The relationship between bipolar disorder (BD) and multiple sclerosis (MS) has gained increasing attention due to the complex interplay between neurological and psychiatric symptoms in affected individuals. BD can significantly impair quality of life, and its prevalence in MS patients remains a critical area of investigation.

We present the case of a a 42 year-old woman. She was admitted to the Psychiatric Hospitalization Unit due to a manic episode with psychotic symptoms. Her psychiatric history includes a visit to the Mental Health Unit one year prior for anxiety-depressive symptoms. Notably, she has a diagnosis of Multiple Sclerosis from 2022.

Based on the described clinical case, we aim to review the available literature on the relationship between bipolar disorder and multiple sclerosis.

A systematic review of the literature was conducted using databases such as PubMed, Scopus, and PsycINFO. Studies published up to 2023 that reported on the prevalence and clinical characteristics of BD in MS patients were included. Data were extracted and synthesized to provide a comprehensive overview.

The review identified 20 relevant studies, with pooled data indicating a prevalence of BD in MS patients ranging from 5% to 20%. Key factors influencing prevalence included demographic variables, such as age and sex, as well as the presence of other psychiatric comorbidities. The literature suggests that inflammatory processes and neurobiological changes in MS may contribute to the development of mood disorders, including BD.

There is significant evidence linking bipolar disorder with multiple sclerosis, highlighting the importance of comprehensive mental health assessments in MS patients. Future research should focus on understanding the pathophysiological mechanisms behind this association and developing tailored interventions to improve overall patient outcomes.

None Declared

Lumateperone, an atypical antipsychotic drug approved in 2021 for bipolar depression, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors. In India, Quetiapine is one of the approved drugs for use in depressive episodes for bipolar disorder.

This post-hoc analysis of an Indian Phase 3 study was conducted to evaluate the correlation of severity of depression assessed via Montgomery-Asberg depression rating scale (MADRS) and severity of hypomania symptoms via Young Mania Rating Scale (YMRS) when treated with Lumateperone 42mg or Quetiapine 300mg.

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included patients with Bipolar II depression with moderate severity having a MADRS score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. In this post-hoc analysis, correlation between MADRS and YMRS were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This post-hoc analysis included 462 patients [231 each in Test and Comparator]. The baseline demographic characteristics were comparable in between treatment arms. The Pearson’s correlation coefficient between change from baseline in MADRS score and YMRS score was statistically significant for both treatment arms at Day 42 [Test: 0.3144, p<0.0001; Comparator: 0.3284, p<0.0001] and the linear regression between 2 arms was not statistically significant (p=0.4203), indicating weak positive correlation between the 2 scales [Figure 1 and Figure 2]. The incidence of TEAEs were similar in both treatment arms [Test: 34.6%; Comparator: 35.5%] and no serious adverse events were reported.

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This post-hoc analysis demonstrated that patients with Bipolar II depression when treated with Lumateperone 42mg or Quetiapine 300mg, the reduction in MADRS score is directly proportional to reduction in YMRS score and both treatments were well tolerated.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. Mangalwedhe: None Declared, S. G. Goyal: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, A. Shetty Employee of: Sun Pharma, S. Saha Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma

Lumateperone, an atypical antipsychotic drug approved in 2021 for bipolar depression, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors. In India, Quetiapine is one of the approved drugs for use in depressive episodes for bipolar disorder.

This post-hoc analysis of an Indian Phase 3 study was conducted to evaluate the correlation of severity of depression assessed via Montgomery-Asberg depression rating scale (MADRS) and quality of life assessed via Quality-of-life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF) when treated with Lumateperone 42mg or Quetiapine 300mg.

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included patients with Bipolar II depression with moderate severity having a MADRS score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. In this post-hoc analysis, correlation between MADRS and Q-LES-Q-SF were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This post-hoc analysis included 462 patients [231 each in Test and Comparator]. The baseline demographic characteristics were comparable in between treatment arms. The Pearson’s correlation coefficient between change from baseline in MADRS score and Q-LES-Q-SF score was statistically significant for both treatment arms at Day 42 [Test: -0.192, p=0.0043; Comparator: -0.299, p<0.0001] and the linear regression between 2 arms was not statistically significant (p=0.0853), indicating weak negative correlation between the 2 scales [Figure 1 and Figure 2]. The incidence of TEAEs were similar in both treatment arms [Test: 34.6%; Comparator: 35.5%] and no serious adverse events were reported.

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This post-hoc analysis demonstrated that patient with Bipolar II depression when treated with Lumateperone 42mg or Quetiapine 300mg, the reduction in MADRS score is inversely proportional to Q-LES-Q-SF score.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. G. Goyal: None Declared, S. Mangalwedhe: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, S. Saha Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma

Lumateperone, an atypical antipsychotic drug approved for Bipolar II depression in 2021, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors.

This post-hoc analysis of an Indian Phase 3 study was conducted to evaluate the impact of Lumateperone 42mg compared to Quetiapine 300mg on quality of life of patients with Bipolar II depression assessed via Quality-of-life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF).

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included patients with Bipolar II depression with moderate severity having a Montgomery-Asberg depression rating scale (MADRS) score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. This post-hoc analysis evaluated Q-LES-Q-SF total score and individual item scores [Physical health(1), Mood(2), Work(3), Household activities(4), Social relationships(5), Family relationships(6), Leisure time activities(7), Ability to function in daily life(8), Sexual drive, interest and/or performance(9), Economic status(10), Living/housing situation(11), Ability to get around physically(12), Ability to do work(13), Overall sense of wellbeing(14), and Overall life satisfaction and contentment(16)] for efficacy outcomes and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This post-hoc analysis included 462 patients [231 each in Test and Comparator]. The baseline demographic characteristics were comparable in between treatment arms. The improvement in Q-LES-Q-SF (total score and individual item scores) is significant from baseline to Day 42 in both treatment arms and comparable [Figure 1 and Figure 2 respectively]. Statistically significant improvement in Test over Comparator was observed for Item 7 (Leisure time activities) and Item 14 (Overall sense of wellbeing) [Figure 2]. The incidence of TEAEs were similar in both treatment arms [Test: 34.6%; Comparator: 35.5%] and no serious adverse events were reported.

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This post-hoc analysis demonstrated that Lumateperone 42mg is comparable to Quetiapine 300mg in treatment of Bipolar II depression as assessed via Q-LES-Q-SF score from baseline to Day 42, and both treatments were found to be well tolerated.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. Mangalwedhe: None Declared, S. G. Goyal: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, A. Shetty Employee of: Sun Pharma, S. Saha Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma

Differentiating bipolar I, bipolar II, and major depressive disorders is essential; therefore, the relationship between affective temperaments and mood disorder diagnoses has garnered considerable attention.

The current study aimed to explore the representative types of Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) profiles observed in the actual clinical setting using a data-driven approach and verify the relationship between TEMPS-A profiles and the proportions of three mood disorders (bipolar I, bipolar II, and major depressive disorders). Through this research, we intend to enhance the utility and applicability of affective temperament assessment based on the TEMPS-A when differentiating among mood disorders in clinical practice.

Psychiatric outpatients diagnosed with bipolar I, bipolar II, or major depressive disorder and aged ≥18 years were analyzed. Latent profile analysis was conducted using TEMPS-A scores, and each patient was classified into a subgroup according to their TEMPS-A scores. After that, multinomial logistic regression was conducted to verify the relationship between TEMPS-A profiles and mood disorder diagnoses.

The findings indicate that seven types of TEMPS-A profiles are the most appropriate (Table 1). The depressive profile did not significantly increase the likelihood of being diagnosed with both bipolar II disorder and bipolar I disorder. The cyclothymic profile and anxious, cyclothymic and depressive profiles significantly increased the likelihood of the diagnosis of bipolar II disorder but did not significantly increase the likelihood of the diagnosis of bipolar I disorder. Furthermore, the cyclothymic and hyperthymic profile; cyclothymic, depressive and irritable profile; and anxious, cyclothymic, hyperthymic and irritable profiles significantly augmented the likelihood of being diagnosed with both bipolar II disorder and bipolar I disorder (Tables 2 and 3).

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Our findings show that certain affective temperaments are closely correlated with one another, and cyclothymic temperament can act as a crucial risk factor for bipolarity. Moreover, our findings suggest the possibility that hyperthymic or irritable temperaments can help differentiate between bipolar I disorder and bipolar II disorder. Further studies using reliable clinical interview schedules are needed, and studies focusing on patients with other mood disorders would be helpful.

None Declared

Emotion dysregulation (ED) is a core feature of bipolar disorder (BD), impacting patients’ ability to manage intense emotional responses and maintain mood stability. Predominant polarity (PP) is a clinical specifier in BD with important implications for prognosis, treatment planning, and outcomes. PP categorizes patients based on the mood episode type they experience most frequently: depressive PP (DPP), manic PP (MPP), or undetermined PP (UPP) when no episode type prevails. Given that PP reflects the types of symptoms most commonly experienced by patients, and that ED is closely linked to mood symptoms in BD, it remains unclear whether ED differs across PP subgroups.

We aimed to compare overall levels of ED and specific emotion regulation (ER) domains across patients with BD and DPP, MPP, and UPP.

We analyzed data from patients with BD enrolled in the Bipolar Exposome-Gene Interaction Naturalistic (BEGIN) study. ED and ER strategy alterations were assessed using the Difficulties in Emotion Regulation Scale (DERS-28) and its subscales: Lack of Control, Non-Acceptance, Interference, Inattention, and Confusion. PP was defined based on the Barcelona proposal. Due to non-normal DERS score distributions (Shapiro-Wilk p < 0.05), the Kruskal-Wallis test was applied to compare DERS total and subscale scores across PP groups, followed by Dunn’s test with Bonferroni correction for pairwise comparisons.

The sample included 64 patients with BD (mean age=51±12.5; 46.9% female). Of these, 17 had DPP, 7 had MPP, and 40 had UPP. Significant differences across PP groups were observed in overall ED (p=0.04), with the UPP group showing higher total DERS scores than the MPP group (Z=2.55, p=0.03). In the Lack of Control subscale, both the DPP and UPP groups scored higher than the MPP group (Z=2.43, p=0.04 and Z=3.14, p=0.01, respectively). No other significant differences were found.

These findings indicate that ED varies across PP groups, emphasizing the potential advantages of tailored interventions within a precision psychiatry framework. Personalized approaches to managing ED may improve long-term outcomes and decrease the risk of recurrence across mood states in BD.

None Declared

Bipolar disorder (BD) is a recurrent psychiatric illness characterized by manic, hypo-manic, depressive and mixed episodes. The endocannabinoid system (ECS) is a vast network of chemical signals and cellular receptors that are densely packed throughout the brain. It is involved in most critical central nervous system functions, such as learning and memory, but also mood regulation. Despite this, there is only anecdotal evidence on the potencial role of the ECS in the pathophysiology of BD.

This study aims to retrospectively assess clinical and sociodemographic variables of patients whose manic episode is temporally associated with the suspension of cannabis use, compared with the rest of a sample of manic patients admitted to an acude psychiatry ward. The objective of the study is to investigate the presence of a specific group of BD patients, with potential clinical and therapeutic implications.

We retrospectively analysed all admitted patients to the acute psychiatry unit at Hospital Clinic of Barcelona from 2015 to 2019 and hospitalized for a manic episode. Patients with core manic symptoms started after cannabis withdrawal were included in the study. Cannabis Withdrawal Induced Mania (CWIM) group (n=20) was compared with the rest of bipolar manic patients in our sample according to several clinical and sociodemographic variables. Univariate and multivariate logistic regression models were performed.

between 2015 and 2019, 315 patients were admitted to the acute psychiatry unit with diagnosis of manic episode. In 282 of the cases, the history of cannabis use was documented. 20 of them meet criteria for CWIM. CWIM group patients were significantly more frequently men (p=0.015) and younger (p<0.001), were not married or in a relationship (p = 0.018) and less frequently had somatic illnesses (p=0.41). Patients with CWIM debuted with a first manic episode and had their first psychiatry admission at a significantly younger age (p=0.008 and p=0.004, respectively). Previous treatment with antipsychotic medication was significantly less frequent in the CWIM group (p=0.022). According to follow-up, there were no significant differences in relapse after three years (p=0.936).

This study found a new clinical profile of patients, who are more suggestive to have a manic episode in context of cannabis withdrawal.

None Declared

A 43-year-old male with a diagnosis of Bipolar Disorder associated with substance use is admitted to the mental health unit due to a psychotic decompensation. The patient has had an unfavorable progression requiring multiple admissions to mental health services. He suffers from dyslipidemia, hypertension, and poorly controlled diabetes. He has had some occasional work but is currently unemployed. He does not engage in leisure or sports activities, which he attributes to being highly sedated by the medication. He is currently being treated with clozapine, valproic acid, quetiapine, and various benzodiazepines.

Achieve stabilization of the psychopathological condition without producing additional side effects such as sedation.

During the hospital stay, Quetiapina is slowly reduced over one week, and Aripiprazole is introduced at a moderate oral dose (Aripiprazole 10 mg). It is then gradually increased to 30 mg/day. After 3 weeks, it is switched to Aripiprazole 400 mg /28 days intramuscularly. At the start of Aripiprazole introduction, there is a good response and a tolerance.

With the combination of Clozapine and Aripirazole 400 mg/28 days intramuscularly, there is a noticeable reduction in psychotic symptoms, allowing for the discontinuation of both Quetiapine and benzodiazepines from the patient’s treatment.

At present, reviewing the outpatient follow-ups the patient has had after hospital discharge, he continues with Aripiprazole 400 mg /28 days intramuscularly, showing overall improvement in functioning. Due to the reduction in sedation, the patient has begun participating in sports and educational activities, which provide him significant personal satisfaction.

Introducing Aripiprazole in combination with Clozapine significantly reduces psychotic symptoms by controlling positive symptoms, which means the patient does not need to rely on benzodiazepines, allowing for their discontinuation. The reduced level of sedation has enabled the patient to engage in sports and other activities that he previously felt hindered from due to medication. It is indeed very important for any patient to resume leisure and sports activities, but in this specific case, the patient had grade III obesity with associated dyslipidemia.

None Declared

We present the case of a 61-year-old retired woman with hypothyroidism and rheumatoid arthritis who was diagnosed with bipolar disorder in 2006 after a manic episode. Her initial treatment included venlafaxine, valproic acid, quetiapine, zolpidem, and lormetazepam. She had several manic episodes over the years, some requiring hospitalization. In 2017, venlafaxine was replaced with vortioxetine, which she now introduces when detecting depressive phases, under psychiatric supervision but with some autonomy. She has remained stable, with occasional manic or hypomanic episodes triggered by stress, but none requiring hospitalization.

Figures 1 and 2 illustrate the patient’s self-perception changes with vortioxetine treatment. Figure 1 shows her as unhappy during the depressive phase (top) and happy after recovery (bottom). Figure 2 depicts her self-image during the depressive phase (left) and after recovery (right).

• - To assess the effectiveness, safety and risk of mood swings of vortioxetine in a patient with bipolar disorder during depressive phases.

• - To determine if effective psychoeducation allows patients to manage some of their medications safely under specialist supervision.

The patient mantains treatment with vortioxetine 20 mg daily, valproic acid 500 mg every 12 hours, quetiapine extended release 400 mg at dinner, zolpidem 15 mg, and lormetazepam 2 mg at bedtime during depressive phases. In manic episodes, quetiapine 300 mg is added, vortioxetine is discontinued, and the dosage of hypnotics is doubled. Intensive psychological support has improved her disease awareness and treatment adherence, allowing her to adjust vortioxetine (but not other medications) as needed under medical supervision. She has not reported any adverse effects from vortioxetine.

Vortioxetine 20 mg could effectively treat depressive phases without causing mania. Though research on its use in bipolar disorder is limited, it shows potential when combined with a mood stabilizer, with a response time of about nine weeks and a low risk of hypomania/mania. It may also help with cognitive decline and brain inflammation related to bipolar disorder, improving cognitive performance and reducing inflammatory markers. Vortioxetine is noted for its effectiveness, tolerability, and low dropout rate.

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Vortioxetine 20 mg may be effective for treating depressive phases in bipolar disorder with a lower risk of manic episodes compared to other antidepressants. Its procognitive and potentially anti-inflammatory effects could also support stability in non-psychiatric comorbidities. For this patient, good psychoeducation has facilitated a degree of independence in managing the medication, which is aided by vortioxetine’s safety and ease of use for both professionals and patients.

None Declared

Bipolar disorder (BD) has a lifetime prevalence of approximately 2% and is one of the 17 most disabling diseases worldwide. Multiple factors, beyond the impact of acute mood episodes, contribute to the burden of the disease. BD is also characterized by cognitive impairment (CI), which affects between 30% and 57% of patients during euthymic phases [1]. The most impacted cognitive domains are memory, attention, processing speed, and executive function [1]. CI plays a critical role in the diminished psychosocial functioning observed in BD patients [2, 3]. However, cognitive profiles in BD are heterogeneous, and the underlying causes of CI are likely multifactorial, involving more than just the effects of acute mood episodes.

In recent years, growing evidence on the biomarkers associated with BD has expanded our understanding of various molecular pathways—such as inflammatory, oxidative stress, and dysmetabolic pathways—which have been linked to CI. These pathways not only affect cognitive function but also contribute to an increased risk of metabolic and inflammatory comorbidities, further exacerbating CI and the overall burden of the illness [4, 5]. As a result, further research into biomarkers of CI is essential, as it may enhance our knowledge of the molecular mechanisms involved and help identify potential pharmaceutical targets.

Despite recent systematic reviews on the topic, most have focused on individual pathways [2, 6], and there is a need for a more comprehensive review of the current evidence regarding biomarkers linked to CI in BD.

The goal of the present review is to examine the relationship between peripheral biomarkers (e.g., blood, saliva, urine) and impairments across specific cognitive domains in individuals with BD in euthymic state.

Inclusion/exclusion criteria: we included studies that assessed patients in euthymic states at the time of both cognitive evaluation and biomarker collection, and we excluded studies employing more invasive techniques (e.g., spinal puncture). Study quality will be assessed using the Joanna Briggs Institute Critical Appraisal tools.

A database search (PubMed, Scopus, PsychInfo) identified 6,767 records after duplicate removal. Following title, abstract, and full-text screening, as well as manual reference list checks, a total of 52 studies were included. Data extraction is currently ongoing and includes publication year, country of origin, study design, sample size, sociodemographic and clinical characteristics, cognitive assessment tools, biomarkers investigated, and study outcomes.

Conclusions will be drawn at the end of the systematic review process. Further research into biomarkers of CI in BD is essential, as it may enhance our knowledge of the molecular mechanisms involved and help identify potential pharmaceutical targets.

None Declared

This is a 26-year-old male patient, diagnosed with bipolar disorder, admitted to a medium-stay unit for two months due to lack of awareness of the disease, after several admissions to the acute unit for manic decompensation with psychotic symptoms after abandoning psychopharmacological treatment and cannabis use.

The patient, who was stable since the beginning of the medium-stay admission after being referred directly from an acute unit, began to show strange behavior that became more pronounced over the days.

To study the relationship between energy drinks and the development of psychotic symptoms in the existing literature, based on a clinical case.

Description of the clinical case.

Bibliographic review related to the topic.

The difficulty in this case was to find out the cause of the psychotic symptoms that the patient was presenting, since he was taking the psychopharmacological treatment well and the urine tests that were carried out every time he returned from the street were negative. He had not had any stressful events either. On one of the outings that he made, an assistant saw that he was drinking a can of Monster. When asked, the patient commented that he usually drank between one and two cans a day. Olanzapine 10 mg (0-0-1) and clonazepam 2 mg (1-0-1) were added to the patient that he was taking. In addition, his outing permits will be withdrawn until clinical stabilization is achieved.

In the acute appearance of psychotic symptoms in patients with a previous history, possible causes must always be investigated, the most frequent being the following: abandonment of psychopharmacological treatment, consumption of toxic substances and stressful events. Although it is true that there are not many studies that support this, cases have been reported in which energy drinks, due to their high caffeine content, could also be one of the triggers.

None Declared

A linguistic feature is a common characteristic associated with various mental disorders. In particular, bipolar disorder is one of the disorders in which verbal abnormalities as symptoms can be prominent. As technology advances and big data processing becomes easier, studies on the linguistic characteristics of bipolar disorder are increasing. However, the results of previous generations, who studied the linguistic features of bipolar disorder without computer-based methods are not considered, and have not been integrated with current research findings. It is necessary to review what methodologies can be used and what limitations should be considered to explore the linguistic characteristics of bipolar disorder.

This scoping review aims to explore how we can analyze linguistic features of bipolar disorder by using textual language. It reviewes the approaches and results of the studies can explain bipolar disorder appropriately.

The study protocol follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Research papers for this review were collected by 3 electronic databases: Google Scholar, PubMed, Web of Science Using inclusion and exclusion criteria, all investigators screened the abstracts and full texts of the articles and extracted the data independently.

We identified 315 potential studies from 3 databases. After screening the abstracts and full texts of articles, 17 (5.3%) articles met our inclusion criteria. We extracted elements such as results, and methodology from the above articles. The purpose of investigating linguistic features is mostly to predict and classify bipolar disorder, and to characterize the linguistic feautres of patients with bipolar disorder and other disorders. The most commonly used methodology is computer-based language analysis, such as natural language processing and learning models. Non-computer based articles, some of them adopted qualitative analysis. We confirmed the following results regarding the linguistic characteristics of bipolar disorder: a reduction in lexical variety, a higher rate of coordinate phrases, words related to power and achievement, and themes of humor and anger. In the narrative description of this, we include discussions on ethical issues.

This scoping study synthesizes a study analyzing the linguistic characteristics of patients with bipolar disorder for the purpose of classification and discrimination. Past and present study uses various collection targets such as letters and web-based data, and adopts various methodologies including computer-based methods and qualitative analysis. In this study, we review the points to consider in order to interpret and apply the results of these studies from a clinical point of view. Additionally, the focus is presented to researchers who analyze the linguistic characteristics of bipolar disorder.

None Declared

Distinguishing between bipolar and unipolar disorder is essential for effective treatment, yet accurate diagnosis remains challenging despite extensive research. The MDQ (Mood Disorder Questionnaire) and BSDS (Bipolar Spectrum Diagnostic Scale) are widely used self-assessment tools, each offering unique advantages. However, these tools are typically used based on total scores, potentially overlooking valuable information within individual items.

This study aims to employ clustering analysis on the MDQ and BSDS, utilizing subscales derived from factor analysis, to better differentiate patients with bipolar and unipolar disorders.

The study included patients diagnosed with bipolar and bipolar depression, with diagnoses confirmed by a psychiatrist according to DSM-IV-TR criteria. A total of 299 patients with bipolar depression and 142 with unipolar depression completed the MDQ and BSDS. Based on prior factor analysis, the MDQ was divided into two subscales: the positive activation subscale (items 3, 4, 8, 9) and the negative activation subscale (items 1, 2, 6, 7, 12, 13). K-means clustering was performed twice: once using the total scores from the MDQ and BSDS (two scores), and using the positive activation subscale, negative activation subscale from the MDQ, and the total score from the BSDS (three scores). The analysis was iterated 1000 times to avoid overfitting.

The analysis identified an optimal solution with K=2. Cluster 1, characterized by high scores on both questionnaires, predominantly comprised bipolar patients. In contrast, Cluster 2, with lower scores, was primarily composed of unipolar patients. Using the total scores from both the MDQ and BSDS for clustering yielded an accuracy of 67.88%. In the second analysis using the MDQ subscales and the BSDS total score, the accuracy improved to 77.55%.

Clustering based on the MDQ and BSDS achieved a 77.55% accuracy in distinguishing bipolarity when using MDQ subscales alongside the BSDS score, demonstrating a promising level of precision with self-report questionnaires. Importantly, segmenting the MDQ into positive and negative activation subscales resulted in a nearly 10% increase in accuracy compared to using total scores alone. This suggests that increasing the dimensionality of the data by incorporating disorder-specific subscales can improve clustering accuracy. These findings highlight the potential of using high-dimensional psychiatric data to develop more effective classification models.

None Declared

Bipolar disorder (BD) is a complex mental health condition characterized by alternating periods of depression and mania, affecting millions worldwide. Despite its prevalence, the use of antidepressants, widely prescribed for unipolar depression, remains debated in the context of bipolar depression due to concerns about mood destabilization, mania induction, rapid cycling, and long-term efficacy and safety. This ambiguity underscores the critical need for a comprehensive analysis to guide clinical practice. This review aims to evaluate the efficacy, safety, and long-term outcomes of antidepressant use in bipolar disorder.

Assess the safety and efficacy of antidepressants in bipolar disorder. Optimize treatment options to help reduce the global burden of bipolar disorder and address a major gap in understanding regarding the role of antidepressants in treating bipolar disorder.

A systematic review of 35 studies, including 18 randomized controlled trials (RCTs), 14 cohort studies, and 3 meta-analyses published between 2010 and 2023, was conducted. Studies were selected based on predefined inclusion and exclusion criteria, focusing on antidepressant efficacy, safety, and long-term effects in BD patients. Data extraction and synthesis followed rigorous methodological protocols. The extracted data were then analyzed to identify trends, themes, and contradictions in the literature.

The use of antidepressants in bipolar disorder should be highly individualized, balancing potential benefits against risks. Clinicians must exercise caution, particularly regarding the risk of mania induction. This review found that antidepressants, especially when combined with mood stabilizers, demonstrated moderate efficacy in treating bipolar depression. Outcomes varied significantly across studies; while some patients benefited from antidepressant use, others experienced increased risks, such as rapid cycling and mania induction. There is a lack of conclusive long-term safety data, highlighting the need for personalized treatment approaches to mitigate risks.

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The role of antidepressants in bipolar disorder treatment remains contentious due to variability in outcomes and safety concerns. A personalized treatment approach, incorporating mood stabilizers, is recommended. This literature review concluded it is essential to balance the benefits and risks. Therefore, a combined treatment regimen with mood stabilizers is recommended. Further research, particularly longitudinal studies, is necessary to establish more definitive, evidence-based guidelines for treating bipolar depression with antidepressants.

None Declared

Bipolar disorder (BD) is a chronic illness that can lead to severe functioning impairment, which can disrupt daily life. This study aims to compare overall functioning and clinical presentation associated with early onset (EO) and mid-life onset (MO) BD.

The objective of this study is to be able to predict the cognitive and functional impairment evolution of bipolar disorder based on the onset.

A total of 154 BD patients (81 in euthymia and 51 in a depressive episode) participated in this cross-sectional study. We selected two groups of subjects based on age at onset of the first mood episode (EO: 0-20 years, n=117; MO: 20-40 years, n=37) and compared socio-demographic, clinical variables and functional impairment assessed by the World Health Organization Disability Assessment Schedule (WHODAS 2.0).

75.2% of the patients with an EO were female, they had higher psychiatric comorbidities prevalence (76.1% vs. 43.2%; p<.001), being personality disorders the most significant (30.2% vs. 5.4%; p=.001), more suicide attempts (51.3% vs. 16.2%; p<.001), mood episodes (mdn=12, iqr=17 vs. mdn=6, iqr=9.5; p=.001), childhood abuse (93.5% vs. 73.9%; p=.014), being verbal (78.0% vs. 52.2%; p=.015) and physical abuse (51.6% vs. 21.7%; p=.009) higher compared to MO. Functionality was also affected, with higher dysfunction percentages in EO (mdn=47, iqr=34.7 vs. mdn=24, iqr=12.5; p<.001) affecting cognition (mdn=8.5, iqr=6 vs. mdn=4, iqr=7; p<.001), self-care (mdn=2, iqr=5 vs. mdn=0, iqr=1; p<.001), daily activities (mdn=12, iqr=13 vs. mdn=4, iqr=10; p<.001) and community participation (mdn=13, iqr=8.7 vs. mdn=8, iqr=7; p<.001).

EO depressed patients (n=38; F: 30; M: 8), had more personality disorders (42.1% vs. 0%; p=.010), suicide attempts (60.5% vs. 0%; p<.001), mood episodes (mdn=12, iqr=12 vs. mdn=5.5, iqr=4.7; p=.001), lower overall functionality (mdn=57, iqr=41.5 vs. mdn=35, iqr=38.3; p=.009), cognition (mdn=10, iqr=6.5 vs. mdn=4, iqr=9; p=.023), self-care (mdn=4, iqr=6.2 vs. mdn=0, iqr=3; p=.008), oneself care (mdn=9, iqr =7 vs. mdn=5, iqr=8.5; p=.025), daily activities (mdn=15.5, iqr=14 vs. mdn=11, iqr=12.7; p=.037) and community participation (mdn= 15.5, iqr=8.2 vs. mdn=11.5, iqr=5.7; p=.030).

EO euthymic patients (n=59; F: 42; M: 17) had more psychiatric comorbidities (74.6% vs. 33.3%; p=.001), physical abuse history (51.2% vs. 0%; p= .002), and lower functionality (mdn=7, iqr=7 vs. mdn=2, iqr=7; p=.004), cognition (mdn=7.5, iqr=7 vs. mdn=4, iqr=7; p=.033), daily activities (mdn=9, iqr=11 vs. mdn=3, iqr=8.5; p=.005) and community participation (mdn=10, iqr=9 vs. mdn= 7, iqr=7; p=.031).

Results suggest that patients with an EO are more associated with severe psychosocial functioning impairment. Future studies are needed to clarify a more severe illness prediction between EO and MO.

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Cariprazine is indicated for the treatment of Schizophrenia in adult patients. Its therapeutic action is dual: as a blocker of D2 dopamine receptors, as a partial agonist at D2 and D3 dopamine receptors, and as a partial antagonist at 5HT2B and 5HT2A receptors of serotonin, as well as a blocker of histamine H1 receptors.

The objective of this paper is to highlight the treatment of Emotional Disorders.

30 patients (n=30) of the Outpatient Psychiatric Clinics of the Department of Psychiatry were studied, of which 15 men and 15 women, who suffered from Bipolar Disorder Type I. All patients were given the YMRS (Young Mania Related Scale) questionnaire, before starting treatment and 30 days after starting treatment with Cariprazine 6 mg, in combination with sodium valproate 1000 mg daily.

Of the 30 patients, 25 presented a clear decrease in the YMRS Scale (percentage 75%), of which 13 were women and 12 were men, respectively. In the present study no superiority in response to treatment was found for either men or women.

Cariprazine is a new therapy in the treatment of Bipolar Disorder Type I. It is of course necessary to complete the study with a larger pool of patients.

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Cognitive impairment in serious mental illness (SMI) is a major determinant of disability across employment, independence, and social outcomes. However, performance-based assessments are commonly unavailable in clinical settings. The remaining choices are self-report vs. clinician impressions and it is not clear across SMI how much clinician vs self-reports are related to objective performance.

In this study, we examine performance-based assessments and their correlations with self-reports and informant judgments of cognitive and social cognitive impairments.

Participants with bipolar disorder (BPl; n=114) and schizophrenia (SCZ; n=126) participated in a comprehensive study of cognition and functioning, including clinical (MADRS), performance-based assessments, self-reports, and observer ratings of cognitive and social cognitive functioning following a 30-day Ecological Momentary Assessment (EMA) assessment period daily assessments of Positive (PA) and Negative (NA) Affect were collected.

In participants with schizophrenia, self-reports of cognitive functioning were uncorrelated with objective data (r=-.02) and with clinician ratings assessments(r-.00), but were correlated with clinician ratings of depression (r=.41) and EMA reports of momentary NA (r=.37). Interestingly, clinician ratings of cognitive performance were correlated with performance data (r= .41) and MADRS (r=.35) but not self-reported cognitive ability (r=-.08). In participants with bipolar disorder, self-reports of performance ability was correlated with performance-based data (r=.43) and clinicians’ ratings of cognitive ability (r=.51). Both MADRS ratings and EMA-based momentary NA ratings were also correlated with self-reported cognitive performance (r>.44), but not objective cognitive performance (r=.14).

There are clear differences in the ability to self-report cognitive performance in schizophrenia and bipolar disorder. However, clinicians appear to be equivalently able to index cognitive impairment across BPI and SCZ. Participants with BPI appear to be much more able to identify their impairments than those with SCZ, but the correlation between clinician ratings and objective performance seems similar across conditions. These data suggest that reliance on self-reports of impairment may require adjustments based on diagnosis or other factors, but that clinician impressions of cognitive impairment converge with cognitive data.

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Patients with bipolar disorder (BD) and major depressive disorder (MDD) face an elevated risk of early mortality from various physical illnesses, particularly cardiovascular disease (CVD). However, it remains uncertain whether depressive or manic symptoms contribute more significantly to CVD outcomes.

This study aimed to assess the association between manic and depressive symptoms and long-term CVD risk factors.

A retrospective study was conducted on patients hospitalized in the female unit of psychiatric department “B” in Sfax, Tunisia, between January and June 2023. Sociodemographic, clinical, and CVD risk factor data were collected from medical records to calculate Framingham Scores. The relationships between mood symptoms (depressive and manic) and Framingham scores, as well as individual CVD risk factors (lipids, blood pressure, BMI, smoking, and fasting glucose), were analyzed.

The study included 50 female patients with a mean age of 45 years (SD = 9.9). Of the patients, 18% were diagnosed with MDD, while 82% were diagnosed with BD; 64% were admitted for manic symptoms, and 36% for depressive symptoms. Clinical obesity was observed in 64% of patients, with 60% diagnosed with hyperlipidemia, 34% with hypertension, and 26% with type 2 diabetes. Notably, 12% of patients had a Framingham score of ≥ 10%, indicating a moderate to high 10-year risk of CVD. Bivariate analysis revealed that patients with manic symptoms had a significantly higher CVD risk than those with depressive symptoms (p=0.034). Manic symptoms were also significantly associated with elevated BMI (p=0.034), fasting glucose (p=0.039), and blood pressure (p<0.001).

This study demonstrates a strong association between manic symptoms and long-term CVD risk in patients with mood disorders, particularly with elevated blood pressure, glucose levels, and BMI. These findings underscore the importance of specific monitoring and intervention programs for CVD risk factors in patients with mood disorders, especially those with BD.

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Lifestyle factors are being increasingly studied in bipolar disorder (BD) due to their possible effects on both course of disease and physical health.

The aim of this study was to jointly describe and explore the interrelations between diet patterns, exercise, pharmacological treatment with course of disease and metabolic profile in BD.

The sample consisted of 66 euthymic or mild depressive individuals with BD. Clinical and metabolic outcomes were assessed, as well as pharmacological treatment or lifestyle habits (diet and exercise). Correlations were explored for different interrelations and a factor analysis of dietary patterns was performed.

Adherence to the Mediterranean diet was low, seen in 37.9% of the patients and was positively associated with perceived quality of life. The amount of exercise was negatively associated with cholesterol levels, with 32.8% of participants rated as low active by International Physical Activity Questionnaire. There was a high prevalence of obesity (40.6%) and metabolic syndrome (29.7%). Users of lithium showed the best metabolic profile. Interestingly, three dietary patterns were identified: “vegetarian,” “omnivore” and “Western.” The key finding was the overall positive impact of the “vegetarian” pattern in BD, which was associated with reduced depression scores, better psychosocial functioning, and perceived quality of life, decreased body mass index, cholesterol, LDL and diastolic blood pressure. Nuts consumption was associated with a better metabolic profile.

A vegetarian diet pattern was associated with both, better clinical and metabolic parameters, in patients with BD. Future studies should prioritize prospective and randomized designs to determine causal relationships, and potentially inform clinical recommendations.

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Maniform symptoms for the first time after the age of 50 are not common, although we can find it in our clinical practice due to the increasing aging of the world’s population.

We present a clinical case of a patient with manifest behavioral symptoms where a differential diagnosis is made between Late-onset bipolar disorder vs Frontotemporal dementia with a behavioral profile (FTD)

62-year-old male with a history of type II diabetes, hypertension and L4-L5 disc herniation. Psychiatric history of recurrent depressive disorder and dysfunctional personality. Treated with venlafaxine 150 mg and gabapentin 600 mg DMD. He was on sick leave from his company due to lower back pain. Married with two children, dysfunctional relationship with them. He was admitted to Psychiatry for the first time in February 2024 due to behavioral disturbances of 5 days’ duration. He was verbose, irritable and described “being better than ever”. A few days earlier he took a Tadalafil tablet, an event that he related to the onset of the condition. Since then, there has been an increase in psychomotor activity, disinhibition and exalted mood. He reported having contact with high-ranking political figures. Upon discharge from hospital, he was diagnosed with an Unspecified Manic Episode and was prescribed Lithium 800mg DMD and Risperidone extended release 75 mg monthly. The symptoms did not improve, he abandoned the treatment and was admitted for the second time in April 2024 where Valproic 1000 mg DMD, Olanzapine 20mg DMD and Risperidone 6 DMD were prescribed.

He has a poor outpatient evolution with loss of autonomy, physical deterioration, hyperfamiliarity, behavioral disinhibition and no awareness of the disease. Given the suspicion of an organic condition, he was referred to Neurology consultations where a cranial magnetic resonance imaging was performed. with results of punctate and hyperintense images in T2 localized in subcortical white matter of nonspecific character and Mini-ACEII test: 22/30. Waiting for PET-CT and with a diagnosis of possible Frontal Release Syndrome to rule out behavioral variant FTD.

Within the differential diagnosis of the condition we find Late-onset bipolar affective disorder and behavioral variant FTD. The first presents with inappropriate, repetitive and stereotyped behavior, as well as a progressive and gradual deterioration. While late bipolar disorder presents with self-limiting episodes and more manifest symptoms. In a PET-CT suggestive of FTD it is likely to find areas of hypoperfusion in frontal and temporal regions. The differential diagnosis between both is a challenge in clinical practice.

None Declared