International Journal of Bipolar Disorders最新文献

Background: This scoping review synthesized evidence on vitamin D, parathyroid hormone (PTH), and serum calcium in bipolar disorder (BD) to evaluate their potential clinical utility.

Methods: A systematic PubMed search identified original studies examining calcium metabolism biomarkers (vitamin D, PTH, serum calcium) exclusively in BD populations. Findings were synthesized narratively due to substantial methodological heterogeneity.

Results: Fourteen studies met inclusion criteria, with small sample sizes (median n = 55) and predominantly cross-sectional designs. Vitamin D comparisons between BD patients and controls yielded contradictory results: three studies reported significantly lower levels in BD patients, two found significantly higher levels, and three found no differences. Vitamin D deficiency definitions varied widely (< 25 to < 50 nmol/L), precluding meaningful comparisons. Four cognition studies showed inconsistent associations with vitamin D, with negative correlations, age-dependent effects, or no associations reported. Two small vitamin D supplementation studies in bipolar spectrum disorders yielded contradictory results in distinct populations, with one in youth and the other in adults. Data on PTH and calcium were sparse and inconsistent.

Limitations: Study limitations included a single database search, substantial study heterogeneity, and inadequate control for confounders, including seasonal variation.

Conclusions: Evidence on calcium metabolism biomarkers in BD is contradictory and methodologically limited. Fundamental inconsistencies in vitamin D status between BD patients and controls, combined with conflicting supplementation data, preclude clinical recommendations. Routine vitamin D screening specifically for BD management cannot be supported. Large-scale, standardized studies are needed before clinical application.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Background: Anxiety disorders (ANX) affect 30-60% of individuals with bipolar disorder (BD), yet limited research has systematically examined clinical characteristics and treatment patterns in this comorbid population. This study investigated demographic, clinical, and pharmacotherapeutic differences between individuals with BD with and without comorbid ANX.

Methods: Cross-sectional data from 2,225 adults with BD enrolled in the Mayo Clinic Bipolar Disorder Biobank were analyzed. Participants were assessed for comorbid ANX, demographics, clinical characteristics, medication use, and treatment response using the Alda-A scale.

Results: Overall, 61% (n = 1,366) had comorbid ANX. Individuals with BD + ANX were younger (40.4 vs. 43.6 years, p < 0.001), more likely female (66.6% vs. 54.8%, p < 0.001), and exhibited higher rates of rapid cycling (64.2% vs. 45.2%, p < 0.001), suicide attempts (40.4% vs. 24.8%, p < 0.001), substance use disorders (63.5% vs. 54.8%, p < 0.001), and somatic comorbidities (MCIRS: 6.68 vs. 5.42, p < 0.001). Pharmacotherapeutically, individuals with BD + ANX were less likely to be currently prescribed lithium, a trend‑level difference (37.1% vs. 47.8%, p = 0.005) and showed a trend towards lower valproic acid use (21.7% vs. 29.6%, p = 0.047), but more likely to receive antidepressants (53.8% vs. 39.5%, p < 0.001), benzodiazepines (39.9% vs. 26.6%, p < 0.001), and gabapentinoids (8.5% vs. 4.5%, p < 0.001). Notably, 17.3% of individuals with BD + ANX received antidepressants without mood stabilizer coverage. Treatment response (Alda-A) scores were significantly lower in BD + ANX group for lithium (4.91 vs. 6.05, p < 0.001) and second-generation antipsychotics (4.67 vs. 5.73, p < 0.001), with a trend‑level reduction observed for mood-stabilizing anticonvulsants (5.16 vs. 6.01, p = 0.005). Similar patterns were observed in both BD-I and BD-II subtypes.

Conclusions: Individuals with BD + ANX represent a more severely affected subgroup with distinct prescribing patterns favoring antidepressants over mood stabilizers and attenuated response to mood stabilizers. These findings highlight the need for anxiety-informed treatment algorithms recognizing anxiety comorbidity as a negative prognostic factor.

Background: Data on factors that influence patient and caregiver preference for long-acting injectable (LAI) formulations of antipsychotics are limited in bipolar I disorder (BP-I), particularly regarding longer dosing intervals. The objective of this study was to explore healthcare experiences, preferences for LAI dosing frequency, and factors influencing preferences for a hypothetical LAI administered once every 2 months, in people living with BP-I, caregivers, and prescribers.

Methods: This qualitative interview study recruited people living with BP-I currently treated with a once-monthly LAI, caregivers, and prescribers from the USA and Canada. In semi-structured interviews, participants were asked about their treatment experiences, views on an ideal treatment, and preferences on LAI dosing frequency. Interview transcripts were analyzed descriptively for key themes.

Results: Twelve people living with BP-I currently treated with a once-monthly LAI, five caregivers, and five prescribers were interviewed. All three participant groups perceived frequency of administration and remaining on the same antipsychotic as key features of an LAI; prescribers also considered previous responses to treatment, treatment access, and the need to maintain control of medication important when prescribing. Participants were positive about an LAI administered once every 2 months compared with LAIs in general due to improved convenience, reduced patient and caregiver impact, and the potential to feel well and stable for longer.

Conclusions: Participants were positive about a potential transition to an LAI given once every 2 months. As each participant group has unique preferences for LAIs and treatment goals, these should be discussed during healthcare interactions to ensure that targeted disease management goals are met.

Background: Bipolar Disorder (BD) is a class of mood disorders that poses a significant diagnostic challenge for clinicians. With its unknown etiology and the increasing disability burden it contributes to, BD necessitates further study to improve patient outcomes. Our study aimed to characterize the demographic trends in BD-related mortality using the CDC WONDER database.

Methods: The CDC WONDER database was utilized to collect data on the mortality burden from 1999 to 2023. Data was stratified by race or ethnicity, sex, age, rural or urban designation, and census region. Data analysis was performed using Joinpoint analysis to help determine trends as well as statistical significance.

Results: Our study found that the rate at which BD was mentioned in death certificates increased throughout the study period and mortality associated with BD increased with age. Additionally, the study found statistically significant increases in age adjusted mortality rate when analyzed in groups. Not only was mortality rate determined to be higher amongst females than their male counterparts, variation by race and ethnicity also persisted, with mortality being highest among the Non-Hispanic White cohort. Mortality burden varied by region, with higher mortality rates in rural areas than in urban areas and in the Midwest United States, compared to other census regions.

Conclusions: Our study expands on prior research related to trends in mortality of BD and aims to highlight the disproportionate mortality burdens related to BD as a potential guide towards future management strategies. Further studies related to how the increased utilization of mental health resources, including telehealth, and focus on earlier treatment initiation can be useful to guide mental health practices in the future.

Background: 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.

Aims: 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 months or longer. We aimed to evaluate their performance against established clinical measures and through inter-ambulatory assessment comparisons.

Methods: 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.

Results: 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.

Conclusions: 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.

Background: 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.

Methods: 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.

Discussion: 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.

Trial registration: Medical Ethical Committee Brabant (METC Brabant; identifier P2314); ClinicalTrials.gov Identifier: NCT06282250. Registered 20 February 2024.

Background: This study aimed to explore and understand the experiences of patients with bipolar disorder type I who underwent magnetic resonance imaging (MRI) brain scans as part of lithium treatment assessment in the European R-LiNK study.

Methods: All participants underwent brain imaging at baseline and three months after starting lithium treatment. 1 H-MRI scans (structural, diffusion-weighted, and single voxel proton spectroscopy) were conducted on both occasions, with 7Li-MRI at the second visit, all at 3T. The study used a qualitative, inductive approach to explore patients' subjective experiences.

Participants: Eight participants were included, four males and four females, aged 22 to 52 years. This group was selected from the R-LiNK study based on s having completed the imaging component before and after lithium treatment initiation.

Results: Seven themes were identified: Motivations for Participation, Experiences with MRI Scans, Psychological Impact of MRI Scans, Patient Reflections on Lithium Use, Integration of Technology in Treatment, Evaluating Combined Treatment Strategies, and Implications for Future Research. Participants commonly described lithium as contributing to mood stabilisation, while the MRI scans provided several individuals with a tangible sense of the biological underpinnings of their illness. Conversely, some participants reported anxiety and discomfort with the MRI procedure and particularly in relation to lithium's side effects, emphasizing the importance of supportive and empathetic communication throughout the treatment process to encourage trust and understanding.

Conclusions: This qualitative study revealed that adding ⁷Li-MRI scans to the early stages of lithium treatment subjectively validated the diagnosis, increased participants' confidence in the treatment process, and highlighted the importance of integrating patient experiences when incorporating advanced technology to monitor treatment response.