Objectives We conducted a randomized, controlled trial comparing the efficacy of an Integrated Risk Reduction Intervention (IRRI) to a control condition with the objective of improving mood stability and psychosocial functioning by reducing cardiometabolic risk factors in overweight/obese patients with bipolar I disorder. Methods A total of 122 patients were recruited from our outpatient services and randomly allocated to IRRI (n = 61) or psychiatric care with medical monitoring (n = 61). Individuals allocated to IRRI received psychiatric treatment and assessment, medical monitoring by a nurse, and a healthy lifestyle program from a lifestyle coach. Those allocated to the control condition received psychiatric treatment and assessment and referral, if indicated, for medical problems. A mixed-effects model was used to examine the impact of the interventions on body mass index (BMI). Exploratory moderator analyses were used to characterize those individuals likely to benefit from each treatment approach. Results Analyses were conducted on the IRRI (n = 58) and control (n = 56) participants with ≥ 1 study visit. IRRI was associated with significantly greater rate of decrease in BMI (d = −0.51, 95% confidence interval: −0.91 to −0.14). Three variables (C-reactive protein, total cholesterol, and instability of total sleep time) contributed to a combined moderator of faster decrease in BMI with IRRI treatment. Conclusions Overweight/obese patients with bipolar disorder can make modest improvements in BMI, even when taking medications with known potential for weight gain. Our finding that a combination of three baseline variables provides a profile of patients likely to benefit from IRRI will need to be tested further to evaluate its utility in clinical practice.

Objective Two-generation studies demonstrate that treating maternal depression benefits school-age children. Although mothers prefer psychotherapy to medication, little is known about how psychotherapy for maternal depression affects offspring, especially in very high-risk families wherein both mothers and children concurrently meet syndromal criteria for psychiatric disorders. This trial evaluated effects of two brief psychotherapies for maternal depression on very high-risk families. Method Mothers with major depressive disorder were randomly assigned to nine sessions of either brief interpersonal psychotherapy for mothers (IPT-MOMS; n=85) or brief supportive psychotherapy (BSP; n=83). Independent assessors evaluated mothers and their children, ages 7-18, diagnosed with at least one internalizing disorder, every three months over one year. Results Symptoms and functioning of mothers and children improved significantly over time, with no between-group differences. However, children of mothers assigned to BSP had more outpatient mental health visits and were more likely to receive antidepressant medication. Mothers reported greater satisfaction with IPT-MOMS than BSP. Improvement in mothers’ depressive symptoms was associated with improvement in child functioning in time-lagged fashion, with children improving 3-6 months after mothers improved. Antidepressant medication use and number of mental health visits received by children did not affect outcomes. Conclusion IPT-MOMS and BSP demonstrated comparable beneficial effects on maternal depression. Children's functioning improved following maternal improvement, independent of youth's treatment. Children of mothers randomized to IPT-MOMS, compared to BSP, achieved comparable outcomes despite less follow-up treatment. Observation of lagged association between maternal improvement and change in child functioning should influence treatment planning for families.

This paper focuses on the relationship between the circadian system and glucose metabolism. Research across the translational spectrum confirms the importance of the circadian system for glucose metabolism and offers promising clues as to when and why these systems go awry. In particular, basic research has started to clarify the molecular and genetic mechanisms through which the circadian system regulates metabolism. The study of human behavior, especially in the context of psychiatric disorders, such as bipolar disorder and major depression, forces us to see how inextricably linked mental health and metabolic health are. We also emphasize the remarkable opportunities for advancing circadian science through big data and advanced analytics. Advances in circadian research have translated into environmental and pharmacological interventions with tremendous therapeutic potential.

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Cognitive Bias Modification for anxious interpretations (CBM-I) is a computerized training program designed to reduce threatening interpretations of ambiguous information. In addition to testing the efficacy of CBM-I for contamination fear on various cognitive outcomes and emotional vulnerability, the current study examined whether the content of CBM-I must match a person's fear domain to be efficacious, and examined the moderating role of preexisting interpretation bias on CBM-I's efficacy. Participants (n = 121) high in contamination fear were assigned to one session of either CBM-I focused on contamination fear content, CBM-I focused on height fear content, or a sham control condition. Planned contrasts indicated that fear domain match does tend to enhance CBM-I's effects: compared to the heights condition, those in the contamination training condition improved on five of the eight cognitive bias-related variables, though there was no change on measures of emotional vulnerability. In contrast, there was little difference between the heights training and sham conditions. Minimal evidence was found for baseline interpretation bias as a moderator. Results support the use of CBM-I that matches the fear domain of the participant, regardless of baseline bias level.