Addiction to psychoactive substances (PAS) can lead to cardiovascular complications. Cardiotoxicity of drugs is known but it is rarely documented by toxicology.

We conducted a prevalence study on PAS use among patients with cardiac symptoms, with an analysis of diagnosis and a description of PAS user's characteristics.

To improve the therapeutic management in addictology for cardiac patients.

Prospective observational study performed during 3 months. Patients admitted in cardiology had to complete a hetero-questionnaire about his PAS consumption and a qualitative toxicological research in urine and/or blood (immunochemical/GC–MS detection).

One hundred and sixty-one patients were included: 86% men, aged 24–68 years (Table 1). Results show a high level of PAS use in our population: 8.7%. A significant PAS use is observed among patients aged 40–70 years, with a prevalence of 22% for the 40–49, 15% for the 50–59 and 7% for the 60–69. PAS detected were mainly cannabis and cocaine. Clinical diagnoses of patients positive to PAS were acute coronary syndromes and severe cardiac arrhythmias.

In patients admitted in cardiology, toxicological screening is rarely done. Our study shows a significant PAS use among patients aged 40–70 years. According to data of the French Health Barometer, there is regular use of cannabis and cocaine at respectively 3% and 1.1% among people aged 18–64. These results invite us to achieve a more systematic identification of PAS use among patients with cardiovascular disorders and to optimize the therapeutic management by a systematic orientation in addictology.

The authors have not supplied their declaration of competing interest.

QTc interval prolongation is considered a risk factor for fatal polymorphic ventricular tachycardia, which can result in sudden cardiac death. Most psychotropic drugs have a dose-dependent potential to prolong the QTc interval. However, other factors require appropriate consideration, including: age; gender; other medications; electrolyte abnormalities; severe comorbid conditions, such as co-occurring alcohol or substances abuse/dependence.

The objective was to study the potential mediating roles of alcohol/substances abuse on QTc prolongation.

The Italian research group STAR Network, in collaboration with the Young Italian Psychiatrists Association, aimed to evaluate the frequency of QTc interval prolongation in a sample of patients under treatment with psychotropic drugs through a cross-sectional national survey.

A sample of 2411 unselected patients were enrolled after performing an ECG during the recruitment period. Sociodemographic and clinical characteristics were collected from medical records. Collected data underwent statistical analysis.

A total of 11.2% of patients reported alcohol abuse, and only 8.9% psychotropic substances. According to the threshold, less than 20% of patients had a borderline value of QTc, and 1% a pathological value. Patients with co-occurring alcohol misuse and drug abuse were more likely to have longer QTc interval.

The present study describes the frequency of QTc prolongation in real-world clinical practice. Before prescribing a psychotropic drug, the physician should carefully assess its risks and benefits to avoid this type of adverse reaction, particularly when additional risk factors are present. The potential role of alcohol and substances on QTc length could be particularly useful in emergency settings.

The authors have not supplied their declaration of competing interest.

Alcoholic hallucinosis is a rare complication of chronic alcohol abuse, characterized by acoustic verbal hallucinations and delusions, mainly of a menacing content, arising in clear consciousness, that appear during or shortly after a period of heavy alcohol consumption.

To outline the key clinical features of alcoholic hallucinosis in order to improve differential diagnosis with other entities.

We studied the evolution of an outpatient followed in a Mental Health Centre of Valladolid and compared it with present data about the condition, found in a bibliographic search of articles no older than 10 years about the topic.

Partial insight about the experience, along with clear consciousness, was key to discard other psychiatric diagnosis that also present acoustic hallucinations. Neuroimagining and functional tests in our patient showed moderate cognitive impairment and cortical atrophy, which contradicts other studies which claim that an acceptable level of cognition must be present in order to gain the necessary insight to meet the diagnostic criteria.

Alcoholic hallucinosis is a rare form of subacute encephalopathy, secondary to an abrupt stop in a previously chronic and heavy alcohol consumption. Its diagnosis is mainly clinical, and neuroleptics are the most used drug, being abstinence essential for an adequate evolution. The course is usually benign, although the acoustic phenomena may not disappear completely.

The authors have not supplied their declaration of competing interest.

Although several authors found a strong association between childhood trauma and substance abuse disorder, many other suggest that specific personological aspects and resilience may contribute to the development of this disease.

To compare the characteristics of psychiatric patients with and without dual diagnosis assessing differences in psychological correlates, such as resilience, coping strategies, self-esteem, temperament, character traits and childhood trauma.

From November 2015 to May 2016, we recruited all patients aged between 18 to 65 years referred to the Psychiatry Ward of “Maggiore della Carità” Hospital in Novara, Italy. Diagnosis of psychiatric disorder was made according to DSM-5 diagnostic criteria. Exclusion criteria were: inability to express a valid inform consent, a personality disorder or mental retardation diagnosis. We administered to each patient: Resilience Scale for Adult (RSA), Brief Cope, Rosenberg Self-esteem Scale (RSES), Childhood Trauma Questionnaire (CTQ), Temperament and Character Inventory (TCI). Patients were subdivided for the analysis into two groups: dual diagnosis and no dual diagnosis (or single diagnosis) group.

Data show that dual-diagnosis patients (n = 40) had lower global levels of resilience (RSA) and cooperativeness (TCI). Higher novelty seeking and reward dependence traits (TCI) were found as well. Moreover, the lower Cope-Avoidance (Brief Cope) was statistically different among patients with dual diagnosis compared to single diagnosis ones.

Identified differences between these two groups could suggest targets to manage during the treatments in order to optimise dual diagnosis patients’ outcomes.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Substance abuse has been correlated with psychotic disorders albeit more accurate details on causality remain to be assessed. Furthermore, the prevalence and prognosis of substance-induced psychotic disorders have not been clearly established.

Retrospective study performed in 124 patients assessed in an Emergency Department (ED) due to psychotic symptoms over a 6-month period. Medical records were reviewed to obtain clinical and socio-demographic variables.

(1) To analyse substance abuse patterns among ED psychotic patients; (2) to estimate the prevalence of substance-induced psychotic disorders in ED; (3) to underpin the socio-demographic and clinical variables associated.

Personal history of substance abuse: THC 31.5%, alcohol 29%, cocaine 18.5%, benzodiazepines 18.5%, opiates 6.5%, MDMA 4%, amphetamines 3.2%, hallucinogens 2.4%. Accumulated time interval of substance abuse prior to psychotic onset: 0–5 years 15% (3.9% developed psychosis during the first year of cannabis use), 5–10 years 9.2%, more than 10 years 20.8%. Urine testing for drug misuse undertaken in 80.6% of cases: positives 53%, negatives 47%. Among positive urine test results: THC 16.5%, benzodiazepines 16.5%, cocaine 6.1%, opiates 5.1%, alcohol 0.9%, amphetamines 0.8%, hallucinogens 0.8%. Substance-induced psychotic disorder (F19.15) was diagnosed among 20.4% of patients. This diagnosis was 1.5 times more prevalent among males. Forty-eight percent of patients were single, 36% married, 12% divorced, 4% widowers. Habitat: 68% urban, 34% rural. Highest prevalence group 36 – 50 year olds.

Both substance abuse and substance-induced psychotic disorders are highly prevalent in our sample. Their socio-demographic and clinical profile is similar to that found in schizophrenia. Further refinements of these findings are warranted.

The authors have not supplied their declaration of competing interest.

Causality between THC and psychotic symptoms has been outlined in several studies and a potential role for THC in the development of Schizophrenia remains to be assessed.

Retrospective study undertaken in a sample of 124 patients assessed in an Emergency Department (ED) due to psychotic symptoms. Medical records were reviewed to obtain clinical and sociodemographic variables.

(1) To analyse the prevalence of THC consumption among psychotic patients in ED; (2) to establish the prevalence of cannabis-induced psychotic disorder; (3) to underpin the socio-demographic and clinical variables associated with cannabis-induced psychosis.

Personal history of cannabis use 31.5% (6.5% as a single drug.) Accumulated time interval of cannabis use prior to the first psychotic episode: 0 – 5 years 15% (3.9% developed psychosis during the first year of cannabis use), 5 – 10 years 9.2%, more than 10 years 20.8%. Cannabis-induced psychotic disorder (F12.5) was diagnosed in 3.3% of the sample. The prevalence of this diagnosis was the same among male and female patients. The highest prevalence of cannabis-induced psychosis was found among 36–50 years old patients (50%). All patients with a diagnosis of Cannabis-induced psychotic disorder had a personal history of THC use and urine tests had been positive for THC in 75% of the cases. Habitat: 75% urban, 25% rural. Marital status: 50% single, 50% married.

Cannabis use is highly prevalent among patients who present with psychotic symptoms in ED and THC is correlated with psychotic episodes. The prevalence of cannabis-induced psychosis has also increased. Further studies comprising larger samples are warranted.

The authors have not supplied their declaration of competing interest.

Cannabis is increasingly used by young people. Its several noxious effects on mental health have become a matter of preoccupation. Although cannabis use may be involved in the etiology of acute psychosis, there has been considerable debate about the association observed with chronic psychosis.

(1) To describe the profile of patients with cannabis use disorders (CUD); (2) to determine the evolutionary aspects.

We proceed with a retrospective and descriptive study conducted among 16 male patients with CUD and hospitalised for the first time in the psychiatric department at the University Hospital Hedi Chaker during the period from 1 January 2012 to 31 December 2014.

An overwhelming majority of the subjects were single and unemployed. One-third of the users had a stay abroad, the half was incarcerated at least once and one patient was implicated in illegal drugs trade. CUD were associated with specific personality disorders: borderline (18.8%) and antisocial (6.3%) personality. Into at least the 2 years of follow-up, different evolutionary aspects were distinguished. Many of the patients were lost to follow (18.8%). A total restitution of symptoms or a recurrence of the same disorders were observed in 25% of cases. About 56.3% of subjects had a change in diagnosis to either schizophrenia (43.3%) or affective disorder (12.5%).

This study showed that cannabis use can be a cause of the emergence of chronic psychosis. This emphasizes the importance of early screening of the vulnerability to psychotic disorder and identify more effective strategies to improve intervention.

The authors have not supplied their declaration of competing interest.

With the popularity of high-tech devices and Internet use in recent years, playing online or offline games has become a popular activity, among young adults (YA). However, research suggests that excessive engagement may in extreme cases lead to symptoms commonly experienced by substance addicts.

Estimate the prevalence of problematic use of video and Internet games (PUVIG) among YA. Determine the factors associated with it.

A cross-sectional study was carried out during the first half of September 2016. A sample of 69 YA with a high education's level was randomly selected from the general population. Data were collected through a global questionnaire consisted of a sociodemographic part, the Young Internet Addiction Test, the Problem Video Game playing questionnaire, online network game scale and the Perceived Stress Scale.

The average age was 27.6 years. The majority (70%) reported using video or Internet games. The risk of dependency to online network games involved 10% of game players while the presence of video games use consequences concerning 16%. Gaming addiction was significantly more likely in boys (P = 0.001). The students had more PUVIG than employees (P = 0.036). A link was highlighted with a problematic Internet use (P = 0.008), a facebook addiction (P = 0.001) and high perceived stress level (0.014).

Playing video and Internet games is a widespread activity among YA. The factors potentially involved are inevitably multiple and complex. It supports the need to carefully explore these emerging practices among this vulnerable population and suggest the establishment of better prevention and better tracking of video gaming.

The authors have not supplied their declaration of competing interest.

Adolescents’ Internet gaming disorders might influence on their social and psychological developmental tasks and physical health negatively. Depression is the commonly co-existed conditions with addictive Internet gaming, but not much research has been reported whether depressive symptoms would precede the addictive Internet gaming in this population.

This prospective observation study was performed to make clear whether adolescents’ depressive symptoms precede their addictive Internet gaming.

Adolescents’ 1-year incidence of the addictive Internet gaming was calculated, and test their depressive symptoms increase the incidence.

In Korea, whole students of the 1st grade in three middle schools were participated in this study. Baseline assessment of 508 students was performed via standardized self-reported questionnaire on May–June, 2015. Internet game use-elicited symptom screen (IGUESS) was used to addictive Internet gaming conditions. IGUESS is the 9-itemed DSM-5 diagnostic criteria-based instrument to screen high risk of Internet gaming disorders. Depressive symptoms was measured by Child Depression Inventory (CDI) group. One year after the baseline assessment, follow-up assessment was performed. Four hundred and forty-eight students have been participated in the 1-year check up without addictive Internet gaming at baseline.

In total, 4.7% of subjects had depressive symptoms at baseline, and incidence of addictive Internet gaming was 9.2%. After adjusted by sex, Internet game use per week, and self-control status, depressive symptoms of baseline increased the 1-year incidence of addictive Internet gaming significantly (OR = 3.5, P = 0.034).

Depressive adolescents have higher possibility they could experience the addictive Internet gaming.

The authors have not supplied their declaration of competing interest.

Psychiatric comorbidities and alcohol craving are known contributors to differences in alcohol consumption patterns.

Univariate and multivariable linear regression models were used to examine the association and interactions between the Inventory of Drug Taking Situations (IDTS) negative, positive and temptation sub-scale scores, sex, as well as co-morbid depression and anxiety determined by Psychiatric Research Interview of Substance and Mood Disorders (PRISM) with alcohol consumption measured by Time Line Follow Back (TLFB) during preceding 90 days in 287 males and 156 females meeting DSM-IV criteria for alcohol dependence.

IDTS positive, negative and temptation scores were strongly associated with increased alcohol consumption measures including the number of drinks per day and number of drinking days per week (P < 0.0001). Male sex was associated with higher amount of alcohol consumption per drinking day (P < 0.001), but not with the number of drinking days per week (P > 0.05). In men, lifetime history of depression was associated with fewer drinking days (P = 0.0084) and fewer hazardous drinking days (P = 0.0214) but not with differences in daily alcohol consumption. In women, depression history was not significantly associated with alcohol consumption measures. Post-hoc sex-stratified analyses suggested that the association of the negative IDTS score with total amount of alcohol consumed by men may be modified (decreased) by lifetime depression history. We found no associations of alcohol consumption measures with anxiety or substance-induced depression.

Decreased frequency of drinking in male alcoholics with lifetime depression history is unexpected. This finding emphasizes the complex relationships between alcoholism and depression, which require further investigation.

The authors have not supplied their declaration of competing interest.

FK506 binding protein 51 is a modulator of the hypothalamic-pituitary-adrenal axis activity. Its function is modulated by the single nucleotide polymorphism rs 1360780. Females often use smoking to cope with stress. The aim of this study was to investigate if the influence of nicotine consumption on cortisol plasma levels is modified by the polymorphism of rs 1360780 in females.

Two hundred and ninety-six female smokers were genotyped for the SNP rs1360780 of FKBP5 protein. Cortisol plasma concentrations were measured in blood plasma drawn three hours after smoking. Severity of tobacco addiction was assessed based on the Fagerström Test for Nicotine Dependence (FTND).

Thirty-six participants were TT-homozygotes and 260 were C allele carriers. In TT homozygotes, we found a significant negative correlation between the FTND sum score and the cortisol plasma concentrations. In a linear regression analysis, the FTND sum score accounts for 12.4% of the variance of cortisol plasma levels. By contrast, we could not find such an association in C allele carriers.

Our results suggest that nicotine is an important confounder in the modulation of HPA axis activity by FKBP5. In the light of these findings, future studies on FKBP5 should include nicotine consumption as a confounder.

The authors have not supplied their declaration of competing interest.

Regular cannabis use is associated with cognitive impairments, including impaired decision making measured by the Iowa Gambling Task. The question remains whether the impulsivity measured in regular cannabis users may participate to impaired decision making. Interestingly, the Cambridge Gambling Task (CGT) is a computerized gambling task allows to differentiate risk taking and impulsivity when making a decision.

This study aims at separately exploring the impact of regular cannabis use on risk taking and impulsivity during decision making process.

To do so, we compared the performance of regular cannabis users and healthy controls during the CGT.

Forty-three regular cannabis users (> 7 units/week) with a cannabis use disorder (CUD), 8 non-CUD regular cannabis users and 30 healthy controls were recruited. Decision-making was assessed using the CGT. The following outcomes were considered: Delay aversion score, Overall proportion bet, quality of decision making, risk taking and risk adjustment.

The analysis on delay aversion score showed a group effect (F = 3.839, P = 0.026) but no effect on other CGT variables. This effect was explained by the fact that cannabis CUD users had a higher delay aversion score than healthy controls and non-CUD cannabis users.

In this study, CUD cannabis users had an increased impulsivity but no increase of risk taking and quality of decision-making. Future work should include the CGT with a clinical scale to evaluate impulsivity and a motor inhibition task to understand if the impairment observed relates to cognitive or motor abilities.

The authors have not supplied their declaration of competing interest.

Exercise addiction is characterized by compulsive and excessive exercise patterns that eventually can lead to musculoskeletal injury. While exercise leads to increased self-esteem and is a useful tool for emotional regulation, the level of psychosocial distress may be negatively affected by such injuries.

The prevalence proportions of post-injury depression and emotional stress in athletes with exercise addiction have not previously been explored and compared to non-addicted athletes.

We wanted to test the hypothesis that athletes with addiction profiles react to injury with higher levels of emotional and social distress compared to athletes without addiction.

A cross-sectional survey was employed and a total of 1167 athletes (673 with diagnosed musculoskeletal injuries and 494 without present injury) responded to the following questionnaires: The Exercise Addiction Inventory, The Major Depression Inventory, The Perceived Stress Scale and EQ-5D to assess quality of life.

We found that 26% of the injured athletes with exercise addiction had symptoms of major depression and 53% reported emotional distress. These proportions were significantly greater compared with the injured non-addicted athletes where 11% had symptoms of major depression and 28% reported stress. Quality of life was also significantly reduced in the addiction group.

Injured athletes with exercise addiction report more post-injury psychosocial distress compared with injured non-addicted exercisers. Future trials need to investigate the effect of emotional assessment and support as a complement intervention to somatic injury treatment. Injured athletes should be examined for exercise addiction as they are at risk of depression.

The authors have not supplied their declaration of competing interest.

Polydrug abuse seems to be especially popular in Ibiza, an important market for new psychoactive substances (NPS). The misuse of psychoactive substances can lead to serious psychiatric symptoms.

To evaluate symptoms induced by NPSs and other club drugs, correlating with the main classes of drugs.

Ninety subjects (M/F 59/31) admitted in the Psychiatric Unit of Can Misses Hospital (Ibiza) referring a recent intake of substances were enrolled. The following scales were administered: TLFB (Timeline follow-back); Positive and Negative Symptoms Scale (PANSS); Symptom checklist-90 (SCL-90) ; Young Mania Rating Scale (YMRS) ; Hamilton Depression Scale (HAM-D); Hamilton Anxiety Scale (HAM-A); Modified Overt Aggression Scale (MOAS); Columbia Suicide Severity Rating Scale (C-SSRS).

Polydrug abuse was reported by 67.4% of the sample; the sample was grouped by the main preferred substance in THC-, stimulants-, and depressors-users. The majority of patients reported a previous psychiatric history. Positive symptoms resulted to be higher among THC-users (P < .05). Anxiety evaluated by SCL-90 was prevalent in the group of Depressors-users (P < .05). The scores of MOAS and SCL-90 subscale for hostility/aggression resulted to be significantly (P < .01) greater in the THC-users group.

Some specific psychiatric symptoms are characteristic of some classes of substances and may help to identify them when a urine sample is not available. The possibility to develop psychiatric symptoms after a recent drug use is more common in two situations: (1) patients with a previous psychiatric history; (2) subjects with a history of very strong substance use.

The authors have not supplied their declaration of competing interest.

After analysis of biological and pharmacological data, we formulated the hypothesis that the factors involved in trafficking of stem cells could be engaged in aetiology of bipolar disorder (BP).

In this study, we considered the role of complement cascade proteins, stromal derived factor-1 (SDF-1), and sphingosine-1-phosphate (S1P) in long-term treated BP.

A group of 30 patients with BP, without the history of lithium treatment, was examined in remission and compared with a group of 30 healthy volunteers. In peripheral blood, we have analysed the concentration of stromal derived factor-1 (SDF-1), sphingosine-1-phosphate (S1P), and some proteins of the complement cascade (C3a, C5a, C5b-9).

Peripheral blood concentration of C3a, C5a, C5b-9 and SDF-1 was significantly higher in BP group compared to control group. The concentration of S1P does not distinguish BP patients from controls.

Our results suggest the possible role of the regeneration system in aetiology of BP.

This work was supported by grant POIG.01.01.02-00-109/09.

The authors have not supplied their declaration of competing interest.

Contemporary treatment guidelines recommend use of second-generation antipsychotics (SGAs) either as mono therapy or in combination with mood stabilizers as first-line treatment. While these drugs have been established to have superior efficacy compared to placebo, there is very less data comparing these antipsychotics with one another. We sought to study differences in the five-year outcome of first episode of mania (FEM) treated with olanzapine or risperidone, either alone or in combination with mood stabilizer.

We conducted a retrospective chart review of patients diagnosed with FEM (ICD-10) in the year 2008 (n = 88) at our centre. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about time to recovery and recurrence after FEM, total episodes, drug compliance and response, and number of follow-up visits from 2008 to 2013. The study was approved by the Institute Ethics Committee.

A total of 88 patients received diagnosis of FEM in the year 2008, of which 50 (56.8%) received risperidone and 35 (39.8%) received olanzapine. The two groups were comparable in socio-demographic and clinical symptomatology of FEM (all P > 0.08). Complete recovery was significantly more in the olanzapine group than the risperidone group (χ2 = 4.84, P < 0.05).

Our study indicates that risperidone and olanzapine, either alone or in combination with mood stabilizers have a similar impact on the five-year course of BD following a first manic episode. However, olanzapine is associated with more complete recovery from FEM than risperidone.

The authors have not supplied their declaration of competing interest.

According to scientific literature, cognitive impairment is a disabling feature of the bipolar disorder (BD), present in all the phases of the disease. Obesity and metabolic disorders represent another risk factor for cognitive dysfunctions in BD, since the excess of weight could adversely influence several cognitive domains.

To highlight the presence of impairment of cognitive functions in a sample of subjects suffering from BD and obesity.

Evaluation of the cognitive performance in a sample of BD patients, considering their anthropometric measures (height and weight) and body mass index (BMI).

The neuropsychological battery MATRICS Consensus Cognitive Battery (MCCB) was administered by trained physicians for the evaluation of seven different cognitive domains in 46 patients (mean age: 43.17 years old; 39.13% male), affected by BD enrolled in the psychiatric unit of Azienda Sanitaria Locale and University of Foggia. In particular, cognitive functions assessed were speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition. BMI was calculated, and patients were divided into a group of normal weight and another one of overweight or obese, on the base of BMI value (BMI cut-off = 25).

The obese patients amounted at 56.52%. We have found the presence of cognitive deficits in two of the seven domains assessed, that are speed of processing (P < 0.01) and reasoning and problem solving (P < 0.05) in the sample of overweight patients.

Cognitive deficits are clearly revealed in BD patients during the euthymic phase of the disorder. The obesity in BD could contribute to increase dysfunctions in cognitive domains.

The authors have not supplied their declaration of competing interest.

Evidence has shown that some patients with bipolar disorder have a relatively accurate sense of their cognitive abilities, whereas others may overreported or underreported cognitive difficulties, which causes a discrepancy in this measures.

To investigate concordance and discrepancy between subjective and objective cognitive measures, as well as to identify factors that could influence this discrepancy.

Patients who met DSM IV-TR criteria for bipolar disorder in partial or full remission (HDRS-17 score ≤ 12; YMRS score ≤ 7) were recruited from outpatient clinic at Barcelona and Porto Alegre. Objective cognitive assessment was performed by the Letter-Number Sequencing (LNS-WAIS III). Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA) was used as a subjective cognitive measure.

Were included 179 patients. We found a concordance between COBRA and LNS in 62 cases, and discrepancy in 117 cases (Fig. 1). The incongruent group (COBRA–and LNS + ) have less years of study (8.10 ± 4.01) than the incongruent group (COBRA+ and LNS–) (13.44 ± 4.05, P = 0.001), and than congruent group (COBRA–and NLS–) (13.75 ± 4.04, P = 0.003). Finally, the congruent group (COBRA+ and LNS + ) was the group with higher functioning impairment.

A few number of false-negative cases were detected, suggesting that COBRA can be used as a screening instrument. A special attention should be provided for subjects with a few years of study, because possibly these subjects presents more difficulty in express its cognitive difficulties.

The authors have not supplied their declaration of competing interest.

Mania is challenging to treat. Typical antipsychotics may be more efficient compared with atypical antipsychotics, however, with unfavourable side effects.

To help the clinician choose between typical and atypical antipsychotics.

To investigate the correlation between change in severity of mania and the corresponding day to day use of typical and atypical antipsychotics.

This retrospective case record study included patients admitted with mania (International Classification of Diseases 10th revision code F30, F31.0, F31.1, F31.2 or F31.6) at the Department of Affective Disorders, Aarhus University Hospital, Denmark, between January 2013, and December 2015. The dose of typical and atypical antipsychotics was standardized as defined daily dose according to the World Health Organization's guidelines. The severity of mania was measured daily with the Modified Bech-Rafaelsen Mania Scale (MAS-M), a validated, nurse administered scale (MAS-M). We applied a linear regression in a mixed model approach to compare the Mas-M score over time under the influence of typical and atypical antipsychotics, respectively, adjusted for baseline characteristics.

We included 43 patients. Patients receiving typical antipsychotics had more recent hospital admissions, a higher dosage antipsychotics and more constraint. The baseline MAS-M score was higher in patients receiving typical antipsychotics. The daily change in MAS-M score was–0.25 for typical antipsychotics and–0.23 for atypical antipsychotics with a difference of 0.02 (95% CI 0.008–0.039).

The rate of improvement of mania may be independent of baseline illness or type of antipsychotic medication. This may be confounded by indication.

The authors have not supplied their declaration of competing interest.