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BackgroundDespite increasing evidence for the effectiveness of individual psychological interventions for bipolar disorder, research on older adults is lacking. We report the first randomised controlled trial of psychological therapy designed specifically for older adults with bipolar disorder.AimsTo evaluate the feasibility and acceptability of recovery-focused therapy, designed in collaboration with older people living with bipolar disorder.MethodA parallel, two-armed, randomised controlled trial comparing treatment as usual with up to 14 sessions of recovery-focused therapy plus treatment as usual, for older adults with bipolar disorder.ResultsThirty-nine participants (67% female, mean age 67 years) were recruited over a 17-month period. Feasibility and acceptability of recruitment, retention (>80% observer-rated outcomes at both 24 and 48 weeks) and intervention processes were demonstrated. The majority of participants started therapy when offered, adhered to the intervention (68% attended all sessions and 89% attended six or more sessions) and reported positive benefits. Clinical assessment measures provide evidence of a signal for effectiveness on a range of outcomes including mood symptoms, time to relapse and functioning. No trial-related serious adverse events were identified.ConclusionsRecovery-focused therapy is feasible, acceptable and has the potential to improve a range of outcomes for people living with bipolar disorder in later life. A large-scale trial is warranted to provide a reliable estimate of its clinical and cost-effectiveness.

Objectives Methods Results Conclusions To provide detailed information on the codesign of a digital intervention to support parents with bipolar disorder (BD) who have young children. Each step of this process is reported, as well as a detailed description of the final version of the intervention in line with the TIDieR framework.Clinical experience and lived experience experts participated in online workshops, meetings, and remote feedback requests, informed by Integrated Knowledge Translation (IKT) principles. The IKT research group responded to each phase of recommendations from the knowledge users.Five clinical experience experts and six lived experience experts engaged with the codesign process. Their recommendations for principles, content, look, and feel, and functionality of the digital intervention were structured over five iterative phases. This led to a final implemented design that was identified by the clinical and lived experience experts (referred to together as the knowledge users group) as genuinely reflecting their input.The IKT principles offer an accessible structure for engaging with clinical and lived experience experts throughout a codesign process, in this case for a digital intervention for parents with BD. The resulting intervention is described in detail for transparency to aid further evaluation and development and to help other teams planning codesign approaches to intervention development. [ABSTRACT FROM AUTHOR]

Objective: This study aims to elucidate the similarities and differences between the concept of resilience and of recovery and build an argument for the integration of these two concepts. Method: A review of the literature on resilience and recovery was conducted. An electronic search of PsychInfo, Web of Science, and EBSCOhost databases was performed to identify relevant peer-reviewed studies. Results: A total of 53 articles on resilience, 29 articles on recovery, and 2 articles that covered both topics were reviewed and analyzed. Conclusions and Implications for Practice: In the field of mental health, resilience and recovery have several factors in common such as the occurrence of adversity and the use of internal strengths and environmental resources to achieve greater subjective well-being. In view of these similarities, we propose that resilience and recovery are different constructs which converge in the recovery journey. We provide theoretical and empirical evidence to support this proposition. Interventions promoting resilience could help people with a psychological disorder not only adapt positively to adversities but also reduce the impact of life stressors on the clinical and personal recovery process, thereby more effectively improving mental health outcomes. [ABSTRACT FROM AUTHOR]

IntroductionBipolar disorder is a severe and chronic mental health problem that persists into older adulthood. The number of people living with this condition is set to rise as the UK experiences a rapid ageing of its population. To date, there has been very little research or service development with respect to psychological therapies for this group of people.Methods and analysisA parallel two-arm randomised controlled trial comparing a 14-session, 6-month Recovery-focused Cognitive-Behavioural Therapy for Older Adults with bipolar disorder (RfCBT-OA) plus treatment as usual (TAU) versus TAU alone. Participants will be recruited in the North-West of England via primary and secondary mental health services and through self-referral. The primary objective of the study is to evaluate the feasibility and acceptability of RfCBT-OA; therefore, a formal power calculation is not appropriate. It has been estimated that randomising 25 participants per group will be sufficient to be able to reliably determine the primary feasibility outcomes (eg, recruitment and retention rates), in line with recommendations for sample sizes for feasibility/pilot trials. Participants in both arms will complete assessments at baseline and then every 3 months, over the 12-month follow-up period. We will gain an estimate of the likely effect size of RfCBT-OA on a range of clinical outcomes and estimate parameters needed to determine the appropriate sample size for a definitive, larger trial to evaluate the effectiveness and cost-effectiveness of RfCBT-OA. Data analysis is discussed further in the Analysis section in the main paper.Ethics and disseminationThis protocol was approved by the UK National Health Service (NHS) Ethics Committee process (REC ref: 15/NW/0330). The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and local, participating NHS trusts.Trial registration numberISRCTN13875321; Pre-results.

International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2017-016965

Children of parents with bipolar disorder are at increased risk of bipolar spectrum diagnoses. This cross-sectional study explores cognitive factors in the prediction of vulnerability to bipolar disorder. Adolescents at high-risk (with a parent with bipolar disorder; n = 23) and age and gender matched adolescents (n = 24) were recruited. Parent and adolescent diagnoses were evaluated (SCID and SADS-L). Adolescents completed self-report measures assessing attributional style (ASQ), appraisal of hypomania-relevant experiences (HIQ), and hypomanic personality/temperament (HPS). Despite limitations in the power of the study, significantly more adolescents at high-risk for disorder received bipolar spectrum diagnoses. Groups did not differ in attributional style, hypomanic temperament or appraisals of hypomania-relevant experiences. A trend in ASQ results and general implications are discussed. The current study suggests that familial risk of bipolar disorder is not inevitably associated with cognitive biases in adolescence. (Contains 1 table.)

Although sleep and circadian rhythm disturbances are significant features of bipolar disorder and are associated with illness severity and recurrence, less is known about their significance prior to illness onset. Therefore, this study investigated these variables using objective assessment methods within a sample at high-risk of bipolar spectrum disorders. Thirty-one high-risk and 24 age- and gender-matched control participants wore an actigraph for 7 days to obtain sleep and circadian activity data. Self-report measures of mood, bed and get-up times, and cognitive style were also obtained. High-risk participants exhibited greater variability in duration, fragmentation, and efficiency of sleep, shorter sleep duration, and later and more variable bedtimes than controls. They also had lower relative amplitude of activity patterns and made more positive self-appraisals for hypomanic experiences. Logistic regression showed that positive self-appraisal and variability in bedtime significantly discriminated between the two groups. Results suggest that sleep and circadian activity differences are apparent in high-risk participants and, therefore, may not simply represent an artifact of the illness. Such individuals also report cognitive styles consistent with those observed in bipolar patients. Relevance of these results to current evolutions of the instability theory of bipolar disorder is discussed. Keywords: actigraphy; hypomania; circadian rhythms; positive self-appraisal; cognitive style