Bipolar Disorder Research Articles

A War of D’s: DRESS or Dengue?

Background: Dengue fever can present with symptoms that mimic drug-related reactions, especially in patients with complex medical histories, such as those with bipolar disorder on multiple medications. Case details: We report a 62-year-old female with a known history of bipolar disorder who was admitted with altered mental status, vomiting, and a rash. Given her psychiatric treatment, there was an initial concern for a drug-related reaction. Investigations: Through investigation was conducted. Results revealed a positive serology for dengue fever, alongside leukopenia and thrombocytopenia. Discussion: This case highlights the diagnostic challenge of differentiating between adverse drug reactions and infectious diseases like dengue in patients on multiple medications. Conclusion: Clinicians must maintain a high index of suspicion for tropical diseases like dengue, particularly in patients with complex comorbidities. This case underscores the importance of comprehensive evaluations in emergency settings and the need for a broad differential diagnosis approach.

Transcription factor 4 expression in the developing non-human primate brain: a comparative analysis with the mouse brain

Transcription factor 4 (TCF4) has been implicated in a range of neuropsychiatric disorders, including major depressive disorder, bipolar disorder, and schizophrenia. Mutations or deletions in TCF4 cause Pitt-Hopkins syndrome (PTHS), a rare neurodevelopmental disorder. A detailed understanding of its spatial expression across the developing brain is necessary for comprehending TCF4 biology and, by extension, to develop effective treatments for TCF4-associated disorders. However, most current knowledge is derived from mouse models, which are invaluable for preclinical studies but may not fully capture the complexities of human neuropsychiatric phenotypes. This study compared TCF4 expression in the developing mouse brain to its regional and cellular expression patterns in normal prenatal, neonatal, and young adult rhesus macaque brains, a species more relevant to human neurodevelopment. While the general developmental expression of TCF4 is largely conserved between macaques and mice, we saw several interspecies differences. Most notably, a distinct layered pattern of TCF4 expression was clear in the developing macaque neocortex but largely absent in the mouse brain. High TCF4 expression was seen in the inner dentate gyrus of adult mice but not in macaques. Conversely, TCF4 expression was higher in the adult macaque striatum compared to the mouse striatum. Further research is needed to show the significance of these interspecies differences. Still, they underscore the importance of integrating rodent and primate studies to comprehensively understand TCF4 function and its implications for human disorders. Moreover, the primate-specific expression patterns of TCF4 will inform genetic and other therapeutic strategies to treat TCF4-associated disorders.

A pre-post trial to examine biological mechanisms of the effects of time-restricted eating on symptoms and quality of life in bipolar disorder

BackgroundThe primary objective of this trial is to examine the mechanisms of time-restricted eating (TRE) as an adjunct to psychiatric care for people with bipolar disorder (BD) with sleep or circadian disruptions. This study builds on prior studies of circadian disruption in BD as well as growing evidence that TRE improves circadian functioning.MethodsOne-hundred fifty participants diagnosed with BD 1 or II will be recruited via advertising in the local community. Main inclusion criteria include: obtaining medical treatment for BD; current sleep or circadian problems; self-reported eating period of ≥ 12 h; no eating disorder or other health conditions that would hinder or limit the safety of following TRE; and not currently experiencing a mood episode, acute suicidality, psychosis, alcohol or substance use disorder. Participants will be asked to complete a baseline period in which daily food intake is logged online for two weeks. After baseline, participants will be asked to follow TRE for 8 weeks and to continue to complete daily food logging during this time. Symptom severity interviews will be conducted by phone or videoconference at baseline, mid-intervention (6 weeks post-baseline), end of intervention (10 weeks post-baseline), and 6 months post-baseline. Self-rated symptom severity and quality of life data will be gathered online at the same time points as symptom severity interviews, and at 16 weeks post-baseline (6 weeks after the TRE period ends). To assess potential mechanisms of change, we will examine the change in diurnal amplitude of ‘clock’ gene expression as a primary mediator at 8 weeks compared to baseline. We will further test whether diurnal amplitude of clock gene expression is predictive above and beyond the role of two covariate potential mediators, glucose tolerance and inflammation at 8 weeks relative to baseline. To provide an index of whether TRE successfully decreases emotional lability, participants will be asked to complete 5 mood assessments per day for 7 days at baseline and at 10 weeks. These mood assessments will be optional.DiscussionThe planned research will provide novel and important information on whether TRE improves sleep/circadian rhythm problems, along with reductions in mood symptoms and improvements in quality of life, for individuals with BD.Trial registrationClinicalTrials.gov ID: NCT06555406.

Long term mortality trends in people with severe mental illnesses and how COVID-19, ethnicity and other chronic mental health comorbidities contributed: a retrospective cohort study.

People with schizophrenia-spectrum and bipolar disorders (severe mental illnesses; 'SMI') experience excess mortality. Our aim was to explore longer-term trends in mortality, including the COVID-19 pandemic period, with a focus on additional vulnerabilities (psychiatric comorbidities and race/ ethnicity) in SMI. Retrospective cohort study using electronic health records from secondary mental healthcare, covering a UK region of 1.3 million people. Mortality trends spanning fourteen years, including the COVID-19 pandemic, were assessed in adults with clinician-ascribed ICD-10 diagnoses for schizophrenia-spectrum and bipolar disorders. The sample comprised 22 361 people with SMI with median follow-up of 10.6 years. Standardized mortality ratios were more than double the population average pre-pandemic, increasing further during the pandemic, particularly in those with SMI and psychiatric comorbidities. Mortality risk increased steadily among people with SMI and comorbid depression, dementia, substance use disorders and anxiety over 13-years, increasing further during the pandemic. COVID-19 mortality was elevated in people with SMI and comorbid depression (sub-Hazard Ratio: 1.48 [95% CI 1.03-2.13]), dementia (sHR:1.96, 1.26-3.04) and learning disabilities (sHR:2.30, 1.30-4.06), compared to people with only SMI. COVID-19 mortality risk was similar for minority ethnic groups and White British people with SMI. Elevated all-cause mortality was evident in Black Caribbean (adjusted Rate Ratio: 1.40, 1.11-1.77) and Black African people with SMI (aRR: 1.59, 1.07-2.37) during the pandemic relative to earlier years. Mortality has increased over time in people with SMI. The pandemic exacerbated pre-existing trends. Actionable solutions are needed which address wider social determinants and address disease silos.

Written Narrative in Patients with Different Mental Disorders

Language disorders are criteria of psychopathology diagnostics listed both in the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistic Manual of Mental Disorders (DSM). However, structure and grammar remain understudied in this aspect, which makes structural analysis a relevant research topic. A structural analysis of written narrative may objectivize particular language disorders, thus facilitating psychodiagnostics of different mental disorders. The research objective was to describe the structural features of written narratives obtained from 127 patients with schizophrenic, bipolar, and personality disorders. The narratives were subjected to structural and statistical analyses. Schizophrenic narratives demonstrated a poor vocabulary, a low volume, and a high degree of formality with a passive narrator. Bipolar texts tended to be long, detailed, egocentric, and active, with multiple participles. Patients with personality disorders emotionally relived their memories, producing reflective written narratives with a lot of actors. The final list of written speech indicators to be used to distinguish between schizophrenic, bipolar, and personality disorders included such variables as text volume, verb tense, non-finite verb forms, first-person singular pronoun, number of actors, passive / active narrator, and laconic / detailed narration.

Effects of Neurodevelopmental Disorders on the Clinical Presentations and Therapeutic Outcomes of Children and Adolescents with Severe Mood Disorders: A Multicenter Observational Study.

Individuals with neurodevelopmental disorders (NDDs) are more susceptible to developing severe or resistant mood disorders. However, they often face challenges in accessing specific treatments. To understand the barriers to treatment in this group, we conducted a secondary analysis of a multicenter observational study on 305 adolescents referred to specialized care (mean age 14.38 ± 0.13 years, 57% girls, 9% bipolar disorder, 91% depressive disorders). NDDs were categorized based on the number of co-occurring NDDs for each subject (none: 67%, one: 18%, two: 7%, three: 5%, four and more: 2%). We explored the predictive value of the number of NDDs on various clinical and therapeutic factors. The analysis revealed significant associations between the number of NDDs and the duration of mood symptoms, persistent irritability, associated disruptive behavioral disorders, lower scores on the Children's Global Assessment Scale (CGAS) at baseline, and polypharmacy. The number of NDDs did not correlate with the use of antidepressants, the Clinical Global Impression-Improvement scale (CGI-I) at discharge, or changes in the CGAS score during the stay. The challenges in distinguishing mood disorders from chronic emotional and behavioral difficulties may contribute to the difficulties in accessing specific care for mood disorders. These results suggest that treatments for mood disorders demonstrate comparable effectiveness when provided regardless of the associations with NDDs.

THE KEY CHARACTERISTICS OF THE COGNITIVE-BEHAVIORAL THERAPY AS A PERFORMANCE FACTOR IN THE PSYCHOLOGICAL PRACTICE

Cognitive Behavioral Therapy (CBT) is a modern, pragmatic, evidence-based psychotherapeutic approach. Numerous studies have proven the effectiveness of CBT in the treatment of depression, anxiety disorders, eating disorders and personality disorders. CBT is used along with the pharmacological treatment of schizophrenia, bipolar disorder, and other mental disorders. The research focuses on the main characteristics of cognitive-behavioral therapy, such as therapeutic relationship, conceptualization, psychoeducation, and relapse prevention, which are essential for therapeutic performance. The ways of reflection development are outlined, the difficulties encountered by a CBT therapist are identified. An evaluation form of the implementation of key components of CBT in practice is proposed, which includes a list of questions for sessions planning and the therapeutic plan development. Keywords: fundamentals of cognitive-behavior therapy (CBT), principles, conceptualization, therapeutic relationships, psychoeducation, reflection, relapse prevention

Exploring Patient Empowerment in Major Depressive Disorder: Correlations of Trust, Active Role in Shared Decision-Making, and Symptomatology in a Sample of Italian Patients.

Background/Objectives: Empowerment in medicine and psychiatry involves patients gaining control over health-related decisions, improving treatment adherence, outcomes, and satisfaction. This concept is especially significant in psychiatric care due to the complex challenges of mental health conditions, including stigma and impairment of emotional and cognitive functioning. We aim to investigate the correlations between patient trust, decision-making involvement, symptom severity, and perceived empowerment among individuals with Major Depression. Methods: Patients with Major Depressive Disorder were recruited in the "Policlinico G. Rodolico" psychiatry outpatient clinic from November 2022 to June 2023. Inclusion criteria: ages 18-65, ability to consent, stable condition, psychiatric medication history, and recent consultation. Exclusion criteria: psychotic features, bipolar disorder, substance abuse, high suicide risk, and severe comorbidities. Measures included the User Scale for Measuring Empowerment in Mental Health Services (SESM), Trust in Oncologist Scale (TiOS), Clinical Decision-Making Style for Patients (CDMS-P), and Hamilton Depression Rating Scale (HAM-D). Analysis used Kendall's Tau correlation and Two-One-Sided Tests procedure. Results: Seventy-three patients completed the study. No relationship was found between decision-making involvement and perceived empowerment (τ = -0.0625; p = 0.448), or between trust in psychiatrists and empowerment (τ = 0.0747; p = 0.364). An inverse correlation existed between patient involvement in therapy management and trust (τ = -0.2505; p = 0.002). Depression severity inversely correlated with empowerment (τ = -0.2762; p = <.001), but not with trust or decision-making involvement. Conclusions: The lack of significant correlations suggests that decision-making involvement and trust alone may not suffice to enhance empowerment. Trust may encourage patient passivity, while skepticism might drive active involvement. Higher empowerment is associated with less depressive symptoms, highlighting its potential connection with patient outcomes.

Ketamine and Esketamine in Clinical Trials: FDA-Approved and Emerging Indications, Trial Trends With Putative Mechanistic Explanations.

Ketamine has a long and very eventful pharmacological history. Its enantiomer, esketamine ((S)-ketamine), was approved by the US Food and Drug Administration (FDA) and EMA for patients with treatment-resistant depression (TRD) in 2019. The number of approved indications for ketamine and esketamine continues to increase, as well as the number of clinical trials. This analysis provides a quantitative overview of the use of ketamine and its enantiomers in clinical trials during 2014-2024. A total of 363 trials were manually assessed from clinicaltrial.gov with the search term "Ketamine." The highest number of trials were found for the FDA-approved indications: anesthesia (~22%) and pain management (~28%) for ketamine and TRD for esketamine (~29%). Clinical trials on TRD for both ketamine and esketamine also comprised a large proportion of these trials, and interestingly, have reached phase III and phase IV status. Combinatorial treatment of psychiatric disorders and non-psychiatric conditions with pharmacological and non-pharmacological combinations (electroconvulsive therapy, psychotherapeutic techniques, virtual reality, and transcranial magnetic stimulation) is prevalent. Sub-anesthetic doses of ketamine may represent novel therapeutic avenues in neuropsychiatric conditions, that is, major depression, schizophrenia, and bipolar disorder, where glutamate excitotoxicity and oxidative stress are likely to be involved. The study suggests that the number of ketamine studies will continue to grow and possible ketamine variants can be approved for treatment of additional indications.

Bipolar disorder among individuals with atopic dermatitis: A case-control study in the All of Us Research Program.

Atopic dermatitis (AD) has been associated with psychiatric comorbidities. To characterize the association between AD and bipolar disorder (BPD) with a case-control study of the NIH All of Us Research Program. Utilizing Systemized Nomenclature of Medicine diagnostic codes, we identified cases of AD. Four age, sex, and race/ethnicity matched controls were found for each case using propensity score matching. After controlling for age, sex, race/ethnicity, income, smoking status, and depression, the relationship between AD and BPD was evaluated using logistic regression. We identified 13,431 AD cases with 53,724 matched controls. Participants with AD were more likely than controls to have BPD (7.8% vs. 4.6%, P<.001). After adjusting for demographics and comorbidities, we observed a significant association (OR 1.49, 95%CI 1.37-1.62, P<.001). Compared to individuals without AD, individuals with AD have 1.49-fold increased odds of having BPD. Further investigation is needed to further understand this association.

Subtypes of Childhood Trauma Exposure Associated with Earlier Onset and Delayed Treatment in Rapid Cycling Bipolar Disorder: A CaseControl Study

ABSTRACT Studies on bipolar disorder (BD) have suggested that exposure to childhood trauma (CT) and rapid cycling BD (RC-BD) are associated with earlier onset and overall worse prognosis. The association between CT exposure and RC-BD in patients from low/middle-income countries has not been sufficiently characterized. Therefore, we performed a case–control study of patients with RC-BD (n = 35), patients without RC-BD (n = 35), and healthy controls (HC) (n = 105) in a low/middle-income country, Colombia, to evaluate CT exposure and RC-BD for clinical associations. We reported a significant number of patients with RC-BD exposed to physical abuse and/or sexual abuse compared with patients without RC-BD during the course of illness. In addition, CT exposure and RC-BD were associated with an earlier age of onset and delayed diagnosis and treatment. In the future, recognition of early CT exposure in populations at risk for BD may help tailor precise interventions and thus change the course of illness and worse prognosis.

Evaluating Anesthesia Practices, Patient Characteristics, and Outcomes in Electroconvulsive Therapy: A Two-Year Retrospective Study.

Background: Electroconvulsive therapy (ECT) is a well-established treatment for various psychiatric disorders. This retrospective study evaluates anesthesia practices, patient characteristics, and outcomes in ECT over a two-year period at the "Dr. Gheorghe Preda" Clinical Psychiatry Hospital in Sibiu, Romania. Methods: From March 2022 to July 2024, the Neuroscience Scientific Research Collective at our institution carried out a retrospective observational study on patients who underwent ECT. The evaluation and treatment protocol involved patients from all over the country. Results: The study involved 30 patients aged between 22 and 67 years and a mean age of 39.4 years; among them, 57% were male. The majority of the patients (68%) lived in urban areas, and 80% came from a different county. Schizophrenia was the most prevalent diagnosis (56.6%), followed by depression (40%) and bipolar disorder (3.4%). Common comorbidities included obesity/overweight, high blood pressure, and sinus tachycardia. A total of 330 ECT sessions were conducted, with an average of 11 sessions per patient, and 10 patients underwent multiple treatment courses. The reported adverse events included arterial hypertension, agitation, tachycardia, and shivering. Conclusions: This study underlines the safety and effectiveness of ECT when patients are closely monitored. Our results are consistent with the global data, suggesting that ECT is a good treatment option for severe psychiatric conditions with a manageable incidence of adverse events.

Investigating light sensitivity in bipolar disorder (HELIOS-BD)

Many people with bipolar disorder have disrupted circadian rhythms. This means that the timing of sleep and wake activities becomes out-of-sync with the standard 24-hour cycle. Circadian rhythms are strongly influenced by light levels and previous research suggests that people with bipolar disorder might have a heightened sensitivity to light, causing more circadian rhythm disruption, increasing the potential for triggering a mood switch into mania or depression. Lithium has been in clinical use for over 70 years and is acknowledged to be the most effective long-term treatment for bipolar disorder. Lithium has many reported actions in the body but the precise mechanism of action in bipolar disorder remains an active area of research. Central to this project is recent evidence that lithium may work by stabilising circadian rhythms of mood, cognition and rest/activity. Our primary hypothesis is that people with bipolar disorder have some pathophysiological change at the level of the retina which makes them hypersensitive to the visual and non-visual effects of light, and therefore more susceptible to circadian rhythm dysfunction. We additionally hypothesise that the mood-stabilising medication lithium is effective in bipolar disorder because it reduces this hypersensitivity, making individuals less vulnerable to light-induced circadian disruption. We will recruit 180 participants into the HELIOS-BD study. Over an 18-month period, we will assess visual and non-visual responses to light, as well as retinal microstructure, in people with bipolar disorder compared to healthy controls. Further, we will assess whether individuals with bipolar disorder who are being treated with lithium have less pronounced light responses and attenuated retinal changes compared to individuals with bipolar disorder not being treated with lithium. This study represents a comprehensive investigation of visual and non-visual light responses in a large bipolar disorder population, with great translational potential for patient stratification and treatment innovation.

Brain-Derived Neurotrophic Factor (BDNF) as a Predictor of Treatment Response in Schizophrenia and Bipolar Disorder: A Systematic Review

Brain-derived neurotrophic factor (BDNF) is a potential biomarker of response to treatment in psychiatric disorders. As it plays a role in the pathophysiological development of schizophrenia and bipolar disorder, it is of interest to study its role in predicting therapeutic responses in both conditions. We carried out a systematic review of the literature, looking for differences in baseline BDNF levels and the Val66Met BDNF polymorphism in these disorders between responders and non-responders, and found information showing that the Val/Val genotype and higher baseline BDNF levels may be present in patients that respond successfully to pharmacological and non-pharmacological treatments. However, there is still limited evidence to support the role of the Val66Met polymorphism and baseline BDNF levels as predictors of treatment response.

Alexithymia and Bipolar Disorder: Virtual Reality Could Be a Useful Tool for the Treatment and Prevention of These Conditions in People with a Physical Comorbidity

Background: Alexithymia, a predictor in chronic illnesses, like cardiovascular and bipolar disorder (CD–BD), could be improved with a virtual reality (VR) cognitive remediation program. This secondary analysis of a previous randomized controlled trial (RCT) evaluates alexithymia improvement and its factors in an experimental group versus a control group, exploring extensions to individuals with comorbid non-psychiatric chronic conditions. Methods: A feasibility cross-over RCT (ClinicalTrials.gov NCT05070065) enrolled individuals aged 18–75 with mood disorders (BD, DSM-IV), excluding those with relapses, epilepsy, or severe eye conditions due to potential risks with VR. Alexithymia levels were measured using the Toronto Alexithymia Scale with 20 items (TAS-20). Results: The study included 39 individuals in the experimental group and 25 in the control group, with no significant age or sex differences observed. Significantly improved alexithymia scores were noted in the experimental group compared to controls (F = 111.9; p &lt; 0.0001) and in subgroups with chronic non-psychiatric comorbidities (F = 4.293, p = 0.048). Scores were particularly improved for difficulty in identifying feelings (F = 92.42; p &lt; 0.00001), communicating feelings (F = 61.34; p &lt; 0.00001), and externally oriented thinking (F = 173.12; p &lt; 0.00001). Conclusions: The findings highlight alexithymia enhancement in BD, even with comorbid non-psychiatric chronic diseases. Given its impact on BD progression and related conditions, like CD, developing and evaluating VR-based tools in this context is suggested by these findings.

Psychometric Validation of the Purpose in Life Test-Short Form (PIL-SF) in Individuals Diagnosed with Severe Mental Illness.

Meaning in Life (MiL) represents a key variable in mental health models of personal recovery. There is a need for straightforward and concise instruments to assess this construct quantitatively in individuals diagnosed with severe mental illness (SMI). The aim of the present study was to test the psychometric properties of the Purpose in Life Test-Short Form (PIL-SF), a brief self-report measuring the presence of MiL, in a sample of individuals with SMI. The participants were 41 adults (21 women, 51.8% and 20 men, 48.2%) aged 18 to 65 years (M = 50.05; SD = 10.73) with a diagnosis of SMI (schizophrenia, 61%; bipolar disorder, 26.8%; borderline personality disorder, 7.3%; and major depression, 4.9%) and clinically stable. The PIL-SF, Satisfaction with Life Scale (SWLS), Oxford Happiness Questionnaire-6 Item (OHQ-6), Engagement in Meaningful Activities Survey (EMAS), and Seeking of Noetic Goals-8 Item (SONG-8) were used. Descriptive analysis, estimation of the internal consistency, and Confirmatory Factor Analysis of the PIL-SF were conducted. Furthermore, correlations between the PIL-SF, SWLS, OHQ-6, EMAS, and SONG-8 were calculated. The PIL-SF showed acceptable internal consistency (ω = 0.81) and an excellent fit as a unidimensional scale (CFI = 1.000, TLI = 1.070, RMSEA = 0.000, SRMR = 0.021), confirming its factorial structure. Regarding construct validity, correlations between the PIL-SF and the SWLS (ρ = 0.54, p < 0.001), the OHQ-6 (ρ = 0.52, p < 0.001), and EMAS (ρ = 0.44, p < 0.005) were positive and significant, whereas the correlations between the PIL-SF and the SONG-8NfM (ρ = -0.35, p < 0.025) were negative and significant. The Spanish version of the PIL-SF appears to be a reliable and valid instrument to measure the presence of MiL in adults with SMI.

Ten Years of Bipolar Telehealth: Program Evaluation of a Team-Based Telemental Health Clinic.

Objectives: Telemental health via videoconferencing (TMH-V) can overcome many of the barriers to accessing quality mental health care. Toward this end, in 2011, the U.S. Department of Veterans Affairs (VA) established the National Bipolar Disorders TeleHealth (BDTH) Program to provide expert mental health consultation and treatment to Veterans with bipolar spectrum disorders. Methods: Initial analyses of BDTH services suggested that participants had positive changes in quality-of-care indices and clinical outcomes; however, that evaluation was based on a limited sample of both participants and VA medical centers. We were able to confirm and expand upon those early results by using nearly eight times the number of participants and more than twice as many medical centers. Results: For the 2,456 Veterans who completed the intake to our program, there were significant improvements in some of the quality metrics (e.g., lithium use) and a 54% reduction in positive suicide screens (p < 0.05). The Veterans who completed the initial and postprogram assessments (n = 815) reported a 16.6% reduction in manic symptoms (p < 0.001), a 29.3% reduction in depressive symptoms (p < 0.001), and a 21.2% reduction in mood episodes (p < 0.001). Additionally, these Veterans demonstrated significant improvements (p < 0.001) in mental health-related quality of life between the two assessments. Conclusions: These analyses provide further support for the general effectiveness and safety of telemental health via videoconferencing. Future research should examine the generalizability of these findings across various subgroups (e.g., minority patients, patients in rural areas), populations, and health care systems.

Extended-Release Lithium Treatment for Adolescents with Bipolar Disorder with or Without Comorbid Autism Spectrum Disorder: Protocol of a Longitudinal Prospective Naturalistic Study for the Assessment of Efficacy and Tolerability.

Background: Lithium is the gold-standard treatment for Bipolar Disorder (BD) in both adults and adolescents, effectively managing mood episodes and reducing suicide risk. While its efficacy in neurotypical youth is well established, its use in adolescents with Autism Spectrum Disorder (ASD) and comorbid BD remains under-researched. Here, we present the protocol for a study aiming to evaluate the efficacy and tolerability of Extended-Release Lithium Salts in treating adolescents with BD and comorbid ASD compared to neurotypical BD patients. Methods: This longitudinal prospective naturalistic comparative study will enroll lithium-naïve adolescents aged 12-18 with BD, with or without comorbid ASD, from the Department of Child and Adolescent Psychiatry and Psychopharmacology. Participants will be followed for six months while receiving Extended-Release Lithium Salts treatment. Primary outcomes will include mood instability, suicidality, emotional dysregulation, and aggression, assessed through a range of clinical rating scales and diagnostic tools at baseline, three months, and six months. Secondary outcomes will focus on the safety and tolerability of Extended-Release Lithium Salts, with measures including side effect ratings, physical exams, and laboratory tests. Results: We hypothesize that Extended-Release Lithium Salts will demonstrate non-inferiority in treating BD symptoms in adolescents with comorbid ASD compared to those without ASD. Conclusions: This study is poised to fill a significant gap in the literature by providing critical data on the use of lithium for adolescents with BD and ASD. Findings will inform clinical practice and future research, potentially guiding more personalized treatment approaches for this complex and vulnerable population.

Commentary on 'Comorbidity of bipolar disorder and borderline personality disorder: Phenomenology, course and treatment considerations' by Temes etal.

Commentary on 'Comorbidity of bipolar disorder and borderline personality disorder: Phenomenology, course and treatment considerations' by Temes etal.

Cortical folding in distinguishing first-episode bipolar and unipolar depression

BackgroundsClinical studies to date have yet to establish distinct boundaries between depression in bipolar disorder (BD) and unipolar depression (UD), leading to misdiagnoses and even exacerbation of the conditions. This study aimed to explore the distinctions in the local gyrification index (LGI) between BD and UD, and to evaluate its potential diagnostic value as a biomarker. MethodsLGI values across 68 cortical regions were measured from 42 patients with BD, 45 patients with UD, and 45 healthy controls (HCs) based on the Desikan–Killiany atlas. General linear model was performed to compare LGI values among the three groups. XGBoost classifier was implemented to develop a binary classification model for distinguishing BD from UD. Additionally, the correlation between clinical characteristics and LGI values was investigated separately within the BD and UD groups. ResultsCompared to HCs, individuals with BD and UD exhibited significantly reduced LGI values in various cortical regions. Nine LGI regions in the BD group displayed reduced values compared to the UD group, except for a singular increase in the left frontal pole (ηp2 = 0.173; P = 0.006). No significant association was found between LGI values and clinical characteristics within the patient groups. The XGBoost classifier achieved a distinction accuracy of 73.7 % between BD and UD, with the left frontal pole making the most significant contribution to the model. ConclusionsThe findings suggest that LGI could be a relatively stable neuroimaging biomarker for distinguishing between BD and UD.