Objective The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. Method An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. Results There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Conclusions Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.

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Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause. For its management, experts agreed in considering verbal de-escalation and environmental modification techniques as first choice, considering physical restraint as a last resort strategy. Regarding pharmacological treatment, the "ideal" medication should calm without over-sedate. Generally, oral or inhaled formulations should be preferred over i.m. routes in mildly agitated patients. Intravenous treatments should be avoided.

Background:The current paper introduces the actual International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder.Concept and structure of the guidelines:The current clinical guidelines are based on evidence-based data, but they also intend to be clinically useful, while a rigid algorithm was developed on the basis of firm evidence alone. Monotherapy was prioritized over combination therapy. There are separate recommendations for each of the major phases of bipolar disorder expressed as a 5-step algorithm.Discussion:The current International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder are the most up-to-date guidance and are as evidence based as possible. They also include recommendations concerning the use of psychotherapeutic interventions, again on the basis of available evidence. This adherence of the workgroup to the evidence in a clinically oriented way helped to clarify the role of specific antidepressants and traditional agents like lithium, valproate, or carbamazepine. The additional focus on specific clinical characteristics, including predominant polarity, mixed features, and rapid cycling, is also a novel approach. Many issues need further studies, data are sparse and insufficient, and many questions remain unanswered. The most important and still unmet need is to merge all the guidelines that concern different phases of the illness into a single one and in this way consider BD as a single unified disorder, which is the real world fact. However, to date the research data do not permit such a unified approach.

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Highlights During the lockdown. Two thirds of university students reported at least ‘much’ increase in anxiety. One third in depressive feelings and. 2.59% an increase in suicidal thoughts. Major depression was present in 12.43%. Severe distress was present in 13.46%. Risk factors were:. Female sex. History of self-injury. History of suicidal attempts. Following studies of law, literature, pedagogics, political sciences and related studies as well as technical but not health sciences. Beliefs in conspiracy theories. Enjoyed acceptance ranging from 20 to 68%. Students of law, literature, pedagogics, political sciences and related studies manifested higher acceptance rates.

Aim ofthe study: To validate the MMSE in Greece. Materials and Methods: 151 subjects took part in the study-64 non-demented subjects (42 males and 22 females) and 87 demented patients (44 males and 43 females), sufferingfrom mild to severe dementia ofvarious types (Alzheimer's disease, vascular dementia, and dementia secondary to other causes). The dementedpatients' age was 68.05 ± 11.72 years (mean ± standard deviation), their education 5.71 ± 2.95 years. The normal subjects' age was 68.57 ± 10.32 years and education was 6.18 ± 3.20 years. The diagnosis was made according to the DSM-IV and the NINCDS-ADRDA diagnostic criteria. Results: MMSE appeared to be valid during test and retest with a Spearman 's coefficient p = 0.98 (p < 0.001). At the score level of23/24, sensitivity is 90.80, specificity 90.62 andpositive predictive value (PPV) of92.94. Conclusion: The present study confirms the MMSE score 23/24 as a valid cutoff levelfor the diagnosis of dementia in Greece.

Introduction: The aim of the current study was to assess the reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies-Depression Scale (CES-D).