Bipolar Disorders最新文献

{"title":"Biofluid Biomarkers of Cognitive Functioning in Bipolar Disorder: A Systematic Review by the Targeting Cognition and Older-Age Bipolar Disorder ISBD Task Forces","authors":"Alexandra J. M. Beunders,&nbsp;Sigfried N. T. M. Schouws,&nbsp;Andrew T. Olagunju,&nbsp;Vicent Balanzá-Martínez,&nbsp;Nicole C. M. Korten,&nbsp;Ralph W. Kupka,&nbsp;Katherine E. Burdick,&nbsp;Andre F. Carvalho,&nbsp;Ariel G. Gildengers,&nbsp;Lars V. Kessing,&nbsp;Roger S. McIntyre,&nbsp;Paula V. Nunes,&nbsp;Ayal Schaffer,&nbsp;Ivan J. Torres,&nbsp;Shang-Ying Tsai,&nbsp;Tamsyn E. Van Rheenen,&nbsp;Eduard Vieta,&nbsp;Lakshmi N. Yatham,&nbsp;Allan H. Young,&nbsp;Lisa T. Eyler,&nbsp;Kamilla W. Miskowiak,&nbsp;Annemiek Dols","doi":"10.1111/bdi.70109","DOIUrl":"10.1111/bdi.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cognitive impairment is common in bipolar disorder (BD), but the underlying pathophysiology remains unclear. This systematic review aimed to (1) summarize all literature describing relationships of biofluid biomarkers and cognition in BD and (2) identify which biofluid biomarkers correlate most consistently with cognition in BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This systematic review followed procedures of the PRISMA statement. PubMed, EMBASE, and PsycINFO were searched from inception until July 2023. Original studies assessing the relationships between biofluid biomarkers and cognitive functioning in adults with BD were included. Studies on neuroimaging markers and genetic biomarkers were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 60 studies, together describing 184 biofluid biomarkers that were measured in relation to cognitive functioning in BD. Biomarkers were organized into ten categories: oxidative stress markers (<i>n</i> = 14); growth factors (<i>n</i> = 13); neurotransmitters (<i>n</i> = 14); neuropeptides and hormones (<i>n</i> = 14); neurodegenerative markers (<i>n</i> = 11); inflammatory/immune markers (<i>n</i> = 59); serostatus to infectious agents (<i>n</i> = 11); amino acids, vitamins, and minerals (<i>n</i> = 7); metabolic factors (<i>n</i> = 23); hemogram, coagulation, and fibrinolysis markers (<i>n</i> = 18). Preliminary evidence for a significant relationship with cognition appeared for HSV-1 IgG, CRP, and homocysteine (Hcy); higher biomarker levels were associated with worse cognition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Included studies were heterogeneous and many were deemed to be of low quality following risk of bias assessment. The identified three biofluid biomarkers represent history of previous infections, current inflammation, and/or physical or psychological stress. Poor physical health, possibly represented by a broad range of biomarker aberrations, may play a role in the pathophysiology of cognitive impairment in BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO registration number: CRD42021224226</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 5","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychotropic Prescribing Patterns Among Bipolar-I Patients Prior to Established Bipolar-I Disorder Diagnosis","authors":"Filmon Haile,&nbsp;Clayton English,&nbsp;Kyueun Lee","doi":"10.1111/bdi.70137","DOIUrl":"10.1111/bdi.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Bipolar I Disorder (BP-I) is frequently misdiagnosed as Major Depressive Disorder (MDD), delaying appropriate treatment. This study aimed to examine treatment patterns among BP-I patients misdiagnosed with MDD and assess the impact of these regimens on the time until BP-I diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted using the MarketScan Commercial Claims and Encounters database, analyzing 21,771 BP-I patients initially misdiagnosed with MDD and 50,667 correctly diagnosed BP-I patients. Treatment patterns and their influence on time to BP-I diagnosis were assessed using multinomial logistic regression and Cox proportional hazards models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the misdiagnosed cohort, 25.1% were initially started on antidepressant monotherapy, with 8.7% continuing this regimen after BP-I diagnosis. In contrast, 7.6% of the initially BP-I diagnosed cohort received antidepressant monotherapy. The time to BP-I conversion was shortest for those on mood stabilizer monotherapy (HR: 1.26, 95% CI: 1.19–1.34, <i>p</i> &lt; 0.001), compared to those on antidepressant monotherapy. After BP-I diagnosis, patients originally misdiagnosed with MDD had different prescribing patterns, exhibiting lower rates of guideline-consistent treatments. Specifically, patients initially diagnosed with BP-I were more likely to receive mood stabilizing therapy, either as monotherapy (OR = 2.63, <i>p</i> &lt; 0.001) or in combination with an antidepressant (OR = 1.84, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Misdiagnosis of BP-I as MDD leads to significant delays in accurate diagnosis and inappropriate treatment regimens, highlighting the critical need for improved diagnostic accuracy at initial presentation. Prompt and accurate BP-I diagnosis can optimize treatment approaches and improve patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 5","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Affective Cognitive Control in Bipolar Disorder Using Transcranial Alternating Current Stimulation: A Double-Blind, Randomized, Sham-Controlled Clinical Trial and Proof of Concept Study","authors":"Jacob D. Kraft,&nbsp;Laura Locarno,&nbsp;Takakuni Suzuki,&nbsp;Justin Riddle,&nbsp;Soo-Eun Chang,&nbsp;Melvin G. McInnis,&nbsp;Flavio Fröhlich,&nbsp;Stephan F. Taylor,&nbsp;Ivy F. Tso","doi":"10.1111/bdi.70142","DOIUrl":"10.1111/bdi.70142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Persistent emotion lability and impulsive behavior in bipolar disorder (BD) are thought to be due to impaired affective cognitive control. Neural synchrony via theta-gamma phase-amplitude coupling (PAC) in the prefrontal cortex facilitates cognitive control and is impaired in BD. This pilot study aimed to investigate the feasibility and efficacy of transcranial alternating current stimulation (tACS) in targeting the neural coordination (i.e., theta-gamma PAC) of cognitive control in a double-blind, randomized, controlled crossover trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants (<i>N</i> = 18) with BD completed an emotional Go/No-Go task during six 5-min stimulation blocks interleaved with 2-min resting blocks. Participants received active- and sham-stimulation 1 week apart; sham comprised a ramp up/down at the beginning and end of the block to mimic stimulation sensations. Tolerability was measured using a side effect questionnaire after active and sham stimulation. Behavioral measures of discriminability (<i>d</i>′) and reaction time during the task, and EEG measures of theta-power and theta-gamma PAC during the interleaved resting states were compared for active versus sham.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Active did not differ from sham stimulation on any side effects (all <i>p</i>'s &gt; 0.11). Effect sizes when comparing discriminability, theta-power, and PAC across active versus sham were small but showed a consistent pattern of improvement in the active relative to the sham condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This pilot study showed that 30-min tACS is tolerable to BD patients and demonstrated preliminary promise in enhancing affective cognitive control. Future studies should determine the optimal dosage to produce more substantial and enduring effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials: NCT05480124</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 5","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speech and Language Markers of Bipolar Disorder: Challenges and Opportunities","authors":"Farida Zaher,&nbsp;Jessica Ahrens,&nbsp;Delphine Raucher-Chéné,&nbsp;Alban Voppel,&nbsp;Lena Palaniyappan","doi":"10.1111/bdi.70119","DOIUrl":"https://doi.org/10.1111/bdi.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinicians aspire to predict the emergence of Bipolar Disorder (BD) in a timely manner. To accomplish this, markers reflecting mental states that can be gathered non-invasively and at large scale are needed. Here, we systematically evaluate evidence relating speech-based markers to mood states in BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched Medline and Google Scholar for all published studies in English up to February 2026 on the use of speech markers in BD. We undertook thematic analysis on abstracts using topic modeling and a qualitative gap analysis to identify potential opportunities for future research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>43 out of 867 studies were included after screening. Topic analysis revealed an emerging focus on mapping mood states to automated speech features. Most studies focused on cross-sectional <i>detection</i> of bipolar mood states, or BD as a diagnosis, rather than the <i>prediction</i> of upcoming mood states. Speech features distinguished BD from schizophrenia, depression, and healthy controls. Manic states were characterized by quantifiable measures of pressured speech, derailment, grammatical errors, and word repetition; depressive states by an increased use of personal pronouns, reduced verbal fluency, and speech quantity. Overall, attempts to replicate observations were limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Acoustic and lexical-semantic markers vary with manic, psychotic, or depressive states. At present, the evidence is insufficient for clinical utility in relapse prediction, response monitoring, or diagnosing mixed episodes or state changes in BD. We recommend that future research leverages the growing capabilities of natural language processing through longitudinal and cross-linguistic studies to strengthen the evidence base and advance the clinical utility of speech markers for BD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 5","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148325022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can We Improve the Prediction of Early Onset Mania and Hypomania in the Community?","authors":"Jan Scott,&nbsp;Jacob J. Crouse,&nbsp;Sarah E. Medland,&nbsp;Brittany L. Mitchell,&nbsp;Nathan A. Gillespie,&nbsp;Nicholas G. Martin,&nbsp;Ian B. Hickie","doi":"10.1111/bdi.70140","DOIUrl":"https://doi.org/10.1111/bdi.70140","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is broad agreement that the onset of bipolar disorders (BD) can be predicted by using combined estimates of familial, genetic and clinical risk. However, there is a lack of consensus about the operationalisation of different risk attributes (e.g., symptoms vs. sub-threshold syndromes; disorder-specific polygenic risk scores [PRS] vs. multiple-disorder PRS dimensions) and their utility for predicting bipolar type 1 (BD-I) and 2 (BD-II). Likewise, analyses often fail to consider the optimal model for predicting outcomes where true cases will be in the minority.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Proof of concept study employing an ensemble machine learning approach (Boosting) to develop models for classifying BD cases vs. non-cases using different combinations of risk attributes extracted from a database from a prospective longitudinal follow-up of twin and non-twin siblings in the peak age range for onset of major mental disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1473 participants (mean age 26.3; female = 866), 104 developed BD-I (<i>n</i> = 30) or BD-II (<i>n</i> = 74). The best performing Boosting classification had an overall area under the receiver operating curve (AUROC) of 85.1% (95% Confidence Intervals: 80%, 88%); correctly identifying 86.7% BD cases. Variables with greatest relative influence were, in rank order: depressive symptoms, psychotic symptoms, a BD-Schizophrenia PRS dimension, hypomanic symptoms, and family history of BD. The model accurately classified 89% of manic cases but only 68% of hypomanic cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Improving the accurate prediction of BD onset would benefit from greater consensus regarding the operationalisation of known risk attributes and selection of analytic models that consider sample imbalances.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 5","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148324658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Do Parents With Bipolar Disorder Perceive the Risk to the Next Generation? Results From a Qualitative Study","authors":"Michelle Laigaard,&nbsp;Christina Wagner,&nbsp;Stine Pedersen,&nbsp;Julie Ravneberg Stokholm,&nbsp;Maj Vinberg","doi":"10.1111/bdi.70139","DOIUrl":"10.1111/bdi.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>There are several high-risk studies of children of parents with bipolar disorder (BD); however, the impact of being an “At-Risk” parent has seldom been studied. The aim is to explore how parents with BD perceive their potential heredity and how they feel toward their children being invited to take part in high-risk family studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Qualitative semi-structured face-to-face interviews were conducted with 14 participants. All interviews were audio recorded, transcribed verbatim, and analyzed inductively using qualitative content analysis by researchers with different professional backgrounds. Data collection continued until no new themes emerged, suggesting data saturation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five main themes were identified: (1) parenting outweighs genetics, (2) guilt—the emotional burden of parenting with bipolar disorder, (3) self-stigmatization, (4) challenges in communication within the family, and (5) reflections on participation in research. Parents often took on the role of a Bipolar-Detective, monitoring their child's mental health and took precautions hoping to prevent them from developing BD. Subtle differences were noted between mothers' and fathers' reflections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This was a qualitative study of selected families with BD parents; the findings should therefore be interpreted with caution. The participants were concerned about their children's well-being due to BD, emphasizing their own parenting challenges over genetic risk. Future studies should address parental fears alongside treating BD and offer guidance on communicating with their children. While most viewed high-risk family study participation positively, some worried about potential pathologizing of their children. These aspects are critical and noteworthy when engaging with children from high-risk families.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 5","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Sectional and Longitudinal Comparison of Commonly Used Screening Tools for Bipolar Disorders","authors":"Anna Tröger,&nbsp;Yiqi Zeng,&nbsp;Thomas Richardson,&nbsp;Emma Palmer-Cooper,&nbsp;Allan H. Young,&nbsp;Rebecca Strawbridge","doi":"10.1111/bdi.70133","DOIUrl":"10.1111/bdi.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Misdiagnosis is common in bipolar disorder (BD). Currently used screening tools are brief and cost-effective, but there is a lack of understanding of their reliability over time, as well as whether responses are influenced by demographic or clinical factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To examine the cross-sectional and longitudinal reliability and validity of two commonly used screening tools, as well as their associations with current mood states and other participant characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 331 adult patients with a diagnosis of BD completed the Mood Disorder Questionnaire (MDQ) and the Hypomania Symptom Checklist-32 (HCL-32) as well as measures of mood online at baseline and three months later.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The MDQ was found to have low reliability with poor internal consistency (α = 0.531; α = 0.647 at respective timepoints) and test–retest reliability (<i>r</i>_<i>s</i> = 0.582). The HCL-32 was more reliable with good internal consistency (α = 0.815 at both timepoints) and test–retest reliability (<i>r</i>_<i>s</i> = 0.725). MDQ scores were significantly positively associated with comorbidities and current symptoms of activation/mania, and negatively correlated with age and years since last hospitalisation. The HCL-32 was also significantly positively correlated with activation/mania, and negatively correlated with age, years since diagnosis and years since last hospitalisation. BD-I patients scored higher than other BD subtypes. Mood state was the only variable with a significant change over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The HCL-32 appeared more reliable than the MDQ, although all participants needed to exceed an MDQ threshold at baseline to participate in the study, which may have biased our results.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 5","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Family Interventions in Bipolar Disorder: A Systematic Review","authors":"Madeha Umer,&nbsp;L. Almendra Burgos M,&nbsp;Nyla Syed,&nbsp;Changjun Xu,&nbsp;Terri Rodak,&nbsp;Cindy-Lee Dennis,&nbsp;Farooq Naeem,&nbsp;Benoit Mulsant,&nbsp;Muhammad Ishrat Husain","doi":"10.1111/bdi.70135","DOIUrl":"10.1111/bdi.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder (BD) is a chronic mental health condition characterized by extreme mood swings, which significantly affects both the individual and their family system. Given the psychosocial impact of BD on families, family interventions (FI) have emerged as a promising approach to improve treatment outcomes. This review explores the effectiveness of FI in managing BD, focusing on various intervention types, their outcomes, and clinical implications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This review followed PRISMA guidelines and registered with PROSPERO (registration number: CRD42023410879). We included studies involving adults diagnosed with BD and their family members, focusing on family-based interventions. Studies were identified through systematic searches in five bibliographic databases and managed using Covidence 2.0. Data extraction and synthesis included primary and secondary outcomes related to clinical, behavioral, and lifestyle measures. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool for quasi-experimental studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Family-focused interventions were found to reduce relapse rates, enhance medication adherence, and improve family communication. Psychoeducational interventions also demonstrated a significant reduction in symptom severity and hospitalization rates. However, findings regarding the long-term sustainability of these outcomes were mixed, and some interventions showed limited generalizability across diverse family structures and cultural contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>FIs are critical in treating BD by improving both clinical and relational outcomes. However, the heterogeneity of family structures and cultural factors calls for more tailored approaches to ensure long-term efficacy. Future research should focus on developing culturally sensitive interventions and exploring the mechanisms by which family dynamics influence treatment adherence and recovery in BD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 5","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lithium Dispensing Patterns in Dutch Youth: Prevalence, Incidence Dosages, and Duration of Use From 2011 to 2022","authors":"Ravish N. Gangapersad,&nbsp;Lisa T. Ringeling,&nbsp;Jens H. J. Bos,&nbsp;Birgit C. P. Koch,&nbsp;Manon H. J. Hillegers,&nbsp;Pilar Garcia-Gomez,&nbsp;Catharina C. M. Schuiling-Veninga,&nbsp;Eelko Hak,&nbsp;Bram Dierckx","doi":"10.1111/bdi.70134","DOIUrl":"10.1111/bdi.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Bipolar disorder (BD) often emerges during mid-adolescence and young adulthood, and leads to functional and social impairment, with a prevalence of 0.87% among Dutch youth. Lithium, the first-line BD maintenance treatment, stabilizes mood, prevents suicide, and is well tolerated, yet its use has declined as long-term second-generation antipsychotics (SGAs) prescriptions increased. This study explores the prevalence, incidence, duration, prior and concurrent use of psychotropic medications, and dosage patterns of lithium dispensing in Dutch youth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective cohort study using the Dutch community pharmacy-based IADB.nl database included 567 youths (6–25 years), who were dispensed lithium between 2011 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The yearly prevalence of lithium dispensing per 100,000 fluctuated between 30.3 in 2011 and 34.8 in 2022 (<i>p</i> = 0.40), with the lowest prevalence in 6–12-year-olds and highest in 20–25-year-olds. Females had overall higher prevalence rates than males (<i>p</i> = 0.03). Overall incidence rose from 7.9 to 9.3 (<i>p</i> = 0.68). In 2011, incidence was 10.7 for both the 13–19 and 20–25 age groups. By 2022, this decreased to 4.2 in 13–19-year-olds and increased to 19.0 in 20–25-year-olds. Approximately 55% of individuals received other psychotropics before lithium, and 52% concurrently, with SGAs and antidepressants being most commonly dispensed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite lithium's efficacy and status as first-line BD maintenance treatment, its dispensing in Dutch youth remains low compared to the BD prevalence. This may be due to misdiagnosis of BD and/or clinicians' reluctance to prescribe lithium, highlighting the need for improved diagnostics, clinician education, and further research into lithium's safety in youths.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 5","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards an Integrated Staging Model for Bipolar Disorders: An International Society for Bipolar Disorders (ISBD) Staging Task Force Consensus Report","authors":"Ralph Kupka,&nbsp;Danella Hafeman,&nbsp;Madeleine McCallum,&nbsp;Afra van der Markt,&nbsp;Hailey Tremain,&nbsp;Martin Alda,&nbsp;Jorge Almeida,&nbsp;Taiane de Azevedo Cardoso,&nbsp;Vicent Balanzá-Martínez,&nbsp;Boris Birmaher,&nbsp;David J. Bond,&nbsp;Elisa Brietzke,&nbsp;Ines Chendo,&nbsp;Iria Grande,&nbsp;Tomas Hajek,&nbsp;Manon Hillegers,&nbsp;Marcia Kauer-Sant'Anna,&nbsp;Rodrigo Mansur,&nbsp;Ives Cavalcante Passos,&nbsp;Ana Gonzalez Pinto,&nbsp;Robert Post,&nbsp;Mauricio Tohen,&nbsp;Gustavo Vazquez,&nbsp;Eduard Vieta,&nbsp;Lakshmi N. Yatham,&nbsp;Flávio Kapczinski,&nbsp;Michael Berk,&nbsp;Anne Duffy","doi":"10.1111/bdi.70136","DOIUrl":"10.1111/bdi.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Three clinical staging models for bipolar disorder (BD) have been published, each with a different but complementary approach and focus. The International Society for Bipolar Disorders Staging Task Force aimed to integrate these models into one comprehensive three-dimensional staging model, separately rating bipolar spectrum, nonmood psychopathology, and (inter-episodic) functional impairment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Via a series of in-person and online meetings, Delphi-surveys, and email discussions, the task force members step-by-step reached consensus on the overall structure of the model and the definition of the various stages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The resulting BD staging model describes the progression of mood psychopathology, nonmood psychopathology, and functional impairment in three independently rated dimensions. The stages of the mood psychopathology are M0 (at risk for BD having a 1st or 2nd degree family member with BD); M1 (prodromal); M2 (first episode classifying for BD-I or BD-II); M3 (recurrent BD); and M4 (chronic unremitting BD), with various substages. Single or recurrent major depression in persons at familial risk for BD is positioned in stage M1. The stages for nonmood psychopathology are: N0 (no symptoms); N1 (subsyndromal symptoms); N2 (one nonmood disorder); N3 (two nonmood disorders); N4 (three or more nonmood disorders). The stages for functional impairment are: F0 (no); F1 (mild); F2 (moderate); F3 (marked); and F4 (severe impairment). Fictitious case vignettes are presented to demonstrate how to apply the model. Limitations of clinical staging are discussed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The proposed three-dimensional clinical staging model for illness progression comprehensively captures the complexity of illness presentation and heterogeneous illness progression in BD, including psychiatric comorbidities and degree of functional impairment. The model provides a framework that requires validation in research and clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 5","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}