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

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

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

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

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 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

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

Melanopsin-expressing intrinsically photosensitive retinal ganglion cells (ipRGCs) are critical regulators of circadian rhythms and various non-image-forming visual functions, such as the pupillary light reflex (PLR), which adjusts the amount of light entering the eye. ipRGCs, through their direct responsiveness to circadian light, influence both circadian entrainment and neurophysiological processes that affect mood regulation. Emerging evidence suggests that melanopsin-mediated PLR may be disrupted in mood disorders, including bipolar disorder (BD) and even patients with increased bipolar disorder-traits. Given the well-documented association between circadian dysregulation and BD pathophysiology, it is hypothesized that changes in ipRGC function may contribute to the neurobiological mechanisms underlying BD.

The primary aim of this review is to synthesize and evaluate the existing body of literature on melanopsin-mediated pupillary responses in individuals with bipolar disorder. Specifically, this review seeks to assess the extent to which these responses are altered in BD and to explore the potential utility of melanopsin-driven PLR as a biomarker for mood dysregulation and circadian disruption in this patient population.

A non-systematic review of the literature on the melanopsin-mediated pupillary light reflex in patients with bipolar disorder, through a targeted search of databases.

The reviewed studies demonstrate consistent alterations in melanopsin-mediated pupillary responses in individuals with BD. Several investigations report reduced PLR amplitude and delayed latency in BD patients, with variability depending on mood state. Manic and depressive episodes appear to be associated with distinct patterns of dysregulation, suggesting that melanopsin signaling may be differentially affected by the phase of illness. One study also shows a variation in ipRGCs responses in remitted BD patients, suggesting an alteration of this system throughout the disease. (Madsen et al. Int J Bipolar Disord 2021;9,7) These findings align with circadian disruptions commonly observed in BD, further supporting a mechanistic link between ipRGC dysfunction and mood regulation.

Melanopsin-mediated pupillary responses have emerged as a promising avenue of investigation for identifying biomarkers of bipolar disorder, particularly concerning circadian rhythm and mood dysregulation. Despite encouraging preliminary findings, the current literature is limited by methodological heterogeneity and small sample sizes. Future research should standardize assessment protocols and investigate how ipRGC dysfunction contributes to BD pathophysiology, potentially leading to novel treatments targeting circadian regulation and improving clinical outcomes.

None Declared

In the realm of mental health treatment, quetiapine, is a commonly prescribed for various conditions like schizophrenia, acute manic episodes, anxiety disorder, and major depressive disorder. Its pharmacological profile includes serotonin, dopamine, histamine, and adrenergic receptor antagonism, with a higher affinity for 5-HT2A receptors compared to D2 receptors. Quetiapine’s unique receptor interactions and low risk of side effects make it a versatile option for clinicians.

This case report aims to shed light on the potential for quetiapine, an atypical antipsychotic, to induce or exacerbate manic or hypomanic symptoms in patients with bipolar affective disorder. By presenting a real-world case study and reviewing existing literature, we seek to contribute to the understanding of how quetiapine dosage can influence mood symptomatology and inform clinical decision-making regarding treatment strategies in bipolar disorder.

This investigation was conducted following SANRA guidelines for case reports, and involved performing a search in PubMed to compile evidence on how quetiapine impacts mood symptoms, particularly at different dosage levels, in individuals with bipolar affective disorder.

In our case involving a 26-year-old male with bipolar affective disorder, he experienced a manic episode when starting quetiapine at 200 mg/day, with symptom resolution after discontinuation of the medication. Patients ranged from 21 to 66 years old, with males being more prevalent (11 out of 15 cases). The most common diagnoses were paranoid schizophrenia (8 cases) and bipolar disorder (4 cases), with two bipolar patients experiencing worsened hypomanic symptoms. Dosages of quetiapine varied from 100 mg/day to 600 mg/day, with symptoms appearing between the 2nd day and 7th week of starting treatment. Most cases (13 out of 15) were managed by stopping quetiapine, while one patient’s dose was increased to 800 mg/day and another reduced to 100 mg/day. Discontinuing quetiapine in the studied patient led to symptom improvement within two weeks, aligning with similar outcomes in other cases.Alternative antipsychotics were effective if quetiapine worsened symptoms. Various theories explain quetiapine’s impact, with poor metabolizers potentially needing higher doses for relief.

Despite the risk of inducing hypomanic/manic symptoms at lower doses of quetiapine, findings suggest that in randomized placebo-controlled studies on bipolar patients treated for depressive episodes, quetiapine has shown a lower likelihood of causing a manic or hypomanic switch compared to a placebo. Clinicians should cautiously monitor patients during the initial dose titration period but can consider quetiapine as a management option for bipolar disorder.

None Declared

Earlier age at menarche has been associated with an increased risk of affective disorders, but also a later onset of schizophrenia in women, indicating a complex relationship between hormonal changes and mental health. This interplay highlights the importance of understanding how pubertal timing and estrogen exposure can influence both mood disorders and psychotic conditions throughout a person’s life.

Our study aimed to explore the relationship between age at menarche and severity of clinical presentation of patients pertaining to mood-psychosis continuum.

The study group consisted of a total of 109 female patients, 71 diagnosed with bipolar disorder and 38 diagnosed with schizophrenia. The dimensional assessment of psychosis and affective symptoms was done using the Schizo-Bipolar Scale (SBS), together with the severity of the symptom domains measured by the Brief Psychiatric Rating Scale (BPRS).

Age at menarche significantly correlated to score on SBS scale (r= 0.257,p=0.028), after controlling for confounders (age and body mass index). Other clinical characteristics or psychometric properties were not related to age at menarche in the group of BD and SCH patients perceived as a unified group, possibly pertaining to one continuum.

Pubertal timing may play a role in the severity of symptoms associated with bipolar disorder and schizophrenia. Further research is needed to elucidate the specific pathways linking age at menarche to symptom severity and to explore the potential implications for early intervention and treatment strategies targeting the interplay between hormonal factors and mental health outcomes in individuals with bipolar disorder and schizophrenia.

None Declared

Metabolic syndrome (MS) is a prevalent condition in individuals with bipolar disorder (BD) and may influence the expression of psychiatric symptoms. Factors contributing to this association include limited access to physical healthcare, lifestyle influences related to psychiatric symptoms, and adverse effects of psychotropic medications.

To compare the clinical characteristics of patients with Bipolar Disorder Type 1 (BD-1) with and without metabolic syndrome (MS).

This was a cross-sectional descriptive study conducted over a three-month period from August to October 2023 at the Psychiatric Service D of Razi Hospital in Tunisia. Patients diagnosed with Bipolar Disorder Type 1 according to the diagnostic criteria of the DSM-5, aged 18 years or older, and in a euthymic phase (confirmed by Hamilton Depression Rating Scale (HDRS) score <8 and Young Mania Rating Scale score <13) were included. Sociodemographic data, clinical features, and treatment information were initially collected from medical records and then verified and completed through direct interviews using a predefined information sheet and psychometric assessments. Metabolic syndrome was diagnosed according to the criteria of the International Diabetes Federation.

All participants provided informed consent before enrollment, and confidentiality of their personal and medical information was strictly maintained. The study protocol was approved by the Institutional Review Board (IRB) of Razi Hospital, ensuring that the research was conducted in accordance with ethical guidelines and principles of patient autonomy, beneficence, and non-maleficence. Participants were informed about the voluntary nature of their participation and their right to withdraw at any time without consequences. Data collection and storage adhered to strict privacy regulations to protect participants’ rights and ensure data security.

Forty patients were included in the study, of whom 28 had MS and 12 did not. The mean age of patients was 34.5 ± 8.2 years in the MS group and 32.1 ± 6.5 years in the non-MS group. Participants with MS had a significantly younger mean age of disorder onset (22.6 ± 8.25 years) compared to those without MS (27.9 ± 4.86 years) (p = 0.02). We found that the mean number of suicide attempts was significantly higher in the MS group (2.8) compared to the non-MS group (1.6) (p = 0.001). Anxiety comorbidity was significantly higher in patients with MS compared to those without MS (57% vs 35%, p < 10^-3).

Our study underscore the importance of addressing metabolic syndrome in the management of patients with BD-1. Given the higher prevalence of metabolic syndrome in this population and its impact on clinical outcomes, interventions aimed at preventing and managing metabolic syndrome components such as obesity, diabetes, and dyslipidemia are crucial.

None Declared

Manic episodes, a defining feature of bipolar disorder, are often triggered by significant psychosocial stressors. In Tunisia, marriage carries deep religious, societal, and familial significance, creating considerable pressure that may act as a precipitating factor for the onset of bipolar disorder. This case series presents three patients who experienced their first manic episode in the immediate aftermath of their wedding.

To highlight the role of marriage as a significant trigger for the first manic episodes in patients with no previous psychiatric history, within the specific socio-cultural context of Tunisia.

These case reports were compiled through clinical observations and interviews with the patients and their families. All three cases involved newlywed males who developed manic symptoms shortly after marriage, requiring hospitalization.

• - Case 1: A 30-year-old male with no personal or familial psychiatric history presented with manic symptoms 5 days after his wedding. Symptoms included expansive mood, irritability, insomnia, grandiose and persecutory delusions, hyperactivity, and logorrhea. He was hospitalized and treated with lithium and risperidone. After 3 weeks, he was discharged and has remained symptom-free for 1 month.

• - Case 2: A 33-year-old male with a paternal history of schizoaffective disorder developed mania the day after his wedding, following alcohol use and sleep deprivation. His symptoms included psychomotor agitation, destruction of objects, verbal aggression, logorrhea, tachyphemia, delusions of grandeur and persecution, insomnia, and hyperactivity. He was treated with clonazepam, lithium and haloperidol. Clonazepam was discontinued before discharge, and haloperidol after 3 months. He had been episode-free for 3 years, then he had a manic episode and was hospitalized for 2 weeks. Now he’s been symptom-free for 2 months

• - Case 3: A 31-year-old male with no personal or familial psychiatric history presented with manic symptoms 7 days after his wedding, including insomnia, expansive mood, grandiose delusions with auditory hallucinations (he believed God told him to have a son who would be the next prophet), hyperactivity, and logorrhea. He was treated with diazepam, lithium, and risperidone. He was discharged after 4 weeks, with diazepam discontinued before discharge and risperidone after 6 months. He has remained episode-free for 1 year.

These cases highlight the significant cultural pressures surrounding marriage in Tunisia, which can serve as a potent trigger for manic episodes in individuals without prior psychiatric history. Early identification and intervention with antipsychotics and mood stabilizers proved effective in all cases. These findings emphasize the importance of psychiatric vigilance in similar socio-cultural settings to manage the onset of bipolar disorder in response to life stressors.

None Declared

Depressive disorders, both unipolar (MDD) and bipolar (BD), impact patients and society greatly. In bipolar depression and seasonal affective disorder the episodic nature and periodicity relate to changes in circadian rhythms. Bright light therapy (BLT) is thought to ameliorate symptoms of depression through its influence on circadian rhythms. Effectiveness of BLT has not been thoroughly established in real-world clinical samples.

To assess effectiveness of BLT in a real-world patients with BD or MDD and assess effect on individual symptoms of depression.

For seventy-four patients with depression Inventory of Depressive Symptoms – Self Rated (IDS-SR) scores were available through Routine Outcome Monitoring (ROM) used in BLT in the outpatient clinic for mood disorders. Patients received one or two weeks of BLT as usual care. Patients suffering from MDD (n=33, 60.6% female, mean age 36.1±11.5 years) were compared to patients suffering from BD (n=41, 70.7% female, mean age 45.0±14.5 years) and changes in individual symptoms were analyzed for these two groups as well as the whole cohort.

IDS-SR scores decreased significantly in both groups of patients and did not differ in effect size between the groups. Explorative analyses of the effects on individual items of the IDS-SR showed that items related to core symptoms of depression such a as mood, concentration and energy level showed the largest improvements.

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Self-report depressive symptoms in patients suffering from either MDD or BD decreased in this naturalistic cohort after receiving BLT.

None Declared

Despite the clinical insight that bipolar disorder is associated with specific mood regulation strategies (e.g., positive rumination), this relationship has rarely been confirmed through empirical research. Previous recall-based studies have failed to establish significant links due to potential memory distortion and recall bias. This study addresses these limitations by using a prospective approach to track the direct effects of emotion regulation strategies on mood symptoms in real time and to assess their persistence.

The study aimed to: (1) identify differences in emotion regulation strategies in response to positive events among individuals with Hypomanic Personality Traits, depression, and normal controls; and (2) examine how these strategies impact the persistence of mood symptoms over a one-week period.

90 participants were divided into three groups based on the Hypomanic Personality Scale (HPS) and the Centre for Epidemiological Studies Depression Rating Scale (K-CESD-R): a hypomanic personality trait group (HPS ≥ 29), a depressed group (K-CESD-R > 13), and a healthy control group (HPS ≤ 21, K-CESD-R ≤ 13). Participants completed an initial online survey to assess emotion regulation strategies immediately following positive social and goal-related events. To assess the moderating effect of emotion regulation strategies on mood persistence, participants were asked to complete follow-up surveys at regular intervals over the course of one week to track the sustained emotional impact of the positive event. The nature of each event was pre-classified, and differences in emotion regulation strategies between groups were analyzed. The moderating role of emotion regulation strategies in the relationship between the initial positive mood response and its persistence over time was analyzed using repeated measures analysis of covariance (ANCOVA).

Emotion regulation strategies significantly moderated the relationship between positive events and mood symptoms. The Hypomanic Personality Traits Group predominantly engaged in maladaptive strategies, such as positive rumination, which led to more pronounced positive mood symptoms over time. The Depressed Group used mood dampening strategies, resulting in minimal improvement in mood. Conversely, the Healthy Control Group employed adaptive strategies, such as savoring, which contributed to stable mood.

This study underscores the critical role of emotion regulation strategies in the persistence of mood symptoms. It highlights the negative impact of maladaptive strategies on mood, particularly for individuals with hypomanic traits or depression, suggesting a need for targeted therapeutic interventions. Future research should focus on refining these interventions and exploring their efficacy in diverse populations.

None Declared

Extreme mood swings are a hallmark of bipolar disorder (BD). Consistent treatment adherence, including medication and regular attendance at outpatient care, is usually necessary for the effective management of BD. However, many individuals with BD struggle with treatment engagement, which is often influenced by several factors, including insight.

This study aims to explore the relationship between patients’ level of insight into their condition and their attendance at scheduled treatments

It was a cross-sectional, descriptive, and analytical study conducted on bipolar disorder patients from the Psychiatry “A” Department, Hedi Chaker University Hospital. Clinical and sociodemographic data were collected from March to September 2023 using a questionnaire along with Medication Adherence Rating Scale (MARS) for assessing treatment adherence and the Birchwood Insight Scale (BIS) to evaluate insight

A total of 37 patients with BD completed the questionnaire. The mean age was 45.4 ± 13.9 years, with a sex ratio (M/F) of 1.46.

In our study, 73% of patients were with BD type I and 27% were with BD type II.

The mean MARS score was 7.14 ± 2.13, and 37.8% of our population were non-adherent to medication.

The mean BIS score was 8.58 ± 2.35, and 56.8% of patients had good insight.

Mean scores of awareness of illness, re-labeling of symptoms, and need for treatment subscales of BIS were respectively 2.86, 2.73, and 2.86.

The MARS score was positively correlated with the BIS score (p = 0.002, r = 0.40).

The MARS score was also positively correlated with both the awareness of illness subscale of the BIS (p = 0.035, r = 0.34) and the re-labeling of symptoms subscale of the BIS (p = 0.41, r = 0.33).

This study demonstrates that certain aspects of insight are significantly associated with treatment adherence in bipolar disorder. Specifically, awareness of illness and re-labeling of symptoms suggest that the ability to reinterpret and understand symptoms may enhance engagement with care. In contrast, the Need for Treatment subscale did not show a significant correlation with attendance, indicating that simply recognizing the need for treatment alone may not be sufficient to ensure consistent participation in care.

None Declared

Over the last decade, there has been a growing recognition of the importance of identifying and treating cognitive impairment associated with bipolar disorder, as it persists during remission periods. Evidence suggests that neurocognitive dysfunction may significantly influence patients’ psychosocial outcomes. An increasing body of research aims to improve understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments

The aim of this study is to explore the prevalence of cognitive impairment among bipolar disorder patients and identify related factors.

It was a cross-sectional, descriptive, and analytical study conducted on bipolar disorder patients from the Psychiatry “A” Department, Hedi Chaker University Hospital. Clinical and sociodemographic data were collected from March to September 2023 through a questionnaire along with The Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) for evaluation of subjective cognitive impairment

A total of 37 patients with BD completed the questionnaire. The mean age was 45.4 ± 13.9 years, with a sex ratio (M/F) of 1.46.

Our results showed that 73 % of patients were with BD type I and 27% were with BD type II.

The mean score of COBRA was 12.54 ± 7.62 and 32.4% of participants presented subjective cognitive disorder.

Subjective cognitive disorder was significantly associated with the number of relapses, hospitalizations and suicide attempts, with respectively p< 0.001, p= 0.02 and p= 0.05

Female patients and patients with poor income presented significantly more subjective cognitive disorders (p = 0.01 and p = 0.02, respectively).

The COBRA score was positively correlated with the number of relapses (p<0.001, r = 0.67).

Our findings indicate that a significant proportion of individuals with bipolar disorder report cognitive difficulties, which may impact their daily functioning and quality of life. Key factors such as poor income, female sex, and the number of relapses and suicide attempts were associated with higher levels of perceived cognitive dysfunction. These results highlight the need for greater attention to cognitive symptoms in the clinical management of bipolar disorder.

None Declared

It is well established that user behavior does not align with clinical recommendations regarding using medication in psychotic disorders, particularly bipolar disorder (BD). Nonadherence to treatment carries a high risk of relapse due to the recurrent nature of the illness and is influenced by multiple factors

The aim of this study is to investigate the prevalence of medication adherence among BD patients and to explore the various factors contributing to poor adherence.

This cross-sectional, descriptive, and analytical study was conducted with patient diagnosed with bipolar disorder at the Psychiatry “A” Department of Hedi Chaker University Hospital. Data on clinical and sociodemographic variables were collected between March and September 2023 using a questionnaire, alongside the Medication Adherence Rating Scale (MARS) to evaluate treatment adherence.

A total of 37 patients with BD completed the questionnaire. The mean age was 45.4 ± 13.9 years, with a sex ratio (M/F) of 1.46.

In this study, 73 % of patients had BD type I and 27% had BD type II.

The mean MARS score was 7.14 ± 2.13 and 62.2% were adherent to their treatment.

Only 16.2% of bipolar patients discontinued their medication due to side effects, while 51.4% present unintentional poor adherence.

A significant association was found between treatment adherence and socio-economic status (p = 0.05).

The MARS score was negatively correlated with the number of hospitalizations (p = 0.05, r = -0.315)

This study highlights that treatment adherence in bipolar disorder is influenced by various factors, with socio-economic status being a significant determinant. The negative correlation between MARS scores and the number of hospitalizations suggests that better adherence is associated with fewer hospitalizations. Improving treatment compliance is crucial to reducing the risk of recurrence and hospitalization in BD.

None Declared

Although manic episodes are the most characteristic and diagnostic, depressive episodes and subsyndromal depressive symptoms are most prevalent through bipolar patients lifetime and are most related to functional impairment. Manic episodes are still more frequently psychiatrically identified and managed and represent for many patients the first contact with mental health professional and the beginning of an adequate follow-up. They are, however, frequently followed by depressive states. For these reasons, post-episodic constitutes an important psychiatric task for monitoring and follow-up, with little evidence supporting its risks and needs.

To elucidate the sociodemographic and clinical characteristics related to depressive switch of bipolar disorder patients after hospital discharge for a manic episode.

This is a prospective study involving consecutive patients admitted for a manic episode in acute inward in Hospital Clínic de Barcelona. Patients were recruited upon admission to the hospital and followed for a period of six months. Clinical evaluations were conducted during ospital admission and at discharge with Brief Psychiatric Rating Scale, Young Mania Rating Scale, Hamilton Depression Rating Scale and Clinical Global Impression scale for Bipolar Disorder. Patients were contacted for follow-up assessments at 1 month and 6 months after discharge. Presence of a depressive episode was evaluated using the DSM-5 criteria.

A total of 46 patients were recruited, of whom 17 (37%) presented a depressive episode in the following 6 months after discharge. In relation to psychiatric history, manic predominance showed a significant negative association with depressive switch (p=0.004), with depressive predominance showing and approached significance for a positive association (p=0.097). Also, schizoaffective disorder diagnosis approached significance for a negative association (p=0.071). Comorbidity with substance use disorder (except tobacco) showed significant positive association (p=0.417). Lithium is the only treatment showing a significant positive association with depressive switch (p=0.046).

Lack of significance for clinical variables suggest no clear capacity for predicting follow-up evolution through psychopathological state at discharge. Manic and depressive predominance show, respectively, a negative and positive association with depressive switch, maintaining the global tendency of individual patient’s disorder. Interestingly, comorbidity with substance use disorder acted as a protective factor for depressive switching. This finding might be in relation with the fact that, whereas in substance users drugs act as a main factor for their psychopathological state and evolution, with a proneness for stimulants towards manic states, non-users present a higher degree of endogeneity, where depressive states constitute the main tendency.

S. Salmeron: None Declared, J. I. Mena: None Declared, E. Cesari: None Declared, H. Andreu: None Declared, L. Olivier: None Declared, O. de Juan: None Declared, B. Serra: None Declared, I. Ochandiano: None Declared, A. Giménez-Palomo Consultant of: AGP has received CME-related honoraria, or consulting fees from Angelini, Janssen-Cilag, Casen Recordati, Rovi, LCN and Lundbec, I. Pacchiarotti Consultant of: IP has received CME-related honoraria, or consulting fees from Janssen-Cilag, Lundbeck, undbeck/Otsuka, CASEN Recordati and Angelini, with no financial or other relationship relevant to the subject of this article.

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 quality of life assessed via Quality-of-life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF) 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 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. In this post-hoc analysis, correlation between Q-LES-Q-SF 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 Q-LES-Q-SF score and YMRS score was statistically significant for both treatment arms at Day 42 [Test: -0.268, p<0.0001; Comparator: -0.281, p<0.0001] and the linear regression between 2 arms was not statistically significant (p=0.8603), 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.

Image 1:

Image 2:

This post-hoc analysis demonstrated that patients with Bipolar II depression when treated with Lumateperone 42mg or Quetiapine 300mg, the improvement in Q-LES-Q-SF score is inversely proportional to 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, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors.

This subgroup analysis of an Indian Phase 3 study was conducted to evaluate the efficacy and safety of Lumateperone 42mg compared to Quetiapine 300mg in treatment of Bipolar II depression when stratified based on age (18-45, >45-65).

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included Indian 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. The patients were stratified based on age: Subgroup 1 [S1]: 18-45 years and Subgroup 2 [S2]: >45-65 years. For efficacy outcomes MADRS score, CGI-BP-S (total score, depression subscore and overall bipolar illness subscore), and Quality of life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF) score were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This subgroup analysis included 462 patients, out of which 320 in S1[Test=159; Comparator=161] and 142 in S2[Test=72; Comparator=70]. The baseline demographic characteristics were comparable in between treatment arms across subgroups. The primary endpoint of reduction in MADRS score from baseline to Day 42 in Test arm was non-inferior to Comparator arm in both subgroups [Figure 1] as the upper 95% CI was below the pre-defined margin of 3.0. The reduction of CGI-BP-S (total score, depression subscore and overall bipolar illness subscore) from Day 14 to Day 42 were comparable in both Test and Comparator arms in both subgroups. The improvement in Q-LES-Q-SF score from baseline to Day 42 were comparable in both Test and Comparator arms in both subgroups. The incidence of TEAEs were comparable in both treatment arms [S1: Test=31.4% and Comparator=36.6%; S2: Test=41.7% and Comparator=32.9%] and no serious adverse events were reported.

Image 1:

This subgroup analysis demonstrated that Lumateperone 42mg is non-inferior to Quetiapine 300mg in treatment of Bipolar II depression as assessed via MADRS score from baseline to Day 42, irrespective of age of the patients and both treatments were found to be well tolerated. Hence, Lumateperone can be considered as valuable treatment option in management of Bipolar II depression.

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