OBJECTIVES:There is a need for ecologically valid measures of real-life cognitive functioning. We investigated: (I) the sensitivity of the Cognition Assessment in Virtual Reality (CAVIR) test, which assesses daily-life cognitive skills in an immersive virtual reality kitchen scenario, to capture cognitive impairments in a Spanish sample of patients with bipolar disorder (BD) compared to healthy controls (HCs); (II) the convergent validity of CAVIR against standard neuropsychological tests and functional measures. METHODS:Patients with BD in full/partial remission (n = 40) and HCs (n = 40) completed the CAVIR-Spanish version and standard neuropsychological tests; the Hamilton Depression Rating Scale (HRDS-17), the Young Mania Rating Scale (YMRS), the Functioning Assessment Short-Test (FAST) and the Brief University of California Performance-based Skills Assessment (UPSA-B). Between-group comparisons of CAVIR global and subtask scores were conducted, together with correlation and linear regression analyses adjusting for age and mood symptoms. RESULTS:CAVIR was sensitive to cognitive impairments in BD, with patients showing poorer performance than HCs on CAVIR global composite (BD = -1.09, 95% CI [-1.44, 0.74] vs. HCs = -0.19, 95% CI [-0.53, 0.15]) (F(1,72) = 9.52, p = 0.003, η p 2 $$ {\eta}_p^2 $$  = 0.12) and subtasks of sustained attention (BD = -1.25, 95% CI [-1.83, -0.70] vs. HCs = -0.14, 95% CI [-0.66, 0.37]) (F(1,69) = 6.12, p = 0.016, η p 2 $$ {\eta}_p^2 $$  = 0.08), processing speed (BD = -1.64, 95% CI [-2.11, -1.18] vs. HCs = -0.20, 95% CI [-0.66, 0.25]) (F(1,68) = 13.67, p < 0.001, η p 2 $$ {\eta}_p^2 $$  = 0.17) and working memory (BD = -0.91, 95% CI [-1.42, -0.41] vs. HCs = 0.05, 95% CI [-0.42, 0.52]) (F(1,71) = 5.50, p = 0.022, η p 2 $$ {\eta}_p^2 $$  = 0.07). The global CAVIR composite and subtasks scores were associated with standard global neurocognitive composite and domains, respectively (σ = 0.50-0.74, p < 0.001). The global CAVIR and all subtasks scores were associated with both observed/interview-based (FAST; σ = -0.29 to -0.55, p < 0.001) and performance-based (UPSA-B; σ = 0.29-0.49, p < 0.05) functional outcomes. CONCLUSIONS:The CAVIR-Spanish version is a sensitive and valid instrument for measuring real-life cognitive skills in BD and may be implemented in clinical settings and treatment trials targeting cognition following further studies.

Background Bipolar disorder (BD) is a prevalent, chronic and severe condition, with a high impact on psychosocial functioning. In the treatment of BD, maintenance therapy is crucial for preventing affective recurrences and long-term complications. The goal of this study was to conduct a descriptive analysis of the trajectories of pharmacological treatment along 20 years in a cohort of patients with BD, to better understand the diversity and changes in treatment patterns. Methods This study analyses the prescription patterns of psychotropic medications and their association with clinical variables (sex, BD type, predominant polarity and psychotic symptoms) in a sample of 68 outpatients with BD (54.4% female, age of 39.31±12.04 at the start of the study) over a 20-year period. Results Maintenance therapy was predominantly based on combination strategies (75.8% at baseline). Our findings showed an increase in polypharmacy and benzodiazepines and a decline of mood stabilizers. Conclusions This study offers insight into maintenance medication patterns among BD patients in a real-world setting over an extended period, revealing how prescribing tendencies have evolved. The widespread use of polypharmacy and benzodiazepines and the decrease in the prescription of mood stabilizers during the follow-up highlight a noticeable divergence between clinical practice and guideline recommendations.

Background The Global Bipolar Cohort (GBC) was established to identify existing bipolar disorder (BD) cohorts worldwide and foster collaborations focused on descriptive and analytic outcomes relevant to BD. A distributed analytic framework has been implemented to engage multiple sites without the need for central data pooling. This report describes the GBC endeavor and global functional impairment patterns. Cross-cohort comparisons of functional correlates are limited by heterogeneous measures and data-sharing constraints. Large, culturally diverse comparisons are needed to distinguish broadly reproducible correlates from cohort-specific effects. Participating sites completed a 28-item descriptive survey covering diagnostic methods, cognition, genetics, treatment, functioning, and follow-up strategies. We implemented a harmonized local logistic regression model of dichotomized functional outcome and shared summary statistics only. Results We identified 69 cohorts across five continents. Thirty-seven cohorts contributed functional outcome analyses from 17,130 participants. Outcome measures included clinician-rated disability scales and social indicators such as employment and marital status. The proportion classified with poor functioning ranged from 16% to 77% (mean 50%). In 32 of 37 cohorts, the overall regression model significantly explained variance in functioning. Current depressive symptoms were the most robust and reproducible correlate of poor functional outcome: they were assessed in 29 cohorts, significant in 22 (75.8%), ranked among the top three correlates in 22, and were the top-ranked correlates in 19. Associations between depressive burden and poor functioning were observed across clinician-rated disability scales and work or social indicators, and across geographically diverse cohorts. Comorbid substance use disorder and medication-related variables were associated with poorer functioning in subsets of cohorts, whereas sex, ancestry, bipolar subtype, psychosis history, and premorbid IQ showed weak or inconsistent associations. Cognitive measures, available in a minority of regression models, showed modest and non-uniform effects. Conclusions Across heterogeneous international cohorts, current depressive symptom burden emerged as the most consistent correlate of poor functioning in bipolar disorder. These findings replicate earlier multisite work at a larger scale, show that protocol-based distributed analyses can identify reproducible clinical signals without sharing individual-level data, and support prioritizing detection and treatment of depressive symptoms when aiming to improve real-world functioning. Future work should expand longitudinal harmonization and representation of under-studied populations.

INTRODUCTION:Predominant polarity (PP) has emerged as a valuable course specifier in bipolar disorder (BD) with implications for prognosis and treatment planning. As the BD population ages, understanding its clinical characteristics becomes essential to tailor personalized interventions across the lifespan. This study aimed to characterize the distribution and clinical profiles of PP subgroups in a cohort of older adults with BD (OABD). METHODS:This cross-sectional study included 101 euthymic OABD aged >50 years. Clinical, neuropsychological and functional characteristics were compared between depressive (DPP), manic (MPP), and undetermined predominant polarity (UPP) subgroups, based on at least 2/3 of lifetime episodes being either depressive or manic polarity. RESULTS:UPP was the most frequent PP in OABD (59.4%), followed by DPP (27.7%) and MPP (12.9%). Patients with DPP presented a later age of onset, a depressive first episode, less psychiatric hospitalizations, and a trend to outperform MPP and UPP in visual memory. Participants with MPP presented more frequently with manic onset. The UPP subgroup exhibited worse clinical outcomes, including higher number of total episodes, more frequent suicidal ideation and seasonality, and worse financial disability compared to DPP. CONCLUSION:PP classification distinguishes meaningful clinical and cognitive subgroups in OABD. The UPP subgroup associates with greater illness severity and functional impairment. These findings support the integration of PP into personalized treatment and prevention strategies in aging BD. Future longitudinal studies are needed to further clarify the trajectory of PP across the lifespan.

INTRODUCTION:Impairment in both psychosocial functioning and neurocognition (NC) performance is present in bipolar disorder (BD) yet the role of sex differences in these deficits remains unclear. The present systematic review and meta-analysis examined whether males and females with BD demonstrate differences in psychosocial functioning and NC performance. METHODS:The Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases were systematically searched from inception until November 20, 2023. RESULTS:Twenty studies published between 2005 and 2023 with a total sample size of 2286 patients with BD were included. A random effects meta-analysis revealed a statistically significant result with a small effect (SMD = 0.313) for sex differences in verbal learning and memory as well as visual learning and memory (SMD = 0.263). Females outperformed males in both domains. No significant sex differences were observed for any other NC outcome or psychosocial functioning. High heterogeneity and differences in assessment scales used should be considered when interpreting these findings, given their potential impact on results. CONCLUSIONS:Future research should adopt a more homogenous, standardized approach using longitudinal designs to gain a clearer insight into sex differences in this population. This approach so may increase the use of preventative therapeutic options to address the difficult clinical challenge of reaching cognitive and functional recovery.

INTRODUCTION:Resilience is present in both clinical and non-clinical populations; yet, there is a paucity of literature examining its role in bipolar disorder (BD). The goal of the present systematic review and meta-analysis was to substantiate the extant literature investigating resilience in BD in comparison to clinical and non-clinical populations. METHOD:PubMed/MEDLINE, PsycINFO, and Scopus were systematically searched from inception to August 8th, 2024. RESULTS:Twenty-eight studies using a validated resilience scale with a total of 3094 people with BD, 4100 healthy controls, and 1768 with other mental diagnoses were included in the systematic review, and 21 were analyzed in a random effects meta-analysis. A statistically significant result with a medium effect (SMD = -0.787, p < 0.001) indicated that people with BD reported lower levels of resilience than healthy controls. Similarly, patients with BD showed higher levels of resilience than patients with schizophrenia (SCZ) (SMD = 0.336, p = 0.013). No significant differences were found between BD and major depressive disorder (MDD). CONCLUSION:Findings should be interpreted with caution due to the high heterogeneity observed and methodological challenges in the definition and measurement of resilience. Future research should aim to better characterize resilience in BD by improving its assessment as a standardized element of clinical evaluation. This will provide a basis for strategies to reduce the burden of this chronic condition.

INTRODUCTION:A discrepancy between current cognitive performance and premorbid IQ may indicate cognitive decline and relate to poorer psychosocial functioning in bipolar disorder, even when cognition appears unimpaired by standard norms. This study examined how objective cognition and IQ-cognition discrepancy relate to psychosocial functioning in older age bipolar disorder (OABD). METHODS:OABD underwent neurocognitive assessment, intelligence quotient (IQ) estimation (using vocabulary subtest of WAIS-III), and psychosocial functioning assessment via the Functioning Assessment Short Test (FAST). IQ-cognition discrepancy scores were calculated as the difference between current cognitive performance and estimated premorbid IQ (range: -10 to +10; negative values indicating possible cognitive decline). Linear regressions examined associations between cognition, discrepancy score, and psychosocial functioning. Discriminant analyses evaluated the ability of these scores to predict functional impairment. RESULTS:The sample included 165 participants (116 OABD and 49 healthy controls). Poorer cognitive performance was significantly associated with worse psychosocial functioning (β = -3.38, p = .002). Greater IQ-cognition discrepancy also predicted worse functioning (β = -0.92, p = .04), though cognitive performance showed a stronger association (β = -2.93, p = .017) and better discriminative ability for functional impairment (AUC = 0.75; cut-off = -0.4 SD; sensitivity = 0.69; specificity = 0.72) compared to discrepancy score (AUC = 0.64; sensitivity = 0.39; specificity = 0.87). CONCLUSIONS:IQ-cognition discrepancy may serve as a useful idiographic marker of functional impairment in OABD, particularly for individuals with high premorbid IQ. Its use could enhance clinical decision-making and broaden inclusion in pro-cognitive intervention trials.

BACKGROUND: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. OBJECTIVE: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. METHODS: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. RESULTS: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. CONCLUSION: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.

OBJECTIVES:Valid measures of psychosocial outcomes in older adults with bipolar disorder (OABD) are needed for clinical and research purposes. This study aimed to validate the Spanish version of the Functioning Assessment Short Test for Older Adults (FAST-O), the first instrument specifically developed to assess psychosocial functioning in OABD. METHODS:We investigated the scale's psychometric properties in terms of internal consistency (reliability), concurrent validity (Spearman correlation), discriminant validity (ROC curve and OABD vs healthy controls -HCs-), and construct validity (internal structure) in a sample of fully or partially remitted patients with OABD (n = 118) and HCs (n = 118) coming from a multi-site observational study. Participants were assessed with the FAST-O and additional clinical and cognitive measures. The Social and Occupational Functioning Assessment Scale (SOFAS) was used to assess concurrent validity. We also examined differences in FAST-O scores between fully euthymic and subsyndromal patients. RESULTS:The FAST-O had an excellent internal consistency (Cronbach's α = 0.91), was moderately correlated with the SOFAS (σ = -0.49, p < .001), and had a good discriminant capacity value (AUC ROC = 0.86 95 % CI [0.81, 0.91]). Significant differences were observed between OABD and HCs in the FAST-O, with OABD displaying significantly higher psychosocial impairment in global and domain scores. The internal structure was similar to the internal structure of the original FAST-O. CONCLUSIONS:The Spanish version of the FAST-O showed good psychometric properties, and was valid and reliable for measuring psychosocial outcomes in OABD. The FAST-O should be implemented in clinical and research settings and cognitive treatment trials.

INTRODUCTION:Bipolar disorder (BD) and schizophrenia (SZ) are serious mental illnesses (SMI) with overlapping symptoms but distinct differences in onset and course. Sex differences are an area of growing interest in SMI. This study aims to examine potential interactions between sex and diagnosis across a broad range of variables, to compare males and females within SZ and BD, and to investigate sex-specific group differences. METHODS:A total of 1516 individuals were included in a cross-sectional study using baseline data from the multicenter PsyCourse Study, including BD (n = 543), SZ (n = 517), and healthy controls (HC) (n = 456). Sociodemographic characteristics, clinical symptoms, psychosocial functioning, quality of life, neurocognitive performance, and somatic comorbidities were assessed. Generalized linear models were used to analyze differences between groups and sexes. False Discovery Rate (FDR) and Bonferroni post hoc comparisons were performed. RESULTS:Significant interactions were identified in age (p = 0.001), age at treatment (p = 0.05), illness duration (p = 0.03), illicit drug use (p = 0.01), and smoking (p = 0.05). Differences in substance use were observed across groups and sexes, with the highest rates found in males with SZ. The BD group showed better functioning and neurocognitive performance compared with the SZ group. Within the BD group, females reported better performance in verbal memory (p = 0.003) and psychomotor speed (p < 0.001) than males. Moreover, both females and males with SMI showed higher rates of thyroid alterations compared with HC (p = 0.01 for females and p = 0.002 for males). CONCLUSIONS:Significant sex differences were observed in substance use and somatic comorbidities. Interactions between diagnosis and sex underscore the importance of considering both factors in clinical assessments. These findings highlight the need to tailor sex-specific treatment for each patient. Further research is needed to explore the role of sex hormones and other biological and societal factors in the presentation and course of these disorders.

Bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) are chronic psychiatric conditions with significant impacts on neurocognitive and psychosocial functioning. Co-occurrence of BD and ADHD (BD-ADHD) presents unique clinical challenges and could exacerbate cognitive and functional impairments. This systematic review and meta-analysis aimed to provide an updated synthesis of the differences in neurocognitive and psychosocial functioning between patients with BD-ADHD, BD, ADHD, and healthy controls (HC). A comprehensive systematic search identified 5639 records, with 34 studies meeting the inclusion criteria for a systematic review and 31 for the meta-analysis. There were no significant differences in cognitive performance across none of the evaluated cognitive domains between BD-ADHD and BD patients. BD-ADHD patients exhibited significantly lower visual memory (SMD=-0.29, 95 % CI=-0.53,-0.04; p = 0.022) compared to ADHD patients. Compared to HC, BD-ADHD patients showed poorer performance in processing speed (SMD=-0.54, 95 % CI= -0.86,-0.22; p < 0.001), sustained attention (SMD=-0.40, 95 % CI=-0.62, -0.19; p < 0.001), visual memory (SMD=-0.47, 95 % CI=-0.69,-0.26; p < 0.001), working memory (SMD=-0.79, 95 % CI=-1.13,-0.44; p < 0.001), cognitive flexibility and higher-order executive functions (SMD=-0.52, 95 % CI=-0.84,-0.20; p = 0.001), and verbal memory (SMD=-0.95, 95 % CI=-1.43,-0.47; p < 0.001). Psychosocial functioning was significantly worse in BD-ADHD patients compared to BD (SMD=-0.46; p < 0.001), ADHD (SMD=-1.00; p < 0.001), and HC (SMD=-3.54; p < 0.001). Our results suggest that the co-occurrence of BD and ADHD is associated with significant neurocognitive and psychosocial impairments. These findings underscore the need for targeted interventions to address the unique challenges of this comorbid condition, informing clinical practice and guiding future research.

Background: Several psychosocial interventions have shown promising effects in treating people affected by childhood maltreatment (CM); however, their comparative efficacy on social functioning remains largely unknown. To address this issue, a systematic review and network meta-analysis (NMA) will be conducted to investigate the comparative efficacy of different psychosocial interventions on global social functioning and specific domains of social functioning, including behavioural, emotional, cognitive and physiological processes. We aim to develop a hierarchical ranking of existing psychosocial interventions concerning their efficacy and acceptability which could inform treatment guidelines.Methods: Randomised controlled trials (RCTs) investigating psychosocial interventions for individuals with exposure to CM when they were younger than age 18 will be included. Primary outcomes will be global and domains of social functioning (measured up to 3, 6, 12 months and at the longest follow-up). Study drop-out will be a secondary outcome that will serve as a measure of acceptability. Study selection and data extraction will be performed by at least two independent reviewers. We will assess the risk of bias for each study using the Cochrane Risk of Bias tool 2 (RoB2) and evaluate the confidence in the results using Confidence in Network Meta-Analysis (CINeMA). The effects of potential moderators, such as age (children/adolescents vs. adults), population type (clinical vs. non-clinical samples), or sex (% males), socioeconomic status (low-income vs. middle-high-income countries), and intervention characteristics (individual vs. group training, number of sessions) will be analysed using subgroup-analyses or meta-regressions. Other candidate moderators/mediators (personality, post-traumatic symptoms, brain structure/function, cognitive reserve) will also be explored and narratively summarised. Sensitivity analyses will be conducted to explore further heterogeneity and assess the robustness of our findings.Discussion: This systematic review and NMA aims to compare multiple existing psychosocial interventions in individuals affected by CM and establish the relative rankings of these interventions for social functioning. Our results may provide practical guidance concerning the most effective psychosocial interventions to reduce the societal burden associated with CM.Protocol registration: PROSPERO CRD42022347034.

Introduction:Beyond mood abnormalities, bipolar disorder (BD) includes cognitive impairments that worsen psychosocial functioning and quality of life. These deficits are especially severe in older adults with BD (OABD), a condition expected to represent most individuals with BD in the upcoming years. Restoring the psychosocial functioning of this population will thus soon represent a public health priority. To help tackle the problem, the Bipolar and Depressive Disorders Unit at the Hospital Clínic of Barcelona has recently adapted its Functional Remediation (FR) program to that population, calling it FROA-BD. However, while scarce previous studies localize the neural mechanisms of cognitive remediation interventions in the dorsal prefrontal cortex, the specific mechanisms are seldom unknown. In the present project, we will investigate the neural correlates of FR-OABD to understand its mechanisms better and inform for potential optimization. The aim is to investigate the brain features and changes associated with FROA-BD efficacy. Methods:Thirty-two individuals with OABD in full or partial remission will undergo a magnetic resonance imaging (MRI) session before receiving FR-OABD. After completing the FR-OABD intervention, they will undergo another MRI session. The MRI sessions will include structural, diffusion-weighted imaging (DWI), functional MRI (fMRI) with working memory (n-back) and verbal learning tasks, and frontal spectroscopy. We will correlate the pre-post change in dorsolateral and dorsomedial prefrontal cortices activation during the n-back task with the change in psychosocial functioning [measured with the Functioning Assessment Short Test (FAST)]. We will also conduct exploratory whole-brain correlation analyses between baseline or pre-post changes in MRI data and other clinical and cognitive outcomes to provide more insights into the mechanisms and explore potential brain markers that may predict a better treatment response. We will also conduct separate analyses by sex. Discussion:The results of this study may provide insights into how FROA-BD and other cognitive remediations modulate brain function and thus could optimize these interventions.

Older Adults with Bipolar Disorder (OABD) represent a heterogeneous group, including those with early and late onset of the disorder. Recent evidence shows both groups have distinct clinical, cognitive, and medical features, tied to different neurobiological profiles. This study explored the link between polygenic risk scores (PRS) for bipolar disorder (PRS-BD), schizophrenia (PRS-SCZ), and major depressive disorder (PRS-MDD) with age of onset in OABD. PRS-SCZ, PRS-BD, and PRS-MDD among early vs late onset were calculated. PRS was used to infer posterior SNP effect sizes using a fully Bayesian approach. Demographic, clinical, and cognitive variables were also analyzed. Logistic regression analysis was used to estimate the amount of variation of each group explained by standardized PRS-SCZ, PRS-MDD, and PRS-BD. A total of 207 OABD subjects were included (144 EOBD; 63 LOBD). EOBD showed higher PRS-BD compared to LOBD (p = 0.005), while no association was found between age of onset and PRS-SCZ or PRS-MDD. Compared to LOBD, EOBD individuals also showed a higher likelihood for suicide attempts (p = 0.01), higher presence of psychotic symptoms (p = 0.003), higher prevalence of BD-I (p = 0.002), higher rates of familiarity for any psychiatric disorder (p = 0.004), and lower processing speed measured with Trail-Making Test part A (p = 0.03). OABD subjects with an early onset showed a greater genetic burden for BD compared to subjects with a late onset. These findings contribute to the notion that EOBD and LOBD may represent different forms of OABD, particularly regarding the genetic predisposition to BD.

Objective: This study aimed to assess the relationship between childhood maltreatment (CM), objective and subjective cognition, and psychosocial functioning in adults with first-episode psychosis (FEP) by examining the moderating role of cognitive reserve (CR). A secondary objective was to explore whether unique CM subtypes (physical and/or emotional abuse, sexual abuse, physical and/or emotional neglect) were driving this relationship. Method: Sixty-six individuals with FEP (M-age = 27.3, SD = 7.2 years, 47% male) completed a comprehensive neuropsychological test battery, the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), the Functioning Assessment Short Test (FAST), the Childhood Trauma Questionnaire (CTQ), and the Cognitive Reserve Assessment Scale in Health (CRASH). Linear regression analyses were conducted to evaluate the interaction effect of CR between CM and cognitive and psychosocial variables, controlling for age, sex, and social desirability (CTQ-denial-minimization). Results: In adults with FEP overall CM interacted with CR to predict COBRA-subjective cognitive complaints, but not neurocognitive or psychosocial functioning. Sexual abuse and physical neglect interacted with CR to predict verbal memory. Most of the CM subtypes interacted with CR to predict FAST-leisure time, whereas only emotional neglect interacted with CR to predict FAST-interpersonal relationships. Overall, greater CR was related to better functioning. Conclusions: The current results indicate that associations between specific CM subtypes, subjective and objective cognition, and psychosocial domains are moderated through CR with greater functioning. Early interventions focused on CR seeking to improve cognitive and psychosocial outcomes, with emphasis on improving subjective cognitive functions would be beneficial for individuals with FEP and CM.

Background: Older adults with bipolar disorder (OABD) are individuals aged 50 years and older with bipolar disorder (BD). People with BD may have fewer coping strategies or resilience. A long duration of the disease, as seen in this population, could affect the development of resilience strategies, but this remains under-researched. Therefore, this study aims to assess resilience levels within the OABD population and explore associated factors, hypothesizing that resilience could improve psychosocial functioning, wellbeing and quality of life of these patients. Methods: This study sampled 33 OABD patients from the cohort at the Bipolar and Depressive Disorders Unit of the Hospital Clinic of Barcelona. It was an observational, descriptive and cross-sectional study. Demographic and clinical variables as well as psychosocial functioning, resilience and cognitive reserve were analyzed. Resilience was measured using the CD-RISC-10. Non-parametric tests were used for statistical analysis. Results: The average CD-RISC-10 score was 25.67 points (SD 7.87). Resilience negatively correlated with the total number of episodes (p = 0.034), depressive episodes (p = 0.001), and the FAST (p < 0.001). Participants with normal resilience had a lower psychosocial functioning (p = 0.046), a higher cognitive reserve (p = 0.026), and earlier onset (p = 0.037) compared to those with low resilience. Conclusions: OABD individuals may have lower resilience levels which correlate with more psychiatric episodes, especially depressive episodes and worse psychosocial functioning and cognitive reserve. Better understanding and characterization of resilience could help in early identification of patients requiring additional support to foster resilience and enhance OABD management.

Background: Older Adults with Bipolar Disorder (OABD) show cognitive impairments with a negative impact on psychosocial functioning and quality of life. However, to date any intervention for the improvement of functioning has been developed for OABD. The current project aims to demonstrate the efficacy of the Functional Remediation program (FR) specifically adapted to OABD, over 60 years old, for improving functional outcome. Methods: This is an experimental, randomized-controlled trial. Two groups will be included: the experimental group (n = 42) will receive a 4-month intervention consisting of 32 sessions of treatment and the control group which will receive treatment as usual (TAU) (n = 42). The intervention will result from the adaptation of the Functional Remediation program for OABD (FROA-BD), that has already proven its efficacy at improving psychosocial functioning in patients with bipolar disorder. Clinical, neuropsychological and functional evaluations will be carried out at baseline, post-intervention and follow-up (one year after baseline evaluation). We hypothesized that patients who have undergone the intervention FROA-BD will improve their psychosocial functioning, cognitive performance, quality of life and well-being. We also hypothesized that all these changes will remain stable after eight month follow-up. Conclusions: The results will provide evidence of the efficacy in improving psychosocial functioning, cognitive performance and quality of life applying the FROA-BD. This project consists in the first attempt to adapt the FR program to OABD population who needs specific needs and approaches. The novelty of this contribution represents an advance in the framework of psychological treatment in later-life bipolar disorder. (c) 2022 SEP y SEPB. Published by Elsevier Espa & ntilde;a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).