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Background Patterns of altered cerebral perfusion and cognitive dysfunction have been described in Bipolar Disorder (BD) acute episodes and euthymia. Knowledge of the relationship between cognitive function and perfusion in a manic state and status when followed up is still limited. Objective To describe brain perfusion alterations and its relationship with cognitive impairment in patients with BD during manic episodes and after 6 months. Methods Observational‐prospective study in 10 type I BD adults during moderate‐severe manic episodes. We assessed sociodemographic data and clinical variables as well as cognitive function through Screening for Cognitive Impairment in Psychiatry (SCIP‐S). Finally, we performed a Brain Perfusion SPECT using a Tc99m‐ethyl cysteine dimer. Results During manic episodes, patients showed cognitive impairment with a mean SCIP‐S score of 63.8 ± 17.16. This was positively correlated with perfusion measured as relative reuptake index (RRI) at the right temporal pole (ρ = 0.65 p = .0435) and negatively correlated with right the orbitofrontal cortex (ρ = −0.70 p = .0077) and the right subgenual cingulate cortex (ρ = −0.70 p = .0256). Episode severity measured by the Young Mania Rating Scale (YMRS) positively correlated with RRI at the right temporal pole (ρ = 0.75, p = .01). At follow‐up, six patients were taking treatment and were euthymic, we found a negative correlation with the YMRS and RRI at the bilateral orbitofrontal cortex (ρ = −0.8827, p = .019). They did not show significant improvement in cognitive performance at SCIP‐S, and there was negative correlation with the following of the SCIP‐S subscales; processing speed with the bilateral dorsolateral prefrontal, the bilateral medial prefrontal, the left temporal pole cortex RRI, and verbal fluency with the bilateral anterior cingulate cortex RRI. Conclusion Cognitive impairment was correlated with brain perfusion patterns at baseline and follow‐up. Large sample size studies with longer follow‐up are needed to describe the changes in perfusion and cognitive functions in BD., Observational‐prospective study in 10 type I BD adults during moderate‐severe manic episode that evaluates brain perfusion and cognition. Cognitive performance did not improve despite clinical improvement at follow‐up, and it was correlated to neocortical decreased perfusion. Clinical improvement was related to an increase in perfusion at orbitofrontal areas.

OBJECTIVES To characterize the immunological variations of patients with a bipolar disorder (BD) diagnosis in manic (BDm) and depressive (BDd) phases, by the quantification of the serum levels of interleukin (IL)-1beta, -2, -4, -6 and tumor necrosis factor alpha (TNF-alpha). METHODS Twenty physically healthy patients with a BD type I diagnosis and 33 matched controls were studied, after giving informed consent. The inclusion criteria included at least three weeks without any kind of psychopharmacological treatment, Young Mania Rating Scale score > or =20 for BDm (n = 10) and Hamilton Depression Rating Scale score > or =21 for BDd patients (n = 10). Exclusion criteria included any infectious diseases, allergies or any other kind of medical illness that required treatment with immunosuppressors, as well as any other diagnosis in Axis I. Physical and laboratory examinations were performed to rule out any clinical illness. Enzyme-linked immunosorbent assay (ELISA) was used to analyze the serum cytokines concentration. RESULTS BD patients, when compared to controls, showed significant differences (p < or = 0.05) in the serum levels of the measured cytokines. The sub-group of BDd patients showed an increase in IL-6 and TNF-alpha, as well as a decrease in IL-2 concentration. The BDm sub-group, on the other hand, showed an increase in TNF-alpha and IL-4 values, with a low concentration of IL-1 and IL-2. The comparison between both sub-groups suggests that there is a distinctive cytokine pattern for the specific phases of the disorder: for mania, we found a high IL-4 and low IL-1beta and IL-6 concentration, while in the depressive phase, the inverse pattern was found. CONCLUSIONS Our results show the existence of phasic differences in the serum levels of cytokines in BD.

Antimicrobial-induced mania, a rare but important side-effect of erythromycin and other drugs, is frequently under-recognized. Although its incidence - considering the wide use of antimicrobials - is statistically low, it should be regarded as a potential risk for patients both with and without a history of a mood disorder. Reports of manic reactions induced by antibiotics related mostly to new compounds have increased; a recent review on the topic, including published and non-published reports, found clarithromycin and ciprofloxacin to be the most frequently associated with the development of mania (Abouesh et al., 2002). Clarithromycin (Klaricid®) is an antibiotic useful in the treatment of upper and lower respiratory tract infections, local infections caused by MAC complex ( Mycobacterium avium or M. intracellulare ) and for the eradication of Helicobacter pylori . Common side-effects include nausea or vomiting, abdominal pain and diarrhoea. Rare side-effects include hepatitis, rash, anaphylaxis, Stevens-Johnson syndrome and ventricular arrhythmias. Side-effects to the central nervous system (CNS), which are not common, include anxiety, dizzness, disorientation, hallucination and insomnia. We report here a case of a manic reaction attributed to clarithromycin, in a patient without a previous clinically identified mood disorder.