Eating Behaviors, Depressive Symptoms and Lifestyle in University Students in Poland.

Young adulthood is the period from the late teens through the twenties and is associated with life transitions that could contribute to the development of obesity. Targeting this group will be critical to reversing the obesity epidemic. The aim of the study was to investigate the eating behaviors and lifestyle of healthcare students in Poland. We enrolled 227 students in the study. Convenience sampling was employed. Diet (Food Frequency Questionnaire), physical activity (International Physical Activity Questionnaire), depressive symptoms (Beck Depression Inventory), impulsivity (Barratt Impulsivity Scale), and eating behaviors (Three-Factor Eating Questionnaire) were assessed. One in three students exhibited depressive symptoms, one in four showed low levels of physical activity. More than 40% of the students did not consume vegetables at least once a day, and more than half did not consume fruit. Only approximately 50% of the students ate fish several times a month. There was an association between high scores of specific eating behaviors and body weight, adherence to the Mediterranean diet, and consumption of specific product groups (sweets, alcohol). The results of our study are expected to contribute to a better understanding of dietary habits and overweight/obesity in university students, and support the development of programs to promote healthy lifestyles in that population.

Association between Anxiety, Depressive Symptoms, and Quality of Life in Patients Undergoing Diagnostic Flexible Video Bronchoscopy.

Bronchoscopy is one of the basic invasive procedures in pulmonology accompanied by patients' anxiety. This study aimed to find an association between predictors of state anxiety/depression and patient's quality of life (QOL) with pulmonary symptoms undergoing diagnostic flexible video bronchoscopy (FVB). A total of 125 adult patients before FVB were included in a prospective observational study. The quality of life (QOL) was assessed by WHOQOL-BREF questionnaire, the depression possibility by the Beck's Depression Inventory-II (BDI-II), and the anxiety level by Spielberger's State-Trait Anxiety Inventory (STAI-S; STAI-T). Results show that the older patients and patients with more comorbidities showed a significantly higher anxiety level. The previous FVB under deep sedation significantly reduced state anxiety. A significantly positive association was found between the STAI score and total BDI-II score. More severe symptoms of anxiety were especially related to lower QOL (physical health, psychological and environmental domains) in patients. Statistically higher trait anxiety in lower social QOL domain scores was observed. Our findings show that high state and trait anxiety were associated with higher depression scores and lower quality of life in the elderly. It seems that the elderly and patients at risk of depression development require more attention in the clinical setting to minimize the anxiety accompanying the bronchoscopy.

Perinatal Mental Health during COVID-19 Pandemic: An Integrative Review and Implications for Clinical Practice.

The COVID-19 pandemic and measures implemented to decelerate its spread have consequences for mental health of societies. The aim of our review was to analyze depressive and anxiety symptoms in perinatal women. The search used PubMed and Web of Science databases. Most studies showed an increase in the prevalence of depression and/or anxiety symptoms. Risk factors identified in our study were mainly related to the possibility of COVID-19 infection, changes in the organization of perinatal care, social isolation and financial problems. Protective factors included social support, the woman's own activity and knowledge about COVID-19. The results of our study point to the importance of the mental health screening including suicide risk assessment in perinatal women. Much of the mental health needs of perinatal women can be met in primary or perinatal care services; however, women with mental health issues should be offered psychiatric consultations and psychological support, and sometimes urgent psychiatric hospitalization is necessary. Healthcare professionals should provide information addressing uncertainty about COVID-19, organization of midwifery and medical care as well as mental health problems and how to get help. Mental health interventions in pregnant women may involve planning physical activity and encouraging to engage in online social activities.

Psychosocial and cultural determinants of dietary intake in community-dwelling older adults: A Determinants of Diet and Physical Activity systematic literature review.

OBJECTIVES: Knowledge of factors determining dietary intake is important to develop targeted strategies to prevent malnutrition and age-related diseases. The aim of the present systematic review was to analyze the state of the art regarding the role of social status, cultural aspects, and psychological distress on dietary intake in community-dwelling older adults. METHODS: A systematic search was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedure. Titles, abstracts, and full texts were screened for predefined inclusion and exclusion criteria. RESULTS: Thirty-nine studies were included. Seven different groups of psychosocial and cultural determinants were associated with dietary intake. Family structure and living situation (e.g., loneliness, marital status), educational level, and income were the most important determinants associated with dietary choices and eating behavior. Less frequently, social assets, demographic parameters, psychosocial status, and awareness of current dietary recommendations were associated with the quality of the eating pattern. CONCLUSIONS: The results of our review indicate heterogeneity of the studies in the field of social and psychological determinants of dietary patterns in older adults, but some important conclusions can be drawn. Further research harmonizing and integrating approaches and methodologies are required to better understand the determinants of dietary intake and the complexity of their interactions.

Impaired Glucose Metabolism in Bipolar Patients: The Role of Psychiatrists in Its Detection and Management.

Bipolar patients have a higher risk of type 2 diabetes and obesity, which are associated with cardiovascular diseases as the leading cause of death in this group. Additionally, there is growing evidence that impaired glucose metabolism in bipolar patients is associated with rapid cycling, poor response to mood stabilizers and chronic course of illness. The aim of the study was to assess the prevalence of type 2 diabetes and other types of impaired glucose metabolism in bipolar patients along with an evaluation of the Fasting Triglycerides and Glucose Index (TyG) as a method of the insulin sensitivity assessment. The analysis of fasting glycemia, insulinemia and lipid profile in euthymic bipolar patients was performed, and the Homeostasis model assessment for insulin resistance (HOMA-IR) and TyG were computed. Type 2 diabetes was observed in 9% and insulin resistance with HOMA-IR in 48% of patients. The TyG and HOMA-IR indices were correlated (p < 0.0001), the TyG index value of 4.7 had the highest sensitivity and specificity for insulin resistance detection. The usefulness of TyG in the recognition of insulin resistance in bipolar patients was suggested. The significant role of psychiatrists in the detection and management of impaired glucose metabolism in bipolar patients was presented.

Is diet important in bipolar disorder? / Czy dieta w chorobie dwubiegunowej ma znaczenie?

In recent years it has been increasingly indicated that diet/nutrition is important in the pathogenesis, course and effectiveness of treatment of various mental disorders. Most of the research published so far has focused on the role of nutrition and nutrients in the development and treatment of depression. The results indicated a relationship between diet and risk of depression. Few studies have examined the relationship between diet and bipolar disorder (BD), although it can be assumed that some of the observations related to people with depression may be related to BD. The authors present an overview of the relationship between diet and bipolar disorder and the use of dietary interventions in the treatment of BD. They also discuss the use of nutrients, including polyunsaturated fatty acids, N-acetylcysteine, vitamin D, folic acid, and zinc, in the treatment of BD. For patients, the supplementation of mood disorders treatment with dietary recommendations, supplementation with selected nutrients, supplementation of micronutrients, may provide - in addition to indirect and direct effect on brain function - the possibility of greater co-participation in the treatment, enhancing the sense of control, coping, which may have a significant effect on the course of BD and the effectiveness of its treatment.

Functional determinants of dietary intake in community-dwelling older adults: a DEDIPAC (DEterminants of DIet and Physical ACtivity) systematic literature review.

OBJECTIVE: The identification of determinants of dietary intake is an important prerequisite for the development of interventions to improve diet. The present systematic literature review aimed to compile the current knowledge on individual functional determinants of dietary intake in community-dwelling older adults. DESIGN: A systematic search was performed in PubMed, Scopus, Web of Science and the Cochrane Library. Titles, abstracts and full texts were screened according to predefined inclusion and exclusion criteria. Studies were included when focusing on dietary intake as an outcome and on chemosensory, oral, cognitive or physical function as a determinant. SETTING: Community. SUBJECTS: Older adults at least 65 years old without acute or specific chronic diseases. RESULTS: From initially 14 585 potentially relevant papers, thirty-six were included. For chemosensory, cognitive and physical function only a few papers were found, which reported inconsistent results regarding the relationship to dietary intake. In contrast, oral function was extensively studied (n 31). Different surrogates of oral function like dental status, number of teeth, bite force or chewing problems were associated with food as well as nutrient intakes including fibre. As all except six studies had a cross-sectional design, no causal relationships could be derived. CONCLUSIONS: Among functional determinants of dietary intake oral factors are well documented in older adults, whereas the role of other functional determinants remains unclear and needs further systematic research.

Atypical depression: current perspectives.

The history and present status of the definition, prevalence, neurobiology, and treatment of atypical depression (AD) is presented. The concept of AD has evolved through the years, and currently, in Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, the specifier of depressive episode with atypical feature is present for both diagnostic groups, that is, depressive disorders and bipolar and related disorders. This specifier includes mood reactivity, hyperphagia, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. Prevalence rates of AD are variable, depending on the criteria, methodology, and settings. The results of epidemiological studies using DSM criteria suggest that 15%-29% of depressed patients have AD, and the results of clinical studies point to a prevalence of 18%-36%. A relationship of AD with bipolar depression, seasonal depression, and obesity has also been postulated. Pathogenic research has been mostly focused on distinguishing AD from melancholic depression. The differences have been found in biochemical studies in the areas of hypothalamic-pituitary-adrenal axis, inflammatory markers, and the leptin system, although the results obtained are frequently controversial. A number of findings concerning such differences have also been obtained using neuroimaging and neurophysiological and neuropsychological methods. An initial concept of AD as a preferentially monoamine oxidase inhibitor-responsive depression, although confirmed in some further studies, is of limited use nowadays. Currently, despite numerous drug trials, there are no comprehensive treatment guidelines for AD. We finalize the article by describing the future research perspectives for the definition, neurobiology, and treatment. A better specification of diagnostic criteria and description of clinical picture, a genome-wide association study of AD, and establishing updated treatment recommendations for this clinical phenomenon should be the priorities for the coming years.

Medical students and stigma of depression. Part 2. Self-stigma. / Studenci medycyny a stygmatyzacja z powodu depresji. Czesc II. Autostygmatyzacja.

Up to 30% of medical students suffer from depression. They have better access to healthcare, but still receive appropriate treatment less frequently than people with depression in the general population. Most of them do not seek medical help as depression is perceived as a stigmatizing disorder, which leads to self-stigma and hampers early diagnosis and treatment. Thus, self-stigma means less effective therapy, unfavorable prognosis and relapses. According to the literature, self-stigma results in lowered self-esteem and is a major obstacle in the performance of social roles at work and in personal life. Stigmatization and self-stigma of depression among medical students are also associated with effects in their later professional life: they can lead to long-term consequences in the process of treating their patients in the future. Currently there are no unequivocal research results indicating the most effective ways of reducing stigmatization and self-stigma. It is necessary to educate about the symptoms and treatment of depression and to implement diverse intervention techniques to change behaviors and attitudes as early as possible.

Depression with atypical features in various kinds of affective disorders. / Depresja z cechami atypowymi w róznych rodzajach zaburzen afektywnych.

OBJECTIVES: Assessment of atypical symptoms in various types of depressive disorders, using the author's questionnaire for symptoms of atypical depression. METHODS: The study involved 70 patients with a diagnosis of depressive episode in the course of recurrent depression, 54 patients with a diagnosis of depressive episode in bipolar disorder (BD) and 58 patients with a diagnosis of dysthymia. To assess the severity of atypical symptoms, the special questionnaire has been elaborated. In each diagnostic group, half of patients had normal body weight, and half were overweight or obese (BMI > 25). RESULTS: Patients with various types of depression did not differ significantly in terms of clinical and demographic factors. Symptoms of atypical depression such as increased appetite, weight gain and leaden paralysis were more common in women. Patients with bipolar depression had significantly increased symptoms such as hypersomnia (compared with dysthymia), and leaden paralysis (vs. recurrent depression and dysthymia). In overweight and obese patients, the severity of atypical symptoms correlated with body mass index and intensity of depression score on the 17-items Hamilton Depression Rating Scale. In this group, all symptoms of atypical depression were significantly more intense in patients with depression in the course of bipolar disorder. CONCLUSIONS: The results indicate higher prevalence of symptoms of atypical depression in bipolar disorder compared with recurrent depression and dysthymia. They also suggest the interdependency between the symptoms of atypical depression, bipolar disorder and obesity.

Analgesic use among nursing homes residents, with and without dementia, in Poland.

Many age-associated diseases are accompanied by pain. There is no doubt that pain is underrecognized among elderly nursing home residents and the diagnosing of pain is a real challenge in subjects with dementia. The aim of the study was to characterize analgesic use among nursing home residents and to delineate the putative associations between pain management and cognitive functions of elderly persons. The study involved 392 subjects (males:females - 81:311) with a mean age of 83.6±5.9 years. The residents' medical files in relation to diagnoses and drug consumption were analyzed, and the screening of cognitive functions was performed using the Mini-Mental State Examination (MMSE). One hundred and thirteen residents (28.8%) received some analgesics. Among them 84 (21.4%) used them routinely, 25 (6.4%) - pro re nata (PRN) and four (1.0%) - both routinely and PRN. Non-opioid analgesics were taken routinely by 53 residents, weak opioids by nine subjects, and one person was receiving strong opioids. Additionally, three individuals were taking a combination preparation of tramadol and acetaminophen. The rate of subjects who were not receiving any pain treatment was higher in residents with MMSE between 0 and 9 points than in those with MMSE between 24 and 30 points (P=0.0151). Furthermore, ten residents (9.1%) with severe dementia were treated with analgesics PRN. The results of our study point to a remarkably low use of analgesics in nursing home residents in Poland and indicate a need to introduce pain evaluation and monitoring of drug treatment appropriateness as a standard procedure in the geriatric assessment in nursing homes.

The 33-item Hypomania Checklist (HCL-33) - a study of the consistency between self - and external assessments in Polish bipolar patients. / Kwestionariusz Hypomania Checklist (HCL-33) u polskich pacjentów z choroba afektywna dwubiegunowa ­ badanie zgodnosci miedzy ocena wlasna a ocena przez osobe z zewnatrz.

OBJECTIVES: The Hypomania Checklist (HCL) has become an important tool for the assessment of hypomanic symptoms in patients with mood disorders and in the general population. The HCL-33 scale, containing 33 symptom items, is a new instrument which, in addition to the self-administered questionnaire, has a version for external rating. The aim of this study is to evaluate the consistency between the self - and external assessments using the HCL-33 in Polish patients with bipolar disorder. METHODS: The data from 81 euthymic bipolar patients recruited in Poznan and Krakow centers were analyzed. All the patients filled out the HCL-33 questionnaire, and, for each patient, the HCL-33 questionnaire-external assessment was completed by his/her significant other. RESULTS: Of the 33 symptom items, sufficient agreement (significance of kappa factor < 0.05) was found for 13 out of the 19 questions of the "active/elated" (factor 1) and for all 14 items of the "irritable/risk-taking" (factor 2). Insignificant consistency was found for 6 items of factor 1 and the question regarding the longest period of hypomania. The inter-rater agreement between patient and significant other was not affected by gender, living together or subtype of relationship with the patient. CONCLUSIONS: The results show significant consistency between self - and external assessments for 27 symptom items (82%) of the HCL-33. The future status of the items showing insufficient consistency should be discussed. Limitation of the study is a small number of subjects recruited from only two centers which may not be representative for the Polish population.

Medical students and stigma of depression. Part I. Stigmatization of patients. / Studenci medycyny a stygmatyzacja z powodu depresji. Czesc I. Stygmatyzacja pacjentów.

The stigmatization of the mentally ill is called the first barrier hampering their treatment and recovery: it leads to the rejection of such individuals, their discrimination and exclusion from participation in various areas of social life. It becomes particularly significant if the patients encounter this attitude among doctors, nurses and others healthcare professionals. The literature describes stigmatizing attitudes towards the mentally ill and it transpires that stigmatization and a negative approach can be found even among medical students, despite the fact that in the course of their studies they receive information on psychiatric disorders and their treatment. The attitude stigmatizing mental illnesses as presented by medical students may be related to their subsequent similar views as physicians, thus adversely affecting the quality of care offered to patients and cause self-stigmatization and its consequences. The paper presents a review of the literature on the stigmatization of patients suffering from depression by medical students and a review of the interventions proposed to-date, as well as a discussion of their effectiveness.

Atypical features in depression: Association with obesity and bipolar disorder.

OBJECTIVES: Depression with atypical features amounts to a significant proportion of depressed patients. Studies have shown its association with bipolarity and, recently, with obesity. In this study, we investigated atypical features of depression in relation to overweight/obesity in three diagnostic categories: unipolar depression, bipolar depression and dysthymia. METHODS: Out of 512 depressed patients screened, we recruited 182 research subjects, consisting of 91 pairs, matched by age, gender and diagnosis, in which one member of the pair was within the normal weight range (BMI≤25) and the other was either overweight or obese (BMI>25). There were 35 pairs with unipolar depression, 27 with bipolar depression and 29 with dysthymia. Symptoms of atypical depression, such as increased appetite, hypersomnia, leaden paralysis, longstanding pattern of interpersonal rejection sensitivity, and, a significant weight gain in the past 3 months, were assessed. RESULTS: All the symptoms of atypical depression were significantly more pronounced in those depressed patients with a BMI>25, compared with depressed subjects with a normal weight. Except for hypersomnia, these symptoms scored significantly higher in women compared to men. Among the diagnostic categories, symptoms of atypical depression were significantly higher in patients with bipolar disorder compared with both major depressive disorder and dysthymia. LIMITATIONS: The preponderance of women, the assessment of atypical depression by adaptation of the DSM criteria, entirely Polish population, specificity of selection criteria. CONCLUSIONS: The results demonstrated a higher intensity of atypical depression's symptoms in overweight/obese depressed patients. They also confirm the association between obesity and bipolarity.

Symptoms of depression among adults in rural areas of western Poland.

OBJECTIVE: To measure the intensity of depressive symptoms in the populations residing in rural areas of western Poland, and to delineate the putative association between the intensity of depression and selected socio-demographic and clinical factors. MATERIALS AND METHOD: The study covered 445 adults recruited from one family physician practice in the rural area of Wielkopolska region. The following tools were applied: Beck Depression Inventory (BDI), the WHO WHOQoL-Bref quality of life assessment scale, and a socio-demographic and clinical questionnaire elaborated by the authors. RESULTS: Depressive symptoms were observed in approx. 30% of the patients. The intensity of symptoms correlated with age, female gender, and inversely correlated with the quality of life. There was no association between depressive symptoms and level of education (counted as years of education), number of somatic illnesses, and family burden of psychiatric disorders. CONCLUSION: Symptoms of depression were noted in approx. 30% of patients who consulted their family physician. The Beck questionnaire is a simple tool whose application could decidedly improve the recognition of depression. It is worth taking note of factors that may be connected with the intensity of depressive symptoms - gender, the number of diagnosed somatic illnesses, and the quantity of drugs administered.

[Bipolar and related disorders and depressive disorders in DSM-5]. / Dwubiegunowe zaburzenia nastroju i zaburzenia depresyjne w klasyfikacji DSM-5.

In 2013, a version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), having number 5, was published. The DSM is a textbook which aims to present diagnostic criteria for each psychiatric disorder recognized by the U.S. healthcare system. The DSM-5 comprises the most updated diagnostic criteria of psychiatric disorders as well as their description, and provides a common language for clinicians to communicate about the patients. Diagnostic criteria of the DSM-5 have been popular all over the world, including countries where the ICD-10 classification is obligatory, and are widely used for clinical and neurobiological research in psychiatry. In this article, two chapters of the DSM-5 pertained to mood (affective) disorders are presented, such as "Bipolar and related disorders" and "Depressive disorders" replacing the chapter titled "Mood disorders" in the previous version of DSM-IV. The aim of this article is to discuss a structure of new classification, to point out differences compared with previous version (DSM-IV). New diagnostic categories, such as e.g. disruptive mood dysregulation disorder or premenstrual dysphoric disorder were depicted as well as some elements of dimensional approach to mood disorders were presented.

Sex dependence of cognitive functions in bipolar disorder.

The objective of the present study was to assess the performance of lithium treated euthymic bipolar patients in tests measuring spatial working memory (SWM), planning, and verbal fluency and to delineate the influence of gender on cognitive functioning. Fifty-nine euthymic bipolar patients, treated with lithium carbonate for at least 5 yr, were studied. Patients and controls underwent a neuropsychological assessment. Bipolar patients had significantly worse results than the healthy controls in the spatial memory and planning as well as verbal fluency tests. We detected a gender-related imbalance in the SWM results. Deficits in SWM were observed in male-only comparisons but not in female-only comparisons. The SWM scores were significantly poorer in male patients than in male controls. In female-only comparisons, female patients did not have significantly poorer SWM results in any category than their controls. Bipolar women scored worse in some other tests. The present study points to the different patterns of neuropsychological disturbances in female and male patients and suggests that sex-dependent differences should be taken into account in order to tailor the therapeutic intervention aimed at the improvement of cognitive functions.

[Burning mouth syndrome: pathogenic and therapeutic concepts]. / Zespól pieczenia w jamie ustnej (burning mouth syndrome)--koncepcje patogenetyczne i terapeutyczne.

Burning mouth syndrome (BMS) is a chronic pain condition characterized by pain, burning sensations and dryness within an oral mucosa, without any clinical changes of the latter. It occurs approximately seven times more frequently in women, mostly in perimenopausal age. The psychiatric aspect of BMS is significant: the most frequent co-morbidities are depression and anxiety disorders, and a number of psychotropic drugs play an essential role in its treatment. In the present review, the most important pathogenic and treatment concepts of BMS have been discussed. The BMS may be similar to neuropathic pain and has some related pathogenic elements with fibromyalgia and the restless leg syndrome. In primary BMS, the features of presynaptic dysfunction of dopaminergic neurons and deficiency of endogenous dopamine levels have been demonstrated. Other neurotransmitters such as serotonin, noradrenaline, histamine as well as hormonal and inflammatory factors may also play a role in the pathogenesis of BMS. In the pharmacological treatment of BMS a variety of drugs have been used including benzodiazepines, anticonvulsants, antidepressants and atypical antipsychotic drugs. In the final part of the paper, the possibility of using atypical antipsychotic drug, olanzapine, in the treatment of BMS has been discussed. In the context of the recent studies on this topic, a case of female patient with the BMS lasting more than ten years has been mentioned, in whom the treatment with olanzapine brought about a rapid and significant reduction of symptoms. The probable mechanism of the therapeutic effect of olanzapine in BMS can include its effect on dopaminergic receptors and probably also on histaminergic, noradrenergic and serotonergic ones.

[Hypomania Check List (HCL-32)--hypomania symptoms questionnaire: description and application]. / Hypomania Check List (HCL-32)--kwestionariusz objawów hipomanii: charakterystyka i zastosowanie.

In current diagnostic classifications such as the International Classification of Diseases (ICD-10) and the American Diagnostic and Statistical Manual (DSM-IV), unipolar and bipolar mood disorders are mentioned, where the differentiating factor is occurrence of mania or hypomania. In DSM-IV, bipolar mood disorder type I (bipolar I), with the episodes of mania, and bipolar mood disorder type II (bipolar II) with hypomania, have been separated. Clinical and epidemiological studies performed in recent decades using more sensitive measures of the assessment of hypomania suggest a marked prevalence of bipolar disorders of not-bipolar I type, amounting to about 3-5% of population. In 2005, Angst and collaborators introduced the Hypomania Check List-32 scale (HCL-32) aimed at a better identification of the occurrence of hypomania symptoms in patients with affective disorders. The studies carried out in many countries have demonstrated a significant sensitivity and specificity of the scale and its usefulness for the assessment of bipolar affective disorders. In the present paper, the Polish version of HCL-32 scale is presented. This version has been already employed in the all-country Polish project TRES-DEP where the features of bipolarity were assessed in depressive patients in whom treatment with antidepressant drugs was unsuccessful.

Risk factors of treatment resistance in major depression: association with bipolarity.

BACKGROUND: An undiagnosed and therefore inadequately treated bipolarity may be an important cause of drug resistance in depression diagnosed as unipolar. The study aimed to detect clinical and demographic characteristics, with a special interest in bipolarity features which could be risk factors for treatment resistance in unipolar depression. METHOD: One-thousand and fifty-one patients recruited from 150 outpatient psychiatric clinics and fulfilling DSM-IV criteria for major depressive episodes, single or recurrent, were studied. Among them, 569 patients with treatment-resistant depression (TR) were compared with 482 patients with non-treatment-resistant depression (NTR). All patients were assessed using the structured demographic and clinical data interviews, Mood Disorder Questionnaire (MDQ) and Hypomania Checklist (HCL-32). RESULTS: Independent risk factors of treatment resistance were: scoring 6 or higher on MDQ, scoring 14 or higher in HCL-32, age at first onset < or = 20 years, more than three previous depressive episodes, and lack of remission or partial remission after the previous depressive episode. LIMITATION: A retrospective assessment of treatment resistance. CONCLUSIONS: Bipolarity features as assessed by MDQ and HCL-32 were identified as significant factors of treatment resistance. Some other clinical variables connected with treatment resistance may be also be associated with bipolarity features.