BrainFit: improving executive and subjective cognitive functioning in late-life mood disorders - a double-blind randomized active-controlled study evaluating the effect of online cognitive training

Introduction

Unipolar and bipolar mood disorders in older adults are accompanied by cognitive impairment, including executive dysfunction, with a severe impact on daily life. Up and till now, strategies to improve cognitive functioning in late-life mood disorders (LLMD) are sparse. Therefore, we aimed to assess the efficacy of adaptive, computerized cognitive training (CT) on executive and subjective cognitive functioning in LLMD.

Methods

In this double-blind, randomized controlled study we enrolled patients over the age of 50 with partly remitted LLMD. Over 8 weeks, patients participated in 24 45-minute sessions of computerized multi-domain training (CT) or an active control condition (ACC) (nonspecific cognitive activity). The primary outcome was executive functioning based on the interference score on the STROOP task (not incorporated in the training). Secondary outcomes were subjective cognitive functioning, depressive symptoms and quality of life. Outcomes were assessed before and after training (T1) and at a 3-month follow-up (T2) and analyzed with linear mixed-model analyses.

Results

Thirty-eight patients were included in the study, 22 in the experimental CT and 16 in the ACC. Mean age was 67.3 years and 52.6% was female. Linear mixed-model analyses showed small within-group effect sizes, corresponding to no statistically significant improvement of executive functioning or depression severity in either group. In both groups we did observe an improvement on subjective cognitive functioning over time. From T0 to T1 the mean score of the Cognitive Functioning Questionnaire (CFQ) of the CT group decreased from 52.7 to 46.8 points (p=0.003) and the mean CFQ score of the ACC group decreased from 52.7 to 45.7 points (p<0.001). This effect remained in both groups at follow-up (T2); respectively p=0.002 and p<0.001.The patients in the AAC also showed an improvement of quality of life directly after the training (T1); i.e. the mean quality of life scores improved from 53 to 57 points (p=0.011), but this effect did not remain at follow-up.

Conclusions

This study shows no beneficial effect of an 8-week computerized CT on the primary outcome, i.e, executive functioning. Subjective cognitive functioning did improve in both groups, indicating that frequent cognitive training is advantageous. Future studies with more intensive training could be designed to explore this result further.

Clinical trial registration

clinicaltrials.gov, identifier NCT04006756.

Association between latent toxoplasmosis and bipolar disorder: a case-control seroprevalence study

BACKGROUND

Toxoplasma gondii (T. gondii) is the most successful obligate protozoan that can infect warm-blooded vertebrate hosts. Some researchers suggest that the presence of Toxoplasma cysts in the brain can lead to mental disorders. Bipolar disorder (BD) is one of the serious neuropsychiatric disorders. Several studies have shown a high seroprevalence of T. gondii in bipolar patients. Therefore, this study aims to determine the prevalence of this infection in patients with BD.

METHODS

In this case-control study, anti-Toxoplasma immunoglobulin (Ig) G and IgM antibodies were measured in serum samples from 115 patients with BD and 115 subjects without this disorder from the general population using commercially available enzyme-linked immunosorbent assay. Demographic characteristics of the patient and control groups, information about T. gondii infection and BD, and their potential risk factors were analyzed. We utilized the Mann-Whitney U test for continuous variables, the chi-square test for categorical data, and multivariate logistic regression to assess T. gondii infection and BD, with significance set at P < 0.05.

RESULTS

Twenty-eight (24.34%) of 115 patients with BD and 10 (8.7%) of 115 controls had anti-T. gondii IgG antibodies. IgM antibodies against T. gondii were not reported to be positive in any participants. Furthermore, there was a statistically significant difference in the results [odds ratio (OR) = 2.89: 95% confidence interval (CI) = 1.08-7.73. P = 0.03]. Within the study population, various factors were identified as significant risk factors for BD: sex (OR 8.10, 95% CI 3.16-20.75), age 20-50 (OR 5.11, 95% CI 1.81-14.45), age over 50 (OR 19.54, 95% CI 4.02-94.89), education level (OR 0.24, 95% CI 0.09-0.60), working status (non-employment, OR 4.12, 95% CI 1.65-10.30), and income (middle, OR 0.29, 95% CI 0.10-0.89; high, OR 0.12, 95% CI 0.01-0.77), all with P-values less than 0.05. In addition, in the group of patients, there was no statistically significant relationship between T. gondii infection with the type of bipolar disease (P = 0.93), the severity of the disease (P = 0.61), and the history of suicide attempts (P = 0.63).

CONCLUSION

This study showed that toxoplasmosis is a risk factor for BD and increases the chance of developing BD. However, more studies with a larger sample size are recommended to clarify the development pathways of this disorder and provide new strategies for the prevention and treatment of this disease.

CLINICAL TRIAL

Not applicable.

Compassionate use of esketamine intranasal in patients with severe major depressive disorder resistant to the treatment

BACKGROUND

Treatment-resistant depression (TRD) is defined as the failure of at least two antidepressants in adequate doses and timing during a major depressive episode. Esketamine intranasal (ESK-IN) has been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of TRD in combination with other antidepressants.

AIMS

To assess the effectiveness and tolerability of a sample of TRD patients who received treatment with ESK-IN as part of the compassionate use program.

METHODS

A retrospective, observational study was carried out on patients with a diagnosis of TRD enrolled in the early access program of ESK-IN in nine centers. Effectiveness was assessed with the Montgomery-Asberg depression rating scale (MADRS) at four time points: baseline, 28, 90, and 180 days of treatment.

RESULTS

The sample included 71 patients (70% women) with a mean baseline MADRS score of 38.27 ± 5.9 and total or partial work disability rates of 85%. ESK-IN treatment was associated with a statistically and clinically significant reduction in the severity of depressive symptoms at all time points assessed. The presence of side effects was common but the majority were mild in severity and resolved after the observation period. Those patients who received psychotherapy in combination with ESK-IN showed a significantly lower MADRS score at 90 and 180 days than those patients who did not undergo psychotherapy.

CONCLUSION

ESK-IN has proven to be effective and safe in a clinical sample of patients with severe TRD. To optimize clinical outcomes, the pharmacological treatment for TRD should always be integrated into a comprehensive therapeutic plan that encompasses strategies such as psychotherapy, social support, and family interventions.

Bipolar Disorders in Saudi Arabia: What Do We Know So Far?

Bipolar disorders (BP) are prevalent neuropsychiatric illnesses affecting 1%-5% of the global population and about 3% of the Saudi population. They are associated with significant comorbidities and negative consequences. Despite being common mental health conditions in Saudi Arabia, stigma persists, with weak character, supernatural beliefs, and weak faith considered as causes. In addition, Saudi patients with BP have been reported to seek help from non-psychiatric healthcare professionals and faith healers. More data are required on BP from Saudi Arabia, including the genetic aspects and their treatment approaches. This narrative review paper explores the epidemiology and clinical manifestations, etiology and biological mechanisms, public knowledge and awareness of the illnesses, and treatment of BP in Saudi Arabia.

The relationship between insight and coping attitudes in bipolar disorder patients

Bipolar disorder is thought to determine the insights and coping attitudes that affect a patient's compliance with treatment, which can positively affect the prognosis of the disease. This study aimed to investigate the relationship between insight and coping attitudes in bipolar disorder patients. This descriptive study was carried out with 127 volunteer patients who were diagnosed with bipolar disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and who were in a euthymic state. The Personal Information Form, Beck Cognitive Insight Scale (BCIS) and Scale of Coping Attitudes (COPE) were used as data collection tools. We found positive correlations between the total COPE score, the total BCIS score and the self-reflectivity subscale score of the BCIS. A positive and significant correlation was also determined between the BCIS subscales and total scores and coping attitudes toward adaptation with the COPE subscales (p < 0.05). A positive and significant relationship was found between the insight scores and total coping scores of the patients and their coping attitudes toward adaptation. We found that when patients' levels of insight increased, their coping attitudes toward adaptation were used more frequently. This study revealed that individuals with high self-reflectivity can cope more effectively with the situations they face.

Using a Behavior Assessment Tool to Decrease Restraint Use in the Emergency Department

INTRODUCTION

Behavioral health visits to emergency departments have increased, increasing the risk of patient violent agitation that may require restraints to control. Our objective was to determine whether using the Behavioral Activity Rating Scale and treatment recommendations matched to patient scores would affect the number of patients who required physical restraints during their stay in the emergency department.

METHODS

In this quality improvement project, nursing performed Behavioral Activity Rating Scale assessments on all behavioral health patients who presented to the emergency department, occurring during triage and at regular intervals with vital signs. Data were collected for a period before implementation and compared with data collected after implementing the Behavioral Activity Rating Scale workflow. Patients who required restraints during their stay, patients who required 2 or more restraints during their stay, and timing of restraint application were analyzed.

RESULTS

Results show a decrease in the number of patients who required restraints during their ED stay, decreasing from a rate of 8.7% to 7.0% (P = .02). There was also a decrease in the number of patients who required multiple restraints, from a rate of 82.2% to 27.2% (P < .001). There was no difference in the number of patients who required restraints 1 hour after their arrival before versus after intervention (P = .40).

DISCUSSION

Early recognition of patient agitation is essential in appropriate treatment of that agitation. The Behavioral Activity Rating Scale assessment is an effective tool to quantify a patient's agitation level. When coupled with treatment recommendations or protocols, it may decrease restraint use in the emergency department.

Well-Being and Mental Health: Where Do We Stand After COVID-19 Pandemic?

ABSTRACT

Mental health encompasses the ability to cope with important stresses of life and to realize one's abilities in the community, and the COVID-19 pandemic represented a very stressful event for people with mental illnesses. Our aim was to assess mental well-being in people living with different mental disorders, comparing results obtained in 2016 with those observed after the COVID-19 pandemic. Ninety-six participants were assessed using the Mental Health Continuum Short Form and classified as "flourishing," "moderately mentally healthy," and "languishing." Overall, a significant increase in the prevalence of "flourishing" and "moderately mentally healthy" subjects and a reduction of "languishing" subjects ( p = 0.003) were observed. However, a significant improvement in well-being ( p = 0.005) was observed only in the schizophrenia spectrum disorder group. Moreover, only subjects that never contracted SARS-CoV-2 showed a significant ( p = 0.019) increase in positive well-being states. Lockdowns may have led caregivers to spend more time with the participants, also increasing treatment adherence, resulting in an improvement of overall well-being in several participants.

Expert opinions on pharmacological symptomatic treatment of behavioral symptoms in frontotemporal dementia: A survey of the Neuropsychiatric International Consortium on Frontotemporal Dementia (NIC-FTD)

BACKGROUND AND PURPOSE

Behavioral variant frontotemporal dementia (bvFTD) is essentially characterized by progressive changes in personality and cognition. Clinically, bvFTD presents with often profound behavioral symptomatology. Despite the high burden of these symptoms for both patients and caregivers, there is no general consensus on an effective pharmacological symptomatic treatment. Interestingly, for multiple similar symptoms in primary psychiatric disorders, there is consensus on an effective pharmacological treatment. The aim of this study is to explore currently preferred clinical practices in the pharmacological treatment of specific core behavioral symptoms in bvFTD by world-leading clinical experts.

METHODS

A digital survey was conducted among members of the Neuropsychiatric International Consortium on Frontotemporal Dementia, comprising neurologists, psychiatrists, and neuropsychiatrists. Respondents recommended pharmacological treatments targeting symptoms including disinhibition, apathy, loss of empathy, hyperorality, perseverative/compulsive behaviors, and positive psychotic symptoms.

RESULTS

Of 48 respondents with a median experience of 11.5 years in treating bvFTD, disinhibition was most frequently targeted (58.4%), followed by perseverative/compulsive behaviors (46.5%). Recommended drug classes included atypical antipsychotics (35.1%), selective serotonin reuptake inhibitors (31.2%), antiepileptics (10.0%), serotonin antagonist and reuptake inhibitors (8.4%), benzodiazepines (4.0%), and others (11.4%).

CONCLUSIONS

Our survey revealed diverse pharmacological treatment practices for behavioral symptoms in bvFTD, reflecting the expected radical heterogeneity in pharmacological treatment strategies. Notwithstanding this, results from this explorative survey could further inform future research directions, and thus in turn potentially aid in establishing more consensus on effective pharmacological management of bvFTD, while the field awaits the development of highly anticipated disease-modifying treatment(s).

Bipolar disorders: an update on critical aspects

Bipolar disorders are chronic psychiatric conditions characterized by recurrent episodes of mania and depression. Affecting over 1% of the global population, these disorders contribute significantly to disability and mortality, often due to suicide and cardiovascular disease. Diagnostic challenges arise from symptom overlap with unipolar depression, frequently leading to delays. Bipolar disorders are driven by complex genetic, neurobiological, and environmental factors and are commonly accompanied by psychiatric and medical comorbidities, further complicating diagnosis and treatment. Standard management strategies include mood stabilizers, antipsychotics, and selective use of antidepressants, complemented by psychosocial interventions like cognitive-behavioral therapy and psychoeducation, which are vital for relapse prevention. Despite recent advancements, the management of bipolar disorders remains challenging, constrained by clinical variability, an absence of specific biomarkers, and differences in approved treatments and treatment guidelines across regions. Emerging research underscores the potential of precision psychiatry and digital health tools to enhance diagnosis and treatment. Nonetheless, critical gaps persist, particularly in implementing equitable care worldwide. This review offers a comprehensive update on bipolar disorders, examining clinical presentation, early diagnosis, pathogenesis, therapeutic strategies, and future perspectives to guide clinicians and researchers in addressing these ongoing challenges in research and clinical practice.

Funding

None.

Budget impact of aripiprazole once every 2 months long-acting injectable for adult patients with bipolar I disorder in the United States

BACKGROUND

Bipolar disorder is a severe recurrent, episodic psychiatric condition with a worldwide prevalence of approximately 1%, affecting more than 5 million adults in the United States in 2020. A subtype, bipolar I disorder (BP-I), which accounts for approximately one-quarter of cases, is associated with impairments in psychosocial functioning and quality of life. Recommended treatment options include daily oral, or long-acting injectable, antipsychotics, including the aripiprazole once every month formulation, which has been shown to improve adherence compared with oral treatments. A new formulation of aripiprazole for administration once every 2 months ready to use (Ari 2MRTU) has been shown to have similar efficacy to monthly treatment, with only 6 doses annually.

OBJECTIVE

To estimate the financial impact of introducing the new formulation of aripiprazole as a treatment option for adults diagnosed with BP-I in the United States.

METHODS

A cohort of eligible patients with BP-I was selected from a hypothetical US health plan of 1 million members, and the treatment costs modeled with a 3-year time horizon, in scenarios with or without the addition of Ari 2MRTU. Inputs into the model included user-definable estimates of the current and projected market share of the available antipsychotics, forecast uptake of aripiprazole new formulation, acquisition, initiation, and administration costs, hospitalization costs, time on treatment, and patient adherence. The budget impact was estimated as the difference in the annual cost for the total cohort for the current and new scenarios, the cost per member per month, and the cost per treated member per month. Deterministic sensitivity analyses were also conducted to examine the extent to which the model results were affected by variations in individual input parameters.

RESULTS

The total budget impact of introducing a formulation of Ari 2MRTU as maintenance monotherapy for treating a cohort of eligible patients with BP-I in the United States from a health plan of 1 million members was estimated to be $898,930 over 3 years, representing a per member per month cost saving of $0.025 and a per treated member per month cost saving of $2.43. The sensitivity analysis supports a modest reduction in budget, with the main driver being adherence with medication regimen.

CONCLUSIONS

The introduction of Ari 2MRTU as a maintenance treatment for adults with BP-I is expected to have a neutral effect on payer budgets in the United States and is a potentially favorable option for patients who prefer less frequent dosing.

Long-acting injectable antipsychotic use in patients with bipolar disorder: Findings from the REAP-BD study

AIMS

This study aimed to assess treatment patterns and the effectiveness of long-acting injectable antipsychotics (LAIs) in patients with bipolar disorder (BD) across various Asian countries. The study focused on comparing the choices of LAIs, other psychotropic medications, and their psychotropic drug load to explore real-world usage and evaluate the potential benefits of LAIs in BD treatment across different countries.

METHODS

A retrospective cohort study was conducted with BD patients diagnosed according to ICD-10-CM codes F31.0 to F31.9 across 13 Asian countries or regions. Data were collected through an online system covering prescriptions for all psychotropic medications including LAIs. The Anatomical Therapeutic Chemical (ATC) Classification System was used to compare medication dosage patterns.

RESULTS

The study analyzed 2029 prescription records for BD, including 103 cases involving LAIs. The highest LAI prescription rates were found in Sri Lanka and Malaysia, with no reported use in Myanmar, India, and Japan. Patients receiving LAIs were younger, more often male, and had higher BMI and drug loads compared to those on oral medications. South Korea and Indonesia showed the highest LAIs drug load. South Korea, Pakistan, and China exhibited the highest total psychotropic drug loads, while Malaysia had the lowest.

CONCLUSIONS

This study is the first to examine LAIs use for BD across Asia. Cross-national differences in LAIs prescriptions and psychotropic drug load highlight variations in treatment practices and healthcare systems. These findings underscore the need for further research and the development of region-specific guidelines to improve BD treatment outcomes.

Achieving Response With Bolus Dosing of Valproate in Electroconvulsive Therapy (ECT)-Induced Mania: A Case Report

Electroconvulsive therapy (ECT) is an effective treatment for various mental illnesses. While it is an excellent modality in treating depression and severe mania, it can also induce mania in certain specific settings. There is so far scarce literature regarding the management of ECT-induced mania with antipsychotics and mood stabilizers, specifically lithium, utilized in different studies. Moreover, there is limited evidence for using valproate for the symptoms. We present a case vignette about managing mania symptoms after ECT by administering a bolus dose of valproate at each session, resulting in progressively improved outcomes.

Deep brain stimulation and digital monitoring for patients with treatment-resistant schizophrenia and bipolar disorder: A case series

AIM

The use of deep brain stimulation (DBS) has been recently extended for treating resistant psychiatric disorders, but the experience in patients with schizophrenia-related disorders and bipolar disorder (BD) is scarce.

METHOD

We conducted an observational, one-year longitudinal study to evaluate the effects of DBS in four treatment-resistant patients with schizophrenia, schizoaffective, and BD, included in a pilot, last-resource protocol. Patients were digitally monitored for objective assessment of behavioral changes.

RESULTS

After one year of its initiation, DBS of the nucleus accumbens (in subjects N2, N3, and N4) and subgenual anterior cingulate cortex (in N1) produced a significant clinical improvement, associated with decreases in the Clinical Global Impression (from 5.25±0.5 to 3.5±1, p=0.035) and in the Hamilton Depression Rating Scale (HADRS scores, from 14.5±6.56 to 1.5±1.29, p=0.020). We observed a notable, durable therapeutic response in two patients from this cohort (N1 and N3), a clinically relevant relief in a third (N2), and a lack of a significant response in the last one (N4). Maintenance electroconvulsive therapy sessions could be discontinued in the three patients that responded to DBS (N1-3). There were no side effects or relevant changes in cognitive functioning. There were relevant differences between physical activity and sleep time among the four participants.

CONCLUSIONS

These results suggest initial evidence that DBS may be an effective and safe alternative for treating complex and resistant forms of schizophrenia-related disorders and BD. Digital monitoring may help to capture objective measures of behavioral changes after the intervention.

Affective temperaments: Effects on treatment response for major depression

There is growing interest in assessing affective temperaments in relation to major depressive disorder (MDD) and bipolar disorder (BD). Needed is evaluation of the impact of temperament ratings on responses to treatment of depression in these disorders. We measured treatment response as %-improvement in HDRS21 depression ratings and correlated this measure as well as response rate (≥50 % improvement) with TEMPS-A ratings of anxious, cyclothymic, dysthymic, hyperthymic, and irritable affective temperaments in 2264 mood-disorder patients (1165 BD, 1099 MDD; 62.3 % women, mean age 48.5 years). Higher dysthymic temperament score was associated with less improvement in depression ratings, greater hyperthymia scores with increased improvement. Both temperaments also were associated with increases (dysthymia) or decreases (hyperthymia) in initial HDRS21 scores. However, higher initial HDRS21 scores led to greater percent-improvement. Multivariable logistic regression sustained independent effects of temperament scores on treatment-response. Reported effects were similar with MDD and BD. Limitations include the observational design limiting causality and uncertain generalizability to other geographical locations or clinical settings. Ratings of dysthymic and hyperthymic temperaments, respectively, were associated with significantly lesser and greater improvement of depression ratings with both MDD and BD.

Effect of Cariprazine on Anhedonia in Patients with Bipolar I Depression: Post Hoc Analysis of Three Randomized Placebo-Controlled Clinical Trials

INTRODUCTION

Anhedonic symptoms in bipolar I (BP-I) depression are associated with decreased quality of life and impaired functioning. We evaluated the effects of cariprazine in patients with BP-I depression with lower or higher levels of anhedonia at baseline.

METHODS

Data were pooled from three clinical trials (NCT01396447, NCT02670538, NCT02670551) analyzing the effects of cariprazine 1.5 and 3 mg/day in adults with BP-I depression. During post hoc analysis, patients were stratified by baseline median Montgomery-Åsberg Depression Rating Scale (MADRS) anhedonia factor score into a lower (score < median) or higher (score ≥ median) anhedonia subgroup. Outcomes included change from baseline to week 6 in MADRS total and anhedonia factor score, with the latter also evaluated after adjusting for other depressive symptoms. Between-group differences in change from baseline to week 6 were compared using least-squares mean differences (LSMD) analyzed via a mixed-effect model for repeated measures.

RESULTS

Median baseline anhedonia factor score was 19, defining the lower (placebo = 211; cariprazine 1.5 mg/day = 200, 3 mg/day = 212) and higher (placebo = 249; cariprazine 1.5 mg/day = 261, 3 mg/day = 250) anhedonia subgroups. In the lower subgroup, cariprazine 1.5 mg/day but not 3 mg/day was superior to placebo in reducing MADRS total (LSMD [95% CI] 1.5 mg/day = - 2.61 [- 4.28, - 0.93], P = .0024) and anhedonia factor scores (- 1.70 [- 2.77, - 0.62], P = .0021) at week 6. In the higher subgroup, both cariprazine doses were associated with significantly greater reductions than placebo in MADRS total (1.5 mg/day = - 3.01 [- 4.84, - 1.19], P = .0012; 3 mg/day = - 3.26 [- 5.12, - 1.40], P = .0006) and anhedonia factor scores (1.5 mg/day = - 1.97 [- 3.13, - 0.81], P = .0009; 3 mg/day = - 2.07 [- 3.26, - 0.89], P = .0006). Anti-anhedonic effects were preserved after adjusting for other depressive symptoms, suggesting the effect was not pseudospecific. Patients in the higher subgroup had higher baseline depression and therefore the lower subgroup may have had a floor effect.

CONCLUSION

Cariprazine demonstrated antidepressant and specific anti-anhedonic effects regardless of baseline anhedonia symptoms in patients with BP-I depression.

TRIAL REGISTRATION

ClinicalTrials.gov identifiers, NCT02670538, NCT02670551, NCT01396447.

Clinical Staging for Personality Disorders in Older Adults

OBJECTIVE

This scientific research aimed to investigate the feasibility of implementing a clinical staging (CS) model for personality disorders (PDs) in older adults. The CS model could provide valuable insights into the life course of personality pathology, prognosis, and treatment decisions for PDs in older adults.

METHODS/DESIGN

The study employed an international Delphi methodology with three rounds and involved 21 experts.

RESULTS

Consensus was achieved on 12 out of 17 statements, confirming the viability of a CS model for PDs in older adults. The proposed model incorporates the Alternative Model for PDs, criterion A, and integrates life course information, distinguishing between chronic PD, re-emergent PD, late-onset PD, and past PD.

CONCLUSION

The findings suggest that international experts support the implementation of a CS model for PDs in older adults, considering both the severity of personality functioning and the retrospective life course of PD expression.

Neurotoxic effects of carbamazepine on the mosquitofish Gambusia affinis

In recent years, the presence of pharmaceuticals in the aquatic environment has gained a significant attention. Carbamazepine, a commonly prescribed antiepileptic drug, has been consistently found in aquatic environments at concentrations ranging from nanograms to micrograms, raising concerns about its potential negative impacts on aquatic organisms. The study examined the acute and chronic neurotoxic effects of environmentally relevant and sublethal concentrations of carbamazepine in the mosquitofish Gambusia affinis. After a 96-hour exposure period, the median lethal concentration (LC50) of carbamazepine for G. affinis was determined as 24 mg L - 1. For the current study, sublethal concentrations i.e., one-tenth (2.4 mg L - 1) and one-fifth (4.8 mg L - 1) of the LC50 value were chosen for assessing the neurotoxic effects along with the environmentally relevant concentration (13 ng L - 1). The research findings indicated that carbamazepine had a disruptive impact on the typical growth and behavior of the fish. During the acute exposure phase, physical deformities were observed in the fish, resulting in neonatal and postneonatal fatalities. Furthermore, the neurotoxic effects of carbamazepine were clearly demonstrated through alterations in various neurological parameters, including acetylcholinesterase, dopamine, gamma-aminobutyric acid, serotonin, monoamine oxidase, 5-hydroxyindole acetic acid, adrenaline, and nor-adrenaline. These findings raise concerns about the survival of fish populations in their natural environment.

Clinical and metabolic correlates of DSM-5 mixed features in subjects with bipolar depression and mania: A cross-sectional study

OBJECTIVE

Evidence on the clinical and metabolic characterization of mixed features (MFs) in bipolar disorder (BD) is limited. We performed a cross-sectional study analyzing clinical and metabolic correlates of MFs in people with bipolar depression or mania/hypomania.

METHODS

We included people with BD consecutively admitted for inpatient treatment from May 2020 to July 2023 as part of the Northern Milan Area Cohort (NOMIAC) project. The SCID-5 was used to confirm the diagnosis and assess DSM-5 specifiers. Young Mania Rating Scale and Montgomery-Åsberg Depression Rating Scale were used to measure symptom severity. Information on socio-demographic, clinical, and metabolic conditions - including obesity, diabetes, hypertension, dyslipidemia, and hypothyroidism - were collected. Multiple logistic regression models were used to compare clinical and metabolic correlates between subjects with and without DSM-5 MFs.

RESULTS

We included 163 inpatients with BD (111 admitted for a manic/hypomanic episode and 52 for a major depressive episode), 39 of whom with MFs. The overall logistic regression model showed that MFs were associated with anxious distress (z = 2.44; p = 0.015) and obesity (z = 2.39; p = 0.017), also being less frequent among moderately/markedly ill people as compared with those borderline/mildly ill (z = -2.71; p = 0.007). Additional analyses corroborated the association between MFs and these characteristics in people with a depressive episode, though not in those with mania/hypomania.

CONCLUSION

Notwithstanding some limitations, our study provides additional insight into the characterization of individuals with MFs, highlighting that anxious distress and symptom severity, along with obesity, may represent core features helpful for the assessment and management of MFs in BD.

Association between rumination, suicidal ideation and suicide attempts in persons with depressive and other mood disorders and healthy controls: A systematic review and meta-analysis

INTRODUCTION

Suicidal ideation and behaviors are a leading cause of disability worldwide. Approximately 90 % of suicide completers have a diagnosable mood disorder. Extant literature reports rumination mediates functional impairment across mood disorders. Herein, we report the association between rumination and suicidality amongst persons with psychiatric disorders and healthy controls.

METHODS

Our systematic review and meta-analysis included relevant articles retrieved from Web of Science, OVID and PubMed from inception to March 20, 2024. Random effects model was used to calculate the correlation between rumination, suicidal ideation and attempt.

RESULTS

A total of 27 eligible studies were included in our systematic review and meta-analysis. Rumination (r = 0.25 [95 % CI: -0.03, 0.49]), reflection (r = 0.15 [-0.71, 0.83]) and brooding (r = 0.13 [-0.58, 0.73]) were nonsignificantly correlated with suicidal ideation in mood disorders. Suicide attempt history was significantly associated with greater odds of rumination in persons with depressive disorders (OR = 1.13 [0.42, 3.02]). In healthy controls, rumination (r = 0.30 [0.21, 0.38]), reflection (r = 0.23 [0.13, 0.32]) and brooding (r = 0.24 [0.12, 0.36]) were significantly correlated with suicidal ideation. Rumination also predicted lifetime history of suicide attempts in healthy controls (OR = 1.70 [1.16, 2.49]).

LIMITATIONS

There were inadequate sample sizes of persons with different mood and psychiatric disorders which may have underpowered our ability to detect clinically meaningful associations.

DISCUSSION

Our study reports a transdiagnostic association between measures of rumination and suicidality. Future research vistas should parse the neurobiological substrates subserving rumination and identify targeted therapies and their association with general cognition and treatment response.

Gender differences in the response to antipsychotics or mood stabilizers in patients with acute mania: An individual patient data meta-analysis of placebo-controlled studies

Evidence suggests a worse clinical course in women compared to men with bipolar disorder. However, little research has explored gender differences in the efficacy of anti-manic medication. We sought to determine whether there are gender differences in efficacy of drug treatment in acute manic episodes of bipolar I disorder, and the influence of dichotomized age as a proxy for menopausal status and baseline severity on gender differences. We performed an individual patient data meta-analysis of 10 short term placebo controlled registration trials for treatment of acute mania (N = 2199) performed between 1996 and 2007 using the (Young) Mania Rating Scale ((Y)MRS)) as outcome. We observed a difference in effect size in mean change and responder status between men and women (NNT = 6.3 vs. 5.3), with a small but significant effect of gender on treatment response (β = 0.031). The effect size was larger in women older than 47 compared to women aged 47 and under (NNT = 4.2 vs. 7.5), and to a lesser extent, larger in men over 47 years compared those aged 47 and under (NNT = 3.8 vs. 6). Results were mainly driven by differences in response in the placebo group and independent of baseline severity. These findings suggest that men and premenopausal women might have a clinically modest advantage over their women and postmenopausal counterparts in treatment with anti-manic medication. Our results were limited by our sample not including antimanic agents registered after 2007 and by the absence of direct biological information regarding sex and menopausal state. Future research should aim to replicate current findings utilizing biological confirmation on the menopausal status and test whether findings are generalizable to newer antimanic agents.

[Long-term courses of bipolar disorders]

BACKGROUND

Bipolar disorder (short: BD) is a severe illness with very heterogeneous trajectories. While some of the patients show no or hardly any long-term impairments, other affected individuals show substantial neurocognitive deficits with a clear decline in psychosocial functioning. Which factors influence the course of the disease is the subject of current research efforts.

OBJECTIVE

This review presents the long-term course of bipolar disease and the factors influencing it. In particular, differential trajectory types are discussed. The cognitive and psychosocial functional level as well as the psychopathological characteristics of the disease are elucidated. In addition, biological factors and treatment approaches influencing the course and prognosis are identified.

MATERIAL AND METHODS

Literature search using PubMed focusing on longitudinal studies over several years (see online supplement).

RESULTS

To date, there are only a few predictors and biomarkers that allow prediction of long-term progression. None have been sufficiently studied to enable clinical use. Appropriate pharmacological and psychotherapeutic treatment of those affected is essential to avoid renewed episodes of the disease.

DISCUSSION

The long-term course of bipolar disorder is highly heterogeneous and multifaceted. Despite intensive research efforts, no predictors have yet been identified that reliably predict the clinical course. This makes further research all the more important in order to offer individualized therapy options, develop new therapies and positively influence the course of the disease at an early stage.

Efficacy and safety of YOXINTINE for depression: A double-blinded, randomized, placebo-controlled, phase 2 clinical trial

BACKGROUND

YOXINTINE contains >98 % of 20(S)-protopanaxadial (PPD), a metabolic product of ginsenosides with pre-clinical neuroprotective activity. Animal experiments and previous studies have shown that PPD has good antidepressant effect and safety.

PURPOSE

To evaluate YOXINTINE in treating depression compared with a placebo in Chinese patients.

STUDY DESIGN

This was a multicenter, double-blinded, randomized, placebo-controlled, phase 2 clinical trial.

METHODS

The study included 178 randomized (1:1:1) Chinese patients with depression. Patients were randomly assigned to receive oral YOXINTINE at doses of 200 or 400 mg or a placebo administered twice daily for 8 weeks. The primary outcome was assessed by measuring changes in the Montgomery-Asberg Depression Rating Scale (MADRS) total score. All adverse reactions were recorded. All demographic and baseline characteristics were comparable.

RESULTS

The changes in MADRS total scores from baseline were -10.43 for the placebo group, -16.24 for the 200 mg YOXINTINE group, and -13.60 for the 400 mg YOXINTINE group. The differences in MADRS total score changes compared with the placebo were -5.81 (95 % CI: -7.69, -3.92; P < 0.0001) and -3.17 (95 % CI: -5.08, -1.25; P = 0.0013) for the 200 mg and 400 mg groups, respectively. The results indicated a significantly greater MADRS score reduction in the 200 mg group (P = 0.0058, 95 % CI: 0.78, 4.51). Adverse event incidence was comparable among all groups.

CONCLUSION

Oral YOXINTINE is safe and significantly improves depressive symptoms. PPD may exhibit antidepressant properties through mechanisms distinct from monoamine reuptake inhibition.

REGISTRATION NUMBER

ChiCTR2300070568.

Systematic review of parenteral ketamine for managing acute agitation in emergency settings

INTRODUCTION

Agitation, a significant psychiatric issue often linked to conditions like schizophrenia, bipolar disorder, and major depression, invariably pose challenges in emergency settings. Acute agitation occurs in 2.6 % of emergency cases and up to 12.2 % among patients with schizophrenia or bipolar disorder. With limited available options for effective management of acute agitation, ketamine is emerging as a fast-onset alternative to antipsychotics like haloperidol.

METHODS

This systematic review, following PRISMA guidelines, searched databases in April 2024 for studies on parenteral ketamine for acute agitation in emergency settings. Data extraction included patient demographics, ketamine administration details, sedation time, need for additional doses, adverse events, and intubation rates.

RESULTS

The search yielded 7410 results, narrowing to 29 suitable studies with 1516 patients (mean age 35.5 ± 12.4 years, 67.9 % male). Ketamine was administered intramuscularly (IM) in 69 % of studies, intravenously (IV) in 6.9 %, and either IV or IM in 24.1 %. Most patients (86.5 %) received IM ketamine at a mean dose of 3.83 ± 1.07 mg/kg, while 13.5 % received IV ketamine at 2.09 ± 1.56 mg/kg. Sedation occurred on average in 6.1 min. However, 24.5 % needed rescue medications or additional doses. Adverse effects included tachycardia (5.1 %), hypertension (5.5 %), hypersalivation (5.6 %), nausea (2.1 %), emergence reactions (1.4 %), and, rarely, cardiac arrest (0.2). While 19.1 % required intubation, the reasons for the same could not be attributed to ketamine exclusively. Furthermore, there was no evidence for worsening or development of psychotic symptoms with ketamine.

CONCLUSION

This review highlights the effectiveness and safety of parenteral ketamine for managing acute agitation in emergency settings. However, further research is needed to optimize ketamine use in this challenging scenario.

Socio-Demographic and Clinical Characteristics of Patients with Substance Intoxication Receiving a Psychiatric Assessment in the Emergency Department of the Maggiore Della Carita Hospital, Novara, Italy

Patients intoxicated with alcohol or other substances are often assessed and assisted in the context of the Emergency Department (ED) by emergency physicians, who usually require a psychiatric assessment. This study aims to analyse the characteristics of a sample of patients receiving a psychiatric consultation in the ED setting of the Maggiore della Carità University Hospital in Novara, Italy, in the period from 1 January 2021 to 31 December 2023, to find out whether and how patients screening positive for alcohol/drugs differ from those screening negative. Socio-demographic and clinical history information and clinical data related to the ED psychiatric consultations were extracted from the PsNet database, a collection of data extracted from the application that serves as the electronic medical record for patients accessing the ED. Statistical analyses were performed using SAS 9.4 and STATA version 17 software. Chi-square/Fisher tests, t-tests, and both univariate and multivariate logistic models were employed. Most of the findings regarding socio-demographic characteristics, symptoms observed during the 1362 psychiatric consultations, and treatments received by a total of 922 patients in the ED were consistent with the literature on this topic. However, some results only partially aligned with previous studies, particularly concerning the higher frequency of anxiety and psychotic symptoms, as well as cognitive impairments, observed in consultations for patients who tested negative for alcohol or substances. Interpreting these findings is complex and raises important questions, which may be addressed more effectively by expanding the sample size (extending the research to other EDs) and analysing its characteristics in greater detail. In this regard, improving diagnostic methods for detecting substance use through laboratory tests would also be beneficial.

A stratified treatment algorithm in psychiatry: a program on stratified pharmacogenomics in severe mental illness (Psych-STRATA): concept, objectives and methodologies of a multidisciplinary project funded by Horizon Europe

Schizophrenia (SCZ), bipolar (BD) and major depression disorder (MDD) are severe psychiatric disorders that are challenging to treat, often leading to treatment resistance (TR). It is crucial to develop effective methods to identify and treat patients at risk of TR at an early stage in a personalized manner, considering their biological basis, their clinical and psychosocial characteristics. Effective translation of theoretical knowledge into clinical practice is essential for achieving this goal. The Psych-STRATA consortium addresses this research gap through a seven-step approach. First, transdiagnostic biosignatures of SCZ, BD and MDD are identified by GWAS and multi-modal omics signatures associated with treatment outcome and TR (steps 1 and 2). In a next step (step 3), a randomized controlled intervention study is conducted to test the efficacy and safety of an early intensified pharmacological treatment. Following this RCT, a combined clinical and omics-based algorithm will be developed to estimate the risk for TR. This algorithm-based tool will be designed for early detection and management of TR (step 4). This algorithm will then be implemented into a framework of shared treatment decision-making with a novel mental health board (step 5). The final focus of the project is based on patient empowerment, dissemination and education (step 6) as well as the development of a software for fast, effective and individualized treatment decisions (step 7). The project has the potential to change the current trial and error treatment approach towards an evidence-based individualized treatment setting that takes TR risk into account at an early stage.

Increasing the Construct Validity of Computational Phenotypes of Mental Illness Through Active Inference and Brain Imaging

After more than 30 years since its inception, the utility of brain imaging for understanding and diagnosing mental illnesses is in doubt, receiving well-grounded criticisms from clinical practitioners. Symptom-based correlational approaches have struggled to provide psychiatry with reliable brain-imaging metrics. However, the emergence of computational psychiatry has paved a new path not only for understanding the psychopathology of mental illness but also to provide practical tools for clinical practice in terms of computational metrics, specifically computational phenotypes. However, these phenotypes still lack sufficient test-retest reliability. In this review, we describe recent works revealing that mind and brain-related computational phenotypes show structural (not random) variation over time, longitudinal changes. Furthermore, we show that these findings suggest that understanding the causes of these changes will improve the construct validity of the phenotypes with an ensuing increase in test-retest reliability. We propose that the active inference framework offers a general-purpose approach for causally understanding these longitudinal changes by incorporating brain imaging as observations within partially observable Markov decision processes.

Error monitoring and response inhibition in adolescents with bipolar disorders: An ERP study

Cognitive control develops throughout adolescence, a high-risk period for bipolar disorders (BD) onset. Despite neurobehavioral abnormalities in adults with BD, there is minimal research investigating deviations in cognitive control in adolescents with BD. Cognitive control involves numerous processes. Identifying the specific neural abnormalities in adolescent BD could provide precise targets for novel interventions that improve illness outcomes. The present study administered a Go/No-Go (GNG) task to 98 adolescents (44 BD; 54 controls) to activate response inhibition and error processes and recorded EEG for event-related potentials (ERPs) analysis. Stimulus-locked N2 and P3 (response inhibition) and response-locked error-related negativity (ERN; early error detection) and error positivity (Pe; conscious error detection) were analyzed. Adolescents with BD had attenuated Pe mean amplitudes following failed inhibition trials. There were no group differences in other ERP amplitudes, including N2, P3, and ERN. The pattern of findings implicates conscious error detection impairment in adolescents with BD, without support for deficits in more automatic, earlier error detection. Impaired conscious error detection in adolescents with BD may be an early expression of BD pathophysiology and a possible intervention target for cognitive rehabilitation. Further studies are needed to examine Pe in BD across the lifetime.

Subchronic Treatment with CBZ Transiently Attenuates Its Anticonvulsant Activity in the Maximal Electroshock-Induced Seizure Test in Mice

The objective of this study is to evaluate the anticonvulsant efficacy of carbamazepine (CBZ) following acute and chronic administration across four treatment protocols in a murine model of maximal electroshock-induced seizures. A single dose of the drug was utilized as a control. The neurotoxic effects were evaluated in the chimney test and the passive avoidance task. Furthermore, plasma and brain concentrations of CBZ were quantified across all treatment protocols. The subchronic administration of CBZ (7 × 2 protocol) resulted in an attenuation of its antielectroshock effect. In the three remaining treatment regimens (7 × 1, 14 × 1, and 14 × 2) the median effective doses of CBZ were comparable to the control. Neither acute nor chronic treatment with CBZ resulted in a discernible impact on motor coordination or long-term memory. The plasma and brain concentrations of CBZ were significantly lower in most chronic protocols when compared to a single-dose application. This may explain the transient attenuation of CBZ effectiveness in the 7 × 2 protocol, but not the return to the previous level. The anticonvulsant and neurotoxic profiles of CBZ did not differ after single and chronic administration. Therefore, experimental chronic studies with CBZ are not prerequisites for concluding and possibly translating results to clinical conditions.

Effects of vagus nerve stimulation on daily function and quality of life in markedly treatment-resistant major depression: Findings from a one-year, randomized, sham-controlled trial

BACKGROUND

Depression treatments aim to minimize symptom burden and optimize quality of life (QoL) and psychosocial function.

OBJECTIVE

Compare the effects of adjunctive versus sham vagus nerve stimulation (VNS) on QoL and function in markedly treatment-resistant depression (TRD).

METHODS

In this multicenter, double-blind, sham-controlled trial, 493 adults with TRD and ≥4 adequate but unsuccessful antidepressant treatment trials (current episode) were randomized to active (n = 249) or sham (n = 244) VNS (plus treatment as usual) over a 12-month observation period. Quarterly outcomes included QoL with the Q-LES-Q, Mini-Q-LES-Q, and EQ-5D-5L, and function with the WHODAS 2.0 and Work Productivity and Activity Impairment Questionnaire (WPAI) item 6. Differences between treatment groups in change in scores from baseline and percentage of time with a meaningful response in Q-LES-Q, Mini-Q-LES-Q, and WPAI item 6 scores were analyzed.

RESULTS

Active VNS was superior to sham in mean change in scores from baseline in the Mini-Q-LES-Q (P = 0.050) and WPAI item 6 (health condition's effect on regular activities [P = 0.050]) used as continuous variables, with a similar trend for Q-LES-Q (P = 0.061). Active VNS was superior to sham in time spent in clinically meaningful benefit (categorical analyses) using the Q-LES-Q (P = 0.029), Mini-Q-LES-Q (P = 0.011), and WPAI item 6 (P = 0.039). The WHODAS 2.0 (P = 0.304) and EQ-5D visual analog scale (P = 0.125) failed to reveal between-group differences.

CONCLUSION

Active VNS was superior to sham VNS in improving QoL and psychosocial function in patients with TRD. VNS has a broader therapeutic impact than symptom improvement alone in patients with marked psychosocial impairment.

Toward Multidisciplinary Tools for Complex Clinical Psychopharmacology Cases: A Qualitative Study with French Healthcare Professionals

Purpose

Psychopharmacology prescriptions are complex, partly due to the complexity of the relationship between diagnosis and its etiology, as well as the iatrogenic impact on symptomatology. Many multidisciplinary tools exist to optimize their management and improve evidence-based practice. However, their multidisciplinary integration seems to be a challenge. This study aimed to collect information on barriers and facilitators perceived by hospital health professionals regarding the use of multidisciplinary tools to address complex situations in psychopharmacology.

Research Design and Methods

A mixed-methods research approach using semi-structured interviews was conducted with physicians and pharmacists from 11 hospital institutions. An interview guide developed from the COM-B model (Capability, Opportunity, and Motivation - Behavior) was used to identify barriers and facilitators to the use of multidisciplinary tools. Data were analyzed using thematic analysis to identify emerging themes and mapped to the COM-B model.

Results

28 professionals were interviewed. Identified barriers were: lack of knowledge and time to address complex situations, incomplete medical records, lack of easily accessible multidisciplinary tools, insufficient levels of evidence in psychopharmacology. Identified facilitators were: continuing education, communication and networking among professionals, implementation of adapted and shared resources, deprescribing, awareness of medication-induced iatrogenesis, accessibility of tools for all populations.

Conclusion

Identified barriers and facilitators in the use of multidisciplinary tools for complex situations in psychopharmacology helped to model factors that enable behavior change. Answers need to be provided to help professionals ensure and optimize psychopharmacological therapies.

The state of (mis) trust: Human-centered technology development & implementation in intensive mental health settings

Innovative technology-based solutions in mental healthcare promise significant improvements in care quality and clinical outcomes. However, their successful implementation is profoundly influenced by the levels of trust patients hold toward their treatment providers, organizations, and the technology itself. This paper delves into the complexities of building and assessing patient trust within the intensive mental health care context, focusing on inpatient settings. We explore the multifaceted nature of trust, including interpersonal, institutional, and technological trust. We highlight the crucial role of therapeutic trust, which comprises both interpersonal trust between patients and providers, and institutional trust in treatment organizations. The manuscript identifies potential key barriers to trust, from sociocultural background to a patient's psychopathology. Furthermore, it examines the concept of technological trust, emphasizing the influence of digital literacy, socio-economic status, and user experience on patients' acceptance of digital health innovations. By emphasizing the importance of assessing and addressing the state of trust among patients, the overarching goal is to leverage digital innovations to enhance mental healthcare outcomes within intensive mental health settings.

Prevalence and correlates of non-suicidal self-injury among patients with bipolar disorder: A multicenter study across China

BACKGROUND

Non-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies.

METHODS

NSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-)Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis.

RESULTS

The enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were "cutting" (41.2 %) and "hitting" (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05).

LIMITATIONS

As a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports.

CONCLUSION

Our study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions.

Association of perioperative initiation of gabapentin versus pregabalin with kidney function: a target trial emulation study

Background

Gabapentinoids, such as gabapentin and pregabalin, are opioid substitutes commonly included in perioperative multimodal analgesia regimens. We investigated whether the initiation of gabapentin and pregabalin during the perioperative period have varying effects on the adverse renal outcomes.

Methods

This study included adult participants who received surgery in the INSPIRE database. The exposure of interest was the initiation of pregabalin or gabapentin during the perioperative period. The primary outcome was renal function decline. Secondary outcomes included incident chronic kidney disease (CKD), hospital-acquired acute kidney injury (AKI), and in-hospital mortality. We conducted a propensity score to balance the baseline characteristics. Cox proportional hazard regression was used to estimate the hazard ratio (HR) of the initiation of gabapentin compared with pregabalin.

Results

Among 640 pairs of pregabalin and gabapentin initiators in the matched cohort, the initiation of gabapentin was associated with a higher risk of kidney function decline (HR, 1.40; 95% confidence interval [CI], 1.04-1.89) as compared with pregabalin. After excluding participants who were diagnosed with CKD at the baseline, the initiation of gabapentin was associated with a higher risk of incident CKD (HR, 1.46; 95% CI, 1.03-2.05) as compared with pregabalin. For the in-hospital outcomes, the proportion of AKI and mortality were similar between participants initiating gabapentin and pregabalin. In addition, the risk of kidney function decline did not vary across each subgroup.

Conclusion

The initiation of gabapentin during the perioperative period was associated with a higher risk of kidney function decline and incident CKD as compared with pregabalin.

Self-Determined Motivation for Alcohol Use and Drinking Frequency, Intensity, and Consequences

Objective: Drinking motives predict drinking behaviors and outcomes among adults. Drinking motives are rarely studied using self-determination theory (SDT), which aligns with harm-reduction approaches to alcohol use, but SDT can offer a complementary theoretical framework to existing drinking motives frameworks that may help explain the observed heterogeneity in drinking motives and account for more variance in drinking outcomes. This study examined the associations between five SDT-based drinking motives with drinking frequency, intensity, and consequences. Method: A total number of 630 adults (Mage = 21.5, 55% female, 88% undergraduates) rated drinking motives using the Comprehensive Relative Autonomy Index for Drinking (CRAI-Drinking) and the Drinking Motives Questionnaire (DMQ), typical alcohol consumption, and negative and positive drinking consequences. Results: Poisson regressions indicated that intrinsic (IRR = 1.13) and identified (IRR = 1.11) regulations were significantly associated with drinking frequency, identified (IRR = 0.94) and positive introjected (IRR = 1.07) regulations were significantly associated with drinking intensity, and amotivation (IRR = 1.16) and intrinsic regulation (IRR = 1.09) were associated with negative and positive consequences, respectively, after controlling for other CRAI-Drinking and DMQ scores, sex, and drinking intensity. After accounting for DMQ scores and sex, CRAI-Drinking scores accounted for 1.7%-9.9% additional deviance in drinking behaviors and consequences. Conclusions: Adults high in autonomous reasons for drinking reported low-risk, high-enjoyment drinking experiences. In contrast, adults with higher scores for amotivation for drinking reported more negative consequences, even after accounting for drinking intensity, suggesting that high amotivation for drinking may be a novel signal for future alcohol-related risks. These findings support the idea that SDT provides a useful framework for understanding drinking motives, behaviors, and consequences.

Neuromodulation Strategies in Lifelong Bipolar Disorder: A Narrative Review

Bipolar disorder is a debilitating psychiatric condition characterized by recurrent episodes of mania and depression, affecting millions worldwide. While pharmacotherapy remains the cornerstone of treatment, a significant proportion of patients exhibit inadequate response or intolerable side effects to conventional medications. In recent years, neuromodulation techniques have emerged as promising adjunctive or alternative treatments for bipolar disorder. We performed a narrative review, according to the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines, to provide a comprehensive overview of the current literature on neuromodulation interventions in bipolar disorder across the course of lifespan. Specifically, it examines the efficacy, safety, and mechanisms of action of various neuromodulation strategies, including, among others, transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and it describes the therapeutic experiences across the different ages of illness. Additionally, this review discusses the clinical implications, challenges, and future directions of the integration, in clinical practice, of neuromodulation into the management of bipolar disorder. By synthesizing evidence from different studies, this review aims to inform clinicians, researchers, and stakeholders about the evolving landscape of neuromodulation treatments and their potential role in improving outcomes for individuals with bipolar disorder.

Self-Induced Mania Methods and Motivations Reported in Online Forums: Observational Qualitative Study

BACKGROUND

In bipolar disorder (BD), mania may be self-induced by manipulation of specific precipitants, as reported in case studies. Another potential source of information on the self-induction of mania is the online postings of users with lived experience of mania.

OBJECTIVE

The primary aim of this study is to examine the range of methods used to self-induce mania or hypomania described by users of online forums with self-reported BD. Second, we summarize the motivations of users to engage in these behaviors.

METHODS

We conducted an observational study of online forum posts that discussed self-induction of mania or hypomania, either in the posters themselves or observed firsthand in others. Posts were identified using Google advanced search operators, then extracted and coded for content in NVivo (version 12 for Mac; QSR International). A total of 44 online forum threads were identified discussing self-induced mania (n=25) or hypomania (n=19). These forums contained 585 posts by 405 usernames, of which 126 usernames discussed methods for self-induction across 327 posts (number of methods per username: median 2, IQR 1-4; range 1-11).

RESULTS

In total, 36 methods were grouped by the authors. The most frequently reported were sleep reduction (n=50), caffeine (n=37), and cessation of medication (n=27). Twenty-six usernames reported their motivation to self-induce mania or hypomania; almost three-quarters (n=19) reported a desire to end a depressive episode. Almost a third of usernames (118/405) explicitly discouraged other forum users from self-inducing mania or hypomania.

CONCLUSIONS

Online forums provide an additional and valuable source of information about triggers for mania that may inform relapse prevention in BD. The online forum conversations investigated were generally responsible and included cautionary advice not to pursue these methods.

Altered brain regional homogeneity, depressive symptoms, and cognitive impairments in medication-free female patients with current depressive episodes in bipolar disorder and major depressive disorder

BACKGROUND

Although symptoms of depressive episodes in patients with bipolar depressive episodes (BDE) and major depressive disorder (MDD) are similar, the treatment strategies for these disorders are completely different, suggesting that BDE and MDD have different neurobiological backgrounds. In this study, we examined the relationship between brain function and clinical symptoms, particularly cognitive function, in female individuals with bipolar disorder and MDD experiencing depressive episodes.

METHODS

Regional homogeneity (ReHo) was analyzed in 51 medication-free female patients with BDE, 63 medication-free female patients with MDD, and 45 female healthy controls (HCs). Depressive symptom severity was assessed using the 24-item Hamilton Depression Rating Scale (HAMD-24), and multidimensional cognitive function was evaluated using the MATRICS Consensus Cognition Battery. Partial correlation analysis was used to explore the links between the brain regions and clinical characteristics. A support vector machine (SVM) was used to assess the classification accuracy.

RESULTS

Compared with HCs, patients with BDE and MDD had decreased ReHo in the left lobule VI of the cerebellum and increased ReHo in the left precuneus. Patients with BDE also had reduced ReHo in the left lobules IV-V of the cerebellum and increased ReHo in the right putamen, unlike patients with MDD who had no significant differences in these regions. Patients with BDE exhibited more severe cognitive deficits in processing speed, attention, word learning, and overall cognitive function than those with MDD. In patients with BDE, a significant negative correlation was found between the right putamen and HAMD-24 scores. However, no significant association was observed between abnormal ReHo levels and cognitive function. The SVM effectively differentiated between patients with BDE, MDD, and HCs.

CONCLUSION

Cognitive impairment was more severe in female patients with BDE than in those with MDD. Changes in the ReHo values of the right putamen and left lobules IV-V may serve as unique neuroimaging markers for BDE. Alterations in the ReHo values of the left precuneus and left lobule VI could serve as common pathophysiological mechanisms for BDE and MDD in women and indicate depressive states.

Cerebrospinal Fluid Biomarkers of Central Nervous System Inflammation Predict Cortical Decline in Bipolar Disorder and Ventricular Enlargement in Healthy Controls

INTRODUCTION

Bipolar disorder has been associated with significant structural brain changes, potentially driven by central nervous system (CNS) inflammation. This study aimed to investigate the relationship between inflammation biomarkers in cerebrospinal fluid (CSF) and longitudinal structural brain changes.

METHODS

We included 29 individuals with bipolar disorder and 34 healthy controls, analyzing three selected inflammation-related biomarkers - interleukin-6 (IL-6), interleukin-8 (IL-8), and chitinase-3-like protein 1 (YKL-40) - in both blood serum and CSF. Structural brain changes were assessed through magnetic resonance imaging at two timepoints, focusing on cortical thickness of the middle temporal cortex and inferior frontal gyrus, as well as ventricular volume.

RESULTS

In healthy controls, baseline CSF levels of YKL-40 predicted ventricular enlargement in both hemispheres. Among individuals with bipolar disorder, higher baseline levels of IL-8 were associated with a decline in cortical thickness in the right and left middle temporal cortex, as well as the right inferior frontal gyrus. No significant associations were observed with serum biomarkers.

CONCLUSIONS

These findings suggest that CSF IL-8 may contribute to cortical decline in bipolar disorder. The lack of association between serum biomarkers and brain changes highlights the specificity of CNS inflammation in these processes. Additionally, the observed link between CSF YKL-40 and ventricular enlargement in healthy controls may indicate a role of CNS inflammation processes in normal brain aging.

INTRODUCTION

Bipolar disorder has been associated with significant structural brain changes, potentially driven by central nervous system (CNS) inflammation. This study aimed to investigate the relationship between inflammation biomarkers in cerebrospinal fluid (CSF) and longitudinal structural brain changes.

METHODS

We included 29 individuals with bipolar disorder and 34 healthy controls, analyzing three selected inflammation-related biomarkers - interleukin-6 (IL-6), interleukin-8 (IL-8), and chitinase-3-like protein 1 (YKL-40) - in both blood serum and CSF. Structural brain changes were assessed through magnetic resonance imaging at two timepoints, focusing on cortical thickness of the middle temporal cortex and inferior frontal gyrus, as well as ventricular volume.

RESULTS

In healthy controls, baseline CSF levels of YKL-40 predicted ventricular enlargement in both hemispheres. Among individuals with bipolar disorder, higher baseline levels of IL-8 were associated with a decline in cortical thickness in the right and left middle temporal cortex, as well as the right inferior frontal gyrus. No significant associations were observed with serum biomarkers.

CONCLUSIONS

These findings suggest that CSF IL-8 may contribute to cortical decline in bipolar disorder. The lack of association between serum biomarkers and brain changes highlights the specificity of CNS inflammation in these processes. Additionally, the observed link between CSF YKL-40 and ventricular enlargement in healthy controls may indicate a role of CNS inflammation processes in normal brain aging.

Kavalactones support motivation to move during intensive training in males preparing for military special operations forces

BACKGROUND

Military special operators, elite athletes, and others requiring uninterrupted optimal performance currently lack options for sleep and mood support without performance-inhibiting effects. Kavalactones, derived from the root of the kava plant (Piper methysticum Forst), have been shown to elevate mood and wellbeing by producing a feeling of relaxation without addiction or cognitive impairment.

METHODS

In this placebo-controlled, crossover study (NCT05381025), we investigated the effects of 2 weeks of kavalactones use on cortisol (diurnal salivary), sleep (RSQ-W; Restorative Sleep Questionnaire, Weekly), mood (DASS-21; Depression Anxiety Stress Scale-21), and motivation state to expend (Move) or conserve (Rest) energy (CRAVE; Cravings for Rest and Volitional Energy Expenditure, Right Now) in a cohort of 15 healthy, physically fit young males engaged in a rigorous, two-a-day preparation class for special operations forces qualification.

RESULTS

Cortisol, sleep, and mood were within normal, healthy parameters in this cohort at baseline. This remained unchanged with kavalactones use with no significant findings of clinical interest. However, a statistically similar, positive slope for within-group Move scores was seen in both groups during kavalactones loading (first group Move slope 2.25, second group Move slope 3.29, p = 0.299). This trend was seen regardless of order and with no apparent effects on the Rest metric (all p ≥ 0.05). Moreover, a significant between-group difference appeared after 1 week of kavalactones use in the first phase (p = 0.044) and persisted through the end of the first loading period (p = 0.022). Following the 10-day washout, this between-groups divergence remained significant (p = 0.038) but was reversed by 1 week after the crossover (p = 0.072), with Move scores once again statistically similar between groups and compared to baseline at study end. Furthermore, the group taking kavalactones first never experienced a significant decrease in Move motivation state (lowest mean score 21.0, highest 28.6, all p ≥ 0.05), while the group receiving kavalactones in the last 2 weeks of the study had Move scores that were statistically lower than baseline (lowest mean score 8.6, highest 25.9, all p ≤ 0.05) at all time points but the last (p = 0.063) after 2 weeks of kavalactones exposure.

CONCLUSIONS

We report a novel finding that kavalactones may support performance by maintaining or rescuing the desire to expend energy in the context of significant physical and mental strain in well-conditioned individuals, even in a context of already normal cortisol, sleep, and mood.

A physical perspective on lithium therapy

Lithium salts have strong medical properties in neurological disorders such as bipolar disorder and lithium-responsive headaches. They have recently gathered attention due to their potential preventive effect in viral infections. Though the therapeutic effect of lithium was documented by Cade in the late 1940s, its underlying mechanism of action is still disputed. Acute lithium exposure has an activating effect on excitable organic tissue and organisms, and is highly toxic. Lithium exposure is associated with a strong metabolic response in the organism, with large changes in phospholipid and cholesterol expression. Opposite to acute exposure, this metabolic response alleviates excessive cellular activity. The presence of lithium ions strongly affects lipid conformation and membrane phase unlike other alkali ions, with consequences for membrane permeability, buffer property and excitability. This review investigates how lithium ions affect lipid membrane composition and function, and how lithium response might in fact be the body's attempt to counteract the physical presence of lithium ions at cell level. Ideas for further research in microbiology and drug development are discussed.

Daytime napping and depressive symptoms in bipolar disorder: A cross-sectional analysis of the APPLE cohort

BACKGROUND

The relationship between daytime napping and depression remains debatable. Thus, we investigated whether daytime napping is associated with depressive symptoms in patients with bipolar disorder.

METHODS

In a cross-sectional study, we enrolled 204 outpatients with bipolar disorder who were participants in the Association between Pathology of Bipolar Disorder and Light Exposure in Daily Life (APPLE) cohort study. Each participant's daytime napping was measured using an actigraph over 7 consecutive days. Depressive symptoms were evaluated using the Montgomery-Åsberg Depression Rating Scale, and scores of ≥8 points were considered indicative of a depressed state.

RESULTS

One-hundred and ten (53.9 %) participants were depressed. In multivariable logistic regression analysis, as the number of nap days, number of naps per day, and nap duration increased, the odds ratio (OR) for depressed state significantly increased. Additionally, compared to the participants who did not nap, the participants who napped on five or more days a week or who had an average nap duration over 60 min had more than three times higher ORs in the depressed state (number of nap days: OR, 3.66; 95 % confidence interval [CI], 1.32-10.17; nap duration: OR, 3.14; 95 % CI, 1.12-8.81).

CONCLUSIONS

We found a significant and independent association between daytime napping and depressive symptoms in patients with bipolar disorder. Further studies are warranted to identify the effect of short napping on depressive symptoms in patients with bipolar disorder.

Inflammation and depression: A study protocol to dissect pathogenetic mechanisms in the onset, comorbidity and treatment response

About one third of patients suffering from Major Depressive Disorder (MDD) do not respond to any antidepressant medications and 75% experience relapses and general health deterioration. Importantly, inflammation can contribute to such negative outcomes, as well as to cause depression in patients who have been exposed to adverse childhood experiences and/or to viral infections, including COVID-19. Depressed patients also have an increased risk for developing comorbidities, such as cardio-metabolic dysfunctions, where inflammatory alterations, again, play a role in connecting MDD and these comorbid conditions. Here, we present our study protocol funded by the Italian Ministry of Health in the context of the PNRR call (M6/C2_CALL 2022; Project code: PNRR-MAD-2022-12375859). The project aims to clarify the role of inflammation: i) in the onset of depression in association with environmental factors; ii) in the mechanisms associated with treatment response/resistance; iii) in depression and its comorbidity. To reach all these aims, we will perform biochemical, transcriptomic, genetic variants analyses on inflammatory/immune genes, pharmacokinetics and machine learning techniques, taking advantage of different human cohorts (adolescent depressed patients exposed to childhood trauma; adult depressed patients; treatment resistant depression patients; both prevalent and incident depression cases identified within a large population cohort). Moreover, we will use in vitro models (primary cultures of astrocytes, neurons and microglia) treated with pro-inflammatory or stressful challenges and preventive compounds to clarify the underlying mechanisms. This 2-years project will increase the knowledge on the role of inflammation in the prevention and treatment of MDD and in comorbid disorders, and it will also provide experimental evidence for the development of novel targets and tools for innovative personalized intervention strategies.

Emotional Response to Various Exercise Types in Patients With Mental Disorders

Objectives This study examined the relationship between different types of exercise bouts and emotional responses in patients with mental disorders. Methods This study utilized an acute pre-/post-interventional design. Patients participated in six types of exercises: yoga, strength training, dual-task exercises, aerobic exercises, multicomponent exercises, and dance. These sessions were conducted for 60 minutes per day, once a week, from June 2018 to February 2019. Emotional states, including pleasantness, relaxation, and anxiety, were evaluated using the Mood Check List-Short Form 2 before and after each session. Results Twenty-four patients with mental disorders, including mood disorders, schizophrenia, and other conditions, aged 20-77 years, participated in a total of 272 sessions across six exercise types. Significant emotional changes were observed before and after the exercises, with an increase in pleasant feelings and a decrease in unpleasant feelings for all exercise types except the dual-task exercises. Yoga, in particular, showed large effect sizes for emotional changes, ranging from 0.65 to 0.72. Conclusions Yoga was found to enhance pleasantness and relaxation while reducing anxiety, whereas dual-task exercises appeared less effective in providing these benefits. These findings can help inform the selection of effective exercise methods for patients with mental disorders.

Theta phase precession supports memory formation and retrieval of naturalistic experience in humans

Associating different aspects of experience with discrete events is critical for human memory. A potential mechanism for linking memory components is phase precession, during which neurons fire progressively earlier in time relative to theta oscillations. However, no direct link between phase precession and memory has been established. Here we recorded single-neuron activity and local field potentials in the human medial temporal lobe while participants (n = 22) encoded and retrieved memories of movie clips. Bouts of theta and phase precession occurred following cognitive boundaries during movie watching and following stimulus onsets during memory retrieval. Phase precession was dynamic, with different neurons exhibiting precession in different task periods. Phase precession strength provided information about memory encoding and retrieval success that was complementary with firing rates. These data provide direct neural evidence for a functional role of phase precession in human episodic memory.

Safety of BI 1358894 in patients with major depressive disorder: Results and learnings from a phase II randomized decentralized clinical trial

The feasibility of conducting a fully remote, interventional, phase II decentralized clinical trial (DCT) was investigated in major depressive disorder (MDD). Key learnings were collated to improve future DCTs. A double-blind, placebo-controlled, parallel-group, DCT enrolled adult MDD patients with inadequate response to first-line antidepressant monotherapy (ongoing ≥8 weeks) and a Montgomery-Åsberg Depression Rating Scale total score (MADRS) ≥22 at screening. Patients were randomized 1:1 to BI 1358894 125 mg or placebo daily for 6 weeks remotely. Safety parameters, primary end point (change from baseline in MADRS at Week 6), and patient experience were assessed. The DCT was considered feasible if the trial protocol could be successfully executed. Overall, DCT procedures were successfully executed per protocol. However, despite achieving a vast patient outreach, the trial was terminated early due to deficient enrollment. Of the 136 patients who consented for enrollment and underwent screening, 45 were randomized and 43 received treatment (BI 1358894, n = 20; placebo, n = 23); 97.7% of patients completed the trial. Patients had a mean (SD) age of 42.2 (13.1) years and most (83.7%) were female. Adverse events were reported by 86.0% of patients (BI 1358894, 90.0%; placebo, 82.6%). Most patients (88%) reported a positive experience with the DCT. Key learnings related to the impact of stringent eligibility criteria, recruitment optimization strategies, plus the benefits and limitations of digital technologies. A fully remote, interventional DCT was feasible in MDD, and was well perceived by trial participants. Learnings related to recruitment optimization and trial design should be considered for future interventional DCTs.

Full-spectrum efficacy of cariprazine across manic and depressive symptoms of bipolar I disorder in patients experiencing mood episodes: Post hoc analysis of pooled randomized controlled trial data

INTRODUCTION

Patients with bipolar I disorder may experience mood destabilization or treatment-emergent affective switch (TEAS) from one symptom pole to the other spontaneously or following treatment. Optimal treatment should address symptoms from both poles without precipitating destabilization.

METHODS

These were pooled post hoc analyses of data from randomized, double-blind, placebo-controlled studies of cariprazine 3-12 mg/d for bipolar I mania (NCT00488618, NCT01058096, NCT01058668) and cariprazine 1.5 mg/d or 3 mg/d for bipolar I depression (NCT01396447, NCT02670538, NCT02670551). Changes from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) total score at week 6 and Young Mania Rating Scale (YMRS) total score at week 3 were analyzed in each indication using a mixed-effects model for repeated measures. Percentages of patients with increasing levels of endpoint response and TEAS (bipolar mania = MADRS total score ≥ 19; bipolar depression = YMRS score ≥ 16) were determined.

RESULTS

Cariprazine significantly reduced manic and depressive symptoms in patients with bipolar I disorder mood episodes. In patients with a manic episode and up to mild baseline depressive symptoms, cariprazine also significantly reduced depressive symptoms. In patients with a depressive episode and manic symptoms in remission at baseline, numerical reduction (without statistical significance) in YMRS indicated no worsening of mania. In both indications, cariprazine-treated patients had numerically greater response rates (presenting symptom pole) than placebo-treated patients; lower percentages of cariprazine- than placebo-treated patients had TEAS at visits where data were collected.

LIMITATIONS

Post hoc analysis.

CONCLUSION

Results suggested that cariprazine had full-spectrum efficacy across symptoms from both poles in patients with bipolar I disorder mood episodes; TEAS risk was low. Patient-level response suggested that improvement was clinically relevant.

[The mediational role of cognitive function on occupational outcomes in persons with major depressive and bipolar disorder]

BACKGROUND

Improving functioning in adults with major depressive disorder (MDD) and bipolar disorder (BD) is a priority therapeutic objective.

METHODS

This retrospective post hoc secondary analysis evaluated 108 patients with MDD or BD receiving the antidepressants vortioxetine, ketamine, or infliximab. The analysis aimed to determine if changes in objective or subjective cognitive function mediated the relationship between depression symptom severity and workplace outcomes. Cognitive function was measured by the Perceived Deficits Questionnaire (PDQ-5), the Digit Symbol Substitution Test (DSST), and the Trail Making Test Part B (TMT-B). Depression symptom severity was measured by the Montgomery-Åsberg Depression Rating Scale (MADRS). Workplace function was measured by the Sheehan Disability Scale (SDS) work-school item.

RESULTS

When co-varying for BMI, age, and sex, the association between MADRS and SDS work scores was partially mediated by PDQ-5 total scores and DSST total scores, but not DSST error scores and TMT-B time.

LIMITATIONS

This study was insufficiently powered to perform sub-group analyses to identify distinctions between MDD and BD populations as well as between antidepressant agents.

CONCLUSIONS

These findings suggest that cognitive impairment in adults with MDD and BD is a critical mediator of workplace function and reinforces its importance as a therapeutic target.

Adolescent and Family-Focused Cognitive-Behavioral Therapy for Pediatric Bipolar Disorders: An Open Trial and Individual Trajectories Study in Routine Psychiatric Care

Psychosocial treatments improve outcome in Pediatric bipolar disorder (PBD), but few are developed specifically for adolescents and none has been evaluated in Europe. This study evaluates family-focused cognitive-behavioral therapy for adolescents (ages 13-18) with PBD in routine psychiatric care in Sweden, adapted for teenagers in a European setting from the Child and Family-Focused Cognitive Behavioral Therapy for PBD (ages 8-12) developed in the US. In a repeated-measure open trial, psychosocial functioning, depression, skills and knowledge about PBD, and family climate were assessed at pre-treatment, post-treatment, and after 6 months. Assessments were made by adolescents (n = 45), parents (n = 61) and clinicians. Both group statistics and individual trajectories are reported. Psychosocial function, as rated by parents and clinicians, improved at post-treatment, and parents reported less mania and improved family climate at post-treatment. Both parents and adolescents reported improved skills and knowledge. Most results after treatment showed medium effect sizes. Significant improvements were seen in most individual trajectories, however no change and even deterioration was observed in some. The present trial shows that AFF-CBT is well accepted and associated with improved psychosocial function in adolescents and improved skills and knowledge about PBD in adolescents and their parents. Regarding mood symptoms and family climate the results showed more individual variability, indicating that adjustments in delivery of the treatment according to the unique patient could be of importance. AFF-CBT seems to be a valuable addition to pharmacological treatments in PBD.

Exercise as a promoter of neurocognitive improvement in people with psychiatric disorders and comorbid obesity: A randomized controlled trial

INTRODUCTION

The psychiatric disorders and obesity comorbidity is related to neurocognitive impairment and inflammation. Exercise is crucial to improve and maintain healthy lifestyles. This randomized controlled trial tested the efficacy of aerobic exercise as promoter of neurocognitive improvement across psychiatric disorders with comorbid obesity (OB).

METHODS

Patients with major depressive disorder, bipolar disorder and, schizophrenia and with comorbid OB (n = 29) received brief healthy lifestyle counseling and were randomized into two groups: guided physical activity group (GPAG) (n = 10) which included 12 weeks of guided-exercise of moderate intensity and frequency, and incentive of autonomous physical activity proposals by the specialist. Standard physical activity group (SPAG) (n = 19) continue with their usual daily physical activity, without guidance or incentives, over 12 weeks. Peripheral blood biomarkers of inflammation, oxidative stress, vascular mechanisms, and metabolic activity, as well as neurocognitive and functional performance were assessed twice, before and after intervention. Mixed one-way analysis of variance and linear regression analyses were performed.

RESULTS

Individuals in GPAG showed better neurocognitive and functional performance than individuals in SPAG after physical activity training (p < 0.05; η²p = 0.14 to 0.15). A significant improvement in cognition before and after the physical activity training in the GPAG group was found (p < 0.0001; η²p = 0.29). In all cases, the effect size was from moderate to large. Inflammatory activity (interleukin [IL-6]), oxidative (mitochondrial reactive oxygen species [mROS] and mitochondrial membrane potential [ΔΨm]) and inter cellular adhesion molecule 1 [ICAM1], leukocyte-endothelium adhesion [LEPMN], and p-selectin [PSEL]) levels, and cardio-metabolic (low-density lipoprotein [LDL], systolic blood pressure [SBP], and insulin) processes were significant predicting neurocognitive improve of individuals with psychiatric disorders and comorbid OB.

CONCLUSIONS

Physical activity programs may have positive impact on neurocognitive and functional performance in individuals with psychiatric disorders and OB. Exercise influences inflammatory, oxidative, vascular, and cardio-metabolic pathways, and modulate cognition. These findings may have a potential translational utility for early intervention in these disorders.

Hospital-treated bipolar disorder in adolescence in Finland 1980-2010: Rehospitalizations, diagnostic stability, and mortality

AIMS

Estimates of the occurrence of bipolar disorder among adolescents vary from country to country and from time to time. Long delays from first symptoms to diagnosis of bipolar disorder have been suggested. Studies among adults suggest increased mortality, particularly due to suicide and cardiovascular diseases. We set out to study the prognosis of adolescent onset bipolar disorder in terms of rehospitalizations, diagnostic stability, and mortality.

METHODS

The study comprised a register-based follow-up of all adolescents admitted to psychiatric inpatient care for the first time in their lives at age 13-17 during the period 1980-2010. They were followed up in the National Care Register for Health Care and Causes of death registers until 31 December 2014.

RESULTS

Incidence of bipolar disorder among 13- to 17-year-old adolescents over the whole study period was 2.8 per 100, 000 same aged adolescents, and across decades, the incidence increased six-fold. Patients with bipolar disorder during their first-ever inpatient treatment were rehospitalized more often than those treated for other reasons. Conversion from bipolar disorder to other diagnoses was far more common than the opposite. Mortality did not differ between those firstdiagnosed with bipolar disorder and those treated for other reasons.

CONCLUSION

The incidence of adolescent onset bipolar disorder has increased across decades. The present study does not call for attention to delayed diagnosis of bipolar disorder. Adolescent onset bipolar disorders are severe disorders that often require rehospitalization, but diagnostic stability is modest. Mortality is comparable to that in other equally serious disorders.