Objective:This meta-analysis provides a quantitative synthesis of associations between reward sensitivity and morningness-eveningness and other circadian-coupled behaviors. The circadian system, which generates patterns of preferences and behaviors such as morningness-eveningness, social jetlag, and rest-activity rhythms, is linked to health outcomes. Reward sensitivity encompasses a trait-level tendency to be motivated by/respond to rewarding stimuli, which is a known risk factor for psychopathology. Theoretical and empirical support suggest these systems work together synergistically, and their interaction uniquely contributes to the onset/course of health conditions, including mood and substance use disorders, beyond the impact of each system independently. This review evaluates the strength of the association between circadian-coupled behavior and reward sensitivity. Methods:A systematic literature search (7/11/2025) was conducted in two databases (MEDLINE/PsycINFO), followed by a two-step screening process. Pooled effects and publication bias estimates were calculated. Results:Most included studies assessed the association between morningness-eveningness and reward sensitivity, which had a nonsignificant pooled effect. In clinical samples, eveningness displayed a moderate positive association with reward sensitivity (null in community samples). The association between morningness-eveningness and reward sensitivity differed by reward sensitivity measure. Social jetlag had a small negative pooled effect and social rhythm disruption had a moderate positive pooled effect. Discussion:Associations between morningness-eveningness and reward sensitivity (k=17) are minimal and heterogeneous, but meaningful effects appear in clinical samples. For social jetlag (k=3) and social rhythm disruption (k=3), the pattern of associations with reward sensitivity is variable. Future directions include prioritization of objective circadian measures, longitudinal designs, and multimodal measurement to clarify mechanisms.

Background Risk of new episodes is a constant concern for people living with bipolar disorder (BD). Research into sleep and circadian rhythm disruption (SCRD) suggests that relapse risk may be measurable in 24-hour rest-activity rhythms (RAR) via actigraphy. The primary aim of the Tipping Point project is to develop an algorithm forecasting relapse based on RAR. A secondary aim is to explore SCRD mechanisms linking RAR to mood dynamics in BD. The mechanistic investigation involves analysis of biological correlates of RAR, and exploration of system instability as a predictor of two types of state transition (relapse and recovery). Method Three prospective studies will enrol adults living with BD I or II. Study 1 (Australia) recruits N = 100 individuals with interepisode BD who will undergo three contiguous 26-week monitoring epochs. Each epoch commences with 14 days of actigraphy, followed by retrospective interviews at 13 and 26 weeks. RAR predictors of time to first relapse will be explored using three computational frameworks - statistical risk, probabilistic network graphs and non-linear dynamic models. Study 2 (India) replicates one of the 26-week epochs of Study 1, recruiting 25 individuals with BD and 25 matched healthy controls. Study 2 investigates the replicability of models identified in Study 1 and tests the mechanistic association between amplitude of the RAR and amplitude of clock gene expression. Study 3 (New Zealand) explores system instability as a mechanism, by investigating whether complex system indicators of relapse risk (from Study 1) also forecast recovery from acute episodes. In Study 3, actigraphy data will be collected from people experiencing a severe episode of BD depression (N = 30) or mania (N = 15). Discussion The Tipping Point project uses a multi-study design to develop a mechanistically-informed predictive algorithm for relapse risk in BD.

Background Risk of new episodes is a constant concern for people living with bipolar disorder (BD). Research into sleep and circadian rhythm disruption (SCRD) suggests that relapse risk may be measurable in 24-hour rest-activity rhythms (RAR) via actigraphy. The primary aim of the Tipping Point project is to develop an algorithm forecasting relapse based on RAR. A secondary aim is to explore SCRD mechanisms linking RAR to mood dynamics in BD. The mechanistic investigation involves analysis of biological correlates of RAR, and exploration of system instability as a predictor of two types of state transition (relapse and recovery). Method Three prospective studies will enrol adults living with BD I or II. Study 1 (Australia) recruits N = 100 individuals with interepisode BD who will undergo three contiguous 26-week monitoring epochs. Each epoch commences with 14 days of actigraphy, followed by retrospective interviews at 13 and 26 weeks. RAR predictors of time to first relapse will be explored using three computational frameworks - statistical risk, probabilistic network graphs and non-linear dynamic models. Study 2 (India) replicates one of the 26-week epochs of Study 1, recruiting 25 individuals with BD and 25 matched healthy controls. Study 2 investigates the replicability of models identified in Study 1 and tests the mechanistic association between amplitude of the RAR and amplitude of clock gene expression. Study 3 (New Zealand) explores system instability as a mechanism, by investigating whether complex system indicators of relapse risk (from Study 1) also forecast recovery from acute episodes. In Study 3, actigraphy data will be collected from people experiencing a severe episode of BD depression ( N = 30) or mania ( N = 15). Discussion The Tipping Point project uses a multi-study design to develop a mechanistically-informed predictive algorithm for relapse risk in BD.

Semi-automated tools used during the preliminary screening of articles in systematic reviews can start with a small set of seed articles and actively learn from human decisions to prioritise more relevant articles for subsequent screening. However, given that these tools are vulnerable to biases and lack clear stopping criteria, their performance in large-scale systematic reviews remains uncertain, especially in reviews covering broad subject areas that require a substantial number of representative seed articles. This article presents a hybrid approach that uses text-mining techniques combined with a semi-automated tool to effectively reduce, screen, and validate a large cohort of articles (N = 90,871). A preliminary evaluation using simulations indicated that this approach has the potential to craft a comprehensive collection of seed articles that covers broad subject areas for semi-automated tools in a large-scale systematic review. The strengths and limitations of using a semi-automated tool alone in such a context are discussed. Our approach increases the efficiency of automated tools by providing a larger and more focused selection of articles to start with, optimising the learning process for those tools and reducing biases. Additionally, our approach could increase the transparency and reusability of keywords for future review updates.

OBJECTIVES:Smartphone apps facilitate the dissemination of resources to help people with bipolar disorder (BD) implement self-management strategies. However, current apps do not address all treatment outcomes valued by people with BD, nor are they designed with scalability in mind. This study evaluated the feasibility and preliminary efficacy of an alpha version of the co-designed PolarUs app, a self-guided intervention developed to support quality of life (QoL) self-monitoring and self-management in BD. METHODS:North American residents with a confirmed diagnosis of BD used the iOS PolarUs app for 12 weeks. To assess feasibility, adherence rates were assessed, operationalized by completion of weekly in-app Brief Quality of Life in BD (QoL.BD) scores. Linear mixed modeling was used to test the hypothesis that QoL (primary outcome) would improve over the intervention period and explore secondary outcomes (i.e., mood symptoms, self-efficacy, subjective recovery, self-compassion). Hierarchical cluster analysis was used to investigate associations between app adherence and primary outcomes. RESULTS:In 170 participants (70% women, mean age 39 years SD = 12.1) there was a steady decline in app adherence over the intervention period, with 37% of participants completing their final weekly assessment. However, significant improvements were observed overall for QoL, mood symptoms, and self-compassion. Four distinct app adherence clusters were observed, displaying varying relationships with baseline QoL and trajectories of QoL improvement. CONCLUSIONS:Preliminary adherence and efficacy data for the PolarUs app are positive and demonstrate how the inclusion of lived experience perspectives in app development supports intervention acceptability and impact.

BACKGROUND:Research demonstrates the effectiveness of evidence-based psychological treatment adjunctive to pharmacotherapy for reducing mood symptoms in bipolar disorder. However, access to these treatments is limited, and innovative strategies are needed to ensure that more patients with bipolar disorder receive the gold-standard treatments that may help them achieve wellness. "Stepped care" models of psychological service delivery represent one potential solution to this problem of treatment access. Under a stepped care model, patients are assigned the minimum necessary psychological treatment for symptom improvement. This typically means that patients who are experiencing more symptoms are assigned to a treatment of greater intensity (e.g., weekly individual therapy) whereas patients who are experiencing fewer symptoms are assigned to a treatment of relatively lesser intensity (e.g., biweekly group therapy). Stepped care models are dynamic, meaning that the level of treatment can be modified depending on the patient's response. Stepped care models have been explored in other clinical populations but require further exploration in bipolar disorder. METHODS:Members of the Psychological Interventions Task Force for the International Society of Bipolar Disorders conducted a narrative review of stepped care models and their application to bipolar disorder. RESULTS:We found evidence that stepped care models are useful approaches to delivering psychosocial treatments for bipolar disorder. We discuss several contextual factors in executing stepped care models in this population (i.e., cultural and pediatric applications), as well as share an example of a stepped care model-Focused Integrated Team-based Treatment for Bipolar Disorder (FITT-BD)-that is currently being evaluated in an academic medical center. CONCLUSION:Further research is warranted to develop and assess robust stepped care models to determine whether they can improve access to treatment of bipolar disorder while not sacrificing outcomes.

Lithium remains a cornerstone in bipolar disorder treatment, yet a narrow therapeutic index and variable patient response hinder its clinical use. The timing of lithium administration, a potentially crucial determinant of efficacy and safety, has been largely overlooked. Here we highlight the bidirectional relationship between lithium and the circadian system: lithium alters molecular clocks, while circadian rhythms influence the pharmacokinetics, pharmacodynamics and side effects profile of lithium. An evaluation of clinical studies of lithium treatment in bipolar disorder over the last 50 years reveals that nearly 90% of reports do not mention lithium administration timing, and none directly assess its impact. We propose that aligning lithium dosing with individual circadian patterns and biological rhythms could improve therapeutic outcomes and reduce toxicity. Drawing from chronobiology, pharmacology and transcriptomic evidence, we advocate for integrating chronotherapeutic strategies into future lithium trials. This approach offers a timely direction to enhance precision psychiatry and mood disorder management. In this Perspective, Ray and colleagues review 50 years of studies on the effectiveness and toxicity of lithium and argue that its effects depend on dosing time. They propose circadian-aligned lithium dosing to improve safety and outcomes in bipolar disorder.

Our objective was to systematically review the epidemiological evidence regarding health effects of daylight-saving time (DST) practices – the abolition of which have been called for without the epidemiology having been comprehensively reviewed. We searched PubMed, Web of Science, Scopus, PsychINFO, and EconLit up to June 2025. The primary inclusion criterion was human studies that consider either acute effects of transitions or DST vs standard time at a given time of year. Included studies were critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies. We narratively synthesize by broader outcome categories in Supplementary Material and provide a synthesis of syntheses in the main text. From 157 studies of varying designs and quality from 36 countries, we find that the messaging of transitions and DST during summer months being uniformly detrimental is not supported. DST-Onset transitions appear associated with increased acute myocardial infarction and fatal traffic accidents, but also with decreased crimes involving physical harm. DST-Offset transitions appear associated with decreased all-cause mortality and workplace accidents, but also with increased crimes involving physical harm. Living with DST (compared to Standard Time) appears associated with decreased all-cause mortality and traffic accidents in summer. Standard Time appears is potentially associated with decreased sleep duration during winter. No clear and consistent effects on psychiatric outcomes are identified. Limited studies prevent clear conclusions being drawn regarding other sleep parameters or circadian rhythms. This review indicates that transitions and living with DST (as opposed to Standard Time) during summer months are not uniformly detrimental; however, the evidence base remains limited and heterogeneous. Rather than advocating for maintaining or removing transitions, our synthesis supports a balanced approach. We recommend recognising both adverse and beneficial patterns and prioritising strategies to mitigate risks while awaiting more robust evidence. Registration https://doi.org/10.17605/OSF.IO/R4W6M

To systematically review and narratively synthesize the epidemiological evidence regarding health effects of Daylight-Saving Time (DST) practices. Peer-reviewed, primary research of humans published in English or German and that assessed either (i) health effects of transitions (we allowed up to one month as the index period), or (ii) health differences between living with DST vs Standard Time at a given time of year, or (iii) or health effects of living at the same latitude but different longitude within the same time zone were included. Eligible health effects were broadly categorised as all-cause mortality, accident (traffic/workplace/home/substance-related)-, cardiovascular-, gastrointestinal, immunologic-, psychiatric-, neurologic-, circadian and sleep-, and cognitive-related outcomes, as well as healthcare appointments/admissions. Adverse and beneficial effects were included. PubMed, Web of Science Core Collection, Scopus, PsychINFO, and EconLit were systematically searched in March 2023 and then updated to June 2025. Studies were organised by outcomes into the following categories: (1) cardiovascular, (2) psychiatric, (3) traffic accidents, (4) non-traffic accidents (e.g., workplace), (5) sleep and circadian, (6) cognitive, and (7) neurological and gastrointestinal and all-cause mortality, and narratively synthesised by at least two authors. Some studies were included under multiple categories. Synthesis conclusions were based on quality and quantity of studies. Next, a synthesis of the syntheses was written and confidence in validity of outcomes was illustrated with agreement from all authors. The authorship team included expertise in sleep and chronobiology with additional expertise in physiology, psychiatry, neuroscience, and epidemiology. Critical appraisal was independently conducted by at least two authors using the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies, with studies categorized as low, medium, or high quality. Narrative syntheses of studies identified additional strengths and limitations. N=157 studies of diverse designs and varying quality from 36 different countries were identified. Exact participant numbers cannot be determined as many studies utilised nationwide databases/registries or included DST-associated assessments as either secondary objectives or as one part of a main objective (e.g., sleep assessment across a year). Nonetheless, the participant pool can be considered substantial. DST-Onset transitions appear associated with increased acute myocardial infarction (17 studies, 6 high quality) and fatal traffic accidents (16 studies, 4 high quality) but decreased crimes involving physical harm (5 studies, 3 high quality). DST-Offset transitions appear associated with decreased all-cause mortality (3 studies, 1 high quality) and workplace accidents (8 studies, 2 high quality), but increased crimes involving physical harm. Living with DST (as opposed to Standard Time) is associated with decreased all-cause mortality and traffic accidents in summer, the latter only tested during initial months (2 high quality studies), and possibly sleep duration during winter (2 low quality studies). No studies identify clear effects on psychiatric outcomes (15 studies, 1 high quality). Apart from DST-Offset associations with increased sleep duration (22 studies, 2 high quality), limited studies prevent clear conclusions being drawn regarding sleep duration for other periods or regarding the timing of sleep onset and offset or regarding circadian rhythm disruptions (6 studies, 0 high quality). What this review shows (including outcome-specific detrimental effects, null effects, and beneficial effects of transitions and of living with DST compared to Standard Time during summer months) is that the evidence does not support the messaging of transitions and DST during summer months being uniformly detrimental. The potential benefits of DST during summer on mortality and traffic accidents and of DST-Offset transitions on sleep, mortality, and work place accidents present an argument for maintaining transitions (from a health perspective) and for identifying mitigation strategies against adverse effects, at least for now, until further research suggests otherwise. https://doi.org/10.17605/OSF.IO/R4W6M

Background: Whether to maintain biannual time transitions or adopt perennial daylight-saving time (DST) or Standard Time is widely debated but health impacts have not been comprehensively reviewed. Method: Five literature databases were screened to September 01, 2024. Effects of transitions and living with DST or Standard Time on all-cause mortality, accidents, cardiovascular-, gastrointestinal-, psychiatric-, neurologic-, cognitive-, and circadian- or sleep-related outcomes were included. The Joanna Briggs Institute's Checklist for Quasi-Experimental Studies was used to assess quality. Findings: N=149 studies of various designs, locations (36 countries), and quality were identified. The evidence suggests DST-Onset transitions increase risk of acute myocardial infarction (17 studies, 5 high quality) and fatal traffic accidents (14 studies, 3 high quality) but decrease crimes involving physical harm (5 studies, 3 high quality). By contrast, DST-Offset transitions are associated with decreased all-cause mortality (3 studies, 1 high quality), fatal traffic accidents, and workplace accidents (8 studies, 1 high quality), but increased crimes involving physical harm. DST-Onset is only observed to affect sleep duration in individuals with early school or work start times, whereas DST-Offset appears to increase duration (17 studies, 2 high quality). Sleep timing shifts of <1-hour following transitions may occur, but are not indicative of circadian disruption. No studies clearly identify effects on psychiatric outcomes (15 studies, 1 high quality) or circadian rhythm disruptions (7 studies, 0 high quality). Living with DST during summer and winter is associated with decreased all-cause mortality and sleep duration, respectively (2 studies, 1 high quality). Interpretation: Benefits of DST during summer on mortality, of DST-Offset transitions on sleep and mortality, and of Standard Time during winter on sleep argue in favour of maintaining transitions. Adverse effects of transitions could be mitigated by strategies to protect individuals at risk of myocardial infarction, reduce traffic accidents, and prevent crimes. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No funding was received for this study. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All extracted data is provided in the main text and appendix.

The International Society for Bipolar Disorders (ISBD) Chronobiology and Chronotherapy Task Force conducted a comprehensive review to deliver concise evidence-based recommendations on the use of bright light therapy (BLT) for bipolar disorder (BD). Adjunctive BLT is likely an efficacious acute treatment for bipolar depression as implicated by higher quality evidence. The position of maintenance BLT for relapse prevention awaits further investigation. Protocols of effective BLT in BD are similar to parameters indicated for treatment of seasonal and non-seasonal major depressive disorder. Anti-manic prophylaxis (especially for BD-I) and clinical monitoring are recommended with initiation of and ongoing light treatment. Administer BLT daily, preferably in the morning or at mid-day. If mornings are prohibitive, then mid-day exposure, implemented to avoid excessively early wake times, is an acceptable alternative. Informed by the literature, target 30 min/day of BLT exposure. Patients wary of emergent hypomania or partial responders, can initiate 15 min/day and increase by 15 min each week to full response (or 30-60 min/day by the fourth week). Consider patient centred outcome assessments to evaluate mood response, safety and side effects. Clinical improvement is typically observed within 1-2 weeks, with response/remission expected by 4-6 weeks. Integration of BLT with other chronotherapeutic strategies may enhance long-term efficacy.

People impacted by bipolar disorder are confronted by many unmet needs that contribute to the overall burden associated with the disorder. We do not have a good understanding of the underlying pathology of bipolar disorder, so we do not have biomarkers to accurately identify those who are at risk of developing the disorder. Delayed diagnosis is the norm, and it can take a decade or more for an individual to receive a diagnosis and to start appropriate treatment. We have evidence-based treatments such as lithium and psychosocial therapies; however, their availability and use are limited. We need a consolidated approach to advance indicated prevention and early intervention for bipolar disorder. In this viewpoint article, we describe these barriers in detail as well as introduce international and national work that is being done to progress the field. At the national level, we introduce the National Health and Medical Research Council Centre for Research Excellence in Bipolar Disorder. The Centre for Research Excellence in Bipolar Disorder comprises a multidisciplinary team of experts from Australia and internationally who are working together to develop a better understanding of opportunities for indicated prevention and early intervention as well as to improve interventions for those impacted by the disorder. Here we describe our research framework, stakeholder engagement activities and strategies for workforce development and capacity building. Ultimately by working together we will attempt to address many of issues faced by individuals impacted by bipolar disorder.

Preliminary evidence suggests that classic psychedelics may exert lasting positive effects on individuals' mood, cognition, and personality, but little is known about how these effects may differ across the lifespan. Emerging adulthood (18-29) is a critical developmental stage in which individuals transition from dependence on community institutions toward full independence. It is a time when psychedelic experimentation is common, and psychedelics could have distinctive psychological impacts during this phase, although the developmental significance of such effects remains largely untested. This integrative review offers a framework to generate hypotheses regarding possible ways that psychedelic use may positively interact with emerging adult development. Here, we review pathways by which classic psychedelics may facilitate emerging adults' positive orthogenetic, veridical-epistemic, eudaimonic, relational, and ethical developmental trajectories through changes in personality trait openness, belief systems, self-insight, and social concern. Finally, we offer future research directions and discuss key challenges for research into studying the developmental impact of classic psychedelic use in emerging adulthood.

Research publications addressing the Sustainable Development Goals (SDGs) have grown exponentially, reflecting an increasing global focus on sustainability challenges. However, linking these publications to relevant SDGs remains a time-consuming and non-trivial task due to the broad scope and interconnected nature of the goals. This study aims to improve the efficiency and accuracy of mapping publications to SDGs using automated methods. Specifically, we investigate the performance of a domain-adapted similarity measure compared to OpenAI's GPT-3.5 Turbo and GPT-4 models. Using a dataset of over 82,000 research publications from an Australian university, we apply the similarity measure to assign SDG tags and benchmark the results against outputs from the two GPT models. Our findings show that the similarity-based method achieves comparable performance, with successful classification rates of 82.89% (GPT-3.5) and 89.34% (GPT4), respectively. The proposed approach provides a reliable, transparent, and cost-effective solution for large-scale SDG classification, particularly valuable for institutions handling sensitive data or lacking access to commercial AI tools. This work provides a practical and reliable approach to help institutions track how their research contributes to the United Nations Sustainable Development Goals.