International Journal of Bipolar Disorders最新文献

Background: Pharmacological treatment for mental illness can paradoxically compromise physical health, with weight gain and related cardiovascular and metabolic diseases among its most concerning side effects. Understanding and mitigating the metabolic consequences of antipsychotic and mood stabilizing treatments is therefore crucial for improving long-term health outcomes in individuals with severe mental illness such as schizophrenia and bipolar disorder. This literature review focuses on the underlying mechanisms linking antipsychotics and mood stabilizers to weight gain in bipolar disorder. Current evidence on both pharmacologic and nonpharmacologic strategies to prevent this side effect is also addressed.

Methods: A literature search was conducted from February-April 2025 using PubMed and Google Scholar. The electronic search was complemented by a manual search for additional articles in reference lists and previous reviews. Relevant reviews, cohort studies, meta-analyses and randomized controlled trials (RCTs) were reviewed.

Results: Our results support that different mood stabilizers and antipsychotics contribute to weight gain through distinct biological mechanisms, including metabolic dysregulation, appetite modulation, and hormonal changes. Nonpharmacologic interventions, such as dietary modifications, physical activity, cognitive and behavioral strategies, play a crucial role in counteracting medication-induced weight gain. Pharmacologic approaches, including adjunctive medications, offer potential in mitigating weight gain, but their effectiveness and safety profiles require further evaluation.

Conclusion: Customized treatment plans tailored to each patient's needs, preferences, goals and circumstances should be considered for the treatment of antipsychotic and mood stabilizer-associated weight gain.

Background: Perinatal bipolar disorder (BD) presents unique challenges due to physiological, hormonal, and psychosocial changes during pregnancy and postpartum, increasing vulnerability to mood instability. Effective management is vital for maternal and infant health, but multiple barriers complicate care. This review aims to clarify whether obstacles arise from limited psychiatric expertise among obstetric providers, insufficient perinatal knowledge among psychiatric providers, or both.

Methods: A thematic review was conducted following PRISMA guidelines, synthesizing literature (2015-2025) from major databases and clinical guidelines on barriers and solutions in perinatal BD management. Both qualitative and quantitative studies were included. Data extraction, quality assessment, and thematic analysis were performed by multiple independent reviewers.

Results: Four major barriers were identified: (i) Diagnostic challenges-obstetric providers may miss or misdiagnose BD due to symptom overlap with normal perinatal changes, while psychiatric providers may lack specific perinatal expertise; (ii) Treatment issues-concerns about medication safety, particularly among obstetricians, and limited access to specialized psychiatric care, leading to increased relapse risk; (iii) Psychosocial barriers-stigma, inadequate support, and new maternal responsibilities hinder help-seeking; (iv) Poor interprofessional communication-fragmented care often results when obstetric and psychiatric providers lack coordination. These barriers adversely impact both mothers and infants, increasing relapse rates and impairing mother-infant bonding. Proposed solutions include improved diagnostic training for both provider types, integrated care models, enhanced patient education, support systems, and policy reforms. However, there remain knowledge gaps regarding long-term outcomes and optimal screening.

Conclusions: Effective perinatal BD management requires multidisciplinary, individualized, and integrated care addressing both clinical and psychosocial barriers. Bridging knowledge gaps between obstetric and psychiatric providers through education, research, and policy reform is essential to improve outcomes for mothers and their families.

Offspring of parents with bipolar disorder (OBD) are at increased risk for mood and behavioral disorders, with emotional dysregulation being an early marker. This pilot study aimed to evaluate the effect of a family-focused intervention on emotional dysregulation in OBD, hypothesizing a significant reduction in CBCL Emotional Dysregulation Profile scores over 12 months. Twenty-five OBD aged 6-16 years participated in a four-session psychoeducational program. Significant reductions were observed in CBCL emotional dysregulation scores suggesting that a brief family-focused program may reduce dysregulation and improve functioning in OBD. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov. ID NCT03299140. Registered on the 17th September, 2017.

Background: To identify, appraise, and synthesise qualitative studies exploring the experiences of informal caregivers (unpaid individuals providing emotional and or practical care) supporting individuals diagnosed with bipolar disorder (BD), and to identify any emotional, practical, or informational needs.

Methods: Ovid, MEDLINE, Scopus, PsychINFO and CINAHL were searched from 1980 to January 2025. Studies were eligible for inclusion if they were peer viewed, published in English, used qualitative data collection and analysis, had data on the experiences of caregivers (aged 18 or above) supporting individuals with BD (aged 14 or above), and were conducted in western countries with individualistic cultures. Studies were appraised using the Critical Appraisal Skills Programme checklist. Data were analysed using thematic synthesis.

Findings: Fourteen papers were included in the review. Three analytical themes: 'challenges of caregiving', 'healthcare system challenges', and 'coping with the shifting landscape' were identified, encompassing six descriptive themes and three supporting subthemes.

Conclusions: Caregivers supporting individuals with BD face complex emotional and physical challenges, coupled with significant imposed losses and responsibilities. The relapsing and unpredictable nature of BD can exacerbate caregiver demands. There is a need for increased societal awareness of BD, improved communication and collaboration between mental health services and caregivers, and improved support for caregiver wellbeing. Further research exploring cultural, gender, and role specific needs of caregivers is warranted.

Background: Bipolar disorders (BD) pose significant therapeutic health challenges due to recurrent and largely unpredictable depressive and (hypo)manic episodes. Traditional self-report methods for symptom monitoring are limited by their dependence on patient adherence which is frequently diminished during symptomatic phases. Circadian movement patterns, measured via actigraphy, have emerged as promising digital biomarkers for distinguishing mood states in BD. This study examined the utility of circadian rhythm parameters in differentiating euthymic, depressive, and (hypo)manic states.

Methods: This study analyzed data from 27 BD patients (mean age = 46 years, 16 female) monitored over 12 months as part of the BipoSense project. Wrist-worn accelerometers continuously recorded physical activity, while mood state was assessed using daily self-reports and biweekly expert evaluations. Circadian rhythm parameters included interdaily stability (IS), intradaily variability (IV), mean activity difference (MeanDiff), and circadian form difference (FormDiff). IS and IV reflect rhythm stability and fragmentation, while MeanDiff and FormDiff quantify overall activity and deviations in circadian rhythm form. Multilevel models were used to predict categorical mood states (depressive, (hypo)manic, euthymic) and dimensional symptom severity.

Results: Physical activity data from 23 patients yielded 2,669 valid days for analysis. In multilevel logistic models, lower MeanDiff (B = -.02, P < .001), reflecting reduced overall activity, lower IS (B = -.80, P = .009), indicating less stable circadian rhythms, and higher FormDiff (B = .03, P < .001), denoting a more rigid circadian activity pattern, were significantly associated with increased odds of depressive days compared to euthymic days. Conversely, higher MeanDiff (B = .02, P = .007) was linked to higher odds of (hypo)manic days. Dimensional linear mixed models showed a similar pattern: lower MeanDiff (β = -.11, P < .001), IS (β = -.06, P = .001), and IV (β = -.06, P = .002), together with higher FormDiff (β = .10, P < .001), predicted increased depressive symptom levels. Conversely, higher MeanDiff (β = .10, P < .001), IS (β = .04, P = .024), IV (β = .07, P < .001), and lower FormDiff (β = -.07, P = .001) were associated with heightened (hypo)manic symptoms.

Conclusions: Circadian rhythm parameters can effectively differentiate mood states in BD, highlighting their potential as clinical markers for episode transitions. Although the study was explorative by nature, the findings emphasize the potential value of integrating circadian biomarkers into digital phenotyping for mood state monitoring. Future studies should explore extended monitoring periods, larger samples, and real-time feedback systems to improve early intervention and personalized treatment strategies in BD.

Background: Although lithium is considered the gold standard for the maintenance treatment of bipolar disorder (BD), its prescription has declined in recent decades. At the same time, second-generation antipsychotics (SGAs), such as quetiapine, and other mood stabilisers such as valproic acid, have been increasingly used. Social media platforms such as X (formerly Twitter) provide real-time insights into public and professional perceptions of these treatments, which may influence their use and adherence.

Aims: To analyse how lithium, quetiapine, and valproic acid have been represented on X, by focusing on user type, engagement levels, and thematic content of tweets.

Method: We conducted a mixed-methods, observational study of tweets published in English and Spanish between 2008 and 2022. Tweets containing the generic or commercial names of lithium, valproic acid, and quetiapine were retrieved and analysed using a validated codebook and semi-supervised machine-learning models. Tweets were categorised by user type and clinical and non-clinical content themes.

Results: Among the 236,797 analysed tweets, quetiapine was the most frequently mentioned drug (69.4%), followed by valproic acid (19.1%) and lithium (11.5%). Lithium tweets showed the highest engagement (54.0 likes and 18.0 retweets per tweet). Patients mainly focused on quetiapine (47.0%), while healthcare professionals more often discussed lithium (58.1%). Tweets containing clinical content were more common in English (78.0%) than in Spanish (54.7%), especially regarding side effects (53.1% vs 8.2%). Tweets on effectiveness were more frequently discussed in English (48.8%), especially for quetiapine (54.7%), but were less common in Spanish (9.8%). Discussion about drug shortages was more prevalent in Spanish tweets (31.6% vs 0.5%), particularly for valproic acid (55.8%).

Conclusions: Despite lithium being the least mentioned drug, it generated the highest level of engagement, particularly among healthcare professionals. In contrast, quetiapine was widely mentioned by patients, which reflects a more socially widespread and, at times, problematic use. These findings highlight the value of listening to conversations on social media to better understand perceptions, concerns, and attitudes that may influence adherence and prescribing trends in mental health.

Background: The postpartum period is a recognized high-risk phase for maternal and infant health, yet predictors of bipolar disorder (BD) recurrence during this period remain unclear, particularly regarding distinctions between BD type I and II. This retrospective observational study assessed rates and clinical correlates of postpartum mood episodes in 248 women with a history of at least one pregnancy, affected by BD I (n:89) and BD II (n: 159). Participants were divided into two groups based on the presence/absence of postpartum mood episodes. Due to non-normal data distribution (Shapiro-Wilk:0.925, p < 0.001; Kolmogorov-Smirnov:0.122, p < 0.001), group comparisons were performed using Pearson's χ² test for categorical variables and the Kruskal-Wallis test for continuous variables. Logistic regression was used to identify clinical variables associated with a history of postpartum mood episodes.

Results: Eighty-two patients (29.4%) in the overall sample had a history of postpartum mood episodes, with a higher prevalence in BD I than BD II (30.3% vs. 27.0%). A later age at BD onset was significantly associated with a lower risk of postpartum recurrences in both BD I (21.4% vs. 55.7%, p:0.010) and BD II (27.3% vs. 59.1%, p < 0.001). In BD I, women with peripartum episodes had an earlier age at menarche (36.0% vs. 10.0%, p:0.003). In BD II, those with peripartum recurrences showed an earlier age at first hospitalization (40.6 ± 13.0 vs. 51.0 ± 12.3 years, p:0.010) and higher rates of medical comorbidities (74.8% vs. 54.5%, p:0.013). Logistic regression analysis confirmed the associations observed between clinical variables and postpartum mood episode risk in both BD I and BD II subgroups.

Conclusion: These findings indicate that in BD I underlying inherited constitutional factors (as age at onset and age at menarche) may influence postpartum episode risk, whereas in BD II recurrence appears more related to illness severity (such as age at first hospitalization and medical comorbidities). Given the lack of established predictors for perinatal recurrences, further studies are warranted to validate and expand these findings, enhancing the understanding of mood recurrence risk during the postpartum period.

Introduction: Predominant polarity (PP) has emerged as a valuable course specifier in bipolar disorder (BD) with implications for prognosis and treatment planning. As the BD population ages, understanding its clinical characteristics becomes essential to tailor personalized interventions across the lifespan. This study aimed to characterize the distribution and clinical profiles of PP subgroups in a cohort of older adults with BD (OABD).

Methods: This cross-sectional study included 101 euthymic OABD aged >50 years. Clinical, neuropsychological and functional characteristics were compared between depressive (DPP), manic (MPP), and undetermined predominant polarity (UPP) subgroups, based on at least 2/3 of lifetime episodes being either depressive or manic polarity.

Results: UPP was the most frequent PP in OABD (59.4%), followed by DPP (27.7%) and MPP (12.9%). Patients with DPP presented a later age of onset, a depressive first episode, less psychiatric hospitalizations, and a trend to outperform MPP and UPP in visual memory. Participants with MPP presented more frequently with manic onset. The UPP subgroup exhibited worse clinical outcomes, including higher number of total episodes, more frequent suicidal ideation and seasonality, and worse financial disability compared to DPP.

Conclusion: PP classification distinguishes meaningful clinical and cognitive subgroups in OABD. The UPP subgroup associates with greater illness severity and functional impairment. These findings support the integration of PP into personalized treatment and prevention strategies in aging BD. Future longitudinal studies are needed to further clarify the trajectory of PP across the lifespan.

Background: Oxytocin (OXT), a neuropeptide involved in social behaviors and emotions, exhibits bidirectional effects depending upon positive or negative environments. Our previous report highlighted dysregulation of OXT on striatocortical functional connectivity (FC) in bipolar disorder (BD) patients. We hypothesized that: (1) in healthy controls (HC), carriers of a "sensitive" OXTR allele would show altered FC, particularly in association with childhood trauma; and (2) this gene-brain relationship would be fundamentally altered or reversed in BD patients, reflecting a gene-disease interaction.

Method: Thirty-nine BD patients and 32 age-matched HC underwent resting-state functional MRI and blood sampling for genotyping and plasma OXT level assessment.

Results: BD patients, compared to HC, demonstrated elevated plasma OXT levels and higher scores in childhood trauma. Gene-disease interactions were observed in the striatocortical circuitry with OXTR rs53576 and rs2228485, with greater robustness in rs2228485. In HC, the rs2228485 AA homozygotes showed enhanced striatocortical FC with the sensory association and limbic areas, which were correlated with the childhood trauma. Conversely, alterations in ventral striatocortical FC were reversed among BD patients, with hypo-FC in AA homozygotes and hyper-FC in G-allele carriers.

Conclusions: These findings highlight a gene-disease interplay, suggesting that individuals carrying the "sensitive" allele may exhibit context-dependent alterations in salience-related brain networks. Our results identify a potential neural mechanism through which the OXTR polymorphism modulates environmental sensitivity, with distinct effects in HC and BD. Childhood trauma may shape striatocortical FC in an OXTR genotype-dependent manner.

Background: As choices of treatments for bipolar disorder types I (BD1) and II (BD2) and major depressive disorder (MDD) continue to evolve, we reviewed studies directly comparing current clinical usage rates of medicinal treatments for these disorders.

Methods: Comprehensive searching of five literature databases through March 2024 identified reports on clinical drug prescription rates for BD and MDD patients. Rates were summarized and compared by random-effects meta-analyses with R-Studio software.

Results: A total of 18 reports (2006-2023) supported comparisons of clinically prescribed treatments for 17,572 mood-disorder patients (mean age 42.8 years; 7936 BD1 age 43.2 years; 6309 BD2, age 43.3; 3327 MDD, age 40.0). Among diagnoses: (BD1 vs. BD2 vs. MDD), treatments differed as: lithium (54.4% vs. 38.0% vs. 6.78%), second-generation antipsychotics (41.6% vs. 22.3% vs. 15.9%), valproate (25.7% vs. 21.5%; no MDD data), lamotrigine (13.1% vs. 27.2%; no MDD data), and antidepressants (34.9% vs. 46.4% vs. 77.5%). International use of lithium for BD appeared to increase between 2006 and 2023.

Limitations: Outcomes were heterogeneous and requiring inclusion of lithium may introduce selection bias.

Conclusions: Clinical treatment selections for BD1, BD2, and MDD patients differed substantially. Use of modern antipsychotics is undergoing major increases for both BD and MDD; optimal use of antidepressants for BD remains uncertain; and notably, international use of lithium tended to increase in the present data.