Psychiatric and Mental Health Commons^™

Ketamine As A Novel Treatment For Bipolar Disorder: Efficacy, Safety, And Future Directions, Sophia M. Valerino

Advances in Clinical Medical Research and Healthcare Delivery

Bipolar disorder is a complex mood disorder characterized by alternating episodes of depression and mania/hypomania, affecting approximately seven million people in the United States. Current pharmacological treatments include lithium, anticonvulsants, and second-generation antipsychotics, but these medications are often associated with significant side effects and poor adherence. Ketamine, a noncompetitive NMDA antagonist, has recently gained attention as a potential treatment for bipolar disorder due to its rapid antidepressant effects, particularly in treatment-resistant mood disorders. This article examines the therapeutic potential of ketamine for bipolar disorder, focusing on its mechanism of action and efficacy. Clinical studies have shown promising results, with ketamine …

A New Paliperidone Palmitate Formulation: How Is It Different And Where Does It Fit In Our Array Of Choices For Long-Acting Formulations Of Risperidone And Paliperidone?, Justin Faden, Leslie Citrome

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Long-acting injectable (LAI) antipsychotics have been shown to enhance treatment adherence and outcomes in individuals with schizophrenia, schizoaffective disorder, and bipolar disorder. In recent years, the U.S. Food and Drug Administration (FDA) has approved several LAIs with differing amenities of care, such as mode of administration, duration of oral medication supplementation, dosing frequency, needle gauge and size, and injection volume, amongst others. Additionally, several LAIs are distinct formulations of risperidone and paliperidone, making it difficult to distinguish between formulations, and many providers are unfamiliar with these newer agents. In 2024, a once-monthly LAI formulation of paliperidone palmitate, manufactured by Luye …

A 6-Month, Prospective, Randomized Controlled Trial Of Customized Adherence Enhancement Versus A Bipolar-Specific Educational Control In Poorly Adherent Adolescents And Young Adults Living With Bipolar Disorder, Jennifer B. Levin, Molly Mcvoy, Joy Yala, Jessica Black, Carla Conroy, Martha Sajatovic

Faculty Scholarship

Objective: Few studies have addressed medication adherence in adolescents and young adults (AYAs) with bipolar disorder (BD). This 6-month prospective randomized-controlled trial (RCT) tested customized adherence enhancement for adolescents and young adults (CAE-AYA), a behavioral intervention for AYAs versus enhanced treatment as usual (ETAU). Methods: Inclusion criteria were AYAs age 13–21 with BD type I or II with suboptimal adherence defined as missing ≥20% of medications. Assessments were conducted at Screening, Baseline, and weeks 8, 12 and 24. Primary outcome was past 7 day self-reported Tablets Routine Questionnaire (TRQ) validated by electronic pillbox monitoring (SimpleMed). Symptom measures included the Hamilton …

Increasing Medication Adherence In Patients With Bipolar Disorder Using Mobile App Reminder, Emmaculate Ndifor

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Background: Bipolar disorder (BD) is the fifth leading course of disability in the world, contributing to many co-morbid conditions and complications. Non-adherence to medication is prevalent in patients with BD. The aim of the project was to use an evidence-based technological intervention to enhance medication adherence in BD patients between 18- 65 years old at an outpatient behavioral health clinic.

Methods: Baseline assessment included a pre Morisky Medication Adherence (MMAS-4) questionnaire. The development of an intervention to improve medication adherence was based on Johnson’s (2002) Medication Adherence Model (MAM).

Interventions: Participants downloaded the Medisafe app, registered medications and set …

Demographic And Clinical Associations To Employment Status In Older-Age Bipolar Disorder: Analysis From The Gage-Bd Database Project, Amulya Mallu, Carol K. Chan, Kaylee Sarna, Joy Yala, Farren B.S. Briggs, Martha Sajatovic

Faculty Scholarship

Objective: The current literature on employment in older adults with bipolar disorder (OABD) is limited. Using the Global Aging and Geriatric Experiments in Bipolar Disorder Database (GAGE-BD), we examined the relationship of occupational status in OABD to other demographic and clinical characteristics. Methods: Seven hundred and thirty-eight participants from 11 international samples with data on educational level and occupational status were included. Employment status was dichotomized as employed versus unemployed. Generalized linear mixed models with random intercepts for the study cohort were used to examine the relationship between baseline characteristics and employment. Predictors in the models included baseline demographics, education, …

Illness Trajectory From Prodromal Symptoms To Incident Bipolar Disorder And Schizophrenia, Manuel A. Gardea Resendez, Javier Ortiz-Orendain, Brandon J. Coombes, Aysegul Ozerdem, Monica J. Taylor-Desir, Balwinder Singh, Alastair J. Mckean, Mark Frye

Research Symposium

Background: The concept of prodrome is highly variable but, when applied retrospectively in cohorts who progress to meet diagnostic criteria for bipolar disorder (BD) and schizophrenia (SZ), it can contribute to clarify early origins and trajectory of the illness. In the context of race and ethnicity, studies with population-based and registry-based cohorts, such as the Rochester Epidemiology Project (REP), can potentially identify, through retrospective assessment of the prodromes of BD and SZ, differences while addressing the heterogeneous nature of the illness.

Objective: We aim to describe and compare the illness trajectories of individuals with BD or SZ prior to the …

Bipolar Disorder In Children (Including Gifted And 2e Children), Ed Malin

Graduate Student Independent Studies

Between the publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 and the DSM-IV in 1993, 277 new disorders were created and made available for life-altering diagnoses. Should it be surprising that, since the late 1990s, psychiatrists in the United States have invented the diagnosis of Childhood-onset Bipolar Disorder? Common practice before that time (and still, in Europe) was that 18 was the earliest age of onset for Bipolar Disorder, based on extensive observation and family history. While lithium and anticonvulsants had been in use to treat adults with Bipolar Disorder, by the late 1990s children …

A Randomized Controlled Trial Of Customized Adherence Enhancement (Cae-E): Study Protocol For A Hybrid Effectiveness-Implementation Project, Jennifer B. Levin, Farren Briggs, Carol Blixen, Douglas Einstadter, Jeffrey M. Albert, Celeste Weise, Edna Fuentes-Casiano, Kristin A. Cassidy, Martha Sajatovic

Faculty Scholarship

Background: Mood-stabilizing medications are a cornerstone of treatment for people with bipolar disorder, though approximately half of these individuals are poorly adherent with their medication, leading to negative and even severe health consequences. While a variety of approaches can lead to some improvement in medication adherence, there is no single approach that has superior adherence enhancement and limited data on how these approaches can be implemented in clinical settings. Existing data have shown an increasing need for virtual delivery of care and interactive telemedicine interventions may be effective in improving adherence to long-term medication. Methods: Customized adherence enhancement (CAE) is …

Using Mhealth To Improve Adherence And Reduce Blood Pressure In Individuals With Hypertension And Bipolar Disorder (Itab-Cv): Study Protocol For A 2-Stage Randomized Clinical Trial, Jennifer B. Levin, Farren Briggs, Mahboob Rahman, Kurt C. Stange, Douglas Einstadter, Celeste Weise, Carla Conroy, Joy Yala, Ethan Radatz, Martha Sajatovic

Faculty Scholarship

Background: Cardiovascular disease in individuals with mental health conditions such as bipolar disorder is highly prevalent and often poorly managed. Individuals with bipolar disorder face significant medication adherence barriers, especially when they are prescribed multiple medications for other health conditions including hypertension. Poor adherence puts them at a disproportionate risk for poor health outcomes. As such, there is a need for effective interventions to improve hypertension medication adherence, particularly in patients that struggle with adherence due to mental health comorbidity. Methods: This 5-year project uses a 2-stage randomized controlled trial design to evaluate a brief, practical adherence intervention delivered via …

The Use Of Violin Family Instruments In Music Therapy With Individuals Experiencing Acute Psychiatric Presentations: A Literature Review, Brianna Rzeznik

Expressive Therapies Capstone Theses

This literature review seeks to better understand the unique ways in which the four contemporary violin family instruments - violin, viola, cello, and double bass - can be used in music therapy with individuals experiencing mania, psychosis, and dissociation. In this paper, I explore the ways in which these four instruments have been used throughout Western music history and the different roles assigned to them by composers, as well as the ways in which they are used in music therapy today. I then explore the acute psychiatric presentations of mania, psychosis, and dissociation, and the treatments and goals that tend …

The Rhythm Of Your Life: The Effects Of Daily Routine On Mental Health, Kristen Brown

Graduate Research Projects

No abstract provided.

Bipolar I And Bipolar Ii Subtypes In Older Age: Results From The Global Aging And Geriatric Experiments In Bipolar Disorder (Gage-Bd) Project, Farren Briggs, Martha Sajatovic, Kaylee Sarna, Joy Yala

Faculty Scholarship

Objectives: The distinction between bipolar I disorder (BD-I) and bipolar II disorder (BD-II) has been a topic of long-lasting debate. This study examined differences between BD-I and BD-II in a large, global sample of OABD, focusing on general functioning, cognition and somatic burden as these domains are often affected in OABD. Methods: Cross-sectional analyses were conducted with data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) database. The sample included 963 participants aged ≥50 years (714 BD-I, 249 BD-II). Sociodemographic and clinical factors were compared between BD subtypes including adjustment for study cohort. Multivariable analyses were conducted …

Punishing The Victim: Model Rule 1.16(A)(2) And Its Relation To Lawyers With Anxiety, Depression, And Bipolar Disorder, Daniel G. Esquivel

St. Mary's Journal on Legal Malpractice & Ethics

Abstract forthcoming.

A Protocol For Improving Early Recognition And Treatment Of Bipolar Disorder, Zelluyah Gaitho

Doctor of Nursing Practice Projects

In bipolar disorder, patients present to a clinician during depressive episodes often leading to a misdiagnosis. In turn, this could lead to inappropriate treatment. This failure to diagnose could be attributed to lack of use of validated screening tools and deviation from clinical guidelines. The purpose of this quality improvement project was to develop a protocol that will help improve early recognition and treatment of bipolar disorder by using the Mood Disorder Questionnaire. A training program was developed to increase knowledge on the proper use of the Mood Disorder Questionnaire (MDQ) and the Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). …

Neuropsychiatric Presentation Of Covid-19: A Case Report Of Disinhibition In An Acute Sars-Cov-2 Infection, I. Jack Abramson, Kristy A. Fisher, Clara V. Alvarez, Jacqueline Horan Fisher

HCA Healthcare Journal of Medicine

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) viral infection is notable for a high degree of symptom diversity. Emerging evidence suggests viral invasion of the central nervous system; therefore, serious neurological and psychiatric manifestations are anticipated. We present the case of a 67-year-old male physician with a history of stable Bipolar Disorder for decades, hospitalized for persistent COVID-19 symptoms with documented positive serology, who presented with new and acute onset neuropsychiatric symptoms of disinhibition proximate the viral infection. We postulate neuroinvasion as the putative origin of the patient’s psychiatric instability. Further investigation is needed to expand upon our understanding of the …

Antipsychotic Treatment Experiences Of People With Bipolar I Disorder: Patient Perspectives From An Online Survey, Martha Sajatovic

Faculty Scholarship

Background: Oral antipsychotic (AP) medications are frequently prescribed to people with bipolar I disorder (BD-I). A cross-sectional online survey examined the experiences of people living with BD-I with a history of recent AP use. Methods: Adults with self-reported physician-diagnosed BD-I (N = 200) who received oral APs during the prior year completed a survey on AP-related experiences, including side effects and their perceived burden on social functioning, adherence, and work. Items also assessed preferences for trade-offs (balancing symptom management and side effects) when considering a hypothetical new AP. The perceived impact of specific, prevalent side effects on adherence, work, and …

Do Not Miss Your Shot: Improving Follow-Up In Patients Receiving Long-Acting Injectable Medications, Mary O'Hara

Doctor of Nursing Practice Final Manuscripts

Background: Serious mental illness including schizophrenia and bipolar disorder affects 1 in 24 adults in California. These chronic disorders are difficult to treat and often sabotaged by medication nonadherence. Long-acting injectable (LAI) medications are one strategy to combat medication nonadherence. Effectively providing treatment with LAI medications can be challenging at the clinic level.

Objectives: Reduce the number of days without medication by reducing the number of days between injection due date and injection administration for patients receiving LAI medications.

Design: Establish appointments for all injection visits. Standardize visit protocol for injection encounters to optimize provider time. Arrange immediate follow-up and …

Perspectives Of Older Blacks And Whites Living With Serious Mental Illness About Outpatient Mental Health Services, Rosalyn Roker

USF Tampa Graduate Theses and Dissertations

In the United States, over three million adults, age 50 and older, reported a diagnosis of serious mental illness (SMI) in the past year. Most of them live in community-settings and are less likely than younger adults to utilize mental health treatment. Lack of and insufficient treatment for SMI places them at increased risk of morbidity, earlier mortality, cognitive decline, and diminished quality of life. The current study aimed to: (1) examine the factors that influence Black and White older adults, who live with SMI, to seek and engage in outpatient mental health treatment; (2) identify the perspectives of Black …

Initiating/Maintaining Long-Acting Injectable Antipsychotics In Schizophrenia/Schizoaffective Or Bipolar Disorder – Expert Consensus Survey Part 2, Martha Sajatovic

Faculty Scholarship

Objective: The aim of this study was to provide recommendations on initiating and maintaining long-acting injectable antipsychotics (LAIs) in individuals with schizophrenia/schizoaffective or bipolar disorder. Methods: A 50-question survey comprising 916 response options was completed by 34 expert researchers and high prescribers with extensive LAI experience, rating relative appropriateness/importance on a 9-point scale. Consensus was determined using chi-square test of score distributions. Results of 21 questions comprising 339 response options regarding LAI initiation, maintenance treatment, adequate trial definition, identifying treatment nonresponse, and switching are reported. Results: Experts agreed that the most important LAI selection factor was patient response/tolerability to previous …

Identifying Patients And Clinical Scenarios For Use Of Long-Acting Injectable Antipsychotics – Expert Consensus Survey Part 1, Martha Sajatovic

Faculty Scholarship

Objective: To assess expert consensus on barriers and facilitators for long-acting injectable antipsychotic (LAI) use and provide clinical recommendations on issues where clinical evidence is lacking, including identifying appropriate clinical situations for LAI use. Methods: A 50-question survey comprising 916 response options was distributed to 42 research experts and high prescribers with extensive LAI experience. Respondents rated options on relative appropriateness/importance using a 9-point scale. Consensus was determined using chi-square test of score distributions. Mean (standard deviation) ratings were calculated. Responses to 29 questions (577 options) relating to appropriate patients and clinical scenarios for LAI use are reported. Results: Recommendations …

Attitudes Toward Antipsychotic Treatment Among Patients With Bipolar Disorders And Their Clinicians: A Systematic Review, Martha Sajatovic

Faculty Scholarship

Introduction: Antipsychotics are recommended as first-line therapy for acute mania and maintenance treatment of bipolar disorder; however, published literature suggests their real-world use remains limited. Understanding attitudes toward these medications may help identify barriers and inform personalized therapy. This literature review evaluated patient and clinician attitudes toward the use of antipsychotics for treating bipolar disorder. Materials and methods: A systematic search of the Cochrane Library, Ovid MEDLINE, Embase, and BIOSIS Previews identified English language articles published between January 1, 2000, and June 15, 2016, that reported attitudinal data from patients, health care professionals, or caregivers; treatment decision-making; or patient characteristics …

International Multisite Survey On The Use Of Online Support Groups In Bipolar Disorder, Rita Bauer, Jörn Conell, Tasha Glenn, Martin Alda, Raffaella Ardau, Bernhard T. Baune, Michael Berk, Yuly Bersudsky, Amy Bilderbeck, Alberto Bocchetta, Letizia Bossini, Angela Marianne Paredes Castro, Eric Yw Cheung, Caterina Chillotti, Sabine Choppin, Maria Del Zompo, Rodrigo Dias, Seetal Dodd, Anne Duffy, Bruno Etain, Andrea Fagiolini, Miryam Fernández Hernandez, Julie Garnham, John Geddes, Jonas Gildebro, Ana Gonzalez-Pinto, Guy M. Goodwin, Paul Grof, Hirohiko Harima, Stefanie Hassel, Chantal Henry, Diego Hidalgo-Mazzei, Vaisnvy Kapur, Girish Kunigiri, Beny Lafer, Erik R. Larsen, Ute Lewitzka, Ramus Licht, Anne Hvenegaard Lund, Blazej Misiak, Patryk Piotrowski, Scott Monteith, Rodrigo Munoz, Takako Nakanotani, René E. Nielsen, Claire O'Donovan, Yasushi Okamura, Yamima Osher, Andreas Reif, Philipp Ritter, Janusz Rybakowski, Kemal Sagduyu, Brett Sawchuk, Elon Schwartz, Ângela Miranda Scippa, Claire Slaney, Ahmad Hatim Sulaiman, Kirsi Suominen, Aleksandra Suwalska, Peter Tam, Yoshitaka Tatebayashi, Leonardo Tondo, Eduard Vieta, Maj Vinberg, Biju Viswanath, Julia Volkert, Mark Zetin, Peter C. Whybrow, Michael Bauer

Psychology Faculty Articles and Research

Background: Peer support is an established component of recovery from bipolar disorder, and online support groups may offer opportunities to expand the use of peer support at the patient’s convenience. Prior research in bipolar disorder has reported value from online support groups.

Aims: To understand the use of online support groups by patients with bipolar disorder as part of a larger project about information seeking.

Methods: The results are based on a one-time, paper-based anonymous survey about information seeking by patients with bipolar disorder, which was translated into 12 languages. The survey was completed between March 2014 and January 2016 …

Late Life Bipolar Disorder Evolving Into Frontotemporal Dementia Mimic, Martha Sajatovic

Faculty Scholarship

Objectives: Although bipolar disorder has been understood classically as a cyclic disease with full recovery between mood episodes, in the last decade, evidence has accumulated supporting progressive features. The clinical picture of advanced or end-stage bipolar disorder is heterogeneous with possible deficits in cognition and behavior, as illustrated by our case series. Cases: From our neuropsychiatric outpatient clinic, we describe four cases with bipolar disorder gradually developing a clinical syndrome, including apathy, disinhibition, loss of empathy, stereotypical behavior, and compulsiveness, fulfilling the criteria for possible behavioral variant frontotemporal dementia. All cases were diagnosed with bipolar 1 disorder at least 10 …

Update On Schizophrenia And Bipolar Disorder: Focus On Cariprazine, Rona Jeannie Roberts, Lillian Jan Findlay, Peggy El-Mallakh, Rif S. El-Mallakh

Nursing Faculty Publications

Schizophrenia and bipolar disorder are severe psychiatric disorders that are frequently associated with persistent symptoms and significant dysfunction. While there are a multitude of psychopharmacologic agents are available for treatment of these illnesses, suboptimal response and significant adverse consequences limit their utility. Cariprazine is a new, novel antipsychotic medication with dopamine D2 and D3 partial agonist effects. Its safety and efficacy have been investigated in acute psychosis of schizophrenia, bipolar mania, bipolar depression, and unipolar depression. Efficacy has been demonstrated in schizophrenia and mania. It is unclear if cariprazine is effective in depression associated with unipolar or bipolar illness. Adverse …

A Technology-Enabled Adherence Enhancement System For People With Bipolar Disorder: Results From A Feasibility And Patient Acceptance Analysis, Martha Sajatovic, Kristina A. Cassidy, Johnny Sams, Edna Fuentes-Casiano

Faculty Scholarship

Objective: As poor medication adherence is common in bipolar disorder (BD), technology-assisted approaches may help to monitor and enhance adherence. This study evaluated preliminary feasibility, patient satisfaction and effects on adherence, BD knowledge, and BD symptoms associated with the use of a multicomponent technology-assisted adherence enhancement system. Methods: This prospective study tested the system in five BD patients over a 15-day period. System components included: 1) an automated pill cap with remote monitoring sensor; 2) a multimedia adherence enhancement program; and 3) a treatment incentive program. This study evaluated system usability, patient satisfaction and effects on adherence (Morisky scale), knowledge …

Patient Choice As A Driver Of Medication-Switching In Non-Adherent Individuals With Bipolar Disorder, Martha Sajatovic, Curtis Tatsuoka, Philipp Dines, Christopher S. Bialko, Melanie Athey, Tiffany Williams, Kristin A. Cassidy

Faculty Scholarship

Objective: Psychotropic-related weight gain is a common concern among patients with bipolar disorder (BD). This concern affects satisfaction with treatment and may lead to non-adherence and relapse. This was a 12-week, uncontrolled prospective trial of patient-choice-facilitated ziprasidone switching among non-adherent BD patients with weight concerns. This study was conducted from January 2011 to July 2012. Method: Patients were asked to identify the "offending" BD medication which they believed was causing weight problems, and this agent was replaced with ziprasidone. The primary outcome was change in adherence as measured with the Tablets Routine Questionnaire (TRQ). Secondary outcomes included medication attitudes, BD …

Prospective, Open-Label Trial Measuring Satisfaction And Convenience Of Two Formulations Of Lamotrigine In Subjects With Mood Disorders, Martha Sajatovic

Faculty Scholarship

Background: Lamotrigine is an anticonvulsant drug indicated for the maintenance treatment of bipolar I disorder and for various types of epilepsy. An orally disintegrating tablet (ODT) of lamotrigine was developed to provide a formulation option that might increase patient convenience and satisfaction. Methods: Subjects with mood disorders who reported difficulty swallowing currently prescribed lamotrigine immediate-release medication (baseline) were enrolled and treated with lamotrigine ODT for three weeks (end of treatment). Subject satisfaction and convenience were measured using the Treatment Satisfaction Questionnaire for Medication (TSQM). Also measured were global psychopathology using the Clinical Global Impression severity index (CGI-S) and depressive symptoms …

Impact Of Sunlight On The Age Of Onset Of Bipolar Disorder, Michael Bauer, Tasha Glenn, Martin Alda, Ole A. Andreassen, Raffaella Ardau, Frank Bellivier, Michael Berk, Thomas D. Bjella, Letizia Bossini, Maria Del Zompo, Seetal Dodd, Andrea Fagiolini, Mark A. Frye, Ana Gonzalez-Pinto, Chantal Henry, Flávio Kapczinkski, Sebastian Kliwicki, Barbara König, Mauricio Kunz, Beny Lafer, Carlos Lopez-Jaramillo, Mirko Manchia, Wendy Marsh, Monica Martinez-Cengotitabengoa, Ingrid Melle, Gunnar Morken, Rodrigo Munoz, Fabiano G. Nery, Claire O'Donovan, Andrea Pfennig, Danilo Quiroz, Natalie Rasgon, Andreas Reif, Janusz Rybakowski, Kemal Sagduyu, Christian Simhandi, Carla Torrent, Eduard Vieta, Mark Zetin, Peter C. Whybrow

Marriage and Family Therapy Faculty Articles and Research

Objective: Although bipolar disorder has high heritability, the onset occurs during several decades of life, suggesting that social and environmental factors may have considerable influence on disease onset. This study examined the association between the age of onset and sunlight at the location of onset.

Method: Data were obtained from 2414 patients with a diagnosis of bipolar I disorder, according to DSM-IV criteria. Data were collected at 24 sites in 13 countries spanning latitudes 6.3 to 63.4 degrees from the equator, including data from both hemispheres. The age of onset and location of onset were obtained retrospectively, from …

Role Of Extended Release Quetiapine In The Management Of Bipolar Disorders, Martha Sajatovic

Faculty Scholarship

Atypical antipsychotics have become a widely utilized component of the bipolar disorder treatment armamentarium, with approximately 45% of bipolar patients prescribed atypicals. Over the last decade all atypical drugs except for clozapine have received a Food and Drug Administration (FDA) bipolar indication. In October 2008, the FDA approved quetiapine XR monotherapy for the treatment of acute depressive episodes of bipolar disorder and acute manic or mixed episodes in bipolar I disorder based on two placebo-control trials. Quetiapine was also approved as adjunct therapy with lithium and divalproex for the treatment of acute manic or mixed episodes as well as maintenance …

Predicting Juvenile Delinquency: The Nexus Of Childhood Maltreatment, Depression And Bipolar Disorder, Christopher A. Mallett, Patricia A. Stoddard Dare, Mamadou M. Seck

Social Work Faculty Publications

Background It is important to identify and provide preventative interventions for youth who are most at risk for offending behaviour, but the connection between early childhood or adolescent experiences and later delinquency adjudication is complicated. Aim To test for associations between specified mental disorders or maltreatment and later delinquency adjudication. Method Participants were a random sample of youth before the juvenile courts in two Northeast Ohio counties in the USA (n = 555) over a 4-year time frame (2003 to 2006). Results Logistic regression analysis identified a lifetime diagnosis of depression and/or bipolar disorder to be predictive of later youth …