⭐今日精選 TOP Picks
Patients With Older-Age Bipolar Disorder (OABD) Visiting a Memory Clinic: Differentiating Underlying Pathophysiology With MRI and Cerebrospinal Fluid Markers.
Journal of geriatric psychiatry and neurology · Patients With Older-Age Bipolar Disorder (OABD) Visiting a Memory Clinic: Differentiating Underlying Pathophysiology With MRI and Cerebrospinal Fluid Markers.
在記憶門診就診的OABD患者中，超過70%無明確神經退化性診斷，但低Aβ42腦脊液濃度與認知功能下降相關，提示阿爾茲海默病病理可能參與OABD相關認知障礙。
P記憶門診就診的老年躁鬱症患者（OABD，n=102）
IMRI視覺評分Scale + 腦脊液生物標記（Aβ42、T-Tau、P-Tau）
C有無神經退化性疾病診斷（如阿爾茲海默病）
O認知功能複合得分與生物標記的關聯
The Association Between Lithium Use and Physical Comorbidities Across Age Groups: A Cross-Sectional Study From the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project.
Acta psychiatrica Scandinavica · The Association Between Lithium Use and Physical Comorbidities Across Age Groups: A Cross-Sectional Study From the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project.
鋰鹽使用與較低的身體併發症 prevalance 相關，且該保護效應隨年齡增加而增強，特別是在心血管、呼吸、泌尿生殖和內分泌系統。
P雙極性障礙患者（n=2873，≥18歲，來自20個國家的GAGE-BD資料）
I目前使用鋰鹽治療
C未使用鋰鹽
O八個器官系統的身體併發症 prevalance
Cortical Thickness in Middle and Older Aged Adults With Bipolar Disorder Across Six International Sites.
Bipolar disorders · Cortical Thickness in Middle and Older Aged Adults With Bipolar Disorder Across Six International Sites.
中老年雙極患者額前皮質（尤其是背內外側和腹外側）皮質變薄明顯，但鋰鹽使用與較厚的前極和前 cingulate 皮質相關，提示其可能具神經保護作用。
P中老年雙極障礙患者（n=308，40-70歲）與對照組（n=287），來自六個國際GAGE-BD站點
I鋰鹽使用狀態
C非使用鋰鹽的雙極患者
O34 個皮質區域的皮質厚度（經MRI測量）
Low-dose lithium vs valproate and incident dementia diagnoses in older adults: A propensity-matched cohort study using electronic health record data.
Psychiatry research · Low-dose lithium vs valproate and incident dementia diagnoses in older adults: A propensity-matched cohort study using electronic health record data.
在≥60歲成人中，低劑量鋰鹽（serum ≤0.4 mmol/L）使用與發痴呆風險顯著降低相關（HR=0.38），優於丙戊酸，且死亡率亦較低。
P≥60歲，新使用鋰鹽或丙戊酸，無既往痴呆或MCI的成人（n=853/組）
I低劑量鋰鹽（serum ≤0.4 mmol/L）
C丙戊酸
O730天內 incident all-cause dementia
Lithium versus valproate in bipolar disorder: Associations with dementia, mortality, suicide attempt, and end-stage renal disease in adults aged 45 years and older - a propensity score-matched retrospective cohort study.
Psychiatry research · Lithium versus valproate in bipolar disorder: Associations with dementia, mortality, suicide attempt, and end-stage renal disease in adults aged 45 years and older - a propensity score-matched retrospective cohort study.
≥45歲雙極患者中，鋰鹽相較於丙戊酸與較低的所有原因痴呆（HR=0.689）、未指定痴呆和自殺未遂風險相關，且未增加腎衰竭或死亡風險。
P≥45歲，新啟用鋰鹽或丙戊酸的雙極患者（n=3056/組）
I鋰鹽
C丙戊酸
Oall-cause dementia, Alzheimer's, vascular dementia, unspecified dementia, mortality, suicide attempt, ESRD
Association between lithium and arterial atherosclerosis in physically healthy bipolar disorder.
Journal of affective disorders · Association between lithium and arterial atherosclerosis in physically healthy bipolar disorder.
在身體健康的雙極I型患者中，較高血清鋰鹽水平（>0.6 mEq/L）與較低頸動脈內中膜厚（CIMT）相關，提示其可能具備抗動脈粥樣硬化作用。
P身體健康的雙極I型患者（n=110，20-60歲）與正常對照組（n=107）
I血清鋰鹽水平
C較低鋰鹽水平（≤0.6 mEq/L）
O頸動脈內中膜厚度（CIMT）
Accelerated biological aging in bipolar disorder as determined by artificial intelligence-based electrocardiographic assessment.
Journal of affective disorders · Accelerated biological aging in bipolar disorder as determined by artificial intelligence-based electrocardiographic assessment.
雙極患者表現出加速的生理老化（ECG-Age 高於實際年齡2.5年），此現象與傳統心血管風險因素無關，提示躁鬱症本身可能促進生理老化。
P雙極患者（n=278，≥30歲）與對照組（n=29,341）
I無（觀察性暴露：診斷為BD）
C無精神疾病對照組
ODelta-Age (ECG-Age minus chronological age)
Mental Health Conditions and Incident Cancer: A Prospective Cohort Study of 402,255 UK Biobank Participants.
International journal of cancer · Mental Health Conditions and Incident Cancer: A Prospective Cohort Study of 402,255 UK Biobank Participants.
雙極症與整體癌症風險增加相關（HR=1.29），尤其在男性中更明顯（HR=1.54），提示需將精神健康納入癌症預防風險分層。
PUK Biobank參與者（n=402,255）
I雙極症診斷
C無精神疾病
O中位隨訪13.4年的 incident cancer
📚其他值得關注的文獻
Higher blood pressure is associated with lower cerebral blood flow in youth with bipolar disorder.
Journal of affective disorders
青年躁鬱患者中，較高血壓與較低腦血流量相關，此關聯在躁鬱群組中更顯著，提示神經血管功能障礙可能為早期病理。
Neural Markers of Reward Valuation and Impulsive Decision-Making in Mania Risk.
JAMA psychiatry
左外側前前皮質和前補充運動區的獎勵期待激活與延遲折現行為（衝動決策）相關，但受憂鬱嚴重程度調節，揭示躁病風險的神經異質性。
Living With Electroconvulsive Therapy-A Qualitative Study of the Subjective Experiences of Patients Having Continuation or Maintenance Electroconvulsive Therapy.
The journal of ECT
接受維持性電痙攣治療的患者普遍認為其益處（防止復發、住院）超過認知副作用，但後勤、污名和家庭支持是關鍵影響因素。
Inequalities in mortality following SARS-CoV-2 infection for people with severe mental illness during and following vaccination roll-out in England: a retrospective, whole-country linked cohort study.
The lancet. Psychiatry
英格蘭重度精神疾病患者在COVID-19後死亡風險雖隨疫苗推廣而下降，但相較於一般人口仍持續偏高，提示長期保護需求。
Resting magnetoencephalography alterations in severe mental illnesses: A systematic review.
Neuroscience and biobehavioral reviews
靜態MEG研究顯示雙極症、精神分裂症與重度抑鬱在Beta波及慢波活動上的異常模式，支持存在從分裂（精神分裂）到僵化（抑鬱）的時間失調譜帶，雙極症居中。
Comparative risk of early-onset dementia with lithium versus valproate in bipolar disorder: A real-world cohort study.
Journal of affective disorders
18-60歲新診斷雙極患者中，鋰鹽啟用相較於丙戊酸與較低早發性痴呆風險相關（HR=0.815），支持其神經保護潛力。
The dynamic influence of exercise on emotional state among people with a history of mood disorder.
Psychiatry research
有情緒障礙病史者運動後數小時內顯著減少焦慮感，但對悲傷、激躁或能量感無影響，效應在雙極與抑鬱群組中相似。
The impact of affective symptoms and mood instability on sexual desire and sexual distress in newly diagnosed bipolar disorder: a longitudinal study.
Journal of psychiatric research
新診斷雙極患者中，抑鬱症狀降低性慾並增加性困擾，躁症狀增加性慾，情緒不穩增加性困擾，提示需在治療中納入性功能評估。
Parental but not child reports of affective lability in offspring predict conversion to bipolar disorder in youth at increased genetic risk.
Journal of affective disorders
在高遺傳風險青少年中，父母報告的情感波動（而非自我報告）可預測後續雙極症轉變，主要由易怒與焦慮抑鬱因素驅動。
Multimodal digital phenotyping of bipolar disorder subtypes: Differences between bipolar disorder I and II based on passive and active behavioral features from smartphones.
Journal of affective disorders
被動智慧型手機感測資料本身無法區分雙極I型與II型，但個人化模式（結合主動自報）達到較佳區分力（AUC=0.77），顯示個體差異是關鍵。
Socioeconomic Position and Somatic Comorbidity in Mental Disorders.
Acta psychiatrica Scandinavica
低社會經濟地位與精神疾病及身體非傳染性疾病共病風險增加相關，但其調節作用有限，精神病與雙極症併發身體疾病風險最高。
An evaluation of the differences in thalamic nuclei and subnuclei among patients with schizophrenia and schizoaffective disorder.
Psychiatry research. Neuroimaging
情感分裂症患者右側丘腦顯著體積減少，尤其是外側後外側與內側核群，提示其較精神分裂症具有更明顯的邊緣系統異常。
Risk of self-harm in first-diagnosed mental disorders: A 16-year territory-wide health-record database study in Hong Kong.
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology
首次診斷精神疾病者自傷風險顯著升高（HR=10.59），躁鬱症為第六高風險類群（HR=6.43），青年和女性為高風險亞群。
Antidepressant use and risk of bipolar disorder in children, adolescents and young adults with unipolar depression: a target trial emulation study.
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology
在兒童至青年單極抑鬱患者中，抗憂鬱藥物使用與後續雙極症轉換風險無顯著短期增加，但52週追蹤見 modest 增加（HR=2.14），可能由混雜因素解釋。
Evening chronotype is associated with affective temperaments, emotional dysregulation, and bipolar-spectrum features: An observational study in 1997 adults from a large community sample.
Journal of affective disorders
夕型昏夜節律與較高憂鬱、焦慮、易怒、循環質氣質及情緒失調相關，並預測較高雙極譜分數，支持其為雙極譜行為的生物標記潛力。
Differential pathways to loneliness in bipolar disorder: The role of childhood adversity and social support by psychotic features.
Journal of affective disorders
具精神病特徵的雙極患者 loneliness 來源主要來自童年逆境且未受社會支持緩衝，而無精神病症狀者則透過社會支持減緩 loneliness，提示需分層式社會介入。
Mood switching in 1629 antidepressant-treated bipolar disorder patients.
Journal of affective disorders
抗憂鬱藥物治療中，約27.6%雙極患者出現情緒轉換（多為新發輕躁），獨立預測因包括較老年齡、較多發作、精神病家族史與自殺企圖。
Associations of lung function abnormalities with the onset and progression of mental disorders in the UK Biobank.
Journal of affective disorders
肺功能異常（特別是PRISm+RSP）與精神疾病新發、併發及死亡風險增加相關，效應在老年男性、吸飲者中更明顯，提示身心整合照護的必要性。
Age-stratified associations between severe mental illness, dementia, and ischemic stroke: findings from the PADRIS-PRESTO cohort.
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology
重度精神疾病與失智症在青壯年期間關聯最強（OR=23.21於30-39歲），缺血性中風則在中年峰值（OR=2.99於40-49歲），提示早期神經心血管篩查的重要性。
Quality in specialist palliative care for patients with pre-existing severe mental disorders: A retrospective cohort study.
Palliative medicine
有既往重度精神疾病的临终患者在姑息治療中較少完成症狀評估、等待時間較長、療程較短，提示需改善此群體的姑息照護可及性與質量。
Amblyopia and adult health: a comprehensive analysis of long-term systemic, sensory and mental health comorbidities in a national cohort.
The British journal of ophthalmology
弱視成人伴隨較高肥胖、糖尿病、心血管疾病及精神疾病（特別是躁鬱、ADHD、自閉症）風險，提示早期視力干預可能具有長期身心健康益處。