Bipolar Disorders最新文献

{"title":"Interaction of Fluoxetine and Caffeine in a Patient With Substance-Induced Mania","authors":"Hassan Barada,&nbsp;Adam J. Elder,&nbsp;Ibrahim Sablaban","doi":"10.1111/bdi.70108","DOIUrl":"10.1111/bdi.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Substance-induced manic episodes may occur in individuals without prior psychiatric illness and can be triggered by medications or stimulants. Selective serotonin reuptake inhibitors (SSRIs) and high caffeine intake have both been associated with mood destabilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To describe a case of acute mania potentially precipitated by excessive fluoxetine use and high caffeine consumption.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials &amp; Methods</h3>\u0000 \u0000 <p>A 42-year-old male with no prior psychiatric history presented with symptoms of acute mania after recently starting fluoxetine and accidentally taking approximately twice the prescribed dose. Clinical evaluation, laboratory testing, urine drug screening, and collateral history were obtained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The patient exhibited elevated mood, grandiosity, pressured speech, and decreased need for sleep. Laboratory results were unremarkable except for cannabis on urine drug screening. Fluoxetine was discontinued, and he was treated with valproate and adjunctive haloperidol during inpatient hospitalization, leading to improvement in symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The manic episode may have been triggered by excessive fluoxetine exposure combined with high caffeine intake. Fluoxetine may also inhibit CYP1A2, potentially increasing caffeine levels and amplifying stimulant effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This case highlights a possible interaction between fluoxetine and caffeine contributing to mania and underscores the importance of assessing stimulant use and medication dosing when evaluating new-onset manic symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147455652","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":"Patient-Reported Outcomes From a Randomized Controlled Trial Comparing Right Unilateral Electroconvulsive Therapy With Algorithm-Based Pharmacological Treatment in Bipolar Depression, With Long-Term Follow-Up on Pharmacological Treatment","authors":"Jeanette Bjørke,&nbsp;Helle Schøyen,&nbsp;Arne Vaaler,&nbsp;Bjørn Auestad,&nbsp;Ulrik Malt,&nbsp;Gunnar Morken,&nbsp;Ketil Joachim Oedegaard,&nbsp;Ole Andreas Andreassen,&nbsp;Per Bergsholm,&nbsp;Ute Kessler","doi":"10.1111/bdi.70105","DOIUrl":"10.1111/bdi.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective was to compare acute and long-term patient-reported outcome measures (PROMs) of symptoms and functioning in treatment-resistant bipolar depression following right unilateral (RUL) electroconvulsive therapy (ECT) and algorithm-based pharmacological treatment (APT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Inpatients with treatment-resistant bipolar depression were randomized to 6 weeks of RUL ECT or APT, followed by pharmacological maintenance treatment for 6 months. Three PROMS—the Medical Outcome Short-Form Health Assessment (RAND-36), the Everyday Memory Questionnaire (EMQ-28), and the Patient Global Impression of Improvement (PGI-I)—and the clinician-rated Montgomery and Åsberg Depression Rating Scale (MADRS) were applied pretreatment, posttreatment, and 6 months posttreatment. Group comparisons were performed using linear mixed-effects analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-three patients (N_{RUL ECT} = 38, N_APT = 35) were randomized to treatment, of which 44 (N_{RUL ECT} = 23, N_APT = 21) completed acute treatment, and 39 (N_{RUL ECT} = 20, N_APT = 19) completed the 6-month follow-up. Immediately posttreatment, RUL ECT and APT patients showed improvements in seven and three of the eight RAND-36 dimensions, respectively, while improvements on the PGI-I were greater for RUL ECT than for APT patients (2.2 vs. 2.9, <i>p</i> = 0.010) as were those on the MADRS (13.1 vs. 18.1, <i>p</i> = 0.010), with no group difference on the EMQ-28. At 6 months, there were no significant group differences for any measure. EMQ-28 scores improved significantly from pretreatment to the 6-month follow-up only in the RUL ECT group (122.5 vs. 91.6, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Two PROMs and the clinician-rated MADRS favored RUL ECT over APT after 6 weeks of treatment. These findings show the acute benefit of RUL ECT in the treatment of bipolar depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147455605","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":"Psychological Therapies and the Bipolar Disorder ‘Iceberg’: Going Deeper Than Current Mood and Relapse Prevention Planning","authors":"Thomas Richardson,&nbsp;Emma Morton,&nbsp;Jennifer Levin,&nbsp;Lauren M. Weinstock","doi":"10.1111/bdi.70099","DOIUrl":"10.1111/bdi.70099","url":null,"abstract":"&lt;p&gt;Bipolar disorder (BD) is linked to high levels of disability, significantly impacting functioning and quality of life. In recent years, there has been increasing research supporting the efficacy of psychological therapies, together with medication, to ameliorate mood symptoms and reduce relapse risk. Aside from these two core treatment targets, there are often psychiatric comorbidities and underlying psychological vulnerabilities, which are not addressed by currently available therapies for BD. As a result, such underlying issues are neither assessed nor addressed in terms of research or clinical practice.&lt;/p&gt;&lt;p&gt;This clinical care article outlines our collective clinical, lived experience and academic views on the underlying or ‘deeper’ issues common to individuals with BD, why these should be addressed, and how. An iceberg metaphor is used throughout to illustrate this concept: Some ‘surface level’ issues are the most obvious and clearly visible, but there are remaining difficulties often hidden ‘under the surface’ which nonetheless ‘support’ (or serve to maintain) the current difficulties (see Figure 1). We do not use the term ‘surface level’ in a disparaging way and emphasise our simple hope to encourage clinicians and academics to think ‘deeper’ than these presenting problems.&lt;/p&gt;&lt;p&gt;In using the term ‘surface level’ we are referring to the issues that are described as pressing concerns for service users with BD, or immediately visible to clinicians, such as acute symptoms of depression or (hypo)mania. This term also refers to work which may be prioritised due to a stronger evidence base, or restrictions such as session limits.&lt;/p&gt;&lt;p&gt;Guideline-recommended psychological interventions for BD include Cognitive Behavioural Therapy (CBT), Interpersonal and social rhythm therapy (IPSRT), group-based psychoeducation, and family-focused therapies. Although there are individual nuances, these interventions share a focus on reducing current mood symptoms; the therapist will often focus on current thinking patterns (e.g., self-critical thoughts) and behaviours (e.g., excessive sleeping, withdrawal) which are maintaining the mood episode. Another common presenting concern addressed by current evidence-based interventions is relapse prevention (also referred to as staying well), through strategies such as understanding triggers for an episode, identifying early warning signs and symptoms, finding behavioural strategies to reduce risk of relapse and developing a shared relapse prevention plan. These treatments address misconceptions, anxieties and questions that the service user may wish to discuss such as ‘Why do I have bipolar disorder?’ and ‘Is there anything I can do besides take medication to stop getting manic?’. As such, these interventions collectively prioritise psychoeducation. Namely, sharing reliable information on the disorder, its triggers and treatments to support acceptance of the diagnosis, medication adherence and engagement in self-man","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12967060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147371984","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":"Fingerprints Encode Risk for Bipolarity","authors":"Raymond Salvador,&nbsp;María Ángeles García-León,&nbsp;Roberto Rodriguez-Jimenez,&nbsp;Pablo Del Olmo-Encabo,&nbsp;Lucila Barbosa,&nbsp;Ana Aquino-Servín,&nbsp;Alejandro Sotero-Moreno,&nbsp;Mar Fatjó-Vilas,&nbsp;Nuria Jaurrieta-Guarner,&nbsp;Manel Sánchez,&nbsp;Carmen Corte-Souto,&nbsp;Ailín Rojo,&nbsp;Carlos Rebolleda-Gil,&nbsp;Patricia Correa-Ghisays,&nbsp;Vicent Balanzá-Martínez,&nbsp;Cristian Caride-Padilla,&nbsp;Salvador Sarró,&nbsp;Isabel Feria-Raposo,&nbsp;Ángeles Sánchez-Cabezudo,&nbsp;Olga Jiménez-Rodríguez,&nbsp;María Llanos Torres,&nbsp;Ruben Moreno-Comellas,&nbsp;Blanca Navarro,&nbsp;Francisco Del Olmo-Romero,&nbsp;José Antonio Larraz-Romeo,&nbsp;Edith Pomarol-Clotet","doi":"10.1111/bdi.70102","DOIUrl":"10.1111/bdi.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fingerprint patterns are developed during pregnancy and share a common embryogenic origin with the central nervous system. Considering the observed relationship between prenatal abnormalities and higher risk for schizophrenia, we previously built fingerprint-based algorithms achieving validation accuracies up to 70% in a large sample of patients with schizophrenia. In this new study, we apply them to a sample of patients with bipolar disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Besides validating the developed algorithms with an independent sample of fingerprints from <i>N</i> = 127 patients with schizophrenia and <i>N</i> = 116 healthy controls, here we applied them to a sample of <i>N</i> = 118 bipolar disorder patients. Scores from a premorbid IQ scale were also obtained from all participants, and the link between these scores and the algorithm outcomes was analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The initial validation provided balanced accuracies similar to those of the original study (57%–68%). When applied to subjects with bipolar disorder (against healthy individuals), algorithms also showed significant predictive power (accuracies: 55%–68%). Consequently, the capacity to discriminate between schizophrenia and bipolar disorder was poor (accuracies: 47%–57%). Regression analyses between averaged probabilities and premorbid IQ scores were significant in schizophrenia (r = −0.184; <i>p</i> = 0.041) and in the whole sample (r = −0.159; <i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Algorithms were predictive of bipolarity, highlighting the existence of fingerprint abnormalities also in bipolar disorder. In addition, the observed associations with premorbid IQ underline the neurodevelopmental origin of fingerprint patterns and suggest the potential use of fingerprints for prediction in other neurodevelopmental disorders. The lack of specificity with the diagnosis of schizophrenia, though, points to the need for new algorithms for differential diagnosis in psychosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12966405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147368840","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":"Empowering Quality of Life Monitoring and Self-Management in Bipolar Disorder: Pilot Evaluation of the PolarUs App","authors":"Erin E. Michalak,&nbsp;Emma E. Morton,&nbsp;Denny Meyer,&nbsp;Greg Murray,&nbsp;Heather L. O′Brien,&nbsp;Steven J. Barnes","doi":"10.1111/bdi.70096","DOIUrl":"10.1111/bdi.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Smartphone apps facilitate the dissemination of resources to help people with bipolar disorder (BD) implement self-management strategies. However, current apps do not address all treatment outcomes valued by people with BD, nor are they designed with scalability in mind. This study evaluated the feasibility and preliminary efficacy of an alpha version of the co-designed PolarUs app, a self-guided intervention developed to support quality of life (QoL) self-monitoring and self-management in BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>North American residents with a confirmed diagnosis of BD used the iOS PolarUs app for 12 weeks. To assess feasibility, adherence rates were assessed, operationalized by completion of weekly in-app Brief Quality of Life in BD (QoL.BD) scores. Linear mixed modeling was used to test the hypothesis that QoL (primary outcome) would improve over the intervention period and explore secondary outcomes (i.e., mood symptoms, self-efficacy, subjective recovery, self-compassion). Hierarchical cluster analysis was used to investigate associations between app adherence and primary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 170 participants (70% women, mean age 39 years SD = 12.1) there was a steady decline in app adherence over the intervention period, with 37% of participants completing their final weekly assessment. However, significant improvements were observed overall for QoL, mood symptoms, and self-compassion. Four distinct app adherence clusters were observed, displaying varying relationships with baseline QoL and trajectories of QoL improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preliminary adherence and efficacy data for the PolarUs app are positive and demonstrate how the inclusion of lived experience perspectives in app development supports intervention acceptability and impact.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12961918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353527","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":"SGLT2 Inhibitors Associated With Improved Kidney Function in Lithium-Treated Patients With Mood Disorders: A Real-World Historical Cohort Study","authors":"Mete Ercis,&nbsp;Idil Tarikogullari,&nbsp;Vanessa K. Pazdernik,&nbsp;Maria L. Gonzalez Suarez,&nbsp;Raman Baweja,&nbsp;Alessandro Miola,&nbsp;Osama A. Abulseoud,&nbsp;Jonathan G. Leung,&nbsp;Susan L. McElroy,&nbsp;Alfredo B. Cuellar-Barboza,&nbsp;Michael J. Gitlin,&nbsp;Aysegul Ozerdem,&nbsp;Mark A. Frye,&nbsp;Balwinder Singh","doi":"10.1111/bdi.70094","DOIUrl":"10.1111/bdi.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed for type 2 diabetes, have shown promise in improving renal outcomes in patients with and without diabetes. However, their effect on lithium-associated kidney dysfunction remains unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This historical cohort study included patients from Mayo Clinic (2001–2023) with mood disorders who received lithium for ≥ 6 months and later used SGLT2i for ≥ 1 month. Data on SGLT2i use and lithium treatment were extracted from electronic health records. Serum creatinine values were used to calculate estimated glomerular filtration rate (eGFR) trajectories. Linear mixed-effects models with piecewise linear splines were used to estimate eGFR slopes before and after SGLT2i initiation, adjusted for age and sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-six patients (mean age 57.4 years, 46.4% female), predominantly with bipolar disorder (87.5%), were included. The mean eGFR, measured nearest to SGLT2i initiation, was 77.9 ± 26.0 mL/min/1.73 m², and the mean duration of SGLT2i use was 19.5 ± 17.8 months. Before SGLT2i initiation, eGFR declined at a rate of −1.43 mL/min/1.73 m² per year (<i>p</i> &lt; 0.001). After initiation, eGFR increased by 0.69 mL/min/1.73 m² per year, reflecting a + 2.13 change (<i>p</i> = 0.025). Sensitivity analyses, including only patients on lithium at SGLT2i initiation (<i>n</i> = 22) or who had &gt; 1 year of SGLT2i use (<i>n</i> = 29) showed similar, though non-significant, changes in slopes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SGLT2i treatment was associated with a significant improvement in eGFR trajectory in patients with mood disorders who received long-term lithium therapy. These findings suggest a potential role for SGLT2is in mitigating lithium-associated kidney dysfunction and highlight the need for randomized controlled trials in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147302069","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":"A Case of Psychosis Caused by Long-Term Overdose of Compound Paracetamol and Amantadine Hydrochloride Capsules","authors":"Yao Yang,&nbsp;Xi-Rui Liu,&nbsp;Hui Li,&nbsp;Shuo Wang,&nbsp;Yan-Hua Zhang,&nbsp;Wu Hong","doi":"10.1111/bdi.70100","DOIUrl":"10.1111/bdi.70100","url":null,"abstract":"","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147289160","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":"Severe Lithium Toxicity due to the Use of Unauthorized Weight Loss Medication","authors":"Georgios Ydraios,&nbsp;Rayan Nasserdine,&nbsp;Emilie Duret,&nbsp;Stergios Tsartsalis,&nbsp;Hélène Richard-Lepouriel","doi":"10.1111/bdi.70101","DOIUrl":"10.1111/bdi.70101","url":null,"abstract":"&lt;p&gt;A 39-year-old female patient, followed in outpatient care for bipolar I disorder, effectively treated with lithium since January 2022 (a dose of 18 mmol 2× per day and latest plasma concentrations around 0.85 mmol/L during the last months), and flurazepam (30 mg/j) for sleep onset difficulties, was referred to the emergency department for involuntary admission on August 13 by her psychiatrist for suspicion of a manic episode with mixed features.&lt;/p&gt;&lt;p&gt;Upon arrival at the psychiatric emergency department, the patient was confused, with disorganized thinking, disoriented as far as the situation, the place and the time, a marked psychomotor slowing, bilateral miosis, spontaneous tremors, jaw dysarthria and muscle rigidity. She reported taking lithium as prescribed (18 mmol 2×/day), flurazepam (30 mg per day), and a weight-loss treatment which she had procured, without prescription, online (of a composition unknown to the patient). Biological tests revealed acute kidney injury (KDIGO III), with elevated lithium levels at 3.94 mmol/L, hypokalemia at 2.6 mmol/L, and hypophosphatemia at 0.22 mmol/L. A prolonged QTc of 570 ms was also noted. A brain CT scan ruled out any intracranial hemorrhage.&lt;/p&gt;&lt;p&gt;Lithium remains a cornerstone in managing bipolar disorder due to its efficacy in stabilizing mood fluctuations. However, its narrow therapeutic index necessitates rigorous monitoring, as interactions with other substances can precipitate toxicity. This case exemplifies the dangers associated with unregulated weight-loss supplements, which may contain undisclosed pharmacologically active ingredients [&lt;span&gt;2&lt;/span&gt;]. The toxicological analysis of the patient's weight-loss product revealed the presence of fluoxetine, furosemide, hydrochlorothiazide, metformin, and sibutramine. The inclusion of diuretics such as furosemide and hydrochlorothiazide is particularly concerning, as they can reduce renal lithium clearance, leading to elevated serum lithium levels and potential toxicity. Additionally, sibutramine, an appetite suppressant withdrawn from the market due to cardiovascular risks, and fluoxetine, a selective serotonin reuptake inhibitor, can further complicate the clinical picture through their own side effect profiles and potential interactions. The prevalence of dietary supplements adulterated with pharmaceutical agents is a growing public health concern. A study assessing the US Food and Drug Administration's Tainted Supplements Database from 2007 through 2016 identified numerous products marketed for weight loss containing undeclared substances, including sibutramine and various diuretics [&lt;span&gt;3&lt;/span&gt;]. These adulterated supplements pose significant health risks, especially when consumed without medical supervision. According to research, nonprescription weight-loss product use remains common, despite the potential for severe adverse effects [&lt;span&gt;4&lt;/span&gt;]. Additionally, a systematic review identified a high prevalence of adolescent use of non","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12937921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147289176","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":"Examining Stepped Care as an Innovation in the Delivery of Psychological Treatments for Bipolar Disorder: Perspectives From Members of the International Society of Bipolar Disorders Psychological Interventions Task Force","authors":"Louisa G. Sylvia,&nbsp;Alexandra K. Gold,&nbsp;Emma Morton,&nbsp;Katie M. Douglas,&nbsp;Harriet Birabwa-Oketcho,&nbsp;David J. Miklowitz,&nbsp;Anna Van Meter,&nbsp;Eric A.Youngstrom,&nbsp;Jennifer B. Levin,&nbsp;Esther Mesman,&nbsp;Maria Faurholt-Jepsen,&nbsp;Greg Murray","doi":"10.1111/bdi.70097","DOIUrl":"10.1111/bdi.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Research demonstrates the effectiveness of evidence-based psychological treatment adjunctive to pharmacotherapy for reducing mood symptoms in bipolar disorder. However, access to these treatments is limited, and innovative strategies are needed to ensure that more patients with bipolar disorder receive the gold-standard treatments that may help them achieve wellness. “Stepped care” models of psychological service delivery represent one potential solution to this problem of treatment access. Under a stepped care model, patients are assigned the minimum necessary psychological treatment for symptom improvement. This typically means that patients who are experiencing more symptoms are assigned to a treatment of greater intensity (e.g., weekly individual therapy) whereas patients who are experiencing fewer symptoms are assigned to a treatment of relatively lesser intensity (e.g., biweekly group therapy). Stepped care models are dynamic, meaning that the level of treatment can be modified depending on the patient's response. Stepped care models have been explored in other clinical populations but require further exploration in bipolar disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Members of the Psychological Interventions Task Force for the International Society of Bipolar Disorders conducted a narrative review of stepped care models and their application to bipolar disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found evidence that stepped care models are useful approaches to delivering psychosocial treatments for bipolar disorder. We discuss several contextual factors in executing stepped care models in this population (i.e., cultural and pediatric applications), as well as share an example of a stepped care model—Focused Integrated Team-based Treatment for Bipolar Disorder (FITT-BD)—that is currently being evaluated in an academic medical center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Further research is warranted to develop and assess robust stepped care models to determine whether they can improve access to treatment of bipolar disorder while not sacrificing outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269863","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":"Correction to “Living With Bipolar Disorder and Medication PRN—A Case-Report”","authors":"","doi":"10.1111/bdi.70098","DOIUrl":"10.1111/bdi.70098","url":null,"abstract":"<p>Dols, A., J. Brennikmeijer, and J. van Os. 2026. “Living With Bipolar Disorder and Medication PRN—A Case-Report.” <i>Bipolar Disorders</i> 28, no. 1: e70086. https://doi.org/10.1111/bdi.70086.</p><p>In the originally published article, the second author's name was incorrectly listed as “John Brennikmeijer.” The author's name should be corrected to “Ansgar John Brenninkmeijer”.</p><p>The authors apologize for this error.</p>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"28 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269949","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}