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There is ongoing debate about the similarities and differences between bipolar disorder (BD) and borderline personality disorder (BPD). Very few studies have concurrently assessed their neuropsychological profile and only on a narrow array of neuropsychological tests. We aimed to investigate the differences of these two patient groups on visual memory, executive function, and response inhibition. Twenty-nine BD patients, 27 BPD patients and 22 controls (all female) were directly compared on paired associates learning (PAL), set shifting (ID/ED), problem solving (SOC), and response inhibition (SSRT) using Cambridge Neuropsychological Test Automated Battery (CANTAB). Rank-normalized outcomes were contrasted in one-way ANOVA tests. Discriminant analysis was finally performed to predict BD or BPD patient status. BD patients performed significantly worse than controls on all tasks. BPD patients performed significantly worse than HC on all tests except SST. Significant differences between the two patient groups were recorded only on ID/ED, where BPD patients performed worse (p = 0.044). A forward stepwise discriminant analysis model based on ID/ED and SOC predicted correctly patients’ group at 67.9% of cases. In conclusion, BD and BPD female patients appear to be more similar than different as regards their neuropsychological functions. This study is the first to show that BPD patients display more deficits than BD patients when directly compared on the set shifting executive function test, a marker of cognitive flexibility. Discerning BD from BPD patients through neuropsychological performance is promising but would improve by using additional subtler tests and psychometric evaluation.

Additional file 1. Additional figures.

USE OF DOUBLE DOSE ELECTROCONVULSIVE THERAPY (ECT) IN A PATIENT WITH CATATONIADomna Tsaklakidou, Antonis Mavromatos, Kalliopi Tournikioti, Athanasios Douzenis2nd Department of Psychiatry, University of Athens, u201cAttikonu201d University General Hospital, Athens, Greece Objectives: The presentation of this case report aims for greater awareness of the usefulness of double dose ECT among psychiatrists.Background and aims: Catatonia from cata- u2018badlyu2019 + Greek tonos u2018tone or tensionu2019, was first described as an independent disease in 1874 by Kahlbaum and it was later considered as a schizophrenia subtype by Kraepelin. Nowadays it is identified as a complex neuropsychiatric syndrome which can develop in numerous medical conditions. Although ECT is a well-established first line treatment for catatonia, it is underutilized because of legal or other limitations such as longer hospital admissions, stigma and additional burden for the personnel.Materials and methods: A 52-year-old woman with catatonia who scored 6/14 screening items in Bush-Francis Catatonia Rating Scale (BFCRS) upon first admission in our department, underwent 17 bilateral ECT sessions of normal dose (stimulus energy up to 100%) showing partial response (4/14 in BFCRS). After regular follow-up for one year, readmission was inevitable because of gradual deterioration of the catatonic symptoms. We conducted 14 bilateral ECT sessions reaching maximum dose (stimulus energy 200%) in the five last sessions. Results: Decided improvement was observed with a score of 1/14 in BFCRS upon discharge, thus not meeting the criteria for catatonia diagnosis (>2/14). Conclusions: ECT is a safe and effective therapy, holding a dominant position in the contemporary psychiatric arsenal. Double dose could be considered in treatment-resistant cases.

Background: We present the case of a 52-year-old woman with depression who developed extrapyramidal symptoms (mainly parkinsonism) and suicidal ideation while on fluoxetine. Methods: The patient underwent neurological and neuroimaging examination. Results: The patient’s neurological and neuroimaging examinations were normal and there was no other cause of extrapyramidal symptoms. The patient showed remission of the aforementioned symptomatology when fluoxetine was discontinued. Conclusions: This case shows that fluoxetine can be associated with extrapyramidal symptoms, and this may have an aggravating affect on clinical depression progress and the emergence of suicidal ideation.