搜索结果：International journal of bipolar disorders

Mental disorders are leading causes of disability worldwide. This study aimed to examine the burden and trends of five major mental disorders-schizophrenia, depressive disorders, bipolar disorder, anxiety disorders, and eating disorders-among working-age population (adults aged 20-64 years) at global, regional, and national levels from 1990 to 2021. Data on the number and age-standardized rates (ASRs) of incidence, prevalence, and years lived with disability (YLDs) for the five major mental disorders were extracted from the Global Burden of Disease (GBD) 2021. Data were stratified by sex, age groups (20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, and 60-64), five socio-demographic index (SDI) regions, 21 GBD regions, and 204 countries/territories. A simulation approach sampling from log-normal probability distributions was used to estimate the combined number and rate of five mental disorders. To facilitate comparisons across varying regions and periods, direct standardization was applied for the age group of 20-64. Age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized YLDs rate per 100,000 population were calculated. The trends from 1990 to 2021 were analyzed using the Estimated Annual Percentage Change (EAPC). The numbers were presented with 95% uncertainty intervals, while ASRs and EAPC were presented with 95% confidence intervals (CIs). From 1990 to 2021, the ASIR of total five mental disorders per 100,000 population decreased from 5958.64 (95% CI: 4611.77, 7700.71) in 1990 to 5824.85 (95% CI: 4456.57, 7610.00) in 2019, then increased to 6886.24 (95% CI: 5253.93, 9017.71) in 2021. The EAPC for ASIR was -0.28 (95% CI: -0.37, -0.19) for the period 1990-2019 and 8.73 (95% CI: -0.04, 18.26) for the period 2019-2021. ASPR followed a similar trend, dropping from 11,245.03 (95% CI: 9020.15, 14045.23) per 100,000 population in 1990 to 11,167.93 (95% CI: 8920.87, 14005.12) per 100,000 population in 2019, then rising to 12,749.63 (95% CI: 10146.50, 16042.68) per 100,000 population in 2021, with the EAPC of -0.10 (95% CI: -0.14, -0.06) for the period 1990-2019 and 6.85 (95% CI: 1.70, 12.25) for the period 2019-2021. ASRs of YLDs per 100,000 population moved from 1931.88 (95% CI: 1325.53, 2775.82) in 1990 down to 1922.36 (95% CI: 1313.18, 2772.93) in 2019, and then rose to 2162.31 (95% CI: 1474.36, 3123.61) in 2021. The EAPC for ASR of YLDs was -0.10 (95% CI: -0.14, -0.06) from 1990 to 2019, while for the period 2019-2021, it was 6.06 (95% CI: 0.99, 11.38). Depressive and anxiety disorders dominated among mental disorders, with depressive disorders recording the highest numbers and ASRs. Low SDI regions indicated the highest ASIR, while high SDI regions recorded the highest ASPR and ASR of YLDs for five total mental disorders. Among 204 countries/territories, Greenland had the highest ASIR, ASPR, and ASR of YLDs for five total mental disorders. This study underscores a global increase in the burden of five major mental disorders among working-age population from 1990 to 2021, with ASRs rising notably after 2019. It underscores the critical need for tailored interventions that are sensitive to the varied impacts across different sexes, age groups, regions, and specific types of mental disorders, thereby enabling the optimal allocation of medical resources.

Social media platforms such as Reddit have become important spaces where individuals articulate their distress, seek support, and explore alternative ways of understanding mental health outside traditional institutional frameworks. These environments provide an opportunity to examine mental health discourse at scale, offering perspectives that extend beyond traditional clinical and research settings. This study aims to examine the structure of mental health communities on Reddit by identifying patterns of association between mental disorders reflected in user activity and assessing how these relationships align with established diagnostic categories in the ICD (International Classification of Diseases). We manually curated 114 Reddit communities focused on specific mental health conditions from the 20,000 most active subreddits in 2022. Each community was labeled into 49 disorders and categorized under 9 ICD diagnostic categories within the group of mental and behavioral disorders, collectively known as the F codes. We constructed a disorder association network by identifying statistically significant user overlaps based on coposting across subreddit pairs using a bipartite configuration model, with Bonferroni-corrected significance (P<.001). We analyzed the connectivity of the network within and across diagnostic categories, examining inter- and intracategory links. Finally, we compared the structure of disorder associations inferred from Reddit with the ICD classification derived from diagnostic criteria using hierarchical clustering. The inferred Reddit network of psychopathology revealed an interconnected structure (density=0.135), with all but 6 disorders forming a single giant component that spans across all 9 diagnostic categories. The most prominent disorders by number of users included hyperkinetic disorders (85,000), depressive episodes and recurrent depressive disorders (73,000), habit and impulse disorders (69,000), pervasive developmental disorders (52,000), and generalized anxiety disorder (44,000). In terms of connectivity, posttraumatic stress disorder (17/48 of all possible connections), obsessive-compulsive disorder (16/48), and depersonalization-derealization disorder (15/48) emerged as the most central in the network of positive disorder associations, while schizotypal disorder, avoidant personality disorder, and agoraphobia were the most central when accounting for the association strength. At the level of disorder categories, several disorders, such as bipolar disorder and premenstrual dysphoric disorder, displayed high intercategory associations but weak intracategory ties, indicating blurred diagnostic boundaries. The network of negative coposting associations revealed a divergence from the expectations of past research; for instance, addiction-related communities (eg, alcohol and opioids) were negatively associated with much of the broader mental health discourse. Finally, hierarchical comparisons showed moderate overlap between the Reddit network of disorder associations and the ICD network of diagnostic criteria, both in pairwise edge similarity (13% of edges present in both networks) and overall clustering (Adjusted Rand Index=0.295). Reddit-based mental health communities reveal a complementary structure of disorder associations shaped by lived experience, often diverging from formal diagnostic criteria and exhibiting patterns of association that do not align with established diagnostic boundaries.

Cognitive disorders can be early and persistent symptoms of bipolar disorder, even in the euthymic phase. These impairments significantly affect patients' quality of life. Early detection and regular follow-up are therefore crucial to effective, comprehensive management. To achieve this, it is essential to have validated tools adapted to the patient's language, guaranteeing accurate and reliable assessment. To facilitate this task, we chose to translate and validate the Arabic version of the COBRA scale. The main objective of this study was to translate and validate the Arabic version of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) scale. Specifically, we aimed to evaluate the psychometric properties, including reliability, validity, and feasibility of the Arabic version of the COBRA in a sample of Arabic-speaking individuals with bipolar disorder and healthy controls. This is a psychometric validation study of the Arabic version of the COBRA, obtained by a back-translation method of the original version, conducted on a sample of 161 participants, including 71 patients diagnosed with bipolar disorder and followed at Razi Hospital and 90 subjects with no personal or family psychiatric history, as assessed by the MINI International Neuropsychiatric Interview. The validity study was based on face and content validity, reliability, discriminative validity, construct validity and feasibility. The Arabic version of the COBRA demonstrated satisfying psychometric properties with excellent internal consistency (Cronbach's alpha=0.86) and all inter-item correlations significantly positive (p < 0.05). Bipolar patients showed significantly greater cognitive complaints than healthy controls, with a mean total score of 17.53 &#xb1; 5.21 versus 7.12 &#xb1; 1.7 respectively, suggesting high discriminative validity of the instrument. Convergent validity was confirmed by significant correlations (p<0.001) with cognitive tests. Factor analysis revealed a four-factor structure explaining 57.48% of the variance, with a dominant factor. The analysis yielded a cutoff score of 10.5 for identifying cognitive impairments with a sensitivity of 90% and a specificity of 97%. Furthermore, COBRA scores were significantly associated with age (r = 0.242, p = 0.002), duration of illness (r = 0.420, p < 0.05), and annual hospitalizations (r = 0.215, p = 0.042).The scale also demonstrated high feasibility. The Arabic version of the COBRA has very satisfactory psychometric properties and can be used to screen for cognitive complaints in patients with bipolar disorder.

There is a lack of research examining whether childhood abuse affects the quality of life (QoL) of individuals living with bipolar disorder and its improvement over the course of treatment. Data from the Clinical Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder were used to explore the associations between childhood abuse and multiple domains of QoL among 476 outpatients with bipolar disorder. Rates of change in QoL throughout treatment were explored with a series of Generalised Estimation Equations for repeated measures. At baseline, childhood abuse was related to poorer QoL in the domains of subjective feelings of wellbeing, social relationships and general activities-but not in physical health or leisure activities. Throughout treatment, participants with a history of childhood abuse reported significantly worse QoL in the same domains, than participants with no history of childhood abuse. Interestingly, exploratory analyses showed that participants with a history of childhood abuse and a current diagnosis of post-traumatic stress disorder (PTSD) had significantly worse QoL in all domains, than participants with no history of childhood abuse or diagnosis of PTSD. There were no significant differences between groups in change in QoL in any of the domains. This study comprehensively investigated the relationships between a history of childhood abuse and QoL among people with bipolar disorder who were receiving pharmacotherapy. Although the present findings need to be replicated, they suggest significant impairment in several domains of QoL associated with childhood abuse, which has service and treatment implications for trauma-informed care. ClinicalTrials.gov identifier: NCT01331304.

Although bipolar disorder (BD) typically emerges in young adulthood, several studies have suggested that the onset of this disorder can occur later in life. However, there are hardly any studies that have established the incidence of BD in older ages and compared clinical features between later-onset and earlier-onset BD. Our study aimed to (1) assess the incidence rate of BD in a population-based prospective study of people older than 35 years, (2) clinically characterize these people with incident BD, and (3) compare their sociodemographic and clinical characteristics with those of people who had already reported lifetime BD at baseline. We included 3,709 participants from a population-based cohort study aged 35 to 75 years at the first psychiatric evaluation (mean age 51.4 years, 54.1% women) with at least two psychiatric evaluations. Those exempt from BD at baseline were followed-up (mean duration 11.3 years) to assess the incidence rate of BD. Diagnostic criteria for mental disorders were elicited according to the DSM-IV using the semi-structured Diagnostic Interview for Genetic Studies. At baseline, 94 participants already met lifetime criteria for BD, whereas five developed BD during the follow-up, corresponding to an incidence rate of 12.2 per 100,000 person-years. Participants who developed BD during the follow-up had a substantially older age at the first episode compared to those who had already reported lifetime BD at the initial psychiatric evaluation (49.8 vs. 29.0 years, respectively). Those with incident BD also reported more frequent initial episodes with mixed symptoms (p&#x2009;=&#x2009;0.003), a shorter duration of initial episodes (p&#x2009;=&#x2009;0.005) and a higher prevalence of pre-existing or co-occurring illicit drug use disorders (p&#x2009;=&#x2009;0.039) than those with pre-existing BD. Although our results support a later emergence of BD in middle-aged adults, they also suggest atypical first manifestations of this later disorder with a high proportion of mixed episodes and high comorbidity with drug use disorders. From a clinical point of view, our data highlight the necessity for a thorough screening for first manifestations of BD also in middle-aged people particularly in the presence of drug misuse, which may delay the earlier recognition of mood episodes.

Antidepressants are still commonly prescribed in bipolar disorders, despite ongoing controversy of the potential risk of inducing hypomania/mania. There is limited knowledge about the characteristics of antidepressant use in older age bipolar disorder (OABD; age &#x2265;50) in the current literature. To describe antidepressant use, sociodemographic and clinical correlates of a global sample of OABD individuals. The Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) consortium provided cross-sectional international data on OABD individuals (n&#xa0;=&#xa0;746) and younger-age bipolar disorder (YABD, age <50&#xa0;years; n&#xa0;=&#xa0;692) regarding antidepressant use. Multivariate logistic regression was employed to assess the association between AD use with demographic and clinical variables. Of 1252 participants, 33.1&#xa0;% of OABD individuals and 38.1&#xa0;% of YABD individuals were using antidepressants. In multivariable models among OABD, antidepressant use was associated with BD type II (OR&#xa0;=&#xa0;1.61, 95&#xa0;% CI: 1.09-2.38), higher depression severity (mild-to-moderate: OR&#xa0;=&#xa0;1.86, 95&#xa0;% CI: 1.13-3.06; severe: OR&#xa0;=&#xa0;4.23, 95&#xa0;% CI: 2.38-7.50), lower YMRS scores (OR&#xa0;=&#xa0;0.93, 95&#xa0;% CI: 0.89-0.97), female sex (OR&#xa0;=&#xa0;1.37, 95&#xa0;% CI: 1.00-1.89), lower education (OR&#xa0;=&#xa0;0.61, 95&#xa0;% CI: 0.43-0.86), and being unemployed (OR&#xa0;=&#xa0;0.69, 95&#xa0;% CI: 0.50-0.96). Antidepressant monotherapy was reported in 18&#xa0;% of OABD users (n&#xa0;=&#xa0;46) and 19&#xa0;% of YABD users (n&#xa0;=&#xa0;51). These findings suggest that both clinical severity and sociodemographic characteristics influence antidepressant prescribing in OABD. Antidepressant use was less prevalent in OABD compared to YABD, and associated with female sex, lower education, lack of occupation, type II BD, higher depression severity and lower mania scores. In OABD, antidepressants appear to be used more commonly in contexts where they may be clinically more indicated, such as increased depression severity.

Individuals with bipolar disorder often experience reduced quality of life (QoL). Transcranial direct current stimulation (tDCS) is a promising non-invasive treatment for bipolar depression that is portable, safe, and suitable for use at home. We developed a home-based tDCS protocol with real-time remote supervision and examined its effect on QoL in bipolar depression. In an open-label design, 44 participants (31 women) with bipolar depression of at least a moderate severity received 21 sessions of home-based tDCS (2 mA, 30 min, F3 anode/F4 cathode) over 6 weeks, with a follow-up visit conducted 5 months from baseline. QoL was assessed using the quality of life enjoyment and satisfaction questionnaire (Q-LES-Q) at baseline, week 2, end of treatment, and follow-up session. Baseline and post treatment scores were compared with healthy control participants (28 adults; 17 women). At baseline and at the end of treatment, bipolar participants showed a significantly lower Q-LES-Q score than healthy controls (p&#x2009;<&#x2009;0.001). Within the bipolar group, there was a significant improvement in total Q-LES-Q scores (p&#x2009;<&#x2009;0.001) and across multiple domains by week 6 and remained elevated at follow-up. Changes in Q-LES-Q were no longer significant after adjustment for depressive symptoms. A 6-week course of supervised home-based tDCS was associated with significant QoL improvements in bipolar depression, which appeared to be closely linked to reduction in depressive symptoms. Randomized, sham-controlled trials are warranted to clarify the specific contribution of tDCS to improve QoL in bipolar depression.

Patients with major depressive disorder (MDD) who exhibit high bipolarity are at increased risk of future diagnostic conversion to bipolar disorder. However, treatment recommendations for MDD with bipolarity are constrained by limited direct evidence. We examined the association between bipolarity and primary pharmacotherapy in long-term stable outpatients with MDD and explored a clinically useful Bipolarity Index (BI) threshold. In this two-center cross-sectional study, participants were classified into an antidepressant (AD) group or a mood stabilizer/second-generation antipsychotic (MS/SGA) group. Bipolarity was assessed with the BI. Receiver operating characteristic (ROC) analysis was used to identify a BI cutoff discriminating MS/SGA from AD. Of 103 participants, 54 were assigned to the AD group and 49 to the MS/SGA group. The BI score was significantly higher in the MS/SGA group than in the AD group (24.1 &#xb1; 12.9 vs 13.3&#xb1; 7.0; p < 0.001). ROC analysis indicated a BI cutoff of 16 (Area Under the Curve = 0.765), yielding 69.4% sensitivity and 77.8% specificity for identifying the MS/SGA group. Among long-term stable outpatients with MDD, higher BI scores were associated with the use of MS and/or SGA rather than antidepressant monotherapy as primary pharmacotherapy. In this Japanese stable outpatient sample, a BI score of 16 or above identified patients who were more likely to be receiving MS and/or SGA. These findings reflect prescription patterns observed in this cross-sectional sample and should not be interpreted as evidence that MS and/or SGA are preferable treatments for patients with greater bipolarity. Further prospective studies are needed to clarify the clinical significance of BI-defined bipolarity and its relationship to treatment outcomes in patients with MDD.

This Swedish nationwide cohort study used large-scale data to investigate the associations between bipolar disorder and somatic disorders and whether these risks differ by subtype, sex, or exposure to compulsory care. 61,071 individuals diagnosed with bipolar disorder in inpatient (from 1973) or outpatient care (from 2001) care were compared with the general population without bipolar disorder. The cohort included individuals born in 1932 or later, with follow-up from 1973 to 2020. Cox regression models estimated associations with a range of somatic conditions, including cardiovascular, endocrine, neurological, and infectious diseases. Subtype-specific analyses were conducted in individuals with type 1 (n&#x2009;=&#x2009;8,352) or type 2 (n&#x2009;=&#x2009;9,674), and in those with a history of compulsory care (n&#x2009;=&#x2009;6,748). Bipolar disorder was associated with significantly increased risks for most examined somatic conditions. The highest hazard ratios (HRs) were observed for sleep disorders (HR 3.79; 95% CI, 3.71-3.87) and dementias (HR 4.32; 95% CI, 3.82-4.79). Type 2 diabetes risk was elevated, while no association was found for type 1 diabetes. Most risks were comparable across bipolar subtypes, though certain conditions-such as migraine and fibromyalgia-were more strongly associated with type 2. Individuals with a history of compulsory psychiatric care showed elevated risks for several conditions. Regardless of sex or subtype, bipolar disorder is associated with substantially higher lifetime risks of a broad range of somatic conditions. Integrated psychiatric and somatic health care may help reduce morbidity and improve outcomes.

Bipolar disorder (BD) is a highly heritable mental illness that affects &#x223c; 1-2% of the world's population and has complex genetic and environmental underpinnings. Early detection is critical to improving treatment outcomes, but current strategies have limited predictive power. Early detection tools such as the Early Phase Inventory for Bipolar Disorder (EPIbipolar) and the Bipolar At-Risk (BARS) criteria assess phenotypic risk factors, including family history (FH) and subthreshold mood problems. Polygenic risk scores (PRS) are a quantitative metric of genetic susceptibility. This study examined the associations between BD-PRS and screening tools in order to assess their combined potential to identify individuals at risk of BD with improved predictive accuracy. The analysis included 1068 participants, including 199 at-risk young adults aged 15 to 35 years and 869 healthy controls aged 18 to 50 years. All of them had no prior psychiatric disorders. Inclusion criteria for the at-risk group comprised a positive FH (1st or 2nd degree) for BD, major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD), or the presence of specific BD risk factors (e.g., subthreshold hypomanic symptoms, mood swings, or sleep disturbances). Participants who had a confirmed BD, schizophrenia, schizoaffective disorder diagnosis, or other psychiatric conditions that could explain the symptomatology, were excluded. Diagnostic assessments that were utilized validated early detection instruments, including EPIbipolar, Bipolar Prodrome Interview and Symptom Scale-Prospective (BPSS-FP), and BARS criteria. Binary logistic regression models were employed to assess associations between BD-PRS and phenotypic risk markers, with adjustments for population stratification. Results revealed significant associations between BD-PRS and BARS criteria risk groups and EPIbipolar "at risk" criteria compared to controls. Significant associations were also identified for subscales including FH for BD, MDD, or schizophrenia, sleep and circadian rhythm disturbances, depressive characteristics, functional impairment, and episodic course. However, no significant associations were observed between BD-PRS and BPSS-FP, which highlights variability in the sensitivity of different early detection instruments. Our findings emphasize the potential of combining genetic susceptibility measures with phenotypic risk markers to enhance early detection strategies for BD. Further research is needed to optimize predictive models and evaluate the clinical utility of PRS in early intervention frameworks.

INTRODUCTION: A substantial proportion of patients with bipolar disorder experience daily variability in mood that seems associated with poor prognostic factors, including impaired functioning, and increased risk of hospitalisation and relapse. The present SmartBipolar randomised controlled trial (RCT) investigated whether group (1) daily smartphone-based outpatient monitoring and treatment including CBT elements with clinical feedback (intervention group) versus group (2) daily smartphone-based monitoring and treatment with CBT elements without clinical feedback (content was the same as intervention group but without clinical feedback) (control group) or group (3) daily smartphone-based mood monitoring only without CBT elements or other smartphone content (control group), improved mood instability and other clinically relevant patient-related outcomes in patients who have had a bipolar disorder for more than two years, and typically many years. METHODS: This study was a pragmatic, randomised controlled trial with a follow-up period of 6 months. The outcomes were (1) mood instability (primary), (2) questionnaire-based evaluations of quality of life, depressive symptoms, manic symptoms, perceived stress, as well as smartphone-based measures of mood, activity, stress, anxiety, irritability, and sleep. Group differences were quantified using linear mixed models. RESULTS: A total of 201 patients with progressed bipolar disorder were included as part of their specialised outpatient treatment in the Mental Health Services in the Capital Region of Denmark. The trial began in March 2021 with last patient follow-up in July 2025. Intention-to-treat analyses showed no differences in the primary outcome mood instability (difference: 0, 95%CI: -0.16; 0.16, p&#x2009;=&#x2009;0.98). In addition, there were no differences in other patient-reported outcome measures. LIMITATIONS: This was an unblinded trial. CONCLUSION: There was no positive or negative effects of smartphone-based monitoring and treatment on primary or secondary outcomes in the present trial. CLINICAL TRIALS REGISTRATION: NCT04230421. Registered January, 2020.

Ambulatory assessment uses digital technology to capture real-time data on mood, mental state and behaviour. It has the potential to enhance traditional clinical outcome measures, but the practical application of these tools fundamentally depends on their performance. This systematic review aimed to assess the performance of active and passive ambulatory assessment and mood monitoring outcome measures in non-randomised and randomised studies in bipolar disorder over 3&#xa0;months or longer. We aimed to evaluate their performance against established clinical measures and through inter-ambulatory assessment comparisons. Systematic review (PROSPERO: CRD42023396473) of performance of mood monitoring and ambulatory assessment protocols in RCTs and non-randomised studies in bipolar disorder. Identified studies were assessed for risk of bias. Due to the very high heterogeneity in included studies and performance metrics we were not able to aggregate the data via meta-analysis. The review included 42 studies with a combined sample of 7,813 participants. We included 28 distinct ambulatory assessment protocols which reported 487 different smartphone-based performance metrics. The considerable variability and inconsistency across these metrics limited our ability to make definitive comparisons of performance. Overall, some active ambulatory assessment approaches showed good performance when compared with established clinical measures. There was a paucity of data examining the performance of passive ambulatory assessment measures. Most studies were rated as having low to moderate risk of bias. While ambulatory assessment holds significant promise, current evidence fails to establish the validity and reliability of passive ambulatory assessment to measure mood. The substantial methodological variation-particularly in how performance metrics are defined and reported-limits meaningful comparison and replication. Greater consistency in ambulatory assessment design and reporting standards is essential to support reliable evaluation and broader adoption of these behavioural assessment tools.

Suicide is the second leading cause of death for children and adolescents aged 6 to 18 years. Pediatric suicidality is underreported, which poses significant challenges for effective intervention and prevention strategies. Identifying populations at risk of suicidality can provide critical benefits in terms of study cohort selection, prevalence estimation, and clinical resource allocation. This study sought to (1) measure the prevalence of mental health comorbidities in pediatric suicidality and (2) identify undiagnosed high-risk suicidality cases by matching them with patients with a similar mental health comorbidity burden. Electronic health record data from a large academic pediatric hospital in Boston, Massachusetts, were analyzed for patients aged 6 to 18 years presenting to the emergency department between June 1, 2016, and June 1, 2022. Suicidality cases were defined using International Classification of Diseases, 10th Revision (ICD-10) codes for 3 suicidality subtypes: suicidal ideation, self-harm, and suicide attempt. Comorbidities of suicidality were calculated as the conditional probability of ICD-10 code pairs. After multiple hypothesis corrections, statistically significant comorbidities and patient encounter demographics were input as covariates into a propensity score matching (PSM) model. The accuracy of the PSM model was validated against chart review by 2 independent subject matter experts. In total, 2.9% (2638/90,980) of emergency department encounters met an ICD-10-based case definition of suicidality during the study period. The prevalence of suicidality by subtype was 2.5% (2275/90,980) for ideation, 1.1% (1030/90,980) for self-harm, and 0.2% (177/90,980) for suicide attempt. Suicidality prevalence was more common for the female sex (1825/43,929, 4.2%) than for the male sex (813/47,045, 1.7%). Comorbidities of suicidality were statistically significant for 55 frequently co-occurring ICD-10 codes. Nearly half of these comorbidities (26/55, 47.3%) were not present in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and nearly a quarter (12/55, 21.8%) consisted of ICD-10 codes for accidental rather than intentional self-harm. Increased probability of suicidality was observed for patients with personality disorder (84/190, 44.2%), gender dysphoria (143/333, 42.9%), bipolar disorder (162/448, 36.2%), depression (1791/5426, 33%), and schizophrenia spectrum disorders (133/411, 32.4%). On the basis of gold-standard chart review, 53.4% of propensity-matched noncases were unrecognized cases of suicidality. PSM using comorbidity profiles is an effective approach for identifying suicidality cases that lack ICD-10 codes for suicidality.

With limited evidence-based options, treatment of depressive episodes in bipolar disorder (BD-DE) remains challenging. This study examines the trajectories of psychotropic drug use and polypsychopharmacy in psychiatric inpatients with acute BD-DE. Using data from the German pharmacovigilance program "Arzneimittelsicherheit in der Psychiatrie" (AMSP), the pharmacological treatment of 1,902 psychiatric inpatients with BD-DE between 2007-2024 was analyzed. Temporal changes in drug use between early (T1: 2007-2010) and late (T2: 2021-2024) periods were calculated using prevalence ratios (PR) with 95% confidence intervals (CI) and Welch's t-test. Overall, 98.5% of inpatients with acute BD-DE were treated with psychotropic drugs. Antipsychotic drugs (APD) were the most used psychotropic drug group (76.2%), followed by antidepressant (ADD; 70.3%) and antiepileptic drugs (AED; 44.3%) during the entire study period. Over time, APD use increased from 70.1% in T1 to 80.7% in T2 (PR 1.15, CI 1.06-1.25), attributable to the increased use of second-generation APD (PR 1.19, CI 1.07-1.32), especially quetiapine and aripiprazole. ADD (T1: 78.1% vs T2: 67.6%; PR 0.87, CI 0.79-0.95) and AED (T1: 56.7% vs T2: 34.6%; PR 0.61, CI 0.51-0.73) use significantly declined, while lithium use remained stable (31.7% from 2007-2024). Although the mean number of psychotropic drugs per patient decreased (T1: 3.85 vs T2: 3.34, p&#x2009;<&#x2009;0.001, d=-0.30), complex polypsychopharmacy consisting of &#x2265;3 psychotropic drugs remained prevalent (66.1% of patients during the entire study period). Combination strategies involving APD, especially use of two APD, significantly increased (T1: 15.6% vs T2: 31.5%; PR 2.01, CI 1.51-2.69). Pharmacological treatment of BD-DE has shifted towards an increased use of second-generation APD while AED are less utilized. ADD use and complex polypsychopharmacy continue to be prevalent, indicating a persistent gap between guideline recommendations and real-world practice.

Bipolar disorder (BD) is a severe mental illness associated with marked functional impairment and reduced life expectancy. Early indicators such as mood instability, circadian rhythm disturbance, and anxiety symptoms often precede the first manic or depressive episode, providing a potential window for preventive intervention. Currently, no structured early intervention program exists for individuals at risk for BD who do not yet meet diagnostic criteria. This study aims to evaluate the feasibility and acceptability of a novel, personalized early intervention program combining light therapy, lifestyle psychoeducation, and imagery-focused cognitive therapy (ImCT) for individuals at risk for BD. The study employs a single-case experimental A-B-A design with staggered baseline and multiple daily assessments. Fifty participants aged 16-35 years identified as being at risk for BD by a specialized early detection team will be included. The intervention consists of three core components: (1) a chronotherapeutic intervention (bright light therapy or blue-light blocking glasses) tailored to individual symptom profiles; (2) one session of lifestyle-focused psychoeducation targeting sleep, nutrition, and physical activity; and (3) six sessions of ImCT to address mood instability and maladaptive mental imagery. Feasibility and acceptability will be assessed through drop-out rates, adherence, and participant feedback. Secondary outcomes include changes in depressive, hyperactive, anxiety, and imagery-related symptoms, as well as sleep quality and activity levels, measured through validated questionnaires and actigraphy. By combining chronotherapeutic, psychological, and lifestyle components, this intervention targets multiple mechanisms implicated in BD risk. Findings will inform the development of preventive strategies for individuals in an at-risk mental state for BD. The study will also provide data on the feasibility of integrating early interventions within routine mental health services and guide the design of future randomized controlled trials. Medical Ethical Committee Brabant (METC Brabant; identifier P2314); ClinicalTrials.gov Identifier: NCT06282250. Registered 20 February 2024.

Between major affective episodes some people with bipolar disorder experience persistent low mood or mood instability. Here we report an initial evaluation of the STABILISE programme (ISRCTN19416314; registration date 01.02.23), an adaptation of individual behavioural therapy that includes concepts and techniques addressing emotion regulation designed to support people experiencing these inter-episode symptoms. This study aimed to evaluate the safety, feasibility and acceptability of the intervention and to explore whether the pattern of clinical change had potential for the intervention to be of benefit. Twelve individuals with inter-episode bipolar symptoms received the STABILISE therapy in a randomised, multiple baseline case series. Participants were randomly assigned to wait 3, 4 or 5 weeks before commencing treatment, which comprised up to 22 sessions up to 7 months. Measures of symptoms, mood lability, recovery and quality of life were completed at intake, pre-therapy, and post therapy. Participants completed weekly measures of affective symptoms over the baseline and therapy periods, and for three weeks after. All 12 participants completed the therapy programme and reported high levels of satisfaction overall. No adverse events were judged to be therapy related. There was one instance of reliable deterioration on one outcome measure. Across all parameters of clinical change 9 of the 12 participants showed an overall pattern of improvement and none showed a pattern of deterioration overall. This study provides preliminary support for the feasibility, acceptability, safety, and clinical potential of the STABILISE therapy. Further investigation of these aspects in a larger sample and within a randomised controlled trial design is required.

Recurrent course and disruption of circadian rhythms are among the core features of bipolar disorder (BD). Thus, ongoing symptom monitoring is an essential part of good clinical management. We conducted a study to validate the English version of the ASERT (Aktibipo questionnaire), a tool for self-assessment of mood symptoms. We also analyzed the relationship of self-assessed symptoms with clinician ratings and actigraphy measures, and investigated the possibility of predicting depressive episodes using subjective and digital measures. This was a longitudinal study of twenty individuals with BD, followed for up to 11 months. The participants completed weekly mood self-assessments (ASERT) using a smartphone app and wore wrist actigraphs. During monthly appointments, the severity of their mood symptoms was rated by clinicians, and the participants completed questionnaires addressing overall functioning (FAST), and biological rhythms (BRIAN). The study confirmed the validity and reliability of the ASERT as a measure of subjective mood. Additionally, we found significant associations between ASERT responses, clinical scales, and actigraphy data (ASERT_dep vs. MADRS &#x3b2;&#x2009;=&#x2009;1.42, p&#x2009;<&#x2009;0.001, ASERT_man vs. YMRS &#x3b2;&#x2009;=&#x2009;0.38, p&#x2009;<&#x2009;0.001, mixed-effect model). In our analysis, a combination of self-assessment and actigraphy data detected depression relapse with 67% sensitivity, 90% specificity, 81% balanced accuracy, and AUC of 0.80. Furthermore, we observed a strong correlation between the actigraphy-derived interdaily stability and BRIAN scores (&#x3b2;=-3.86, p&#x2009;=&#x2009;0.005) overall functioning, emphasizing the significance of circadian rhythm disruptions in BD. This study highlights the potential of digital tools, such as digitally administered self-assessments and actigraphy, to enhance the management of BD by providing valuable insights into mood states and detecting relapse. Further research is needed to refine and optimize these tools for widespread clinical application, such as informing personalized treatment plans.

Many individuals with bipolar disorder have decreased levels of cognitive functioning even when in a euthymic mood state. Persons with bipolar disorder are usually treated with psychotropic agents, but the effects of these medications on their cognitive functioning have not been extensively studied. A total of 567 people with bipolar disorder were assessed on a cognitive battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and Trail Making Test, part A (Trails A) and Letter-Number Sequencing. The machine-learning tool of cross-fit partialing-out least absolute shrinkage and selection operator (LASSO) regression was used to examine the independent association between the cognitive test scores and receipt of individual psychotropic medications considering relevant demographic and clinical covariates. Ordered logistic regression models were employed to examine the effects of medication dosage on the cognitive scores. We found that 3 medications, ziprasidone, benztropine, and clonazepam, were independently associated with significantly reduced cognitive scores compared with individuals not receiving these medications. Benztropine showed a significant dose-related relationship with all of the cognitive measures. Reduced memory and psychomotor speed were the domains most associated with receipt of these medications. Prescribers may consider limiting the administration of the medications which can affect cognitive functioning. Interventions should be further developed for people with bipolar disorder to improve their cognitive functioning and quality of life.

Mixed features in mood disorders are widely recognized but prevalence estimates are inconsistent, leading us to update of our 2018 systematic review of mixed features in major depressive disorder (MDD) and bipolar disorder (BD). We systematically searched 5 databases for reports on adults with episodes of BD or MDD assessed for mixed features by DSM-5 definitions or &#x2265;3 opposite-polarity features. Data were extracted thrice independently, and pooled prevalence rates calculated with confidence intervals (95&#xa0;% CI). We identified a total of 26 studies from 5 world regions, reporting on mixed features in 3107/17,164 MDD episodes (18.1&#xa0;%; [CI: 17.5-18.7]), 1886/5750 BD-depressions (32.8&#xa0;% [31.6-34.0]), and 721/2069 BD-[hypo]manic episodes (34.8&#xa0;% [32.8-36.9]). Mixed features were thus nearly twice as frequent in BD versus MDD and similar with BD depression and [hypo]mania. Rates varied markedly by diagnostic criteria: &#x2265;3 opposite-polarity features yielded higher prevalence than DSM-5 criteria (MDD: 23.8&#xa0;% vs. 3.60&#xa0;%; BD-depression: 35.0&#xa0;% vs. 29.3&#xa0;%; BD-[hypo]mania: 36.9 vs. 31.2&#xa0;%). Heterogeneous study-design and definitions, with under-representation of some world regions, may affect generalizability. Mixed features were prevalent in mood disorders, particularly in BD, but rate-estimates depend strongly on diagnostic criteria. Harmonization of definitions is required to support prognostic and therapeutic implications.