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Objetivo: Este trabajo busca determinar las variables clínicas, socio-demográficas, y terapéuticas asociadas a la duración de la internación en un Hospital de Emergencias Psiquiátricas de la Ciudad Autónoma de Buenos Aires (CABA), Argentina. Método: El presente es un estudio analítico, de tipo transversal, en el que se incluyeron consecutivamente 350 pacientes de entre 18 y 65 años, internadas desde junio de 2013 hasta diciembre de 2017 en la sala de internación de mujeres del Hospital de Emergencias Psiquiátricas “T. de Alvear”. Al momento del alta se recabaron datos sociodemográficos, clínicos y sobre las condiciones de externación de todas las pacientes. Resultados: Las variables que predijeron a duración de la internación fueron: diagnóstico de psicosis, la utilización de litio y anticonvulsivantes, estar desocupada, menor autonomía económica, no haber constituido una familia y haber modificado el núcleo conviviente durante la internación. Conclusión: Las variables representativas de vulnerabilidad social y económica se asociaron con la utilización de camas de internación psiquiátrica. Son necesarias políticas públicas que permitan interrumpir la relación entre pobreza y patología mental.

The aim of this study was to determine the clinical, socio-demographic, and therapeutic variables associated with the length of hospitalization in a psychiatric emergency hospital in Buenos Aires City.The present retrospective analytical study included 350 consecutively admitted patients aged 18-65, from June 2013 until December 2017 in a public psychiatric hospital in Buenos Aires City. Data collected included socio-demographic, clinical and discharge conditions.Variables that predicted the length of hospitalization were: diagnosis of psychosis, the use of lithium and anticonvulsants, unemployment, no economic autonomy, not have formed a family and have modified the living support group during the hospitalization.The representative of social and economic vulnerability variables were associated with the utilization of psychiatric inpatient beds. Public policies are requested to interrupt the relationship between poverty and mental pathology.

The aim of this study was to investigate sexual health and sexual risk behaviors for sexually transmitted infections (STI) among women with bipolar disorder (BDW). Sixty-three euthymic women diagnosed with bipolar disorder type I, II or not otherwise specified were included and matched with a control group of 63 healthy women. Demographic and clinical data, structured sexual health measures and extensive assessment of sexual risk behavior were obtained and compared between groups. BDW had casual partners, were in non-monogamous sexual partnerships and had sex with partners with unknown HIV condition more frequently than healthy control women. History of two or more STI was more frequent among BDW. Inclusion of sexual behavior risk assessment among BDW in treatment is necessary to better identify those women with higher risk for STI and to take measures to improve their sexual health. Fil: Marengo, Eliana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Martino, Diego Javier. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Igoa, Ana. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Fassi, Guillermo. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Scápola, María. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Urtueta Baamonde, Mariana. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Strejilevich, Sergio. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina

Background The aim of this study was to investigate reproductive health and level of planning of pregnancies among women with bipolar disorder (BDW). Methods 63 euthymic women, with bipolar disorder type I, II or not otherwise specified diagnosis, were included and were matched with a control group of 63 healthy women. Demographic and clinical data, structured reproductive health measures and planning level of pregnancies were obtained and compared between groups. Results Lower level of planning of pregnancies and higher frequency of unplanned pregnancies were found among BDW. Women with bipolar disorder reported history of voluntary interruption of pregnancies more frequent than women from control group. Current reproductive health care showed no differences between groups. Limitations Data based on self-report of participants and retrospective nature of some collected measures may be affected by information bias. The pregnancy planning measure has not been validated in this population before. Demographic and clinical characteristics of the sample study limit generalization of these findings. Conclusions Adverse reproductive events, as unplanned pregnancies and elective interruption of pregnancies, may be more frequent among BDW. Clinician must be aware of the reproductive health during treatment of young BDW and take measures to improve better family planning access. Fil: Marengo, Eliana. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Martino, Diego Javier. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Igoa, Ana. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Scápola, María. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Fassi, Guillermo. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Baamonde, Mariana Urtueta. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Strejilevich, Sergio. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina

OBJECTIVE: The aim of this study was to identify psychopathological factors associated with long term functional outcome in euthymic bipolar disorder patients and to test new measures of mood instability and symptoms intensity. METHOD: Fifty five patients with more than 12 months of follow-up were included. In addition to traditional clinical variables, the time spent ill was documented using a modified life charting technique based on NIHM life-charting method. New measures, Mood Instability Factor and Mood Intensity Factor, were defined and assessed. Functioning Assessment Short Test (FAST) was used to assess disability. RESULTS: The follow-up period was 3.00±1.51 years. Weeks with subsyndromal depressive symptoms (â=0.133, t=2.556, p=0.014), weeks with mild manic symptoms (â=1.441, t=3.10, p=0.003), and the Mood Instability Factor (â=0.105, t=3.593, p=0.001) contributed to approximately 46% of the FAST total score variance. CONCLUSIONS: New methodologies including subsyndromal symptoms and mood instability parameters might contribute to understand the worse long-term functional outcome that affects a considerable percentage of BD patients even after episode remission. Concerns about therapeutic approaches are discussed. Fil: Strejilevich, Sergio. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina. Instituto de Neurología Cognitiva; Argentina Fil: Martino, Diego Javier. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Murru, A.. Universidad de Barcelona; España Fil: Teitelbaum, J.. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Fassi, G.. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Marengo, Eliana. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Igoa, A.. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias. Programa de Trastornos Bipolares; Argentina Fil: Colom, F.. Universidad de Barcelona; España

Background The relationship between neurocognitive impairment and clinical course in bipolar disorder (BD) is inconclusive. The aim of this study was to compare time to recurrence between patients with and without clinically significant cognitive impairment. Methods Seventy euthymic patients with BD were included. Based on baseline neurocognitive performance, patients were divided into those with (n=49) and those without (n=21) clinically significant cognitive impairment. Both groups of patients were prospectivelly assessed by a modified life chart method during a mean of 16.3 months. Results Patients with some cognitive domain compromised had an increased risk of suffering any recurrence (HR: 3.13; CI 95%: 1.64–5.96), hypo/manic episodes (HR: 2.42; CI 95%: 1.13–5.19), or depressive episodes (HR: 3.84, CI 95%: 1.66–8.84) compared with those patients without clinically significant cognitive impairment. These associations remained significant after adjusting for several potential counfounders such as number of previous episodes, time since last episode, clinical subtype of BD, exposure to antipsychotics, and subclinical symptoms. Limitations We classified patients as with or without clinically significant cognitive impairment, although deficits in different cognitive domains may not be equivalent in terms of risk of recurrence. Conclusions The results did not support the hypothesis that the experience of successive episodes is related to a progressive neurocognitive decline. On the contrary, cognitive impairment could be the cause more than the consequence of poorer clinical course. Alternatively, a specific subgroup of patients with clinically significant cognitive impairment and a progressive illness in terms of counts of recurrence and shortening of wellness intervals might explain the association showed in this study.

Bipolar Disorders are among the ten leading causes of morbity and lithium is considered first-line treatment and the most cost-effective. Nevertheless, its use takes a back seat to other treatment options less effective, safe and more expensive; and the reasons for this remains unclear. The present study investigates clinical concepts related to its underutilization.An anonymous questionnaire concerning different aspects of lithium clinical use (compared efficacy, adverse effects, practical aspects regarding its use, use in special populations) was administered during the XXV Congress of the Argentinean Psychiatrist Association.164 questionnaires were analyzed. Less than one-third of the sample referred lithium as their most frequent treatment option, although almost 60% qualified it as effective. Almost two-thirds considered its utilization as more complex and ill-ascribed adverse effects to it. One third referred not to use it in youth and senior populations.Contrary to current recommendations, lithium is under utilized. This is the first report on the possible causes leading to such phenomena, which can be related to ill concepts regarding its safety, clinical use and adverse effects; although not to its effectiveness.

The aim of this study of 53 persons with bipolar disorder (BD) was to evaluate the relationship between history of exposure to antidepressants (AD) and mood stabilizers (MS) and the percentage of time spent ill.BD outpatients with more than 12 months of prospective follow-up were included. Outcome was documented using a life charting technique. Current and previous exposure to AD and MS were assessed using a scale that provides a quantitative measure of exposure to psychotropic medications. Regression models were used to correct for possible confounders.Previous treatment with AD was an independent predictor of polarity changes (P.001) and mixed symptoms (P = .01). In contrast, "years of exposure to MS" was an independent predictor of time spent asymptomatic (P = .019). The ratio between exposure to AD vs MS was associated with less weeks asymptomatic (P = .03), more mixed symptomatology (P = .019), and more polarity changes (P = .001).Antidepressant exposure was a major predictor of mood instability in the long-term outcome of BD. The ratio used of previous exposure to AD vs MS was associated with poor outcomes, suggesting that the harmful effect of AD may be additive and related to how much they are used.

The main aim of this study was to compare patients with euthymic bipolar I (BDI) and bipolar II (BDII) disorders and healthy controls in measures of social cognition. Additional aims were to explore the association between social cognition performance with neurocognitive impairments and psychosocial functioning. Eighty one euthymic patients with BDI or BDII and 34 healthy controls were included. All subjects completed tests to assess verbal memory, attention, and executive functions. Additionally theory of mind (ToM) and facial emotion recognition measures were included. Psychosocial functioning was assessed with the GAF. Both groups of patients had lower performance than healthy controls in ToM, and a lower recognition of fear facial expression. When neurocognitive impairments and exposure to medications were controlled, performance in ToM and recognition of fear facial expression did not allow predicting if a subject was patient or healthy control. Social cognition measures not enhance variance beyond explained by neurocognitive impairments and they were not independent predictors of psychosocial functioning. Impairments in facial emotion recognition and ToM are mediated, at least partly, by attention-executive functions deficits and exposure to psychotropic medications. Likewise, social cognition measures did not contribute to variance beyond neurocognitive impairments.

Valproate-induced hyperammonemic encephalopathy is a rare but severe and potentially fatal adverse event. Frequently, the use of valproic acid produces an elevation of ammonia levels. In some people, this is associated with the development of encephalopathy without evidence of liver failure, usually reversible with discontinuation or dose reduction. Although there is important evidence about this adverse event in patients with neurologic disorders, the data in the psychiatric setting is scarce. We review the available studies and case reports about valproate-induced hyperammonemic encephalopathy in people treated with valproic acid for psychiatric disorders. We describe the clinical and therapeutic characteristics, and the physiology of this adverse event.