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Zusammenfassung Hintergrund Die COVID-19-Pandemie mit ihren Schutzmaßnahmen (z. B. Lockdown) hat einen weitreichenden Einfluss auf die Befindlichkeit aller Menschen. Das Ziel dieser Studie war es, Lebensstilvariablen während des ersten österreichischen Lockdowns bei Patient*innen mit bipolarer Erkrankung im Vergleich zu einer gesunden Kontrollgruppe zu untersuchen und subjektive Veränderungen durch die Pandemie zu erheben. Methode Anfang April 2020 wurde eine Online-Befragung mit 75 Teilnehmer*innen (35 Patient*innen und 40 Kontrollpersonen) mit standardisierten Fragebögen (Beck Depression Inventory-2, Food Craving Inventory, Altman Self Rating Mania Scale) sowie nicht-standardisierten COVID-19-spezifischen Fragen zum Thema „Psychische Belastung und Auswirkungen der COVID-19-Pandemie bei bipolarer Störung“ per LimeSurvey durchgeführt. Ergebnisse Beide Gruppen gaben an, dass sich die Pandemie negativ auf ihre psychische Gesundheit ausgewirkt habe. Die Studienteilnehmer*innen mit bipolarer Störung zeigten signifikant höhere Werte im Beck Depression Inventory-2 (p Konklusion Diese Studie lieferte erste Hinweise auf die psychische Belastung und auf die ungünstigen Auswirkungen auf den Lebensstil von Menschen mit einer bipolaren Störung zu Beginn der COVID-19-Pandemie. Eine psychiatrische Betreuung und Erste-Hilfe-Maßnahmen für Patient*innen mit psychischer Störung wären gerade in Krisenzeiten wichtig, um einen gesunden Lebensstil zu pflegen und so ungünstigen Entwicklungen gegenzusteuern.

Believing or "credition" refers to psychological processes that integrate the cognitions and emotions that influence our behavior. In the credition model by Angel and Seitz, four parameters are postulated: proposition, certainty, emotion and mightiness. It is assumed that believing processes are influenced by both the individual as well as socio-cultural factors and external circumstances. External or environmental circumstances can include threatening situations such as the ongoing pandemic. It has been hypothesized that believing processes related to the pandemic differ between individuals with bipolar disorder (BD) and healthy controls (HC).To investigate credition in individuals with BD during the coronavirus disease 2019 (COVID-19) pandemic.Psychiatrically stable individuals with BD (Individuals with BD reported significantly more negative propositions [Believing parameters were associated with psychiatric symptoms in BD during the pandemic. Findings broaden knowledge about the susceptibility of believing processes for ambient challenges in individuals with BD.

OBJECTIVE: Circadian rhythm disruption is commonly observed in bipolar disorder (BD). Daylight is the most powerful signal to entrain the human circadian clock system. This exploratory study investigated if solar insolation at the onset location was associated with the polarity of the first episode of BD I. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area of the Earth.METHODS: Data from 7488 patients with BD I were collected at 75 sites in 42 countries. The first episode occurred at 591 onset locations in 67 countries at a wide range of latitudes in both hemispheres. Solar insolation values were obtained for every onset location, and the ratio of the minimum mean monthly insolation to the maximum mean monthly insolation was calculated. This ratio is largest near the equator (with little change in solar insolation over the year), and smallest near the poles (where winter insolation is very small compared to summer insolation). This ratio also applies to tropical locations which may have a cloudy wet and clear dry season, rather than winter and summer.RESULTS: The larger the change in solar insolation throughout the year (smaller the ratio between the minimum monthly and maximum monthly values), the greater the likelihood the first episode polarity was depression. Other associated variables were being female and increasing percentage of gross domestic product spent on country health expenditures. (All coefficients: P ≤ 0.001).CONCLUSION: Increased awareness and research into circadian dysfunction throughout the course of BD is warranted.

The COVID-19 pandemic with its protective measures (e. g. lockdown) had far-reaching effects on everyone's well-being. The aim of this study was to examine lifestyle variables during the first Austrian lockdown in patients with bipolar disorder in comparison to a healthy control group and to assess subjective changes caused by the pandemic.At the beginning of April 2020, an online survey of n=75 participants (35 people with bipolar disorder and 40 healthy controls) with standardized questionnaires (Beck Depression Inventory-2, Food Craving Inventory, Altman Self Rating Mania Scale) as well as non-standardized COVID-19-specific questions on the subject of "Psychological stress and effects of the COVID-19 pandemic in bipolar disorder" was created and distributed via LimeSurvey.Both groups reported a negative impact on their mental health. The participants with bipolar disorder showed significantly higher values in the Beck Depression Inventory-2 score (p0,001), in emotional distress due to social distancing (p=0,003) and significantly lower values in muscle-strengthening exercise (p=0,039) and in sport units (p=0,003) compared to the control group. In addition, patients with bipolar disorder smoked more often than individuals of the control group. People with bipolar disorder were 42,9% more likely to report they were less efficient during the pandemic, and 22,9% experienced weight gain compared to before the pandemic. The control group, on the other hand, was less efficient at 17,5% and 5,0% reported weight gain. However, a comparison with pre-pandemic data showed a decrease in food craving in both groups.This study provided first evidence of self-reported adverse effects on mental stress and lifestyle in people with bipolar disorder at the beginning of the COVID-19 pandemic. Psychiatric care and early interventions for patients with bipolar disorder would be particularly important in times of crisis in order to help maintain a healthy lifestyle and thus counteract unfavourable developments.Die COVID-19-Pandemie mit ihren Schutzmaßnahmen (z. B. Lockdown) hat einen weitreichenden Einfluss auf die Befindlichkeit aller Menschen. Das Ziel dieser Studie war es, Lebensstilvariablen während des ersten österreichischen Lockdowns bei Patient*innen mit bipolarer Erkrankung im Vergleich zu einer gesunden Kontrollgruppe zu untersuchen und subjektive Veränderungen durch die Pandemie zu erheben.Anfang April 2020 wurde eine Online-Befragung mit 75 Teilnehmer*innen (35 Patient*innen und 40 Kontrollpersonen) mit standardisierten Fragebögen (Beck Depression Inventory-2, Food Craving Inventory, Altman Self Rating Mania Scale) sowie nicht-standardisierten COVID-19-spezifischen Fragen zum Thema „Psychische Belastung und Auswirkungen der COVID-19-Pandemie bei bipolarer Störung“ per LimeSurvey durchgeführt.Beide Gruppen gaben an, dass sich die Pandemie negativ auf ihre psychische Gesundheit ausgewirkt habe. Die Studienteilnehmer*innen mit bipolarer Störung zeigten signifikant höhere Werte im Beck Depression Inventory-2 (p0,001), in der emotionalen Belastung durch die räumliche Distanzierung (p=0,003) und signifikant niedrigere Werte im Kraftsport (p=0,039) sowie im Sport generell (p=0,003) im Vergleich zur Kontrollgruppe. Außerdem rauchten Patient*innen mit bipolarer Erkrankung während dieser Zeit kompensatorisch mehr als Personen der Kontrollgruppe. Personen mit bipolarer Störung gaben mit 42,9% häufiger an, während der Pandemie weniger leistungsfähig zu sein, und 22,9% verzeichneten eine Gewichtszunahme im Vergleich zu vor der Pandemie. Die Kontrollgruppe war hingegen mit 17,5% weniger leistungsfähig und 5,0% berichteten über eine Gewichtszunahme. Ein Vergleich mit Prä-Pandemie-Daten zeigte jedoch eine Abnahme im Food Craving in beiden Gruppen.Diese Studie lieferte erste Hinweise auf die psychische Belastung und auf die ungünstigen Auswirkungen auf den Lebensstil von Menschen mit einer bipolaren Störung zu Beginn der COVID-19-Pandemie. Eine psychiatrische Betreuung und Erste-Hilfe-Maßnahmen für Patient*innen mit psychischer Störung wären gerade in Krisenzeiten wichtig, um einen gesunden Lebensstil zu pflegen und so ungünstigen Entwicklungen gegenzusteuern.

Introduction : Altered levels of acute-phase proteins are often described in different conditions in BD. Nevertheless, data on the association between lithium treatment and inflammatory markers in the long-term course of BD are still missing. The aim of the study was to examine the long-term course of BD concerning long-term lithium treatment, chronic inflammatory processes and symptom progression. Furthermore, the association between duration of lithium treatment and levels of hsCRP was explored. Methods : 267 individuals (males= 139, females= 128) with BD were included. Duration of lithium treatment as well as symptom progression, defined as the increase in severity of symptoms, number of episodes a year and duration of episodes within a period of 1.5 years in the past and hsCRP were evaluated. Results : Male individuals with symptom progression over time had significantly lower duration of lithium treatment compared to individuals without symptoms progression (U= 47.4, p=.037). There were significantly higher levels of hsCRP in male individuals with symptom progression compared to males without symptom progression (U= 47.5, p=.027). Further, there was a significant negative correlation between the duration of lithium treatment and hsCRP levels in the whole sample (r= -.276, p Conclusion : Our results show that an altered inflammatory state may be associated with a more severe illness course in BD. Further, a longer duration of lithium treatment may be associated with lower symptom progression. The shown association between hsCRP-levels and lithium treatment duration suggests a potential anti-inflammatory effect of lithium as a mediator of its significant positive outcome effect in BD.

Bipolar disorder (BD) is associated with impairments in cognitive functions, in which metabolic factors, e.g., overweight, seem to play a significant role. The aim of this study was to investigate the association between nutritional factors and cognitive performance in euthymic individuals with BD. A study cohort of 56 euthymic individuals with BD was compared to a sample of 53 mentally healthy controls. To assess cognitive function, the following tests were applied: California Verbal Learning Test, Trail Making Test A/B, d2 Test of Attention-Revised, and Stroop’s Color-Word Interference Test. Furthermore, a 4-day food record was processed to evaluate dietary intake of macronutrients, specific micronutrients, and food diversity. Body mass index and waist to height ratio were calculated to assess overweight and central obesity. Results showed no nutritional differences between individuals with BD and controls. Individuals with BD performed worse in the d2 test than controls. Hierarchical regression analyses yielded no association between cognitive and nutritional parameters. However, waist to height ratio was negatively correlated with almost all cognitive tests. Central obesity seems to affect cognitive functioning in BD, while the lack of finding differences in nutritional data might be due to problems when collecting data and the small sample size. Consequently, further studies focusing on objectively measuring food intake with adequate sample size are needed.

Throughout the COVID-19 pandemic, mental health of individuals with bipolar disorders (BD) is potentially more vulnerable, especially regarding COVID-19-related regulations and associated symptomatic changes. A multicentric online study was conducted in Austria, Germany, and Denmark during the COVID-19 pandemic. Overall, data from 494 participants were collected (203 individuals with BD, 291 healthy controls (HC)). Participants filled out questionnaires surveying emotional distress due to social distancing, fear of COVID-19, and the Brief Symptom Inventory-18 to assess symptom severity at four points of measurement between 2020 and 2021. General linear mixed models were calculated to determine the difference between the groups in these pandemic specific factors. Individuals with BD reported higher distress due to social distancing than HC, independently of measurement times. Fear of COVID-19 did not differ between groups; however, it was elevated in times of higher infection and mortality due to COVID-19. Individuals with BD reported higher psychiatric symptom severity than HC; however, symptom severity decreased throughout the measured time in the pandemic. Overall, individuals with BD experienced more distress due to the COVID-19 situation than HC. A supportive mental health system is thus recommended to ensure enhanced care, especially in times of strict COVID-19-related regulations.

The global spread of the coronavirus disease (COVID-19) has created new challenges for the entire healthcare system, and those who work directly with the patients or even on the front lines with COVID-19 patients have been particularly stressed. Only a few studies are currently available investigating psychosomatic symptoms among healthcare workers, particularly frontline workers, over the entire pandemic period (2020–2022). There is also a lack of knowledge about strategies to prevent stress during and after a health crisis. Methods: An online survey was conducted at three times (April 2020, winter 2020/2021, and winter 2021/2022) during the COVID-19 pandemic in Austria. The sample included 160 healthcare workers at screening time 1, 1.361 healthcare workers at screening time 2, and 1.134 healthcare workers at screening time 3. The survey included COVID-19 work-related fears, satisfaction with the frontline work, and standardized inventories to assess psychosomatic symptoms, such as the Patient Health Questionnaire (PHQ-D). Results: Psychosomatic symptoms were more common among women compared to men, and among frontline workers compared to non-frontline workers, especially during the course of the pandemic at t2 and t3. Self-reported scores of COVID-19 work-related fears were significantly associated with psychosomatic symptoms. Furthermore, in frontline workers, there was a significant association between the feeling of being safe and well-informed and psychosomatic symptoms. Conclusion: COVID-19 work-related fears and psychosomatic symptoms have been prevalent among healthcare workers throughout the pandemic. Feeling safe and informed appears to be essential to prevent psychosomatic symptoms, leading to a recommendation for employers in the healthcare sector to focus on communication and information. As frontline workers are especially prone to psychosomatic symptoms, more stress prevention programs for them will be essential to maintain productivity and reduce sick days and fluctuations in the healthcare system.

The COVID-19 pandemic affects both mentally healthy and ill individuals. Individuals with bipolar disorder (BD) constitute an especially vulnerable group. A multicentric online study was conducted in Austria, Denmark, and Germany after the first lockdown phase in 2020. In total, 117 healthy controls (HC) were matched according to age and sex to 117 individuals with BD. The survey included the Brief Symptom Inventory-18, Beck Depression Inventory-2, Pittsburgh Sleep Quality Index, and a self-constructed questionnaire assessing COVID-19 fears, emotional distress due to social distancing, lifestyle, and compliance to governmental measures. In individuals with BD, increased symptoms of depression, somatization, anxiety, distress due to social distancing, and poorer sleep quality were related to emotional distress due to social distancing. The correlation between emotional distress due to social distancing and anxiety showed 26% of shared variance in BD and 11% in HC. Negative lifestyle changes and lower compliance with COVID-19 regulatory measures were more likely to be observed in individuals with BD than in HC. These findings underscore the need for ongoing mental health support during the pandemic. Individuals with BD should be continuously supported during periods of social distancing to maintain a stable lifestyle and employ strategies to cope with COVID-19 fears.

Affective disorders such as major depressive disorder and bipolar disorder are associated with higher infection rates and a more severe course of coronavirus disease (COVID-19). In turn, COVID-19 could trigger mental disease relapse. Vaccinations lead to a reduction of infections and the prevention of severe courses. This work aims to survey the willingness of individuals with affective disorders to get vaccinated and concerns about vaccinations.An online study (April-May 2021) assessed the current infection and vaccination rate amongst individuals with affective disorder in Austria by surveying attitudes towards the vaccination, the willingness to get vaccinated soon and possible reasons for decision. The analyses included 59 individuals with affective disorders and 59 healthy controls, matched for sex and age.There was an overall high willingness to get vaccinated against COVID-19. Individuals with affective disorders were more skeptical about vaccinations in general but there was no significant difference between the groups in the willingness to get vaccinated against COVID-19. In both groups reasons for waiting were mainly fears of acute and/or long-term side effects and the fast development of the vaccines.It was a cross sectional design. Due to the online design, no objective rating of current psychopathological symptoms was assessed. Willingness to get vaccinated in general and against COVID-19 in particular were self-created variables, whereas item statistics and factor analysis were conducted.Because of the higher risk for individuals with affective disorders, preventive strategies like vaccinating should be promoted in this group. It is important to help individuals with AD to overcome barriers such as negative beliefs and concerns about acute and/or long-term side effects.

Immune-mediated inflammatory processes and oxidative stress are involved in the aetiopathogenesis of bipolar disorder (BD) and weight-associated comorbidities. Tryptophan breakdown via indoleamine 2,3-dioxygenase-1 (IDO-1) along the kynurenine axis concomitant with a pro-inflammatory state was found to be more active in BD, and associated with overweight/obesity. This study aimed to investigate tryptophan metabolism in BD compared to controls (C), stratified by weight classes, in a longitudinal setting, dependent on the incidence of BD episodes. Peripheral tryptophan, kynurenine, and neopterin were assessed in the serum of 226 BD individuals and 142 C. Three samples in a longitudinal assessment were used for 75 BD individuals. Results showed a higher kynurenine/tryptophan in both BD compared to C and overweight compared to normal weight persons. Levels remained stable over time. In the longitudinal course, no differences were found between individuals who were constantly euthymic or not, or who had an illness episode or had none. Findings indicate that tryptophan, kynurenine, and IDO-1 activity may play a role in pathophysiology in BD but are not necessarily associated with clinical manifestations. Accelerated tryptophan breakdown along the kynurenine axis may be facilitated by being overweight. This may increase the risk of accumulation of neurotoxic metabolites, impacting BD symptomatology, cognition, and somatic comorbidities.

Background: Sleep disturbances are common early warning signs of an episode of bipolar disorder, and early recognition can favorably impact the illness course. Symptom monitoring via a smartphone app is an inexpensive and feasible method to detect an early indication of changes such as sleep. The study aims were (1) to assess the acceptance of apps and (2) to validate sleeping times measured by the smartphone app UP!.Methods:UP! was used by 22 individuals with bipolar disorder and 23 controls. Participants recorded their time of falling asleep and waking-up using UP! for 3 weeks. Results were compared to a validated accelerometer and the Pittsburgh Sleep Quality Index. Additionally, participants were interviewed regarding early warning signs and their feedback for apps as monitoring tools in bipolar disorder (NCT03275714).Results: With UP!, our study did not find strong reservations concerning data protection or continual smartphone usage. Correlation analysis demonstrates UP! to be a valid tool for measuring falling asleep and waking-up times.Discussion: Individuals with bipolar disorder assessed the measurement of sleep disturbances as an early warning sign with a smartphone as positive. The detection of early signs could change an individual's behavior and strengthen self-management. The study showed that UP! can be used to measure changes in sleep durations accurately. Further investigation of smartphone apps' impact to measure other early signs could significantly contribute to clinical treatment and research in the future through objective, continuous, and individual data collection.

Background The coronavirus disease (COVID-19) pandemic, a global health crisis, has resulted in widespread socioeconomic restrictions including lockdown, social distancing, and self-isolation. To date, little is known about the psychological impact of the COVID-19 pandemic and lockdown on patients with bipolar disorder as a particularly vulnerable group. Methods An online survey was conducted in Austria at two points of measurement (T1 April 2020 during the first lockdown vs. T2 May 2020 at post-lockdown). The sample comprises 20 patients with bipolar disorder (mean age = 49.4 ± 15.6 years) and 20 healthy controls (mean age = 32.7 ± 9.6 years). A 2 × 2 factorial design to compare two time points (T1 vs. T2) and two groups (patients vs. healthy controls) was used. Main outcome measures included the Brief Symptom Inventory-18 (BSI-18) and a (non-validated and non-standardized) assessment to determine COVID-19 fears and emotional distress due to social distancing. Multiple linear regression analyses were used to assess the longitudinal association of COVID-19 fears/emotional distress due to social distancing during lockdown (T1) and psychological symptoms after lockdown (T2). Results At T1, results demonstrated higher scores in BSI-18 subscales depression, anxiety and global severity index as well as emotional distress due to social distancing in bipolar patients compared to controls. There was a significant time x group interaction in the BSI-18 subscale somatization showing a decreasing trend in patients with BD compared to controls. No time effects in BSI-18 subscales or COVID-19 fears/emotional distress due to social distancing were observed. Regression analyses showed that COVID-19 fears during lockdown predicted somatization, only in patients. Conclusions There was a connection between the lockdown measures and somatization symptoms observed in patients. When the first steps of easing the social restrictions in May 2020 took place, somatization decreased only in the bipolar compared to the control group. Higher COVID-19 fears during lockdown predicted later symptoms at post-lockdown. Long-term impacts of the COVID-19 pandemic need further investigations to improve current therapeutic approaches and prevent fears and distress during lockdown in individuals with bipolar disorder in times of crisis.