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Background: Cannabis is the most commonly abused drug among patients with bipolar disorder. Available data has shown that the risk of psychotic disorders increases with the frequency and intensity of cannabis abuse. The present purpose was to review relevant studies to investigate whether cannabis use can be linked to the onset of mania in bipolar disorder., Methods: Articles published between 1972 and December 2013 were searched on Medline and PsychInfo using the following keywords: first manic episode, or onset mania, or bipolar disorder and cannabis. Relevant papers cited in the references of selected articles were further considered for inclusion into the review., Results: Lifetime use of cannabis among bipolar patients appears to be around 70% and approximately 30% of patients with a bipolar disorder present a comorbidity of cannabis abuse or dependence. Cannabis use is associated with younger age at onset of first mania and with more frequent depressive or manic episodes, although the evidence is somewhat inconsistent. Likewise cannabis consumption is related to poorer outcome and an increased risk of rapid cycling or mixed episodes. In contrast, neuro-cognitive functioning seems to be positively affected in patients with psychiatric comorbidity. While cannabis use often precedes first manic episodes, the causal direction remains to be determined., Limitations: Variations in definition of cannabis use/dependence. Lack of controlled studies limiting definite conclusions about a putative causal relationship between cannabis and onset of mania., Conclusions: Further investigations are needed to clarify the relationships between cannabis use and first manic episode., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Temperament is considered as a biological disposition reflected by relatively stable features related to mood and reactivity to external and internal stimuli, including variability in emotional reactions. The aim of the present study is to test the hypothesis that affective temperaments might differ according to co-occurring mood disorders among patients with alcohol and/or opiate dependence; to explore the relationship between temperaments and dual substance use disorders (SUDs, alcohol and other drugs). Ninety-two patients attending an alcohol addiction treatment facility and 47 patients in an opiate addiction treatment facility were assessed for SUDs, mood disorders and affective temperaments using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego 39-item auto-questionnaire. Comparison of patients with bipolar disorder, depressive unipolar disorder and no (or substance-induced) mood disorder revealed significant differences for the cyclothymic subscale, with highest scores among patients with bipolar disorder. No difference was observed for the depressive, irritable, hyperthymic and anxious subscales. After adjustment for age, gender and bipolar disorder, irritable temperament was a significant risk factor for past or present history of drug use disorders in patients treated for alcohol addiction (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.05-1.93). Anxious temperament was a significant risk factor for history of alcohol use disorders in patients treated for opiate addiction (OR 3.30, 95% CI 1.36-7.99), whereas the hyperthymic subscale appeared as a significant protective factor (OR 0.65, 95% CI 0.42-0.99). The results highlight the need to consider temperamental aspects in further research to improve the long-term outcome of patient with addictive disorders, who often present complex comorbidity patterns.

Objective: Mental health advance directives (ADs) are potentially useful for bipolar patients due to the episodic characteristic of their disease. The aim of the present study is to evaluate the impact of advance directives based on cognitive therapy (ADBCT) on the number and duration of hospitalizations as well as compulsory admissions and seclusion procedures., Method: Charts of all treatment non-adherent patients and committed patients who wrote their ADs following an ADBCT intervention within a 24 months period prior to the beginning of the study were included. Number and duration of psychiatric hospitalizations for a mood or a psychotic episode as well as compulsory admissions and seclusion procedures were recorded for each patient 2 years before ADBCT and during a follow-up period of at least 24 months., Results: The number of hospitalizations, the number of compulsory admission procedures and the number of days spent in psychiatric hospital reduced significantly after ADCBT in comparison to the 2 years who preceded this intervention., Conclusion: This retrospective data suggest that ADBCT is effective for patients with compliance and coercion problems. However, these results need to be confirmed in randomized controlled trials., Practice Implications: ADBCT seems to be a useful approach for treatment-non-adherent and previously coerced patients.

Objective: To evaluate web-based information on bipolar disorder and to assess particular content quality indicators., Methods: Two keywords, "bipolar disorder" and "manic depressive illness" were entered into popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality. "Health on the Net" (HON) quality label, and DISCERN scale scores were used to verify their efficiency as quality indicators., Results: Of the 80 websites identified, 34 were included. Based on outcome measures, the content quality of the sites turned-out to be good. Content quality of web sites dealing with bipolar disorder is significantly explained by readability, accountability and interactivity as well as a global score., Conclusions: The overall content quality of the studied bipolar disorder websites is good.

Depressive states may at times be particularly tricky to ascertain or confirm during a time-limited consultation. For example, a patient may present with what has been termed as smiling depression. We present the case of a female patient with bipolar II disorder whose difficult-to-ascertain depression could be confirmed by her automatic wristwatch, which regularly stopped when she was hypokinetic as a result of her depression.

Objective: Although the maximal quetiapine doses in the published studies were restricted to 800 mg/day, higher quetiapine doses are not unusual in clinical practice. The aim of the present study was to evaluate the effectiveness, tolerability and clinical reasons associated to the use of high dosage of quetiapine (>800 mg), when used under routine clinical conditions, in a sample of bipolar disorder and schizoaffective bipolar inpatients., Methods: Charts of all bipolar and schizoaffective adult inpatients, who had received quetiapine for a mood episode between 1999 and 2005 were retrospectively reviewed. These charts also included the assessment of manic and depressive symptoms on admission and at discharge using the Beck-Rafaelsen Mania Scale (MAS) and the Montgomery Asberg depression rating scale (MADRS), respectively., Results: Data of 50 patients were analyzed. The overall F in repeated measures ANOVA revealed a significant MAS scores reduction between admission and discharge. MAS scores reduction did not differ between the high and low quetiapine groups. Similarly, a significant MADRS reduction was found. Again, no differences between the high and the low dose group were found. Logistic regression analysis of the 50 patients revealed only mixed episodes predicted high quetiapine dosage., Conclusions: The present study confirms quetiapine efficiency and tolerability in the treatment of bipolar episodes, even in doses > to 800 mg and found a link between quetiapine doses and mixed episodes.

The case of a bipolar patient with concomitant multidrug addiction is described who presented a decrease in valproate plasma level of more than 50% shortly after antiretroviral therapy was initiated. Despite important dose augmentations of up to 4 g/day, plasma levels were difficult to raise to the target concentration of 50 mg/dL. The possible mechanisms underlying the observed pharmacokinetic changes are discussed: (i) a uridine diphosphate-glucuronosyl transferase induction by efavirenz; and (ii) a plasma protein displacement of valproate by efavirenz with subsequent increased elimination of the free fraction.

Unlabelled: Bipolar disorder is a severe mood disorder characterized by recurrence of mania and depression. Despite the use of mood stabilizers, a significant proportion of bipolar patients experience relapse, psychosocial impairment and persistent symptoms. A significant part of patients show poor adhesion to the pharmacological treatment. This article aims to provide an overview of research focusing on psychoeducational and cognitive-behavioral treatment (CBT) of bipolar patients., Method: Studies were identified through Medline searches between 1971 and 2005., Results: Studies on bipolar patients suggest that psychoeducational interventions may improve treatment adherence, illness knowledge, ability to cope with early manic symptoms and tend to reduce the risk of manic relapses. CBT tends to diminish depressive symptoms, improve treatment adherence and reduce the risk of depressive and manic relapses. Most psychoeducational and CBT studies share a common medical model of the illness, thereby making clear distinctions of impact of each intervention difficult. Few studies focused on patients with problems with mood stabilizers adherence. It is now important to develop specific interventions for those patients., Conclusion: According to these studies, bipolar patients are likely to benefit from psychoeducational or CBT interventions added to usual pharmacotherapy. In order to overcome limitations of existing research, future studies should adjust for the effect of pharmacological treatment, the type and severity of psychopathology at baseline, the acceptance of and the adaptability to the illness and it's awareness.

Purpose: - The objective of the study was to determine the level of involuntary treatment that mood disorder patients and their families wish in the event of a manic or hypomanic episode., Method: - A survey was conducted within two self-help organizations during two conventions gathering over 500 patients, along with families and caregivers. A clinical vignette depicting an uncollaborative hypomanic patient beginning to endanger his professional and financial situation and to put undue stress upon his family was presented and followed by an eight-item questionnaire. The level of coercive treatment seen as appropriate was measured by visual analogue scales., Results: - The 503 respondents disagreed partially with the statement that the patient should decide by himself about his hospitalization and partially favored some involuntary treatment over treatment refusal. There was no difference between patients, relatives and caregivers related to acceptance of coercive hospitalization and treatment. Respondents assigned a major role to treating teams and family members in decisions for coercive treatment., Conclusion: - Most respondents (including a majority of patients) support a moderate degree of coercive treatment in the event of a hypomanic or manic state. Surveys of opinions from concerned people could influence, practice, legislation and possibly advance directives that could be written by patients or patients organizations.

Comments on an article about the administration of olanzapine for bipolar depression disorder published in the periodical 'Journal of Psychopharmacology.' Improvement of receptor binding profile; Tolerability to the drug.