The covid-19 pandemic is a difficult global phenomenon that causes a lot of anxiety and uncertainty. This situation has involved reactions of fear. Healthcare professionals are necessarily in contact with patients, but may find themselves torn between the duty to care and the duty to protect themselves and their relatives.

To assess perceived stress among medical residents in Tunisia

We conducted a descriptive study among a representative sample of residents working at a teaching hospital in Tunis during the first half of 2021 in different departments. We prepared a questionnaire for the study divided in two parts: socio-demographic data; professional data (function, practice setting); data related to contact with covid-19 patients ; questions on fear of covid-19 contamination and the Perceived stress scale (10items)

Our sample consists of 100 residents in 10 different specialties, including 70 in services with direct contact with Covid-19 patients. Stress management is rated good for 30 residents, average for 40 residents and poor for 30 residents. This management depends on the number of guards, the number of patients examined, the technical platform available and especially the period of the pandemic.

Medical residents are in the front line in university hospitals in tunisia. The stress to which they are subjected depends on the working conditions and coping skills of each of them.

No significant relationships.

Pediatric epilepsy is a debilitating disease that impacts not only children with epilpsy but also persons arround them. It is often considered as a source of anxiety for family caregivers.

Assess the level of anxiety in caregivers of children with epilepsy and to identify factors related to it.

We conducted a cross-sectional, descriptive and analytical study between July and October 2020. It included caregivers of children with epilepsy hospitalized in the pediatric neurology department of Sfax. We used the STAI-Y scale to assess the level of state anxiety (STAI-AE).

Forty four womens participated in our study. Low socio-economic level was found in 31.8% of cases. The average age of children was 4.9 years. The mean duration of epilepsy was 2.2 years. It was comorbid with an autism spectrum disorder or an intellectual disability in 15.9% of cases. In 70.5% of the cases, the children were dependent on their caregivers in their daily lives. The level of anxiety was moderate in 27.3% and high to very high in 13.6% of them. A higher state-anxiety score was correlated with a longer duration of epilepsy (p=0.033), a lower familial socioeconomic level (p=0.013) and a higher number of children in family (p=0.048).

Pediatric epilepsy is associated with significant level of anxiety in family caregivers. This anxiety increases with the duration of the disease and with the presence of socioeconomic and family difficulties. Thus, psychosocial support for caregivers should be integrated into a global approach of the disease.

No significant relationships.

Chronic functional gastro-intestinal disorders can affect cognitive functioning of patients (1). Wong et al (2) showed attentional and executive function impairment, Aizawa et al. (3) found impairment of cognitive plasticity and activity of frontal and temporal arias of brain during performing tests in these patients.

Assessing of cognitive functioning of the female patients with chronic functional constipation.

42 Rome IV adult female patients with chronic functional constipation and 26 adult normative female volunteers were tested with Brief Assessment of Cognition in Schizophrenia (BACS).

Both groups were comparable by age (patients’ group 29,5±6,1, volunteers’ group 28,5±9,6, ns) In both groups subjects demonstrated normal level of cognitive functioning but the scores of the patients were closer to the lower level than the scores of the volunteers. The difference was significant in composite scores and in several other scores (Tab.1). Table1.

The findings of the study once more indicate some link between gastrointestinal dysfunction and cognitive functioning. Even these slight decrease in some aspects of cognition from normal population could have negative impact on everyday functioning. The origin of this link is still under question.

No significant relationships.

Anxiety disorders (ADs) are pervasive, detrimental, and associated with numerous psychiatric disorders; however, their etiology and effective treatment strategies are not yet fully explored.

We aimed to study whether the symptom severity of ADs is related to mindfulness and metacognition among adults. In addition, we wanted to compare metacognition and mindfulness between patients with ADs and healthy controls (HC).

Two hundred participants were enrolled in this study. Structured clinical interview, sociodemographic form, Five Facet Mindfulness Questionnaire-Short Form (FFMQ-S), Metacognition Questionnaire-30 (MCQ-30), and Hamilton Anxiety Rating Scale (HAM-A) were administered. Multivariate analysis of covariance (MANCOVA) was conducted to compare the groups in terms of mindfulness and metacognition. Correlation and multiple linear regression analyses were performed to measure the association between anxiety symptom severity, mindfulness, and metacognition.

The main finding indicates that Positive Beliefs about Worry are associated with reduced symptom severity of ADs. Furthermore, the results suggest that HC have more Positive Beliefs about Worry and Nonjudging of Inner Experience compared to patients with ADs, who use Negative Beliefs about Uncontrollability and Danger and Need to Control Thoughts to a greater extent.

This study suggests that dysfunctional metacognitive beliefs may influence symptom severity of ADs among adults. We advise that focusing on reducing maladaptive metacognitions may be beneficial while treating ADs in adults

No significant relationships.

Mass hysteria also called mass psychogenic illness (MPI), defined as a social phenomenon, consists of collective anxiety due to a perceived threat and can culminate in a cascade of symptoms suggestive of organic disease without an identifiable cause. Its history dates back to the 14th century and impacts people from all cultures and regions of the world. Before the 20thcentury, MPI emerged across Europe, often in socially isolated convents, in highly stressful environments.

The aim of this study is to explore the available literature on mass hysteria phenomena in Portugal, historical origins, applications and eventual position in modern psychiatric semiology.

Non-systematic review of literature published in Medline/Pubmed. Search terms included: mass hysteria, nocebo, groupthink, emotional contagion.

In Portugal two great phenomena of mass hysteria were described. In 1917, the “sun miracle” occurred, where thousands of individuals reported having seen the sun rotating in the sky and changing its size and colours. Years later, more than 300 students from 14 schools described the same symptoms: dizziness, dyspnea and rash, without an identifiable cause. In common these young people had “sugar strawberries”. In May 2006, the young people in the television series were infected with a vírus, and clinical picture was similar to that presented by young people in real life. For the first time, a fictional illness on television triggered an illness in real life.

More studies should be carried out on these phenomena as their early recognition can have a tremendous impact on the ease of identification, diagnosis and treatment.

No significant relationships.

Conversion disorder (a term that describes what was previously called hysteria) refers to motor or sensory symptoms, or both, that resemble a neurological disease, but that do not originate from or cannot be explained by a known physical disease.

To find reliable tools that can guide the difficult diagnosis of conversion disorder.

Bibliographic review

The exact prevalence of the disorder is unknown. It is estimated that approximately 5% of referrals to neurology are for this disorder. Approximately one third of patients referred to the neurologist have symptoms that cannot be explained by an organic disease. Involuntary movements are the most common motor manifestations of the conversive syndrome, being tremor one of the most frequent manifestations. The first differential diagnosis of conversion disorder is neurological disease. It is currently not necessary for the diagnosis to assess whether or not the symptoms are produced intentionally, as the assessment of conscious intentionality is unreliable. The neurological examination is the fundamental tool for the diagnostic approach, being even more enlightening than the complementary tests. Hoover’s sign, Babinski’s combined leg flexion, plantar flexion of the ankle, tremor and its distraction and synchronisation manoeuvres, as well as the clinical differences between epileptic seizures and non-epileptic seizures of psychogenic origin, are some of the reliable tools for a correct diagnosis.

The diagnosis of the disease should be one of exclusion. There must be clinical data showing clear evidence of incompatibility with a neurological disease and conversion symptoms do not correspond to known physiological mechanisms and anatomical pathways.

No significant relationships.

Psychogenic nonepileptic seizures (PNES) consist of paroxysmal changes in responsiveness, movements, or behaviour that superficially resemble epileptic seizures.

Presentation of a clinical case of a PNES in a patient with a diagnose of secondary epilepsy, illustrating the relevance of an adequate evaluation, differential diagnosis, and intervention.

Description of the clinical case, with brief literature review and discussion. A search was conducted on PubMed and other databases, using the MeSH terms “nonepileptic seizure”, and “epileptic seizure”.

We report the case of a 45-year-old female patient, brought to the emergency department because of tonic axial and limb nonsynchronous movements, closed eyes, long duration, with immediate awareness, no desaturation, tongue bite, facial flushing, dyspnoea or sphincter incontinency. She was medicated with clonazepam 1 mg and levetiracetam 1000 mg ev. TC-CE had no acute alteration. Bloodwork had no other major alteration except valproic acid below therapeutic levels (her usual medication, along with other antiepileptic drugs, antidepressant and antipsychotic). The antecedents of the patient: mild intellectual disability and an accidental traumatic brain injury in infancy, with secondary epilepsy. She was transferred to Psychiatry department. No electroencephalogram (EEG) was realized, because she had a recent one confirming PNES, and many other emergency observations with the diagnosis of PNES.

This clinical case showcases the diagnostic difficulties that clinicians face when there is an overlap in symptoms, emphasizing the need to combine patient history, witness reports, clinician observations, and ictal and interictal EEG to help distinguish these different clinical identities.

No significant relationships.

Functional neurological disorders (FNDs), also known as “conversion disorder”, consist in the appearance of neurological symptoms that do not correspond to any medical condition and produces an impairment in social, occupational and other areas in the patient’s life. This disorder can represent up to 30% of neurologist’s consultation. We introduce the case of a 23-year-old man who attended the emergency services due to fainting and was finally diagnosed with FND.

To summarize the difficulties of making a diagnosis of FND and the importance of a multidisciplinary approach.

A narrative review through the presentation of a case.

The patient presented many absence seizures during his stay in the hospital. These episodes were characterized by non-reactivity, dysarthria, tremors, tachycardia and hyperventilation. The neurological examination and imaging tests didn’t show any pathological findings. During the psychiatric interview he revealed he had lived a severe conflict with his brothers the previous week and he was being excluded within his family. Furthermore he didn’t have any social support besides his mother in the city he was living, leading this situation to an incrementation of anxiety. Due to the absence of any abnormalities in the examination and recent psychological conflict that was affecting him, FND diagnose was made.

Very frequently the absence of a clear psychological trigger and the presence of neurological alterations can hinder the study of the patient. This makes necessary a multidisciplinary approach and the knowledge of signs that can help to carry out an accurate diagnosis.

No significant relationships.

Psychogenic nonepileptic seizures (PNES), the most common conversion disorder, are episodic alterations in behaviour that resemble epileptic seizures without its characteristic EEG changes. PNES presumably reflect a physical manifestation of underlying psychological distress and can be as disabling as epilepsy. Standardized treatment approaches for PNES care are lacking.

Our aim is to review the literature for therapeutic interventions in PNES.

A literature search was conducted in PubMed/MEDLINE database for randomized controlled trials (RCTs) examining the effect(s) of specific intervention(s) in patients with PNES. Search terms were “psychogenic-nonepileptic-seizures” and selection was based on the abstracts of all the studies retrieved. Priority outcome was frequency of PNES.

We identified 8 eligible RCTs. Samples ranged from 19 to 82 patients. Follow-up periods varied from 6 weeks to 18 months. Regarding reduction of PNES frequency, several interventions were effective: motivational interviewing combined with psychotherapy; cognitive behavioural therapy informed psychotherapy (CBT-ip); combination of CBT-ip and sertraline; immediate withdrawal of antiepileptic drugs after PNES diagnosis; a standardized diagnostic approach associated with psychiatric inpatient consultation. Treatment with sertraline alone and brief educational interventions didn’t reduce PNES frequency significantly. Beside PNES rate reduction, most interventions conveyed some type of benefit such as improvement in quality of life, mood or functionality.

The majority of the beneficial interventions included a structured communicational approach and/or psychotherapeutic treatment. Our analysis highlights the importance of a multidisciplinary strategy that includes psychotherapy. Further studies with larger samples and longer follow-up periods are needed to robustly inform evidence-based treatment for PNES.

No significant relationships.

Therapies focused on exposure like prolonged exposure (PE) or Eye Movement Desensitization and Reprocessing (EMDR) dominate the treatment of posttraumatic stress disorder (PTSD). There are many patients with PTSD who are not fully responding with exposure-therapies. or don’t want exposure therapies at all. Many patients don’t like to be confronted with elements of their traumatic experience. IPT has proven to be highly efficient in e.g. depression and bulimia and is promising as a treatment for PTSD while NOT using exposure. IPT aims to repair the damage trauma does to interpersonal trust and social functioning.

Learn more about IPT. Learn more about the way IPT is used in the treatment for patients with PTSD (adaptations).

Literature review focused on IPT for PTSD.

Among the consequences of PTSD are affective numbing, interpersonal hypervigilance, and social withdrawal (1). Numbness, an avoidance particularly of negative affect, makes it hard to read one’s interpersonal environment. Thus in adapting IPT for PTSD, we devote the early part of treatment to affective reattunement: helping patients to identify their emotions and to recognize them as helpful social signals. Once patients can read their feelings, they can put them to use to handle relationships better, deciding whom they can trust and whom they can’t. IPT for PTSD tends to focus on role transitions, which are usually inherent having been traumatized (2).

In the past there has been several kinds of research that show that group IPT and individual IPT reduce PTSD and depression in traumatized patients with PTSD.

No significant relationships.

The Covid-19 pandemic has brought with it far-reaching consequences that affect the mental health of a significant population. Those suffering from somatic symptom disorder (SSD) present a significant focus on physical symptoms, with excessive thoughts and behaviours, to an extent that results in major distress and dysfunction. Aggravation of SSD could be associated with various stressors, including the current pandemic, and culminate in an increased severity of the base presentation.

The authors present the case of an elderly man with previous diagnosis of SSD which began to aggravate and evolve into a depressive psychotic state, precipitated by the beginning of the Covid-19 pandemic.

The authors conducted a non-systematized literature review with focus on those articles most pertinent to the topic in question as well as presenting a clinical case as compliment.

With the pandemic overwhelming the globe, the literature has demonstrated a significant correlation with aggravation of mental health and psychiatric cases. The patient in question was previously followed in consultation for SSD. With the pandemic acting as precipitating stressor, the patient demonstrated a significant aggravation in his base presentation with the development of psychotic depression. He was subsequently hospitalized with implementation of psychotherapeutic and psychopharmacological methods, with remission of the psychotic state, with poor response of the SSD.

External stressors are an important influence on psychiatric disorders. Whenever potential life stressors, especially those that exert influence on a global scale, the psychiatrist should be attentive to the possibility of significant aggravation of a stabilized clinical picture and offer support.

No significant relationships.

The term hypertension means super-stress - psychoemotional. It is generally accepted that this condition is more inherent in men.

Study psychological features of arterial hypertension patients depending on severity.

Examined 102 men, ages 31 to 62; the average age was 46.4 ± 0.32 years. Of these, with stage I AG 46 patients (1 group), with stage I AG 45 (2 group), with stage III AG 11 (3 group). Psychological status of patients was examined using the MMPI test.

The averaged personality profile of patients showed that a profile exceeding 80 T points is typical for all comparison groups: 82,6%, 73,3%, 81,8%, in groups 1, 2 and 3, respectively. The first profile type in frequency was the profile with a leading peak on the first scale in combination with a moderate rise on the right scales: seventh-eighth: 63.7% of the total number of surveyed. This profile reflected mainly depressive tendencies. The second most frequent profile reflected alarming trends: an increase on the 2nd scale with the main peak at 7. Persons with depressive manifestations were characterized by a focus on compliance with the normative criteria of the social environment, with anxious manifestations, personal characteristics were manifested by hostility, irritability, chronic social maladaptation

Thus, the psychoemotional conditions identified are characterized by frustration, high levels of anxiety, interpersonal disorders, reduced performance, which may be considered mental health disorders

No significant relationships.

The study of the personal characteristics of patients with SD2 continues to be an urgent problem.

Study the features of the psychoemotional status of patients with type 2 diabetes mellitus

The study included 62 patients with T2DM (HbA1c 7,3±1,3%) and visceral obesity (Grade 2) were included mean age 56.1 ± 2.4; BMI: 34.8 ± 2.3.. Research methods: the Beck test, the Hamilton scale, the Spielberger-Hanin questionnaire

Clinical signs of anxiety-depressive disorders were detected in (47) 75.8% of patients. - 1 group, 15 patients - 2 comparison group (without affective disorders). Beck’s test: 23.5 + 0.5 against 10.6 ± 0.3 and Hamilton’s shock 22.4 ± 0.4 against 7.9 + 0.2 revealed a reliable difference between groups (p < 0,001). In both groups of patients on the Spielberger-Hanin scale, moderate reactive anxiety was identified: 44.9 ± 0.7 versus 36.7 ± 0.5 point, which is significantly higher (p < 0,001) in patients of the 1 group. The level of personal anxiety 56.0 ± 0.5 versus 37.5 ± 0.4 points, which also revealed a reliable difference between groups (p < 0,001).

The findings suggest a high incidence of anxiety-depressive disorders in patients of patients with T2DM and visceral obesity, which should be considered in pathogenetic therapy for these patients.

No significant relationships.

Conversion is the transformation of a conflict (unconscious) into a somatic symptom or a “non-verbal way of expressing psychological discomfort”, through somatizations. The disorder suggests a neurological or medical disease, associated psychological factors appear and is not produced intentionally.

To describe a case of conversion disorder.

Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology.

An 18-year-old boy came to the emergency room for paralysis. He has anesthesia of lower limbs. He shows indifference towards this symthoms.He denies any stressful situation. On examination, no psychotic or affective symptoms were observed. Belle indifference. Blood tests and a cranial CT scan were performed without alterations, so the patient was admitted for study. The electromyogram, lumbar puncture and cranial magnetic resonance show negative results. Suggestion is carried out, proving effective and recovering gait and sensitivity. These episodes are repeated up to 4 times until finally, during an interview with the family, episodes of bullying come to light. We work in therapy with a diagnosis of conversion disorder.

The most frequent symptoms in conversion disorder are mutism, paralysis, anesthesia, blindness and seizures. It is usually monosymptomatic for each patient. Diferencial diagnosis with neurological pathology should be made.

No significant relationships.

Cancer and its treatments have been shown to have a negative psychological effect on many cancer patients. One of these effects is often described as body image disturbance.

To assess body image in cancer patients and its association with clinical variables.

This was a cross-sectional study, conducted over 1 month, involving 100 cancer patients followed in the oncology department at the Habib Bourguiba University Hospital in Sfax (Tunisia). All participants completed a 10-item Body Image Scale (BIS) questionnaire to assess body image dissatisfaction.

These results showed that half of the patients were female, and 70% of them were married. Their mean age was 51.96 years with extremes ranging from 41 to 60 years. Their level of education did not exceed primary school in 61% of cases, and 68% of them were unemployed. A total of 58% of patients received chemotherapy and 44%, 25%, and 11% of persons were affected by breast, digestive and cavum cancer, respectively. Impaired body image was noted in 81% of cases with an average BIS score of 15.39. An altered body image was statistically correlated with female sex (p = 0.005), absence of professional activity (p = 0.032), and the presence of anxiety-depressive symptoms (p = 0.008).

In this study most of the cancer patients had body image disturbances. Therefore, it is to the health team and nurses that take the concept of body image more serious and make use of some interventions to minimize the possible side effects.

No significant relationships.

Psychosomatic illnesses correspond to physical symptoms (with or without objectivable organic lesions), that psychological factors such as stress and personality type, would have a potential effect on their appearance, evolution and / or worsening. These psychosomatic conditions are quite common but difficult to diagnose. Doctors from different specialties are consulted by the patients and multiple examinations and investigations are run by specialists in order to get to the final diagnosis. These psychosomatic conditions may appear under different types of illnesses : respiratory (asthma), dermatological (psoriasis, eczema), digestive (gastric ulcer, ulcerative colitis, Crohn’s disease), cardiovascular (arterial hypertension, infarction), neurological (migraine)…

Study management modalities of psychosomatic disorders through cases followed in consultation at the university psychiatric hospital Ar-razi of Salé in Morocco

through cases followed in consultation at the university psychiatric hospital Ar-razi of Salé in Morocco

From the results observed in the patients recruited in this study, we retain the need for a bio-psycho-social approach, through a global approach of the patient in all its dimensions, not only biological, but also psychological and social ; we also retain the essential role of the psychiatrist in the management of these psychosomatic disorders, both in preventive and curative terms, by allowing a better understanding of the interactions between physical and mental health.

psychosomatic conditions are quite common but difficult to diagnose and the need for a bio-psycho-social approach, through a global approach of the patient in all its dimensions, not only biological, but also psychological and social is crucial.

No significant relationships.

Pregabalin is a treatement with a complexe mechanism of action. It’s an antiepileptic drug used as adjunctive treatment of partial epilepsy, it is also taken in the treatment of neuropathic pain, and generalized anxiety disorder, in addition to epilepsy. Some of the advantages of pregabalin include. pharmacokinetics, safety, and tolerability. Clinical trials have demonstrated the efficacy of pregabalin comparable to benzodiazepines, without risk of abuse.

to assess the efficacy of pregabalin in patients with generalized anxiety disorder in the Ar-Razi university psychiatric hospital in Salé in Morocco

To assess the place of pregabalin in the treatement of anxiety disorders through patients hospitalized in the Ar-Razi university psychiatric hospital in Salé in Morocco The evaluation instruments are: For anxiety the Hamilton Anxiety Scale and For therapeutic efficacy CGI-therapeutic index

based on the results of our study on the patients who have improved after an optimal duration of treatment, in conjunction with psychological monitoring, we retain that pregabalin can significantly improve the quality of life of anxious patients and also guarantee them a better prognosis

Pregabalin was significantly more efficacious for the treatment of psychic and somatic symptoms of generalized anxiety disorder and was well tolerated by most study patients.

No significant relationships.

The extant findings have been of great heterogeneity due to partial volume effects in the investigation of cortical gray matter volume (GMV), high comorbidity with other psychiatric disorders, and concomitant therapy in the neuroimaging studies of social anxiety disorder (SAD).

To identity gray matter deficits in cortical and subcortical structures in non-comorbid never-treated patients, so as to explore the “pure” SAD-specific pathophysiology and neurobiology.

Thirty-two non-comorbid free-of-treatment patients with SAD and 32 demography-matched healthy controls were recruited to undergo high-resolution 3.0-Tesla T1-weighted MRI. Cortical thickness (CT) and subcortical GMV were estimated using FreeSurfer; then the whole-brain vertex-wise analysis was performed to compare group differences in CT. Besides, differences in subcortical GMV of priori selected regions-of-interest: amygdala, hippocampus, putamen, and pallidum were compared by an analysis of covariance with age, gender, and total subcortical GMV as covariates.

The SAD patients demonstrated significantly decreased CT near-symmetrically in the bilateral prefrontal cortex (Monte Carlo simulations of P < 0.05). Besides, smaller GMV in the left hippocampus and pallidum were also observed in the SAD cohort (two-sample t-test of P < 0.05).

For the first time, the current study investigated the structural alterations of CT and subcortical GMV in non-comorbid never-treated patients with SAD. Our findings provide preliminary evidences that structural deficits in cortical-striatal-limbic circuit may contribute to the psychopathological basis of SAD, and offer more detailed structural substrates for the involvement of such aberrant circuit in the imbalance between defective bottom-up response and top-down control to external stimuli in SAD.

No significant relationships.

Lurasidone 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.

A case of a patient with a manic episode treated with lurasidone is presented, in order to provide further evidence on this topic.

The 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.

Approximately 3 weeks after the treatment adjustment, the patient reached the psychopatological stabilty.

Antidepressive 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.

I received financing from Angelini Pharma, Casen Recordati, Janssen, Exeltis and Otsuka.

Bipolar disorder (BD) is a chronic deteriorating illness which has a strong impact on functionality. In the past few years, orexins have gained importance as possible biomarkers of circadian rhythms, affected in BD. Up to this date, we have not found any bibliographical review evaluating the association of orexins and BD.

To review published literature in relation to the associaton of orexins and BD.

A bibliographical search was conducted in PubMed. Inclusion criteria were a) the study evaluated orexins in plasma or cerebrospinal fluid, and b) patients with BD were included within the subjects of study.

Reference lists of the articles that met inclusion criteria were also examined.

Ten articles were retrieved from the initial search. Only three met inclusion criteria and another one was selected from the reference list examination. One study observed significantly higher levels of orexin A in plasma of BD patients versus depression and controls. Other found higher concentration of orexin A of unipolar and bipolar depression versus controls, but this result was not statistically significant. Another one did not find differences in orexin A concentration between mania, depression and controls. The remaining study detected significantly lower concentration of orexin A in BD versus depression, schizophrenia and controls.

Despite being heterogenous, the results point out there are differences in orexin levels in BD when compared to other diagnostic groups or controls. This sets a starting point to focus research on this subject and continue analyzing the role of orexins as biomarkers in BD.

No significant relationships.