Overweight and obesity, despite their comorbidities and mortality, could deteriorate the quality of life of people with bipolar disorder.

The objective of this study is to evaluate the quality of life among patients with bipolar disorder and investigate a possible interaction between obesity and deterioration of the quality of life.

This study aims to highlight the importance of preventing overweight and obesity in people with bipolar disorder to obtain an adequate quality of life subsequently an acceptable control of the illness.

Fifty euthymic bipolar patients (Hamilton Depression Scale score ≤ 8, and Young Mania Rating Scale score ≤ 6) received the Medical Outcomes Study 36-Item Short-Form Health Survey in Arabic validated version in order to investigate the quality of life.

We examined 50 euthymic bipolar patients (60% men, 40% women). The average age was 46, 5 years (23–70). Most patients (69%) were over weighted (BMI ≥ 25.0 kg/m2) (body mass index), of whom 40% were obese (BMI ≥ 30.0 kg/m2). Seventy-two percent of the investigated patients had an affected quality of life (score < 66.7). The mental items were deteriorated in 80% of the cases. An affected quality of life was correlated with obesity. The BMI was significantly and negatively correlated with the scores of dimensions D4 (mental health) and D8 (perceived health) (P < 0.01).

The investigation of quality of life in people with mental disorder enables to reveal the social handicap caused by these illnesses consequently emphasizes health care in mental affections.

The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

The difficulties of diagnosis and clinical differentiation of bipolar disorders, schizophrenia and schizoaffective disorder have been repeatedly noted both foreign and Russian authors.

Full medico-psychological service clinical documentation research, including bipolar disorder patient records.

Determination of bipolar disorders in accordance with the DSM-5 criteria among psychiatric outpatients.

A group of 142 patients with established according to ICD-10 diagnoses: schizophrenia, schizoaffective disorder 137 (96.5%); the average patient's age 50 ± 13 and bipolar disorder and mania episode 5 (3.5%) – 55.4 ± 14.4 has been investigated.

It was found that 18 (12.7%) of all patients meet the DSM-5 bipolar disorder criteria compared with the primary diagnosis (3.5%). Structure of the diagnosis of bipolar disorder was represented as follows: bipolar disorder type I – 11 (61.2%), bipolar disorder type II – 7 (38.8%). Consequently, due to formal application DSM-5 bipolar disorder criteria BD determination 3.5 times more.

Traditionally, the diagnosis of schizophrenia is preferred over bipolar disorder. Manic episode in bipolar disorder can be evidently regarded as an acute schizophrenia manifestation. The diagnostic criteria for DSM-5 are convenient in diagnostics of manic and depressive episodes in case of their combination in I type bipolar disorder.

The authors have not supplied their declaration of competing interest.

Obtain and analyze information on treatment guidelines, with particular emphasis on the use of antipsychotics, in patients diagnosed with bipolar disorder I and bipolar disorder II who are treated at a mental health center in a district of Madrid (Spain) under the conditions of habitual clinical practice.

Then, compare with recently published literature.

We performed a descriptive study of a sample of 100 patients diagnosed with bipolar disorder (type I and type II) at any stage of the disease who receive regular treatment in a mental health center in a district of Madrid. Information regarding the treatment used, especially the use of antipsychotics (either in a single therapy or in combination with other drugs such as mood stabilizers, antidepressants, hypnotics or anxiolytics), was collected retrospectively from the data obtained from the medical record.

Ninety-four percent of patients are taking mood stabilizer treatment (68% lithium, 24% valproate, 1% and 1% carbamazepine and lamotrigine). Four percent take lithium and valproate in combination. Forty-eight percent of patients are taking some antipsychotic (atypical about 90%). Of these, only 10% in injectable form, and 5% take both oral and injectable antipsychotics.

The diminished use of injectable antipsychotics, well below recent publications, draws the attention. You can probably explain this low proportion of injectable medication because we are generally dealing with stable patients with a long-term disorder.

The authors have not supplied their declaration of competing interest.

Early stages of bipolar disorder are sometimes misdiagnosed as depressive disorders. This symptomatology can lead to misinterpretation and under diagnosis of bipolar disorders.

To describe a patient with a new diagnosis of bipolar disorder after 23 years of psychiatric care.

We report a case of a 66-year-old man, with a previous psychiatric diagnosis of recurrent depressive disorder for the last 23 years, after a hospitalization in a psychiatric inpatient unit because of a major depressive episode. In subsequent years, he was regularly followed in psychiatric consultation with description of recurrent long periods of depressed mood requiring therapeutic setting, alternating with brief remarks of not valued slightly maladjusted behaviour. At 65, he came to the emergency room presenting with observable expansive and elevated mood, disinhibited behaviour, grandiose ideas and overspending, leading to his hospitalization with the diagnosis of a manic episode. In the inpatient unit care, we performed blood tests, cranial-computed tomography (CT) and a cognitive assessment. His medication has also been adjusted.

Laboratory investigations were unremarkable. Cranial-CT showed some subcortical atrophy of frontotemporal predominance, without corroboration by the neuropsychological evaluation. The patient was posteriorly transferred to a residential unit for stabilization, where he evolved with major depressive symptoms that needed new therapeutic adjustment. Later he was discharged with the diagnosis of bipolar disorder.

Our case elucidates the importance of ruling out bipolar disorder in patients presenting with depressive symptoms alternating with non-specific maladjusted behaviour, which sometimes can be a challenging task.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

To assess the clinical outcomes associated with social cognition impairment in euthymic patients with bipolar disorder.

It was a cross-sectional study with convenience sample. The diagnose of bipolar disorder was performed by psychiatrist, using DSM-IV criteria, at bipolar disorder program – Hospital de Clinicas de Porto Alegre (Brazil), where the sample was recruited. The social cognition was assessed by psychologists using the Reading the Mind in the Eyes Test.

We included 46 euthymic BD patients: BD I (n = 39), women (n = 32), age (49.11 ± 13.17), and years of education (10.56 ± 3.80). Patients with social cognition impairment were not different of patients without social cognition impairment regarding socio demographic factors (gender, age, educational level, marital status, and employment status). Patients with social cognitive impairment showed higher rates of BD I patients (P = 0.036) and higher proportion of hospitalization in the first episode (P = 0.033), as compared to patients without social cognition impairment.

This is a preliminary study demonstrating that BD patients with social cognition impairment show worse clinical outcomes. Severe BD onset seems to be an important predictor of social cognition impairment. However, more studies are needed investigating social cognition impairment in subjects with bipolar disorder.

The authors have not supplied their declaration of competing interest.

To assess the clinical outcomes associated with social cognition impairment in euthymic patients with bipolar disorder.

It was a cross-sectional study with convenience sample. The diagnose of bipolar disorder was performed by psychiatrist, using DSM-IV criteria, at bipolar disorder program – Hospital de Clinicas de Porto Alegre (Brazil), where the sample was recruited. The social cognition was assessed by psychologists using the Reading the Mind in the Eyes Test.

We included 46 euthymic BD patients: BD I (n = 39), women (n = 32), age (49.11 ± 13.17), and years of education (10.56 ± 3.80). Patients with social cognition impairment were not different of patients without social cognition impairment regarding socio demographic factors (gender, age, educational level, marital status, and employment status). Patients with social cognitive impairment showed higher rates of BD I patients (P = 0.036) and higher proportion of hospitalization in the first episode (P = 0.033), as compared to patients without social cognition impairment.

This is a preliminary study demonstrating that BD patients with social cognition impairment show worse clinical outcomes. Severe BD onset seems to be an important predictor of social cognition impairment. However, more studies are needed investigating social cognition impairment in subjects with bipolar disorder.

The authors have not supplied their declaration of competing interest.

Previous optimistic assumptions about the prognosis of BAD based on the control of mood symptoms is now challenged as majority of patients continue to have cognitive deficits during the euthymic phase.

To describe cognitive impairment in euthymic BAD and study the association with clinical characteristics.

Identify the prevalence and severity of cognitive impairment (CI); to correlate CI with the first episode, illness duration, number of episodes and predominant polarity.

Patients attending the psychiatry clinic of the National Hospital of Sri Lanka diagnosed with BAD in the remission phase were recruited. An interviewer-administered questionnaire and Montreal Cognitive Assessment test was used to ascertain clinical characteristics and cognitive functions respectively. Scores of 18–26 described as mild, 10–17 moderate and < 10 as severe cognitive impairment.

Total sample size was 58. Mean age = 48.84 (SD12.5). Fifty-five percent were females. Mean duration of illness was 179.7 months (SD128.5). A mean of 6 episodes were experienced during the course of illness (min = 1, max = 18); 58.6% had depression, 37.9% had manic and 3.4% had mixed as their first episode. The predominant polarity was depressive in 65.5%. No cognitive impairment – 8.6%, mild – 63.8%, moderate – 27.6% and none with severe. There was a significant association between the presence of cognitive impairment and the predominant polarity being depressive (r = 10.886, df = 4, P = 0.028). No significant association was found between illness duration, number of episodes or the type of first episode.

Patients with a predominant depressive polarity are more likely to experience cognitive impairment. Cognitive impairment had no association with illness duration, type of episode or number of episodes.

The authors have not supplied their declaration of competing interest.

Due to recent aviation accidents, like German Wings flight 9525, aviation related mental health disorders have recently received much attention. Several psychological disorders have been associated with aviation ever since its beginning, both in passengers and aviation professionals. A clinical case is revised of a 33 years old air hostess, without previous psychiatric history, who was admitted twice in a manic state, and a third time abroad in Nice, France, after prolonged sleep privation due to consecutive transatlantic flights.

Scientific revision of psychological disorders in passengers (flight related psychological stress, flight phobia, post-traumatic stress disorders after plane crashes…), aviation professionals (mood changes, sexual function disorders, jet lag, sleep disorders), ground staff, and populations living within close distance to airports (burnout, circadian rhythms disorders due to high noise levels…).

Research in Pubmed, Medscape, scientific literature and other publications, with the following research terms: aviation related mental health disorders, flight related psychological disorders, flight phobia, aerophobia, aviophobia, flight related anxiety, flight related mood disorders, flight induced mania, psychological stress and air travel; articles in English, Portuguese and Spanish.

Fifty-eight articles, one book and four publications were considered relevant; the case of the patient is thoroughly described with data retrieved from the clinical file.

Several important issues concerning both mental and physical health are highlighted by this clinical case, yet, surprisingly, scientific knowledge has progressed at a rather slow pace and mental health professionals have not given much attention to this issue.

The authors have not supplied their declaration of competing interest.

Differentiating between bipolar (BD) and schizoaffective disorder (SAD) can be challenging, especially during early stages of the illness.

Comparing clinical profiles and socio-demographic characteristics of patients diagnosed with BD and SAD.

The study, conducted between 2014–2016, included 67 inpatients from the Timisoara Psychiatric Clinic, diagnosed with either BD (n = 35) or SAD (n = 32), according to ICD-10 criteria. The following parameters were analyzed: number of episodes, number of times hospitalized, onset age, frequency and nature of psychotic symptoms, family history of psychiatric disorders and socio-demographic characteristics (age, sex, marital status). Data were obtained by direct interview and patient files. Symptom severity was measured with Brief Psychiatric Rating Scale (BPRS).

There were no significant differences between the two samples regarding age or sex distribution. Schizoaffective patients were more frequent unmarried (P = 0.007). Onset age was significantly lower in SAD patients (22.41 years for SAD, 28.36 years for BD). SAD patients had the highest number of episodes and needed more frequent hospitalization. Bipolar patients had higher percentage of family history of affective disorders when compared to schizoaffective patients (41% versus 36%). Hallucinations were more frequently found in schizoaffective patients than in bipolar patients (P = 0.004). We found no significant differences between the two samples regarding the presence or the type of delusions. The SAD sample had significantly higher BPRS total scores than bipolar patients (P = 0.035).

Although this study revealed numerous similarities between BD and SAD, it also identified differences that may be helpful in establishing the correct diagnosis.

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.

The authors have not supplied their declaration of competing interest.

Epidemiological studies indicate that the majority of patients with bipolar disorder are diagnosed many years later. Unipolar depression represents the most frequent misdiagnosis.

This study aimed to examine the symptom profiles of depressed patients in order to identify clinical specificities of bipolar depression.

A total of 31 depressed patients were recruited from psychiatry outpatient department of Hedi Chaker university hospital in Sfax (Tunisia), during October and November 2016. Unipolar and bipolar patients were compared on a broad range of parameters, including sociodemographic and clinical characteristics. Depressive symptoms were rated using the Montgomery Asberg Depression Rating Scale (MADRS) and Bipolar Depression Rating Scale (BDRS).

The total sample comprised 31 patients with 16 men and 15 women. It involved 20 with unipolar depression and 11 with bipolar depression. Patients with bipolar depression had more family history of bipolar disorder (P = 0.037) and a triggering factor had been identified less often (P = 0.03). MADRS scores were similar in bipolar and unipolar patient (median score 28.22 versus 28.36; P = 0.964). BDRS scores were significantly higher in bipolar depressed patients (median score 33 versus 25; P = 0.01). The mixed subscale (item 16 to 20) scores were particularly higher (median 6 vs. 1.2; P ≤ 0.01) especially concerning irritability (P = 0.001). Increased motor drive (P = 0.004) and agitation (P = 0.008).

Our findings suggest that the presence of mixed symptoms is very important to recognize depressed patients as having a bipolar disorder. We also recommend routine use of the BDRS for patients presenting for treatment of depression.

The authors have not supplied their declaration of competing interest.

Phenylephrine, pseudoephedrine and ephedrine are the sympathomimetic drugs that have been used most commonly in oral preparations for the relief of nasal congestion. These drugs stimulate the central nervous system that is affected by the alpha and beta adrenergic agonism. Sympathomimetic agents used in the treatment of flu and common cold with ephedrine and pseudoephedrine are case reports. That the manic and psychotic episodes are triggered. In this article, we would like to present a bipolar manic disorder with two manic episodes and both of them triggered by influenza drugs.

A 25-year-old man patient was admitted to psychiatric outpatient clinic with increasing complaints such as increasing energy, speaking much, decreasing sleep, increasing the libido after using the flu drug that prescribed to him containing phenylephrine. Also, 2 years ago, he has manic attack triggered after the flu drug.

In recent years the study of epilepsy and bipolar disorder in common suggests that bipolar disorder may affect the kindling phenomenon. In our case, two of reasons in the neurobiology of developing manic attacks the kindling phenomenon is likely to be effective. First, the possibility of using cold medicine containing ephedrine or pseudoephedrine in the first manic episode, in the second manic episode having spent the attack with FAQ stimulant effect of lower phenylephrine. Second, in the first episode after using the 5–6 tablets developing manic attacks. In the second attack to be triggered with just 2 doses may indicate the effect of kindling.

The authors have not supplied their declaration of competing interest.

Elective circumcision operation for male children can affect their psychological status.

We aimed to investigate the traumatic effect of the circumcision procedure and the predictive factors that could contribute to this effect.

One hundred and thirty-four children who admitted to urology and child surgery clinics to perform a circumcision procedure were included in the study. The whole group was divided into two groups including general anesthesia (GA) (n = 71) and local anesthesia (LA) (n = 63) groups. The procedure was performed under general and local anesthesia in the relevant groups. All of the participants filled the Child Depression invenTory (CDI), State (SA), and Trait (TA) Anxiety and Childhood Anxiety Sensitivity index (CASI) before the operation, and the Child Posttraumatic Stress Reaction index (CPSRI) 1 month after the operation.

CDI, CASI and TA scores of the children were similar in both groups, however, SA scores of the LA group were higher than GA group (P < 0.001), and CPSRI scores of the GA group were higher than LA group (P = 0.04). When the other parameters were controlled in regression analysis, only CDI scores predicted CPSRI scores in LA group (P = 0.02), and TA scores predicted CPSRI scores in the GA group (P = 0.03).

Children who witness the surgical procedure of the circumcision do not develop serious PTSD symptoms. In contrast, children who experience general anesthesia procedure during circumcision develop more serious PTSD symptoms than children operated with local anesthesia. Trait anxiety and depressive symptom severity may be important in developing PTSD symptoms after circumcision operation.

The authors have not supplied their declaration of competing interest.

About 20% of children suffer from an anxiety disorder and symptoms may persist in adulthood. About 13 in every 100 children from 9 to 17 years old experience anxiety disorders, girls seem more vulnerable than boys. Theoretical models of anxiety emphasize the effect of parenting on development and maintenance of child anxiety.

This research aims to study the nature of correlation between parenting styles and anxiety in children who attend Tirana Child & Adolescent Psychiatric Service.

One hundred and seventy-five children and 175 their parents filled Spence Children Anxiety Scale (SCAS) and Parenting Styles & Dimensions Questionnaire (PSDQ) was found a significant correlation between parenting styles and anxiety in children.

Parental overprotection produces vulnerable children who become adults ready to give up in front of life difficulties therefore; it is necessary parents’ awareness in practicing a balance in their parenting styles, in order to reduce children's anxiety.

The authors have not supplied their declaration of competing interest.

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders that manifest among children. Despite the fact that the teacher's role is essential in the assessment and management of pupils with ADHD and the recommendation of participation of teachers for the success and efficiency of diagnoses and treatment, the vast majority of teachers have neither understanding nor knowledge of ADHD.

The current study explores the kindergarten and elementary school teachers’ knowledge regarding early detection and management of ADHD.

Cross sectional survey using stratified random sampling technique was carried out in governmental and private elementary and kindergarten schools in four cities of Qassim region, Saudi Arabia.

The study included 1095 teachers, 711 (59.3%) did not get information about ADHD during undergraduate studies. Teachers’ overall ADHD knowledge mean was 21.7 + 5.5 out of 38 marks. Teachers with high qualification degree and kindergarten specialty scored 56.4% and 60.2%, respectively. Teachers who attended conferences related to ADHD scored 64.5%, while teachers who read about ADHD or have been ever asked to diagnose/teach an ADHD student had 59.4% and 62.1%, respectively. The sources for those who got their information through reading were statistically significant in overall knowledge, general knowledge and treatment dimensions. As scientific studies and books were the highest with percentage of 24.6% and 23.3%, respectively, 4% and 3.6%, respectively, 3% and 3%, respectively. The level of ADHD knowledge perception showed that 76% of teachers were knowledgeable in relation to overall ADHD perception.

Teachers who have higher qualifications or training in identifying ADHD children scored higher in our study.

The authors have not supplied their declaration of competing interest.

Attitudinal ambivalence is a mediator between attitudes and health behaviors. The present study contributes to our understanding of affective attitudes ambivalence.

We studied the ambivalence of affective attitudes towards health among adolescents.

We compared the affective attitudes ambivalence between younger (10–14 years) and older (15–16 years) adolescents.

Older (n = 51, Mage = 15.09 ± 0.30) and younger adolescents (n = 28, Mage = 12.96 ± 0.99) performed a modified Etkind Color Test. We calculated the associations between 13 factors related to health (e.g. sport, risky behavior) and positive emotions, as well as the associations between same factors and negative emotions. Thompson, Zanna and Griffin ambivalence index was a measure of attitudinal ambivalence.

Among younger adolescents all 13 correlations between negative and positive attitudes towards health related factors were significant and negative: −0.402 < r < −0.804 (which means the greater is the association between a word and positive emotions, the smaller is the association between the same word and negative emotions; and vice versa). Only 5 correlations were significant and negative among older adolescents (−0.209 < r < −0.463): environment, risky behaviors, family, sleep, my psychological well-being.

The difference in ambivalence indexes was significant in two groups of adolescents [F(14,64) = 5.97, P = −0.0001]. Younger adolescents had significantly lower ambivalence indexes in affective attitudes towards all 13 factors.

Older adolescents had more ambivalent affective attitudes towards health related factors compared to younger adolescents.

The authors have not supplied their declaration of competing interest.