Philippe Courtet

Eating dysregulation has been associated with suicide risk, but its short-term relationship with suicidal ideation remains unclear. Given its dynamic nature, appetite-related disturbances may be suitable for real-time monitoring using Ecological Momentary Assessment (EMA). This study examined the prospective association between daily eating dysregulation and passive suicidal ideation over 12 months. A prospective EMA study was conducted in 550 psychiatric outpatients with recent suicidal ideation or suicide attempts. Participants completed daily smartphone-based assessments through the MEmind app. Linear mixed-effects models evaluated between-person (mean levels) and within-person (daily fluctuations) associations between eating dysregulation and passive suicidal ideation, adjusting for age, sex, time, and missingness. A total of 81,023 EMA responses were analyzed. No significant linear changes over time were observed. Higher average eating dysregulation was associated with greater passive suicidal ideation (b = 10.11, p < .001). Within individuals, days with higher-than-usual eating dysregulation were also associated with increased passive suicidal ideation (b = 2.32, p < .05). The model explained 27% of the variance. Eating dysregulation is both a stable and dynamic correlate of passive suicidal ideation. Daily variations in eating behavior may serve as a real-time marker of suicide risk, highlighting the potential of EMA to support early detection and personalized prevention strategies.

Background: The European Psychiatric Association (EPA) undertook a study to investigate treatment preferences of European psychiatrists towards Bipolar Disorder (BD), as part of the Ambassador programme series of surveys. Methods: We conducted a cross-sectional online survey among psychiatrists and psychiatry trainees from 40 European countries. The questionnaire contained clinical vignettes of different phases of BD including manic, rapid cycling, mixed, hypomanic, and depressive episodes, for both initial and subsequent treatment strategies. Results: The final sample consisted of 654 participants, from Central and Eastern Europe (CEE), Southern Europe (SE), Northern Europe (NE), and Western Europe (WE). The majority preferred pharmacotherapy, most commonly as a combination of two or three drugs to treat all phases of the BD, with lithium being the most preferred option in all phases. Among antipsychotics, olanzapine and quetiapine were the most commonly chosen. Antidepressants were applied in almost 20% of responses for the depressive phase. Psychosocial interventions were not systematically implemented, particularly during manic and mixed episodes, but when recommended, the most common approaches included psychoeducation, cognitive behavioural therapy (CBT) in up to 40% in depressive phase, and lifestyle recommendations. However, latent class analysis identified four different classes of prescribers. Conclusions: Psychiatrists showed broadly similar pharmacological treatment preferences for BD, with frequent use of lithium-based combination therapies and limited implementation of psychosocial interventions, although latent class analysis revealed distinct prescribing profiles. These findings support the need for enhanced dissemination of evidence-based guidelines and greater integration of psychosocial approaches in BD care.

Background: Suicide is a major public health challenge. Traditional assessments of suicidal thoughts and behaviors rely on retrospective measures that are subject to recall bias and show limited predictive accuracy. Ecological momentary assessment (EMA) can improve suicide risk assessment by capturing real-time information in participants’ natural environments. However, EMA burden often results in short follow-up periods. Objective: This study aimed to examine the association between suicidal ideation (SI) and multiple variables collected in real time using smartphone-based EMA over 6 months, with the goal of identifying short-term predictors of suicide risk in a clinical population. A secondary objective was to explore whether baseline depression and psychological pain predicted EMA-reported SI. Methods: This is a prospective EMA-based study carried out among outpatients at high risk of suicide, recruited in Madrid, Spain. At baseline, depression, suicidality, and psychological and physical pain were assessed using traditional questionnaires (Inventory of Depressive Symptomatology, Columbia Suicide Severity Rating Scale, and Visual Analog Scales). During the 6-month follow-up, participants completed daily smartphone-based EMA prompts assessing SI, nonsuicidal self-injury, negative affect, interpersonal experiences, sleep, and eating habits. Each day, 2-4 questions derived from validated instruments were randomly selected from a pool of 34 items to minimize participant burden. Mixed-effects models examined within-person variability, temporal trends, and real-time associations between EMA variables and SI. Intraindividual variability was quantified using intraclass correlation coefficients and root mean squared successive differences. Linear regression analyses explored associations between EMA variables and demographic covariates and evaluated whether baseline depression and psychological pain predicted the mean and variability of SI and negative affect. Results: A total of 99 participants were included in the final analysis, and 13,900 EMA responses were obtained. The slope of SI showed no significant changes over time, with similar results for negative affect, interpersonal difficulties, sleep problems, and appetite. Substantial within-person variability was observed across all EMA domains. Negative affect (ß=0.193, SE 0.03; t ₉₈ =6.21; P <.001) and interpersonal difficulties (ß=0.03, SE 0.168; t ₉₈ =5.96; P =.001) were significantly associated with SI and remained significant in combined models. In a subsample of 37 participants, lower baseline psychological pain was associated with lower levels of negative affect and SI over time, whereas higher baseline depression was associated with greater negative affect. Conclusions: This study provides novel insights into the real-time relationship between SI and key psychological and behavioral variables, particularly negative affect and interpersonal difficulties, using smartphone-based EMA in a high-risk clinical population. The substantial within-person variability highlights the dynamic nature of suicide risk and the limitations of traditional assessments. Future studies should aim to translate EMA-based monitoring into actionable interventions to provide real-time support for individuals at high risk of suicide.

Introduction: Major depressive disorder (MDD) is a prevalent and disabling condition, yet predicting individual response to antidepressants remains difficult. Traditional symptom-based assessments, typically conducted weeks apart, may miss early and dynamic changes. Daily self-reported measures of wellbeing dimensions, particularly via simple tools such as visual analog scales (VAS), could provide ecologically valid and patient-centered markers of early treatment response. This study aimed to identify distinct early trajectories of self-rated health during antidepressant initiation and examine their associations with baseline clinical characteristics and outcomes at 6–8 weeks. Methods: In this multicenter naturalistic study, 1,536 outpatients with MDD initiating agomelatine monotherapy were recruited across 388 community psychiatry centers. The primary outcome was daily self-rated health during the first 14 days, assessed using the EuroQol VAS. Latent class analysis identified distinct trajectories of self-rated health evolution, with model selection based on Akaike and Bayesian Information Criteria, entropy, and clinical interpretability. Results: A five-class solution was retained, including persistently high or low trajectories, stable intermediate patterns, and one subgroup showing marked early improvement despite low baseline values. Trajectories were associated with baseline clinical severity and different symptomatic and functional outcomes at 6–8 weeks. Patients with rapid early improvement had the highest remission rates, whereas those with severe baseline symptoms and limited early improvement had the poorest outcomes. Conclusion: These findings support the clinical utility of early wellbeing trajectories for personalized monitoring during antidepressant treatment.

Objectives: To investigate pharmacological treatment patterns in individuals with bipolar disorder (BD) with and without comorbid substance use disorder (SUD) and anxiety disorder (AX), we leveraged the Global Bipolar Cohort to analyze cross‐regional practices across North America, Europe, and the Pacific. Methods: Fourteen cohorts contributed aggregate data on pharmacotherapy, demographics, diagnostic subtypes, and comorbidities. Proportional meta‐analyses using generalized linear mixed models were conducted to examine prescription trends and identify clinical differences. Results: The sample ( N = 11,521) was 60% female and 84% Caucasian. Participants were categorized into four mutually exclusive groups based on comorbidity status: those with comorbid AX only, comorbid SUD only, both AX and SUD, or neither. The AX+SUD subgroup showed higher rates of attention‐deficit/hyperactivity disorder (ADHD), post‐traumatic stress disorder (PTSD), rapid cycling, obesity, and unemployment, reflecting a more severe clinical profile. Regional variations were notable: North American cohorts reported higher prevalence of AX and SUD than European and Pacific cohorts. Antidepressants use for AX were more common in Europe and the Pacific, while North American prescribing patterns were more variable. Benzodiazepine use was high among individuals with SUD across all regions. Lithium and first‐generation antipsychotic prescriptions varied, with higher rates observed in Europe. Conclusions: Findings underscore the heterogeneity of BD and the influence of comorbid AX and SUD on illness burden and treatment. Regional prescribing variations underscore the need for context‐specific guidelines. Gaps in data on medication‐assisted treatment for SUD point to areas for future research. These insights can support more individualized and effective care for complex BD presentations.

Background: Epigenetic age accelerations have been associated with the clinical expression of BD; however, with few available studies. Method: We calculated Horvath, Hannum, EN, GrimAge, and PhenoAge epigenetic ages in a sample of 139 individuals with BD. We used a latent profile analysis to identify subgroups of individuals based on their profile of epigenetic age accelerations. We compared these profiles for socio‐demographic characteristics, course of BD, associated psychiatric conditions, current medication use, telomere length, mitochondrial DNA copy number (mtDNAcn), markers of metabolic syndrome, and of systemic inflammation. Results: The latent profile analysis identified two subgroups, one with accelerated and one with decelerated epigenetic aging (respectively 58% and 42%). Subgroups did not differ for socio‐demographic characteristics, course of BD, associated psychiatric conditions, nor current medication use. The accelerated aging subgroup was characterized by higher depressive symptoms ( p < 0.001), lower mtDNAcn ( p < 0.001), higher levels of systemic inflammation (platelet/neutrophil ratio, neutrophil/lymphocyte ratio, systemic inflammation index, p < 0.001) that remained significant after correction for multiple testing. Some associations with anxiety symptoms, social functioning, blood pressure, and waist circumference did not remain significant after correction for multiple testing. Conclusions: Most individuals with BD were characterized by an accelerated epigenetic age profile. This study suggests a link between epigenetic age acceleration, systemic inflammation, and mtDNAcn. This subgroup might represent a target for personalized prevention and treatment.