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BACKGROUND: In addition to factors intrinsic to bipolar disorder (BD), sexual functioning (SF) can be affected by extrinsic causes, such as psychotropic drugs. However, the effect of mood stabilizers on SF and quality of life (QoL) is an underexplored research area. AIM: To analyze SF in BD outpatients in euthymia for at least 6 months treated only with mood stabilizers and the association between SF and QoL. METHODS: A multicenter cross-sectional study was conducted in 114 BD outpatients treated with (i) lithium alone (L group); (ii) anticonvulsants alone (valproate or lamotrigine; A group); (iii) lithium plus anticonvulsants (L+A group); or (iv) lithium plus benzodiazepines (L+B group). The Changes in Sexual Functioning Questionnaire Short Form (CSFQ-14) was used. Statistical analyses were performed to compare CSFQ-14 scores among the pharmacological groups. An adaptive lasso was used to identify potential confounding variables, and linear regression models were used to study the association of the CSFQ-14 with QoL. MAIN OUTCOME MEASURES: Self-reports on phases of the sexual response cycle (ie, desire, arousal, and orgasm) and QoL were assessed. RESULTS: The A group had better total SF scores than the L group and the L+B group. Relative to the A group, the L and L+B groups had worse sexual desire; the L group had worse sexual arousal; and the L+A group and the L+B group had worse sexual orgasm. Regarding sociodemographic factors, being female and older age were associated with worse total SF and all subscale scores. Among all subscales scores, higher sexual arousal scores were associated with better QoL. CLINICAL IMPLICATIONS: Potential modified extrinsic factors such as psychotropic medication that can affect SF can be addressed and adjusted to lessen side effects on SF. STRENGTHS & LIMITATIONS: Sample of patients with euthymic BD in treatment with mood stabilizers and no antipsychotics or antidepressants, substance use as an exclusion criterion, and use of a validated, gender-specific scale to evaluate SF. Major limitations were cross-sectional design, sample size, and lack of information about stability of relationship with partner. CONCLUSIONS: Lithium in monotherapy or in combination with benzodiazepines is related to worse total SF and worse sexual desire than anticonvulsants in monotherapy. While the addition of benzodiazepines or anticonvulsants to lithium negatively affects sexual orgasm, sexual arousal (which plays a significant role in QoL) improves when benzodiazepines are added to lithium. Anticonvulsants in monotherapy have the least negative effects on SF in patients with BD. García-Blanco A, García-Portilla MP, Fuente-Tomás L de la, et al. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. J Sex Med 2020;17:930-940.

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In a cyclical and recurring illness such as bipolar disorder, prodrome detection is of vital importance. This paper describes manic and depressive prodromal symptoms to relapse, methods used in their detection, problems inherent in their assessment, and patients' coping strategies. A review of the literature on the issue was performed using MEDLINE and EMBASE databases (1965-May 2006). 'Bipolar disorder', 'prodromes', 'early symptoms', 'coping', 'manic' and 'depression' were entered as key words. A hand search was conducted simultaneously and the references of the articles found were used to locate additional articles. The most common depressive prodromes are mood changes, psychomotor symptoms and increased anxiety; the most frequent manic prodromes are sleep disturbances, psychotic symptoms and mood changes. The manic prodromes also last longer. Certain psychological interventions, both at the individual and psychoeducational group level, have proven effective, especially in preventing manic episodes. Bipolar patients are highly capable of detecting prodromal symptoms to relapse, although they do find the depressive ones harder to identify. Learning detection, coping strategies and idiosyncratic prodromes are elements that should be incorporated into daily clinical practice with bipolar patients.

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Como consecuencia de la desinstitucionalización de los pacientes psiquiátricos, el papel de los cuidadores ha adquirido un interés relevante a lo largo de los últimos años. Con el objetivo de conocer el impacto de la enfermedad en los cuidadores, 88 familiares de pacientes diagnosticados de trastorno bipolar (DSM-IV) completaron un cuestionario autoadministrado que recogía información sobre variados aspectos clínicos, sociodemográficos, carga experimentada, actitudes y conocimientos acerca de la enfermedad, entre otras cuestiones. Encontramos que los familiares necesitaban con frecuencia ayuda psiquiátrica por el estrés generado por la enfermedad, percibían afectación en los planos laboral, lúdico y económico, junto con la estigmatización social. Resultaban de gran ayuda en la cumpliementación terapéutica y la información recibida acerca de la enfermedad y los recursos destinados eran percibidos como insuficientes. También se obtuvo información de las parejas que describían afectación en las relaciones conyugales, sexuales y en la crianza. Es necesario, por tanto, identificar aquellos factores que contribuyen al estrés familiar. Intervenciones como los grupos psicoeducativos pueden mejorar el conocimiento de la enfermedad y mejorar las técnicas de afrontamiento

As a result of the progressive deinstitutionalization of psychiatric patients, there has been a growing interest in the role of carers over the past few years. In order to find out about the impact of the illness on carers, 88 relatives of patients diagnosed with bipolar disorder (DSM-IV) were asked to complete a self-administered questionnaire. This contained 65 ítems, covering, a mong others, various clinical and demographic aspects, the burden felt by relatives, their knowledge of the illness and attitudes towards it. It was found that a high percentage of relatives needed psychiatric help. They experienced disruption to their work, economic and social lives, as well as suffering a social stigma. While making a major contribution to the implementation of treatment, they complained of lack of information about the nature of the disorder and limited resources. Spouses, who were also questioned, described the high impact on their marital and sexual relationships and co-parenting. It is therefore necessary to identify the factors that contribute to stress on the family. Psychoeducational groups for relatives can help to do so, improving their coping skills skills and knowledge of the illness, and reducing their distress and subjective burden

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