Linguistic anomalies observed in the Sentence Completion Test in patients with schizophrenia.

BACKGROUND: Schizophrenia is a chronic, debilitating disorder characterised by distorted thinking, perceptions, behaviours, and even language impairments. We investigated the linguistic anomalies in Korean schizophrenia patients compared to non-psychotic psychiatric controls to determine whether the linguistic anomalies in English speakers with schizophrenia were replicated in Korean speakers. METHODS: Thirty-four schizophrenia patients and 70 non-psychotic psychiatric controls were included in this study. The SCT was utilised as the text data for analysis. For linguistic analysis, we evaluated texts regarding semantics and syntax. We separately counted the number of semantic or syntactic errors in the written texts of study participants and compared them between patients and controls. RESULTS: Schizophrenia patients showed significantly more semantic errors (p < .001) and syntactic errors (p < .001) per 1,000 characters than non-psychotic psychiatric controls. Specifically, inappropriate word or syntactic component selection is noticeable in schizophrenia patients. These differences were still significant after adjusting for general intelligence measured by the K-WAIS-IV. CONCLUSION: Schizophrenia patients showed both semantic and syntactic errors in written language. Moreover, these errors seemed to be partly independent of general intelligence. Notably, patients showed a noticeable number of syntactic errors. Further investigation into the language of patients with schizophrenia and schizophrenia-spectrum disorders is required.

Fever as a Side Effect after Electroconvulsive Therapy.

BACKGROUND: Electroconvulsive therapy (ECT) is the most important and safe nonpharmacological treatment for psychiatric disorders. Some patients experience unexplained fever after ECT, but only a few studies have reported on this. METHOD: We investigated fever after ECT by retrospectively reviewing the medical records of patients. Patients treated at the ECT unit of the Department of Psychiatry at Asan Medical Center, Seoul, South Korea, between 30 June 2004 and 30 June 2019, were included. Differences in variables were compared between groups with or without fever after ECT sessions. RESULT: There were 28 patients (8.8%) in the fever group. Forty-three ECT sessions (1.5%) resulted in fever after treatment. The female-to-male ratio was higher in the fever group than in the control group, and the mean number of total ECT sessions was also higher in the fever group than in the control group, but there were no other differences between the 2 groups. CONCLUSION: Comparing fever and control sessions, fever sessions relatively preceded control sessions and had a longer seizure duration. Postictal delirium occurred more often in the fever sessions than in control sessions. Fever sessions had a higher white blood cell count and lower concomitant quetiapine dosage than control sessions. Because 8.8% of patients who received ECT experienced fever after treatment more than once, fever after ECT is considered to be a common side effect.

Antidepressant Prescription Patterns in Bipolar Disorder: a Nationwide, Register-based Study in Korea.

BACKGROUND: The role of antidepressants (ADs) in bipolar disorder is long-standing controversial issue in psychiatry. Many clinicians have used ADs as a treatment for bipolar depression, and the selection of therapeutic agents is very diverse and inconsistent. This study aimed to examine recent AD prescription patterns for patients with bipolar disorder in Korea, using the nationwide, population-based data. METHODS: This study utilized the Korean nationwide, whole population-based registry data of the year 2010, 2011, and 2013. All prescription data of the ADs, antipsychotics, and mood stabilizers of the sampled patients diagnosed with bipolar disorder (n = 2,022 [in 2010]; 2,038 [in 2011]; 2,626 [in 2013]) were analyzed for each year. RESULTS: Annual prescription rate of ADs was 27.3%-33.6% in bipolar disorder, which was gradually increasing over the 3-year period. The combination pattern of ADs and antipsychotic drugs tended to increase over 3 years. The proportion of females and the prevalence of comorbid anxiety disorder were significantly higher in AD user group in all three years. Among individual ADs, escitalopram was prescribed most frequently, and fluoxetine and bupropion were prescribed to the next many patients. The mean duration of bipolar depressive episodes was 135.90-152.53 days, of which ADs were prescribed for 115.60-121.98 days. CONCLUSION: Our results show prescription rate of ADs in bipolar disorder was maintained at substantial level and increased in recent 3 years. More empirical data and evidence are needed to establish practical treatment consensuses.

Pattern of pharmacotherapy by episode types for patients with bipolar disorders and its concordance with treatment guidelines.

This study aimed to investigate the overall prescription pattern for patients with bipolar disorders in Korea and its relevance to the practice guidelines. Prescription records from all patients with bipolar I and II disorders who have been admitted or who started the outpatient treatment during the year of 2009 in 10 academic setting hospitals were reviewed. A total of 1447 patients with bipolar I and II disorders were included in this study. Longitudinal prescription patterns of inpatients and outpatients were analyzed by episode types and compared with the clinical practice guideline algorithms. In all phases, polypharmacy was chosen as an initial treatment strategy (>80%). The combination of mood stabilizer and atypical antipsychotics was the most favored. Antipsychotics were prescribed in more than 80% of subjects across all phases. The rate of antidepressant use ranged from 15% to 40%, and it was more frequently used in acute treatment and bipolar II subjects. The concordance rate of prescriptions for manic inpatients to the guidelines was higher and relatively more consistent (43.8%-48.7%) compared with that for depressive inpatients (18.6%-46.9%). Polypharmacy was the most common reason for nonconcordance. In Korean psychiatric academic setting, polypharmacy and atypical antipsychotics were prominently favored in the treatment of bipolar disorder, even with the lack of evidence of its superiority. More evidence is needed to establish suitable treatment strategies. In particular, the treatment strategy for acute bipolar depression awaits more consensuses.

Metabolic syndrome and elevated C-reactive protein levels in elderly patients with newly diagnosed depression.

BACKGROUND: Depression and metabolic syndrome (MeS) are prevalent in elderly people and are associated with adverse outcomes, especially cardiovascular disease. Increased C-reactive protein (CRP) levels are a risk factor for depression and chronic medical disorders, such as cardiovascular disease and MeS. OBJECTIVE: The aim of this study was to evaluate the risk of MeS and CRP levels in elderly (>60y) patients with newly-diagnosed major depressive disorder. METHODS: We enrolled 30 subjects with newly diagnosed depression and 30 age- and sex-matched controls who presented for a health examination at Asan Medical Center, Seoul, Korea. Sociodemographic, MeS components, and CRP were measured before starting treatment with antidepressants. RESULTS: There were no significant differences in sociodemographic characteristics or lifestyle factors between depressive and healthy control patients. The newly-diagnosed depression group showed a significantly increased risk of MeS (odds ratio = 4.75, 95% CI: 1.58-14.25) compared with the control group. Of the 5 MeS components examined, only waist circumference was significantly different between the 2 groups (odds ratio = 4.33, 95% CI: 1.20-15.61). Elevated CRP levels were significantly associated with an increased risk for depression (odds ratio = 4.57, 95% 1.45-14.39). CONCLUSIONS: The risks of MeS and elevated CRP levels are higher in elderly patients with depression than in normal subjects. Physicians need to be alert to these cardiovascular risk factors when diagnosing and prescribing antidepressants for depression in the elderly. Clinical investigators are encouraged to assess markers of inflammation and review detailed information on risk factors such as waist circumference for MeS in patients with depression.

Case report: bipolar disorder as the first manifestation of CADASIL.

BACKGROUND: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebrovascular disease, clinically characterized by variable manifestations of migraine, recurrent transient ischemic attack or lacunar strokes, cognitive decline, and mood disturbances. However, manic episodes have rarely been documented as an initial symptom of CADASIL and bipolar disorder presenting as the first manifestation in CADASIL has not been reported previously from evaluations by psychiatrists or psychological testing by psychologists. CASE PRESENTATION: A 53 year old woman developed symptoms of mania in her 50s leading to a personality change involving a continuously labile mood and irritability over a number of years. Neuropsychological testing revealed an intact memory, but impairment in attention and executive function. In the Rorschach test, she showed a high level of cognitive rigidity. Magnetic resonance imaging findings were very consistent with a diagnosis of CADASIL, which was confirmed by genetic testing for NOTCH3 mutations. Atypical antipsychotics proved to be helpful in treating her manic symptoms and for behavior control. CONCLUSION: We present a novel case of CADASIL that first presented as bipolar disorder. We contend that when patients show a late onset personality change or chronically irritable mood that deteriorates over many years, an organic cause such as CADASIL must be considered. Further studies are needed to better understand the exact impacts of cerebral tissue lesions and psychiatric symptoms in CADASIL patients.

Revisiting Rorschach test and Minnesota Multiphasic Personality Inventory-II patterns in Kraepelinian vs. DSM-wise Schizophrenia: How They Differ and What It Means for Diagnosis.

OBJECTIVE: This retrospective chart review study aimed to investigate the differences in the Rorschach test and Minnesota Multiphasic Personality Inventory (MMPI)-II profiles among patients with Kraepelinian schizophrenia, those with DSM-wise schizophrenia, and controls. Kraepelinian schizophrenia is characterised by a chronic, deteriorative disease course and a predominance of negative symptoms. METHODS: Patients with Kraepelinian schizophrenia were selected based on medical record reviews. We then compared their Rorschach test and MMPI-II results with those of the DSM-wise schizophrenia group and the control group. RESULTS: The Rorschach test revealed a significant increase in DV2 score and a decrease in D score in patients with Kraepelinian schizophrenia compared to those with DSM-wise schizophrenia. In the MMPI-II profiles, patients with Kraepelinian schizophrenia exhibited an elevated L relative to those with DSM-wise schizophrenia. CONCLUSION: Our results suggested the value of revisiting psychological tests in clinically delineated subgroups, such as Kraepelinian schizophrenia. Although patients fall under the same diagnostic category of schizophrenia, considering different phenotypes is important when interpreting psychological test outcomes. Additionally, our study indicated that both schizophrenia groups did not show as many abnormalities as expected compared to controls. This highlights the potential value of revisiting established profiles of certain psychological tests and calls for further research on other psychological tests.

Prevalence and Correlates of Suicidal Ideation among Psycho-Oncology Outpatients.

PURPOSE: The characteristics of suicidal ideation among psycho-oncology outpatients remain unexplored. This study determined the prevalence and risk factors of suicidal ideation among patients in a psycho-oncology outpatient clinic. MATERIALS AND METHODS: The prevalence of suicidal ideation during the previous 2 weeks among 545 psycho-oncology outpatients aged 80 years or below was determined using the Patient Health Questionnaire-9 Item 9. Descriptive analyses, including the prevalence of suicidal ideation, were performed. After multiple imputation, multivariable logistic regression was performed using demographic and clinical variables and functional (the Functional Assessment of Cancer Therapy-General) and emotional status (the Hospital Anxiety and Depression Scale and the distress thermometer). RESULTS: There were 252 (46.2%) suicidal ideators. After adjusting for sex and age, active disease [odds ratio (OR)=1.708, 95% confidence interval (CI)=1.049-2.780], lower levels of physical (OR=0.948, 95% CI=0.905-0.992) and emotional well-being (OR=0.925, 95% CI=0.875-0.978), and higher degrees of depressive symptoms (OR=1.126, 95% CI=1.036-1.224) and psychological distress (OR=1.201, 95% CI=1.071-1.347) were associated with suicidal ideation. CONCLUSION: Approximately half of the psycho-oncology outpatients experienced suicidal ideation, emphasizing the importance of identifying and understanding the risk factors of suicidal ideation specific to this group. For those who are under active cancer treatment, show poorer physical and emotional well-being, and report more severe depressive symptoms and psychological distress, a thorough evaluation of suicidal ideation needs to be performed.

Linguistic anomalies in the language of patients with schizophrenia.

In terms of thought disorder, the language of patients with schizophrenia itself could be a valuable resource. Some valuable studies on the language of patients with schizophrenia have been performed. However, most such studies have been confined to English-speaking countries, or at least those where Indo-European languages are spoken. Therefore, we investigated linguistic anomalies in the language of Korean patients with schizophrenia. Short texts written by 69 patients with schizophrenia from a single mental hospital and matched normal control participants were analyzed. We evaluated these texts in terms of semantic and syntactic errors. Then, we compared the error rates adjusted for text length between patients and normal control participants. We also divided the patients with schizophrenia into two groups by their duration of illness and compared these two groups to investigate the relationship between the duration of illness and linguistic anomalies. The patients with schizophrenia committed a total of 1.86 (2.52) semantic errors and 1.37 (1.79) syntactic errors per 100 characters, which were significantly more frequent than errors committed by normal control participants. Furthermore, there was a notably high number of semantic errors relative to syntactic errors in the language of patients with schizophrenia. Our study results are consistent with previous studies from English-speaking countries, implying that the linguistic anomalies of patients with schizophrenia are not confined to a single language. Because language is essential in mental function, further research on linguistic anomalies in patients with schizophrenia is recommended.

Heart rate variability in the subsyndromal depressive phase of bipolar disorder.

AIMS: To compare the heart rate variability of bipolar patients in the subsyndromal depressive phase with healthy controls and to evaluate the relationship between severity of subsyndromal depressive symptoms and heart rate variability. METHODS: Thirty-three bipolar patients in the subsyndromal depressive phase and 59 healthy controls were enrolled. A patient was considered to be in a subsyndromal depressive phase when the Montgomery-Åsberg depression rating scale score was ≤10 and the Clinical Global Impression-Severity scale (CGI-S) was ≤3 for the previous 1 month. After approximately 10 min of supine rest, all participants underwent resting electrocardiograms for 5 min in the supine position using limb leads. Different parameters of heart rate variability were analyzed in the time and frequency domains. RESULTS: Bipolar patients had significantly lower standard deviation of all RR intervals (SDNN), proportion of adjacent NN intervals that differ by >50 ms (pNN50), log total power (log TP) and very low frequency power (VLF) compared to healthy controls. There were significant negative correlations between CGI-S score and some heart rate variability parameters, including heart rate variability index, SDNN, root mean square successive difference (RMSSD), pNN50, log TP, VLF, low frequency power (LF) and high frequency power (HF). CONCLUSION: Patients with bipolar disorder in the subsyndromal depressive state have reduced heart rate variability relative to healthy controls, and reduction of heart rate variability appears to be correlated with severity of symptoms in bipolar patients.

Personality traits and affective morbidity in patients with bipolar I disorder: the five-factor model perspective.

In this study, we aimed to extend the present knowledge regarding the relationship of personality traits, as specified by the five-factor model (FFM), with the affective morbidity of bipolar I disorder. The primary aim of this study is to investigate the association of personality traits with affective morbidity, particularly with hospitalization for depressive, manic, or mixed episodes, in patients with bipolar I disorder. The Revised NEO Personality Inventory was administered to 83 subjects who showed a euthymic mood state. Multivariate Poisson regression analysis was performed to identify associations between five domains of personality and the number of hospitalizations for affective episode(s) (manic, depressive, and mixed state). As a secondary research interest, we attempted to determine personality traits which would be significantly different between subjects with Affective Switch from mania into depression Without Euthymia (ASWE) and non-ASWE. The Neuroticism score was positively associated with the number of hospitalization for depression and the total number of hospitalizations Extraversion and Openness scores showed a negative relationship with the number of hospitalizations for depression and the total number of hospitalizations. We found that ASWE patients showed significantly higher Neuroticism scores than did the non-ASWE group. However, there was no significant association between the hospitalization for manic episode and any particular personality trait based on the FFM. This study reveals that personality traits based on the FFM may contribute to an increased likelihood of depressive morbidity and switch into depression.

Interaction between genetic variants of DLGAP3 and SLC1A1 affecting the risk of atypical antipsychotics-induced obsessive-compulsive symptoms.

Adverse effects of atypical antipsychotics (AAP) can include obsessive-compulsive (OC) symptoms. Based on biological evidence of the relationship between the glutamatergic system and both OC disorder and AAP, this study aimed to determine whether DLGAP3, coding a post-synaptic scaffolding protein of glutamatergic synapses, is associated with AAP-induced OC symptoms. Furthermore, we explored the interactions between DLGAP3 and a previously reported susceptibility gene, the glutamate transporter gene SLC1A1, regarding this phenotype. Subjects were clinically stable schizophrenia patients receiving AAP treatment (n = 94), and they comprised an OC group (n = 40) and a non-OC group (n = 54) (patients with and without AAP-induced OC symptoms, respectively). We performed allelic/genotypic/haplotype association analyses for seven tag single-nucleotide polymorphisms of DLGAP3 and gene-gene interaction analyses with rs2228622 of SLC1A1, observing a nominally significant association between AAP-induced OC symptoms and rs7525948 in both simple chi-square tests and the regression analyses (nominal P < 0.05). In the logistic regression analysis of gene-gene interaction, we found a significant interaction effect of rs7525948 of DLGAP3 and rs2228622 of SLC1A1 (permutation P = 0.036) on AAP-induced OC symptoms, with a 30.2 times higher odds for individuals carrying risk genotypes at both loci in comparison with the reference group, which had no risk genotypes. This study provides suggestive evidence that DLGAP3 and its interactive effect with SLC1A1 might be involved in susceptibility to developing OC symptoms in schizophrenia patients receiving AAP treatment.

Characteristics of Patients Presenting to a Psycho-Oncology Outpatient Clinic.

OBJECTIVE: We aimed to determine the overall profile of patients in a psycho-oncology clinic and the differences in their characteristics according to the cancer site. METHODS: The charts of 740 patients aged under 81 years were reviewed. The data from 586 completed questionnaires were subjected to multiple comparison analyses using one-way analysis of variance to examine the demographic and clinical differences according to the cancer site. RESULTS: Most (n=532, 71.9%) patients were referred. Most new patients (n=426, 96.6%) received a psychiatric diagnosis; the most common diagnosis was depressive disorder (n=234, 31.6%). Likewise, depressive disorder accounted for the majority of diagnoses in all groups except for the digestive system cancer group in which sleep-wake disorder was the most prevalent. The female genital cancer group showed a higher level of anxiety symptoms than other groups, except for breast and haematolymphoid cancer groups, and psychological distress than all other groups. CONCLUSION: There appear to be delays in the referral of cancer patients seeking psychiatric help to a psycho-oncology clinic. Along with tailoring approaches by cancer site, thorough evaluation and appropriate management of sleep-wake and anxiety symptoms are important for digestive system and female genital cancer patients, respectively.

Factors associated with post-electroconvulsive therapy delirium: A retrospective chart review study.

ABSTRACT: Although electroconvulsive therapy (ECT) is generally a safe therapeutic method, unexpected adverse effects, such as post-ECT delirium, may occur. Despite its harmful consequences, there has been little discussion about the predictors of post-ECT delirium. Thus, the current study aimed to clarify the factors associated with post-ECT delirium by reviewing electronic medical records of 268 bitemporal ECT sessions from December 2006 to July 2018 in a university hospital.Demographic and clinical characteristics of sessions involving patients with or without post-ECT delirium were compared. Multiple logistic regression analysis was applied to analyze the correlation between variables and post-ECT delirium.Post-ECT delirium developed in 23 sessions (8.6%). Of all the demographic and clinical variables measured, only etomidate use was significantly different between delirium-positive and delirium-negative groups after Bonferroni correction. The regression model also indicated that etomidate use to be significantly associated with post-ECT delirium.In this study, etomidate was associated with a higher risk of developing post-ECT delirium, an association that appeared unrelated to other possible measured variables. Practitioners should take into account the risk of post-ECT delirium while choosing anesthetics, so as to prevent early discontinuation before sufficient therapeutic gain is achieved.

Sex-different association of DAO with schizophrenia in Koreans.

The gene encoding D-amino acid oxidase (DAO), which acts as a receptor for the schizophrenia-associated neurotransmitter, N-methyl-D-aspartate (NMDA), is regarded as a potential candidate gene for schizophrenia. However, the potential association of the DAO gene with schizophrenia has been the subject of some debate. Here, we tested three single nucleotide polymorphisms (SNPs) of DAO in a group of Korean schizophrenia patients, and found no significant association in the overall study subjects. Interestingly, however, we found gender-specific differences in allele distributions, with SNP rs2070586 appearing to act as a risk allele in female schizophrenia patients, but as a protective allele in males. Our data support the hypothesis that DAO plays a role in schizophrenia, possibly in a gender-dependent manner.

Rapamycin increases the incidence of neuropsychiatric illness in kidney transplant patients through the suppression of neural stem cells.

Rapamycin inhibits protein translation in cells, including neural stem cells (NSCs), by suppressing the mechanistic target of rapamycin (mTOR). This drug has been widely used together with calcineurin inhibitors in transplantation patients to prevent graft rejection. Previous studies have reported an association between mTOR and depression, but few investigations of this have occurred in transplant recipients. We have here tested the psychiatric effects of rapamycin in mice. The animals treated with rapamycin showed decreased locomotion and sugar consumption. In these rapamycin-treated mice also, the granule cells in the dentate gyrus (DG), which actively differentiate and proliferate from NSC, showed decreases in both excitatory and inhibitory synaptic transmission. Furthermore, the SOX2/NeuN ratio in the DG was decreased in mice treated with rapamycin. We further show that kidney transplantation patients who are receiving rapamycin have more psychiatric disorder such as adjustment disorder. Clinical attention is thus needed when administering rapamycin to transplant recipients due to its behavioral effects and its impact on NSC.

Preliminary evidence on the association between XBP1-116C/G polymorphism and response to prophylactic treatment with valproate in bipolar disorders.

The 116C/G polymorphism in the promoter region of XBP1 is known to be associated with bipolar disorders. The G allele of the XBP1-116C/G polymorphism has reduced XBP1-dependent transcription activity compared with the C allele. Valproate treatment has been known to rescue the impaired response of cells with the G allele. We investigated the hypothesis that the G allele of XBP1-116C/G has better prophylactic treatment response to valproate compared to the C allele. This study involved 51 patients with bipolar disorder who were treated with valproate for prophylactic treatment. Prophylactic treatment response to valproate was retrospectively assessed using a scale described by Grof et al. [Grof, P., Duffy, A., Cavazzoni, P., Grof, E., Garnham, J., MacDougall, M., O'Donovan, C., Alda, M., 2002. Is response to prophylactic lithium a familial trait? Journal of Clinical Psychiatry 63, 942-947.]. We found that the patients with the G allele of XBP1-116C/G showed a better prophylactic treatment response to valproate compared to the C allele. This result is in agreement with in-vitro data showing that valproate ameliorates the endoplasmic reticulum (ER)-stress response compromised by the G allele.

Ethnic differences in brain-derived neurotrophic factor Val66Met polymorphism in Croatian and Korean healthy participants.

AIM: To compare the frequency of alleles and genotypes in brain-derived neurotrophic factor (BDNF) val66met polymorphism in ethnically homogenous Caucasian (from Croatia) and ethnically homogenous Asian (from South Korea) healthy participants, as inter-population differences in BDNF val66met may be responsible for the divergent findings in genetic and association studies. METHODS: BDNF val66met was genotyped in 800 (556 Croatian and 244 Korean) healthy participants. Frequencies of alleles and genotypes were evaluated using a chi(2) test. RESULTS: The frequencies for genotypes (chi(2)2=114.69; P<0.001) and alleles (chi(2)1=120.07; P<0.001) between Korean and Croatian individuals differed significantly, due to significantly lower (46.3% and 19.5%, P<0.001) frequency of "Met" allele and significantly higher (53.7% and 80.5%, P<0.001) frequency of "Val" allele in Croatian than in Korean participants. CONCLUSION: The study found significant ethnic differences in BDNF val66met polymorphism. The most frequent genotype among Korean participants was "Met/Val" and they had similar distribution of "Met" and "Val" alleles. In contrast, the most frequent genotype among Caucasian participants was "Val/Val" and they had different distribution of "Met" and "Val" alleles. These ethnic differences require matching participants for ethnicity in pharmacogenetic studies and in the studies investigating genetic variations in neuropsychiatric disorders.

Weight change in the acute treatment of bipolar I disorder: a naturalistic observational study of psychiatric inpatients.

BACKGROUND: Bipolar patients have increased prevalence rates of overweight and obesity compared with the general population. Recent increases in the use of atypical antipsychotics and combination therapies have led to growing concern about obesity and metabolic disturbances. We therefore evaluated weight change and its correlates during the treatment of acute mania in a closed-ward hospital setting. METHODS: We evaluated weight change over 4 weeks in 179 consecutive patients with bipolar I disorder presenting with acute manic symptoms. RESULTS: Overall weight change was +2.7+/-3.0 kg (+4.6+/-5.2%). Whereas 24.6% of patients were obese at baseline, 36.3% were obese after 4 weeks. Duration of illness was correlated with weight change, but its effect was not robust. Baseline weight/BMI, sex, age of onset, and history of previous medication were not significantly correlated with weight changes. Patients prescribed olanzapine plus valproate showed the largest increase in weight (3.8+/-2.9 kg). Overall, patients on any kind of atypical antipsychotics showed greater weight gain than those on typical antipsychotics or without antipsychotics. Combination treatment with antipsychotics and mood stabilizer resulted in greater weight gain than monotherapy with an antipsychotic or mood stabilizer. LIMITATIONS: The short-term assessment (4 weeks) of weight change and the lack of variables previously reported to be related to weight gain, such as number of depressive episodes, warrant caution in the interpretation of our results. CONCLUSIONS: Even during short period of acute treatment, bipolar patients showed significant weight gain and became obese in a closed-ward setting. Clinicians prescribing combination therapies should pay more attention to weight gain and obesity.