Bipolar Spectrum Disorders Research Articles

Metformin for Overweight and Obese Children With Bipolar Spectrum Disorders Treated With Second-Generation Antipsychotics (MOBILITY): Protocol and Methodological Considerations for a Large Pragmatic Randomized Clinical Trial

Metformin for Overweight and Obese Children With Bipolar Spectrum Disorders Treated With Second-Generation Antipsychotics (MOBILITY): Protocol and Methodological Considerations for a Large Pragmatic Randomized Clinical Trial

Cytomegalovirus infection associated with smaller cerebellum in severe mental illness

IntroductionPostnatal cytomegalovirus (CMV) infection of immunocompetent hosts is usually inapparent but typically results in lifelong latency. Congenital CMV infections as well as CMV infections in patients with immunodeficiencies have been linked to major cerebellar pathology. Patients with severe mental illness have been repeatedly found to have smaller cerebellum, and they may be particularly susceptible to CMV infections. Finally, both animal and human studies have shown a differential male and female immune response to CMV.ObjectivesWe evaluated whole cerebellar grey matter volumes (CGMV) in CMV immunoglobulin G (IgG) seropositive (CMV+) and seronegative (CMV-) patients with severe mental illness and healthy controls (HC). We hypothesized that CMV seropositivity, reflecting previous infection and current latency, is associated with smaller CGMV in patients but not in HC, and that such a putative association may be sex-dependent.MethodsWe included 529 adult patients with severe mental illness (CMV+ 57%, women 48%), i.e., 324 patients with schizophrenia spectrum disorders and 205 patients with bipolar spectrum disorders, and 494 HC (CMV+ 56%, women 45%). MRI scans were obtained with a 1.5T Siemens scanner (n=596) and two 3.0T General Electric scanners (n=427), and processed with FreeSurfer v6.0. Circulating CMV IgG concentrations were measured with immunoassays. In age-, scanner- and estimated total intracranial volume-adjusted analyses of covariance (ANCOVAs), we investigated main and interaction effects of CMV status and sex on CGMV in patients and HC.ResultsCMV+ patients had smaller CGMV than CMV- patients (p=0.042). There was no CGMV difference between CMV+ and CMV- HC (p=0.858). The adjusted CGMV means in CMV+ patients and CMV- patients were 115078 mm3 and 116725 mm3, respectively (p=0.042); the adjusted CGMV means in CMV+ and CMV- HC were 117980 mm3 and 117840 mm3, respectively (p=0.858) (Image). Among patients, a trend towards CMV-by-sex interaction (p=0.073) was found. Post-hoc analyses showed a significant CMV-CGMV association in the female patient group (p=0.005), with no association among male patients (p=0.840).Image:ConclusionsCMV IgG seropositivity is associated with smaller cerebellum in severe mental illness, an effect driven by the female patients, but not among HC. This may indicate a CMV-related deleterious impact on cerebellum restricted to patients.Disclosure of InterestNone Declared

Stratified therapeutic security and understanding backwards care pathway moves. A 5-year retrospective cohort analysis from the Dundrum Forensic Redevelopment Evaluation (D-FOREST) study in Dublin, Ireland

IntroductionSecure forensic hospital settings provide care and treatment to mentally disordered offenders with a history of serious violence. Most modern forensic hospitals operate a system of stratified therapeutic security, where patients are placed on the internal care pathway according to individual risks and needs. Unfortunately, at times patients move ‘backwards’ from a unit of lower to a unit with higher therapeutic security. This is a challenge to manage from an individual patient and service perspective.ObjectivesThe aim of this study was to analyse backwards moves along the care-pathway within a complete national cohort of forensic in-patients in Ireland over a five-year period. We aimed to clarify the reasons for these moves and ascertain if they were linked to mental illness, security or other issues.MethodsA naturalistic retrospective five-year observational cohort study was completed. All in-patients in the Central Mental Hospital, Dundrum, Ireland or associated high support hostels between January 2016 and January 2021 were included (60 months). Demographic data, data pertaining to diagnosis, data pertaining to backwards moves and reasons for those moves were gathered. Data was gathered as part of the Dundrum Forensic Redevelopment Evaluation study (D-FOREST study).ResultsA total of n=231 patients were included; the majority (n= 203; 87.9%) were male. The most common diagnosis was schizophrenia (64.1%), followed by schizoaffective disorder (12.6%), bipolar affective disorder (4.8%) and autistic spectrum disorder (3.5%). Mean age at admission was 35.9 years, SD 9.5.Over the 60-month period, a total of 93 backwards moves relating to 50 patients occurred. Reasons for backward moves included deteriorating mental state (8.7%), assaults (4.3%), challenging behaviour (4.3%), security (1%) and others. Binary logistic regression demonstrated that lacking capacity to consent to medication (Odds ratio 0.352, 95%CI 0.198-0.627, p<0.001) and higher (worse) scores on HCR-20 Historical scale (Odds ratio 1.13, 95%CI 1.01-1.27, p=0.035) were associated with backwards moves, when adjusting for age and Dundrum-1 need for therapeutic security scores.ConclusionsBackwards care pathway moves are a major issue in forensic hospitals both nationally and internationally. We were surprised at the strength of association between lacking capacity to consent and backwards moves. Understanding backwards moves will assist in supporting patients and minimising length of stay.Disclosure of InterestL. Jordan Grant / Research support from: This study was funded by the Health Service Executive for the Republic of Ireland as part of the Dundrum Forensic Redevelopment Evaluation (D-FOREST) study, G. Crudden: None Declared, D. Mohan: None Declared, H. Kennedy: None Declared, M. Davoren: None Declared

No Increased Detection of Nucleic Acids of CNS-related Viruses in the Brains of Patients with Schizophrenia, Bipolar Disorder, and Autism Spectrum Disorder.

Viral infections are increasingly recognized in the etiology of psychiatric disorders based on epidemiological and serological studies. Few studies have analyzed viruses directly within the brain and no comprehensive investigation of viral infection within diseased brains has been completed. This study aims to determine whether viral infection in brain tissues is a risk factor for 3 major psychiatric disorders, including schizophrenia, bipolar disorder, and autism spectrum disorder. This study directly evaluated the presence of viral DNA or RNA in 1569 brains of patients and controls using whole-genome sequencing and RNA sequencing data with 4 independent cohorts. The PathSeq tool was used to identify known human viruses in the genome and transcriptome of patients and controls. A variety of DNA and RNA viruses related to the central nervous system were detected in the brains of patients with major psychiatric disorders, including viruses belonging to Herpesviridae, Polyomaviridae, Retroviridae, Flaviviridae, Parvoviridae, and Adenoviridae. However, no consistent significant differences were found between patients and controls in terms of types and amount of virus detected at both DNA and RNA levels. The findings of this study do not suggest an association between viral infection in postmortem brains and major psychiatric disorders.

Postpartum psychosis during delivery hospitalizations and postpartum readmissions, 2016–2019

Up-to-date data on population-level risk factors for postpartum psychosis is limited though increasing substance use disorders, psychiatric disorders, autoimmune disorders, and other medical comorbidities in the obstetric population may be contributing to increased baseline risk for postpartum psychosis. To determine trends in and risk factors for postpartum psychosis during delivery hospitalizations and postpartum readmissions. Analyzing the 2016-2019 Nationwide Readmission Database, this repeated cross sectional study identified diagnoses of postpartum psychosis during delivery hospitalizations and postpartum readmissions within 60 days of discharge. The relationship between demographic, clinical, and hospital level factors present at delivery and postpartum psychosis was analyzed with logistic regression models with adjusted odds ratios (aORs) with 95% CIs as measures of association. Separate models were created for postpartum psychosis diagnoses at delivery and during a postpartum readmission. Temporal trends in diagnoses were analyzed with joinpoint regression to determine the average annual percent change (AAPC) with 95% CIs. Of 12,334,506 deliveries in the analysis 13,894 (1.1 per 1000) carried a diagnosis of postpartum psychosis during the delivery hospitalization and 7,128 (0.6 per 1000) had a 60-day postpartum readmission with postpartum psychosis. Readmissions with postpartum psychosis increased significantly over the study period (p=0.046). The majority of readmissions with a postpartum psychosis diagnosis occurred 0-10 days (43% of readmissions) or 11-20 days after discharge (18% of readmissions). Clinical factors with the highest adjusted odds for postpartum psychosis readmission included delivery postpartum psychosis (aOR 5.8, 95% CI 4.2, 8.0), depression disorder (aOR 3.7, 95% CI 3.3, 4.2), bipolar spectrum disorder (OR 2.9, 95% CI 2.3, 3.5), and schizophrenia spectrum disorder (aOR 2.9, 95% CI 2.1, 4.0). In models analyzing postpartum psychosis diagnoses at delivery, risk factors associated with the highest odds included anxiety disorder (aOR 3.9, 95% CI 3.5, 4.2), schizophrenia spectrum disorder (aOR 2.5, 95% CI 1.9, 3.4), bipolar disorder (aOR 1.8, 95% CI 1.6, 2.1), stillbirth (OR 3.6, 95% CI 3.1, 4.2), and substance use disorder (OR 1.7, 95% CI 1.6, 1.9). Chronic conditions such as pregestational diabetes, obesity, and substance use were also associated with delivery and readmission postpartum psychosis. Postpartum psychosis is increasing during postpartum readmissions and associated with a wide range of obstetric and medical comorbidities. Close follow up care after delivery for other medical and obstetric diagnoses may represent an opportunity to identify postpartum psychiatric conditions including postpartum psychosis.

Brain folding increases in sharpness and complexity over third trimester-equivalent development


 
 
 Background and Hypothesis:
 Gyrification, or convolution, of the cerebral cortex is a promising transdiagnostic marker for early neurodevelopment. Previous studies have related differences in sulcogyral shape to schizophrenia, bipolar disorder, and autism spectrum disorder, but the physical mechanisms underlying these differences remain poorly understood. The focus of this study was to explore decomposed curvature metrics, the principal curvatures, as physically meaningful quantitative biomarkers to track brain development. We hypothesize that the average sharpness and complexity of sulci and gyri, reflected by principal curvatures, increase throughout third trimester-equivalent development.
 Methods:
 Cortical surfaces generated from magnetic resonance imaging (MRI) were obtained from the developing Human Connectome Project. Global sharpness was calculated from the principal curvature of maximum magnitude, with average sharpness defined separately for gyral (positive) and sulcal (negative) curvatures. Global complexity of folds (eg., curviness along the length of a fold) was calculated from variance in the principal curvature with minimum magnitude. Trajectory of each summary metric was fit over time using polynomial regression.
 Results:
 Forty-three subjects were removed due to incomplete curvature analysis or missing subject information, such that 541 preterm and term-born infants were evaluated with scan age ranging from 27 to 45 weeks postmenstrual age (PMA). Across this developmental range, sharpness and complexity increased until a plateau around term-equivalent. Average sharpness of gyri was best correlated with age of scan (R2 = 0.877).
 Conclusion and Potential Impact:
 During the pre- and postnatal development period, total cortical surface area continues to increase after birth, but the overall sharpness and complexity of folding plateaus at ~37 weeks post-menstrual age. Exploring these physically meaningful curvature metrics can provide improved parameters for comparison to mechanistic models of brain folding.
 
 

Impact of mood disorders and personality disorders on suicide intent among self-harm patients.

The present research examined the impact of mood disorder and personality disorders on suicide intent among self-harm patients using cross sectional research design. A clinical sample of 220 self-harm inpatients with age of 18 to 35 years was collected through purposive sampling technique from different mental health departments of Rawalpindi, Jhelum and Multan hospitals. Study was conducted from June 2019 till November, 2021. Data was compiled in three steps. In step-I, rapport was established with patients and identification of intent was carried out by administering Beck Suicide Intent Scale. In step-II, mental illness was identified by administering Mood Disorder Questionnaire, Personality Diagnostic Questionnaire and subscale of Depression from Depression Anxiety and Stress Scale. In step-III, in order to confirm his / her responses and diagnosis, a detailed semi-structured clinical interview was carried out with each participant who responded positively to Personality Diagnostic Questionnaire. Results revealed that bipolar spectrum disorder, depression and antisocial personality disorder were significantly positive predictors of suicide intent among self-harm patients. On the other hand, narcissistic personality disorder and borderline personality disorder were found to be significantly negative predictors of suicide intent among self-harm patients. Results of current research highlighted those predisposing factors that discriminate self-harm from attempted suicide. The study has important implications for identification of intent of self-harm patients, which could help in devising a proper treatment plan for the management of such challenging patients.

Brain development after intrauterine exposure to lithium: A magnetic resonance imaging study in school-age children.

Lithium is often continued during pregnancy to reduce the risk of perinatal mood episodes for women with bipolar disorder. However, little is known about the effect of intrauterine lithium exposure on brain development. The aim of this study was to investigate brain structure in children after intrauterine exposure to lithium. Participants were offspring, aged 8-14 years, of women with a diagnosis of bipolar spectrum disorder. In total, 63 children participated in the study: 30 with and 33 without intrauterine exposure to lithium. Global brain volume outcomes and white matter integrity were assessed using structural MRI and diffusion tensor imaging, respectively. Primary outcomes were total brain, cortical and subcortical gray matter, cortical white matter, lateral ventricles, cerebellum, hippocampus and amygdala volumes, cortical thickness, cortical surface area and global fractional anisotropy, and mean diffusivity. To assess how our data compared to the general population, global brain volumes were compared to data from the Generation R study (N=3243). In our primary analyses, we found no statistically significant associations between intrauterine exposure to lithium and structural brain measures. There was a non-significant trend toward reduced subcortical gray matter volume. Compared to the general population, lithium-exposed children showed reduced subcortical gray and cortical white matter volumes. We found no differences in brain structure between lithium-exposed and non-lithium-exposed children aged 8-14 years following correction for multiple testing. While a rare population to study, future and likely multi-site studies with larger datasets are required to validate and extend these initial findings.

An examination of bidirectional associations between physical activity and mood symptoms among individuals diagnosed and at risk for bipolar spectrum disorders

ObjectivesActivation, a construct including energy and activity, is a central feature of Bipolar Spectrum Disorders (BSDs). Prior research found motor activity is associated with affect, and this relationship may be stronger for individuals with BSDs. The aims of this study were to investigate bidirectional relationships between physical activity and mood and evaluate whether bipolar risk status moderated potential associations. MethodsYoung adults at low-risk, high-risk, and diagnosed with BSD participated in a 20-day EMA study in which they wore an actiwatch to measure physical activity and sleep/wake cycles. They also reported depressive and hypo/manic symptoms three times daily. Multilevel linear models were estimated to examine how bipolar risk group moderated bidirectional relationships between physical activity and mood symptoms at within-day and between-day timescales. ResultsPhysical activity was significantly associated with subsequent mood symptoms at the within-day level. The relationship between physical activity and depressive symptoms was moderated by BSD risk group. An increase in physical activity resulted in a greater reduction of depressive symptoms for the BSD group compared to the low-risk and high-risk groups. ConclusionsInterventions targeting activity like behavioral activation may improve residual inter-episode mood symptoms.

Genetic contributions to transdiagnostic symptom dimensions in patients with major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders

Major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia spectrum disorders (SZ) exhibit considerable phenotypic and genetic overlap. However, the contribution of genetic factors to their shared psychopathological symptom dimensions remains unclear. The present exploratory study investigated genetic contributions to the symptom dimensions “Depression”, “Negative syndrome”, “Positive formal thought disorder”, “Paranoid-hallucinatory syndrome”, and “Increased appetite” in a transdiagnostic subset of the German FOR2107 cohort (n = 1042 patients with MDD, BD, or SZ). As replication cohort, a subset of the German/Austrian PsyCourse study (n = 816 patients with MDD, BD, or SZ) was employed. First, the relationship between symptom dimensions and common variants associated with MDD, BD, and SZ was investigated via polygenic risk score (PRS) association analyses, with disorder-specific PRS as predictors and symptom dimensions as outcomes. In the FOR2107 study sample, PRS for BD and SZ were positively associated with “Positive formal thought disorder”, the PRS for SZ was positively associated with “Paranoid-hallucinatory syndrome”, and the PRS for BD was negatively associated with “Depression”. The effects of PRS for SZ were replicated in PsyCourse. No significant associations were observed for the MDD PRS. Second, genome-wide association studies (GWAS) were performed for the five symptom dimensions. No genome-wide significant associations and no replicable suggestive associations (p < 1e−6 in the GWAS) were identified. In summary, our results suggest that, similar to diagnostic categories, transdiagnostic psychiatric symptom dimensions are attributable to polygenic contributions with small effect sizes. Further studies in larger thoroughly phenotyped psychiatric cohorts are required to elucidate the genetic factors that shape psychopathological symptom dimensions.

The Relationship Between Bipolar Spectrum Disorder and Creativity

Bipolar spectrum disorder as one of the most debated and studied topics in clinical psychology has been brought to the attention of the public because of its plausible connection to creativity. Recent events of celebrities claiming their onsets of bipolar episodes reinforces the belief of the connection and it will rely on the field of clinical psychology to give the public an unbiased and cautiously experimented theory to such an issue. This paper discusses the topic by defining the variations of bipolar spectrum disorder and creativity and evaluates the presenting the current recognition of the connection between the two subjects. Later, through examining the experimental processes of the behavioral, genetic psycho-neuron, and psychoanalytic perspectives, this paper provides a comprehensive view to the readers regarding the experimental process and each approach’s strengths and potential flaws. Even though the experiments prove the correlation between bipolar spectrum disorder and creativity, the underlying symptoms of bipolar can only act as a catalyst for creativity. Future studies should try to further validify and solidify the experimental results and promote the findings to the public through appropriate media.

Veterans affairs serious mental illness patients: Differences in high-intensity service use by personality disorder status.

Individuals with serious mental illnesses (SMI) or personality disorders (PD) have complex treatment needs and are at risk of adverse outcomes. Yet, little is known about the impact of comorbid SMI and PD on risk factors. This study used the Veterans Health Administration (VHA)'s corporate data warehouse (CDW) to assess the differences between those with and without a comorbid PD, as well as the prevalence and impact of PD diagnoses on high-intensity/emergency service utilization in VHA patients with a SMI diagnosis (schizophrenia spectrum disorders and bipolar spectrum disorders). In fiscal year 2018, 163,904 VHA patients had encounters that listed SMI diagnoses, including 9,216 patients who had encounters that listed PD diagnoses. Bivariate analyses and logistic regression were used to compare group characteristics and determine whether a PD diagnosis was associated with utilization of high-intensity care services. The SMI with no PD and SMI with comorbid PD (SMI-PD) groups differed in terms of demographic, medication, clinical, and service utilization characteristics, including that the SMI-PD group was 5.25 times more likely to have documented suicide risk and 4.73 times more likely to have documented behavioral risk. After controlling for multiple patient characteristics, patients in the SMI-PD group were 1.35 times more likely to have some emergency department (ED) utilization and 1.94 times more likely to have some inpatient mental health use. Having a diagnosed comorbid PD was associated with increased prevalence of medical and psychiatric problems. Findings suggest that patients with comorbid PDs have particularly high-treatment needs and may benefit from assessment of, and adapted treatments for, PDs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Neuropsychiatric sequelae of medication non-adherence in people living with HIV

&lt;abstract&gt; &lt;p&gt;Non-adherence to anti-retroviral therapy (cART) among people living with HIV/AIDS (PLWHA) is complex, multifactorial, and leads to increases in viral load, immunosuppression, and HIV burden related to direct CNS virulence and cART re-initiation (i.e., immune reconstitution syndrome). Among behavioral disturbances, which may become long-lasting without proper treatment, major depressive disorder, generalized anxiety disorder, schizophrenia, and bipolar spectrum disorders are frequent, as well as exacerbation of other premorbid underlying psychiatric conditions, such as post-traumatic stress disorder (PTSD) and substance use and related conditions, not to mention neurocognitive disorders that are encompassed under the umbrella term of HIV-Associated Neurocognitive Disorders (HAND). In this review, we summarized the neuropsychiatric sequelae of medication non-adherence in PLWHA by utilizing two clinical vignettes to illustrate how syndemic factors may interact and lead to unique presentations.&lt;/p&gt; &lt;/abstract&gt;

Symptom Exacerbations of Patients Attending a Community Mental Health Center During the COVID-19 Pandemic.

The aim of this study was to examine the effect of the COVID-19 pandemic on the clinical conditions of the patients with bipolar disorder (BD) and schizophrenia spectrum disorders (SSD) in a community mental health center (CMHC). Symptom exacerbations, emergency service admissions, drug dose increases, additional medication prescriptions, and psychiatric hospitalizations of patients with BD and SSD in the CMHC were evaluated retrospectively. The data from the 1-year prior, 6-months prior, 6-months after the onset and 1-year after the onset of the pandemic were compared. Hospital and CMHC medical records were used for outcomes. Personal and Social Performance (PSP) Scale was used to assess the level of functioning. 107 patients with the diagnosis of BD and 121 patients with the diagnosis of SSD were recruited. In the BD group, there was increase in the frequency of symptom exacerbations (p=0.001) and additional medication prescriptions or increased dose (p=0.007), with decrease in emergency service admissions (p=0.039) during the pandemic. In the patients with SSD, the number of patients with exacerbation of symptoms (p=0.001) and with increased dose or additional medication prescriptions (p=0.004) were higher during the pandemic. There was no increase in the rate of hospitalized patients in the period of first 6 months and first one year. Symptom exacerbations were more frequent in the SSD group with Covid (+) in family (p=0.016). The fact that the hospitalization rates remained the same despite an increase in the acute exacerbations provides info on the role of CMHCs and how mental health system functioned during the pandemic.

Early indicators of bipolar risk in preschool offspring of parents with bipolar disorder.

Offspring of parents with bipolar disorder (BD-I/II) are at increased risk to develop the disorder. Previous work indicates that bipolar spectrum disorder (BPSD) is often preceded by mood/anxiety symptoms. In school-age offspring of parents with BD, we previously built a risk calculator to predict BPSD onset, which generates person-level risk scores. Here, we test whether preschool symptoms predict school-age BPSD risk. We assessed 113 offspring of parents with BD 1-3 times during preschool years (2-5 years old) and then approximately every 2 years for a mean of 10.6 years. We used penalized (lasso) regression with linear mixed models to assess relationships between preschool mood, anxiety, and behavioral symptoms (parent-reported) and school-age predictors of BPSD onset (i.e., risk score, subthreshold manic symptoms, and mood lability), adjusting for demographics and parental symptomatology. Finally, we conducted survival analyses to assess associations between preschool symptoms and school-age onset of BPSD and mood disorder. Of 113 preschool offspring, 33 developed new-onset mood disorder, including 19 with new-onset BPSD. Preschool irritability, sleep problems, and parental factors were lasso-selected predictors of school-age risk scores. After accounting for demographic and parental factors, preschool symptoms were no longer significant. Lasso regressions to predict mood lability and subthreshold manic symptoms yielded similar predictors (irritability, sleep problems, and parental affective lability), but preschool symptoms remained predictive even after adjusting for parental factors (ps < .005). Exploratory analyses indicated that preschool irritability univariately predicted new-onset BPSD (p= .02) and mood disorder (p= .02). These results provide initial prospective evidence that, as early as preschool, youth who will develop elevated risk scores, mood lability, and subthreshold manic symptoms are already showing symptomatology; these preschool symptoms also predict new-onset BPSD. While replication of findings in larger samples is warranted, results point to the need for earlier assessment of risk and development of early interventions.

Inflammation and cognition in severe mental illness: patterns of covariation and subgroups

A potential relationship between dysregulation of immune/inflammatory pathways and cognitive impairment has been suggested in severe mental illnesses (SMI), such as schizophrenia (SZ) and bipolar (BD) spectrum disorders. However, multivariate relationships between peripheral inflammatory/immune-related markers and cognitive domains are unclear, and many studies do not account for inter-individual variance in both cognitive functioning and inflammatory/immune status. This study aimed to investigate covariance patterns between inflammatory/immune-related markers and cognitive domains and further elucidate heterogeneity in a large SMI and healthy control (HC) cohort (SZ = 343, BD = 289, HC = 770). We applied canonical correlation analysis (CCA) to identify modes of maximum covariation between a comprehensive selection of cognitive domains and inflammatory/immune markers. We found that poor verbal learning and psychomotor processing speed was associated with higher levels of interleukin-18 system cytokines and beta defensin 2, reflecting enhanced activation of innate immunity, a pattern augmented in SMI compared to HC. Applying hierarchical clustering on covariance patterns identified by the CCA revealed a high cognition—low immune dysregulation subgroup with predominantly HC (24% SZ, 45% BD, 74% HC) and a low cognition—high immune dysregulation subgroup predominantly consisting of SMI patients (76% SZ, 55% BD, 26% HC). These subgroups differed in IQ, years of education, age, CRP, BMI (all groups), level of functioning, symptoms and defined daily dose (DDD) of antipsychotics (SMI cohort). Our findings suggest a link between cognitive impairment and innate immune dysregulation in a subset of individuals with severe mental illness.

User perspectives on long-term remote active electronic self-monitoring of mood symptoms in bipolar spectrum disorders

BackgroundUser feedback is crucial in the development of electronic self-monitoring tools for bipolar spectrum disorders (BSD). Previous studies have examined user experiences in small samples self-monitoring over relatively short time periods. We aimed to explore the experiences of a large sample of individuals with BSD engaged in long-term remote active electronic self-monitoring. MethodsAn online survey, containing closed and open questions, was sent to participants with BSD enrolled on the Bipolar Disorder Research Network (BDRN) True Colours mood-monitoring system. Questions related to experiences of using True Colours, including viewing mood graphs, and sharing data with healthcare professionals (HCPs) and/or family/friends. ResultsResponse rate was 62.7 % (n = 362). 88.4 % reported finding using True Colours helpful. Commonly reported benefits were having a visual record of mood changes, patterns/triggers and identifying early warning signs. Limitations included questions not being comprehensive or revealing anything new. One third had shared their graphs, with 89.9 % finding it helpful to share with HCPs and 78.7 % helpful to share with family/friends. Perceived benefits included aiding communication and limitations included lack of interest/understanding from others. LimitationsResponder bias may be present. Findings may not be generalisable to all research cohorts. ConclusionsThe majority of participants valued long-term self-monitoring. Personalisation and ease of use were important. A potential challenge is continued use when mood is long-term stable, highlighting the need for measures to be sensitive to small changes. Sharing self-monitoring data with HCPs may enhance communication of the lived experience of those with BSD. Future research should examine HCPs' perspectives.

Bipolar spectrum disorders in neurologic disorders.

Psychiatric symptoms frequently predate or complicate neurological disorders, such as neurodegenerative diseases. Symptoms of bipolar spectrum disorders (BSD), like mood, behavioral, and psychotic alterations, are known to occur - individually or as a syndromic cluster - in Parkinson's disease and in the behavioral variant of frontotemporal dementia (FTD). Nonetheless, due to shared pathophysiological mechanisms, or genetic predisposition, several other neurological disorders show significant, yet neglected, clinical and biological overlaps with BSD like neuroinflammation, ion channel dysfunctions, neurotransmission imbalance, or neurodegeneration. BSD pathophysiology is still largely unclear, but large-scale network dysfunctions are known to participate in the onset of mood disorders and psychotic symptoms. Thus, functional alterations can unleash BSD symptoms years before the evidence of an organic disease of the central nervous system. The aim of our narrative review was to illustrate the numerous intersections between BSD and neurological disorders from a clinical-biological point of view and the underlying predisposing factors, to guide future diagnostic and therapeutical research in the field.

The Mood Disorder Assessment Schedule: Initial validation of a new measure for early identification of bipolar spectrum disorders in inpatient adolescents

Due to the significant impairment associated with subthreshold bipolar symptomatology and the harmful effects of delayed diagnosis, there is a great need for diagnostic tools that can facilitate early identification of bipolar spectrum disorders. The Mood Disorder Assessment Schedule (MDAS) is a newly developed measure that focuses on autonomous changes in mood and energy, a key indicator of bipolar spectrum problems which is not included in current diagnostic tools for bipolar disorders. The current study tested the ability of the MDAS to identify individuals at risk for bipolar spectrum disorders. In a cross-sectional sample of 396 inpatient adolescents, the MDAS identified a group of individuals with several bipolar spectrum disorder (BSD) indicators, including greater manic and depressive symptoms, affective lability, suicidal behavior, adverse reactions to antidepressants, and a family history of bipolar disorder and suicidal behavior. When compared to a standard diagnostic interview for bipolar disorders (i.e., Kiddie Schedule for Affective Disorders and Schizophrenia [KSADS]), the MDAS yielded stronger clinical utility in its ability to identify individuals with BSD indicators. Therefore, the MDAS appears to be a promising diagnostic tool for identifying adolescents at risk for BSDs and may help facilitate earlier diagnosis and prevent harmful effects of improper treatment.

Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria.

Digital and mobile health interventions are increasingly being used to support healthy lifestyle change, including in certain high-risk populations such as those with severe mental illnesses (SMIs). Life expectancy in this population lags 15 years behind counterparts in the general population, primarily due to obesity-related health conditions. We tested the feasibility and usability of a 12-week interactive obesity treatment approach (iOTA) to adults with chronic SMIs (depression, bipolar disorder and schizophrenia spectrum disorder) receiving treatment in community settings. The iOTA incorporates short message service (SMS) text messages to supplement monthly in-person health coaching. Factors hypothesized to be associated with weight change were illness severity and treatment engagement. Severe psychiatric symptoms were defined as baseline Clinical Global Impression severity score of >5. Criterion engagement was defined as a text messaging response rate >80% during the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores, was also evaluated. Participants provided qualitative data, further informing assessment of intervention feasibility, usability, and acceptability. A total of 26 participants were enrolled. The mean age was 48.5 (SD 15.67) years; 40% (10/26) were Black and 60% (15/26) female. Participants with lower symptom severity and adequate engagement demonstrated significantly decreased weight (F1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F1,7=4.33, P=.08). Loss-of-control eating was not observed to impact treatment outcome. Participants voiced preference for combination of live health coaching and text messaging, expressing desire for personalized message content. These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in community settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity, two factors known to impact weight loss outcomes. These important findings suggest specific adaptations may be needed for optimal treatment outcomes in individuals with SMI.