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Research increasingly implicates glutamatergic dysfunction in the pathophysiologies of psychotic disorders. Auditory mismatch negativity (MMN) is an electroencephalography (EEG) waveform linked to glutamatergic neurotransmission and is consistently attenuated in schizophrenia (SCZ). MMN consists of two subcomponents, the repetition positivity (RP) and deviant negativity (DN) possibly reflecting different neural mechanisms. However, whether MMN reduction is present across different psychotic disorders, linked to distinct symptom clusters, or related to sex remain to be clarified. Four hundred participants including healthy controls (HCs; n = 296) and individuals with SCZ (n = 39), bipolar disorder (BD) BD typeI (n = 35), or BD type II (n = 30) underwent a roving MMN paradigm and clinical evaluation. MMN, RP and DN as well their memory traces were recorded at the FCZ electrode. Analyses of variance and linear regression models were used both transdiagnostically and within clinical groups. MMN was reduced in SCZ compared to BD (p = 0.006, d = 0.55) and to HCs (p < 0.001, d = 0.63). There was a significant group × sex interaction (p < 0.003) and the MMN impairment was only detected in males with SCZ. MMN amplitude correlated positively with Positive and Negative Syndrome Scale total score and negatively with Global Assessment of Functioning Scale score. The deviant negativity was impaired in males with SCZ. No group differences in memory trace indices of the MMN, DN, or RP. MMN was attenuated in SCZ and correlated with greater severity of psychotic symptoms and lower level of functioning. Our results may indicate sex-dependent differences of glutamatergic function in SCZ. [ABSTRACT FROM AUTHOR]

Abstract Background The distinction between bipolar I and bipolar II disorder and its treatment implications have been a matter of ongoing debate. The aim of this study was to examine differences between patients with bipolar I and II disorders with particular emphasis on the early phases of the disorders. Methods 808 subjects diagnosed with bipolar I (N = 587) or bipolar II disorder (N = 221) according to DSM-IV criteria were recruited between April 1994 and March 2022 from tertiary-level mood disorder clinics. Sociodemographic and clinical variables concerning psychiatric and medical comorbidities, family history, illness course, suicidal behavior, and response to treatment were compared between the bipolar disorder types. Results Bipolar II disorder patients were more frequently women, older, married or widowed. Bipolar II disorder was associated with later “bipolar” presentation, higher age at first (hypo)mania and treatment, less frequent referral after a single episode, and more episodes before lithium treatment. A higher proportion of first-degree relatives of bipolar II patients were affected by major depression and anxiety disorders. The course of bipolar II disorder was typically characterized by depressive onset, early depressive episodes, multiple depressive recurrences, and depressive predominant polarity; less often by (hypo)mania or (hypo)mania-depression cycles at onset or during the early course. The lifetime clinical course was more frequently rated as chronic fluctuating than episodic. More patients with bipolar II disorder had a history of rapid cycling and/or high number of episodes. Mood stabilizers and antipsychotics were prescribed less frequently during the early course of bipolar II disorder, while antidepressants were more common. We found no differences in global functioning, lifetime suicide attempts, family history of suicide, age at onset of mood disorders and depressive episodes, and lithium response. Conclusions Differences between bipolar I and II disorders are not limited to the severity of (hypo)manic syndromes but include patterns of clinical course and family history. Caution in the use of potentially mood-destabilizing agents is warranted during the early course of bipolar II disorder.

Background: The distinction between bipolar I and bipolar II disorder and its treatment implications have been a matter of ongoing debate. The aim of this study was to examine differences between patients with bipolar I and II disorders with particular emphasis on the early phases of the disorders. Methods: 808 subjects diagnosed with bipolar I (N = 587) or bipolar II disorder (N = 221) according to DSM-IV criteria were recruited between April 1994 and March 2022 from tertiary-level mood disorder clinics. Sociodemographic and clinical variables concerning psychiatric and medical comorbidities, family history, illness course, suicidal behavior, and response to treatment were compared between the bipolar disorder types. Results: Bipolar II disorder patients were more frequently women, older, married or widowed. Bipolar II disorder was associated with later "bipolar" presentation, higher age at first (hypo)mania and treatment, less frequent referral after a single episode, and more episodes before lithium treatment. A higher proportion of first-degree relatives of bipolar II patients were affected by major depression and anxiety disorders. The course of bipolar II disorder was typically characterized by depressive onset, early depressive episodes, multiple depressive recurrences, and depressive predominant polarity; less often by (hypo)mania or (hypo)mania-depression cycles at onset or during the early course. The lifetime clinical course was more frequently rated as chronic fluctuating than episodic. More patients with bipolar II disorder had a history of rapid cycling and/or high number of episodes. Mood stabilizers and antipsychotics were prescribed less frequently during the early course of bipolar II disorder, while antidepressants were more common. We found no differences in global functioning, lifetime suicide attempts, family history of suicide, age at onset of mood disorders and depressive episodes, and lithium response. Conclusions: Differences between bipolar I and II disorders are not limited to the severity of (hypo)manic syndromes but include patterns of clinical course and family history. Caution in the use of potentially mood-destabilizing agents is warranted during the early course of bipolar II disorder. [ABSTRACT FROM AUTHOR]

Objective: Compare patients diagnosed as DSM-5 type II bipolar disorder (BD2) vs. major depressive disorder (MDD).Methods: We compared characteristics of 3246 closely and repeatedly evaluated, consenting, adult patient-subjects (n = 706 BD2, 2540 MDD) at a specialty clinic using bivariate methods and multivariable modeling.Results: Factors more associated with BD2 than MDD included: [a] descriptors (more familial psychiatric, mood and bipolar disorders and suicide; younger at onset, diagnosis and first-treatment; more education; more unemployment; fewer marriages and children; higher cyclothymic, hyperthymic and irritable temperament ratings, lower anxious); [b] morbidity (more hypomanic, mixed or panic first episodes; more co-occurring general medical diagnoses, more Cluster B personality disorder diagnoses and ADHD; more alcohol and drug abuse and smoking; shorter depressive episodes and interepisode periods; lower intake ratings of depression and anxiety, higher for hypomania; far more mood-switching with antidepressants; lower %-time depressed; DMI > MDI course-pattern in BD2; more suicide attempts and violent suicidal behavior); [c] item-scores with intake HDRS21 higher for suicidality, paranoia, anhedonia, guilt, and circadian variation; lower somatic anxiety, depressed mood, insight, hypochondriasis, agitation, and insomnia; and [d] treatment (more lithium, mood-stabilizing anticonvulsants and antipsychotics, less antidepressants and benzodiazepines).Conclusions: BD2 and MDD subjects differed greatly in many descriptive, psychopathological and treatment measures, notably including more familial risk, earlier onset, more frequent recurrences and greater suicidal risk with BD2. Such differences can contribute to improving differentiation of the disorders and planning for their treatment. [ABSTRACT FROM AUTHOR]

Background and purpose: The boundary between bipolar disorder and borderline personality disorder has always been a matter of debate. Despite the importance of this issue, only a few studies have directly compared these two groups. The main purpose of this study was to compare the cognitive profile of patients with bipolar disorder and borderline personality disorder in terms of attentional bias. Materials and methods: In this causal-comparative study, attentional bias was compared between 52 patients with bipolar II disorder and 50 patients with borderline personality disorder attending cognitive disorder and psychological clinics in Babol, Iran. Also, 50 healthy individuals were studied as control group. Dot-probe task was done and Young Mania Rating Scale was completed. Data were then analyzed using independent T-test. Results: The mean age and sex (F and M) of patients with bipolar II and borderline disorders and healthy controls were 25±1.73 (52% and 48%), 27.33±2.87 (61% and 39%), and 26.47±2.34 (50% and 50%), respectively. Mean scores for attentional bias in control group and patients with bipolar II and borderline disorders were 11.36±6.57 (P=0.0012), 19.67±6.85 (P=0.0025), and 16.26±5.85 (P=0.003), respectively. Conclusion: In current study, both patient groups had poor performance in attentional bias tasks compared with control group. Patients with bipolar disorder showed more deficits in attention bias than patients with borderline personality disorder and healthy individuals. According to the differences in attention bias found in this study, cognitive studies may help to clarify the boundaries between bipolar disorder and borderline personality disorder.

In this open-label naturalistic study, we assess the feasibility, tolerability, and effectiveness of a repetitive transcranial magnetic stimulation protocol with a reduced total pulse number for treating patients suffering from bipolar disorder type II. All patients received one rTMS treatment session of 1000 pulses for 20 consecutive working days, accumulating to 20.000 rTMS pulses applied over 4 weeks. We measured the patients' symptoms before the start, halfway through, directly after, and one month after treatment. We quantified the depression symptoms using both the Beck depression inventory scale and the symptom checklist-90 depression subscale. Patients showed a significant reduction in depression symptoms directly after treatment and an even further reduction one month after treatment. The remission rates were at 26% halfway through treatment (after the 10th session), 61% directly after treatment (after the 20th session), and increased to 78% at the 1-month follow-up. Importantly, the protocol proved to be feasible and highly tolerable in this patient population, with no adverse effects being reported. Considering these positive results, further research should focus on replicating these findings in larger clinical samples with control groups and longer follow-up periods, while potentially adding maintenance sessions to optimize the treatment effect and stability for bipolar disorder type II patients. [ABSTRACT FROM AUTHOR]

Background and purpose: The boundary between bipolar disorder and borderline personality disorder has always been a matter of debate. Despite the importance of this issue, only a few studies have directly compared these two groups. The main purpose of this study was to compare the cognitive profile of patients with bipolar disorder and borderline personality disorder in terms of attentional bias. Materials and methods: In this causal-comparative study, attentional bias was compared between 52 patients with bipolar II disorder and 50 patients with borderline personality disorder attending cognitive disorder and psychological clinics in Babol, Iran. Also, 50 healthy individuals were studied as control group. Dot-probe task was done and Young Mania Rating Scale was completed. Data were then analyzed using independent T-test. Results: The mean age and sex (F and M) of patients with bipolar II and borderline disorders and healthy controls were 25±1.73 (52% and 48%), 27.33±2.87 (61% and 39%), and 26.47±2.34 (50% and 50%), respectively. Mean scores for attentional bias in control group and patients with bipolar II and borderline disorders were 11.36±6.57 (P=0.0012), 19.67±6.85 (P=0.0025), and 16.26±5.85 (P=0.003), respectively. Conclusion: In current study, both patient groups had poor performance in attentional bias tasks compared with control group. Patients with bipolar disorder showed more deficits in attention bias than patients with borderline personality disorder and healthy individuals. According to the differences in attention bias found in this study, cognitive studies may help to clarify the boundaries between bipolar disorder and borderline personality disorder. [ABSTRACT FROM AUTHOR]

Objective. To study the association of CREB1 gene with depression and bipolar disorder type II. Methods. Three hundred and sixty-two patients with depression, 381 patients with bipolar disorder type II and 416 healthy subjects were included. There were no significant differences in gender, age and year of education between depression group, bipolar disorder type II group and control group. Patients with severity of depression were evaluated by Hamilton Depression Rating Scale. Hypomania Check List-32 was used to screen the history of hypomanic episode of patients with depression and patients with bipolar disorder type II. A total of 2 mL of venous blood was collected from each subject, and whole genome of peripheral blood leukocyte DNA was extracted using a centrifugal column genomic DNA kit. Single nucleotide polymorphism (SNP) genotyping of SNaPshot was used to identify the rs10932201 and rs3770704 loci of CREB1 gene, and the effects of SNP on CREB1 expression in brain were analyzed using BRAINEAC database. Results. The genotypes of rs10932201 and rs3770704 of CREB1 gene in the depression group, bipolar disorder type II group and control group were well matched with Hardy-Weinberg equilibrium (P>0.05). Linkage disequilibrium analysis showed that there was a strong linkage disequilibrium between rs10932201 and rs3770704 (r²>0.4). At the rs10932201 locus of CREB1 gene, there was a significant difference in allelic frequency between the bipolar disorder type II group and the control group (χ²=4.27, P=0.042); there was no difference in allelic frequency between the depression group and the control group. There were no significant differences in either allelic or genotypic frequency of rs3770704 of CREB1 gene in the depression group and bipolar disorder type II group compared with the control group. In the haplotype constructed between rs10932201 and rs3770704 of CREB1 gene, the frequency of haplotype A-T in the bipolar disorder type II group was 57.5%, which was statistically significant (χ²=4.07,P=0.044). Expression quantitative trait loci analysis showed that rs10932201 was associated with CREB1 gene expression in temporal cortex (P=0.048). Conclusion. The rs10932201 of CREB1 gene is associated with bipolar disorder type II, and may be a risk factor for bipolar disorder type II, not depression. [ABSTRACT FROM AUTHOR]

In this open-label naturalistic study, we assess the feasibility, tolerability, and effectiveness of a repetitive transcranial magnetic stimulation protocol with a reduced total pulse number for treating patients suffering from bipolar disorder type II. All patients received one rTMS treatment session of 1000 pulses for 20 consecutive working days, accumulating to 20.000 rTMS pulses applied over 4 weeks. We measured the patients’ symptoms before the start, halfway through, directly after, and one month after treatment. We quantified the depression symptoms using both the Beck depression inventory scale and the symptom checklist-90 depression subscale. Patients showed a significant reduction in depression symptoms directly after treatment and an even further reduction one month after treatment. The remission rates were at 26% halfway through treatment (after the 10th session), 61% directly after treatment (after the 20th session), and increased to 78% at the 1-month follow-up. Importantly, the protocol proved to be feasible and highly tolerable in this patient population, with no adverse effects being reported. Considering these positive results, further research should focus on replicating these findings in larger clinical samples with control groups and longer follow-up periods, while potentially adding maintenance sessions to optimize the treatment effect and stability for bipolar disorder type II patients.

• Bipolar disorder subtypes share pathophysiologic pathways on candidate-gene studies. • Subtype II has specific contributions of gene interactions and low-effect alleles. • In genome studies, subtypes contrasted in their relation to depression and psychosis. • Polygenic risk scores were able to differentiate bipolar disorder type II. • Research suggests transdiagnostic genetic backgrounds across the bipolar spectrum. The identification of bipolar disorder (BD) type II patients has both treatment and prognostic implications. Better understanding of its underlying genetics may yield useful diagnostic tools. A systematic review on BDII genetics was done using articles published in 2009–2019, following PRISMA recommendations. The most studied polymorphism was BDNF Val66Met with several gene-gene interactions within the dopaminergic system. Associations were reported within the monoaminergic systems (DRD3, ADH1B and SLC6A4) , calcium (CACNB2 and CACNG2) and cAMP (PDE1DA , PDE4B and DISC1) signal transduction pathways and the immune system (TNFα , IFNδ and IL-10). Chromosomes 2, 3 and 10 were associated with BDII and polygenic risk scores distinguished between BD subtypes and with major depressive disorder. Research on BDII stems from BDI findings, however with a stronger contribution of gene-gene interactions and low-effect alleles on known neuroplasticity and monoaminergic system genes. Genome studies point to transdiagnostic backgrounds, with wider associations across bipolar spectrum disorders. Findings able to accurately differentiate BDII remain elusive, dependent on better phenotypic characterization and new research methods. [ABSTRACT FROM AUTHOR]

Background: Two current theories regarding the neuroscientific bases of mood disorders involve alterations in glutamatergic neurotransmission and excessive activation of inflammatory pathways. We hypothesized that glutamate (Glu) levels and peripheral inflammatory markers would be associated with cognitive function, in patients with Bipolar Disorder Type II (BP-II), and that such factors would be associated with psychological treatment outcomes.Aims: The primary aim of this study was to explore the relationship between the neurotransmitter Glu, cytokines (CRP, IL_6, and TNFa) and neuropsychological and related functioning. The secondary aim was to assess cognitive functioning as a predictor of poor response to psychological therapy.Methods: Proton magnetic resonance spectroscopy data were acquired from the anterior cingulate cortex (ACC) of 15 participants with BP-II, and 13 healthy controls in a 3T magnetic resonance imaging scanner. The Digit Symbol Task (DST) for processing speed, TMT-B for executive function and Rey Auditory Verbal Learning Test (RAVLT) were administered to assess cognitive domains.Results: There was no significant difference in anterior cingulate Glu, or inflammatory markers between groups. Furthermore, we found no significant difference between groups in any cognitive tests. Scores on the DST were found to be significantly associated with poor response to psychological therapy.Conclusions: This study may highlight an association between neuropsychological dysfunction and treatment outcome in euthymic patients with BP-II. We did not find any association between peripheral inflammatory markers and brain Glu levels. This may have been in part due to the small sample size.

Background: Two current theories regarding the neuroscientific bases of mood disorders involve alterations in glutamatergic neurotransmission and excessive activation of inflammatory pathways. We hypothesized that glutamate (Glu) levels and peripheral inflammatory markers would be associated with cognitive function, in patients with Bipolar Disorder Type II (BP-II), and that such factors would be associated with psychological treatment outcomes. Aims: The primary aim of this study was to explore the relationship between the neurotransmitter Glu, cytokines (CRP, IL_6, and TNFa) and neuropsychological and related functioning. The secondary aim was to assess cognitive functioning as a predictor of poor response to psychological therapy. Methods: Proton magnetic resonance spectroscopy data were acquired from the anterior cingulate cortex (ACC) of 15 participants with BP-II, and 13 healthy controls in a 3T magnetic resonance imaging scanner. The Digit Symbol Task (DST) for processing speed, TMT-B for executive function and Rey Auditory Verbal Learning Test (RAVLT) were administered to assess cognitive domains. Results: There was no significant difference in anterior cingulate Glu, or inflammatory markers between groups. Furthermore, we found no significant difference between groups in any cognitive tests. Scores on the DST were found to be significantly associated with poor response to psychological therapy. Conclusions: This study may highlight an association between neuropsychological dysfunction and treatment outcome in euthymic patients with BP-II. We did not find any association between peripheral inflammatory markers and brain Glu levels. This may have been in part due to the small sample size. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the psychosocial functioning of euthymic Bipolar Disorder Type - II (BD-II) patients and its association with cognitive functions and subclinical symptoms. The hypothesis was BD-II patients would have a low level of psychosocial functioning compared to healthy subjects, and the psychosocial functioning would be associated independently with cognitive dysfunction and subclinical symptoms. Method: Thirty-three subjects that met the criteria for BD-II according to Structured Clinical Interview for DMS-IV and thirty-five healthy subjects were included. Clinical symptoms were assessed by the Hamilton Depression Rating Scale (HDRS); Young Mania Rating Scale (YMRS); Hamilton Anxiety Rating Scale (HARS); and psychosocial functioning was assessed by Functioning Assessment Short Test (FAST). Neurocognitive assessment battery consisted of WAIS-R general information subtest, Wisconsin Card Sorting Test (WCST) perseverative errors, non-perseverative errors, and category completed subtests; Trail Making Test-B (TMT-B); Stroop TBAG form; Trail Making Test-A (TMT-A); Auditory Consonant Trigrams (ACT) ACT; and Wechsler Memory Scale-Revised (WMS-R). Results: Clinical symptoms assessed by the different scoring subtests were significantly different between the two groups. In addition, FAST scores were associated with ACT scores in BD-II group. Conclusion: BD-II patients had cognitive dysfunctions and low level of psychosocial functioning even in their euthymic states. Working memory dysfunction was independently associated with the psychosocial functioning of euthymic BD-II patients. [ABSTRACT FROM AUTHOR]

Considering the overestimation of bipolar II diagnosis at the expense of borderline personality disorder, and the consequent difficulty in accessing effective psychotherapeutic practice, the aim of this paper is to identify traits considered as common in these disorders and to distinguish them in order to improve diagnostic sensitivity. The confusion is explained by the diagnostic overshadowing between these disorders; several studies have confirmed how affective instability and impulsive behaviour seem to be appropriate traits to compare these two disorders. For this purpose a revision of international literature from the last 15 years was carried out. Affectivity shows differences in speed of change, interpersonal responsiveness, affective modulation and valence, for borderline personality disorder from euthymic to anxiety, depression and anger whilst for bipolar disorder II from euthymic to depression to elevation. Compared to impulsivity, borderline personality disorder and bipolar disorder II differ in cognitive impulsivity (information processing speed); borderline personality disorder reported a lack of premeditation (no consideration of consequences) and a lack of persistence (problems remaining engaged in settings). Results will be discussed in the conclusion section. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study to investigate the differences between depressive episodes of disorder type I (BD-I), type II (BD-II) and unipolar depression (UD). Methods: For this purpose patients from outpatients or inpatients units have been included in the study. Fourtynine patients who were diagnosed with BD-I depressive episode, 47 patients who were diagnosed with BD-II depressive episode, and 46 patient who were diagnosed with major depressive episode (UD) according to DSM-IV have been evaluated consecutively. Exclusion criterion was ordered treatment for current episode. Diagnostic interviews were done with SCID-I and II, information about patient and disease were recorded by using SKIP-TURK. Hamilton Depression Rating Scale (HDRS), Suicide Intent Scale (SIS), Barratt Impulsivity Scale (BIS), The Eating Attitudes Test (EAT), Pittsburg Sleep Quality Index (PSQI) and Arizona Sexual Experience Scale (ASES) were used to evaluate each patient. Results: Melancholic features and psychotic symptoms were more frequent in BD-I, atypical features and suicid attempt were more frequent in BD-II. Sudden onset and seasonality were mostly found in BD-II. However, item scores of HDRS, except items assessing middle and terminal insomnia, genital symptoms, and insight, were different between the groups. There was a strong relation between HDRS and BIS scores in UD, a moderate relation between BIS and PSQI scores in BD-I, and a moderate relation between BIS and EAT scores in BD-II patients. Conclusion: Although some similarities in the characteristics of depressive episodes of mood disorders exist, there are some remarkable differences between them that can be useful in differential diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Abstract: Background: Bipolar disorder II (BPII) and unipolar depression (UD) are both characterized by episodes of major depression (MDE), however DSM-IV criteria for MDE are identical, regardless of diagnosis. As a result, misdiagnosis of BP II and UD is common, leading to inappropriate treatment. Because women are twice as likely as men to experience MDE, differentiating UD from BP II in the context of depression is especially important for women. We examined symptoms and clinical features of MDE in women with UD and BPII to compare presentations of the two disorders in women. Methods: We compared characteristics of depressed women meeting DSM-IV criteria for BPII (n=48) or UD (n=48), matched on age. Results: Feelings of worthlessness occurred in 98% of participants with UD versus 85% with BPII (p=0.03). Participants with UD experienced either insomnia or hypersomnia, but participants with BPII were more likely to experience both simultaneously (p=0.04). Those with UD were significantly less likely to have >5 prior mood episodes compared to those with BP II (12% versus 61%; p<0.0001) and had a later age of onset (p=0.003). Limitations: Small sample size and exclusion criteria (i.e., comorbid substance abuse) may limit generalizability of findings. Conclusions: Among a sample of women, number of prior episodes, feelings of worthlessness, age of onset, and sleep patterns distinguished between UD and BP II depressive episodes. A better understanding of differential presentation of BP II versus UD depression in women may help guide clinicians to more accurate diagnoses and, ultimately, better treatment. [Copyright &y& Elsevier]

Affective instability is a psychophysiological symptom observed in some psychopathologies. It is a complex construct that encompasses (1) primary emotions, or affects, and secondary emotions, with each category having its own characteristics, amplitude, and duration, (2) rapid shifting from neutral or valenced affect to intense affect, and (3) dysfunctional modulation of emotions. Affective instability is often confused with mood lability, as in bipolar disorders, as well as with other terms. To clarify the concept, we searched databases for the term affective instability and read related articles on the topic. In this article we situate the term within the current affective nomenclature and human emotional experience, explore its psychophysiological features, and place it within the context of psychopathology. We explain why the term can potentially be confused with mood pathology and then define affective instability as an inherited temperamental trait modulated by developmental experience. [ABSTRACT FROM AUTHOR]

Affective instability is a psychophysiological symptom observed in some psychopathologies. It is a complex construct that encompasses (1) primary emotions, or affects, and secondary emotions, with each category having its own characteristics, amplitude, and duration, (2) rapid shifting from neutral or valenced affect to intense affect, and (3) dysfunctional modulation of emotions. Affective instability is often confused with mood lability, as in bipolar disorders, as well as with other terms. To clarify the concept, we searched databases for the term affective instability and read related articles on the topic. In this article we situate the term within the current affective nomenclature and human emotional experience, explore its psychophysiological features, and place it within the context of psychopathology. We explain why the term can potentially be confused with mood pathology and then define affective instability as an inherited temperamental trait modulated by developmental experience. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Bipolar Disorder I (BD I) and Bipolar Disorder II (BD II) vary considerably, with differences in symptomatology, management and prognosis. For patients with depression, the distinction between BD I and BD II is not always apparent, and hinges on the differentiation between manic/mixed and hypomanic episodes. Other putative differences between patients with BD I and II exist and may assist in distinguishing between these two conditions. Methods: Data were obtained from the National Epidemiological Survey on Alcohol and Related Conditions. A total of 1429 subjects were included in our analysis based on DSM-IV criteria, 935 with BD I and 494 with BD II. We examined for differences in a number of variables including demographics, clinical features, depressive symptoms, and co-morbid conditions using t-tests and chi-square analyses for a comparison of means as well as a logistic regression for variables found to be significant. Results: Key differences between BD I and BD II were identified in all categories in our comparison of means. In the regression analysis, a number of variables were determined to be predictors of BD I, including unemployment (OR=0.6), taking medications for depression (OR=1.7), a history of a suicide attempt (OR=1.8), depressive symptoms such as weight gain (OR=1.7), fidgeting (OR=1.5), feelings of worthlessness (OR=1.6) and difficulties with responsibilities (OR=2.2), as well as the presence of specific phobias (OR=1.8) and Cluster C traits (OR=1.4). Conclusions: Our results indicate that in addition to the differences between manic/mixed and hypomanic episodes, other significant differences exist that may be used to help differentiate BD I from BD II. [Copyright &y& Elsevier]

Abstract: High rates of anxiety disorders have been reported in bipolar disorders. The study aimed to investigate prevalence of anxiety disorders in remitted bipolar subjects and their influence on the illness severity. Bipolar subjects with anxiety disorders were younger, had earlier age at onset of illness, and were overrepresented by female subjects and those with earlier onset illness compared to those without anxiety disorder. The study demonstrated that (1) anxiety disorders are highly prevalent in bipolar subjects, (2) individual anxiety disorders, particularly SP and PD seem to have an effect on illness severity, (3) bipolar subjects with comorbid anxiety tend to have a poorer course and are less responsive to treatment, and (4) anxiety tends to be associated with an earlier age at onset of bipolar disorder (BPD) and results in a more complicated and severe disease course. [Copyright &y& Elsevier]

Introduction: Differences between BD-I and BD-II patients with regard to specific illness characteristics are poorly understood. Objectives: This study is mainly aimed to compare sociodemographic and clinical characteristics between BD-I and BD-II patients with the goal of clarifying possible predictors of clinical course. Methods: The sample of this cohort study is composed of 387 currently euthymic bipolar patients. Participants were all receiving only maintenance treatment; their psychopharmacological regimens and psychopathological conditions were stable at assessment. Results: BD-II patients were more likely to be female, had more frequently a recent depressive episode and substance abuse/dependence relative to BD-I. BD-II patients were also less likely to have a positive history of psychiatric conditions in family, psychotic symptoms at first episode, and first depressive illness episode. Moreover, BD-II were older at their illness onset and first treatment than BD-I patients. Furthermore, BD-I were more likely to have higher depressive, manic, anxiety, and symptoms severity than BD-I patients. Being female (OR=.289), having psychiatric conditions in family (OR=.273), and higher severity of illness at CGI (OR=.604) were all significantly associated with BD-II. Conclusions: Additional studies are required to replicate these results, and facilitate the prediction of BD outcomes according to the specified profile. [ABSTRACT FROM AUTHOR]

• Differential characteristics between BD-I and BD-II patients were documented. • Being female, having psychiatric family conditions, and higher illness severity were linked to BD-II. • Substantial clinical differences may help to characterize bipolar subgroups. Differences between BD-I and BD-II patients with regard to specific illness characteristics are poorly understood. This study is mainly aimed to compare socio-demographic and clinical characteristics between BD-I and BD-II patients with the goal of clarifying possible predictors of clinical course. The sample of this cohort study is composed of 391 currently euthymic bipolar patients. Participants were all receiving only maintenance treatment; their psychopharmacological regimens and psychopathological conditions were stable at assessment. After univariate analyses, BD-II patients were more likely to be female, had more frequently a recent depressive episode and substance abuse/dependence relative to BD-I subjects. BD-II patients were also less likely to have a positive history of psychiatric conditions in family, psychotic symptoms at first episode, and first depressive illness episode. Moreover, BD-II were older at their illness onset and first treatment than BD-I patients. Furthermore, BD-I were more likely to have higher depressive, manic, anxiety, and symptoms severity than BD-II patients. After logistic regression analyses, being female (OR = 0.289), having psychiatric conditions in family (OR = 0.273), and higher severity of illness at CGI (OR = 0.604) were all significantly associated with BD-II. Additional studies are required to replicate these results, and facilitate the prediction of BD outcomes according to the specified profile. [ABSTRACT FROM AUTHOR]

Introduction : Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middle-income countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed. Areas covered : Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments. Expert opinion : Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.

Objective: The goal of this mixed methods descriptive study was to explore Advanced Practice Registered Nurses' (APRNs') knowledge of bipolar disorder (BPD) and their perceptions of facilitators and barriers to screening patients with known depression for BPD., Methods: A mixed method study design using surveys on BPD knowledge and screening practices as well as focus group data collection method for facilitators and barriers to screening., Results: 89 APRNs completed the survey and 12 APRNs participated in the focus groups. APRNs in any practice setting had low knowledge scores of BPD. No significant differences in screening for BPD for primary and non primary care APRNs. Qualitative findings revealed screening relates to tool availability; time, unsure of when to screen, fear of sigma, symptoms knowledge of BPD, accessible referral system, personal experiences with BPD, and therapeutic relationships with patients., Conclusion: Misdiagnosis of BPD as unipolar depression is common in primary care settings, leading to a long lag time to optimal diagnosis and treatment. The wait time to diagnosis and treatment could be reduced if APRNs in primary care settings screen patients with a diagnosis of depression by using validated screening tools. These results can inform APRN practice and further research on the effectiveness of screening for reducing the morbidity and mortality of BPDs in primary care settings; underscores the need for integration of mental health care into primary care as well as the need for more APRN education on the diagnosis and management of bipolar disorders.