These results support a similar pattern of cognitive deficits in both subtypes of bipolar disorder.

1 Purinoceptor agonist-induced currents in untreated (proliferating) and lipopolysaccharide (LPS; 100 ng ml`)-treated (non-proliferating) rat microglial cells in culture were recorded by the whole-cell patch-clamp technique. These cells have two preferred resting membrane potentials, one at -35 mV and another one at -70 mV. 2 Most experiments were carried out in non-proliferating cells. ATP, ATP--y-S and X,4-MeATP (1 -1000 jLM in all cases) evoked an inward current at a holding potential of -70 mV, followed, in some experiments, by an outward current. At -70 mV 2-methylthio ATP (1-1I000 1M) evoked an inward current, whereas at -35 mV it produced an outward current only. 3 When K+ was replaced in the pipette solution by an equimolar concentration of Cs' (150 mM), the main outward component of the ATP-y-S (10 LM) induced response disappeared. Instead, an inward current was obtained. Replacement of K+ by Cs' did not affect the inward current evoked by 2-methylthio ATP (300 pM). 4-Aminopyridine (1-1O mM), however, almost abolished this current and unmasked a smaller outward current.4 The rank order of agonist potency was 2-methylthio ATP > ATP> aP-MeATP. Adenosine and UTP were inactive. Suramin (300 JLM) and reactive blue 2 (50 gLM) antagonized the effect of 2-methylthio ATP (300 tiM). 5I-V relations were determined by delivering fast voltage ramps before and during the application of 2-methylthio ATP (300 JAM). In the presence of extra-(1 mM) and intracellular (150 mM) Cs', the 2-methylthio ATP-evoked current crossed the zero current level near 0 mV. When both Cs' (1 mm) and 4-aminopyridine (1 mM) were present in the bath medium, the intersection of the 2-methylthio ATP current with the zero current level was near -75 mV. 6 2-Methylthio ATP (1-1I000 jM) induced the same inward current both in proliferating and nonproliferating microglia. However, the depolarizing response to 2-methylthio ATP (300 laM) was larger and longer-lasting in the proliferating cells. When the free Ca2" concentration in the pipettes was increased from the standard 0.01 to 1 JAM, the amplitude and duration of this depolarization was increased in non-proliferating cells. 4-Aminopyridine (1 mM) enhanced the duration, but not the amplitude of responses.7 ATP and its structural analogues stimulate microglial purinoceptors of the P2Y-type. This leads to the opening of non-selective cationic channels and potassium channels. Depending on the resting membrane potential, depolarization or hyperpolarization prevails. Although the inward current produced by 2-methylthio ATP is of similar amplitude in proliferating and non-proliferating microglia, the resulting depolarization is smaller in the latter cell type because of the presence of voltage-sensitive, outwardly rectifying potassium channels.

The study evaluated a telephone call and text message intervention to improve adherence to medication among patients with severe mental illness.Methods: A randomized clinical trial was conducted, and outpatients with schizophrenia or bipolar disorder were assigned to the intervention group or to a usual care control group. The intervention was provided by trained nurses. Medication adherence was measured with the Medication Adherence Report Scale. Results:The study sample comprised 120 participants. Logistic regression analysis showed that intervention group participants were significantly more likely than control group participants to be medication adherent at 6 months (odds ratio=4.11, p=.007). The superiority of the intervention emerged during months 4 to 6. Social desirability, diagnosis, and medication did not affect the results.Conclusions: Telemedicine via telephone can deliver lowthreshold support to patients who are otherwise at high risk of progressive nonadherence to their psychotropic medication after 6 months.

Bipolar disorder is a mood disorder which requires complex treatment. Current treatment guidelines are based on the results of published randomized clinical trials and meta-analyses which may not accurately reflect everyday clinical practice. This multi-national, multi-centre, observational cohort study describes clinical management and clinical outcomes related to bipolar disorder in real-life settings, assesses between-country variability and identifies factors associated with clinical outcomes. Adults from 10 countries in Europe and South America who experienced at least one mood episode in the preceding 12 months were included. Overall, 2896 patients were included in the analyses and followed for at least 9 months across a retrospective and prospective study phase. Main outcome measures were the number and incidence rate of mood episodes (relapses and recurrences) and healthcare resource use including pharmacological treatments. Relapses and recurrences were reported in 18.2 and 40.5% of patients, respectively; however, the reported incidence rate of relapses was higher than that of recurrences [1.562 per person-year (95% CI 1.465-1.664) vs. 0.691 per person-year (95% CI 0.657-0.726)]. Medication use was high during all episode types and euthymia; the percentage of patients receiving no medication ranged from 11.0% in mania to 6.1% in euthymia. Antipsychotics were the most commonly prescribed drug class in all disease phases except for patients with depression, where antidepressants were more frequently prescribed. Visits to the psychiatrist were the most frequently used healthcare resource. These results provide a description of treatment patterns for bipolar disorder across different countries and indicate factors related to relapse and recurrence.

BackgroundSchizophrenia and bipolar disorder are characterized by a high disease burden. Antipsychotic medication is an essential part of the treatment. However, non-adherence is a major problem. Our aim was to examine potential determinants of non-adherence for patients with severe mental disorders.MethodsBaseline data of the study “Post stationary telemedical care of patients with severe psychiatric disorders” (Tecla) were used. Medication adherence was assessed with the Medication Adherence Report Scale German version (MARS-D). A logistic regression was calculated with age, sex, education, employment status, level of global functioning, social support and intake of typical and atypical antipsychotics as predictors.ResultsN = 127 participants were included in the analysis (n = 73 men, mean age 42 years). The mean MARS-D Score was 23.4 (SD 2.5). The most common reason for non-adherence was forgetting to take the medicine. Significant positive determinants for adherence were older age (OR 1.02, 95% CI 1.011–1.024, p < 0.0001), being employed (OR 2.46, 95% CI 1.893–3.206, p < 0.0001), higher level of global functioning (overall measure of how patients are doing) (OR 1.02, 95% CI 1.012–1.028, p < 0.0001), having social support (OR 1.02, 95% CI 1.013–1.026, p < 0.0001), and intake of typical antipsychotics (OR 2.389, 95% CI 1.796–3.178, p < 0.0001). A negative determinant was (female) sex (OR 0.73, 95% CI 0.625–0.859, p = 0.0001).ConclusionsEspecially employment, functioning and social support could be promising targets to facilitate adherence in patients with schizophrenia or bipolar disorder.Trial registrationThis study is retrospectively registered at the German Clinical Trials Register with the trial registration number DRKS00008548 at 21/05/2015.