hope for success, therapeutic compliance, beliefs about bipolar disorder was conducted with validated questionnaires before, after, and 18 months after receiving psychoeducation to register possible changes. Results. Statistically significant increase in acceptance of illness, perceived self-efficiency, hope for success, therapeutic compliance, and positive modification of beliefs about bipolar disorder were detected. The observed change occurred right after the intervention, but it was not sustained during the follow-up. Conclusions. Psychoeducation may exert a positive influence on virtually important cognitive variables, which seem to be clinically important. This influence may disappear with time, thus the interventions should either be repeated or the duration of intervention should be prolonged. The study shows new possible research directions in the field of searching for the mechanism of action of psychoeducation in bipolar disorder, as well as of its active components. [ABSTRACT FROM AUTHOR]

Aim. The aim of the study was to evaluate a relationship between concentrations of homocysteine (HCY), vitamin B12 and folic acid and disturbances of cognitive functions during acute episode of bipolar depression. Methods. 116 patients were studied (93 women, 23 men), aged 20-78 (mean 51±13) years during acute episode of bipolar depression. Depression was evaluated by the 17-item Hamilton's Depression Rating Scale (HDRS). The following tests measuring cognitive functions were applied: Trail Making Test, Wisconsin Card Sorting Test, Stroop Test and Wechsler Adult Intelligence Scale-Revised. In all patients, the measurements of serum homocysteine, vitamin B12 and folic acid were carried out.. Results. Hyperhomocystemia (HCY>15pM/l) was detected in 41 patients (35%), more frequently in men (52%) than in women (31 %). Patients with hyperhomocysteinemia achieved worse results in sub-tests of WAIS-R (verbal understanding and perceptional organization). In men, negative correlation was found between HCY concentration and number of errors in Stroop Test, and WCST (total errors and non-perseverative errors). In women with bipolar disorder, type II, negative correlation between HCY concentration and time of Stroop Test, and between vitamin B12 concentration and number of errors in Stroop Test, were demonstrated. In the whole group and in men, there was positive correlation between higher folic acid concentration and the number of errors in Stroop Test. Conclusions. The results obtained show higher HCY concentration in considerable proportion of patients with bipolar depression, especially in men. They also confirm a connection Badanie było częściowo finansowane z grantu ministra nauki i szkolnictwa wyższego nr 402 466740. Autorzy nie byli poddawani żadnym wpływom w toku badań i ich opracowywania. between high homocysteine concentration and worse performance in some neuropsychological tests. Such relationship was more marked in men. [ABSTRACT FROM AUTHOR]