Bipolar Disorder: an impossible diagnosis.

Following the recent debates on the discrepancy between the predominant weight of bipolar disorder (BPD) in the clinical reality and its relatively low prevalence figures emerging from epidemiological surveys, the present paper contends the ability of current operational diagnostic system to properly detect the clinical entity of bipolar disorder.As an episode of mania/hypomania is the necessary requirement for a diagnosis of bipolar disorder to be made, in this editorial we maintain that: a) the most severe forms of mania, characterized by cloudy consciousness, mood incongruent delusions, and physical symptoms are likely to escape DSM IV criteria, that are shaped around hypomania or mild mania; b) the impossibility to diagnose mania when this occurs during antidepressant treatments impedes diagnosing those cases whose natural illness pattern is Depression followed by Mania (known as DMI pattern); c) given that approximately 50% of cases have their onset of BPD with affective episodes other than mania/hypomania any prevalence figure necessarily underestimates BPD; d) the sub-threshold forms of BPD, well described in the concept of Bipolar Spectrum, are beyond the possibility to be recognized using operational diagnoses in spite of their utmost clinical relevance.

Amphetamine derivatives and obesity.

This study aims to investigate the anamnestic, psychopatological and clinical features of overweight/obese subjects with and without an history of amphetamine derivatives consumption. This survey was conducted on a consecutive series of 451 overweight/obese subjects referring to the Clinics for Obesity of the University of Florence. Subjects with and without previous amphetamines derivatives consumptions were compared in terms of psychopathological and clinical features by means of the Structured Clinical Interview for DSM-IV, the Eating Disorder Examination questionnaire (EDE-Q), the Binge Eating Scale (BES), the Beck Depression Inventory (BDI), and the Spielberg's State-Trait Anxiety Inventory (STAI). Among the 451 participants, 136 patients (30.1%) reported a previous use of amphetamine derivatives drugs. Amphetamine users reported a high rate of childhood overweight, and showed higher BMI, EDE-Q Total score, Weight Concern, Shape Concern subscales and BES scores than amphetamine non-users, whereas the two groups of patients did not differ in terms of BDI and STAI scores. Amphetamine derivatives are widely used by obese patients seeking weight loss treatment. The amphetamine derivatives consumption is associated with higher levels of eating psychopathology and a more severe overweight.