Psychiatric Symptoms as the First or Solitary Manifestation of Somatic Illnesses: Hyperammonaemia Type II.

AIM: We describe the difficulties encountered in making a diagnosis where a somatic condition manifests itself alongside psychiatric symptoms associated with possible psychiatric comorbidities. METHODS: A case study is presented of a 15-year-old girl who was eventually diagnosed with ornithine transcarbamylase (OTC) deficiency (hyperammonaemia type II), following an initial diagnosis of pervasive developmental disorder, selective mutism, and anorexia nervosa. RESULTS: The OTC disease is not fully expressed in females and its prevalence is lower than in males. Around 17-20% of female patients found with a defective OTC gene on an X chromosome can suffer from OTC deficiency that may result in elevated levels of ammonia in the blood; this occurs when one of the X chromosomes become inactivated. Patients typically present with nausea, migraines, and a history of dietary protein avoidance. In more severe cases, ataxia, confusion, hallucinations, and cerebral oedema can occur. The OTC deficiency can thus remain undiagnosed in women for many years. CONCLUSION: Somatic comorbidity in psychiatric inpatients is commonly found; however, such disorders are rarely diagnosed or even treated adequately.

Decreased leucocyte telomere length in male patients with chronic bipolar disorder: lack of effect of long-term lithium treatment.

OBJECTIVES: Bipolar disorder (BD) may be connected with accelerated aging, the marker of this can be shorter telomere length (TL). Some data suggest that lithium may exert a protective effect against telomere shortening. The study aimed to compare the TL between patients with BD and control subjects. The effect of long-term lithium treatment was also assessed. METHODS: The study group comprised 41 patients with BD, including 29 patients treated longitudinally with lithium (mean 16.5 years) and 20 healthy people. TL was assessed by the quantitative polymerase chain reaction (qPCR). RESULTS: In the control group, the TL was significantly longer in males than in females. Male bipolar patients had significantly shorter TL compared with the control male group. In bipolar patients, there was no correlation between TL and duration of treatment. The TL was negatively correlated with age in male bipolar patients. CONCLUSIONS: The study did not confirm the lithium effect on TL in bipolar patients. TL showed gender differences, being shorter in BD males, compared to control males, and longer in healthy males, compared to control females.

Interaction between polymorphisms of the oxytocinergic system genes and emotion perception in inpatients with anorexia nervosa.

OBJECTIVE: The empirical literature describes the role of the oxytocinergic system in emotion perception (EP). Variants in the oxytocin (OXT) and oxytocin receptor genes have been associated with mental disorders, including anorexia nervosa (AN), that are characterized by difficulties in socioemotional functioning. Our study aimed to examine whether variability within the genes related to OXT pathways may play a role in facial EP in inpatients with AN. METHOD: Single nucleotide polymorphisms (SNPs) of the following genes: oxytocin receptor (rs2254298, rs53576), OXT (rs6133010), OXT-arginine-vasopressin (rs2740204), CD38 (rs6449197, rs3796863), and human leucyl/cystinylaminopeptidase (rs4869317) were genotyped in 60 AN female inpatients and 60 healthy control females (HCs). Associations between genetic polymorphisms and EP as well as clinical symptoms were examined. RESULTS: The AN group showed decreased EP abilities compared with HCs. SNPs of rs2740204, rs6133010, and rs53576 were associated with differences in EP in women with AN and in HCs. The SNP of rs4869317 was associated with the level of eating disorders symptoms in HCs. CONCLUSIONS: The OXT system may be involved in EP difficulties in AN. SNPs within genes related to OXT pathways may influence EP abilities. The leucyl/cystinylaminopeptidase rs4869317 SNP may be involved in the development of eating disorders psychopathology.

Inpatient psychiatric treatment is not always effective in adolescent sample.

OBJECTIVE: Numerous studies confirm efficacy of psychiatric treatment as well as psychiatric placebo. The aim of the current study was the assessment of improvement rate and factors associated with treatment response in naturalistic group of adolescent inpatients. METHODS: Eighty two consecutive adolescent inpatients were recruited. Each patient at the admission and discharge was assessed with brief psychiatric rating scale (BPRS), eating attitude test (EAT-26), clinical global impression scale (CGI-S) and children global assessment scale (CGAS). Individual and family history was assessed by semi-structured interview. Patients, who improved in at least two interviewer-based scales (IMP, n = 67) were compared to the rest (N-IMP, n = 15). For statistical analysis STATISTICA package was used. RESULTS: The main difference between groups was ICD-10 diagnosis distribution: in the IMP group more anxiety-related disorders (F4), in the N-IMP group more personality disorders (F6). Other differences include history of paediatric hospitalisations and surgery (more in the N-IMP group). Most of the analysed factors did not differ between groups. CONCLUSIONS: The inpatient treatment seems to be most effective in severe mental states and in anxiety-related disorders and least effective in personality disorders. Due to limited inpatient treatment efficacy we believe outpatients services are crucial in adolescent psychiatry.

Genetic polymorphisms and serum concentrations of adiponectin and resistin in anorexia nervosa and healthy controls - pilot study.

BACKGROUND: A possible role of adipokines in the regulation of body weight in patients with anorexia nervosa (AN) has been proposed. Polymorphisms in genes encoding adiponectin and resistin in AN have not been widely assessed, yet. OBJECTIVES: 1) Assessment the frequency of ADIPOQ c.45T>G, ADIPOQ c.276G>T polymorphisms in adiponectin and RETN c.62G>A, RETN c.-180C>G in resistin genes in AN patients and control group (C) 2) Analysis of correlation between these polymorphisms and serum ADP or RETN. METHODS: We examined 67 AN girls and 38 C aged 11-18. Analyses of polymorphisms in ADIPOQ and RETN genes were performed using RFLP method and adiponectin and resistin serum levels - with commercially available ELISA kits. RESULTS: In AN subjects, TT genotype in ADIPOQ c.276 polymorphism as well as GG genotype of RETN c.-180 were significantly more frequent than in CG. In ADIPOQ c.45 polymorphic site, TT alleles were the most frequent in both examined groups. In RETN c.62 GA and GG alleles distribution did not differ between the groups and the most frequently observed genotype was GG. The mean serum adiponectin level in AN was significantly higher and resistin - lower than in controls. There were no statistically significant relationships between serum adiponectin and resistin levels and allele frequency in polymorphisms ADIPOQ c.276 as well as RETN c.-180 in the examined groups. CONCLUSION: Differences in genotype frequencies of ADIPOQ c.276 and RETN c.-180 suggest a need for studies on a larger cohort of patients with AN.

Which aspects of long-term outcome are predicted by positive and negative symptoms in early-onset psychosis? An exploratory eight-year follow-up study.

BACKGROUND: Early-onset psychoses show substantial variability of diagnostic and functional outcome. Finding reliable prognostic factors may allow to allocate resources to those with the worst prognosis. The aim of the study was to gain new insights regarding the potential value of baseline negative and positive symptoms as predictors of outcome in psychoses of early onset. METHOD: Sixty-three patients with early-onset schizophrenia spectrum psychosis hospitalized in an adolescent psychiatry unit were assessed with the Positive and Negative Syndrome Scale during the index admission. Associations with diagnosis, illness course and functional outcome were analysed in mean 8 years of follow-up (range 3.4-13.5 years). RESULTS: The mean age at the index admission and the follow-up was 16.6 ± 1.2 and 24.5 ± 3.0 years, respectively. A significant majority of subjects continued psychiatric treatment (95%) and had been readmitted (71%). The mortality rate was 3% (suicide and accident). Negative symptoms were related to mental health service utilization during the follow-up. General severity of symptoms, specifically positive and cognitive factors were associated with the diagnosis of schizophrenia and inversely with diagnostic shift outside the schizophrenia spectrum at the catamnesis. Poor impulse control at baseline was associated with worse functional outcome. The drug-free subgroup with no occupational/educational activity compared with the drug-treated subjects showed lower levels of baseline negative symptomatology. CONCLUSION: The study findings suggest that in patients with early-onset psychosis negative and positive symptoms show a differential prognostic value. Pharmacotherapy may attenuate the effect of symptoms on functional outcome. These hypotheses need to be tested in future studies using confirmatory approaches.

Executive functioning improves after remission of psychosis and may not deteriorate at short follow-up in early-onset schizophrenia.

OBJECTIVE: Cognitive functions are important determinants of outcome in schizophrenia. Psychiatric hospitalization and intensive treatment in the early-onset psychosis may reduce the severity of psychotic symptoms and improve cognitive functions. It is not clear if after discharge improvement or further deterioration of cognition is observed. The aim of the current study is the evaluation of executive functioning in early onset schizophrenia (EOS) across stages of illness. METHODS: Two groups of EOS patients: hospitalized subjects with first episode (FES, n=16) at the introduction of pharmacotherapy (T1) and after mean 7 weeks (T2) and stable outpatients group (SO, n=24) were assessed with the Wisconsin Card Sorting Test (WCST) the Positive and Negative Syndrome Scale. Matched healthy (n=32) controls were assessed with WCST. RESULTS: All patients performed significantly worse in WCST than healthy controls. Subjects in acute psychotic episode (FES T1) presented more pronounced executive impairment and psychopathological symptoms than after the resolution of psychotic symptoms (FES T2). No differences in executive function between FES T2 and SO group were observed. In all assessments perseverative errors correlated with negative symptoms. CONCLUSION: Cognitive impairment is present at the onset of EOS and persists in attenuated but stable form after the resolution of psychotic symptoms.

Executive impairment predicts schizophrenia diagnosis and treatment status in mid-term follow-up of early-onset psychosis.

OBJECTIVES: Early-onset psychoses (EOP) vary considerably with regard to diagnostic stability and functional outcome. The aim of this study was the assessment of executive dysfunction as a predictor of outcome in EOP. METHOD: This was a retrospective cohort study. Twenty-five hospitalized patients with non-affective EOP were assessed with the Wisconsin Card Sorting Test (WCST) during the index admission. Associations with current diagnosis, further admissions, current treatment status and occupational and relationship outcome were analyzed in 6 years of follow-up. RESULTS: The mean age at the index admission and the follow-up was 16.1 ± 1.35 and 22.0 ± 2.1 years, respectively. After discharge, almost all subjects (96%) at least briefly continued psychiatric treatment, and the majority of them (76%) were readmitted. Worse baseline WCST results were associated with a follow-up schizophrenia diagnosis, being a psychiatric in- or outpatient at the moment of follow-up assessment and receiving psychotropic medication. A low number of completed categories correlated with receiving a disability pension at the follow-up. CONCLUSION: In patients with EOP, baseline executive function impairment was associated with schizophrenia diagnosis and psychiatric treatment at the follow-up. The association between baseline results and psychiatric treatment may explain the limited effect of baseline impairment on follow-up occupational and relationship status.

Adolescent insanity revisited: course and outcome in early-onset schizophrenia spectrum psychoses in an 8-year follow-up study.

OBJECTIVES: Despite inclusion of adolescent insanity-a concept proposed by Thomas Clouston in late XIX century-into the broader nosological entity of dementia praecox, the uniqueness of early psychosis is still discussed. The aim of the current study is the assessment of course and outcome in the large sample of early-onset psychosis subjects. METHOD: Of 299 patients hospitalized in the period 1998-2008 in an adolescent psychiatry ward with schizophrenia spectrum diagnosis 158 completed a follow-up interview. Data concerning current diagnosis, further admissions, current treatment status and occupational and relationship outcome were analyzed after a mean of 8 years of follow-up. RESULTS: Mean age at the index admission and the follow-up was 16.6 ± 1.2 and 24.5 ± 3.0 years respectively. After the subsequent discharge almost all subjects (97%) at least briefly continued psychiatric treatment and 75% of patients had been readmitted. Overall diagnostic stability was 42%. For schizophrenia spectrum disorders and schizophrenia diagnostic stability was 72% and 78%, respectively. At the follow-up assessment 119 (77.3%) of the traced subjects declared current psychiatric treatment and 110 (73.3%) were receiving pharmacotherapy. Almost half of the subjects (48%) were employed or studying and more than a third (35.8%) remained in a stable relationship. Different distributions of baseline diagnoses were observed in males and females, and the latter showed a better outcome. CONCLUSION: Early-onset psychoses were characterized by limited diagnostic stability, a necessity for further treatment and hospitalizations and significant percentage of unfavorable functional outcomes. Baseline diagnosis of acute and transient psychotic disorders and female gender were associated with an overall better outcome.

Inverse relationship between leptin increase and improvement in depressive symptoms in anorexia nervosa.

OBJECTIVES: Anorexia nervosa (AN) often presents with comorbid depressive symptoms and is characterized by low levels of neuroimmunomodulatory hormone - leptin. Treatment-induced weight gain tends to normalize those variables. The aim of the study was the longitudinal assessment of the relationship between leptin levels and depressive symptoms in patients with AN, since previous cross-sectional studies in different populations brought conflicting results. METHODS: Thirty AN inpatients were assessed twice - at admission and after mean body mass index (BMI) increase of 3.2 kg/m(2). Physical parameters were measured, blood samples for leptin levels drawn and depression evaluated with both clinician - (Hamilton Depression Rating Scale - HDRS) and self - (Beck Depression Inventory - BDI) rated scales at the same morning. Correlation coefficients between changes in assessed variables, and linear regression for changes in depression scores were calculated. RESULTS: BMI and leptin levels showed significant increase after treatment, respectively 14.45±0.90 vs. 17.61±0.87 and 1.87±1.14 vs. 7.47±4.65, whereas severity of depressive symptoms measured with BDI and HDRS was significantly reduced: 18.69±12.65 vs. 11.62±11.59; 12.76±6.90 vs. 5.66±4.91, respectively. In linear regression analysis decrease of the clinician-rated depression score (HDRS) was directly associated with decrease in the self-assessed depressive symptoms (BDI) (standardized Beta=0.45; t=2.60; p<0.05) and inversely related to the increase in leptin level (standardized Beta=-0.33; t=-2.08; p<0.05). CONCLUSIONS: These results may suggest, that increase in leptin levels during weight recovery in patients with AN is associated with objectively measured depressive symptoms. Longitudinal studies in other populations are warranted to establish whether this relationship is valid across the weight spectrum.

[Neurocognitive and social cognition deficits in patients with anorexia nervosa]. / Deficyty neuropoznawcze i spolecznego poznania u pacjentów z jadlowstretem psychicznym.

In the first part of the article the authors present a set of the actual concepts explaining problems of cognitive functions and social cognition currently observed in patients with anorexia nervosa (AN). It is possible; through the neuroimaging research, to get better understanding of the brain specifics in these individuals. Even though, the AN remains a disease with very complex and multifactorial etiology which remains a huge medical challenge. Currently, popular is the view that takes into consideration the integrating role of the insula and subcortical structures (such as hippocampus, amygdala, thalamus) in the regulation of cognitive and emotional processes in people suffering from AN. There is still an open problem, however, of the selection of therapeutic interventions targeting these deficits. The second part of the article presents the attempt to describe deficits in neurocognitive and social cognition in people with AN occurring prior to illness, during and after the recovery. Particular attention has been paid to the most frequently described in the literature--neurocognitive deficits such as rigidity of thinking, weak central coherence, and deficits in social cognition, including mental processes of perception and expression of emotions, disorders of the theory of mind (ToM) and empathy. The results of previous studies, their scarcity in Poland, do not give a satisfactory answer to the question whether the above mentioned disorders are a feature of endophenotype or condition in an episode of the disease. Research point to the more permanent nature, which may be more resistant to therapeutic modifications.

[Autism spectrum disorders - epidemiology, symptoms, comorbidity and diagnosis]. / Zaburzenia ze spektrum autyzmu - epidemiologia, objawy, wspólzachorowalnosc i rozpoznawanie.

In the new classification of American Psychiatric Association - DSM-5 - a category of autistic spectrum disorders (ASD) was introduced, which replaced autistic disorder, Asperger syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified. ASD are defined by two basic psychopathological dimensions: communication disturbances and stereotyped behaviors, and the diagnosis is complemented with the assessment of language development and intellectual level. In successive epidemiological studies conducted in 21 century the prevalence of ASD has been rising, and currently is estimated at 1% in general population. The lifetime psychiatric comorbidity is observed in majority of patients. The most common coexisting diagnoses comprise disorders ofanxiety-affective spectrum, and in about 1/3 of patients attention deficit/ hyperactivity disorders could be diagnosed. Prodromal symptoms of ASD may emerge before 12 months of life, however reliability of diagnosis at such an early age is poor. Several screening instruments, based on the parental and/or healthcare professional assessments may be helpful in ASD detection. However, structured interviews and observation schedules remain the gold standard of diagnosis.

EEG in Down Syndrome-A Review and Insights into Potential Neural Mechanisms.

Introduction: Down syndrome (DS) stands out as one of the most prevalent genetic disorders, imposing a significant burden on both society and the healthcare system. Scientists are making efforts to understand the neural mechanisms behind the pathophysiology of this disorder. Among the valuable methods for studying these mechanisms is electroencephalography (EEG), a non-invasive technique that measures the brain's electrical activity, characterised by its excellent temporal resolution. This review aims to consolidate studies examining EEG usage in individuals with DS. The objective was to identify shared elements of disrupted EEG activity and, crucially, to elucidate the neural mechanisms underpinning these deviations. Searches were conducted on Pubmed/Medline, Research Gate, and Cochrane databases. Results: The literature search yielded 17 relevant articles. Despite the significant time span, small sample size, and overall heterogeneity of the included studies, three common features of aberrant EEG activity in people with DS were found. Potential mechanisms for this altered activity were delineated. Conclusions: The studies included in this review show altered EEG activity in people with DS compared to the control group. To bolster these current findings, future investigations with larger sample sizes are imperative.

Effect of Transcranial Direct Current Stimulation (tDCS) on Depression in Parkinson's Disease-A Narrative Review.

INTRODUCTION: Depression is the most prevalent comorbid neuropsychiatric condition in individuals with Parkinson's disease (PD), and its underlying mechanisms are not yet fully understood. Current treatment methods are characterised by moderate effectiveness and possible side effects, prompting the search for new non-invasive and safe treatment methods. METHODS: This narrative review explores the use of transcranial direct current stimulation (tDCS) in the treatment of depression in PD, based on neuropsychological measures. Searches were conducted in the PubMed/Medline, Research Gate, and Cochrane databases. RESULTS: Nine relevant studies were identified, where depression scores served as either primary or secondary outcomes. Stimulation protocols displayed heterogeneity, especially concerning choice of stimulation site. Patient samples were also heterogeneous. The majority of the studies incorporated anodal stimulation targeting the left dorsolateral prefrontal cortex (DLPFC). The results revealed a reduction in depression scores among PD patients following tDCS. Potential mechanisms through which tDCS may alleviate depression in PD were discussed and recommendations for future research were made. CONCLUSIONS: Preliminary evidence suggests that tDCS applied anodally to the left DLPFC reduces depression scores in people with PD; however, due to the heterogeneity of the studies analysed, the use of tDCS in this field should be approached with caution and warrants further validation and confirmation.

The Effects of Transcranial Direct Current Stimulation (tDCS) in HIV Patients-A Review.

Introduction: HIV is a severe and incurable disease that has a devastating impact worldwide. It affects the immune system and negatively affects the nervous system, leading to various cognitive and behavioral problems. Scientists are actively exploring different therapeutic approaches to combat these issues. One promising method is transcranial direct current stimulation (tDCS), a non-invasive technique that stimulates the brain. Methods: This review aims to examine how tDCS can help HIV patients. Searches were conducted in the Pubmed/Medline, Research Gate, and Cochrane databases. Results: The literature search resulted in six articles focusing on the effects of tDCS on cognitive and behavioral measures in people with HIV. In some cases, tDCS showed positive improvements in the measures assessed, improving executive functions, depression, attention, reaction time, psychomotor speed, speed of processing, verbal learning and memory, and cognitive functioning. Furthermore, the stimulation was safe with no severe side effects. However, the included studies were of low quality, had small sample sizes, and did not use any relevant biomarkers that would help to understand the mechanisms of action of tDCS in HIV. Conclusions: tDCS may help patients with HIV; however, due to the limited number of studies and the diversity of protocols used, caution should be exercised when recommending this treatment option in clinical settings. More high-quality research, preferably involving neurophysiological and neuroimaging measurements, is necessary to better understand how tDCS works in individuals with HIV.

The Effectiveness of Transcranial Direct Current Stimulation (tDCS) in Binge Eating Disorder (BED)-Review and Insight into the Mechanisms of Action.

INTRODUCTION: Binge eating disorder (BED) is the most common eating disorder among those contributing to the development of obesity, and thus acts as a significant burden on the lives and health of patients. It is characterized by complex neurobiology, which includes changes in brain activity and neurotransmitter secretion. Existing treatments are moderately effective, and so the search for new therapies that are effective and safe is ongoing. AIM AND METHODS: This review examines the use of transcranial direct current stimulation (tDCS) in the treatment of binge eating disorder. Searches were conducted on the PubMed/Medline, Research Gate, and Cochrane databases. RESULTS: Six studies were found that matched the review topic. All of them used the anodal stimulation of the right dorsolateral prefrontal cortex (DLPFC) in BED patients. tDCS proved effective in reducing food cravings, the desire to binge eat, the number of binging episodes, and food intake. It also improved the outcomes of inhibitory control and the treatment of eating disorder psychopathology. The potential mechanisms of action of tDCS in BED are explained, limitations in current research are outlined, and recommendations for future research are provided. CONCLUSIONS: Preliminary evidence suggests that the anodal application of tDCS to the right DLPFC reduces the symptoms of BED. However, caution should be exercised in the broader use of tDCS in this context due to the small number of studies performed and the small number of patients included. Future studies should incorporate neuroimaging and neurophysiological measurements to elucidate the potential mechanisms of action of tDCS in BED.

Sensory Processing Sensitivity as a trait of temperament - evolutionary, socio-cultural, biological context and relation to mental disorders. / Wrazliwosc Przetwarzania Sensorycznego jako cecha temperamentu ­ kontekst ewolucyjny, spoleczno-kulturowy, biologiczny oraz zwiazek z zaburzeniami psychicznymi.

This article presents the trait of sensory processing sensitivity (SPS), its characteristics, assessment tool and association with psychiatric disorders based on an analysis of the literature on SPS since 1997. An overview of research on SPS in several relevant contexts is presented: evolutionary/adaptive, socio-cultural, temperamental/personality, and biological, taking into account the influence of genetic factors and the activity of specific areas of the central nervous system involved in processing emotional and cognitive stimuli. High sensitivity of sensory processing is an innate trait, biologically determined and modulating developmental processes, occurring in 20-35% of the general population regardless of gender. It is characterized by deeper processing of stimuli, ease of overstimulation, strong emotional reactions and empathic bonds, as well as sensitivity to subtleties in the surrounding world. SPS can be associated with susceptibility to the development of a wide range of psychiatric symptoms and disorders, including depressive and anxiety disorders, social phobia, alexithymia, burnout, internalizing and externalizing disorders and selective mutism in children.

The Effectiveness of Mindfulness in the Treatment of Methamphetamine Addiction Symptoms: Does Neuroplasticity Play a Role?

INTRODUCTION: Methamphetamine is a highly stimulating psychoactive drug that causes life-threatening addictions and affects millions of people around the world. Its effects on the brain are complex and include disturbances in the neurotransmitter systems and neurotoxicity. There are several known treatment methods, but their effectiveness is moderate. It must be emphasised that no drugs have been approved for treatment. For this reason, there is an urgent need to develop new, effective, and safe treatments for methamphetamine. One of the potential treatments is mindfulness meditation. In recent years, this technique has been researched extensively in the context of many neurological and psychiatric disorders. METHODS: This review explores the use of mindfulness in the treatment of methamphetamine addiction. Searches were conducted in the PubMed/Medline, Research Gate, and Cochrane databases. RESULTS: Ten studies were identified that used mindfulness-based interventions in the treatment of methamphetamine addiction. The results show that mindfulness is an effective form of reducing hunger, risk of relapses, stress indicators, depression, and aggression, alone or in combination with transcranial direct current stimulation (tDCS). Mindfulness also improved the cognitive function in addicts. The included studies used only behavioural measures. The potential mechanisms of mindfulness in addiction were explained, and it was proposed that it can induce neuroplasticity, alleviating the symptoms of addiction. CONCLUSIONS: Evidence from the studies suggest that mindfulness may be an effective treatment option for methamphetamine addiction, used alone or in combination with tDCS. However, further high-quality research is required to establish the role of this treatment option in this field. The use of neuroimaging and neurophysiological measures is fundamental to understand the mechanisms of mindfulness.

Evolutionary aspects of bipolar affective illness. / Ewolucyjne aspekty choroby afektywnej dwubiegunowej.

Bipolar affective illness (bipolar disorder - BD), also known as manic-depressive illness, is characterized by periodic opposite states of mood, activity, and motivation (mania and depression) sometimes of extreme intensity. The development and maintenance of such states in evolution can betoken a possibility of their adaptive character, enabling adaptation to an unfavorable external situation (depression) and a mobilization to using resources when available (mania). In the article, the main focus is put on the evolutionary aspect of "bipolarity" and manic/hypomanic states. Molecular-genetic studies show that in evolution, the genes connected with a predisposition to BD have been conserved. In the paper, the evolutionary adaptive concepts connected with the functioning of Homo sapiens during the middle and late Pleistocene periods were discussed as well as the "mismatch" theories associated with not befitting brain functioning to contemporary conditions. The benefits of mania and hypomania, also in the context of their link to depression were delineated, indicating their relationship to the increase in reproductive success. They result from such features of mania/hypomania as increased exploratory, psychomotor and sexual activity, and prompt risk-taking. The reproductive success can be connected with hyperthymic and cyclothymic temperaments, most frequently occurring in subjects with BD. The hyperthymic temperament often leads to increased social status and a tendency to leadership, and the cyclothymic temperament can increase creativity. Examples of the relationship between manic/hypomanic states and the phenomenon of emigration as well as the advancement of American society are provided.