Asenapine is the most recent compound that hasbeen FDA- and EMA-approved for treatment of mania. Its efficacy and safety havebeen assessed in placebo-controlled trials, but little is known about itsperformance in routine clinical conditions. The MANACOR study assessed costsassociated with treatment of mania in several hospital settings acrossCatalonia, Spain. As part of the protocol, we compared cost-effectiveness ofasenapine versus other treatment options.

A combined prospective and retrospective datacollection and analysis was conducted from January 2011 to December 2013following a clinical interview and assessment of manic and depressive symptoms(YMRS, HDRS-17), clinical state (CGI-BP-M), psychosocial functioning (FAST),sexual dysfunction (PRSexDQ) and health resource costs associated withtreatment with asenapine versus other antipsychotics.

152 patients from different university hospitalswere included. 53 patients received asenapine and 99 received otherantipsychotics. Considering inpatients (N=117), those treated with asenapinepresented a significantly less severe manic episode (p=0.001), less psychoticsymptoms (p=0.030) and, more comorbid personality disorder (p=0.002). Regardingoutpatients, those treated with asenapine showed significantly less severemanic episode (p=0.046), more previous mixed episodes (p= 0.013) and, moresexual dysfunction at baseline (p=0.036). No significant differences were foundin mean total costs per day.

Non-randomized study design.

Clinicians tended to use asenapine in patientswith less severe manic symptoms but more complex clinical profile, includingmore mixed episodes in the past, concomitant personality disorder, and sexualproblems. Treatment with asenapine was not associated with higher costs when comparedto other options.

Frailty is a state of increased vulnerability that entails a high risk of adverse outcomes. While traditional approaches define frailty as an exclusively physical condition, there is an increasing number of authors that include psychological and social components in the conceptualization of the syndrome.

Assuming a multidimensional approach to frailty, this study aims to examine which domain (physical, psychological or social) is the most significant predictor of disability and quality of life.

A longitudinal study was designed recruiting 95 community-dwelling elderly. Frailty domains were assessed at baseline with the Tilburg Frailty Indicator. Disability in basic and instrumental activities of daily living/ADL and IADL were measured with the Barthel Index and with the Lawton and Brody Scale. Quality of life was evaluated with EUROHIS-QOL-8 and WHOQOL-OLD.

The mean age of the participants was 78.5±6.2 years, and most were women (67.4%). After controlling for life-course determinants and comorbidity, physical frailty contributed to the prediction of most of the adverse outcomes: ADL disability (3.3%), IADL disability (2.2%), global quality of life (EUROHIS-QOL-8: 4.7%; WHOQOL-OLD: 2.9%) and quality of life facets: sensory abilities (4.5%), social participation (5.6%), death and dying (3.0%) and family/family life (2.8%). Psychological frailty predicted past, present and future activities (7.2%) and intimacy (4.0%), whereas the effect of social frailty was not significant when compared with the other domains.

The results of the present study highlight the relevance of physical factors, but also the importance at least of the psychological components, in the definition of frailty.

Assess prevalence and clinical relevance of 'with mixed features” using a more liberal (2 opposite pole symptoms) compared to the more conservative DSM-5 (3 opposite pole symptoms) threshold in depressed bipolar disorder (BD) patients.

BD outpatients were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation. Prevalence and clinical correlates of baseline depressive episodes 'with mixed features” were compared using a more liberal threshold and the more conservative DSM-5 threshold.

Among 503 BD patients, 151 (30.8%) had baseline syndromal major depressive episodes, among whom 'with mixed features” occurred in 22.5% (34/151) using a more liberal threshold, but in only 9.9% (15/151) using the more conservative DSM-5 threshold. Hence, the rate of 'with mixed features” for depressive episodes using the more liberal compared to the conservative threshold was more than twice (2.3 times) as high (Chi-square=8.8, p=0.004). Moreover, the more liberal threshold yielded more important statistically significant clinical correlates of 'with mixed features” compared to pure depressive episodes, which were not significant using the more conservative DSM-5 threshold. Specifically, using the more liberal threshold, mixed compared to pure depression was associated with more anxiety disorder comorbidity and alcohol use disorder comorbidity, and less antidepressant use.

Further studies are warranted to assess our preliminary observation that a more liberal 'with mixed features” threshold for bipolar depression may be more inclusive and have more clinical relevance.

Neurocognitive deficit is present in both recurrent depressive disorder and bipolar disorder, both during the acute episode and euthymia.

Identifying differences in neurocognitive functioning of depressive bipolar, depressive unipolar patients and a healthy control group.

This study was conducted in Timisoara, Romania, between 2009 and 2013 and consists of inpatients from the Timisoara Psychiatric Clinic, diagnosed with either bipolar disorder (n=65) or recurrent depressive disorder (n=87), according to ICD-10 criteria and a healthy control group (n=70). For assessing neurocognitive functioning we used the d2 Test of Attention and the Rey verbal memory test.

We found statistically significant differences (p<0.001) between the patient groups and the control group regarding 'Total Number of Items Processed” (TN), 'Percentage of Errors” (E%) and 'Concentration Performance” (CP). We found no significant statistical differences between the two patient groups regarding the aforementioned parameters.

During depressive episodes, the severity of the neurocognitive deficit is similar in both bipolar and unipolar patients.

This study aimed to 1) determine changes over time in PwD and caregiver ratings of PwD QoL 2) to identify the factors associated with any changes in QoLratings and 3) to identify any discrepancies between PwD and caregiver ratings of PwD QoL.

Using a longitudinal design, we investigated QoL of 69 people with mild Alzheimer’s disease and their caregivers. We examined the influence of awareness of disease, cognitive status, mood, functionality, neuropsychiatric symptoms and burden. Univariate and multivariate regression analyses were conducted to examine the contribution of the various co-factors.

At baseline, we observed that caregivers’s QoL was associated to PwD QoL (t= 3.557, p< 0.001) and mood (t = −3.673, p < 0.001). PwD QoL was associated to caregivers’s QoL (t= 5.087, p<0.001). After one year, caregiver’s QoL was associated to awareness of disease (t=-2.196, p< 0.05) and PwD mood (t=-2.242, p< 0.05) and QoL (t=3.696, p<0.001). PwD QoL was associated to caregivers’ QoL (t=4.596, p<0.001).

In mild dementia, the cognitive impairment and functionality were not the primary factors that accounted in PwD and family caregivers’ ratings of QoL. Our findings suggested that there was an association between PwD and caregivers’ QoL over time. In addition, non-cognitive factors, such as awareness of disease and mood played an important role in PwD and caregivers’ QoL ratings.

This study investigates the factors associated with the impairment of awareness in mild dementia.

Using a longitudinal design, 69 people with mild Alzheimer's disease (AD), and their family caregivers were interviewed and reassessed after one year. The dyads completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), the Quality of Life in Alzheimer's Disease Scale (QoL-AD), the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR) scale, the Cornell Scale for Depression in Dementia (CSDD), the Pfeffer Functional Activities Questionnaire (PFAQ), the Neuropsychiatric Inventory (NPI), and the Zarit Burden Interview (ZBI). Univariate and ordinal regression analyses were conducted to examine the contribution of the various factors.

The level of awareness of disease presented a significant difference (p<0.001) between baseline and after one year. After one year, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. At baseline, ordinal regression showed that impaired awareness was associated with cognitive function (p<0.05) and ADL (p<0.001). After one year, the predictors of impaired awareness were ADL (p<0.001), low levels of PwD QoL-AD reported by caregivers (p<0.05) and higher levels of caregivers’ formal education (p<0.05).

At least in the earlier stages of dementia, it should not be assumed that awareness will inevitably decrease as dementia progresses. The results confirmed that awareness and cognition are relatively independent, and showed that in mild PwD awareness is mainly manifested by poor recognition of changes in ADLs.

Bipolar disorder is complex and it can be difficult to diagnose. Hypomania is considered normal and not diagnosed, so bipolar II disorder often it is misdiagnosed as recurrent major depressive disorder. How much of major depresiv disorder is actually bipolar disorder? The concept of bipolar spectrum will help in reducing undiagnosed bipolarity. Disclose of hypomania is a important factor for the identification of bipolar II disorder.

Bipolar spectrum disorder is a continuum from pure depression to symptoms of mania along a horizontal and vertical plan.

This study aims to examinante major depression according to a new view of the bipolar spectrum and provide to answer the question: What part of major depression is in fact bipolar depression?

Were interviewed 190 patients adult with MDD, first episode or recurrent depression. Used the Hypomania Checklist-32 and Mood Disorder Questioner to identify symptoms of hypomania which will show us bipolar disorder hidden between major depresiv disorder. Patients underwent a detailed psychiatric assessment using categorical criteria of DSM-IV for bipolar disorder and dimensional criteria (tolerant criteria) of Zurich study (2005).

Interviews were taken over a one year period 2011-2012.

The tests HCL-32 and MDQ showed that about 20% (1/5) of depresive patients meet criteria for hypomania according to DSM-IV criteria. These patients are in fact bipolar disorder, treated as major depressive disorder. Refereed dimensional criteria, 24-39% (1/4-1/3) are in fact bipolar disorder.

A major part of MDD is in fact Bipolar Disorder and should be treated as such.

the Medline database was searched for 2014 publications using the following keywords: ‘clozapine’; ‘refractory bipolar disorder’; ‘ effectiveness’; ‘ side effects’.

Medline search returned 110 results. Manual inspection of abstracts allowed selecting six papers for further review.

The first meta-analysis of the efficacy of clozapine in the treatement of refractory bipolar disorder, published in2014,showed the effectiveness and safety of rapid clozapine titration by decreasing the need for psychotropic co-medications, and reducing the number of psychiatric hospitalization. Other papers suggested that this molecule present adverse reaction associated with problems in clinical and biological tolerance which explains its abondan.

clozapine used at low dose is a molecule of future in the treatment of bipolar disorder and recent publication showed that its side effects join the other second generation antipsychotics

This study examined the prescribing patterns for medications to treat bipolar disorder in outpatient-based psychiatric practice focusing on atypical antipsychotics.

Retrospective chart review of patients admitted to a university hospital with a primary diagnosis of bipolar disorder in a period from January 2008 to December 2012 was conducted. We reviewed Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnosis and detailed clinical information at index episode. Psychotropic medications were grouped into six categories; atypical antipsychotics, typical antipsychotics, lithium, anticonvulsants, antidepressants, and minor tranquilizers. Severity, rapid cycling type, psychiatric comorbidity and disease duration were computed focusing on atypical antipsychotics.

In 344 patients who were prescribed major psychotropic medications, atypical antipsychotics were prescribed in 70.9% of subjects, anticonvulsants in 73.3%, lithium in 36.9%, antidepressants in 41.9%, and typical antipsychotics in 0.9% of subjects. About 12.5% of subjects were treated with the monotherapy. Atypical antipsychotics prescription was favored in subjects with manic and mixed episodes or severe episode. Prescribing trend is independent of rapid cycling type. Prescription of antidepressants were more frequent in subjects who were recently diagnosed as bipolar disorder or prescribed new medications or existed psychiatric comorbidity.

The development of bipolar disorder's psychopharmacology has been reflected in the prescription pattern of psychotropic medications in Korea. This study suggests that atypical antipsychotics have played major role in treatment of bipolar disorder.

The limits of bipolar disorder can be difficult to trace and they merge with other syndromic groups, and this is a diagnostic and therapeutic challenge. Indeed, an early diagnosis can reduce the duration and severity of the episodes as well as the risk of suicide.

The objective of our study was to determine the different clinical diagnoses made before the bipolarity and the main therapeutic errors and their consequences.

This is a retrospective descriptive study based on the records of bipolar patients hospitalized . Data were collected using a medical form assessing sociodemographic and clinical data, the diagnoses obtained before the bipolarity, corollaries therapeutic conducts and the time required to adjust the diagnosis.

Seventy cases of bipolar patients hospitalized in our department were reviewed.

• In 28.5% of cases, the first retained diagnosis was other than bipolar disorder: the most frequent initial diagnosis was major depressive disorder (35%), followed by a not specified psychotic disorder (25%), schizophrenia (12.1%) of personality disorder (10%) and substance abuse (6.3%).

• An average of eight years was necessary for the diagnosis of bipolar disorder, starting from the first hospitalization.

• In over 60% of the cases, treatment with incisive antipsychotic was introduced and lasted more than six months. An antidepressant was prescribed in 35% of the cases. The prescription of mood stabilizers was absent in the majority of cases (> 70%).

In one third of the cases, the diagnosis of bipolar disorder is delayed causing an inadequate therapy management.

Mixed states are very common although largely under identified. They pose a real problem for clinical characterization. Their features, in particular evolutionary, warrant special attention

The goal of the study was

1. 1) Describe the epidemiological characteristics of patients with mixed state

2. 2) To study the evolutionary and prognostic clinical aspects of mixed states

3. 3) To evaluate our clinical practice in the treatment of mixed states and to compare it with international recommendations

We achieved a retrospective descriptive cross-sectional study on 77 cases of patients with bipolar disorder. Our study was conducted between September 2004 and September 2013.

The prevalence of patients with a mixed access among admissions for bipolar disorder during the study period was 32.35%. The average age of our patients was 38.08 years, ranging from 16 to 68 years. The sex ratio was 1.26. A history of suicide attempts (TS) was found in 30 cases (39%). A substance abuse occurs in 42cas (54.5%). The average age of onset of the disease in our patients was 26 years. The average number of hospitalizations was 5.44 hospitalizations. The average total duration in days of hospitalization was 73.73 days.

Recognition of these mixed states and the use of appropriate treatment are needed to improve the prognosis and quality of life of patients

In bipolar I disorder (BD1), manic episodes with depressive symptoms are generally more severe than pure manic episodes, but are not easily identified. The DSM-5 ‘With Mixed Features’ specifier, and accompanying patient-rated Mini-International Neuropsychiatric Interview (M.I.N.I.) module, were designed to aid diagnosis.

To examine patients with BD1 who have mania with depressive symptoms, across countries.

To improve the identification of depressive symptoms during a BD1 manic episode.

This naturalistic study surveyed psychiatrists and their patients with BD1 (manic episode within previous 3 months), in Germany, Italy, Spain, UK, Turkey, Australia, Brazil and Canada. Psychiatrists provided information on depressive symptoms (DSM-5 ‘With Mixed Features’ specifier plus patient-rated M.I.N.I. module); anxiety, irritability, and agitation; suicide attempts; and treatment response.

Of 1,035 bipolar patients, 34% had mania ‘With Mixed Features’(≥05;3 depressive symptoms), and displayed more severe symptoms, and higher rates of attempted suicide than patients without mixed features. Across countries, severe anxiety occurred in 3.5–19.5% of patients; severe irritability in 4.3–17.0%; and severe agitation in 4.3–19.6%. The proportion of patients experiencing ‘prominent dysphoria or depressed mood’ was highest in Italy (64.2%). Recurrent suicidal ideation ranged from 8.0% (Germany) to 25.7% (Spain); lifetime rate of attempted suicide was highest in Canada (64.7%). Between-country differences were also reflected in the M.I.N.I. module outcomes.

Patients with BD1 ‘With Mixed Features’, suffer from a greater burden of disease than patients with pure mania, and there is variation between countries – as detected by physician and patient evaluations.

Olfactory perception and emotional reactivity were assessed by the Multidimensional Assessment of Thymic State (MATHYS) in a large sample of stable bipolar patients (N = 1,271).

We observed a significant negative correlation between olfactory perception and subsyndromal depressive symptoms (r=-0.8; P < 0.01) while a slight positive correlation between olfactory perception and manic symptoms was found (r=0.2; P < 0.01). Limitations: The degree of olfactory perception was assessed by self-report questionnaire.

Odor perception may be an illness state marker of mood syndromes in bipolar disorder. Alternatively, differences in odor perception may identify heterogeneous subgroups within the bipolar spectrum. Further studies are needed to understand the implications of odor perception as well as other signatures (e.g. deficit in odor acuity, deficits in the affective processing related to olfaction) in patients with bipolar disorder.

Immune alterations are considered an important factor in etiopathogenesis of bipolar disorder.

The aim of the study has been to assess the relation between soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular cell adhesion molecule-1 (sICAM-1), in acute and remission phase of mania, in regard to severity of depressive and manic symptoms.

The study has explored serum levels of sVCAM-1 and sICAM-1 in 40 patients with mania. The adhesion molecules' levels of patient group have been analyzed in acute and remission phases, in regard to severity of depressive sympotoms (measured by Hamilton Depression Scale) and in regard to severity of manic symptoms (measured by Young Mania Rating Scale).

The acute serum levels of sVCAM-1 have been inversily associated to YMRS score and directly associated to HAMD score, in acute phase. Serum levels of sICAM-1 have shown no association to severity of affective symptoms, in both phases of the disorder.

Our results suggest that cellular adhesion acute could be one of the factors mediating affective symptoms presentation in bipolar mania.

Interplay between nervous and immune systems plays an important part in clinical presentation and course of affective disorders.

The aim of the study has been to assess the relation between soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular cell adhesion molecule-1 (sICAM-1), in acute and remission phase of bipolar depression, in regard to acute and long-term measures of overall severity of the bipolar disorder.

The study has explored serum levels of sVCAM-1 and sICAM-1 in 43 patients with bipolar depression. The adhesion molecules’ levels of patient group have been analyzed in acute and remission phases, in regard to bipolarity index (BPIX) and in regard to global functioning (measured by Global Assesment of Functioning Scale- GAF)

The acute serum levels of sICAM-1 have been associated to BPIX. Moreover, sVCAM-1 serum selevels have been associated to BPIX in both phases of the disorder. In addition, acute sVCAM-1 levels have been associted to GAF score in accute phase.

Our results suggest that cellular adhesion is an important factor in clinical presentation and overall severity of bipolar disorder.

The wide spectrum of neuropsychiatric conditions collectively known as 'anxiety disorders” are highly comorbid with depression and are the most common psychiatric conditions encountered in the general population. Despite considerable advances in understanding symptomatology, the functional mechanisms of anxiety-related behaviour remain poorly understood.

Using the CADITM platform, we carried out an analytical integration of quantitative differential proteomics data obtained from cingulate cortex (CC) synaptosomes of high and low-anxiety (HAB/LAB) mice to enable the detailed identification of the mechanisms that, at least in part, underlie the HAB phenotype.

The synaptic environment in the CC of HAB animals is dominated by the stabilization and enlargement of existing excitatory dendritic spines, increased high-frequency stimulation of excitatory glutamatergic synapses, enhanced control over the modulation of synaptic strength and relatively weakened inhibitory GABAergic control together with increased spontaneous synaptic activity in non-glutamatergic network members. This is coupled with increased oxidative phosphorylation, enhanced fatty acid oxidation and ATP production in synaptic mitochondria. While ketone bodies appear to be the main energy source for ATP synthesis, glucose/lactate metabolism is mainly used to maintain NADH/FADH2 homeostasis. The effects of increased oxidative and ionic stress appear simultaneously and synergistically controlled through at least seven different mechanisms without involving the glutathione-associated network.

In high-anxiety trait animals, cingulate cortex activity is characterized by low de novo synaptic spine generation, over-activation of excitatory networks, long-term potentiation (LTP) maintenance, significant neurotransmission imbalances and structural as well as metabolic adaptations to persistent mitochondrial Ca2+ loading and oxidative stress.

Internet addiction is a behavioural problem that has gained increasing scientific recognition in the last decade, with some researchers claiming it is a '21st Century epidemic”, leading the APA to include Internet Gaming Disorder in the appendix of the DSM-5.

Internet addiction treatment literature is scarce, particularly regarding the expert view on Internet addiction. To fill this gap in knowledge, this paper aims to explore how Internet addiction therapy experts experience the presenting problem of Internet addiction in psychotherapy.

A total of 20 psychotherapists from 6 different countries (i.e., Germany, UK, USA, Canada, Austria and Switzerland) were interviewed regarding their individual experience of treating clients suffering from Internet addiction. Data were analysed using Interpretative Phenomenological Analysis.

Two superordinate themes were identified during the analysis: 'risk” and 'addiction”. Risk factors included individual, situational and structural characteristics. Psychotherapists treating Internet addiction viewed Internet addiction as actual psychopathology, containing addiction symptoms, criteria and diagnosis, and drew on its similarities with other addictions.

Internet addiction treatment experts highlight the existence and severity of Internet addiction as psychopathology requiring professional therapy. Clients who seek help for their Internet addiction-related problems experience their condition as distressing and as significantly impairing their functioning. Internet addiction fulfils the conditions for a mental disorder classification as outlined in the DSM-5, and should be taken seriously not to marginalise those affected. Parents and significant others, researchers and clinicians, and healthcare and insurance providers may benefit from the presented insights.

GAD and disturbed sleep are prevalent, debilitating, and frequently comorbid problems for which successful treatment remains limited. The adoption of regular exercise can promote sleep but whether it does so for GAD patients is unknown.

To quantify the magnitude of the effect of six weeks of either twice weekly resistance (RET) or aerobic exercise training (AET) on self-reported sleep among GAD patients

Thirty sedentary women, aged 18-37 years, with a primary DSM-IV diagnosis of GAD were randomized to RET, AET, or wait list (WL). RET involved two weekly sessions of lower-body weightlifting. AET involved two weekly sessions of leg cycling matched to RET on exercise time, work performed and weekly load progression. Participants completed the Pittsburgh Sleep Diary daily for seven days at baseline and week six. Sleep outcomes included total sleep time (TST), bedtime, time in bed (TIB), sleep onset latency (SOL), wakefulness after sleep onset, and sleep efficiency, calculated as TST divided by TIB and expressed as a percentage. Hedges’ d effect sizes and associated 95% confidence intervals (95% CI) were calculated for each exercise condition compared to WL. Twenty participants provided complete data and were included in analyses.

RET decreased weekend TST (d=-1.23; 95%CI:-2.27, −0.18), TIB (d=-2.01; 95%CI:-3.29, −0.72), and SOL (d=-2.05; 95%CI:-3.34, −0.76), and increased weekend sleep efficiency (d=1.32; 95%CI:0.16, 2.47). AET reduced weekend SOL (d=-1.87, 95%CI:-3.17, −0.56) and TIB (d=-1.45, 95%CI:-2.68, −0.23).

Preliminary findings suggest that short-term exercise training improves self-reported sleep parameters among GAD patients.

Body dysmorphic disorder is characterized by a preoccupation with an imagined defect in appearance that causes clinically significant distress or impairment in important areas of functioning.

This study aimed to evaluate body dysmorphic disorder, self-esteem, and depression in cosmetic rhinoplasty patients

250 cosmetic rhinoplasty patients completed a demographic questionnaire, dysmorphic concern questionnaire (DCQ), Rosenberg self-esteem scale, and Beck depression index-II (BDI-II). Data were analyzed by appropriate tests.

Of 250 patients, 30 (12.0%) were male and 220 (88.0%) were female. Mean ± SD was 24.0 ± 4.7 for age. Frequency of body dysmorphic disorder (BDD) was 18.0% (45). BDD showed a significant correlation with lower self-esteem and higher depression (both P<0.001). From patients who had BDD, 5(11.1%) showed minimal depression, 14 (31.1%) mild depression, 25(55.6%) moderate depression and 1 (2.2%) severe depression. Also, BDD showed a significant association with the job (Higher in students and housewives, P= 0.04) and cigarette smoking (P<0.001).

Lower self-esteem showed in the patients with age <25 years old (P<0.001), students (P=0.003), Lower education (P<0.001) and lower income (P=0.03).

The prevalence of depression (BDI score >13) was 107 (42.2%). Severity of depression was significantly higher in married patients (P=0.003), lower education (P=0.001), lower income (P=0.04), cigarette smoking (P=0.008), having more children (P<0.001) and having a history of previous cosmetic surgery (P=0.001).

There should be special concerns about psychiatric aspects of people who seek cosmetic surgeries.