Adults with bipolar disorder (BD) often experience both objectively measurable cognitive impairments and subjectively perceived cognitive errors, though research shows a weak correlation between the two. While prior studies have identified cognitive subgroups using objective testing, this study is the first to use perceived cognitive errors and mood symptoms to identify four distinct clusters: low symptoms/low cognitive errors, low symptoms/moderate errors, high symptoms/moderate errors, and high symptoms/high errors. Importantly, psychological well-being—including self-efficacy, life satisfaction, and life meaning—declined as both perceived cognitive errors and mood symptoms increased. Contrary to expectations and the neuroprogression hypothesis, neither age nor duration of BD diagnosis was associated with greater perceived cognitive loss.

These findings suggest that perceived cognitive errors are not just proxies for mood symptoms like depression but are also influenced by hypo/mania and play a meaningful role in predicting psychological well-being. The strongest impairments were found in individuals reporting both high depressive and manic symptoms, along with frequent distractibility, forgetfulness, and false triggering. Moreover, those with the highest symptom burdens also reported poorer sleep quality, greater alcohol misuse, and were prescribed more psychotropic medications. These results highlight the need to address subjective cognitive difficulties directly, as they independently affect quality of life and may not be fully explained by mood state or aging alone.

Reference: Haglili O, Sixsmith A, Star AP, et al. Correction: Perceived cognitive loss, symptomology, and psychological well-being with bipolar disorder. Int J Bipolar Disord. 2024 Nov 18;12(1):39. doi: 10.1186/s40345-024-00361-8. Erratum for: Int J Bipolar Disord. 2024 Oct 5;12(1):34. doi: 10.1186/s40345-024-00357-4. PMID: 39557709; PMCID: PMC11573948.

Lithium remains a leading long-term treatment for bipolar disorder but is associated with potential renal risks, particularly chronic kidney disease (CKD). In this large retrospective study of more than 4,000 patients treated with lithium, 620 experienced at least one episode of severe kidney impairment (eGFR < 30 ml/min/1.73 m²), though only 153 developed confirmed CKD stage 4. About half of these cases were transient and reversible. Patient survival after CKD4 was strongly linked to age rather than lithium continuation. Many patients remained on lithium post-CKD4 or even during renal replacement therapy (RRT), with no significant impact on survival, suggesting that discontinuation may not always improve renal outcomes.

The study highlights that lithium-related kidney decline often progresses slowly and that outcomes depend more on age and comorbidities than treatment cessation. Most patients with CKD had significant somatic illnesses, notably cardiovascular disease. Continued lithium use, when well-monitored, may be appropriate even after renal impairment, especially to avoid psychiatric relapse. These findings support close collaboration between psychiatrists and nephrologists, early recognition of “creeping creatinine,” and proactive renal monitoring. Importantly, many patients with severe renal decline are missed in RRT-based assessments, underscoring the need for more comprehensive tracking.

Reference: Aiff H, Attman PO, Golic M, et al. Prospects for lithium treated patients with severe renal impairment. Int J Bipolar Disord. 2025 Feb 14;13(1):5. doi: 10.1186/s40345-025-00372-z. PMID: 39953220; PMCID: PMC11828763.

The Life Goals (LG) app is a mobile adaptation of a self-management program for individuals with bipolar disorder (BD), designed to align symptom coping strategies with personal goals. In a qualitative study involving 18 participants who used the app for six months, users generally reported that the Mood Monitoring and educational modules were beneficial, helping them track emotional patterns and reflect on their condition. However, some found components too basic or impersonal—particularly those who had lived with BD for years—and called for more tailored, interactive, and engaging content. Feedback on the proposed provider dashboard was mixed; while some saw value in sharing their app data with clinicians to improve care, others had concerns about privacy and provider responsiveness.

The study’s findings highlight the importance of personalization, customization, and interactivity in digital mental health interventions (DMHIs) for sustained engagement. Participants expressed a desire for features like behavior tracking, integrated health data, and peer interaction, suggesting these could improve long-term app use and mental health outcomes. The feedback also emphasized the need to design tools that adapt over time and accommodate users with varying levels of BD experience. While limited by a small, homogenous sample and retrospective interviews, this work informs the development of more responsive, user-centered DMHIs and supports future enhancements to the LG app, including the provider dashboard and just-in-time adaptive interventions (JITAIs).

Reference: Rusch A, Carley I, Badola P, et al. Digital mental health interventions for chronic serious mental illness: Findings from a qualitative study on usability and scale-up of the Life Goals app for bipolar disorder. Front Digit Health. 2022 Nov 21;4:1033618. doi: 10.3389/fdgth.2022.1033618. PMID: 36479190; PMCID: PMC9719982.