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Historical background of long-acting injectable antipsychotics Soon after the introduction of antipsychotics (APs) in the 1950s, poor adherence to oral formulations was found to be a critical issue. This led to the development in 1966 of the first long-acting injectable (LAI) AP fluphenazine enanthate, and fluphenazine decanoate some 18 months later, to reduce the incidence of side effects of the former [Johnson, 2009]. Haloperidol decanoate became available in Europe in 1981 and in the USA in 1986 [Knudsen, 1985]. Clinical trial results showed a dramatic reduction in the morbidity of schizophrenia [Gottfries and Green, 1974; Johnson, 2009]. However, the concept of LAIs for schizophrenia was not initially received warmly by the medical profession for fears of increased side effects, lack of efficacy, and the fact this was seen as an attempt by psychiatrists to impose a treatment upon patients without due regard to their feelings or rights [Johnson, 2009] as well as the potential for medicolegal problems [Glazer and Kane, 1992]. However, with subsequent surveys and trials suggesting their benefits [Rifkin et al. 1977; Schooler et al. 1980; Hogarty et al. 1979], LAIs became more widely adopted. The introduction of the oral second-generation APs (SGAs) brought claims of better tolerance and less severe side effects, even though their use may be hindered by metabolic syndrome [Meyer and Stahl, 2009]. They also have potential to prevent or reverse accelerated frontotemporal cortical grey matter decline, and to provide a greater degree of neuroprotection than first generation APs (FGAs) [Keefe et al. 2004; Robinson et al. 2006]. The introduction of SGAs led to a decline in the use of LAI FGAs [Patel et al. 2003; Patel and David, 2005]. However, it soon became clear that atypical characteristics did not bring better adherence rates with oral SGAs. The recent introduction of LAI SGAs allows psychiatrists once

Most studies to date indicate that globally defined late-stage patients have a worse overall prognosis and poorer response to standard treatment, consistent with patterns for end-stage medical disorders. We believe it is possible at this juncture to speak broadly of 'early'- and 'late'-stage bipolar disorder. Next steps require further collaborative efforts to consider the details of preillness onset and intermediary stages, and how many additional stages are optimal.

Background The general medical impacts of coronavirus (COVID‐19) are increasingly appreciated. However, its impact on neurocognitive, psychiatric health and quality of life (QoL) in survivors after the acute phase is poorly understood. We aimed to evaluate neurocognitive function, psychiatric symptoms and QoL in COVID‐19 survivors shortly after hospital discharge. Methods This was a cross‐sectional analysis of a prospective study of hospitalized COVID‐19 survivors followed up for 2 months after discharge. A battery of standardized instruments evaluating neurocognitive function, psychiatric morbidity and QoL (mental and physical components) was administered by telephone. Results Of the 229 screened patients, 179 were included in the final analysis. Amongst survivors, the prevalence of moderately impaired immediate verbal memory and learning was 38%, delayed verbal memory (11.8%), verbal fluency (34.6%) and working memory (executive function) (6.1%), respectively. Moreover, 58.7% of patients had neurocognitive impairment in at least one function. Rates of positive screening for anxiety, depression and post‐traumatic stress disorder were 29.6%, 26.8% and 25.1%, respectively. In addition, 39.1% of the patients had psychiatric morbidity. Low QoL for physical and mental components was detected in 44.1% and 39.1% of patients respectively. Delirium and psychiatric morbidity were associated with neurocognitive impairment, and female gender was related with psychiatric morbidity. Conclusion Hospitalized COVID‐19 survivors showed a considerable prevalence of neurocognitive impairment, psychiatric morbidity and poor QoL in the short term. It is uncertain if these impacts persist over the long term.

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.

Background: The general medical impacts of coronavirus (COVID-19) are increasingly appreciated. However, its impact on neurocognitive, psychiatric health and quality of life (QoL) in survivors after the acute phase is poorly understood. We aimed to evaluate neurocognitive function, psychiatric symptoms, and QoL in COVID-19 survivors shortly after hospital discharge. Methods: This was a cross-sectional analysis of a prospective study of hospitalized COVID-19 survivors followed-up for 2 months after discharge. A battery of standardized instruments evaluating neurocognitive function, psychiatric morbidity, and QoL (mental and physical components) was administered by telephone. Findings: Of the 229 screened patients, 179 were included in the final analysis. Among survivors, the prevalence of moderately impaired immediate verbal memory and learning was 38%, delayed verbal memory (11.8%), verbal fluency (34.6%), and working memory (executive function) (6.1%), respectively. Moreover, 58.7% of patients had neurocognitive impairment in at least one function. Rates of positive screening for anxiety were 29.6%, depression (26.8%), and post-traumatic stress disorder (25.1%) respectively. In addition, 39.1% of the patients had psychiatric morbidity. Low QoL for physical and mental components was detected in 44.1% and 39.1% of patients, respectively. Delirium and stress-related symptoms increased approximately 4-fold the odds of developing neurocognitive impairment. Female gender and neurocognitive impairment diagnosis were related with an increase of 2.5 and 4.56-fold odds respectively of psychiatric morbidity. Interpretation: Hospitalized COVID-19 survivors showed a high prevalence of neurocognitive impairment, psychiatric morbidity, and poor QoL in the short-term. It is uncertain if these impacts persist over the long-term.

Pharmacotherapies for BD should be chosen to minimize neurocognitive side-effects, which may already be compromised by the disease process itself. Neurocognitive evaluation should be considered in BD patients to better evaluate treatment impact on neurocognition. A comprehensive neuropsychological evaluation also addressing potential variables and key aspects such as more severe cognitive deficits, comorbidities, differential diagnosis, and evaluation of multiple cognitive domains in longitudinal follow-up studies are warranted.