Major depressive disorder (MDD) and bipolar disorder (BD) are psychiatric diseases that affect behavior and impair cognition. A gene important to these disorders is the brain derived neurotrophic factor (BDNF) which is involved in processes controlling neuroplasticity. Previous studies have suggested that BDNF expression levels have to be finely regulated for normal mental health and cognition. This study therefore aimed to identify cis-regulatory elements that regulate BDNF promoter IV (BP4), which plays a role in mood and cognition, and investigated how polymorphisms in these cis-regulatory elements might alter BP4 activity contributing to MDD and BD. BP4-LacZ transgenic mice and primary neuron cultures were used to show that BP4 was active in the hippocampus, cortex and amygdala and responded to PKC, KCl and Wnt signaling activation. Using comparative genomics, two highly conserved regions were identified, BE5.1 and BE5.2, which contain the rs10767664 and rs12273363 polymorphisms respectively. Reporter gene assays in primary cultures derived from these brain structures showed that BE5.1 and BE5.2 were responsible for “filtering” or “gating” the effects of different combination of activated signal transduction pathways on BP4. Thus, BE5.1 increased BP4 response to forskolin in cortical cultures while abolishing BP4 response to PMA in hippocampal cultures. Similarly, BE5.2 permitted BP4 response to KCl and combined forskolin and PMA treatment, but not individual forskolin and PMA treatment nor LiCl in cortical cultures. Significantly, the minor allele of rs12273363, which has been associated with MDD and BD susceptibility, acted as a more potent repressor of BP4 response to neuron depolarization by KCl and PKA/PKC activation in different primary cultures. The possible relevance of these findings to the role of altered BDNF expression in MDD and BD are discussed.

To align the neuropsychological functioning of our adult euthymic patient group with that reported in previous studies on euthymic bipolar disorder (BD), we used a neuropsychological battery that examined sustained attention (Rapid Visual Information Processing Task), verbal memory (California Verbal Learning Task), executive functioning (Intradimensional-Extradimensional Shift Task, Barrett Impulsivity Task, and Framing Task), and emotion responsiveness/regulation (Positive Affect/Negative Affect Scales, Behavioral Inhibition/Behavioral Activation Scale, and Affective Lability/Affective Intensity Scales) in patients versus healthy volunteers (HV). Our results corroborated existing evidence of reduced sustained attention, impaired verbal memory and executive functioning, and abnormal emotional responsiveness and regulation in euthymic BD relative to healthy controls (Chapter 2). To investigate how abnormal development of brain function in BD leads to deficits in decision-making, motor inhibition, and response flexibility, we examined child and adult BD using a novel risky decision-making task, and used cross-sectional (age x diagnosis) functional magnetic resonance (fMRI) designs to examine neural activation associated with motor inhibition and response flexibility in BD relative to HV. During the risky decision-making task, adult euthymic BD patients were no different from healthy controls in their proportion of risky lottery choices over a range of competing lotteries. This matched behavioral performance was associated with similar prefrontal and striatal brain activation between the patient and control groups during response, anticipation, and outcome phases of decision-making (Chapter 3). These results are different from previous studies that have shown increased risk taking during decision-making in euthymic BD. Similarly, young BD patients were no different from age-matched healthy and patient controls in their pattern of decision making during the risky choice task. This was evidenced by a similar number of risky lottery selections over the range of changing expected values between the young BD group and control groups (Chapter 4). Using a cross-sectional, fMRI analytic design during the stop signal task, we found that child and adult BD showed similar behavioral performance to child and adult HV during motor inhibition. However, this matched behavioral performance was associated with abnormal neural activation in patients relative to controls. Specifically, during unsuccessful motor inhibition, there was an age group x diagnosis interaction, with BD youth showing reduced activity in left and right ACC compared to both age-matched HV and adult BD, and adult BD showing increased activation in left ACC compared to healthy adults. During successful motor inhibition there was a main effect of diagnosis, with HV showing greater activity in left VPFC and right NAc compared to BD (Chapter 5). These neuroimaging data support existing laboratory-based evidence of motor inhibition impairments in BD relative to HV, and indicate brain dysregulation during motor control is important to BD pathophysiology. A previous behavioral study showed impaired response flexibility in young BD patients relative to age-matched controls when using the change task. Here, we used the change task during fMRI to examine response flexibility in child and adult BD compared to child and adult HV. We found that patient and control groups showed similar change signal reaction times in response to change cues. However, this matched behavioral performance was associated with abnormal age group x diagnosis activations in brain regions important in signal detection, response conflict, response inhibition, and sustained attention. Specifically, during successful change trials, child BD participants showed frontal, parietal, and temporal hyperactivation relative to healthy children and adult BD, while adult BD showed hypoactivation in these regions relative to healthy adults. These novel fMRI findings during the change task indicate impaired neural activation during response flexibility may be important to the pathophysiology of BD development.

A study was conducted in which a computerized battery of information processing tasks (called the COGLAB) was administered to three subject groups: patients with schizophrenia, patients with bipolar disorder, and normal controls. The tasks included Mueller-Lyer illusion, reaction time, size estimation, Wisconsin Card Sort, backward masking. and Asarnow Continuous Performance.

MicroRNAs (miRNAs) are a family of small non-coding RNAs that regulate gene expression at both the mRNA and protein levels. MiRNAs have been shown to affect neuronal differentiation, synaptosomal complex localization and synapse plasticity, all functions thought to be disrupted in schizophrenia. We investigated the expression of 667 miRNAs (miRBase v.13) in the prefrontal cortex of individuals with schizophrenia (SZ, N = 35) and bipolar disorder (BP, N =35) using a real-time PCR-based Taqman Low Density Array (TLDA). After extensive QC steps, 441 miRNAs were included in the final analyses. At a FDR of 10%, 22 miRNAs were identified as differentially expressed between cases and controls, 7 dysregulated in SZ and 15 in BP. Using in silico target gene prediction programs, the 22miRNAs were found to target brain-specific genes contained within networks overrepresented for neurodevelopment, behavior, and SZ and BP disease development. Given that miRNAs can bind to their targets with imperfect complementarity, computational prediction of true miRNA:mRNA interactions has been difficult and therefore, functional validation of miRNA:mRNA interactions has been relatively sparse. Thus, it was the goal of this study to demonstrate biological functionality of miRNAs on their targets by evaluating transcriptional and translational levels of gene expression(real-time PCR, western blot) as well as determining miRNA target-site specificity (luciferase reporter gene assays). We investigated two miRNAs, miR-132 and miR-137, both of which have been shown to regulate neuronal function and development, and are believed to be associated with schizophrenia from two distinct avenues of research, miR-132 from expression studies and miR-137 from genetic studies. We demonstrated miR-132 down-regulates NTF3, DISC1, and GRIK5 at the transcript level and down-regulates GRIK5 at the protein level as well. Furthermore, we demonstrated miR-137 down-regulates TCF4, CACNA1C, CDK6, ANK3, and ZNF804A at the transcript level, and down-regulates TCF4, CACNA1C, and CDK6 at the protein level. Going further, we also demonstrated miR-137 binds specifically to target sites in the 3'-UTR of CACNA1C, TCF4, and CDK6, suggesting repression of these genes is directly mediated by miR-137. In total, this study provides strong evidence that miRNA dysregulation may contribute to schizophrenia pathogenesis.

Abstract FUNCTIONAL AND BIOCHEMICAL CONSEQUENCES OF SINGLE NUCLEOTIDE POLYMORPHISMS IN THE HUMAN VESICULAR MONOAMINE TRANSPORTER 1 GENE (SLC18A1) By Sally Gamal Shukry, B.S. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Biology at Virginia Commonwealth University. Virginia Commonwealth University, 2012 Major Advisor: Jennifer K. Stewart Associate Professor and Graduate Director, Department of Biology Single nucleotide polymorphisms (SNP) in the human VMAT1 gene (SLC18A1) have been associated with schizophrenia in three different populations: Han Chinese, Western European and Japanese. Effects of these mutations on transport function of the hVMAT1 protein have not been reported. The goal of this study was to investigate functional and biochemical differences in human VMAT1 proteins with a threonine or proline at amino acid position 4 (Thr4Pro) and a serine or threonine at position 98 (Ser98Thr). COS1 cells were transfected with variant SNPs coding for 4Thr/98Ser, 4Pro/98Ser, or 4Thr98Thr. Western blotting demonstrated robust over expression of the genes and no differences in electrophoretic mobility of the proteins. Maximal transport of serotonin by the VMAT1 protein with 4Pro/98Ser was less than that of the 4Thr/98Ser or the 4Thr/98Thr. Response of the 4Pro/Ser98 to the VMAT inhibitor reserpine was lower than that of the 4Thr/98Thr. These findings suggest mechanisms for human VMAT1 links to schizophrenia.

>Magister Scientiae - MSc / INTRODUCTION: Sustained attention is known to be dysfunctional in psychotic disorders. Sustained attention is the ability to remain focused on a specific time-locked stimulus within a task. We aimed to determine whether there are specific group differences between CON and three psychotic disorders: SCZ, MPD and BPD, then to determine differences between these psychotic disorders. This included differences in behavioural performance and prominent electrophysiological event-related potential (ERP) wave components during cueing and target processing of a visual sustained attention task. Further we aimed to characterize ERP waveform component relationships across and within these groups for demographics, substance use, behavioural performance, and clinical variables, the last limited to the psychotic groups. Lastly, we investigated the effects of prescribed medications on ERP wave components within the psychotic groups. METHODOLOGY: 103 participants (29 schizophrenia (SCZ), 28 bipolar disorder with a history of psychosis (BPD), 21 methamphetamine-induced psychotic disorder (MPD), and 30 controls (CON)) underwent electroencephalography (EEG) record while completing a visual continuous performance task. Participants were presented with 60 trials with three consecutive S’s, the presentation of the third S required a behavioural response. Prominent ERP waveform components were extracted from cues and target stimulus. Group differences were determined by ANOVA with Bonferroni post-hoc correction or multivariate Kruskal-Wallis test dependent on data distribution. Relationships between ERP wave components were determined appropriate with Spearman’s Rank order correlation analyses. RESULTS: (1) MPD reported higher use of substances compared to CON, SCZ and BPD. SCZ behavioural performance was poorer compared to CON which was shown by their longer response times, reduced accuracy and increased errors of omission. Clinically, MPD was found to have a shorter duration of illness compared to SCZ. Then SCZ was found to have more positive symptoms compared to BPD whereas BPD had more negative symptoms compared to SCZ. For the first cue, wave component differences were found only over the left hemisphere, for P100 amplitude over the frontal cortex, P300 amplitude over the central cortex, and N170 amplitude over the parietal cortex. For the presentation of the second cue, differences noted for all groups were localised to the frontal and central brain regions, for P100 and N170 ERP waveforms. For the target stimulus wave component differences were found over the prefrontal, frontal and parietal brain regions, within CON, SCZ, BPD and MPD. (2) For the first cue, education positively correlated with the N170 left parietal amplitude in CON and P300 right parietal amplitude in MPD. During the second cue, the left parietal N170 latency in SCZ correlated positively with education and the left central P300 latency correlated negatively with education in MPD. The age on the day of testing correlated positively with the target left frontal P300 latency in MPD. For the first cue, substance use positively correlated with the left and right parietal P300 latency and negatively for the right parietal P100 amplitude in SCZ. In MPD, a negative correlation was noted across left and right prefrontal N170 and P300 amplitudes, and positive correlation for the left prefrontal P300 latency in MPD. For the target stimulus, correlations were evident for the left and right parietal N70, N170 amplitudes, P300 latency, the right parietal P100 amplitude and left central P300 latency in SCZ. For the first cue, in SCZ PANSS total score correlated positively with left and right central P300 amplitudes and the left parietal P300 amplitude. For the second cue; in MPD, the PANSS negative symptom score, positively correlated with the P100 and N170 left parietal amplitude, left and right parietal P150 amplitude, left central and right parietal P300 amplitude. For the target, the Hamilton depression rating scale correlated positively with the left and right frontal P300 amplitude in MPD and then negatively with the right parietal P300 amplitude in SCZ. Behavioural performance in CON, positively correlated with the left parietal N70, P100, P150 and N170 amplitude the number of correct responses, and left central N170 amplitude. While the number of impulsive responses correlated negatively with the left parietal N70, P100, P150 and N170 and the left central N170 amplitude of CON. For the second cue, behavioural performance was related to the fronto-parietal relationship across all groups. For the target stimulus, impulsive responses positively correlated with the left parietal N70 latency in SCZ. Overall response time negatively correlated with the right parietal P300 latency for SCZ. (3) Medication was found to affect ERP wave components during the sustained visual attention task. For the first cue FGA’s increased the left central P100 amplitude in both SCZ and BPD and decreased the left parietal P100 amplitude in SCZ only. The use of antipsychotics increased the right parietal N70 and left central P100 amplitudes in BPD, specifically the right prefrontal N170 amplitude was increased with the use of SGA’s. Then clozapine use increased the left frontal P100 amplitude in SCZ. For the second cue, SGA’s decreased the right parietal P150 amplitude in SCZ but in MPD the right parietal P150 amplitude was increased with haloperidol use, and FGA. SGA’s increased the left parietal P300 latency in BPD and sodium valproate decreased the left prefrontal P300 latency. For the target stimulus, SGA’s decreased the right parietal P100, P150 and left parietal P150 amplitudes and increased the left central P300 latency in BPD. CONCLUSION: (1) sustained attentional performance is poorer in SCZ. Our study adds to previous studies showing attention processing deficits in SCZ, are evident during cueing of a sustained attention tasks; (2) substance use was found to slow cognitive processing, education improved executive function and information processing, and symptom severity was associated with dysfunction of prefrontal and frontal cortices; (3) antipsychotic medication was related to improved processing of salient information. These data support the current literature and provide novel insights to the attentional processing deficits during cueing in the psychotic disorders.

Objetivo: Identificar os medicamentos preferidos no Brasil para tratar o transtorno bipolar e a opinião dos psiquiatras brasileiros sobre a litioterapia. Métodos: Um questionário de múltipla escolha com 14 itens foi desenvolvido para estudar estas questões. Foram enviados 10.059 questionários para psiquiatras brasileiros. Resultados: 820 psiquiatras (8,6%) responderam aos questionários. Lítio foi a medicação de primeira escolha em todas as fases do transtorno. Antipsicóticos foram a segunda escolha no tratamento da mania, superando os anticonvulsivantes. Antidepressivos foram a segunda medicação mais utilizada nos episódios depressivos. Mais de 80% de psiquiatras acreditam que o lítio é um medicamento seguro e de fácil manejo. Características epidemiólogicas como região de origem, alto nível educacional, grande experiência clínica e interesses acadêmicos podem ter influenciado tais resultados. Conclusão: Lítio é o medicamento de primeira linha no tratamento do transtorno bipolar no Brasil, a despeito do que ocorre em outros países. Apesar deste panorama favorável, algumas dificuldades podem ser identificadas como a falta de conhecimento sobre o lítio por profissionais da área de saúde mental e pacientes. / Objective: Identify preferred drugs to treat bipolar disorder in Brazil and the impressions of Brazilian psychiatrits about lithium therapy. Methods: A 14 items multiple-choice questionnaire was developed to answer this issue. Questionnaires were posted to 10,059 Brazilian psychiatrists. Results: 820 psychiatrists (8.6%) have answered the questionnaires. Lithium was the preferred medication used in all phases of the disorder. Antipsychotics were second choice in treatment of mania, overcoming anticonvulsants. Antidepressants were the second more used medication for depressive episode. More than 80% of psychiatrists believe that lithium is a safe drug and there is no difficult to handle with. Epidemiological characteristics such region of origen, high degree, large clinical practice and academic interests may influenced those results. Conclusion: Lithium is the first line drug to treat bipolar disorder in Brazil, despite what occur in others countries. Although this favorable panel, some difficults can be identified as mental health professional and patients\' lack of information about lithium.

RESUMO Introdução: Nas últimas décadas a ideia limitada de que o tratamento para o Transtorno Afetivo Bipolar (TAB) consiste apenas em encontrar a medicação \"certa\" tem sido amplamente dissipada. A complexidade clínica dessa doença e os diferentes graus de adesão à farmacoterapia, demanda a utilização de opções terapêuticas variadas. Entre as alternativas para suprir essa demanda, tem-se combinado ao tratamento farmacológico uma abordagem psicoeducacional como opção eficaz no tratamento dos indivíduos com TAB. O uso da psicoeducação em formato de grupo tem sido frequentemente utilizada em vários estudos com bons resultados, porém a Psicoeducação Domiciliar ainda não foi avaliada e tal formato não tem sido aplicado em ensaios controlados até o momento. Objetivo: o objetivo deste estudo foi avaliar a eficácia da Psicoeducação Domiciliar em pacientes com Transtorno Afetivo Bipolar, em tratamento farmacológico padrão, realizada em suas residências. Metodologia: Tratase de um estudo randomizado controlado com 30 pacientes portadores de TAB tipo I ou II, de acordo com os critérios do DSM-IV TR; eutímicos com pontuação 8 na Escala de Depressão de Hamilton (HAM-D) 17 itens e 6 na Escala de Mania de Young (YOUNG). A distribuição dos sujeitos em dois grupos foi feita por meio de randomização estratificada. O grupo experimental (GE) composto de 15 pacientes recebeu além do tratamento farmacológico, visitas domiciliares com intervenção psicoeducacional. O grupo controle (GC) composto de 15 pacientes recebeu, além do tratamento farmacológico, visitas domiciliares placebo, sem intervenção psicoeducacional. Ambos os grupos receberam visitas semanais totalizando 8 sessões, com 90 minutos de duração cada uma. Os instrumentos de avaliação foram a escala de HAM-D para sintomas de depressão, e YOUNG, para a mania. As escalas para avaliar a recuperação funcional foram: WHOQOL-Bref e Escala de Adequação Social (EAS). Utilizou-se para avaliar a adesão medicamentosa a Escala de Adesão Medicamentosa (EAM) e o Teste de Morisk e Green. Resultados: Com relação à avaliação sintomática não houve recaída em ambos os polos, maníaco e depressivo, durante o estudo, somente uma diminuição nos escores da escala de HAM-D no grupo experimental ao longo do tempo (p<0,01). Na escala de YOUNG não houve uma diferença significativa entre os tempos e entre grupos (p=0,20). Na avaliação funcional as médias se mantiveram ao longo do tempo na escala EAS (p=0.08) e na escala WHOQOL-bref. Contudo em relação à adesão medicamentosa, no início do estudo a média de adesão no grupo experimental era 60% avaliada pela escala de Morisky e Green, no final do estudo houve um aumento dessa aderência para 93.3% (p=0.03). Na avaliação da Adesão Medicamentosa pela EAM o grupo experimental teve um aumento significativo nas médias ao longo do tempo (p<0,001), confirmando um aumento importante na adesão medicamentosa. Conclusão: Os dados demostraram que uma abordagem Psicoeducacional Domiciliar Breve de 8 sessões realizada em pacientes com TAB teve um impacto significativo na melhora da adesão medicamentosa. Não foi observado impacto funcional, pois as médias das escalas de avaliação funcional não se alteraram significativamente durantes o estudo em ambos os grupos. Não foi possível avaliar o impacto clínico da psicoeducação na sintomatologia afetiva destes pacientes, pois desde o início do estudo, eles permaneceram eutímicos, sem recaídas depressivas nem maníacas. A Psicoeducação Domiciliar demonstrou sua eficácia como abordagem psicossocial melhorando a adesão ao tratamento dos pacientes com TAB. / ABSTRACT Introduction: In last decades the restricted idea for Bipolar Disorder (BD) treatment was only to find the \"right\" medication has been largely dispelled. The clinical complexity of this disease, and the different levels of adherence to pharmacotherapy, demands the use of diverse therapeutic options. Among the alternatives to answer this demand, it has combined to pharmacological treatment to psychoeducational approach as an effective option in the treatment of individuals with BD. The use of psychoeducation in group has often been used in several studies with good results, but the Home Visit Psychoeducation at patients homes has not been evaluated and this format has not been applied in controlled trials to current. Objective: To evaluate the effectiveness of Home Visit Psychoeducation in patients with bipolar affective disorder in standard pharmacological treatment. Methodology: This is a randomized controlled trial with 30 patients with bipolar I or II, according to the DSM-IV TR, with score 8 on the Hamilton Depression Rating Scale (HAM-D) - 17 items 6 and the Young Mania Rating Scale (YOUNG), follow up at Mental Health System of Ribeirão Preto. The patients distribution was made by stratified randomization, patients, were divided into stratified blocks according to gender, age, education and marital status. The experimental group (EG) consisting of 15 patients received in addition to pharmacological treatment, home visits with psychoeducational intervention. The control group (CG) composed of 15 patients received, in addition to pharmacological treatment, \"placebo\" home visits. It is understood by \"placebo\" home visits unstructured visits without psychoeducational intervention. Both groups received weekly visits in a total of 8 sessions with 90 minutes duration. The scales used to assess symptomatic recovery were: HAM-D for depression, and YOUNG for mania. The Scales to assess functional recovery were: WHOQOL-Bref and the Social Adjustment Scale (SAS). The Medication Adherence Scale (MAS) and the Test of Morisk and Green were used to assess medication adherence. Results: In relation to symptomatic assessment there was no relapse in both poles, manic and depressed during the study, only a decrease in scores on HAM-D in the experimental group throughout the time (p<0,01), not significant difference between groups (p=0,67). In YOUNG scale there was no significant difference between times and among groups (p=0,20). The scores of the functional assessment scale EAS remained throughout the time (p=0,08), the scale WHOQOL-bref there was no significant difference in the four domains. However in relation to medication adherence at the beginning of the study the average membership in the experimental group was 60% as assessed by Morisky and Green scale at the end of the study there was an increase this adherence to 93.3% (p=0,03). In the evaluation of the Medication Adherence EAM the experimental group had a significant increase in the average throughout the time (p<0,001), confirming a significant increase in medication adherence. Conclusion: Our data demonstrated that a Home Visit Psychoeducational in brief 8 sessions held in homes of patients with BD had a significant impact on improving medication adherence. There was no functional impact, the averages of functional assessment scales have not significantly changes during the study in both groups. It was not possible to assess the clinical impact of psychoeducation on affective symptomatology of these patients, because since the beginning of the study, they remained euthymic, without depressive relapses nor manic.

Thesis advisor: R. Shep Melnick / This paper's main focus is on the American Disability Insurance law. It begins with an outline of the debate that led up to the passing of the original legislation. The paper then examines the law more closely and depicts the changes the law has undergone in the last 50+ years. Next, the current disability benefits process is depicted and questions are posed about inherent difficulties in the disability insurance program. The paper then examines the challenges mental disability causes for the disability insurance program, using a case study of bipolar disorder. Disability insurance programs abroad are next explored with a focus on how other countries have dealt with the problems the United States is facing in its own program. The paper concludes with an examination of the future prospects of the American Disability Insurance program; suggestions are made regarding useful changes to the law. / Thesis (BA) — Boston College, 2007. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Political Science. / Discipline: College Honors Program.

O Transtorno Bipolar [TB] é uma doença crônica e recorrente, que traz prejuízos significativos para o indivíduo. No idoso bipolar as recorrências são cada vez mais rápidas e os episódios mais longos, com um elevado risco de desenvolvimento de um quadro demencial, estando também estas associadas as alterações inerentes ao processo de envelhecimento. O presente estudo teve por objetivo comparar os benefícios da adição da Terapia Cognitivo Comportamental [TCC] e da Psicoeducação [PE], em grupo, ao Tratamento Padrão [TP] terapêutica farmacológica convencional do TB em idosos. Realizou-se um estudo controlado, com a amostra distribuída por conveniência e avaliação cega das medidas de desfecho. Os instrumentos utilizados foram o Protocolo de Pesquisa para a caracterização sociodemográfica e o histórico clínico, a Escala de Depressão Geriátrica, a Escala de Avaliação de Mania de Young Modificada, o Questionário de Crenças Irracionais, o Inventário de Sintomas de Stress para Adultos Lipp e o Inventário de Qualidade de Vida. Os critérios de inclusão para o estudo foram ter TB tipo I ou II, com idade igual ou superior a 60 anos, estar eutímico ou em remissão parcial dos sintomas, a ausência de um quadro demencial ou de delirium. Os participantes foram distribuídos em três grupos, o da adição da TCC ao TP, o da adição da PE ao TP e apenas o TP. Os participantes foram avaliados antes e após a intervenção. As intervenções em grupo ocorreram em 21 encontros semanais, com uma hora e trinta minutos de duração cada. Participaram do estudo 26 idosos bipolares, com a média etária de 66,6 anos, sendo a maioria do sexo feminino (65,4%), casada (50%) e morando com o cônjuge (26,9%). Os resultados demonstraram a equivalência das amostras antes da intervenção. Após esta, observou-se no grupo da TCC uma redução significativa dos sintomas de mania (p=0,034), do padrão de crenças irracionais (p=0,046) e da média das crenças pontuadas (p=0,019). Não houve mudanças significativas nos grupos da PE e do TP. Notou-se na amostra total um aumento significativo do nível de estresse (p=0,014) e da qualidade de vida na área da saúde (p=0,046), no período pós-intervenção. Quanto ao desfecho clínico, o grupo da TCC foi o que se manteve estável por um maior período de tempo, quando comparado com os demais grupos, mas isto não foi significativo. Neste estudo observou-se que o grupo da TCC foi o que mostrou melhores resultados e que se manteve em eutimia por um maior período de tempo. Embora os estudos de acompanhamento ao longo do tempo com idosos sejam difíceis de serem conduzidos, devido à maior desistência ao longo destes, sugere-se a realização de estudos longitudinais, controlados, que visem a desenvolver protocolos de intervenção para o tratamento dos idosos bipolares, proporcionando uma melhora na sua qualidade de vida e um envelhecimento saudável / The Bipolar disorder [BD] is a chronic and recurrent disease, which brings significant impairment to the individual. For the elderly bipolar patients, recurrences are even faster and episodes are, usually, longer and with a high risk of developing dementia symptoms. It is, also, associated with inherent changes during the process of aging. This study aimed to compare the benefits of adding cognitive behavioral group therapy [CBT] and psychoeducation group therapy [PE], in elderly bipolar patients under standard treatment [ST], i.e., conventional pharmacological therapy. The present study was a controlled one, with the sample distributed by convenience and with a blind evaluation of outcome measures. The instruments used were: a Research Protocol for the socio-demographic characterization and clinical history, the Geriatric Depression scale, the scale of Assessment of Modified Young Mania, the Irrational Beliefs Questionnaire, the Lipp Inventory of Stress Symptoms for Adults and Quality of Life Inventory. The study criteria for inclusion were patients with BD type I or II, who were clinically described as euthymic or in partial remission of symptoms, aged 60 years or over, in absence of dementia or delirium symptoms. Participants were distributed into three groups: (a) the addition of CBT to ST, (b) the addition of PE to ST and (c) only ST. Participants were assessed at baseline and at the end of the intervention. Group interventions occurred in 21 weekly meetings lasting an hour and thirty minutes long each. The participants were elderly bipolar (n=26), mean age of 66.6 years, most females (65.4%), married (50%) and living with the spouse (26.9%). The baseline evaluation showed an equivalence of symptoms among the patients. After the intervention, the CBT plus ST group showed a significant reduction of symptoms of mania (p = 0.034), a lower pattern of irrational beliefs (p = 0.046) and a lower score of punctuated beliefs (p = 0.019). There were no significant changes in the groups of the PE and the ST. Also, all participants showed a significant increase in the stress level (p = 0.014) and in quality of life concerning health area (p = 0.046). As for the clinical outcome, CBT Group remained stable for a longer period of time, when compared with the other groups, but this was not a significant result. Nevertheless, CBT group remained euthymic much longer and showed a better outcome compared to the other ones. Follow-up studies with elderly patients are difficult to be conducted due to the great withdrawal over time, as so, it is suggested controlled longitudinal studies, aimed to develop intervention protocols for the treatment of elderly bipolar, providing an improvement in their quality of life and a healthy aging