Bipolar Disorder and Suicide: a Review

Relationships Among Demographic Factors, Stigma, Social Support, and Self-Management in Individuals With Bipolar Disorder in Remission

The current cross-sectional study aimed to investigate the extent to which demographic characteristics, stigma, and social support impact the self-management abilities of individuals with bipolar disorder in remission. Participants (N = 114) completed a demographic questionnaire, Self-Stigma Scale-Short Form, Social Support Rating Scale, and Self-Management Scale for Patients With Bipolar Disorder. Mean scores were 60.65 (SD = 10.42) for self-management, 35.76 (SD = 7.14) for social support, and 21.38 (SD = 5.06) for stigma. In the univariate analysis, age, educational level, method of payment for care, illness duration, and number of hospitalizations demonstrated significant associations with self-management (p < 0.05). Correlation analysis revealed a positive correlation between self-management and social support (r = 0.574, p < 0.01) and negative correlations between self-management and stigma (r = -0.489, p < 0.01) and stigma and social support (r = -0.476, p < 0.01). Multiple linear regression analysis included number of hospitalizations (β = -3.818), social support (β = 0.436), literacy (β = 2.132), and stigma (β = -0.397). Individuals in remission from bipolar disorder exhibit moderate levels of self-management. Follow-up interventions should prioritize enhancing social support and addressing stigma to promote improved self-management and overall well-being. [Journal of Psychosocial Nursing and Mental Health Services, 62(7), 26-35.].

Molecular mechanisms of quetiapine bidirectional regulation of bipolar depression and mania based on network pharmacology and molecular docking: Evidence from computational biology

BACKGROUND

Quetiapine monotherapy is recommended as the first-line option for acute mania and acute bipolar depression. However, the mechanism of action of quetiapine is unclear. Network pharmacology and molecular docking were employed to determine the molecular mechanisms of quetiapine bidirectional regulation of bipolar depression and mania.

METHODS

Putative target genes for quetiapine were collected from the GeneCard, SwissTargetPrediction, and DrugBank databases. Targets for bipolar depression and bipolar mania were identified from the DisGeNET and GeneCards databases. A protein-protein interaction (PPI) network was generated using the String database and imported into Cytoscape. DAVID and the Bioinformatics platform were employed to perform the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of the top 15 core targets. The drug-pathway-target-disease network was constructed using Cytoscape. Finally, molecular docking was performed to evaluate the interactions between quetiapine and potential targets.

RESULTS

Targets for quetiapine actions against bipolar depression (126 targets) and bipolar mania (81 targets) were identified. Based on PPI and KEGG pathway analyses, quetiapine may affect bipolar depression by targeting the MAPK and PI3K/AKT insulin signaling pathways via BDNF, INS, EGFR, IGF1, and NGF, and it may affect bipolar mania by targeting the neuroactive ligand-receptor interaction signaling pathway via HTR1A, HTR1B, HTR2A, DRD2, and GRIN2B. Molecular docking revealed good binding affinity between quetiapine and potential targets.

LIMITATIONS

Pharmacological experiments should be conducted to verify and further explore these results.

CONCLUSIONS

Our findings suggest that quetiapine affects bipolar depression and bipolar mania through distinct biological core targets, and thus through different mechanisms. Furthermore, our results provide a theoretical basis for the clinical use of quetiapine and possible directions for new drug development.

Interpersonal relationships and suicidal ideation among Chinese youths: A network analysis

BACKGROUND

Suicidal ideation is a noteworthy health problem that requires further study in the field of interpersonal relationships. The main scope of relationships include family, teachers, peers, and the Internet. However, few studies have considered the effects of interpersonal interactions. Based on the Interpersonal Theory of Suicide, this study explores the relation between different interpersonal relationships and suicidal ideation.

METHODS

A network analysis approach was used to test the relationships. Cross-sectional data (N = 1694; 52.1 % boys; Mage = 11.86 years, SD = 1.59) were collected from primary and secondary students in October-November 2022. Participants completed a survey including demographic part and questionnaires: Positive and Negative Suicide Ideation Inventory (PANSI), Interpersonal Needs Questionnaire (INQ), Family Adaptability and Cohesion Evaluation Scale (FACES II), Inventory of Parent and Peer Attachment (IPPA), Student-Teacher Relationship Scale (STRS) and Facebook Intensity Scale (FIS).

RESULTS

All variables showed a significant correlation in this inferred network. Family, teacher-student, and peer relationships are protective against suicidal ideation. The closeness of the teacher-student relationship showed the highest strength centrality. However, online interpersonal relationship is a risk factor for suicide. Thwarted belongingness and perceived burdensomeness are proximal factors of suicidal ideation that influenced all interpersonal relationships.

LIMITATIONS

The network analysis as a data-driven and exploratory method may be limited to provide exact cause and effect relationship.

CONCLUSIONS

This study shows that teacher-student connections may be more important than other relationships of young people. Improper peer and online interpersonal relationship could be risky for suicide. Further studies are needed to examine the role of these relationships elaborately.

The Epidemiological, Clinical, and Therapeutic Profile of Bipolar Patients in Eastern Morocco

INTRODUCTION

 Bipolar disorder is a severe psychiatric disorder. The objective of our study is to describe the epidemiological, clinical, and therapeutic profile of patients followed for bipolar disorder in this hospital.

MATERIALS AND METHODS

This is a cross-sectional, descriptive study conducted over a period of two years within the mental health and psychiatric diseases department of the Mohammed VI University Hospital in Oujda, Morocco, including 206 patients followed for bipolar disorder on an outpatient basis or hospitalized in one of the departments of the hospital.

RESULTS

We included in our study 206 patients with an average age of 37.34+/-12.53 and a male predominance. About 17% of our patients reported a personal medical history and 18.4%, a personal surgical history. Regarding the family history, 40.3% have a medical and surgical history and 63.1%, a psychiatric family history. The consumption of psychoactive substances is present in 49.5% of our patients. About 26.7% reported psychological trauma during childhood. Our patients have reported a history of suicide attempts with a prevalence of 26.6% in several settings: depressive (15%), delusional (5.8%), hallucinatory (3.9%), and anxious (1.9%). Several means were used during these suicide attempts, in particular, defenestration (40%), drug ingestion (36.4%), caustic ingestion (16.4%), strangulation (16.4%), and hanging (10.9%).

CONCLUSION

 It is important to develop a personalized approach to the patient wherever possible and, if necessary, to involve other specialists in diagnosis and treatment.

Assessment of Suicide Risk in Patients with Depressive Episodes Due to Affective Disorders and Borderline Personality Disorder: A Pilot Comparative Study

This study assessed suicidal risk in patients suffering from non-psychotic depressive disorders within various clinical and nosological forms (F31-F34 mood disorders and F60.31-emotionally unstable personality disorder). Clinical and psychological features were presented, as well as predictors of suicidal risk in patients of these groups. We performed a comparative analysis of the anxiety and depression level, the level of mental pain, fear of death and the severity of anti-suicidal motives in patients with affective disorders and borderline personality disorder (BPD). Based on the results, 100% of patients in these clinical nosological groups were found to have a high level of suicidal risk. Patients with affective disorders have weak anti-suicidal motives and are not fully aware of the consequences of their own death. Patients with BPD have a higher suicidal risk than patients with affective disorders; they are characterized by less pronounced social orientation, demonstrativeness, self-centeredness, less pronounced levels of anxiety and fear of death.

Latent Profile Analysis of Suicidal Ideation in Chinese Individuals with Bipolar Disorder

Individuals with bipolar disorder (BD) have a greater suicide risk than the general population. In this study, we employed latent profile analysis (LPA) to explore whether Chinese individuals with different phases of BD differed at the levels of suicidal ideation. We recruited 517 patients. Depressive symptoms were measured using the 24-item Hamilton Depression Rating Scale (HAMD-24), and manic symptoms were evaluated using the Young Mania Rating Scale (YMRS). The extent of suicidal thoughts was determined through the Beck Scale for Suicide Ideation (BSSI). The scores of HAMD and YMRS were used to perform LPA. LPA categorized participants into three classes: one exhibiting severe depressive and mild manic symptomatology, another showing severe depressive and severe manic symptomatology, and the third one displaying severe depressive and intermediate manic symptomatology. Suicidal ideation levels were found to be remarkably elevated across all three classes. Additionally, the three classes showed no significant differences in terms of suicidal ideation. Our research confirms the link between depressive symptoms and suicide, independent of the manic symptoms. These findings carry meaning as they provide insight into the suicide risk profiles within different phases of BD.

Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs

Adolescents are considered one of the most vulnerable groups affected by suicide. Rapid changes in adolescents' physical and mental states, as well as in their lives, significantly and undeniably increase the risk of suicide. Psychological, social, family, individual, and environmental factors are important risk factors for suicidal behavior among teenagers and may contribute to suicide risk through various direct, indirect, or combined pathways. Social-emotional learning is considered a powerful intervention measure for addressing the crisis of adolescent suicide. When deliberately cultivated, fostered, and enhanced, self-awareness, self-management, social awareness, interpersonal skills, and responsible decision-making, as the five core competencies of social-emotional learning, can be used to effectively target various risk factors for adolescent suicide and provide necessary mental and interpersonal support. Among numerous suicide intervention methods, school-based interventions based on social-emotional competence have shown great potential in preventing and addressing suicide risk factors in adolescents. The characteristics of school-based interventions based on social-emotional competence, including their appropriateness, necessity, cost-effectiveness, comprehensiveness, and effectiveness, make these interventions an important means of addressing the crisis of adolescent suicide. To further determine the potential of school-based interventions based on social-emotional competence and better address the issue of adolescent suicide, additional financial support should be provided, the combination of social-emotional learning and other suicide prevention programs within schools should be fully leveraged, and cooperation between schools and families, society, and other environments should be maximized. These efforts should be considered future research directions.

Early warning signals observed in motor activity preceding mood state change in bipolar disorder

INTRODUCTION

Alterations in motor activity are well-established symptoms of bipolar disorder, and time series of motor activity can be considered complex dynamical systems. In such systems, early warning signals (EWS) occur in a critical transition period preceding a sudden shift (tipping point) in the system. EWS are statistical observations occurring due to a system's declining ability to maintain homeostasis when approaching a tipping point. The aim was to identify critical transition periods preceding bipolar mood state changes.

METHODS

Participants with a validated bipolar diagnosis were included to a one-year follow-up study, with repeated assessments of the participants' mood. Motor activity was recorded continuously by a wrist-worn actigraph. Participants assessed to have relapsed during follow-up were analyzed. Recognized EWS features were extracted from the motor activity data and analyzed by an unsupervised change point detection algorithm, capable of processing multi-dimensional data and developed to identify when the statistical property of a time series changes.

RESULTS

Of 49 participants, four depressive and four hypomanic/manic relapses among six individuals occurred, recording actigraphy for 23.8 ± 0.2 h/day, for 39.8 ± 4.6 days. The algorithm detected change points in the time series and identified critical transition periods spanning 13.5 ± 7.2 days. For depressions 11.4 ± 1.8, and hypomania/mania 15.6 ± 10.2 days.

CONCLUSION

The change point detection algorithm seems capable of recognizing impending mood episodes in continuous flowing data streams. Hence, we present an innovative method for forecasting approaching relapses to improve the clinical management of bipolar disorder.

Investigating the relationship between DNA methylation, genetic variation, and suicide attempt in bipolar disorder

Individuals with bipolar disorder are at increased risk for suicide, and this can be influenced by a range of biological, clinical, and environmental risk factors. Biological components associated with suicide include DNA modifications that lead to changes in gene expression. Common genetic variation and DNA methylation changes are some of the most frequent types of DNA findings associated with an increased risk for suicidal behavior. Importantly, the interplay between genetic predisposition and DNA methylation patterns is becoming more prevalent in genetic studies. We hypothesized that DNA methylation patterns in specific loci already genetically associated with suicide would be altered in individuals with bipolar disorder and a history of suicide attempt. To test this hypothesis, we searched the literature to identify common genetic variants (N=34) previously associated with suicidal thoughts and behaviors in individuals with bipolar disorder. We then created a customized sequencing panel that covered our chosen genomic loci. We profiled DNA methylation patterns from blood samples collected from bipolar disorder participants with suicidal behavior (N=55) and without suicidal behavior (N=51). We identified seven differentially methylated CpG sites and five differentially methylated regions between the two groups. Additionally, we found that DNA methylation changes in MIF and CACNA1C were associated with lethality or number of suicide attempts. Finally, we identified three meQTLs in SIRT1 , IMPA2 , and INPP1 . This study illustrates that DNA methylation is altered in individuals with bipolar disorder and a history of suicide attempts in regions known to harbor suicide-related variants.

An ecological momentary cognitive assessment study of over-attribution of threat and suicide risk factors in people with serious mental illness

INTRODUCTION

People with serious mental illness (SMI; schizophrenia, schizoaffective disorder, bipolar disorder) are at increased risk of suicidal ideation (SI). Over-attribution of social threat, or attributing threatening emotions to neutral faces, may contribute to social isolation through increased social avoidance and decreased social approach motivation. These factors are related to suicide, as well as perceived burdensomeness (PB) and thwarted belongingness (TB). This study examined how over-attribution of threat relates to PB, TB, and social motivations.

METHOD

N = 273 participants with SMI were assessed for current SI and behavior, and were stratified into SI (N = 130) vs. non-SI (N = 143) groups. Participants completed smartphone surveys (via ecological momentary assessments [EMA]) 3×/day for 10 days. They also completed the Mobile Ecological Test of Emotion Recognition (METER) 1×/day. Linear mixed models and multi-level mediation tested the relationships between over-attribution of threat, METER performance, PB/TB, and social motivations.

RESULTS

Participants with and without SI did not significantly differ in over-attribution of threat or METER performance. In separate models, there was a relationship of over-attribution of threat with increased PB (B = 1.00, SE = 0.21, t = 4.72, p < .001), reduced social approach motivation (B = -0.74, SE = 0.22, t = -3.33, p < .001), and increased social avoidance (B = 0.90, SE = 0.24, t = 3.70, p < .001), all significant when adjusting for facial affect recognition ability. A model examining social motivations as a mediator between over-attribution of threat and PB/TB was not significant.

CONCLUSION

These results suggest that over-attribution of threat relates to interpersonal constructs related to SI irrespective of facial affect abilities. This study may inform understanding of social cognitive processes related to suicide in SMI.

Perceived loneliness and social support in bipolar disorder: relation to suicidal ideation and attempts

BACKGROUND

The suicide rate in bipolar disorder (BD) is among the highest across all psychiatric disorders. Identifying modifiable variables that relate to suicidal thoughts and behaviors (STBs) in BD may inform prevention strategies. Social connectedness is a modifiable variable found to relate to STBs in the general population, but differences exist across subgroups of the general population and findings specifically in BD have been equivocal. We aimed to clarify how perceived social connectedness relates to STBs in BD.

METHOD

146 adults (86 BD, 60 healthy controls) completed clinical interviews (Hamilton Depression Rating Scale; Structured Clinical Interview for DSM-5) and self-report measures of loneliness (UCLA Loneliness Scale) and social support (Interpersonal Support Evaluation List). Analyses explored differences in indicators of social connectedness (loneliness and social support) between BD participants and healthy controls, and explored relationships between STBs (lifetime suicide attempts and current suicidal ideation) and indicators of social connectedness in BD participants.

RESULTS

BD participants reported significantly higher loneliness and lower social support than healthy controls. In BD participants, perceived social support was significantly related to both ever having attempted suicide and number of lifetime attempts. Interestingly, perceived loneliness, but not social support, was significantly associated with current suicidal ideation.

CONCLUSIONS

Findings expand the evidence base supporting a relationship between perceived social connectedness and STBs in BD. They suggest that this modifiable variable could be a fruitful treatment target for preventing STBs in BD.

Associations of altered leukocyte DDR1 promoter methylation and childhood trauma with bipolar disorder and suicidal behavior in euthymic patients

Altered DNA methylation (DNAm) patterns of discoidin domain receptor 1 (DDR1) have been found in the blood and brain of patients with schizophrenia (SCZ) and the brain of patients with bipolar disorder (BD). Childhood trauma (CT) is associated with changes in DNAm that in turn are related to suicidal behavior (SB) in patients with several psychiatric disorders. Here, using MassARRAY® technology, we studied 128 patients diagnosed with BD in remission and 141 healthy controls (HCs) to compare leukocyte DDR1 promoter DNAm patterns between patients and HCs and between patients with and without SB. Additionally, we investigated whether CT was associated with DDR1 DNAm and mediated SB. We found hypermethylation at DDR1 cg19215110 and cg23953820 sites and hypomethylation at cg14279856 and cg03270204 sites in patients with BD compared to HCs. Logistic regression models showed that hypermethylation of DDR1 cg23953820 but not cg19215110 and CT were risk factors for BD, while cg14279856 and cg03270204 hypomethylation were protective factors. In patients, CT was a risk factor for SB, but DDR1 DNAm, although associated with CT, did not mediate the association of CT with SB. This is the first study demonstrating altered leukocyte DDR1 promoter DNAm in euthymic patients with BD. We conclude that altered DDR1 DNAm may be related to immune and inflammatory mechanisms and could be a potential blood biomarker for the diagnosis and stratification of psychiatric patients.

Suicide Probability Among Patients With Schizophrenia and Bipolar Disorder

PURPOSE

To evaluate the possibility of suicide and related factors among individuals with schizophrenia and bipolar disorder (BD).

METHOD

Data were collected for 270 individuals registered in a community mental health center using the Suicide Probability Scale (SPS). Subsequently, t test and multiple linear regression analyses were conducted on independent samples.

RESULTS

There was no statistically significant difference found between mean SPS scores of participants with schizophrenia and BD. However, hostility subscale mean scores of participants with schizophrenia were higher than those of participants with BD, and the difference was statistically significant. Sex, family history of mental illness, need for help with medication, suicidal ideation in the past 10 days, and number of suicide attempts were important predictors of suicide probability.

CONCLUSION

Individuals with schizophrenia and BD and in remission should be evaluated periodically for the possibility of suicide. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Predictive Value of qEEG in Manic Switch of Depressed Patients

Backgrounds: More than half of the patients with bipolar disorder (BD) had depressive episodes at the onset of BD. Despite some suggested clinical predictors, there are no certain criteria for predicting which unipolar depression patient switch to manic episodes during the treatment course. Electrophysiological markers can address this issue. Methods: Pretreatment quantitative electroencephalography (qEEG) records of patients diagnosed with major depressive disorder (MDD) or BD at the first visit were included in the study. Patients with MDD were also grouped with manic switch (MS) or MDD based on the diagnosis of later visits. The qEEG spectral power was analyzed across 3 groups, that is, MS, MDD, and BD. Results: Compared to patients whose diagnosis did not change, patients with MS had accelerated high-frequency activities predominantly in the left hemisphere (central-parietal-occipital regions). In contrast, they showed increased slow wave activity predominantly in the right hemisphere (parietal-occipital regions). Conclusion: It can be concluded that searching for electrophysiological markers, which have distinct advantages of repeatability, noninvasiveness, and cost-effectiveness, can facilitate the prediction of the MS.

Marked alteration of phosphoinositide signaling-associated molecules in postmortem prefrontal cortex with bipolar disorder

AIM

The etiology of bipolar disorder (BD) remains unknown; however, lipid abnormalities in BD have received increasing attention in recent years. In this study, we examined the expression levels of enzyme proteins associated with the metabolic pathway of phosphoinositides (PIs) and their downstream effectors, protein kinase B (Akt1) and glycogen synthase kinase 3β (GSK3β), which have been assumed to be the targets of mood stabilizers such as lithium, in the postmortem brains of patients with BD.

METHODS

The protein expression levels of phosphatidylinositol 4-phosphate 5-kinase type-1 gamma (PIP5K1C), phosphatidylinositol 4-kinase alpha (PIK4CA), phosphatase and tensin homolog deleted from chromosome 10 (PTEN), Akt1, and GSK3β were measured using enzyme-linked immunosorbent assays and multiplex fluorescent bead-based immunoassays in the prefrontal cortex (PFC). Specifically, PTEN, Akt1, GSK3β, and PIP5K1C were measured in seven BD patients and 48 controls. Additionally, PIK4CA was analyzed in 10 cases and 34 controls.

RESULTS

PTEN expression levels were markedly decreased in the PFCs of patients with BD, whereas those of Akt and GSK3β were prominently elevated. Moreover, patients medicated with lithium exhibited higher Akt1 expression levels and lower PTEN expression levels in comparison with the untreated group.

CONCLUSION

Our results suggest that the expression levels of Akt1/GSK3β and its upstream regulator PTEN are considerably altered.

The prevalence and clinical correlates of suicide attempts in patients with bipolar disorder misdiagnosed with major depressive disorder: Results from a national survey in China

BACKGROUND AND AIM

Suicide is nearly always associated with underlying mental disorders. Risk factors for suicide attempts (SAs) in patients with bipolar disorder (BD) misdiagnosed with major depressive disorder (MDD) remain unelucidated. This study was to evaluate the prevalence and clinical risk factors of SAs in Chinese patients with BD misdiagnosed with MDD.

METHODS

A total of 1487 patients with MDD from 13 mental health institutions in China were enrolled. Mini International Neuropsychiatric Interview (MINI) was used to identify patients with BD who are misdiagnosed as MDD. The general sociodemographic and clinical data of the patients were collected and MINI suicide module was used to identify patients with SAs in these misdiagnosed patients.

RESULTS

In China, 20.6% of patients with BD were incorrectly diagnosed as having MDD. Among these misdiagnosed patients, 26.5% had attempted suicide. These patients tended to be older, had a higher number of hospitalizations, and were more likely to experience frequent and seasonal depressive episodes with atypical features, psychotic symptoms, and suicidal thoughts. Frequent depressive episodes and suicidal thoughts during depression were identified as independent risk factors for SAs. Additionally, significant sociodemographic and clinical differences were found between individuals misdiagnosed with MDD in BD and patients with MDD who have attempted suicide.

CONCLUSIONS

This study highlights the importance of accurate diagnosis in individuals with BD and provide valuable insights for the targeted identification and intervention of individuals with BD misdiagnosed as having MDD and those with genuine MDD, particularly in relation to suicidal behavior.

Sex differences in serum trace elements and minerals levels in unmedicated patients with major depressive episode: The role of suicidal ideation

BACKGROUND

We aimed to examine the influence of gender on serum trace elements and minerals levels in depression, as well as the impact of suicidal ideation (SI) on these gender dimorphisms.

METHODS

A total of 260 unmedicated patients with a current major depressive episode were enrolled. The Beck Scale for Suicide Ideation was utilized to evaluate SI. The serum levels of copper, zinc, iron, calcium, phosphorus, and magnesium were quantified.

RESULTS

Within the non-SI (NSI) group, females exhibited higher levels of copper (p = 0.001) and phosphorus (p = 0.008), and lower levels of zinc (p = 0.022) and calcium (p = 0.008) compared to males. Conversely, no discernible gender disparities were observed in the SI group (all p > 0.05). Also, no group differences in these trace elements/minerals were observed between the SI and NSI groups (all p > 0.05). Notably, serum iron levels exhibited a significant group-by-sex interaction effect (p = 0.024). Further analysis revealed that iron levels were higher in the SI group than in the NSI group among females (p = 0.048), but lower in females than in males within the NSI group (p < 0.001). Moreover, a positive association between the fourth quantile of serum iron and SI was detected in females (odds ratio [OR] = 2.88, 95 % confidence interval [CI]: 1.08-8.11).

CONCLUSIONS

Gender effects on serum trace element/mineral levels were different in depressed patients with and without SI. Female patients were susceptible to SI when serum iron was at the upper end of normal.

Validation of a youth suicide risk calculator in an adult sample with bipolar disorder

BACKGROUND

Bipolar disorder (BD) conveys the highest risk of suicide of all mental disorders. We sought to externally validate a risk calculator (RC) of suicide attempts developed in youth with BD from the Course and Outcome of Bipolar Youth (COBY) study in an adult sample.

METHODS

A prospective cohort of adults with BD from the National Institute of Mental Health Collaborative Depression Study (CDS; N = 427; mean (+/- SD) age at intake (36 +/- 13 years)) was secondarily analyzed to validate the COBY RC for one-year risk of suicide attempts/deaths. Nine of the ten predictor variables from the COBY RC were available in the CDS and used: age, age of mood disorder onset, first and second (partial) degree family history of suicide, history of psychotic symptoms, substance use disorder, prior suicide attempt, socioeconomic status, and non-suicidal self-injury (prospectively, incompletely at baseline).

RESULTS

Over a mean (SD) follow-up of 19 (10) years, 29 % of the CDS sample attempted suicide. The RC predicted suicide attempts/deaths over one-year follow-up with an area under the receiver operating characteristic curve (AUC) of 0.78 (95 % CI 0.75-0.80). The RC performed slightly better in those with a younger age of mood disorder onset.

LIMITATIONS

Clinical samples may limit generalizability; the RC does not assess more acute suicide risk.

CONCLUSIONS

One-year risk of suicide attempts/deaths can be predicted with acceptable accuracy in youth and adults with BD, comparable to commonly used RCs to predict cardiovascular risk. This RC may help identify higher-risk individuals with BD for personalized treatment and research. https://cobysuicideattemptsrc.shinyapps.io/Shiny.

Cause-specific mortality and comorbid neurodevelopmental disorder in 167,515 patients with bipolar disorder: An entire population longitudinal study

OBJECTIVE

Studies addressing premature mortality in bipolar disorder (BD) patients are limited by small sample sizes. Herein, we used almost 99 % of the population of Taiwan to address this issue, and its association with comorbid neurodevelopmental disorders and severe BD.

METHODS

Between 2003 and 2017, we enrolled 167,515 individuals with BD and controls matched 1:4 for sex and birth year from the National Health Insurance Database linked to the Database of National Death Registry in Taiwan. Time-dependent Cox regression models were used to examine cause-specific mortality (all-cause, natural, and unnatural causes [accidents or suicide]).

RESULTS

With adjustments of sex, age, income, urbanization, and physical conditions, suicide was associated with the highest risk of mortality (reported as hazard ratio with 95 % confidence interval: 9.15; 8.53-9.81) among BD patients, followed by unnatural (4.94; 4.72-5.17), accidental (2.15; 1.99-2.32), and natural causes (1.02; 1.00-1.05). Comorbid attention-deficiency hyperactivity disorder did not contribute to the increased risk of cause-specific mortality; however, comorbid autism spectrum disorder (ASD) increased such risks, particularly for natural (3.00; 1.85-4.88) and accidental causes (7.47; 1.80-31.1). Cause-specific mortality revealed a linear trend with the frequency of psychiatric hospitalization (all, p for trend <0.001), and BD patients hospitalized twice or more each year had 34.63-fold increased risk of suicide mortality (26.03-46.07).

CONCLUSIONS

BD patients with a higher frequency of psychiatric hospitalization have the highest risk of suicide mortality, and comorbid ASD was associated with an increased risk of natural and accidental causes of mortality.

A diagnostic model based on bioinformatics and machine learning to differentiate bipolar disorder from schizophrenia and major depressive disorder

Bipolar disorder (BD) showed the highest suicide rate of all psychiatric disorders, and its underlying causative genes and effective treatments remain unclear. During diagnosis, BD is often confused with schizophrenia (SC) and major depressive disorder (MDD), due to which patients may receive inadequate or inappropriate treatment, which is detrimental to their prognosis. This study aims to establish a diagnostic model to distinguish BD from SC and MDD in multiple public datasets through bioinformatics and machine learning and to provide new ideas for diagnosing BD in the future. Three brain tissue datasets containing BD, SC, and MDD were chosen from the Gene Expression Omnibus database (GEO), and two peripheral blood datasets were selected for validation. Linear Models for Microarray Data (Limma) analysis was carried out to identify differentially expressed genes (DEGs). Functional enrichment analysis and machine learning were utilized to identify. Least absolute shrinkage and selection operator (LASSO) regression was employed for identifying candidate immune-associated central genes, constructing protein-protein interaction networks (PPI), building artificial neural networks (ANN) for validation, and plotting receiver operating characteristic curve (ROC curve) for differentiating BD from SC and MDD and creating immune cell infiltration to study immune cell dysregulation in the three diseases. RBM10 was obtained as a candidate gene to distinguish BD from SC. Five candidate genes (LYPD1, HMBS, HEBP2, SETD3, and ECM2) were obtained to distinguish BD from MDD. The validation was performed by ANN, and ROC curves were plotted for diagnostic value assessment. The outcomes exhibited the prediction model to have a promising diagnostic value. In the immune infiltration analysis, Naive B, Resting NK, and Activated Mast Cells were found to be substantially different between BD and SC. Naive B and Memory B cells were prominently variant between BD and MDD. In this study, RBM10 was found as a candidate gene to distinguish BD from SC; LYPD1, HMBS, HEBP2, SETD3, and ECM2 serve as five candidate genes to distinguish BD from MDD. The results obtained from the ANN network showed that these candidate genes could perfectly distinguish BD from SC and MDD (76.923% and 81.538%, respectively).

The altered temporal properties of dynamic functional connectivity associated with suicide attempt in bipolar disorders

OBJECTIVE

The suicide risk in bipolar disorder (BD) is the highest among psychiatric disorders, and the neurobiological mechanism of suicide in BD remains unclear. The study aimed to investigate the underlying relevance between the implicated abnormalities of dynamic functional connectivity (FC) and suicide attempt (SA) in BD.

METHODS

We used the sliding window method to analyze the dynamic FC patterns from resting-state functional MRI data in 81 healthy controls (HC) and 114 BD patients (50 with SA and 64 with none SA). Then, the temporal properties of dynamic FC and the relationship between altered measures and clinical variables were explored.

RESULTS

We found that one of the five captured brain functional states was more associated with SA. The SA patients showed significantly increased fractional window and dwell time in the suicide-related state, along with increased number of state transitions compared with none SA (NSA). In addition, the connections within subcortical network-subcortical network (SubC-SubC), default mode network-subcortical network (DMN-SubC), and attention network-subcortical network (AN-SubC) were significantly changed in SA patients relative to NSA and HC in the suicide-related state. Crucially, the above-altered measures were significantly correlated with suicide risk.

CONCLUSIONS

Our findings suggested that the impaired dynamic FC within SubC-SubC, DMN-SubC, and AN-SubC were the important underlying mechanism in understanding SA for BD patients. It highlights the temporal properties of whole-brain dynamic FC could serve as the valuable biomarker for suicide risk assessment in BD.

To be or not to be: The active inference of suicide

Suicide presents an apparent paradox as a behavior whose motivation is not obvious since its outcome is non-existence and cannot be experienced. To address this paradox, we propose to frame suicide in the integrated theory of stress and active inference. We present an active inference-based cognitive model of suicide as a type of stress response hanging in cognitive balance between predicting self-preservation and self-destruction. In it, self-efficacy emerges as a meta-cognitive regulator that can bias the model toward either survival or suicide. The model suggests conditions under which cognitive homeostasis can override physiological homeostasis in motivating self-destruction. We also present a model proto-suicidal behavior, programmed cell death (apoptosis), in active inference terms to illustrate how an active inference model of self-destruction can be embodied in molecular mechanisms and to offer a hypothesis on another puzzle of suicide: why only humans among brain-endowed animals are known to practice it.

Sex differences in the effects of repeated ketamine infusions on bone markers in patients with unipolar and bipolar depression

BACKGROUND

Patients with depression, especially women, are associated with low bone mineral density (BMD). Traditional antidepressants are associated with negative effects on BMD. Few studies have examined the effect of ketamine on BMD, and it remains unclear whether there are sex differences in the effects of ketamine on BMD in patients with depression.

METHODS

A total of 102 patients with unipolar and bipolar depression were administered six infusions of intravenous ketamine over a 12-day period. Plasma levels of eight bone markers were examined at baseline, 24 h after the sixth infusion and again 2 weeks (Days 13 and 26).

RESULTS

Linear mixed models showed all bone markers had significant time main effect (all p < 0.05). Compared with baseline, the whole sample showed increased levels of leptin and osteoprotegerin at Days 13 and 26, as well as Dickkopf-related protein 1 at Day 13, and decreased levels of osteocalcin, sclerostin, osteopontin, parathyroid hormone and fibroblast growth factor 23 at Days 13 and 26 (all p < 0.05). Females had a higher level of leptin at Days 13 and 26, and lower levels of osteocalcin and sclerostin at Day 13 than males (all p < 0.05). Increases of leptin were associated with depressive symptom improvements at Day 13 and Day 26 in females (both p < 0.05). In males, higher baseline osteocalcin levels were associated with greater depressive symptom improvement at Day 26 (β = 0.414, p = 0.009).

CONCLUSIONS

Our results suggest that repeated ketamine infusions may be associated with modulation of bone markers in patients with depression and present sex differences. Baseline osteocalcin level may be served as a predictor for the antidepressant effects of ketamine in males. Trial registration Data were derived from an open label clinical trial, which was registered at Chinese Clinical Trial Registry (ChiCTR-OOC-17012239). Registered 26 May 2017. http://www.chictr.org.cn.

Is There Somebody Looking out for Me? A Qualitative Analysis of Bullying Experiences of Individuals Diagnosed with Bipolar Disorder

According to the World Health Organisation, there are globally 40 million individuals with bipolar disorder (BD), and they experience stigma and discrimination, as many people with mental illness do. Work bullying (WB) is a common organisational problem, deteriorating the well-being and performance of employees and organisations. Although WB experiences have been researched for over three decades, we do not know much about the experiences of this group and what they need to extend their work-life. The current research aims to understand the workplace bullying experiences of individuals with BD and factors that may foster or hinder their participation in the labour force. The research methodology was based on in-depth interviews with 19 employees diagnosed with BD. Bullying experiences were mapped onto the Negative Acts Questionnaire. The data were analysed using the deductive qualitative content analysis on MAXQDA. Results showed that individuals with BD were exposed to bullying in work settings. Perceived reasons for the negative behaviours were mainly the undesirable individual characteristics of the bully, prejudices toward bipolar disorder, and already-existing toxic behaviours within the organisation. To reduce bullying, participants suggested that, among others, top management include equal and fair treatment of disadvantaged employees as performance criteria for supervisors and that organisations provide training against bullying, investigate complaints, apply sanctions, and establish an inclusive environment. If organisations set a stable and enduring vision, enhance a common identity for all employees, work on team building, and emphasise team efforts and goals, the organisational environment would be more inclusive, and individuals with BD would have longer work lives.

Impact of Toxoplasma gondii and Human Microbiome on Suicidal Behavior: A Systematic Review

BACKGROUND

Suicide remains a persistent global health challenge, resisting widespread prevention efforts. According to previous findings, toxoplasmosis is particularly associated with altered decision making, which could lead to risk-taking behavior, thereby increasing the likelihood for suicidal behavior (SB). In addition, discussion about the role of microbiome in psychiatric disorders has emerged lately, which also makes it relevant to investigate its role in the context of SB. Therefore, two systematic reviews are integrated in this paper, and the existing knowledge is comprehensively summarized regarding the association between microbial pathogens and SB.

METHODS

We conducted a systematic search with keywords including SB and Toxoplasma gondii (Suicid* AND Toxoplasm*) and microbiome (Suicid* AND Microbiome AND Microbiota) throughout PubMed and Scopus to retrieve related studies up to 9 November 2023, identifying 24 eligible records. The subjects of the included studies had to have fulfilled the criteria of an SB disorder as defined by DSM-5, and death cases needed to have been defined as suicide.

RESULTS

Most studies reported significant association between toxoplasmosis and SB, suggesting a higher likelihood of SB in the infected population. Regarding the microbiome, only very few studies investigated an association between SB and alterations in the microbiome. Based on six included studies, there were some indications of a link between changes in the microbiome and SB.

CONCLUSION

The cognitive aspects of decision making in T. gondii-infected individuals with SB should be further investigated to unravel the underlying mechanisms. Further sufficiently powered studies are needed to establish a link between SB and alterations in the microbiome.

Focal adhesion is associated with lithium response in bipolar disorder: evidence from a network-based multi-omics analysis

Lithium (Li) is one of the most effective drugs for treating bipolar disorder (BD), however, there is presently no way to predict response to guide treatment. The aim of this study is to identify functional genes and pathways that distinguish BD Li responders (LR) from BD Li non-responders (NR). An initial Pharmacogenomics of Bipolar Disorder study (PGBD) GWAS of lithium response did not provide any significant results. As a result, we then employed network-based integrative analysis of transcriptomic and genomic data. In transcriptomic study of iPSC-derived neurons, 41 significantly differentially expressed (DE) genes were identified in LR vs NR regardless of lithium exposure. In the PGBD, post-GWAS gene prioritization using the GWA-boosting (GWAB) approach identified 1119 candidate genes. Following DE-derived network propagation, there was a highly significant overlap of genes between the top 500- and top 2000-proximal gene networks and the GWAB gene list (Phypergeometric = 1.28E-09 and 4.10E-18, respectively). Functional enrichment analyses of the top 500 proximal network genes identified focal adhesion and the extracellular matrix (ECM) as the most significant functions. Our findings suggest that the difference between LR and NR was a much greater effect than that of lithium. The direct impact of dysregulation of focal adhesion on axon guidance and neuronal circuits could underpin mechanisms of response to lithium, as well as underlying BD. It also highlights the power of integrative multi-omics analysis of transcriptomic and genomic profiling to gain molecular insights into lithium response in BD.

Correlation between low frequency fluctuation and cognitive performance in bipolar disorder patients with suicidal ideation

BACKGROUND

Patients with bipolar disorder (BD) are at high risk of suicidal ideation (SI), and BD patients with suicidal ideation (BDSI) have shown marked abnormalities in spontaneous brain function. Cognitive impairment, on the other hand, is considered to be one of the core symptoms of BD. However, few studies have addressed the association between cognitive performance and abnormal spontaneous brain function in BDSI.

METHODS

In the current study, the MATRICS Consensus Cognitive Battery (MCCB) was used to assess cognitive performance in BDSI (n = 20), BD subjects without suicidal ideation (BDNSI) (n = 24) and healthy controls (HC) (n = 30). Their cognitive performance was then correlated with amplitude of low frequency fluctuation (ALFF) values obtained by resting-state functional magnetic resonance imaging (rs-fMRI).

RESULTS

We found that ALFF was significantly higher in the left precuneus and right posterior cingulate cortex in the BDSI group and significantly lower in the right precuneus in the BDNSI group than in the HC group. In addition, in the BDSI group, visual learning performance was positively correlated with ALFF values in the left precuneus.

CONCLUSIONS

Our findings support the notion that BD patients present with ALFF abnormalities, which are associated with cognitive performance in BDSI.

Ketamine, an Old-New Drug: Uses and Abuses

Ketamine as an old-new drug has a variety of clinical implications. In the last 30 years, ketamine has become popular for acute use in humans. Ketamine in standard doses is principally utilized for the induction and maintenance of surgical procedures. Besides its use in anesthesia and analgesia, recent studies have shown that ketamine has found a place in the treatment of asthma, epilepsy, depression, bipolar affective disorders, alcohol and heroin addiction. Ketamine primarily functions as a noncompetitive antagonist targeting the N-methyl-D-aspartate (NMDA) receptor, but its mechanism of action is complex. It is generally regarded as safe, with low doses and short-term use typically not leading to significant adverse effects. Also, ketamine is known as a powerful psychostimulant. During the past decade, ketamine has been one of the commonly abused drugs.

Suicidality and its associated factors among mood disorder patients in emergency department in China: a comparative study using propensity score matching approach

Suicidality in mood disorder patients is common, especially in emergency department (ED), but the patterns and associated factors of suicidality are not clear. This study compared biomarkers and mental health symptoms (i.e., depression, anxiety, and psychiatric symptoms) between mood disorder patients with and without the whole range of suicidality comprising suicidal ideation (SI), suicide plan (SP), and suicide attempt (SA). This cross-sectional, comparative, convenient-sampling study was conducted between January 2021 and March 2022, in emergency department of Beijing Anding Hospital, China. Patients with mood disorders at a psychiatric emergency department were assessed, with measurements of suicidality, biomarkers, depressive, anxiety, and psychiatric symptoms were assessed using the 24 items-Hamilton Depression Rating Scale (HAMD-24), Hamilton Anxiety Rating Scale (HAMA), Young Manic Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS), respectively. The propensity score matching (PSM) method was used to identify patients in mood disorder with and without SI, SP, and SA. A generalized linear model (GLM) was used to assess the differences in biomarkers, depressive, anxiety, and psychiatric symptoms between patients in mood disorder with and without SI, SP, and SA. In total, 898 participated in this survey and completed the assessment. Illness duration was significantly negatively associated with SA (OR = 0.969, 95%CI = 0.939-0.999, P = 0.046). HAMD-24 total score was significantly positively associated with the SI (OR = 1.167, 95%CI = 1.134-1.201, p < 0.001), SP (OR = 1.159, 95%CI = 1.126-1.192, p < 0.001) and SA (OR = 1.189, 95%CI = 1.144-1.235, p < 0.001) of the matched samptched sample. However, YMRS total score was significantly negatively associated with the SI (OR = 0.928, 95%CI = 0.905-0.951, p < 0.001), SP (OR = 0.920, 95%CI = 0.897-0.944, p < 0.001) and SA (OR = 0.914, 95%CI = 0.890-0.938, p < 0.001) of the matched sample after adjusting for age, gender, marital status, and occupation. The duration of illness, severity of depressive symptoms and severity of manic symptoms appeared to be more likely to influence suicidality. Considering the significant risk of suicide in mood disorders on psychiatric emergency care, timely treatment and effective management of suicidality in this population group need to be developed.

Mapping Violent Behaviors and Psychiatric Symptoms Among Male Psychiatric Inpatients from a Network Perspective

Psychiatric symptoms are common risk factors of violent behaviors among psychiatric patients. This study explored the interrelationship between violence and psychiatric symptoms in male psychiatric inpatients. This is a cross-sectional survey conducted in 2019. All patients admitted to the Male Psychiatry Unit of the Second Xiangya Hospital were consecutively recruited. The presence of five violent behaviors and eleven psychiatric symptoms were collected by reviewing medical records and were included as categorical variable in the network analyses. A total of 673 participants were included. The most central symptoms were "flight of ideas", "property-oriented violence", "emotional high", "verbal violence", "physical violence attempt", and "physical violence" in the network of psychiatric symptoms and violent behaviors. The bridge symptoms connecting violence and psychiatric symptoms were "verbal violence", "property-oriented violence", "hyperbulia", and "emotional high" according to the indices of bridge expected influence. The directed acyclic graph analysis revealed that "emotional high" and "hyperbulia" were the key psychiatric symptoms triggering violence, while "verbal violence" and "property-oriented violence" were the most upstream violent behavior. Verbal and property-oriented violence should be addressed in the risk assessment among male psychiatric inpatients. In addition, emotional high and hyperbulia are the potential treatment targets for violent behaviors.

Bipolar affective disorder in India: A multi-site population-based cross-sectional study

Introduction

Bipolar Affective Disorder (BPAD) merits careful consideration within the medical and healthcare communities, researchers, and policymakers. This is due to its substantial disability burden, elevated prevalence of co-morbidities, heightened lifetime risk of suicidality, and a significant treatment gap. This article focuses on the lifetime and current prevalence, correlates, co-morbidities, associated disabilities, socio-economic impact, and treatment gap for BPAD in the adult population of the National Mental Health Survey (NMHS) 2016.

Materials and Methods

The NMHS 2016 was a nationally representative study conducted across 12 Indian states between 2014 and 2016. A multi-stage, stratified, random cluster sampling technique based on probability proportionate to size at each stage was used. The diagnosis of BPAD was based on Mini-International Neuropsychiatric Interview 6.0.0. Sheehan's Disability Scale was used to assess the disability.

Results

A total of 34,802 adults were interviewed. The overall weighted prevalence of BPAD was 0.3% [95% confidence interval (CI): 0.29-0.31] for current and 0.5% (95% CI: 0.49-0.51) for lifetime diagnosis. Male gender [odds ratio (OR) 1.56] and residence in urban metropolitans (OR 2.43) had a significantly higher risk of a lifetime diagnosis of BPAD. Substantial cross-sectional co-morbidities were noted as per MINI 6.0.0 with the diagnosis of current BPAD such as tobacco use disorder (33.3%), other substance use disorders (14.6%), and anxiety disorders (10.4%). Two-thirds of persons with current BPAD reported disability of varying severity at work (63%), social (59.3%), and family life (63%). The treatment gap for current BPAD was 70.4%.

Conclusion

Most individuals with current BPAD reported moderate-severe disability. There were substantial co-morbidities and a large treatment gap. These warrant concentrated efforts from policymakers in devising effective strategies.

Neuroprotective effects of dimethyl fumarate against manic-like behavior induced by ketamine in rats

Medications for treating bipolar disorder (BD) are limited and can cause side effects if used chronically. Therefore, efforts are being made to use new agents in the control and treatment of BD. Considering the antioxidant and anti-inflammatory effects of dimethyl fumarate (DMF), this study was performed to examine the role of DMF on ketamine (KET)-induced manic-like behavior (MLB) in rats. Forty-eight rats were randomly divided into eight groups, including three groups of healthy rats: normal, lithium chloride (LiCl) (45 mg/kg, p.o.), and DMF (60 mg/kg, p.o.), and five groups of MLB rats: control, LiCl, and DMF (15, 30, and 60 mg/kg, p.o.), which received KET at a dose of 25 mg/kg, i.p. The levels of total sulfhydryl groups (total SH), thiobarbituric acid reactive substances (TBARS), nitric oxide (NO), and tumor necrosis factor-alpha (TNF-α), as well as the activity of antioxidant enzymes including catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx) in the prefrontal cortex (PFC) and hippocampus (HPC), were measured. DMF prevented hyperlocomotion (HLM) induced by KET. It was found that DMF could inhibit the increase in the levels of TBARS, NO, and TNF-α in the HPC and PFC of the brain. Furthermore, by examining the amount of total SH and the activity of SOD, GPx, and CAT, it was found that DMF could prevent the reduction of the level of each of them in the brain HPC and PFC. DMF pretreatment improved the symptoms of the KET model of mania by reducing HLM, oxidative stress, and modulating inflammation.

Associations of potential plasma biomarkers with suicide attempt history, current suicidal ideation and subsequent suicidal events in patients with depression: A discovery study

A growing body of evidences suggests that suicidal ideation (SI) and suicidal behaviors have biological bases. However, no biological marker is currently available to evaluate the suicide risk in individuals with SI or suicide attempt (SA). Moreover, the current risk assessment techniques poorly predict future suicidal events. The aim of this study was to examine the association of 39 new and already described peripheral cells and proteins (implicated in the immune system, oxidative stress and plasticity) with lifetime SA, past month SA, current SI, and future suicidal events (visit to the Emergency Department for SI or SA) in 266 treatment-seeking individuals with mood disorders. Equal parts of patients with and without past history of SA were recruited. All individuals at inclusion gave blood, were evaluated for SA recency, current SI, and were followed for two years afterwards. The 39 peripheral blood cellular and protein markers were entered separately for each outcome in Elastic Net models with 10-fold cross-validation, followed by single-analyte covariate-adjusted regression analyses for pre-selected analytes. Past month SA was associated with increased plasma levels of thrombospondin-2 and C-reactive protein, whereas current SI was associated with lower plasma serotonin levels. These associations were robust to adjustments for key covariates and corrections for multiple testing. The Cox proportional hazards regression showed that higher levels of thrombospondin-1 and of platelet-derived growth factor-AB predicted a future suicidal event. These two associations remained after adjustment for sex, age, and SA history, and outperformed the predictive value of past SA. Thrombospondins and platelet-derived growth factors have never been investigated in the context of suicide. Altogether, our results highlight the involvement in the suicidal process of platelet biological response and plasticity modifiers and also of inflammatory factors. They also suggest that SI and SA may have different biological correlates and that biomarkers associated with past SA or current SI do not automatically also predict future events.

Suicide Safety Plan Self-knowledge in Serious Mental Illness: Psychiatric Symptom Correlates and Effects of Brief Intervention

Psychiatric symptoms experienced by people with serious mental illness (SMI; schizophrenia, bipolar and other psychotic disorders) may impact suicide safety planning. This study examined safety plan self-knowledge, or an individual's own knowledge and awareness of their safety plan, in a sample of people with SMI. Participants (N = 53) with SMI at elevated risk of suicide completed a 4-session intervention that included safety plans, with one intervention group that included mobile augmentation. Self-knowledge was assessed from previous safety plans at 4-, 12- and 24-weeks. Fewer warning signs generated was correlated with greater psychiatric symptoms (r = - .306, p = .026) and suicidal ideation (r = - .298, p = .030). Fewer coping strategies generated was correlated with greater suicidal ideation (r = .- 323, p = .018). Preliminarily, there was greater self-knowledge of warning signs over time among participants in the mobile intervention. These preliminary findings highlight the relationship of safety plan self-knowledge to symptoms and suggest that mobile augmentation of safety planning may be beneficial. Trial Registration: NCT03198364.

How do bipolar disease states affect positive and negative emotion processing? Insights from a meta-analysis on the neural fingerprints of emotional processing

BACKGROUND

Functional magnetic resonance imaging studies on emotion processing in patients with bipolar disorder (BD) show hyperactivity of limbic-striatal brain areas and hypoactivity in inferior frontal areas compared to healthy participants. However, heterogeneous results in patients with different disease states and different valences of emotional stimuli have been identified.

METHODS

To integrate previous results and elucidate the impact of disease state and stimulus valence, we conducted a systematic literature search for journal articles in the Web of Science Core Collection including MEDLINE databases and employed a coordinate-based-meta-analysis of functional-MRI studies comparing emotion processing in BD-patients with healthy participants using seed-based d mapping (SDM) to test for between-subjects-effects. We included 31 studies published before 11/2022 with a total of N = 766 BD-patients and N = 836 controls.

RESULTS

Patients with BD showed hyperactivated regions involved in salience processing of emotional stimuli (e.g., the bilateral insula) and hypoactivation of regions associated with emotion regulation (e.g., inferior frontal gyrus) during emotion processing, compared to healthy participants. A more detailed descriptive analysis revealed a hypoactive (anterior) insula in manic BD-patients specifically for negative in comparison to positive emotion processing.

DISCUSSION

This meta-analysis corroborates the overall tenor of existing literature that patients with BD show an increased emotional reactivity (hyperactivity of salience-processing regions) together with a lower (cognitive) control (hypoactivity of brain areas associated with emotion regulation) over emotional states. Our analysis suggests reduced interoceptive processing of negative stimuli in mania, pointing out the need for longitudinal within-subject analyses of emotion processing.

Impaired olfactory function in bipolar disorder patients during acute episodes regardless of psychotic symptoms

Background

The aim of this study was to analyze whether the presence of psychotic symptoms affects olfactory function in patients with bipolar disorder (BD). We also compared olfactory function between the period of episode and remission in patients with BD.

Methods

BD patients in the acute phase were tracked to the remission stage. The psychiatric symptoms and social function of the enrolled subjects were assessed using the Hamilton Rating Scale for Depression (HAMD), the Young Mania Rating Scale (YMRS), the Hamilton Rating Scale for Anxiety (HAMA), the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment Function (GAF). Olfactory sensitivity (OS) and olfactory identification (OI) was assessed using the Sniffin' Sticks test. Differences in OS and OI among the episodic group, the euthymic group, and the healthy control (HC) group were compared. According to whether BD is accompanied by psychotic symptoms, the OS and OI in the BD with psychotic symptoms group (P-BD), the BD without psychotic symptoms group (NP-BD), and the HC group were compared.

Results

The P-BD and NP-BD groups exhibited impaired OI compared with the HC group, but there was no significant difference in OI between the P-BD and NP-BD groups, or in OS among all three groups. All patients with episodic BD had significantly lower OS and OI compared with the HC group. OI in euthymic BD patients was still impaired; however, OS recovered, showing no significant difference compared with that in the HC group.

Conclusion

The results indicate that patients with episodic BD have impaired OS and OI, regardless of psychotic symptoms. OI may be a characteristic marker of BD, and OS may be a state marker that can be used to distinguish between episodic and euthymic BD.

Drug Safety and Suicidality Risk of Chronic Pain Medications

Chronic pain is one of the main leading causes of disability in the world at present. A variety in the symptomatology, intensity and duration of this phenomenon has led to an ever-increasing demand of pharmacological treatment and relief. This demand for medication, ranging from well-known groups, such as antidepressants and benzodiazepines, to more novel drugs, was followed by a rise in safety concerns of such treatment options. The validity, frequency, and diversity of such concerns are discussed in this paper, as well as their possible effect on future prescription practices. A specific caution is provided towards the psychological safety and toll of these medications, regarding suicidality and suicidal ideation. Most significantly, this paper highlights the importance of pharmacovigilance and underscores the necessity of surveillance programs when considering chronic pain medication.

Positive mental health in adults with bipolar disorder: exploring social support subtypes, negative social interactions and potential to flourish

BACKGROUND

Bipolar disorder (BD) (i.e., BD-I or BD-II) is a serious mental illness (SMI) that can cause significant life challenges, but its impact and management may be mediated by psychosocial factors. This study's primary objectives were to investigate whether adults with BD differ from those without in terms of social support, negative social interactions (NSIs), and positive mental health (PMH). Secondly, examine whether gender differences exist in terms of these variables, as well as whether specific social support subscales and NSI predict PMH for those with BD.

METHODS

Using data extracted from a national Canadian survey, 563 adults reporting a lifetime BD diagnosis were compared to a matched, non-BD sample using the Social Provisions Scale 10 Items (SPS-10), the NSI Scale, and the Mental Health Continuum - Short Form (MHC-SF) Scale. For the BD sample, males and females were compared based on study variables, and hierarchical regressions were subsequently performed to assess whether SPS-10 subscales and NSIs predicted PMH.

RESULTS

Respondents with BD reported significantly lower SPS-10 and PMH scores, and significantly higher NSI scores. Within the BD sample, females reported significantly higher SPS-10 and NSIs scores, and 'social integration' and 'reassurance of worth' positively predicted PMH, while NSI uniquely predicted lower PMH levels for both males and females.

CONCLUSIONS

The results implicate specific psychosocial factors and gender in the degree to which adults with BD might flourish, particularly in terms negative relationships. The implications of social erosion and the bi-directionality of social support are also considered.

Gender differences in suicide among patients with bipolar disorder: A systematic review and meta-analysis

OBJECTIVE

To examine gender differences in suicidal ideation, suicide attempts, and suicide deaths in patients with bipolar disorder.

METHODS

PubMed, Web of Science, and Embase were systematic searched from inception to March 7, 2023. Two reviewers extract data independently. Demographic data, the number of males and females with bipolar disorder, and the number of individuals with suicidal ideation, suicide attempts, and suicide deaths among participants were extracted.

RESULTS

The pooled prevalence of suicidal ideation in males and females was 48.0 % and 44.0 %, respectively, and the overall male-to-female ratios present a statistically insignificant result (OR = 0.95, 95%CI = 0.75-1.21) among patients with bipolar disorder. The pooled prevalence of suicide attempts in males and females was 6.7 % and 9.3 %, respectively, and there was a statistically significant lower prevalence among male patients with bipolar disorder (OR = 0.71, 95%CI = 0.67-0.75). However, the pooled prevalence of suicide deaths in males and females was 0.7 % and 0.3 % respectively, and there was a statistically significant higher prevalence among male patients with bipolar disorder (OR = 1.86, 95%CI = 1.63-2.13).

LIMITATIONS

The included studies were from mainly middle- and high-income countries and used inconsistent measurement tools. Thus, there is a potential for bias in our results.

CONCLUSIONS

Among patients with bipolar disorder, females were found to have a higher prevalence of suicide attempts, while males have a higher prevalence of suicide deaths. However, there is no significant gender difference in suicidal ideation. Efforts to optimize recognition, treatment, and administration in males and females may reduce gender differences.

Prevalence of suicidal ideation and suicide attempts in individuals with psychosis and bipolar disorder in South Asia: systematic review and meta-analysis

BACKGROUND

Suicidal ideation and attempts are growing public health concerns globally. Evidence from high-income countries suggests that individuals with psychosis and bipolar disorder are at increased risk of suicidal ideation and attempts, but there is a scarcity of evidence from South Asia.

AIMS

To estimate the prevalence of suicidal ideation and attempts in individuals with psychosis and bipolar disorder in South Asia.

METHOD

In this systematic review and meta-analysis, four databases (PsycINFO, Web of Science, EMBASE and Medline) were searched until December 2022. Pooled prevalence was estimated with random-effects models. Heterogeneity was quantified with the I2-statistic.

RESULTS

The pooled sample size across the 21 studies was 3745 participants, 1941 (51.8%) of which were male. The pooled prevalence of suicide attempts in South Asian people with either psychosis or bipolar disorder was 22% (95% CI 17-27; n = 15). The pooled prevalence of suicidal ideation with psychosis or bipolar disorder combined was 38% (95% CI 27-51; n = 10). Meta-regression, subgroup and sensitivity analysis showed that the pooled prevalence estimates for both suicide attempt and ideation remained unaffected by variations in critical appraisal ratings and study designs. Only one study reported data on suicide-related deaths.

CONCLUSIONS

One in four individuals diagnosed with psychosis or bipolar disorder have reported suicide attempts, whereas up to one in three have experienced suicidal ideation. These findings underscore the urgent need for clinicians to regularly assess and monitor suicidal ideation and attempts among individuals with these disorders in South Asia.

Diagnosis and Treatment of Bipolar Disorder: A Review

Importance

Bipolar disorder affects approximately 8 million adults in the US and approximately 40 million individuals worldwide.

Observations

Bipolar disorder is characterized by recurrent episodes of depression and mania or hypomania. Bipolar depressive episodes are similar to major depressive episodes. Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods. The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation. Approximately 75% of symptomatic time consists of depressive episodes or symptoms. Early diagnosis and treatment are associated with a more favorable prognosis. Diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode. Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine. Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain. Antidepressants are not recommended as monotherapy. More than 50% of patients with bipolar disorder are not adherent to treatment. Life expectancy is reduced by approximately 12 to 14 years in people with bipolar disorder, with a 1.6-fold to 2-fold increase in cardiovascular mortality occurring a mean of 17 years earlier compared with the general population. Prevalence rates of metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%) are higher among people with bipolar disorder, contributing to the risk of early mortality. The annual suicide rate is approximately 0.9% among individuals with bipolar disorder, compared with 0.014% in the general population. Approximately 15% to 20% of people with bipolar disorder die by suicide.

Conclusions and Relevance

Bipolar disorder affects approximately 8 million adults in the US. First-line therapy includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine.

Aberrant functional connectivity within and between brain networks in patients with early-onset bipolar disorder

OBJECTIVE

This study used independent component analysis (ICA) to investigate the connectivity patterns of resting-state functional large-scale brain networks in patients with early-onset bipolar disorder (BD).

METHODS

ICA was used to extract brain functional network components from 43 early-onset BD patients and 21 healthy controls (HCs). Then, the functional connectivity (FC) and functional network connectivity (FNC) within and between the independent brain networks was calculated, and the correlation between the connectivity changes and neuropsychological scale was evaluated.

RESULTS

Compared with HCs, FC increased in the right hippocampus and inferior temporal gyrus, and left triangular inferior frontal gyrus of the anterior default mode network (aDMN); right median cingulate and paracingulate gyri, and inferior parietal lobule of the posterior DMN (pDMN); and right precentral and postcentral gyrus of the sensorimotor network (SMN) in early-onset BD patients. However, FC decreased in the left superior frontal gyrus of the aDMN, left paracentral lobule of the SMN, and left lingual gyrus and calcarine of the visual network in early-onset BD patients. There was no significant correlation between FC values of differential brain regions within resting-state networks (RSNs) and neuropsychological scores (uncorrected p > 0.05). In addition, the FNC among the pDMN-auditory network, pDMN-visual network, left frontoparietal network (lFPN)-visual network, lFPN-aDMN and dorsal attention network-ventral attention network (DAN-VAN) were increased in early-onset BD patients. The zFNC of the pDMN-visual network was positively correlated with the anxiety/somatization score (r = 0.5833, p < 0.0001) and sleep disorders (r = 0.6150, p < 0.0001). The zFNC of the lFPN-aDMN was positively correlated with despair (r = 0.4505, p = 0.004 × 10 < 0.05 after Bonferroni correction). The zFNC of the DAN-VAN was positively correlated with cognitive impairment (r = 0.4598, p = 0.0032 × 10 < 0.05 after Bonferroni correction). The zFNC of the DAN-VAN showed a positive correlation trend with the Hamilton Depression Scale (HAMD) total score (r = 0.4404, p = 0.005 × 10 = 0.05 after Bonferroni correction).

CONCLUSIONS

Patients with early-onset BD showed changes in a wide range of neural functional networks, involving changes in executive control, attention, perceptual regulation, cognition and other neural networks, which may provide new imaging evidence for understanding the pathogenesis of early-onset BD and for therapeutic intervention targets.

Suicide Assessment and Prevention in Bipolar Disorder: How Current Evidence Can Inform Clinical Practice

Bipolar disorder is associated with a considerable risk of suicide, and this fact must be incorporated into management of all patients with the condition. This article highlights the importance of a more nuanced understanding of the factors associated with the increased risk of suicidal behavior in people diagnosed as having bipolar disorder and interventions that could mitigate it. Several sociodemographic, clinical, environmental, and other variables have been associated with suicide attempts or deaths in bipolar disorder. Youths with bipolar disorder are a particularly vulnerable group, and their trajectory of illness could be modified by early interventions. Several medications have been studied regarding their relationship to suicide risk in bipolar disorder, and interventional psychiatry is a newer area of research focus. Finally, community-based approaches can be incorporated into a comprehensive approach to suicide prevention. This article summarizes the current understanding of key variables that can help inform a clinical risk assessment of individuals and interventions that can be employed in suicide prevention in bipolar disorder.

Factors associated with suicidal attempts in female patients with mood disorder

Aim

This study aims to establish a nomogram model to predict the relevance of SA in Chinese female patients with mood disorder (MD).

Method

The study included 396 female participants who were diagnosed with MD Diagnostic Group (F30-F39) according to the 10th Edition of Disease and Related Health Problems (ICD-10). Assessing the differences of demographic information and clinical characteristics between the two groups. LASSO Logistic Regression Analyses was used to identify the risk factors of SA. A nomogram was further used to construct a prediction model. Bootstrap re-sampling was used to internally validate the final model. The Receiver Operating Characteristic (ROC) curve and C-index was also used to evaluate the accuracy of the prediction model.

Result

LASSO regression analysis showed that five factors led to the occurrence of suicidality, including BMI (β = -0.02, SE = 0.02), social dysfunction (β = 1.72, SE = 0.24), time interval between first onset and first dose (β = 0.03, SE = 0.01), polarity at onset (β = -1.13, SE = 0.25), and times of hospitalization (β = -0.11, SE = 0.06). We assessed the ability of the nomogram model to recognize suicidality, with good results (AUC = 0.76, 95% CI: 0.71-0.80). Indicating that the nomogram had a good consistency (C-index: 0.756, 95% CI: 0.750-0.758). The C-index of bootstrap resampling with 100 replicates for internal validation was 0.740, which further demonstrated the excellent calibration of predicted and observed risks.

Conclusion

Five factors, namely BMI, social dysfunction, time interval between first onset and first dose, polarity at onset, and times of hospitalization, were found to be significantly associated with the development of suicidality in patients with MD. By incorporating these factors into a nomogram model, we can accurately predict the risk of suicide in MD patients. It is crucial to closely monitor clinical factors from the beginning and throughout the course of MD in order to prevent suicide attempts.

Systematic Review and Meta-analysis: International Prevalence of Suicidal Ideation and Attempt in Youth

OBJECTIVE

Globally, rates of youth suicide vary considerably. Suicidal thoughts and behaviors (STB) are consistently associated with risk of death by suicide. However, international trends in STB have not yet been compared. To address this gap, an international meta-analysis of epidemiological and school-based studies that report on STB in youth was conducted.

METHOD

Systematic searches were conducted in PubMed and PsycINFO through April 2022. Eligible studies included prevalence of active suicidal ideation (SI) or suicide attempts (SA) in community youth younger than age 22. All studies were coded by 2 authors. Mixed models accounting for shared methods and including hypothesized moderators were conducted using the metafor package in R.

RESULTS

There were 371 effect sizes for SI, 94 for SI with a plan, and 316 for SA, representing 149 regions. Year of data collection ranged from 1981 to 2021. Participants were 6 to 21 years old. The prevalence of SI ranged across regions from 14.3% to 22.6%; the prevalence of SA ranged from 4.6% to 15.8%. Year was not associated with increasing STB prevalence except for studies from the United States, which showed increasing rates of SI and SA since 2007.

CONCLUSION

This is the most comprehensive meta-analysis of STB in youth, providing valuable data about how risk factors most commonly associated with suicide vary internationally and over time. International rates of STB among youth are not improving and may be getting worse in the United States, despite efforts to reduce suicide risk. Most studies did not report rates of SI or SA separately for LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) youth and youth of color. A better understanding of proximal risk at the individual level will be important to informing future prevention efforts, especially for high-risk groups.

Long-term exposure to ambient air pollution, genetic susceptibility, and the incidence of bipolar disorder: A prospective cohort study

There is mounting recent evidence showing that air pollution exposure may be related to the risk of mental health, yet the association between long-term exposure to air pollution and the risk of incident bipolar disorder (BD) remains unclear. Thus we aim to identify associations between air pollution and the incidence of BD in a prospective population-based cohort. In total, 482,726 participants who were free of BD from the UK Biobank were included in this prospective study. We applied time-varying Cox proportional hazards models, accounting for relevant confounders, and used annual-year moving averages of air pollution as time-varying exposures. The genetic risk for BD was categorized into three categories (low, intermediate, and high) according to the tertiles of polygenic risk score. During a median of 10.79-year follow-up, 923 incident BD events were recorded. Long-term exposures to PM2.5, PM10, NO2, and NOx were associated with increased BD risk. Estimated HRs (95% CIs) for each interquartile range increase in PM2.5, PM10, NO2, and NOx concentrations were 1.31 (1.18-1.45), 1.19 (1.09-1.31), 1.19 (1.08-1.30), and 1.16 (1.07-1.26), respectively. Associations were still observed and even stronger at pollutant concentrations lower than WHO air quality guideline. In subgroup analysis stratified by genetic risk, we observed consistent associations between all pollutants and BD risk in intermediate and high genetic risk groups, but not in low genetic risk group. For example, the HRs (95% CIs) for PM2.5 were 1.00 (0.94-1.53), 1.30 (1.06-1.59), and 1.34 (1.16-1.54) in low, intermediate, and high genetic groups, respectively. In conclusion, long-term exposure to air pollution was significantly associated with an elevated risk of BD. Associations of air pollution with BD occurred only within intermediate and high genetic risk categories and were even stronger at the pollutants levels below WHO air quality guidelines. These findings could help inform policy makers regarding ambient air quality standards and BD management.

Psychiatric Treatment and Repeat Suicide Attempts Among Adults With Substance Use, by HIV Status, United States, 2014-2020

OBJECTIVES

The association among psychiatric treatment history, HIV, and suicide reattempts among people starting treatment for substance use is not well understood. The objective of this study was to describe, by HIV status, the risk and protective factors associated with suicide reattempts among adults seeking treatment for substance use.

METHODS

The study included 340 390 US adult residents aged ≥18 years in the Addiction Severity Index-Multimedia Version network from January 1, 2014, through December 31, 2020. We used adjusted logistic regression models to estimate strength of association between prior psychiatric treatment, HIV status, and sociodemographic factors and suicide reattempts within 30 days of treatment evaluation.

RESULTS

Adults who had been prescribed psychiatric medication were less likely to have a recent suicide reattempt (adjusted odds ratio [aOR] = 0.8; 95% CI, 0.7-0.8) than adults with no prescription history. Adjusted models found similar protective effects between psychiatric treatment and suicide reattempts among adults reporting abuse, mental illness, injection drug use, and limited activity because of a medical condition. Conversely, the following were associated with recent suicide reattempts: being male (aOR = 1.4; 95% CI, 1.3-1.5), having a high school education/GED (General Educational Development) or less (aOR = 1.2; 95% CI, 1.1-1.2), being single (aOR = 1.2; 95% CI, 1.1-1.3), experiencing a pain problem (aOR = 1.2; 95% CI, 1.2-1.3), and not being referred to substance use treatment by court (aOR = 3.4; 95% CI, 3.2-3.7).

CONCLUSIONS

A history of prescribed psychiatric medication is significantly associated with a reduced risk for suicide reattempts among adults seeking substance use treatment. Clinicians should consider incorporating mental health and suicide assessments into substance use treatment plans.

Countering the declining use of lithium therapy: a call to arms

For over half a century, it has been widely known that lithium is the most efficacious treatment for bipolar disorder. Yet, despite this, its prescription has consistently declined over this same period of time. A number of reasons for this apparent disparity between evidence and clinical practice have been proposed, including a lack of confidence amongst clinicians possibly because of an absence of training and lack of familiarity with the molecule. Simultaneously, competition has grown within the pharmacological armamentarium for bipolar disorder with newer treatments promoting an image of being safer and easier to prescribe primarily because of not necessitating plasma monitoring, which understandably is appealing to patients who then exercise their preferences accordingly. However, these somewhat incipient agents are yet to reach the standard lithium has attained in terms of its efficacy in providing prophylaxis against the seemingly inevitable recrudescence of acute episodes that punctuates the course of bipolar disorder. In addition, none of these mimics have the additional benefits of preventing suicide and perhaps providing neuroprotection. Thus, a change in strategy is urgently required, wherein myths regarding the supposed difficulties in prescribing lithium and the gravity of its side-effects are resolutely dispelled. It is this cause to which we have pledged our allegiance and it is to this end that we have penned this article.

From Plants to Psycho-Neurology: Unravelling the Therapeutic Benefits of Bioactive Compounds in Brain Disorders

The brain's sensitivity to oxidative stress and neuronal cell death requires effective pharmacotherapy approaches. Current pharmacological therapies are frequently ineffective and display negative side effects. Bioactive chemicals found in plants may provide a potential alternative due to their antioxidant and neuroprotective properties and can be used in therapy and the management of a variety of neuropsychiatric, neurodevelopmental, and neurodegenerative illnesses. Several natural products, including vitamin C, Cammelia sinensis polyphenols, Hypericum perforatum, and Crocus sativus have shown promise in lowering oxidative stress and treating symptoms of major depressive disorder (MDD). Similarly, bioactive compounds such as curcumin, luteolin, resveratrol, quercetin, and plants like Acorus gramineus, Rhodiola rosea, and Ginkgo biloba are associated with neuroprotective effects and symptom improvement in neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD). Furthermore, in neurodegenerative diseases, natural compounds from Rhodiola rosea, Morinda lucida, and Glutinous rehmannia provide neurological improvement. Further study in clinical samples is required to thoroughly investigate the therapeutic advantages of these bioactive substances for persons suffering from these illnesses.