Several studies have reported that Bipolar Disorder (BD) is characterized by neuropsychological deficits both during affective episodes and euthymic phases; in particular, bipolar patients (BPs) show psychomotor slowing and impairment of memory during Major Depressive Episodes and frontal-executive deficits in Hypomania.

The aim of the present study is to compare possible differences in cognitive performances of BPs during euthymia or during an affective episode.

22 BPs with an affective episode (depressive = 7, mixed = 7, manic = 8) and 5 euthymic patients underwent neuropsychological tests, after assessing the diagnosis by SCID-I. The cognitive abilities tested by raters included attention, verbal abilities, memory, abstract reasoning, executive functioning and semantic knowledge. One-way ANOVAs were performed on mean total scores of neuropsychological tests comparing euthymics versus BPs in the different phases of illness.

The 20% of euthymic patients showed attentive, verbal and memory deficits; the 40% showed perceptual and executive functioning deficits. Depressed (p = 0.03) and manic (p = 0.01) patients showed worse scores at Trail Making Test A (TMT-A) than euthymics. Manic patients presented the most severe deficits in memory as showed by the scores of Corsi's test (F = 4.96, p = 0.01), Recall of Prose (F = 4.06, p = 0.02) and California Verbal Learning Test (F = 3.67, p = 0.03).

Euthymic patients showed deficits in several cognitive domains. Manic patients had more severe deficits in attention and memory in comparison with depressed, mixed and euthymic patients. Controlled studies with larger samples are needed to confirm these data.

Experimental evidence indicates that patients with severe mental illness such as schizophrenia or mood disorders have a higher incidence of overweight and obesity (Daumit et al., 2003).

This review describes the neuropsychological functioning and therapeutical approaches (psychotherapeutic, pharmacological, surgical) in obese patients with psychiatric disorders.

To provide suggestions for good clinical practice in obese subjects with psychopathology, based on data found in the literature.

MEDLINE and PubMed databases (1962-2012) were searched for English-language articles.

Most of the literature says that the best treatment for these patients should use an integrated approach, starting from an assessment of the psychological and cognitive resources to set up a more effective and personalized therapeutic path.

Obese patients who have psychiatric disorders represent a population that requires specific treatment measures; in fact, the development, the maintenance and the outcome of the problem of weight are influenced not only by physical and life style factors, but also by specific factors related to psychopathology, neuropsycology, and side effects of certain drugs.

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.