Information is not available on the maintenance efficacy of lurasidone in bipolar disorder.

To evaluate the recurrence prevention efficacy of lurasidone plus lithium (Li) or valproate (VPA) for the maintenance treatment of bipolar disorder.

Patients with bipolar I disorder received up to 20 weeks of open-label lurasidone (20–80 mg/d) plus Li or VPA. Patients who achieved consistent clinical stability were randomized to 28 weeks of double-blind treatment with lurasidone (20–80 mg/d) or placebo, plus Li or VPA.

A total of 496 patients met stabilization criteria and were randomized to adjunctive lurasidone vs. placebo. Fewer patients in the lurasidone group had recurrence of any mood episode compared with the placebo group, with a hazard ratio of 0.71 (P = 0.078). In pre-planned secondary analyses, recurrence rates were significantly lower for the lurasidone group treated with a modal open-label dose of 80 mg/d (hazard ratio [HR], 0.35; P = 0.020); when patients presented with an index episode of depression (HR = 0.57; P = 0.039); and when outcome was time-to-all-cause discontinuation (HR = 0.72; P = 0.034), or time-to-recurrence based on symptom severity criteria (HR = 0.53; P = 0.025).

In patients stabilized on lurasidone plus Li or VPA, continued treatment was associated with non-significant reduction in risk of recurrence of any mood disorder (primary). Consistent with dose-response effects observed during acute treatment of bipolar depression, risk of recurrence on lurasidone was significantly reduced after open-label treatment with the 80 mg/d dose, and in the 20–80 mg/d dose in patients presenting with an index episode of depression.

Clinicaltrials.gov: NCT01358357.

Sponsored by Sunovion Pharmaceuticals Inc.

Drs. Pikalov, Cucchiaro, Mao, and Loebel are employees of Sunovion Pharmaceuticals IncDr. Calabrese has received research support from Abbott, AstraZeneca, Bristol-Myers Squibb, Cephalon, Cleveland Foundation, Eli Lilly, GlaxoSmithKline, Janssen, Lundbeck, NARSAD, Repligen, Stanley Medical Research Institute, Takeda, and Wyeth. Dr. Calabrese consulted to or served on advisory boards of Abbott, AstraZeneca, Bristol-Myers Squibb, Cephalon, Dainippon Sumitomo, Elan, EPI-Q, Inc., Forest, France Foundation, GlaxoSmithKline, Hoffman LaRoche, Janssen, Johnson and Johnson, Lundbeck, Merck, Neurosearch, OrthoMcNeil, Otsuka, Pfizer, Repligen, Servier, Solvay, Sunovion, Supernus, Synosia, Takeda, Teva, and Wyeth. Dr. Calabrese has provided CME lectures supported by AstraZeneca, Bristol-Myers Squibb, France Foundation, GlaxoSmithKline, Janssen, Johnson and Johnson, Merck, Sanofi-Aventis, Schering-Plough, Pfizer, Solvay, Sunovion, and Wyeth.

Suicidal behaviour is one of the most relevant public health problems and it is associated with a significant disability and psychosocial impairment. Affective temperaments, hopelessness, suicidal ideation, and suicide intent may be significantly involved in suicidal behaviour.

The present study explored the complex relation between these clinical variables and suicide.

We aimed to evaluate the specific role of affective temperaments and other risk factors as potential predictors of suicide risk.

The sample included 276 patients (19.9% men, 81.1% women; mean age: 48.1 years, SD:16.9), of which most with major affective disorders, who were admitted at the Psychiatric Unit of the University of Genoa (Italy). All participants have been evaluated using the Temperament Evaluation of Memphis, Pisa and San Diego Auto-questionnaire (TEMPS-a), Beck Hopelessness scale (BHS), Scale for Suicide Ideation (SSI), and Intent Score Scale (ISS).

Patients with anxious temperament significantly differ in terms of residual interepisodic symptoms, substances abuse, adherence to treatment, and current episode duration when compared with those having other affective temperaments. Only suicidal ideation and irritable temperament resulted significant predictors of suicide preparation. In addition, suicidal ideation and prior suicide attempts represent significant predictors of suicide intent.

The present findings suggest the importance of systematic evaluation for suicidal behaviour that may allow clinicians to identify patients at higher suicide risk. As these data may be influenced by the severity of the psychopathological conditions and psychiatric medications, which were used during admission by our patients, further additional studies are needed to test these preliminary findings.

The authors have not supplied their declaration of competing interest.

Individuals with a history of childhood traumatic experiences may exert maladaptive coping strategies and impaired adult quality of life.

The present study explored the association between childhood traumatic experiences, coping strategies, and quality of life.

We aimed to evaluate whether childhood traumatic experiences or specific coping strategies may significantly predict quality of life.

This is a cross-sectional study including 276 patients (19.9% men, 81.1% women; mean age: 48.1 years, SD: 16.9), of which most with major affective disorders, who were recruited at the psychiatric unit of the university of Genoa (Italy). All participants were assessed using the Childhood Trauma Questionnaire (CTQ), Coping Orientation to Problems Experienced (Cope), and Short Form 12 Health Survey version 2 (SF-12).

Subjects with a history of emotional abuse were more likely to have an earlier age of onset of their psychiatric conditions, an earlier age of their first treatment/hospitalization, higher recurrent episodes and days of hospitalization, longer illness duration and non-psychiatric treatments at intake when compared with those who did not present any history of abuse. Based on regression analyses, only positive reinterpretation and growth, focus on and venting of emotions, and substance abuse, but not childhood traumatic experiences, resulted positive predictors of physical quality of life. Moreover, focus on and venting of emotions was able to predict mental quality of life.

While traumatic experiences did not predict quality of life, specific coping strategies were significant predictors of quality of life. Further studies are requested to test these preliminary results.

The authors have not supplied their declaration of competing interest.

Although the diagnosis of bipolar disorder is currently based on clinical criteria, preliminary studies showed that palmitic and arachidonic acid levels are able to discriminate adult patients with major depressive disorder (MDD) from those with bipolar disorder (BD).

To replicate and to expand previous findings by investigating the relation between mood disorders and platelet and plasmatic fatty levels.

To compare the lipidic profile of individuals with different mood disorder (MDD vs. BD) and to investigate the relation with specific clinical features (duration of illness, attempted suicide, psychotic symptoms).

Potential participants were recruited from the outpatient and inpatient psychiatric units of the university hospital of Palermo (Italy). Diagnosis of DSM IV mood disorders was made using the MINI. Symptom severity was assessed using the HAM-D rating scale and the YMRS. Fatty acid profile was analyzed using mass spectrometry.

Preliminary analyses were performed on 8 patients with MDD and 6 with BD. Groups were similar in terms of demographic variables. Patients with MDD showed highest levels of platelet palmitic acid, stearic acid, and arachidonic acid. Furthermore, plasmatic docosahexaenoic acid was negatively related with manic symptoms severity (Rho = –0.697; P = 0.025) and platelet alpha linolenic acid was positively related with illness duration (Rho = 0.845; P = 0.040).

These preliminary findings suggest that platelet fatty acids may be possible biological markers to improve the diagnosis of BD.

The authors have not supplied their declaration of competing interest.

Bipolar disorder (BD) and epilepsy are the chronic recurrent diseases with several similarities in pathogenic mechanisms. There are high prevalence of comorbidity between affective disorders and epilepsy. However, most recent studies focused on association epilepsy with depression, while lack of scientific data about relationship between epilepsy and BD.

This study examined the frequency of bipolar disorder in epileptic patients.

To improve the diagnostic tool for BD in epileptic patients.

We observed 50 patients with epilepsy (PE). In this study, the symptoms of BD were measured by the Hypomania Checklist-32 (HCL-32).

The mean age of the entire cohort was 40 (SD = 19.2) years. The proportion of females were 62%. The mean score using HCL-32 were 11.1 (SD = 4.5, range: 3–20) with 17 (34%) scoring above 14, the cut-off points for the basic version of the HCL-32. Among of high score subgroup there were 6 men and 11 women, maximum age was 74 and minimum 19, the mean age of the subgroup were 37 years. The patients 8 out of 17 (47%) received a score of 20 or more (maximum of 37) on the bipolar index that corresponds to ≥ 20% probability BD.

The results of the study observed a high prevalence of BD in PE. Future research addressing (1) using of psychiatric examination instruments to assess affective symptoms among PE and (2) treatment management of affective symptoms by antiepileptic drugs might result in better treatment outcomes among patient with comorbidities of BD and PE.

The authors have not supplied their declaration of competing interest.

Age of onset of illness may be useful in explaining the heterogeneity among older bipolar patients.

To examine the relationship of age of onset with clinical, demographic and behavioral variables, in older patients with bipolar disorder.

This was a cross-sectional, descriptive and analytical study, including 24 patients suffering from bipolar disorders, aged 65 years or more and followed-up in outpatient psychiatry unit at Hedi Chaker university hospital in Sfax in Tunisia. We used a standardized questionnaire including socio-demographic, behavioral and clinical data. Age of onset was split at age 40 years into early-onset (< 40 years; n = 12) and late-onset (≥ 40 years; n = 12) groups.

The mean age for the entire sample was 68.95 years. The mean age of onset was 39.95 years. The majority (60%) of patients were diagnosed with bipolar I. Few meaningful differences emerged between early-onset and late-onset groups, except that tobacco use was significantly higher in the late-onset group (66.6% vs. 16.6%; P = 0.027). No significant differences between the early-onset and late-onset groups were seen on demographic variables, family history and number of medical diagnoses or presence of psychotic features.

Our study found few meaningful behavioral differences between early versus late age at onset in older adults with bipolar disorder.

The authors have not supplied their declaration of competing interest.

The prevalence of bipolar disorder (BD) is continuously increasing worldwide. Based on pathophysiological prospective, BD is related to the change in neural circuitry involved in the regulation of emotion. Since there is a cultural variation in emotion expression, it is expected that BD is subject to cultural differences. The literature suggests that the prevalence of BD is influenced by gender, region and ethnicity.

Exploring the pervasiveness of BD in the Arab cultures.

Aims – exploring the pervasiveness of BD in six different but related Arab cultures;

– examining the gender differences in BD in the Arab cultural context.

This study used 327 freshmen university students (42% males and 58% females) from six different Arab universities and administered the Mood Disorder Questionnaire (MDQ). The validity and reliability of the MDQ was measured on 220 Qatari university students.

The results showed that BD was positively related to age and that males exhibited greater BD symptoms than females. The MDQ scores varied between the Arab subcultures. Sudanese subjects scored the highest on the MDQ, and therefore showed the highest numbers of BD characteristics, followed by Palestinians, Egyptians, Yemenis, Qataris, Jordanians and Tunisians. The Tunisians exhibited the lowest BD symptoms among six Arab cultures.

The findings suggested that it is arguable that BD is sensitive to cultural variations in the Arab world, with males showing a higher number of bipolar symptoms. It is arguable that BD is influenced by cultural openness and socioeconomic status.

The authors have not supplied their declaration of competing interest.

Cognitive dysfunctions concerning working memory, attention, psychomotor speed, and verbal memory are a disabling feature of the bipolar disorder (BD). According to scientific literature, cognitive disturbances are present not only in depressive and manic phases of BD, but also during the euthymic period, without regard to whether or not drugs are assumed.

To determine the presence of one or more dysfunctions in cognitive domains in a sample of subjects suffering from BD, in euthymic phase, compared with healthy controls.

Evaluation of the following cognitive performances in subjects affected by BD: speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition.

Forty-six patients affected by BD in the euthymic phase (mean age: 43.17 years old; 39.13% male), and 58 healthy controls (mean age: 39.21 years old; 51.72% male) were enrolled in the psychiatric unit of Azienda Sanitaria Locale, Foggia. The neuropsychological battery MATRICS Consensus Cognitive Battery (MCCB) was administered by trained psychiatrists.

We found the presence of cognitive impairment, affecting six out of seven of cognitive functions assessed (P < 0.001): speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving.

These preliminary results from our case-control study show that cognitive deficits are clearly present also during the euthymic phases of subjects with bipolar disorder (mainly pertaining attention/vigilance domain). These cognitive abnormalities may represent a biomarker of bipolar disorder.

The authors have not supplied their declaration of competing interest.

The majority of studies revealed that cognitive deficits are an important aspect in many psychiatric illnesses, such as bipolar disorder and major depressive disorder. In the past, cognitive impairment was considered part of depression and it was expected to diminish as other mood symptoms improved with treatment.

This study is based on the review of recent literature, performed in order to understand the dimension of executive impairment in unipolar and bipolar depression.

Both unipolar and bipolar depressed patients display cognitive deficits in several cognitive domains within executive functions. Different subcomponents of executive functions are altered in both types of patients, but impairments in sustained attention appear specific in bipolar depression while dysfunctional divided attention is reported in unipolar disorder. Studies describe deficits in planning strategies and monitoring processes that are characteristically impaired in unipolar depressed patients. Also these subjects tend to make more perseverative responses suggesting set shifting deficits and moreover they require longer time and more cognitive effort in order to accomplish tasks involving inhibitory control or cognitive flexibility. Other findings suggest that bipolar I depressed patients perform worse than bipolar II depressed patients and unipolar depressed patients across all executive functions especially in the decision making process that is considered to be a trait marker for bipolar disorder with no differences between the two types of bipolar subjects.

Executive functions represent a term that includes a higher order of cognitive abilities with deficits that are present in both disorders but display slightly different patterns of impairment.

The authors have not supplied their declaration of competing interest.

Psychomotor disturbances are among the core symptoms of endogenous depression. They reflect the underlying pathophysiology of the depressive episode and are sensitive to the neurobiological effects of its pharmacological treatment. Being objectively manifested, the psychomotor functions and dysfunctions are technically recordable and measurable by the available motion analysis systems.

To objectively record and measure the psychomotor dysfunctions in bipolar depression and their dynamics during pharmacological treatment.

We introduced an original (internationally patented) equilibriometric method for objective and quantitative recording of psychomotor dysfunctions during stepping locomotion in 37 hospitalized patients with bipolar depression and 30 well-matched healthy controls. Two separable psychomotor functions were analyzed in parallel: conscious (voluntary) activity and subconscious (automatic) reactivity. Both patients and controls were examined twice in order to quantify their psychomotor dynamics. Patients were examined at the first day of their hospitalisation and the day before their discharge. The two consecutive examinations of the controls were with equivalent time intervals.

There was no significant psychomotor dynamics (P > 0.05) in the healthy controls between their first and second equilibriometric recording. Psychomotor activity and/or reactivity of the patients were relatively slower at their first recording and significantly accelerated (P < 0.05) at their second recording after effective pharmacological treatment.

Objective recording and quantitative assessment of psychomotor dynamics in patients with bipolar depression during the pharmacological treatment of their current episode could be a sensitive measure of their improvement and might be used as a surrogate pharmacodynamic biomarker for objective treatment monitoring.

The authors have not supplied their declaration of competing interest.

Bipolar disorder (BD) is frequently associated with cognitive deficits in attention, verbal memory and executive functions that have been related to various clinical characteristics of the disorder.

However, few studies have examined the effect of gender on cognition despite its clinical relevance.

The aim of our study was to investigate potential diagnosis-specific gender effects on visual memory/learning and executive functions in BD.

Cognitive performance of 60 bipolar-I patients and 30 healthy controls was evaluated by using CANTAB battery tasks targeting spatial memory (SRM), paired associative learning (PAL), executive functions (ID/ED, SOC). A multivariate analysis of covariance (MANCOVA) of neuropsychological parameters was performed with gender and diagnosis as fixed effects and age and education as covariates. Following univariate analyses of covariance (ANCOVA) were undertaken to examine the effect of gender on each neuropsychological task.

Bipolar patients showed significantly poorer performance in paired associative learning (PAL), set shifting (ID/ED) and planning (SOC). Moreover, a diagnosis specific gender effect was observed for cognitive functioning in BD (gender × diagnosis interaction P = 0.029). Specifically, male healthy controls outperformed healthy females in tasks of visual memory/learning but this pattern was not sustained (SRM) or was even reversed (PAL) in BD patients.

The present study is one of the few studies that have examined the effect of gender on neurocognitive function in BD. Our findings indicate that the gender-related variation observed in healthy subjects is disrupted in BD. Moreover, they suggest that gender may modulate the degree of frontotemporal dysregulation observed in BD.

The authors have not supplied their declaration of competing interest.

The problem of social functioning of psychiatric patients is one of the most relevant these days.

Studying characteristics of emotional intelligence parameters in patients with depressive-paranoid symptoms in psychotic disorders in the structure of F 20.0, F25.1 and F33.3.

Participants Study involved 40 patients divided into three groups according to nosology:

– Group 1: F 20.0;

– Group 2: F 25.1;

– Group 3: F 33.3.

MSCEIT (Russian version of the adapted version of Sergienko O.O., Vetrova I.I.), the scale of PANSS and PSP.

The highest rates are in the group F25.1, except for the scale D. In group F 20.0 compared to other scales reduced scale index N. In group F 33.3 reduced compared to the scales A and E are indicators of scales D and H. 2. The observed negative correlation scale D performance of N5, G1, G5, G8, G14 (PANSS) in group F 20.0 and positive correlation in group F 33.3 of G6. E indicators scales show positive correlation with G3, group F20.0, and F33.3. Also was found a negative correlation with the performance scale O13 H group F20.0. 3. The positive correlation between the level of social functioning and performance scale H group F20.0 scales and indicators in the group D F33.3.

The findings are the “resource area”, which have become “target” of rehabilitation programs for this group of patients.

The author has not supplied his/her declaration of competing interest.

Bipolar I disorder (BD I) is characterised by at least one full-manic episode. In bipolar II disorder (BD II), all upswings are hypomanic, which means they never reach full-blown mania. Therefore, BD II evolves into BD I, but BD I can never evolve into BD II. Differential diagnosis of patients evaluated for BD II should include BD I, major depressive disorder (MDD) and borderline personality disorder (BPD). Patients with BPD often have the same type of severely disrupted life as well as patients with BD II because of the multiple episodes of significant mood disorder symptoms.

Establishing some personality traits in patients suffering from BD II, their relationship and predictability.

The test group was formed out of 55 patients diagnosed with BD II in remission phase from 2012 until 2015. Three measuring instruments were used: Eysenck's Personality Questionnaire (EPQ), Self-destruction Scale (SAD) and Beck Depression Inventory (BDI).

We calculated the prevalence of personality traits (neuroticism, psychoticism, elements of borderline personality Disorder), their correlation and predictive validity.

We established the prevalence of neuroticism, elements of Borderline Personality Disorder and their significant predictability in patients with BD II in remission.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

Smartphones are becoming widely popular and the number of users is significantly increasing, reaching over 65% in South Korea in 2013 and the children begin to use a smartphone at earlier age. Earlier and higher exposure of multimedia is known to have negative effects on children's physical and mental status.

The aim of the present study was to examine young children's exposure to smartphone and identify the effects of high exposure of smartphone on children's behaviors among Korean children from ages 3–5 years.

In 2014–2015, the parents of 400 children aged 3–5 years (207 boys and 193 girls) were surveyed using a questionnaire on the use of smartphone, children's behaviors, temperaments, social and language development at 3 community-based children's mental health centers.

Many children used televisions (95.5%), computers (37.3%) or tablet PC (36.2%), and smartphones (84.6%). Most (74.2%) started using mobile medias before age 2. Parents gave children devices like smartphones to keep them calm (60.8%), when being busy doing something (52.2%), and at playtime (34.3%). The children's age at first smartphone use and the frequency were not associated with children's behaviors and temperaments. Higher use group (> 2 h/d) show more somatic symptoms (OR 8.97, P < .001), more attention problem(OR 4.43, P < .001), more aggressive symptoms (OR 1.30, P < .001) and more withdrawal symptoms(OR 1.22, P < .001) than lower use group.

Young children in Korean urban communities had almost universal exposure to mobile devices, especially smartphone. Early and severe exposure of smartphone by young children aged 3–5 years is highly associated with children's behaviour problems like both internalising and externalising problems.

The authors have not supplied their declaration of competing interest.

Eight hundred and forty-two parents completed our risk and associated features screening questionnaire. Out of these, 494 answered the question regarding handedness (209 had children diagnosed with ASD). This asked the parents to state how they perceived their child's handedness. An ADOS assessment has been conducted for 170 of the children whose parents were included in the study, based on clinical relevance for the case. The data were analysed using Excel and SPSS 22.0. For the comparisons, Chi2 and the Kruskal–Wallis test were used.

Children with ASD had more left-handedness (χ2(2) = 12.54, P = 0.002). There were no differences between boys and girls in terms of perceived handedness in any of the groups. There were no differences in the ADOS scores according to the perceived hand laterality (χ2(2) = 0.58, P = 0.74).

Rightward-asymmetry in regions of corpus callosum has been reported to correlate with symptoms severity in ASD. The finding of different perceived handedness in children with ASD versus children with other psychiatric pathologies is useful for designing appropriate, individualized training programs for motor therapy.

The authors have not supplied their declaration of competing interest.

Epidemiological data indicate that 30% to 50% of young people contact the child psychiatrist for behavioral disorders problems. Protective factors research that reduce the risk of conduct disorders are just as important as the research of risk factors. The aim of this work is to introduce the preventive factors in the reduction of conduct disorders, including 4 domains: individual, family, school and community. The emphasis is placed on preventive factors at the community level, which are covered by the national, state and local policies that support programs oriented towards children and young people. Good infrastructural community support enable young people to participate in activities where they have opportunities to make choices, make decisions and share responsibility. These experiences help young people to develop new skills, increase their self-confidence and make the difference, while such programs help adults to create a basis for understanding and working together with young and engaged people.

The interest in the behavior of young people and their perspective creates a culture of care for young people instead of a culture of ignoring or even marking behavior among young people as deviant and antagonistic, which has a significant preventive effect on the development of behavior disorder.

The authors have not supplied their declaration of competing interest.

Stress is an integral part of parenting. The stress of parenting is especially increased at parents of children with developmental disabilities, which can have negative effects on the health of the parents, the relationship with the child and total parental behavior. The objective of this work is to assess the level of stress of parenting among parents of children with developmental disabilities. Parents were involved in workshops support within a regional project. The workshops were conducted twice a month, in the duration of two hours, during the one-year period. The workshops were led by experts in various fields, and work with parents was psycho-educational and supportive. The assessment was made using the questionnaire Parenting Stress Index-Short Form, within the two time frames, at the beginning of the project and after 12 months. The results showed that nearly two-thirds of parents of children with disabilities were under clinically significant stress at the beginning of the service. By retesting after twelve months, it was found that parental stress decreased, and the decrease is particularly evident in the parental competence experience. Although stress is reduced to some extent by the way the parent is experiencing emotional exchange with the child, its level still remains high.

Our experience shows that supportive workshops, which we participated in significantly, but insufficiently contributed to the stress reduction among parents. This paper discusses other possible interventions, which would specifically be aimed at developing strategies for reductions of clinically high level of parental stress.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.