Introduction Healthy lifestyles are relevant to several diseases and to maintain individuals’ mental health. Exposure to epidemics and confinement have been consistently associated with psychological consequences, but changes on lifestyle behaviours remain under-researched. Materials and Methods An online survey was conducted among the general population living in Spain during the COVID-19 home-isolation. In addition to demographic and clinical data, participants self-reported changes in seven lifestyle domains. The Short Multidimensional Inventory Lifestyle Evaluation was developed specifically to evaluate changes during the confinement (SMILE-C). Results A total of 1254 individuals completed the survey over the first week of data collection. The internal consistency of the SMILE-C to assess lifestyles during confinement was shown (Cronbach's Alpha = 0.747). Most participants reported substantial changes on outdoor time (93.6%) and physical activity (70.2%). Moreover, about one third of subjects reported significant changes on stress management, social support, and restorative sleep. Several demographic and clinical factors were associated to lifestyle scores. In the multivariate model, those independently associated with a healthier lifestyle included substantial changes on stress management ( p < 0.001), social support ( p = 0.001) and outdoor time ( p < 0.001), amongst others. In contrast, being an essential worker ( p = 0.001), worse self-rated health ( p < 0.001), a positive screening for depression/anxiety ( p < 0.001), and substantial changes on diet/nutrition ( p < 0.001) and sleep ( p < 0.001) were all associated with poorer lifestyles. Conclusions In this study, sizable proportions of participants reported meaningful changes in lifestyle behaviours during the COVID-19 pandemic in Spain. Moreover, the SMILE-C was sensitive to detect these changes and presented good initial psychometric properties. Further follow-up studies should collect relevant data to promote healthy lifestyles in pandemic times.

Cardoso T. Risk of dementia in bipolar disorder and the interplay of lithium: a systematic review and meta-analyses.Objectives: To assess whether bipolar disorder (BD) increases the rate of dementia and whether lithium is related to a lower risk of dementia in BD. Methods: A total of 10 studies (6859 BD; 487 966 controls) were included in the meta-analysis to test whether BD is a risk factor for dementia. In addition, five studies (6483 lithium; 43 496 non-lithium) were included in the meta-analysis about the potential protective effect of lithium in BD. Results: BD increases the risk of dementia (odds ratio (OR): 2.96 [95% CI: 2.09-4.18], P < 0.001), and treatment with lithium decreases the risk of dementia in BD (OR: 0.51 [95% CI: 0.36-0.72], P < 0.0001). In addition, secondary findings from our systematic review showed that the risk of progression to dementia is higher in BD than in major depressive disorder (MDD). Moreover, the number of mood episodes predicted the development of dementia in BD. Conclusion: Individuals with BD are at higher risk of dementia than both the general population or those with MDD. Lithium appears to reduce the risk of developing dementia in BD.• The diagnosis of bipolar disorder increases the risk to develop dementia almost three-fold.• Treatment with lithium decreased the risk for dementia by 49% in individuals with bipolar disorder compared to controls/non-lithium treated people with BD.• Dementia can be seen as an endpoint of bipolar disorder staging model. Limitations• There is a possibility that publication bias may have potentially inflated our results.• The majority of the evidence comes from registry-based studies that have several limitations such as data collection, reliability of diagnosis, selection bias, and confounders.• Additional studies are needed to understand the pathophysiology of BD that leads to cognitive deterioration, brain abnormalities, and to the development of dementia. 510

Background Essential workers have been shown to present a higher prevalence of positive screenings for anxiety and depression during the COVID-19 pandemic. Individuals from countries with socioeconomic inequalities may be at increased risk for mental health disorders. Objective We aimed to assess the prevalence and predictors of depression, anxiety, and their comorbidity among essential workers in Brazil and Spain during the COVID-19 pandemic. Methods A web survey was conducted between April and May 2020 in both countries. The main outcome was a positive screening for depression only, anxiety only, or both. Lifestyle was measured using a lifestyle multidimensional scale adapted for the COVID-19 pandemic (Short Multidimensional Inventory Lifestyle Evaluation–Confinement). A multinomial logistic regression model was performed to evaluate the factors associated with depression, anxiety, and the presence of both conditions. Results From the 22,786 individuals included in the web survey, 3745 self-reported to be essential workers. Overall, 8.3% (n=311), 11.6% (n=434), and 27.4% (n=1027) presented positive screenings for depression, anxiety, and both, respectively. After adjusting for confounding factors, the multinomial model showed that an unhealthy lifestyle increased the likelihood of depression (adjusted odds ratio [AOR] 4.00, 95% CI 2.72-5.87), anxiety (AOR 2.39, 95% CI 1.80-3.20), and both anxiety and depression (AOR 8.30, 95% CI 5.90-11.7). Living in Brazil was associated with increased odds of depression (AOR 2.89, 95% CI 2.07-4.06), anxiety (AOR 2.81, 95%CI 2.11-3.74), and both conditions (AOR 5.99, 95% CI 4.53-7.91). Conclusions Interventions addressing lifestyle may be useful in dealing with symptoms of common mental disorders during the strain imposed among essential workers by the COVID-19 pandemic. Essential workers who live in middle-income countries with higher rates of inequality may face additional challenges. Ensuring equitable treatment and support may be an important challenge ahead, considering the possible syndemic effect of the social determinants of health.

Recent studies have evaluated the role of brain-derived neurotrophic factor (BDNF) in mood disorders; however, little is known about alterations in nerve growth factor (NGF) and glial cell line-derived neurotrophic factor (GDNF). The aim of this study was to evaluate differences among serum neurotrophic factors (BDNF, NGF and GDNF) in depressed patients and healthy controls and to verify the association between serum neurotrophic levels and clinical characteristics in a young, depressed population stratified by gender. This is a cross-sectional study with depressed patients and population controls 18-29 years of age. The concentrations of neurotrophic factors were determined by the ELISA method. The diagnosis of depression and the duration of the disease were assessed by the Structured Clinical Interview according to the diagnostic and statistical manual of mental disorders. Depression severity was measured with the 17-item Hamilton Rating Scale for Depression, and the severity of anxiety symptoms was measured using the Hamilton Anxiety Rating Scale. Serum BDNF and GDNF were lower in major depressive disorder (MDD) patients compared to controls (p ≤ 0.001). Serum NGF levels were higher in MDD patients versus controls (p ≤ 0.001). BDNF was associated with the duration of disease only in women (p = 0.005). GDNF was not associated with clinical characteristics in either gender. In women, NGF was associated with the severity of depressive symptoms (p = 0.009), anxiety (p = 0.011) and disease duration (p = 0.005). NGF was associated with disease duration in men (p = 0.026). Our results demonstrated that significant neurochemical differences in NGF and BDNF, but not in GDNF, were associated with the clinical features of MDD when patients were stratified by gender.

Major depressive disorder (MDD) is a debilitating disorder and its pathophysiology is associated with deregulation of the immune system. We investigated the changes in circulating levels of proinflammatory cytokines (specifically IL-6 and TNF-α) measured by the ELISA kit in two psychotherapeutic interventions for MDD: Narrative Cognitive Therapy (NCT) and Cognitive Behavioral Therapy (CBT). This is a randomized clinical trial including 97 individuals (18 to 29years-old) with MDD. In CBT there was a significant difference in serum levels of IL-6 and TNF-α, therefore indicating that CBT was more effective than NCT on serum levels proinflammatory cytokines.