Mood Disorders (Psychology)

BACKGROUND: Bipolar disorder (BD) may be associated with significant and persistent cognitive impairment. The aim of this study was to describe the profile of cognitive deficits in BD at different phases of the illness and determine whether it is different from that of schizophrenia and unipolar (UP) depression.

METHODS: A systematic review of the computerised literature of neuropsychological studies of BD published between 1980 and 2000.

RESULTS: General intellectual function: this was largely preserved in BD. Impairments when present were limited to acute episodes and to performance scores. Attention: attentional abnormalities were seen in symptomatic BD patients and persisted in remission in measures of sustained attention and inhibitory control. Memory: verbal memory was impaired even in euthymic patients while visuo-spatial memory deficits were variable depending on the tasks used. Executive function: all aspects of executive function (planning, abstract concept formation, set shifting) were impaired in symptomatic BD patients. Performance on executive function tests was sensitive to the presence of even residual symptoms but it may be normal in fully recovered patients with uncomplicated BD. Comparison to other patient groups: no major differences in cognitive profile between BD and UP depression were found. Remitted BD patients out-performed stable schizophrenics on most cognitive measures but this advantage disappeared when they were acutely symptomatic.

CONCLUSIONS: Symptomatic BD patients have widespread cognitive abnormalities. Trait related deficits appear to be present in verbal memory and sustained attention. Executive function and visual memory may be also affected at least in some recovered BD patients

Anhedonia, the loss of pleasure or interest in previously rewarding stimuli, is a core feature of major depression. While theorists have argued that anhedonia reflects a reduced capacity to experience pleasure, evidence is mixed as to whether anhedonia is caused by a reduction in hedonic capacity. An alternative explanation is that anhedonia is due to the inability to sustain positive affect across time. Using positive images, we used an emotion regulation task to test whether individuals with depression are unable to sustain activation in neural circuits underlying positive affect and reward. While upregulating positive affect, depressed individuals failed to sustain nucleus accumbens activity over time compared with controls. This decreased capacity was related to individual differences in self-reported positive affect. Connectivity analyses further implicated the fronto-striatal network in anhedonia. These findings support the hypothesis that anhedonia in depressed patients reflects the inability to sustain engagement of structures involved in positive affect and reward.

Mood disorders such as major depressive disorder and bipolar disorder are chronic and recurrent illnesses that cause significant disability and affect approximately 350 million people worldwide. Currently available biogenic amine treatments provide relief for many and yet fail to ameliorate symptoms for others, highlighting the need to diversify the search for new therapeutic strategies. Here we present recent evidence implicating the role of N-methyl-D-aspartate receptor (NMDAR) signaling in the pathophysiology of mood disorders. The possible role of NMDARs in mood disorders has been supported by evidence demonstrating that: (i) both BPD and MDD are characterized by altered levels of central excitatory neurotransmitters; (ii) NMDAR expression, distribution, and function are atypical in patients with mood disorders; (iii) NMDAR modulators show positive therapeutic effects in BPD and MDD patients; and (iv) conventional antidepressants/mood stabilizers can modulate NMDAR function. Taken together, this evidence suggests the NMDAR system holds considerable promise as a therapeutic target for developing next generation drugs that may provide more rapid onset relief of symptoms. Identifying the subcircuits involved in mood and elucidating the role of NMDARs subtypes in specific brain circuits would constitute an important step toward the development of more effective therapies with fewer side effects.

Evidence from imaging and anatomical studies suggests that the midcingulate cortex (MCC) is a dynamic hub lying at the interface of affect and cognition. In particular, this neural system appears to integrate information about conflict and punishment in order to optimize behavior in the face of action-outcome uncertainty. In a series of meta-analyses, we show how recent human electrophysiological research provides compelling evidence that frontal-midline theta signals reflecting MCC activity are moderated by anxiety and predict adaptive behavioral adjustments. These findings underscore the importance of frontal theta activity to a broad spectrum of control operations. We argue that frontal-midline theta provides a neurophysiologically plausible mechanism for optimally adjusting behavior to uncertainty, a hallmark of situations that elicit anxiety and demand cognitive control. These observations compel a new perspective on the mechanisms guiding motivated learning and behavior and provide a framework for understanding the role of the MCC in temperament and psychopathology.

Background: Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use. Methods: We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication. Results: In total, 140 case–control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = –0.583) with a large effect for psychotic disorders (Hedges g = –0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics. Limitations: Study quality significantly moderated effect sizes in case–control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings. Conclusion: Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk.

Objective. The literature on bipolar in children and adolescents was reviewed to provide an update for clinicians.
Review process. Literature of particular relevance to evidence-based practice was selected for critical review.
Outcomes. An up-to-date overview of clinical features, epidemiology, prognosis, aetiology, assessment and intervention was provided.
Conclusions. Bipolar disorder in children and adolescence is a relatively common, multifactorially determined, and recurring problem which persists into adulthood. Psychometrically robust screening questionnaires and structured interviews facilitate reliable assessment. Multimodal chronic care programmes involving medication (notably lithium) and family oriented psychotherapy are currently the treatment of choice.

Background. Schizophrenia (SZ) and bipolar disorder (BD) may overlap in etiology and phenomenology but differ with regard to emotional processing. We used facial affect as a probe for emotional processing to determine whether there are diagnosis-related differences between SZ and BD in the function of the underlying neural circuitry.
Method. Functional magnetic resonance imaging (fMRI) studies published up to 30 April 2012 investigating facial affect processing in patients with SZ or BD were identified through computerized and manual literature searches.
Activation foci from 29 studies encompassing 483 healthy individuals, 268 patients with SZ and 267 patients with BD were subjected to voxel-based quantitative meta-analysis using activation likelihood estimation (ALE).
Results. Compared to healthy individuals, when emotional facial stimuli were contrasted to neutral stimuli, patients with BD showed overactivation within the parahippocampus/amygdala and thalamus and reduced engagement
within the ventrolateral prefrontal cortex (PFC) whereas patients with SZ showed underactivation throughout the entire facial affect processing network and increased activation in visual processing regions within the cuneus.Patients with BD showed greater thalamic engagement compared to patients with SZ; in the reverse comparison,patients with SZ showed greater engagement in posterior associative visual cortices.
Conclusions. During facial affect processing, patients with BD show overactivation in subcortical regions and underactivation in prefrontal regions of the facial affect processing network, consistent with the notion of reduced
emotional regulation. By contrast, overactivation within visual processing regions coupled with reduced engagement of facial affect processing regions points to abnormal visual integration as the core underlying deficit in SZ.

Facilitated processing of negative information might contribute to the etiopathogenesis and maintenance of depressive symptoms. Cardiac vagal tone, indexed by heart rate variability (HRV), is believed to represent a proxy of the functional integrity of the neural networks implicated in brooding rumination, affective interference and depression. The present study examined whether HRV may moderate the relation between brooding rumination, affective interference and depressive symptoms in a sample of healthy individuals (n = 68) with different degrees of depressed mood. Self-report measures of depression and brooding were collected, whereas the emotional Stroop task was employed to measure affective interference. Three-minute resting-state electro-cardiogram was recorded to obtain time-and frequency-domain vagally mediated HRV parameters. Stepwise linear regression analyses revealed that HRV was a significant moderator of the positive association between depression and brooding rumination, but not of the association between depression and affective interference. An integrated model is supported, in which vagally mediated HRV appeared to potentiate the positive link between depressive symptoms and brooding rumination. Considering that HRV and brooding rumination were found to have an interacting role in determining the severity of depressive symptoms, they may represent potential clinical targets in the prevention and treatment of depressive symptoms.

Realistic models of decision-making and social interactions, considering the nature of memory and biases, continue to be an area of immense interest. Emotion and mood are a couple of key factors that play a major role in decisions, nature of social interactions, size of the social network, and the level of engagement. Most of the prior work in this direction focused on a single trait, behavior, or bias. However, this work builds an integrated model that considers multiple traits such as loneliness, the drive to interact, the memory, and mood biases in an agent. The agent system comprises of rational, manic, depressed, and bipolar agents. The system is modeled with an interconnected network, and the size of the personal network of each agent is based on its nature. We consider a game of iterated interactions where an agent cooperates based on its past experiences with the other agent. Through simulation, the effects of various biases and comparative performances of agent types is analyzed. Taking the performance of rational agents as the baseline, manic agents do much better, and depressed agents do much worse. The payoffs also exhibit an almost-linear relationship with the extent of mania. It is also observed that agents with stronger memory perform better than those with weaker memory. For rational agents, there is no significant difference between agents with a positive bias and those with a negative bias. Positive bias is linked with higher payoffs in manic and bipolar agents. In depressed agents, negative bias is linked with higher payoffs. In manic agents, an intermediate value of mood dependence offers the highest payoff. But the opposite is seen in depressed agents. In bipolar agents, agents with weak mood dependence perform the best. Individual and group decision-making and social interactions have been studied for long and continue to remain of interest. Some early models were fairly simplistic 1,2 , and they assumed perfectly rational behavior which is often not the case in reality. Time and again, research in the domains of psychology and behavioral sciences asserts that humans, as well as animals, are subject to a wide array of cognitive biases 3,4. Later works moved away from the assumption of perfect rationality and started incorporating various cognitive biases into decision models 5-8. However, the effects of emotion and mood disorders on decisions and interactions still need to be explored. Although we humans aspire to be rational decision-makers and never let emotion cloud our judgment, such is never really the case 9. This has been understood for long-the importance of emotion was captured succinctly by Simon 10 : "Hence, in order to have anything like a complete theory of human rationality, we have to understand what role emotion plays in it. " A great deal of research has focused on the impact of emotion on memory but the findings have been extremely diverse, with some claiming emotional memories are indelible 11 , while others claim that emotion has no effect whatsoever on memory 12. Even among those that agree that emotion has some impact on memory, some claim memories associated with positive emotions are stronger 13,14 and last longer, while others claim the opposite 15. Appraisal theory has been used in prior works to quantitatively define emotion, where an agent evaluates the reward with respect to its goal or expectation 16,17. If the reward obtained is better than the agent's expectation, positive emotion is induced; and the reverse also holds. The process of storing information for the first time in memory is called encoding and this process leaves a trace in the memory. The strength and longevity of the trace depend on how well it has been encoded. Mood has been seen as the summary of recent emotions 18. While emotions change after each episode, mood maintains a historical context, yet staying temporally relevant. Mood affects the behavior of an individual in terms OPEN

"BACKGROUND:

The functional outcome of Bipolar Disorder (BD) is highly variable. This variability has been attributed to multiple demographic, clinical and cognitive factors. The critical next step is to identify combinations of predictors that can be used to specify prognostic subtypes, thus providing a basis for a staging classification in BD.

METHODS:

Latent Class Analysis was applied to multiple predictors of functional outcome in a sample of 106 remitted adults with BD.

RESULTS:

We identified two subtypes of patients presenting "good" (n=50; 47.6%) and "poor" (n=56; 52.4%) outcome. Episode density, level of residual depressive symptoms, estimated verbal intelligence and inhibitory control emerged as the most significant predictors of subtype membership at the p<0.05 level. Their odds ratio (OR) and confidence interval (CI) with reference to the "good" outcome group were: episode density (OR=4.622, CI 1.592-13.418), level of residual depressive symptoms (OR=1.543, CI 1.210-1.969), estimated verbal intelligence (OR=0.969; CI 0.945-0.995), and inhibitory control (OR=0.771, CI 0.656-0.907). Age, age of onset and duration of illness were comparable between prognostic groups.

LIMITATIONS:

The longitudinal stability or evolution of the subtypes was not tested.

CONCLUSIONS:

Our findings provide the first empirically derived staging classification of BD based on two underlying dimensions, one for illness severity and another for cognitive function. This approach can be further developed by expanding the dimensions included and testing the reproducibility and prospective prognostic value of the emerging classes. Developing a disease staging system for BD will allow individualised treatment planning for patients and selection of more homogeneous patient groups for research purposes.
"

Purpose: This article focuses on recent evidence linking Rapid eye movement (REM) obstructive sleep apnea (OSA) (REM-OSA) to neurocognitive dysfunction and mood changes, the proposed mechanisms for increased risk of neurocognitive dysfunction in REM-OSA, and future research prospects.

Methods: PubMed and Google Scholar records were examined for articles utilizing predefined keywords. In this work, we mainly included studies published after 2017; nevertheless, critical studies published prior to 2017 were considered.

Results: REM-OSA is an under-recognized stage-related sleep-disordered breathing in which obstructive respiratory events happen chiefly in stage REM. The disorder is commonly seen amongst younger patients and females and has recently been linked to cardiometabolic complications. Although less symptomatic than non-REM-OSA and non-stage-specific OSA, current findings indicate that REM-OSA may have neurocognitive repercussions and mood changes and could be linked to insomnia, increased dreams, and nightmares.

Conclusion: Currently available evidence indicates that REM-OSA may present with insomnia and nightmares and could affect cognitive function and mood.

Objective. To determine the prevalence of suicidal ideation among Métis men and women (20-59 years) and identify its associated risk and protective factors using data from the nationally representative Aboriginal Peoples Survey (2006). Study design. Secondary analysis of previously collected data from a nationally representative cross-sectional survey. Results. Across Canada, lifetime suicidal ideation was reported by an estimated 13.3% (or an estimated 34,517 individuals) of the total population of 20-to-59-year-old Métis. Of those who ideated, 46.2% reported a lifetime suicide attempt and 6.0% indicated that they had attempted suicide in the previous 12 months. Prevalence of suicidal ideation was higher among Métis men than in men who did not report Aboriginal identity in examined jurisdictions. Métis women were more likely to report suicidal ideation compared with Métis men (14.9% vs. 11.5%, respectively). Métis women and men had some common associated risk and protective factors such as major depressive episode, history of self-injury, perceived Aboriginal-specific community issues, divorced status, high mobility, self-rated thriving health, high self-esteem and positive coping ability. However, in Métis women alone, heavy frequent drinking, history of foster care experience and lower levels of social support were significant associated risk factors of suicidal ideation. Furthermore, a significant interaction was observed between social support and major depressive episode. Among Métis men, history of ever smoking was the sole unique associated risk factor. Conclusion. The higher prevalence of suicidal ideation among Métis women compared with Métis men and the observed gender differences in associations with some associated risk and protective factors suggest the need for gender-responsive programming to address suicidal ideation.

Genetic factors are important in the etiology of bipolar disorder (BD). However, first-degree relatives of BD patients are at risk for a number of psychiatric conditions, most commonly major depressive disorder (MDD), although the majority remain well. The purpose of the present study was to identify potential brain structural correlates for risk and resilience to mood disorders in patients with BD, type I (BD-I) and their relatives. Structural magnetic resonance imaging scans were acquired from 30 patients with BD-I, 50 of their first-degree relatives (28 had no Axis I disorder, while 14 had MDD) and 52 controls. We used voxel-based morphometry, implemented in SPM5 to identify group differences in regional gray matter volume. From the identified clusters, potential differences were further examined based on diagnostic status (BD-I patients, MDD relatives, healthy relatives, controls). Whole-brain voxel-based analysis identified group differences in the left hemisphere in the insula, cerebellum, and substantia nigra. Increased left insula volume was associated with genetic preposition to BD-I independent of clinical phenotype. In contrast, increased left substantia nigra volume was observed in those with the clinical phenotype of BD-I. Changes uniquely associated with the absence of a clinical diagnosis in BD relatives were observed in the left cerebellum. Our data suggest that in BD, genetic and phenotype-related influences on brain structure are dissociable; if replicated, these findings may help with early identification of high-risk individuals who are more likely to transition to syndromal states.

Pervasive sensing has opened up new opportunities for measuring our feelings and understanding our behavior by monitoring our affective states while mobile.
This review paper surveys pervasive affect sensing by examining and considering three major elements of affective pervasive systems, namely ‘‘sensing,’’ ‘‘analysis,’’ and
‘‘application.’’ Sensing investigates the different sensing modalities that are used in existing real-time affective applications, analysis explores different approaches to emotion recognition and visualization based on different types of collected data, and application investigates different leading areas of affective applications. For each of the three aspects, the paper includes an extensive survey of the literature and finally outlines some of challenges and future research opportunities of affective sensing in the context of pervasive computing.

Recent studies have reported that the genome-wide-supported CANCNA1C rs1006737 risk allele for Bipolar Disorder modulates brain function within limbic (amygdala, anterior cingulate gyrus) and hippocampal regions. Here we demonstrate that bipolar patients and their unaffected relatives with the high-risk allele express enhanced amygdala activity during emotional processing; reduction in ventral prefrontal engagement was associated with disease expression with bipolar carriers of the high-risk variant showing the greatest deviance.

The assessment of risk factors is a crucial step in the prevention and treatment of affective disorders and should encompass personal dispositions. The aim of this study was to assess the value of chronotype and temperament as independent predictors of depressive symptoms among medical students. The study surveyed 140 students of the Faculty of Medicine with a battery of questionnaires: the Beck Depression Index (BDI), Hypomania Checklist 32 (HCL-32), Pittsburgh Sleep Quality Index (PSQI), Chronotype Questionnaire and Eysenck Personality Questionnaire Revised. The results were tested using Pearson’s correlation quotient and general linear model. Ten percent of the participants demonstrated a BDI score suggestive of clinically significant depressive symptoms. BDI score correlated positively with HCL-32 score. A rise in BDI was independently predicted by elevated Neuroticism and PSQI scores and morningness. Those effects were independent from each other and from other parameters of the model. The presence of depressive symptoms might be associated with bipolar features among medical students. Poor sleep quality predicted depressive symptoms, similarly to Neuroticism and independently of temperament and chronotype. Future studies on the associations between personal dispositions and mood disorders among medical students are required to help identify those at greater risk of developing affective illness. Effective prophylaxis and early intervention are warranted to ensure better treatment results.

The lack of appropriate animal models is a major limitation in research of bipolar disorder (BPD): at this time there are very few models for this devastating disease. Whereas limited attempts have been made to develop comprehensive models for BPD, the new notion of endophenotypes encourages us to explore the possibility of developing separate models for separate facets of the disorder. Since more models are available for depression, there is a dire need for models for mania that will be relatively easy and simple to induce and test and will therefore be practical for purposes of screening possible new drugs or mutant mice that are developed based on novel molecular theories. Such models may already be tentatively available as they were developed in the context of other disorders, but there is a need to validate them for mania. The present paper proposes such models for most of the facets of mania including: increased energy, activity or restlessness; extreme irritability; reduced sleep; provocative, intrusive or aggressive behaviour; increased sexual drive; abuse of drugs; distractibility, reduced ability to concentrate; and unrealistic beliefs in one's abilities and powers resulting in poor judgement. Validating these models may demand a major research effort but it may be worthy as validated models for the different facets of mania could then be used efficiently and may be utilized to construct a standard battery of tests that can serve to explore the various components of manic-like behaviour in rodents.

The aim of the present study was to examine levels of energetic arousal (EA), tense arousal (TA), and hedonic tone (HT) in individuals with different circadian preferences. Subjects were males with extreme either morning (M-type) or evening (E-type) preferences (N ¼ 31), selected using the Morningness-Eveningness Questionnaire cutoff points derived from the Polish population norms. They completed the UWIST Mood Adjective Check List every 1.5 h between 08:00 to 20:00 h in laboratory conditions. The obtained data showed higher levels of TA and lower levels of HT in E-types over the whole day as compared to M-types. As for EA, M-types showed higher levels than E-types between 08:00 to 17:00 h, but the two groups showed no differences during the later hours of the day. Both groups were found to exhibit similar diurnal patterns in TA and HT, and dissimilarity between M-types and E-types appeared in the daily course of EA. The results show the three-dimensional
model of mood is more advantageous in M-types than in E-types during the hours of typical human activity.

This review is intended to guide primary care providers in differentiating patients with bipolar depression from those with unipolar depression and inform patient management. Up to 64% of clinical encounters for depression occur in primary care, with misdiagnosis of bipolar depression common in both primary care and psychiatry. Although bipolar disorder is characterized by manic, hypomanic, and depressive episodes, the most common and debilitating symptomatic presentation is depression. Misdiagnosis as unipolar depression is common, often resulting in mistreatment with an unopposed monoamine antidepressant. Antidepressants are often ineffective for treating bipolar depression and may cause detrimental consequences such as treatment-emergent hypomania/mania, rapid cycling, or increased suicidality. Factors that are suggestive of bipolar disorder versus unipolar depression include earlyonset depression, frequent depressive episodes, family history of serious mental illness, hypomania/mania symptoms within the depressive episode, and nonresponse to antidepressants. Comorbid medical (e.g., cardiovascular disease, hypertension, obesity) and psychiatric (e.g., attention-deficit/hyperactivity disorder, anxiety disorder, personality disorders, and substance use disorder) conditions are common and contribute to premature mortality for patients with bipolar disorder compared with the general public. Cariprazine, fluoxetine/olanzapine, lurasidone, and quetiapine are approved to treat bipolar depression; only cariprazine and quetiapine are approved to treat both bipolar mania and depression. Primary care providers who can differentiate presenting symptoms of bipolar depression from unipolar depression and offer appropriate treatment options will optimize patient care in clinical practice. Relevant information for this review was identified through a multistep literature search of PubMed using the terms bipolar depression/bipolar disorder plus other relevant terms.

Morningness-eveningness, time of day, and physical exercises have been shown to influence mood states. This study aimed to test whether impact of physical exercise on mood depends on time of day and chronotype. Ninety-four participants (age 32 ± 6 years; 34% females; weekly training volume 4 ± 1 hours) filled the Composite Scale of Morningness and reported their current mood using the UWIST Mood Adjective Checklist before and after a 60-minute long CrossFit training session which took part in the morning (beginning at 6:30 or 7:45) or in the evening (beginning at 19:30 or 20:45). In this quasi-experiment the measurements were taken by the occasion of the participants' usual training, in their preferred hours. There were only a few evening-types in the studied sample, while morning and intermediate chronotypes were over-represented. Participation in CrossFit training resulted in mood improvement consisting of increase in energetic arousal (η2 = 0.29) and hedonic tone (η2 = 0.47) and reduction of tense arousal (η2 = 0.14), all significant at p = 0.001. Furthermore, CrossFit training during morning hours boosted mood in the intermediate/evening chronotype group to the levels observed in morning chronotypes (η2 = 0.29, p < 0.05, for the three-way interaction effect). We conclude that participation in intense physical exercise, such as CrossFit training, may allow compensation for the negative effects of non-optimal time of day on experienced moods, particularly in the case of neither/evening-types.

Background: The study aimed to elucidate previously observed associations between morningness-eveningness and depressive symptomatology in university students. Relations between components of depressive symptomatology and morningness-eveningness were analysed.
Methods: Nine hundred and seventy-four university students completed Polish versions of the Centre for Epidemiological Studies – Depression scale (CES-D; Polish translation appended to this paper) and the Composite Scale of Morningness. Principal component analysis (PCA) was used to test the structure of depressive symptoms. Pearson and partial correlations (with age and sex controlled), along with regression analyses with morning affect (MA) and circadian preference as predictors, were used.
Results: PCA revealed three components of depressive symptoms: depressed/somatic affect, positive affect, interpersonal relations. Greater MA was related to less depressive symptoms in three components. Morning circadian preference was related to less depressive symptoms in depressed/somatic and positive affects and unrelated to interpersonal relations. Both morningness-eveningness components exhibited stronger links with depressed/somatic and positive affects than with interpersonal relations. Three CES-D components exhibited stronger links with MA than with circadian preference. In regression analyses only MA was statistically significant for positive affect and better interpersonal relations, whereas more depressed/somatic affect was predicted by lower MA and morning circadian preference (relationship reversed compared to correlations).
Limitations: Self-report assessment.
Conclusions: There are three groups of depressive symptoms in Polish university students. Associations of MA with depressed/somatic and positive affects are primarily responsible for the observed links between morningness-eveningness and depressive symptoms in university students. People with evening circadian preference whose MA is not lowered have less depressed/somatic affect.

Background: Little is known about the association of various psychiatric disorders with the risk of devel- oping dependence or abuse among users of various psychoactive substances (conditional dependence, CD; conditional abuse, CA).
Objectives: Evaluate the association of psychiatric disorders with CA only, CD only and CA + CD.
Method: Secondary analysis of data from 43,093 non-institutionalized US adults in the first wave (2001–2002) of the National Epidemiological Survey on Alcohol and Related Conditions. A structured diagnostic interview allowed classification by lifetime psychiatric diagnosis (DSM-IV criteria) and psy- choactive substance use. Data were analyzed using weighted proportions, 95% CIs, and weighted logistic regression models to generate odds ratios (OR) adjusted for socio-demographic characteristics.
Results: Psychiatric disorders were associated with higher prevalence of psychoactive substance use, regardless of type of disorder or substance. CA, CD and CA + CD prevalence rates were generally higher than unconditional prevalence rates among respondents with and without psychiatric disorders. Respondents with multiple disorders (mainly mood and anxiety disorders) had higher rates of CA + CD on most, but not all, psychoactive substances (e.g., not heroin), while schizophrenia was associated only with higher rates of tranquilizer CA + CD. Psychiatric disorders had few associations with CA only and CD only on psychoactive substances.
Conclusion: Study findings suggest that mood and anxiety disorders are associated with increased preva- lence of substance use and increased transition from use to CA and CD, while schizophrenia is associated with increased transition from abstinence to use, especially for marijuana. Findings did not support the self-medication hypothesis of substance use disorders.

Background Research on insight in patients with mood disorders has grown in recent years. Several instruments to assess insight have been used, but most of them have been specifically designed for psychosis and may not appear relevant to mood disorders. The aim of the present study is to develop a short, multidimensional, reliable and valid scale to measure insight in patients with mood disorders, based on the Amador's Scale to Assess Unawareness of Mental Disorders (SUMD).

The Mood Disorder Questionnaire (MDQ; Hirschfeld et al., 2000) is a screening measure for bipolar disorder (BD), previously found to comprise separate Positive and Negative Activation subscales. We sought to replicate these factors and examine their associations with a range of psychopathology. To further explicate the nature of Negative Activation, we examined associations with the Difficulties in Emotion Regulation Scale (DERS), a measure of emotion dysregulation. The sample consisted of 1,787 participants from an outpatient treatment facility. Confirmatory Factor Analysis replicated the existence of Positive and Negative Activation subscales. Logistic regressions, as hypothesized, found that Positive Activation was positively associated only with BD, while Negative Activation was associated with almost all disorders. The Impulse and Goals subscales of the DERS were uniquely associated with Negative Activation, suggesting it may specifically assess impulsive behavior in emotional situations. The findings suggest that it may be important to attend to both MDQ subscales.

IMPORTANCE The large contribution of psychiatric disorders to premature death and persistent disability among young people means that earlier identification and enhanced long-term care for those who are most at risk of developing life-threatening or chronic disorders is critical. Clinical staging as an adjunct to diagnosis to address emerging psychiatric disorders has been proposed for young people presenting for care; however, the longer-term utility of this system has not been established. OBJECTIVES To determine the rates of transition from earlier to later stages of anxiety, mood, psychotic, or comorbid disorders and to identify the demographic and clinical characteristics that are associated with the time course of these transitions. DESIGN, SETTING, AND PARTICIPANTS A longitudinal, observational study of 2254 persons aged 12 to 25 years who obtained mental health care at 2 early intervention mental health services in Sydney, Australia, and were recruited to a research register between June 18, 2008, and July 24, 2018 (the Brain and Mind Centre Optymise Cohort). MAIN OUTCOMES AND MEASURES The primary outcome of this study was transition from earlier to later clinical stages. A multistate Markov model was used to examine demographic (ie, age, sex, engagement in education, employment, or both) and clinical (ie, social and occupational function, clinical presentation, personal history of mental illness, physical health comorbidities, treatment use, self-harm, suicidal thoughts and behaviors) factors associated with these transitions. RESULTS Of the 2254 individuals included in the study, mean (SD) age at baseline was 18.18 (3.33) years and 1330 (59.0%) were female. Data on race/ethnicity were not available. Median (interquartile range) follow-up was 14 (5-33) months. Of 685 participants at stage 1a (nonspecific symptoms), 253 (36.9%) transitioned to stage 1b (attenuated syndromes). Transition was associated with lower social functioning (hazard ratio [HR], 0.77; 95% CI, 0.66-0.90), engagement with education, employment, or both (HR, 0.47; 95% CI, 0.25-0.91), manic-like experiences (HR, 2.12; 95% CI, 1.19-3.78), psychotic-like experiences (HR, 2.13; 95% CI, 1.38-3.28), self-harm (HR, 1.42; 95% CI, 1.01-1.99), and older age (HR, 1.27; 95% CI, 1.11-1.45). Of 1370 stage 1b participants, 176 (12.8%) transitioned to stage 2 (full-threshold) disorders. Transition was associated with psychotic-like experiences (HR, 2.31; 95% CI, 1.65-3.23), circadian disturbance (HR, 1.66; 95% CI, 1.17-2.35), psychiatric medication (HR, 1.43; 95% CI, 1.03-1.99), childhood psychiatric disorder (HR, 1.62; 95% CI, 1.03-2.54), and older age (HR, 1.24; 95% CI, 1.05-1.45). CONCLUSIONS AND RELEVANCE Differential rates of progression from earlier to later stages of anxiety, mood, psychotic, or comorbid disorders were observed in young persons who presented for care at various stages. Understanding the rate and factors associated with transition assists planning of stage-specific clinical interventions and secondary prevention trials. JAMA Psychiatry.

Studying emotion dynamics through time series models is becoming increasingly popular in the social sciences. Across individuals, dynamics can be rather heterogeneous. To enable comparisons and generalizations of dynamics across groups of individuals, one needs sophisticated tools that express the essential similarities and differences. A way to proceed is to identify subgroups of people who are characterized by qualitatively similar emotion dynamics through dynamic clustering. So far, these methods assume equal generating processes for individuals per cluster. To avoid this overly restrictive assumption we outline a probabilistic clustering approach based on a mixture model that clusters on individuals’ vector autoregressive (VAR) coefficients. We evaluate the performance of the method and compare it to a non-probabilistic method in a simulation study. The usefulness of the methods is illustrated using 366 ecological momentary assessment time series with external measures of depression and anxiety.