Mario Amore

Introduction: Bipolar Disorders (BD) are severe, recurrent, and well-characterized psychiatric conditions with lithium as the first-line approved treatment for BD. This study aims to evaluate lithium response using the ALDA scale and to identify reliable predictors in a cohort of patients with BD. Methods: In this cross-sectional observational study, one hundred and fourteen consecutively recruited patients with a primary diagnosis of BD type I or II were included between June 2022 and June 2025. Sociodemographic and clinical characteristics were collected through a semi-structured interview. Lithium response was retrospectively assessed using the ALDA scale. Psychometric instruments (CTQ, MEQ, MWQ, DDFS, RRS, BIS-11) were administered. Logistic regression analyses were performed to identify independent predictors of lithium response. Results: Forty-one (36%) individuals were classified as lithium responders according to the ALDA Scale. Lithium responders were younger, engaged in physical activity more frequently, were more frequently diagnosed with BD type II, had a shorter illness duration, a Manic–Depressive–Interval (MDI) course, and showed fewer residual symptoms. Non-responders were associated with rapid cycling, psychotic symptoms, more hospitalizations, and illicit substance use. Childhood trauma, impulsivity, and rumination were more common among non-responders, while morning chronotype was more prevalent among responders. In the regression analysis, the MDI pattern, higher total scores for attentional impulsivity and rumination, and morning chronotype were all significantly associated with lithium responsiveness. On the other hand, the presence of psychotic symptoms, a history of ≥ 5 hospitalizations, comorbid substance use, and higher scores of emotional abuse were associated with a lower likelihood of response to lithium. Discussion: Integrating the evaluation of trauma history, impulsive profiles, ruminative tendencies, and circadian features into clinical assessment may enhance the prediction of lithium response. conclusion: Our findings support the development of personalized treatment strategies for BD. Conclusion: Our findings support the development of personalized treatment strategies for BD.

The development of cognitive impairment (CI) is a frequent and debilitating consequence of COVID-19 and can persist for more than 1 year after the acute infection stage. Previous neuroimaging studies in COVID-19 survivors with CI have revealed widespread alterations in functional connectivity (FC), particularly within fronto-parietal circuits and subcortical nuclei such as the hippocampus, basal ganglia, and thalamus. This study focuses on neural correlates of CI in subjects who recovered from COVID-19 and the relationship between FC patterns and discrete cognitive domains. Resting-state functional MRI data from 136 subjects were analyzed using a ROI-to-ROI approach across 246 brain regions derived from the Human Brainnetome Atlas. Group comparisons were performed based on the presence or absence of CI, and correlation analyses were conducted between FC and scores obtained from a comprehensive neuropsychological test battery. Whole-brain FC showed no difference between patients with and without CI. In the whole study sample, hypoconnectivity between two basal ganglia regions and two frontal motor regions was associated with impaired performance in the cognitive domain “Reasoning and Problem-Solving,” while hyperconnectivity between the prefrontal thalamus and the postcentral gyrus was associated with impaired performance in the same cognitive domain. Our findings indicate that FC alterations within the cortico-striatal and thalamo-cortical circuits may subtend deficits in higher-order executive functions in post-COVID-19 patients and highlight the importance of examining discrete cognitive domains in relation to brain connectivity.

Objective: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides precise diagnostic criteria to differentiate between bipolar disorder (BD) type I and II; nevertheless, it can be challenging to come up with the right diagnosis. The aim of this study is to evaluate the sociodemographic differences, clinical features, comorbidities, and pharmacological pattern between patients with BD type I and II. Methods: A total of 680 patients with BD type I and II were consecutively recruited to our psychiatry department. A semi-structured interview was used to collect several information. Results: Patients with BD type I were mostly males, single, with a lower current age, and unemployed compared to patients with BD type II. Furthermore, patients with BD type I showed an earlier age at onset and a significant higher prevalence of psychotic and residual symptoms, a higher number of hospitalizations, and involuntary admissions. On the other hand, patients with BD type II were associated with a significant higher prevalence of lifetime suicide attempts, psychiatric comorbidities, and use of alcohol. Finally, antidepressant drugs were prescribed more often to patients with BD type II, while antipsychotics and mood stabilizers were mostly prescribed in patients with BD type I. Conclusion: the differentiation of the 2 nosologic bipolar diagnosis is in line with the current scientific interest, confirming the existence of a markedly different profile between BD type I and II. This differentiation could reduce the heterogeneity of bipolar presentation in research, optimize clinical assessment, and increase the interest in developing more precise and individualized therapeutic strategies, also implementing psychosocial therapies.

Emotion regulation,personality disorders,suicidality

Andrea Amerio, Eleonora Vai, Edoardo Bruno, Alessandra Costanza, Andrea Escelsior, Anna Odone, Domenico De Berardis, Andrea Aguglia, Gianluca Serafini, Mario Amore, Seyyed Nassir Ghaemi. Clin Psychopharmacol Neurosci 2023;21:2-9. https://doi.org/10.9758/cpn.2023.21.1.2

Bipolar depression is a leading cause of morbidity in patients with bipolar disorder (BD) with at least half of bipolar patients who initially present with a depressive episode. While several pharmacologic agents have been approved in Europe and are currently available for treating bipolar mania as monotherapy or adjunctive with currently available medications, there are limited evidence-based treatment options that may be successfully prescribed to treat bipolar depression. Novel encouraging data are now emerging concerning the use of partial dopamine agonists having different binding affinities for D2 and D3 dopamine receptors in the treatment of bipolar depression. Evidence demonstrated the initial use of these agents to treat depressed bipolar patients but findings are still quite controversial. The present Editorial provides a critical perspective about the current use of most recent partial dopamine agonists having different binding affinities for D2 and D3 dopamine receptors in the treatment of bipolar depression. Overall, novel encouraging data are now emerging regarding the use of partial dopamine agonists but future clinical studies in human subjects are warranted to extend our knowledge about the real-world effectiveness of these novel compunds in patients with bipolar depression.

Background: The Diagnostic and Statistical Manual for Mental Disorders (5th edition) introduced the specifier “with Mixed Features” to the diagnosis of Major Depressive Episode to designate the presence of (hypo) manic symptoms as part of the clinical presentation. This change has led to renewed attention on the operational definition, diagnosis, and treatment of Mixed Depression. Objective: To investigate the diagnostic and therapeutic approaches towards Mixed Depression among a representative sample of Italian psychiatrists. Methods: Between March and April 2021, 342 psychiatrists working in Italian adult mental health services were invited to participate in an anonymous online survey comprising 32 questions designed to investigate clinical and psychopathological approaches regarding the management of mixed depression in daily psychiatric practice. Results: 83.74% of participants reported having performed a diagnosis of mixed depression in the last five years, with the majority of respondents affirming that they had not used any diagnostic tool. Only 7,5% of the surveyed psychiatrists considered the DSM-5 criteria to be fully adequate in the description of this clinical entity. The most used pharmacological approach was combined therapy, in particular antipsychotics plus mood stabilizers. For monotherapy, the preferred drugs were Valproate and Quetiapine. Regarding the conceptualization of mood disorders, 199 of the participants chose the Kraepelinian unitary spectrum view; meanwhile, 101 expressed their preference for the binary model. Conclusion: Our results suggest a prominent position of mixed depression in the context of mood disorders. Univocal operational criteria and additional research on pharmacological treatment are also needed to ensure the correct recognition and management of mixed depression.

Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time.Methods: The STAR Network “Depot Study” was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS < 41 or BPRS ≥ 41).Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions—conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently—showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline.Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders.

Lurasidone is a novel azapirone derivative and atypical antipsychotic agent with a high binding affinity for dopaminergic (D₂), serotoninergic (5-HT_2A), and 5-HT₇ receptors (antagonist), a moderate affinity for 5- HT_1A receptors (partial agonist), and no appreciable affinity for histaminergic (H₁) and muscarinic (M₁) receptors. It was recently included by the European Medication Agency among the in-label pharmacological treatments for children and adolescents affected by early onset schizophrenia. As a dopamine and serotonin antagonist, lurasidone acted on a variety of receptors and showed its efficacy both as an antipsychotic and an activating compound. Administered with food or within 30 minutes from a meal, it presents sufficient bioavailability and does not interact with most of the other drugs during metabolism. With little effects on hormones and weight gain, potential procognitive profile due to its 5-HT₇ antagonism, and reduced extrapyramidal side effects, lurasidone could be a good choice in terms of both effectiveness and tolerability, particularly for patients headed towards a long-term treatment. This article aims to summarize the available scientific evidence from the literature on the use of lurasidone in children and adolescents and to provide recommendations for clinical management and future research.

People with schizophrenia (SCZ) present serious and generalised deficits in social cognition (SC), which affect negatively patients’ functioning and treatment outcomes. The genetic background of SC...