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Introduction: There are numerous reports of a higher prevalence of metabolic disorders in patients with schizophrenia and bipolar disorder (BD), yet its connections to diet and physical activity remain not fully explained. This article aimed to evaluate diet, physical activity and selected biochemical and anthropometric parameters associated with metabolism in patients with schizophrenia and BD and to analyse the relationships between these variables in the subjects., Materials and Methods: A total of 126 adults participated in the study: 47 patients with schizophrenia, 54 patients with BD and 25 patients in mental illness remission (reference group). Data were collected on the underlying illness and concomitant illnesses, and the severity of symptoms of the current episode was assessed using the following scales: PANSS, MADRS and YMRS. An assessment of the subjects' diet (KomPAN questionnaire) and their physical activity (International Physical Activity Questionnaire) was carried out. Anthropometric and blood pressure measurements were taken and BMI and WHR were calculated. Serum concentrations of fasting glucose, TSH, total cholesterol, LDL and HDL fractions, triglycerides and leptin, ghrelin and resistin were determined. For statistical analysis, the significance level was set at 0.05. For multiple comparisons one way ANOVA or Kruskal Wallis were used with post hoc Tukey and Dunn tests, respectively. To determine correlation of variables, Pearson's linear correlation coefficient or Spearman's rank correlation coefficient were used., Results: A total of 50.8% of the subjects had at least one metabolic disorder-most commonly excessive body weight (66.7%) and abdominal obesity (64.3%). Patients did not differ significantly in terms of physical activity, but they did differ in mean time spent sitting-with this being significantly longer for all groups than in the general population. The subjects differed in diet: patients with BD consumed less unhealthy foods than patients with schizophrenia. The highest correlations between physical activity, diet and variables defining metabolic disorders were found in patients with BD. Only in patients with schizophrenia were there significant correlations between the course of the disease and physical activity., Discussion: The results suggest the existence of associations between diet, physical activity, and metabolic disorders in both BD and schizophrenia patients. They also suggest a tendency among those patients to spend long periods of time sitting., Competing Interests: The authors declare that they have no competing interests., (© 2023 Głodek et al.)

Lithium is a drug of choice as a mood-stabilizer for the maintenance treatment of bipolar disorder. 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 connected with lithium prophylaxis performed at the Poznań 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 connected with a predisposition to bipolar illness. 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-3β, MMP-9, and NTRK2 genes. The polymorphism of the GSK-3β 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 activity and pathogenesis of bipolar mood disorder were discussed.

Objective: The aim of this study was to assess the perception of speech in adverse acoustic conditions during manic and depressive episodes of mood disorders., Methods: Forty-three patients with bipolar disorder (mania, N=20; depression, N=23) and 32 patients with unipolar depression were included for analyses. Thirty-five participants served as the control group. The study of speech understanding was carried out using the Polish Sentence Matrix Test, allowing for the determination of the speech reception threshold (SRT). The test was performed in the clinical groups both during an acute episode and remission; during remission, patients underwent audiometric evaluation., Results: Compared with control subjects, patients with mood disorders had worse speech understanding (higher SRT), regardless of the episode or remission. A manic episode in the course of bipolar disorder was not associated with worse speech understanding compared with remission of mania. However, an episode of depression in the course of both bipolar disorder and unipolar depression was associated with worse speech understanding compared with remission of depression. In bipolar depression, this correlated with age, duration of the disorder, number of episodes, and number of hospitalizations, as well as in remission with age and duration of illness. In unipolar depression, poor speech understanding was more severe in individuals with hearing impairment., Conclusions: These findings revealed that patients with mood disorders had impaired speech understanding, even while in remission, and manic episodes in the course of bipolar disorder were not associated with impaired speech understanding compared with mania remission.

Predicting lithium response (LiR) in bipolar disorder (BD) may inform treatment planning, but phenotypic heterogeneity complicates discovery of genomic markers. We hypothesized that patients with "exemplary phenotypes"-those whose clinical features are reliably associated with LiR and non-response (LiNR)-are more genetically separable than those with less exemplary phenotypes. Using clinical data collected from people with BD (n = 1266 across 7 centers; 34.7% responders), we computed a "clinical exemplar score," which measures the degree to which a subject's clinical phenotype is reliably predictive of LiR/LiNR. For patients whose genotypes were available (n = 321), we evaluated whether a subgroup of responders/non-responders with the top 25% of clinical exemplar scores (the "best clinical exemplars") were more accurately classified based on genetic data, compared to a subgroup with the lowest 25% of clinical exemplar scores (the "poor clinical exemplars"). On average, the best clinical exemplars of LiR had a later illness onset, completely episodic clinical course, absence of rapid cycling and psychosis, and few psychiatric comorbidities. The best clinical exemplars of LiR and LiNR were genetically separable with an area under the receiver operating characteristic curve of 0.88 (IQR [0.83, 0.98]), compared to 0.66 [0.61, 0.80] (p = 0.0032) among poor clinical exemplars. Variants in the Alzheimer's amyloid-secretase pathway, along with G-protein-coupled receptor, muscarinic acetylcholine, and histamine H1R signaling pathways were informative predictors. This study must be replicated on larger samples and extended to predict response to other mood stabilizers.

Bipolar patients have a higher risk of type 2 diabetes and obesity, which are associated with cardiovascular diseases as the leading cause of death in this group. Additionally, there is growing evidence that impaired glucose metabolism in bipolar patients is associated with rapid cycling, poor response to mood stabilizers and chronic course of illness. The aim of the study was to assess the prevalence of type 2 diabetes and other types of impaired glucose metabolism in bipolar patients along with an evaluation of the Fasting Triglycerides and Glucose Index (TyG) as a method of the insulin sensitivity assessment. The analysis of fasting glycemia, insulinemia and lipid profile in euthymic bipolar patients was performed, and the Homeostasis model assessment for insulin resistance (HOMA-IR) and TyG were computed. Type 2 diabetes was observed in 9% and insulin resistance with HOMA-IR in 48% of patients. The TyG and HOMA-IR indices were correlated ( p < 0.0001), the TyG index value of 4.7 had the highest sensitivity and specificity for insulin resistance detection. The usefulness of TyG in the recognition of insulin resistance in bipolar patients was suggested. The significant role of psychiatrists in the detection and management of impaired glucose metabolism in bipolar patients was presented.

In recent years it has been increasingly indicated that diet/nutrition is important in the pathogenesis, course and effectiveness of treatment of various mental disorders. Most of the research published so far has focused on the role of nutrition and nutrients in the development and treatment of depression. The results indicated a relationship between diet and risk of depression. Few studies have examined the relationship between diet and bipolar disorder (BD), although it can be assumed that some of the observations related to people with depression may be related to BD. The authors present an overview of the relationship between diet and bipolar disorder and the use of dietary interventions in the treatment of BD. They also discuss the use of nutrients, including polyunsaturated fatty acids, N-acetylcysteine, vitamin D, folic acid, and zinc, in the treatment of BD. For patients, the supplementation of mood disorders treatment with dietary recommendations, supplementation with selected nutrients, supplementation of micronutrients, may provide - in addition to indirect and direct effect on brain function - the possibility of greater co-participation in the treatment, enhancing the sense of control, coping, which may have a significant effect on the course of BD and the effectiveness of its treatment.

Background: Peer support is an established component of recovery from bipolar disorder, and online support groups may offer opportunities to expand the use of peer support at the patient's convenience. Prior research in bipolar disorder has reported value from online support groups., Aims: To understand the use of online support groups by patients with bipolar disorder as part of a larger project about information seeking., Methods: The results are based on a one-time, paper-based anonymous survey about information seeking by patients with bipolar disorder, which was translated into 12 languages. The survey was completed between March 2014 and January 2016 and included questions on the use of online support groups. All patients were diagnosed by a psychiatrist. Analysis included descriptive statistics and general estimating equations to account for correlated data., Results and Conclusions: The survey was completed by 1222 patients in 17 countries. The patients used the Internet at a percentage similar to the general public. Of the Internet users who looked online for information about bipolar disorder, only 21.0% read or participated in support groups, chats, or forums for bipolar disorder (12.8% of the total sample). Given the benefits reported in prior research, clarification of the role of online support groups in bipolar disorder is needed. With only a minority of patients using online support groups, there are analytical challenges for future studies.

There is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information. 1171 patients with a diagnosis of bipolar disorder in 17 countries completed a paper-based, anonymous survey. 81% of the patients used the Internet, a percentage similar to the general public. Older age, less education, and challenges in country telecommunications infrastructure and demographics decreased the odds of using the Internet. About 78% of the Internet users looked online for information on bipolar disorder or 63% of the total sample. More years of education in relation to the country mean, and feeling very confident about managing life decreased the odds of seeking information on bipolar disorder online, while having attended support groups increased the odds. Patients who looked online for information on bipolar disorder consulted medical professionals plus a mean of 2.3 other information sources such as books, physician handouts, and others with bipolar disorder. Patients not using the Internet consulted medical professionals plus a mean of 1.6 other information sources. The percentage of patients with bipolar disorder who use the Internet is about the same as the general public. Other information sources remain important., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

In 2013, a version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), having number 5, was published. The DSM is a textbook which aims to present diagnostic criteria for each psychiatric disorder recognized by the U.S. healthcare system. The DSM-5 comprises the most updated diagnostic criteria of psychiatric disorders as well as their description, and provides a common language for clinicians to communicate about the patients. Diagnostic criteria of the DSM-5 have been popular all over the world, including countries where the ICD-10 classification is obligatory, and are widely used for clinical and neurobiological research in psychiatry. In this article, two chapters of the DSM-5 pertained to mood (affective) disorders are presented, such as "Bipolar and related disorders" and "Depressive disorders" replacing the chapter titled "Mood disorders" in the previous version of DSM-IV. The aim of this article is to discuss a structure of new classification, to point out differences compared with previous version (DSM-IV). New diagnostic categories, such as e.g. disruptive mood dysregulation disorder or premenstrual dysphoric disorder were depicted as well as some elements of dimensional approach to mood disorders were presented.

The objective of the present study was to assess the performance of lithium treated euthymic bipolar patients in tests measuring spatial working memory (SWM), planning, and verbal fluency and to delineate the influence of gender on cognitive functioning. Fifty-nine euthymic bipolar patients, treated with lithium carbonate for at least 5 yr, were studied. Patients and controls underwent a neuropsychological assessment. Bipolar patients had significantly worse results than the healthy controls in the spatial memory and planning as well as verbal fluency tests. We detected a gender-related imbalance in the SWM results. Deficits in SWM were observed in male-only comparisons but not in female-only comparisons. The SWM scores were significantly poorer in male patients than in male controls. In female-only comparisons, female patients did not have significantly poorer SWM results in any category than their controls. Bipolar women scored worse in some other tests. The present study points to the different patterns of neuropsychological disturbances in female and male patients and suggests that sex-dependent differences should be taken into account in order to tailor the therapeutic intervention aimed at the improvement of cognitive functions.

Long-term mood instability and fluctuations in mood are quintessential features of bipolar disorder; however a great majority of of mood rating scales are cross-sectional and focused on acute symptoms. NIMH Life Chart Methodology (NIMH-LCM) and ChronoRecord program on the contrary record the severity, duration and frequency of mood swings. Many bipolar patients need combined treatment and take multiple medications, which is associated with better treatment outcome but also with the increased risk of side effects. Treatment with drug combination negatively impacts the compliance of the patients. Simultaneous assessment of daily mood fluctuations and monitoring of life events and medications may help to optimize treatment and to better detect nuances of partial response. TacyJakJa.pl an Internet site, in which patients keep on-line diaries concerning their course of disease and treatment, makes this tool available to a large number of patients. Not only does it enable the patients to learn about mood disorders, but also it increases their involvement in their treatment.

A number of candidate genes for lithium prophylactic efficacy have been proposed, some of them being also associated with a predisposition to bipolar illness. The aim of the present study was to investigate a possible association between polymorphisms of 14 common genes with the quality of prophylactic lithium response in patients with bipolar mood disorder, in relation to the putative role of these genes in the pathogenesis of this disorder. Some association with lithium prophylactic efficacy was found for the polymorphisms of 5HTT, DRD1, COMT, BDNF and FYN genes, but not for 5HT2A, 5HT2C, DRD2, DRD3, DRD4, GSK-3, NTRK2, GRIN2B and MMP-9. Possible aspects of these genes with regard to the mechanism of lithium activity and pathogenesis of bipolar mood disorder are discussed.

Objective: Matrix metalloproteinase 9 (MMP-9) has been implicated in a number of pathological conditions including cancer and heart diseases, and recently also in such neuropsychiatric disorders as schizophrenia and bipolar illness. Therefore, we investigated a possible association between functional polymorphisms of the MMP-9 gene and the response to lithium, the main mood-stabilizing drug in bipolar illness., Methods: One hundred and nine bipolar patients treated with lithium for at least 5 years were analyzed. The lithium response was assessed as--excellent: no affective episodes during lithium treatment; partial: 50% or more reduction in the episode index; no response: less than 50% reduction, no change or worsening in the episode index. The -1562C/T MMP-9 gene polymorphism (rs3918242) was assessed by PCR-RFLP method., Results: Genotype distributions were not in Hardy-Weinberg equilibrium. No association was found between polymorphism studied and the quality of response to prophylactic lithium administration., Conclusion: The functional polymorphism of the MMP-9 gene, analyzed in this study, may not be associated with the treatment response to lithium in bipolar patients., (Copyright © 2011 John Wiley & Sons, Ltd.)

Objectives: Glucocorticoid receptor has been considered in the pathogenesis of bipolar disorder as it is an important regulator of the circadian rhythm and HPA negative feedback. As glucocorticoid receptor may be possibly related to lithium action we aimed to investigate variation in the GR gene in association with response to lithium treatment in Polish population of bipolar patients., Methods: We analyzed 115 bipolar patients treated with lithium carbonate for 5-27 years. Thirty patients were identified as excellent lithium responders (ER), 58 patients as partial responders (PR), and 27 patients were non-responders. Genotypes of eight analyzed polymorphisms of GR gene (rs10052957, rs6196, rs6198, rs6191, rs258813, rs33388, rs6195, rs41423247) were established by TaqMan SNP Genotyping Assays. Statistical analysis was done with Statistica version 9.0. Linkage disequilibrium analysis was performed in Haploview v. 4.1., Results: We have found significant differences in allele frequencies for BclI polymorphism between patients with different lithium response with C allele associated with excellent lithium response. For the other GR polymorphisms any significant association with different lithium response was found. We observed a strong linkage disequilibrium of five GR polymorphisms (rs6198, rs6191, rs6196, rs258813, rs33388), with TAAGA haplotype more prevalent in the group of partial- and non-responders to lithium., Conclusion: The GR gene variation seems to be involved in the response to lithium treatment in our group of bipolar patients.

Objectives: There is still debate about whether the quality of long-term efficacy of lithium in patients with bipolar disorders is influenced by atypical features. Extended Cox regression models allow for the use of all follow-up data on diseases with multiple episodes. The aim of the present analysis was to apply the best suited of these models to analyze the influence of atypical features on the widely used outcome measure of time to recurrence in a large multicenter cohort of lithium responders established by the International Group for the Study of Lithium Treated Patients., Methods: A conditional extended Cox model with a random frailty term was applied to the data of 336 bipolar I and II disorder patients, all of whom were responders to lithium with treatment for up to 30 years., Results: Differences were found in the long-term outcome, even in patients who have demonstrated a relatively good response to lithium treatment. The hazard for recurrence was negatively influenced by the presence of atypical features, mainly mood-incongruent psychotic symptoms, interepisodic residual symptomatology, and rapid cycling., Conclusions: As a result of the findings, physicians should regularly reassess the quality of response in bipolar disorder patients with atypical features and, if necessary, modify treatment. Extended Cox regression models are well suited for evaluating long-term outcome and should be used more extensively to analyze treatment outcome in psychiatric and somatic disorders.

In bipolar patients, neuropsychological and biochemical disturbances persist into the remission period. Excellent lithium responders (ELRs) comprise around one third of lithium-treated patients and have total remission of recurrences on lithium monotherapy. The objective of the study was to assess the performance on neuropsychological tests and to measure brain-derived neurotrophic factor (BDNF) plasma levels in ELRs compared to patients where the effect of lithium was not optimal, and with matched healthy control subjects. The study was performed with 60 patients on prophylactic lithium treatment, 13 of whom were ELRs, and with 60 matched healthy controls. Neuropsychological tests from the CANTAB battery measuring spatial working memory and sustained attention were used. ELRs performed better on all neuropsychological tests, and had higher plasma BDNF levels than the remaining lithium patients but not different from those of healthy controls. ELRs may constitute a specific subgroup of bipolar patients in which long-term lithium administration can produce complete normality.

FYN belongs to the protein kinase family that phosphorylates NMDA receptor subunits, participating in the regulation of ion transmission and BDNF/TrkB signal transduction pathway. Lithium inhibits glutamatergic transmission via NMDA receptors, exerting neuroprotective effect against excitotoxicity. The aim of this study was to find possible association of three polymorphisms of FYN gene with prophylactic lithium response in the group of bipolar patients. We analyzed 101 bipolar patients treated with lithium carbonate for 5-27 years (mean 15 years). Twenty-four patients were identified as excellent lithium responders (ER), 51 patients as partial responders (PRs), and 26 patients were non-responders. Genotypes of the three analyzed polymorphisms were established by PCR-RFLP. Statistical analysis was done with Statistica. No significant differences in genotype distribution and allele frequencies were observed between T/G and A/G FYN polymorphisms and lithium response. We observed a trend toward association of TT genotype and T allele of T/C polymorphism with worse lithium response. The results of the study demonstrated only marginal association between FYN polymorphisms and prophylactic lithium response in bipolar patients. The results are discussed in light of our previous studies on FYN gene in bipolar illness and BDNF gene in lithium response.

We investigated three polymorphisms in the NMDA receptor 2B subunit gene (GRIN2B) as a candidate gene for lithium response involved in glutamatergic neurotransmission. One hundred five bipolar patients treated with lithium for at least 5 years were analyzed. The lithium response was assessed as excellent - no affective episodes during lithium treatment; partial - 50% reduction in the episode index; or no response - less than 50% reduction, no change or worsening in the episode index. Genotypes for the -200G/T, 366C/G and rs890G/T GRIN2B polymorphisms were established using the PCR-RFLP method. Genotype distributions were in Hardy-Weinberg equilibrium for all three polymorphisms. No association was found between the three polymorphisms studied and the treatment response to lithium. The authors conclude that polymorphisms of the GRIN2B gene did not show an association with the treatment response to lithium in bipolar patients.

The neuroplasticity hypothesis of bipolar disorder indicates that the BDNF/Trk signaling pathway is associated with the pathogenesis of this illness and treatment with mood stabilizers, such as lithium. This paper describes a relationship between response to lithium prophylaxis and polymorphisms of two functionally connected genes: BDNF and NTRK2, in bipolar illness. Analyses of four SNPs of the BDNF gene (rs2030324, rs988748, rs6265 [Val66Met]and rs2203877) and three of the NTRK2 gene (rs1187326, rs2289656, rs1187327) were performed in the 108 bipolar patients, classified as excellent responders (23%), partial responders (51%) and nonresponders (26%) to lithium. An association of C/G (rs988748) and G/A (rs6265) polymorphisms of the BDNF gene with a degree of prophylactic lithium response were found. No association with lithium response was revealed with the polymorphism of NTRK2 gene, neither with interaction of BDNF and NTRK2 genes.

Both serotonin transporter and brain-derived neurotrophic factor (BDNF) genes have been previously implicated in the efficacy of lithium prophylaxis. The aim of the present study was to assess a possible interaction between serotonin transporter genotype (5HTTLPR) and BDNF Val66Met polymorphism, and the prophylactic response to lithium. The study was performed on 111 patients with bipolar mood disorders (43 male, 68 female), aged 30-77 (mean 54 years) who have been treated with lithium carbonate for at least 5 years (5-27 years, mean 15 years). In the group studied, 31 patients (28%) were classified as excellent responders (ER), 54 (49%) as partial responders (PR), and 26 (23%) as non-responders (NR) to lithium prophylaxis. Age at onset of the illness, duration of illness before treatment introduction and on lithium as well as number of affective episodes before lithium treatment did not differ between these three subgroups of patients. A significant interaction between BDNF and 5HTTLPR polymorphism and lithium response was found. S individuals (patients with s/s or s/l genotype) having Val/Val genotype were significantly more frequent in NR compared with ER or/and PR. Also, S individuals showed extreme differences in response to lithium prophylaxis depending on having either Val/Val or (Val/Met + Met/Met) genotypes of BDNF polymorphism: 9/48 (19%) of ER and 18/48 (37%) of NR in the first group, and 12/30 (40%) and 1/30 (3%) in the second group, respectively. The results obtained may show a significant epistatic interaction between 5-HTTLPR and BDNF polymorphism, and response to lithium prophylaxis., (Copyright 2007 Wiley-Liss, Inc.)

Background: The aim of the study was to assess the relative frequency of various kinds of depression in patients with bipolar and unipolar affective illness. The study was performed in the framework of the DEP-BI project aimed at assessing the prevalence of bipolar disorders among depressive outpatients treated by psychiatrists in Poland., Methods: Eight-hundred and eighty patients (237 male, 643 female) participated in the study. The patients were classified into the following diagnostic categories: bipolar affective illness type I, type II, bipolar spectrum disorder and unipolar affective illness. The various kinds of depression in each group were assessed by means of a semistructured questionnaire added to the diagnostic interview., Results: In the group of bipolar patients, a significantly higher frequency of psychotic depression in male compared to female patients was observed. Male bipolar patients compared with unipolar depressed ones had significantly more episodes of psychotic depression (odds ratio, OR, 4.29) and atypical depression (hypersomnia and hyperphagia; OR 2.82), and those with bipolar spectrum had more episodes of treatment-resistant depression (OR 2.56). Female bipolar patients compared with unipolar depressed ones had significantly more frequently an early onset of depression (before 25 years; OR 2.95) and postpartum depression (OR 2.48). On the other hand, the percentage of agitation, irritability, distractibility, thought racing and panic attacks during depression was not different in patients with bipolar and unipolar affective illness either in males or females., Conclusions: Some kinds of depression occur with a higher frequency in patients with bipolar compared to unipolar affective illness. The occurrence of a given type of depression may constitute an aid for the diagnosis of bipolar illness. The results of this study did not confirm the concept of bipolar mixed depression based on the presence of anxiety symptoms occurring during the depressive episode. The limitation of our study may be the lack of formal criteria or a structured interview to assess the symptoms occurring during depressive episodes.

Background: Correct diagnosis and criteria of affective disorders is always a subject of interest to researchers and practitioners., Methods: The study aimed at assessing frequency of various traits and symptoms of bipolar affective disorders (BP-I, BP-II, BP-S spectrum) in patients (n=246) treated for recurrent affective disorders (unipolar-UP). The analysis was based on criteria of affective disorders of Ghaemi et al. and Hirschfeld's Mood Disorders Questionnaire., Results: UP was confirmed in 32.9% of individuals, whereas 19.5% were BP-I, 35% BP-II and 12.6% BP-S. UP patients were significantly more often professionally active than those with BP (37.2% vs. 22.7%). Duration of a disorder was significantly shorter and the number of depressive episodes lower in the UP group. In comparison with UP, BP-I were associated with the previous occurrence of unusual and/or risky behaviour (OR=24.5), excessive, irrational expenditure (OR=21.1), lack of a critical attitude with respect to social behaviour (OR=20.3), increased sex drive (OR=17.7), and excessive self-confidence (OR=12). BP-II were associated with a lack of criticism with regard to social behaviour (OR=12.7) and unusual and/or risky behaviour (OR=10). Spectrum BP were most strongly associated with short term hypomanic episodes, including drug induced episodes (OR=15.8) and lack of criticism (OR=11.8). Early onset of depression (before 25 years of age) increased the risk of all three types of BP (by a factor of 3 to 5)., Limitations: This was a naturalistic study, in which treatment was uncontrolled., Conclusions: Results of the study are a voice in the discussion on too narrow criteria defining bipolar affective disorders.

Unlabelled: Over the last few years researchers have paid a lot of attention to the problem of the correct diagnosis of affective disorders. Propositions have appeared regarding the widening of the officially accepted criteria to be used in diagnosis., Aim: The aim of the study was to assess the probability of various types of bipolar affective disorders (type 1 and 2 CHAD, as well as spectrum) among patients (n = 246) treated for recurrent depressive disorder (CHAJ)., Method: The analysis was based on the broadened criteria for affective disorders introduced by Ghaemi et al. and Hirschfield's Questionnaire on affective disorders., Results: The appearance in the past of strange, risky behaviour was associated with a greater risk of type 1 CHAD in comparison to CHAJ (OR=24.5), as did extreme, irrational expenditure (OR=21. 1), a lack of criticism with respect to one's own social behaviour (OR=20.3), increased interest in sex (OR=17.7), as well as extreme self confidence (OR=12). A lack of criticism with respect to one's own social behaviour and strange, risky behaviour was associated with a greater risk of type 2 CHAD (OR=12.7 and OR=10, respectively). The greatest risk of spectrum CHAD type disorders were associated with hypomania, including drug induced (OR=15.8). as well as a lack of criticism with respect to one's own social behaviour (OR=11.8). Panic attacks appeared more often in bipolar affective disorders in comparison to recurring depressive disorders, but their frequency was similar in all three groups (CHAD-I, CHAD-II, CHAD-S). The early occurrence of depression (before 25 years of age) increased the risk of each of the three types of bipolar affective disorders significantly (by a factor of 3 to 5)., Conclusions: The findings indicate the necessity of discussion on sharp criteria of bipolar affective disorders. The results should be helpful in the diagnosis of such disorders, which could have important consequences for effective therapy.

A relationship between response to lithium prophylaxis and T-50C polymorphism of glycogen synthase kinase-3beta (GSK-3beta) gene was investigated in 89 bipolar patients (41 male and 48 female) who have been taking lithium for at least 5 years. The patients were delineated as excellent responders, partial responders and non-responders to lithium. The results obtained suggest that this polymorphism may not be related to the degree of prophylactic lithium response.

Lithium is one of the most commonly used drugs in the prophylaxis and treatment of bipolar disorder. The mechanisms of mood stabilization by lithium incorporate its effect on serotonergic neurotransmission. This paper investigates a relationship between response to lithium prophylaxis and polymorphisms in two genes: T102C of 5-HT2A receptor and G68C (Cys23Ser) of 5-HT2C serotonin receptor gene. Genotypes were estimated in 92 bipolar patients (39 males and 53 females) who have been taking lithium for at least 5 years. The patients were classified as excellent responders, partial responders and non-responders to lithium. The obtained results suggest that these polymorphisms may not be related to the degree of prophylactic lithium response.

Unlabelled: The main objective of the study was to evaluate the occurrence of bipolarity among outpatients with a recurrent major depressive disorder., Method: The uniDEP-BI study was conducted throughout Poland by 96 psychiatrists from 16 sites, who were trained in the study instruments. The sample was selected from the population of outpatients with at least one depressive episode (n = 880). The final study group included 246 working age adults (75.2% of females) treated for recurrent unipolar disorder. The study questionnaire consisted in the DSM-IV criteria of major depressive episode, (hypo)manic episode, criteria for bipolar spectrum disorder by Ghaemi et al., Results: Unipolar mood disorder was confirmed in 32.9% cases, bipolar I disorder was found in 19.5%, bipolar II in 35% and bipolar spectrum disorder in 12.6% of the assessed patients. Patients with bipolar compared to the unipolar mood disorder had significantly more frequently a family history of bipolar disorder, short (hypo)manic episodes after antidepressive treatment, premorbid cyclo-, hyperthymic or impulsive (borderline type) personality, recurrent depressive episodes, atypical depressive symptoms, early onset of depression (< 25 yrs), distracted attention and panic attacks. Subjects with confirmed recurrent depressive disorder were significantly more often working (37.2% vs. 22.7%). Duration of the illness was significantly shorter and the number of previous depressive episodes was significantly lower in this group., Conclusions: The findings showed that the bipolarity features are more common among patients with unipolar mood disorders. It also points to a need of proper and deeper diagnostics of affective disorders and verification of rules and period of antidepressive and normothymic treatment.

Background: Significant proportion of patients treated for depression may have various types of bipolar mood disorders. The aim of the study was to assess the frequency of bipolar disorders among outpatients having at least one major depressive episode, treated by 96 psychiatrists, representing all regions of Poland., Methods: The study included 880 patients (237 male, 643 female), identified to following diagnostic categories: bipolar I, bipolar II, bipolar spectrum disorder and major depressive disorder., Results: Bipolar mood disorders were found in 61.2% of patients studied, bipolar I more frequent in men and bipolar II in women, and bipolar spectrum in 12% of patients. Patients with age ranges 19-49 and 50-65 years did not differ as to the percentage of diagnostic categories. Patients with bipolar mood disorders compared to major depressive disorder had significantly more frequent family history of bipolar disorder, premorbid hyper- or cyclothymic personality, early onset of depression, symptoms of hypersomnia and hyperphagia, psychotic depression, post-partum depression, and treatment-resistant depression. Bipolar spectrum patients had most clinical features similar to classic types of bipolar disorders., Limitations: Neither structured interview for family history, nor formal criteria for a number of clinical manifestations were used. The population treated by psychiatrists may not be representative and present a subgroup with more severe mood disorders., Conclusions: Bipolar mood disorders may be very prevalent among depressive outpatients treated by psychiatrists in Poland, which is confirmed by the results of recent studies. Bipolar patients (including bipolar spectrum) significantly differ from major depressive disorder as to numerous clinical features related mostly to depressive episode.

Serotonin transporter promoter length polymorphism (5-HTTLPR) has been implicated in the pathogenesis of mood disorders and in the therapeutic response to serotonergic drugs. In this study, the 5-HTTLPR was estimated in 67 patients with bipolar mood disorder, receiving lithium carbonate for prophylactic purposes for the period of more than 5 years (mean 15 years). The patients were divided into excellent responders (n = 18), partial responders (n = 35) and poor responders (n = 14). In lithium non-responders, the genotype s/s and the allele s was significantly more frequent than in excellent and partial responders. The obtained results are discussed in view of other studies showing an association of S genotype with worse response to serotonergic drugs. A supposition is made that prophylactic management of bipolar illness can be optimized by defining 5-HTTLPR genotype.

Aim: To assess the frequency of bipolar disorders among outpatients with affective illness treated by 96 Polish psychiatrists, representing all regions of Poland., Methods: The study was performed on 880 patients (237 male, 643 female). They were identified, according to the criteria used, into the following diagnostic categories: 1. Bipolar affective illness, type I (Bipolar I); 2. Bipolar affective illness, type II (Bipolar II); 3. Bipolar spectrum disorder; 4. Unipolar affective illness., Results: Affective disorders having bipolar features were found in 61.2% of the patients studied, bipolar I more frequent in men (27.4% vs 17.6%) and bipolar II more frequent in women (31.7% vs 21.5%). Bipolar spectrum was identified in 12% of the studied patients. Patients with bipolar affective illness compared with unipolar affective illness had a family history of bipolar disorder significantly more frequently, premorbid features of hyper- or cyclothymic personality, early onset of depression (before 25 years), symptoms of atypical depression (hypersomnia and hyperphagia), episodes of psychotic depression, postpartum depression, and treatment-resistant depression. The group of bipolar spectrum had most clinical features similar to classic types of bipolar affective illness and showed significant differences with unipolar affective illness., Conclusions: In outpatients, who had a depressive episode in the past and were treated by psychiatrists in Poland, bipolar disorders may amount to 60% of them. Patients with bipolar affective illness significantly differ from patients with unipolar affective illness as to the numerous clinical features, not connected with manic, hypomanic or mixed states. The results of the study may also indicate a legitimacy to delineate a bipolar spectrum disorder.

The purpose of the study was to evaluate the efficacy of lithium prophylaxis in patients with bipolar affective disorder and to determine clinical differences between lithium responders and non-responders. Clinical and demographic data of 103 patients treated with lithium for at least 10 years were analysed. 24 patients had no episodes on lithium (excellent responders--ER), in 48--at least 50% reduction of episode index (number of episodes/year) was observed, and the remaining 31 did not benefit from lithium treatment. Duration of illness before lithium introduction was significantly longer in lithium non-responders. Lithium responders had significantly higher episode index before lithium. Percentage of excellent responders diminished during treatment. The trend toward higher lithium plasma level in excellent responders was observed. Non-responders had significantly more depressions during first year of lithium prophylaxis. Depressive episodes during first year of treatment may be a predictor of non-response.

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]

In 2013, a version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), having number 5, was published. The DSM is a textbook which aims to present diagnostic criteria for each psychiatric disorder recognized by the U.S. healthcare system. The DSM-5 comprises the most updated diagnostic criteria of psychiatric disorders as well as their description, and provides a common language for clinicians to communicate about the patients. Diagnostic criteria of the DSM-5 have been popular all over the world, including countries where the ICD-10 classification is obligatory, and are widely used for clinical and neurobiological research in psychiatry. In this article, two chapters of the DSM-5 pertained to mood (affective) disorders are presented, such as "Bipolar and related disorders" and "Depressive disorders" replacing the chapter titled "Mood disorders" in the previous version of DSM-IV. The aim of this article is to discuss a structure of new classification, to point out differences compared with previous version (DSM-IV). New diagnostic categories, such as e.g. disruptive mood dysregulation disorder or premenstrual dysphoric disorder were depicted as well as some elements of dimensional approach to mood disorders were presented. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to assess the prophylactic effect of long-term lithium administration in patients with bipolar mood disorders entering treatment in the 1970s and 1980s at the outpatient clinic of the Department of Psychiatry, University of Medical Sciences, Poznan, Poland. Methods: The clinical characteristics of two groups of patients before and during lithium therapy were compared, namely, the 60 bipolar patients who entered lithium prophylaxis in the 1970s and 49 patients who entered in the 1980s. Both groups received the drug over a 10-year period. Results: The patients who entered lithium in the 1970s had fewer previous episodes of depression and more of mania than the patients who entered the therapy in the 1980s, although the total number of affective episodes was similar in both groups. The overall prophylactic efficacy of lithium over a 10-year period of administration was similar in both groups, except for a trend towards a greater number of depressive episodes in the first year of lithium prophylaxis in the 1980s group. The excellent lithium responders constituted 35% of the 1970s patients and 27% of those in the 1980s group. The 1970s patients were maintained on a higher level of serum lithium compared to the patients in the 1980s group and had more lithium-induced side effects. Conclusions: A decrease in lithium prophylactic efficacy in consecutive decades was not observed. Small differences between the bipolar patients entering lithium therapy in the 2 decades were observed in terms of the previous history of illness and during the course of lithium administration. [ABSTRACT FROM AUTHOR]

Aim, material and method: The aim of the study was to assess the occurrence of bipolar disorder in subjects (N=246) receiving treatment due to recurrent depressive disorders. A structured questionnaire based on the diagnostic criteria of major depression and (hypo)mania according to DSM-IV, the criteria of bipolar spectrum disorder by Ghaemi et al. and the Mood Disorder Questionnaire by Hirschfeld, was used. In 19.5% of the subjects, bipolar I disorder was diagnosed, in 35% -- bipolar II disorder, and in 12.6% -- bipolar spectrum disorder. Such symptoms as excessive sociability, excessive interest in sex, risk and unusual behaviours or irrational money spending were diagnostically the most characteristic of bipolar disorder. Results: Brief episodes of (hypo)mania, including those induced by the use of medicines, as well as the early onset were related to the highest probability of the occurrence of bipolar disorders. [ABSTRACT FROM AUTHOR]