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IntroductionIn December 2019, infection with the novel coronavirus (SARS-CoV-2) was first reported in the city of Wuhan, China. Although generally recognized for its often fatal respiratory problems, other neuropsychiatric complications are receiving increasing attention.ObjectivesWe will try through a clinical case to explain the psychiatric disorders in the context of this infection, and to highlight the two main explanatory theories of psychiatric disorders, in relation with the SARS-Cov-2 infection.MethodsWe report here a case of SARS-CoV-2 infection in a 54-year-old female patient with no specific pathological history, including psychiatric, who presented a fever, anosmia, and asthenia in the absence of any respiratory signs. Her PCR came back positive and her chest CT scan was normal.The patient was treated with paracetamol with vitamin C,with good clinical improvement. She came 15 days later to the psychiatric emergency room with psychomotor excitement. The patient was motorically unstable, could not hold still, her mimicry was hypermobile, contact with her was familiar, she was logorrheic with flight of ideas,she verbalized multiple projects, her mood was euphoric and her sleep was disturbed. Her blood tests were unremarkable.ResultsThe diagnosis of manic episode was retained, and the patient was put on Olanzapine 10 mg, sodium Valproate 1g and Lorazepam 2.5 mg in degression with good clinical improvement.ConclusionsAlthough the data in the literature remain scarce concerning the impact of this virus on mental health, we will try through this clinical case to explain the psychiatric disorders in the context of this viral epidemic, due to stress and inflammation.DisclosureNo significant relationships.

IntroductionLurasidone is an atypical antipsychotic used in the treatment of schizophrenia and bipolar depression. Both indications are approved by the FDA nowadays, whereas in Europe it is only approved for schizophrenia. Lurasidone has been barely studied for the treatment of acute mania, nonetheless it is sometimes used off-label.ObjectivesA case of a patient with a manic episode treated with lurasidone is presented, in order to provide further evidence on this topic.MethodsThe patient is a 43 year-old-woman with diagnosis of type I bipolar disorder, personality disorder and borderline intellectual functioning, resident in our Hospital’s long-stay psychiatric rehabilitation unit. She was previously under treatment with venlafaxine 75 mg/day, valproate 1500 mg/day and levomepromazine 25 mg on demand; remaining stable for months. The patient presented an episode consisting on agitation, irritability, verbiage, tachyphase, verbal aggressiveness and behavioral disturbances. Psysical restraint was needed for one day long and zuclopenthixol acetate 50 mg IM was administered twice within 5 days for the acute agitation. Venlafaxine was immediately withdrawn and lurasidone was progressively introduced up to 111 mg daily.ResultsApproximately 3 weeks after the treatment adjustment, the patient reached the psychopatological stabilty.ConclusionsAntidepressive withdrawal and introduction of Lurasidone were effective to treat the acute manic episode in this patient. It has been previosuly suggested that lurasidone caused improvement in emergent manic symptoms in patients with bipolar depression, and in subsyndromal hypomanic symptoms in patients with mixed features of depression. However, no studies have been made yet to evaluate the efficacy of lurasidone in acute mania.DisclosureI received financing from Angelini Pharma, Casen Recordati, Janssen, Exeltis and Otsuka.

IntroductionAssessment and management of bipolar disorder, and particularly manic episodes in adolescents means a challenge. The presence of comorbid disorders, and divergent interpretations of manic symptoms in the context of the adolescent natural inmaturity, can make diagnosis and treatment hard goals to achieve. The existence of juvenile specific criteria for bipolar disorder is a debate topic. This concept emerged from an attempt to solve diagnosis issues and involves a wide range of definitions for mania.ObjectivesLiterature review concerning bipolar disorder in young population: Main comorbidities, psychosocial problems, prognosis. Clinical presentation: Shared and specific features compared to adult population. Available treatment options. Issues related to safety and tolerability.MethodsWe present a case of a 16 year old woman diagnosed with bipolar II disorder, hospitalised in an inpatient adolescent unit in 2021. Review of the literature available (clinical guidelines, PubMed).ResultsPatient initially oriented as a Bipolar II disorder, after depressive episodes followed by hypomanic symptoms in the past years. The following clinical course was conditioned by personality traits. Emotional disregulation and a complex family environment made affective symptoms difficult to evaluate, leading to a diagnostic hypothesis of personality-related disorder. After a period of outpatient treatment in a day hospital, she debuted with a clinical picture of manic symptoms, mixed features and rapid mood cycling.ConclusionsAfter an initial trial, stabilization was achieved with aripiprazole and asenapine. Combination therapy might be necessary in longer-term treatment, according to existing evidence. Diagnosis and treatment concerns are interfered by the limited number of trials.DisclosureNo significant relationships.

From its first depictions in ancient medical literature to contemporary depictions in brain imaging, mania has been largely associated with its Greek roots, \"to rage.\" Prior to the nineteenth century, \"mania\" was used interchangeably with \"madness.\" Although its meanings shifted over time, the word remained layered with the type of madness first-century writers described: rage, fury, frenzy. Even now, the mental illness we know as bipolar disorder describes conditions of extreme irritability, inflated grandiosity, and excessive impulsivity.Spanning several centuries,Manic Mindstraces the multiple ways in which the word \"mania\" has been used by popular, medical, and academic writers. It reveals why the rhetorical history of the word is key to appreciating descriptions and meanings of the \"manic\" episode.\" Lisa M. Hermsen examines the way medical professionals analyzed the manic condition during the nineteenth and twentieth centuries and offers the first in-depth analysis of contemporary manic autobiographies: bipolar figures who have written from within the illness itself.

Abnormal brain networks with emotional response in bipolar disorder (BD). However, there have been few studies on the local consistency between manic episodes in drug-naive first-episode BD patients and healthy controls (HCs). The purpose of this study is to evaluate the utility of neural activity values analyzed by Regional Homogeneity (ReHo). Thirty-seven manic episodes in first-episode, drug-naive BD patients and 37 HCs participated in resting-state functional magnetic resonance rescanning and scale estimation. Reho and receiver operating characteristic (ROC) curve methods were used to analyze the imaging data. Support vector machine (SVM) method was used to analyze ReHo in different brain regions. Compared to HCs, ReHo increased in the left middle temporal gyrus (MTG.L), posterior cingulate gyrus (PCG), inferior parietal gyrus, and bilateral angular gyrus, and decreased in the left dorsolateral superior frontal gyrus in target group. The ROC results showed that the ReHo value of the left PCG could discriminate the target group from the HCs, and the AUC was 0.8766. In addition, the results of the support vector machine show that the increase in ReHo value in the left PCG can effectively discriminate the patients from the controls, with accuracy, sensitivity, and specificity of 86.02%, 86.49%, and 81.08%, respectively. The increased activity of the left PCG may contribute new evidence of participation in the pathophysiology of manic episodes in first-episode, drug-naive BD patients. The Reho value of the left posterior cingulate gyrus may be a potential neuroimaging biomarker to discriminate target group from HCs.

Smartphones allow for real-time monitoring of patients' behavioral activities in a naturalistic setting. These data are suggested as markers for the mental state of patients with bipolar disorder (BD). We assessed the relations between data collected from smartphones and the clinically rated depressive and manic symptoms together with the corresponding affective states in patients with BD. BDmon, a dedicated mobile app, was developed and installed on patients' smartphones to automatically collect the statistics about their phone calls and text messages as well as their self-assessments of sleep and mood. The final sample for the numerical analyses consisted of 51 eligible patients who participated in at least two psychiatric assessments and used the BDmon app (mean participation time, 208 [SD 132] days). In total, 196 psychiatric assessments were performed using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Generalized linear mixed-effects models were applied to quantify the strength of the relation between the daily statistics on the behavioral data collected automatically from smartphones and the affective symptoms and mood states in patients with BD. Objective behavioral data collected from smartphones were found to be related with the BD states as follows: (1) depressed patients tended to make phone calls less frequently than euthymic patients (β=-.064, P=.01); (2) the number of incoming answered calls during depression was lower than that during euthymia (β=-.15, P=.01) and, concurrently, missed incoming calls were more frequent and increased as depressive symptoms intensified (β=4.431, P<.001; β=4.861, P<.001, respectively); (3) the fraction of outgoing calls was higher in manic states (β=2.73, P=.03); (4) the fraction of missed calls was higher in manic/mixed states as compared to that in the euthymic state (β=3.53, P=.01) and positively correlated to the severity of symptoms (β=2.991, P=.02); (5) the variability of the duration of the outgoing calls was higher in manic/mixed states (β=.0012, P=.045) and positively correlated to the severity of symptoms (β=.0017, P=.02); and (6) the number and length of the sent text messages was higher in manic/mixed states as compared to that in the euthymic state (β=.031, P=.01; β=.015, P=.01; respectively) and positively correlated to the severity of manic symptoms (β=.116, P<.001; β=.022, P<.001; respectively). We also observed that self-assessment of mood was lower in depressive (β=-1.452, P<.001) and higher in manic states (β=.509, P<.001). Smartphone-based behavioral parameters are valid markers for assessing the severity of affective symptoms and discriminating between mood states in patients with BD. This technology opens a way toward early detection of worsening of the mental state and thereby increases the patient's chance of improving in the course of the illness.

Background Levetiracetam and brivaracetam (BRV) are antiseizure medications that exert effects by binding to synaptic vesicle protein 2A (SV2A). BRV exhibits higher affinity and selectivity for SV2A and is generally considered to have a favorable psychiatric tolerability profile. However, reports on serious psychiatric adverse events remain scarce. Case Presentation We herein report a 60‐year‐old man with a history of bipolar disorder who had remained psychiatrically stable for many years under aripiprazole treatment. He was diagnosed with focal epilepsy based on stereotyped focal seizures with impaired awareness and right temporal epileptiform discharges observed on electroencephalography. BRV was initiated at a dose of 50 mg/day and later increased to 100 mg/day. Several weeks after initiation, he developed elevated mood, marked irritability, emotional dysregulation, and delusion‐like ideation, progressing to a manic episode with psychotic features requiring inpatient psychiatric care. BRV was discontinued and replaced with lacosamide, coupled with intensification of a mood‐stabilizing treatment, which resulted in the gradual resolution of manic symptoms. No epileptic seizures occurred during BRV treatment or after the medication switch. Conclusion This case suggests that, despite its generally favorable psychiatric tolerability, BRV may be associated with the emergence of symptoms in patients with bipolar disorder. These findings highlight the importance of careful psychiatric risk assessment and close monitoring when initiating BRV in individuals with underlying mood vulnerability. A patient with Bipolar I disorder developed manic symptoms following the initiation of brivaracetam for focal epilepsy. Although brivaracetam is generally considered to have favorable psychiatric tolerability, this case highlights a potential risk of mood destabilization in patients with underlying bipolar disorder.

Objective To systematically evaluate the efficacy and safety of different combination therapies in the treatment of mania in bipolar disorder, and to provide evidence‐based support for individualized clinical treatment. Methods PubMed, Web of Science, Cochrane Library, CNKI, VIP, and Wanfang databases were systematically searched from inception to July 2025. Randomized controlled trials comparing ziprasidone or olanzapine combined with mood stabilizers (lithium carbonate or sodium valproate) for the treatment of manic episodes in bipolar disorder were included. Two reviewers independently performed literature screening, data extraction, and quality assessment. Meta‐analysis was conducted using RevMan 5.4 software. Results A total of 10 RCTs involving 842 patients were included. Meta‐analysis showed no significant difference between the two groups in overall clinical efficacy (OR = 1.18, 95% CI: 0.80–1.75, p = 0.41). Ziprasidone was superior to olanzapine in reducing YMRS scores (MD = −1.47, 95% CI: −1.97–0.96, p < 0.00001). The incidence of adverse reactions was significantly lower in the ziprasidone group compared to the olanzapine group (OR = 0.16, 95% CI: 0.08–0.31, p < 0.00001). Furthermore, ziprasidone was associated with significantly greater increases in BDNF and T3 levels after treatment. Conclusion Although the efficacy of ziprasidone plus mood stabilizers is comparable to that of olanzapine plus mood stabilizers in the treatment of manic episodes of bipolar disorder, ziprasidone offers advantages in improving manic symptoms (YMRS scores), reducing adverse events, and enhancing neuroendocrine indicators. It may serve as a favorable alternative in clinical practice. Further high‐quality, multicenter, large‐sample studies are needed to confirm its efficacy and safety.

Background Mania and depression are the predominant mood episodes in bipolar disorder (BD), and their frequency significantly affects the long-term prognosis of patients. Method This is a multicenter, longitudinal cohort study in China. Sociodemographic and clinical characteristics of patients were statistically analyzed. Poisson regression analyses were performed to identify factors associated with the frequency of manic and depressive episodes. Results A total of 520 BD patients were enrolled in this study. Poisson regression model analysis showed that shorter years of education (OR = 1.03, P  = 0.03), mixed polarity of the first episode compared to mania (OR = 2.33, P  < 0.01) or depression (OR = 1.79, P  = 0.01), earlier age at diagnosis (OR = 1.03, P  = 0.01), comorbid substance use disorder (OR = 1.41, P  = 0.02), presence of psychotic symptoms (OR = 1.18, P  = 0.04), use of antidepressant medication (OR = 1.52, P  = 0.01), and non-use of mood stabilizers (OR = 1.57, P <0.01) are positively associated with the frequency of manic episodes. Being male (OR = 1.22, P  = 0.01), the use of mood stabilizers (OR = 1.47, P <0.01) and a diagnosis of bipolar II disorder (BD-II) compared to bipolar I disorder (BD-I) (OR = 1.27, P  = 0.01) are positively associated with the frequency of depressive episodes. Conclusion The study highlights the critical association of clinical and sociodemographic factors with the frequency of manic and depressive episodes in BD patients. Addressing these factors may improve long-term outcomes for individuals with bipolar disorder.