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Objective: To examine attachment and affective temperament in patients who have been diagnosed with Bipolar Disorder and to investigate possible differences in both variables among Bipolar I Disorder (BD-I), Bipolar II Disorder (BD-II), and cyclothymic patients., Methods: Ninety (45 male and 45 female) outpatients with bipolar or cyclothymic disorder between the ages of 18 and 65years were recruited consecutively between September 2010 and December 2011 at the Bipolar Disorder Unit of the Psychiatry Day Hospital affiliated with the University General Hospital "A. Gemelli" in Rome, Italy. Patients were assessed using the Structured Clinical Interview for DSM-IV, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Temperament Evaluation of Memphis, Pisa, and San Diego-auto-questionnaire version, and the Experiences in Close Relationships (ECR) questionnaire applied by trained interviewers., Results: The 3 groups of patients differed only on the ECR Anxiety scores with BD-I patients having the highest anxiety levels, followed by the BD-II patients, and the patients with cyclothymic disorder reporting the lowest level of anxiety., Conclusions: This finding suggests that bipolar disorder (type I, type II) and cyclothymic/dysthymic temperament are more strongly associated with insecure attachment style as compared to the general population., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The diagnosis of bipolar disorder (BD) is predominantly clinical. Some authors have suggested that BD is underdiagnosed and that many patients, particularly those with major depressive disorder, actually have BD. Some studies have suggested that BD is wrongly diagnosed, probably because of the idea of a "bipolar spectrum." To address this potential overdiagnosis, clinicians should carefully and systematically assess whether symptoms are included in diagnostic criteria and include the individual context of the patient.

Epidemiological studies suggest that n-3 polyunsaturated fatty acid (n-3 FA) deficiency is a risk factor for bipolar disorders (BDs). The aim of this study was to determine whether such a deficit does exist in patients with BD and to characterize the overall plasma fatty acid (FA) profile in these patients. Using gas chromatography/mass spectrometry, we measured fasting plasma levels of 15 FAs in 42 patients diagnosed with BD according to DSM-IV criteria and in 57 age- and gender-matched healthy controls. Plasma docosahexaenoic acid (DHA) levels were significantly decreased in bipolar patients (p < 0.001 versus healthy controls). Compared with controls, patients had higher plasma levels of all other FAs, including arachidonic acid (AA, p < 0.001), alpha-linolenic acid (ALA, p < 0.001), and eicosapentaenoic acid (EPA) (p < 0.001). Although in the present study we observed significant DHA deficits in the plasma of bipolar patients our findings do not support the therapeutic use of ALA and/or EPA supplementation. DHA may provide a basis for possible pharmacological intervention in psychiatric disorders at the level of second messengers linked to the phosphatidylinositol cycle. Finally, measurement of FA levels in plasma seems to be more reliable and reproducible than assays of erythrocyte FA content., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The aims of the study were: (1) to study possible associations between temperament, personality dimensions, and psychopathological variables in a clinical sample of euthymic patients with bipolar disorder (BD) and cyclothymia; and (2) to assess how Cloninger's temperament and personality dimensions were associated with affective temperaments. Participants, consisting of 60 patients with BD (type I or II) and cyclothymia in the euthymic phase, completed Akiskal's Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), and Cloninger's Temperament and Character Inventory-revised version (TCI-R). The diagnostic groups differed in past hospitalization, for age at onset of the disorder, and on two affective temperaments: the TEMPS-A Hyperthymia, and the TEMPS-A Irritability. There were six significant associations between affective temperaments and Cloninger's personality dimensions, ranging from 0.26 to 0.54. The measures of Akiskal and of Cloninger tap common behavioral features in patients with bipolar disorder and cyclothymia, yet the differences indicate that the two measures are not redundant. BD and cyclothymic patients differed significantly in temperament and personality, differences that may have important implications for treatment.

Objectives: To compare two samples of Bipolar (BD) patients presenting "pure" (D) and mixed (Mx) depression to assess any difference in terms of clinical outcome, social functioning and quality of life during a 1-year follow-up., Methods: A total of 114 depressed outpatients (HDRS > 13) were included. "Pure" depressed (D, n = 76) were divided from "mixed" depressed (Mx, n = 38) by the number of concomitant manic symptoms. All patients were evaluated by the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Young Mania Rating Scale (YMRS), the Global Assessment of Functioning (GAF), the Social Adjustment Self-reported Scale (SASS) and the Quality of Life Scale (QoL), at baseline and after 1, 3, 6 and 12 months of treatment., Results: Mx patients were significantly younger at the onset of BD. Manic features persisted significantly higher in Mx than in D patients all over the follow-up period. Axis I comorbidities had a negative impact on the course of social functioning over the medium term period, while Mx patients showed a faster improvement in social adjustment than "pure" depressed patients., Conclusions: Mixed features may persist relatively stable throughout a depressive episode, having a negative impact over clinical and functional outcome, but not on social adjustment.

Comorbid conditions are frequent in bipolar disorder (BD) and may complicate the treatment and course of illness. We investigated the role of substance use disorder (SUD), axis II personality disorders (PD) and continuous personality traits on the medium-term outcome (6 months) of treatment for bipolar depression. One hundred and thirty-nine BD patients meeting criteria for a depressive episode were included in the study. SUD and PD were diagnosed according to structured interviews. Personality dimensions were evaluated by the Temperament and Character Inventory. Depressive severity over time was evaluated by the Hamilton Rating Scale for Depression. Neither PD nor SUD influenced the outcome of depression. Variables independently associated with a poor outcome were a high baseline severity and high scores for the temperamental trait of Harm Avoidance. Though several limitations characterize the present study, neurotic personality traits seem to be associated with a slower recovery from depressive symptoms in BD, independently from their initial severity., (Copyright © 2012 S. Karger AG, Basel.)

Background: Mixed mood states, even in their sub-threshold forms, may significantly affect the course and outcome of bipolar disorder (BD)., Aim: To compare two samples of BD patients presenting a major depressive episode and a sub-threshold mixed state in terms of global functioning, clinical outcome, social adjustment and quality of life during a 1-year follow-up., Methods: The sample was composed by 90 subjects (Group 1, D) clinically diagnosed with a major depressive episode and 41 patients (Group 2, Mx) for a sub-threshold mixed state. All patients were administered with a pharmacological treatment and evaluated for depressive, anxious and manic symptoms by common rating scales. Further evaluations included a global assessment of severity and functioning, social adjustment and quality of life. All evaluations were performed at baseline and after 1, 3, 6 and 12 months of treatment., Results: The two groups were no different for baseline as well as improvement in global severity and functioning. Though clearly different for symptoms severity, the amount of change of depressive and anxiety symptoms was also no different. Manic symptoms showed instead a trend to persist over time in group 2, whereas a slight increase of manic symptoms was observed in group 1, especially after 6 months of treatment. Moreover, in group 1, some manic symptoms were also detected at the Young Mania Rating Scale (n = 24, 26.6%). Finally, improvement in quality of life and social adjustment was similar in the two groups, though a small trend toward a faster improvement in social adjustment in group 1., Conclusions: Sub-threshold mixed states have a substantial impact on global functioning, social adjustment and subjective well-being, similarly to that of acute phases, or at least major depression. In particular, mixed features, even in their sub-threshold forms, tend to be persistent over time. Finally, manic symptoms may be still often underestimated in depressive episodes, even in patients for BD.

Introduction: There is a lack of studies regarding sexuality and sexual behavior in women with bipolar disorder. The aim of this study is to investigate sexual behavior in women affected by bipolar disorder in order to stimulate interest and debate in this area of care., Methods: Sixty women (30 BD I and 30 BD II) consent to participate in the study and were included in the sample. Moreover, sixty female healthy subjects without histories of psychiatric disorders were recruited as normal controls. Patients and healthy subjects were given the Sexual Interest and Sexual Performance Questionnaire, a questionnaire devised to explore various aspects of sexual behavior., Results: The results of the present study suggest an increase of sexual interest in patients with BD I as compared both with BD II patients and healthy controls. In women with BD I such increase of interest was detected on some items of section I of the Sexual Interest and Sexual Performance Questionnaire, in particular "Actual Value of Sexuality" and "Implicit Sexual Interest", which implicitly explore sexual interest without overtly focusing upon sexual problems. Moreover, we observed a higher desired frequency of intercourse in women with BD I than BD II and a higher occurrence of repeated sexual intercourse in women with BD I than BD II., Conclusions: The main finding of the present study was an increase of sexual interest in BD I as compared with BD II female patients and normal controls. This result was detected when sexual interest was explored implicitly. Our study is limited by the small size of our subject groups. Further investigations on larger subject samples are needed to better clarify particular aspects of sexual behavior of BD patients., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Introduction: The present research study starts up from the current scientific and academic interest concerning Deficit and Attention/Hyperactivity Disorders, which in this period seems to have an "epidemic" diffusion. Some authors have proved how the Deficit and Attention/Hyperactivity Disorder may predispose to the development of other psychopathological attitude in adulthood. A recent study has underlined a common comorbidity between ADHD in childhood and Bipolar Disorder. The aim of the present was to verify the existence of an ADHD diagnosis in patients with depression (Unipolar and Bipolar) and to verify if such syndrome overstays in the present psychopathological picture. Moreover there has been even the intention to investigate on a difference in ADHD symptomatology in patients with Bipolar and Unipolar Depression., Materials and Methods: The study has been conducted on a sample of 67 patients with depression diagnosis (35 patients with bipolar depression diagnosis, 32 patients with depression unipolar diagnosis) enrolled at the Bipolar Disorders Unit of the Clinical Psychiatry and Drug Dependence Institute of the Policlinico Universitario A. Gemelli in Rome. The evaluation has been performed through the supply of the following psychometric tests: Neo Personality Inventory (Mole-pi-R), Brown Attention Deficit Disorder Scale (Brown ADD-Scale), Adult ADHD Self-Report Staircases (ASRS-v1.1), Criteria of the Deficit and Attention / Hyperactivity Disorder for childhood according to the DSM-IV-Tr., Results: The achieved results point out that 42% of the sample has satisfied the ADHD Criterions during their childhood according to the DSM-IV-Tr and that symptomatology seems to remain in the present psychopathological picture. As to polarity of depression it has emerged that patients with Bipolar Depression diagnosis have satisfied with a greater frequency the ADHD criteria during their childhood than patients with Unipolar Depression., Conclusions: Our results seem to confirm the hypothesis that patients with bipolar depression diagnosis have more Deficit and Attention / Hyperactivity Disorders comorbidity diagnosis than others.

Objectives: The first objective of our study is the evaluation of correlation between affective temperaments and psychopathological dimensions in a clinical sample of patients with Bipolar Disorder and the individualization of possible differences within the three diagnostic subtypes (bipolar I, II and cyclothymia). The second one is to observe whether any specific temperament may influence the number of hospitalizations or the age of the bipolar depression onset., Materials and Methods: At the Bipolar Disorder Unit of Policlinico Gemelli (Rome, Italy) a group of 60 patients with Bipolar Disorder (BD) has been enrolled. All patients have been submitted to the TEMPS-A for the evaluation of affective temperament and TCI-R for the evaluation of psychopathological dimensions of personality., Results: BD I group showed 5 significant correlations from moderate (r=0.40) to high degree (r=0.60). SD dimension of TCI shows 3 significant correlations with TEMPS-A dimensions: it is inversely correlated with Cyclothymia (r= -0.57; p<0.01), Irritability (r=0.60; p<0.01) and Anxiety (r=-.45; p<0.05). BDII group showed 5 significant correlations. Irritability dimension of TEMPS-A presented the highest number of correlations with TCI dimensions: it was inversely correlated to SD (r= -.65; p<0.01) and directly correlated with HA (r=0.48; p<0.05) and ST (r=-0.49; p<0.05). In the comparison of diagnostic groups with regards to temperamental dimensions, only Hyperthymia and Irritability dimensions were significative., Conclusions: Many works have evaluated temperament through the use of these two tools (TEMPS-A and TCI-R) but few have analysed correlation between them and none has focused attention on patients with bipolar disorder diagnosis only.

Background: Behavioural addictions (BAs) can be understood as disorders characterized by repetitive occurrence of impulsive and uncontrolled behaviours. Very few studies have investigated their association with mood disorders. The present study was undertaken to determine the prevalence of the main behavioural addictions in a sample of bipolar outpatients in euthymic phase or stabilised by medications and to investigate the role of impulsivity and temperamental and character dimensions., Methods: One-hundred-fifty-eight Bipolar Disorder (BD) (DSM-IV) outpatients were assessed with tests designed to screen the main behavioural addictions: pathological gambling (SOGS), compulsive shopping (CBS), sexual (SAST), Internet (IAD), work (WART) and physical exercise (EAI) addictions. TCI-R and BIS-11 were administered to investigate impulsivity and personality dimensions mainly associated with BAs. The clinical sample has been compared with 200 matched healthy control subjects., Results: In bipolar patients, 33% presented at least one BA respect to the 13% of controls. Significantly higher scores at the scales for pathological gambling (p<.001), compulsive buying (p<.05), sexual (p<.001) and work addictions (p<.05) have been found. Self-Directness (p=.007) and Cooperativeness (p=.014) scores were significantly lower while impulsivity level was significantly higher (p=.007) in bipolar patients with BA than those without BA., Conclusions: To our knowledge, this is the first study investigating the prevalence of behavioural addictions in BD showing a significant association of these disorders. BAs are more frequent in bipolar patients than in healthy controls and are related to higher impulsivity levels and character immaturity., (2010 Elsevier B.V. All rights reserved.)

Objectives: In literature there are a few studies evaluating comorbidity between bipolar disorder (type I, II and cyclothymic ) and personality disorders. Aim of the current study is to deepen the existing comorbidity between Axis II and the three subtypes of bipolar disorder., Materials and Methods: At the Psychiatry Day Hospital of Gemelli Polyclinic seventy patients with a diagnosis of bipolar disorder (type I, II and cyclothymic ) were enrolled. Axis I diagnosis was defined by the SCID-I. Axis II diagnosis was made by the SCID-II., Results: Of seventy patients in euthymic state, thirty-nine patients (55.7%) show comorbidity with Axis II. The different clusters are such represented: two patients (5.1%) are part of cluster A, twenty-four patients (61.5%) of cluster B, nine patients (23%) of cluster C, and four patients (10.4%) have Not Otherwise Specified personality disorder. On the whole thirty-nine patients whereof twenty-four (61.5%) with bipolar disorder type I, six (15.3%) with bipolar disorder type II and nine patients (23.0%) with cyclothymic disorder show comorbidity for a Axis II disorder. It must be observed that, in our sample, the comorbidity between cyclothymic and personality disorder is significant., Conclusions: In our sample more than half of the patients (55.7%) show a comorbidity for a Axis II disorder. Most of the patients present a Cluster B personality disorder and even cyclothymic patients in 23% of cases have comorbidity with Axis II disorders.

Introduction: Bipolar disorder patients (BP) with comorbid Substance Use Disorder (SUD) may present clinical features that could compromise adherence and response to pharmacological treatment. The purpose of this study was to examine clinical and psychopathological features of BP with and without comorbid SUD in a real-world setting., Methods: The sample was composed by 131 affective patients. Sixty-five patients were affected by Bipolar Disorder I (BP-I, 49.2%), 29 by Bipolar Disorder II (BP-II, 22.3%) and 37 by Cyclothymic Disorder (CtD, 28.5%), according to DSM-IV. Sixty-six patients were diagnosed for a comorbid SUD. All patients have been submitted to psychometric assessment with Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Young Mania Rating Scale (YMRS), Global Assessment Scale (GAS), Social Adjustment Self-reported Scale (SASS), Quality of Life Scale (QoL), at baseline and repeated follow-up periods (1, 3, 6, 12 months)., Results: BP comorbid for SUD were more likely diagnosed as BP-II and CtD and were less likely to present a moderate-severe manic symptomatology. Furthermore, personality disorders were more frequent in SUD patients than in non-comorbid BP. BP with SUD were not different for primary outcome measure (HDRS, HARS, YMRS, GAS) from non-comorbid BP; however, BP with SUD were significantly more impaired in social functioning (SASS) at any stage of the follow-up and poor functioning increased the risk of relapse in substance use during treatment. Finally, SUD comorbidity did not represent a risk factor for treatment drop-out, while in our sample young age, low treatment dosage and BP-I diagnosis were significantly associated with drop-out., Discussion: The primary finding of this work is that BP with comorbid SUD are significantly more compromised in social functioning. Second, these patients were less likely to be diagnosed for BP-I and to present a severe manic symptomatology. Finally, we found that the diagnosis of SUD, but young age, low treatment dosage and BP-I diagnosis to be risk factors for treatment drop-out. Physicians should be alert to these differences in their clinical practice.

Some studies have suggested that aripiprazole might be a useful treatment for bipolar depression. There are no studies evaluating the effect of aripiprazole on anhedonia. In the present study, effects of aripiprazole were investigated under routine clinical conditions. Anhedonia was measured in patients with bipolar disorder type I (n=50) using the self-rated Snaith-Hamilton Pleasure Scale (SHAPS) and depression was assessed using the Montgomery-Asberg Depression Rating Scale. Anhedonia was present in 52% of all patients and was significantly reduced during treatment with aripiprazole. All patients completed the 16-week trial. Only 16% of patients experienced side effects (akathisia, headache). Future studies should investigate the specificity of anti-anhedonic and anti-depressant properties of aripiprazole in bipolar patients.

Objective: Several lines of research suggested that aripiprazole might be a useful treatment for acute bipolar depression. The aim of this open-label trial is to give more evidence of the clinical effectiveness and tolerability of aripiprazole in acute bipolar depression., Research Design and Methods: Aripiprazole response was prospectively assessed for 16 weeks using the Montgomery-Asberg Depression Rating Scale (MADRS), the Clinical Global Impression Severity Scale (CGI-S), and the Young Mania Rating Scale in 85 bipolar patients with acute depression inadequately responsive to one mood stabilizer., Main Outcome Measures: Aripiprazole was well tolerated. Only three (3.5%) patients discontinued the study for side effects. The most common side effect was akathisia, occurring in 17/80 (21.2%) patients. Patients showed statistically insignificant weight gain (0.9 +/- 2.64 kg) over the 16-week trial., Results: Patients showed a significant decrease in mean MADRS and CGI-S, and 80 (94.1%) patients completed the 16-week trial. Thirty-nine (45.8%) patients received aripiprazole as monotherapy and 46 received the drug adjunctively (54.1%). Fifty-two (65%) patients met criteria for response (>/= 50% reduction in MADRS total score), 30 (37.5%) patients met criteria for remission (final MADRS total score

A number of studies have demonstrated that affective disorders in epilepsy represent a common psychiatric comorbidity; however, most of the classic neuropsychiatric literature focuses on depression, which is actually prominent, but little is known about bipolar depression, and very little about mania, in epilepsy. Biochemical, structural, and functional abnormalities in primary bipolar disorder could also occur secondary to seizure disorders. The kindling paradigm, invoked as a model for understanding seizure disorders, has also been applied to the episodic nature of bipolar disorder. In bipolar patients, changes in second-messenger systems, such as G-proteins, phosphatidylinositol, protein kinase C, myristoylated alanine-rich C kinase substrate, or calcium activity have been described, along with changes in c-fos expression. Common mechanisms at the level of ion channels might include the antikindling and the calcium-antagonistic and potassium outward current-modulating properties of antiepileptic drugs. All these lines of research appear to be converging on a richer understanding of neurobiological underpinnings between bipolar disorder and epilepsy. Mania, which is the other side of the coin in affective disorders, may represent a privileged window into the neurobiology of mood regulation and the neurobiology of epilepsy itself. Future research on intracellular mechanisms might become decisive for a better understanding of the similarities between these two disorders.

Oxcarbazepine (OXC) is a keto-congener of carbamazepine, which has fewer side effects and drug interactions. However, the efficacy of OXC in treating bipolar disorder is not as well established as that of carbamazepine. This article is a systematic literature review of all studies regarding OXC and bipolar disorders, with particular attention to papers published in the last 6 years. Using the terms 'oxcarbazepine and bipolar disorder', 'oxcarbazepine and mania' or 'oxcarbazepine and bipolar depression', a computer-aided search of MEDLINE for the years 2000-2006 has been conducted. Since its introduction as an antiepileptic drug in early 2000, clinical research regarding the potential role of OXC in the treatment of bipolar disorder remains limited. There is a lack of double-blind, placebo-controlled studies. Studies recently published have small samples of patients, with insufficient follow-up periods and other methodological weaknesses. The efficacy of OXC in bipolar disorder has not been widely studied. Some authors recommend using OXC as monotherapy or as add-on therapy in refractory mania, although results are not conclusive. It is unknown whether OXC has efficacy in the maintenance treatment of bipolar disorder. OXC can be particularly useful as an add-on treatment in bipolar disorder patients for whom previous treatments have failed, or in patients who have difficulty tolerating adequate dosages of standard approved treatments.

The neuroendocrine system, which plays an important role in regulation of mood, is dysfunctional in patients suffering from mood disorders. In order to improve the quality of life for patients, additional research is needed to define clinical implications of neuroendocrine dysfunction in mood disorders. It would be important to define which specific hormonal responses that are blunted in affective disorders contribute to mood symptoms and which medications that normalize neuroendocrine function are conditioning the impact of mood symptoms. Consideration and evaluation of endocrine status result important in psychiatric patients, both to ensure proper diagnosis and adequate treatment.

Objectives: Temperament represents one of the basic elements of bipolar spectrum. Methods: A systematic search was undertaken in MEDLINE (from 1977 to 2007) to obtain articles published in English regarding the association of temperament and bipolar disorder. Keywords used were “temperament”, “bipolar disorder”, “assessment”, “bipolar spectrum”, “subthreshold”. Results: In opposition to the dichotomic conception which up to the end of XIX century considered mania and depression as two distinct and separate categories, Kraepelin has postulated a psychopathological “continuum” between temperament and affective disorders called “bipolar spectrum”. This concept has been reintroduced in contemporary psychiatry by Akiskal''s works. By rebuilding the history of patients affected by bipolar disorder, temperamental traits can be already observed in the pre-morbid period and can also persist during disorder-free intervals. Conclusions: By interpreting and diagnosing multiple expressions of bipolar spectrum, psychiatrists today are facing one of the most important challenges in everyday clinical practice. The temperamental “dysregulation” is the pathological basis of mood disorders and some temperamental traits in individuals can reflect a predisposition to develop a mood disorder. [Copyright &y& Elsevier]

Introduction: The purpose of this study is to contribute to the knowledge of the clinical characteristics of the bipolar spectrum by examining factors associated to course of symptoms in BP patients. We evaluated differences between acutely depressed versus subthreshold mixed patients. Methods: 90 depressed patients (Group 1, HDRS: 18.2±4.6, YMRS: 1.4±2.9) and 41 patients presenting a mixed subthreshold symptomathology (Group 2, HDRS: 9.1±3.2, YMRS: 9.6±6.4) were included in the study. All patients underwent structured diagnostic interviews for axis I and axis II disorders (SCID-I, SCID-II) and have been submitted to psychometric assessment with Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Young Mania Rating Scale (YMRS), Global Assessment Scale (GAS), Social Adjustment Self-reported Scale (SASS), Quality of Life Scale (QoL), at baseline and repeated follow-up (1, 3, 6, 12 months). Personality dimensions were evaluated by Temperament and Character Inventory (TCI-R). Results: The most important result is the slight increase in depressive symptoms in subthreshold mixed patients after 3 months of treatment. These patients were more likely diagnosed as BP-I, were non-SUD patients and/or non-comorbid for axis II personality disorders and had a shorter duration of current episode prior intake. Measures of social and functional adjustment were not different in the two groups, though a slight trend for depressed patients to report a poorer quality of life. No difference in personality traits were observed among the two samples. Conclusions: Our study confirms the importance of considering subthreshold symptoms in the evaluation and treatment of patients with Bipolar Disorder. [Copyright &y& Elsevier]

Objectives: Behavioural addictions (BAs) can be understood as disorders characterized by repetitive occurrence of impulsive and uncontrolled behaviours. Very few studies have investigated their association with mood disorders. The present study was undertaken to determine the prevalence of the main behavioural addictions in a sample of bipolar outpatients in euthymic phase or stabilised by medications and to investigate the role of impulsivity and temperamental and character dimensions. Methods: One-hundred-fifty-eight Bipolar Disorder (BD) (DSM-IV) outpatients were assessed with tests designed to screen the main behavioural addictions: pathological gambling (SOGS), compulsive shopping (CBS), sexual (SAST), internet (IAD), work (WART) and physical exercise (EAI) addictions. TCI-R and BIS-11 were administered to investigate impulsivity and personality dimensions mainly associated with BAs. The clinical sample has been compared with 200 matched healthy control subjects. Results: In bipolar patients, 33% presented at least one BA respect to the 13% of controls. Significantly higher scores at the scales for pathological gambling (p< .001), compulsive buying (p< .05), sexual (p< .001) and work addictions (p< .05) have been found. Self-Directness (p=.007) and Cooperativeness (p=.014) scores were significantly lower while impulsivity level was significantly higher (p=.007) in bipolar patients with BA than those without BA. Conclusions: To our knowledge, this is the first study investigating the prevalence of behavioural addictions in BD showing a significant association of these disorders. BAs are more frequent in bipolar patients than in healthy controls and are related to higher impulsivity levels and character immaturity. [Copyright &y& Elsevier]

Introdution: Our study represents a pilot evaluation about how the MOOD-SR recognizes subthreshold manifestations that may be associated with clinical symptomatology in a group of bipolar patients. Methods: At Day Hospital of Psychiatry, Policlinico “A. Gemelli”, Bipolar Disorders Unit, it has been conducted an experimental study on a heterogeneous sample of 24 patients with a diagnosis of Bipolar Disorder type I. Patients have been assessed with the MOOD-SR, a clinical self-reported interview, that is specific for the spectrum of subthreshold pathology, and with the Quality of Life (QoL), that investigates the patient''s quality of life. Results: We have found that 16 patients on 24 report a score higher than 60 (68,4%). Among these, 10 female patients on 15 have a total score higer than 61 (68.75%) while 6 male patients on 9 obtain a total score higher than 60 (62,5%). However, these results have only preliminary value, further studies are needed in order to obtain a deeper evaluation. Conclusion: Spectrum manifestations are both indicator of course and response to treatment and predictive for relapse. This finding may represent an important preventive instrument for maniacal relapse in patients with Bipolar Disorder, that is often underdiagnosed or confused for Unipolar Depression. By adequately recognizing the problem we will be able to refine diagnosis and individualize therapy. [Copyright &y& Elsevier]