Mood Instability Research Articles

Mood instability and cardiovascular modification in cardiovascular disease outpatients. The ABC study on heart disease

Abstract Introduction Mood instability (MI) is a condition characterized by unpredicted frequent fluctuations in a person's emotional state. It is a common personality trait observed in the general population, and it has been reported to be associated with a range of adverse health outcomes, and may also serve as an additional risk factor for cardiovascular morbidity. Purpose To assess mood instability and its effects on cardiovascular function among CVD outpatients. Methods Consecutive patients who were presented to the cardiac outpatient clinic in the last 5 years were recruited and divided into 2 groups according to the presence or absence of MI symptoms based on the patient’s self-assessment psycho-emotion questionnaire. Cardiovascular functions were assessed and compared between both groups. Results A total of 415 patients were included in this preliminary analysis. Patients' mean age was 66±18 years, and 57% were males. Coronary artery diseases were registered in 93(22%) patients. 137 (33%) patients suffered mood instability symptoms, and they shared most demographic and clinical characteristics with patients who did not suffer from MI. However, males were more frequent among patients with no MI symptoms. Interestingly, we observed a significant difference in systolic blood pressure values (SBP) between both groups, (SBP= 150±23 Vs 145±21 mmHg, p= 0.02, for patients with and without MI, respectively). Yet, no difference was observed in diastolic blood pressure (DBP) values (80±12 Vs 79±11 mmHg for patients with and without MI, respectively, p<0.19). Patients with MI symptoms had also a higher heart rate (HR) (77±15 bpm) than patients without symptoms (72±13 bpm, p=0.0003). Using multivariable linear regression models, mood instability (β±SE= 4.3±2.2, p<0.049) and age (β±SE= 0.4±0.05, p<0.0001) were independent predictors for higher SBP values. Mood instability was also independently associated with a higher heart rate (β±SE= 5.1±1.4, p=0.001). Results Kept true even stronger with repeated BP and HR measurements. Conclusion Our results showed that mood instability is associated with a significant increase in systolic blood pressure and heart rate values in cardiac outpatients.

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.

Alterations of striatal phosphodiesterase 10 A and their association with recurrence rate in bipolar I disorder

Phosphodiesterase 10 A (PDE10A), a pivotal element of the second messenger signaling downstream of the dopamine receptor stimulation, is conceived to be crucially involved in the mood instability of bipolar I disorder (BD-I) as a primary causal factor or in response to dysregulated dopaminergic tone. We aimed to determine whether striatal PDE10A availability is altered in patients with BD-I and assessed its relationship with the clinical characteristics of BD-I. This case-control study used positron emission tomography (PET) with 2-(2-(3-(4-(2-[18F]fluoroethoxy)phenyl)-7-methyl-4-oxo-3,4-dihydroquinazolin-2-yl)ethyl)-4-isopropoxyisoindoline-1,3-dione ([18F]MNI-659), a radioligand that binds to PDE10A, to examine the alterations of the striatal PDE10A availability in the living brains of individuals with BD-I and their association with the clinical characteristics of BD-I. [18F]MNI-659 PET data were acquired from 25 patients with BD-I and 27 age- and sex-matched healthy controls. Patients with BD-I had significantly lower PDE10A availability than controls in the executive (F = 8.86; P = 0.005) and sensorimotor (F = 6.13; P = 0.017) subregions of the striatum. Lower PDE10A availability in the executive subregion was significantly associated with a higher frequency of mood episodes in patients with BD-I (r = –0.546; P = 0.007). This study provides the first evidence of altered PDE10A availability in patients with BD-I. Lower PDE10A availability in the executive subregion of the striatum is associated with an increased recurrence risk, suggesting that PDE10A may prevent BD-I relapse. Further studies are required to elucidate the role of PDE10A in BD-I pathophysiology and explore its potential as a treatment target.

Phyto-nanotechnology: A novel beneficial strategy for Alzheimer's disease therapy

Alzheimer's disease, a neurodegenerative condition, is characterized by the slow and progressive deterioration of the cognitive functions of geriatric patients. It occurs due to exacerbation of neurons in the brain, indicated by loss of memory, mood instability, and even death. The aggregation of amyloid β protein and neurofibrillary tangles-atypical forms of tau protein is the major cause of this disease. Phytoconstituents have been frequently employed in treating Alzheimer's disease. These natural compounds act through different molecular mechanisms to treat the disease. However, their potential in Alzheimer's disease therapy may be limited due to poor blood-brain barrier permeability, off-target effects, low bioavailability, etc. In recent times, nanotechnology has gained attraction to overcome these challenges. This article focuses on the potential phytoconstituents for Alzheimer's disease treatment and the associated limitations. Moreover, it highlights various nanoformulation strategies employed to penetrate the blood-brain barrier effectively, avoid side effects, improve bioavailability, and target specificity in treating Alzheimer's disease. The integration of nanotechnology with plant-derived compounds has the potential to revolutionize the therapeutic landscape for Alzheimer's disease.

The BRIDGE project: a feasibility randomised controlled trial of brief, intensive assessment and integrated formulation for young people (age 14-24) with features of borderline personality disorder (Protocol).

Borderline personality disorder (BPD) is a severe mental disorder that is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and mood as well as marked impulsivity. BPD has its peak incidence and prevalence from puberty through to emerging adulthood. BPD is a controversial diagnosis in young people. Commonly, young people with BPD are under-diagnosed, untreated, are not in employment or training and are estranged from their families. Yet, they have complex needs and are at high suicide risk. To assess the feasibility of conducting a randomised controlled trial (f-RCT) of a BRIDGE, a brief intervention programme for young people (age 14-24) with BPD symptoms (sub-threshold or threshold) in a community sample from Scotland, UK. Forty young people (age 14-24) meeting criteria for BPD symptoms, will be randomised in a 1:1 ratio to receive either a) the BRIDGE intervention plus service-as-usual or b) service-as-usual alone. Follow up will be 12 weeks and 24 weeks post-intervention. The study is carried out between 2021 to 2024. The two primary outcomes of the MQ funded, BRIDGE project (f-RCT) are i. recruitment rates and ii. retention rates. The study will present the acceptability and appropriateness of our putative outcome measures for a future definitive randomised controlled trial (d-RCT). Young people with BPD benefit from good clinical care and targeted intervention, however are regularly missed or mislabelled. The community based feasibility trial would provide initial evidence of variable needs of young people with complex needs, who maybe missed or excluded from services as they don't "fit" a model/diagnosis. Workable multi-agency service model proposed in the trial would be a major advance in understanding care pathways regardless of trial outcome. ClinicalTrial.gov, identifier NCT05023447.

Causal Relationship Between Mood Swing and Gynecological Disorders: A Mendelian Randomization Study.

Gynecological disorders are a wide range of health problems affecting the female reproductive system, which poses substantial health challenges worldwide. Increasing number of observational studies have associated mood instability to common female diseases, but the underlying causal relationship remains unclear. In this work, Mendelian randomization (MR) analysis was applied to explore the genetically predicted causal relationship of mood swings and several prevalent gynecological disorders. Instrumental variables (IVs) of mood swings were selected from UK Biobank (UKB), with 204,412 cases and 247,207 controls being incorporated. The genetic variants for female disorders were obtained from genome-wide association studies (GWASs) and FinnGen consortium. To avoid biases caused by racial difference, only European population was included here. Five strong analytical methodologies were used to increase the validity of the results, the most substantial of which was the inverse variance weighting (IVW) method. Pleiotropy, sensitivity, and heterogeneity were assessed to strengthen the findings. We found mood swings was significantly positively associated with risk of endometrial cancer (OR= 2.60 [95% CI= 1.36, 4.95], P= 0.0037), cervical cancer (OR= 1.01[95% CI= 1.00,1.02], P= 0.0213) and endometriosis (OR= 2.58 [95% CI= 1.18, 5.60], P= 0.0170) by IVW method. However, there was no causal relationship between mood swing and ovarian cancer. No pleiotropy and heterogeneity existed and sensitivity tests were passed. This study reveals that mood swing may serve as a genetically predicted causal risk factor for endometrial cancer, cervical cancer, and endometriosis in the European population, while no such association was observed for ovarian cancer. These findings make up for observational research's inherent limitations and may improve patient outcomes in the field of gynecological health. However, the study's focus on European populations may limit the applicability of these results globally.

Mood instability metrics to stratify individuals and measure outcomes in bipolar disorder

Mood instability metrics to stratify individuals and measure outcomes in bipolar disorder

Evidence for mood instability in patients with bipolar disorder: Applying multilevel hidden Markov modeling to intensive longitudinal ecological momentary assessment data.

Bipolar disorder (BD) is a chronic psychiatric condition characterized by large episodic changes in mood and energy. Recently, BD has been proposed to be conceptualized as chronic cyclical mood instability, as opposed to the traditional view of alternating discrete episodes with stable periods in-between. Recognizing this mood instability may improve care and call for high-frequency measures coupled with advanced statistical models. To uncover empirically derived mood states, a multilevel hidden Markov model (HMM) was applied to 4-month ecological momentary assessment data in 20 patients with BD, yielding ∼9,820 assessments in total. Ecological momentary assessment data comprised self-report questionnaires (5 × daily) measuring manic and depressive constructs. Manic and depressive symptoms were also assessed weekly using the Altman Self-Rating Mania Scale and the Quick Inventory for Depressive Symptomatology Self-Report. Alignment between HMM-uncovered momentary mood states and weekly questionnaires was assessed with a multilevel linear model. HMM uncovered four mood states: neutral, elevated, mixed, and lowered, which aligned with weekly symptom scores. On average, patients remained < 25 hr in one state. In almost half of the patients, mood instability was observed. Switching between mood states, three patterns were identified: patients switching predominantly between (a) neutral and lowered states, (b) neutral and elevated states, and (c) mixed, elevated, and lowered states. In all, elevated and lowered mood states were interspersed by mixed states. The results indicate that chronic mood instability is a key feature of BD, even in "relatively" euthymic periods. This should be considered in theoretical and clinical conceptualizations of the disorder. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Therapeutic Role of Lamotrigine in Borderline Personality Disorder: A Comprehensive Review of Outcomes, Mechanisms, and Treatment Strategies.

Borderline personality disorder (BPD) is a severe mental health condition characterized by pervasive instability in mood, self-image, and interpersonal relationships, significantly impacting individuals' personal, social, and occupational functioning. Current treatment strategies primarily include psychotherapy and pharmacotherapy, but there remains a need for more effective and targeted pharmacological options. This review examines the therapeutic role of lamotrigine in BPD, focusing on its efficacy, safety, mechanisms of action,and practical treatment strategies. A comprehensive review of the existing literature was conducted, including clinical trials, observational studies, and relevant pharmacological data. Key focus areas included lamotrigine's impact on BPD symptoms, pharmacological profile, and comparative effectiveness with other treatments. Lamotrigine has shown promise in managing BPD symptoms, particularly in stabilizing mood and reducing emotional dysregulation and impulsivity. Clinical trials suggest that lamotrigine can effectively address core symptoms of BPD, with a safety profile generally comparable to other treatments. The medication's mechanism of action, which involves modulation of glutamate release and mood stabilization, aligns with the therapeutic goals for BPD. Lamotrigine represents a potential adjunctive treatment for BPD, offering benefits in mood stabilization and symptom management. Integrating psychotherapy and other pharmacological options should be considered within a multimodal treatment approach. Further research is needed to better understand its long-term efficacy and safety and its role in combination therapy.

Behavioral skill practice as a predictor of mood and family functioning in adolescents with bipolar and depressive mood disorders: Results of a 6-month randomized trial of family-focused therapy.

Behavioral interventions require considerable practice of treatment skills in between therapy sessions. The effects of these treatments may vary with the degree to which patients are able to implement these practices. In offspring of parents with bipolar and major depressive disorders, we examined whether youth who frequently practiced communication and problem-solving skills between family-focused therapy (FFT) sessions had less severe mood symptoms and better psychosocial functioning over 6 months than youth who practiced less frequently. We randomly assigned offspring (ages 12-19) of parents with mood disorders to 12 sessions of FFT plus a mobile app that encouraged the practice of communication, problem-solving and mood management skills (FFT-MyCoachConnect [MCC] condition) or 12 sessions of FFT with an app that only allowed for tracking of symptoms and stress (FFT-Track condition). Independent evaluators assessed youths' mood and psychosocial functioning at 9-week intervals over 27 weeks. Clinicians rated participants' between-session skill practice at each FFT session. FFT-MCC was associated with more frequent skill practice than FFT-Track over 18 weeks of treatment. Skill practice was associated with reductions in youths' mood instability and perceptions of family conflict over 27 weeks in both app conditions. Skill practice mediated the effects of app condition on youths' mood instability and family functioning. Mobile applications as adjuncts to family therapy for youth with mood disorders can help increase skill practice. These findings provide preliminary causal evidence for behavioral skill practice improving mood symptoms and family functioning among youth with mood disorders.

The interplay between borderline personality disorder and oxytocin: a systematic narrative review on possible contribution and treatment options.

Borderline personality disorder (BPD) is a complex mental health condition marked by instability in mood, relationships, self-image, and behavior. Individuals with BPD often struggle with intense emotions, impulsivity, and maintaining stable relationships. Oxytocin, known as the "love hormone" or "bonding hormone," plays a crucial role in social bonding, trust, empathy, and emotional regulation and its dysregulation may contribute to BPD difficulties. This systematic review aims to analyze existing literature, examining the intricate interplay and encouraging future research and treatment strategies. A systematic search of Literature in PubMed, Embase and Psychinfo, without any language or time restriction, was performed until March 2024 combining thesaurus and free-search indexing terms related to "borderline personality disorder" and "oxytocin", producing 310 results (77 in PubMed, 166 in Embase and 67 in Psychinfo). Ninety-four full texts were analyzed, and 70 articles were included in qualitative analysis. Oxytocin may influence attachment styles, parental behaviors, and stress responses, particularly in individuals with a history of childhood trauma. The interaction between oxytocin, genetics, early life experiences, and environmental factors contributes to the complexity of BPD. Genetic variations in the oxytocin receptor gene may influence social and emotional abilities and contribute to the development of psychopathology. Additionally, early adverse experiences, such as childhood maltreatment, can alter oxytocin functioning, impacting social cognition and emotional regulation.However, oxytocin's role in BPD treatment remains uncertain, with some studies suggesting potential benefits for specific symptoms like social threat avoidance, while others indicate adverse effects on nonverbal behavior and mentalizing. Understanding oxytocin's role in BPD offers insights into potential therapeutic interventions. While oxytocin-based treatments may hold promise for addressing specific symptoms, further research is needed.

Experiences of imagery-based treatment for anxiety in bipolar disorder: A qualitative study embedded within the image based emotion regulation feasibility randomised controlled trial.

Intrusive mental imagery is associated with anxiety in bipolar disorder (BD) and presents a novel treatment target. Imagery-based treatments show promise in targeting anxiety and improving mood instability. This qualitative study explored experiences of receiving up to 12 sessions of a brief structured psychological intervention: Image-Based Emotion Regulation (IBER), which targets maladaptive mental imagery in the context of BD with an aim to modify the emotional impact of these images. A qualitative study embedded within the Image Based Emotion Regulation (IBER) feasibility randomised controlled trial. Semi-structured interviews were conducted with 12 participants in the treatment arm of the trial who received IBER + treatment as usual. Data were analysed using thematic analysis. Despite some initial scepticism about imagery-focused treatment, all participants expressed broadly positive accounts of treatment experiences. High levels of engagement with imagery modification techniques, beneficial use of techniques post treatment and improvements in anxiety management and agency were described by some. Three sub-groups were identified: those who reported a powerful transformative impact of treatment; those who embedded some new techniques into their daily lives, and those who felt they had techniques to use when needed. No participants reported overall negative experiences of the IBER treatment. Findings from this study highlight the value for treatment recipients of modifying the underlying meanings associated with maladaptive imagery, and the personalised skills development to manage anxiety within bipolar disorders. Findings can inform treatment refinements and further trial-based evaluations.

Mood instability in patients with unipolar depression measured using smartphones and the association with measures of wellbeing, recovery and functioning

Objective While mood instability is strongly linked to depression, its ramifications remain unexplored. In patients diagnosed with unipolar depression (UD), our objective was to investigate the association between mood instability, calculated based on daily smartphone-based patient-reported data on mood, and functioning, quality of life, perceived stress, empowerment, rumination, recovery, worrying and wellbeing. Methods Patients with UD completed daily smartphone-based self-assessments of mood for 6 months, making it possible to calculate mood instability using the Root Mean Squared Successive Difference (rMSSD) method. A total of 59 patients with UD were included. Data were analyzed using mixed effects regression models. Results There was a statistically significant association between increased mood instability and increased perceived stress (adjusted model: B: 0.010, 95% CI: 0.00027; 0.021, p = 0.044), and worrying (adjusted model: B: 0.0060, 95% CI: 0.000016; 0.012, p = 0.049), and decreased quality of life (adjusted model: B: −0.0056, 95% CI: −0.011; −0.00028, p = 0.039), recovery (adjusted model: B: −0.032, 95% CI: −0.0059; −0.00053, p = 0.019) and wellbeing. There were no statistically significant associations between mood instability and functioning, empowerment, and rumination (p’s >0.09). Conclusion These findings underscore the significant influence of mood instability on patients’ daily lives. Identification of mood fluctuations offer potential insights into the trajectory of the illness in these individuals.

(014) WOMEN WITH POSTORGASMIC ILLNESS SYNDROME: DATA FROM AN INTERNATIONAL PROSPECTIVE REGISTRY

Abstract Introduction Postorgasmic Illness Syndrome (POIS) describes a debilitating collection of flu-like or allergy-like symptoms experienced post-orgasm. The disorder can be divided into primary or secondary subtypes, and even further into seven clusters. POIS is considered a rare, poorly understood condition that largely affects people with penises. Objective To assess females’ experiences with POIS, including symptomology, treatments trialed, and sexual function via the Female Sexual Function Index-6 (FSFI-6). To also compare their experiences with men who have POIS. Methods An IRB-approved RedCAP survey was created and administered in September of 2023. The anonymous survey was distributed to the following online platforms: Twitter, Instagram, email, Reddit to include r/POIS and r/SampleSize, and the POISCenter forum. The survey was closed on November 5th, 2023 and descriptive statistics were performed. Results Of 424 records, nineteen indicated they have a vulva and vagina. Authors individually and thoroughly assessed all nineteen records and eliminated duplicate responses, records that did not meet any of the established symptom criteria, and incomplete responses. After this, ten records were included in the statistical analysis. Participants identified as white/caucasian (7), Hispanic/Latina (2), and Iranian/Persian (1). One of the ten respondents has been diagnosed by a medical professional. Five participants indicated that they experience a “sensation of a flu-like state.” Three experience “extreme fatigue or exhaustion.” One experiences “feverishness or perspiration.” One experiences “mood instability and/or irritability.” Providers visited for their symptoms included primary care, endocrinologist, obstetrician/gynecologist, and mental health. Treatments trialed include allergy medications, anti-depressants, prednisolone, pelvic floor physical therapy, and pain relievers (i.e., NSAIDs). Seven participants completed the FSFI-6; three had a score of less than or equal to 19 (the cutoff for female sexual dysfunction(FSD)) and four had a score of greater than 20. Conclusions POIS has been viewed as a “male-only” condition. While it largely impacts men, this data suggests that women are not immune to it and when compared to men, their experiences vary. From this prospective registry, the most common symptoms experienced by women were “flu-like.” Additionally, none of the participants visited a urologist compared to 65% of men who have. While nearly 60% of the FSFI-6 respondents are not classified as having FSD, it is important to note that only one participant stated they were “very satisfied” with their sex life. More data is needed on this understudied population affected by POIS. Disclosure No.

Mental Well -Being of Medical Students (Interns) During COVID-19 Lockdown and Coping Methods

The heath care crisis under COVID-19 had unparalleled consequences. The whole personnel involved in the management of COVID infected persons suffered a lot in term of burnout, stress, financial hardship, sleep disturbance, anxiety, depression, and suicide in addition to risk of infection while treating such patients. Isolation and self-neglect may eventually result in anger, irritability and mood instability. Further, the daily contact with patients and the scarcity of resources are factors that contribute to the overall stress that healthcare workers undergo during this time. The present study highlights the major psychological crisis faced by the undergraduate MBBS student (Intern) who has to undergo compulsory clinical rotational postings in management of COVID19 infected patients. Keywords: COVID19, health professional-Intern, psychological crisis, career outcome

Diagnosis and pharmacological management of attention deficit hyperactivity disorder in adults with and without intellectual disability: cohort study using electronic health records.

Attention deficit hyperactivity disorder (ADHD) is increasingly diagnosed in adults. People with intellectual disability have higher rates of ADHD yet there is little evidence on the presentation and pharmacological treatment of ADHD in this population or how this differs from the general population. Retrospective cohort study using data from electronic health records. Adults with intellectual disability newly diagnosed with ADHD between 2007 and 2022 were matched to adults with ADHD without intellectual disability and their clinical features and treatments were compared. A total of 159 adults with ADHD and intellectual disability and 648 adults with ADHD without intellectual disability formed the dataset. Adults with intellectual disability had higher rates of psychiatric co-morbidity and spent more time under mental health services than those without intellectual disability. They were more likely to have recorded agitation, aggression, hostility, and mood instability, and less likely to have poor concentration recorded in the 12 months prior to the diagnosis of ADHD. Following diagnosis, people with intellectual disability were significantly less likely to be prescribed any medication for ADHD than controls without intellectual disability (adjusted odds ratio 0.60, 95% confidence interval 0.38-0.91), and were less likely to be prescribed stimulants (27.7% v 46.0%, p < 0.001). The presence of behaviors that challenge in adults with intellectual disability may indicate co-occurring ADHD. Further work to define the safety and efficacy of medication for ADHD in adults with intellectual disability is needed to understand differences in prescription rates and to avoid inequities in care outcomes.

Supplemental Material for Evidence for Mood Instability in Patients With Bipolar Disorder: Applying Multilevel Hidden Markov Modeling to Intensive Longitudinal Ecological Momentary Assessment Data

Supplemental Material for Evidence for Mood Instability in Patients With Bipolar Disorder: Applying Multilevel Hidden Markov Modeling to Intensive Longitudinal Ecological Momentary Assessment Data

Study protocol: group-based psychoeducation for relatives of patients with bipolar disorder—a large scale real-world randomized controlled parallel group trial, the R-bipolar RCT

BackgroundRelatives of patients with bipolar disorder (BD) often experience emotional burden with stress and depressive symptoms that again increase the likelihood of destabilization and relapses in the patient. The effects of group-based psychoeducation have not been investigated in large-scale real-world settings. We are currently conducting a large-scale real-world randomized controlled parallel group trial (RCT) to test whether group-based psychoeducation for 200 relatives to patients with BD improves mood instability and other critical outcomes in relatives and the corresponding patients with BD.MethodsThe trial is designed as a two-arm, parallel-group randomized trial with a balanced randomization 1:1 to either group-based psychoeducation or a waiting list for approximately 4 months and subsequent group-based psychoeducation. The primary outcome measure is mood instability calculated based on daily smartphone-based mood self-assessments. Other relevant outcomes are measured, including patients’ reported outcomes, assessing self-assessed burden, self-efficacy, and knowledge about BD.DiscussionThis protocol describes our currently ongoing randomized controlled trial (RCT) that aims at investigating group-based psychoeducation as an intervention for relatives of individuals diagnosed with bipolar disorder (BD). The study is the first large-scale real-world RCT to focus on a relatively short intervention of psychoeducation (6 sessions of 2 h each) in a large group of relatives (approximately 30 participants per group). With this focus, we wish to test an intervention that is feasible to implement in real-life psychiatric settings with limited budgets and time. It is also the first study to use mood instability in relatives as the primary outcome measure and to investigate whether mood instability and other affective symptoms in patients and relatives covary. It could be considered as limitations, that the trial is not blinded and does not include long-term follow-up.Trial registrationClinicalTrials.gov NCT06176001. Registered on 2023–12-19. The study is approved by the data agency (P-2021–809). The project was allowed to be initiated without permission from the Scientific Ethical Committees for the Capital Region, because it according to section 1, paragraph 4 of the Committee Act was not defined as a health scientific intervention study (case number 21063013).

STRATEGIES TO MITIGATE THE IMPACT OF POST-COVID-19 SYNDROME ON HIGHER EDUCATION QUALITY

The SARS-CoV-2 pandemic has left a profound impact not only on the physical health of humanity but also on neurological, social, and ecological well-being. Neurological and psychological disorders resulting from the pandemic have negatively affected the quality of learning and significantly worsened learning outcomes among students in higher education institutions. The purpose of this study is to compare the prevalence and evaluate the symptoms of post-COVID syndrome, and to identify their impact on the quality of education among senior students in two higher educational institutions: Poltava State Medical University and Poltava National Pedagogical University named after V.G. Korolenko. It has been observed that damage to the nervous system and the simultaneous appearance of a combination of symptoms including headache, memory impairment, insomnia, anxiety, unmotivated weakness, and excessive fatigue are significantly high among students of both universities. The aforementioned complaints, along with the need for increased time to complete educational tasks post-illness, memory impairment, and sleep disturbances, indicate that the academic performance, psychological state, and psychosomatic background of students are at a low level. Therefore, it is essential to develop recommendations for cognitive rehabilitation tailored to this group of students, considering their significant educational workload (samples were collected from senior students). Moreover, the low and moderate physical activity levels of senior students in higher education may exacerbate symptoms of post-COVID-19 syndrome, necessitating the development of recommendations for physical rehabilitation. Students experiencing weakness, increased fatigue, reduced work capacity, sleep disturbances, and mood instability should consider reviewing the organization of the educational process, especially in distance learning conditions, and making lifestyle changes accordingly. Therefore, thoroughly elaborated healthcare recommendations and rehabilitation measures to enhance the quality of the educational process should be implemented into healthcare practice.

The role of brain activation and inhibition systems on self- Destructive behaviors with the mediating role of emotional dysregulation in teenage girls with borderline personality

Introduction: Borderline personality disorder (BPD) is a mental health condition characterized by instability in mood and interpersonal relationships. These patients are on the border between neurosis and psychosis. Aim: This study aimed to investigate the role of Behavioral Inhibition Systems/Behavioral Activation Systems in self-destructive behaviors in female vocational school students with BPD according to the mediating role of emotional dysregulation. Method: The research had a descriptive-correlational method, and its statistical population consisted of all female students with BPD at technical and vocational schools in an educational district of Tehran. 176 students were selected using the purposive sampling method. Data collection tool included Jackson and Claridge's Borderline Personality Disorder Scale (1991), Behavioral Inhibition System/Behavioral Activation System Questionnaire by Carver and White (1994), Self-Destructive Behaviors Questionnaire by Sansone et al. (1998), and Difficulties in emotion regulation scale by Gratz and Roemer (2004). Data were analyzed using the PLS-SEM method with SmartPLS software. Results: The indirect effect of BIS/BAS on self-destructive behaviors with a mediating role of emotional dysregulation was -0.553 and significant (p&lt;0.05). The direct effect of BIS/BAS on emotional dysregulation was -0.436 and significant (p&lt; 0.05). Furthermore, the direct effect of BIS/BAS on self-destructive behaviors was -0.504 and significant (p&lt;0.05), and the direct effect of emotional dysregulation on self-destructive behaviors was 0.506 and significant (p&lt;0.05). Conclusion: There was a significant relationship between behavioral activation and inhibition systems with self-destructive behaviors according to a mediating role of emotional dysregulation.