Bipolar Disorder treatment includes not only the remission of Major Depressive or Manic/Hypomanic Episodes, but also the prevention of recurrences. Purpose of this trial is to evaluate the effectiveness of Mood Stabilizers and Atypical Antipsychotics in preventing recurrences.

67 patients with a diagnosis of Bipolar Disorder type 1 and 2 were followed retrospectively for a period of 48 months. Clinical and demographic information were collected by clinical charts and interviews with patients. A survival analysis was performed considering death events change of treatment, a Major Depressive or Hypomanic/Manic Episode or a hospitalization.

Patients treated with Lithium survived longer than patients treated with Valproate (Log Rank: χ2=3.86, p=0.05) which resulted to be superior in terms of recurrence prevention compared to Atypical Antipsychotics in monotherapy (Olanzapine, Quetiapine or Risperidone) (Log Rank: χ2=4.54, p=0.03). Lithium association with an Atypical Antipsychotic resulted more efficacious in terms of recurrence prevention compared to Lithium (Log Rank: χ2=7.01, p=0.008) or Atypical Antipsychotics in monotherapy (Log Rank: χ2=8.61, p=0.003).

These preliminary data would indicate that Lithium association with an Atypical Antipsychotic would be more effective in preventing Major Depressive or Hypomanic/Manic recurrences in bipolar patients.

Bipolar disorder (BD) may be characterized by the presence of psychotic symptoms and comorbid substance abuse. In this context, structural and metabolic dysfunctions have been reported in both BD with psychosis and addiction, separately. In this study, we aimed at identifying neural substrates differentiating psychotic BD, with or without substance abuse, versus substance-induced psychosis (SIP) by coupling, for the first time, magnetic resonance imaging (MRI) and positron emission tomography (PET).

Twenty-seven BD type I psychotic patients with (n = 10) or without (n = 17) substance abuse, 16 SIP patients and 54 healthy controls were enrolled in this study. 3T MRI and 18-FDG-PET scanning were acquired.

Gray matter (GM) volume and cerebral metabolism reductions in temporal cortices were observed in all patients compared to healthy controls. Moreover, a distinct pattern of fronto-limbic alterations were found in patients with substance abuse. Specifically, BD patients with substance abuse showed volume reductions in ventrolateral prefrontal cortex, anterior cingulate, insula and thalamus, whereas SIP patients in dorsolateral prefrontal cortex and posterior cingulate. Common alterations in cerebellum, parahippocampus and posterior cingulate were found in both BD with substance abuse and SIP. Finally, a unique pattern of GM volumes reduction, with concomitant increased of striatal metabolism, were observed in SIP patients.

These findings contribute to shed light on the identification of common and distinct neural markers associated with bipolar psychosis and substance abuse. Future longitudinal studies should explore the effect of single substances of abuse in patients at the first-episode of BD and substance-induced psychosis.