Background: An increased risk of cognitive decline has been reported in patients with older age bipolar disorder (OABD); however, the underlying factors contributing to this association remain unclear. This cross-sectional study aims to identify the clinical features associated with cognitive impairment in OABD. Methods: A total of 152 participants, aged at least 50 years and diagnosed with bipolar disorder (BD) and related disorders in agreement with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria, were included in the study and divided into two subgroups based on the presence/absence of cognitive impairment, defined as a diagnosis of Mild Neurocognitive Disorder or Major Neurocognitive Disorder. Univariate comparisons and multivariate logistic regression models were performed to investigate the associations between clinical variables and cognitive impairment. Results: Cognitively impaired patients had a higher prevalence of otherwise specified BD/cyclothymic disorder, while BD type 2 was more common in the cognitively unimpaired group. Additionally, the cognitively impaired group had a later onset of major mood episodes (p < 0.05), fewer lifetime depressive episodes (p = 0.006), a higher prevalence of vascular leukoencephalopathy (p = 0.022) and dyslipidemia (p = 0.043), a lower prevalence of agoraphobia (p = 0.040), worse global functioning (p < 0.001), and higher psychopathology severity (p < 0.001). Late onset, vascular leukoencephalopathy, and dyslipidemia were all independently associated with cognitive impairment. Conclusions: Atypical BD, late onset of mood episodes, and somatic comorbidities like vascular leukoencephalopathy and dyslipidemia are associated with a higher risk of developing cognitive impairment and neurodegenerative disorders in OABD patients.

Background: Psychiatric symptoms are highly prevalent in patients with severe obesity, often representing pivotal factors in the development and progression of this condition. This study examines the association between negative emotional dysregulation (NED) and weight loss following bariatric surgery. Methods: Ninety-nine patients were consecutively enrolled at the Obesity Center of the Pisa University Hospital between March 2019 and February 2021, during a routine psychiatric evaluation before bariatric surgery. Psychopathological dimensions were assessed using the Mini-International Neuropsychiatric Interview (MINI), the Reactivity, Intensity, Polarity, and Stability questionnaire in its 40-item version (RIPoSt-40), the Wender–Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) and the Barratt Impulsiveness Scale (BIS-11). Based on a RIPoSt-40 cut-off score of 70, subjects were divided into two groups: with (NED+) and without (NED−) NED. Results: NED+ subjects had a higher rate of psychiatric comorbidities and eating disorders than NED− patients. Of the total sample, 76 underwent bariatric surgery, and 65 of them were re-evaluated one-year after surgery. Among them, 10 of 28 NED+ subjects (37.5%) had inadequate weight loss one year after surgery compared to 5 of 37 NED− subjects (13.5%) (p = 0.035, OR 3.55, 95%, C.I. 1.05–12.03). Conclusions: Our results suggest a significant association between NED and inadequate weight loss at one-year post surgery.

Depressive symptoms are a customary finding in hospitalized patients, particularly those who are undergoing long hospitalizations, underwent major surgical procedures or suffer from high levels of multimorbidity and frailty. The patients included in this case series shared high degrees of frailty-complexity and were evaluated within the ordinary consultation and liaison psychiatry service of the University Hospital in Pisa, Italy, from September 2021 to June 2023. Patients were administered at least one follow-up evaluation after a week and before discharge. To relate this case series to the extant literature, a comprehensive systematic review of vortioxetine safety and efficacy was performed. None of the six patients included developed serious safety issues, but one patient complained of mild-to-moderate nausea for some days after the vortioxetine introduction. Five out of six patients exhibited at least a slight clinical benefit as measured by the clinical global impression scale. Of the 858 entries screened via Scopus and Medline/PubMed, a total of 134 papers were included in our review. The present case series provides preliminary evidence for vortioxetine’s safety in this healthcare domain. The literature reviewed in this paper seems to endorse a promising safety profile and a very peculiar efficacy niche for vortioxetine in consultation and liaison psychiatry.

Cognitive Reserve (CR) has been proposed as a protective factor against cognitive decline and functional impairment in psychiatric disorders, including bipolar disorder (BD). However, how CR differs between BD, other psychiatric populations, and healthy individuals remains unclear. This systematic review and meta-analysis aimed to evaluate differences in CR between individuals with BD, healthy controls (HCs), at-risk populations, and patients with other psychiatric disorders. Following PRISMA guidelines, we systematically searched PubMed/MEDLINE, Scopus, PsycINFO, and Web of Science for studies assessing CR in BD and control populations, using validated CR measures or proxies (e.g., education, intelligence quotient, occupational status, leisure activities). A multilevel random-effects meta-analysis was performed to compare CR levels between BD and HCs, and BD and other psychiatric disorders. Twelve studies (N = 1861 participants) met inclusion criteria. Meta-analytic findings revealed that individuals with BD exhibited significantly lower CR than HCs (SMD = -0.45, 95 % CI: -0.69 to -0.20, I² = 84.5 %), whereas no significant differences emerged between BD and MDD (SMD = -0.23, 95 % CI: -0.49 to 0.03, I² = 41.7 %). Sociodemographic and clinical variables did not significantly moderate CR levels. CR is lower in BD compared to HCs, suggesting its contribution to cognitive and functional impairments. Conversely, similar CR between BD and MDD highlight shared clinical vulnerabilities. These results underscore the need for targeted interventions to enhance CR in patients with BD. Future research should prioritize standardized CR assessment and investigate modifiable factors contributing to CR development in psychiatric populations.