Symptoms Of Bipolar Disorder Research Articles

Bipolar Disorder Symptom Monitoring Measures: A Mixed-Methods Study of Patient Preferences

To determine the perceived acceptability and helpfulness of bipolar disorder symptom measures and rank the measures in order of preference among individuals with bipolar disorder. We recruited 20 participants 18 years of age or older with any type of bipolar disorder from a primary care clinical site and a national advocacy organization. We used a simultaneous complementary mixed-method design involving completion of symptom measures, a semistructured interview, and numerical ranking of measures. Participants completed three symptom measures or combination of measures: 1) Affective Self-Rating Scale; 2) combination Patient Mania Questionnaire-9 (PMQ-9) and Patient Health Questionnaire-9 (PHQ-9); and 3) combination Altman Self-Rating Mania Rating Scale and PHQ-9. A semistructured interview was conducted, and participants ranked their preferences for measures. Interviews focused on participants' rationale for measuring preferences. Interviews were analyzed by two psychiatrist-investigators using content analysis, and themes were determined. Average rank of each measure was determined. The average rank for each measure was 1.48 for the combination PMQ-9 and PHQ-9, 1.68 for the Affective Self-Rating Scale, and 2.85 for the combination Altman Self-Rating Mania Rating Scale and PHQ-9, indicating that the combination PMQ-9 and PHQ-9 (top-ranked measure by 55% of participants) was the most preferred among the three measures. Major themes that emerged from the data were: 1) measure format; 2) patient experience; 3) clinical practice; and 4) therapeutic effects. Individuals with bipolar disorder preferred the combination PMQ-9 and PHQ-9 for use in monitoring treatment due to perceived strengths such as format, ease of completion and interpretation, accurate description of experiences, and feasibility of use in practice.

Do bipolar disorder symptom profiles matter for suicide risk? A latent class approach to investigating differences in suicidal desire and acquired capability.

Depressive and mixed symptoms in bipolar disorder (BD) have been linked to higher suicide risk. Based on Klonsky and May's three-step theory and Joiner's Interpersonal Psychological Theory of Suicide, we hypothesized that patients diagnosed with BD who reported severe levels of depressive symptoms and mixed depressive and manic symptoms would also report higher levels of suicidal desire and acquired capability of suicide, as well as suicidal thoughts and behaviors. The sample included 177 outpatients diagnosed with BD. Latent class analysis was conducted to replicate the identified groups of a previously conducted study using a smaller but overlapping dataset. Between-class and pairwise analyses with measures of suicidal desire and acquired capability were conducted. As expected, the classes characterized by severe depressive symptoms and mixed symptoms reported higher levels of suicidal desire. However, the results regarding acquired capability were less consistent. Given the overall elevated suicide risk of BD and the consistent relationship between depressive symptoms and other strong correlates of suicide, clinicians who work with patients diagnosed with BD should closely monitor changes in their depressive symptoms.

ECGPsychNet: an optimized hybrid ensemble model for automatic detection of psychiatric disorders using ECG signals

Background. Psychiatric disorders such as schizophrenia (SCZ), bipolar disorder (BD), and depression (DPR) are some of the leading causes of disability and suicide worldwide. The signs and symptoms of SCZ, BD, and DPR vary dynamically and do not have uniform detection strategies. The main causes of delays in the detection of psychiatric disorders are negligence by immediate caregivers, varying symptoms, stigma, and limited availability of physiological signals. Motivation. The brain functionality in the patients with SCZ, BD, and DPR changes compared to the normal cognition population. The brain–heart interaction plays a crucial role in tracking the changes in cardiac activities during such disorders. Therefore, this paper explores the application of electrocardiogram (ECG) signals for the detection of three psychiatric (SCZ, BD, and DPR) disorders. Method. This paper develops ECGPsychNet an ensemble decomposition and classification technique for the automated detection of SCZ, BD, and DPR using ECG signals. Three well-known decomposition techniques, empirical mode decomposition, variational mode decomposition, and tunable Q wavelet transform (TQWT), are used to decompose the ECG signals into various subbands (SBs). Various features are extracted from the different SBs and classified using optimizable ensemble techniques using two validation techniques. Results. The developed ECGPsychNet has obtained the highest classification accuracy of 98.15% using the features from the sixth SB of TQWT. Our proposed model has the highest detection rates of 98.96%, 96.04%, and 95.12% for SCZ, DPR, and BD. Conclusions. Our developed prototype is able to detect SCZ, DPR, and BD using ECG signals. However, the automated ECGPsychNet is ready to be tested with more datasets including different races and age groups.

A Review of the Impact of Bipolar Disorder on Working Performance

While the symptoms of bipolar disorder (BD) have been recognized for centuries, only recently has attention been directed towards comprehensively understanding the conditions impact on everyday functioning, especially the research on bipolar patients real-life application in working environment are limited. Despite its significance, the effect of BD on work performance is frequently disregarded or inadequately quantified. Work functioning encompasses an individuals ability to acquire and maintain paid employment as well as engage in meaningful work that aligns with their educational background, skills, aspirations, and expectations. The quality of life in terms of ones health, ones ability to function physically and socially, ones ability to get employment, and ones ability to produce at work are all known to be significantly impacted by BD. Our study aimed to investigate how a specific aspect of executive functioning (EF) in individuals with BD influences work efficiency. The Result demonstrates that Bipolar illness significantly impairs functional abilities as well as work-related outcomes like productivity and job success. BD has a more significant negative impact on outcomes linked to the workplace than depression alone. It is crucial to remember that BD can also be linked to good qualities like creativity, resiliency, and high levels of energy.

Correlation between low frequency fluctuation and cognitive performance in bipolar disorder patients with suicidal ideation

BackgroundPatients with bipolar disorder (BD) are at high risk of suicidal ideation (SI), and BD patients with suicidal ideation (BDSI) have shown marked abnormalities in spontaneous brain function. Cognitive impairment, on the other hand, is considered to be one of the core symptoms of BD. However, few studies have addressed the association between cognitive performance and abnormal spontaneous brain function in BDSI. MethodsIn the current study, the MATRICS Consensus Cognitive Battery (MCCB) was used to assess cognitive performance in BDSI (n = 20), BD subjects without suicidal ideation (BDNSI) (n = 24) and healthy controls (HC) (n = 30). Their cognitive performance was then correlated with amplitude of low frequency fluctuation (ALFF) values obtained by resting-state functional magnetic resonance imaging (rs-fMRI). ResultsWe found that ALFF was significantly higher in the left precuneus and right posterior cingulate cortex in the BDSI group and significantly lower in the right precuneus in the BDNSI group than in the HC group. In addition, in the BDSI group, visual learning performance was positively correlated with ALFF values in the left precuneus. ConclusionsOur findings support the notion that BD patients present with ALFF abnormalities, which are associated with cognitive performance in BDSI.

Prevalence and Pattern of Olanzapine Emergent Obsessive–Compulsive Symptoms: A Cross-sectional Study

Objective: Olanzapine is an atypical antipsychotic medication and known for metabolic side effects but olanzapine-induced obsessive–compulsive symptoms are another important behavioral side effects which are less studied and only a few case reports reported these side effects. This study aims to estimate the prevalence and pattern of olanzapine-induced obsessive–compulsive symptoms in schizophrenia and bipolar affective disorders (BPADs). Methods: Subjects were recruited from psychiatry outpatient department. Subjects with schizophrenia ( n = 41) and BPAD ( n = 18) taking olanzapine at least more than 6 months were evaluated for clinical profile and the presence of obsession and compulsion symptoms by means of Yale-Brown Obsessive–Compulsive Symptom (YBOCS) checklist scale and data were collected on the structured format. Results: Eighteen (30.5%) of the 59 patients met YBOCS checklist scale for both obsessive–compulsive symptoms among subjects with schizophrenia and BPAD subjects. The mean duration of olanzapine intake was 2 years and the mean dose of olanzapine was 12.5 ± 5.21 mg in obsessive–compulsive symptoms (OCSs) present subjects and the mean dose was 13.78 ± 5.21 mg in subjects not having OCSs. Contamination was the most common obsession and checking was the most common compulsion. Conclusions: These findings suggest that obsessive–compulsive symptoms occur in a substantial percentage of patients taking olanzapine in schizophrenia and BPAD and most of the subjects had more than one OCS.

The new mode of computerized therapy in improving the symptoms of bipolar disorder in adolescents

BackgroundBipolar disorder usually leads to serious mental health problems, including anxiety, depression, psychotic symptoms, and cognitive impairment. Therefore, timely diagnosis and treatment are crucial. The existing computer therapy is mostly based on Acceptance and Commitment Therapy (ACT), which takes functional contextualism as its philosophical foundation and empirical research on the basic properties of human cognition and language. Its goal is to improve psychological flexibility by balancing acceptance and change.Subjects and Methods The study designed a computerized treatment program for bipolar disorder based on six core technologies of ACT: (1) facing bipolar disorder directly, (2) accepting the current situation without avoiding it, (3) cognitively controlling one’s own state, (4) observing one’s psychological state more, (5) living in the present, and (6) maintaining independent values. Adolescents were selected for the MDQ questionnaire, and a control group experiment was conducted. The experimental group received computerized therapy for eight weeks of intervention.ResultsAfter treatment analysis, the results were obtained and analyzed by SPSS 23.0. The MDQ value of the experimental group significantly decreased, but there was no significant improvement in the control group. 58% of the tested adolescents in the experimental group showed significant improvement in symptoms.ConclusionsThe research results show that the new computer therapy model for bipolar disorder based on ACT has certain effects and can be used for primary autonomous intervention treatment. Further treatment is worthy of deeper research.AcknowledgementThe research foundation ability improvement project of Young and middle-aged teachers in colleges and universities in Guangxi in 2022, No. 2022KY1458.

Correlation between emotion dysregulation and mood symptoms of bipolar disorder: A systematic review and meta-analysis.

Emotion dysregulation (ED) is a transdiagnostic construct characterized by difficulties regulating intense emotions. People with bipolar disorder (BD) are more likely to show ED and use maladaptive emotion regulation strategies than adaptive ones. However, little is known about whether ED in BD is a trait or it is rather an epiphenomenon of mood symptoms. We conducted a systematic review and meta-analysis of the evidence across major literature databases reporting correlations between measures of emotion regulation (overall ED and different emotion regulation strategies) and measures of depressive and (hypo)manic symptoms in BD from inception until April 12th, 2022. Fourteen studies involving 1371 individuals with BD were included in the qualitative synthesis, of which 11 reported quantitative information and were included in the meta-analysis. ED and maladaptive strategies were significantly higher during periods with more severe mood symptoms, especially depressive ones, while adaptive strategies were lower. ED significantly correlates with BD symptomatology, and it mainly occurs during mood alterations. ED may be a target for specific psychotherapeutic and pharmacological treatments, according to precision psychiatry. However, further studies are needed, including patients with mood episodes and longitudinal design, to provide more robust evidence and explore the causal direction of the associations.

Limbic brain subregions associated with mental health symptoms in youth with and without prenatal alcohol exposure.

Prenatal alcohol exposure (PAE) can result in reduced brain volume and an increased risk of mental health challenges. Limbic brain structures such as the hippocampus, thalamus, and amygdala often exhibit smaller volumes in youth with PAE, and similar volume reductions are observed in unexposed youth with symptoms of depression, bipolar disorder, anxiety, and schizophrenia. However, the role of volume reductions in these brain regions in mental health challenges remains unclear for individuals with PAE. Thirty-four youth with PAE and 72 unexposed youth aged 7-16 years completed a T1-weighted magnetic resonance imaging scan. FreeSurfer was used to process and extract volumes for hippocampal subfields, thalamic subnuclei, and amygdalar subnuclei. Depression and anxiety symptoms were measured using the Behavioral Assessment System for Children (BASC-2/3-PRS), the Children's Depression Inventory, and the Multidimensional Anxiety Scale for Children. We tested whether limbic subregion volumes differed between youth with and those without PAE and whether volumes were associated with depression and/or anxiety symptoms, controlling for age and gender. Multiple hippocampal and thalamic subregions, but not amygdalar subnuclei, were smaller in individuals with PAE. Multiple group-brain interactions were observed for depression symptoms and subregion volumes. Negative associations between anxiety and limbic subregions were observed across groups. These findings show extensive volume reductions in the hippocampus and thalamus in youth with PAE. PAE also appears to disrupt the association between depression symptoms and limbic subregions in youth, which may have implications for interventions in these individuals. Anxiety symptoms in youth with and without PAE are similarly associated with limbic volumes.

Supplemental Material for Linking Childhood Trauma and Dissociation to Psychotic Symptoms in Major Depressive Disorder, Bipolar Disorders, and Schizophrenia: A Transdiagnostic Examination Using Patient and Clinician Ratings

Supplemental Material for Linking Childhood Trauma and Dissociation to Psychotic Symptoms in Major Depressive Disorder, Bipolar Disorders, and Schizophrenia: A Transdiagnostic Examination Using Patient and Clinician Ratings

Reproductive Hormones and Female Mental Wellbeing

Fluctuating hormone levels during the menstrual cycle and major reproductive cycle stages have been linked to mood changes, mental health conditions, and an increased likelihood of psychotic episodes. This knowledge could potentially be used for the predictive modeling of exacerbations and mood deterioration through the collection and analysis of data from wearables and apps. A literature search for a narrative review has been conducted using selected keywords in Pubmed, Embase and Google Scholar. Based on published data, it can be seen that hormonal changes affect the severity of symptoms in several mental health conditions, including depression, PMDD, PTSD, bipolar disorder and schizophrenia. The influence of FSH, LH, testosterone, and other hormone precursors has also been investigated, but there is less information available regarding their impact. E2 levels have been measured as a treatment–response biomarker and have demonstrated significant predictive ability for treatment responder groups. On the other hand, FSH has been demonstrated to be helpful in predicting treatment non-responder groups in schizophrenia. Monitoring reproductive hormones in combination with wearables or digital solutions has the potential to predict mood changes more effectively. Precise and frequent hormone measurements might prove to be more effective than relying on absolute threshold levels. Further research is needed to validate the utility and precision of hormone use in the field of mental health.

The effect of perceived parental attitude score on symptoms of bipolar disorder and schizophrenia

Objectives: We aimed to investigate the effect of perceived parental attitudes on the symptoms of these diseases in patients with schizophrenia and bipolar disorder (BD) and to compare the perceived parental attitudes between these two disorders. Methods: This cross-sectional study was conducted between August 2020 and August 2021 at a university hospital in Turkey. Fifty-two patients with BD and 50 patients with schizophrenia in remission, aged 16-50 years, who met the respective diagnostic criteria defined by the Diagnostic and Statistical Manual of Mental Disorder-5 were included in the study. Results: The mean age of patients with BD was 38.90 ±1 0.95 years, while it was 39.08 ± 11.51 years for those with schizophrenia. Females comprised 65.38% (n = 34) of the BD group and 78.00% (n = 39) of the schizophrenia group. Our results showed that the severity of various negative schizophrenia symptoms increased with higher levels of perceived parental libertarian attitude. In addition, the severity of delusion, which is one of the positive symptoms of schizophrenia, was found to increase with lower perceived parental interest. We did not find a significant relationship between the severity of mania and depression symptoms and perceived parental attitudes. Conclusions: In addition to supporting previously reported relationships of various factors and schizophrenia and BD, our results suggest that the increase in the level of liberality of parents has a negative impact on the negative symptoms of schizophrenia. In addition, the decrease in the level of interest of parents towards their children exacerbates delusion symptoms.

Melatonin secretion patterns are associated with cognitive vulnerability and brain structure in bipolar depression

ABSTRACT Circadian rhythm disruption is a core symptom of bipolar disorder (BD), also reflected in altered patterns of melatonin release. Reductions of grey matter (GM) volumes are well documented in BD. We hypothesized that levels and timing of melatonin secretion in bipolar depression could be associated with depressive psychopathology and brain GM integrity. The onset of melatonin secretion under dim light conditions (DLMO) and the amount of time between DLMO and midsleep (i.e. phase angle difference; PAD) were used as circadian rhythm markers. To study the time course of melatonin secretion, an exponential curve fitting the melatonin values was calculated, and the slope coefficients (SLP) were obtained for each participant. Significant differences were found between HC and BD in PAD measures and melatonin profiles. Correlations between PAD and depressive psychopathology were identified. Melatonin secretion patterns were found to be associated with GM volumes in the Striatum and Supramarginal Gyrus in BD. Our findings emphasized the role of melatonin secretion role as a biological marker of circadian synchronization in bipolar depression and provided a novel insight for a link between melatonin release and brain structure.

Multiple psychiatric polygenic risk scores predict associations between childhood adversity and bipolar disorder

BackgroundIt remains unclear how adverse childhood experiences (ACE) and increased genetic risk for bipolar disorder (BD) interact to influence BD symptom outcomes. Here we calculated multiple psychiatric polygenic risk scores (PRS) and used the measures of ACE to understand these gene-environment interactions. Method885 BD subjects were included for analyses. BD, ADHD, MDD and SCZ PRSs were calculated using the PRS-CS-auto method. ACEs were evaluated using the Children Life Event Questionnaire (CLEQ). Participants were divided into groups based on the presence of ACE and the total number of ACEs. The associations between total ACE number, PRSs and their interactions were evaluated using multiple linear and logistic regressions. Secondary analyses were performed to evaluate the influence of ACE and PRS on sub-phenotypes of BD. ResultsThe number of ACEs increased with the ADHD PRS. BD participants who had ACEs showed an earlier age of BD onset and higher odds of having rapid cycling. Increased BD PRS was associated with increased odds of developing psychotic symptoms. Higher ADHD PRS was associated with increased odds of having rapid cycling. No prediction effect was observed from MDD and SCZ PRS. And, we found no significant interaction between ACE numbers and any of the PRSs in predicting any selected BD sub-phenotypes. LimitationsThe study was limited by sample size, ACE definition, and cross-sectional data collection method. ConclusionsThe findings consolidate the importance of considering multiple psychiatric PRSs in predicting symptom outcomes among BD patients.

The relationship between dysfunctional attitudes, maladaptive perfectionism, metacognition and symptoms of mania and depression in bipolar disorder: The role of self-compassion as a mediating factor

BackgroundMaladaptive cognitions appear to be associated with the severity of mood symptoms in bipolar disorder (BD), but findings are mixed and generally cross-sectional in design. MethodThis study (n = 331) explored the associations between maladaptive cognitions and mood symptoms in BD over time (3 months), and the potential mediating effect of self-compassion cross-sectionally. Dysfunctional attitudes, maladaptive perfectionism and maladaptive metacognitions were explored separately with depressive and manic symptoms, and with current mood state in BD. ResultsThe results showed maladaptive metacognitions to be the only significant predictor of depression at 3-month follow-up (β = 0.31, p < .001), with no relationship to mania over time. Cross-sectionally, self-compassion partially mediated the relationship between all maladaptive cognitions and depression, with higher dysfunctional cognitions and lower self-compassion predicting increased severity of depressive symptoms. Only the relationship between dysfunctional attitudes and mania was partially mediated by self-compassion, however, the relationship was weak and suggestive that higher self-compassion predicted increased mania. LimitationsThe study duration limited the possible analysis. Future longitudinal research is needed. Also, the study sample was not representative of the clinical population, making results less generalisable. Additionally, limited significant findings regarding manic symptoms supports the need for further research into active cognitions during this phase of BD. ConclusionsMaladaptive metacognitions were predictive of future depression severity, therefore, further exploration of metacognitive therapy for BD should be explored. Furthermore, self-compassion was shown to partially mediate the relationship between negative cognitions and mood, therefore further exploration of compassion-based therapies for BD is needed.

The impact of body mass index on the clinical features of bipolar disorder: A STEP-BD study.

The effects of body mass index (BMI) on the core symptoms of bipolar disorder (BD) and its implications for disease trajectory are largely unexplored. To examine whether BMI impacted hospitalization rate, medical and psychiatric comorbidities, and core symptom domains such as depression and suicidality in BD. Participants (15 years and older) were 2790 BD outpatients enrolled in the longitudinal STEP-BD study; all met DSM-IV criteria for BD-I, BD-II, cyclothymia, BD NOS, or schizoaffective disorder, bipolar subtype. BMI, demographic information, psychiatric and medical comorbidities, and other clinical variables such as bipolarity index, history of electroconvulsive therapy (ECT), and history of suicide attempts were collected at baseline. Longitudinal changes in Montgomery-Åsberg Depression Rating Scale (MADRS) score, Young Mania Rating Scale (YMRS) score, and hospitalizations during the study were also assessed. Depending on the variable of interest, odds-ratios, regression analyses, factor analyses, and graph analyses were applied. A robust increase in psychiatric and medical comorbidities was observed, particularly for baseline BMIs >35. A significant relationship was noted between higher BMI and history of suicide attempts, and individuals with BMIs >40 had the highest prevalence of suicide attempts. Obese and overweight individuals had a higher bipolarity index (a questionnaire measuring disease severity) and were more likely to have received ECT. Higher BMIs correlated with worsening trajectory of core depression symptoms and with worsening lassitude and inability to feel. In BD participants, elevated BMI was associated with worsening clinical features, including higher rates of suicidality, comorbidities, and core depression symptoms.

Factors associated with psychiatric and physical comorbidities in bipolar disorder: a nationwide multicenter cross-sectional observational study.

Bipolar disorder (BD) is a chronic and disabling affective disorder with significant morbidity and mortality. Despite the high rate of psychiatric and physical health comorbidity, little is known about the complex interrelationships between clinical features of bipolar illness and comorbid conditions. The present study sought to examine, quantify and characterize the cross-sectional associations of psychiatric and physical comorbidities with selected demographic and clinical characteristics of adults with BD. A nationwide multicenter cross-sectional observational epidemiological study conducted from October 2015 to March 2017 in Slovakia. Out of 179 study participants [median age 49 years (interquartile range IQR 38-58); 57.5% females], 22.4% were free of comorbidity, 42.5% had both psychiatric and physical comorbidities, 53.6% at least one psychiatric comorbidity, and 66.5% at least one physical comorbidity. The most prevalent were the essential hypertension (33.5%), various psychoactive substance-related disorders (21.2%), specific personality disorders (14.6%), obesity (14.5%), and disorders of lipoprotein metabolism (14%). The presence of an at least one physical comorbidity, atypical symptoms of BD, and unemployed status were each associated with an at least one psychiatric comorbidity independent of sex, early onset of BD (age of onset <35 years), BD duration and pattern of BD illness progression (p < 0.001). The presence of various psychoactive substance-related disorders, BD duration, atypical symptoms of BD, unemployed status, pension, female sex, and not using antipsychotics were each associated with an at least one physical comorbidity independent of the pattern of BD illness progression (p < 0.001). In several other multiple regression models, the use of antipsychotics (in particular, olanzapine) was associated with a decreased probability of the essential hypertension and predicted the clinical phenotype of comorbidity-free BD (p < 0.05). This cross-national study has reported novel estimates and clinical correlates related to both the comorbidity-free phenotype and the factors associated with psychiatric and physical comorbidities in adults with BD in Slovakia. The findings provide new insights into understanding of the clinical presentation of BD that can inform clinical practice and further research to continue to investigate potential mechanisms of BD adverse outcomes and disease complications onset.

Construct validation of Minnesota Multiphasic Personality Inventory-3 (MMPI-3) scales relevant to the assessment of bipolar spectrum disorders.

The Minnesota Multiphasic Personality Inventory-3 (MMPI-3) is a commonly used psychological test that includes several scales relevant to measuring manic and depressive symptoms of bipolar spectrum disorders. The goal of the present study was to evaluate the construct validity of MMPI-3 scale scores with respect to self-report measures of bipolar psychopathology. Using a sample of 644 university students in New Zealand, we calculated correlations between scores on the MMPI-3 and the Hypomanic Personality Scale-Short Form (HPS-SF) total and factor scores and the Altman Self-Report Mania Scale (ASRM) total and item scores. For associations against the HPS-SF, almost all of the hypotheses were supported, whereas for the ASRM scale, several were not. We also estimated a series of regression models predicting HPS-SF and ASRM scores from meaningfully associated MMPI-3 scores. Hypomanic Activation (RC9), Activation (ACT), and Self-Importance (SFI) scores emerged as the most consistent and substantial predictors of criteria, with SFI scores being more specifically associated with total scores and criteria related to Social Vitality. Several internalizing and thought dysfunction MMPI-3 scales were also meaningfully associated with scores on the HPS-SF and ASRM. Implications and limitations, such as the use of a university student convenience sample, are discussed.

Predictors of diagnostic conversion from major depression to bipolar disorder: a Swedish national longitudinal study.

It is clinically important to predict the conversion of major depression (MD) to bipolar disorder (BD). Therefore, we sought to identify related conversion rates and risk factors. This cohort study included the Swedish population born from 1941 onward. Data were collected from Swedish population-based registers. Potential risk factors, including family genetic risk scores (FGRS), which were calculated based on the phenotypes of relatives in the extended family and not molecular data, and demographic/clinical characteristics from these registers were retrieved. Those with first MD registrations from 2006 were followed up until 2018. The conversion rate to BD and related risk factors were analyzed using Cox proportional hazards models. Additional analyses were performed for late converters and with stratification by sex. The cumulative incidence of conversion was 5.84% [95% confidence interval (95% CI) 5.72-5.96] for 13 years. In the multivariable analysis, the strongest risk factors for conversion were high FGRS of BD [hazard ratio (HR) = 2.73, 95% CI 2.43-3.08], inpatient treatment settings (HR = 2.64, 95% CI 2.44-2.84), and psychotic depression (HR = 2.58, 95% CI 2.14-3.11). For late converters, the first registration of MD during the teenage years was a stronger risk factor when compared with the baseline model. When the interactions between risk factors and sex were significant, stratification by sex revealed that they were more predictive in females. Family history of BD, inpatient treatment, and psychotic symptoms were the strongest predictors of conversion from MD to BD.

Mental health literacy and relational health literacy among college students

Objective: The aim of the present study was to examine MHL and RHL in a sample of college students in the United States, and to explore linkages among literacies and related constructs. Participants: Participants were 169 (N = 169) participants who were adult college students at a state university in the southern United States. Participants were recruited through an online recruitment management system that allows college students to participate in research studies for participation credit. Method: We analyzed online survey data using descriptive analysis. In effort to develop a measurement tool to measure relational mental health literacy, we conducted an exploratory factor analysis on the Relational Health Literacy Scale (RHLS) that was developed for the present study. Results: Results suggest that college students would be willing to seek mental health resources from some professional sources. Participants were able to more easily identify symptoms of anxiety and depression, and struggled to accurately identify symptoms of mania, bipolar disorder and schizophrenia. Respondents also demonstrated some awareness of relationship health issues. Conclusions: Implications for further research, practice and policy making are presented and discussed.