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Introduction In literature Leonard introduce, after Wernike (1900) and Kleist (1928), the concept of cycloid psychoses, and he gives again a weight to the mixed forms in affective disorders [1–4] . A lot of different medical conditions cause pychiatric problems, like hyperammonemia, hyponatiremia, thyroid disfunction, urinary infections and still others. The aim of our study is to evaluate the role of a medical condition in perplexity inside psychotic mixed states in bipolar disorder (BD). We propouse three different cases and literature review. Method Three patients with perplexity in BD were assessed with: the SCID-P for axis I diagnosis, HRSD, YMRS, internistical examination, blood test exams and urinanalysis, and first level brain imagin (CT and/or MRI). We conducted a systematic review of the literature (PubMed, Embase, PsychInfo), using the terms “bipolar disorder”, “mixed states”, “perplexity” and “medical condition”. Results All our patients present: hyperammonemia, reduction of TSH and presence of infection at the urinanalysis, and a resolution of perplexity with the normalization of the blood test and urinanalysis. Discussion and conclusion To our knowledge there are not studies that confirm the relationship between thyroid and epatic dysfunction, and urinary infection with perplexity in psychotic mixed states in BD, and the resolution with the normalization of blood and urinary exams. Further research is warranted to replicate our clinical observations and to confirm our results. [ABSTRACT FROM AUTHOR]

Introduction Alcohol dependence (AD) is a major public health problem. Currently, three drugs for the treatment of AD have been approved: acamprosate, disulfiram and oral naltrexone. Quetiapine XR is an atypical antipsychotic has been shown to be a promising medication for the treatment of alcoholism [1,2] . The aim of our study is evaluate quetiapine efficacy on impulsivity in a sample of alcoholic patients. Method A sample of alcoholic patients ( n = 40) was assessed at the entrance and 2 months with: SCID-P, Brief-Temps, BIS-11, GSR, BPRS, SCI-DER, and CGI. The medium dosage of quetiapine is 300 mg. Results Using the last observation carried forward, the mean total BIS score decreased from 60.8 at baseline to 40.2 at the final visit ( P = .03). More pronounced improvement was observed in motor impulsiveness ( P < .03) and attentional impulsiveness ( P < .05) compared with non-planning impulsiveness ( P = .09). We observed an improvement in SCI-DER total score ( P = .02), in particular in derealization ( P = .03) and autopsychic depersonalization ( P = .04). A mean weight gain of 4.8 kg was observed. There is not significant different related to the different affective temperament. Discussion and conclusion Analyses revealed a significant effect of Quetiapine XR in improving impulsivity and dissociation, in particular motor and attentional impulsiveness, derealization and autopsychic depersonalization. Moreover, an improvement of dissociative symptoms is probably connected with the blockade of postsynaptic 5-HT1A receptors [3] . Methodological limitations, clinical implications and suggestions for future research directions are considered. [ABSTRACT FROM AUTHOR]

Introduction Pregabalin is widely used in neurology, psychiatry and primary healthcare, and recently in literature different studies explain the possible misuse [1,2] . Pregabalin has shown greater potency in preclinical models of epilepsy, pain and anxiety, and may have potential in the treatment of cocaine addiction [3] . The purpose of this report is to review the clinical evidence for the potential of abuse and misuse of pregabalin. We propose ten different cases and literature review. Method Ten inpatients with misuse of pregabalin were assessed with: the SCID-P, Anamnestic Folio, HAM-A and DAST. We conducted a systematic review of the literature (PubMed, Embase, PsychInfo), using the terms “pregabalin”, “misuse”. Results All our patients present: cocaine, alcohol and/heroin positive in drugs urine screening at admission; a significant high level of total anxiety at the HAM-A Tot ( P < .001), and especially at the item 7 ( P < .001); the misuse of pregabalin is made for sniffing; the predominant symptoms assessed were euphoria, psychomotor activation and sedation. Discussion and conclusion Schifano F et al., [1,2] suggest that pregabalin should carefully prescribe in patients with a possible previous history of drug abuse. Our result identifies a particular population the misuse pregabalin that are abuser of cocaine, alcohol and/or heroin. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered. [ABSTRACT FROM AUTHOR]