We conducted a retrospective study to investigate the efficacy and safety of lurasidone (LUR) in outpatients with depressive episodes of bipolar disorder II (BD2) in real world setting.

We retrospectively analyzed the clinical data obtained from the medical records of the Horikoshi Psychosomatic Clinic between February 2020 and April 2022. A total of 78 patients with BD2 who experienced a depressive episode were included in this study. The primary outcome was the mean change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to 8 weeks (W). The secondary outcome was the mean change in the MADRS score from baseline to 2, 4, and 12 W. Discontinuation and adverse event rates were measured after 24 W.

After starting LUR, the mean total score of the MADRS significantly decreased at 8 W (-11.8 ± 8.26, P < 0.0001). Patients with BD2 who underwent the treatment with LUR showed significantly great improvement at 2 W (-8.38 ± 8.75, P< 0.0001), 4 W (-11.2 ± 8.36 P < 0.0001), and 24 W (-11.6 ± 7.29, P < 0.0001). The discontinuation and adverse event rates in patients who underwent LUR were 23.1 % and 37.2 %, respectively.

LUR significantly improved depressive symptoms in patients with BD2 at 8 W. Moreover, treatment with LUR resulted in early improvement at 2 W and efficacy for 24 weeks. In summary, LUR demonstrated effectiveness and safety in acute depressive episodes of BD2, including mid-term efficacy in real-world clinical settings.

This retrospective observational study aims to evaluate the incidence, disease burden, and geographic distribution of bipolar disorder based on hospital records in Ecuador over an eleven-year span. Hospital discharge data, publicly available from 2011 to 2021, were analyzed to assess incidence, DALYs, and the spatial distribution of hospitalized cases during this period. Between 2010 and 2021, a total of 6,821 hospitalized cases of bipolar disorder were documented in Ecuador, comprising 2,423 males and 4,398 females. The incidence rate peaked in 2019, with the lowest rate reported in 2020. There was no linear association between time and incidence rates or number of cases, but a significant increase was observed from 2017 to 2019 (p < 0.0001). The incidence rate was significantly higher in females compared to males (p < 0.0001). The average annual incidence was 3.47 cases per 100,000 person-years. The mean age at diagnosis was 40.76 years, with females being diagnosed at a younger age than males (p = 0.01548). Bipolar disorder-related deaths totaled 27 (12 males, 15 females). The burden of disease, expressed in DALYs, ranged from 66.769 to 126.98 per 100,000 population, with the hospitals from the private sector contributing most to the average DALYs. YLDs represented over 99% of the total burden. This study highlights the significant gender differences and temporal trends in bipolar disorder incidence in Ecuador, emphasizing the need for targeted public health strategies.

Bipolar disorder is characterized by alternating episodes of mania or hypomania and depression, encompassing various forms such as cyclothymia, bipolar I disorder, and bipolar II disorder. Manic periods present with increased energy and decreased sleep, whereas depressive episodes involve poor energy and extended sleep duration. Despite the availability of treatments, approximately 30% of patients with bipolar disorder are drug resistant and require alternative strategies. Recent research highlights the role of long noncoding RNAs (lncRNAs) as potential biomarkers for bipolar disorder, aiding in distinguishing it from other mood disorders and improving diagnostic accuracy. LncRNAs such as GAS5 and FOXD3-AS1 are downregulated in bipolar disorder patients, suggesting their utility as diagnostic tools. LncRNAs regulate gene expression through interactions with DNA, RNA, and proteins, influencing various biological processes. Studies have identified several lncRNAs linked to bipolar disorder, including lincRNA-p21, lincRNA-ROR, and lincRNA-PINT. These findings underscore the potential of lncRNAs as biomarkers and therapeutic targets, facilitating more personalized treatment strategies. This review explores the diagnostic and therapeutic potential of lncRNAs in bipolar disorder, aiming to enhance the current understanding and management of this condition.

Less than 50 % of people with bipolar disorder (BD) receive best-practice care. Consensus methods can address this gap by including BD knowledge-users in setting priorities and creating actionable solutions. The objective of this scoping review is to identify, map and synthesize the evidence on consensus methods used for advancing care for people with BD.

We conducted a scoping review according to JBI methodologies. Systematic searches were performed using MEDLINE, EMBASE, PsycInfo, and CINAHL, for studies published in English, from 2000 to 2023. Only primary peer-reviewed articles that used evidence-informed consensus or prioritization methods that involved adults with BD and/or caregivers or family members were included. Articles were analyzed for: type-of-consensus methods; study characteristics; and methodological limitations.

Nine studies met our inclusion criteria. Participants of those studies included people with lived experience of BD, caregivers, healthcare providers, researchers and mental-health-advocates with lived experience. Five studies utilized Delphi as their consensus method; additional consensus methods included online surveys, focus groups, panels and prioritization rankings. The key methodological limitations that were identified were: participant diversity, lack of a co-design approach, low retention rates, and lack of guidelines for the approaches used.

Studies were published in English only, did not include non-BD mood disorders and excluded BD youth.

Studies utilizing consensus methods for persons living with BD have highlighted their utility for informing strategic research investment, and developing healthcare systems and guidelines. We provide recommendations for future applications of these methods in BD populations.

Individuals with mental disorders frequently use YouTube to express themselves, reach an audience, or as a means of understanding their condition. Testimonies posted on YouTube provide longer and richer perspectives than the short posts found on other social media platforms. Research focusing on the depiction of mental disorders on YouTube is blossoming. Bipolar disorders (BDs) are disabling mood disorders. The diagnosis of any mental disorder, and more so BD, is often a life-changing event. However, no published study has investigated the portrayal of diagnoses of BD on YouTube.

This study aims to investigate the portrayals of BDs on YouTube, focusing on the diagnosis narratives and their accompanying narrative context, in particular, reports of personal experiences and reactions.

We performed a manual content analysis of 39 testimonies (women: n=24, 62%) depicting BDs and their diagnosis by individuals with BD. We also performed a thematic analysis of the corpus relying upon a deductive and inductive approach.

Our manual content analysis revealed that portrayals included the disclosure of diagnoses of BD-I (as per both coders' agreement: 10 testimonies) and BD-II (11 testimonies) to a similar extent. The reactions to the diagnosis were mostly negative (8 testimonies), followed by positive (5 testimonies), while fewer portrayals indicated a denial of the condition (4 testimonies). Several portrayals made mention of issues in the areas of money and accommodation (15 testimonies), profession and education (13 testimonies), and relationships (20 testimonies). Medication (31 testimonies) and psychotherapy (23 testimonies) were often mentioned as part of treatment for BD, most generally in positive terms. The 8 themes emerging from the thematic analysis were: "reactions on diagnosis, treatment, and health care professionals' expertise," "trial and error in medication," "positive effects of BD," "disability, stigma, and shame," "loss," "family planning and genetics," "identity change (psychological and physical)," and "human social relationships."

Overall, our results underline the complexity and richness of the depiction of the diagnosis of BD and its narrative context, and highlight the importance of the moment of the diagnosis, medication, and psychotherapy. Our study emphasizes the need for further exploration of the impact of social media on mental health awareness.

To date, no studies have investigated the efficacy of theta burst stimulation (TBS) in the treatment of bipolar disorder (BD), and the results are inconclusive.

We aim to systematically review the existing literature related to the efficacy of TBS in BD and synthesize the results through meta-analysis.

We searched for PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of science, PsycINFO, CNKI, and Wan fang databases without language restriction through July 30, 2023, and included randomized-controlled trials that assessed the treatment effect of TBS in patients with BD. We used a random-effects model to pool effect sizes, which were expressed as Cohen's d (or Odds ratio) and 95% confidence intervals (CIs). The outcome measures include changes in Montgomery-Asberg Depression Rating Scale (MADRS) scores, response and remission rates of depression, and dropout rates.

Eight randomized sham-controlled trials were included in the meta-analysis. The overall effect size of the outcome measures, including changes in MARDS scale scores, response rate, and remission rates, were -0.81 (95% confidence interval [CI]: 4.07 to 2.44), 1.07 (95% CI: 0.47 to 2.44) and 0.74 (95% CI: 0.38 to 1.45), respectively. Notably, the TBS group showed favorable efficacy without major adverse events.

Current studies indicate that TBS does not show significant antidepressant efficacy in patients with BD, although it is very well tolerated.

Bipolar disorder (BD) imposes significant social, psychological, and economic burdens on individuals and their caregivers. While developing treatments for BD patients is crucial, supportive interventions for caregivers in low- and middle-income countries (LMICs) are equally important, given the limited resources and healthcare infrastructure. Understanding caregiver experiences in these settings is essential for creating effective interventions. This scoping review synthesizes knowledge of caregiver experiences in assisting individuals with BD in LMICs.

Following Arksey and O'Malley's scoping review framework, we examined quantitative and qualitative studies on caregiver experiences. A comprehensive literature search was conducted across five databases, with two authors independently screening studies, extracting data, and reviewing references for additional eligible studies. Findings are presented through narrative synthesis according to PRISMA-ScR guidelines.

Out of 3518 records, 104 studies met the eligibility criteria. Five main themes and eight subthemes were identified: (1) burden of caregiving (impaired quality of life), (2) caregiver challenges (lack of understanding, family/social disruptions, financial restraints, mental and physical fatigue), (3) caregiver needs (information access, involvement, social support, financial assistance), (4) coping mechanisms, and (5) the silver lining in caregiving.

This review highlights significant challenges faced by caregivers of individuals with BD in LMICs, emphasizing the need for better psychoeducation, healthcare communication, and supportive resources. Addressing financial constraints and stigma is also crucial. Future research should focus on culturally adapting evidence-based strategies to support caregivers in these settings.

Background/Objectives: Emerging laboratory technologies, such as breathomics, may enhance the early diagnosis of psychiatric disorders, including Bipolar Disorder (BD). This study investigates the detection of volatile sulfur compounds (VSCs) in exhaled breath as potential biomarkers for BD, comparing VSC levels between individuals with BD, healthy controls, and individuals with non-pathological hyperactivity. Methods: A matched case-control study was conducted involving 24 patients with BD and 95 healthy controls recruited at the University Hospital of Cagliari. Controls were selected using a matched-pair design based on age (±5 years) and sex through a block-matching technique to ensure comparability with cases. Participants underwent psychiatric interviews, completed the Mood Disorder Questionnaire (MDQ), and had their exhaled breaths analyzed for VSCs using a gas chromatograph (OralChroma™). Controls were selected and randomized for age and sex. Results: Patients with BD exhibited significantly higher levels of methyl mercaptan (CH3SH) compared to healthy controls (18.62 ± 5.04 vs. 9.45 ± 18.64 ppb, p = 0.022). Among individuals without BD, those with positive MDQ scores showed lower levels of CH3SH than those with negative scores (9.17 ± 5.42 vs. 15.05 ± 18.03); however, this difference did not reach statistical significance (p = 0.254), highlighting how the deep connection between some clinical and laboratory aspects needs to be investigated more thoroughly. Conclusions: The results suggest a correlation between oral dysbiosis and metabolic alterations in patients with BD, with CH3SH levels being higher in cases compared to controls. Further studies are needed to validate the use of VSCs as potential biomarkers for BD and to investigate their role in individuals with non-pathological hyperactivity.

Background and Objectives: In recent years, bipolar disorder (BD), a multifaceted mood disorder marked by severe episodic mood fluctuations, has been shown to have an impact on disability-adjusted life years (DALYs). The increasing prevalence of BD highlights the need for better diagnostic tools, particularly those involving genetic insights. Genetic association studies can play a crucial role in identifying variations linked to BD, shedding light on its genetic underpinnings and potential therapeutic targets. This study aimed to identify novel genetic variants associated with BD in the Taiwanese Han population and to elucidate their potential roles in disease pathogenesis. Materials and Methods: Genotyping was conducted using the Taiwan Precision Medicine Array (TPM Array) on 128 BD patients and 26,122 control subjects. Following quality control, 280,177 single nucleotide polymorphisms (SNPs) were analyzed via chi-square tests, and linkage disequilibrium (LD) analyses were employed to examine the associations among key SNPs. Results: Eleven SNPs reached significance (p < 10-5), with the variant rs11156606 in the ABCD1 gene-implicated in fatty acid metabolism-emerging as a prominent finding. LD analysis revealed that rs11156606 is strongly linked with rs73640819, located in the 3' untranslated region, suggesting a regulatory role in gene expression. Additionally, rs3829533 in the MTHFSD gene was found to be in strong LD with the missense variants rs3751800 and rs3751801, indicating potential alterations in protein function. Conclusion: These findings enhance the genetic understanding of BD within a Taiwanese cohort by identifying novel risk-associated variants and support the potential for using these markers in early diagnosis and targeted therapeutic strategies.

Although accumulating studies have explored the neural underpinnings of intelligence quotient (IQ) in patients with bipolar disorder (BD), these studies utilized a classification/comparison scheme that emphasized differences between BD and healthy controls at a group level. The present study aimed to infer BD patients' IQ scores at the individual level using a prediction model.

We applied a cross-validated Connectome-based Predictive Modeling (CPM) framework using resting-state fMRI functional connectivity (FCs) to predict BD patients' IQ scores, including verbal IQ (VIQ), performance IQ (PIQ), and full-scale IQ (FSIQ). For each IQ domain, we selected the FCs that contributed to the predictions and described their distribution across eight widely-recognized functional networks. Moreover, we further explored the overlapping patterns of the contributed FCs for different IQ domains.

The CPM achieved statistically significant prediction performance for three IQ domains in BD patients. Regarding the contributed FCs, we observed a widespread distribution of internetwork FCs across somatomotor, visual, dorsal attention, and ventral attention networks, demonstrating their correspondence with aberrant FCs correlated to cognition deficits in BD patients. A convergent pattern in terms of contributed FCs for different IQ domains was observed, as evidenced by the shared-FCs with a leftward hemispheric dominance.

The present study preliminarily explored the feasibility of inferring individual IQ scores in BD patients using the FCs-based CPM framework. It is a step toward the development of applicable techniques for quantitative and objective cognitive assessment in BD patients and contributes novel insights into understanding the complex neural mechanisms underlying different IQ domains.

To assess whether bipolar disorders are associated with the risk of HIV infection and whether the risk of bipolar disorders is increased among people with HIV (PWH) and their siblings.

Nationwide, population-based, combined matched nested case-control and cohort study of PWH of Danish origin (1995-2021), a comparison cohort from the background population, matched on date of birth and sex, and sibling cohorts.

Conditional logistic regression and Cox regression was used to calculate adjusted odds ratios (aORs) for HIV infection and hazard ratios among PWH for bipolar disorder and receipt of lithium.

We included 5322 PWH and 53 220 comparison cohort members. In the case-control study, bipolar disorder was associated with an increased risk of HIV infection [aOR: 1.9, 95% confidence interval (CI): 1.2-3.0], especially when injection drug use was the route of infection (aOR: 7.6, 95% CI: 2.0-28.9). In the cohort study, we observed an increased risk of bipolar disorders among PWH, especially in the first 2 years of observation (hazard ratio: 4.2, 95% CI: 2.4-7.4), whereas the risk of receipt of lithium was lower and the CI crossed 1. The 20-year risk of bipolar disorders for PWH was approximately 1%. Siblings of PWH also had an increased risk of bipolar disorder but not to the same degree as PWH and not of receipt of lithium.

Bipolar disorders are associated with the risk of HIV infection, and PWH have increased risk of bipolar disorder and receipt of lithium beyond what familial factors could explain.

Bipolar disorder (BD) is psychiatric disorder of not fully acknowledged pathophysiology. Studies show the involvement of innate-immune system activation and inflammation in BD course and treatment efficiency. Microglia are crucial players in the inflammatory response possibly responsible for BD innate-immune activity. Lithium is a mood stabilizer used in treatment for 75 years. Immunomodulation was previously described as one of the potential modes of its action. We hypothesized that lithium might modulate the microglia response to innate-immune-associated cytokines (10 ng/mL TNF-α, 50 ng/mL IL-1β, 20 ng/mL IFN-γ). We aimed to investigate whether lithium treatment and pretreatment of microglia modify the expression of genes associated with NLRP3 inflammasome. We also aimed to verify lithium treatment effect on caspase activity and extracellular IL-1β concentration. For the first time, our study used human microglial cell line - HMC3, the cytokine stimuli and lithium in concentration corresponding to that in the brains of patients. To analyze lithium mode of action, we analyzed the short- and long-term treatment and pretreatment. To assess the influence on microglia responding to innate-immune cytokines, we analyzed the expression of genes involved in innate-immune and inflammasome (TSPO, TLR4, NFKB1, CASP1, CASP4, NLRP3, IL-1β, IL-6), caspase activity, extracellular IL-1β concentration, phospho-GSK-3β(Ser9) expression and lactate concentration. We found that lithium treatment significantly reduced NLRP3 inflammasome-related genes expression. We observed that lithium treatment reduces inflammasome activity, which may attenuate the inflammatory state. Interestingly, the lithium pretreatment resulted in significantly elevated inflammasome activity, suggesting that lithium does not impair the immune response to additional stimuli.

As global gene discovery efforts move away from a historic Eurocentric focus and advance toward embracing more diverse populations, consideration of sociocultural aspects of bipolar disorder (BD) become critical to their success. Diversity can be leveraged to accelerate gene discovery, via different patterns of linkage disequilibrium that lead to greater resolution of mapping association signals, and convergence of genes and pathways implicated within and across diverse ancestral groups, improving our understanding of the molecular underpinnings of disease. However, it is not just the differences in linkage disequilibrium structure and allele frequency that drive differences in genomic signals between populations. In this review, we focus on the role of social, cultural, and societal factors on BD and their potential impact on disease prevalence, clinical course and outcome, and disease burden. Social, cultural, and geographical differences in expression of symptoms and frequency of clinical subtypes in BD present both opportunities for and challenges to the field. In this era of global multiancestry research, resources that facilitate the collection and harmonization of data from culturally and ancestrally diverse population groups will enhance our ability to gain true biological understanding. Such resources are essential to disambiguate the genetic and environmental components of disease risk, as well as inform effective lifestyle interventions to improve outcome for global citizens living with BD.

Neuroimaging is a powerful noninvasive method for studying brain alterations in bipolar disorder (BD). To date, most neuroimaging studies of BD have included smaller cross-sectional samples reporting case versus control comparisons, revealing small to moderate effect sizes. In this narrative review, we discuss the current state of structural neuroimaging studies using magnetic resonance imaging, which inform our understanding of altered brain trajectories in BD across the lifespan. Alternative methodologies such as those that model patient deviations from age-specific norms are discussed, which may help derive new markers of BD pathophysiology. We discuss evidence from neuroimaging genetics and transcriptomics studies, which attempt to bridge the gap between macroscale brain variations and underlying microscale neurodevelopmental mechanisms. We conclude with a look toward the future and how ambitious investments in longitudinal, deeply phenotyped, population-based cohorts can improve modeling of complex clinical factors and provide more clinically actionable brain markers for BD.

Old age bipolar disorder (OABD), increasingly common as the population ages, presents unique diagnostic and treatment challenges. This selective review focuses on issues especially relevant to outpatient management.

People with OABD may have similar frequency and severity of mood episodes compared to younger adults. Depression predominates, and mixed symptoms in both depressive and manic episodes are common. Comorbidity and excess mortality are high, with a particular bidirectional association with cerebrovascular disease. Lithium may outperform valproic acid and second-generation antipsychotics in efficacy. Tolerability and long-term safety can be improved with relatively lower target drug therapeutic levels. Outpatient clinicians treating OABD should take an active role in the recognition and management of medical comorbidities. A careful history and examination might reveal subtle signs of bipolar disorder or mixed features and change treatment. A primary target for treatment is to reduce polypharmacy when appropriate. Further trials are needed to make specific and clear recommendations in OABD.

Mental disorders (MDs) are among the major causes of morbidity and mortality worldwide. Individuals with severe MDs have a shorter life expectancy, primarily due to cardiovascular diseases. Echocardiography facilitates the evaluation of alterations in cardiac morphology and function, resulting from various cardiac pathologies. The aim of this review was to explore the current evidence base behind the myocardial deformation observed in echocardiography in patients with MDs. We primarily focused on the data regarding speckle tracking echocardiography. PubMed, using medical subject headings, was searched to identify studies on this topic. The collected data demonstrated changes in myocardial function in schizophrenia, bipolar disorder, depression, anxiety disorder, stressor-related disorder, post-traumatic stress disorder, eating disorders, sleep-wake disorders, substance-related and addictive disorders, neurocognitive disorders, and borderline personality disorder. The recurrent findings included impaired Left Ventricular Ejection Fraction and Left Ventricular Hypertrophy. Global Longitudinal Strain was significantly altered in patients with anorexia nervosa, bipolar disorder, and substance-related disorders. All reported studies support the consideration of cardiology consultations and a multidisciplinary approach in the care of patients with MDs with suspected cardiac dysfunction. Further investigation is warranted to determine the significance and prognostic value of myocardial deformation and strain measurements among individuals with MDs, focusing on the value of early detection, especially in asymptomatic cases.

Bipolar disorder (BD) is a chronic and often severe mental illness. Yet despite the well-documented complexities in its diagnosis and treatment, little research has been dedicated to understanding the complex inner landscape experienced by those living with BD. Even as qualitative research has explored the lived experience of BD across a variety of perspectives, i.e., what BD looks like, there is a lack of research exploring what BD means to those living with the condition. We conducted individual, semi-structured interviews with 20 adults with clinically stable BD to explore their perceptions of the condition, their construction of meaning of their illness, and their view of BD in relation to their sense of self. We coded the transcripts according to the principles of thematic analysis and analyzed the data using an interpretative phenomenological analysis approach.

We identified three overarching domains: (1) Benefit or burden: a dialectic through which participants weighed the valence of their illness over time; (2) Self or other: the internal or external locus through which they experienced BD; and (3) From ineffability to meaning making: the process of naming, understanding, and incorporating BD into their life's whole. Within each domain, themes and subthemes outline nuanced and often conflicting perspectives of participants' illness experiences.

Across the varied and nuanced perspectives uncovered, our work provides a framework of three domains central to the inner reality of lived bipolar experience. Thoughtful understanding of patients' experiences, perspectives, and desires within these three domains may aid clinicians and loved ones alike in more sensitively and effectively addressing the unique individual needs of those living with BD. It may also be informative for individuals living with BD themselves. By exploring patients' perspectives in each of the three domains we identified, those with or at risk for BD as well as those caring for people with BD may be better positioned to help identify the inner work and practical interventions (such as finding bipolar community, or pathways to occupational thriving) needed to achieve a rich, meaningful life with BD.

Bipolar disorder (BD) is a severe mental illness characterized by significant mood swings. Effective drug treatment modalities are crucial for managing BD.

To analyze the current status and future trends of global research on BD drug treatment over the last decade.

The Web of Science Core Collection database spanning from 2015 to 2024 was utilized to retrieve literature related to BD drug treatment. A total of 2624 articles were extracted. Data visualization and analysis were conducted using CiteSpace, VOSviewer, Pajek, Scimago Graphica, and R-studio bibliometrix to identify research hotspots, key contributors, and future trends.

The United States, China, and the United Kingdom have made the most significant contributions to research on BD drug treatment and formed notable research collaboration networks. The University of Pittsburgh, Massachusetts General Hospital, and the University of Michigan have been identified as the major research institutions in this field. The Journal of Affective Disorders is the most influential journal. A keyword analysis revealed research hotspots related to clinical symptoms, drug efficacy, and genetic mechanisms. A citation analysis identified the management guidelines published by Yatham et al in 2018 as the most cited paper.

This study provides a detailed overview of the field of BD drug treatment, highlighting key contributors, research hotspots, and future directions. The study findings can be employed as a reference for future research and policymaking, which may enable further development and optimization of BD pharmacotherapy.

This study aims to investigate the prospective associations between four types of perceived discrimination (country of origin, race and ethnicity, sexual orientation, and weight) and the development of manic symptoms in a diverse, nationwide sample of adolescents aged 9-14 years in the U.S.

We analyzed prospective cohort data from the Adolescent Brain Cognitive Development Study (N = 7466; ages 9-14 years at Year 1 or 2 in 2017-2020; 48.5 % female; 39.4 % racial/ethnic minority). Multiple zero-inflated negative binomial analyses were conducted to examine the associations between Year 1 or 2 discrimination (by country of origin, race and ethnicity, sexual orientation, weight, sum score), and Year 3 manic symptoms (7 Up Mania scale), adjusting for covariates (age, sex, race and ethnicity, household income, parental education, sipping alcohol, puffing tobacco, anxiety symptoms, depressive symptoms, Year 1 manic symptoms, and study site).

After adjusting for covariates, perceived discrimination based on country of origin (incidence rate ratio [IRR] = 1.46; 95 % confidence interval [CI] 1.15-1.86), sexual orientation (IRR = 1.36; 95 % CI 1.21-1.53), race and ethnicity (IRR = 1.28; 95 % CI 1.13-1.46), weight (IRR = 1.21 95 % CI 1.09-1.34), and sum scores (IRR = 1.18 5 % CI 1.12-1.24), were significantly associated with higher manic symptoms.

Perceived discrimination based on country of origin, race and ethnicity, sexual orientation, weight, and sum scores, are prospectively associated with greater manic symptoms in adolescents. These findings underscore the need for targeted interventions to address discrimination and associated psychological impacts. Efforts to reduce discrimination and to support affected adolescents are important components of comprehensive mental health care and public health strategies.

Obstructive sleep apnea (OSA) has been increasingly recognized as a comorbidity in many psychiatric disorders, including bipolar disorder (BD). This study aimed to synthesize existing evidence to determine the frequency of OSA in patients diagnosed with BD and identify potential predictors of its occurrence.

PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases were searched for English-language papers published up from 1st January 1960 to 31st October 2023 that reported incidences of OSA in patients with BP and provided sufficient data for quantitative analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane Handbook (version 5.1.0) guidelines were followed. Meta-regression analyses were done to identify predictors that correlate with the prevalence of obstructive sleep apnea.

The systematic review identified a total of 14 eligible studies. The pooled prevalence of OSA in individuals with BD was determined to be [24.55%] (95% confidence interval (CI): [17.25 to 32.63%, I2=99.57%]). Meta-regression analyses showed that male gender was associated with a higher prevalence of OSA, while body mass index (BMI) and mean age showed no significance in predicting OSA prevalence.

Our results demonstrated higher incidence of OSA in patients with BD. Male BD patients had higher rate of OSA.

Although resourcefulness has been successfully taught during formal training programs, it can also be acquired informally through life experiences. Family caregivers have many opportunities for learning to be resourceful on their own and those who participate in research may acquire knowledge or skills that increase their resourcefulness. The effects of such differential experiences on the resourcefulness of family caregivers have not been examined over time.

This study compared changes in resourcefulness over time in caregivers who received no intervention, an educational program, biofeedback, or Resourcefulness Training©.

This longitudinal analysis of data from a randomized controlled trial involved 219 caregivers of persons with bipolar disorder who completed the Resourcefulness Scale© before no intervention, an educational program, biofeedback, or Resourcefulness Training, and at 6 and 12 months afterward. Differences across the groups were examined using RMANOVA. Patterns of mean scores including differences and linear trends in resourcefulness for the four groups were examined.

Overall, caregivers increased linearly in resourcefulness over time [F(1,215) = 4.836, P = .015]. Although each group showed improvement in resourcefulness, caregivers who received Resourcefulness Training showed the greatest improvement from baseline (estimated mean = 88.244, SE = 2.734) at both 6 months (estimated mean = 92.610, SE = 2.813, P = .026) and 12 months post-intervention (estimated mean = 95.049, SE = 2.752, P = .003).

Consistent with resourcefulness theory, the findings showed caregivers of persons with bipolar disorder became more resourceful over time with or without formal training. However, those who received Resourcefulness Training demonstrated resourcefulness skills sooner and to a greater extent, thereby providing the rationale for formal Resourcefulness Training programs.

Bipolar disorder (BD) is a neuropsychiatric disorder characterized by severe disturbance and fluctuation in mood. Dynamic functional connectivity (dFC) has the potential to more accurately capture the evolving processes of emotion and cognition in BD. Nevertheless, prior investigations of dFC typically centered on larger time scales, limiting the sensitivity to transient changes. This study employed hidden Markov model (HMM) analysis to delve deeper into the moment-to-moment temporal patterns of brain activity in BD. We utilized resting-state functional magnetic resonance imaging (rs-fMRI) data from 43 BD patients and 51 controls to evaluate the altered dynamic spatiotemporal architecture of the whole-brain network and identify unique activation patterns in BD. Additionally, we investigated the relationship between altered brain dynamics and structural disruption through the ridge regression (RR) algorithm. The results demonstrated that BD spent less time in a hyperconnected state with higher network efficiency and lower segregation. Conversely, BD spent more time in anticorrelated states featuring overall negative correlations, particularly among pairs of default mode network (DMN) and sensorimotor network (SMN), DMN and insular-opercular ventral attention networks (ION), subcortical network (SCN) and SMN, as well as SCN and ION. Interestingly, the hypoactivation of the cognitive control network in BD may be associated with the structural disruption primarily situated in the frontal and parietal lobes. This study investigated the dynamic mechanisms of brain network dysfunction in BD and offered fresh perspectives for exploring the physiological foundation of altered brain dynamics.

This study aims to determine the prevalence of psychiatric disorders in the sample population in a barangay in the City of Balanga, Bataan using the MINI International and Neuropsychiatric Interview and to describe the profile of those with psychiatric disorders based on sociodemographic and health characteristics.

This is a cross sectional study from Barangay Tenejero, City of Balanga, Bataan done in 2019. Systematic random sampling was done where all zones were included. Sample size was 432 households (with at least one adult per household) based on a level of significance of 5%. Data were obtained using the sociodemographic profile, health profile, MINI International Neuropsychiatric Interview Screen and MINI International Neuropsychiatric Interview 6 done through face-to-face interview. Descriptive statistics were used in analysis.

Forty-four of the participants have a diagnosis of at least one psychiatric disorder (10.50%). Of these, the most common psychiatric disorders were major depressive disorder (3.58%) followed by any psychotic disorder (1.91%) and generalized anxiety disorder (1.91%). Among the population, 3.10% have suicidal behavior. Psychiatric disorders are more common among women and people with low incomes. Among those with psychiatric disorders, mental health service utilization is low with only 4.55-6.82%.

This study reports for the first time the prevalence of psychiatric condition in a barangay in the City of Balanga, Bataan. Though the prevalence rate (10.50%) is low compared to other community data, the findings emphasize the need for strategies to promote mental disorder diagnosis and treatment. This study will influence and guide contextualized community mental health services and policies.

In bipolar disorder (BD), mania may be self-induced by manipulation of specific precipitants, as reported in case studies. Another potential source of information on the self-induction of mania is the online postings of users with lived experience of mania.

The primary aim of this study is to examine the range of methods used to self-induce mania or hypomania described by users of online forums with self-reported BD. Second, we summarize the motivations of users to engage in these behaviors.

We conducted an observational study of online forum posts that discussed self-induction of mania or hypomania, either in the posters themselves or observed firsthand in others. Posts were identified using Google advanced search operators, then extracted and coded for content in NVivo (version 12 for Mac; QSR International). A total of 44 online forum threads were identified discussing self-induced mania (n=25) or hypomania (n=19). These forums contained 585 posts by 405 usernames, of which 126 usernames discussed methods for self-induction across 327 posts (number of methods per username: median 2, IQR 1-4; range 1-11).

In total, 36 methods were grouped by the authors. The most frequently reported were sleep reduction (n=50), caffeine (n=37), and cessation of medication (n=27). Twenty-six usernames reported their motivation to self-induce mania or hypomania; almost three-quarters (n=19) reported a desire to end a depressive episode. Almost a third of usernames (118/405) explicitly discouraged other forum users from self-inducing mania or hypomania.

Online forums provide an additional and valuable source of information about triggers for mania that may inform relapse prevention in BD. The online forum conversations investigated were generally responsible and included cautionary advice not to pursue these methods.

Objective: Bipolar disorder (BD) is a challenging psychiatric disorder and a complex disease. The associated reduction in serum vitamin D3 (VitD3) levels in BD patients and the contribution of zinc (Zn) to the treatment, along with the severe side effects of lithium (Li) treatment, were encouraging to assess the efficacy of different correlated combinations of therapeutic/nutraceutical treatments such as olanzapine (Oln), VitD3, and Zn against Li. Methods: Mania was induced in C57BL/6 mice by administering methylphenidate (MPH) for 14 consecutive days. On the 8th day of MPH injection, different treatment regimens were administered, Li, Oln, VitD3/Zn, VitD3/Zn/Oln, VitD3 + Zn + Oln + Li50mg/kg (C50), and VitD3 + Zn + Oln + Li100mg/kg (C100). Both VitD3 (850 IU/kg) and Zn (180 mg/kg) were supplied with food for 2 weeks before starting the induction of mania, which continued until the end of MPH administration. Behavioral, brain oxidative stress, thyroid hormones, VitD3, Zn, GsK-3β, and Bcl2 levels, as well as brain histopathological alterations, were assessed. Results: Manic mice exhibited alterations in all tested parameters, and the histopathological examination of the cortex and hippocampus confirmed these results. The VitD3/Zn/Oln, C50, and C100 treatment regimens reversed most of the behavioral and pathophysiological alterations; however, the C50 treatment regimen was the most efficient. Conclusions: This study emphasizes the importance of combining different antimanic medications like Li and Oln with nutraceutical supplements to increase their antimanic efficacy, reduce their adverse effects, and, ideally, improve the BD patient's quality of life.

There is limited evaluation of approaches to identify patients with new onset bipolar affective disorder (BPAD) when using administrative datasets.

Using the Massachusetts All-Payer Claims Database (APCD), we identified individuals with a 2016 diagnosis of bipolar disorder with mania and examined patterns of psychiatric and medical care over the preceding 48 months.

Among 4806 individuals aged 15-35 years with a 2016 BPAD with mania diagnosis, 3066 had 48 months of historical APCD data, and of those, 75 % involved information from ≥2 payors. After excluding individuals with historical BPAD or mania diagnoses, there were 583 individuals whose 2016 BPAD with mania diagnosis appeared to be new (i.e., 34 new diagnoses per 100,000 individuals aged 15-35 years). Most individuals received medical care, e.g., 98 % had outpatient visits, 76 % had Emergency Department (ED) visits, and 50 % had mental health-related ED visits during the 48 months prior to their first mania diagnosis. One-third (37.2 %) had a depressive episode before their initial BPAD with mania diagnosis.

Study was conducted in one state among insured individuals. We used administrative data, which permits evaluation of large populations but lacks rigorous, well-validated claims-based definitions for BPAD. There could be diagnostic uncertainty during illness course, and clinicians may differ in their diagnostic thresholds.

Careful examination of multiple years of patient history spanning all payors is essential for identifying new onset BPAD diagnoses presenting with mania, which in turn is critical to estimating population rates of new disease and understanding the early course of disease.

Bipolar disorder (BD) is a recurrent chronic disorder characterised by fluctuations in mood and energy disposition. Diseases could lead to degenerative alterations in brain structures such as corpus callosum (CC). Studies demonstrated that abnormalities in CC are associated with BD symptoms. The present study aims to analyse the CC of the patients with statistical shape analysis (SSA) and compare the findings with healthy controls.

Forty-one BD patients and 41 healthy individuals in similar age groups, which included 23 female and 18 male subjects, participated in the study. CC was marked with landmarks on the mid-sagittal images of each individual. The mean 'Procrustes' point was calculated, and shape deformations were analysed with thin-plate spline analysis.

Significant differences were observed in the shape of CC between the two groups, where maximum CC deformation was observed in posterior region marks in BD patients. There was no significant difference between the CC area of the BD patients and controls.

CC analysis conducted with SSA revealed significant differences between patients and healthy controls. The study findings emphasised the abnormal distribution of white matter in CC and the variable subregional nature of CC in BD patients. This study may enable the development of more targeted and effective treatment strategies by taking into account biological factors and understanding the differences in the brain regions of individuals with BD.

Bipolar disorder (BD) is a psychiatric condition that is frequently misdiagnosed and linked to inadequate treatment. Long non-coding RNAs (lncRNAs) have lately gained recognition as crucial genetic elements and are now regarded as regulatory mechanisms in the neurological system. Our objective was to measure the quantities of HOXA-AS2 and MEG3 ncRNA transcripts. HOXA-AS2 and MEG3 ncRNA levels were checked in the peripheral blood of 50 type I BD and 50 control samples by real-time PCR. Furthermore, we conducted ROC curve analysis and correlation analysis to examine the association between gene expression and specific clinical characteristics in instances with BD. Additionally, a computational study was performed to investigate the binding sites of miRNAs on the HOXA-AS2 and MEG3 lncRNAs. BD subjects showed a significant increase in the expression of HOXA-AS2 and MEG3 compared to controls. The lncRNAs HOXA-AS2 and MEG3 have an area under the ROC curve (AUC) values of 0.70 and 0.71, respectively. There was a significant correlation between the expression levels of ncRNAs HOXA-AS2 and MEG3 in the peripheral blood of patients with BD and occupation scores. The data presented indicate a potential correlation between the expression of HOXA-AS2 and MEG3 lncRNAs with an elevated risk of BD. Furthermore, these lncRNAs may be linked to several molecular pathways. Our findings indicate that the amounts of lncRNAs HOXA-AS2 and MEG3 in transcripts might be a promising potential biomarker for patients with BD.

Genetic contributions to human cortical structure manifest pervasive pleiotropy. This pleiotropy may be harnessed to identify unique genetically-informed parcellations of the cortex that are neurobiologically distinct from functional, cytoarchitectural, or other cortical parcellation schemes. We investigated genetic pleiotropy by applying genomic structural equation modeling (SEM) to map the genetic architecture of cortical surface area (SA) and cortical thickness (CT) for 34 brain regions recently reported in the ENIGMA cortical GWAS. Genomic SEM uses the empirical genetic covariance estimated from GWAS summary statistics with LD score regression (LDSC) to discover factors underlying genetic covariance, which we are denoting genetically informed brain networks (GIBNs). Genomic SEM can fit a multivariate GWAS from summary statistics for each of the GIBNs, which can subsequently be used for LD score regression (LDSC). We found the best-fitting model of cortical SA identified 6 GIBNs and CT identified 4 GIBNs, although sensitivity analyses indicated that other structures were plausible. The multivariate GWASs of the GIBNs identified 74 genome-wide significant (GWS) loci (p < 5 × 10-8), including many previously implicated in neuroimaging phenotypes, behavioral traits, and psychiatric conditions. LDSC of GIBN GWASs found that SA-derived GIBNs had a positive genetic correlation with bipolar disorder (BPD), and cannabis use disorder, indicating genetic predisposition to a larger SA in the specific GIBN is associated with greater genetic risk of these disorders. A negative genetic correlation was observed between attention deficit hyperactivity disorder (ADHD) and major depressive disorder (MDD). CT GIBNs displayed a negative genetic correlation with alcohol dependence. Even though we observed model instability in our application of genomic SEM to high-dimensional data, jointly modeling the genetic architecture of complex traits and investigating multivariate genetic links across neuroimaging phenotypes offers new insights into the genetics of cortical structure and relationships to psychopathology.

In the current literature the influence of sex on the clinical presentation of the bipolar disorder (BD) in adults has been indicated. It was of the interest whether such a phenomenon is also present in the pediatric population.

The authors collected retrospective clinical data in 288 patients hospitalized on the psychiatry ward aged 10-17 years; 80.2 % females and 19.8 % males.

No sex differences were observed in the age of onset, the time from the onset of symptoms to the diagnosis of BD, the number of symptoms during hospital stay, or family history of psychiatric disorder (U Mann-Whitney's p > 0.05). In males the most frequently recorded first episode of BD was mania or hypomania (51 %), and in females, a depressive episode (51 %). The main reason for the hospitalization in boys was episodes of mania (63 %), then mixed episodes (30 %), and depression (7 %). Whereas girls were most often hospitalized due to mixed episodes (52 %), less frequently depression (22 %), and mania (26 %). Co-morbid psychiatric disorders were found more often in boys than in girls (63 % vs 45 %; χ2p-value>0.05). The co-occurrence of the dissocial personality, borderline, tic disorders, pervasive developmental disorders and hyperkinetic disorders was different in both sexes.

The main limitations of the study are the very high proportion of female subjects and the retrospective character of the study.

It seems that the clinical presentation of BD in the pediatric population can somewhat depend on the sex of the patients.

For bipolar disorder (BD), the inconsistency of treatment guidelines and the long phases of pharmacological adjustment remain major challenges. BD is known to be comorbid with many medical and psychiatric conditions and they may share inflammatory and stress-related aetiologies, which could give rise to this association. The integrated stress response (ISR) responds to various stress conditions that lead to alterations in cellular homeostasis. However, as a causative mechanism underlying cognitive deficits and neurodegeneration in a broad range of brain disorders, the impact of ISR on BD is understudied. Mendelian randomization has been widely used to repurpose licensed drugs and discover novel therapeutic targets. Thus, we aimed to identify novel therapeutic targets for BD and analyze their pathophysiological mechanisms, using the summary data-based Mendelian Randomization (SMR) and Bayesian colocalization (COLOC) methods to integrate the summary-level data of the GWAS on BD and the expression quantitative trait locus (eQTL) study in blood. We utilized the GWAS data including 41,917 BD cases and 371,549 controls from the Psychiatric Genomics Consortium and the eQTL data from 31,684 participants of predominantly European ancestry from the eQTLGen consortium. The SMR analysis identified the EIF2B5 gene that was associated with BD due to no linkage but pleiotropy or causality. The COLOC analysis strongly suggested that EIF2B5 and the trait of BD were affected by shared causal variants, and thus were colocalized. Utilizing data in EpiGraphDB we find other putative causal BD genes (EIF2AK4 and GSK3B) to prioritize potential alternative drug targets.

Bipolar disorders (BD) are chronic, debilitating disorders. The blood-brain barrier (BBB) has been increasingly investigated in BD. This systematic review aimed to assess the available evidence on the relationship between BD and markers of BBB dysfunction.

A systematic search in PubMed, Embase, PsycINFO, CINAHL and Web of Science was run where the primary outcomes were BBB markers such as S100B, albumin ratio, matrix metalloproteinase (MMP), cell adhesion molecule (CAM), and tight junction proteins. Techniques included blood, cerebrospinal fluid (CSF), post-mortem, genetic and imaging methods in BD compared to healthy controls.

55 studies were identified, 38 of which found an association between BD and markers of BBB dysfunction. 16/29 studies found increased blood/CSF albumin ratio, S100B, CAMs or MMP levels in BD participants compared to controls. 5/19 post-mortem studies found increased levels of chondroitin sulphate proteoglycans, intercellular CAM, neurexin or claudin-5 mRNA in distinct locations throughout the brain in BD compared to controls. One imaging study identified extensive BBB leakage in 30 % of BD participants, compared to 0 % in controls.

The diversity in methodologies used in the included studies makes direct comparison of results challenging. Furthermore, imaging methods are the gold standard, but only one study used them. Other markers are only indicative of BBB permeability.

This review suggests an association between BD and BBB dysfunction. Further research is needed to provide definite answers considering the existing literature's limitations, and to clarify whether this association provides a pathogenic mechanism, or is an epiphenomenon of BD.

Data are needed on differences in community-dwelling populations with bipolar disorder (BP) regarding trust in research and access to care. We characterized community members by lifetime history of bipolar disorder. We hypothesized that those with BP would have less trust in research, visit a health provider less, and participate less in research than those without BP. We also hypothesized that those with BP would be more likely to have a history of marijuana (MJ) use.

A cross-sectional design was used for this analysis. The study population consisted of 12,489 members (78.0%) from the HealthStreet community engagement program who were interviewed by a Community Health Worker about health history and demographics.

Among the sample, the rate of BP was 10.6% (n = 1326). Those reporting BP were more likely than those who did not (n = 11,163), to report muscle, bone, and mental health problems, to be younger, female, to have visited the doctor in the past 12 months, to be interested in participating in research, and be current MJ users. Trust did not differ between BP groups.

Our analysis found that persons with BP had higher access to care and more interest in research, thus our primary hypothesis was rejected. Our secondary hypothesis, that persons with BP were more likely to have a history of MJ use was upheld. These findings are important because they address a crucial gap in the literature surrounding BP and lay the groundwork for future community-level research.

Parental psychosis (bipolar disorder and schizophrenia) are major risk factors for mental health problems in offspring. Although interventions that focus on parenting and the family environment have shown effectiveness in mitigating this risk, no systematic review has examined the impact of simply treating adult bipolar disorder or schizophrenia on their dependent children's outcomes.

To systematically review the effects (in randomized controlled trials) of adult-based interventions for bipolar disorder and schizophrenia, on offspring mental health and wellbeing.

Eligibility criteria included randomized controlled trials that examined the treatment of adults with bipolar disorder and schizophrenia that also included child mental health and wellbeing outcomes. PubMed, Scopus, PsycINFO, and PsychArticles databases were searched.

168,317 studies were reviewed; however, zero studies that met the inclusion criteria could be found.

The existing research aimed at treating adult bipolar disorder and schizophrenia has so far overlooked the potential advantages that these treatments could provide for their offspring. This is a missed opportunity to understand the mechanisms of intergenerational transmission. Researchers examining treatments for adults with bipolar disorder and schizophrenia should, where appropriate, consider including both adult and child mental health outcomes in their trials.

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=431007, identifier CRD42023431007.

Mania is associated with disturbed dopaminergic transmission in frontotemporal regions. D-amphetamine (AMPH) causes increased extracellular DA levels, considered an acknowledged mania model in rodents. Doxycycline (DOXY) is a second-generation tetracycline with promising neuroprotective properties. Here, we tested the hypothesis that DOXY alone or combined with Lithium (Li) could reverse AMPH-induced mania-like behavioral alterations in mice by the modulation of monoamine levels in brain areas related to mood regulation, as well as cytoprotective and antioxidant effects in hippocampal neurons. Male Swiss mice received AMPH or saline intraperitoneal (IP) injections for 14 days. Between days 8-14, mice receive further IP doses of DOXY, Li, or their combination. For in vitro studies, we exposed hippocampal neurons to DOXY in the presence or absence of AMPH. DOXY alone or combined with Li reversed AMPH-induced risk-taking behavior and hyperlocomotion. DOXY also reversed AMPH-induced hippocampal and striatal hyperdopaminergia. In AMPH-exposed hippocampal neurons, DOXY alone and combined with Li presented cytoprotective and antioxidant effects, while DOXY+Li also increased the expression of phospho-Ser133-CREB. Our results add novel evidence for DOXY's ability to reverse mania-like features while revealing that antidopaminergic activity in some brain areas, such as the hippocampus and striatum, as well as hippocampal cytoprotective effects may account for this drug's antimanic action. This study provides additional rationale for designing clinical trials investigating its potential as a mood stabilizer agent.

Cariprazine treats acute manic and depressive episodes in bipolar I disorder (BP-I), but its efficacy in preventing relapse of mood episode remains unknown.

In this phase 3b, double-blind, placebo-controlled study, patients with BP-I with acute manic or depressive episodes (each with/without mixed features), were treated with cariprazine 3.0 mg/day during a 16-week open-label treatment period; those who achieved stable remission within 8 weeks and remained stable for at least another 8 weeks were randomized to receive cariprazine 1.5 or 3.0 mg per day or placebo in the double-blind treatment period for up to 39 weeks. The primary efficacy endpoint was time to relapse of any mood episode. Adverse events (AEs) were assessed.

Patients (440/896) enrolled in the open-label treatment period achieved stability criteria and were randomized to receive cariprazine 3.0 mg/day (n = 148), cariprazine 1.5 mg/day (n = 147), or placebo (n = 145) in the double-blind treatment period. Relapse rates were 17.9%, 16.8%, and 19.7% in the cariprazine 3.0 mg/day, cariprazine 1.5 mg/day, and placebo groups, respectively. Neither dose of cariprazine was more effective than placebo on the primary outcome (3.0 mg/day: HR = 0.89, [95% CI: 0.5, 1.5]; 1.5 mg/day: HR = 0.83, 95% CI [0.5, 1.4]). The most frequently reported AEs (≥5%) were akathisia, headache, insomnia, and nausea in the open-label treatment period and increased weight and insomnia in the double-blind treatment period. In the open-label and double-blind treatment periods, 7.5% and 1.6% of patients experienced an AE leading to discontinuation.

Cariprazine was not superior to placebo in the prevention of relapses in this study. Relapse rates were unusually low in the placebo group. Cariprazine was well-tolerated.

Bipolar disorder (BD) is one of the most impairing psychiatric illnesses. Those with pediatric-onset BD tend to have worse outcomes; therefore, accurate conceptualization is important for aspects of care, such as tailored treatment interventions. Sensation seeking behaviors may be a window into the psychopathology of pediatric-onset BD. Participants with BD and healthy controls (HC) ages 7-27 completed self-report assessments, including the Sensation Seeking Scale- V (SSS-V). Among the BD group, there was a significant positive correlation between the Disinhibition subscale and age. Analyses indicated that the BD group scored lower on the Thrill and Adventure Seeking subscale but higher on the Disinhibition scale when compared to the HC group. We found that individuals with pediatric-onset BD are more likely to engage in socially risky behaviors. These results are an important step in understanding sensation seeking characteristics in BD youth and improving treatment, ultimately helping individuals live a more stable life.

Endoxifen, a protein kinase C inhibitor and selective estrogen receptor modulator, primarily used in breast cancer treatment, has recently emerged as a potential therapeutic option for managing manic episodes associated with bipolar disorder (BD). This review aims to assess the existing evidence base for endoxifen in BD treatment and evaluate the strengths and limitations of current research findings.

A systematic search was conducted on Medline, Embase, and Web of Science databases. We included studies published in English that used endoxifen in BD, alongside any relevant studies identified through manual searching and conference papers with full-text availability. Information pertaining to dose, duration, clinical effects, and safety profiles was extracted from the included studies. The Cochrane Risk of Bias 2 tool was used to assess the risk of bias in clinical trials.

The final review included seven case reports (including two conference presentations), two clinical trials, and one prospective study. Most studies administered endoxifen 8 mg and reported an improvement in manic symptoms. Several case reports included patients with comorbid substance use, and most patients received mood stabilizers concurrently. Few reports lacked any structured outcome measures. The clinical trials used divalproex 1000 mg as an active comparator, which was deemed sub-therapeutic. Despite being multicentric, the first trial lacked data on center-wise recruitment, and certain methodological concerns were observed across the included trials. There were no serious adverse effects noted, except for a significant elevation in lipid profile within a 3-week period. Limited data were available regarding endoxifen efficacy and safety in mixed episodes, depressive episodes, and maintenance treatment.

There is a paucity of research on the efficacy and safety of endoxifen in BD. While existing evidence suggests short-term efficacy in manic episodes, significant limitations were identified in most of the included studies. Further research is imperative to establish the efficacy and safety of endoxifen in BD before considering its recommendation as a viable treatment option.

This work presents LiFT (a lithium fiber-based test), a low-cost electrochemical sensor that can measure lithium in human saliva and urine with FDA-required accuracy. Lithium is used for the treatment of bipolar disorder, and has a narrow therapeutic window. Close monitoring of lithium concentration in biofluids and adjustment of drug dosage can minimize the devastating side effects. LiFT is an inexpensive, yet accurate and simple-to-operate lithium sensor for frequent at-home testing for early identification of lithium toxicity. The low cost and high accuracy of LiFT are enabled through an innovative design and the use of ubiquitous materials such as yarn and carbon black for fabrication. LiFT measures Li+ through potentiometric recognition using a lithium selective sensing membrane that is deposited on the ink-coated yarn. A detection limit of 0.97 µM is obtained with a sensitivity of 59.07±1.25 mV/decade for the Li+ sensor in deionized water. Moreover, the sodium correction extended LiFT's linear range in urine and saliva to 0.5 mM. The LiFT platform sends the test results to the patient's smartphone, which subsequently can be shared with the patient's healthcare provider to expedite diagnosis and prevention of acute lithium toxicity.

A history of anxiety is more common in people with Parkinson's disease (PD). The prospective risk of PD in those newly presenting with anxiety and factors that increase the risk of PD in patients with anxiety have not been investigated.

To investigate the incidence of PD in people with anxiety aged ≥50 years and clinical features associated with later diagnosis of PD in people with anxiety.

A retrospective cohort study using UK primary care data between 2008 and 2018, assessing patients with new-onset anxiety aged ≥50 years.

Weibull survival regression models were fitted and hazard ratios (HRs) for modelling time-to-PD was estimated in those with and without anxiety, and when determining the risk of developing PD in those with anxiety. Results were adjusted for sociodemographic and lifestyle factors, and relevant physical and mental health conditions.

The risk of PD increased two-fold compared with the non-anxiety group after adjustment for age, sex, social deprivation, lifestyle factors, severe mental illness, head trauma, and dementia (HR 2.1, 95% confidence interval = 1.9 to 2.4). In those with anxiety, the presence of depression, hypotension, tremor, rigidity, balance impairment, constipation, sleep disturbance, fatigue, and cognitive impairment were associated with an increased risk of developing PD.

The risk of developing PD was at least doubled in people with anxiety compared with those without. The clinical features of those who developed PD can help identify patients presenting with anxiety who are in the prodromal phase of PD.