The aim of the study is to evaluate the frequency of subsyndromal mood disorder in artists.

We have recruited 84 artists, 23 women, 61 men, mean age 33.6+ 12 years, 57.1% professional comedian artists ; Diagnosis of hypomania and dysthymia was accorded to Mini DSM IV criteria. The software Epi info 6 was used for data analysis

67.9% were single and 25% were married, About half of the sample have low level economic socio (150 $/ month),35.7% consumed alcohol and 11.9% consumed hachich.

Hypomania was diagnosed in 52.4% artists, hypomania passes was diagnosed in 28.8% artists, 2.7% have dysthymie and 44% have cyclothymia, 3.6% have no mood disorder past and no actual mood disorder,There was a correlation between the prevalence of the hypomania and the marital status (frequent at single), and with the age (frequent at young). As well as between the dystymia and the sex (frequent at men). No relationship was found between hypomania or dysthymia and level of study, social class, consumption of alcohol and hachich.

In our data sub syndromal desorder in artist is frequent specially hypomania and cyclothymia that confirm that this population must have special managment.

Major depressive episodes are the main features of bipolar disorder (BD) and finding an efficient therapy represents a tough challenge especially when BD associates diabetes mellitus (DM). Atypical antipsychotics proved efficacy in monotherapy and more so in association with mood stabilizers, but choosing the atypical antipsychotic requires special cautions due to metabolic adverse effects.

To choose a therapeutic scheme that improves rapidly acute depressive symptoms and has a good endocrine-metabolic tolerability.

Male BD patient, 49 years old, hospitalized for a major depressive episode while taking poly-pharmacological treatment. The patient also has DM for which he takes two oral anti-diabetics. When inpatient, he had persistent hyperglycemia (>250mg/dl). DM's complications (poly-neuropathy, myocardial and retinal angiopathy) and diabetic status oriented us choosing quetiapine (600mg/day) for both antidepressive effect and its safe metabolic profile. We used as adjuvant valproat (1000mg/day). Antidiabetic medication was adjusted following the clinical outcome. Instruments: depression (MADRS), mania (YMRS), CGI-BP, diabetes (glycemia, HbA1c, glycosuria, body weight, ECG), adverse events and relapse (follow-up 6 months). The evaluations were performed weekly during hospitalization (6 weeks) and then monthly.

Quetiapine and valproat therapy led to depressive symptoms remission (MADRS <50% vs. baseline). At the same time, the metabolic effects were minimal. DM was compensated (glycemia <120mg/dl). These results maintained till the end of the follow-up period.

Acareful option for treatment and monitoring of BD associated with DM is necessary to obtain an optimal therapeutic response and to maintain remission for a longer period of time.

Accumulating evidence proposes BDNF as a candidate molecule in the pathophysiology of affective disorders. Reduced levels of peripheral BDNF have been found in drug-free patients with major depressive disorder (MDD), in drug-treated depressed or manic patients with bipolar disorder type I (BD-I), but not in drug-treated euthymic BD-I individuals. No study explored BDNF serum levels in patients with bipolar disorder type II (BD-II). Our aims were to confirm previous findings on peripheral BDNF in MDD and BD-I patients; to explore circulating BDNF also in patients with BD-II; to exclude the influence of comorbid psychiatric disorders on BDNF levels in affective patients.

We measured serum BDNF concentrations in 85 subjects, including 24 euthymic patients with unipolar depression (UD), 17 euthymic patients with BD-I, 11 euthymic patients with BD-II, 11 UD patients with a current major depressive episode and 22 drug-free healthy controls. At the assessment time, 15 patients were drug-treated; the remaining ones were drug-free for at least 4 weeks.

As compared to healthy controls, serum BDNF concentrations were significantly reduced in all the patient groups with no significant inter-group differences. Drug treatments and comorbid psychiatric disorders had no effect on lowered circulating BDNF levels in affective patients.

Present results confirm previous findings of reduced BDNF in patients with MDD and reveal, for the first time, that serum BDNF levels are decreased also in euthymic patients with UD, BD-I and BD-II, independently from drug treatment status and concomitant Axis I psychiatric disorders.

Bipolar Affective Disorder is one of the ten most disabling diseases.UK Guidelines recommend that specialist opinion is saught for difficult to treat patients and our aim was to characterize the Bipolar Patients referred to a Specialist Tertiary Centre.

A consecutive sample of thirty patients referred, who met ICD 10 criteria for Bipolar Disorder, were studied. Information was collected from the patient files. Recorded variables included socio-demographic, clinical and treatment characteristics.

20% were male, 80% female. The mean age was 46.2 years old (SD 13.5).The modal age of first episode of mental illness was 18.5 years. High rates of unemployment (76.7%) and family history of mental illness (93.3%) were found. 30% were Bipolar I, 63.3% Bipolar II, and 6.7% Bipolar III. 56.7% met criteria for Rapid Cycling. 83.3% had anxiety features, 73.3% a risk of self- harm and 53.3% psychotic symptoms. Low rates of substance misuse were found.73,3% had a concurrent medical illness. The mean number of psychotrophic medications was 3.23(SD 1.54) and ECT was tried in 23.3% of the patients.

This sample had higher rate of rapid cycling than found in routine bipolar populations. The majority of patients were at a high risk of self-harm, showed features of anxiety, had a positive family history and concurrent medical illnesses which worsened their prognosis and turned them into a “very difficult to treat” group. The characteristics of the sample satisfy the referral policy of the Centre and the current and draft UK Guidelines.

Structural brain abnormalities of the medial temporal lobe have been found in people with bipolar disorder (BPD). It is not known whether these abnormalities progress over the course of the illness.

We conducted a prospective cohort study of 20 patients with bipolar disorder and 21 control subjects recruited from the community. Participants were group matched for age, sex and premorbid IQ. Longitudinal change in grey matter density was evaluated using the technique of tensor based morphometry (TBM) in SPM2.Changes in grey and white matter density were estimated and compared to changes in cognitive function and clinical outcome.

Patients with bipolar disorder showed a larger decline in hippocampal, fusiform and cerebellar grey matter density over 4 years than controls. No significant changes in white matter density were found. Reductions in temporal lobe grey matter correlated with decline in intellectual function and with global assessment of functioning. No associations were found with medication.

Patients with bipolar disorder lose hippocampal, fusiform and cerebellar grey matter at an accelerated rate compared to healthy controls. This tissue loss is associated with a corresponding deterioration in cognitive function.

The enduring cyclic evolution of bipolar disorder affects various psychological and functional aspects.

70 bipolar subjects, from the evidence of the Second psychiatric Clinic Cluj, were assessed by: a socio-demographical questionnaire, MADRS, YMRS, WHO-QOL Bref, GAF. Controls were 30 matched subjects diagnosed with dermatological diseases.

Quality of life, functionality are decreased from the first mood episode, but decrease seriously with the progression of the disease and number of episodes. Items regarding independency, joy of life, sexual satisfaction, efficiency were significantly decreased compared to somatic patients.

The progression of the disorder, comorbidities are interrelated.

Single mood events, the turn-over and number of episodes, various comorbidities, longterm treatments significantly affect in adults the quality of life, functionality, leading to demoralization, social dependence.

Bipolar disorder not otherwise specified (BPD-NOS) may be a waste-basket diagnosis for patients who do not fit into the well-defined criteria. There are few studies investigating the course and features of BPD-NOS and some authors claimed that the frequency could be higher than expected. Özcan et al (2003) found that 9% of the bipolar patients in a university research clinic specialized in bipolar disorder were diagnosed as BPD-NOS. Frequency of BPD-NOS among bipolar patients hospitalized in year 2006 in a a tertiary care state reference hospital in İstanbul/Turkey and features leading to the diagnosis as “atypical” are investigated.

Files of patients hospitalized in 2006 were evaluated retrospectively. Of the 6423 general psychiatric hospitalizations, 1463 were diagnosed as mood disorders. Forensic and adolescent patients, as well as alcohol & substance abuse co-morbidity were excluded.

There were 821 (56%) male and 642 (44%) female mood disorder patients. BPD-NOS diagnosis among all mood disorder patients were 194 (13.2%). Re-hospitalization rate of patients treated with the diagnosis of BPD-NOS was 6.7%. Duration of illness, episode duration, symptom variety and treatment responses were he most common features “making the diagnosis atypical”.

A more systematic and detailed evaluation is needed for appropriate acute or preventive treatment. Studies are needed on patients with BD-NOS with comorbid schizophrenia or delusional disorder as specified in DSM-IV-TR.

The object was to explore behavioral disorders at adolescent of female sex with a primary cerebral dysfunction.

49 adolescent of female gender in age of 11-16 with a primary cerebral dysfunction, behavioral disorders and with intelligence quotient more than 80 on the Wechsler's scale were observed. All adolescent were explored with clinical, neuropsychological and neurological methods.

At all adolescent were early psychical disorders (in 100% of cases), brain trauma in age of 7 (22%) and negative sociological environment (79%). They had symptoms of psychoorganical syndrome with behavioral and emotional disorders. These disorders were presented by such psychopathological variants as apathic (15%), labile (38%), hyperactive (41%) and aggressive (16%). The spectrum of the behavioral disorders was studied in the relation to the age. The standard development of behavioral disorders was noticed in the age of 7-10. The worsening of cerebral dysfunction, psychopathological traits of personality disorders were in the age of 12. And the formation of the psychopathy with behavioral disorders was in the age of 16.

The behavioral disorders at adolescent of female sex with primary cerebral dysfunction were bound with gender and options of psychoorganical syndrome.

Suicidal risk is very high among bipolar disorder (BPD) patients. Risks of suicide attempts are not as well quantified but remain the most important factor for predicting risk of completed suicide.

We retrospectively evaluated 88 patients diagnosed as bipolar I, II, or unipolar depression. Of these, 44 had made at least one suicide attempt, and were matched for age, sex and diagnosis with 44 patients who had never attempted suicide.

In the univariate contrasts, suicidal patients were more likely to be: men, single, younger currently but not at onset, bipolar, substance abusing, and being unemployed. In a logistic regression only older age in the control group and occupation held the significance.

Study findings may not generalize to other samples, settings, and treatments.

Our results support previous finding of literature but overall add a consistent emphasis on the role two variables involved in the precipitation of suicide attempts in bipolar and unipolar patients, that is the role of age and that of occupation. The former may be identified as Trait-dependent risk factors (unchangeable) the latter as State-dependent risk factors (which can potentially be modified).

According to Axer's definition a social network is a certain number of people with whom a person remains contact. These people provide stimuli - both positive and negative. In everyday life and even more during the periods of disease all people need to experience positive aspects of their network - especially support.

The purpose of the research is to analyze the structure of social networks as well as types and sources of support received by patients with bipolar affective disease (BID).

The study group consisted of euthymic outpatients (40 patients). The control group consisted of healthy volunteers of sex and age corresponding to the case group. Assessment of a structure of a social network and the amount of support received was made according to Bizoń's questionnaire and Cohen's ISEL.

It has been shown that social networks of BID patients differ from the ones of healthy people. Patients have social networks characterized by the structure and activity comparable with that of healthy people. But often there is only one person who carries the whole burden of support. When compared to the control group these patients receive less support, and the emotional support is the most deficient.

Information about a patient's social network may be helpful when planning treatment in hospital as well as preparing psychosocial interventions in an outpatients' clinic. The information enables to recognize deficiencies so as to make attempts to reorganize or reconstruct a network.

According to Aaron Beck dysfunctional thinking patters appear also in euthymic patients, after withdrawal of acute disease's symptoms. Patients have disordered, negative image of themselves, of their future and the surrounding world.

It has been shown that a way a man perceives possessed social support has for him a basic meaning.

The purpose of the research is to analyze the relationship between perceived social support and patient's cognitive style.

The study group consisted of euthymic outpatients diagnosed with recurrent depressive disorder (40 patients) or bipolar affective disorder (40 patients). The control group consisted of healthy volunteers of sex and age corresponding to the case group. Assessment of a cognitive style was made according to Rosenberg Scale, Hopelessness Scale HS-20 and Automatique Thoughts Questionnaire ATQ 30, assessment of the amount of received support - according to Cohen's ISEL.

The presented study revealed that, in both groups of patients, a thinking style is disturbed and that there is a link between a cognitive style and the perception of the level of received support. The link was stronger in the group of patients with unipolar affective disorder. In both groups correlations concerning the emotional support were the highest.

The most important therapeutic implication of the obtained results is confirmation or emphasis of the existence, in the therapy of affective disorders, a common field for cognitive-behavioral therapy and psycho-social interventions. According to shown correlations an improvement in functioning on one field may positively influence other.

Research suggests that cannabis use negatively impacts on onset and outcome of schizophrenia. Possible effects in mood disorders have received little investigation. The first study analysing the influence of cannabis exposure on clinical and social treatment outcomes within a bipolar disorder (BP) population during 1 year of treatment is presented.

3684 patients were enrolled in an observational study when psychotropic treatment for mania was initiated/changed. The influence of cannabis exposure on baseline-corrected clinical and social treatment outcome measures was examined. Mediating effects of six variables on associations between cannabis and outcome measures were investigated further.

Over 12 months of treatment, cannabis users exhibited higher levels of BP overall illness severity, mania and psychosis, and less severe depression symptoms compared to non-users. These associations were most frequently mediated by abuse of alcohol and other substances. Users more frequently abused alcohol and other substances; these associations were not mediated by other variables. Cannabis users engaged in more social activities but had a higher probability of not having a relationship and fewer dependents to care for. Associations with activities and dependents to care for were mediated by various variables, whereas no variables mediated the association with not having a relationship.

Cannabis use impacts on clinical outcomes in patients with BP, with a modest impact on social outcomes. More research is required to further elucidate the mechanism by which cannabis exerts its influence. Understanding the associations between cannabis use and outcome measures may offer valuable insights into treatment strategies.

Studies have consistently indicated a strong association between mood and substance-related disorders, which is even greater for bipolarity. The goal of this study is to verify the validity of this association throughout the bipolar spectrum and if there is a dose-response gradient.

We performed a systematic review in Medline and Lilacs for articles published since 1980, using the keywords “substance” and “bipolar” associated with “dual diagnosis”, “co occurrence”, “comorbidity” or “coexistence”. 370 articles were retrieved, of which 8 were selected according to the following inclusion criteria: population studies; approaching specifically this comorbidity; and discriminating different subtypes of affective disorders according to DSM (-III, -III-R or IV) or ICD 10 criteria.

56.1 to 62.3% of bipolar patients present any addiction lifetime, which corresponds to an OR of 3.6-18.9. The magnitude of this association is greater for BD I in relation to BD II (OR 3.9-18.9 vs. 3.6-9.0). This co-occurrence is significant even for subsyndromic bipolarity (OR 2.5-4.3). More severe bipolarity coexists with more harmful patterns of substance consumption: BP I is more associated with drug dependence (OR 11.1), while BP II presents a greater chance of substance abuse (OR 3.9). Subsyndromic bipolarity is more associated with alcohol dependence (OR 3.2-23.8).

The whole bipolar spectrum poses a significant chance of a comorbid substance disorder in a dose-response gradient: The greater the severity of bipolar disorder, the greater its association with any addiction and with more harmful patterns of substance consumption.

Selective mutism is an acquired disorder of interpersonal communication in which the child refuses or withholds the speech in some circumstances while displays normal speech in other situations. It is a relatively rare disorder and it appears to be slightly more common in girls than boys. Different etiological explanations have been hypothesized and we often find comorbidity with other psychiatric pathology. However the most frequent association occurs with social phobia, with values of 90 to 100% of comorbidity being referred in some studies.

The authors undertook a review on this subject, focusing on different aetiology approaches, including genetics, temperamental, psychological, developmental and social conceptualizations. Issues concerning assessment and treatment were explored as well. They point out the importance of an integrative approach of the several theories described, in order to understand the complexity of the pathology and consequently achieve more accurate treatment strategies.

Although rare, selective mutism deserves particular attention because this condition can have dramatically negative effects on social and educational functioning in childhood reflecting later in adult life.

Though a number of agents are available to treat acute manic episode but either because of their comparable efficacy to lithium or their dose related side effects, need for better agent is always being felt.

To study the efficacy and side effect profile of lamotrigine and its double blind comparison with lithium in acute mania.

We recruited 50 patients with diagnosis of manic episode according to DSM-IV and were divided into two groups. One group was given lamotrigine 100mg and another lithium 900mg in a double blind fashion. Patints were assessed subsequently on BPRS, CMRS,UKU side effect scale and CGI till next 28 days.

Subjects in lamotrigine group did not show much improvement at the end of 4th week as compared to lithium group. Side effect profile of both groups were in accordance with reported literature except that 61.9% patients in lamotrigine group showed weight loss. Also rash were found in only 3.5% of the lamotrigine group even with such a rapid escalation of the dose.

We found that lamotrigine is ineffective in case of acute manic episode when compared with lithium.

Evaluate the suicide behaviour of the bipolar patient, to understand how and when this kind of behaviour may occur, what are the risk factors that can increase this occurrence and what are the possible preventive strategies.

Retrospective study in a sample of 84 patients (42 of female sex and 42 of male sex) chosen aleatorially and admitted in Sobral Cid Hospital with bipolar disorder diagnostic. The work was authorized by the ethics for Health Commission of the Sobral Cid Psychiatry Hospital.

In the total of 84 patients with bipolar disorder, there were 206 admissions, 122 of them were readmissions. The mean age was 44.5 ± 14.9 years, half were single/divorced and the majority of patients with bipolar type I diagnosis (81%). In what concern to the total of admissions, 43% patients were in maniac phase, 36% in depressive phase, 13% in mix phase, and just 8% in hippomaniac phase. There were suicide behaviours in 29%, and suicidal ideation (19%) was the most frequent. Suicide attempts occurred in 10% of admissions. In those admissions with suicidal ideation, the patients were in the majority of times in depressive and mixed phase (85%), as well as those with suicide attempts (95%).

Bipolar disorder, suicidal ideation, suicide attempt.

The depression prevalence is 40-70% in teenagers.it is twice as many as boys. Insufficient parents' attention to psychosocial need satisfaction (PSNS) can be effective in teenagers depression. This research studied the depression and PSNS in girl students living in Kashan –IRAN 2006

It was a Descriptive- Cross sectional research that studied 509 high school students whom were selected randomly from the schools of Kashan 2006.The Beck questionnaire were used for depression determination ;scores less than 5,5-7,8-15and more than 16 were considered normal, mild, moderate and sever depression. The PSNS was studied by a researcher made questionnaire that its reliability and validity has been assessed scores which were considered for low psns was 1-31,moderate was 32-62 and high psns was 63-93. X2 and T test were used to analyze the data.

The research showed that 53/3% of girls was depressed. The high PSNS were 49/9%, 62/2%, 84/1% and 87/3% in sever,moderate,mild and no depression girls respectively which showed significant direct relationship between PSNS and depression. The girl who were fully satisfied of psychosocial needs showed just 2/9% severe depression while the depression was 50% among girls with low PSNS (p<0/05).

The parents' attention to psychosocial needs of teenagers can decrease depression in teenagers.

Psychosocial need satisfaction, Teenager, Depression

The objective of this study is to assess the frequency of adult Attention Deficit Hyperactivity Disorder (ADHD) comorbidity and the effect of ADHD comorbidity on various demographic and clinical variables in patients diagnosed with bipolar disorder (BD).

103 patients with BD (51 female, 52 male) presenting at outpatient clinic of the BD Unit of the Department of Psychiatry of Çukurova University Faculty of Medicine were included in this study. All patients were evaluated for the presence of adult ADHD diagnosis and comorbidity using the entire SCID-I and the childhood ADHD sections of K-SADS-PL. Furthermore, the patients have also completed the Wender Utah Rating Scale (WURS-25) and Present Symptoms Scales.

13 of the 103 patients diagnosed with bipolar disorder (12.6%) were diagnosed with adult ADHD. BD patients with ADHD comorbidity had mood episodes at an earlier age and had higher numbers of previous total episodes, depressive and hypomanic episodes and higher numbers of hospital admittances than those without comorbidity. Overall, a larger portion of the patients with comorbidity had axis I comorbidities and panic disorder and alcohol abuse disorders were found at higher rates.

Adult ADHD is a common comorbidity in BD patients, which adversely affects the course of the disease and disrupts the social adjustment of the patients. Regular monitoring and scanning that keeps in mind the diagnosis of ADHD, will help prevent the problems and complications in the disease process, particularly in patients with early onset BD.