Filippo De Giorgi

Background: Youth mental health services increasingly encounter adolescents and young adults with complex affective presentations and trauma histories. Dissociation has been proposed as a clinically relevant marker within bipolar vulnerability pathways but remains underrecognized in early-intervention settings. This pilot study investigated the prevalence and clinical correlates of bipolar at-risk (BAR) status in a help-seeking youth sample, with specific focus on dissociative symptoms in this vulnerable population. Methods: A pilot study with a cross-sectional design was conducted in a specialized outpatient clinic for 14–25-year-olds. Seventy-six participants without Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision bipolar disorder completed a multidimensional assessment, including dissociative (Dissociative Experiences Scale version 2 [DES-II], Adolescent-DES [A-DES], Structured Clinical Interview for DSM Dissociative Disorders [SCID-D]), affective, anxiety, impulsivity, and prodromal symptom measures. BAR status (BAR+) was determined via clinical interview according to Bechdolf criteria. Clinically significant dissociation (DES+) was defined by established cut-offs at the DES-II and A-DES scales. Group comparisons, binary logistic regression and exploratory mediation analysis were performed. Results: In our sample, 44.7% of the participants met BAR+ criteria and 42.9% displayed clinically significant dissociation. Patients with BAR+ status more frequently reported familiar history of affective disorders, previous antidepressant use, loneliness, and non-suicidal self-injury. They displayed more severe depressive symptoms and impulsivity, as well as higher scores at all the affective temperament subscale except for hyperthymic. BAR+ patients displayed higher prevalence of dissociative symptoms than BAR− (51.6% vs. 24.2%; p = 0.045). Among the BAR+ subgroup, DES+ youths showed greater traumatic burden, depressive symptoms, and anxious temperament scores. Dissociation was associated with BAR+ status (OR 3.2) after adjusting for age, gender, and loneliness, while attentional impulsivity did not mediate this relationship. Conclusions: Dissociative symptomatology is highly prevalent among help-seeking youths and is directly associated with subthreshold bipolar-spectrum vulnerability. A dissociative BAR phenotype, marked by emotional instability and trauma exposure, may delineate a clinically complex subgroup, supporting the integration of dissociation-focused assessment into youth bipolar-risk staging and early-intervention protocols.

Background: The present study aimed to investigate the clinical correlates of treatment response to mood stabilizers in patients with bipolar disorder (BD), with a specific focus on trait-related characteristics such as impulsivity and affective temperaments. Methods: In- and outpatients diagnosed with BD were recruited at the Section of Psychiatry of the General Hospital/University of Perugia. Socio-demographic, clinical, and current psychopathological characteristics were collected. The treatment response was retrospectively assessed using the Alda Scale. Trait characteristics were evaluated through the Barratt Impulsiveness Scale (BIS-11) and the Brief Temperament Evaluation of Memphis, Pisa, and San Diego—Münster version (briefTEMPS-M). Bivariate analyses and a general linear model were employed to analyze the correlates of treatment response to mood stabilizers. Results: Among the investigated variables, trait impulsivity showed a significant negative association with treatment response. A similar effect was observed for depressive temperament, while other affective temperaments were not significantly associated with treatment outcomes. Patients with good treatment responses exhibited higher illness duration and lower severity of BD, higher prevalence of comorbid anxiety disorders, lower diurnal variation in depressive symptoms, and lower functional impairment in autonomy and occupational domains. The main limitations of this study were represented by the small sample size, the retrospective assessment of treatment response, and the inclusion of patients from a single center. Conclusions: The present findings suggest that impulsivity and depressive temperament should be investigated as potential predictors of poor response to mood stabilizers in BD. These trait dimensions, together with other clinical markers, may serve as useful targets for patient stratification and the development of personalized treatment strategies.

Background and Objectives: Affective disorders, namely bipolar (BDs) and depressive disorders (DDs) are characterized by high prevalence and functional impairment. From a dimensional point of view, BDs and DDs can be considered as psychopathological entities lying on a continuum. A delay in treatment initiation might increase the burden associated with affective disorders. The aim of this study is to analyze the correlates of a long duration of untreated illness (DUI) in these conditions. Materials and Methods: Subjects with BDs and DDs, both in- and outpatients, were recruited. Long DUI was defined according to previous research criteria as >2 years for BDs or >1 year for DDs. Socio-demographic, clinical and psychopathological characteristics of the recruited subjects were collected. Bivariate analyses were performed to compare subjects with a long and short DUI (p < 0.05). Results: In our sample (n = 61), 34.4% of subjects presented a long DUI. A long DUI was significantly associated with longer overall illness duration (p = 0.022) and a higher rate of psychiatric (p = 0.048) and physical comorbidities (p = 0.023). As for psychopathological features, depressive symptoms were more severe in the long DUI subgroup, as demonstrated by a higher score at the Clinical Global Impression-severity of depression (p = 0.012) item and at the anxiety/depression factor of the Positive and Negative Syndrome Scale (p = 0.041). Furthermore, subjects with a long DUI displayed more severe disruption of circadian rhythms, as evaluated by the Biological Rhythms Interview for Assessment in Neuropsychiatry total (p = 0.044) and social domain (p = 0.005) scores and by the Hamilton Depression Rating Scale diurnal variation items (18a: p = 0.029, 18b: p = 0.047). Conclusions: A long DUI may underpin higher clinical severity, as well as worse illness course and unfavorable prognosis in affective disorders. Intervention strategies targeting comorbidities, depressive symptoms and circadian rhythms may decrease disease burden in subjects with a long DUI.