⭐今日精選 TOP Picks
Comparative effectiveness of mood stabiliser monotherapy versus second-generation antipsychotic monotherapy versus combination therapy for continuation and maintenance treatment after a first episode of psychotic mania in North America, Chile, and Spain: a target trial emulation using data from the BD-CAUSAL Collaboration.
The lancet. Psychiatry · Comparative effectiveness of mood stabiliser monotherapy versus second-generation antipsychotic monotherapy versus combination therapy for continuation and maintenance treatment after a first episode of psychotic mania in North America, Chile, and Spain: a target trial emulation using data from the BD-CAUSAL Collaboration.
首次發作伴精神病性特徵的躁狂患者，使用情緒穩定劑單療法在預防復發方面優於第二代抗精神藥物單療法或聯合療法，提供早期治療選擇的重要實證。
P16歲以上、首次發作伴精神病性躁狂、未使用過情緒穩定劑或第二代抗精神藥物的雙極症患者
I情緒穩定劑單療法
C第二代抗精神藥物單療法 或 聯合療法（情緒穩定劑+第二代抗精神藥物）
O2年內因精神科原因導致的住院或急訪次數
Comparing 8-Year Survival Rates in Older-Age Bipolar Disorder (OABD) and Its Clinical Predictors to the General Population.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · Comparing 8-Year Survival Rates in Older-Age Bipolar Disorder (OABD) and Its Clinical Predictors to the General Population.
50歲以上雙極症患者在8年追蹤中所有原因死亡率顯著高於對照組，提醒老年躁鬱症需關注身體健康與長期照護。
P50歲以上雙極症患者（n=227）及年齡、性別匹配對照組（n=681）
I無（觀察隊列研究）
C年齡與性別匹配的一般人群
O8年內全因死亡率、受限平均生存時間
Association Between Lithium Use and Suicide-Related Behaviors in Bipolar Disorder: A Multicenter Study.
Bipolar disorders · Association Between Lithium Use and Suicide-Related Behaviors in Bipolar Disorder: A Multicenter Study.
在12-45歲雙極症患者中，過去一年使用鋰鹽與自殺相關行為（自殺念頭、嘗試、非自殺性自傷）顯著負相關，部分機制經由降低攻擊性行為 mediate。
P12-45歲雙極症患者（n=585，具完整資料）
I過去一年內使用鋰鹽
C未使用鋰鹽
O自殺相關行為複合端點（自殺念頭、自殺嘗試、非自殺性自傷）
Association between lithium treatment and vascular calcification in bipolar disorder: A retrospective cohort study.
Journal of affective disorders · Association between lithium treatment and vascular calcification in bipolar disorder: A retrospective cohort study.
雙極症患者接受鋰鹽治療與主動脈及冠状動脈鈣化風險顯著降低相關，提示鋰鹽可能具備血管保護作用。
P有雙極症且具基線及約10年追蹤胸部X光的患者（n=177）
I鋰鹽治療狀態（依藥歷分組）
C未使用鋰鹽
O主動脈鈣化（AC）及冠状動脈鈣化（CAC）
Higher blood pressure is associated with lower cerebral blood flow in youth with bipolar disorder.
Journal of affective disorders · Higher blood pressure is associated with lower cerebral blood flow in youth with bipolar disorder.
雙極症青少年中，較高的舒張壓與收縮壓與前額葉及多腦區腦血流減少顯著相關，提示血壓可能經由神經血管路徑影響認知與情緒功能。
P13-20歲雙極症患者（n=76）及健康對照組（n=68）
I收縮壓（SBP）與舒張壓（DBP）
C較低血壓
O前額葉、 cingulate cortex、insula 等區域腦血流（CBF）
Distinct brain functional patterns across the entire disease course between bipolar disorder and major depressive disorder: A Gaussian mixture model analysis.
Journal of affective disorders · Distinct brain functional patterns across the entire disease course between bipolar disorder and major depressive disorder: A Gaussian mixture model analysis.
雙極症與重性抑鬱症在抑鬱階段及部分緩解期可經腦功能磁振造影區分，但完全緩解後無法區分，提示兩種疾病在恢復期生物學上可能趨同。
P雙極症（n=109）與重性抑鬱症（n=145）患者，年齡15-50歲
I無（橫斷面神經影像研究）
C重性抑鬱症
O靜息態fMRI中dfALFF特徵的高斯混合模型分群準確率
Electroconvulsive therapy in Germany: a nationwide multilevel analysis of determinants, regional patterns, and institutional variation.
European archives of psychiatry and clinical neuroscience · Electroconvulsive therapy in Germany: a nationwide multilevel analysis of determinants, regional patterns, and institutional variation.
德國電痙攣治療的使用與區域診斷負荷關聯甚微，主要受機構規模與結構因素影響，提示存在區域與機構間的獲取不公平。
P2023年德國精神科住院患者（n=837,762筆出院紀錄）
I接受電痙攣治療
C未接受電痙攣治療
O電痙攣治療接受率及其區域與機構變異
📚其他值得關注的文獻
Longer Sleep Duration Predicts Progression to Bipolar or Psychotic Disorders in Youth Accessing Early Intervention Mental Health Services.
Bipolar disorders
青少年心理健康服務使用者中，較長睡眠 duration 預測未來發展為全閾值雙極症或精神病症的風險增加，提示過度睡眠可能是早期脆弱性標記。
Medicine Use Preceding Fatal Poisonings Among Individuals With Bipolar Disorder.
Basic & clinical pharmacology & toxicology
在芬蘭全國cohort中，三環抗憂鬱藥、Gabapentinoids、阿片類等藥物使用與雙極症患者致命中毒顯著相關，提醒高風險個體用藥需謹慎。
Independent associations of psychiatric disorders with atrial fibrillation and acute coronary syndrome: An analysis of the National Inpatient Sample.
International journal of cardiology. Cardiovascular risk and prevention
在全美住院樣本中，雙極症與心房顫動和急性冠狀綜合症發生率呈負相關，而憂鬱症與焦慮症則分別呈微增或降低關聯，提醒精神疾病與心血管風險的複雜關係。
SGLT2 inhibitors versus GLP-1 receptor agonists and risk of kidney replacement therapy and healthcare utilization in bipolar disorder with chronic kidney disease: An active-comparator, new-user cohort study.
Journal of affective disorders
雙極症合併慢性腎病患者中，SGLT2i 與 GLP-1 RA 在腎替代療法風險上無顯著差異，但 SGLT2i 相關醫療使用略高，顯示兩種藥物在此人群中的需謹慎比較。
Demographic moderators of the relationship between psychiatric diagnosis and functional capacity in people with serious mental illness.
Psychiatry research
在重度精神疾病患者中，年齡是功能容量的主要負向調節變數，且MDD男性功能表現較差，提示需針對特定族群設計功能復健介入。
Somatostatin expression is associated with mitochondrial-related gene expression in a brain region-specific manner: Evidence from human transcriptomic analysis.
Behavioural brain research
腦區特異性地，胰島素抑制 Somatostatin 與線粒體相關基因（如BCL2、MFN2、SOD2）表達呈正相關，提示其在情緒障礙中的神經機制可能經由線粒體調節。
Symptom Burden and Quality of Life in Patients With Severe Mental Disorders Initiating Cancer Treatment.
Clinical oncology (Royal College of Radiologists (Great Britain))
伴有重度精神疾病（含雙極症）的癌症患者在開始治療前已顯著較低生活品質與較高身心症狀負担，強調需早期整合精神與支持性照護。
Neurofilament Light Chain as a Biomarker in Geriatric Psychiatry Practice: A Narrative Review.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
血神經纖維輕鏈（NfL）隨年齡升高且受腎功能影響，在主要精神疾病中多未顯著升高，但升高者可能暗示神經退化共病，需結合臨床脈絡解讀。
Association of lithium treatment with incident cardiovascular disease in patients with bipolar disorder: A claims-based longitudinal cohort study.
Journal of affective disorders
在北京職工醫保資料中，雙極症新診患者使用鋰鹽與未來發生缺血性心臟病及總體心血管疾病風險顯著降低相關，尤其在老年男性及具心血管風險者中效果較顯著。
Resting magnetoencephalography alterations in severe mental illnesses: A systematic review.
Neuroscience and biobehavioral reviews
靜態MEG顯示雙極症、精神分裂症與重性抑鬱症在Beta波動、複雜度及慢波活動上存在共同且特異的改變，支持以神經動態分層重度精神疾病的框架。
Cognitive impairment in bipolar disorder: How close to dementia?
Journal of affective disorders
雙極症患者可依認知功能分為痴呆樣、輕度及保留型三組，其中痴呆樣組表現接近重度神經認知障礙，提醒長期隨訪認知變化的重要性。
Prevalence of Psychotropic Use and Psychotropic Polypharmacy in a Finnish National Cohort of Persons With Intellectual Disabilities.
Journal of intellectual disability research : JIDR
芬蘭智力障礙者中精神藥物使用率極高（42.3%），且多重使用常見（18.2%），顯示需加強用藥審核與非藥物介入。
Variables associated with self- and proxy-perceived difficulties in independent living for patients with bipolar disorder and comorbid dementia.
European archives of psychiatry and clinical neuroscience
在雙極症併癡呆患者中，患者與代理人對獨立生活困難的感知受不同變數影響，提示需同時考慮雙方觀點來規劃照護與支援。
Gastrointestinal Diagnoses and Symptoms in Medicare Patients With Neuropsychiatric Diseases.
Journal of clinical gastroenterology
在美國Medicare住院患者中，雙極症與腸易激綜合症及消化不良顯著相關，提醒臨床師關注精神疾病患者的胃腸共病。
Comparative risk of early-onset dementia with lithium versus valproate in bipolar disorder: A real-world cohort study.
Journal of affective disorders
在18-60歲雙極症新用藥患者中，鋰鹽起始組5年內痴呆風險低於丙戊酸鹽組，提示鋰鹽可能具備較佳神經保護效應。
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（含雙極症）進行運動後，焦慮顯著下降，但對悲傷、激躁或精力感無影響，提示運動可能為快速緩解焦慮的非藥物選項。
Structural brain alterations of the subcortical limbic system in schizophrenia and bipolar disorders.
Schizophrenia research
雙極症與精神分裂譜系症患者在海馬旁結構（如右側 nucleus accumbens、fornix）體積較健康對照組小，提示邊緣系統結構異常可能是共同生物學基礎。
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
新診斷雙極症患者中，較高抑鬱評分與性慾下降及性痛苦上升相關，而躁狂評分升高與性慾增加相關，情緒不穩則主要影響性痛苦，提示需關注性功能作為病情反映的一環。
Differential burden of five major mental disorders in the United States across the COVID-19 pandemic.
European archives of psychiatry and clinical neuroscience
COVID-19期間，美國焦慮症與重性抑鬱症負擔顯著增加，而雙極症、思覺失調及鬱病輕微下降，顯示疫情對不同精神疾病的衝擊具有選擇性。
Low-dose lithium vs valproate and incident dementia diagnoses in older adults: A propensity-matched cohort study using electronic health record data.
Psychiatry research
60歲以上非雙極症族群中，低劑量鋰鹽組730天內痴呆發生率顯著低於丙戊酸鹽組（3.1% vs 8.3%），提示鋰鹽可能具備預防痴呆的潛力，但受監測偏倚限制。
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
45歲以上雙極症新用鋰鹽組與丙戊酸鹽組比較後，前者在所有原因痴呆（HR=0.689）與自殺嘗試（HR=0.594）上風險顯著較低，支持鋰鹽作為長期穩定劑的優勢。
Association between lithium and arterial atherosclerosis in physically healthy bipolar disorder.
Journal of affective disorders
身體健康的雙極症患者中，較低血清鋰鹽水平與較高頸動脈內中厚度相關，提示鋰鹽可能經由調節脂質或炎症發揮抗動脈硬化作用，但需注意體重管理。
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，父母報告的情感不穩（特別是易怒與憂慮）可預測其後雙極症發病，但子自我報告無此關聯，提示臨床早期篩檢應重視親代觀察。
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
僅用被動智慧型手機感測器資料難以區分雙極I型與II型，但個人化模型結合主動自報可達較佳辨識力（AUC 0.87），顯示個人化數位表型在亞型區分中的潛力。
Accelerated biological aging in bipolar disorder as determined by artificial intelligence-based electrocardiographic assessment.
Journal of affective disorders
雙極症患者經AI-ECG評估其生理年齡顯著高於實際年齡（平均快2.5年），提示其可能存在加速生物老化過程，與心血管風險無關。
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
在香港首次診斷精神疾病者中，雙極症自傷風險顯著升高（HR=6.43），僅次於藥物及酒精使用障礙，提醒需將自傷風險評估納入雙極症常規照護。
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
在兒童與青少年單極憂鬱者中，抗憂鬱藥使用雖未顯著增加短期轉為雙極症風險，但52週隨訪中見 modest 增加（HR=2.14），可能反映嚴重程度而非藥物因果效應。
Migration background and specialized mental health care utilization in young adults: a register-based study in the Netherlands.
Social psychiatry and psychiatric epidemiology
在荷蘭年輕移民中，總體專科精神健康服務使用率低於本土出生者，但精神病與焦慮症的使用率較高，提示需關注移民背景對心理健康服務獲取的影響。