BACKGROUND: Chronotype is associated with circadian rhythmicity, a core etiological factor underlying bipolar disorder (BD). Given converging evidence linking late chronotype with poor mental health, the goal of the present study was to examine chronotype (in)stability and its relation to mood symptoms over time.
METHODS: Participants with BD I (n = 271), BD II (n = 88), and healthy controls (n = 217) were included (follow-upM=10 years, Range=5-15) from the Prechter Longitudinal Study. Chronotype category and midpoint of sleep, corrected for weekend sleep-debt (MSFsc), were measured with the Munich Chronotype Questionnaire administered every 12 months alongside clinician-rated mood and medication usage. Self-reported mood was measured bi-monthly. Mixed effects models tested whether mood was associated with (in)stability of chronotype category and MSFsc covarying for age, sex, age, and medication.
RESULTS: Compared to HC, individuals with BD self-reported having a later chronotype that significantly fluctuated over time. Individuals with BDI showed significantly less stability in MSFsc than HC. Anticonvulsant use was associated with more stability in MSFsc whereas antidepressant use was associated with less stability in MSFsc.
CONCLUSIONS: In a large longitudinal cohort, individuals with BD displayed significant instability in circadian typology. Psychopharmacology in BD may have differential impacts on circadian timing that is important to monitor.

OBJECTIVE: To investigate: (i) whether mood states associated with bipolar disorder are associated with poorer quality of life in older adults, and (ii) what are some of the predictors of quality of life in older adults with mood states associated with bipolar disorder.
METHODS: The authors completed a cross-sectional multilevel analysis of panel data from seven waves of The English Longitudinal Study of Ageing dataset. The main analysis included 567 participants who reported experiencing mood states associated with bipolar disorder. Some participants reported this in more than one wave, resulting in 835 observations of mood states associated with bipolar disorder across the seven waves. Quality of life was assessed using the Control, Autonomy, Self-realization, and Pleasure-19 (CASP-19) measure.
RESULTS: The presence of mood states associated with bipolar disorder was significantly associated with poorer quality of life, even after controlling for multiple covariates (age, sex, social isolation, loneliness, alcohol use, education level, and economic status). Loneliness significantly predicted poorer quality of life in older adults with mood states associated with bipolar disorder. In contrast, higher educational attainment and being female predicted better quality of life in this group.
CONCLUSIONS: Older adults with mood states associated with bipolar disorder have potentially worse quality of life compared to the general population, which may be partly driven by loneliness. This has ramifications for the support offered to this population and suggests that treatments should focus on reducing loneliness to improve outcomes.

UNASSIGNED: This study aimed to outline the picture of the sexual functions of male patients with affective disorders as an important part of their lives.
UNASSIGNED: The sample consisted of 57 male patients diagnosed with mood disorders in remission. They were interviewed for demographic and clinical data, asked to fill in number of self-descriptive questionnaires\' Sexual Function of Man (SFM/K), the Montgomery-Åsberg Depression Scale (MADRS) and Young Mania Scale (YMRS), and the Alcohol Use Disorders Identification Test (AUDIT).
UNASSIGNED: Lower levels of sexual functioning were experienced by patients who had suffered from affective disorder for a longer time, and who had a diagnosis of recurrent depressive disorder (F33), in comparison with patients with bipolar disorder (F31). The most common sexual dysfunction was premature ejaculation, while the rarest was erectile dysfunction. An occurrence of any sexual disorder at least once in the past was reported by 66% of all patients. Participants did not have problems with alcohol usage.
UNASSIGNED: A worse quality of sexual functioning was associated with a longer history of affective disorder. Sexual dysfunction can be affected by even the most minor depressive and manic-depressive components. The tools used excluded non-heterosexual patients. Further research based on bigger samples is required.

BACKGROUND: The bio-psycho-social model is mostly used to understand the etiology and pathogenesis of psychiatric disorders. Even though in our era, the biological factors became more dominant in the field, the stress-diathesis model is quite acceptable to explain and understand the evolution of psychotic as well as affective disorders.
BACKGROUND: In this case report we present a patient, in her late 40\'s, admitted to our department with a manic-psychotic episode for the first time in her life, after the massive terror attack of October 7, and in which we suggest that the signs and symptoms might be explained using the psycho-dynamic theory.
CONCLUSIONS: We conclude suggesting that the equilibrium of the bio-psycho-social model, should be adjusted in the context of time and space, especially during a situation of catastrophic scale in the patient environment.
CONCLUSIONS: Although stress is a risk factor for the development of affective disorders and especially manic-psychotic episodes, there is scarce literature to support it. On the other hand, psycho-dynamic theories sometimes consider stressful life events as a causative factor for the development of depressive as well as manic episodes.

OBJECTIVE: A clinical and psychopathological analysis, nosological differentiation of prolonged and chronic manic and manic-delusional states (PMDS) within the framework of the paroxysmal course of endogenous psychoses, determination of the patterns of their development, diagnostic criteria and prognosis.
METHODS: The study included 76 female patients (average age 37.2±8.3 years) who were hospitalized for endogenous mental illnesses with a paroxysmal course that occurred with the clinical picture of PMDS. The patients were divided into two groups: clinical (n=43) and follow-up (n=33). Clinical-psychopathological, clinical-follow-up, psychometric, statistical methods were used.
RESULTS: A clinical and dynamic typology of PMDS has been developed, according to which 2 groups have been identified: «monomorphic» PMDS and «polymorphic» PMDS. «Monomorphic» PMDS included 2 subtypes - «acute» and «chronified» and were characterized by the same clinical picture that remained unchanged throughout, while «polymorphic», which also included 2 subtypes - «developing» and «double mania subtype», were characterized by the variability of clinical picture. «Acute» and «developing» subtypes of PMDS predominantly developed in schizoaffective psychosis and bipolar disorder; the «chronified» subtype and the «double mania» subtype were more often observed within the framework of the schizoaffective variant of paroxysmal-progressive schizophrenia.
CONCLUSIONS: The clinical and dynamic structure of PMDS is heterogeneous and differs in psychopathological structure, as well as in the level of stability of symptoms and characteristics of its course. The developed clinical typology of PMDS is prognostically significant and provides information about the further dynamics of the disease.
UNASSIGNED: Клинико-психопатологический анализ, нозологическая дифференциация затяжных и хронических эндогенных маниакальных и маниакально-бредовых состояний (ЗЭМБС) в рамках приступообразного течения эндогенных психозов, определение закономерностей их развития, критериев диагностики и прогноза.
UNASSIGNED: В выборку исследования были включены 76 больных (средний возраст 37,2±8,3 года) женского пола, находившихся на стационарном лечении по поводу эндогенных психических заболеваний с приступообразным течением, протекавших с клинической картиной ЗЭМБС. Обследованные больные были разделены на две группы: клиническую (n=43) и катамнестическую (n=33). Использовались следующие методы: клинико-психопатологический, клинико-катамнестический, психометрический, статистический.
UNASSIGNED: Разработана клинико-динамическая типология ЗЭМБС, в соответствии с которой было выделено 2 типа: «мономорфные» и «полиморфные» ЗЭМБС. «Мономорфные» ЗЭМБС включали 2 подтипа — «острый» и «хронифицированный» и характеризовались одной и той же неизменной на всем протяжении клинической картиной, а «полиморфные», включающие также 2 подтипа — «развивающийся» и «подтип двойной мании», отличались изменчивостью клинической картины. «Острый» и «развивающийся» подтипы ЗЭМБС преимущественно развивались при шизоаффективном психозе и биполярном аффективном расстройстве (p<0,05); «хронифицированный» же подтип и подтип «двойной мании» чаще наблюдались в рамках шизоаффективного варианта приступообразно-прогредиентной шизофрении (p<0,05).
UNASSIGNED: Проведенное исследование показало, что клинико-динамическая структура ЗЭМБС является неоднородной и различается по психопатологической структуре, а также по уровню стабильности симптоматики и характеристикам ее течения. Разработанная клиническая типология ЗЭМБС является прогностически значимой и несет информацию о дальнейшей динамике заболевания.

BACKGROUND: Bipolar disorders (BD) are among the most significantly impairing of childhood and adolescent psychiatric disorders. Although BD symptoms may begin in adolescence, they are frequently not diagnosed until adulthood, and accordingly BD scales could aid diagnostic assessment in paediatric populations. This review aims to synthesis the evidence for the accuracy of BD symptom index tests for discriminating BD from non-BD (other diagnoses or healthy controls) in paediatric population. Additionally, several theoretically relevant moderators of diagnostic accuracy were evaluated.
METHODS: A systematic search across three databases were conducted from 1980 to 2022, augmented by grey literature database searches, citation chaining and contacting authors. Data from eligible studies were synthesized using meta-analysis. A multilevel model was fitted to account for nested effect sizes, with 31 potential moderators examined in univariate and multivariate models.
RESULTS: Twenty-Eight studies were eligible, yielding 115 effect sizes for analysis. Meta-analytic modelling indicated BD symptom index tests have a high diagnostic accuracy (g = 1.300; 95% CI: 0.982 - 1.619; p < .001) in paediatric population. Accuracy was relative to the type of comparison group, index test content, index test informant and index test\'s scale or subscale.
CONCLUSIONS: Screening tests based on mania content, caregiver report and non-healthy comparison groups have clinical utility in identifying paediatric BD. Other informant-and-content combination may not accurately identify paediatric BD. Unlike healthy controls, tests derived from studies using non-healthy comparison groups, represent BD symptom non-specificity and BD symptom overlap with other disorders, providing external validity and clinical utility.

OBJECTIVE: This study aimed to create and validate robust machine-learning-based prediction models for antipsychotic drug (risperidone) continuation in children and teenagers suffering from mania over one year and to discover potential variables for clinical treatment.
METHODS: The study population was collected from the national claims database in China. A total of 4,532 patients aged 4-18 who began risperidone therapy for mania between September 2013 and October 2019 were identified. The data were randomly divided into two datasets: training (80%) and testing (20%). Five regularly used machine learning methods were employed, in addition to the SuperLearner (SL) algorithm, to develop prediction models for the continuation of atypical antipsychotic therapy. The area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI) was utilized.
RESULTS: In terms of discrimination and robustness in predicting risperidone treatment continuation, the generalized linear model (GLM) performed the best (AUC: 0.823, 95% CI: 0.792-0.854, intercept near 0, slope close to 1.0). The SL model (AUC: 0.823, 95% CI: 0.791-0.853, intercept near 0, slope close to 1.0) also exhibited significant performance. Furthermore, the present findings emphasize the significance of several unique clinical and socioeconomic variables, such as the frequency of emergency room visits for nonmental health disorders.
CONCLUSIONS: The GLM and SL models provided accurate predictions regarding risperidone treatment continuation in children and adolescents with episodes of mania and hypomania. Consequently, applying prediction models in atypical antipsychotic medicine may aid in evidence-based decision-making.

暂无摘要。

BACKGROUND: Bipolar disorder is highly prevalent and consists of biphasic recurrent mood episodes of mania and depression, which translate into altered mood, sleep and activity alongside their physiological expressions.
OBJECTIVE: The IdenTifying dIgital bioMarkers of illnEss activity and treatment response in BipolAr diSordEr with a novel wearable device (TIMEBASE) project aims to identify digital biomarkers of illness activity and treatment response in bipolar disorder.
METHODS: We designed a longitudinal observational study including 84 individuals. Group A comprises people with acute episode of mania (n = 12), depression (n = 12 with bipolar disorder and n = 12 with major depressive disorder (MDD)) and bipolar disorder with mixed features (n = 12). Physiological data will be recorded during 48 h with a research-grade wearable (Empatica E4) across four consecutive time points (acute, response, remission and episode recovery). Group B comprises 12 people with euthymic bipolar disorder and 12 with MDD, and group C comprises 12 healthy controls who will be recorded cross-sectionally. Psychopathological symptoms, disease severity, functioning and physical activity will be assessed with standardised psychometric scales. Physiological data will include acceleration, temperature, blood volume pulse, heart rate and electrodermal activity. Machine learning models will be developed to link physiological data to illness activity and treatment response. Generalisation performance will be tested in data from unseen patients.
RESULTS: Recruitment is ongoing.
CONCLUSIONS: This project should contribute to understanding the pathophysiology of affective disorders. The potential digital biomarkers of illness activity and treatment response in bipolar disorder could be implemented in a real-world clinical setting for clinical monitoring and identification of prodromal symptoms. This would allow early intervention and prevention of affective relapses, as well as personalisation of treatment.

Older adults with bipolar disorder experience distinct challenges compared to younger age groups with bipolar disorder. They potentially require adaptations to the care they receive. This study aimed to explore experiences of care and changing care needs in older adults with bipolar disorder. People with bipolar disorder (aged ≥60) were recruited through three NHS Trusts in the North West of England, charity organisations, a confidential university participant database, and social media. Participants completed single time-point biographical narrative interviews, which were analysed using narrative analysis. Sixteen participants\' accounts led to the creation of four themes: (1) \'Navigating the disruption caused by diagnosis\'; (2) \'The removal of services that provided hope\'; (3) \'Later life: We are on our own now\'; and (4) \'Changing care needs in later life: We still need support\'. The care needs of older adults with bipolar disorder appear to change over time, and services often fail to offer adequate, tailored care for this group at present. Current support requires adaptation to be effective and appropriate and to enable this group to age well in later life.