International Journal of Bipolar Disorders最新文献

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.

Background: Both bipolar disorder (BD) and epilepsy (ES) have been linked to polycystic ovary syndrome (PCOS) that is one of the most common endocrine disorders in women of reproductive age. The antiseizures medication valproate is widely used in the treatment of both disorders but has been suspected to increase the risk of PCOS. Previous studies have been limited by small sample sizes and heterogeneous definitions. We aimed to investigate the association between valproate exposure and incident PCOS in females with BS and ES.

Methods: We conducted a register-based cohort study including all females in Denmark with a first diagnosis of BD (ICD-10: F30.x-F31.x) or ES (ICD-10: G40.x) between January 1, 2000, and July 31, 2022. Women with BD, ES, valproate exposure, or PCOS prior to January 1, 2000, were excluded. Exposure to valproate was primarily modeled as current cumulative exposure. We also included a never/ever analysis and an overall cumulative analysis, accumulating dosages over the entire study period. The outcome was incident PCOS (ICD-10: E28.2). Cox regression models adjusted for age at diagnosis and calendar year were applied.

Results: The cohort comprised of 20,967 women, 8,003 diagnosed with BD and 12,964 diagnosed with ES. In total, 266 females developed PCOS during follow-up, of whom 160 had been exposed to valproate. In the main analysis, current cumulative exposure was strongly associated with PCOS, with HRRs rising from 4.43, 95%CI:3.42-5.73 (0-90 DDDs) to 7.08, 95%CI:3.85-13.03 (> 365 DDDs), P < 0.001. In the never/ever analysis, valproate exposure was also associated with increased PCOS risk (HRR 1.55, 95%CI:1.20-2.00). By contrast, overall cumulative exposure showed a less consistent pattern, with risk most clearly elevated in the highest dosage category (> 365 DDDs, HRR 2.04, 95%:CI 1.28-3.20), p < 0.01.

Conclusions: Valproate exposure was associated with an increased risk of PCOS. The risk was especially pronounced during current and cumulative exposure, whereas overall cumulative exposure suggested increased risk at higher thresholds. These findings suggest that PCOS risk may be driven by acute pharmacological effects, although long-term cumulative use may also contribute. The results reinforce recommendations to avoid valproate in women of reproductive age when possible.

Background: 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.

Methods: 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.

Results: 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 = 0.003), a shorter duration of initial episodes (p = 0.005) and a higher prevalence of pre-existing or co-occurring illicit drug use disorders (p = 0.039) than those with pre-existing BD.

Conclusions: 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.

Background: Bipolar disorders (BD) are severe mental illnesses with recurrent depressive and (hypo-)manic episodes and a chronic course. While anecdotal and cross-sectional studies suggest a link between BD and creativity, longitudinal evidence is limited. This study investigates the role of creativity in individuals with varying risk for developing BD, using data from the multicenter, prospective Early-BipoLife study. N = 1,255 individuals aged 15-35 years were assessed and followed for over two years. Of these, N = 1,105 were included in the analyses; 150 were excluded due to missing creativity questionnaires. Creativity was measured with the Barron-Welsh Art Scale (BWAS) and the Creative Achievement Questionnaire (CAQ); BD risk was assessed with the EPIbipolar. Analyses included comparisons of mean creativity scores across BD risk groups and logistic regressions testing prospective associations between continuous creativity scores and transition to manifest BD. To enhance clinical applicability, group comparisons and odds ratios (ORs) were also calculated, providing estimates of relative risk across subgroups defined by BD risk status and creativity level.

Results: At baseline (BL), participants at high BD risk scored significantly higher on the CAQ than those at low risk, while no differences were observed for BWAS scores. During FU, 25 of 1,105 individuals transitioned to manifest BD. Logistic regression analyses did not reveal significant associations between creativity and transitions. However, group comparisons indicated elevated transition likelihood in individuals with high BD risk, with the highest ORs in those combining high BD risk and high creativity (BWAS: OR = 7.05, 95% CI: 1.94-25.56; CAQ: OR = 5.57, 95% CI: 1.88-16.54) compared to low-risk individuals with low creativity.

Conclusions: High BD risk was associated with higher CAQ scores at BL, suggesting heightened creativity may precede transition. Prospective analyses over two years did not confirm this association, likely due to the small number of transitions. Nonetheless, cross-sectional differences and group comparisons suggest that individuals with both high BD risk and high creativity, particularly real-world accomplishments captured by the CAQ, may show an increased likelihood of transition. These preliminary findings warrant replication in larger, longer-term studies. Importantly, creativity should not be pathologized but considered both as a resource and as a potential modifier of risk trajectories.

Bipolar Disorder (BD) is a highly complex and heterogeneous disorder. As such, accurate diagnosis is often delayed, and effective treatment options are limited. The Integrated Network, a program of Breakthrough Discoveries for thriving with Bipolar Disorder (BD²), was designed as a platform for longitudinal deep phenotyping of a diverse group of people with bipolar disorder to define disease trajectories and to gain insight into the biological drivers of the illness. Biosamples, including whole blood, serum, plasma, and peripheral blood mononuclear cells (PBMCs), will be collected longitudinally and will also be made available. The Integrated Network is designed to be the largest and most comprehensive prospective longitudinal study conducted in bipolar disorder, allowing for the development of precision-based treatment strategies that optimize quality of life for people living with bipolar disorder.

Bipolar disorder (BD) is a highly heritable mental illness that affects ∼ 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.

Background: 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.

Results: 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.

Conclusions: 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.