Manic Symptomatology Research Articles

Digital phenotyping in bipolar disorder: Using longitudinal Fitbit data and personalized machine learning to predict mood symptomatology.

Effective treatment of bipolar disorder (BD) requires prompt response to mood episodes. Preliminary studies suggest that predictions based on passive sensor data from personal digital devices can accurately detect mood episodes (e.g., between routine care appointments), but studies to date do not use methods designed for broad application. This study evaluated whether a novel, personalized machine learning approach, trained entirely on passive Fitbit data, with limited data filtering could accurately detect mood symptomatology in BD patients. We analyzed data from 54 adults with BD, who wore Fitbits and completed bi-weekly self-report measures for 9 months. We applied machine learning (ML) models to Fitbit data aggregated over two-week observation windows to detect occurrences of depressive and (hypo)manic symptomatology, which were defined as two-week windows with scores above established clinical cutoffs for the Patient Health Questionnaire-8 (PHQ-8) and Altman Self-Rating Mania Scale (ASRM) respectively. As hypothesized, among several ML algorithms, Binary Mixed Model (BiMM) forest achieved the highest area under the receiver operating curve (ROC-AUC) in the validation process. In the testing set, the ROC-AUC was 86.0% for depression and 85.2% for (hypo)mania. Using optimized thresholds calculated with Youden's J statistic, predictive accuracy was 80.1% for depression (sensitivity of 71.2% and specificity of 85.6%) and 89.1% for (hypo)mania (sensitivity of 80.0% and specificity of 90.1%). We achieved sound performance in detecting mood symptomatology in BD patients using methods designed for broad application. Findings expand upon evidence that Fitbit data can produce accurate mood symptomatology predictions. Additionally, to the best of our knowledge, this represents the first application of BiMM forest for mood symptomatology prediction. Overall, results move the field a step toward personalized algorithms suitable for the full population of patients, rather than only those with high compliance, access to specialized devices, or willingness to share invasive data.

Systematic Review and Network Meta-Analysis: Efficacy and Safety of Antipsychotics vs Antiepileptics or Lithium for Acute Mania in Children and Adolescents

To compare second-generation antipsychotics (SGAs) and mood stabilizers (MSs) in youth with a bipolar disorder type I (BD-I) manic/mixed episode. A systematic PubMed/Embase/PsycInfo literature search until December 31, 2023, for randomized trials of SGAs or MSs in patients≤18 years of age with BD-I manic/mixed episode was conducted. The study included a network meta-analysis comparing treatments regarding mania symptoms and mania response (co-primary outcomes), and secondary efficacy and tolerability outcomes. Eighteen studies (n= 2844, mean age= 11.74, female participants= 48.0%, mean study duration= 5.4 weeks) comparing 6 SGAs (aripiprazole, asenapine, olanzapine, quetiapine, risperidone, and ziprasidone) and 4 MSs (lithium, oxcarbazepine, topiramate, and valproate) were meta-analyzed. All 6 SGAs outperformed placebo in reducing manic symptomatology, including risperidone (standardized mean difference [SMD]=-1.18, 95% CI=-0.92,-1.45, Confidence in Network Meta-Analysis [CINeMA]= moderate confidence), olanzapine (SMD=-0.77, 95% CI=-0.36,-1.18, low confidence), aripiprazole (SMD=-0.67, 95% CI=-0.33,-1.01, moderate confidence), quetiapine (SMD=-0.60, 95% CI=-0.32,-0.87, high confidence), asenapine (SMD=-0.54, 95% CI=-0.19,-0.89, moderate confidence), and ziprasidone (SMD=-0.43, 95% CI=-0.17, 0.70, low confidence), whereas no mood stabilizer outperformed placebo. Concerning mania response, risperidone (RR= 2.58, 95% CI= 1.88, 3.54, low confidence), olanzapine (RR= 2.42, 95% CI= 1.33, 3.54, very low confidence), aripiprazole (RR= 2.05, 95% CI= 1.44, 2.92, low confidence), quetiapine (RR= 1.89, 95% CI= 1.45n 2.47, moderate confidence), asenapine (RR= 1.81, 95% CI= 1.28, 2.55, very low confidence) and lithium (RR= 1.35, 95% CI= 1.00, 1.83, p= .049, very low confidence) outperformed placebo, without superiority of other MSs vs placebo. Individually, risperidone was more efficacious in reducing manic symptomatology than all other comparators, except olanzapine and topiramate, yet with low/very low confidence, and was associated with increased prolactin and glucose. Pooled together, SGAs outperformed both placebo and MSs for mania symptom reduction (SMD=-0.68, 95% CI=-0.86,-0.51 and SMD=-0.61, 95% CI=-0.82,-0.40, moderate confidence), and mania response (RR= 1.85, 95% CI= 1.53, 2.24 and RR= 1.65, 95% CI= 1.33, 2.04, moderate confidence) without differences between MSs and placebo. There were no significant treatment-placebo differences for all-cause discontinuation, whereas lithium, ziprasidone, and oxcarbazepine were associated with more adverse event-related drop-outs than placebo. Most SGAs were associated with more sedation, weight gain, and metabolic issues vs placebo and MSs. SGAs were more efficacious than placebo and MSs in treating acute mania symptoms, however, their use must be carefully weighed against important side effects.

Latent Profile Analysis of Suicidal Ideation in Chinese Individuals with Bipolar Disorder.

Individuals with bipolar disorder (BD) have a greater suicide risk than the general population. In this study, we employed latent profile analysis (LPA) to explore whether Chinese individuals with different phases of BD differed at the levels of suicidal ideation. We recruited 517 patients. Depressive symptoms were measured using the 24-item Hamilton Depression Rating Scale (HAMD-24), and manic symptoms were evaluated using the Young Mania Rating Scale (YMRS). The extent of suicidal thoughts was determined through the Beck Scale for Suicide Ideation (BSSI). The scores of HAMD and YMRS were used to perform LPA. LPA categorized participants into three classes: one exhibiting severe depressive and mild manic symptomatology, another showing severe depressive and severe manic symptomatology, and the third one displaying severe depressive and intermediate manic symptomatology. Suicidal ideation levels were found to be remarkably elevated across all three classes. Additionally, the three classes showed no significant differences in terms of suicidal ideation. Our research confirms the link between depressive symptoms and suicide, independent of the manic symptoms. These findings carry meaning as they provide insight into the suicide risk profiles within different phases of BD.

Relating depressive and manic symptomatology to 1H-MRS spectra

BackgroundAlterations in neurochemical levels are potential biomarkers of affective disorders and offer a window into illness etiology. Much of the research done to date limits focus to few metabolites and relies on dichotomous diagnoses. Here, using 1H magnetic resonance spectroscopy (MRS), we generate profiles of association between depressive and manic symptom rating scales and numerous metabolites. MethodsMRS data were collected in 30 individuals (7 = major depressive disorder; 5 bipolar disorder and 18 unaffected individuals) in the right anterior cingulate cortex (ACC), insula and hippocampus. All participants were administered mania and depression symptom scales. ResultsSmall to medium relationships were observed between total choline (tCho), N-acetylaspartate (NAA), myo-inositol (mIns) and depressive and manic symptoms. Associations between NAA and mania (r = –0.47, p = 8.88×10−03) in the hippocampus, and tCho (r = –0.48, p = 8.79×10−03) and NAA (r = –0.44, p = 0.01) and mania in the ACC withstood multiple testing correction. ConclusionsElevated levels of choline-containing compounds (tCho) and reduced NAA measured in the ACC and hippocampus are associated with mania indexed dimensionally. These metabolites may represent potential in vivo biomarkers for bipolar disorder symptomatology that warrant follow-up.

Dynamics of affect, cognition and behavior in a general population sample of adolescents and young adults with current and remitted anxiety disorders: An Ecological Momentary Assessment study

BackgroundMeasures of dynamic changes in affect/emotions (variability, instability, inertia) have been linked to anxiety disorders (AD). We examine dynamics in affect, cognition and behavior in youth with current and remitted AD. MethodsMental disorders were assessed in a general population sample (N = 1180, age 14–21; Dresden, Germany) using standardized interview. Ecological Momentary Assessment of real-life affect, cognition and behavior took place eight times/day for four days. ResultsIndividuals with current AD (n = 65) compared to healthy controls (HC, n = 531) revealed heightened variability of anxious and manic symptomatology, experiential avoidance, optimism and positive thoughts. Remitted AD (n = 52) showed lower variability of anxious and manic symptomatology and positive thoughts compared to current AD, while no differences were found compared to HC. Current AD and HC differed significantly in instability. Remitted AD showed lower instability of all constructs except for anger than current AD, and higher instability on all constructs except for positive and negative thoughts compared to HC. Current AD showed higher inertia of anger and negative thoughts than HC, and less inertia of positive thoughts than remitted AD. DiscussionAD in youths is particularly linked to higher variability and instability of intertwined emotion-related experiences that partly persist after remission, informing emotion regulation models and interventions.

Exploration of mood spectrum symptoms during a major depressive episode: The impact of contrapolarity-Results from a transdiagnostic cluster analysis on an Italian sample of unipolar and bipolar patients.

Subthreshold hypomania during a major depressive episode challenges the bipolar-unipolar dichotomy. In our study we employed a cross-diagnostic cluster analysis - to identify distinct subgroups within a cohort of depressed patients. A k-means cluster analysis- based on the domain scores of the Mood Spectrum Self-Report (MOODS-SR) questionnaire-was performed on a data set of 300 adults with either bipolar or unipolar depression. After identifying groups, between-clusters comparisons were conducted on MOODS-SR domains and factors and on a set of sociodemographic, clinical and psychometric variables. Three clusters were identified: one with intermediate depressive and poor manic symptomatology (Mild), one with severe depressive and poor manic symptomatology (Moderate), and a third one with severe depressive and intermediate manic symptomatology (Mixed). Across the clusters, bipolar patients were significantly less represented in the Mild one, while the DSM-5 "Mixed features" specifier did not differentiate the groups. When compared to the other patients, those of Mixed cluster exhibited a stronger association with most of the illness-severity, quality of life, and outcomes measures considered. After performing pairwise comparisons significant differences between "Mixed" and "Moderate" clusters were restricted to: current and disease-onset age, psychotic ideation, suicidal attempts, hospitalization numbers, impulsivity levels and comorbidity for Cluster B personality disorder. In the present study, a clustering approach based on a spectrum exploration of mood symptomatology led to the identification of three transdiagnostic groups of patients. Consistent with our hypothesis, the magnitude of subthreshold (hypo)manic symptoms was related to a greater clinical severity, regardless of the main categorical diagnosis.

Effects of the COVID-19 pandemic in a preexisting longitudinal study of patients with recently diagnosed bipolar disorder: Indications for increases in manic symptoms.

BackgroundThe coronavirus disease 2019 (COVID‐19) pandemic interfered in the daily lives of people and is assumed to adversely affect mental health. However, the effects on mood (in)stability of bipolar disorder (BD) patients and the comparison to pre‐COVID‐19 symptom severity levels are unknown.MethodBetween April and September, 2020, symptoms and well‐being were assessed in the Bipolar Netherlands Cohort (BINCO) study of recently diagnosed patients with BD I and II. The questionnaire contained questions regarding manic and depressive symptoms (YMRS and ASRM, QIDS), worry (PSWQ), stress (PSS), loneliness, sleep, fear for COVID‐19, positive coping, and substance use. As manic, depressive and stress symptoms levels were assessed pre‐COVID‐19, their trajectories during the lockdown restrictions were estimated using mixed models.ResultsOf the 70 invited BD patients, 36 (51%) responded at least once (mean age of 36.7 years, 54% female, and 31% BD type 1) to the COVID‐19 assessments. There was a significant increase (X2 = 17.06; p = .004) in (hypo)manic symptoms from baseline during the first COVID‐19 wave, with a decrease thereafter. Fear of COVID‐19 (X2 = 18.01; p = .003) and positive coping (X2 = 12.44; p = .03) were the highest at the start of the pandemic and decreased thereafter. Other scales including depression and stress symptoms did not vary significantly over time.ConclusionWe found a meaningful increase in manic symptomatology from pre‐COVID‐19 into the initial phases of the pandemic in BD patients. These symptoms decreased along with fear of COVID‐19 and positive coping during the following months when lockdown measures were eased.

What is special about suicidal depression?

ObjectiveBipolar disorder is one of the most frequent psychiatric disorders among suicidal patients. A large part of patients with bipolar disorder (30–50%) will attempt suicide. Suicidal ideation being a major risk factor of suicidal act, it is crucial to better characterize patients with suicidal bipolar depression (i.e. depression with current suicidal ideation). The aim of this study was to characterize suicidal bipolar depressed patients in comparison with non-suicidal depressed patients in terms of clinical characteristics, evolution of depression and suicidal ideation course over time, and risk of suicide attempt during follow-up.MethodsAmong patients with bipolar disorder recruited from the network of FondaMental expert centres for bipolar disorder between 2009 and 2017, we selected patients with at least mild depression and without current manic symptomatology at baseline (N = 938). Suicidal depression was defined by a baseline score ⩾2 for item 12 of the QIDS-SR (28.9%). A subsample of about 300 patients (w/ or w/o suicidal ideation at baseline) was followed up for 2 years.ResultsBaseline clinical features (e.g. depression severity, childhood trauma, global functioning) were more severe in patients with without suicidal depression. Suicidal patients tended to remain more suicidal throughout the followup (3.4-fold higher risk of persistent suicidal ideation at the 2-year visit despite an improvement in depressive symptomatology).ConclusionsDepressed bipolar disorder patients reporting suicidal ideation had more severe clinical features and were more prone to report persistent suicidal ideation during the follow-up, independently of thymic state. Clinicians should closely monitor this subgroup of patientsDisclosureNo significant relationships.

A new approach for seasonal pattern: is it related to bipolarity dimension? Findings from an Italian multicenter study

Objective The aims of this study were to assess the impact of seasonal pattern on several clinical dimensions in inpatients with a current major depressive episode and to evaluate clinical differences between unipolar and bipolar depression according to seasonal pattern. Methods Study participants were 300 patients affected by major depressive disorder (MDD) or bipolar disorder (BD) currently experiencing a major depressive episode (MDE) and were recruited at three University Medical Centres in Italy. All study subjects completed several evaluation scales for depressive and hypomanic symptoms, quality of life and functioning, impulsiveness, and seasonal pattern. Results Several differences between BD with and without seasonal pattern, MDD with and without seasonal pattern but in particular between BD and MDD with seasonal pattern were found. Patients with MDE with seasonal pattern had more frequently received a longitudinal diagnosis of BD. Conclusions A large number of patients with BD and seasonal pattern, but also a considerable number of patients with MDD and seasonal pattern, endorsed manic items during a current MDE. Seasonal pattern should be associated with a concept of bipolarity in mood disorders and not only related to bipolar disorder. A correct identification of seasonal patterns may lead to the implementation of personalised pharmacological treatment approaches. KEY POINTS High prevalence of mixed features in mood disorders with seasonal pattern, supporting the need for a dimensional approach to major depressive disorder and bipolar disorder. Significant percentage of patients with a primary diagnosis of major depressive disorder had seasonal pattern. Significant percentage of patients with a primary diagnosis of major depressive disorder reported (hypo)manic symptomatology.

Characterization of depressed bipolar patients with current suicidal ideation.

Bipolar disorder is one of the most frequent psychiatric disorders among suicidal patients. A large part of patients with bipolar disorder (30-50%) will attempt suicide. Suicidal ideation being a major risk factor of suicidal act, it is crucial to better characterize patients with suicidal bipolar depression (i.e. depression with current suicidal ideation). The aim of this study was to characterize suicidal bipolar depressed patients in comparison with non-suicidal depressed patients in terms of clinical characteristics, evolution of depression and suicidal ideation course over time, and risk of suicide attempt during follow-up. Among patients with bipolar disorder recruited from the network of FondaMental expert centres for bipolar disorder between 2009 and 2017, we selected patients with at least mild depression (Montgomery-Åsberg Depression Rating Scale total score >11) and without current manic symptomatology (Young Mania Rating Scale total score <7) at baseline (N = 938). Suicidal depression was defined by a baseline score ⩾2 for item 12 of the Quick Inventory of Depressive Symptomatology-Self Report (N = 271, 28.9%). Non-suicidal depression was defined by a baseline item 12 of the Quick Inventory of Depressive Symptomatology-Self Report score <2 (N = 667, 71.1%). A subsample of about 300 patients (with or without suicidal ideation at baseline) was followed up for 2 years. Baseline clinical features (e.g. depression severity, childhood trauma, global functioning) were more severe in patients with than without suicidal depression. Suicidal patients tended to remain more suicidal throughout the follow-up than patients without suicidal ideation at baseline (3.4-fold higher risk of persistent suicidal ideation at the 2-year visit despite an improvement in depressive symptomatology). Depressed bipolar disorder patients reporting suicidal ideation had more severe clinical features at baseline and were more prone to report persistent suicidal ideation during the follow-up, independently of thymic state. Clinicians should closely monitor this subgroup of patients.

Errors in identifying emotion in body postures and facial expressions among pediatric patients with bipolar disorder

ABSTRACT Introduction Facial emotion processing impairments have been consistently demonstrated among patients with pediatric bipolar disorder (PBD). However, less is known about other domains of nonverbal emotion recognition in this group. Therefore, the aim of the current study was to investigate emotion identification for body postures in addition to facial expressions among PBD patients and matched healthy comparison (HC) subjects. Method Youth with PBD (n = 25) and HC subjects (n = 25), equal on intellectual and demographic variables, completed the body postures and faces subtests of the Diagnostic Analysis of Nonverbal Accuracy-2 scale (DANVA-2) along with diagnostic and clinical assessments. Results Compared to HC, PBD patients made significantly more errors identifying emotion in both body postures and faces. Poorer performance on the faces subtest was associated with more problematic peer functioning. Greater manic symptoms were associated with poorer performance on negative emotional stimuli but not positive. Conclusions In addition to impairments in facial emotion processing, youth with PBD also show impairments in the ability to correctly identify emotion from body postures. In this group, greater manic symptomatology appears to impair processing for negative facial expressions and body postures, but not positive ones. Interestingly, facial emotion processing impairments appear to be a better indicator of real-world psychosocial difficulties among PBD patients compared to body postures. Psychosocial treatments for youth with PBD should focus on improving the ability to accurately identify and respond to various facial and body postural cues, as well as symptom management and emotion regulation strategies.

Features of cognitive disorders in patients with primary episodes of bipolar affective disorder

The aim of the work was to study the features of cognitive disorders in the primary episode of bipolar affective disorder, taking into account the gender factor and clinical variant. Materials and methods. 153 patients with primary episode of bipolar affective disorder: with prevalence of depressive symptomatology (44 men and 75 women), with prevalence of manic symptoms (15 men and 8 women) and with simultaneous presence of depressive and manic symptomatology or with rapid or severe manic symptoms and 5 women) were examined using the Stroop test. Results and discussion. In patients with the depressed primary episode variant, a general slowdown in the performance of all four subtests of the Stroop test was detected: reading time of the names of colors printed in black font (TNFb) in all patients 63.7±8.1 sec., in men 65.0±9.6 sec., in women 63.0±7.0 sec.; names of colors (NС) were respectively 96.6±9.2 sec, 96.5±9.1 sec and 96.6±9.3; reading time of color names where the font color is different from the word value (TNCd) – respectively 153.5±20.3 sec., 153.8±23.3 sec., 153.3±18.6 sec.; name of the word color where the font color is different from the word value (NCWd) – 62.6±7.9 sec., 63.8±9.3 sec. and 61.9±6.9 sec. In patients with a manic variant, the time to perform the Strup test is the smallest of all groups: TNFb – 44.3±4.0 sec., 44.5±4.1 sec. and 43.8±4.1 sec.; NC – 62.7±4.9 sec., 61.7±5.5 sec. and 64.6±3.2 sec.; TNCd – 116.2±9.5 sec., 118.0±10.5 sec. and 112.9±6.4 sec.; NCWd – 43.3±4.0 sec., 43.5±4.1 sec. and 42.8±4.1 sec, respectively. In patients with mixed variant indicators occupy an intermediate position: TNFb – 59,8±16,1 sec., 57,3±14,6 sec. and 62.8±19.0 sec.; NC – 79.1±10.1 sec., 76.5±10.3 sec. and 82.2±10.0 sec.; TNCd – 124.3±22.5 sec., 120.7±18.9 sec. and 128.6±27.7 sec.; NCWd – 58.5±15.7 sec., 56.2±14.3 sec. and 61.4±18.5 sec. in accordance. Gender differences in Stroop test performance are not significant. Conclusions. The primary episode of BAD is characterized by the presence of cognitive impairment, the structure and expressiveness of which is determined by the clinical variant. In the depressive variant revealed the greatest overall slowdown in the execution of the Stroop test with a significant number of errors, with manic - deterioration of attention, behavioral inhibition and maximal impulse control when mixed - a marked slowdown in the performance of the Stroop test with a significant number of errors. Gender differences in cognitive impairment are insignificant

Efficacy of the interpersonal and social rhythm therapy (IPSRT) in patients with bipolar disorder: results from a real-world, controlled trial

BackgroundBipolar disorder (BD) is one of the most burdensome mental disorder, with a lifetime prevalence of 2.4%, with a prevalence of 0.6% for bipolar type I and 0.4% for bipolar type II. Several interventions have been developed to implement the treatment strategy of bipolar disorder, including the Interpersonal and Social Rhythm Therapy (IPSRT). This intervention has been specifically developed to manage patients’ stressful life events, improve the disruptions of social and circadian rhythms and increase adherence to medications. The aim of the present study is to assess the efficacy of IPSRT on affective and anxiety psychopathology, social functioning, response to pharmacological treatment and affective morbidity index (AMI) in BD patients.MethodsBD patients were consecutively recruited at the Mood Disorder Unit of the University of Campania “Luigi Vanvitelli” and randomly assigned to the experimental group receiving the IPSRT or to the Treatment as Usual (TAU) group. Patients were assessed at baseline, after 3 and 6 months with several validated assessment tools and with the affective morbidity index.ResultsAt the end of the intervention, compared to controls, patients from the experimental group reported a significant improvement in anxious depressive and manic symptomatology, global functioning; and response to mood stabilizers. Patients in the IPSRT group reported a reduction at the AMI score.ConclusionsIPSRT has been confirmed to be effective in improving the clinical symptomology of BD patients and in improving the affective morbidity index. Further studies with longer follow-up are needed in order to assess the stability of the results.Trial registration The study was approved by the local ethical review board (N001567/28.01.2018)

Opposing Changes in the Functional Architecture of Large-Scale Networks in Bipolar Mania and Depression.

Manic and depressive phases of bipolar disorder (BD) show opposite symptoms in psychomotor, thought, and affective dimensions. Neuronally, these may depend on distinct patterns of alterations in the functional architecture of brain intrinsic activity. Therefore, the study aimed to characterize the spatial and temporal changes of resting-state activity in mania and depression, by investigating the regional homogeneity (ReHo) and degree of centrality (DC), in different frequency bands. Using resting-state functional magnetic resonance imaging (fMRI), voxel-wise ReHo and DC were calculated-in the standard frequency band (SFB: 0.01-0.10 Hz), as well as in Slow5 (0.01-0.027 Hz) and Slow4 (0.027-0.073 Hz)-and compared between manic (n = 36), depressed (n = 43), euthymic (n = 29) patients, and healthy controls (n = 112). Finally, clinical correlations were investigated. Mania was mainly characterized by decreased ReHo and DC in Slow4 in the medial prefrontal cortex (as part of the default-mode network [DMN]), which in turn correlated with manic symptomatology. Conversely, depression was mainly characterized by decreased ReHo in SFB in the primary sensory-motor cortex (as part of the sensorimotor network [SMN]), which in turn correlated with depressive symptomatology. Our data show a functional reconfiguration of the spatiotemporal structure of intrinsic brain activity to occur in BD. Mania might be characterized by a predominance of sensorimotor over associative networks, possibly driven by a deficit of the DMN (reflecting in internal thought deficit). Conversely, depression might be characterized by a predominance of associative over sensorimotor networks, possibly driven by a deficit of the SMN (reflecting in psychomotor inhibition).

Psychoeducation Can Ameliorate Somatic and Manic Symptomatology in Youth at High-Risk for Bipolar Disorder: A Randomized-Controlled Study

Background: Bipolar Disorder (BD) is a chronic, recurrent and potentially severe psychiatric disorder with relatively high prevalence rates and debilitating consequences. Delays in diagnosis and treatment of BD have been associated with longer depressive episodes, higher suicidality, shorter euthymic periods and poorer functioning in adulthood. For these reasons, early recognition of BD is clinically important. Given the high hereditary rates for BD, offspring of BD patients (high-risk [HR] group) are perfect candidates for research on early detection and prevention strategies. Psychoeducation is a structured and systematic intervention, in which the knowledge of the illness and its treatment is transferred to the patient and/or family in a didactic approach. Psychoeducation is a core component of psychotherapeutical interventions such as cognitive-behavioral therapy (CBT), family focused therapy (FFT) and interpersonal and social rhythm therapy (IPSRT). Several studies which explored the effectiveness of CBT, FFT and IPSRT in HR youth reported positive out-comes; but previously explored prevention interventions were mainly focused on symptomatic HR and none of them were done among asymptomatic HR. Therefore with this study, we aimed to evaluate the effect of psychoeducational intervention on asymptomatic HR youth. Methods: In this prospective randomized controlled study, total of 60 cases were enrolled and randomized into two group as cases who received psychoeducational intervention (PE+) (n=30) and who did not receive psychoeducational intervention (PE-) (n=30) on the first visit (T0). Groups were evaluated regarding their psychiatric symptomatology and quality of life (QoL) using DSM-5 Level 1 Cross-cutting Symptom Scale Child Form (CCSS-5) and Pediatric Quality of Life Questionnaire throughout four interviews with 3-month intervals (T0 – T3). Results: Even though psychoeducation did not have effect on QoL of the high-risk population; overall reduction in somatic and manic symptom severity in CCSS-5 was more distinct for PE+ group compared to PE- group. Conclusion: Results from this study are, to an extent, in line with previous psychotherapeutic interventions done in symptomatic HR which include psychoeducation as a core component. In fact improvement in affective symptomatology with CBT and longer remission periods with FFT can be explored in the same scope with the overall reduction in manic symptom severity we showed in PE+ group; but improvement in somatic symptomatology should be approached from a different angle. Overall reduction in somatic symptom severity of PE+ group that we found might be due to the positive effect of psychoeducation on family communication and problem-solving skill. However, there is no previous research indicating the presence of somatic symptoms/somatization disorders among HR youth; so whether somatic symptoms are the consequences of family conflict or a core component of prodromal phase of BD is still unclear. Studies state that psychological interventions are most effective if they are performed in the early stages of BD; therefore asymptomatic HR youth are critical for prevention strategies and more studies are needed in this population.

Features of changes in the cognitive sphere of patients with a primary episode of bipolar affective disorder

153 patients with primary episode of bipolar affective disorder were divided to three groups: with prevalence of depressive symptomatology (44 men and 75 women), with prevalence of manic symptoms (15 men and 8 women) and with simultaneous presence of depressive and manic symptomatology or with rapid or severe manic symptoms (6 men and 5 women) and were examined using the Rey–Osterrieth test. It was found that they had impaired cognitive functioning whose structure and severity were related to the clinical type of the primary episode. In patients with depressive variant revealed approximately equal deterioration of test performance across all assessment vectors, while reproduction (immediate and delayed) observed synchronous deterioration of indicators, with the degree of deterioration of characteristics between copying and immediate and retarded reproduction. In the manic variant the performance of test is significantly different from the depressive variant. Patients with a manic variant showed the lowest indicators in the presence of individual elements of the figure, accuracy and diligence. At the same time, indicators for most estimation vectors are unstable, varying with immediate and delayed reproduction without some systematicity. Such features reflect on the cognitive functions of the maniac state with its acceleration of the speed of thinking, its chaos, instability of attention, difficulties of concentration and inability to productive activity. In patients with mixed episode, the Ray–Osterrieth test scores reflect complex contradictory tendencies of changes in the affective area, related to the rapid phase change and the presence of opposite affective manifestations. Quantitative values of indicators in patients of this group has an intermediate position between indicators of patients with depressive and manic variants. Common disorders inherent in patients of all groups were distortion of the integrity and symmetry of the figure, contamination of the elements of the figure and the omission of minor details. The differences in the structure and severity of cognitive impairment between men and women are not statistically significant.

Measuring personal recovery in people with bipolar disorder and exploring its relationship with well-being and social role participation.

The relevance of personal recovery receives increasing attention in mental health care and is also important for people with bipolar disorder (BD). There is a need for reliable and valid instruments measuring personal recovery. Therefore, the current study evaluated the psychometric properties of a Dutch translation of the Questionnaire about the Process of Recovery (QPR) in a sample of people with BD and explored the relationship with constructs of well‐being, social role participation, and psychopathology. A cross‐sectional survey study was conducted in which 102 people diagnosed with BD completed the QPR. Factor structure of the QPR was evaluated by conducting confirmatory factor analyses (CFA), and internal consistency was assessed by calculating reliability coefficients. Convergent validation measures assessed well‐being, social role participation, and symptomatology. Incremental validity was determined by evaluating the ability of the QPR to explain variance in symptomatology above and beyond well‐being. Findings of the CFA supported a unidimensional factor structure, and internal consistency estimates were excellent. Scores of the QPR showed strong correlations with convergent measures, but were only weakly associated with manic symptomatology. Moreover, personal recovery explained additional variance in symptoms of depression and anxiety above and beyond well‐being, indicating incremental validity. The QPR appears to be a reliable and valid tool to assess personal recovery in people with BD. Our findings underline the importance of personal recovery in the context of treatment of BD. Personal recovery demonstrates a substantial overlap with well‐being.

Features of astenic and obsession symptomatics in patients with primary episodes of bipolar affective disorder

The aim of the work is to establish the features of asthenic, somatovegetative and obsessive symptoms in the primary episode of bipolar affective disorder, taking into account the gender factor and clinical variant.Materials and methods. Clinically examined 153 patients with primary episode of bipolar affective disorder: with prevalence of depressive symptomatology (44 men and 75 women), with prevalence of manic symptoms (15 men and 8 women) and with simultaneous presence of depressive and manic symptomatology or with rapid or severe manic symptoms and 5 women).Results and discussion. Feeling depleted and reduced energy potential were found in 40.3 % of all patients, 40.9 % of men and 40.0 % of women with depression, and 45.5 %, 66.7 % and 20.0 % with mixed variant; decrease in working capacity – in 68.9 %, 65.9 %, 70.7 %, and 81.8 %, 83.3 %, 80.0 %; rapid fatigue – in 68.1 %, 65.9 %, 69.3 %, and 54.5 %, 50.0 %, 60.0 %; attention disorders – in 45.4 %, 36.4 %, 50.7 %, and 72.7 %, 83.3 %, 60.0 %. In the manic variant, there is only a violation of concentration of attention: 56.5 %, 46.7 % and 75.0 %. In the depressive variant, 62.2 % of all patients, 59.1 % of men and 64.0 % of women were obsessive, while 18.2 %, 33.3 %, and 0.0 % had mixed opinions, ideas of self-humiliation – in 40.3 %, 29.5 % and 46.7 %, and in 27.3 %, 33.3 % and 20.0 %. Somatic vegetative disorders in the depressive variant were found in 98.3 % of all patients, in 97.7 % of men and in 98.7 % of women; at manic - in 30.4 %, 26.7 % and 37.5 % respectively; when mixed - 100 %. Gender differences in asthenic, somatovegetative, and obsessive symptoms are insignificant.Conclusions. The prevalence of asthenic, somatovegetative, and obsessive symptoms in the primary episode of bipolar affective disorder is determined by the clinical option, and gender differences are insignificant

Functional outcome and social cognition in bipolar disorder: Is there a connection?

BackgroundInterest in social cognition in bipolar disorder (BD) has increased considerably over the past decade, with studies highlighting major impairments, especially in mental state reasoning, even during euthymia. A causal relationship between social cognition deficits and social functioning has already been established in individuals with schizophrenia, but there is still little information about links between social cognition and social functioning in BD. Our aim was therefore to review the relationship between functional outcome and social cognition in patients with BD. MethodsWe conducted a systematic review of the literature. Relevant articles were identified through literature searches in the MEDLINE/PubMed, EBSCOHost and Google Scholar databases for the years 2000–2017, using the keywords bipolar, social cognition, theory of mind, mentalizing, emotion recognition, emotion processing, and functioning. A total of 20 studies met our inclusion/exclusion criteria. ResultsWe found that functioning was significantly correlated with three domains of social cognition (ToM, emotion processing, and attribution bias). Twelve of 13 studies reported a correlation with emotion processing, but a correlation with ToM was only found in three of the 11 studies that assessed it. Six studies found an effect of depressive symptoms on emotion processing and no significant association was found with manic symptomatology. ConclusionsTo the best of our knowledge, the present review is the first to specifically explore the relationship between social cognition and social functioning in patients with BD. This exploration is of interest, as it enhances current understanding of this disorder and, by so doing, should improve patient outcomes.

Diagnosing Bipolar Disorder in Pediatric Patients

As many as 2 million youths in the US alone could have bipolar disorder. In this CME brief report, get up-to-date on common presentations of pediatric bipolar disorder, DSM-5 diagnostic criteria, and structured interviews and screening tools that can help you detect manic symptomatology.