Transformation and operation of a uniform psychiatric ward dedicated to COVID-19 patients during the pandemic. / Transformacja i zasady dzialania psychiatrycznego oddzialu jednoimiennego w trakcie pandemii COVID-19.

This article aims to describe the experience of transforming the Clinical Department of Adult, Child and Adolescent Psychiatry of the University Hospital in Krakow (CDACAP) into award designated by the Malopolska Voivod to provide the treatment for mentally ill adults from Malopolska Voivodship and adolescents from the south of Poland during the COVID-19 pandemic. We discuss sequent stages of transformation, practical solutions and difficulties encountered in the process. 9 patients with confirmed SARS-CoV-2 infection were hospitalized in the CDACAP between 09.04 and 29.05.2020, and 97 were tended to by consulting psychiatrists in the main building of the University Hospital in Krakow between 23.03 and 23.05.2020. In our experience, the Polish healthcare facilities, especially psychiatric and long-term care ones, were ill-equipped to operate during the pandemic crisis. This situation has brought out the nationwide lack of systemic solutions, particularly in the areas of child and adolescent psychiatry as well as forensic psychiatry. Functioning during the epidemic and confronting the risk of rapid deterioration in patients'condition clearly pointed out the necessity of creating psychiatric wards within the multispecialty hospitals. The requirement for ensuring separate spaces for patients with SARS-CoV-2 infection or with exclusion thereof should be considered in the psychiatric reform which assumes the regional responsibility of stationary wards.

Zinc and copper concentration do not differentiate bipolar disorder from major depressive disorder. / Stezenie cynku i miedzi nie róznicuje choroby afektywnej dwubiegunowej i jednobiegunowej.

OBJECTIVES: The aim of this study was to compare the zinc and copper concentration in the group of patients with bipolar disorder (BD) and major depressive disorder (MDD). METHODS: 110 patients with the diagnosis of BD and 114 with MDD were qualified to the study. To assess the levels of microelements, the flame atomic absorption spectrometry (FAAS) was used in the case of zinc and the electrothermal atomic absorption spectrometry (ETAAS) was used in the case of copper. RESULTS: There were no differences between concentration of zinc and copper in remission and depressive phase between patients with BD and MDD. Additionally, there were also no statistically significant differences in comparisons including type I and II, early or late phase of BD and MDD. CONCLUSIONS: The lack of differences in zinc and copper concentrations between patients with bipolar disorder and major depressive disorder might indicate that those disorders have similar etiology.

A systematic review of how patients value COPD outcomes.

Our objective was to summarise systematically all research evidence related to how patients value outcomes in chronic obstructive pulmonary disease (COPD).We conducted a systematic review (systematic review registration number CRD42015015206) by searching PubMed, Embase, PsycInfo and CINAHL, and included reports that assessed the relative importance of outcomes from COPD patients' perspective. Two authors independently determined the eligibility of studies, abstracted the eligible studies and assessed risk of bias. We narratively summarised eligible studies, meta-analysed utilities for individual outcomes and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach.We included 217 quantitative studies. Investigators most commonly used utility measurements of outcomes (n=136), discrete choice exercises (n=13), probability trade-off (n=4) and forced choice techniques (n=46). Patients rated adverse events as important but on average, less so than symptom relief. Exacerbation and hospitalisation due to exacerbation are the outcomes that COPD patients rate as most important. This systematic review provides a comprehensive registry of related studies.

Lipid Peroxidation and Immune Biomarkers Are Associated with Major Depression and Its Phenotypes, Including Treatment-Resistant Depression and Melancholia.

To examine immune-inflammatory and oxidative (I&O) biomarkers in major depression (MDD) and its related phenotypes, we recruited 114 well-phenotyped depressed patients and 50 healthy controls and measured serum levels of interleukin (IL)-1α, soluble IL-1 receptor antagonist (sIL-1RA), soluble IL-2 receptor (sIL-2R), soluble IL-6 receptor (sIL-6R), soluble tumor necrosis factor receptor 60 and 80 kDa (sTNF-R1/R2), and thiobarbituric acid reactive substances (TBARS). Obtained results indicate that MDD is characterized by increased sIL-1RA, sTNF-R1, and TBARS concentrations. Melancholic depression is associated with increased sIL-6R but lowered IL-1α levels. A current episode of depression is accompanied by significantly increased sIL-6R compared to the remitted state. Treatment-resistant depression (TRD) is accompanied by increased sIL-6R and TBARS but lowered sTNF-R2 levels compared to non-TRD patients. These immune markers are not significantly correlated with Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Scale (MADRS), number episodes, or age at onset. Our findings show that increased sIL-1RA, sTNF-R1, and TBARS levels may be trait markers of depression, while increased sIL-6R levels may be a state marker of melancholia and an acute phase of depression. MDD is accompanied by increased lipid peroxidation and simultaneous activation of immune pathways, and the compensatory anti-inflammatory reflex system (CIRS). TRD is characterized by highly increased oxidative stress and probably increased TNFα and IL-6 trans-signalling. Novel treatments for major depression should target oxidative stress pathways, while new treatments for TRD should primary target lipid peroxidation and also activated immune-inflammatory pathways.

Are there differences in lipid peroxidation and immune biomarkers between major depression and bipolar disorder: Effects of melancholia, atypical depression, severity of illness, episode number, suicidal ideation and prior suicide attempts.

BACKGROUND: There is evidence that major depression (MDD) and bipolar disorder (BD) are accompanied by activated immune & oxidative (I&O) pathways. METHODS: To compare I&O biomarkers between MDD and BD we assessed serum levels of thiobarbituric acid reactive substances (TBARS; a lipid peroxidation marker), soluble interleukin-2 receptor (sIL-2R), sIL-6R, IL-α, sIL-1R antagonist (sIL-1RA), tumor necrosis factor receptor 60kDa/80kDa (sTNFR60/R80) in 114 MDD and 133 BD patients, and 50 healthy controls. We computed z-unit weighted indices reflecting the 5 cytokine receptor levels (zCytR), cell-mediated immunity (zCMI) and I&O pathways (zCMI+TBARS). RESULTS: There are no significant differences in biomarkers between MDD and BD. BD/MDD with atypical features is characterized by increased sIL-6R and TBARS, whereas melancholia is associated with higher TBARS and lower sTNFR60 levels. Severity of illness, as measured with the Hamilton Depression Rating Scale, is correlated with increased sIL-6R, sTNFR80, TBARS, zCytR and zCMI+TBARS. The number of episodes the year prior to blood sampling is positively associated with sTNFR80, TBARS, zCMI, zCMI+TBARS, while number of hospitalizations is positively associated with sIL-1RA. Prior suicidal attempts are associated with increased sIL-1RA, IL-1α, zCMI, TBARS and zCMI+TBARS, while TBARS is associated with current suicidal ideation. CONCLUSIONS: There are no I&O biomarker differences between MDD and BD. Atypical depression is associated with increased IL-6 trans-signaling and lipid peroxidation. Severity of depression, number of episodes and suicidal attempts are associated with activated I&O pathways. Increased TBARS is the single best predictor of BD/MDD, atypical depression, melancholia and current suicidal ideation.

The serum concentration of copper in bipolar disorder. / Stezenie miedzi w surowicy w chorobie afektywnej dwubiegunowej.

OBJECTIVES: Some scientific reports indicate the changes in the concentration of serum copper in patients with bipolar disorder (BD), however the data are inconclusive. The aim of this study was to assess the concentration of copper in the blood serum of patients in various phases of BD compared to healthy volunteers, taking into consideration the specific clinical features, and the stage of illness. METHODS: The study enrolled 133 patients with a diagnosis of BD (type I, II and NOS), including 61 people in depressive episode, 23 in mania or hypomania and 49 in remission. The control group consisted of 50 people. Atomic absorption spectrometry was used to measure the concentration of copper. RESULTS: There were no statistically significant differences in the serum copper concentration between patients in various phases of BD (mania/hypomania, depression, remission), sub-types (Type I, Type II + NOS) or stages and healthy volunteers. However, serum copper concentrations in patients in stage 1 was significantly higher than in advanced stages (2+3+4), (ß = 0.22; p = 0.02). Serum copper concentration was also the higher, the later the age of onset was (ß = 0.33; p < 0.001), and the lower, the greater the number of illness episodes (ß = - 0.23; p = 0.02) (multiple regression model, adj R2 = 0.19, p = 0.0001). CONCLUSIONS: The dependencies demonstrated above may reflect pathophysiological processes that occur in the course of BD (e.g., inflammatory response and oxidative stress) with a different intensity depending on its stage.

Vortioxetine: A review of the pharmacology and clinical profile of the novel antidepressant.

The aim of this paper was to review the up-to-date evidence base on pharmacology and clinical properties of vortioxetine. Vortioxetine is a novel antidepressant, approved by the US Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD). Because vortioxetine exhibits both an antidepressant and anxiolytic effect, it may be effective in treating both depressive and anxiety disorders, such as generalized anxiety disorder (GAD). Based on its pharmacodynamics profile and preclinical studies, it is believe that the drug's clinical action is mediated mainly by selective blockade of serotonin reuptake (by inhibiting the serotonin transporter [SERT]) and direct modulation of 5-HT receptors activity (such as 5-HT3, 5-HT7, 5-HT1D and 5-HT1B). In patients with MDD the recommended doses range is 5-20mg/day. Vortioxetine was shown to be more effective than placebo both in MDD and GAD. In terms of side effects, nausea, vomiting, diarrhea, and dry mouth were most commonly observed in individuals receiving vortioxetine. In direct comparison to duloxetine, vortioxetine is found to have a smaller efficacy but had a lower risk of developing the common antidepressant-induced adverse effects.

Associations of Serum Cytokine Receptor Levels with Melancholia, Staging of Illness, Depressive and Manic Phases, and Severity of Depression in Bipolar Disorder.

To examine cytokine receptor biomarkers in bipolar disorder (BD), we recruited 133 well-phenotyped BD patients and 50 normal controls and measured serum levels of soluble interleukin 1 receptor antagonist (sIL-1RA), soluble interleukin-2 receptor (sIL-2R), sIL-6R, and tumor necrosis factor receptor 60 and 80 kDa (sTNFR60/80). sIL-1RA and sTNFR80 are significantly higher in BD than in controls and sTNFR80 and higher in melancholic than in non-melancholic patients and controls. Kapczinski's stages 3 + 4 are characterized by lowered sIL-2R and increased sTNFR80 levels. Acute phase depression is characterized by increased sTNFR80 levels as compared with controls, manic, and euthymic patients. Both sTNFR60 and sTNFR80 levels are significantly and positively related with severity of depression but not mania. Logistic regression analysis showed that the significant predictors for BD are increased sIL-1RA levels, nicotine dependence and a family history of depression and alcoholism. The risk factors for stages 3 + 4 are lowered sIL-2R levels and nicotine dependence. Melancholia is predicted by higher sTNFR80 levels and female sex. Severity of depression is predicted by female sex, nicotine dependence, and increased sTNFR60 and sTNFR80 levels. Cell-mediated immunity is activated during a current episode of depression but not (hypo)mania or the euthymic state. There are no associations between the biomarkers and age at onset, duration of illness, severity of mania, bipolar (BP)2 or BP1 subtypes, rapid cycling, atypical depression, psychotic or suicidal symptoms, and a family history of psychiatric disease. The results show that increased sIL-1RA may be a trait marker of BD, increased sTNFR80 a state marker of the depressive phase, especially melancholia, while lower sIL-2R but higher sTNFR80 may be staging biomarkers.

The serum zinc concentration as a potential biological marker in patients with major depressive disorder.

Despite many clinical trials assessing the role of zinc in major depressive disorder (MDD), the conclusions still remain ambiguous. The aim of the present clinical study was to determine and comparison the zinc concentration in the blood of MDD patients (active stage or remission) and healthy volunteers (controls), as well as to discuss its potential clinical usefulness as a biomarker of the disease. In this study 69 patients with current depressive episode, 45 patients in remission and 50 controls were enrolled. The zinc concentration was measured by electrothermal atomic absorption spectrometry (ET AAS). The obtained results revealed, that the zinc concentration in depressed phase were statistically lower than in the healthy volunteers [0.89 vs. 1.06 mg/L, respectively], while the zinc level in patients achieve remission was not significantly different from the controls [1.07 vs. 1.06 mg/L, respectively]. Additionally, among the patients achieve remission a significant differences in zinc concentration between group with and without presence of drug-resistance in the previous episode of depression were observed. Also, patients in remission demonstrated correlation between zinc level and the average number of depressive episodes in the last year. Serum zinc concentration was not dependent on atypical features of depression, presence of psychotic symptoms or melancholic syndrome, age, age of onset or duration of disease, number of episodes in the life time, duration of the episode/remission and severity of depression measured by the Hamilton Rating Scale for Depression (HDRS), and the Montgomery-Asberg Depression Rating Scale (MADRS). Concluding, our findings confirm the correlation between zinc deficit present in the depressive episode, and are consistent with the majority of previous studies. These results may also indicate that serum zinc concentration might be considered as a potential biological marker of MDD.

Phospholipid-protein balance in affective disorders: Analysis of human blood serum using Raman and FTIR spectroscopy. A pilot study.

Raman and FTIR (Fourier Transform Infra Red) spectroscopies provide information on the chemical structure of compounds through identification and analysis of functional groups. In the present study, both spectroscopic techniques were used for investigating the phospholipid - protein balance in blood serum of depressed subjects (major depressive disorder and bipolar disorder type I or II) taking also into account their age and gender. The obtained results were compared with those of healthy subjects. The Raman and FTIR (using ATR (Attenuated Total Reflectance) technique), spectra show that a correlation between the level of phospholipids and proteins exists. Indeed, in depressed subjects the quantity of phospholipids and proteins is lower, compared to healthy ones. The second derivative of FTIR spectra shows that phospholipids directly affect the structure of proteins and their functions. In all male depressed subjects a higher amount of phospholipids and proteins compared to female depressed subjects was measured, offering them faster recovery perspectives. Spectroscopy results show that the phospholipids' and proteins' levels are lower in depressed subjects from 41 to 65 compared to the age group between 20 and 40, independently from the gender. Consequently, this study shows that Raman and infrared spectroscopies might be applied as a diagnostic tool to evaluate the balance between phospholipids and proteins in blood serum as a potential biomarker in depressive disorders.

Study of the Serum Copper Levels in Patients with Major Depressive Disorder.

Copper may be involved in the pathophysiology of depression. Clinical data on this issue are very limited and not conclusive. The purpose of the study was to determine the copper concentration in the serum of patients with major depressive disorder and to discuss its potential clinical usefulness as a biomarker of the disease. A case-control clinical study included 69 patients with current depressive episode, 45 patients in remission and 50 healthy volunteers. Cu concentration was measured by electrothermal atomic absorption spectrometry (ETAAS). The mean serum copper level in depressed patients was slightly lower (by 11 %; not statistically significant) than in the control group. Furthermore, there was no significant difference in Cu2+ concentration between depressive episode and remission, nor between remission and control group. In the remission group were observed significant correlations between copper levels and the average number of relapses over the past years or time of remission. There was no correlation between serum copper and severity of depression, as measured by HDRS and MADRS. The obtained results showed no significant differences between the copper concentration in the blood serum of patients (both with current depressive episode and in remission) and healthy volunteers, as well as the lack of correlations between the copper level in the active stage of the disease and clinical features of the population. Our study is the first conducted on such a large population of patients, so the results may be particularly important and reliable source of knowledge about the potential role of copper in depression.

Lurasidone: The 2016 update on the pharmacology, efficacy and safety profile.

The aim of this paper was to review the up-to-date evidence base on pharmacology and clinical properties of lurasidone. Lurasidone is an atypical antipsychotic, approved by the US Food and Drug Administration (FDA) for the treatment of schizophrenia and bipolar depression. Lurasidone exhibits both an antipsychotic and antidepressant action. Based on its pharmacodynamics profile, it is believed that the drug's clinical action is mediated mainly through the D2, 5-HT2A and 5-HT7 receptors inhibition. In patients with schizophrenia the recommended dose range is 40-80mg/day. In bipolar depression broader dosage ranges (20-120mg/day) were found to be effective. In terms of side effects, higher rates of akathisia, parkinsonism and hyperprolactinemia were observed in individuals receiving lurasidone (as compared to patients treated with other atypical antipsychotics). On the other hand, treatment with lurasidone yields relatively lower risk for developing sedation or overweight/obesity.

Thiobarbituric Acid-Reactive Substances: Markers of an Acute Episode and a Late Stage of Bipolar Disorder.

BACKGROUND: Lowered antioxidant defense systems and increased oxidative stress are implicated in bipolar disorders (BD). Early and late stages of BD may present different biological features (including the level of oxidative stress) and may therefore require different treatment strategies. The aim of this study was to analyze serum levels of lipid peroxidation [measured as thiobarbituric acid-reactive substances (TBARS), a derivative of malondialdehyde] in BD patients at various stages and phases of the illness and compare their TBARS levels with those of healthy controls. METHOD: A total of 129 patients (58 in the depressive episode, 23 in the manic episode and 48 in remission) diagnosed with type I (n = 69) or type II (n = 60) BD and 50 healthy volunteers (control group) were enrolled in the study. The level of lipid peroxidation was measured in blood serum using a TBARS assay kit. RESULTS: TBARS levels in the acute episode of mania/hypomania and depression (but not in remission) were significantly higher than in healthy controls. With regard to the BD stage, both early- and late-stage BD TBARS levels were significantly increased in patients in the depressive episode. In late-stage BD, the TBARS level in patients in remission remained elevated compared with controls. A multiple regression model confirmed the association between the TBARS level and BD stage or acute BD. CONCLUSION: Our findings indicate that TBARS levels reflect the oxidative stress state which increases both in the acute phase of BD (mania/hypomania and depression) and with BD progression (stage).

Decreased serum zinc concentration during depressive episode in patients with bipolar disorder.

OBJECTIVES: Zinc may be involved in the pathophysiology and treatment of depressive disorder. However, data on this issue in bipolar disorder (BD) are limited. The aim of the study was to assess zinc concentrations in the blood serum of patients at various phases and stages of bipolar disorder. METHODS: The study included 129 patients with a diagnosis of bipolar disorder type I (n=69) or type II (n=60). Fifty-eight were in a depressive episode, 23 in a manic episode and 48 in remission. Fifty healthy volunteers made a control group. Zinc concentration was measured using flame atomic absorption spectrometry. RESULTS: Serum zinc level in patients diagnosed with BD type I in the depressive phase was significantly reduced as compared with mania, remission and healthy subjects. In the BD type II, serum zinc level in hypomania, depression or remission phase was not significantly different from the control group. In the whole group, lower level of zinc in depression compared to remission and control subjects was found during late stage of the illness but not in the early stage. Zinc concentration was not dependent on the severity of manic or depressive symptoms and subtype of depression but correlated positively with the number of manic/hypomanic relapses in the past year. LIMITATIONS: Lack of prospective model, heterogeneity of pharmacological treatment, small number of subgroups presenting specified clinical features. CONCLUSIONS: Decreased serum zinc concentration occurs in depression in BD type I and probably in depression in the late stage of BD.

A web-based study of bipolarity and impulsivity in athletes engaging in extreme and high-risk sports.

BACKGROUND: We hypothesised that men and women who engage in extreme or high-risk sports would score higher on standardised measures of bipolarity and impulsivity compared to age and gender matched controls. METHODS: Four-hundred and eighty extreme or high-risk athletes (255 males and 225 females) and 235 age-matched control persons (107 males and 128 females) were enrolled into the web-based case-control study. The Mood Disorder Questionnaire (MDQ) and Barratt Impulsiveness Scale (BIS-11) were administered to screen for bipolarity and impulsive behaviours, respectively. RESULTS: Results indicated that extreme or high-risk athletes had significantly higher scores of bipolarity and impulsivity, and lower scores on cognitive complexity of the BIS-11, compared to controls. Further, there were positive correlations between the MDQ and BIS-11 scores. CONCLUSION: These results showed greater rates of bipolarity and impulsivity, in the extreme or high-risk athletes, suggesting these measures are sensitive to high-risk behaviours.

[The place of quetiapine extended release in the treatment of mental disorders]. / Miejsce kwetiapiny o przedluzonym uwalnianiu w terapii osób z zaburzeniami psychicznymi.

This article presents a summary of available data on the use of quetiapine extended release (QUE-XR). QUE-XR is an example of an atypical antipsychotic drug that can be used in a single dose, thereby simplifying the treatment regimen. From the therapeutic standpoint, this issue is of paramount importance, since approximately 50% of patients have adherence issues. Therefore, availability of the drug which is comfortable in administration can significantly improve treatment outcomes. Due to its antipsychotic, antidepressive, mood stabilizing and anxiolytic efficacy, QUE-XR seems to be a promising drug with potentially broad spectrum of indications (in patients with schizophrenia, bipolar disorder, major depression and some anxiety disorders - both in the acute phase of treatment, and the maintenance treatment). Notably, QUE-XR seems to ameliorate sleep disturbances, and it may also improve patients' quality of life (as suggested by some studies). Due to the simple dosing regimen of QUE-XR, conducting therapy with this drug may contribute to the improvement of compliance. Yet, the primary clinical criterion for selection of the type of formulation of quetiapine should be the individual preferences of the patient, and the knowledge and experience of the treating physician.

The serum magnesium concentration as a potential state marker in patients with unipolar affective disorder.

AIM: The growing body of evidence suggests that magnesium levels can serve as a marker of major depressive disorder (MDD), but findings from clinical trials remain inconclusive. The aim of the presented study was to determine the magnesium concentration in serum of patients with MDD (in the active stage of the disease or in remission) and to analyze the role of magnesium levels as apotential marker of the disease. METHODS: Sixty-nine patients with current depressive episode, 45 patients in remission and 50 healthy volunteers were enrolled into the case-control study. The magnesium concentration was measured by flame atomic absorption spectrometry (FAAS). RESULTS: The mean serum magnesium concentration of patients in the depressed phase was significantly higher, compared to the control group. Moreover, magnesium levels of patients in the remission were not significantly different from the concentrations recorded in the healthy volunteers. There was also a positive correlation between the magnesium levels and the severity of depression measured by the Hamilton Rating Scale for Depression (HDRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). CONCLUSIONS: The obtained results may suggest a role of magnesium as a state marker reflecting the pathophysiological changes underlying MDD and accompanying severe depressive episodes.

The serum concentration of magnesium as a potential state marker in patients with diagnosis of bipolar disorder.

AIM: Few scientific reports indicate changes in the concentration of magnesium in the blood of patients with bipolar disorder (BD). So far very little studies concerning these issues have been conducted. Therefore, the aim of this study was to evaluate the serum magnesium level in patients with bipolar disorder (in different phases of the disease) in comparison to healthy volunteers. METHODS: The study included 129 patients (58 subjects in depressive episode, 23 in manic episode and 48 patients in remission) with the diagnosis of bipolar disorder type I or II. The control group consisted of 50 healthy people. Magnesium concentration was measured using flame atomic absorption spectrometry (FAAS). RESULTS: Patients with a current depressive or manic/hypomanic episode had statistically significantly elevated serum magnesium levels compared to healthy volunteers. Moreover, a positive correlation between the duration of the manic/hypomanic episode and the relapse frequency in the last year was observed. The concentration of magnesium in patients in remission was unchanged in relation to the control group. CONCLUSIONS: Presented findings suggest a role of serum magnesium level as a potential state marker, reflecting the pathophysiological changes associated with acute episodes of bipolar disorder.

Temperamental dimensions of the TEMPS-A in male and female subjects engaging in extreme or/and high risk sports.

OBJECTIVES: We investigated temperamental dimensions of the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPS-A) as well as bipolarity features in male and female subjects engaging in extreme or/and high risk sports. METHODS: The web-based case-control study was performed in 480 subjects engaging in extreme or/and high risk sports (255 male, 225 female) aged 26 ± 6 years and in 235 age- and sex-matched healthy controls subjects (107 male, 128 female), aged 28 + 9 years. The TEMPS-A questionnaire, 110 questions version, has been used, evaluating five temperament domains: depressive, cyclothymic, hyperthymic, irritable and anxious. The Mood Disorder Questionnaire (MDQ) was employed for the assessment of bipolarity. RESULTS: Both male and female athletes had significantly higher scores of hyperthymic temperaments compared with control male and female subjects who had declared themselves as not involved into the activities of extreme or/and high risk sports. In addition, compared with controls, male sportsmen had lower scores of depressive and anxious temperaments, and female athletes had higher scores of cyclothymic and irritable temperaments. Both male and female athletes obtained significantly higher scores of bipolarity as measured by the MDQ, than control men and women. LIMITATIONS: Web-based study involving a risk of selection and recall bias, problematic homogeneity of the experimental group. CONCLUSIONS: Subjects engaged into extreme or/and high risk sports have significantly higher scores of hyperthymic temperament, measured by the TEMPS-A and present sex-specific features of other temperaments. Such subjects obtain also greater bipolarity scores as measured by the MDQ.