Built all 18 canonical wiki pages: overview; diagnosis/spectrum; epidemiology/course; genetics/neurobiology; mania/mixed states; bipolar depression; maintenance; lithium; antidepressants; psychotherapy/self-management; comorbidity/differential diagnosis; suicide/mortality/physical health; pregnancy/reproductive health; guidelines; biomarkers/digital phenotyping; clinical-trials landscape; patient experience/advocacy; red flags/safety. All remain draft pending a separate audit.
Scale: 2,930 wiki lines; every page 150–191 lines; 286 unique PMIDs across wiki pages; 18 NCT IDs in the trials page.
Built the literature layer:BIBLIOGRAPHY.md with 292 unique PubMed records cited anywhere in the condition; six landmark notes; a 21-entry international guideline/consensus registry; STATISTICS.md with 120 data rows; and a four-file patient-voice layer with method/ethics, nine directly checked public organizations, aggregate themes and annotated sources.
Rewrote OPEN-QUESTIONS.md: 24 stable questions (Tier 1 and Tier 2) plus 12 cross-domain “Dots not yet connected” junctions. Absence statements are explicitly limited to searches retrieved on this date.
PubMed searches run (live E-utilities): diagnosis and diagnostic screening (MDQ/HCL/BSDS, hypomania duration, mixed features, bipolar II/cyclothymia and mimics); prevalence/incidence, treatment gap, course, recurrence, predominant polarity, diagnostic conversion and occupational function; GWAS/cross-disorder genetics, ENIGMA/structural-functional imaging, circadian, inflammatory and metabolic markers; acute mania and mixed-state RCTs/meta-analyses; bipolar-depression RCTs and network meta-analysis; maintenance, discontinuation, lithium concentration/safety/suicide, lamotrigine, valproate and antipsychotics; antidepressant efficacy, treatment-emergent switch, rapid cycling and STEP-BD; psychoeducation, CBT, family-focused therapy, social rhythm and digital self-management; ADHD/anxiety/substance/personality/medical differentials; suicide, cause-specific mortality, cardiovascular/metabolic care; pregnancy, postpartum, lactation, lithium and antiseizure-medication outcomes; guidelines; biomarkers/digital phenotyping; qualitative patient/carer experience and stigma.
ClinicalTrials.gov searches run (live v2 API): condition sweep for bipolar disorder; acute depression, mania, maintenance, neuromodulation, psychedelic/metabolic and precision-treatment records; direct re-fetch of every retained NCT record.
Non-journal sources checked: official guideline pages for NICE, VA/DoD, APA, BAP, RANZCP and JSMD; public organization sites for DBSA, International Bipolar Foundation, Bipolar UK, Bipolar Scotland, Bipolar Australia, Mood Disorders Society of Canada, GAMIAN-Europe, SADAG and Bipolar India. Automated access limitations (HTTP 403/406) are recorded rather than treated as full page verification.
Identifier verification: the final condition-wide live PubMed E-summary check resolved 292/292 unique cited PMIDs; the bibliography reconciliation found no missing, extra or duplicate records, and its first-author metadata matched the live summaries. Direct ClinicalTrials.gov v2 calls resolved 18/18 unique NCT IDs.
Static checks: all 18 wiki pages contain draft frontmatter, TL;DR, Open questions, Related pages and References; all local sibling links target canonical filenames; no unresolved verification or placeholder markers remain.
Could not fully verify: anti-bot responses prevented automated content-level inspection of International Bipolar Foundation and Mood Disorders Society of Canada; their official domains and page identities resolved, and the limitation is disclosed in patient-voice/organizations.md. Currency was not established for every older national guideline; each uncertain status is labeled in the registry.
Next: run the required separate-session audit, re-fetch every claim→identifier pair, check numeric claims against abstracts/full texts, re-run absence searches, correct discrepancies, and promote only fully checked pages to curated.
Scope completed: audited all 18 files in wiki/ (2,958 lines), the 299-record master bibliography, six landmark notes, the 120-row statistics reference, the guideline registry, and all four patient-voice artifacts. Also reconciled INDEX.md and OPEN-QUESTIONS.md because they contain condition-level claims and citations.
Live identifier verification: extracted 299 unique cited PMIDs from the final condition and re-fetched every identifier through PubMed E-utilities on 2026-08-30; 299/299 resolved. Extracted 20 unique NCT identifiers and directly retrieved every /api/v2/studies/{NCT} record; 20/20 resolved. No PMID or NCT was supplied from memory.
Claim/reference reconciliation: for every wiki page, compared the PMID set in the body with its References section. Final result: 18/18 exact matches, no missing reference, no uncited reference, and no wiki PMID absent from BIBLIOGRAPHY.md. The final condition-wide and bibliography PMID sets are identical at 299 unique records.
Quantitative audit: rechecked sample sizes, event rates, effect estimates, confidence intervals, P values and endpoint wording against live PubMed records across all pages, six notes and 120 statistics rows. Estimates that differ because of population or method remain separated rather than averaged.
Citation-label errors found and fixed (10): two uses of PMID 37595997 were attributed to Bahji instead of Yildiz; PMID 1586272 was attributed to Gelenberg instead of Keller; two uses of PMID 36542401 were attributed to Depp instead of Goulding; PMID 25554993 was attributed to Proudfoot instead of Barnes; three overview journal labels were wrong (PMID 37595997, PMID 38470559 and PMID 40408762); and the bibliography journal for PMID 38470559 was corrected to Current Psychiatry Reports. The final label/title/identifier pairs were rechecked against the live records.
Stale-absence and currency searches rerun: repeated targeted PubMed searches for clinical biomarker validation, digital monitoring/intervention, bipolar–borderline discrimination, hypomania thresholds, mixed states, lithium hemodialysis, psychotherapy components and guideline biomarker adoption. Repeated the active ClinicalTrials.gov bipolar-condition query (329 returned records before relevance screening), guideline-site checks and multilingual organization searches.
Substantive/currency issues found and fixed (6 clusters): (1) added 2026 monitoring meta-analysis, SmartBipolar RCT, mixed-diagnosis circadian-feedback RCT and implementation synthesis, preserving the distinction between monitoring, targeted intervention and bipolar-specific evidence; (2) replaced the stale 2017-latest Indian adult-guideline statement with the live-verified 2025 update (PMID 41694044) and added the registered German AWMF update/expired prior-validity state; (3) added two directly verified active recurrence-prediction trials (NCT05828056; NCT06204705) and converted the hospitalization-prevention absence into a dated, query-bounded evidence gap; (4) corrected the geographic organization gap by directly verifying four additional organizations in Japan, Colombia, Brazil and Argentina; (5) replaced the categorical bipolar–BPD discriminator statement with current systematic-review and preliminary classifier evidence while retaining the external-validation boundary; and (6) reran the lithium-hemodialysis search and expressed the gap positively as reliance on toxicokinetic, case-level and consensus evidence rather than randomized efficacy evidence.
Literature-layer corrections: bibliography expanded from 292 to 299 live-verified PMIDs; guideline registry from 21 to 23 entries; trial identifier set from 18 to 20; public-organization directory from 9 to 13. Mood Disorders Society of Canada now fetched directly with HTTP 200; the IBPF anti-bot limitation remains disclosed without inferring inactivity.
Final flags: 0 unresolved verification markers; 0 unresolved citation mismatches; 0 unresolved substantive issues. The IBPF access barrier is a transparent source-access limitation, not an unresolved claim because no program-specific assertion is made from the blocked page.
Promotion: all 18 wiki pages promoted from draft to curated; INDEX.md and CONDITIONS-ROADMAP.md updated to audited.
Window: publications and newly indexed records since 2026-08-28 (prompt date_from; last LOG heading used by the scheduler). Identifier retrieval was live PubMed E-utilities esearch/esummary/efetch and ClinicalTrials.gov v2 /studies/{NCT}; no PMID or NCT was written from memory.
PubMed searches (pdat and edat, mindate 2026/08/28): diagnosis/spectrum; epidemiology/course; genetics/neurobiology; mania/mixed; bipolar depression; maintenance; lithium; antidepressants; psychotherapy/digital self-management; comorbidity; suicide/mortality/physical health; pregnancy; guidelines/consensus (title); biomarkers/digital phenotyping; RCTs; patient experience; plus a bipolar-title catch-all. pdat counts were inflated by September/December 2026 print issues of earlier e-publications (93 bipolar-title hits). The actionable set was the 12 edat-indexed records plus records with pubmed/epub date on or after 2026-08-28.
Triage dropped (honest empty for these topics): no new mania, maintenance, lithium, antidepressant, psychotherapy, pregnancy, or guideline papers that changed a claim. ADHD perinatal cohort (Vigod, PMID 42663665) is ADHD-centered. ERG letter, exploratory imaging (n=33), pediatric white-matter (n≈20/arm), social-support cross-section (n=105), chatbot case reports (n=2), Cureus case material, and an MDD anhedonia consensus (PMID 42314447; entrez June 2026) were not added. September-issue papers already indexed before 2026-08-28 (Halstead Lancet Psychiatry multimorbidity, PMID 42586082, pubmed 2026-08-12; Yocum prescribing trends, PMID 42578538; Marks cortical thickness, PMID 42568249) were not backfilled.
Survived triage — papers (4): Wu et al. Han Chinese rare-CNV analysis, 3,915 cases / 7,820 controls (PMID 42661060); de Deus et al. ERG systematic review, 32 studies n=1,334, with the quantitative meta-analysis limited to MDD (PMID 42669383); Uelman et al. NESARC-III bipolar I × cannabis-use-disorder severity (PMID 42664567); Dong and Ye incident heart-failure meta-analysis, bipolar RR 1.95 (95% CI 1.31–2.91; I²=80.1%) (PMID 42668911; PMC release 2026-08-01, PubMed entrez 2026-08-30). No landmark note.
ClinicalTrials.gov: all 20 previously cited NCT IDs resolved on direct v2 re-fetch; overall status and results-posting were unchanged (none have results). Added three pipeline-changing records: NCT06929273 (KarXT mania open-label extension BALSAM-3; recruiting; n=450); NCT06372964 (lumateperone pediatric bipolar depression phase 3; recruiting; n=384; last update 2026-08-28); NCT07286175 (adjunctive brenipatide time-to-relapse phase 2; recruiting; n=400). Protocol text does not state brenipatide’s pharmacologic class; the page does not invent one. Seen but not added: NCT06696755 icalcaprant bipolar-depression phase 2 (last update 2026-08-14, before the window); mixed-diagnosis pediatric lumateperone safety (NCT06229210); osteoarthritis radiofrequency ablation false-positive (NCT07789340).
Guidelines: live page checks of NICE CG185 (still last updated 2 Sep 2025), VA/DoD 2023, BAP, RANZCP, JSMD, CANMAT and AWMF BipolarLiving found no completed replacement. APA psychiatryonline.org returned HTTP 403. Registry last-verified date updated; no new entry.
Statistics / patient organizations: three new statistics rows (heart-failure RR; two NESARC-III attempt rates). Organization homepages re-fetched: 11/13 HTTP 200; IBPF remains 403; Bipolar Scotland changed from HTTP 200 (2026-08-30) to HTTP 403 without inferring inactivity. No new organization added. IHME/WHO/NIMH portals resolved but did not yield a new bipolar-specific burden figure beyond existing cited estimates.
Pages edited and demoted to draft:wiki/genetics-and-neurobiology.md, wiki/biomarkers-and-digital-phenotyping.md, wiki/suicide-mortality-and-physical-health.md, wiki/clinical-trials-landscape.md. Bibliography 299→303; statistics 120→123 rows; trial identifiers 20→23. OPEN-QUESTIONS.md OQ-15 and OQ-19 sharpened; no question closed. INDEX.md counts and page statuses updated.
Decision noted: PubMed MCP tools were not available; NCBI E-utilities were used as the live equivalent required by the sweep prompt.
Next sweep should chase: posted results or status changes on NCT06951711 / NCT07140913 / NCT06929273 (KarXT mania), NCT07286175 (brenipatide), NCT06372964 (pediatric lumateperone), NCT06696755 (icalcaprant, if updated), and NCT06656416 (ALTO-100 still last verified Jul 2025); any completed AWMF S3/BipolarLiving 2.1, APA replacement, RANZCP replacement, or KMAP-BP sixth edition; whether Wu’s novel Han Chinese CNV loci replicate; a bipolar-specific ERG meta-analysis (de Deus pooled MDD, not BD); and whether Dong’s heart-failure estimate is superseded by a lower-heterogeneity synthesis. Recheck Bipolar Scotland interactively if automated 403 persists.
2026-08-31 — Independent audit of the 2026-08-31 sweep (auditor: Claude; author audited: Grok)¶
Scope: the four wiki pages the sweep edited and demoted (genetics-and-neurobiology.md, biomarkers-and-digital-phenotyping.md, suicide-mortality-and-physical-health.md, clinical-trials-landscape.md), plus every sweep-touched line in BIBLIOGRAPHY.md, STATISTICS.md, guidelines/REGISTRY.md, patient-voice/organizations.md, OPEN-QUESTIONS.md and INDEX.md. Pages the sweep did not edit were not re-audited; they retain the 2026-08-30 audit.
Live identifier verification (this session): all 111 unique PMIDs on the four edited pages plus OPEN-QUESTIONS.md re-fetched by PubMed E-utilities ESummary — 111/111 resolved. All 23 unique NCT IDs re-fetched directly through /api/v2/studies/{NCT} — 23/23 resolved, none with a results section, every page-stated overall status, phase, enrollment and status-verified month matching the live record. The sweep's claim that the 20 previously cited records were unchanged is confirmed. Condition-wide reconciliation: 304 cited PMIDs = 304 bibliography records, and body/References sets match exactly on all four pages (20/34/25/13).
Claim-to-source checks: ~40 claim–identifier pairs read against live abstracts and, where needed, full text. The four new papers' abstracts were fetched by EFetch and each new sentence compared against them; the three new trial records were read at protocol level (title, conditions, interventions, eligibility, primary outcome).
Substantive error found and fixed (1): the Dong 2026 heart-failure claim (PMID 42668911) was attributed to a "seven-cohort synthesis." Seven retrospective cohorts met the review's inclusion criteria overall, but the PMC full text (PMC13525515) states that four contributed the bipolar estimate (McDermott 2005, Chen 2022, Yoo 2023, Lee 2024). Corrected on suicide-mortality-and-physical-health.md, in the STATISTICS row and in OQ-15; added the leave-one-out range (1.73–2.40) and the fact that the bipolar and schizophrenia intervals overlap with no formal between-group test, so the "higher than schizophrenia" ordering is a point-estimate comparison only.
Precision fixes (2): on biomarkers-and-digital-phenotyping.md, the de Deus ERG review (PMID 42669383) pooled only five of its 32 included studies — added to both the table row and the body, since "the only significant pooled parameter" reads stronger without it; and the significant parameter is the mixed-scotopic b-wave implicit time, with its CI lower bound at the null (g=0.23, 0.00–0.46), now stated.
Consistency fix (1): the sweep cited PMID 42314447 in guidelines/REGISTRY.md search provenance without adding it to BIBLIOGRAPHY.md, breaking that file's stated invariant and the INDEX count. Record verified live (Cutler AJ, et al. Psychiatry Res. 2026;364:117225) and added as an explicitly screened-and-excluded, non-bipolar entry. Bibliography 303→304; INDEX counts updated.
Source-access fix (1): Bipolar Scotland, recorded by the sweep as HTTP 403, returned HTTP 200 on the audit re-fetch (title "Bipolar Scotland - Scotland's Bipolar Charity"). The directory and source note now record the successful retrieval and identify the 403 as a request-level anti-bot response. Re-checked with the same method: ibpf.org still 403 (limitation correctly disclosed), psychiatryonline.org still 403.
Absence and currency re-checks: re-ran the ClinicalTrials.gov active-record query behind the trials page's hospitalization-prevention gap — no active record randomizes an alert-plus-response pathway with hospitalization prevention as the clinical-utility endpoint; the nearest hits are a transitional-care feasibility study (NCT07213492, primary outcome feasibility/acceptability) and a probiotic relapse trial (NCT03349528), so the dated, query-bounded gap statement stands. Re-fetched NICE CG185: last updated 02 September 2025, exactly as the sweep recorded.
Verified without change: Wu 2026 (PMID 42661060) — 3,915 cases / 7,820 controls, rare-deletion overrepresentation, only 3q29 and 15q11.2 replicating among 12 European loci: matches the abstract verbatim in substance. Uelman 2026 (PMID 42664567) — 33.71% (21.64–48.36) vs 16.65% (13.17–20.83), n=753 / 35,556, correctly framed as adjusted cross-sectional rates. All three new trial rows match their records, including BALSAM-3's mania/mixed-mania population and the sweep's correct refusal to invent a pharmacologic class for brenipatide (the protocol states none; it does describe a self-injected agent with diabetes-related exclusions).
Verdict: the sweep was sound in its identifier handling — no fabricated or mismatched citation, no stale absence, honest recording of what it could not fetch. The single real defect was the cohort-count overstatement, which the abstract alone would not have caught. Promotion: all four pages promoted draft → curated; INDEX.md returned to 18 curated pages. 0 items remain flagged.
Next sweep should also chase:NCT05065294 (psilocybin therapy for bipolar II depression, active-not-recruiting) surfaced in the audit's re-query and is not yet cited on the trials page — consider it when next revisiting the bipolar II portfolio gap; and whether Dong's four-cohort heart-failure estimate is superseded by a larger, lower-heterogeneity synthesis.
Scope and disposition: extended all 18 canonical wiki pages without restarting or deleting prior verified content. Every touched page was set to status: draft and last-curated: 2026-09-03 for independent re-audit.
Evidence-base result: condition-wide PubMed coverage increased from 304 to 393 distinct records (21.8 per wiki page across the condition); 382 distinct records now appear directly across wiki pages. The master bibliography was reconciled to all 393 condition-wide PMIDs, including four earlier records cited only as screened context in this log.
Searches run: 90 live topic-specific PubMed E-utilities searches—five per page—covering functional burden and recovery; diagnostic validity across age groups; incidence/onset/course; genomics, circadian biology, bioenergetics and neuroprogression; acute mania and mixed states; bipolar depression; maintenance and discontinuation; lithium concentration, renal effects, interactions and pharmacogenomics; antidepressant efficacy/switch/continuation; psychotherapy components and lifestyle; ADHD/OCD/autism/epilepsy differentials; suicide and physical-health pathways; pregnancy/postpartum/lactation; guideline grading and disagreements; circulating/imaging/polygenic/digital biomarkers; experimental treatments; stigma, recovery, adherence and employment; and emergency recognition/agitation/prediction. Additional targeted live searches resolved long-acting injectable maintenance evidence and lithium-response GWAS evidence.
Identifier integrity: live PubMed ESummary resolved 393/393 PMIDs present anywhere in the final condition; selected new records were also retrieved with EFetch for abstract-level claim extraction. Direct ClinicalTrials.gov v2 /studies/{NCT} calls resolved 29/29 NCT identifiers with no errors. No PMID or NCT was written from memory.
What was deepened: added actual effect sizes and confidence intervals for cognitive remediation, youth mania treatment, valproate, lumateperone, ketamine versus ECT, enriched maintenance therapy, LAIs, antidepressant continuation, lithium concentration and renal decline, psychoeducation, comorbidity prevalence, smoking/physical activity, postpartum relapse, lactation exposure, biomarkers and passive relapse prediction. Added explicit contradictions where symptom benefit did not yield function, internal digital performance lacked external validation, continuation reduced depression but numerically increased mania, and lithium efficacy gradients coexist with renal risk.
Guidelines and literature layer: added mixed-presentation CANMAT/ISBD ranks, ACOG modified-GRADE/good-practice distinctions, historical BAP/CANMAT provenance and a NICE-methods critique; expanded STATISTICS.md by 20 source-locked rows; sharpened four open questions and added two cross-domain junctions.
Deliberately left alone: canonical page structure, verified pre-existing prose and citations, the six landmark paper notes, patient-voice organization files, and non-bipolar conditions. No speculative biomarker, psychedelic, ketogenic-diet or digital-monitoring efficacy claim was promoted beyond the design and population actually studied; mixed-diagnosis estimates remain labeled as such.
Next audit: independently re-fetch and check every new claim–PMID pair, especially author labels and exact numeric transcription; confirm that guideline rank terminology matches each source's own grading system; and validate that pooled mixed-diagnosis ketamine/ECT and digital estimates are not read as bipolar-specific effects.
2026-09-03 — Independent audit of the evidence-broadening pass (auditor: Claude; author audited: codex)¶
Scope. The 2026-09-03 deepening pass by codex touched all 18 canonical wiki pages plus INDEX.md, OPEN-QUESTIONS.md, BIBLIOGRAPHY.md, guidelines/REGISTRY.md and statistics/STATISTICS.md. This audit targeted the new material. The pre-pass per-page citation sets were reconstructed from the author session's own file inventory, giving an exact new/old split; previously audited prose (2026-08-30 and 2026-08-31) was not re-litigated, but every inline author/year label on all 18 pages was machine-checked against live ESummary records.
Citation breadth — the measure this pass existed to move. Before: 297 distinct PubMed records across the 18 wiki pages = 16.5 per page (mean 21.3 citations per page). After: 382 distinct records = 21.2 per page (mean 26.3 citations per page). Eighty-six records were new to their page and 85 were new to the condition; no prior citation was dropped. The additions were spread deliberately — 4–6 new records on every page, none reused across more than one page except Simjanoski 2023 (PMID 37263531), which was already cited on genetics-and-neurobiology.md. This was genuine widening, not padding with the condition's existing landmark set; page length rose only ~17 lines per page (2,958 → 3,267 wiki lines) while the distinct-record base rose 29%.
Live identifier verification (this session). All 393 unique PMIDs anywhere in the condition re-fetched by PubMed E-utilities ESummary: 393/393 resolved. All 86 page-new records additionally retrieved by EFetch and read at abstract level; two read at PMC full-text level (PMC6380965, and the earlier-audited PMC13525515 context). All 33 unique NCT IDs re-fetched directly through /api/v2/studies/{NCT}: 33/33 resolved, none with posted results; overall status, phase, enrollment and status-verified month matched every page-stated value. No identifier was written from memory.
Reconciliation. Body-vs-References PMID sets match exactly on 18/18 pages. Condition-wide cited set = bibliography set = 393, with no duplicate, missing or uncited record. All wiki links resolve to canonical filenames; every page carries frontmatter, TL;DR, Open questions, Related pages and References; page lengths 166–212 lines; zero [unverified] or placeholder markers.
Claim-to-source checks. Roughly 110 new claim–identifier pairs were read against the live records. The large majority transcribed exactly, including hard cases the author handled well: the Hou 2016 lithium-response hazard ratio, whose direction is confusingly reported in the source (correctly attributed to the alternate alleles); the Vita 2025 lithium mania-response estimate that "barely crossed the null" (RR 1.35, 1.00–1.83, p=.049, very-low confidence); the Kishi 2016 rapid-cycling sensitivity analysis; and the Imaz 2019 lactation figures reproduced with the source's own denominators.
Defects found and fixed (8).
antidepressant-controversy.md and red-flags-and-safety-concerns.md both stated that Melhuish Beaupre 2020 (PMID 32134853) estimated antidepressant-associated mania at 14%. That figure is background context in the review's opening, not a pooled estimate it derived. Both sentences rewritten to describe what the review actually did (24 clinical and 10 genetic studies; five clinical factors meta-analysed) and to label the 14% as cited background.
bipolar-depression.md attached the Durgam 2025 adverse-event rates (PMID 39946099) to the 200-participant bipolar subgroup; the abstract reports them for the combined MDD/bipolar mixed-features population. Now labelled, with the absent mania/hypomania treatment-emergent events added.
bipolar-depression.md cited Shi 2025 (PMID 39549887) without noting that the paper carries a published expression of concern (J Affect Disord. 2025;378:350–351). Disclosed, and the vague "high heterogeneity" replaced with the actual I² values (75% response, 90% remission, 99% pooled symptom difference).
comorbidity-and-differential-diagnosis.md quoted Salazar de Pablo 2025's 3.72% bipolar occurrence after stimulant exposure (PMID 40900605) without its confidence interval — a number stripped of the context that makes it meaningful. The interval (0.77–16.05 across four studies, a twentyfold span) and the two other intervals are now stated.
maintenance-and-relapse-prevention.md presented Kishi 2016's RR 0.63 (PMID 27207910) as a pooled estimate "across seven LAI trials overall". Seven trials were identified (n=1,016); RR 0.63 comes from the risperidone-LAI-versus-placebo comparison specifically. Corrected, and noted that the report gives P values rather than confidence intervals for those estimates.
red-flags-and-safety-concerns.md attributed to Pacciardi 2019 (PMID 30721526) a caution against generalizing inhaled-loxapine safety to unsupervised community use. The review argues the opposite — it advocates community self-administration on the basis of preliminary results from the first ten participants of NCT02525991. Rewritten to state the review's actual position, with the respiratory contraindication quantified from the PMC full text (symptomatic bronchospasm 53.8% in the asthma trial, n=52, and 19.2% in the COPD trial, n=53, versus 11.5% and 11.1% on placebo) and with NCT02525991 verified live: completed 2019-12-31, n=323, status verified Nov 2020, no results posted as of today — so unsupervised use remains a proposal.
patient-experience-and-advocacy.md credited Jagfeld 2021 (PMID 34139411) with organizing bipolar experience around the CHIME processes. CHIME is pre-existing; the review's contribution is the bipolar-specific POETIC adaptation that makes "Tensions" an explicit component across 12 qualitative studies. Corrected, with the review's own demographic limitation added. Its reference line also named the wrong journal for Astill Wright 2025 (PMID 41105870) — J Affect Disord. → J Med Internet Res. 2025;27:e71525.
psychotherapy-and-self-management.md ended its lifestyle paragraph with curation-process commentary ("the new comparison here is deliberate recurrence rather than evidence-base widening"). Removed — that is a note about the build, not content about bipolar disorder. The substantive Simjanoski finding was kept.
Stale absence found and corrected (1).clinical-trials-landscape.md concluded its ketogenic-diet paragraph with "Registered, adequately controlled bipolar trials are needed before efficacy claims." A live ClinicalTrials.gov query today returns several bipolar-specific registered ketogenic studies. The sentence now names them with live-verified detail — NCT06221852 (randomized, open-label, first-episode, n=50, recruiting), NCT07121894 (single-arm bipolar depression, n=30, recruiting) and NCT06920940 (adolescents, n=80, recruiting) alongside the already-tracked NCT06081426 — and states the absence precisely: none is blinded, all are ongoing, and no completed adequately powered randomized efficacy trial with a mood-episode endpoint exists.
Absence re-verified and re-dated (1). The trials page's hospitalization-prevention gap was re-queried today across three formulations. It stands: no active record randomizes an alert-plus-response pathway with hospitalization prevention as the clinical-utility endpoint; the nearest records remain NCT07213492 (primary outcomes feasibility and acceptability) and NCT03349528 (probiotics). The bullet is re-dated to 2026-09-03 and now names those nearest records.
Pre-existing defect found in passing and fixed (1).PMID 33845326 was cited on comorbidity-and-differential-diagnosis.md and in BIBLIOGRAPHY.md as "Villarroel J, et al. Machine learning for the differential diagnosis of bipolar and borderline personality disorders. Psychiatry Res.". The record is Bayes A, et al. "Differentiation of bipolar disorder versus borderline personality disorder: a machine learning approach." J Affect Disord. 2021;288:68–73. This survived the 2026-08-30 and 2026-08-31 audits. Author, title and journal corrected in both files; the claim's numbers were correct but its 73% overall accuracy is now shown with the asymmetry that makes it interpretable (84.1–87.8% for bipolar disorder versus 50.0–57.7% for borderline personality disorder — chance-level for the latter in a small, bipolar-II-weighted sample).
Checked and confirmed without change. BEAM-BD (PMID 37530824) hazard ratios and event counts; Elmosalamy 2025 bipolar-II monotherapy counts and rates; Vega-Núñez, Rowland, Barendse, Song and Fang on the biomarkers page; Rhee 2022 and Rhee 2025 ECT estimates; Ferentinos, Lai, Kwon and Betzler on comorbidity; Alcaíno, Duffy, Youngstrom, Pavuluri and Dols on diagnosis; Solmi, Pedersen, Esaki, Lee and Harvey on epidemiology; Kuang, Liang, Yan, Passos and Muneer on genetics; Yatham 2021/2006, Jauhar, Goodwin and ACOG on guidelines; Hsu, Macaron, Arnold, Al-Soleiti and Hou on lithium; Nestsiarovich, Mari, Kishi 2021 and Bai on maintenance; Vita, Fornaro and Fountoulakis on mania; Dean, Samamé, Silva Ribeiro, Afzal and Bora on overview; Tse, Latifian, Favre, Loots and Astill Wright on patient experience; Imaz, Newmark and Costoloni on pregnancy; Tan, Bond, Hautzinger and Frank on psychotherapy; Lublóy, Gonzalez and Thompson on red flags; Vancampfort, Pietschnig, Hu, Braithwaite and De Hert on suicide/physical health. All 20 new STATISTICS rows carry source, population and method matching their records; both new REGISTRY entries and both new "Dots not yet connected" junctions match their sources.
Verdict. The deepening pass did the thing it was asked to do: it widened the evidence base rather than lengthening pages against the same references, and it was disciplined about not over-reading mixed-diagnosis, internally validated or enriched-design estimates. Its real failure modes were a reversed source stance (Pacciardi), a background figure presented as a derived estimate (Melhuish Beaupre, twice), a subgroup/whole-population mix-up (Durgam), a pooled-versus-pairwise conflation (Kishi 2016), one undisclosed expression of concern, one stale absence, and one leak of build commentary into page prose — none of which the abstract alone would catch without deliberately re-reading each source against each sentence.
Promotion. All 18 wiki pages promoted draft → curated. INDEX.md updated to audited. 0 items remain flagged.
Next sweep should chase: posted results for NCT02525991 (self-administered inhaled loxapine outside hospital; completed 2019, still unposted); completion/results of the bipolar ketogenic trials NCT06221852, NCT07121894 and NCT06920940; whether the expression of concern on Shi 2025 (PMID 39549887) resolves to a retraction or correction; NCT05065294 (psilocybin for bipolar II depression), still uncited on the trials page; and whether Fang 2026's call for closed-loop intervention trials is answered by any registered alert-plus-response protocol with a hospitalization endpoint.
2026-10-09 — Periodic literature sweep (author: Claude, claude-opus-5-5)¶
Window and method: records entered into PubMed (edat) 2026-08-28 to 2026-10-09. The window overlaps the 2026-08-31 sweep, so records it had already triaged were not re-processed. Every identifier came from live NCBI E-utilities (esearch/esummary/efetch) or the ClinicalTrials.gov v2 API in this session. The PubMed MCP connector was not authenticated, so E-utilities served as the live equivalent. The full query manifest, with PubMed translations and returned IDs, is at literature/sweeps/2026-10-09.json.
Sources actually queried: PubMed (21 topic searches plus a catch-all of 375 records, after excluding battery/electrode/surgical "bipolar" and "lithium" chemistry; 210 unique topic records screened by title and pub-type); Cochrane Database of Systematic Reviews through PubMed ("Cochrane Database Syst Rev"[jour] × bipolar/mania/lithium/mood-stabilizer/antipsychotic/psychoeducation/severe-mental-illness terms: one record); Europe PMC (non-MEDLINE title search, 133 hits, mostly EPA 2026 and CINP congress abstracts plus 12 preprints); ClinicalTrials.gov v2 (direct re-fetch of all 29 previously cited NCT IDs plus candidates; first-posted ≥2026-08-28 query, 12 records; results-first-posted ≥2026-08-28 query, 0 records); Crossref (updated-by for every added DOI, no mailto); PMC/Europe PMC full text where available. Not queried: WHO ICTRP and named non-US registries; Unpaywall (LIFEBANK_CONTACT_EMAIL unset, so skipped per SOURCES.md); CENTRAL and the Cochrane Library site (HTTP 403); SciELO/LILACS (HTTP 403). No claim about regional (Latin American) literature was made. Absences below are absences in PubMed/Europe PMC/ClinicalTrials.gov only.
Cochrane: the only CDSR record in the window was zuclopenthixol acetate for "acute schizophrenia and similar major mental illnesses" (Jayakody 2026, PMID 42781843; 11 RCTs, 714 participants). Its abstract gives no bipolar- or mania-specific estimate, so no wiki claim changed. It is logged as a screened contextual record. No Cochrane review superseded or contradicted anything this condition asserts.
Survived triage — wiki edits (31 PMIDs + 1 preprint; 11 pages demoted to draft, last-curated: 2026-10-09):
bipolar-depression.md: Ket-BD, the first bipolar-specific midazolam-controlled serial-ketamine RCT (Orsini 2026, PMID 42684694; NCT05004896; MADRS −7.3, d 0.7, n=68). It replaces the page's statement that only mixed-diagnosis ketamine evidence existed. Also added a mixed-features dose-related NMA (Fornaro 2026, PMID 42815730).
clinical-trials-landscape.md: 2026-10-09 re-fetch results; four verification-month updates; three records past primary completion without a status update (NCT05849402, NCT06506019, and the stale NCT06656416). Added a new "reported since last sweep" table covering Ket-BD, the bipolar II psilocybin open-label study (Downey 2026, PMID 42765891; NCT05065294, which the 2026-08-31 audit flagged as uncited and whose registry record is still un-updated since 2024) and a retrospectively registered bright-light RCT (NCT07860957). Added two new neuromodulation registrations (NCT07857122 FEAST; NCT07845409 tACS).
maintenance-and-relapse-prevention.md: Hong Kong LAI self-controlled case series (Deng 2026, PMID 42711749). New section on conflicting first-mania emulations: BD-CAUSAL (Szmulewicz 2026, PMID 42716056) versus Taiwan lithium- vs valproate-combinations (Li 2026, PMID 42765449).
suicide-mortality-and-physical-health.md: lithium-vs-valproate suicide cohort plus NMA (Wei 2026, PMID 42765379); two Chinese multicentre lithium analyses that appear to share one 585-person sample and are flagged as non-independent (Xu 2026, PMID 42671279; Guan 2026, PMID 42713736); cardiorespiratory fitness MA (Arida 2026, PMID 42702273).
lithium.md: renal-decline predictors (İnanlı 2026, PMID 42810282, where duration was not a predictor); copeptin and concentrating capacity (Zittema 2026, PMID 42847926); tirzepatide series (Rescalli 2026, PMID 42803597); SILENT after poisoning, 7.6%, not predicted by serum level (Pineda-Torcuato 2026, PMID 42703744); lithium vs valproate mortality and dementia in a cohort only ~22% bipolar, a fact verified from the full-text baseline table (Hou 2026, PMID 42839929); multi-trait lithium-response PGS (Sharew 2026, PMID 42841250).
biomarkers-and-digital-phenotyping.md: EDIT-B RNA-editing blood test, external European validation, AUC 0.873 (Weissmann 2026, PMID 42833865; NCT05603819). The TL;DR was qualified accordingly, with the reference-standard, prevalence and incremental-value caveats stated.
genetics-and-neurobiology.md: Swedish FGRS network analysis, where bipolar is transitional between internalizing and psychotic clusters with no direct schizophrenia edge (Kendler 2026, PMID 42742582); multi-ancestry exome preprint, 13 genes (Liao 2026, medRxiv doi:10.64898/2026.09.30.26364416, preprint, not peer reviewed).
pregnancy-and-reproductive-health.md: valproate discontinuation in women of child-bearing potential (Colas 2026, PMID 42700484); new perimenopause section (Radosavljevic 2026, PMID 42811911; quotations taken from the PMC full text).
guidelines.md: five ISBD task-force documents plus the TRBD and JSMD corrections (see Guidelines below).
Content conflict found in existing material:epidemiology-and-course.md faithfully transcribes Jiang 2025 (PMID 40499832), whose abstract gives global bipolar incidence of 53.9 million in 2021. Liang 2026, from the same GBD round, gives 25.28 million prevalent and 1.63 million incident cases at ages 15–49. Jiang's figure therefore exceeds GBD prevalence and is very likely mislabelled. The page and STATISTICS now flag it as unreconciled. The GBD Results Tool was not queried, and the next audit or sweep should settle it.
Guidelines: NICE CG185 re-fetched and still last updated 02 Sep 2025. AWMF BipolarLiving v2.1 is still at registration stage. CANMAT homepage returned HTTP 200 with no new document found. Korean KMAP-BP 2026 PubMed search: 0. Five ISBD task-force consensus documents were missing from the registry. All were published before this window and missed by earlier sweeps, and all were added: TRBD definition (Vieta 2025, PMID 40808269, correction PMID 42478728), bright-light recommendations (Geoffroy 2025, PMID 40705857), chronobiology Delphi (Crouse 2026, PMID 42429210, preprint PMID 40585074), staging (Kupka 2026, PMID 42310905) and older-adult lithium ranges (Shulman 2026, PMID 42489486). A publisher correction to the JSMD English paper was indexed (PMID 42768410). Neither correction's text was retrievable because both are Wiley-hosted. Registry 25→30 entries.
ClinicalTrials.gov: all 29 previously cited NCT IDs resolved. None changed overall status and none posted results. NCT02525991 (self-administered inhaled loxapine) is still unposted since 2019. The ketogenic trials NCT06221852, NCT07121894 and NCT06920940 are still recruiting. NCT06696755 (icalcaprant) has not been updated since 2026-08-14 and is still not cited. Six records were added to the condition (NCT05004896, NCT05065294, NCT05603819, NCT07857122, NCT07845409, NCT07860957), for 38 NCT IDs condition-wide. The hospitalization-endpoint alert-plus-response gap still stands: none of the 12 newly posted records addresses it, and the nearest new digital item, the MoodSensing app cohort (screened, not cited), is an uncontrolled observational pilot.
Follow-ups from the previous LOG: Shi 2025 (PMID 39549887) still carries its expression of concern (Crossref and PubMed), with no retraction. NCT05065294 is now cited. Fang 2026's call for closed-loop hospitalization trials remains unanswered in the registry. No bipolar-specific ERG meta-analysis or lower-heterogeneity heart-failure synthesis appeared in the window. Wu 2026 Han Chinese CNV loci have no replication yet, though the Liao exome preprint is relevant context.
Statistics / patient voice: STATISTICS 143→159 rows plus one conflict caveat. Organization homepages re-checked: 11 of 13 returned HTTP 200 with a browser user agent, IBPF still 403, and mdsc.ca timed out at the connection level, which is not taken as evidence of inactivity. No organization was added. Qualitative studies seen in the window (resilience focus groups, caffeine use, peer support in Chile, AMBIENT-BD co-production) were screened but not added. That is a candidate for the patient-voice layer at the next deepening pass, not a sweep edit.
Screened and dropped (representative): single-site imaging and EEG classifiers; case reports; congress abstracts (Europe PMC); the letter/reply exchange on an ML trajectory paper; a nutraceutical NMA with no depression signal; a lithium-dementia MA dominated by non-bipolar exposure; the GLP-1 RA kidney-replacement cohort in bipolar disorder with CKD; the aspirin-RCT secondary biomarker analysis (null; the parent RCT is not cited here); a YMRS methodology consensus; a GP-setting diagnostic SR; and the green-space GPS study (n=29).
Retraction checks: all 31 added PMIDs passed the PubMed publication-type check. Crossref returned no retraction for any. Corrections are recorded for Vieta 2025 and the JSMD paper. Kendler 2026's DOI returned 404 from Crossref, so its check rests on PubMed alone.
Landmark note: none. Ket-BD is important but small (n=68, two weeks), and no paper in the window changed practice on its own.
Next sweep / auditor should chase: (1) verify Ket-BD and EDIT-B against full text when accessible; this sweep read both abstract-only. (2) Settle the Jiang 2025 GBD incidence figure against the GBD Results Tool. (3) Obtain the TRBD and JSMD correction texts. (4) Check whether BD-CAUSAL reports a lithium-vs-valproate split in its full text. (5) Watch for peer-reviewed publication of the Liao exome preprint. (6) Track NCT07860957 (bright light) and NCT05849402 / NCT06506019 for results. (7) Backfill remaining 2025–2026 ISBD/society consensus documents listed in REGISTRY watch-list item 15. (8) Recheck mdsc.ca.
2026-10-16 — Periodic literature sweep (author: Codex)¶
Window and method: 2026-08-28 through 2026-10-16 inclusive, as requested. Read CONVENTIONS.md, CLAUDE.md, SOURCES.md, this LOG and INDEX before editing. Repeated the overlapping window rather than assuming the 9 October sweep exhausted it. PubMed searches used explicit pdat bounds; a supplementary edat catch-all caught newly indexed material. Later print issues can represent earlier electronic publications, so prior-sweep records were distinguished from new additions. Every newly written PMID was retrieved through live NCBI E-utilities, every cited NCT was retrieved through the live ClinicalTrials.gov v2 API, and the three retained ISRCTN DOIs were resolved through Crossref. The reproducible search manifest records queries, translations, returned identifiers, source-access limits and per-record checks.
PubMed actually queried: 22 main queries covering diagnosis/spectrum; epidemiology/course/burden; genetics; neurobiology; mania/mixed states; bipolar depression; maintenance/relapse; lithium; antidepressants; psychotherapy/self-management; comorbidity; suicide/mortality/physical health; pregnancy/reproduction; guidelines; biomarkers/digital phenotyping; trials; neuromodulation; patient experience; safety; meta-analysis; and publication-date/entry-date catch-alls. The union contained 718 records before relevance filtering (the broad lithium search also retrieved chemistry/dental papers, which were excluded). Titles, abstracts, publication types and prior-sweep coverage informed triage. A targeted Polish metabolic-guideline search found the paired second part missed by the condition-only query. A separate exact-title PubMed search for the Liao exome preprint’s publication returned zero; that is an absence in that PubMed query only.
Cochrane actually queried: 18 topic-specific CDSR searches plus a broader drug/severe-mental-illness context search, all through PubMed with the same publication-date window. The topic-specific searches returned zero; the broad search returned two contextual reviews: zuclopenthixol acetate for acute schizophrenia/similar major mental illnesses and medical cannabis for insomnia. Neither supplied bipolar-specific evidence warranting a change to this condition’s assertions. No replacement or contradiction was identified in these retrieved CDSR records. CENTRAL and the Cochrane Library website were not searched (HTTP 403).
Beyond PubMed actually queried: Europe PMC REST search for 18 topics with FIRST_PDATE:[2026-08-28 TO 2026-10-16], returning 324 unique records (190 MED, 90 PMC-source records, mostly conference abstracts, and 44 preprints); three MED identifiers outside the PubMed union were additionally resolved through E-utilities. Full-text availability metadata and accessible XML were inspected. Crossref updated-by was checked for all seven retained papers and the follow-up/correction records. WHO ICTRP was queried, but returned a small COVID-heavy set whose coverage was insufficient for a current global portfolio claim. The documented ISRCTN XML API date-filtered condition search succeeded and returned nine records; CRiB2 was also directly re-fetched. ISRCTN’s HTML search returned a cookie/JavaScript holding page. ChiCTR’s homepage was fetched but no usable date-filtered search was completed, so ChiCTR is not claimed as searched. SciELO and LILACS could not be searched (HTTP 403); no unqualified claim about regional literature or transportability is made. OpenAlex and DOAJ were not queried. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL was unset; no owner address was sent to an API.
Seven PubMed records survived triage: (1) Rodríguez-Toscano 2026, PMID 42850618, added to the pregnancy page and STATISTICS after full-text Methods and Table 1 verification: 487/796 reported effective contraception, but collection was 2010–2011 and the definition includes condoms/diaphragm. This is historical service evidence, not 2026 coverage. (2–3) Wichniak 2026, PMID 42857933 and PMID 42857934, the Polish Psychiatric Association’s paired antipsychotic metabolic-risk recommendations, added as one specialty guideline entry and a bounded guideline-page row; Part I’s publisher PDF was retrieved, Part II’s catalogue scope verified from PubMed. (4–7) Peng’s mitochondrial-modulator network meta-analysis (PMID 42863801), Halabi’s concurrent hypomanic-symptom detection study (PMID 42879783), Shabaka’s extracorporeal-therapy cohort (PMID 42850782) and Pineda-Torcuato’s EXTRIP-context cohort (PMID 42871752) were retained in the bibliography only. Their full texts were not retrieved; no numerical efficacy, prediction or dialysis claim was imported into the wiki from those abstracts. The latter poisoning cohorts may overlap with existing cohorts and require independence checks before synthesis.
Trials: all 38/38 NCT IDs cited condition-wide resolved; 0/38 has posted registry results. The azetukalner extension (NCT07217860) now reports active, not recruiting, replacing this page’s enrolling-by-invitation snapshot. ALTO-100 (NCT06656416) is still recruiting but now verified October 2026, with primary completion estimated September 2027 and study completion October 2027; its old stale August 2026 completion warning was corrected. The bright-light record (NCT07860957) was updated 13 October and remains completed without posted results. The raw date-filtered condition searches returned 74 updated records, 13 newly posted records and zero with first-posted results; these counts precede removal of non-psychiatric “bipolar” device studies. Long-unposted inhaled loxapine (NCT02525991) still has no registry results; the tracked ketogenic records remain recruiting.
Non-US trial finding that changed the page: ENERGISE-BD (ISRCTN14945909; doi:10.1186/isrctn14945909) is a recruiting UK randomized, registry-labelled single-blind ketogenic-diet versus NHS Eatwell trial, target 206, with a 12-week depression-response primary endpoint. It was registered before this sweep window but returned in the date-filtered update search and was missing here. It corrects the earlier overgeneralization that all retrieved ketogenic studies were unblinded; it provides a trial design, not efficacy evidence. Also added COMBINER (ISRCTN17178652; doi:10.1186/isrctn17178652; target 303, recruiting, 24-month lithium/quetiapine maintenance comparison) and CRiB2 (ISRCTN10362331; doi:10.1186/isrctn10362331; actual enrolment 222, completion recorded 31 January 2026, everyday-functioning endpoint). Their registry data sharpen OQ-8 and OQ-13 without answering them. OQ-16 now explicitly calls for contemporary contraceptive-coverage evidence.
Guidelines and statistics: directly retrieved NICE, CANMAT bipolar resources, AWMF, RANZCP and VA/DoD pages. NICE still reports its 2 September 2025 update; AWMF remains a registration; RANZCP continues to label its mood-disorders CPG no longer current; VA/DoD still displays 2023. ISBD’s members-only “2025 Update” symposium listing does not expose a replacement guideline and was not treated as one. Registry entries 30→31. WHO’s bipolar fact sheet, dated 11 September 2026, gives 36 million people (0.4%) in 2023, approximately 32 million adults, citing GBD 2023. Added that source-locked estimate separately from GBD 2021; statistics rows 159→161 including the contraception row. The IHME GBD Results page exposed only an application shell, so the previously flagged GBD 2021 incidence/prevalence labelling conflict remains unresolved.
Patient-organisation material: retrieved Bipolar UK’s September Brighton university campaign and 9 October public ambassador reflection; added short annotations to patient-voice/sources.md, without adopting campaign reach as population statistics or an individual story as an aggregate theme. DBSA’s homepage was retrieved with no new item retained. IBPF returned 403. MDSC’s direct homepage request again timed out; live web-search results retrieved its public peer-support page, which does not establish a new bipolar-specific programme. No private account or closed-group content was used.
Prior follow-ups: Ket-BD and BD-CAUSAL remain subscription-only in Europe PMC metadata; their full-text verification and lithium-versus-valproate split remain pending. EDIT-B’s PubMed record was re-fetched, but a usable full text was not obtained. Europe PMC now lists the TRBD correction as free in PMC, but XML retrieval failed (500) and HTML returned 403; the JSMD correction remains inaccessible. Neither correction’s substantive effects are inferred. Shi’s ketamine/ECT meta-analysis (PMID 39549887) still links an expression of concern in PubMed’s CommentsCorrections; its publication-type list and Crossref updated-by alone did not show it. The existing concern disclosure is retained. No retraction was identified in those retrieved checks.
Retraction integrity: each of the seven newly retained PMIDs passed both the live PubMed publication-type check and Crossref updated-by check, with no retraction/concern flags and no failed Crossref lookup. The three retained ISRCTN DOI lookups also returned no updates. Retraction status is a dated database observation, not a guarantee about future notices.
Changed: three wiki pages (clinical-trials-landscape.md, pregnancy-and-reproductive-health.md, guidelines.md) remain status: draft, each last-curated: 2026-10-16; bibliography 425→432 records; guideline registry; statistics; patient-voice source list; OQ-8/OQ-13/OQ-16; INDEX; this LOG; and the manifest at the prescribed path. No landmark note was warranted. Most records received no addition: case reports, small/internal classifier studies, congress abstracts, preprints and mixed-diagnosis findings did not justify new wiki claims.
Verification and hand-off: checked identifier provenance, bibliography uniqueness and wiki reference reconciliation; checked changed-page structure, local targets and site-builder mapping for the manifest. No page was promoted and this is not an independent medical audit. Publishing is left to the subsequent workflow as instructed; no git command, publishing/deployment script or global content generator was run.
Next sweep / independent auditor: retrieve and check the four bibliography-only full texts, especially whether the lithium-poisoning cohorts overlap; inspect ENERGISE-BD’s masking implementation and results when available; watch COMBINER recurrence and CRiB2 functional outcomes; follow the refreshed ALTO-100 timeline and azetukalner parent/extension records; continue checking loxapine, bright-light and ketogenic results; resolve the GBD 2021 labelling conflict using an actual GBD result table; obtain the TRBD/JSMD corrections and Ket-BD/EDIT-B full texts; check the Liao preprint for peer-reviewed publication; and complete the previously listed ISBD consensus backfill. No pending question is represented as resolved by a registry entry alone.
2026-10-23 — Periodic literature sweep (author: Grok)¶
Window and method: publications from 2026-08-28 through 2026-10-23, repeating the overlapping window rather than treating the 16 October sweep as exhaustive. Read CONVENTIONS.md, CLAUDE.md, SOURCES.md, this LOG and INDEX before editing. PubMed used pdat as the primary date type and an edat catch-all, plus an incremental edat search for 2026-10-17 through 2026-10-23. New PMIDs were those absent from the 2026-10-16 returned sets and from the bibliography. Every PMID written below was retrieved through live NCBI E-utilities in this session. Every NCT written below was retrieved through the live ClinicalTrials.gov v2 API in this session. The reproducible search manifest records queries, translations, counts, returned identifiers, source limits and per-record checks. No git command was run and no .git or .gitignore was created.
PubMed actually queried: the same topic set as 16 October (diagnosis, epidemiology, genetics, neurobiology, mania, depression, maintenance, lithium, antidepressants, psychotherapy, comorbidity, pregnancy, guidelines, biomarkers, trials, neuromodulation, patient experience, red flags, meta-analysis, plus publication-date and entry-date catch-alls). Counts are in the manifest. The publication-date catch-all returned 636 records and the entry-date catch-all 479. The incremental entry-date search returned 34. The union of records new against the prior sweep and the bibliography was 75, and those 75 were triaged. The mortality topic search first returned HTTP 429. The retry returned HTTP 200, count 103, with seven PMIDs new against the prior mortality set (42902526, 42901238, 42898785, 42897416, 42892769, 42887787, 42083011). All seven were triaged; two were retained. Follow-up queries: Liao exact-title search count 0 (an absence in that PubMed query only); heart-failure bipolar meta-analysis in the window count 0; ERG query count 8, all retinal bipolar cells; ISBD consensus search count 14; GBD/bipolar title search count 12; Cochrane bipolar-title search count 1; Wu CNV follow-up count 1 and not in the new-PMID delta; Shi PMID 39549887 count 1.
Cochrane actually queried: 18 topic-specific "Cochrane Database Syst Rev"[jour] searches in the same publication-date window, each count 0, plus a broader context search that returned two PMIDs already screened on 16 October (42863850 and 42781843). Neither was treated as new bipolar evidence. A title search for bipolar, mania or lithium in that journal returned PMID 41574662, whose title is a comparison of bipolar coagulation with clamp-crush technique for liver resection, not bipolar disorder. No Cochrane review in these PubMed results superseded a claim in this condition. CENTRAL was not searched. cochranelibrary.com returned HTTP 403.
Beyond PubMed actually queried: Europe PMC REST searches for 18 topics with FIRST_PDATE:[2026-08-28 TO 2026-10-23], plus an incremental title query for 2026-10-17 to 2026-10-23 (hitCount 7: five MEDLINE records and two preprints, PPR1345599 and PPR1348081, screened and not added). Non-MEDLINE records were present in the topic results; they were conference abstracts and preprints, and none was added. Europe PMC full-text XML for the Nature GWAS (PMC12163093) returned HTTP 500; NCBI PMC efetch returned the article and the locus-count sentences were taken from that file. Crossref updated-by was checked for every retained DOI and was empty. WHO ICTRP (trialsearch.who.int) returned HTTP 502, so it was not successfully searched. The ISRCTN XML API date-filtered query returned HTTP 200 and 10 identifiers; the three already cited trials were re-fetched and still match the trials page, and ISRCTN15962574 was screened and not added. ChiCTR’s homepage returned HTTP 200 with no usable date-filtered search, so ChiCTR is not claimed as searched. The EU Clinical Trials Register search page returned HTTP 200 and its results were not parsed, so it is not claimed as searched. SciELO returned HTTP 403. LILACS timed out. No absence claim about regional literature is made. OpenAlex and DOAJ were not queried. Embase, Scopus and Web of Science were not available. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL was unset; no owner address was sent to an API. Crossref was queried without a mailto parameter.
Retained, inside the window: (1) Motta 2026, PMID 42902526, abstract only, not open access. Controlled cardiovascular incidence IRR 1.66 (1.32–2.08) from a 32-study observational meta-analysis. The authors call the prevalence pool extremely heterogeneous, so no precise prevalence row was added. Coronary and cerebrovascular incidence ratios were truncated in the retrieved abstract and were not invented. (2) Richards-Brown 2026, PMID 42894408, South London and Maudsley cohort n=88. Median diagnostic delay 556 versus 50.5 days; deprivation unadjusted. One qualified epidemiology sentence. (3) Williams 2026, PMID 42897866, PMC full text. Women with bipolar disorder n=106 versus 300 age-matched controls. FNIH OR 2.24 (1.11–4.55) and EWGSOP2 OR 2.78 (1.47–5.20). The 8.9% and 11.4% figures are combined-sample percentages (Table 1 n=406), and confirmed sarcopenia was 2 and 3 women, so the association is carried by probable sarcopenia. (4) Torres-Cortes 2026, PMID 42901238, abstract only. Pediatric lifetime suicide-attempt prevalence 26.2% (24.4–28.0). Treatment effect sizes in that abstract were not imported as new trial evidence, and the curated diagnosis page was not edited.
Retained, outside the window, with the reason stated on the page: (5) O'Connell 2025, PMID 39843750, Nature, NCBI PMC full text. 158,036 cases and 2,796,499 controls, 298 loci, 36 credible genes, architecture differing by ascertainment and by bipolar subtype. Found because a GBD follow-up query from 2025 matched “global burden of disease” in the abstract, not because it falls inside 2026-08-28. It replaces the 64-locus headline. Mullins 2021 stays as the historical row. The weak-prediction claim stays with Li 2021. No landmark note was written; a structured note would be a genetics rebuild, and that note is deferred. (6) Lafer 2026, PMID 42545207, ISBD NExT, PMC full text, PMC-live 4 August 2026. Searches through 1 March 2026. Conclusion: despite limited high-quality evidence, activity and exercise show promising physical and mental health benefits, and multicenter trials are needed. The abstract’s pilot response figure was not imported. (7) Nunes 2026, PMID 42460615, ISBD older-adult lithium systematic review, PMC full text, PMC-release 16 July 2026. Fourteen observational studies, 8,808 older adults, usual levels 0.47–0.67 mmol/L, toxicity signals from 0.82 mmol/L. The authors say this is consistent with age-adjusted targets. It does not estimate the concentration that prevents relapse, and it is kept distinct from Shulman’s implementation paper (PMID 42489486). (8) Mio 2026, PMID 42249599, ISBD Vascular Task Force, abstract only, June 2026. Catalogued as a research agenda. No imaging metric and no treatment recommendation were imported.
Trials: 35 previously content-cited NCT records were re-fetched. None has a results section, and overall status was unchanged for the records already described. BALSAM-2 (NCT06951711) is still recruiting, now verified October 2026, last updated 2026-10-20, primary completion estimated 2026-11-02, enrollment 274. The prior “38” headline had included three log-only screened identifiers (NCT06229210, NCT06696755, NCT07789340); they are now named on the trials page as screened and not added, and they are still not portfolio rows. Added NCT07890805 (PolarUs; not yet recruiting; first posted 2026-10-22; n=504; primary outcome QoL.BD over 12 weeks; participants cannot be fully blinded) and NCT07664852 (B-HAPPI; recruiting; first posted 2026-06-24, so before the window, and updated 2026-10-22; phase 3; n=126; quadruple-masked pramipexole versus placebo; SHAPS at 6 weeks). Condition searches: 8 updated since 17 October, 4 first posted since 17 October, 19 first posted since 28 August, 0 with results first posted in the window. Other new or updated records (mixed severe-mental-illness cohorts, digital-phenotype cohorts, device false positives, completed studies with no results) were screened and not added. NCT07213492 remains the nearest alert-plus-response record and still uses feasibility and acceptability, not hospitalization, as its primary outcomes. ISRCTN15962574 (online bipolar parenting intervention; target 284; actual enrolment 303; no longer recruiting; completion 31 January 2027; primary outcome the child’s SDQ at 24 weeks) was screened and not added to the mood-efficacy table. ENERGISE-BD, COMBINER and CRiB2 were re-fetched and still match the existing table. ENERGISE-BD is still labelled single-blind; the record does not say who is masked.
Guidelines, statistics, organisations: NICE CG185 still last updated 02 September 2025. AWMF BipolarLiving is still Anmeldung version 2.1. A Stellungnahme dated 22 October 2026 on that page is about a Medizinischer Dienst Bund quality-criteria directive, not a bipolar guideline. RANZCP still says the 2020 mood-disorders CPG is more than five years old and no longer current. VA/DoD still shows the 2023 guideline. The ISBD “2025 Update” page is still a members symposium listing. Registry 31→34. WHO fact sheet re-fetched (title Bipolar disorder; page date still 11 September 2026): still “In 2023, an estimated 36 million people (or 0.4% of the global population), including approximately 32 million adults.” Statistics 161→166. The GBD Results page was still an application shell of about 5.5 KB, so the Jiang 2025 versus Liang 2026 labelling conflict stays unresolved. Secondary GBD analyses from the follow-up query were not added. Patient-organisation homepages were re-checked. DBSA, Bipolar UK and its news page, Bipolar Australia, GAMIAN, SADAG, Bipolar India, JABD, the Colombian association, ABRATA and FUBIPA returned HTTP 200. Bipolar Scotland’s title string now reads “Bipolar Scotland: Connect and Find Support”; that is a title change, not evidence of a new programme, and no new item was added. IBPF returned HTTP 403. MDSC timed out again, which is not taken as inactivity. No dated new patient-voice item was found.
Prior follow-ups still open, and one reconfirmed: Shi PMID 39549887 was re-fetched. Publication types are still Journal Article, Meta-Analysis, Comparative Study and Systematic Review. Crossref updated-by is empty. EFetch CommentsCorrections still has RefType ExpressionOfConcernIn pointing to J Affect Disord. 2025 Jun 1;378:350-351, doi 10.1016/j.jad.2025.03.010, PMID 40044086. The concern is not resolved and no page text was changed. The four bibliography-only full texts from 16 October were not retrieved. TRBD and JSMD correction full texts were not retrieved. Ket-BD, EDIT-B and BD-CAUSAL full texts were not retrieved. The erratum PMID 42906901 (“Digital technologies for long-term management of bipolar disorder”) has no matching original citation in this condition and was not added. No new Wu CNV replication was in the delta.
Retraction integrity: each of the eight added PMIDs had no retraction or expression-of-concern publication type, and Crossref updated-by was empty. Williams, Lafer and Nunes are open access in PMC. O'Connell is in PMC (PMC12163093) and was read there. Motta and Torres-Cortes have no PMCID. Mio’s full text was not retrieved.
Changed: six wiki pages, all already status: draft, now last-curated: 2026-10-23 — genetics-and-neurobiology.md, epidemiology-and-course.md, lithium.md, suicide-mortality-and-physical-health.md, guidelines.md, clinical-trials-landscape.md. Bibliography 432→440 distinct records. Guideline registry 31→34. Statistics 161→166. OQ-10, OQ-14, OQ-15 and OQ-19 sharpened and not closed. INDEX updated, including the NCT-count reconciliation. This LOG. Manifest at literature/sweeps/2026-10-23.json. No landmark note. No curated page was demoted or edited. Most of the 75 new records received nothing: surgical and optical false positives, case reports, classifiers, mixed-diagnosis studies, preprints and secondary GBD analyses.
Next sweep should chase: Motta’s full text, so the coronary and cerebrovascular incidence ratios can be quoted from the paper rather than omitted; Torres-Cortes full text, including any quality grading of the included meta-analyses; BALSAM-2 after its 2026-11-02 primary-completion estimate; PolarUs and B-HAPPI as they start and, later, report; ENERGISE-BD masking implementation (who is masked) and results; COMBINER recurrence and CRiB2 outcomes; the four bibliography-only full texts from 16 October and whether the lithium-poisoning cohorts overlap; TRBD correction PMID 42478728 and JSMD correction PMID 42768410; Ket-BD, EDIT-B and BD-CAUSAL full texts; peer-reviewed publication of the Liao preprint; a GBD Results table that can reconcile Jiang PMID 40499832 with Liang PMID 42688390; loxapine NCT02525991, bright light NCT07860957 and the ketogenic trials; whether Shi’s expression of concern is resolved; mdsc.ca. ISRCTN15962574 completes 31 January 2027 and matters here only if a patient-mood outcome is reported. SciELO and LILACS remained unreachable, so a later sweep that can search them should not treat today’s PubMed silence as a regional silence. No open question is answered by a registry entry alone.