Search Results (15)

Background: While attention deficit/hyperactivity disorder (ADHD) is characterized by neurodevelopmental heterogeneity, the influence of familial structural factors—particularly parental age and skipped-generation caregiving—on comorbidity patterns remains insufficiently studied. This study examined the associations between parent–child age gaps, skipped-generation family structures, and psychiatric comorbidities in children with ADHD. Methods: Data came from Taiwan’s NHIRD (2009–2013), including 79,163 ADHD cases and 395,815 matched controls. Key variables included maternal and paternal age at childbirth and grandparent-paid insurance premiums as a proxy for skipped-generation caregiving. Conditional logistic regression was used to estimate odds ratios (ORs) for 20 psychiatric and developmental comorbidities. Results: Children with ADHD exhibited significantly higher odds of various comorbidities, including oppositional defiant disorder (OR = 147.05, 95% CI = 101.0–214.1), somatoform disorder (OR = 25.78, 95% CI = 7.96–83.46), anxiety disorder (OR = 24.49, 95% CI = 17.9–33.5), emotional disturbances during childhood and adolescence (OR = 13.99, 95% CI = 9.15–21.4), and autism spectrum disorder (OR = 8.07, 95% CI = 6.63–9.82). Advanced maternal age (>35 years) was associated with increased odds of autism spectrum disorder (OR = 1.47, 95% CI: 1.29–1.67) and speech/language delay (OR = 1.33, 95% CI: 1.17–1.52), whereas younger maternal age (≤25 years) was linked to higher odds of anxiety disorder (OR = 1.23, 95% CI: 1.13–1.33) and adjustment reaction (OR = 1.41, 95% CI: 0.95–2.11). Maternal age under 20 years showed the highest odds for bipolar disorder (OR = 2.01, 95% CI: 1.04–3.88). For paternal age, older age (>35 years) was associated with increased odds of autism (OR = 1.14, 95% CI: 1.04–1.26) and speech/language delay (OR = 1.15, 95% CI: 1.04–1.27), whereas paternal age ≤20 years was strongly linked to bipolar disorder (OR = 3.58, 95% CI: 1.54–8.32) and anxiety (OR = 1.39, 95% CI: 1.01–1.93). Children from skipped-generation families—defined as grandparent-paid insurance premiums without parental cohabitation—had significantly higher odds of bipolar disorder (OR = 2.88, 95% CI: 1.36–6.11), personality disorder (OR = 9.23, 95% CI: 2.23–38.20), adjustment reaction (OR = 2.23, 95% CI: 1.39–3.59), and emotional disturbances during childhood/adolescence (OR = 1.69, 95% CI: 1.13–2.54). Conclusions: Both extremes of parental age and skipped-generation caregiving are linked to specific associations with certain psychiatric comorbidity patterns in children with ADHD. These findings highlight the importance of integrating family structure into diagnostic assessments and treatment planning and support the development of targeted early interventions. Full article

Background: An increased risk of cognitive decline has been reported in patients with older age bipolar disorder (OABD); however, the underlying factors contributing to this association remain unclear. This cross-sectional study aims to identify the clinical features associated with cognitive impairment in OABD. Methods: A total of 152 participants, aged at least 50 years and diagnosed with bipolar disorder (BD) and related disorders in agreement with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria, were included in the study and divided into two subgroups based on the presence/absence of cognitive impairment, defined as a diagnosis of Mild Neurocognitive Disorder or Major Neurocognitive Disorder. Univariate comparisons and multivariate logistic regression models were performed to investigate the associations between clinical variables and cognitive impairment. Results: Cognitively impaired patients had a higher prevalence of otherwise specified BD/cyclothymic disorder, while BD type 2 was more common in the cognitively unimpaired group. Additionally, the cognitively impaired group had a later onset of major mood episodes (p < 0.05), fewer lifetime depressive episodes (p = 0.006), a higher prevalence of vascular leukoencephalopathy (p = 0.022) and dyslipidemia (p = 0.043), a lower prevalence of agoraphobia (p = 0.040), worse global functioning (p < 0.001), and higher psychopathology severity (p < 0.001). Late onset, vascular leukoencephalopathy, and dyslipidemia were all independently associated with cognitive impairment. Conclusions: Atypical BD, late onset of mood episodes, and somatic comorbidities like vascular leukoencephalopathy and dyslipidemia are associated with a higher risk of developing cognitive impairment and neurodegenerative disorders in OABD patients. Full article

Background/Objectives: Life events and lack of social support are risk factors for a relapse or recurrence in patients with a bipolar disorder, yet studies focusing on older adults remain limited. Our aim was to investigate the influence of life events and social support on the course of bipolar disorder in older adults. Methods: A retrospective cohort study included patients aged 55 years and older in treatment for bipolar disorder and who used lithium. During a follow-up of maximum 5 years, relapses and recurrences, life events and six social support variables were constructed based on patients’ electronic medical files. Results: We included 100 older patients with a mean age of 68.1 (SD 8.6) years; 69% were female. At least one relapse or recurrence was observed within the 5 years of observation in 52% of our patients. Life events were noted in the medical files in 24 out of these 52 (46.2%) patients. Living alone, a lower quality of social support and having at least two children was significantly associated with the onset of a relapse or recurrence (p = 0.024, p < 0.001, p = 0.022, respectively). Conclusions: Older adults with bipolar disorder have a high rate of relapses or recurrences within 5 years of observation, and half of the relapses or recurrences were preceded by life events. Social factors may also play a significant role in the onset of relapses and recurrences. Our results underline the necessity for incorporating social and environmental factors into prevention of relapses or recurrences for older bipolar patients. Full article

The relationship between unemployment and mental disorders has been a significant subject of study since at least the Industrial Revolution. However, most data show associations of unemployment and isolated mental disorders, and this study field has been neglected in the last years. Therefore, this narrative review aims to provide an updated overview of the association between unemployment and mental health in general as well as the most prevalent mental disorders. A literature search was conducted using PubMed with the initial search terms “unemployment” and “mental health”. The identified disorders were then used as search terms for a more in-depth search. Two raters screened abstracts and identified the literature containing relevant information. As a main result, it could be demonstrated that regardless of age and sex, there is still a broad association between unemployment and mental well-being in general (e.g., quality of life measure for example by the General Health Questionnaire), suicide attempts, suicide rates, as well as specific psychiatric disorders (substance use disorder, schizophrenia, depression, bipolar disorders, compulsive/obsessive disorders, eating disorders, specific personality disorders, intelligence disorders/impairment, and ADHD). The most significant association was found for affective disorders (depression) and substance use disorders. The association in general was particularly evident for long-term unemployment and mental disorders. Returning to work reduced the prevalence rates of mental disorders significantly. The literature review confirms the results of much older and disease centered studies that unemployment and mental disorders are associated with each other. The main conclusion is that early medical detection and intervention among the mentally ill are as crucial as labor market policy interventions to prevent, avoid, and reduce unemployment. Full article

Introduction: Impairments in social cognition and cognitive deficits in bipolar disorder (BD) offer insights into the disorder’s progression. Understanding how interventions impact both cognitive and emotional aspects of social cognition is essential. This study examines the effects of virtual reality (VR) cognitive remediation on cognitive skills, stratified by age, in the early stages of the disorder. Methods: A secondary analysis of a randomized controlled trial (RCT) compared the efficacy of VR cognitive remediation on cognitive skills between young adults (≤58 years) and older adults (≥59 years) in the experimental group with BD. Results: The experimental group included 39 participants: 24 ≤ 58 years and 15 ≥ 59 years. Young adults showed greater improvement in the Digit Span Backward (0.37 ± 0.35 vs. 0.07 ± 0.26, F = 9.882, p = 0.020) and Digit Symbol tests (3.84 ± 3.05 vs. 1.16 ± 3.8, F = 5.895, p = 0.020). Older adults improved more in the Frontal Assessment Battery (1.00 ± 0.95 vs. 0.54 ± 0.21, F = 5.295, p = 0.027), Matrix test (0.58 ± 0.35 vs. 0.37 ± 0.26, F = 4.606, p = 0.038), and Test of Tale (0.81 ± 0.36 vs. 0.42 ± 0.38, F = 10.115, p = 0.003). Conclusions: Young adults improved more in complex cognitive tasks, while older adults showed better results in simpler tasks. The effectiveness of VR may be due to hyperstimulation of mirror neurons. Further studies are needed to confirm these findings. Full article

Introduction: Dementia, depression, and cardiovascular disease are major public health concerns for older adults, requiring early intervention. This study investigates whether a virtual reality cognitive remediation program (VR-CR) can improve cognitive function and depressive symptoms in older adults, and determines the necessary sample size for future studies. Integrated VR and CR interventions have shown promising outcomes in older adults with neurodegenerative and mental health disorders. Methods: This secondary analysis of a randomized controlled trial involves adults aged 58–75 years with bipolar disorder, excluding those with acute episodes, epilepsy, or severe eye diseases. The experimental group received standard treatment plus VR-CR, while the control group received only standard treatment. Results: No baseline differences were found between the experimental and control groups. No significant improvement was observed in the overall cognitive function test (p = 0.897) or in depressive symptoms (p = 0.322). A phase III efficacy study requires a sample size of 28 participants (alpha = 0.05, beta = 0.20). Conclusions: VR-CR can potentially treat depressive symptoms in adults and older adults, but the results support conducting phase III studies to further investigate these outcomes. However, the improvement in cognitive performance in the elderly is less pronounced than in younger individuals. Full article

Background: A wide range of conditions, including mixed depressive symptoms, hyperactivity, cognitive impairment (CI) might be expressions of Bipolar Spectrum Disorder (BSD) according to the neo-Kraepelinian perspective, even in advanced age. CI, which has a high prevalence in the elderly population, when it occurs in comorbidity with depression further hinders therapy response and functional ability. The present study aims to explore risk factors associated with CI in elderly individuals experiencing a depressive episode during lockdown a period marked by significant stressors and rhythm disruption. Methods: A case-control study analyzed data from a previous RCT (secondary analyses) on elderly individuals living at home, assessing depressive symptoms, cognitive performance, hyperactivity, and hypertension before (T0) and during lockdown (T1). Results: Participants with lower pre-pandemic cognitive performance were more prone to lockdown depression compared to those with higher baseline function (F = 6.074; p = 0.016). Among those experiencing lockdown depression without prior depression, those with low cognitive performance were more prevalent than the control group without depression (OR = 11.8; p = 0.015). Conclusion: This study highlights a potentially vulnerable subgroup within the elderly population that requires targeted interventions and support during stressful events. Future research should explore the underlying mechanisms linking cognitive decline and depression in older adults, particularly those with a possible bipolar spectrum predisposition. Full article

Background: Older adults with bipolar disorder (OABD) are individuals aged 50 years and older with bipolar disorder (BD). People with BD may have fewer coping strategies or resilience. A long duration of the disease, as seen in this population, could affect the development of resilience strategies, but this remains under-researched. Therefore, this study aims to assess resilience levels within the OABD population and explore associated factors, hypothesizing that resilience could improve psychosocial functioning, wellbeing and quality of life of these patients. Methods: This study sampled 33 OABD patients from the cohort at the Bipolar and Depressive Disorders Unit of the Hospital Clinic of Barcelona. It was an observational, descriptive and cross-sectional study. Demographic and clinical variables as well as psychosocial functioning, resilience and cognitive reserve were analyzed. Resilience was measured using the CD-RISC-10. Non-parametric tests were used for statistical analysis. Results: The average CD-RISC-10 score was 25.67 points (SD 7.87). Resilience negatively correlated with the total number of episodes (p = 0.034), depressive episodes (p = 0.001), and the FAST (p < 0.001). Participants with normal resilience had a lower psychosocial functioning (p = 0.046), a higher cognitive reserve (p = 0.026), and earlier onset (p = 0.037) compared to those with low resilience. Conclusions: OABD individuals may have lower resilience levels which correlate with more psychiatric episodes, especially depressive episodes and worse psychosocial functioning and cognitive reserve. Better understanding and characterization of resilience could help in early identification of patients requiring additional support to foster resilience and enhance OABD management. Full article

Introduction: Rehabilitative interventions employing technology play a crucial role in bipolar disorder (BD) treatment. The study aims to appraise the virtual reality (VR)-based cognitive remediation (CR) and the interpersonal rhythm approaches to treatment outcomes of BD across different age groups. Methods: Post-hoc analysis of a 12-week randomizedcontrolled cross-over feasibility trial involving people with mood disorders (BD, DSM-IV) aged 18–75 years old: thirty-nine exposed to the experimental VR-based CR vs 25 waiting list controls. People with BD relapse, epilepsy or severe eye diseases (due to the potential VR risks exposure) were excluded. Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) was used to measure the outcome. Results: Cases and controls did not statistically significantly differ in age and sex distributions. Personal rhythm scores improved over the study follow-up in the experimental vs the control group (APC = 8.7%; F = 111.9; p < 0.0001), both in young (18–45 years) (APC = 5.5%; F = 70.46; p < 0.0001) and, to a lesser extent, older (>46 years) adults (APC = 10.5%; F = 12.110; p = 0.002). Conclusions: This study observed improved synchronization of personal and social rhythms in individuals with BD after a virtual reality cognitive remediation intervention, particularly in social activity, daily activities, and chronotype, with greater benefits in the younger population. Full article

A common infection, human cytomegalovirus (HCMV) has been associated with a variety of human diseases, including cardiovascular disease and possibly certain cancers. HCMV has also been associated with cognitive, psychiatric, and neurological conditions. Children with congenital or early-life HCMV are at risk for microcephaly, cerebral palsy, and sensorineural hearing loss, although in many cases sensorineural loss may resolve. In addition, HCMV can be associated with neurodevelopmental impairment, which may improve with time. In young, middle-aged, and older adults, HCMV has been adversely associated with cognitive function in some but not in all studies. Research has linked HCMV to Alzheimer’s and vascular dementia, but again not all findings consistently support these associations. In addition, HCMV has been associated with depressive disorder, bipolar disorder, anxiety, and autism-spectrum disorder, although the available findings are likewise inconsistent. Given associations between HCMV and a variety of neurocognitive and neuropsychiatric disorders, additional research investigating reasons for the considerable inconsistencies in the currently available findings is needed. Additional meta-analyses and more longitudinal studies are needed as well. Research into the effects of antiviral medication on cognitive and neurological outcomes and continued efforts in vaccine development have potential to lower the neurocognitive, neuropsychiatric, and neurological burden of HCMV infection. Full article

Background: Older adults with mood disorders constitute a heterogeneous group in a complex spectrum interlinked with physical comorbidities. Worldwide, Bipolar disorders in older people (OABD) remain underestimated and underdiagnosed. OABD is challenging in the clinical setting and is associated with adverse outcomes (increased risk of anti-social behaviour triggered by inappropriate drugs and increased incidence of health deficits, including cancer). This article aims to describe the state of the art of OABD in the Italian framework and provide a new field of research. Methods: We performed an overview of the literature, selecting our target population (over 65 years) and synthesising the main challenging issues. By exploiting the Italian database from the Minister of Health in 2021, we analysed epidemiological data in the age range 65–74 years and 75–84 years old. Results: Females showed the highest prevalence and incidence in both groups, with a regional difference across the country but more evident in the Autonomous Provinces of Bolzano and Trento for the 65–74 years range. Several projects recently focused on this topic, and the urgency to define better the epidemiological framework is mandatory. Conclusions: This study represented the first attempt to report the comprehensive Italian framework on OABD aimed at fostering research activities and knowledge. Full article

The average age of fathers at first pregnancy has risen significantly over the last decade owing to various variables, including a longer life expectancy, more access to contraception, later marriage, and other factors. As has been proven in several studies, women over 35 years of age have an increased risk of infertility, pregnancy problems, spontaneous abortion, congenital malformations, and postnatal issues. There are varying opinions on whether a father’s age affects the quality of his sperm or his ability to father a child. First, there is no single accepted definition of old age in a father. Second, much research has reported contradictory findings in the literature, particularly concerning the most frequently examined criteria. Increasing evidence suggests that the father’s age contributes to his offspring’s higher vulnerability to inheritable diseases. Our comprehensive literature evaluation shows a direct correlation between paternal age and decreased sperm quality and testicular function. Genetic abnormalities, such as DNA mutations and chromosomal aneuploidies, and epigenetic modifications, such as the silencing of essential genes, have all been linked to the father’s advancing years. Paternal age has been shown to affect reproductive and fertility outcomes, such as the success rate of in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI), and premature birth rate. Several diseases, including autism, schizophrenia, bipolar disorders, and paediatric leukaemia, have been linked to the father’s advanced years. Therefore, informing infertile couples of the alarming correlations between older fathers and a rise in their offspring’s diseases is crucial, so that they can be effectively guided through their reproductive years. Full article

Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called “late onset” patients (LOBD), and the elder patients with a long-standing clinical history, the so called “early onset” patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970–2021 using the MeSH terms “bipolar disorder” and “aged” or “geriatric” or “elderly”. The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar depression. Mood stabilizers, rather than second generation antipsychotics, are the treatment of choice for maintenance. If medication fails, electroconvulsive therapy is recommended for mania, mixed states and depression, and can also be offered for continuation and maintenance treatment. Preliminary results also support a role of psychotherapy and psychosocial interventions in old age BD. The recommended treatments for OABD include lithium and antiepileptics such as valproic acid and lamotrigine, and lurasidone for bipolar depression, although the evidence is still weak. Combined psychosocial and pharmacological treatments also appear to be a treatment of choice for OABD. More research is needed on the optimal pharmacological and psychosocial approaches to OABD, as well as their combination and ranking in an evidence-based therapy algorithm. Full article

The purpose of the study was three-fold: (1) to estimate the national trends in antipsychotic (AP) polypharmacy among 6- to 24-year-old patients in the U.S.; (2) to identify frequently used AP agents and mental disorder diagnoses related to AP polypharmacy; and (3) to assess the strength of association between AP polypharmacy and patient/provider characteristics. We used publicly available ambulatory health care datasets to evaluate AP polypharmacy in office-based or hospital outpatient department settings to conduct a cross-sectional study. First, national visit rates between 2007 and 2011 were estimated using sampling weights. Second, common diagnoses and drugs used in AP polypharmacy were identified. Third, a multivariate logistic regression model was developed to assess the strength of association between AP polypharmacy and patient and provider characteristics. Between 2007 and 2011, approximately 2% of office-based or hospital outpatient department visits made by 6- to 24-year-old patients included one or more AP prescriptions. Of these visits, 5% were classified as AP polypharmacy. The most common combination of AP polypharmacy was to use two or more second-generation APs. Also, bipolar disorder and schizophrenia were the two most frequent primary mental disorder diagnoses among AP polypharmacy visits. The factors associated with AP polypharmacy were: older age (young adults), black, having one or more non-AP prescriptions, and having schizophrenia or ADHD. Full article

Pediatric bipolar disorder (BD) rates have notably increased over the past three decades. Given the significant morbidity and mortality associated with BD, efforts are needed to identify factors useful in earlier detection to help address this serious public health concern. Sleep is particularly important to consider given the sequelae of disrupted sleep on normative functioning and that sleep is included in diagnostic criteria for both Major Depressive and Manic Episodes. Here, we examine one component of sleep—i.e., circadian phase preference with the behavioral construct of morningness/eveningness (M/E). In comparing 30 BD and 45 typically developing control (TDC) participants, ages 7–17 years, on the Morningness-Eveningness Scale for Children (MESC), no between-group differences emerged. Similar results were found when comparing three groups (BD−ADHD; BD+ADHD; TDC). Consistent with data available on circadian phase preference in adults with BD, however, we found that BD adolescents, ages 13 years and older, endorsed significantly greater eveningness compared to their TDC peers. While the current findings are limited by reliance on subjective report and the high-rate of comorbid ADHD among the BD group, this finding that BD teens demonstrate an exaggerated shift towards eveningness than would be developmentally expected is important. Future studies should compare the circadian rhythms across the lifespan for individuals diagnosed with BD, as well as identify the point at which BD youth part ways with their healthy peers in terms of phase preference. In addition, given our BD sample was overall euthymic, it may be that M/E is more state vs. trait specific in latency age youth. Further work would benefit from assessing circadian functioning using a combination of rating forms and laboratory-based measures. Improved understanding of sleep in BD may identify behavioral targets for inclusion in prevention and intervention protocols. Full article