To examine the characteristics of major depressive episodes (MDEs) with underlying anxious distress (ANXD), specifically whether these characteristics are influenced by the presence of Benazzi's depressive mixed state (DMX) or are unique to ANXD. Sociodemographic and clinical characteristics of patients with or without ANXD and of patients with ANXD with or without Benazzi's DMX were retrospectively examined in 160 patients with MDEs. Overall, 45.6% of patients met the criteria for ANXD. The mean Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) total score and frequencies of Benazzi's DMX, psychotic features, and psychiatric adverse events associated with antidepressants were significantly higher in patients with ANXD than in those without ANXD. Benazzi's DMX and male sex were independently associated with ANXD (odds ratio, 95% confidence interval: 4.95 [2.45-10.04], p < 0.001 and 2.11 [1.04-4.27], p < 0.038, respectively), regardless of depressive symptom severity or bipolar disorder diagnosis. In patients with ANXD with Benazzi's DMX, the rate of bipolar disorder diagnosis, QIDS-SR suicidal ideation score, and number of MDEs were significantly higher. The frequency of psychiatric adverse events associated with antidepressants and sociodemographic disadvantages in education and marital status were also numerically higher compared with patients with ANXD only. Although ANXD itself is not a defining feature of bipolarity, its coexistence with Benazzi's DMX suggests an underlying bipolar disorder. Furthermore, high suicidality, high frequency of psychiatric adverse events associated with antidepressants, and sociodemographic disadvantages may be influenced by Benazzi's DMX. Further studies are required to validate these findings.

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. 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. 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. 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.

ABSTRACT Background 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. Methods Besides validating the developed algorithms with an independent sample of fingerprints from N = 127 patients with schizophrenia and N = 116 healthy controls, here we applied them to a sample of N = 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. Results 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; p = 0.041) and in the whole sample (r = −0.159; p = 0.002). Conclusions 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.

The authors declare no conflicts of interest. The authors confirm that the data supporting the findings of this study are available.

It remains unclear to what extent long-term lithium use leads to significant eGFR decline. This study examines the course of eGFR in a 10-year prospective cohort of lithium users and the association with duration of lithium use, lithium serum concentration, and comedication. This 10-year prospective cohort study included patients using lithium at inclusion. Medical records were reviewed for lithium concentration, eGFR, discontinuation of lithium, and other medication use. Primary outcome was a description of eGFR decline, quantified as delta eGFR per year of follow-up. In total 196 patients were analyzed (42% male, mean age 51.1 ± 12.2, median follow-up time 8.8 years [IQR 1.3]). Median yearly decline was 0.79 mL/min/1.73 m2. Of the participants, 48% had a yearly decline between 0.5 and 2.5 mL/min/1.73 m2, while 11% showed a decline > 2.5 mL/min/1.73 m2. Duration of lithium use was associated with eGFR decline. A positive association between lithium serum concentration and kidney function decline was shown, when corrected for age, sex and duration of lithium use. Comedication was not associated with eGFR decline. In the participants who discontinued lithium (20%) during follow up, there was no significant difference in eGFR before and after cessation. This study provides further evidence that eGFR decline occurs in most long-term lithium users. Of this cohort, 59% of the participants had faster eGFR decline than the mean decline in the general population. Lithium exposure, quantified as mean serum lithium concentration, could be a contributing factor in this decline. eGFR trajectory was not altered by ceasing lithium.

Bipolar disorder is a severe mental disorder affecting millions worldwide, necessitating comprehensive policies and interventions. To provide assessment of global inequalities in the burden of bipolar disorder and their projected trajectories to 2050. Global Burden of Disease 2021 data from 204 countries and territories were analyzed, stratified by age, gender, and Socio-demographic Index (SDI) quintiles. Age-standardized prevalence (ASPR), incidence (ASIR), and years lived with disability (ASR YLD) per 100,000 population were calculated. Inequalities were assessed using the slope index of inequality (SII) and concentration index (CI), and ARIMA models were applied to project trends to 2050. From 1990 to 2021, global incidence of BDincreased, while prevalence and years lived with disability (YLDs) remained relatively stable (ASPR: 453.7 [95% UI: 381.6-540.8] to 454.6 [95% UI: 377.9-545.8]). Females consistently had higher prevalence than males (474.2 vs. 435.0 per 100,000 in 2021). High-SDI regions reported the highest rates, with Australasia reaching 1110.8 (95% UI: 940.3-1305.9). The SII for incidence rose slightly (10.87-11.38), while the CI declined (0.096-0.012), indicating increasing absolute but decreasing relative inequalities. Projections suggest a rising global burden, with female prevalence remaining higher and incidence rates converging between genders (global ASIR: 33.8 per 100,000). Global inequalities in bipolar disorder persist, disproportionately affecting females and high-SDI regions. Projected trends indicate an increasing burden with a narrowing gender gap in incidence, emphasizing the need for targeted interventions and further research on long-term impacts, including the effects of COVID-19.

ABSTRACTIntroductionThe association between subjective and objective cognitive function in mood disorders is hotly debated, particularly in the choice of outcomes to measure pro‐cognitive effects of interventions. We systematically reviewed the evidence regarding this association, including analysis of predicting or moderating factors.MethodsWe searched Ovid MEDLINE, EMBASE, PsycINFO, and Cochrane Library for studies examining subjective and objective cognitive function in mood disorders (from inception to July 2024). Studies using correlational analyses to examine the association between subjective and objective cognitive function were included in the meta‐analysis.ResultsFifty‐five studies (59 publications) were identified (n = 5798), with 35 studies included in the meta‐analysis. There were weak but statistically significant positive correlations between subjective and objective cognition in all domains except sustained attention, which was at a trend level (p = 0.05). Mood state or mood disorder diagnosis did not impact these correlations. No subjective measure was more highly associated with objective cognitive function than others. Our narrative review of the remaining 20 studies (that did not examine subjective‐objective correlations) demonstrated a shift towards calculation of a discrepancy or sensitivity score, rather than simply correlating measures.ConclusionThis is the first systematic review and meta‐analysis examining the association between subjective and objective cognition in mood disorders. Our results support the general consensus that there is not a strong relationship. This may relate to the limited ecological validity of objective cognitive tests and highlights the need for assessment of both subjective and objective cognitive function to adequately capture patients' cognitive status.

ABSTRACTIntroductionRisk for suicide is disproportionately elevated among youth with bipolar spectrum disorder (BD), which is characterized by recurrent mood episodes and significant shifts in sleep and circadian rhythm. Disruptions in circadian rhythm, such as 24‐h rest‐activity patterns, are a relevant risk factor for SI, yet understudied in BD youth. The present cross‐sectional study examined the associations between actigraphy‐derived rest‐activity rhythms (RARs) and self‐reported suicidal ideation (SI) severity in a sample of 54 BD youth (aged 12–18 years).MethodParticipants completed daily wrist actigraphy (Mdays = 18.89, range: 6 to 29 days) and non‐parametric RAR measures were derived for analyses. At the same time, participants provided self‐report data on depressive symptoms and SI severity (number of days between actigraphy start and questionnaire completion: Mdays = −7.74, SD = 13.33, range: −46 to 28 days). Primary analyses examined associations between RAR variables and SI severity, controlling for several key covariates including age, BD subtype, psychotropic medication use, and depressive symptoms.ResultsResults revealed that greater interdaily stability and higher average activity levels during wake were associated with lower SI severity. These results remained significant even when controlling for the aforementioned covariates.ConclusionResults indicated that greater and more consistent activity levels within and across days are associated with lower suicide risk. Findings suggest that RARs are relevant for suicide risk detection and intervention for BD youth.