Bipolar Disorder (BD) is a severe, chronic and disabling condition. The gold standard of treatment is lithium, but the introduction of Second Generation Long-Acting Antipsychotics (SGA-LAIs) has been addressed several problems in the administration of oral SGAs in BD such as the patient’s adherence to the treatment. The aim of this commentary was to provide an overview of the use of SGA-LAIs in the treatment of BD. All considered, the use of SGA-LAIs such as Risperidone Long-Acting and Aripiprazole Long-Acting may have an important impact on the maintenance treatment of BD both in monotherapy or in association with mood stabilizers. In our opinion, the treatment with a SGA-LAI should be initiated as early as possible in BD, especially when non-adherence is suspected. Moreover, as personality disorders (PD) and BD may often coexist, it is worthy to note that the PD-BD comorbidity may further decrease treatment adherence and, therefore, we believe that the early use of a SGA-LAI both in monotherapy or in association with mood stabilizers may dramatically improve the compliance and the overall outcomes in such cases. However, he safety profile should be always kept in mind when choosing an SGALAI in the treatment of BD.

Background: The people suffering from bipolar disorders experience a poor quality of life as compared to the general public, it includes difficulties in the areas of work, interpersonal relationship and activities of daily living. During the course of illness the social and family dysfunction affect the persons having bipolar disorder their physical, emotional, social and functional well-being impacted. Aim: To examine the instrumental activities of daily living of patient suffering from bipolar affective disorder and its relationship with their subjective wellbeing and self-efficacy. Methods: A cross-section survey was done on thirty patients having bipolar affective disorder using three scales to measure instrumental activities of daily living, subjective well-being and self-efficacy with Lawton instrumental activities of daily living. Results: The mean age of patients was 38 ± 12 years, with almost equal numbers from both the gender. Most of the patients studied up to graduation (60%), most of them were unemployed. Most of the subjects were in depressive phase (53%), while in mania (27%) and in mixed phase 20%. The activities of daily living and selfefficacy of patients was found to be significantly correlated. The subjective well-being of patients and self-efficacy were also positively correlated. On the other hand there is a weak positive correlation found between subjective wellbeing of patients was and activities of daily living. Conclusion: The subjective well-being and self-efficacy of patients with bipolar disorder must be assessed independently and not to be confused with activities of daily living and the interventions need to be planned for improving functioning of patients.

Objective: Analyses of longitudinal data pertaining to a single person can provide insight into the emotional dynamics of bipolar disorder at the symptom level. Aims were to examine (1) co-variation of a priori selected mental states in daily life in a patient with bipolar disorder; and (2) connections between these mental states during a hypomanic and a depressive period in bipolar disorder. Methods: A single person diagnosed with bipolar disorder used the Experience Sampling Method (ESM) to collect data on experiences and mood ten times a day, for three months. Linear regression analyses were performed, stratified by hypomanic or depressive period. The a priori selected set of dependent variables included ‘anxiety’, ‘down’, ‘cheerful’, ‘satisfied’, ‘tired’ and ‘lonely’. Independent variables were the same symptoms as collected one random moment earlier during the same day (t-1, lagged). Regression coefficients were presented in network graphs. Results: Mood fluctuated strongly over time. The variable ‘down’ was central in the networks of both the hypomanic and depressive period. ‘Satisfied’ was only central in the hypomanic network. Conclusion: In this patient, depression was the central emotion during both hypomanic and depressive periods. The distinction between depression and hypomania may sometimes lie in respectively the absence and presence of certain positive mood states. Furthermore, the present paper showed that extreme mood shifts in bipolar disorder can be studied after generating mood networks to gain precise insights in dynamic relations and the degree of cohesion between symptoms. These insights may be useful in the clinical setting to support self-monitored and personalised feedback and interventions.

Introduction: Current classification of bipolar disorder (BD) in type I or type II may be of little use in routine clinical practice to provide information on relevance epidemiological and clinical variables. New complementary coders like the predominant polarity (PP), which is defined as a clear tendency in the patient to present relapses in the manic polarity predominance (MPP) or in the depressive polarity predominance (DPP) along the disease may be important to develop clinical and pharmacological strategies to prevent any kind of relapse. Objectives: To define the concept of PP and the epidemiological and clinical variables associated with the PP in order to know the clinical implications of that specific diagnosis factor. Methods: We realized a systematic review in the principal medical databases (until June 2016) including key words as “bipolar disorder”, “polarity and “predominant polarity”. Results: After apply the inclusion criteria we analysed 16 articles. The MPP was associated with manic onset of illness, history of substance abuse before the beginning of the disease and with a better response to atypical antipsychotics and mood stabilizers. Meanwhile the DPP is related with a depressive onset of the disease, a higher number of relapses, longer acute episodes, and a higher risk of suicide. Also, the delay until the correct diagnosis, the presence of mixed states and the comorbidity with anxiety disorders are more frequents in DPP that shows an increased use of quetiapine and lamotrigine. Conclusion: PP may be useful in the clinical management of BD. Further studies on biological and clinical factors are needed, with a common definition and a unified methodology

Objective: The aim of this study was Effectiveness of Integration of Mindfulness-based cognitive therapy (MBCT) and recovery cognitive behavioral therapy (RCBT) on adolescents with spectrum bipolar disorder (BD). Methods: BD diagnosis in 80 adolescents was based on DSM-IV TR that patients were randomly assigned to one of the following: Experimental group under combined treatment MBCT & RFCBT, and groups MBCT, RFCBT and Control group (TAU) under pharmacological treatment. The questionnaires used in the research included: Manian Yang MYR questionnaire, K-SADS quality of life questionnaire, impulsivity questionnaire, bipolar depression questionnaire, Beck anxiety inventory, Coke drug abuse questionnaire. We used an analysis of variance (MANOVA), including one or two factors, with repeated measures at different evaluation times: baseline, post-treatment, 6-month follow-up. Results: We found significant between-group differences at all evaluation times after the treatment. The experimental group showed that the effect of MBCT treatment on improving the psychiatric and psychological symptoms of individuals in three stages (pre-test, post-test and follow-up) (849/0) is significant. The effect of RFCBT treatment on improving the psychiatric and psychological symptoms of individuals in three stages (pre-test, post-test and follow-up) is somewhat significant and the effect of treatment (group membership) in the post-test and follow-up stage 0.27% and 0.31%, respectively, meaning that 0.27% of individual differences in the improvement of psychiatric and psychiatric symptoms (during the test) and 31/0% (follow-up) for differences in membership group (treatment effect) and finally the integration of psychiatric and psychological MBCT and RFCBT improves the symptoms of spectrum bipolar disorders exist. Conclusion: Our results suggest that a combined treatment is effective in patients with refractory bipolar disorder. Suggestions for future research are commented on.

The importance of travel-induced episodes of bipolar illness is reinforced through a clinical vignette.